Interest in BDSM is present in most of the general population. Further research is needed to destigmatize it by confirming BDSM as a leisurely preference rather than a psychiatric affliction. Holvoet L, Huys W, Coppens V, et al. Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population. J Sex Med 2017;14:1152-1159.

Introduction BDSM (bondage and discipline, dominance and submission, and sadism and masochism) increasingly receives attention from the scientific community. Where earlier research efforts mainly focused on epidemiologic characteristics, psychological and biologic factors driving BDSM preferences have recently gained interest as well. Aim To bring together all the existing scientific literature on BDSM from a biopsychosocial perspective. Methods Based on the PRISMA guidelines, the current systematic review brings together all the existing literature on BDSM from a biopsychosocial perspective. Main Outcome Measure Prevalence rates of BDSM interests were investigated in the literature, as well as the associations between BDSM interests on one hand and personality traits, adverse childhood experiences, education levels, sexual orientations and biological markers on the other. Results Biologic factors such as gender identity, sex hormone levels, and the neurologic constitution of the brain’s pain and reward systems influence BDSM orientation. With regard to psychological factors, both personality traits (eg, higher levels of openness or extraversion) and the presence of a personality disorder have been associated with a heightened interest in BDSM, although only limited supporting evidence is available. Additionally, sensation-seeking levels and impulsivity seem to contribute, because they presumably guide one’s drive to explore new or more-intense kinks. Whereas attachment styles impact couple dynamics, they also influence willingness to explore limits in a BDSM context. Lastly, education levels impact relational and sexual dynamics. Strengths and Limitations The limitations of the current review reflect those of the topical scientific literature. Although the number of studies focused on all aspects of BDSM is exponentially growing, most of these are only descriptive, and very few focus on underlying driving processes. Conclusion From this biopsychosocial perspective, we offer a dimensional approach while integrating the factors driving the onset and evolution of BDSM interests. De Neef N, Coppens V, Huys W, et al. Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) From an Integrative Biopsychosocial Perspective: A Systematic Review. Sex Med 2019;7:129–144.

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Introduction: Previous research has shown rather high prevalence rates of BDSM-related activities in the Belgian population. Nevertheless, BDSM is still being stigmatized and pathologized. Yet very few studies have focused on these phenomena among BDSM practitioners and in the general population. The current two-part study investigated a) stigmatizing attitudes and beliefs about BDSM in the general population, and b) self-reported stigma in members of the BDSM community. Methods and results: In study 1, a crosssectional survey questionnaire, containing the Big Five Inventory and a self-developed stigma-questionnaire, was completed by 300 members of the general population lacking any interest in BDSM (135 males, 158 women, 4 gender fluid, 3 genderless). Three dimensions of stigmatizing attitudes and beliefs about BDSM were identified, being prejudices, discrimination and incomprehension. About 86% maintained stigmatizing beliefs about these sexual interests and practices. Higher age, higher levels of conscientiousness, and lower levels of openness and agreeableness were found to be predictors for stigmatization. Study 2 involved 256 BDSM practitioners (110 males, 135 women, 7 gender fluid, 2 genderless) who completed a questionnaire with items concerning experienced stigmatization or discrimination because of their BDSM interests. About 28% reported not feeling comfortable to share their interests with the outside-world. Conclusion: These results suggest that people who do not conform to the current social standards of our society may not be explicitly excluded, but often seem to remain the subject of stigmatization and discrimination. Proper education about the concept of BDSM could be a first step in stigma-reduction.