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1. Poor circulation:
In using restraints, care must be taken not to compromise the circulation of the restrained limb. Restraints must NOT be so tight as to cause the following: numbness and tingling (pins and needles), cold sensation (can also be checked by the dominant by touching hands or feet); blue color of hands/feet; diminished sensation; burning sensation. Serious injury can result if these signs and symptoms of compromised circulation persist. The restraint must be released at the first sign.

2. Choking:
While I have no idea how common this practice is in the D/s community.... it is so potentially dangerous I have to speak to it. Choking.... compressing the neck.... is sometimes done as part of sex play.... (erotic asphyxia) ..in which case the choking is used to heighten orgasm. Any miscalculation can result in death by strangulation. Choking in any other context... as part of power exchange... not only carries the risk of miscalculation resulting in serious injury or death. Some people are especially sensitive to carotid pressure and develop a slowed heart rate in response. This can result in simple fainting, or more severe heart rhythm disturbances. For this reason, choking is not a recommended activity.

5. Abrasions:
These are rubbing injuries, typically sustained from restraints. Also from carpets... the so called rug burn. These should be washed with warm, soapy water, and if significant, dressed with bacitracin and covered with a sterile dressing and gauze.

6. Burns:
First degree burns result in reddened and painful skin. Second degree burns blister. Third degree burns destroy tissue. Extensive second degree and any third degree burns require medical attention. Minor burns should be treated immediately with immersion in cold water. Grease... butter, petroleum jelly, etc. should NOT be used. Burns blisters, when opened, should be treated as abrasions and covered with bacitracin and dressed with a sterile dressing.

10.Animals:
If an animal is used in erotic play, a muzzle should be used to prevent animal bites which are serious, especially to the face. The animal's toenails should be clipped as well.

11. Beating:
There are some areas of the body that should be avoided when administering a beating. The kidneys area, which is located on the back where the ribs join the spine, is one such area to avoid. The area of the spleen is also vulnerable to excessive force. This area is on the left side of the abdomen just under the ribs. Head injuries can be serious and heavy blows to face and head are not wise. Stick to the tush, the upper back, shoulders, and legs.

12. Frostbite:
Sometimes ice is used in D/s play. If there is prolonged contact to skin, frostbite can result. The first response to cold is blueness to the area... then redness and burning or diminished sensation.... followed by tissue injury. The area must be rewarmed IMMEDIATELY in WARM, not HOT water. Serious, extensive frostbite needs to be seen by a physician. The extremities... the fingers and toes...are most likely to get serious frostbite.

16. Strains and sprains:
These are injuries sustained to ligaments and tendons around joints. They may be complications of restraint and suspension. If pain is so severe that the joint cannot be moved, a doctor consultation is advisable. For minor injuries, remember RICE: Rest, Ice, Compression and Elevation. Rest the affected joint. Use ice for 24 hours, then heat. Ace bandages can provide compression and reduce swelling. Elevate the effected joint.

17. Branding, Cutting and Piercing:
These activities by their very nature cause injury. Any activity that breaks the skin must be done under sterile conditions. This means the skin must be cleaned first with warm soapy water... Then, the area should be washed with betadine. Allow the betadine to dry, then wipe off with an alcohol wipe. The person doing the activity should be wearing sterile gloves, both to protect him/herself from blood contamination, as well as protecting their partner from infection. Any of these instruments should only be used if they are sterile. Either purchase them in a sterile fashion and discard... as with needles... or sterilize. An item can be considered sterile if it is brought to a rolling boil and kept there for 20 minutes. It must be completely immersed in the boiling water. These activities may result in infection... please see above for signs of infection and treatment. Any infection accompanied by fever should be evaluated IMMEDIATELY by a doctor. These activities will result in bleeding. Minor bleeding can be stopped by continuous, direct pressure over the wound. Remember to wear gloves. If bleeding is spurting out, an artery may have been opened and this requires emergency medical treatment. Apply direct pressure and get to a hospital. Another complication of these acts may be shock, due to excessive blood loss. Follow guidelines for treatment of active bleeding.. keep the person warm, and raise the legs higher than the head. Get emergency medical attention. Shock can be recognized by pallor, sweating, tremulousness, faintness, rapid, thready pulse and loss of consciousness..

18. Psychological risks.
The D/s power exchange can be a deeply fulfilling, joyous, and thrilling way of life in the right context. Some "mental health awareness" unique to our community seems in order. There is a pattern for submissives particularly, to be aware of. In pain play, for example, the central nervous system responds with an outpouring of endorphins.. the natural painkiller., whose chemical structure is similar to morphine. This may indeed be the physiologic basis of subspace..... As this wears off.. there is a "letdown" and should not be confused with depression. Depression that is clinically significant lasts 2 weeks or more, and is characterized by persistent low mood, decreased energy, disturbed sleep and appetite, feelings of helplessness and hopelessness, and sometimes suicidal thoughts, delusions and hallucinations. These symptoms should lead one to consult a physician. Other hazards include those associated with the use of sleep deprivation..... (one should not drive sleep deprived!) . Psychological consequences of sleep deprivation include altered perception... (hallucinations), unstable mood, irritability, decreased fine motor performance and impaired judgment. Much the same picture is produced by prolonged sensory deprivation.