As someone who has had his PA to 4ga, lemme inform you of this. The initial piercing isn't through much tissue, just a thin membrane on the bottom. Infections aren't a problem, they are cleaned 'naturally' daily. When the piercing loosens a little and you go up in gauge it isn't bad if you just go up 1 size. The long term effects some people have, and I think started to happen to me is when the hole gets larger which way does it travel? I felt like mine was traveling to 'join' the existing hole, so I removed it. Three years later, I still have to hold my finger over the F&*^$ing hole!!!!
Some girls loved it, others not so much. Decide how YOU feel about it, you have to live with it.