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Theses, Dissertations, and Other Capstone Projects
2018
Motivations, Expectations and Experiences of
Genital Piercings in the Transgender Community:
An Exploratory Study
Haley Peterson
Minnesota State University, Mankato
Follow this and additional works at: https://cornerstone.lib.mnsu.edu/etds
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Recommended Citation
Peterson, Haley, “Motivations, Expectations and Experiences of Genital Piercings in the Transgender Community: An Exploratory
Study” (2018). All Theses, Dissertations, and Other Capstone Projects. 811.
https://cornerstone.lib.mnsu.edu/etds/811
Running head: MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL
1
Motivations, Expectations and Experiences of Genital Piercings in the Transgender Community:
An Exploratory Study
Haley Peterson
A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Arts
in Clinical Psychology
April 2018
Minnesota State University, Mankato
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
2
Date________4/30/2018_________
Motivations, Expectations and Experiences of Genital Piercings in the Transgender Community:
An Exploratory Study
Haley Peterson
This thesis has been examined and approved April of 2018 by the following members of the
student’s committee.
______________________________________
Eric Sprankle, Psy.D., Thesis Chair
______________________________________
Jeffrey Buchanan, Ph. D, Committee Member
______________________________________
Jessica Flatequal, M.A., Committee Member
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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Table of Contents
Abstract……………………………………………………………………………………………5
Introduction …………………………………………………………………………………….6-7
Literature Review………………………………………………………………………………8-22
Body Modifications…………………….……………………………….……………..8-14
Stigma and Minority Stress Model……………………………………………………14-20
Genital Piercings in the Transgender Community..………………………………….20-21
Aims of Current Study..………………………………………………………………………22
Method…………………………………….………………………………………………….22-32
Participants………………………………….………………………………………..22-23
Procedure……………………………………………………………………………..23-27
Data Analysis…………………………….……………………………………………28-32
Results…………….……………………….………………………………….………………32-38
Motivations……………………………………………………………………………33-34
Making the Decision……………………………………………………………………..34
Expectations…………………………………………………………………………..34-35
Experience………………………………………………………………………………..35
Relation to Gender Identity and Expression…………………………………………..36-37
Why the Research is Important……………………………………………………….37-38
Discussion…………………………………….………………………………………………39-45
Motivations………………………………………………………………………………39
Making the Decision………………………………………………………………….39-40
Expectations…………………………………………………………………………..40-41
Experience………………………………………………………………………………..41
Relation to Gender Identity and Expression………………………………………….41-42
Why the Research is Important………………………………………………………42-43
Implications…………………………………………………………………………..43-44
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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Limitations of the Current Study……………………………………………………..44-45
Future Directions…………………………………………………………………………45
References…………………………………….…………………………………………………..46-51
Appendix A- Demographics Table ………………………………………………..………….…52
Appendix B- Definitions of Transgender Identities and Sexual Orientation………….….….53-54
Appendix C- Definitions of Transition-Related Procedures…………………………………55-56
Appendix D- Qualtrics Screener Survey…………………………..…………………………57-63
Appendix E- Consent Form for Interview……………………………………………………64-65
Appendix F- Semi-Structured Interview Script……………………….…………………………66
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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Abstract
Purpose. Motivations and experiences of people who have body modifications has been
studied over the past several decades. However, the majority of these studies may include, but do
not exclusively, study the motivations and experiences of genital piercings in the transgender
community. This study uses a qualitative design to explore the motivations, expectations, and
experiences of getting a genital piercing within the transgender community, as well as how
genital piercings relate to transgender identities. Methods. Participants were required to be at
least 18, have a genital piercing, and identify as transgender. Recruitment was conducted through
Facebook and a professional piercer. Participants were directed to take an online screener survey
before being invited to participate in a semi-structured interview. Four participants completed the
screener survey. One of those four participants followed through with the online interview. To
analyze the interview transcript, a hybrid-method of thematic analysis was used. Double-coding
was used to validate the code developed. Results. The analysis found eight themes: Motivation
to Reclaim One’s Body; Support; Piercers Should Create a Safe Environment; Genital Piercing
Leads to Acceptance; Connecting to One’s Sexual Identity through a Genital Piercing; Use of a
Genital Piercing to Self-Express and Identify with One’s Gender; Lack of Information or
Resources; and An Alternative Modification. Discussion. The results from this study can be used
to give direction for future research. One important finding was the utility of a genital piercing to
develop self-acceptance and an alternative to less accessible transition-related procedures.
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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Motivations, Expectations and Experiences of Genital Piercings in the Transgender Community
Interest in why one chooses to modify their body in a way that is not mainstream began
in 1989 and continues to be a topic of interest today (Scott, 2015). Body modification refers to
“the alteration of the body from is natural state”, such as a body piercing or tattoo (Scott, 2015,
p. 55). Much of the literature surrounding body modification focuses on the motivations and
experiences of people who choose to modify their bodies, including genital piercings. Genital
piercings are frequently studied under the umbrella of body modifications, or body piercings in
combination with tattoos, and it has been documented that this form of body piercing has been
important to individuals who get them for reasons such as sexual expression and enhancement,
self-expression, resisting cultural norms, finding community and others (Armstrong, Caliendo &
Roberts, 2006; Armstrong et al., 2007; Caliendo, Armstrong & Roberts, 2005; Myers, 1992;
Pitts, 2000).
However, the existing literature on body modification centers around cisgender
individuals. Cisgender is a term that refers to a person whose gender matches their sex assigned
at birth (LGBTQ+ Definitions, n.d.). Additionally, the limited research that covers the lesbian,
gay, bisexual and transgender (LGBT) community is often restricted to LGB individuals and
excludes those who identify as transgender. Transgender is an umbrella term that refers to
anyone who does not identify with their assigned sex at birth (LGBTQ+ Definitions, n.d.).
Examples of identities that are considered transgender are genderqueer, gender fluid, nonbinary,
bigender, and agender. This is not an exhaustive list as many other identities fall under the
transgender umbrella term. For definitions of these terms, please refer to Appendix B. When the
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
7
transgender community is not excluded from the research, they are discussed in combination
with the LGB community and not explicitly.
The practice of, or the desire to engage in, other forms of body modifications in the
transgender community have been documented (Cole et al., 2012; Grant et al., 2011). The types
of body modification referred to are medical procedures done in order to change the appearance
of one’s body to match their gender. Matching one’s gender with their assigned sex at birth has
been found to be motivated by a desire to avoid experiencing stigma due to their minority status
(Bockting et al., 2013). Although a large portion of the transgender community desires to modify
their bodies, the stigma faced that leads to wanting these modifications also acts as a barrier to
getting them. For example, many report having to pay out-of-pocket for these procedures and are
unable to afford them (Grant et al., 2011). It is important to note here that, although for some the
end goal is to fully align their body and gender, not everyone has the goal of changing all or any
part of their body to match their gender.
A search on the motivations behind and experiences of having a genital piercing was
expanded to chatrooms and blogs due to the limited nature of the literature exclusively on this
population. This search found that there are some who have used a genital piercing similarly to
how some use medical procedures to change the appearance of their genitals. Some chatroom
users indicate that they desired to reclaim or reconnect with their bodies, and a genital piercing
helped them to achieve that (FTM Triangle Piercing, 2016; NSFW Transgender genital piercing
MTF, 2017). This search also found some motivations commonly reported in other populations:
sexual enhancement and expression and self-expression. The purpose of the study is to explore
the motivations, expectations and experiences of those in the transgender community to get a
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
8
genital piercing. It also explores how a genital piercing may relate to one’s gender identity and
expression.
Literature Review
Body Modifications
History of Body Modifications
The practice of body modification, specifically piercing and tattooing various sites on
one’s body, has been found all over the world and as far back as can be traced (Anderson, 2016;
Dorfer et al., 1999; Williams, 2017). Anderson (2016) reported that the use of body piercings has
been documented in “monumental texts” on many areas of the body, including genitals, such as
The Holy Bible: 1611 edition, King James Version and Kama Sutra, which was written between
1st and 6th centuries AD. Anderson stated that mummies, wall paintings, and carved figures, up to
5,000 years ago, have indicated the practice of body piercings in ancient tribes. Body piercings
have been used for reasons such as signaling family membership or rite of passage at different
stages of life (e.g., childhood to adolescence) (Anderson, 2016). Dorfer et al. (1999) noted that
prehistoric mummies in Siberia, Peru, and Chile have been discovered with well-preserved
tattoos that appear to range from aesthetic in nature to therapeutic. It is believed some of these
tattoos were therapeutic due to their virtually hidden placement on the body. Additionally, the
famous Tyrolian Iceman, which is the oldest European mummy, has been found with tattoos
whose pattern resembles modern day acupuncture (Dorfer et al., 1999). Ritual tattooing, “the act
of giving or receiving tattoos that have some special significant rather than solely acting as body
adornment,” has been found in Polynesia, Micronesia, Melanesia, and Asia dating back 2,000
years (Williams, 2017, p. 272). Ritual tattooing has been found to be used for various reasons
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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among these civilizations, including rite of passage, communicate marriageability, class, rank,
tribe or community, ward off evil or disease, and to mark accomplishments (Dorfer et al., 1999;
Williams, 2017). Many of these practices have, at some point, fallen out of popular practice in
some of these tribes and a few of them have since been revived (Williams, 2017).
Similar to the resurgence of body modification practices in previously mentioned areas of
the world, in North America, a drastic change in practices of body modifications has occurred in
the late 20th century. According to Atkinson and Young (2007), this practice was once reserved
for “the social underbelly” and has since evolved into a more mainstream practice of “cultural
expression and ideological representation through body manipulation” (p. 118). They reported
that body modification is popular across people, despite various demographic characteristics.
Motivations for people to modify their bodies, as conveyed by Atkinson and Young, are
“subcultural membership and resistance; personal status and passage; creativity and
individuality; physical endurance and pain thresholds; beauty and art; and spirituality” (p. 128).
The categories of motivations identified by Atkinson and Young have been supported by many
other authors. Some of the most common reasons for body modifications are sexual enhancement
and sexual expression (Armstrong, Caliendo & Roberts, 2006; Caliendo, Armstrong & Roberts,
2005; Myers, 1992), self-expression (Armstrong et al., 2007; Caliendo, Armstrong & Roberts,
2005; Greif, Hewitt & Armstrong, 1999; Myers, 1992; Pitts, 1999; Pitts, 2000; Tobar-Dupres,
1999), resisting the dominate culture (Davis, 1997; Pitts, 1999; Pitts, 2000), and to seek
uniqueness and community (Armstrong et al., 2007; Myers, 1992; Pitts, 2000).
Sexual Enhancement and Sexual Expression
Within these four categories, sexual enhancement and sexual expression, as well as self-
expression, were more frequently identified as reasons among cisgender samples for getting a
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
10
genital piercing. Caliendo et al. (2005) found that 79% of their sample felt that a genital piercing
helped to express themselves sexually, and 77% felt the piercing enhanced their personal
pleasure with sex. Rates were similar among cisgender men and women. Through several
interviews, Myers (1992) reported sexual enhancement to be the most compelling reason for
body modifications. Myers (1992) cautioned readers to the fact that the sample included a higher
proportion of sadomasochists (SM); but added that sexual enhancement was also a top
motivating factor for those who were not. Powls and Davies (2012) define sadomasochism as
involving key elements of “a hierarchical power structure (i.e., domination and submission),
intense stimulation (e.g., physical or emotional pain), sexual stimulation, restraint, bondage, role-
play and fantasy, usually for sexual gratification” (p. 223).
Self-Expression
Many have noted that self-expression is another common motivation for choosing to get a
body modification (Armstrong et al., 2007; Caliendo, Armstrong & Roberts, 2005; Greif, Hewitt
& Armstrong, 1999; Myers, 1992; Pitts, 1999; Pitts, 2000; Tobar-Dupres, 1999). Greif et al.
(1999) distributed self-report surveys to 766 college students in the United States and Australia
and found 48% of their sample reported their motivation to modify their bodies was self-
expression. Caliendo et al. (2005) also used self-report surveys to explore motivations for getting
either a nipple or genital piercing. They found that self-expression was among the highest rated
reason for choosing to get a nipple piercing and highly rated for genital piercings as well.
Resisting the Dominate Culture
Pitts (1999) described literature that also indicates body modifications are used as a
means of self-expression. However, this self-expression was a way for women to deviate from
the traditional look men expected of women or resisting the dominate culture. Pitts (2000) also
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
11
interviewed members of the LGBT community to explore the motivations and experiences in
relation to their body modification. Pitts reported that, while sexual and self-expression may be
motivators, a deeper meaning may exist in the body modifications. This sample describes their
nonmainstream body modifications match their nonmainstream identities, it is to celebrate their
deviation from popular culture, or both.
Uniqueness and Community
Finally, some reported that seeking uniqueness and community as motivating factors for
body modifications. Seeking uniqueness and community seem like conflicting ideas to pair
together, but Armstrong et al. (2007) explained it as a phenomenon where individuals were
simultaneously seeking a uniqueness that secured their membership to a community. Other
studies have indicated that body modifications are chosen by people as a way to find community
separate from uniqueness (Myers 1992; Pitts, 2000; Wohlrab, Stahl & Kappeler, 2007). Through
interviews with people who identify as cisgender, heterosexual and homosexual, and/or SM
found affiliation, or community, as one of the seven motivations for getting a body modification,
including genital piercings. Also, through interviews of those who identify as part of the LGBT
community, Pitts (2000) found that finding a sense of community through body modifications to
be a common theme among participants. Pitts (2000) reports that there is “an interest in
signifying group membership, building community, and creating ‘safe space’ in the margins” (p.
459). The findings of these studies indicate that sexual expression and enhancement, self-
expression, resisting the dominate culture, and uniqueness and community to be among the most
common motivations to get a genital piercing.
Body Modifications for the Transgender Community
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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Some who identify as transgender and gender non-conforming, but certainly not all, choose
to live as a gender that is different than the sex assigned to them at birth in a number of different
ways. This process is referred to as transition and it is different for everyone. Not all who
transition choose to live full-time as their gender different from their assigned sex at birth. For
those who wish to live full-time as their gender versus their assigned sex at birth, a surgery to
change the appearance of their genitals may be the most appropriate. A surgery would allow
them to permanently change their genitals, so they match one’s gender rather than their assigned
sex at birth. For someone who does not wish to live in their gender full-time, other social
changes may be appropriate. A social change may include changing one’s style of dress or hair,
adopting certain gender roles, or changing their name and pronouns to match their desired gender
rather than their assigned sex at birth. A large national survey conducted by Grant et al. (2011)
on the transgender community found that 55% of their sample lived full-time in a gender
different from their assigned sex at birth. An additional 27% hoped to live full-time this way but
were not yet, and 18% of the sample did not want to live full-time as a gender different from
their assigned sex at birth. Currently, there are two different medical treatments for transitioning:
hormone treatment and surgery. In their survey, Grant et al. (2011) found that 61% of their
sample had medically transitioned, which was defined as having either hormone treatment or
surgery. They found only 33% of their sample had surgically transitioned, which only included
those who had undergone surgery related to their transition. They do caution that these numbers
are only representative of those who have had the opportunity to transition because they are
costly procedures that not all who want them can afford to do so.
One of the more common, non-surgical transition-related procedures is hormone therapy.
Sixty-two percent (62%) of respondents of the National Transgender Discrimination Survey
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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indicated that they had received hormone therapy (Grant et al., 2011). It is common for people
who have undergone other transition-related surgeries to have also had hormone-therapy. Grant
et al. (2011) found that 93% of their sample had both hormone-therapy and surgeries. The World
Professional Association for Transgender Health (Cole et al., 2012) reports Factor and
Rothblum’s (2008) finding that, although it is a common goal, hormone therapy is not always
used to achieve complete feminization or masculinization and may instead be used to achieve an
androgynous, or neutral, presentation.
An androgynous presentation may be achieved through the “minimization of existing
secondary sex characteristics” (Cole et al., 2012, p. 33). Feminizing hormones used are estrogen,
androgen reducing medications (or “anti-androgens”), and progestins. They have various effects
including “breast growth (variable), decreased libido and erections, decreased testicular size, and
increased percentage of body fat compared to muscle mass” (Cole et al., 2012, p. 36).
Testosterone as well as progestins and GnRH agonists, which may be used briefly to “assist with
menstrual cessation” are masculinizing hormones used for those who are transitioning from
female secondary sex characteristics to male secondary sex characteristics (Cole et al., 2012, p.
50). Effects of these hormones are “deepened voice, clitoral enlargement (variable), growth in
facial and body hair, cessation of menses, atrophy of breast tissue, increased libido, and
decreased percentage of body fat compared to muscle mass” (Cole et al., 2012, p. 36). Cole et al.
(2012) report known risks to undergoing hormone therapy that range from weight gain to type 2
diabetes and various forms of cancer.
Different types of transition-related surgeries exist that target both genital appearance and
target other areas of the body. These surgeries also include changing the appearance of the chest,
face, and the removal of reproductive organs. Transgender women who desire to change the
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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appearance of their chest may undergo breast augmentation surgery, which is breast implants or
lipofilling (Cole et al., 2012; Grant et al., 2001). Additionally, transgender women who desire to
change the appearance of their genitals may undergo orchiectomy (removal of testes) or
vaginoplasty (creation of a vagina and/or removal of the penis (Cole et al., 2012; Grant et al.,
2011). Lastly, other surgeries not aimed at changing the appearance of one’s chest or genitals
include various facial feminization surgeries (Cole et al., 2012; Grant et al., 2011). For a
complete list of surgeries and definitions, refer to Appendix C.
The survey conducted by Grant et al. (2011) indicated that 21% of people had received
breast augmentation surgery, 25% received orchiectomy, and 23% have had a vaginoplasty.
Those whose assigned sex at birth is female but are transitioning to male have the option of
subcutaneous mastectomy for chest surgery (Cole et al., 2012; Grant et al., 2011). For genital
surgeries, people transitioning from female to male may get a hysterectomy (removal of ovaries),
metoidioplasty (releases the clitoris), phalloplasty (creation of testes and penis), vaginectomy
and scrotoplasty (Cole et al., 2012; Grant et al., 2011). Grant et al. (2011) report that 43% of
their sample have had chest surgery, 21% received a hysterectomy, 4% had metoidioplasty and
2% had received phalloplasty.
Stigma and Minority Stress Model
Stigma
Researchers have documented stigma experienced by both individuals who have chosen
to modify their bodies through genital piercings and the transgender community (Armstrong,
Caliendo & Roberts, 2006; Bockting et al., 2013; Gordon et al., 2017; Grant et al., 2011; Levitt
& Iooilito, 2014). Currently, many professionals either lack knowledge surrounding genital
piercings, have a negative view of those who have one, or both (Armstrong et al., 2006).
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
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Armstrong et al. (2006) found that some professionals even believe “people who choose to have
body piercings deserve whatever outcome occurs” (p. 173). Within the transgender community,
stigma is experienced in the healthcare system as well, but they experience stigma in many other
domains, such as employment, housing, and education, to name a few (Grant et al., 2011; Levitt
& Iooilito, 2014). For example, through a national survey, Grant et al. (2011) identified that 50%
of their sample had to teach their health provider about transgender care, 28% postponed care
due to discrimination, and 19% were refused care because of their gender identity. Due to the
prominence of stigma in the lives of those who identify as transgender and have genital
piercings, a dive into the literature surrounding stigma is warranted. First, a description of Link
and Phelan’s extension of Goffman’s stigma theory will be discussed. Then, the minority stress
model and its application to the transgender community will follow.
Link and Phelan (2001) reported that Goffman’s (1963) theory of stigma jumpstarted a
great deal of research devoted to expanding that initial theory. However, they explain that many
of these studies expanding on the conceptualization of stigma are inadequate due to challenges.
One of those challenges is the literature focuses solely on the individual rather than the systemic
structures that have created and perpetuated the stigma. To remedy issues within the definition of
stigma, Link and Phelan expand on these many definitions and break it down into four parts:
“People distinguish and label human differences,” “dominant cultural beliefs link labeled persons
to undesirable characteristic–to negative stereotypes,” “labeled persons are placed in distinct
categories so as to accomplish some degree of separation of ‘us’ from ‘them,’” and “labeled
persons experience status loss and discrimination that lead to unequal outcomes” (Link &
Phelan, 2001, p. 367). In addition, these labels and stereotypes generating stigmatized groups are
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
16
created and perpetuated by persons in positions of power, or those who belong to the dominate
group.
According to Link and Phelan (2001) previous definitions of stigma were lacking in the
inclusion of structural discrimination that contributed to the loss of status and result of unequal
outcomes due to discrimination. Structural discrimination refers to the efforts of various
institutions that lead to the disadvantage of stigmatized groups (Link & Phelan, 2001).
Institutions may include educational systems, healthcare systems, or public policies. For
example, in 2011 many in the transgender community were receiving inadequate healthcare due
to their providers not having the knowledge necessary to treat them (Grant et al., 2011). At that
time, the healthcare system not requiring providers to be knowledgeable lead to unequal
treatment of those who identify as transgender. Furthermore, Link and Phelan attribute this loss
of status and unequal outcomes to negative social psychological processes experienced by an
individual belonging to a stigmatized group. They explain that once a stigmatized person
becomes aware of their status in a stigmatized group, they may become fearful of and anticipate
rejection. The effects of experiencing this fear of rejection due to group membership result in
“strained and uncomfortable social interactions with potential stigmatizes, a compromised
quality of life, low self-esteem, depressive symptoms, unemployment and income loss (Link &
Phelan, 2001, p. 374). Link and Phelan (2001) explain that different stigmatized groups will have
various outcomes or experiences depending on the prominence of the differences labeled and
stereotyped or the number of stereotypes based on the stigmatized identities one may have.
Minority Stress Model
Meyers (2003) expands on stigma theories with a minority stress model, based off of
experiences of the lesbian, gay and bisexual (LGB) community, to illustrate that stigmatized, or
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
17
minority, persons experience common as well as unique stressors due to their minority status.
According to Meyers’ theory, not only is the stress experienced by minority communities unique,
but it is also chronic due to it being “relatively stable underlying social and cultural stressor[s]”
(Meyers, 2003, p. 321). Lastly, Meyers (2003) states these stressors are socially based because
they look beyond the individual and their exclusive experiences to the institutions and structures,
as in Link and Phelan’s (2001) theory of stigma.
Meyers (2003) comprises a continuum of social structures contributing to minority stress
from distal (objective stressors void of one’s interpretation) to proximal (subjective and internal
evaluations of stressors) including “(a) external, objective stressful events and conditions
(chronic and acute), (b) expectations of such events and the vigilance these expectations requires,
and (c) the internalization of negative social attitudes” (Meyers, 2003, p. 656). Meyers further
explains that proximal stressors may lead to one having “expectations of rejection,” “hide their
identity for fear of harm,” or “internalize[d] stigma” (p. 677). Although the majority of the model
explains negative effects of minority status, Meyers (2003) adds that this group membership may
involve positive effects as well. Specifically, Meyers explains that stigmatized groups often
experience a sense of community, which has been shown to alleviate negative effects of minority
status for some. Coping with minority stress can also occur at the individual level, which may
include how resilient one is (Meyers, 2003). Meyers (2003) reports one study even found that, in
addition to social support, self-acceptance was also found as an ameliorating factor, among
adolescents.
Stigma and Minority Stress for Transgender Community and People with Genital Piercings
The minority stress model was originally created to explain the effects of additive stress
in the gay community (Meyers, 2003). However, this model has been applied to the transgender
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
18
population in recent literature. First, the minority stress model states that a minority group
experiences unique stressors due to their minority status in addition to the more common
stressors others experience. Levitt and Iooilito (2014) conducted interviews to test the minority
stress model with the transgender community. They identified five distinct stressors. The first is
shifting positions of power dependent on the gender they transition to. A transgender woman
would experience a loss of power due to transitioning from a position of power as a man to a
woman. A second distinct stressor was no job protection due to fewer antidiscrimination laws in
comparison to other minority groups. Third, for those who do not wish to be out, their legal,
identifying documentation makes it difficult to hide their gender minority status. Fourth, they
may experience “challenges in forging sexually intimate relationships because of prejudices and
because their bodies are sites of their oppression and sexual intimacy has to be redefined to
respect their gender identities” (p. 59). And last, those who identify as transgender may have
difficulties finding a safe community because they may face rejection from other minority
groups that they may otherwise find support from. For example, Levitt and Iooilito (2014) state
that sexual minorities typically find support within the LGB community but those who identify
as transgender may face rejection from this community.
Through an online survey, Bockting et al. (2013) tested the minority stress model and
found their sample experienced many negative outcomes from these additional stressors faced in
the transgender community. Specifically, their sample experienced higher rates of depression,
anxiety, somatization, and overall psychological distress. They also found that this type of
psychological distress was positively associated with both enacted and felt stigma. Those
findings support the application of the minority stress model in that minority populations are
experiencing stress beyond that of someone who may not hold minority status. Gordon et al.
MOTIVATIONS, EXPECTATIONS AND EXPERIENCES OF GENITAL PIERCING
19
(2017) point out that sexual minorities experience both mental health and physical health
inequities, but many studies tend to focus on the mental health aspect. Therefore, they used
previously collected survey data to assess how minority stress in the transgender community
impacts their physical health. They found that those who identify as transgender “had a higher
risk of functional limitations with regards to mobility and usual activities as well as a higher risk
of experiencing pain and anxiety or depressive symptoms compared to those perceived as highly
gender conforming” (Gordon et al., 2017, p. 2135). They also addressed mental health impacts
and report findings congruent with other studies. Specifically, they found that the transgender
community has a higher risk of depressive symptoms, anxious symptoms, PTSD, self-harm
behaviors, and suicidality. It is clear that those who are part of the transgender community
experience additional and unique stress and negative mental and physical health outcomes.
Meyers (2003) explained that those belonging to minority groups may have expectations
of rejection and a desire to conceal their identities to avoid harm. Literature indicates that those
belonging to the transgender community experience this expectation of rejection and stigma
which leads to efforts to conceal their identity. Bockting et al. (2013) investigated the effects of
concealing a transgender identity. They refer to identity concealment as “efforts to pass as a
nontransgender woman or man, either in the role congruent with their gender assigned at birth or
in the cross-gender role” (Bockting et al., 2013, p. 944). Furthermore, concealment is a strategy
used to avoid stigma and efforts to pass can be an additional source of stress. They found that
even successful passing may not relieve minority stress. Rood et al. (2017) conducted a series of
interviews to assess efforts to conceal one’s gender identity. Their participants explained that
they conceal their identity “as a way to protect themselves from becoming targeted” (Rood et al.,
2017, p. 711). Similar to Bockting et al. (2013), this study also found that even if one
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successfully conceals their identity, they then experience stress from “devaluing” and
“minimizing” one’s true identity (p. 711). These findings support the application of the minority
stress model in the transgender community in that the stigma experienced leads to efforts to hide
one’s minority status.
Another important aspect Meyers explored in the minority stress model was the impact of
social support as a way to combat the negative effects of minority stress. Bockting et al. (2013)
found the impact of social support in the transgender community had similar ameliorating effects
as Meyers (2003) found in the gay community. Their findings did support this. In their sample,
they found that “peer support significantly moderated the relationship between enacted stigma
and psychological distress, thus emerging as a demonstrated factor of resilience in the face of
actual experiences of discrimination” (p. 948-949). Bockting et al. (2013) found this
ameliorating effect only occurred when there were high levels of social support and concluded
that there must be ongoing social support to be effective. Like Meyers (2003) in the gay
community, Bockting et al. (2013) found that belonging to a minority group does not mean one
will only experience negative effects but that positive effects exist that may relieve negative
outcomes from stigma.
Genital Piercings in the Transgender Community
Genital Piercings in the Transgender Community
With much of the current literature on motivations and experiences of genital piercings
being focused on the cisgender community, chatrooms and blogs were explored. A search within
these blogs and chatrooms for people who have piercings and identify as transgender indicates
that transgender people may also choose to get a genital piercing for sexual enhancement and
expression. On Susan’s Place, a website for the transgender community on a variety of topics,
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one thread was created to ask the community if anyone has gotten a vertical clitoral hood after a
labioplasty. This user, Sailor, indicated that their “motivation is really to increase sensitivity”
(Topic: Clitoral Hood Piercing, 2014). These threads included other people who discussed an
interest in genital piercings in a sexual way as either on themselves for them-self or on them-self
for their partner. One user, Alex, posted that they find their apadravya piercing “hot” and that it
has “…been a hit with all my partners” (NSFW Transgender genital piercing MTF, 2017).
Additionally, yet less frequently endorsed, some individuals who identify as transgender
expressed an interest in the use of a genital piercing to aid in other methods in changing their
genital appearance, such as tucking. For example, on Susan’s Place Chandler stated, “I have
thought about getting those big hole that you see people have in their ear now days down both
sides, tucking it in and lacing it up like a shoe.lol” (Topic: Pre-Transition Genital Piercing,
2011). On the “asktransgender page”, a thread was dedicated to the use of genital piercings for
tucking, “Mtf, haven’t ever presented female yet, but I want to try tucking just to see how it
feels” (Tucking with a genital piercing?, 2015). On another reddit page, “piercing”, Alex posted
“totally understand. when i was younger (and with less modifications i do now) i felt a yearning
for a lot of modifications on a very intrinsic level close to the way i felt about other things
specific to transitioning. along with my tongue split, after i got my apadravya I just felt much
more whole. that and i have no interest in bottom surgery whatsoever” (NSFW Transgender
genital piercing MTF, 2017). Rory commented on another thread under this page, “ftm” stating
they used the genital piercing as a way to reconnect to their body by changing the look of their
genitals, “Piercing felt right for me because I wanted to enhance and re-own (if that makes sense)
what my body took away from me” (FTM Triangle Piercing, 2016). These posts may indicate
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22
that some in the transgender community may be using genital piercings as an alternative to other
surgeries or hormone treatments to modify their bodies.
Aims of Current Study
The purpose of the current study is to explore the motivations, expectations, and
experiences of those who identify as transgender in getting a genital piercing in order to fill the
literature gap and assist in creating future hypotheses for this type of research. The study also
seeks to understand any thoughts and feelings that may contribute to their decision to get the
piercing. It also aims to determine whether and how a genital piercing relates to transgender
identities. An additional aim to this study is to expand the research on the transgender
community in hopes of contributing to a greater understanding of transgender identities and
decreasing the social stigma surrounding them. Since no previous research literature exists
exclusively on this population, to the best of the researcher’s knowledge, no hypotheses were
developed. The blogs and chatrooms as well as desires for other forms of body modifications in
the transgender community may indicate potential directions that may be found, but they are not
sufficient enough to create a hypothesis. As previously stated, this study is exploratory due to a
lack of literature and may serve in assisting future researchers as a starting point for developing
future hypotheses.
Methods
Participants
To be included in this study, participants had to be at least 18 years of age or older,
identify as transgender and have at least one genital piercing. Any gender identity under the
transgender umbrella fit criteria including, but not limited to, genderqueer, nonbinary, bigender
and agender. Participants who completed the screener survey, available through Qualtrics,
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included five individuals whose identity fell under the transgender umbrella and had at least 1
genital piercing. These five participants completed the questionnaire, but only four of those
participants provided contact information at the end of the survey and were contacted for further
participation in the interview. One of the four participants, Star, contacted decided to proceed
with the interview. Refer to Table 1 in Appendix A for full demographic description on
participants. All of the participants were from the Midwest region of the United States of
America and between the ages of 20 to 30. Four of the five participants identified as white and
one as Mexican/Native American. Two participants identified as genderqueer, one as
transsexual, one as nonbinary/transman, and one as genderqueer. Four of the five participants
have a vertical hood piercing and one had a guiche piercing and a prince albert piercing.
Explanations of genital piercings can be found in Appendix D under question 12 of the Qualtrics
screener survey. Star identified as gender fluid and uses they/them pronouns. Star defined gender
fluid as “gender is a spectrum but I feel like I float kinda right in the middle uhm and somedays I
will be a lot more uhm feeling more masculine of center and there are other days where I feel a
lot more feminine of center but I still feel like I’m like I exist very close to the middle of that line
uhm but it does fluctuate back and forth”. Star is in their 20s and resides in the Midwest region
of the United States of America. Their genital piercing is a vertical hood piercing. Participants
were asked to complete a gender dysphoria questionnaire as part of the Qualtrics survey, to see
details on the questionnaire please see the Measures section. One participant endorsed high
levels of appearance congruence and gender identity acceptance. The remaining participants
endorsed moderate levels of appearance congruence and gender identity acceptance. Institutional
approval for the study was obtained from Minnesota State University, Mankato on June 14,
2017.
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Procedure
Measures
The Transgender Congruence Scale (TCS), created by Kozee, Tylka, and Bauerdand (2012), was
used to measure the degree to which participants felt comfortable with their gender identity and
external appearance. The scale measures the degree of comfort on a 5-point likert scale ranging
from 1 Strongly Disagree to 5 Strongly Agree. There are two subscales within this scale, the
Appearance Congruence Subscale and the Gender Identity Acceptance Subscale. To score, all of
the responses were averaged for the total and for each subscale. There are three questions that are
reverse coded. A lower number indicates a lesser degree of appearance congruence and gender
identity acceptance. Kozee, Tylka, and Bauerdand (2012) found that their TCS had high internal
consistency (α = .92). The Appearance Congruence subscale also had high internal consistency
(α = .94). The Gender Identity Acceptance subscale had acceptable internal consistency (α = .77).
Kozee, Tylka, and Bauerdand (2012) also found “The TCS total score and subscale scores were
not associated with social desirability or search for life meaning, supporting the discriminant
validity of the TCS’s scores” (p. 192).
Recruitment
Recruitment was conducted through a professional piercer in Minneapolis, Minnesota and
through Facebook groups for LGBT and piercing communities. The professional piercer
announced the project to other professional piercers through a closed messaging board. She
explained the nature of the project and asked piercers to contact any of their current or former
clients who may be interested in participating. They were provided with a link to a screener
survey, available through Qualtrics. Qualtrics is an online platform for creating and distributing
surveys. Through Facebook, groups created for LGBT and piercing communities were sought
