What causes pain can simultaneously become a source of sexual excitement.

Pain and Aggression do not always exist on the opposite side of pleasure: they can become incorporated into the sexual experience, acquire erotic meaning, and even intensify sexual excitement.

The relationship between Pain, Aggression, and Sexual Excitement is central to understanding Otto Kernberg, M.D.'s conceptualization of sadomasochism. At the same time, he considers sadomasochistic elements not only in the context of perversions, but across a broad spectrum of sexual functioning—from normal sexuality to severe forms of pathology.

In his article Sadomasochism, Sexual Excitement, and Perversion (1991), published in the Journal of the American Psychoanalytic Association, Otto Kernberg writes:

“ Sadomasochism, I believe, starts out as the potential for erotic masochism—for sexual excitement with pain—in both sexes, and constitutes a very early capability to link aggression with the libidinal elements of sexual excitement in an essential way, thus paving the road toward the entire spectrum of sadomasochism at all levels of development and pathology.

In light of clinical experience, it seems reasonable to assume that the experience of severe pain may intensify the attachment to the representation of the inflicter of pain, and bring about both a transformation of pain experienced into very early forms of aggression, and varying degrees of erotization of that painful experience and its aggressive elements. It is as if sexuality had, as one of its functions, the neutralization of aggression by incorporating it into the very fabric of sexual excitement.

The unconscious identification with the aggressor linked with the erotization of pain facilitates a sexualization of primitive omnipotence, a primitive condensation of love and hatred that may proceed in several directions. The profound sexual excitement and gratification derived from the expression of sadomasochistic impulses in the context of a sexually gratifying relationship points to the fundamental need to integrate love and hatred while assuring the dominance of love.

Sexual excitement, in this regard, may be considered a basic affect that permits overcoming primitive splitting of love and hatred, and tolerating ambivalence. Hatred, we might say, is “coopted” by love.

As the counterpart of this progressive development, under extremely pathological circumstances, the loving, affectionate aspects of sexual excitement may be recruited by the aggressive elements, leading to perversity, the malignant recruitment of love at the service of aggression. “

Thus, the question of the erotization of pain is not merely a question of WHAT can produce Sexual Excitement.

This is a question of HOW the psyche links Pain, Aggression, Sexual Excitement, Love, and Hatred—and how the same affective elements can give rise to such different psychological constellations: from sadomasochistic elements in the sexual life of a loving couple to situations in which either sadism or masochism becomes the only source of gratification, and gratification arises not from love but from the discharge of aggression. 

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(c) Yuliia Holopiorova,

Ukrainian Association of Transference-Focused Psychotherapy