Sadomasochism

What is sadomasochism?

Sadomasochism is the collective name for erotic play in which one person delivers pain, discomfort, or humiliation and the other takes it, with the consent of both. The word joins sadism and masochism into a single concept. Within BDSM it stands for the S and the M. Since the ICD-11 it is no longer a psychiatric diagnosis.

What sadomasochism looks like in practice

Usually smaller than the word suggests. Sadomasochism is not a category of acts but a division of roles: someone gives, someone receives, and both know where it is going.

A common case from the soft end: a couple agrees that one of them has the run of the other that evening and that pinching, biting, and slapping are allowed, with one agreed word that stops everything. No gear comes into it. What is sadomasochistic about that evening is in the division, not in the intensity.

At the other end of the same concept: a two-hour session with impact play, a blindfold, and a buildup that goes from taps to strokes, with a pause every ten minutes and a list of what is ruled out beforehand. That falls under it too. The difference between the two is in intensity and preparation, not in kind.

How ordinary that first example is shows in Belgian population research. Lien Holvoet and colleagues at the University of Antwerp put 54 BDSM activities to 1,027 representatively chosen Belgians in The Journal of Sexual Medicine. Nearly half, 46.8 percent, had done at least one of them at some point. Of the whole sample, 12.5 percent regularly did something from that list; 7.6 percent called themselves a practitioner.

Where the word sadomasochism comes from

From two writers and one psychiatrist, in that order.

Both halves come from the same man: the Viennese psychiatrist Richard von Krafft-Ebing. That is not lore but archive work. Harry Oosterhuis writes in Medical History that these are terms coined by Krafft-Ebing himself, one after the Marquis de Sade, the other after the Austrian writer Leopold von Sacher-Masoch. Two proper names, then, both of a writer, both declared a disease by a physician. Krafft-Ebing’s Psychopathia sexualis appeared in 1886.

The compound word took another thirty years. The Online Etymology Dictionary dates sado-masochism to 1916 and describes it as “coexistence of sadism and masochism in the same person”. Note what that says: the word was not coined for a couple, but for one person who has both sides in them. The abbreviation S&M is only from 1965. Before that this kind of sexuality was called algolagnia, a word the German physician Albert von Schrenck-Notzing invented in 1892 from the Greek algos, pain, and lagneia, lust.

How the S and the M relate to each other

Not as two tribes seeking each other out, but as two sides that often sit in the same person.

That is exactly what Holvoet measured, and it is the finding that gets retold least often: interest in dominant and in submissive activities was about equal in her sample, and the two were strongly correlated. Whoever finds one appealing turns out, statistically, to find the other appealing too. That makes switching not a curiosity but almost the standard form.

Why it still feels like a split has to do with language. In a scene you have to choose who stands where, because two people cannot both hold the rope at once. That practical division then hardens into an identity, and people start saying they “are a sadist” instead of that they gave that evening.

There is a second reason. The clinical tradition described sadism and masochism as two separate deviations with two separate names, and that vocabulary made its way into the scene. What psychiatry pulled apart is, in practice, rarely so neatly separated.

Why people seek out sadomasochism

For the sharpness, and for what the sharpness pushes away.

The appeal is rarely in damage and usually in attention. The one who gives has to read what comes back non-stop: breathing, muscle tension, whether the other is still answering. The one who receives has nothing to decide for an hour. That is a rare combination, and many people only find out they miss it once they have had it a single time.

• For the one receiving the stimulus it is a way to quiet the head without drink and without a screen.
• For the one giving it it offers a kind of concentrated watching that is asked for nowhere else in life.
• For two people together a vocabulary grows. “A bit sharper” is easier to say than “I feel far away”.

The research supports that, and at the same time draws a line. In the Australian population study by Juliet Richters and colleagues, with 19,307 respondents, people who did BDSM had not more often been sexually coerced, were not unhappier, and not more anxious; men even scored lower on psychological complaints than other men. What it does not say is that sadomasochism is the cause of that. The researchers conclude only that it is a sexual preference and not a symptom.

Sadomasochism heals nothing. A relationship where no one has talked for months does not get better from it, and grief does not dissolve in it.

How people do sadomasochism

Almost always with a conversation beforehand that takes longer than people expect.

The fixed parts are a list of what is and is not allowed, a safeword that ends everything at once, and an agreement about what happens afterward. That last one gets skipped most often and causes the most discomfort.

Within that there are roughly three directions, which run into each other:

1. Blow and pressure. Spanking, caning, pinching. Rhythm and buildup do the work, not force.
2. Sensation. Candle wax, ice, clothespins, scratching. The skin registers something new, and the tension is in not knowing what is coming.
3. The head. Humiliation, orders, waiting. No pain comes into this, and yet it works along the same axis.

What separates the careful version from the sloppy one is not intensity but pace. Anyone who builds up too fast misses the point where a stimulus tips from unpleasant to pleasant, and that point is the whole subject.

Is sadomasochism a disorder?

No, and as of recently that is official too.

Up to and including the ICD-10, sadomasochism had its own code: F65.5, under “disorders of sexual preference”. The description that Richard Krueger and colleagues quote in full in Archives of Sexual Behavior is quite broad: “A preference for sexual activity that involves bondage or the infliction of pain or humiliation.” Under that wording you could get the diagnosis because you did it, without anything else being wrong.

That has since been cut. Anyone who, on 4 August 2026, searches the World Health Organization’s ICD-11 for sadomasochism gets exactly one hit, listed as “sadomasochism (deprecated)”: a lapsed search term that redirects to code 6D36, Paraphilic disorder involving solitary behaviour or consenting individuals. That code applies only if one of two things is going on. Either the person suffers greatly under their own pattern of arousal, and that distress demonstrably does not stem from rejection by others. Or the behavior carries a high risk of serious injury. On masochism the same search engine now returns nothing at all.

The road there ran through the Scandinavian countries. Krueger records that Denmark took the category off its national list as early as 1995, followed by Sweden in 2009, Norway in 2010, and Finland in 2011. The WHO working group named the argument for it plainly: it is about consensual or solitary behavior without inherent harm, so it does not belong in a public-health manual. What does exist as a diagnosis, code 6D33, is about coercion, and the WHO draws a line around it itself: “Coercive Sexual Sadism Disorder specifically excludes consensual sexual sadism and masochism.”

Misconceptions about sadomasochism

“Sadomasochism and BDSM are the same word.” Almost, but not quite. BDSM covers three pairs, of which sadomasochism is one; bondage and power exchange can happen without a single blow. Sadomasochism is also the older word and sounds more clinical, which explains why people in the scene rarely use it about themselves.

“A sadomasochist is someone who gives and receives.” That was the original meaning from 1916, and in everyday use that meaning has shifted to the whole practice. Someone who has both sides in them now usually calls themselves a switch.

“It is about violence.” Violence is by definition without consent. Take away the consent, and the term goes too: then it is abuse, and that is in the criminal code and not in this glossary.

What I see myself

I am Victor, a gigolo, twenty-five years in BDSM and trained as a psychotherapist. I almost never hear the word sadomasochism from the mouth of someone who does it. Women who write to me say “I want someone to take over” or “I want to know how much I can take”. The umbrella word comes from books and from the news, not from bedrooms.

The division of roles that people have worked out for themselves in advance often does not hold. Someone comes in with the announcement that she is submissive, and halfway through it turns out she responds most sharply at the moment she gets to say what happens. That is not a contradiction. It is exactly what Holvoet found in figures.

And there is one pattern I see in everyone talking about this for the first time. The question under the question is never about technique.

What you can do yourself

• Write down what you want to give and what you want to receive, even if you are sure you are only one of the two. The chance that the answer surprises you is big enough to write it down.
• Say the safeword out loud once before anything happens. A word that has never been said often will not come out at the moment it has to.
• Have the other name a number along the way. “Are you okay” always gets a yes, even from someone who really wants to stop.
• Have any injury that stays checked: an open spot, a bruise still there after a week, a tingling or numb patch of skin. Tell the doctor honestly how it happened; a doctor simply does their work with that.
• Plan the day after. Aftercare right after is well known; the after-swing two days later surprises almost everyone.
• Do nothing from the breathing or choking category without reading up. That is the one area where the ICD-11 does name a risk, and where the risk does not go away with practice.

More reading on sadomasochism

Within this glossary, sadism and masochism split the concept into its two halves, and sadist and masochist are about the people behind those halves. Paraphilia explains when psychiatry speaks of a disorder at all. On the blog, why you hire a BDSM gigolo to feel pain tells how this goes up close.

Beyond this site, the ICD-11 itself is freely searchable and rather sobering: you see with your own eyes that the diagnosis is no longer there. The article by Krueger and colleagues is the best explanation of how that decision came about, including the objections that were raised.

Where this fits on this site

Experiencing once how this works, without anything in your own life riding on it: that can happen within an appointment. I am on the giving side, from very light to fairly firm, and the first twenty minutes always sit lower than people expect. The page about the BDSM date sets out what we go over beforehand.

Sources

• 6D36 Paraphilic disorder involving solitary behaviour or consenting individuals. ICD-11 for Mortality and Morbidity Statistics, release 2025-01, World Health Organization. Consulted on 4 August 2026 via the WHO’s ICD-11 API. The classification itself, and so the only source that can establish what is and is not in it now. Gives that a search for sadomasochism in the ICD-11 yields exactly one hit, the index term “sadomasochism (deprecated)” under code 6D36; that masochism returns no hits at all; the full definition of 6D36 with its two conditions (marked distress that is not solely a consequence of rejection by others, or a high risk of serious injury); and at code 6D33 the line “Coercive Sexual Sadism Disorder specifically excludes consensual sexual sadism and masochism”.
• Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11). Richard B. Krueger, Geoffrey M. Reed, Michael B. First, Adele Marais, Eszter Kismodi & Peer Briken, Archives of Sexual Behavior 46(5), 1529-1545, 2017 (DOI 10.1007/s10508-017-0944-2, open access via Europe PMC; authors and pagination checked against Crossref). Written by the WHO working group that made the proposal, and so the source for the why. Gives the full ICD-10 text of F65.5 Sadomasochism, the recommendation to remove fetishism, fetishistic transvestism, and sadomasochism because they concern consensual or solitary behavior without inherent harm, and the national removals by Denmark in 1995, Sweden in 2009, Norway in 2010, and Finland in 2011.
• Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population. Lien Holvoet, Wim Huys, Violette Coppens, Jantien Seeuws, Kris Goethals & Manuel Morrens, The Journal of Sexual Medicine 14(9), 1152-1159, 2017 (DOI 10.1016/j.jsxm.2017.07.003; authors and pagination checked against Crossref). The first population study of the spread of BDSM interest, and from the Dutch-language region at that. Gives the representative sample of 1,027 Belgians, the 54 activities and 14 fetishes put to them, the 46.8 percent who did at least one activity at some point, the 12.5 percent who do so regularly, the 7.6 percent who call themselves a practitioner, and the finding that interest in dominant and submissive activities was comparable and strongly correlated.
• Demographic and Psychosocial Features of Participants in Bondage and Discipline, “Sadomasochism” or Dominance and Submission (BDSM): Data from a National Survey. Juliet Richters, Richard O. de Visser, Chris E. Rissel, Andrew E. Grulich & Anthony M. A. Smith, The Journal of Sexual Medicine 5(7), 1660-1668, 2008 (DOI 10.1111/j.1743-6109.2008.00795.x; authors and pagination checked against Crossref). A representative telephone population survey of 19,307 Australians aged 16 to 59, set up to test the hypothesis that BDSM is linked to coercion, sexual problems, or psychological complaints. Gives that 1.8 percent of the sexually active participants had done BDSM in the previous year (2.2 percent of the men, 1.3 percent of the women), that participants had not more often been sexually coerced and were not unhappier or more anxious, that men who did BDSM scored lower on psychological complaints than other men, and the conclusion that for most practitioners BDSM is a sexual interest or subculture and not a pathological symptom.
• Sexual Modernity in the Works of Richard von Krafft-Ebing and Albert Moll. Harry Oosterhuis, Medical History 56(2), 133-155, 2012 (DOI 10.1017/mdh.2011.30, open access). Used here for one point only: who coined the two halves of this word. Oosterhuis, who worked through the archive material around Krafft-Ebing, records that both terms were indeed minted by him, and after whom they are named. The rest of this article, on Krafft-Ebing’s view of perversion as a sliding scale, is used on the page about masochism and not here.
• sado-masochism. Online Etymology Dictionary, Douglas Harper. A lexicographic reference that dates the first use of each word. Gives the dating of sado-masochism to 1916, the description “coexistence of sadism and masochism in the same person”, the first use of the abbreviation S&M in 1965, and the finding that algolagnia was the older word, coined in German in 1892 by Albert von Schrenck-Notzing from the Greek algos and lagneia.
• Psychopathia sexualis. Richard von Krafft-Ebing, 1886, catalog data via Open Library. A bibliographic reference for the year and author of the book in which sadism and masochism were fixed as medical concepts.

Related terms

Sadomasochism is the umbrella word; everything below is a half of it, a person in it, or a condition on it.

• Sadism. The giving half, and why that half got the bad name.
• Masochism. The receiving half, with the brain research into how context changes pain.
• Sadist. The person behind the S, and what that word does and does not say about someone.
• Masochist. The person behind the M, and why people keep that label to themselves for years.
• BDSM. The wider umbrella that sadomasochism is one of the three letter pairs of.
• Algolagnia. The nineteenth-century word that came before sadomasochism.
• Impact play. The striking form most people first run into this in.
• Switch. The one who does both sides, with the find that the word is four hundred years older as a whip than as a role.
• Pain play. The Dutch practical name for the pain half of this, with the research into how that pain lands.