Sex, Sex Surrogates, and Disability

Recently a debate erupted in France over a proposal to use state funds to pay for sex surrogates for the disabled. News reports can be found here and here. Some advocates for the disabled applauded the move, including the French Association of the Paralyzed. However, the proposal was eventually altered and the call for the funding of sex surrogates was dropped before a vote on the proposal was held. This is a shame, for respect for the autonomy and the wellbeing of the disabled provides us with good reason to support such a proposal.

The French socialist politician Jerome Guedj put the proposal forward. As he noted, the use of sex surrogates is not uncommon. They operate in the United Kingdom, Belgium and the United States, though their legal status is often a bit unclear. The advocacy of sex surrogates was not the most novel part of Guedj’s proposal. The most interesting and the most controversial element of the proposal was that sex surrogates be included as part of the social services provided to the severely disabled. That is, the proposal called for the state to fund sex surrogates. Guedj said that he advocated the proposal in order to help the severely disabled “discover their sexuality and their bodies.”

He is right to do so. The lives of the disabled are difficult at the best of times. Severe disability hampers mobility, economic prospects and the pursuit of some of life’s most important goods, including the goods of sexual expression and sexuality intimacy. Sexuality and disability is a taboo topic. We need to think more about just what it is like to be denied the opportunity for sex and physical intimacy. Ignoring the fact that the disabled have sexual desires risks further marginalizing their interests.

It is important to be clear on precisely what a sex surrogate is and does. According to the International Professional Surrogates Association (IPSA),

IPSA’s Surrogate Partner Therapy is based on the successful methods of Masters and Johnson. In this therapy, a client, a therapist and a surrogate partner form a three-person therapeutic team. The surrogate participates with the client in structured and unstructured experiences that are designed to build client self-awareness and skills in the areas of physical and emotional intimacy. These therapeutic experiences include partner work in relaxation, effective communication, sensual and sexual touching, and social skills training. Each program is designed to increase the client’s knowledge, skills, and comfort. As the days pass, clients find themselves becoming more relaxed, more open to feelings, and more comfortable with physical and emotional intimacy. The involvement of the team therapist, a licensed and/or certified professional with an advanced degree, is a cornerstone of this therapy process. Clients often experience apprehension as they begin therapy and when they begin to experience changes. The team therapist assists the client with these and other emotional issues. Sessions with the therapist are interwoven with the surrogate partner sessions in order to facilitate understanding and change. Open, honest, consistent communication between all team members is a fundamental ingredient of successful surrogate partner therapy.

A proper sex surrogate is trained to help individuals, including the disabled, deal with sexual dysfunction and problems with sexual and physical intimacy. Their role is not simply to help individuals achieve sexual release. Their aim is to nurture a person’s sexuality and to help them gain esteem, sexual health and confidence. This may involve everything from touching to sexual intercourse.

There are two arguments that speak in favour of Guedj’s proposal.

(1) Severely disabled individuals have sexual desires. They want very much to act on them. To do so would be an expression of their sexual autonomy. Therefore, any policy that facilities the satisfaction of the sexual desires of disabled people would facilitate sexual autonomy. Therefore, Guedj’s proposal would facilitate sexual autonomy.

(2) This policy would assist severely disabled people in expressing their sexual identity and in finding pleasure and meaning in life. It would in addition help to boost their self-esteem, their body image, and their mental health. It would help them realize the considerable health benefits associated with sexual activity. These are all important ingredients or causes of happiness and wellbeing. Therefore, Guedj’s policy would help facilitate the welfare of severely disabled people.

That a policy facilitates autonomy and wellbeing speaks strongly in its favour. We must also answer objections to it. The following three objections were raised to the proposal.

(1) One worry is that permitting sex surrogates opens the door to legalizing prostitution. This argument is compelling only in so far as one thinks that prostitution is problematic. It’s certainly not clear that it is inherently wrong. It is possible that it could be practiced safely when important provisions are in place to protect the health and welfare of prostitutes and their clients. Indeed, the legalization of prostitution may be a means of minimizing harm, including harm to the disabled who might turn to escorts and prostitutes for sexual gratification.

There is, in addition, a big difference between permitting sexual surrogates for the purpose of assisting the disabled in satisfying their sexual desires and permitting prostitution. The policy permitting sex surrogates should include a provision that only certified, trained sex surrogates be employed, and that these sex surrogates work with sex therapists and patients to meet the patient’s specific needs, and that sex surrogates agree to abide by the IPSA’s code of ethics. There is no reason to think that legalizing sex surrogacy of this sort will lead to legalizing prostitution. Indeed, it might be a way of resisting the need to do so since it will minimize the need that a disabled person might have to use a prostitute or escort, as happens in some jurisdictions, including Canada and the United Kingdom

(2) Another worry is that it could leave recipients emotionally vulnerable. Of course, it is true that any form of therapy leaves a person exposed to this sort of harm. This may be a cost that many who are disabled are willing to accept for the benefit of being able to express themselves sexually and to have the taboo about their sexuality explored and dealt with openly and honestly. To act to shield the disabled from this sort of harm is to treat them paternalistically. Let them decide.

(3) A third worry is that the practice would merchandise the body. This is a weak argument. The body is already well and truly merchandised. Simply look no further than the standard fashion magazine or the pornographic offerings of the Internet. Of course, there is no reason to think that we should further this process. But if sexual surrogates offer their services freely and with a genuine interest in helping the disabled, there is little reason to think that the practice of funding sexual surrogates is more likely to lead to the body being merchandized than other forms of accepted employment.

Guedj’s policy is a progressive alternative to the status quo. It or something like it is the way forward. To ignore the issue of disability and sexuality is to be complicit in condemning severely disabled people to a life without sexuality, without the ability to satisfy healthy sexual desires. It may force them to seek out more dangerous alternatives on the black sexual market, e.g., escorts and prostitutes.