Discover the Legal World of Sexual Surrogacy for the Disabled

In a gripping and honest article that ran in a 1990 issue of the Sun magazine, late poet and journalist Mark O'Brien wrote about the challenges of attaining intimacy as a disabled man. Paralyzed by polio from the neck down, O'Brien composed the piece from the inside of an iron lung, striking the keys of his computer with a mouthstick clenched between his teeth.

"As a man in my 30s, I still felt embarrassed by my sexuality," the Boston-born writer wrote. "I wanted to be held, caressed and valued. But my self-hatred and fear were too intense. I doubted I deserved to be loved. My frustrated sexual feelings seemed to be just another curse inflicted upon me by a cruel God."

O'Brien, who lived in an iron long for all but a few hours a week, eventually lost his virginity at age 36 to a sexual surrogate named Cheryl Cohen Greene. His surrogacy experience inspired the 2012 movie "The Sessions" with John Hawkes and Helen Hunt, and, according to O'Brien, paved the way for his future romantic relationship with writer Susan Fernbach.

Stories like O'Brien's are all too common among people with disabilities, according to Kirsty Liddiard, Ph.D., a senior research fellow at the School of Education and iHuman institute at the University of Sheffield in the United Kingdom. While researching her book, "The Intimate Lives of Disabled People," Liddiard spoke with several men with disabilities who had paid for sex.

"People with disabilities are assumed to be devoid of sexual abilities and desires," Liddiard said. "Using a sex surrogate is one of the creative ways that people with disabilities access their sexuality in a world where it is habitually denied."

Sexual surrogacy—sometimes called surrogate partner therapy—is a therapeutic relationship where a surrogate is paid for sexual activity with the goal of improving a client's issues around sex and intimacy. Based on the client's experience levels, abilities and goals, surrogacy can involve anything from sex education and safer sex assistance to intimate touch and stimulation.

Sessions are led by professional sex surrogates and coaches, such as Joslyn Nerdahl, a certified sex coach and clinical sexologist based in Vancouver, British Columbia. Formerly a traditional sex worker, Nerdahl has worked as a sex and intimacy coach at Sensual Solutions, a sensual touch and erotic coaching service provider, for more than six years.

According to Nerdahl, sexual surrogate therapy looks different from client to client.

"It depends on how much mobility they have. It depends on experience," she said.

"Someone who was sexually active before a spinal cord injury versus someone who was born with a disability and who's been in a chair their whole life, that's really going to change what they're looking for," she added.

Before beginning therapy, clients fill out an extensive intake form and go through a thorough vetting process to learn more about their disability, mobility, dexterity, sensation ability and any special requests.

"It's very client-led," Nerdahl said. "I basically ask them what their goals are. And if you could tell me what your ideal session looks like, what would that be?"

An ideal session could be anything from trying a toy to learning about the female body, because the client may not have ever seen a naked woman in person before, so they may want to ask questions and learn about anatomy.

"Sometimes they have specific requests like they want their earlobes massaged," she added.

With couples, Nerdahl might help them get into sexual positions they're not able to get into on their own. She might also help them with safer sex practices, such as how to put on a condom.

A frequent practice she employs with her disabled and nondisabled clients is called "body mapping."

"It's a great exercise for everyone," Nerdahl explained. "It basically involves systematically going through different areas of the body that are not genitals or typical, generalized hot-button zones. You try different forms of touch and record the results, which can be really surprising at times. Some areas of the body that we don't necessarily consider sexual can often become much more sensitive when typical areas aren't functioning as they once did. So earlobes or hands or knees or hips—these areas that often get overlooked can become new erogenous zones."

A longtime sex and human rights advocate, Nerdahl believes sex and intimate touch are not a luxury. Rather, they're a basic human right.

"Sex is a natural part of being human," Nerdahl said. "We were designed to experience pleasure and connection together."

She pointed out how newborn babies can die if they are not held or if they're cut off from physical touch.

"Why would we think this wouldn't hold true for us as we grow older?" she asked. "Sex has so many health benefits. Orgasms can increase your immune system, lubricate your joints, relieve stress, help with insomnia—the list goes on."

Nerdahl believes intimate touch is especially important for people with disabilities.

"They get touched so often by care aides and doctors and family and folks who are taking care of them. But rarely is it intimate or erotic in nature," she explained.

"I've also had clients that confide in me that they're a little confused about their gender identity or sexual orientation, but they haven't had the opportunity to really explore that in a way we might do, like at a party or college when you have your wild phase," she added. "They don't have access to those things and it can be really isolating."

In most U.S. states and Canada, it is illegal to purchase sex. But since sexual surrogacy isn't necessarily synonymous with paying for sex, sex surrogate therapy falls into a legal gray area in both countries. Nerdahl noted that Canada operates under the Nordic model, where laws criminalize the buyers and not sellers of sexual services.

"So, technically, the clients that we're providing service for would be considered a criminal," she noted.

Nerdahl is a staunch advocate for the decriminalization of sex surrogacy and sex work in general.

"This is a health and wellness issue, it's a social service issue—it's not a criminal problem," she said. "If everyone is of legal age and everyone is a consenting adult, it's a human right and there should be no legal issue."

Liddiard, too, supports the decriminalization of sex work but cautioned that paid-for sexual encounters are problematically entrenched in conventions of gender, heteronormativity and heterosexuality. Reflecting on the disabled people she interviewed about their sex lives, Liddiard noted that commercial sex is designed in a way to accommodate men's sexual needs, and disabled women are often left out of the discussion completely.

"Ultimately, providing greater access to sexual surrogacy services to disabled people is only a 'Band-Aid' solution," Liddiard said. "The goal must be to build an inclusive sexual culture that views people with disabilities as dateable, lovable and viable sexual partners."

"Sex has so many health benefits. Orgasms can increase your immune system, lubricate your joints, relieve stress, help with insomnia—the list goes on."

Nerdahl believes intimate touch is especially important for people with disabilities.

"They get touched so often by care aides and doctors and family and folks who are taking care of them. But rarely is it intimate or erotic in nature," she explained.

"I've also had clients that confide in me that they're a little confused about their gender identity or sexual orientation, but they haven't had the opportunity to really explore that in a way we might do, like at a party or college when you have your wild phase," she added. "They don't have access to those things and it can be really isolating."