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ABSTRACT & COMMENTARY
By Rebecca H. Allen, MD, MPH
Assistant Professor, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
Dr. Allen reports no financial relationships relevant to this field of study.
SYNOPSIS: In this cross-sectional survey of 333 women, the majority reported current pubic hair removal (87%), and two-thirds reported removing all their pubic hair. Most women (60%) had experienced at least one complication because of the removal, the most common complications being epidermal abrasions and ingrown hairs.
SOURCE: DeMaria AL, et al. Complications related to pubic hair removal. Am J Obstet Gynecol 2014;210:528.e1-5.
The authors surveyed women from two publicly funded reproductive health clinics at the University of Texas Medical Branch between April 2012 and June 2012 regarding pubic hair removal and sexual health. Women were approached for the study if they were between age 16 and 40 years. The 30-minute survey was available in both English and Spanish and addressed the degree and frequency of pubic hair removal and complications experienced. Women were excluded from the analysis (n = 33) if they had never removed their pubic hair, did not indicate how much pubic hair they removed, did not select a race/ethnicity category, or had missing body mass index data. In addition, 79 women who were approached declined to participate (17.6%), but they were no different in age or race/ethnicity from the participants.
In total, the responses of 333 women were analyzed. The mean age of participants was 24.7 years (SD 5.5) and 45% were Hispanic, 25% black, and 30% white. The majority (87%) were current hair removers. Two-thirds of the sample removed all their pubic hair while one-third partially removed hair. The most common methods used to remove hair were razor blade (89.5%), depilatory cream/foam (16%), electric razor (15%), trim (11.8%), wax (7.2%), laser (0.6%), and pluck (0.9%). Of the 194 women (59.5%) who had ever experienced a complication as a result of removing their pubic hair, 120 (37%) experienced an epidermal abrasion, 107 (33%) ingrown hairs, 69 (21%) severe itching, 60 (18%) cuts, 43 (13%) rash, 16 (5%) infection, 7 (2%) allergy, and 4 (1%) burns. There was no difference in the complications reported between total hair removers and partial hair removers. Only 4% of women had ever sought health care for a complication due to hair removal and only 4% reported discussing safe hair removal practices with a health care provider. Overweight/obese women were almost twice as likely to report experiencing complications than those women who were under/normal weight (odds ratio, 1.96; 95% confidence interval, 1.16-3.30).
It will not be a surprise to any practicing obstetrician-gynecologist that female pubic hair removal, including total hair removal, is a current trend in society. This practice is generally more common among adolescents and young women,1 and, as this study shows, crosses racial and ethnic lines. Societal views of what is attractive have changed in the past decades as evidenced by media depictions of highly desirable women (e.g., Playboy magazine centerfolds, pornography).2 Many adolescent and young women have internalized these views and now feel that complete and total removal of pubic hair is necessary to be sexually attractive. Pediatric gynecologists find that girls are removing pubic hair as soon as they begin to develop it, making Tanner staging difficult.3 Women report multiple reasons for removing their pubic hair including partner preference, increasing their own femininity and attractiveness, and to feel clean and sexy.3 One study reported that pubic hair removal was associated with younger age, a greater interest in sex, finger stimulation to the vagina and clitoris, and having a casual sex partner.4
This study found that shaving with a razor is the most frequently used method of pubic hair removal. This is likely because it is affordable, accessible, and familiar to women from shaving their legs and underarms. The fact that epidermal abrasions and ingrown hairs were the most common complications also aligns with shaving as the most popular method. The authors hypothesized that overweight/obese women may have a higher rate of complications because they have more difficulty viewing the area that needs shaving. Based on the patients that I see in my office, I anticipated that this study would find a higher rate of complications due to hair removal and that more women would have sought medical care for complications. In the past decade, there have been increasing numbers of emergency department visits for genitourinary injuries related to grooming such as cuts from shaving, but also lacerations and burns from wax.4 In addition, case reports of severe complications from shaving and waxing among women with diabetes, such as necrotizing fasciitis and sepsis, have been published.5
Nevertheless, total pubic hair removal is here to stay in our culture and, therefore, the question is how do we help our patients remove pubic hair safely? Certainly gynecologists are well-positioned to provide advice and manage complications in this area. Complications from pubic hair removal can include razor burn, mechanical folliculitis (ingrown hairs), infectious folliculitis (Staphylococcus aureus, Streptococcus pyogenes), spread of infection (human papilloma virus, molluscum contagiosum, herpes simplex virus), and contact dermatitis.3 Diabetic and HIV-positive women should be warned regarding the risks of hair removal. Appropriate counseling for our patients regarding pubic hair removal can include the following3:
- Trim pubic hair first.
- Soak in warm bath beforehand.
- Use shaving cream/gel, never dry shave.
- Use a fresh blade for each session.
- Shave in the direction of the hair.
- Stretch the skin slightly to reach difficult areas; do not overstretch the skin.
- Consider using aftershave lotion specific for the pubic area (after first testing for contact dermatitis on the arm).
- For irritation and ingrown hairs, consider topical mild hydrocortisone cream (e.g., desonide 0.05% lotion) and topical antibiotic (clindamycin 1% lotion).
- Go as long as you can between shavings to reduce irritation.
- Wear cotton underwear and avoid tight-fitting clothing.
- Generally not advised in the pubic area due to risk of irritation and contact dermatitis.
- If used, only apply products designed for pubic area.
- Only apply on bikini area (area outside underwear).
- Never leave the cream on longer than recommended.
- Make sure wax is not too hot.
- Be sure to use hygienic salons where staff wash their hands and wear gloves.