I am on vacation for another week. But I've invited Dr. Lori Brotto to handle the Savage Love Letters of the Day. Dr. Lori Brotto is a clinical psychologist and sex researcher at the University of British Columbia in Vancouver. You can follow her on Twitter @DrLoriBrotto, take part in her studies here, and hear her chat about cultivating sexual satisfaction here. Dr. Brotto will be answering your questions all week.

I am a heterosexual female who has been happily, wonderfully married for 20 years. Seven years ago, I contracted a chronic illness, Lyme disease, and over the years it has progressed to the point where now I am no longer able to have sex with my husband. I desperately want to, but my body betrays me and my desires. I love my husband. He is loyal, devoted, and also my caretaker as now my mobility has been compromised due to the strain of Lyme that I have. I don't want my husband to be miserable in the sex department just because my body isn't working as it should, but an affair, or "lover" if you will, isn't acceptable to me. I don't want to be replaced emotionally by another woman. I just want my man to get laid. So we agreed that finding a sex worker would be better than an affair since there are no strings attached. The question is, how do we find one? Yeah he could go down to Aurora Avenue and find one, but (sorry ladies) ewww. That's not what I want for him. It seems it's easy to find a well-recommended hairdresser, massage therapist, or physician, but what about a sex worker? How do we find this person? Ads online or in the newspaper? It feels like throwing darts, blindfolded. Is there any advice you can provide?

Sick Seeking Sex Worker

Dr. Brotto's response after the jump...

Lyme disease is a bacterial disease caused by the bite of an infected tick. It is named after the town in Connecticut where many of the early cases were first identified, but we now know that ticks carrying Lyme disease can live anywhere that is wooded or forested. The Centers for Disease Control and Prevention (cdc.gov), among other things, tracks the geography of Lyme disease and shows that most new cases in recent years were seen in Maine, Delaware, New Hampshire, and Vermont. Symptoms of Lyme disease seem to differ from person to person and can appear early on as a rash that resembles a bull’s eye. Those with advanced Lyme disease or those with lingering symptoms after antibiotic treatment can have severe headaches, pain, swelling, arthritis, and nerve damage. A smaller number of people with chronic Lyme disease can develop severe muscle or joint pain, fatigue, sleep problems, and other unforgiving symptoms. From your description, SSSW, it sounds like you have a more debilitating form of Lyme.

For readers who have never heard of Lyme disease, you can imagine trying to have sex when your energy gas tank is on empty, while you’re in severe pain, feeling swollen like a water balloon, and potentially having cognitive problems like lack of concentration. SSSW, I applaud you and your husband for making sex important throughout your disease, and I’ve worked with countless others who’ve given up on sex in the face of a chronic illness. However, when you say you’re no longer able to have sex, I assume that you mean penis-in-vagina sex, right? What about all of the myriad other ways of feeling pleasure and getting off—oral sex, mutual/single masturbation, dildo/vibrator play, sharing fantasies, sensual touch, erotic baths, etc.? With penis-in-vagina intercourse potentially off the sexual menu, have you expanded the menu options and tasted other dishes? Because It Feels Good by frequent Savage Love letter guest expert Debby Herbenick and Guide to Getting It On by Paul Joannides are fabulous guides to diversifying any menu with pleasure practices that accommodate physical abilities. There are also physical aids if your Lyme disease symptoms include mobility limitations, like the Intimate Rider chair (by the way, you don't need to have movement limitations/pain to ride this arousing apparatus!). You can also switch roles and use a strap-on for pegging pleasure with the chair. If your symptoms wax and wane, you should be planning your sexy time when symptoms are more manageable.

When a partner takes on the role of caretaker, his role as lover gets diluted, and this may mean making extra efforts to carve out and protect his role as lover. There are many creative ways of doing this, ranging from getting extra help with some of the caretaking (if that's possible) to making sure your dirty talk is not “contaminated” by your health-related requests—i.e., don't ask for oral play and request that he “pass the ibuprofen” in the same sentence. Also, defending your identity as sexual from your identity as “patient” is perhaps trickier and yet essential. Don't forget the second G in GGG is as much about receiving as it is about giving.

So you wanna find a sex worker? I might recommend a sexual surrogate instead (or first) and urge you to play along as well. Most surrogates are versatile with two- and three-way play. They can also provide “hands on” education on how to adapt sex to your abilities. Because many belong to a professional surrogate association, clients are often relieved when it comes to standards of practice. In the United States, the legal status of surrogates is not defined and there are no laws regulating surrogates. Like finding any professional, you should interview and shop around and settle on one that you and your husband feel comfortable with.

Good luck!