As reported in the American Journal of Clinical Dermatology, body piercings in general can cause complications of infection, bleeding, contact dermatitis, scarring, or nerve damage. Genital piercings carry a risk of infertility following significant infection, urethral obstruction, priapism or fistula formation in males. In anarticle about the care of young women who have genital piercings, Young and colleagues report that young women who have complications from a genital piercing often seek help from the piercer or from the internet rather than from a medical provider. The authors also point out that there are many assumptions written in the literature (such as high rates of loss of sexual response or high rates of sexually transmitted diseases) that is not based in scientific evidence. The aim of the latter article is to utilize descriptive evidence to establish helpful care options for providers. In order to obtain data, surveys were completed by 240 females with genital piercings as well as health care providers who offered care to women with genital piercings.
Two qualitative research studies are described in the article and include reasons for a female acquiring a genital piercing. These reasons range from sexual enhancement to psychological healing from events such as rape. "These deeply personal events produce feelings of loss that often predispose an individual to reclaim that part of the body..." In one of the studies with 35 females who had genital piercings, some of the issues they faced as complications included local sensitivity, skin irritation, sexual problems, infection, scarring, and UTI. In the research by Young et al. that appears in the Journal of the American Academy of Nurse Practitioners the results showed that most of the 240 women were Caucasian, heterosexual, married, in excellent health, college-educated women who declared salaries around 45,000/year. The researchers were surprised to learn that over half of the women with genital piercings reported abuse, more than one third had reported some type of forced sexual experience against their will, and most had been told that they suffered from depression.
Although many of the women reported that they attended to skin care near the genital piercing, there was little mention of limitation of physical activities due to the piercing including vigorous fitness activities. The women who completed the survey had very positive feelings about the piercing, and most chose a piercing at the clitoral hood. When the participants were asked about the response from health care providers towards the genital piercing, many described that the provider was shocked and often told the patient that cleanliness was very important and at times to remove the jewelry. Some patients decided to take the jewelry out prior to an annual exam to avoid judgement. Of the 60 health care providers who responded to the survey, many of the comments to the open-ended questions were related to labor and delivery, many of the comments were positive, and some of the comments were very judgmental towards the character of the patient who had genital piercings.
Regarding the "implications for nurse practitioners" in this article, the authors suggest that the health care provider be responsive to women about the genital piercing. In other words, acknowledge that it is there in a non-judgmental manner, and inquire about it if there are concerns. It is also suggested that the provider collaborate with the patient if removal of the jewelry seems necessary. It is very interesting that in the survey respondents who were pregnant with a piercing, over half of them did not remove the jewelry for labor and delivery, and no complications have been noted in the literature regarding labor and genital piercings according to the authors.
As always, we want to ask ourselves if and how this information can relate to our role in providing pelvic rehabilitation care. If a patient presents for an examination, we can follow the recommendation in this article to "be responsive" and acknowledge the piercing. It should not need to be removed for an examination and/or treatment. Could the piercing itself be a possible source of scar tissue, nerve irritation, tender point, or hypersensitivity? That seems entirely possible, and this possibility can be explored with the patient and with the referring provider as appropriate. Because genital piercings (and piercings in general) are more popular, we may have questions posed to us by patients, colleagues, or by a patient's family members. Awareness of this descriptive data may allow us to give a more thoughtful answer, and to feel more confident in our approach when examining or treating a patient who has a genital piercing.