In Europe, sexual health is increasingly treated as an important component of overall health and well-being. Public-health systems and clinical guidelines address issues ranging from sexual education and sexually transmitted infections to contraception, sexual dysfunction and reproductive health. In other parts of the world, the situation of sexual responses could be different.
But the European continent’s approach to sexual well-being raises a more complicated question: Can sexual intimacy itself become part of healthcare?
That debate has surfaced particularly around people living with severe disabilities, chronic illnesses or conditions that limit their ability to form or maintain intimate relationships.
In Germany, the debate became prominent after the Green Party suggested that public authorities should consider financing what is sometimes described as “sexual assistance” for people with severe health conditions.
Elisabeth Scharfenberg, then a Green Party spokeswoman, told Welt am Sonntag that she could imagine public financing for sexual assistance. Under the proposal, local authorities could provide information about available services and potentially offer financial support to people who meet certain conditions.
The idea was controversial. Germany has long had a legal framework permitting prostitution, and sexual-assistance services have emerged for some people with disabilities, severe illnesses and those living in care facilities. Such services can vary considerably, from affectionate touching and companionship to sexual intercourse.
The central argument is that physical disability or serious illness should not automatically mean the loss of intimacy, affection or sexual expression.
But whether public money should pay for such services is an entirely different question. Under the proposal discussed at the time, people seeking assistance would have needed medical certification establishing that they were unable to achieve sexual satisfaction through other means. They would also have needed to demonstrate that they could not afford the service themselves.
That immediately raised ethical and practical questions. Should sexual intimacy be regarded as a medical need in the same way as medication, physiotherapy or other forms of treatment? Who determines whether an individual has a genuine medical need? And should taxpayers be required to finance a service that remains deeply contested even when prostitution itself is legal?
Experts were divided on this. Some critics argued that treating sex as a publicly funded remedy could undermine human dignity and reduce complex social and emotional needs to a transactional service.
Others working with people in care settings have argued that intimacy, touch and sexuality can be important aspects of human well-being and should not automatically disappear because someone is elderly, disabled or dependent on others for daily care.
The Netherlands experiment
Germany’s debate has also been influenced by approaches elsewhere in Europe, particularly the Netherlands, where discussions and arrangements around sexual assistance for some people with disabilities have existed for years.
However, it is important not to oversimplify the European picture. There is no single European model in which governments routinely prescribe or pay for sex workers as medical treatment.
Legal systems, reimbursement arrangements and professional practices differ considerably from one country to another.
What is more widely shared is the recognition that people with disabilities and older people do not cease to have sexual identities simply because they require care.
That recognition has helped push sexuality further into conversations about dignity, autonomy, relationships and quality of life.
But….
Sexual health goes beyond avoiding disease. The broader European public-health conversation is also changing. Sexual health is no longer understood solely as protection against sexually transmitted infections or unintended pregnancy. Modern approaches increasingly consider sexual well-being, consent, relationships, sexual function and the ability to experience intimacy.
That is particularly relevant when dealing with sexual dysfunction.
Cardiologists in France, for instance, have highlighted the relationship between sexual activity, psychological well-being and cardiovascular health. Medical professionals have also stressed that erectile dysfunction should not simply be dismissed as a bedroom problem.
In some men, it can be an early warning sign of underlying cardiovascular disease because the blood vessels involved in erectile function can be affected by the same vascular problems that contribute to heart disease.
Sexual difficulties can therefore sometimes provide doctors with an opportunity to identify broader health problems.
There are also psychological dimensions. A satisfying and consensual sex life can contribute to emotional well-being, intimacy and stress reduction, although it should not be presented as a universal treatment for depression, cardiovascular disease or other medical conditions.
Should sex be healthcare?
This is where the debate becomes particularly delicate. There is a significant difference between recognising sexuality as part of human well-being and classifying commercial sexual services as medical treatment.
A person with a disability may have every right to sexual expression, companionship and intimacy. That does not automatically mean the state has an obligation to purchase sexual services on their behalf.
The question becomes even more complicated when public funding is involved.
Healthcare systems operate with limited resources. Governments must decide which interventions produce sufficient health benefits to justify public expenditure. A policy that funds sexual assistance would therefore have to answer difficult questions about eligibility, medical necessity, consent, safeguarding, taxation, professional regulation and equality.
There are also concerns about exploitation and the protection of both clients and sex workers.
At the same time, dismissing sexuality completely from discussions about disability and healthcare can create another form of discrimination. People who depend on carers for almost every aspect of daily life can have their sexuality ignored, infantilised or treated as though it no longer exists.
Perhaps the most useful distinction is this:
Sexuality can be an important part of health and human dignity without every sexual service becoming healthcare.
Europe’s evolving debate reflects that tension. On one side is a growing recognition that sexual well-being matters. On the other is the difficult question of where personal autonomy ends and public responsibility begins.
Perhaps that is the real public-health conversation: not simply whether people should have more sex, but whether societies are prepared to acknowledge that intimacy, sexuality, disability, ageing and health can coexist.and deserve to be discussed without shame, while still being governed by consent, dignity and appropriate safeguards.
