Below is part of a long and interesting article from Quartz, which is well worth a read – “50 SHADES OF CARE, Why doctors need to pay more attention to their kinky patients,” by Christy Duan, Medical student, Albert Einstein College of Medicine:

‘…I’ve learned that there’s a big difference between a consensual, negotiated kink relationship and abuse. It’s abuse if there is no explicit consent, which includes situations where someone is afraid to impose limits because of potential consequences.

“If you’ve had no reason to familiarize yourself with kink…it can be very easy for healthcare providers to assume that they know what’s going on with a patient when they may have no idea,” Dr. Keely Kolmes, a San Francisco-based psychologist in private practice who works with kink-oriented clients, told Quartz. “Clinicians can do a great deal of harm if they’re misinformed.”

As mandatory reporters, healthcare providers are responsible for reporting injuries caused by specific weapons, such as guns and knives. They must also report suspected abuse of vulnerable patients, which can include children, the elderly, and people with disabilities. However, in the US laws differ from state to state, and can be difficult to interpret.

In my training, I learned that healthcare providers are not required to report suspected abuse between adults in most states. But many “doctors have no idea what the law is. They just know that they’re supposed to report violence,” Waldura said. “We have very little training in it. So what happens is a fear response.”

Despite conferring with lawyers and risk management about this issue, Waldura said that no one has a definitive answer.

Ham Mason, a queer submissive activist and person of color who has been practicing kink for 20 years, said that there also needs to be more awareness of diversity in the community.

“When you think about the face of BDSM, it’s usually either a gay man or straight people and usually the face is white,” she told Quartz. Because of this stereotype, healthcare providers may assume that people of color aren’t kinksters and think that disclosures of kink activity may be a “cover story” for abuse, Mason said. “It could be a matter of having your children taken away or not.”

Her concerns are not unfounded. The National Coalition for Sexual Freedom’s Incident Reporting and Response said it received 178 requests for legal assistance from kink-oriented clients in 2014. These requests involved 73 criminal, 33 child custody, and 15 discrimination issues.

In addition to becoming more kink aware, providers should “assume the potential for abuse exists in all patients” regardless of their social identity or sexual behavior, and screen appropriately, said Lewis.

Kolmes has worked with submissive/bottom clients who have been in abusive kinky relationships and struggle with whether it was the play or partner that was bad for them. Dominant/top clients also have concerns about crossing boundaries and being a good partner, Kolmes said. Despite these concerns, she doesn’t recommend avoiding kink altogether.

“We see a lot of clients who have been abused or sexually assaulted in the past. We don’t tell them to avoid love and romance and sexual relationships. We work with them on actually figuring out what their boundaries are, helping them stay present and not dissociate, and to learn how to have healthy, loving relationships,” Kolmes said. “Telling someone to avoid kink would be like telling a non-kinky person to avoid love and sex…’

Full article here.