Tattooing still flourished at the end of the nineteenth century on Ponapé, one of the Caroline Islands, despite most of the islanders converting to Christianity. Parents tattooed their children in secret, against the will of the missionaries. The style was unique to the Carolines. Especially the women were beautifully decorated from the waist, over the thighs and buttocks to the genitals. The tattoos were purely decorative and not all girls dared undergo such a radical procedure, especially regarding the genitalia. This tattoo comprised a rectangular panels surrounding the genitals. To alleviate the pain, the tattooist treated the wounds with disinfectant plant sap. After the wounds healed and the scabs had fallen off, the girls would apply coconut oil to the tattoos for several weeks.

Beneath the kariut, the traditional leaf skirt, it was customary for the vulva to be tattooed blue. As soon as a girl displayed interest in boys, the mons pubis and the outside of the labia majora were tattooed blue. Girls feared rejection if a boy looked under their skirt and saw no tattoo, and only after being tattooed could they consider themselves complete women.