Frequently Asked Questions

What is the APP POSITION ON ORAL PIERCINGS?

There has recently been considerable sensationalized derogatory press regarding oral piercings. Unfortunately many of the pertinent facts are not being reported. A well-informed and discerning consumer is subject to far fewer dangers. When performed by a skilled and experienced professional using appropriate sterile, disposable instruments the risks are minimal and the procedure is instantaneous and essentially painless. Proper placement and the correct style and size of inert jewelry are absolutely critical.

Also vital is the cooperation of the piercee to care for the piercing adequately. Following the piercing the use of ice, rest, and elevation (just like with any wound) drastically diminishes the aftermath. An over-the-counter non-steroidal anti-inflammatory taken according to package instructions for the first few days can also help to keep swelling down. Most piercees report little or no bleeding and a minimum of swelling for a few days. Tongue and other oral piercings heal extremely quickly and uneventfully when all aspects are handled according to accepted practice.

Highly suggested for optimal safety is to replace the initial jewelry (which has some extra room to allow for the usual amount of initial swelling) with a snugger piece which fits closer to the body. There is then less chance of contacting the jewelry with the teeth and other oral structures. Also, balls made of acrylic can be worn inside the mouth to minimize risk of damage to the teeth. Further, a smaller ball can be worn on the underside of the tongue to reduce contact with the sublingual portion of the oral cavity. These and other precautions can be taken which bring risk of getting and wearing oral piercings to a negligible level.

Many of our colleagues have dedicated tremendous time and effort to become highly educated and skillful specialists. To disparage us and our field offhandedly without taking the details into consideration is not an accurate or helpful response. Particularly since many individuals still desire oral piercings, and intend to get them, it is far more constructive to provide accurate information and specific guidelines on what one should look for in a piercer. Please see our informational brochure Choosing a Piercer for details.

This organization of committed professionals upholds an extremely high standard of safety and hygiene. Members’ web sites can also be accessed for additional information.

If you would care to speak with a board member or if you have specific questions you would like for us to answer, please feel free to contact us.

What is the APP POLICY ON PIERCING MINORS?

Regardless of any local legislation being more lenient, the following is an appropriate minimum standards policy on piercing minors:

For any piercing of a minor, a parent or legal guardian must be present to sign a consent form. Proof positive, state issued photo identification is required from the legal guardian, and a bona fide form of identification from the minor. In the event the parent has a different last name and/or address from the child, court documentation is needed to prove the relationship, i.e., divorce papers, or a remarriage certificate.

Under no circumstances is it acceptable or appropriate for a piercer to perform piercing on the nipples or genitals of an individual under 18 years of age.

What is the APP POSITION ON STERILE GLOVES?

The APP mission is to promote and uphold minimal standards of safety and hygiene. As such, it is our official position that aseptic technique performed with clean disposable gloves is appropriate and acceptable. The above applies, except where sterile gloves are mandated by local laws. If a piercer wishes to use sterile gloves, naturally they may do so, but it is certainly not to be construed as required for a safe, hygienic piercing.

What is the APP POSITION ON Navel Piercings and Pregnancy?

Navel jewelry may be left in place; some women leave jewelry in during their entire pregnancy and delivery. If, during your pregnancy the piercing becomes uncomfortable, you can replace the jewelry with Tygon or PTFE, which are inert plastics (something like thick fishing line). These will bend and flex with your changing body, be more comfortable, and are safe to wear. Once your pregnancy is over, you can return to the jewelry.

Even long after the piercing is totally healed, it may or may not stay open without something in place. This varies from person to person. Wearing an inert plastic in the piercing will insure that it can be maintained.

In the event you elect to remove the jewelry entirely there is a chance it could be reinserted using an insertion taper even if the old jewelry wonÕt go back in readily. If it cannot be reinserted it is quite likely that it can be repierced.

As a side note, some women who lack sufficient tissue quantity or pliability for navel piercing prior to pregnancy are often well suited afterwards.

There is no special care that is required during pregnancy for healed piercings.

What is the APP POSITION ON Breast Feeding and Piercing

In our collective, massive experience, we have no awareness of even a single case of a woman who wished to breast feed and could not as a result of having had a nipple piercing. The milk ducts are a multiplicity of little pore-like ducts. Therefore, the likelihood of closing them all off from a piercing of usual size is virtually nil.

Most women do remove their jewelry for breast feeding and we believe this to be appropriate. As a result, some milk may come from the site of the piercing during nursing, which is not harmful nor problematic. Some will use an insertion taper (a tool designed for this purpose) to facilitate reinsertion or to check regularly and make certain the holes are open.

There is no special care that is required during pregnancy for healed piercings.

What is the APP POSITION ON Body Art During Pregnancy?

It is advisable to refrain from undergoing any and all body art procedures during a pregnancy, even just an ear lobe stretch. It is best to let your body focus on the important, complex and demanding task that it is handling already.

What is the APP POSITION ON Body Art Following Pregnancy?

We suggest that a three month waiting period be observed following delivery in order for the body to normalize and regain physiological and hormonal equilibrium before piercing.

Further, we suggest that a longer period be observed prior to nipple piercing. It is advisable and prudent to wait three months following the cessation of breast milk production before piercing of the nipples.

What is the APP POSITION ON Body Piercing During Nursing?

With the exception of a 3-month post-partum delay we do not find it contraindicated to receive piercings (with the obvious exception of the nipples) during nursing. The body is not under the same type of demands as during pregnancy.

Further, we suggest that a longer period be observed prior to nipple piercing. It is advisable and prudent to wait three months following the cessation of breast milk production before piercing of the nipples.

What is the APP POSITION on Stud 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 in inside a fresh or unhealed piercing. We consider unsafe 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. Such procedures place the health of recipients at an unacceptable risk. For this reason, the APP must strongly recommend that reusable ear piercing guns not be used for any type of piercing procedure.
While piercing guns may seem to be a quick, easy and convenient way of creating holes, they have major drawbacks in terms of sterility, tissue damage and inappropriate jewelry design. These concerns are addressed below.

Reusable ear piercing guns can put clients in direct contact with the blood and body 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 aerosolize, becoming airborne in microscopic particles, and contaminate the inside of the gun. The next client’s tissue and jewelry may come into contact with these contaminated surfaces. There is thus a possibility of transmitting bloodborne disease-causing microorganisms through such ear piercing, as many medical studies report.

As 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 for contracting such infection.
Additionally, it is not 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 procedure.

Piercing guns can cause significant tissue damage.

Though slightly pointy in appearance, most ear piercing studs are quite dull. Piercings must therefore be accomplished by using 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, at the most in scarring and potentially 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 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. 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 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, is constricted and further irritated. 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 consequences are minimal when jewelry is custom fit to the client, allows sufficient room for swelling, and is installed with a needle piercing technique which creates less trauma and swelling.

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 hole. The fluid coagulates, becoming sticky and trapping bacteria against the skin. Unless thoroughly and frequently removed, this becomes an invitation to 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.

A further note on ear piercing studs:

Most ear piercing studs are not made of materials certified by the FDA or ASTM as safe for long term implant in the human body. Even when coated in non-toxic 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 corrosion- and defect-free coating for such studs is extremely difficult, medical literature considers only implant grade (ASTM F-138) steel and titanium to be appropriate for piercing stud composition. Studs made of any other materials, including non-implant grade steel (steel not batch certified as ASTM F-138), 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 piercers 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 piercers’ 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 stud 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 piercers to operate 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 reject the risks of gun piercing in the interests of the public health.


References Cited Below*

What is the APP POSITION on Piercing Kits?

As an association of dedicated, educated, highly experienced piercing professionals we are adamant that piercing kits for sale to the general public represent a serious potential health hazard. Much piercer education and training is necessary in order to perform a safe, sterile, accurate piercing. Simply providing such tools to an inexperienced consumer is a dangerous act of negligence.

The use of these piercing kits by untrained consumers results in significantly greater potential for the transmission of bloodborne pathogens and diseases than do piercings performed by skilled professionals.

An area of particular concern is that of underage individuals performing body piercings on themselves and their friends using readily available piercing kits sold through mail order, on the Internet, or by calling a toll free telephone number. Young people are particularly at risk because, without parental consent, minors are denied professional piercing services in virtually all states where legislation has passed. However, they can still obtain the kits and get pierced without their parents' consent or knowledge. Should an infection or other complication occur, no responsible adult will be on hand to oversee the situation or provide access to appropriate medical care.

Also of great concern is the possibly deadly potential for the contaminated needle to be reused on multiple people. Further, there are dangers of accidental needle sticks to others, since limited or no instructions are included for appropriate disposal of the used needle.

Through legislation, many states allow body piercing that is performed only by a trained, licensed professional in an environment that provides hospital sterilization and submits itself to health department inspections. Most states (43) currently have legislation regarding personal criteria for the piercer, requirements for the piercing establishment, and highly specific laws necessitating parental consent for the piercing of minors. The laws and guidelines, along with the efforts of the professional body piercing community provide those interested in receiving a body piercing with a safe, clean environment to do so, and with a piercing technician who has appropriate training and sufficient experience to be hygienic and proficient.

The nature of the piercing kits do not allow for any of these safety measures to take place. The kits can be purchased by anyone, which is the most relevant aspect of the eminent danger of piercing kits. Piercing kits are not purchased by licensed, experienced professional piercers, who already have access to such items and equipment through legitimate industry sources. Instead, they are purchased by those who either do not have access to an experienced piercer, or who do not have sufficient understanding of the issue to appreciate that sterility, skill and education are an integral part of the piercing procedure.

As professional piercers we want to keep the art of body piercing safe for all who give and receive piercings. We take our field seriously and understand that the risks can be substantially minimized with proper training, equipment, and sterilization. Over-the-counter piercing kits undermine all the work we and our legislators have done to protect the public health while allowing our art form to flourish.

Just say NO to piercing kits and those who sell them or use them.

Regarding Genital Piercings

Genital piercings are often assumed to be the most painful and easily infected of body piercings. Both the piercers who perform them and the clients who request them are sometimes reported to operate in questionable hygienic and ethical territory. However, these perceptions need not be reality. Due to the elastic and resilient nature of much of the genital tissue, as well as the protection from contamination offered by clothing, genital piercings often heal more quickly and with fewer complications than do other piercings. Furthermore, the act of piercing the genitals is for many clients a conscious act of reclaiming and redefining their bodies as a source of pleasure rather than of misplaced shame. Because genital piercings represent an integral facet of sexual freedom, it is important that they be available to adults who seek them. However, it is equally important that they be provided by an experienced, reputable professional in a clean, safe environment.

In the interest of public safety, the Association of Professional Piercers would like to clarify the facts about genital piercing and its risks. Our comments are based upon twenty years of professional experience, research and extensive clinical practice by several hundred exemplary piercers. While we are not ourselves doctors, we do work in conjunction with medical practitioners and researchers. We trust that our comments will be taken in the spirit intended, as an effort to round out the existing dialogue. With full and appropriate information, it is our hope that consumers will be better able to make educated choices about their bodies and the ways in which they choose to celebrate them. It is also our hope that those who seek to protect and regulate the health of the public do so circumspectly, without unduly limiting or denigrating free bodily expression in its many forms.

Some criticism of genital piercings focuses on the perceived risk of piercing nerve-laden genital tissue. There is also concern that genital tissue may be more susceptible to infection than are piercings of other body parts. Furthermore, it is possible that sexual contact can increase the threat of complications. When performed by a conscientious professional piercer using proper aseptic technique, the risks of complications from the piercing itself are minimal. When these conditions are paired with appropriate and thorough aftercare on the part of an educated client, negative consequences are extremely rare.

As with all piercings, genital piercings should only be performed on consenting, sober adults by a skilled and licensed (where applicable) practitioner. All piercing studios should be designed to provide a sanitary, controlled environment that conforms to appropriate local and state regulations, as well as to OSHA Bloodborne Pathogens standards. All tools, needles and jewelry must be sterile, and all needles must also be single-use. The practitioner must have specific knowledge of both aseptic technique and of the procedure at hand. He or she must also make every reasonable effort to maintain the physical and psychological comfort and safety of the client.

It is unquestionably true that some genital tissue contains much higher concentrations of nerve tissue than many other areas of the body. However, it is also true that this same tissue is physiologically designed to take increased abuse from friction, pressure and manipulation. Due to the rigors of childbirth, women’s genital tissue is by necessity well equipped to stretch, give and quickly repair itself, often with little pain or consequence. Both women and men describe the pain of the most common genital piercings as being similar in intensity to other body parts, and sometimes less so. The more advanced genital piercings (such as clitoris and ampallang) may be more intense, but these are usually performed only by the most experienced piercers who have greater technical and anatomical expertise. However, they tend to also be requested by, and are often limited to, clients who have already received and healed other piercings. Since anesthetics are not used in accepted practice, the continued existence of these piercings should attest to the manageability of the pain.

As to the risks of excessive bleeding or neurological damage from common genital piercings, these risks are minimized when piercings are performed by a skilled and educated piercer using accepted techniques. Piercing-specific anatomical knowledge coupled with inspection of the area should allow a qualified piercer to perform the common piercings without incident. Specialized tools and procedures have also been developed by industry professionals in order to most successfully and safely manage the piercing procedure. When properly employed, these further reduce the risk of unanticipated consequence.

The physiologic function of genital tissue requires that it be extremely elastic and vascular and therefore quick to heal. With few exceptions, genital piercings will heal within a month or two, while tougher tissue such as ear cartilage, navels and nostrils may take six months or longer. Because healing time is often so short, this implies a very small window of opportunity for infection to set in. Furthermore, genital tissue is not subject to frequent exposure and casual contact with the external environment and dirty hands the way other body parts may be. (Certainly an office worker lost in thought would not be toying idly with a labia ring as she might be with an earring or nostril ring.) Clothing further protects the piercing from airborne contaminants, which can be a cause of infection and irritation for facial piercings.

The predominant cause of contamination and infection for genital piercings is most likely unprotected sexual contact. Even in the case of monogamous partners, body fluids, unwashed hands and oral bacteria can easily lead to infection if introduced in a wound. Fortunately, this exposure is 100% preventable. In addition to explaining appropriate cleaning protocol, a responsible piercer will emphasize to the client that during healing, all sexual and oral contact must be made fluid safe, either through abstinence or the use of barriers such as condoms and dental dams. Furthermore, undue stress, abuse or manipulation of the piercing site and/or jewelry should be avoided during healing. Of course it is the responsibility of the client to follow through with these instructions after leaving the piercing studio. Providing the client with thorough written instructions and an invitation for follow-up care can greatly improve compliance and healing success.

In this discussion, it bears mentioning that the average genital piercing customer is a more informed consumer than the usual navel, ear or tongue piercing client. While often no more complicated from a piercer’s standpoint, genital piercings are a more advanced step in the mind of the piercee. Therefore those who elect to get them have usually already received and healed at least one other piercing, and are often more informed about the piercing process and aftercare. They are more likely to do advance research than are navel or facial piercing customers, and may be more likely to follow up with the piercer should questions or concerns arise. While of course genital piercings should never be done on anyone under eighteen (even with parental consent), these piercees are generally not eighteen-year-olds who are hiding the piercing and any consequences from their parents. In fact, these piercings are just as often being done on parents and other middle-aged adults, who are looking for new ways to appreciate their bodies and their relationships.

In short, genital piercings can be done safely and healed easily, provided the clients follow through with appropriate aftercare and abstain from unsafe contact. Since these clients are often the most educated and conscientious of the piercing clientele, compliance with suggested care is more likely than it is with other piercings.

While the idea of genital piercings stirs up fears of sexual taboos and contagious diseases for some (particularly for those physicians who see only worst case scenarios), the reality is truly quite different. Genital piercings today are being performed on a wide variety of people of all ages, sexualities and professional backgrounds. When performed under hygienic conditions by ethical and educated piercers on clients who follow suggested aftercare procedures, they represent a safe and creative way to assert bodily ownership and redefine the acceptability of pleasure. It is the challenge of professional piercers and those who regulate them to assure that these piercings remain both safe and available to those who choose them.

*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.

return to top of page