I still remember the moment rather clearly: I was sitting in my gastroenterologist’s office a few years ago, mustering the courage to ask my sweet (and likely straight) doctor a very gay question.

“Would I ever be able to take PrEP?” I ventured. “Just, you know, in theory.”

He paused, as if surprised that I would even ask. “Yes, of course. Lots of our patients do.”
 

This was a potentially life-altering bit of news. You see, I have Crohn’s disease, a chronic illness where inflammation attacks my intestines and wreaks havoc on my digestion. To keep those symptoms at bay, I take medication that suppresses my immune system, which as a side effect makes me more vulnerable to infections of all sorts.

And so, I always assumed PrEP—the miracle drug that guards against HIV infection—would be a nonstarter for me. The very non-scientific math in my head went something like this: compromised immune system = higher infection risk = PrEP not working for me. (I can’t totally blame myself for this ignorance; though my sex ed in high school was probably better than average, sexual education is still woefully inadequate, leaving so many of us in the dark.)
 

By extension, I counted myself out entirely from the life of a gay slut. I was, at the time, in a long-term monogamous relationship, but starting to itch for more sexual adventure. Each time I pondered leaving my partner, one of the (many) doubts that popped up was, “If I can’t take PrEP, it would be too risky to be a slut, so I may as well stay in this safe, monogamous sexual box.”
 

How wrong I was. My doctor’s casual affirmation that PrEP would, indeed, work for me opened up an entire world of sexual potential; though my fantasies were already quite vivid, now they suddenly felt like real possibilities. It took many more months of internal emotional wrestling before I was ready to leave my relationship. But when I did find myself single again, I was thrilled to discover that my chronic illness didn’t have to hold me back from experiencing the sexual life of my dreams. With a prescription for PrEP (and DoxyPEP) in hand, I jumped headfirst into the world of bathhouses and sex clubs and naked parties, and never looked back.
 

Maybe you don't have Crohn’s disease like me, but disability or chronic illness or even chronic pain affects so many of us. The 2026 PTP Pink Paper, for example, found that 28 percent of queer people report living with chronic pain. Script spoke to experts to learn how we can make the most of our sex lives, despite the limitations of our bodies and minds.

Understand your body and its limits

The first step in building a satisfying sexual life with chronic illness is developing an understanding of your body and its limits.
 

Carol Queen, PhD, a staff sexologist, company historian and curator of the antique vibrator museum at Good Vibes, suggests approaching your body with curiosity. Is your movement restricted in some way that affects your ability to take certain sexual positions, or to thrust comfortably? Are there certain kinds of touch—for example, friction versus pressure—that feel better than others? And how does your energy level affect your ability or desire to engage in sex?
 

Masturbation can be a great investigative tool: Queen says that self-stimulation can help you learn what feels good, what doesn’t and what you might want to try later with a partner.
 

These self-reflections can go beyond physical matters, too. Often, chronic illness extends to the mind. Depression, for example, can come with an inability to feel pleasure or arousal, Queen says. The medications used to treat mental health can also cause a drop in libido. Or the very fact that you acquired a chronic illness can lead to a sort of mental trauma.
 

“Our mental health affects our sexual enjoyment,” says Tim Lagman, resident sex educator at the lube brand pjur. For HIV positive folks, for example, their HIV status can hang as a “cloud over their head,” Lagman says, with the worry that they’ll transmit the infection to someone else.

Once you’re aware of how your mental health impacts your sex life, you have some options. You might find a therapist, or work through your mind-body connection related to any trauma, Queen says. Or you might talk to your doctor about adjusting meds that could be impacting your libido.

Find your unique workarounds

Once you have a better idea of how your physical or mental ailments impact your sexual pleasure, you can start to discover ways to work within those limitations.

Lagman likes to use the idea of “good enough sex” to help clients reset their expectations. “It’s highly unrealistic to have OnlyFans-style, Hollywood-style, porn-style sex every single day,” he says. 
 

Instead, you can ask yourself: How can I enjoy sex without it being so calculated? Does sex have to be penetrative? Does sex have to have an orgasm? “There’s an infinite number of ways that you can enjoy sex,” Lagman says. 
 

I’m sorry to report, you might also want to talk to your doctor about sex. Much like talking to my doctor opened up a world of sexual possibility, speaking with a medical expert about your sexual pleasure—awkard as it may be—can, in some cases, help you work through sexual frustrations, Queen and Lagman say. Perhaps your primary care doctor can connect you to a specialist to work with your pain or ailment as it relates to sex. Or maybe you need to adjust your medications to help your sex drive. 

 

Finally, start looking for “hacks,” as Queen calls them. Maybe you change your meds. Maybe there’s sex furniture. Maybe your phallus doesn’t work but you can wear a strap-on. “There are hacks for so many things,” Queen says. If you’re not sure what your adaptations might be, search online for a community or knowledge base or Reddit thread about your condition, where folks share best practices. 
 

Throughout the process, remember that you are entitled to finding a sexual life that works for you. “Pleasure helps you maintain a quality of life, and it’s not an extra, and it’s not something you’re greedy for wanting,” Queen says. “It’s never too much. You should never let anybody shame you for this.”
 

Communicate with your partner(s)

Even after you’ve put in the work of understanding your body and your unique workarounds, there’s one last, very important thing to do: communicate with your sexual partner(s).

You’re not obligated to disclose your entire medical history, but “you have to be an advocate for yourself. So if that means keeping your illnesses private, that also means you need to vocalize your needs in the bedroom,” Lagman says.

Those needs can and do change from encounter to encounter. “It can be contingent; you can say yes in some circumstances or no in other circumstances,” Queen says. Maybe your pain is flaring, or maybe you don’t trust this partner enough to try something. You can tell them you simply don’t feel up to any given thing at that moment, or suggest an alternative like kissing or masturbation or avoiding penetration. “Any reason you give is a good reason,” Queen says.
 

It’s not only chronically ill or disabled people who have these types of limits: we all do. If you can communicate with someone in the moment, you have a better chance of feeling safe with that person and experiencing pleasure, Queen says. Learning to communicate and negotiate during sex, therefore, is a skill that serves all of us.