In the United States, the prevalence and nature of urologic injury from personal grooming products is largely unknown. In a national stratified probability sample of consumer product-related injuries presenting to U.S. EDs, we found a modest rate of GU injuries related to grooming product usage (3% of all GU injuries documented). Injuries occurred slightly more often in women (56.7%). When stratified by sex, differences in product type and injury diagnosis were observed. For both sexes, the number of incident cases increased approximately linearly during the study period but was most dramatic among women. From a public health perspective, pubic hair removal has been implicated in the spread of certain sexually transmitted infections; however, the evidence has largely been anecdotal or limited to case reports.1,4,10
Pubic hair removal has also been associated with a decreased incidence of pubic lice.16
At-home pubic hair removal is typically accomplished by shaving, waxing, trimming with scissors or clippers, or tweezing. Although minor adverse events, such as rash, folliculitis, pain, or irritation, have been reported after at-home hair removal techniques,10
case reports of subacute complications after pubic hair removal, such as methicillin-resistant Staphylococcus aureus
or follicular keratosis requiring excision,18
have been reported. Abscess was the primary diagnosis identified in 15.6% of that cohort, with patients typically presenting a various number of days after grooming. Systemic or life-threatening injuries associated with grooming products have been reported in published studies. Dendle et al11
described a 20-year-old Australian woman with poorly controlled type 1 diabetes who developed life-threatening sepsis with Streptococcus pyogenes
and Herpes simplex
after undergoing complete pubic hair removal with hot wax.
Body hair removal practices are potentially influenced by a variety of factors, including sex, age, partner and sexual activity status, sexual orientation, and body image.1,5,6
Not surprisingly, the demographic group largely purported to remove pubic hair—young women—had the greatest injury prevalence. We found that more than one-half of all GU injuries due to pubic hair removal were in women, who also had a younger age distribution, because about one-half were 19–28 years and 21% were ≤18 years old. One report, which surveyed women in a gynecologic clinic, found that >70% of adolescent girls aged 12–20 years routinely shaved or waxed their pubic hair.5
In an Internet-based survey completed by 2451 women aged 18–68 years, total pubic hair (vs partial) removal was associated with younger age.1
Male injuries constituted a substantial portion of the cohort and were found to increase at a rate that paralleled female grooming injuries. This finding is congruent with contemporary studies that report relatively high pubic hair removal among men.6,7
Although few published reports have described the effect of grooming practices on external genital injury, the CPSC issued a Hazards Screening Report in 2005,19
describing injuries related to “personal use” products from 1997 to 2003. Individual product categories included electric grooming devices, unpowered grooming devices, and grooming devices nonspecified, in addition to other categories such as clothing, eye glasses, and shopping carts. An estimated 506,650 injuries due to personal items occurred in 2003, with 5.0% requiring hospitalization and 370 deaths (none related to hair removal devices). Although the hazards report estimated 285.5 million electric grooming products were in use in U.S. households in 2003, it is unknown what portion were hair removal devices. Thus, because genital hair removal is a relatively common practice, the overall injury rate has been very low. Nevertheless, we found a sharp increase in the number of both men and women who presented to U.S. EDs with GU injury in recent years.
From our findings, urologists, ED, and urgent care providers who treat patients with grooming-related GU injury should advise patients on safe depilatory techniques. For example, hair clippers might be a superior tool, because they accomplish hair removal in a quick and economic fashion but pose less risk of microscopic lacerations or abrasions to the skin. In addition to preventing future harm, patient counseling potentially reduces the amount of healthcare resources spent on what are, arguably, preventable injuries.
This is the first study to describe the epidemiology of GU injures secondary to hair removal practices. Its strengths included the large, nationally representative sample taken from a well-validated source; however, several limitations were present. The NEISS likely underestimates the effect of grooming product-related GU injury, because it does not capture injuries managed by primary care physicians or in urgent care settings. Furthermore, because these injuries are often “minor,” those not treated or patient self-treated are missed. We also only identified those injuries related to a limited number of depilation products codes and thus could not account for GU injuries due to other grooming products, such as soaps. However, we would expect this number to be very low.