Yes it is real. Marriage is not an excuse to pressure anyone into anything. Your rights to your body do not vanish after you've signed a piece of paper committing to a relationship with another person. And one would think that a spouse would be the one person to understand and stick by your feelings. Sex should not be the foundation of a relationship.
Violence full stop is abuse. And abuse is abuse. Not saying no because you are medicated and can't say no is not consent. Not saying no because you are afraid to is not consent. Someone engaging sexual acts with someone who has not consented is abuse.

I know it is real because my uncle did it to my auntie, hence the reason my youngest cousin was born.