Private Duty: Negotiation

This article  originally appeared in Kink-E-Zine, in a column called “Private Duty” that had an ask-the-kinky-nurse format. These articles were edited by a kinky MD, Dr. Who.

Question: I’m a somewhat new top and I’m just starting to play with more people. I want to be responsible so I’ve used a long negotiation form that includes a bunch of health questions, but I’m totally confused by some of the questions on the form, and I’m just not sure what to do with all that information anyway. The bottoms I’ve played with have mostly not had any health issues, or at least none they’ve put on the form… What are really the important things to ask someone you’re going to play with, and what does the information mean?

Holy shit, this is a big question. Probably the answer could be delivered in novel form, but my editor tells me to keep this column to about 500 characters (this one’s going to be long, sorry editor), so I want to say up front that this answer is going to be incomplete. I almost hesitate to answer this question at all, but in the spirit of Voltaire (“the perfect is the enemy of the good”), let’s plow forward.

In general, as a top it’s your responsibility to make sure that your bottom is in adequate health to endure the activities you’re planning to do. A heavy physical scene requires a certain degree of physical fitness and might not be suited for someone who has had a heart attack in the past. But even something like a pure protocol training session might cause problems, for instance if you expect your bottom to kneel for extended periods of time and they have a history of arthritis in their knees.

Accordingly, the health information that you need to know as a top will vary a lot depending on what type of play you’re going to do. A heavy impact scene involving chain and a half-a-cow flogger nicknamed “Big Bertha” is going to require different negotiation than a scene that’s more about D/s and position training, and that again is much different than negotiating a piercing scene that will end in oral sex. I really recommend that you get a mentor to go over this with you, or perhaps attend a negotiation class.

I want to start out with HOW you ask about health issues, because that will play a big part in what information you will be given. If you ask the bottom, “Do you have any health problems?” in many cases, without really thinking, they’ll shrug and say “no, not really!”  A much better question to ask is: “What medical or health issues do you have?” or “What medications to you take?” These are more open-ended and doesn’t allow for a simple “nope it’s all good”- which is almost never an accurate answer, by the way.

Regardless of the type of scene you’ll be doing, one of the key health issues to cover is asthma, so that you know whether your bottom might start having trouble breathing in the middle of your scene. Stress and intense emotion, as well as physical exertion, are common triggers for an asthma attack- since BDSM play can cause those things, it’s not at all uncommon to see bottoms have asthma attacks in mid-scene. Someone who has asthma should have an albuterol (“rescue”) inhaler- ask them where their inhaler is and have them put it somewhere accessible when you play.

Heart problems can surely lead to disaster if not properly accounted for. Histories of a heart attack or chest pain are more common than you might think. Young adults can have heart diseases which can lead to sudden death. Of course you’re most probably not a doctor, so you might have a hard time diagnosing the exact state of your bottom’s exercise tolerance. But you can just ask about other recreational activities your bottom enjoys: if they do a 2 hour hike once a week they’ll probably survive some physical abuse. If they have shortness of breath after climbing a flight of stairs – well, you’ll better take it slowly.

Bloodborne disease status is always good to know (hepatitis and HIV are the big ones). When I top, I always disclose when I was last tested, as well. Of course this is much more relevant for some scenes (those involving sexual contact or subcutaneous play) than for others (a scene involving receptive foot worship and then watching the bottom jerk off would be pretty close to zero risk).

Many types of play will involve some sort of strain on the bottom’s joints- kneeling can be hard on the bottom’s knees, most bondage is at least somewhat strenuous on the joints involved, hair pulling can be a problem for someone with chronic neck issues, etc. So I ask about joint problems. I tend to do this as part of a “whole body review”- while we’re talking, I’ll start at the bottom’s head and work my way down, asking questions as I go.

It’s very important to know if someone is diabetic, for two main reasons. Diabetics tend to have trouble with circulation to their extremities- I would never do impact/subcutaneous play below the knees on any diabetic, and would go as far to not do any play below the waist for someone with severe diabetes. The other issue with diabetics is blood sugar fluctuations. From a scene perspective, I would mostly be concerned about a drop in blood sugar (this can be caused by taking diabetic medications but not eating normally).  Symptoms of low blood sugar include cold, clammy skin, confusion, trembling, and more (google “symptoms of hypoglycemia” for more info than you could possibly want). If you’re playing with a diabetic, you would want to have some easy source of sugar around (juice works well) to give them in case they start to feel (or you start to suspect) that their sugar is low. Again, BDSM and diabetes could be a whole chapter, if not book, all by itself.

Blood thinners are another important point to consider. If the bottom is on heavy-duty blood thinners like coumadin, they could have severe bleeding or bruising from even mild play, and I would consult a kink aware medical professional before attempting to play at all (the same applies for someone with any form of hemophilia, which are clotting disorders). If they’ve taken something like ibuprofen, aspirin, naproxen, or other more mild blood thinners, this is something to be aware of but not necessarily a red light. Just know that if your bottom has taken one of those medications, anything that breaks the skin will cause more bleeding that you expect, and that bruising will also be more than you expect.

Surgical history is another area to cover- it would be bad to discover that your bottom has breast implants only after you’ve got saline leaking out from a play piercing you just placed.

These are just the highlights, and this column is not in any way an exhaustive discussion of this topic. Hopefully this has at least given you some ideas of the truly key information! And one more thing: taking a first aid and/or CRP class is a good idea if you want to be a responsible, confident dominant.