Vampire myths have existed throughout modern civilization, dating back as far as ancient Mesopotamia, but these blood-sucking monsters weren’t hot until the John William Polidori story “The Vampyre” in 1819. It is, in that way, the precursor to Anne Rice, Twilight and every sexualized vampire in between.

So what is it about vampires that we find so sexy? Is it because we all want our necks bitten? Or is it more about the erotic appeal of blood? After all, there sure are a lot of bloody selfies kicking around Instagram this time of year.

And maybe more to the point, why do we associate blood, our life force, and its main organ, the heart, with our own feelings of love and lust in the first place?

I asked a range of experts — from a heart doctor, to a blood-play dominatrix, to a horror-film historian and a few sexual scholars — to explain all that they could about the relationship between horror and desire, and the bloody turn-on of the red stuff that courses through our veins.

Dr. Gregory Marcus, a cardiologist and professor of medicine at the University of California, San Francisco

My suspicion is that the relationship between the love and heart comes from the sensation we all experience in our chest whenever we feel a strong emotion. That can be attributed to a couple of things: First, the nerves that receive signals from inside our chest and abdomen are very different than the nerves right underneath our skin. The nature of the nerves near the skin is more specific. For example, using the back of your hand, you can easily distinguish between something that’s sharp or dull, or hot or cold. But when it comes to sensations that arise in the heart, lungs and stomach, the nerves aren’t that exacting. So it’s easy to experience less describable sensations that emanate from inside the chest.

Number two has to do with the autonomic nervous system, through which our emotions can release adrenaline and result in sensations in our gut and chest. These nerves then influence the heart and the blood vessels and circulate adrenaline, in some cases, dilating blood vessels and resulting in the flushed cheeks or sweaty palms that are often equated with love.

Alexandre O. Philippe, the director of 78/52: Hitchcock’s Shower Scene, which deeply explores one of the most psychosexual horror scenes of all times

There’s a fine line that separates fear and desire. You could say the moment you cross fear, you enter desire and vice versa. I think desire and fear are the single most important emotions. What you fear and what you desire dictate what you do with your life. With that in mind, it makes sense that we’re drawn to the way horror cinema blends ideas of sexuality and horror.

It also means that an image that may repulse you can still create desire. David Cronenberg often does this, specifically in his films The Brood and Shivers. At once, they’re very attractive and very repulsive. Feeling those two emotions at the same time when you walk out of a theater is very interesting. Another movie is Re-Animator with Barbara Crampton. It mixes sex and lust with horror. Obviously Psycho is the most famous example, the sight of seeing Janet Leigh undressing for the shower before getting slashed can generate desire.

As part of my survey of 4,175 Americans’ sexual fantasies, I asked participants how frequently they fantasize about various body fluids, including blood. Thirteen percent reported having had a fantasy involving blood; however, just 1.5 percent reported having fantasies about blood often. Also, just a handful of people — 18 people, or less than one-half of one percent of the total sample — described blood as part of their favorite fantasy of all time. It took different forms when it did, though. Some described it as “bloodplay” or “knifeplay,” in which one partner is cut and one or both partners then taste the blood and/or include it in the sex act in some way. Others described vampire fantasies, in which either they or their partner are a vampire and engage in bloodsucking.

Speaking of vampires, I asked participants whether they’d ever fantasized about a mythical creature, and one-third reported having done so. But again, these were usually one-off fantasies because only 4 percent said they had fantasies about such creatures often. Vampires were, though, the single most commonly fantasized about mythical creature. In fact, 10 percent of the sample reported having had a vampire fantasy before. Demons and werewolves were the next most popular.

Bettie Bondage, a BDSM coach and performer whose work caters to the niche population of blood enthusiasts

I’ve been doing BDSM work for about seven years. I started as a professional submissive and eventually discovered I liked dominating. In particular, I liked what we call “edge play,” especially involving branding and scarification. Blood play or blood sports is a type of edge play.

In my personal life, I have a couple regulars who come in for stitching. Usually when people come in for the first time, they try something light — at least light for me — like a single needle. What I do privately and as a performer is a little more heavy. For example, there’s a gentleman I see who likes to have needles shoved under his finger and toenails. That’s a lot of blood. Other times, we sew his belly button shut or sew his dick to his belly button. He was just dripping blood everywhere. Sometimes we rip off a couple toenails. There’s so much blood during sessions sometimes that I’ve actually slipped in it. Recently, I took the blood and made a heart with a little “S” above it on his back in honor of his girlfriend. He took a photo and sent it to her so she could participate, too.

I also do blood bonding. Not necessarily with me, but I’ll set up a blood bonding unity ceremony for people. Again, for example, there’s this couple who wanted to blood bond together and drink each other’s blood. So I drew blood from both of them and mixed it with a little bit of water in a glass for them to drink.

I do blood cupping as well, which takes the ancient Chinese medicine practice of glass cupping with fire and combines it with blood play. I put needles in to tenderize the area, and then, as the blood starts to pool, I quickly put the cup over it. That makes it easy to pull out a significant amount of blood. Personally, I like to use that blood to turn people into pieces of art. I use their bodies as a canvas and paint them with their own blood.

Blood play is very cathartic. It also makes you feel high. Former alcoholics have told me this is their way to get high without really getting high. It’s like being stoned. They get really giggly. Not in a silly way, but in that they just become like a puddle of mud. The high — or “blood buzz” — is like that sensation after you have a really amazing orgasm. People are ecstatic and smiling when we finish up. For me, too. After an hour and a half of doing a session, I get this kind of high and have to really check in with myself. Because when you’re playing with someone’s lifeforce, it shouldn’t be taken lightly. You can have light fun during the play, but the experience shouldn’t be taken so lightly that it doesn’t really matter. It’s special.

My sexuality is sadist. Obviously the word has a negative connotation, and one of the things that happens is people think that’s all I can do. That is, cause pain or be painful. But when people meet me and get to know me, they’re often like, “Oh, you’re funny.” Like it’s a surprise. Sadism gets a negative rap. I not only get erotic pleasure from giving people pain, but I also want them to get into it and enjoy it as well. We’re both feeding off each other in that way.

Trust me, sadism can be fun. Sadism can be sweet. And sadism can be sexy.

DJ Williams, the director of research and co-founder of the Journal of Positive Sexuality and an expert in the more existential elements of blood play

Fetishes are commonly stigmatized, but stigma around fetishes involving body fluids, especially blood, are particularly shamed. The reason for this has to do with longstanding cultural and historical processes involving symbolism. Cultural narratives focusing on blood, as the essential fluid associated with life, are tightly interwoven with broader discourses of religion and medicine. These discourses explain and tightly regulate bodies and their behaviors — thus, culturally un-sanctioned practices involving bodies are highly transgressive. Basically, mainstream discourses about bodies (and blood) are so long-standing and powerful that most people are unaware of them.

Blood play can, however, potentially be a healthy and safe aspect of one’s sexuality. Because it’s culturally transgressive, blood play can be extremely empowering for those who engage in it. Simply put, it can be a meaningful personal expression of people taking ownership of — and making purposeful choices — about their own bodies. Blood play may also connote an element of raw human interaction, perhaps resisting deference to cultural refinement and common social etiquette and civilized standards.

Key qualities of healthy and safe blood play are similar to essential aspects of any other sexual practice, which we summarize as the 4Cs. Among all participants, there must be (a) clear consent about what will and will not occur; (b) communication about expectations, boundaries, risks, etc.; (c) an ethic of care for all involved — in other words, whatever happens should be meaningful and enjoyable to all; and (d) caution, or an awareness of risks pertaining to the activity and how these may or may not be managed. In short, the acceptability of diverse sexual experiences should be far more about ethical aspects of participation in behaviors rather than common social norms.

I’ve seen many forensic cases where blood play is a sexual aspect of violent crime, including homicide. For example, the common underlying theme among serial murderers is a strong desire to completely control and dominate another human being to the point of taking that person’s life. Doing so reflects a desire to “play God,” and thus, having ultimate power over another person. In such cases where offenders eroticize the blood of victims, there seems to be a more intense feeling of power since sexuality is fused with extreme control over victims.

Anna Randall, a sex therapist who works with all sorts of alternative lifestyles when it comes to sex and relationships, including blood-play enthusiasts

What is a compulsion anyway? Is a serious golfer, an avid baseball fan, a distance runner or a mountain climber — all of whom might spend every weekend participating in their interest — compulsive? Like any behavior, who defines it as compulsion? Who finds the activity compulsive?

Psychopathology looks at the level of distress the compulsion is causing the participant as important. Are they doing it to a level that causes them financial problems or impairs their ability to get work done? Are they asking others to inflict this onto them and finding partners unwilling to go as far as they want? More and more scholarly articles are being published on how many individuals find their kink/BDSM activities as psychological healing. The idea of taking back their power, their control for what can and cannot be done to them and their agency over their body is described in these articles.

It’s understandable that a non-kink outsider could see this as violence, as it’s certainly hard for them to imagine any erotic appeal for themselves. Yes, there may be a small subset of kinky people who may be doing this to enact past trauma, but I believe that number is far less than popular writings and pathologizing beliefs might have us believe.

Personally, as a therapist, I look at what the activity is providing for the person. Is it an altered state, a way to reduce stress or an exciting part of the kink experience? If the person is distressed by their interest, it’s my job to help them understand their erotic template, to help reduce internal erotic conflicts and to help them determine what is their own vision of sexual health. It’s not to inflict my own.