This is Poland, not "Hasta La Vista." Do people with disabilities deserve sexual assistance?

The sexual life of people with disabilities in Poland has little in common with scenes from the Belgian film Hasta La Vista. There, three adult men – completely paralyzed, blind, and wheelchair users – set out to Spain to experience their first time. Even more distant seems to be the reality of the protagonist of Untouchables – a millionaire in a wheelchair whose financial status allows him to overcome walls too high for most people in the same physical condition, including in relationships with women.

The sexuality of people with disabilities itself is pushed out of collective consciousness. On one hand, there is the myth of Jack the Ripper, according to which they are hypersexual, unable to control their urges, and potentially dangerous. On the other – much more often – there is infantilization. Disabled people are treated like eternal children, deprived of sexual needs, fantasies, the right to desire and pleasure. There is also the so-called Frankenstein myth, according to which people with intellectual disabilities are portrayed as sexual deviants requiring constant supervision and isolation.

The topic of sexual assistance periodically emerges in the Polish public debate, but it has never stayed long. A certain breakthrough was in 2019 with the creation of the Sekson project, aimed at providing reliable education on sexuality and parenthood for people with mobility impairments. Simultaneously, the first scientific works and studies dedicated to this issue began to appear.

What sexual assistance is not

Sexual assistance is not a synonym for sexual intercourse. It includes, among other things, hugging, massage, learning intimacy, exploring one’s own body. It should not be equated with sex work, although it may partially overlap with it.

– The benefits of sexual assistance also have a therapeutic dimension. Introducing such support can help both physically and psychologically – says Beata Płaczek, a sexual educator working with people with disabilities. – It’s not just about sex. Touch, pleasure, or relaxing muscle tension can have a healing effect on mental health. It is part of a broader understanding of rehabilitation – she explains.

The fact that professional sexual assistance can bring tangible benefits was proven by 45-year-old Kuba Sulewski, an activist working to normalize conversations about sexuality for people with disabilities, living with cerebral palsy. In 2022, he traveled with his sister Ania to Brussels, where he used the services of a sex worker for the first time.

This event inspired the Szczecin play A Midsummer Night’s Dream. It was not without moral panic. In conservative commentary, there were rhetorical questions about how the sister could have taken her paralyzed brother to a prostitute. Some even claimed she should be reported to the police as a procurer.

– After all this, I thought that we simply lack physicality. We hug less, are touched less, have less closeness. And sex altogether – says Kuba.

Sulewski’s story drew thousands of reactions and comments – from expressions of support to condemnation. Today, however, sexual assistance has practically disappeared from public debate. It’s not surprising. In Polish realities, its systemic regulation would mean facing questions about the status of sex work, conservative morality, applicable law, and fears of using such solutions for human trafficking.

"Decayed West"? Or maybe it’s worth learning?

In Belgium, Germany, the Netherlands, or Switzerland, sexual assistance has been functioning for years. This is primarily possible because these countries have regulated sex work in various forms. In Germany, organizations train Sexualbegleiter – workers accompanying people with disabilities sexually.

Czechia has developed an interesting model. Since 2015, the organization Rozkoš bez rizika has been developing a system of training sexual assistants. Candidates undergo specialized preparation funded by public resources.

Similar solutions operate in Switzerland, where an association of sexual assistants offers 200-hour training. Importantly, assistants are not only those providing sex work. Among course participants are also therapists, caregivers, and professionals in helping professions.

In France, a pilot training program called “Supporting the emotional, intimate, and sexual life of people with disabilities” was launched over a decade ago. French media reported that it involved thirteen people aged 21 to 74: masseurs, caregivers, special education teachers, retirees, sex workers, and even magnetizers. All were invited by the Association for the Promotion of Sexual Support (APPAS).

Even then, it was clear that even in countries that adopted such a support model, there was no consensus on the scope of duties of assistants. One participant declared: “I won’t touch genitals – that’s my boundary.” Another did not exclude full sexual contact if that was the conscious need of the person using assistance.

This shows that sexual assistance is not a solution free of dilemmas. Yes, it can serve a therapeutic function, support building a relationship with one’s own body, reduce tension, or counter loneliness. At the same time, it raises questions about boundaries, responsibility, and emotional safety for all parties involved.

One of these risks was described a few years ago by Vladana Augstenová, a certified sexual assistant from Prague. In an interview with Martyna Wojciechowska, she recalled a client with Down syndrome who started treating their meetings as a romantic relationship. He called her, sent messages, and demanded further contact. Ultimately, she had to completely end the acquaintance.

This leads to one of the most difficult questions related to sexual assistance. What to do if a person with an intellectual disability falls in love with their assistant? How to set boundaries without hurting the person seeking such support?

According to Prof. Zbigniew Izdebski, the answer primarily lies in professional preparation.

– It’s a matter of professionalism. People with Down syndrome often tend to hug, pet, or talk about love. We teach students to maintain appropriate distance from clients. If someone says “I love you,” you can respond: “I like you, you are my patient. I am here as a therapist, but I have my partner, and I love him.” Professionalism must be maintained. I see no problem in that – says Izdebski.

This very professionalization is one of the arguments most often cited by supporters of sexual assistance. They argue that it’s not about removing boundaries but rather about clearly defining them and preparing those performing this work for situations that may arise in relationships with individuals particularly vulnerable to emotional dependence.

According to research by Prof. Izdebski from 2002, conducted among women providing sexual services on the streets and in agencies in several Polish cities, one in five had clients with disabilities. Sometimes, meetings were organized by the fathers of these men, and visits took place in their homes.

Pros and cons of assistance. What about sex workers?

– The problem arises when a woman or man works in the sex industry not because they want to, but because they have no other choice – says Prof. Izdebski. He emphasizes that in cases of people performing sex work voluntarily, there is no objectification or exploitation.

Another aspect of the problem is pointed out by the Association Bez. Its representatives argue that in practice, the discussion most often concerns men with disabilities’ right to pay for women’s bodies. From this perspective, the need for autonomy of one gender is contrasted with the autonomy of the other.

The debate also concerns language. Some critics say that the term “sexual assistance” medicalizes the phenomenon and blurs the boundaries between care, therapy, and sex work. Terms like “medically supported sex,” “intimacy trainers,” or “sex coaching” serve similar functions. In some Western European countries, people with disabilities can even get referrals for this kind of support.

“Assistant” does not so much provide a sexual service as help a person with a disability to explore their own body, build a relationship with their sexuality, or experience closeness. Supporters of assistance argue that this approach allows viewing the sexuality of people with disabilities as an element of health and quality of life, not just a domain of satisfying urges.

Both sides of the dispute appeal to similar values – dignity, autonomy, and the right to decide over one’s own body. They mainly differ in whether sexual assistance truly enhances these values or if it might instead reinforce inequalities and create new forms of exclusion.

What is problematic is that men with disabilities are often “introduced from above” into the world of sex work. As described by the NordicModelNow.org portal, in Australia, social workers and caregivers sometimes are obliged to organize visits for their clients to sex workers. They may have to accompany them during meetings, with costs covered by the family. Critics see this primarily as objectification of both people with disabilities and sex workers.

In Poland, similar scenarios remain purely theoretical considerations. Some supporters of legalizing sexual assistance believe that only those whose type and degree of disability practically prevent them from independently fulfilling sexual needs or building intimate relationships should be authorized to receive such support.

A study conducted in 2010 among people with spinal cord injuries showed that about one-third would consider using such support if it were available. Meanwhile, a study from 2022 by graduates of the University of Warsaw’s sociology department, in collaboration with the National Panel of the Ariadna Research, indicates that 41% of Poles accept the use of sexual services by people with disabilities. Among men, this percentage is 51%, while among women it is 34%. At the same time, 31% of women and about a quarter of all respondents could not take a clear stance.

Doubts are also raised by Dr. Izabela Ślęzak from the University of Łódź. Between 2007 and 2013, she conducted research among women working in escort agencies. Results show that clients included men with physical disabilities, most often communicative and relatively independent.

The women interviewed by the researcher classified them among the least desirable clients, alongside aggressive and insolvent individuals. Sometimes they refused meetings or approached them with great reluctance. As Ślęzak notes, bodies deviating from socially established norms of attractiveness often excluded these men from the circle of desirable interaction partners. Additionally, providing services required non-standard skills and greater engagement, which some women perceived as an additional burden.

The researcher also pointed out another problem:

“Refusing to engage in sexual interactions with disabled men was also rooted in the fear stemming from the interviewees’ lack of knowledge about the nature of the dysfunction, its impact on the possibility of sexual intercourse, and consequently, the difficulty in imagining how such a meeting could proceed.”

During seven years of research, Ślęzak did not meet a single person providing sexual services who specialized in working with clients with disabilities.

This raises further questions. If Poland decided to legalize sexual assistance, who would provide it? Would it mean creating a new profession, a system of training and certification? Or perhaps specialized preparation for people already working in the sex industry?

– We are sexual illiterates, so we still have more questions than answers. Let’s not forget that it is also demanding and burdensome work – says Prof. Zbigniew Izdebski.

He emphasizes that such work should only be undertaken by mature and aware individuals of the consequences of their decisions. Equally important, in his opinion, is ensuring their right to refuse to provide services if, for various reasons, the client “does not fit within the boundaries of what the person is willing to work with.”

Caregivers and personal space

Parents and guardians – usually caregivers – of people with disabilities often simply do not know how to respond to their needs related to sexuality. Moreover, how to find space for a conversation about intimacy when one performs simultaneously as a nurse, caregiver, cook, and therapist around the clock, seven days a week?

Research by Remigiusz Kijak from 2010 showed that 75% of adults with intellectual disabilities have never been in a relationship, and 87% have not started sexual activity. One reason may be that many of them remain under family care throughout their lives, often without real opportunities for independence and building their own space.

Lack of their own room, privacy, constant presence of caregivers, not knocking on doors – what often results from concern and the need to ensure safety, can lead to a restriction of autonomy. And without autonomy, it is difficult to speak of intimacy.

This is also a consequence of many years of neglect by the state in the area of personal assistance and independent living for people with disabilities. As Kuba Sulewski notes, in Warsaw, there is still a lack of enough supported and protected apartments that would allow people requiring support to live independently outside the family home.

– If I had my own space, everything would look completely different. I recently returned from Zamość. They have such apartments, and luckily they are also open to residents of Warsaw. I go there from time to time to practice my independence. It’s not perfect because I share a room with others, but I have care, someone to help me with daily activities, feed me, wash me. Why do I have to go all the way to damn Zamość to have at least this minimum?

A song of a future without sexuality

For now, solutions available to a few are trips to Belgium, Czechia, or Germany, financed out of their own pockets. For people who often struggle with low benefits and limited financial independence, this is practically unreachable.

The state still does not provide sufficient support, caregivers of people with disabilities are aging, and supported housing – long functioning as a standard in many Western European countries – remains an exception rather than the rule in Poland.

Kuba Sulewski points out that one of the elements of this problem is also the level of social pension. Lack of financial security limits the ability to decide about one’s own life, and the system additionally hampers families of people with disabilities from improving their economic situation. It’s a multi-layered deadlock.

Sulewski summarizes: – I would first like to have access to an assistant who can help me go to the post office or the office, proper rehabilitation, and a chance for a safe future. Sexual assistance is important. I’m glad more people are starting to talk about it. But many things need to be fought for first. Or at least in parallel.

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