It also appears that males are more likely to prefer sadomasochistic activities than females. This means that male sadists may have difficulty in finding willing masochistic females to be sexual partners. If partners are located, an agreement is reached about what will occur. The giving and receiving of actual or pretended physical pain or psychological humiliation occurs in most cares only within a carefully prearranged script. Any change from the expected scenario generally reduces sexual pleasure.
Sadomasochistic activities can also occur between homosexual couples.
The DSM-IV defines mental disorders. Previous editions of the DSM listed sadism and masochism as diagnosable disorders just for having such fantasies or urges over a period of time. That is, you must have the fantasies, urges, etc., and the fact that you have them must make you effectively dysfunctional in an important area of your life. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.