Cox-GeorgeC, BewleyS. 2018;0:1–4. doi:10.1136/bmjsrh-2017-200012
I, Sex Robot: the health implications
of the sex robotindustry
Chantal Cox-George,1 Susan Bewley2
1St George’s University Hospitals
NHS Foundation Trust, London,
2Women’s Health Academic
Centre, King’s College London,
Dr Chantal Cox-George, St
George’s University Hospitals
NHS Foundation Trust, London
SW17 0QT, UK; ccoxgeorge@
Received 25 October 2017
Revised 6 April 2018
Accepted 8 April 2018
To cite: Cox-GeorgeC,
BewleyS. Published Online
First: [please include Day
Month Year]. doi:10.1136/
The sex technology industry is
already estimated to be worth
US$30 billion.1 While sex toys are
well-established, sex robots (‘sexbots’),
anthropomorphic devices created for
sexual gratification, are no longer
science fiction. Four companies sell
adult sexbots priced between US$5000
and US$15 000. They must be distin-
guished from ‘paedobots’ – childlike
robotic models at present only produced
by one company.2 The market appears to
be men, and so far only ‘female’ adult
sexbots have been created, although one
company reports aiming to sell ‘male’
devices later in 2018.3 Sex robots are
realistic mannequins with variable ages,
appearances and textures, and customis-
able oral, vaginal and anal openings.
The medical profession needs to be
prepared for inevitable questions about
the impact of sex robots on health. Apart
from free-market profits, the majority
of arguments in their favour use ‘harm
limitation’ somewhat defensively to
convince others that this is one way
to protect the vulnerable. Opponents
reject the hypothesis that they reduce
sexual crimes, and instead raise concerns
about the potential for harm by further
promoting the pervasive idea that living
women too are sex objects that should be
constantly available - ‘misogynistic objec-
tification’ - and intensifying existing
physical and sexual violence against
women and children.
What characterises all discussions of this
issue is the paucity of an evidence base.
This might falsely reassure clinicians not
to concern themselves with changing their
current clinical practice. However, an
absence of evidence does not excuse the
medical profession from discussing and
debating the issues, as there will inevitably
be consequences for physical, mental and
We aim to provide a succinct summary
of the arguments for and against the sex
robot industry and to assess the potential
health implications that may affect both
patients and clinicians. To find infor-
mation about the health consequences
of sex robot use a narrative literature
review via PubMed and Google was
conducted, using the terms ‘robot’, ‘sex’,
‘sex toys’, ‘doll’, ‘child sex abuse’, ‘sex
therapy’, ‘paedophile*’ with follow-up
of embedded references, and informal
discussions with expert informants from
various specialties. In order to explore the
themes identified, we considered sexbots
within the contexts of pornography, sex
dolls and virtual reality.
We found no reports of primary data
relating to health aspects of the use of sex
We identified four key themes relevant to
►Potential to treat paedophiles and sex of-
►Changing societal norms.
Do sex robots promote safer sex?
Some people envision a future with no sex
trafficking, sex tourism or sex trade. One
hypothetical future red-light district has
been described where the spread of sexu-
ally transmitted infections is prevented
by providing robotic prostitutes made of
bacteria-resistant fibre, flushed for human
fluids after use.4 This well-intentioned
scenario is optimistic, and sexbots can
already be bought, or leased for parties.
There may be legal liability ramifications
should the engineering of sexbots fail,
leading to injury or infection, and with
unclear responsibility for condoms and
Cox-GeorgeC, BewleyS. 2018;0:1–4. doi:10.1136/bmjsrh-2017-200012
Third-party interests, witnesses and bystander
effects have to be considered as sexbots enter the
public domain. Greater tolerance of sexbots relies on
society having an informed and agreed view of a lais-
sez-faire governmental approach, rather than one regu-
lating financial exchanges related to sexual activity.
This chimes with present disputes about ‘full’ versus
‘limited’ decriminalisation of prostitution, which the
British Medical Association recently rejected for want
of good evidence of sex workers’ health and safety
protection.6 It is speculative whether the develop-
ment of a sexbot marketplace will lead to lesser risk of
violence and infections, or drive further exploitation
of human sex workers. Sexual violence survivors and
activists already campaign against ‘rape culture’7 - the
idea that (overwhelmingly) male violence is regarded
as entitled and prosecution is so difficult that perpetra-
tors of sexual abuse act with impunity.
Do sex robots have therapeutic value?
Psychosexual therapists should examine the future
impact of sex robots on empathy and human rela-
tionships. It is at least plausible that sex robots will
be helpful for patients who would benefit from sexual
practice without pressure, although this might move
some further away from human intimacy. Sexual
activity with robots has been described as a mastur-
batory practice, so someone with sexual dysfunction,
which may already lead to isolation, “might become
even more isolated by the illusion of having a substi-
tute satisfaction”.8 Psychosexual therapists might use
sexbots to assist couples with mismatched libido or to
help treat erectile dysfunction,9 but potential adverse
consequences, such as rejection of the non-interacting
partner or threats to the integrity of the relationship,
are underplayed. Sexbots might provide ‘companion-
ship’ for the lonely, mentally and physically disabled,
the elderly, or those who find intercourse traumatic,9
though this justification requires a change in meaning
of ‘companion’ from a living, interacting person. It
also seems patronising to argue for a ‘lesser’ sexual
experience when most people with disabilities can
form mutually satisfying relationships. Artificial
intelligence means sexbots will move, eye-track,
‘speak’ and simulate sexual functions as they “adapt
to their user’s needs and even moods”2 However, it
remains unproven that intimacy ‘needs’ will be satis-
fied: there could be worsened distress.10 While a
human may genuinely desire a sexbot, reciprocation
can only be artificially mimicked.
Do sex robots have potential to treat paedophiles and sex
Even before sexbots, there was little consensus on the
impact of pornography, although there are claims of
an association with reduced incidences of rape and
prostitution, confounded by causality, transparency
and recognition that there are conflicts of interest.
Countervailing risks have been expressed including
commodifying human beings, normalising sexual devi-
ancy, becoming ‘addictive’, acting as a practice ground
for violence, and promoting the control of vulnerable
individuals.11 While many sexbot users may distin-
guish between fact and fantasy, some buyers may not,
leading to concern about potentially exacerbating the
risk of sexual assault and rape of actual children and
Virtual reality has been shown to evoke realistic (and
potentially gratifying) responses in sexually deviant
and non-deviant men in controlled research settings.12
One company (with a decade’s experience producing
life-like child sex dolls) claims that they help individ-
uals “redirect dark desires”,12 thus protecting poten-
tial victims. The company’s chief executive officer,
a self-confessed paedophile, believes that aberrant
sexual desires cannot be remedied but instead should
be expressed legally and ethically, otherwise life would
not be “worth living”.13 This might be taken literally
or seen as a manipulative suicide threat.
In the USA, virtual child pornography is considered
legally distinct from imagery involving real children.14
In the UK, it would not be illegal to own a child sexbot,
although a man has been jailed for “importing an
obscene article”, a child sex doll.15 Forensic physicians
working in Sexual Assault Referral Centres have been
involved in police investigations of customs offences,
providing age assessment of child sex dolls (size,
age-related features, Tanner staging, hair, clothing) (L
O’Connor, ME Vooijs, S Lewis, C White, K Shardlow,
BP Butler, personal communications, 2017).
Given present major weaknesses in the evidence
base, and the lack of evidence of effective treatments
of sexual offenders against children, we would strongly
caution against the use of paedobotsas putative ‘treat-
ment’ unless as part of robust, scientifically and ethi-
cally acceptable research trials.
Will there be changes in societal norms?
Sexbots are generally female and ‘air-brushed’, raising
the question of public interest in avoiding gender
discrimination and inequality due to the promotion
of distorted views of attractiveness that reduce female
body confidence. There are worries about blurred
boundaries to consent16 and permission for enacted
violence when sexbot ‘personalities’ can be selected
that simulate non-consensual sex - that is, rape. The
Foundation for Responsible Robotics states that the
sex between human and robot is intrinsically different
to sex between humans because “machinery … cannot
grant consent or be raped”17 But can the user’s moti-
vation be entirely discounted? An established UK
judgement determined that consent does not protect
against charges of unlawful and malicious wounding
and assault occasioning actual bodily harm.18
If therapeutic benefit were demonstrated, would
doctors ‘prescribe’ sexbots based on ‘harm reduction’,
Cox-GeorgeC, BewleyS. 2018;0:1–4. doi:10.1136/bmjsrh-2017-200012 3
and how would onward use be controlled?12 It would
not be surprising if some doctors had conscientious
objections based on feeling professionally or morally
compromised. Even if sexbots ‘worked’ and contrib-
uted to health, the products’ high cost would presum-
ably limit accessibility.
Evidence-based healthcare is at the core of medical
professionalism and practice. The current dearth of
information on health aspects of sexbots may relate
to rapid commercial innovation, low sales, few direct
consultations, failure to recognise and report health
and social consequences for patients, or inadequate
investment in research.
However, absent evidence of efficacy of both thera-
peutic value and sexual satisfaction will hardly dampen
market forces. Potential profits and rising demand will
incentivise companies to produce cheaper sexbots.
Technological advances will drive competition to create
the most affordable but desirable model. Research has
explored ‘robotiquette’ for the management of human-
robot interactions.19 We call for more research in this
sphere. Future health studies might include medical
observations, case reports, and measurement of visual
and neural responses of users, alongside evidence of
the impact of robots, and sexbots in particular, in the
education, criminal justice and social science sectors.
The UK General Medical Council and medical
defence organisations have not issued any guidance,
but doctors might be advised to avoid using sexbots
themselves, given police interest, prosecutions, and the
potential negative impact on public trust.
The overwhelmingly predominant market for
sexbots will be unrelated to healthcare. Thus the
‘health’ arguments made for their benefits, as with
so many advertised products, are rather specious.
Currently, the ‘precautionary principle’ should reject
the clinical use of sexbots until their postulated bene-
fits, namely ‘harm limitation’ and ‘therapy’, have been
Acknowledgements The authors wish to thank the many
colleagues who offered insights but who withheld their names
out of discretion.
Contributors CCG is an Academic Foundation Year 2 Doctor
at St George’s Hospital in London with interests in sexual and
reproductive health. She researched and drafted the article. SB
is Professor of Women’s Health at King’s College London. She
advised and edited the article. Both authors approved the final
Funding The authors have not declared a specific grant for this
research from any funding agency in the public, commercial or
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally
Data sharing statement No additional data available.
© Article author(s) (or their employer(s) unless otherwise
stated in the text of the article) 2018. All rights reserved. No
commercial use is permitted unless otherwise expressly granted.
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