Audience members need medical treatment after sex scenes at the OPERA

Sancta Susanna opera organisers were less than apologetic about the ill-effects experienced by attendees, with a spokesperson saying they understood "what they are letting themselves in for"

More than a dozen opera-goers required medical assistance following a risque performance that depicted explicit lesbian sex, real blood, and naked roller-skating nuns.

Sancta Susanna, a radical feminist opera organised by composer Paul Hindemith, debuted to crowds in Stuttgart, Germany, on October 5, and will run for seven performances until November 3. The polarising one-act opera dates back to 1921, when it first caused a scandal, and over 100 years later, it has been staged for the first time.

Crowds attending the premiere barely managed to scrape through the first performance, however. The opera, which shows a "radical vision of the Holy Mass", lasts just one act, during which performers tell the story of a nun discovering her sexuality. But their method of portrayal left 18 audience members requiring assistance during some particularly shocking scenes.

The Daily Mail reports that they needed assistance after suffering nausea and shock, and in three cases, a doctor had to be called to their aid. Those requiring attention had seen real sex acts, painful stunts, both real and fake blood, the infliction of bodily wounds and piercings - all carried out on stage.

Florentina Holzinger, an extreme performance artist, is behind the adaptation of the controversial opera. This modern performance sees its all-female cast playing nuns who strip off their habits throughout the course of the "sensual, poetic and wild" show. But scenes grow increasingly bizarre, including when an actress with dwarfism dressed as the Pope is raised into the air and spun around by a robotic arm, while another performs Eminem songs dressed as Jesus.

But the opera runners were unapologetic about the ill-effects the audience experienced at the 18-rated show. An opera spokesman told the Mail that those affected by the performance that the people affected were sitting in the front row, and would have known "what they are letting themselves in for".

During the opera, the central character, Susanna, discovers her sexuality, eventually pulling down Jesus' loincloth on the crucifix in a scandalous climate. At one point in the show, the naked nun even has sex with the icon. Other performers are seen hanging out of bells as clappers, with just bare bottoms or heads visible, while one is seen lifting a sword in the shape of a crucifix and pushing it down her throat.

In one exchange, an actress playing Jesus is even depicted spanking a semi-naked nun wearing roller skates. One disturbing scene shows bodies strung up on the wall, in a recreation of Christ on the cross, before vats of fake blood cascade down over them. In relation to the sexual violence shown, the theatre issues explicit trigger warnings, saying some viewers may be left in "discomfort" or even "traumatised" by the performance.

Viktor Schoner, the opera's artistic director, said the performance fulfilled a "central task of art" by "exploring boundaries and crossing them with pleasure". The State Opera website echoes the director's comments, stating that the "natural nudity" in Sancta Susanna is "a very central means of expression".

The site states: "Of course, theater and opera merely imitate reality: when people love, suffer and die on the opera stage, it is all just an act. Things have been different for decades in performance art: here the person performing does not embody a character, here the body itself is the medium - and in Florentina Holzinger's work in particular, natural nudity is a very central means of expression."