Why some people enjoy pain, and what the body does when they do

The same question covers a hot curry, a deep-tissue massage, a cold plunge and a spanking. Psychologists have a name for the first three, benign masochism, and a growing set of hormone and pain-threshold studies for the fourth. The two literatures started apart and now point the same way. Pain turns pleasant when the person chose it, controls it and knows it will stop.

The sexual version is common enough that the old diagnostic view has not survived the surveys. In a general-population sample of 1,040 Quebec adults, interest in masochism passed the line the authors drew for a statistically unusual interest, in men and in women alike. The catalog estimates masochism at 23 percent of adults, the same share as pain play, its umbrella for pain given and received by agreement.

Benign masochism outside the bedroom

Chili, cold water and sad films all start as something the body treats as a threat. Paul Rozin and his co-author Schiller called the enjoyment of them benign masochism in 1980, and in a 2013 study with Guillot, Fincher and colleagues he tested it on 243 University of Pennsylvania students and 147 adults recruited on Mechanical Turk. Each rated 29 activities that start out aversive: sad films, chili burn, roller coasters, exhaustion after exercise, bitter tastes, disgusting jokes and several kinds of pain.

Pain came out near the bottom of the list. Flashes of cold pain, the first seconds in a shower that is too cold, scored lowest of all, with a mean liking of 16.8 out of 100 and 12 percent rating it above 50. In a smaller follow-up, 24 percent agreed that their favourite massage was the most painful one they could stand; 59 percent said the same of their favourite roller coaster.

Rozin's explanation is that the pleasure comes from the gap between the body's alarm and the mind's knowledge that there is no danger. He calls it "mind over body", a kind of mastery, and the study supports one prediction that follows from it: for many people the favoured intensity of an aversive experience sits a notch below the level they cannot tolerate. By Rozin's estimate, more than two billion adults enjoy the burn of chili on the same terms.

Context that turns pain pleasant

Pain and pleasure share hardware in the brain. Siri Leknes and Irene Tracey reviewed the imaging and animal evidence in 2008 and found the two processed in overlapping regions, with the opioid and dopamine systems modulating both and each able to dampen the other.

Leknes's group then showed the switch in a scanner. In a 2013 study in Pain, 16 healthy volunteers received the same moderate pain in two settings. When moderate pain was the worst possible outcome, they rated it unpleasant. When the alternative was intense pain, they rated the identical stimulus as pleasant. The authors called it a hedonic flip. Skin conductance and activity in pain regions fell, and activity rose in the brain's reward and valuation circuitry, when nothing about the stimulus had changed except what it meant.

A consensual scene builds a comparable frame on purpose. Intensity is agreed in advance, a safeword can stop it, and the person receiving chose to be there. The laboratory work does not test BDSM directly, and its sample was small. It demonstrates the mechanism practitioners describe, in which the meaning of a sensation changes how the brain scores it.

What researchers measured during scenes

Three research groups have taken saliva and blood samples from practitioners before and after real scenes, and their results agree on the person receiving.

Brad Sagarin and colleagues sampled 58 practitioners across two studies published in 2009. Cortisol, the stress hormone, rose during the scene for the partners who were bound, receiving stimulation and following orders, and did not rise for the partners giving them. Women in the receiving role also showed a rise in testosterone. Afterwards, the participants who said the scene went well showed lower cortisol and reported feeling closer to each other.

In Flanders, Elise Wuyts and colleagues tested 35 practising couples in 2020, with 27 people in an ordinary social interaction as controls. The submissive partners showed rises in cortisol and in endocannabinoids, the body's own cannabis-like molecules tied to reward. Dominant partners showed the endocannabinoid rise only when the scene centred on power, which suggests the reward for the giver comes from control more than from the pain itself. The same team measured pain thresholds in 2021: practitioners had higher thresholds than controls to begin with, the submissives' thresholds rose further for a time after the scene, and they reported less fear of pain.

A 2022 systematic review by Wuyts and Manuel Morrens found only ten studies on the biology of BDSM in total. The pattern is consistent, stress and reward rising together in the receiving partner, and it rests on small, self-selected samples.

The altered state called subspace

Practitioners describe a floating, time-distorted state during intense scenes and call it subspace. One experiment has put a measure on it. James Ambler and colleagues randomly assigned 14 experienced practitioners to the top or bottom role for a scene, published in 2017. The tops showed the focused absorption psychologists call flow. The bottoms showed a Stroop-test result consistent with transient hypofrontality, a temporary quieting of the prefrontal cortex, along with some facets of flow.

The same group found a comparable pattern outside a bedroom. At the Dance of Souls, a 160-person ritual in which dancers wear temporary piercings hung with weights or hooks, Klement and colleagues reported in 2017 that cortisol rose from before the dance to during it, while self-reported stress and negative mood fell.

The comedown has its own entry. Subdrop, the low mood some people feel hours or days after an intense scene, is one reason communities treat aftercare as part of the activity.

How common the interest is

Interest in receiving pain in a sexual setting is common, and the surveys that ask about practice record far smaller numbers. Joyal and Carpentier's 2017 survey of 1,040 Quebec adults, selected to match the province's population, found masochism above the 15.9 percent threshold for both sexes, with no significant difference between men and women, and linked to higher satisfaction with the respondent's own sex life. At the other end, Richters and colleagues asked 19,307 Australians in 2001 and 2002 about the previous year: 1.8 percent of sexually active respondents said they had been involved in BDSM. The two surveys asked different questions in different countries, so the gap between them is a range and cannot be read as a ratio.

The catalog's index ranks the pain-related entries by estimated prevalence, and the table lists the five highest.

Entry	Estimated prevalence	What it names
Pain play	23 percent	Pain given and received by agreement, the umbrella term
Spanking	22 percent	The most common interest in the Sensation and Pain category
Impact play	20 percent	Striking with a hand or implement, spanking included
Flogging	8 percent	Impact with a many-tailed implement
Sadism	5 percent	Arousal from giving pain, the other half of the pair

Masochism sits at rank 22 of the catalog's 486 entries, and sadism at 5 percent is under a quarter of it. The Sensation and Pain category holds 51 entries, and 36 of them carry a risk flag, from caning to breath play, against 118 flagged entries across the whole catalog.

The people who like it

The old clinical assumption held that enjoying pain signals damage, and the population data have not supported it. In the Australian survey, people who had engaged in BDSM were no more likely than others to have been coerced into sex, and the men among them scored lower on psychological distress than other men.

Wismeijer and van Assen compared 902 BDSM practitioners with 434 controls in 2013. The practitioners were less neurotic, more extraverted, more open to experience and more conscientious, less sensitive to rejection and higher in well-being. They were also less agreeable. Both groups were recruited online and chose to take part, so the study describes the people who answered, and cannot say whether the practice produces the traits.

Greitemeyer reported in 2022 that dark personality traits, psychopathy above all, went with sexual masochistic preferences, and that everyday masochistic tendencies went with sexual sadistic ones. A 2025 study of 470 UK participants in five kink communities found self-stigma, the person's own shame about the interest, the strongest predictor of distress, followed by experiences of prejudice.

Where the manuals stand

The diagnostic manuals separate the interest from a disorder. The DSM-5-TR of 2022 keeps sexual masochism disorder, and diagnoses it only when the interest causes clinically significant distress or impairment. The ICD-11, adopted by the World Health Organization in 2019, dropped sadomasochism as a diagnosis and kept only coercive sexual sadism disorder, defined by a partner who did not consent.

Richard von Krafft-Ebing coined masochism in 1886 as a diagnosis, after the novelist Leopold von Sacher-Masoch. The clinical meaning has since narrowed to distress and harm, and the everyday meaning has widened to cover the chili eater. The post on whether a kink is normal sets out the criteria, and the BDSM article covers the negotiation that surrounds pain when it is part of a scene.