BDSM Bullshit, Part 1: Impact play over bruises

During my time in the kink scene, I’ve heard some amazing myths, misconceptions, and complete and utter bullshit. Some of them I heard during casual conversation. Some of them I heard from a presenter standing in front of a class. Some of them dropped my jaw. Some of them made me blink in confusion. Some of them made me facepalm. All of them are really kinda ridiculous (and some are outright dangerous)… but if something is said enough it gets an aura of truth, or “truthiness” as Colbert might say. Well, despite their truthiness, I’d like to dissuade your belief in some kinky myths. Because there are plenty of real risks to WIITWD without making up more! If people are interested in this particular rant, I may get back on my soapbox to address other myths, with possible topics to include:

So, impact play over bruises. I have two super fun BDSM myths about this, and the really amusing part is they are completely opposite in their recommendations! Let’s start with the easiest one- I recently was sitting in a class where the instructor said something like this (I wrote down as exact a quote as I could): “You can help a bruise heal FASTER by tapping and hitting over it, as that *breaks up the blood clot and keeps the bruise from coming to the surface*.”

All I can do is double facepalm. Bruises are caused by trauma. Further trauma WILL NOT HELP THEM HEAL, IT WILL JUST CAUSE MORE BRUISING. Seriously… what the fuck. Here are some things you can do in the first few days that will actually speed healing of a bruise: applying ice (on for 10-20 minutes every couple hours) and avoiding hot showers/baths for the first 48 hours, resting the area, applying gentle compression (wrapping in an ACE bandage), and elevation [3][4]. NSAID use (ibuprofen, naproxen, etc) is controversial. [5] The studies I read (such as this one: [6]), do not support the effectiveness of arnica use, although arnica is popular in the kink community. AFTER the first three days, GENTLE massage (stopping if there is any pain) and heat MAY help a bruise heal– studies to prove or disprove this are lacking.

Moving on- myth 2 goes something like this: “Impact play on top of already existing bruises can cause a portion of that bruise to become dislodged and cause a stroke.”BaGG birthday aftermath

Let’s take this bullshit a step at a time. This myth relies on two pieces of layman’s physiology: 1) Bruises happen when we break blood vessels under the skin and those blood vessels bleed into the surrounding tissue, where the blood sits and forms clots. 2) Some strokes are caused by a blood clot traveling into your brain. So far, sorta OK, but a little knowledge sometimes only means that your bullshit will sound more convincing.

First step- how could a soft blood clot be pushed through a vein wall and end up in your circulation? Vein walls are not full of big holes like tubes of swiss cheese or something. Now, when we get down to the level of capillaries, they do have some permeability, but this is at the level of gas/nutrient exchange, NOT at the level of big gaping holes that blood clots can get smashed into. Also, veins are spongy and collapse under pressure. Trying to force a blood clot into a vein would be like putting a wet sponge on top of a partially filled water balloon, hitting the sponge with a bat, and thinking that the sponge is somehow going to end up inside the (still intact) balloon.

Now for the real fun- even if you did get a blood clot in a vein in your legs/ass/back, it would not give you a stroke because of how your circulation works. The veins in your body feed into the right side of the heart, which then sends blood to the lungs to be oxygenated. Then the blood comes back to the left side of the heart and is pumped to the rest of your body, including your brain. Because why would your body send deoxygenated blood from your ass straight to your brain? It wouldn’t. Your body knows better, even if you do not. So, very special circumstances (patent foramen ovale and elevated RA pressures, for those interested) exempted, clots from your peripheral circulation (such as a DVT, or deep vein thrombosis) that break off and end up in your central circulation will go to your lungs and cause a pulmonary embolism, not to your brain to cause a stroke. A pulmonary embolis is a bad thing to have happen, by the way, and it could be caused by BDSM play, but it’s not going to be caused by impact play over bruises. It’s much more likely to be caused by leaving someone in tightly restricted bondage for a long time (hours), especially if the legs are in a dependent (lower than the rest of the body) position. You’ve heard of people getting blood clots from sitting on an airplane? Same concept.

Now that we’ve established that having a stroke is NOT actually a risk of doing impact play over existing bruises, and that impact play over bruises will NOT help them heal faster (seriously- WTF), does that make it an OK thing to do? Are there actual risks to this practice? Well, you could end up getting a hematoma, which is a fancy medical word for “big fucking bruise”- this is when blood collects in a muscle or under the skin in a large enough amount that the body has difficulty re-absorbing it. In extreme cases, these have to be drained by a doctor, and there is an infection risk involved in having a large collection of blood just sitting there under your skin. There is also risk of pressure from the hematoma damaging nearby tissues, including nerves. I would worry more about this on an area like the inner thigh (lots of nerves and blood vessels fairly close to the surface) than on the ass (though, you know, the sciatic nerve is there, and damage to the sciatic nerve sucks). A lot of tissue damage causing a very large bruise, especially in a vascular area like the inner thigh, could also cause something called “compartment syndrome”- which is when the swelling cuts off blood flow to the tissues, possibly requiring surgical intervention to prevent tissue necrosis (death).

Another possible complication from severe or repeated trauma to an area is heterotopic ossification — “healing can be complicated by the formation of ectopic bone within skeletal soft tissues (heterotopic ossification) in patients with severe extremity injuries.” [1] This is most common after surgical procedures such as total hip arthroplasty, total knee arthroplasty, and proximal humeral arthroplasty, and fractures, especially distal humerus fractures, but it also can occur in athletes with high impact sports, such as football players. Speaking specifically to breast impact, there is some evidence that breast trauma can be a risk factor for cancer: “Models of epithelial cell generation indicate that a causal link between physical trauma and cancer is plausible… The most likely explanation of the findings is that physical trauma can cause breast cancer.” [2] There are also indications that trauma causes abnormal tissue (scarification, calcification) that can make cancer more difficult to detect. Most research on the correlation of trauma with breast cancer looks at seatbelt injuries, so there may be limited applicability of this research.  I could write an entire article on breast play, but for now I’ll leave the topic there.

These complications are unlikely to various extents, but a lot MORE likely than impact play over bruises helping them to heal (!!) or giving you a stroke. If we’re going to be scared of things, let’s be scared of REAL things instead of lecturing each other about the dangers of the monster in the closet.

 

References:

[1] UpToDate: Surgical management of severe extremity injury; Jeremy W Cannon, MD, FACS & Todd E Rasmussen, MD, FACS

[2] Can physical trauma cause breast cancer? Rigby JE1, Morris JA, Lavelle J, Stewart M, Gatrell AC

[3] Bruise: First Aid, Mayo Clinic http://www.mayoclinic.org/first-aid/first-aid-bruise/basics/art-20056663

[4] Muscle injuries: optimising recovery. Järvinen TA1, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M.

[5]  Treatment of skeletal muscle injury: a review. Baoge L1, Van Den Steen E2, Rimbaut S2, Philips N2, Witvrouw E3, Almqvist KF4, Vanderstraeten G5, Vanden Bossche LC2.

[6] Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery. Stevinson C1, Devaraj VS, Fountain-Barber A, Hawkins S, Ernst E.

Thank you to Dr. Who for his contributing thoughts on this subject!

Whenever I write something like this, I am asked about my “qualifications”- which is certainly a reasonable question. I’m an ER nurse and ACLS (Advanced Cardiac Life Support) instructor. I also got input on the ideas in this post from a kinky MD (Dr. Who). I would, however, emphasize that I’m not posting this in any sort of “official” capacity- it’s a rant, not medical advice. Also, nurses (and doctors!) can and do say idiotic/incorrect things, so using your own judgement no matter how “qualified” the source is always a good thing. Thanks!

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