What this essentially means is that instead of attempting to understand and accommodate for voluntary sadomasochism, the law typically views these incidences as cases of assault. This can be seen with the well-known case in Great Britain, where 15 men were trialed for a range of offences relating to sadomasochism. Samois, the earliest known lesbian S/M organization in the United States, was founded in San Francisco in 1978.Harsh acts of S&M may include consensual torture of the sensitive parts of body, such as cock and ball torture for males, and breast torture and pussy torture for females. Acts common for both genders may include ass torture (ex. using speculum), face torture (ex. nose torture), etc. In extreme cases, sadism and masochism can include fantasies, sexual urges or behavior which cause observably significant distress or impairment in social, occupational, or other important areas of functioning, to the point that they can be considered part of a mental disorder. However, this is widely considered to be rare, as psychiatrists now regard such behaviors as clinically aberrant only if they are identifiable as symptoms or associated with other problems such as personality disorder or neurosis. There is some controversy in the psychology professions regarding a personality disorder referred to alternately as "self-defeating personality disorder" or "masochistic personality disorder", where masochistic behavior may not be in relation to other diagnosed mental disease.
It has less commonly been associated with spasm of accommodation on attempted upward gaze, pseudoabducens palsy (also known as thalamic esotropia) or slower movements of the abducting eye than the adducting eye during horizontal saccades, see-saw nystagmus and associated ocular motility deficits including skew deviation, oculomotor nerve palsy, trochlear nerve palsy and internuclear ophthalmoplegia. Causes
Parinauds syndrome results from injury, either direct or compressive, to the dorsal midbrain. Specifically, compression or ischemic damage of the mesencephalic tectum, including the superior colliculus adjacent oculomotor (origin of cranial nerve III) and Edinger-Westphal nuclei, causing dysfunction to the motor function of the eye. Classically, it has been associated with three major groups:

Young patients with brain tumors in the pineal gland or midbrain: pinealoma (intracranial germinomas) are the most common lesion producing this syndrome. Women in their 20s-30s with multiple sclerosis
Older patients following stroke of the upper brainstemHowever, any other compression, ischemia or damage to this region can produce these phenomena: obstructive hydrocephalus, midbrain hemorrhage, cerebral arteriovenous malformation, trauma and brainstem toxoplasmosis infection. Neoplasms and giant aneurysms of the posterior fossa have also been associated with the midbrain syndrome. Vertical supranuclear ophthalmoplegia has also been associated with metabolic disorders, such as Niemann-Pick disease, Wilsons disease, kernicterus, and barbiturate overdose. Diagnosis
Diagnosis can be made via combination of physical exam, particularly deficits of the relevant cranial nerves. Confirmation can be made via imaging, such as CT scan or MRI. Treatment
Treatment is primarily directed towards etiology of the dorsal midbrain syndrome.