It can be awkward to talk to a doctor about sex. They're a professional, you tell yourself. They've heard it all before.

But what if they haven't?

That can be the reality for people who engage in alternative sex practices.

As a recent study uncovered, fewer than half of people who engage in BDSM (bondage/discipline sadism/masochism) are honest with their doctors about their bedroom behavior.

Titled "Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients," the Journal of Sexual Medicine study noted that those who aren't open cite fear of judgement as the reason for their secrecy.

According to Michelle Konstantinovsky of Cosmopolitan, the authors are now also looking into precisely what consequences could arise from staying silent.

But as Carol Queen, sex educator and author of The Sex & Pleasure Book, told the magazine, the fundamental problem is an obvious one.

"A [clinician] might bypass or fail to recognize your needs if they don’t have all the information," she said. "Doctors aren’t mind readers and they’re mostly very poorly trained about kinky sexual practices. Hearing real info from patients will help them put faces to sexual practices and help them better understand what the stakes are."

Of course, pop culture has gone a long way towards normalizing alternative sex practices, but mishaps still arise. Bruises. Scratches. Sprains. Even breaks.

After the Fifty Shades of Grey books landed on the shelves in 2012 and 2013, a spike in sex-toy-related emergency room admissions was reported nationwide, according to data cited by The Washington Post.

According to sex therapist Anna M. Randall, executive director of TASHRA, the group behind the study, as many as 13 percent of those surveyed had told doctors their injuries were caused by something other than BDSM.

"People make up stories; some are embarrassed, but most are more worried about being shamed by their doctors or not getting good care," she told Cosmopolitan.

What to say to your doctor

Sex educator Sunny Megatron advises BDSM practitioners to be direct, factual and brief when talking to their doctor.

"Use blanket phrases like, 'I like rough consensual sex,' 'I have multiple partners,' and 'We like things kinky,' without divulging every last detail," she wrote for Your Tango. "Make sure you are confident in your answers and state explicitly that your activities are always consensual."

This post originally appeared on Mamamia, Spring.St's Australian sister site. You can read it here.