I’ve lost count of the number of women I’ve heard talk of their frustrations with the response they’ve received from counsellors, therapists, and medical and caring professionals after disclosing current or past involvement in the sex industry. One of the most common complaints is the practitioner’s conviction that prostitution is a ‘lifestyle choice’ and that, apart from the odd, isolated incident, it’s not inherently traumatising. This can manifest as questions, such as: why did you let it happen? Why don’t you just leave? Why do you keep going back?

Women talk about feeling judged, invalidated, gaslit even, and as if they have no right to feel traumatised by their experiences in the sex industry. This should give pause for concern. It would appear to be evidence of a failure of the basic therapeutic aim of providing a space where the client can explore and process issues and experiences to lighten their load and eventually, hopefully, live more satisfyingly and healthily.

The women’s testimonies echo how victims of domestic violence were treated in the past – even the questions can be the same. It took decades of feminist activism to bring about change in the response to domestic violence, and there is still a way to go. There are many reasons for the slow rate of change. Perhaps one of the most potent is a reluctance to face up to the suffering that exists just below the surface in our communities and to acknowledge that large numbers of seemingly upstanding citizens cause untold harm to their partners and children in the privacy of their own homes.

Similar dynamics are at play in regard to prostitution – a reluctance to face up to the suffering involved and that it is not just a few weirdos who cause that suffering, but people we know and work with.

What makes us sexually interested in one person rather than another, and at a specific moment in time and place, is deeply personal. Respecting and honouring other people’s sexual autonomy is fundamental to the functioning of a healthy society. It doesn’t matter that you are overwhelmed with sexual desire for someone; if they don’t reciprocate, you’d better take a cold shower or do some yoga, or whatever works for you. Gone are the days when a woman was deemed on her marriage to have given her spouse lifelong consent to any and every sexual activity at any and every time and place of his choosing.

Forcing sex on someone against their will – rape – is almost universally considered a serious crime. This is an intrinsic recognition that our sexual integrity is fundamental to our sense of self, and that any assault on it is uniquely damaging.

We understand unwanted sex to be damaging both to the individual and to society – except, it seems, when money is involved. Every single one of us knows that it is impossible to conjure up sexual interest at will. And yet the myth that ‘sex work is real work’ persists. As if having sex with a random stranger really is no different from serving them a hamburger. And as if having to be sexually intimate and feign sexual interest with a series of strangers is not going to have profound consequences – even when there is some semblance of choice.

But when you examine that notion of choice, you quickly see that it, too, is not what it may at first seem, especially now in this age of Big Porn. Sarah, who became involved in prostitution as an 18-year-old, articulates it brilliantly:

‘Beginning to engage in prostitution might seem like a big decision, but for many girls it’s almost an inevitability; the difference between life before and after prostitution for some girls is basically just the addition of a fee. Being exposed to porn from a very young age gave me a look at what was valued in a woman, and what men wanted to do to women. And as those things came to pass, the message was legitimised and deeply entrenched in me in the way only experience can entrench it.

‘Between being assaulted and raped throughout childhood and adolescence, exchanging blow jobs for bus fares in high school; the years I spent being pornographically photographed and subjected to painful and humiliating porn-inspired sex acts by male partners… there are lessons that are hammered into your psyche through the violation of your body.’ 1

Not a lifestyle choice

While Sarah’s experiences were obviously unique to her, the changes that mass early exposure to online pornography and its seepage into mainstream culture have caused are fairly ubiquitous, including the well-documented increase in boys sexually harassing girls, and early engagement in sexual behaviour.

Combine this reality with economic deprivation, ‘sex work is real work’ propaganda, predatory pimps, and the brutal student financial regime, and you have a perfect storm that makes the notion that students are making a truly free choice to enter prostitution pretty much an oxymoron.

And yet, service providers often position these women as in control and making a choice. Too often they are described as ‘too complex’, their lifestyles ‘too chaotic’, and the causation of their problems is located in something inherently wrong with them. If they turn to the NHS, they are likely to be given a diagnosis of Emotionally Unstable Personality Disorder (EUPD), for which they are sometimes told there is no cure. This not only belies the immense trauma they have experienced, but also obscures who was responsible for that trauma – the men who buy sexual access to women and girls and the people who facilitate and profit from that.

The documented psychological consequences of prolonged sexual trauma include a list of symptoms2 that are almost a mirror image of those of EUPD.

Trauma is not pathological; it is a completely natural, rational, valid and justified response to sexual violation – but without acknowledgement of its existence and legitimacy, recovery is impeded.3

To illustrate how these themes play out in practice, I provide two case studies. The first illustrates that not one of a series of caring professionals would acknowledge and address the trauma inherent in prostitution. The second illustrates how a trauma-informed approach led to a happier outcome.

Handbook for universities

Many readers will be aware of the promotion in UK universities of the ‘sex work is real work’ and ‘free choice’ tropes, under the guise of supporting student ‘sex workers’ and helping them to ‘keep safe’.

In response, we decided to create a handbook for universities, setting out an alternative and more holistic vision.

Our handbook provides a realistic understanding of the sex industry in sometimes harrowing detail, the short- and long-term impact of involvement within it, and how best to support those who are caught up in it.

The chapter on supporting students covers the context of student involvement in the sex industry, general challenges in working with this group of students, therapeutic versus ethical neutrality, general principles and dos and don’ts, a detailed example, and the need to also provide support to students who want to kick a porn habit.

The handbook emphasises that universities should have the overarching aim of no student having to resort to the sex industry because of a lack of other options, and it argues that any efforts to bring about positive change on university campuses in respect to sexist attitudes and sexual misconduct are doomed to failure unless sex education programmes directly address the sex industry and porn consumption.

The handbook is available as a free PDF download or as a printed copy to buy.5

Case studies: names within case studies are pseudonyms, but the responses are based on real experience. We thank the contributors for permission to publish their comments.


1. Nordic Model Now! #MeToo Stories. [Online.] https://nordicmodelnow.org/2021/11/26/the-incest-to-prostitution-pipeline (accessed 14 December 2021).
2. Yuan NP, Koss MP, Stone M. The psychological consequences of sexual trauma [Online.] NRCDV publications. 2006. https://vawnet.org/sites/default/files/materials/files/2016-09/AR_PsychConsequences.pdf (accessed 15 December 2021).
3. Herman JL. Recovery from psychological trauma. Psychiatry and Clinical Neurosciences 2002; January. https://onlinelibrary.wiley.com/doi/full/10.1046/j.1440-1819.1998.0520s5S145.x
4. British Psychological Society. [Online.] www.bps.org.uk/power-threat-meaning-framework (accessed 16 December 2021).
5. Nordic Model Now! Publication. [Online.] https://nordicmodelnow.org/the-nordic-model-now-handbook-for-universities/ (accessed 16 December 2021