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The Brussels Collaboration On Bodily Integrity. Genital Modifications in Prepubescent Minors: When May Clinicians Ethically Proceed? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-50. [PMID: 39018160 DOI: 10.1080/15265161.2024.2353823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors ("children"). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or "endosex" females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform any nonvoluntary genital cutting or surgery, from "cosmetic" labiaplasty to medicalized ritual "pricking" of the vulva, insofar as the procedure is not strictly necessary to protect the child's physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit-risk calculations, but on a fundamental concern to respect the child's privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter's sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians' widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity.
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Desai N, Breuner CC. Tattoos and Piercings in Female Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2023; 36:14-17. [PMID: 35995085 DOI: 10.1016/j.jpag.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 01/18/2023]
Abstract
This article covers body art in female adolescents and young adults, including tattoos, piercings, and intimate piercings. We review the epidemiology, definitions, motivations, proactive counseling, regulations, complications, and removal practices. Providers are likely to encounter and manage young women with tattoos and piercings and should be familiar with how to support young women before and after obtaining body art. Providers should be familiar with the treatment of the most frequent complications of body art in young women, which include allergic reactions and localized soft tissue infections. Finally, we review the techniques and indications for body art removal.
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Affiliation(s)
- Neerav Desai
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Cora C Breuner
- Seattle Children's Hospital University of Washington, Seattle, Washington
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Abstract
Tattooing is a permanent form of body art applied onto the skin with a decorative ink, and it has been practiced from antiquity until today. The number of tattooed people is steadily increasing as tattoos have become popular all over the world, especially in Western countries. Tattoos display distinctive designs and images, from protective totems and tribal symbols to the names of loved or lost persons or strange figures, which are used as a means of self-expression. They are worn on the skin as a lifelong commitment, and everyone has their own reasons to become tattooed, whether they be simply esthetic or a proclamation of group identity. Tattoos are representations of one’s feelings, unconscious conflicts, and inner life onto the skin. The skin plays a major role in this representation and is involved in different ways in this process. This article aims to review the historical and psychoanalytical aspects of tattoos, the reasons for and against tattooing, medical and dermatological implications of the practice, and emotional reflections from a psychodermatological perspective.
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Sadura F, Wróbel MS, Karpienko K. Colored Tattoo Ink Screening Method with Optical Tissue Phantoms and Raman Spectroscopy. MATERIALS 2021; 14:ma14123147. [PMID: 34201157 PMCID: PMC8227768 DOI: 10.3390/ma14123147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/30/2022]
Abstract
Due to the increasing popularity of tattoos among the general population, to ensure their safety and quality, there is a need to develop reliable and rapid methods for the analysis of the composition of tattoo inks, both in the ink itself and in already existing tattoos. This paper presents the possibility of using Raman spectroscopy to examine tattoo inks in biological materials. We have developed optical tissue phantoms mimicking the optical scattering coefficient typical for human dermis as a substitute for an in vivo study. The material employed herein allows for mimicking the tattoo-making procedure. We investigated the effect of the scattering coefficient of the matrix in which the ink is located, as well as its chemical compositions on the spectra. Raman surface line scanning has been carried out for each ink in the skin phantom to establish the spatial gradient of ink concentration distribution. This ensures the ability to detect miniature concentrations for a tattoo margin assessment. An analysis and comparison of the spectra of the inks and the tattooed inks in the phantoms are presented. We recommend the utilization of Raman spectroscopy as a screening method to enforce the tattoo ink safety legislations as well as an early medical diagnostic screening tool.
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Notara V, Gnardellis C, Sakellari E, Soultatou P, Petratou E, Dragomanovits K, Lagiou A. Health knowledge and motives on tattooing: A community-based cross-sectional study in Greece. J Cosmet Dermatol 2021; 21:720-728. [PMID: 33786952 DOI: 10.1111/jocd.14119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/04/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tattooing is becoming an increasingly common trend mainly but not merely among the youth. However, the choice of ink body art is associated with an increase of dermatological complications. AIM To assess young persons' health knowledge and motives toward tattooing. METHODS The main instrument used was an online structured questionnaire with scaling and dichotomous questions, consisting of three components: (a) the participants' sociodemographic profile, (b) health knowledge assessment, (c) motives toward or against tattooing. Simple univariate techniques and multiple logistic regression were used to data analysis. Two logistic models were developed having as dependent variable whether the respondents have or would like to have a tattoo. The independent variables in the models were sociodemographic characteristics of participants and three variables concerning respondents' health knowledge and motives on tattooing. RESULTS The study sample amounted to 629 young adults living in Athens, the capital city of Greece. The prevailing age group among tattooed persons was 19-25 years old (69.5%), with females being more likely to be tattooed than males. Among tattooed participants, knowledge in specific health complications appeared high, while in other potential complications was particularly low. The main motives identified were ideology/message and aesthetics/fashion (77% in total). Quite interesting, participants with medium and high health knowledge level showed, respectively 50%, and three times higher probability of having tattoos compared to low level. Only 16.2% of the tattooed participants regarded tattoo as dangerous to health (p < 0.0005). CONCLUSIONS The likelihood of acquiring ink body art is increasing critically among young adults. Even though this tendency is accompanied with adequate levels of knowledge concerning health hazards, systematic health education programs for more informed and safe choices are needed to be implemented, with particular emphasis on young people.
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Affiliation(s)
- Venetia Notara
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece.,Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece
| | - Charalampos Gnardellis
- Department of Animal Production, Fisheries and Aquaculture, University of Patras, Patras, Greece
| | - Evanthia Sakellari
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece.,Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece
| | - Pelagia Soultatou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Eleni Petratou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Kalliroi Dragomanovits
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Areti Lagiou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece.,Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece
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Abstract
Tattooing and permanent make-up have become mainstream procedures. Many factors play a role in the final outcome of a tattoo and the satisfaction of the customer. The technical and artistic skills of the tattooist will determine the esthetic result and will help to guide the customers in their decision and choice of the tattoo. Although tattooing is by many considered as safe one should be are aware of the risks of complications related to this body modification technique. Some customers have a medical problem and some doubt about the safety of the procedure. People with increased risk of adverse events often seek medical advice prior to decide to get a tattoo or PMU. Physicians should not only be informed about the medical history of their patients but also have some basic knowledge of the practice of tattooing and the effects this procedure can exert on the skin and on the health condition of the patient. Contraindications and special precautions with regard to skin diseases and specific systemic conditions will be addressed in this article.
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Affiliation(s)
- Christa De Cuyper
- Dermatology, AZ Sint-Jan Brugge-Oostende AV, Meiboomstraat 15, 8370 Blankenberge, Belgium.
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Gurnani P, Williams N, Al-Hetheli G, Chukwuma O, Roth R, Fajardo F, Nouri K. Comparing the efficacy and safety of laser treatments in tattoo removal: A systematic review. J Am Acad Dermatol 2020; 87:103-109. [PMID: 32763326 DOI: 10.1016/j.jaad.2020.07.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although lasers have been the criterion standard for tattoo removal, selecting the best modality can be challenging because of the varying efficacies and adverse effects. OBJECTIVE To evaluate all lasers used to remove tattoos and assess their efficacies and adverse effects. METHODS Our systematic review searched PubMed, MEDLINE, Embase, Scopus, CINAHL, Cochrane Central Register of Trials, and ClinicalTrials.gov for all laser treatments. The outcomes measured included laser parameters, treatment methods, patient and tattoo characteristics, clearance rate, and adverse effect rate. The quality of the included articles was appraised by using specific assessment tools and given a high, moderate, or low risk of bias. RESULTS Our search led to 3037 studies, with 36 being included in the systematic review (7 randomized controlled trials, 2 nonrandomized controlled trials, and 27 case series). Although quality-switched neodymium-doped yttrium-aluminum-garnet lasers are safe and effective, picosecond lasers have shown superiority with blue, green, and yellow tattoo pigments. Both are safe and effective for black tattoos. LIMITATIONS Variability among studies. CONCLUSIONS Picosecond lasers show superiority when treating blue, green, and yellow tattoos. The R20 and R0 novel techniques can effectively reduce treatment time. Further randomized controlled trials are required to make a more definitive recommendation.
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Affiliation(s)
- Pooja Gurnani
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; Florida International University Herbert Wertheim College of Medicine, Miami, Florida.
| | - Natalie Williams
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ghadah Al-Hetheli
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; Department of Dermatology and Cutaneous Surgery, College of of Medicine, Qassim University, Saudi Arabia
| | - Olivia Chukwuma
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Rebecca Roth
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Francisco Fajardo
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Keyvan Nouri
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Health Implications and Counseling Considerations for Individuals With Piercings and Tattoos. Nurs Womens Health 2020; 24:210-227. [PMID: 32505360 DOI: 10.1016/j.nwh.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/01/2020] [Indexed: 11/21/2022]
Abstract
Body art has become common and mainstream. Tattoos and body piercings represent highly individual expressions of identity and personal values. Health care services are enhanced when clinicians understand the anatomy and physiology, common discomforts, and real but rare serious risks of body modification and are prepared to provide compassionate support for individuals' choices. Special consideration must be given to the needs of childbearing women. By opening channels of communication, clinicians can engage with clients in shared decision making to help those who possess or desire body art take steps to reduce the risk of adverse effects and obtain prompt and effective medical care when problems arise. Through respectful discussion of existing body art, the therapeutic relationship is strengthened, and greater insight into an individual's health needs may be achieved.
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Sapiano MRP, Jones JM, Savinkina AA, Haass KA, Berger JJ, Basavaraju SV. Supplemental findings of the 2017 National Blood Collection and Utilization Survey. Transfusion 2020; 60 Suppl 2:S17-S37. [PMID: 32134122 PMCID: PMC7885895 DOI: 10.1111/trf.15715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This report provides supplemental results from the 2017 National Blood Collection and Utilization Survey on characteristics of the donor population, autologous and directed donations and transfusions, platelets, plasma and granulocyte transfusions, pediatric transfusions, severe donor-related adverse events, cost of blood units, hospitals policies and practices, and inventory, dosing, and supply. METHODS Weighting and imputation were used to generate national estimates including number of donors, donations, donor deferrals, autologous and directed donations and transfusions, severe donor-related adverse events, platelet and plasma collections and transfusions, number of cross-match procedures, irradiation and leukoreduction, and pediatric transfusions. RESULTS Between 2015 and 2017, successful donations decreased slightly by 2.1% with a 10.3% decrease in donations by persons aged 16-18 years and a 14.4% increase in donations by donors aged >65 years. The median price paid for blood components by hospitals decreased from $211 to $207 for leukoreduced red blood cell units, from $523 to $517 for leukoreduced apheresis platelet units, and from $54 to $51 for fresh frozen plasma units. Plasma transfusions decreased 13.6%, but group AB plasma units transfused increased 24.7%. CONCLUSION Between 2015 and 2017, blood donations declined slightly because of decreases in donations from younger donors, but the number of donations from older donors increased. The price hospitals pay for blood has continued to decrease. Plasma transfusions have decreased, but the proportion of plasma transfusions involving group AB plasma have increased.
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Affiliation(s)
- Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexandra A Savinkina
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Kathryn A Haass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James J Berger
- U.S. Department of Health and Human Services, Office of HIV/AIDS and infectious Disease Policy, Office of the Assistant Secretary for Health, Washington, DC
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Giulbudagian M, Schreiver I, Singh AV, Laux P, Luch A. Safety of tattoos and permanent make-up: a regulatory view. Arch Toxicol 2020; 94:357-369. [DOI: 10.1007/s00204-020-02655-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
AbstractThe continuous increase in the popularity of tattoos and permanent make-up (PMU) has led to substantial changes in their societal perception. Besides a better understanding of pathological conditions associated with the injection of highly diverse substances into subepidermal layers of the skin, their regulation has occupied regulatory bodies around the globe. In that sense, current regulatory progress in the European Union is an exemplary initiative for improving the safety of tattooing. On one hand, the compilation of market surveillance data has provided knowledge on hazardous substances present in tattoo inks. On the other hand, clinical data gathered from patients enabled correlation of adverse reactions with certain substances. Nevertheless, the assessment of risks remains a challenge due to knowledge gaps on the biokinetics of highly complex inks and their degradation products. This review article examines the strategies for regulating substances in tattoo inks and PMU in light of their potential future restriction in the frame of the REACH regulation. Substance categories are discussed in terms of their risk assessment and proposed concentration limits.
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Inkskinned: Gender and Personality Aspects Affecting Heavy Tattooing—A Moderation Model. JOURNAL OF ADULT DEVELOPMENT 2019. [DOI: 10.1007/s10804-019-09342-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mortensen K, French MT, Timming AR. Are tattoos associated with negative health-related outcomes and risky behaviors? Int J Dermatol 2019; 58:816-824. [PMID: 30677140 DOI: 10.1111/ijd.14372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tattoos have reached broadening mainstream acceptance. Medical professional societies have noted that tattoos may co-occur with high risk behaviors. METHODS Using a variety of statistical models applied to a sample of 2,008 adults residing in the United States via Amazon's Mechanical Turk, we estimate the associations between tattoo characteristics, three health-related outcomes (overall health status, ever diagnosed with a mental health issue, sleep problems), and three risky behaviors (current smoking, ever spent time in jail or prison, and number of sex partners). RESULTS We find that the presence, number, and specific features of tattoos are positively correlated with two of the health-related outcomes (ever diagnosed with a mental health issue and trouble sleeping) and all three of the risky behaviors (P < .05). Magnitudes are larger for those with multiple, visible, and offensive tattoos. CONCLUSIONS Our results suggest that individuals with tattoos are more likely to engage in risky behaviors relative to their non-tattooed counterparts, which may lead to health consequences. Dermatologists, healthcare providers, and public health advocates should recognize that having a tattoo(s) is a potential marker for mental health issues and risky behaviors.
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Affiliation(s)
- Karoline Mortensen
- Department of Health Management and Policy, University of Miami, Coral Gables, FL, USA
| | - Michael T French
- Departments of Health Management and Policy, Sociology, Economics, and Public Health Sciences, University of Miami, Coral Gables, FL, USA
| | - Andrew R Timming
- University of Western Australia Business School, Crawley, Australia
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McBride DL. Clinical Guidance to Tattooing and Piercing Among Youth. J Pediatr Nurs 2018; 39:83-84. [PMID: 29183636 DOI: 10.1016/j.pedn.2017.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 11/19/2022]
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Tattoos and Piercings: Increasingly Accepted but Still Risky. MCN Am J Matern Child Nurs 2018; 43:112. [PMID: 29470269 DOI: 10.1097/nmc.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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