Social media, e-commerce and home services have given rise to all sorts of new services offered in non-traditional business contexts. Recently there have been reports in the media of a company that rents out realistic sex dolls to use at home; there are currently several such companies in Canada. The dolls consist of an articulated metal support covered with a flexible material (silicone or thermoplastic elastomer [TPE]) cast or molded. The dolls are about the same height (about 1.5m or 5ft) and weight (30-60kg or 70-130lb) as a real person. Customers place their order online, we deliver the doll to them and we pick it up afterwards to clean and disinfect it before renting it again.

If operators usually "require" the use of condoms (a general recommendation for the safe use of sex toys, especially if they are used by different people), it is reasonable to assume that the interior and exterior surfaces of the doll have come into contact with bodily fluids. And since future users will probably also come into contact with these surfaces through mucous membranes, the risk of disease transmission should be considered a public health issue. Another secondary concern is ingestion or absorption through the skin of talcum or cornstarch-based baby powder that is used to smooth the doll's skin after cleaning.

The rental of sex dolls is just one example of the growing number of atypical services whose activities, however disturbing, are outside the purview of public health authorities. Examples range from inflatable birthing pools, hookahs, and children's toy subscription services (to name a few). Although less arousing than sex dolls especially the expencive sex robot, all of these rental products could come into contact with bodily fluids, and should be disinfected before reuse. However, since the consumer uses the product at home, the company is not normally under the authority of public health inspectors – unless there is a complaint; in this case, public health authorities can take measures to eliminate a particular health risk.

Should public health authorities regulate the rental of sex dolls?
Rental services for products like sex dolls do not fit into any specific public health portfolio. Some provinces have expanded the scope of their personal services laws to cover activities conducted outside of traditional venues (e.g. mobile shops and trade shows). However, some activities, including the rental of dolls, also do not quite fit the definition of a personal service. For example, in British Columbia's Guidelines for Personal Service Establishments, a personal service is defined as a service performed by one person (ie, a human being) on ??or for another person. Interaction with an adult doll does not fall within this definition. And even if one considers the sex doll as a tool or an instrument, the definition of a personal service depends on the nature of the activity (ex. tattoo or massage), the place (ex. , beauty or hair salon) and intent (e.g. Newfoundland and Labrador's Personal Services Act specifies that services must be offered for aesthetic or cultural reasons). Again, this does not cover interactions with sex dolls or companies that rent them out for home use. Elsewhere in Canada, there is no official definition of what constitutes a personal service. So what power do public health authorities have over companies offering services, including doll rentals, that pose risks of disease transmission that we don't yet know about?

Will exhibitors and the public be able to find a solution without help?
Currently, there are no evidence-based public health guidelines for disinfecting sex toys. This is distressing, since studies have shown that the sharing of sexual accessories could allow the transmission of infections between partners, both in men and women, and that infectious agents could remain longer on sexual accessories in TPE than on silicone ones.

But even if there is no guide for sex toys, The web is full of resources on cleaning and disinfecting environmental surfaces that have come into contact with bodily fluids. Many of these resources are derived from personal service materials. Examples include recently released documents from the British Columbia Ministry of Health and Public Health Ontario, which not only provide detailed information on cleansing bodily fluids, but also describe the types of disinfectants and appropriate uses. These resources are a wealth of information on infection prevention and control; it would be very helpful for business owners to read them in full so that their services are as safe as possible.

That said, operators and the public may have difficulty finding reliable resources or even interpreting them. And depending on the province and the amount of bodily fluids, we will sometimes recommend partial disinfection, sometimes full disinfection, which only adds to the confusion. For all these reasons, it is highly unlikely that operators or the public will come to fully understand on their own the hygiene practices necessary for the rental of risky products.

Focus on education to help operators and the public understand disinfection needs
Public health inspectors play a crucial role in educating operators and the public. Some Silicone love dolls are a good example of this, as the complex design of the product can pose real challenges for reprocessing. The dolls have two or three orifices (which sometimes include removable parts); they also have seams, hair, eyelashes and phallic accessories. Let's not forget the materials: while silicone dolls are usually non-porous and heat-resistant, some types of TPE are porous or hygroscopic, or even sensitive to heat, which complicates disinfection.

There are also practical considerations. For the operators, it is important that the reprocessing does not damage the surface of the headstock unnecessarily and that the duration of the process is reasonable. For customers, it is important that the doll is completely disinfected (but does not have the characteristic smell of sanitizer) and that the sanitizer has been rinsed off well so that the doll does not cause irritation or of allergy. These criteria highlight the importance of the expertise of public health inspectors in developing a disinfection protocol that will properly sanitize the product without damaging it and without leaving (or creating) dangers for the next one. user.

Communicate with the public about these atypical services
In addition to providing recommendations for operators regarding disinfection, public health inspectors and health authorities have a critical role to play: actively communicating with the public about non-traditional services. In the case of sex dolls for men, the hygiene risks are so obvious that some people might think that health authorities are already monitoring or regulating the activities of these companies. This is why there is a need to improve communication on the role of health authorities and on the fact that the consumer must be vigilant and informed about hygiene practices.

Summary
Given the vast array of new products and services available through social media and the online marketplace, it can be difficult for operators and the public to find the information needed to avoid hazards. Public health authorities must also be present online, and find creative and interesting ways to educate the public about the risks associated with certain activities. Consumers should also be aware that companies offering the services or delivering the products to homes may never have had the chance to consult a public health inspector. When it comes to hygiene and sex dolls, the consumer must be vigilant.