(See also Overview of Paraphilias and Paraphilic Disorders.)
Sexual masochism is a form of paraphilia. Most people with masochistic tendencies do not have sexual masochism disorder.
Some amount of sadism and masochism is commonly play-acted in healthy sexual relationships, and mutually compatible partners often seek one another out. For example, the use of silk handkerchiefs for simulated bondage and mild spanking during sexual activity are common practices between consenting partners and are not considered sadomasochistic.
Most masochists interact with a consenting partner, who may have sexual sadism (that is, who experiences sexual excitement from inflicting physical or psychologic suffering on another person). In these relationships, the humiliation and beating are simply acted out, with participants knowing that it is a game and carefully avoiding actual humiliation or injury.
In contrast, sexual masochism disorder involves one or both of the following:
Treatment of masochism is usually ineffective.
Asphyxiophilia is considered a subtype of sexual masochism disorder. People with asphyxiophilia partially choke or strangle themselves by applying a noose around their neck, or they allow a partner to do so.
Typically, people use articles of clothing (such as scarves or underwear) as the noose. They may attach the noose to an object in the room (such as a doorknob or bedpost). A temporary decrease in oxygen to the brain at the point of orgasm is sought as an enhancement to sexual release, but the practice may accidentally result in brain damage or death.