“What about sex?” Is a valid question when dealing with disability.

When I got diagnosed with diabetes, I didn’t even think to ask how it would affect my sex life. I was 22, in my final year of my undergraduate degree and in love with my first serious girlfriend. Sex was a big part of my – and our – lives, and yet I never thought to ask about how this new diagnosis would affect things.

It wasn’t just sex. It was how as a couple we navigated this new world of monitoring and checking and counting. Plot twist: we didn’t. The diabetic burnout caught me quickly and only left enough room for me to crawl to the end of my degree. But had I asked the doctors and specialists at my first appointment about how this might affect things, would I have been any more prepared?

Any disability brings with it elements of sexual and social adaptation. But we rarely talk about those. We don’t talk about the mid-sex moments where you suddenly know your blood sugar is dangerously low and you have to stop while your partner grabs you lucozade and wipes the hypo sweat from your body. We don’t talk about how deeply unsexy a chronic illness can make you feel – in my case how my stomach being covered in injection bruises makes me hideously self-conscious. And if we don’t talk about them for adults who are newly diagnosed – people in relationships who, realistically, medical professionals should expect to be having sex – we’re definitely not talking to young people about it.

We’re not warning young people with autism about the sensory overload of sex and how to process it; we’re not telling the chronic asthmatic that the breathlessness of sex might be scary; we’re not equipping the young person with anxiety how intimacy might increase or decrease their symptoms. And we should be. If young people are under specialist care, this is something that should be addressed at an age appropriate point in treatment. It should be something young people are able to consider – because without having access to these considerations, they can’t really consent fully.

Intimacy and sex are risky activities – emotionally and physically. But that risk is one that most of us take, and experience the reward for. In terms of some disabilities, the risk is higher than the reward. Chronic pain conditions that are exacerbated by sex can lead to the choice between a few hours of pleasure or days of pain. That’s a choice that no one can make unless they know it’s a choice in the first place.

Disability shows up in every experience a disabled person has, and it isn’t fair to dismiss sex from the equation.

I thought of my sex life as an after thought when I was diagnosed. Really, it should have been a talking point from the beginning.