Sex, Problems and solutions

Disabled people: sex therapists


by Vanessa Charles


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Nina de Vries, 42 years old, has been travelling or receiving people in her home for many years. She provides erotic sensations to people with a physical or mental handicap. She massages, caresses, kisses and hugs people who can do the same with her and thus gives them a pleasure that can go as far as orgasm through masturbation. Penetration and fellatio are excluded from the services of this sexual assistant whose services are paid for.

Disabled people have the right to a sexual life

When it comes to sexuality, the mentally handicapped person does not do less, he does it differently, writes psychologist Denis Vaginay. Neither angel nor beast, but profoundly human, he has the right to blossom by living his sexuality fully. This reality should no longer be contested. Breaking a taboo, the Zurich section of Pro Infirmis has asked Nina de Vries to train sexual assistants.

This profession has existed for years in Holland, Denmark and Germany where associations put disabled people in contact with women capable of relieving their sexual needs. They are volunteers from the medical professions (nurses, care assistants), who are sensitive to the problems of the disabled. They are trained to kiss, caress, undress or massage disabled people who can also call them for a simple discussion or a purely sensual relationship.
In Holland, these professionals go as far as full sexual intercourse. The health insurance reimburses their services at a rate of two sessions per month. The rate is about 120€ per hour.

Intimate experiences

Based on the principle that people with disabilities are often disadvantaged in terms of sexuality, Pro Infirmis Zurich has decided to follow these examples and to train sexual assistants who will work independently and offer intimate, sensual and erotic experiences to people with disabilities in return for payment: tenderness, but also body contact, advice on masturbation, sexual games and erotic massage.

People with disabilities, especially those with intellectual disabilities, have limited opportunities to discover, explore and experience their sexuality. There are many barriers to this: insufficient mobility, limited communication skills, lack of information, etc.

To help them live better, Pro Infirmis Zurich has developed various offers: advice on sexuality, documentation and educational material, courses on love and friendship, and surprise parties. One of these offers is the training of sex assistants. By the end of 2003, 8 to 12 of these people were working independently in the canton of Zurich. Preferably working in a profession related to the body, they were selected and trained by Nina de Vries in an 18-day course. Ms. de Vries' many years of experience have enabled her to design a course that prepares the candidates for their delicate task with great care and sensitivity.

Coached and supervised

These sex assistants will be coached and supervised. They undertake to provide services agreed upon in advance at a fair price; they undertake to maintain a professional distance from mentally handicapped clients and to devote the necessary time to providing said services. Pro Infirmis asks them to be capable of having equal relations with disabled people and to adapt their behavior in order to take into account the particular needs of people who think, feel and function differently.

Their addresses will be included in a list that the Zurich association will give to those concerned on request. Another list containing the contact details of prostitutes will be available to those who wish to have full sexual relations. This list will include professionals who respect the rules established by Pro Infirmis.

What do parents, institutional leaders and specialists think of this type of service?

For Catherine Agthe, sex educator, direct sexual help is welcome. But it is only one offer among many and can only be offered on a case by case basis. The majority of people with disabilities live their sexuality for themselves or with a partner and not all of them want this type of service. Nevertheless! For the few who could benefit from it because they experience a significant lack of physical contact, do not know how to masturbate or are self-harming through masturbation, etc., it is important that the service be offered to them.
The services of sexual assistants can contribute to a sense of well-being.

To trust

The sex educator is currently piloting three relationships between people with disabilities and prostitutes. Even if this goes well, it will always be preferable to use professionals trained in disability, relationships, sexology, sexual abuse, and ethics, who are able to address specific needs with sensual and sexual approaches that are different from the fairly straightforward approaches of prostitutes.

Is there a danger that the person with a mental disability will fall in love and not be able to handle the relationship?

There is no such thing as zero risk in this area, because it is life. But sexual assistants will be trained and competent to manage the relationship. And we could also sometimes trust the disabled person a little more, because who owns their desire? The person, his parents, his guardian, his educators, the management of the institution? This raises the whole problem of the dependence of the latter and that of the third parties involved with their values, their morals and their fantasies... It is often around the third party that all the fears, the resistance, the denials and the silences are nested.

Mrs. Agthe welcomes the "innovative and courageous" initiative of Pro Infirmis Zurich. In French-speaking Switzerland, many people think about these individualized offers but few dare to talk about them. There is a growing awareness among professionals and the stir caused by the Zurich breakthrough is helping to advance the cause. Even though enormous progress has been made in 20 years, it will take a few more years before the usefulness of sexual assistants is recognized in Switzerland and institutions open their doors to them.

No to sex tourism

La Farandole, in Fribourg, accommodates 36 adults aged 18 to 60 with a moderate to severe mental disability in two homes, three apartments and a studio. The residents' right to sexuality is recognized. This is one of the quality criteria that must be met in order to obtain subsidies from the OFAS. Homosexuality is not a problem as long as the relationship is between two consenting persons. Masturbation is not a problem either, as long as it does not turn into exhibitionism and is done in private.

All residents of La Farandole who are of childbearing age voluntarily use contraception, whether or not they are having sexual relations. The risk of pregnancy is to be avoided at all costs. The management did not object to a resident's desire to visit a prostitute he was paying for himself, but they would not have tolerated the lady coming to see him in the institution. The man in question had previously been duly informed by family planning and knew how to protect himself.

At La Farandole, we do not accept "sex tourism" or grooming. One adult had to leave for another institution because he was forcing sex on young women who were unable to defend themselves. On the contrary, stable partnerships are preferred. The studio is designed to accommodate a couple. It is currently occupied by two men because none of the couples formed go beyond a few kisses and "I love you" exchanged in front of the television... The institution collaborates closely with the family planning service. The role of the educators is limited to detecting needs and reporting them. At La Farandole, they remain cautious about the "experiment" carried out in Zurich with sexual assistants. At present, no one in this institution would need their services. If this were to be the case, it would be necessary to establish a framework for their intervention and a precise charter with them.

Do not whet the appetite

Marc, 33 years old, with Down's syndrome, lives in one of La Farandole's homes. His mother is convinced that he is not sexually frustrated. This man is content to satisfy himself in his room and everyone respects his practices and privacy at these times. One or two buddies in his household say they have sex "on the mouth" with their girlfriend when they kiss her, but this friendship does not go beyond that. The needs of these people are not huge and do not extend to a full sexual relationship. Mark's mother would not mind her son having sex with a mentally handicapped person as long as they were a stable couple and each respected the other. She would like to be informed and involved in the supervision of this relationship.

This mother condemns the initiative taken by a father who took his son to see prostitutes. According to her, one should not arouse desires and needs that do not exist. The discovery of pleasure in this way risks whetting appetites which can then turn into an obsession and lead to dependence. It would also be wrong to overestimate the needs of people with a mental handicap, says our interlocutor.

"I couldn't pay someone to have sex with my son," says Marc's mother. And this is also true for future sex assistants. She could at least consider using the services of these people for slightly handicapped people who are capable of discernment, able to express themselves and to evaluate the situation. In this case, the intervention would have to be carefully prepared with the psychologist, the different intervening parties and the family planning, without forgetting the parents. For the others, the risk of abuse seems too great. The mentally handicapped person will become attached and fall in love because he or she will not understand that the good done to him or her is only a paid service... Why go so far when many people with Down's syndrome are content to hold hands?

Prohibited to touch the breasts

Homato Institution, les Buissonnets, Fribourg. About thirty profoundly handicapped people of both sexes, aged between 18 and 38, live in total dependence in five apartments. Some of them have sexual needs, which they try to satisfy often awkwardly by masturbation.

How should an educator react when he or she sees that someone is hurting himself or herself by masturbating and not getting his or her way? Should he or she provide assistance? If a resident asked to be masturbated, which has never happened before, we would have to discuss it," say our interlocutors.

At Homato, issues related to sexuality are discussed with parents and handled in collaboration with family planning. It is important that residents do not associate educators with physical pleasure. It is true that affectionate bonds are created on both sides and are necessary for the daily care of the residents. The educators are often solicited for hugs, but they must show by a clear physical attitude coupled with a verbal denial that certain gestures such as touching the breasts are not allowed. This is because educators should not be directly involved in the sexuality of residents.

Take into account the parents' opinions

Could this be the role of sexual assistants from outside the institution?

Homato officials are not convinced. They fear that the mentally handicapped person will misunderstand the true nature of the relationship with the sex therapist. People with a mental age of less than three years are not able to distinguish between a pure service and love. To avoid falling into emotional dependency, physical pleasure and love should be clearly separated, which educators say Homato residents are not able to do. The new Pro Infirmis Zurich service clearly does not meet the needs of people with severe multiple disabilities, according to our interviewees, who would like to know more before making a final decision.

In matters of sexuality, Homato always takes into account the parents' opinions, even if their child is an adult. Nothing is done that would go against their values. Their trust in the institution is at stake. Sometimes, however, serious discussions with parents are necessary. For example, when they want to give their child a drug that prevents any erection, because they cannot morally accept that their child should satisfy himself.

What else might interest you:

Ben Lewin's 2013 film release "The Sessions: see the trailer.

The film is based on the true story of severely disabled author Mark O'Brien, who survived polio as a child with an iron lung and is now in a wheelchair. In his late thirties, he chose to see a surrogate sex therapist in order to lose his virginity. John Hawkes plays Mark, and Helen Hunt ably plays Cheryl, the extraordinarily sensitive and gentle therapist. William H Macy is the Catholic priest and Mark's confessor, who cheerfully advises him to seek the services of a sexual surrogate.

Vanessa Charles

A (very) close friend of Cupid and a true lover of relationships of all kinds, I am the main editor of Give Me Date. I answer your questions about couples, sexuality and dating and I test dating sites to give you a subjective opinion on how to find love or meet new people.

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