Introduction. Body piercing and tattooing are accepted by a growing number of teenagers and young adults as a way of self‐expressing. Some authors suggest association between body piercings/tattoos and early sexual initiation, higher number of sexual partners, or risky sexual behaviors.

Aim. The aim of the study was to evaluate sexual behaviors among young adults with body modifications (BMs)—tattoos and piercings.

Methods. One hundred twenty young healthy adults, ages between 20 and 35, were included in the population study. The study group was divided into three subgroups: controls (N = 60), adults with tattoos (N = 28), and adults with piercings (N = 32). The research instrument was a self‐prepared questionnaire containing 59 questions assessing socioepidemiological parameters, sexual behaviors, incidents of sexual harassment in the past, and self‐attractiveness evaluation, as well as questions concerning tattoos and piercings. Socioepidemiological variables and sexual behaviors were compared between subgroups.

Main Outcome Measures. To assess and describe the correlation between having BM—tattoos and piercings—and sexual behaviors in the population of young adults by using the logistic regression model.

Results. Adults with BMs have had their first intercourse statistically earlier and were more sexually active compared with controls. There were no statically significant differences in sexual orientation, sexual preferences, engaging in risky sexual behaviors, frequency of masturbation, and history of sexual abuse between the groups. In contrast, the frequency of sexual intercourses was statistically higher and oral sex was more likely to be a dominant sexual activity in adults with BM compared with controls. The multivariate logistic model revealed that adults with BM were four times less likely to participate in religious practices and twice more likely to have early sexual initiation.

Conclusions. Having BM is associated with early sexual initiation and more liberal attitudes toward sexual behaviors but not with engaging in risky sexual behaviors. Nowosielski K, Sipiński A, Kuczerawy I, Kozłowska‐Rup D, and Skrzypulec‐Plinta V. Tattoos, piercing, and sexual behaviors in young adults. J Sex Med 2012;9:2307–2314.