No abstract

Recent media attention implies that prostitution seeking is widespread, an "ordinary" aspect of masculine sexual behavior. Other accounts suggest that customers are "peculiar," characterized by distinct qualities, perversions, or psychological impairments. Using the nationally representative General Social Survey (GSS), this study demonstrates that prostitution seeking is relatively uncommon. Only about 14% of men in the United States report having ever paid for sex, and only 1% report having done so during the previous year. Furthermore, this study dissects whether customers are ordinary or peculiar by comparing a new sample of active customers who solicit sex on the Internet with an older sample of arrested customers, a sample of customers from the GSS, and a nationally representative sample of noncustomers. The customers of Internet sexual service providers differed greatly from men in general and also from other customers. The remaining samples of customers differed slightly from noncustomers in general. We argue for a balanced perspective that recognizes the significant variety among customers. There is no evidence of a peculiar quality that differentiates customers in general from men who have not paid for sex.

A growing but still limited body of research has examined the views and experiences of clients of sex workers. The current study is based on a content analysis of 2,442 postings on a popular forum where clients review sex workers and discuss their interactions with them. The article explores the reported experiences of a sample of clients who become involved in extended relationships with escorts and the emotional aspects of these associations. Findings show that there is a spectrum of experiences, ranging from counterfeit intimacy to an authentic emotional bond between the two parties. Many clients struggle with the unanticipated demands of an evolving romantic relationship and experience ongoing tension between its instrumental and expressive dimensions.

Background A rising number of female-affirmed transgender adolescents are being treated with gonadotropin-releasing hormone analogues and subsequently cross-sex hormones at early or mid-puberty, with vaginoplasty as the presumed final step in their physical transition. But, despite the minimum age of 18 years defining eligibility to undergo this irreversible procedure, anecdotal reports have shown that vaginoplasties are being performed on minors by surgeons in the United States, thereby contravening the World Professional Association for Transgender Health (WPATH) standards of care (SOC). Aim To explore surgeons' attitudes toward ethical guidelines in the SOC; any professional experiences of performing vaginoplasty on transgender minors; views of surgical risks, benefits, and harm reduction measures; and perceptions of future challenges and concerns in this area of surgical practice. Methods A qualitative semistructured interview approach was used to collect data from 13 male and 7 female surgeons who perform transgender vaginoplasty in the United States. Outcomes Professional experiences and attitudes toward vaginoplasty in transgender minors were analyzed using the constant comparative method applied to 20 individual interview transcripts. Results While there was close agreement concerning surgical techniques, proper patient selection, and predictive elements of postoperative success, attitudes toward the SOC and the reliance on the guidelines varied. The sole practitioner model is gradually giving way to a more holistic team approach, with patient responsibility dispersed among different professionals. Different approaches to surgical training, professional standards, and fellowship programs were suggested. Several participants expressed a need for centralized data collection, patient tracking, and increased involvement of the WPATH as a sponsor of studies in this emergent population. Clinical Implications Drawing on surgeons' attitudes and experiences is essential for the development of standards and practices. A more precise and transparent view of this surgical procedure will be essential in contributing to the updated version 8 of the WPATH SOC. Strengths and Limitations The abundant data elicited from the interviews address several meaningful research questions, most importantly patient selection criteria, surgical methods, and issues critical to the future of the profession. Nevertheless, the limited sample might not be representative of the surgical cadre at large, particularly when exploring experiences and attitudes toward vaginoplasty in minors. A larger participant pool representing WPATH-affiliated surgeons outside the United States would improve the generalizability of the study. Conclusion Taken together, the study and its findings make a significant contribution to the planned revision of the WPATH SOC.

Recent research has provided increased information about the clients of sex workers; however, little is known about the population of older male customers who contract for heterosexual services online. Clients (N = 208) between 60 and 84 years of age were obtained through sex work review sites and online discussion forums. Participants completed a 129-item questionnaire focusing on physical health, sexual and non-sexual behaviors with sex providers, and the qualities sought in the same. More than half reported having visited sex providers between 13 and 24 times or more during the past 12 months. Participants' advancing age was positively associated with frequency of paid sex. Most frequent sexual activities with providers were fellatio without a condom, followed by penile-vaginal sex with a condom. Analyses also examine the relationship between aging and buying sex. Those with higher incomes and without spouses or partners were more likely to report non-sexual activities with providers, and many participants sought a "GFE" or girlfriend experience, in which paid sexual exchanges are part of a relationship that mirrors conventional non-remunerative relationships.