SM with blood (blood play): HIV, hepatitis and safety rules

Which practices are we talking about?

Blood play (blood play) covers SM practices where blood appears, on purpose or not:

• cutting (small incisions with a scalpel or blade);
• needle play (needles through the skin, play piercing);
• impact play that ends up breaking the skin (whip, cane);
• bites, deep scratches, razors;
• and, unintentionally, tears during fisting or very intense penetration.

What are the risks?

Bloodborne infections

CATIE is clear: activities that break the skin increase the risk of transmitting HIV and hepatitis C. WHO notes that hepatitis C is first and foremost a bloodborne virus, and that hepatitis B spreads through blood and fluids in the presence of wounds. HCV can survive several days on an object: a shared tool (blade, needle, stained whip, glove) can be enough.

Skin infections

A poorly cleaned wound can get infected (staph, strep): spreading redness, heat, pus, fever = see a doctor.

Accidents

A cut too deep, a vessel hit, fainting at the sight of blood, especially if one of you is high.

How to reduce the risks?

According to CATIE and Sexosafe:

1. Sterile, single-use equipment: new blades, needles, scalpels for each person, then thrown into a sharps container (available from pharmacies or harm-reduction services).
2. Gloves for whoever handles, changed between partners.
3. Disinfect the skin beforehand (alcohol, chlorhexidine), and care for wounds afterwards: cleaning, dressing, monitoring.
4. Don’t get blood in the mouth, anus, penis or another wound (yours or your partner’s): CATIE’s central advice.
5. One tool per person: what made someone bleed doesn’t go on someone else. Porous objects (leather, wood, rope) can’t be properly disinfected: keep them for one person.
6. Areas to avoid: face, neck, wrists, inner elbow, groin, anywhere large vessels or nerves run.
7. Sobriety: Sexosafe advises against drugs during hard sex, because they mask pain, the warning signal.

Sexual health side

• Hepatitis B vaccine: essential if you do blood play.
• Regular hepatitis C testing (every 3 months with risky practices or PrEP): hepatitis C is now curable (hepatitis C).
• PrEP or an undetectable partner for HIV. After exposure to the blood of a partner of unknown status: PEP within 48 hours.

And the framework?

Blood play is edgeplay: it takes experience, precise negotiation, a safeword and aftercare. See also BDSM and hard sex: safety.