Throughout history, sex workers used a wide range of methods to prevent pregnancy, from herbal drinks and wool pessaries to vinegar-soaked sponges and early condoms made from animal intestines. Some of these methods were surprisingly effective; many were not. The reality is that unwanted pregnancies were common, and when prevention failed, women often turned to dangerous herbal mixtures to end a pregnancy. The history of contraception among sex workers is really the history of contraception itself, since these women had the strongest practical need to control their fertility and were often the earliest adopters of new methods.
Ancient Egyptian and Roman Methods
The earliest recorded contraceptive techniques date back roughly 4,000 years. Ancient Egyptian doctors recommended mixtures of crocodile dung and honey, or swabs of acacia and honey, placed inside the vagina and left there for extended periods. These weren’t as absurd as they sound. Acacia ferments into lactic acid, which has mild spermicidal properties. The honey and dung acted as a physical barrier. Egyptian women also used intravaginal pessaries (insertable plugs) combined with douching.
In the Greek and Roman world, methods grew more varied. The physician Dioscorides recommended pepper-based pessaries and a mixture of cedar oil and alum applied before intercourse. Cedar oil is mildly acidic and may have created a hostile environment for sperm. Wool soaked in various substances was a common delivery method. Women would insert a piece of soft wool treated with oils, resins, or plant extracts to physically block and chemically interfere with conception. The most common categories of birth control in ancient Rome included herbal options, pessaries, and folk remedies, all documented by physicians like Soranus and Dioscorides in medical texts that survived for centuries.
Silphium: The Ancient Wonder Drug
One plant stands out in ancient contraceptive history. Silphium, a fennel-like plant that grew only in a narrow coastal strip of what is now Libya, was so valuable that its image appeared on coins. The Roman naturalist Pliny described women drinking it with wine and applying it with soft wool to their genitals to start menstruation, a common euphemism for ending or preventing pregnancy. The physician Soranus suggested dissolving a chickpea-sized piece of silphium seed in water and drinking it as a contraceptive.
Silphium was harvested so aggressively that neither the Greeks nor the Romans ever managed to cultivate it outside its natural habitat. It was eventually driven to extinction, likely by the first or second century CE. Its disappearance suggests it worked well enough that demand outstripped supply for centuries. No modern analysis of its active compounds has been possible, since no specimens survive.
Sponges, Douches, and Early Condoms
By the 19th century, methods had become somewhat more refined but remained unreliable. The American physician Charles Knowlton recommended that women insert a small sponge tied with a string into the vagina during intercourse, then use a chemical douche afterward to wash away sperm. He suggested solutions of zinc sulfate, alum, or potash. If those weren’t available, even plain water was considered better than nothing. Other practitioners listed withdrawal, sponges, and douching as the main options available to women.
Condoms existed long before the 19th century but were expensive and hard to obtain. Early versions were made from linen or animal intestine and didn’t differ much across 18th-century Europe. They were primarily used by wealthier clients and were designed more to prevent disease than pregnancy. The real turning point came in 1839, when Charles Goodyear’s discovery of vulcanized rubber made condoms affordable enough for the working classes. Before that, animal-gut condoms had to be soaked before use, were reused repeatedly, and often tore.
Sponges and condoms both depended on the user’s ability to find, purchase, or make them and to place and remove them correctly. For sex workers seeing many clients in a day, consistent use was difficult. French spermicides also entered the market in this period, though their effectiveness was limited.
Herbal Abortifacients When Prevention Failed
When contraception failed, women turned to a category of herbs known as emmenagogues, defined in traditional medicine as herbs that stimulate menstrual flow even when it isn’t due. “Herbs for delayed menses” was a longstanding euphemism for ending an unwanted pregnancy. Many emmenagogues double as abortifacients.
The most commonly used plants included tansy, pennyroyal, rue, mugwort, wormwood, yarrow, and savin (a type of juniper). These were brewed into teas, concentrated into tinctures, or applied directly. Pennyroyal oil was particularly well known and particularly dangerous. The amounts required to induce a miscarriage often posed serious toxicity risks, including kidney and liver damage. Women who survived an unsuccessful herbal abortion attempt frequently needed further medical intervention. These methods were genuinely life-threatening, and deaths from pennyroyal and tansy poisoning are documented throughout the historical record.
Toxic “Medical” Treatments
Some of the most dangerous practices came not from folk medicine but from physicians. In the 1800s and early 1900s, doctors frequently prescribed mercury for sexually transmitted infections, and it also saw use as a contraceptive douche. A French-made device held liquid mercury compound in a receptacle, with a hose and attachments for vaginal insertion. The “irritating effect” of mercury douching was documented as early as 1910 in a Journal of the American Medical Association article titled “Poisoning by Mercuric Chloride through Vaginal Douches.” A 1916 case in the British Medical Journal described a 27-year-old woman who douched with dissolved mercury tablets, then placed one tablet directly inside her vagina. These weren’t fringe practices. They were prescribed by mainstream doctors of the era.
The Rhythm Method’s Late Arrival
One method conspicuously absent from most of this history is fertility timing. Doctors in the 19th century did recommend having sex only during a woman’s “safe period,” but they got the timing wrong. Before 1930, most physicians misidentified when ovulation occurred, meaning women following medical advice were often having unprotected sex during their most fertile days.
It wasn’t until the 1920s and 1930s that two gynecologists, Kyusaku Ogino in Japan and Hermann Knaus in Austria, correctly identified that ovulation normally occurs 12 to 16 days before the start of the next menstrual period, and that an unfertilized egg survives less than a day. Even after this discovery, the rhythm method required regular cycles and careful tracking, making it impractical for sex workers.
The Honest Reality: Many Did Get Pregnant
Despite all these methods, the truth is that many sex workers did get pregnant, repeatedly. Modern data from low- and middle-income countries estimates unintended pregnancy among sex workers at 27 per 100 women per year. Historically, without access to modern contraception, the rate was almost certainly higher. A recent global analysis found that 37.7% of sex workers reported at least one induced abortion in their lifetime, and 21.7% reported multiple abortions.
Historically, pregnancies that weren’t ended through herbal means often resulted in births. Children born to sex workers were frequently placed in foundling homes, raised by relatives, or abandoned. In many eras, brothels expelled pregnant women, creating additional pressure to use whatever methods were available, regardless of risk. Criminalization and social stigma also limited sex workers’ access to whatever reproductive health services existed in their time, pushing them toward riskier self-managed options.
The full picture, then, is not that sex workers had reliable ways to prevent pregnancy. They had a patchwork of partially effective, often dangerous techniques. They used every tool available to them, from acacia honey in ancient Egypt to rubber condoms in the industrial age. But unwanted pregnancy remained a constant occupational hazard until the arrival of hormonal birth control in the 1960s.