It’s not all about wheelchairs - chronic pain, neurodiversity, and mental health are all relevant too, and learning to talk with clients about what they need and how they experience pleasure is essential.
Consent is conditional by design, it requires specific circumstances and/or conditions to be maintained continuously. The introduction of money or some material good as a requisite condition does not negate this basic fact.
Vanilla sex has always turned me off. I look for something deeper. That's why I reinvented myself as fetish practitioner. You can have sex and feel absolutely nothing. That's so heteronormative for it to be 'put penis in vagina and cum'. For me, sex is erotica.