Information for Professionals
confronted with
Erotic Power Exchange
(BDSM, S&M, D&s, etc.)

HIV and an increasing openness in society - influenced by better scientific knowledge and understanding of human sexuality as well as trends in pop-music, movies, art and literature - are presumed to be the main causes for the increasing interest in erotic power exchange (BDSM or S&M). It is hard to identify whether there is indeed an increased interest or if increased openness on the subject has simply brought about more publicity. Since reliable research has never been done in this area, this perceived interest can not be quantitatively determined. The general opinion, however, is that it is not so much an increase of the number of people being into it - but mainly a matter of more people feeling comfortable about talking about erotic power exchange more openly.

Organizations active in the area over the last decade have detected an upward trend in the interest in erotic power exchange, which leads to a dramatic increase in the need for information. Increased media coverage of both eroticism and sexuality issues in general as well as erotic power exchange and video clips no doubt contribute to this trend as well. As a result of this, professionals such as therapists, local psychology units, general practitioners, telephone help circles, social workers, sexual information centers, sexologists, but also politicians and people active in law enforcement are confronted with situations, that have either a direct or indirect relation to erotic power exchange, more frequently.

The Erotic Power Exchange Information Center - a combined effort of the POWERotics Foundation and the Dutch BDSM Media Information Center - provides basic information, helpful to everyone, who will be confronted with erotic power exchange in their profession. At the end of this article you will find pointers to other useful information the POWERotics public section offers on the subject, including the extensive POWERotics book list. Further in-depth information is available on request and in the POWERotics member section.

Main Page ~ Table of Contents

   I. What is BDSM?
   II. Identifying the problems
   III. Combinations with other sexual behaviors
   IV. What "causes" erotic power emotions?
   V. How many people are involved in bdsm?
   VI. Support for professionals - contact info

I. What is BDSM?

In more modern terms we like to speak about erotic power exchange (EPE) or BDSM (bondage, domination, sadism and masochism), rather than use terms like sadomasochism. This distinction is used in order to try and distinguish forms of eroticized power play from other, unwanted, behavior.

Erotic power exchange is social role play, revolving around the power element that forms a part of every relationship between human beings. Hence it is not - although often depicted as such - a purely sexual game. In fact many people will identify it as a lifestyle and, sociologically speaking, one might even identify it as a separate culture or at least subculture. Erotic power exchange identifies the power element, magnifies it and uses the power dynamics between partners as one of the instruments to build and shape a relationship. It is usually - but not always - connected but not restricted to the sexual activities between partners in a relationship.

What identifies erotic power exchange from sadomasochism (as widely acknowledged by the psychiatric community, probably most prominently in the Diagnostic and Statistical Manual of Mental Disorders IV - the latest diagnostic manual published by the American Psychiatric Association in 1992) is the freedom of choice for both partners to enter into forms of erotic power exchange. The choice to engage in erotic power exchange as well as the choice of role are non-compulsive are both voluntary. It is usually driven by very deep personal emotions and it should be safe, sane and informed consensual, based on mutual respect and trust and (not always!) love. Next, the partners within erotic power exchange should adhere to certain basic rules known as the concepts of erotic power exchange, such as discussing and negotiating each other's wants, needs, emotions as well as negotiating and acknowledging emotional and physical boundaries. In other words, erotic power exchange is role play by free and voluntary choice of the participants, as opposed to any situation where either of the partners has no choice or is forced or manipulated into a role.

Unfortunately, erotic power exchange is often judged or described based on outdated definitions, as formulated by Krafft-Ebing, Freud, Schrenk-Notzing, Lacassagne, Thoinet and Eulenburg, some of which date back to the previous century. As a result of this, dominance and submission within an erotic power exchange context are often described as "sadism" and "masochism"; terms (and clinical definitions) which have been formulated to describe mental distortions, not sexual behavior. Sadly, for several decades everybody either involved in or trying to describe erotic power exchange activity has - and many still do - used these terms as well, thus only contributing to the unfortunate confusion of tongues which forms the basis for stereotyping and social stigmatizing.

Next to this - given its individual character and determination - erotic power exchange is very hard to describe in a few words. Hardly two erotic power exchange couples or situations are alike, which makes it impossible to try and describe the activity in a few simple terms. Every simplification will almost automatically lead to oversimplifying and thus stereotyping. For example, erotic power exchange is often mistaken for algolagnia ("pain lust"). Pain can be, but does not have to be an erotic component. Using pain in an erotic setting is only one of the very many rituals or conventions power exchange can have.

Contributing to the confusion even more - especially to the outsider - is the effect know as the "safe haven syndrome". The erotic power exchange community in general is very tolerant and as a result will often be a (temporary) safe haven for others who may be attracted to some of the aspects of erotic power exchange but not all of them and who are mainly attracted by the tolerance within the group. As a result of this the community is rather overcrowded with people that are into pain kicks (algolagnia), transvestites and fetishists, but also with people from entirely different fields, such as parts of the science fiction culture.

Since erotic power exchange - the main instrument of which is symbolism in almost all forms and shapes as long as it is in some way connected to power - can have all sorts of elements, "borrowed" from other kinks so to speak, these connections are not entirely illogical. In a commendable effort to be non-discriminatory but sometimes overly politically correct (a type of social behavior quite natural to any group who is itself the victim of discrimination and stigmatizing) the erotic power exchange community has failed to identify itself from others and only recently subgroups within the community - such as the homosexual and Maledom/femsub groups - are identifying and carefully exploring their own identity and mutual differences in culture, although this is far from widespread yet.

Table of Contents

II. Identifying the Problems

As a result of all this even to a professional it may not always be easy to identify and recognize an erotic power exchange related problem or question. It may be that the client has a problem or a combination of problems that may result from (hidden or latent) erotic power exchange emotions. Only by asking questions and educating themselves will the modern professional be prepared to assist his or her clients.

Roughly, erotic power exchange related problems can be divided in (a combination of) the following areas:

  ¥ Coming out
  ¥ Self questioning and uncertainty
  ¥ Relational problems
  ¥ Contact problems
  ¥ Technical questions

The last category - which comes down to questions like "how do I do things", "what is safe and what is not" - usually is only identified by specialized BDSM organizations (link to an index of Local BDSM Support Groups), and best answered by such organizations or specialized media, although especially information on health-related questions and some safety aspects could benefit greatly from serious input from people, active in the medical profession.

Coming out

Coming out problems generally have three main causes,the first one being: the public taboo that results in - fear of - rejection, stereotyping, stigmatization and prejudice. A second contributing cause in many cases is a system of sexual education that entirely ignores or sometimes even condemns alternative forms of eroticism. This makes it difficult for people to accept themselves and their emotions, let alone to talk about them with others.

Probably one of the most flamboyant examples of ignorance, when it comes to sexual education, are the information campaigns on HIV and AIDS in many countries. Some erotic power exchange activities are very specific and not directly related to intercourse. From an HIV point of view, however, activities that hold the potential risk of accidental blood contact - such as intense whipping, needle play and knife play or simple mishaps - are potential causes for infection. However, no attention whatsoever is usually given to such activities. Since these do not always concern intercourse or other direct genital or anal contact they are not addressed by the information provided in the majority of information campaigns. It has been left almost entirely to small groups, specialized media and individuals to first of all identify these risks and find or develop proper information about them. Given the fact that estimates identify as much as thirty percent of the adult population - regardless their sexual preference - as (potentially) engaged in some form of erotic power exchange activity, one can safely say a major target group has been left in the cold entirely in this area.

Another example: very recent research in various European countries shows an increase in the number of people infected with sexually transmitted diseases, which increase can not be explained. Only after having been asked repeatedly by people form the erotic power exchange community researchers reluctantly admitted that alternative forms of eroticism have been left out of the research, since they were considered to be too marginal to be of any significant influence. Asked if these researchers had any figures of the number of people involved in alternative forms of eroticism the answer was they had not tried to establish this, but just assumed it could not be that many.

The third cause for coming out problems often is a "self-inflicted" one: individual people are afraid of their own emotions, unable to identify them and are afraid of being condemned or rejected by a partner, friends or society in general.

Self questioning and uncertainty are a direct result of stereotyping and misinformation, since the fear to be stigmatized or rejected will effectively block a lot of potential possibilities to communicate with trusted and loved ones, such as parents, friends or partners. To most people - many of them are confronted with their emotions at a very young age - this leads to fears about either being - or turning into - a sadist or being abnormal. Uninformed, sensational and excess-oriented media publicity contributes to the persistent stereotypes. The lack of good and unprejudiced information perpetuates the misinformation and keeps so many people from exploring their feelings in an open and healthy manner.

An extra barrier here is formed by governmental regulations in many countries, which makes it hard if not entirely impossible for organizations and specialized media to communicate serious information on the subject. In many countries and territories any and all information on erotic power exchange is considered either illegal, pornographic or both as a result of which those trying to communicate serious information are not only branded "pornographic" in the process, but are forced to find underground or alternative ways to try and communicate information. This, to the outsider (which every newcomer to erotic power exchange is as well) makes finding reliable information hard if not entirely impossible sometimes and makes it hard to separate pornography and fiction from information. Even in the most liberated countries in the world the main outlet for such information still are sex boutiques, meaning that entire groups - such as women or underaged - can not be reached.

This leads to lack of information, misinformation or very one-sided information and contributes heavily to coming out and other problems.

Coming out, accepting and talking about erotic power exchange emotions usually is the most important problem. Virtually everyone with these emotions is confronted with coming out problems sooner or later. It is quite common for people to keep these emotions to themselves for quite a while and people will frequently be afraid that they are entirely insane or that they are the only one having these feelings. Coming out will result in fear to be rejected: by a partner, an employer, the neighborhood, parents, friends, family and children. In many countries this fear is very real. Many will even fear of being rejected or condemned by the people they need to turn to for help, not to mention fear of losing custody over children or losing jobs as a result of opening up about their preferences.

Homosexuals - who already have faced a coming out - will usually have fewer problems in this area, which is why the coming out situation is mainly important for heterosexuals and is - at large - not yet even identified as a serious problem. Heterosexuals never used to have coming out problems when it comes to sexual preference. Both young and old may have a manifest coming out problem, which may lead to frustration, fear for oneself and severe loneliness.

Coming out is the territory for those who know about it and have done it, in other words BDSM people and organizations. They will not only recognize the situation but, the fact, that there are others in the same position can be both knowledge and support to a person who has just come out or who is about to. Plus, since the people in these organizations have had the same feelings, emotions (and sometimes face the same potential social threats and dangers) makes them less of a threat to the person facing or going through a coming out (as opposed to professional therapists for example). Professionals, confronted with coming out problems, will do well to point their client to others, such as these organizations.

Relational problems

Relational problems may arise mainly for two reasons: either one of the partners is too afraid to risk his or her entire relationship and avoids the subject of erotic power exchange or is rejected or misunderstood by the other partner when they do broach the subject. These elements may also be the underlying problem in a parent/child conflict.

It is important to identify that approximately 30 percent of the people attracted to or fascinated by erotic power exchange, have developed or identified such emotions at a very young age: between the age of five and twelve. Well over fifty percent of the entire group has identified erotic power exchange emotions before the age of eighteen. Since the period between first identification and the first careful steps in the coming out process will - on average - be something between ten and twenty years (during which time these emotions generally speaking will be kept very secret but valued as - although often scary - very personal and important) the increasing difficulty many people have with these feelings is obvious.

In many cases, coming out (or better not coming out at all or too late) is the basis for all other problems, such as these. Frequently, the person involved will have nurtured these emotions himself or herself for a long time before even starting to talk about them. Fear of being rejected and fixation on these emotions have only accumulated and thus things are likely to explode. An extra factor to take into account here is that the existing relationship obviously did not have sufficient quality and trust so the partner in question has always been afraid to talk about it.

Relational problems may take a form that is not easy to combine with erotic power exchange: such as irritation, lack of sexual interest, sex outside the relationship and visiting prostitutes and BDSM clubs. The latter two may very well cause financial problems and all are likely to be at the root of unidentified guilt. In individual cases, even though the partners can express their feelings, the social environment may make it impossible for them to give their emotions the proper outlet, such as having children, neighborhood influences or outright fear for consequences.

Contact problems and self questioning

Contact problems, as well as loneliness and separation, are usually a result of the other three problems. This may also result from the fact that the person over-prioritizes his or her erotic power exchange emotions when searching for a partner, as a result of which he/she will fail to find a partner. Depending on the self-confidence and self-esteem of the person involved, this may lead to temporary or permanent problems.

Note: please also read the "Stages of Erotic Power Exchange" article on this site for more background information.

Problems in these areas will usually identify themselves to professionals as relational problems, divorce, unsociable behavior, loneliness, sexual problems, family problems, excessive drinking, drug abuse, self-centering or even attempted suicide. At an early age, an inability to socialize or learning problems may also be indications.

Another common response to the uncertainty about whether or not erotic power exchange behavior and emotions are acceptable and "normal" is an effort to split erotic power exchange emotions and activity from everyday life by assuming another identity during epe-activities. This may go as far as using other names and different social behavior. This effort to try and bring some form of order in the confusion by the person involved may lead to temporary or permanent identity problems.

A very specific form of symptomatic behavior as a result of contact problems is auto-SM, which in itself is harmless. However, people who fall into the negative spiral as a result of (the fear of) rejection may not only experiment with themselves but while doing so will try to incorporate both roles within themselves, eventually totally losing touch with the basic emotions and developing a multiple personality disorder as well as guilt feelings in the process.

Another piece of confusion: sexual experiments are very normal during adolescence. Erotic power exchange related experiments - such as self-bondage - may very well be a part of this. That as such however, is no indication erotic power exchange emotions have been developed or will be in a later stage.

It is not uncommon for people, who identify erotic power exchange emotions, to start to question themselves as well as their emotions. The fear of "turning into a sadist", or worse "a monster" is very real to many people. Considering the fact that these emotions may emerge at a very young age they are a likely to become a serious problem in many cases. Many fear that once they start, they will become addicted and will need more and more. Social taboo, stereotyping, prejudice and prejudiced legislation are causes for this, combined with incomplete or sometimes ignorant sexual education.

These fears - as described probably nurtured for just as long a period as the emotions themselves - may lead people alienating from their social environment and losing touch with reality.

Table of Contents

III. Combinations with
      other sexual behavior

A considerable number of people with erotic power exchange emotions will combine EPE with other forms of sexual behavior. Fetishism in some form - such as a fascination for leather, rubber and latex, lingerie, high heels, foot worship and forms of cross dressing and gender bending - is the most common combination. Others are strict role-oriented play forms such as doctor/patient, teacher/pupil, governess/pupil, uncle/niece. Partner exchange, exhibitionism and forms of group sexuality may also be combined with erotic power exchange. It is important to understand that these forms are not a part of the erotic power exchange emotions as such, but are mainly used to express the power element in some form. Pornography would have everyone to believe that urolagnia and coprolagnia (a.k.a. watersports and scatalogical play) are a more or less standard element of erotic power exchange, just as pain lust (algolagnia). While in individual cases this may be true, these are certainly not common characteristics of EPE.

Next to this, people involved in erotic power exchange may have fantasies of all kinds; their active involvement in erotic power exchange activity does not mean they have the intention to realize their entire fantasy. In fact, what usually happens is that the fantasy as such remains a fantasy and the active play only contains parts of the fantasy or other circumstances, that may trigger or stimulate the fantasy. This is especially true for the heterosexual Maledom/femsub culture.

Although the gay community is somewhat more assertive about their sexual preferences, the assumption that erotic power exchange is mainly a gay-game is untrue. Research (Cosmopolitan, June 1997) shows that 43 percent of the American heterosexual couples have considered or actively incorporated spanking in their love making; bondage 36 percent, whipping 9 percent and urolagnia 7 percent. In Europe, in general, 25% of the adult population has or has had erotic power exchange related fantasies (Intomart and NIPO 1994). Pornography and prostitution, although probably the most outward indications of erotic power exchange, paint a very stereotypical picture that does not describe the reality of erotic power exchange.

Juvenile traumas and child abuse will be found within the erotic power exchange community, just as it will in any other segment of the population. It does not appear in any ratio greater than in those segments. Just as other significant influences in people's lives - such as the quality of parenting, education, the environment, religion, etc., have an impact on development, childhood trauma or abuse may contribute to the way already existing - but possibly latent - erotic power exchange emotions will develop. However, juvenile or other traumas and abuse are not "a cause" for the development of erotic power exchange emotions, as has long been assumed. By itself, juvenile trauma or (child) abuse is not a problem in an erotic power exchange relationship, as long as it is identified as a contributor to personality and erotic power exchange is not used in some pseudo-therapeutic manner. Erotic power exchange behavior should never be confused with a need for attention.

A potential risk in this area is that - as a result of the closeness, intensity and the specific power dynamics between partners - erotic power exchange may take on an unwanted therapeutic character. This may lead to people withdrawing from or not turning to professional help (which usually is a combination of this effect and the feeling the person in question is - or will be - misunderstood by the professional) but laying the burden on the dominant partner.

Table of Contents

IV. What "causes" erotic power
     emotions? When do they first
     emerge?

There are hardly any "general rules" when it comes to erotic power exchange. That certainly is true for the question what "causes" the development of erotic power exchange emotions. There are many theories, however none of them is based on fundamental scientific research. Scientific publications present research finding for work usually based on either individuals or very small groups and decent general large scale research has never been done. More importantly, almost all scientific publications concern people and their "treatment" who sought help from professionals, not well-adjusted people capable of making their own choices in a safe, sane, informed and consensual way. Therefore, there is no real answer to this question and - to most of the people who are into erotic power exchange - the answer to this question is entirely unimportant.

More recent results from research in various molecular biology and medical areas points to genetic as well as biological factors, that may well be significantly more important to sexual behavior and sexual preference than purely psychological factors. It is becoming apparent that the influences of various hormones (adrenaline, endorphins, steroids, pheromones and others) play an important role in erotic power exchange behavior.

There are also great differences in the moment erotic power exchange emotions emerge. As described, recent and ongoing research by POWERotics indicates 50 percent of the people who responded recollect erotic power exchange emotions prior to their 18th birthday, the majority of them even before the age of 12. They may emerge at an age as early as five, six or seven. Others develop (or discover) erotic power exchange emotions at a later age, quite often after a fundamental change in their personal life, such as a divorce. Some others respond emotionally to an external impulse or stimuli, such as reading a book or seeing a movie.

Table of Contents

V. How many people are
     involved in epe/bdsm?

The lack of any fundamental quantitative research makes it difficult to estimate how many people are into erotic power exchange. We can derive some figures from other research, but for example, the question of how many people have fantasies about it and how many of them will actively do something with them can not be answered. Even the above figures, based on national research in different countries are, at best, estimates.

There are no reliable figures about how many dominants and how many submissives there are, or about the male-to-female ratio. However, based on practical experience, BDSM organizations come to the following careful and preliminary conclusions (relevant for heterosexuals):

  ¥ There may be three times as many submissives as dominants.
  ¥ Although men are usually more outward about their sexual preferences it is estimated that the male-to-female ratio is 50/50.
  ¥ The number of female submissives seems to be greater than the number of male submissives.

One should always remember that the erotic power exchange "world" is not strictly divided into dominants and submissives. A considerable number will be attracted to both roles in different ways and intensity. These people are generally known as "switches."

In general, women will concentrate their erotic power exchange emotions on one (the) partner whereas men tend to place more emphasis on the power exchange emotions as such. This, however, is a very general observation and will, in many individual cases, not be true.

Table of Contents

VI. Support for professionals

Direct questions may be sent to the Erotic Power Exchange Information Center at:


  ¥ email:

Please mention your question as well as your profession in your email.

To read more about these subjects, you can click here
to scroll this page to the "Professional References"
section of the menubar on the left where you
can choose from links to other topic pages.


Based on materials from the Erotic Power Exchange Information Center
© 1996-2000; republished here with their permission;
see the Contributors page for contact links.