Disclosing Kink as a Patient in Medical Contexts

[ro****]

Hi All,

I'm curious if/when you disclose your practice of BDSM/kink in medical contexts, be it to your GP, to Accident and Emergency, a psychologist, psychiatrist, or genealogist etc in reproductive health.

How do you screen for practitioners that are understanding of the lifestyle? Practitioners who will not judge, guilt, or pathologise/see it as a sign of disease/ psychological disturbance.

What does your first conversation look like? How do you prepare yourself for that conversation? When do you choose to disclose versus not to disclose?
Does kink alter you access medical care?
Are there any kink specific discussions you feel are necessary medically (outside of contraception and sti screening)?

Many thanks xx


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For personal context (and to likely overshare);

I'm 22. I've been practicing for a couple of years now. Even though I have a strong idea of what I like and do my best to educate myself on all things kinky, my lived experienced is comparatively little to other kinksters.

I'm asking this question as I'm aware of how kink influences how I access medical care, especially in regards to mental health where I often won't disclose it for *** of my sexual preferences being pathologised and going on my medical record as a symptom.

I feel this is especially likely from a psychiatric perspective. This *** also inhibits potentially useful discussions within a psychology setting (I decided to engage with a psychologist when I reached adulthood to process unhelpful habits, past experiences, and develop healthy programs.)

I have a wonderful doctor who I have alot of rapport with and who seems quite sexually inclusive.
I hold the discussions I know are necessary to ensure physical safety - the gender of my partners, my non monogamy and need for frequent screening - but I've never disclosed I practice kink.

Outside of my GP I often hesitate to voice my sexual practices. I'm very reserved about my private life, even with close friends and family, only ever really discussing it with partners.

I'm mindful my health is paramount and will risk being shamed to ensure I remain physically sound, but would love to hear how you navigate finding practitioners you feel comfortable with.

[Deleted Member]

it should be discussed with own doctor, specially mental health as it could change management.

[Deleted Member]

So an an emergency medical worker I can tell you we do not care if you disclose you are in the lifestyle or not. Most of the er workers have seen it all or are also into kink. What we care you do tell us is how an *** happened so we know what we are looking for and how to treat it without doing more harm to you. This does include use of any substance. We want to avoid medication chemical interactions. So for emergency situations go to the nearest and best equipped hospital.

[QXX666]

You don’t have to disclose your private kinky life to anyone unless you have to justify your bruises/cut impact play marks.
But if you feel you need/want to just contact local lgbtiqa+ organisations and ask them for the details of doctors, therapists/psychologists they recommend.

[4R****]

2 hours ago, psychshark said:

So an an emergency medical worker I can tell you we do not care if you disclose you are in the lifestyle or not. Most of the er workers have seen it all or are also into kink. What we care you do tell us is how an *** happened so we know what we are looking for and how to treat it without doing more harm to you. This does include use of any substance. We want to avoid medication chemical interactions. So for emergency situations go to the nearest and best equipped hospital.

Absolutely this! Here in the UK it's the same situation. You can be fairly certain that those in the medical profession have seen and heard it all - Especially those who work in MH. You said you've got a Dr who you're comfortable with so my advice is bite the bullet and have an honest conversation with them. They will probably be relieved that they can finally talk openly about what they've so far only suspected about you. And they will either be able to advise you themself or at the very least will know someone who can. 

[li****]

Love this question, it's shows great self awareness and wisdom to be thinking this way x

[turret]

Yes, it took me a while to open up about my sexual practice which I saw as self harm as I was pushing my heart to its absolute limit and from that complications have been ongoing fortunately opening up to my doctor he was totally glad and said everything is in complete confidence, also a trip to ane I opened up about it too and they were great just advising me to avoid substances in bdsm settings as understandably one can loose the plot

[ro****]

1 hour ago, littlefairylcmtb said:

Love this question, it's shows great self awareness and wisdom to be thinking this way x

Thank you!

[Deleted Member]

Important questions, I have always asked... no matter how embarrassing!! A long time ago, I asked anal sex questions with a Proctologist. It was really embarrassing, and wanted to hide.🙈

[Deleted Member]

Unless you have kids, being embarrassed is the worst outcome.

[Deleted Member]

These are excellent points and excellent questions. Diagnostically speaking, in order to be considered a mental illness, and must cause you significant distress and impair your functioning in at least one domain in your life. functionally, if it isn’t causing any permanent mental or physical harm, it really isn’t an issue. I have plenty of patients who have disclosed intimate details about their sexuality and I see it for what it is: their sexuality. A good medical provider will explore this with you and listen to you without being judgemental.

From what I can tell in your profile and your post, you are setting, healthy boundaries, engaging in risk management, and caring for your physical health. All good things.

What I am picking up on is a lot of anxiety. Everyone has some degree of anxiety. If you find your anxiety is negatively affecting your quality of life and your functioning, then I would recommend you speak with a physician and/or a therapist for help.  Trust them with smaller disclosures, and if they respond in a non-judge mental way, then work your way up to bigger and bigger disclosures. A good therapist will not judge you, but rather help you explore and understand. Hope this helps!

[Deleted Member]

GP's, doctors, nurses, psychologists, psychiatrists all have a code of confidentiality so while it can be embarrassing or make you feel self-conscious, medical people are one of the best to open up to about things, as even if they did know anyone you know, they can't divulge anything from your conversations & it can be a weight off your shoulders sometimes to be able to speak to someone about your kink side, like a psychologist, to say things you can't really talk to friends & family about

[4R****]

4 minutes ago, BrumDaddyDom said:

GP's, doctors, nurses, psychologists, psychiatrists all have a code of confidentiality so while it can be embarrassing or make you feel self-conscious, medical people are one of the best to open up to about things, as even if they did know anyone you know, they can't divulge anything from your conversations & it can be a weight off your shoulders sometimes to be able to speak to someone about your kink side, like a psychologist, to say things you can't really talk to friends & family about

That's generally correct however, confidentiality is not absolute and there may be rare occasions when disclosure of patient information is justified. A police request or where there is a legal obligation may be one of those times but your duty of confidentiality and your legal and ethical duties still need careful consideration. The GMC says that Dr's etc. must not disclose personal information to a third party without the patient’s explicit consent unless it is of overall benefit to a patient lacking capacity to consent, required by law, ordered by a court, or justifiable in the public interest.

I've brought that up for accuracy but in honesty, the likelihood of your private kink life being disclosed to anyone is practically non-existent.

[HamCoBondage]

15 minutes ago, BrumDaddyDom said:

GP's, doctors, nurses, psychologists, psychiatrists all have a code of confidentiality so while it can be embarrassing or make you feel self-conscious, medical people are one of the best to open up to about things, as even if they did know anyone you know, they can't divulge anything from your conversations & it can be a weight off your shoulders sometimes to be able to speak to someone about your kink side, like a psychologist, to say things you can't really talk to friends & family about

One exception is if they feel that the individual kinkster is threatening the health and well-being of themself or others or a crime will be committed.

[HamCoBondage]

But even then, it has to be something pretty drastic. Such as “I get off to playing Russian Roulette” or something like that

[McGraw]

Having seen how seriously confidentiality is taken in the medical profession I’d have little compunction about disclosing my kinks to a professional on health grounds should the need arise. Everybody I know in medical is so busy at work they may only give attention to an individuals activities to the extent they must to do their jobs and have likely seen or heard it all before.

[Wi****]

8 hours ago, 4RCH said:

Absolutely this! Here in the UK it's the same situation. You can be fairly certain that those in the medical profession have seen and heard it all - Especially those who work in MH. You said you've got a Dr who you're comfortable with so my advice is bite the bullet and have an honest conversation with them. They will probably be relieved that they can finally talk openly about what they've so far only suspected about you. And they will either be able to advise you themself or at the very least will know someone who can. 

I an tesifty as a UK nurse. We see everything, a few of us are in to kink. The more you can tell us the better we can help

[AZ****]

Hey everyone. I’m going to chime in here. As a licensed psychologist in the US, who sees those in the lifestyle, confidentiality under federal (HIPPA) and state law is quite strict. If you are concerned about a professional judging you or not understanding the intricacies of bdsm dynamics you can ask your insurance provider for recommendations or you can visit ********************  (kink aware professionals) and see if there are providers who specialize. You can also ask a therapist if they would be willing to keep this topic vague in your notes vs. going into a a lot of detail. Hope this helps.

[CopperKnob]

I think that the thing to remember, like others have said, is that professionals have a duty to, or are mandated to, report concerns for an individual that they have worries about with or without your consent as part if safeguarding practices. I think that whilst it feels awkward, having that first, conversation along the lines of, "you'll see I have marks/bruises, I'm confirming that they were consensual" is a lot better than dealing with what may be felt to be invasive questioning as part of further enquiries by other agencies. On the other side of the coin though, i'd suggest that any disclosure like this will be recorded on your file so, at the point that you've sustained marks/bruising/*** which was non consensual, you'll need to be clear that that is the case.

[CopperKnob]

7 hours ago, 4RCH said:

That's generally correct however, confidentiality is not absolute and there may be rare occasions when disclosure of patient information is justified. A police request or where there is a legal obligation may be one of those times but your duty of confidentiality and your legal and ethical duties still need careful consideration. The GMC says that Dr's etc. must not disclose personal information to a third party without the patient’s explicit consent unless it is of overall benefit to a patient lacking capacity to consent, required by law, ordered by a court, or justifiable in the public interest.

I've brought that up for accuracy but in honesty, the likelihood of your private kink life being disclosed to anyone is practically non-existent.

The other point to raise on this is that most Stat agencies will already have discussed consent to share information with other agencies and unless the individuals have specified restrictions it would be shared as appropriate, but only as appropriate unless safeguarding concerns are present at which point, consent is preferred but not required. It's rare that medical professionals will ask for explicit consent to make onwards referrals each and every time (although that's what we would hope for)

[Deleted Member]

Hi there, so, I was a mental health crisis worker for about five years in a city downtown core, I’ve seen some shit! Lol, and I would agree with some of the above statements….. we hear it all!!! Definitely I have had to address some seriously deviant sexual behaviour with various individuals, ie non consensual. And there have been many times I have worked with individuals that were reliving past trauma and discussed how that had shaped their present sexual proclivities. There’s a wide spectrum that mental health workers hear about and even sometimes witness lol. Regarding being able to *trust a professional in the helping field, well that can be easy or complicated…. No matter what, your feelings are valid… always…. If something makes you feel uncomfortable I would definitely suggest sharing…. There are instances where a professional counsellor/psychologist etc could be the most non judgmental and highly professional you could hope to meet out there , and still the individual seeking treatment needs a different worker, issues of transference are the first thing that comes to mind, you could have the best shrink in the world but if they for example look or have similar mannerisms with someone’s ***r, well it’s perfectly justifiable to look for someone else. In the end, it’s your feelings that are important and if trust is the issue or transference or just a feeling that something is off then the professional should be able to hear it without taking it too personally. One thing I could suggest is to discuss things like confidentiality and what that involves with your health care provider, knowing what the professional limitations are can help build some trust. You could also discuss what experience the worker has with sexual orientation/gender identity/fetishes and that might help alleviate some stress? In all honesty, at least from what I have seen working in the mental health field, you would be talking to some of the most understanding non judgmental people out there, we mostly just want to help a person get some resolution and feel better….. more information helps us do the job better.

[ro****]

5 hours ago, crookedtree said:

Hi there, so, I was a mental health crisis worker for about five years in a city downtown core, I’ve seen some shit! Lol, and I would agree with some of the above statements….. we hear it all!!! Definitely I have had to address some seriously deviant sexual behaviour with various individuals, ie non consensual. And there have been many times I have worked with individuals that were reliving past trauma and discussed how that had shaped their present sexual proclivities. There’s a wide spectrum that mental health workers hear about and even sometimes witness lol. Regarding being able to *trust a professional in the helping field, well that can be easy or complicated…. No matter what, your feelings are valid… always…. If something makes you feel uncomfortable I would definitely suggest sharing…. There are instances where a professional counsellor/psychologist etc could be the most non judgmental and highly professional you could hope to meet out there , and still the individual seeking treatment needs a different worker, issues of transference are the first thing that comes to mind, you could have the best shrink in the world but if they for example look or have similar mannerisms with someone’s ***r, well it’s perfectly justifiable to look for someone else. In the end, it’s your feelings that are important and if trust is the issue or transference or just a feeling that something is off then the professional should be able to hear it without taking it too personally. One thing I could suggest is to discuss things like confidentiality and what that involves with your health care provider, knowing what the professional limitations are can help build some trust. You could also discuss what experience the worker has with sexual orientation/gender identity/fetishes and that might help alleviate some stress? In all honesty, at least from what I have seen working in the mental health field, you would be talking to some of the most understanding non judgmental people out there, we mostly just want to help a person get some resolution and feel better….. more information helps us do the job better.

Thank you very much. This was very validating and helpful. Appreciate the tips on how to screen/start those conversations.

[Deleted Member]

I have known a few nurses and doctors some of them probably use this site and or app most have no interest or are just going to do thier jobs and say what ever.

[pl****]

I imagine it is very clinical. Or humorous. Do tell

[Cr****]

I brushed on it with my therapist a few weeks ago for context purposes with him. He didn’t bat an eye, but he can now understand my relationship dynamic with fewer words said because he has that tidbit of information. I’m also very open in therapy and I don’t leave out details because if you’re not honest in therapy, you won’t receive honest help, and you aren’t honest with yourself in the end. The point of therapy is to get tools and work on being the best version of yourself of course! Now, this isn’t something I’ve disclosed with my OB yet because it’s just my dom and myself. Once we find a great unicorn match, it’ll be brought up in visits to make sure we’re being safe.