1: Bondage and Restraint
DISCLAIMER: I am not a medical professional. All information in this article is based solely on my own research in the topic, my experience with bondage and restraint and my current certifications in First Aid, CPR and Bloodborne Pathogens. This article is an excerpt from an academic paper and uses medicalized, academic language.
CONTENT WARNING: Mentions of medicalized terms for health conditions within the body, specific mentions of BDSM / Kink practices included under the umbrella of bondage & restraint and mentions risks of injury, impairment and accidental death.
by Mx. Chelsey Morgan
An Introduction to Kink
Humanity has always had a vested interest in the taboo. We have carefully crafted social constructs to reinforce a culture of erotophobia, insistent on denying our natural inclination toward the dark. But in that darkness, we have found belonging. We have found shelter in those who choose to embrace desire. For some, Kink refers to a community. It’s an identity adopted by those who consider erotic deviance core to their distinctive selves. Though kink is not confined to those who take on the identity or who regularly engage in BDSM, which is an umbrella term for activities that fit under its compound acronym: Bondage and Discipline (B/D), Dominance and Submission (D/s), and Sadism and Masochism (S/M). For many people, kink refers to any erotic or sexual practice, concept or fantasy that deviates from the “accepted norm”. By that definition, it can include common sexual or even artistic practices that some wouldn’t associate with Kink or BDSM at all. Whether you categorize BDSM and Kink as “rough sex” or “adventure-seeking” or if you hold it as a core identity, this is for you. In this article, I will address safety concerns in one of the most common Kink and BDSM practices, bondage and restraint, so as to curate risk-awareness for those interested in diving into the dark.
To ensure shared understanding, the word “bodymind” will be used in accordance with Sins Invalid’s Disability Justice framework which acknowledges that the body and mind cannot be separated as they often are in a biomedical approach to learning. This does not mean, however, that the body and mind are not different. It is simply to acknowledge the truth of what it is to be human in moments in which a person’s full being is being discussed (Berne 2015). Additionally, the words “Kink” and “BDSM” will both be used as umbrella terms for those who are actively a part of the BDSM community and to refer to erotic practices that are often engaged in by those who do not identify as kinky. This includes all people who engage in kink. Specifically, those of all gender identities, those who identify as disabled, and those whose bodyminds find liberation in the clear communication, creativity and inclusivity inherent in kink.
However, as a disclaimer, this is not a comprehensive overview of all the dangers associated with kink, nor is it a comprehensive list of kinky behaviors. This is meant to be used as a starting point to assess health risks associated with introducing one aspect of kink into your erotic profile, specifically the risks associated with bondage and restraint, which is often first explored by beginners in the kink community and by those who may not even identify as kinky. The potential dangers involved in participating in a scene involving this type of play ranges in that, depending on the degree of restraint and the length of time that a person might experience symptoms, there can be very different impacts on overall health. For that reason, the conditions will be categorized as low, medium and high risk. However, not all people share the same experience and so it is important to assess risks in accordance with your own bodymind.
Perhaps one of the most common entry points into kink, bondage is a type of play that is fraught with unique, and often overlooked, risks that have the potential to be permanently damaging or even disabling. For the purposes of this paper, we are defining bondage as any practice of restricting or restraining the body, whether by cuffs, rope, restraints of any kind, gags and/or hoods, or by one partner physically restricting the movement of another (ie: holding back their hands, arms, etc.). Bondage, in this case, will also include all levels of touch that align with that definition, ranging from light restraint to total immobility, mumification and suspension.
Generally speaking, the risks involved in bondage and restraint can be separated medically into low, medium, and high-risk categories. However, with each sign of potential complication, the same level of precaution should be taken to ensure that an injury does not escalate from minimal to potentially impairing. Low level risks associated with bondage include rope / leather burns, marks or indentations in the skin, bruises or subtle discoloration and temporary circulation impairment. Depending on personal environmental risk factors, those might pose more serious concerns for certain populations, as visible bruising may cause concern from community members, physicians or other mandated reporters that are not kink-aware.
Blood Stasis and Nerve Damage
Medium level risks associated with bondage are categorized as such because, though they are indicators of potential or developing dangers, they are not a risk to your physical health if recognized and treated, nor do they cause disabling conditions in most bodies. These medium level risks commonly associated with bondage include but are not limited to a condition called blood stasis, which occurs when circulation begins to rapidly slow to a part of the body. This occurs most often when bondage restraints are too tight, blocking blood vessels from properly providing oxygen to the affected part of the body. Blood stasis, when recognized early or immediately, is not an immediate danger to most bodies as it does not cause any immediate damage. More often than not, the condition will reverse itself once the restraint is removed and blood flow is restored with potential for rope marks and bruising at the restraint site (Bongki Park et al, 2015).
Blood stasis can be recognized most easily but a tingling in the restrained limb (ie: full hand or full leg tingling); however, if tingling is not occurring in the entire limb but instead in a single appendage (ie: single finger, toe, etc.), it is most likely an indication of the beginnings of nerve damage. If blood stasis occurs for a long period of time, tingling may turn to numbness, which is an indication of a high-level health risk. In that case, should circulation rapidly return, the sudden flow of built-up lactic acid can lead to serious health complications or cardiac arrest (Bongki Park). In this case, before removing the restraint, double check for a pulse on the effected limb. If there is a pulse, the restraint is okay to remove. If not, best practice is to consult a physician.
In the case of nerve damage, it is important to act as quickly as safely possible, as nerve damage can become permanent without any indicators or symptoms. Nerve damage or loss of nerve function occurs when the myelin, or the insulation that protects delicate nerve fibers in the body, is damaged, most commonly by prolonged compression. When the myelin is damaged, nerve impulses that control motor functioning can slow and even stop, causing neurological problems that can be potentially disabling (Tonkin 2010). In some cases, the body will be able to repair the myelin and nerve function can return over time. There are also treatments available to help restore some or all nerve function in the case of damage. However, if the myelin is compressed for a long period of time, damages can quickly become irreparable (“Myelin Repair”). To prevent both blood stasis and nerve damage from occurring, it is important to ensure that restraints are placed with roughly an inch and half of space between the body and the restraint, and that they are placed on areas of the body with more musculature to protect more vulnerable areas. As a general rule of thumb, do not tie or restrain in such a way that puts any load bearing pressure on any joints, any visible blood vessels or veins or on any part of the body without major musculature like the wrists, shins, ankles or neck.
Take a deep breath.
Another risk that can be associated which some bondage and restraint-based play is the risk of asphyxiation or impaired breathing. This always must be treated as high risk as this can cause immediate health issues for all bodies. In bondage, there are a few different ways that airways can be blocked. For example, bondage that includes gags or hoods of any kind, including circular and hollow gags, can easily cause asphyxiation if not carefully considered. For starters, when using gags during bondage, be sure that you and the wearer are aware of the material being used, as allergic reactions can happen when certain fabrics or materials enter the mouth. To mitigate the risk of choking on a gag, make sure to never leave a person who is gagged unattended at any time and to be sure that the person gagged is in a position that maximizes airflow and that enables swallowing. Often, if a person has something in their mouth, they will salivate at a higher rate (Michalodimitrakis). If that person is bound in such a way that they cannot swallow or drain the saliva, risk of choking increases significantly. If participating in a bondage activity where your partner is gagged or is unable to speak for any reason, it is imperative that an alternative to the “safe word” is used, such as an item that a person can drop from their hands or a noise maker, so that all play partners are aware if a boundary is being crossed.
Other types of bondage play that can affect the airways and potentially cause impaired breathing or asphyxiation include play that involves rope and suspension, where pressure is often put on the chest, and restraint that involves a partner being physically held down by another partner or partners. This can restrict a person’s ability to physically expand their chest in order to properly breathe, causing panic or limiting certain bodyminds who may already have impaired functioning. If ropes, restraints or another body is close to the neck or upper chest, it can cause damage or block the windpipe which can lead to serious injury or death. In order to mitigate these risks, it is imperative that actions are taken during negotiation to make sure that access needs and impairments are understood by all parties participating in play and that tools like gags, hoods and physical restraint are used with an understanding of how each of these actions may affect the specific bodyminds of the people engaging in play.
Perhaps the most common, serious and often overlooked health risks during play involving bondage and restraint is falling. Whether a person is suspended in a swing, a hammock or using intricate rope bondage techniques, or even if a person is not suspended at all but is simply in a position that affects their balance in any way, there is an increased risk of serious injury associated with falling. This is because, when falling, the body’s instinct is to brace our muscles to minimize injury. If a person is restrained in such a way that they do not have the ability to properly brace themselves, falling may easily cause broken bones, torn muscles, head, neck or spinal injuries and other physical traumas to the body. Falling may happen for any reason, whether that be faulty or failing equipment, impaired balance due to restraints placed around the legs and ankles, or by another health issue such as dizziness, numbness from lack of circulation or nerve damage or from fainting. For that reason, it is not entirely preventable, but action should be taken to protect all partners from the risk. Ways to protect the body in case of a fall include providing a soft surface or “crash mat” under suspended partners so that falls occur on a softer surface, double checking all rigging before suspension or restraint to ensure maximum safety and being sure to only practice high risk activities like suspension after you’ve done proper research or have had proper training to do so. It is also important to be sure that all partners have sufficiently eaten and are hydrated and that their bodyminds are not impaired by drugs or alcohol in a way that alters the state of consciousness that is typical for them. This decreases the risk of fainting and of rigging mistakes that can cause accidental injury to occur.
Things we can’t control.
The final physical health risk that will be discussed can present itself on any place in the spectrum from low to high risk and that is external emergency. In any situation, it is impossible to predict when a medical or environmental emergency is going to take place. In the case of medical emergencies, all of these precautions can be taken to ensure that medical emergency is not directly caused by the bondage or restraint activity. However, if you are playing with someone who has a physical impairment, chronic pain or chronic illness, psychological or mental health disorder or whose bodymind has any other impairment of any kind, medical emergencies can be triggered for any number of reasons that can make a scene unsafe. Similarly, environmental emergencies such as fires, earthquakes or even an altered state of privacy that crosses the limits of one or more play partners are often unpredictable. For that reason, it is important to pre-negotiate a safety plan in the case of emergencies that consists of a safe word / drop item, safety and / or medical shears to release the bound partner from their restraints as quickly and safely as possible and, if needed, any medication, like inhalers for instance, should be placed within a safe distance and a clear exit plan should be made in the event of an emergency.
Aftercare and Final Thoughts
In addition to ensuring proper negotiation and play practices, understanding the psychical health risks involved in bondage and restraint play can help to provide proper aftercare for both the bound person and the un-bound partner(s). To ensure shared language, “aftercare” is defined here to refer to the practice of giving time and attention to the individual needs of each partner after a scene in an effort to consider the physical and emotional wellbeing of each person. In the case of bondage, common recommendations for aftercare include stretching, yoga or massage to restore proper circulation throughout the body if that is accessible to you. It can also include re-hydrating and eating to restore your bodymind to its optimal functioning, tending to wounds using proper first aid or homeopathic techniques and caring for marks on the body minimize bruising if they are not desired by the person whose body was bound. Additional aftercare will depend solely on the needs of the people involved in play and should be negotiated prior to engaging in any sort of kink or BDSM play.
For so many people, kink is an incredibly liberating practice that is essential to their erotic repertoire. For others, kinky activities like bondage and restraint are in no way related to their identity but often show up in their search for sexual variety. For people with impairments that affect their mobility or musculature, bondage can be an incredibly liberating way to curate the most pleasurable sexual or kinky experience for their bodymind. For neurodiverse populations or people with sensory processing impairments, bondage may help them to add focus, additional stimulation and clarity to sexual experiences. By understanding the physical risks associated with such a common activity, informed consent and liberated boundaries become possible so I encourage you to do your research. Understand how this type of play best interacts with the needs of your individual bodymind and that of your partner(s). Investigate the taboo. Enjoy the community of freedom that has found it’s home in the dark. And please, kink responsibly.