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Health & Sex

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.

Question & Answers

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.

Watch a video on blow jobs with condom

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:

  • Discharge or pus from the vagina, penis or anus. In women, the discharge is more than normal. The discharge may be watery, milky, yellowish or greenish in colour. It can also smell differently.
  • A burning sensation, irritation, pain during or after urination or having to frequently urinate in small amounts.
  • Sores, warts, blisters on the vagina, mouth, penis or anus.
  • Itching in the pubic hair, the labia, glans or anus.
  • Swollen glands in the groin.
  • Pain in the lower abdomen.
  • Blood loss during or after sex.
  • Pain in one or both testicles.

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:

  • You have had a condom break or have had unsafe sex
  • You have STI symptoms
  • You have been warned about an STI by someone with whom you have had sex

 

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 tests

Blood is always taken from you. This is tested for syphilis, HIV and, if necessary, hepatitis B.

 

Physical examination

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.

 

Self-check

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.

 

Results

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.

 

Test sites

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.

 

Your personal situation

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:

  • Do you have experience with contraceptives?
  • Do you want to use hormones or not?
  • Do you smoke? Can you/do you want to stop smoking? Smoking and hormone use can be a bad combination.
  • Can you remember to take a contraceptive every day, or do you not want to have to think about it for a long time?
  • Do you want to take contraceptives orally, or apply it to your skin or vagina?
  • Is it important for you to have your monthly period? Or would you rather not have your cycle at all?
  • Are you afraid of changes in your body?
  • Do you wish to have a child soon?

 

Different types of contraception

Below, 8 reliable forms of contraceptives are described.

Birth control pill

Contraceptive ring

Patch

Depo-Provera

Intrauterine device (IUD)

Hormone stick (Implanon)

Sterilization

 

What is not safe if you are a sex worker are:

  • Using spermicidal vaginal pastes or tablets
  • Withdrawal
  • Calendar and temperature method

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?

First:

  1. Make sure you have some good condoms. A good condom can be recognized by the CE logo.
  2. Always check the expiration date.

During sex:

  1. Make sure there is no contact between penis and vagina, mouth or anus, before putting on the condom.
  2. Tear open the packaging of the condom carefully. Do not use teeth or scissors.
  3. Hold the tip of the condom between thumb and forefinger. This prevents air from getting into the condom. Make sure your nails do not touch the condom.
  4. Do not put on the condom until your client has a good erection. If necessary, pull the foreskin down. You are still holding the tip between thumb and index finger. Note: the condom edge must be on the outside. Otherwise, you cannot roll it down. Then roll the condom down as far as possible with your other hand.
  5. Use plenty of lubricant
  6. After the orgasm, immediately pull the penis out of the vagina or anus. Do this before the penis becomes limp. Then make a knot in the condom. Be careful not to get sperm on your hands, because then you can still infect yourself.

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?

  • Go to the toilet as soon as possible and try to pee. Any bacteria thus leave the vulva.
  • Then rinse only the outside of the vulva, not inside, so bacteria cannot penetrate into the vagina.
  • If you do not use contraception, get the morning after pill from a pharmacy or drugstore as soon as possible. You have to take this within 72 hours. There is now a morning-after pill that you can take up to five days (120 hours) after a broken condom; this is the Ella-One. But the faster, the better.
  • Contact the P&G Zevenhuizen or the nearest GGD and have yourself tested for STIs a week later. If you develop symptoms before that, make an appointment earlier.

What should you do if the condom breaks or falls off during anal sex (with a woman or man)?

  • Contact P&G Zevenhuizen in Alkmaar (088-0125705) or the nearest GGD immediately. If it happens over the weekend or in the evening, go to the emergency department of a hospital. A doctor can then assess whether you are eligible for a PEP treatment.

PEP

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

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.

 

Regular testing

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.

 

Women

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.

 

Men

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.

 

Pregnancy

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.

 

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.

 

Unplanned pregnancy

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.

 

Wanted pregnancy

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.

 

Abortion

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.

 

Costs

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.

 

Legislation

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

  • Wash and internally rinse your vagina more than once a day.
  • Use soap or soapy products for washing your vagina. These disturb the acidity and thereby the natural balance in the vagina. If you like to wash the vagina with soap, do not do this more than once a week. Special vaginal soap such as Lactacyd is often ineffective and does not balance the disturbed acidity. It can even aggravate your symptoms.
  • Do not wash or rinse with Dettol, vinegar or other caustic agents. These damage your vagina.
  • Use vaginal steam baths or apply herbs. This makes the vagina dryer. This may be pleasant for the customer, but is disastrous for the vagina. It can damage the vaginal mucosa. When your vaginal mucosa is damaged, the risk of an STI increases.
  • Use pads, sponges or panty liners if you are not on your period.
  • Switch from anal sex to vaginal sex without changing condoms.
  • Share sex toys without using a condom.

 

What you should do

  • Wash your vagina with lukewarm water only.
  • Rinse internally only once a week, only with lukewarm water.
  • Change tampons and sponges regularly (use for no longer than four hours).
  • Always use a condom with lubricant (without Nonoxynol-9).

 

Pain and odour of the vagina

You may suffer from various vaginal symptoms:

  • Change in your discharge
  • Discharge with an unpleasant odour (fish smell)
  • Redness, irritation
  • Pain, burning sensation while urinating
  • Pain during and after sex
  • Blood loss after sex
  • Swollen labia
  • Wounds, sores, chapping, cuts

 

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:

  • Use of antibiotics or other medications
  • Pregnancy
  • Washing your vagina with soap or vaginal douches
  • Excessive use of remedies such as Lactacyd
  • Keeping vaginal sponges or tampons in for too long
  • Switching directly from anal to vaginal fucking or sharing sex toys without changing condoms
  • Many (changing) sex contacts
  • Having an STI

 

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:

  • Use once (do not rinse and re-insert).
  • Never keep in for more than four hours.
  • Do not use natural sponges or household sponges.
  • Always use a condom in addition to the sponge.
  • Always dampen a dry sponge with a few drops of water.
  • If you cannot find a sponge in your vagina: direct the shower head to your vagina and allow the sponge to fill with water. It will then drop down more easily.

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.

 

Care of the anus

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:

  • Before you rinse, try to defecate on the toilet first.
  • If you rinse with water: use clean, lukewarm water.
  • Do not use disinfectants.
  • With the shower hose: the water pressure must not be too high.
  • If necessary, apply some lubricant in your anus and to the end of the shower hose.
  • Relax your sphincter and gently insert the hose.
  • After inserting the liquid from the Microlax (enema) or the water, relax the sphincter muscle and let the water flow out with the faeces.
  • Do not rinse too often, as this can disrupt your metabolic system.
  • Clean the 'tools' used well with soap and water.
  • When used by multiple people: clean the tool with a solution of one part bleach in ten parts water. Then rinse the 'tools' thoroughly with water.

 

Hair removal

You can depilate your body, and in particular your pubic area, in different ways.

 

Shaving

Shaving your pubic hair is the easiest and the least expensive. Disadvantages, however, are:

  • Ugly red bumps and ingrown hairs can often arise.
  • You have to maintain it well.
  • You can easily hurt yourself.
  • Your skin can get irritated by blades or shaving cream.

 

Tips

  • Use a new, sharp razor blade and special shaving cream for sensitive skin.
  • Make the place you want to shave cold.
  • Pull the skin taut with one hand.
  • Do not shave against the direction of hair growth.

 

Depilatory cream

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.

 

Tips

  • Try a bit in advance to see how your skin reacts. If you do not have red spots the next day, you can use the cream.
  • Avoid contact with the mucous membrane of the labia, vulva and anus.
  • Do not use soap, deodorant or other perfumed products for the first 24 hours.
     
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