The Legal, the Emotional and the Medical Side

3. The Medical Side

The following remarks aren't meant to scare people off, but to show them how to prevent accidents during bondage.

Generally one can say that any spots where you can feel the pulse of a person can't stand any direct pressure. Especially dangerous for obvious reasons are throat and neck. You mustn't ever put a rope around the neck. If the neck is involved in some other kind of tying up you should be aware that there is a tug forward to a pressure lateral to the neck vein. Especially when the passive part is standing up or suspended this may lead to the CVS reflex (Carotis Sinus Vein reflex), which in turn leads so immediate unconsciousness.
If this happens you should remove all bondage utensils at once, especially those around the neck and the upper body (if necessary with the bandage scissors, the strap cutter or the package tape cutter lying ready - knifes aren't suitable for this because of their sharp unprotected blade, but in an emergency you can use them, too), put the person's legs up, fill a towel with ice cubes or wet it with cold water at least and put it against the neck. If your partner is unconscious for more than a few seconds you should put him/her in the stable lateral position and call the emergency doctor at once.
If the pressure to the neck isn't removed at once your partner may die. (The danger is especially great when a person ties him-/herself up; because then noone is there to help in case of fainting.)

Other places particularly at risk are the armpits, the inner upper arm, the inner wrist and the upper part of the rather sensitive thumb tendon (when using handcuffs you should always push the engaging safety device, and when tying up the wrist with a rope the hands should be laid together with the palms), the inner ellbow, the groin, the back of the knees and the Achilles' tendon. In these places you often find arteries, sensitive tendons and lymph vessels. To reduce the pressure you can pad the ropes with foam rubber, sweat bands or towels.
A large knot on a otherwise not too tight rope can also lead to problems at the tender places of the body.

With bondage while standing up, particularly when the arms are outstretched, or supension bondage with the head upwards, there can be circulation problems. Especially people with low blood pressure or tall people tend to have such problems. Therefore you have to take care that the tied up person can't collapse uncontrolled. If you know about existing circulation problems you should rather tie your partner up sitting or lying down. Indications for such problems are: Paleness, cold sweat everywhere, flat, barely perceptible breathing, reduced responsiveness (that's the reason why maybe the necessary negative feedback is missing). What you have to do is the same as with SCV reflex; see above - free your partner, put his/her legs up; maybe the stable lateral position.

Circulatory problems may - intentionally or unintentionally - occur in tied limbs, too. A shortterm congestion of blood in the vessels may sometimes be quite exciting - for example in the penis -, but this can lead to problems rather quickly. (For people with disposition for varicose veins for example such a buildup of blood may lead to a worsening or even to real varicose veins. In the worst case even a vescular obstruction is possible, so you should take care NEVER to pull the rope too tight around the legs when there are varicose veins.) Indications for a blood congestion are a blue discolouration of the skin, cool skin, a numb feeling, the feeling of pins and needles or prickling. Measures: Immediate untying of the rope, a soft massage of the limb. If varicose veins develop a visit to the doctor.
Now a few remarks to the ligature of the penis and/or testicles: There are quite a few man who like it. The ligature or tying up of the penis (for example with a tight cockring or another exotic toy from the sex shop reduces the backflow of the blood and so can lead to a longer lasting erection. That's the aim in most cases, and it can be very exciting. If the ligature lasts too long, however, it can be rather painful. The decision when to remove the tie should depend upon the needs of the tied up person.

Some men like it, many women hate it: The ligature of the breasts. The more or less tight wrapping of the breasts with rope or elastic band sensitizes the skin of the breasts and especially the nipples. At the same time the pressure to the glands can be extremely painful, and the consequences like absolutely unerotic and distressing irritations of the glands can be immensely protracted. Some women do have an aesthetical problem with tied up breasts; especially when they begin to go blue because of the congestion. A good active should show consideration.

To tie up someone nakedly in a chilly room is not the way. Especially with women this may lead not only to a bad cold but to a cystitis as well or even worse. Because a bondage session is often very exciting some victims loose the feeling for the temperature and don't notice when they are freezing. So it's the responsibility of the active part to take care of adequate heating and check whether the victim is all right in that department, too. Even when for the eye it's not the most pleasant of sights sometimes it's quite useful to put on some ski socks. To keep the shoes on can prevent cystitis, too. Attention: If you use a fan heater you should never put it less than at least one meter away from the tied up person.

Something that is often done because it's so much fun is tying a person up and then fucking her senseless on the carpet. Because of the movement, though, this may lead to unpleasant burns on the back of the person below. A padding like a sheet or a blanket is a better idea.
With bondage over a longer time - for example letting someone sleep the whole night while still tied up immovable - there may develop bruises or even sores. This is the case especially when the person is lying on a padding which doesn't absorb sweat. It can be prevented by allowing him/her to sometimes change positions and by not using your favourite rubber sheet.
Abrazions you should disinfect and then put on a plaster. Superficial bruises you can treat with a cooling ointment.

Generally you should bear in mind that the ropes change the kind of pressure they put on the body with any movement. So you have to check the tightness of the ropes regularly.
Some kinds of bondage force the body into unnatural postures, which may lead to overstretching and straining of muscles and joints. Particularly quick this may happen with ellbow bondage with symptoms of pulled tendons or muscle or even an irritated articular capsule. Measures: Hot pack, hot baths and ointments giving off heat. If the trouble lasts longer a visit to the doctor is necessary.

Someone "just" trying to repeat japanese bondage like he has seen people so easily doing in a movie may be confronted with the problem of a dislocated shoulder joint. In such a case an ice bag should immediately be put on the shoulder to prevent severe swelling and to make the setting possible. Everything else should only be done by an emergency doctor.
The models in bondage movies and copies are professionals knowing exactly the limits of their bodies. So you should always be careful when repeating something you have seen somewhere else.

The feedback of the passive part should ALWAYS be taken seriously. Something one person can stand without a problem may be unbearavle for the next. You as the active part are not tied up, so you can't know what exactly is happening inside; even if you do have some experience with bondage yourself as a passive part.
If despite all the precaution and control a nerv irritation or even contusion occurs, because the rope or the handcuffs have been to tight the place should immediately be cooled with an icebag. Nerv irritations can be quite unpleasant and lead to numbness in the fingers sometimes lasting several days or even weeks.

You may think that this has been a kind of horror catalogue for potential nasty consequences of bondage. But you have to pay attention to the fact that bondage is the kind of sexual practice where the most small accidents occur. Mostly they result only in a slight abrazion or a slightly irritated nerv, but even this can in most cases be prevented by a bit of precaution.
By the way, bondage is no protection against contagious venereal diseases, so safer sex is indispensable here, too. Particularly when someone can't defend oneself it's a serious breach of trust to make sex to him/her without agreement and without condoms.

From: Das Bondage-Handbuch, Matthias T. J. Grimme, Charon Verlag 1999

Bruce Esinem of Esinem.com has organized some further important Infos.
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