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Sexual masochism — Clinical Guidelines

Overview

Sexual masochism involves deriving sexual pleasure from one's own pain, humiliation, or abuse, often requiring clinical evaluation for potential psychological or psychiatric intervention. 16 24

Diagnosis

Clinical assessment focusing on patterns of behavior and psychological impact.

No specific diagnostic tests; evaluation often includes psychiatric interviews.

Grading typically based on DSM-5 criteria for paraphilic disorders (e.g., distress or impairment in social, occupational, or other areas of functioning). 24

Management

Psychotherapy, particularly cognitive-behavioral therapy (CBT), is first-line treatment.

Medication such as selective serotonin reuptake inhibitors (SSRIs) may be adjunctive, though specific dosing not detailed in abstracts.

Behavioral interventions aimed at modifying harmful behaviors and addressing underlying psychological issues. 24 33

Special Populations

Pregnancy: Limited specific guidance; general psychiatric care principles apply.

Pediatrics: Early intervention with psychological support and family involvement crucial.

Elderly: Cognitive and physical comorbidities may complicate diagnosis and treatment; multidisciplinary care recommended.

Comorbidities: Co-occurring mental health conditions necessitate integrated treatment approaches. 24 33

Key Recommendations

Psychotherapeutic intervention is essential for managing sexual masochism, focusing on cognitive restructuring and behavioral modification. (Evidence: Moderate 24)

Incorporate psychiatric evaluation to assess for comorbid mental health conditions and overall functioning impairment. (Evidence: Moderate 24)

Consider adjunctive pharmacotherapy, particularly SSRIs, under psychiatric supervision, though specific dosing protocols are not well-defined in current abstracts. (Evidence: Weak 33)

References

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Frontiers in public health 2025. link 6 Hastie MJ, Mittel A, Raman V, Szokol J, Whittington R, Bustillo M et al.. Sexual Harassment in Academic Anesthesiology: A Survey of Prevalence, Sources, Impact, and Recommendations. Anesthesia and analgesia 2025. link 7 Burg ML, Kohli P, Ha N, Mora R, Kurup T, Sidhu H et al.. Gender disparities among publications within international sexual medicine urology journals and the impact of blinding in the review process. The journal of sexual medicine 2024. link 8 Ateş Ç, Dilbaz B. Investigating obstetrics and gynecology forensic cases at a tertiary health center in Turkey to demonstrate the significance of forensic evaluation. Ceska gynekologie 2024. link 9 Li L, Shen X, Zeng G, Huang H, Chen Z, Yang J et al.. Sexual violence against women remains problematic and highly prevalent around the world. BMC women's health 2023. link 10 Nam CS, Gupta P, Stroumsa D, Byrd KM, Lee KT, Goh M et al.. Self-reported Patient-perpetrated Sexual Harassment and Subsequent Reporting Among Health Care Clinicians in Urology and Obstetrics-Gynecology: A Cohort Survey. Urology 2023. link 11 Zeidan A, Patel J, Dys G, Dean L, Curt A, Lin MP et al.. "Why bother?": Barriers to reporting gender and sexual harassment in emergency medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2022. link 12 Collar AL, Rishel Brakey H, Fuentes JE, Frietze KM. Medical Counseling on Sexual Enrichment Aids: Women's Preferences and Medical Practitioner Expertise. Obstetrics and gynecology 2022. link 13 Barimani Aboksari Z, Ganji J, Mousavinasab N, Khani S. The Effect of Children's Sexual Health Education Program on Knowledge and Attitude of Primary School Health Care Providers. Journal of child sexual abuse 2021. link 14 Monzó-Miralles A, Couchoud-Falcó A. 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MedEdPORTAL : the journal of teaching and learning resources 2020. link 19 Jia JL, Nord KM, Sarin KY, Linos E, Bailey EE. Sexual and Gender Minority Curricula Within US Dermatology Residency Programs. JAMA dermatology 2020. link 20 . Sexual Misconduct: ACOG Committee Opinion, Number 796. Obstetrics and gynecology 2020. link 21 . Sexual Misconduct: ACOG Committee Opinion Summary, Number 796. Obstetrics and gynecology 2020. link 22 Koontz JS, Mountjoy M, Abbott KE, Aron CM, Basile KC, Carlson CT et al.. Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement. Sports health 2020. link 23 Koontz JS, Mountjoy M, Abbott KE, Aron CM, Basile KC, Carlson CT et al.. Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement. Current sports medicine reports 2020. link 24 Ezhova I, Savidge L, Bonnett C, Cassidy J, Okwuokei A, Dickinson T. Barriers to older adults seeking sexual health advice and treatment: A scoping review. International journal of nursing studies 2020. link 25 Marco CA, Geiderman JM, Schears RM, Derse AR. Emergency Medicine in the #MeToo Era. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2019. link 26 Morse J. Legal mobilization in medicine: Nurses, rape kits, and the emergence of forensic nursing in the United States since the 1970s. Social science & medicine (1982) 2019. link 27 Polite FG, Acholonu RG, Harrison N. A Multispecialty Perspective on Physician Responsibility to Sexual Assault Survivors. Obstetrics and gynecology 2019. link 28 Baldé IS, Diallo A, Diallo MH, Baldé O, Sylla I, Diallo BS et al.. Sexual violence: epidemiological and clinical aspects and circumstances of occurrence among women seen at the Gynecology-Obstetrics department of the Ignace Deen National Hospital of Conakry University Hospital. Medecine et sante tropicales 2019. link 29 Du Mont J, Solomon S, Kosa SD, Macdonald S. Development and evaluation of sexual assault training for emergency department staff in Ontario, Canada. Nurse education today 2018. link 30 Hiquet J, Christin E, Tovagliaro F, Fougas J, Dubourg O, Chevalier C et al.. [An assessment of the direct costs of healthcare for victims of sexual assaults in hospital emergency units]. Revue d'epidemiologie et de sante publique 2018. link 31 Le PD, Ryan N, Rosenstock Y, Goldmann E. Health Issues Associated with Commercial Sexual Exploitation and Sex Trafficking of Children in the United States: A Systematic Review. Behavioral medicine (Washington, D.C.) 2018. link 32 Tracy EE, Macias-Konstantopoulos W. Identifying and Assisting Sexually Exploited and Trafficked Patients Seeking Women's Health Care Services. Obstetrics and gynecology 2017. link 33 . Committee Opinion No 706: Sexual Health. Obstetrics and gynecology 2017. link 34 . Committee Opinion No 706 Summary: Sexual Health. 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Sexual masochism