Social Science & Medicine 99 (2013) 169e175

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Social Science & Medicine

journal homepage: www.elsevier.com/locate/socscimed

Health discourse and within-group stigma in professional BDSM

Danielle J. Lindemann
Center for Women and Work, Rutgers University, 50 Labor Center Way, New Brunswick, NJ 08901, USA

a r t i c l e i n f o

a b s t r a c t

Article history:
Available online 31 August 2013

This article directly deals with health and stigma within practices of erotic labor. Scant previous literature
has focused on erotic laborers perceptions of stigma and the ways in which regimes of stigmatization
operate within their particular social worlds. I use the commercial BDSM (Bondage, Discipline, Sadism,
Masochism) dungeon as a strategic research site to investigate these workers conceptions and management of their own stigma, and I nd that discourses about stigma are inextricably entwined with
concerns about health and wellbeing. Data are derived from ethnographic eldwork with professional
dominatrices (pro-dommes) who work in New York City and San Francisco as well as in-depth interviews conducted between September 2007 and April 2008. Counter to stereotypes of erotic laborers as
violent or as vectors of disease, BDSM workers are in fact not only concerned about safety but professionally invested in it, reinforcing it through an identity politics of hierarchies of erotic labor. There are
multiple implications of this work for public perception and policydimplications that could only be
brought to light through the ethnographic method.
2013 Elsevier Ltd. All rights reserved.

Keywords:
United States
Sex work
Disease
BDSM
Dominatrix

Introduction
Scholarly work, journalistic discourse, and policy debates surrounding the topics of sex work and BDSM (Bondage, Discipline,
Sadism, and Masochism) have long been focused on the subject of
health. Literature addressing the public health risks of erotic labor
often mobilizes epidemiological concerns about disease transmission, as well as concerns about systemic violence and the safety
of individuals who engage in these practices. Similarly, a central
thread within journalistic pieces addressing the topics of both sex
work and BDSM has been the physical well-being of their practitioners (Goldman, 2008; Hallgrmsdttir, Phillips, Benoit, & Walby,
2008; Stephenson, 2012).
While pursuing an ethnographic analysis of BDSM communities
in New York and San Francisco, I encountered a recurrent discourse
that is particularly illuminating in light of these historical emphases. Professional dominatrices (pro-dommes) systematically
authenticated their own actions by referring to themselves as
pure and real as opposed to other participants, whom they
stigmatized for an array of reasons. In previous work, I have discussed various elements of this embattled purity regime
(Lindemann, 2012), including pro-dommes focus on their work as
artistic (Lindemann, 2010) and on the therapeutic properties of

E-mail address: Danielle.lindemann@gmail.com.

0277-9536/$ e see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.socscimed.2013.08.031

BDSM (Lindemann, 2011). Here, I will unpack two central components of this discourse: health and safety. In doing so, I dene
health and safety as overlapping terms that refer to the positive
condition of the body (as in, freedom from disease) and physical
well-being (as in, freedom from non-consensual pain or physical
injury), respectively.
I nd that many pro-dommes routinely engage in within-group
stigmatization, symbolically distancing themselves from their
counterparts who put their own safety in jeopardy as well as those
who compromise their clients health. By engaging in this form of
identity politics, they duplicate public discourses about these sexual practices, providing a compelling example of how healthrelated stigma can function internally as a form of validation
within a marginalized population. Put in other terms, pro-dommes
engage in techniques of neutralization (Matza & Sykes, 1957).
These purifying narratives concerning health and safety represent a
method of subscribing to the dominant system, in some senses, to
manage the stigma of the profession.
Much prior work has called attention to the stigmatization of
sex workers (Cornish, 2006; Scambler, 2007; Schur, 1984; Shoham
& Rahav, 1968) and has discussed the health dimensions of these
stigmas (Okal et al., 2009; Padilla et al., 2008; Scambler, 2008).
However, with some notable exceptions (Bernstein, 2007; Moore,
2007), scant research has focused on erotic laborers own perceptions of stigma and the ways in which regimes of stigmatization
operate internally within their particular worlds. Furthermore,
while literature concerning participants in BDSM has paid attention

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D.J. Lindemann / Social Science & Medicine 99 (2013) 169e175

to the health-related dimensions of these practices (Beckmann,

2001; Downing, 2007; Easton & Hardy, 2004; Henkin & Holiday,
1996), these works largely focus on unpaid practices; scant
research has addressed the links between commercial BDSM,
health, and safety.
In examining this particular discourse, I draw attention to the
ways in which the ethnographic method and interviewing, with
their capacities for investigating meaning (Geertz, 1973), can
uniquely contribute to public discourses about non-normative
erotic practices. Ethnographic research becomes a crucial tool for
unpacking the connotations erotic laborers ascribe to their cultural
practices. As a venue where the woman ostensibly plays the
dominant role in the erotic transaction, the dominatrixs dungeon
serves as a strategic research site in which we can evaluate the links
between erotic labor, BDSM, health, and policy interventions.
Background and signicance
Public health research at the intersection of erotic labor and BDSM
The sphere of commercial BDSM lies at the intersection of
multiple scholarly and public debates surrounding health and wellbeing. First, erotic labor has long been the topic of research and
broader social concerns about hygiene and disease transmission.
Much of this work has focused on safe sex practices, exploring
various dimensions of prophylactic use (Bucardo, Semple, FragaVallejo, Davila, & Patterson, 2004; Choi & Holroyd, 2007; Garcia,
Yam, & Firestone, 2006; Hansen, Margarita Lopez-Iftikhar, & Alegria, 2002; Pickering, Quigley, Hayes, Todd, & Wilkins, 1993).
Researchers have also looked at the use of alcohol and drugs
among sex workers and their clients as these behaviors relate to
condom use, as well as looking at their public health implications
more generally (Casabona, Snchez, Salinas, Lacasa, & Verani, 1990;
Plant, Plant, & Thomas, 1990; Tuan et al., 2004; Van den Hoek,
Coutinho, van Haastrecht, van Zadelhoff, & Goudsmit, 1988).
Other scholarship has concentrated on substance abuse as a factor
in the physical well-being of sex workers (Carey & Peterson, 1974;
Davis, 1971; Maticka-Tyndale, Lewis, Clark, Zubick, & Young,
2000; McKeganey & Barnard, 1996; Sanders, 2007).
Additional work has also brought into focus some of the other
health risks inherent in the lived realities of commercial erotic
workers. These include unclean and unsafe work environments
(Overs & Longo, 2003; Scambler, Peswanie, Renton, & Scambler,
1990), harassment and violence (Miller & Swartz, 1995;
Vanwesenbeeck, de Graaf, van Zessen, Straver, & Visser, 1995),
victim-blaming and inaction by the police (Miller & Swartz, 1995),
and customers who incentivize more dangerous sexual practices
(Higrd & Finstad, 1992). While much literature surrounding disease transmission, violence, and safety within sex work has focused
on prostitutes in particular, physical risk has been a theme within
scholarship about various types of erotic labor. For example, exotic
dancers express many of the same physical and emotional health
concerns as prostitutes do (Maticka-Tyndale et al., 2000; see also
Brooks, 2010; Lewis & Maticka-Tyndale, 1998).
Finally, various literatures have discussed the safety issues
associated with practices of BDSM. Historically, research about
consensual sadomasochism has broached the topic from the stance
of concern or alarm about its psychosocial repercussions (Avery,
1977; Freud, 1938; Krafft-Ebing, 1965: 53). While more recent
research has begun to move away from characterizing practices of
BDSM as psychologically unhealthy (Sandnabba, Santtila, &
Nordling, 1999: 273; Scott, 1997: 289; and Stoller, 1991: 21),
scholars have continued to explore the physical risks involved in
this form of sexual behavior. Powell (2010) nds, for instance, that
the impact of BDSM on health is mixed, with it actually beneting

the health of some practitioners but proving health-wearing on

others.
Finally, this concentration on bodily injury plays into a broader
literature about the connection between perceived violence and
public health more generally. In the past few decades scholars have
focused on the notion of violence as a public health issue (Satcher,
1995) and even a priority (Edelman & Satcher, 1993). Public discourses often discuss the perceived violent characteristics and the
physical risks of BDSM, contextualizing these characteristics within
this broader discussion (Goldman, 2008; Stephenson, 2012).
Health, stigma, and the dungeon: signicance for public discourse
The dominatrixs dungeon serves as a strategic research site that
is uniquely suited to contributing to these interlocking public discourses about erotic labor for several reasons. First, it is an example
of a counterfactual: it is a sphere of erotic labor in which there are
seldom victimization narratives about its practitioners. Yet prodommes have received no empirical consideration within literature on commercial sexuality, little individual attention within the
literature on BDSM, and in fact, almost no scholarly attention at all
(Lindemann, 2010: 590). At the same time, prior scholars have
called out for further empirical work highlighting the diversity of
sex work and its health correlates (Harcourt & Donovan, 2005). In
fact, the scant work that has been done in this area reveals wide
discrepancies among the physical threats involved in various forms
of erotic labor (Cohan et al., 2006; Harcourt & Donovan, 2005;
Jackson, Highcrest, & Coates, 1992). Secondly, while the literature
cited in the above section represents a rich lode of information
about stigma and health among both erotic laborers and BDSM
participants, it touches on but does not fully unpack the internal
regimes of stigma that potentially operate within these marginalized groups.
In ethnographically exploring processes of meaning-making
within this commercial erotic arena, I shine a light on new
contours of commercial eroticism. I also illuminate their implications for debates about health and erotic work more generally.
There are multiple repercussions of this work for public
perception and policy, as they relate to the potential consequences of sex work deregulation, the divergent health risks
associated with different forms of erotic labor, and the importance of the communal elements of identity discourses as they
relate to well-being.
Terminology
Pro-dommes, also sometimes called mistresses, are women
who receive money from clients to participate as the dominant
partners in a variety of sadomasochistic and fetishistic scenarios.
The clients of pro-dommes are primarily male and are referred to as
submissives, subs, or slaves. Engaging in BDSM activities,
commercial or otherwise, is often referred to within the community as doing a scene or playing. Professional dominatrices also
refer to their interactions with their clients as sessions. In contrast
to commercial sessions, unpaid BDSM practices are referred to as
lifestyle practices.
As I will explore, few pro-dommes have intercourse with their
clients, but their work is highly erotic in nature and more often
than not involves sexual release on the parts of the clientsdmost
commonly, through the clients masturbating to climax. Whether
or not one considers these activities sex acts, it is useful to
theorize professional erotic dominance in the context of sex
work because it is like sex work from an analytical perspective in
that it involves nancial compensation for erotically-charged
activities.

D.J. Lindemann / Social Science & Medicine 99 (2013) 169e175

Methods and sample

Data are derived from (non-participant) observational, ethnographic eldwork at a variety of venues in two cities over an eightmonth period, from September 2007 to April 2008. These included
a BDSM club, parties, workshops, meetings, and other events that
constituted the public world of BDSM in New York City and San
Francisco. I never made participation in BDSM activities a part of
my research. While this choice was problematic in some senses, it
also helped me to draw clear boundaries around my role as a
researcher and navigate the tension between distance and closeness in the eld. (While space constraints prevent further elaboration on this topic, a broader discussion of my reasons for these
choices as an ethnographer, and the potential biases involved in my
interactions with my informants, can be found in Lindemann,
2012.)
I also conducted in-depth, semistructured interviews with 52
pro-dommes who worked in the New York City metropolitan area
and 14 professional dominatrices who worked in the San Francisco
Bay area. Fifty-nine of these 66 women also engaged in these
practices in their personal lives. In addition, I conducted ten indepth interviews with men who had paid for erotic dominance at
least once, whom I found through my eldwork and my connections in the Scene. I also informally dialogged with more clients
during my eldwork. The research protocol for this project was
approved by the Institutional Review Board.
I generated the sample of pro-dommes by locating these informants mainly through their Internet advertisements. However, I
also located respondents through snowball sampling and through
my own personal connectionsdcolleagues, friends, and friends of
friends who were part of the BDSM Scene. As in the cases of most, if
not all, qualitative studies of erotic labor, the sample is not a
random sample of this type of workers. While I took steps to
interview and speak informally with a diversity of pro-dommesdfrom various types of dungeons, in various stages of their
careers, and in two different locales with (as I will discuss) differing
levels of criminalization of these activitiesdI acknowledge that this
sample, as a whole, was skewed toward pro-dommes with longer
career tenures, those who were also in the lifestyle, and those
who had some stake in portraying BDSM as a safe activity.
The pro-dommes in this sample ranged in age from 20 to 58,
with a median age of 37 (mean 37.3). Forty-one (62%) selfidentied as white, four (6%) as black, four (6%) as Latina, four
(6%) as Asian, and one (2%) as Native American. One of the 66
women self-identied as MTF transgendered, while the rest were
cisgendered. All pro-dommes had at least a high school degree, and
only one womans highest level of education was high school.
Sixteen (26%) indicated that their highest level of education was
some college (this included women who were still in college at the
time of interview), 20 (33%) received college degrees and stopped
there, and twenty-four (39%) received some sort of graduate
training. The median length of time that interviewees had been
working as professional dominants at the time of interview was
about seven years.
I kept detailed notes of my eldwork which I subsequently
hand-coded for analysis. I also taped, transcribed, and hand-coded
each in-depth interview. To analyze the constellations of meaning
inherent in these data, I organized interview responses and eld
notes based on the most commonly-occurring themes. I then
organized these themes internally based on their dominant narratives, while not disregarding antithetical cases. For example, as I
will discuss, pro-dommes from New York commonly deployed the
internally-purifying discourse related to health that I explore here,
while those who worked in San Francisco seldom did. In making
claims about regimes of internal stigmatization among pro-

171

dommes I do not overlook this absence in Bay Area pro-dommes

narratives. I do not imply that all pro-dommes everywhere engage
in this discourse; rather, that pro-dommes who work in New York
City do, and examining their rhetoric has real consequences for how
we think about the intersection of BDSM, erotic labor, and health.
My choice to write in the rst person throughout this article is
indicative of my desire to highlight my own awareness of my
presence and my positionality as an ethnographer and an analyst. It
also speaks to my orientation toward qualitative data collection.
Like many ethnographers, I conceive of research interactions as
generative moments, during which the researcher is not simply a
passive receptacle for data; rather, data gets produced (not simply
collected) during the interplay between researcher (the I) and
informant. This kind of reexivity adds to qualitatively-produced
knowledge in a way that is not possible within other forms of
research.
Findings
Counter to stereotypes of erotic laborers as violent or as vectors
of disease, BDSM workers are in fact not only concerned about
safety but professionally invested in it, reinforcing it through hierarchical identity politics. Pro-dommes engaged in three interwoven hierarchical discourses, within which concerns about health
and safety became central elements. First, pro-dommes stigmatized their peers who performed sexual extras (also called full
service), interpreting these actions as impure, inauthentic, and
unsafe. Secondly, my informants actively puried themselves in
contradistinction to individuals whom they perceived as engaging
in BDSM in an overly aggressive and physically threatening manner.
Third, these women discussed the measures they took to preserve
their clients well-being, drawing distinctions between authentic
dommes, who are well-trained in safe practices and their phony
counterparts who participate in unsafe play.
While my sample may be particularly skewed toward prodommes who do not engage in sexual extras, my nding that
only a minority of these women participate in these practices is
consistent with prior work on diversity among forms of erotic labor,
which suggests that commercial BDSM involves little to no genital
contact (Harcourt & Donovan, 2005: 203) and that pro-dommes are
less likely than other sex workers to have sex (Cohan et al., 2006:
419). Only one of my informants indicated that she had ever in her
life had sexual intercourse for money. This element of professional
erotic dominance differentiates it from many other forms of erotic
labordprostitution, obviously, but also sensual massage and even
in some cases stripping, as, at some clubs, lap dancing is proximal to
and periodically crosses over with prostitution (Bott, 2006: 35). On
the other hand, while few of my informants indicated that they had
ever engaged in sexual extras, such as handjobs and oral sex, my
eldwork revealed that it was common knowledge among BDSM
practitioners that there were some dungeons where these practices
did occur.
My informants, overall, were very critical of this minority of prodommes who performed extras in their sessions; they interpreted these practices as evidence of a kind of inauthenticity. One
client told me, for instance, Thats tip number one for you: if
theyre having sex, theyre probably not dommes.That would be a
phony domme. That would be a prostitute. A pro-domme made a
similar claim when she asserted that she would never perform
extras in her sessions: First, Im a germ freak and second,
because thats not a real dominatrix. Thats a girl giving a handjob.
Thats a prostitute. Another woman told me that she had largely
retired from the industry, explaining, For one thing, [its because
of] Craigslist. Im a mistress, and its some girl who bought a vedollar fake whip. Whos really a hooker. Theyre the ones who do

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D.J. Lindemann / Social Science & Medicine 99 (2013) 169e175

full service. In this way, many pro-dommes neutralized their own

stigma by foregrounding their purity, contrasting themselves to the
fakes, hooker, and prostitutes who engaged in such activities.
This particular narrative incorporated health concerns in two
ways. First, as in the case of the germ freak, many informants
interpreted the exchange of uid and skin-on-skin contact as unclean or impure. Secondly, some women working as pro-dommes
felt that these sexual acts inherently involved ceding dominance,
and thus placing their own safety in jeopardy. As one woman told
me, If you open yourself up in that way [providing sexual extras],
you literally give up the power. And who knows what could happen
then? While this poignant statement is indicative of some of these
womens broader discourses about sex, dominance, and safety (i.e.
that holding onto the power ensured their well-being), it is
important to be wary of interpreting it as a statement about all
BDSM relationships. Based on both my own observations as a
eldworker and prior literature, most participants in noncommercial BDSM, both dominant and submissive, maintain collective understandings that ensure their safety regardless of their
roles in the exchange.
Informants also repeatedly emphasized that they do not
perceive their work as violent, and they stigmatized the minority of
their peers whose BDSM activities, they felt, were motivated by
unsafe levels of violence or aggression. This technique of neutralization likely arises in response to the long history of literature
conating consensual BDSM activities and violence. However, I
should emphasize that none of my informants viewed their actions
as violent, and that this sharp distinction between consensual
BDSM and violence is consistent with not only with their narratives and my own observations as a eldworker but also with
much contemporary research on lifestyle BDSM, which largely interprets BDSM activities in the context of play rather than
aggression (Barker, Gupta, & Iantaf, 2007; Beckmann, 2009;
Calia, 1994; Moser & Kleinplatz, 2006).
Pro-dommes only made reference to violence or aggression in
order to clearly delineate the non-violent motivations behind their
work. As one woman told me, I wont hit somebody I dont like. I
will not hit out of anger. If Im angry, Ill have to work through it.
Part of being a mistress is also having control over oneself. Another
informant asserted, Some women do this because they hate men.
Thats not me. Thats unsafe. Others told me that they had actually
turned away clients who had wanted overly aggressive sessions.
The contention that BDSM may involve pain but becomes risky
when it is motivated by aggression was common among my informants, bolstering claims prior scholars have made in their work
surrounding consensual sadomasochism (Weinberg, 1983: 106).
Behavior that an onlooker may view as brutal is reasonable to the
participants within the context of their agreed-upon framework.
Many informants told me that they subscribed to the credo Safe,
Sane, Consensualda kind of Hippocratic oath for BDSM practitioners. Further, though their activities often involved pain, participants maintained that it was an agreed-upon level of pain that
could be held in check through the use of a safe word: a prearranged term (like cantaloupe) that, when called out by the
submissive, indicates that he does not wish to continue. Other
verbal cues, such as Stop, That hurts, or Let me go, may be
misinterpreted by the dominatrix as part of the role-playing scenario, while a safe word unambiguously communicates distress and
ensures termination of the activity. Additionally, for clients who
may be gagged or otherwise unable to speak, physical cues such as
blinking three times may be employed.
The practice of using safe words underscores the importance of
ethnographic work in exploring regimes of meaning-making
within this social world. As a eldworker, I witnessed rsthand
the disjuncture between BDSM participants constellations of

meaning and the outward appearance of their activities. On one

occasion, for example, I was attending an event in the basement of a
New York nightclub, where I witnessed a male BDSM participant
striking a female submissive with a bullwhip. She cried out in what
seemed to be agony whenever the whip made contact with her
skin. While other partygoers stood off to the side watching this
scene or milled around seemingly oblivious to it, I became so
disturbed that I left the room. When I returned, the activity had
been completed, and the female victim was sitting on a couch,
smiling and chatting with a group of people.
This incident highlights the potential importance of qualitative
eldwork for public health discourses focusing on marginalized
populations. While BDSM has been publicly contextualized within
the framework of violence, it is clear that this is not the primary
framework the practitioners themselves use to consider their work.
As I will discuss, this distinction between violence and play has
real implications for public perceptions and regulation of these
practices.
Not only did pro-dommes and other BDSM participants
conceptualize their own activities as nonviolent, but they also
described themselves in contrast to their peers whose play
bordered on violent or dangerous. One pro-domme, in the context
of explaining the activities she would not perform in her dungeon,
asserted that not all members of the BDSM community followed
her same safety protocols:
I will not beat somebody unconscious.There are toys that I
wont let people play with, that I dont know [those peoples]
abilities. Like rubber oggers. And polyurethane canes. I dont
even bring em out, because I see abominable techniquedwhich
you will see at [the club in New York]dall the time. All the time.
Its dreadful. Absolutely. I cantdI cantdI have to leave.
What makes technique bad?
If you do not know where youre hitting, how youre hitting. You
hit someone on a bone or you hit someone where theres a
concentration of nerves or lymph nodes, youre gonna damage
them. I saw a guy take a cane and hit someone on the neck.
Thats when I said, Okay, thats it. I cannot take it anymore. That
is dangerous and its irresponsible. [emphasis in original]
While they were able to regulate, to some degree, the behavior
of those engaging in BDSM at public clubs or partiesdand I
encountered examples of this kind of intra-community policing in
my eldworkdpro-dommes often felt they were unable to check
the behavior of their peers in the commercial sphere. One woman
succinctly encapsulated an assertion I heard repeatedly from my
informants when she told me, These girls thatre coming into the
dungeons now they dont have the faintestdthe foggiest idea about
protocols, safety. They have no skills. Thats not a real mistress.
When pro-dommes discussed the threats to physical safety that
could result from improper or unsafe techniques, they often tethered these comments to assertions about the need for new prodommes to go through training processes. For example, one prodomme, emphasizing the safety dimensions of predicament
bondage, told me, If someones good, thats the rst thing they
teach you is safety. A different pro-domme explained, similarly,
Ive had people pass outdquite a few, I learned a lot about that.
[Over time, I learned] to recognize that somebodys about to pass
out. [I learned about] not putting their hands up and their [penis]
and ball[s] in bondage. Thats like recipe #1 for passing outdan
overweight guy whos scared and cant breathe.You have to learn,
you know? [emphasis added].
This idea that one needs to learn, be trained, or apprentice
came up repeatedly in my eldwork. In part, cultural capital within

D.J. Lindemann / Social Science & Medicine 99 (2013) 169e175

the world of professional dominatrices derives from ones capacity

to play safely, which is connected to ones skill level as well as ones
tenure in the industry. It is no coincidence that the dominatrix
celebrities within the BDSM Scenedthe women everyone in the
community seems to know and respectdhave been around the
longest (some since the 1970s) and are described as having some of
the best technique.
This discourse about the need for new pro-dommes to gain
knowledge and to go through training, partially to avoid potential
health risks, is particularly illuminating within the context of the
larger literature about erotic labor. Dominatrices place a discursive
emphasis on expertise that has few correlates in the world of
commercial eroticism. Various organizations within the Scene offer
classes, panels, and demonstrations on aspects of BDSM, and some
of these cater specically to pro-dommes. In contrast, while attorneys in San Francisco do give classes on the legal aspects of sex
work, there are few classes on how to improve ones technical skill
as a prostitute. Furthermore, for some strippers at least, indicators
of a lack of technique or professionalism can actually work to their
benet by signaling authenticity to customers, conveying that a
dancer is more like a real girl (Frank, 2002: 209).
While I am not arguing that BDSM necessarily involves more
technical expertise than other forms of erotic labor, I am making the
claim that because of the specic organization of their labor prodommes push technical and safety concerns to the forefront of
their discursive interpretations of their work in a way that we do not
see among other kinds of erotic laborers. However, it should be
noted that this discourse is in line with work on lifestyle BDSM,
which has highlighted the fact that technical expertise as well as
emotional skills are central to these practices (Weiss, 2011;
Williams, 2006). At the same time, pro-dommes seemed to be
less concerned about the potential for disease transmission.
Partially this was because, as noted, most do not engage in genital
contact and uid exchange with their clients.
Further, it is telling that when pro-dommes were asked about
diseases and other safety issues, their responses tended to
concentrate on their clients safety rather than their own. For
instance, when I asked one informant Have you ever had any
safety issues in session? she replied, I once had a client break a rib
when I did body-scissors on him. I once had a client break a toe
during a wrestling session. I think thats it? Even the question Has
this job ever made you fear for your safety? often elicited responses about these womens desire to preserve the physical wellbeing of clients. Many of my informants indicated that they had
denied requests for sessions that they had deemed unsafe for the
potential submissives. These included incidents in which clients
arrived at the dungeon under the inuence. Though one might
expect these women to contextualize these occurrences within a
discussion of their own safety and the clients unpredictability, they
largely discussed the potential risks to these men of engaging in
these activities while intoxicated. Some also said that they refused
to engage in edge playda term used in the BDSM community for
an activity (such bloodletting, extreme smothering, or playing with
re) that is potentially more dangerous than typical BDSM
practices.
The reversal inherent in this narrative further suggests that the
element of risk works differently within commercial BDSM than it
does within other forms of erotic laborda difference that has signicance for the public framing of commercial eroticism. In her
work on erotic dancers, for instance, Barton provides a compelling
counterfactual: women age out of that industry partly because
there is an accrual of instances in which they feel their safety is in
jeopardy. Many of her respondents had experienced sexual
harassment and abuse, and everyone of the strippers she interviewed had experienced at least one psychologically disturbing

173

scenario while on the job (Barton, 2006: 63). While three of my

informants had similar stories to telldall involving clients who
were under the inuence and attempted to seize control of the
sessiondthese were the exception, not the rule.
In part, this nding may be related to the skewedness of this
sample of pro-dommes. However, it is doubtful that selection bias
accounts for the entirety of this difference between BDSM and
other forms of erotic labor, since prior work relating to variations in
health risks among erotic laborers supports this same conclusion.
One study of erotic laborers who came to be treated at the St. James
Inrmary in San Francisco, for example, found that BDSM professionals were at a lower risk for work-related violence than maleto-female sex workers (who were at signicantly higher risk), those
who engaged in street-based sex work, sex trades, massage parlor
work, and stripping (Cohan et al., 2006: 419).
A concatenation of mechanisms likely drives this difference
between BDSM and other erotic industries. First, professional erotic
dominance is explicitly organized as a reversal of gendered power,
with the woman framed as the aggressor within its theatrical
frame. Secondly, BDSM is a form of indoor erotic labor, which has
been found to be less risky than street work (Sanders & Campbell,
2007). Pro-dommes are able to take safety precautions, such as
screening clients over the phone and in person during periods of
negotiation prior to their sessions. This sphere of erotic labor also
has processes of informal and formal internal monitoring; for
instance, dungeons keep lists of difcult and potentially dangerous
clients whom they have banned, and pro-dommes who are friends
share these names with each other. Moreover, the women who
populate this sphere are individuals with high levels of cultural
capital. As prior researchers have pointed out (Bernstein, 2007: 98),
class differences play a large role in the ways in which erotic laborers organize and conceive of their labor.
Caveats
The dominatrixs dungeon is not a commercial erotic utopia. It is
not my intention to frame it as one. By pro-dommes own accounts,
there are very real health and safety risks to their work, for both
themselves and their clients, that they control through various
procedures, monitoring, and training. Most indicated that they had
never feared for their own safety in any of their sessions, but a few
said that they had. Furthermore, as discussed, my sample was likely
skewed toward pro-dommes who had some stake in portraying
BDSM as a safe activity. One of the reasons these women participated in techniques of neutralization that were mimetic of public
concerns about the health risks of their practices was likely because
they were invested in legitimating these practices in the public eye.
While I did interview a few women who represented the discredited group (for example, one who had intercourse with her
clients and seven who were not in the lifestyle), their number was
not large enough for me to draw any kind of meaningful conclusions about their potential reverse-discourse(s). In addition, the
sample was skewed toward pro-dommes who work in New York.
As discussed, these women were more likely than those in San
Francisco to engage in this internally-stigmatizing discourse.
However, many studies of erotic laborers suffer from these same
constraintsdnon-randomized sampling and a skew toward more
politically-engaged sex workers and those who have spent more
time in the industrydand none have uncovered the unique kind of
intra-group-stigmatizing narratives surrounding health and safety
that can be found in the BDSM sphere. In addition, other research in
this area, including studies with different sampling frames, supports the claim that there are differences between the health correlates of professional erotic dominance and other forms of
commercial eroticism (Cohan et al., 2006).

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D.J. Lindemann / Social Science & Medicine 99 (2013) 169e175

Finally, it is clear that not all BDSM practitioners adhere to rigid

safety standardsdas pro-dommes own narratives indicate. One
client in a New York City dungeon was taken to the hospital in a
coma around the same time I was doing eldwork (Goldman,
2008). It is not my contention, nor was it my informants, that all
pro-dommes engage in safe, sanitized practices. Yet, while some of
my informants may have exaggerated the safety precautions they
took in their sessions in order to manage their own stigma and
highlight the distinction between themselves and impure, unsafe dominatrices, I did not nd their descriptions of their safeguards to be inconsistent with the behaviors I observed at public
events in the BDSM community. During my eldwork within this
community, I witnessed rsthand the use of safe words and internal monitoring, with the occasional ejections of individuals who
violated others boundaries.
Conclusions and signicance for public health debates
The professional dominatrix is caught in the crosshairs of public
health debates about both sex work and BDSM. Health and physical
risk have been pervasive themes, not only within scholarship surrounding these practices but within journalistic and public policy
discourses as well. In contrast to accounts that associate BDSM with
violence or characterize erotic laborers as carriers of disease, I
found that professional dominatrices were not only concerned
about health and well-being but professionally invested in it. Discussing their work in the context of play, they eschewed notions
of their work as violent or unsafe. Moreover, they reinforced safety
through a purifying identity politics of hierarchies of erotic labor.
There are multiple implications of this work for public perception and policy. First, it has repercussions for discussions concerning sex work deregulation. There has been considerable public
debate concerning the passage of legislation, particularly in Europe,
that seeks to decriminalize and destigmatize practices of erotic
labor. A recurrent thread within decriminalization arguments is the
assertion that, within this unchecked and unregulated industry,
these workers face issues of exploitation and threats to health and
their physical safety (Brants, 1998; Kilvington, Day, & Ward, 2001;
Symanski, 1974). Further, consensual sadomasochism has been
selectively criminalized (Beckmann, 2001), with its practitioners
facing issues of disputed child custody, civil suits, and sometimes
even criminal charges (Gross, 2006: 61; Bell, 1995: 144).
Compellingly, I found that the legality of BDSM practices was
associated with a crystallization of these purity discourses related to
health. The prostitution statutes in New York and California render
most of what pro-dommes do with their clients legal in the former
state and illegal in the latter. In New York, where commercial BDSM
was not criminalized, pro-dommes were much more likely to
contrast themselves to hookers and whores, describing themselves as purists and artists; few characterized themselves as sex
workers. Those who worked in San Francisco, where BDSM was
illegal under prostitution statutes, were much more likely to describe
themselves as sex workers and to socialize with other types of sex
workers. There are several potential reasons for this discrepancy,
including the fact that San Francisco is a more sex-positive city in
many ways and has more resources available for sex workers, but the
legal discrepancy clearly inuences these womens perceptions of
their labor as well. As one woman pointed out, in a statement I heard
often from Bay Area pro-dommes, All of us, under the letter of California law, can get popped for prostitution, so why not just fess up to
the fact that its sex work? It would be useful, from a policy
perspective, to analyze whether internal regimes of stigma exist
within other forms of erotic labor, the connection between such regimes and formal legal structures, and the association of these regimes with the commitment to safe practices.

Second, the mechanism that this ethnographic exploration

uncovereddof professional self-regulation and guild-like protection of communal interests that relies on a distinction between us
professionals and them sex workersdhas elements that could be
potentially tapped into public health efforts in many settings. On a
positive note, we might consider the advantages of mobilizing
other structurally-marginalized groups in such a way. However,
this discourse also contains negative elements that merit caution
for interventionists or those who would romanticize erotic labor
networks (reied hierarchies of class, race, and self-stigma). And
perhaps most importantly, the discourse is also potentially splintering and inhibitive of collective activism among various types of
erotic laborers.
These discoveries and their public health implications could not
have been made using quantitative methods. While quantitative
analyses of sex work have revealed differences in the health risks of
various types of erotic labor, they could not get at the regimes of
stigma circling the topic of health that persist within this particular
population. In fact, much public discourse regarding both erotic
labor and consensual sadomasochism have focused on abstract
concerns about health and risk without looking empirically at the
lived realities of erotic laborers and the ways in which they make
meaning of their labor.
The ethnographic research discussed challenges pre-existing
notions about BDSM that underlie its pathologization and criminalization. Finally, though pro-dommes in San Francisco may be
more likely to identify with other kinds of sex workers, in many
ways these ndings also tell a cautionary tale about treating all
forms of erotic labor as a monolith. Not only do pro-dommes and
their submissives have different experiences surrounding health
and safety than do some of their counterparts in other erotic industries, but the way they interpret these concerns differs as well.
Using ethnographic methodology to unravel these laborers webs of
meaning is a key step toward demystifying these private erotic
encounters that have long been fodder for public discourse.
Acknowledgments
The author wishes to acknowledge Helena Hansen and Seth
Holmes as well as her two anonymous reviewers for their feedback
on earlier drafts. All errors are the authors own.
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