Health conditions and medication

This site has warnings about blood thinners scattered over half a dozen pages and nowhere anybody can be sent. This is that page. It is written for the person who is fairly sure they want to do this and is quietly worried that their medication makes it a bad idea.

Consenting adults only. Everything on this page is about adults over 18 who have freely agreed to it.

Written from first-hand experience or extensive research by the editor.

I am not a doctor and none of this is medical advice. It is the practical version: the conditions and medications that change what I would do in a room, in one place so there is somewhere to send people. Ask your GP about anything here, and NHS 111 if you are unsure whether something needs looking at. Everything below concerns consenting adults over 18. Mental health has its own page, mental health and spanking.

Nobody can guess, so it has to be asked

The person receiving is the only one who knows what is going on inside them. A top can see skin, build and how somebody moves. He cannot see a prescription, a clotting disorder, or an operation from March.

I got this wrong early on. Someone bruised in a way that made no sense for what had happened, and it turned out she took low-dose aspirin every morning and had stopped thinking of it as medication years ago. I had not asked, which was my failing rather than hers.

So it goes in the negotiation as its own item, and gets asked again on the day, because things change. The wording matters: "any health stuff?" gets a no from almost everybody, while "are you on any medication, and does anything affect bruising, breathing or blacking out?" gets real answers.

Blood thinners and clotting

A bruise is blood leaking out of small vessels under intact skin. These drugs remove part of the body's ability to close those leaks quickly, so the same force leaves a much larger and darker mark, spreading well beyond where the blow landed and taking two or three times as long to clear. Deep bleeding into the tissue is likelier too, the hard tight lump that gets more painful instead of less.

Aspirin needs saying out loud because nobody counts it. A 75mg tablet every morning is medication, it affects platelets for days rather than hours, and skipping today's undoes nothing. Haemophilia, von Willebrand disease, low platelets and liver disease sit in the same category.

None of which makes the answer automatically no. What I do: hand only, a fraction of the usual force, nothing with an edge, stop well before I otherwise would, and wait two days to see what appeared before deciding whether that was too much. See marks and bruising for the timeline.

Blood pressure, fainting and dizziness

Most positions put the head lower than the heart and hold it there. Then the person stands up, and that is when they go grey and sit down heavily on the floor. Things stack: blood pressure medication blunts the correction for a change in position, adrenaline drops fast at the end, a warm room dilates vessels, pain can cause a vasovagal faint even in people who have never had one, and nobody has eaten since lunch.

• Eat beforehand, and keep water in the room.
• Break up long stretches head-down. Fifteen minutes, then up and level.
• Get up in stages: elbows, kneeling, sitting on the edge of the bed for a minute, then standing with a hand on an arm.
• If somebody goes pale, sweaty or vague, get them flat with their legs raised. Standing them up to check is the wrong instinct and a common one. What to do next is on first aid for a spanking session.

Epilepsy

Pain, stress and lost sleep are recognised seizure triggers for some people, and a session can supply all of them at once. That does not put it off limits.

It means the top needs to know first: what your seizures look like, how long yours last, whether you get a warning, whether there is rescue medication and where, and who to call. It rules out any position where a fall lands on a hard edge, so a bed rather than bent over a worktop, and it rules out restraint.

If one happens, move the furniture rather than the person, cushion the head, do not hold them down or put anything in their mouth, and turn them onto their side once the movements stop. Call 999 if it passes five minutes, if another follows without recovery, if it is their first, if they are injured, or if they do not come round.

Diabetes

Neuropathy is the part people miss. Reduced sensation means damage is noticed late or not at all, which removes the feedback this activity depends on, so any area with poor sensation comes off the target list and the top checks the skin by eye rather than waiting to be told. Healing is slower and infection risk higher, so a split another person would ignore wants cleaning and covering.

Hypoglycaemia is the one that turns into an incident. A long scene is exertion, adrenaline moves blood sugar about, and the early signs of a hypo look almost exactly like the shaky, sweaty, confused state that follows an intense session anyway. Nobody tells them apart by eye. So test rather than guess, keep glucose in the room itself, and eat properly afterwards: aftercare matters for anyone and here it is part of the plan. Pump sites and sensors do not get struck.

Asthma

Face down into a soft mattress, weight across the back, anything tight around the ribs, a long stretch of crying: all of it makes breathing harder, and so does an unfamiliar house with a cat in it. So the inhaler goes in the room. Not a handbag in the hall, not a coat downstairs, not the car. If somebody wheezes they sit up and lean forward, use it, and everything stops until breathing is properly normal rather than nearly.

Skin

Eczema and psoriasis both mean a barrier that is already compromised: eczema breaks and infects readily, plaques bleed from small trauma. Work around those patches rather than over them.

Long-term steroid use is the serious item here and the one nobody connects. Oral steroids over months, and potent topical steroids on the same area for a long period, thin the skin and weaken the small vessels in it, so it splits at forces that would leave nothing on somebody else, and tears rather than grazes. If you are on long-term prednisolone, put yourself in the blood thinners section above.

Surgery, hernias, backs and bones

Recent surgery means waiting longer than you want to, abdominal and pelvic operations especially, where bending, straining and being held in a position are all out. Ask your GP: "when can I do heavy exercise again?" gets the answer without volunteering one further detail.

Hernias dislike raised abdominal pressure, so no bending over a hard edge and no straining against being held. Back and disc problems are workable and have their own page at what if I have a bad back. Osteoporosis changes the arithmetic on force, because ribs and vertebrae fracture at loads that would be unremarkable at thirty: nothing heavy near bone, no weight across the ribcage, no firm holding down.

Pregnancy

If you are pregnant, or have been recently, talk to your GP or midwife before any impact play, and avoid positions that put weight or pressure on the abdomen. I am not going to write more guidance than that, because I have none I would trust. The real questions about position, blood pressure and the abdomen belong to a midwife or a GP rather than to a man with a website. And take a partner willing to guess on your behalf as information about the partner.

What to say, and how to say it

You do not owe anybody a diagnosis. You owe them the practical consequence, which is a far easier sentence to get out. "I take apixaban, so I bruise much more than you would expect. Nothing hard, and no cane." That is a complete disclosure. No history, no apology.

What a top actually needs:

• Any medication, and anything affecting bleeding or clotting.
• Anything that could make you lose consciousness or have a seizure.
• Anything limiting which positions you can take, or for how long.
• Anything that reduces sensation anywhere.
• Anything you might need in a hurry, and where it will be.
• Allergies, including latex, plasters and animals in the house.
• Whether somebody should be called, and who.

Send it as a message the day before if saying it aloud is unbearable. And anybody who treats a health disclosure as an inconvenience has told you what he is like while you still have your coat on. See negotiation.

When to get medical help

NHS 111 is free at any hour and exists for the "is this serious" question. A GP is right for anything not improving, anything that looks infected, or anything still going after a few days. 999 or A&E for chest pain, breathing difficulty an inhaler does not fix, a seizure past five minutes, blood in the urine, bleeding that will not stop, or somebody who cannot be roused.

Then the thing that actually stops people going, which is embarrassment. No clinician needs to know why it happened, or with whom. "I was hit with a wooden paddle on Saturday" is the mechanism, and the mechanism is what changes the treatment. You may be asked whether you are safe at home, possibly alone, which is the system working rather than an accusation. Answer straight and it goes no further.