The Kink Clinical Guidelines Revision - 2026©

Introduction: “Kink” refers to a diversity of sexual, gender, and relationship interests, behaviors, orientations, desires, and identities often stigmatized by the cisgender, heterosexual, and monogamous (CHM) dominant culture. In these Guidelines, intended for all clinicians, we will capitalize Kink to emphasize its socio-political and community importance.

Just as we refer to MSM (Men who have Sex with Men) to include men who are sexually active with men but who do not define themselves as Gay, Kink includes people who do not define their sexuality as Kink, but who engage in, fantasize about, struggle with personally accepting, or are concerned with the lack of social acceptance of their Kink interests. Some of these individuals are active in Kink communities, while some are not.

We respect everyone’s right to define themselves as they choose, but in interactions among people involved in Kink and clinicians, we suggest that you refrain from using words that have been used historically to denigrate or pathologize people. We recommend that you ask all individuals about how they prefer to be referred to, how they define their sexualities, and use those terms.

People often experience subtle or overt discrimination, rejection, and social sanctions when they are Kink-identified. Unfortunately, attempts to hide or suppress Kink desires can result in stress, unsatisfying relationships, self-loathing, unmet healthcare needs, and can have an adverse impact on individuals’ lives. Despite these problems, many people continue to pursue Kink.

Clinicians (and patients) are not immune from the effects of growing up in a sex-negative, Kink stigmatizing culture and may harbor unrecognized biases. These biases can lead to inappropriate or missed diagnoses, misguided treatment goals, or a lack of engagement in the treatment process. Many Kink-involved patients seek professional assistance for issues unrelated to their Kink. Clinicians should not assume, (because of their own bias or discomfort) that Kink should be a focus of therapy. The Kink Guidelines Revision are one step towards addressing these concerns and providing nonjudgmental care for all.

© 2026 by Diverse Sexualities Research and Education Institute (DSREI).  All rights reserved.  If you would like to post or distribute these Guidelines, which is encouraged, please complete the agreement form following these guidelines.

The Kink Clinical GuidelinesRevision - 2026©

1)  The Clinician’s Beliefs about Kink –

     Clinicians understand that Kink interests, behavior, or identity…

  • Do not indicate the presence of psychopathology, a mental disorder, or the inability of individuals to control their behavior.
  • Do not typically reflect a response to trauma or abuse.
  • Can be recognized at any age, usually evolves over one’s lifespan, is influenced by their own experiences, the beliefs of others, and by other, intersecting identities (e.g., race, religion). The same obviously holds true for other forms of sexuality.

      Additional Information

Clinicians recognize that exploration of Kink may result from curiosity, pleasure, identity exploration, or a desire to please one or more partners. In interacting with Kink patients, many clinicians lack the nonjudgmental attitudes and knowledge about the range of consensual Kink practices needed to provide care to Kink-identified, and Kink-exploring patients.

     2) Avoiding Clinical Bias

  • Kinky patients often have had negative experiences with clinicians in the past, which might affect their initial interactions with a new clinician. The clinician should not judge the patient’s affect on the basis of such interactions alone.
  • The presence of Kink interests does not imply any underlying psychopathology, history of trauma, or an inability to control one’s behavior. Please note, individuals with psychopathology may also have Kink interests.
  • Clinicians do not assume that any clinical problems are caused by Kink.
  • Reparative or conversion therapy, that is, “treatment” intended to eliminate Kink, is unethical, ineffective, and never appropriate.
  • Diagnoses of psychopathology should not be based solely on Kink interests. Diagnostic criteria should not differ based on the specifics of patients’ sexual interests (e.g., CHM, Kink, LGBTQ+).

     Additional Information

Clinicians recognize that they need sex-positive, Kink-positive, and non-discriminatory perspectives to effect nonjudgmental and supportive care. A “sex-positive” perspective entails treating sex as a normal and healthy part of life, respecting others’ sexual desires, having nonjudgmental attitudes about consensual sexual practices, regardless of whether you would choose them for yourself. Similarly, “Kink positivity” reflects the same nonjudgmental and positive perspective but is specifically focused on Kink sexualities. To that end, clinicians support evidence-based continuing education.

Treatment to promote acceptance of one’s Kink interests is more effective than trying to change those interests. Treatment may alter the way in which Kink is expressed or experienced, but not the presence of Kink per se in the patient’s life.  Exploring how Kink interests might be expressed differently might be appropriate. It is important to remember that not all interests need to be actualized; some joyfully remain as erotic fantasy.

The interaction of one’s Kink and psychological problems can be conceptualized as: 1) Kink and problems are independent of each other. 2) A specific Kink is the cause of the patient’s problems. 3) Kinks are not the cause of the problems but affect how problems are manifest. 4) The problems are not the cause of the patient’s Kink but may affect how the Kink is expressed. 5) Or a mix of all of the above.

The diagnostic criteria and rationale put forth for Paraphilias and Paraphilia Disorders in the ICD-10, ICD-11, and DSM-5-TR are flawed and should not be relied upon.

      3) Consent

“Explicit Prior Permission” (EPP) has become a framework to determine the adequacy of consent in legal situations (whether criminal or civil). The American Law Institute has created a draft framework for the revised Model Penal Code intended to help understand consent. This framework can be useful to clinicians to assess the adequacy of consent. It requires that participants:

  • Understand the risks of participating. Participants agree on the nature and intensity of the specific acts involved. (Clinicians can help patients determine their risk profile.)
  • Agree as to what level or type of “resistance” can be ignored.
  • Can stop and withdraw from the activities, or a particular aspect of the activity, at any time (i.e., via safewords or safe signals).
  • Are adults and have the capacity to consent freely.
  • Will avoid serious injury including protracted loss of function of a limb or organ,permanent serious disfigurement or risk of death.

Additional Information

Consent is an ongoing, dynamic process and should not be reduced to simple “yes-or-no” negotiations. Consent discussions include clear and honest statements of limits, desires, goals, aftercare, debriefing, risks, probable and possible outcomes.

Consent, how it is managed and negotiated, is often an issue in Kink relationships and a concern for the clinician treating Kink patients. By definition, Kink is consensual. If it is not consensual, it constitutes violence. EPP is a place to start, but this is a complex topic and much has been written and debated about it. Kink communities do attempt to educate their members about consent; the process and adequacy of consent are ongoing issues.

     4) Stigma

  • Clinicians recognize how stigma, discrimination, and violence directed at people involved in Kink can have an adverse impact upon their health and well-being.
  • Clinicians understand that distress about bias against Kink can result in a patient’s understandable reluctance to engage with the clinician.
  • Distress about Kink might reflect internalized stigma (or internalized Kinkphobia) rather than serving as evidence of disorder or diminution of the patient’s ability to function.

     Additional Information

The effects of stigma are significant and usually arise as patients struggle with defining themselves and/or accepting themselves, managing interpersonal conflicts, being outed by others, as well with privacy and confidentiality concerns. People often have conflict with other co-existing identities (e.g., submissive feminist women, Black individuals who identify as slaves). Kinkphobia, an irrational fear of Kink, may be internalized, but is also a phenomenon among people who attribute negative intentions to members of the Kink communities.

Kink activities have been used inappropriately to deprive individuals of their civil rights. Intimate partner violence/domestic violence (IPV/DV) can be confused with Kink and can also co-exist with Kink activities or relationships. IPV/DV assessments need to be Kink-informed. Inappropriate or inadequate assessments of patients can threaten the individuals’ employment, immigration, child custody, financial status, and potential imprisonment for consensual adult activities.

     5) Personal Growth and Support

Clinicians recognize that Kink experiences can lead to healing, personal growth, and empowerment.

  • Kink may be therapeutic in some situations, but Kink is not therapy.
  • Suppression of Kink interests or expression also can have negative effects on the patient’s health.
  • Helping patients to find a group of like-minded individuals, (i.e., Kink support groups), may be helpful in alleviating stigma and enhancing personal growth.

     Additional Information

Kink support groups can be formal or informal groups of individuals with common interests (e.g., bondage) or who share other identities (e.g., Kink-identified people of color). Please note that underage individuals may have interests in Kink, but Kink communities can only provide support to adults. There are some sex-positive, youth education platforms (i.e., Scarleteen), which can be supportive.

 

Clinician Qualifications and Expertise

All clinicians should routinely seek supervision, consultation, and further training, as well as keep up with the latest academic evidence-based literature on Kink. Licensing boards, continuing education programs, training programs, and academic courses should help clinicians stay current with the latest science and clinical skills concerning Kink. Clinicians should also have an awareness of local and international Kink community practices. It is incumbent upon the professional to recognize that this area of practice is constantly changing.

It is a rare individual who has not absorbed the dominant culture’s sex-negative beliefs, including or especially about Kink. To combat these biases, clinicians should evaluate their own beliefs critically. We refer to this process as developing Cultural Expertise, which can be understood as a combination of cultural competence (i.e., clinical knowledge and skills required to interact effectively with patients involved in or contemplating exploring Kink), cultural humility (i.e., ongoing personal introspection into one’s own biases and limitations), and cultural literacy (i.e., knowledge of Kink). Cultural Expertise requires a commitment to lifelong learning.

Training courses may give certificates of attendance, but do not confer certification.

Levels of Kink Clinicians’ Expertise

Kink Aware – The clinician is open to seeing patients who are Kink-identified, engage in Kink activities, or have questions or concerns regarding Kink. The clinician is sex- and Kink-positive and is cautious about preconceived notions (whether positive or negative), about what having a Kink identity, interests, and/or participating in Kink means for/about the patient. The clinician approaches the patient with an attitude of cultural humility. Clinicians operate from the desire to expand their Cultural Expertise.

Kink Informed –The clinician meets the definition of Kink Aware and demonstrates significant clinical experience or knowledge of several types of Kink interests and/or behaviors. Clinicians are committed to expanding their Cultural Expertise to improve interactions with patients.

Kink Expert –The clinician meets the definition of Kink Informed as well as demonstrating extensive clinical experience and knowledge of the treatment of patients with a variety of Kink interests and/or behaviors. Clinicians are actively expanding their Cultural Expertise related to Kink.

Supervising Kink Expert – The clinician meets the definition of a Kink Expert and has additional training and experience in supervising and training Kink Aware Clinicians.

Kink Specialist – Acknowledgement for non-clinicians of educational achievements

 

Agreement to Post the Kink Clinical Guidelines Revision – 2026©

The final version of Kink Clinical Guidelines Revision – 2026 (Guidelines) has now been approved and copyrighted. The copyright is owned by the Diverse Sexualities Research and Education Institute (DSREI, https://dsrei.org), a 501(c)(3) nonprofit corporation. These Guidelines were compiled by Charles Moser, PhD, MD and Peggy J. Kleinplatz, PhD and are administered by DSREI.

Permission to use or post the Guidelines comes with a few rules:

1)  Anyone can link to the Kink Clinical Guidelines Revision – 2026 official website (https://xxx) or share that URL.  If you wish to post these Guidelines on your own or your organization’s websites or distribute the Guidelines, you must register.

2)  There is no fee for registering and those registered agree that they will not charge any fees to others for posting or distributing the Guidelines.  Only the complete copyrighted version of the Guidelines may be posted.  Posting an excerpt of the copyrighted version is acceptable, if it is acknowledged that it is an excerpt and a link to the complete version is also posted.

3)  The poster will attribute ownership to DSREI and agrees to register. The agreement form is below.  Registration information will be used to notify the poster when updated versions are approved and the poster agrees to post the updated versions of the Guidelines as soon as possible.

Please send the signed Registration Statement to tdscb@proton.me.

Registration Statement –

I, _________________________ (insert name of organization or individual), agree to post the Kink Clinical Guideline Revision, 2026 document, unedited, adhering to the rules above, on the website, ___________________________ (URL). I can be contacted at ____________________ (email address).  I affirm that I have the legal authority to sign this agreement as an individual or for my organization.  By typing my name below, this is considered a legal signature.

 

Signature: ____________________________________________Date: ___________________

©2026 Diverse Sexualities Research and Education Institute, all rights reserved

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