D/s Medical Advice

Prevention and Treatment of Injuries / Adverse Conditions

Introduction
Sexually Transmitted Disease
Injuries: Prevention and Treatment

I. Introduction

This text has been prepared by a friend of mine that is an M.D. with a personal and professional interest in D/s. It covers topics such as safer sex, preventing and treating injury, and psychological safety. It is offered freely to the D/s community in the hopes of assisting others to find joy and fulfillment in a safe and sane environment.

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II. STD... Sexually Transmitted Disease

A. By far the most pressing concern in any sexual encounter is the prevention of STD: Sexually Transmitted Disease.

These are diseases that can be passed from one partner to another by different forms of sexual contact. The risk of contracting a STD is determined by several factors:

The prevalence of the disease in your area... for example, you are more likely to contract HIV (the AIDS virus) in Newark, NJ than in Duluth, Minn.
The population your sex partner is part of... for example... the rates of HIV positivity are higher in prostitutes and IV drug abusers than the general population.
The type of sexual activity engaged in... for example, anal intercourse carries a higher risk for HIV transmission than oral sex.
The specific disease... for example... the herpes simplex virus is more easily contracted by oral - genital contact than the HIV virus, which requires contact with body fluids (semen or blood).

B. A List of STDs:

The following is a list of SOME STDs... please note this list is not inclusive and is not intended to substitute for medical advice. Contact your doctor if you have ANY concerns or questions about your own health risks or needs.

AIDS... caused by the HIV (Human Immunodeficiency Virus) virus. It is contracted by exposure to bodily fluids... semen and blood.

Herpes... caused by the herpes simplex virus it causes a chronic, relapsing illness characterized by recurrent genital blisters. It can be passed from mother to infant during childbirth as well... It can be contracted when the virus is "shedding"... becoming active... and may occur before the reappearance of genital lesions..

Gonorrhea... caused by a bacteria (gonococcus), it can cause sterility, arthritis, heart problems and disorders of the central nervous system. In women, it can cause Pelvic Inflammatory Disease (PID). Common symptoms include: for women... frequent, burning urination; pelvic pain; a green or yellow vaginal discharge; swollen vulva. For men... a pus like discharge from the penis..

CMV... Cytomegalovirus... can be transmitted sexually as well as from mother to child during pregnancy. In the fetus, it causes deafness and mental retardation. In adults, it can cause blindness and metal disorders. Common symptoms include... swollen glands, fatigue, fever, and general weakness, nausea and vomiting, loss of vision. It is spread in saliva, semen, blood, cervical and vaginal secretions, urine and breast milk by: close personal contact, vaginal, anal and oral intercourse, blood transfusion and sharing IV drug equipment, from mother to child during pregnancy, childbirth or breastfeeding..

Hepatitis B... contracted like HIV through exchange of body fluids or blood... causes inflammation of the liver with jaundice, fever, weakness, nausea and vomiting. Can lead to acute liver failure or chronic active hepatitis. Follow precautions for HIV .

C. Prevention:

The only absolute protection against sexually transmitted disease is complete avoidance of contact with all bodily secretions of another... All other measures provide SAFER SEX ... the more information you have, the better able you will be to assess your risk and take appropriate precautions. By far the most effective means of REDUCING the risk of STDs is CONSISTENT, CORRECT and CAREFUL use of CONDOMS during vaginal, anal and oral intercourse. Care should be taken when withdrawing not to spill semen from the condom. Yes... condoms should cover the penis during fellatio (giving "head " to a man). The appropriate use of condoms is critical when considering the HIV virus. Since infection invariably leads to AIDS (97%) and AIDS invariably results in premature death... each sexual encounter must be evaluated in that light. When toys are used that result in contact with bodily secretions... for example, a vibrator used for vaginal or anal intercourse... it should ONLY be used with that partner and not shared between partners.

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III. Injuries... Prevention and Treatment

A. The most important factors in the prevention of injury during D/s activity are picking the right partner and using common sense.

For a sub, picking the right dominant is crucial. In order to avoid injuring a sub, a dominant must have control of him/herself, and a deep sense of responsibility to protect the well being of those in his/her care. Skill and knowledge of techniques employed isn't bad, either.

B. Safety tips for Subs:

First meetings are particularly risky. There are many sources of information on safety tips. I recommend a chat room, safe for new subs, on AOL as a place to ask questions and get helpful advice from knowledgeable people. Submissives should always know how and feel free to use a safeword or gesture to stop D/s activity at any time. A safeword is a word that when uttered, signals the dominant partner to STOP immediately. If unable to speak... (as when gagged)... a safe gesture is employed.

C. The use of alcohol and/or drugs is to be avoided during D/s play as it clouds judgment...

the dominant partner may not be able to exercise the necessary control when intoxicated, and the submissive partner might not be able to accurately assess her limits... leading to injury. DRINKING/DRUGGING AND D/s DO NOT MIX.

D. Specific Injuries... Prevention and Treatment

1. Poor circulation ...

In using restraints, care must be taken not to compromise the circulation of the restrained limb. Restraints must NOT be so tight as to cause the following: numbness and tingling (pins and needles), cold sensation (can also be checked by the dominant by touching hands or feet); blue color of hands/feet; diminished sensation; burning sensation. Serious injury can result if these signs and symptoms of compromised circulation persist. The restraint must be released at the first sign.

2. Choking ...

While I have no idea how common this practice is in the D/s community... it is so potentially dangerous I have to speak to it. Choking... compressing the neck... is sometimes done as part of sex play... (erotic asphyxia) ..in which case the choking is used to heighten orgasm. Any miscalculation can result in death by strangulation. Choking in any other context... as part of power exchange... not only carries the risk of miscalculation resulting in serious injury or death. Some people are especially sensitive to carotid pressure and develop a slowed heart rate in response. This can result in simple fainting, or more severe heart rhythm disturbances. For this reason, choking is not a recommended activity.

3. Bruises ...

In the context of D/s play, not all bruises can be prevented. Those who engage in activities leaving frequent bruises do well to consider the following. On a daily basis, taking 1000mg. of vitamin C... which helps with tissue repair. Avoid the frequent use of aspirin, ibuprofen (Motrin), naprosyn (Naproxen, aleve) and other drugs of the nonsteroidal anti-inflammatory class. Activities leaving bruises are to be completely avoided if a person is taking COUMADIN, a drug to prevent clotting. Bruises can be treated simply with ice for the first 24 hours followed by application of heat.

4. Lacerations ...

This is the medical word for a cut. Welts that bleed are forms of lacerations, as are those inflicted by knives or razors. The two main considerations with lacerations are first: blood is a body fluid that can transmit disease, and disposable gloves should be worn when treating a partner's lacerations... Secondly, the prevention of infection. Lacerations should be washed with warm, soapy water and if significantly open, dressed with an antiseptic ointment (bacitracin is good) and covered with a bandaid or sterile dressing. Minor bleeding can be stopped with direct pressure over the wound. If bleeding persists, consult a physician or go to emergency room.

5. Abrasions ...

These are rubbing injuries, typically sustained from restraints. Also from carpets... the so called rug burn. These should be washed with warm, soapy water, and if significant, dressed with bacitracin and covered with a sterile dressing and gauze.

6. Burns ...

First degree burns result in reddened and painful skin. Second degree burns blister. Third degree burns destroy tissue. Extensive second degree and any third degree burns require medical attention. Minor burns should be treated immediately with immersion in cold water. Grease... butter, petroleum jelly, etc. should NOT be used. Burns blisters, when opened, should be treated as abrasions and covered with bacitracin and dressed with a sterile dressing.

7. Vaginal Injuries ...

To prevent injury to vaginal tissues, care should be taken not to introduce anything into an unlubricated vagina. If sufficient vaginal secretions are not generated, a water based lubricant such as KY jelly should be employed. Care should be taken introducing large objects at the introitus... the entrance to the vagina, as the tissues there can be torn if excessive force is employed. Douching, unless prescribed by a physician, is NOT recommended. The vagina is self cleaning. (Much better even than an oven). Should there be soreness, redness ,swelling etc.. these should be checked by a physician as some STDs present that way and distinguishing injury from infection can sometimes be difficult. Objects that are breakable (such as light bulbs) must never be inserted into the vagina.

8. Anal injuries ...

See above. Liberal use of KY jelly is critical, as is slow penetration of the anus, allowing tissues to stretch and the muscles to relax. Enemas should NOT be used to "clean" the rectum following any vigorous anal penetration because there are always microtears in the rectal wall. Introducing an enema under those conditions could cause serious infection and illness. Enemas given recreationally should not contain chemicals, should be around skin temperature, and should not be given too fast. CONDOMS MUST BE WORN FOR ANAL INTERCOURSE TO PROTECT AGAINST STDS. Any object... finger, dildo, or penis, used in anal play must be thoroughly cleaned in warm soapy water before being put into the vagina or mouth in order to prevent infection. Condoms should be changed when switching from anal to vaginal or oral intercourse. Glass objects do not belong in rectums. Be careful not to lose anything inserted into the rectum... unlike the vagina, which is a closed space, the rectum is an large vault and items can be difficult to retrieve. Please leave mice and guinea pigs in their cages.

9. Penile injuries ...

Use common sense. If catheters are used, they should be sterile and used ONLY for that sub once. Rubber cannot be resterilized. Do not force anything into the urethra... (the opening into the penis). If compression of the penis is practiced with any kind of device, pain is a good barometer of when to stop. Any deep lacerations sustained to the penis must be evaluated medically. Lacerations in this area should be avoided.

10.Animals ...

If an animal is used in erotic play, a muzzle should be used to prevent animal bites which are serious, especially to the face. The animal's toenails should be clipped as well.

11. Beating ...

There are some areas of the body that should be avoided when administering a beating. The kidneys area, which is located on the back where the ribs join the spine, is one such area to avoid. The area of the spleen is also vulnerable to excessive force. This area is on the left side of the abdomen just under the ribs. Head injuries can be serious and heavy blows to face and head are not wise. Stick to the tush, the upper back, shoulders, and legs.

12. Frostbite ...

Sometimes ice is used in D/s play. If there is prolonged contact to skin, frostbite can result. The first response to cold is blueness to the area... then redness and burning or diminished sensation... followed by tissue injury. The area must be rewarmed IMMEDIATELY in WARM, not HOT water. Serious, extensive frostbite needs to be seen by a physician. The extremities... the fingers and toes...are most likely to get serious frostbite.

13.Wax ...

Use only paraffin candles for wax play. The height that the wax is dropped from determines how hot it will be when it hits the skin..Less than 6 inches dripping height CAUSES BURNS... avoid this.

14.Bite wounds ...

Bite wounds on the face should be avoided and if serious, should be seen by a doctor. All bites should be thoroughly cleaned with warm soapy water, covered with bacitracin and a dry sterile dressing. Infection is the major complication of bites. Signs of infection include: redness extending from the wound, swelling around the bite, pain at the site, heat at the site and fever. An infected bite is very serious and should be treated by a doctor.

15.Electricity-related injuries ...

If toys are used that involve electricity, the major injury is an accidental burn. These should be evaluated and treated as outlined in the burn section above. Please keep all electric toys away from water, and check all wires before play to make sure they are intact, and not frayed. Should electric shock occur, the possibility exists that the person's heart will stop and CPR will be required. Before touching the person, make sure that the electric source is off... interrupt it using an insulated item or at the source (circuit breaker). If the person is not breathing , and you know CPR... follow the protocol. Otherwise, call 911 and tilt the person's head back (person is positioned on back) to open the airway. Taking a CPR basic course is the best way to save a life.

16. Strains and sprains ...

These are injuries sustained to ligaments and tendons around joints. They may be complications of restraint and suspension. If pain is so severe that the joint cannot be moved, a doctor consultation is advisable. For minor injuries, remember RICE: Rest, Ice, Compression and Elevation. Rest the affected joint. Use ice for 24 hours, then heat. Ace bandages can provide compression and reduce swelling. Elevate the effected joint.

17. Branding, Cutting and Piercing ...

These activities by their very nature cause injury. Any activity that breaks the skin must be done under sterile conditions. This means the skin must be cleaned first with warm soapy water... Then, the area should be washed with betadine. Allow the betadine to dry, then wipe off with an alcohol wipe. The person doing the activity should be wearing sterile gloves, both to protect him/herself from blood contamination, as well as protecting their partner from infection. Any of these instruments should only be used if they are sterile. Either purchase them in a sterile fashion and discard... as with needles... or sterilize. An item can be considered sterile if it is brought to a rolling boil and kept there for 20 minutes. It must be completely immersed in the boiling water. These activities may result in infection... please see above for signs of infection and treatment. Any infection accompanied by fever should be evaluated IMMEDIATELY by a doctor. These activities will result in bleeding. Minor bleeding can be stopped by continuous, direct pressure over the wound. Remember to wear gloves. If bleeding is spurting out, an artery may have been opened and this requires emergency medical treatment. Apply direct pressure and get to a hospital. Another complication of these acts may be shock, due to excessive blood loss. Follow guidelines for treatment of active bleeding.. keep the person warm, and raise the legs higher than the head. Get emergency medical attention. Shock can be recognized by pallor, sweating, tremulousness, faintness, rapid, thready pulse and loss of consciousness..

18. Psychological risks ...

The D/s power exchange can be a deeply fulfilling, joyous, and thrilling way of life in the right context. Some "mental health awareness" unique to our community seems in order. There is a pattern for submissives particularly, to be aware of. In pain play, for example, the central nervous system responds with an outpouring of endorphins.. the natural painkiller., whose chemical structure is similar to morphine. This may indeed be the physiologic basis of subspace... As this wears off.. there is a "letdown" and should not be confused with depression. Depression that is clinically significant lasts 2 weeks or more, and is characterized by persistent low mood, decreased energy, disturbed sleep and appetite, feelings of helplessness and hopelessness, and sometimes suicidal thoughts, delusions and hallucinations. These symptoms should lead one to consult a physician. Other hazards include those associated with the use of sleep deprivation... (one should not drive sleep deprived!). Psychological consequences of sleep deprivation include altered perception... (hallucinations), unstable mood, irritability, decreased fine motor performance and impaired judgment. Much the same picture is produced by prolonged sensory deprivation.

Psychological health between dominants and submissives is fostered by clear, open communication, respect, trust and communication , communication , communication. If you can't talk to each other, you shouldn't play!

I hope this document has been useful to you. Please consult a doctor for any questions or concerns you may have. Better to be safe than sorry. Better to be informed than not. What you don't know, in this area CAN hurt you.