Sexual masochism involves acts in which a person experiences sexual excitement from being humiliated, beaten, bound, or otherwise abused. Sexual masochism disorder is sexual masochism that causes significant distress or substantially interferes with daily functioning.
Sexual masochism is a form of paraphilia. Most people with masochistic tendencies do not have sexual masochism disorder.
Some amount of sadism and masochism is commonly play-acted in healthy sexual relationships, and mutually compatible partners often seek one another out. For example, the use of silk handkerchiefs for simulated bondage and mild spanking during sexual activity are common practices between consenting partners and are not considered sadomasochistic.
Most people who engage in masochistic activities are open about their involvement in BDSM (bondage-domination-sadism-masochism) activities. Most interact with a consenting partner, who may have sexual sadism (that is, who experiences sexual excitement from inflicting physical or psychological suffering on another person). In these relationships, the humiliation and beating are simply acted out, with participants knowing that it is a game and carefully avoiding actual humiliation or injury, often by using a prenegotiated "safe word." However, some masochists increase the severity of their activity with time and may stop using their safe word as way to protect themselves, which can potentially lead to serious injury or death.
In contrast, sexual masochism disorder involves the following:
People are distressed by their behavior or unable to function because of their behavior.
Acts result in severe bodily or psychological harm and even death, as can occur in asphyxiophilia.
The person has been living with the condition for 6 months or more.
Treatment of masochism is not necessary if the person is not significantly distressed or impaired by their behavior. However, in some cases, using a combination of cognitive-behavioral therapy and antiandrogen medications (which work by blocking the effects of testosterone) can be beneficial.
Asphyxiophilia (autoerotic asphyxiation)
Asphyxiophilia is considered a subtype of sexual masochism disorder. People with asphyxiophilia partially choke or strangle themselves by applying a noose around their neck during masturbation, or they allow a partner to do so.
Typically, people use articles of clothing (such as scarves or underwear) as the noose. They may attach the noose to an object in the room (such as a doorknob or bedpost). A temporary decrease in oxygen to the brain at the point of orgasm is sought as an enhancement to sexual release, but the practice may accidentally result in brain damage or death.
