Manscaping's Hidden Dangers - Who Knew?

When I saw Prevalence of Pubic Hair Grooming-Related Injuries and Identification of High-Risk Individuals in the United States, a review of injury and morbidity published in JAMA Dermatology this week, I was reminded of a line by blue collar comic Ron White, “I had the right to remain silent, but not the ability.” The study provides windows into both the culture of peer-reviewed journals and American society. It reports a web-based poll of 7570 adults, part of a demographically constructed panel that evaluates marketing and consumer information. Here are the results:

• 7570 respondents, 55.5% male, 68.1% Caucasian, mean age 41.9, 63.2% married or living with partner
• 76% groomed pubic hair, 85% of women, 66% of men
• 77% groomed using direct vision, 21% used a mirror, the remaining 17% used feel
• Non-electric razors were preferred at 47%, followed by electric razors, scissors, wax, electrolysis and laser hair reduction
• 25% of groomers reported injuries, slightly more women than men
• 66.5% had suffered more than one injury and 32% more than five. They were labeled “high-frequency injury.” [You have got to love scientific descriptions]
• The injuries included lacerations 61%, burns 23%, rashes 12%
• After adjustment, a high-risk group was identified. For both women and men, removal of all pubic hair, 11 or more times was associated with a higher frequency of injuries.
• 1.4% required medical attention and these events occurred more often “when others were grooming the participant’s pubic hair (…P<.001) and when groomers were laying on their backs (…P<.001) [Publication does require appropriate statistical evidence]

To be honest, this gave me new information, perhaps too much information, about our American culture; but I think the real lesson lies in what the article tells us about peer-review journals and the publishing narrative. First, a bit of perspective. In a study also from UCSF’s Urology Department (evidently this is a ‘center of excellence’ in this research topic) the reported incidence of these injuries in the emergency department was 335 over eight years, part of the 37.4 million annual visits to the emergency department for injuries. So, the incidence is exceedingly low, so low that the original ED study inflates the number of 335 to an estimated 11,000. (There is no information regarding how this value was calculated)

The scientific method we are taught is one of hypothesis, testing, results, and conclusion. How well does this study follow the method? There is no hypothesis; it is merely a descriptive study. The testing is a poll, admittedly, of demographically chosen individuals. But they were demographically selected for marketing and consumer information research. Given no hypothesis, it is hard to identify the results, but data-mining provides categories and numbers. To make the results more ‘scientific,’ there is a statistical analysis replete with p values and regression models.

For me, the real deviation from the scientific method is found in the wording and phrases in the conclusions. Highlights of the discussion included

• “We found significantly greater prevalence of grooming among younger groups. This finding could signify a generational trend, indicating that this behavior may continue to become more universal as the population ages.”
• “In men and women, grooming frequency and removing all pubic hair were associated with increased risk for injury and repeated high-frequency injuries in a dose-response fashion.” [Italics added]
• “Some grooming methods may be safer than others, although more research is necessary.”
• “Waxing in women may protect against high-frequency injuries, although more research is necessary to confirm this finding.”

Conclusions in the softer sciences, the ones the media love to share, often have a narrative line of their own - there is a big problem, there is an underlying scientific reason, and fixing the big problem requires action. The phrase, “may continue to become more universal,” suggests a growing problem and without any frame of reference, the study’s measure of the incidence of 60% seems significant. And consider how they describe the increased risk, it occurs in a “dose-response fashion,” implying an underlying physiologic cause, like a drug effect. Finally, the authors offer a possible remediation, “waxing in women may protect” followed quickly by the call to action, “more research is necessary to confirm this finding.” This is not hard science and the misleading framing with statistics and phrasing as a disease serves us poorly.