Sexual surrogate therapy melds physical and emotional contact in order to help individuals discover and develop a healthy sexual identity. Developed in the early 1970s at the University of Missouri by Masters and Johnson, sexual surrogacy is used to treat a plethora of ailments, concerns and insecurities from the perspective of all sexualities and genders. Sexual surrogacy aims to build on the clinical sphere with physical human contact. However, the line between prostitution and sexual surrogacy may appear nonexistent for some.

After all, surrogates, the majority of whom are women, receive money for their services, which invariably include performing and receiving sexual acts. While some argue this will only lead to the further demoralization of our society, others find faults with the therapy itself, remarking on the instability of human emotions and sexual feelings and the danger of destructively violating an individual’s space and mind.

Many professional medical associations have in fact banned the use of such therapy while many more professionals remain skeptical. Conversely, many professionals insist that surrogacy helps. In many other countries, such as Israel, people are mostly amenable to the treatment mainly pertaining to the rehabilitation for injured soldiers. Although legal in the United States, surrogacy remains taboo not only for some of the psychiatric community but it piques the concerns of the general public as well.

Surrogates, on the other hand, insist their practices are a physical, yes, but also an emotional form of therapy. Some go even further, asseverating that “surrogacy is much more cerebral than prostitution.” One such surrogate avers this sentiment explaining that she needs “to figure out what the underlying issues are, and put the pieces together very quickly.” Sex workers, on the other hand, serve a sole sexual purpose and the reward is instantaneous, whereas surrogate therapy transcends the immediate by teaching a client how to develop their sexuality and social abilities by coaxing them to explore their underlying concerns. Their function then goes beyond the corporeal as they serve as an “educator, counselor and co-therapist.” Their goal is not to make their clients achieve orgasm, but aid them in discovering their sexualities, and ultimately build a strong and confident sense of self.

Further, in most cases, intercourse is a rare occurrence. Although research on sexual surrogacy is relatively scarce (one of the reasons surrogacy takes heat in the medical community), one study reports that approximately 90 percent of the time is spent doing nonsexual exercises. Through honest conversations and hands-on experience, surrogates help their clients conquer social and sexual insecurities and elevate self-esteem.

Surrogates should also be differentiated from sexual coaches who educate people on enhancing their sexual expression to become better lovers. In addition, these surrogates are trained and work with a therapist in order to delve beyond good sexual technique so their clients can experience a healthy sexual and social existence.

The International Professional Surrogates Association (IPSA) estimates around 100 surrogates are practicing in the United States, though they are only aware of 40. Overwhelmingly, they are well-educated, Caucasian females dealing with heterosexual males. The average age of surrogates is 39 years and most live in California and tend to be married with kids.

Heterosexual male surrogates are the rarest, conceivably due to double standards within our culture.However, the variant reasons people see therapists span all spectrums of sexual concerns and issues. Surrogates address specifically male sexuality problems, such as premature ejaculation, impotence, or concerns over penis size. Female-based concerns are also addressed by surrogates, as they can focus on female orgasm difficulties as well as menopause. Surrogates can also work with couples to help foster a better sexual connection (curing “dead bed” and incongruity in sexual desires) as well as a stronger emotional bond, helping couples improve communication and intimacy skills.

Surrogates also help individuals who are outside of conventional sexual and gender identities, such as those with fetishes, sex addicts, cross-dressers, transvestites, transsexuals, and those confused by their sexuality or gender. They also help those resolving their sexualities at odds with aging, disabilities, deformities, and medical effects. But surrogates treat issues beyond the bedroom as well, by helping clients hone their social skills in the dating scene when faced with divorce or widowhood as well as shyness and self-deprecation.

Surrogates treat these issues over an average of a 6-8 month span and under strict professionalism in order to curb romantic feelings developing on behalf of the patient and are not directly hired by clients, but set up by their therapists. Intensive sessions from 6 to 12 hours are offered for visitors from out of town. The actual therapy is slow and gradual with various exercises helping the clients change their negative body image and sexuality concerns. About a third of the time is spent in conversation with the client relaying sexual information and offering encouragement and support and a mere 13 percent is dedicated to sexual activities, with body awareness, relaxation, and body image exercises constituting the majority of the time left.

Sensate focus sessions are deliberate and gradated exercises designed to teach individuals how to become intimate and comfortable with other peoples’ bodies as well as their own. In the first stage of the activity, the client explores the surrogate's body, excluding breasts and genitalia, noting in silence the different textures and curves of their partner’s body and then when it is their turn, experiencing caressing for themselves. In the second stage, clients are permitted to touch the genitals in addition to the greater body but with the same purpose: exploration and awareness, not sexual arousal or climax. Through ‘hand riding’ the person being touched subtly informs the toucher what feels good by placing their hand on top of his or hers, indicating desire for a change in pressure, speed, or to move to a different spot. In the third stage mutual touching is permitted, but intercourse is still forbidden. In ensuing stages, the woman may move on top but still without intercourse occurring. By gradually desensitizing the fear of corporal intimacy and by banning intercourse alleviates performance pressure or expectations and, thereby, individuals are liberated from debilitating conceptions.

However, ignorance as to what a surrogate actually does and skepticism by some psychiatric professionals taints the surrogate’s work and aims. Critics take offense to sexual surrogacy arguing that it creates a slippery slope towards legalization of prostitution, ultimately threatening the moral roots so deeply entwined in our country’s founding history. More research is needed on the benefits of the surrogate therapy until a more educated and accurate understanding of the practice can exist. Further, most surrogates have no follow-up of their patients considering it too invasive.

Until concrete knowledge is accrued, controversy over surrogacy in the medical field remains heated. It is in the very nature of sexuality to be dangerously intimate and complex and as a result many argue that surrogacy is too risky and violates a major tenet of therapy. Psychiatrists are not permitted to sleep with their clients; however, the law makes up for this concerning surrogates by forbidding paid sexual activity with the mentally disturbed.

As a sexual counselor at the Royal Women’s Hospital explains, “forming [an] emotional and dependent relationship with someone you are paying . . . If your aim is helping people form satisfying sexual and emotional relationships, [is] counterproductive.” Surrogates and their supporters would rebut that they are functioning in the same manner as psychiatrists, aiding their clients to overcome their negative body issues and sexuality concerns and become comfortable, confident and happy in their own skins. If the methodology is in question, how else is a person going to get over their fear of sex?

Despite protests and lack of data on the efficacy of sexual surrogacy, it appears to be not only productive but legitimate. Through controlled and careful sessions with a sexual surrogate, people of all genders and sexual orientations work to overcome a myriad of disabilities and anxieties they would otherwise never have surpassed. Physical, in conjunction with emotional contact, ensures a more complete address and rectification of the specific issue at hand.

One surrogate asserts that her “passion is to help [people] rediscover [their] sensual spirit. [She] leads [them] through a reawakening experience that will free [their] heart, ignite [their] sexuality and enable [them] to live a more open, unrestricted life.” It’s therapy that seeks to have the individual live the most pleasurable life. Indeed, who can say that’s not a noble endeavor?