Sex Surrogacy. Who knew?

When the folks promoting this DVD, a re-release, got in touch, I couldn’t resist taking a look at their film: Private Practices: The Story of a Sex Surrogate. It was originally released in 1985 and directed by Kirby Dick, the same guy who did This Film is Not Yet Rated.
It’s about what it sounds like–turns out that there is a field within sex therapy, in which trained practitioners try to help their clients get over sexual anxiety and disorders by literally having sex with them. The film follows one of these therapists, Maureen Sullivan, as she rehabs two very different men, 25-year-old Kipper, a virgin grad student, and 45-year-old John, a newly divorced fella with a lot of insecurity to battle.
I felt so torn while watching this highly provocative film. On the one hand, I can understand why this form of therapy exists. Americans are so hung up on sex, but rarely deal with it in a straight-forward open way. This approach feels very European–it’s sex, so what, get over it.
On the other hand, it all felt rather creepy too. Sullivan creates real relationships with her clients, as do all good therapists, but I wonder how much their experiences with her actually translate into the real world. She has to have sex with them, after all. She has to pretend that she enjoyed it and enjoys being around them. The real world is a far messier place, where your sexual partner has his or her own nexus of desires, anxieties, and moods to contend with. Sullivan is like a blank slate sexual partner. I hope these guys don’t go out after their experiences with her expecting other women to be as singularly focused or servile (I mean, she is being paid).
And apparently this practice is very much alive and well. I uncovered a 2003 article in New York Magazine on sex surrogacy and lots of websites offering it up. Anyone else know any good feminist analysis on this phenomena?
If you want a dose of super 80s fashion inspiration and a glimpse into a thought-provoking and bizarre subculture, check it out on Netflix.

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  1. Feminista_84
    Posted March 20, 2009 at 11:31 am | Permalink

    This is a gross violation of ethical principles surrounding the client – therapist relationship. As someone in training to be a psychologist, I find this dangerous. Quite simply it is taking advantage of that client – therapist bond.

  2. LadyG
    Posted March 20, 2009 at 11:35 am | Permalink

    Word..I haven’t seen the movie or anything, but the concept creeps me out. Will another form of therapy address “anger issues” where the client gets to stab the therapist to get over his insecurity?

  3. FrumiousB
    Posted March 20, 2009 at 11:37 am | Permalink

    She has to pretend that she enjoyed it and enjoys being around them.
    Does she? I mean, your psychologist and your dermatologist don’t have to pretend they enjoyed treating you.

  4. analog
    Posted March 20, 2009 at 11:43 am | Permalink

    Does anyone have any information on why this is not considered prostitution? She is having sex for money? [For the record, I do not think there is anything inherently wrong with prostitution or sexual surrogacy, I just don't understand what the difference is.]

  5. FrumiousB
    Posted March 20, 2009 at 11:44 am | Permalink

    Feminista_84, a sex therapist is not a psychologist. A sex therapist is a sex therapist. Having sex with your sex therapist no more implies that you must have sex with your psychologist than getting a melanoma evaluation at the dermatologist implies that you must strip down and let your psychologist examine you naked. Further, clients are not required to have sex with a sex therapist, although that is the point of seeing one. Going to a sex therapist and not having sex would be like going to a dentist and refusing to open your mouth – or like going to a psychologist and refusing to speak.

    Posted March 20, 2009 at 11:50 am | Permalink

    oh please, somebody just wants a “valid” excuse to make money while having sex with random people. Nothing’s wrong with that, but don’t pretend otherwise.

    Posted March 20, 2009 at 11:52 am | Permalink

    News flash: it’s SEX. I would hardly compare having SEX with your client to treating your client’s teeth or listening to your client’s problems.

    Posted March 20, 2009 at 12:07 pm | Permalink

    Seems like it might be a way to reclaim the role of the sacred prostitute. I do wonder how this doesn’t get prosecuted as sex for money though.

  9. agoodshinkickin
    Posted March 20, 2009 at 12:14 pm | Permalink

    I’ve got to say that as someone with a sexual dysfunction I find a lot of the above comments disturbing.

  10. Brandi
    Posted March 20, 2009 at 12:22 pm | Permalink

    There have been a couple of court cases related to it. Some sex therapists are ultimately charged with prostitution. They end up showing that they keep patient files and treat the person as a therapy client rather than a john. Some have not been successful, however, because I think it is such a fine line.

  11. FeministMan
    Posted March 20, 2009 at 12:22 pm | Permalink

    In the past, all sex therapy I have read about had the objective of improving the patient’s sex life with hir partner. It seems odd to improve someone’s sex life by having sex with them and not working out the emotional, intellectual, and physical problems hir might be having with a person hir is actually emotionally attached to.
    However, I see nothing wrong with two adults having consensual sex whether money is involved or not. Maybe this alternative type of therapy really could help people with no other options.
    But let’s hope this isn’t a women-dominated field that works to heal the sexual lives of men. Where are the male therapists? Straight women are sexual beings too and I think people of every gender should have an equal opportunity for therapy so it doesn’t become as sexist as the field of sex work.

  12. idiolect
    Posted March 20, 2009 at 12:29 pm | Permalink

    I don’t have any immediate problem with sexual surrogacy in general and can envision it being something potentially very helpful and healthy, when done right, but regarding this particular therapist/movie:
    She has to have sex with them, after all. She has to pretend that she enjoyed it and enjoys being around them.
    That’s what creeps me out, and that’s also probably what’s at the core of the complaints of people who would say that this is basically prostitution framed so as to be legally murky (although, that’s a whole other can of worms that I’m going to leave alone for now). Anyway, is this really true? It doesn’t seem very therapeutic to me if this is really the way it is. The healthy version I can envision involves sexual acts only as one element of a more complex professional relationship, where the sex stuff is done to explicitly teach something particular or work through some particular fear and so on, not the sex therapist being “a blank slate sexual partner.”
    (fwiw, I don’t think anyone trying to “reclaim the role of the sacred prostitute,” as tiggrrl said, should have the “pretend that she enjoyed it” approach either…)

  13. cndjl
    Posted March 20, 2009 at 12:32 pm | Permalink

    I just find it interesting that these men, “a 25-year-old virgin and a divorced man with low self-esteem”, with their dysfunctions, came to agree to opening up, being naked, and engaging in sexual activities in front of the camera for anyone to see. Doubly therapeutic?

  14. idiolect
    Posted March 20, 2009 at 12:41 pm | Permalink

    On a second read-through — I wonder how much about this field is different now, given that the movie was made almost 25 years ago?

  15. idiolect
    Posted March 20, 2009 at 12:44 pm | Permalink

    (And how much of it will be portrayed differently by a ‘documentary’ crew?)

  16. sk1
    Posted March 20, 2009 at 1:02 pm | Permalink

    this reminds me of a movie i recently rented called Bliss( i was just renting anything that sheryl lee had been in (as a big twin peaks and david lynch fan) and didn’t expect much from this film that was described as a “soft porn” about a woman going to a sex therapist because she couldn’t orgasm. i was actually surprised to find it to be quite sensitively and tastefully made and it did not tie things up in a neat little bow once she orgasmed like i was afraid of. unfortunatly the male characters are the focus of the film and way more developed than sheryl lee’s character – despite her mental and sexual health being the focus of the film, and there is a healthy dose of fuzzy movie psychology, but it has some moments that are pretty progressive and a satisfying ending. now i’m interested in checking out this documentory to see how it compares and contrasts.

  17. spike the cat
    Posted March 20, 2009 at 1:04 pm | Permalink

    Word. It cracks me up how some folks love to compare sex to mundane services such as cleaning teeth, until the conversation flips to the psychological ramifications of people not getting sex or not getting enough of it. Then, all of the sudden sex is this universally shared human need intertwined with all of the complexities of life…

  18. SaltyLilKipper
    Posted March 20, 2009 at 1:15 pm | Permalink

    I’m kind of sick of the idea that it’s weird and uptight to not think of sex as “just sex”. Sex for most humans is a lot more complex than that.

  19. rhowan
    Posted March 20, 2009 at 1:18 pm | Permalink

    Porn stars have sex for money too, and they get to bypass the “prostitute” label. I imagine the reasoning is similar.

  20. salymander
    Posted March 20, 2009 at 1:20 pm | Permalink

    Wow, I am incredibly offended by everyone’s response to this. Especially on behalf of agoodshinkickin.
    Courtney, you say that you watched this movie, but were you paying actually paying attention? I fear for your understanding of therapy on a basic level. Therapists do NOT pretend to care about their clients, they actually DO care otherwise they would not BE therapists. Of course they’re human and there are bad therapists just like there are bad plumbers.
    Sexual surrogacy is very important and it is not prostitution. People above seem to be very ignorant about this. A very basic explanation may be found on wikipedia:
    A sex surrogate is a member of a sex therapy team who engages in intimate physical or sexual relations with a patient in order to achieve a therapeutic goal. The practice was introduced by Masters and Johnson with their work on Human Sexual Inadequacy in 1970.
    Most surrogates are women, a few are men, and there are married couples that practice surrogacy together. Some surrogates work at counseling centers while others have their own office. Some surrogates offer additional services besides surrogacy such as telephone counseling or sexological bodywork.
    The majority of surrogates have professional certification in the fields of sexuality, psychology or counseling. This allows them to work closely with psychiatrists, psychologists, sexologists and other therapists in the best interests of the patient.
    Sex surrogates use a combination of three techniques — talking, listening and demonstration — to help resolve a patient’s sexual problems.
    Patients frequently present these specific problems:
    1. Trouble with intimacy
    2. Lack of confidence
    3. Communication problems
    4. Dating anxiety
    5. Sexual inhibitions.
    6. Erectile dysfunction
    7. Premature ejaculation
    8. Diseases that cause painful intercourse.
    There are people who have experienced a change in sexual lifestyle due to an acquired disability (accident, paralysis, disease, trauma), and a surrogate can help them explore and develop sexual potential. The causes of sexual dysfunction are numerous and the methods a surrogate might use to help improve sexual function are varied.
    Since many sexual problems are psychological rather than physical, communication plays a key role in the therapeutic process between a patient and the sex surrogate, as well as between the surrogate and the therapist.
    Surrogates offer therapeutic exercises to help the patient. These may include relaxation techniques, intimate communication, teaching social skills, and some sexual touching.
    I’m pretty sure prostitutes don’t work WITH a group of therapists to help their clients.

  21. mydishonestheart
    Posted March 20, 2009 at 1:44 pm | Permalink

    This, this!!
    I’m a massage therapist; in my line of therapy we don’t have sex with our clients and can still choose to not work with one based on any number of reasons. There is no HAVE to work with someone in therapy. Personal reasons, professional reasons, all can inhibit the theraputic relationship and be cause for a cessation of therapy or a recommendation to another therapist.
    Care is very, very much a factor in any client/therapist relationship, and sex therapists do not violate that relationship simply by performing their therapy. A massage therapist or psychologist would be in violation of that relationship for sleeping with a client, but a sex therapist very much wouldn’t. Its an incredibly vital form of therapy; the sexual psyche is a large part of who we are as human being, and sexual dysfunction can reflect on our lives and those of our family and friends’ lives just as much as depression can.

  22. insomniac
    Posted March 20, 2009 at 1:49 pm | Permalink

    What salymander said.
    In my own words, I am a bit shocked by the comments above. As for the main entry, perhaps Courtney found it disturbing because it was a woman who was the sex surrogate and an immediate parallel to an escort is somehow attained when lines are blurred.
    I do wonder what Courtney would think about a man being the sex surrogate?
    Society considers birth a personal and spiritual event too (as it instructs sex to be). Doesn’t stop people from hiring surrogate mothers (whatever their reasons may be). When that isn’t a problem, why is this?
    Also, this reminds me of an Irving Wallace book I had read that dealt with sex therapists. Forgot the name unfortunately.

  23. tryingtosmile
    Posted March 20, 2009 at 1:57 pm | Permalink

    Heartily agreed.
    Perhaps it was the movie’s portrayal, I haven’t seen it so I can’t say, but Courtney’s critique did seem to draw heavy comparisons between sex surrogacy and prostitution.
    Having a close friend who has been through this first hand, I can say that it is very important work that is so beneficial for the patients. I really don’t think prostitution can provide those kind of results.

  24. kb
    Posted March 20, 2009 at 2:22 pm | Permalink

    why? ok, for you, there’s more emotion there, but you’re not the whole world. for some people, sex really is like any other job.

  25. Katherine
    Posted March 20, 2009 at 2:24 pm | Permalink

    I think it would be so much easier to take this seriously if it weren’t nearly all women therapists treating heterosexual men. Do women not have sexual issues? Or gay men? Or lesbians?

  26. kb
    Posted March 20, 2009 at 2:27 pm | Permalink

    I will point out that lots of people have problems with birth surrogates.

  27. kb
    Posted March 20, 2009 at 2:30 pm | Permalink

    well, I have seen articles about a male who does this for women. So they do exist. Now, there’s a good point to be made about who was included in the movie, but that doesn’t mean no other permutations exist. I can’t really say about gay or lesbian therapists.

  28. kb
    Posted March 20, 2009 at 2:34 pm | Permalink

    there are men who do this for women. I don’t know what the stats are, but I have seen a detailed article about at least one. and honestly why do you assume that this would be a substitute for talking about the relationship with the partner? in the article above, they were both used, depending on the goal of the treatment.

  29. salymander
    Posted March 20, 2009 at 2:36 pm | Permalink

    My psychologist friend reminded me that it is also important to note that sex surrogacy is not JUST about sex. It is about basic human contact. We’re talking about people who have been raped, people who were abused, people with phobias, and people who are disabled. In many cases, the sexual surrogate is simply teaching their client to sit in on a sofa next to another person, to hold hands, and to not be afraid of (again) BASIC HUMAN CONTACT.
    I haven’t seen this documentary, so it’s possible that in this instance sexual surrogacy was not portrayed well. But that should not color the entire spectrum of what this kind of therapy can do for people.

  30. insomniac
    Posted March 20, 2009 at 2:37 pm | Permalink

    I ask with genuine curiosity, are these the same people who have problems with sex surrogates? In other words, are their reasons the same?

  31. wax_ghost
    Posted March 20, 2009 at 3:08 pm | Permalink

    Thanks for this response, since it really adds to the conversation.
    An honest question (for you or anyone who feels like they can answer it): Isn’t part of the problem the idea that there is “sexual dysfunction” in the first place? I mean, I would consider something like pedophilia or necrophilia to be a sexual dysfunction but not something like being unable to orgasm or keep an erection – I think those are more common than our virile young sex-obsessed culture would like to admit. Doesn’t everyone have different ways of acting out their sexual selves, ways that shouldn’t automatically be considered “dysfunction”? Or am I missing something?

  32. The Law Fairy
    Posted March 20, 2009 at 3:38 pm | Permalink

    Going to a sex therapist and not having sex would be like going to a dentist and refusing to open your mouth – or like going to a psychologist and refusing to speak.
    Wait, what????
    I think you simply must be mistaken. Perhaps there is a handful of therapists who utilize this technique, but I cannot for one minute believe that is what sex therapists are FOR. I have certainly heard plenty about sex therapists in the past, and even sex classes — but this???? NOTHING like anything I have ever heard about, and yet you seem to be suggesting not only is it common, it is the definition of a sex therapist. I call bullshit.

  33. kb
    Posted March 20, 2009 at 3:56 pm | Permalink

    it’s not wrong and uptight, but it is not universal. It’s also not at all f-ing universal for women but not for men(though that’s a different rant). Nothing is wrong with you if you say that you want sex to involve more emotions than that, and not use this kind of sex therapist, or have casual sex. Nothing is wrong with someone else who doesn’t want/need that many emotions involved and does use this kind of sex therapist. Nothing is wrong with telling partner A that you couldn’t do casual sex with them, it’s full emotions or nothing then telling partner B that you will do casual sex with them. Every set of partners/circumstances are different.

  34. Fitz
    Posted March 20, 2009 at 3:58 pm | Permalink

    Did you even read the article? It’s obvious that’s he’s not talking about all therapists that specialize in sex, but the subset that this article is about.
    “turns out that there is a field within sex therapy, in which trained practitioners try to help their clients get over sexual anxiety and disorders by literally having sex with them.”

  35. The Law Fairy
    Posted March 20, 2009 at 4:06 pm | Permalink

    I share this concern. The fact that a handful of men in this line of work exist, compared to significantly more women, bothers me immensely. If anything, my experience has been (based on communications with friends and my own personal sexual experience) that straight women often tend to need more help achieving a satisfying sex life than do straight men. Logically, then, if this profession equitably reflected needs being met, there should be a lot more MALE therapists out there. That there aren’t makes me question the legitimacy of the practice to some extent. This is NOT to say that it is inherently illegitimate, or that sex surrogates are dressed-up prostitutes, or anything remotely like that. Just that I wonder how healthy a sex-related profession can be when it is so obviously steeped in a sexist culture, without making apologies or attempting to correct for that fact.

  36. The Law Fairy
    Posted March 20, 2009 at 4:10 pm | Permalink

    Did you even read the comment? If Frumious meant a SUBSET of sex therapists, /she could have and should have said so. S/he did not, but instead simply said “sex therapists.” The reference was a comparison of sex therapists to psychologists, which makes it sound like a comparison of two different fields of work and NOT like a discussion of a particular subset.

  37. Honeybee
    Posted March 20, 2009 at 4:25 pm | Permalink

    I suspect alot of men would love to go into this field, but that the demand is low.
    The demand for male prostitutes is alot less for for female prostitutes… so I would assume for the same reasons as that that alot of women might not be into this either.
    Then again personally… were I not married and in need of this, I might consider it!

  38. Honeybee
    Posted March 20, 2009 at 4:27 pm | Permalink

    “An honest question (for you or anyone who feels like they can answer it): Isn’t part of the problem the idea that there is “sexual dysfunction” in the first place? I mean, I would consider something like pedophilia or necrophilia to be a sexual dysfunction but not something like being unable to orgasm or keep an erection”
    Umm… I don’t understand this comment.
    Why would not being able to orgasm or keep an erection NOT be a sexual dysfunction? That seems like the very definition of it to me. Just because they are common issues doesn’t mean they aren’t dysfunctions. Am I missing something?

  39. elektra
    Posted March 20, 2009 at 4:30 pm | Permalink

    I don’t understand the difference, either, except that the so-called sex surrogate is expected to have more formal education than the so-called prostitute.
    And, this is anecdotal, but when I asked a girlfriend of mine (who’s a practicing sex therapist, and saw said film) about whether or not sex surrogacy is standard practice in her field, she replied that while some therapists employ (mostly female) surrogates for their (male) clients, “sex therapists [themselves] are simply psychotherapists who focus on sex-related issues, not glorified hookers”.

  40. voluptuouspanic
    Posted March 20, 2009 at 4:35 pm | Permalink

    As a sociology grad student who studies embodiment and paid work, I find this topic just endlessly fascinating. I even find the immediate zomg!prostitute! jump fascinating. The discussion really reminds me of a lot of the work built of Hoschild’s The Managed Heart about emotion work. People don’t “pretend” to like clients in therapy, etc. They carefully manage their emotions to benefit the client. I see the same thing in sex surrogacy. Now I don’t know much about this line of work, but I can imagine that it’s not all just straight PIV take your clothes off and get busy sex. I’m sure it’s very nuanced and based on exploring the body and sexuality.

  41. wax_ghost
    Posted March 20, 2009 at 4:39 pm | Permalink

    Well, we act like the only possible way for a sexual part to “function” is to do something. But having that part do nothing is as normal and natural and predictable as having it do something, so why do we automatically call it doing nothing “dysfunction”?
    It’s like the idea that all women will have an orgasm from PIV sex. For a long time in the past, and for many people still, women who don’t or can’t come from PIV sex are considered “dysfunctional”. But as I think we all know, that doesn’t mean there is actually something wrong with her – she might be experiencing a sexual dysfunction or maybe it’s the concept itself that she should be able to orgasm from PIV sex that is the real dysfunction.
    I’m specifically thinking of a guy I used to be friends with who had had a botched circumcision. Though we weren’t ever sexual with each other at all, he talked to me about it sometimes and his biggest problem was that he couldn’t find a partner who would treat the rest of his body besides his penis as erogenous zones. Because our society has this weird concept that men’s pleasure is focused almost exclusively in their penises, but his largely wasn’t, he couldn’t find a partner who could satisfy him sexually. That didn’t mean, though, that his penis wasn’t “functional” – it still “worked” just fine, according to him. The dysfunction was in the lack of comprehension of the women he had been with that his sexual focus was on other parts of his body.

  42. a.
    Posted March 20, 2009 at 4:42 pm | Permalink

    Knowing people who have had sexual issues due to disability, it can be a huge barrier to intimacy because of how it can feel like a lot of baggage to bring into a new relationship. Some people unhappily avoid romantic relationships altogether for this reason. Working through it with someone who isn’t there to judge you or have expectations of you, or be tangled up emotionally with you, who is knowledgable and experienced with sexual disfunction/trauma – it could be a very healthy way of getting through something.
    Of course, like anything in a patriarchal culture that sexualizes and exploits women, there are potentially issues. But honestly I don’t think a woman can safely pursue relationships at all in this culture without a risk of abuse/rape – don’t we all navigate this all the time when choosing who we date? But that doesn’t mean things are black and white, and that everything related to sex with men has to always be bad for women.
    Yes, we have to consider the way sexism impacts prostitution, porn and sex work, how it causes women working in these industries to be victimized and exploited, and how this impacts the lives of women who aren’t even directly involved. But that does not mean that all sex work is bad for women by any stretch. Many women who participate in sex work, esp. done within a feminist framework, find it a very empowering and positive, when it is on their terms.
    On another note, My first sexual experience was rape. A few years later, I was lucky to have a male partner who had also had been raped, who worked through it with me in a way that is similar to what some sex surrogates do. Without this experience, I don’t think I could have ever had healthy sexual relationships in adulthood. This type of relationship is probably not going to happen by chance for most people.

  43. Courtney
    Posted March 20, 2009 at 4:45 pm | Permalink

    Did you even read my post? “Sullivan creates real relationships with her clients, as do all good therapists”

  44. wax_ghost
    Posted March 20, 2009 at 4:48 pm | Permalink

    It can be either or both. It doesn’t always have to be either filled with emotion or as “mundane” as cleaning your teeth. Personally, I’ve had plenty of passionate sex and I’ve had plenty of dispassionate sex; I’ve had sex so good it made me cry or made me feel healed emotionally, and I’ve had sex that did what I needed it to do: give me the physical release of an orgasm.

  45. salymander
    Posted March 20, 2009 at 5:43 pm | Permalink

    Yes Courtney, I read and re-read your post MANY time. But you contradict yourself here. You may SAY that the therapists relationships are real. But you immediately retract it with this remark: “She has to pretend that she enjoyed it and enjoys being around them.”
    That is not how ANY kind of therapy works. It isn’t pretending. I also find your comment about sexual surrogacy being a “bizarre subculture” very insensitive. Especially coming from a liberal feminist blog that discusses issues of gender and sexuality so much. Would you use this type of language if you were discussing Transgender people and their sexuality?

  46. Honeybee
    Posted March 20, 2009 at 5:44 pm | Permalink

    Yes but surely if someone wants to seek treatment for something like that – whats wrong with that? Sex is also for procreation remember, so I’d say it’s pretty important overall to most people.

  47. The Law Fairy
    Posted March 20, 2009 at 5:45 pm | Permalink

    See, but I think that’s exactly the problem. If this is NOT like prostitution, then there SHOULD be more demand for male therapists. The fact that this world appears to mirror that of prostitution is what concerns me.
    Same disclaimers about not saying it IS prostitution, etc., etc., etc.

  48. salymander
    Posted March 20, 2009 at 5:47 pm | Permalink

    Wow that’s really amazing, thank you so much for sharing your experience. I heartily concur that it takes a special kind of person to help other through traumatic sexual experiences.

  49. wax_ghost
    Posted March 20, 2009 at 5:49 pm | Permalink

    Where did I say there was something wrong with the person for seeking help with something that s/he considers a problem?

  50. mydishonestheart
    Posted March 20, 2009 at 6:28 pm | Permalink

    I’m going to take a stab at answering this, but I’m certainly not an expert on the subject :)
    I don’t think the term is being used in the sense of your botched circumcision example — the fact that he said it worked just fine means it wasn’t dysfunctional. Even if there’s scar tissue, its still a perfectly good penis. :)
    The sense of dysfunction I’ve been taking away from the conversation is something like an inability to orgasm, whether or not through physical nerve dysfunction or an emotional blockage. Sex therapy can help determine what the issue is; if the nerves physically don’t work, they can refer to a doctor, but in the case of emotional blockages, inexperience, lack of exploration, etc. sex therapy can help.
    The reason dysfunction is being used as “something not doing something” is because sexual organs are capable of doing these things. I don’t mean someone being asexual, that’s perfectly fine. For example, erectile dysfunction. The penis is meant to be able to get increased bloodflow to hold an erection; it can be a physical or emotional problem preventing it, but either way, it is outside the “norm”. (I really hate the word normal, but I’m not sure what to use in its place. Apologies =/)
    Ultimately, that person’s erectile dysfunction is dysfunction by text book example, but whether or not its truly dysfunctional (in my opinion) is up to the person who has it. One man who struggles to get an erection may be perfectly okay with it while another isn’t, and the sex therapist would be there to aid the person who wasn’t.
    Just about everything is subjective and relative, but in terms of therapy its generally safe when describing a condition to use textbook definitions of dysfunction. However, when talking to a client, that’s when it may or may not be a dysfunction, depending on their lives, who they are, everything.
    This was much longer than I intended. o.O I hope it helped and was clear, haha.

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