[12][13][14] While Karen Finley was a student at the San Francisco Art Institute, she became immersed in the Bay Area's punk music scene, witnessing the emergence of the bands The Dils and the Dead Kennedys.

Having received an MFA in 1982 from the San Francisco Art Institute,[17] Finley procured her first NEA grant and moved to New York City.

She quickly became part of the city's art scene, collaborating with artists such as The Kipper Kids (Brian Routh — whom she married/divorced — and Martin von Haselberg) and David Wojnarowicz.

Finley's early recordings featured her ranting provocative monologues over disco beats (and she would often perform her songs late night at Danceteria, where she worked).

These recordings include the singles "Tales of Taboo" from 1986 and "Lick It" from 1988 (both produced by Madonna collaborator Mark Kamins) plus the 1988 album The Truth Is Hard to Swallow.

She was notably one of the NEA Four, four performance artists whose grants from the National Endowment for the Arts were vetoed in 1990 by John Frohnmayer after the process was condemned by Senator Jesse Helms under "decency" issues.

In conjunction with the re-release, both "Tales of Taboo" and "Lick It" appeared on 12-inch again with new remixes by Super DJ Dmitry, Junior Vasquez, and other DJs of note.

She was also featured in Time during this period, though she felt that the magazine misrepresented her by "eroticizing" works (such as one that addressed rape) based on her nudity alone; in other words, that they could not absorb any information beyond her naked body.

In 2009, Finley created a memorial at the concentration camp in Gusen, Austria to commemorate the murder by lethal injection to the heart of 420 Jewish children by the Nazis in February 1945.

In 2012, Finley was a Fellow at Kelly Writers House at the University of Pennsylvania where she introduced a new work, Broken Negative Catch 23, a deeply personal reflection of her performance We Keep Our Victims Ready that had ignited the NEA controversy 23 years before.

This led to Finley reading some of her early AIDS writing at Participant Gallery in the summer of 2013 at a tribute to the late artist Gordon Kurtti.

In 2017, Finley appeared as the lead actor in director Bruce Yonemoto's film, Far East of Eden, which explores institutional and state racism in 1910s California through the lens of racist Senator James Duval Phelan.

Finley's work was influenced by her professors at the San Francisco Art Institute, Linda Montano and Howard Fried and pioneer performance artist Carolee Schneemann.

She was also influenced by jazz artists such as Billie Holiday and the beat poets of San Francisco, such as Gregory Corso and Allen Ginsberg.