In the gynecologist’s office, they apologize for not shaving their legs, they apologize for the shape of their labia, they apologize for the look of their anus, for their vulva’s odor, for being on their period, for the length of their pubic hair. They apologize for not shaving, trimming, cutting, plucking, or dissolving their pubic hair.

First off, no more apologies! Second, let’s agree that all forms, length, colors, kinkiness, thickness, thinness, absence or presence of pubic hair are acceptable.

Now that we’ve worked through that, let’s begin an honest discussion about the how’s and why’s of pubic hair maintenance, or lack thereof.

First, some facts.

The majority of women use a razor and shaving, followed by trimming with scissors, hair removal cream, waxing and, lastly, laser hair removal.

Lesbians are less likely than heterosexual women to remove pubic hair.

95% of women in a recent study said that they took care of their grooming at home, without the aid of a salon or professional.

Other forms of hair removal include electrolysis, sugaring and threading.

RAZORS & SHAVING

As you might imagine, razors are sharp. And the vulva is delicate with soft, highly-innervated skin underneath the pubic hair. In the past, when we prepared a woman for Cesarean Section, we shaved with a razor at the top of a woman’s pubic hairline.

New data has shown that using a razor on the mons increases risks for infection.

Now, for surgery, we use clippers instead of a razor. Razors makes small breaks in the skin and bleeding can occur, creating opportunity for bacteria and viruses to penetrate the skin. The consequences of using a razor on the vulva are increased risk for infection (folliculitis) and increased risk for the spread of herpes (should you have relations with someone, for instance, who either didn’t tell you they had herpes or didn’t know they had herpes and was shedding virus asymptomatically). In addition, you are at increased risk of getting HPV and molluscum contagiousum (an annoying viral infection that causes raised bumps in the areas that are affected).

The bottom line: making little cuts in one’s skin on the vulva can lead to viral and bacterial infections, and painful ingrown hairs. In addition, shaving can lead to painful rashes, blisters, pimples, redness/soreness and itching. My advice: steer clear of the razor — if you want to trim the hair, use a small pair of nail or hair scissors, being careful to avoid nicking your delicate skin.

TRIMMING

Probably the most self explanatory and safest method. Basically, grasp a small amount of your hair with your fingers, hold gently and trim with a small pair of scissors. This will provide a ‘barely there’ appearance, without the harmful potential side effects of shaving, waxing or depilatory creams.

DEPILATORY CREAMS

The main advantage of creams, is, like razors and trimming, it can be performed at home. Creams work by using acidic chemicals to dissolve hair. These chemicals are caustic and have a pungent, if slightly fascinating, odor. One should avoid using creams on broken skin or near the eyes. Regrowth appears 5–8 days after removal, so there is need for repeat applications, and thus, cost. Some women have a darkening of their skin color after using the creams as well. Generally, good results, minimal harm and a bit messy.

HOT WAXING

Hot waxing of the vulva and bikini area has become part of the cultural conversation, on countless movies, and sitcoms. I’ve tried it a few times (upon first moving to Hawaii) and likened it to a medieval torture ritual, but that’s just me. All kidding aside, there are some risks to know about with waxing.

One, waxing, like shaving, can create small breaks in the skin surface, which then makes women more susceptible to all of the bacterial and viral infections we discussed above. Dangerous staph infections, not to mention yeast infections, are more common with waxing. As the name implies, hot wax can cause burns which can also lead to infections. Ingrown hairs, like with shaving, occur frequently, and, over time, the skin can become scarred and coarse, losing the softness that so many women desire when they first started waxing. Sadly, there are also reports of women in salons being exposed to contaminated wax, creams, and cloths. Even the therapist herself may have fomites from her hands, body and clothing that can be spread to clients while waxing. Of all the possible methods, this one scares me the most for my patients.

LASER HAIR REMOVAL & ELECTROLYSIS

Laser hair removal uses high intensity pulses of light to damage or destroy the hair follicle. Light is absorbed by dark objects more easily, so women with dark hair on fair skin are ideal candidates for laser hair removal; though newer lasers are able to find success for women with dark skin and dark hair. While lasers typically cover patches of skin surface in a given pulse of light, electrolysis provides energy directly to individual hair follicles to destroy them. They both can cause burns and scarring and therefore need to be done by highly trained professionals. Some level of pain should be expected during these hair removal sessions. Side effects can include itching, pink skin, redness, swelling, acne and infections.

Rarely hypo- or hyper-pigmentation can occur. There are many different types of lasers used nowadays, and their waves lengths are tailored to match the pigmentation of patients’ skin tones. Both electrolysis and laser hair removal often require multiple sessions to see effective results. But the results are permanent, which many women prefer. Both laser hair removal and electrolysis can also be quite costly, but women are quite pleased with results.

Though women have been ‘ladyscaping’ for centuries, there is a marked uptick in the numbers of women grooming their pubic hair.

I think the widespread and frequent access to internet porn has profoundly affected men’s perceptions of what women’s genitalia should look like.