Intimacy in an Iron Lung

The developing status of sexual surrogates for the disabled, as part of a right to health and well-being: So wrong?
(The Sessions/Fox)

"As my father lay dying and his private nurses washed him, made him comfortable and gave him his medication, they also lingered gently over his private parts as they sponged him. These were mountain girls from the state of North Carolina to whom death and sex were integral with life."

So comments Google+ user Ray Chatham in the discussion surrounding a short documentary released last week from The New York Times' Stefania Rousselle. Rousselle investigated the state of sexual surrogacy for disabled people in France, where it is contentiously illegal. 

Equating love and sexual attraction may actually be problematic for the person whose body is paralyzed, atrophying, but who is no less loved.

Surrogacy involves paying a professional who engages in intimate contact (broadly defined, though certainly not always intercourse) with a patient. It technically began in the early 1970s, and is maybe best known as something done to help people with extreme anxiety about sex to gradually work past it. 

In a different sense, it's also used for patients with serious physical disabilities -- and, maybe even thornier, mental disabilities like dementia. You might remember the 2012 film The Sessions, for which Helen Hunt got an Oscar nomination playing a surrogate who worked with a poet paralyzed by polio. The story was based on the real experiences of Mark O'Brien, who by the end lived in an iron lung for all but a few hours per week, and ultimately lost his virginity to a surrogate.

In March, the French National Ethics Committee decided that sexual surrogacy was an "unethical use of the human body for commercial purposes." Committee member Anne-Marie Dickelé justified it to Rousselle: "The sexuality of the disabled cannot be considered a right."

But some French people like Laetitia Rebord, who is confined to a wheelchair due to spinal muscular atrophy, are campaigning passionately against the committee's decision. She's 31, a virgin, and wants to have sex -- "In her sexual fantasies, she is a fit and impetuous blonde who dominates her male partners." As she told Rousselle, "Eventually, one has to address the issue and understand why we are demanding this. I can't move. I can't masturbate."

The International Professional Surrogates Association notes that in most countries, including the United States, sexual surrogacy is simply undefined by law. It remains unregulated -- unless someone wants to allege prostitution, which could potentially become slippery, though it has not yet been successfully legally challenged as such in the U.S. 

North Carolina-based sex therapist Dona Caine Francis says the distinction is that prostitution is about instant gratification, where surrogate therapy involves "months or many sessions in coming as you get to know each other and develop both this deeply personal and deeply therapeutic relationship first."

That's the way surrogacy is portrayed in the 1986 documentary (on Netflix) Private Practices. Director Kirby Dick follows surrogate Maureen Sullivan through encounters with real clients -- men with issues like anxiety and premature ejaculation -- throughout the course of their work together.  Sullivan meets with them regularly, at first only to talk, and then gradually escalating physical contact. Their relationships are clearly limited, finite, and tailored to address specific issues.

Sexual surrogacy for people with physically debilitating conditions invites a different discussion, probably because social anxiety is less outwardly appreciable as a barrier to a healthy sex life than, say, quadriplegia. The ends are also different: Sometime surrogates are working temporarily with clients to pepare them real-life sexual relationships; in these cases, they're standing in for them indefinitely. 

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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