Bondage and discipline, Domination and submission, Sadism and Masochism (BDSM), is the erotic practice of negotiating, manipulating, and forming relationships based on consent and the balance of power. Previously seen as a “perverse” form of sex-play, BDSM has become an increasingly prevalent topic in the media and in personal sex lives. Recent research illustrates the need to learn to communicate skillfully to BDSM practitioners in the community. This includes learning the terminology, understanding the frameworks and practices, and recognizing the spectrum of relationships in the BDSM community. These considerations in clinical practice, as well as the emphasis in this community on open communication, safety, and sex-positive rhetoric is an ideal instrument for education and clinical support for safe sex practices. Pharmacological considerations are explored in Bondage and discipline, Domination and submission, Sadism and Masochism, with a focus on medication advisories for all practices.