Category Medical

2022 NEHA Review

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Shortly after the APP’s 2022 conference in Las Vegas, APP member John Johnson traveled to Spokane, Washington to represent the association’s Legislative and Regulatory Affairs Committee (LRAC) at the annual education conference hosted by the National Environmental Health Association (NEHA).

APP members Matt Bavougian, Steve Joyner, and John Johnson each have positions on NEHA’s body art committee which created the Body Art Model Code (BAMC). NEHA represents health inspectors around the United States who visit body art studios and enforce local codes. This NEHA conference in Spokane featured four days of body art inspector training and the APP’s John Johnson was there to speak on behalf of body piercing facilities and discuss the most practical and effective methods for their inspection.

The NEHA conference is similar to our APP conference in many ways, lectures and other presentations take place each day with topics related to environmental health, opportunities to network are everywhere, and of course the exposition hall where vendors display their products and services is a main attraction.

Like piercers who attend the APP’s conference, health inspectors and other environmental health officials attend conferences such as NEHA to stay up-to-date with trends, technology, and information relevant to their profession. Today, these environmental health specialists have great interest in body art like professional piercing.

Body piercing is now considered mainstream by many and regulators are very interested in effective health codes and their enforcement. The APP’s LRAC works closely with organizations like NEHA who have a need for body piercing health and safety information. We appreciate everyone at NEHA who supports the APP’s mission of safe piercing.

At the time of this article NEHA is accepting change requests for the Body Art Model Code.

Point 89: Gentian Violet Concerns & Alternatives

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Piercers in Canada were recently informed by Health Canada that they were not allowed to use products containing gentian violet.1 A recall was put in place due to a link to cancer risk. At least one manufacturer voluntarily discontinued sales of their products and their license was cancelled.

Continue reading →

Point 88: Health Canada Warns about Gentian Violet

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At the beginning of June, Health Canada warned Canadians of potential cancer risk associated with gentian violet. This was concerning to many professional piercers in Canada and internationally, due to the fact that gentian violet is a product commonly used for marking before a piercing. There has been some debate in the piercing community over whether the gentian violet product recall should affect our industry.

In Issue 89, we’ll have a thorough examination of the studies that triggered the product recall and what that may mean for professional piercers and consumers in general. Thankfully, in the meantime, there are non-gentian violet options available in the form of pressure marks and non-gentian markers. It should be noted that when opting for markers, skin specific pens and surgical markers should be used rather than permanent ink pens and markers.

Point 74: “FDA Approved” – Let’s Get Real – Pat McCarthy

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FDA over the counter drug labeling

Pat McCarthy headshotPat McCarthy
Owner of Piercology

“Approved by the FDA” is a claim we’ve all seen on corporate websites or mentioned in marketing literature and online ads. Salespeople sometimes refer to the products they promote within the body art community as being “FDA approved”. Clients who come to Piercology often ask me or my piercing staff if the US Food and Drug Administration (FDA) has approved the products we use. I’m sure many of you have faced similar questions or simply wondered yourselves.

I’ve done some research in order to clarify the issue and answer in a fair and honest way the following questions. Does a manufacturer or distributor have the legitimate right to claim a particular product was approved by the FDA? If the product has an Over-the-Counter (OTC) drug label and a National Drug Code (NDC) number what does that really mean?

This is what I’ve discovered:

The classification of cosmetics and drugs are defined by law, based on their intended use. Each classification has associated laws and regulations. There is a lot of information available, so let’s start with a few excerpts directly from the FDA website:

The Federal Food, Drug, and Cosmetic Act (FD&C Act) defines cosmetics by their intended use, as “articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body…for cleansing, beautifying, promoting attractiveness, or altering the appearance” [FD&C Act, sec. 201(i)]. Among the products included in this definition are skin moisturizers, perfumes, lipsticks, fingernail polishes, eye and facial makeup preparations, cleansing shampoos, permanent waves, hair colors, and deodorants, as well as any substance intended for use as a component of a cosmetic product.

The FD&C Act defines drugs…as “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease” and “articles (other than food) intended to affect the structure or any function of the body of man or other animals” [FD&C Act, sec. 201(g)(1)].

Under the FD&C Act, cosmetic products and ingredients, with the exception of color additives, do not require FDA approval before they go on the market. Drugs, however, must generally either receive pre-market approval by FDA through the New Drug Application (NDA) process or they must conform to a “monograph” for a particular drug category, as established by FDA’s Over-the-Counter (OTC) Drug Review. These monographs specify conditions whereby OTC drug ingredients are generally recognized as safe and effective, and not misbranded…(and) state requirements for categories of nonprescription drugs, such as what ingredients may be used and for what intended use.

In other words, the FDA does not approve cosmetic products or formulas. It is essentially left up to a manufacturer to insure their product complies with the standards, packaging, and label requirements. We all want to think “natural”, “botanical”, and “herbal” formulas are safer and better in some way. Maybe they are, but I remain skeptical until I know where the ingredients come from and if they have certificates of authenticity. I want answers to questions such as where was the formula developed and manufactured, is there a scientifically based and tested preservative system to prevent bacterial growth, is there stability testing, and has the product been tested against the type of bacterial concerns we face in our professional lives such as Staph, E.coli and MRSA? I’ve often wondered how some non-OTC products on the market have “healing claims” yet despite their intended use they are not registered as an OTC drug with an NDC number?

FDA over the counter drug labeling
“FDA published a final regulation (21 CFR 201.66), establishing standardized content and format for the labeling of OTC drug products.”

Contrary to what some people hope or believe, the FDA does not have a system in place to approve the vast majority of non-prescription OTC drug products intended for human use either. It is up to the manufacturer to insure their product(s) follow the existing monographs and prove their products are both safe and effective. At first glance it seems as if the government is relying on an “honor” system they believe responsible companies will follow.

Unfortunately, the result of leaving it up to others is that some claims seem “too good to be true”. Is it possible for example that a single product can be effective as a “skin prep” and gentle enough for “aftercare”? The concept of “electrified water” seems promising, but if sealed packaging is required to prevent a reduction in efficacy how do we know if the product works as promised after it’s opened, or after a few weeks or months. Critical questions should be asked regarding how a product is manufactured and if the prevailing monographs are being followed. Also important to question: how has the product been tested and where can the test results be found?

The FDA issues “Establishment Licenses” to manufacturing facilities that comply with rigorous standards that include “Current Good Manufacturing Practices” (cGMP) so it is important to know where the products we use and recommend come from. Topical antiseptics for example should be manufactured following cGMP regulations to insure the facility has appropriate procedures in place to prevent the presence of objectionable microorganisms in drug products that are not manufactured as sterile. A licensed facility typically has the staff, equipment and procedures in place to validate the raw materials, formulas and every stage of the production process.

Incredibly, there are documented cases of companies using “NDC-like” numbers on their labels without ever applying for or obtaining the legitimate NDC. Typically however, the vast majority of companies file an application to obtain the NDC prior to offering the product for sale to the public. Does this mean all OTC drug formulas are approved in advance? NO! Does it mean the FDA has approved the product because an NDC number has been assigned? NO! Obtaining an NDC number means the manufacturer has provided the required information and followed the correct steps during the application process. This includes stating the intended use of the product and confirming the active and inactive ingredients are not restricted or used in amounts beyond the established limits. Also, the OTC drug label structure and claims must all fall within the prevailing FDA monograph.

A section of the FDA website supplies a frequently updated NDC directory, which clearly states: “Assignment of an NDC number does not in any way denote FDA approval of the product. Any representation that creates an impression of official approval because of possession of an NDC number is misleading and constitutes misbranding. (21 CFR 207.39)”

So why do some companies claim their products have been “FDA approved” when in fact it’s not an accurate statement? Do they think we are easily fooled? Maybe…

The FDA website explains the drug application of OTC classified products, which states: “OTC drugs are defined as drugs that are safe and effective for use by the general public without seeking treatment by a health professional. Because there are over 300,000 marketed OTC drug products, FDA reviews the active ingredients and the labeling of over 80 therapeutic classes of drugs. OTC drug monographs are a kind of “recipe book” covering acceptable ingredients, doses, formulations, and labeling. Once a final monograph is implemented, companies can make and market an OTC product without the need for FDA pre-approval. These monographs define the safety, effectiveness, and labeling of all marketing OTC active ingredients.”

DailyMed is a website operated by the US National Library of Medicine (NLM) to publish up-to-date and accurate drug labels to health care providers and the general public. The contents are provided and updated daily by the FDA. As a handy reference source that lists individual OTC drugs that have been assigned an NDC number, it is important to know the information provided usually comes with this disclaimer: “Most over the counter (OTC) are not reviewed and approved by the FDA. However, they may be marketed if they comply with applicable regulations and policies. FDA has not evaluated whether this product complies.”

Food and Drug Administration headquarters
FDA headquarters

The bottom line is this, don’t be fooled by marketing claims that a particular product has been “approved” by any government agency, including the FDA. My best advice is to look up the NDC number on a site like DailyMed, find out the origin of the product, and ask the manufacturer or distributor for documented test results from a recognized and trusted lab to substantiate their claims of safety and efficacy. It always pays to ask questions, for your sake and for the sake of your clients.

Many products used in our industry may be well intentioned, including those meant for aftercare, but it’s important to know if the manufacturer follows aseptic cGMP techniques and the FDA monograph rules that cover acceptable ingredients, doses, formulations, and labeling of an OTC drug product. “Natural” does not automatically mean it’s better, safer, or more effective. Ask to see bona fide test results.

I’ve seen enough in my 22+ years in this business to know it’s OK to be skeptical. It’s OK to question what you do as a professional and strive to be the best you can be. It just makes good sense to protect yourself and your clients in order to grow your business. Because your friend or another artist uses a product does not prove anything! Before you choose to work with any product, or recommend it for your clients, find out where it comes from, and what testing has been done to prove it is both safe and effective for the intended purpose. Good luck and may your business grow and prosper in the future.

Some background: Pat is the owner of Piercology in Columbus, OH, one of the oldest and most successful piercing studios in the USA. He was the first elected President of the Association of Professional Piercers. He is the founding and current President of the Association of Body Art Professionals in Ohio. Pat has been working with Ohio legislators on body mod studio regulations, and he frequently lectures Ohio Health Inspectors on bloodborne pathogens and best practices in piercing and tattoo studios.

Point 74: President’s Corner – Brian Skellie

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Brian Skellie working with asepsis

Brian Skellie headshot at 2014 APP conference by April BerardiBrian Skellie
APP President

Technology for infection prevention:

Why the introduction of more technological advances help to reduce cross contamination risks

The benefits of thousands of years of advancements in infection control are applied and built upon daily: a brief history of sterilization.

Charles Chamberland’s Autoclave (1880), the first steam sterilizer
Chamberland’s Autoclave (1880), the first steam sterilizer
Denis Papin’s digester (1680), the first pressure cooker.
Papin’s digester (1680), the first pressure cooker.

Chamberland’s Autoclave (1880), the first steam sterilizer patterned after Papin’s digester (1680), the first pressure cooker.

Asepsis is the most effective technological advancement for a purposeful reduction of microbes to an irreducible minimum. This begins with policy and training, and follows through with checklists, review, and reminders for implementation.

Primum non nocere = above all else we should do no harm.

Antonj van Leeuwenhoek’s microscope (1683)
Antonj van Leeuwenhoek’s microscope (1683)

Physics was the first step in decontamination, using thermal energy: fire and the effects of the sun. Advances have been made in E-beam and radiation, both ionizing and non-ionizing, for sterilization. As a result, new equipment and supplies are now available providing an almost infinite sterilization shelf life. Part of what was found useful from the sun, apart from drying, was the power of short wavelength ultraviolet light to disrupt the DNA of cells. This has been harnessed for disinfection of exposed environmental surfaces, air, and water, but this form of sterilization is not appropriate for initial piercing jewelry. Further study of properties of the sun have resulted in functional plasma etching and cleaning processes and H2O2 gas plasma sterilization. At some point, gadgets for disinfection of procedure rooms such as UV-C robots and hydrogen peroxide (H2O2) vapor foggers may have an application in scale for our trade.

Joseph Lister’s antiseptic sprayer (1867)
Joseph Lister’s antiseptic sprayer (1867)

Chemistry was the next big step in the fight against preventable iatrogenic infection with germicides, from chlorine solutions and carbolic acid to EO gas. Recognizing the potential for stopping infection transmission during procedures by thoroughly cleaning the worker’s hands and the subject site with a germicidal product was an enormous step that has become part of our established thinking. Materials themselves can be used to leverage the natural properties of copper (Cu+) and silver (Ag) that make touch and transfer surfaces inhospitable to microbes, and other embedded compounds have been developed for similar purposes. Some even work with nanotech surface treatments.

Instrument cleaning technology is constantly improving on the basic two fronts of physical action and chemical reaction. Advancements in products safe for the worker and environmentally friendly have brought forth alkaline or enzymatic detergent, or peracetic acid options.

surgical tools from the late 1800s
outmoded surgical equipment from the late 1800s

Consumables have long been a source of worker and client protection and potential oversight. Gloves and other Personal Protective Equipment (PPE) do create a barrier when used correctly, but do not take the place of adequate hand hygiene and application of asepsis. For further protection against exposure to environmental hazards, wearable vapor detectors can be used to alert the worker of chemical hazards from cleaning and disinfecting products. Essential detectors for sterilization or cleaning parameters should be used for validation of each process. Test Soils with protein detection for washing instruments, even manual cleaning should be tested, and Chemical and regular Biological Indicators for sterilization loads.

Cleaning appliances have made validation tests easier and more repeatable, with the availability of small automated instrument washers and medical and dental ultrasonic cleaners. Our last line of defense against cross contamination comes from our environmental air quality, which can be improved with air cleaners equipped with HEPA filtration and UV, thermal or plasma disinfection, and floor scrubbers to vacuum up the dust, wash and dry the floor automatically and robotically.

The health and safety of our clientele and personnel depend on adequate sterilization and disinfection. The advancements listed have changed the way we do our jobs and protect ourselves from risk. As we look towards the future it is impossible to know the impact further technological advancements will have, but they will undoubtedly continue to change how we practice our trade.

Point 73: A Parent’s Guide to Safe Piercing for Children’s Ears

3 Comments read Issue 73, Medical, Public Education, Science & Body Modifications, Sterilization

Child's ear piercing performed by Becky Dill at Cold Steel Piercing Photo by Danielle Greenwood
Child’s ear piercing performed by Becky Dill at Cold Steel Piercing
Photo by Danielle Greenwood

Proper technique, sterility, piercing placement, aftercare, jewelry material, and style are among the many important factors that go into a successful piercing. First, let’s look at the technique itself. Piercing guns use pressure to force a pointed object, the jewelry, through the skin. While these mechanisms may seem like a quick, easy, and convenient way of creating holes, they can have major drawbacks in terms of tissue damage, inappropriate jewelry designs, and sterility. These concerns have been documented in medical literature over the years and provide proof of these concerns.

Due to the dull nature of the jewelry used in piercing guns, more damage is caused to the tissue when compared to piercings done with quality piercing needles. The effects are similar to a blunt force trauma including significant pain, swelling, scarring, and an increased potential for complications. The gun then pinches the back of the jewelry in place snugly against the skin, allowing no way for the new wound to breathe and heal properly. The customer is often told to turn the jewelry, which only further pushes growing bacteria into the wound, increasing the risk of infection and delaying the healing process considerably.

Additionally, it has not been documented how often piercing guns malfunction. Some operators report that the earring adapter that holds the jewelry often will not release the earring, requiring its removal with pliers. These pliers, which contact contaminated jewelry immediately after it has passed through the client’s tissue, may be reused on multiple customers without full sterilization. Few, if any, gun piercing establishments possess the expensive sterilization equipment necessary for such a process. Occasionally the intense pressure and speed of the gun’s spring-loaded mechanism is not sufficient to force the blunt jewelry through the flesh. In these cases, the earring stud may become lodged part way through the client’s ear. The gun operator, who may not be trained to deal with this possibility, has two options. S/he can remove the jewelry and repierce the ear, risking contamination of the gun and surrounding environment by blood flow from the original wound. Alternately, the operator can attempt to manually force the stud through the client’s flesh, causing excessive trauma to the client and risking a needlestick-type injury for the operator.

Diagram showing the differences in the "cutting edge" of ear piercing studs used in piercing guns. The bottom silhouette is a single use hollow needle.
Diagram showing the differences in the “cutting edge” of ear piercing studs used in piercing guns. The bottom silhouette is a single use hollow needle. Reference: Ear piercing techniques and their effect on cartilage, a histologic study

There may also be a greater likelihood of more serious complications when cartilage or structural tissue such as noses are pierced using a piercing gun. This type of tissue (cartilage) has less blood supply than earlobe tissue and therefore a correspondingly longer healing time; this means that infection in this area can be more likely and more destructive.

Another common concern is sterilization and asepsis. Any kind of procedure which involves contact with blood or bodily fluids requires strict adherence to crosscontamination prevention.

As is now well known, the hepatitis virus can live for extended periods of time on inanimate surfaces, and could be harbored within a reusable piercing gun for several weeks or more. Hepatitis and common staph infections, which could be found on such surfaces, constitute a serious public health threat if they are introduced into even one reusable piercing gun. Considering the dozens of clients whose initial piercings may have direct contact with a single gun in one day, this is a cause for serious concern. Babies, young children, and others with immature or compromised immune systems may be at a higher risk.

Some will argue that the piercing gun never comes in contact directly with a customer’s skin, or is sterilized or disposed of after a single use. This might be true, but the gun operator’s hands do—if they touch the customer’s skin and then touch the gun, the gun is now contaminated. When the gun drives the stud through the flesh— whether or not the skin starts to bleed – there is no way of knowing whether or not tiny particles of blood have been dispersed into the air contaminating everything around it. Piercing guns are usually made with plastic and cannot be adequately cleaned and sterilized for reuse. A quick wipe with an antiseptic pad is not effective in removing disease-carrying blood. Although many manufacturers now make disposable options, these do not negate concerns regarding possible damage to tissue, jewlery quality, or inadequate staff training.

The Association of Professional Piercers does not support the use of piercing guns because the reusable versions can’t be sterilized using APP approved equipment, such as an autoclave. Without proper sterilization, the risk of spreading diseases such as Hepatitis and staph infections increase.

The Bottom Line: Professional piercers use a more modern approach to piercing that’s less traumatic, cleaner, and more likely to result in a smooth healing process.

The Point Issue 73 - Professionals dont use piercing guns

Point 73: Children’s Ear Piercing – Kendra Jane B

2 Comments read Issue 73, Medical, Public Education, Sterilization

Kendra Jane BerndtThe Point Issue 73 - Professionals dont use piercing guns
April Thomas
Julie Taylor

Most of us receive at least one phone a week— sometimes even a day—from a concerned parent wanting to know the best option to pierce their child’s lobes. We are frequently seeing that the safe piercing message is reaching the masses. However, we are still seeing many piercings done with piercing guns. Whether it is because they are unable to find the information in the places they are visiting or because they are intimidated to visit their local tattoo or piercing studio to have their questions answered, parents are using less than favorable methods to pierce their children’s lobes. Perhaps they are leery of taking their six or seven year old daughter or son into said studio because of things that have nothing to do with piercing, such as the music, a worry of profanity or inappropriate behaviour, etc.

Within this article, we have presented similar information in two forms. The first is intended for an audience with a more complete understanding of piercing industry jargon and intricacies. The second presentation has been simplified with our clients in mind. Our intention was to provide something that you are able to print and send home. You can choose which presentation is most appropriate for your target audience. Either way, we encourage you to share the link to this article and repost on every site that questions the safest way to pierce children’s ears.

What is the APP’s position on ear piercing guns?
It is the position of the Association of Professional Piercers that only sterile disposable equipment is suitable for body piercing, and that only materials which are certified as safe for internal implant should be placed inside a fresh or unhealed piercing. We consider any procedure that places vulnerable tissue in contact with either non-sterile equipment or jewelry that is not considered medically safe for long-term internal wear to be unsafe. Such procedures place the health of recipients at an unacceptable risk. For this reason, APP Members may not use reusable ear piercing guns for any type of piercing procedure.

Reusable ear piercing guns can put clients in direct contact with the blood and bodily fluids of previous clients.
Although they can become contaminated with bloodborne pathogens dozens of times in one day, ear piercing guns are often not sanitized in a medically recognized way. Plastic ear piercing guns cannot be autoclave sterilized and may not be sufficiently cleaned between use on multiple clients. Even if the antiseptic wipes used were able to kill all pathogens on contact, simply wiping the external surfaces of the gun with isopropyl alcohol or other antiseptics does not kill pathogens within the working parts of the gun. Blood from one client can become aerosolized, becoming airborne in microscopic particles, and contaminate the inside components of the gun. The next client’s tissue and jewelry may come into contact with these contaminated surfaces. This creates the possibility of transmitting bloodborne disease-causing microorganisms through such ear piercing, as many medical studies report.

The Point Issue 73 - childrens ear piercing Frankie PistoneAs is now well known, the Hepatitis virus can live for extended periods of time on inanimate surfaces, and could be harbored within a piercing gun for several weeks or more. Hepatitis and common staph infections, which could be found on such surfaces, constitute a serious public health threat if they are introduced into even one reusable piercing gun. Considering the dozens of clients whose initial piercings may have direct contact with a single gun in one day, this is a cause for serious concern. Babies, young children, and others with immature or compromised immune systems may be at higher risk.

Additionally, it has not been documented how often piercing guns malfunction. Some operators report that the earring adapter that holds the jewelry will often not release the earring, requiring its removal with pliers. These pliers, which contact contaminated jewelry immediately after it has passed through the client’s tissue, may be reused on multiple customers without full sterilization. Few, if any, gun piercing establishments possess the expensive sterilization equipment (steam autoclave or chemclave) necessary for such a process.

Piercing guns can cause significant tissue damage.
Though slightly pointy in appearance, most ear piercing studs are quite dull. Therefore, these instruments use excessive pressure over a larger surface area in order to force the metal shaft through the skin. The effect on the body is more like a crush injury than a piercing and causes similar tissue damage. Medically, this is referred to as “blunt force trauma.” At the least, it can result in significant pain and swelling for the client, but it also has the potential to cause scarring and increased incidence of auricular chondritis, a severe tissue disfigurement.

Occasionally the intense pressure and speed of the gun’s spring-loaded mechanism is not sufficient to force the blunt jewelry through the flesh. In these cases, the earring stud may become lodged part way through the client’s ear. The gun operator, who may not be trained to deal with this possibility, has two options. S/he can remove the jewelry and repierce the ear, risking contamination of the gun and surrounding environment with blood flow from the original wound. Alternately, the operator can attempt to manually force the stud through the client’s flesh, causing excessive trauma to the client and risking a needlestick-type injury for the operator. How often such gun malfunction occurs has not been documented by manufacturers, but some gun operators report that it is frequent.

When used on structural tissue such as cartilage, more serious complications such as auricular chondritis, shattered cartilage, and excessive scarring are common. Gun piercings can result in the separation of subcutaneous fascia from cartilage tissue, creating spaces in which fluids collect. This can lead to both temporary swelling and permanent lumps of tissue at or near the piercing site. These range from mildly annoying to grossly disfiguring, and some require surgery to correct. Incidence can be minimized by having the piercing performed with a sharp surgical needle, which slides smoothly through the tissue and causes less tissue separation. A trained piercer will also use a post-piercing pressure technique that minimizes hypertrophic scar formation.

Cartilage has less blood flow than lobe tissue and a correspondingly longer healing time. Therefore infections in this area are much more common and can be much more destructive. The use of non-sterile piercing equipment and insufficient aftercare has been associated with increased incidence of auricular chondritis, a severe and disfiguring infection in cartilage tissue. This can result in deformity and collapse of structural ear tissue, requiring antibiotic therapy and extensive reconstructive surgery to correct. Again, medical literature has documented many such cases and is available on request.

The Point Issue 73 - childrens ear piercing - Courtney MaxwellThe length and design of gun studs is inappropriate for healing piercings.
Ear piercing studs are too short for some earlobes and most cartilage. Initially, the pressure of the gun’s mechanism is sufficient to force the pieces to lock over the tissue. However, once they are locked on, the compressed tissue cannot return to its normal state. This constriction causes further irritation. At the least, the diminished air and blood circulation in the compressed tissue can lead to prolonged healing, minor complications, and scarring. More disturbingly, the pressure of such tight jewelry can result in additional swelling and impaction. Both piercers and medical personnel have seen stud gun jewelry completely embedded in ear lobes and cartilage (as well as navels, nostrils and lips), even when pierced “properly” with a gun. This may require the jewelry to be cut out surgically, particularly in cases where one or both sides of the gun stud have disappeared completely beneath the surface of the skin. Such risk is minimal when jewelry is custom fit to the anatomy of the client, and installed with a needle piercing technique which creates less trauma and swelling. Custom fit jewelry should allow sufficient room for swelling and can be downsized to fit snugly on healed tissue.

Jewelry that fits too closely also increases the risk of infection because it does not allow for thorough cleaning. During normal healing, body fluids containing cellular discharge and other products of the healing process are excreted from the piercing. But with inappropriate jewelry, they can become trapped around the fistula. The fluid coagulates, becoming sticky and trapping bacteria against the skin. Unless thoroughly and frequently removed, this becomes an invitation for secondary infection. The design of the “butterfly” clasp of most gun studs can exacerbate this problem. Again, these consequences can be avoided with implant-grade jewelry that is designed for ease of cleaning and long-term wear.

Not all piercing jewelry is safe for prolonged wear.
Most ear piercing studs are not made of materials certified by the FDA, ASTM, or ISO as safe for long term implant in the human body. Even when coated in nontoxic gold plating, materials from underlying alloys can leach into human tissue through corrosion, scratches and surface defects, causing cytotoxicity and allergic reaction. Since manufacturing a durable corrosionand defect-free coating for such studs is extremely difficult, medical literature considers only implant grade steel (ASTM F138) and titanium (ASTM F67 and ASTM F136) to be appropriate for piercing jewelry composition. Studs made of any other materials, including nonimplant grade steel (steel not batch certified as ASTM F138), should not be used, regardless of the presence of surface plating.

Misuse of ear piercing guns is extremely common.
Even though many manufacturers’ instructions and local regulations prohibit it, some gun operators do not stop at piercing only the lobes, and may pierce ear cartilage, nostrils, navels, eyebrows, tongues and other body parts with the ear stud guns. This is absolutely inappropriate and very dangerous.

Although gun piercing establishments usually train their operators, this training is not standardized and may amount to merely viewing a video, reading an instruction booklet, and/or practicing on cosmetic sponges or other employees. Allegations have been made that some establishments do not inform their employees of the serious risks involved in both performing and receiving gun piercings, and do not instruct staff on how to deal with situations such as client medical complications or gun malfunction. Indeed, surveys conducted in jewelry stores, beauty parlors, and mall kiosks in England and the US revealed that many employees had little knowledge of risks or risk management related to their procedure.

Considering that a large proportion of gun operators’ clientele are minors or young adults, it is not surprising that few gun piercing complications are reported to medical personnel. Many clients may have been pierced without the knowledge or consent of parents or guardians who provide healthcare access. Therefore, the majority of the infections, scarring and minor complications may go unreported and untreated. Furthermore, because of the ease of acquiring a gun piercing and the lack of awareness of risk, many consumers fail to associate their negative experiences with the piercing gun itself. They believe that, since it is quicker and easier to acquire a gun piercing than a manicure, gun piercing must be inherently risk-free. Often it is only when complications prove so severe as to require immediate medical attention that the connection is made and gun stud complications get reported to medical personnel.

Despite these pronounced risks associated with gun piercing, most areas allow gun operators to perform piercings without supervision. Recent legislation has begun to prohibit the use of guns on ear cartilage and other non-lobe locations, and the state of New Hampshire has made all non-sterile equipment illegal, but these changes are not yet nationwide. It is our hope that, with accurate and adequate information, consumers and the legislatures will understand and therefore reject the use of gun piercing in the interests of the public health.

References Cited:

Pediatric Emergency Care. 1999 June 15(3): 189-92.
Ear-piercing techniques as a cause of auricular chondritis.
More DR, Seidel JS, Bryan PA.

International Journal of Pediatric Otorhinolaryngology. 1990 March 19(1): 73-6.
Embedded earrings: a complication of the ear-piercing gun.
Muntz HR, Pa-C DJ, Asher BF.

Plastic and Reconstructive Surgery. 2003 February 111(2): 891-7; discussion 898.
Ear reconstruction after auricular chondritis secondary to ear piercing.
Margulis A, Bauer BS, Alizadeh K.

Contact Dermatitis. 1984 Jan; 10(1): 39-41.
Nickel release from ear piercing kits and earrings.
Fischer T, Fregert S, Gruvberger B, Rystedt I.

British Journal of Plastic Surgery. 2002 April 55(3): 194-7.
Piercing the upper ear: a simple infection, a difficult reconstruction.
Cicchetti S, Skillman J, Gault DT.

Scottish Medical Journal. 2001 February 46(1): 9-10.
The risks of ear piercing in children.
Macgregor DM.

American Journal of Infection Control. 2001 August 29(4): 271-4.
Body piercing as a risk factor for viral hepatitis: an integrative research review.
Hayes MO, Harkness GA.

Journal Laryngology and Otology. 2001 July 115(7): 519-21.
Ear deformity in children following high ear-piercing: current practice, consent issues and legislation.
Jervis PN, Clifton NJ, Woolford TJ.

Cutis. 1994 February 53(2): 82.
Embedded earrings.
Cohen HA, Nussinovitch M, Straussberg R.

Scandinavian Journal of Rheumatology. 2001; 30(5): 311.
Does mechanical insult to cartilage trigger relapsing polychondritis?
Alissa H, Kadanoff R, Adams E.

British Journal of Dermatology. 2002 April 146(4): 636-42.
Decrease in nickel sensitization in a Danish schoolgirl population with ears pierced after implementation of a nickel- exposure regulation.
Jensen CS, Lisby S, Baadsgaard O, Volund A, Menne T.

Toxicology In Vitro. 2000 Dec 14(6): 497-504.
Cytotoxicity due to corrosion of ear piercing studs.
Rogero SO, Higa OZ, Saiki M, Correa OV, Costa I.

Journal of the American Medical Association. 1974 March 11; 227(10): 1165.
Ear piercing and hepatitis. Nonsterile instruments for ear piercing and the subsequent onset of viral hepatitis.
Johnson CJ, Anderson H, Spearman J, Madson J.

Journal of the American Medical Association. 1969 March 24; 207(12): 2285.
Hepatitis from ear piercing.
Van Sciver AE.

Journal of the American Medical Association. 291.8 (2004): 981-985.
Outbreak of Pseudomonas aeruginosa infections caused by commercial piercing of upper ear cartilage.
Keene, William E, Amy C Markum, and Mansour Samadpour.

Point #73: President’s Corner – Brian Skellie

2 Comments read Issue 73, Medical, President's Corner, Sterilization, Technology
Brian Skellie working with asepsis

Brian Skellie headshot at 2014 APP conference by April BerardiBrian Skellie
APP President

The APP is always going to be a work in progress, since standards are ever changing with new evidence. Lauded among the guiding principles we maintain as safety standards for our membership is the practice of asepsis. We refer to many procedural acts as practice, as they are rarely ever perfect and require a profound theoretical understanding coupled with regular exercise and critical self observation for improvement. Asepsis requires the right combination of cleaning and sterilization with touching and not touching manual, instrumental and environmental surfaces for infection prevention and control (IPC).

We apply two types of asepsis to reduce or eliminate infection transmission: medical asepsis which emphasizes protection for the client and their environment is more concerned with cleanliness and prevention of the spread of the clients own organisms to other clients, while surgical asepsis which focuses on sterilization and maintaining sterility for items that will be introduced to a wound or piercing cavity or penetrate the skin, thus preventing the introduction of organisms to the client. Medical asepsis can be referred to as clean technique, and surgical asepsis as sterile technique. A thorough and effective means of surgical asepsis should be implemented for all body art procedures. [CE resource]

“Sterile technique is not one set-in-stone method, this is a guideline for establishing your own individual technique.” Nor is it advocating precautions beyond what our sort of minimally invasive ear piercing procedures require for antisepsis and sterility. For those who are curious to learn more about Maximum Sterile Barrier precautions, the CDC HICPAC describes further steps that can be taken for more seriously invasive punctures such as a central venous or arterial catheter. For body artists, an achievable version of surgical asepsis (sterile technique) maintains barriers such as sterile gloves, masks and eye protection, and removes obstacles likely to compromise these barriers such as hanging earrings and necklaces, long hair, rings and watches.

“I think that when you say ‘aseptic technique,’ a lot of people automatically think ‘operating room’ or ‘surgical procedure,’” explains Kathleen Meehan Arias, MS, CIC, president of the Association for Professionals in Infection Control and Epidemiology (APIC) and director of Arias Infection Control Consulting LLC. “That’s rightly so because that is where the bulk of it is. But whenever you are doing anything that bypasses the skin barrier, you should automatically think aseptic technique.” — Applying Aseptic Technique in all Clinical Settings

This outline of technique suggestions comes from the AORN, APIC and CDC standards and recommended practices as well as a number of textbook resources such as Asepsis, the Right Touch. Much of it needs very little interpretation for our purposes. Safety precautions should result in greater control of the procedure, clinical benefits, reduced harm, and limited liability for negligence.

Rationale: There exist standards for prevention of surgical site infection that apply to even minor invasive elective procedures, and piercing falls within this category by definition.

“When implemented, these guidelines should reduce the risk of disease transmission in the piercing environment, from piercee to piercer, and from piercee to piercee. Based on principles of infection control, the document delineates specific guidelines related to protective attire and barrier techniques; handwashing and care of hands; the use and care of sharp instruments and needles; sterilization or disinfection of instruments; cleaning and disinfection of environmental surfaces; disinfection and the decontamination room; single-use disposable items; the handling of previously worn piercing jewelry; disposal of waste materials; and implementation of recommendations.”— Piercing Experience adapted IPC standards from the CDC

My personal observation is that these policies have helped limit risk at my studio. They have been reviewed by legal counsel, qualified bioscientists, medical professionals, and university professors. That said, I’m sure that they could always use more input and adaptation. Body art safety is an ever-evolving field of interest.

One might say there is no single right way to pierce. Many variations are possible with an understanding and application of asepsis. We are an industry in which studios market based on their specialties, and for some that is participation in continuing education, gaining knowledge, and raising standards. Maintaining a positive tone one can show those as strengths without diminishing others. This is crucial to developing the bonds between us as fellow professionals. If you believe something you do has advantages, feel free to share that with your customers in a way that does not end up overly critical of our other colleagues.

2013 APP Procedure ManualIt should be clear that these position statements in support of surgical asepsis are neither contradictory nor accusatory of others currently using APP minimum standards for medical asepsis according to our 2013 revised Procedure Manual. They build upon them as we are all encouraged to do as Members, employing additional precautions and elective limitations based on evidence and strong theoretical rationale. My preference is to demonstrate best practices as an educator instead of the minimums. If we all did no more than what was required, the industry would not be as interesting.

I believe that it is the responsibility of each of us to uphold the values we feel are important, and to continually advance our standards in order to achieve our goals. I do have romantic hopes that over time the industry will move in the direction of pure, validated, ethical materials and practices that are as harmless as possible. A predictable, consistent, safe, simple, and gentle piercing experience is attainable today and can be refined based on these principles and open communication among colleagues. The recommendations that I make in addition to APP minimums result from a continually researched process of elimination and adaptation, and they are freely shared for peer review. Please consider this a formal request for comments.

Point #70: When is Piercing Mutilation? – Paul King

3 Comments read International, Issue 70, Legislation, Medical, News

PKing photo for conference 2011By Paul King
APP Treasurer

Considering Female Genital Piercing as “Female Genital Mutilation” in the United Kingdom

The Current UK Situation

On March 19, 2015, the London Evening Standard published Martin Bentham’s article online, “Women with Vagina Piercings to be Classed as FGM.”[1] The tabloid article is claiming that the United Kingdom’s (UK) Department of Health is requiring that healthcare professionals report known incidences of female genital piercing as “female genital mutilation.” This article was and is still being widely shared in social media and has proliferated through various copycat online articles through sites such as BBC and Huffington Post, etc.[2] The response has been an incredulous outcry from UK piercers,  other piercers worldwide, piercing enthusiasts, and even UK nurses.[3]

In this article, I will outline some pertinent history on the topic of “Female Genital Mutilation,” particularly in the UK and how it relates to female genital piercing; explain some key legal definitions and concepts; illuminate legal and ethical concerns; and suggest options for immediate responses and longer range strategies potentially affecting the Association of Professional Piercers (APP), UK piercers, global body altering industries, and other body modification communities.

A Brief Overview of “Female Genital Mutilation

To some degree, most of us have an idea of what “female genital mutilation” is and what it is not. However, “Female Genital Mutilation” (“FGM”) is a very complex subject containing passionate and sometimes conflicting beliefs. Within individuals as well as between groups, “Female Genital Mutilation” includes diverse and sometimes contradictory understandings of “Human Rights,” patriarchy, feminism(s), xenophobia, Islamophobia, sexism, racism, colonialism, Western ideology, economics, etc. I have studied this subject intensely for several years; I  am still learning and therefore I make few claims.[4] Most of the complexities of “FGM” are outside the scope of this article.

Throughout this paper, I use “FGM” and “female genital mutilation” in quotations. I believe the phrase and acronym are popularly recognized so I perpetuate their usage, however, with great ambivalence. I prefer and generally use “female genital alteration,” (“FGA”), or even more neutral, “genital alteration.”[5] These are less biased and less reductive ways to talk about diverse procedures of the genitals that contain debated and complicated social meanings and motivations, as well as a wide range of psychological and physical outcomes. Even the term “female genital piercing” carries problems of vagueness, which leads to confusion. As any professional and experienced piercer can tell you, not all piercings are the same; a “clit piercing” is not a “clitoral hood piercing.”[6]

The language and visual images used by the programs to eradicate “FGM” are so compelling and horrifying for the majority of Westerners that it becomes unimaginable to call into question data, rhetoric, or effects of this authoritative campaign.[7] Although the United Nations (UN) agencies including the World Health Organization (WHO) have made four separate categories to differentiate the “FGM” practices, their literature describes all “FGM” practices as having the exact same physical and emotional traumas. As a result, the most invasive infibulation with clitoral excision carries the same description of trauma as the most benign prick.[8] The UN et al. understands what they’re doing, they’re not looking for compromise; they are seeking complete eradication of all practices within one generation.[9] Setting aside further ethical considerations of UN et al.’s campaign for the eradication of “FGM,” we will only address the repercussions from the overreaching definition of “Type IV female genital mutilation.”

Illustrations by Jennifer Klepacki from The Piercing Bible: The Definitive Guide to Safe Body Piercing by Elayne Angel www.piercingbible.com
Illustrations by Jennifer Klepacki from The Piercing Bible: The Definitive
Guide to Safe Body Piercing by Elayne Angel www.piercingbible.com

The legal definitions of “FGM” includes: “Type IV is a category that subsumes all other harmful, or potentially harmful, practices that are performed on the genitalia of girls and women.”[10] The UN and therefore the UK provide no qualitative or quantitative scale for “harm.” A rash, abrasion, puncture, burn, and/or contusion, etc., any injury that is a result of a deliberate action, no matter how temporary or permanent is technically “harm.”[11] The UN/WHO’s own documents acknowledge their definitional language for “female genital mutilation” was deliberately broad to close any potential legal “loopholes” for the practices they were trying to target.[12] 

The UN/WHO have identified “female genital mutilation” as occurring in ethnic groups in or immigrated from 28 African countries as well as Iraq, Israel, Oman, United Arab Emirates, the Occupied Palestinian Territories, India, Indonesia, Malaysia and Pakistan. I would assert that the UN/WHO never intended or considered for their definitions to include Western “normal” personal grooming practices on adult female bodies that frequently result in injuries. The UN/WHO’s stance on Western women altering their genitalia for aesthetics using cosmetic surgical procedures was intentionally left ambiguous.[13] To further complicate the ethics in this issue, other  UN policies do not consider “traditional” genital modifications of the male body as “mutilation,” in fact, the UN agencies UNAIDS and WHO, fund and promote medicalized male genital alteration in the same African communities in which they seek to eradicate female genital alteration.[14]

Important History Relevant to the UK

The trending tabloid articles take out of context an issue with a long history. For perspective, Ioffer some background on the development of the UK’s “FGM”campaign. This historical timeline is by no means exhaustive:

In 1985, the UK passed its first regulation on the prohibition of mutilating female genitalia. “Mutilation” is never defined.[15]

In 1987, UK authorities conducted “Operation Spanner.” This investigation targeted adult male homosexuals engaged in consensual BDSM.[16] Among the arrested was one of the UK’s most prominent and historically important professional body piercers, Alan Oversby, a.k.a. “Mr. Sebastian.” His criminal activity included, “performing a [Prince Albert] piercing for the purposes of sexual pleasure….”[17] All defendants pled guilty and lost all appeals, both in the UK and EU courts.[18] For this article, the crucial point to understand is that UK law will disregard adult consent to criminally convict a body piercer. In the Spanner Case, guilt was determined on the subjective ideas of “harm.” Current understandings are that one can pierce at least male genitals for adornment, but not for sexual gratification.[19]

In 2003, the UK replaced its first anti-“FGM” law of 1985, with the “Female Genital Mutilation Act 2003,” but they still did not clearly defined “mutilation.” In addition, the act refers to “child abuse” and the protection of “girls” throughout the document, then concludes under the definitions section 6 (1), “Girl includes woman.”[20] Obviously, this muddles the understanding of what constitutes “child,” “girl,” “child abuse” as well as a consenting (female) adult.[21] 

In 2008, The United Nations (UN) and the World Health Agency (WHO) released an UN inter-agency seminal work on the subject of “FGM.”[22] This document contains their standpoint on the issue, definitions, and candid rationale for their language choices. This is the document that most national governments refer to when considering definitions and implementing their own programs. It is the source document from which the National Health Services (NHS) and the Information Standards Board’s program ISB 1600 draw their global statistics, UK statistical projections, and legal definitions.[23] 

UN et al.’s Type IV female genital mutilation is defined as “All other harmful procedures to the female genitalia for non-medical purposes, for example pricking, piercing, incising, scraping, and cauterization.” This is where Western-style female genital piercing would be classed. The term “Medical” includes any procedure not necessary for physical and psychological health. Cultural and religious necessities are explicitly excluded as medically necessary. The UN et al. also specifically includes “stretching” and “harmful substances.” It also states “herbs” as well as implying chemical bleaches, depilatory creams, hot waxes, etc. when they cause any injury fall into this category.[24] The UN explains that they use such broad language to “close loopholes” in their campaign against “FGM.”[25] Of course the problem of this slippery slope argument is that they have included ANYTHING that causes ANY degree of injury to the female genitalia.  This includes female genital body piercing and potentially the reinsertion or stretching of a female genital piercing.[26] Looking through medical reports for the US and Europe reveals thousands of female genital injuries, annually. Research reveals that most of these emergency room visits and treatments are for procedures we would never label “mutilation”such as “personal grooming” with razors, scissors, and clippers; skin bleaching; electrolysis; “Brazilian” waxing; pubic hair dyeing; and pubic hair removal with lasers or depilatory creams; etc.[27] Presented this way, Type IV’s all inclusiveness may seem absurd. However, the UN categories were not intended to understand and document “our” bodies and practices; this descriptive system was intended to scrutinize “their” bodies and practices. For the law to make any sense, the allegation of “female genital mutilation” must be kept in context with the bodies being targeted as “FGM-affect.”

        

The 2013 UK Intercollegiate FGM report instructs authorities, including healthcare professionals, on how to identify, record, and report “FGM.”[28] This includes explanations for “FGM-affected” immigrant communities from the previously mentioned UN/WHO listed countries. The UK draws from this list for their statistics of probable “FGM” risk in the UK, since authorities admit there had been no prosecutions and little actual evidence to support concerns of widespread “female genital mutilation.”[29]

On April 1, 2014, the Information Standards Board released directive ISB 1610. This document detailed information on standardized codes and procedures for healthcare workers to report incidences of “female genital mutilation” in the UK. This guide includes UN/WHO definitions for Type I, II, and III. However, Type IV, which covers anything else, now includes “unknown” as ISB Type 9. “Type 9” mutilation means some sort of injury and/or scarring has occurred but it can’t be identified or there isn’t a clear ISB code for it. Type 9 is how “piercing” should be categorized.[30]

In July 2014, the Department of Health issued “Recording FGM in the Patient Healthcare Record” reminding healthcare providers, particularly General Practitioners, that ISB 1610 requires mandatory reporting of “FGM” byall healthcare staff effective Sept. 1, 2014. The Department of Health has been collecting and reporting this data since then.[31]

In Jan 2015, the Secretary of State and Parliament released a comprehensive report, in response to a July 2014 summit, requesting greater cooperation between the departments of law enforcement, education, and healthcare to escalate the campaign against FGM in the UK.[32]

Female Genital diagram TexOn March 10, 2015, the House of Commons released a report titled, “Female Mutilation: Follow Up.” The Home Affairs Committee demanded that laws be clarified to include all UK female genital cosmetic surgeries on the grounds that it is hypocritical to specifically target the eradication of female genital procedures of “FGM” -identified communities both located inside and outside the UK, while allowing the rest of UK females to modify their genitals.[33] This report is likely the impetus for the Evening Standard’s article of March 17, 2015.

On March 17, 2015, The London Evening Standard’s website posted the article “Women with Vagina Piercings to be Classed as FGM.” This article appears to have ignited the current public awareness that female genital piercing could be, and perhaps have been, categorized as “female genital mutilation.” Requests have been made of the author and the paper to see if they have knowledge of any evidence that the government specifically addresses Western-style practices of female genital piercing, so far, without reply. Most likely, the author was drawing from previous documents that generally include “piercing” as a standard example of the UN Type IV / ISB Type 9 “FGM.”[34]

Concluding Thoughts

At the time of this writing, I have no evidence that UK authorities would interpret the piercing of a white indigenous adult female’s genitals for adornment as “female genital mutilation.” The protection of the genitals of all minors under the age of 16 is already enforced by strict regulations. The UK has cultural views and therefore legal guidelines on young persons that differ from many states in the US. In the UK, persons 16 and older can consent to sex and medical treatments, without the necessity of parental consent.[35]Although, internationally, there exists a widely held professional ethical standard that only persons considered adults, at the “age of majority,” should have their genitals pierced. However, if a UK body piercer performed a female genital piercing on an adult woman from a UN/WHO/UK recognized “FGM-affected community” the legal outcome gets trickier to predict.[36] If the piercing were discovered by a healthcare provider, the situation would create an ethical dilemma for the healthcare worker, compelled by law to report any alterations. If the reported incident were investigated by law enforcement, it could lead to criminal prosecution of the body piercer, counter staff, shop owner, and/or a friend(s) that accompanied the piercing client (anyone that “aids, abets, [counsels] or procures”) for violation of the Female Genital Mutilation Act 2003 carrying a penalty of a fine with up to 14 years imprisonment.[37] To mitigate risk, a UK piercer could refuse to pierce female genitalia, while continuing to pierce male genitalia. As another option, UK piercers could sort clients by using the same geographical criteria as the National Health Services and law enforcement; however, in practice, I doubt denying services based on country of origin would go  over well. It would probably lead to accusations of xenophobia and racism.

Therein lies the crux of an ethical dilemma. Most people will not believe that every injury of the female genitals is “mutilation.” “Female genital mutilation” is understood to only happen in “FGM-affected communities.” It’s common sense that Janet Jackson’s, Christina Aguilera’s, or Lady Gaga’s pierced genitalia is not “female genital mutilation,” and as such the definitions of and rules for “female genital mutilation” should not apply.[38] However, “common sense” is not universal; it is influenced by life experience, education, class, economics, religion, ethnicity, sex, gender, country of origin, etc. Healthcare workers, police, legislators, and the public operate under this blind bias.[39] Few want to admit that they see and treat others differently, that is because it directly clashes with other deeply held Western values of tolerance, decency, and fairness.

In March 2015, the UK Home Affairs Committee recognized the “double standard” of pressuring other communities to stop their “mutilation” practices while allowing UK females to have genital cosmetic surgeries. They have appealed to parliament to amend the 2003 law in order to criminalize female genital cosmetic surgery.[40] This action will likely meet allegations of patriarchy and sexism. Many Westerners fail to realize that our understandings of medicine and science (such as “necessary” or “not necessary”) as well as violence, mutilation, harm, pain, etc. are always shaped by culture. Ones most deeply held religious and moral beliefs, including notions of what is “right” or “wrong” are shaped by the culture one is born into. The dominant culture within any particular nation is in a more powerful position to propagate its beliefs.

The UK government and anti-“FGM” organizations genuinely desire to protect immigrant women and their daughters. Most Westerners, this author included, would find it repugnant to defend the most commonly told story of a practice that physically restrains a very young girl crying against her will, to have her clitoris cut out and her vagina sewn shut, a procedure that endangers her life, sexual pleasure, and ability to procreate. However, the anti-“FGM” campaigners risk weakening their public support when they overreach their claims to consider all practices regardless of invasiveness, all females regardless of age, and all physical and psychological consequences regardless of the wide range of experiences and perceptions, as the same. Once the UN et al. labels a community as practicing “FGM,” then at the international level, those community adult women’s legal “rights” to consent to any genital alteration are stripped away.[41] 

I’m not saying we should do nothing for individuals that want to be helped, or that we should not impose policies to protect minors, particularly in our own countries, but I do believe definitions and regulations that could specifically deny a female adult the choice to consent or not to consent to altering her genitals, whether by: piercing the genital tissue; or shaving, trimming, bleaching, dyeing, lasering, or waxing the pubic hair; or surgically altering the appearance, etc., violate current commonly-held notions of sexual equality and fairness. 

So what can be done in the UK?  Ultimately, the course of action is best decided by the piercers and the women of the UK, although international piercing communities should assist when asked. Currently, an e-petition is circulating that UK citizens can sign requesting that the government legally recognizes female genital piercing is not mutilation.[42] UK citizens can write and call their elected officials. They can email responses to all names and department heads associated with the anti-”FGM” regulations.Everyone can email news agencies that spread the story. At its source, this is an international issue that will keep occurring as a result of the definitions and policies of United Nations and the World Health Organization. Since the medical field and personal grooming industries may be affected, alliances should be sought. Body piercing communities and their allies should simultaneously apply pressure for legislative changes at both the local as well as the international levels.

As I conclude this article, I am reminded of the small group of piercers that came together in 1994, to stand up against a misguided California state bill that was going to unnecessarily burden our industry. The Association of Professional Piercers was born from this handful of determined activists. Twenty years later, the APP has educated thousands of piercers and has helped shaped numerous city, county, state/province, and national regulations around the world. My concerns about this current issue in the UK are somewhat eased by the excitement of what the future may hold with this opportunity for the UK piercing community to unite behind a common cause.

Author’s note: This article was written on a very tight deadline. I am filled with deep gratitude for Nici Holmes, Kendra Jane, Marina Pecorino, and Elayne Angel for their incredible assistance during this process, filled with last-minute questions and requests.

 

The Association of Professional Piercers’ Official Response on the UK Categorization of “Piercing” as “Female Genital Mutilation.”

The Association of Professional Piercers does not consider elective female genital piercing to be mutilation or “Female Genital Mutilation” (“FGM”). We support the right for all adults to pierce their bodies in a safe, informed, and consensual manner when performed by a qualified practitioner under appropriate asepsis.

We are urging UK government officials to readdress the language of the current laws and regulations to clarify the confusion arising from the current definitions, including definitional section 6 (1) of the Female Genital Mutilation Act 2003, in which “Girl includes woman,” as well as any “FGM” regulations that include the term “pierce,” such as ISB 1610 of 2014. We are available to assist in this process.

The Association of Professional Piercers is an international non-profit organization dedicated to the dissemination of vital health and safety information about body piercing to piercers, health care professionals, legislators, and the general public. Socially and legislatively, body piercing is situated within the greater body modification community. As a result, we recognize that our role extends beyond the discipline of body piercing. Our position on body art practices such as tattooing, cosmetic tattooing, branding, scarification, suspension, and other forms of body modification is as follows:

We support the right for all adults to adorn or modify their bodies in a safe, informed, and consensual manner when performed by a qualified practitioner under appropriate asepsis. While the APP does not directly regulate, perform outreach, or offer procedural guidelines on practices other than body piercing, we support health and safety organizations that do. Our most fundamental principles as expressed in our environmental criteria and ethical standards extend to the greater body modification community and its practices.

 

Bibliography

  1. Ahmadu, Fuambai S. and Richard A. Shweder. “Disputing the myth of the sexual dysfunction of circumcised women: An interview with Fuambai S. Ahmadu by Richard A. Shweder.” Anthropology Today, 25 (2009): 14–17.
    DOI: 10.1111/j.1467-8322.2009.00699.x
  2. American Academy of Pediatrics. “Informed Consent, Parental Permission, and Assent in Pediatric Practice by the Committee on Bioethics.”Pediatrics 95, no. 2, (1995): 314-317.
    http://www.cirp.org/library/ethics/AAP/
  3. Bibbings, Lois, and Peter Alldridge. “Sexual Expression, Body Alteration, and the Defence of Consent.”Journal of Law and Society 20,no. 3 (1993): 356-370. Retrieved from http://www.jstor.org/stable/1410312
  4. Bjerring, Peter, Henrik Egekvist, and Thomas Blake. “Comparison of the Efficacy and Safety of Three Different Depilatory Methods.”Skin Research and Technology4, no. 4 (1998): 196-199. DOI: 10.1111/j.1600-0846.1998.tb00110.x
  5. Brunn Poulse, Pia, and Maria Strandesen. “Survey and Occurrence of PPD, PTD and Other Allergenic Hair Dye Substances in Hair Dyes.” The Danish Environmental Protection Agency. 2013.
    http://www2.mst.dk/udgiv/publications/2013/02/978-87-92903-92-1.pdf
  6. Christoffersen-Deb, Astrid. “’Taming Tradition’: Medicalized Female Genital Practices in Western Kenya.”Medical Anthropology Quarterly 19, no. 4 (2005): 402-418. http://www.jstor.og/stable/3655495.
  7. Coleman, Doraine L. “The Seattle Compromise: Multicultural Sensitivity and Americanization.” Duke Law Journal 47, no. 4 (1998): 717-783. http://www.jstor.org/stable/1372912
  8. Darby, Robert, and J. Steven Svoboda. “A Rose by Any Other Name?: Rethinking the
  9. Similarities and Differences between Male and Female Genital Cutting.”Medical Anthropology Quarterly 21, no. 3 (2007): 301-323.
    DOI: 10.1525/MAQ.2007.21.3.301.
  10. Delanty, Gerard. “Habermas and Occidental Rationalism: The Politics of Identity, Social Learning, and the Cultural Limits of Moral Universalism.”Sociology Theory 15, no. 1 (1997): 30-59.
    http://www.jstor.org/stable/202134
  11. Eyal, Nir. “Informed Consent.” In The Stanford Encyclopedia of Philosophy,edited by Edward N. Zalta  (Fall 2012 Edition).
    http://plato.stanford.edu/archives/fall2012/entries/informed-consent/    .
  12. Filc, Dani. “The Medical Text: between Biomedicine and Hegemony.”Social Science & Medicine 59, (2004).
    DOI:10.1016/j.socsimed.2004.01.003
  13. Glass, Allison S., Herman S. Bagga, Gregory E. Tasian, Patrick B. Fisher, Charles E. McCulloch, Sarah D. Baschko, Jack W. McAninch, and Benjamin N. Breyer. “Pubic Hair Grooming Injuries Presenting to US Emergency Departments.”Urology 80, no. 6 (2012): 1187-1191.
    DOI: 10.1016/j.urology.2012.08.025.
  14. Hastings Center. “Seven Things You Should Know About Female Genital Surgeries in Africa.”Hasting Center Report 42, no. 6 (2012): 19-27.
    DOI: 10.1002/hast.81
  15. Herbenick, Debby, Venessa Schick, Michael Reece, Stephanie A. Sanders, and J. Dennis Fortenberry. “Pubic Hair Removal among Women in the United States; Prevalence, Methods, and Characteristics.”Journal of Sexual Medicine 7, no. 10 (2010): 3322-30.
    DOI: 10.1111/j.1743-6109.2010.01935.x
  16. Johnsdotter, Sara, and Birgitta Essén. “Genitals and Ethnicity: the Politics of Genital Modifications.”Reproductive Health Matters Journal 18, no. 35 (2010): 29-37. http://www.ncbi.nlm.nih.gov/pubmed/20541081
  17. Kelly, Brenda, and Charles Foster. “Should Female Genital Cosmetic Surgery and Genital Piercing Be Regarded Ethically and Legally as Female Genital Mutilation?”International Journal of Obstetrics & Gynaecology (BJOG). 2012.
    DOI: 10.1111/j/1471-0528.2011.03260.x
  18. King, Paul R. “Investigations of Female Genital Alteration in the United States Within Nonimmigrant Communities.” UC Berkeley Undergraduate Journal. 2015. In press.
  19. Leonard, Lori. “‘We Did It for Pleasure Only’: Hearing Alternative Tales of Female Circumcision.”Qualitative Inquiry 6, no. 2 (2000b): 212-228.
    DOI: 10.1177/107780040000600203
  20. Moyn, Samuel.The Last Utopia: Human Rights in History. Cambridge: Belknap Press. Kindle edition, 2010.
  21. Prinz, Jesse. The Emotional Construction of Morals. Oxford University Press. Kindle Edition. 2007.
  22. Schramme, Thomas. “Should We Prevent Non-therapeutic Mutilation and Extreme Body Modification?”Bioethics 22, no. 1 (2008): 8-15.
    DOI: 10.1111/j.1467-8519.2007.00566.x
  23. Sheldon, Sally, and Stephen Wilkinson. “Female Genital Mutilation and Cosmetic Surgery Regulating Non-Therapeutic Body Modification.”Bioethics, 12 no. 4, (1998): 263–285.
    DOI: 10.1111/1467-8519.00117
  24. Smith, Courtney. “Who Defines ‘Mutilation’? Challenging Imperialism in the Discourse of Female Genital Cutting.”Feminist Formations 23, no. 1 (2011): 25-46.
    DOI: 10.1353/ff.2011.0009
  25. Trager, Jonathan D.K. “Pubic Hair Removal: Pearls and Pitfalls.”Journal of Pediatric and Adolescent Gynecology19, no. 2 (2006): 117-23. http://www.sciencedirect.com/science/ article/pii/S108331880600060X
  26. UNAIDS & World Health Organization. “Male Circumcision.”Technical Guidance Note for Global Fund HIV Proposals, 2011. http://www.unaids.org/en/media/unaids/contentassets/documents/programmes/programmeeffectivenessandcountrysupportdepartment/gfresourcekit/20110831_Technical_Guidance_Male_Circumcision_en.pdf
  27. UNFPA-UNICEF. “Female Genital Mutilation/Cutting: Accelerating Change (Joint Funding Proposal).” UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting. E-book. http://www.unfpa.org/publications/female-genital-mutilationcutting-accelerating-change.
  28. UNICEF. “Eradication of Female Genital Mutilation in Somalia.” United Nations International Children’s Emergency Fund, 2004.
    www.unicef.org/somalia/SOM_FGM_Advocacy_Paper.pdf‎
  29. Wade, Lisa. “The Politics of Acculturation: Female Genital Cutting and the Challenge of building Multicultural Democracies.”Social Problems 58, no. 4 (2011): 518-537. http://www.jstor.org/stable/10.1525/sp.2011.58.4.518
  30. Wagner Jr., Richard F., Trudy Brown, Rebecca E. Archer, and Tatsuo Uchida. “Dermatologists’
  31. Attitudes toward Independent Nonphysician Electrolysis Practice.”American Society for Dermatological Surgery 24, no. 3 (1998): 357-362.
    http://www.ncbi.nlm.nih.gov/pubmed/9537011
  32. World Health Organization. “Eliminating Female Genital Mutilation: an Interagency Statement: UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF, UNIFEM, WHO.”World Health Organization, (2008). http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/
  33. World Health Organization. “Global Strategy to Stop Health-care Providers from Performing Female Genital Mutilation: UNAIDS, UNDP, UNFPA, UNICEF, UNHCR, UNIFEM, FIGO, ICN, IOM, WCPT, WMA, MWIA.”World Health Organization,(2010). http://www.who.int/reproductivehealth/publications/fgm/rhr_10_9/en/
  34. Yoder, Stanley P., Noureddine Abderrahim, and Arlinda Zhuzhuni. “Female Genital Cutting in the Demographic and health Surveys: A Critical and Comparative Analysis.”DHS Comparative Reports no. 7, (2004). Calverton, Maryland: ORC Macro.
    http://www.measuredhs.com/publications/publication-cr7-comparative-reports.cfm
  35. Young, Cathy, Myrna L. Armstrong, Alden E. Roberts, Inola Mello, and Elayne Angel. “A Triad of Evidence for Care of Women with Genital Piercings.”Journal of the American Academy of Nurse Practitioners, (2010). DOI: 10.1111/j.1745.7599.2009.0479.x

 

[1] My article won’t digress into an anatomy lesson, but it is noteworthy that Western-style piercers do not pierce “vaginas.” http://www.standard.co.uk/news/health/women-with-vagina-piercings-to-be-classed-as-suffering-from-fgm-10113202.html

[2] http://www.bbc.co.uk/newsbeat/31938409; http://www.huffingtonpost.co.uk/2015/03/18/vaginal-piercings-classed-fgm-new-nhs-guidelines_n_6892376.html; http://www.thefrisky.com/2015-03-19/nhs-genital-piercings-count-as-female-genital-mutilation/; http://www.independent.co.uk/life-style/health-and-families/health-news/women-with-vaginal-piercings-will-be-recorded-as-suffering-fgm-under-new-nhs-rules-10116464.html; http://www.dailymail.co.uk/news/article-2999462/Women-vaginal-piercings-classed-having-suffered-female-genital-mutilation-says-Department-Health.html; http://www.infowars.com/uk-regulation-to-label-women-with-vagina-piercings-victims-of-genital-mutilation/; http://www.prisonplanet.com/uk-regulation-to-label-women-with-vagina-piercings-victims-of-genital-mutilation.htm; http://www.telegraph.co.uk/women/womens-health/11480359/FGM-Vaginal-piercing-to-be-recorded-as-female-genital-mutilation.html; http://www.mirror.co.uk/news/uk-news/fgm-women-vaginal-piercings-classed-5356141; http://guernseypress.com/news/uk-news/2015/03/17/vaginal-piercings-classed-as-fgm/

[4] A 60-page excerpt of my 2014 honors thesis, “Investigations of Female Genital Alteration in the US Within Nonimmigrant Communities” is pending publication for this Fall 2015, in the UC Berkeley Undergraduate Journal.  http://escholarship.org/uc/our_buj

[5] I only use the language of “female genital mutilation” when specifically addressing the UN et al.’s “FGM eradication campaign.”

[6] Refer to the anatomical drawings showing the variety of female genital piercings. Illustrations by Jennifer Klepacki. Used with permission of The Piercing Bible: The Definitive Guide to Safe Body Piercing. www.piercingbible.com.

[7] World Health Organization, “Eliminating Female Genital Mutilation: an Interagency Statement: UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF, UNIFEM, WHO,” World Health Organization, (2008), 11, http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/; UNICEF, “Eradication of Female Genital Mutilation in Somalia,” United Nations International Children’s Emergency Fund, 2004, www.unicef.org/somalia/SOM_FGM_Advocacy_Paper.pdf‎; (For alternative narratives and standpoints to the anti-”FGM” campaign, see: Lori Leonard, “‘We Did It for Pleasure Only’: Hearing Alternative Tales of Female Circumcision,” Qualitative Inquiry 6, no. 2, 2000: 212-228, DOI: 10.1177/107780040000600203; and Hastings Center, “Seven Things You Should Know About Female Genital Surgeries in Africa,” Hasting Center Report 42, no. 6 (2012): 19-27, DOI: 10.1002/hast.81

[8] Ibid, 9, 11, 24.

[9] UNFPA-UNICEF, “Female Genital Mutilation/Cutting: Accelerating Change (Joint Funding Proposal),” UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting. E-book, 2012, 12, http://www.unfpa.org/publications/female-genital-mutilationcutting-accelerating-change2012.

[10] WHO, Eliminating Female Genital Mutilation…2008, 26.

[11] Ibid., 26-28.

[12] Ibid.

[13] Ibid., 28.

[14] UNAIDS & World Health Organization, “Male Circumcision,” Technical Guidance Note for Global Fund HIV Proposals, 2011. http://www.unaids.org/en/media/unaids/contentassets/documents/programmes/programmeeffectivenessandcountrysupportdepartment/gfresourcekit/20110831_Technical_Guidance_Male_Circumcision_en.pdf

[15] Prohibition of Female Circumcision Act 1985, Chapter 38, http://www.legislation.gov.uk/ukpga/1985/38

[16] “BDSM” is the acronym for Bondage and Discipline, Sadomasochism. It is an umbrella term for a wide range of sexual play and expression considered outside mainstream sexual norms.

[17] Bibbings, Lois, and Peter Alldridge, “Sexual Expression, Body Alteration, and the Defence of

Consent,” Journal of Law and Society 20,no. 3 (1993): 361, http://www.jstor.org/stable/1410312

[19] Ibid.

[20] Female Genital Mutilation Act 2003, Chapter 31, http://www.legislation.gov.uk/ukpga/2003/31/pdfs/ukpga_20030031_en.pdf

[21] Since the age of sexual consent and medical consent is 16 in the UK, clearer language that addresses the specific  age would correct this problem, as an example: “under 16,” “16 through 17 years of age,” “under 18 years of age,” or  “18 years of age and older.”

[22] WHO, Eliminating Female Genital Mutilation…, 2008.. (I critique this document in much greater depth in my thesis, “Investigations of Female Genital Alteration…”.)

[23] As an aside from our immediate issue, the 2008 UN Interagency statement on FGM is the source of the UK’s ongoing issue of whether female cosmetic surgeries are mutilation or not. (The document takes the stance those “elective” surgeries such as vaginal rejuvenation and hymen repair ARE mutilation while acknowledging many Western countries may not agree).

[24] WHO, “Eliminating Female Genital Mutilation…., 2008, 27, 28.

[25] Ibid., 28.

[26] All italic emphasis in this paragraph was added by the author. I include “reinsertion” since when jewelry has been taken out of a piercing, the piercing fistula starts to shrink, reinsertion in some instances may stretch the piercing channel. Generally, in a well-healed piercing and executed by an experienced piercer, changing female genital jewelry carries a remote possibility of tissue trauma; as such I did not include “jewelry changes” under Type IV.

[27] Bjerring, Peter, Henrik Egekvist, and Thomas Blake. “Comparison of the Efficacy and Safety of

Three Different Depilatory Methods.” Skin Research and Technology 4, no. 4 (1998): 196-199. DOI: 10.1111/j.1600-0846.1998.tb00110.x; Brunn Poulse, Pia, and Maria Strandesen, “Survey and Occurrence of PPD, PTD and OtherAllergenic Hair Dye Substances in Hair Dyes,” The Danish Environmental Protection Agency, 2013, http://www2.mst.dk/udgiv/publications/2013/02/978-87-92903-92-1.pdf; Glass, Allison S., Herman S. Bagga, Gregory E. Tasian, Patrick B. Fisher, Charles E. McCulloch, Sarah D. Baschko, Jack W. McAninch, and Benjamin N. Breyer, “Pubic Hair Grooming Injuries Presenting to US Emergency Departments,” Urology 80, no. 6 (2012): 1187-1191, DOI: 10.1016/j.urology.2012.08.025; Herbenick, Debby, Venessa Schick, Michael Reece, Stephanie A. Sanders, and J. Dennis Fortenberry, “Pubic Hair Removal among Women in the United States; Prevalence, Methods, and Characteristics,” Journal of Sexual Medicine 7, no. 10 (2010): 3322-30, DOI: 10.1111/j.1743-6109.2010.01935.x; Trager, Jonathan D.K. “Pubic Hair Removal: Pearls and Pitfalls.” Journal of Pediatric and Adolescent Gynecology 19, no. 2 (2006): 117-23. http://www.sciencedirect.com/science/article/pii/S108331880600060X

[28] “Tackling FGM in the UK: an Intercollegiate Recommendations for Identifying, Recording, and Reporting,” 2013.

[29] Ibid., 12.

[30] Information Health and Standards Board for Health and Social Care, “ISB 1610,” 2014, http://www.isb.nhs.uk/documents/isb-1610

[32] Secretary of State, “Female Genital Mutilation: The Case for a National Action Plan,“ https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384349/FGMresponseWeb.pdf

[34] I use the APP’s definition of “body piercing” to mean: “Western-style practices of female genital piercing.”

[36] There could also be a legal issue of Actual Bodily Harm, “ABH” (not related to “FGM”) if the client or piercer received sexual pleasure from the piercing process or if the piercing were performed in the context of a BDSM sexual scene. See information on the Spanner Case.

[37] “Female Genital Mutilation Act 2003,” sections 2 and 5.

[38] These three celebrities have all gone public with their genital piercings; no “outings” were done for this article. (Vibe Magazine interview with Serena Kim) http://brownsista.com/janet-jacksons-interview-with-vibe-vixen/; ((christina Aguilera’s Vertical clitoral hood piercing was confirmed with Taj Waggaman, body piercer, in a personal communication, March 23, 2015); (Lady Gaga, September 12, 2011), http://www.thesuperficial.com/photos/lady-gagas-about-to-feel-a-breeze/0913-lady-gaga-upskirt-01

[39] This is a link to a forum with nurses discussing the London Evening Standard “FGM” article. They expressed personal opinions on how they should interpret female genital piercing and the law. http://www.practicenursing.co.uk/forum/topic.aspx?TOPIC_ID=23989

[40] House of Commons, “Female Genital Mutilation: Follow Up,” 2015, 6, 7. http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhaff/961/961.pdf

[41] WHO, “Eliminating Female Genital Mutilation…,” 2008, 10.

Point #67: Is Triclosan Safe?

1 Comment read Medical, News

IMG_3716Kim Zapata headshotBy Kimberly Zapata

Triclosan is an antibacterial agent found in various consumer products, from hand soap to shampoo, deodorant, toothpaste, and clothing and kitchenware. As piercers, we encounter triclosan on a daily basis; it is the active ingredient in the soaps we use—and recommend. However, in April 2014 Scientific American: 60 Second Health reporter Christopher Intagliata posted a podcast about the potential dangers of triclosan. Intagliata explained that the researchers for mBio (the journal which conducted the study)found various levels of triclosan “in blood, urine, breast milk and mucus.” But with such prevalent usage, that was no surprise; that was to be expected. What was a surprise was that the residues from this antimicrobial which, by definition, are added to consumer products “to reduce or prevent bacterial contamination”may actually “boost bacterial growth in our bodies.”

Intagliata explained  that when “[r]esearchers swabbed inside the noses of 90 adults, 37 of the 90 tested triclosanpositive for triclosan—and those who did were twice as likely to have the bug Staphylococcus aureus living in their noses.” But why? According to Blaise Boles, study author from the University of Michigan, “when bacteria are exposed to sublethal levels of antibiotics, they get stressed, and ‘they attach to surfaces and hunker down, in things we call biofilms.’” In short, the more antibacterials a bacteria is exposed to—in small doses of course—the more defensive, aggressive, and resistant it becomes.

This is not the first such study of its kind. Triclosan safety has been questioned since the late 1970s—in fact, the FDA first proposed removing triclosan from certain products in 1978—but this debate truly took center stage late last year (2013) when the FDA agreed to review its safety. In November 2013 the FDA stated that, in light of “several scientific studies [that] have come out since the last time [the] FDA reviewed this ingredient [triclosan, it does]…merit further review.” However the FDA is also quick topointout that, at this time, “triclosan is not currently known to be hazardous to humans.”

But what does this mean for piercers, piercees, and the entire body modification community? Yes, as many of us know, triclosan is an active ingredient in the antimicrobial soaps we use daily, but this study was small in scope, and the findings are not definitive for or against the use of triclosan. According to mBio, what this data does do is “demonstrate the unintended consequences of unregulated triclosan use and contribute to the growing body of research demonstrating inadvertent effects of triclosan on the environment and human health.” As such, the FDA will continue to review the effectiveness—and potential hazards—of triclosan usage, with the hopes of determining whether these products are “generally recognized as safe and effective” by September 2016. Therefore, since this is an ingredient that could have the potential to affect how we go about our jobs on a daily basis, we urge you to keep yourself abreast of the information available on the topic.