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The hidden dangers of clinical play – in the words of a pro

A few weeks ago during a party in Bologna I held a micro-lecture from my Master class series about the use of chemicals and pharmaceuticals for BDSM play. At the end of the talk I was approached by a girl who, thanks to her nurse studies, pointed out an inaccuracy in my presentation. Meetings like that are wonderful to better oneself, so we got talking about a subject I hold very dear: the dangers caused by approaching extreme eroticism carelessly.
On my way to my hotel I thought that sharing the considerations and the discoveries from that conversation would have been nice, so I got back in touch with that young lady to offer you an interview summing up our chat:


Hi, would you like to introduce yourself to the readers?

To be completely honest: no. I really cherish my privacy, and telling who I am wouldn’t be that important anyway. For this interview’s purposes I believe it to be sufficient to say that I work in a hospital, I handle pharmaceuticals, instruments and medical procedures on a daily basis, and I am especially keen on stay rigorously informed on my fields of interest. In my private life I enjoy BDSM and I know its practices well, so these two things together give me a clear and complete perspective on the world of clinical play.


All right. I’d like to begin from the omission error you saw in my lecture. I briefly mentioned the possibility of using the balsamic liquid-soaked swab inside those Vicks inhaler sticks as a “burning” brush for tormenting a sub’s privates. What did I forget to say?

That some of those nasal decongestioners, sprays mostly but also some sticks, contain Phenylephrine, which is a direct sympatheticomimetic molecule. In other words it mimics the instructions from the sympathetic nervous system, inducing vasoconstriction in the vasal smooth muscle. This means it is very efficient in reducing mucus, so much that clinically it is the most used compound in its class.
The problem is that if you use more than its proper dose or use it recreationally, its effect become systemic, possibly causing addiction but above all becoming hypotensive and thus causing severe malaise that can become very serious.


My fault. This is a classic example of those “invisible” dangers most kinksters don’t think about, partly due to ignorance and partly for oversight. Also typical are those who bind a standing partners with their hands above the head, as they have seen in a thousand videos and photos, and when they eventually free them they let the arms down without thinking twice. This gesture however impacts the blood flow and the pressure drop easily causes dizziness or fainting, so the subjects crash down and hurt themselves: I have witnessed several such accidents happen in misguided good faith. Speaking as a kinkster and as a medical professional, can you recall other similar examples?

When you deal with health care every day, it is very easy to notice risky behaviors in those around you, but personal health is a matter that each one of us has to manage taking also responsibility for the risks deriving from their actions. Things change instead if you expose others to those risks, therefore a collective job of health information becomes paramount.
One fitting example concerns the promotion of a healthy sexual life and STDs (Sexually Transmitted Diseases) prevention. The safest and most efficient method to prevent them is using a condom, but committing to memory the “ABC method” may come handy too.

A is for ‘Abstinence from unprotected sex’. This doesn’t mean you’ll never have intercourse without a condom: just until you are sure about your partner’s health status. Once you both are tested – blood and urine – and cleared you can serenely proceed. Also inform yourself about how to ensure a safer sex life, both pregnancy-wise and about infections.

B stands for ‘Be faithful’. This rule has nothing to do with morality, and is strictly about health. If you have unprotected sex, the smart thing to do is to do it only with people whose health you are 100% sure about. Whether you have one or more partners, you are therefore best off if you keep your condomless sex limited just to a set circle of persons, and use a condom and inform all your partners if you meet someone new. At least until you are sure that new person is healthy and faithful!

C = Condom. It shouldn’t be used just for vaginal and anal penetration (by the way: did you know there is a female version, called Femidom?), but for oral contacts too. In fact, STDs can be contracted through oral sex too, yet very few people protect themselves for that – even in the case of occasional partners! Sure, you must balance pleasure and safety… but it is better to be safe than sorry.


Although there was no ill intent, right while we were chatting we witnessed two troubling episodes. The former happened in the area dedicated to clinical play, where the dominant caressed the needles before inserting them…

You must never do that: if the needles were correctly stored in their sealed package, they are sterile and they must stay so! Unless you are wearing sterile gloves worn with the sterile process used by surgeons, and you opened the package preserving its sterility, when you touch the needle you contaminate it… so what’s the point of disinfecting or even sterilizing – I’ve seen that too – the area you are going to prick?
You must also remember that it is pointless to wear gloves if you haven’t washed your hands or at least swabbed with a hydroalcoholic solution (my pick would be Chlorhexidine, which you can buy from pharmacies). Maybe you also want to avoid covering body surfaces with povidone-iodine, since it is a very aggressive solution and some skins are especially sensitive to it.

needle play

Ph: Peter Coulson

Talking about needles, you also told me you saw scenes that made your skin crawl for the lack of skill they revealed.
Luckily I never observed episodes of similarly catastrophic incompetence in the places I hang out at, but ignorance can play ugly tricks at all levels. For example, you mentioned you noticed how many people know how to correctly insert needles in their subs’ skin, but then they are unaware of the right way to remove them without causing damage.

If we talk about hypodermic or subcutaneous applications at the most – intradermal ones pose a rather high risk of damage already – needles must not be inserted  flush to the skin, but with a 10-30° angle or you tear the tissue. You must pinch and lift with your fingertips the spot you want to pierce, so you have a fold that’s easier to manage. Then you pierce through with decision and a steady hand, without jiggling the needle.

To remove it you do the same in reverse: pinch, lift and pull out with a quick single action; the needle tip must never stop inside the tissue, for it might harm anything around it, and must never, ever be touched, including after removal.
You describe the right way to dispose of used needles yourself in your books, but basically they must be dumped in special containers without trying to cap them again and risk to prick yourself. Lacking a specific sharps container, you can place them in a transparent jar with a secure lid, so that nobody will put their fingers in.

The technique of playpiercing is just that. Unless you are a professional piercer, trying to show off is just a senseless hazard. Just imagine that I was once present at a session where the needle was shoved in the pubis like in a pincushion: it drew a spurt of urine, evidence that the bladder had been pierced with a damage that might have required urgent hospitalization!


Chilling. I could answer with those geniuses that pierce through nipples unaware of what they are doing. Care to tell them?

Especially with younger girls I’d reccommend not to go through the nipple, because it is the final confluence of the lactiferous ducts. In case of a later pregnancy, the scar tissue that forms may cause issues and annoyance when breastfeeding.


corset piercing

A rather elaborate corset piercing

The other event that got me thinking was when a smiling couple came to proudly show their corset piercing, that is two parallel series of piercings in the back, joined by a criss-crossed ribbon, just made with… large safety pins! Do you remember their answer when I tried pointing out that they were taking a big risk? It was a surreal conversation: I said «well, I might have not used safety pins…»

…and he countered «Don’t worry, I sterilized them soaking them in bleach for two hours!»
There is a huge difference between cleansing – the action of cleaning a surface or an object with a cleaning agent to wipe dirt away – disinfecting, whose purpose is to kill the pathogenic micro-organisms that cause illness, and for which you use disinfectants, and finally sterilizing, which is the process by which we kill every form of living micro-organism and spore, and must be maintained with specific techniques and controlled environments. Sterilizing instruments with bleach is simply not possible. You could at best disinfect them, but then using those intstruments without a proper sterile technique means to contaminate them all over again.
It is important to remember that wearing gloves but not washing your hands is totally useless.


What I actually meant was that, contrary to a needle specifically designed for that purpose, the tip of a safety pin renders the flesh and it is very rough on a microscopic level, therefore needlessly painful and easy to shed small plating shards inside the skin. When I objected that I was referring to the material, he cut me off with a cocksure tone…

…«Ah, you’re talking about their nickel content! But she’s not allergic to it, and if it swells too much I’ll give it a good cortisone coating anyway!»
Actually, you should never use anything containing cortisone or other corticosteroids without a medical prescription.
Even if you are not allergic to a specific substance, that doesn’t mean it will happily stay inside your body: the immune system reacts anyway to expel the foreign body, be it deeply inside or just under the skin. And to think that I later saw that lady lying down with her pierced back on an uncleaned surface…


Gawd. It is comforting to know that most BDSM practices are remarkably less dangerous than medical play, at least because they do not violate the natural barriers of the body. After so many years I grew convinced that the underlying problem is the widespread belief that, once you start playing with domination and submission, the regular laws of physics, medicine, law and so on stop being valid “because sex is not part of daily life anyway” – which in itself says a lot about how people think. In your job, did you ever encounter those infamous cases of people rushed into the ER for accidents somehow connected with uncommon sex practices?

The answer is «yes», but I don’t have the heart to tell about them!


My point is that in the heat of the moment you don’t think of the possible but not exactly intuitive consequences of your actions. I once personally met somebody who had inserted a bottle in his ass bottom side first, thus creating a “suction effect” in the intestine that prevented him to pull it out until an emergency team drilled through the glass base to let air in and balance the vacuum. The really absurd part however is that I later found out that this is a relatively common thing. The San Francisco fire department even has a specialist on call for the removal of stuck cockrings…

Here you can have different scenarios. Congestion is an edema-based swelling of the part caused by a slow lymphatic return, which solves itself in 48 hours tops, which however is too long a time to keep the ring on. Priapism instead is a very painful penis erection that has nothing to do with sexual arousal, and isn’t affected by ejaculation.
The big hazard with constrictions and compressions to bodily tissues depends on the reduced blood flow in areas which must be supplied: tissues need the oxigen and nutrients transported by blood along with a series of other substances. When hematic influx ceases or is reduced, you encounter tissue ischemia, which if maintained for a long time evolves into necrosis, meaning tissue death. Consider that for some types of tissue a few minutes are a huge amount of time already. Necrotic tissues must be removed, or they will infect and cause sepsis.
This is a reason why if you engage in medical play it is paramount to inform the partner about any health condition you may have, for example if you have bleeding diathesis – the tendency to bleed a lot – blood vessels issues or coagulatory deficit caused by platelets disorders.


Not every extreme eroticism-related accident has a mechanical origin though. During our conversation we also noticed how ignoring psychology can be a source of major damages.

I am more a neurology person than a psychologist, yet I have witnessed many situations where the excited will to do BDSM make people inattentive about the psychological needs of their partner, even in those cases where it is patent that there is some affective, social or self-esteem issue in play. While physical practices, instruments and sessions are widely discussed, there is no education about the psycho-relational aspect, and this is a problem in itself. Those more vulnerable are given no tools for knowing when and how to defend themselves from the – rare, yet real – people who knowingly exploit their weaknesses for personal gain.


Ok, I’d say these are complaints enough. Just not to close on a needlessly negative note, what would you suggest to someone who wanted to learn how to prevent the sort of messes we talked about?

I feel that education is a circular process, so it is possible to learn in any given moment. Be well informed before engaging into any practice, or at least take a First Aid course like anyone should.
As soon as you have any doubt about what you are doing, the sensible thing to do is to consult someone more experienced than us or a medical professional. You can rest assured that they have already seen much worse, and they have no interest in judging you.

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