From Issue 2.2 - October/November 1995
My Cutting Isn't Scarring Enough!
Dear Dr. Beth:
My lover has done the same cutting on my upper arm four times, and it
has repeatedly faded to near-invisibility. What can we do to increase
visible scarring without causing an infection?
--Frustrated
Dear Frustrated:
Cutting is an SM technique which is not for the squeamish or the
inexperienced. A basic understanding of skin structure in the area of
a cutting is essential for a scene to be safe and aesthetic. Otherwise
the bottom may end up looking like the main attraction in a third-rate
sushi bar. A well-done cutting can be uniquely satisfying for
aficionados of this type of play.
Human skin has two main layers, the
dermis and the epidermis. The epidermis has five layers which get
pushed out from the stratum basale, where new epidermal cells come are
formed, to the stratum corneum, which contains keratin and which dries
up and falls off. There is no blood supply in the
epidermis. Underneath the epidermis is the dermis, a tough layer made
of elastic fibers; it contains blood vessels, lymph vessels and
nerves. These layers are not laid flat one on top of another like
sheets of paper. Instead, the dermis has lots of folds, ridges and
valleys. The epidermis lies on top of these folds and follows
them. This elastic layer is much thicker in some places than in
others. The skin of the outer arms and legs, the back, and the palms
and soles is relatively thick. The skin of the inner arms and thighs,
the chest, the genitals, and the face is much thinner and unsuitable
for cuttings.
SM cuttings are intended to involve the
epidermis. Because of the irregular nature of the dermis, superficial
ridges in this layer will inevitably be cut as well. This is why
cuttings bleed. However, cuttings should never go all the way through
the dermis. A cutting that goes all the way through the dermis for
more than an inch isn't a cutting, it's a laceration and may need
stitches. This type of accident is likely to happen if the bottom
moves suddenly against the blade. Apply direct pressure to stop the
bleeding and have the wound checked by a health care
professional.
Basic care of a cutting is the same as for any other cut
or scrape. The skin should be cleaned well with an antiseptic solution
such as betadine or rubbing alcohol before starting the cutting, and a
sterile blade should be used to do the cutting, so infection is less
likely than with an accidental injury. After the cutting is completed,
many people like to clean the fresh cutting with rubbing alcohol. This
has both health and aesthetic benefits, and may produce interesting
sound effects as well.
A cutting should be kept covered with
sterile gauze until a scab forms. In order to minimize scarring, the
scab should then be left alone. Antiseptic ointments are popular, but
I'm not a big fan of them, since they can interfere with wound healing
and sometimes harbor bacteria themselves. It is also not necessary to
repeatedly cleanse a cutting with alcohol, hydrogen peroxide,
Hibiclens, etc. These can actually slow healing by killing delicate
new cells.
The amount and type of scarring will depend on a number of
factors. Some people are genetically prone to forming keloids, which
are thick raised scars; if the person receiving the cutting or their
family members tend to form keloids, this may happen after a cutting,
even if no previous wounds have keloided. Cuttings which are affected
by traction or movement of underlying muscle, such as horizontal cuts
in skin of the breasts, are likely to have thicker scars than cuts in
other places or vertical aspects of the same cutting. Cuttings which
become infected are also more likely to scar permanently. While some
people have deliberately used keloids as a method of scarification,
these can sometimes be chronically painful.
The reasons for doing
cuttings are as varied as the SM community itself. Some people do it
primarily for the sensation, some because they have eroticized
bloodletting, and some desire permanent scarification for artistic
and/or spiritual purposes. There are methods for increasing the
permanence of a cutting. Ash from either wood or cigar tobacco may be
rubbed into cuttings to produce a grey coloration; freshly burned ash
is probably sterile. Sterile tattoo ink can be rubbed across the
cutting and then covered with Tegaderm. Another technique involves
repeatedly pouring red wine vinegar over the cutting to give a pinkish
tint to light skin. One person has had good results by repeatedly
rubbing the scab off in the shower, daily from day one.
Whenever a
foreign substance is introduced into the skin, it causes more
inflammation and more chance for infection. It is essential to use
clean, sterile substances and to take extra care to keep the cutting
clean after introducing a coloring or scarring agent. People with
immune system disorders or those taking cortisone-type medications or
cancer chemotherapy should be even more careful. And everybody who
gets a cutting should be up-to-date on their tetanus and hepatitis
immunizations.
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.