Of course it is always possible to cross that proverbial line and enter the realm of insanity and cause injury. However, if limits are set and are respected hopefully that will not be the case. In my day I did try being on the receiving end of gut punching. It was at the NY Bondage Club and it was administered by one of the guys who basically runs the operation. He was very careful not to cross any line. And yes! One needs to tense and flex the abs to avoid any possible injury issues. It really was not something that I found exciting, but I wanted to try it.
Regarding CBT... never much into ball torture... but the younger version of whipped guy certainly made more than a few trips around the block went it came to cock torture...
Regarding your question regarding “conventional sex”: For some guys traditional sex always lacks something and for others it does not. Unfortunately some crave and definitely need the pain aspect to be totally satisfied.... in a sense it is a curse of sorts... in such cases one needs to think outside the box and disregard what is considered and expected to be the norm. It can be viewed as a higher (or at least a different) understanding of what constitutes pleasure.