Ask the Doctor of Perversity
by Beth Brown, MD

From Issue 2.4 - February 1996

Temperature Play

Dear Dr. Beth:

A play partner has recently expressed an interest in playing with hot wax and other extremes of temperature, but I'm worried about the safety of this kind of play. Can you offer some helpful advice?
--Warm Heart/Cold Feet

Dear Warm/Cold:

"Hot" is a word used (and overused!) to describe everything from objects of sexual desire to taco sauce. "Cold" could denote anything from a rejecting object of sexual desire to Republicans in Congress. Here I want to use these words in their most exact meaning -- the temperature of an object relative to human body temperature.

Hot and cold objects can provoke some of the same kinds of feelings as painful stimuli. This is because the nervous system processes extremes of temperature in the same way as certain types of pain. Sensations such as touch and vibration are perceived by way of large, myelinated (insulated) nerve fibers that have structured nerve endings in the skin. Pain, cold, and heat are perceived via uncovered loose nerve fibers in the skin, and are all transmitted along the same type of small, unmyelinated nerves that go to the brain through the same part of the spinal cord -- the spinothalamic pathway. While these three types of sensation -- pain, cold, and heat -- all have separate nerve endings, the nerve impulses end up in the same area of the brain, the thalamus. Extremes of any of the three can elicit similar responses from a bottom.

Playing with Fire: Heat

There are many ways of making the skin feel hot, but you are right to be cautious! There is not much difference between body temperature and a level of heat that can cause burns. A brief exposure to 110-115 degrees F can cause a first degree burn, and hotter surfaces for longer periods cause more serious burns.

The easiest way to use heat in SM play is dripping hot wax. Paraffin candles burn somewhat cooler than beeswax candles, and so are safer to use. Unscented, undyed candles are also best since there are no additives to alter the melting characteristics. Hot wax from a candle is easier to handle than other hot liquids, and it is safer because it cools very rapidly once it has left the candle.

The impact of the wax can be gauged and adjusted -- pouring from a greater distance above the bottom's skin allows the wax more time to cool on the way down. Based on the bottom's response, the height of the candle can be adjusted to intensify the sensation without causing an actual burn. If the wax is hot enough to burn the skin, pain nerves will be recruited in addition to heat-sensitive nerves, and the dripping wax will hurt more than the increase in temperature alone would cause.

There are advanced techniques of scarification, such as branding, in which extremely hot objects, usually metal, are used to cause deliberate burns to create scars for ritual or decorative purposes. These techniques require a great deal of skill and experience. Unless you know what you are doing, don't mess with these types of play. If done badly or not cared for correctly, the third-degree burns produced by branding can become infected and/or produce scars much different than the ones intended. Fire play with burning alcohol is also an advanced technique, and should be avoided until you have learned the skill from someone more experienced.

Putting a Bottom on Ice

Temperature play with cold can be particularly wicked, because it is easy for a bottom to confuse hot and cold sensations. John Varley's Titan series contains a scene in which a man is interrogated by being shown a hot poker, and then tortured blindfolded. He thinks his testicles are being burned with the hot poker, but when the blindfold is removed, he finds himself sitting in a pool of melted ice.

There is a much wider temperature range between body temperature and dangerous levels for cold than for heat. Tissue damage due to cold is caused by formation of ice crystals in cells and blood vessels. Unlike heat burns, which are very rapid, freeze injuries (frostbite) or non-freeze cold injuries (chilblain) are slow to occur. Depending on the temperature, these injuries develop over minutes to hours. Ice, at 32 degrees F, is cold enough to shock but not cold enough to cause damage over a period of several minutes.

When heat and cold are used together in a scene the feelings are much more intense, because alternating hot and cold sensations can confuse the nerves. Hot and cold nerve endings respond to differences from body temperature, but when rapidly repeated changes in temperature are administered to an area, these calculations can become wildly inaccurate. The bottom may feel as if they are being subjected to incredibly high degrees of heat and cold or both at once -- and pain nerves may be recruited as well, even though the skin is not burning.

Skin which has been flogged or spanked to increase the blood flow to the surface will be more sensitive to temperature sensations. This is the skin equivalent of turning up the volume.

The mental state of the bottom has a great deal to do with how the sensations are experienced as well. Much of what the heat or cold feels like will be affected by the bottom's expectations. The anesthesiologist's slogan, "Pain is in the Brain" is nowhere more true than in temperature play!

Beth Brown, MD (DoctorBeth@aol.com) is a Bay Area family physician. She is a contributor to The Lesbian S/M Safety Manual (Pat Califia, editor; Alyson Press, 1988). Please send questions that you would like her to address in future issues to DoctorBeth@aol.com.

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