UNIVERSITY OF CINCINNATI
10 July 2008
Date:___________________
Rebecca Lehman
I, _________________________________________________________,
hereby submit this work as part of the requirements for the degree of:
Master of Science
in:
Health Promotion and Education
It is entitled:
A Content Analysis of On-Line Information on Body Piercing
and Body Modification
This work and its defense approved by:
Dr. Keith King
Chair: _______________________________
Dr. Amy Bernard
_______________________________
_______________________________
_______________________________
_______________________________
A Content Analysis of On-Line Information on Body Piercing and Body Modification
A thesis submitted to the
Division of Graduate Studies and Research
University of Cincinnati
in partial fulfillment of the requirements for the degree of
Master of Science
In the Division of Human Services
of the College of Education, Criminal Justice & Human Services
2008
by
Rebecca Lehman
B.A., University of Cincinnati, 2002
Abstract
AN ABSTRACT OF THE THESIS FOR MASTER OF SCIENCE DEGREE IN HEALTH
PROMOTION AND EDUCATION, PRESENTED ON 10 JULY 2008, AT THE
UNIVERSITY OF CINCINNATI, OHIO.
TITLE: A Content Analysis of On-Line Information on Body Piercing and Body
Modification
MASTERS COMMITTEE MEMBERS Dr. Keith King (Chair) and Dr. Amy Bernard
This study was a content analysis of websites of 75 US-based body piercing
establishments affiliated with the Association of Professional Piercers. The purpose of
the study was to investigate the information available on the websites about studio
cleanliness, safety precautions, potential complications from body piercings, body
piercers‟ professional experience and affiliations, recommended aftercare,
recommended resources on body modification, and the body modification procedures
available.
The gathered information was unique in body modification research in that the
information came from within the industry, as opposed to clients of the industry. Body
piercing establishments provided much information that promoted safe piercing practices
and minimization of risk of negative complications. The study found that the examined
establishments demonstrated frequent practice of stretching body piercings and
providing surface piercings and some practice of procedures that use dermal/biopsy
punches, subdermal implants, and intentional scarification.
iii
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Acknowledgements
Countless thanks are due to the following people:
Dr. King & Dr. Bernard, for their work as committee chair and member,
respectively.
Meg & Ned, for their patience, continued support, and wealth of insight.
Miss Faye, for her constant support, humor, and encouragement.
Dawn, for her patience and invaluable support - both emotional and financial.
Karie, Denise, & Un, for their feedback, insights, and help laughing through the
frustrations of this project.
Jesse, for grudgingly understanding the importance of “weekends off” and
frequent bouts of cheerleading.
v
Table of Contents
Page
Abstract
iii
Acknowledgements
iv
List of Tables
vii
Chapter 1: The Problem………………………………………………………..
1
Statement of the Problem……………………...............................................
4
Research Questions…………………………………………………......
5
Delimitations………………………………………………………………
6
Limitations…………………………………………………………………
6
Assumptions………………………………………………………………
6
Operational Definitions………………………………………………......
6
Chapter 2: Review of Literature……………………………………………….
7
Body Piercing in Cultural Context……………………………………....
7
Prevalence of Body Piercing…………………………………………....
8
Risks and Complications of Body Piercing……………………………
10
General Complications…………………………………………... 10
Prevalence of Complications……………………………………. 13
Perception of Risk……………………………………………......
14
Recommendations to Decrease Complications………………………
15
Role of Body Piercers…………………………………………………… 18
Emerging Body Modification Procedures…………………………......
19
Stretching………………………………………………………….
19
Punch and Taper…………………………………………………. 19
Scalpelled Piercings……………………………………………… 20
Tongue Splitting…………………………………………………..
20
Frenectomies……………………………………………………... 20
Microdermal Implant……………………………………………... 20
Transdermal Implant……………………………………………... 21
Subdermal Implant……………………………………………….. 21
Intentional Scarification………………………………………….. 21
Internet as a Source of Health Information……………………………
22
Gaps in the Literature……………………………………………………
22
Summary………………………………………………………………….
23
Chapter 3: Methods…………………………………………………………….
25
Participants……………………………………………………………….. 25
Instrumentation…………………………………………………………... 26
Procedures……………………………………………………………….. 28
Data Analysis…………………………………………………………….. 30
Chapter 4: Results and Discussion…………………………………………... 32
Units of Analysis………………………………………………………….
32
Body Piercing Establishment and Website Characteristics…………. 33
Information on Cleanliness and Safety Precautions…………………. 35
Hygiene During Body Piercing………………………………….. 35
Sterilization Equipment…………………………………………..
38
Licensure………………………………………………………….. 40
Age Policies……………………………………………………….
40
Identification Policies…………………………………………….. 41
Other Policies……………………………………………………..
42
Jewelry Used in Initial Body Piercings…………………………. 42
vi
Information about Body Piercers……………………………………….
Early Professional Development………………………………..
Health Related Training and Certification……………………...
Continuing Education…………………………………………….
Years of Experience………………………………………………
Reported Affiliation………………………………………………..
Information about Potential Complications and Adverse Effects……
Potential Complications and Adverse Effects During the
Procedure…………………………………………………..
Potential Complications and Adverse Effects After the
Procedure…………………………………………………..
Potential Psychosocial Complications and Adverse Effects…
Information on Aftercare…………………………………………………
What to Expect During Normal Healing………………………..
General Aftercare…………………………………………………
Salt Water/Saline Soaks…………………………………………
Cleaning with Soap……………………………………………….
Oral Piercing Aftercare…………………………………………...
Genital Piercing Aftercare………………………………………..
Recommended Resources……………………………………………...
On-Line Resources……………………………………………….
Print Resources…………………………………………………...
Video Resources………………………………………………….
Procedures Available…………………………………………………….
Other Information of Note……………………………………………….
Availability of Information………………………………………………..
Discussion………………………………………………………………...
Chapter 5: Conclusions and Recommendations………………………….
Conclusions…………………………………………………………….
Discussion………………………………………………………………
Recommendations……………………………………………………..
Recommendations for Practice……………………………….
Recommendations for Improving this Research…………….
Recommendations for Future Research……………………..
References……………………………………………………………………..
Appendices…………………………………………………………………….
Appendix A: Body Modification Content Rating Form……………..
Appendix B: Panel of Experts Information………………………….
Appendix C: Tables…………………………………………………...
vii
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61
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69
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75
80
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112
112
113
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124
List of Tables
Table 1.1
Table 4.1
Table 4.2
Table 4.3
Table 4.4
Table 4.5
Table 4.6
Table 4.7
Table 4.8
Table 4.9
Table 4.10
Table C1
Table C2
Table C3
Table C4
Site-Specific Complications of Body Piercings………………………..
Information on Hygiene, Cleanliness, Safety Precautions…………...
Information on Body Piercers……………………………………….......
Years of Experience Reported in Body Piercer On-Line
Biographies……………………………………………………………......
Information on Potential Complications and Adverse Effects………..
Potential Post-Procedural Complications and Adverse Effects and
Frequency of Reporting………………………………………………….
Information on Aftercare…………………………………………………
Recommended On-Line Resources……………………………………
Availability of Body Modification Procedures………………………….
Other Information of Note………………………………………………..
Availability of Information………………………………………………...
Body Piercing Establishment Hours of Operation…………………….
Aftercare Guidelines and Frequency of Recommendation…………..
Oral Piercing Aftercare Guidelines and Frequency of
Recommendation…………………………………………………………
Estimated Healing Time by Body Piercing and Frequency of
Estimation………………………………………………………………….
viii
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Chapter One
The Problem
Body piercing is a procedure which involves creating an opening in the surface of
the skin and placing jewelry in it. The procedure is usually quick and performed without
anesthesia. Body piercing has a long history throughout most cultures and has
experienced a recent surge in popularity in Western culture, particularly among
adolescents and young adults.
According to nationally representative data collected in 2004, 14% of the U.S.
population had ever had a body piercing (excluding earlobe piercings). While only 2% of
those born before 1963 had ever had a body piercing, 32% of those born between 1975
and 1986 had a body piercing (Laumann & Derrick, 2006). Seventy-four percent of those
who had ever had a body piercing obtained their first body piercing before age 24. Onequarter to one-half of university undergraduate students reported they had ever had a
body piercing (Armstong, Roberts, Owen, & Koch, 2004; Burger & Finkel, 2002; King &
Vidourek, 2007; Mayers, Judelson, Moriarty, & Rundell, 2002).
The above data demonstrated that body piercing in the US was more common
among younger individuals. Roberts, Auinger, and Ryan (2004) asserted that the steady
increase in rates of adolescents who reported having a body piercing demonstrated the
growing popularity of body piercing among adolescents. Their data collected in 1996
found that 4.3% of adolescents reported having a body piercing. More recent studies
found that between 27% and 69% of adolescents had ever had a body piercing (Carroll,
et al., 2002; Deschesnes, Demers, & Finès, 2006; Gold, Schorzman, Murray, Downs, &
Tolentine, 2005; Braithwaite, Robillard, Woodring, Stephens, & Arriola, 2001). All but
one study of adolescent body piercing found that girls were significantly more likely than
boys to have a body piercing.
1
The Problem - 2
Body piercing could potentially result in a variety of negative health
consequences and adverse effects for the pierced individual. These potential
complications included bruising and bleeding at the piercing site, migration of jewelry,
allergic reaction to jewelry, nerve damage, scarring and formation of keloids, localized
infection, systemic infection, tetanus, and infection with bloodborne pathogens such as
hepatitis and HIV (Meltzer, 2005; Samantha, Tweeten, & Rickman, 1998; Stirn, 2003).
Rates of reported complications varied, but were disturbingly high. In their
national data set on body piercing, Laumann and Derick (2006) found that 23% of
participants with body piercings reported complications, which most frequently occurred
later than three weeks after obtaining the body piercing. Huxley and Grogan (2005)
found that 19% of participants with body piercings had experienced health problems
associated with the body piercing. Mayers et al. (2002) found a similar rate among
university undergraduate students, where 17% of those with body piercings reported
medical complications. Two other studies of university undergraduates found much
higher rates of medical complications: Armstrong, Roberts, Owen, and Koch (2004)
found that 69% reported complications; Greif, Hewitt, and Armstrong found that 70%
reported complications. Skin irritation and infection at the piercing site were the most
commonly reported complications in these two studies.
Despite the frequency of complications of body piercings, researchers found that
the risk of complications played only a small role in decision-making around body
piercing. King and Vidourek (2007) found that while the majority of those who had
obtained a body piercing considered the risk of infection and scarring before obtaining
their most recent piercing (81% and 70%, respectively), less than half considered the
risk of allergic reaction and HIV infection. They found that only one in five participants
considered the risk of Hepatitis B and C and Tetanus. Huxley and Grogan (2005) found
that 39% of those with body piercings had not considered potential health risks before
The Problem - 3
the piercing procedure was performed. As possible complications of body piercing, 68%
of participants in the study identified infection, 10% identified contraction of infectious
diseases, and only 1% identified allergic reaction.
Body piercers played a key role in the risk of complications. Bruising, bleeding,
migration, nerve and tissue damage, and allergic reaction to jewelry were largely due to
the placement of the piercing and quality of jewelry selected by the body piercer. The
Health and Safety Executive (2003) noted there were two occasions when infections
could occur: at the time of obtaining the body piercing and during the healing period.
Infections during the former were due to poor infection control practices by the body
piercer. Infections during the latter were due to poor hygiene at and excessive touching
of the piercing site.
Several strategies have been recommended in the professional literature to
reduce the risk of health complications. These strategies have largely targeted three
groups: 1) the body piercing industry; 2) medical professionals such as doctors and
nurses; 3) community and university based health educators. At the time of this study,
no evaluations had been conducted to assess the efficacy of these strategies. The
recommendations were based on general medical knowledge and previous
recommendations and regulations enacted with tattooing. Body piercers, despite having
been the key figures in the body piercing industry, had not been involved in research.
The role of body piercers in reducing complications was important because most
people who had body piercings reported obtaining piercings from “professional” body
piercers (Deschesnes, Demers, & Finès, 2006; Huxley & Grogan, 2005; Laumann &
Derick, 2006). Also, body piercers were viewed as being among the top sources of
information about body piercings (Gold et al., 2005). Caliendo, Armstrong, and Roberts
(2005) found that when individuals with intimate body piercings had complications they
commonly sought advice from body piercers rather than from medical professionals.
The Problem - 4
Body piercers were also knowledgeable of additional procedures such as body
modifications. Body modification involves the voluntary modification in the appearance
of the body by piercing, cutting, tattooing, or inserting implants under the surface of the
skin. Such examples include tongue splitting, branding, scarification, and microdermal,
subdermal, and transdermal implants.
The Internet was a growing source of information and health information for
adolescents and college students (American College Health Association, 2006; Brown,
Teufel, & Burch, 2007). There were several Internet websites and on-line communities
related to body piercing and body modification. Web searches for body piercing
establishments result in hundreds of websites. Most body piercers who were members
of the Association of Professional Piercers (the leading professional association in this
field) had websites about their body piercing establishment and work.
Statement of the Problem
There are many issues pointing to a need for health promotion and education
around body piercing, including: 1) the growing popularity and relative frequency of body
piercing; 2) the substantial risk of complications from body piercing; 3) the lack of
consideration of risk when obtaining a body piercing. The field of health promotion and
education is lacking a core set of information from which to develop educational
materials and programs. Previous researchers have identified the prevalence of piercing
and complications and medical professionals are able to identify key risks for infection.
Researchers in health information have identified the internet as a common source of
health information for the public. To date, no research has been published about
information available on-line about body modification and its associated risks.
The purpose of this study was to investigate the information available on
websites of body piercing establishments. The present study examined websites to
identify the information provided about studio cleanliness, safety precautions, potential
The Problem - 5
complications from body piercings, the body piercers‟ professional experience and
affiliations, aftercare, recommended resources on body modification, and procedures
available. The study also examined the extent to which these topics were covered in the
websites posted by body piercing establishments.
Research Questions
The research questions of the study are:
1. What information do body piercing establishments post on their websites about
the cleanliness of the body piercing establishment, the safety precautions used
during the piercing process at the establishment, potential complications of body
piercings, and the professional experience and/or affiliations of the body piercers
employed at the establishment?
2. To what extent do body piercing establishments post information on their
websites about the cleanliness of the body piercing establishment, the safety
precautions used during the piercing process at the establishment, potential
complications of body piercings, and the professional experience and/or
affiliations of the body piercers employed at the establishment?
3. What information do body piercing establishments post on their websites about
aftercare?
4. To what extent do body piercing establishments post information on their website
about aftercare?
5. What resources do body piercing establishments recommend for information on
body modification, as noted on their websites?
6. What body modification procedures are available at body piercing establishments
according to their websites?
The Problem - 6
Delimitations
This study was delimited to websites posted by professional body piercers who were
affiliated with the Association of Professional Piercers (APP) and whose websites
were listed as US-based and linked through the “Find an APP Piercer” search page
on the APP website at the time of the study.
Limitations
The study was limited by the researcher‟s ability to navigate all pages of the websites.
Assumptions
The study was based on the assumption that researcher thoroughly searched and
corrected recorded information from each website examined.
Operational Definitions
1. Aftercare – the set of procedures used to maximize a body modification‟s
chances of healing without health complications, including but not limited to: how
to clean the modification; what to clean it with; how often to clean it.
2. Body piercing – any opening in the surface of the skin made to place jewelry in.
For the purposes of this study, this includes all body piercings performed by the
participants, including soft-lobe piercings.
3. Body piercing establishment – a location where body piercings are performed by
body piercer(s) for profit.
4. Body modification – voluntary modification in the appearance of the skin of the
body by piercing, cutting, tattooing, or inserting implants under the surface.
5. Body modification procedures – any procedure performed in order to intentionally
modify the appearance of the skin by piercing, cutting, tattooing, or inserting
implants under the surface. For the purpose of this study, these are limited to
procedures performed by non-medical professionals at body piercing
establishments.
Chapter Two
Review of Literature
There are many issues pointing to a need for health promotion and education
around body piercing, including: 1) the growing popularity and relative frequency of body
piercing; 2) the substantial risk of complications from body piercing; 3) the lack of
consideration of risk when obtaining a body piercing. The field of health promotion and
education is lacking a core set of information from which to develop educational
materials and programs. Previous researchers have identified the prevalence of piercing
and complications and medical professionals are able to identify key risks for infection.
Researchers in health information have identified the internet as a common source of
health information for the public. To date, no research has been published about
information available on-line about body modification and its associated risks.
The purpose of this study was to investigate the information available on
websites of body piercing establishments. The present study examined websites to
identify the information provided about studio cleanliness, safety precautions, potential
complications from body piercings, the body piercers‟ professional experience and
affiliations, aftercare, recommended resources on body modification, and procedures
available. The study also examined the extent to which these topics were covered in the
websites posted by body piercing establishments.
Body Piercing in Cultural Context
Body piercing is a procedure which involves creating an opening in the surface of
the skin and placing jewelry in it. The procedure is usually quick and performed with no
anesthesia. Body piercing has been practiced in many cultures throughout known history,
including in the Aztec, Mayan, Egyptian, Greco-Roman, Persian and Babylonian empires
and tribes of Central Africa, the Middle East, and South America (Stewart, 2000; Stirn,
7
Literature Review - 8
2003). In more recent Western culture, the trend of ear piercing spread during the
sixteenth century from women in Spain to women in France and England. Similarly, a
trend of nipple piercing spread from Louis the XIV‟s France to England. In the late 1970s,
piercing was associated with the punk movement, starting in London and New York.
Body modification through tattooing and body piercing appears to have been present
throughout recorded and pre-historic cultures. In societies where body modification was
not socially acceptable, body piercing and tattooing practices went “underground” and
those with modifications chose easily covered locations.
From its modern emergence in the punk movement, body piercing has spread to
more mainstream popularity and acceptance, especially among adolescents. In modern
Western culture, many music and television celebrities popular with adolescents are
commonly shown with pierced navels, eyebrows, lips, and areas of the ears other than
the earlobe. Three-fourths of adolescents – both pierced and not pierced – reported
liking body piercings on others (Gold, Schorzman, Murray, Downs, & Tolentino, 2005).
Because of the role body piercing has begun to play in adolescent identity formation,
McGuinness (2006) argues that body art such as tattooing and piercing have recently
become an adolescent “rite of passage”. Personal aesthetics, self-expression, and
rebellion are commonly stated reasons for getting body piercings among adolescents
and college students (Deschesnes, Demers, & Finès, 2006; Gold et al., 2005; Greif,
Hewitt, & Armstrong, 1999).
Prevalence of Body Piercing
Laumann and Derrick (2006) conducted a national study on tattoos and body
piercings and found that 14% of the population has body piercings (defined as non-softlobe piercing) and an additional 9% had considered or planned on obtaining a future
body piercing. Reflecting body piercing as a growing trend among adolescents and
young adults, they found that while only 2% of those born before 1963 had ever had
Literature Review - 9
body piercing, 13% of those born between 1964 and 1974 had and 32% of those born
between 1975 and 1986 had. They also reported that 74% of those with body piercings
obtained their first before age 24. Laumann and Derrick provided the only known
population-based probability sample of body piercing among adults.
A few studies have examined at the prevalence of body piercing among US
university students. King and Vidourek found that 35% of students at a large state
university had ever had a body piercing (defined as non-soft-lobe piercing). Armstrong,
Roberts, Owen, and Koch (2004) found that 45% of students at a large state university
had ever had a body piercing (defined as non-soft-lobe piercing). Thirty-two percent of
students had a current body piercing. Mayers, Judelson, Moriarty, and Rundell (2002)
found that 51% of undergraduate students at Pace University in Pleasantville, NY, had
ever had a body piercing (defined as any piercing on men and non-soft-lobe piercing on
women). Of the 315 body piercings among the sample, 39 (12%) had been removed.
King and Vidourek, Armstrong, et al., and Mayers, et al. found that female participants
were significantly more likely to be pierced than male participants. Burger and Finkel
(2002) found that 24% of undergraduate students at a small Midwestern university had
ever had a body piercing (defined as non-soft-lobe piercing).
Several studies have examined the prevalence of body piercing among North
American adolescents. In their survey of 2,180 12-18 year old high school students in
Quebec, Canada, Deschesnes, et al. (2006) found that 27.3% of students reported
having a body piercing (defined as non-soft-lobe piercing). Forty four percent of girls
reported having a body piercing, compared to 10.6% of boys reported having one. Boys
were significantly more likely than girls to be pierced before age 12 (29.4% and 13.1%,
respectively). Roberts and colleagues (2004) reported on data collected in 1996 from a
nationally representative US survey of 13-18 year old high school students. They found
that 4.3% of students reported having a body piercing (defined as non-ear piercing), with
Literature Review - 10
girls more likely than boys to report having a body piercing (7.1% and 1.5%,
respectively). Roberts, et al. believe that the low percentages in 1996 compared to the
higher percentages reported in later studies demonstrated the growing popularity of
body piercing among adolescents.
Unlike the larger studies above, other research into adolescents and body
piercing have been conducted with smaller samples of specific adolescent groups. Gold
and colleagues (2005) surveyed 12-21 year old patients at an urban, hospital-based
adolescent clinic. They found that 43% of participants age 12-17 and 59% aged 18-21
reported having a body piercing (defined as any piercing for boys and non-soft-lobe
piercing for girls). In contrast to other studies, Gold, et al. found that girls were less likely
to be pierced than boys (46% and 54%, respectively). In a study of 12-22 year old
military beneficiaries who attended the Adolescent Clinic at the Naval Medical Center in
San Diego, CA, Caroll and colleagues (2002) found that 27% of participants reported
they had ever had a body piercing (defined as non-soft-lobe piercing) and 20% had a
body piercing at the time of the survey. Nine percent obtained their first piercing at or
before the age of ten, 11.9% while 11-13 years old, 33.6% while 14-16 years old, and
45.5% while they were 17 years old or older. Braithwaite, et al. (2001) surveyed
adolescent detainees age 11 to 18 and found that 69% reported having a body piercing
(defined as any piercing). Girls had more piercings on average than boys (3.6 and 2.0,
respectively). Carroll and Anderson (2002) surveyed 15 to 18 year old girls in a
nonresidential educational program for at-risk girls. Thirty-six-point-seven percent of
participants reported having a body piercing (defined as non-soft-lobe piercing).
Risks and Complications of Body Piercing
General complications. Body piercing can result in a variety of negative health
consequences for the individual who is pierced. These complications include: bruising
and bleeding at the piercing site; migration of jewelry, wherein during the healing
Literature Review - 11
process the jewelry is pushed closer to the surface of the skin, leaving a scar in the path
it takes; allergic reaction to jewelry, especially common with jewelry containing nickel;
nerve damage, caused by the needle damaging a nerve during the body piercing
procedure; scarring and formation of keloids (hypertrophic scarring); infection at the
piercing site; systemic infections, including staphylococcus and tetanus; infection with
bloodborne pathogens, including Hepatitis and HIV (Meltzer, 2005; Samantha, Tweeten,
& Rickman, 1998; Stirn, 2003).
Armstrong (2005) noted the importance of body piercers being trained and
educated regarding the prevention of piercing complications. Many of the potential
complications are largely due to the placement of the piercing, quality of jewelry selected
by the body piercer, and cleanliness of procedure.
The piercer or piercing establishment also play a key role in the development of
infection. The Health and Safety Executive (2003) noted that there are two occasions
where infection can occur, the first of which is under the control of the piercer. Infection
can occur at the time of piercing due to poor hygiene in terms of disinfection of
equipment disinfection between customers, poor surface cleaning, used and clean
instruments coming into contact with one another, poor piercer hygiene, and poor state
of cleanliness of the premises. The second occasion where infection can occur is during
aftercare of the new piercing, which is under the control of the pierced individual.
Infection can occur during aftercare due to poor hygiene/cleaning of the piercing site and
excessive touching of the piercing site and/or jewelry.
Whether due to conditions during the piercing procedure or due to individuals‟
compliance with aftercare procedures, certain piercings carry specific risks. Armstrong
(2006), Meltzer (2005), Stirn (2003), and Stewart (2000) provided detailed lists or charts
of site-specific complications. Their findings have been combined and summarized in
Table 1.
Literature Review - 12
Table 1.1
Site-Specific Complications of Body Piercings
Piercing Site
Potential Complications
Ear
Pseudomonas chondritis; nonmenstrual toxic shock syndrome;
keloid formation; embedded earrings; traumatic tear
Tongue
High risk of infection due to prevalence of bacteria; obstruction of
airway due to aspirated jewelry; dental abrasions and fractures;
gingival trauma; increased salivation; damaged cheek tissue;
permanent numbness; loss of taste; speech impediments
Nose
Jewelry swallowing or aspiration; perichondritis and necrosis of
nasal wall; septal hematoma formation
Navel
Discoloration, persistent discharge, and increased risk of infection
and keloids due to friction from clothing
Nipples
Inflammation, infection, and abscess of milk ducts
(granulomatous/nonpeuperal mastitis); infection of breast implants;
breastfeeding impairment
Male Genitals
Prostatitis; testicular infection; paraphimosis; priapism; urethral
damage; increased risk of contracting STIs
Female Genitals
Strictures; fibrosis; nerve damage to clitoris; increased risk of
contracting STIs
Note: The above complications have been cited in the following research articles: Armstrong
(2006); Meltzer (2005); Stirn (2003); and Stewart (2000).
Literature Review - 13
Prevalence of complications. The bulk of literature found in literature searches on
body piercing in MedLine, CINAHL, and Academic Search Premier involved case studies
of individuals with acute health complications that resulted from or involved a body
piercing. A survey reported in BBC News (2002) found that 95% of general practitioners
in two northern England cities had treated patients with a complication resulting from a
piercing. Several studies examined the prevalence of complications in samples of
individuals with body piercings.
In their national data set on US body piercing, Laumann and Derick (2006) found
that 23% of participants with body piercings reported complications. Four percent of
respondents experienced medical problems due to the piercing during the first three
weeks after obtaining it while 3% experienced problems that started during the first three
weeks and continued beyond three weeks. Fifteen percent experienced medical
problems due to the piercing later than three weeks after obtaining the piercing. Navel
piercings were reported as the most problematic of all reported body piercings. Twentythree percent of those who reported having a tongue piercing reported chipped or
broken teeth due to the piercing. Huxley and Grogan‟s (2005) research echoed the
complication rates reported by Laumann and Derick. They found that 19% of participants
with body piercings had experienced health problems associated with the piercing.
Studies researching the prevalence and medical complications of body piercing
and tattoos in undergraduate university students have reported similar results as the
general population studies reported above. King and Vidourek (2007) found that 18% of
participants reported complications with their most recent body piercing. According to
Mayers et al., (2002), the reported incidence of medical complications was 17% among
students with body piercings. Nine percent reported bacterial infection of the piercing
site, 4.5% reported bleeding, and 3% reported suffering local trauma.
Literature Review - 14
Gold et al. (2005) also found similar rates of medical complications of body
piercing among urban adolescents. Twelve percent of participants with body piercings
reported complications. More specifically 10% experienced an infection at the piercing
site, 2% experienced bleeding, and 1% experienced an allergic reaction. Thirty-three
percent of all participants, both pierced and non-pierced, reported knowing someone
who had had a medical or health problem related to body piercing. The most commonly
reported complications were infections (74%), bleeding (30%), and allergic reactions
(26%). One participant reported knowing someone who experienced tetanus as a result
of a body piercing.
Two studies in university students reported much higher rates of complications
than the four studies above. Armstrong and colleagues (2004) found that 69% of
students with body piercings reported complications, including skin irritation (42%),
infection at the piercing site (23%), and allergic reaction to the jewelry (3%). Greif and
colleagues (1999) found that 70% of students with body piercings experienced health
problems associated with their piercing, including infections at the piercing site (45%),
skin irritation (39%), and hepatitis (0.5%).
Perception of Risk. Two sets of researchers found that despite the potential
complications of body piercings, the risk of complications played only a small role in
decision-making around body piercing.
In their research with college students at a large state university, King and
Vidourek (2007) found that college students varied in their considerations of both
obtaining body piercings and risks associated with body piercings. Before obtaining their
last piercing, 31% of participants spent less than one week considering the piercing,
41% spent one to four weeks, and 41% spent greater than four weeks. King and
Vidourek found gender differences in consideration of complications. Females were
more likely than males to consider the risks of infection (85% vs. 59%), scarring (75% vs.
Literature Review - 15
45%), and allergic reaction (47% vs. 23%). Males were more likely than females to
consider the risks of HIV infection (38% vs. 29%) and tuberculosis (13% vs. 9%). A small
and relatively equal percentage of males and females considered the risks of Hepatitis B
(19% and 21%, respectively), Hepatitis C (23% and 20%), and tetanus (19% and 21%).
According to Huxley and Grogan (2005), 39% percent of participants with body
piercings reported that they had not considered potential health risks before the piercing
procedure was performed. While 68% of participants with body piercings identified
“infection” as a possible complication of body piercing, only 10% identified contraction of
infectious diseases and 1% identified allergic reaction as potential complications.
Location of the body piercing establishment (28%) was the most influential factor
affecting choice of body piercing professional, followed by recommendation (19%) and
reputation of the professional (14%). Cleanliness of establishment was not cited by any
participants in an open-ended questions as a as a factor influencing choice of piercing
professional.
Recommendations to Decrease Complications
Several articles comment on strategies to reduce the risk of health complications
from body piercing. These can be divided into recommendations for industry regulations,
medical professionals, and health education.
A few articles call for regulation and standardization of the body piercing industry
as a strategy to reduce complications. Griffith and Tengnah (2005) called for regulating
piercing premises for infection control, proper disposal of waste products, and strict
enforcement of age and consent laws. Armstrong (2005) advocated for the same as well
as for a system of documentation of complications from piercing for public and consumer
health reasons. Stirn (2003) argues that health authorities and piercers need to establish
uniform and obligatory regulations in the areas of training and education, as well as
hygiene enforcement.
Literature Review - 16
Open, non-judgmental communication from physicians and nurses is the most
recommended strategy for medical professionals (Gold, et al., 2005; McGuinness, 2006;
Schnirring, 2003; Stirn, 2003). Stirn (2003) also argued that medical professionals need
to stay up-to-date with research in piercing prevalence and complications in order to be
able to competently and non-judgmentally give advice and treat complications. Gold, et
al. (2005) recommended such information be added to “the list of items addressed at
adolescent and preadolescent well visits.” McGuiness (2006) asserted that medical
professionals to discourage adolescents from self-piercing and that medical
professionals should draw on adolescents‟ concern about image and appearance when
discussing piercing and tattooing risks. Greif, et al. (1999) argue another strategy for
reducing complications from body piercing: they call on medical professionals to
investigate, be knowledgeable of, and advocate for tattooing and piercing legislation and
regulation.
Many of the suggestions for medical professionals lie in the area of health
education. Several articles address the need for general health promotion and education
performed by health educators as opposed to (or along with) medical professionals.
Deschesnes, et al. (2006) argued that “health education measures aimed at adolescents
need to be put in place in order to prevent undesired consequences” in those seeking
body piercings. These researchers also stated that health education measures need to
be non-judgmental and based in scientific knowledge. Such measures need to educate
about potential complications and “precautions that should be taken in order to make an
informed and safe decision.” Greif, et al. (1999) called for health promotion materials
aimed at potential body piercing clients distributed by piercers in conjunction with schoolbased health education that provides “a balanced appraisal of the risks of the
procedures.” They also recommend using websites to educate about the possible
dangers of piercings. Braithwaite, et al. (2001) recommended that health education
Literature Review - 17
about body piercing should be combined with other HIV and substance use risk
reduction messages.
The Association of Professional Piercers (APP) was formed in 1994 (APP, 2007).
It initially began as a political action group and grew into a self-described international
health and safety organization. The organization is “a united group of piercing
professionals which freely share information to help fellow members, piercers,
healthcare professionals, health inspectors, and the public to get the best and most upto-date information about body piercing” (APP, 2007).
The APP has many tactics to improve the professionalism of the industry and to
promote public health. To become a member of the organization, a body piercer and the
establishment in which they work has to uphold a stringent set of safety and hygiene
standards (APP, 2007). The APP standards are equal to or more stringent than state
and local standards. If met, these safety and hygiene standards minimize risk of
transmission of bloodborne pathogens and infection caused by the body piercing
procedure. The APP also provides education support and conferences where body
piercers can improve their technique. Improved technique can in turn minimize
complications from the piercing procedure such as bruising, bleeding, and nerve
damage.
The APP also provides information through its website and members about safe
piercing practices. This information encourages piercing-seeking individuals to make
healthy decisions and choose clean piercing establishments. The APP provides a
pamphlet that gives detailed instructions on how to assess a body piercer and their
establishment in terms of safety and cleanliness (APP, 2004). This pamphlet also gives
points of information about aftercare. They also have developed a “Piercee‟s Bill of
Rights” which empowers piercing-seeking individuals to demand safe and clean piercing
practices (APP, no date). These items are the only professionally produced health
Literature Review - 18
education materials found to date. They are available for purchase by any individual or
organization, not just APP members. The APP does not provide details on the materials‟
effectiveness or any research into their effectiveness.
Role of Body Piercers
The majority of people who have had body piercings report obtaining them from a
piercer they identify as a professional and/or in a piercing establishment. In their national
data set, Laumann and Derick (2006) found that 68% of those who reported they had
ever had a body piercing obtained them only in a professional parlor or shop (19.4% had
self-pierced at least one piercing; 12.5% had been pierced by someone outside of a
professional parlor or shop). Ninety percent of participants in another study reported
obtaining their body piercing from a professional (Huxley & Grogan, 2005). Similarly,
89.9% of high school students in Quebec reported obtaining their first body piercing from
a professional body piercer (Deschesnes, et al., 2006).
Along with being the leading source of body piercings, body piercers are a
common source of information. Three-fourths of urban adolescents endorsed
professional body piercing shops as a top source of information about body piercings
(Gold et al., 2005). Caliendo, Armstrong, and Roberts (2005) reported that when
participants with intimate body piercings had complications they commonly sought nonmedical advice from a body piercer.
As mentioned above, body piercers control one of the major risk areas for
infectious complications with body piercing (Health and Safety Executive, 2003). Their
compliance with sterile procedures and establishment hygiene is crucial to the
minimization of the spread of infectious diseases. Their selection of quality jewelry and
accurate placement of the piercing is crucial to minimization of allergic reaction, scarring,
and jewelry rejection.
Literature Review - 19
Emerging Body Modification Procedures
From the main page of the popular body modification website BMEzine.com,
many procedures can be found that are performed by body modification artists that go
beyond the traditional definition of body piercing. These procedures include using dermal
punches, scalpels, and a variety of jewelry that vary from the traditional hoops or
barbells used in body piercing.
Literature searches through CINAHL, MedLine, and Alt-HealthWatch returned no
articles that discuss the procedure, risks, or prevalence of the below body modifications.
Because there is no professional literature on the procedures, the procedural details
below come from the BME Encyclopedia on BMEzine.com.
Stretching. Stretching is a procedure that increases the diameter of a body
piercing (BME Encyclopedia, 2006f). The procedure is typically done repeatedly over
time and started after the initial healing of the body piercing. The procedure is done
through several methods. Some of these include: using a tapered probe to rapidly
stretch the diameter of the body piercing and immediate placement of jewelry that fits the
desired diameter; wearing heavy jewelry in the piercing which gradually stretched the
diameter by the constant pull of its weight; periodically wrapping one to several layers of
tape around the jewelry currently being worn (typically with Teflon tape).
This procedure can be done in nearly every body piercing site. Though the
procedure can be done on any body piercing, the BMEzine.com site most frequently
features stretching in soft-tissue lobes, the area between the lower lip and chin, nostrils,
and nipples.
Punch and taper. This procedure was developed to increase the chance of
viability of body piercings on flat surfaces of the body, such as the chest, stomach, wrists,
or back (BME Encyclopedia, 2006c). It is performed using dermal punches and a
tapered or blunt probe. The dermal punches are used to create openings perpendicular
Literature Review - 20
to the skin‟s surface and the probe is used to separate the dermis from the connective
tissue below it. The openings and the path made between them with the probe are made
to fit the jewelry that is to be placed in the tissue.
Scalpelled piercings. Body piercings are scalpelled for two primary reasons (BME
Encyclopedia, 2006d). An initial body piercing can be scalpelled in order to
accommodate large jewelry in the body piercing site. For example, a tongue piercing can
be done with a scalpel to create an opening that was 6 millimeters or larger. Also, a
scalpel can be used on a pre-existing body piercing site to rapidly enlarge the opening.
Commonly, this is done in sites where the individual was already stretching the diameter
of the body piercing to accommodate larger jewelry.
Tongue splitting. According to the BME Encyclopedia (2006i), tongue splitting is
“the central bifurcation of the tongue, so as to achieve a „forked tongue.‟” The procedure
can be performed in several ways, including: a laser surgery procedure performed by an
oral surgeon; tying a tight loop with sutures or dental floss from a fully healed tongue
piercing to the tip of the tongue parallel to the split along the center of the tongue and
taking several weeks to complete; scalpelling along the center of the tongue, the
resulting cut may be left to heal as is, cauterized, or sutured.
Frenectomies. Two locations where connective tissue were removed, usually by
scalpel, were the tongue frenum and the penile frenum (BME Encyclopedia, 2006a; BME
Encyclopedia, 2006h).
Microdermal implant. Microdermal implants are also called surface anchors or
dermal anchors (BME Encyclopedia, 2006b). They are “a flat plate which [sat] beneath
the skin with a single exit for a barbell post giving the visual effect of jewelry (a bead,
spike, etc.) that appears to be screwed right into the body”. The procedure to implant a
microdermal implant involves creating an opening with a needle or dermal punch then
Literature Review - 21
separating the dermis from the connective tissue below it. The jewelry is placed in the
opening created by the separation process.
Transdermal implant. Transdermal, or percutaneous, implants are deeply-placed
jewelry that is intended to be permanent. BME Encyclopedia (2006j) describes the
procedure to obtain a transdermal implant:
“1. The location where the transdermal passes through the skin is marked,
as well as an incision point (usually an inch or two away).
“2. The incision is opened with a scalpel and a dermal elevator (often a
septum elevator) is used to create a pocket to slide in the implant.
“3. Using a dermal punch or scalpel, and using the elevator as a backing
(so underlying tissue isn't damaged), the hole that the implant will pass
through is made.
“4. Through the first incision, the base of the transdermal is slid in, until its
post passes through the hole. If the implant is two parts, the top half is
screwed on.
“5. The initial incision is closed with sutures or suture tape.” (BME
Encyclopedia, 2006j)
Subdermal implant. Subdermal implants involve the placement of threedimensional objects under the dermis (BME Encyclopedia, 2006g). Subdermal implants
are usually made of Teflon or silicone, but any biocompatible material (including implantgrade steel, titanium, high-karat gold, and nylon) can be used. To place the implant, an
incision is made with a scalpel and the dermis is separated from the connective tissue
below with a dermal separator. The implant is placed in the space created between the
dermis and connective tissue and the initial incision is sutured.
Intentional scarification. Intentional scarification involves using a variety of
methods to break the surface of the skin in attempt to apply scars in a controlled manner
(BME Encyclopedia, 2006e). Procedures involve such methods as: branding with a
heated object in the shape of the desired design (“strike branding”); cutting the outline of
Literature Review - 22
the design with a scalpel and removing the skin between the outlines (“skin removal
scarification”); using electro-surgical units to pass a high-frequency current through the
skin to cauterize the desired skin surface (“electrosurgery branding” or “Hyfrecator
branding”); using a tattoo gun with no ink to create detailed scars (“tattoo gun
scarification” or “etching”); using the rotating abrasive tip of a dremel to grind away
layers of skin (“dremel scarification” or “abrasive scarification”)
Internet as a Source of Health Information
In their research on early adolescent health literacy, Brown, Teufel, and Birch
(2007) found that nearly 10% of boys and 7% of girls reported that they had learned the
most about health from the internet over school, parents, nurses, or other sources. The
older the participant, the more likely they were to use internet for information: 8% of 9year-old participants, 15% of 11-year-olds, and 19% of 13-year-olds reported they would
first turn to the internet if they had an important question about health. Participants‟
confidence in the quality of information increased with age, as well.
The American College Health Association (2006) found that 70% of college
students had obtained health information through the internet. The prevalence of the
internet as a health information source was second only to parents (73%). However, only
22% of participants reported that the health information on the internet was “believable.”
Gaps in the Literature
While key sources for infection were developed by the Health and Safety
Executive (2003) and seem to be generally accepted, and while research has been
conducted into reported rates of body piercing and reported rates of complications as
reported by individuals who had been pierced, there are considerable gaps in knowledge
around body piercing and body modification in general.
The recommendations reported in the last section were made based on general
medical knowledge and previous recommendations and regulations enacted with
Literature Review - 23
tattooing. No research was found on the effectiveness of these recommendations for
body piercing nor was any research found on specific health promotion or education
measures taken within the medical community or general public.
The transition of this knowledge into health promotion and education materials or
programs for the general public was not found. Nor had any health promotion and
education materials or programs about body piercing been reported or evaluated.
Griffith and Tengnah (2005) mentioned body modification performed by body
piercers that have not been studied in terms of prevalence or complications, which
included branding, tongue splitting, genital beading, and cutting/scarification. The
website BMEzine.com (2006), which focuses on body piercing, tattooing, implants,
scarification, suspension, and other forms of body modification, shows emerging trends
in the areas of body surface piercing (piercing on flat portions of skin with a specific style
of jewelry) and microdermals (or “single-point piercings”). The health risks and health
education needs of these have yet to be studied.
Despite the multiple roles of body piercers as professionals who perform and
give information about body piercings, research about or involving the participation of
professional piercers has not been found. Research into body piercing to this point has
been limited to those who have obtained piercings.
Summary
Body piercing has a long history and growing popularity in modern Western
culture. Body piercing is particularly popular among adolescents and college students.
One-quarter to one-half of college students have ever had a body piercing. Nearly onethird of the US population age 21-32 has ever had a body piercing.
Body piercings carry a variety of potential health complications. There is some
variation by body piercing site, but all body piercings carry the risk of bruising, bleeding,
tissue trauma, keloid formation, allergic reaction to jewelry, bacterial infection, and
Literature Review - 24
transmission of infectious agents. Reports of health complications vary widely in the
research from 12% among urban adolescents to 70% in undergraduate university
students. Nationwide, the prevalence of reported complications is 23%. Despite the risk
of potential health complications, only 61% of those who obtained body piercings
considered the risks before the piercing procedure was performed and cleanliness of the
establishment did not weigh in their choice of piercing professional.
Researchers have proposed a variety of methods to reduce the rate of
complications with body piercings. These recommendations span the fields of industry
regulation, medical professionals interacting with pierced and pre-pierced individuals,
and health education. No research has been done in assessing the effectiveness of
these recommendations.
In general, there is a lack of published research regarding body piercing. Most
published research addresses prevalence, association of body art with high-risk
behavior, and health complications of body piercing. Despite their roles as providers of
body piercings and information about body piercing, no research has been published
that involves the participation of body piercers. Research on body modification published
thus far has been limited to the areas of tattooing and body piercing.
The growing popularity of body piercing combined with the substantial risk of
complications from body piercing and the lack of consideration of risk when obtaining a
body piercing points to a growing need for research that would be useful to health
education regarding body piercing.
Chapter Three
Methods
There are many issues pointing to a need for health promotion and education
around body piercing, including: 1) the growing popularity and relative frequency of body
piercing; 2) the substantial risk of complications from body piercing; 3) the lack of
consideration of risk when obtaining a body piercing. The field of health promotion and
education is lacking a core set of information from which to develop educational
materials and programs. Previous researchers have identified the prevalence of piercing
and complications and medical professionals are able to identify key risks for infection.
Researchers in health information have identified the internet as a common source of
health information for the public. To date, no research has been published about
information available on-line about body modification and its associated risks.
The purpose of this study was to investigate the information available on
websites of body piercing establishments. The present study examined websites to
identify the information provided about studio cleanliness, safety precautions, potential
complications from body piercings, the body piercers‟ professional experience and
affiliations, aftercare, recommended resources on body modification, and procedures
available. The study also examined the extent to which these topics were covered in the
websites posted by body piercing establishments.
Units of Analysis
The units of analysis were websites posted by body piercing establishments.
These websites were limited to the 75 websites of US-based piercing establishments
linked at the time through the Association of Professional Piercers‟ (APP) “Locate an
APP Piercer” search page on the APP homepage (APP, 2008). Websites of individuals
and piercing establishments associated with the APP were chosen due to the role the
APP plays in the field of body piercing.
25
Methods - 26
The APP is an international nonprofit professional organization with almost 240
members in seven countries. It requires standards of personal experience and
environmental care for membership, including cleanliness standards, business licensure,
CPR certification, first aid certification, and bloodborne pathogens training. The APP
hosts the annual APP Conference, attended by members and non-members for
professional networking and skill-building workshops. It also publishes the quarterly
industry journal The Point and multiple health education brochures, as well as a
procedural manual of body piercing techniques.
Instrumentation
A body piercing website rating form was developed based on the research
questions, information from the literature, and feedback from a panel of experts. The
form, titled “Body modification content rating form,” can be found in Appendix A. The
form contains fifteen areas that were assessed for each website. The first seven areas
were background information on the body piercing establishment and website surveyed.
The remaining eight areas referred to specific components of the website and the
established research questions.
The six areas of background information recorded were: 1) establishment (name
of the establishment); 2) date of review (the date the website was reviewed by the
researcher); 3) website URL; 4) date of the most recent update to the website; 5) the city
and state in which the establishment is located; 6) the “hit count” of the website (a record
of how many times the site has been visited); establishment days & hours (time which
the establishment is open for business). This information was gathered for the purpose
of maintaining a clear record of sites surveyed so as not to repeatedly visit sites, to have
a record of when and from where the information was gathered, and – for the 4th, 6th, and
7th questions – general interest of the researcher.
Methods - 27
The eight areas that addressed the research questions were: 1) information on
cleanliness (of the establishment); 2) information on safety precautions used during the
piercing process; 3) information on potential complications and adverse effects (of body
piercing procedures); 4) body piercer experience/affiliations; 5) information on aftercare;
6) recommendations for further information on body modifications; 7) procedures
available; 8) and other information of note. The information found on the websites was
recorded verbatim on the rating form.
Under seven of the eight main areas listed above, there were subcategories.
These subcategories were developed by review of literature, information posted on the
APP website, and feedback from the panel of experts. These were designed to help sort
information gathered from the websites.
Under the area “information on cleanliness,” there were five subcategories:
sterilization information; information on spore testing of sterilization equipment; surface
disinfection of piercing room; whether the establishment had any licenses for operation
(city, county, or state licensing); and “other” for information gathered that didn‟t fall in the
above categories. Under the area “information on safety precautions used during
piercing process,” there were four subcategories: piercing set-up technique; age and
consent policies; jewelry selection (process by which they selected jewelry and/or variety
of jewelry available in terms of sizes, materials used); and “other.” Under the area
“information on potential complications and adverse effects,” there were four
subcategories: information on potential complications that could arise during or due to
the piercing procedure; and information on potential complications that could arise after
the procedure; psycho-social effects; and “other.” Under the area “body piercer
experience/affiliations,” there were six subcategories for information on: the piercers‟
apprenticeships; the piercers‟ professional experience; professional organizations with
which the piercers were affiliated; any first aid and/or bloodborne pathogens certification
Methods - 28
the piercers had obtained; and “other.” Under the area “information on aftercare,” there
were four subcategories: general aftercare information provided; site-specific piercing
aftercare information (e.g. oral piercings, surface piercings, genital piercings);
information for follow-up with piercer (e.g. when/how to contact, follow-up visits needed);
and “other.” Under the area “recommendations for further information on body
modifications,” there were three subcategories: on-line resources (including any links to
outside organizations, other establishments, or on-line communities); print; and “other.”
Under the area “procedures available,” there were ten subcategories: body piercings;
stretching; surface piercings; dermal punch procedures; scalpelled procedures;
microdermals/dermal anchors; transdermal implants; subdermal implants; scarification;
and “other.” Information for this category was culled from the website through text, price
listings, photo portfolios, and other means, as information on some of the modifications
was not readily available or highly publicized given their rarity and questionable legality.
Face and content validity of the instrument were established by a panel of
experts that consisted of experts in the fields of health education research and the field
of body piercing. The panel included two associate professors from a large state
university, one of whom had previous research experience in the topic of body piercing.
The panel also included two professional body piercers. Both professional body piercers
had completed apprenticeships, maintained certificates in first aid and bloodborne
pathogens, were involved professionally in the field, and had over ten years of
professional body piercing experience each.
Procedures
Following the approval of the researcher‟s graduate thesis committee and
establishment of face and content validity of the instrument, the researcher completed a
content analysis of all websites of US-based piercing establishments that were linked at
Methods - 29
the time through the “Locate an APP Piercer” search page on the APP homepage. Each
website was searched by the researcher for the information sought in the instrument.
The researcher accessed each website through the “Locate an APP Piercer”
search page on the APP homepage. If the link was not operating, the researcher used
an on-line search engine to seek a current URL for the website using the name of the
establishment. The new website was verified by the stated city and state location of the
shop on the APP member list.
Once at the website of the body piercing establishment, the researcher
completed the rating form for that website. Only one form was completed for each
website regardless of how many links were provided to it from the APP page (for
example, in instances where multiple body piercers were affiliated with the APP from
one body piercing establishment that runs one website for the whole establishment). The
form was completed digitally, recording verbatim through copy-and-paste method what
was posted on the website.
The primary investigator recorded the name of the establishment, the date the
website was searched, and the URL of the website in the corresponding places on the
rating form. If the date of the most recent update to the website was available on the
website, this date was recorded in the appropriate place on the rating form. If the date of
the most recent update to the website or the hit count was not available on the website,
the comment “n/a” (for “not available”) was recorded in the appropriate place on the
rating form. If the location of the establishment was listed on the website, it was recorded
on the form by city and state. If there were multiple locations of the business, the
number of locations was recorded and all cities and states in which the locations were in
were recorded. If the location of the establishment was not listed on the website, the
location was recorded as listed on the APP website followed by a parenthetical note “not
posted on site.”
Methods - 30
The primary investigator read all text on the website and followed all provided
links. Text and links that contained information related to the research questions were
copied and pasted directly into the rating form. Information about the procedures
available at the piercing establishment were culled from posted lists of procedures
provided, price lists for procedures, and review of photographs posted in on-line copies
of body piercers‟ portfolios. If a procedure was demonstrated to be provided, the word
“yes” was placed after the name of the procedure on the rating form. If there was strong
evidence that a procedure had been provided but could not be confirmed, the word
“probably” was recorded after the name of the procedure on the rating form. For
example, large-sized piercings on ear cartilage were most commonly achieved through
using a dermal punch procedure, though the possibility that the piercing could have been
stretched could not be completely ruled out. Therefore, when such piercings were found
in the photo portfolio but no other evidence that the establishment was providing dermal
punch procedures could be found, the word “probably” was placed after the name of the
procedure on the rating form.
Information that might have been relevant to health education but that did not fall
under the areas developed for the research questions were copied and pasted into the
twelfth area of the instrument, “other information of note.”
After completing an instrument for a website, a copy was stored on the hard-drive
of a computer in a secure location. A back-up copy was stored in on an external
memory device also kept in a secure location. Also, a copy of the form was printed and
the print copy was stored in a secure location.
This research process was completed on a census of all websites of that were
stated to be US-based body piercing establishments linked through the “Find an APP
Piercer” search page.
Methods - 31
Data Analysis
Once a census survey of all body piercing establishments stated to be US-based
linked through the “Find an APP Piercer” search page was completed, the primary
investigator conducted a content analysis of all information gathered in the instrument.
The researcher reviewed all information found through the websites under each area of
the instrument and identified common themes found throughout. The researcher
recorded major themes and the frequency with which body piercing establishments
provided information about these themes. In so doing, frequencies and percentages
were computed to determine the extent to which certain types of information were
displayed on the websites. Descriptive statistics were used to answer research
questions. In addition, under each theme, the researcher used quotes from the websites
which served to reinforce the identified theme present.
The themes and frequency with which each theme was found in the websites
was recorded in chapter four of this thesis.
Chapter Four
Results and Discussion
There are many issues pointing to a need for health promotion and education
around body piercing, including: 1) the growing popularity and relative frequency of body
piercing; 2) the substantial risk of complications from body piercing; 3) the lack of
consideration of risk when obtaining a body piercing. The field of health promotion and
education is lacking a core set of information from which to develop educational
materials and programs. Previous researchers have identified the prevalence of piercing
and complications and medical professionals are able to identify key risks for infection.
Researchers in health information have identified the internet as a common source of
health information for the public. To date, no research has been published about
information available on-line about body modification and its associated risks.
The purpose of this study was to investigate the information available on
websites of body piercing establishments. The present study examined websites to
identify the information provided about studio cleanliness, safety precautions, potential
complications from body piercings, the body piercers‟ professional experience and
affiliations, aftercare, recommended resources on body modification, and procedures
available. The study also examined the extent to which these topics were covered in the
websites posted by body piercing establishments.
Units of Analysis
The units of analysis were 75 websites posted by body piercing establishments
that were linked as US-based establishments through the Association of Professional
Piercers‟ (APP) “Locate an APP Piercer” search page and were surveyed by the primary
investigator between 29 April, 2008, and 4 May, 2008. The websites were found through
their link on the “Locate an APP Piercer” page; any website whose link on that page did
not work was found using an on-line search engine with a search for the name of the
32
Results - 33
body piercing establishment given on the APP search page. The new website was in
turn verified by confirming the location and name of the body piercing establishment as
reported on the APP search page.
Body Piercing Establishment and Website Characteristics
Seventy-five websites were examined, representing 75 body piercing
establishments. The 75 establishments represented at least 99 locations offering body
piercing services. Sixty-one websites (81%) listed only one location for their
establishment. Eight websites (11%) listed two locations run by the body piercing
establishment, two (3%) listed three locations, and four (5%) listed four locations.
Of the 75 websites, two (3%) had no information available relevant to the study.
One of these two had only a main page with a message that the shop would be closed
during the APP conference. The other of these two had a main page for the
establishment and a link to information on piercing – the linked page contained only a
photo of the outside of the establishment.
Seventy-two websites (96%) reported the city and state of the locations run by
the body piercing establishment. The city and state of three establishments that did not
report their locations were obtained from information on the APP website. The 75 body
piercing establishments had locations in 29 states in the continental US. The west and
east coasts were well represented, as was the Midwest, the eastern portion of the south,
and the western portion of the west. The establishments had locations in 76 cities.
Of the 75 websites examined, nine (12%) had hit counters and six (8%) listed the
date of their most recent update. Hit counters varied widely in their hit counts and
reported recording hits in different ways. The lowest hit count was 1,038 visitors
recorded since February 2007. The highest was 572,740 hits, with no date given for
when the site began recording hits. Three websites (4%) reported the date from which
their hit counts began being recorded. One website reported that it recorded only unique
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visitors (i.e. multiple visits from the same computer would only count as one hit); all
others did not report whether they recorded only unique visitors or all hits to the website.
Given the wide variance in hit counts, the paucity of hit counters, and variety of methods
with which the hits could be recorded, no mean hit count was calculated. The least
recently updated site reported its latest update as 11 February, 2007. The most recently
updated site reported its latest update as 27 April, 2008, four days before it was
surveyed. All other updates occurred between 28 December, 2007, and 17 April, 2008.
Of the 75 websites examined, 55 (73%) listed information on the days and times
the locations were open. All 55 of these websites listed the days the establishment was
open and times the establishment opened; 53 (71%) listed the times the establishment
closed. In instances where one establishment had multiple locations, the days and
times of each location‟s hours of operation were recorded. For analysis purposes, the
earliest time one of their locations opened was recorded as the opening time of the
establishment and the latest time one of their locations closed was recorded as the
closing time of the establishment.
Of the 55 establishments that reported the days of the week they were in
operation, all 55 (100%) were open for business on Wednesdays, Thursdays, and
Fridays. Fifty-four (99%) were open on Saturdays and 53 (98%) on Tuesdays. Forty-six
(84%) were in full operation and one was open “by appointment only” on Mondays.
Forty-two (76%) were in full operation and one was open “by appointment only” on
Sundays.
Most establishments (67-76%) opened at noon on the days they were open.
Closing times varied widely. The first table in Appendix C lists the opening and closing
times of establishments.
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Information on Cleanliness and Safety Precautions
Of the 73 websites that provided information relevant to the study, 59 (80%)
provided information on the hygiene procedures, sterilization procedures or tools,
licensing, health and safety related policies, or jewelry used in the piercing process.
Main themes found are summarized in Table 4.1
Hygiene during body piercing. Forty-one of the websites (56%) examined posted
information about hygiene of the piercing area and/or process. Nine (12%) provided
specific language stating that the establishment met and/or exceeded the minimum
safety standards of the APP.
Fifteen establishments (21%) described that the body piercer(s) at the
establishment followed universal precautions to prevent the transmission of disease.
Words such as “universal precautions,” “aseptic technique,” and “sterile technique” were
used. Three websites (4%) provided articles about sterilization and infection control,
including one article written in 1998 that adapted CDC infection control guidelines for
use in the body piercing industry. Five websites (7%) posted detailed explanations of
the sterilization room and process by which they sterilized and maintained sterility of
instruments used in the body piercing process. One website included a photo-and-text
slide show that went through the entire piercing process, emphasizing aseptic technique
throughout. Another posted the steps staff members followed for all cleaning
procedures, including the cleaning of new jewelry and changing of the sharps container
that holds used needles.
Twenty-five websites (34%) used specific language stating that they exclusively
use single-use needles. Most went on to describe that after the needle was used on a
client it was immediately disposed of in a sharps container and that the client would see
this procedure. Although single-use needles came pre-sterilized, six of the 25 websites
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stated that they sterilized the single-use needles in the establishment before they were
used on a client.
Twenty-three websites (32%) used specific language stating that that all nondisposable equipment used in the body piercing process was sterilized between every
use. Only some of these specified that jewelry was part of the equipment used in the
process. Fifteen websites (21%) specifically stated that the body jewelry used in the
body piercing process was sterilized at the establishment before use. Others may have
meant to imply that jewelry was part of the equipment used and thereby implicitly stated
that it was sterilized before use in the body piercing process. Two websites (3%) stated
that everything they used in the body piercing process was single-use. Though
everything was single-use, the websites stated that they sterilized the equipment at the
establishment before use. They also disposed of everything in front of the client.
Eleven websites (15%) described that the equipment being sterilized was
sterilized in pouches made for the sterilization process. Of these, four described using
integrator strips in the sterilization pouches. A piercing establishment in Pasadena, CA,
described the strips:
These are small strips that are foiled in the back. On the front, is a small shiny
line that has a pass or fail section posted and a button on the right side that holds
chemicals within… After the sterilization cycle is complete, the integrator shiny
line that started out white in color is now a Grey [sic] or a black color. If the line
is Grey all the way through, then everything is definitely sterilized properly.
Because the integrator strip and the button of chemicals measure the amount of
steam, heat, pressure, and time released in the cycle, the chemicals will not be
pushed along the white line into the pass area if anything is remotely wrong with
the cycle.
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Table 4.1
Information on Hygiene, Cleanliness, Safety Precautions
Posted Information
N
%
Hygiene of the body piercing area and/or process
41
56
Policies regarding piercing minors
35
48
Use only APP-approved materials in initial body piercings
31
42
Participate in spore testing of sterilization equipment
28
38
Exclusively use single-use needles
25
34
Kind of sterilization equipment used at establishment
24
33
All non-disposable equipment sterilized between each use
23
32
Provide information on styles of jewelry used in initial body piercings
23
32
Require valid photo ID before performing body piercings
20
27
Body jewelry sterilized before use
15
21
Body piercer(s) followed universal precautions
15
21
Disinfectant process of body piercing room/area
13
18
Participate in governmental or business licensure
12
16
Equipment sterilized in sterilization pouches
11
15
Body piercer(s) wore gloves throughout process
11
15
Do not pierce individuals under influence of alcohol, drugs
6
8
N = 73 websites
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Two of these establishments posted that their staff initialed and dated the integrator
strips before putting them in the sterilization pouch. The other two posted that the client
initials the strips before putting them in the sterilization pouch, which was sterilized while
the client waited and then the client confirmed their initials before the body piercing
process began.
Eleven websites (15%) stated that the body piercers wore gloves throughout the
entire body piercing process, with eight (11%) stating that the gloves were frequently
changed throughout the process. Two (3%) specifically stated that they offer latex-free
options – one (1%) stating that the entire establishment used no latex and the other
stating that non-latex gloves were used upon request.
Thirteen websites (18%) described the disinfectant process they used in the body
piercing room. All of these, at a minimum, cleaned all surfaces of the room related to the
body piercing process between every client with a disinfectant.
Sterilization equipment. Twenty-eight websites (38%) posted information about
the sterilization equipment they use and/or how frequently they test the equipment for
effectiveness. Twenty-four websites (33%) posted what kind of sterilization equipment
they use at their establishment(s). Twenty-one (29%) reported having an autoclave
steam sterilizer. According to a body-piercing establishment in Concord, CA, “autoclaves
achieve sterilization through the use of intense steam-heat and pressure over an
extended period of time.”
Eight websites (11%) posted that they have a Statim sterilizer. Five of these
eight have a Statim along with an autoclave; three have only a Statim. A body piercing
establishment with locations in Pasadena and West Hollywood, CA, described the
typical use of the statim:
Before every piercing we gather all of the materials used in the procedure
(including new needles, jewelry, gauze, and cotton swabs, etc.) and we run them
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though… the Statim2000 by Scican [which] allows us to sterilize while you wait.
Using vacuum pulse technology, the Statim2000 runs a full sterilization cycle in
only 6 minutes.
While the statim does not use sterilization pouches, two establishments described using
integrator strips, which the client initialed before the sterilization process was started.
Six establishments (6%) described using an ultrasonic cleaner in conjunction with
the autoclave sterilizer. A body piercing establishment with locations in Pasadena and
West Hollywood, CA, explained that an ultrasonic machine works by “creat[ing] tiny
implosions on the tool‟s surface by sending sound waves through an ultrasonic cleaning
liquid. These implosions help remove any surface contaminants before the tools move
on to the next step in the sterilization process.” In all of the establishments that stated
they use an ultrasonic cleaner, the next step after completion of the ultrasonic process is
being rinsed, dried, then placed in a sterilization pouch and being autoclaved.
Spore testing is a process by which sterilization equipment is tested for its
effectiveness. A body piercing establishment in Concord, CA, described the process:
Spore testing (biological sterilizer monitoring) works on the scientific theory that if
the sterilization equipment kills the viable non-pathogenic microorganisms
contained on each test strip, then it is capable of killing the weaker, yet
dangerous blood borne pathogens, such as human immunodeficiency virus (HIV)
and hepatitis B (HBV), that may be present on the instrumentation being
sterilized. The spores used, Geobacillus, stearothermophilus and Bacillus
atrophaeus, are harmless to humans, however they are difficult to kill via
sterilization.
Such bacteria are present on a test strip which is sent to the body piercing establishment
by the company that runs their spore tests. The strip is included in a normal sterilization
cycle, and then mailed to the company, who then tries to culture bacteria from the test
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strip. If no bacteria are found to be present, the sterilization equipment is deemed to be
in effective working order. The company sends results to the body piercing
establishment that they can keep for their records or post in the establishment.
Twenty-eight establishments (38%) posted specific language describing their
participation in spore testing of their sterilization equipment. Thirteen (46%) reported
they have their equipment spore tested on a weekly basis. Two (7%) reported that they
have their equipment spore tested two times per month and one reported that they do so
every two weeks. Six (21%) reported that they have their equipment spore tested once
a month. Seven others (25%) reported that they participate in spore testing but did not
give the frequency with which their equipment was spore tested. Eight (11%)
establishments gave the name (or had scanned results sheets with the name) of the
company that performs their spore testing. Three reported using North Bay Bioscience,
two reported using a university program, and three reported using other private
companies.
Licensure. Twelve establishments (16%) posted information about participation in
governmental or business licensure. Seven websites (10%) stated that they are certified
or licensed to operate through their state health department. Two stated they are
certified or licensed through their county board of health and one through its city‟s
Environmental Health Department. Three were members of their local Better Business
Bureau and one of these belonged to its local Chamber of Commerce.
Age policies. Thirty-five establishments (48%) posted information about their
policies regarding providing body piercings to minors. Four establishments (5%) stated
that they do not provide any body piercings to minors. Thirty-one establishments (42%)
stated that they provide some body piercing services to minors. All 31 of these detailed
their policies for parental consent. A typical example of a policy, from a body piercing
establishment in New York City, follows:
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Without exception, a parent or legal guardian must be present with a minor to
sign our release form.
Each party must have a valid photo ID. Acceptable photo ID must include
one of the following: a driver‟s license, passport, state-issued identification card
or military ID. A valid school photo ID and birth certificate with state seal is
acceptable for minors younger than driving age. Photocopies of any ID are not
acceptable.
If the parent‟s last name and/or address is different from the minors, there
must be legal documentation to prove the relationship (birth certificate, divorce
papers, adoption papers, marriage certificate).
Court papers were required to prove a relationship with a legal guardian.
Two establishments (3%) required a parent or guardian to bring a birth certificate along
with their and the minor‟s valid identification. One establishment (1%) required both
parents to be present and provide valid identification for themselves and the minor (in
cases of divorce or death of a parent, legal documentation of the situation was required).
Several websites also stated that legally emancipated minors must bring valid photo ID
and original court documents demonstrating the emancipation.
Of the thirty establishments who stated they provide services to minors, five
(17%) specified that they will only provide services to those age 16 and older. Of the
thirty establishments, sixteen (53%) specified which body piercings they would provide.
Most specified that they would not provide body piercings below the neck with exception
of the navel, regardless of parental consent. Many also specified they would not provide
surface piercings on minors regardless of parental consent, and several specified they
would not provide earlobe piercings larger than 10gauge.
Identification policies. Twenty body piercing establishments (27%) stated on
their website that individuals seeking a body piercing must present valid photo ID in
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order to obtain a body piercing. Two (3%) specified that individuals must present a valid
photo ID every time they seek to obtain a body piercing, regardless of whether they‟ve
previously obtained body piercings at that establishment. Valid ID was typically defined
as non-expired driver‟s license, state-issued ID, passport, or military ID.
Other policies. There were six policies or requests of clients not described above
that were listed by two or more establishments on their website. Six body piercing
establishments (8%) stated that clients must not be under the influence of drugs or
alcohol at the time they are seeking to obtain a body piercing. Four establishments (5%)
posted policies about the presence of children in the piercing area. One stated no
children were allowed in the piercing area, one forbade children under 16 years, one
forbade children under 14 years, and one forbade children under 12 years. Two
establishments (3%) stated that they reserve the right to refuse services at any time.
Six establishments (8%) requested that clients eat several hours prior to
obtaining the body piercing. Four establishments (5%) requested that clients avoid
blood-thinners, such as aspirin, for up to 24 hours before obtaining a body piercing.
Three establishments (4%) requested that clients do not come if they are feeling ill.
Jewelry used in initial body piercings. Thirty-eight body piercing establishments
(52%) posted information about the jewelry they use in initial body piercings.
Thirty-one establishments (42%) provided information on their websites
demonstrating they only use jewelry made of implant grade quality materials in initial
body piercings1.
Body jewelry used in most initial body piercings involves either ends being
threaded onto a post or a bead being held in place by tension from a metal ring. In this
context, 23 websites (32%) provided information about the type of jewelry they use.
1
The APP lists the following materials as ones that are appropriate for initial piercings:
implant grade stainless steel and titanium, gold (14K or higher), platinum, Tygon, and
PTFE (Teflon) (APP, 2004).
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Regarding body jewelry that involves ends being threaded onto a post, 23 websites
(32%) stated that they only use internally threaded body jewelry in their establishment(s).
A body piercing establishment located in Boise, ID, explained their choice:
Internally threaded means that the bar is the “female” (no visible threads) and the
bead is the “male” (a threaded post extending from the bead). The bead threads
INTO the bar.
Externally threaded is the opposite. The bar has visible threads at the
end and threads into the bead.
Each time you take an externally threaded piece of jewelry in and out of
your piercing you are “dragging” those threads through your piercing… External
threads may tear new tissue (leading to scarring), trap bacteria, and release
polishing compounds into the piercing.
Two-thirds of the websites that stated that they exclusively use internally threaded body
jewelry explained a similar rationale. Many also addressed the issue that externally
threaded body jewelry usually costs less than internally threaded and stated that
externally threaded body jewelry is usually made of metals that don‟t meet APP
standards for materials.
Regarding body jewelry where a bead is held in place by tension from a metal
ring, three websites stated that they only use body jewelry with rounded ends on the
ends of the metal ring that hold the bead in place. A body piercing establishment
located in Atlanta, GA, explained their choice, using photos of three different types of
rings:
This first ring [has non-rounded ends of the ring] and the ball does not fit
appropriately. Notice the large gap between the ball and ring. If the gap in this
type of ring were to shift into a piercing the ends can pinch or otherwise cause
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discomfort to the wearer. The large gap will harbor dead skin and bacteria,
increasing infection risk.
This second ring has slightly less gap then [sic] the one above, although
collection of dead skin and bacteria would still be evident…
[In] this captive ring [with rounded ends]… the ball and ring fit smoothly
without significant gaps. The ring is round and the ends smooth and uniform…
This has proven an ideal piece for long term wear in a healed piercing.
Seven websites (10%) explained what “polish” is in terms of body jewelry and
described the standard to which they adhere. A body piercing establishment with
locations in three cities in Oregon stated “the finish of high quality jewelry should have a
mirror-like sheen and be free of nicks, scratches, and polishing compounds.” Other
establishments explained that nicks and scratches could irritate a body piercing and
impede the healing of an initial body piercing. Polishing compounds could irritate a body
piercing and introduce harmful chemicals into the wearer‟s body.
Three websites (4%) contained extensive text on body jewelry, covering technical
information on the materials and processes with which body jewelry is made and/or how
to fit body jewelry appropriately.
Information about Body Piercers
Fifty-four websites (74%) posted information about the body piercers who worked
at their establishment or other staff who worked in areas related to body piercing at their
establishment (for example, an apprentice to the body piercer or a counterperson in the
body piercing area). Three biographies (or “bios”) that did not contain information
related to the individuals‟ work experience or training were not recorded. Pages about
an individual that contained no text but had scanned photos of pertinent certificates (for
example, training completed, certifications, APP conference attendance) were recorded.
In total, biographies of 117 body piercers were recorded. Information from these
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biographies included early professional development, health related training and
certification, continuing education, years of experience, and affiliation with the APP,
which is summarized in Table 4.2.
Early professional development. Nine of the individuals (7%) described early
experimentation with body piercing. This included non-professional piercing of self and
friends, typically during adolescence. Thirty-three individuals (28%) referenced
participating in an apprenticeship. Apprenticeship was described as industry-specific
training of a few months to several years under a professional body piercer. Five of the
33 individuals who referenced participating in an apprenticeship were still participating in
their apprenticeship.
Twenty individuals (17%) attended trainings from one or more training
establishments that taught basic to advanced body piercing and body modification skills.
Nine of these individuals (45%) attended training at The Gauntlet, a former training
establishment that was well-known in the early 1990s for its groundbreaking work in
body piercing and body modification. Eight (40%) attended trainings led by Fakir
Musafar, the “father of the modern primitives movement.” Seven (35%) attended
trainings at Professional Piercing Information Systems, a company which provides
courses on body piercing and body modification technique as well as bloodborne
pathogens and disease transmission prevention trainings.
Seven individuals (6%) referenced previous or current experience as a
counterperson at a body piercing establishment, five of whom were still currently working
the counter and were in their apprenticing process.
Health related training and certification. Fifty-seven individuals (49%) referenced
having received or maintaining current certification in bloodborne pathogens. Fifty
individuals (43%) referenced having received or maintaining current certification in CPR.
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Table 4.2
Information on Body Piercers
Posted Information
N
%
Referenced membership in APP
103
88
Provided information on years of experience
75
64
Have received and/or maintain current certification in bloodborne pathogens
57
49
Have received and/or maintain current certification in CPR
50
43
Have received and/or maintain current certification in first aid
49
42
Attend APP conferences
37
32
Participated in an apprenticeship
33
28
Attended trainings taught at industry-specific education centers
20
17
Still participating in an apprenticeship
5
4
N = 117
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Forty-nine individuals (42%) referenced having received or maintaining current
certification in first aid. Six individuals (5%) referenced receiving training from Health
Educators, Inc., a company that specialized in body modification industry-specific
bloodborne pathogens, disease transmission prevention, and wound maintenance and
healing training.
Continuing education. Thirty-seven individuals (32%) referenced attending APP
conferences. Many of these included scans or written details of the seminars and
trainings they attended while at the conferences.
Thirteen individuals (11%) referenced having or working towards post-secondary
degrees. Two of the body piercers were registered nurses and one was currently
pursuing her nursing degree. One was a licensed EMT. Three body piercers had
master degrees, one in Somatic and Cultural Studies, one in Medical Anthropology, and
one in Fine Arts.
Years of experience. Seventy-five individuals (64%) included information on their
years of experience in the field of body piercing. Years of experience were calculated
from when the individual began performing body piercings in a professional or semiprofessional environment or when they began a body piercing apprenticeship. The
years of experience reported are summarized in Table 4.3. The mean years worked
was 9.64 years. Over half (42, 56%) of those who listed their years of experience had
worked ten years or longer. Two individuals not included in calculations because their
exact length of time piercing was not available also stated that they had been working as
body piercers “since the early „90s.” All individuals who reported three years of
experience or less also reported that they were still in an apprenticeship.
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Table 4.3
Years of Experience Reported in Body
Piercer On-Line Biographies
Years
No.
%
1 year
5
4
2 years
2
2
3 years
1
1
4 years
2
2
5 years
3
3
6 years
3
3
7 years
6
5
8 years
4
3
9 years
5
4
10 years
6
5
11 years
6
5
12 years
8
7
13 years
7
6
14 years
5
4
15 years
6
5
16 years
2
2
17 years
1
1
20 years
1
1
“Since the early 1990s”
2
2
N = 117
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Reported affiliation with the Association of Professional Piercers. Fourteen of the
websites that offered bios of the body piercing staff (26%) did not reference
membership in or affiliation with the APP in the staff member‟s bio or on the page of the
bio, though two of these sites (4%) did include a reference to attending APP conferences.
Forty of the websites (74%) included reference to membership in or affiliation with the
APP in the member‟s bio or on the page of the bio. Five of these 40 (13%) provided
explanations of what the APP is and does. Three additional websites whose bio
information did not fulfill the analytical requirements to be recorded above offered
information about the body piercing staff being members of the APP, two of which
included explanations of what the APP is and does.
Information about Potential Complications and Adverse Effects
Thirty-four websites (47%) provided information about complications related to
body piercings. Information was categorized into complications that can occur during
the body piercing procedure, ones that can occur after the procedure, and psycho-social
complications. The general themes found are summarized in Table 4.4.
Potential complications and adverse effects during the procedure. Thirteen
websites (18%) provided information on complications that can occur during the
procedure. With all but one of these – pain during the body piercing procedure – the
websites described the potential complication and described how the risk for it was
minimized at their establishment.
Nine establishments (12%) described the many complications that can result
from the use of a piercing gun during the body piercing process. With varying degrees
of detail, all nine discussed the issues described in the excerpt below, which is from the
website of a Columbus, OH, based body piercing establishment. The text was a reply to
the “frequently asked question” of “Do you perform any piercings with a piercing gun?”:
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Table 4.4
Information on Potential Complications and Adverse Effects
Posted Information
N
%
Potential post-procedural complications of body piercings
30
41
Occurring during the body piercing procedure
13
18
Risk of contracting bloodborne pathogens
9
12
Potential complications resulting from use of a piercing gun
9
12
Breast-feeding and nipple piercings
6
8
Pain during the body piercing process
5
7
Anesthetics for body piercing process
3
4
Potential psychosocial complications
2
3
N = 73
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There are several reasons why we do not use ear piercing guns for any type of
piercing.
First, there is no way to sterilize piercing guns. Most guns are made of
plastic and will melt under the extreme heat and pressure of an autoclave… and
chemical sterilization has not been proven to kill all blood borne pathogens; this
is extremely dangerous since fluid microspray (microscopic particles of tissue,
blood and other body fluids) might be present on the gun after a piercing.
Second, guns are considerably more painful than a piercing needle
because guns use the blunt end of the jewelry to do the piercing – actually
tearing the skin, traumatizing the area, and complicating healing.
Third, since both the instrument and the jewelry were designed for
earlobes, they are not compatible with other areas of the body, increasing the
risk of infection and further complicating the healing process.
Fourth, standard piercing gun studs are usually made of a poor quality
metal that can cause additional complications.
Lastly, the jewelry is poorly designed in that the backing traps and
collects waste, hair, and debris, holding it against or close to the piercing. This is
far from an ideal healing environment.
One website (1%) addressed the use of single-use piercing guns, also advising against
them because of the pain and blunt trauma during the piercing process and the
complications of healing due to tissue trauma, poor quality metal, and poor jewelry
design.
The potential of the risk of contracting bloodborne diseases could be inferred
from more than half of the websites based on their explanations of the aseptic or sterile
process they use. Nine (12%) specifically and explicitly addressed the risk. In eight of
the nine cases, it was discussed in the context of how to choose a body piercing
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establishment (i.e. risk is greater if they don‟t use aseptic procedure). HIV and hepatitis
B were the most commonly referenced pathogens. One website stated that the risk of
contracting bloodborne diseases was increased if the body piercer and/or the individual
getting pierced were under the influence of drugs or alcohol.
Five websites (7%) addressed the issue of pain during the body piercing process.
All of the websites acknowledged and normalized pain as a potential adverse effect of
the body piercing process. In answering the “frequently asked question” of “Will my
piercing hurt?” a Saginaw, MI, based establishment posted, “most of the time you feel a
quick, sharp, poke, then a little throb aftwards. But it fully depends on you and how your
mental state is at the time. If you [sic] ready to accept your piercing you will be
accepting terms with yourself and your experience.” Two of the 5 websites that
addressed pain also addressed the use of anesthetics. A body piercing establishment
located in Minneapolis, MN, explained its policy:
We do not use, or suggest, anesthetics because injectable and topical
anesthetics can be deadly in the hands of someone who does not know how to
use them. Only properly licensed medical professionals can legally administer
injectable and topical anesthetics.
In addition, a properly performed piercing by a knowledgeable,
professional hurts far less than such an injection.
A Cambden Town, UK, based establishment with locations in San Francisco, CA, also
stated that the injection of anesthetics may be more painful than a properly performed
body piercing. This establishment gave two more reasons why they do not provide
anesthetics: “Creams and gels are not sterile and so may cross contaminate the area;
freezing sprays may cause frostbite encouraging blistering and sores.”
One website stated that the establishment would provide anesthetics, though it
did not discuss pain during the body piercing process. A body piercing establishment
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located in Blacksburg, VA, posted on its website “we use numbing medicine for all
clients at no extra charge.”
Three other potential complications or adverse reactions were described on one
website each. A Cambden Town, UK, based establishment with locations in San
Francisco, CA, stated that individuals with seafood allergies will likely have an allergic
reaction to iodine, which it stated is used in many skin preparations. The website stated
“if you have an allergy to seafood a different skin prep must be considered.” A body
piercing establishment located in East Lansing, MI, stated that it would not pierce the
navel of any individuals who have “had an apodectomy [sic] or tummy tuck surgery” due
to decreased blood flow to the body piercing site due to scar tissue from the surgery.
The same establishment also stated “not under any circumstance will we re-pierce any
previously pierced area of the body more than twice, even if the area is completely
healed,” again due to decreased blood flow to the body piercing site due to scar tissue.
Potential complications and adverse effects after the procedure. Thirty websites
(41%) described potential complications and adverse effects that could arise after the
body piercing process was completed. The potential complications and adverse effects
described on at least two websites are listed in Table 4.5 and discussed below.
Infection at the piercing site was the most commonly referenced potential
complication. A body piercing establishment located in Austin, TX, described the typical
list of symptoms: “redness and swelling; a sensation of heat at the piercing site; pain,
especially throbbing or spreading pain; unusual discharge; unusual smell from the
piercing site; fever accompanied by symptoms above.” Ten websites (14%) stated that
infections are usually the result of failure to adhere to aftercare instructions. In particular,
failure to keep unclean objects (for example, hands, telephones, linens) away from the
piercing site, exposing the site to body fluids, or submerging the piercing in standing
water were commonly cited potential causes of infection.
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Table 4.5
Potential Post-Procedural Complications and Adverse Effects and Frequency of Reporting
Potential complication/adverse effect posted on website
N
%
Infection of the piercing site
18
25
Scarring at the piercing site
12
16
Irritation at the piercing site
10
14
Migration/Rejection of body jewelry
10
14
Allergic reaction
8
11
Discolored tongue (with tongue piercing only)
8
11
Hypertrophic scarring (keloid)
5
7
Damage to teeth, gums (with oral piercings only)
5
7
Abscess
4
5
Follicular cysts
4
5
Constriction
2
3
N = 73
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Ten websites (14%) stated it was important to leave the body jewelry in place
while treating the infection. A body piercing establishment located in Denver, CO,
explained:
In the event that an infection is suspected, quality jewelry or an inert alternative
should be left in place to allow for drainage of the infection. Should the jewelry
be removed, the surface cells can close up sealing the infection inside the
piercing channel, resulting in an abscess.
Five websites (7%) also stated that clients concerned about a potential infection
should visit their body piercer and/or seek medical treatment. A body piercer would be
able to help them determine whether there was an infection or whether the piercing site
was irritated. Also, these stated that an increase in certain aftercare behavior, especially
warm salt water soaks or compresses, could help early infections clear up without
medical intervention.
Development of scar tissue at the piercing site was the second most commonly
cited post-procedural complication. Twelve websites (16%) addressed the issue of
scarring in two main contexts: development of large amounts of scar tissue (such as
with hypertrophic scarring); scars at the piercing site after the piercing has healed and
body jewelry is removed. For the former issue, the websites stated that development of
scar tissue is typically due to irritation, friction, infection, or poor jewelry placement. The
websites provided recommendations to minimize scarring from each of these sources:
body piercings that become irritated or experience a lot of friction needed to have the
source of irritation or friction resolved in order to minimize the development of scar tissue;
infection could be prevented by adhering to recommended aftercare behavior; poor
jewelry placement could be resolved by changing the jewelry to a more appropriate
piece of body jewelry or by removing the body jewelry, waiting for the wound to heal, and
having the body piercing redone. Healed body piercings from which the body jewelry
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was removed were likely to have a small amount of scar tissue at the exit points of the
body jewelry. The websites stated that the appearance of this scar tissue would
dissipate some over time and could be more quickly minimized by daily gentle tissue
massage. The twelve websites that addressed scarring acknowledged that scarring is a
likely potential adverse effect of body piercings and that individuals seeking body
piercings should be aware of and consider this before obtaining any body piercings.
Ten websites (14%) posted information about the potential complication of
irritation. A body piercing establishment located in Philadelphia, PA, explained irritation:
More often than not, what you think is an infection is really irritation, caused by
anything that puts pressure on the jewelry or holds it in an unnatural position. If
your piercing is red, swollen right around the hole, peeling, excreting white or
yellow fluid or blood, or appears to have a solid lump or bubble of discolored skin
around it, it is probably irritated. This is a sign that you are subjecting it to
excessive abuse.
Common causes are: wearing restrictive clothing over the piercing
(navels and nipples); sleeping on it (navels and ear cartilage); holding the phone
against it (ear lobes and cartilage); sex too soon (genitals); getting hit or pulled
on; or playing with it.
Other websites cited exposure to harsh cleaners, exposure to beauty or cleaning
products, overcleaning, and using too strong a salt water solution as possible causes of
irritation.
The course of action recommended by most to resolve irritation was seeking out
the source of the irritation and minimizing it. In cases of mechanical irritation, such as
described in the excerpt above, the source needed to be found and removed (e.g. not
wear certain articles of clothing, change sleeping position). In cases of chemical
irritation, the irritating chemical needed to be kept away from the body piercing site (e.g.
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change cleaners, use appropriate saline mixture, cover during shower or hairstyling to
protect against other products).
Migration or rejection of jewelry was listed as a potential complication by ten
websites (14%). According to a body piercing establishment located in North Olmstead,
OH:
Rejection is usually caused by „back pressure‟ often caused by using straight
bars, or simply the body refusing to accept the piercing. Rings can get knocked
around quite a bit and that irritation can also cause rejection. In fact, any piercing,
[if] it received enough trauma, can be rejected. Infection and allergy/sensitivity
are also types of irritation and can lead to rejection. Some piercing [sic] will
„migrate‟ to a more comfortable setting with being rejected.
Rejection can occur at any point in the life of a piercing – either during initial healing or
after being healed for several years. Once a piercing has begun migrating or rejecting, a
line of scar tissue would be left by the jewelry as it was slowly moving out of the original
piercing site. Two websites (3%) gave instructions to contact a body piercer to discuss
the situation if a body piercing began to migrate or reject.
Allergy or sensitivity to body jewelry and/or cleaning products was a potential
complication cited by ten websites (14%). A body piercing establishment located in
Philadelphia, PA, explained:
It is always possible for living bodies to react to foreign substances introduced
into them. Some people are extremely sensitive to certain jewelry materials or to
cleaning solutions. Allergic reactions often appear as rashes, excessive clear
fluid discharge, discharge, redness, itching, or the skin pulling away from the
jewelry. They usually show up immediately. When using implant grade body
jewelry and recommended cleaning solutions, they are rare.
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The websites that discussed allergic reaction recommended making sure to use high
quality, implant grade body jewelry to minimize risk of allergic reaction to jewelry. They
also stated that if a cleaning product was suspected as the source of allergic reaction,
cessation of use of the product was recommended.
Several websites noted that infections, irritation, and allergic reaction present
themselves in similar ways, making it difficult for many clients to know what they are
dealing with. These websites recommended that clients speak with a body piercer,
preferably in person, to discuss any abnormalities with their body piercing.
Three potential complications or adverse effects were provided about oral
piercings. Eight websites (11%) posted that individuals may experience a discolored
tongue, typically a white or off-white color. All eight stated that this is due to too
frequently cleaning the mouth with mouthwash; one also stated that using inappropriate
mouthwash can cause this as well. Five websites (7%) stated that oral piercings can
cause damage to the enamel of the teeth and to the gums. The websites stated the risk
of this can be minimized by not playing with the jewelry, wearing jewelry of appropriate
length, chewing food carefully so as to avoid biting the jewelry, and by being careful not
to catch lip piercing jewelry on the front teeth if opening the mouth widely. Eight
websites (11%) advised that clients who have high blood pressure should consult with
their physician about using salt water or saline solutions to rinse oral piercings.
Four websites (5%) discussed the potential complication of abscess. These
were all in the context of discussing infections. They recommend that risk for abscess
can be minimized by carefully and consistently adhering to given aftercare behavior and,
in the case of an infection, leaving high quality body jewelry in the piercing so as to allow
drainage of the infection. Medical treatment was advised.
Four websites (5%) discussed follicular cysts. A body piercing establishment
located in Vienna, WV, explained that follicular cysts “are an obstruction (usually a hair
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or skin cells) inside the piercing which causes fluid to become trapped, resulting in a fluid
filled bump.” Follicular cysts were described as being red, tender bump near the exit(s)
of a body piercing which may release a clear or yellowish liquid, which may contain a
small amount of blood. The websites recommended clients check that their jewelry is
properly fitted to prevent recurrences. Follicular cysts could be relieved through warm
sea salt soaks or gentle cleaning. One website recommended continued aftercare to
prevent recurrences.
Six websites (8%) addressed an apparently common concern over a potential
adverse effect of nipple piercings preventing or causing problems with nursing. All six
said that breastfeeding was still possible while or after having nipple piercings. “There
has not been a single documented case that we are aware of, where a woman who
wished to breastfeed could not as a result of having had a nipple piercing,” stated the
website of an establishment that has four locations in Indianapolis, IN. All six websites
stated that nipple piercings needed to be well healed before beginning breastfeeding.
Five of these six recommended removing the jewelry for feedings because they pose a
choking hazard for the nursing infant. These five websites also noted that some milk
may come through the openings of the nipple piercings.
Two websites (3%) addressed concerns around body piercings and pregnancy,
labor, and delivery. While several websites stated that women should not be pierced
during pregnancy or while trying to become pregnant, only two websites went into detail
about adverse effects of pregnancy and labor on body piercings. A body piercing
establishment located in Atlanta, GA, stated that “a small percentage of women find that
their piercings are rejected from the body [especially navel piercings]… Our clients and
friends have worn body jewelry through labor and delivery of all kinds over the last
decade.” A body piercing establishment located in Taylor, MI, provided the following
information about genital piercings and labor and delivery:
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Piercings which are in danger of tearing when the vaginal opening widens should
be removed. Horizontal hood piercings may stretch uncomfortably or tear with
the jewelry in place… Properly placed labia piercings should be able to stay in
throughout the pregnancy, labor, and delivery, but it‟s best to get professional
advice.
This establishment recommended discussing the issue with the doctor or midwife prior to
delivery. Both body piercing establishments stated they can help clients in this situation
with the removal and replacement of jewelry.
Two websites (3%) discussed the potential complication of constriction, which
occurs when the jewelry has too small a diameter, is too thick in gauge, or where the
piercing was placed inappropriately by the body piercer who provided the body piercing.
According to a body piercing establishment in Eureka, CA, “a darkening of the skin
between the entrances [of the body jewelry] indicates that the piercing is constricted by
the jewelry.” Constriction can typically be resolved through changing to more
appropriate body jewelry.
Potential psychosocial complications and adverse effects. Only two potential
psychosocial complications or adverse effects were described on the websites examined.
A body piercing establishment located in Saginaw, MI, addressed individuals
seeking heavier body modifications, including dermal punch, ear scalpelling, scarification,
tongue splits, and genital subdermal implants: “Plan on [these modifications] being
permanent, leaving marks for life, and, can be problematic, so ask and find out all you
can. Fully understand and accept what you are about to get into.” They strongly
suggested individuals seeking heavier modifications speak with individuals who have
already received these modifications in order to get a full perspective on the effects of
body modifications.
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A body piercing establishment located in Philadelphia, PA, addressed individuals
seeking facial piercings:
If you‟re considering a facial piercing, you‟ve obviously decided to go public with
your perforated identity. Because however small your jewelry, there‟s just no
hiding a facial piercing during the first few months of healing.… This section is for
those who are ready to be visibly marked. And whose jobs and/or parents don‟t
mind…
While most facial piercings heal very quickly and easily, an infection or
scarring in the middle of your face can be rather unsightly. So get the
information ahead of time, and think before you act. And don‟t underestimate
how much one piece of jewelry can change others‟ perceptions of you. Having
facial piercings puts you on the frontlines of the public‟s reaction to body piercing.
Whether it counts for or against you, your business is on the table. Just consider
what doors you are opening or closing with the one little ring.
The establishment recommended that individuals seeking facial piercings should
consider how the desired piercing will affect their physical and social lifestyle before
obtaining the piercing.
Information on Aftercare
Forty-five websites (62%) posted information about aftercare, generally describing it as
behavior that will help the body piercing heal. Five websites (7%) specified that
aftercare is not meant in and of itself to heal or treat a wound, but to keep the piercing
clean to allow ideal conditions for the body to heal itself. Aftercare information is divided
into what to expect during healing, general aftercare, salt water/saline soaks, cleaning,
oral piercing aftercare, and genital piercing aftercare. The general themes found are
summarized on Table 4.6.
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Table 4.6
Information on Aftercare
Posted Information
N
%
General aftercare guidelines for body piercings
45
62
Aftercare guidelines for oral piercings
31
42
Salt water/saline soaks
29
40
Adverse effects of body piercing to anticipate in healing process
24
33
Cleaning with soap
23
32
Aftercare guidelines for genital piercings
16
22
N = 73
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What to expect during normal healing. Twenty-four websites (33%) provided
information about what adverse effects of body piercing are normal during the healing
process.
Twenty-three (32%) discussed “crusties” – whitish/yellow fluid secreted from the
piercing that tends to dry around the ends of the body jewelry and at the openings of the
body piercing. According to a Columbus, OH, based body piercing establishment,
crusties include “blood plasma, lymph, and dead cells.” They stated “this is not pus, but
indicates a healing piercing.”
Seventeen websites (23%) stated that discoloration – redness around the
openings of the body piercing lasting a few days to a few weeks and/or bruising – was
normal. Fifteen websites (21%) stated that swelling of the piercing site lasting a few
hours to a few days was normal. They provided guidelines in their aftercare for dealing
with swelling. Fourteen websites (19%) stated that a small amount of bleeding from the
openings of the body piercing for a few hours to a few days was normal. Fourteen
websites (19%) stated that tenderness at and around the body piercing site lasting a few
hours to a few days was normal. Fourteen (19%) stated that itching and/or tightening of
tissue around the body piercing was normal, typically not starting until a few days after
the body piercing was obtained. Five websites (7%) described that a healed piercing
may develop an accumulation of malodorous white secretions (similar to smegma) if not
cleaned regularly.
General aftercare. Forty-five websites (62%) provided information about general
aftercare of body piercings. A tenth of these (n=7, 11%) reposted or provided links to
the current APP body piercing aftercare guidelines as their only aftercare information.
One website posted links to APP aftercare along with its own aftercare guidelines. While
most of the guidelines from the APP would match the general guidelines described
below, the number of websites who linked/reposted the APP guidelines is not counted in
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the numbers provided for how many websites promote a specific behavior because the
websites did not post original material. Guidelines that were posted on two or more
websites are recorded in the second table of Appendix C.
Seven websites (10%) used specific language stating they provide aftercare
information at the time of obtaining a body piercing, generally before the body piercing is
performed and in oral and written forms.
Touching of the body piercing with unclean hands, submersion in standing water,
contact with body fluids, and exposure to dirty objects were cited as leading cause of
infections. All of these behaviors potentially introduced foreign bacteria into the piercing.
The use of alcohol-based cleaning products (rubbing alcohol, witch hazel),
hydrogen peroxide, antibiotic ointments/creams, and wound care/surgical scrub (iodine,
Betadine, Hibiclens) were strongly discouraged. To a lesser extent, use of “ear care”
solutions was discouraged. The excerpt below, from the website of a body piercing
establishment located in Philadelphia, PA, describes the commonly given reasons for
this:
Alcohol is far too harsh. It irritates and dries out the skin and can delay
healing…and may not be as effective on germs (when used topically) as
previously thought.
Peroxide does kill many bacteria, but it also destroys the healthy skin
around the piercing. Used long enough, it can eat away at the skin and actually
keep your piercing from healing.
Antibiotic ointments [such as] Neosporin, Bacitracin and triple antibiotic
ointments… have large amounts of petroleum jelly in them, which keeps oxygen
out of the piercing and creates the perfect warm moist environment for bacteria
to breed. The greasy barrier also keeps water and cleaning solutions from
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effectively reaching your piercing, making it impossible to clean. Read the label:
“Do not use on puncture wounds.”
Betadine/Hibiclens… may be used for first aid or surgical wound care, but
for long term care they are actually too strong and may delay healing. Betadine
may be useful to clear up an infection, but when used too often it can actually kill
healthy skin cells…
[Ear care solution] has proven to be problematic for many people. It is
not as effective a cleanser as antimicrobial soaps and does not penetrate or
remove oil and discharge in the piercing. Most [ear care] products have a very
short shelf life of a month or less… It seems some manufacturers may be using
formulas which are not compatible with human tissue…
For these reasons, most establishments advised against using the products
listed above and instead advised using the aftercare guidelines for salt water/saline
soaks and cleaning with soap.
Contrary to popular belief about the need to rotate ear piercings, body piercing
establishments specifically recommended not moving body jewelry. These
establishments stated movement of body jewelry can irritate the body piercing, cause
crusted discharge to tear tissue, and introduce foreign bacteria into the body piercing.
These behaviors generally encourage the development of scar tissue, increase the risk
of infection, and delay the healing process.
Changing or temporarily removing body jewelry was discouraged for the same
reasons. Also, websites that recommended leaving jewelry in place at all times noted
that, upon the removal of jewelry, both new and well-healed body piercings could tighten
up in minutes, making reinsertion of the body jewelry difficult or impossible. If jewelry
was removed and reinsertion becomes difficult, use of a taper by a body piercer might
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be required in order to put the body jewelry back in place. This process was described
as generally non-problematic, but can cause irritation to the body piercing.
Websites recommended that any behavior that moved the body jewelry from its
initial placement and/or subjected it to repeated motion should be avoided in order to
minimize irritation. This included avoiding sleeping on the piercing, wearing restrictive
clothing, or using restrictive bandages. The websites stated that by minimizing irritation
in these ways, one also minimized risk of migration or rejection of the body jewelry.
Thirteen websites (18%) provided estimated healing times for a variety of body
piercings. In giving these estimated healing times, nine of these websites stated that the
healing times are estimates only and that any individual may heal their body piercing in
more or less time than states. A body piercing establishment located in Philadelphia, PA,
gave a typical explanation of estimated healing times:
Below are approximate healing times for well-cared-for piercings for most people.
Keep in mind that your piercing may heal more quickly or take even longer.
Since most piercings have periods of both doing well and “acting up”, do not
assume that the disappearance of discharge means you are healed. Continue
suggested aftercare for at least the amount of time listed below for your piercing.
After this amount of time, if your piercing no long has discharge or “bad days”
and has not done so for at least a month, it may be healed. If you pay attention
to what your body is doing over time, you will know when it is done.
At the end of the healing time, cleaning twice daily is no longer required,
although cleaning once daily is still suggested. At this point, jewelry can safely
be changed, but should not be left out of any piercing. Even once the hole
becomes permanent, it can still shrink and make jewelry reinsertion more difficult.
Estimated healing times are listed in Table C4. As demonstrated in this table,
estimated healing times for varied somewhat by piercing and within each body piercing.
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For example, three establishments stated that nostril piercings have an estimated
healing time of two to three months and two establishments stated that nostril piercings
have an estimated healing time of six months to a year. Earlobe piercings, by contrast,
had a much closer range of estimated healing times – eight establishments said six to
eight weeks, two said two to three months. In general, genital piercings that did not go
through deep tissue and oral piercings had the shortest estimated healing times.
Surface piercings had the longest healing times.
After providing aftercare guidelines, seven websites included a disclaimer that
stated that the guidelines were not medical advice. Rather, the guidelines were general
advice for promoting healing and were based on professional experience and
observation.
One website also provided aftercare guidelines for brandings.
Salt water/saline soaks. Twenty-nine websites (40%) provided information about
using salt water/saline soaks as part of aftercare. Twenty-eight (97%) of these provided
general aftercare guidelines, as well.
Twenty-five of the 29 websites (86%) provided directions for making salt water
solutions. They all recommended using non-iodized salt, generally recommending sea
salt and occasionally recommending kosher salts. Twenty (27%) gave directions to mix a
quarter teaspoon of salt with eight ounces of water, preferably distilled or purified water.
Two gave instructions to mix an eighth of a teaspoon of salt with eight ounces of water.
Two gave a range of one-quarter to one-eighth of a teaspoon salt with eight ounces of
water. An outlier was a website that recommended a range of solutions, from one
teaspoon of salt per eight ounces of water to one teaspoon of salt per gallon of water.
Fifteen of the twenty-five (60%) specifically stated that stronger solutions were not better,
as they could irritate the body piercing.
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According to the website recommendations, the solution should be made with
warm to hot (“as hot as you can tolerate”) water. Once the solution was prepared, it was
applied to the body piercing. Ideally, the solution was in a cup which was placed over
the piercing (creating a seal with the rim of the cup) or the piercing was dipped into the
solution. Fifteen websites (60%) stated that if it was not possible to soak the piercing
directly in the solution, cotton balls, gauze pads, or paper towels could be soaked in the
solution and applied to the body piercing. If this method was used, it was recommended
that the balls/pads/towels be changed frequently.
Six websites (24%) recommended using a moistened q-tip to remove crusted
discharge from the body piercing site and the body jewelry just before or while soaking
the body piercing in the salt solution. Fourteen websites (56%) recommended rinsing the
area around the body piercing with clean water after completing the soak. Most of these
recommended drying the area with a clean paper towel or gauze pad.
Nineteen of the 25 (76%) gave a time frame for which to soak the piercing.
These varied widely from “a few minutes” to 20 minutes. Most (n=13, 68%)
recommended between five and fifteen minutes.
Twenty-four of the websites (96%) gave a frequency with which to perform salt
water soaks. These varied between four times per day to “a few times a week.” Thirteen
(52%) recommended between two and four times per day; twenty-three (92%)
recommended between one and four times per day.
Eleven of the websites (44%) discussed premixed saline solutions for use during
or between salt water soaks. There were two ways in which premixed solutions could be
used: saline could be purchased and used as described above for soaking the piercing;
and saline sprays or mists could be used to regularly irrigate the body piercing. Several
websites that discussed saline sprays or mists stated that these did not fully replace salt
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water soaks. Rather, they should be used in conjunction with a reduced amount of salt
water soaks.
Various reasons were cited for why to perform the soaks. Eight (32%) stated that
warm salt water soaks help soften and draw out discharge and impurities from the body
piercing. Eight (32%) stated that warm salt water soaks promote blood circulation at the
body piercing site. Six (24%) stated that salt water soaks sooth and prevent irritation of
the body piercing site. Five (20%) stated that salt water soaks promote air circulation at
the body piercing site.
Cleaning with soap. Twenty-three websites (32%) provided information on
cleaning a body piercing with soap as a part of the aftercare process. All of these had
provided general aftercare guidelines as well as the soap cleaning guidelines.
Seventeen of these websites (53%) specifically recommended anti-microbial
and/or anti-bacterial soap, typically the brands Provon or Satin. These are gentle antimicrobial soaps that are free of dyes and perfumes. Two websites (9%) specified
avoiding soaps containing the antibiotic triclosan. Eight websites (35%) recommended
“natural” and “cruelty-free” soaps, such as Dr. Bronner‟s or castille. Only one of these
eight advocated the exclusive use of natural soaps. One website, of a body piercing
establishment located in Colorado, did not recommend soap citing of the specific climate
of the state.
Thirteen websites (57%) posted that the cleaning should be performed in the
shower. Six of these recommended cleaning at the end of the shower so as to remove
and prevent later exposure to any cleaning products used in normal showering (e.g.
shampoo, body soap). Fourteen websites (61%) stated that the individual should wash
their hands with anti-microbial soap before performing the cleaning. Twelve (52%)
recommended soaking (e.g. salt water soak) or rinsing (e.g. in the shower) the area of
the body piercing before cleaning to soften and/or remove crusted discharge.
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Eighteen websites (78%) stated that the individual should create a lather with
soap and apply it to the area of the body piercing and exposed body jewelry. Seven
(30%) specified to not apply lather to the inside of the piercing. Seven (30%) specified
to apply lather to the inside of the piercing by rotating the body jewelry through the
piercing (two of these specified to not rotate lather into the body piercing the first seven
to ten days after obtaining the body piercing and one specified not to rotate lather into
the body piercing during the first several cleanings).
After the lather sat on and/or in the piercing for thirty seconds to two minutes, the
individual should rinse all of the soap off of and/or out of the body piercing. Nine
websites (39%) specified that the individual may rotate the body jewelry through the
piercing during rinsing in order to ensure all soap is rinsed off (one advised to be careful
of irritation, though). Two of the websites that specified that the body jewelry should not
be rotated during the lathering process also specified that the body jewelry should not be
rotated during rinsing. Ten websites (43%) stated that the piercing should be dried with
disposable paper towels or clean gauze to avoid exposure to bacteria and chemical
residues which may be present in reusable cloth towels.
Fifteen websites (65%) gave a frequency with which to perform the cleaning. Six
(26%) stated to clean the body piercing with soap two times per day; five (22%) stated to
clean one time per day; four (17%) stated to clean one to two times per day. Fourteen
(61%) stated that it was important to not “over-clean” the body piercing (clean with soap
too frequently) because doing so may irritate the body piercing.
Oral piercing aftercare. Thirty-one websites (42%) posted information on oral
piercing aftercare, three of which simply reposted or linked to the APP oral piercing
aftercare guidelines. Guidelines that were posted on two or more websites are recorded
in Table C3.
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Accompanying most oral piercing aftercare guidelines was commentary that
individuals may experience similar adverse effects as with any body piercing: swelling,
slight bleeding, tenderness, and bruising. In oral piercings the typical white-yellow
discharge made during the healing process is in a moist environment, so it does not
“crust” inside the mouth.
The primary recommended aftercare behavior is regular cleaning through rinsing
the mouth. Twenty-seven of the websites (87%) specifically recommended using
alcohol-free mouthwashes such as the brands Biotene or Tech2000; five of these
recommended diluting the alcohol-free mouthwash. Alcohol-based mouthwashes were
to be avoided because alcohol was too harsh a cleaning product and could cause
irritation and drying, thus impeding the healing process. Twenty websites (65%)
recommended using salt water/saline rinses. The salt water/saline solution was to be
made using the instructions given for general salt water/saline solution used in body
piercing aftercare – generally ¼ teaspoon to eight ounces of water. Three websites
(10%) stated that alcohol-based mouthwashes diluted with preferably distilled water
could be used. Diluted alcohol-based mouthwashes were recommended in the context
of an individual not being able to access or use alcohol-free mouthwash.
There were varied recommendations for frequency of rinsing and with which
products to rinse. Twenty websites (65%) recommended rinsing after eating, drinking
anything other than water, or smoking. Fifteen of these recommended rinsing with
alcohol-free mouthwash; three recommended salt water/saline solution; two
recommended distilled or purified water. Six of the websites that recommended rinsing
with alcohol-free mouthwash after eating, drinking, or smoking stated that individuals
should not rinse with alcohol-free mouthwash more than four to five times per day to
avoid irritating or drying the oral piercing. Two of these six websites as well as four other
websites recommended that post-eating/drinking/smoking mouthwash rinses should be
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accompanied with twice daily sea salt/saline rinses. Two other websites recommended
that post-eating/drinking/smoking mouthwash rinses should be accompanied by three to
five times daily sea salt/saline rinses. One website that recommended posteating/drinking/smoking salt water/saline rinses and one website that didn‟t
recommended these rinses both recommended twice daily mouthwash rinses.
Maintenance of general oral hygiene through regular brushing was discussed by
fifteen websites (48%). Six websites (19%) reminded individuals to brush their teeth two
to three times per day. One website recommended brushing teeth after eating or
drinking any fluids other than water in conjunction with a mouthwash rinse. Three
websites recommending regular brushing as well as six other websites (total of nine
websites, 29%) recommended gently brushing the jewelry. This helped remove plaque
build-up that could cause irritation and increase risk of infection of the oral piercing.
Three websites (10%) recommended avoiding potential irritation caused by toothpaste –
two of these recommended avoiding toothpaste with baking soda or peroxide and one of
these recommended avoiding toothpaste altogether by brushing with water only.
Many of the aftercare guidelines were recommended in order to prevent
introduction of foreign bacteria to the oral piercing. This was intended to reduce risk of
infection. Behaviors that were recommended because they prevented introduction of
foreign bacteria included: avoiding oral contact with body fluids by avoiding tongue
kissing, oral sex, or sharing eating/drinking utensils; using a new toothbrush or cleaning
the old toothbrush in a dishwasher; avoiding introducing unclean objects into the mouth,
such as fingers, pen caps, and glasses; regularly cleaning the mouth through rinsing and
brushing.
Many of the aftercare guidelines were recommended in order to prevent irritation
of the oral piercing. Irritation was stated to delay healing and increase risk of infection
and development of scar tissue. Behaviors that were recommended because they may
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prevent irritation included: using alcohol-free mouthwash; avoiding spicy, salty, acidic,
and/or hot food and beverages during initial days of healing; avoiding excessive talking
during initial days of healing; avoiding playing with jewelry; avoiding chewing gum;
avoiding sucking and straws; gently brushing jewelry as part of brushing process;
avoiding toothpaste with baking soda or peroxide.
Three of the recommended aftercare behaviors were recommended in order to
avoid damage to teeth or gums. Five of the twenty websites that recommended the
avoidance of playing with the jewelry/piercing stated that this behavior is a leading cause
of tooth and gum damage. Chewing food slowly and carefully while paying attention to
jewelry/piercing placement, avoiding opening the mouth wide if one has a lip piercing
(the jewelry may catch the edge of front teeth), and downsizing the jewelry once swelling
had subsided were all recommended in order to minimize risk of tooth and/or gum
damage.
Genital piercing aftercare. Sixteen websites (22%) provided aftercare
information specifically for genital piercings. Recommended aftercare for genital
piercings closely followed general aftercare for body piercings. Extra attention was paid
to the issues of avoiding contact with body fluids, avoiding mechanical irritation, and
increased bleeding at the piercing site.
Accompanying most genital piercing aftercare guidelines was commentary that
individuals may experience similar adverse effects as with any body piercing: swelling,
bleeding, tenderness, bruising, and discharge that may dry in a clear or white/yellow
crust around the openings of the piercing and/or on the jewelry. Six websites specifically
stated that genital piercings may be expected to bleed more than other body piercings,
particularly piercings of the penile shaft or glans. These websites provided information
on bandaging the piercing with gauze or using panty-liners for one to several days in
order to prevent getting blood on clothing.
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The most commonly provided recommendation regarding the aftercare of genital
piercings was to avoid contact with body fluids. This was recommended in order to
prevent infection of the genital piercing. A body piercing establishment located in Buffalo,
NY, explained: “This piercing is and [sic] open channel to your blood stream which
increases the likelihood of contracting a STD if engaging in unprotected sex. Even if you
are in a monogamous relationship large amounts of bacteria are transferred during
sexual activity.” Most (n=14, 88%) specified that barriers should be used during oral or
genital contact. Recommended barriers included condoms, dental dams, and Tegaderm
style bandages. Five websites (31%) stated that men with penile piercings (especially
frenum or Prince Albert piercings) might find condoms that have a larger reservoir tips
more comfortable and less likely to break than regular condoms. Four websites (25%)
recommended avoiding condoms that contain spermicide, as the chemicals in this
product may irritate genital piercings.
Other behaviors were recommended in order to reduce risk of infection due to
exposure to foreign bacteria. Six websites (38%) recommended cleaning genital
piercings with soap or salt water/saline soaks immediately following sexual contact.
Three websites (19%) recommended that any hands that would touch on or near the
genital piercing needed to be washed before doing so.
Several recommendations were given to reduce irritation of genital piercings.
Two websites (13%) stated that individuals should refrain from sexual activity for two
weeks after obtaining a genital piercing. Seven websites (44%) stated that it wasn‟t
necessary to fully refrain from sexual activity, but care should be taken to avoid abuse or
trauma to fresh genital piercings. These websites emphasized being gentle with the
genital piercing and avoiding any behaviors that caused pain, tugging, or tearing at the
genital piercing site. Four websites (25%) recommended performing a sea salt/saline
soak before engaging in sexual activity in order to remove any crusted discharge. If left
Results - 75
in place, this crusted discharge could irritate or tear skin in and around the genital
piercing.
Recommended Resources
Over half of the websites (n=42, 58%) surveyed provided links and information
for further resources on body piercing and/or body modification. Forty-two (58%)
provided links to websites related to body piercing and/or body modification. Two (3%)
provided information on print resources. One (1%) provided information on instructional
DVDs.
On-line resources. One hundred and one websites were linked to from the
websites surveyed. The categories of websites are summarized on Table 4.7.
Four websites linked to (4%) were categorized as “industry” websites. Links to
the Association of Professional Piercers were provided on 33 websites (45%).
Professional Piercing Information Systems, a company that sells sterilization and body
modification equipment as well as provides industry-specific courses on technique and
bloodborne pathogens, was linked to by four websites (5%). Links to Health Educators,
Inc., a company that provides industry-specific courses on bloodborne pathogens and
disease transmission prevention, were provided on three websites (4%). Links to the
websites of Fakir Musafar, “the founder of the modern primitive movement” and longstanding teacher of body modification procedures and rituals, were provided on two
websites (3%).
Forty-one of the websites linked to (41%) were identified as websites for body
piercing establishments. Only three of these were linked to by multiple websites. Four of
the websites examined (5%) provided links to Rings of Desire, a body piercing
establishment in New Orleans, LA, that has been closed since March, 2006. Three of
the websites examined (4%) provided links to Infinite Body Piercing, a body piercing
establishment in Philadelphia, PA. Two of the websites examined (3%) provided links to
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Table 4.7
Recommended On-Line Resources
Posted Information
N
%
Body piercing establishments
41
41
Jewelry manufacturers
18
18
“Other”
16
16
Own social networking page
13
13
Body piercing industry websites
4
4
Governmental/business organizations
4
4
Jewelry retailers
4
4
On-line body modification communities
3
3
Suspension organizations
3
3
Aftercare products
1
1
N = 101
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23rd Street Body Piercing, a body piercing establishment in Oklahoma City, OK. The
remaining 38 websites to which links were provided were linked to by only one website
examined. These websites represent body piercing establishments and tattooing
establishments that offer body piercing located throughout the US, Canada, and
Australia.
Eighteen websites to which links were provided (18%) were categorized as
jewelry manufacturers. These are establishments whose primary purpose was the
development, manufacturing, distributing, and sale of jewelry designed for body
piercings and/or body modifications. Unless otherwise noted, these manufacturers
primarily manufactured metal body jewelry. Nine of the websites examined (12%)
provided links to Anatometal, a jewelry manufacturer based out of Santa Cruz, CA.
Eight of the websites examined (11%) provided links to Industrial Strength, an
international jewelry manufacturer based out of Carlsbad, CA. Four websites (5%) each
provided links to Body Vision, Neometal, and Tawapa jewelry manufacturers based out
of Los Angeles, Silverdale, WA, and San Francisco, respectively. Tawapa manufactures
body jewelry only out of organic materials, including amber, animal bone, water buffalo
horn, and various hardwoods. Three websites (4%) each provided links to Glasswear
Studios, a jewelry manufacturer based out of Ashland, OR. Glasswear manufactures
body jewelry exclusively out of glass, including softer glass such as soda lime and
barium crystal and harder glass such as borosilicate (Pyrex) and fused quartz. Five
websites of jewelry manufacturers had links provided to them on two each of the
websites examined (3%). All of these manufacturers were based out of the US. These
included a manufacturer who exclusively manufactures jewelry out of glass, another who
exclusively manufactures jewelry out of soft silicone, and another who exclusively
manufactures jewelry out of organic materials who also sells antique tribal body jewelry.
Eight websites of US-based jewelry manufacturers had links provided to them on only
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one (1%) each of the websites examined. Seven of these were based out of the US and
one was based out of Brighton, England. One of these manufacturers makes high-end
metal and organic body jewelry.
Four of the websites to which links were provided (4%) were categorized as
“jewelry retailers,” all of which primarily conducted business on-line. Three of the four
on-line retailers sold body jewelry as well as a limited amount of non-body piercing
jewelry and clothing. The fourth sold a wide variety of body modification related
merchandise, including clothing, books, stickers, and tattoo machines. The four retailers
were US-based.
Only one of the websites examined (1%) provided links to aftercare products. It
provided links to five products: Biotene (an alcohol-free pro-biotic mouthwash); Emu oil;
H2Ocean (pre-packaged sterile saline); TECH 2000 (an alcohol-free anti-bacterial
mouthwash); and Satin (a medical grade liquid anti-bacterial soap).
Links were provided to four websites (4%) of organizations categorized as
“governmental/business.” These organizations were linked to by one website (1%) each.
These organizations are: the Florida Department of Health; the Greater Redding
Chamber of Commerce; the Occupational and Safety Health Administration; and the
Texas Department of Health.
Three on-line body modification communities were linked to by the websites
examined. Body Modification Ezine (BMEzine) had links provided to it by 19 of the
websites examined (26%). Tribalectic on-line body modification community had links
provided to it by seven of the websites examined (10%). The Church of Body
Modification had links provided to it by two of the websites examined (3%).
Thirteen links (13%) were provided to body piercing establishments‟ own pages
on internet-based social networking sites. Twelve establishments (16%) provided links
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to their own MySpace.com page. One establishment (1%) provided a link to its own
Friendster.com page.
Three of the websites examined (4%) provided links to the websites of
organizations dedicated to the body modification ritual of suspension. Suspension is a
ritual by which individuals suspend their body from specially made hooks that are placed
through temporary piercings. Two of the websites examined (3%) provided links to
Suspension.org, a clearinghouse of information about suspension that also maintains a
list of suspension groups world-wide. Two of the websites examined (3%) provided links
to the Constructs of Ritual Evolution suspension group based out of Costa Mesa, CA.
One of the websites examined (1%) provided a link to ihung, a suspension group based
out of Columbus, OH.
Sixteen websites that had links provided to (16%) them were categorized as
“other.” Thirteen of these links were active; three were inactive. Two had links provided
to them on two each of the websites surveyed: 3D Body Art, showcasing the body
modification work of Steve Haworth; the One Project, which annually hosts a three-day
festival dedicated to ritual. Each of the following active websites were linked to by only
one each of the websites surveyed: Bod-Mod.com (“Anthropological, Cultural, and
Ethnographic Studies Place”); Fakir Rants (archive of columns by Fakir Musafar,
published on BMEzine.com); Human Anatomy Online; Gauntlet Enterprises (former
world-renowned body piercing training establishment); The Lizardman (a man who
completed a full-body modification with green tattooing, implants, and split tongue);
ModBase (software for body modification establishments); the MySpace page
StopBodyArtDiscrimination; Piel Tattoo and Piercing Magazine (online version); Piercing
FAQ (an archive of information related to body piercing); and Scar Wars (an annual
convention about scarification). Links were provided to three websites that are no longer
active but were still deemed by the researcher to be noteworthy. One of the websites
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examined provided an inactive link to Piercing Mildred, a former on-line game where
participants could electronically pierce, tattoo, or otherwise modify a character and earn
play money for further body modification procedures for their character. One of the
websites examined provided an inactive link to Bodyart Web Directory, a former archive
of information related to body modification. One of the websites surveyed provided an
inactive link to a tattoos page at the National Geographic website.
Print resources. Two of the websites examined (3%) provided information on
print resources. Infinite Body Piercing, a body piercing establishment in Philadelphia,
PA, provided information on its own print resources, including Starting Point: A Primer of
Modern Body Piercing, The Infinite Guide to Stretching, and Aftercare. Infinite Body
Piercing also provided a long list of books from its own library that were available for sale,
most of which were body modification related. Nomad, a body piercing establishment in
Bend, OR, provided details on the following books: A Brief History of the Evolution of
Body Adornment in Western Culture: Ancient Origins and Today by Blake Perlingieri;
Spirit + Flesh by Fakir Musafar; The Quest for Human Beauty by Julian Robinson; Body
Play, Volume 1 by Fakir Musafar; and Tribal Arts magazine Feature, Summer/Autumn
2001 by Jonathan Fogel.
Video resources. One of the websites examined (1%) provided information on
DVD resources. Nomad, a body piercing establishment in Bend, OR, offers for sale two
DVDs: Nomad Extreme Tribal DVD; and Nomad Advanced Male Genital Freehand
Technique DVD. The website stated “these DVDs are strongly recommended for
advanced piercers with five or more years of professional experience.”
Procedures Available
The availability of procedures was determined by examining on-line portfolios,
price lists, website photos, and text about procedures. Using this process, of the 73
websites that had information related to the study 71 (97%) demonstrated that they
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provided body piercing. The availability of body modification procedures is summarized
on Table 4.8.
Sixty establishments (82%) demonstrated that they provided stretching services.
Fifty-two establishments (71%) demonstrated that they provided surface piercing. Of
these, one also demonstrated that it provided surface-to-surface (or “surface weaving”)
piercings, where a single piece of jewelry is place in two or more surface piercings.
Seven establishments (10%) demonstrated that they provided dermal punch
procedures. An additional nine establishments (12%) included photos in their online
portfolios that included ear cartilage modifications that were very likely created by dermal
punch procedure. This means that a fifth (22%) of establishments might offer
procedures that involve the use of dermal punches. Seven establishments (10%)
demonstrated that they provided scalpelled procedures. One additional establishment
(1%) included photos in their online portfolio that included modifications that were very
likely created through a scalpelled procedure. Scarifications performed by scalpel were
not included in this count.
Fifteen establishments (21%) demonstrated that they provided
microdermals/dermal anchors. Two establishments (3%) demonstrated that they
provided subdermal implants. None demonstrated that they provided transdermal
implants, though one included photos in its online portfolio of what was likely a
transdermal implant.
Thirteen establishments (18%) demonstrated that they provided scarification.
Five of these provided branding scarification only. Five provided both branding and
scalpel scarification. Two provided scalpel scarification only. One provided scalpel,
branding, and electrocautery scarification.
Nine establishments (12%) demonstrated that they offer or support the body
modification ritual of suspension, where individuals suspend their body from specially
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Table 4.8
Availability of Body Modification Procedures
Procedure
N
%
Body piercing
71
97
Stretching
60
82
Surface piercing
52
71
Microdermals/dermal anchors
15
21
Scarification
13
18
Suspension ritual
9
12
Dermal punch procedures (suspected)
9
12
Dermal punch procedures (confirmed)
7
10
Scalpelled procedures (confirmed)
7
10
Temporary corset ritual
5
7
Subdermal implants
2
3
Scalpelled procedures (suspected)
1
1
N = 73
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made hooks that are placed through temporary piercings. Five (7%) demonstrated that
they provided the body modification ritual of temporary corsets. This is a ritual where
several temporary piercings are made, have captive bead rings placed in them, and
ribbons or strings are threaded through the rings to give the appearance of a laced-up
corset. Two establishments (3%) demonstrated that they provided the body modification
ritual of play piercing, where an individual is pierced with typically small gauge needles
which are left in place for a short period of time. One establishment demonstrated that it
offered the body modification ritual of cheek skewering, where one long skewer is
pierced through both cheeks. One establishment demonstrated that it offered or
supported kavadi ritual, a traditionally Hindu ritual in which a frame with long weighted
skewers is held to the body while the individual walks or dances and the skewers pierce
into the skin of the back and chest. One establishment demonstrated that it provided the
body modification ritual of flesh pulls, where a specially made hook (or hooks) is placed
in temporary a piercing and the individual uses their own strength and/or weight to put
pressure on the hook by pulling against another person, people, or inanimate object.
One establishment demonstrated that it offered a body piercing called “pocketing”
(sometimes called “anti-piercing”), where the ends of the piercing are under the surface
of the skin and the middle portion of the jewelry is above the surface.
Other Information of Note
Twenty-one websites (29%) provided information that was not anticipated by the
survey instrument and was recorded in the “other” category. These mainly included
articles posted on the websites about body modification and information to consider
when making body modification related decisions. The general themes found are
summarized in Table 4.9.
Seven websites (10%) provided information about what to look for when
choosing a body piercing establishment and/or body piercer. Five of these were longer
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Table 4.9
Other Information of Note
Posted Information
N
%
Body modification procedures/techniques
10
14
Information on what to look for when choosing body piercing establishment
7
10
On-line forums
7
10
Process of becoming a body piercer
3
4
Body piercing etiquette
2
3
N = 73
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articles; two were answers to “frequently asked questions.” The information provided
emphasized the importance of carefully choosing a body piercing establishment and/or
body piercer in order to minimize risks during the piercing process. These risks included
contraction of bloodborne pathogens, complications due to improper placement of the
body piercing, improper or poor quality jewelry, or infection due to poor body piercer
hygiene. The information provided emphasized researching the studio cleanliness,
sterilization processes, aseptic technique (or lack thereof), jewelry selection, portfolio of
work, training and certifications, affiliations, aftercare information, and/or bedside
manner of the body piercer.
Ten websites (14%) provided information about body modification procedures.
Five websites (7%) provided information that explained the process of stretching body
piercings. Four websites (5%) provided explanations of freehand technique and stated
that that was process they used in performing body piercings. A body piercing
establishment located in Salt Lake City, UT, explained the process and their rationale for
using it:
At [our establishment] we use Freehand Technique, meaning that we do not use
clamps or forceps during your piercing… By taking the clamps out of the
procedure, you recieve [sic] a much safer and much less painful piercing. There
is less truama [sic] to the tissue, which often means less swelling and a faster
healing period.
Two websites (3%) provided detailed information on the process and potential
adverse effects associated with surface piercings. One website (1%) provided detailed
information about branding scarification.
Seven websites (10%) provided online forums for individuals to participate in.
Three of these were electronic guest books where individuals who had been pierced at
the establishment were encouraged to post about their experience. Two of these were
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discussion forums in which the public and the body piercers of the establishment
participated. Two had electronic forms for submitting questions about body piercing to
the body piercer at the establishment.
Three websites (4%) provided information about the process of becoming a
professional body piercer. One website (1%) provided their establishment‟s detailed
curriculum for apprentices. One website (1%) provided general information on the basic
concepts of body piercer apprenticeships. One website (1%) included a brief article on
learning how “to pierce well” (emphasis in original).
Two websites (3%) provided information on body piercing etiquette. These
covered information on how to behave in the body piercing area, the importance of
asking questions and following the body piercer‟s suggestions, and tipping body piercers
for their services.
Three websites (4%) provided lengthy articles related to body piercing. One
website provided an article titled “Health standards and guidelines for body and ear
piercing” that was attributed to Alberta Health and Wellness. One website provided a
state-by-state listing of body piercing related legislation and bills in the United States up
through the year 2000. One website provided an article titled “Parental Guidance,”
attributed Michael Rooney and published in Pain magazine. The article discussed
rationale for not piercing minors and ethical issues for body piercers around parents
making decisions about their minors getting body piercings.
Availability of Information
Throughout the process of recording data from the websites on the coding
instrument, the researcher kept records of the URL (unique resource locator, or website
address) the information came from and how far from the homepage information was
found. Any time material was copied from a website into the survey instrument, the URL
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Table 4.10
Availability of Information
Links taken to get to information
N
%
0
56
8.7
1
256
39.6
2
224
34.7
3
110
17
N = 646
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was also copied into the form above the text. The researcher also kept track of how
many links away from the homepage the text was found. The URL provided through the
APP “Locate an APP piercer” search page was considered the homepage the website.
Any information found on the homepage was coded as the number zero (0) next to the
URL on the survey instrument. If the researcher followed a link on the homepage and
found material on the new page that was copied into the survey instrument, the
information found on that page was coded as the number one (1) next to the URL. If the
researcher followed a link on that page that was also not available on the homepage and
found material on the new page that was copied into the survey instrument, the
information found on that page was coded as the number two (2) next to the URL.
At the completion of data collection, all coded numbers were tabulated and the
availability of information was calculated by percentage. Over four-fifths of information
was found within two links of the homepage. Results indicated that 8.7% of information
recorded on the instrument was gathered from the homepages of the websites. In
addition, 39.6% and 34.7% of information recorded on the instrument was gathered from
the first and second links from the homepage, respectively. The remaining 17.0% of
information was recorded on the third link from the homepage. No information was
found further than three linked pages from the homepage.
The format of the majority of websites was what made information highly
accessible within a few links. Most pages had a format where the menu for all major
pages was on the top and/or sides of the homepage and each page to which it linked.
Discussion
Seventy-five websites were examined, representing 75 body piercing
establishments with 99 locations in 76 cities in 29 states of the continental US. Seventytwo of these websites contained information relevant to the study. These websites were
selected for the sample because they were listed as US-based body piercing
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establishments through the Association for Professional Piercer‟s “Find an APP Piercer”
search page.
Well over half of the websites provided information on cleanliness and safety
precautions. This information was broken into the themes of: hygiene during body
piercing; sterilization equipment; licensure; age policies; identification policies; other
policies; and jewelry used in initial body piercings.
Fifty-six percent posted information about hygiene during the body piercing area
of the establishment and/or process. Nearly one-quarter of these stated that they met or
exceeded the minimum safety standards of the APP. A fifth described using universal
precautions to prevent the transmission of disease. A third of the establishments stated
that they use single-use needles in the body piercing process, preventing transmission
of bloodborne pathogens and other diseases. Fifteen percent stated that the body
piercers wore gloves during the entire body piercing process, over a third of which stated
that the gloves were frequently changed. Eighteen percent described the process by
which the body piercing area was cleaned and disinfected between clients.
Thirty-two percent of websites stated that all non-disposable equipment used in
the body piercing process was sterilized between every use. A fifth of websites stated
that body jewelry used in the body piercing process was sterilized before use. Fifteen
percent described the process by which they sterilized equipment, a quarter of which
described a process by which the client could check to make sure the equipment was
properly sterilized.
Over a third of the establishments provided information about the sterilization
equipment they use and/or how frequently they test the equipment for effectiveness.
Thirty-eight percent of establishments stated they participated in spore testing, which
tested their sterilization equipment for effectiveness, on a mostly weekly basis.
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Sixteen percent of the establishments posted information about participation in
governmental or business licensure. Nearly half of the websites surveyed posted
information about their policies regarding providing body piercings to minors. Of the
40% of establishments who reported they will provide body piercings to minors, all had a
similar policy: valid documentation must demonstrate the identity of the parent/legal
guardian, the minor, and the relationship between the two. Establishments limited the
kinds of body piercings they would provide to minors regardless of parental consent.
Twenty-seven percent of websites stated that individuals must present valid photo ID in
order to obtain a body piercing.
Six other policies or requests of clients were listed on websites. Six
establishments stated that clients must not be under the influence of drugs or alcohol at
the time they are seeking to obtain a body piercing. Four establishments posted policies
forbidding children under certain ages from the body piercing area. Two establishments
stated that they reserve the right to refuse services at any time. Six establishments
requested that clients eat several hours prior to obtaining a body piercing. Four
establishments requested that clients avoid blood-thinners for up to 24 hours before
obtaining a body piercing. Three requested that clients do not come if they are feeling ill.
Just over half of the websites surveyed contained information about jewelry used
in initial body piercings. This information included the materials the jewelry was made of
and/or style of jewelry used. Four materials were considered safe for initial piercings by
the APP: implant grade quality metals (stainless steel, titanium); 14K or higher gold;
tygon, and PTFE. Thirty-one establishments provided information on their websites
demonstrating that they only use jewelry made of these materials in initial body piercings.
Body jewelry used in most initial body piercings involved either jewelry where
ends are threaded onto a post or jewelry where a bead is held in place by tension from a
metal ring. A third of establishments stated that they only use internally threaded body
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jewelry, meaning that the threads into which the ends fix are inside the post of the
jewelry, not exposed. A tenth of websites explained that they only use jewelry with a
high quality polish, meaning the jewelry is free of nicks, scratches, and polishing
compounds.
Three-fourths of the websites provided information about the body piercers who
worked at their establishment. Information was recorded on 117 body piercers, including
early professional development, health related training and certification, continuing
education, years of experience, and affiliation with the APP.
Twenty-eight percent of piercers referenced participating in an apprenticeship,
which was described as industry-specific training of a few months to several years under
a professional body piercer. Four percent were still participating in their apprenticeship.
Seventeen percent of piercers developed their body piercing and body modification skills
through attending industry-specific training. Almost half of the piercers referenced
having received or maintaining current certification in bloodborne pathogens. Nearly all
of these referenced having received or maintaining current certification in CPR and first
aid, respectively.
Two-thirds of piercers included information on their years of experience as a
body piercer. The mean years worked was 9.64 years. Over half of those who listed
their experience had worked ten years or longer. Most of the individuals with three years
of experience or less clearly stated they were still in their apprenticeship.
Three-quarters of the websites that included information on the body piercers
employed at the establishment referenced membership in the APP in either the text of
the body piercer‟s biography or on the page where the biography was located. Five of
these included information about what the APP is and does.
Information about potential complications and adverse effects was found on
nearly half of the websites. Potential complications and adverse effects discussed
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included those that could occur during the body piercing process, those that could occur
after the body piercing process, and those that were psycho-social in nature.
Potential complications and adverse effects that could occur during the body
piercing process were discussed on thirteen websites. All but one – pain experienced
during the procedure – were discussed in the context of how the risk for the potential
complication was minimized at the establishment.
The most frequently discussed process-based complication were the risks
associated with using a piercing gun for body piercings (including lobes). Use of
piercing guns was discouraged for many reasons: most piercing guns cannot be
sterilized; the gun piercing process causes microspray of tissue, blood, and body fluid
that is rarely successfully removed from the piercing gun between clients; piercing guns
are more painful than a piercing needle; piercing guns cause trauma to the tissue being
pierced, complicating the healing process; most jewelry used with piercing guns is made
of poor quality metal and the design complicates the healing process.
The risk of contracting bloodborne pathogens during the body piercing process
was discussed by a tenth of the websites, typically in the context of how to choose a
body piercing establishment (i.e. the risk is greater at an establishment that does not use
aseptic procedure). HIV and hepatitis B were the most commonly referenced pathogens.
Seven percent of the websites addressed the issue of pain during the body
piercing process, acknowledging and normalizing pain as a potential adverse effect of
the body piercing process. Two websites addressed the issue of using anesthetics to
minimize pain during the body piercing process. They would not provide them for many
reasons, including: only properly licensed medical professionals can administer many
forms of anesthetic; injections of anesthetics may hurt more than a properly performed
body piercing; cream/gel anesthetics may not be sterile, thus containing a risk for cross-
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contamination; freezing/cooling techniques may cause tissue damage, thus complication
healing.
Forty-one percent of websites described potential complications and adverse
effects that could arise after the body piercing process was completed. These include:
infection of the piercing site; scarring at the piercing site; irritation at the piercing site;
migration/rejection of jewelry; allergic reaction to metal or cleaning products; discolored
tongue due to over cleaning oral piercings; damage to teeth and gums from oral
piercings; abscess; follicular cysts; and constriction of tissue by too-small jewelry.
In nearly every case, the websites describing the potential complications stated
that the risk for most of these complications was typically minimized by properly
following aftercare guidelines. Most important of these was minimizing contact with the
body piercing site of unclean items and body fluids. Minimizing movement at the piercing
site and movement of the body jewelry also minimized risk for these complications.
Several websites noted that infections, irritation, and allergic reaction present
themselves in similar ways, making it difficult for clients to know what complication they
are experiencing. These websites recommended that clients speak with a body piercer,
preferably in person, to discuss any abnormalities and receive strong advice on how to
resolve the complication.
An apparently common concern over a potential adverse effect – that nipple rings
would limit breastfeeding ability – was discussed by eight percent of the websites. All
said that breastfeeding was still possible after or while having nipple piercings. All
recommended that the piercings be well healed before beginning breastfeeding and all
but one recommended removing jewelry for feedings as it posed a choking hazard to the
nursing infant.
Only two psychosocial complications were described on the websites surveyed.
One establishment recommended that individuals seeking heavy modifications such as
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dermal punch, ear scalpelling, scarification, tongue splits, and genital subdermal
implants discuss the permanent and potentially life-changing nature of these with
individuals who already had them. Another establishment encouraged individuals to
give great thought to the social and work-related impact of facial piercings.
Sixty-two percent of the websites posted information about aftercare, generally
describing it as behavior that would help the body piercing heal. Information on general
body piercing aftercare, oral piercing aftercare, and genital piercing aftercare was found,
as well as what one should expect during the healing process.
A third of the websites provided information about what to expect during the
healing process. These included: whitish/yellow fluid secreted from the body piercing
that tends to dry around the ends of the body jewelry and openings of the body piercing;
redness and/or bruising around the openings of the body piercing; swelling; bleeding
from the openings of the body piercing; tenderness at and around the body piercing site;
and itching and/or tightening of the tissue around the body piercing.
General aftercare of body piercings was discussed by 62% of the websites, 16%
of which reposted or posted links to the APP guidelines. A tenth of establishments
specifically stated on their websites that they provide oral and/or written aftercare
instructions at the time of performing the body piercing.
Aftercare guidelines were designed to limit exposure of the body piercing to
external bacteria, clean the body piercing site, and encourage the body‟s ability to heal
the wound of the body piercing. Some of the most commonly given guidelines included:
do not touch the body piercing with unclean hands (own or others‟); do not submerge the
body piercing in standing bodies of water; do not use alcohol (rubbing, witch hazel),
hydrogen peroxide, antiseptic/antibiotic creams, or iodine/Betadine on the piercing site;
leave the body jewelry in place; and avoid contact with body fluids. Maintenance of
general health through diet, regular sleep, and exercise, as well as the use of
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multivitamins and/or vitamin C and/or zinc was recommended by nearly half of those
providing aftercare instructions. Avoidance of behaviors that caused chemical or
mechanical irritation of the piercing site was also commonly recommended. Use of
regular salt water/saline soaks and cleaning with antibacterial soap were also frequently
recommended.
Oral piercing aftercare was discussed by 42% of the websites. In their basic
rationale, the guidelines were closely aligned with regular body piercing aftercare:
minimize exposure to sources of foreign bacteria; regularly clean the piercing site;
minimize chemical and mechanical stress. The first of these was achieved by avoiding
contact with other people‟s body fluids by avoiding tongue kissing, oral sex, and shared
utensils, getting a new toothbrush, and keeping objects (pencils, pen caps, fingers,
eyeglasses) out of one‟s mouth. The second of these was achieved through regular
rinsing with alcohol-free mouthwash and/or salt water/saline and good general oral
hygiene practices. The third of these was achieved by not playing with jewelry, avoiding
irritating foods, avoiding chewing gum, and avoiding harsh or irritating cleaners.
Individuals are also advised to anticipate swelling with oral piercings. Swelling could be
minimized by holding ice in the mouth, using anti-inflammatories, and sleeping with
one‟s head elevated.
Genital piercing aftercare guidelines were provided by 22% of the websites.
These guidelines closely followed those for general body piercings, with extra attention
paid to the issues of avoiding contact with body fluids, avoiding mechanical irritation, and
increased bleeding at the piercing site. The first two of these were discussed primarily in
the context of sexual activity.
Only 3% of websites stated that individuals with genital piercings need to abstain
from sexual activity during initial healing (two weeks). Others stated that it wasn‟t
necessary to fully refrain from sexual activity, but that care should be taken to avoid
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abuse or trauma to fresh genital piercings. Recommended behaviors to avoid irritation
included avoiding behaviors that cause pain, tugging, or tearing at the piercing site and
performing a salt water/saline soak before engaging in sexual activity.
Avoidance of contact with body fluids involved using barrier methods of
protection during sexual activity. Dental dams were recommended for oral sex and
condoms for penetrative acts. Cleaning of hands before touching the piercing site and
cleaning of the piercing site after sexual activity were both recommended to prevent risk
of infection.
Over half of the websites surveyed provided links and information for further
resources on body piercing and/or body modification: 58% provided links to websites
related to the topic; 3% provided information on print resources; and 1% provided
information on instructional DVDs.
One hundred and one websites were linked to from the websites surveyed.
These were divided into ten categories: industry-related; body modification
establishments; jewelry manufacturers; jewelry retailers; aftercare products;
governmental/business; on-line body modification communities; social networking;
suspension; and other. Industry-related websites included the APP website as well as
organizations that provide body piercing and body modification related training. Fortyone body piercing establishments were linked to, mostly each establishment was linked
to on only one website. Eighteen jewelry manufacturers were linked to, the most popular
of which were the large implant-grade metal jewelry manufacturers Anatometal and
Industrial Strength. Four jewelry retailers were linked to, all US and internet-based.
Links to five aftercare products were provided on one website. Governmental and
business organizations, to which four links were provided, included state departments of
health, a chamber of commerce, and the Occupational and Safety Health Administration.
Three on-line body modification communities were linked to, the most popular by far of
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these was Body Modification Ezine which had 19 websites provide links to it. Twelve
establishments provided links to their own MySpace.com page and one provided a link
to its Friendster.com page. Links were provided to websites of organizations dedicated
to suspension, which is a ritual by which individuals suspend their body from specially
made hooks that are placed through temporary piercings. Sixteen websites that had
links provided to them were categorized as “other” and included topics such as 3D body
art, ritual-based festivals, general piercing information, and a now-defunct game that
involved electronically piercing, tattooing, or otherwise modifying an on-line character.
Of the websites that had information related to the study, 98% demonstrated that
they provided body piercings through their portfolio, price list, website photos, or text
about procedures. Eighty-two percent demonstrated that they provided stretching
services. Seventy-one percent demonstrated that they provided surface piercing.
Dermal punch procedures were clearly provided by 10% of the establishments and
potentially provided by an additional 12%. A tenth of the establishments demonstrated
that they provided scalpelled procedures (scarifications performed by scalpel not
included). A fifth demonstrated that they provided microdermals/dermal anchors.
Eighteen percent of the establishments demonstrated that they provided scarification by
branding, scalpelling, or electrocautery. Twelve percent demonstrated that they offer or
support the body modification ritual of suspension. Other body modification rituals that
were demonstrated on the websites surveyed included corsetry (rings in temporary
piercings that have ribbons laced through them), play piercing (small gauge needles
pierced and briefly left in place), cheek skewering, kavadi, and flesh pulls (hooks in
temporary piercings against which the person pulls).
Twenty-nine percent of the websites provided information that was not
anticipated by the survey and was recorded in the “other” section of the instrument.
These mainly included articles posted on the websites about body modification and
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information to consider when making body modification related decisions: Seven
websites provided information about what to look for when choosing a body piercing
establishment/body piercer; ten provided information on procedures such as stretching
and freehand piercing technique; three provided information the process of becoming a
professional body piercer; two provided information on body piercing etiquette. Seven
websites included on-line forums in which individuals could participate.
Chapter Five
Conclusions and Recommendations
Body piercing has a long history and growing popularity in modern Western
culture. Body piercing is particularly popular among adolescents and college students.
One-quarter to one-half of college students have ever had a body piercing. Nearly onethird of the US population age 21-32 has ever had a body piercing.
Body piercings carry a variety of potential health complications. There is some
variation by body piercing site, but all body piercings carry the risk of bruising, bleeding,
tissue trauma, keloid formation, allergic reaction to jewelry, bacterial infection, and
transmission of infectious agents. Reports of health complications vary widely in the
research from 12% among urban adolescents to 70% in undergraduate university
students. Nationwide, the prevalence of reported complications is 23%. Despite the risk
of potential health complications, only 61% of those who obtained body piercings
considered the risks before the piercing procedure was performed and cleanliness of the
establishment did not weigh in their choice of piercing professional.
Researchers have proposed a variety of methods to reduce the rate of
complications with body piercings. These recommendations span the fields of industry
regulation, medical professionals interacting with pierced and pre-pierced individuals,
and health education. No research has been done in assessing the effectiveness of
these recommendations.
In general, there is a lack of published research regarding body piercing. Most
published research addresses prevalence, association of body art with high-risk
behavior, and health complications of body piercing. Despite their roles as providers of
body piercings and information about body piercing, no research has been published
that involves the participation of body piercers. Research on body modification published
thus far has been limited to the areas of tattooing and body piercing.
99
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The growing popularity of body piercing combined with the substantial risk of
complications from body piercing and the lack of consideration of risk when obtaining a
body piercing points to a growing need for research that would be useful to health
education regarding body piercing.
Researchers and medical professionals have identified the prevalence of body
piercing, potential complications, and key risks for infection. Researchers have also
identified the internet as a common source of health information for the public. At the
time of this project, no research had been published about information available on-line
about body modification and its associated risks.
The purpose of this study was to investigate the information available on
websites of body piercing establishments. The study examined websites to study the
information provided about studio cleanliness, safety precautions, potential
complications from body piercings, the body piercers‟ professional experience and
affiliations, aftercare, recommended resources on body modification, and procedures
available. The study reported the extent to which these topics were covered in the
websites posted by body piercing establishments. It also noted other information
provided on body piercing establishments‟ websites not anticipated by the research
questions.
The first chapter of this thesis outlined information that demonstrated the need
for this research and the parameters within which the research was conducted. The
second chapter of this thesis outlined the body of knowledge about body piercing and
body modification at the time of the study, including frequency of body piercing, potential
complications of body piercing and their associated factors, and emerging body
modifications. The third chapter of this thesis described the process by which the
research was conducted, including a description of the instrument through which
information was gathered. The fourth chapter of this thesis detailed all major data
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gathered from the research, including information about the websites examined and the
establishments they represent, information on body piercing processes, cleanliness,
potential complications, and aftercare, as well as additional resources recommended for
information on body piercing and modification. This chapter provides a discussion of the
findings and offers specific recommendations for practitioners and researchers.
Conclusions
The study was a census study of all websites of body piercing establishments
listed as US-based establishments through the Association of Professional Piercers
“Find an APP Piercer” search page. Seventy-five websites were examined, representing
75 body piercing establishments with 99 locations in 76 cities in 29 states of the
continental US. Information posted on the following topics and the extent to which
information on the topics were recorded and analyzed: cleanliness of the body piercing
establishment; safety precautions used during the piercing process at the establishment;
potential complications of body piercings; professional experience and/or affiliations of
the body piercer(s) employed at the establishment; recommended aftercare for body
piercings; and recommended on-line, print, and video resources on body piercing and
body modification. Using a variety of methods, including reviewing on-line photo
portfolios, general text, and pricelists, the body modification procedures available at the
examined body piercing establishments were recorded.
Body piercing establishments were found to generally be open every day of the
week. Of those that provided business hours, all were open Tuesdays through
Saturdays, 84% were open on Mondays, and 76% were open on Sundays. The vast
majority of establishments opened at or around noon on the days they were open;
closing times varied widely.
Well over half of the websites provided information on cleanliness and safety
precautions. This included information on hygiene during the body piercing process,
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sterilization equipment, licensure, jewelry used in initial body piercings, and age,
identification, and other policies.
Fifty-six percent posted information about hygiene during the body piercing area
of the establishment and/or process, nearly one-quarter of which stated that they met or
exceeded the minimum safety standards of the APP. One-fifth to 1/3 described using
prevention practices such as universal precautions to prevent the transmission of
disease, single-use needles in the body piercing process, and use of gloves during the
entire body piercing process.
Thirty-two percent stated that all non-disposable equipment used in the body
piercing process was sterilized between every use. Fifteen percent described the
process by which they sterilized equipment, a quarter of which described a process by
which the client could check to make sure the equipment was properly sterilized. Over a
third (38%) of the establishments provided information about the sterilization equipment
they use and/or how frequently they test the equipment for effectiveness. Sterilization
equipment was tested for effectiveness by a process called spore testing, in which a test
strip containing live non-pathogenic spores was sterilized by the equipment and then
tested for living cultures by an independent laboratory. Thirty-eight percent of the
establishments stated they participated in spore testing, most commonly on a weekly
basis.
Twelve establishments (16%) posted information about participation in
governmental or business licensure. Ten establishments (14%) were certified or
licensed to operate through their state, county, or city departments of health. Three (4%)
were members of their local Better Business Bureau, one of which also belonged to its
local Chamber of Commerce.
Forty-seven percent of the websites examined posted information about their
policies regarding providing body piercings to minors. Of the 40% of establishments
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who reported they will provide body piercings to minors, all had a similar policy: valid
documentation must demonstrate the identity of the parent/legal guardian, the identity of
the minor, and the relationship between the two. Establishments limited the kinds of
body piercings they would provide to minors regardless of parental consent: most would
not provide body piercings below the neck with the exception of navels; many would also
not provide surface piercings or earlobe piercings larger than 10 gauge.
Twenty body piercing establishments stated that individuals must present valid
photo ID in order to obtain a body piercing. Valid ID was typically defined as nonexpired driver‟s license, state-issued ID, passport, or military ID.
Fifty-two percent of the websites examined contained information about jewelry
used in initial body piercings. This information included the materials the jewelry was
made of and/or style of jewelry used. Four materials are considered safe for initial
piercings by the APP: implant grade quality metals (stainless steel, titanium); 14K or
higher gold; tygon, and PTFE. Forty-two percent of the establishments provided
information on their websites demonstrating that they only use jewelry made of these
materials in initial body piercings. Body jewelry used in most initial body piercings
involved either jewelry where ends are threaded onto a post or jewelry where a bead is
held in place by tension from a metal ring. Thirty-two percent of establishments stated
that they only use internally threaded body jewelry, meaning that the threads into which
the ends fix are inside the post of the jewelry, not exposed. This style was
recommended because it minimized tissue damage during insertion and was typically
made of higher quality materials. Seven websites (10%) explained that they only use
jewelry with a high quality polish, meaning the jewelry is free of nicks, scratches, and
polishing compounds. The higher quality the polish of body jewelry, the less likely was
jewelry-caused irritation in a body piercing.
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Three-quarters of the websites provided information about the body piercers who
worked at their establishment. Information was recorded on 117 body piercers on topics
including early professional development, health related training and certification,
continuing education, years of experience, and affiliation with the APP.
Thirty-three individuals (28%) referenced participating in an apprenticeship,
which was described as industry-specific training of a few months to several years under
a professional body piercer. Five of these thirty-three were still participating in their
apprenticeship. Twenty individuals (17%) developed their body piercing and body
modification skills through attending industry-specific training offered by specialized
training companies.
Forty-eight percent of the body piercers referenced having received or
maintaining current certification in bloodborne pathogens. Forty-three percent and 42%
referenced having received or maintaining current certification in CPR and first aid,
respectively. Thirty-seven individuals (32%) referenced attending APP conferences.
Sixty-four percent included information on their years of experience as a body
piercer. The mean years worked was 9.64 years. Over half (56%) of those who listed
their years of experience had worked ten years or longer. Most of the individuals with
three years of experience or less (63%) clearly stated they were still in their
apprenticeship.
Information about potential complications and adverse effects was found on
thirty-four websites (47%). Potential complications and adverse effects discussed
included those that could occur during the body piercing process, those that could occur
after the body piercing process, and those that were psycho-social in nature.
Potential complications and adverse effects that could occur during the body
piercing process were discussed on 18% of the websites. The most frequently
discussed process-based complication was the risk associated with using a piercing gun
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for body piercings (including lobes). The risk of contracting bloodborne pathogens
during the body piercing process was discussed by nine websites (12%), typically in the
context of how to choose a body piercing establishment (i.e. the risk is greater at an
establishment that does not use aseptic procedure). HIV and hepatitis B were the most
commonly referenced pathogens. Five websites (7%) addressed the issue of pain
during the body piercing process, acknowledging and normalizing pain as a potential
adverse effect of the body piercing process.
Forty-one percent of the websites described potential complications and adverse
effects that could arise after the body piercing process was completed. These included:
infection of the piercing site; scarring at the piercing site; irritation at the piercing site;
migration/rejection of jewelry; allergic reaction to metal or cleaning products; discolored
tongue due to over cleaning oral piercings; damage to teeth and gums from oral
piercings; abscess; follicular cysts; and constriction of tissue by too-small jewelry.
In nearly every case, the websites describing the potential complications stated
that the risk for most of these complications was typically minimized by properly
following aftercare guidelines. Most important of these was minimizing contact of
unclean items and body fluids with the body piercing site. Minimizing movement at the
piercing site and movement of the body jewelry also minimized risk for these
complications.
Several websites noted that infections, irritation, and allergic reaction present
themselves in similar ways, making it difficult for clients to know what complication they
are experiencing. These websites recommended that clients speak with a body piercer,
preferably in person, to discuss any abnormalities and receive non-medical advice on
how to resolve the complication.
Only two psychosocial complications were described on the websites examined.
One establishment recommended that individuals seeking heavy modifications such as
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dermal punch, ear scalpelling, scarification, tongue splits, and genital subdermal
implants discuss the permanent and potentially life-changing nature of these with
individuals who already had them. Another establishment encouraged individuals to
give great thought to the social and work-related impact of facial piercings.
Forty-five websites (62%) posted information about aftercare, generally
describing it as behavior that will help the body piercing heal. Information on general
body piercing aftercare, oral piercing aftercare, and genital piercing aftercare was found,
as well as what one should expect during the healing process.
A third of the websites provided information about what to expect during the
healing process. This included: whitish/yellow fluid secreted from the body piercing that
tends to dry into a crust around the ends of the body jewelry and openings of the body
piercing; redness and/or bruising around the openings of the body piercing; swelling;
bleeding from the openings of the body piercing; tenderness at and around the body
piercing site; and itching and/or tightening of the tissue around the body piercing.
General aftercare of body piercings was discussed by 62% of the websites.
Aftercare guidelines were designed to limit exposure of the body piercing to external
bacteria, clean the body piercing site, and encourage the body‟s ability to heal the
wound of the body piercing. Some of the most commonly given guidelines included: do
not touch the body piercing with unclean hands (own or others‟); do not submerge the
body piercing in standing bodies of water; do not use alcohol (rubbing, witch hazel),
hydrogen peroxide, antiseptic/antibiotic creams, or iodine/Betadine on the piercing site;
leave the body jewelry in place; and avoid contact with body fluids. Maintenance of
general health through diet, regular sleep, and exercise, as well as the use of
multivitamins and/or vitamin C and/or zinc was recommended by nearly half of those
providing aftercare instructions. Avoidance of behaviors that cause chemical or
mechanical irritation of the piercing site was also commonly recommended. Almost two-
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thirds of websites recommended the use of regular salt water/saline soaks and cleaning
with antibacterial soap.
Oral piercing aftercare was discussed by thirty-one websites 42% of the websites.
In their basic rationale, the guidelines were closely aligned with regular body piercing
aftercare: minimize exposure to sources of foreign bacteria; regularly clean the piercing
site; minimize chemical and mechanical stress. The first of these was achieved by
avoiding contact with other people‟s body fluids by avoiding tongue kissing, oral sex, and
shared utensils, getting a new toothbrush, and keeping objects (pen caps, fingers,
eyeglasses) out of one‟s mouth. The second of these was achieved through regular
rinsing with alcohol-free mouthwash and/or salt water/saline and good general oral
hygiene practices. The third of this was achieved by not playing with jewelry, avoiding
irritating foods, avoiding chewing gum, and avoiding harsh or irritating cleaners.
Individuals are also advised to anticipate swelling with oral piercings. Swelling could be
minimized by holding ice in the mouth, using anti-inflammatories, and sleeping with the
head elevated.
Genital piercing aftercare guidelines were provided by 22% of the websites.
These guidelines closely followed those for general body piercings, with extra attention
paid to the issues of avoiding contact with body fluids, avoiding mechanical irritation, and
increased bleeding at the piercing site. The first two of these were discussed primarily in
the context of sexual activity.
Over half of the websites examined provided links and information for further
resources on body piercing and/or body modification: 58% provided links to websites
related to the topic; 3% provided information on print resources; and 1% provided
information on instructional DVDs. One hundred and one websites were linked to from
the websites examined. These were divided into ten categories: industry-related; body
modification establishments; jewelry manufacturers; jewelry retailers; aftercare products;
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governmental/business; on-line body modification communities; social networking;
suspension; and other.
Of the 73 websites that had information related to the study, information on the
body piercing and body modification procedures available at the establishment was
found on 71 (97%). Eighty-two percent of the establishments demonstrated that they
provide stretching services. Seventy-one percent demonstrated that they provided
surface piercing. Dermal punch procedures were clearly provided by 10% of the
establishments and potentially provided by an additional 12% of the establishments.
Twenty-one percent of the establishments demonstrated that they provided
microdermals/dermal anchors. Eighteen percent demonstrated that they provide
scarification by branding, scalpelling, or electrocautery. Twelve percent demonstrated
that they offer or support the body modification ritual of suspension. Ten percent of the
establishments demonstrated that they provided scalpelled procedures (not including
scarifications performed by scalpel). Other body modification rituals that were
demonstrated on the websites examined included corsetry, play piercing, cheek
skewering, kavadi, and flesh pulls.
Information that was not anticipated by the study was found on 29% of the
websites examined. These mainly included articles posted on the websites about body
modification and information to consider when making body modification related
decisions. Seven websites (10%) included on-line forums in which individuals could
participate.
Discussion
This content analysis of 75 body piercing establishment websites provides
detailed information about body piercing from the body piercing industry. The study was
the first to examine practitioners and establishments within the industry for body piercing
and modification information, as opposed to individuals who have patronized
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establishments within the industry. The findings thus provide a more thorough
understanding of the information on body piercing websites and in turn have implications
for interpreting previous research and for future health promotion practice and research.
One area where this research culled out new information that affects previous
and future research is in the discussion of complications. Previous researchers
identified bruising, bleeding, swelling and/or other signs of local trauma as negative
complications of body piercings (Armstrong, 2006; Meltzer, 2005; Stirn, 2003; Stewart,
2000). These outcomes were described by body piercing establishments as normal
parts of the body piercing and/or healing process. This would imply that while bruising,
bleeding, swelling, and other signs of local trauma are adverse effects of the body
piercing process, they are to be anticipated and as such are not unexpected negative
complications.
Previous research into the prevalence of complications such as infection and
allergic reaction has relied on self-reporting by the pierced individual (Armstrong, et al.,
2004; Gold, 2005; Greif, et al., 1999; Huxley & Grogan, 2005; King & Vidourek, 2007;
Laumann & Derick, 2006; Mayers, et al., 2002). The current study found that body
piercing establishments stated on their websites that it can be difficult for pierced
individuals to distinguish between infection, irritation, and allergic reaction. These
establishments recommended that individuals consult with a body piercer or a medical
professional for proper diagnosis and treatment recommendations. Relying on pierced
individuals to self-report negative complications such as infection and allergic reaction is
problematic because they may be ill equipped to distinguish what they are experiencing.
The literature on body piercing thus far focused largely on the role body piercers
and body piercing establishments play in minimizing risks of negative complications
during the body piercing procedure (Armstrong, 2005; Griffith & Tengnah, 2005; Stirn,
2003). Several recommendations were given in the literature to minimize risk, primarily
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on minimizing risk of transmission of bloodborne pathogens. The establishments
examined in the current study largely demonstrated that they are meeting these
recommendations and many communicated how and why they did so. Of the 73
websites that provided information relevant to the study, 59 (80%) provided information
on the hygiene procedures, sterilization procedures or tools, licensing, health and safety
related policies, or jewelry used in the piercing process. Thirteen websites (18%)
provided information specifically about complications that can occur during the
procedure.
As well as focusing on the ways they minimized risk to clients, the body piercing
establishments in the current study focused on ways the clients could minimize their own
risk of post-procedure complications. Thirty websites (41%) described potential
complications and adverse effects that could arise after the body piercing process was
completed, emphasizing ways to minimize risk for these complications. In the
discussion of complications, emphasis was placed on adhering to aftercare guidelines as
a means for minimizing risk. The emphasis on post-procedural complications may
reflect the findings of Laumann and Derick (2006), who discovered that reported
complications from body piercings most frequently occurred later than three weeks after
obtaining the body piercing.
Many establishments demonstrated their commitment to adolescent safety
through their parental consent guidelines and rationales for limiting the body piercings
they would provide to minors. Several establishments also reinforced messages about
minimizing risk during the body piercing process in offering tips for clients to evaluate
body piercing establishments.
Huxley and Grogan (2005) found that location of the body piercing establishment,
recommendation by friends, and professional reputation were the three greatest factors
in choosing a body piercer and that cleanliness of establishment was not a factor for any.
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Huxley and Grogan (2005) and King and Vidourek (2007) explored the degree to which
individuals considered risks of complications before obtaining body piercings, which
varied widely depending on the potential complication. The current study found that, to a
limited extent, body piercing establishments encouraged potential clients to consider
risks in many ways before obtaining body piercings. Thirteen websites (18%) discussed
potential complications that could result from the piercing procedure, discussing all of
these (except pain) in the context of how they minimized the risk of the potential
complication.
A tenth of the websites examined included information on how to choose
a body piercing establishment that provided safe body piercings. Four-fifths of the
websites examined provided information on the safety standards they adhere to,
creating norm of safe piercing practice that clients should look for and expect. This norm
encouraged individuals seeking body piercings to consider cleanliness of establishment
first among factors in choosing a body piercing establishment.
The previous literature on body piercing has included no information on aftercare
of body piercings. Complications of body piercings most frequently arise during the
aftercare period (Laumann & Derick, 2006). The current study found that the examined
establishments place an emphasis on aftercare as a means of minimizing postprocedural complications. Twenty-four websites (33%) provided information about what
adverse effects of body piercing are normal during the healing process (e.g. swelling,
bruising, discoloration, discharge). Forty-five websites (62%) provided information about
general aftercare of body piercings. The lack of previously published information on
aftercare, coupled with the potential importance of aftercare in preventing potential
complications, makes this newly recorded information on aftercare key in the promotion
of behaviors that minimize risk of body piercing complications.
The previous literature has focused on the clients of the body piercing industry;
the researcher found no studies that noted involvement of or sought information from
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body piercing practitioners. The current study found that the practitioners at the
websites examined posted openly about their credentials and experience. Threequarters of the websites examined included information about the individuals employed
at the body piercing establishment. Information was recorded on 117 body piercers on
topics such as professional development, health related training and certification,
continuing education, and years of experience.
Throughout many articles in the existing literature, recommendations are given
for open, non-judgmental communication between physicians and nurses and their
patients about body piercing (Gold, et al 2005; McGuinness, 2006; Schnirring, 2003;
Stirn, 2003). Other articles called for a need for informed health education about body
piercing (Braithwaite, et al., 2001; Deschesnes, et al., 2006; Greif, et al., 1999).
Professionals in all of these circumstances need current and accurate information from
which to base their discussions and education. The information gathered in this study
can provide a base from which to work until further study supports or disproves these
results. The data contained in this research is unique in that it is founded on the
experience of professionals within the field of body modification. Information that could
not be found elsewhere in the literature that could prove useful includes: detailed
aftercare guidelines; body modifications other than body piercing; and recommended
resources for information on body piercing and modification.
Recommendations
Recommendations for practice. The information gathered in this study can be of
great value to health education and medical practitioners and researchers. While the
veracity of the information gathered can only be tentatively accepted, a foundation has
been laid for improved research and improved health education that involves information
from within the body piercing/modification industry.
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There are several key areas of note for health promotion and education. First
among these is the safety and hygiene practices at APP body piercing establishments
and the rationale for these practices. The experience and education of APP body
piercers and recommended certifications in bloodborne pathogens, CPR, and first aid
are also important to be aware of. A major advancement from this study are
recommended aftercare guidelines and the rationale for these guidelines, which can be
useful both in terms of educating piercing seeking individuals as well as providing
support to pierced individuals. Review of resources that are recommended by APP
member establishments could be helpful in the development of health promotion
strategies. Awareness of emerging non-traditional body modifications – such as
stretching, surface piercing, dermal anchors, and scarification, as well as body
modification rituals such as suspension, play piercing, and pulling – will be key for future
efforts in health promotion around body modification.
Recommendations for improving this research. There were several limitations to
this research that could be improved upon with a different research design. First the
sample was very limited – a census study of body piercing establishments that were
listed as US-based members of the APP were included. The results of this research are
not able to be generalized to any groups nor the body piercing industry as a whole.
Second, the method through which information was obtained – via websites – can be
problematic. Available information is limited to what the establishments decided to place
on their website. Considering that the establishments established their websites for
commercial reasons (as denoted by the “.com” suffix on the URL) as opposed to
education reasons, their decisions on which information to post may be based more on
business than on client education. While it was illuminating to review the extent to which
topics were posted on as a limited gauge of what is valued or notable within the sample,
general information on each desired topic was not available for all establishments. Many
Recommendations - 114
factors may affect what establishments post on their website about the procedures they
perform, providing limited availability of information on prevalence of non-body piercing
body modifications. In addition, the employees of the establishments have expertise
specifically in body modification and may lack expertise in website development and
publishing, limiting what information they are able to post.
Recommendations for future research. Given that this study was designed to be
a content analysis, there is much future research that can be drawn from it. Every
theme that was explored can benefit from further exploration in health and health
education research.
This study was limited to body piercing establishments that were listed as USbased establishments through the APP on-line member search page. Membership in
the APP requires demonstration of experience and knowledge, training in safety
measures, as well as environmental safety requirements of the establishment. This may
mean that APP-affiliated establishments have higher adherence to and promotion of key
safety considerations. The APP also provides general aftercare guidelines and position
statements on issues related to body piercing, which may have influenced the uniformity
of messages around aftercare. This research was also a census study. All of these
points lead to the non-generalizability of the results to other groups. Research into nonAPP-affiliated body piercing establishments needs to be done to illuminate the standards
and ideas of the body piercing industry as a whole. In particular, areas of establishment
policies, establishment hygiene, body piercer background, jewelry standards, and
aftercare guidelines need to be explored.
The professional body piercer members of the panel of experts advised the
researcher that the APP does not support members performing any procedures outside
of providing body piercings with a needle. This would exclude procedures that use
dermal punches, tapers, and scalpels, including scarification and implant procedures.
Recommendations - 115
The body piercers on the panel of experts also advised that use of dermal punches and
scalpels is, at best, a legal gray area in some states and illegal in others because it
causes the body piercer using them to cross the line into practicing medicine without a
license. These two factors may have caused members to not demonstrate through their
websites the full variety of body modification procedures they provide. Research into the
true prevalence of these procedures is needed.
This study examined the websites of body piercing establishments and found a
general wealth of information about body piercing and modification. How
establishments‟ websites are used by the general public as well as by future and
previous clients could be useful. It could also be useful to investigate how body piercers
perceive their websites, how they determine which information to post, and
whether/under what circumstances they recommend their website to clients.
Previous research involving the concept of “safe piercing practices” has followed
a loosely-defined set of standards developed in the public health and medical sectors.
Research into the integration of those standards with those provided and outlined by
professionals in the field of body piercing/modification is needed. This can then be used
to develop more solid health promotion and education programming around safe body
piercing/modification practices, which can be further studied.
This study raised issues around the definition of outcomes of body piercing as
negative complications or anticipated adverse effects. Further research into this issue is
needed, and such research needs involvement of both medical professionals and body
piercing practitioners. Research into true prevalence of negative complications –
particularly those difficult for non-professionals to distinguish such as irritation, infection,
and allergic reaction – is needed. Awareness of the body piercing healing process – be
it with undesired negative complications or anticipated adverse effects – among the
Recommendations - 116
piercing seeking public as well as medical and health education professionals needs to
be explored.
A relatively consistent set of aftercare guidelines was found in this study. Further
research into consistency in the industry as a whole is needed, as is medical research
into the effectiveness of these aftercare guidelines. Research exploring awareness of
and adherence to aftercare guidelines would also be beneficial. Awareness of these
aftercare guidelines among those who work with pierced populations, particularly
medical and health education professionals, would illuminate areas where further
education of these professionals is needed.
Exploration of the resources recommended by the body piercing establishments
in the study could be useful. Particularly notable are the on-line communities
established around body piercing/modification. These can be useful tools in research as
gateways into modified communities as well as looking at emerging trends in body
modification. Consistency of message around safety and aftercare messages in these
establishments could also make useful research.
Based on the frequency and openness with which body piercing establishments
provided information on cleanliness, aftercare, and professional background, as well as
the client-centered focus of the websites, it is the researcher‟s belief that professional
body piercers can be great allies of health promoters and medical professionals. Based
both on their involvement in body piercing/modification and their vast knowledge of body
piercing/modification, further research that involves the participation of body piercers
practitioners is strongly recommended.
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Appendix A
Body Modification Content Rating Form
1. Piercing establishment (Name):
2. Date of review:
3 May 2008
3. Website URL:
4. Date of most recent site update:
n/a
5. Establishment location (City, State):
6. Hit count:
n/a
7: Establishment days & hours:
n/a
8. Information on cleanliness:
URL:
Sterilization information:
Information on spore testing of sterilization equipment:
Surface disinfection of piercing room:
City/County licensing:
Other:
9. Information on safety precautions used URL:
during piercing process:
Piercing set-up technique:
Age & consent policies:
Jewelry selection:
Other:
10. Information on potential complications URL:
and adverse effects:
During procedure:
Post-procedure:
Psychological:
Other:
11. Body piercer experience/affiliations:
URL:
Professional bio:
Apprenticeship:
Professional experience:
Professional affiliations:
First aid/bloodborne pathogens training:
Other:
12. Information on aftercare:
General:
For specific piercing:
Follow-up with piercer:
Other:
13. Recommendations for further
information on body modifications:
On-line:
Print:
Other:
URL:
URL:
121
Appendix A - 122
14. Procedures available:
Body piercing:
Stretching:
Surface piercings:
Dermal punch procedures:
Scalpelled procedures:
Microdermals/dermal anchors:
Transdermal implants:
Subdermal implants:
Scarification:
Other:
15. Other information of note:
URL:
URL:
Appendix B
Panel of Experts Information
The panel of experts contained four individuals, two who were professional body
piercers with over a decade of experience each and two who were experienced
researchers in health promotion and education. Their information follows:
Ned Dixon
Body Piercer, Beelistic Tattoo and Piercing
Cincinnati, OH
Meagan Kreiner
Body Piercer, Venus by Maria Tash
New York City, NY
Keith King, PhD, CHES
Associate Professor, Health Promotion and Education
College of Education, Criminal Justice, and Human Services
University of Cincinnati
Amy Bernard, PhD, CHES
Associate Professor, Health Promotion and Education
College of Education, Criminal Justice, and Human Services
University of Cincinnati
123
Appendix C
Tables
Table C1
Body Piercing Establishment Hours of Operation
Open
Day
Monday
Tuesday
Wednesday
Thursday
Time
Closed
N (%)
Time
N (%)
10:00
3 (7%)
18:00
2 (5%)
11:00
4 (9%)
19:00
5 (12%)
12:00
34 (76%)
20:00
11 (26%)
13:00
2 (4%)
21:00
8 (19%)
14:00
2 (4%)
22:00
14 (33%)
23:00
2 (5%)
0:00
1 (2%)
10:00
3 (6%)
18:00
3 (6%)
11:00
5 (9%)
19:00
8 (15%)
12:00
37 (70%)
20:00
10 (19%)
13:00
3 (6%)
21:00
8 (15%)
14:00
2 (4%)
22:00
18 (34%)
14:30
1 (2%)
23:00
3 (6%)
15:00
1 (2%)
0:00
1 (2%)
16:00
1 (2%)
10:00
3 (5%)
18:00
3 (6%)
11:00
5 (9%)
19:00
8 (15%)
12:00
39 (71%)
20:00
11 (21%)
13:00
3 (5%)
21:00
9 (17%)
14:00
2 (4%)
22:00
18 (34%)
14:30
1 (2%)
23:00
3 (6%)
15:00
1 (2%)
0:00
1 (2%)
16:00
1 (2%)
10:00
3 (5%)
18:00
2 (4%)
11:00
6 (11%)
19:00
7 (13%)
12:00
38 (69%)
20:00
11 (21%)
13:00
3 (5%)
21:00
9 (17%)
14:00
2 (4%)
22:00
20 (38%)
14:30
1 (2%)
23:00
3 (6%)
15:00
1 (2%)
0:00
1 (2%)
124
Appendix C - 125
Friday
Saturday
Sunday
16:00
1 (2%)
10:00
3 (5%)
18:00
1 (2%)6
11:00
6 (11%)
19:00
8 (15%)
12:00
38 (69%)
20:00
11 (21%)
13:00
3 (5%)
21:00
15 (28%)
14:00
2 (4%)
22:00
7 (13%)
14:30
1 (2%)
23:00
4 (8%)
15:00
1 (2%)
0:00
1 (2%)
16:00
1 (2%)
1:00
10:00
4 (7%)
18:00
2 (4%)
11:00
6 (11%)
19:00
4 (8%)
12:00
37 (69%)
20:00
8 (15%)
13:00
3 (6%)
21:00
11 (21%)
14:00
1 (2%)
22:00
15 (29%)
14:30
1 (2%)
23:00
7 (13%)
15:00
1 (2%)
0:00
4 (8%)
16:00
1 (2%)
1:00
1 (2%)
11:00
3 (7%)
17:00
4 (10%)
12:00
28 (67%)
18:00
12 (30%)
13:00
6 (14%)
19:00
4 (10%)
14:00
5 (12%)
20:00
9 (23%)
21:00
3 (8%)
22:00
5 (13%)
23:00
2 (5%)
0:00
1 (3%)
N = Number of those opening/closing that day
Appendix C - 126
Table C2
Aftercare Guidelines and Frequency of Recommendation
Guideline
N
%
Do not touch the body piercing with hands that are not freshly washed (own
27
60
26
58
Do not use alcohol on the body piercing (rubbing alcohol, witch hazel)
25
56
Do not use hydrogen peroxide on the body piercing
25
56
Leave the body jewelry in place (don‟t change jewelry without the aid of a
24
53
Do not use antiseptic/antibiotic creams or ointments on the body piercing
23
51
Avoid contact with body fluids (own and others‟)
22
49
Do not use strong cleaning solutions on the body piercing (iodine, Betadine,
21
47
Keep beauty/cleaning products away from the body piercing
20
44
Promote general health (regular sleep, healthy diet, exercise)
17
38
Avoid over-cleaning
16
36
Avoid contact with dirty fabrics (linens, clothes)
16
36
Supplement diet with a multivitamin, zinc, and/or vitamin C
15
33
Do not wear restrictive clothing
15
33
Do not move or rotate body jewelry
13
29
With clean hands/gauze/tissue, periodically check and tighten ends of
13
29
12
27
hands or others‟)
Do not submerge the body piercing in standing bodies of water, including
swimming pools, hot-tubs, lakes, oceans, or own bathtub (unless
freshly cleaned)
body piercer or remove temporarily)
Hibiclens)
jewelry
Use Tegaderm/Clean Seals to cover body piercing if it is known it will be
exposed to standing water
Appendix C - 127
Avoid sleeping on the body piercing
12
27
Contact the body piercer if jewelry needs to be removed or replaced for
11
24
Keep hair away from the body piercing
9
20
Do not use “ear care” solution (benzethonium or benzalkonium chloride
8
18
8
18
7
16
Avoid Band-Aids and/or restrictive bandages
6
13
While playing sports, a bandage (eye patch, ace bandage) may be worn
6
13
Reduce or eliminate intake of alcohol, drugs, caffeine, and/or aspirin
5
11
Avoid contact with pet hair, dander
5
11
Carry a clean, spare end for body jewelry
5
11
Reduce or stop smoking
4
9
Downsize jewelry (change to a shorter post) after swelling subsides in the
4
9
Avoid tanning beds
3
7
Take non-prescription anti-inflammatories to reduce swelling
3
7
For above-neck piercings, sleep with a propped pillow to reduce overnight
3
7
3
7
medical purposes
solutions)
Maintain cleanliness of phones, glasses, hats, other objects the body
piercing may come in regular contact with
Do not hang objects (e.g. charms) from the jewelry until the body piercing is
healed
over a navel piercing for protection
body piercing
swelling during initial healing
Select one cleaning product and use it exclusively
N = 45
Appendix C - 128
Table C3
Oral Piercing Aftercare Guidelines and Frequency of Recommendation
Guideline
N
%
Use an alcohol-free mouthwash (Biotene, Tech2000)
27
74
Anticipate swelling of the tongue with tongue piercings
23
74
Ice can help relieve swelling of the tongue
23
74
Use salt water/saline for oral rinse
20
65
Don‟t play with jewelry/piercing
20
65
Avoid oral contact with body fluids (tongue kissing, oral sex, shared utensils)
19
61
Reduce or eliminate use of tobacco
19
61
Get a new toothbrush
18
58
Downsize jewelry (change to a shorter post) after swelling subsides
18
58
Anti-inflammatories (ibuprofen) can help relieve swelling
16
52
Avoid spicy, salty, acidic, and/or hot food and beverages for the first days to
15
48
Open mouth and/or chew with consciousness of jewelry
15
48
Avoid alcohol and/or drugs
14
45
With oral-to-surface piercings, provide oral piercing aftercare inside mouth
12
39
Avoid chewing gum
11
35
Avoid chewing on fingernails, putting fingers in mouth
11
35
Sleeping with head elevated can reduce overnight swelling
9
29
Avoid chewing on pen caps, glasses, etc.
9
29
Brush jewelry as part of oral hygiene process
9
29
Avoid excessive talking during initial healing
8
26
Brush teeth regularly
7
23
Avoid blood-thinners
7
23
week of healing
and traditional body piercing aftercare to the surface
Appendix C - 129
With clean hands/gauze/tissue, periodically check and tighten ends of jewelry
6
19
Avoid caffeine
4
13
Permissible to use diluted alcohol-based mouthwash solution
3
10
Avoid straws, sucking
3
10
Avoid toothpaste with baking soda, peroxide
3
10
N = 31
Appendix C - 130
Table C4
Estimated Healing Time by Body Piercing and Frequency of Estimation
Body Piercing
Ampallang
Description
Time
N
%
Horizontally through
4-8 months
2
15
the glans,
3-6 months
2
15
transecting or
6-8 months
1
8
6-9+ months
1
8
~3 Months
1
8
6-8 weeks
1
8
4-6 months
1
8
Vertically through
4-8 months
2
15
the glans,
3-6 months
2
15
transecting the
6-8 months
1
8
6-9+ months
1
8
~3 months
1
8
6-8 weeks
1
8
passing above the
urethra
Apadravya
urethra
Beauty
Oral-to-surface
2-3 months
3
23
Mark/Marilyn/Madonna
piercing above the
6-8 weeks
1
8
upper lip on either
1-2 months
1
8
side
8-10 weeks
1
8
Horizontally through
2-3 months
3
23
the bridge of the
8-10 weeks
2
15
nose
3-5 months
1
8
1-3 months
1
8
Through any portion
6-12 months
2
15
of the cartilaginous
3-6 months
2
15
part of the earlobe
6-8 months
1
8
2-12 months
1
8
6-9+ months
1
8
~3 months
1
8
2-8 months
1
8
4-8 months
1
8
2-3 months
1
8
4-9 months
1
8
Oral-to-surface
3-4 months
1
8
piercing through the
4-6 weeks
1
8
Bridge (Earls)
Cartilage
Cheek
Appendix C - 131
cheek
Clitoral hood
Clitoris
Dydoe
Earlobes
Eyebrow
Foreskin
Vertically or
2-8 weeks
3
23
horizontally through
6-8 weeks
2
15
the clitoral hood
2-3 months
1
8
2-3+ weeks
1
8
2-6 weeks
1
8
4-8 weeks
1
8
Horizontally through
2-4 weeks
2
15
the clitoris
6-8+ weeks
2
15
Through the coronal
8-12 weeks
2
15
ridge of the glans
3-5 months
1
8
6-9+ months
1
8
2-3 months
1
8
6-8 weeks
1
8
Through the non-
6-8 weeks
8
62
cartilaginous part of
2-3 months
2
15
the earlobe
1-3 months
1
8
4-6 weeks
1
8
Diagonally through
6-8 weeks
4
31
the ridge of the
2-3 months
3
23
eyebrow
6-12 months
1
8
1-3 months
1
8
2-4 months
1
8
4-8 weeks
1
8
4-6 weeks
1
8
6-8+ weeks
2
15
Vertically where the
4-6 weeks
2
15
inner labia meet,
6-8+ weeks
1
8
Horizontally through
2-3 months
4
31
skin on underside of
6-8 weeks
4
31
penile shaft
3-4+ weeks
1
8
All genital piercings
1-6 months
1
8
Placed so rings are
on the end of penis
when foreskin is
rolled forward
Fourchette
between introitus
and anus
Frenum
“Genitals”
Appendix C - 132
Guiche
Labia (Inner)
Labia (Outer)
Labret/Lip
1-3 months
1
8
6-24 weeks
1
8
Horizontally through
2-3 months
3
23
tissue between
8-10 weeks
2
15
scrotum and anus
6-8 months
1
8
3-4+ months
1
8
6-8 weeks
1
8
Horizontally through
2-4 weeks
2
15
tissue of inner labia
2-8 weeks
2
15
6-8 weeks
2
15
2-3 months
1
8
4-6+ weeks
1
8
4-8 weeks
1
8
Horizontally through
2-6 months
2
15
tissue of outer labia
6-8 weeks
2
15
3-5 months
1
8
3-4 months
1
8
2-3 months
1
8
Oral-to-surface
2-3 months
5
38
piercing under the
6-8 weeks
2
15
lower lip
6-12 weeks
1
8
1.5-4+ months
1
8
1-2 months
1
8
8-10 weeks
1
8
6-10 weeks
1
8
3-6 weeks
1
8
3-4+ months
1
8
1-2 months
1
8
Through protruding
6-12 months
4
31
lip of skin on upper
3-6 months
3
23
Lip frenulum
Horizontally through
(“scrumper”)
gums-to-lips
frenulum
Lorum (“LOwer
Horizontally
frenUM)
between penile
shaft and scrotum
Lowbret (“LOWer
Oral-to-surface just
laBRET”)
above the lowest
portion of lower
mouth/gums
Navel
Appendix C - 133
or lower portion of
6-8 months
1
8
4-12+ months
1
8
6-9 months
1
8
~3 months
1
8
5-12 months
1
8
9-12 months
1
8
Vertically,
3-6 months
3
23
horizontally, or
3-5 months
2
15
diagonally through
2-6 months
2
15
base of nipple,
6-12 months
1
8
where the nipple
6-9+ months
1
8
meets the areola
1-3 months
1
8
2-4 months
1
8
2-3 months
1
8
9-12 months
1
8
Vertically,
3-6 months
3
23
horizontally, or
4-6 months
2
15
diagonally through
2-6 months
2
15
base of nipple,
3-5 months
1
8
where the nipple
6-9+ months
1
8
meets the areola
1-3 months
1
8
2-4 months
1
8
2-3 months
1
8
9-12 months
1
8
Through the nostril,
2-3 months
4
31
typically at the
6-12 months
2
15
horizontal crease
2-4 months
2
15
2-12 months
1
8
6-9+ months
1
8
1-3 months
1
8
3-6 months
1
8
6-10 weeks
1
8
Enters in the end of
6-8 weeks
3
23
the urethra and
2-6+ weeks
1
8
exits where the
4-9 weeks
1
8
glans meets the
4-6 weeks
1
8
underside of the
2-8 weeks
1
8
navel
Female Nipple
Male Nipple
Nostril
Prince Albert
Appendix C - 134
penile shaft
Princess Albertina
Enters the urethra
6-8 weeks
1
8
3-4+ months
1
8
Enters in the end of
4-6 months
3
23
the urethra and
6-8 months
1
8
exits where the
2-8 weeks
1
8
Horizontally through
2-3 months
4
31
surface of out layer
6-10 weeks
2
15
of scrotal tissue
3-4 months
1
8
6-8 weeks
1
8
Horizontally through
2-3 months
4
31
nasal septum
6-8 weeks
4
31
1-3 months
2
15
2-6 months
1
8
4-6 weeks
1
8
4-9 months
1
8
Runs parallel to the
4-12 months
2
15
surface of the skin,
8-12 months
1
8
entering and exiting
3-? Months
1
8
Vertically through
6-8+ weeks
3
23
the mid-line of the
4-6 weeks
3
23
tongue
2-3 months
2
15
4 weeks
1
8
3-6 weeks
1
8
4-8 weeks
1
8
1 month
1
8
3-6 weeks
2
15
1 month
1
8
and exits in
membrane between
the urethra and
introitus
Pubic
Surface piercing at
upper base of penis
Reverse Prince Albert
glans meets the
upper side of the
penile shaft
Scrotum (hafada)
Septum
Surface
on the same plane
Tongue
Tongue web, Lip
Horizontally through
frenulum
frenulum between
Appendix C - 135
base of tongue and
bottom of mouth
Transverse lobe
Transverses the
3-6 months
2
15
Horizontally through
8-10 weeks
2
15
base of clitoral
3-6 months
2
15
hood, passing
3-4+ months
1
8
underneath the
4-6 months
1
8
2-3 months
1
8
lower earlobe
Triangle
clitoris
Vertical lip/labret
Vertically through
lower lip, entering
below lip and
exiting at top of lip
N = 13
Descriptions of piercings summarized from Mass (2001).