Tattoos, piercing, and sexual behaviors in young adults PDF

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2307 ORIGINAL RESEARCH—PSYCHOLOGY Tattoos, Piercing, and Sexual Behaviors in Young Adults jsm_2791 2307..2314 Krzysztof Nowosielski, MD, PhD,*† Adam Sipin´ski, MD, PhD,† Ilona Kuczerawy, MA,‡ Danuta Kozłowska-Rup, MA,§ and Violetta Skrzypulec-Plinta, MD, PhD, Professor¶ *Department of Gynecology and...

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Tattoos, piercing, and sexual behaviors in young adults Krzysztof Nowosielski The journal of sexual medicine

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2307

ORIGINAL RESEARCH—PSYCHOLOGY Tattoos, Piercing, and Sexual Behaviors in Young Adults

jsm_2791

2307..2314

Krzysztof Nowosielski, MD, PhD,*† Adam Sipin´ski, MD, PhD,† Ilona Kuczerawy, MA,‡ Danuta Kozłowska-Rup, MA,§ and Violetta Skrzypulec-Plinta, MD, PhD, Professor¶ *Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Poland; †Department of Health Science, Medical Collage in Sosnowiec, Poland; ‡Department of Gynecology and Obstetrics, District Hospital in Pyskowice, Poland; §Department of Neonatology, Municipal Hospital in Ruda Slaska, Poland; ¶Medical University of Silesia, The School of Health Care, Department of Women’ Disease Control and Prevention, Katowice, Poland DOI: 10.1111/j.1743-6109.2012.02791.x

ABSTRACT

Introduction. Body piercing and tattooing are accepted by a growing number of teenagers and young adults as a way of self-expressing. Some authors suggest association between body piercings/tattoos and early sexual initiation, higher number of sexual partners, or risky sexual behaviors. Aim. The aim of the study was to evaluate sexual behaviors among young adults with body modifications (BMs)—tattoos and piercings. Methods. One hundred twenty young healthy adults, ages between 20 and 35, were included in the population study. The study group was divided into three subgroups: controls (N = 60), adults with tattoos (N = 28), and adults with piercings (N = 32). The research instrument was a self-prepared questionnaire containing 59 questions assessing socioepidemiological parameters, sexual behaviors, incidents of sexual harassment in the past, and self-attractiveness evaluation, as well as questions concerning tattoos and piercings. Socioepidemiological variables and sexual behaviors were compared between subgroups. Main Outcome Measures. To assess and describe the correlation between having BM—tattoos and piercings—and sexual behaviors in the population of young adults by using the logistic regression model. Results. Adults with BMs have had their first intercourse statistically earlier and were more sexually active compared with controls. There were no statically significant differences in sexual orientation, sexual preferences, engaging in risky sexual behaviors, frequency of masturbation, and history of sexual abuse between the groups. In contrast, the frequency of sexual intercourses was statistically higher and oral sex was more likely to be a dominant sexual activity in adults with BM compared with controls. The multivariate logistic model revealed that adults with BM were four times less likely to participate in religious practices and twice more likely to have early sexual initiation. Conclusions. Having BM is associated with early sexual initiation and more liberal attitudes toward sexual behaviors but not with engaging in risky sexual behaviors. Nowosielski K, Sipin´ski A, Kuczerawy I, Kozłowska-Rup D, and Skrzypulec-Plinta V. Tattoos, piercing, and sexual behaviors in young adults. J Sex Med 2012;9:2307–2314. Key Words. Tattoos; Piercings; Body Modifications; Sexual Behaviors; Correlation; Adults

Introduction

B

ody modifications (BMs), such as tattoos and piercings, have a long history deeply rooted in ancient civilizations, when decorating the body was attributed to the social role and position. Since the Middle Ages, tattooing was accredited to social exclusion and redemption. Although BMs are still

© 2012 International Society for Sexual Medicine

perceived as signs of pathology, currently tattoos and piercings are becoming more socially acceptable [1–3]. Body piercing and tattooing have been practiced in almost every society. In some cases, it might be related to ritual ceremonies and religious rites. Recently, piercing other parts of the body (except ears, mouth, and nose) has become J Sex Med 2012;9:2307–2314

2308 popular. Little is known about the current number of individuals with BM. A large study by Laumann and Derick showed that 24% of adult Americans between 18 and 50 years of age have tattoos and 14% have body piercings [4]. The rate of piercings is even higher in college population and reaches 50% [5]. In Germany, according to the study by Stieger et al., approximately 19.8% of young adults have piercings (excluding the earlobe) and 15.2% have tattoos [6]. There are no available data on the number of individuals with piercings and tattoos in the Polish population. Body piercing and tattooing are accepted by a growing number of teenagers and young adults as a way of self-expressing [5]. Motivations for the acquisition of tattoos and body piercings seem to be diverse [7]. Wohlrab et al. [7] identified 10 categories of reasons: beauty, art, and fashion; individuality; personal narrative; physical endurance; group affiliations and commitment; resistance; spirituality and cultural tradition; addiction; sexual motivation; and no specific reason. However, most frequently mentioned in the literature are the expression of individuality and the embellishment of the body—BM may have a communicative character [3,4]. Additionally, piercings and tattoos may increase one’s sexual attractiveness and sexual sensations. Stirn et al. also reported an association between BM and a history of sexual abuse [8]. Furthermore, some possible side effects of BMs have been recently reported by Edlin et al., who suggested a possible association between squamous cell carcinoma of the penis/urethra and genital piercing [9]. Finally, there are some reports on BM, especially piercings and steel penis ring, used as sexual enhancement device, which could cause less or more serious injuries in patients [10]. Popular beliefs that BMs, especially piercings, were associated with homosexuality, sadomasochism, and fetishism have been reported in few small studies but have not been confirmed on large samples [11]. BMs were shown to be more common in individuals using alcohol and drugs, who were smoking, who were members of criminal organizations, and those who engaged in gambling and other risk-taking behaviors [1,3]. Having tattoos and piercings also correlates with personality traits. However, caution is suggested when attributing psychopathology to adults who possess tattoos and/or body piercings [11–13]. Some authors suggested some association between body piercings/ tattoos and risky sexual behaviors, early sexual initiation, higher number of sexual partners, and nonuse of contraception [1–4,11,13–17]. Further J Sex Med 2012;9:2307–2314

Nowosielski et al. studies are needed to evaluate those correlations and to describe sexual behaviors in individuals with BMs, especially in a noncollege sample of adults.

Aim The aim of the study was to evaluate sexual behaviors among young adults with BMs—tattoos and piercings. Main Outcome Measures To assess and describe the correlation between having BMs—tattoos and piercings—and sexual behaviors in the population of young adults by using the logistic regression model. Material and Methods

Study Population A total number of 250 young healthy adults, 100 with BM and 150 without any type of BM, between 20 and 35 years old, were eligible for the population study. The participants with BMs (tattoos and piercings) were recruited in five tattoo studios in the Upper Silesian Region in Poland. The controls—adults without any BMs—were recruited from among patients of several general practitioner offices in Katowice, Poland, who were seen for a yearly routine physical check-up. From among the eligible individuals, 30 with BM and 60 without BM refused to participate—the refusal rates were 30% and 40%, respectively. Based on medical interviews conducted by two trained medical students with all subjects who agreed to participate, adults with history of depression and other mental disorders, severe somatic diseases, thyroid dysfunction, diabetes mellitus, liver dysfunctions, unstable coronary heart disease, extreme kidney failure, and no sexual initiation were excluded from the project. Finally, 120 individuals were included in the study. The study group was divided into three subgroups: controls (N = 60)—subjects without BM, adults with tattoos (N = 28), and adults with piercings (N = 32). Socioepidemiological variables and sexual behaviors were compared between subgroups. Study Design The research instrument was a self-prepared questionnaire containing 59 questions assessing socioepidemiological parameters, sexual behaviors (age of the first sexual intercourse, the number of lifetime sexual partners, having a regular partner,

2309

Tattoos, Piercing, and Sexual Behaviors being sexually active during the past 4 weeks, sexual orientation, sexual preferences, dominant type of sexual activity, frequency of sexual intercourses, frequency of masturbation, type of performed sexual activity, and preferred place of sexual activity), engaging in risky sexual behaviors (answer yes or no), the quality of relationship with the current sexual partner (five-point scale), incidents of sexual harassment in the past (answer yes or no), and self-attractiveness evaluation (1–10 point scale), as well as questions concerning tattoos and piercings (number, location, influence on self-attractiveness and sexual life, and perception by the sexual partner), which were answered only by the subjects with BM. Each participant was first interviewed by a trained medical student. All the persons who agreed to participate in the study read and signed an informed consent form. Standard medical evaluation form was used to qualify subjects for the study population. In order to guarantee the maximum privacy, all participants who were included in the study were then asked to fill in the questionnaire by themselves and to return it to the researchers. Sexual activity was defined as any of the following: caressing, foreplay, masturbation, and vaginal/ anal intercourse or oral sex. The participants were classified as engaging in risky sexual behaviors if they have had at least one of the following: multiple sexual partners and onenight-stand sexual relationships, sexual intercourse with persons known to be human immunodeficiency virus (HIV) positive, used a drug or had sex with prostitutes, sex with homosexuals or bisexuals, sex for money or drugs (a tendency to trade sex for material gain), failure to use or irregular use of condoms, used intravenous drugs and shared needles, and sexual activity while using alcohol and/or psychoactive substances [18].

The clinical study had been approved by the Bioethical Committee of the Medical University of Silesia (KNW-6503-48/II/06/08).

Statistical Analysis The obtained results were analyzed statistically with the Statistica 8.0 computer program (StatSoft, Krakow, Poland). By reason of non-normal distribution of the sample population and the lack of variance homogeneity, nonparametric Mann– Whitney U-test was used for the analysis of quantitative variables. The following tests were used for the qualitative variables: chi square with Yates’ correction and Fisher’s exact test (for the sample size less than or equal to 20). The logistic regression model was used to assess the correlation between having BMs (tattoos and piercings) and sexual behaviors. The first stage consisted of a univariate analysis, in which the variables that significantly influenced having BM were established. Raw odds ratios (ORs) were calculated. In the last stage, only variables that were statistically significant in the univariate analysis were included in the multivariate model. Age, gender, religiosity, marital status, residency, education, self-attractiveness, and the quality of relationship with the current sexual partner were classified as confounders as they may influence both having BM as well as sexual behaviors [1–4,11,12,14,15,17]. The value of P < 0.05 was adopted as the level of statistical significance. Results

The mean age of respondents was 24.93 ⫾ 3.10 years (Table 1). Adults with piercings were statistically younger compared with controls and respondents with tattoos (Table 2). Tattoos were acquired by more male respondents compared with females, whereas piercing by more women

Table 1 General characteristics of the study population—quantitative variables P* Variable

Control (N = 60)

Tattoos (N = 28)

Piercing (N = 32)

T vs. C

P vs. C

T vs. P

Age (mean, SD, range) Age of the first sexual intercourse (mean, SD, range) No. of lifetime sexual partners (median, range) Quality of the relationship with the current sexual partner (five-point scale) (mean, SD) Self-attractiveness (1–10 scale) (mean, SD)

25.42 ⫾ 3.08 (20–35) 18.79 ⫾ 1.92 (14–22)

25.71 ⫾ 2.65 (21–35) 16.61 ⫾ 1.68 (11–19)

23.37 ⫾ 3.03 (18–30) 17.16 ⫾ 1.72 (13–21)

0.96 0.000005

0.002 0.0003

0.002 0.23

1 (1–10)

4 (1–10)

3 (1–30)

0.000001

0.003

0.005

4.59 ⫾ 0.69

4.40 ⫾ 0.82

4.55 ⫾ 0.81

0.38

0.96

0.44

7.22 ⫾ 1.47

8.53 ⫾ 1.32

7.22 ⫾ 1.83

0.00007

0.61

0.001

*Mann–Whitney U-test T vs. C = tattoos vs. control; P vs. C = piercing vs. control; T vs. P = tattoos vs. piercing; SD = standard deviation

J Sex Med 2012;9:2307–2314

2310 Table 2

Nowosielski et al. General characteristics of the study population—qualitative variables

Variable (%, N) Gender Male Female Religious commitment Roman Catholic Atheist Other Regular partition in religious practices Education Primary Secondary Tertiary Marital status Married Partnership Single Residency† Rural Small city Large city

Control (N = 60)

Tattoos (N = 28)

Piercing (N = 32)

31.67 (19) 68.33 (41)

57.14 (16) 42.86 (12)

96.67 3.33 0 65.00

53.57 35.71 10.71 7.14

(58) (2) (0) (39)

(15) (10) (3) (2)

P* T vs. C

P vs. C

T vs. P

25.00 (8) 75.00 (24)

0.03

0.63

0.02

75.00 25.00 0 31.25

(24) (8) (0) (10)

0.0001 0.001 0.03 0.0001

0.001 0.001 0.99 0.002

0.12 0.12 0.09 0.02

1.67 (1) 18.33 (11) 80.0 (48)

17.86 (5) 28.57 (8) 53.57 (15)

15.63 (5) 15.63 (5) 68.74 (22)

0.1 0.03 0.0001

0.08 0.56 0.31

0.89 0.35 0.29

26.66 (16) 56.67 (34) 16.67 (10)

10.72 (3) 57.14 (16) 32.14 (9)

6.25 (2) 81.25 (26) 12.5 (4)

0.16 0.97 0.17

0.02 0.02 0.76

0.66 0.06 0.11

21.67 (13) 38.33 (23) 40.0 (24)

3.57 (1) 25.0 (7) 71.43 (20)

3.13 (1) 56.25 (18) 40.62 (13)

0.03 0.09 0.01

0.03 0.12 0.87

0.97 0.02 0.02

*Chi2 test/Fisher’s exact test †Small city—less than 100,000 citizens; large city—more than 100,000 citizens T vs. C = tattoos vs. control; P vs. C = piercing vs. control; T vs. P = tattoos vs. piercing

compared with men. Respondents with BM were less likely to be Roman Catholics and less likely to participate in religious practices compared with controls. There were no statistical differences in education level between the groups. Adults with BM lived mostly in small and large cities whereas 22% of controls in the rural area; the differences were statistically significant. Furthermore, controls were more likely to be married compared with adults with BM (Table 2). Adults with BM have had their first intercourse statistically earlier compared with controls (Table 1). The number of sexual partners was the highest in the group of subjects with tattoos. There were no differences between the groups in the quality of relationship with the current sexual partner. Additionally, adults with tattoos rated their self-attractiveness statistically higher compared with controls and respondents with piercings (Table 1). The evaluation of sexual behaviors revealed that adults with tattoos were statistically more sexually active compared with controls (Table 3). Respondents with piercings were more likely to have a regular partner compared with adults with tattoos. There were no statically significant differences in sexual orientation, sexual preferences, engaging in risky sexual behaviors, frequency of masturbation, and history of sexual abuse between the groups. In contrast, frequency of sexual intercourses was statistically higher in adults with piercings compared J Sex Med 2012;9:2307–2314

with controls, whereas oral and anal sex was more likely to be the dominant sexual activity in adults with BM compared with controls (Tables 3 and 4). Additionally, adults with BM had sex in alternative places (other than bedroom) more often compared with controls. The main reasons for having a piercing were the following: the need for expressing one’s individuality (81.25%, N = 26) and fashioning oneself (50.0%, N = 16). From among adults with piercings 34.4% (N = 11) claimed that places with piercings are more sensitive to sexual stimulations. Additionally, 56.6% (N = 18) declared that piercing stimulation is extremely pleasant for them and 59.4% (N = 19) declared that piercing stimulation is pleasant for their sexual partner. For 78.1% (N = 25), having a piercing causes sexual excitement for the partner. Furthermore, having a piercing increased self-esteem in 43.7% (N = 14) of subjects and did not change the esteem in the rest of them. In one case, having a piercing was perceived negatively by the sexual partner, did not influence the relationship for six subjects, and was perceived positively by the partners of 25 adults. The main reasons for tattooing were the following: the need for expressing one’s individuality (96.86%, N = 26) and expressing one’s rebellion (42.86, N = 12). From among adults with tattoos 32.15% (N = 9) of adults with tattoos claimed that having a tattoo increased their self-esteem. Similarly, 57.14% (N = 16) declared that the tattoo is

2311

Tattoos, Piercing, and Sexual Behaviors Table 3 Sexual behaviors in the study population P† Variable (%, N) Having a regular partner Sexually active during the past 4 weeks* Sexual orientation Heterosexual Homosexual Bisexual Sexual preferences Traditional Sadomasochism Fetishism Dominant type of sexual activity Oral sex Anal intercourse Vaginal intercourse Frequency of sexual intercourses Daily A few times a week Once a week A few times a month Once a month Less than once a month Frequency of masturbation Never Rarely Occasionally Often Always Type of performed sexual activity Oral sex Anal intercourse Vaginal intercourse Group sex Mutual masturbation Preferred place of sexual activity Bedroom Shower Car Public place Have you ever had sex in? Bedroom Kitchen Shower Car Public place Victim of sexual harassment

Control (N = 60)

Tattoos (N = 28)

Piercing (N = 32)

T vs. C

P vs. C

T vs. P

85.00 (51) 85.00 (51)

71.43 (20) 100 (28)

96...