Genital Piercings: What Is Known O C And What People With .
UNJ June 2006-173.ps5/16/063:35 PMPage 173Genital Piercings: What Is KnownAnd What People with GenitalPiercings Tell UsCONTINUINGMyrna L. ArmstrongCarol CaliendoAlden E. RobertsNurses in many practicearenas are encountering clients with bodypiercings in visible(face and ears) and semi-visible(navel, nipple, and tongue) sites.Nurses caring for patients withurology problems are encountering more patients with bodypiercings in intimate sites suchas the genitals. For example:While performing a physicalassessment, the professionalnurse discovers that the 25-yearold female client is wearing twosilver rings on her labia.A 32-year-old male presentswith a groin injury. During theexamination, the urologic nursenotices several pieces of jewelryin his scrotum and penis.As the proliferation of bodypiercings continues so will numbers of clients who seek care fortreatment of adverse effects.These patients may present forMyrna L. Armstrong, EdD, RN,FAAN, is a Professor, Texas TechUniversity Health Sciences CenterSchool of Nursing, Texas TechUniversity – Highland Lakes, MarbleFalls, TX.Carol Caliendo, ND, CNM, CRNP, isDean, College of Professional Studies,and a Professor, School of Nursing,Carlow University, Pittsburgh, PA.Alden E. Roberts, PhD, is aProfessor, Department of Sociology,Anthropology, and Social Work, TexasTech University, Lubbock, TX.Nurses need information about people with genital piercings so thatthey may provide non-judgmental, clinically competent care. Thegenital piercing procedure, types of genital piercings, informationfound in the health care literature, and data from 37 subjects whohave self-reported genital piercings are presented.health care for a variety of physical conditions, including piercing-related infections, bleeding,nerve damage, or allergic reactions (Meyer, 2000).For health care providers, thephysical aspects of treatment andcare may pose a dilemma, but somight their personal reaction tothe genital piercings. The authorshave overheard the followingtypes of responses to the abovesample client interactions, “Whywould someone do such athing?” and “Are these peoplenormal?” Others have been heardto exclaim, “They must be sexfiends,” or “Watch out! Thesepeople have lots of STDs andother awful diseases.”Professional nurses may notagree with or accept the practiceof genital body piercing, normake the choice to have anythingbut their own ears pierced. Infact, just the thought of piercingthe genitals may provoke feelingsof discomfort and distaste bothpersonally and professionally.Additionally, lack of knowledgeand understanding of these clientpractices may challenge thenurse’s ability to provide nonjudgmental care. Some healthprofessionals feel that peoplewho choose to have body piercings deserve whatever outcomeoccurs (Ferguson, 1999). In contrast, this type of body art couldbe a meaningful part of theclient’s human behavior (Meyer,2000), including a deliberatemodification of one’s appearancesimilar to what Shilling (1997)and Atkinson (2002, p. 219) call“purposive body projects.”The focus of this article is toaddress the (a) genital piercingprocedure, (b) various types ofgenital piercings, (c) genitalpiercing information, includingrecent information about complications and treatment found inthe health literature, and (d) datafrom 37 subjects who have selfreported genital piercings. Thesesubjects were part of a larger studyreported elsewhere (Caliendo,Authors’ Note: Parts of this work were funded by Carlow College Office ofSponsored Programs, Iota Mu and Zeta Sigma Chapters, Sigma Theta Tau,International, and the Texas Tech University Health Sciences Center School ofNursing Research and Practice Committee.Note: CE Objectives and Evaluation Form appear on page 180.UROLOGIC NURSING / June 2006 / Volume 26 Number 3173EDUCATION
UNJ June 2006-174.psCONTINUINGEDUCATION5/16/063:35 PMPage 174Armstrong, & Roberts, 2005). Oneaim of that research was to seekfurther information about individuals with genital piercings, fromthose who actually have genitalpiercings. The information contained in this article is additionalanecdotal information not reported in that study.Genital Piercing ProcedureAccording to Ferguson (1999),genital piercings are “largely aWestern phenomenon” (p. 29).They are created similarly to general body piercings but the procedure should always be doneby highly experienced piercers(Christensen, Miller, Patsdaughter,& Dowd, 2000). No state or countyordinance regarding body art inthis country seems to be requiring special procedures or bodypiercer expertise when performing genital body procedures(Armstrong, 2005).To perform a genital piercing,the skin is cleaned, the locationmarked, and a 12 to 16-gauge hollow needle (with a piece of jewelry attached to it) is threadedthrough the skin. As smallamounts of bleeding and serosanguinous fluid usually emergefrom the pierced site when thepuncture track is made, hepatitisB and C will always be a potential risk (Armstrong, 2004;Tweeten & Rickman, 1998).However, the use of a new, sterileneedle for each piercing andmeticulous attention to universalprecautions should minimizethis risk. Various amounts ofpain are reported at the time ofpiercing (Hansen, Olsen, &Langklide, 1998).Proper jewelry (inert nontoxic substances such as surgicalstainless steel, niobium, or titanium) is important to minimizeinfections and allergic responses.Most quality jewelry for genitalpiercings is sold in the piercer’sstudio. Health care providersshould be knowledgeable aboutcorrect removal of jewelry (apotential need with extensive174infection or trauma) as wire cutters often produce further harmto the surrounding tissue. Asillustrated in Figure 1, there aretwo major types of jewelry: thebarbell type and a captive bead.The barbell has either a curved orstraight shank (or post) with ballsat both ends. To remove the barbell, use a forceps to hold theshank of the jewelry, while turning the ball counter-clockwise.The captive bead type has twopieces: a bead, held in place byan incomplete metal circle. Toremove this, release the tensionon the bead by opening the forceps within the ring; doing thiswill cause the bead to “pop” outof place (Halliday, 2005). Jewelrycan collect cellular debris aroundit so wear gloves during theremoval process.Genital sites (see Figure 1) ofthe foreskin, penis, scrotum, clitoris, perineum, and labia are allcommon areas for intimate piercings but creativity abounds inregard to genital piercing.Sometimes other pieces of “inertforeign material such as beads, orpearls, etc.” (Cronin, 2001, p.382) can also be inserted underpenile tissue. These additions,called penis marbles, nodules, orbulleetus, originated in Easterncultures. Piercers will informallysay that more men than womentend to obtain genital piercingsbut no accurate data on the actual incidence by gender is available. For men, the “Prince Albert(PA)” is a common genital piercing, which perforates the urinarymeatus and corona. This frequently affects the flow and aimof the urine stream and may forcemen to sit during urination(Caliendo et al., 2005; Ferguson,1999). While the PA definitelyhas physical disadvantages, theremay be benefits as well. Thistype of piercing has beendescribed as causing “an intenseurethral stimulation during intercourse” (Anderson, Summerton,Sharma, & Holmes, 2003, p. 247).Females tend to have fewerstyles of genital piercings, mostlikely related to less tissue forany attachment of jewelry ontheir anatomical structures(Anderson et al., 2003). Femalepiercings are usually found onthe hood of the clitoris and thelabia (see Figure 1), althoughrecently the “Princess Albertina,” avariance on the Prince Albert, hasbeen reported. This new piercingis done “above, or just inside thevagina orifice” (Halliday, 2005, p.55). International medical literature frequently refers to the Britishlaw, Prohibition of FemaleCircumcision Act of 1985, whichforbidsfemalemutilation;Anderson et al. (2003) believe thisdissuades Britain’s piercers fromtoo much creativity with femalegenital piercings. Stirn (2003)asserts that women with genitalpiercings are trying to preventsexual contacts by guarding theirbody from further violation.However, a study by Millner,Eichold, Sharpe, and Lynn (2005)identified (n 33) increased frequency of sexual desire, level ofdesire, and level of arousal withclitoral hood piercings.Pierced genital sites usuallyheal within a few weeks tomonths, depending on the location and amount of piercings(Anderson et al., 2003), yet infections can arise at any time,whether following the procedure, due to poor aftercare, or asa result of secondary trauma tothe site. Motion in genital locations (erection of the penis) isalso a factor. Any patent tract canexpose a person to local infectionas well as invade surroundingtissues predisposing them to systemic illness, especially if theinfection is not properly treatedin a timely manner. Consistentand conscientiousness dailycleansing of the site post-piercingwith diluted saline solution aswell as an antibacterial soap andwater are important to removemost harmful organisms andaccumulation of discharge.Sexual activity should beUROLOGIC NURSING / June 2006 / Volume 26 Number 3
UNJ June 2006-175.ps5/16/063:35 PMPage 175Figure 1.Common Types of Genital PiercingsFigureDescriptionFemale GenitalOuter or inner labia: Can be placed on any location and often done as multiple piercings. Thethickness of the tissue can accommodate severalpieces of jewelry, sometimes may find those thatwear heavier gauge. Healing time: Inner, 1-3months; Outer: 1-2 months.Clit/clitoris hood: The clitoris (hood) is recommended rather than the clitoral body. Direct clitoral piercing is very painful and can producenerve damage. Either horizontal or vertical piercings are placed. This is said to produce “intenseclitoral sensation during intercourse” (Andersonet al., 2003, p. 249). Healing time: 4-6 weeks.Male GenitalAmpallang or pallang: Not a common piercing. Ahorizontal bar is placed through the center of thehead of the penis, either thru or above the urethra. An experienced piercer is important forexact location, is painful, and can produce heavybleeding. Healing time: 6-8 months (Anderson etal., 2003; Peate, 2000; Stewart, 2001).Apadravya: Another uncommon type of piercing.Vertical piercing through the penis shaft, behindthe head, mostly between the start of the frenulum to the top of the glans. Healing time: 2-5months (Stewart, 2001).Dydoe: Piercing is done through both sides of therim of the glans on circumcised men. Originmight be Jewish. Healing time: 2-4 months(Anderson et al., 2003; Stewart, 2001).Foreskin: Piercing is usually done on both sides ofthe foreskin and closed with rings, deliberatelymaking intercourse difficult. Healing time: 1-2months.UROLOGIC NURSING / June 2006 / Volume 26 Number 3avoided for at least 2 weeks.When sexual activity is resumedafter healing, Stork (2002) andMeltzer (2005) both recommendthe use of two condoms duringintercourse to accommodate thepresence of jewelry in the genitalsite and, thus, diminish thechance of condom breakage.Other suggested genital piercingprecautions include “the use ofgloves for touching.and dentaldams or other appropriate barriers for oral sex” to prevent contamination from body fluids[whether from the client or partner]” (Pokorney & Berg, 1999, p.343).Evaluation and TreatmentOf Potential ComplicationsInterestingly, most of themedical information regardinggenital piercing complicationscomes from the United Kingdom,Germany, and the Scandinaviancountries. It is not known if theypublish more about genital piercings because they are more openabout the topic, if there are moreEuropeans who wear genitalpiercings, or if more complications occur in those countriesbecause there are less stringentpiercing restrictions. Recentlyreported complications include apenis fistula resembling glanularhypospadium(MacLeod&Adeniran, 2004) and a Founier’sgangrene with necrotizing fascitis (Ekelius, Fohlman & Kalin,2005). Paraphimosis, urethralstructures, and hypertropic scarring are also frequently mentioned (Anderson et al., 2003;Jones & Flynn, 1996; Meltzer,2005; Stewart, 2001). Placementof the correct size of jewelry mustaccommodate a “minimal extension of the hardware when thepenis is flaccid and not impingewhen the penis is in an erectstate” (Halliday, 2005, p. 53).Engorgement and priapism couldbe present with penile rings(Meltzer, 2005).Newly created piercingsshould be considered open175CONTINUINGEDUCATION
UNJ June 2006-176.psCONTINUING5/16/063:35 PMPage 176Figure 1. (continued)Common Types of Genital PiercingsFigureDescriptionMale GenitalFrenum: Easy to perform and not as painful, thisis a piercing of the frenulum, or ring(s) whichencircles the head of the penis which snugly fitsin the groove around the glans. Not recommended for circumcised men. A variation of this is thefrenum ladder, multiple barbell piercings downthe midline of the penis. Healing time: 2-3 months(Anderson et al., 2003; Stewart, 2001).EDUCATIONGuiche: Pronounced “geesh.” Piercing donebetween scrotum and anus, behind the testes,usually corresponds above the inseam of pants.Healing time: 3-4 months (Meyer, 2000; Stewart,2001).Hafada: Scrotal skin is pierced somewherebetween the scrotum and penis with either ringsor a barbell. Piercing is not considered painful,and is more decorative than sexual enhancement.Does not penetrate scrotal sac. Healing time: 2-3months (Anderson et al., 2003).Prince Albert: A ring inserted through the externalmale urethra and out the base of the frenulum.One of the most common male genital piercings.Healing time: 1-2 months (Anderson et al., 2003,Meyer, 2000; Stewart, 2001).Three major types ofpiercing jewelry wornby those with intimatepiercingsCaptive Beadwounds and potential sites forinfections. Staphylococus aureusis frequently cultured from manytypes of infected piercing sites(Ferguson, 1999; Halliday, 2005;Meltzer, 2005). When anypierced site becomes infected,176BarbellCurved Barbellearly treatment includes leavingthe jewelry in place so it canserve as a “portal for drainageand healing” (Armstrong, 2004,p. 51). When there is no resolution within a few days, furthertreatment is advised, usuallywith a systemic antibiotic, especially if there are signs of surrounding cellulitis (Halliday,2005).No further information aboutspecific treatment of genitalpiercings could be located. Whathas been documented frequentlyis that if treatment for infectionor other complications is needed,the intimately pierced individualtends to seek consultation firstfrom a professional body piercerrather than a health care professional (Caliendo et al., 2005).Intimately pierced individualsreport strong beliefs that healthcare providers have limitedinformation in regard to genitalpiercings (Armstrong, 2004;Caliendo, 1999; Caliendo et al.,2005).From the Health CareLiteratureInformation about generalbody piercings has been available worldwide for many years.Yet, for genital piercings therehas been limited informationwithin the health literature(Caliendo et al., 2005). When anassumption is published, it iscited frequently without substantiated data (Armstrong, 2004;Ferguson, 1999; Stewart, 2001;Stork, 2002; Tweeten & Rickman,1998).From the review of literatureand within the authors’ own clinical practices, stereotypical assumptions about individuals whochoose genital piercings are noted.These assumptions include: (a)genitally pierced persons belong to“fringe” groups and are differentfrom people in mainstream society(Christensen et al., 2000; Falcon,2000); (b) motives are self-harmand individuals with genital piercings are masochists (Stork, 2002;Waldron, 1998); and (c) there is ahigh incidence of infectious disease, such as hepatitis, HIV, andSTDs (Fiumara & Eisen, 1983;Gokhale, Hernon, & Ghosh, 2001;Jones & Flynn, 1996; Stork, 2002).UROLOGIC NURSING / June 2006 / Volume 26 Number 3
UNJ June 2006-177.ps5/16/063:35 PMPage 177Figure 2.Self-Reported Characteristics of Women and Men withIntimate Body PiercingsAim. The purpose of this paper is to report the findings of a study exploring factors associated with female and male intimate body piercing, withparticular emphasis on health issues.Background. Nipple and genital piercings (intimate piercings) havebecome common types of body art. Scant medical and nursing literatureis available, leading to little understanding of these body modifications byhealth care providers.Method. A convenience sample of intimately pierced individuals (63women and 83 men) from 29 states in the United States of America wassurveyed via an author-developed questionnaire. Questions focused ondemographic characteristics, decision factors, and health problems related to intimate piercings. Self-reported characteristics were comparedbetween female and male participants, and participants were compareddemographically to United States general population.Results. Participants reported wearing nipple piercings (43%), genitalpiercings (25%), and both types (32%). Respondents were significantlyyounger, less ethnically diverse, better educated, less likely to be married,more often homosexual or bisexual, and they initiated sexual activity at ayounger age than the U.S. population. Deliberate, individual decisions forprocurement of the intimate piercings were made. Average purchase consideration was at age 25 (nipple) and 27 (genital); average age to obtainthe piercing was 27 (nipple) and 27 genital. Purposes for obtaining thepiercings included uniqueness, self-expression, and sexual expression.Most participants still liked their piercing (73%-90%). Health concernsrelated to intimate piercings were described by both those with nipplepiercings (66%) and with genital piercings (52%), and included site sensitivity, skin irritation, infection, and change in urinary flow (male genital).Few STDs (3%) were reported and no HIV or hepatitis. Usually non-medical advice was sought for problems — often from the body piercer.Conclusion. Understanding the client rationale is not a necessary prerequisite for providing quality patient care; however, awareness of purposes and decision making in intimate piercing can help nurses to be sensitive to client needs and plan appropriate health education.Reprinted with permission from Blackwell Publishing, Ltd. Reprinted fromCaliendo, C., Armstrong, M.L., & Roberts, A.E. (2005). Journal of AdvancedNursing, 49(5), 474-484.Self-Reported Data fromIndividuals with GenitalPiercingsTo obtain information fromthose who have genital piercings,a 260-item questionnaire requesting objective and subjective datawas sent to interested, intimatelypierced people who answered anational or alternative newspaper advertisement. One hundredforty-six subjects participated inthis study and results are reported elsewhere; a synopsis of thestudy appears in Figure 2(Caliendo et al., 2005).The current discussion concentrates on the data subset of 37subjects who specifically selfreported only genital piercings.General demographic information includes 15 females and 22males; age range 18 to 59 years;residence across 16 states; 84%Caucasian; and 54% single.Almost half had completed somecollege and a quarter had anundergraduate degree. While63% of respondents reportedchurch attendance when growingUROLOGIC NURSING / June 2006 / Volume 26 Number 3up, now they rated their currentreligious faith in two distinctgroups, either moderately strongto very strong (39%) or moderately weak to very weak (39%).Most (84%) reported good toexcellent health with many(73%) having annual physicalexaminations.Over half of the respondents(53%) obtained their genitalpiercing in their home region andpaid between 40 and 75 for thepiercing. Thirty-eight percentreported no bleeding during theactual piercing event. Pain during the procedure ranged from asmall (39%) to a large amount(22%). Healing time was notasked.Participants were asked ifthey considered themselves to berisk takers. One sub
Genital Piercings: What Is Known And What People with Genital Piercings Tell Us Myrna L. Armstrong Carol Caliendo Alden E. Roberts N urses in many practice arenas are encounter-ing clients with body piercings in visible (face and ears) and semi-visible (navel, nipple, and tongue) sites. Nurses caring for patients with urology problems are .
Promoting genital autonomy by exploring commonalities between male, female, intersex, and cosmetic female genital cutting J. Steven Svoboda*1 Attorneys for the Rights of the Child, Berkeley, CA, USA All forms of genital cutting – female genital cutting (FGC), intersex genital cutting,
children, because of the observation in adults that most genital warts contain HPV types 6/11 (and less commonly types 16 and 18) while warts on the hands contain HPV types 1-4 [8, 9]. If genital warts in children are caused solely by sexual abuse, the same HPV types should be found in genital warts in children and adults.
female genital mutilation All regulated health and social care professionals and teachers are now required to report known cases of FGM in girls under 18 identified as part of their work to the police within 1 . This includes genital piercings and tattoos for non-medical reasons
Female genital mutilation/cutting (FGM/C) is an umbrella term for any procedure of modification, partial or total removal or other injury to the female genital organs for non-medical reasons [1]. In 1990 the Inter-African Com-mittee on Traditional Practices Affecting the Health of Women and Children adopted the term 'female genital mutilation'.
Female Genital Surgeries in Africa By THE PuBlIC POlICy ADVISORy NETwORK ON FEMAlE GENITAl SuRGERIES IN AFRICA western media coverage of female genital modifications in Africa has been hyperbolic and one-sided, presenting them uniformly as mutilation and ignoring the cultural complexities that underlie these practices.
Ritual female genital mutilation: management of women during the reproductive years Introduction The term female genital mutilation (FGM), also called female genital cutting or female circumcision, includes all procedures . modifications were incorporated in order to avoid ambiguities
Gross anatomy of female genital organs-1. Gross anatomy of female genital organs-2. Development of female genital organs and tract. Histology. Normal Pap smear under microscopy. . Pathology of female reproductive system Ovaries- neoplastic diseases, cysts (torsion), endometriosis, hemorrhagic corpus
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