Piercing: Pain or Pleasure? Or both?

You might be thinking, aren’t piercings common? And the answer is yes, you probably know someone with an ear piercing or two (or twelve!). However, you may not know someone with a nipple piercing, or a clitoris piercing, or even one through the tip of the penis! There are many reasons someone may choose to get an intimate piercing; however, this decision is not without risks. No matter what your reason for the piercing—to increase pleasure, to jazz up your genitals, to just to be different, or if you are just curious to learn about piercings--read on for more info!

Okay, so, what is an intimate piercing? In this blog, intimate piercings are piercings located on the nipples, anus, and genitals. Yes, the genitals. In fact, any genital location can be pierced (cringing yet?) including the clitoral hood, inner and outer labia, perineum, scrotum, and the penile glans, shaft, and foreskin. The jewellery can range from a stud, hoop, or barbell.

 

Ouch! Doesn’t that hurt?

Now, you are probably wondering, does that hurt? Well, it may hurt, but it may not… I know, helpful right?! Like with any other piercing, how an intimate piercing feels when it is actually happening varies from person to person. Some people have reported pain (a “stabbing” sensation; Angle, 2009) or discomfort (a “pricking” sensation; Angle, 2009), whereas others have reported enjoying the feeling, or did not find it painful at all (Angle, 2009). Piercings happen quickly, so if there is pain or discomfort, these feelings usually disappear quickly (Angle, 2009).

One’s piercing experience may also depend on the type of genital piercing. Some may hurt more than others. For example, a frenum piercing (through surface skin located on the underside of the penis, between the shaft and the glans of the penis) may be less painful than an ampallang (that penetrates directly through the penile glans, horizontally) (Hogan et al., 2010). This difference makes sense because less of the penis is being pierced in the frenum piercing than in the ampallang, and because of this difference, healing times are also longer for the ampallang (about 5 months) than the frenum piercing (2-5 weeks).

 

Why get one?

Another common question is why would someone want an intimate piercing? However, this question is much like asking, why do people get tattoos, or why do people get plastic surgery? All of these questions are asking something similar. Why do people go out of their way to apply body modifications that might be painful?

The most common reason for getting an intimate piercing is self-expression (Caliendo et al., 2005). Intimate piercings are a way to express one’s identity and uniqueness. The piercing becomes part of their aesthetic. Someone might like the way it looks, or like how it makes them feel, which is also a part of self-expression, even if it is not readily visible. Intimate piercings can also be a form of sexual expression. Research indicates that those with intimate piercings are likely to identify as a sexual minority (e.g., lesbian, gay, bisexual), be single, and start their sexual debut at a younger age than those who do not have intimate piercings (Caliendo et al., 2005). Other studies have found that intimate piercings can be a way to overcome past traumatic experiences, as it may help people reclaim their body (Van Hoover et al., 2017). Another common reason is because they “just wanted to” or because they “liked the way it looked” or even “for the heck of it” (Hogan et al., 2010).

Now the big question, do intimate piercings increase sexual pleasure? While improving sexual pleasure is a motive for getting an intimate piercing, it is possible to experience temporary or permanent loss of sensation if the piercing is poorly placed (Angle, 2009). Having an experienced piercer and discussing whether or not you want the piercing as a sensation enhancer or as a decoration only will help increase positive outcomes (Angle, 2009). Research shows that sexual outcomes are generally positive for most people with intimate piercings:  Hogan and colleagues found that 75-85% of participants reported an increase in their own sexual pleasure, and 62-67% reported increased partner sexual satisfaction (Hogan et al., 2010). However, just over half of the men (53%) reported complications from their intimate piercings, which ranged from urination flow changes to infection (Hogan et al., 2010). Despite issues such as these, 93% of participants said they would get an intimate piercing again (Hogan et al., 2010).

 

Common piercings in the vulvar area

Clitoral hood piercings

o   Description: This is the most common vulva piercing. This piercing goes though the clitoral hood and around the clitoris.

o   Positives: No more painful than other body piercings (similar to ear piercings), a healing time around 4-8 weeks, usually done for aesthetic reasons, and is the safest option for clitoral piercings.

o   Negatives: Doesn’t provide much sexual pleasure, not everyone’s anatomy is suitable for this type of piercing (larger hood size and symmetry are needed), and there is a risk of infection.

Triangle piercings

o   Description: Goes through the base of the clitoral hood, behind (but not through) the clitoris.

o   Positives: It can increase sexual pleasure during clitoral stimulation.

o   Negatives: Painful to get (it passes through lots of tissue and some nerves), risk of clitoral nerve damage, it can take up to 12 weeks to heal, and not everyone’s anatomy is suitable for this type of piercing (e.g., the hood may not protrude enough to be pierced).

Vertical or horizontal clitoral piercings

o   Description: This piercing goes directly through the clitoris either vertically or horizontally.

o   Positives: Healing time of 2-6 weeks. It can greatly increase pleasure if done correctly.

o   Negatives: This piercing is not advised because the clitoral area is highly sensitive, vascular, and contains many nerves, which can be damaged. Not everyone’s anatomy is suitable for this type of piercing (e.g., the clitoris has to be large enough to pierce).

 

Common piercings in the penile area

Prince Albert piercing

o   Description: This is the most common penile piercing. The piercing is ring-like and it extends along the underside of the glans, from the urethral opening to the location where the glans and shaft meet.

o   Positives: Intense urethral stimulation during penetration for both partners. 1-2 months to heal, which is one of the shortest healing times for penile piercings.

o   Negatives: Changes in urinary flow. Complications can arise such as urethral tears and proneness to more frequent sexually transmitted infections (STIs).

Dydoe

o   Description: Passes through the ridge that is located between the shaft and glans (in people who do not have a foreskin). 

o   Positives: Enhances sexual pleasure as it adds pressure to the glans, a highly sensitive area. Can stimulate partner during penetrative sexual activities.

o   Negatives: Can take up to 4 months to heal. Reported to be one of the most painful genital piercings.

Frenum or Frenum Ladder

o   Description: Located on the underside of the shaft of the penis, between the shaft and the glans of the penis. The Ladder consists of a series of parallel frenum piercings down the middle, underside of the penile shaft.

o   Positives: Easier and less painful procedure compared to other penile piercings. Healing time of 1-3 months. Enhances sexual pleasure for person and partner/s during penetrative sexual activities. Low risk of rejection.

o   Negatives: Risk of infection. The piercing may migrate.

I hope you enjoyed the quick tour of piercings!

So, to sum things up: There are many reasons people get intimate piercings, with self-expression, sexual expression, and enhanced pleasure being the main ones. There are different types of genital piercings (more than what is listed above – those are just some of the more common ones!), with various benefits and risks, as well as goals (e.g., sexual pleasure, aesthetics). If you are considering an intimate piercing, remember that all piercings have associated risks, so it is important to do more research, be clear about your goals, and talk to a professional about the risks and benefits before getting it done – this type of piercing is not something that should be done on a whim, or ever worse, after a night of partying.

If you get one, or two, or twelve, make sure to follow healing protocols to decrease chances of infection and rejection. Depending on your goals and your anatomy, certain piercings might be better suited for you than others.

Written by Suraya Meghji, Life science 2021

 

References

Angle, E. (2009). The piercing bible: the definitive guide to safe body piercing. Crossing Press. https://books.google.ca/books?id=uz-84gxdYAgC&dq=intimate+piercings+hurt&lr=&source=gbs_navlinks_s

Armstrong, M. L., Caliendo, C., & Roberts, A. E. (2006). Genital Piercings: What Is Known And What People with Genital Piercings Tell Us. Urological Nursing , 26(3), 173–179.

Caliendo, C., Armstrong, M. L., & Roberts, A. E. (2005). Self-reported characteristics of women and men with intimate body piercings. Journal of Advanced Nursing, 49(5), 474–484. https://doi.org/10.1111/j.1365-2648.2004.03320.x

Hogan, L., Rinard, K., Young, C., Roberts, A. E., Armstrong, M. L., & Nelius, T. (2010). A Cross-Sectional Study of Men with Genital Piercings. British Journal of Medical Practitioners, 3(2), 315.

Millner, V. S., Eichold, B. H., Sharpe, T. H., & Lynn, S. C. (2005). First glimpse of the functional benefits of clitoral hood piercings. American Journal of Obstetrics and Gynecology, 193(3), 675–676. https://doi.org/10.1016/j.ajog.2005.02.130

Van Der Meer, G. T., Schultz, W. C. M. W., & Nijman, J. M. (2008). Intimate body piercings in women. Journal of Psychosomatic Obstetrics and Gynecology, 29(4), 235–239. https://doi.org/10.1080/01674820802621874

Van Hoover, C., Rademayer, C.-A., & Farley, C. L. (2017). Body piercing: motivations and implications for health. Journal of Midwifery & Women’s Health, 62(5), 521–530. https://doi.org/10.1111/jmwh.12630

When Antidepressants Leave Lasting Damage: Living with Post-SSRI/SNRI Sexual Dysfunction

For many people, sexuality is a very important aspect of life. It is integral to our personal identity, our quality of life, and the ways we connect with other human beings.

So what happens to those of us whose sexuality is removed or severely diminished by a medication? What about when that eliminated or compromised sexuality does not recover, even after cessation of that medication? For people with long-term Post-SSRI/SNRI Sexual Dysfunction (PSSD), the impacts to our lives can be devastating.

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are classes of psychoactive pharmaceuticals used to treat depression and other mental health conditions. They come under many names and are known for causing reduced libido during treatment for many people. (Higgins, Nash & Lynch 2010) SSRIs are more notorious for this side-effect then SNRIs, but both can have an impact on sexual functioning. For many users of antidepressants, the sexual side-effects are the reason they eventually discontinue the drug, with or without medical supervision (Francois D 2017).

When patients bring their concerns about sexual functioning while on antidepressants to their doctor or psychiatrist, they are almost universally told that their sexuality will return to normal after tapering off the drug. Unfortunately, recent data has emerged showing that this is not always true(Reisman 2020)  (Bahrick 2008) Some patients continue to experience sexual dysfunction for weeks, months, or years after withdrawing from such treatment. Sometimes, these symptoms only emerge after the patient has tapered off the medication.

“I am left with a near total lack of sensation up until orgasm - an orgasm that often feels like it's a third of the strength that it once was.  I used to daydream about sex quite often.  Now I have virtually no sexual thoughts, even after going weeks without masturbating.” –Mark, age 32, PSSD for 7 years

Even more alarming are the patients coming forward who have experienced a total elimination of their sexuality that persists indefinitely. These patients report a severe or total loss of erotic sensation in their genitals, sometimes to the point of tactile numbness. Some patients have been unable to experience attraction, arousal, or orgasm for years or even decades, with no other discernable cause apart from treatment with antidepressants.

“In addition to the loss of libido and sexual sensation (numbness of genitalia and other erogenous zones), my general sensitivity to the pleasure of touch has declined. A caress on bare skin registers as little more than pressure. Again, there is a feeling of numbness, as if there is some kind of barrier between my skin and the source of contact… When I brought some literature on PSSD to my former psychiatrist, she refused to even look at it, dismissing it—and my concerns—as “ridiculous.” I have also raised it with my current GP, but he’s not interested in hearing about it.” - Ellen, age 48, PSSD for 15 years

Furthermore, these long-term impacts on sexual functioning are often accompanied by emotional and cognitive symptoms such as “brain fog” or reduced emotional range, commonly referred to as “emotional blunting.” (Opbroek et al 2002) A common variant of this is the reduced or removed ability to experience emotions of romantic attachment. (Fisher, 2007) Patients have reported feeling permanently emotionally flat or experiencing memory and sleeping problems that began at the same time as their sexual dysfunction. For some people, these emotional and cognitive symptoms can be equally or even more difficult to cope with than the sexual dysfunction.

The prevalence of these symptoms among patients treated with SSRIs and SNRIs is unknown, as are the underlying causes, risk factors, and recovery rates. There is currently no known effective treatment. (Bala 2017)

What is known is that many people who experience PSSD find it extremely debilitating to their relationships and overall quality of life. The loss of one’s sexuality and the associated symptoms is a traumatic experience and can lead to increased depression, relationship dissolution, and suicide.

“To say that PSSD has negatively impacted my life would be an understatement of tremendous magnitude. The implications of this cannot be remotely imagined by a normal person. In my opinion, healthy human sexuality is a requisite for being able to properly perceive and navigate the world, even things that seem totally removed from sexuality. It fuels many aspects of our personality and behavior without the average human being even realizing it – until it is taken away.” - Jake, age 29 (PSSD for 11 years, since age 18)

For many years, the medical community was sceptical of the existence of PSSD. Patients were frequently told that their symptoms were a result of their mental health condition, despite the fact they had never experienced such symptoms prior to antidepressant treatment. That view is now shifting due to the dedicated work of researchers, whose documentation of PSSD cases led to the recognition of PSSD as an iatrogenic (meaning caused by medical treatment) condition by the European Medicines Agency. (Healy, D. 2020). Though not yet recognised outside of Europe, doctors around the world are slowly becoming more aware of the risk of Post SSRI/SNRI Sexual Dysfunction. Health Canada put SSRIs and SNRIs under review for long-term sexual dysfunction in 2018 and the report is expected later this year. (Health Canada 2018)

“One major issue with the experience of developing PSSD was the lack of information available to the consumer of antidepressants. I was not informed of the possibility of these side effects persisting – I did my due diligence in looking up the medications, reading pamphlets on the side effects, and talking to pharmacists and doctors, but it was never mentioned that these side effects could persist; for simplicity’s sake, I was “chemically castrated,” without my consent, and without any sort of warning. Being completely blindsided by the persistent side effects has made this experience that much more devastating.” - Andrew, age 29, PSSD for 2 years

Raising awareness is the first step towards achieving research into the causes, rates, and potential treatments of this disorder. Patient activist groups are now springing up around the world to advocate for recognition and research.

Our group PSSD Canada was established in May 2020 to advocate for PSSD sufferers in our home country of Canada and internationally. We are not anti-psychiatry or against the use of antidepressant medication, but we advocate for greater research, awareness, and transparency of the potential health risks so that patients can be informed of the risks and benefits before choosing this treatment option. Please view our mission statement here: https://pssdcanada.squarespace.com/mission-statement 

We collect personal stories, academic sources, and professional statements of support on our mwebsite www.pssdcanada.squarespace.com 

If you have questions or are interested in getting involved, please get in touch: pssdcanada@gmail.com

Emily Grey, Co-ordinator PSSD Canada

 

References 

Bahrick, A. S. (2008). Persistence of sexual dysfunction side effects after discontinuation of antidepressant medications: Emerging evidence. The Open Psychology Journal, 1, Article 42-50.  https://pdfs.semanticscholar.org/c8e7/5efa92141ab40afd2a83da435c39bc8371cd.pdf;   

Francois D, Levin A, Kutscher E, Asemota B. Antidepressant-Induced Sexual Side Effects: Incidence, Assessment, Clinical Implications, and Management. Psychiatr Ann. 2017; 47: 154-160; https://www.healio.com/psychiatry/journals/psycann/2017-3-47-3/%7Bdecf437a-8f22-446c-923a-19e84670a187%7D/antidepressant-induced-sexual-side-effects-incidence-assessment-clinical-implications-and-management

Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI Sexual Dysfunction: A Literature Review. Sex Med Rev. 2018;6(1):29-34. doi:10.1016/j.sxmr.2017.07.002; Retrieved from https://www.researchgate.net/publication/318839298_Post-SSRI_Sexual_Dysfunction_A_Literature_Review

Healy D. (2020) Antidepressants and sexual dysfunction: a history. Journal of the Royal Society of Medicine. 113(4):133-135. Retrieved from https://journals.sagepub.com/doi/full/10.1177/0141076819899299

Fisher, H., & Thomson Jr, J.A.  (2007) Lust, Romance, Attraction, Attachment: Do the side-effects of serotonin-enhancing antidepressants jeopardize romantic love, marriage and fertility?  Evolutionary Cognitive Neuroscience. SM Platek, JP Keenan and TK Shakelford (Eds.). Cambridge, MA: MIT Press Pp. 245-283;  Retrieved from http://helenfisher.com/downloads/articles/18ecn.pdf

Health Canada, 2018, Safety and effectiveness reviews started between 2018-11-01 and 2018-11-30 Retrieved from https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/new.html

Higgins, A., Nash, M., & Lynch, A. M. (2010). Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug, healthcare and patient safety2, 141–150. https://doi.org/10.2147/DHPS.S7634;

Opbroek, A., Delgado, P.L.,  Laukes, C.,  McGahuey, C.,  Katsanis, J.,  Moreno, F.A.,  & Manber, R.,  Emotional blunting associated with SSRI-induced sexual dysfunction. Do SSRIs inhibit emotional responses?, International Journal of Neuropsychopharmacology, Volume 5, Issue 2, June 2002, Pages 147–151, Retrieved from  https://doi.org/10.1017/S1461145702002870

Reisman Y. (2020) Post-SSRI sexual dysfunction  BMJ 2020;368:m754; Retrieved from https://www.bmj.com/content/368/bmj.m754?utm_source=twitter&utm_medium=social&utm_term=hootsuite&utm_content=sme&utm_campaign=usage