Pleasure as Caregiving: The Ins and Outs of Facilitated Sex

A woman forms the logo for Hand Angel. (Photo:

When it comes to typical volunteer activities, you probably think of walking shelter dogs or helping out at a soup kitchen. But in Taiwan, there’s an NGO called Hand Angel, which promotes the sexual rights of people with physical disabilities by providing free hand jobs to those who are unable to pleasure themselves.

Hand Angel screens recipients to make sure that they are recognized by the government as being physically — but not mentally — incapacitated. Once approved, each person is entitled to a maximum of three hand jobs. The volunteers (there are 10, from a range of backgrounds) can caress the applicants and kiss them on the face, but penetration (finger, oral, intercourse) is off-limits.

Unsurprisingly, the service has come under fire, according to Vice, with Internet users posting comments like, “Do they also offer Mouth Angels?” and a Taipei official stating, “I don’t think we need to bring up disabled people’s sexuality as an independent issue. There are more important and urgent problems we need to deal with.”

But there’s also a groundswell of support for the concept of facilitated sex. “Facilitated sex, otherwise known as sexual assistance, is supporting a person with a disability along the whole spectrum of sexual expression,” sexuality educator Mitchell Tepper, PhD, author of Regain That Feeling, tells Yahoo Health. “That may mean helping someone arrange a date, setting up for masturbation and cleaning up afterwards, helping to transfer somebody into bed to be with a partner, or — in the case where both partners have disabilities — positioning them so they can make contact.” As one Hand Angel participant explained to Vice, “The whole process was full of respect and equality. This might be deemed as controversial by society, but … what we desire is no different from others.” 

Satisfying a need 

For people who don’t have a physical disability, it’s easy to take for granted partner sexual activity and engaging in solo pleasure. “Any disability that results in severe muscle weakness or paralysis can make it difficult for a person to engage in sexual activity on their own,” Tepper says. He points to examples like complete cervical spinal cord injury, cerebral palsy (which may result in paralysis and severe spasticity), and traumatic brain injury that affects planning, movement, and coordination.

Sexual rights advocates argue that sex is an essential need, the same as eating and bathing. And as such, people with disabilities deserve to have a means to access their sexuality. “Caregiving is intended to assist people with the activities of daily living that they would normally engage in themselves if they didn’t have a limitation,” says Linda Mona, PhD, founder and president of Inclusivity Clinical Consulting Services, and a clinical psychologist specializing in health psychology, sexual health, diversity, and inclusion. “Everyone has a right to have their basic needs met, and that includes sexual activity.”

So if an individual wants to engage in masturbation or intercourse, the question becomes whether he or she has the physical ability to do so. For some people, that may translate to help with transportation and access to social venues where they might mingle and eventually form a relationship. Others need assistance with setup (think: being given a vibrator, or positioning their hands to facilitate masturbation). Or they may require more direct aid, such as having another person’s hands on top of theirs to manually guide them to orgasm.

But many physically limited people don’t know where to turn for help with their private desires. Needless to say, it would be awkward to request sexual facilitation from their regular caregiver. Even more uncomfortable, 80 percent of people who are disabled are cared for by relatives, according to Mona.

(That said, family members stepping up to the plate is not unheard of, as evidenced in this Reddit AMA from a physically incapacitated man who received sexual assistance from his mother. Mona encountered a similar situation in her practice, where a mother helped her son with a disability prepare for masturbation.)

“As a result of the difficulties involved, the vast majority of people in this predicament simply go without expressing their sexuality altogether,” says Mona. “The emergence of Hand Angel is a reflection of the fact that we haven’t adequately addressed the sexual rights of people with disabilities.”

Although its status as a nonprofit is unique, Hand Angel isn’t alone in the quest to bring sexual satisfaction to people living with physical disability. Tepper explains that White Hands is a Japan-based business that, for a fee, provides hand jobs to those with physical limitations. TLC Trust in the U.K. and Touching Base in Australia allow people with disabilities to legally hire sex workers.

In the U.S., sexological bodywork is a profession where certified sexologists help individuals and couples — including those with physical or mental limitations — get in touch with their sexuality using methods like breathing techniques and erotic massage. The educators are certified by the state of California, and since most of the work doesn’t require direct genital touching, it is legal in many countries, including America.

Related: My Boyfriend Has a Disability. So What?

Then there’s sexual surrogacy, also available in the U.S., where a surrogate partner engages in intimate activity with a client as part of therapy“Although people are not paying for a specific sexual service, this has always existed in a gray legal space,” Tepper says. To date, there has never been a case brought against a surrogate.

Even brothels and sex toy companies are getting in on the cause: Mustang Ranch in Nevada provides discounts to people with disabilities on Sundays. SportSheets has a line of toys dedicated to assisting those with physical limitations, and Liberator Sex sells cushions that are strategically designed to help people get into sex positions with more ease.

Mona points out that in some European countries, including the Netherlands, the government provides funds to cover up to 12 months’ worth of sexual services to the disabled, because people are more well-adjusted and function better overall as a result. Indeed, research shows that sexual activity — including masturbation — improves physical and psychological health.

A values clash

At the same time, the idea of facilitated sex can challenge the core ideologies of both the recipient and the giver. “If the options available don’t fit someone’s value set, they need to ask themselves what their priorities are, and whether it’s worth it,” Mona says. “It boils down to what the individual feels comfortable with and whether they have resources for navigating their sexuality.”

In her practice, she brainstorms what clients are comfortable with based on their moral and religious beliefs. For instance, if they aren’t capable of participating in sexual activity on their own but don’t want to ask for assistance, fantasy, erotic reading, or an X-rated film might be avenues to explore.

Related: 8 ‘Helpful’ Things That Don’t Really Help People With Disabilities

And while the idea of getting off via emotionless sex may not sit well with many people, services like Hand Angel aren’t purely playing to animalistic instincts; they can be a meaningful source of intimacy. “Often, people with a disability only experience touch in a medical sense, like by a medical doctor or caregiver,” Mona says. “To be assisted with touching in an erotic way allows them to form a human connection that they’ve previously been cut off from.”

Tepper adds: “Intimacy doesn’t necessarily mean being in a long-term relationship where you share all of your deepest feelings. It can be expressed through a brief episode of mutual caring.”

Facilitated sex also allows people to get in tune with their own bodies. “Disabled people are frequently divorced from their bodies in a number of ways,” Mona says. “This is a means for them to physically reconnect with themselves.” In her clinical experience, clients who have pursued erotic assistance say that it’s a powerful, positive experience. “People report that they feel whole again,” she adds. “The quote I hear time and time again is, ‘I finally feel human.’”

On the giver’s side, the comfort level depends on his or her role. “Most regular caregivers will agree to set someone up for masturbation but won’t hold a vibrator,” Mona says. “As the level of need increases, the level of discomfort increases.”

But trained professionals, like surrogates or sexological bodyworkers, have few moral qualms. “They generally find the work of helping people explore their sexuality to be extremely rewarding,” Tepper says.

That said, even if both parties are onboard, it’s tricky ground to navigate. For one thing, there’s a safety issue: “If you have a vulnerable person, are you putting them at risk for physical or sexual abuse?” Mona says.

For another, it’s a loaded topic in terms of legality. “It’s not lawful to pay for sex, but hiring a facilitator to assist you with sex, rather than engaging in a sexual act, is a different question,” Mona says. “Still, I’ve been told that facilitated sex would never hold up in court.”

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