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Article on Genital Piercings

Posted Mar 31 2010 7:18am
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Young C, Armstrong ML, Roberta AE, Mello I, Angel E
J Am Acad Nurse Pract. 2010;22:70-80

It is increasingly frequent for healthcare providers to encounter genital piercings (GPs) in women. Women with GPs are no longer on the social fringe or part of the "punk" culture who are experimenting with behaviors that are "socially provocative." Over the past 30 years, GP has become mainstream, and women engage in it for a variety of reasons. Healthcare providers may make unfounded assumptions about these women and their reasons for seeking a GP. Knowing why many women choose GP allows the healthcare provider to better understand and support these women.

The purpose of this study was to evaluate 3 dimensions of evidence for the care of women with GPs. Following a literature review, a cross-sectional study replicated previous work, using a Web-based survey. Women were recruited for the study through advertising in newspapers and through the "snowball" method. All data were collected through a Website. The resulting triad of evidence included descriptive quantitative and qualitative data about women (n = 240) with GPs, and clinical observations from 60 healthcare providers who have cared for women with GPs.

The Web-based survey contained basic demographic questions (age; education; salary; religiosity; state of health; history of depression, abuse, forced sexual activity); risk behavior (age at first intercourse, sexual orientation, risk-taking, cigarette use, alcohol consumption, drugs, sexual partners, type of body piercings, tattoos); and postprocedural experiences (satisfaction, complications, activity, whether they were asked to remove jewelry).

The findings were consistent with the study being replicated, as well as with previous research on this topic. Three important findings about women with GPs were validated: (1) GPs were deliberate actions, sought for personal and sexual expression; (2) women with GPs treat piercings as a normal, meaningful part of their lives that produce sexual enhancement and expression; and (3) the information about GP care for these women comes from non-health providers. New findings were that many women with GP have experienced depression (47%), abuse (physical, 18%; emotional, 27%; sexual, 14%), and forced sexual activity (35%) in their lives.

The investigators suggest that the presence of GPs should not delay or limit the provision of important healthcare for women who have infections, pregnancy, or other health issues. Health-protective, as well as health-promotion, behaviors are important to reduce risks. Nurse practitioners can be effective and resourceful advocates in 3 specific areas of care: (1) responsiveness to women with GPs, (2) collaborative decision-making for the removal of jewelry, and (3) promotion of applicable patient education.

Although I'm not convinced that this study provided more data than the original study, the implications section is very strong and provides new information that might guide clinical practice. Particularly clear are the sections that explain that women choose GP purposefully and that it is a meaningful and often therapeutic part of their lives. Genital piercing apparently enhances feelings of self-worth and somehow removes the shame or guilt related to previous life events. This finding should help the healthcare provider treat GPs with respect and understand that for these women, a GP represents more than a piece of jewelry. As a result of this understanding, healthcare providers should be more sensitive to including women in decisions to remove the jewelry when required, rather than taking a unilateral action. This discussion provides an opportunity to explore patient or provider concerns about the jewelry and offers teaching opportunities. The article also provides several useful Internet resources, such as the Association of Professional Piercers. It is clear that these researchers, one of whom is a Master Piercer, have an intense interest in this subject and have the desire to provide accurate and helpful information.

However, as I read this article, I found that the way the study was reported made it needlessly difficult to understand. Much is made of the "triad of evidence," but the description of these 3 components of data is confusing. It was also difficult to tell if the study author was presenting data from the original study, comparing that data to the current study, or only reporting data from the current study.

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