Selling and paying for sex is illegal throughout most of the world but that doesn’t stop people from taking part on both ends. A list compiled by Havocscope, a company that collects data on black market activity, exposes just how much some countries spend on the dirty deed. However, it doesn’t mention much about the type of people who partake in the act. Luckily, Medical Daily is here to delve into the psychology and health of men who pay for sex.

Using data from public health programs and law enforcement initiatives, Havocscope was able to compile a chart showing the estimated revenue earned through sex work in various countries, Metro reported. The chart shows China spends the most on prostitution by a significant amount, shelling out over $73 billion each year. Spain came in second, spending an estimated $26.5 billion a year, while Japan trailed in third, spending $24 billion. (If you were wondering about the U.S., it came in 5th place at $14.6 billion.)

These figures may show us prostitution is a thriving industry, but they don’t tell us much about the actual sex consumer. So, we must turn to science.

A Psychological Profile

Men who pay for sex, according to a 2015 study conducted by researchers at the University of California, Los Angeles (UCLA), are not only less likely to have empathy toward women, but they’re also more likely to commit rape in the future. Comparing about 100 men who paid for sex to 100 who didn’t, the researchers found those who paid exhibited higher levels of sexually aggressive behaviors. They were more likely to be antisocial, have a preference for impersonal sex, and express their masculinity in hostile ways.

"We hope this research will lead to a rejection of the myth that sex buyers are simply sexually frustrated nice guys," said Melissa Farley, the study’s lead author and executive director of Prostitution Research and Education, a San Francisco-based nonprofit in a statement .

While the UCLA study points to a darker side of this kind of man's psyche, other research suggests there’s a more sensitive characteristic that’s common among them: the need for emotional intimacy.

This was the result of a 2012 study looking at 394 conversational threads on the website, The Erotic Highway, an international guild for "erotic entertainers." About one third of men speaking on these threads reported the desire to have a "limited romantic or emotional connection in addition to, or instead, of [a] purely physical" one with a sex worker.

Moreover, the researchers found that while some men did have negative attitudes toward these women, the majority of them seemed to respect female sex workers, and took pride in the pleasure they were able to achieve with them. Some of the men also described deep emotional relationships, spoke of introducing prostitutes to their children, or even leaving their wives for them.

Men’s Physical Health

Along with similarities between their mentalities, there are also similarities when it comes to the physical health of men who pay for sex. A recent study from the University of Portland looked at condom usage and sexual risk taking among 208 men who paid for sex (aged 60 to 84), and found almost 60 percent reported going without protection during their sexual encounters. What’s more, 95 percent reported going without protection for manual masturbation and 90 percent didn’t use a condom when receiving oral sex.

Unsurprisingly, men who reported more unprotected sex were also more likely to be diagnosed with an STD. What's more, the study found as the men aged, they also became less likely to use protection. "Medical and mental health clinicians should not assume that old age is a barrier to paying for sex, particularly among the generations that began engaging in sexual activity prior to the epidemic emergence of the HIV virus," the research team wrote in a statement.

While there's not much we can do about these men's personalities, there are steps governments can take to reduce health risks. For example, experts from the World Health Organization, as well as those writing in The Lancet — a popular medical journal — have agreed decriminalizing sex work can benefit all parties involved. As it stands, most sex workers can’t report being subjected to violent incidents out of risk of exposing their professions — decriminalization would allow them to feel safer .

Legal prostitution may also improve the reach of public health and safety messages regarding the use of condoms to those who pay for sex. A 2014 paper from UCLA found these measures could dramatically reduce the transmission of STDs in the general population. Proof this works was seen in Rhode Island, when it accidentally legalized prostitution for six years from 2003 to 2009. During that time, there were approximately 2,000 less gonorrhea cases in both the sex market and the population at large.

That said, while we may not be able to change the people who pay for sex or work as prostitutes, at least there’s hope in making the activity safer.

Source: Farley M, et al. Comparing Sex Buyers With Men Who Do Not Buy Sex: New Data on Prostitution and Trafficking. Journal of Interpersonal Violence. 2015.

Milrod C, Weitzer R. The Intimacy Prism: Emotion Management among the Clients of Escorts. Men and Masculinities. 2012.

Mildrod C, Monto M. Condom Use, Sexual Risk, and Self-Reported STI in a Sample of Older Male Clients of Heterosexual Prostitution in the United States. American Journal of Men’s Health. 2016.