Every now and then Hugh finds it sexually arousing when his wife, Barbara, causes him physical pain. About once a month, at his request, Barbara spanks Hugh with a metal brush. Hugh and Barbara both describe their relationship as very satisfying. Hugh:

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Hugh does not meet DSM 5 criteria for a mental disorder because his sexual preferences, involving consensual pain, do not cause distress or impairment in social, occupational, or other important areas of functioning for him or his wife. They both describe their relationship as very satisfying, indicating that this behavior is a consensual part of their sexual life and does not negatively impact their well-being.

Every Now and Then Hugh Finds It Sexually Arousing When