Genital Piercings: What Is Known O N and What People with Genital T I N Piercings Tell Us U Myrna L

Home , Ampallang, Apadravya, Dydoe, Genital piercing, Tongue piercing

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C Genital Piercings: What Is Known O N And What People with Genital T I N Piercings Tell Us U Myrna L. Armstrong I Carol Caliendo N Alden E. Roberts G

urses in many practice Nurses need information about people with genital piercings so that E arenas are encounter- they may provide non-judgmental, clinically competent care. The D ing clients with body genital piercing procedure, types of genital piercings, information U piercings in visible found in the health care literature, and data from 37 subjects who N(face and ears) and semi-visible have self-reported genital piercings are presented. C (navel, nipple, and tongue) sites. A Nurses caring for patients with T urology problems are encounter- health care for a variety of physi- ing more patients with body Additionally, lack of knowledge I cal conditions, including pierc- piercings in intimate sites such and understanding of these client O ing-related infections, bleeding, as the genitals. For example: practices may challenge the nerve damage, or allergic reac- N While performing a physical nurse’s ability to provide non- tions (Meyer, 2000). assessment, the professional judgmental care. Some health For health care providers, the nurse discovers that the 25-year- professionals feel that people physical aspects of treatment and old female client is wearing two who choose to have body pierc- care may pose a dilemma, but so silver rings on her labia. ings deserve whatever outcome might their personal reaction to A 32-year-old male presents occurs (Ferguson, 1999). In con- the genital piercings. The authors with a groin injury. During the trast, this type of body art could have overheard the following examination, the urologic nurse be a meaningful part of the types of responses to the above notices several pieces of jewelry client’s human behavior (Meyer, sample client interactions, “Why in his scrotum and penis. 2000), including a deliberate would someone do such a As the proliferation of body modification of one’s appearance thing?” and “Are these people piercings continues so will num- similar to what Shilling (1997) normal?” Others have been heard bers of clients who seek care for and Atkinson (2002, p. 219) call to exclaim, “They must be sex treatment of adverse effects. “purposive body projects.” fiends,” or “Watch out! These These patients may present for The focus of this article is to people have lots of STDs and address the (a) genital piercing other awful diseases.” procedure, (b) various types of Professional nurses may not genital piercings, (c) genital Myrna L. Armstrong, EdD, RN, agree with or accept the practice FAAN, is a Professor, Texas Tech piercing information, including University Health Sciences Center of genital body piercing, nor recent information about compli- School of Nursing, Texas Tech make the choice to have anything cations and treatment found in University – Highland Lakes, Marble but their own ears pierced. In the health literature, and (d) data Falls, TX. fact, just the thought of piercing from 37 subjects who have self- the genitals may provoke feelings reported genital piercings. These Carol Caliendo, ND, CNM, CRNP, is of discomfort and distaste both subjects were part of a larger study Dean, College of Professional Studies, personally and professionally. reported elsewhere (Caliendo, and a Professor, School of Nursing, Carlow University, Pittsburgh, PA. Authors’ Note: Parts of this work were funded by Carlow College Office of Alden E. Roberts, PhD, is a Sponsored Programs, Iota Mu and Zeta Sigma Chapters, Sigma Theta Tau, Professor, Department of Sociology, International, and the Texas Tech University Health Sciences Center School of Anthropology, and Social Work, Texas Nursing Research and Practice Committee. Tech University, Lubbock, TX. Note: CE Objectives and Evaluation Form appear on page 180.

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C Armstrong, & Roberts, 2005). One infection or trauma) as wire cut- styles of genital piercings, most O aim of that research was to seek ters often produce further harm likely related to less tissue for further information about individ- to the surrounding tissue. As any attachment of jewelry on N uals with genital piercings, from illustrated in Figure 1, there are their anatomical structures T those who actually have genital two major types of jewelry: the (Anderson et al., 2003). Female I piercings. The information con- barbell type and a captive bead. piercings are usually found on tained in this article is additional The barbell has either a curved or the hood of the clitoris and the N anecdotal information not report- straight shank (or post) with balls labia (see Figure 1), although U ed in that study. at both ends. To remove the bar- recently the “Princess Albertina,” a I bell, use a forceps to hold the variance on the Prince Albert, has Genital Piercing Procedure shank of the jewelry, while turn- been reported. This new piercing N According to Ferguson (1999), ing the ball counter-clockwise. is done “above, or just inside the G genital piercings are “largely a The captive bead type has two vagina orifice” (Halliday, 2005, p. Western phenomenon” (p. 29). pieces: a bead, held in place by 55). International medical litera- E They are created similarly to gen- an incomplete metal circle. To ture frequently refers to the British eral body piercings but the proce- remove this, release the tension law, Prohibition of Female D dure should always be done on the bead by opening the for- Circumcision Act of 1985, which U by highly experienced piercers ceps within the ring; doing this forbids female mutilation; C (Christensen, Miller, Patsdaughter, will cause the bead to “pop” out Anderson et al. (2003) believe this & Dowd, 2000). No state or county of place (Halliday, 2005). Jewelry dissuades Britain’s piercers from A ordinance regarding body art in can collect cellular debris around too much creativity with female T this country seems to be requir- it so wear gloves during the genital piercings. Stirn (2003) I ing special procedures or body removal process. asserts that women with genital piercer expertise when perform- Genital sites (see Figure 1) of piercings are trying to prevent O ing genital body procedures the foreskin, penis, scrotum, cli- sexual contacts by guarding their N (Armstrong, 2005). toris, perineum, and labia are all body from further violation. To perform a genital piercing, common areas for intimate pierc- However, a study by Millner, the skin is cleaned, the location ings but creativity abounds in Eichold, Sharpe, and Lynn (2005) marked, and a 12 to 16-gauge hol- regard to genital piercing. identified (n=33) increased fre- low needle (with a piece of jew- Sometimes other pieces of “inert quency of sexual desire, level of elry attached to it) is threaded foreign material such as beads, or desire, and level of arousal with through the skin. As small pearls, etc.” (Cronin, 2001, p. clitoral hood piercings. amounts of bleeding and serosan- 382) can also be inserted under Pierced genital sites usually guinous fluid usually emerge penile tissue. These additions, heal within a few weeks to from the pierced site when the called penis marbles, nodules, or months, depending on the loca- puncture track is made, hepatitis bulleetus, originated in Eastern tion and amount of piercings B and C will always be a poten- cultures. Piercers will informally (Anderson et al., 2003), yet infec- tial risk (Armstrong, 2004; say that more men than women tions can arise at any time, Tweeten & Rickman, 1998). tend to obtain genital piercings whether following the proce- However, the use of a new, sterile but no accurate data on the actu- dure, due to poor aftercare, or as needle for each piercing and al incidence by gender is avail- a result of secondary trauma to meticulous attention to universal able. For men, the “Prince Albert the site. Motion in genital loca- precautions should minimize (PA)” is a common genital pierc- tions (erection of the penis) is this risk. Various amounts of ing, which perforates the urinary also a factor. Any patent tract can pain are reported at the time of meatus and corona. This fre- expose a person to local infection piercing (Hansen, Olsen, & quently affects the flow and aim as well as invade surrounding Langklide, 1998). of the urine stream and may force tissues predisposing them to sys- Proper jewelry (inert nontox- men to sit during urination temic illness, especially if the ic substances such as surgical (Caliendo et al., 2005; Ferguson, infection is not properly treated stainless steel, niobium, or titani- 1999). While the PA definitely in a timely manner. Consistent um) is important to minimize has physical disadvantages, there and conscientiousness daily infections and allergic responses. may be benefits as well. This cleansing of the site post-piercing Most quality jewelry for genital type of piercing has been with diluted saline solution as piercings is sold in the piercer’s described as causing “an intense well as an antibacterial soap and studio. Health care providers urethral stimulation during inter- water are important to remove should be knowledgeable about course” (Anderson, Summerton, most harmful organisms and correct removal of jewelry (a Sharma, & Holmes, 2003, p. 247). accumulation of discharge. potential need with extensive Females tend to have fewer Sexual activity should be

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Figure 1. avoided for at least 2 weeks. C Common Types of Genital Piercings When sexual activity is resumed O after healing, Stork (2002) and Figure Description Meltzer (2005) both recommend N the use of two condoms during Female Genital T intercourse to accommodate the I Outer or inner labia: Can be placed on any loca- presence of jewelry in the genital tion and often done as multiple piercings. The site and, thus, diminish the N thickness of the tissue can accommodate several chance of condom breakage. U pieces of jewelry, sometimes may find those that Other suggested genital piercing I wear heavier gauge. Healing time: Inner, 1-3 precautions include “the use of months; Outer: 1-2 months. gloves for touching...and dental N dams or other appropriate barri- G ers for oral sex” to prevent conta- Clit/clitoris hood: The clitoris (hood) is recom- mination from body fluids E mended rather than the clitoral body. Direct cli- [whether from the client or part- toral piercing is very painful and can produce D nerve damage. Either horizontal or vertical pierc- ner]” (Pokorney & Berg, 1999, p. ings are placed. This is said to produce “intense 343). U clitoral sensation during intercourse” (Anderson C et al., 2003, p. 249). Healing time: 4-6 weeks. Evaluation and Treatment Of Potential Complications A Interestingly, most of the Male Genital T medical information regarding I Ampallang or pallang: Not a common piercing. A genital piercing complications horizontal bar is placed through the center of the comes from the United Kingdom, O head of the penis, either thru or above the ure- Germany, and the Scandinavian N thra. An experienced piercer is important for countries. It is not known if they exact location, is painful, and can produce heavy publish more about genital pierc- bleeding. Healing time: 6-8 months (Anderson et ings because they are more open al., 2003; Peate, 2000; Stewart, 2001). about the topic, if there are more Europeans who wear genital piercings, or if more complica- Apadravya: Another uncommon type of piercing. tions occur in those countries Vertical piercing through the penis shaft, behind because there are less stringent the head, mostly between the start of the frenu- piercing restrictions. Recently lum to the top of the glans. Healing time: 2-5 months (Stewart, 2001). reported complications include a penis fistula resembling glanular hypospadium (MacLeod & Adeniran, 2004) and a Founier’s gangrene with necrotizing fasci- tis (Ekelius, Fohlman & Kalin, Dydoe: Piercing is done through both sides of the 2005). Paraphimosis, urethral rim of the glans on circumcised men. Origin might be Jewish. Healing time: 2-4 months structures, and hypertropic scar- (Anderson et al., 2003; Stewart, 2001). ring are also frequently men- tioned (Anderson et al., 2003; Jones & Flynn, 1996; Meltzer, 2005; Stewart, 2001). Placement of the correct size of jewelry must accommodate a “minimal exten- Foreskin: Piercing is usually done on both sides of sion of the hardware when the the foreskin and closed with rings, deliberately penis is flaccid and not impinge making intercourse difficult. Healing time: 1-2 when the penis is in an erect months. state” (Halliday, 2005, p. 53). Engorgement and priapism could be present with penile rings (Meltzer, 2005). Newly created piercings should be considered open

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C Figure 1. (continued) with a systemic antibiotic, espe- O Common Types of Genital Piercings cially if there are signs of surrounding cellulitis (Halliday, N Figure Description 2005). T Male Genital No further information about I specific treatment of genital Frenum: Easy to perform and not as painful, this piercings could be located. What N is a piercing of the frenulum, or ring(s) which has been documented frequently U encircles the head of the penis which snugly fits is that if treatment for infection I in the groove around the glans. Not recommend- or other complications is needed, ed for circumcised men. A variation of this is the the intimately pierced individual N frenum ladder, multiple barbell piercings down the midline of the penis. Healing time: 2-3 months tends to seek consultation first G (Anderson et al., 2003; Stewart, 2001). from a professional body piercer rather than a health care profes- E sional (Caliendo et al., 2005). Guiche: Pronounced “geesh.” Piercing done Intimately pierced individuals D between scrotum and anus, behind the testes, report strong beliefs that health usually corresponds above the inseam of pants. care providers have limited U Healing time: 3-4 months (Meyer, 2000; Stewart, C 2001). information in regard to genital piercings (Armstrong, 2004; A Caliendo, 1999; Caliendo et al., T 2005). I From the Health Care O Hafada: Scrotal skin is pierced somewhere Literature between the scrotum and penis with either rings N or a barbell. Piercing is not considered painful, Information about general and is more decorative than sexual enhancement. body piercings has been avail- Does not penetrate scrotal sac. Healing time: 2-3 able worldwide for many years. months (Anderson et al., 2003). Yet, for genital piercings there has been limited information within the health literature (Caliendo et al., 2005). When an Prince Albert: A ring inserted through the external assumption is published, it is male urethra and out the base of the frenulum. cited frequently without substan- One of the most common male genital piercings. tiated data (Armstrong, 2004; Healing time: 1-2 months (Anderson et al., 2003, Ferguson, 1999; Stewart, 2001; Meyer, 2000; Stewart, 2001). Stork, 2002; Tweeten & Rickman, 1998). From the review of literature and within the authors’ own clinical practices, stereotypical assump- Three major types of Captive Bead Barbell Curved Barbell tions about individuals who piercing jewelry worn choose genital piercings are noted. by those with intimate These assumptions include: (a) piercings genitally pierced persons belong to “fringe” groups and are different from people in mainstream society (Christensen et al., 2000; Falcon, 2000); (b) motives are self-harm and individuals with genital piercings are masochists (Stork, 2002; wounds and potential sites for early treatment includes leaving Waldron, 1998); and (c) there is a infections. Staphylococus aureus the jewelry in place so it can high incidence of infectious dis- is frequently cultured from many serve as a “portal for drainage ease, such as hepatitis, HIV, and types of infected piercing sites and healing” (Armstrong, 2004, STDs (Fiumara & Eisen, 1983; (Ferguson, 1999; Halliday, 2005; p. 51). When there is no resolu- Gokhale, Hernon, & Ghosh, 2001; Meltzer, 2005). When any tion within a few days, further Jones & Flynn, 1996; Stork, 2002). pierced site becomes infected, treatment is advised, usually

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Figure 2. up, now they rated their current C Self-Reported Characteristics of Women and Men with religious faith in two distinct O Intimate Body Piercings groups, either moderately strong to very strong (39%) or moder- N Aim. The purpose of this paper is to report the findings of a study explor- ately weak to very weak (39%). T ing factors associated with female and male intimate body piercing, with Most (84%) reported good to I particular emphasis on health issues. excellent health with many Background. Nipple and genital piercings (intimate piercings) have (73%) having annual physical N become common types of body art. Scant medical and nursing literature examinations. U is available, leading to little understanding of these body modifications by Over half of the respondents I health care providers. (53%) obtained their genital N Method. A convenience sample of intimately pierced individuals (63 piercing in their home region and women and 83 men) from 29 states in the United States of America was paid between $40 and $75 for the G surveyed via an author-developed questionnaire. Questions focused on piercing. Thirty-eight percent demographic characteristics, decision factors, and health problems relat- reported no bleeding during the E ed to intimate piercings. Self-reported characteristics were compared actual piercing event. Pain dur- between female and male participants, and participants were compared ing the procedure ranged from a D demographically to United States general population. small (39%) to a large amount U Results. Participants reported wearing nipple piercings (43%), genital (22%). Healing time was not C piercings (25%), and both types (32%). Respondents were significantly asked. younger, less ethnically diverse, better educated, less likely to be married, Participants were asked if A more often homosexual or bisexual, and they initiated sexual activity at a younger age than the U.S. population. Deliberate, individual decisions for they considered themselves to be T procurement of the intimate piercings were made. Average purchase con- risk takers. One subject said I “sometimes” yet another stated sideration was at age 25 (nipple) and 27 (genital); average age to obtain O the piercing was 27 (nipple) and 27 genital. Purposes for obtaining the “I take calculated risks, not stu- piercings included uniqueness, self-expression, and sexual expression. pid ones.” As to actual high-risk N Most participants still liked their piercing (73%-90%). Health concerns behavior, only 8% reported related to intimate piercings were described by both those with nipple drinking or using drugs before piercings (66%) and with genital piercings (52%), and included site sensi- their genital piercing procedure tivity, skin irritation, infection, and change in urinary flow (male genital). (routine alcohol consumption Few STDs (3%) were reported and no HIV or hepatitis. Usually non-med- was not asked). A subject com- ical advice was sought for problems — often from the body piercer. mented that it was the “policy of Conclusion. Understanding the client rationale is not a necessary pre- the artist to prohibit alcohol as it requisite for providing quality patient care; however, awareness of pur- thins the blood.” Almost half poses and decision making in intimate piercing can help nurses to be sen- (49%) of the participants report- sitive to client needs and plan appropriate health education. ed no cigarette smoking; however, 30% smoked one-half to one Reprinted with permission from Blackwell Publishing, Ltd. Reprinted from pack or more daily. Caliendo et Caliendo, C., Armstrong, M.L., & Roberts, A.E. (2005). Journal of Advanced al. (2005) have already reported Nursing, 49(5), 474-484. that these respondents denied STDs, HIV, hepatitis, recurrent enlarged lymph nodes, allergies, or urinary tract infections. Self-Reported Data from (Caliendo et al., 2005). While this population is Individuals with Genital The current discussion con- unique just by having genital Piercings centrates on the data subset of 37 piercings, Caliendo et al. (2005) To obtain information from subjects who specifically self- felt the sample did not reveal those who have genital piercings, reported only genital piercings. great differences from main- a 260-item questionnaire request- General demographic informa- stream society. One subject ing objective and subjective data tion includes 15 females and 22 explained: was sent to interested, intimately males; age range 18 to 59 years; I have three adult daugh- pierced people who answered a residence across 16 states; 84% ters (who are also pierced national or alternative newspa- Caucasian; and 54% single. and tattooed) plus two grand- per advertisement. One hundred Almost half had completed some children. We all have forty-six subjects participated in college and a quarter had an respectable jobs — I worked this study and results are report- undergraduate degree. While for the state for 6 years and ed elsewhere; a synopsis of the 63% of respondents reported also have my degree in study appears in Figure 2 church attendance when growing British & Russian history. We

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C aren’t deviants — we’re all opportunity to share my port the surrounding tissue and O well-educated, family people piercing experience. “avoid rejection, migration, or who just live an alternative A female stated: tearing” (Armstrong, 2004 p. 50). N lifestyle. My genital piercing has Respondents reported wearing T Many replied, as one subject made me more interested in jewelry with gauges ranging from I stated, “my piercing was my own sex, and I enjoy it a lot more. 2 to 14. The smaller sizes repre- desire and decision w/plenty of It doesn’t ever bother me, sent very heavy gauge (typically N deliberation (over a year)”; most of the time I can’t even used for males), while the larger U another said “I wanted one for a tell it’s there. I also like the gauges tend to be used for female I long time, but it was only a few fact that if people know I had piercings. One subject described minutes when the opportunity one they would be shocked. what could happen if a heavy N presented itself.” Another sub- When you look at me, you enough gauge is not used: G ject, a health care worker, stated: can’t see any tattoos, just my “I got pierced by an ‘appren- My piercings have not earrings and nose ring (when tice’ and he used the wrong E affected my career. I do not I wear it). A lot of people, gauge...18-gauge ring which discuss or bring up the topic like the people I work with, turned out to be too small in D of [genital] piercings with my think I’m “sweet and inno- diameter to pierce that kind of U patients or co-workers. My cent.” My piercing has com- flesh. Thus 2 years later...the hole C tongue piercing is far enough pletely changed my sex life. had stretched to about a 12 gauge back that it does not inhibit I’m willing to experiment (to or more...some piercers call that A my speech and is not easily an extent), and I’m just more the piano wire effect.” T seen. My tattoos are also cov- open. Of the men (n=22) in this data I ered and not noticeable. Aesthetics also seemed to subset, 17 (77%) had a Prince The three frequently report- surface in the subjective data Albert piercing. One stated: O ed purposes for obtaining their with both genders. The subjects I personally have...a N piercings were sexual expres- spoke of “seeing it and liking it,” Prince Albert (PA)...It is very sion, sexual enhancement, and “I liked the way it looked,” “I pleasurable for both partners uniqueness (Caliendo et al., wanted to visually enhance my during intercourse as for a 2005). One woman said, “I’m vaginal labia,” and “want[ing] to male it rubs and pulls on the more sexual than I use[d] to be.” be unique.” Another called his head of the penis and for the Another subject expressed his piercing a “new accessory for an female adds a rigid rubbing feelings this way: old toy.” sensation and fullness...many In general, I feel good Almost all of the subjects tell me they love their PA about my genital piercing. I reported a daily skin care routine penis piercing except for one had to enlist assistance of my for their genital piercings as minor thing. During urination partner to change out my first washing with antibacterial soap while standing you must hold barbell, because the balls and water in the shower at least your thumb over the point were screwed on too tight. once a day, then rotating the jew- where jewelry enters the penis Other than that, I haven’t had elry, followed by another wash- behind the glans, as the pres- any problems. I feel it has ing and rinsing. “I wash as I sure of the urine stream will enhanced the degree of sexu- always have” was a common force some urine out of a small al pleasure I experience report. Most made comments opening occasionally spray- alone, or with a partner. My such as, “You need to keep your ing their shoes. piercing experience was a hands off the piercings — that’s Three of the males combined declaration of independence, what causes problems.” Emphasis their Prince Albert piercing with and freedom of expression, also was on a thorough cleaning an ampallang and apadravya (see regardless of what anyone around the genital area following Figure 1). Another described a thinks of my piercing. I got it urination and bowel movements. frenum ladder of six barbells run- for me. It was the first deci- Many of the subjects reported ning horizontally toward the sion I got to make alone. only removing the piercings to scrotum. No artificial penile nod- When I turned 18, my body change the jewelry, or as one ules or beads were reported. was finally mine. I got to dec- reported, for short periods of Of the 15 women with geni- orate it as I see fit. It’s like time such as for the “metal detec- tal piercings, seven had clitoral moving into your own place tor at the airport, surgery, and a hood piercings, while six com- for the first time. I can hang MRI at [the] hospital.” bined clitoral hood piercings pictures, posters, repaint, Heavier grades of jewelry (up with labia piercings. One woman and it’s all mine. Thank you to 1.75 inch thick) are recom- reported that she combined geni- for providing me with the mended for genital sites to sup- tal piercings “as a way of honor-

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ing my sexuality.” Another stat- Caliendo, C., Armstrong, M.L., & Roberts, Obstetrics and Gynecology, 193(3), C ed, “My piercings (labia and cli- A.E. (2005). Self-reported character- 675-676. istics of women and men with inti- Peate, I. (2000). Body piercing: Could you O toris) gave me a feeling of control mate body piercings. Journal of answer your patient’s questions? in my life when I needed it.” Advanced Nursing, 49(5), 474-484. British Journal of Nursing, 9(20), 28- N Christensen, M.H., Miller, K.H., 36. T Summary Patsdaughter, C.A., & Dowd, L.J. Pokorney, C., & Berg, R. (Eds.). (1999). I General and subjective infor- (2000). To the point: The contempo- Body art: A comprehensive guide- rary body piercing and tattooing book and model code. Denver, CO: N mation about those who chose to renaissance. HT: The Magazine for National Environmental Health obtain genital piercings was pre- Healthcare Travel Professionals, Association. U sented. Particularly, the assump- 8(1), 38-43. Sackett, D.L., Strauss, S.E., Richardson I tions made from the literature are Cronin, T.A. (2001). Tattoos, piercings, W.S., Rosenberg, W., & Haynes and skin adornments. Dermatology (2001). Evidenced-based medicine: N refuted by objective and subjec- Nursing, 13(5), 380-383. How to practice and teach EBM. tive data collected from intimate- Ekelius, L., Fohlman, J., & Kalin, M. London: Churchill Livingstone. G ly pierced individuals them- (2005). The risk of several complica- Shilling, C. (1997). The body and differ- tions of body piercing should not be ence. In K. Woodward (Ed.). Identity selves. E Professional nurses must not underestimated. Lakartidningen, and difference (pp. 63-121). London: 102(37), 2560-2562, 2564. Sage. base practice decisions on as- Falcon, M. (2000, August 24). Genital Stewart, C. (2001). Body piercing; D sumptions but on the “best evi- piercing: Health-care culture shock. Seductions and medical complica- U dence with clinical experience, USATODAY – Health. Retrieved tions of a risky practice. Medical C research, (as well as) associated September 11, 2000, from www. Aspects of Human Sexuality, 1(5), usatoday.com/life/health/doctor 45-50. A patient values” (Sackett, Strauss, Ferguson, H. (1999). Body piercing. Stirn, A. (2003). Medical consequences Richardson, Rosenberg, & Haynes, British Medical Journal, 319, 1627- and psychological motivations. The T 2001, p. 10). Thus, providing clini- 1630. Lancet, 361(9364), 1205-1215. I cally competent care is driven by Fiumara, N.J., & Eisen, R. (1983). The titi- Stork, B. (2002). Medical complications the latest knowledge and evidence vating penile ring. Sexually of modern art: What you need to O Transmitted Diseases, 10, 43-44. know about body piercing. Advance from research and patient sources. Gokhale, R., Hernon, M., & Ghosh, A. for Nurse Practitioner, 10(1), 59-64. N Data found here provide further (2001). Genital piercing and sexual- Tweeten, S.S.M., & Rickman, L.S. (1998). empirical evidence that may help ly transmitted infections. Sexually Infectious complications of body to improve client outcomes by Transmitted Infections: The Journal piercing. Clinical Infectious of Sexual Health & HIV, 77(5), 393- Diseases, 26(3), 735-740. advancing evidence-based nurs- 394. Waldron, T. (1998). Tattoos, body piercing ing practice in relation to people Halliday, K.A. (2005). Body piercing: are linked to psychiatric disorders in with genital piercings. • Issues and challenges for nurses. youth. The Brown University Child Journal of Forensic Nursing, 1, 47-56 and Adolescent Behavior Letter, References Hansen, R.B., Olsen, L.H., & Langklide, 14(7), 1-4. Anderson, W.E., Summerton, D.J., N.C. (1998). Piercing of the glans Sharma, D.M., & Holmes, S.A. penis. Scandinavian Journal of (2003). The urologist’s guide to geni- Urology and Nephrology, 32, 219- tal piercing. BJU International, 220. 91(3), 245-251. Jones, S.A., & Flynn, R.J. (1996). An Armstrong, M.L. (2004). Caring for the unusual (and what piercing) cause patient with piercings. RN, 67(6), 46- of paraphimosis. British Journal of 53. Urology, 78, 803. CE test located on page 180. Armstrong, M.L. (2005). Tattooing, body MacLeod, T.M., & Adeniran, S. (2004). An piercing, and permanent cosmetics: unusual complication of penile A historical and current view of piercing: A report and literature state regulations, with continuing review. British Journal of Plastic concern. Journal of Environment Surgery, 57(5), 462-464. Health, 67, 38-43. Meyer, D. (2000). Body piercing: Old tra- Atkinson, M. (2002). Pretty in ink: ditions creating new challenges. Need CE Credit? Conformity, resistance, and negotia- Journal of Emergency Nursing, 26(6), tion in women’s tattooing. Sex Roles, 612-614. Visit the “Education” 47(5/6), 219-235. Meltzer, D.J. (2005). Complications of Caliendo, C. (1999). Female intimate body piercing. American Family section at body piercing: A nursing phenome- Physician, 72(10), 2029-2036. nological inquiry. Unpublished doc- Millner, W.S., Eichold, B.H., Sharpe, T.H., www.suna.org toral thesis. Case Western Reserve & Lynn, S.C. (2005). First glimpse of University, Cleveland. the functional benefits of clitoral hood piercings. American Journal of

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