This is a topic no one seems to want to talk about but it's a real concern in BDSM play.  Out of the thousands of hours of sessions I've been involved in I have had this happen maybe 15 times - so although it's rare, it does happen.

BDSM play can be strenuous and intense but it isn't always extreme situations that cause a submissive to faint or pass out.  When you lose consciousness it's because the body is under stress and decides to shut down.  The combination of adrenaline and odd positioning that often accompany a session can be enough in itself to cause an event.  Throw in a little pain and the ante goes up.  The following are just some of the causes of fainting in session:

*Lack of hydration
*Hypoglycemia (low blood sugar) - including Non-Diabetic Hypoglycemia
*A sudden lowering of blood pressure (many causes including ED drugs, vasovagal stimulation from pain, etc.)
*Extreme temperatures
*Lack of blood flow
*Underlying heart issues or circulatory issues

There are a plethora of factors that can contribute to fainting in session and it can happen to anyone, at any age, so heed the following precautions:

1. Hydrate well prior to a session.  In My experience lack of hydration is the #1 factor.   For longer sessions, bring water or a sports drink.

2. Avoid erectile dysfunction drugs like Cialis and Viagra.  I know it's fun to have a raging hard-on in session but ED drugs lower blood pressure (see above) and if you are on alpha blockers or nitrate drugs this can make the effect worse and is dangerous.  If you do take ED drugs for a session, move slowly when changing positions, avoid positions of standing immobility and by all means inform your Domme.

3. Eat normally prior to a session.  I know some subs can get a "case of the nerves" prior to sessioning and have a loss of appetite, but coming to a session on an empty stomach could have you ending up on the floor. Eat and drink normally at least 30 minutes prior to your session.

4. When placed in standing positions. like on the St. Andrews cross, don't lock your knees.  It lowers circulation to the brain.

5. If you get overheated easily and you are going to be engaging in very physical play or even cross-dressing, ask that the room temperature is lowered.  An overly warm room can cause light-headedness and subsequent fainting in some subs.

6. Be honest in your dealings with your BDSM provider.  If you have ever felt lightheaded, dizzy or lost consciousness in session, tell them up front.  Some subs are just more prone to this.  That way she can take the necessary precautions.  Be honest about medical conditions, your age, medications and other relevant information she requires.  If she chooses not to see you because of it, so be it.  It could be a disaster if she is unprepared to deal with your condition.

7. At the first sign of lightheadedness, dizziness or disorientation - tell your Top immediately so they can take the necessary measures to keep you safe.

Advice for Tops:

In my personal experience, ED drugs, CBT and the St. Andrews cross = a perfect storm.  One of the factors is lack of circulation due to locked knees and hands above the heart in this position.  Use extreme caution in this situation or avoid it all together if you are not familiar with the sub and his responses.  The good news is, most subs revive quickly once you lay them flat.  They may be disoriented for a few seconds and think they were out longer than they were, but it's usually only for a few seconds.

If your sub loses consciousness, the most important thing is not to panic.  The biggest issue you have at this point is moving them safely to a prone position.  If they are on the cross, unhook the legs first and pull them out a bit so they don't fall forward when you release their hands.  Have full weight release clamps on the wrist connectors.  Their full weight will be on their wrists and it will be difficult (if not impossible) to unclamp them without release clamps.  While releasing the wrists, push your shoulder into their torso to bear their weight the best you can and guide them to the floor.  The bigger the sub the harder they will fall and this can be a difficult maneuver to do on your own, but they must come down in order to wake up.

Once they are flat on the floor aid in circulation by propping their feet up above their heart.  As stated, most subs wake instantly, but it's still a good idea to have them rest in this position for a while before trying to move.  Give them water to sip.  Simple sugars like juice or hard candy (always keep some candy in your play bag) are helpful in cases of insulin drop.   Most subs are able to rest for 5-10 minutes and want to continue the session but use your discretion as to whether to continue or not and if you do, keep them in sitting or lying positions.  Tables are best but I have never had an issue on a spanking bench either.

If your sub does not revive quickly or becomes incontinent this is not a good sign and it's time to call emergency response.

Although I did have this post reviewed by a doctor/sub client, it is not meant to be all encompassing and if in doubt, always err on the side of caution.  

Mistress Ayn,

My experience a few years ago was a bit different than passing out but I'd like to add it here. To be honest I'm still not sure what happened or all the details. Toward the end of a two hour session I basically "zoned out". Mistress noticed an issue and wanted to call 911 but I talked her out of it and said I'd be fine. I got dressed and left her apartment, set my "home" location on the car GPS and drove home. I have no recollection of leaving her place or driving from downtown Phoenix to almost Tucson. My awareness (coupled with a great deal of fear) returned after I'd exited the freeway and was heading on town streets toward home. Mistress had left a message on my cell and sent an email to check up on me and related what had happened. It reminded me of things people used to tell me happened when I was a practicing alcoholic and experiencing a blackout. I haven't had a drink or drugs in many years so that wasn't the issue in this case. I suspect it may have been either a mild TIA or due to poor eating/dehydration.

The good news is I've sessioned after this (and told Mistress what had happened) and have not had a repeat.

Wow marstoy. That is truly frightening and I have never heard of anything quite like that happening. It's quite a drive from Phoenix to Tucson and to remember nothing of it is really disturbing. Was the session particularly intense?

Mistress Ayn,

The session wasn't particularly intense and the bondage wasn't in positions that should have caused problems. One thing I didn't ask was if Mistress put something in the enema she gave me that could have caused a problem.

Several excellent points in this post.

I've never had it happen in a session (although I did get choked out by a Domme at a photo shoot after I said something smartass... but, that was more being knocked out than passing out). I have, however, come close multiple times and had to call "Red" to prevent it (in all these cases, there was barely any time to say "Yellow" to warn the Domme that I was heading towards trouble).

Basically, the symptoms for me are feeling extremely queasy and having "flop sweat" pouring out of just about every pore (I also "turn white as a ghost"). One time the cause was eating just before we started playing (the Domme was running late and hadn't eaten, so we took about 15 minutes and shared a decent size meal in the dungeon before diving right into play afterwards), the rest were because of activities that brought on very large endorphin releases (being ball kicked very hard five times in a row; hard corporal without any real warmup; and rope ties on my balls that squeezed my testes as they tried to migrate and escape). Also when my breath is taken away and I feel a large and sudden rush of blood to my crotch, like what happened when I saw Mistress Ayn for the first time (I will never forget how sexy she was in that red dress and heels), makes me feel very faint.

Because of these incidents, I actually don't eat anything within the last hour or two before a session and make sure I communicate my need for warmup before a Domme does anything truly painful to me as part of my pre-session communication. I also look at Mistress Ayn's pictures a lot, just so that I can be prepared for the sudden onslaught of Her beauty and charm when I am in Her presence.

Asp, you are fortunate that you have symptoms in time to catch it - and you recognize what it is enough to say something. Some do, but most don't. Trying to push through it never works, so you are wise to notify your Top and have them get you flat.

Unfortunately, most don't have early symptoms or if they don't, they don't recognize them for what they are - a precursor to blackness. On occasion, I've touched a sub and felt that cold sweat or looked into his eyes and saw that blank stare and knew to get him vertical, but it's rare to get the indications in time to act.

As far as that blood pressure drop due to My entering the room, there's not much that can be done about that - except may condition training . . .

Thank You Mistress for writing about this subject. I expect it is far more common that most would think. Hopefully Dommes have had an American Heart Association CPR course. Some Atlanta hospitals offer them periodically and the cost is minimum.

I have never passed out while being whipped but I have passed out about 3 times in my life when thinking of some negative medical condition, even if it was a condition I did not have!

Part of the reason for the post is that I am reminded of 2 things:

I think one of the ladies who posts a maxfisch gave a guy a long whipping and he passed out during that

and

there is a video out in cyberspace when you search for extreme or severe whipping.

The team in Hungary or Rumania that does elite pain and has almost a dozen other websites has a clip that is about 5 minutes, though the stuff they sell and buy runs from 20 to 60 minutes I think.

Anyway, there is this woman restrained and she is being whipped and asks to stop and they do not.

She cries a little and says Why don't you or Why can't you understand?

A little bit later she goes out and the whipping team stops the whipping and releases her from her restrains and that is all we see.

There are people who obviously pass out while in breath control, suffocation and/or ass smothering and hand to mouth smothering.

There are lots of clips of that and there are clips of that from a ass smothering website called cplwresting, I think.

1/3 or 1/2 or so of the sessions, either girl girl or girl guy, end with the guy or losing girl going out.

Mistress Ayn,
Thank you for this post. I experienced passing out during session just last week (late October) . My Mistress and second mistress in the room handled it safely and took wonderful care of me. For this I am blessed. I was standing, attached to the cross, one mistress chaining and roping me to the cross. The other Mistress spanking,paddling my ass. I felt myself enter my sub space (which is my goal) started to feel hot as hell, mumbled about being hot and next thing I remember is being held by mistress and cool down by the other. So sweet and caring . Not sure what caused it but we took a break and than pushed on with the session. Got checked by Dr later in day. All clear and ok. I value the care both took in making sure I was ok. Neither of them panicked (from what I can tell ) and i will never forget how well it was handled. Strange thing I am a super mental sub. It’s about getting my mind you can have my body but dominant my mind and that’s what I seek. Break my walls down I must say. My last memory before passing out was wonderful I have never felt so close to what I seek. That might be trouble but I see it as a break through Thanks for listening