Sexology, the study of sexuality, was built on the uncritical acceptance of prostitution as an institution expressive of both men's and women's sexuality. Alfred C. Kinsey, Sc.D., and his colleagues worked from the 1940s through the 1970s to articulate a sexuality that was graphically portrayed in magazines. Even today, some assume that prostitution is sex. In fact, prostitution is a last-ditch means of economic survival or "paid rape," as one survivor described it. Its harms are made invisible by the idea that prostitution is sex, rather than sexual violence.
Prostitution has much in common with other kinds of violence against women. What incest is to the family, prostitution is to the community. Prostitution is widely socially tolerated and its consumers (commercial sex customers who are called johns or tricks by women in prostitution) are socially invisible.
Herman (2003) polled attendees at a trauma conference, asking how many currently or previously treated patients who had been used in prostitution. Three-quarters of the 600 attendees raised their hands. Describing prostitution as hidden in plain sight, Herman noted that 30 years ago, rape, domestic violence and incest were similarly invisible.
Prostitution Is ViolentAlthough clinicians are beginning to recognize the overwhelming physical violence in prostitution, the internal ravages of prostitution have not been well understood. Prostitution and trafficking are experiences of being hunted down, dominated, sexually harassed and assaulted. There is a lack of awareness among clinicians regarding the systematic methods of brainwashing, indoctrination and physical control that are used against women in prostitution. There has been far more clinical attention paid to sexually transmitted diseases (STDs) among those prostituted than to their depressions, lethal suicidality, mood disorders, anxiety disorders (including posttraumatic stress disorder) dissociative disorders and chemical dependence.
Regardless of prostitution's status (legal, illegal or decriminalized) or its physical location (strip club, massage parlor, street, escort/home/hotel), prostitution is extremely dangerous for women. Homicide is a frequent cause of death (Potterat et al., 2004).
Prolonged and repeated trauma precedes entry into prostitution, with most women beginning prostitution as sexually abused adolescents (Bagley and Young, 1987; Belton, 1992; Dworkin, 1997; Farley and Barkan, 1998; Silbert and Pines, 1983b, 1981; Simons and Whitbeck, 1991) (Table 1). Homelessness is frequently a precipitating event to prostitution. Women in prostitution are frequently raped and physically assaulted (Farley et al., 2003; Hunter, 1994; Miller, 1995; Parriott, 1994; Silbert and Pines, 1983a).
Prostituted women are unrecognized victims of intimate partner violence by pimps and customers (Stark and Hodgson, 2003). Pimps and customers use methods of coercion and control like those of other batterers: minimization and denial of physical violence, economic exploitation, social isolation, verbal abuse, threats and intimidation, physical violence, sexual assault, and captivity (Giobbe, 1993, 1991; Giobbe et al., 1990). The systematic violence emphasizes the victim's worthlessness except in her role as prostitute.
Clearly, violence is the norm for women in prostitution. Incest, sexual harassment, verbal abuse, stalking, rape, battering and torture are points on a continuum of violence, all of which occur regularly in prostitution. A difference between prostitution and other types of gender violence is the payment of money for the abuse. Yet payment of money does not erase all that we know about sexual harassment, rape and domestic violence.
The experiences of a woman who prostituted primarily in strip clubs, but also in massage, escort and street prostitution, are typical (Farley et al., 2003). In strip club prostitution, she was sexually harassed and assaulted. Stripping required her to smilingly accommodate customers' verbal abuse. Customers grabbed and pinched her legs, arms, breasts, buttocks and crotch, sometimes resulting in bruises and scratches. Customers squeezed her breasts until she was in severe pain, and they humiliated her by ejaculating on her face. Customers and pimps physically brutalized her. She was severely bruised from beatings and frequently had black eyes. Pimps pulled her hair as a means of control and torture. She was repeatedly beaten on the head with closed fists, sometimes resulting in unconsciousness. From these beatings, her eardrum was damaged, and her jaw was dislocated and remains so many years later. She was cut with knives. She was burned with cigarettes by customers who smoked while raping her. She was gang-raped and she was also raped individually by at least 20 men at different times in her life. These rapes by johns and pimps sometimes resulted in internal bleeding.
Yet this woman described the psychological damage of prostitution as far worse than the physical violence. She explained that prostitution "is internally damaging. You become in your own mind what these people do and say with you" (Farley et al., 2003).
Almost two decades earlier, Norwegian researchers noted that women in prostitution were treated like commodities into which men masturbate, causing immense psychological harm to the person acting as receptacle (Hoigard and Finstad, 1986).
