Strong symptoms of nausea were reported by 18 theatergoers who rushed to see the first two performances of the blasphemous opera Sancta at the State Opera in Stuttgart this past weekend.

The controversial production, created by choreographer and director Florentina Holzinger, features live sex, piercing, and large quantities of both fake and real blood. It seems that a segment of the audience who came to enjoy the performance was caught…unprepared.

“On Saturday, we had eight people, and on Sunday, 10 people who needed care from our staff,” said opera spokesperson Sebastian Embling, according to the Guardian. In three cases, the symptoms of nausea experienced by the spectators were so severe that a doctor had to be called to ensure that no more serious problems would arise.

Holzinger is known for her unconventional performances that blend elements of dance theater and variety shows, typically featuring a female cast performing partially or fully nude. In the past, the 38-year-old choreographer has presented shocking scenes on stage, including live sword swallowing, tattooing, masturbation, and “action painting” with blood and fresh feces.

“Good technique in dance for me doesn’t just mean someone can do a perfect tendu (a ballet movement) but also that they can urinate on command,” Holzinger stated earlier this year in an interview with the Guardian.

The Sancta performance, with which Holzinger is trying her hand at the opera genre for the first time, premiered at the State Theater of Mecklenburg last May. It is based on the “expressionist” opera Sancta Susanna, composed in 1921 by German musician Paul Hindemith, an early work that scandalized the audience of its time as it was considered extremely blasphemous.

Hindemith’s original opera tells the story of a young nun who experiences intense internal conflict as repressed sexual desires awaken within her while she prays before the statue of the Crucified Christ. Although it was initially supposed to premiere at the Stuttgart State Opera in 1921, it was first presented to the public in 1922 due to protests that erupted over its sacrilegious content.

The version presented this year in Stuttgart, provoking extreme reactions from the audience and a scandal in the international press, features naked nuns roller-skating on a pipe in the center of the stage, a wall with crucified naked bodies, and a lesbian priest.

Holzinger had presented the Sancta opera last June in her hometown, Vienna, infuriating Austrian bishops from Salzburg and Innsbruck, who described the performance as a “disrespectful caricature of the divine liturgy.”

The Austrian artist, for her part, has explained that the aim of her opera is not to mock the church but to explore the parallels between the conservative institution and BDSM communities and other sexual subcultures.

Reports of severe symptoms of nausea and shock among the audience, however, do not seem to have caused commercial damage to Sancta, as tickets have sold out not only for the remaining five performances in Stuttgart but also for those in a Berlin theater where the work will be presented in November.