Sex workers face increased risk of muscle dysmorphia

A study published in Sexual Health has found a connection between involvement in sex work and symptoms of muscle dysmorphia among adolescents and young adults in Canada. Researchers found that individuals with a history of sex work reported higher levels of overall muscle dysmorphia symptoms, particularly in their drive for increased muscle size and functional impairments linked to their condition.

Sex work, broadly defined as engaging in sexual activity for monetary compensation, has long been associated with adverse health outcomes. These include heightened risks of mental health issues such as depression, anxiety, and post-traumatic stress disorder, as well as physical risks like sexually transmitted infections and violence. Despite these well-documented challenges, little attention has been paid to the relationship between sex work and muscle dysmorphia—a mental health condition characterized by a pathological preoccupation with muscularity.

“Muscle dysmorphia is very understudied yet there continues to be evidence of its symptomatology being quite prevalent. Therefore, it remains critical to investigate correlates of this symptomatology, specifically contexts that may be objectifying and traumatic, such as sex work,” said study author Kyle T. Ganson, an assistant professor at the University of Toronto.

The study analyzed data from the second wave of the Canadian Study of Adolescent Health Behaviors, which surveyed 912 participants aged 16 to 30 years across Canada. Participants were recruited online through platforms like Instagram and Snapchat in late 2021. While the recruitment was not targeted, the resulting sample included a diverse range of individuals in terms of gender, race, and socioeconomic status.

Participants were asked whether they had ever engaged in sex work, defined as receiving payment for oral, vaginal, or anal sex. Those who answered “yes” were categorized as having a history of sex work. To assess muscle dysmorphia, researchers used the Muscle Dysmorphic Disorder Inventory (MDDI), a 13-item questionnaire measuring symptoms related to the drive for muscular size, appearance intolerance, and functional impairments caused by the condition.

The Canadian Study of Adolescent Health Behaviors also collected demographic data, including participants’ age, gender identity, sexual orientation, race, income, and education level. These factors were included in the analysis to account for their potential influence on the findings.

Approximately 4% of participants reported having engaged in sex work. The researchers found significant associations between a history of sex work and elevated muscle dysmorphia symptoms. Specifically, individuals who reported engaging in sex work scored higher on the MDDI’s overall symptom scale. These individuals also demonstrated greater “drive for size” symptoms, reflecting an intense desire to increase muscle mass, and greater functional impairments, such as disruptions to daily life caused by their preoccupation with muscularity.

“The primary takeaway is that those who were involved in any lifetime sex work, that is, they were paid for sex, had greater muscle dysmorphia symptomatology, and specifically symptoms related to drive for size (i.e., the desire and behaviors to increase muscularity) and functional impairment (i.e., were more likely pass on social or occupational activities for muscularity goals),” Ganson told PsyPost.

However, no significant relationship was found between sex work and appearance intolerance, a dimension of muscle dysmorphia characterized by dissatisfaction with one’s physical appearance. This result suggests that muscle dysmorphia in this population may stem more from functional or psychological factors than from purely aesthetic concerns.

The researchers proposed several potential explanations for these findings. The heightened “drive for size” and functional impairments may reflect an effort to cope with the psychological stress and stigma associated with sex work. Additionally, the pursuit of muscularity might serve as a perceived means of protection against violence or a strategy to conform to client preferences for certain body ideals.

“I’m not particularly surprised by the findings,” Ganson said. “There is strong evidence that when one’s body is objectified, particularly sexually, then there is more likelihood of self-objectification and body dissatisfaction, both of which motivate engagement in behaviors to change one’s body towards a sociocultural ideal (muscularity in this case). From this theoretical standpoint, these associations make sense to me.”

While the findings shed light on an underexplored topic, the researchers acknowledged several limitations. The data were collected through self-reported surveys, which can be subject to biases such as underreporting or exaggeration. Additionally, the study’s cross-sectional design means it cannot establish causality; it is unclear whether sex work preceded the development of muscle dysmorphia symptoms or vice versa.

The researchers emphasized the need for further investigation into muscle dysmorphia. “This research can help inform future investigation (i.e., specifically among sex workers) and create targeted and tailored prevention and intervention programming to curtail or address muscle dysmorphia,” Ganson said.

The study, “Involvement in sex work is associated with muscle dysmorphia symptomatology among a sample of Canadian adolescents and young adults,” was authored by Kyle T. Ganson, Nelson Pang, Alexander Testa, Rachel F. Rodgers, Jori Jones, and Jason M. Nagata.