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Various types of robots have already been successfully used in medical care, and the use of new technologies is also playing an increasing role in the area of sexuality. Sex robots are marketed as advanced sex toys and sex dolls with artificial intelligence. Only a few considerations about the therapeutic use of sex robots in sexual therapy are debated in expert discussions.
The aim of this study was to conduct a first exploratory survey on the attitudes of sex therapists and physicians toward the therapeutic benefits of sex robots.
This study comprised a quantitative online survey and a qualitative interview study. A self-constructed questionnaire was used to survey the general attitudes of sex therapists and physicians regarding the benefits of sex robots in therapy. The qualitative study was designed to gain in-depth insight into the participants’ beliefs and attitudes. Therefore, semistructured interviews were conducted. The quantitative data were evaluated by statistical analysis, and the interviews were transcribed and analyzed by using a grounded theory approach.
A total of 72 sex therapists and physicians completed our self-constructed questionnaire (response rate 15%, 72/480). Only a few respondents (11%, 8/72) said that the use of sex robots was not conceivable for them, and almost half of all therapists and physicians could imagine recommending sex robots in therapy (45%, 33/72). The attitude toward sex robots as a therapeutic tool was very heterogeneous, with gender (
The results of this study provide a first overview of the potential therapeutic use of sex robots. Moral, ethical, and treatment-related issues in this context are still unresolved and need to be further researched. We suggest integrating the topic into the training of sex therapists to form opinions beyond media images and to show therapy possibilities. Scientists engaged in sexual research should be involved in the development of sex robots to design robots with positive effects on sexual education, sexual therapy, sexual counseling, and sexual well-being for interested groups.
Robotics is an interdisciplinary field of research and practice, which is also relevant to sexuality because of the possibilities offered by human-machine interactions [
Sex robots have triggered discussions in professional circles about robot design, social norms, and the status of human-robot sex in connection with human relationships as well as the possible benefits of sex robots [
The success of sexual gratification dolls that can be defined as material representations of the human body for sexual use paved the way for the design of robots in the field of sexuality [
Robot sex also involves software robots without a materially embodied counterpart, in which the counterpart is represented virtually in an immersive virtual reality (VR) application. Immersive VR applications can also be combined with teledildonics. These are sex toys that offer haptic stimulation of male or female genitalia, synchronized with VR application [
In the international literature, the controversy about robot sex began 10 years ago, largely triggered by David Levy's monograph
Döring [
This study is based on the uses and gratifications approach. Studies following this approach investigate how recipients actively deal with media [
A few studies about the acceptance of and attitudes toward sex robots already exist, whereby the study participants were not therapists or physicians, but the sample comprised people from the general population.
In 2016, Scheutz and Arnold [
A study by Szczuka and Krämer [
The acceptance of sex robots among the general population is high. The same applies to the assessment of the potential benefits of sex robots for the treatment of sexual problems. As women and people with a generally negative attitude toward robots rate sex robots more negatively, it can be assumed that these groups of individuals may also have a lower acceptance of sex robots in the therapeutic context. The results lead us to the question whether sex therapists evaluate the use of sex robots similarly to the general population. The Foundation for Responsible Robotics [
This was an exploratory pilot study to examine the attitudes toward and acceptance of sex robots in sex therapy by sex therapists and physicians in Germany, Austria, and Switzerland. A questionnaire was used for the quantitative survey, followed by a qualitative interview study with semistructured interviews to deepen the results.
The study protocol was approved by the Ethics Committee of the Sigmund Freud University Vienna (approval number—electronic ID: LAWW6CYK@VV5BX86374).
The quantitative data were collected with 3 questionnaires. The therapeutic acceptance of sex robots and the conditions under which the use of sex robots in sexual therapy appears acceptable were determined by using a self-developed questionnaire. This questionnaire was combined with 2 standardized questionnaires: The Questionnaire on technical affinity-attitude towards and handling of electronic devices (TA-EG) [
With the TA-EG we wanted to learn more about the experiences and attitudes of the participants regarding technical devices. The subscales of TA-EG are enthusiasm for technology, subjective competence with technology, positive consequences of technology, and negative consequences of technology.
In the third and last part of the questionnaire, the NEO-FFI was used to collect personality traits to find out if they influence the attitudes of the participants and to learn more about the target group that is open to the therapeutic use of sex robots. The participants received 60 short statements describing themselves and were asked to evaluate the statements according to whether they applied to them or not. NEO-FFI factors include neuroticism, extraversion, openness to experience, tolerability, and conscientiousness.
Semistructured interviews were chosen for this purpose as they are considered as a valid and consistent method of data collection in qualitative research [
For the quantitative survey, sex therapists and physicians were recruited through 4 professional associations: Institute for Sexual Therapy; German Society for Sexual Medicine, Sexual Therapy, and Sexual Science; Swiss Society of Sexology; and Austrian Society for Sexual Sciences. Cover letters were used to inform sex therapists and physicians about the survey, the implementation, the purpose of our investigation, and the exploitation of the results.
The theoretical sampling for the qualitative study was determined by the first results obtained from the quantitative data, which showed that sex therapists and physicians differ in their attitudes toward sex robots in gender, age, and education. Participants were sampled through Google searches. To obtain a broad spectrum of opinions in the interviews, female and male therapists with different ages and professional backgrounds were searched for. The information regarding age and education was found on the therapists’ homepage.
The data for our online survey was collected using the Unipark software, which complies with all data protection regulations. The data collection took 4 weeks. A total of 480 therapists and physicians were contacted by email, which embedded a link to the online questionnaire. Of these, we received a total of 72 complete survey responses (response rate 15%). For the interviews, a total of 50 female and male therapists with medical, psychological, or social educational backgrounds of different ages were contacted by email. In total, 5 interviews were conducted by telephone and were digitally recorded. These ranged from 17 to 49 min, depending on the schedule of the participant and the number of issues they wanted to discuss.
Statistical analyses were conducted using SPSS 18. Descriptive statistics were used to evaluate most of the items. Statistical correlations were calculated using appropriate statistical test procedures (cross table, Spearman correlation, Wilcoxon-Mann-Whitney test, and binary logistic regression analysis). The open questions of the questionnaire were analyzed by content analysis. All interviews were transcribed verbatim. The transcripts were evaluated according to grounded theory analysis using Microsoft Office Word. The grounded theory is, among other methods, one that is suitable for research that seeks to discover something new [
The participants of the quantitative survey were all members of sexual associations in Germany, Austria, and Switzerland. A total of 72 sex therapists and physicians completed the self-constructed questionnaire.
All interviewed therapists were very well informed about sex robots, had technical knowledge, attended advanced training courses on the subject, and were familiar with the various application areas of sex robots
Sample description of quantitative study (N=72).
Variables | Statistics | |
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Male | 27 (38) |
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Female | 45 (62) |
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Range | 32-80 |
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Mean (SD) | 51 (9.6) |
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Married | 38 (52) |
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Long-term relationship | 19 (26) |
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Divorced | 7 (9) |
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Single | 5 (6) |
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Other relationship | 3 (4) |
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Sexual therapeutic education | 64 (89) |
|
Sexual therapists | 53 (83) |
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Sexual physicians | 11 (17) |
|
Psychotherapists | 25 (35) |
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Psychologists | 15 (21) |
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Physicians | 15 (21) |
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Psychodynamic therapy | 17 (68) |
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Systemic therapy | 10 (40) |
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Cognitive behavioral therapy | 8 (38) |
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Gestalt therapy | 7 (28) |
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Individual therapy | 55 (87) |
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Couple therapy | 50 (79) |
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Outpatient setting | 42 (66) |
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Group therapy | 10 (15) |
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|
|
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Orgasmic disorders | 56 (78) |
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Erectile dysfunction | 51 (71) |
|
Mental disorders | 28 (40) |
Sample description of interview study.
Person | Gender | Age (years) | Profession |
1 | Male | 71 | Sex therapist, psychologist |
2 | Female | 54 | Sex therapist, physician |
3 | Female | 50 | Sex therapist |
4 | Male | 53 | Sex therapist |
5 | Female | 77 | Psychotherapist, psychologists, active in the academic field of sexual sciences |
To find out how well known the topic of sex robots is among therapists and physicians, we asked them whether they had already heard or read about sex robots or seen something about them. A total of 56 participants of the sample (77%, 56/72) had already heard of sex robots. The majority received their information via the internet (51%, 29/56). Approximately one-third (32%, 18/56) said they had heard about them at a further training course and another 30% (17/56) reported to have read about sex robots in a scientific journal.
The question “How positive do you generally rate the existence of sex robots?” was analyzed on the basis of frequencies. Participants were allowed to indicate their percentage score based on an interval from 0% to 100%. The mean was 32% (SD 29.27). Accordingly, the existence of sex robots was not rated as very positive. The majority of respondents believed that sex with a robot could not replace sex with a human being (90%, 65/72). More than half of the participants would define sex with a robot as masturbation (58%, 42/72).
The participants of this study were asked which use of sex robots would be imaginable for them. To be able to assess this, we provided various situations, motives, and robot use patterns, whereby the interviewees were able to indicate which use of sex robots would be conceivable. The responses (
One part of the questionnaire related to the potential of sex robots as a tool in sex therapy as well as to the idea of recommending sex robots in the role of a practitioner (eg, “If you think about your practice and your experience: which use of sex robots would be conceivable for you as a practitioner for your patients?”). The participants were asked about their imaginable use of sex robots, judging by their work and experiences as a therapist.
At the time of the survey, none of the respondents had already recommended the use of sex robots to a patient. Some sex therapists recommended the use of sex toys to their patients, for example, as a couple exercise at home. Other therapists completely disagreed and declined such recommendations. Overall, almost half of all respondents (45%, 33/72) could imagine recommending sex robots in therapy. The entire sample was asked about therapeutic situations in which they would consider the use of sex robots conceivable. The answers to the question about imaginable situations for the general use of sex robots showed a similar frequency distribution as the question about imaginable situations from the point of view of the practitioner. Most of the respondents could imagine the use for people with physical disabilities (61%, 44/72), to live out sexual fantasies (48%, 35/72), and for people living in isolated environments, for example, prisons (44%, 32/72). In comparison with the question regarding which use of sex robots would be generally conceivable for the participants, it was noticeable that the respondents were less in favor of recommending sex robots in a therapeutic setting.
In the questionnaire, we asked sex therapists and physicians which diagnoses (eg, based on 10th revision of the International Statistical Classification of Diseases and Related Health Problems, ICD) they regarded as suitable for the use of sex robots and for which purposes they would recommend a sex robot to support therapy. To answer this question, diagnoses from the ICD-10 and possible problems were mentioned. One-third (33%, 24/72) rejected any use for their patients. Only 19% (14/72) could imagine using sex robots for patients who wanted to improve their sexual relationship. The most frequent use was conceivable in
In addition, the participants were asked via open questions for which other patient groups they considered the use of sex robots as useful. This option had been used 25 times. Overall, 2 therapists added that they could see benefits for older people and patients suffering from dementia. Furthermore, 4 people mentioned
Attitudes toward different uses of sex robots (N=72).
Imaginable use of sex robots | Statistics, n (%) |
For physically handicapped persons | 47 (65) |
To be able to live out certain sexual fantasies | 44 (61) |
In isolated environments, for example, prisons, space stations, etc | 36 (50) |
To temporarily replace a human sexual partner | 34 (47) |
To be able to experience a sexual relationship when, for certain reasons, a sexual relationship with a person cannot arise | 34 (47) |
Instead of prostitution | 31 (43) |
To improve general psychological well-being | 30 (41) |
As a sex toy in the relationship | 30 (41) |
Out of sexual interest | 30 (41) |
To discover sexual pleasure for yourself (again) | 28 (38) |
To learn sexual practices | 27 (37) |
As a remedy for loneliness | 24 (33) |
Instead of cheating on the partner | 23 (31) |
For pornographic movies | 23 (31) |
To make forms of sexual harassment/sexual violence more tangible for training and prevention purposes | 23 (31) |
Out of technological interest | 22 (30) |
To expand your own sexual practices | 20 (27) |
To have sex regularly | 19 (26) |
As a remedy for boredom | 18 (25) |
For mixed group sex with humans and sex robots | 14 (19) |
To practice intimacy with someone else | 12 (16) |
To minimize the risk of sexually transmitted diseases | 12 (16) |
To build a sexual relationship | 11 (15) |
To facilitate the practice of religious/spiritual abstinence | 8 (11) |
To permanently replace a human sexual partner | 5 (6) |
To experience a trustful sexual relationship | 4 (5) |
No use at all would be conceivable | 8 (11) |
Evaluation of therapeutic use in different diagnoses and situations (N=72).
Diagnoses and situations of sex robot use in therapy | Statistics, n (%) |
For patients with social anxiety | 36 (50) |
For people who do not have a partner and still want to lead a sex life without having to resort to prostitution or fleeting acquaintances | 36 (50) |
Ejaculatio praecox | 34 (47) |
Erectile dysfunction | 29 (40) |
Psychoeducation | 28 (38) |
Orgasm disorders | 27 (37) |
Vaginismus | 23 (31) |
Paraphilias | 22 (30) |
Sexual aversion | 17 (23) |
Frigidity | 16 (22) |
Dyspareunia | 15 (20) |
Patients who want to improve their sexual relationship with their partner | 14 (19) |
Sexual maturity crisis | 14 (19) |
Sex addiction | 11 (15) |
Gender identity disorders | 9 (12) |
Not at all | 24 (33) |
In addition, the respondents of the questionnaire were asked future-oriented questions such as “How likely do you think you’ll be using sex robots in therapy within the next year/the next 5 years/the next 25 years?” For this question, the participants could choose an answer on 4 scales, ranging from very probable to very unlikely. It was found that 90% (64/72) of the therapists thought that the use of sex robots in therapy within the next year was very unlikely or unlikely. Only 68% (49/72) thought that they were very unlikely or unlikely to recommend a sex robot in the next 5 years, whereas 32% (18/2) thought they would consider it. When asked what would happen in the next 25 years, therapists were more likely to consider a recommendation. Only 38% (27/72) thought that a recommendation would be (very) unlikely, whereas 62% (45/72) thought it would be highly likely.
The content analysis of the open question whether sex robots will change sexuality showed that the answers could be divided into 3 categories. Some therapists and physicians emphasized positive changes, such as the expansion of sexuality and therapy options. Others noted negative effects, such as the loss and replacement of real human relationships, and some statements can be described as neutral. In total, 46 people gave open answers with 49 units of sense being indicated.
Future changes in sexuality caused by sex robots as predicted by surveyed therapists.
Category | Example answers | Number of units of senses |
Positive aspects | “Expansion of therapy options”; “Relieve tension”; “Enhancing sexual possibilities”; “Experience sexual pleasure and emotional attention” | 12 |
Neutral aspects | “Variant of sexuality”; “A new sex toy”; “Comparable to the internet”; “Another option” | 17 |
Negative aspects | “Sensuality gets lost”; “Build pressure”; “Dehumanization of sexuality”; “Prohibiting practicing with partner” | 20 |
In the questionnaire, we also asked therapists to indicate whether using sex robots could lead to ethical issues, with 62% (45/72) of the sample answering this question in the affirmative. To obtain detailed information on possible ethical problems, an open question was asked. In total, 30 persons gave open answers with 34 units of sense being indicated. The content analysis of the open question revealed 5 categories. The first category
Ethical problems as predicted by surveyed therapists.
Category | Example answers | Number of units of senses |
Dehumanization | “No more distinction between robots and human”; “Dehumanization”; “Confusion between human and machine” | 10 |
Violence | “Performing trial offences”; “Risk of crossing borders in sexual contact with people”; “Sexual violence”; “Glorification of sexuality with children” | 7 |
Neglect of interpersonal relationships | “Partner replacement, that is, no social relationship is established”; “Lack of understanding and flexibility in interpersonal relationships”; “Alienation from oneself, other people, and the world” | 6 |
Narcissistic disorders/selfishness | “The tendency to use other people to satisfy one’s own needs will increase”; “More narcissistic disorders” | 4 |
Nonethical problems mentioned | “Sex addiction”; “Addiction development”; “Strengthening of sexual dysfunction” | 5 |
We also tested whether the therapists’ and physicians’ attitudes differ with regard to gender, age, and profession. The examined attitudes are the conceivable use of sex robots in certain situations, as well as the ability to recommend a sex robot as a practitioner in certain situations and the willingness to recommend a sex robot for certain diagnoses or sexual disorders. Only significant results are presented below.
In the quantitative survey, male and female therapists differed in their attitudes toward sex robots. There was a significant difference between women and men regarding the variable
There were differences in attitudes toward sex robots in general and also in therapeutic practice between younger and older therapists. There was a significant difference in age with regard to the imaginability of the general use of sex robots (χ²2=6.4, N=72;
The therapists also differed in their attitudes toward sex robots with regard to their profession. There was a clear correlation between the profession and the idea of recommending sex robots to patients. A medium positive correlation was found between the recommendation of sex robots in certain situations and the profession
A large part of the sample (88%, 63/72) also completed the TA-EG and the NEO-FFI. Binary logistic regressions were calculated to check whether the general attitude toward sex robots as well as the assessment of the therapeutic potential could be predicted by the factors of NEO-FFI and the scales of TA-EG. However, no relationship could be established between these aspects and the attitudes toward the therapeutic use of sex robots.
One result of the qualitative study is that the subjective definition of sex robots influences the evaluation of them as a therapeutic tool. Two different positions became apparent. One definition understands sex robots as a consumer product that is only used for physical satisfaction. “As consumer goods, sex robots are not a good development for sexuality and interpersonal relationships.” According to the same therapist, sex robots differ from other technical aids (eg, vibrators). Furthermore, 2 people compared sex robots with the
Many thoughts about the therapeutic benefits and dangers of sex robots from the point of view of sex therapists could be collected. Therapists who saw therapeutic benefits in sex robots also expressed ambivalent feelings toward them: “Even though I want to be open for this development, I have ambivalent feelings, for example, when I think of the loss of social skills as a possible consequence.”
All therapists described the concern that the use of sex robots could lead to loneliness,
The use of sex robots for patients with deviant sexual behavior was discussed by all therapists. Sex robots could have the potential to reduce the sex drive of certain sexually active persons within the framework of therapy. “Whenever sexuality becomes dangerous, the use of sex robots is worth considering if it can protect a real human life.” Therapists mention the use of sex robots in the context of sexual violence or rape and in the context of pedophile patients, with the strongest contrast of opinions being seen here. What seems important here is that pedophile patients must be treated differently. For some, an impulse control disorder is predominant, whereas others may be traumatized. Therapists point out that the benefits of sex robots must be decided individually for each specific case: “Pedophile patients are not all the same and it has to be decided here quite individually which patient could benefit from it.” For some patients, it could be an opportunity to live out their sexuality with a sex robot. Then, they could discuss in therapy which fantasies were behind it (eg, not being able to cope with an adult). For some patients, the use of sex robots could be a kind of substitute. For others, the stimuli for the abuse of children might intensify. A therapist pointed out the following: “It should be considered that the neuronal connection could be intensified by living out the fantasies with child sex robots in the patients’ brain.” Another therapist assumed that the abuse would be intensified by the use of child sex robots and underlined “that the production of child sex robots is generally immoral.” In contrast to this, another therapist argued that the patient’s thoughts, for example during masturbation, could also lower the barrier to committing a crime and that prohibitions—important as they may be—do not necessarily reduce the number of criminal offences, but rather provide an additional attraction for many patients. The therapist argued as follows: “If a child can be protected, then it makes sense to torture a doll instead.” Another therapist addressed one’s own fear of
The use of sex robots for people with contact disorders—the emotional interaction with another person is limited because of social anxiety—was also controversially evaluated. Those who completely reject the use of sex robots in therapy explained that sex robots are only a solution for loneliness for a short time. The use of sex robots could be seen as a kind of
Some therapists discussed the use of sex robots in the context of the patient’s gender, by referring to supposed differences between female and male sexuality, whereby male sexuality was described as more
This category collects considerations relating to the quality of human-robot sexuality. The therapists explained what they understood by healthy sexuality and how sexuality had already changed because of pornography, the internet, and technical equipment. In this context, reflections were made on the question of how sexuality will be further changed by new developments such as sex robots. For therapists, sexuality has something to do with desire, eroticism, and communication. A therapist described the core of sexuality as something mental, but the physical part of it remains unmentioned here: “The core of the sexual event is the mental encounter.” Sexuality must be negotiated, and it must go beyond the
Core Categories. The aim of the qualitative study was to gain more detailed insights into possible therapeutic uses of sex robots for different types of patients. Overall, 3 categories were generated as follows: (1) definition of sex robots: consumer goods versus therapeutic aids, (2) benefits and dangers of sex robots, and (3) quality of robot sexuality.
Following the uses and gratifications approach, this study is one of the first ones to systematically explore motives, possible application scenarios, and attitudes of sex therapists toward sex robots as a tool in sexual therapy. The presented results about the possible therapeutic use of sex robots (eg, for patients with contact disorders, patients with deviant sexual behavior, and patients with different sexual disorders) complement the few considerations about sex robots that have been existing in the scientific discourse so far. The participants in the quantitative study were to a large extent already familiar with sex robots (77%), but there were also therapists who stated that they had not heard or read anything about them yet. This is mainly because of the fact that sex robots are a very young field of research, and experiences in the therapeutic context have not been available yet.
On the one hand, this study shows that therapists and physicians are generally skeptical toward sex robots. The existence of sex robots was not rated as very positive. On the other hand, only few respondents stated that the use of sex robots was not conceivable for them and almost half of all respondents could imagine recommending sex robots for therapy. The fact that therapists initially adopted a critical and cautious attitude toward the
In the meaning of expectancy-value theory, an attitude (A) toward an object (object O) can be expressed in a function of beliefs (B) toward this object and the evaluations (E) of these expectations. We would like to use this theoretical thinking to better understand the ambivalent attitude of therapists between skepticism and openness. The results of this study provide an insight into the beliefs and evaluations of therapists. It was shown that there are various ethical concerns. These beliefs influence the attitude toward sex robots. For example, it became clear that female therapists and physicians expressed more ethical concerns about sex robots in this survey and rated them more negatively than male therapists. We were able to determine that the ethical evaluation of sex robots strongly depends on whether they are classified as sexual aids, along other sex toys (and their use is normalized), or whether they are understood as a different category, namely, not as objects used
A comparison with existing research results reveals interesting similarities and differences between the attitudes of therapists and the general population toward sex robots. Both the study of the general population and of the therapists indicated significant gender differences. Women rated sex robots more critically than men. Scheutz and Arnolds [
With regard to the possible benefit of sex robots as a therapeutic tool, the general population [
With regard to the treatment of pedophile patients, the results showed the opposite picture compared with attitudes in the general population. Although the general population is strongly against the use of sex robots in this context [
In the context of age effects, it would be obvious to assume that the younger generation’s knowledge and openness to technology should also manifest itself in different attitudes toward sex robots. In line with this expectation, the survey found significant differences between younger and older therapists. Younger therapists were actually more open to the topic. Other studies in the field of e-mental health applications also found similar age differences between therapists, for example, in their attitudes toward the internet and online therapy [
Other studies also showed that the negative evaluation of robots is generally a factor that influences attitudes toward sex robots [
Consistent with our findings that personality traits have no influence on respondents’ attitudes toward sex robots, Szczuka et al [
There are some methodological limitations to this study. Owing to the small sample size, the results of this study need to be interpreted with caution. For this reason, the results are not representative. Comparable online survey studies with psychotherapists, however, show even lower response rates than ours [
Another limitation of this study is that not all respondents shared the same level of knowledge about sex robots. The provision of a stimulus in the questionnaire such as images or film clips to define sex robots makes it possible to survey the same level of knowledge. In this survey, we refrained from using this kind of stimulus as the state of research is still so young that there is hardly any illustrative material available. In addition, media representations of intimate human-robot relationships show stereotypical gender roles and heteronormativity [
In spite of the small sample, the investigations provide first exploratory results.
Further research on a larger sample of therapists is necessary to gain a more differentiated picture of the therapeutic potential. Similar to other authors before us, we conclude that ethical responsibility in the digital age cannot be perceived as a
Interview Guide.
electronic mental
International Statistical Classification of Diseases and Related Health Problems
The Questionnaire on technical affinity-attitude towards and handling of electronic devices
virtual reality
The authors thank Hogrefe for providing the NEO-FFI and the authors of the TA-EG. The authors thank Jessica Huss, MSc, and Cornelia Küsel, MA, for their scientific support. The authors also gratefully acknowledge all participants for giving their time.
None declared.