Piercing Safety Statistics

Genital piercings appear in the original table at 44.6%, on a sample of 14 with a confidence interval running from 23.7% to 67.5%. That interval is too wide to be worth quoting as a figure and we have left it out of the table rather than present it as a rate. Bone et al. excluded earlobes from the study by design, so the paper offers no lobe comparator.

The tongue result is the one that surprises people

Oral piercings carry the highest complication rate in the dataset by a clear margin, and the highest rate of seeking professional help. That is worth setting against the general assumption that cartilage is the risky category. On this evidence the mouth is riskier than the ear.

Simplot and Hoffman stated the negative result explicitly: “The expected increase in complications and morbidity of piercing through cartilage was not found in this study.” It is the oldest and smallest of the three, and the weight of evidence sits against it, but it exists and it is peer reviewed.

The honest phrasing is “larger and more recent studies find roughly one and a half to two times the complication odds,” not “studies show cartilage is more dangerous.” All three are self-report surveys with recall bias and a self-defined idea of what counts as a complication. None of them is a clinician-confirmed infection rate.

Where cartilage genuinely is different: severity

The stronger cartilage finding is not how often things go wrong but how badly. Cartilage has poor blood supply, which makes infection harder to clear and deformity more likely.

These are outbreak investigations and pooled case series. They describe how severe cartilage infections can be and what causes them. They do not establish how often cartilage piercings become infected, and should not be quoted as incidence.

A MEDLINE search for healing-duration studies in piercing returns no paper that measured time to heal by site. The Association of Professional Piercers, the body most often cited for healing times, publishes no healing chart at all. Its aftercare brochure contains no healing durations. Across its entire website it offers two statements: that 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,” and that “a tongue piercing usually heals in 6-8 weeks, compared to 6-9 months or longer for a navel piercing.” The APP describes its own guidance as based on “a combination of vast professional experience common sense, research, and extensive clinical practice.” It publishes no earlobe figure and no nipple figure.

The public-health sources that do publish charts disagree with each other by wide margins:

Across official sources the spread is: ear cartilage 6 weeks to 12 months, nipple 2 months to 2 years, tongue 2 weeks to 2 months. A 2022 review in Canadian Family Physician devoted entirely to ear piercing states no healing duration at all. The CDC publishes none.

What this means in practice. Healing figures, including the ones this studio gives clients, are professional convention refined by observation. They are useful for planning. They are not clinical measurements, and any source presenting them to three significant figures is presenting confidence it has not earned. The one genuinely measured number in this area is not healing at all: a 2012 split-ear study of 14 patients measured post-procedure pain duration at 3.8 days after a laser piercing against 17.5 days after a spring-loaded gun.

Their conclusion runs to one sentence: “Persons with GP still remain a hidden variable so no baseline figures assess the overall GP picture.” Seventeen described cases across seventeen years is the entire record of complications specific to the placement. There is no rate to publish, because there is no denominator to divide by.

Read the first sentence of that abstract again, because it describes a method rather than a result. General body-art figures get projected onto genital piercing, and the projection then gets copied forward by the next writer. That is precisely the mechanism behind every unsourced number this page has had to cut — and it is rare to find it named inside a peer-reviewed journal by authors watching it happen to their own subject. A 2018 review in the Dermatology Online Journal arrived independently at the same place: “there is a deficiency in the literature regarding the short and long-term complications of body piercings.”

What that means for the figures at the top of this page

Bone et al. is the strongest complication dataset piercing has, and it still cannot answer a question about an advanced placement. Genitals are 2% of its 1,934 recorded piercings, roughly thirty-nine of them. Surface and dermal piercings are not a category in it at all — the fieldwork ran in 2005, before dermal anchors were in common use. The 27.5% and 31.0% headline figures describe navels, noses, ears and tongues. Carried across to a surface bar, a dermal anchor or a genital piercing they are not cautious estimates. They are measurements of something else.

Endpoint: the Europe PMC REST search service, which indexes MEDLINE and PubMed in full. The 49 records in the first row are cavitation physics, metal forming, mosquito thermal preference, microneedle drug delivery and steerable surgical needles. The 33 in the second row are dominated by naval engineering, because a surface-piercing propeller is a real object with a real literature and a surface piercing is not.

There is therefore no rejection rate, no migration rate and no measured lifespan for surface piercings at any placement. The circulating claims that they “last five to seven years” or “reject within one to two years” rest on no prospective cohort, because no prospective cohort has followed surface piercings to an endpoint. No study has compared surface-bar, staple-bar or curved-barbell geometry against any outcome either, and none has tested anchoring depth or placement against retention.

Practitioner consensus is not worthless. It is how the craft actually transmits, and a piercer who has watched a thousand surface bars settle or fail knows things worth hearing. It is simply not a measurement, and rendering it as a percentage converts experience into a claim experience cannot carry.

The case report is Patel, Scroggins-Markle and Kelly, 2013: a 19-year-old with a Mycobacterium fortuitum infection at a dermal piercing on the finger, resolved on clarithromycin and ciprofloxacin over two months, in a patient who had been swimming daily at a water park. Sample size, one. The paper opens with this line:

It measures nothing, reports nothing and cites nothing. It is also, so far as this research could establish, the one indexed and citable-looking sentence in the medical literature that puts “dermal piercing” and “rejection” in the same clause. Every percentage attached to it was added afterwards by somebody else.

The complete peer-reviewed literature on dermal anchors

Four case reports totalling roughly five patients, one technique paper and one animal study. There is no cohort, no case series with a denominator, and no registry. Nothing here measures rejection, migration, embedding, lifespan or removal complications.

The one aspect with published guidance is removal, and what it says is that removal is not standardised. Elder et al. state that “there is limited dermatologic literature detailing a standard removal technique,” and warn that emergency-department removal by rocking with non-serrated hemostats “may lead to unnecessary damage to the skin, infections, and scarring.” That is a real, useful, sourced finding about dermal anchors. It is also the only one.

The healing figure is trade consensus, and the trade body says so

The one specific healing duration published anywhere for genital piercing comes from the Association of Professional Piercers, quoted in full in the healing section above: 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.” That is a real quotation from a real trade body and it is worth knowing. It is not a study.

The APP piercing FAQ page runs to 39,578 characters as rendered and contains exactly one reference to the literature — a 2007 paper in the Journal of Trauma Nursing about diagnostic imaging. No healing statement on that page carries a source. The APP also states its own basis on the same page, and states it honestly: its comments rest on “decades of professional experience, research and extensive clinical practice by several hundred exemplary piercers,” and “while we are not ourselves doctors, we do work in conjunction with medical practitioners and researchers.” Quoted with that framing intact, the figure is useful. Repeated as a medical fact, it is an upgrade nobody authorised.

The self-report literature, and who answered it

The largest dataset is Caliendo, Armstrong and Roberts, 2005: 146 intimately pierced people, 63 women and 83 men, across 29 US states. Health concerns were described by 66% of those with nipple piercings and 52% of those with genital piercings, covering site sensitivity, skin irritation, infection and change in urinary flow. Few sexually transmitted infections were reported, at 3%, and no HIV or hepatitis. Advice for problems was usually sought from a non-medical source, often the piercer.

Those percentages describe the 146 people who volunteered, and the authors say so plainly: the respondents were “significantly younger, less ethnically diverse, better educated, less likely to be married, more often homosexual or bisexual and they initiated sexual activity at a younger age than the US population.” It is a convenience sample. The 66% and 52% figures are properties of that group, not of genital piercing.

Sexual function: one exploratory study, and no controlled trial

Millner et al. published a study of vertical clitoral hood piercing in the American Journal of Obstetrics and Gynecology in 2005. Its published abstract, in full: “In this exploratory study, we identify a positive relationship between vertical clitoral hood piercing and desire, frequency of intercourse and arousal. There were no dramatic differences in orgasmic functioning. Clinicians can play key roles in educating patients about potential outcomes and risks of genital piercing.”

Its sample size is not stated in the abstract and the full text is paywalled, so no effect size, percentage or number of participants can honestly be quoted from it. The authors call it exploratory themselves. A 2017 German-language review found the direction consistent — tattoos and piercing, genital piercing in particular, “positively affect the sexual satisfaction and the sexual appeal of men and women” alongside a controversial association with high-risk sexual behaviour — but that is a narrative review with no pooled data. No controlled study of sexual function and genital piercing exists.

What emergency departments see

Two surveillance analyses of the same US injury database give the clearest severity signal available. A 2020 analysis identified 184 genital foreign-body injuries between 2008 and 2017, of which 87 were piercing injuries; the penile foreskin was the most commonly injured part at 100 of the 184 cases, mean age was 35.9, men outnumbered women 127 to 57 — and 166 patients, 90.2%, were treated and released. A 2024 analysis of the same surveillance system found that injuries to the pubic region were 16.8 times more likely to require hospitalisation than body-piercing injuries of the ear.

These two studies draw on overlapping data and are not fully independent of one another. Both count emergency-department visits, not piercings, and the authors of the 2024 analysis state the missing piece themselves: “Further study should identify the total number of annual body piercings in the United States.” Until somebody does, no US surveillance figure can be turned into a per-piercing rate.

The complication types that have been described

Urethral rupture, paraphimosis, urethral obstruction from scarring, priapism, fistula formation, squamous cell carcinoma at a Prince Albert site, urethral and bladder-neck injury, intraurethral condylomata, lichen sclerosus, and gonorrhoea, chlamydia and warts at piercing tract openings have all been reported in the peer-reviewed literature. Each has been described once or twice. “Has been reported” is the strongest available claim. Never “occurs in X% of cases,” because there is no denominator behind any of them.

Two sources that appear to conflict, and how they actually relate

The one line here that is not a judgement call

That is a categorical statutory prohibition, not a studio policy, and it is why genital and nipple piercing is adults-only everywhere in California regardless of what a parent is willing to sign. Other states draw these lines in different places; the US body art law reference in this library sets out the state-by-state picture.

The question of whether a genital piercing affects condom integrity, breakage or slippage is asked constantly and has never been examined. Two searches were run against Europe PMC on August 29, 2026: piercing together with condom, barrier method, condom breakage or condom failure returned 8 records; piercing together with condom, latex or barrier protection returned 20. None of the 28 examined barrier integrity. The returns were prison harm-reduction surveys, blood-donor seroprevalence studies, latex membrane manufacturing patents and cadaveric anatomy papers.

So there is no evidence that genital piercings increase condom failure, and no evidence that they do not. Both claims circulate; neither has a source. The only related published guidance is an infection-control instruction rather than a finding about barriers — the APP advises 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.” That is about the healing wound, not about the latex.

This is the clearest example on the page of why an absence deserves its own sentence. A reader who is told nothing assumes the question was answered somewhere. A reader who is told “no study has measured this” can weigh the decision themselves, which is the whole point.

Nickel release: the EU sets a limit, the United States does not

Entry 27 of Annex XVII to the EU REACH regulation restricts nickel in jewelry. The operative text sets a migration limit rather than a content limit:

There is no United States equivalent. The Consumer Product Safety Commission states plainly that “there are no mandatory federal requirements specifically for jewelry,” pointing instead to voluntary consensus standards. US federal law regulates lead and cadmium in children's jewelry; it does not regulate nickel release. The practical consequence shows up in testing: a 2025 systematic review found that 31.1% of North American earrings screened showed excess nickel release, and that 24.7% of European earrings intended for piercing exceeded the regulatory limit when tested by EN 1811, despite that limit being legally binding there.

Nickel allergy and piercing

The association is well established. A 2025 systematic review and meta-analysis found an odds ratio of 5.9 for nickel allergy in pierced compared with unpierced people in the general population, across a pooled sample of 5,333. A North American analysis of 17,912 patch-tested patients found nickel sensitivity rising from 14.3% in people with one piercing to 34.0% in those with five or more.

Two cautions belong with those numbers. The best general-population estimate of nickel contact allergy is 11.4%, pooled across 20,107 patch-tested individuals, and it is not US-specific. And a 15-year Danish follow-up of 442 adults found no association with ear piercing overall, with elevated prevalence only among women pierced before Denmark's nickel regulation took effect. That result points at the mechanism: the risk factor is nickel-releasing jewelry, not piercing as such. Which is the argument for regulating the metal rather than the practice.

A post can therefore release more than the legal limit and still pass a compliance test. That is not a loophole anyone hid; it is what happens when a legal threshold meets a laboratory method with a known error band. But it means the two numbers cannot be compared directly, and a page quoting one without naming which it means will read as an error to anyone who knows the other.

What the surveillance found against the pass threshold

Uter and Wolter tested 160 piercing posts across 15 laboratories in 12 German states in 2014, to EN 1811:2011 with its 2012 amendment. Their finding, verbatim: nickel release “exceeded 0.35 µg/cm² per week in 26 of 160 piercing posts (16.2%), and 0.88 µg/cm² per week in 2.0-5.9% of other parts, that is, the current respective ‘pass’ thresholds, with no change from the previous 2008 survey.” Six years apart, the same failure rate.

A 2025 systematic review and meta-analysis approached it from the regulatory side and found that 24.7% of European earrings intended for piercing exceeded the regulatory limit when tested by EN 1811. Screening by dimethylglyoxime, a cruder and more sensitive method, flagged critical nickel release in 11.3% of European earrings against 34.5% of earrings from Asia and 31.1% from North America. The same review put nickel allergy at an odds ratio of 5.9 in the general population across 5,333 people and 3.6 in dermatitis patients across 20,330, with etiological fractions of 82% and 69.7% respectively.

Sourcing note. The text of entry 27 quoted on this page was read from the United Kingdom’s assimilated version of Annex XVII on legislation.gov.uk. Direct retrieval of the European Union consolidated text was attempted and failed: eur-lex returned an empty JavaScript shell for every URL pattern tried and the European Chemicals Agency site refused automated requests. The wording is not known to differ between the two, but this page has not verified it against the EU original and does not claim to have.

One further precision point. Entry 27’s operative text names no test standard. It says only that “the standards adopted by the European Committee for Standardisation (CEN) shall be used as the test methods.” EN 1811 is the CEN standard used, but “REACH specifies EN 1811” is shorthand rather than a quotation, and the naming happens outside the restriction itself.

The mechanism argument, as the professional bodies state it

The Association of Professional Piercers describes the difference this way: “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.’” The National Environmental Health Association describes the professional alternative as “a sterile, disposable, hollow needle that cleanly breaks the skin and removes unwanted tissue.”

California's own statute uses similar language without editorialising, describing the device as applying a stud “using a mechanical device to force the needle or stud through the ear.”

The finding that cuts against our own industry

The only comparative histological study of the question does not support the tissue-damage claim. Van Wijk, Kummer and Kon, publishing in the Journal of Plastic, Reconstructive and Aesthetic Surgery in 2008, pierced 22 fresh human cadaver ears with two spring-loaded guns, one hand-force system and a piercing needle, and examined the cartilage histologically. Their conclusion:

The study has real limits: 22 cadaver ears, no healing response, no infection modelled. But it is the direct evidence on the question, it was designed specifically to test the assumption, and it rejected it. A studio asserting that guns cause more cartilage damage than needles is asserting something the only comparative study contradicts. We have made a version of that claim ourselves. On this evidence it is not supportable as stated, and the case has to rest elsewhere.

Where the case does rest

What the FDA actually says

The FDA's compliance policy guide on ear piercing devices records a position and then declines to act on it. Its stated view is that “articles intended to be used for ear-piercing were devices which should be restricted to prescription dispensing,” and that attempts to regulate them “ad hoc” produced no broad industry compliance. Its stated policy is that “because of the absence of documented data establishing that indiscriminate use of ear-piercing devices represents a significant consumer problem… it would serve no useful purpose at this time to devote our limited resources to this area.” It is accurate to say the FDA has expressed the opinion that these devices should be restricted. It is not accurate to say the FDA restricts them.

The definition that does the work

A matching carve-out sits one subdivision earlier. Section 119301(d) provides that “‘Body art facility’ does not include a facility that only pierces the ear with a disposable, single-use, presterilized clasp and stud or solid needle that is applied using a mechanical device to force the needle or stud through the ear.”

And the section that says it outright

The accurate claim is narrower than “exempt,” and more interesting. Gun ear piercing in California is not unregulated. It is regulated by Article 7, four sections numbered 119325 to 119328, instead of by the twenty-four sections that govern everybody else. The legislature did not overlook the practice. It wrote it a second, far shorter law of its own. Note also that the words “gun” and “ear piercing instrument” appear nowhere in the Act; the statutory term is “mechanical stud and clasp device.”

Section 119327(b) adds a grandfather clause: the one-hour training requirement “shall not apply to an individual who was employed to perform mechanical stud and clasp ear piercing prior to the effective date of this article.” Both regimes require the same jewelry: ASTM F138, ISO 5832-1 or AISI 316L or 316LVM steel, solid 14 to 18 karat gold, niobium, ASTM F136 titanium, platinum, or equally biocompatible materials.

Three limits on the carve-out that get reported wrong

Penal Code section 652(c) provides that “body piercing” means the creation of an opening in the body for the purpose of inserting jewelry or other decoration, “including, but not limited to, the piercing of a lip, tongue, nose, or eyebrow,” and then states flatly: “‘Body piercing’ does not include the piercing of an ear.” No device condition. No tragus exception.

The same pair of statutes diverges a second time, and this one has practical consequences for parents. Penal Code section 652(a) permits a minor's piercing when performed “in the presence of, or as directed by a notarized writing by,” the parent or guardian. Health and Safety Code section 119302(b), enacted later and framed as being “pursuant to Section 652 of the Penal Code,” permits it only “in the presence of” the parent or guardian. The later and stricter provision offers no notarised-letter alternative. Reporting that a notarised note is sufficient in California is a common error.

California sets no statutory minimum age for ear piercing. No age floor for the client appears in section 119302, in Penal Code section 652, or anywhere in Article 7. The only age requirement in Article 7 is section 119327(a)(1), which requires the person performing the piercing to be at least 18. Studios set client minimums as policy. Apollo's is five years old, with a parent or guardian present and photo identification. That is a studio rule, and we call it one rather than dressing policy up as law.

Note how the carve-outs interact. Because a standard stud-and-clasp lobe piercing is not “body piercing” under section 119301(e), the parent-present requirement in section 119302(b) does not reach it. Pierce the same child's lobe with a needle at a registered studio and the requirement applies.

If a studio, this one included, quotes you a figure in any of these five categories, the correct response is to ask which study it came from.

The seventeenth line is worth pausing on, because this studio uses implant-grade titanium and says so. ASTM F136 is a specification for the metallurgy of a surgical implant alloy. It governs chemistry and mechanical properties, and it is a good reason to prefer that metal. No study has tested whether jewelry made to it heals better than jewelry that is not. The inference from metallurgy to healing is reasonable, widely shared, and untested, and those three things are all true at once.

The Apollo Tattoo & Piercing Studio operates at 2625 Main Street in Santa Monica. Blue Mason, the founder, has been tattooing since 2007 and is a Fakir-certified piercer. The studio holds a 4.9 star rating across more than 623 Google reviews. Every piercing is performed with a single-use hollow needle, never a stud-and-clasp device, in titanium meeting ASTM F136 and in solid gold from BVLA.

We do not publish an Apollo infection rate, an Apollo complication rate, or a count of piercings performed. We have not measured those things under conditions that would make the numbers mean anything, and a studio-reported safety statistic with no methodology behind it is marketing wearing a lab coat. Our authority on this subject is credentials, method, and a willingness to show our working. It is not numbers we have not measured.

Apollo does perform genital piercing, at $200, by consultation only. That the service is adults-only is not a house rule we could waive: Health and Safety Code section 119302(d) prohibits nipple and genital piercing on a minor outright, and no parental consent reaches it. The consultation requirement is ours, and the material in the genital piercing section is why — when a placement has no measured healing time and no baseline complication rate, a conversation is the only honest substitute for a number.

Related reading: piercing prices, the piercing aftercare guide, the ear piercing chart, and our first piercing guide. The rest of this reference library is indexed at body art facts, which also covers heavy body modification and US body art law.

Peer-reviewed literature

• Bone A, Ncube F, Nichols T, Noah ND. Body piercing in England: a survey of piercing at sites other than earlobe. BMJ. 2008;336(7658):1426–1428. PMC2432173
• Ziegler JP, Pagedar NA, Moline M, et al. Ear Piercing Complications: Comparing Cartilage and Soft Tissue Piercings in a Large Survey Cohort. The Laryngoscope. 2026. doi:10.1002/lary.70572
• Simplot TC, Hoffman HT. Comparison between cartilage and soft tissue ear piercing complications. American Journal of Otolaryngology. 1998;19(5):305–310. doi:10.1016/s0196-0709(98)90003-5
• Binkhamis K, Habib HA, Alkahtani MK, et al. Cartilage Ear Piercing Probable Infections among Females between 18 and 28 Years Old in Riyadh. Journal of Nature and Science of Medicine. 2022;5(2):182–187. doi:10.4103/jnsm.jnsm_108_21
• van Wijk MP, Kummer JA, Kon M. Ear piercing techniques and their effect on cartilage, a histologic study. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2008;61 Suppl 1:S104–9. doi:10.1016/j.bjps.2007.01.077
• Keene WE, Markum AC, Samadpour M. Outbreak of Pseudomonas aeruginosa Infections Caused by Commercial Piercing of Upper Ear Cartilage. JAMA. 2004;291(8):981–985. jamanetwork.com
• Evans H, Bolt H, Heinsbroek E, et al. Eurosurveillance. 2018;23(37). PMC6144469
• Trevitt BT, Katelaris AL, Bateman-Steel C, et al. Emerging Infectious Diseases. 2023;29(10):2008–2015. CDC EID
• Sosin M, Weissler JM, Pulcrano M, Rodriguez ED. The Laryngoscope. 2015;125(8):1827–1834. doi:10.1002/lary.25238
• von Spreckelsen B, Jensen MB, Johansen JD, Ahlström MG. Nickel Allergy and Piercings: A Systematic Review and Meta-Analysis. Contact Dermatitis. 2025;93(4):275–284. doi:10.1111/cod.14837
• Alinaghi F, Bennike NH, Egeberg A, Thyssen JP, Johansen JD. Prevalence of contact allergy in the general population. Contact Dermatitis. 2019;80(2):77–85. PMID 30370565
• Warshaw EM, et al. Body piercing and metal allergic contact sensitivity: NACDG data. Dermatitis. 2017;28(6):333–341. PMID 29135681
• Mortz CG, et al. Adolescence Cohort Study 15-year follow-up. Contact Dermatitis. 2013;68(6):348–356. PMID 23692035
• Nelius T, Armstrong ML, Rinard K, Young C, Hogan L, Angel E. Genital piercings: diagnostic and therapeutic implications for urologists. Urology. 2011;78(5):998–1007. doi:10.1016/j.urology.2011.05.066 · PMID 22054364
• Lee B, Vangipuram R, Petersen E, Tyring SK. Complications associated with intimate body piercings. Dermatology Online Journal. 2018;24(7). doi:10.5070/d3247040908 · PMID 30261561
• Caliendo C, Armstrong ML, Roberts AE. Self-reported characteristics of women and men with intimate body piercings. Journal of Advanced Nursing. 2005;49(5):474–484. doi:10.1111/j.1365-2648.2004.03320.x · PMID 15713179
• Millner VS, Eichold BH, Sharpe TH, Lynn SC. First glimpse of the functional benefits of clitoral hood piercings. American Journal of Obstetrics and Gynecology. 2005;193(3 Pt 1):675–676. doi:10.1016/j.ajog.2005.02.130 · PMID 16150259. Sample size not stated in the abstract; full text not retrieved.
• Stirn AV, Zannoni R. Tattoos, body piercings and sexual health. Bundesgesundheitsblatt. 2017;60(9):1009–1015. doi:10.1007/s00103-017-2603-0 · PMID 28744723. German language, narrative review.
• Garcia MM, Lloyd GL, Sharma V. Genital foreign bodies and piercing injuries in the National Electronic Injury Surveillance System, 2008 to 2017. Urology Practice. 2020;7(3):220–223. doi:10.1097/upj.0000000000000087 · PMID 37317396
• Cirks BT, Maranich A, Nylund CM, Barron J, Reeves PT. Emergency Department Visits After Body Piercings. Pediatric Emergency Care. 2024;40(12):882–888. doi:10.1097/pec.0000000000003284 · PMID 39418627
• Holbrook J, Minocha J, Laumann A. Body piercing: complications and prevention of health risks. American Journal of Clinical Dermatology. 2012;13(1):1–17. doi:10.2165/11593220-000000000-00000 · PMID 22175301
• Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. Journal of the American Academy of Dermatology. 2006;55(3):413–421. doi:10.1016/j.jaad.2006.03.026 · PMID 16908345. Self-reported, 33% response rate.
• Patel M, Scroggins-Markle L, Kelly B. An unusual mycobacterial skin infection associated with a dermal piercing. Case Reports in Dermatological Medicine. 2013;2013:149829. doi:10.1155/2013/149829 · PMID 24073343
• Alet JM, Abi-Chahla ML, Pelissier P. Complications after microdermal piercing in the hand: report of two cases. Chirurgie de la Main. 2015. doi:10.1016/j.main.2015.07.004 · PMID 26498993
• Chandran J, Weber W. Removal of dermal piercings. American Journal of Emergency Medicine. 2024;82:215.e1–215.e2. doi:10.1016/j.ajem.2024.05.028 · PMID 38845289
• Elder AJ, Deirawan H, Adlam T, Moossavi M. Step-by-step guide to the punch removal technique for dermal piercing. Cureus. 2023;15(8):e43516. doi:10.7759/cureus.43516 · PMID 37719601
• Kluger N, Jolly M, Guillot B. Local complications related to abdominal microdermal implants during pregnancy. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2010. doi:10.1016/j.bjps.2010.03.045 · PMID 20417168
• Sheldon RR, Loughren MJ, Marenco CW, et al. Microdermal Implants Show No Effect on Surrounding Tissue During Surgery With Electrocautery. Journal of Surgical Research. 2019;241:72–77. doi:10.1016/j.jss.2019.03.039 · PMID 31009888. Animal study, four swine.
• Acuña-Chávez LM, et al. Bacterial infections in patients with nipple piercings: a qualitative systematic review. GMS Infectious Diseases. 2022;10:Doc03. doi:10.3205/id000080 · PMID 35463814
• Yang S, et al. Body piercing and risk of hepatitis B and C: a systematic review and meta-analysis of 40 studies. Medicine (Baltimore). 2015;94(47):e1893. doi:10.1097/md.0000000000001893 · PMID 26632685
• Sindoni A, et al. Health risks for body pierced community: a systematic review. Public Health. 2022;205:202–215. doi:10.1016/j.puhe.2022.01.035 · PMID 35339940
• Uter W, Wolter J. Nickel and cobalt release from earrings and piercing jewellery: analytical results of a German survey in 2014. Contact Dermatitis. 2018;78(5):321–328. doi:10.1111/cod.12941 · PMID 29282733
• Sun GE, et al. Is chronic nipple piercing associated with hyperprolactinemia? Pituitary. 2013;16(3):351–353. doi:10.1007/s11102-012-0431-7 · PMID 22965248. Eleven participants; far too few to establish an absence of effect.
• Lane JE, Waller JL, Davis LS. Relationship between age of ear piercing and keloid formation. Pediatrics. 2005;115(5):1312–1314. doi:10.1542/peds.2004-1085
• Muntz HR, et al. Embedded earrings: a complication of the ear-piercing gun. International Journal of Pediatric Otorhinolaryngology. 1990;19(1):73–76. PMID 2341236

Statutes and regulations

• California Health and Safety Code section 119301, definitions. leginfo.legislature.ca.gov
• Section 119302, minors. leginfo.legislature.ca.gov
• Section 119303, informed consent and health questionnaire. leginfo.legislature.ca.gov
• Section 119306, practitioner registration. leginfo.legislature.ca.gov
• Section 119307, bloodborne pathogen training. leginfo.legislature.ca.gov
• Section 119310, jewelry for newly pierced skin. leginfo.legislature.ca.gov
• Section 119312, facility health permit. leginfo.legislature.ca.gov
• Sections 119325 to 119328, Article 7, mechanical stud and clasp ear piercing. leginfo.legislature.ca.gov
• California Penal Code section 652, body piercing of a minor. leginfo.legislature.ca.gov
• California Penal Code section 653, tattooing a minor. leginfo.legislature.ca.gov
• REACH Annex XVII entry 27, nickel. The text quoted on this page was read from the United Kingdom’s assimilated version of Annex XVII, because direct retrieval of the European Union consolidated text failed. legislation.gov.uk

Standards, agencies and professional bodies

• ASTM F136-26, wrought Ti-6Al-4V ELI alloy for surgical implant applications. store.astm.org
• ASTM F138-19, wrought 18Chromium-14Nickel-2.5Molybdenum stainless steel for surgical implants. store.astm.org
• ASTM F899-23, wrought stainless steels for surgical instruments. store.astm.org
• ISO 5832-3:2021, implants for surgery, wrought Ti-6Al-4V alloy. iso.org
• EN 1811:2023 and EN 12472:2020, listed in the Commission Communication of 20 December 2023, OJ C/2023/1604.
• US Consumer Product Safety Commission, Jewelry FAQ. cpsc.gov
• US Food and Drug Administration, CPG Sec. 320.100, Ear Piercing Devices. fda.gov
• CDC, A Rational Approach to Disinfection and Sterilization. cdc.gov
• Association of Professional Piercers, Issues with Piercing Guns. safepiercing.org
• Association of Professional Piercers, Piercing FAQ and Oral Piercing Risks. safepiercing.org. The page runs to 39,578 characters as rendered and carries one literature citation, which concerns diagnostic imaging.
• Association of Professional Piercers, Aftercare, and Jewelry for Initial Piercings. safepiercing.org
• Europe PMC REST search service, used for the documented literature searches on this page. ebi.ac.uk. All searches run August 29, 2026.
• National Environmental Health Association, Policy Statement on Ear Piercing Guns, July 2018, and Body Art Model Code, October 2019 edition. neha.org

Corrections are welcome. If a figure on this page is wrong, or a source has been superseded, tell us and we will change it and say what changed.