Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer, survivors and their partners, it can feel even more awkward. In fact, sex ranks among the top five unmet needs of survivors, and a new digital health startup, Will2Love, has been launched to help fill this void.
Sixty percent of cancer survivors — 9.3 million individuals in the United States alone — end up with long-term sexual problems, but fewer than 20 percent get professional help, according to Leslie R. Schover, PhD, Will2Love’s founder. Among the barriers she cites are overburdened oncology clinics, poor insurance coverage for services related to sexual health and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients and survivors about these issues.
Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for health care practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health.
“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” she adds.
The problem is twofold: how to encourage oncology teams to do a better job of assessing and managing sexual problems and how to help those impacted by cancer to discuss their sexual concerns.
Schover says that simple, open-ended questions such as: “This treatment will affect your sex life. Tell me a little about your sex life now,” can help to get the conversation started.
Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.
Sexual dysfunction after cancer can often lead to depression and poor quality of life for survivors and their partners.
Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, explains Schover. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.
“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stresses. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”
Schover hopes that Will2Love will bring much-needed attention to the topic by providing easily accessible resources for patients, survivors, their partners and health care providers. (Box)
Currently visitors to the website can subscribe to its e-newsletter and receive a free introductory five-part email course covering topics related to what your doctor may not be telling you about sex, fertility and cancer. After the fifth lesson, users will receive a link to the Will2Love “Sex and the Survivor” video series. “Sexual health is a right,” Schover stresses, and oncology professionals, patients and survivors need to be assertive to get the conversation started.
It’s not always clear if a woman is really having an orgasm, as Meg Ryan demonstrated in When Harry Met Sally.
In the nascent field of orgasm research, much of the data relies on subjects self-reporting, and in men, there’s some pretty clear physiological feedback in the form of ejaculation.
But how do women know for sure if they are climaxing? What if the sensation they have associated with climax is actually one of the the early foothills of arousal? And how does a woman know when if she has had an orgasm?
Neuroscientist Dr Nicole Prause set out to answer these questions by studying orgasms in her private laboratory. Through better understanding of what happens in the body and the brain during arousal and orgasm, she hopes to develop devices that can increase sex drive without the need for drugs.
Understanding orgasm begins with a butt plug. Prause uses the pressure-sensitive anal gauge to detect the contractions typically associated with orgasm in both men and women. Combined with EEG, which measures brain activity, this allows for a more accurate picture of a woman’s arousal and orgasm.
Dr Nicole Prause has founded Liberos to study brain stimulation and desire.
When Prause began studying women in this way she noticed something surprising. “Many of the women who reported having an orgasm were not having any of the physical signs – the contractions – of an orgasm.”
It’s not clear why that is, but it is clear that we don’t know an awful lot about orgasms and sexuality. “We don’t think they are faking,” she said. “My sense is that some women don’t know what an orgasm is. There are lots of pleasure peaks that happen during intercourse. If you haven’t had contractions you may not know there’s something different.”
Prause, an ultramarathon runner and keen motorcyclist in her free time, started her career at the Kinsey Institute in Indiana, where she was awarded a doctorate in 2007. Studying the sexual effects of a menopause drug, she first became aware of the prejudice against the scientific study of sexuality in the US.
When her high-profile research examining porn “addiction” found the condition didn’t fit the same neurological patterns as nicotine, cocaine or gambling, it was an unpopular conclusion among people who believe they do have a porn addiction.
The evolution of design of the anal pressure gauge used in Nicole Prause’s lab to detect orgasmic contractions.
“People started posting stories online that I had falsified my data and I received all kinds of sexist attacks,” she said. Soon anonymous emails of complaint were turning up at the office of the president of UCLA, where she worked from 2012 to 2014, demanding that Prause be fired.
Does orgasm benefit mental health?
Prause pushed on with her research, but repeatedly came up against challenges when seeking approval for studies involving orgasms. “I tried to do a study of orgasms while at UCLA to pilot a depression intervention. UCLA rejected it after a seven-month review,” she said. The ethics board told her that to proceed, she would need to remove the orgasm component – rendering the study pointless.
Undeterred, Prause left to set up her sexual biotech company Liberos, in Hollywood, Los Angeles, in 2015. The company has been working on a number of studies, including one exploring the benefits and effectiveness of “orgasmic meditation”, working with specialist company OneTaste.
Part of the “slow sex” movement, the practice involves a woman having her clitoris stimulated by a partner – often a stranger – for 15 minutes. “This orgasm state is different,” claims OneTaste’s website. “It is goalless, intuitive, and dynamic. It flows all over the place with no set direction. It may include climax, or it may not. In Orgasm 2.0, we learn to listen to what our body wants instead of what we think we ‘should’ want.”
Prause wants to determine whether arousal has any wider benefits for mental health. “The folks that practice this claim it helps with stress and improves your ability to deal with emotional situations even though as a scientist it seems pretty explicitly sexual to me,” she said.
Prause is examining orgasmic meditators in the laboratory, measuring finger movements of the partner, as well as brainwave activity, galvanic skin response and vaginal contractions of the recipient. Before and after measuring bodily changes, researchers run through questions to determine physical and mental states. Prause wants to determine whether achieving a level of arousal requires effort or a release in control. She then wants to observe how Orgasmic Meditation affects performance in cognitive tasks, how it changes reactivity to emotional images and how it compares with regular meditation.
Brain stimulation is ‘theoretically possible’
Another research project is focused on brain stimulation, which Prause believes could provide an alternative to drugs such as Addyi, the “female Viagra”. The drug had to be taken every day, couldn’t be mixed with alcohol and its side-effects can include sudden drops in blood pressure, fainting and sleepiness. “Many women would rather have a glass of wine than take a drug that’s not very effective every day,” said Prause.
Prause is studying whether these technologies can treat sexual desire problems. In one study, men and women receive two types of magnetic stimulation to the reward center of their brains. After each session, participants are asked to complete tasks to see how their responsiveness to monetary and sexual rewards (porn) has changed.
With DCS, Prause wants to stimulate people’s brains using direct currents and then fire up tiny cellphone vibrators that have been glued to the participants’ genitals. This provides sexual stimulation in a way that eliminates the subjectivity of preferences people have for pornography.
“We already have a basic functioning model,” said Prause. “The barrier is getting a device that a human can reliably apply themselves without harming their own skin.”
There is plenty of skepticism around the science of brain stimulation, a technology which has already spawned several devices including the headset Thync, which promises users an energy boost, and Foc.us, which claims to help with endurance.
Neurologist Steven Novella from the Yale School of Medicine uses brain stimulation devices in clinical trials to treat migraines, but he says there’s not enough clinical evidence to support these emerging consumer devices. “There’s potential for physical harm if you don’t know what you’re doing,” he said. “From a theoretical point of view these things are possible, but in terms of clinical claims they are way ahead of the curve here. It’s simultaneously really exciting science but also premature pseudoscience.”
Biomedical engineer Marom Bikson, who uses tDCS to treat depression at the City College of New York, agrees. “There’s a lot of snake oil.”
Sexual problems can be emotional and societal
Prause, also a licensed psychologist, is keen to avoid overselling brain stimulation. “The risk is that it will seem like an easy, quick fix,” she said. For some, it will be, but for others it will be a way to test whether brain stimulation can work – which Prause sees as a more balanced approach than using medication. “To me, it is much better to help provide it for people likely to benefit from it than to try to create fake problems to sell it to everyone.”
Sexual problems can be triggered by societal pressures that no device can fix. “There’s discomfort and anxiety and awkwardness and shame and lack of knowledge,” said psychologist Leonore Tiefer, who specializes in sexuality. Brain stimulation is just one of many physical interventions companies are trying to develop to make money, she says. “There’s a million drugs under development. Not just oral drugs but patches and creams and nasal sprays, but it’s not a medical problem,” she said.
Thinking about low sex drive as a medical condition requires defining what’s normal and what’s unhealthy. “Sex does not lend itself to that kind of line drawing. There is just too much variability both culturally and in terms of age, personality and individual differences. What’s normal for me is not normal for you, your mother or your grandmother.”
And Prause says that no device is going to solve a “Bob problem” – when a woman in a heterosexual couple isn’t getting aroused because her partner’s technique isn’t any good. “No pills or brain stimulation are going to fix that,” she said.
Female sexual function is an important component of a woman’s sexual health and overall well-being. New research examines the relation between female sexual functioning and changes in relationship status over time.
Female sexual functioning is influenced by many factors, from a woman’s mental well-being to age, time, and relationship quality.
Studies show that sexual dysfunction is common among women, with approximately 40 million American women reporting sexual disorders.
A large study of American adults between the ages 18-59 suggests that women are more likely to experience sexual dysfunction than men, with a 43 percent and 31 percent likelihood, respectively.
Treatment options for sexual dysfunction in women have been shown to vary in effectiveness, and the causes of female sexual dysfunction still seem to be poorly understood.
New research sheds light on the temporal stability of female sexual functioning by looking at the relationship between various female sexual functions and relationship status over a long period of time.
Studying the link between relationship status and female sexual desire
Previous studies that examined sexual functions in women did not look at temporal stability and possible interactions between different female sexual functions.
But researchers from the University of Turku and Åbo Akademi University – both in Finland – looked at the evolution of female sexual desire over a period of 7 years.
The new study was led by Ph.D. candidate in psychology Annika Gunst, from the University of Turku, and the results were published in the Psychological Medicine science journal.
Researchers examined 2,173 premenopausal Finnish women from two large-scale data collections, one in 2006 and the other 7 years later, in 2013.
Scientists used the Female Sexual Function Index – a short questionnaire that measures specific areas of sexual functioning in women, such as sexual arousal, orgasm, sexual satisfaction, and the presence of pain during intercourse.
Researchers took into consideration the possible effects of age and relationship duration.
The average age of the participants at the first data collection was 25.5 years. Given that the mean age was quite low and the average age of menopause is much later, at 51 years, the researchers did not think it necessary to account for the possible effects of hormonal changes.
Relationship status influences sexual desire over time
Of the functions examined, women’s ability to orgasm was the most stable over the 7-year period, while sexual satisfaction was the most variable.
The ability to have an orgasm improved across all groups during the study, with single women experiencing the greatest improvement.
Women with a new partner had a slightly lower improvement in orgasmic ability than single women, but a higher improvement than women who had been in the same relationship over the 7-year period.
The study found that women who had stayed in the same monogamous relationship over the entire 7-year observation period experienced the greatest decrease in sexual desire.
By contrast, women who had found a new partner over the study duration experienced lower decreases in sexual desire.
Women who were single at the end of the observation period reported stable sexual desire.
According to the researchers, relationship-specific factors or partner-specific factors that have no connection with the duration of the relationship do have an impact on women’s sexual functions. Consequently, healthcare professionals should account for partner-specific factors when they treat sexual dysfunction in women.
However, researchers also point out that sexual function needs to be further examined in a short-term study to have a better understanding of the diversity in sexual function variation.
Strengths and limitations of the study
Researchers point out the methodological strengths of the study, as well as its limitations.
Firstly, because the study was longitudinal, it reduced the so-called recall bias, meaning that participants reported their own experience with higher accuracy.
The study also benefited from a large study sample, validated measures, and structural equation modeling, which reduces errors in measurement.
However, the authors note that the long 7-year timeframe may not account for short-term fluctuations, and varying sexual functions may interact differently when studied over a long period of time.
The study did not examine sexual dysfunctions.
Finally, the authors mention that they did not have access to data about cohabitation, or about the duration of singlehood.
Hello and welcome to almost 2017, a time when millions of people have pledged their hearts (and vaginas) to a fictional character named Christian Grey who likes to engage in BDSM. Although the 50 Shades of Grey fervor is alive and well, especially as the second movie’s premiere approaches, tons of myths about BDSM persist.
“‘BDSM’ is a catch-all term involving three different groupings,” Michael Aaron, Ph.D., a sex therapist in New York City and author of Modern Sexuality, tells SELF. First up, BD, aka bondage and discipline. Bondage and discipline include activities like tying people up and restraining them, along with setting rules and meting out punishments, Aaron explains. Then there’s DS, or dominance and submission. “Dominance and submission are more about power dynamics,” Aaron explains. Basically, one person will give the other power over them, whether it’s physical, emotional, or both. Bringing up the rear, SM is a nod to sadism, or liking to inflict pain, and masochism, liking to receive it. It’s often shortened to “sadomasochism” to make things easier.
Got it? Good. Now, a deep dive into 9 things everyone gets wrong about BDSM.
1. Myth: BDSM is a freaky fringe thing most people aren’t into.
“There’s a lot of misunderstanding about how common this is,” Aaron says. “A lot of people may think just a small minority has these desires.” But sex experts see an interest in BDSM all the time, and a 2014 study in the Journal of Sexual Medicine also suggests it isn’t unusual. Over 65 percent of women polled fantasized about being dominated, 47 percent fantasized about dominating someone else, and 52 percent fantasized about being tied up.
“It’s 100 percent natural and normal [to fantasize about BDSM], but some people come and see me with shame,” certified sex coach Stephanie Hunter Jones, Ph.D., tells SELF. There’s no need for that. “It’s a healthy fantasy to have and one that should be explored,” Jones says.
2. Myth: BDSM is always about sex.
Sex isn’t a necessary part of the action. “BDSM doesn’t have to be sexual in nature—some people like it for the power only,” Jones says. It’s possible to play around with BDSM without involving sex, but for some people, incorporating it into sex ratchets things way up.
3. Myth: You can spot a BDSM fan from a distance.
All sorts of people like BDSM, including those who seem straitlaced. For them, it can actually be especially appealing because it offers a chance to exercise different parts of their personalities. “Some of the most conservative-seeming individuals are into BDSM,” Jones says.
4. Myth: If you’re into BDSM, your past must be one big emotional dumpster fire.
“One of the biggest misconceptions is that people do BDSM because of some sort of trauma in their background,” Aaron says. People who engage in BDSM aren’t automatically disturbed—a 2013 study in the Journal of Sexual Medicine actually found that BDSM proponents were as mentally sound, if not more so, than people who weren’t into it. “We conclude that BDSM may be thought of as a recreational leisure, rather than the expression of psychopathological processes,” the study authors wrote.
5. Myth: BDSM is emotionally damaging.
When done properly, BDSM can be the exact opposite. “I often use BDSM as a healing tool for my ‘vanilla’ couples,” or couples that don’t typically engage in kink, Jones says. She finds it especially helpful for people who struggle with control and power dynamics.
To help couples dig themselves out of that hole, Jones will assign sexual exercises for them to complete at home. Whoever feels like they have less power in the relationship gets the power during the role play. “This has saved relationships,” Jones says, by helping people explore what it feels like to assume and relinquish control first in the bedroom, then in other parts of the relationship.
6. Myth: The dominant person is always in charge.
When it comes to dominance and submission, there are plenty of terms people may use to describe themselves and their partners. Top/bottom, dom (or domme, for women)/sub, and master (or mistress)/slave are a few popular ones. These identities are fluid; some people are “switches,” so they alternate between being submissive and dominant depending on the situation, Jones explains.
Contrary to popular opinion, the dominant person doesn’t really run the show. “In a healthy scene [period of BDSM sexual play], the submissive person is always the one in control because they have the safeword,” Jones says. A safeword is an agreed upon term either person can say if they need to put on the brakes. Because a submissive is under someone else’s control, they’re more likely to need or want to use it. “Whenever the safeword is given, the scene stops—no questions asked,” Jones says.
7. Myth: You need a Christian Grey-esque Red Room to participate in BDSM.
Christian should have saved his money. Sure, you can buy BDSM supplies, like furry blindfolds, handcuffs, whips, paddles, floggers, and rope. But there’s a lot you can do with just your own body, Jones explains: “You can use fingers to tickle, you can use hands to spank.” You can also use things around the house, like scarves, neckties, and stockings for tying each other up, wooden spoons for spanking, and so on. Plus, since your mind is the ultimate playground, you may not need any other toys at all.
8. Myth: If your partner is into BDSM, that’s the only kind of sex you can have.
When you’re new to BDSM but your partner isn’t, you might feel like you need to just dive in. But you don’t have to rush—people who are into BDSM can also like non-kinky sex, and it can take some time to work up to trying BDSM together. And much like your weekly meals, BDSM is better when planned. “BDSM should never be done spontaneously,” Jones says. Unless you’ve been with your partner for a long time and you two are absolutely sure you’re on the same page, it’s always best to discuss exactly what you each want and don’t want to happen, both before the scene happens and as it actually plays out.
9. Myth: BDSM is dangerous.
The BDSM community actually prides itself on physical and emotional safety. “A number of discussions around consent are integral to individuals in the community—people have negotiations around what they’re going to do,” Aaron says. People in the community use a couple of acronyms to emphasize what good BDSM is: SSC, or Safe, Sane, and Consensual, and RACK, or Risk-Aware Consensual Kink.
Of course, sometimes it’s still a gamble. “A number of things people do have some danger—boxing, skydiving, and bungee jumping are all legal—but it’s about trying to be as safe as possible while understanding that there’s some inherent risk,” Aaron says. It’s up to each person to set parameters that allow everyone involved to enjoy what’s going on without overstepping boundaries.
If you’re interested in trying BDSM, don’t feel overwhelmed—you can take baby steps.
“There are a number of entry points for people,” Aaron says. One is FetLife, a social media website for people with various kinks. You can also look into Kink Academy, which offers educational videos for different payment plans starting at $20 a month. Another option is Googling for “munches,” or non-sexual meet-and-greets for kinky people in your area, along with searching for kink-related organizations in your city—most big cities have at least one major resource. They usually go by different names, like TES in New York City and Black Rose in D.C., Aaron explains, but when you find yours, you may be on the road to opening up your sex life in a pretty exciting way.
Throughout most of our history, rape was a property crime.
Today we do not, in the modern United States at least, think of a woman’s sexuality as a financial asset. But that is a recent phenomenon. For most of our history, rape was not treated the same way as other violent assaults because it wasn’t just a violent assault, it was also a crime against property.
You can see this view–of a woman’s sexuality belonging to her father and later her husband–in laws concerning rape and sexual assault. It was even possible for a father to sue a man who had consensual sex with his daughter because he had lost the value of his daughter. Based on this view, value is lost in terms of her work if she became pregnant and was no longer able to earn wages, or in terms of a future wife for someone else because of this stain on her character. Men could not be held accountable for raping their wives because a wife was a man’s property and consent to sex–at any time of his choosing–was part of the arrangement.
Lest you think that these laws are ancient examples of a culture that no longer bears relation to our current policies on rape, spousal rape was not made illegal in all fifty states until 1993, where it still may carry a less severe sentence than other rape offenses. The tort of seduction was technically on the books in North Carolina in 2003.
This context is important given our current cultural attitudes toward sexual assault. To understand this culture and how it can be amended, we need to look more deeply at the historical understandings of rape and consent.
Force Means No
The framework for defining rape underpins our understanding of who is required to prove consent or non-consent. The Hebrew Scriptures, which established longstanding cultural norms that helped form a basis for what was morally and legally acceptable in early America, make a distinction between a woman who was raped within a city and one who was raped outside of the city limits. The first woman was stoned to death and the second considered blameless (assuming she was a virgin). This distinction is based on the idea that it was the woman’s responsibility to cry out for help and show that she was non-consenting. A woman who was raped in the city obviously had not screamed because if she had someone would have come to her rescue and stopped the rape. The woman outside the city had no one to rescue her so she could not be blamed for being victimized.
This brutal logic, which is completely inconsistent with how we know some victims of rape react to an attack, was continued in the American legal system when our laws on rape were formulated. Rape was defined as a having a male perpetrator and a female victim and involving sexual penetration and a lack of consent. But it was again the woman’s responsibility to prove that she had not consented and the way that this was demonstrated was through her resistance. She was only actually raped if she had attempted to fight off her attacker. Different jurisdictions required different levels of force to show a true lack of consent. For example, fighting off an assailant to your utmost ability or even up to the point where the choice was either to submit to being raped or to being killed. Indeed, the cultural significance of chastity as a virtue that the female was expected to guard was so profound that many female Christian saints are saints at least in part because they chose to die rather than be raped or be a bride to anyone but Christ.
Potential canonization aside, it was consistently the responsibility of the woman alleging that she was the victim of a rape to prove that she had fought off her attacker in order to show that she had not consented. If she could not show that she had sufficiently resisted, she was deemed to not have been raped. Her chastity was someone else’s property, either her father’s or her husband’s/future husband’s, so it was always understood that someone, other than her, had the right to her sexuality. The assailant had assumed that he had the right to use her sexually and was only a rapist if she acted in such a way that a reasonable man would have known that she did not belong to him. Her failure to communicate that fact, that she was the property of some other man, was a sign that she had in fact consented. Therefore the rape was not his moral failing in stealing another man’s property but her moral failing in not protecting that property from being stolen.
We can see the effects of this ideology in how we treat rape victims today. Although we don’t necessarily require evidence of forceful resistance, it is considered helpful in prosecuting a rape case. Rape shield laws may have eliminated the most egregious examples of slut-shaming victims, but an innocent or even virginal victim is certainly what the prosecution could hope for if they were trying to design their most favorable case. One of the first questions that will be asked of the victim is “did you say no?” In other words “what did YOU do to prevent this from happening to you?” The burden is still often legally and almost always culturally on the victim to show that they did not consent.
There is an alternative approach that has been gaining traction on college campuses and elsewhere known as the concept of “affirmative consent.” Take a look at the video below, which elucidates the differences between the “no versus no” approach compared to affirmative consent, which is often described as “yes means yes.”
In this video, Susan Patton and Rush Limbaugh both represent examples of rape culture. The contrast between the views of Savannah Badlich, the advocate of affirmative consent, and Patton, who is against the idea, could not be starker. To Badlich, consent is an integral part of what makes sex, sex. If there isn’t consent then whatever happened to you, whether most people would have enjoyed it or indeed whether or not you orgasmed, was rape. It is your consent that is the foundation of a healthy sexual experience, not the types of physical actions involved. In contrast, Patton expressed the view that good sex is good sex and consent seems to not play a role in whether it was good sex, or even whether it should be defined as sex at all. The only thing that could indicate if something is an assault versus a sexual encounter is whatever physical evidence exists, because otherwise, the distinction is based only on the assertions of each individual. Again we are back to evidence of force.
What is “Rape Culture”?
Rape culture refers to a culture in which sexuality and violence are linked together and normalized. It perpetuates the idea that male sexuality is based on the use of violence against women to subdue them to take a sexual experience, as well as the idea that female sexuality is the effort to resist or invite male sexuality under certain circumstances. It overgeneralizes gender roles in sexuality, demeans men by promoting their only healthy sexuality as predatory, and also demeans women by considering them objects without any positive sexuality at all.
According to this school of thought, the “no means no” paradigm fits in perfectly with rape culture because it paints men as being predators who are constantly looking for a weak member of the herd to take advantage of sexually, while also teaching women that they need to be better than the rest of the herd at fending off attacks, by clearly saying no, to survive. If they can’t do that, because they were drinking or not wearing proper clothing, then the attack was their fault.
“Yes Means Yes”
Affirmative consent works differently. Instead of assuming that you can touch someone until they prove otherwise, an affirmative consent culture assumes that you may not touch someone until you are invited to do so. This would be a shocking idea to some who assume that gamesmanship and predation are the cornerstones of male sexuality and the perks of power, but it works out better for the majority of men and women, who would prefer and who should demand equality in sex.
This video gives a brief highlight of some of the issues that are brought up when affirmative consent is discussed and the difficulties that can still arise even with affirmative consent as a model.
Evaluating Criticism of Affirmative Consent
The arguments are important so let’s unpack some of the key ones in more detail. The first objection, expressed in both videos, is how exactly do you show consent? Whenever the affirmative consent approach comes up, one of the first arguments is that it is unenforceable because no one is going to stop sexual activity to get written consent, which is the only way to really prove that a person consented. We still end up in a “he said, she said” situation, which is exactly where we are now, or a world where the government is printing out sex contracts.
The idea that affirmative consent will by necessity lead to written contracts for sex is a logical fallacy that opponents to affirmative consent use to make the proposition seem ridiculous. Currently, we require the victim to prove non-consent. Often the victim is asked if they gave a verbal no or if they said they did not want the contact. The victim is never asked: did you put the fact that you didn’t want to be touched in writing and have your assailant read it? The idea that a written explanation of non-consent would be the only way we would take it seriously is absurd, so it would be equally absurd to assume that requiring proof of consent would necessitate written documentation. Advocates for affirmative consent don’t want sex contracts.
In addition, even under our current framework we accept a variety of pieces of evidence from the prosecution to show that the victim did not consent. A clear “no” is obviously the strongest kind of evidence, just as under an affirmative consent framework an enthusiastic verbal “yes” would be the best evidence, but that is just what the best evidence is. That is certainly not the only kind of evidence available. Courts already look at the entire context surrounding the incident to try to determine consent. The process would be virtually the same under an affirmative consent model. The only difference would be that the burden would be on the defendant to show that they believed they had obtained consent based on the context of the encounter instead of placing the burden on the victim to show that, although they didn’t say “no,” they had expressed non-verbally that they were unwilling to participate.
The shift in the burden of proof is sometimes cited as a reason not to adopt an affirmative consent model. Critics argue that this affects the presumption that the accused is innocent until proven guilty. Which is, rightly, a cornerstone of our judicial system. If this model did, in fact, change that presumption then it wouldn’t be an appropriate answer to this problem. But it does not.
Take another crime as an example. A woman’s car is stolen. The police issue a BOLO on the car, find it, and bring the suspect in and sit him down. They ask him “did you have permission to take that car?” and he replies “Yes, officer, she gave me the keys!”
He is still presumed innocent and, as far as this brief hypothetical tells us, hasn’t had his rights violated. It looks as though he is going to get a fair trial at this point. That trial may still devolve into another he said, she said situation. She may allege that she didn’t give him the keys but merely left them on the kitchen table. At that point, it will be up to the jury to decide who they believe, but that would have been the case in any event. He is presenting her giving the keys to him as one of the facts to show his innocence.
If a woman’s car is stolen we don’t question her about how many miles are on the odometer. We don’t ask if she wore a seatbelt the last time she drove it. We don’t care if she had been drinking because her alcohol consumption doesn’t negate the fact that she was a victim of a crime. We certainly wouldn’t force her to prove that she didn’t give the thief the keys. That burden would rightly be on him and we would be able to both place that burden on him and at the same time presume him to be innocent until he failed to meet that burden.
Adopting an affirmative consent model changes how consent is perceived. It is primarily a cultural change in understanding who is responsible for consent. Rather than making the non-initiating party responsible for communicating a lack of consent, affirmative consent requires that the initiating party obtains obvious consent.
That is how affirmative consent works. It wouldn’t require a written contract or even necessarily a verbal assertion. Context would always matter and the cases would still often become two competing stories about what the context meant. And it doesn’t mean that we are assuming that person is guilty before they have the chance to show that they did, in fact, get that consent. It just means that we are placing the burden of proving that consent was obtained on the party claiming that consent had been obtained.
There is no other category of crime where we ask the victim to show that they didn’t want to be the victim of that crime. A man who is stabbed in a bar fight, regardless of whether he was drunk or belligerent, isn’t asked to prove that he didn’t want a knife wound.
We need to change our cultural framework of rape and consent. When we are working under an affirmative consent framework what we are doing is changing the first question. Currently, our first question is for the victim: did you say no? Under an affirmative consent model our first question is for the suspect: did you get a yes?