Smooth talking: the phenomenon of pubic hair removal in women.
Article Type: Report
Subject: Hair (Removal)
Hair (Methods)
Hair (Social aspects)
Hair (Health aspects)
Authors: Riddell, Lenore
Varto, Hannah
Hodgson, Zoe G.
Pub Date: 09/22/2010
Publication: Name: The Canadian Journal of Human Sexuality Publisher: SIECCAN, The Sex Information and Education Council of Canada Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2010 SIECCAN, The Sex Information and Education Council of Canada ISSN: 1188-4517
Issue: Date: Fall, 2010 Source Volume: 19 Source Issue: 3
Topic: Event Code: 290 Public affairs
Geographic: Geographic Scope: Canada Geographic Code: 1CANA Canada
Accession Number: 244025469
Full Text: Abstract: This exploratory, descriptive study investigated the motivations and practices behind the phenomenon of pubic hair removal among women. A final sample of 660 women aged 16-50 years who had ever removed their pubic hair completed surveys asking about their reasons for, methods of, and side effects associated with this practice. Based on their usual practices for areas of hair removal, bikini line was reported by about 50% of participants and whole pubic area by about 30%. Shaving, salon waxing, and trimming with scissors were the most common usual methods although many more reported having ever tried more than one of these or other methods. Appearance in a bathing suit was the most common reason given for pubic hair removal followed by feeling attractive and by the notion that pubic hair removal is cleaner. Side effects ever experienced were common and included razor bump and ingrown hairs but also rash, pimples, and cuts among other less common types of pubic skin traumatization. Further research is proposed to better understand the social constructs of pubic hair removal and to develop best practice guidelines for health professionals in relation to this phenomenon.

Acknowledgements: The authors wish to thank the Women's Health Research Institute for statistical and conceptual support. Dr. Virginia Hayes was also integral to the research process and we wholeheartedly thank her for her help and support. Authors' disclosure statement: No competing financial interests exist.

Introduction

Pubic hair removal has become ubiquitous in mainstream Western society over the past twenty years. Once restricted to the bikini line or reserved for certain cultural and religious groups, it has become the norm for girls and women to remove most or all of their pubic hair. It is now unusual for clinicians in the authors' urban setting to examine any woman under the age of 30 who still has all of her pubic hair. Anecdotally, clinicians report more pubic area rashes, razor burn, wax burns, and generally irritated pubic skin than ever before. Case reports are beginning to appear in the medical literature about more serious consequences of hair removal such as septicemia (Dendle, et al., 2007), second-degree burns (Haque & Al-Ghazall, 2004), contact dermatitis (Quain, Militello, & Crawford, 2007), and bacterial skin infections (Trager, 2006). Debate about hair removal on legs and underarms has been part of the feminist discourse since the 1960s. However, there is a noticeable lack of discussion around pubic hair removal. Concerns about female infantilization, hygiene obsession, and continued social control of the female body have been acknowledged, yet research outlining the practices, complications, and/ or perceived benefits of pubic hair removal has been limited. The main aim of the present study was to further our understanding of the phenomenon of extensive pubic hair removal with a future goal of developing best practice guidelines for health care professionals regarding this practice.

Cultural understanding of pubic hair

Various claims have been made about the evolutionary significance of retention of pubic hair in women. In The Naked Woman, Morris (2004) theorizes that pubic hair could act as a trap for pheromones, serve as a visual sign of reproductive maturity, and/or function as a protective pad during intercourse. While such observations are of interest, evolved traits do not preclude cultural modifications. Pubic hair removal has been endorsed by religions in some cultures but, until recently, the practice has not been the norm in Western society. Widespread acceptance of the bikini in the mid-1960s led to bikini line hair removal although the majority of pubic hair was left untouched. That changed in the mid-1990s. According to popular culture, the removal of pubic hair beyond the bikini line was popularized when seven Brazilian sisters opened a hair salon in New York City in 1994 (Labre, 2002). The "Brazilian," leaving only a small strip of pubic hair or removing all pubic hair, has rapidly become part of the female personal-grooming repertoire.

Articles and images abound in the popular press and internet on various forms of pubic hairlessness. In addition, a burgeoning industry has developed around the practice. Women are offered a variety of methods for the removal of their pubic hair: plucking and tweezing, shaving, waxing, trimming, depilatory creams, electrolysis, and lasers to remove all or portions of their pubic hair. Promoted by consumer capitalism and clever marketing, many women spend a great deal of time and money on removing their pubic hair. Tiggemann and Hodgson (2008) note that "the lack of body hair associated with spurious hygiene is a very sure way to keep women continuously shaving and waxing...and of course buying the necessary products" (p. 895).

Norms of hair removal

Removal of leg and underarm hair has been described as part of the female beauty norm in Westernized women (Basow & Braman, 1998; Tiggemann & Lewis, 2004; Toerien & Wilkinson, 2004). Although the removal of body hair may be seen as less harmful than other methods of altering one's body in order to maintain a societal norm (e.g., plastic surgery or extreme dieting), the message that females must change themselves in order to be accepted is perpetuated. This is emphasized by Basow and Braman's (1998) study on the phenomenon of leg and underarm hair removal in relation to perceived sexual attractiveness. Women in this study felt that hair removal was socially mandated and that to reject this norm was to risk unfavorable evaluation from peers and sexual partners. Men rated women with leg and underarm hair as less attractive, less sociable, less intelligent, and less hygienic. Toerien and Wilkinson (2004) also examined this issue in an in-depth qualitative exploration of the depilation norm among 678 British women. A number of consistent patterns emerged around the meanings and practices of women who remove their body hair, specifically that hairless women were viewed as attractive, feminine, smooth, clean, and tidy. Although these studies provide a snapshot of women's practices and the meanings placed on hair removal, they do not specifically examine practices and outcomes related to the removal of pubic hair.

Existing literature on pubic hair removal

A review of the literature reveals a paucity of articles outlining practices, attitudes, and behaviours related to pubic hair removal. Only two studies (Toerien, Wilkinson, & Choi, 2005; Tiggemann & Hodgson, 2008) examined the issue of pubic hairlessness. In Toerien et al.'s study, women were asked about their pubic hair removal as well as the removal of leg and underarm hair. The majority (85.7%) of female participants reported removal of some or all of their pubic hair primarily by shaving (64%) or home waxing (20%). Significantly fewer women over 51 years of age had ever removed their pubic hair in comparison with women younger than 20 years old. Tiggemann and Hodgson found similar findings in addition to examining the possible effect of the media on women's choice, frequency, and method of pubic hair removal. They reported a relationship between women's frequency of pubic hair removal and the amount of pubic hair removed and their reading of fashion magazines and watching of popular television programs. This study also confirmed the prior finding that although women recognized the social and normative pressures on them to remove pubic hair they were consistently unwilling to identify these influences as a reason for their own personal choice to remove their pubic hair (Tiggemann & Kenyon, 1998; Tiggemann & Lewis, 2004). In addition to the need for further research on the reasons for and practice of public hair removal, we also need more information on women's experience of the side-effects of these procedures which have been reported to include rashes, ingrown hairs, microabrasions, folliculitis, and infections including sexually transmitted infections (STI) (Dendle et al., 2004; Haque & A1Ghazal, 2004; Quain et al., 2007; Trager, 2006).

The present study

Given the lack of research on pubic hair removal, this exploratory, cross-sectional, descriptive study sought to document women's reasons for removing some or all of their public hair, the methods employed, and the side-effects they experienced and attributed to their pubic hair removal practices. Our goals were to stimulate the generation of hypotheses for future research and to identify issues that might be considered in the development of best practice guidelines for health professionals in relation to pubic hair removal.

Methods

Recruitment of participants

Women were invited to participate in a study to "learn about the reasons that women chose to remove some or all of their pubic hair". Inclusion criteria were: living in the catchment area of the Lower Mainland of British Columbia; being aged 16-50 years; and being able to read and write English. The study was described as an information seeking questionnaire about pubic hair removal. Because the description may have been taken to mean that only women who practiced pubic hair removal should apply, the sample cannot be used to infer the percentage of women aged 16-50 Who actually do so. Recruitment took place through the use of posters in public spaces, online networks, and dispersal through clinics and private physician offices. Ethical approval was obtained from the University of British Columbia's Behavioural Research Ethics Board. The consent form described a variety of measures designed to protect their privacy and also stated that they could leave any question blank.

Materials and procedures

Participants completed a two-part questionnaire created by the researchers based on the existing literature (Tiggemann & Lewis, 2004; Toerien & Wilkinson, 2004)and on their clinical experience. The questionnaire was pre-tested and assessed at a Grade 6 literacy level using the Simplified Measure of Gobbledygook (SMOG) readability test. Part A had 12 questions that were either open-ended or answered on a checklist. Questions were designed to elicit pubic hair removal practices and experiences that occurred "ever" and "usually" with an invitation to "check all that apply." The checklist on participants' reasons for removing "some or all of my pubic hair" offered 17 brief statements giving possible reasons for doing so with each item reported on a five point Likert scale that ranged from strongly disagree (1) to strongly agree (5). Part B of the questionnaire gathered demographic information including age, education, and ethnicity. The study took place over a three month period (February 1, 2008 to April 30, 2008). Participants had the option of completing the survey online or on paper and submitting the completed questionnaire online or at drop-off boxes that were emptied weekly.

Data analysis

The data was entered into Statistical Package for the Social Sciences, version 15 for Windows (SPSS 15) and exploratory data analysis and descriptive statistics were performed using SPSS.

Results

Characteristics of the study participants Among the 806 women who completed the survey, 682 met the criteria of living in the Lower Mainland of British Columbia, being aged 16--50, and being able to read and write English. Among these 682 women, 660 (96.8%) had at some time in their life removed some or all of their pubic hair at least once and 22 (3.2%) had never removed any of their pubic hair. As noted above, the study description may have implied that potential participants had done so. This finding cannot be used to infer the actual percentage of women who had not done pubic hair removal. The age range of all participants (removers and nonremovers) was 16 to 50 years (mean 32 years) with no significant difference in age between women who had ever removed their pubic hair (mean age = 32 years) compared to the ages of those that had not (mean age = 36 years; [t.sub.(1,22)]= -2.15, p = 0.43).

This study focuses on the 660 women who had a history of pubic hair removal or were currently removing some or all of their pubic hair. Most of these women were Caucasian (85%), followed by Asian (7%), Indian/ Pakistani (5%), First Nations (2%), and Hispanic (2%) with only one woman who identified as Black. This was also a well educated sample with 90% having at least some college education. Most participants (93%) identified as heterosexual and reported that they were in committed relationships (77%).

[FIGURE 1 OMITTED]

Removal of pubic hair

Each participant was asked at what age she started removing her pubic hair, from where she had ever removed pubic hair, and from where she usually removes her pubic hair. When asked "how old were you when you first removed your pubic hair?" the average age the respondents reported was 18 with a few starting as young as 9 (Fig. 1). Overall 75% reported pubic hair removal by the time they were 20 years old and 96% by 32 years old. One woman reported advent of pubic hair removal at age 39.

Reasons for pubic hair removal

In order to elicit reasons for pubic hair removal, participants were given 17 brief statements reflecting possible answers to the statement "I remove some or all of my pubic hair because...".

Examples include: "It looks better in a bathing suit"; "People would look at me funny if I didn't"; "men prefer women without pubic hair"; "I think it is cleaner"; "It makes me feel attractive"; "It makes oral sex feel better"; and " I like the feeling". Fig. 2 shows the number of women who "strongly agreed" or "agreed" with selected statements that may be taken to reflect their own strongest reason(s) for pubic hair removal.

The most frequently cited reason was "It looks better in a bathing suit" followed by "It makes me feel attractive" (Fig. 2). Liking the feeling and feeling "feminine" and "more comfortable" were similarly rated and at a similar level as for the one hygiene-related reason "I think it is cleaner." Men's preferences ("my partner prefers it" and sexual enhancement ("oral sex feels better" and "it encourages my partner to do it) were similarly ranked although not in the top five among the reasons offered. The least subscribed item in Fig. 2, "It's the thing to do", suggests social pressure as a reason for pubic hair removal for some women as was also the case for "people would look at me funny if I didn't" and "Women are supposed to do it" (not shown).

[FIGURE 2 OMITTED]

Areas of pubic hair removal

In terms of the most common areas of pubic hair removal "ever tried", the bikini line was most common experience (about 74%) with approximately 64% reporting that they had ever removed hair from their whole pubic area (Fig. 3). A sizeable percentage of respondents thus had experience with two or more levels of pubic hair removal. About 45% reported "usually" removing bikini line hair with fewer doing so for the other areas. All of the "usually" responses were lower than "ever". To the extent that "usual" implies current, it appears that many participants had experimented with several options and consolidated to their current practices according to preference although this still included usual use of more than one method in many cases.

[FIGURE 3 OMITTED]

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Methods of hair removal

Among the eight methods of pubic hair removal presented, the ones that predominated among those "ever tried" were shaving (reported by the vast majority), followed by trimming, waxing (home, salon), and creams and plucking (Fig. 4). A similar pattern was shown for "usual" methods but at a lower level than for lifetime experience. A free text box was provided for women to indicate why they chose their usual method(s) of pubic hair removal. In this respect, the majority choice of shaving was considered to be fast, quick, and/or easy.

Side effects associated with method of pubic hair removal

When asked "have you ever experienced any of the following as a result of removing your pubic hair", the most commonly reported side effects were ingrown hairs (81%) and razor bumps (80%) (Fig. 5). Other commonly cited side effects were rashes, pimples, and cuts with bums cited much less often. It should be noted that this survey did not differentiate between shaving with an electric razor or a blade razor. In addition, because respondents cited multiple methods either ever used or usually used, it was not possible to confidently assign frequency of reported side effects to specific methods.

Discussion

The present study was predicated on the understanding that pubic hair removal is now the norm for women in mainstream Western society and that more research should be done to document the social and health implications of this relatively new phenomenon to guide professional practice and public education in this area. The women's reasons for removing their pubic hair, the methods used, the side effects experienced and the social implications of this now common procedure are the focus of the discussion that follows.

Social construct: Body hair and norms of female attractiveness

Femininity is generally considered by feminists as a way of playing out an ideological system where female bodies react and enact gender roles as determined by social mores. Removal of leg and underarm body hair became the female norm between the World Wars and has been attributed to advertising campaigns which focused on equating body hair with poor hygiene and ugliness (Lewis, 1987) and therefore unappealing to the male gaze. Lewis also argues that removal of body hair is equated with being feminine, whereas male body hair is synonymous with masculinity. The fact that bathing suit apparel was the most common reason cited in the current study for removal of pubic hair supports the notion that depilatory practices are influenced, or dictated, by social mores. In discussing pubic hairlessness, Trager (2006)noted that showing pubic hair while wearing a bathing suit is considered an "extreme fashion faux pas" (p. 118). This is illustrated by the recent popular movie, Sex and the City (2008), where one of the female characters is admonished by her female friends for not maintaining removal of her pubic hair. Our finding that "It looks better in a bathing suit" was the most commonly endorsed reason for pubic hair removal, is consistent with this fashion expectation.

The socially constructed view that body hair in women in general is a flaw unfit for public display has been described by feminist analysts as evidence of further objectification of the female body. The link between hair removal and objectification of women was not clearly evident in our Study although some women did identify the influence of the prevailing societal context ("It's the thing to do") as their reason for pubic hair removal. While this was the least-strongly subscribed among the top 11 reasons reported, it does appear to reflect an awareness of social pressure. The observation that women who are aware of normative pressures may not recognize the influence of these pressures on their own actions (Tiggemann & Lewis, 2004; Tiggemann & Hodgson, 2008) thus warrants further exploration as does the link between social rewards and pubic hair removal.

Developmental stages

The development of pubic hair goes through five distinct stages (Tanner stages) with each indicating a stage of sexual maturity. Drawing from his clinical experience as a pediatrician, Trager (2006) noted that younger girls are removing their pubic hair as soon as pubic hair growth starts. Our study supports this finding as some women were as young as nine when they started removing their pubic hair. The removal of some or all pubic hair results in a female pubic area in adult women that has an appearance similar to that of an earlier developmental stage. To the extent that Morris (2004) was correct in suggesting that pubic hair serves as one of the secondary sexual characteristics that signals reproductive maturity, the social trend toward its removal by adult women is of interest.

Social construct: Media influences

The feminist discourse on body acceptance has focused primarily on issues related to body shape, youthful appearance, and the submissive female. Few would disagree that the sexualized female body remains a mainstay of advertising. The fact that this sexualized female is almost uniformly smooth and hairless has received little attention. For example, underarm and leg hair is rarely seen in current mainstream media, advertising, or pornography. Compared to pornography from 20 years ago, current pornography rarely includes pubic hair that has not either been significantly trimmed or removed altogether. The societal shift towards pubic hairlessness may be influenced by the current pornography industry as it complies with demands for more explicit visual images. Further research on this theme is required.

Social construct: Body hair as unclean

A number of women in this sample reported removing their pubic hair "because it is cleaner". This is an interesting finding considering the lack of evidence to support pubic hair being dirty or unhygienic. Lewis (1987), in her discussion on the cultural significance of body hair in men and women, argues that the widespread removal of female body hair for 'cleanliness' is based on a cultural obsession with cleanliness which may relate to achieving the "American Dream" of wealth and success. After all, removal of body hair requires the resources of access to water, products and time. This concept is reinforced by a recent survey (United Press International, 2008) by an American laser company which indicated that American women spent more than $10,000 over a lifetime and greater than 58.4 days in their lives using shaving products in managing unwanted hair. Others, most notably Labre (2002), relate the obsession with cleanliness to a cultural understanding of women's natural fluids as unclean. Despite the lack of evidence that pubic hair is unclean, this belief continues to prevail and is promoted in popular media and by businesses invested in hair removal. Web sites devoted to pubic hair removal reinforce this notion as Nicole Williams (2010)states in her blog Hair Removal Haven: "pubic hair in the pubic region is a hot spot for germs that cause foul odor and skin irritations. Shaving of the pubic hair will greatly reduce the likelihood of these problems". Multi-million dollar companies associated with hair removal continue to emphasize the cleanliness factor with the underlying message being that hair is dirty, and thus, ensure that women continue to need and use their products. Cleanliness, in itself, is a powerful construct and one which imparts a moral duty to perform hygienic measures--in this case--the removal of pubic hair. Research that includes questions about women's perceptions of the cleanliness of their genital area would be beneficial in adding to the scarce academic literature on pubic hair removal.

Social construct/affirmation

Given that over half of our participants indicated that they removed their pubic hair because they liked the feeling or felt attractive, feminine, or more comfortable as a result, it would appear that they viewed these as positive reasons and affirmations of their practice of pubic hair removal. Enhancement of sexual activity was mentioned less often but also appears to be a reason of affirmation. While these reasons do not appear to reflect the previously mentioned unrecognized responses to social pressures and rewards (Tiggemann & Lewis, 2004; Tiggemann & Hodgson, 2008), further research is needed to better understand the inter-relationships among the varied reasons that our participants most strongly endorsed for their own pubic hair removal.

Side effects and health concerns

The percentage of participants who experienced side effects such as razor bumps, in-grown hairs, rashes and cuts is high and worrisome, Several studies on preoperative genital shaving as compared to other methods of hair removal have consistently found increased bacterial infection rates related to shaving (Kovach, 1990; Basevi & Lavender, 2001; Kaptanoglu & Duruk, 2005). Unfortunately, as we only asked about hair removal methods "usually" and "ever" used, and side effects "ever" experienced, we are unable to examine which hair removal methods were associated with specific side effects because respondents frequently selected more than one response to each of the questions. Microabrasions, contact dermatitis, and skin disruption due to methods of pubic hair removal may also increase the potential for the transmission of viruses (including HIV, hepatitis, herpes simplex and human papilloma). This finding of widespread skin irritation has important implications for future clinical studies and policy development. Salons and esthetician services remain largely unregulated in Canada (and elsewhere) and little is known about their hygienic practices, training programs, and the potential for disease transmission. Further investigation is needed to determine the link between particular methods of hair removal and associated side effects. In addition, the relation between pubic hair removal and the acquisition of infection warrants further exploration.

Limitations and future research

How women learn about pubic hair removal practices is unknown and future studies will need to address this question. Our study indicated that the main reason women chose shaving as their preferred hair removal practice was low cost and convenience. Further, little is known about adolescent pubic hair removal practices and this study did not reach that target group despite being available widely online and through paper surveys available in youth clinics. This lack of a youth sample may reflect embarrassment related to the topic or a perceived time management issue. Alternate formats and venues will need to be explored to reach this group.

A major limitation of this study is that the sample was self-selected and few women who did not remove their pubic hair completed the survey. The lack of a comparison group limits broad applicability and may over-represent the prevalence of pubic hair depilation. The average age of the women in this study was 32 which may be reflected in an older average age of onset removal of pubic hair for this sample. A younger sample might well provide a different age of beginning hair removal or differing reasons for doing so. Further, this was a well-educated, predominantly Caucasian sample and information cannot be generalized to other populations. Future research is needed to explore ethnic and contextual differences in experience of and reasons for pubic hair removal in women.

Overall, our findings suggest the need for additional research into the reasons why women remove their pubic hair, as well as how and why they are using particular methods. This may lead to a more thorough understanding of the social constructs of pubic hair removal and to research-based recommendations for methods of hair removal that prevent dermatitis and the spread of infections. This is an important area for further research because pubic hair removal may increase the risk for a variety of dermatological concerns. As health care professionals, further information on pubic hair removal behaviours will enable us to develop best practice guidelines to prevent negative health outcomes.

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Lenore Riddell (1), Hannah Varto (2), and Zoe G. Hodgson (3)

(1) Nurse Practitioner/Senior Practice Leader, BC Women's Hospital and Health Centre, Vancouver, BC

(2) Clinical Practice Leader & Family Nurse Practitioner, Child & Youth Program, Vancouver Coastal Health, Vancouver, BC

(3) Women's Health Research Institute, Provincial Health Services Authority, Vancouver, BC

Correspondence concerning this article should be addressed to Lenore Ridell, 4500 Oak St., Vancouver, BC, Canada, V6H 3N1. Email: lriddell@cw.bc.ca
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