There are many different types of people who are sex workers. And every sex worker has their own way to protect themselves from Sexually Transmitted Infections (STIs) It’s not just (cis-gendered) women who do sex work. Men, gay, trans　and lots of different types of people work it too! There are some people who don’t even categorise what they are doing, as sex work. Also, depending on where you are working, the type of client you have, you can have a completely different play style and character. So even if you know your safe sex, there may be time where it doesn’t go as planned. There are some people who use condoms at work, but don’t use condoms privately, “because my lover doesn’t like it”, and other reasons. On this page, you’ll find information on how as sex workers we can have a long, healthy, sexy relationship with our body. We’ll also introduce safe sex working tips that you can start using straight away! If you think you can do it, why not challenge yourself!

Basic facts before starting work

1) If you think “sex work is bad”, or “I’m a sexual minority so there are inherent risks in what I do”, if your customer asks you to do something that you don’t want to do, you might think, it can’t be helped, I can’t do anything to stop it. And if you just accept the situation for what it is, you start to feel disempowered. You might not even be able to do the every day things that you normally can do. We need to pick up tricks on how to confidently express our boundaries, strongly voicing our objection, or softly and gently refusing, so that we can protect ourselves.

2) When you have a cold, or an STIs, our immune system is low and we can easily catch other diseases or illnesses. When your body’s not feeling 100%, be careful when you play. Get checked out from time to time, it’s important that we pick up illnesses earlier rather than later.

3) It’s possible to pass viruses on with razors, toothbrushes, body piercing, needles. Also, it’s a good idea to keep your bath tub and chairs clean.

4) It’s best to get to know your body, the shape of your sex organs/genitals, colour, and odour. So if anything changes because of a disease, you’ll notice it straight away!

5) If you are working from a customer’s room, before you enter, always mark out the escape route, (checking to see if you need to pay to open a door, where the stairs are etc) Pretend that you are using the bathroom or putting stuff away in the closet and have a look around and make sure there is no one else hiding. To prevent voyeuristic recordings, make sure that mobile phones and laptops aren’t looking towards you, and check to see if there is a lens peaking out of the bag, also you can tell your customer’s up to something suspicious, if they are always looking towards one direction. There are some super clever cameras like pen videos so be careful!

6) Teas and coffees can be spiked with sleeping pills. So it’s best to be particularly careful with drinks. It’s better if you serve the drinks to you and your customer yourself!

7) People often dilute lubricant with water, but there are living organisms in the water that can breed and make the lubricant go off, so it’s best to only dilute the amount you are going to use each time.

8) Try not to keep your eyes off the customer when you are working. Keep a watch out to make sure your valuables aren’t getting stolen or that they aren’t trying to take the condom off. There are a few tricks to prevent valuables from getting stolen, you can hide them by folding them into your clothes you’ve taken off or keep them in your boots. With condoms, you can reduce the chance of the condom being taken off by changing positions whilst the customer is still inside you. Try and challenge yourself with these tricks!

9) If a condom breaks and/or they ejaculate (cum) inside, you may be able to prevent pregnancy by taking the emergency contraceptive pill or the morning after pill. The pill needs to be taken within 72 hours from when you had the unsafe sex. If you carry it around with you, you’d be a lot less stressed just in case the unexpected happens. However, don’t forget that the emergency contraceptive pill doesn’t protect you against STIs and there are a few side effects too. It won’t work if you throw up the pills due to side effects. Make sure you check how many grams, how many tablet you need to take.

Oral sex (fellatio and cunnilingus)

Whether your are the one doing the licking or being licked, it’s still possible to catch an STIs.

1) When you are doing oral sex with a condom, make sure you take off as much of your lip cream or lip stick. Oil based products have a tendency to make small holes in the condom. You can pretend to kiss erotically and use their back or thighs to smudge the lipstick off. Don’t replace lubricant with hand cream or chocolate!

2) If you have bleeding from the gums or ulcers, try and avoid deep kissing and definitely use a condom!

3) There are a lot bacteria crawling around in the mouth, including the bacteria that causes gingivitis, and tooth decay, so best to gargle before you start playing. Mouthwashes don’t work unless you gargle for at least 20 to 30 seconds. You can suggest to your customer, “this mouthwash is really strong so I recommend you to gargle with water after as well” to encourage them to wash their mouth out really well.

4) If you licked your customer’s genitals and they ejaculate (cum) inside your mouth, try and prevent the ejaculate (cum) from touching your throat (tonsils), and make sure you spit it all out as soon as you can. It’s reported that it’s easy to catch Chlamydia and Gonorrhea via oral sex and ejaculating (cumming) inside the mouth. To reduce the risk, make sure the ejaculate (cum) doesn’t touch your throat (tonsils), don’t swallow it, and spit it out of your mouth as soon as you can. Also, it’s possible to catch Gonorrhea and Chlamydia from pre-ejaculatory fluid (pre-cum) so best to remove the spit from your mouth. Keep your partner feeling good by making hot noises of dribbling whilst you protect yourself!

5) Don’t lick or touch warts or wounds. Avoid licking the urethra (eye of penis), concentrate on the shaft and balls instead or you can stimulate them without your mouth completely by using your thighs and breasts instead, it’s easy to tempt them in to safer ways of playing. It’s really important to gargle after you play as well.

6) If ejaculate (cum) enters your eye or nose, don’t scrub it but rinse it off gently with water.

7) If you were getting licked, after play, make sure you rinse yourself and pee to clean out the urethra from pathogens that may have creeped up. If you use too much soap, you will affect the vagina’s self cleansing action, so avoid the mucosal barrier and wash outside of the labia minora (inner lips).

8) If you are licking or getting licked, I suggest you do it in the bathing area so you can wash straight away. If your in the bathing area, it doesn’t matter if you dribbling out a lot of spit as well!

Dildos, fingering, fisting

Fingering is a type of play in itself but it can also be used to prepare the hole to relax and widen. It’s best to not push it but to take it slowly, without damaging the wall lining. It good to just start with one finger when fingering, and from thin dildos and get accustomed to it. Try not to cut your nails just before play. And try to avoid pointy bits when cutting your nails! Make sure you remove fake nails and rings. If you are going to play with your fake nails, or if you have long nails, you can wrap a tissue at the end of your finger and put a condom on or you can use a finger guard to soften the stimulation. It’s also handy to have female condoms (femidoms – which are 4 times the size of condoms) and surgical gloves as well. 。If you go from oral sex to vaginal or anal sex, its possible to spread an infection from your mouth to your genitals. If you are going from one spot to another or sharing dildos, make sure you use a new condom every time.

Anal sex

1) There are many different ways to wash to prepare for anal sex, glycerine, purified water, enema showers, bidet/washlets. When you’re cleaning out, make sure you don’t insert too much water or glycerine. Also be careful with the water pressure, best to do it very slowly.

2) Make sure you have a condom on standby before the pre-cum starts!

3) The rectum is easily damaged so use lubricant, and insert very slowly so that the condom doesn’t rip due to friction. Bareback and cumming inside carry a very high risk so best to avoid it. If you have hemorrhoids or inflammation your risk is increased.

4) If they cum inside you, try and squeeze it out as soon as you can. You can also do a gentle enema to force it out as well. The insertive side should also pee to wash out the urethra. If you have a urinary tract infection or an STIs, it’s a lot easier to catch something else. If you have bleeding, intestinal mucus, or if cum is still inside, you may become infected as well.

5) If you get hemorrhoids, it’s easy to bleed so if you feel pain, best to listen to your body and rest. You don’t want to get to a point where you have to spend more time and money to get better.

Post vaginal construction operation

It is the best to avoid intense insertion for about six months. When starting to have sex again, keep an eye out for changes in the physical condition, leakages (recording amount if there is), odour, colour and bleeding. When washing internally, be careful not to cause any damage and use the soft Nelaton catheter and wash out until the water becomes clear. Make sure to use a dilation lubricant.

What to do when it’s difficult to access HIV medication, during disasters, arrests etc.

Even if you are arrested, you have the right to contact a lawyer (or a state appointed lawyer – you can’t pick who) and treating doctor. They might say that you can’t, but you have the right. If you can’t access your medication, you’ll have to stop treatment, so it’s best to ask your treating doctor beforehand what to do in that situation. It’s not officially recognised but some doctors recommend you have one month extra worth of medication. If you can’t get in touch with a hospital or a doctor in the event of an emergency, continue to take your medication as per usual, and on principle, you should stop taking all HIV meds at the same time. It’s not good to take the medicine a few days apart , or just take one of the ARRT meds at a time, or just take the remaining meds available without the other meds at the same time. If you do this, you might develop a resistance to the medication. It’s important to stop all drugs, wait a while and resume treatment to get the best therapeutic effects. As an exception, if you are receiving treatment including Stocrin (Efavirenz), Viramune (Nevirapine), Intellence (Etravirine), it is recommended that you stop taking these medicine 2-7 days before you stop taking the other HIV medicines (best to talk to you treating doctor about the timing for when to stop each medication). The half life (the amount of time it takes for the medicine to reach half its strength) of these medicines are longer than the other medicines, so if you stop at the same time as the other medicines, it’s the same as taking only one medicine. Make sure you record the date and time of when you stopped taking what medicine, when, and contact your doctor.

Female hormones, etc

If you combine female hormones, anti-androgens, HIV medicines, psychoactive drugs (cannabis, amphetamines etc), sexual enhancing drugs (Levitra, Cialis, Viagra), psychiatric medication, there may be side effects. There are also reports that say to not drink medicine with tea or alcohol. There are contraindications with taking the female hormones with anti-HIV protease inhibitors and non-nucleoside reverse trascriptase inhibitors. It’s the same if you are taking the contraceptive pill and protease inhibitors at the same time, so it’s important you find another contraceptive method. If you’re not trans but taking similar drugs, you should be careful too. This also applies for people who use female hormone meds to be rejeuvenated, or to increase breast size, including taking supplements that contain Pueraria. Also, hormones meds, can interfere with sexual enhancing drugs (Levitra, Cialis, Viagra) making them stronger or weaker, however there are no other side effects. However, there is not enough research to show the effect of hormones on ejaculation, be mindful for changes in your mind and body. It’s difficult for people with diabetes to take these drugs, so be cautious when taking them. In the research we have done with trans* people, people have reported that they are importing drugs that aren’t available in Japan or are too expensive in Japan, there were also people who hadn’t seen a doctor once since they started to take the drugs. If you change your hormone balance with meds, if you suddenly quit taking meds, if you don’t take your hormone treatments after your operation, it possible to expereince menopause-like symptoms (osteoporosis, mental health issues) and if you are FTM, you might experience menstruation. It’s said that female hormones and other similar drugs can have a negative impact on your liver. There are some people who experienced side effects with female hormones and after talking to their doctor switched over to placental injections/supplements. Placental extracts are associated with facial whitening beauty cosmetic and supplements, but it’s also a medical product prescribed to people with liver dysfunction.

Hormones during emergency

How to access emergency medicine when you are overseas or during disasters. There are long-term slow-release hormones, anti-androgen: 3 months, and for female hormones you can swap from oral delivery to stick-on types. Keep in mind that it might sometimes be difficult to access needles, so it may be best to change to non-injection types. Also, if you get arrested, needles will be confiscated/taken off you. Different medicines and hormones pills have different merits. It depends on your individual situation and your physical condition, so there isn’t one medicine we can 100% suggest to anyone. It’s best to talk to your doctor, and get tested once a year (more if you just got an operation) to make sure the amount of hormones you are taking is right for you. Even if it is to just stay healthy a little bit more. Also, it’s important to build up your knowledge and information about it all too.

If you get lost with all the information, if you understand it all but have difficulty acting on it, SWASH runs workshops to help you out. We can exchange information, do role playing and aim towards having more confidence in the work we do. Contact us if you want someone to come to your shop to run a workshop.

Medical editor KojiNiwa, Shigeru Hayashi