This post is also available in: 简体中文 (Chinese (Simplified)) ไทย (Thai) 한국어 (Korean)

A visual sexual health check is a check of a client’s body to look for signs and symptoms of potential sexual health issues, including sexually transmitted infections (STI). 

During a visual sexual health check, you should look at the client’s:

• genital areas
• anal area
• mouth
• skin (especially thighs, groin, butt and hands)

Many STI and bloodborne viruses (BBV) do not have visible symptoms. A lack of visible symptoms does not necessarily mean that the client does not have an STI or BBV. 

You can find information on variations that can look like STIs here. 

Visual health checks are just one of many things you can do to protect your health at work, and can be combined with other prevention tools like using a condom and/or other barriers.

It is recommended that you perform a visual STI check with all clients, no matter what genitals or gender identity they have. 

Your local sex worker peer organisation can provide more advice or information on visual sexual health checks, and some run regular workshops on the topic. 

How to do visual sexual health check

You may not be able to do every single thing on this list, there are tips for quicker and more discreet health checks below. 

How do I check a penis for potential STI?

• Have as much light as possible 
• Lift the penis and testicles and have a good look around the genital area
• Pull back the foreskin (if uncircumcised)
• Gently squeeze along the shaft of the penis to see if any abnormal discharge comes out (sometimes called ‘milking the penis’)
• Remember that pre-cum can look normal and still transmit STI
• Look at the area between the anus and penis (the perineum)
• Check around the anal area
• Look through the pubic hair (mainly for pubic lice) and check the thighs, groin and buttocks
• Look over the mouth and lips for blisters and sores, especially if you kiss your clients
• Trust your instincts and ask questions about things you see if you feel safe and able to do so. Remember that the client’s explanation for something may not be informed by medical advice, and that they may say what they think will give them the best chance of getting the service they want. 

Wash your hands after performing a visual check, as you may have made contact with non-visible STI or other bacteria. 

How do I check a vulva and vagina for potential STI?

• Have as much light as possible 
• Look between the inner and outer lips/labia
• Notice any unusual discharge or unpleasant smells. This can be difficult as vaginal smell and discharge can change often due to things like menstrual cycles, weather and body chemistry. 
• Look for anything yellow or green and any smells that seem particularly unusual to you
• Look between the anus and vulva (the perineum)
• Check around the anal area
• Look through the pubic hair (mainly for pubic lice) and look around the genitals, thighs and buttocks
• Look over their mouth and lips for blisters and sores, especially if you kiss your clients
• Remember that some of these symptoms are common for other issues such as thrush or bacterial vaginosis, which are not STI
• Trust your instincts and ask questions about things you see if you feel safe and able to do so. Remember that the client’s explanation for something may not be informed by medical advice, and that they may say what they think will give them the best chance of getting the service they want. 

Remember to wash your hands after performing a visual check as you may have made contact with non-visible STI or other bacteria.

What to look for during a visual STI check

When performing a visual STI check, there are some things that will be more obvious than others. 

Some of the more visible signs may be:

• Sores (including in or around your client’s mouth)
• Blisters
• Rashes or other changes in skin appearance, colour or texture
• Warts
• Lumps
• Bleeding
• Unusual discharge
  • Unusual discharge from a penis may look milky, thick, yellow, grey, green, or bloody 
  • Unusual discharge from a vagina may be harder to spot, but yellow, grey, green, chunky, or bloody discharge and/or unpleasant smells can help alert you to a potential STI 
• Scratches/cuts (not a sign of an STI but increase the risk of STI transmission)

Some signs that may be harder to spot include: 

• Redness
• Swollen glands
  • Usually in the groin, pelvis or anal area
  • Often feel like soft, round bumps under the skin
  • Can be the size of a pea or a grape, but they can be larger
  • Redness on or around the glands can indicate inflammation
• Unpleasant odour
• Itching
  • Scratches, redness, and inflammation can indicate itching
  • Itching may suggest a non-visible STI
• Pubic Lice (aka Crabs)
  • Small, flat, brown bugs on the skin or pubic hair 
  • White eggs attached to the base of pubic hairs 
  • Most often found in the pubic area but can be found elsewhere on the body such as in facial hair (including eyebrows and eyelashes) and body hair such as armpits and chest hair

Remember that STI frequently have no signs or symptoms. Using a condom and/or other barrier is the best way to protect yourself from STI and BBV, even when there are no visible signs when you check your client.

When should I do a visual STI check?

Checking clients for visible signs of STI is common practice for sex workers, particularly if they offer full service (penetrative sex) or oral sex/blow jobs. Checks can be done as a regular practice at the start of the booking or more discreetly, depending on where and how you work.

The best time to check your client is before they have a shower or go to the toilet because urinating can clear any discharge that may be present, and it can take up to half an hour for it to build up and be noticeable again. This may not always be possible, depending on how and where you work, but try to do it as early as possible. 

How do I check a client discreetly?

Checking a client “discreetly” just means that you’re incorporating the check into the service, rather than doing it before the service starts. Any activity where you’re able to have a close look at the genitals and surrounding area is a good opportunity to do it.

This can be helpful if you think your client may be put off by a more formal visual sexual health check, if you feel uncomfortable bringing it up, or if starting the booking with a health check does not suit how or where you work. 

Doing a thorough check under good light is the best option, but a brief or discreet check is better than no check at all! Some workers who work in low-light environments carry small torches to help check clients. 

Here are some good opportunities to do a quick and discrete check:  

• While helping your client undress for the shower, or while in the shower with them
• During a massage at the beginning of the booking
• During a handjob at the beginning of the booking (be sure to check for any visible sores, warts or rashes before touching their genitals, and/or wash your hands afterwards if you find anything you’re concerned about)
• Find a reason to face away during foreplay such as removing underwear, face sitting,  or touching yourself and use the distraction as a chance to do your check
• Before rolling on the condom or giving oral

What do I do if I think my client has an STI?

Try not to get upset with a client if you find something that looks like an STI. They may not have realised themselves, and some may respond negatively to feeling ashamed. 

If you have spotted something that you think might be a sign of a potential STI, here are some tips on handling the situation: 

• If you’re comfortable, you can casually mention to your client what you’ve noticed, ask if it is unusual for them, and/or ask if they have had it looked at by a doctor. 
• You can recommend the client visit a clinic for tests and treatment before they come back. It can be useful to keep some contact cards from your local sexual health clinic on hand to give to clients.
• You can decide to offer an alternative service, such as a massage or a hand job with a condom or glove. 
• You can decide that you are not comfortable continuing, refuse the service and ask the client to come back another time.

It is good to think about what you would like to do if you suspect a client has an STI before you start working. This can help you feel prepared and confident if you ever need to bring it up during a booking. If you are working in a brothel, parlour or agency, find out what the management or receptionists will do to support you in these situations before you start seeing clients.

Making decisions about who you see, what services you offer, and how you offer them is your call. It is up to you to decide if and how you would like to proceed.

What do I do if I think I’ve been exposed to an STI?

If you think you may have been exposed to an STI, it is important to look after yourself and get tested within the recommended timeframe. You can find a list of sex worker-friendly sexual health clinics on our Where To Test page.

While potential exposure can cause anxiety and internalised whorephobia, it helps to know that the majority of STI are treatable, and most are curable using prescription medications. Remember that anyone who has sex can get an STI, and it is not a reflection on your worth or a punishment for your work or choices. Check out our BBV and STI FAQ page for general STI and BBV information or contact your local sex worker organisation for additional support. 

You can also find detailed information about specific infections and conditions and how they might impact your work in our BBV, STI and related conditions section.

Lines to get your client to practice safer sex

Try and make your client feel comfortable by explaining that the check is for their health as well as yours. Tell them you do it with everyone – including regulars. Develop a routine that works for you.

• Using a condom/dam helps me relax and get more into it
• You will feel so good, you won’t even notice the condom
• Don’t worry – I’m very good at what I do!
• We are protecting your health as much as mine when we use safer sex practices
• These condoms are ultra-thin, so you won’t feel like you have anything on at all
• Our policy is that you get kicked out if you ask for condomless services, I’ll let it pass this time
• You have two choices: you can use a condom and have a great time or refuse to use one and go elsewhere
• Sex workers have such low rates of STIs and HIV in Australia because we practice safe sex
• I never have unsafe sex, and I’m not about to start now