Winnie Kao (aka "Buffy"): “I went to this place in Lemon Grove that pierced all my friends’ belly buttons and one of my friend’s eyebrows, this place where they don’t check I.D.s.”

It’s karaoke night at Hennessey’s Tavern in Pacific Beach, and Erin Grimmer is feeding ice cubes to her pet plant. The plant is named Phyl, short for prophylactic, since they found him next to the condoms in Kmart. Phyl has wide black packing tape adhered around the circumference of his plastic pot because, Erin explains, Phyl is gothic. At the other end of the table, Marie Marandola argues with Nina Cibil over who gets to dress up as which Rocky Horror Picture Show character for the “dyke march” in Hillcrest.

More than 60,000 piercings have taken place in Dr. Jefe's tiny whitewashed room.

All three girls have their tongues pierced, though their quiet, aqua-haired companion does not. All three cite the same simple reason for their piercing: it was something fun to do. In the midst of speculating about whether to seat herself on the lap of a stranger at the next table and tell him she likes White Russians, Erin pauses to elaborate on her tongue- piercing decision. “It was kind of a spur-of-the-moment thing,” she says.

Cynthia. Sean, who would later become Cynthia's husband, told her that the metal jewelry in her nipples, tongue, and ears were “sharp edges” that he couldn’t quite accept.

“Part of it was a way of keeping people at a distance,” she says, “and it worked. It’s not often you walk up to someone with a mohawk and strike up a conversation.” The people who were attracted by her piercings, she says, were much like her, “a little more artistic, more independent, more willing to go a little edgy, a little more permanent with their fashion.”

You can always change your mind about a tongue piercing. Once the jewelry is removed, the hole closes up in 48 hours.

Seventeen-year-old Winnie Kao goes by the name Buffy. Her appearance is quintessentially punk rock: in the middle of summer, she sucks on a cigarette in front of Pannikin wearing black tennis shoes and a long-sleeved black dress with a ladder of safety pins near the hem. Her crop of shiny Taiwanese hair frames a pretty face heavily painted with makeup brushes, in the context of which her tongue piercing seems incidental.

“I went to this place in Lemon Grove that pierced all my friends’ belly buttons and one of my friend’s eyebrows, this place where they don’t check I.D.s,” she said. “The guy at the counter was, like, ‘So, are you 18?’ I’m, like, ‘No…’ He’s, like, ‘Do you have a brother or sister who could fake a signature?’ I’m, like, ‘Nope.’ He’s, like, ‘Okay…’ I was, like, ‘Well, will they still do it?’ He’s, like, ‘I don’t know. You’ll have to talk to them.’ Because he wasn’t a piercer, he was just a tattoo artist. So the piercer, she was a girl, actually, and she came in and she was, like, ‘So! What do you need?’ And I was, like, ‘Um, I want to get my tongue pierced.’ She’s, like, ‘Okay, let’s go.’ I’m, like, ‘Good deal.’ ”

Native tribes in the American Northwest have practiced tongue piercing since before European explorers set foot here, but only in the last five years has it become common in the broader population. Ten years ago, fewer than 5 piercing shops existed in San Diego. Now there are 63. While there have been no national surveys on body piercing, a study of students at a college in rural New York found that 12 percent of female respondents had tongue bars.

Tongue piercing’s burgeoning popularity has led to a great deal of scrutiny: state governments crafting regulatory legislation, dental and medical associations publishing articles and fact sheets about metal jewelry’s toll on teeth and gums, school nurses and counselors harping on its psychological implications for young people. Those who wear tongue bars tend to think they’re not worth all the analysis.

Jeff Fagan is one such person. In 1994 Jeff (better known as Dr. Jefe) opened Dr. Jefe’s Body Piercing in Ocean Beach. Since then, more than 60,000 piercings have taken place in his tiny whitewashed room in the back that, with its rows of cabinets and clusters of yellow bottles, looks distinctly like a doctor’s office.

Dr. Jefe is all for regulation of the piercing industry. He’s skeptical about people who probe too deeply for the emotional roots of tongue piercing — people like me, who look eagerly for answers where there may not be anything complicated to explain. A hefty man in his mid-30s, Dr. Jefe’s own piercings (in his tongue, nose, eyebrow, upper ear, and earlobes, which stretch to encompass a ring 5/8˝ in diameter) complement the gritty residue of a Philadelphia accent.

“People look way, way too far into tongue piercing and try to analyze it way too much,” he says somewhat defensively. “In some ways it’s a visual aspect. Why are you wearing your necklace?” he asks, gesturing at the carved jade around my neck. “Because it’s pretty, it’s adorning your body. Jewelry in the tongue is the same thing. You don’t need it, but you have it because it’s fun. You don’t need a sports car either.”

Dr. Jefe is not alone is his nonchalance about the matter. Marie got her tongue pierced at a mutilation party on Erin’s 18th birthday, at which the entertainment was a caravan down to Pacific Beach to get piercings and tattoos. Like Erin and Marie, almost one-third of respondents in a study of body art among college students said they took only a few minutes to decide on their piercing.

“I just woke up one day and was, like, ‘You know what? Screw it. I’m going down there. I’m getting it pierced.’ And I just went,” Buffy recalled gleefully.

Reckless as this may seem, Dr. Jefe is quick to point out that you can always change your mind about a tongue piercing. Once the jewelry is removed, the hole closes up in 48 hours. The knowledge that the procedure is not a lifetime commitment goes a long way toward explaining why many are so casual about it.

“I took it out for one day, and then I was, like, ‘No, wait, I did spend $60 and a lot of pain on that, Marie says. “So I kind of punched it back through.”

The tongue’s self-healing capabilities have an interesting consequence. For almost everyone, a tongue piercing is temporary, like a hip winter coat that’s worn for a few seasons and then discarded.

“I always knew I would take it out before college,” Buffy says. “First of all, it closes right away. But also, it’s like, ‘You’re over your teen phase, get over it.’ ”

Growing out of a piercing isn’t something that happens only to teenagers. Cynthia Raymond is the kind of hairdresser who shifts easily from role to role, one minute therapist, the next a mother, entertainer, confidante. With the same warmth and thought that she shows her clients, Cynthia approaches the subject of her piercings.

“We don’t really have ritual in our lives anymore,” she said, leaning forward to make herself heard over the whir of midday traffic. “I think this is the creation of a new kind of ritual.” Dropping her voice a notch, Cynthia explains that she had her nipples pierced soon after a long-term boyfriend broke up with her.

“You would think that a piercing would hurt a lot, but I was in so much pain that it didn’t. I drove myself home,” she said, incredulous at her own numbness. “There are so many reasons that we inflict pain on ourselves. Is it to make us feel like we’re alive? To make us feel like we’re human? Is it because we dislike ourselves?”

At 38, the words of another boyfriend made Cynthia realize that her tongue bar — and her other piercings — no longer made sense. Sean, who would later become her husband, told her that the metal jewelry in her nipples, tongue, and ears were “sharp edges” that he couldn’t quite accept in the context of her feminine body.

“I took out all my jewelry because of that conversation with Sean,” Cynthia says, unfolding her hands on the table. “When I took my clothes off, I had armor here, here…” (touching her chest and face). “He said it didn’t mesh for him, that it was a dichotomy. The conversation was one of those things that — it just brought me to tears, because I just hadn’t even thought about that.”

Lawrence Friedman, a professor of pediatrics at UCSD and chief of the division of pediatric and adolescent medicine, sees children and teenagers in his office once a week. A Georgetown University graduate originally from Connecticut, Dr. Friedman has his own views on why people are drawn to tongue piercing.

“Every generation needs to feel an identity with itself, so that there are trends in music and fashion that come and go. I grew up in the late ’60s and ’70s and had long hair, wore bell-bottoms, listened to the Stones, et cetera. The children of people who are currently tattooed and pierced are going to look for a different way to make themselves stand out from the generation that preceded them [their parents],” Dr. Friedman wrote in an e-mail interview.

Though perhaps a broad-brush generalization, there is a healthy dose of validity in his analysis. A study of tattooing and body piercing among college students found that nearly two-thirds of those with piercings agreed with the statement “To be myself, I don’t have to please or impress anyone else.” For many survey respondents, no doubt the “anyone else” refers to members of the older generation.

Buffy Kao vehemently denies that getting her tongue pierced had anything to do with defying her Chinese parents, who had told her that they would take away her car if she went through with it. Despite this, Buffy is eager to convince me of her complete freedom. In a low-pitched voice that seems intentionally unaffected, Buffy states one of her philosophies as matter-of-factly as she can. “If you want to be friends with me,” she says, cocking her pretty head to one side, “you either put up with my crap or you leave, because I am not about to go and adjust myself for every human being.”

Watching her proudly light a cigarette, I get the feeling that this hearty “fuck you” to the world is directed not just at her parents but at the teenage mainstream. She doesn’t like to admit it, but Buffy says that the glamour side of having a metal bar through her tongue — its associations with counterculture youth and rebellion — is something she has come to enjoy.

Cynthia echoes this sentiment. “Part of the reason I wanted it was that it was kind of a secret club. You know, I didn’t know very many adults, very many 34-year-olds, that were doing that.”

Lisa and Dave Carlson, a married couple living in Pacific Beach who had their tongues pierced together four years ago, also said that being “different or alternative” was a piece of the attraction. They wanted me to know that they wouldn’t have removed their piercings just because they were having children, that they wouldn’t have cared what other parents thought.

And while only 21 percent of those involved in the study of college students’ and body art said they got their piercing “to be different,” half cited self-expression as their motivation. The line between them is thin.

In her sunny back yard in Pacific Beach, Lisa tips back her white plastic chair and hesitates uncomfortably. “You know what it was?” she begins, trying to explain why she and Dave had their tongues pierced. “It seemed sexual to me. That’s what the appeal was.”

“Now we’re getting somewhere,” says Dave. He seems relieved to be through with our stilted conversation about the other, clearly lesser reasons they got their tongues pierced, relieved to have broached the subject that Dr. Jefe refers to as “that sex thing.”

Lisa and Dave are the kind of gentle neo-hippies who drink soy milk and hang tie-dyed clothes in front of their windows. After expressing their concern for an injured wasp that had appeared on the table, Lisa and Dave speak candidly about their disappointing sexual adventures with tongue bars.

“You hear people whisper about it… ‘Oh, tongue rings, they’re good for fellatio’ or…you know, oral sex or whatever. So in the back of your mind you’re, like, wow, hey, how do you find out if it’s true? So that was part of what drew me in,” Dave says.

“It turned out not to be true — at all,” Lisa offers, shaking her head. Dave elaborates.

“Yeah! It just kind of hurt, you know, because it’s just a metal ball and there’s no sensation in the ball, so you don’t know what’s too hard or…”

“That’s enough,” Lisa says, laughing.

Others didn’t have much more luck.

“My boyfriend, who actually did the piercing, thought it would make everything a lot better,” Cynthia says. “It didn’t really work out. After a while, he named my barbell the Black and Decker Pecker Wrecker.”

Grinning mischievously, Erin says that a guy she knew said “it hurt when I wore the bar with the dice on one side instead of the ball.”

When I tell these stories to Dr. Jefe, he is surprised. Why would tongue piercing have become such an erotic symbol, he wondered, if there weren’t actually any pleasurable results? He offers possible explanation.

“Now, I tell people straight out, if you don’t know what you’re doing, this isn’t going to help you. But also, it’s not about fixing what’s not broken, it’s just about adding something a little extra, you know. Female tongue piercings look good, they look sexy, but they’re not all that functional, because the size of the ball versus the male genital part is nothing,” he explains in an authoritative tone.

A girl named Lauren (who didn’t give me her last name because her place of employment doesn’t allow tongue bars) lets me watch her get her tongue pierced. Seeing her sweat as Dr. Jefe grabs her tongue with tongs, and listening to her throw up in the bathroom afterwards, made tongue piercing seem like a long way to go to look sexy. But in the context of other things we do to be attractive, I realized, tongue piercing is not all that extreme, when done correctly. It’s less permanent than plastic surgery, medically safer than a corset, and cheaper than good cologne.

The problems occur when it’s not done correctly. The tongue isn’t just cartilage, it’s a muscle; and performing a safe piercing is more complicated than just keeping the needle sterile. A tongue bar has to be placed just right to avoid damage: centered between the arteries, in front of the frenulum. While this knowledge alone can be gained by reading an anatomy book, learning how to locate that spot on an actual person takes practice and training.

That’s why Dr. Jefe and others are so concerned about lack of regulation in the industry. In 1998 the State of California passed a law requiring body-piercers to register with their respective county health departments. The law also asked a statewide health organization, the California Conference of Local Health Officers (CCLHO), to establish registration requirements or conditions that an individual would have to meet in order to begin a body-piercing practice. The CCLHO has since decided on those conditions, and one of them is that an applicant must “provide proof of successful completion of an approved health and safety class” and that the applicant “must demonstrate by examination, knowledge of basic…body piercing techniques, health and safety precautions, sanitation and sterilization techniques.”

The County of San Diego Department of Environmental Health, however, has not yet implemented these standards, which means that it is legal to start a body-piercing business with nothing more than a needle, a cash register, and a business license. According to Liz Quaranta, chief of the food and housing division (which issues permits for tattoo parlors), the department is currently working on enforcement of the registration requirements.

The implications of this laxness are unclear. On one hand, body piercing is partly a self-regulating industry. People decide where to get pierced according to where their friends tell them to go, so in theory, a business with a malpractice problem would be shut down by word of mouth. Additionally, tongue piercing isn’t brain surgery, and the frequency of complications is relatively low.

“If you weigh relative health risks and the potential consequences, I’d probably be in favor of greater enforcement of things like cigarette purchases, seat belt use, helmet use, rather than piercing. I’ve probably seen dozens of kids with pierced tongues and actually haven’t seen any complications,” Dr. Friedman says.

On the other hand, some of the health risks associated with tongue piercing aren’t immediately apparent to those who suffer from them. Unlike infection, which manifests itself in the days and weeks after the piercing, tooth chipping and gum-tissue damage occur over a number of years. Most people wouldn’t blame their piercer for a tooth they damaged three years after the initial piercing, even though good practice could potentially thwart such damage.

“I know people who come in, watch me do a piercing, and then go out and start doing it themselves, because they’ve seen how it’s done. What they’re not seeing is the thought process that goes behind it. These people have no clue about how to judge the size of someone’s mouth, the thickness of the tongue. So to be nice and safe they put a nice, long barbell on everybody’s mouth, and then they bite on it and end up breaking a tooth,” he says.

Dr. Jefe is right about the dangers of long barbells. A study published in the Journal of Periodontology found that nearly half of the people wearing tongue bars for over four years cracked or chipped their molars and that “barbell stem length appears to differentially affect prevalence of recession and chipping.”

Without even knowing these statistics, the threat of breaking a tooth was enough to make Dave remove his barbell. “After biting into it a few times and making my head ring, I realized I was going to break a tooth, and I thought, ‘How worth it is this…’ How worth it is anything if you’re taking away from your body?”

In many areas of Africa and the Middle East, body piercing is a manifestation of oppression. Women are branded and mutilated as signs of their inferiority, as reminders of their powerlessness. Here, however, piercing has become an expression of freedom: it’s not just that people can do it, they do it because they can.

At Synbad’s on Garnet Avenue, a pretty waitress with a cropped shirt and low-riding denim miniskirt pours hot coals into our hookah. When she’s finished, Marie proudly relates the story of her piercing’s relationship with her former employer.

“The whole time I was working at Denny’s I just kind of kept my tongue in my mouth, so no one really saw it. When I went to eat there last week, my old boss was, like, ‘When did you get that?’ I was, like, ‘I’ve had it the whole time!’ ” Triumphantly, Marie blew a plume of peach smoke into the air and rolled her tongue bar across her lips at our waitress, who pushed her tattooed hips toward us and smiled.