RISK FACTORS AND WARNING SIGNS

Levels of Risk. One of the most frequent questions to come up regarding erotic bondage is the question of “Is it safe to do this?” This can be a very difficult question to answer meaningfully.

What does the word “safe” mean? One of the definitions in my dictionary is “freedom from risk.” In that context, it is never entirely safe to do erotic bondage, because the risk level can never be reduced to zero. Thus, the only entirely safe way to engage in erotic bondage is to not engage in it at all. On the other hand, I’ve certainly heard many people try to rationalize various extremely dangerous behaviors on the grounds that, “Hey, everything is risky.” This seems like a very dangerous line of reasoning to me.

While it is, of course, true that “everything is risky,” trying to summarize the risk levels in this very crude way seems to lump all forms of risk in together. Yes, “everything is risky” – but not to the same degree!

Actually, the concept of “degree of risk” may be a very productive concept in determining how to consider various aspects of erotic bondage. After a great deal of research and contemplation, I have come up with what seems to be a workable plan to categorize the degree of risk associated with various aspects of erotic bondage.

They are:

1.    Average level of risk.

2.    Above average level of risk.

3.    Extremely high level of risk.

I should note that, among bondage fans, not everybody agrees about which bondage practices fall into which category.

“Average level of risk” erotic bondage is bondage that is, in general, done in compliance with widely recommended safety principles. When people engage in erotic bondage in this way, there are almost no case reports of bad outcomes or significant injuries. Problems that are reported seem to involve emotional issues (such as the inadvertent triggering of a phobia or a panic attack) with a lack of adequate BDSM education, or with relationship difficulties.

“Above average level of risk” erotic bondage is bondage that is done in a way that places the bottom, and perhaps also the top, at a significantly increased, but not extremely severe, risk of physical or emotional injury. While there seem to be an increased number of reports of bad outcomes, most injuries that occur can be treated on an outpatient basis.

In my experience, the most frequently reported cause of lasting injuries is bondage applied so tightly that the bondage feels painfully tight. The single most common cause of bondage-related injuries severe enough to require an actual visit to a hospital emergency room involve having a bottom fall while in bondage. These falls are frequently due to some kind of equipment failure, such as having an overhead screw eye pull loose, or having a larger item of bondage-related equipment such as a whipping post suffer some sort of structural failure. They are also often due to placing a bottom in an unstable position while in bondage such as standing upright with their hands tied behind their back and their feet tied together.

“Extremely high level of risk” erotic bondage places the bottom, and perhaps also the top, at direct, immediate risk of very severe injury. When bondage is done in this way, there are a very significant number of case reports of bad outcomes in which someone is hospitalized or even killed.

As far as I’ve been able to discover, by far the single most common cause of bondage-related fatalities involves engaging in bondage while alone. This can be either a form of autoerotic asphyxiation (which the participant might not regard as bondage at all), or some form of self-bondage that does not involve any strangulation. If a gag is involved in bondage of this sort, the risk level is increased even further.

A comment about the right to choose one’s own risk level. In various writings about bondage, and about other aspects of SM, there are frequent messages along the lines of “never do this” or “that is unsafe.” These comments, while usually well-intentioned and often useful, can send something of a mixed message.

It is not necessarily wrong, unethical, reckless, or irresponsible to take risks of an above-average level. However, we as a society tend to look a bit askance at risks taken for the purpose of achieving pleasure, such as the risks associated with activities like auto racing, white water rafting, skydiving, and so forth. Furthermore, we especially tend to look a bit askance at risks taken for the purpose of achieving sexual pleasure. (Indeed, a large percentage of the population regards taking the risks associated with doing any sort of bondage for the purpose of heightening sexual pleasure, no matter how mild and relatively risk-free such bondage seems to its participants, as being well above the acceptable level of risk.)

RISK FACTORS AND WHAT TO DO ABOUT THEM

Here’s a list of the top thirteen – a baker’s dozen – of the most common bondage-related problems and what to do about them.

While I have mentioned various risk factors associated with bondage throughout this book, I thought it would be useful to compile the major ones in one location and discuss each of them. In many cases, of course, simply describing the risk factor suggests obvious means of mitigating it.

Keep in mind the “Take one more precaution than you think you need to” rule.

Risk Factor Number One: Playing bondage games while alone. From what I have been able to determine, after talking with large numbers of people and doing other research, the number one cause of bondage-related fatalities is playing bondage games while alone – i.e., self-bondage games or activities in which the top bound the bottom and then went beyond “yelling distance.”

There were case reports in which the person died of some unrelated cause such as a heart attack while engaged in bondage or some other SM-related activity. (Deaths during sex are actually not all that rare.) However, doing bondage while alone was, by a huge margin, the most common activity in which a fatal outcome was directly caused by what was going on. If a gag was used, the risk level increases even further.

Please note that I am not referring to autoerotic asphyxiation games (activity in which a person suffocates or strangles themselves in order to heighten erotic sensation) here. While it is possible to play such games in conjunction with bondage, they are not necessarily the same thing. Many people who play such autoerotic asphyxiation games would deny that what they do is intrinsically a form of bondage.

Most self-bondage fans who are not killed by autoerotic asphyxiation seem to die from some form of what called positional asphyxia (see p. 273).

There is just no question that if another person is not within yelling distance, then the bound person is very much “working without a net.”

Risk Factor Number Two: Falling. My interviews, experience, and research led me to the conclusion that the number-one cause of bondage fans ending up in a hospital emergency room was for treatment of injuries – including many fractures – that were sustained in a fall. Abound person, particularly a person whose feet are bound, is at increased risk for falling. This risk level can be increased by activities such as wearing high-heeled shoes. Furthermore, if a person has their arms bound in any way, they are limited in both their ability to steady themselves to prevent a fall or to catch themselves and reduce their chances of being injured if they fall. If their hands are bound behind their back when they fall, they may be at very great risk of injury.

“Master, I can’t feel my hands.”

In my experience, the single most common cause of an injury-producing, bondage-related fall is the pulling loose or other failure of an overhead eyebolt or similar item while the bottom is in a standing position with their hands tied over their heads to this item.

When moving a person who has been bound in any way, keep close to them so that you can steady them as soon as they start to lose their balance.

A warning about panic snaps: One of the items of conventional wisdom in the SM community is that panic snaps – special snaps designed to be opened readily even when under stress – should be used when the bondage involves a vertical rope under tension. I am growing more and more disenchanted with this recommendation. (For my reasons why, see p. 297.)

I feel far more comfortable with block-and-tackle devices that allow a more controlled, gradual lowering of the bottom if necessary. Even winding the rope once or twice entirely around the loop in the eyebolt can make such a lowering much more simple. (If you want to learn more about this, look at what the climbing and boating books have to say about “belaying turns.”)

Risk Factor Number Three: Painfully tight bondage. While it is probably always risky to tie someone so that numbness and/or tingling results, most reports of tingling that persists after the bondage is removed seem to be strongly associated with painfully tight bondage. It seems to be true that most bondage which causes some tingling or numbness but is not painful goes away almost immediately after the bondage is removed. On the other hand (so to speak), most bondage that causes persistent tingling, numbness, or even weakness in the limb causes not only numbness and tingling, but is itself painful.

Risk Factor Number Four: Playing while intoxicated. I’m something of a student of “SM horror stories.” Whenever I heard of an SM scene that ended badly, I always try to learn as many details as I can. Whenever possible, I try to talk personally with the people involved. One of the items that is mentioned with astonishing frequency is the use of intoxicants by one or both parties. It has become very obvious to me that intoxicant use was an “essential co-factor” in many SM-related disasters, and that had intoxicants not been used it is quite plausible that the incident would never have happened. Based on my research, I have concluded that intoxicant use by any person in the scene automatically increases the degree of risk by one level, and that intoxicant use by both people automatically takes the scene up to the “extreme” degree of risk.

Risk Factor Number Five: Playing with an abusive top. While many people perceive this to be the major risk factor associated with bondage, I have found that case reports of this type of incident are actually somewhat rare. Still, they most definitely do happen. Happily, this is one case in which the conventional wisdom does seem effective: Take your time and get to know someone before you let them tie you up. If possible, get references from previous play partners. Make sure that a third person knows where you are, who you’re with, what you’re doing, and when you’re expected back – and that your bondage partner credibly believes that this is true before the play starts. Don’t do too much bondage on the first few play dates.

Risk Factor Number Six: Playing in isolated areas. An isolated area can be defined as an area in which a bound bottom cannot readily get the attention of a third person if the top were to become unconscious. Incidents of this type are rare, but they do sometimes happen. (One fictional account of such an incident, in which a top dies while a bottom is in bondage in a cabin in the woods, appears in the book “Gerald’s Game” by Stephen King.)

It should be pointed out that if a top were to have a severe medical emergency under these circumstances, such as a sudden cardiac arrest, any reasonable life-saving attempt may well be impossible.

The risk level associated with this practice can be greatly mitigated by a little foresight – for example, telling someone where you’ll be and when you’re expected back. Other steps include making sure that a bound bottom can reach something like a telephone or an alarm panic button if they really need to.

Limiting the bondage can also be useful. For example, I know one bottom who will let herself be put in fairly stringent bondage under such circumstances, but she will not let herself be tied to any fixed object such as a bed, chair, or overhead eyebolt.

I would suggest that there be at least two different methods available to the bottom to either free themselves or summon help under such circumstances. Because two lives may be at stake here, this is an excellent example of a “take one more precaution than you think you need to” type of situation.

Risk Factor Number Seven: Withholding information from your partner or giving them false information. Unfortunately, this mistake is fairly common, and can cover a wide variety of topics. I know of cases in which people have not told their prospective partner of important medical conditions (such as a heart condition or seizure disorder). I also know of cases in which people have claimed to not have a sexually transmitted disease when they knew that they did.

There are people who overstate how much experience they have, either as a top or a bottom. There are people in committed relationships who claim that it’s fine with their spouse or life partner if you play with them, when in fact it’s not.

The list goes on and on.

Risk Factor Number Eight: A medical emergency occurring during the play. Medical emergencies do occasionally occur during SM play, and they may not even have any direct relationship to what is happening. Probably the most common medical emergency is a bottom who faints while in a standing position. Other emergencies can include injuries caused by falls or burns, or heart attacks and seizures.

Thus, many sadomasochists make a point of taking classes in First Aid and CPR. Some SM clubs go as a group; some even have their own “in-house” instructors. (I have been regularly teaching classes in First Aid and CPR within the SM community for many years.) If you’re not sure where you can go to take a class, look under “first aid instruction” in your local yellow pages.

Risk Factor Number Nine: Failure to deal promptly with “bad pain.” Experienced SM practitioners come to know the difference between “good pain” and “bad pain.” “Good pain,” such as might be produced by pinching the bottom’s nipples, typically has an erotic component to it, is not significantly damaging, and adds to the energy of the play. “Bad pain” such as painfully tight bondage typically does not have an erotic component, may be significantly damaging, and detracts from the energy of the play. “Bad pain” also has a way of involving a joint, especially the neck, lower back, shoulders, or wrists. Failure to promptly alleviate “bad pain” can lead to long-term problems.

Risk Factor Number Ten: Loss of emotional balance. This is a relatively rare condition that, when it occurs, usually happens to the bottom. It is commonly associated with the top increasing the intensity of the activity too quickly (the classic mistake of the inexperienced or careless player.) It is also commonly associated with a bottom’s having waited much longer than they should have waited to use their safeword or to express a concern in some other way.

“Could you  please make-that a little tighter?”

The most dangerous aspect of this problem is that the bottom may have become so emotionally overwhelmed by what’s going on that they have lost their ability to use their safeword, even though they desperately want to.

For this reason, tops are well advised to do occasional “affirmative checkins” with their bottoms. They should not assume that all is well simply because their bottom has not called a safeword or expressed concern in some other way.

If the top determines that the bottom has lost their emotional balance, it’s almost always best to stop the SM play and become a sympathetic supporter. Reassure them, remove the bondage, make sure that they’re adequately warm (a blanket can help), and offer them something to drink. This is not the time to argue with them or to become personally defensive. This is also not a good time to discuss in detail what happened during the scene.

While loss of emotional balance occasionally happens suddenly and without warning, as might happen when the play unexpectedly triggers a phobia, most of the time there is significant warning before this occurs, so stay alert.

Risk Factor Number Eleven: Playing with unfamiliar equipment. This is a common error, and it tends to happen to overly egotistical tops who should have known better. You wouldn’t think that I would have to advise people not to do things like try to use a piece of SM equipment until they clearly understand how to apply and remove it, or how to raise and lower it, or how to make sure that it’s securely locked into place. But the human condition being what it is…

Risk Factor Number Twelve: Environmental emergency. Just as medical emergencies may occur during an SM scene for reasons entirely un-related to the play, so may other emergencies occur. For example, every now and then an earthquake strikes while an SM scene is in progress, or someone glances out the window and sees that the house next door is on fire. Therefore, the top needs to have a clear, workable plan for freeing the bottom with a high degree of speed and safety.

Power failures may occur at any moment, and may even be associated with something such as an earthquake. Thus, many bedrooms and playrooms have power-failure lights in them. These lights go on automatically if the power goes off.

Risk Factor Number Thirteen: Equipment failure. Every now and then, an item of SM equipment just simply fails. Probably the most common equipment failure that I have seen or heard about is an overhead eyebolt (or, especially, a screw-eye) pulling loose. This typically happens when the force of the pull is along the same axis as the axis in which the eyebolt or screw-eye is attached. For example, a screw-eye is placed straight up into some wood and the direction of the pull is straight down.

Locks sometimes fail, and the reason is often unclear. For this reason, people who like metal bondage equipment should make sure their “get loose kit” includes extra keys, a good pair of bolt-cutters, a hacksaw and several high-quality blades, and related items.

Knots sometimes get pulled much more tightly into rope and rope-like materials than was expected. Items useful in helping to work such knots free are listed on p. 50. Of course, as a final option, you can use a knife blade or your EMT scissors. (Note that knots put into nylon stockings can easily be pulled so tightly that it will be impossible to untie them by any means.)

WARNING SIGNS AND WHAT THEY MEAN

When a limb is bound, it may develop an unusual color, an unusual temperature, an unusual size, and other abnormalities. How should we evaluate these abnormal findings, and when should we become concerned about them?

When emergency medical personnel evaluate a limb that may be injured, they usually evaluate the blood supply and nerve function of the limb in addition to checking for any injuries. This is sometimes referred to as checking the circulation, sensation, and movement, or the “CSM,” of the limb. We bondage fans should know something about how to do this, so let’s take a look at each component.

To evaluate the circulation in the bottom’s limbs, the top should first ask about the presence of any underlying medical condition that might impair the bottom’s circulation. These matters are usually covered in presession negotiations. Diabetes is one common example of such a condition.

Then the top should briefly inspect the bottom’s limbs. This inspection is especially important when playing with a new partner. Normally, this will only take a very short time. Briefly look at and touch each hand and/or foot to get a general impression of its color, temperature, and size. This is important because, among other things, some people’s limbs are naturally cooler and/ or paler than other people’s are.

Key Point: It’s difficult to know if a limb has become unusually cold or pale after you have applied bondage to it unless you first noted its color and temperature before you applied the bondage.

It is especially important to note any differences between the two limbs upon this initial examination. For example, if one of the bottom’s hands is noticeably cooler, paler, or bigger than the other, the top should ask about this. (This bottom might need to see a doctor.)

By the way, both as a convenience and as a safety measure, it is usually a good idea to remove rings, watches, bracelets, and other such items from the bottom’s limbs before applying the bondage. In particular, large bracelets, or rings with precious stones prominently attached, might cause problems.

“ My right foot is starting to go numb.”

If the bottom has adequate circulation to their limbs, this brief “look and touch” exam will likely be adequate. However, if the bottom has problems with their circulation, the top may want to examine them a bit further.

To check further for adequate circulation, the top can perform what’s called a “capillary refill” test. To perform this test, simply press down on a fingernail so that the nailbed blanches white and then release the pressure. The normal reddish color should return within about two seconds. This test is more accurate if the limb is raised above the level of the bottom’s heart.

A “squeeze test” can also be done to check capillary refill. To perform this test, simply have the bottom squeeze a tight fist for a few seconds, then have them open — but not fully extend — their fingers. Their palm should be a whitish color when their fist is first opened but due to capillary refill should return to its normal color within a few seconds.

The top can, if they wish, learn how to feel for the pulses in the bottom’s wrists. Various medical books and first aid courses will teach how to feel for the radial and ulnar pulses in the hand and wrist, and the posterior tibial and dorsalis pedis pulses in the foot and ankle. However, if the bondage is tight enough to cause problems, this will usually become much more apparent by other signs. Thus, absent or diminished pulses in a bound limb is usually more of a secondary warning sign than a primary warning sign.

To evaluate the status of the nerves in a bottom’s limb, check for sensation and movement by asking the bottom to move the limb and its digits, and to report back on the sensations they feel. Normal sensation has no associated tingling, numbness, or pain. Normal movement involves full range of motion with no loss of strength or dexterity.

With these signs understood, bondage can be thought of as having three basic levels of tightness: average tightness, above-average tightness, and extreme tightness.

Average tightness. With average tightness, the bound limb remains essentially normal in its appearance and function. There is no obvious increase in redness, paleness, or size of the limb. (An increase in redness or size would be due to some restriction of venous and lymphatic return; this is usually not harmful for brief periods.) The limb does not become cooler to the touch and there is no increase in capillary refill time. Pulses can be felt, and the bottom reports no numbness, tingling, or pain. In essence, the status of the limb is identical to its pre-bondage state. When bondage is done to this degree of tightness, I have heard almost no reports of post-bondage problems such as persistent tingling, weakness, loss of strength or dexterity, and so forth, as long as the bound limb is kept this way no longer than the two-hour maximum bondage time recommended by this book.

(Every now and then a bottom will report some post-bondage problems even when tied in this most conservative manner, but these reports are very rare and the problems reported tend to be minor.)

Above-average tightness. With above-average tightness, there is frequently some change in the appearance of the limb. The limb may become redder or paler in color, or increase a bit in size due to inhibition of venous and lymphatic return. It may also become cooler. (These changes can also be caused by raising the limb above the bottom’s heart, regardless of the tightness of the bondage.) However, these changes do not seem to be associated with post-bondage problems if the bondage is kept on for no longer than two hours. Pulses can still be felt and capillary refill time remains normal or is only slightly prolonged.

While this level of bondage is not painfully tight, tingling in the bound limb may appear. This type of tingling typically develops gradually and is often quickly relieved if the bottom can shift position or have one or more of the coils of rope slightly moved or eased. (The top can use the curved portion of the blunt, bottom edge of their EMT scissors for this.)

Note: The bottom will often still be able to move fingers that have become numb. This is because the muscles that move the fingers are themselves located on the bottom’s forearms and not on the hands themselves. Thus they are “above” the bondage and not subject to its risks. This being the case, the top should not rely overly much on whether or not the bottom can move their hands to evaluate the degree of tightness.

One possible exception to this phenomenon are the muscles that spread the fingers apart in a lateral direction. Thus a command to the bottom to “spread your fingers apart” can be revealing. (Note that many of the muscles that move the thumb are above the bondage. Therefore, the ability of the bottom to move their thumb may not provide much valuable information.)

The question of how to evaluate tingling (which often progresses to numbness) in bound limbs is not a simple question to answer. This tingling is generally due to moderate but non-damaging pressure by the ropes on the nerves themselves rather than bondage that impaires circulation.

While as a general rule, it’s safer to not tie someone so tightly that tingling develops, and to loosen the bondage if such tingling does appear, for the sake of intellectual honesty I should note that many people have shared with me that they have routinely been doing bondage that causes tingling or even numbness in their hands on many occasions for a number of years with no reports of significant post-bondage problems.

There are many case reports of persistent tingling that persists for a period of days or even weeks, but this tingling does not seem to be associated with significant weakness, loss of dexterity, or compromised circulation.

So this is, admittedly, something of a gray area. While the risk level is somewhat increased, and there are a significant number of reports of post-bondage problems, these problems are often more annoying than serious.

Extreme tightness. When bondage is applied that is extremely tight, virtually all the warning signs appear either as soon as the bondage is applied or very shortly thereafter, and there are many reports of serious post-bondage problems. These problems include persistent severe tingling, persistent numbness, and loss or strength and/or dexterity in the limb.

With extreme tightness, the limb quickly becomes redder or paler in color and may even become somewhat bluish in color (or even greenish… yuck!) after a few minutes. It is almost always cooler to the touch. Pulses are often absent. Due to no inflow of blood, the limb may not swell in size. Capillary refill is greatly delayed or entirely absent. Tingling develops almost immediately and rapidly progresses to numbness.

In particular, this degree of bondage is often painful when it is first applied. Thus, we have something of an especially useful warning sign. If the bondage is not immediately painful, there may be some post-bondage problems but they are usually minor. However, if the bondage is immediately painful, we have entered a definite danger zone. If the painful bondage is also associated with immediate signs of compromise to the blood supply and nerve supply to the limb, then there is no doubt that the risk of substantial post-bondage problems has become very high indeed.

In BDSM circles, there is talk of “good pain” which is experienced as being, in some way or another, rewarding for the bottom to receive and is not associated with significant damage. A well-placed paddle stroke upon the bottom’s rump often produces “good pain.” There is also talk of “bad pain,” which is experienced as being unrewarding to receive and is often associated with significant damage. A whip stroke which “wraps” around the bottom’s ribs instead of landing squarely on the back often produces “bad pain.” Many experienced bottoms can tell instantly if a given sensation produces “good pain” or “bad pain.”

This concept can frequently be extended to bondage. I’ve had several experienced bottoms tell me that they can quickly tell the difference between bondage that is “good tight” as opposed to bondage that is “bad tight.” Thus, feedback from the bottom, especially if the bottom is experienced in being tied, is especially important. In particular, if the bottom reports that the bondage is “bad tight” the top should promptly adjust the bondage — or remove it entirely if necessary.

A final caution about cumulative effect. We live in an age when repetitive stress wrist injuries such as carpal tunnel syndrome have become epidemic. Obviously, bondage could be looked at as one form of repetitive stress.

The obvious question emerges: Is there a significant potential for cumulative damage from activities like the repeated compression of bound tissues?

At this point, based on the best information I have available to me, I have seen no evidence that such cumulative damage is highly likely. The SM community is large, contains many practitioners of more than 20 years’ experience and, due to the Internet, is increasingly well interconnected. While there have been some occasional case reports of problems, there has certainly been no groundswell of warnings associated with the cumulative effects of doing bondage. If it were true that there was a significant risk of cumulative damage, I would think that such reports would have emerged.

Certainly there are many case reports of injuries associated with something like an overhead screw eye pulling loose, so I don’t think that this relative lack of reported problems is due to inadequate reporting.

I have heard some case reports that indicate that once a nerve has been damaged, it might be easier to damage it in the future. But exactly how to interpret such reports, or what conclusions to make from them, is not immediately clear.

From what I can gather, if you follow the advice in this book, particularly about not leaving the bondage on for longer than two hours without at least a ten-minute break before reapplying the bondage, and steer clear of painful, numbing tightness, your risk of cumulative damage, while not nonexistent, seems to be very low.