Sexual masochism


The essential feature of sexual masochism is the feeling of sexual arousal or excitement resulting from receiving pain, suffering, or humiliation. The pain, suffering, or humiliation is real and not imagined and can be physical or psychological in nature. A person with a diagnosis of sexual masochism is sometimes called a masochist.

The Diagnostic and Statistical Manual of Mental Disorders , also known as the DSM , is used by mental health professionals to diagnose specific mental disorders. In the 2000 edition of this manual (the Fourth Edition Text Revision also known as DSM-IV-TR ) sexual masochism is one of several paraphilias . Paraphilias are intense and recurrent sexually arousing urges, fantasies, or behaviors.


In addition to the sexual pleasure or excitement derived from receiving pain and humiliation, an individual with sexual masochism often experiences significant impairment or distress in functioning due to masochistic behaviors or fantasies.

With regard to actual masochistic behavior, the person may be receiving the pain, suffering, or humiliation at the hands of another person. This partner may have a diagnosis of sexual sadism but this is not necessarily the case. Such behavior involving a partner is sometimes referred to as sadomasochism.

Masochistic acts include being physically restrained through the use of handcuffs, cages, chains, and ropes. Other acts and fantasies related to sexual masochism include receiving punishment or pain by means of paddling, spanking, whipping, burning, beating, electrical shocks, cutting, rape, and mutilation. Psychological humiliation and degradation can also be involved.

Masochistic behavior can also occur in the context of a role-playing fantasy. For example, a sadist can play the role of teacher or master and a masochist can play the role of student or slave.

The person with sexual masochism may also be inflicting the pain or suffering on himself or herself. This can be done through self-mutilation, cutting, or burning.

The masochistic acts experienced or fantasized by the person sometimes reflect a sexual or psychological submission on the part of the masochist. These acts can range from relatively safe behaviors to very physically and psychologically dangerous behavior.

The DSM lists one particularly dangerous and deadly form of sexual masochism called hypoxyphilia. People with hypoxyphilia experience sexual arousal by being deprived of oxygen. The deprivation can be caused by chest compression, noose, plastic bag, mask, or other means and can be administered by another person or be self-inflicted.

Causes and symptoms


There is no universally accepted cause or theory explaining the origin of sexual masochism, or sadomasochism in general. However, there are some theories that attempt to explain the presence of sexual paraphilias in general. One theory is based on learning theory that paraphilias originate because inappropriate sexual fantasies are suppressed. Because they are not acted upon initially, the urge to carry out the fantasies increases and when they are finally acted upon, a person is in a state of considerable distress and/or arousal. In the case of sexual masochism, masochistic behavior becomes associated with and inextricably linked to sexual behavior.

There is also a belief that masochistic individuals truly want to be in the dominating role. This causes them to become conflicted and thus submissive to others.

Another theory suggests that people seek out sadomasochistic behavior as a means of escape. They get to act out fantasies and become new and different people.


Individuals with sexual masochism experience sexual excitement from physically or psychologically receiving pain, suffering, and/or humiliation. They may be receiving the pain, suffering, or humiliation at the hands of another person, who may or may not be a sadist, or they may be administering the pain, suffering, or humiliation themselves.

They experience distressed or impaired functioning because of the masochistic behaviors, urges, and fantasies. This distress or impairment can impact functioning in social, occupational, or other contexts.


Although masochistic sexual fantasies often begin in childhood, the onset of sexual masochism typically occurs during early adulthood. When actual masochistic behavior begins, it will often continue on a chronic course for people with this disorder, especially when no treatment is sought.

Sadomasochism involving consenting partners is not considered rare or unusual in the United States. It often occurs outside of the realm of a mental disorder. More people consider themselves masochistic than sadistic.

Sexual masochism is slightly more prevalent in males than in females.

Death due to hypoxyphilia is a relatively rare phenomenon. Data indicate that less than two people per million in the United States and other countries die from hypoxyphilia.


The DSM criteria for sexual masochism include recurrent intense sexual fantasies, urges, or behaviors involving real acts in which the individual with the disorder is receiving psychological or physical suffering, pain, and humiliation. The suffering, pain, and humiliation cause the person with sexual masochism to be sexually aroused. The fantasies, urges, or behaviors must be present for at least six months.

The diagnostic criteria also require that the person has experienced significant distress or impairment because of these behaviors, urges, or fantasies. The distress and impairment can be present in social, occupational, or other functioning.

Sexual masochism must be differentiated from normal sexual arousal, behavior, and experimentation. It should also be differentiated from sadomasochistic behavior involving mild pain and/or the simulation of more dangerous pain. When this is the case, a diagnosis of sexual masochism is not necessarily warranted.

Sexual masochism must also be differentiated from self-defeating or self-mutilating behavior that is performed for reasons other than sexual arousal.

Individuals with sexual masochism often have other sexual disorders or paraphilias. Some individuals, especially males, have diagnoses of both sexual sadism and sexual masochism.


Behavior therapy is often used to treat paraphilias. This can include management and conditioning of arousal patterns and masturbation. Therapies involving cognitive restructuring and social skills training are also utilized.

Medication is also used to reduce fantasies and behavior relating to paraphilias. This is especially true of people who exhibit severely dangerous masochistic behaviors.

Treatment can also be complicated by health problems relating to sexual behavior. Sexually transmitted diseases and other medical problems, especially when the sadomasochistic behavior involves the release of blood, can be present. Also, people participating in hypoxyphilia and other dangerous behaviors can suffer extreme pain and even death.


Because of the chronic course of sexual masochism and the uncertainty of its causes, treatment is often difficult. The fact that many masochistic fantasies are socially unacceptable or unusual leads some people who may have the disorder not to seek or continue treatment.

Treating a paraphilia is often a sensitive subject for many mental health professionals. Severe or difficult cases of sexual masochism should be referred to professionals who have experience treating such cases.


Because it is sometimes unclear whether sadomasochistic behavior is within the realm of normal experimentation or indicative of a diagnosis of sexual masochism, prevention is a tricky issue. Often, prevention refers to managing sadomasochistic behavior so it primarily involves only the simulation of severe pain and it always involves consenting partners familiar with each other's limitations.

Also, because fantasies and urges originating in childhood or adolescence may form the basis for sadomasochistic behavior in adulthood, prevention is made difficult. People may be very unwilling to divulge their urges and discuss their sadistic fantasies as part of treatment.



American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association,2000.

Andreasen, Nancy C., M.D., Ph.D., and Donald W. Black, M.D. Introductory Textbook of Psychiatry. Third edition. Washington, DC: American Psychiatric Publishing, Inc.,2000.

Baxter, Lewis R., Jr., M.D. and Robert O. Friedel, M.D., eds. Current Psychiatric Diagnosis & Treatment. Philadelphia: Current Medicine, 1999.

Ebert, Michael H., Peter T. Loosen, and Barry Nurcombe, eds. Current Diagnosis & Treatment in Psychiatry. New York: Lange Medical Books, 2000.

Ali Fahmy, Ph.D.

User Contributions:

Melisa, If don't think you will ever be able to reach a point in your relationship where you will actually trust this guy, you should quit now while you're still ahead. As far as the bondage thing. So long as he makes it clear that he never really wants you to have true full control, and he is willing to always have an 'escape word', and so long as you never actually hurt him, and so long as you don't mind (which I think you actually then you should be OK. Good luck. Scott the Sexologist.
How do you find a psychologist to help you get rid of it? >__<
i love it when i ask my husband to choke me during sex. . . but sometimes i know he wonders where this came from hes given me hints as to talking to some one about it.....and now am wondering could this have anything to do with me being molested as a child????? he feels like he can really hurt me cause i want it tighter.
O.k. I always thought I may have a problem. after reading this arcticle i realize i definatley do. I love pain. It excites me. the more it hurts, the more I like it. I have a boyfriend that cant stand that side of me. I realize i need to get help, but i dont have the time or the money. I also have a daughter to think about. Im very private about the things I like when my kids around. I dont want her seeing the things I saw growing up. I dont want her to end up like me.
Something you should know about the connection between pain and sexual arousal. When a farmer wants a Bull to breed with a Cow in heat, the farmer sometimes rubs an ointment on the Bull's scrotum. The ointment contains an irritant that causes itiching and the Bull gets an erection. I know it excites the hell out of me when I have pain or irritation on my scrotum. I don't know why that is, but it does. I've burned my scrotum with a cigarette a number of times. The odd part is, that it doesn't 'hurt' when I'm sexually aroused. In fact, that pain makes me even more aroused than I already was. I've used wires (not needles) that have sharp points on them to irritate my scrotum. I've used a belt, and a riding crop to whip my buttox with. Some of the time that is exciting, and sometimes not. I've come to terms with my sexual desires. I am no longer in denial of it. It's a very liberating feeling.
Someone please help (support or suggestions). I am a 36 y.o. gay male and i obviously have this disorder. (my symptoms and actions more involve the psyvhological aspect of being punished though). I have gotten stimulated by being hit, threatened, tied up/restarined but as each years ago the means by which i seek to be punished get more twisted and more dangerous. Just recently I was in an intense situation where i engaged in sexual relations with 21 y.o. guy who wasnt single. His partner found out about us and he started to call rape on me in order to save him relationship troubles. (By "starting to call rape" i mean that he started to tell friends and some familybut decided not to actually file charges. Nothing came of it and eventually his friends and family concluded that he made it up. 4 Months later when the young guy and i ran into eachother he was shocked that i didnt hate him. It turned me on that I was in danger of being charged with rape and facing jail and much more just to save him problems or even to entertain him. He also confessed that it turned him on and he wished I had confirmed his accuasations 4 months ago and he would have enjoyed me serving time for him (as a sign of love and sacrifice). We both agreed and decided to start the rumors again that i "raped" him 4 months ago.We had the whole thing planned out (at least 80% of the plan) and now we re at odds for an unrelated reason so we postponed the plan (we were supposed to carry out april 1st, 2011). I cant help but wonder if thisd is a sign and a chance for me to save myself and my soul. I know it would not be erotic once it happened and my life was ruined.(and maybe the other guy's as well if this messed with his mind too, after). But the other part of me feels there is no help for me and that if my mind is as twisted and perverted as this then maybe i deserve my fate. (i stopped looking for treatment years ago, i am now 36 and have had these fantasies since my teens or as early as ican remember, though maybe not quite so intense. Thank you for hearing me out.
I think I have this. It's very mild. As a child (ages 3 - 5) I first discovered that touching felt good, but it was only when I was imagining some form of torture. It was apparent in the imaginary stories I'd tell friends about torture and stuff and I'd get excitement I couldn't understand from it. Now, I'm 19 and I only get excited when I'm pinned down or tied up during any form of sexual behavior and when my bf is lying on top of me telling me I'm worthless/that I'm trash and that I can't do anything to get away. It's mild - I haven't gotten any scars or anything and my boyfriend's sadistic behavior is solely for my own pleasure and is an act that he doesn't mind putting on.

I just know while watching movies involving a character begging/pleading for mercy or reading a book with a vivid scene of that nature, I get turned on. I used to think it was because I was sadistic until I discovered how submissive I am and how I just identify with the character in the movie.

I'm scared to talk to people about it and get diagnosed. The fantasies or thoughts of masochism sometimes interfere when I'm in class and get in my way. What do I do? :(
I've had the desire to physically hurt myself since I was maybe 7 years old. Over the years I've kept in a secret except to a few relationships.I know its been said that corporal punishment could be a starting point. My dad only hit me because my mother told him to. After he would tell me how much he loved me and hated punishing me. My mother was a violent, narrcisstic, sociopath who spent most of my life ignoring me (unless she needed something; like smoothing over someone's feelings that she had hurt). That was my job growing up, the go-between, the one that makes everything "nice". I would take blame for things I didn't do just to end the commotion. My mother locked my sister and I outside ALOT. When she'd come home from work she needed to "decompress" so we werent allowed in the house. If we did come in, it was straight up to bed and you better not make a sound. I did a couple times and onces she beat me over my entire body with her high heel shoe. The next time it was a hairbrush. I don't think I was more than 5 or 6. The irony is that I, like most abused people, didn't know this behavior was wrong. I met a man, got married, had two beautiful boys and we lived in Maryland. This was unacceptable to my mother, she wanted me next door where I'd always been. She concocted a lie about my father being deathly ill and that I should come home so that we could spend all the time he had left together. Like clockwork, I told my husband we were moving, forced him to leave a job he loved, pulled my kids from school, and left good friends. We were told he had less than 2 years, that was 2000 and he is still as healthy as a horse. But what could we do, we were back so we tried to make the best of it. My job as "middle man" or "whipping boy" became unbearable. My only sibling, a sister was so jealous i had married first, had children first, etc she couldnt see straight. She would create all sorts or drama, alot of which really hurt myself or my boys. But, as usual, my parents said "We don't know how to deal with her"..."You talk to her". She was like Teflon nothing stuck to her, she could do and said anything she damn well pleased. One day my husband and I decided that we needed to speak to him regarding my mothers alcohol usage. Alot of horrible tragigies had befallen both extended families and my mom began to drink, ALOT, especially in front of my boys who were 9 and 5. My Dad said he was thrilled, that he had wanted to approach her and this would be the perfect way to do it...its effect on the boys. Well that was August 2004 and she has not spoken to me once, nor has my father (because he's an enabling coward), nor my sister who is loving having me "out of the picture". She has two beautiful girls and I miss them to death. My mother has spoken to every relative telling them lies about me and my husbands so visits are a bit awkward. What I can settle within my heart is the pain she has caused my boys and my neices...they are innocent.So back to the point of this message is there any question how i turned out to be a freak. Thanks for listening
I like this article. I have this disorder. I fantasise about having pain and that arouse me. It has put myself into social dysfunction in the sense that I most often find myself uninterested in social events and friends. It has hurt my performance in my job . Internet porn also sells good amount of these stories and videos. I got addicted to those. I spent most of my time there. In some sites , where people like that meet each other, I am a regular visitor. It is too difficult to get rid of this thought process. I am now scared of such thoughts because they are ruining my life, but I am unable to ignore them. I am also unable to disclose this to somebody, even to my wife. The thoughts are quite strong.
I have mixed feelings, its obvious we have neen brainwashed into thinking the onlu way to have sex is in the most plane & straitforward way, in what the S&M community call vanella sex. On the other hand, I do agree some people do have a problem, because their sexual fantasies have taken control of their life and or become danderious to their physical and or mental health. I think one good measire of your own situation is, are there boundries, such as using protection,
Certain things you won't enhage in, and certain practaces you maintain like the use of safe words, insuring someone is hiv negative, disease free, drugg free, of
age, etc. Being able to see the big picture is part of this, it can help you choose to role play a fantasy rather than do something that might actualy get you tossed into jail &o ruin your life, or do something that would endanger your
health or end your life.
Masochism results from Classical (Pavlovian) conditioning. This may occur accidentally, from unplanned, unintended circumstances, especially among youths experiencing early sexual stimuli. Example: a youngster finds literature or visual pornography wherein explicitly sexual images are depicted in a context of abuse, and/or humiliation. Through repeated viewing, or even by repeated thoughts and mental images triggered by such material, the individual learns to associate pain and degradation with sexual arousal. Such ideation becomes more firmly embedded if paired with direct physical stimulus, such as masturbation. A similar cycle of Pavlovian conditioning may be initiated and reinforced among victims of sex abuse, including and especially children and youth, as such activity usually involves some degree of physical pain. Unfortunately, the suffering is paired with sexual stimulation which, may be inherently pleasurable. In addition, the coercion and guilt experienced by youngsters subjected to such encounters tends to reinforce the sense of being worthless or "dirty," thus setting up the victim to, in future, "choose" sexual scenarios and partnerships wherein s/he is being abused or degraded. Popular mainstream entertainment frequently displays subtle or not-so-subtle images of abuse or subjugation in a sexual context. A typical erotic theme in cowboy movies of the 'fifties and 'sixties comprised scenes in which the film's female sex symbol would be spanked, or dunked into a pond by the leading man once he had become annoyed by the slightest aspect of her behavior. The spanking, of course, was administered over the "gentleman's" lap, on the pretty lady's perky buttocks. This, or the wet dress resulting from a pond-dunking, would further drive home for the viewer the combined sensual and disciplinary aspects of these situations. In each case the woman would emerge displaying fury and humiliation, further linking themes of sex, pain, discipline and subjugation. At least three decades ago, music videos started featuring images of domination, an example being "Physical" performed by Olivia Newton-John. This video portrays Newton-John, a stunningly beautiful woman, dressed in tight, sexy "workout" garb, tormenting chubby men in a fitness club in ways that are clearly mean-spirited, forcing them to exercise ever-faster, ever-longer, until they are very obviously in severe distress or even on the verge of a heart-attack. Of course today's hip-hop scene, which aggressively touts subjects such as rape, violence, and other aspects of misogyny, works hard to normalize such deviance in the minds of its young male and female viewers. Yet the examples I've provided pale in comparison with the over-the-top pornography depicting real, sadistic/ masochistic acts that any person, young or old, may stumble across on the internet. The conclusion? Parents, many of whom frankly seem to be asleep at the wheel when it comes to monitoring the entertainment ingested by their young ones, need to exercise better judgement and more direct involvement in their innocent children's lives. This will help equip our sons and daughters to, in future, enjoy full, healthy sexual relations based on strong self-esteem and respect for one's partner, rather than neurotic fantasies implanted by ill-advised viewing, reading and listening habits. In many ways, our society is primed for building deviants. Its influences are so pervasive that we no longer recognize them for what they are. As described, some of the young lives influenced by the toxic soup in which they live may, as a result, develop destructive attitudes and habits of their own, perhaps causing them in future to help initiate members of the next generation into a version of sex that is crude and degrading. Let's use intelligence and discernment in evaluating the influences that pervade our homes, rather than allowing ourselves and our children to mindlessly (...)
Its not so much the pain that brings the pleasure as is said in this article for me its pleasure that brings the desire for pain I need to feel even the slightest pain to reach climax without pain or discomfort(which also brings a type of pain) climax cannot be reached. I know it hurts and I have the desire to stop but the urge to feel pain is more over whelming. But for me its not just my own pain that triggers arousal but the pain of others as well in my head I see pain=pleasure=orgasm its all the same thing to me I know the difference but its the same... Sex doesn't have to be crude or degrading but pain has to be there... I think it came from a lack of stimulating partners I felt like something was missing I still do and it is hard to find a partner willing to cause you physical harm; pain is my foreplay and it is my sex without it I can not truly be happy. Everyday its a constant struggle to not experiment into that category of self infliction.
I am a 33 year-old female with one child and I love being submissive or masochistic. I always love putting myself in some sort of danger where I could or could not possibly get hurt. The reason why I got tattoos or piercings is because I love feeling the needle going into my skin---it feels like some sort of release. My husband says that the only way he can get me to be submissive is during sex where I am willing to degrade myself or being in some sort of pain during sex. He's not into my masochistic side, so I decided to find someone who is. He is the best thing that has happened to me. At first it started out pretty innocent and vanilla then we started master/slave routine. One time we met for lunch and he ordered me to place a bullet vibrator on my clit, and I gave him the remote control and he controlled me throughout lunch. He ordered me not moan or scream when I was feeling waves of pleasure. It was sooo hot! This last time he put a ball gag in my mouth while he teased me and bit my nipples.

I know. I know. Morally, I am wrong because I am cheating on my husband. (He is also cheating on his wife) But I look forward to our once a month rendezvous and I feel so complete. Recently, I found another guy to have sex with; and he likes me to orally pleasure him until I choke on his penis. I like choking. My husband just like making love. I find it boring and sometimes I have to ask him to pinch my nipples to wake me up from the BORING sex.

I don't know where this behavior comes from but I like it. I don't think I need help and I am a very private person so I won't discuss this with anyone. I'm just glad that I'm not alone.
doris carter
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