usBarbara Krakower, a sex therapist from Boca Raton, Fla., isn't hands-on when it comes to treating her patients for sexual issues, but sometimes she relies on those who are -- sex or partner surrogates.
First, there was the 54-year-old virgin whose mother had taught him, "Women are no good and you don't need them when you have me."
Then, a wheel-chair bound man was going through a divorce and was fearful of initiating a new relationship.
One of the saddest cases, she said, was a 32-year-old whose first lover berated him when he couldn't sustain an erection. After they broke up, his next three sexual encounters petered out the same way.
In each case, Krakower offered to call in a surrogate, someone who is paid to consult with the therapist to get to the root of the patient's phobia or inhibition and then ultimately work it out between the sheets.
Sex surrogacy may be the oldest or the newest profession in the world. And like the former, it's very hands on. "Philosophically, it's been around a long time," she said.
French fathers initiated their adolescent sons by introducing them to their mistresses. In other cultures a young virgin is given physical guidance before consummation of the marriage.
Today, at least in Florida, the state neither bans nor condones it. "There's no written law either way," she said.
Sex surrogacy emerged in the 1970s and flourished for more than a decade before the HIV/AIDS epidemic put a focus on safe sex practices, according to Barbara Keesling, who for 12 years worked as a sex surrogate and is now a professor at California State University at Fullerton.
A former post office worker and Playboy bunny, she saw an ad for a sex surrogate and responded. She trained and interned in a non-sexual massage method developed by sexperts Masters and Johnson.
She not only worked while married, but says her husband also worked in the same profession, one that they say helped others.
"Most of the clients I treated either had premature ejaculations or sexual anxiety," said Keesling, 55. "You can't throw them in and have sex with them. You have to retrain their sexual ability."
One client was such a huge success that he contacts Keesling every few years to tell her how is life is going.
"He couldn't have sex at all -- he ejaculated with just one touch," she said. "Since then, he has had several relationships and partners."
After the 1980s, society adapted more conservative attitudes. Now sex surrogates work directly with therapists, charging an equally professional rate.
"The legal problem has always been the link between prostitution and surrogacy," said Pepper Schwartz, sexpert and professor of sociology at the University of Washington. "But they are trained to work with the therapist so they are not just having sex.
"Usually, you are dealing with people who have some pretty strong problems," she said. "And it's expensive. You can get a prostitute for way less."
The surrogates are credentialed and trained by the International Professional Surrogates Association (IPSA) and can be either male or female.
Therapists say more men than women use surrogates because they tend to have more performance anxiety than women.
According to the organization's code of ethics, "the surrogate's relationship with the client is temporary; always within the context of the therapeutic situation and in association with the supervision of the therapist."
Legality issues have not been problematic, mostly because surrogates don't advertise their skills and are usually referred by licensed therapists.
No one knows why, but they are easier to find in California, New York, Florida and Pennsylvania.
For some who struggle with sexual problems, having a surrogate partner is "a godsend," according to Schwartz. "It's hard to go from the theoretical to the practical, particularly if you don't have a partner to work with."
Such was the case with the 54-year-old virgin who sought Krakower's help.
"His whole life was his mother, and she had brainwashed him into believing that women were no good and you don't need them when you have me," Krakower said.
"Not until his mom died, did he realize what he learned was wrong and he really wanted to establish a loving relationship," she said.
He turned to a sex or partner surrogate and he wanted to learn how to establish a relationship with a woman.
The therapist set the ground rules: The surrogate was expected to help him adjust socially and Krakower would guide her along the way. Her fee -- and this was a decade ago -- was $125 an hour.
"If he did well with the social adjustment, we would move on to something more sexual," she said.
"First of all, he needed a wardrobe adjustment -- basically he had dorky clothes," Krakower said. "She went shopping with him and went on dates to the movies and sat at his house and chatted."
A second patient had a musculoskeletal disorder and was confined to a wheelchair.
"His wife was divorcing him and he had a lot of anxiety about a new relationship," she said. "We thought a surrogate could help him jump start it."
After the first consultation, the man decided not to go further. "He was scared," Krakower said.
A third patient, a professional man in his 30s, was interested, but couldn't afford the surrogate.
"He was very good looking and very successful," she said. "He was a really good, good man with a great personality."
But he had suffered from a history of flagging erections since losing his virginity with his college girlfriend.
"She handled it poorly, making a mockery of him and laughing at him and he became gun-shy," Krakower said. "It had a huge snowball effect and he simply would not get involved with women."
But, like the Acid Queen in The Who's rock opera, "Tommy," who introduces the "deaf, dumb and blind kid" to sex, these relationships risk "breaking your little heart."
Sometimes the patient becomes attached emotionally to his teacher. The 54-year-old virgin fell in love with his surrogate partner, a phenomenon that is not uncommon, according to Krakower.
The relationship lasted four months but never landed in the bedroom, largely because of the virgin's "hard-wired" personality disorder.
"She was trying to get him to feel more comfortable with nudity and they got naked together, but it never went further than that," his therapist said. "He was absolutely terrified."