Elsevier

The Lancet

Volume 361, Issue 9364, 5 April 2003, Pages 1205-1215
The Lancet

Review
Body piercing: medical consequences and psychological motivations

https://doi.org/10.1016/S0140-6736(03)12955-8Get rights and content

Summary

Body piercing is increasing in popularity around the world. In this review, I describe the history, origins, and peculiarities of various forms of body piercing, and procedures involved, variations in healing time, legal aspects and regulations, and complications and side-effects. I have also included a discussion of the motivation for and psychological background behind body piercing. In presenting research results, I aim to raise awareness of the many risks associated with body piercing. In presenting psychological data, I intend to create an understanding of the multifaceted and often intense motivations associated with body piercing, and, thus, to diminish any prejudices held by health professionals against people with piercings.

Section snippets

Prevalence

Body piercing and other body modifications have increased tremendously in popularity in recent years, and have started to be practised across many social and age groups.7 However, no exact statistics for these practices are available, and estimates of incidence have been derived from studies with few participants. Estimates of the prevalence of the related body modification of tattooing in the USA lie between 7 million and 20 million people—the higher estimate is equivalent to around 13% of the

Effect on health-care systems

Reports of side-effects and complications associated with body piercing are increasing. These side-effects are thought to have an economic effect on health-care systems.12 In a 1999 UK survey, 95% of family practitioners in Bury and Rochdale stated they had seen patients with a complication resulting from a piercing.13 Among Pace University undergraduates in NY, USA, 17% reported a medical complication such as bleeding, tissue trauma, or bacterial infection relating to body piercing, especially

History, origins, and global significance

Body piercing confined to the ears, mouth, and nose has been a common practice in almost every society around the world as far back as can be traced.17 Furthermore, body piercing is practised by contemporary tribal societies on almost all continents (figure 2), but especially in Africa, Asia, and South America. Next to beauty and community affiliation, the main motivations for body piercing in tribal societies are ritual initiation, rites of passage, and sexuality. The ability to stand pain is

Regulations

Body piercing is done in regulated and unregulated shops, department stores, jewellery shops, homes, or physicians' offices. Generally no antibiotic is used, and sterilisation methods vary. Ear piercing is frequently done in beauty salons or jewellery stores, and body piercing often takes place in tattoo

establishments. In general, body piercing is in the hands of unlicensed personnel, who have learned techniques from magazines, videos, and other people who do piercings (piercers).30 Although

Sites and procedures

Earlobes and ear cartilage are the sites most frequently pierced. Other body parts that are often pierced include eyebrows, nose, cheeks, lips, frenulum, tongue, uvula, nipple, navel, and various genital sites (Table 1, Table 2, Table 3, Table 4, Table 5). Piercings in less frequently used sites, including flat surfaces such as the chest wall or the palm of the hand, have a high rate of rejection.23

Body piercing is usually done without anaesthesia. A hollow 12–18-gauge needle is passed through

General

The rate of acute complications resulting from body piercing is determined by piercing site, material, practitioner experience, hygiene, and aftercare (table 6). Local infection or bleeding is reported in 10–30% of piercings.42, 43, 44 In the UK, 95% of family practitioners reported treating medical complications arising from body piercing 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 common

Psychological and sociological perspectives

Few data exist for the psychological and sociological aspects of body modifications in western societies. Most reports in this area have discriminative overtones, associating a certain psychopathological or antisocial behaviour with forms of body modification such as tattoos or piercings.93 Even forensic and psychiatric studies associate culturally-sanctioned practices such as tattooing and body piercing with self-mutilation—ie, deliberate, non-suicidal destruction of one's own body tissue.94

Conclusion

Depending on where on the body a piercing is located, body piercing makes both an introverted, private, and an extroverted, public statement towards society. In return, piercing is perceived with ambivalence and somewhat negatively by society. However, the collective prejudices against body piercing and the often severe side-effects seem to be incentives rather than disincentives for the practice. Thus, irrespective of personal judgment, this form of body modification should be accepted as a

Search strategy

The material covered in this review was obtained from in-depth research, extensive field-work, and personal knowledge. I searched Medline, PSYNDEX, PsychLit, and PubMed databases of English, German, and French articles published from 1966 until December, 2002, using the search term “piercing” (578 references), and then narrowing results to articles relevant to “body piercing” and “ear piercing”. I reviewed sources mentioned in the bibliographies of these references for additional citations, and

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