Needles
Needle play has become a whole area to itself, with artistic practitioners creating large and elaborate patterns – occasionally using thousands of needles.

Needles of various gauges and lengths are used. Some use a given size because it's comfortable for them to control.  Others vary the size, depending on placement and intent.   For beautiful design work, 25 gauge 1 ½ inch needles are frequently used.  For certain body parts, though, shorter and smaller needles may be preferable.

Always make sure to clean the skin well, wear gloves and avoid recapping needles – buy a sharps container instead.  While a plastic soda bottle can be used in a pinch, they aren't as sturdy or as safe.

When the scene is over, make sure to clean off the area, and if doing a large needle scene, apply some Neosporin.    A big needle scene opens up a lot of holes in the skin to infection.

Cutting
Often done as a form of body art, this involves cutting through some of the layers of skin – deeper than that risks permanent and serious damage.

To increase the pain of cutting, alcohol can be sprayed on during and after finishing up, or the skin spread to increase pain and scarring.  Both techniques increase bleeding, so don't do this when doing an intricate design.

Skin must be prepped well (three times).  Use sharp disposable scalpels of a comfortable length; they come in the “regular” long size, and in various “thumb” scalpel sizes.  Make sure you know which blade works best for you; some find a 15 or an 11 blade are the easiest to use.  Don't use a scalpel blade alone – it's hard to control and puts the cutter at risk of getting cut and both parties at risk of spreading blood borne pathogens.

Cutting often causes scars, but the practice of “scarification” – deliberately causing scars – is done by removing strips of skin or by repeatedly cutting the same area.

Wartenberg Wheel
The Wartenberg Wheel is probably the most frequently purchased and used toys around.

By rolling, tapping or scraping, it can create a range of intensity and type of sensation.  Small enough to reach almost anywhere.
Because the pins can reach far enough through the skin to come in contact with blood, these instruments should be carefully disinfected / sterilized, or you should use disposables.  This is, obviously, even more important if using a wheel on more than one person.

Suturing
Suturing requires dexterity, training and practice.. Needles and sutures come in a variety of sizes, shapes and materials.  For male bits I'd use a 4-0 or 3-0 suture on an FS-2 needle.  For labial/vulvar work involving large bites of tissue, I'd go for a 2-0 suture on a PSLX or FLX needle.  If sewing the labia shut where they meet, I'd use 3-0 on an FS-2 needle..  The safest suture material to use for kink is monofilament, such as PDS, prolene, or ethilon/nylon.  Esutures.com sells soon to expire or recently expired sutures.Large needles and suture create more blood – I take precautions to protect myself, the table and the floor.  Have clean or sterile gauze available for holding pressure if you hit a “pumping bleeder”. 

Surgical Stapling
Surgical staplers come in various types - the number of staples and the size of the staples vary by manufacturer.  They don't penetrate the skin as deeply as many people think – they were designed to pulled the top of the skin together at the end of surgery.  They look a lot scarier than they feel.  Removal is easy with a surgical staple remover, making sure to center the remover over the staple.

Blood Pressure Cuff
Sure, it's always wise to have a blood pressure cuff around when you play … but, in this case, it's not for arms any more.   Wrap the penis and/or scrotum in a covering to keep your cuff clean, wrap it in the cuff and then start pumping.  A lazy top can use an automatic cuff, but a manual cuff gives you more control.

Cupping
Cupping, when applied to flatter, thicker skinned parts of the body, is more like massage than kink, though it can leave pretty, but short lived, marks. But there are some parts of the body that are neither flat nor thin skinned, and on these parts the suction can be teasingly painful.  Combining cupping with ginger, needles, and cutting (aka wet cupping) brings the pain up a notch or two.

Violet Wands
An ultra-techie toy, with scores of attachments, its very own guild, and the ability to summon the aura of Frankenstein's lab.  This is a Dom/me's delight. Its stunning range of sensation is only hinted at by its early medical claims that included both stimulating hair growth and stopping it.  After using one, you'll believe both claims.  Of course, after having one used on you, you'd believe anything the nice Dom/me tells you to believe.

Basically Violet Wands generate a high voltage, low amperage, high frequency pulsed DC electrical discharge.  In other words, sparks.  BIG SPARKS. Sparks that arc, lick,  tickle and bite.  Zeus approved.

TENS Units
Like the Violet Wand, these electro-toys have a broad range of sensation, from an exquisite sense of deep vibration to sharp, punishing pulses.  These are sensations you just don't get in the vanilla world.  Unless you have a back problem, that is. On the theory that the mind can only focus on one thing at a time, these are used to block back pain. Cool, though I can't focus on even one thing, anyway.

Sponge Baths
ts not all about pain is it?  This is one of the few procedures where you don't have to read the section on Safety.  Read it anyway, while the nice Nurse sponges you off.  Remember that soap is drying.  So, be sure to apply a moisturizing cream afterwards.  You may have to rub it in.  Repeat as necessary, until the swelling subsides.

Acupressure
Practiced in China for over 3,000 years, this science associates certain areas on the foot, hands and face with other areas of the body.  Me?  I prefer to cut out the middle man and just have those other areas rubbed directly.  But who am I to judge? 

Capzasin,Ben-Gay
Probably in your medicine cabinet at this very moment, these creams create a warm tingly sensation that, like the TENS units, distract your mind from other pain.  Applied to thinner, more delicate tissue, however …Once on this roller-coaster, you're pretty much there for the ride, about 20 minutes or so.In a pinch, Tabasco will do nicely.  Evil smile. (But be careful – too hot and you can do permanent damage)

Speculums
Vaginal exams. These require either a disposable sterile speculum or a well disinfected reusable speculum.  Wear clean gloves and make sure you use lube. Insert it closed and once it's in place you can start to open it. Try not to yank on it; remember, if there have been any babies born, etc, there may be scar tissue.  Make sure to know if your partner likes a nice warm speculum or an icy cold one – proceed as you see fit ... Anything you insert must be high level disinfected. If you are putting dildos, vibrators, etc inside, either bag 'em with a condom or know who they belong to after you play: your subject.

Anal exams. The rectal/anal area is considered “dirty” in surgical circles. Despite the bowel's job to carry waste to the outside, it is a very fussy organ – it really hates to be overly touched. Always make sure that a rectal speculum is well lubed before insertion, and if your victim doesn't have a lot of anal experience, start with a lubed finger first. Anal tearing is uncomfortable and can lead to REALLY bad things, like a rectal fistula, which is hard to cure. Anything you might want to stick up there should be well disinfected, and toys should be put into condoms or belong to person whose anatomy you're exploring.

Gloves
Sometimes the picture says it all.  The snap of rubber gloves will widen eyes, clench cheeks and press knees together.  If you're 'nilla.  Otherwise: Eyes close, cheeks spread.

Enema Play
We saved this one for the end. The Dominant carefully prepares the solution (coffee, castille soap and a few others are available from on line sites), instills a certain amount, then makes the sub hold the solution until the Dom/me is happy and lets the bottom empty.  Or it can be instilled as a punishment in the same manner as above, usually with an inflatable stopper to make sure nothing leaks out of the bottom's bottom. Don't use more than 1000 ml = 1 liter = 1 quart.Some people use drinking alcohol in the enema, with a stopper.  Since the bowel absorbs alcohol directly, and extremely rapidly, into the blood stream, your bottom will be flat out drunk in no time.  I don't recommend this type of play, but for those who want to do this, never exceed 2 oz of wine or 1 oz of hard liquor or you may be looking at acute alcohol poisoning.  This practice is especially dangerous for diabetics, especially if there is any sugar in the mix.