The limits of consent as a concept in its own right
Dr. Wignall begins by pointing out something that can feel counterintuitive, especially in sex-positive and consent-oriented spaces:
We like to think that consent is the main thing that the community does so well. And I argue that it isn’t.
This is not an argument against consent. It’s an argument against consider consent as sufficient.
Consent is often understood as a moment: something that is obtained, confirmed, or controlled. Communication, on the other hand, is a process. It is ongoing, contextual and relational. And when researchers examine what actually influences sexual health outcomes across studies and settings, communication repeatedly emerges as the critical factor.
Communication is already happening, we just don’t always mention it
One of Dr.’s most important observations. Wignall stems from his work studying sexual subcultures.
In many of these spaces, people don’t explicitly say the word “consent.” But when he interviews participants about how they approach sex with different partners, they describe a rich web of communicative practices:
chat beforehand
checking in during meetings
debriefing
pay attention to body language
developing safe words
informal negotiation of expectations
None of this should be labeled “consent” in a formal sense – but all of it should falls entirely under communication.
Dr.’s point Wignall is not saying consent doesn’t matter. That’s it communication is the mechanism through which consent becomes meaningful, adaptive, and protective.
Why communication has a greater impact on results
When Dr. Wignall prepared a lecture on wellbeing for an online course in Britain, he examined research across multiple contexts and populations. He asked a version of the same question asked in this interview: what actually makes the biggest difference?
Time and time again the answer was communication.
Communication affects:
Consent could open the door. Communication determines what happens inside.
The ‘Block and Forget’ culture – and why it’s a sexual health problem
Dr. Wignall gives a concrete example of men who have sex with male communities (MSM).
There’s a general, informal rule: if you meet someone and the experience isn’t good, you block them. The meeting disappears. No sequel. No conversation. No clumsiness.
From an emotional avoidance perspective, this makes sense. But from one perspective on sexual healthDr. Wignall claims it is deeply problematic.
When communication ends immediately after sex:
There is no way to discuss symptoms
no way to track possible exposure
no way to clarify timelines or risks
This became especially visible during the COVID-19 pandemic. People started sending short messages after contact – not necessarily to deepen the connection, but to keep a channel of communication open in case symptoms developed.
That shift revealed something important: communication after sex is a health intervention.
Awkward conversations are still protective conversations
Dr. Wignall notes that this shift didn’t stop with COVID. In some cases it evolved into practices such as:
wait a few months before blocking
send a short message ‘that wasn’t great, but let’s keep the contact open’
tolerating short-term discomfort for long-term health
These are not romantic gestures. These are practical, preventive measures.
Sexual health isn’t just about what happens during sex. It’s about what people can talk about after sex, especially if the experience was less than ideal.
Avoidance may feel easier, but silence comes with risks.
Communication errors in healthcare: when stigma blocks care
Dr. Wignall extends this argument to healthcare settings, where communication gaps can have serious consequences.
For example, people who engage in BDSM often anticipate the judgment of sexual health care providers. As a result, they may withhold information about consensual practices.
Dr. Wignall describes cases where:
patients suffered bruises from consensual impact play
Lack of communication led to caregivers misinterpreting injuries
individuals were reported or treated inappropriately
This is an extreme example, but it illustrates a broader problem. When communication between patients and healthcare providers fails, the quality of care suffers.
Without open dialogue:
In these contexts Communication is not soft skills. It is a clinical necessity.
Stigma silences people – and silence harms health
A recurring theme in the work of Dr. Wignall is how stigma disrupts communication.
When people expect judgment – whether it’s:
sexual practices
number of partners
relationship structure
kink or BDSM
—they are less likely to reveal relevant information. That lack of disclosure does not protect them. It increases the risk.
Good sexual health care depends on an environment in which people can speak honestly without fear of moral evaluation.
Consent versus communication: a false choice
Dr. Wignall is not advocating replacing consent with communication. He advocates expand the framework.
Consent is essential, but is static if not supported by communication.
Communication is dynamic, but needs an ethical basis.
Together they create sexual health. Individually they fall short.
What this means for sexual health professionals
For sex therapiststeachers and doctors, the insights of Dr. Wignall translate into concrete practice shifts:
Teach communication, not just consent
Consent education that does not include skills to talk before and after sex is incomplete.
Normalize conversations after sex
Checking in after sex – about pleasure, feelings or health – is not an exaggeration. It’s protective.
Reduce stigma to improve disclosure
Clients and patients talk more when they feel safe. Safety improves results.
View clumsiness as a trait, not a failure
Many necessary conversations about sexual health feel uncomfortable. That doesn’t make them wrong.
Communication as the common thread of sexual well-being
The work of Dr. Wignall reminds us that sexual health is not based on a single moment of agreement. It’s built on it ongoing dialogue– between partners, between communities and between patients and healthcare providers.
When communication is a priority:
When communication is avoided, even well-intentioned systems fail.
Summary: Communication and sexual health
Sexual health researcher Dr Liam Wignall says consent alone is not enough for healthy sexual outcomes. Research in communities and health care settings shows that communication – before, during and after sexual encounters – is the most important factor influencing well-being. Practices such as check-ins after sex, maintaining communication channels after casual encounters, and open dialogue in healthcare help reduce risk and stigma. When communication breaks down due to avoidance or judgment, sexual health outcomes worsen. Prioritizing communication in addition to consent improves safety, quality of care and sexual well-being.
Last takeaway
Consent is important. But it’s not the finish line.
Dr. Liam Wignall challenges us to look at what actually keeps people safe, connected and supported over time. Time and time again, the answer is communication: messy, persistent, and sometimes awkward communication.
Sexual health does not improve when conversations end in ‘yes’.
It improves as the conversations continue.
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