PAs, Residential Staff & Health Professionals
Over the past years, health professionals have been discussing the place for sex work with disabled people. In 2007, a day was devoted to the topic at SHADA, the Sexual Health and Disability Alliance.The following passage comes from one of the founder members of SHADA, Lorna Couldrick, who is a Senior Lecturer at the School of Health Professions, University of Brighton.
"SHADA has been working constructively to address the sexual disenfranchisement of disabled people whereby their sexual needs are often unrecognised or disregarded. Much can be done to change the terrible ignorance, and damage that it does, by raising awareness particularly of: the general public; policy makers; disability professionals in health social care and education; sexual health professionals; professional bodies etc. However for a few disabled people surrogate sexual partners are a valuable resource, either as a stepping stone to achieving confidence is establishing other intimate relationships or as a way of achieving sexual pleasure.
In my research I met a man who described very graphically the problem of severe disability following a traumatic accident at the age of 16. He was sexually inexperienced. He went through a long period of rehabilitation and attended a specialist college for disabled people. Sex was never discussed, neither in health or in education. By the time he went to university he was coping well both academically and socially. However he could never dare to take his socialising onto intimacy. How do you invite a girl back to your bed when she (or someone) would have to undress him, hoist him into bed, remove his convene etc..
Several respondents in my study had similar stories. How do you learn to manage severe functional problems? Many young people may be apprehensive about their first sexual encounters but it is infinitely harder for disabled people. They have virtually no role models, disability specific literature or media representations to guide them.
Several respondents wanted safe, un-sleazy places to rehearse what they could and couldn't do sexually. Several cited the sexual surrogacy service in The Netherlands. A couple of people had tried it. One described it as a turning point, making such a fundamental difference to his self identity and confidence. In the absence of any other health / state provision sex workers are a potentially invaluable resource.
For some disabled people it is forming and maintaining relationships that is problematic. This is so in the non-disabled population too. However the non-disabled person does have access to another outlet, masturbation that may not be available to the disabled person. For these reasons I see the option to engage a sex worker (working of his or her own free will and not being coerced) as an essential human right for disabled people.
At SHADA we have been considering the use of sex workers (prostitutes) and have involved both lawyers and sex workers in this work. For me the problem is not paying for sex but ensuring the sex worker is protected. SHADA has been working to consider how the disabled person (or his or her agent) can ensure the sex worker has made an informed and voluntary decision to engage in this work and that neither the sex worker or the disabled person is exploited. "
Guidelines for dealing with clients who want/need sex workers
When a disabled person expresses sexual needs, the first thing to sort out is what they really want – sex in a relationship, paid sex, or both (perhaps at different stages of their sexual journey). We see both as valid choices.
TLC hopes to help reduce the stigma surrounding sex workers and initiate a move towards sex work being integrated into all other health care.
TLC is well aware of the sensitive nature of dealing with disabled clients who want to use the services of sex workers. You may be juggling between the needs of the client, the views of their family, your own feelings, and the moral indignation of your colleagues, your boss and the Board of Governors. Here are some guidelines to help you
1) The buying and selling of sex is not illegal in the UK. A huge number of perfectly respectable people hire sex workers and most sex workers themselves are highly professional, not the "victims" commonly portrayed in the media.
2) Calling up on behalf of a client is not illegal. If you feel uneasy or at risk making the phone call, TLC has an advocate who is happy to do so. He is a confident, kind-hearted disabled man called Greg whose telephone number is 020 8459 5002 . Best request that the sex worker dresses like your client's aunty, to avoid gossip and other residents guessing what is happening. Not that we feel this is shameful, but people appreciate being given privacy.
3) You don't need to worry about your client - they will be in safe hands. There is no need to prepare your client by undressing them - just so long as they are clean and the money is ready in an envelope! If the policy of your establishment is that you cannot leave your client alone with someone who has no CRB, (criminal records bureau) check, then you will have to make an application for a check on the selected sex worker (if he or she agrees). It is virtually impossible for the sex worker to apply for their own check, because they are self-employed.
4) What to do if others try to stop this arrangement Remind them that disabled people have rights to a personal life and privacy. If the reason given is that they fear a public scandal, remind them that there is much more likely to be a public scandal if they prevent the disabled person from having a sexlife, than if they ban it. Let us know and we will ensure that any banning is exposed. Another way forward is to hire an advocate for the disabled person, to make a formal complaint.
5) A wide range of services are available - same sex and heterosexual, escorting socially, striptease, kissing and cuddling, erotic massage, sexual coaching and teaching, tantric sex, full sexual service including vaginal or anal intercourse (using safer sex), girlfriend or boyfriend experience, domination and a whole range of bondage, discipline and sado-masochsim, fetish play, such as foot adoration, transvestite cross-dressing, etc. Many sex workers offer a wide range of services, and most have limits, which they express clearly. You might want to discuss all the available options with your client, to ensure he or she gets value for money, and an appropriate appointment is booked.
6) If there are no sex workers on this site in your area, you can find a sex worker by calling numbers advertised in your local paper, listed under "escort", "massage", "personal services" or "sauna", or looking on a local escort website, which you can find easily enough through google.
7) Call a few numbers to find the most competent and friendly sex worker who suits your client's needs. You will be able to tell the best, just by talking to them.
A friend told us this story. He called a massage parlour offering "extras" and explained to the receptionist that he wanted to discuss whether they did X or Y. She said she would ask and came back to him after a minute, saying, no, they did not do X or Y. He realised he would not be safe at this parlour, and this is a good example of how easy it can be to tell what sort of standards they work to.
8) You need no secret codes or specialist knowledge. We are sometimes asked what kind of questions are best asked when selecting a sex worker with the view to booking an appointment. Here are some examples:-
FIRST QUESTION (Breaking the ice and introducing disability)
"I am phoning to book an appointment for a young disabled man who cannot use the phone. Do you take disabled clients?
"I have a disabled client who cannot speak on the phone. He needs mild domination. Can you tell me if this is part of your service and what your charges are?
"I have a disabled client who is a virgin and wants someone to give her a good first experience. Is this something you have any experience of?
SECOND QUESTION (practicalities)
"My client will not be able to travel to visit you. Can you come here-one lunchtime? He lives two miles outside the city at.... and how much extra would that cost?
"My client uses an electric wheelchair. Is your flat totally accessible including the bathroom?
"My client cannot undress herself and uses a catheter. Can I accompany her to get her set up ready for sex? Or, Can I be present during your visit.
THIRD QUESTION (specifying sexual needs and getting prices)
"What are your limits?
"My client wants a warm experience with kissing and cuddling.
"How much for this with penetrative sex for one hour?
"My client wants a girlfriend experience, going out with you for the afternoon, ending in intercourse back in his bedroom, with a bit of spanking by yourself. How much would that cost?
"My client is into enema sex. Can you do this, if so how much? Or can you recommend a specialist locally?
7) Setting off Ensure that your client does not attend the session with a cold or other infection, and is well washed and groomed. If they have a learning disability, ensure they totally understand the nature of this transaction. They should take along enough money for the fee and a tip, but not carry lots of surplus cash.
PAs
PAs are usually shown a job description when they apply for a job. This may include specific personal requirements, such as not interfering or being judgmental about the disabled person's lifestyle, and specific personal needs, such as placing the person's body in position for masturbation or sex, or arranging sex workers. It is essential for a happy working relationship that both parties agree on the jobs listed, and boundaries are clear and adhered to. Sexual services should not be included in the list of duties: for this the client should be referred to sex workers.
Residential Staff
Residential staff are seldom in agreement on sexual matters but it is healthy to hold open discussions, to let everyone voice their opinion, and then agree that issues around sexuality should be handled only by those members of staff who feel comfortable doing so. Sexual happiness may be very important to some residents, but they may not dare to express their desires, unless asked. It should be the duty of at least one member of staff to ask.
Technical advice and support can be obtained on the Sex and Disability Helpline on 0707 499 3527. The member of staff may be obliged to run specific requirements past their boss and even the board of the Home, in order to proceed. Discretion is preferable, so that any sexual activity is not rubbed in the noses of those who feel uncomfortable about it, especially other residents, who might gossip.
Magazines, sexual instruction books, porn and sex toys can be purchased by mail order, and will arrive in plain wrapping. They should not be opened by anyone except the resident or their confidante.
If a sex worker is going to visit a resident, he or she will dress demurely on arrival so that others will need not know the purpose of her visit. It should be timed so that the sex worker can enter un-noticed, for example when everyone else is eating or watching their favourite TV programme.
Since 2001, Denmark’s social service guidelines on disability have stipulated that care staff in institutions must be prepared to help disabled people obtain sex. That includes accompanying them to a prostitute.
Arranging sex is part of the job for staff at the Hulegaarden residential home for mental disability near Copenhagen. Its director, Lars Nielsen, said: ‘We have many hours of discussion, in groups, before actually doing so. It is clear that there is no human being who is not also a sexual being. If we do not allow disabled people to have the experience of sex, we cannot expect them to build up their lives.
‘The social workers who accompany people to prostitutes receive their salary from Hulegaarden. In that respect, you can argue that Danish society is already paying for the practice.’
Other Health Professionals
Frequently, occupational therapists, social workers and other health professionals try to ignore the sexual needs of their clients, until forced to take notice once inappropriate behaviour or other disasters occur.
We feel that sex should be discussed just like any other human need. If in doubt, ask your client to call the Sex and Disability Helpline on 0707 499 3527.
As you are reading this website, we presume that you are planning to take interest in your clients' sexual health and happiness. You may be feeling ill prepared to help them because sexuality was not included in your training. Outsiders is planning training courses to meet this gap. See www.outsiders.org.uk. Until this training begins, studying the Outsiders website will prepare a long way towards doing this work. Mostly you will be offering encouragement, reassurance, and using your common sense.
Don't tell clients what to do, but ask them what is troubling them and discuss the options. When you consider the healing power of touch alone, sex workers can provide an invaluable service to people recovering from strokes and accidents, old people, those with progressive disabilities, and lonely people in general.
Sometimes, health professionals come across clients who are seriously sexually frustrated and lonely, with no funds to pay a sex worker and no opportunities to form relationships. The only thing we can do to help them is to sit and listen with empathy. Rarely do we receive bursary funds to rescue them.