BDSM health, safety, and risks

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BDSM is, of course, not risk-free. Nothing is. Just walking along the street, or having missionary-position sex, or even just lying in bed all have some risk associated with them. But just as we watch where we’re going so we don’t step in unexpected holes in the sidewalk, or just as we use a condom during sex, practising BDSM or having relationships with others where BDSM is a component can be engaged in safely as long as we recognise and take steps to minimise the risks.

Beyond some of the obvious risks, such as bruising or cuts from caning and whipping, there are other, less obvious risks for the innocent and the unwary. This article is not intended to be exhaustive, but I will try to touch on many of the areas of BDSM health and safety, particularly those where the risks and hazards may not be obvious to those new to BDSM.

Physical health and well-being

The first and most obvious area I want to talk about, is physical well-being. Quite a few BDSM activities involve physical components which can potentially cause skin, body, muscle, organ, or bone damage.

External bruising, weals, cuts, and abrasions

Bleeding from flogging

External bruising, weals, cuts, and abrasions commonly occur during impact play. Heavy flogging and caning can easily cause bruising. Very heavy caning and whipping performed on someone whose skin is not used to it can create bleeding cuts. Abrasion and tearing of the skin can occur in most forms of impact play, particularly when the implement used is dragged across the skin as it strikes. Flogging and whipping are good candidates for this, as is caning when it not done perpendicular to the skin. Some ropes can also abrade the skin, particularly ropes made out of rough natural fibres such as hemp.

These sorts of injuries generally only require time to heal. There are creams which you can get from pharmacies which will help bruising disappear faster.

Weals, cuts, and abrasions damage the skin and create opportunities for germs to enter. Where the site of the damage becomes infected the body itself will often heal itself. Keep the wound area clean, well-ventilated, and maybe use some antiseptic cream. See a doctor if severe.

Very importantly, cuts and any other openings in the skin can let in something more serious such as HIV or Hepatitis from an infected partner.

Where there is a chance of any skin damage, it is advisable to always ensure that the area of skin which may be affected is disinfected. Pharmacies can provide disinfecting swabs, either alcohol- or non-alcohol based, depending on preference, as well as latex gloves which prevent infection via sweat, skin oils, and other body fluids. Make sure that the equipment being used---such as floggers, canes, etc.---are clean and disinfected, and don’t use the same implement on more than one person if there’s a chance that it has become contaminated by blood, sweat, or body fluids from someone else.

To prevent skin damage in the first place, make sure that there are no rough edges on the implements being used. Also make sure there is no grit or dirt embedded in the tails of your floggers and whips as this will abrade or cut the skin when the tails strike, and be sure that your canes aren’t split in any way.

Your partner’s skin will get damaged if it’s not acclimatised to being struck. Don’t start whaling into them with your heaviest implements from the get go. Slowly build up to give them a chance to get used to the impacts, and be prepared to stop before damage starts to occur such as when you see the skin reddening.

Internal bruising

Internal bruising and damage to internal organs can happen when someone is caned, flogged, or beaten on the soft tissue around either their neck or around their hips, stomach, breasts, or genitals. The shoulder blades on the back, the buttocks, and the thighs are relatively good targets for impact play because they are either bony (shoulder blades) or thick with muscle (buttocks and thighs). The neck, hips, breasts, stomach, and genitals are instead quite soft and it’s easy for the impact from the strikes to carry through to sensitive internal organs and cause serious bruising.

Hits to these areas are usually mostly unintentional, but it is quite easy when aiming for the buttocks with a flogger for a miscalculation to allow the tails of the flogger to wrap around a submissive and strike them on their front or sides.

Bad internal bruising can mean a trip to the doctor or hospital.

Muscle, ligament, and bone damage

Bondage positions which place strain on joints are notable risks for muscle or ligament damage

Muscle, ligament, and bone damage can also occur in BDSM play. These sorts of injuries are not commonly the direct result of impact play and are more likely to occur during bondage and other forms of restraint.

In particular, muscle and ligament damage can occur when someone is restrained in a way which awkwardly positions their limbs or which awkwardly loads their muscles. It may only take a bit of tickling, or a knock causing them to lose the balance to pop joints, tear muscles or ligaments, and cause strains.

To diminish the risk of these sort of injuries make sure when you tie your partner that you don’t put any strain on joints in a direction different from their normal range of movement, such as pulling or pushing on joints instead of just rotating them, or by pulling them sideways.

Broken bones

Broken bones are less common in BDSM, but can occur when suspension bondage goes wrong and your partner drops on to the solid floor unexpectedly. Some of the people who do this sort of bondage will place soft cushions under their partner just in case.

If you are causing your partner a lot of pain then they may feel the need to cry out, punch the wall, hammer the ground with their fists, or twist back and forth for all they’re worth while gripping some bit of furniture. All of these risk muscle damage or broken hand, finger, or wrist bones. If this is an area in which you play, make sure that your partner has soft restraints to struggle against, and has cushions or pillows to punch rather than wood or concrete.


Teeth can also break due to gnashing in moments of particular excitement or strain. Keep a sports mouth guard, gag, or a rubber pony bit for your partner to clamp their teeth down onto. Gags are good because they can also muffle screaming allowing your partner to yell their lungs out without annoying the neighbours too much.


Burns are not uncommon in BDSM scenes and come from two main sources: rope burns from a rope being dragged or drawn across the skin quickly, and burns from hot AND cold objects being used during play.

Rope burns easily occur when rope is being placed and tied on someone, and when it is being untied and removed. This happens due to friction as the rope is dragged across the skin. Many bondage tops will place their own hand or fingers between a rope and their bottom’s skin as they are tying or untying to be sure that the rope rubs on their hands or fingers instead of on their partner’s skin.

Rope burns are heat burns and are compounded by the earlier-mentioned abrading of the skin which can occur due to the roughness of the rope. This can cause the burned skin to be torn off and create an excellent possibility of infection.

Burns due to the accidental application of something too hot or too cold, or for too long, can happen during wax play, fire play, hot branding, and cold branding.

Burns from wax play can occur when the candle is held too close or when the candle burns hotter than expected

Wax play is when molten wax from a candle is dripped on bare skin. The temperature of the wax at impact can be controlled by varying the distance the drops fall, but candles vary and changing from one candle which burns at a low temperature to one which burns at a high temperature during a scene and not compensating can create burns. Usually these are not severe because the drops themselves don’t carry a lot of heat energy. Also, cries of agony from your partner will usually tell you something is going wrong and you’ll stop.

On the other hand, when a lot of wax is dripped or poured on your partner and has a chance to pool on their body while still molten---say on their chest or in the small of their back---this can create a serious burn.

Fire play is the deliberate use of flame on or near your partner. Usually this involves a small amount of volatile liquid being applied to, then allowed to evaporate from a submissive’s skin, and then this vapour is ignited. This creates a quick burst of warmth felt on the skin underneath. This can go awry when it’s done in the vicinity of hair and the hair catches fire. Instead of the flame being above the skin, the hair itself burns down to the skin and damages the skin. This can become much worse if the hair is oily, or if any of the fluid being used for the flame play has got into it.

Unexpected flame on someone’s skin should be extinguished quickly with water, or by quickly covering them with a fire blanket in very extreme cases. In other words, if you do flame play make sure you have something handy with which to put out any unexpected ones.

Fire play can be quite spectacular, particular when there’s a large woof of flame or when it’s dark and the flame stands out. Another risk here though, is that of inhaling the flame or of it rising into your face or that of your partner. For example, don’t light your partner’s boobs if they’re sitting up, as I have seen done, because the flame rises quickly into their face and it’s very easy for them to gasp in surprise and take in a mouthful of flame.

Hot branding can easily be a source of problematic burns

Hot branding is using a metal design made out of wire or thin sheet metal, heating it to red heat in the flame of something like a propane torch, and then quickly applying it to a submissive’s or bottom’s skin. This burns a permanent design into their skin. This is very, very easy to get wrong and can lead to major burns by, for example, using too-thick wire (such as coat-hanger wire), or by using too-heavy metal. These can easily lead to third-degree burns requiring hospitalisation and surgery to treat.

Advice: don’t try it without having been trained by an expert.

Cold branding is similar to hot branding but uses intense cold, such as from dry ice or from other liquid gases. The same problems and risks exist as with hot branding.

Medical consequences

Some BDSM activities can cause no obvious physical damage, but can still have consequences which may need medical attention or hospitalisation.

Many times this occurs due to a lack of adequate supervision where a helpless submissive or bottom is allowed to get into a situation which is not initially risky or dangerous, but which ends up deteriorating until harm or injury occurs.

Temperature play

Temperature play involves using heat or cold during a scene. In innocuous cases this may simply involve covering someone who is tied up with blankets so they get hot and start to sweat, or by spraying them with cold water or putting ice cubes down their underwear. However, leaving someone in position where they remain too hot or too cold when they are unable to do anything about it can have serious physiological consequences.

Overheating can cause dehydration and, if the body’s temperature is allowed to rise too much, can eventually cause delirium and brain damage. This is a particular risk during mummification where the body’s main temperature regulation mechanism, sweating, is effectively disabled by the skin being completely covered in plastic wrap.

Uncontrolled cooling can, of course, lead to hypothermia. Some people have been known to try ice-water enemas on their partner or to stick an ice dildo into an unprotected vagina or anus. The problem with these is that the walls of the vagina and the anus are quite thin and a very dramatic transfer of heat away from the blood can occur during this sort of play leaving actual chilled blood circulating in the body. This can easily cause a coma or brain damage.

More, an ice dildo taken straight from the freezer (-20°C or -4°F) and stuck in an orifice---even with lubricant--can easily end up with vaginal or intestinal membrane stuck to it, causing internal tearing.

All of the above may lead to hospitalisation or permanent damage.


Trusting that a submissive will be able to breathe through their nose assumes that their nose doesn't block up due to allergy or some other reason

Asphyxiation is a condition where the body fails to get enough oxygen. It can occur as a direct result of breath play, or as an unintended consequence of mummification play or from bondage. It can also occur accidentally during some BDSM play.

Breath play is the deliberate blocking of a submissive’s or bottom’s ability to breath. This can be by blocking their nose or mouth, by the use of a gag, or by the use of a device to control how much air they receive---such as a modified gas mask. This is, of course, risky and requires the top or dominant to be super attentive to make sure their partner doesn’t actually suffocate.

Asphyxia can occur unintentionally during mummification or some forms of rope bondage where the rope is tied too tightly around the chest. Mummification involves wrapping the bottom or submissive in plastic kitchen wrap. When the kitchen wrap or rope is too tight it can make it difficult or impossible for the submissive to get enough air, or it can mean that breathing becomes too hard for them to continue to do, so much so that their muscles eventually weaken and after a while they can no longer breath.

Positional asphyxia can occur when someone is laying face down

A number of positions, such as laying face down, can make it difficult to breathe and eventually lead to asphyxiation. Positional asphyxia can also occur in less obvious positions - such as when someone is seated and leaning forward, or when they are restrained with their hands pulled tightly above their head - particularly if the person concerned is carrying a lot of extra body weight around their hips.

Asphyxia or suffocation can occur when someone who is tied or restrained vomits---which can be caused by heat or other factors---and then inhales it. This is, again, a particular risk for someone who is restrained and who can’t do anything to properly expel the vomitus, and for someone who is wearing a gag for the same reason.

Someone who is asthmatic is particular vulnerable to asphyxia should they have an attack during a bondage scene. Asthma constricts the airways and if the person is already tied such that they are only able to just get enough air, asthma will take them to the point where they no longer get enough air.

Many asthmatics use a special inhaler which directly delivers steroids to the passages in their lungs to provide almost instantaneous relief. If your partner does suffer from asthma and does use an inhaler, make sure it is kept handy during play and that you know how to help them use it. This applies both to dominants and submissives because even a dominant may have an asthma attack during a scene.

Where breath play involves completely covering or blocking the submissive’s mouth, say with a ball gag, and requiring them to breath through their nose, an allergy attack can cause their nose to block and prevent them breathing at all.

An allergic reaction to something, such as to house dust or a perfume, can also trigger an asthma attack, with the same consequences mentioned above.


Fainting is a usually brief loss of consciousness due to lack of oxygen to the brain. When it occurs during a BDSM scene it usually indicates a problem with the way the scene is being done or the way the bottom or submissive is reacting to it.

Fainting can occur simply as a result of a submissive standing on their feet too long, particularly if their arms are raised, such as in flogging scenes using a St. Andrew's Cross.

Fainting can also be an indicator that asphyxia is beginning to occur (see above). It can also occur due to heat stroke and can be caused by extensive muscle straining (such as struggling during bondage).


Infection can occur in BDSM scene particularly when skin is damaged, torn, or abraded and germs, viruses, or bacteria enter the wound. In more obvious risk cases, it can occur when someone with a cold or flu plays with someone and coughs or sneezes in their vicinity. In this article I’ll just be considering the former from now on, where infection enters through the skin.

BDSM is often seen as sexual and sexually-transmitted diseases (STDs) are a real risk. The usual preventative measures, such as condoms and prophylactics, masturbation only, or even abstinence, are effective as you’d expect. Someone who is tied and blindfolded is, however, not in a position to be sure that their partner is doing the right thing and trust is vital here.

As discussed earlier under cuts and abrasions, HIV and infections such as Hepatitis, can be transferred via body fluids such as saliva, sweat, blood, and tears. Even if there is no obvious skin damage, or even no reddening, there can still be openings through which the germs, viruses, or bacteria can get in. Use latex gloves and make sure that bits of the body likely to be touched, hit, or played with are disinfected. Pharmacies are good sources of all that you need.

While skin damage is an indirect, but common, consequence of impact play, it is a direct consequence of forms of BDSM play such as tattooing, scarification, cutting or piercing. These directly break the skin with knives or needles and special care must be taken to ensure that the "work" sites are kept clean and that the implements used are clean and disinfected.

For more information about cutting and infection, see this article.

Burns, as mentioned earlier, cause major skin damage and, consequently, are also a major infection risk.


Bruising from cupping

Bruising is damage to the blood vessels just below the surface of the skin causing them to leak blood into the surrounding tissue. Your local pharmacy should be able to provide you with something which can be applied after play and which will help the bruising go away faster than normal.

Most commonly bruising is superficial, meaning that it occurs in the surface of the skin. In some badly-executed impact play scenes, strikes can occur on soft tissue above major organs, such as the liver, and can lead to the organ itself being damaged or bruised.

Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis (DVT) is the formation of blood clots inside veins, usually from diminished blood flow due to external pressure being applied to the area. Eventually the blood clots are released due to movement and they travel to interesting places, such as the lungs or brain, and cause mischief. This is a well-known air-traveller’s affliction due to having to sit on your butt in the one position in the plane for an extended period of time. Bondage bunnies are potentially at risk from DVT and someone who is tied up for long periods should be moved around from time to time to prevent this occurring.

Shock, or acute stress reaction

Shock, or acute stress reaction, is a response of the body to extremes of pain (amongst other things) and can be characterised by withdrawal, agitation, confusion, detachment, anxiety, appearing to be in a daze, and other symptoms. For someone who is having an unfamiliar or intense BDSM experience shock can be their reaction and may not be the positive outcome everyone is hoping for. If in doubt, stop the scene, make sure they stay warm and give them plenty of water to drink.

Numbness and nerve damage

Numbness and nerve damage can occur where blood flow to a particular part of the body has been interrupted for an extended period of time. In worse case scenarios, flesh will become necrotic or gangrene may set in. This is mostly the realm of bondage where ropes have been too tight or have been left on for too long. Most bondage tops will regularly check their submissive’s extremities---such as feet, hands, breasts, and penis---to make sure that they don’t feel cold, that they still have sensation, and that they can wiggle their fingers and toes. It is, unfortunately, not uncommon to find a long-term BDSM aficionado who can point out a part of their body, such as the tip of a finger, which no longer has any sensation due to play gone wrong.

Nerve damage can also occur in come cases of piercing or cutting where nerve endings in the skin are damaged directly by the needle or knife blades.


Some people are allergic to latex

Allergies can be troublesome in BDSM for reasons already mentioned. Common allergies include being allergic to latex or to some forms of disinfectant. This can, of course, be problematic when trying to play safely. There are alternatives to these available, such as different types of disinfectant, and you should consult your local pharmacy as they should be familiar with this problem.

Emotional and psychological aspects

BDSM experiences can often be intense, and can often have intense emotional consequences. For people new to BDSM it can release feelings which they have never felt before. These feelings can be very strong, appealing, and even intoxicating, and the person feeling them may not have the skill or experience with themselves to be able to properly recognise them, process them fully, and put them away where they belong. This can sometimes cause very poor and inappropriate responses.

Emotional or psychological trauma

Emotional or psychological trauma can occur in BDSM scenes which, while they may have been executed well, may cause an intense psychological reaction in the top or the bottom, or in both.

Because BDSM play is often about power and control and about taking it away from a submissive or bottom in some way, simulated rape or "play" rape is sometimes a theme, e.g., "Ah ha! You can’t escape from me now! I’m going to fuck you and there’s nothing you can do to stop me!" For someone who has been abused, such as in their childhood, or for someone who really has been raped, such scenes can trigger strong and often negative reactions. They can re-awaken intense memories and feelings which may have been put away or repressed long ago. In worse-case scenarios this can require professional treatment.

People new to BDSM can be surprised and overwhelmed by the strength of the feelings released in themselves and in their partners. This can reach the level of trauma. For example, a top who believed themselves to be gentle and kind may be surprised by the feelings released with their partner, by the amount of pain they enjoy inflicting, or by how rough and aggressive they may become, even if their partner suffered no harm during the scene. This can be hard for some tops to accept and they may experience disgust at themselves.

A bottom or submissive may come to feel violated or abused during a scene, even if they consented and were fully aware of everything that would be done to them. In some cases this can be a defensive reaction or denial, where they cannot accept their own intense feelings and they blame their partner for making them feel that way. This can be a particular problem when bondage is involved as the submissive can convince themselves that they were raped.

Separation trauma or distress

Separation trauma or distress can occur in a submissive or bottom as a consequence of an intense experience with their partner. The feelings they have can be so strong that they feel extremely vulnerable and dependent on their partner. In this state they may have trouble either enduring the end of the scene or the the withdrawal of their partner, or even bearing their partner briefly leaving the room---such as to get a drink or to go to the toilet. After most intense scenes, it’s usually advisable for the top or dominant to remain nearby for a while afterwards, often in actual physical contact---such as touching or cuddling---while their submissive partner "comes down".


Codependency is where one person in a relationship takes on an excessive care-taking role over their partner. Because of the inherent control and authority aspects of BDSM, codependency is a serious and potential risk in a dominant/submissive (D&s) relationship. It can occur when a submissive tries to hand over too much authority over themselves to their dominant partner, such as by insisting that their dominant takes responsibility for a variety of aspects of their life and behaviour which have no bearing on the D&s side of their relationship.

One example of codependency in D&s can be where a submissive insists that any poor behaviour, rudeness, lack of honesty, or signs of disrespect on their part towards others are matters for his or her dominant to deal with when, in reality, these are or should be their own personal responsibility.

Dominants can also create codependency situations by trying to micromanage a submissive.


Abuse, in BDSM terms, is the inappropriate use of a partner. In non-BDSM relationships abuse is often evidenced by physical abuse, such as hitting or striking, or by verbal abuse and insults. Hitting, striking, and verbal abuse can be parts of normal, healthy play---such as impact play or humiliation play---and this can make abuse in a BDSM context difficult to recognise. Indeed, a top who is motivated by an abusive reason to strike their partner may actually be hitting their partner in a way which their partner finds exciting and exhilarating.

It is perhaps easier to recognise abuse in the perpetrator by their intentions---such as to genuinely harm their partner. A top who acts due to anger or spite is abusive. In a healthy relationship, BDSM or not, the intent should be that each partner grows and has positive experiences due to the relationship. A top who acts out of spite is not doing something to help him or her become a better person.

Because the actions in a BDSM scene or relationship may seem on the surface to be abusive, it’s necessary to consider the responses and feelings of the bottom or submissive. If there’s long-term fear for them, or if the submissive is afraid of their interactions with their partner, or if the relationship is making the bottom or submissive less confident about themselves, more timid, or more anxious, then it is likely to be abusive.

It’s important to note that abuse can be self-inflicted. It’s not uncommon for people who have been abused, or have been part of an abusive relationship, to look for or drift into an abusive relationship with a new partner. The partner may not even realise it when BDSM is involved, and may, for example, simply think they are providing an excellent flogging when their partner is actually imaging that they are back in their childhood being beaten by their father, or that they are baring their back for their partner to whip when in fact their top is taking out inappropriate misogynistic urges on them.


From this discussion above it may seem that BDSM is a veritable minefield of catastrophes waiting to happen, many of the risks and hazards are the same sorts of things you have to learn about when getting involved with another person, or when getting involved in any moderately physical sport. It can be tempting to just jump in, but doing preparation or thinking ahead can mitigate most risks and make BDSM fun, safe, exciting, and liberating.