DSM-IV defines sexual masochism as intense sexually arousing fantasies, sexual urges, or behaviors, recurrent over a period of at least 6 months, “involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.” In addition, there should be clinically significant distress or impairment. Most masochism, as found in heterosexual or homosexual sadomasochistic scenes, involves consensual simulated acts and thus would not be considered disordered. Suffering as the unintentional result of sexual activity is also not considered masochistic.

Masochistic fantasies are common but are not often enacted in reality in the repetitive way characteristic of paraphilic masochism. Masochism is one of the more common paraphilias for which women seek treatment. Masochistic sexual practices can be life threatening, including masturbatory activities such as asphyxiophilia, which may involve strangulation and self-torture for sexual arousal.