Sex surrogates: saviours or sinners? Padma Deva, 32, who is based in Somerset, runs the website sacredsexuality.co.uk and also works as a surrogate, explains that a session with a surrogate is very different from that with a sex worker. "A sex worker is employed for instant gratification and provides a service which is to some degree entertainment," she says. With a surrogate it's quite the opposite. Whatever I do with the client has a therapeutic intent and there's some degree of communication and trust. A former management consultant, she began studying tantric sex in her twenties, because she was worried about her own lack of sex drive and inability to achieve an orgasm. Now a trained psychotherapist who has also completed two years" training with the International Professional Surrogate Association in Los Angeles, Deva stresses that surrogacy is only necessary when a client has no partner to practise with. Her clients, whom she sees over the course of a nine-hour programme costing £4,000, have included bankers and lawyers, students and builders. Some are married, some single. Her oldest client was 65, the youngest 25. "Every client I've worked with has left the programme with new-found confidence," she says. Dubious as it sounds, surrogacy's origins are legitimate. The concept was developed in the Fifties by the pioneering American sex researchers Dr William Masters, a gynaecologist, and Virginia Johnson, a psychologist, during tests of their landmark programme for treating sexual dysfunction. Over 11 years they worked with nearly 600 people to treat sexual problems. Unimpressed by old-style, Freudian talking therapies, Masters and Johnson believed that only practice could make perfect. The pair assigned couples physical "homework" to work through together. Single male patients presented more of a challenge, so they recruited 54 women "surrogates" to help them. Previous success rates for sexual dysfunction had been very low. In contrast, Masters and Johnson's two-week, "hands-on" programme was proved to be 80 per cent effective over five years, and 75 per cent effective when surrogates were used. But even in the free-love era, surrogacy was viewed with suspicion. In 1970 the couple regretfully ended the practice when they were sued by a man who claimed his wife was working as a surrogate. The result, Masters said later, was a complete reversal of previous success rates with single, impotent men, with 75 per cent of therapy now failing. More than 40 years on, surrogacy is an ever more clandestine world. Since the advent of Aids, the field has become increasingly niche, with only a handful of practitioners in both the US (where prostitution is largely illegal and surrogates are frightened of possible repercussions) and the UK (where prostitution is legal but cannot be advertised). Only in Israel is surrogacy remotely mainstream. In 1984, the Chief Rabbinate approved it as a form of therapy, and it is especially used to help rehabilitate army veterans. Having a family is central to Judaism and the Rabbinate understood that there are so many late-virgin single people who were never able to date or create a relationship with the help of talk therapy alone. They need the experiential component in order to overcome their problems and fears," says Shai Rotem, an Israeli male surrogate, who practises in both the UK and the US. The therapist Andrew G Marshall, author of the captivatingly-titled Make Love Like a Prairie Vole: Six Steps to Passionate, Plentiful and Monogamous Sex, thinks the process is fraught with danger. "If you are having physical relations with a client, you will end up with a very confused relationship," he says. Paula Hall, a counsellor for Relate, is more open to the idea but believes the surrounding ethics are too complex for surrogacy ever to become truly acceptable. "Sex therapy can be very frustrating if you're working with someone who's single," she says. But unless you happen to know someone ethical working in your locality, it's very hard to know who to refer a client to. It's a moral minefield. And Sue Newsome, 51, a sex and relationship coach from the West Country, who sometimes does work similar to surrogacy, agrees the field is in urgent need of regulation. There's no governing body, which makes everyone nervous about who to recommend. It's a tricky area. Support for surrogates is most vocal among campaigners for disabled rights. "Sex is right at the bottom of the list when it comes to the disabled's care requirements," says TLC's Tuppy Owens, which campaigns for care workers to recognise their disabled clients" right to a sex life. But they have a right to enjoy all elements of life like everyone else. Vik, a 37-year-old, severely disabled man who is confined to a wheelchair, used the TLC Trust two years ago to contact a sex worker who helped him lose his virginity. He says: "If I'm ever going to go into a relationship, I need to know what I can and can't do and the only way to know was to try it." Vik, like many, believes a sympathetic sex worker can provide just as good a service as a surrogate. Newsome, however, who does much work with disabled clients, believes there is a vast difference. "If the client just wants a straightforward erotic experience then a sex worker can work well, but surrogates who have the appropriate training can help people overcome mental, emotional and physical blocks," she says. Newsome's work with the disabled began after an early encounter with a paraplegic man. He'd been written off sexually and wanted someone he could basically sit with who would affirm him as a sexual man, to ask questions and receive frank, honest answers, to discover how sex is for real people, as opposed to the way it's portrayed on TV. I learnt a lot from him. She has gone on to work with people who are deaf, have cerebral palsy and multiple sclerosis, and thalidomide victims. Four years ago, in front of an audience of medics at the Royal Society of Medicine, Newsome, who is a trained counsellor and Tantra teacher, "made love" to the head of a tetraplegic client, to demonstrate how the sexual needs of the disabled were frequently neglected. Newsome used head massages, as well as plenty of eye contact, to give the man, who had been left with no feeling below the neck after falling from a building, the nearest thing to a sexual experience he could enjoy. "He became immensely aroused by this process, in a way that felt like sexual arousal," she says. Obviously, it was different to what he'd experienced pre-injury, but he still felt like it was happening in his whole body. It was a profound experience. Although Newsome was nervous the audience would find the performance either "ridiculous or boring," many were moved to tears by the sight of the man rediscovering his former sexual self. In keeping with the Masters and Johnson model, where surrogates work together with a counsellor, Newsome has also mentored surrogate work with adult virgins, the estimated four per cent of the population who are older than 25 and have never had sex. Other typical clients include men with erectile problems, such as impotence and premature ejaculation, and women with vaginismus, when the vaginal walls contract, making penetration difficult. Many have been sexually abused or are inhibited by negative beliefs about sex, learnt from parents, teachers and the Church. Mark O'Brien explained how his unhappiness derived not only from his physical frustrations, but also because he had been brought up to regard sex as taboo and shameful. "People snigger and titter whenever sex is mentioned, but there is a huge amount of pain out there relating to sexual issues and a good surrogate can really make a difference," says Mike Lousada, a London-based sex therapist, who offers "psychosexual bodywork" that can involve intimate massage, although not penetration, and whose clients have included the feminist writer Naomi Wolf, who is vehemently against all forms of sexual exploitation but who left a session with Lousada in a "state of bliss." But why are "hands-on" sessions necessary? Surely most sexual problems could be solved by talking alone. Lousada insists not. There are so many people who have read all the textbooks, but when they get into a physical situation they freeze up. If you have never seen a man or a woman naked before, for example, you want to be able to do it with someone you trust, in a safe space, to gain confidence to practise what you have learnt in the outside world. As The Sessions makes clear, O'Brien hadn't even seen his own naked body until Cohen Greene showed it to him in a mirror. Despite the salacious aura, the only in-depth study of surrogate work, in 1983, found that nearly half of a session was spent in non-sexual exercises, to help clients become more aware of sensory stimulus. Imparting sex information took up 34 per cent of the time and teaching social skills 4.5 per cent. Only 13 per cent involved making love. But what kind of person would want to be a surrogate? Mare Simone, 57, author of Make Love More Luscious, who is based in California but visits the UK for work, was raped as a teenager. It affected my trust of men and I needed something to help me heal. Having failed to find a surrogate who could help, she decided to train as one herself. The more I've recovered from my own trauma and emotional blocks, the more I wanted to help others with similar challenges. My job is so fulfilling and enjoyable. Seeing my customers leave with a new-found sexual confidence is a wonderful sight. But sessions may signify only the start, rather than the conclusion, of any healing process. O'Brien was, at least initially, unsure that his were worthwhile. "I had expected somehow that seeing the surrogate would change my life, [but] you can't just demand love," he told an interviewer. You have to be lovable. Yet perhaps this realisation was necessary for O'Brien to move forward. With Cohen Greene, he learned that "sex is a part of ordinary living, not an activity reserved for gods, goddesses and rock stars. I realised it could become a part of my life if I fought against my self-hatred and pessimism. He died in 1999, but for his last three years, he lived happily with a girlfriend, having learnt that sex was worthless outside a loving relationship. "Sex for the sake of sex alone has little appeal to me," he said. It seems like a ceremony whose meaning has been forgotten.