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Rapid Responses: Rapid Responses published:
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Cosmetic piercing at laparoscopic 'port'- it's time to make it safer
- Sachchidananda Maiti (16 June 2008)
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piercings
- Sally S Brooks (16 June 2008)
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Double standards for obtaining consent for piercings
- Avril F Danczak (23 June 2008)
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Body piercing: Health and Regulation Issues
- Umo I Esen (24 June 2008)
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Re: Double standards for obtaining consent for piercings
- Paul R Coleman (26 June 2008)
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Body piercing in England: training and ethical issues
- NORMAN NOAH, Fortune Ncube (3 July 2008)
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Sachchidananda Maiti, Senior Specialist Registrar-Obs &Gynae St Mary's Hospital, Hathersage Road, Manchester, M13 OJH
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It is interesting to note that this study confirms general impression as gynaecological minimal access surgeon of ever increasing number patients with piercing at the umbilicus. Pre-operatively all metallic jewelleries at body piercing must be removed to avoid risk of burns with the use of diathermy with any operative procedures. Even temporary removal of jewelry may lead to closure of the subcutaneous tract. Any piercing needs to be documented during preoperative assessment. Preoperative informed consent should include instruction that all pierced jewelry needs to be removed, preferably by the patient before the procedure. For the operation, patients may be offered the use of sterile “sleepers,” which are substitutes made of plastic to avoid closure of the wound canal perioperatively. (1) Use of universally available, nonmetallic, sterile, intravenous catheter may be a very simple, safe, effective method for perioperative temporary replacement of navel piercing jewelry. (2) Ref: (1) Volker R. Jacobs, John E. Morrison, Jr., Stefan Paepke and Marion Kiechle. Body Piercing Affecting Laparoscopy: Perioperative Precautions. The Journal of the American Association of Gynecologic Laparoscopists 2004; 11( 4):537-41 (2) Oliver J. Muensterer. Temporary Removal of Navel Piercing Jewelry for Surgery and Imaging Studies. Pediatrics 2004;114( 3): e384-e386 Competing interests: None declared |
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Sally S Brooks, secretary se19 3nl
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I read the article in the BMJ with interest and thought your readers would be interested in my son's experiences. Tom is 18 years old and had a piercing in his chin. He became ill with a fever, nausea, headache etc and was teken to hospital three days later with suspected meningitis. He was treated with IV antibiotics for two weeks after which he was found to have a heart mumur. Tests revealed a damaged heart valve, leaky and with an abscess. He had this replaced with a tissue valve (thanks so much to Kings Cardiac team, who saved his life). He chose this type of valve to avoid a life time on Warfarin, but of course in years to come this will need replacing with a metal valve so he will then have to be on the medicaiton. All this could have been avoided with proper education about the dangers of piercings. My family are happy to talk to the medical profession about our experiences if this would help. Competing interests: None declared |
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Avril F Danczak, GP The Alexandra Practice 365 Wilbraham Road Manchester M16 8NG
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Consent for piercing is curious example of double standards in obtaining consent for invasive procedures. Peircing is a surgical procedure with significant complication rates;a third get complications, a fifth require professional help and 1% even require admission to hospital. The risk of death is not negligable, as piercing can transmit blood borne viruses or result in life threatening sepsis. Any doctor performing a procedure such as this would ask for explicit (usually written) consent with discussion of the risks being documented. Why is there no such requirement for tattooing and piercing, both of which may have long term or serious complications? Many young people under the age of 16 undergo such procedures, without parental consent being formally obtained,and are at risk. It seems that the public are happy to accept lower standards of information and consent from less qualified people than they expect from health care professionals.The consequences of tattooing and piercing can be irreversible; the standards of skill, sterilisation and consent applied should be the same as that for any other surgery. Competing interests: None declared |
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Umo I Esen, Consultant Obstetrician and Gynaecologist South Tyneside NHS Foundation Trust,Harton Lane South Shields, NE34 OPL
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The article by Bone et al (1) makes the point that the prevalence of body piercing is increasing. The body piercing industry is poorly regulated and practitioners within the industry require no formal qualifications and there are no formal training programmes. The Local Government Act of 2003 (2) which came into force in 2004 was supposed to remedy the situation, but enforcement is patchy and not much has changed since the Act, despite the growth in the industry. Body piercing is a significant public health problem with risks especially to people with underlying health problems (3 ). It can also lead to unnecessary investigations and inappropriate treatments when patients present with persistent and "unexplained" signs and symptoms(4,5) Piercing of the lips, nostrils and tongue can present difficulties during resuscitation especially in emergency situations as value able time is lost trying to remove the piercing and jewellery within them for effective resuscitation, more so as many doctors are unfamiliar with the release mechanisms of these devices (6). Modern day “genital mutilation” (multiple genital piercing) is occurring under the guise of body piercing. Bone et al (1) limited their survey to the age group 16-24 years, however a lot of children and indeed toddlers are undergoing body piercing as there is no minimum age of consent for body piercing.When does the piercing of children become abuse of children ? References. 1. Bone A , Ncube F, Nichols C, Noah ND. Body piercing in England: a survey of piercing at sites other than earlobe. BMJ 2008; 336:1426-8 2. Local Government Act 2003: Regulation of cosmetic piercing and skin colouring businesses. (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_4076283. Accessed 24th June 2008 ) 3. Ochsenfahrt C, Friedl R, Hannekum A, Schumacher BA.Endocarditis after nipple piercing in a patient with bicuspid aortic valve. 2001 . Ann Thorac Surg. 71 (4): 1365-6 4. Modest GA, Fangman JJ. Nipple piercing and hyperprolactinaemia. N Engl J Med. 2002, 347 (20): 1626-7 5. Esen UI, Orife S. Penile Jewellery: a cause of post-coital bleeding. J Obstet Gynaecol. 2006 ,26(5):483-4 6. Khanna R, Kumar SS, Raju BS, Kumar AV. Body piercing in the accident and emergency department. J Accid Emerg Med. 1999, 16:418-21 Competing interests: None declared |
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Paul R Coleman, Father SS0 7PJ
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My then 14 year old daughter managed to obtain a body piercing at the top of her chest. This was done at a local tattoo shop with no parental consent. A phone call to the local envirnmental health department and shop quicly decured a refund of the fee charged. I have since journeyed into the lack of regulation in this area and have involved my local MP in investigating the apparent lack of enforcement and weak regulation. When all other professions are well regulated it seems time to take body piercings under the wing of a body such as the Health Professions Council. Competing interests: None declared |
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NORMAN NOAH, PROFESSOR OF PUBLIC HEALTH London School of Hygiene and Tropical Medicine, Fortune Ncube
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The information from our paper [BMJ 2008;336;1426-1428] showed that body piercing in England and Wales is not being carried out as well as it could and should be. Even though we found that proportionally more complications occurred after piercings carried out by non-specialists, we are anxious to clarify that the problems are not merely with them, as they are relatively fewer in number. Most problems follow specialist piercing. Most specialist piercers now use pre-sterilized instruments and are aware of the risks of transmitting blood borne viral infections [BBVs], and we would be surprised if BBV transmission by specialist piercers does occur to any extent in the UK. Moreover, Environmental Health Officers throughout England and Wales generally are extremely efficient in ensuring the use of pre-sterilized instruments to prevent BBV and other infections. Nevertheless there remain important gaps in hygiene and training, and there are some ethical issues that also need to be addressed. The following list has been compiled from the experiences of one of us in investigating outbreaks of hepatitis B, in visiting premises of cosmetic skin piercers and producing guidelines for them, as well as involvement as an expert witness in several legal actions taken by members of the public who have developed complications following a piercing. Training: there appears to be no formal training process or diploma. We consider this essential. It should include a basic knowledge of anatomy, microbiology and disinfection, hygiene and sound technique. Hygiene and aftercare advice: Some of the disinfectants used in cleansing the skin before piercing are unsuitable for the purpose. There needs to be consensus on this, with the appointment possibly of an approved national microbiologist adviser who can ensure uniformity and efficiency. The aftercare advice is generally appalling.The bacterial infections that sometimes supervene, occasionally leading to permanent deformity and scarring, are as often, in our opinion, caused by poor aftercare advice as by poor piercing technique. Death has followed piercing in persons with an existing heart condition. There should be an agreed list of pre-existing medical conditions about which each piercer should ask the customer, with clearance from their GP if necessary. Use of ear-piercing instruments [‘guns’]: These must not be used on any part of the body except the external ear. There is no evidence that guns are more likely to cause an infection in the pinna than the needle method, but infections in the pinna are more difficult to treat, and more likely to lead to permanent scarring than earlobe piercing. Use of local anaesthetics: there is no general consensus on these, and some piercers use ethyl chloride which we suspect is more painful than the piercing. There is some confusion among piercers about what needs to be prescribed by a doctor. This could be clarified. Age of consent: except for tattooing, there appear to be no laws governing the age of consent. With the possible exception of the ear lobe, for all other areas of the body including the pinna of the ear, we consider that there should be rules about the age of consent and parental permission. Other ethical issues include ensuring that neither the piercer or customer is under the influence of alcohol or drugs when the piercing is performed. Finally, to protect themselves, we recommend that piercers should inform customers about any complications that may arise, and ensure that this has been recorded. Norman Noah
Fortune Ncube
Competing interests: NN has acted as a paid hygiene consultant to acupuncturists and manufacturers of ear piercing equipment and an unpaid hygiene consultant to tattooists and beauty therapists. He has also acted as an expert witness in judicial cases concerned with the hygiene of skin piercing |
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