Wax On, Wax Off: Pubic Hair Grooming and Potential Complications

Abstract

Pubichairgrooming isbecomingan increasinglycommonpracticeamong women of all societies and demographic groups. In the United States, womenaremore likely togroomfor reasons that are sexuallydrivenand aremore likely to stopgroomingwhen lacking a current sexual partner. Further, pubic hair removal is significantly associated with a greater interest in sex and having a casual sex partner. Waxing is apopularepilation technique forpubichair removal,which involves applying hot wax to an area of skin that is then covered with muslin. The muslin is quickly removed, extracting the wax and unwanted hairs from the pubic area. Although relatively safe, waxing can cause microtrauma to the skin and its underlying structures with reported complications that include folliculitis, local spread of infection, burns, and syringoma development. Waxing-inducedfolliculitisofthepubicarea isacommoncomplication, usually secondary to infectionwithStaphylococcusaureus,Streptococcus pyogenes, orPseudomonasaeruginosa. The sourceof infectionmaybe normalskin flora,autoinoculation,contaminationofwaxingtools,orcolonizationof the individualperformingtheprocedure.Other infectionscan occur, andone reportdescribedawomanwithpoorly controlled insulindependent diabetesmellituswhodevelopedherpes simplex virus reactivationandsubsequentgroupAstreptococcustoxicshocksyndromefollowinga“Brazilian”bikiniwax.Anotherreportdescribedthedevelopment ofsyringomas in thegroin regionofa31-year-oldman,whichwasthought to be an inflammatory, hyperplastic response to repetitivewaxing. Pubichairwaxingcanalsocauseburns,withmostbeingsuperficialorpartialthicknessburns.Severeburnsrequiringdebridementandsplit skingrafting have been described following the use of self–waxing kits. Waxingcausesdeficits in themucocutaneousbarrier thatmaybesufficient for viral entry and transmission, potentially increasing the risk of acquiring sexually transmitted infections (STIs). One study demonstrated a correlation between sexually transmitted molluscum contagiosumand theuseof pubic hair removal practices. Still, there is a paucityofdataregardingtransmissionofotherviralagents, likelycomplicated bytheasymptomaticgenital sheddingofherpessimplexvirusesand long latency periods of human papillomaviruses. Becauseof itspopularity, healthpractitioners shouldbeawareof the potential dermatologic and systemic complications associatedwithpubic hairwaxing.While it has been shown that pubic hairwaxing directly correlates with increased sexual prevalence, more studies are necessary to further elucidate the risk of STI transmission after waxing. Individualswhowax their pubic hair shouldbe informedof this possible risk and perhaps be advised to abstain from sexual activity for a certain period of time after waxing.