Two weeks later, the girl’s image was in a back-page online ad, and she was being sold for sex from an apartment complex while being abused into submission by the young man who was now her pimp. Three days before her last visit to the ED, the patient was brutally raped by three clients, or “johns.” Some of the bruises and burn marks were from this assault. The baby wipe found in the girl’s vagina had been inserted to hide the patient’s copious vaginal discharge to allow her to continue working.

Had a more detailed history been taken of this patient’s background, social history, and home situation, and a more thorough exam performed, some of the signs of abuse may have been noted.

A Crime We Must Learn to Recognize

Sadly, this case is an all-too-common occurrence in EDs just like yours. Domestic minor sex trafficking (DMST) is the commercial sexual exploitation of American children within US borders. Sex trafficking is also called sex slavery or often mislabeled as prostitution. An estimated 100,000 children under age 18 become entrapped in the sex-slave market every year in the U.S. The average age of entry into the sex-trade industry in the U.S. is 12–14, according to a 2009 report by the National Center for Missing and Exploited Children.¹

Victims come from all socioeconomic and racial backgrounds and may be male, female, or transgender. This article focuses on underage female victims, but there is no doubt that women, boys, and men experience this scourge in significant numbers as well.

Despite being well-educated about child abuse, elder abuse, and domestic violence, most providers lack the training and ability to recognize victims of the sex-slave industry. Most victims of sexual exploitation never report “sexual assault.” DMST victims frequently present to EDs, but are rarely detected as such.

Supply and Demand

Children who experience violence and/or lack of support at home are at increased risk of becoming victims of sex slavery. Once indoctrinated, victims may be found in strip clubs, 24-hour massage parlors, and escort services. They may be walking the street (“track”) but often are bought online and directed via cell phone to meet johns at hotel rooms.^2,3

We live in a world that demands women and children be sold for sex. From movies to music to clothing lines, the sexualization of girls and women is rampant. The “pimp and ho” and “porn star” culture is commonly referenced and portrayed as either humorous or admirable. The abusive nature of prostitution is ignored or disguised.