Sex workers can play an important, if controversial, role in boosting confidence and quality of life for people with profound disabilities. Here pioneering sex therapist Tuppy Owens tells Andrew Mernin why it’s time to stop running away from the issue.

“Just because people are disabled, doesn’t mean they don’t have sexual urges,” says Tuppy Owens, who has spent decades helping people with disabilities enjoy sex and find love.

Owens is a sex therapist, campaigner, published author and former adult model. She is also founder of the TLC Trust, which helps disabled people to access sex workers safely.

Users visiting the site can browse a database of sex workers who have been vetted by TLC to check they can provide a safe and understanding experience for people with a range of disabilities; including those related to brain and spinal injury and neurological disease.

Tuppy Owens

TLC is closely linked to the Outsiders Club, also founded by Owens to help people with social and physical disabilities find partners, make friends and enjoy “peer support”.

After “helping a couple of disabled guys get laid” in 1978, she formulated plans for a club run by and for disabled people looking for friendship, romance and support.

The link between experiencing sex – via TLC – and finding love, possibly through the Outsiders Club, is absolutely intrinsic, believes Owens.

Crucially, sexual services can help to build the self-esteem and confidence needed to enter a loving, intimate relationship.

“If a disabled person feels nervous about starting a sexual relationship because they don’t really know what their bodies are capable of, they could go to a sex worker a couple of times so that they could be a better lover when they do find a partner.

“We don’t know how many sex workers are hired, how many disabled people use them or how they find them. Often their assistants or healthcare professionals will organise it for them because they are better [technically].

We vet both the sex workers and the people who want to join Outsiders to make sure the disabled people are safe.”

The legal aspect of helping disabled clients access sex workers is fraught with risks. At a very basic level, the individual must have capacity to make a choice about consenting to sex. But professionals looking to help clients visit a sex worker must of course consider a range of legal and other implications (as case manager John Walker explains below).

Owens’ mantra on the issue of legality is that: “It is illegal not to support disabled people to enjoy the same pleasures as others enjoy in the privacy of their own homes, under the Equality Act 2010 and the Human Rights Act 1998.

“This is great because when someone complains that they aren’t allowed to have sex, I can quote those laws and they have to go back to the person who won’t allow them to do it and say that’s illegal to stop them.”

TLC-vetted sex workers may visit the client’s house, offer services at their own accessible property or at a hotel.

In a residential care setting, Owens says, “there is usually someone running the home” that wouldn’t allow this sort of thing to happen on site.

“Care homes are becoming more interested but whether they would actually allow sex workers in the home is another thing.”

In terms of criminal law, the exchange of sexual services for money is legal in England, Wales and Scotland. A number of related activities are illegal, however, including soliciting in a public place, kerb crawling, owning or managing a brothel and pimping. Prostitution is illegal in Northern Ireland, meanwhile.

“People think sex work is still illegal in this country – even people who should know better,” says Owens.

Once the legal minefield is navigated, other challenges may arise, including the potential threat of emotional attachment issues.

Owens says: “If a person gets too keen on just one sex worker, we might suggest that they find another one because we don’t want them to fall in love. Obviously, a sex worker may have lots of other clients so there’s no point in getting too attached.”

Aside from mere pleasure, there are many other reasons why a person would choose to visit a sex worker. According to TLC, a common motivation for site visitors is to be taught what their bodies are capable of and how to please a potential partner.

Some users seek a “girlfriend or boyfriend” experience – pretending to be partners either in public in a non-sexual way or in the bedroom – or wish to lose their virginity. Others may be unable to achieve an orgasm alone, while acceptance is also an important factor.

TLC says: “Sexual expression may mean many things, and disabled people need to know that you will not be judged by your requests, however embarrassing you find them. People who provide sexual services have heard it all before, and are totally discreet.

“For many disabled people, just being in a warm set of arms, and having their bodies accepted, is incredibly powerful and helps to build your sexual confidence and walk tall ,or wheel tall, in the world

“Having your sexuality taken seriously without stigma or disapproval can be liberating and life-changing. For some, actually enjoying an orgasm at last can bring your life into balance.”

While male users may instigate the use of one of TLC’s vetted providers, women are advised to contact TLC first as it can be easy for them to “be lured by unprofessional guys”.

Owens says: “There tends to be more men looking for sex workers than women. With TLC I always tell women to ring me first so I can walk them through it. I want to be absolutely sure that they have a nice time – and that always works.”

An anonymous female user of services promoted on the site says: “Due to a combination of ill health and traumatic personal experiences, I had spent a long period of time avoiding physical contact and intimacy, but had reached a point where I felt confident enough to address the situation.

“I had many concerns, about safety especially, but I liked the way the website gave no- nonsense information and everything seemed very open…I was keen to work with ‘professionals’, as I thought that after all they knew what they were doing and also working with people with all kind of issues, disabilities and health issues meant they had experience of dealing with situations that might not be easy/ obvious for others to deal with.”

The woman was initially advised to meet a practitioner who offered a full body massage to help her to reconnect with herself physically; before considering taking the next step.

She says: “I was extremely nervous but the gentleman providing the service was kind, professional and at all times made it clear that I was able to stop anything that I did not like. In the end, everything went well and was far less difficult then I expected.

“Having taken this first step I then corresponded briefly with the second person I had been put in touch with and set up a booking. Again, the practitioner was lovely, caring, very open and had a great sense of humour and he made me feel safe at all time.

“Both experiences have been really helpful and, in some way, much less of a big deal than I thought they were going to be, in setting me back onto the path of being ‘physical’ again.”

Owens founded the TLC Trust in 2000 with the support of a disabled man who had reached his mid-40s without losing his virginity. Since then, scores of sex workers have been vetted and joined, with many happy customers along the way.

Among them was the young lady who wanted to buy herself a “birthday shag” for her 21st, and a man whose parents sought out a sex worker to help him have his first sexual experience at 38.

Owens would like to see disabled people’s desire to experience sex and love being taken more seriously by the professionals around them and society in general.

“Things haven’t really moved on in recent years, in fact I think they’ve gotten worse. Often people come to the Outsiders because they have been very lonely.

“Not only do they not have a good sex life, but they may have few friends, which is terrible. Even if they don’t end up finding a relationship they’ve been given the confidence to flirt and do other things that help to form relationships.”

Owens, who won a UNESCO award in 2015 for her innovative approach to sexual health and human rights, sees sexual services as empowering and positive to people with severe injuries – not shameful or something to be embarrassed about.

Could their costs therefore be factored into an individual’s care package? Owens would like to see this, although she is doubtful it will happen anytime soon.

“When you think about how much compensation a brain injured person requires, how much would they need to hire a sex worker [regularly] from when they were injured?

Obviously when they are younger, they would have a sex worker more often, maybe twice a month, then a bit less when they are 50 or so and less again when they are 80. It could be quite expensive overall.”

The prospect of sex workers becoming just another intervention on the rehab journey seems somewhat remote.

However, as Owens has long argued, sex is an integral part of the human experience and simply ignoring it under a cloud of taboo benefits no-one.


Sexual services and rehab – a case manager’s view

When a client asks to visit a sex worker, professionals must navigate a tricky terrain with no manual to guide the way, writes brain injury case manager John Walker.

The matter of clients using sex workers predisposes that they have the mental capacity to engage in that relationship. Having the capacity to have sex is a different question from having the capacity to utilise a sex worker however; and from a legal point of view, this is a foremost consideration.

Another consideration is the notion of the law of unforeseen consequences, in that embarking on the arrangement could result in all sorts of unexpected results.

It is therefore incumbent on a professional such as a case manager to risk assess the whole process as best they can.

There is also the potentially complex situation that surrounds the client’s family. The adult brain injured person rarely exists in isolation, but rather in the context of their family.

Understandably, families affected by severe injury tend to be more risk averse and protective, although sometimes, for example, parents who you may expect to be antagonistic towards the idea of sex workers, can actually be very liberal about it.

But overall, the case manager may be faced with very divergent views from the various people in the client’s life. Even after these challenges have been addressed, there are some relevant legal barriers that must be overcome before you consider putting a client in touch with a sex worker.

One part of the law determines how the process is driven along. Any practitioner in the area must be very clear that they are not, in any way, causing or inciting the process to take place.

Sections of the Sexual Offences Act 2003 ensure that the individual with whom the client would engage, for example, is not underage and is operating in the UK freely of their own volition.

Practitioners have to be very mindful of the legal context and make sure they are operating within criminal law. They must also navigate the fact that lots of bits of legislation can have contradictory effects in the UK.

Of course, as Tuppy Owens mentions in her interview, there are also relevant elements of the Equalities and Human Rights acts, which help to make a strong case for access to sexual services by disabled individuals.

It is important to stress that the majority of brain injured adults who express an interest in visiting a sex worker never go on to do so.

From a rehab perspective, the issue may be approached as a problem-solving exercise. The client might tell you “I want this” but because of their brain injury may not be aware of the range of different factors in achieving it.

Working through the barriers to fulfilling this aim doesn’t mean the client will necessarily achieve it; but the process of pursuing it can serve as good cognitive, psychological and emotional practice that might better equip them to deal with life in the future.

At the same time, taking a client’s sexual requirements seriously is important and can positively influence their rehabilitation.

While most sex-related issues that occur after a brain injury are those that affect existing intimate relationships, some clients will indeed seek a sex worker visit. They may see the process as a stepping stone towards having the skills and confidence to pursue a loving relationship.

Sex is a very basic human need and without it people can become frustrated. After a
brain injury, what wasn’t necessarily a driver towards behavioural problems could become a contributing factor to the overall difficulties the client has.

Obviously, sex is also closely linked with self-esteem and self-worth. There is certainly anecdotal evidence that young men with brain injuries can benefit from a safe, carefully arranged sexual encounter.

For various reasons, including greater frequency of brain injury prevalence, this client group seems to be the most likely to seek sexual services after injury.

If clients have difficulties with inhibitory control caused by the brain injury, addressing their sexual frustrations could help to reduce possible behavioural problems in the community.

There are a number of different agencies who deploy sex workers with experience of working with clients with neurological impairment.

Clearly there is no prescribed method to helping clients narrow this field. Instead, the process involves conversations with agencies to work out whether there is someone with the adequate experience conveniently located for the client.

In the entire management of this tricky issue, case managers can find themselves operating from two very different positions. One is from the perspective of care and nurture and a commitment to introducing new experiences where possible.

The other is slightly opposing in nature, with a remit of control, risk management and consideration of the law. Always being aware of your position on this spectrum can help to manage the situation in the interest of the client’s wellbeing.

In summary, there is no guide book on this topic for brain injury professionals and each case must be considered in its own context. Based on my own experience I would strongly recommend discussing the issue as a multidisciplinary group – and definitely do not ignore any sexual concerns your client has, however awkward the topic may seem.

John Walker is a brain injury case manager who runs Education and Case Management Services with his wife Judith James.


From marital faux pas to dating game pitfalls

How occupational therapists play a key role in unlocking the power of sex in rehab.

Occupational therapy, as defined by the NHS, is supporting people whose health prevents them from doing the activities that matter to them.

When the slightest mention of the activity provokes mass embarrassment among clients and their families, however, the field becomes particularly challenging.

But such awkwardness must be overcome because sex really does matter and can have a huge influence on an individual’s life after brain injury.

So says Rachel Lees, a specialist occupational therapist (OT) at Neural Pathways, which provides therapy and rehab services for people with neurological conditions.

“It’s so important. Sex is a massive thing but as soon as you get to the topic, everyone panics and shys away from it. But it’s an important human need and part of helping people get back their quality of life.

“As OTs we look at everything holistically. We have a duty of care to support the client if they want to get into a new relationship or need help with an existing one as it’s such a huge part of anyone’s life.”

The impact of sex and intimate relationships on any individual extends far beyond the bedroom walls; for brain-injured adults in rehab, failing to meet these basic desires can be hugely disruptive to their recovery.

Lees says: “I had a client who was getting really down because he wanted companionship – a relationship and everything that comes along with that.

“It was impacting on his performance in other areas of his rehab. Because he was feeling low and had self-esteem issues, he was getting frustrated and agitated.

“Not having sexual and relationship needs met might increase frustration and anxiety and affect self-esteem. It really can affect everything.”

As well as helping clients address sexual and relationship needs, OTs in multidisciplinary teams are key in assessing whether they have capacity to consent to relationships.

Part of this involves considering how sex or a relationship would impact on the rest of
their rehab.

As an OT, Lees has never been involved in facilitating a brain-injured client’s visit to a sex worker or escort. She has, however, helped them to overcome the anxiety that might precede a planned sexual encounter.

A crucial part of her role is helping clients deal with behavioural changes that can affect relationships.

“After a brain injury, sexual and social disinhibitions rise quite commonly and people can become more inappropriate. They may have never said anything inappropriate before their injury but now they just can’t filter it out.”

This can cause obvious problems in marriages and other relationships that pre-dated the injury.

“Their partner could be embarrassed by their behaviour. For example, I had a client who was out with his wife and paid attention to, and made a comment about, another woman’s breasts. So it can be a bit embarrassing.”

Similar challenges occur when single clients attempt to navigate the dating game in an age of Tinder and other instantly accessible apps.

“They may need support workers to act as the filter they no longer have or be that person looking over their shoulder who says: ‘Do you think that’s an appropriate thing to say? How can we make it more appropriate?’”

While sex and relationships influence an individual’s overall wellbeing, they can also be a useful area in which to hone problem- solving skills.

Even the mere process of going on a date can involve numerous tasks that may be highly challenging for a person with cognitive difficulties. Overcoming them with the help of the OT can be an important part of rehab.

“A lot of clients don’t have the skills to use computers because of their cognitive impairments. They go online and struggle to write information about themselves – so they struggle in terms of putting a dating profile together and we can work on their computer skills.

“Then, if they are going out for a date, do they need support to attend it? How do they budget for the date? What would they wear? There is a whole list of things we could get involved in as an OT as part of their rehab programme. We often look at pros and cons of different options and then seek a solution to each problem.”