Many healthcare professionals associate body art with criminal activity or psychiatric disturbance, based in part on some early descriptive studies [1-3]; some are still trying to make that case [4,5]. Individuals often associate tattoos and body piercings with gang members, prisoners, military personnel, or rebellious teenagers [4,5]. In reality, however, a variety of people, including professionals, clergy, or other "respected members of society" acquire body art for an assortment of reasons. Unfortunately, a healthcare professional's negative attitude about body art may interfere with the optimal treatment of patients with these types of ornamentation [6-8].
The history and health hazards associated with body piercing will be reviewed here. Tattooing is discussed separately. (See "Tattooing in adolescents and adults".)
Body piercing has a long history, with rumored reports of Roman centurions wearing nipple rings in their breast plates to hold their capes in place and as a sign of loyalty to their Emperor [9,10]. The Mayans are believed to have pierced their tongues as part of spiritual rituals [9,10]. Queen Victoria's husband, Prince Albert of Saxe-Coburg and Gotha, also is rumored to have had his penis pierced, although the veracity of this assertion is unproven [6,10,11].
Published information regarding the prevalence of tattooing and body piercing among adolescents and young adults (which comes primarily from surveys, case reports, and reviews of the literature) shows progressively increasing amounts of body art, which has become mainstream among individuals aged 16 to 25 years [12-17]. Data from surveys of high school and college students (13 to 25 years of age) indicate a prevalence of 25 to 35 percent for body piercing (excluding traditional earlobe piercing in males and females) [13,14,18-20]. Nearly one-half of 225 adolescents surveyed at an urban, hospital-based adolescent clinic reported piercings (earlobe piercings were excluded in females but not males; 58 percent of respondents were African American, and 30 percent were Caucasian) . In a 2010 Pew Research Center report examining how young people view their lives, 23 percent of 18- to 29-year-olds and 9 percent of 30- to 45-year-olds have at least one piercing other than earlobe sites . No recent statistics are available regarding adolescents.
Although body piercing has been associated with risk-taking behaviors, the population sampled appears to affect the behaviors associated with body art [4,22]. In an urban, clinic-based survey (484 adolescents), body piercing was associated with disordered eating behaviors, gateway drug use, hard drug use, sexual activity, and suicide . In another study, college students with body piercings reported substantively and significantly greater frequency of premarital sexual activity than nonpierced college students .