BDSM Bullshit Part 4- Impact play on calves and DVTs

What is it with kinky people and myths about DVTs? I don’t understand why this is a thing. On this episode of kinky mythbusting, I’ll address DVTs and kinky things that don’t cause them yet again…

 

Question (sent to me and shared with permission):

The other night I witnessed a scene where the top was using a heavy, hard impact implement on the calves of his bottom’s legs. This concerned me as my training (admittedly years ago) taught us to avoid this area as it can cause deep vein thrombosis which can lead to blood clots and serious injury or in extreme cases, death. Is my memory serving me correctly or am I in error here. Your thoughts are appreciated.

 

My reply:

A deep vein thrombosis (DVTs) doesn’t “lead to” a blood clot, it IS a blood clot. Bruises are blood that pools/clots OUTSIDE the veins/capillaries. DVTs are clots that form deep INSIDE the veins. “A risk factor for thrombosis can be identified in over 80 percent of patients with venous thrombosis… there is often more than one factor at play in a given patient.” [1] Common risk factors are pregnancy, oral contraceptive use, more than 48 hours of immobility, inherited thrombophilia, malignancy, or infection. [1] In the ER, we most commonly see DVTs in people who have cancer and/or who are immobile- after surgery, or when they have a leg in a cast, for example. “The risk of thrombosis is increased in all forms of major injury.” [2] See this article for info on the signs and symptoms of DVT.

If trauma injures the wall of a large and deep-seated vein, it could make conditions right for a deep-vein clot to form. For example, there is a high incidence of DVTs in IV drug users who inject into their femoral vein, due to irritation, infection, and trauma. [3] In terms of trauma from impact play, these veins are deep in the tissue and are flexible. Causing damage to them, resulting in clot formation as a DIRECT result of a blow, is not something I’ve ever seen in the ER or found in the literature. Much MORE concerning would be if pain/bruising caused the bottom to significantly decrease their mobility, even just for a few days, because immobility is a risk factor for DVTs (although it does not directly cause DVTs). DVTs are mainly concerning because clots can travel from the leg to the lung, causing a serious condition called pulmonary embolism. The idea of a clear path from calf DVT to thigh DVT to pulmonary embolism is a misrepresentation, and research based treatment options are sketchy (details of this are outside the scope of this article).

A little anecdotal story: I have a friend who injured his knee doing resistance play. He was given a knee immobilizer, and while he was nursing this injury (which very much decreased his mobility) he got a DVT, then he got a pulmonary embolism (blood clot in the lungs). Pulmonary embolism is potentially fatal, and he was on anticoagulants for months. Point being that if you’re going to obsess about DVTs, I’d personally worry more about resistance play/wrestling (IMHO the most dangerous types of play we kinky perverts do, and the cause of a majority of kink-related ER visits I’ve seen) rather than direct trauma to a calf from, say, caning.

Impact play over bruises also will not cause DVTs/pulmonary embolism. However, all of this is not to say that there aren’t real risks of deep, heavy impact play- of course there are! More on that here!

 

References:

[1] Overview of the causes of venous thrombosis, UpToDate.com. Kenneth A Bauer, MD, Gregory YH Lip, MD

[2] Goldhaber SZ. Risk factors for venous thromboembolism. J Am Coll Cardiol 2010; 56:1.

[3] High prevalence of iliofemoral venous thrombosis with severe groin infection among injecting drug users in North East Scotland: successful use of low molecular weight heparin with antibiotics. Mackenzie AR, Laing RB, Douglas JG, Greaves M, Smith CC, Postgrad Med J. 2000;76(899):561.

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 (Miette Rouge). I would, however, emphasize that I’m not posting this in any sort of “official” capacity- this is 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!