In 2012, The Alternative Sexualities Health Research Alliance (TASHRA), a registered 501c-3 nonprofit community-based research organization, was established from a visionary impulse. Co-founders Richard Sprott, PhD, our Research Director, and Anna Randall, LCSW, MPH, DHS, our Executive Director, noticed an increase in discussions about kink, BDSM, and fetish in mainstream discourse. However, they  also saw a significant gap in informed and competent healthcare for kink-involved people. Recognizing this, they  understood the pressing need to diminish stigma, combat discrimination, and enhance healthcare tailored specifically for individuals drawn to these alternative sexual practices. Through their  tenacious commitment, cutting-edge research, and community engagement, they established TASHRA with  an ethos rooted in the belief: kink thrives when health thrives.

This journey has led to a proliferating portfolio of TASHRA’s initiatives. Some of the many ongoing enterprises include the conduct of four IRB-approved research studies and the dissemination of our research findings through academic pathways and community integration; focusing on the mentoring of new professionals, while uplifting seasoned ones in kink studies; and introducing innovative transdisciplinary care strategies. Additionally, our programs offer expanded monthly professional development syllabi for healthcare providers and coordinated specialized groups for kink-proficient clinicians. Always looking to offer more, TASHRA is currently in plans for an innovative system to augment kink-proficient mental health accessibility that will cater specialized care to kink-identifying individuals. We are expanding our monthly professional development syllabus for healthcare providers, coordinating  specialized groups for kink-proficient clinicians; and are currently innovating a system to augment kink-proficient mental health accessibility, cater specialized care to kink-identifying individuals, and offer intensive training for budding clinicians.

Clinical Training and Support:

Since initiating our virtual continuing education program in the Spring of 2020, TASHRA has shown commitment to be a vanguard in the advancement of kink research and education. We have hosted over 45 educational events; enrolling 1,526 participants, while ensuring a broad and diverse reach. Out of these, 38 were specifically designed for clinicians, offering essential continuing education credits; and seven were developed for the community, seamlessly integrating academic knowledge with real-world experiences.

Our comprehensive suite of training topics underscores TASHRA’s dedication to broadening the understanding of kink in the clinical world. Addressing a myriad of themes, from navigating the complexities of integrating kink-aware practices in clinical environments to empowering clinicians in the establishment of a kink-inclusive practice, we aim to furnish clinicians with the necessary tools and knowledge to serve the kink community with sensitivity and expertise. Moreover, understanding that clinicians might themselves be a part of the kink community, our programs also focus on guiding them in their navigation within this realm, ensuring a harmonious integration of their professional and personal lives.

Complementing our research endeavors, TASHRA’s peer consultation groups offer a vibrant platform for mental health providers to hone their clinical skills, specifically tailored for kink-involved clientele. Since its inception in early 2021, over 30 adept clinicians have benefited from these invaluable sessions. 

Each training we offer is curated to fill a knowledge gap. Whether it’s understanding the intersection of law and BDSM, comprehending the psychological aspects of different kink practices, or acknowledging the importance of culturally competent care for diverse groups within the kink community, we’ve strived to provide a holistic educational experience. Our goal is to ensure that every clinician, regardless of their background or prior knowledge, has access to the resources they need to provide effective, empathetic, and informed care.

A sampling of TASHRA’s Training Programs taught by TASHRA’s educational team and invited guest presenters: 

  • BDSM and the DSM (Diagnostic and Statistical Manual)
  • Elements-Building a Kink-Inclusive Practice with guest presenter Carrie Jameson, LPCC
  • Kink-Claiming the Trauma: From Sexual Assault to Sexual Empowerment with guest presenter Andrew Pari, LCSW, CCTP
  • Playing with Dark Emotions: Playing with fear and shame in scenes of humiliation, objectification, and dehumanization
  • From the Playroom to the Courtroom: BDSM, Consent, and the Law with guest presenter, Susan Wright from the National Coalition for Sexual Freedom
  • Power, Privilege, and Play: A primer on healing through anti-racist kink affirming care with with guest presenter Traci Medeiros-Bagan, LMFT
  • Black & Blue: Suicide in our own leather, kink, and queer communities
  • Exploring Kink, BDSM, and Cannabis in Mental Health Practice with with guest presenter Dianielle Simpson-Baker, MA, MFT
  • Engaging with Healthcare and Kink Play for People with Larger Bodies with with guest presenter Asher Laramie, MD

In the dynamic realm of kink education, TASHRA’s commitment has remained unyielding: empowerment through education. Last year, we revised our Training Contract to align more closely with the principles of inclusivity. This essential step wasn’t merely symbolic but was a genuine commitment to prioritize and fairly compensate historically under-compensated communities. Our trainers, equipped with rich lived experiences, aren’t merely recognized but justly rewarded.

Our scholarship program, introduced in August 2021, further underscores our commitment. By providing 72 scholarships, covering around $4,050 in registration fees, we’ve actively worked to ensure that financial limitations don’t hinder access to quality education. This initiative supports health professionals in their training, ensuring a brighter and more informed healthcare landscape for the kink community. 

As we progress in our mission, our primary focus remains: inclusivity, excellence, and a profound commitment to both the clinical and broader community. We are more than just educators; we are advocates, dedicated to enhancing the understanding and acceptance of kink.

Feedback from our attendees speaks volumes about our dedication and impact:

“Thank you for this thought provoking, trauma-aware, kink-positive training.
TASHRA always offers such wonderful trainings. Thank you.” 

– Participant in Kink and Healing: Two Approaches, April 2023

“This was a daring and important training, and I appreciate getting to take it!” 

– Participant in Understanding Bestiality and Zoophilia, May 2022 

“Phenomenal class. I learned a great deal, especially on how the community has appropriated CNC.” 

– Participant in Playing with the Boundaries of Consent: Clinical Issues Concerning Consensual Non-Consent Scenes and Relationships, October 2022

Formal Research:

Simula’s 2018 paper outlines the burgeoning academic field of BDSM Studies. For perspective, while the term “BDSM” was scarcely mentioned in literature before 1980, the years 2020 to 2023 observed a remarkable 7,350 publications on the topic, with estimations reaching an anticipated 8,820 by the close of 2024. Our zealous drive to elevate understanding and challenge preconceived notions is palpable. 

Over the past decade, TASHRA has ventured courageously into the intricate world of kink, establishing itself as a luminary in a domain that’s often misinterpreted. As leaders in kink health and research, our initiatives have ranged from in-depth explorations to widespread surveys. In 2013, our inaugural Kink Health Project unveiled the challenges and support mechanisms within the San Francisco kink community. Our ongoing Gerbil Survey, informal as it might be, serves as a pulse check at community events. By 2016, our extensive Kink Health Study had already surveyed over 1,000 U.S. kink-involved adults, unveiling their health concerns, navigation strategies, and more.

Currently, TASHRA is spearheading its most monumental research initiatives. The International Kink Health Survey, launched in May 2022, broadens our previous study to an international scale, focusing deeper on mental health nuances within the community. Meanwhile, our PrEP4Kink study, a pioneer in its domain, targets HIV prevention in the kink community. Additionally, our ongoing Authority Transfer Relationships (ATR) study delves deep into the realm of power dynamic relationships. We are also on the cusp of launching the Kink and Flourishing Study (KFS), aiming to empirically assess the therapeutic aspects of kink involvement, a topical theme of great interest. 

From our foundational Kink Health Project in 2014, the comprehensive 2016 Kink Health Survey, to the ongoing International Kink Health Study (IKHS), TASHRA has relentlessly championed understanding the complex health and wellness dynamics of the global kink community. The IKHS epitomizes our extensive reach. Engaging with over 1,000 participants, predominantly online, our in-person community events have also been instrumental in building bridges with varied kink community factions, particularly those from rural areas and diverse racial/ethnic groups. Our research illuminates the health impacts of kink, spotlighting healthcare-related stigmas and their ramifications.

Over the last 15 years, we have taken the lead in organizing the maiden symposium on BDSM and consensual non-monogamies at the American Psychological Association Convention, introducing groundbreaking dialogues on “Variations in Love” and charting a future research course for BDSM sexuality and polyamory. This endeavor showcased our steadfast commitment to spotlighting the essential research avenues in this field.

Throughout our decade-long odyssey documenting the health and healthcare narratives of kink-identified individuals, we have remained unwavering in our mission to:

  • Delve into the health intricacies of erotic, sexual, relationship-diverse, and gender-diverse communities.
  • Fine-tune medical and mental health practices that are culturally insightful and affirming.
  • Spread awareness to challenge and correct prevailing misconceptions surrounding kink-identified individuals.

As Kink Studies flourishes, TASHRA stands as a pillar in its advancement. Our research has revealed pivotal insights: 50% of those involved in kink activities hesitate to share this aspect of their lives with healthcare professionals, primarily due to apprehensions of rejection or stigmatization, which potentially compromises their care. Bondage-related injuries, especially nerve compression, have been pinpointed as a common kink-associated ailment. However, there’s a silver lining: a resounding 80% view their kink practices as enriching for their mental and physical health.

Community Education and Engagement:

Community outreach and educational engagement remain at the heart of TASHRA’s pursuits. Our community education program stands as an emblematic representation of our unwavering dedication. Since its formative years, TASHRA has orchestrated community workshops and has done countless presentations around the US and world. 

In 2023, to further our mission of disseminating knowledge and fostering profound connections, we introduced the “KinkHealth News” – TASHRA’s premier kink science newsletter which is currently distributed to over 2900 . Crafted with meticulous attention, this periodic publication serves as a conduit to keep our community abreast of TASHRA’s endeavors and the continually evolving domain of kink studies. Previous editions have spotlighted community luminaries, like ‘Pearls and Poison’, while our ‘Research Corner’ sheds light on avant-garde findings in the field, such as a study on Consent Violations by David Pasoff. A distinctive newsletter segment invites community inquiries about kink and its effect on health; and where we publish expert perspectives from medical practitioners and therapists. In one notable query, a community member’s question pertained to the ramifications of erotic biting, to which one of our medical team answered, “Human bite wounds are notably susceptible to infections due to the myriad of bacteria present in the human mouth. Such wounds, with an infection rate comparable to, or even surpassing, animal bites, can also inflict damage to underlying structures and transmit infections such as HIV and Hepatitis. Immediate medical attention is imperative, especially if the injury is located on critical areas, like the face or neck.”

Professional Development/Program Staff:

At the heart of TASHRA’s mission lies a commitment to professional development and empowering our dedicated staff and the wider community. Our co-founders, with visionary foresight, have amassed an international cadre of professionals, trainees, and students; each bringing a wealth of interest, expertise, and a diversity of experiences. Our growing professional staff over the last three years are rich with experience in the fields of sexology, clinical care, medicine, research, statistics, social media and development. As our funding and resources paths expand, so does our ability to add more passionate and talented team members to our ever expanding line of programs, projects and services, all in the service of kink health. 

Partnerships with esteemed organizations such as the International Society for the Study of Women’s Sexual Health (ISSWSH), and collaborations with transformative initiatives like the Entrepreneur Program of San Francisco Leather & LGBTQ Cultural District underscore our dedication to expanding horizons and refining methodologies.

Our organization has become a nurturing ground for over 42 research interns and volunteers, ranging from early-career professionals intrigued by kink studies, to graduate students aspiring towards specialized degrees in mental health or research, to passionate community members eager to contribute to science. Several of these interns and volunteers, under the guidance of our Research Director, Executive Director, and Clinical Training team, have authored dissertations that delve deep into areas pivotal to our mission; with titles encompassing themes from the nuances of mentoring in the Leather/BDSM community to the complexities of erotic hypnosis fetishism. Here is a sampling:

  • Elyssa Brooke Helfer:  A kink in the system: Assessing the impact of Master’s level human sexuality education on mental health practitioners’ attitudes and perceived competency working with kink-involved clients;
  • Kevin M. Smith:  Coming out kinky: Informing the design of a health communication campaign to promote disclosure of kink identity to physical care providers; 
  • Alex Townsend Lotz-Nigh:  Reclaiming our power: Experiences of bondage and discipline, domination and submission, and sadomasochism (BDSM) practitioners with a childhood abuse history; 
  • Audriannah Levine-Ward: The lived experience of bondage/discipline, dominance/submission, and sadomasochism (BDSM) practitioners: An interpretative phenomenological analysis; 
  • Ty David Lerman:  Old Guard vs. New Guard: An exploration of the impact of mentoring in the gay men’s Leather/BDSM community; 
  • Daniel Lee Garrett, Jr.:  Empowering the Self: A grounded theory study of gay and bisexual men in the pup play community;
  • Sam D. Hughes: Erotic Hypnosis Fetishism: Implications for Sexual Identity Development, Consent, Minority Stress, and Intersectionality

Elyssa Helfer, LMFT, PhD, CST, a valued TASHRA volunteer lead team member’s words beautifully encapsulate the profound impact and essence of our endeavors, “I cannot speak about my dissertation without also speaking about TASHRA. The support I received from Richard made what felt impossible possible. Working with Richard, Anna, and the rest of the TASHRA team has fueled an even deeper passion for advancing our field to become more affirming and inclusive for erotically marginalized communities. The mentorship, community connection, and career opportunities that TASHRA has inspired have moved my career in a direction that I could have only dreamed of. To know that there is a team of dedicated, passionate, and incredibly knowledgeable professionals fighting to enhance the lives of kinky folks around the world is truly special. It is a privilege to be a part of this team and I look forward to what the next 10 years bring!”

Partners, Presenters, and Donors 

Partnerships with esteemed organizations such as the International Society for the Study of Women’s Sexual Health (ISSWSH), and collaborations with transformative initiatives like the Entrepreneur Program of San Francisco Leather & LGBTQ Cultural District. These underscore our dedication to expanding horizons and refining methodologies and have ignited plans for the further expansion of professional opportunities and community services. Collaborations with the Center for Positive Sexuality, Community-Academic Consortium for Research on Alternative Sexualities (CARAS), Diverse Sexualities Research and Education Institute (DSREI), and the National Coalition for Sexual Freedom (NCSF) have been integral to our organization’s growth. 

We extend our heartfelt gratitude to the guest presenters and colleagues who have enriched our clinical training and community education sessions: Zita Nickeson, PhD, LMHC, PCPC, CST, CSE; Lee Harrington; Stormy Kittyhawk; Asher Laramie, MD;  Danielle Simpson-Baker, MA, MFTI; Julie Lehman, LMFT;  Andrew Pari, LCSW, CCTP, Diplomate CCTP; Dossie Easton, MFT; WillowKat; Silva Neves, COSRT; Luna Matatas; Pup Amp; Laura A. Jacobs, LCSW-R; Marla Renee Stewart, MA; Markie L.C. Twist, PhD, LMFT, LMHC; Eve Minax; Stephen Ratcliff, MA, LPC, NCC, CST;  Master Hines; Keziah Mayers, MA, LMHCA, NCC;  Erik Wert, DO, MPH, AAHIVS; Hani Miletski, PhD, MSW; Josephine Blomqvist Almbring, MBACP;  Avgi Saketopoulou, PsyD; Princess Kali; Master Joshua; Traci Medeiros-Bagan, MFT; Carrie Jameson, LCPC; Matt Sevier, CNS; Rhoda Lipscomb, PhD, LPC and many others.

In an environment where the political landscape and conventional funding avenues often impede sex research, TASHRA’s resolve remains unshaken. We have funded ourselves for over a decade almost exclusively through the sales of our online continuing education courses and personal donations.  Since 2021, we’ve been deeply appreciative of the generous support from Kicking Assets (a Tides Foundation fund) allowing us to support our operations and the International Kink Health Survey. Their endorsement amplifies our vision of championing social justice and fostering a deeper understanding within the kink community. In a monumental stride for the field of kink research, our 2022 initiative, PrEP4Kink: Testing the Effects of an Interactive Educational Intervention on PrEP Uptake among Kink-Involved Adults, secured backing from Gilead Sciences, Inc., marking a first in addressing this distinctive sexual minority population. Stay tuned for upcoming reports and insights from our studies in the forthcoming year.

To our individual and community organization donors; your generosity has been the cornerstone of our journey. Each contribution, whether big or small, signifies a belief in our mission and vision. We are grateful for the early years with Jess Waldura, MD, MAS, TASHRA’s third co-founder. A special acknowledgment to Weston Milliken, Russell Stambaugh PhD, Charles Moser MD, Lyle Swallow, Carlos Morales LMFT, Susan Dundas, Andrea Mize, Brad Sagarin PhD, Robert Odell LICSW, Rene Gandolfi DVM, and our monthly and anonymous benefactors. We’re also immensely grateful to organizations like the Sisters of Perpetual Indulgence, the Folsom Street Organization, Alta California Leather Corps, The Leathermen’s Discussion Group, Cleveland Leather Annual Weekend, and Leather & LGBTQ Cultural District – SOMA, San Francisco. Thank you to these and so many others for standing beside us.

TASHRA Team: Staff, Interns, & Students

In 2020, we reached a significant milestone by bringing on our first paid staff member. We’re thrilled to spotlight Kaylie Engel, who stepped unto the roles of Professional Development Services Manager and Communications Coordinator. Kaylie’s dedication has been instrumental in shaping our clinical training series, amplifying our social media presence, and streamlining the general operations of TASHRA. We’re truly honored to have her on board.

Our heartfelt gratitude extends to the wider team who have poured their passion, authenticity, and heart into advancing kink health. Immense thanks to Ale, Zita, Steve, Kevin, Kez, Elyssa, Erik, Kaston, Julie, Ari, Anand, Angie, Tiffany, Kristine, and many more. Your advocacy and support have been the backbone of our success.

A special mention to the numerous students and interns who have joined us over the decade. Your contributions have been invaluable and do not go unnoticed. Each one of your has played a part in our journey, and we’re deeply grateful for the energy and expertise you’ve brought to TASHRA.


It’s been a busy 10 years for our growing international organization; filled with amazing connections, deepened understandings, and an ever-growing body of research and research-based curriculum on the care of the kink-interested. Most of all, we are honored to have gathered a growing community of healthcare professionals, kink scholars, volunteers, students and members of the kink community, all interested in helping people with erotic interests outside the mainstream, live authentic, safe, and satisfying lives.

While we’ve made significant strides, challenges remain. We are an organization of dreamers and doers; but doing requires expanding available resources. Engaging and representing marginalized subgroups, confronting restrictions to sexual expression, reaching out to rural communities, and addressing the healthcare system’s biases are uphill tasks. But every challenge is an opportunity for TASHRA to innovate, adapt, and redouble our efforts.

In conclusion, as we reflect on our journey, our successes, and our challenges, our message remains unwavering: “Kink thrives when health thrives.” Since 2012, TASHRA has been dedicated to understanding and addressing the unique healthcare needs of the kink-involved community. Our mission is not just about research and training; it’s about empowering individuals to live authentically and ensuring they receive equitable, non-judgmental care.

To continue this vital work, we need your support. Consider making a donation to help us sustain and expand our initiatives. Your contributions directly enable us to conduct essential research, train healthcare professionals, empower community members, and advocate for equitable treatment. Donate here. Furthermore, we invite you to be an active part of our mission. Join our Board or Community Advisory Committee, and explore more ways to get involved here. Share this Impact Report on social media, to help us amplify our message and our findings. Together, let’s ensure that the next decade for TASHRA and our community of kink-involved people is even more impactful and inclusive.