Editorial BMJ Sex Reprod Health: first published as 10.1136/bmjsrh-2017-200012 on 4 June 2018. Downloaded from I, Sex Robot: the health implications of the sex robot industry Chantal Cox-George,1 Susan Bewley2 1St George’s University Hospitals INTRODUCTION METHODOLOGY NHS Foundation Trust, London, The sex technology industry is We aim to provide a succinct summary UK 2Women’s Health Academic already estimated to be worth of the arguments for and against the sex Centre, King’s College London, US$30 billion.1 While sex toys are robot industry and to assess the potential London, UK well-established, sex robots (‘sexbots’), health implications that may affect both anthropomorphic devices created for patients and clinicians. To find infor- Correspondence to Dr Chantal Cox-George, St sexual gratification, are no longer mation about the health consequences George’s University Hospitals science fiction. Four companies sell of sex robot use a narrative literature NHS Foundation Trust, London adult sexbots priced between US$5000 review via PubMed and Google was SW17 0QT, UK; ccoxgeorge@ gmail. com and US$15 000. They must be distin- conducted, using the terms ‘robot’, ‘sex’, guished from ‘paedobots’ – childlike ‘sex toys’, ‘doll’, ‘child sex abuse’, ‘sex Received 25 October 2017 robotic models at present only produced therapy’, ‘paedophile*’ with follow-up Revised 6 April 2018 2 of embedded references, and informal Accepted 8 April 2018 by one company. The market appears to be men, and so far only ‘female’ adult discussions with expert informants from sexbots have been created, although one various specialties. In order to explore the company reports aiming to sell ‘male’ themes identified, we considered sexbots devices later in 2018.3 Sex robots are within the contexts of pornography, sex realistic mannequins with variable ages, dolls and virtual reality. appearances and textures, and customis- We found no reports of primary data able oral, vaginal and anal openings. relating to health aspects of the use of sex The medical profession needs to be robots. prepared for inevitable questions about the impact of sex robots on health. Apart THEMES IDENTIFIED from free-market profits, the majority We identified four key themes relevant to http://jfprhc.bmj.com/ of arguments in their favour use ‘harm healthcare providers: limitation’ somewhat defensively to ► Safer sex convince others that this is one way ► Therapeutic potential to protect the vulnerable. Opponents ► Potential to treat paedophiles and sex of- reject the hypothesis that they reduce fenders sexual crimes, and instead raise concerns ► Changing societal norms. about the potential for harm by further on September 25, 2021 by guest. Protected copyright. promoting the pervasive idea that living Do sex robots promote safer sex? women too are sex objects that should be Some people envision a future with no sex constantly available - ‘misogynistic objec- trafficking, sex tourism or sex trade. One tification’ - and intensifying existing hypothetical future red-light district has physical and sexual violence against been described where the spread of sexu- women and children. ally transmitted infections is prevented What characterises all discussions of this by providing robotic prostitutes made of issue is the paucity of an evidence base. bacteria-resistant fibre, flushed for human This might falsely reassure clinicians not fluids after use.4 This well-intentioned to concern themselves with changing their scenario is optimistic, and sexbots can current clinical practice. However, an already be bought, or leased for parties. absence of evidence does not excuse the There may be legal liability ramifications To cite: Cox-George C, medical profession from discussing and should the engineering of sexbots fail, Bewley S. Published Online First: [please include Day debating the issues, as there will inevitably leading to injury or infection, and with Month Year]. doi:10.1136/ be consequences for physical, mental and unclear responsibility for condoms and bmjsrh-2017-200012 social well-being. cleaning protocols.5 Cox-George C, Bewley S. 2018;0:1–4. doi:10.1136/bmjsrh-2017-200012 1 Editorial BMJ Sex Reprod Health: first published as 10.1136/bmjsrh-2017-200012 on 4 June 2018. Downloaded from Third-party interests, witnesses and bystander Countervailing risks have been expressed including effects have to be considered as sexbots enter the commodifying human beings, normalising sexual devi- public domain. Greater tolerance of sexbots relies on ancy, becoming ‘addictive’, acting as a practice ground society having an informed and agreed view of a lais- for violence, and promoting the control of vulnerable sez-faire governmental approach, rather than one regu- individuals.11 While many sexbot users may distin- lating financial exchanges related to sexual activity. guish between fact and fantasy, some buyers may not, This chimes with present disputes about ‘full’ versus leading to concern about potentially exacerbating the ‘limited’ decriminalisation of prostitution, which the risk of sexual assault and rape of actual children and British Medical Association recently rejected for want adults. of good evidence of sex workers’ health and safety Virtual reality has been shown to evoke realistic (and protection.6 It is speculative whether the develop- potentially gratifying) responses in sexually deviant ment of a sexbot marketplace will lead to lesser risk of and non-deviant men in controlled research settings.12 violence and infections, or drive further exploitation One company (with a decade’s experience producing of human sex workers. Sexual violence survivors and life-like child sex dolls) claims that they help individ- activists already campaign against ‘rape culture’7 - the uals “redirect dark desires”,12 thus protecting potential idea that (overwhelmingly) male violence is regarded victims. The company’s chief executive officer, a man as entitled and prosecution is so difficult that perpetra- with self-confessed paedophilic impulses,13 believes tors of sexual abuse act with impunity. that aberrant sexual desires cannot be remedied but instead should be expressed legally and ethically, other- 14 Do sex robots have therapeutic value? wise life would not be “worth living”. This might be Psychosexual therapists should examine the future taken literally or seen as a manipulative suicide threat. impact of sex robots on empathy and human rela- In the USA, virtual child pornography is considered tionships. It is at least plausible that sex robots will legally distinct from imagery involving real children.15 be helpful for patients who would benefit from sexual In the UK, it would not be illegal to own a child sexbot, practice without pressure, although this might move although a man has been jailed for “importing an some further away from human intimacy. Sexual obscene article”, a child sex doll.16 Forensic physicians activity with robots has been described as a mastur- working in Sexual Assault Referral Centres have been batory practice, so someone with sexual dysfunction, involved in police investigations of customs offences, which may already lead to isolation, “might become providing age assessment of child sex dolls (size, even more isolated by the illusion of having a substi- age-related features, Tanner staging, hair, clothing) (L tute satisfaction”.8 Psychosexual therapists might use O’Connor, ME Vooijs, S Lewis, C White, K Shardlow, sexbots to assist couples with mismatched libido or to BP Butler, personal communications, 2017). help treat erectile dysfunction,9 but potential adverse Given present major weaknesses in the evidence consequences, such as rejection of the non-interacting base, and the lack of evidence of effective treatments partner or threats to the integrity of the relationship, of sexual offenders against children, we would strongly http://jfprhc.bmj.com/ are underplayed. Sexbots might provide ‘companion- caution against the use of paedobotsas putative ‘treat- ship’ for the lonely, mentally and physically disabled, ment’ unless as part of robust, scientifically and ethi- the elderly, or those who find intercourse traumatic,9 cally acceptable research trials. though this justification requires a change in meaning of ‘companion’ from a living, interacting person. It Will there be changes in societal norms? also seems patronising to argue for a ‘lesser’ sexual Sexbots are generally female and ‘air-brushed’, raising experience when most people with disabilities can the question of public interest in avoiding gender on September 25, 2021 by guest. Protected copyright. form mutually satisfying relationships. Artificial intel- discrimination and inequality due to the promotion ligence means sexbots will move, eye-track, ‘speak’ of distorted views of attractiveness that reduce female and simulate sexual functions as they “adapt to their body confidence. There are worries about blurred user’s needs and even moods”2 However, it remains boundaries to consent17 and permission for enacted unproven that intimacy ‘needs’ will be satisfied: there violence when sexbot ‘personalities’ can be selected could be worsened distress.10 While a human may that simulate non-consensual sex - that is, rape. The genuinely desire a sexbot, reciprocation can only be Foundation for Responsible Robotics states that the artificially mimicked. sex between human and robot is intrinsically different to sex between humans because “machinery … cannot 18 Do sex robots have potential to treat paedophiles and sex grant