“The aspects of death and sex are intimately intertwined for both are part of life,” begins a 1968 article in the Journal of Sex Research; “This applies for the normally healthy human being in general, but it has special meaning for the patient with a life threatening disease such as cancer” (Schon 288). Published in a special issue of the journal devoted to the topic of Sex and Illness, the article interrogates the ways in which cancer patients assigned significance to, and projected meanings onto, sex. “Sex, sexual organs and sexual relationships are not as mystic as the world likes us to believe,” it concludes; “rather they are vehicles or extensions of the self, of the person in general, in his relationship to the environment” (Schon 301).
In the decades since, academic literature on sex and illness has not exactly been lacking—though much of this literature points toward a lack of another kind: the dearth of clinicians skilled in addressing issues of sex with terminally ill patients. In one 2023 study, 55 palliative care professionals were asked how frequently they spoke with their cancer patients about sexuality; 34 (69%) responded “rarely or never” (Bramati et. al. e186). This, despite calls for greater attention to issues of sexual well-being as part of the holistic approach to palliative care: “it is essential for nurses to include a sexual history as part of their assessment when working with couples facing end-of-life issues,” a 2004 article in the American Journal of Hospice and Palliative Medicine insists (Stausmire 34). Reluctance to broach the subject may be due to discomfort or stigma, or to misperception of palliative care patients’ priorities: “Dying individuals and their loved ones are often mistakenly viewed as asexual,” as John G. Cagle and Sage Bolte note in a 2009 article in Health & Social Work; “However, quantitative and qualitative evidence suggests otherwise—that dying individuals are sexual beings with a host of related concerns, fears, hopes, and aspirations” (229).
Dying for Sex, the recently-released FX miniseries, uses narrative to affirm this quantitative and qualitative evidence in no uncertain terms. Inspired by the 2020 Wondery podcast of the same name created by Nikki Boyer and Molly Kochan, which chronicles Kochan’s real-life sexual adventures in the wake of a terminal breast cancer diagnosis, Dying for Sex explores the prioritization of pleasure at the end of life, as Molly (Michelle Williams) funnels the energies of her remaining time into an overdue exploration of her sexuality. “Many couples have barely functional sex lives or no sexuality at all by the time they reach the palliative care phase,” observes the author of one study (Redelman 369)—and in Dying for Sex, this is the case for Molly and her husband, played in the series by a well-meaning but problematic Jay Duplass. After learning her cancer has metastasized to her bones, Molly leaves her husband for a foray into the world of anonymous online hookups; she creates a dating profile, swaps pictures, swipes right, and goes on date after date, sometimes-ill-fated, sometimes revelatory. In this way, Dying for Sex offers a “quest” narrative, in Arthur Frank’s terms (115)—specifically, the quest to experience orgasm in partnered sex.
Research on sexuality among cancer and other palliative care patients largely focuses on the sexual “dysfunction” often initiated or exacerbated by treatment side effects and self-image—often, of course, though not always; in her chapter on “Sexuality and Cancer” in The Routledge International Handbook of Social Work and Sexualities, Christine Benjamin explicitly invokes Boyer and Kochan’s podcast as a counternarrative to the loss or depletion of sexual identity among cancer patients (241). On the interdisciplinary palliative care team, sexual health is frequently figured as the province of the social worker; indeed, as Cagle and Bolte note, “[i]n 2001, the National Hospice and Palliative Care Organization (NHPCO) identified the assessment of sexuality as a core competency for social workers in end-of-life care settings” (223). A range of screening strategies and assessment models exist in social work, models with acronyms like PLISSIT (later revised as EX-PLISSIT) and BETTER, which ideally seek to “accommodate for the negotiated nature of communication by providing a patient-centered approach with adequate time for reflection” (226). Ultimately, Cagle and Bolte insist, “If social workers are expected to assess and intervene when individuals have sexually related concerns, they should be aware of the possible range of meanings that ‘sexuality’ can hold” (225). And for Molly, the meaning of sexuality does not align with the broad definition researchers identified in a 2004 study of palliative care patient perspectives—a definition centered on “emotional connectedness” (Lemieux et. al. 634). Rather, Molly’s sexual quest is one for control—over her own body, and over those of (consenting) others.
As presented in the podcast, the real Molly’s quest for sexual fulfillment is self-directed; in the fictionalized version, it is largely facilitated—aptly—by a social worker. A foil for and corrective to Molly’s oncologist—a blundering, awkward older white male doctor who punts concerns about vaginal dryness as a “psychological” matter—the Black, queer, kinky Sonya (Esco Jouléy) goes well beyond NHPCO “competency.” More than merely identifying sexual gratification as the organizing focus of Molly’s “bucket list,” Sonya introduces Molly to the world of kink, of political pleasure and political pain, bringing her along to a sex party and introducing her to a top (Robby Hoffman) who teaches her to dominate by learning to submit. The lessons here are rather heavy-handed, making recourse to the plot of the “[r]epressed, self-conscious straight white women getting Sherpa-ed into liberation through the enlightened guidance of queer characters,” as a New York Times review notes—refashioning, perhaps, the “Black Lady Therapist” trope into the more niche, and more complex, role of Queer Black Palliative Care Social Worker.
The show is rather heavy-handed in centering Molly’s sexuality in the D/S dynamic, which the Molly of the podcast explores with curiosity and openness, without identifying the domme persona as necessarily integral to her burgeoning sexual identity; it also leans into Molly’s history of childhood sexual trauma—a history that is noted in the podcast without the kind of relentless psychologization on which the series insists. But in both its podcast and television incarnations, Dying for Sex disrupts a hackneyed, saccharine plot—one that the fictional version of Molly herself mocks, as she questions the trajectory of the relationship she develops with her unnamed neighbor (Rob Delaney). “Neighbor Guy,” as Delaney’s character is billed, collapses details of several of Molly’s real-life sexual partners into a composite character: a lonely, bumbling, sadistic and humiliation-seeking sub who has “never done anything like this before,” but who does, as he puts it, “do something that neither of us want, which is talk about my feelings,” and eventually professes his love. Molly is no Manic Pixie Sick Girl, bent on redeeming the brooding, devoted boy/man with her brave and beautiful death, but the show can’t help but gesture at a little Sad Guy redemption nevertheless.
But if “‘Dying for Sex’ is This Century’s Kinky, Horny ‘Love Story,’” as television critic Mary McNamara declared in the Los Angeles Times, it is not only for its reconceptualization of the central romantic plot, but for its reclamation of agency for the dying woman, one that has been long overdue in onscreen portrayals of terminal illness. Love Story, after all, is rooted in medical paternalism: Jenny’s nonspecific terminal diagnosis is notably delivered in her absence, to her husband Oliver, who is encouraged to conceal it from it her: “Act as normal as possible for as long as possible,” the doctor instructs; “That’s really the best thing.”
Dying for Sex upends the performative “normal” in multiple ways, drawing on an established relationship between disability/chronic pain and BDSM to utilize kink as a liberatory tool. Pointing to the example of performance artist Bob Flanagan, who memorably integrated masochism and chronic illness, Dawn Reynolds argues that the intersection of disability and BDSM “models alternative sexual options for people with disabilities” (40). Rachel Jobson invokes José Esteban Muñoz’s conceptualization of “queer utopia” in noting how BDSM provides those who experience chronic pain “a space of potentiality where different futures and different perspectives on pain can be imagined and explored,” citing the words of disability scholar, artist, and activist Leah Lakshmi Piepzna-Samarasinha on the sexual disabled body: “I think about how lucky I am to still get to come” (n.p.).
Moreover, Molly’s domming, it turns out, is a transferable skill. As Stephanie Tellier writes in a 2017 article in Sexuality and Disability, “The purposeful communication within the BDSM community can be a useful framework of honest, needs and desires based communication for persons with disabilities. In the BDSM community, these conversations are the norm and expected as part of safe and consensual play, and can result in having more in-depth communication within the relationship, as well as higher levels of sexual satisfaction” (489). For Molly, this “purposeful communication” directly translates to a mid-series clinical encounter, in which she both models and demands the kind of consensual, “needs and desires based communication” she requires. “I’m going to hold your hand now, okay?” Molly asks her doctor, after inviting him to sit beside her. She asks his first name, asks where he’s from, in a kind of ironic, patient-initiated parody of “bedside manner,” before explicitly stating her needs: “Jerry, going forward, I need you to walk me through ahead of time, step by step, what will happen during a procedure. I need you to answer all my questions, and Nikki’s. I need you to listen to me when I say what I feel, and hear me when I say I need a break.” She does what Love Story’s tragic heroine couldn’t dream of: topping her oncologist.
The fact that Molly’s sexual self-advocacy is presented or perceived as radical illuminates the patriarchal, heteronormative stronghold on sex—and by extending this self-advocacy to her medical care, the series arguably queers the clinical encounter, interrogating and seeking to disrupt the grip of paternalism in medical practice. May we never “act as normal as possible” again.
Works Cited
Benjamin, Christine. “Sexuality and Cancer.” The Routledge International Handbook of Social Work and Sexualities, edited by SJ Dodd. Routledge, 2021, pp. 233-250.
Bramati, Patricia, et al. “Attitudes of Palliative Care Specialists toward Assessing Sexual Dysfunction in Patients with Cancer.” Journal of Pain and Symptom Management, vol. 66, no. 2, 2023, pp. e185-e188.
Cagle, John G., and Sage Bolte. “Sexuality and Life-Threatening Illness: Implications for Social Work and Palliative Care.” Health & Social Work, vol. 34, no. 3, 2009, pp. 223-233.
Frank, Arthur. The Wounded Storyteller: Body, Illness, and Ethics. University of Chicago Press, 1995.
Jobson, Rachel. “Thinking Pain Otherwise: Chronic Pain, BDSM, and Crip/Queer Utopia.” Feral Feminisms, vol. 14, no. 1, 2024, https://feralfeminisms.com/wp-content/uploads/2024/08/04-FF-ISSUE14.1-Jobson.pdf.
Lemieux, Laurie, et al. “Sexuality in Palliative Care: Patient Perspectives.” Palliative Medicine, vol. 18, no. 7, 2004, pp. 630-637.
Redelman, Margaret J. “Is There a Place for Sexuality in the Holistic Care of Patients in the Palliative Care Phase of Life?” American Journal of Hospice and Palliative Medicine, vol. 25, no. 5, 2008, pp. 366-371.
Reynolds, Dawn. “Disability and BDSM: Bob Flanagan and the Case for Sexual Rights.” Sexuality Research & Social Policy, vol. 4, 2007: pp. 40-52.
Schon, Martha. “The Meaning of Death and Sex to Cancer Patients.” Journal of Sex Research, vol. 4, no. 4, 1968, pp. 288-302.
Stausmire, Julie M. “Sexuality at the End of Life.” American Journal of Hospice and Palliative Medicine, vol. 21, no. 1, 2004, pp. 33-39.
Tellier, Stephanie. “Advancing the Discourse: Disability and BDSM.” Sexuality and Disability, vol. 35, no. 4, 2017, pp. 485-493.
Image Credit: Dying for Sex Poster, Copyright FX. Used under fair use provision (review).
