Fetishism substitutes an object for relationship. The experience is incomparable. In practice, it is the submissive or masochist that has the final say. For more strenuous activities the individuals should be in good physical shape, just as for any other sport. The shared education and experience of other players can be invaluable.
Sexism tries to impose dominant-submissive roles according to gender.
Sometimes it is a full time relationship. Who's in charge is far fiom obvious. It is a dance involving both parties. Some come from healthy families and are looking for self fulfillment. Still others are new to the concept and felt a connection when they tried it.