Been playing a healslut run with a modlist built around Devious Followers Continued.

Generally, the idea is to play support for a follower who does all the actual fighting while I deal with all the “boring” stuff like looting, gear upgrades, selling stuff, getting leads for bounties, setting up camp. In combat I'm a healstick cowering behind my follower buffing his health while he goes on the attack with a melee weapon. I've played almost 150 hours over four playthroughs, and there have consistently been two frustrating issues that keep cropping up:

Firstly, the sex-upon-defeat system. In theory, I'd like a setup where I can be raped while my tank is preoccupied with other enemies; maybe he comes back in time to split open the skull of my would-be rapist, maybe he doesn't get back until the deed's been done. The idea being to add an element of vulnerability and peril to fights, but not fatal peril, because I want to play through my mistakes instead of getting a scot-free redo.

In practice what I've seen happen is that I get attacked, which (I think) puts the attackers into a non-hostile faction, then the follower AI goes "cool, no more hostiles, coast is clear" and proceeds to stand around while I get assaulted. D'oh. Or, I manage to struggle and throw my attacker off, in which case everyone just kinda sheepishly shrugs and ignores one another for a bit, which is also immersion-breaking.

I haven't tried a SexLab game that is solo (I got into SexLab modding explicitly to play healslut with a Devious Follower), but I strongly suspect these defeat sex mechanics just don't work that well with a follower, and especially not with a Devious Follower. I'm sure there's a combination of mods and settings somewhere in the labyrinth that works, but if there is I haven't found it. As a result I've been slowing paring back on my use of this system - at this point I use Death Alternative and nothing else. I miss the threat of rape on failure, but it is more functional.

The second big issue is more one with base Skyrim itself rather than any mod: followers are terrible. The game is very clearly designed around having a combat-competent player character, and to be fair, when you're cleaving through masses of bandits yourself your incompetent follower isn't really a glaring issue.  They help a little, but you deal the majority of the DPS. I don't think I noticed this when I first played through Skyrim. But of course as a passive healslut, you need your follower to be the killing machine that is usually the player. There are a couple of related problems as I've noticed that makes this hard:

• follower AI is just bad. Give them a bow and they will prefer to plink away at the enemy with the bow, even if (a) the enemy is getting close and winding up a melee power attack and (b) there are multiple archers. They also don't seem to have any situational awareness - I've often seen them completely ignore charging enemies at the start of combat, only responding when the enemy gets a hit in. Finally, the AI also has trouble with obstacles like tables, chairs and occasionally stairs. Interior tiles like the "bandit fort" one seem to cause the most problems.
• followers don't scale well. I'm not even talking about how they tend to level slower, though this also appears to be true. Even if you use a mod to make them level together with you, the game's enemy scaling assumes you're going to fight smarter and better when you're leveled up, so it throws tougher and more dangerous enemies against you. So take the snow troll on the way up to High Hrothgar at around lvl 12 for instance. As a player what I would do against this tough enemy is to get quick hits in then retreat out of melee range, especially when the troll telegraphs its attacks; maybe kite it a little as I drink potions or fire off a spell. It's I think what the game expects you to do. The follower of course does none of that, even with a follower framework that ostensibly improves the AI. He goes right up in the troll's face and proceeds to just facetank it and exchange blows, with the predictable outcome that he gets pounded down into the ground in record time.

The result is that the follower becomes more and more useless and prone to going down in a couple of hits as the game goes on, which puts a big dent in the fantasy, which, to me at least, requires a powerful dom full of unstoppable brute strength and killing power. Otherwise what is left is the squalid reality of a small man gaslighting and emotionally abusing a partner. Which is probably more realistic as far as how real-world versions of DF relationships go, but... that's not a fun fantasy.

I have been exploring partial solutions, a follower framework mainly. Been tinkering with the settings in Nether's Follower Framework, and I think I've found a setting that works okay. Regular legendary difficulty (x3 damage output for everyone but the player) and an additional x5 follower-specific damage output. It's unclear to me if that means the follower is putting out five times normal damage, or fifteen, but hey, it works, at least.