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 Violent
Although 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).
American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Press.
Bagley C, Young L (1987), Juvenile prostitution and child sexual abuse: a controlled study. Canadian Journal of Community Mental Health 6:5-26.
Belton R (1992), Prostitution as traumatic reenactment. Presented at the International Society for Traumatic Stress Annual Meeting. Los Angeles.
Bownes IT, O'Gorman EC, Sayers A (1991), Assault characteristics and posttraumatic stress disorder in rape victims. Acta Psychiatr Scand 83(1):27-30.
Cotton A, Farley M, Baron R (2002), Attitudes toward prostitution and acceptance of rape myths. J Appl Soc Psychol 32(9):1790-1796.
Cotton A, Farley M, Schmidt M (2001), Prostitution myth acceptance, sexual violence, and pornography use. Presentation at Annual Meeting of the American Psychological Association. San Francisco; August 27.
Dworkin A (1997), Prostitution and male supremacy. In: Life and Death. New York: Free Press, pp139-151.
Farley M, Barkan H (1998), Prostitution, violence, and posttraumatic stress disorder. Women Health 27(3):37-49.
Farley M, Cotton A, Lynne J et al. (2003), Prostitution and trafficking in nine countries: an update on violence and posttraumatic stress disorder. In: Prostitution, Trafficking and Traumatic Stress, Farley M, ed. Binghamton, New York: Haworth Press, pp33-74.
Farley M, Lynne J, Cotton A (in press), Prostitution in Vancouver: violence and the colonization of First Nations Women. J Transcult Psychiatry.
Giobbe E (1991), Prostitution: buying the right to rape. In: Rape and Sexual Assault III: A Research Handbook, Burgess AW, ed. New York: Garland Press.
Giobbe E (1993), An analysis of individual, institutional and cultural pimping. Mich J Gend Law 1:33-57.
Giobbe E, Harrigan M, Ryan J, Gamache D (1990), Prostitution: A Matter of Violence against Women. Minneapolis: WHISPER.
Herman JL (2003), Introduction: hidden in plain sight: clinical observations on prostitution. In: Prostitution, Trafficking and Traumatic Stress, Farley M, ed. Binghamton, N.Y.: Haworth Press, pp1-13.
Hernandez TK (2001), Sexual harassment and racial disparity: the mutual construction of gender and race. University of Iowa Journal of Gender, Race and Justice 4:183-224.
Hoigard C, Finstad L (1986), Backstreets: Prostitution, Money, and Love. University Park, Penn.: Pennsylvania State University Press.
Houskamp BM, Foy DW (1991), The assessment of posttraumatic stress disorder in battered women. J Interpers Violence 6:367-375.
Hunter SK (1994), Prostitution is cruelty and abuse to women and children. Mich J Gend Law 1:1-14.
Kemp A, Rawlings EI, Green BL (1991), Post-traumatic stress disorder (PTSD) in battered women: a shelter sample. J Trauma Stress 4:137-148.
Leone D (2001), One in 100 children in sex trade, study says. Honolulu Star Bulletin, Sept. 10.
MacKinnon CA (1993), Prostitution and civil rights. Mich J Gend Law 1:13-31.
Miller J (1995), Gender and power on the streets: street prostitution in the era of crack cocaine. J Contemp Ethnogr 23(4):427-452.
Parriott R (1994), Health Experiences of Twin Cities Women Used In Prostitution. Minneapolis: WHISPER. Available at: http://www.angelfire.com/ mn/fjc/healthex2.html. Accessed Sept. 20, 2004.
Potterat JJ, Brewer DD, Muth SQ et al. (2004), Mortality in a long-term open cohort of prostitute women. Am J Epidemiol 159(8):778-785.
Ramsay R, Gorst-Unsworth C, Turner S (1993), Psychiatric morbidity in survivors of organised state violence including torture. A retrospective series. Br J Psychiatry 162:55-59.
Schmidt M, Cotton A, Farley M (2000), Men's attitudes toward prostitution and self-reported sexual violence. Presented at the 16th Annual Meeting of the International Society for Traumatic Stress Studies. San Antonio; Nov. 18.
Schwartz, H (2000), Dialogues with Forgotten Voices: Relational Perspectives on Child Abuse Trauma and Treatment of Dissociative Disorders. New York: Basic Books.
Silbert MH, Pines AM (1981), Sexual child abuse as an antecedent to prostitution. Child Abuse Negl 5:407-411.
Silbert MH, Pines AM (1983a), Victimization of street prostitutes. Victimology 7(1):22-133.
Silbert MH, Pines AM (1983b), Early sexual exploitation as an influence in prostitution. Social Work 28(4):285-289.
Simons RL, Whitbeck LB (1991), Sexual abuse as a precursor to prostitution and victimization among adolescent and adult homeless women. J Fam Issues 12:361-379.
Stark C, Hodgson C (2003), Sister oppressions: a comparison of wife battering and prostitution. In: Prostitution, Trafficking and Traumatic Stress, Farley M, ed. Binghamton, N.Y.: Haworth Press, pp17-32.
Vanwesenbeeck I (1994), Prostitutes' Well-Being and Risk. Amsterdam, The Netherlands: VU University Press.
Weathers FW, Litz BT, Herman JA et al. (1993), The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Presented at the 9th Annual Meeting of the International Society for Traumatic Stress Studies. San Antonio; Oct. 24-27.
White JW, Koss MP (1993), Adolescent sexual aggression within heterosexual relationships: prevalence, characteristics, and causes. In: The Juvenile Sex Offender, Barbaree HE, Marshall WL, Hudson SM, eds. New York: Guilford Press.