Disability and the male sex right

This article explores the connection between disability and the sexual rights of disabled men, particularly in relation to prostitution and sexual exploitation of women with disabilities. It discusses the construction of male sexuality and its impact on women with disabilities, who are more vulnerable to sexual assault and harassment. The article argues for the need to disaggregate the concept of sexual rights according to gender.

Disability and the male sex right
Sheila Jeffreys
School of Social and Political Sciences,University of Melbourne,Victoria 3101,Australia
a r t i c l e i n f o s y n o p s i s
Access to prostituted women is increasingly justified by disability charities and services on the
grounds of the sexual rights of the disabled.In Australia,for example,disabled men form a
niche market for the legalised prostitution industry. Male sexuality is constructed out of male
dominance and is likely to manifest the eroticisation ofhierarchy and the idea that males
should have the sexual right to access the female body. This model of sexuality poses problems
for all women in the form of sexual harassment and violence, pornography and prostitution. It
poses particular problems for women with disabilities who are more vulnerable to sexual
assault and harassment from carers and disability fetishists.The sexual rights idea does not
generally take gender into account. Thus sexual rights for men with disabilities can include the
right to pay for or demand sexual servicing from women in prostitution, nursing or caring work.
This article seeks to disaggregate the notion of sexual rights according to gender.
© 2008 Elsevier Ltd.All rights reserved.
Introduction
In this article I will look in an exploratory way at several
issues concerning disability and sexual exploitation that
might seem at first to be distinct.They include the sexual
abuse of women with disabilities and the prostitution of
women with disabilities, the exploitation of prostituted
women by men with disabilities, and men's sexual fetishising
of women with disabilities. The connecting factor is the
sexuality of male dominance. In relation to sexuality, disabled
men may pursue interests that are in stark contradiction to
those of disabled women. Organisations supporting men with
disabilities campaign for their sexual rights which may mean
using pornography and prostituting women.These forms of
sexual exploitation teach and represent an objectifying
sexuality.It is precisely this form of sexuality that disabled
women suffer from,in the form of unwanted sexual contact
and the fetishising of disability. It is important to disaggregate
the interests of men and women when considering the issue
of disability and sexuality.
Feminist disability theorists have been working for three
decades to provide an understanding of disability which takes
gender into account (Morris, 1989; Fine & Asch, 1988;
Matthews,1983).They have pointed out that women with
disabilities can be seen as at least doubly disadvantaged i.e. by
discrimination on the grounds of gender and disability,and
often by a third form of exclusion and discrimination in the
form of racism as well (Begum, 1992).They have shown that
the model of rehabilitation of people with disabilities that the
medicalmodel of disability promotes,has a male body and
male sexuality in mind.Rehabilitation programmes seek to
cultivate ‘competitive attitudes’and address ‘concerns about
male sexuality’.They are about ‘enabling men to aspire to
dominance notions of masculinity’ whilst ignoring the needs
of disabled women (Begum, 1992: 72). Feminists have
criticised the understanding ofsexuality that is applied to
women with disabilities by doctors, in which they are seen as
functionalif they have a usable vagina for a male partner's
satisfaction.This is a very masculine model which does not
countenance women's pleasure, the clitoris, and more
imaginative approaches which do not have to be focused on
penis in vagina sex, or even heterosexual (Titchkosky, 2000).
Feminist approaches to disability have given little attention,
however,with the notable exception of the work of Amy
Elman,to the need to disaggregate the concept of the sexual
rights of the disabled (Elman, 1997).
Feminist theorists have also criticised the limitations of
the ‘socialmodel’ of theorising disability.This article starts
from the understanding that disability is to a large extent
socially constructed (Oliver, 1990), an approach that has been
termed the ‘social model’ of theorising disability (Lloyd,
2001).According to this approach the problems that women
Women's Studies International Forum 31 (2008) 327–335
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with disabilities face are not the sad but inevitable result of a
biological or acquired flaw,and an individual responsibility.
The disabled experience problems such as violence and
penury because the societiesin which they live do not
acknowledge persons with disabilities and want them to be
‘out of sight, out of mind’ (DVIRC, 2003). The values of
capitalist societies based on male dominance are dedicated to
warrior values,and a frantic able-bodiedness represented
through aggressive sports and risk-taking activities which do
not make room for those with disabilities.Feminist critics
have pointed out, however, that the social model can
reproduce a form of mind/body split, by downgrading the
lived experience ofthe body which is not merely a social
construction. It can serve to obscure the very real experiences
of pain, for instance, that women with disabilities face
(Titchkosky,2000).Women's physical experience of impair-
ment will affect the ways in which they are vulnerable to
men's violence,and the forms that this takes. But sexual
violence againstwomen with disabilities is also a classic
example of how the problems of disability are socially
constructed.This violence is founded on the male sex right,
a construction of male dominance, and enabled by economic,
mobility and emotional factors that women with disabilities
suffer as a result of the obstacles placed in the way of their
integration into an able-bodied world.
The sexuality of male dominance is based upon what the
political theorist,Carole Pateman,calls the ‘male sex right’
(Pateman,1988).This is the privileged expectation in male
dominant societies that men should have sexual access to the
bodies of women as of right. Such societies organise delivery
of this access to men, and the removal of obstacles, in various
ways. This can be through the provision of legalised
prostitution or the tolerance of illegal prostitution.It can be
through enabling the creation of other aspects of the
prostitution industry such as pornography,strip clubs and
sex phonelines (Jeffreys,in press-a).It can be through child
marriage in traditional societies or the early sexualisation of
children in the west (Moschetti, 2006).
In relation to disability this law of the male sex right leads
men and boys to sexually abuse women,girls and boys made
vulnerable to them by virtue oftheir dependence on male
carers, or through institutionalisation. It leads to the provision of
prostituted women to men with disabilities (see Sullivan, 2007),
the provision of what are euphemistically called ‘sex surrogates’,
or even the requirement that nurses and carers masturbate men
with disabilities,which is called ‘facilitated sex’(Earle,2001;
Davies, 2001). It also leads men who fetishise and get sexually
excited by women's disabilities to harass women amputees and
seek sexual access to women with disabilities through various
forms of exploitation and trafficking,the mail order bride
business, prostitution and pornography (Elman, 1997).
The fetishising of disability comes from the way in which,
under male dominance, male sexuality is constructed to
eroticise hierarchy and to objectify.As the radical feminist
legal theorist,Catharine MacKinnon,points out,gender is a
hierarchy,and it is the eroticising of male dominance and
female subordination that forms the foundation ofwhat is
commonly understood as sex in male dominant culture
(MacKinnon, 1989; Jeffreys, 1990). The eroticising of hierarchy
by men is not restricted to gender.Other forms of hierarchy
are eroticised too, such as age in paedophilia, race in relation
to the racist sexual stereotyping thatunderpins the male
interests ofusing exotic prostituted women,such as those
who have been trafficked or are available in sex tourism
destinations (Jeffreys, 1997). Disability provides another
hierarchy for eroticisation.Women with disabilities offer the
double delights of gender inequality and disability as sources
of sexual satisfaction to dominant male sexuality. Thus some
men come to fetishise women's disability (Elman, 1997).
Some of those men who sexually fetishise disability seek to
become disabled themselves,usually through amputation of
limbs (Elliott, 2003). This condition is commonly called
amputee identity disorder or BIID (Body Identity Integrity
Disorder).The power and influence of the male sex right is
indicated in the fact that a movement to get amputation of
healthy limbs available to such men is under way with the
support of respected psychiatrists and surgeons,such as the
editor of the US Diagnostic and StatisticalManual, Michael
First (First, 2004).
Despite the rather clear differences in the ways in which
male and female sexuality are constructed under male
dominance,when disability studies have approached the
issue of sexuality they have notusually disaggregated the
interests of women with disabilities from those of men with
disabilities. When sexuality is addressed in the literature this
often fails to mention the problem of sexual exploitation that
women with disabilities face. The definition of sexual
exploitation that I use comes from the United Nations Draft
Convention Against Sexual Exploitation (1991) in Defeis
(2000, p.335).
Sexual exploitation is a practice by which person(s) achieve
sexual gratification,or financial gain, or advancement,
through the abuse of a person's sexuality by abrogating that
person's human right to dignity,equality,autonomy,and
physical and mental wellbeing. (For discussion of this Draft
Convention and the text see: Defeis, 2000).
Prostitution and pornography are included in this under-
standing as sexually exploitative practices.In this article
sexualexploitation means gaining access to sexualuse of a
person's body by means of any form of unequalpower e.g.
payment, force or its threat, emotional manipulation by
someone in a position of power, superior age or knowledge. It
is distinguished from wanted sexualinteraction with equal
desire and pleasure for both partners,freely entered into.
Unwanted or coercive sex in relationships and from carers
Internationalresearch suggests that women with disabil-
ities suffer significantly more from sexual violence than other
women (Elman, 2005). In general women with disabilities are
‘assaulted,raped and abused at a rate ofat least two times
greater than women without,yet are less likely to receive
assistance or services if they experience violence’ (DVIRC, 2003,
p. 12). Some forms of abuse are unique to women with
disabilities.Sexualabuse ofa woman with a disability may
include,for example,forced sterilisation or forced abortion
(DVIRC, 2003: 12). Lack of sex education for girls with
disabilities can contribute to their vulnerability to male sexual
use. Also women with disabilities, ‘face alarming ratesof
violence from paid and non-paid carers’ (DVIRC, 2003: 23).
328 S.Jeffreys / Women's Studies International Forum 31 (2008) 327–335

Feminist scholars have paid considerable attention to the
problem of unwanted sex in the relationships of able-bodied
women in the last decade (Jejeebhoy,Shah & Thapa,2005;
Gavey, 2005; Phillips, 2000). The difficulties for women with
disabilities,however,are likely to be greater than those of
girls and women without for several reasons.These include
self esteem and body image problems which may make them
more easily manipulated emotionally (Hassouneh-Phillips &
McNeff, 2005). Physicalor intellectual disabilities,mobility
problems or dependence upon carers,make it more difficult
for them to protect themselves against unwanted touch and
sexual contact. Women with high degrees of physical
impairment,may suffer disproportionately low ‘sexualand
body esteem’(Hassouneh-Phillips & McNeff,2005: 227).A
study of women with high degrees of physicalimpairment
found that they were vulnerable to ‘getting into and staying in
abusive relationships over time’ because they saw themselves
as sexually inadequate and unattractive (Hassouneh-Phillips
& McNeff,2005: 227).These women are less likely to marry
than other women with disabilities and this may make them
more likely to suffer abuse rather than face loneliness and lose
the person who cares for them ‘For some women, these
disadvantages translate into an increased tolerance of abuse
in intimate partner relationships out of fear that no one else
will want or care for them’ (Hassouneh-Phillips & McNeff,
2005: 229).
Research shows that 40–72% of women with physical
disabilities ‘have been abused by an intimate partner,family
member,caregiver,health care provider, or other service
provider’(Hassouneh-Phillips & McNeff,2005: 229). These
statistics cover abuse in general and make no special mention
of sexual abuse,for which figures are difficult to obtain.But
one particularly poignant quote from the 2005 study suggests
that women with disabilities might allow men to engage in
abusive sexual behaviours towards them out of a desperate
desire to hold onto the relationship,‘my main thing that I
think my relationship with my men is to please my man… and
so I do everything that I can do to please. Because it's
constantly in my head — am I pleasing him sexually?’
(Hassouneh-Phillips & McNeff,2005: 237). The prolonged
exposure to abuse that some women with disabilities suffer
because of the restrictions to mobility and lack of alternatives
they suffer in a society which is not organised to ensure their
integration, leads to increased risk for ‘negative health
outcomes including injury,chronic pain, depression,post-
traumatic stressdisorder, substance abuse,homicide and
suicide’(Hassouneh-Phillips & McNeff,2005: 237).
Douglas Brownridge's study in Violence Against Women on
partner violence against women with disabilities found that
the women had a 1.4 to 1.9 times greater likelihood of physical
violence than other women over the previous 5 years,with
the greatest disparity in relation to ‘more severe forms of
violence’(Brownridge,2006: 812).But sexualviolence was
much the most common form of violence they experienced.
Women with disabilities were three times more likely to
report ‘being forced into sexual activity by being threatened,
held down, or hurt in some way’ (Brownridge, 2006:812). The
research found that the male partners of women with
disabilities were 1.5 times more likely to ‘engage in
proprietary behaviors’than those of other women (Brown-
ridge,2006: 818).The increased risk of violence suffered by
the women with disabilities in this study is attributed to
‘ideologiesof patriarchy and male sexual proprietariness
which were particularly strong in these relationships’
(Brownridge,2006: 818).Brownridge's research focused on
partner violence and the researcher was careful to point out
that women with ‘developmentaldisabilities’and the most
severe forms of disability,were less likely to be partnered,
though research suggests thatthey receive a particularly
severe degree of violence. As Amy Elman, whose earlier work
was the first to examine the issue of men's sexual fetishising
of women with disabilities (Elman, 1997) has commented in
her more recent work, it is important to pay attention to
distinguish the ways in which women and girls are sexually
exploited in relation to different forms ofphysical,mental
health and intellectual disability (Elman, 2005).
Another recentstudy echoed Brownridge's conclusions,
finding a high rate of sexualassault amongst women with
disabilities (Martin et al.,2006).This study,too, found that
there was a considerable discrepancy between the rates of
physical violence, which were not significantly more than for
women without disabilities,and the rate of sexualassault,
which was 4 times the rate of other women.It found that
young and non-white women, unmarried women and
employed women were more likely to be assaulted.
The sexual abuse of women with psychiatric disorders or
intellectualimpairment,however,is not just perpetrated by
carers or other residents in care homes or institutions.It can
take the form of sexual exploitation in the prostitution industry.
The feminist movement has been split in recent years between
those who see prostitution as violence against women (Barry,
1995; Jeffreys, 1997; Stark & Whisnant,2004),and those who
use the language of neo-liberalism to normalise that form of
men's behaviour by defining prostitution as ‘sex work’, speak-
ing of women's choice and agency in entering prostitution, and
describing prostituted women as entrepreneurs (Pattaniak,
2002; Lisborg,2002).My perspective is that prostitution is
harmful to all women. But prostitution depends upon the
exploitation of the most vulnerable and marginalized of
women, indigenous women, trafficked women, as the business
can fi nd it difficult to attract women who have other
opportunities to earn a living. As a result, women with mental
health problems and intellectual impairment are vulnerable to
exploitation in the industry.
The prostitution of women with disabilities
In legalised prostitution systems,such as those in most
states of Australia, women with psychiatric disorders or
intellectual disabilities are exploited in brothel prostitution. In
Australia the legal brothel and strip club industry was worth
2 billion Australian dollars in 2006 according to an industry
report (IBIS World, 2007, p. 4), though the illegal industry, much
of it in the grip of organised crime, still makes up around 80% of
the industry (Sullivan,2007,p. 202).There is no evidence to
suggest that women with disabilities are being deliberately
employed in prostitution but there are indications that women
suffering intellectual impairment are particularly vulnerable to
being exploited in the industry. Prostitution may offer the only
form of ‘work’ that a woman with a disability is able to access,
especially ifa woman is subject to periods ofpsychological
wellness and periods of illness and unable to hold down regular
329S.Jeffreys / Women's Studies International Forum 31 (2008) 327–335

employment.Women with intellectual disabilitiesmay be
particularly susceptible to the inducements of pimps and easily
manipulated in prostitution.
Sexual exploitation of women with disabilities is not
necessarily understood to be a problem in relation to the legal
industry.Under the Australian state of Queensland's criminal
code,however,it is an offence to have carnalknowledge of
someone who is defined as having an ‘intellectual impairment’
(Carrick,2006).Participants in a discussion about the issue of
prostitution and disability on Australia's NationalRadio (see
Carrick,2006) argued that this was an abuse of the rights of
people with disabilities. The prohibition on women with
intellectual disabilities being exploited in brothel prostitution
was unfair,Delaney and Candy,from SSPAN,SexualService
Providers Advocacy Network, considered. When asked whether
a woman with the mental age of 10 should be allowed to work
in a brothel,however,Delaney said she thought not.But the
SSPAN spokeswomen pointed outthat the prohibition also
potentially prohibited women suffering mentalillness from
being prostituted in brothels.Someone with bipolar disorder,
for instance,‘who may get psychotic from time to time,
somebody with severe depression,who may be good for
some periods,not so good at other periods,who may be
stabilised on medication’ (Carrick, 2006). This raises the
question ofwhether prostitution is a good work choice for
women suffering depression when the rates of depression in
prostituted women or those who have managed to leave
prostitution are so high, and many other mental health
conditions such as post-traumatic stress disorder have been
identified in prostituted women (Farley, 2003).
Evidence about the exploitation of girls and women with
disabilities in prostitution is anecdotal at present.No research
has been conducted into the percentage of prostituted women
who fall into this category. But the anecdotal evidence suggests
that girls with disabilities are being prostituted. In April 2007 a
convicted double police murderer named Bandali Debs
appeared before a court in Melbourne charged with the murder
of an ‘intellectually disabled teenager’whom he shot after
‘having sex’with her (Jenkins,2007,p. 5). Kristy Mary Harty's
body was found in undergrowth in the bush and she is described
as having been ‘working as a masseuse and was prostituting
herself to drivers at Dandenong the day she died’ (Jenkins, 2007,
p. 5). Evidence of such exploitation is only available when media
reports of court cases related to prostitution choose to mention
the disability,as in a case from New Zealand,which decrimi-
nalised prostitution in 2003.In 2005 a male illegal brothel
owner was prosecuted for employing two underage prostituted
girls in a brothel,supplying drugs,and paying for sex with a
minor. The 14 year old girl is described as being drug addicted
and the 16 year old as having ‘severe learning difficulties’
(Henzell,2005,p. 3). The offence was underage prostitution
since there is nothing in the New Zealand legislation to prohibit
the prostitution of those with intellectual disabilities.
When women with disabilities are used in the prostitution
industry in Australia this is incidental and the disabilities are
not highlighted so as to appealto disability fetishists.Male
disability fetishists,however,do deliberately target women
with disabilities.In the age of the Internet,the male sexual
interest of fetishising disabilities in women has expanded and
been normalised by websites offering pornography and
services such as the ordering of mail order amputee brides.
Disability fetishism
All manner of women's disabilities are offered to ‘devo-
tees’ on sites such as ampulove. The range of pornography on
offer demonstratesthat there are men who get sexually
excited about everything from braces on teeth and braces on
legs to amputation (Elman,1997).Amputation is the most
common interest and offers three sub-specialisations.Devo-
tees are those men who get sexual satisfaction from women's
disability, particularly limb amputation. Pretenders are those
who pretend to be amputees or disabled themselves by tying
one leg up behind them or using wheelchairs. Wannabes are
those who seek actualamputations,preferably in hospitals
and through public health services. The latter two categories,
though overwhelmingly male, may include some women. The
male behaviour of disability fetishism originates in the
construction of male sexuality to eroticise power difference.
Men's expectation that they may pursue,approach and stalk
women with disabilities,make them into pornography and
sexually exploit them in prostitution and as mail order brides,
is an aspect of the male sex right.
It is the devotees that create the most difficulties for women
with disabilities.They may harass amputee women in the
street,join organisations and attend conferences that support
amputees in order to derive sexualsatisfaction from seeing
stumps and getting close to them, or even become prosthetists.
Material from the Amputee Coalition of America shows how
this latter form of sexual abuse works.According to the ACA,
women amputees are harassed on the Amputee Web Site,
which is a facility set up to serve amputees. They are stalked by
‘devotees’(Amputee-online,n.d.). The result is that ‘Many
amputees fear revealing the fact that they are amputees in case
a devotee without moral fibre sexually harasses them via e-mail’
(Amputee-online,n.d.).They are advised,‘if a person starts
asking you various questions about crutches,clothing,do you
go to bars, shoes and other habits, BE SUSPICIOUS!’ (Amputee-
online, n.d.).
The website held a debate on the issue of devotees.
Members of ACA wrote about their response to devotee
interest in female amputees in the organisation. Gracie
Rossenberger,board member of ACA,when asked what her
concerns were about devotees,responded,‘These are indivi-
duals who are enamoured with the maimed bodies of human
beings. They repulse me’ (Amputee-online, 2000). She worries
that the presence of devotees will keep members away from
the ACA. They should not have to ‘work up the courage to come
to a meeting’ and have to worry about ‘unaccompanied
women … walking to their room unescorted,going to the
pool and having deviants take their pictures’ (Amputee-
online, 2000).She is concerned as more and more children
become involved in the organisation that devotees will
attempt to ‘interact with the children’.She worries that they
get into ‘professional positions’ where they can ‘use us to feed
their fascination on a daily basis’ and does not want to have to
‘question and squirm every time a prosthetist touches me
because I don't know if he is or isn't a devotee’. She asks, ‘How
safe can we feel standing there partially dressed,totally
vulnerable and exposed wondering if there is a hidden camera
taking our picture that will end up in next month's “new
attractions” on the internet. There are so many women whose
pictures have been taken without their awareness that are
330 S.Jeffreys / Women's Studies International Forum 31 (2008) 327–335

now being viewed and used for fantasies by this population
and we have no way to stop this hideous invasion of our
privacy’ (Amputee-online, 2000).
In the same discussion CarolWallace wrote ‘Attending
conferences these days feels like being in a “meat market” as
they hang around the sidelines hoping to catch a “glimpse” of
our stumps’ (Amputee-online, 2000). Some women, she says,
‘unknowingly wear clothing that exposes their stumps’ which
provides the ‘turn on they are looking for’to the point of
excess.As she reports, ‘“Over-stimulated to the point of
emotional shutdown” is how one devotee so aptly described
his experience of seeing so many of us in one place. How nice
to know our loss is someone else's “overload”’. She asks ‘What
level of trust can you have in a man who might leave you for a
“prettier” stump?’(Amputee-online,2000).She explains the
involvementof some amputee women in the creation of
pornography for devotees by the fact that they have ‘no other
way to earn a living and there is big money in the selling of
pictures’.There is even trafficking in amputated women,she
states,‘Foreign women are a target of devotees,who bring
them to the United States and set them up as prostitutes for
their population to use.For many of these women their new
lifestyle is a step above the way they were living before coming
here’ (Amputee-online,2000). Men's amputee fetishism is,
thus, a source of harassment and distress to women amputees.
The infiltration of fetishists into amputee networks makes
places of potential safety and support into places of danger.
The sexual interest that devotees have in women with
disabilities is, in some cases, transferred onto their own
bodies with the result that they become ‘pretenders’or
‘wannabes’. ‘Pretenders’ go around in wheelchairs or with one
leg constantly bent upwards simulating disability,whereas
‘wannabes’ seek to have limbs amputated. The desire to have
limbs amputated is overwhelmingly a male preoccupation.
Recently,‘wannabes’have created a politicalmovement to
demand toleration, and limb amputation on the public health
service (British Broadcasting Corporation,2000; Furth &
Smith, 2002; Elliott,2003).The desire for limb amputation
is called body identity integrity disorder (BIID) by those
campaigning for recognition (First,2004). As severalcom-
mentators have pointed out,it is similar to transgenderism
(Jeffreys, 2005, in press-b). One similarity is the fact that both
interests of men appear to be sexually motivated and forms of
masochism (Lawrence,2006). In both cases the fetishists
themselves proclaim that their disorder has nothing to do
with sex, but is rather an issue of ‘identity’, which can only be
resolved through surgical removal of healthy limbs or sexual
characteristics i.e. legs or penises.
Both psychiatrists,such as MichaelFirst, and wannabes,
such as Greg Furth, are involved in discussions as to whether
BIID should be included in the Diagnostic and Statistical
Manual, the US encyclopedia of psychiatric conditions which
is edited by First (Furth & Smith,2002). Such an inclusion
would enable limb amputation to be recognised as a form of
therapy and mean that it could be performed with public
health service funding. In the context of the serious obstacles
that people with disabilities have to overcome in their lives in
order to find love and sexualpleasure,it might be hard to
establish full sympathy with a population of largely male
disability fetishists which is seeking state support to become
amputees for sexualpurposes.The fact that this proposal
receives any support reflects the importance attached in male
dominant societies to men's desires,however unreasonable.
Men's sexualdesires,which are developed out oftheir
unequal power relations with women, are regarded as
legitimate and accommodated by male dominant states
with the provision of legalised or tolerated prostitution and
pornography industries. Men's problematic sexual behaviour
in buying access to women and girls causes serious mental
and physicalharms to the women involved (Jeffreys,2004;
Farley, 2003), as well as social harms such as organised crime,
destruction of relationships and of socialamenity (Sullivan,
2007). One unfortunate result ofthe normalisation of this
industry is that disability organisations and activists,such as
Disability Now in the UK,seek access to the same masculine
privilege that other men possess, of sexually exploiting
women in prostitution (Disability Now,2005).The legalised
industry in Australia markets prostitution to organisations for
people with disabilities, their carers and men with disabilities
as a way to ‘educate’men with disabilities sexually,enable
them to realize their sexual rights, or reduce their aggression.
Prostitution and the sexual ‘needs’ of men with disabilities
Disability is an important niche for expansion by prostitu-
tion industries. The sexual rights of the disabled are employed
as a way to make prostitution respectable and to suggest that
it serves a noble purpose. Thus the sex industry lobby group,
Sexual Freedom Coalition, in the UK, staged a demonstration
of disabled men against proposed legislation that would have
restricted men's rights to access prostituted women in
February 2008 (SexualFreedom Coalition,2008). A 2008
documentary,aired on Channel 4 in the UK and SBS in
Australia, is described in an Australian newspaper review as a
‘charming documentary on the sexuality of disabled people’.
A disabled man who was taken on a trip to Spain by his
parents to access prostituted women in a special brothel for
‘people with various disabilities’ is filmed making a return trip
with two other disabled men (Schwartz,2008).
This normalisation of prostitution in the interests of
servicing disabled men's ‘sexualrights’ is supported by the
rhetoric about the sexualrights of people with disabilities
that is common to much academic and practitioner literature
on disability (Earle, 2001). Much of the material on sexuality
and disability is composed of reasonable argumentsfor
information and training to be supplied to persons with
disabilities so that they may understand sexuality,pleasure
themselves, develop relationships, and, in the case of men and
boys, learn not to engage in unacceptable behaviours such as
masturbation in public.But the sexual rights argument goes
further and leads to demands that men with disabilities,
though gender is never referred to in this literature which is
carefully neutral,should not only be able to access porno-
graphy and prostitution, but be helped by their carers,
including nurses,to do so. The argument has gone so far,
under the title of ‘facilitated sexuality’,that it appears that
nurses may be expected to become adjuncts to the sex
industry or even a part of it,by directly ‘sexually facilitating’
men with disabilities themselves (Earl, 2001).
Manifestos of sexual rights have come from several
quarters onto the international stage and into human rights
discussions in the decades since the sexualrevolution.The
331S.Jeffreys / Women's Studies International Forum 31 (2008) 327–335

manifestos are gender neutral,which is problematic when,
under male dominance, male and female sexuality are
constructed in such different ways.As Jennifer Oriel (2005)
has pointed out in her study of the implications of sexual
rights arguments for women, not only is sexuality constructed
around the male sex right,with its assumed right to access
women, but sexual pleasure for men is often specifically
constructed out of the subordination of women, through rape,
pornography and prostitution.Thus any concept of women's
sexual rights must be based upon recognition of the inequal-
ity of men and women, of women's vulnerability, and specific
understanding of women's right to bodily integrity and not to
be sexually exploited. Based on this understanding,the
United Nations Convention on Disability,which came into
force in 2008, usefully states that ‘Every person with
disabilities has a right to respect for his or her physical and
mental integrity on an equal basis with others’ (United
Nations, 2008: Article 17). A gender neutral concept of sexual
rights, on the other hand, leads directly to the idea that men
with disabilities should be able to abuse women in prostitu-
tion in the same way as men without disabilities do,despite
the fact that rights should be positive in their effects and not
bring harm through the infliction of a ‘right’ upon another.
The normalisation of sexual exploitation in relation to men
with disabilities is revealed in a 2005 survey by the UK
organisation,Disability Now (Disability Now, 2005). This
revealed the importance ofdisaggregating the interests of
women from those of men since the survey found that it was
men with disabilities that were using and wished to use
prostituted women.It found that just over one-fifth of men
with disabilities in the UK (22.6%) have used sexual services,
despite the fact that brothel prostitution is illegal. This figure
is double the national male average of 11%.The male
respondents would almost all consider doing so if there was
a legal, regulated service. The figures were rather different for
women, with less than 1% of women having used ‘sexual
services’,although 16.5% had considered it and 19.2% would
think about using a legal,regulated service.Disability Now
used the survey in support of its call for prostitution in the UK
to be legalised. Pornography, too, is argued by some disability
rights advocates to be vitally necessary to the sexual rights of
the disabled. Thus Tim Noonan, in an article on ‘Netporn and
the Politics of Disability’states that,‘access to online porn
resources is even more crucial and significant for people with
disability, often being THE ONLY — rather than ONE of
SEVERAL options for consumption and participation’ (Noonan,
n.d.).
In the state of Victoria in which I live, which has legalised
brothel prostitution,brothels specialise in offering ‘services’
to people with disabilities (Sullivan,2007).This is a money
spinner for the prostitution industry. Also, by promoting itself
as offering education and needed sexual relief to people with
disabilities,the industry normalises itselfand improves its
image. Sexpo, the trade show of the prostitution and
pornography industry which is held in state capitals all over
Australia to promote prostitution, has a section of the display
area dedicated to charities for people with disabilities, such as
the Muscular Dystrophy Association,and advertises itself as
educating people for sex and lifestyles. The cause of ensuring
men with disabilities access to prostitution is well advanced
in Australia. In Victoria service providers have an obligation to
support the sexual lifestyles of ‘people’with disabilities and
this obligation may include access to prostitution (Sullivan,
2007: 176). Two Australian organisations exist that are
dedicated to enabling men with disabilities to gain access to
prostitution. One, Accsex/Access Plus, receives Federal Health
Department funding.Another is Touching Base which was
created in New South Wales through the support of the
prostitution industry in that state and People With Disabil-
ities to ‘facilitate the links between people with a disability,
their support organisations and the Sex Industry’(Touching
Base,n.d.). Mainstream health and disability organisations
support Touching Base,such as Family Planning Association
NSW and The Spastic Centre of NSW.It offers ‘professional
development’ to prostituted women through training them to
work with men with disabilities, and promotes prostituted
women as ‘sex therapists’who can offer specialised services
to people with disabilities such as teaching men with
intellectual disabilities how to do sex. It advises that disability
service providers should institute Sexuality Lifestyle Assis-
tants to provide transport, positioning and other services that
will enable men with disabilities to prostitute women.
Touching Base sees residential aged care as another
potential niche market for the prostitution industry. According
to an article on their website,aged care services arrange for
their male clients to access prostituted women.As a ‘lifestyle
coordinator’in nursing homes commented,carers provide
sexual intimacy to elderly men, ‘If male patients are fit enough,
some homes send them to brothels’(Gray,2005).A spokes-
person for the Daily Planet brothel, commented, ‘It happens all
the time.Severalof our girls have nursing backgrounds and
often still work in aged care… Some homes send men in small
groups,so they can chat about it all afterwards,just like the
boys…If people are treated with dignity,they feeldignified’
(Gray, 2005). The Touching Base website features a discussion
on the question, ‘How does the right that individual sex
worker's (sic) have to decline a client, sit with the right of people
with disability to access commercialsexualservices without
experiencing discrimination on the basis of their disability?’.
George Taleporos wonders whether brothel managers would
find themselves in breach of the Disability Discrimination Act if
they failed to provide access to a prostituted woman.Being
refused access would, Taleporos considers, ‘have a devastating
effect on that person's self esteem’(Touching Base,n.d.).The
fact that such a question can be raised suggests that legalised
prostitution educates men in the idea that women are products
to be used rather than as persons with a right not to be sexually
exploited.
Prostitution is posited as a way that men with intellectual
disabilities could be dissuaded from sexually assaulting other
persons with intellectual disabilities. This form of sexual
assault,predominantly in institutions,and in many cases
consisting of repeated abuse of the same victim,is emerging
as a worrying issue (Bazzo, Nota, Soresi, Ferrar & Minnes, 2007).
Thus Anthony Walsh from Family Planning in the Australian
state of Queensland says that ‘our experience at Family Planning
Queensland, suggests that many men with significant intellec-
tual disabilities,are perpetrating sexualoffences’(Carrick,
2006).The answer,he considers,is ‘sexuality education and
appropriate support’ which could help in ‘decreasing the risk of
sexual assault against vulnerable people in our society’ (Carrick,
2006). The worrying possibility is that service providers might
332 S.Jeffreys / Women's Studies International Forum 31 (2008) 327–335

consider prostituted women as the appropriate deliverers of
this form of ‘education’,especially when brothels set them-
selves up as specialists in the field and specially train their
workers,as is happening in legalised brothelprostitution in
Australia.
The sexualuse of prostituted women,who are paid to
dissociate emotionally whilst their bodies are entered,is not
an appropriate means of sex education,or of reducing men's
sexual violence.Rather than teaching boys and men with
disabilities about mutual sex,respect for the personhood of
women,relationships and intimacy,prostitution teaches the
exact opposite. The other implication here is that if men with
disabilities are not given access to prostituted women into
whom to ejaculate, they may attack others, as if there were a
biological sexual drive which, if not satisfied, would naturally
lead men to such violence.Prostituted women are already
being used as a means to calm down sexually aggressive men
with disabilities in Australia,as the stories about clients on
the Touching Base website make clear.‘Andy’ engaged in
problematic behaviour such as stealing women's clothing. He
was supported in forming the idea that he wanted to access
prostituted women, despite cultural inhibitions that he
experienced towards this idea.He began,and continued,to
visit prostituted women though he could not remember the
visits (Touching Base,n.d.).‘Bill’ was violent and aggressive
and sexually harassed his carers after an accident affected his
speech and the left side of his body. The visit to a prostituted
woman that his carers arranged was unsatisfactory because
he experienced premature ejaculation.His aggressive beha-
viour continued (Touching Base,n.d.). The idea that the
prostitution of some women will lead to a reduced rate of
sexual aggression towards others, the catharsis argument, is a
myth which feminists have long sought to dispel in relation to
men without disabilities,so it would be hard to see why it
should deserve a revived currency in relation to disability
(Jeffreys, 1997). Some of those writing in the field of disability
studies express the forms ofsex education that boys with
intellectualdisabilities need in ways that would preclude
sexual exploitation such as, ‘how to express positive attitudes
towards their sexuality and their body, share rules promoting
self-respect and respect of others, enjoy the greatest degree of
autonomy possible, live with one's sexuality within satisfying
social relationships,adequately practise safe sexual acts and
defend themselves from possible aggressors’(Bazzo et al.,
2007,p. 111).This approach is more likely to be effective in
changing sexually exploitative behaviour than the provision
of prostituted girls and women, some of whom, after all, may
themselves have disabililties.
In countries where prostitution is not legalised and ‘sex
therapy’cannot be offered in brothels,such as the USA,men
with disabilities may have to make do with ‘sex surrogates’
who can only be obtained through a regular therapist.Sex
surrogates are paid,as in prostitution,but are promoted as
subtly different.They are recommended in some disability
studies literature (see Aloni & Katz, 2003). In one article by a
man with a disability who decided to access a ‘sex surrogate’
for his first sexual experience,the ‘services’offered sound
remarkably identicalto those of prostitution.Mark O'Brien,
who is paraplegic,wanted to be ‘held,caressed and valued’
(O'Brien,1990).But, unfortunately,he was unable to find
anyone to have a loving relationship with him.Surrogacy/
prostitution was his recourse. The ‘surrogate’ undressed him,
after his carer delivered him to a friend's home for the
experience, and then sucked his penis, instructed him to kiss
her breasts and on the second visit managed to get his erect
penis into her vagina.There was no ‘therapy’,just the usual
practices of prostitution.
The supposed differences between prostitution and
surrogacy are detailed in a document from ‘The Sex Institute’
in New York (Noonan, 2002). Sex surrogates provide ‘sex
therapy’we are told, and are ‘mostly female working with
heterosexualmales’.The difference lies in intent.Thus ‘the
prostitute's intent’was to immediately ‘gratify localised on
genital pleasure’whereas the surrogate's intent was ‘long-
term therapeutic re-education and re-orientation ofinade-
quate capabilities of functioning or relating sexually’ (Noonan,
2002: 3). There has to be a ‘supervising therapist’and the
‘usual therapeutic approach is slow and thorough…Exercises
are graduated and concentrate on body awareness, relaxation
and sensual/sexual experiences that are primarily non-
genital.’ (Noonan, 2002: 3). Where appropriate, the surrogate
also teaches ‘vital social skills and traditional courtship
patterns which finally include sexualinteraction.’(Noonan,
2002: 3) None of this happened with Mark O'Brien above,
who seems to have got old-fashioned prostitution instead.
Men with disabilities are likely to have difficulties
accessing the exploitation ofwomen in pornography and
prostitution because ofmobility issues or intellectualdis-
abilities. In male dominant cultures where these forms of
abuse of women are considered an ordinary expression of
men's sexuality the argument has arisen that it is just and fair
for the carers of such men,including nurses,to enable this
access and thus ensure that men with disabilities have their
‘rights’.This is called ‘facilitated sex’.This concept creates a
conflict of interest between such men with disabilities and
their largely female carers,who may have very good reasons
for not wanting to supply pornography, help their patients to
masturbate, deliver them to brothels or help to position them
for sexual intercourse. The carers are likely to be poor migrant
women who will be in no position to defend themselves
against demands by their clients for such services (Lyon,
2006).This conflict is not necessarily well recognised in the
literature.Thus Sarah Earle,a UK nursing studies academic,
criticises the ‘overriding concern with risk and prevention of
sexual abuse and exploitation,to the cost of patients’sexual
needs’in literature on sex and disability (Earle,2001: 434).
Earle is not sympathetic to the fact that carers,or personal
assistants,may be unenthusiastic about recognising the
‘sexual needs’of men with disabilities,and tend to see their
clients as expressing ‘wants’ rather than ‘needs’ (Earle, 1999).
An article in Learning Disability Practice, gives an indication of
the kind of sexualharassment carers experience in one UK
setting. The article explains that ‘sexual harassment by service
users is seen as “part of the job” in many day centres’ (Parkes,
2006: 35). One focus group participant ‘described how a male
service user targeted her sexually.“He just became comple-
tely obsessed…bit like a love/hate thing,you know what I
mean, sort of very…er masturbating, you know what I mean?
It was quite stressful”’ (Parkes,2006: 35).
The discussion of facilitated sex in the UK takes place in a
contextin which local governmentfunding is ‘available to
disabled people as directpayments for personalassistance’
333S.Jeffreys / Women's Studies International Forum 31 (2008) 327–335

(Earle, 2001: 436). Earle defines ‘facilitated sex’ as ‘ranging from
the provision of accessible information and advice to the
organisation of sexual surrogacy’(Earle,2001: 437).It might,
she says, include assistance to ‘negotiate the price when using
the services of a prostitute’ (Earle, 2001: 437). More specifically,
a person might be required to ‘facilitate sexualintercourse
between two or more individuals,to undress them for such a
purpose, or to masturbate them when no other form of sexual
relief is available’ (Earle, 2001: 437). Earle uses gender neutral
language and may be thinking of female nurses masturbating
men with disabilities, a form of unwanted and potentially
highly distasteful activity but one within the ordinary expecta-
tions in male dominated societies thatwomen should be
accessible to men and sexually service them.She does not
comment on whether female nurses would be expected to
masturbate women with disabilities,or whether male nurses
would be expected to do so, or whether women with disabilities
would want any of this kind of contact. She does not comment
on whether male nurses would wish to masturbate men with
disabilities, or whether there would be any demand for such a
service. One problem here is that male carers might be able to
use the justification of facilitated sex for sexually abusing
women in their care. The major problem is that expecting carers
to sexually service men is just another form of sexual
exploitation.As women in many occupations are developing
sexual harassment codes and understandings that they do not,
as employees,have to sexually service their bosses,fellow
workers, or clients, it seems that some disability rights
advocates may be seeking to sexualise nursing and caring in
ways that are in direct contradiction to this progress.
Earle (2001: 438) explains that ‘for some disabled people,
facilitated sex is qualitatively no different to other forms of
assistance, such as help with washing, dressing and elimination
needs’ and suggests that if ‘the nursing profession was able to
appreciate this lack ofdistinction,it might be possible for
facilitated sex to play a greater role within the provision of
holistic care’ (Earle, 2001: 438). The provision of ‘facilitated sex’
such as masturbating men with disabilities will enrich the role
of the nurse, Earle argues, by offering nurses ‘an opportunity to
develop their skills in nursing the whole person. Furthermore,
the inclusion of sexuality within a holistic framework would be
intellectually and emotionally rewarding and would ‘add value’
to the role of the nurse’ (Earle, 2001: 439).
In the last half of the 19th century,Florence Nightingale,
recognised as the founder of the nursing profession,worked
to relieve nursing of the stigma of prostitution so that it could
become respected (Woodham-Smith,1950). Nursing was
associated with prostitution because nurses touched men's
naked bodies and respectable women were not supposed to
do such a thing.Nursing did become a respected profession,
but in the twenty first century sexual rights campaigners look
set, if they are successful,to make prostitution part of a
nurse's job and undo all that good work.
There is a fundamental contradiction involved in the way
that disability politics approaches sexual exploitation. Rhetoric
about sexual rights which gives men with disabilities the right
to prostitute women, and even to demand sexual servicing from
carers and nurses,is contradicted by the need to free women
with disabilities from sexual exploitation.Prostitution and
‘facilitated sex’teach a depersonalised,objectifying form of
sexuality to men with disabilities which requires that a woman
suffers emotional and/or physical abuse. The issue of the sexual
demands that are made of personalcarers is an area that is
greatly in need of feminist research,to discover how women
who are often vulnerable by virtue of financial desperation or
even debt bondage,language problems and illegal status are
dealing with the expectation,in some cases,that they are
available to be prostituted.The discussion ofdisability and
sexuality needs to incorporate feminist understandings of what
constitutes sexual exploitation and, where appropriate,disag-
gregate the interests of women with disabilities from those of
men with disabilities.
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