Pubic Hair Grooming Prevalence and Motivation Among Women in the United States FREE ONLINE FIRST

Pubic hair grooming is an increasingly prevalent trend in the 21st century.¹ Several studies^2- 5 during the past 5 years have found that most women report engaging in pubic grooming and hair removal, including total removal of all pubic hair. This practice is most common in younger women. Other factors that have been associated with pubic hair grooming include race, being in an unmarried relationship, sexual activity, and higher scores on sexual function scales,^1,4 which implies better sex life satisfaction for women who groom.²

Pubic hair grooming practices pose some potential risks of injury to women, most often related to shaving.^6,7 Obese women are particularly prone to injury during pubic hair grooming, which is important to any practitioners who address gynecologic health.⁶ There are also known benefits to pubic hair grooming, such as decreased rates of pubic hair lice.⁸

Knowledge of grooming behaviors is important for health care professionals because these behaviors reflect cultural norms and a source of patient morbidity. Much of what is believed to be the driving factor for grooming is a cultural trend, epitomized by representation of genitalia in popular media.¹ The mainstream media’s portrayal of women discussing and engaging in pubic hair removal is also a major factor for grooming-related influences.⁹ Furthermore, there is an increasing trend of genital cosmetic surgery, and a previous study¹⁰ highlights that the motivating factor is aesthetics rather than functionality. Some surgeons believe that the current grooming trends are responsible for this increase because women are able to visualize their labia more easily now than in the past and are thus more motivated to change their appearance.¹¹

A major limitation of the existing literature on pubic hair grooming in women is generalizability.^2- 5 Most studies^2- 4 to date have used convenience samples that are racially and demographically homogenous. Some studies^4,5,12 have enrolled more diverse populations but have been limited to specific geographic regions and often limited age ranges. To date, there are no nationally representative samples of US women and their current pubic hair grooming practices. Such a sample is relevant for health care professionals because women often seek advice related to grooming and counseling on risks for injury; hence, it is important for health care professionals to be familiar with the common grooming practices among women. The objective of this study is to report on pubic hair grooming practices and characteristics associated with grooming in a nationally representative sample.

We conducted a nationally representative survey of noninstitutionalized adults aged 18 to 65 years residing in the United States. A questionnaire examining the demographic characteristics of people who reported a lifetime history of any pubic hair grooming vs never having groomed was developed. For the purposes of this study, we focused exclusively on the women responders.

The survey was conducted with the GfK Group (formerly Knowledge Networks). Details regarding GfK study methods have been reported previously.¹³ Panel members for surveys are recruited using random probability-based sampling to ensure that a representative sample is obtained. Panel members are randomly recruited using address-based sampling methods. GfK samples addresses from the US Postal Service's Delivery Sequence File. Address-based sampling estimates that 97% of households can be reached and contacted through household mail.¹³ Once the panel members are recruited, they receive notification via email to participate in a study sample. Panel members may also check their personal online member page to participate in survey taking. The topic of the survey is given to participants. Participants do not see any questions from a particular survey until they accept the survey. GfK provides a laptop or netbook computer and free internet service to all panel members without access to the internet. For the current study, panel members received 1000 points for completing the survey, which is the cash equivalent of $1.

In addition to standard measures taken by GfK to enhance survey cooperation, email reminders were sent to nonresponders on day 3 of the field period. A pretest survey was conducted in December 2012 to ensure responders understood the questions. The final survey was conducted in January 2013. All participants provided written informed consent before the beginning of the survey. Data analysis was performed from November to December 2015.

GfK uses statistical weighting adjustments to correct for known deviations. Additional survey errors, such as noncoverage and nonresponse, are also corrected for using panel demographic poststratification weights. The Committee on Human Research at the University of California, San Francisco, approved the study.

The following demographic data were collected: age, race, relationship status, educational level, and geographic region. We also asked about personal and ideal hairiness (using diagrams), the role of a partner’s preference for grooming, and specifics about sexual activity.

For the current study, we explored differences in characteristics of groomers, defined as women who reported any grooming, vs nongroomers.

Data analysis was conducted using the survey function within STATA statistical software, version 12.0 (StataCorp), to account for complex sampling design. P < .05 was considered statistically significant, and all statistical tests were 2 sided. All missing or incomplete data were excluded from the analyses. Demographic characteristics and sexual characteristics were compared between groomers and nongroomers using 2-sided t tests. All variables with P < .20 in univariate models and variables thought to be suggestive of grooming were added to the multivariate logistic model. Multivariate logistic regression was used to see which factors have the greatest odds of the outcome of grooming. Of women who reported pubic hair grooming, the prevalence of instrument used and areas most often groomed were obtained via summary statistics.

A total of 3372 women were surveyed. Fifty-six women did not answer the grooming question; consequently, 3316 women were included in the analysis. Demographic information is presented in Table 1. Overall, there was broad representation across the United States in terms of age and racial diversity. A total of 2778 women (83.8%) reported a lifetime history of pubic hair grooming, and 538 (16.2%) reported no grooming history (Table 2). There was a bimodal distribution to the frequency of grooming, with the mean frequency being monthly grooming. A total of 133 women (4.8%) reported performing daily grooming. When asked where they groom, most women reported grooming the hair above and around the vagina (2054 [73.9%] and 2087 [75.1%], respectively), and relatively few reported grooming the buttocks and around the anus (196 [7.1%] and 621 [22.4%], respectively). A total of 1710 women (62.1%) reported removing all their pubic hair. A total of 2577 women (92.8%) reported that they performed their own grooming.

The most common motivations for grooming were for hygienic purposes (1640 [59.0%]) and/or as part of their routine (1292 [45.5%]) (Table 2). A total of 875 (31.5%) reported grooming because they believe it makes their genitals more attractive, and 586 (21.1%) reported grooming because of partner preference. When asked about situations for which they groom, women reported sex as the most common reason (1544 [55.6%]) but also vacation (1270 [45.7%]) and health care professional visit (1111 [40.0%]).

In bivariate χ² analysis (Table 3), grooming was significantly associated with age; younger women were more likely to report grooming than older groups. Women who groomed were more likely to have higher educational levels and incomes. White women were more likely to report grooming than women of other self-identified racial/ethnic groups. Women who were widowed, separated, or single were less likely to groom, but there was no difference in the percentage of married women who reported grooming. There was also no difference in grooming habits by geographic region or number of recent sexual partners. The Figure presents the distribution of grooming frequency during the past year in relation to age, educational level, and race.

Women who reported grooming had twice the mean number of lifetime partners as those who did not groom (9.0 vs 4.4, P = .005) and were significantly more likely to have more regular sexual activity (P = .001) and engage in active and receptive oral sex (P < .001).

On multivariate regression, we found several factors associated with grooming (Table 4). When compared with younger women (aged 18-24 years), women aged 45 through 55 years (odds ratio [OR], 0.05; 95% CI, 0.01-0.49; P = .01) and those older than 55 years (OR, 0.04; 95% CI, 0.00-0.34; P = .003) were significantly less likely to groom. Women with some college (OR, 3.36; 95% CI, 1.65-6.84; P = .001) or a bachelor’s degree (OR, 2.39; 95% CI, 1.17-4.88; P = .02) were more likely to have groomed. Race was also significantly associated with grooming, with all groups reporting less grooming when compared with white women. No association was found between grooming and income, relationship status, or geographic location.

On multivariate regression, the role of partner preference still held when controlling for relevant demographic factors. Women who reported that their partners did not groom were significantly less likely to groom (OR, 0.43; 95% CI, 0.24-0.75; P > .003). Women were also less likely to groom if their partner did not prefer it (OR, 0.04; 95% CI, 0.02-0.10; P < .001). Number of lifetime sexual partners was associated with grooming (OR, 1.05; 95% CI, 1.02-1.09; P = .003). Of note, frequency of sex, types of sexual activity, and sex of sexual partner were not associated with grooming after multivariable adjustment.

The grooming practices of a representative sample of adult women in the United States were evaluated. Overall, the prevalence of pubic hair grooming in women is substantial. We found many factors associated with pubic hair grooming, including age, race, educational level, and the number of lifetime sexual partners.

Pubic hair grooming has been the subject of a number of recent research efforts. Herbenick et al² published the initial large study on grooming. Although the study population was large, most participants were white (86%) and young (mean age, 32 years). Their group also reported that younger age was a significant predictor of grooming, as was relationship status and sexual activity; namely, unmarried women and those who engage in oral sex were more likely to groom. A follow-up study⁵ comparing men and women’s grooming practices was again a convenience sample recruited from college campuses who were mainly white and younger. Additional studies^6,12 have sought to broaden the respondent base, mainly through convenience samples in Texas, where there was a larger representation of Latina women. DeMaria and Berenson¹² also found that white women were significantly more likely to engage in grooming than black and Latina women. After multivariate regression, these authors also reported a positive association of grooming with income and a negative association with age. Within this study, the authors also found that there were increased rates of grooming-related injuries among obese women.

Our findings corroborate previous studies^2,5 in terms of the inverse association between age and grooming habits. Much has been written about the new trends in popular culture related to hairlessness and genitals. Ramsey et al¹ published a review that addresses the sociocultural, anthropologic, psychological, and sexual aspects of pubic hair removal. These authors suggest that the modern trend of pubic hair removal likely originated in South America (hence the term Brazilian as slang for complete pubic hair removal) but that the increased prevalence of pornography that depicts bare genitalia, popular magazines, and television are primary drivers of the trend in the United States.

We found that women groom for social events but also groom when visiting a health care professional. This finding suggests that women are self-conscious about their appearance even in nonsocial settings. Thus, any exposure to her genital area may drive a woman to groom, even when the health care professional is an unbiased professional providing medical care.

Unlike prior studies,^2,5 we did not find an association between income and grooming; however, we found a positive association between grooming and educational level. The multivariable analysis and control for many confounding factors likely underlie this absence of effect. The role of education may be explained by the same cultural norms that contribute to younger women engaging in pubic hair grooming. Given the wide availability of explicit media depicting pubic hair grooming in women, it seems less likely that education is related to more exposure to popular culture ideals. Similar to other studies,^4,12 we found a difference in racial distribution of groomers, with white women being far more likely to groom than any other racial/ethnic group. This finding has been documented in a prior study¹² and seen as most likely to be related to cultural norms and ideals of beauty among different racial groups.

Our study is unique in assessing the role of the partner in grooming. Indeed, we found that women were far more likely to groom if their partner also groomed and if their partner preferred that they groom. This finding is important because it highlights the role of sexual relationships as being a strong predictor of grooming. In contrast to the study by Herbenick et al,² which looked at similar outcomes and measures, we did not detect an association between types of relationship and types of sexual activity and grooming after multivariable analysis. A clear example of this behavior is demonstrated by 22.4% of women who groomed around the anus while only 10.0% engaged in any anal-related sexual activity in the prior year. This difference between our study and prior studies is the role of multivariate regression to control for confounders and the representative nature of our sample. Thus, although the prevailing wisdom has been that grooming is related to specific types of sexual activities or relationships in women, our analysis disputes these conclusions.

To our knowledge, our study is the first representative sample of women from across the United States. Its strengths include a large, nationally representative sample from a well-validated source. Participants completed our survey via the internet, which facilitates privacy and ease of access. Internet access was provided to all those without access. However, our study is not without limitations. All individuals contacted must have had a home address in the United States and be noninstitutionalized. Thus, these results may be difficult to generalize to the entire US population. Given the sensitive nature of our survey, some participants may not have felt comfortable answering questions about sexual behavior and pubic hair grooming.

Female pubic hair grooming is a common practice seen by all health care professionals and providers of aesthetic treatments for women. Familiarity with the motivations and characteristics of women who groom can help inform health care professionals in terms of identifying women for counseling regarding grooming risks. Furthermore, our study demonstrates that, contrary to prior studies,^2,3,5 grooming is less associated with specific sexual activity and relationship type and more associated with age, race, and educational level. We also found that women were more likely to groom based on their partner’s preference and some groom before visiting a health care professional. Thus, our study demonstrates a role for cultural sensitivity as it relates to pubic hair grooming because women have diverse motivations for grooming that are not universal. Future directions for research include understanding the cultural differences as they relate to pubic hair grooming and the role of the health care professional in influencing women’s grooming habits.