Understanding Internalized Stigma and Sexual Identity in Sex Workers

Sex work is a deeply misunderstood profession, often viewed through a lens of moral judgment, pathologization, or cultural taboo. Even in places like Nevada where certain forms of sex work are legal, workers continue to face harmful stereotypes that affect not only how others see them—but how they see themselves.

In this post, we’ll explore the psychological concept of internalized stigma, how it intersects with sexual identity, and how both impact mental health in individuals who engage in sex work. This is part of an ongoing effort to support affirming, trauma-informed care for a population that is too often overlooked or misunderstood in clinical settings.

What Is Internalized Stigma?

Internalized stigma occurs when a person begins to absorb and believe negative societal messages about a core part of their identity. This is common among individuals from marginalized communities—whether due to race, gender, sexuality, disability, or profession.

For sex workers, internalized stigma may sound like:

• “What I do makes me unlovable.”

• “I don’t deserve a real relationship.”

• “I can’t be a good parent or partner because of my work.”

• “People only care about me for my body.”

• “I chose this, so I don’t have the right to feel traumatized.”

Over time, these messages erode self-worth, increase shame, and create a split between one’s public persona and private emotional experience. This can result in chronic depression, identity confusion, isolation, and maladaptive coping strategies.

The Impact on Sexual Identity and Self-Expression of Sex Workers

Sex workers—especially those assigned female at birth or who identify as LGBTQIA+—often have complicated relationships with their own sexual identity. Some may feel empowered and in control of their erotic expression. Others may feel emotionally detached, dissociated, or pressured to conform to clients' desires rather than their own.

Common dynamics include:

• Sexual numbing: disconnecting from personal desire to perform or “get through” encounters

• Erotic confusion: difficulty separating professional sexuality from personal orientation

• Queer erasure: hiding same-sex attraction or gender diversity in heteronormative brothel environments

• Body dysmorphia: linked to unrealistic standards of beauty or repeated objectification

These experiences are often invisible to clinicians unless providers explicitly ask and create safe, nonjudgmental space for exploration.

Shame and Silence: The Hidden Cost of Double Lives

Many sex workers lead compartmentalized lives—one version of self shown to clients, another to family or romantic partners, and perhaps another in therapy. The labor of maintaining these roles can result in:

• Emotional exhaustion

• Chronic imposter syndrome

• Avoidance of intimacy

• Distrust in support systems

When shame is internalized, it becomes harder to seek help, assert needs, or even imagine a life where self-expression and self-compassion coexist.

Supporting Sexual Identity Integration in Therapy

Affirming therapy does not assume a client’s relationship to their work or sexuality—it asks.

Therapists and psychiatric providers can support healing by:

• Using open-ended, non-pathologizing language (“How do you feel about your work? How does it impact how you see yourself sexually?”)

• Affirming that empowerment and trauma can coexist

• Offering psychoeducation on boundaries, consent, attachment, and internalized shame

• Exploring gender, desire, and erotic identity through narrative or somatic work

• Validating both pleasure and pain as parts of the human sexual experience

Moving Toward Self-Compassion and Wholeness

Healing from internalized stigma is not about rejecting sex work or embracing it—it’s about reclaiming agency and integrating identity. For some, that may mean continuing in the profession with pride. For others, it may mean leaving and redefining their sense of self outside of the work. Both are valid.

At the core, recovery involves learning to say: “I am more than what others see.” “I get to define who I am.” “My story matters—even the parts I was told to hide.”