Can Sex Work Help Heal Trauma and Anxiety?

These mental health advocates and sex workers think so.
Photo of Carmen Shakti by Emily McCarty

Carmen Shakti wanted to become a psychologist but had challenges with formal education. She always wanted to help people, but didn't know what direction that would take her. After a self-described "healing experience" with her partner and a professional sex worker, she realized this was her calling—to help others overcome anxiety and trauma via sex work.

Shakti had a previously abusive relationship, so she wanted to set up her practice to focus on healing and safe exploration of sexuality. She's worked with clients who have never had sexual intimacy due to severe anxiety disorders out of her home in Vancouver, BC.


"I had one client who was probably in his forties and he had never had a sexual experience with another person because he had such severe social anxiety," she told VICE. After working with Shakti, he emailed her with positive news. He had met a woman whom he cared about and started his own sexual exploration.

People with disabilities still face social stigma and isolation when it comes to intimacy. According to a 2014 British poll from The Guardian, 44 percent of people had never had sex with someone with a physical disability and never would. This is down from 2008, when 70 percent said they would not have sex with someone with a disability.

Dave Symington knows about the intersection of disability and sexual connection. That's why he helped found EASE Canada, which provides advocacy and education on sexuality for people with disabilities.

He says while he cannot hide his disability—at 19 he became a quadriplegic after a diving accident—those with with mental health disabilities are often invisible.

EASE Canada founder Dave Symington

"It's the hidden disabilities that seem to be more troubling in society," Symington said. "People that I know who really struggle with mental health issues…oftentimes it's the isolation. I think that at least the sexual side [with sex work] serves a part of that picture where you can have an experience of intimacy."

Shakti uses her training in Tibetan tantric philosophies to create safe spaces for her clients with sexual trauma. She does tantric massage, breathing exercises, and meditation.


"In the case of sexual trauma, people need to find someone with training who can help them to heal," she said. "Sexual abuse is so common in our culture and it's not dealt with in a sensitive manner at all. So I think that sex workers are a really important part of that healing."

Symington has heard again and again how interacting with a sex worker or surrogate partner completely changes their capability for creating and maintaining intimate relationships.

"People who have never been on a date before and had these experiences [with surrogate partners] learn how to communicate. They're comfortable with somebody. Having peer support… seems like a small thing but it's huge in building your confidence and self-esteem," he said.

Surrogate partners differentiate themselves from sex workers in that they are referred from therapists and follow a plan to focus on intimacy and connection more than sexual acts themselves.

Mark Shattuck is a surrogate partner in San Francisco, as well as media coordinator and treasurer for International Professional Surrogates Association (IPSA). The association has been around for 40 years and is one of the few—if not only—programs providing surrogate certification.

Shattuck says surrogates only work in triadic relationships—the surrogate, the client, and their therapist. Many of their clients have sexual trauma or mental health issues preventing them from forming romantic or sexual relationships on their own.


"I think that's probably one of the bigger things that surrogate partners are good for, is for people with childhood sexual abuse or are rape survivors, and they have never been able to be in their body during sex. They say, hey, I want to get back my sexuality and take it for myself," Shattuck told VICE. "You are now in a trusting environment where you can explore your sexuality and get back in your body."

Shattuck works full-time at a day job. He does surrogacy work on the side because of the connection and value he says he brings to people's lives.

"They come to me in the beginning and may be struggling with certain issues. Then seeing them transform and come into their own—that is super rewarding," Shattuck said. "I have some people who have had trauma and they cannot even look me in the eye or have a hard time touching. We help people become more aware of their body so they can go out into the world and create their own relationships."

Shattuck recognizes the high price tag as an accessibility issue—a two hour session with a surrogate can cost about $300. He says although it's an important issue, he doesn't see sex workers legally taking mental health clients any time soon in the US.

In Canada, Bill C-36 allows Shakti to sell her services but it's still illegal to buy sex or use explicit language in advertising. She says she would love to see it covered by health insurance so more people can see the benefits of sex work.


Some countries have already taken the step toward covering sex work for those with disabilities. People in the Netherlands, where sex work is completely legal, can use their disability benefits however they like, including purchasing sex. A 21-year-old British man with learning disabilities flew to Amsterdam just to use these services, highlighting the importance of the issue within the disability community.

Symington wants to see EASE's training rolled out across the country—not just for surrogates, but for advocates and therapists as well. Down the road, he'd also like to see an allowance in government funded health plans.

"In my extended health plan through CSIL (Choices in Supports for Independent living), I'm allowed 500 dollars a year for massage. If you could use some of those funds for services like this, we would love to see some kind of subsidy available," he said. "And a change in public attitudes."

He realizes that views on sex work—even within the disability community—are still stigmatised.

"People have a concept—an idea that they were raised with—around sex work," Symington said. "But usually after some discussion about working with someone who is trained and oriented about disability, that they provide more of a therapeutic service, that they have some skills and alternative knowledge—then they tend to loosen their ideas of what that might be. And be more open to having those experiences."

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