Chronically Ill and Disabled People Have Sex.
The Basics
-Disabled and chronically ill people can have consensual sex.
-Disabled and chronically ill people can have pleasurable sex.
-Health conditions can make having pleasurable sex difficult for some people with chronic illness and disabilities.
-Many disabled and chronically ill people can feel pressured into having sex when they don't want to due to health conditions and reliance on partners as caregivers.
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Basic Models of consent
No Means No
-If someone says no they revoke consent from sex. Otherwise, consent is assumed.
Problem: This can lead to rape in people who feel physically or emotionally unsafe saying no, especially vulnerable groups like disabled people.
Yes Means Yes
-Both parties should physically or verbally say yes to sex in order to have consent.
Problem: Can lead to being pressured into saying yes by power dynamics and in inter-able relationships expectations of sex
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A potential solution:
Enthusiastic Consent
-Both parties must enthusiastically want to have sex for consent to be present.
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Problems for disabled people
Disabled people may have sex for many reasons other than just their own sexual pleasure for example
-To show gratitude to a partner
-As part of their job as a sex worker
-Transactionally in order to keep a partner who they rely on for care
-To have a child / get pregnant
-To support marriage or long term relationship
-To support cardiovascular health and pelvic floor strength in mostly bedbound patients (seriously, can be doctor recommended, check with your provider)
Enthusiastic consent does not provide a model for these sorts of sexual interactions.
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A better solution: Authentic Consent
Authentic consent is when both parties consent to sex for authentic reasons they believe in. These can be any reason, not just sexual pleasure, as long as the person is not being coerced.
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Authentic Consent is better for disabled people because
-The emphasis is not on reason but on coercion. It is okay to have sex because you want to do so for your marriage. It is unhealthy to feel coerced into having sex because of the expectation of marriage. The emphasis is on your decision and autonomy.
-It leaves room for both transactional sex and rape. A sex worker choosing to sleep with a client is very different from a sex worker being raped and having their boundaries ignored, even though neither situation is enthusiastic consent.
-It acknowledges the legitimacy of reasons other than sexual arousal for wanting sex. These reasons are far more common in chronically ill and disabled people for whom sex may not be as physically rewarding due to chronic pain, fatigue, or medications that suppress sexual arousal.
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How to practice authentic consent
-Talk to your partner about consent and your desire to practice authentic consent
-Ask yourself when you think about having sex what your reason for doing so is and whether it is an authentic expression or something you feel societally pressured to do
-Acknowledge the legitimacy of reasons other than sexual arousal for wanting sex and clearly explain to your partner your desires for your sex life
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Things to remember
-Sex is not mandatory in relationships! Lots of people have healthy loving relationships even when sex is off the table.
-All reasons for sex should be respected as long as both parties are making informed unpressured decisions
-Protecting your health is always a valid reason to say no to sex and your partner should never challenge that
-If you desire to have sex for your partner's pleasure, that is a valid way of expressing your love and you shouldn't feel guilty for "not enjoying it enough"
-If having transactional sex is your best option for improving your life/health/living situation that is a valid decision that no one should judge you for
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Summary
In an ideal world, all sex would be had with enthusiastic consent. But we do not live in an ideal world. The model of authentic consent offers disabled people a healthy way to think about their sexual autonomy and maintain healthy sex lives, whatever that may look like for them.
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Sex in a relationship with chronic illness can be complicated. I think a lot of posts on this topic cover the basics: your health is important and no one should force you to have sex if you don't want to. But for me, that is just the starting point.
Of course, consent is important. But to simply imagine a world where all chronically ill people either have enthusiastic enjoyable sex all the time or never engage in sex with long-term supportive partners ignores reality. So many of us live with conflicting motivations around sex. Wanting to save spoons for other necessary life actions. Wanting sex but knowing our bodies may have physical consequences. Not wanting sex for long periods due to medications but still wanting to support our partner's sexual desires. This is why I advocate for authentic consent.
Authentic consent is not always enthusiastic, but it is uncoerced and freely given out of any reasoning the person believes in. This can be simple things like both people just wanting sex. But also complex things like wanting to feel more like a partner and less like a patient in a relationship complicated by large caretaking needs. Any reason is valid as long as it is authentically yours.
Authentic consent also serves the disability community by illuminating the legitimacy of transactional sex or survival sex. While neither of these practices would exist in an ideal world where disabled people had their needs met by default we do not live in an ideal world. Therefore, these choices are legitimate avenues for people with disabilities to meet their basic needs, oftentimes with few other options. By acknowledging the agency in this choice we can more clearly differentiate between someone making a choice to engage in transactional sex and sex worker or relationship abuse and rape.
In summary, sex for disabled and chronically ill people is not so straightforward as models like enthusiastic consent would suggest and it's important that we prioritize the autonomy of disabled people to choose for themselves how they want their sex lives to unfold. Authentic consent is one strong way to do this.
