Physical safety basics: circulation, nerves, safety shears

Checklist 1: Breathing

Care should be taken to ensure the person being bound can breathe easily throughout all stages of play[5]. The hogtie position places pressure on the abdomen, which may create difficulty in breathing known as postural asphyxia[1].

Checklist 2: Circulation

Breast bondage may reduce or prevent venous return, so that blood cannot escape from the breast tissue[3]. As a result, the breasts may swell and turn pink or red after a few minutes[3][6].

One source describes a position with a forced bent-down upper body that sends a burning sensation through the body if the person remains in it for a long time[8].

Checklist 3: Nerves

TK wraps are used in suspension bondage, and if the ropes are misplaced, body weight can crush the radial nerve[2]. This can lead to the serious and possibly irreversible condition known as wrist drop[2].

There is no absolutely safe position for the top wrap of a TK wrap, and the mid-point gap between the triceps and the deltoid muscles is the most problematic[2].

Checklist 4: Balance and position

In asymmetric bondage, such as standing on one leg with the other ankle bound to the standing thigh, the lack of balance is disorientating for the person bound[9].

Checklist 5: Choking and strangulation

Sexual choking, which is often performed as a form of strangulation, carries health risks, and sex researchers and kink educators argue it is not as safe as people think[7]. There are also significant problems with consent and legal issues, including US cases where consensual adult choking involving injury or death resulted in criminal or civil charges[7].

Checklist 6: Marks, injuries and getting care

BDSM marks and injuries are common and quite varied, from small scratches to very large bruises, according to a 2023 survey of 513 US adults[10]. Research on this topic is still limited, and the authors describe their findings as a starting point for future study[10].

In a survey of 1,398 kink-involved people, 13.5% reported past kink-related injuries, and 19.0% reported delaying or avoiding healthcare because of anticipated stigma[4]. Some 58.3% had not disclosed their kink behaviour to their physical healthcare clinician[4]. Convenience sampling and a self-report design limit how far these results can be generalised[4].

Checklist 7: Safe words and marks in the research

In a 2023 survey, more BDSM experience was positively associated with the use of safe words[10]. The same survey found that practitioners with more BDSM experience inflicted more marks than those with less experience[10].