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Thousands flock to the beach in Gulf Shores, Ala., on July 31, 2010. Nurse practitioner Hannah Varto is a straight talker, so it's not surprising that her study of hair removal in the nether regions — of particular interest now that swimsuit season is here — is entitled Smooth Talking. THE CANADIAN PRESS/ AP -Dave Martin

Nurse practitioner Hannah Varto is a straight talker, so it's not surprising that her study of hair removal in the nether regions — of particular interest now that swimsuit season is here — is entitled Smooth Talking.

She approached a colleague because she noticed a lot more young women were going for total hair removal, and she was seeing more rashes, and a lot of herpes and genital warts among her patients.

"Should I tell them not to remove their pubic hair, should I tell them that they should do it, but they should shave and not wax, or — I just didn't know," said Varto, who works in the Child & Youth Program for Vancouver Coastal Health.

Her colleague and co-author Lenore Riddell had been wondering the same thing, but they couldn't find much in the literature.

"We don't quite get it — why are women doing this, especially if they're having outcomes of having razor burn and ingrown hairs and folliculitis? What is the motivation?" Varto said in an interview.

She is also concerned about the lack of regulation for salons and estheticians, and whether there's a potential for disease transmission if a wooden or metal stick goes into a wax pot, is wiped on a woman's genitals, and then the stick is dipped in the wax pot again.

The pair launched a questionnaire that gave them a sample size of 660 women who had ever removed some or all of their pubic hair, to find out more information about the why, the how and any possible consequences.

They presented their findings at the annual meeting of the Society of Obstetricians and Gynaecologists of Canada in Vancouver, and earlier in the Canadian Journal of Human Sexuality.

The number 1 reason was so that hair wouldn't show outside of the bathing suit. But other reasons emerged as well, specifically around feeling attractive and more feminine or that it was the preference of their male partner.

"The third reason that came in there was about women thinking it was cleaner, or more hygienic," Varto said, adding that they were most interested in that response in terms of clinical practice.

"Is it really more hygienic?"

The voluntary respondents ranged from 16 to 50, and had a mean age of 32. The majority removed their hair by shaving, followed equally by trimming and salon waxing. Fifty per cent said they usually just did the bikini line, while 30 per cent usually did the whole area.

"Almost all of the women reported at some point having razor bumps, rashes, ingrown hairs, pimples and cuts from whatever method they have ever tried using, and followed by a smaller percentage having had burns — and obviously burns are going to be more from any waxing, whether that's home or salon waxing."

One of the limitations of the study, Varto said, was that they couldn't correlate a specific method of hair removal to a specific outcome. But no matter what, she said the side-effects of hair removal include skin traumatization.

"Are we opening up portals of entry for increasing a woman's risk to, say, the HPV virus that causes warts, or to the herpes simplex virus that causes genital herpes? Are we opening portals of entry to the skin that makes a woman more susceptible to these infections? And we don't have a good answer to that."

Lucy Cabral, an instructor at the Yorkville School of Makeup and Esthetics — part of George Brown College in Toronto — said that with waxing, "your follicles and your pores are opened, so you're now more susceptible to infection."

The school has one wax pot that is kept at a constant temperature to keep the wax at the consistency of maple syrup, she said.

"If you were to overheat the wax to try to kill any germs, you would, first of all, break down the composition of the wax, and scald your client."

"What we teach our students here is that there's absolutely no double-dipping. So we do not use any metal spatulas, which a lot of salons and spas unfortunately will still use," she said.

"We hear it a lot — very, very often I'll have students come back and share horror stories with me that, you know, they're basically working in this reputable salon or spa and they're still double-dipping. And that's because there's no regulation as of yet with our industry. We're hoping that will change soon."

Younger clients are more likely to go for a full Brazilian wax, she said, attributing the trend to "all the little tiny weeny bikinis."

Waxing will keep the area hair free for three to four weeks, but it can be painful and the skin can be red or end up with a slight rash for about 24 to 48 hours, she said.

Patrons aren't advised to take Aspirin because it can thin the blood and there can be some bleeding when the area is waxed, she said. Some people opt for a topical numbing cream or ice packs beforehand.

Exfoliation before and for about three to five days after treatment will help prevent ingrown hair, Cabral said.

"Because what happens when you're waxing any area of the body, you're weakening the hair shaft, the hair becomes finer, so if there's a buildup of dead skin cells on the surface of the skin, that hair cannot push through basically — it can't emerge out of the follicle, so usually it curls back in or it might enter into another follicle and that's usually when an infection can occur."

Staph infections aren't common, but when they occur they might look like a pus-filled pimple, she explained.

"It can happen if the person isn't exfoliating, if the waxing technician didn't perform the service properly. What I mean by that, if she didn't pull it in the opposite direction parallel to the skin. So basically she broke off the hair."

"It's not just ripping away. There is a little bit of technique."

Afterwards, a client can apply a cold compress, witch hazel or chilled aloe vera to soothe the area, she recommended. "The discomfort is usually only 24 hours for most women, not even."

Women who opt for salon waxing should ask to see the space to make sure it looks clean and there's no wax on the floor, the bed or the trolley where they have the actual wax heater. Look at what kind of spatulas they're using (if they're not disposable wooden ones, they may be double-dipping), and come right out and ask if they're double dipping.

"And you can see, because if they're double-dipping with the wooden spatula, they'll have one off to the side. Or they'll have it inside the actual wax container, and you know that it's being reused on a number of people," Cabral said.

And finally, because waxing or shaving removes superficial layers of skin, there's not as much protection against sunburns or pigmentation occurring in the sun.

"So sunscreen or sunblock would be recommended."

Varto's study is predicated on the understanding that pubic hair removal is now the norm for women in mainstream Western society, and recommends more research to document the social and health implications to guide professional practice and public education.

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