The article discusses several recent novels that tackle sexual violence and sexual health. One striking example is Lucy Monroe's Blackmailed into Marriage:
Its entire plot revolved around vaginismus, a condition that causes vaginal muscles to involuntarily contract shut.... The book is laden not only with explicit depictions of a wide variety of sex acts, but also jaw-dropping clinical-yet-romantic descriptions of the couple engaging in the most common treatment for vaginismus: the insertion of a series of dilators.I realize it's a painful medical condition, but surely everyone who reads the article thinks... A Harlequin with dildos?! That certainly seems to be the magazine's take.
I wasn't impressed by the one Lucy Monroe novel I tried, but I am impressed that she's apparently managed to write about something horrendously intimate in a matter-of-fact way, and get it published widely. (See Monroe's website for an interesting contrast between the banal fairytale described by the book's cover copy and the public health statement farther down the page.) She has also written about endometriosis and about impotence in a wheelchair-bound man.
Taboo topics
The argument is sometimes made that romance fiction is inherently feminist. I’m not convinced that romance is inherently feminist, though many individual novels have feminist themes1. One could argue that the genre’s focus on relationships inherently facilitates discussion of sexual health. That has only recently become true as romances become more explicit--and it's by no means true for all of romance’s subgenres. However, I do find it significant that romance is the one fiction genre in which these issues are aired to a broad audience.(General health is a subject found in all genres2. Sexual violence crops up regularly in other genres, but I think the focus on the path to recovery is primarily found in romance and nonfiction.)
What's clear is that romances broach subjects that are taboo in other genres. Whether this is feminist depends on whether the taboos are differentially applied to subjects relevant to women, and on how these woman-oriented themes are written and received. Regardless, it's a good thing that these stories can be written and widely disseminated and discussed.
The flip side: They're short
1. "The brevity of the books can force quick solutions", e.g. the vaginismus sufferer who was cured in a single night.
Macleans focused entirely on short-form Harlequin Presents novels (generally less than 200 pages). In erotic romance, you find still more of these themes. For example, Robin Schone’s Scandalous Lovers (450 p.) involves post-menopausal sex; Megan Hart's Broken (380 p.) explicitly describes masturbation and quadriplegic sex.
Unconvincing happy endings can happen in longer novels too (cf. Broken). But I agree, the short format can constrain the plot's development (apart from the sturm und drang)... and sometimes leads to curing systemic illnesses overnight.
Conundrums
Macleans talked about issues to do with format. I think some of the thornier issues are more qualitative.• Even given an important topic, not all portrayals are equal. Illness, violence, pain, and shame can all too easily be trivialized and commodified into simply a means to ratchet up the emotional intensity of the read.
• Romance novels spread both good information and misinformation. For example, Kalen Hughes has debunked several myths about the hymen. Given how often the hymen is mentioned in the romance genre, it's astonishing how frequently it's accompanied by inaccurate physiology and counterfactual emotional and moral interpretations.
• Many romance novels use sexual health as a metaphor for character. Having a sexually transmitted infection can indicate bad character. A powerful, attractive man is often depicted as potent almost to the point of priapism. Many novels portray the heroine's virginity or ignorance of orgasm as emblematic of good character and femininity; some explain her virginity by invoking abuse or ill health. While I think it's almost always done unintentionally, this pattern can implicitly equate victimhood or frailty with feminine desirability, or sexual repression with good character.
Even though all of the above can (and has) gone wrong at times, it's great that romances from Harlequins to erotic romances are, in their own ways, expanding the boundaries of what's written. And ultimately I think it says something important about readers:
"I think that women who do read our books know damn well that they're going to get something that could be light but could have some meat to it," Marton says. "They are not just perfectly happy getting that -- they're interested in getting that."Yes, Virginia, the romance novel is nearly as varied as its readership.
1 From Laura Vivanco's examination of Harlequin/Mills & Boon novels:
while I found many romances which could be considered feminist, and while the authors I corresponded with identified as feminists, there were a few novels which were anti-feminist in tone and yet others where feminist issues simply didn't arise in the course of the story.2 In romance, several sites list novels involving major health issues. Laura Vivanco enumerates a number of ways in which love and physical health are intertwined in romance narratives; physical health may reflect the health of a relationship (from weight loss and pallor through literal heart failure).
. Corum’s penile peculiarities fit right in with the 
