The Biology of BDSM: A Systematic Review

J Sex Med. 2022 Jan;19(1):144-157. doi: 10.1016/j.jsxm.2021.11.002. Epub 2021 Dec 6.


Introduction: BDSM is an abbreviation used to reference the concepts of bondage and discipline, dominance and submission, sadism and masochism, enacted by power exchanges between consensual partners. In recent years, attention has shifted from the idea of BDSM as a pathological and tabooed niche practice towards viewing BDSM as a healthy form of intimacy.

Aim: This systematic review brings together all existing literature on the biology of BDSM and places it in a broader biological context.

Methods: A systematic search was conducted on PubMed, Web of Science and PsycARTICLES, of which 10 articles are included and discussed in this systematic review.

Results: There is evidence for cortisol changes in submissives as a result of a BDSM interaction, suggesting involvement of the physiological stress system. Endocannabinoid changes implicate the pleasure and reward system. In dominants, this biologically measured pleasure seemed to be dependent on power play rather than pain play. Testosterone and oxytocin are also implicated in BDSM, though their role is less evident. Research into brain region activity patterns related to BDSM interest suggests a role for the parietal operculum and ventral striatum in the context of the pleasure and reward system, the primary and secondary somatosensory cortex in the context of pain perception, empathy-related circuits such as the anterior insula, anterior midcingulate cortex and sensorimotor cortex and the left frontal cortex in the context of social and sexual interactions. Pain thresholds are shown to be higher in submissive individuals and a BDSM interaction may cause pain thresholds to rise in submissives as well.

Conclusion: BDSM interactions are complex and influenced by several psychological, social and biological processes. Though research is limited, there is emerging evidence for an interaction between several biological systems involved in these types of interests and activities. This means there is an important role for future research to replicate and supplement current results. Wuyts E, Morrens M. The Biology of BDSM: A Systematic Review. J Sex Med 2022;19:144-157.

Keywords: BDSM; Biological Assessment; Functional Brain Imaging; Pain Threshold; Sexuality; Submissive.

Publication types

  • Systematic Review

MeSH terms

  • Biology
  • Humans
  • Masochism* / psychology
  • Pleasure / physiology
  • Sadism* / psychology
  • Sexual Behavior / psychology