More women are discovering the power of tattoos

After a long struggle with infertility and miscarriage, Katie Tonkiss chose to have two small hearts tattooed on the inside of her right wrist. The hearts are more than decorative — they symbolize her bond with the two children she and her husband ultimately adopted. They also represent a way of reclaiming control over her body.

Skip to end of carousel Get Well+Being tips straight to your inbox +Being newsletter , your source of expert advice to help you live well. End of carousel "I felt that this was something I could choose to do after such a long time of having no real choice," says Tonkiss, 40, a senior lecturer in sociology at Aston University in England. "It was an expression of celebrating after a lot of self-blame and frustration."

She is not alone. Today more American women than men have tattoos — 38 percent of women vs. 27 percent of men , according to Pew Research Center. Overall, nearly a third of Americans have at least one tattoo, Pew says, including 56 percent of women ages 18 to 29 and 53 percent ages 30 to 49.

Tattoos' popularity among women reflects changing attitudes about a practice that once was male-dominated. Today, many women are choosing tattoos as important signifiers of empowerment, identity and personal values, experts say. Frequently, they use body art to honor something or someone or to cope with trauma. Women who have escaped human trafficking, for example, often alter or remove their "branding" tattoos as a way of rejecting the past and starting over, according to Our Rescue , a trafficking survivors support organization.

Also, many women just find tattoos fun and a modern fashion statement.

"In my mother's day, the only people who got tattoos were jazz musicians and Navy men, and very few women," says Cindy L. Farley, professor emerita in the nurse-midwifery women's program at Georgetown University's School of Nursing and a researcher who has studied the health effects of tattoos on women.

Tonkiss, moved by her experience, conducted a study of women who, like herself, were forced to navigate the sorrow and disappointment of infertility and found solace and strength through tattoos.

"Tattooing offered a reconciliation with the body after often traumatic fertility treatments and the grief of miscarriage," she says. "Women got the tattoos to create a memorial of the 'journey' through infertility and pregnancy loss, choosing symbols such as compasses and the phoenix rising from the flames to express the sense that they had navigated their path and come through the other side."

An intensely personal choice Cheri Van Hoover , retired adjunct professor of midwifery and women's health at Thomas Jefferson University in Philadelphia, says tattooing has joined the ranks of other beauty practices among women and is often intensely personal.

"Just as women change their bodies in less permanent ways to be beautiful, it's the same with tattoos," she says. "It's a way of expressing individuality and telling their own unique story. Women will tattoo the site of a mastectomy scar, sometimes with flowers and trees — things that represent life and renewal — or they will memorialize children who have died, particularly from suicide. I have seen and spoken with women who have had these types of tattoos."

But experts point out that getting "inked" also can pose certain unique health risks for anyone who is pregnant. In addition to allergic reactions and infections — which also affect men — tattoos sometimes cause problems during pregnancy, childbirth and breastfeeding. And, if regret sets in, they can be difficult and costly to remove.

Not FDA-regulated Tattoos are created by injecting colored inks into the second layer of the skin, known as the dermis, a process that can be mildly uncomfortable to seriously painful. It's usually performed without topical anesthesia.

The dyes are not regulated by the Food and Drug Administration and can be taken off the market only if they cause problems, which usually result from bacteria, contamination or adulteration with other ingredients.

The FDA also does not regulate tattoo parlors, which come under the authority of state and local health departments.

"A tattoo is an open wound that results from applying multiple jabs with a needle," making it susceptible to infection, causing redness, swelling or more serious complications if the infection spreads to the bloodstream, says Farley, who co-wrote a paper with Van Hoover describing the potential harm.

"Reactions can include allergic contact dermatitis to the pigment, and red [dye] is one of the more common offenders," says Adam Friedman, professor and chair of dermatology at George Washington University School of Medicine and Health Sciences. "The areas in the tattoo which contain the pigment will be swollen, scaly and very itchy."

Treatment includes topical and injected steroids, "but it is a temporary fix," Friedman says. "This can be very frustrating and disabling."

Pregnancy and tattoos For this and other reasons, experts urge women to avoid getting a new tattoo or having one removed during pregnancy or while breastfeeding. "There are unknown ingredients in the ink that can be absorbed by the body," Van Hoover says. "A potential allergic reaction or infection might require further treatment, and the medications could affect the fetus."

Pregnancy also alters and stretches the skin, "so there is the potential to change the tattoo through stretch marks, especially if it's on the abdomen, which is going to get bigger," Farley says.

Women should not get a new tattoo while they are breastfeeding; the same holds true for having a tattoo removed, because chemicals might be released into the body during the process, Van Hoover says. "Anything that gets into the mother's bloodstream gets into the breast milk," she says.

Even an old tattoo can cause problems. A lower-back tattoo sometimes makes giving an epidural — injecting numbing medication into the space around the spinal nerves — tricky during labor and birth, Farley says. Passing a needle through skin cells with dyes could be depositing dyes "into a space where they weren't intended to be," she says.

There may be ways around it, however, she says. Among other things, an anesthesiologist could insert the epidural needle through a bare area in the tattoo design or choose a different place along the lower back, she says.

Some women (and men) also decide to get rid of their tattoos, a procedure that can cost nearly $700, according to the American Society of Plastic Surgeons . Because it is considered a cosmetic procedure, insurance won't cover it. Removal methods include laser treatments, chemical peels, dermabrasion and surgical excision and may cause discoloration or scarring.

While Van Hoover has studied and written about the dangers of tattoos, she nevertheless finds them beautiful and does not discourage women from getting them. "I admire tattoo art and respect the personal narrative of what women are expressing on their bodies," she says. "I just hope we can find ways to make it safe as possible."

For Tonkiss, the power of a tattoo was worth any discomfort and future risks, she says. Before getting it, she and her children used to draw little hearts on their wrists to stay connected whenever they were apart. "The tattoo was a way to create a permanent connection through an image that meant something to us," she says.