[Guest Post] Forget Perfection, Bring Me the Glory – Life as a Disabled Kinkster by Pippin Strange

Today I am so, so honoured to be sharing a guest blog from one of my most favourite people. Pippin is my metamour – my sweetie The Artist’s primary partner – and a dear friend. Among many other things, they identify as disabled, queer and a survivor. They are also supremely wise, powerfully compassionate, ridiculously talented, and kinky as fuck in the best possible way. 

Content notes  are: chronic pain, intestinal health, ableism, intimate partner abuse and rape. Please look after yourselves when engaging with these topics.

Buckle in and get some coffee for this one, folks. It’s longer than I usually post, but I devoured every word and you should too.

Amy x
______________________

A person sitting in their wheelchair facing away from the camera looking up at a big tree.It’s a bad pain day. My joints are twinging; something untoward is happening in my lower abdomen; my neck feels like two bars of iron stuck on either side of my spine. And my fatigue levels are high – even sitting forward in my wheelchair is a challenge, and I’ve done well to make it out of the house.

Suddenly we come to a patch of bumpy pavement. The Magician increases their pushing speed ever so slightly, and every little jolt sets my buttocks singing with joyful agony from last night’s caning. It’s exquisite. Once we’re on the smooth ground again, I tell them my arse still hurts and it’s all their fault. Even before they stop pushing, I know they have broken into that devilishly handsome, sadistic grin. I shiver. They bend down and we kiss deeply, leaving me wanting more.

I’m Pippin Strange, otherwise known as the Minstrel. I’m a genderqueer, queer, polyamorous switch in my late thirties, with two delightful partners – the Magician (also known on Coffee and Kink as the Artist!), and the Ranger. My relationship with each of them includes kink – I submit to the Magician (who is my primary partner), and I switch with the Ranger.

I’m also disabled. I have joint hypermobility, and an unnecessarily interesting selection of long-term mental and physical illnesses, the former including Complex PTSD, the latter including ME/CFS and some form of seizure disorder. I’m also neurodivergent, with no formal diagnosis but the strong likelihood that I am both dyspraxic and autistic. I take several forms of medication, I’m housebound a lot, and I usually use my beloved wheelchair when out and about. For good or ill, being disabled permeates every part of my life, including my sex life, and it has done ever since I reached adulthood.

An evening in a university town, nearly twenty years ago. I’ve just come back from the bathroom. My lower abdomen is again in a scary amount of pain. The Saboteur – my boyfriend, later to become my husband – is not shy of expressing his disappointment that I’m yet again not well enough for intercourse. I’ve been close to screaming with the pain, but instead we focus on his sadness that we’re not going to fuck. I assure him, desperately, that yes I really am trying my best to sort out whatever is wrong with my innards so that he can be inside me again. I feel like a failure.

I say “an evening”. Actually this happens several times. On at least one occasion, I decide to give it a go anyway, because I can’t bear the guilt any more. The pain is too much, self-preservation kicks in, I speak out. He stops and withdraws. But he is the wronged party; I get no sympathy from him.

Fast forward to the present. An afternoon in an industrial city in the Midlands. The Ranger is above me, fucking me, and it’s glorious. His hands pin mine above my head. My lips are pressed against his collar bone, moaning words of helpless submission into the his soft skin. I know I’m not going to come like this, not in this position, but I love it, I love it so much, and I’m desperate to keep going, to feel the rhythm change and hear his gasps as he comes inside me. But my thigh muscles are too weak, and my right hip joint is complaining. This is not a sexy pain. I keep going anyway, because it is wonderful and I want it so much. But he notices something, checks, asks if I’m comfortable. I realise that I’ve been foolish, and admit that I’m not. He pulls out of me, shifts aside so I can stretch out. I breathe an apology for having to stop but he tells me I have nothing to be sorry for. He smiles at me, praises me for answering his question honestly, tells me how good I am. And seeing I’m eager to stay in the scene, he starts dominating me in a different way…

Looking back, I’ve been a sub-leaning switch for as long as I’ve had any sexual urges at all. And I suspect that I have being disabled, even more than being queer, to thank for how much I’ve allowed this part of me to blossom. My body is already othered, already weird, already unacceptable. I’m already rebelling against a cultural norm every time I use it in any way that brings me pleasure. So if conforming is impossible, at least for someone with my drives and my stubbornness, I’m damn well going to rebel in whatever way I like best. And now that I’m gnarled and middle-aged (and the hottest I’ve ever been) and I only have sexual or romantic relationships with people who are actively lovely (rather than, say, completely dreadful), kink – as both dominant and submissive – has become a crucial part of my sexual identity. And a crucial part of how I cope with the day-to-day reality of my health conditions and the impact they have on my life.

A winter morning. I’m so fatigued that my arms have mostly stopped working. But I have the Ranger stretched out at my side, beautiful and helpless and mine. I can do so little to him physically right now, but there’s so much I can order him to do to himself – and I do, stroking his face and holding his gaze with mine and enthralling him with words. I have no power to do much with my muscles, but I have so much power over him.

To be a disabled dom makes, I would say, an instinctive sense. I’m someone who feels far too powerless in my life far too much of the time. And here is the Ranger, a man I love, kind and fascinating and staggeringly gorgeous. And here he is handing temporary control of his body and mind to me, calling me “Sir”, eyes widening with pain or pleasure as he falls at my command and I play with the power he’s given me. Yes fucking please, on every level. 🙂

And the flip-side of that: one of the worst frustrations I experience in being incapacitated with fatigue so much of the time is how little ability I have to do caring, lovely things for the people who I love. Put simply, my dominating the Ranger makes him happy, and I love making the people I love happy.

When I’m submitting, it’s more complicated. I already spend far too much of my life feeling powerless and in pain. So why does, for instance, being held down by the Magician’s firm hand while they torture my nipples until I squeal not only make me wet, but also give me a welcome sense of peace, healing, well-being, and even power?

The obvious answer is that in that situation, however powerless I feel, I actually am nothing of the kind. Every instant is something I have passionately chosen. But it’s more than that. While I do struggle to feel powerful in my everyday life, something that I never struggle to feel is responsible. With PTSD, an anxiety disorder, and a mind that is by nature a constant torrent of words, the feeling of falling into subspace and allowing my mind to be quiet, slow, responsive to what is immediate rather than what is ongoing, brings an instant and glorious relief, and, ironically, a growth of true power within me that lasts long after the scene. As an abuse survivor who struggles with low self-esteem, being praised for my submission by a beloved partner is incredibly healing. As a caree who does not always feel at ease about my needs, to have a situation in which I am cherished and guarded and cared for as a submissive, and in which that adds to the pleasure experienced by the dominant, reclaims some of that space for me away from my own internalised ableism.

And the pain? As every masochist and every chronic pain sufferer knows, pain varies, in quality as well as in intensity. The angry bite of a headache, the enervating ache of a stiff muscle, the sickening dragging agony of an inflamed intestine… “pain” is one word for all these things, but they have little in common beyond it. I defy anyone to enjoy anything about having Ulcerative Colitis, but most of the pains involved in sensation play within kink are of a kind that are at least potentially pleasurable, and at no point give the kind of “wrongness” signals that the body is coming to serious harm. Even when I’m being spanked to the point of tears, I know that I’m safe, that no harm is coming to my body worse than a few bruises or welts. It is blessedly different from anything that comes from my health conditions. It’s not uncommon, even, for kink sensations, coupled with post-impact endorphins, to temporarily overwhelm and drive out my chronic pain; especially useful for me given I cannot safely take most painkillers!

The sense of achievement in sensation play is also a mighty difference between kink pain and chronic pain, and gives me a taste of something that I miss. I’ve always loved the feeling of having successfully pushed my body beyond what I believed it could do. To stand, for instance, on top of a big Scottish hill, gazing down at the incredible view, and thinking I made it. Since I now have moderately severe M.E., exerting my body beyond very narrow (and varying) limits is actively dangerous – it can make me more ill for days, weeks or even months. But a hard spanking challenges my body without that risk. And since I’m afterwards able to gaze on the Magician or the Ranger, the view’s not bad from the top of that hill either.

When it comes to sensations that are pleasurable as well as painful (clothes pegs on my nipples, a punch on my butt, a flogger on my thighs, a bite on my shoulder…), my body gets to feel something it can relish, just as much as with sensations that are purely pleasurable. More so, often, since the high background level of tension in my body can make pure pleasure paradoxically painful to me. A mixture of kink pain and pleasure allows my body to relax into the sensations and relish them intensely – and to be able to relish a physical experience in this body is a powerful thing indeed. Like a lot of people with chronic pain, I wrestle with the temptation to hate my body or feel thoroughly disconnected from it. At its best, sensation play as a sub brings me back into affectionate synchronicity with this fractious, fragile, and yet utterly wonderful meatsack of mine. It is beyond precious.

As I write this, the ring and little finger on my right hand are a trifle numb. Two days ago, with the Magician’s own chronic pain flaring but both of us feeling enthusiastic, we tried something new. They sat back on pillows, comfortably, calmly eating an apple like a (gorgeous) movie villain. And I gave them a show. Stripping at their instruction, torturing my nipples, scratching my thighs, pleasuring myself while they watched me and praised me and noted with delicious smugness that turning me into their helpless toy and slave had been so very, very easy…

It was wonderful. Squirmy and embarrassing and hot and beautiful and loving. And I wrenched my neck. It had been playing up for a few days, and the slightly unfamiliar position I was lying in did the rest. I felt odd after I came (I mean, happy! but odd), and the following day I woke up with my neck, jaw, and shoulders a mess, and the obvious symptoms of some mild and hopefully temporary nerve damage, as well as some indications that I’d had a seizure in my sleep. I don’t regret a thing about that scene (although I am thinking that I might need to go to the doctor if the symptoms continue…), but in future I’ll need to take a lot more thought about how I position myself, and ask for some Tiger Balm or ibuprofen gel as part of my after-care…

I don’t want to give the impression that being a disabled kinkster is easy. That, it certainly is not.

Events are a problem. I can’t get out of the house much, and when I can theoretically get to something, worries about access and the likelihood of running into at least some kind of ableist bullshit can be prohibitively exhausting.

Meeting new potential play partners is a problem. I’m horribly vulnerable, and already a survivor of assault, harassment, rape and ableist relationship abuse. Disabled people are on average twice as likely to be abused over the course of their lives as currently-abled people, and to say that I am very wary of the possibility of it happening to me again is an understatement. The kink scene and the polyamory scene are both riddled with ableism, from the usual cultural disdain for disabled bodies, to the fetishising of certain of those bodies in Fetlife groups, to the extreme end of Relationship Anarchy that rejects anything like a carer/caree (or mutual carer!) relationship between romantic partners – or even one that is merely stable and secure and committed, as is essential for me – as intrinsically oppressive. On top of that, anyone I go on an actual date with needs to be someone both the Magician and I trust to be, at least in a small way, my carer for a couple of hours – including pushing my wheelchair if the situation requires it. Thankfully I already have my two wonderful partners, not to mention three superb “kissing friends”, one of whom I may also start kinking with soon; I am quite beautifully polysaturated! But even if I were more interested in, say, casual play with a stranger or acquaintance than I am, it would not be remotely an option for me.

And then there’s the actual impairments. There are some activities I’d love to do that are either physically impossible for me, or which I cannot do for long. Ever tried giving a blow job with your jaw a clicky mass of pain, and when you have both a strong gag reflex and emetophobia? Not the easiest thing. 😉 I actually love sucking my partners’ cocks, both as a dom and as a sub, but my Gods do I have to be having a good day before I can, and deep-throating is most definitely not an option. And sometimes I am just too mentally ill for kink to be safe. Anxiety and depression and even flashbacks are one thing, and under the right circumstances kink can actively help, but on those thankfully rare occasions when my perception of reality is a little porous, let’s just say that telling a partner I’m their helpless captive is not a sensible plan…

But those limitations do come with their own blessings. I can’t have some perfect scene that lasts for hours and doesn’t require extensive in-scene management of my energy, pain levels, and whatever my brain might be up to. And since I can’t have it, I don’t need to try. Instead, my partners and I can get on with doing what works for us on the day – and finding creative solutions to some of the difficulties. After the Ranger and I stopped having PIV sex with him on top in the scene I describe earlier, we found another position that was a lot more sustainable for me, and in which I was able to come really quite explosively. Would we have found that position if my hips had been behaving themselves? I’m not sure we would. My difficulties with stroking his cock for any length of time I have gone some way to fixing, buying him as an anniversary gift a stroker toy that gives me a much easier grip, and which he loves in its own right (not least because it is purple!). The frankness about my body that I have had to develop to survive means that I’m good at giving accurate feedback, vital when trying something new.

The Magician and I, since we live together, engage in a lot of micro-kink: scenes that last literally seconds long and which we fit randomly into our day whenever we’re both up for it. A brisk hand or hairbrush spanking while we run a bath. Their hand closing briefly over my mouth while we’re snuggling. A glare over the top of their glasses that rapidly becomes a contest, with me trying to make them laugh before they can turn me into a subby heap (they usually win 😉 ). Even the very fact that they’re my carer sometimes creates micro-kink situations, as helping me out of bed turns into mutual fondling, encouraging me to rest becomes sternly ordering me to, and helping me undress when my arms aren’t working properly becomes, well, stripping me naked.

Perhaps this above all: every body and every brain has its moments of misfiring. The Magician is disabled too; the Ranger is also not in consistently perfect health. And they both know they can trust me absolutely to understand and empathise when it’s their needs or limitations that mean that a scene has to be changed or halted, or just isn’t possible that day. I don’t want to romanticise the lessons that being disabled has taught me, when the primary lesson it has taught me is that all disabled people live in severely ableist societies with inadequate access, respect, and understanding, and that this desperately needs to change. But I have been forced over the past two decades to teach myself something powerful about how futile it is to search for what is perfect, and how much better it is to build what is glorious instead. And if there is one thing that makes me both a good dominant and a good submissive, it is probably that.

Photo provided by the author. Do not steal it.

Keeping Your Sexy Going When Times Are Hard

We all go through difficult times in our lives. It’s part of being human. Today’s prompt from Kayla Lords’ 3o Days of D/s, which I’m working from for #KinkMonth, is all about maintaining kinky fuckery in a relationship when times are tough. She asks:

Does it surprise you that you might not maintain the same level of D/s during the stressful times? Do you think you know how you’ll handle your relationship when it does?

A white female-read person with long dark hair wearing a blue shirt. They have their hand to their forehead and a stressed expression on their face. For a post about sex in difficult times.

Now, I’m a person for whom sex is very important. I have (arguably, depending upon who you ask) an above-average drive and sex is a really important part of intimate relationships for me. This doesn’t change when times get stressful. It just means I have to be a bit more creative to make sure that I continue to prioritise sex in my life.

Here’s some things that have worked for me. Maybe they’ll help you, too, next time “life” gets in the way.

Make dates with your partner

If you have a partner or partners, schedule dates and stick to them. During this time, make a rule that you won’t answer your phones, check email or discuss the current stressful topic. Instead, whatever you enjoy doing together, do that: make some tasty food, order in, watch a film, take a walk, share a hot bath. Relax and practice being present with and grateful for each other. This is less about “scheduling time for sex” and more about carving out time for your relationship and making sure you stay connected to each other. Do this, and the sex should follow.

Make dates with yourself

Whether you have a partner or not, making time for yourself is important. Put “Me Time” in your Google calendar if you have to! A minimum of one four-hour block a week is ideal if you can do it. During this time, you should only do things that feel good to you: read a good book, watch your favourite TV show, surf the internet guilt-free, go for a run, cuddle your pet, write in your journal. Whatever feels good. During this time, give yourself permission to do things like watch porn, read erotica, fantasise and masturbate if you want to. Again, this isn’t about “scheduling time to jerk off” – it’s about freeing up time and space to focus on yourself and give yourself permission to feel good.

Explore erotic energy without penetration, or orgasm, necessarily being the goal

When was the last time you and your partner just had a heavy make-out session that didn’t necessarily lead to any kind of genital contact? What about the last time you shared a sexy shower, gave each other massages, or even just casually hung out naked because you could? Erotic, sexual and intimate energy can take many forms and we’re so accustomed, once we get into sexual relationships, to rushing straight into genital-focused sex with orgasm as the assumed end goal. When times are hard, it can be the ideal time to explore other types of touch, connection and intimacy. If your brain won’t switch off long enough to let you reach climax, or your cock isn’t getting hard when you want it to, this can be a beautiful way to maintain a sexual connection with your partner and yourself.

Biology comes first

This is so basic, but don’t underestimate the power of trying to sleep 8 hours per night, drink plenty of water, eat well, and get plenty of exercise and fresh air. These simple rituals of taking care of yourself can completely transform how you feel. None of us can have sizzling sex when we’re exhausted or malnourished.

Get a change of location for stressful subjects

I have been known to do it at times, but generally I really prefer not having conversations about difficult topics or current stresses in mine and Mr CK’s bedroom. This is because our room, for me, is a place for cuddles, restful sleep, and… sex. I understand being able to do this is a privilege and not everyone has that ability. For me, though, a change of location – ideally to a pub, coffee shop or even just taking a walk – for talking things through can help to keep the stress out of our sexy space. Even having difficult conversations in the living room instead of the bedroom can be useful.

Give yourself permission to NOT want sex

This might sound counter-intuitive, but it’s actually really, really important. Nothing will kill your libido faster than beating yourself up for the times when you DON’T want to have sex! It’s okay to not want to have sex sometimes, whether that’s due to tiredness or work stress or depression or the fact that you’d really rather just watch Netflix. Beating yourself up makes the very idea of sex into a stressful and painful topic. Giving yourself permission to not want sex sometimes also gives you permission for the times you do want it.

I hope some of these ideas will be useful to you the next time you’re having a difficult time but would like to keep getting your sexy on. You’ve got this. I believe in you.

Kinky item of the day: Gags! I adore gags. What about this large ball gag, which is silicone – meaning it’s non-porous and will stay hygienic for longer?

FYI, the above is an affiliate link. If you buy through it, I may make a small commission. This does not affect my opinions which are, and will always be, my own.

The image featured in this post was offered for use via Creative Commons Licensing.

Sex Not Stigma: Using My Sexuality to Manage My Mental Health

Content note: this post discusses mental health struggles in detail and includes slurs and a brief reference to suicide.

Today is #WorldMentalHealthDay. Thousands of brave people have spoken out about their struggles with various mental health conditions. I shared a little bit of my story on Twitter too, if you’re interested. Short version: I live with depression and anxiety.

I use a whole litany of tools to manage my mental health. I take medication, I’m working with The Best Therapist Ever, and I’ve learned to effectively regulate my physical and mental energy levels. I’ve also consistently found sex, masturbation and kink to be really useful and positive items in this toolbox.

A black and white picture of a heterosexual-read couple, sitting together with the woman's head resting on the man's shoulder in an affectionate fashion. They both have dark hair and the man has a beard and tattoos. Pixture by Hot Octopuss and given for a sponsored post about Mental Health Week.

#SexNotStigma

It is ridiculous to me that today, in twenty-freaking-seventeen, that there is STILL such stigma around both mental illness and sex. They are two of the great taboos that plague our society.

As a woman, admitting that you like to have sex can be a radical – and dangerous – act.  Speaking up about a mental health struggles is risky and brave for anybody to do. Words like “crazy” and “psycho” are thrown around with abandon. People with mental health issues are routinely portrayed as dangerous. Services that actually help us are thin on the ground and getting cut left, right and centre. Being a woman who talks about sex and is also open about her mental health. Ohhh, boy…

I’ve had my promiscuity chalked up to my mental health conditions more times than I can count. (“Poor girl, she’s acting out sexually because she’s depressed” at best, or “crazy whore!” at worst.) Interestingly, the same has also been true in reverse (“you wouldn’t be so depressed if you’d stop sleeping around!”) But that’s not how this works! I’m a proud slut[1] AND I have a mental health condition. One did not cause the other and ceasing one[2] will not “cure” the other.

The #SexNotStigma campaign aims to break taboos when it comes to talking about sex, including that surrounding sex and mental health. This post is my attempt to add my voice to that vital conversation.

I wrote recently about how I don’t think “don’t play when you’re depressed” is useful or realistic advice, and today I want to expand on that and talk about why, far from being off-limits when I’m low, sexuality has probably helped save my life more than once.

Sex: intimacy, connection, love.

Some people want to be left alone and can’t bear to be touched when they’re depressed. My experience is usually the opposite. I want to be around the people I love and trust, to connect with them in deep and profound ways. Sex is one of the ways in which I connect with some of the important people in my life. Therefore, honestly, fucking my brains out (or at least fucking my sadness out for a while) is one of the best ways a partner can help me when I’m struggling.

Sex reminds me, viscerally and in the moment, that I am loved. For me, mental health wise, a really good fuck with someone I love is basically a cuddle on speed. Throw in a few dozen orgasms (yes, your girl over here is SUPER multi orgasmic) and you will see a marked improvement in the happiness of your Amy.

Sex helps me to focus on all the joyful things – pleasure, love, connection, vulnerability, sensation – in a world that’s fucked.

Sex literally reminds me that there’s so much to live for.

Masturbation: the ultimate self-love.

Self-loathing is a feature of my depression and an unwelcome visitor that likes to pop in from time to time. I’ve learned that the best way to combat it is to be excessively kind to myself – the way you’d be kind to a partner, friend or child who was in pain. Sometimes I take myself out for coffee and cake. Sometimes I give myself permission to stay in bed, read and nap – take a “mental health day,” if you will. And sometimes, I masturbate!

Aside from the obvious benefits of all the happy chemicals that are released at the point of orgasm, masturbation is a means of reminding myself that I am worthy and deserving of pleasure. And on the occasions when romantic rejection or the ending of a relationship triggers my depression, masturbation reminds me that my sexual (and loving!) relationship with myself is the first, last and most important one of my life.

Who needs that git who dumped me when you have cutting edge sex toys, am I right?

Kink: freedom in bondage.

Submitting to a safe partner can be really positive for me when I’m feeling low.

Kink, especially pain play, pulls me out of my head and into my body. It’s hard to be sad when all I can think about is the hand spanking my ass! It’s grounding. It makes all the noise in my head go quiet.

Submission makes me feel useful. When I feel worthless, a well-timed “good girl” can do wonders. To know that I am pleasing somebody else, that I am serving them, gives me a purpose. It reminds me that I have value.

Kink gives me permission to be vulnerable. Play gives me chance to cry if I need to, to scream if I want to, to get pent-up emotions out. It releases me from the responsibility of decision making, of caring for myself or anyone else, even if only for a short time. It gives me permission to just be.

Discovering new paths to pleasure

Mental illness can impact sexuality in many ways. In particular, feeling very low can make it difficult to get in the right headspace to enjoy sex or orgasm. Certain types of common antidepressants including Selective Serotonin Reuptake Inhibitors (SSRIs) can also cause erectile dysfunction and anorgasmia. When I first started taking citalopram – a common SSRI – I lost my ability to orgasm for a month.

Was it hell? Yes. Did it also teach me something valuable, namely that I kinda have an orgasm denial kink? Also yes. While this is something I prefer to be voluntary and not drug-induced, going through this experience taught me something really valuable about my fetishes. So there’s value in that.

Problems such as ED and anorgasmia suck (if you’ll pardon the pun) but they also force you to get creative. I finally broke through my month-long dry spell with a high powered vibrator. That’s how I learned that I love really intense vibration! If your cock isn’t getting hard in the way you want it to, you might discover other routes to sexual bliss that you’d never have previously considered or bothered to try.

Integrating the two

I’ve come to terms, over ten years of having a formally diagnosed mental health condition, that it’s not going away. It’s with me for life and I am better off learning how to manage it than hoping it will disappear. Just like a diabetic would take insulin every day, I take my antidepressants to keep me healthy. (Conceptualising my illness as being exactly comparable to a physical health issue – BECAUSE IT IS – has been surprisingly empowering.)

I’ve also grown into my sexuality in the last ten years. From a girl who was terrified to admit, even in a whisper, that she liked girls and might want to be spanked, I’ve grown into a woman who owns her desires and explores them unapologetically.

And, crucially, I’ve learned to integrate these two things. When my bisexual, kinky and non-monogamous identities ceased to be sources of shame, my mental health directly improved as a result. When my condition started to be properly managed, my sex life improved instantly. And when I learned to use my sexuality to enhance my mental health, I gained a tool that has saved my life.

[1] Yay, reclaiming slurs!
[2] Because you can totally choose to stop being mentally ill, right?

This post was kindly sponsored by the lovely folks at Hot Octopuss, a fantastic and innovative sex toy company who are committed to tackling taboos around sex. Check out their brilliant range of products, including the new Queen Bee, and their blog, where they talk sex, health and stigma. They’ve even offered a discount code for Coffee & Kink readers – use CK10 to get 10% off (and send a little bit of support my way.) All opinions are, and will always be, my own.

A banner ad for sex toy company Hot Octopuss, who sponsored a post on sex and mental health