Sunday, June 27, 2010

No link between working in prostitution and post traumatic stress


I have had some reactions on my blog which purport to say that working in prostitution causes irreversible psychological damage, or as they say this, post traumatic stress. The funny thing is that this is absolutely not the case!!!! I can empirically prove that working in prostitution in itself has no negative effects on emotional well being. But for me personally, it doesn't answer the question if it is okay then to have sex with a person who detests having sex with you (as in my case by visiting prostitutes). And it doesn't mean that there are no problems with human traffickers or exploitation and the such (always worrisome). And I don't make this claim to provocate people.

I'll provide some links to reports with some quotes.

The first report by Charrlotte Seib from New Zealand:

Seib, Charrlotte (2007) Health, well-being and sexual violence among female sex workers : a comparative study. [QUT Thesis]

"Sex workers interviewed in 2003 (after legalisation) were compared to a prior study of this population conducted in 1991 (before official regulation of the sex industry). Further, in-depth analysis of the 2003 cohort compared sex workers employed in legal and illegal sectors, to assess violence, health status and job satisfaction. Methods: Cross-sectional, convenience sampling was used to collect data from female sex workers in 2003."

"In general, it appears that the majority of sex workers enjoyed at least as much job satisfaction as women working in other occupations. It also appears that this sample had equivalent mental health to women from the general population, although the sub-group of illegal workers generally had poorer health."

The next report (with the quotes retrieved from

Sarah Romans, MD, et al., in the Feb. 2001 Australian and New Zealand Journal of Psychiatry article "The Mental and Physical Health of Female Sex Workers: A Comparative Study," wrote:
"There were no differences in mental health... or in self-esteem... between the two groups [female prostitutes and females who weren't prostitutes].... Overall, despite any personal problems arising from the particular nature of their work, these women described as adequate relationships with partners, friends and work colleagues. Two papers have suggested that sex workers have high rates of psychological symptoms; however, both used convenience samples and lacked a comparison group making interpretation of the results difficult. Our results challenge prevailing ideas that sex work and psychiatric morbidity are inevitably associated."

A Dutch report:
Evaluatie opheffing bordeelverbod - De sociale positie van prostituees 2006 (by Helga Dekker, Ruud Tap and Ger Homburg)
Here's the link

This report which studied 354 prostitutes in the Netherlands gives in my opinion a surprisingly good representation of indoor prostitutes if you look at their workplace and background.

Quote (translated from Dutch from page 81):
"The emotional well-being, measured on the 4DKL-scale for distress, doesn't stand out in a negative way compared to that of other women. Prostitutes in privéhuizen [brothels without bar] and window prostitutes do show a little higher degree of distress, which can point at stress, for example by overload, problems or unpleasant events in life."


Anonymous said...

most prostitutes suffer from bi polar mental disorder

Donkey said...

Thank you for reading this post! I appreciate it! I think typically 3 of every 100 visitors on my blog read for more than 10 minutes. And you even comment!

A miracle..... :S

I like you to show evidence of your claim.

Sine FourEx said...

I like your blog. You think a lot like me.

One issue that I cannot fully resolve is the idea that prostitution is inherently harmful. By this I mean prostitution coupled with the usual social stigma, requirement to hide the activity from loved ones, the ever present possibility of violence and the constant testing of sexual boundaries/sexual assaults. I cannot see how high volume prostitutes remain sane when they must cope with these issues. Any attempt to blame harms on social stigma is avoiding the issue, stigma is not going away.

You quote some reports that indicate that there is no link between prostitution and mental harms. I found the reports on to be unconvincing. The report "Burnout Among Female Indoor Sex Workers" uses 4 measures of mental health, sex workers score OK on 3 measures and badly on one of the measures. I think this report is misrepresented in

The report by Roessler at Page 8 indicates that
"This ratio in our study is almost 1 : 1 suggesting that the burden of
sex work during the last year mpacts on the women mental health to an extent comparable to the rates developed during their whole previous lives. This indicates how burdensome sex work actually is." What is your opinion of this report?

I think this is an area that is worth further study. It would be really interesting to conduct a proper study. Measure the mental health of all 15 year old girls in Ukrainian or Moldovan orphanages. We know they will be tossed out at age 16 and a large percentage will end up in prostitution during the next 4 years. Repeat the mental health tests at age 20. Compare the prostituted girls against the control group (the non-prostituted) and publish the results. That would provide a definitive answer to this mental health issue.

If using 16 year old girls is a problem, maybe the test could be conducted in Germany. Take 100 unemployed school-leavers at random, force them to take jobs in brothels (its only work after all and is neither immoral nor undignified according to the law) and test them after a year. Publish results.

If prostitution was found to be damaging to mental health, it may mean that prostitution should be banned completely (Sweden's prostitution as violence turns out to be true) or some limit must be placed on prostitutes exposure to men (like radiation dosages).

Have you ever seen a study that examined mental health before/after prostitution? Do you still think there is no link between prostitution and poor mental health? Why are some survivors so traumatised and others not?

If 20% in Holland are forced, they are actually being raped repeatedly. Why do they not stand out in mental health reports? Do women get used to repeated rapes and it has no mental affect at all? Why can prostitutes be raped with little affect on them and 'normal' women get traumatised for years and years? Is rape actually a lesser crime than everyone thinks it is and 'normal' women are exaggerating?

I don't actually think rape is a lesser crime, I think societies willingness to tolerate some women being subjected to repeated rape is inexcusable. We see a "trafficking victim", we do not see a woman who has been raped 10 times a day, by different men, for years. Why is this? Why do "normal" women tolerate this?

Lots of questions. I'd be interested in your current opinion the issues.

Donkey said...

Hi Sine FourEx. Thank you for commenting!!!!

I read the report you referred to:

The mental health of female sex workers (Rössler W, Koch U, Lauber C, Hass A-K, Altwegg M, Ajdacic-Gross V, Landolt K., Acta Psychiatr Scand 2010: 1–10)

I think this research shows that there is a big relationship between working conditions and mental problems. Street workers and non-European women are doing very badly. The European women who work indoors do quite well.

It think this research proves that prostitution itself is not the problem. And that is what I claim. The point is, who are the voluntary and the free prostitutes???? This is still a vexing problem. It is not easy to see.

The research indicates that it would be best for clients to visit indoor European prostitutes. That could help a bit.

What I find interesting about this research is that 1,6% say that are forced into prostitution at the moment of the interview. This is highly remarkable, because many times forced prostitutes are simply not interviewed, or they simply don't admit that they are forced.

I think this research doesn't show how many forced prostitutes there really are. I think the forced prostitutes keep in the dark, and don't show themselves to researchers.

Sine FourEx said...

The 1.6% is remarkable, maybe the authors were sympathetic interviewers, who knows. The authors have a caveat that they believe this is an underestimate since forced women are likely to be more hidden. To be honest, I don't believe that Zurich is better regulated than Amsterdam or anywhere else. The true number of forced women is likely to be much higher.

Regarding Mental Health
There is a report entitled "Mental health of female survivors of human trafficking in Nepal." that compares girls trafficked into prostitution with others trafficked into the circus. (Google only has a cached copy of PDF today).

Considering that these girls were young, their work location known to be bad (Mumbai mostly), and many were infected with HIV, they show remarkable resilience. They do score badly compared to the circus workers. It seems that humans are built to withstand almost anything and keep going.

29.6% of the sex trafficked girls suffered from PTSD, highter than the girls trafficked into the circus (7%), higher than tortured males (14%) and women trafficked into Israel (17%). It is much lower that women displaced in warfare (59.3%).

It seems that being forced to work in prostitution (under very poor conditions) is worse than torture. It is curious that you find 10% to 20% of women are forced, but researchers find no mental health issues at all. The work conditions in Holland must be so much better than Israel or India.