In the film The Sessions, a man paralyzed by childhood polio and mostly confined to an iron lung seeks the help of a sexual surrogate to learn how to fulfill his yearnings for physical intimacy.
The movie tells the real-life story of American writer-poet Mark O'Brien (John Hawkes) and how he lost his virginity at age 38 under the gentle guidance of Cheryl Cohen Greene, a certified sexual surrogate portrayed by Helen Hunt.
Pulling no visual punches – it includes Hunt with full-frontal nudity – The Sessions dispels the widespread notion that people with disabilities have no interest in physical intimacy, while encouraging them to embrace their sexuality in whatever way they can.
According to the Los Angeles-based International Professional Surrogates Association (IPSA), only a few dozen sexual partner surrogates are now practising in the United States, and similar therapy is offered by clinics only in a small number of countries, among them Israel and England.
"It's not very common any more, it was more common in the seventies," says Cory Silverberg, co-author of The Ultimate Guide to Sex and Disability, written with fellow Canadians Fran Odette and Dr. Miriam Kaufman.
Silverberg, a sexuality educator working in New York, says he's not aware of any certified sexual surrogates offering services in Canada or affiliated with the IPSA.
"The thing about the sexual surrogate that makes it different than a sex worker is they always work in collaboration with a certified sex therapist," he says.
Indeed, the IPSA points out that surrogate partner therapy, based on methods pioneered in 1970 by Masters and Johnson, includes a client, a sex therapist and surrogate partner working together as a team. Clients can include people with disabilities or anyone with issues related to sexual expression.
Sex therapists talk one-on-one with patients, while surrogate partners work with the clients on relaxation, communication, and sensual and sexual touch.
"Sex therapists are all talk. Surrogate partners are talk and touch," association president Vena Blanchard explains on the IPSA website.
In Canada, there are a number of other avenues for people with disabilities to explore their sexuality.
At the Come As You Are sex shop in downtown Toronto, co-owner Sarah Forbes-Roberts says staff go out of their way to help customers with disabilities, creating a comfortable and supportive environment.
The philosophy of the shop, a worker-owned co-operative, has always been one of inclusion.
"From the day when we first opened 16 years ago, our space has always been physically accessible," says Forbes-Roberts. "It seems like a minor thing, but it's a huge deal. At most retail stores, most people with disabilities can't get through the door if they're using a wheelchair."
Many of the shelves and racks displaying products – from sex toys and physical aids to books on sexuality – are located at eye level of customers in wheelchairs.
"We are also very careful about the products we carry in the store," she says. "And we look for products that might have a better switch on them or might be easier to position the body against.
"A lot of people have multiple disabilities. There are lots of kinds of disabilities. So we really work with the person on a one-on-one basis to figure out what their needs are."
"Our philosophy is that everybody is entitled to explore healthy sexuality, no matter what that means to them – and that means something different for everybody."
The Sexual Awakening Centre in Toronto also welcomes people with disabilities, offering workshops, lectures, training courses and private coaching.
"We will work with anybody who is inquiring about exploring their sexuality," says owner Atia Marie, a former sex worker who uses only her first two names.
"We don't offer sexual surrogacy," she says. "However, oftentimes in our work people will be inquiring about how to enhance sexual pleasure. So we can share traditional tantric practices for enhancing their awareness of energy moving through the body, even if they had an injury, for example, where they are paraplegic.
"There's still ways to access pleasure through their bodies, even if it doesn't translate directly to their genitals."
In Vancouver, a non-profit advocacy and education organization for people with physically challenging conditions, called EASE (Equitable and Accessible Sexual Expression), has endorsed Sensual Solutions, a for-profit company that provides sexual coaching and escorts to people with disabilities.
"So far, it is only for men, women and couples who have physical disabilities, challenges, injuries," says the owner of Sensual Solutions, who prefers to be known only by her first name, Trish. "So mostly (people with) spinal cord injury, paralysis from stroke, cerebral palsy, those have been our biggest clients so far and we do offer services to people with muscular dystrophy and ALS."
Trish says that while working part-time as a phone receptionist for an escort agency, she would have conversations with men with disabilities "who just wanted some time and either weren't doing that well on the dating circuit or on their personal attempts to try to have relationships."
But escorts at the agency either didn't feel comfortable or felt they had inadequate knowledge to deal with the needs of clients with disabilities, she says.
After assembling a focus group of men with disabilities to discuss their needs, creating a business plan and running the idea past her own doctor, Trish decided to fill that niche.
"I see the vulnerability in our clients and our people come in and help with that so they don't feel that they're going to be robbed or taken advantage of," she says.
"Because our sensual coaches, while some of them might be nurses or personal care aides in their regular job, some of them are not. Some of them are massage therapists, tantric practitioners, sex workers, and they really have been drawn to this. They want to be of service."
Sensual Solutions, which is licensed by the City of Vancouver as an escort agency, makes house calls and charges $225 an hour, with graduated discounts for longer sessions.
Asked how her service differs from prostitution, Trish says the company's sexual coaches "are specifically there to work on certain intimacy issues with the client ... the goal is to help clients find new ways of pleasure.
"Let's be honest, I have to follow the law, but these people want intimacy, they want touch," she says.
"So part of their body doesn't work. How can we help them re-align their erogenous zones somewhere else?
"It's about trial and error, it's about feeling very comfortable with the client and treating them with dignity and respect."