I am a sex worker and I would like to share my views on some ways sex work could be integrated into mental healthcare and welfare services. This is often considered a controversial topic addressing a not that urgent issue. There are several initiatives, projects policies aiming to control to minimize sex work, or the damage done by and done to sex workers. There is extensive discussion in the scientific literature why sex work is present, and why is it so constant. Regardless of the reasons, the earliest records mentioning prostitution as a profession date back to 2400 BCE, and it is undoubtedly present still. While discussing the cultural, social, psychological, and evolutionary reasons and underlying mechanisms why sex work evolved and persisted for so long would give valuable insights, addressing the current state of this industry is more essential.

Even in the face of radical social, ideological, political, and economic changes, this profession is often described as "remarkably unchanged". This statement is not entirely true. For example, social inequalities and uneven distribution of wealth often made parts of society more financially vulnerable, while enabling others to pay for such services. Social trends, such as increased divorce rates, international travel, and adult spending a larger proportion of their lives single all contribute to increased demand. Technological advancements, especially telecommunication and widespread internet access have altered the way and efficacy of advertising the sex trade. As sex work became more international, norms, solidarity, and support among sex workers became weaker, making many vulnerable.

The trade and services changed radically too. New types of sexual practices became more accepted, ranging from "girlfriend experience" to rare kinds of paraphilias, new services have been established such as erotic massages or social escort companions. This also led to inequalities within the industry, for example, a prostitute in the United Kingdom charges £50-70 per service on average, while an escort girl working for a prestigious international agency could expect as much as £2100 for a `short overnight stay'. Meanwhile, in Ukraine, sex workers working in rural areas are only paid £12-20 per service (can be several hours), in much less safe circumstances.

As described above, sex work may be constant, but it is formed by changes affecting the rest of society. On the other hand, with some exceptions, this trade is always in the 'grey-zone'. For example, in the UK exchange of sexual services for money is legal, but owning or managing a brothel is illegal. These policies are made considering not only to minimize the disturbance to those who do not wish to have any connection with this trade but also to protect sex workers. It is believed that making brothels or "pimping" illegal will decrease exploitation or non-voluntary sex work. The main problem is that in practice the sex trade is not determined by laws or regulations, but by demand. There can be several reasons why someone decides to work in this industry, and there can also be various motives why someone would seek such services, but due to the discreet and intimate nature of the work, the determining factors are all tied to the supply and demand in the given area.

Instead of trying to find ways to push sex work down, while constructing programs to provide short-term, often unwanted help to sex workers, it is worth considering integrating this profession more into society. Sex workers satisfy a very essential need, providing not only sexual intercourse but also company, a listening ear, a safe space where is no judgment. Otherwise dangerous paraphilias can be safely practiced, believed to be shameful wants can be satisfied, never said fantasies can be discussed. Victims of sexual abuse, people with mental health conditions, couples with sexual problems can not only talk or discuss their problems, as it would be possible in a clinical setting but can also receive practical help too. All of these attributes make sex work a potentially valuable addition to mental health and wellbeing services.

I have a few years of experience as a prostitute, which means that I have insight only into a small part of this industry and this post was mostly motivated by my personal experiences and views, and thoughts from my colleagues. While I was lucky enough that I didn't really encounter the darker side of this industry I believe many others share my views. I would be keen to hear your take on this! 

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Thanks for sharing this, Mary. I thought it was very interesting and thought-provoking.

As a moderator, I was unsure whether to approve this post (and so the posting was delayed by a week or two). I was concerned about whether this is actually a post intended for the EA forum or if it's a post that's resubmitted here along with other forums for whatever purposes. I now believe that it is a legit post arguing for an interesting (though controversial) cause, so I apologize for the delay.

I'd be interested in two things:

  1. Whether there are any studies exploring the mental health and wellbeing effect of sex work services, and what do they point to?
  2. What policy recommendations do you have? Or more broadly, what are the potential high-impact interventions in this space?

Thank you very much for approving this post! I completely understand why it might seem concerning!

(1) There are surprisingly few studies in the current literature about the effects of sex work on customers (one of the rare exceptions: https://journals.sagepub.com/doi/abs/10.1177/1469540516648373). There are an immense amount of studies on how it affects sex workers, but conducting studies about customers is very complicated. There are some more obvious reasons for this, such as social stigma or the anonymity of customers, but I imagine there are several others. But even just the extent to which sexual dissatisfaction affects mental health is not that well researched. As for every field exploring its original state is essential for any meaningful and sustainable change.

(2) I believe that the first and one of the biggest obstacles is the lack of social acceptance. For example in Antwerp, after the local sex trade expanded due to increased immigration, the sex worker's union was founded, which swiftly gained political power. After the Eastern block was opened, there was another steep increase in immigration rates, which further expanded the sex trade but also increased the prevalence of organized crime. The sex trade became linked with organized crime, which turned the public opinion against the red light district. This put pressure on the town council, which led to the introduction of harshly restrictive policies. I think the main point is that without carefully exploring the sociological, cultural, and psychological aspects of sex worker-customer and sex trade-community relationships, most new policies and regulations are likely to fail. An initiative bringing sex workers and mental health professionals together, exploring ways of cooperating while collecting and analyzing data to plan the next steps may be viable. 

I agree that impartial investigation of the cause area is essential. My goal was to give my point of view - as a sex worker, which hopefully gives more information about how we see sex trade. Any changes in this trade would necessitate the involvement of highly trained experts, but it would happen to us. The way we react to any new regulation or policy determines if it is successful or not. This is how I see it, but what do you think what would be useful?

I downvoted the OP because it doesn't seem to be suited to this forum. The author's experiences are interesting, but I don't think the post contains an attempt to explore the potential cause area impartially.

Hmm, so from my point of view this post is written with the intention to bring a class of interventions to the attention of people who care about mental health, which seems good to me.

I agree this post is not an impartial exploration, but I tentatively would like this forum to also be welcoming to new altruistically minded people who have a new idea about helping people, even ideas that are in their infancy in terms of the question whether it’s among the most effective ways to do good.

So instead of feedback that their initial thoughts don’t belong here, I’d prefer seeing feedback how they could find out how strong the case for their idea is, or interested people can share their thoughts about it themselves. E.g. point to studies of the mental health burden, maybe sketch how you might do a cost-benefit analysis of possible interventions.

Thanks for the post, I thought about this before and am glad you shared the idea and that it wasn’t filtered out by the moderators!

One perspective I learned about from an interview with Manisha Shah on Probable Causation was the idea that legalizing sex work can have fairly large effects on reducing sex related crime:

And what these three coauthors do is they study the effects of of what they call Tipplezones in the Netherlands. And so Tipplezones are basically these like legal these these neighborhoods where they create these legal street prostitution zones in the Netherlands. And they do this, if I remember correctly, in about nine different cities in the Netherlands. And so what this paper does is they look at the impact of creating these these legal street prostitution zones on things like sexual abuse and rape and drug related crimes. And they find a decrease in all of these things, right. So they find sexual abuse and rape decreases 30 to 40 percent. They also find reductions in in drug related crimes in the Netherlands.

And again, in both cases, very similar to the Netherlands paper, we find that there is a decrease in gonorrhea incidence by around 40 percent and there is also a decrease in reported rape offenses by about 30 percent [after legalization in a natural experiment].


I can generally well imagine that decriminalizing sex work and making it a better and safer experience for sex workers could have fairly large effects on mental health of people whose sexual needs are not met at all, which I expect to be maybe a third of the adult population?

Would be interesting to see studies looking at the effect on mental health outcomes of decriminalization, or maybe of actually meeting with a sex worker and how many people are less well due to lacking sex.

I think there's still ongoing debate on whether legalization and/or decriminalization actually increases human trafficking. Here's a natural experiment in Europe estimating that legalizing did increase human trafficking in the countries legalizing: https://www.sciencedirect.com/science/article/pii/S0305750X12001453

I haven't read the paper, and I don't know if this just reflects trafficking increasing overall in the world, or just moving to countries with legal prostitution from countries without.

If this effect is real, maybe there's regulation that could eliminate it.

I am also happy to answer any questions both about the post or about my experience as a prostitute! 

I am commenting to create public knowledge, in a form stronger than a mere upvote, that I think this post is on the right track and that wellbeing increases from just tackling loneliness, lack of affection, lack of validation, etc. directly ought to be a serious cause candidate. 

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