Mistrust and missed opportunities: BDSM practitioner experiences in healthcare

Stigma and discrimination have been shown to be significant barriers to healthcare utilization and provider trust among sexual minority groups including BDSM and kink communities. This exploratory study sought to better understand medical mistrust and experiences of discrimination in primary care settings and how these factors predict hiding kink-related injuries from healthcare providers. A total of 301 individuals who self-identified as being a member of the BDSM community and engaged in BDSM-play activities completed an online survey. Participants completed measures including experiences with BDSM-play-related injuries, disclosure of BDSM activity to healthcare providers, measures addressing mistrust in in healthcare providers (such as avoidance of questions about sexual health or STI testing), and experiences with discrimination in healthcare settings because of BDSM group membership (such as perceptions of being insulted or receiving poor care). Nearly, 40% of participants indicated at least one experience with discrimination in the healthcare system because they identified as a member of the kink community. Over 20% of participants indicated there were BDSM-related concerns they would have liked to discuss with their primary care provider but did not. Participants who hid injuries from their primary care provider had higher levels of medical mistrust and more experiences with medical discrimination than those who disclosed their injuries. A stepwise logistic regression determined that medical mistrust served as a significant predictor of hiding injuries from healthcare providers. Patients who are members of the BDSM community are likely to have had negative healthcare experiences, and these experiences impact their communication with and trust in future medical encounters. Strengths of the study include addressing diverse components of stigma in healthcare including both experiences with discrimination as well as perceptions of the medical field. Furthermore, potential direct consequences of past negative experiences such as hiding injuries from healthcare providers were examined. Given the likely impact of race, gender, and BDSM group membership on experiences with discrimination, a limitation includes the limited representations of BDSM participants from minoritized racial and ethnic groups. Furthermore, in addressing injuries, the survey did not differentiate intended or expected injuries obtained in BDSM play from unintentional or unwanted injuri