D/s
Medical Advice: Prevention and Treatment of Injuries /
Adverse Conditions
Table
of Contents:
I.
Introduction
II.
Sexually Transmitted Disease
A.
Risk Factors
B. Partial List of Diseases
HIV/AIDS
Herpes
Gonorrhea
CMV
Hepatitis B
C.
Prevention
III.
Injuries: Prevention and Treatment
A.
The Importance of the Right Partner
B. Safety Tips
for subs
C. Drugs and Alcohol
D. Specific Injuries: Prevention and Treatment
Circulation
Choking
Bruises
Lacerations
Abrasions
Burns
Vaginal Injuries
Anal Injuries
Penile Injuries
Animals
Beatings
Frostbite
Wax
Bite Wounds
Electricity -Related Injuries
Strains and Sprains
Branding, Cutting, and Piercing
Psychological Risks
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I.
Introduction
This text has been prepared by an M.D. with a personal
and professional interest in D/s.
It covers topics such as safer sex, preventing and
treating injury, and psychological safety.
It is offered freely to the D/s community in the hopes
of assisting others to find joy and
fulfillment in a safe and sane environment.
------------------------------------------------------------------------
II.
STD... Sexually Transmitted Disease
A.
Risk Factors
By far the most pressing concern in any sexual encounter
is the prevention of STD: Sexually Transmitted Disease. These
are diseases that can be passed from one partner to
another by different forms of sexual contact. The risk
of contracting a STD is determined by several factors:
-
1.
The prevalence of the disease in your area..... for
example, you are more likely to contract HIV (the
AIDS virus) in Newark, NJ than in Duluth, Minn.
2. The population your sex partner is
part of.... for example.... the rates of HIV-positivity
are higher in prostitutes and IV drug abusers than
the general population.
3. The type of sexual activity engaged
in ... for example, anal intercourse carries a
higher risk for HIV transmission than oral sex.
4. The specific disease ... for example
... the herpes simplex virus is more easily
contracted by oral - genital contact than the HIV
virus, which requires contact with body fluids
(semen or blood).
B.
A List of STDs:
The
following is a list of SOME STDs.... please note this
list is not inclusive and is not intended to substitute
for medical advice. Contact your doctor if you have ANY
concerns or questions about your own health risks or
needs.
AIDS
......
caused
by the HIV (Human Immunodeficiency Virus) virus. It is
contracted by exposure to bodily fluids... semen and
blood.
Herpes
.....
caused
by the herpes simplex virus it causes a chronic,
relapsing illness characterized by recurrent genital
blisters. It can be passed from mother to infant during
childbirth as well... It can be contracted when the
virus is "shedding"... becoming active... and
may occur before the reappearance of genital lesions.
Gonorrhea
.....
caused
by a bacteria (gonococcus), it can cause sterility,
arthritis, heart problems and disorders of the central
nervous system. In women, it can cause Pelvic
Inflammatory Disease (PID). Common symptoms include: for
women.... frequent, burning urination; pelvic pain; a
green or yellow vaginal discharge; swollen vulva. For
men..... a pus like discharge from the penis.
CMV
- Cytomegalovirus .....
.....
can be transmitted sexually as well as from mother to
child during pregnancy. In the fetus, it causes deafness
and mental retardation. In adults, it can cause
blindness and metal disorders. Common symptoms
include... swollen glands, fatigue, fever, and general
weakness, nausea and vomiting, loss of vision. It is
spread in saliva, semen, blood, cervical and vaginal
secretions, urine and breast milk by: close personal
contact, vaginal, anal and oral intercourse, blood
transfusion and sharing IV drug equipment, from mother
to child during pregnancy, childbirth or breastfeeding.
Hepatitis
B.....
contracted
like HIV through exchange of body fluids or blood...
causes inflammation of the liver with jaundice, fever,
weakness, nausea and vomiting. Can lead to acute liver
failure or chronic active hepatitis. Follow precautions
for HIV .
C.
Prevention
The
only absolute protection against sexually transmitted
disease is complete avoidance of contact with all bodily
secretions of another..... All other measures provide
SAFER SEX ..... the more information you have, the
better able you will be to assess your risk and take
appropriate precautions. By far the most effective means
of REDUCING the risk of STDs is CONSISTENT, CORRECT and
CAREFUL use of CONDOMS during vaginal, anal and oral
intercourse.
Care
should be taken when withdrawing not to spill semen from
the condom. Yes.... condoms should cover the penis
during fellatio (giving "head " to a man). The
appropriate use of condoms is critical when considering
the HIV virus. Since infection invariably leads to AIDS
(97%) and AIDS invariably results in premature death...
each sexual encounter must be evaluated in that
light.
When
toys are used that result in contact with bodily
secretions... for example, a vibrator used for vaginal
or anal intercourse... it should ONLY be used with that
partner and not shared between partners.
------------------------------------------------------------------------
III.
Injuries... Prevention and Treatment
A.
Picking The Right Partner:
The most important factors in the prevention of injury
during D/s activity are picking the right partner and
using common sense. For
a sub, picking the right dominant is crucial. In order
to avoid injuring a sub, a dominant must have control of
him/herself, and a deep sense of responsibility to
protect the well being of those in his/her care. Skill
and knowledge of techniques employed ain't bad, either.
B.
Safety tips for Subs:
First
meetings are particularly risky. There are many sources
of information on safety tips. I recommend a chat room,
safe for new subs, on AOL as a place to ask questions
and get helpful advice from knowledgeable people. Also,
safety tips can be found at the following website: http://www.mouse~works.com/subnation/main.html
. Submissives
should always know how and feel free to use a safeword
or gesture to stop D/s activity at any time. A safeword
is a word that when uttered, signals the dominant
partner to STOP immediately. If unable to speak... (as
when gagged).... a safe gesture is employed.
C.
Alcohol and Drugs:
The use of alcohol and/or drugs is to be avoided
during D/s play as it clouds judgment.
TThe
dominant partner may not be able to exercise the
necessary control when intoxicated, and the submissive
partner might not be able to accurately assess her
limits.... leading to injury. DRINKING/DRUGGING AND D/s
DO NOT MIX.
D.
Specific Injuries.... Prevention and Treatment
Poor circulation:
In
using restraints, care must be taken not to compromise
the circulation of the restrained limb. Restraints must
NOT be so tight as to cause the following: numbness and
tingling (pins and needles), cold sensation (can also be
checked by the dominant by touching hands or feet); blue
color of hands/feet; diminished sensation; burning
sensation. Serious injury can result if these signs and
symptoms of compromised circulation persist. The
restraint must be released at the first sign.
Choking:
While
I have no idea how common this practice is in the D/s
community.... it is so potentially dangerous I have to
speak to it. Choking.... compressing the neck.... is
sometimes done as part of sex play.... (erotic asphyxia)
..in which case the choking is used to heighten orgasm.
Any miscalculation can result in death by strangulation.
Choking in any other context... as part of power
exchange... not only carries the risk of miscalculation
resulting in serious injury or death. Some people are
especially sensitive to carotid pressure and develop a
slowed heart rate in response. This can result in simple
fainting, or more severe heart rhythm disturbances. For
this reason, choking is not a recommended activity.
Bruises:
In
the context of D/s play, not all bruises can be
prevented. Those who engage in activities leaving
frequent bruises do well to consider the following. On a
daily basis, taking 1000mg. of vitamin C... which helps
with tissue repair. Avoid the frequent use of aspirin,
ibuprofen (Motrin), naprosyn (Naproxen, aleve) and other
drugs of the nonsteroidal antiinflammatory class.
Activities leaving bruises are to be completely avoided
if a person is taking COUMADIN, a drug to prevent
clotting. Bruises can be treated simply with ice for the
first 24 hours followed by application of heat.
Lacerations:
This
is the medical word for a cut. Welts that bleed are
forms of lacerations, as are those inflicted by knives
or razors. The two main considerations with lacerations
are first: blood is a body fluid that can transmit
disease, and disposable gloves should be worn when
treating a partner's lacerations..... Secondly, the
prevention of infection. Lacerations should be washed
with warm, soapy water and if significantly open,
dressed with an antiseptic ointment (bacitracin is good)
and covered with a bandaid or sterile dressing. Minor
bleeding can be stopped with direct pressure over the
wound. If bleeding persists, consult a physician or go
to emergency room.
Abrasions:
These
are rubbing injuries, typically sustained from
restraints. Also from carpets... the so called rug burn.
These should be washed with warm, soapy water, and if
significant, dressed with bacitracin and covered with a
sterile dressing and gauze.
Burns:
First
degree burns result in reddened and painful skin. Second
degree burns blister. Third degree burns destroy tissue.
Extensive second degree and any third degree burns
require medical attention. Minor burns should be treated
immediately with immersion in cold water. Grease...
butter, petroleum jelly, etc. should NOT be used. Burns
blisters, when opened, should be treated as abrasions
and covered with bacitracin and dressed with a sterile
dressing.
Vaginal Injuries:
To
prevent injury to vaginal tissues, care should be taken
not to introduce anything into an unlubricated vagina.
If sufficient vaginal secretions are not generated, a
water based lubricant such as KY jelly should be
employed. Care should be taken introducing large objects
at the introitus... the entrance to the vagina, as the
tissues there can be torn if excessive force is
employed. Douching, unless prescribed by a physician, is
NOT recommended. The vagina is self cleaning. (Much
better even than an oven). Should there be soreness,
redness ,swelling etc., these should be checked by a
physician as some STDs present that way and
distinguishing injury from infection can sometimes be
difficult. Objects that are breakable (such as light
bulbs) must never be inserted into the vagina.
Anal injuries:
See
above. Liberal use of KY jelly is critical, as is slow
penetration of the anus, allowing tissues to stretch and
the muscles to relax. Enemas should NOT be used to
"clean" the rectum following any vigorous anal
penetration because there are always microtears in the
rectal wall. Introducing an enema under those conditions
could cause serious infection and illness. Enemas given
recreationally should not contain chemicals, should be
around skin temperature, and should not be given too
fast. CONDOMS MUST BE WORN FOR ANAL INTERCOURSE TO
PROTECT AGAINST STDS. Any object ... finger, dildo, or
penis, used in anal play must be thoroughly cleaned in
warm soapy water before being put into the vagina or
mouth in order to prevent infection. Condoms should be
changed when switching from anal to vaginal or oral
intercourse. Glass objects do not belong in rectums. Be
careful not to lose anything inserted into the rectum...
unlike the vagina, which is a closed space, the rectum
is an large vault and items can be difficult to
retrieve. Please leave mice and guinea pigs in their
cages.
Penile injuries:
Use
common sense. If catheters are used, they should be
sterile and used ONLY for that sub once. Rubber cannot
be resterilized. Do not force anything into the
urethra... (the opening into the penis). If compression
of the penis is practiced with any kind of device, pain
is a good barometer of when to stop. Any deep
lacerations sustained to the penis must be evaluated
medically. Lacerations in this area should be avoided.
Animals:
If
an animal is used in erotic play, a muzzle should be
used to prevent animal bites which are serious,
especially to the face. The animal's toenails should be
clipped as well.
Beating:
There
are some areas of the body that should be avoided when
administering a beating. The kidneys area, which is
located on the back where the ribs join the spine, is
one such area to avoid. The area of the spleen is also
vulnerable to excessive force. This area is on the left
side of the abdomen just under the ribs. Head injuries
can be serious and heavy blows to face and head are not
wise. Stick to the tush, the upper back, shoulders, and
legs.
Frostbite:
Sometimes
ice is used in D/s play. If there is prolonged contact
to skin, frostbite can result. The first response to
cold is blueness to the area... then redness and burning
or diminished sensation.... followed by tissue injury.
The area must be rewarmed IMMEDIATELY in WARM, not HOT
water. Serious, extensive frostbite needs to be seen by
a physician. The extremities... the fingers and
toes...are most likely to get serious frostbite.
Wax:
Use
only paraffin candles for wax play. The height that the
wax is dropped from determines how hot it will be when
it hits the skin. Less than 6 inches dripping height
CAUSES BURNS... avoid this.
Bite
wounds:
Bite
wounds on the face should be avoided and if serious,
should be seen by a doctor. All bites should be
thoroughly cleaned with warm soapy water, covered with
bacitracin and a dry sterile dressing. Infection is the
major complication of bites. Signs of infection include:
redness extending from the wound, swelling around the
bite, pain at the site, heat at the site and fever. An
infected bite is very serious and should be treated by a
doctor.
Electricity-related
injuries:
If
toys are used that involve electricity, the major injury
is an accidental burn. These should be evaluated and
treated as outlined in the burn section above. Please
keep all electric toys away from water, and check all
wires before play to make sure they are intact, and not
frayed. Should electric shock occur, the possibility
exists that the person's heart will stop and CPR will be
required. Before touching the person, make sure that the
electric source is off.... interrupt it using an
insulated item or at the source (circuit breaker). If
the person is not breathing , and you know CPR... follow
the protocol. Otherwise, call 911 and tilt the person's
head back (person is positioned on back) to open the
airway. Taking a CPR basic course is the best way to
save a life.
Strains and sprains:
These
are injuries sustained to ligaments and tendons around
joints. They may be complications of restraint and
suspension. If pain is so severe that the joint cannot
be moved, a doctor consultation is advisable. For minor
injuries, remember RICE: Rest, Ice, Compression and
Elevation. Rest the affected joint. Use ice for 24
hours, then heat. Ace bandages can provide compression
and reduce swelling. Elevate the effected joint.
Branding, Cutting and Piercing:
These
activities by their very nature cause injury. Any
activity that breaks the skin must be done under sterile
conditions. This means the skin must be cleaned first
with warm soapy water... Then, the area should be washed
with betadine. Allow the betadine to dry, then wipe off
with an alcohol wipe. The person doing the activity
should be wearing sterile gloves, both to protect
him/herself from blood contamination, as well as
protecting their partner from infection. Any of these
instruments should only be used if they are sterile.
Either purchase them in a sterile fashion and discard...
as with needles... or sterilize. An item can be
considered sterile if it is brought to a rolling boil
and kept there for 20 minutes. It must be completely
immersed in the boiling water. These activities may
result in infection... please see above for signs of
infection and treatment. Any infection accompanied by
fever should be evaluated IMMEDIATELY by a doctor. These
activities will result in bleeding. Minor bleeding can
be stopped by continuous, direct pressure over the
wound. Remember to wear gloves. If bleeding is spurting
out, an artery may have been opened and this requires
emergency medical treatment. Apply direct pressure and
get to a hospital. Another complication of these acts
may be shock, due to excessive blood loss. Follow
guidelines for treatment of active bleeding.. keep the
person warm, and raise the legs higher than the head.
Get emergency medical attention. Shock can be recognized
by pallor, sweating, tremulousness, faintness, rapid,
thready pulse and loss of consciousness..
Psychological
risks:
The
D/s power exchange can be a deeply fulfilling, joyous,
and thrilling way of life in the right context. Some
"mental health awareness" unique to our
community seems in order. There is a pattern for
submissives particularly, to be aware of. In pain play,
for example, the central nervous system responds with an
outpouring of endorphins.. the natural painkiller.,
whose chemical structure is similar to morphine. This
may indeed be the physiologic basis of subspace..... As
this wears off.. there is a "letdown" and
should not be confused with depression. Depression that
is clinically significant lasts 2 weeks or more, and is
characterized by persistent low mood, decreased energy,
disturbed sleep and appetite, feelings of helplessness
and hopelessness, and sometimes suicidal thoughts,
delusions and hallucinations. These symptoms should lead
one to consult a physician. Other hazards include those
associated with the use of sleep deprivation..... (one
should not drive sleep deprived!) . Psychological
consequences of sleep deprivation include altered
perception... (hallucinations), unstable mood,
irritability, decreased fine motor performance and
impaired judgment. Much the same picture is produced by
prolonged sensory deprivation.
Psychological health between dominants and submissives
is fostered by clear, open communication, respect, trust
and communication , communication , communication. If
you can't talk to each other, you shouldn't play!
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I
hope this document has been useful to you. Please
consult a doctor for any questions or concerns you may
have. Better to be safe than sorry. Better to be
informed than not. What you don't know, in this area CAN
hurt you.
Long life, good health, play safe.
A D/s Physician
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