Related topics: •  Poll: Are You Pierced?

Jennelle Nevins lay back on a seat at the Chicago tattoo and body-piercing parlor, trying not to stare at the inches-long needle that thick tattooed fingers were about to push into her navel. Nevins was about to do something she'd never done before, and she felt excited about getting a ring in a place other than her ears.

But after the body piercer popped the needle through the 23-year-old woman's skin, it dangled there for several seconds before it was replaced with a stainless steel ring. It was over in a moment. Afterwards, Nevins tottered out of the shop on wobbly legs, opened her car door, and slumped into a seat. Then she fainted.

"I don't think it was the pain, it was more the adrenaline rush and the size of the needle," Nevins says. "I probably got up too quickly, too -- he kind of scooted me out of there."

That wasn't the end of Nevins' discomfort. Nevins, who got her piercing in 1995, says she suffered from pain and chronic infections for a year after getting her belly button pierced. The soreness lingered still another year.

"It was a much longer healing process than I would have thought," Nevins says. Soon after she got pierced, her roommate's dog jumped up on her and got his toenail stuck in the ring, ripping out part of the jewelry. "It was tender for a while and was constantly getting infected."

Millions of people, many of them teen-agers, get pierced every year, and the list of body parts that can be pierced, pricked, and lanced keeps growing. Aside from the traditional earlobes, rings and other metal objects have found their way to the upper part of the ears, and to belly buttons, tongues, noses, lips, eyebrows, cheeks, nipples, and genitals.

Many young people get pierced to be in style, and others to flaunt tradition or assert their individuality. But some don't realize that body piercings can become a health problem if they aren't done correctly or if they aren't properly cared for. Nevins admits that she had no idea that follow up for a pierced belly button would be more challenging than pierced ears. It never occurred to her that the needle itself might pose a threat of serious viral infection. But health experts say that's only one of the risks you face when you get a piercing.

"When you look at a lot of the newspaper and magazine articles about body piercing, it all sounds so good -- they imply that it's a very care-free procedure," says Myrna Armstrong, a registered nurse who is also a professor at the Texas Tech University Health Sciences Center School of Nursing and a researcher of body arts. "Unfortunately, we have a lot of types of body piercing that get infected that we're seeing medical complications from. We're also seeing more creativity and more risk-taking because of it."

Piercing is, in fact, an ancient tradition dating back to the Egyptian pharaohs who pierced their navels and Roman soldiers who spiked their nipples. Throughout history, and in all parts of the world, piercing has been used for various ornamental and religious reasons. According to the Journal of Pediatric Health Care, even in priggish Victorian-era England, Queen Victoria's husband, Prince Albert, had his penis pierced.

The fad had pretty much died down in Western civilization by the early 20th century. But in the '60s, ear piercing among girls and women began to appear again in certain groups and then quickly infiltrated mainstream society. The piercing of other body parts besides the ears didn't see a resurgence in popularity until the 1990s.

Today more people are getting pierced, and a growing number of them are teen-age girls, although it's impossible to keep track of the actual figures. Many report getting pierced because they want to look cool or different, and some say they do it to emulate their favorite pierced celebrities. "I like how Britney Spears' looks," says 14-year-old Lindsey Olney-Bell, referring to the pop singer's navel piercing.

Medical professions are starting to speak out about the tradition for the first time -- not because they object to the holes people get in unlikely places -- but because without outside regulation, the procedure can be hazardous. In addition to spawning rampant infections, improperly done piercings can lead to the transmission of serious illnesses, such as hepatitis B and C, and sexually transmitted diseases.

"Most of us are appalled by the whole industry because it's not regulated," says Dr. John Wolf Jr., a member of the American Academy of Dermatology and chair of the dermatology department at Baylor College of Medicine in Houston. "There is no way of knowing if the piercers have taken proper precautions."

In fact, in most states, no regulatory agency oversees the body piercing industry. And while a good number of piercers may be attentive to sterilization techniques and state regulations, many are not, according to Armstrong. Even new laws aimed at preventing the piercing of minors without parental consent tend to be sporadically enforced. As a result, there are countless ads in alternative weeklies, and piercing Web sites aimed at young people are booming.

Some shops are conscientious about not piercing teen-agers. More than two years after California passed a bill to make body piercing on minors under 18 illegal without parents' permission, Olney-Bell was turned away from two San Francisco piercing shops where she tried to get her navel pierced -- even though she was accompanied by her mother. She says the shops were worried she would grow taller and the jewelry would be rejected. The third shop they visited readily agreed to do the piercing, but only because the 14-year-old's mother was present.

Soon after, 15-year-old Hillary Combs walked into one of the first two shops that turned Olney-Bell away and -- using a fake I.D. claiming she was 20 years old -- had her belly button pierced.

Groups like the Association of Professional Piercers, which is pushing for responsible sterile piercing and age minimums, may help clean up the industry. But until every piercer who works with the public follows safe guidelines, people need to educate themselves as much as possible, Armstrong says. There are general hazards that come with any type of piercing, as well as additional hazards to specific areas of the body.

"Piercing of the earlobe is so solidly entrenched in our society," Wolf says, "that nobody is going to be able to change that habit. But whenever you pierce the skin, there can be problems." Wolf says piercings can cause scarring, cysts, bacterial infections, and dermatitis, especially among people who have allergies to nickel or other metals or alloys. Keloidal scars -- raised blisters of scar tissue that appear in or around a piercing -- are common, and sometimes have to be removed surgically.

The Centers for Disease Control and Prevention has a similar warning: People who get pierced run the risk of serious infection, mainly viral infections such as hepatitis B and C, or bacterial infections such as tetanus or staphylococcus. To avoid these risks, the needles used must be properly sterilized, Wolf says. The best way to sterilize an instrument is through a technique called "autoclaving," he explains, in which each instrument is wrapped and placed in equipment that exposes it to extreme heat. To be safe, ask about a shop's sterilization techniques and watch them do a few procedures, Armstrong says.

One type of piercing -- in the tongue -- can be particularly dangerous. Because a piercing is essentially an open wound, it gives bacteria a pathway into your bloodstream. This can lead to an infection of the floor of the mouth called Ludwig's angina, which is sometimes fatal. Ludwig's angina is characterized by swelling of the mouth and throat. At first, this might be mistaken for the normal swelling associated with a piercing, but it progresses quickly and can eventually cause the airway to close.

Bacteria that travel through the bloodstream to the heart can cause an infection called endocarditis. People with heart defects are particularly susceptible to this.

Tongue piercing has also raised the ire of the American Dental Association (ADA). The ADA has roundly criticized oral piercings, including those on lips, cheeks, and particularly the tongue.

"Bottom line is, don't do it," says Dr. Richard H. Price, a practicing dentist in Newton, Massachusetts, and a spokesperson for the ADA. Price says one young woman created a space between her front teeth by driving her barbell between them; he had to fix another college student's cracked molar after the student bit on his tongue barbell while snacking on a bagel. The ADA also links piercings to speech impediments; tongue swelling that can impede breathing, gingival injury or recession; and accidental swallowing of jewelry.

A study of 52 young adults with tongue piercings found that negative effects can crop up in as little as two years. About half of the people studied experienced receding gums after two years, and almost half had chipped back teeth after four years of wearing a 5/8 inch tongue barbell.

Tight clothing often irritates new piercings, especially those on nipples, navels, and genitals. Nipple piercings in a woman might eventually cause her milk ducts to close if not done correctly, Armstrong says, although she says there has not been enough research in this area.

Healing times vary depending on the individual, and that's certainly true of genital piercings. For men who get their scrotums or penises pierced, it could take between one and eight months. Genital piercings don't tend to become terribly infected, says Kelley Muldoon, a nurse practitioner in Connecticut, but they can increase your risk of transmitting sexually transmitted diseases while they're healing. For a woman who has pierced her clitoris or labia, it could take one to four months for the piercing to stop oozing, Muldoon says.

"You've got to be careful that no body fluids, oral or genital, get to any piercings because the healing times vary so much you increase the risk of transmission," she says. If you have a genital piercing, she says, be sure to use condoms or dental dams when having sex until the piercing is healed.

An additional concern with the penis being pierced, Armstrong adds, is that the urinal stream can be diverted, forcing some men to sit on the toilet to urinate to contain the spray.

Armstrong has found that the navel is prone to bacterial infection. One study she conducted on college students found that 45 percent of people with belly-button piercings had navel infections. "The area is dark, moist, and has fuzzies," she says, all of which can lead to minor infections. In addition, piercings in areas like the navel and eyebrows can lead to rejection of the jewelry if it is inserted too shallowly.

Finally, any area that has cartilage should be avoided, experts say. Cartilage, the soft bone tissue in your ears and nose, has a poor supply of blood, which aids in healing, so such piercings are more susceptible to infections and scarring.

Despite these health threats, experts say piercing can be done safely. It's just a matter of choosing your piercer carefully, understanding the complications that can occur in the area to be pierced, and using proper hygiene.

Where should one turn for intelligent, informed piercing advice? Many teens learn about piercing studios and methods through word of mouth or by surfing the Web, two sources of information that can be very shaky, Armstrong says. She's trying to convince teens and adults to ask doctors and nurses for information about piercing, although she admits that this advice is a double-edged sword. Unfortunately, she says, many health professionals simply try to discourage youths from getting pierced and neglect to tell them how to protect themselves.

"I would love to tell you they should go to a health care provider, and the health care provider is going to be realistic and nonauthoritative and nonjudgmental," she says. "But I can't guarantee that."

Hillary Combs, now 16 and freshly tongue-pierced (accompanied by her father this time around), couldn't agree more. She researched her latest piercing for seven hours on the Internet. "I found out about most of the dangers and complications from doctors and dentists," she says. "But they failed to say that there are ways of preventing them."

Armstrong's goal is to teach health-care providers how to talk to teens about body piercing, what to expect after the piercing and safe places to go. It's better to talk about the health issues openly rather than telling kids not to do it and risk them piercing themselves with Mom's sewing needle, she says. "The consumer really has to be knowledgeable. He or she needs to take the time to make an informed decision, and not to do it impulsively. Then, if they choose to do it, they must know the responsibility that they have to their own body. They have to be very diligent in their skin care, not just for a couple of weeks, but for as long as they have that piercing -- because at any time it could get infected," says Armstrong.

Although medical experts at the Centers for Disease Control and Prevention and the American Dental Association oppose body piercing, body piercing shops continue to be flooded with customers. If you decide to get pierced, consider these tips developed by Myrna Armstrong and other experts:

•Talk to your friends who have been pierced. Ask them about their experiences, seek their suggestions and ask what they would change if they had to do it over.

•Think about why you want to get pierced. You don't have to pierce your body to belong. Know you're directly involved in your health decisions and can always change your mind or wait.

•Go to a qualified body piercing shop. Never pierce your own body or let a friend or family member do it, even if he or she says they know how.

•Choose the spot you want to pierce carefully. Facial piercings are exposed sites and can lead to infections. Piercings in the navel and nipple are a concern because the area is covered with clothes, shielded from the light and air, and may take longer to heal because of body moisture and irritation from tight clothing.

•The piercer should use disposable equipment or use equipment with steam heat (autoclaving) to sterilize his or her instruments. Look for brown sterile markings on the package to indicate sterility. Non-medical professionals shouldn't use prescription "numbing" medicine, although sometimes ice is rubbed on the skin.

•Make sure the person piercing you protects both of you from infection. The piercer should wear new, disposable gloves for each piercing. Transmitting HIV/AIDS, hepatitis B, and tetanus is always a risk when the skin is punctured. Before piercing, the spot should be cleaned with an antimicrobial soap and water. Alcohol, peroxide and Betadine should not be used at any time because they are overly strong and drying to the skin.

•Make sure you keep the area clean after the piercing. There may be redness, swelling, oozing, and the beginnings of a scab near the hole. Do not touch the hole or the jewelry except to clean it as advised by your piercer.

•Select your jewelry carefully. To decrease the risk of infections and allergic reactions, use jewelry that is made from smooth surgical grade stainless steel, 14-karat gold, niobium, or titanium.

Nevins, who got her navel pierced, says she experimented with a couple of antibacterial remedies to clean the pus and ooze that characterized her sore belly button. She finally stumbled upon Bactine, an antiseptic that seemed to do the trick, and the healing finally began. While the ring causes her occasional twinges when she wears tight athletic shorts, Nevins says she has really enjoyed her piercing and has no regrets. And finally, she can enjoy the ring without pain. "Only in the last two or three years do I not feel it anymore," she says.

Hillary Combs offers this parting advice to her teen-age peers: "I would recommend to any child with parents who are unsure about the piercing, show your desire and motivation by researching it first," she says. "Your parents will find that it takes a lot to go out there and research something. If you really want it badly, don't just say the good things, admit the bad things."

-- Kristin Kloberdanz, MA, a former associate editor for Consumer Health Interactive, is an editor at Book magazine in New York City.

References

Last updated January 20, 2009
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