Experiences of discrimination among BDSM and kink practitioners

This is the authors' abstract. We don't add key points for this paper.

Bondage, discipline, dominance/submission, and sadomasochism (BDSM) encompasses a range of sexual practices, mainly characterized by an erotic exchange of power and role play. Kink refers to “non-conventional” or “non-normative” sexual practices, concepts, and fantasies, including BDSM and fetishes. The meanings, expressions, and interpretations attributed to these two concepts vary widely, from a form of sexual exploration to an identity, an avenue for learning new skills, a means of finding new friends or building social connections, or even a lifestyle. Despite increasing societal awareness of sexual diversity, these practices remain stigmatized.1 Practitioners frequently face discrimination across various social spheres, including family, friendships, workplaces, and healthcare settings. This stigma is historically rooted in myths, false beliefs, and misinformation, which have contributed to the pathologization of these practices within both the healthcare system and society.1 Such stigma can negatively impact practitioners’ well-being, social integration, and access to competent healthcare.1,2 Although research on BDSM and kink communities has expanded in recent years, most studies have originated in North America and Europe, leaving significant gaps in understanding these populations in other cultural contexts, such as Latin America. Particularly, no studies have examined the healthcare experiences of BDSM/kink practitioners in this region. This study addresses that gap by exploring experiences of discrimination among BDSM/kink practitioners in Chile, with a particular focus on healthcare settings, where stigma can directly impact access to services and overall health outcomes. We conducted an online cross-sectional survey in 2020 among 543 Chilean BDSM/kink practitioners aged 18-54. Many socio-demographic and BDSM/kink-related items in the questionnaire were adapted from a previous Spanish study3 and included sociodemographic and BDSM-related variables (Supplemental Table 1), along with measures of outness,4 experiences of discrimination across different social domains, and interaction with healthcare providers (Supplemental Table 2). Descriptive statistics and logistic regression analyses were performed to examine the associations between discrimination, gender identity, sexual orientation, and BDSM-related social support (Supplemental Tables 3 and 4). Participants provided informed consent before responding to the survey. The University’s Ethics Committee reviewed and approved the study with registration number UALBIO2022/03. Participants’ sociodemographic characteristics and BDSM-related profiles are presented in Supplemental Table 1; 29.5% of BDSM/kink practitioners reported experiences of discrimination, with healthcare being one of the most commonly cited domains (11.8%). As shown in Supplemental Table 3, outness was positively correlated with healthcare-related discrimination, BDSM community belonging, and community social support. Both community belonging and social support were also positively associated with any and healthcare discrimination. Supplemental Table 4 presents the logistic regression results. Non-binary/queer and bisexual participants were significantly more likely to report experiences of discrimination compared to their masculine and heterosexual counterparts. Seeking medical attention for BDSM-related injuries was also a strong predictor of healthcare discrimination. In contrast, BDSM role did not predict discrimination. These findings indicate that healthcare discrimination is not experienced uniformly across all BDSM/kink practitioners, but is instead shaped by intersecting identity factors such as gender and sexual orientation. Non-binary/queer and bisexual participants were significantly more likely to report discrimination, aligning with previous research showing that individuals with multiple marginalized identities are often exposed to compounded forms of stigma.1 While BDSM roles (e.g., dominant, submissive, or switch) are essential within the community, they were not significantly associated with higher discrimination levels. This suggests that external stigma operates independently of specific role preferences within BDSM/kink communities and is instead likely shaped by broader societal cis-heteronormative structures and systemic challenges faced by these groups. Another key finding was the relationship between BDSM/kink community support and experiences of discrimination. While greater social support within the community fostered a sense of belonging and shared experiences, it also increased visibility (outness), which, in turn, was associated with greater exposure to stigma. This pattern is consistent with findings from studies on other sexually marginalized groups, where increased visibility can strengthen peer acceptance while simultaneously heightening vulnerability to external judgment. Many individuals actively conceal their BDSM activities from family, colleagues, and even close friends due to societal expectations, family dynamics, and broader cultural stigma surrounding sexuality.4 Additionally, participants who sought medical support for BDSM-related injuries were more likely to report discrimination in healthcare settings. This indicates that disclosure of BDSM and kink practices to healthcare providers may lead to biased or prejudiced treatment. Anticipated and experienced stigma may discourage individuals from seeking timely or appropriate medical care, a phenomenon also documented in other marginalized populations. This avoidance represents a public health concern, as it can contribute to poorer physical and mental health outcomes over time, reinforcing the need for inclusive and discrimination-free healthcare environments. Given these outcomes, it is crucial for healthcare providers to be aware of and recognize the discrimination faced by BDSM/kink practitioners, particularly those with diverse gender identities and sexual orientations. Integrating education on sexual diversity and “non-normative” sexual practices into medical (and healthcare-related) training could help reduce stigma and improve clinical interaction, and thus, care quality. Establishing clear guidelines for nonjudgmental, inclusive healthcare practices is essential to ensure respectful interactions with this population. Training programs for health professionals should address implicit biases and promote patient-centered communication to ensure that all individuals receive competent, respectful, and affirming care, according to their specific needs. Beyond healthcare, these results have broader implications for social policies and anti-discrimination measures. While many countries have advanced in recognizing LGBTQIA+ rights, legal and institutional protections for BDSM/kink practitioners remain limited. The absence of explicit safeguards against discrimination based on consensual sexual practices leaves individuals vulnerable to stigma in workplaces, education, and social services. Strengthening legal frameworks and promoting inclusivity initiatives may help mitigate some of these challenges and advance equity and human and sexual rights. This study contributes to the limited research on BDSM/kink-related discrimination, particularly in healthcare. Its focus on healthcare stigma and intersecting identities offers novel insights into the structural and relational challenges faced by this population in the Chilean context. However, certain limitations should be acknowledged. The sample was obtained through online recruitment, which may introduce selection bias and limit the generalizability of the findings to the broader BDSM/kink community. A high proportion of participants identified with a feminine gender, while relatively few identified as homosexual and dominant, raising questions about how representative the sample is of Chile’s BDSM population. The reliance on self-reported data may also introduce recall or social desirability biases, particularly when addressing sensitive topics such as stigma and discrimination. Furthermore, cultural factors specific to Chile may shape the nature and extent of reported experiences, potentially limiting the applicability of these findings to other contexts or regions. Future research should aim to address these limitations by employing longitudinal and mixed-methods designs, recruiting larger and more diverse samples, and conducting comparative studies across cultural contexts. Moreover, further investigation is needed to examine the long-term effects of discrimination on the mental and physical health of BDSM/kink practitioners, as well as the protective role of social networks and resilience factors. This study highlights the significant impact of discrimination on non-binary/queer, bisexual, and highly visible BDSM/kink practitioners in Chile, particularly within healthcare settings. Addressing these challenges requires prioritizing comprehensive sexual education that incorporates BDSM-related topics, equipping healthcare providers and communities with the necessary tools to foster acceptance and inclusivity, and to support sexual diversity. The authors thank all the participants for their contribution and the Unidad de estudios sexológicos, CIBIS, at the Universidad de Almería. Manuel Catalán Águila (Conceptualization [equal], Data curation [equal], Investigation [equal], Methodology [equal], Project administration [equal], Visualization [equal], Writing—original draft [equal], Writing—review & editing [equal]), Inmaculada Fernández Agis (Conceptualization [equal], Data curation [equal], Formal analysis [equal], Investigation [equal], Methodology [equal], Project administration [equal], Supervision [equal], Validation [equal], Writing—review & editing [equal]), and Jenna Marie Strizzi (Conceptualization [equal], Data curation [equal], Formal analysis [equal], Investigation [equal], Methodology [equal], Project administration [equal], Supervision [equal], Validation [equal], Writing—original draft [equal], Writing—review & editing [equal]) The authors received no financial support for the research, authorship, and/or publication of this article. The authors declare that they have no conflicts of interest related to this study.