Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients.

INTRODUCTION: The term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) and sexual fetishism. Individuals who engage in kink could be at risk for health complications because of their sexual behaviors, and they could be vulnerable to stigma in the health care setting. However, although previous research has addressed experiences in mental health care, very little research has detailed the medical care experiences of kink-oriented patients.

AIM: To broadly explore the health care experiences of kink-oriented patients using a community-engaged research approach.

METHODS: As part of the Kink Health Project, we gathered qualitative data from 115 kink-oriented San Francisco area residents using focus groups and interviews. Interview questions were generated in collaboration with a community advisory board. Data were analyzed using a thematic analysis approach.

MAIN OUTCOME MEASURES: Themes relating to kink-oriented patients' experience with health and healthcare.

RESULTS: Major themes included (i) kink and physical health, (ii) sociocultural aspects of kink orientation, (iii) the role of stigma in shaping health care interactions, (iv) coming out to health care providers, and (v) working toward a vision of kink-aware medical care. The study found that kink-oriented patients have genuine health care needs relating to their kink behaviors and social context. Most patients would prefer to be out to their health care providers so they can receive individualized care. However, fewer than half were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure. Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions.

CONCLUSION: Like other sexual minorities, kink-oriented patients have a desire to engage with their health care providers in meaningful discussions about their health risks, their identities, and their communities without fear of being judged. Additional research is needed to explore the experiences of kink-oriented patients in other areas of the country and internationally.