Fifty Shades of What? The Medical Science of Kink

You’ve heard about Fifty Shades of Grey. But what does science say about BDSM?

fifty-shadesIf by now you haven’t heard of Fifty Shades of Grey, you are probably living on a remote island. The erotic romance trilogy was first published in 2011, and topped best-seller lists around the world. The series set a record for being the fastest selling paperback book of all time.

The first book was turned into a movie which was released in early 2015 and which set a record for highest grossing February film ever. The storyline is notable for its explicitly erotic scenes featuring elements of sexual practices involving bondage, discipline, sadism, and masochism (BDSM), which has left many people asking, wait, Fifty Shades of what are we talking about?

BDSM is a also known as kink or “kinky” sexual practices, and is a catch-all phrase that can  include a wide variety of activities including role playing, restraints, power exchange, and sometimes administration of pain as sexually stimulating activities.

Medical research in sexual minorities and subcultures historically for decades has focused on BDSM as a pathological indicator, and only in recent years, alongside popular culture exposure such as Fifty Shades of Grey, has research begun to de-pathologize or explore other implications to kink behavior. Interestingly, there have been a series of recent medical research papers that have identified benefits in people who engage in what most would consider alternative sexual behaviors.

BDSM is often misconceived to be “all about pain” when in fact clinical studies show that people who engage in  BDSM activities do so for reported sensory enhancement pleasure, as well as mood and intimacy benefits. A 2009 study(1) showed that individuals experienced a reduction in the stress hormone cortisol and elevation in testosterone levels after kink activities suggesting that there is a biochemical enhancement for some who engage in these behaviors. This same study revealed improved measures of psychological relationship closeness in participants. Both people who received and administered kink activities were notable for these increased measures of intimacy.

Another study in 2013 determined that BDSM participants were less neurotic, more extraverted, more open to new experiences, had more conscientiousness, yet were less agreeable compared to non-BDSM control groups. The subjective well-being of BDSM was higher than that of the control group, and the study summarized that people who engage in BDSM are characterized by greater psychological and interpersonal strength and autonomy, rather than by psychological maladaptive characteristics as previously focused on in historical assumptions (2).

This was a surprising study, and received a good deal of media attention at the time it was published, and has led to elaborate conversation pieces regarding why these traits may be noted in people who engage in kink behaviors. Some suggestions have been made including the following as to why we may see benefits to kink activities:

  • Improved communication between partners: Engaging in different sexual stimulus activities requires enhanced ability to communicate preferences.
  • Enhanced intimacy: Multiple studies on sexual function have suggested adventure and trying new sexual activities together improves intimacy and trust between partners.
  • Better emotional health: Couples who have greater intimacy and communication have been shown to be happier people and their relationships succeed for longer.
  • Reduction in stress and anxiety: People who report satisfying sexual relationships report lower levels of stress and anxiety in life in general.

A popular assumption historically has been that BDSM participants have a preference for kink activities as a result of traumatic sexual experiences, yet this assumption is not based in science, and in fact several research studies debunked this association, revealing no difference between BDSM and non-BDSM individuals in prevalence of sexual or other abuse experiences. A recent study found BDSM-practicing individuals reported lower sexual functioning distress, and have normative scores on standardized clinical psychopathology and severe personality pathology measures (2,3).

Nonetheless the American Psychological Association’s Diagnostic and Statistical Manual (DSM-5) considers many BDSM associated practices a disorder, but a medical diagnosis of can only be made if personal or relationship distress is characteristic of an individual’s complaint.

The DSM-5 excludes consensual BDSM as a diagnosis when the sexual interests cause no harm or interpersonal problems. The ICD-10 indicates that “Mild degrees of sadomasochistic stimulation are commonly used to enhance otherwise normal sexual activity”. The fundamental principles for the exercise of BDSM require that it should be performed with the informed consent of all involved parties.

SSC is an abbreviation for “safe, sane and consensual”, which means that everything is based on mechanically safe activities, that all participants be of sufficiently sound and sane mind to consent, and that all participants fully consent to BDSM participation. It is mutual consent that makes a clear legal and ethical distinction between BDSM and such crimes as sexual assault or domestic violence.

Fifty Shades of Grey has also sparked countless controversies, first and foremost of which include accusations that the characters depict an abusive relationship, and that stalking and coercion are romanticized. The main complaint amongst sexuality experts interviewed about Fifty Shades is the trope of the emotionally damaged kinkster, as the dominant character Christian Grey is ashamed of his sexuality, and the storyline asserts his BDSM interests are a result of traumatic and abusive childhood, which perpetuates a common myth about BDSM which modern research has begun to repetitively nullify as a false association.

Yet in 2013 a book titled The Normal Bar, which was based upon the most extensive study ever conducted on relationships and included data from 100,000 people worldwide, and compiled by renowned sociologists including Dr. Pepper Schwartz, revealed the helpful influence that reading Fifty Shades of Grey had on relationships. First and foremost, 52 percent of readers (men and women) believed that the book had a positive impact on their relationship. Follow up questions as to why Fifty Shades of Grey was so impactful, revealed the following themes:

  1. It gave couples ideas of how to improve variety in the bedroom, and helped turn vanilla sex (non-kinky sex) into coconut cream pie
  2. It made a hot sex life hotter
  3. It opened up communication to discuss what each person wanted in a sexual relationship to become more fulfilled

The Normal Bar also revealed that 94 percent of men and 78 percent of women want more variety in the bedroom, and that couples surveyed who reported being extremely happy together help themselves stay enamored with one another by keeping sexual and intimate variety alive over the years (4).

Nonetheless BDSM and kink activities are clearly not for everyone, and the takeaway I advise my patients is to search ultimately for a personal, authentic sexual expression. Whether you love or leave the Fifty Shades books and movie, the dialogue which Fifty Shades has provoked in our culture is ultimately valuable not to dictate whether someone should or shouldn’t be kinky, but to empower an open dialogue about sexual choices.

When we talk candidly as a culture about sex, and more importantly with our partner, this promotes sex positivity in which consenting adults are given permission to seek and embrace a genuine and personally meaningful sexual life.

Even if you personally opt to leave the handcuffs out of the bedroom, the characteristics of healthy sexual expression and exploration that medical studies are beginning to elucidate from people who participate in kink, can dramatically improve your sex life — even if the most risqué item in your bedroom are white sheets. Great sex is self-defined, and more importantly learned from exploration.

  1. Sagarin BJ et al. Hormonal changes and couple bonding in consensual sadomasochistic activity. Arch Sex Behav. 2009 Apr;38(2):186-200.
  2. Wismeijer, A. et al. Psychological Characteristics of BDSM Practitioners. J Sex Med 2013;10:1943-1952.
  3. Connolly PH. et al. Psychological functioning of BDSM practitioners. J Psychol Human Sex 2006;18:79-120.
  4. Schwartz, P. et al. The Normal Bar: The Surprising Secrets of Happy Couples And What They Reveal About Creating A New Normal In Your Relationship. Harmony Press. 2013.