Hit me baby, one more time: A brief overview of sexual masochism

In a previous blog, I briefly examined the psychological literature on sexual sadism. Today’s blog looks at its counterpart – sexual masochism – often viewed as two sides of the same coin. Sexual masochists comprise those individuals who derive sexual gratification from receiving physical and/or psychological pain. The sexologist Richard von Krafft-Ebing coined the term ‘masochism’ in his 1886 sexology book Psychopathia Sexualis deriving the name from the 19th-century novelist Leopold von Sacher-Masoch, whose book Venus in Furs (well known to us that are big Velvet Underground fans) depicts a man’s humiliation and suffering by a female dominatrix. There are other names for the same phenomenon – such as ‘algolagnia’ – that refer to those people who have a craving for pain. Algolagnia was coined by the German physician in the late 1880s but never caught on in the same way as the term ‘masochism’.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) acknowledges the overlap between masochism and sadism but they are classed as two distinct entities. The DSM-IV defines masochism as when the individual experiences “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer” over a six-month period. To distinguish it as a disorder rather than a non-problematic sexual preference, the masochistic sexual urges, fantasies and/or behaviours have to cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning”. Interestingly, other paraphilic behaviours such as hypoxyphilia (examined in a previous blog) come under the rubric of sexual masochism.

Early empirical studies such as those published in the Kinsey Reports in the late 1940s and early 1950s reported that a quarter of both males and females had experienced sexual arousal from being bitten by their partner during sex although later studies have reported much lower figures of around 3% to 5%. In a late 1980s, a study published in the Journal of Sex and Marital Therapy, by Dr Ethel Person (Columbia University, New York, USA) and colleagues surveyed college students about their sexual behaviours and fantasies. Results showed that around 4% had been tied up or sexually degraded during sex, and that 1% had spanked, whipped, or hit a consenting partner during sex (although ‘consenting partner’ does not necessarily mean they enjoyed being smacked, whipped or beaten). Dr Charles Moser (Institute for Advanced Study of Human Sexuality, California, USA) claims about 10% of the adult population engages in sadomasochistic activity.

Masochistic fantasies are not uncommon. For instance, in a 1980s study published in the Archives of Sexual Behavior, Dr Claude Crépault and Marcel Couture (University of Quebec, Canada) reported that 46% of men had sexual fantasies of being kidnapped and raped by a woman, 12% had fantasies relating to being humiliated, and 36% fantasized about being bound and sexually stimulated by a woman.

Although there is a lot of evidence showing that sexually masochistic desires, fantasies and behaviours are relatively common among men, there has been some dispute about women’s interest in sexual masochism. Research certainly indicates that consensual sexually masochistic behaviour by females can occur and some authors argue that there is a biologically based tendency towards submissiveness in females. However, some claim that it is very rare in women. Back in 1977, Dr Andreas Spengler (University of Hamburg, Germany) has claimed that almost all women who participate in sadomasochist activities are prostitutes that have no personal preference for such activity. However, a number of more recent studies among sadomasochists (1985-2002) have all indicated that a small but significant minority of women engage in both sexually masochistic and sadistic activities (13% to 30%) – very few of which were prostitutes. However, when compared to male sadomasochists, female counterparts were less likely to need sadomasochist activity to fulfil their sexual satisfaction.

Research has also indicated that men are more likely than women to experience masochistic desires during adolescence although a significant minority of male masochists do not express an interest in such behaviour until they have reached adulthood. Studies of sadomasochists show little difference in sexual orientation. For instance, Spengler’s study of 245 male sadomasochists reported that 30% were heterosexual, 31% were bisexual and 38% homosexual. Other studies have found much higher levels of heterosexuality although amongst female sadomasochists there tends to be higher levels of bisexuality than in the study by Spengler.

In a 1985 study carried out by academics at California State University and led by Dr Norman Breslow, 182 sadomasochists (of which 52 were women) were surveyed. One-third of the men (33%) were dominant, 41% were submissive, and 26% were both. Similar results were found among the females. Spanking and ‘master-slave relationships’ were the most preferred sexual activities for both male and female sadomasochists although there were some minor differences. More females preferred bondage and restraint whereas more men preferred pain and whipping. Klismaphilia may also have been a co-morbid paraphilia as 33% men and 22% of females made sexual use of enemas.

A more recent Finnish study led by Dr Laurence Alison reported in the Archives of Sexual Behavior reported that flagellation and bondage were among the most popular activities among sadomasochists. However, there was a wide range of lesser activities that carried greater risk of physical harm including piercings, hypoxyphilia, fisting, knifeplay, and electric shocks. There were also major differences depending upon sexual orientation (for instance, gay men were more likely to engage in activities such as “cock binding”). Most interestingly, the research team identified four sadomasochistic sub-groups based on the type of pain given and received. These were:

• Typical pain administration: This involved practices such as spanking, caning, whipping, skin branding, electric shocks, etc.
• Humiliation: This involved verbal humiliation, gagging, face slapping, flagellation, etc. Heterosexuals were more likely than gay men to engage in these types of activity.
• Physical restriction: This included bondage, use of handcuffs, use of chains, wrestling, use of ice, wearing straight jackets, hypoxyphilia, and mummifying.
• Hyper-masculine pain administration: This involved rimming, dildo use, cock binding, being urinated upon, being given an enema, fisting, being defecated upon, and catheter insertion. Gay men were more likely than heterosexuals to engage in these types of activity.

There are many theories on why people engage in such behaviours from traditional learning theories (based on both operant and classical conditioning) through to psychoanalytic interpretations. Most of these theories place the origins of the behaviour within a developmental framework and argue that the root of the paraphilic behaviour begins in childhood. Somewhere in childhood and adolescence, the individual starts to associate pleasure with pain, and then become sexualized in adulthood.

In a 1995 paper published by the sexologist Kurt Freund and colleagues, they noted there was a distinct difference between commonplace consensual and play-oriented sadomasochistic activities and more dangerous and potentially fatal practices of a small minority of hardcore sadomasochists. As with many paraphilias, sexual masochism would only classified as a mental disorder if it causes significant psychological and physical impairment (that in very extreme circumstances may be life threatening). This has been echoed by Dr Richard Krueger (New York State Psychiatric Clinic, USA) who noted in a 2010 review on the diagnostic criteria for sexual masochism that the main criticisms and concerns surrounding this behaviour (and paraphilias more generally) is that they “should not be included in the DSM because they are not mental disorders, they are unscientific, they are unnecessary, and to do so pathologizes groups who engage in alternative sexual practices” (p.348).

However, in 2006, Dr Charles Moser and Peggy Kleinplatz (Carleton University, Canada) argued in the Journal of Psychology and Human Sexuality that there is no evidence that sadomasochists more often need emergency services “than practitioners of other sexual behaviours” (p. 106), although this has been disputed by others in the field. The review by Dr Krueger concludes that:

“While masochistic and/or sadomasochistic behavior occur with some frequency in the population and is associated with generally good psychological or social functioning, there are a very small number of cases where masochistic fantasy and behavior result in severe harm or even death. These cases clearly indicate a sexual interest pattern that has become pathological. Since so little is know about this behavior, further research is indicated, and inclusion in the DSM would facilitate this” (p.353).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Alison, L., Santtila, P., Sandnabba, N. K., & Nordling, N. (2001). Sadomasochistically oriented behavior: Diversity in practice and meaning. Archives of Sexual Behavior, 30, 1–12.

Baumeister, R. F. (1988). Masochism as escape from self. Journal of Sex Research, 25, 28–59.

Breslow, N., Evans, L., & Langley, J. (1985). On the prevalence of roles of females in the sadomasochistic subculture: Report of an empirical study. Archives of Sexual Behavior, 14, 303–317.

Crépault, C., & Couture, M. (1980). Men’s erotic fantasies. Archives of Sexual Behavior, 9, 565–576.

Donnelly, D., & Fraser, J. (1998). Gender differences in sado-masochistic arousal among college students. Sex Roles, 39, 391-407.

Freund, K., Seto, M. C., & Kuban, M. (1995). Masochism: A multiple case study. Sexuologie, 4, 313-324.

Hucker, S. J. (2008). Sexual masochism: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp. 250-263). New York: Guildford Press.

Kinsey, A. C., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual behavior in the human female. Philadelphia: Saunders.

Krueger, R.B. (2010). The DSM diagnostic criteria for sexual masochism. Archives of Sexual Behavior, 39, 346–356.

Moser, C., & Kleinplatz, P. J. (2006). DSM-IV-TR and the paraphilias: An argument for removal. Journal of Psychology and Human Sexuality, 17, 91-109.

Ormerod, D. (1994). Sado-masochism. Journal of Forensic Psychiatry, 5, 123–136.

Paclebar, A. M., Furtado, C., & McDonald-Witt, M. (2006). Sadomasochism: Practices, behaviors, and culture in American society. In E. W. Hickey (Ed.), Sex crimes and paraphilia (pp. 215–227). Upper Saddle River, NJ: Pearson Education.

Person, E.S., Terestman, N., Myers, Goldberg, E.L. & Salvadori,  C. (1989). Gender differences in sexual behaviors and fantasies in a college population. Journal of Sex and Marital Therapy, 15, 187-198.

Sandnabba, N. K., Santtila, P., Alison, L., & Nordling, N. (2002). Demographics, sexual behaviour, family background and abuse experiences of practitioners of sadomasochistic sex: A review of recent research. Sexual and Relationship Therapy, 17, 39–55.

Sandnabba, N. K., Santtila, P., & Nordling, N. (1999). Sexual behavior and social adaptation among sadomasochistically oriented males. Journal of Sex Research, 36, 273–282.

Spengler, A. (1977). Manifest sadomasochism of males: Results of an empirical study. Archives of Sexual Behavior, 6, 441–456.