Medically assisted sex? How 'intimacy coaches' offer sexual therapy for people with disabilities

For years, Spencer Williams felt he was missing something in his love life.

The 26-year-old Vancouver university student and freelance writer has cerebral palsy. He says he meets lots of potential sex partners but had trouble finding what he was looking for.

"I always refer to my wheelchair as it comes to dating … as a gigantic cock block," he says. "It doesn't always get me to the places I want, especially when it comes to being intimate."

"I thought, if something didn't happen now, I was going to die a virgin."

So he Googled "sexual services for people with disabilities."

That's how Williams found Joslyn Nerdahl, a clinical sexologist and intimacy coach.

"I answer a lot of anatomy questions. I answer a lot of questions about intercourse, about different ways that we might be able to help a client access their body," says Nerdahl, who moved from traditional sex work to working as an intimacy coach with Vancouver-based Sensual Solutions.

"I believe [sex] can be very healing for people and so this was a really easy transition for me, to make helping people with physical disabilities feel more whole."

Sensual Solutions is geared toward people with disabilities who want or need assistance when it comes to sex or sexuality. It can involve relationship coaching, sex education or more intimate services. They call the service "medically assisted sex." It costs $225 for a one-hour session.

Nerdahl notes that some people with disabilities are touched often by care aids or loved ones who are assisting with everyday activities such as getting dressed or eating.  But her clients tell her that despite that frequent physical contact, the lack of "erotic touch" or "intimate touch" can leave them feeling isolated, depressed or even "less human."

'Help a client access their body'

Nerdahl says each session with a client is different, depending on the person's level of comfort and experience, as well as his or her particular desires and physical capabilities.

Williams says his sessions might start with breathing exercises or physio and move on to touching, kissing and other activities.

An intimacy coach may help a client put on a condom or get into a certain position.

A session might also involve "body mapping," Nerdahl says, describing it as "a process of going through different areas of the body, in different forms of touching, to figure out what you like and what you don't like."

Social stigma

Sex and sexual pleasure remains a taboo topic when it comes to people with disabilities.

For Williams, accessing this service is about more than sexual pleasure. But it's about that, too.

"[T]he sex is obviously why I'm seeking this out, but I'm also seeking services like this out because I feel the need to be close. I feel the need to connect. I feel the need to be touched, to be kissed."

"Sometimes people ... offer to sleep with me as a pity, and I often don't appreciate that. I want things to be organic and natural," says Williams.

I feel the need to be close. I feel the need to connect. I feel the need to be touched, to be kissed.- Spencer Williams

He much prefers his sessions with Nerdahl, in which he is able to explore physical and emotional intimacy in a non-judgmental and supportive setting, even though it's something he pays money for.

"I think it freaks people out when we talk about sex and disability because most of the time they haven't thought about that person in a wheelchair getting laid," Nerdahl says. "They just assume they don't have a sex life because they're in a chair, and that's just not the case."

Legal grey area

The stigma is further complicated because Canada's prostitution laws have no provisions for services that blur the line between rehabilitation and sex work.

Currently, it's legal to sell sex and sex-related services, but illegal to purchase them. (Sex workers can be charged for advertising services or soliciting services but only if in the vicinity of school grounds or daycare centres.)

Kyle Kirkup, an assistant professor at the University of Ottawa's Faculty of Law, calls the current laws a "one-size-fits-all approach" that criminalizes the sex trade regardless of context or intent.

The current law doesn't include provisions for people with disabilities, or which deal specifically with services like Sensual Solutions whose intimacy coaches may come from clinical or rehabilitation backgrounds.

"A person with a disability who purchases sexual services would be treated exactly the same as any other person who purchased sex," he says.

"So it's a very kind of blunt instrument that doesn't actually do a very good job of contextualizing the reasons why people might pay for sex."

There are other countries, however, such as the Netherlands that view medically assisted sex in another way entirely; sex assistants' services may be covered by benefits, just like physiotherapy or massage.

This story appears in the Out in the Open episode "Enablers".