Sexual masochism disorder falls within the category of psychiatric sexual disorders known as paraphilias, which involve recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling and have the potential to cause harm to oneself or others. Sexual masochism refers to engaging in or frequently fantasizing about being beaten, bound, humiliated, or otherwise made to suffer, resulting in sexual satisfaction. If people with this sexual preference also report psychological or social problems as a result, they may be diagnosed with sexual masochism disorder. The types of distress that people with this disorder may experience include severe anxiety, guilt, shame, and obsessive thoughts about engaging in sexual masochism. (If a person has a masochistic sexual interest but experiences no distress and is able to meet other personal goals, then they would not be diagnosed as having a disorder.)
One specific type of sexual masochism is called asphyxiophilia, in which a person receives sexual satisfaction by having their breathing restricted. While some people engage in this practice with partners, others prefer to restrict their breathing while they are alone, and accidental death may happen as a result.
Sexually masochistic behavior is usually evident by early adulthood, and sometimes begins with masochistic or sadistic play during childhood.
To be diagnosed with sexual masochism disorder, according to the DSM-5, a person must experience recurrent and intense sexual arousal from being beaten, humiliated, bound, or from some other form of suffering. These types of urges, fantasies, or behaviors must be present for at least six months and cause clinically significant troubles or difficulty in social, occupational, or other important areas in life.
The extensive use of pornography involving the act of being humiliated, beaten, bound, or otherwise made to suffer is sometimes an associated feature of the disorder.
There is no universally accepted theory explaining the root of sexual masochism. However, some theories attempt to explain the presence of sexual paraphilias in general. One suggests that paraphilias originate because when inappropriate sexual fantasies are forbidden, they become stronger as they are suppressed. When they are finally acted upon, a person is in a state of considerable distress and/or arousal. In the case of sexual masochism, masochistic behavior becomes associated with and inextricably linked to sexual behavior. Another theory suggests that sadomasochistic behavior is a form of escape. Through acting out fantasies, these individuals feel new and different. Theories stemming from the psychoanalytic camp suggest that childhood trauma such as sexual abuse, or other significant childhood experiences, can later manifest in a paraphilic disorder.
Treatment for sexual masochistic disorder typically involves psychotherapy and medication. The goal of psychotherapy may be to uncover and work through the underlying cause of the behavior that is causing distress. Cognitive therapies include restructuring cognitive distortions and empathy training. Restructuring cognitive distortions involves correcting any beliefs a patient has that may lead them to act on harmful thoughts. Cognitive-behavioral therapy can also help an individual learn skills to manage their sexual urges in healthier ways. Other common strategies include aversion therapy and imagery/desensitization techniques, in which individuals imagine themselves in a situation where they are participating in sexual masochism, and then experience a negative event to reduce future desire to participate in that activity again.
Various medications can be used to decrease the level of circulating testosterone in the body with the aim of reducing the frequency of erections. Antidepressant medications may also be used to reduce sex drive.