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Spotlight on Sex Surrogacy

July 27th, 2007

Dr Petra

In this month’s UK edition of Cosmopolitan there’s a fascinating article on sex surrogacy by Julia Buckley. In the piece two sex surrogates are interviewed – a female sex surrogate who works with male clients, and a male surrogate who works with female clients. Both surrogates in the Cosmo feature deal with clients who want to improve their sexual abilities or to have sexual experiences. They detail how they work with clients, what they think their surrogacy offers, and how they keep a split between their work and home life.

Sex surrogacy is an interesting and controversial area. For some, sex surrogacy is seen as a legitimate form of therapy or care. Supporters claim that it is a means of helping people learn more about their body, improve sexual techniques, reduces sexual problems, and is an opportunity for those with disabilities or serious physical or mental health problems to enjoy pleasurable sexual experiences. Detractors argue that it’s just another word for prostitution (which they view negatively) and is not an ethical or professional form of giving therapy or education about the body.

I find the issue of how ‘hands on’ we are within sex therapy and research a really important area that needs discussion and debate. For any other area of therapy or research it is possible to teach or coach clients, or to observe them engaging in activities they wish to improve or are having problems with. Yet when it comes to sex we’re growing increasingly ‘hands off’. Sex research, while it can – and should – be about observing people have sex and measuring their responses, is much more likely to be conducted in much more distanced ways using surveys or interviews. There are a variety of methods we can use to study sex, but we tend to use ones that require self report, rather than observing actual behaviour.

Of course there’s a good reason to offer a variety of methods to study sex. Many who’d want to be observed having sex or who’d want to show their body to a researcher probably won’t be representative of the general population so we’d have to be cautious in how we used any data from such research. And offering questionnaires or interviews online or over the phone could allow for those who’re more shy or who’re talking about very sensitive topics to share their stories.

The same issue affects sex therapy where it’s much more common for those with problems to be referred homework they do outside of the therapist’s view, and to read books and report back on their experiences rather than have sex under the watchful eye of a professional or be guided by a therapist/surrogate who has sex with clients.

There are some valid reasons why this climate exists. Sadly there has been a high level of widespread sexual abuse amongst therapists to clients (particularly male therapists abusing women). Plus sex therapists and researchers working in a primarily sex negative cultural climate wish to appear professional and respectable and so distance themselves from the sexually charged elements of their work.

However, there’s a growing group of people offering sex surrogacy and this needs to be examined. Some who offer surrogacy are clearly well intentioned and caring people who’ve clearly thought carefully about the support or treatment they’ll be offering their clients. Some are driven by spiritual or political agendas. Some will work with clients with disabilities or health problems, while others specialise in clients who just want to learn better sexual skills. Some have undergone training from a surrogacy organisation, some have created their own brand of surrogacy.

Different approaches guide their work, but most seem to offer a mix of confidence building, massage, meditation, breathing techniques, as well as touching and sexual contact. Most sex surrogates do not see themselves as prostitutes (although they do charge for their services) but align themselves more closely with sex therapists. Some do define themselves as prostitutes but see their role as a sex worker as one that is nurturing and therapeutic. Some see their private and working lives as intertwined, others see the sex they have with clients and sex they have with partners as entirely separate and enforce a strict home/work split.

I’m all in favour of offering sex surrogacy as a valid option to help people improve their sexual lives. Where I have concerns is around issues of efficacy and regulation. I have met people who call themselve sex surrogates who I think are inspiring and who have a lot to teach the wider sexological community. But I have also met surrogates who I feel are not skilled, qualified or caring, who charge money for services that seem to have no therapeutic value, and who claim qualifications they do not have.

For instance, a few years ago I met a couple who offer hands on sex therapy. They teach masturbation, sexual practices and also masturbate clients to show them how to orgasm. Which is fine. Except they were charging a great deal of money for the service and had clients who obviously needed referrals to medical or psychological support who they were not referring. Instead they were recommending their own aromatherapy products and suggesting that doctors wouldn’t be much help. When I asked what qualifications they had they told me one had no qualifications, the other had been on a course in Indian head massage.

There are obvious tensions between sex therapists, psychologists, medics and researchers with sex surrogates. The former group are keen on regulation, standards and measuring performance. Surrogates, particularly those working from political or spiritual perspectives, do not always like the concept of measurement or regulation. And they dislike the snobbery and heirarchies of the therapeutic/medical professions.

Medics and therapists are seeing clients who’ve been to surrogates and had negative experiences, and surrogates are seeing clients who’ve been profoundly let down by the medical or therapeutic community.

Way back in the 1970s there were calls for a wider debate on how we proceed with the issue of surrogacy, with suggestions that surrogacy could be a valid form of treatment – but it needed careful training, support and regulation in order to protect both clients and professionals. We’ve still not had this discussion properly. Leonore Tiefer has recently revisited aspects of this debate in her paper “Sex therapy as a humanistic exercise” in the journal Sexual and Relationship Therapy (copies can be ordered from the journal if you’re interested in the wider paper). It’s great that magazines like Cosmo are raising the issue of surrogacy. Let’s hope the wider sexological and surrogacy communities feel able to further this debate.

If you are considering seeing a sex surrogate it’s worth co sidering the following…

- Do you have a problem with your mental or physical health (including a potential sexually transmitted infection or sexual problem). If so you should consult with your GP first.
- Is your relationship in trouble? If you are having problems with your partner then it may be better to see a relationship therapist.
- Have you got a sexual problem (for example caused by previous abuse, a view that sex is bad or dirty, or another issue that’s getting in the way of enjoying sex). If so, you may want to see a sex therapist. You can get psychosexual therapy on the NHS (although there can be a waiting list) ask your GP for a referral. Alternatively you can refer yourself to a therapist privately.
- Is sex uncomfortable or painful? If so, speak to a doctor.

There’s no reason why you shouldn’t see a sex surrogate, but if you have any of the above problems they should not be your first port of call – and you should let your doctor or therapist know if you are also seeing a sex surrogate.

Sex surrogates should be avoided if….

- They do not practice safer sex (use condoms or dental dams)
- They make you feel uncomfortable or embarrassed
- They do not listen to your needs, fears or desires
- They discourage you from speaking to your doctor or another therapist
- You feel pressured into sexual activities you do not enjoy
- They move at a pace that is too fast for you, or make you feel you’re there to please them
- They advocate any alternative therapies that are not supported by your doctor
- You are taking any medication or seeing a therapist and they suggest you stop treatment
- They cannot tell you what ideas or philosophies underpin the work they do
- They seem to be charging more than a regular private therapist would
- There seems to be a lot of hidden charges and you have to pay for many ‘extras’ (e.g. lubricant or sex toys)
- You have a disability and they make you feel uncomfortable or ashamed as a result, or if they try things with you that your disability does not allow.

Remember you do not have to keep on seeing a surrogate, and you can leave if they do not make you feel comfortable.

The organisation ICASA and the International Professional Surrogates Association offer sex surrogacy and may be worth contacting if you are interested in this area either as a therapist or medic interested in referring patients/clients, a sex surrogate, or as a potential client. However it is worth noting ICASA has a mixed reputation among professionals and clients and not everyone is keen on their ideologies and approaches. Again, there is a problem of approaches and outcomes being independently for this organisation, which reminds us of the need for evaluating and monitoring surrogacy. If you are disabled and would like more information on surrogacy there’s stacks of useful links at TLC Trust. You can read one person’s account of seeing a surrogate here.

I’m still in favour of using surrogacy within our sex therapy and education – and for a more hands on approach to the study of sex and treatment of sexual problems. But I do still feel there’s a lot of ethical, legal and professional problems to be ironed out – and it’s time we made a greater effort to do this.

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