i once knew someone whose therapist freaked out about her cutting but said nothing about the fact that she wanted partners to choke and hit her during sex because apparently it magically stops being self-harm the moment an orgasm is involved. i think i’d hate sex positivity less (jk i’d still fucking hate it) if it wasn’t even seeping into the medical field and impeding good care as a result. like my mother can tell her patients to stop smoking because it’s objectively bad for their health, but as a future therapist i now have to worry about whether it’s “judgmental” to address when a patient is very clearly self-harming through sex or putting themselves and partners at risk by fucking multiple people in an attempt to avoid intimacy