If you work as a sex worker, your health is important. How can you protect yourself as well as possible against health risks? Recognizing STIs, testing for pregnancy and hygiene recommendations.
STIs (sexually transmitted infections) are infectious diseases that are caused by a bacterium or a virus. Examples of STIs caused by a bacterium (bacterial) are chlamydia, gonorrhoea and syphilis. Examples of STIs caused by a virus (viral) are herpes genitalis, genital warts, hepatitis A, hepatitis B and HIV. A bacterial STI can be treated well. A course of antibiotics or an antibiotic injection kills the bacteria. After treatment (usually after a week), you are no longer contagious. You can, however, be infected again, for example if you have unprotected sex or due to a broken condom. It is important that you get treatment on time. If you walk around for too long with a bacterial STI, this can lead to infertility. A viral STI cannot always be cured. You can, though, inhibit or suppress the virus, and thus the symptoms, with medication. If you have symptoms (warts, blisters), you are contagious. It is therefore important to treat such symptoms properly. That makes the chance of infecting your clients and/or your partner as small as possible.
The pathogens that cause an STI are found in the vagina, penis, anus, mouth and throat. But also in the vaginal fluid, pre-cum, semen and blood. You can also contract an STI through unprotected sex with someone who has an STI. That means when you have intercourse without a condom or when you have anal sex without a condom. But it also means if you give a blow job without a condom or engage in cunnilingus without a dental dam.
You can also contract an STI when you rub your vagina against the penis, without getting fucked. After all, there is skin-to-skin contact.
Often, you do not notice that you have an STI. You may have few to no symptoms. If you do have symptoms, these usually include:
Do you want to know if you have an STI? Then take an STI test. At P&G Zevenhuizen, this is free and anonymous! Because you have a lot of different sexual contacts as a sex worker, we advise you to come by every 3 months for an STI check.
Do you want to know if you have an STI? Then take an STI test. At P&G Zevenhuizen, this is free and anonymous! Because you have a lot of different sexual contacts as a sex worker, we advise you to come by every 3 months for an STI check. We test you for chlamydia, gonorrhoea, hepatitis B, syphilis and HIV. If necessary, we can also test you for herpes genitalis, genital warts, pubic lice, scabies and LGV. In the following situations, we advise you to come by sooner:
What happens during the examination?
The examination (consultation) consists of a number of parts. This depends on your specific situation.
Answering questions (anamnesis)
When you are in the examination room, the nurse will first ask you a number of questions. This is to clarify which examinations are necessary for you. The questions are about your sexual contacts, among other things.
Blood is always taken from you. This is tested for syphilis, HIV and, if necessary, hepatitis B.
If you have symptoms, you may opt for a physical examination. For women, this means a speculum examination (internal vaginal examination with a 'duckbill') and, if necessary, a smear from the urethra in men. Men also have to pee in a jar. (They can do this after the examination in the toilet.) The examination may be supplemented with a smear from the throat and/or anus. Additional examination may be done when indicated.
If you do not have any symptoms, it is possible to do part of the examination yourself instead of having it done by a nurse. For women, this means taking a swab from the vagina and anus, and for men, it is possible to submit urine for the examination and to take a smear from the anus (for anal contact).
How long does the examination take?
On average, the examination will take 20 to 30 minutes. But this can of course take longer due to specific symptoms.
The results of the STI test will be known after a week. There are different ways to request your results. This can be done online, via a secure website, but you can also call us to request the results. You can make an appointment online for an STI test.
At P&G Zevenhuizen in Alkmaar, you can take an STI test free of charge and anonymously. You can also get tested by your own doctor. The costs of testing will then depend on your own deductible (health insurance). Should you have a test done by your doctor, it is advisable to tell your doctor what work you are doing so that he will test you for all STIs. If the distance to Alkmaar is too far, you can also make an appointment in Hoorn and Den Helder for a consultation on sexual health and an STI test. Make an appointment.
Do not you want to get pregnant? Then it is best to use means of prevention, contraception, in addition to condoms. This will allow you to have sex with your partner without a condom and without becoming pregnant. There are many different types of contraceptives. Which one suits you best depends on your personal situation. If you have had sex without a contraceptive, you may want to consider taking a morning-after pill. Contraception does not protect against an STI. To protect against that, you must use a condom. For personal advice, contact a nurse from P&G Zevenhuizen, free of charge.
There are many different forms of contraception. They differ for example in the way they are taken and in the side effects. To determine which contraception best suits you, you can answer the following questions for yourself:
Below, 8 reliable forms of contraceptives are described.
What is not safe if you are a sex worker are:
A condom that breaks during sex is very annoying and can cause you to contract an STI or become pregnant. How do you use a condom?
If your vagina is dry, this can be painful during fucking, and a condom can break more easily. By using sufficient lubricant, you can prevent a condom from tearing or getting stuck. If you have anal sex (ass fucking), you have to use extra lubricant. Use water-based lubricant. Do not use a lubricant based on Nonoxynol-9. This medicine is harmful to your vagina or anus. Also do not use (massage) oil as a lubricant. This can damage the condom. If you often have broken condoms, then visit the P&G Zevenhuizen. We can then do a condom demonstration with you.
If your condom breaks, it can be very frightening. The condom can not only tear but also slip and stay behind in the vagina or anus. What should you do as a woman if the condom breaks or slips off?
What should you do if the condom breaks or falls off during anal sex (with a woman or man)?
If you have had unsafe anal sex with someone who is (possibly) HIV positive, you can receive a PEP treatment. This is a treatment with medicines (HIV inhibitors) that reduces the chance that you become infected with HIV. These drugs prevent the virus from implanting in your body.
It is important to start as soon as possible so that the virus does not get a chance to settle into your body. The PEP course must be started within 72 hours after the risk. But the sooner you start, the better. A PEP course lasts 4 weeks. A doctor decides whether you need PEP.
If you are unsure whether you are eligible for PEP, contact P&G Zevenhuizen or take the PEP test at www.mantotman.nl
Is PEP also an alternative to a condom?
No. Using a condom gives more guarantee of preventing an HIV infection than PEP. Moreover, the condom also protects you against other STIs and (in a woman) against pregnancy, while PEP does not. You can also become sick from PEP (nauseated and fatigued), and you have to go to the hospital several times for checks. Finally, the PEP course can cost you a lot of money, because the deductible for the health insurance is taken into account.
PrEP is a pill with HIV inhibitors that can prevent an HIV infection. It is intended for temporary use by people who are HIV negative, but who run a substantial risk of becoming infected.
The number of new HIV infections has remained stable in recent years. The Netherlands has about 1,100 new HIV patients every year. In 2013, 71% of all new HIV infections were diagnosed in gay men. New HIV infections are taking place despite all the information available about safe sex, the availability of cheap condoms and the care organized through STI clinics for risk groups, such as free testing for STIs and HIV. To further reduce the number of new HIV infections, new methods such as PrEP are needed. PrEP complements existing prevention strategies such as condoms.
How do you get PrEP?
PrEP can be prescribed by your GP, among other things. GPs can use the Dutch PrEP guideline for this. The guideline describes what PrEP is, how it works, and how he/she can prescribe it.
It is important that you get tested for STI and HIV before taking PrEP and every three months thereafter. This can be done free of charge at a GGD or via mantotman.nl. We also advise you to have your kidney function checked every three months (with a blood test) and to have a check for hepatitis C virus done. This must be done through your GP, and the costs of this kidney test and hepatitis C test count against your deductible. For more information, visit: http://www.prepnu.nl/.
Both men and women can become infected with Hepatitis B through unprotected sex. Men also run an increased risk of becoming infected with Hepatitis A. By vaccinating against Hepatitis B (and A) you can protect yourself against the virus. Hepatitis B is a severe inflammation of the liver caused by the Hepatitis B virus. Hepatitis B is very contagious and is common in the Netherlands. You can become infected by unsafe sexual contact or blood-to-blood contact.
Because of the multiple sexual contacts that you have as a sex worker, you run a greater risk of Hepatitis B infection. We therefore offer free vaccination. If you come for an STI examination at P&G Zevenhuizen, the nurse will discuss with you whether you have previously been vaccinated against Hepatitis B. If you are not yet vaccinated, the nurse will take blood from you and give you the first vaccination. The blood is to test whether you have been in contact with Hepatitis B before. If this is the case, then follow-up vaccinations are no longer necessary. In total, you need three vaccinations to fully protect against Hepatitis B. The second vaccination you get one month after the first vaccination, and the third vaccination, after 6 months. After three vaccinations, you are protected against Hepatitis B for life. The vaccine is safe and effective. You usually do not suffer from side effects. Sometimes there is some pain, redness and a stiff feeling at the site of the injection. These are normal side effects.
If you have sex with men as a male sex worker, it is possible to vaccinate yourself against hepatitis A and B. Men who have sex with men also run a risk of hepatitis A through sexual contact. Hepatitis A is another form of hepatitis that you contract via oral-anal contact (rimming). Almost everyone is cured of hepatitis A, but you can be pretty sick for a few months. There is a special vaccine that protects against hepatitis A and B (Twinrix®). This combination vaccine is a series of 3 vaccinations. The second vaccination is given one month after the first vaccination, and the third vaccination, after 6 months. After three vaccinations, you are protected against Hepatitis A and B for life. The vaccine is safe and effective. You usually do not suffer from side effects of the vaccination. Sometimes there is some pain, redness and a stiff feeling at the site of the vaccination. These are normal side effects.
If your period does not start on time, you could be pregnant. This may be because you have (deliberately) not used contraception and want to become pregnant. Or the pregnancy may be completely unexpected and even unwanted. To be sure whether you are pregnant, it is best to do a pregnancy test.
A pregnancy test is available without a prescription at any drugstore or pharmacy. You can take the test as soon as two or three weeks after you had unprotected sex.
With this test, you can see if the HCG hormone is present in your urine. You produce this hormone when you are pregnant. If this hormone is present in your urine, your pregnancy test will be positive. This means that you are pregnant.
Any properly performed test is very reliable. It is important to read the instructions carefully and thoroughly beforehand. A false positive result is rare (test says you are pregnant, but you are not). A false negative result can occur (test says that you are not pregnant, but you are). Often, the reason for this is that the test was done too early. That is, you did the test too soon after the unsafe sex.
Have doubts about the results of your pregnancy test? Are you shocked by the result? Or do you find it difficult to do the test yourself? Then make an appointment with P&G Zevenhuizen for sexual health consultation. The nurse will then do the test and help you further if necessary.
When you are unexpectedly pregnant, it can lead to a lot of doubts and emotions. Taking a decision about a pregnancy can be very difficult. Especially when the pregnancy is unexpected.
Do you want to continue the pregnancy, or do you want to end the pregnancy via an abortion? You may also think of alternatives such as giving the baby up for adoption or placement in a foster family.
This is a decision that is sometimes difficult to take. Especially when you do not have anyone with whom you dare to or can talk about this decision. The nurse at P&G Zevenhuizen can give you support. You can come to our sexual health consultation hour to talk about this. We can support you in taking a decision. Sometimes, we invite a social worker to join the interview.
When you find out that you are pregnant, there is a lot to think about. You may have questions about when your first ultrasound is. But also about how long you can continue working. Do you want to keep working during your pregnancy? And how long is sex work in combination with your pregnancy still desirable? This can be very personal. You can always talk to the nurse at P&G Zevenhuizen about this. In the Netherlands, you are under supervision of a midwife during your pregnancy. From about 8 weeks after the start of your last menstruation, you go to the midwife for a check of you and the baby. You can register with a midwife yourself. If you find this difficult, or you have done the pregnancy test at P&G Zevenhuizen, we can support you in this. Even if you do not have health insurance, you are entitled to obstetric care. We always advise you to take out health insurance, even if you are pregnant. You can work with a social worker to get health insurance.
Some women know quite quickly that a pregnancy is undesirable. In the Netherlands, it is possible to terminate the pregnancy. This is called an abortion. In the Netherlands, an abortion can be done until the 24th week of pregnancy. There are different methods for terminating a pregnancy. The methods that are used depend on the gestational stage and what you want. This is always done in consultation with the abortion clinic and with you. There is the medical abortion (the abortion pill) and suction curettage. Up to 8 weeks of pregnancy (that is 8 weeks after the start of your last menstruation), you can use the abortion pill. An important condition for this is that you must be able to speak Dutch or English well. Together with you in the abortion clinic, whether you are eligible for the abortion pill will be checked. If you are more than 8 weeks pregnant, the abortion is done by suction curettage. With suction curettage, the abortion clinic will always discuss with you whether you want an anaesthetic.
The costs of an abortion are covered by the Exceptional Medical Expenses Act (AWBZ). The AWBZ is a national insurance. In order to be insured under the AWBZ, you must have a BSN number and be able to prove that you have been living or working in the Netherlands for at least 3 months.
If you are staying in the Netherlands illegally or cannot prove that you live/work here, you have to pay for the procedure yourself. The costs can vary widely and vary per person and per situation.
If it turns out that you have to pay for an abortion yourself, the social worker can work with you to figure out how much this will cost.
In the Netherlands, an abortion can be done until the 24th week of pregnancy. Doctors in abortion clinics use 22 weeks as a limit in practice. This is because doctors can accurately determine the term of the pregnancy within 2 weeks. If you opt for an abortion, you always have a conversation first. After this interview, a mandatory cooling-off period of 5 days starts. So there is a minimum of 5 days between the interview and the treatment. The attending physician must also be sure that your choice is voluntary and well-considered. If you are 16 days or less overdue, you do not have a mandatory cooling-off period. An abortion may only be performed in an abortion clinic or a hospital. You can contact an abortion clinic yourself. At P&G Zevenhuizen, we can always refer you to an abortion clinic or make an appointment for you.
As a sex worker (woman or man), it is important to take good care of your body. You work with it, after all. How do you keep your body clean and cared for? And in such a way that you are not at extra risk for a condition such as an STI or a fungal infection? How can you continue working while you are menstruating?
Care of the vagina
The vagina is elastic and eight to ten centimetres long. In its relaxed state, the front and rear walls touch each other. The wall of the vagina is thick and pleated. The folds allow the vagina to stretch and in principle fit any size of penis. The wall is covered with a thin layer of mucous membrane. This partially protects you against, for example, viruses and bacteria. It is therefore important that you keep your vagina healthy. It is very normal to have discharge. Every woman has this. One more than the next. Often your discharge changes around your ovulation or menstruation. That is also normal As a sex worker, you want your vagina to look and smell good. How do you do that?
What you should not do
What you should do
Pain and odour of the vagina
You may suffer from various vaginal symptoms:
These symptoms may point to many different causes:
for example, an STI, skin condition, cervical cancer, reduced resistance due to medication, diabetes, HIV infection or pregnancy. But for sex workers, the most common causes of pain and odour in the vagina are bacterial vaginosis and fungal infection (candida). These are not STIs. These disorders are caused by an imbalance in the vagina, for example due to:
Working during menstruation
It is your choice whether or not to continue working during your period. Some women feel less fit during their menstruation. That may be a reason to choose not to work and to give yourself some rest. If you use the pill, the contraceptive ring or patch, you can arrange not to have a period by not including a stop week. You can also continue working while you are on your period. Special sponges are available for the blood collection. There are dry and wet sponges. Advice for using sponges:
If it still does not work contact the nurse at P&G Zevenhuizen by telephone. She can remove the sponge for you. Are we closed? Then call your doctor's urgent care clinic. If you have more questions about this subject, you can always make an appointment with the nurse.
If you are going to engage in anal sex (also called butt fucking), you can clean your anus in advance. If you have a regular bowel movement and wash your anus shortly beforehand, this is not necessary. Reason enough to do it anyway is that you certainly do not want to suffer from poo remnants and unpleasant odours. You can rinse with an enema. There are different types of enemas: Microlax or a water enema with a shower hose. Accessories are also available in leather shops. Tips for anal flushing:
You can depilate your body, and in particular your pubic area, in different ways.
Shaving your pubic hair is the easiest and the least expensive. Disadvantages, however, are:
Depilatory cream is a chemical substance that can irritate your skin. Therefore, buy cream that has been specially developed for the bikini line. This is also the most suitable for men's skin.