Fleur walks into the room and sits beside a client on the bed. A caregiver is there to introduce them, and has warned that the client might need time to get used to a new person.
He doesn’t. Almost at once, he tells the caregiver that she can go. This is a private moment. He is tense, his head full of images of how this is supposed to go. They come from porn; the organisation that cares for him has given him DVDs and he has watched them, many times.
"In his head, I was going to do exactly what was on the videos," Fleur, who uses only her first name to protect her privacy, told The Brussels Times. "I’m not going to play beach volleyball in white panties."
So she undresses. For him, that is enough. He has seen a woman naked, which is what he wanted that day, and he can finally relax.
Fleur provides intimacy and sexual assistance to people with disabilities in Belgium. She talks with them, touches them, and when they want it, she has sex with them. Fleur sees it as care work, though others call it sex work, but Belgian law has no dedicated legal status for what she does.
People with disabilities have sexual needs and desires, yet for those who depend on others in daily life, even a hug can be restricted. Meeting those needs can mean crossing boundaries that care workers are not expected to cross.
For people like Fleur, the question is where does care work end and sex work begin, and what does the distinction mean in practice?
"Everybody has sexual needs, everybody has desires," Steven De Weirdt, a psychologist at Aditi vzw, an organisation for intimacy and sexuality in health care, told The Brussels Times. "Everybody has sexual rights also."
A high five, never a hug
Fleur knows the problem from the inside. She used to work as a caregiver at different organisations.
When a resident asked about sex, she said, the answer was usually no, and an alternative was rarely provided. One rule stayed with her. At one organisation, staff were told to give a particular man only high fives, never hugs. Years earlier, a caregiver had said she didn't like a hug he gave her.
Though the caregiver was long gone and nobody had reported a problem with him since, "we are still only giving him a high five," Fleur said.
The DVD in the opening scene was not a one-off either. Fleur has heard of several organisations handing porn to residents who showed sexual behaviour, sometimes after they harassed others out of frustration.
When her first client showed her his DVD, she found hardcore material, such as a man grabbing a woman’s head to force oral sex. For many of her clients, porn was their only sex education. Men approaching 40 asked her why the people on screen never talk, and were so mean to each other.
"Sex is supposed to be clumsy," she said, "and you can laugh."
Aditi sees sexual assistance as one way of addressing this gap. De Weirdt gave three reasons for their work, education, prevention, and quality of life, and the stakes can be high. De Weirdt recalled a woman paralysed in an accident at 18, who, years later, wanted to talk with her carer about sex.
"If this caretaker says, well, I don’t want to talk about this, then this is a 26-year-old woman that will never experience any form of sexuality anymore," he said.
What intimacy can mean
Fleur calls her work experiential intimacy care. Some sessions are only talking, others involve kissing, cuddling, massage or, when the client wants it, sex. One client, a man with autism in his late thirties, saw a sexologist because he didn't know how to masturbate. He struggled to translate her words into actions, so the sexologist referred him to Fleur.
"I can literally sit next to him and show him," Fleur said. "I can go hands-on. All with consent and all with very strict rules, but it works."
Florence Caeymaex, Professor in Ethics and Medical Humanities and one of the authors of a 2017 opinion on sexual assistance by Belgium's Advisory Committee on Bioethics, agreed on the need.
"It’s not the job of a nurse to explain how to have sexual intercourse," she said. "That’s why it’s better to have someone who is specialised."
Often, it is not about penetration. One client with an intellectual disability wanted to experience sex. Several sessions in, they were lying naked together, cuddling and talking, and though, strictly speaking, the two had not had intercourse, he told her he loved having sex with her. “Then why go further?” Fleur said.
"It's touch, it’s a connection with someone, it's being close to someone, it’s feeling safe," she said. Some clients have told her that only now, touched again after years, they realise how lonely they had been before.
Care or sex work?
On the question of whether this service is care work or sex work, for Aditi, the answer is care.
Few of the 130 trained sexual assistants Aditi works with are "professional" sex workers. They include housewives, a postman, and an HR manager. Many others work in health care. Clients pay a fixed fee, all of which goes to the assistant rather than the organisation.
"Of course, the act that they are doing is often sexual," De Weirdt said, "But they are not working in the sex business. They are working in the caretaking business."
However, Minne Marlo, a body-orientated trauma and sex therapist, sees it differently. She runs Meerdanseks, a platform in Flanders and Brussels that connects clients with intimacy professionals, offering anything from coaching and cuddling to sexual services.
Care and sex work sit on “a gradient rather than a line,” she said, warning against a binary that might demonise sex work, where disabled people receive noble sexual assistance and others clients of sex work are suspect.
"People with a disability have desire, full stop. And people without one often need care, full stop," she said.
Belgium decriminalised sex work in 2022. Since 1 December 2024, sex workers can also work under employment contracts. But sexual assistance has no status on its own.
Fleur, who started through Aditi and now works independently as Fleur Sens, wants a recognised name for the work and mandatory training. "There is a care part," she said.
However, there is little agreement on what recognition should look like. Aditi wants its assistants recognised as care workers. Marlo, meanwhile, would rather build on existing law when it is evaluated this December, warning that tying the status to disability “would draw the circle too small.” Caeymaex has also questioned whether a separate law is needed.
In the meantime, for De Weirdt, "it all starts with being open to discussion."
Until then, some residents who ask about intimacy will still be handed a DVD.
