Masochists have persistent interest in sexual activities that demean, humiliate, or cause suffering to themselves, and they actively participate in sexual activities to reach this goal (DSM-IV code 302.83; in ICD-10 sadomasochism is coded as F65.5).(34) Masochists generally have a few partners with whom they become repetitively involved. Since masochism requires dominance and control by another individual, it is a paraphilia that cannot be forced upon others. Masochists frequently demonstrate some transient interest in masochism to an uncommitted sexual partner hoping that, if they become involved on a sustained basis, that partner will acquire a sexual interest in tying them up, spanking them, or whipping them. In reality, this is an exceedingly difficult interest for a new partner to acquire and, as a result, masochists sometimes join sadomasochistic clubs where it is easier to find a partner to hurt them.

A dangerous variant of masochism is autoerotic asphyxiation (hypoxyphilia), in which individuals are sexually aroused by suffocating themselves, hanging themselves, or in some way cutting off their source of oxygen while masturbating.(89) These individuals frequently rig equipment to temporarily hang themselves and set up what they view as a failsafe system to disrupt the hanging experience should they lose consciousness. Unfortunately, these systems sometimes fail and the individual dies. Some individuals engage in transvestic fetishism during the asphyxiation episode.

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