Body Piercing: Issues and Challenges for Nurses

Typical Piercing Locations

Ear piercings can be accomplished at multiple sites of the lobe and pinna. Cartilaginous piercings have the tendency to heal more slowly, and to develop more complications than simple lobe piercings (Stirn, 2003). A complication common to cartilaginous piercings of the ear is known as hypertrophic scarring that occurs in some individuals because of a chronic inflammatory process. In this condition, excessive scar tissue forms around the healing fistula. In addition to normal wound care; some practitioners recommend adding hydrogen peroxide to the cleaning regimen. Hydrogen peroxide is known to be damaging to forming epithelial cells, and can inhibit continued anomalous scar formation (D. Munro, personal communication, November 2, 2004). (see Table 1 )

A common variant for all types of ear piercings is known as gauging. This is the process of stretching an established piercing so that the site can accommodate larger hardware. The hardware may be solid or tunnel style. Although slow gauging is recommended, some individuals chose to seek unlicensed individuals who will scalpel the larger hardware into place to speed the process. Gauging can be as small as a ¼ inch (00 gauge), or greater than 3-inches in diameter.

Miscellaneous facial piercings can include the eyebrow, nares, nasal septum, and the nasal bridge (also known as the earl). Eyebrow piercings tend to lie along the natural hairline of the brow. A variant known as the anti-brow, is located along the lower orbital ridge, or may be placed at the temple. The temple location is not recommended due its proximity to the temporal branch of the trigeminal nerve. The initial temple piercing should not interfere with nerve conduction; however, excessive swelling or infection can cause permanent damage to the underlying nerve tissue in this region (J. Morehouse, personal communication, December 12, 2003). (see Table 2 )

Earl piercings are located at the nasal bridge, between the eyebrows. This soft tissue piercing is prone to a phenomenon called migration. Migration occurs when frequent irritation or movement of piercing hardware, causes the forming fistula to shift. This can lead to an asymmetrical, or tilted, piercing appearance when healed. The incidence of migration is decreased by the use of high-density, low-porosity, non-toxic plastic barbell shafts (C. Shull, personal communication, January 15, 2004).

Nasal piercings can occur at either nare, or centrally at the nasal septum. Traditional earrings should never be worn at these sites as they enhance scarring and granuloma formation. Detachable clasp style jewelry also increases the risk of foreign body aspiration. An additional risk is for the embedding of jewelry into the subcutaneous tissue during swelling that is impeded by the immovable clasp (Cronin, 2001; Stirn, 2003). Piercings of the nares are usually maintained with a captive bead hoop or a post variant known as the nostril screw. The nostril screw is a straight metallic post that has a unique series of bends along its length to secure this hardware into place, and still allow for ease of removal. Nostril screws lie flat against the nasal mucosa to decrease the risk of secondary trauma to the nare. The shape of the nostril screw also provides room for tissue expansion during the inflammatory process.

Though piercings of the nares are cartilaginous, nasal septum piercings pass only through soft tissue. The nasal septum piercing is initially maintained with a U-shaped device. This device can be turned upward so that the ends reside inside of the nostrils. This decreases the risk of traumatic movement during the healing process. This type of hardware is known as the septum retainer. Once healing has completed, this piercing can be maintained with semi-circular barbells, captive bead hoops, or other devices.

Cheek, lip, and tongue piercings are of similar categories, as they all enter the oral cavity. The American Dental Association (ADA) takes a strong position against all oral-piercing styles (2002). Concerns include dental trauma, speech impediments, changes in salivary flow, interference with oral vascular perfusion patterns, and risk of secondary infection. (see Table 3 )

Cheek piercings are named according to their location on the face and maintained with a variant of barbell jewelry. Instead of two balls on either end of the barbell, there is one ball on the external surface, and a flat disk on the interior surface. These barbell variants are known by the term flat backed labret (see Figure 1). In a patient with poor oral hygiene or poorly fitted hardware, there is risk of gingival irritation, erosion, or infection (ADA, 2002).

Tongue piercings are maintained with straight barbells, and are initiated anterior to the lingual frenulum at the midline. Extreme swelling can occur as part of the inflammatory response, so longer bars are placed initially. After the initial swelling has subsided, this bar should be replaced with one shorter and more appropriate in length for the individual. Due to the tongue's highly vascular nature, location in the upper airway region, and proximity to the central nervous system, this piercing has the highest risk of complications (Stirn, 2003).

Navel piercings are becoming quite common (Armstrong, 2004). Healing times vary according to personal anatomy, hygiene, and clothing styles (Stirn, 2003). This piercing can accommodate either a captive bead or curved barbell. Circular captive bead hardware extends beyond the body surface and receives more friction during normal wear, which can delay the healing process. Curved barbells tend to sit flush with the skin surface during wear, receive less friction, and tend to heal more rapidly. (see Table 4 )

Rejection is a common occurrence with poorly placed navel piercings (C. Shull, personal communication, January 15, 2004). This process can occur at any highly mobile, fairly flat piercing site. Rejection is related to a chronic inflammatory process during which several stages of attempted healing occur simultaneously. The offending object, in this case the piercing hardware, is walled off from the body with necrotic tissue. The hardware is then pushed out of the body laterally. New scar tissue is formed as this process progresses. Once initiated, this is a slow and inevitable process.

Nipple piercings are popular with both men and women. This piercing crosses the nipple base, but not through the areola (see Figures 2a & 2b). The fistula can be placed horizontally, vertically, or diagonally (APP, 2002). Many find this piercing pleasurable; others find this piercing simply ornamental (C. Shull, personal communication, January 15, 2004). Newer ornamentation includes a device known as a nipple shield. This decorative metal disk is held in place over the areola by use of barbell jewelry through the nipple piercing. Important potential complications include mastitis, spontaneous milk production in females, and localized infection (Stirn, 2003).

The term "surface piercing" includes a wide range of locations. This term is used to identify the piercing of anatomically flat locations. Flat piercing sites are difficult to retain with metal hardware and are best maintained with high-density, low-porosity, non-toxic plastics. Recommended materials include Tygon (S-54-HL) and PTFE (polytetrafluoroethylene) (APP, 2000). These materials are hollow tubes, which can accommodate threaded balls that would normally be attached to internally threaded barbell style jewelry (APP, 2002). Surface piercings can be found on the nape of the neck, chest wall, forearms, pubis, sternal notch, and other locations. (see Table 4 )

Genital piercings have been documented throughout human history. It has been reported that the majority of individuals who choose genital modifications are over the age of 30 (Larkin, 2004). Men with genital piercings are found in both the heterosexual and homosexual communities (Stirn, 2003). Many men find these piercings attractive and find urethral stimulation arousing (Perforations, n.d.). Men may choose these piercings for simple ornamentation or for their partner's pleasure (C. Shull, personal communication, September 16, 2003). (see Table 5 and Table 6 )

Stirn (2003) notes a study that reports female genital piercing is strongly related to overcoming past trauma and is often a therapeutic action toward healing. Some women choose genital modifications after dysfunctional sexual relationships (Stirn, 2003). Like men, some women chose these piercings simply as ornamentation (C. Shull, personal communication, September 16, 2003).

During the Victorian era, tailors performed a penile piercing - known as a dressing ring - to allow men to secure their penis to their clothing and provide a smoother appearance while wearing tight trousers (Larkin, 2004; Stirn, 2003). This is the accepted origin of the most common male genital piercing, the Prince Albert, or the PA (see Figure 3). This piercing enters the penile urethra and exits the inferior surface of the penis at the frenulum. Depending on the gender of the receiving partner and sexual position used, this transurethral piercing can stimulate the male partner's prostate, or female partner's G-spot. The reverse PA (Figure 4) also enters the male urethral orifice, but exits the superior surface of the penile glans. When compared to the PA, healing times tend to be longer for this variant, as there is more tissue between the urethra and the exit site. The apadravya (see Figure 5) can be considered a blend of the PA and reverse PA. Frequently individuals who want this piercing will begin with a PA, then obtain a reverse PA, and later change the jewelry to allow these separate piercings to become an apadravya. Since each of these piercings transect the urethra, diversion of urinary and seminal flow is a common occurrence (Stirn, 2003). (see Table 5 )

The ampallang (see Figure 6) is a horizontal transcoronal piercing. Depending on the consumer's preference, and piercer's skill, this piercing may or may not cross the urethra.

Jewelry sizing is an important concern with all piercings that transect the penile glans and is highly individualized. Care must be taken to size jewelry so that there is minimal extension of the hardware while the penis is flaccid and for the jewelry to not impinge on the penis when in the erect state.

The prince's wand is a unique male genital piercing. This piercing initially appears to be a PA, however, upon inspection, the jewelry is actually T-shaped, and has an extension that resides within the urethra. This extension is a hollow metal tube and can extend into the urethra by 3-6 inches. It is held in place by the exit piercing at frenulum. The prince's wand decreases the urinary and seminal diversion that is so common with the PA and reverse PA. This device can also act as an interior splint during intercourse with a semi-erect penis.

The most common female genital piercing is to the clitoral hood. By piercing the tissue that covers the clitoris, additional stimulation can be provided to this sensory organ. Not all women find this piercing pleasurable, and response to clitoral hood piercings is highly individualized. The deep clitoral, or triangle piercing, is placed below the clitoral nerve bundle and initially is one of the more painful female genital piercings. Capture bead or semi-circular barbell hardware is usually chosen to encircle the clitoris. (C. Shull, personal communication, June 28, 2004). (see Table 6 )

The Princess Albertina is a female variant of the male PA. This piercing enters the female urethra. The exit site is anatomically dependent, and can occur above, or just inside, the vaginal orifice.

J Foren Nurs. 2005;1(2):47-56. © 2005 International Association of Forensic Nurses

Cite this: Body Piercing: Issues and Challenges for Nurses - Medscape - Jul 01, 2005.