Body Piercing: Medical Consequences And Psychological .
REVIEWReviewBody piercing: medical consequences and psychologicalmotivationsAglaja StirnBody piercing is increasing in popularity around the world. In this review, I describe the history, origins, andpeculiarities of various forms of body piercing, and procedures involved, variations in healing time, legal aspectsand regulations, and complications and side-effects. I have also included a discussion of the motivation for andpsychological background behind body piercing. In presenting research results, I aim to raise awareness of themany risks associated with body piercing. In presenting psychological data, I intend to create an understanding ofthe multifaceted and often intense motivations associated with body piercing, and, thus, to diminish any prejudicesheld by health professionals against people with piercings.Body piercing is defined as “a penetration of jewellery intoopenings made in such body areas as eyebrows, helix ofthe ears, lips, tongue, nose, navel, nipples, and genitals”.1,2Piercing of the earlobe (table 1), referred to as earpiercing, which has traditional roots in western societies,is not included in this definition, and is distinguished frompractices that do not have a traditional background inwestern societies. Kelly Muldoon,3 however, hassuggested that what was once considered traditional—ie,single hole ear piercings—has now come to includepiercings above and below the neck.3 Body piercing sitesother than the face are also called “intimate”4 or “nonmainstream”.5 By comparison with tattoos, ear and bodypiercings are not considered permanent by practitioners ofbody art, because the tracts, especially if small, can close ifjewellery is removed for a period of time. However, inregulatory legislation, definitions are kept wider andpermanence is judged differently. For example, inlegislation in the state of Virginia, USA, body piercing isdefined as “the act of penetrating the skin to make a hole,mark or scar, generally permanent in nature”.6 In thisreview, I include earlobe piercing in the definition of bodypiercing, especially with respect to medical complicationsand side-effects.Published online March 4, .pdfKlinikum der Johann-Wolfgang-Goethe-Universitaet, Klinik fuerPsychosomatische Medizin und Psychotherapie,Psychotherapeutische Ambulanz (Hs 93), Heinrich-HoffmannStrasse 10, D-60528 Frankfurt am Main, Germany (A Stirn MD)(e-mail: stirn@em.uni-frankfurt.de)PrevalenceBody piercing and other body modifications haveincreased tremendously in popularity in recent years, andhave started to be practised across many social and agegroups.7 However, no exact statistics for these practices areavailable, and estimates of incidence have been derivedfrom studies with few participants. Estimates of theprevalence of the related body modification of tattooing inthe USA lie between 7 million and 20 million people—thehigher estimate is equivalent to around 13% of thepopulation.8 These data suggest the possibility that thenumber of pierced individuals is even greater, especially ifthose with ear piercing are included. Gauntlet, a chain ofpiercing shops located in California and New York in theUSA and in Paris in France, reported doing at least 30 000new piercings per year in the late 1990s.9 Results from asurvey among 481 college students in New York showedthat 42% of the men and 60% of the women surveyed hadbody piercings.10 In 2000 in Australia, a random sampleSearch strategyThe material covered in this review was obtained from in-depthresearch, extensive field-work, and personal knowledge. Isearched Medline, PSYNDEX, PsychLit, and PubMeddatabases of English, German, and French articles publishedfrom 1966 until December, 2002, using the search term“piercing” (578 references), and then narrowing results toarticles relevant to “body piercing” and “ear piercing”. Ireviewed sources mentioned in the bibliographies of thesereferences for additional citations, and have thus includedrelevant books. Additionally, I did an extensive internet searchfor “piercing”, and narrowed results as before.THE LANCET Published online March 4, 2003 1For personal use. Only reproduce with permission from The Lancet Publishing Group.
REVIEWbody piercing in one way or another include surgeons,accident and emergency doctors, radiologists, urologists,gynaecologists, obstetricians, dentists, dental surgeons,otolaryngologists, internists, paediatricians, sportsphysicians, psychiatrists, and psychotherapists. Thesespecialists should be familiar with issues that may beconcerned with body modification, be able to discuss thetopic from an informed and non-prejudiced perspective,and have access to up-to-date information to enablethem to advise people with, or who are contemplating,body piercing. However, prejudices and negativeattitudes towards body-modified individuals seemcommon even among health professionals.16Rights were not granted to include thisimage in electronic media. Please referto the printed journal.Figure 1: Removal of a tongue piercingsurvey of 10 030 individuals aged at least 14 years showedthat 10% had had a tattoo at some point in their lives and8% had some form of body piercing.11 The number ofindividuals with body piercings in western societies is stillrising and has not yet reached its peak.In this article, I present the various contemporary formsof body piercing, their history and origins, and expose thepeculiarities of piercing practices and summarise researchresults from various medical faculties. I have paid specialattention to studies in psychosomatic medicine andpsychotherapy, and, in addition to data from medicalstudies, have analysed results from the few studies thathave been undertaken by psychologists, socialanthropologists, and sociologists.Effect on health-care systemsBody piercing confined to the ears, mouth, and nose hasbeen a common practice in almost every society aroundthe world as far back as can be traced.17 Furthermore,body piercing is practised by contemporary tribalsocieties on almost all continents (figure 2), butespecially in Africa, Asia, and South America. Next tobeauty and community affiliation, the main motivationsfor body piercing in tribal societies are ritual initiation,rites of passage, and sexuality. The ability to stand painis closely linked to passing through adolescence toadulthood, and is often commemorated by bodypiercing. The piercing of the male genital region hasbeen confirmed only in a few tribes in Borneo, who wearbone implants (palang) in the glans.18 In many tribalsocieties, body piercing is connected to other forms ofbody modification such as tattooing, encumberments(wearing iron, stone, or cane rings as heavy bracelets,anklets, neck ornamentation, footwear, manacles,encasements, chains, penile rings, etc), or compressionof limbs through tight bands. Piercing of earlobes or lipsmostly starts at an early age and frequently involvesgradual stretching and widening of the resulting holesover time (figure 3).Practitioners of various Asian religious traditions suchas shamans in animistic or semianimistic religionsperform temporary ritual piercings through their cheeksor tongue as an extroverted documentation of their stateof trance. Similar piercings are seen in the followers ofSufism, the mystical form of Islam, and in adherents ofextreme forms of Hinduism in India, Sri Lanka, andMalaysia—both in ascetics (sadhus) and in lay people.19In ceremonies dating from as early as the ancient MayanReports of side-effects and complications associated withbody piercing are increasing. These side-effects arethought to have an economic effect on health-caresystems.12 In a 1999 UK survey, 95% of familypractitioners in Bury and Rochdale stated they had seenpatients with a complication resulting from a piercing.13Among Pace University undergraduates in NY, USA,17% reported a medical complication such as bleeding,tissue trauma, or bacterial infectionrelating to body piercing, especially of thenavel.11 Emergency situations, such astrauma and bleeding (including motorvehicle accidents, aspiration of the tongueor mouth jewellery, or interference withintubation) when speed of treatment iscrucial and health-care professionals areunsure about how or when to removejewellery,14 can be especially problematicRights were not granted to include this image in(figure 1). In a survey of 28 accident andemergency doctors, only six were able toelectronic media. Please refer to the printed journal.accuratelydescribetheopeningmechanisms of the commonly used typesof jewellery in body piercing.15 Suchknowledge is essential for fast action incase of emergency.General instructions on dealing withbody piercings to inform a wide range ofmedical practitioners are not ionals likely to be involved with Figure 2: Nose piercing in Australian Aboriginal Man2Panos PicturesAPHistory, origins, and global significanceTHE LANCET Published online March 4, 2003 For personal use. Only reproduce with permission from The Lancet Publishing Group.
REVIEWRights were not granted to include thisimage in electronic media. Please referto the printed journal.APcivilisations (700 AD), whose royalty pierced theirtongues and genitals as part of religious bloodlettingrituals,20 devotees pierce their bodies on special religiousoccasions (figure 4), often in multiple ways, or wearkavandis (frameworks of sharp metal rods that penetrateincreasingly deeper into the flesh the longer they areworn).21 Practitioners intend to show their devotion to acertain deity or to “break the illusionary boundaries ofthe ego as it is dictated by the body in order to reachhigher states of consciousness”.22 A quite similar conceptexisted among North American Indian populations, suchas the Mandan and the Lakota, who underwent ritualsuspensions from chest piercings (Sun dance, O-Kee-Pa)to attain altered states of consciousness.23Names for and interpretations of the significance ofbody piercings, especially of rather extreme forms, havebeen made up by promoters of body art in westernsocieties to increase interest in the practice.17 Reliablehistorical evidence of ancient piercing practices existsonly for penis piercings to which jewellery is attached, asdocumented in the Kama Sutra.24 Egyptian Pharaohspiercing their navels as a rite of passage is more myththan fact, and Roman and Greek athletes attaching theirtunics to their bodies by a nipple piercing is pureinvention.17By the Victorian era, mentions of female nipplejewellery can be found in journals,17 and male genitalpiercing was possibly also being practised. One of themost popular types of male genital piercings, the PrinceAlbert, is named after Queen Victoria’s husband. Albertsupposedly wore a penile ring, which he called a dressingring, to firmly secure his genitals in either the right or theleft leg of the extremely tight uniform trousers of theperiod.19 However, historical evidence for thisinterpretation is disputed.17 Little is known about thepractice in the 19th and the beginning of the 20thcentury. However, solid evidence shows that tongue,nipple, and labia piercings were done, often togetherwith tattoos, in Germany shortly after World War II.25Body piercing was probably also common before the warand existed in the USA or the UK, along with the wellknown and documented practice of tattooing.In connection with a renaissance of body modificationpractices such as tattooing, piercing became commonamong members of the punk movement towards the endof the 1970s in Europe, at first with simple safety pins,and then, probably because of allergic reactions, withFigure 4: Singapore Hindu man in Hindu Thaipusamprocession, Singaporeincreasingly finer alloys of niobium or titanium. Punks’self-wounding decorations signified mutilation and thussocial stigmatisation. They created a counterculture thatwas supposed to shock and provoke, which wasinterpreted as an expression of a feeling of impotence ina competitive society.26 At the same time, body piercingbecame popular among homosexual and sadomasochistsubcultures in the USA and UK. Fashion designers tookpiercing, along with punk and sadomasochistic styles, asan inspiration, and these trends had repercussions onmainstream taste. Body piercing also became atrademark among idols of the music and film scenearound this time.27During the past 20 years, body piercing has becomecommon in the USA, the UK, France, Germany, andother western countries. Previously identified exclusivelywith individuals outside mainstream society, bodypiercing is gaining widespread popularity, especially withadolescents.28 In 1997, the Hartford Courant cited thetattoo industry (of which body piercing practice is apart) as being among the top six fastest growingbusinesses.29 Recent developments in body art heapplication of a heated material to theskin; cuttings—designs cut into the skinusing a sharp blade, leaving a fine scar;and implants—implantation of threedimensional objects under the skin for thepurpose of affecting a sculptural changeof the surface.Aglaja StirnRegulationsFigure 3: An Apa Tani woman from northeast India with wooden disks in piercednose and earlobesBody piercing is done in regulated andunregulated shops, department stores,jewellery shops, homes, or physicians’offices. Generally no antibiotic is used,and sterilisation methods vary. Earpiercing is frequently done in beautysalons or jewellery stores, and bodypiercing often takes place in tattooestablishments. In general, body piercingis in the hands of unlicensed personnel,who have learned techniques frommagazines, videos, and other people whodo piercings (piercers).30 Although someTHE LANCET Published online March 4, 2003 3For personal use. Only reproduce with permission from The Lancet Publishing Group.
REVIEWpractitioners claim to be certified, there are no officialagencies that grant certification and it is up to the piercer tounderstand and use aseptic techniques and steriliseequipment correctly. In a highly unregulated industry,uninformed clients have difficulty knowing whether thepiercer is using proper procedures and equipment.However, self-interest groups and associations have beenfounded by professional piercers and tattooists in severalcountries to promote good practice. They provide onlineguidelines for hygiene and techniques, and work in closeassociation with health workers on the development ofmodel codes for comprehensive approaches and consistentregulations.31–34Despite the industry’s rapid growth, the USA has nouniversal regulations for body art practitioners. Only 13(26%) states apply some regulatory authority over tattooingestablishments, and only six of these exercise authority overbody-piercing establishments.32,35In the UK, the local government (miscellaneousprovisions) act of 1982 relates only to tattooing, acupuncture, electrolysis, and earlobe piercing, which reflects the lowincidence of other forms of piercing at the time thelegislation was framed.36 Female genital piercings are notpermitted under the UK prohibition of female circumcisionact, 1985, which prohibits cutting, piercing, or otherwisemodifying female genitalia for non-medical reasons.4 In theUK, only London Boroughs have any powers to inspectbody piercers.13 After a recent department of healthconsultation exercise,37 however, proposals have been putforward to introduce relevant legislation, albeit alongside thederegulation of other forms of skin piercing.384The European Union has issued a general prohibition ofpiercing jewellery containing nickel, which becameeffective, for example, in Germany in June, 2000.39 InGermany, hygiene regulations in piercing and tattooestablishments are enforced by local health departments.Several programmes have been developed for bettercompliance of piercing and tattoo establishments in termsof maintaining hygiene standards, at times in cooperationwith tattoo establishments.40,33Sites and proceduresEarlobes and ear cartilage are the sites most frequentlypierced. Other body parts that are often pierced includeeyebrows, nose, cheeks, lips, frenulum, tongue, uvula,nipple, navel, and various genital sites (tables 1–5).Piercings in less frequently used sites, including flatsurfaces such as the chest wall or the palm of the hand,have a high rate of rejection.23Body piercing is usually done without anaesthesia. Ahollow 12–18-gauge needle is passed through the bodypart and body jewellery inserted in the hole. A commonside-effect is bleeding, which can be substantial in certainsites. Piercing guns can lead to tissue crushes and aredifficult to sterilise. The type of jewellery used depends onthe body part and has to be appropriate in length andwidth to accommodate the swelling that follows thepiercing procedure. The alloy should be composed ofsurgical grade steel, niobium, titanium, or 14 or 18 caratgold to avoid skin reactions to brass or nickel.41 Healingtimes for body piercing vary substantially with the site(tables 1–5).THE LANCET Published online March 4, 2003 For personal use. Only reproduce with permission from The Lancet Publishing Group.
REVIEWHealth effects and complicationsGeneralThe rate of acute complications resulting from bodypiercing is determined by piercing site, material,practitioner experience, hygiene, and aftercare (table 6).Local infection or bleeding is reported in 10–30% ofpiercings.42–44 In the UK, 95% of family practitionersreported treating medical complications arising from bodypiercing in various sites: navel (40%), ear (35%), nose(12%), nipple (5%), and 8% split between tongue, chin,eyebrows, and genitals.13 Infection was the most commoncause of complication accounting for 78% of all admissions.Typical symptoms are redness, swelling, warmth, pain, andpurulent drainage. The most common causal agents areStaphylococcus aureus, group A streptococcus, andPseudomonas spp, which can cause life-threateningcomplications even in the earlobe.42 However, the incidenceof severe complications in the ear region is below 1%.44The risk of sexually transmitted diseases (STD) varieswith the circumstances and hygiene of the piercingprocedure.12 Viral transmission is another risk (hepatitis B,C, D, or G), and a few cases of fatal fulminant hepatitishave been described immediately after piercing.42,45,46However, whether piercing is a general risk factor forhepatitis infection is unclear.47–49 HIV infection can probablybe transmitted by piercing.42 In general, both piercer andrecipient risk transmission of viral and bacterial infectionsfrom exposure to contaminated needles or instruments.12Transmission of tetanus, leprosy, and tuberculosis havealso been reported.42,50,51Pseudolymphoma or lymphadenopathy can occur in anyindividual who has been pierced.52 Any break in the skincan expose a person to the danger of a local infection as wellas systemic illness. Cellulitis or abscesses can result frominfection invading surrounding tissue. In extreme cases,infection can become systemic, especially if local infectionis not properly treated or immune response is impaired.53–55Scars and keloid scars can also result.41,56THE LANCET Published online March 4, 2003 5For personal use. Only reproduce with permission from The Lancet Publishing Group.
REVIEWOperating theatre proceduresHealth professionals working in operating theatres must beclear about policy and procedures concerning piercings.Electrical burns can occur if body jewellery is worn andexposed to a current, as occurs during electrocauterisation.Also, all piercing jewellery must be removed beforemagnetic resonance tomography procedures. Jewellerymay be removed—id
jewellery can be found in journals,17 and male genital piercing was possibly also being practised. One of the most popular types of male genital piercings, the Prince Albert, is named after Queen Victoria’s husband. Albert supposedly wore a penile ring, which he called a dressing ring, to firmly secure his genitals in either the right or the
Jul 31, 2018 · Strategies Regarding Corporate Veil Piercing and Alter Ego Doctrine July 31, 2018 2. Strategies Regarding Corporate Veil Piercing and Alter Ego Doctrine. Overview. 1. “Piercing the Corporate Veil” and “Alter Ego” Liability 2. Case Studies 3. Minimizing the Risk of “
The self-piercing rivet, top sheet, and bottom sheet were treated as deformable bodies. During the SPR process, the holder and die held the two sheets. Six pairs of contacts exist in this self-piercing process. The self-piercing rivet contacts both sheets at rivet bottom, inside the rivet's semitubular shank and outside the rivet's semitubular .
circumstances to "pierce the corporate veil.” B. Piercing the Corporate Veil A short discussion cannot do justice to the developments in the area of corporate veil piercing in Texas over the last 20 years; however, a brief summary is provided below. 1. Alter Ego Theory Traditionally, most veil piercing cases were premised on the alter ego theory.
Texas Supreme Court ' Pertuis, 423 S.C. at 655, 817 S.E.2d at 280. Piercing the corporate veil "Piercing the corporate veil is a common law doctrine by which courts disregard the separate cor-porate entity in particular circum-stances and impose liability on the participants behind the entity's veil" Robert B. Thompson, Piercing
Body piercing includes piercings of body sites other than the earlobe, such as the face, nose, nipple, genitalia, tongue, lip, brow and others. Upon completion of the piercing, jewellery is inserted into the piercing site. Infection risk: Microorganisms can infiltrate the tissue under the skin or mucous membrane at the
applied. As one such technology, the self-piercing riveting (SPR) method is gaining much attention. The fatigue strength of the SPR joints has been investigated by a number of authors for a number of materials [1-5]. For example, Fu and Mallick [1] examined the static and fatigue strengths of self-piercing rivet joints in aluminum alloy sheets.
Piercing the Corporate Veil as a Remedy of Last Resort after Prest v Petrodel Resources Ltd: Inching towards Abolition? Dr Edwin C. Mujih* Abstract This article analyses the veil-piercing rule in the light of the June 2013 decision of the Supreme Court in Prest v Petrodel Resources Ltd. The article examines many issues relating to the rule
FoNS guidelines for writing a final project report July 2012 1 Guidelines for writing a final project report July 2012 FoNS has a strong commitment to disseminating the work of the project teams that we support. Developing and changing practice to improve patient care is complex and we therefore believe it is essential to share the outcomes, learning and experiences of those involved in such .
