Ever since I started writing this blog’s monthly STD Awareness column, I’ve kept my eye out for news related to sexually transmitted diseases. And, while some might find my enthusiasm for STD-related items to be slightly odd, I have been intrigued by what has been splashed across headlines so far this year.
First, in January, the claim surfaced that pubic lice (colloquially known as crabs) are being driven to extinction as their natural habitat is felled by razors and waxes. Then, just last month, a little-known STD called molluscum contagiosum got its 15 minutes when it was associated with the increased popularity of hairless pubic regions.
Some say hair removal is causing a decline of pubic lice; others say it increases virus risk. So what’s the deal?
These headlines might raise some questions: Does waxing or shaving my pubic area decrease my risk of crabs, but increase my risk of molluscum contagiosum? Should I shave or not? The answers to these questions aren’t quite as simple as the headlines make them out to be. Let’s take them one by one.
Does Waxing Prevent Pubic Lice Infestations?
The claim: As reported in the media, pubic lice are disappearing, and the Brazilian wax is the culprit. Articles cite statistics that pubic-hair removal is more popular among young people, and then jump to the conclusion that this trendy hairlessness is spurring a decrease in pubic-lice prevalence.
What the science says: The problem with this claim is that it isn’t backed by solid scientific data — it’s supported by anecdotes from doctors who have noticed a decline in pubic lice among their patients. As the saying goes, though, the plural of anecdote is not data: Without well-designed population studies spanning many years, we can’t actually know if there are fewer pubic lice today than there were before our groins were subjected en masse to depilation techniques. Furthermore, as that other saying goes, correlation does not equal causation: Even if there were a correlation between the Brazilian’s popularity and a decline in public lice, we would need more specialized data to determine if pubic-hair removal actually caused the lowly louse’s depopulation.
One study, which appeared in a reputable medical journal and is often trotted out as evidence that hair removal is driving the pubic louse into extinction, was actually just a letter to the editor. The authors noted a reduction in public-lice infestations among patients at their clinic in Leeds, England, which correlated with the Brazilian’s rise in popularity in the United Kingdom. However, they didn’t collect any data about their patients’ hair-removal practices — they merely assume that waxing rates are higher because everyone says they’re higher. Not too scientific!
It would be interesting to know if pubic-lice infestations have been decreasing. However, pubic lice isn’t a reportable disease — while they are unpleasant, infestations don’t constitute the kind of public-health concern that demands detailed data collection. Major health organizations, such as the Centers for Disease Control and Prevention (CDC) and the World Heath Organization, don’t collect information on incidence, so we are hearing anecdotes from doctors, not hard data. Additionally, because pubic lice can be identified by a savvy layperson (perhaps with the aid of a magnifying glass) and eliminated with nonprescription medications, infestations could easily fly under the radar.
However, can shaving or waxing one’s pubic hair treat an existing pubic-lice infestation? It might seem plausible, but the CDC, Planned Parenthood, and other health authorities don’t recommend it. Pubic lice (and their eggs) are treated with a topical medication, and it might be necessary to apply it from neck to toe. Although pubic lice are specialized to survive in the pubic region, they can live elsewhere on the body.
Take-home message: The idea that pubic-hair removal is driving the extinction of crabs is, for now, simply a hypothesis. Although it seems plausible, without more rigorous study we can’t know whether or not this species is in decline, and if that decline is due to increasingly bare nether regions.
Does Shaving Increase Risk for Molluscum Contagiosum?
The claim: The recent surge in body-hair removal has opened up new territory for the sexually transmitted virus molluscum contagiosum (MCV), which causes wartlike growths. The trauma caused by waxing and shaving, even if only on a microscopic level, can give virus particles more entryways into the skin than would be provided by an unshaven, intact epidermis. Furthermore, shaving might make an existing MCV infection worse, as razors can drag virus particles over the skin, depositing them in new locations.
What the science says: These headlines derived from another letter to the editor printed in the same journal that ran the letter about pubic lice. The authors’ data set consisted of only 30 adults diagnosed with MCV at a single dermatology clinic in France. Of these 30 subjects, 93 percent shaved, clipped, or waxed their pubic hair. The researchers did not compare this group to a control group of people without MCV, so we have no way of knowing if these results are statistically significant. Nevertheless, the authors speculate that hair removal, by causing “micro-traumatisms” (small tears in the skin), could increase risk for MCV and “perhaps” genital warts. They call for detailed, controlled studies.
An intact epidermis is our front-line defense against infectious disease, and wounds — even microscopic tears — can make us more vulnerable to pathogens, including viruses. And sexually transmitted viruses like MCV, herpes simplex virus, and human papillomavirus are spread by skin-to-skin contact. Therefore, it’s plausible that waxing, shaving, plucking, or nicking one’s skin while clipping can increase risk of certain STDs. But a profile of 30 patients, without so much as a control group, is hardly a smoking gun.
Take-home message: The above claims about MCV risk are speculation for now, but there are perfectly plausible reasons to think that small injuries caused by shaving, waxing, plucking, and clipping can increase risk for skin-to-skin transmission of STDs.
To Shave or Not to Shave?
Many of us might feel societal pressure to remove pubic hair. We might think that prospective sexual partners won’t find us attractive unless we remove it. In actuality, preferences among people vary wildly, and many don’t care either way. Or we may absorb messages that tell us pubic hair is “dirty,” which is a myth.
If you do decide to shave, wax, or engage in other hair-removal techniques, it’s important to be informed of the risks. Experts (linking to Fox News? Now I feel dirty) remind us that the tiny traumas caused by most hair-removal processes can, in theory, open doors for sexually transmitted viruses. Additionally, one recent study found an upsurge in emergency-department visits related to pubic-hair-removal mishaps. Injuries, usually lacerations, arose from razors, scissors, and hot wax. Other studies have found that side effects of waxing can include burns, mechanical folliculitis, infectious folliculitis, other infections, and contact dermatitis or vulvitis; and that shaving can cause microscopic skin injuries that allow pathogens to enter the body and be spread via razor.
However, although there’s no shortage of emergency-department horror stories, the percentage of injuries requiring a trip to the hospital is thought to be small. If you want to remove your pubic hair, you can decrease risk by practicing good hygiene; being careful while using sharp instruments; or going to hygienic beauty salons where hands are washed, gloves are worn, and equipment is sterile.
The choice to remove one’s body hair or leave it in place is a deeply personal decision that can be informed by perceived cultural norms, religious tenets, and individual preferences. It’s important not to let societal messages negatively influence your body image, and to make choices that reflect your own preferences — not those of others.
And remember, the best way to avoid STDs is to limit sexual contact; use dental dams and latex condoms; and be regularly screened for STDs, along with your partners. A Planned Parenthood health center can provide STD testing and treatment, as well as condoms, dental dams, and information about safer sex.