By LIBERTY GADD

Last December, 23-year-old university student Jane* noticed her labia had become inflamed following a professional Brazilian wax she had a week earlier.

Over the next three days the inflammation worsened and Jane began to find it difficult to walk.

Her GP advised her to go to a hospital immediately. Embarrassed, and convinced the inflammation and soreness would subside, she went to work instead.

By next morning the inflammation had worsened and she had developed a fever. After consulting her housemate and a medical hotline, Jane went to the emergency department of her local hospital.

Doctors told her she had an abscess the size of a large grape on her labia, the result of bacteria entering into a traumatised pubic hair follicle.

Jane said the doctors acted quickly, as they were concerned that the infection was close to her reproductive organs and could compromise her fertility.

Doctors initially recommended Jane have surgery to remove the abscess but were keen to see how she responded to IV antibiotics first.

The abscess began to subside as IV antibiotics were administered every six hours and Jane remained in hospital care for three days. On release, she was prescribed an oral antibiotic.

The antibiotics necessary to treat the abscess left her with secondary short-term health problems including folliculitis (inflamed hair follicles), yeast overgrowth infections and hair loss.

Jane said her gynaecologist had seen a recent increase in the number of infections following pubic hair removal, however the statistical risk of a complication remains relatively small.

Despite this increase, many who choose to remove their pubic hair remain unaware of the potential complications.

Why are we removing our pubic hair?

Waxing and other hair removal techniques are not a new trend, but Australia’s obsession with pubic hair removal has left doctors fascinated by the forces driving it.

Dermatologist Jonathan Trager’s article Pubic Hair Removal – Pearls and Pitfalls points toward “swimwear styles” as a driving factor in the trend.

Dr Trager said that while pubic hair removal was a relatively new phenomena in the Anglo-Saxon world, “in Islamic societies, removal of pubic hair is a religiously endorsed practice”.

Claire Francoise Skin and Beauty  Clinic owner, beautician Claire Francoise, said social media had also contributed to society’s obsession with pubic hair removal.

“Images are a lot briefer. With Instagram now people are … becoming celebrities through social media and … they’re usually in pretty skimpy outfits and skin looks perfect, hair looks perfect,” she said.

“I think what that does is it makes women really analyse themselves.”

A Huffington Post article on pubic hair trends suggested the predominance of porn actors and actresses with groomed or absent pubic hair had also influenced society's view on the issue.

In general, pubic hair removal trends differ between age groups, with older clients usually opting for a bikini line rather than more radical removal.

Is there an increased risk of STI?

A study by French dermatologist Francois Desruelles found pubic hair removal could increase a person’s susceptibility to the viral infection molluscum contagious. The virus, which is transmitted through skin-to-skin or sexual contact, causes lesions.

The study observed “30 new cases of [the virus] presenting in a private office of dermatology in Nice, France, from January 2011 to March 2012”.

The study found 93 per cent of the subjects had been engaged in pubic hair removal, with 70 per cent shaving, “13 per cent clipping and 10  per cent waxing.”

East Malvern Dermatology dermatologist Gayle Ross said that it was possible that without the protective barrier that pubic hair offered, minor STIs might be easier to get.

“If you do not have hair as a sort of barrier and you’ve got broken skin, then you’d think it [molluscum contagiosum] would be more common,” she said.

Royal Women’s Hospital family planning clinic gynaecologist Paddy Moore said further study should be conducted to properly determine a link between pubic hair removal and increased susceptibility to STIs.

“No one has really done a controlled study where they look at a population that’s comparative by age and other demographics that might give them an increased infection risk, and then looked at a group that … had had hair removed versus a group that hadn’t,” Dr Moore said.

“That’s the kind of work you’d have to do,” she said.

A JAMA Dermatology journal article published in February 2014 also said  “[w]axing causes deficits in the mucocutaneous barrier … potentially increasing the risk of acquiring sexually transmitted infections.”

Dr Moore said there had not been an increase in patients presenting with STIs at the family planning clinic despite the continuing pubic hair removal trend.

Folliculitis and skin conditions 

Doctors and Ms Francoise agreed the most common complications following pubic hair removal include folliculitis, ingrown hairs and dermatological problems.

Dr Ross said she commonly saw patients with folliculitis that had resulted from pubic hair removal.

“Folliculitis … is [an] infection down the hair follicles. That can be fairly mild or it can be quite nasty; so big deep sores, sort of boils and things, and they can scar,” Dr Ross said.

Jane has been treated for folliculitis twice since the abscess, once in January and again in March, and said the condition produced itchy red bumps around hair follicles on her body.

Dr Moore said she sees one or two cases of incidental folliculitis among about 240 patients each month, but that acute folliculitis was rare and usually occurred only in immune-compromised patients.

“The cases I’ve seen of that I think are two cases; one … in the course of working out why she had such bad folliculitis, we realised she was diabetic, and the other one was pregnant so also immunocompromised,” she said.

Ms Francoise said waxing could also result in skin peeling and bruising when performed incorrectly.

“When there’s problems it’s usually because the person performing the treatment has been ill informed or does not have enough in salon like experience.”

She  said the beauty industry was under-regulated, and that better training and explanation to the client would reduce hair removal complications.

Surgery linked to hair-removal obsession

Labiaplasty is a surgical procedure that reshapes or reduces the size of a woman’s labia minora and is usually done for cosmetic purposes.

Dr Moore said increasing interest in labiaplasty surgery could be linked to society’s fascination with pubic hair removal.

“[Waxing] certainly increases the focus on the genital appearance, and as a result of that possibly women, in particular … are expressing more and more dissatisfaction with the appearance of their labia and their genitalia,” Dr Moore said.

Dr Moore said gynaecologists and the medical profession were concerned about the increasing popularity of the procedure.

“It has been a concern over the last decade to the point where the British College, the American College, and the Australian and New Zealand College have issued statements … not recommending surgery,” he said.

Dr Moore said serious complications can follow labiaplasty and that the surgery itself may not address the underlying issues prompting patients to have surgery in the first place.

“The concern about it [labiaplasty] is that you can get problems with infection and ongoing pain as a result or not feel any better about the appearances of your labia or your sexual functioning … or your sexuality which may have been the issue in the first place,” she said.

Implications on personal life

Folliculitis, infections and skin complications in the pubic region can leave patients feeling embarrassed.

Jane said that while her abscess had cleared, she still felt self-conscious.

“It’s also been really hard in terms of having sex with my boyfriend. Because … my body there has been so sore, it’s made me not want to and it’s made me very self-conscious,” Jane said.

“And now because … I’m so hesitant about using hair removal, it’s made me even more self conscious and even though he [my boyfriend] is wonderful and so lovely and doesn’t care, it bothers me.”

Dr Ross said patients were often unaware of the potential complications flowing from hair removal.

“I don’t think they get warned adequately by the beauticians,” she said.

Jane said she hopes other women who wax or shave their pubic hair will be proactive in seeking medical assistance if necessary.

“Don’t do what I did, because if I had gone the day after I had noticed that it was worse than a regular ingrown hair I wouldn’t have had to go to hospital.”

*Jane is not her real name.