Safer BDSM: An Introduction


Steve McCullough

The phrase "safe, sane, and consensual" is the cornerstone of responsible BDSM. This can be expanded upon to include such notions as:

  • BDSM play is actively desired by both the top and bottom
  • BDSM play is done for mutual erotic pleasure and/or personal growth
  • BDSM play is focussed on physical and emotional well-being
  • BDSM play is negotiated and agreed to
  • BDSM play can be stopped by either partner as needed
  • BDSM play involves intimacy and trust

The terms "safe" and "sane" imply one another: safe and consensual play is almost certainly sane; sane and consensual play will almost certainly be safe. Play that is "safe" and "sane" will nevertheless involve certain risks. Understanding the risks involved and consenting to them freely is what makes makes your BDSM practise into responsible play. I use the word "safe" to refer to understanding and minimizing risk. It may be counter-intuitive, but safe play can actually go further and harder than careless play: a few safety precautions when whipping will allow you to exert more force with less likelihood of causing injury; planning your bondage more carefully will allow longer and more elaborate sessions with less risk of harm. Like in other kinds of sex play, safer BDSM sex is more pleasurable sex.

"Sane" is important on its own for a couple of reasons. Sanity means, at least, a shared view of the real world; more specifically, it means knowing the real risks of your behaviour and taking responsibility for that behaviour. You can't play sane with someone who wants to be genuinely injured, or who wants to inflict lasting harm. Sanity means recognizing the difference between pleasurable pain and agony, between getting hurt and getting injured. "Sane" also means "sober." It's difficult to be responsibly attentive and in control during BDSM play when under the influence of alcohol or drugs. Being in an altered state of mind can lead bottoms to misjudge their capacity or tops to disregard it -- either of which can lead to agony and injury, not pain and pleasure. Even more dangerous perhaps is the effect many recreational drugs have on the nervous, respiratory, and cardiovascular systems. Impaired judgement combined with increased physiological risk is extremely dangerous, and therefore outside of responsible play.

Note that the following forms of BDSM play are not going to be covered in what follows: suspension bondage, mummification, catheters, electrical play, and branding. These are advanced forms of play that demand a great deal of experience and/or medical knowledge to avoid injury. If you are interested in exploring them, I suggest you contact experienced players in local or nearby BDSM organizations for training. These are not activities that can be explored safely without guidance.


Safety in BDSM is first and foremost a combination of knowledge and communication. Note that safety is here understood to involve understanding, accepting, and minimizing risk. Precious little is without risk; safety and responsible play involve a realistic assessment of risk, practices that minimize risk, and free consent to run risks.


BDSM scenes should operate within parameters agreed to by everyone involved. This makes negotiation an extremely important aspect of play. Play can sometimes begin with negotiations, which can be conducted in a variety of ways that involve tops and bottoms in their roles before a scene formally begins, in verbal power foreplay. Minimally, negotiations should identify what each partner would like to get from a scene and approximately what they can give and/or take in each case. Experienced pairs will obviously deal with this process differently than will total strangers. The key in both cases is clear and honest communication.

Negotiations should include relevant medical history. This needn't be exhaustive, but as you agree on the overall shape of the scene, both tops and bottoms are expected to disclose any conditions or history that may affect the scene. If your teeth have been capped, your top will need to know this before applying a bit; if you suffer from tennis elbow, then you won't be able to flog an eager bottom all night long.


It is commonly understood that the top is in control within the limits set by the bottom. It is therefore imperative that tops respect the limits set by their bottoms; it is equally important that bottoms be honest and realistic about their experience and capacities. Testing one's limits is one of the rewards (and often a primary goal) of SM play, but whether or not this will happen on any given occasion should be negotiated.


BDSM activity demands a lot of responsibility. Bottoms and tops should both pay close attention to themselves and to their partner. Bottoms are sometimes not in a good position to do this (perhaps due to strictures, sense deprivation, or endorphins), which renders tops all the more responsible to pay attention to the responses of bottoms. In fact, it's a good idea for tops to actively check in with bottoms regularly during play, roles permitting.


Because responsible BDSM is consensual and erotic in nature, it is necessary that both partners be empowered to call a halt to a scene for any reason. Negotiation and attentiveness should all but eliminate the need for anyone to pull this emergency brake, but sometimes unexpected things happen. A safeword is a previously arranged word that will call a halt to the scene for any reason, The top and bottom can then address the problem out of role and modify or end the festivities as required.

It is important to choose a safeword that you will be unlikely to forget under pressure. The nature of the scene may make some words inappropriate, as a bottom may well want to beg for mercy (and not receive it). Suggested words to use include: "safeword," "911," or the traffic light signals "red," "yellow," and "green" (which allows one to call a slowdown rather than a complete halt).

It's also important to plan for a safe gesture in the event that the bottom is gagged, hooded, or otherwise unable to vocalize. Most of us are unused to communicating primarily by gesture, so tops are required to be especially attentive in the case of a safe gesture scene. Gestures require much the same forethought as do safe words: choose a gesture that you will be able to make or see given the arrangement of the scene. Some suggestions include having the bottom drop a ball or make a short, distinctive pattern of grunts. Use your imagination, but always be attentive to making the signal unambiguous and easy to send and receive.

Needless to say, it is imperative that a safeword be respected. Calling a scene to a halt is a matter of necessity and safety, and is always fair play.

Playing with strangers

This is intrinsically risky, but the risks can be minimized. Jay Wiseman recommends the "NTA test" for assessing a potential playmate: this involves asking yourself "How would I feel naked, tied up, and alone with this person?" Listen to your gut reaction, and think with your head. Other simple precautions can help you get to know a new playmate and minimize your risk:

Minimal bondage: refusing gags, blindfolds, and immobilization bondage is probably a good policy until you know and trust someone.

Silent alarm: this deterrent is perhaps the most effective insurance against a bad experience. Let a trusted friend know where you will be, with whom, and for how long. Arrange to call that friend at a certain time or set of intervals to assure them that all is well. Do this by means of a code so that a coerced call will still set off the alarm. In the event you do not call as arranged, your friend should immediately call the police. You should make sure you tactfully let your new playmate that this is happening, and encourage them to do likewise.

Sexually Transmitted Infections (STIs)

Sexually transmitted infections are very common and quite easy to contract. Their effects range from annoying to life-threatening. In any case, they can put strain on a relationship, and even the most innocuous STIs have been implicated with more serious health problems. The good news is that you can avoid them simply by keeping your bodily fluids to yourself.

Viral STIs can be transmitted by means of semen, vaginal fluid, saliva, blood, urine, and faeces -- pretty much anything that can be excreted or secreted by the body. Protecting yourself from infection is straightforward: don't give any of these substances access to your body. This means using protection for your mucous membranes (any orifice) and any broken skin, which includes pimples and your mouth after you've brushed your teeth (it takes 3-4 hours for the micro-cuts made by tooth brushing to heal over).

BDSM play, because it is often less genital-to-genital in focus than other kinds of sexual activity, offers plenty of safety from many mechanisms of infection. On the other hand, BDSM practices can involve exposure to blood, faeces, and urine, which pose their own problems in terms of disease prevention.

Use barrier protection when you are likely to come into contact with your partner's bodily fluids. Gloves, dental dams, condoms, and kitchen wrap are all good choices. Be especially careful when dealing with your partner's blood, which may be shed during activities such as whipping, piercing, or cutting. Hepatitis and HIV are both readily transmitted by contact with infected blood.

Percussive play

The wide range of percussive toys used in BDSM offers a range of possible sensations. It's important to remember that striking toys such as paddles and canes can transmit force deeply into the body. Whips and floggers, on the other hand, tend to focus their effects on the skin and the first few layers of tissue beneath. Thus, flogging play risks cutting and bruising whereas paddle play risks reddening and deep bruising. Make sure that marking has been included in any negotiations, and that unexpected or unwanted marks aren't left by accident or inattention. Note that bullwhip crackers can cause extremely severe cuts, and should not be used near exposed skin except by the very experienced and practised, and are to be used only for sound effects rather than sensation play.


It's wise (often necessary) to warm up to severe activities such as heavy flogging. The body needs the opportunity to sensitize and adjust to the strong stimulation presented by most BDSM activity. Successful percussion play will respect the cycle of readiness (the bottom implicitly or explicitly cues The top that he or she is ready), impact, and assimilation (the bottom physically and emotionally absorbs the blow and recovers). One method sometimes used to allow a bottom to adjust the pace of the scene is for The bottom to ask for blows when they are ready to receive them, and to ask for them using a 1 to 10 scale that indicates how much force they can withstand.

Targets / anatomy

Light flogging or whipping can be applied to almost any area of the body except the eyes. For any percussive play harder than very gentle, the following target considerations should be observed:

Always avoid the joints and the eyes. These areas are very fragile, slow to heal, and difficult to do without.

When addressing the front of the torso, avoid targets below the rib cage; when addressing the back, stay above the shoulder blades. This is primarily because the kidneys are easily injured both from the front (they extend below the ribs) and the back (because they are firmly tied to the back and the rib cage). Whip-wielding tops should be aware of the risk of the whip tail curling around the side of a bottom's ribs and accidentally striking a vulnerable target. Avoid this by tucking a pillow on either side of the bottom when they are lying down. This will allow you to more freedom to play harder.

Paddling and caning should be restricted to heavily muscled areas such as the buttocks, the upper back, and the chest (on some men). Heavy hitting on fatty areas may result in ruptured tissue and deep internal bleeding. Accordingly, women's breasts should be considered off-limits except for light flogging play. The thighs are a good target for light paddling or caning, but only well-muscled thighs should be a target for heavy percussive play.

The thighs and the lower legs are possible targets for whipping and paddling, as long as care is taken not to damage the smaller muscles, and some protection is provided for the many joints (knees, ankles. feet) in the area.

Genital flogging should generally remain gentle. "Bunji" floggers whose tails are made of thin rubber are a good choice for genital flogging because they can provide a nasty sting, but impart little force. Remember during any genital play that erect penises are more vulnerable than flaccid ones.

Bondage play

Bondage materials

Rope: Perhaps the most versatile bondage material. It comes in a huge variety of textures and diameters, can be cut to any length, and can be tied into bonds, harnesses, cuffs -- you name it. It also has a significant safety advantage: in an emergency, it can be cut to free the bottom. Crash scissors (emergency medical scissors) are available from pharmacies and from Lee Valley Tools. They allow safe cutting away of bonds or clothing close to the skin, and are an essential tool to have on hand in any BDSM scene. A small knife may be useful for some emergencies -- an Exacto knife or short, sharp carving knife are more precise than a long blade. Remember that fine motor control is reduced under stress, making knives much more dangerous to use than any kind of scissors in an emergency.

Rope ½" or wider isn't useful for most bondage; rope less than 1/8" heightens the risk of too-tight bonds. ¼" nylon or cotton rope is a good choice for most non-weight-bearing bondage play. It's advisable to tie a bottom with rope wrapped multiple times around a limb; ½" is the minimum recommended width, which is easily achieved with two or three wraps of ¼" rope.

A minimal knowledge of knotting is advised for safe rope bondage; the good old square (reef) knot is fine to use in bondage, but tends to pull tight under tension, which means that tucking the knot is a good idea. Tucking involves tying the knot and then passing the free ends of the rope back under the wraps in opposite directions; this draws the wraps together and spreads any tension across all of them. Tucking thus prevents undesirable effects that can affect wrapped-rope bonds: tighening of knots, spreading of the wraps (when the wraps move apart, turning a nice wide single bond into a bunch of single-wrap bonds) and differential tightening of the wraps (when the last wrap pulls away from the body under tension, tightening all the other wraps -- be careful: this can turn a loose bond into a very tight one). Tucking is also useful with the lark's head (ring hitch or cow hitch) knot and granny knots. Tucking isn't necessary with another good knot, the obi knot (so called because it is the knot martial artists use to tie their belts) because a tuck is built in to that knot. It's advisable to get a book on knotting; keep in mind, however, that most books don't take human bondage into account in the design of their knots.

Leather: Many varieties of bondage gear are available in leather, which has an appeal all its own. Leather bonds tend to be wider than rope or metal bonds, and thus more comfortable and safer to use in terms of circulation problems. Some leather bondage gear secured by hardware (snaps, zippers, buckles, d-rings) can be difficult to get off in a hurry, so plan ahead for some way to get a bottom out of bondage quickly if need be. Attaching leather cuffs to chains or ropes with snap clasps is a good way to get them free quickly. More and more equipment, including restraints and hoods, is being made with velcro closures which can be very secure and can also be released in a hurry. Note that cutting a heavy leather such as latigo can be extremely difficult, even with crash scissors.

Metal: Most commonly used are handcuffs, which come in a couple of varieties. Cheap "play" cuffs control their tightness with a lever. This makes them easy to remove, but also risks accidental tightening. Heavy duty double-locking cuffs are recommended for more secure bondage. There are also a variety of manacles and cuffs available in metal. Metal is unforgiving on our relatively soft bodies, so various risks to nerves and circulation posed by bondage are all the more risky with metal bonds. Tops will need to have extra keys available, as well as equipment to release a bottom in a hurry: keep bolt cutters and a hacksaw with extra blades on hand in play with metal restraints. Slide clips, carabiners, threaded chain links, and other easily-removed closures can often be used to secure metal or leather bondage gear. It's a good idea to have at least a couple of possible escapes should the need arise.

Emergency planning

Regardless of the type of bondage you use, you must be able to free a bound bottom quickly. This need may arise because of an emergency that arises internal to the scene (a medical emergency, a panic attack, a safeword call) or external to it (an earthquake, mom coming home). Have a couple of backup plans ready. Extra keys backed up by bolt cutters backed up by a hacksaw, say, or crash scissors backed up by a knife. I have found that wearing a multitool such as the aptly-named Leatherman line keeps a bunch of useful tools handy should all else fail (useful accessories on my Leatherman Wave include a sharp knife, a leather knife, a saw, and a pair of scissors). You should thus have an emergency kit handy both to release the bottom and to provide any medical attention either of you may need. With a kit ready and with redundant release plans in place, you will be better able to stay calm in the event something does go wrong, which will greatly increase your ability to deal with whatever happens.


Most bondage puts pressure on the tissues underneath the bonds. It is important to ensure that this pressure won't do any damage. This generally means avoiding nerves and blood vessels that are close to the surface. Too much circulation constriction for too long will result in tissue death, and possibly the loss of a limb. Nerve damage can result in permanent numbness or loss of function. Thus, the top must be careful about the placement of bonds and diligent about monitoring the bottom during lengthy periods of bondage. The bottom, in turn, must immediately report any circulation or nerve problems to the top.

For example, the radial nerve runs along the bone from the thumb to the elbow. If wrist bondage puts too much pressure on this nerve, the thumb will become tingly and then numb. Only a few moments of this pressure can result in numbness that can last for days. If bonds are not removed at this point the bruised nerve may become damaged and the numbness permanent.

Places to be cautious with tight or suspensive bondage include:

  • Wrist, outside edge (radial nerve)
  • Elbow, inside (ulnar nerve)
  • Armpit (major nerves and arteries for arms)
  • Lower leg, just below knee (nerve connected to foot)


Bondage applied to a safe portion of the body must be applied carefully and not left on too long. It is generally suggested that no tight bonds be left on for longer than 20 minutes. At this time they should be loosened, but can be tightened again after the circulation has returned to normal. One method for timing bondage comes from Lolita Wolf: bondage too tight to fit a finger under should be left on for a maximum of 10-15 minutes; if you can fit a finger under the bonds, leave them on for a maximum of 30 minutes; if you can fit three fingers under them, a maximum of 45 minutes.

These are just suggestions, though, and opinions differ. One recent idea that has challenged these traditional timing guidelines is the observation that pain is the key clinical indicator that bonds are causing damage. Some experienced bondage players suggest that bonds can be left on for much longer periods of time as long as they aren't causing pain. Tops should always depend on feedback from bottoms as well as their own observations. Avoid at all costs bondage tight enough to cause pain in and of itself.

When setting bonds, note that the final position the bottom winds up in may exert more force on a bond than you initially set; plan ahead and go over the whole bondage situation as it comes together to ensure a moderately-tight bond isn't pulled too tight by gravity or your bottom's struggles.


Fainting, falling, and breathing problems in bondage are often a matter of the position in which the bottom is tied.

When upright, the human body relies on regular movement of the legs to assist the heart in pumping blood the full height of the body. When a bottom is immobilized in a standing position, blood will tend to pool, which may lead to fainting. Fainting is also a risk when bonds are released and blood flow returns to normal.

The following bondage situations increase the risk of falling:

  • the feet or arms are bound together (in the former because it is hard to balance, and in the latter because it's hard to break a fall)
  • the bottom is bound off-balance (be careful upon release to allow the bottom to regain balance)
  • use of a blindfold or hood (these may be very disorienting)

Be aware of the demands that various bondage positions make of the body. When planning a scene, take into account relevant medical conditions: any cardiopulmonary disorder may make the hogtie position more risky. Face-down positions require some forethought, especially of bound hands or breasts are going to be trapped under a bottom's body weight. Proceeding gradually and being ready to remove bonds are the best methods of dealing with any problems.

Positional asphyxia: breathing requires a certain amount of effort. When we breathe in, muscles in the thorax actively expand the rib cage; when we breathe out, this expansion relaxes, and the rib cage returns to rest. Bound positions that place more stress on the expansive motion of inhalation or that require the body to actively contract during exhalation risk positional asphyxia, which involves the body becoming too exhausted to breathe, and can eventually result in death. Positions to be aware of here include the hogtie, fetal position, crucifixion, or play that involves weight being placed on a bottom's chest.


When a bottom is held in bondage for any length of time, it is a safety fundamental to regularly check their limbs for circulation or sensation problems. In most cases, tops should be careful not to move out of sight or earshot of bound bottoms, especially if the bottom is gagged. In situations where a top leaves the bottom alone, the top should arrange some warning system (such as a baby monitor) to alert them to any possible trouble, and be close enough to safely get to the bottom in about 30 seconds. The degree of monitoring should be appropriate to the level of bondage. Bottoms with less freedom of movement require more attention from responsible tops.

Note that assuring the safety of tops is also important in bondage scenes. A well-bound bottom is often described as being as helpless as an infant; should something unexpected happen to the top, this bottom will be left in a very precarious position.

When monitoring a bottom's limbs, it is useful to check the colour and temperature of the extremities. If the skin reddens, becomes pale, or becomes cool, then circulation is being impaired; nerves are best monitored through the bottom paying attention to any sensations of tingling and numbness. It's a good idea for a top to check out the bottom's hands and feet before bondage to know what the bottom's normal circulation looks and feels like, so that changes can be recognized. There are various tests useful to check on the status of bound limbs:

capillary refill test: press firmly on a finger- or toe-nail and release. The colour of the skin under the nail should change back to normal colour in less than 2 seconds.

squeeze test: have the bottom clench a tight fist for a few seconds, then release; the palm should change back to normal colour within a few seconds.

movement tests: to check on nerve compression in the hands, ask the bottom to spread the fingers (other movements of the fingers are controlled by muscles in the forearm and are not affected by wrist bondage).

Breasts and genitals

Extra care must be taken when binding the genitals and female breasts.

Penis and vulva bondage should be approached with care because of their extreme sensitivity. Both can, of course, take a lot of stimulation, but they should be respected as easily injured. Recall that an erect penis is more vulnerable than a flaccid one. If a cock ring is applied tightly, it should not be left on for more than 20 minutes, and should be removed before orgasm, as the sudden pressures of ejaculation can damage constricted vessels. Play with cock rings should generally rely on adjustable and easily- removed leather and latex rings until you are confident and experienced. A solid metal ring is unforgiving if something goes wrong.

The genitals can endure considerable clamping (with clothes pins, etc.). Note that the inner labia are much more delicate than the outer labia, and care should be taken to avoid abrasion or tearing of these membranes.

The breasts should be bound carefully because fatty tissue is not well supplied with blood, and necrosis sets in faster than in muscular tissue. Breast bondage should be removed at the first sign of tingling, numbness, or bad pain. Recall the 20-minute rule for tight bondage.

The 20-minute rule goes for nipple clamps as well. Remember too that they hurt more coming off than going and staying on.


Using a gag makes any bondage play more risky because it complicates communication. Be aware of this and plan for it.

There are a few risks specifically associated with gags. Loose material (cloth, say) used to stuff the mouth can possibly migrate further into the mouth and possibly 1) block the airway, leading to problems with suffocation, 2) trigger the gag reflex, causing the bottom to vomit into their gagged mouth, 3) trigger a vagus nerve response that can lead to cardiac arrest. These risks can be minimized by using a gag whose mouth-stuffing is securely attached to the face strap. There are many kinds of these, including ball gags, wedge gags, and bit-type gags. These may involve risk to the bottom's teeth (as with a metal bit), or risk tendon and muscle strain (as with a ball gag). A wedge gag that allows the bottom's teeth to distribute bite pressure is the most ergonomic of these. Foam-covered stick gags are another good option.


Be sure not to exert pressure on the eyes when playing with blindfolds; this can result in retinal damage. The eyes are set below the forehead and above the cheek, however, and both of these structures can effectively absorb pressure.

Vision contributes to our ability to balance correctly, so be aware that when blindfolded, bottoms may be easily disoriented. This is also an issue when blindfolds are removed; make sure you minimize the danger of a fall for anyone coming out of sight deprivation, especially if combined with a standing position.

Penetration play

STI precautions are important for all penetration play. This means barrier protection for any body parts or toys involved in penetrative play. Gloves are an excellent idea to protect everyone; in addition to being a barrier to transmission, their smoothness makes the use of the fingers much easier and safer.

Vaginal penetration

Be aware of the fragility of the vaginal walls and the sensitivity of the cervix. And although the vagina is self-lubricating (unlike the anus), lubrication is recommended for play involving large toys or extended periods of time.

Anal penetration

Lubricate, lubricate, lubricate! Anal insertion play must be accompanied by buckets o' lube. This is because the anal canal and rectum are not naturally lubricated, and are made up of very delicate tissue. Insufficient lube can lead both to bad pain and to increased risk of STI transmission due to tears in the mucous membrane.

Successful anal insertion strategies involve control of the the two sphincters that resist anal penetration. The outer sphincter (which we see as the anus, or asshole) can be relaxed with conscious effort. The inner sphincter is less under our command, although it tends to follow the lead of the outer sphincter. It's possible to "fool" the inner sphincter into relaxing by the following method: insert a finger or small butt plug until you feel resistance; stop right away and stay there -- the inner sphincter is resisting the inward pressure, but will very soon (30-60 seconds) get too tired to resist; when you feel the discomfort go away (and this should happen), then you can push the insertion further. Repeat the push/stop/wait/push cycle as necessary.

Note that anything to be inserted anally must be capable of being retrieved. It should have a wide flange/base, a long cord, or be attached to someone else's body. Should something be lost in the anus, do not panic; if it is a small item (a ball from a set of anal beads, say) it can likely be excreted without worry (remember -- expelling stuff is something the anus is good for other than sex). If you've lost something large or awkwardly shaped, suck up your ego and head for the emergency room. It will be embarrassing, but they really have seen it all before, and you'll have your butt back to take better care of next time.

One more note on anatomy: above the 1-2" anal canal between the sphincters, and the 4-6" rectum (so about 6-8" in), the rectum makes a sharp turn to the left. This is called the sigmoidal junction, and you should be aware of this when playing with long insertion toys. They should be flexible enough to negotiate the curve.


Anal or vaginal fisting requires you to pay close attention to all the cautions mentioned above, with the following extra concerns:

  • remove all jewellery
  • always use gloves
  • it's important to have short, well manicured nails even when wearing gloves

When fisting, it is important to go slowly: start with a few fingers and work very gradually up to the whole hand. Keep the tips of the thumb and fingers together to make the hand as narrow as possible, and keep the palm facing towards the front of the body. The possibility for injury, bad pain, and STI vulnerability is very high with incautious fisting, so maintain good communication with your bottom, and go slow.

Lube for anal fisting should be oil-based or thick water-based, depending on the situation, and keeping in mind that latex and oil-based lube are incompatible. Stick with thick water based lube for vaginal fisting, as oil-based lubes can promote bacteria and yeast growth. Remember to keep adding lube as you proceed and, with anal fisting in particular, upon removing the hand.

Blood play

Blood play presents inherent risks of STI infection because blood is a good carrier of both Hepatitis and HIV. Basic precautions include wearing gloves and making sure sharps are disposed of in a sturdy container with a lid. Piercing and cutting are advanced skills, and should only be attempted after some study and training.

Because disposable gloves can be easily punctured with blades or needles, heavier nitrile or latex gloves may be used, if they are carefully cleaned before reuse. They could also be protected in turn by a larger disposable glove. (Note that about 1 in 10 piercings result in a needle-prick injury to the top.)

It is advisable in play with multiple piercings that the needles be counted in and out, and returned to their caps when removed. This double mechanism should ensure that no used needles get lost on the floor, in the bed, on the bench, etc.

Sterile conditions

Blood play such as piercing and cutting involves the exposure of layers of skin that are normally free of microorganisms (sterile). As such, the skin itself should be thoroughly cleaned and made as close to sterile as possible. This is achieved chemically by wiping the area with hydrogen peroxide or an iodine solution such as Betadyne. Any sharp objects used in blood play should ideally also be sterile, which is only reliably achieved by autoclave sterilization. Get friendly with your local medical clinic or tattoo shop. In practice, it may be sufficient to clean your implements with the same chemicals you use to clean the skin. Just be aware that highly disinfected is not "sterile."

First aid

The injuries inflicted in blood play are decorative and erotic in nature; they should be treated promptly and carefully after the scene to encourage healing and prevent infection. Most blood play should require only that wounds be cleaned with soap and water and covered with a clean dressing.

To stop severe bleeding, apply pressure to the wound, preferably using a clean dressing. If possible (i.e., if there is no danger of dislocation or broken bones), elevate the wound while applying pressure to lessen the flow of blood. Tourniquets and pressure on arteries should be avoided except in dire emergency.

Scat play & watersports

Urine is bacterially sterile, but not necessarily virally sterile. HIV has been found in small quantities in urine, making ingesting the urine of am HIV-positive partner possibly risky. Thus, it would be wise to avoid getting anyone else's urine in your eyes or mouth.

Faeces contain a great many microorganisms, bacteria, and possibly parasites that your body has carefully and labouriously expelled; they should not be invited back in. Faecal contact should not occur without some sort of barrier protection (several layers of kitchen wrap, say). Faeces should never be ingested. There are ways to simulate faecal play without the risks of the real thing: various foods (mashed potatoes, say) can mimic the texture of faeces, and tiny quantities of butyric acid more than effectively mimic the smell.

Heat play & burns

Heat sources

Note that it is dangerous to play with cigarettes, cigars, and matches, as they all burn at a very high temperature. Matches burn the hottest of the three and can cause serious injury. Cigars and cigarettes both burn hottest immediately after air has been drawn through them, and should be used with great care, as the ash can complicate burn healing.

Wax play should ideally involve low-temperature candles. Stick with plain white parrafin, as coloured candles and beeswax candles burn much hotter. It is best to test candles before play, as variations in waxes and production batches may vary their melting temperature. In any case, always drip wax sparingly; do not allow it to flow in a stream, and do not allow it to pool on the skin. Both can cause severe burns and very bad pain.

"Simulated" heat provided by athletic liniments and other ointments often has a delayed effect; give a bottom time to fully respond before increasing the intensity of play.

Ice can be used to simulate heat, especially when used as a mind fuck with a bottom who is unable to see what the top is doing.


It is wise to securely restrain a bottom for heat play, as any movement on their part may lead to accidental injury. Avoid heat play on or near the face, as accidents here could have drastic consequences in terms of vision, disfigurement, etc. Severe or unexpected burns can lead to shock, which in extreme cases may cause death.

Be prepared to douse the heat if needed -- both at the source and on the bottom's body. This means having a supply of cold water available for fire play, or an effective cleaning agent for simulated heat play with lotion. Dish soap is recommended for removing athletic liniment, and yoghurt for cooling its sting.

First aid

All burns are highly susceptible to infection, and tend to be difficult and painful to heal. Proper care is very important.

First degree burns (affecting only the top layer of skin): treat with running cold water or a cold compress, but not directly with ice. Repeat until the burn stops hurting, and cover with a sterile compress. Soothing or antiseptic lotions such as aloe vera should not be used until the wound has been cooled.

Second degree burns (affecting the top and deeper layers of skin): Cool as with a first degree burn, do not use any lotion, clean the wound with a non-shedding cloth, and cover with layers of sterile bandage.

Third degree burns (affecting all layers of skin and tissue beneath): Cover with a clean cloth and pour cool (not ice-cold) water on the area. Get the victim to a hospital. Keep them calm and lying down to minimize shock.

Breath Control

Breath control is one of many terms used to refer to cutting off air and/or blood circulation at the neck for the purposes of erotic stimulation. Other terms include "scarfing" and "auto-asphyxiation." Medical and BDSM authorities have come up with no safe ways to pursue this activity. These activities are dangerous in part because the risks they entail are not obvious. The primary risk is in fact cardiac arrest from one of three sources: "PVC-on-T" fibrillation, respiratory acidosis, or vagal-outflow asystole.

Note that two of these mechanisms are the desperate efforts of the body to protect itself from what it sees as certain death by asphyxiation. The nervous system interprets pressure on the neck as a deadly threat, and so the body goes to remarkably dangerous lengths to protect itself, taking measures that may prove to be fatal. In breath control play, it is the survival mechanisms of the body that pose the threat, not merely a temporary loss of breath.

Physical risk #1: cardiac arrest

  • when the heart is low on oxygen, it responds by firing off extra contractions (premature ventricular contractions [PVCs])
  • if a PVC occurs during the "electrical repolarisation" phase of the heart's contraction cycle, it can trigger ventricular fibrillation (a form of cardiac arrest)
  • more PVCs fire as less oxygen is available to the heart
  • PVCs are multiply difficult to predict, and it is difficult to know if they are happening without a heart monitor; moreover, they do not simply end when oxygen is available again, and may continue for minutes or hours
  • each PVC may be lethal

Physical risk #2: Respiratory acidosis

  • two related mechanisms can contribute to acidosis, which is literally a drop in the pH of the blood stream because respiration is interrupted (and so the blood becomes more acidic)
  • carbon dioxide in the blood stream exists with water in chemical equilibrium with carbonic acid. When there is more CO2 in the blood, this relationship produces an excess of carbonic acid, which results in an overall increase in the ph of the blood stream
  • in addition, when there is too little oxygen in the blood, the mechanism by which the body breaks down glucose into pyruvate and uses it for energy is disrupted. Without enough oxygen available, some of the pyruvate is converted into lactic acid, which further contributes to the acidity of the blood
  • healthy blood has a pH of 7.35-7.45; if it drops below 7.1, unconsciousness and coma ensue, and a blood pH of 6.9 or lower cannot sustain life

Physical risk #3: Carotid sinus and Vagal nerve

  • pressure on the carotid artery also presses on the carotid sinus bodies, which then cause vasodilation in the brain; this decrease in blood flow brings on unconsciousness
  • the sinus bodies also trigger the vagus nerve to send a message to slow down the heart; usually the rate and force both decline by 1/3, but sometimes they drop to zero, and the heart "flatlines"; this is asystole, a very dangerous form of cardiac arrest
  • whether or not this extreme result will happen is unpredictable, as is the length of time it may take for these effects to happen. They are many documented cases of this sort of cardiac arrest occurring after as little as 5 seconds of pressure on the neck
  • this effect has led many police forces to reclassify choke holds as deadly force or ban them altogether

The great risk in all these cases is the unpredictability of the cardiac arrest. Like unconsciousness, the advent of cardiac arrest often occurs without warning. There seems to be no way to determine the likelihood of any of these effects happening before they do, which tends to be too late. Applying pressure "just" to the point of unconsciousness remains risky, because unconsciousness may be a symptom of one of these life-threatening mechanisms.

So the risks involved with breath control are high and unpredictable. Moreover, there seems to be no way to minimize them. Part of my point here is, quite frankly, to discourage breath control play; more generally, it is to provide a more accurate assessment of the physiological risks it involves, which are not at all obvious. Please consult jay Wiseman's "The Medical Realities of Breath Control Play" for a more detailed presentaiton of the issues -- I've drawn quite shamelessly on his work here.

Emotional Support

All aspects of BDSM play can involve powerful emotional responses, sometimes unexpected and severe. Panic attacks can take even experienced bottoms by surprise, especially when facial bondage (gags, blindfolds, hoods) are being used. Emergency measures must be in place to respond to a panic attack. Tops should also be aware that bottoms experiencing severe panic may present a threat; panic triggers "fight or flight" neurological responses. The activity that triggered the reaction should be immediately withdrawn and any tight bondage loosened, but the bottom should not be totally freed, both because in their terror they may pose a threat and because the sudden transition may risk fainting or falling. Tops should instead offer soothing reassurance and talk the bottom down until they regain control. A scene should not be continued after a panic attack.

Winding a successful scene down should incorporate emotional support for all players; bottoms and tops both need to "come down" from the mental experience as well as taper off the severity of the physical aspects of the scene. Both bottoms and tops may feel spacey and nonverbal after a scene. Don't plan on or push for conversation beyond gratitude and reassurance. A snack, drink, and a nap are often called for before the aftereffects of a scene really wear off.

Quick rules to stay healthy

"Take one more precaution than you think you need to."
- Jay Wiseman

  1. Stay sober when playing.
  2. Don't get anyone else's bodily fluids in our mouth, eyes, genitals, or open cuts.
  3. Get tested for STIs annually or whenever your health seems poor.
  4. Respect yourself and your right to say no to any activity you aren't interested in or comfortable with.
  5. Think with your head; know the risks involved in what you're doing and take steps to minimize them.
  6. Be prepared for the unexpected.

Resources & References

Deborah Addington. A Hand in the Bush: The Fine Art of Vaginal Fisting
Patrick Califia. Sensual Magic
Dossie Easton and Catherine Lizst. The Bottoming Book
Dossie Easton and Catherine Lizst. The Topping Book
Hardy Haberman. Family Jewels: A Guide to Male Genital Play and Torment
Trevor Jacques. On the Safe Edge: A Manual for SM Play
Philip Muller and Molly Devon. Screw The Roses, Send me the Thorns
Jay Wiseman. Erotic Bondage Handbook
Jay Wiseman. SM 101
Jay Wiseman. "The Medical Realities of Breath Control Play."
Lolita Wolf's home page
San Francisco Sex Information
Greenery Press


This document owes its existence especially to the following sources:

Much of what follows draws heavily on these texts, and in some cases (especially the section on breath control) summarizes or paraphrases them. Go out and buy the books. They provide vastly more detailed information than you'll find in this admittedly cursory introduction.

Thanks to the organizers and participants at the 2002 "Healthy Sexualities, Healthy Lives" conference, the AIDS PEI and Abegweit Rainbow Collective First Annual Conference for Prince Edward Island's GLBT Community. It was their invitation to Venus Envy to present a workshop on "Safer SM" that led to the creation of this document.


This blog was... how do you

This blog was... how do you say it? Relevant!! Finally I've found something that helped me. Many thanks! 

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