[TW] The Courtesans of Nye County
Framework for Legal Prostitution in Nevada
The following essay is about sex work.
It acknowledges the humanity of sex workers, the existence of assault and human trafficking. Please take care of yourself if this subject is triggering to you.
I want to be clear that the stories of sex workers are not mine. I can only speak to what I’ve observed as a clinician and friend of people in “the industry”. I am grateful to those who trust me to hear their experiences and advise on their specific health needs.
My hope is that by covering sensitive topics, I can encourage dignity and respect across the spectrum of adult sexuality.
Reader discretion is advised.
As I continue to draft essays that address the topic of intimacy, I want to be mindful of the boundaries of my partner: that’s you.
While some of my writing is focused on life in medicine, I enjoy speaking and writing candidly about human sexuality. I’m thinking the best way to be respectful and not bombard your inbox with content you don’t want is to put my edgier essays behind a paywall. To make them “For Paid Subscribers Only”. I will also put a [Trigger Warning- TW] in the subject line.
Some draft essays include:
“What Men Get Wrong About Sex with Women” and “The Psychology and Deep Connection of Kink”
Please answer the following poll to help guide my rollout of these delicate topics:
On to the Good Stuff…
Since last I wrote you, all of the following have happened:
A pediatrician in one of my social networks was outed to the Medical Board about the anonymous OnlyFans account he produces with his wife.
Two female physician colleagues have asked about hiring male sex workers because they’re exhausted with online dating and low-effort lovers.
I was invited by an international medical society to pitch a talk on sex work to an audience of clinicians and academics.
Given the influx of questions on the topic, it’s as good a time as any to tell you what I know.
My interest in sex workers as a population started when I decided to take a tour of the "World Famous Chicken Ranch Brothel" in Pahrump; so named because dust-bowl era patrons of the original Texas ranch would trade live chickens to the working ladies in exchange for services. Eggs, after all, were a commodity in those days. Plus, the excess animals collected at the ranch could be sold for cash.
This particular business is the inspiration behind "The Best Little Whorehouse in Texas". The brothel management relocated to Nevada from Texas in 1973 after a local media expose put pressure on the governor to shut it down. You can read more about the history of the Chicken Ranch here: https://www.tshaonline.org/handbook/entries/chicken-ranch
As you may be aware, Nevada is the only state in the US where regulated prostitution is legal; but not in all jurisdictions. Counties with a population under 700,000 can allow prostitution at the discretion of the local government. There are 23 licensed brothels spread across 7 rural counties in Nevada.
Pahrump is the closest town to Las Vegas that allows legal prostitution. Street level solicitation, online escort services and the trafficking of humans for sex is not legal anywhere. But far more money changes hands for black market prostitution than for legal prostitution in Nevada. Signs posted throughout our airports, casinos and entertainment venues encourage visitors to report human trafficking to law enforcement. Justice Department data indicates that Las Vegas is a top location for the sale of human trafficking victims within the United States. Multiple legal challenges have been brought against the brothel industry but local jurisdictions seem to recognize the value of having an outlet for sex work that requires health and safety oversight; and minimizes risk to workers.
I occasionally go out to the tiny, desert town of Pahrump in Nye County for business. During one of those trips, I asked for a free tour of the Chicken Ranch brothel out of pure curiosity. My tour guide had a degree in finance from the University of California system and very clearly leverages her education to run a profitable enterprise. She keeps a home in Southern California where she also works as an exotic dancer. She has a sizable social media following and makes adult content which she sells via an online platform. She understands the intricacies of business ownership, independent contracting, tax law and financial investment. She has also figured out ways to navigate the healthcare system to get what she needs without having to explain or justify her livelihood to medical staff.
During our tour, she spoke to me about how clients often crave intimacy as much as they crave sex. She said she especially enjoys “The Girlfriend Experience”; an encounter that may include 8 minutes of sex and 52 minutes of listening to the client’s stories about their job, home life, medical diagnoses and family problems. Courtesans have helped coach clients through their first ever sexual experiences; provided services to disabled clients and helped couples navigate their first threesome. Some ladies offer special services like kink play and erotic massage.
Ladies go into legal, regulated sex work in Nevada for a myriad of reasons. Interest in intimacy, creative expression, scheduling preferences, an attempt to save money for educational or travel pursuits and lack of interest in corporate culture are all factors. Given the rural location of many of the brothels, there are likely people doing sex work due to a lack of other economic options.
While many women have been victims of sexual violence in the past, the regulation of sex work in the brothels has strictly enforced codes of conduct and health. They fall under the jurisdiction of local counties but there are additional “House Rules” that vary by location.
Brothels and courtesans both require licenses and have to register with the local sheriff’s office.
Courtesans have control over what services they do and don’t provide. They are independent contractors; not employees.
They set their own rates. The house (in most facilities) keeps half.
Comprehensive STI screenings are mandatory before beginning a “tour” and subsequent testing is required on a weekly basis by state law.
Condoms are mandatory.
Some courtesans don’t kiss.
Each room at the Chicken Ranch has a panic button that alerts the sheriff’s office as well as house security if a patron becomes violent with a lady. I have heard that other brothels have similar security features.
BDSM/kink sessions at the Chicken Ranch require the presence of two ladies so that no one is alone with a client during those types of encounters.
State law prohibits advertising despite multiple legal challenges regarding free speech.
The brothels in Nevada offer a relatively safe alternative to independent sex work but they are not without some deeply problematic structural issues. Women travel in from other states to work at the brothels. Courtesans are required to pay room and board to the house regardless of whether or not they receive any bookings. While some women self-promote and book private client appointments during their tours, most are required to attend “lineups” for patrons who walk in without prior reservations. They also hang out at the bar to chat with and solicit potential customers. These common areas can be much busier during certain high-profile events in Las Vegas.
Courtesans go through rigorous and frequent STI testing. In addition to blood testing for HIV, Hepatitis and Syphilis, courtesans are swabbed for gonorrhea, chlamydia, trichomoniasis. Licensed brothel owners can be held liable if a patron contracts an STI from one of their courtesans.
Criticism has been directed at brothel ownership over the business model including the 50% cut that the house takes, restrictions on courtesan outings during tours, “lineup” rules and the fact that ladies have to pay the house regardless of booking/income. It is possible for a courtesan to leave the brothel owing money to the house rather than having made money. These issues have led to accusations of exploitation on the part of the brothel owners.
My clinical experience with sex workers is now in the context of community outreach and grassroots advocacy. Since my first trip to the Ranch, I’ve made friends with a few ladies who are vocal advocates of sex workers’ rights and access to healthcare. Through these connections, I've volunteered to serve as a consultant for a group of independent professionals (mostly women) who film in Vegas and around the country. I've learned a lot by being in those text threads: about how they screen for predators, how they plan content creation events and how they utilize technology to cobble together an income. Most of the group chat is a combination of logistical planning, business advice and humor. I make myself available to answer questions about things like PREP, doxyPEP, HPV vaccination, STI treatment and pregnancy prevention. I also answer questions about navigating the labyrinthine healthcare system. It’s decidedly unglamorous but an interesting and fun community to be a part of. It’s also a small way for me to quietly contribute my medical education to benefit public health.
While some full-service sex workers see clients in the brothels, many more are piecing together a living through porn, product endorsements, podcasts, OnlyFans and internet-facilitated prostitution. Some have regular day jobs and do content creation on the side. As you may be aware, teachers, doctors, university professors and other professionals have come under public scrutiny when their OnlyFans accounts have been made public. While there is ongoing stigma, the sale of sexual content online is not limited to those who consider themselves to be professional sex workers.
Whether or not a sex worker has been the victim of human trafficking, this is an incredibly stigmatized and marginalized group of people. They are often glamorized or treated as curiosities; dehumanized despite the incredibly intimate services they provide. It’s still widely culturally acceptable to use terms like “whore” and “hooker” as insults. Stigmatization of SW's is pervasive in traditional healthcare environments so most avoid revealing their work to their doctors; this secrecy puts them at increased risk but many have figured out ways to subvert the system.
Abandonment of patients by the medical community isn’t limited to sex workers. Whether the issue is sex work, queerness, non-monogamy or kink, medical professionals receive no training on how to answer completely valid questions on the spectrum of human sexuality. Even my own OB/GYN became rigid and uncomfortable when I revealed my lack of interest in monogamy. She taught me through her visible discomfort that it wasn’t safe to talk to her.
My hope is that medical schools and residency training programs will begin to address human sexuality, including sex work, in a way that doesn’t dismiss or shame patients who need guidance. People deserve to have their concerns addressed with dignity and respect. This is about individual and public health; not casting judgement from some arbitrary moral high-ground.
Special thanks to Alice Little for her advisory and editorial assistance in the drafting of this article.
Resources and Recommendations
Sell/Buy/Date A hybrid documentary/narrative movie from Executive Producer Meryl Streep and Tony Award Winning comedian Sarah Jones. They do a wonderful job of highlighting the nuances of the world’s oldest profession.
Comprehensive STI screening and treatment
Planned Parenthood: A stalwart in the provision of low-cost sexual healthcare access.
Wisp: Commercial provider for STI testing and treatment online.
Organizations that support Sex Workers and victims of human trafficking
The Cupcake Girls: Support, resources, advocacy and outreach to sex workers and victims of human trafficking. Locations in Las Vegas and Portland, OR.
SWAID Vegas: Peer-support organization providing micro-grants and emergency supplies directly to sex workers.
The Sex Worker’s Outreach Program of Los Angeles: Peer support program by sex workers, for sex workers. Their website includes a list of resources for healthcare, legal aid, safety, mental health, housing and harm reduction.
Sex-Positive Healthcare and Other Professionals
Kink and Polyamory Aware Professionals Network: Medical, mental health, legal and other professionals who are sensitive to diverse expressions of sexuality.
Very interesting and complex!