Massive physical and psychological impairments

Many women in prostitution develop severe health problems, both physical and psychological. Few have a health insurance or can afford costly and lengthy treatment. Many continue to work in prostitution despite severe pain because they have to make money or are pressured by their pimps. If the women want to get health insurance, they are often asked to pay contributions for the previous years without insurance. Without support from a specialized counseling service, many women then continue to find themselves without health insurance or on a mountain of debt.

Women are at increased risk to get sexually transmitted diseases such as syphilis, hepatitis and HIV. A ruined vaginal flora, tears, injuries and fissures of the vagina or anus are also among the more common medical conditions. Gynecologist Liane Bissinger also reports frequent bladder infections and pelvic floor weakness even among very young women. Painful inflammation of the fallopian tubes is not uncommon.

In brothels, one can often only order unhealthy convenience food. Women on the street and in drug related prostitution often do not have the money for sufficient and healthy food. This poor and inadequate diet leads to gastrointestinal diseases and other ailments. Frequent vomiting due to disgust can also cause lasting damage to the gastrointestinal system. Women who often have to bear the weight of the johns on top of them complain of pain in their hip joints and back.

The often poor hygiene in the prostitution sites and sleep disturbances have additional negative effects on the women's health. They usually have no fixed day/night rhythm, are only exposed to artificial light in most cases, and have to be available to the clients at all times. Many therefore resort to sleeping pills in high doses.

According to a study by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ), women in prostitution often experience violence: 92% experience sexual harassment and 59% sexual violence. Two thirds of the women have already been raped in prostitution, half of them more than five times. 87% of the women report physical violence, 82% psychological violence.

So it is no wonder that the affected women take refuge in alcohol, drugs and medication to endure their daily lives. It is not uncommon for substance abuse to be encouraged by the pimps, because this pushes the women into an even greater dependency.

Many women dissociate during the sex act, meaning they imagine they are in a completely different place and look at the event as if they were looking at it from outside. Dissociation is often used unconsciously as a protective mechanism when people are exposed to unbearable and cruel situations. If dissociation makes the situation seem more bearable in the short term, it can lead to disturbed self-perception and a lack of identification with one's own body in the long term.

Overall, the psychological stress and trauma among women in prostitution is very high. According to studies, one in two suffers from depression, one in three experiences anxiety and panic attacks, and one in four has had suicidal thoughts.

With these multiple medical conditions, it is no wonder that the mortality rate of prostituted women is twelve times higher than that of the average population. Femicides are also not uncommon in prostitution. While robust figures are not collected, according to the private initiative Sexindustry Kills, which collects information on femicides in prostitution, 40 murders and attempted murders of women in prostitution have been counted since 2017, i.e. since the Prostitution Protection Act came into force. The likelihood of being killed as a prostitute is 18-40 times higher than for the average population.