Many critics and scientists have raised concerns that Fifty Shades glorifies abuse and pervasive sexual violence against women. Some studies have found a relationship between reading the first volume of Fifty Shades and signs of eating disorders, engaging in binge drinking, and having emotionally abusive partners. This is not to say that the book causes such behaviours because it may be that those who engage in them are drawn to the book. Despite these critiques, other professionals argue that although the book is "disturbing", reading about these fantasies has value if it enhances the real sexual lives of women. But as with video games, the question can be posed: will the violence remain in the realm of fantasy or will it seek expression in actual behaviour, and if the latter, what then?

In today's era of rapidly changing social and sexual values, sex therapists face new conundrums. What is the proper therapeutic stance when a couple with marital problems both agree that his sexual dysfunction is unrelated to the fact that he likes to dress up in a maid's uniform and have his wife humiliate him as part of their erotic life? Or when people find consenting partners to inflict pain on one another or draw blood in order to feel sexually aroused? With such questions in mind, I ventured south from Pittsburgh to the swanky Hilton Conference Center in Miami for the annual meeting of one of the major professional sexuality societies. The clumsy but intriguing title of the conference promised to be stimulating: "Embracing the Sensuality of Diversity in Identities and Cultures." It didn't disappoint.

I learned from a presentation on "Kink Sex" that there are no fewer than 500 "paraphilias", a more objective term that about 35 years ago replaced "perversion" and later "sexual deviation". These include obtaining sexual gratification in atypical ways such as needing a leg cast to be aroused or receiving shocks to the male organ, known as CBT or Cock & Ball Torture. The term "paraphilia" is derived from the Greek roots "philia", meaning love, and "para", meaning amiss, as in wrong or improper. The new CBT (not Cognitive Behaviour Therapy, familiar to professionals and laymen) seems to miss the mark as a way of expressing love. Many might still consider this form of sexual pleasure to be inherently abnormal.

But this is no longer the view of the psychiatric establishment. The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association has the last word in defining what is a disorder. The newly released fifth edition (DSM-5) introduced a distinction between "paraphilia", which is not inherently pathological, and "paraphiliac disorder", which is. A paraphilia is now pathological only if it does not abide by three individualistic criteria: consent by mature adults, lack of personal distress, and avoiding harm to others. Sexual abnormality is no longer defined by any objective psychological criteria for mental health, and it is taboo to identify abnormal sexual behaviour on the basis of religious belief.

The keynote speaker of one of the plenary sessions—let's call her Molly—an articulate and funny African-American woman, presented a talk entitled "A Journey into BDSM and Race". Her written précis recounted a personal narrative of being a "black submissive in the kink world, ‘a minority within a minority'". She traced her journey towards affirming a preference to be sexually aroused by enacting the role of black slave being beaten on the rear with paddles by a series of white masters—mostly men but also a few women.