We've written about fetish and role play escorting before. It is an endless topic simply because the sheer range of client fetishes is so extreme. At the same time, with the increasing availability of fetish material online, in ebooks and in reports in mainstream media, more and more escorts are adding fetish work to their existing escorting businesses.

"I invented "Liza Valerina" nearly six years ago as my escort persona. My brand and my signature. I work in Seattle mainly. Though I travel four or five times a year." Said Liza when we reached her by Skype. We'd been intrigued with her wonderfully ambiguous ad.

"The headline is pretty vague, isn't it? I mean "Gentlemen, I am here to touch your hidden heart" could pretty much mean anything from a quick hand job to a two day long orgy – and it has. But to start at the beginning. Like a lot of girls in this business I started escorting for extra cash while I went to school. I was doing a nursing degree and I thought I'd like to finish without a lot of debt and maybe even a few dollars in the bank. "Liza Valerina" was a pretty vanilla girl when she started."

Seattle is a competitive escort market but I am pretty and a bit busty so I did alright with a very simple "Student offers girlfriend experience" ad. I didn't want to work that much and I was selective. And, quite honestly, while I liked the money the work bored me. I was seeing the same sort of men day in day out and they all seemed perfectly happy with very straight consenting adult activities. I kept my rates in line with similar girls offering similar services.

"I think I would have kept doing really straight escorting until I finished school except, one day, a client wrote a review on one of the hobbyist sites. The key part of the review was this, "Liza is a pretty girl with a clean apartment and a good if distant attitude. I had an OK time and I am not complaining; but she seemed pretty bored with the whole thing."

There I was thinking it didn't show. Well it did. I would have been happier with a really crappy review which I knew was wrong; but this guy just nailed it. I was bored and, I am afraid, I let it show. One of the things that isn't on the curriculum but that you learn in nursing school is how to put some distance between yourself and patients. You have to in order to be professional. Which is ok but there are ways to avoid becoming impersonal. Here is a simple one, use the patient's name. Nurses who find themselves referring to their patients as "dear" or "hon" or "mom" in the obstetrics service are not really engaged in their work. And the same is true in escorting. Worse, I was doing it on my dates.

I'd just finished my first year of the nursing program and part of that year is a pretty intensive practical psychology unit. I've always been drawn towards the whole study of psychology and some of the things we were learning seemed to resonate in my escorting life. In particular, I noticed that a lot of my clients seemed to have more than just sex on their mind when they saw me. I did a bit of research, the internet is a wonderful thing, and I realized there were girls out there making a lot more money than I was catering to what people call "the fetish market".

"Fetish" covers a lot: everything from cross dressing to domination and submission all the way through to foot and shoe things, strap-ons, and bondage. It is a huge list of stuff but, at root, it is about men – and it is almost always men, very few women have fetishes – fixating on a particular thing or constellation of things in an obsessive way.

Now, most fetishes are pretty harmless. If a client wants me to wear peep toe black patent high heel pumps throughout a date, why not. Especially if I get to pick the heels. But there is a key differentiator: some fetishes are about you doing some to or for the client, others are the client doing something for you, but the ones I stay away from is where the client wants to do something to you. I think escorting of any kind is risky enough without putting yourself into a vulnerable position as part of the date.

So, OK, "fetish". Liza Valerina was going to branch out. But how? I really didn't have the first clue about how to "do fetish". And, the more I read, the more I realized that fetish dates were really not about me. They were about the hidden desires of my clients. What I needed to do is make it subtly clear that I was up for fulfilling those desires.

I looked at some of the posts from girls doing domination and fetish work and I was struck at how explicit they were. I had to look up some of the acronyms – what the heck is CBT when it is at home? – but the laundry list of activities left me a bit cold. I couldn't imagine a client looking down a list and mentally ticking off "uniform" bondage, strap-on" but, apparently that is how fetish dates happened.

I didn't know what half the things on the list were and I was not equipped for some of the rest. So I thought I would start rather small. My new post read "Nursing student interested in expanding her horizons – foot and shoe fetishes entertained. Other urges considered."

I ran that post and was, frankly, amazed at the response. I like my potential clients to get in touch via email. And, on my fetish post that was the only contact I put in. I had forty emails in about six hours. My regular post was lucky to see half a dozen a day.

While there were several foot fetishists, the real draw turned out to be the fact I was a nursing student. Who knew that there was a whole medical fetish community out there. But there is. Plus, a lot of the guys getting in touch were simply reassured that I was an escort who was also a nursing student. I think that is about the whole safety thing which, I have to admit, I am scrupulous about. But there were lots of guys who had a nurse fantasy. Some just wanted me in my uniform for an otherwise regular date, others had much more elaborate ideas.

The way I work my business is that when someone gets in touch with me via email I direct them to my website. There I have things like rates, etiquette and pictures. If they like what they see then they fill out a screening form and if they check out I get in touch with them.

Before I put up my fetish post I built a really simple "foot fetish page" with different rates and a little blurb on what I was interested in. I wrote about creating "a safe space in which to explore your sacred, secret, obsessions." And I also suggested that I was open to the whole "foot, shoe fetish thing including, but not limited to, foot worship, pedicures, nail polish, shoe buying expeditions and footplay." I had a few quite good pictures of my feet, bare, in hose, in shoes and, just for fun, in a tub full of suds.

Reading my email I quickly put up another page of me in both my normal nurse's uniform – basically just the standard blue tunic and pants with a stethoscope around my neck and I also put up some pictures of myself in a very old style nurses uniform from the 1950's I had found in a thrift store years ago and worn for Halloween. All starchy with the pinned bib and a matching nurse's cap. I headed the page "The Nurse will see you now". Just for fun I listed a few "procedures" including "manual relief", "specimen donation", "prostate manipulation" and "deep cleanse". And I put eye watering prices besides each. Plus, just for the fun of it, I included "chastity supervision" as I had come across a web site advertising male chastity devices. Why not?

I felt a bit like a traffic cop directing the foot fetishists to one page and the potential clients interested in nursing specialties to another. And here I found out something: men with fetishes are much more reliable clients than guys who want a "girlfriend" for an hour or two. Almost all of them filled out their screening forms which included a section where I asked them to, briefly, describe their particular interest. I was pretty naïve and I was, to tell the truth, a bit shocked at the remarkably well worked out scripts these men apparently carried around with them. (After a few fetish dates I began to realize that these scripts, often at an incredible level of detail, are very common in the fetish world.) While there were a few which I was uncomfortable with, most of the scripts were pretty tame. And almost all the fetishists screened beautifully. I began to book my first dates.

I have always done exclusively incalls. I have a nice condo in a building in the University District. Nothing fancy but very safe and in a concrete building so very quiet. I saw my regular escorting clients there without any problem so I was not too worried about my new lines of business. I thought I would start slowly with a guy who had been really excited by the picture of my feet in the sudsy tub. I booked an hour at twice my normal rate. So easy. I just wore a pretty skirt and blouse and greeted him barefoot at the door. I won't go into detail but I can say that it was far and away the easiest date I have ever done.

With that kind of fetish the escort is always completely in charge. You tell your client what he is to do and he does it. Of course, he has told you in his emails what he wants to be told to do and so there is a script. Some scripts end before the client reaches completion, others will involve a sexual element. It really depends. But it is also completely up to you.

As you might guess, foot fetishists are often very, very submissive. They crave being told exactly what to do with your feet. The dates I really like involve Nordstrom's designer shoes. I have a couple of clients who like nothing better than to take me for a light supper and then we are off to Nordstrom Rack which is an outlet store with fabulous shoes. The advantage of the outlet store is that no one seems to mind if my client is on his knees fitting different shoes onto my pretty feet. I get the shoes and very well paid for my time. Win/win I say.

"Liza's" nurse escort business is a little more complicated. In nursing school you are taught to be efficient. Not to dawdle, get the work done quickly and move on to the next patient. Exactly the opposite happens when I put on my escort scrubs or my Florence Nightingale starched poplin. Everything takes a long, long time.

I have to say the smartest thing I did was grab a few gowns from supplies the last time I was on a practicum. My medical clients arrive and, first thing, I send them to my washroom to shower and to put on two gowns: one the right way, the other backwards. It very much sets the stage. Depending on their script they either go into my bedroom which I have set up a little like a hospital room – nothing huge, but I clear out my things and have an instrument tray and that sort of thing. I have some pretty basic white sheets and one of those thin hospital blankets. I often have them put on a sleep mask and I turn out the lights. I'll leave them like that for twenty minutes.

Then I come into the room and get to work. Regardless of which procedure they have requested I always glove up and give them a suppository to start the session. Just glycerin but of ample size. I leave them with it for another ten minutes or so and then get to work.

When I first started doing my nurse escort business I did everything either in the bed or in the washroom. However, once I realized how lucrative this line of business was, I set up a little examining room in the storage space at the back of my condo. Nothing terribly elaborate but I found an old examining table on craigslist – with stirrups which have come in handy. I have a mirrored light which I got at auction and an old medical cabinet with all manner of rather nasty looking devices. It is just amazing what you can find in thrifts, on Craigslist or at auctions.

It turns out that there is an extensive community of medical fetishists. They have their own websites and forums. A lot of what they are interested in leaves me cold. Again, I won't get into details but my business is not about hurting anyone.

I run my post a week on and a week off. Because I have set my fetish rates fairly high I don't have to book a lot of clients. Which is good because there is a lot of prep time for the medical fetish clients and a girl can only have so many pedicures.

So the bulk of my business is feet and medicine but I am also open to other fetishes though I don't go looking for them, they find me. Or, more accurately, they are referred to me. I have made friends with a number of dominas in the area. I am not very keen on whips and chains and bondage, beyond strapping my clients into the stirrups for their procedures, seems like far too much work. So I send those clients to other dominas. I thought I might do cross dressing but once I looked into it I decided it really was not for me so those clients are referred out as well. Of course the dominas reciprocate with medical fetishes but they also send me clients whose fetishes they are not set up to do.

For example, I have one lovely client whose idea of a really good time is to do all my washing, vacuum my condo, organize my wardrobe and then be locked naked in my closet for an hour or two with weights in uncomfortable places. I can't imagine why the domina who referred him wasn't interested but her loss is my gain. I only wish he could afford to come over twice a week.

And remember my "throw away" about chastity supervision. Believe it or not I have half a dozen clients under supervision if not lock and key. Talk about a lovely little sideline. The delightful thing about it is that these clients really do like having their sexual activity monitored then controlled and, when they are ready, entirely at my whim. I figured out a system where they come on as chastity clients and are put through various levels of chastity discipline. I do a lot of it remotely and take payment by PayPal. Sometimes, however, I will meet a chastity client at a mall. He pays me, I give him his key and send him to the washroom. He has five minutes and then he gives me his key back. I quickly check that his device is in place and leave. Obviously, this particular fetish is not for everybody; but what fetish is?

I have pretty much given up doing straight dates. I don't have time. I finished my nursing degree and got a really good, very regular, two day a week, twelve hour shift plus overtime position at one of the cosmetic surgery clinics in town. Very low stress, mainly doing recovery room work but occasionally scrubbing in. I get the occasional extra shift but basically I can book my fetish escorting dates from Sunday to Thursday.

I've been toying with the idea of getting a separate space for my medical fetish dates. Really set it up with a full medical bed, examining room and so on. I have a lot of the equipment already and there is no question there is the demand. The overhead would be pretty minimal. The alternative, which may make more sense, would be to rent a bigger condo with two bedrooms one of which would be equipped as a hospital room. I'm looking around.

Having a fetish friendly post up off and on for five years has led to some very odd requests but also to some great, very regular clients. Which is the thing I had not anticipated. "Liza Valentina" when she was doing straight dates met the usual share of weirdos; but doing her fetish work she has yet to meet a man who has worried her at all.

Probably because men who have a specific fetish channel a lot of their sexual energy into that fetish. An escort who can cater to their particular fetish is rare and very precious. When a man finds that I am willing and able to scratch, very precisely, the exact itch he has he wants to see me again and again. It's a nice place to be.