Q: I have very vulgar thoughts about suicide or harming/killing someone. And I have had a very strong sexual relationship with this man and we hurt ourselves badly but in a very pleasing sexual way. Problem is, I am no longer with him and I only get off with pain or giving pain. I’m not sure where I’m headed. Or if I should seek help. In the past I saw a therapist for masturbating too much and she only said that “People who masturbate have no real feelings.” Concerned in the UK.

A: I’m concerned too. I hope you misunderstood the therapist. What you heard is just not true. Most people who masturbate very definitely have real feelings. You, however, say you masturbate “too much”. (I’m not sure what that means but for now I’ll take you at your word.) You are now only able to have an orgasm when pain is involved. And you seem to have a fascination with violent death. You are right to wonder what’s going on.
Unfortunately, I can’t tell you on the basis of the little information I get from a letter. So the answer to your question is yes, you should seek help – or at least an evaluation to help you understand what is going on in your mind and to get some recommendations. Ask your doctor for a referral to an open-minded psychiatrist who has experience with a range of sexual expression and who can handle intense feelings.
I wish you well.
Dr. Marie