Sex workers can be and often are the first-line providers of care to the sexual health of men or who have sex with men, especially those who donít identify as gay. The services provided by whores, escorts, and erotic masseurs begin with something that is often underrated in our culture: healing through pleasure. Inside every gay man are traces of a kid whoís been shamed, humiliated, silenced, or terrorized for being queer. For some people, going to a professional for sex is one way to gain permission to experience pleasure in our own bodies, which can be an amazingly powerful healing event.

Sex workers can also serve as providers of information on health matters ranging from safer sex to sexual hygiene. They can be role models of healthy male sexuality, sexual self-acceptance, and/or gay identity. They can be shame busters and stress-reduction engineers, and more. In this article, Iíd like to look at sex work as health care from two different directions. What are the health-care issues that face sex workers themselves (especially since caregivers are notoriously lax about self-care)? And what are the opportunities for sex workers to convey health-consciousness to their clients?

I started working as a massage therapist in New York City over six years ago. Since then, I have done approximately 3000 sessions with clients. I got my state certification training in California at the Body Electric School, which also offers extensive training in erotic massage as a healing practice. The vast majority of the sessions I do combine Swedish/Esalen-style massage with tantric massage, which incorporates erotic touch into the massage with the intention of raising and circulating erotic energy around the body. More often than not, the client has an ejaculation -- or ďrelease,Ē in the parlance of the trade -- but always in the context of a full-body experience.

Most of the time I keep my clothes on and discourage clients from interacting with me. However, in the course of my work as a professional masseur, I have engaged with clients in oral sex (active and receptive), anal sex (active and receptive), fisting, foot worship, water sports, power-and-surrender, verbal humiliation and other kinds of role-playing, body shaving, and various forms of intense body play, including spanking, flogging, bondage and discipline, blindfolding, hot wax, cock & ball torture, and experimenting with toys like titclamps, buttplugs, and vibrators. So I consider my professional employment as a masseur to fall within the realm of sex work. I donít especially relate to the term ďprostituteĒ -- I like the designation one client bestowed upon me, which is ďpleasure activist.Ē

While I have incorporated many kinds of sexual interaction into my bodywork, I have also coached people on breathing and meditation. I have referred people to acupuncturists, chiropractors, medical doctors, dentists, psychotherapists, psychic healers, colonic hydrotherapists, nutritional counselors, and yoga studios. I have worked with men and women who have a history of being sexually abused and assisted them in their struggle to regain contact with their erotic bodies, to practice consent, and to honor their desires. I have shared what I know about using diet, vitamins, herbal supplements, and homeopathic remedies to treat specific ailments. Iíve given people reading lists, xeroxed articles, and brochures on tantric sex workshops. Iíve turned people on to some really great music. And Iíve listened. I consider myself a holistic health practitioner, meaning that I donít treat bodies, I treat people, and I try to remember that every person who arrives at my massage table has numerous dimensions -- physical, emotional, erotic, ethical, and spiritual.

I donít claim to represent or speak for sex workers as a class of people. I think my experience and practice is not typical of sex workers. I also think I am not alone in my attitudes toward sex work.

I notice that most of the conversations that take place around sex workers, especially in the context of gay menís health, focus on them almost exclusively as an at-risk population, a vector of transmission, and the words ďsubstance abuseĒ and ďsuicideĒ are usually in the picture. Iím not saying there arenít sex workers for whom those are pressing issues. I just donít recognize myself in those conversations.

I came into this line of work at the advanced age of 39 with an almost absurdly idealistic attitude about sexual healing. Thatís because I trained with the Body Electric School in California, which was founded by a former Jesuit named Joseph Kramer as part of a mission to heal the split between sexuality and spirituality in Western culture. Howís that for ambitious? His sense of mission enflamed me. Among other things, he inspired me to investigate the work and ideas of Wilhelm Reich, a radical psychoanalyst and associate of Freudís who revolutionized 20th century thinking about sexuality as energy. As far back as 1926, Reich was saying things like ďThose who are psychically ill need but one thing -- complete and repeated genital gratification.Ē

My initial contact with Joe Kramer involved taking his weekend workshop, ďCelebrating the Body Erotic,Ē which has introduced thousands of men all over the country to some basic principles of tantric sex. The workshop is structured as a series of rituals that give men practice at integrating eye contact, breathing, being in heart space, and intentional touch, including genital massage. The climax of the workshop (so to speak) is a Taoist erotic massage ritual in which each person is massaged for an hour and a half, breathing consciously and being continually pleasured erotically without the goal of ejaculation.

For many gay men, this is a new experience and one that is ultimately as much a spiritual experience as an erotic experience. That was certainly true of me. My first Taoist erotic massage broke through a logjam of unprocessed AIDS grief. I discovered, quite unexpectedly, that by trying to cultivate only positive emotions I had blocked myself from feeling almost anything, including sexual arousal. Once I let myself feel the flood of sensations, which included weeping and sobbing for quite a long time, I felt clearer and lighter and able to feel all my feelings. That was my first glimpse of sexual healing.

Joe Kramer also introduced me to the ancient concept of the sacred prostitute -- or ďsacred intimate,Ē as he translated it -- who held the space for sex to be an experience about connection to spirit or communion with God, if you needed that in your life. Since we donít have temples that provide that kind of worship ceremony in the United States, Joe Kramer devised an elaborate training for sacred intimates, envisioning it as a contemporary occupation. I was perhaps foolish enough to take it seriously as something to undertake professionally. In any case, I got a lot out of that training. Among other things, the Body Electric School is very scrupulous in its training programs about hygiene and protocol. So in addition to excellent instruction in skillful touch and breathwork, I got instilled with basic hygienic practices that are important in maintaining a bodywork practice.

The cardinal rule of medical ethics is ďFirst, do no harm.Ē That means to yourself as well as to anybody else. A lot of the basic concepts of hygiene have to do with being mindful about preventing myself from being exposed to health hazards. Protecting myself means protecting my client. Both of us benefit.

So, for instance, I use clean sheets and towels for each client. I wash my hands, with soap and hot water, before and after a session. I try to be mindful about butt hygiene and scat germs, since probably at least half of the people I see for erotic massage enjoy some version of butt-pleasuring. I always have a supply of disposable latex gloves available for buttplay or use with toys, and dispose of them properly afterwards. Finger cots are also useful to have around, little rubbers that slide over a single finger -- I get them at hospital supply stores. If Iím inside someoneís butt with an unrubbered finger or anything else, I try to be really mindful of where that hand goes next. If I do a session where Iím playing with someoneís butt, and then I answer the phone, and then I pour a glass of water out of a pitcher in the refrigerator, Iíve left a possible trail of microbes that could expose me and any houseguests to parasites or hepatitis. Also I pay attention to lube containers and oil bottles -- am I touching them with clean hands? I often use disposable gloves to slip over a tube of KY, for example. One last word to the wise about butt stuff: Clip your fingernails. These are really basic safer-sex education things that I picked up from Body Electric trainings, and theyíre worth mentioning particularly to professionals who presumably have more sexual contacts than the average person.

One of the things I like most about being a professional bodyworker is the invitation to pay attention to my own body. Am I eating right? Am I exercising? Am I keeping my body clean and well-groomed? Am I getting enough sleep? If I donít get to a yoga class once a week, I feel tight and cranky in my body. If I donít get a massage myself every couple of weeks, I start feeling really draggy. And I constantly have to be attentive to overworking. Bodyworkers suffer all the emotional strains of people who are self-employed. I never know when the next chunk of change is going to come along, so Iím reluctant to turn down any work. But I have to be careful about burning out. Some signs of that are when I have trouble staying in my body. Do I find that Iím numbing myself out with food, or booze, or Net-surfing? Maybe itís time to take a break.

Some of the most important issues of self-care for sex workers have to do with groundedness. Touching a lot of different people, especially on an intimate basis, can be really really fun and exciting and satisfying at times. It also means taking on a lot of extra energy from other people, emotional and spiritual energy, and you have to find ways to clear that stuff out. I remember when I started out, I thought it was my job to have sex with absolutely anybody who walked in the door, just because they wanted it. The third day, a guy came for a massage who was really depressed and angry and a complete black cloud of negative energy. Visions of sexual healing dancing in my head, I got naked and gave him a very erotic session and was wide open with him -- and promptly got sick and wasnít able to work at all for several days. It was like Iíd drunk a couple of gallons of toxic waste.

So I had to learn very quickly how to assess peopleís energy, how to control how much of it to take on, how to maintain my own balance and my own values and my own mood. Taking showers is one way of clearing. Drinking a lot of water is important. I also got into the habit of burning sage, especially after an emotionally intense session, which is Native American medicine for clearing and purifying sacred space for doing ritual.

Another issue for sex workers is emotional support. Unlike office work, you donít necessarily have a crew of people around you who do the same thing, whom you can talk to about your work. Unlike social work or psychotherapy, thereís no tradition of supervision for sex workers. You walk around with this gigantic secret in your head that you feel like you canít share with just anybody. What happens when you feel overwhelmed, or troubled, or ashamed, or anxious, or conflicted, or you find your boundaries getting slippery, or your safe-sex standards flying out the window? What are your own emotional needs? What are your own sexual wounds that you might be acting out in your work? It helps to know these things about yourself, and if you donít have a friend you trust to discuss these things with, it helps to find a psychotherapist to explore these questions with. I know I have a tremendous amount of fear and trepidation about being judged or shamed by other people if I talk about my erotic bodywork practice, especially when I have conflicts or troublesome questions. I had an assumption that any therapist would fixate on this work as being illegal or pathological or compulsive or dangerous. Luckily, thatís not turned out to be the case.

In dealing with clients, Iíve come to realize that almost everything I do becomes a model of behavior. If Iím direct and honest and upfront with them, itís a signal that they are free to be direct and honest and upfront with me. Likewise, if Iím erratic about returning phone calls or slippery with them about the fee or manipulative about the transaction in any way, Iím issuing them a license to be erratic or slippery or manipulative with me. How I dress, how clean my bathroom is, how mindful I am about sexual hygiene -- all of those things send a message.

I started my practice with a very idealistic attitude about my ability to provide a sense of erotic abundance and sexual generosity. I was willing to get naked and interact with many of my clients. That period lasted about two years. In my experience and observation, many guys who go into sex work do it for a couple of years at most. What happens is usually one of three things: they find a boyfriend (which may have been the goal in the first place); they disappear into a self-destructive spiral with drugs; or they become completely drained of energy and move on to some less taxing occupation. Some version of the last category happened to me. Yet I was very committed to offering loving touch and healing through pleasure, so I redefined my boundaries to make it clear to my clients that what I was offering was massage, not sex.

I want to put in a word about the value of massage, and specifically erotic bodywork. These days we have a lot of language to talk about sexual addiction and sexual compulsion. But we donít talk very much about sexual starvation, erotic malnutrition, and touch deprivation. Being touched is a primary human need. Very few of us get touched as much as weíd like. I know thereís a lot of value to getting touched or massaged in an atmosphere that is strictly non-sexual; sometimes thatís a welcome relief and profoundly healing in itself. At the same time, for me personally, I find it kind of strange for a massage therapist to touch every part of my body but steer around my genitals, as if they donít deserved to be touched and nurtured along with the rest of me. My sexuality then gets split off from the rest of my body. As gay men, most of us grew up having to compartmentalize our sexuality and keep it hidden, creating an unhealthy split inside us. In the work that I do, Iím specifically giving my clients a place to integrate their erotic energy with the rest of who they are. When you get a good massage, every part of you is touched and honored, often more completely and intimately than with sex partners.

A lot of the sex we have with each other is driven by a sense of lack: ďI have to go outside myself to get something to make me whole or make up for some deficit.Ē Or we think of orgasm as something that someone else gives you. Tantra is about cultivating your own erotic energy and orgasmic capacity, which is the same pool of energy that supplies your ability to love and to pray. With tantric massage, Iím empowering the person on the table to breathe and expand and experience his own erotic self, not mine. Iím the guide, not the ride. Modelling boundaries is one of the most important things I can convey to my clients.

For sex workers, one of the most important though trickiest aspects of interacting with clients is the area of sexual ethics. Negotiating what weíre going to do together has several layers to it. Although on one level it can be a simple professional fee for service, there are always health issues in the picture. It is theoretically possible to have an erotic massage or a paid sexual encounter that is entirely free of risk of exposure to HIV or sexually transmitted diseases, and certainly many sessions are conducted with scrupulous adherence to safer-sex principles. But we all know that in the real world, there are many gray areas, and what one person considers acceptable sexual practice may be a red flag for someone else. This raises all the tricky questions. Do I disclose my HIV status? Do I ask for my partnerís? What about rimming? What about sucking? What about swallowing cum? In any encounter, but especially for sex workers who have an added responsibility, whatís important is frank and honest discussion so that if there are any risks involved, the risk is knowingly shared by both partners.

Another ethical issue for sex workers is getting tested frequently for STDs and being mindful of exposing clients to communicable infections like crabs or herpes. Itís embarrassing as hell to have to call up a sex partner and say ďI have crabs or scabies or gonorrhea and you should get treated for it.Ē Among sexually active gay men, this is an ethical issue that we donít address enough, in my opinion. But I think sex workers have an especially important responsibility to model integrity around sharing risks and contacting people about STDs if they show up.

I know that many of the questions Iíve had to face come from the active imaginations of my clients. One of my clients who likes to ejaculate while having his prostate stimulated one day posed this question to me: ďWhat if you got some blood under your fingernail from the last guy?Ē It was a perfectly reasonable question, and I assured him that I washed my hands after every session, but I made a note to myself to question any buttplay without a glove or a finger cot. Another client said, ďI liked it when you sucked me, but what if the guy at 2:00 had gonorrhea or chlamydia?Ē Good question.

When I hear questions like that, I definitely have to sort through layers of guilt and shame and defensiveness in response. But I really appreciate knowing that my clients are partners with me in looking at sex work as health care.

For anyone considering sex work as an occupation, you can look at sex work as an easy way to make money. You can treat it as something animalistic and mechanical and squirt-oriented and something to get over with as fast as possible. But you have to consider whether your attitude is supporting sex-shame and sex-negative messages from the culture and whether youíre missing the opportunity to have and provide someone with a transcendent experience.

Iíve partaken of almost every possibility in the gay male sexual subculture and have definitely had ecstatic experiences in bathhouses and bookstores, parks and porn theaters. But Iíve also had plenty of experiences in gay sex venues that felt alienated and heartless, and Iím aware that sex workers are part of that landscape. I really donít want my work to contribute to feelings of emptiness and spiritual deadness. I want more erotic abundance and sexual generosity in the world. And sex workers have the opportunity -- maybe even the responsibility -- to be community leaders in advocating healing through pleasure.

Originally prepared as a talk for the Boulder Gay Menís Health Summit in 1999, first published in Genre magazine, March 2000

To find out more about my bodywork practice, you can visit my webpage here.

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