Disabled Sex Behind Paywall: The Sexual Politics and Pleasure Ecosystem for People with Disabilities

1. Introduction

An estimate of 15% of the global population live with some form of disability, making up the world’s largest minority (World Health Organization). Since the 60s, the international disability rights movement has advocated for integrating people with disabilities in the public domains, campaigning for equitable access to independent living, employment, education, housing, transportation, and healthcare. Specifically, a social model of disability began to emerge in the 70s, framing disability as consequences of disabling socio-economic constructs and inaccessible infrastructures, instead of results of medical tragedy or body impairments. Based on the social model, disability is understood as discrimination and exclusion perpetuated by the ableist public policies, inaccessible architecture and transportation design, the abusive practices of employers, medical authorities, and non-disabled peers (Shakespeare, 2000). Since the dawn of the disability rights movement, progress has been made in locating more equitable resources for disabled people in the public spheres. Yet unsurprisingly, their sexual rights and agency in the intimate realms remain overlooked in media, policies, and academic discourses.

In response to the lag in disabled sexual rights, critical disability studies scholar Abby Wilkerson identifies sexual agency as core to the liberation struggles of all marginalized groups, rather than an afterthought once “more basic” goals are achieved. Wilkerson argues that sexual agency not only entails one’s “capacity to choose, engage in, or refuse sex acts”, but is also integral to how others “recognize and respect one’s identity” (Wilkerson, 2002). Similarly, British sociologist Jeffrey Weeks coined the phrase “sexual citizenship” to indicate one’s sense of belonging associated with social acceptance of their sexuality. Therefore, the social marginalization of disabled sexuality contributes to the sexual frustration, lower sexual-esteem and self-acceptance for disabled individuals.

To understand the contemporary services and programs designed to restore the sexual citizenship of disabled population, this paper reviews the commercial sex service provided for people with disabilities. Specifically, the paper analyzes these services’ legal, medical, and ethical complications due to their nuanced position at the intersection of rehabilitative service and sex work. Inspired by the social model of disability, this paper recognizes the immediate impacts of disabilities and chronic illnesses on bodies but rejects impairments as the inevitable determining factors of disabling experiences. It thus contextualizes the oppression of disabled sexuality in the socio-political barriers stemming from a history of eugenics, stigmatization, and discrimination. By zooming in on commercial sex services, a care labor deeply tabooed due to its association with condemned hypersexuality and unnatural perversion, this paper aims to understand how these services introduce progresses and challenges to destigmatizing disabled sexuality.

2. Disabled Sexual Politics

Stigmatization & Infantilization

Historically, disabled sexuality has been marginalized due to stigmas and infantilization. The stigmatization demonizes disabled sexuality to be out of control, instigating public fear towards the sexual expression of disabled bodies. Meanwhile, infantilizing attitudes asexualize disabled bodies altogether, creating a culture of overprotectiveness. In particular, the disabled sexuality has been linked with conflicting imageries of the “asexual, oversexed, innocent or perverts” (Brown, 1994). This conflict reveals the underlying intention to segregate disabled individuals from the public in the name of maintaining sexual boundaries. It deems all disabled people to lack agency and therefore need to be protected from predatory members of the public, while the public also needs to be protected from the deviant perversion of disabled sexuality.

The visceral reality of human vulnerability, fragility, and abnormality signified by disabilities challenges the image of the healthy, sane, and abled body at the center of western medical narratives. Gayle Rubin identifies sexual perversion as a social vector of oppression, interwoven with concurring gender, race, class, and ethnicity-based oppression (Wilkerson, 2002). Therefore, the sexual perversion associated with disability are instrumentalized to segregate the disabled, poor, sick, and ethnically underprivileged from the rest of the society.

Adopting this narrative of disabled sexual perversion, eugenic agenda prevents disabled people from reproducing and being reproduced to eliminate disability (Earle, 2001). Since the 18th century, eugenics had explicitly and implicitly denied disabled individuals’ rights to form intimate relationships and to reproduce through series of forced sterilization, home isolation, sex-segregated institutionalization, or restricted access to reproductive health services.

As the development of sexuality is core to one’s transition into adulthood (Earle, 2001), the infantilization of people with disabilities asexualizes them and prevents them from maturing into socially acceptable sexual and gender identities. In the US, only 3 states explicitly include youth with disabilities within their comprehensive sex education curriculums, and only 5 states mandate these curriculums to be accessible to youth with disabilities. In institutional settings, sex education is rarely discussed, and the need of privacy is often ignored (Lehmann, 2005; Shakespeare, 2000). Youth and adults with disabilities are denied the opportunities for sexual expression and exploration that their non-disabled peers readily enjoy (Earle, 1999). Therefore, disabled youth and adults feel segregated from their non-disabled peers who “naturally '' know how to form intimate relationships and derive pleasure from sexual interactions. Furthermore, people with learning disabilities are commonly referred to as “boys and girls” in specialized care institutions while they are biologically adults (Brown, 1994). These infantilizing attitudes inhibits disabled individuals from experiencing themselves as sexually viable adults and discourages them from engaging in sexual and intimate relationships as their non-disabled peers.

In the healthcare industry, a huge gap exists between the nurses’ understanding of the patients’ biopsychosocial needs vs. the patients’ own definition of their needs. Disabled sexuality is often excluded from nursing practices and training, causing nurses to be reluctant, ignorant, embarrassed, or disgusted towards the sexual needs of disabled patients (Earle, 2001). Nurses lack the knowledge to advice about the impact of disabilities on sexuality or to assist in facilitating the sexual needs of disabled patients. Some nurses also fear the risk of sexual abuse as a result of trespassing sexual boundaries in care work. Therefore, the common attitude towards disabled sexuality is one of neglect and asexualization. This asexualization by healthcare authorities further deprives disabled people of their sexual citizenship.

Furthermore, sexuality for disabled people has long been an area of distress and self-doubt, making it more enticing to shun away from it than to “engage with everything from which so many were excluded” (Shakespeare, 2000). Unwanted celibacy and sexual frustration can cause lower self-esteem and damaged self-confidence, preventing one from accepting themselves, and impeding intimacy and sex with partners. Therefore, to recognize one’s sexual citizenship means to connect one’s fulfillment, frustration, and confusion with the collective experience of inclusion, segregation, and discrimination across various layers of social life.

Currently, sexual rights advocacy for disabled people confronts one common pushback: sexual rights have lower priority than other “more basic” survival needs when there is limited time and funding. As “ending poverty and social exclusion comes higher up on the list of needs than campaigning for a good fuck and access to clubs and pubs”, the sexual rights of disabled individuals tend to trail behind other social justice issues in state policies (Shakespeare, 2000). Disabled scholar Tom Shakespeare identifies this segregation between sexual needs and the “more basic” survival needs as a side effect of disability rights movement taking lineage from trade unionism and socialism. The movement began with a primary concern over labor participation in the public domains. It’s only since the 80s that the social model of disability has corroborated the notion of “the personal as political” from feminist movements, expanding focus onto the private life of disabled individuals. Wilkerson argues that leveraging the personal experience of sexuality to advocate for sexual democracy challenges the racism, ableism, capitalism, sexism, and ageism which scrutinizes and marginalizes certain bodies and sexualities to begin with (Wilkerson, 2002). Therefore, access to sexual pleasure is more than just finding “a good fuck”. It is inseparable from having full access to society. Advocating for disabled sexual citizenship improves disabled people’s self-esteem and self-confidence and facilitates their self-acceptance alongside acceptance by partners. Promoting disability-inclusive sex education relieves disabled people’s insecurities associated with intimate relationships, which can reduce sexual abuse or intimate partner violence.

3. Commercial Sex Services & Disabled Clients

Existing Commercial Sex Services

Currently, commercial sex services available for disabled clients include intimate services provided by sex workers, facilitated sex by the clients’ personal assistants, carers, sexual surrogacy by clinical therapist and surrogate partners, as well as medically-assisted sex offered by intimacy coaches and clinical therapists. The following section will discuss these services’ different modes of engagement and the socio-political implications for the languages used to promote these services. To ensure inclusive representation of the various types of services discussed, the paper refers to disabled people who pay for commercial sex services as clients, and people who provide these services as providers. Additionally, because most existing literature centers around cis-men clients working with cis-women providers, there is an absence of non-heteronormative and LGBTQI+ client-provider relationship in research. The later section of paper dives more into the gender skew in disabled sexuality discourse, the resulting bias in client-provider pool, as well as its contention from the perspectives of feminism, disability rights movement, and legislation.

Since the beginning of human civilization, sex workers have been working at the margins of society to provide sexual services to people across social status and ethnicities. Currently, most sex workers or escorts conduct their services in business spaces, such as saunas and adult-exclusive facilities, as well as private spaces such as rental apartments and hotel rooms. While “sex workers” and “escorts” are sometimes used interchangeably with “prostitutes”, these two terms highlight sexual services as viable labor output and validates the providers’ agency in offering these services.

When professional care and the social norms asexualize and stigmatize disabled people, sex workers have been working closely with disabled clients to address their sexual needs. In a Disability Now ‘Time to talk’ sex survey, 37.6% of men and 16.2% of women responded that they had considered paying for commercial sex to address their needs (Sanders, 2007). According to UK-based sex therapist Tuppy Owens, for every 100 sex workers listed on an advertising site, they could be seeing around 8 disabled clients monthly (Ryan, 2013). Disabled clients visit sex workers not only for pleasure and novelty, but also to improve their sexual-esteem, or for companionship and human connection in general. Disabled clients who worry about being “inadequate” lover due to physical impairments, or those who lack experience with intimate relationships during adolescence and young adulthood also seek sex workers. Simon, a 29-year-old male who became disabled at age 19 described his motivation to visit sex workers, “I had a compelling wish not to die a bloody virgin… at least now I won’t be bloody petrified with a girlfriend and think what do I do now” (Sanders, 2007). Some disabled clients view interactions with sex workers as a mutual exchange of emotional warmth and intimacy which are not always accessible to them in their day to day. Paul, a 44-year-old male wheelchair user with acquired disabilities said, “You know it’s wonderful to feel flesh to flesh when you haven’t felt it for years… the two women [sex workers] I seen most often I don’t always have penetrative sex with… that does not matter because I’m enjoying being with them” (Shakespeare, 2000).

Similarly, Ava and Krystal, two UK-based female sex worker who have worked in an adult sauna for more than 10 years, reaffirmed that disabled clients seek their services to ease stress and responsibility about sex, or to have affectionate body contact and cuddling. However, most sex workers lack professional training about caring for disabled clients with health complications and accessibility needs. Many of them are inexperienced in interacting with disabled people in general. Therefore, they have to learn on the spot relying on intuitions and empirical advice from colleagues. Tracy, a female sex worker working in adult sauna described her challenges with a male client who used a wheelchair, “he wanted to be lifted into the jacuzzi which took a couple of us and it was hard. We needed extra help really as we didn’t really know if we were lifting him right”. Tracy also shared her experience of being innovative while working with a paralyzed male regular, “It was horrible because you don’t know what to do at first… He had hand relief and oral and I had to move his hands to touch me… When he went home he had got a computer and he can touch the buttons… Getting used to speaking to him through his computer was strange, but we did it and he came to see me for about 18 months” (Shakespeare, 2000).

Another UK-based sex worker expressed frustration about the lack of communication between sex work communities and disability right organizations due to taboos associated with sex work: “I do not promote my service to organization although I did have some conversations with SPOD (The Association to Aid Personal and Sexual Relationships of People with a Disability) after their television program about sex workers and people in wheelchairs… I got in touch with them and said I would like to have some training. They did not seem to be able to provide any information…” (Shakespeare, 2000). In Australia, where independent sex work is legal and regulated, charity organization Touching Base Inc. works with disabled clients, their carers, and sex workers to help them connect with each other, to aid with legal and human right issues, and offer disability-related training for providers. Touching Base Inc. is funded privately by local human rights campaigners, academic researchers, and politicians. It serves as a successful example of how breaking down the access barriers between the two communities help them better acquire social support. Conversely, in countries where sex work is criminalized or illegal, such as the United States and Canada, or in countries where sex work is partially legal, such as the Greater Britain, organizations that run on government funding and private patronage risk damaging their legitimacy and reputation by affiliating with the sex industry. Therefore, even though the business interests of sex workers align with the political interests of disability rights organizations, social stigmatization of sex work alongside the asexualization of disabled population make it difficult to facilitate mutual aid between these two marginalized communities. Sex workers and disabled clients lack legal protection and can be penalized for engaging in commercial sex.

Specifically, sexual surrogacy involves a three-person therapeutic group of the client, a therapist, and a trained surrogate partner. The three individuals work together to address the specific challenges and needs of the client. The International Professional Surrogates Association (IPSA) adopts a therapy-centric narrative of sexual surrogacy by framing it as “Surrogate Partner Therapy”. In this therapy, surrogate partners’ main goal is to help clients build “self-awareness and skills in the areas of physical and emotional intimacy”. Sexual surrogacy work revolves around “therapeutic experiences” such as “partner work in relaxation, effective communication, sensual and sexual touching, and social skills training”. IPSA’s therapy-centric narrative aligns Surrogate Partner Therapy with rehabilitation services, targeting people who experience anxieties associated with intimate relationship or sexual dysfunctions. The client may experience emotional challenges during the services, requiring support from both the therapist and the surrogate partner to work through emotional issues and apply newly developed self-knowledge. IPSA website indicates that “genital-genital contact may or may not be therapeutically indicated. When it is indicated, it is often a minor part of the therapy” (International Professional Surrogates Association, 2020). IPSA’s wording intentionally obscures the potentially sexual nature of the surrogate-client interaction. This can be due to how sexual surrogacy functions at the gray area between sex work and rehabilitative services. Currently, there are no explicit laws against sexual surrogacy, yet many major psychology and social work organizations refrain from making statement on surrogate partner referral (Pathak, 2020). Thus, IPSA’s meticulous language choice represents an ironic challenge in disability-oriented commercial sex services: to make commercial sex services for disabled clients more publicly accessible and destigmatize the imageries of disabled people having sex, providers must use desexualized and medicalized languages to refrain from explicitly referring the services’ sexual nature.

Despite the limited support from disability organizations, sex workers still try to make their services as accessible as possible by marketing for easy parking, ramps, lifts, first-floor spaces, accessible bathrooms in their business listings (Shakespeare, 2000). Overall, disabled clients report their experiences with sex workers as positive, highlighting sexual rights and pleasure at the core of the experience. Kelly, who worked in a sauna, said, “We are not just here for able bodied people” (Sanders, 2007). Krystal also professionally summarizes her work: “It is care in the community, I look at this as an extension of my job as a nurse” (Shakespeare, 2000). Therefore, instead of reenforcing stigmas associated with disabled sexuality, sex workers take on multifaceted roles as friends, mentors, carers, and healers to provide sexually gratifying and emotionally enriching experiences for disabled clients. Sex work for disabled clients operates within a pleasure-centric or need-based service framework in the gray area of legislation, where clients and providers navigate the undefined realm of disabled sexuality and learn from each other’s bodies and expertise.

In comparison, facilitated sex or facilitated sexual expression encompasses a continuum of sexual services, usually performed by the disabled clients’ personal assistants or caretakers paid by state subsidies or personal funds. While the personal assistants or carers normally do not participate in sexual interaction with the clients, they act as mediators between sex-related information or services and the clients who experience challenges acquiring those resources independently. A comprehensive framework of facilitated sex includes providing accessible sexual health information and dating advice, assisting in acquiring sex toys and goods, arranging services with sex workers, facilitating sexual positions during sexual interaction with a third party, and sexual surrogacy work (Bonnie, 2002; Earle, 1999).

Similar to services offered by individual sex workers and escorts, sexual surrogacy is not limited to clients with disabilities, but can be beneficial to them. For clients who see sex workers, although the providers may find creative solutions to warrant sexual intimacy and emotional satisfaction based on the clients’ disabilities and needs, they have limited experiences managing disability-specific health conditions. In comparison, sexual surrogacy offers the benefit of a safety net, as the clients explore their sexuality in a more structured rehabilitative framework with professional therapists and trained surrogate partners. Furthermore, sex work services can be more pleasure-driven and spontaneous, without long-term commitment from the clients. In comparison, sexual surrogacy emphasizes the educational aspects of learning to form healthy relationships. It benefits from building an expansive surrogate-client relationship that encourages the clients to prioritize long-term personal development over immediate fulfillment of sexual pleasure.

Outside the therapeutic framework of sexual surrogacy, intimacy coaches, clinical sexologists, bodyworkers, and massage therapists also work in a similar rehabilitative fashion to provide sexual services to disabled clients. Vancouver-based clinical sexologist and intimacy coach Joslyn Nerdahl works with Sensual Solutions, a group of providers working in a semi-formal sexual surrogacy setting. Providers are marketed as intimacy coaches, which include massage therapists, clinical sexologists (professionals that support clients’ psychosexual growth with sex therapy and education), nursing professionals, personal carers, life coaches, tantric practitioners, fitness trainers, and sexological bodyworkers (professionals that promote somatic sex education). These trained providers offer coffee dates, sex education, relationship coaching, cuddles, sensual non-therapeutic massage, tantra practice, as well as intimacy coaching and assistance featuring “affectionate skin to skin experiences” (Sensual Solutions, 2016). Sensual Solutions brands its services as “medically-assisted sex”, as all providers have training and accumulated experiences in body work, healing modalities, and therapies, some with professional certification in areas of expertise. For example, Joslyn transitions into clinical sexology and intimacy coaching training from traditional sex work. Spencer Williams, a 26-year-old male with cerebral palsy described his session with Joslyn would start with breathing exercise and move on to touching, kissing, and other activities. Joslyn also incorporated “body mapping” in her session, which is a process of touching and stimulating different erogenous zones to figure out what is pleasurable for the clients. Other responsibilities for intimacy coaches include assisting with condom use, facilitating sexual positions, exploring sex toys, discussing fantasies and fetishes (CBC, 2018; Sensual Solutions, 2016). Similar to clients who see sex workers, Spencer explains his motivation to session with Joslyn as seeking sexual pleasure and intimate connection: “I feel the need to be close. I feel the need to connect. I feel the need to be touched, to be kissed” (CBC, 2018). Working with intimacy coaches who are knowledgeable about sex, anatomies, and experienced with facilitating emotional connection with clients encourages Spencer to explore his sexuality in a judgement-free zone.

Sensual Solution’s emphasis on the “sensual” nature of “medically assisted sex” adopts a similar euphemistic strategy to that of IPSA. By highlighting the “medical” and rehabilitative aspects of the service, Sensual Solutions destigmatizes disabled sex and frames it as a fundamental biophysiological needs of disabled people that requires “medical” attention. The medicalization protects the services under the current Canadian law which declares the purchase, sale, and advertise sexual services illegal and penalize such transaction (Government of Canada, Department of Justice, 2015). Additionally, it validates intimacy coaches’ diverse skillsets and knowledge in sex, anatomy, and healing, expanding what “medical” can mean in sexual service and disability care. The implication of using “sensual” instead of “erotic” or “sexual” is three-fold here. “Sensual” highlights the possibility of eliciting pleasure from non-genital-focused sexual activities, hence expanding what “sex” means. However, it can also be interpreted as a de-sexualization of the service, emphasizing a care and healing-focused lens of sexual pleasure that are commonly overlooked. This de-sexualization thus contributes to the strategic medicalization of the service to better survive under the law. Overall, these languages serve to diversify what sex, healing, care, and rehabilitation mean for clients and provide some legal protection for clients and providers. Nonetheless, it confronts the same dilemma that IPSA faces, that is the need to tone down the sexual nature of the services in order to make it more palatable for public exposure and navigating the gray area of law.

Unlike IPSA which frames sexual surrogacy as therapy, Sensual Solutions deliberately uses “non-therapeutic” services to designate any sexual interaction between the providers and clients. In the Our Ethos page on Sensual Solutions website, it reads “The designated Sensual Solutions representative shall apply only non-therapeutic services that are comfortable to the client” and “The Sensual Solutions representative’s relationship with the client is temporary; always within the context of the non-therapeutic situation and in association with the supervision of the therapist, if the client wishes” (Sensual Solutions, 2016). This seems contradictory to the rehabilitative aspect of “medically-assisted sex” that Sensual Solutions promotes. The ethos guideline also emphasizes the need to discuss “the objectives and parameters of the non-therapeutic relationship” with the supervising therapist to ensure informed consent. Furthermore, for providers with “professional degree, certificate, license, or accreditation, which applies to other than this work”, they work primarily as a surrogate partner, with additional interaction and methods integrated based on consensus of the provider and the therapist (Sensual Solutions, 2016). Upon a closer analysis of the ethos guideline, the underlying conflict in marketing language implies a tentative resolve to maximize legal protection for the providers and clients. Abstaining from the therapeutic framework relieves Sensual Solutions of medical liabilities and potential conflict of interests with other traditional medical and rehabilitative services. Highlighting a non-therapeutic provider-client relationship also reduces the provider’s prescriptive authority. It fosters a more equitable power dynamic between providers and clients. With the support of clinical therapists, the emphasis on equitable dynamic helps providers and clients establish healthy boundaries and prevent sexual abuse.

4. Legislation, Payments & Consents

Currently, the policies and regulation of commercial sex differ greatly around the world. This section of the paper focuses on countries such as the United Kingdom, Netherlands, Denmark, United States and Canada, where prominent commercial sex industries exist with varying levels of government support, ranging from criminalization to state-subsidized support.

Out of all these countries, Netherlands is known for legalizing sex work, and is the only country that currently subsidizes sexual services for disabled citizens. While this subsidy is not explicitly designated for sexual services, disabled citizens can use their disability benefits to access sexual services for up to 12 times a year (Davies, 2013). This subsidy greatly relieves the financial burden for disabled clients, because when acquiring commercial sex services without government subsidy or insurance coverage, disabled clients are paying hefty fee out of pocket. For example, Vancouver-based Sensual Solutions charged an hourly rate starting at $100. And because many disabled people are unemployed or have lower income, they use disability aid or social security money to see providers. A UK-based disabled client reported spending about £200 every month from Disability Living Allowance and working tax credit to pay for sex workers (Sanders, 2007). The high costs thus become a barrier for disabled individuals interested in commercial sexual services.

Inspired by the Dutch policy, Chris Fulton, a 29-year-old male with cerebral palsy and muscular dystrophy launched a campaign in 2013 to advocate for similar subsidy scheme in the UK. Since 2008, the purchase and sale of sexual services are legal in Greater Britain, but the act of soliciting, running brothels, and primping are criminalized (Casciani, 2008). Chris Fulton explained his motivation by saying that commercial sex for disabled people “need to be brought out into the open in a managed and constructive way” (Davies, 2013). This means that UK needs to instate more regulation for sex work, especially when it comes to services for disabled clients. Similarly, Torben Hansen, a Danish man with cerebral palsy, campaigned for Danish government to introduce subsidized sexual services for disabled citizens. He explained, “I want [the government] to cover the extra expenses for the prostitutes to get here, because it’s a lot more expensive getting them to come to my home rather than me going to a brothel” (BBC, 2005). Denmark has decriminalized sex work in 1999, yet sex work has not been recognized as a legal profession under the protection of law. Therefore, to provide legal and government-subsidized sex work for disabled clients require decriminalizing sex work as a first step and offering legal protection and proper regulation for providers and clients as a second step.

Sex Work for Disabled Sexual Rights

Traditionally, female sex workers outnumber male sex workers, while male clients outnumber female clients. This resulted in a gender skew in the client-provider pool that reproduces the traditional division of masculinity and femininity (Earle, 1999). Many of those opposing government-subsidized sexual services specifically discriminate against sex work as a form of service labor. Kristen Brosboel, who was a Social Democrat member of the Danish Parliament, disagreed with the need to support disabled clients’ visit to sex worker with taxpayers’ money as it conflicted with the government’s effort to prevent prostitution and “helping women out of prostitution” (BBC, 2005). Some feminist and human right lobbyist share the similar views that all forms of prostitution are violence against women and the act of promoting sexual rights contribute to the patriarchal agenda of perpetuating gender division. And because commercial sexual service for disabled people inherited the same gender skew of traditional sex work, opponents see sex facilitation for disabled men by female providers as a power play to sexually subjugate women for male pleasure (Sanders, 2007).

The anti-prostitution critiques are founded on essentialist assumptions that men have stronger sexual drive than women, men are more sexually experienced than women, and that men always have social power over women. They derive from the stereotypes that “prostitution” involves men with higher socio-economic status looming sexual control over lower income women via transactional sex. Therefore, as “prostitution” becomes by-product of patriarchy and classism, all commercial sexual services are reduced to subservient compliance with social inequity. Additionally, the essentialist critiques of “prostitution” over-simplify the political nature of sexual services provided by contemporary women in the “sex work”’ framework. By defaulting female sex workers as victims of male sexuality, anti-prostitution discourses overlook many sex workers’ agency over their bodies and works in the current system, such as their ability to select the clients they work with, design how they deliver the services (Sanders, 2007), and reject other less preferable occupations. These discourses also undervalue the sexual expertise, interpersonal communication, and emotional labor performed by sex workers as valid care work.

Furthermore, the anti-prostitution discourses fail to recognize how helping disabled people access sexual pleasure through sex work actually subverts the patriarchal norms that exalt the “alpha” masculinity rooted in ableism. Ableism means the social preferences for able-bodied people and discrimination against disabled people. The “alpha” male archetype finds its parallel in the image of healthy and abled male body at the center of western medical framework. An “alpha” male is considered fit, confident, sexually virile and dominant, essentially everything that a disabled body is not expected to be. The fetishization of “alpha” masculinity hence contributes to the marginalization of disabled bodies as sexually inactive, and disabled men as sexually inferior. In the case of female providers working with disabled male clients, the female providers tend to be physically stronger, more sexually experienced, and professionally capable, which undermines the traditional heteronormative sexual dynamics. These services help disabled male clients reclaim their sexual citizenship when they do not conform to normative masculinity (Sanders, 2007). The services also extend beyond being pleasure-centric to provide intimate connection and facilitate emotional growth for the clients. Therefore, a one-size-fit-all approach to discriminate against “prostitution” fails to recognize the providers’ autonomy and agency in performing a multifaceted care labor in the “sex work” discourse. It devalues how these services help disabled male clients subvert the patriarchy that marginalizes disabled sexuality to begin with.

Buying Sex as Disabled Sexual Rights

Some opponents of disability-oriented commercial sexual services do not necessarily oppose commercial sex, but are concerned with how disability-facing commercial sex can further segregate disabled individuals and their sexuality from the rest of society. Mik Scarlet, a disabled writer and campaigner, interprets these services as “the world telling you that disabled are so unsexy that the only way they can have sex is to pay for it… I want a world that sees disabled people as sexual and valid prospective partner” (Ryan, 2013). Similarly, some advocates of the disability rights movement argue that commercial sexual services for disabled individuals perpetuate the ableism that marginalize them as “others”, forcing them to seek “non-normative form of sexuality and relationship formation” (Sanders, 2007). They believe these services are not challenging the culture that stigmatizes sexuality and disability as disabling environments (Brown, 1994). Instead, effort should be redirected to tackle systematic discrimination and help disabled people form natural sexual and intimate relationships without relying on commercial services. Additionally, opponents argue that having to pay for sex can reinforce the clients’ negative stereotypes about their own disability and sexuality as they cannot obtain pleasure and intimacy through “mainstream and valued” ways (Brown, 1994).

To dissect these arguments, it’s important to acknowledge the wide spectrum of disabilities and their unique blend of symptoms for each individual. Therefore, arguments that speculates on disabled people’s sexual decision as if they all share the same body with identical physiological and psychosocial needs risk over-generalization. Currently, many disabled people do seek commercial sexual services because they face challenges finding sexual fulfillment or intimate connection otherwise. Such challenges can be the result of social isolation or stigmatization associated with the clients’ mobility or sensory impairments, communication challenges, or learning disabilities. Additionally, these challenges can be caused by geographical regions, race, class, gender identities, sexual orientation, religions, and other identity and environmental factors. In today’s social climate, it’s likely that someone who is white, heterosexual, employed, and upper-middle class with spinal cord injury would find it easier to “organically” form intimate relationship than someone who is black, queer, has congenital cerebral palsy, unemployed, and live in a lower income neighborhood. If the latter is more dependent on facilitate sex, losing access to commercial sexual services will likely marginalize these two people disproportionally. While it’s imperative to resist and protest the disabling environments that oppress disabled sexuality, it should not be done at the cost of sacrificing the sexual rights and freedom of choice of some disabled people more than others.

Additionally, paying for commercial sexual services does not exclude disabled clients from building personal intimate relationships. Today, disabled clients can choose from a variety of services that range from being pleasure-centric to those focused on sex education and intimate skill development. These services each offer unique sets of sexual knowledge that can benefit the clients when they develop personal relationships. Furthermore, rejecting commercial sexual services for disabled people without challenging commercial sexual services for able-bodied people also risks segregating disabled people from the rest of the society. In turn, supporting disabled people to access commercial sexual services actually questions the validity of a division between “deviant sexual activity” (Sanders, 2007) and the “mainstream and valued” ways of seeking pleasure. It re-envisions a social world where neither disability nor sexuality is stigmatized, and the choice to pay for commercial sex becomes integral to one’s sexual rights.

The importance of being socially acceptable to pay for commercial sex can be exemplified by the underserved sexual needs of disabled women ad LGBTQI+ people. Despite the positive influences of commercial sexual services on disabled men, services for disabled women and LGBTQI+ people trail behind. This is because disability rights movements tend to prioritize disability status as an identity label, relegating gender identities and sexuality as an after-thought. In rehabilitative services, the sexual health information and support available to disabled patients often center around male problems of erectile dysfunction, ejaculation and fertility issues, while women’s bodies and needs are largely ignored (Earle, 1999). When disabled female sexuality is discussed for women with learning disabilities, heteronormativity is the default, and the possibilities of lesbian relationships are often ignored (Brown, 1994). These service paradigms reinforce the male-centrism in disabled sexuality discourse. A London-based sex worker reported that sometimes fathers of disabled men booked appointments for their sons (Ryan, 2013). While there are generally less disabled female clients, there is also less research showing a comparable support system for disabled women. One of the common reasons why disabled women hesitate to pay for sex is that they fear higher risk of sexual abuse, hence don’t feel safe with male escorts (Ryan, 2013). Essentialist stereotypes also claim men to have higher sex drive and that women prefer sex in a relationship (Sanders, 2007). Such misconception normalizes the purchase of sex by men and stigmatizes women’s desire to pay for pleasure.

To defy this norm, Vancouver-based provider Sensual Solutions makes an effort to offer more gender-inclusive services. Sensual Solutions’s highlights the diverse gender identities and sexual orientations of its providers, including “heterosexual, bisexual, gay and lesbian women and men” (Sensual Solutions, 2016). Sensual Solutions’s service model suggests a viable pathway to develop more LGBTQI+-inclusive commercial sexual services by training providers to offer safe spaces for clients who experience oppression across multiple social factors. This training can benefit from collaboration with disability rights advocacy groups as well as feminist and LGBTQI+ support groups. While this service model itself is not sufficient in dismantling the androcentrism of disabled sexuality discourses, creating a space where disabled women and LGBTQI+ people feel acceptable to pay for sex and intimacy marks a milestone in the process of reclaiming disabled sexual rights.

Consensual Sex vs. Sexual Abuse

Many people who oppose commercial sexual services for disabled clients are concerned with disabled people’s ability to give informed consent and the resulting risk of sexual abuse and exploitation. The contention about consensual sex vs. sexual abuse escalates around people with learning disabilities, especially women with learning disabilities. As people with learning disabilities are more dependent on their carers or providers, such dependence can lead to inequitable power dynamic that allows for exploitative or abusive behaviors. Furthermore, people with learning disabilities can have difficulties in understanding the occurrence of abuse, articulating their abuse, and their recounts are less likely to be believed (Earle, 1999). The conversation about how to judge one’s capacity to consent, and how much a person with learning disabilities need to understand about the sexual interaction to consent become the core challenges of legislators.

In UK, the 1956 Sexual Offences Act (SOA) represented an effort to protect women with learning disabilities from sexual abuse, but it ended up exacerbating the stigmatization of disabled sexuality. The SOA 1956 used discriminatory language to refer to people with learning disabilities as “defectives”. “Defectives” was defined as someone suffering from “a state of arrested or incomplete development of mind which includes severe impairment of intelligence and social functioning (Section 45 SOA)” (Evans & Rodgers, 2000). SOA 1956 failed to recognize the varying degrees of “Intelligence and social functioning” that people with learning disabilities have, therefore assuming all of them are vulnerable to the same degree and need to be protected the same way. The “defective” narrative also hyper-focused on how people with learning disabilities deviated from “normal milestones of mental development” (Evans & Rodgers, 2000), neglecting the ranges of activities they can do as anyone else.

Specifically concerned with the sexual abuse of women with learning disabilities, or more narrowly, women with IQ lower than 50 (Lehmann, 2005), SOA 1956 forbade sexual intercourse with these women in the name of protection, even when consent is given. The only exclusion is consensual marital sex, or when the sexual partner is judged unaware of the woman’s learning disabilities. While consensual marital sex may not be prosecuted, the disabled women’s ability to consent remained scrutinized (Evans & Rodgers, 2000). Offenders pledged guilty under SOA 1956 would face up to 2 years of imprisonment. SOA 1956 especially forbade male healthcare professionals, nursing home staff, or guardians from engaging in sexual intercourse with the women (Curtice & Kelson, 2011). Therefore, the legal liability associated with sexual interaction with women with learning disabilities restricted carers or providers from any peripherally sexual services, such as supporting them to access commercial sexual services or assisting them to have sex with their sexual partners (Evans & Rodgers, 2000). SOA 1956’s short cut solution to prevent sexual abuse and prosecute sex offenders actually jeopardized the sexual citizenship of women with learning disabilities. It instated an ableist over-protectiveness that surveilled and oppressed the sexual expression of these women as well as dismissed their varying ranges of abilities and psychosocial needs. The risk of prosecution against the sexual partners, carers, or providers further segregated women with learning disabilities from building intimate relationships. SOA 1956’s delegitimization of personal consent also reflected a poor political decision fueled by social anxiety, which automatically associated disabled sexuality with unwanted pregnancy, abortion, sexual abuse and assault. Therefore, it denied all possibilities of sexual pleasure for women with learning disabilities, and perpetuated the norms of infantilization and asexualization that silenced their voices. By defaulting men as offenders and women as victims of sexual offences, SOA 1956 also overlooked cases of sexual abuse of disabled men by women, same sex sexual abuse, or sexual abuse by other people with learning disabilities. This gendered bias reinforces the victimization of women in sexual activities.

In 2003, and updated SOA replaced the 1956 version, acknowledging that for people with learning disabilities that can consent to sex, they have the rights to engage in consensual sexual interaction “as anyone else”. Offences of sexual abuse apply when sexual interaction involves people with learning disabilities who cannot make decision or cannot refuse. Offensive interaction includes touching, inciting sexual activity, engaging in sexual activity when a disabled person is present, forcing or threatening a disabled person to watch a sexual interaction. While the updated SOA still leaves some ambiguity for the judges’ interpretation, clinicians can be involved for consultancy or assessment in a prosecution (Curtice & Kelson, 2011). In April 2021, a UK court case about facilitated sex for disabled client demonstrated a positive interpretation of the SOA 2003. The client of the case, a male with Klinefelter syndrome (genetic disorder causing developmental delay), requested sex facilitation from his social worker to contact a sex worker (Samuel, 2021). This triggered the intervention of local court to determine whether this facilitation was lawful under SOA 2003. The Court of Protection eventually decided that the client clearly demonstrated ability to engage in and consent to sexual interaction. Therefore, the court ruled a care plan for him to have facilitated sex with a sex worker was not in contrary to the SOA 2003. The judge explained that SOA 2003 intended to protect “those who are sexually vulnerable in relationships which may easily become exploitative and in which inequality may corrode meaningful consent”. It’s not meant to “repress autonomous sexual expression” or “criminalize carers motivated to facilitate such expression” (Samuel, 2021). The court case highlighted that progresses in legislation is key to advancing the sexual rights for disabled people. Because of the diverse disabilities and psychosocial needs of clients, a “one-size-fit-all” law risks sacrificing the needs of some disabled people at the cost of protection for others. Therefore, a case-by-case analysis is necessary for making an ethical judgement.

5. Conclusion

Disabled sexuality has been marginalized to have lower priority in the disability rights movement. Disabled bodies are stigmatized to be oversexed and perverted, leading to a history of eugenic treatments. Contradictorily, disabled people are also infantilized and asexualized. Their sexual expressions are constantly denied in the name of protecting them from sexual exploitation. Therefore, the sexual needs of disabled people are overlooked by healthcare professionals and in specialized institutions. This leads to an absence of sex education that causes many disabled people to lack sexual knowledge, experience lower self-esteem in sexual relationships, or face challenges in developing intimate connection. Commercial sexual services for disabled clients thus function at the gray area between traditional sex work and rehabilitative services to help disabled clients develop intimate skills, improve confidence, and reclaim sexual citizenship. Existing service models include commercial sex provided by sex workers and escorts, sexual facilitation by the clients’ carers, sexual surrogacy with a clinical therapist and a surrogate partner, and a semi-formal sexual surrogacy featuring intimacy coaches that work as sex educators, surrogate partners, sexological bodyworkers, etc. The implementation of these services has been challenged by legislations that discriminate against sex work, and disability rights discourse that concern about these services further marginalizing disabled sexuality. Some opponents also worry that these services increase the risk of sexual abuse due to disabled people’s presumed inability to consent. The paper analyzes the opposing arguments, and echoes

disabled scholar Tom Shakespeare’s critique of existing sexual norms: “Why should men be dominant? Why should sex revolve around penetration? Why should sex only involve two people? Why can’t disabled people be assisted to have sex by third parties? What is normal sex?” (Shakespeare, 2000). The paper concludes that by helping disabled clients access sexual pleasure, commercial sexual services subvert an inherently ableist patriarchy that marginalizes disabled sexuality. These services contribute to building a social world that destigmatizes sexuality and disability as well as dismantling the division between “normal” and “abnormal” ways of seeking pleasure. Additionally, they highlight the rights to pay for sex as integral parts of one’s sexual citizenship.

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