STUTTGART, Oct 11 — Eighteen audience members at Stuttgart’s state opera required medical attention for severe nausea during a weekend performance that showcased live piercing, unsimulated sexual acts, and a significant amount of both fake and real blood.

The opera’s spokesperson, Sebastian Ebling told The Guardian that eight patrons were treated on Saturday and 10 on Sunday following performances of Sancta, a provocative work by Austrian choreographer Florentina Holzinger.

In three cases, a doctor was summoned for treatment.

Holzinger, 38, is renowned for her boundary-pushing performances that blend dance theatre and vaudeville.

Her all-female cast is known to perform either partially or fully nude, with previous shows incorporating elements such as live sword-swallowing, tattooing, and the use of bodily fluids in art.

"Good technique in dance to me is not just someone who can do a perfect tendu, but also someone who can urinate on cue,” Holzinger stated in an interview with The Guardian earlier this year.

Sancta marks Holzinger’s debut in opera and premiered at the Mecklenburg state theatre in Schwerin in May.

The performance draws inspiration from Paul Hindemith’s controversial 1920s expressionist opera Sancta Susanna, which also faced backlash during its initial release.

This year’s rendition caused discomfort among attendees by replacing the traditional musical elements with a series of audacious visuals, including naked nuns roller-skating on a half-pipe and a lesbian priest conducting mass amid a backdrop of crucified naked bodies.

According to the report, after Holzinger took Sancta to her home city of Vienna in June, it faced condemnation from bishops in Salzburg and Innsbruck, who labelled it a "disrespectful caricature of the holy mass.”

Holzinger has clarified that her opera aims to investigate connections between conservative institutions and kink communities, rather than to mock the church outright.

Ebling urged future attendees to thoroughly review the performance warnings beforehand, which highlight potential triggers such as incense, loud noises, and explicit sexual content.

"If you have questions, speak to the visitor service ... and when in doubt during the performance, it might help to avert your gaze,” he was quoted saying.

Despite reports of audience members needing medical assistance, Holzinger’s Sancta seems unaffected commercially, with all five remaining performances at Stuttgart’s state opera and two shows at Berlin’s Volksbühne in November now sold out.