The Mental Health Impacts of the Sex Trade
People are embracing the importance of mental health in ways that seemed impossible just a few decades ago. It’s not uncommon, especially for younger folks, to casually talk about depression, anxiety, or therapy with friends. Mental health is showing up in popular culture as a key theme in TV shows, movies, and pop songs. It’s also a focus of many proposed and passed laws in recent years. This attention on mental health is a great step forward. We need to make sure that folks who are at high risk for trauma and experiencing poor mental health, including people who sell sex, are top of mind as new paths for healing are created.
Who’s Selling Sex
Some freely choose to sell sex. It’s far more common for people to do it to survive or because they’ve been tricked, coerced, or forced to by sex traffickers who target vulnerable people. This includes those without strong support networks, facing financial strain, who have experienced violence in the past, and who are marginalized by society. As a result, LGBTQ+ and Black girls are at particular risk for sexual exploitation. Many stay stuck in the sex trade into adulthood.
Most people who’ve sold sex say they started when they were minors, wanted a way out, and were harmed by it. Research conducted with them confirms that few get enjoyment from performing sexual acts on men they can’t reject.
“After a few years of the sex trade, I couldn’t take it anymore. I felt trapped in the industry and it made me feel so alone and so sad. I wanted a “normal” life,” wrote Esperanza Fonseca, a sex trade survivor, of the harms and trauma she experienced while in the life. “I didn’t want to give random men access to my body anymore. I didn’t want to pretend every day to be okay with clients who played out their worst fantasies on me…”
— Esperanza, Sex Trade Survivor“I felt trapped in the industry and it made me feel so alone and so sad…I didn’t want to give random men access to my body anymore. I didn’t want to pretend every day to be okay with clients who played out their worst fantasies on me…”
The Mental Health Impacts of The Sex Trade
Knowing that most people sell sex because they don’t have other options or are being trafficked makes it easy to understand why they suffer high rates of mental health issues. They also experience social stigma and discrimination, mistreatment by law enforcement, physical violence, harassment, and the fear of being arrested or prosecuted. All this can lead to the increased stress, anxiety, depression, and post-traumatic stress disorder (PTSD) that people in the sex trade struggle with.
One study conducted in the US found that 68% of people who sell sex reported symptoms of depression, and 55% reported symptoms of anxiety. Another study in Canada found that they had higher rates of PTSD compared to the general population, with almost one-third of participants reporting symptoms consistent with a PTSD diagnosis. Research also shows that selling sex involves such repetitive exposure to trauma that PTSD is more common for people who’ve lived through it than those who have lived through military combat.
When people who sell sex were asked about their mental health…
Substance abuse is another common burden for people who sell sex, and some assume that addiction leads into the sex trade. However, research suggests that substance abuse is more often a response to selling sex than a cause of it with the overwhelming majority of women stepping up drug usage while selling sex. It’s likely that people need to dissociate from reality to survive their days in the sex trade. In one survivor’s words, “Everything is so raw, so hurting, that even though I knew the drugs would destroy me, I still used them to self-medicate.”
— Jerri, Sex Trade Survivor“Everything is so raw, so hurting, that even though I knew the drugs would destroy me, I still used them to self-medicate.”
Reducing Trauma
There are many negative impacts of the sex trade, including psychological and emotional trauma. Unwanted sex—even when it is compensated and “chosen”—usually causes harm. It thrives on social inequity and routinely ensnares the most vulnerable people. The best way to address the mental health crisis among people in the sex trade is to reduce the size and harms of the sex trade. We can start by decriminalizing people who sell sex; a proven approach known as partial decriminalization or the Equality Model.
Partial decriminalization lifts all penalties for those who sell sex while continuing to hold people who cause harm accountable. It puts survivors’ needs and experiences at the center and recognizes the violence, racism, and gender inequity wrapped up in the sex trade. Public education also chips away at the stigma and calls out the trauma inflicted by sex buyers, pimps, and law enforcement. One of the most significant reforms is the removal of persistent barriers to economic independence after leaving the sex trade: criminal records that bar survivors from employment. Partial decriminalization ends the justice system’s failed response of arresting and prosecuting people in prostitution.
By redirecting focus from criminalizing and shaming sex trade survivors to providing trauma-informed social services and resources—such as affordable housing, economic opportunity, legal aid, and mental and physical health care—we can create successful paths out of the sex trade for people who want them. Offering these same supports to vulnerable people would also reduce the number of folks who’d ever have to start selling sex to survive.
Learn more about partial decriminalization and supporting survivors of the sex trade:
CPD Wrongly Targets People Selling Sex – CAASE
Legalization Isn’t an Antidote to Prostitution’s Harms
Free Legal Services for Survivors of Sexual Harm
CAASE published this piece on May 4, 2023. It was authored by CAASE’s Communications Manager Hayley Forrestal with input from CAASE’s Public Policy and Advocacy Director Madeleine Behr. Learn more about our staff here.
