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Sex therapists talk with their patients to help them confront their sexual problems and improve their sex lives. But some patients need more than talk therapy. They need practice in the bedroom, and have no spouse or partner to turn to.
For these patients, some sex therapists turn to surrogate partners — people who help patients with intimacy issues using a hands-on approach. This can include having sex with the patient.
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Although use of surrogate partners is rare among patients of both genders, they are increasingly being used by
women whose physical or mental health problems prevent them from enjoying a healthy sex life , experts say. In the past, such therapy was employed almost exclusively by men.
"More and more women are now claiming their birth right to either have an orgasm, or healthy relationship or have sexual satisfaction," said Shai Rotem, a surrogate partner who is based in Los Angeles but practices internationally.
In his 14 years as a surrogate partner, Rotem has worked with women who have a condition called vaginismus, which makes sex painful , women in their 40s or 50s who are virgins and women who have experienced sexual trauma.
The practice is controversial, and most sex therapists don’t work with surrogate partners. Some question its legality, although no laws specifically prohibit surrogate partners, according to the International Professional Surrogates Association (IPSA). And the therapy comes with baggage, including the risk of the patient becoming attached to his or her surrogate partner.
But many experts say surrogate partner therapy has its place in sex therapy, and can be useful to the right patients.
Use by women
Surrogate partner therapy got its start in the 1970s and went through a boom period before dwindling in more recent years. At its peak, the IPSA had 200 to 300 members in the United States, but now has about 50, said Vena Blanchard, president of the IPSA.
Recently, there's been a rise in the number of requests to the IPSA from women patients, accompanied by an increase in certified male surrogate partners. Currently, about 35 to 40 percent of IPSA surrogates are male, Blanchard told MyHealthNewsDaily.
"There's been a steady increase in women taking ownership of their sexuality," Blanchard said. They don't just want sex therapy to please their partner. "They want to make their own lives better for themselves," Blanchard said.
The trend seems to be international. When the Tel Aviv Sex Therapy Clinic was founded in Israel in 1989, none of the patients were female. Now about 40 percent of referred cases are women, said Ronit Aloni, who heads the clinic.
What surrogate partners do
Surrogate partners work with their patients to build their communication skills and self-confidence, and help them become more comfortable with physical and emotional intimacy. Rotem said sessions are well-planned and less anxiety-provoking for patients than real-world sexual encounters, where anything can happen. "[This] is way safer than meeting strange men in a bar," he said.
Rotem begins with exercises in eye contact and hand-holding. Intercourse, when it happens, will be much later in the course of therapy. Every patient is different, but most of Rotem's patients require intercourse as part of their treatment, he said. Treatments usually last between three to six months, meeting for a total of 30 to 35 hours, Rotem said.
Rotem believes he has helped patients. One success was a woman in her mid-40s who had been emotionally abused by her father as a child, was afraid of men and had never had sex with a man, Rotem said. She recently contacted Rotem to say she had been dating a man for three months and was vacationing with him in Hawaii. Another patient with a similar case contacted Rotem to say she was getting married.
"They're not only sexually satisfied and sexually fulfilled, they have full-on relationships, they're loved," Rotem said.
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