Sexual Masochism Disorder Fast Facts

Sexual masochism disorder is a mental health-related issue in which a person is sexually aroused by experiencing pain or humiliation, and their sexual urges or behavior cause them distress.

The disorder more often affects women than men.

People with the disorder may participate in activities that put them at risk of physical harm.

Sexual masochism disorder differs from masochism in that its behavior involves distress. People who engage in masochistic activities with consenting partners and are not distressed by the behavior do not have the disorder.

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People with the disorder may participate in activities that put them at risk of physical harm.

What is Sexual Masochism Disorder?

Sexual masochism disorder (SMD) is a mental health-related issue in which a person is sexually aroused by experiencing pain or humiliation and has strong urges to engage in activities that bring about these situations. Although such urges are very common, they rise to the level of a disorder when they cause significant psychological, emotional, or physical distress in the person experiencing them. The disorder is more common in women than in men.

Sexual masochism disorder should be distinguished from masochism, which is a desire to engage in sexual acts involving pain or humiliation. When the behavior is acted on only with consenting partners and does not cause distress or actual physical harm, masochism does not meet the criteria for sexual masochism disorder.

Symptoms of Sexual Masochism Disorder

Common symptoms of masochism disorder include:

  • Sexual arousal, fantasies, or urges involving pain or humiliation
  • Acting on the urges
  • The behavior, urges, or fantasies cause distress or impair a person’s ability to function at home, school, or work

What Causes Sexual Masochism Disorder?

The cause of sexual masochism disorder is unknown, but different factors likely trigger it in different cases. Scientists believe that physical, medical, and psychological factors may all play a role in producing the disorder’s behavior.

Studies have indicated that most people with masochistic urges have felt those urges since childhood, but research has not definitively identified any common causal factor that may underlie the behavior. Research has not supported the theories that masochism is triggered by a history of childhood trauma or abuse. Only a minority of people with masochistic urges report having experienced abuse. Similarly, the theory that masochism and related behaviors are a manifestation of other underlying mental health issues does not have scientific support. Some studies indicate that people who participate in non-disordered masochistic activities have better than average overall mental health.

Is Sexual Masochism Disorder Hereditary?

Some studies have attempted to explain why sexual disorders such as sexual masochism disorder sometimes seem to cluster in individual families. While these studies suggest that a genetic component could play a role in the development of the disorders, no specific link between genes and SMD has been found.

How Is Sexual Masochism Disorder Detected?

Sexual masochism disorder usually emerges in late adolescence or early adulthood. Warning signs can include:

  • Unusual preoccupation with sex during childhood
  • Sexual fantasies that cause distress or impairment
  • Only being aroused by masochistic fantasies or acts
  • Interest or participation in activities that could cause severe physical harm or death

How Is Sexual Masochism Disorder Diagnosed?

Diagnosis of sexual masochism disorder begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that sexual masochism disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

  • A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
  • Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for sexual masochism disorder. These criteria include:

  • The patient is consistently aroused by fantasies, urges, or acts that involve receiving extreme pain, torture, or humiliation for sexual arousal.
  • The symptoms cause significant impairment in social situations, at work, or elsewhere.
  • The symptoms have been present for at least six months.

It is important to note that being aroused by masochistic acts with consenting partners is not a sign of the disorder. Doctors will consider the diagnosis only if the urges or acts cause distress or put the person in danger of serious physical harm.


How Is Sexual Masochism Disorder Treated?

In most cases, masochistic urges do not cause distress or impairment and do not require treatment. Treatment is usually only required if the person experiencing the urges is troubled by them and requests treatment. Doctors may also recommend treatment if a person’s urges or activities put them at risk of actual physical harm or death.

Treatment of sexual masochism disorder may include both psychotherapy and medications. Common treatment options include:

  • Cognitive-behavioral therapy teaches a person to recognize the situations that trigger their masochistic urges and develop new, healthy ways to cope with those situations.
  • Group therapy or support groups
  • Relaxation therapy
  • Antidepressant medications, typically serotonin reuptake inhibitors (SSRIs)
  • Antiandrogen drugs, such as gonadotropin-releasing hormone (GnRH) agonists and depot medroxyprogesterone acetate, work to lower testosterone levels and decrease sexual urges

How Does Sexual Masochism Disorder Progress?

Even with treatment, sexual masochism disorder has a high rate of recurrence, and the symptoms can cause significant mental health complications over the long term. In some cases, the person may engage in dangerous activities that put them at risk of injury or death.

Of particular concern is a specific type of SMD called autoerotic asphyxiation (asphyxiophilia), in which a person is aroused by restricted breathing during sexual activity. People with this disorder may use objects or clothing (e.g., scarves or underwear) to choke themselves. This type of activity carries an extreme risk of accidental asphyxiation and death.

In addition to the possibility of physical harm, SMD can also result in long-term psychological or social complications, including:

  • Anxiety or other mental health-related issues
  • Loss of healthy interpersonal relationships

How Is Sexual Masochism Disorder Prevented?

There is no known way to prevent sexual masochism disorder. However, treatment may relieve the effects of the disorder and make it less likely that the sufferer will experience severe complications over time.

Sexual Masochism Disorder Caregiver Tips

Some people with sexual masochism disorder also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the issues commonly associated with the disorder:

  • Some people with the condition also suffer from depression.
  • Some people with the disorder have a co-existing anxiety disorder.
  • Bipolar disorder is more common in people with sexual masochism disorder.

Sexual Masochism Disorder Brain Science

Sexual masochism disorder is classified as a paraphilic disorder. These disorders involve sexual arousal induced by unusual situations, objects, or targets of arousal. Common paraphilias include:

  • Fetishes (e.g., sexual arousal triggered by specific objects or situations)
  • Voyeurism
  • Exhibitionism
  • Pedophilia

Paraphilias are not inherently considered to be disorders. Some people have sexual interests or urges that others may regard as unusual but don’t cause distress or harm. Factors that make a paraphilic interest elevate to a disorder include:

  • The urges or acts are illegal (e.g., pedophilia).
  • The urges or acts involve non-consenting targets (either children or non-consenting adults).
  • The urges or acts have the potential to cause harm.
  • The urges or acts cause significant distress or impairment to the person experiencing them.

Sexual Masochism Disorder Research

Title: Acute Intense Paraphilic Desire (DSM-V) Down-Regulation Via taVNS Modulation [Transcutaneous Afferent Vagus Nerve]

Stage: Not Yet Recruiting

Principal Investigator: Athavan Gananathan, MD

American University Of Montserrat

Montserrat, West Indies

Transcutaneous Afferent Vagus Nerve Stimulation [taVNS] is used to modulate persistent & intense desire control amongst a specific participant group.

The physiologic effects of taVNS stimulation have been extensively researched for over 150 years. Drug-resistant depression (MDD), migraine headaches, pelvic pain modulation, facilitation of motor learning in neonates, post-stroke rehabilitation, and seizures are some of the conditions investigated with favorable results using taVNS intervention. taVNS physiologic and mental effects have been noted to have advantageous therapeutic results on a vast diagnostic spectrum.

A clinical testing program for pre- and post-test was devised as a means to identify and measure treatment effects in specific T3, 4, and early 5 (Tanner) sub-group visual stimulation. The programmatic (software) of the stimulation medium created for this study aims to abate the use of a phallometric device purposed to measure sexual stimulation effects on participants.

Great effort has been assigned for the preservation of visual data to be shared in the investigators’ research center with other researchers internationally. The participant testing platform created for this study allows for a full-proof research, ethics anonymous, and confidential registry and testing process (triple blind).

Aggressive optimum (supra-threshold and below-pain threshold) taVNS is the therapeutic modality of choice to examine desire down-regulation effects using taVNS. DSM-V stock participants must be sub-grouped in the paraphilic categorical structure of the DSM-V.


Title: Optimizing a Multi-Modal Intervention to Reduce Health-Risking Sexual Behaviors: Component Selection

Stage: Recruiting

Principal investigator: Ryan R. Landoll, PhD

Uniformed Services University of the Health Sciences

Bethesda, MD 

The goal of this project is to evaluate the components of the app-based intervention Mission Wellness to reduce health-risking sexual behaviors (HRSBs; e.g., condom non-use, multiple sexual partners) in active-duty members of the US Military to improve their sexual and reproductive health (SRH) and readiness to serve. Following the multiphase optimization strategy (MOST) framework, factorial component selection experiments (CSEs) will be conducted to evaluate which five experimental intervention components (i.e., Narratives, Skills, Scenarios, Future, and Risk) elicit the greatest improvements in the outcomes of interest given key constraints.

Negative SRH outcomes (e.g., sexually transmitted infections [STIs], unintended pregnancy, STI-related cancers) reduce human performance and undermine military readiness. Service members face unique challenges in maintaining SRH during their military service. HRSBs (e.g., multiple sexual partners, unprotected sexual behavior) offer potential intervention targets to improve SRH. Electronic-health interventions are cost-effective and dynamic and have the potential to reach millions of users as part of an overall strategy for individual behavior and systems change. In civilian populations, e-health interventions have demonstrated success in reducing HRSBs. However, effective HRSB-prevention interventions must consider the specific values, mission, and context of military populations and settings. The MOST framework is used to develop highly effective, efficient, and economic behavioral interventions that are particularly well suited to be used in this context.

This project aims to address this problem by delivering an optimized app-based prevention intervention package ready for evaluation via a subsequent randomized controlled trial (RCT). The specific purpose of this project is to determine which component(s) should be included in the packaged app-based intervention Mission Wellness for US service members based on their effects on the outcomes of interest (i.e., improved knowledge, motivation, and behavior skills related to SRH and reduced HRSBs) in no more than 25 minutes of content. The components tested in the factorial CSEs include Narratives, Skills, Scenarios, Future, and Risk. Each component has two levels: “on” (included) or “off” (not included). The main and interaction effects of components will be measured to determine the elements constituting the packaged intervention.


Title: Study of Maintenance of the Efficiency and Adverse Effects of Pharmacological Treatments in Sex Offenders With Paraphilia (ESPARA)

Stage: Not Yet Recruiting

Study Chair: Florence Thibaut, MD/PhD

Hospital Cochin

Paris, France 

This research concerns the evaluation of the maintenance of the efficiency and incidence of adverse effects of pharmacological treatments in sex offenders with paraphilia.

Despite the increasing use of pharmacological treatments in these indications, few data indicate which sex offender populations benefit from which pharmacological treatments and which adverse events are observed, particularly with anti-androgens or antidepressant treatments that are widely used in these subjects. A recent Cochrane study showed that psychodynamic treatment is less effective in terms of sexual delinquency compared to probation alone and has not demonstrated significant efficacy of cognitive-behavioral therapy (CBT) compared to the lack of treatment, except for a study in which anti-androgen therapy was associated with CBT. Another recent study concluded that the tolerance, even of anti-androgenic drugs, was uncertain, as all studies were small and of limited duration, and new research is needed in the future. Further research demonstrating the efficacy of SSRIs in treating paraphilic disorders is still needed, and long-term studies are lacking. Their use for this indication is still off-label.

As far as we know, this cohort should be the largest population of paraphilic sex offenders studied for the longest time to date in a field where research is insufficient. This large sample receiving routine care and followed for three years should allow for analyzing the maintenance of the effectiveness of the pharmacological treatments received (SSRIs or anti-androgens) and their tolerance. In addition, this analysis of clinical practices should be crucial to improve the knowledge of the indications for these treatments, which could be reviewed concerning their effectiveness and tolerance, especially in the most serious cases of paraphilic sex offenders.

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