13 October 2015
Article by Amy Clifton, National Assembly for Wales Research Service
Much of the attention surrounding the Public Health (Wales) Bill has focused on e-cigarettes. However another interesting area of the Bill concerns special procedures and intimate piercing (Parts 3 and 4 of the Bill). Stage 1 of the scrutiny process is well underway by the Health and Social Care Committee, and some Members have commented that it has opened their eyes to some of the more extreme new trends in body modification.
The Bill as drafted would create a mandatory licensing scheme for practitioners and businesses carrying out special procedures in Wales. The special procedures currently included are acupuncture, electrolysis, body piercing and tattooing, although the Bill would also allow Welsh Ministers to amend this list through secondary legislation.
Many stakeholders indicated in their evidence to the Committee that there is currently a significant lack of quality control within the tattoo and piercing industries. The Committee heard alarming reports that many procedures are being done by people with little, if any, knowledge of anatomy, infection control or healing processes.
Stakeholders also highlighted additional procedures they believe should be included the Bill. These included body modification (scarification, dermal implants, branding and tongue splitting), injection of liquid into the body (botox or dermal fillers), and laser treatments (tattoo removal or hair removal).
The Assembly Outreach team made a short video, interviewing practitioners across Wales, you can watch the special procedures video on YouTube.
Tattoo artists in the video express particular concern about branding, scarification, ‘extreme body modification’ (such as tongue splitting and penis splitting) and dermal implants. They explain that scarification (where a section of the skin is removed to leave a scar) is often performed dangerously:
People are doing it with scalpels, people are doing it with tattoo machines with no ink in, you know, and just gouging in scars.
The tattooists also say that branding is being done with blowtorches and bent coat hangers, and adapted soldering irons, and describe concerns about dermal implants, such as inserting horns and stars under the skin:
Inserting foreign objects into your body is not a good thing without some sort of legislative weight behind it to say, ‘That’s unsafe’, or, ‘Is the material safe?’ or ‘Has it been checked?’; ‘Is it sterile? Have you autoclaved it before you put it in there? Where did you get it from? Has this come out of a five-penny ball machine round the corner?’
Another procedure highlighted as a potential concern is ‘wet cupping’ (also known as ‘Hijama’). This is a therapeutic procedure which combines the use of suction cups and controlled bloodletting (insertions are made to the skin with a scalpel), and is becoming increasingly popular, particularly in some Asian communities. Dr Ncube (consultant Epidemiologist and Head of Blood Borne Viruses in Public Health England) told the Committee that the risk of infection needs to be investigated, and that work is underway on this. He recommended that the potential need for regulation for ‘wet cupping’ should be reviewed once the evidence has been established.
The Bill proposes to set an age restriction of 16 years old for intimate piercing. It defines the intimate body parts as the anus, breast, buttock, natal cleft, penis, perineum, pubic mound, scrotum and vulva.
Whilst there is support for the principle of an age restriction, many stakeholders believe that 18 would be a more appropriate minimum age limit for intimate areas. For example, the Chartered Institute of Environmental Health (CIEH) believes that 18 would be a more appropriate age restriction, as this is in line with the minimum age for tattooing, and reflects the level of maturity needed to make such decisions. Stakeholders also reasoned that an individual aged 16 is still growing and therefore the risk of damage to skin is greater. It was also noted that intimate body piercings require a higher standard of aftercare than tattoos, as they are potentially more susceptible to infection.
Dr Ncube supports a higher age limit, noting that there are long term implications with genital piercing. He gave a case study example of a father with a genital piercing, who was playing with his daughter, and his daughter accidentally kicked him.
The trauma that was caused by the genital piercing resulted in the formation of gangrene in his penis. It’s a condition called Fournier’s condition. Because of that, the scarring that occurred was profound. So, genital piercing is attended with considerable risks, and it’s not just the piercing alone that is important, but it’s the long-term implications of it.
There was also a strong message from stakeholders, including Public Health Wales, that tongue piercing should be included in this part of the Bill, with witnesses describing a high risk of complications, harm and infection.
The Welsh Dental Committee sets out evidence for this view:
The data varies, but in 2 UK studies (including one in Cardiff) over 90% of the dentists surveyed had seen patients with tongue piercings, and about half had treated patients for complications arising from tongue piercing. About half of the patients had received advice about risks of piercing, but the advice was very limited and usually about pain and swelling
Complications of tongue piercing can occur immediately after the piercing, and then after healing. Reports consistently show approximately 90% of piercees will have immediate complications including pain, swelling, bleeding, nerve damage and infection. There are a small number of reports of severe spreading infection which has compromised the airway, putting life at risk.
Read our previous blog post on these parts of the Bill for more information.
The Committee will question the Minister for Health and Social Services on 21 October about the evidence it has heard so far on the Bill. It will then work on recommendations for its Stage 1 report which will be published by 27 November.