New research. Sex Work Stigma and Psychological Distress

We would like to present new German-Swedish research under the name “Sex Work Stigma and Psychological Distress. A Mixed-Methods Analysis of an International Sample of Sex Workers”

This research was published in May 2025 on the portal researchgate.net

Introduction 

Research shows that sex workers are particularly vulnerable to mental health challenges. As sex workers are a very heterogeneous group, research focusing on associations between personal working conditions of sex workers and their mental health is needed.

Methods 

In this cross-sectional, anonymous online survey, we used Spearman rank order correlations to examine, in a convenience sample of 76 sex workers from different countries surveyed in 2022, whether the degree of self-determination in the engagement in sex work, the degree of self-organization of sex work, the role-identification as a sex worker, and sex work motive (engaging in sex work to meet financial needs versus for pleasure) and internalized sex work stigma (Internalized Sex work Stigma Scale) are associated with psychological distress. Thematic analysis of open text answers was used to identify sex workers’ suggestions for political and social change.

The study included adult individuals (age ≥ 18), who had engaged in sex work within the last 2 years, regardless of whether they were still active at the time of the survey which began during the COVID-19 pandemic. Sex workers providing sexual services without direct physical contact, such as online sex or the creation of pornographic videos/pictures, were explicitly invited to participate in the study. Exclusion criteria were reporting not being a sex worker and/or carrying out the survey more than one time.

The recruitment was conducted between May and October 2022, and the survey was offered in five languages: German, English, Spanish, Swedish, and Bulgarian. Print versions of the questionnaire were offered, to include sex workers who needed assistance filling out the survey as well as those who had no Internet access. The study invitation was distributed via social media (26 international sex work–related Facebook groups, 115 sex work–related accounts on, 7 sex work–related Reddit threads, and several Twitter posts). Seven large sex work networks, multiple personal sex worker websites, and 75 specialized German counseling centers were informed via e-mail or telephone. Furthermore, 80 escort agencies, 22 call-boy agencies, 30 BDSM studios, and 9 private room rentals were contacted. Various influencers who work as sex workers were also will-ing to support and share the study invitation.

Results 

Psychological distress was negatively correlated with self-determination and positively correlated with internalized sex work stigma. The participants advocated for the decriminalization and destigmatization of sex work, improved access to health care, improved workers’ rights, and fighting sexual exploitation.

Policy Implications.

Perspectives by sex workers should be used to inform policy decisions to first understand and then better implement the needs of this diverse group.

Requests for Politics and Society that Would Improve Working Conditions in Sex Work

Themes developed in response to the question, “Do you have any suggestions for politics and society that could improve your work situation if implemented?” using thematic analysis, are illustrated in Table 4. A total of 63 participants (82.9% of the total sample) provided a response to this question. Given that responses were coded for multiple themes, a total of 102 answers were extracted.

In their answers, most of the participants challenged legal frameworks criminalizing sex work.

In this group, some participants positioned themselves against prostitution laws specific to Germany, which were perceived as restricting and discerning. Criticized legal requirements included application for and carrying of identifying documents and participation in health counseling.

Other respondents opposed the Nordic model of sex work, which is characterized by criminalization of the purchase of sex.

The next frequent proposal related to destigmatization, increasing social acceptance, and occupational appreciation. While many respondents expressed a desire for reduced stigma, some participants articulated a goal of professional equality. Increased education on sex work and clear separation of sex work from forced prostitution, trafficking, and abuse was further mentioned.

Some of the responses advocated for better access to health care and other support services, such as STI check-ups and vaccinations, financial aid, creditworthiness, and better trained health professionals. In a few responses, participants demanded improved working conditions and, in connection to laws restricting sex workers, more rights.

Some participants wished for strengthened measures against sexual exploitation. Responses in this category underline the urgency for participants to separate sex work from non-consensual forms of sexual encounters, including but not limited to human and sex trafficking, exploitation, abuse, and forced prostitution

Conclusions

Findings from this study highlight relevance for social policy in three key areas.

First, reducing stigma and strengthen-ing autonomy involves public education campaigns and further discussion of possible legal reforms, allowing sex workers to have greater control over their lives and work environments. Educational campaigns should inform soci-ety about adverse effects of sex work with lower degrees of self-determination, whereas national and international co-operation against sexual exploitation should be vigor-ously promoted in policy.

Second, providing mental health resources tailored to the unique needs of sex workers can help address the psychological impacts of stigma and occu-pational stress, ensuring access to non-judgmental and com-prehensive mental health care.

Third, sex workers would perceive the decriminalization and recognition of sex work as legitimate labor as protective with regard to legal pen-alties and improvement of their working conditions, as it would foster safer and healthier workspaces. Perspectives by sex workers are valuable to encourage policy decisions that prioritize the diverse needs of this heterogeneous group.

The results emphasize the need for efforts to challenge stigmatization of sex workers, internalized stigma in sex workers, and the need to counteract working conditions where sex workers’ self-determination is limited. Destigmatization, decriminalization, health care access, workers’ rights, and sexual exploitation are topics of concern to sex workers.

Full research text with ability to download PDF-file is available on the portal researchgate.net

May 2025

Authors

Freya Brunswig

Bachelor of Science Master’s Student at MSH Medical School Hamburg – University of Applied Sciences and Medical University

Juliette F.M. Desbuleux

Research Assistant at the Institute of Forensic Psychiatry and Sex Research - University of Duisburg-Essen

Leonhard Kratzer

PhD Consultant at Klinik St. Irmingard

Charlotta Holmström

Associate professor/Managing Director at Malmö University