I've made the point elsewhere that I believe BDSM and all its interesting kinks is probably going to be one of the last things to come out of the closet. However, in the last couple decades, we've seen a lot of "loosening up;"
people living together and becoming life partners without getting married;
gay pride, lots of lgbt stuff;
anal play (and one of the things about anal play is that "getting clean" is pretty much a recognized necessity)
gay marriage (the last few years);
finally, there was "fifty shades of grey;" (and, Oh, Please!!! THAT wasn't bdsm!)
I believe that all the stuff that was done and played in private will someday soon become public knowledge. We are, after all, a consumer society, and there is lots of money in the "implements" of bdsm (restraints, whips, etc), medfetish, enemas, anal play, object insertions, and all the other fun stuff we enjoy as kinksters. I admit that my erotic nature is informed and fulfilled by most of this stuff, and it's a lot of fun. In a sense, if you're a kinkster, viagra/cialis for stimulation is not as important as enjoying your partner to the utmost, whether you are Dom or sub, since kinky erotic behavior stimulates the areas of the brain that enhance libido. And now there are sooo many ways...