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Today, the emphasis that is put on consent in the way judges consider sadomasochist practices reflects the diminishing importance of sexual paternalism. Here, we compare the latter with the persistence of medical paternalism, which ought to have been made impossible by the body of laws on the rights of sick people (March 4, 2002 and April 22, 2005 laws). The "victims" of sadomasochist practices are much more informed than patients, and the contractual formalism of "erotic" contracts is much stronger than those of consent to medical activities. Nevertheless, magistrates still fear the outbreak of violence in the very codified sadomasochist world whereas they are reluctant to admit, as in case of Jehovah witnesses transfused against their will, that there could be a mistreatment of patients saved in spite of their refusing medical care. The aim is to show that the question of consent cannot be apprehended without taking into account the context which determines and sets its limits, that is to say either medical or sexual paternalism, whose importance often goes unnoticed.