The controversial state of ‘hands on’ sex therapy

Dr Petra Boynton has written a fascinating article on sex surrogacy, the controversial practice of using ‘hands on’ tutoring as part of therapy for sexual disorders.

‘Sex therapy’ is an umbrella term for a number of established psychological and behavioural treatments for sexual difficulties.

Most commonly, it involves a therapist working with a couple to discuss the problem, work out what might be going wrong, and then asking the couple to try a number of approaches to improve their relationship, communication and lovemaking.

These three approaches are key as, despite what the drug adverts might imply, many sexual problems arise from anxiety, mismatched expectations, and unhelpful learnt responses, rather than simply physical problems with the sexual organs.

This can be true for a wide range of problems, including erectile dysfunction (not being able to get or keep it up), vaginismus (where the muscles of the vagina involuntarily tighten to prevent penetration), early or absent orgasm, or loss or lack of sexual interest.

A common approach is to initially ask the couple not to have sex and simply focus on touching and intimacy (an approach known as sensate focus).

This takes the pressure off, reduces anxiety, and once the couple start feeling more connected, therapy focuses on introducing sexual activities or exercises for the couple to try at home to help deal with the remaining difficulties.

Similarly, the therapist might ask the couple to try new ways of communication, and consider how they understand their partner, both sexually and in everyday life.

You’ll notice this is very couples focussed, as is most sex therapy, potentially limiting the options for someone whose sexual problems are preventing them from getting a partner.

One option is to use a ‘sex surrogate’, someone who is employed by the sex therapist to practice sexual exercises with the patient.

It was pioneered in the UK by the now retired therapist Dr Martin Cole, who became a controversial figure in the 60s and 70s media for advocating, even at the time, quiet radical views on sexual freedom and treatment.

His clinic provided, amongst a range of other treatment and advice services, sex therapy using surrogates and even managed to get public money for his clinical work.

Surrogate therapy is rarely used in mainstream clinics these days, largely because of the difficulty of getting competent and responsible surrogates, getting suitable referrals, and dealing with the ethical dilemmas and media interest.

However, surrogate therapy is still being researched and has been found to be effective in limited trials.

For example, a study published earlier this year in the Journal of Sexual Medicine found surrogate therapy was significantly more effective than couples therapy alone in treating vaginismus.

Nevertheless, the use of surrogates in sex therapy has received very little attention from researchers, and is poorly regulated, meaning its not clear how effective involving a surrogate in therapy might be.

Petra Boynton discusses the state of modern surrogate therapy, what’s involved, and gives some advice if you’ve considered it as an option.

It’s probably worth remembering that many sexual problems can be successfully treated on the NHS where you’ll get therapy from qualified and experienced psychologists and psychotherapists who don’t use surrogates, so it’s always worth enquiring with your local services.

For private therapy, it’s always worth checking that the person is fully qualified and accredited by recognised national associations.

Link to Dr Petra Boynton ‘ Spotlight on Sex Surrogacy’.