E19: 7 Domains of Personal Grooming

This "7 Domains" is about shaving or removing unwanted hair. We're going to be talking about women's unwanted hair mostly. And to do this, we're going to have the podcast dream team for this interview, or at least my dream team.

We're going to have a reproductive endocrinologist who specializes in hair, where it shouldn't be and why. And that reproductive endocrinologist is me. And we're going to have an anthropologist who studies why people do things, why there's certain patterns of behavior, why people across cultures do what they do, and that will be Katie Ward. She's a woman's health nurse practitioner with a doctorate in nursing practice, who has a clinical practice in women's health and teaches at the College of Nursing at the University of Utah and is an anthropologist who has some done some studies and publications on hair down there.

Dr. Jones: So welcome to the "Katie and Kirtly" show, Katie.

Dr. Ward: Thank you so much. This is really fun to be here.

Dr. Jones: So let's start with the evolution of human hair patterns. We've been called the naked ape because we have so much less hair than our cousins, the great apes, and our siblings in our closer genetic tree, but we still have hair, men on their faces and men and women in their private areas, their pubic area, and their axilla, which the armpit. So, Katie, why did we lose our hair?

Dr. Ward: Well, I think the accepted reason really is it has to do with being able to sweat. So besides being a hairless ape or a particularly sweaty ape, and we're the most mobile of the apes. So our lineage has gone, you know, wandered the four corners of the Earth and done that mostly on our feet. And in order to dissipate heat loads, probably necessary to lose some of that hair that holds it in. So I think that's sort of the generally accepted reason for why we've evolved to be more hairless. Having that skin exposure has also allowed us to absorb vitamin D in higher latitudes in the planet. And so there are probably a lot of good evolutionary reasons for losing a lot of our hair in terms of just allowing us to stay cool and absorb vitamin D. It's really the opposite explanation for that and the one Darwin actually kind of proposed was that, you know, maybe we've kept hair because it's attractive to the other member of the opposite sex. So either it's gone away because its absence is attractive, or we've kept what we've kept because the presence is attractive and signals something.

Dr. Jones: So I thought it was because the not only is the hair in our pits, our groin pit and our armpit are remaining hair, but it's also those sweat glands are different sweat glands than in rest of our body because they give off pheromones and they smell different. And so we were trapping our smell, whether you want that or not, but that's . . . So I've heard that as well.

Dr. Ward: Wanted to or not. Yes, I think that so in the, you know, theories about why we've lost other hair but kept the hair that we have, pheromones is one sort of a visual cue, I guess if you're particularly near-sighted and you're looking to figure out which, you know, which parts of the body you might be interested in, that contrast can be useful. Or that it provides some kind of protection from friction or disease transmission. So there's some theories about that, but the interesting thing is even if people take all that hair off and cover up, clean off all the smell, we seem to manage to reproduce pretty successfully.

Dr. Jones: We certainly do. Well, I want to move a little bit into the physical domain. We've been talking about the evolutionary differences that make us, (a) we stood up, when we stood up, we changed our hips, we changed our ankles and knees, and we started to walk. And when we started to walk, we looked around and we started moving and we got sweaty. So that was a good thing.

In terms of hair, I'm going to talk a little bit about facial hair because facial hair on women is not seen as desirable by women, and it's not very common and it can be a sign of a medical problem. So the reason you might have hair as a female on your face is because either you're making too many androgens, male hormones like testosterone, or you might have a receptor for testosterone, this is the lock and key that turns on genes to make hairs on your face. The receptor may be just very, very competent at grabbing testosterone and holding on hard.

There are some cultures, peoples who have normal testosterone levels, but very little hair. And I think of East Asians who really don't really have very much hair on their face and they don't have very much hair down there, but they have normal testosterone levels and Mediterranean women who have normal testosterone levels tend to have more hair. They often have a little, you know, downy mustache and a few more hairs, but when women develop a lot of hair, either on their chest, especially on their chest, because it's extremely rare for normal testosterone levels in women to lead to hair on your chest or hair on your face, that is often something that we work up.

So we consider that a medical problem and women mostly as long as . . . except for some very special women, when they get hair on their face, they really don't like that. And so there are different ways that women might choose to remove hair on their face, including shaving, of course. There are things that try to dissolve hair, there are creams, there's plucking, and waxing, and lasering, but hair on your face as a woman is up particularly outward sign that most women are very disturbed by.

The other thing that happens with normal aging is the normal aging does things differently to your face and to your genital area. So the area in your groin and in your armpits is very sensitive to testosterone and it grows hair that's kind of thicker and curlier even at normal low levels of testosterone. But after menopause, when your estrogen falls, testosterone tends to be a little bit more predominant and women tend to grow a few more hairs on their face, you know, the little grandma who isn't plucking or shaving anymore and she's got these little whiskers and women lose their pubic hair. And for some, that's a problem.

So for shaving your face, there are some medical consequences, but probably not as many medical consequences there is for shaving either axilla or in the groin. So, Katie, tell me a little bit about how women who choose, and we'll get to why in a bit, what are the ups and downs? What are the medical consequences of shaving in your groin or your armpit or any kind of treatment you want?

Dr. Ward: Yeah. So, you know, the whiskers you were talking about, they're usually, you know, scattered and they're growing in a place that doesn't have quite as much perspiration sitting on it. So maybe not quite as much bacteria as we were talking about the areas that tend to grow pubic hair have special sweat glands that have more body odor, more oil and are prone to maybe some more pimples and things like that. So as you start thinking about the ways that people are working to remove that, you know, they may be damaging a bunch of other structures in addition to the follicle on the skin.

So when you look at what people are doing to remove their hair, I think, you know, far and away the most common thing is to either trim that with an electric razor or shave it with a bladed razor. Probably next most common is to wax and then laser it off. And then there's some other techniques with like sugaring and threading that, you know, are not quite as common, I don't think, but any of those are going to start to disturb the skin a little. So the most common injury that I think people get are cuts or abrasions, but that open skin then becomes a place where bacteria can grow. And so, you know, you often see people get a little bit of folliculitis or ingrown hairs and if you incorporate some bacteria in that, you can definitely get some bigger infections. And I have, over the years, had one or two patients get a cellulitis that required hospitalization.

Dr. Jones: So an infection.

Dr. Ward: Yes.

Dr. Jones: So cellulitis is an infection in the skin where they've been shaving and some of the follicles, the little skin places where the hair came out got infected and then it got spread into the skin nearby and you can get pretty serious infections in your groin, especially if you have any other . . . if you have diabetes or you don't fight as well, or if sometimes it just happens.

Dr. Ward: Yeah. And so I have had a couple of people get really quite sick over the course of my practice. I'd say most people, you know, manage to remove their hair without a lot of serious consequences like an infection or cellulitis but often deal with some minor things, like itching and ingrown hairs and that there are sort of temporary inflamed follicle or a rash.

Dr. Jones: Ooh, ow. Owie.

Dr. Ward: That sounds pretty awful, doesn't it? People who laser sometimes end up with hyperpigmentation. So you've taken off your hair but then change the color of your skin. I've seen people have allergic reactions to products that they're using. And then for women who are doing this in a salon or someplace, there is a little bit of a risk for some cross-contamination and spread of other infections or maybe even what are typically sexually transmitted infections between contaminated equipment. So there are some rare and serious long-term consequences.

Dr. Jones: Well, I remember seeing a young woman who came in to see me. She was maybe 13 and she had a rare bleeding disorder. Her mom brought her in because her periods were excessively heavy, and I did an examine and I found that she had no pubic hair. Either she had been shaving or someone had been shaving. And I'd remember thinking, "Thirteen is just too young. That's too young."

Dr. Ward: Yeah. This is where I got sort of started in this. I've been working in women's health for 30 years now, and at the beginning of my career, not very many of my patients took off all of their pubic hair. So I think most people were sort of concerned about what was beyond their bikini line. And I have to say this disclaimer, during the pandemic, when I'm seeing men with long beards wearing masks, it kind of reminds me of pubic hair outside your bikini line. I got to say, I'm not liking the beard beyond the mask look.

Dr. Jones: Well, you know, it goes back to that San Francisco, you know, back to the '70s. And we're going to make the transition to the social domain because if you're going to San Francisco, was taped, that song. Women at that time didn't shave anywhere. They didn't shave their legs, they didn't shave their armpits, and they didn't shave their pubic area.

And shaving your legs I know became quite a big thing in this country when nylons became . . . So having smooth legs was very, very attractive according to the culture of the time in the United States and in Europe, and you made your legs smooth by wearing these beautiful nylons. And when their nylons were all going to parachutes during the war, women started shaving more. And then there you go. Then they were shaving and shaving. But during the '70s, it was a really granola girl wouldn't shave anything. It was all natural.

Dr. Ward: Right. And I think it was little bit of a counter-culture reaction, right? These were young women who were not going to conform to the things that their mothers had been doing. But the thing I was thinking about, the 13-year-old was, you know, 30 years ago, one, we didn't have the internet and people weren't seeing quite so many images, but I think now one of the unfortunate things for young teens, both male and female, is that they're seeing a lot of images on the internet of messages about what they should be looking like. And so I think that what I've noticed over the course of my career is, one, you know, we've gone from women not having to shave quite such a large area to being concerned about all of it and I think the images are available for kids at very young ages who are feeling like they need to conform to a particular appearance.

Dr. Jones: Well, I remember stealing my father's. And for those of you who are regulars on my podcast, in the podcast, "The 7 Domains of When Does a Girl Become a Woman," I stole my dad's razor because I couldn't find my mom's and my dad's was in his dopp kit at about 13 and started shaving my legs because that's what I thought women did and at 13 I wanted to be a woman. And so I shaved my legs and didn't let anybody know, but my dad's razors kept getting dull. And I think he put two and two together and realized I was stealing his razor. And we had to have a conversation about that.

Dr. Ward: Was that one of those razors where you had to unwrap the blade out of a little piece of paper and screw it into the buzzer?

Dr. Jones: Yes.

Dr. Ward: I have vivid memories of stealing my mother's razor just like that.

Dr. Jones: Yes. Well, the concept of beauty or the concept that pubic hair is somehow taboo, I went back at your suggestion and looked at all of the Botticelli Venuses and all the Venuses and either they had their very, very, very long red hair covering their pubic area or they didn't have any pubic hair. And this is in the Renaissance.

Dr. Ward: Yeah. And, you know, those were paintings, so they weren't photographs. So this was a decision the artist was making about what they were displaying. So whether that was how women really looked or how artists, you know, wanted them to look. I guess we don't know for sure, but for a long time, we certainly weren't displaying pubic hair. And then there was that very famous painting where . . . it was shocking at the time where it was a woman reclining with all of her pubic hair on display.

Dr. Jones: And did they cover it up with the sheets so no one could see?

Dr. Ward: No. But it was considered a very shocking painting for its day. It still is actually. I think it's still . . .

Dr. Jones: Well, if you look back at those paintings, when there were men who were nude, they didn't have hair either. When you watch the man or the woman reaching up, if they were nude for an apple or something, they didn't have any armpit hair either. So the concept of growing hair or axillary hair was not considered beautiful.

Dr. Ward: No.

Dr. Jones: Do you think that any of this is co-cultural with female genital mutilation, the concept of being smooth? So when mothers are bringing their little girls to have a circumcision done, they say that they want them to be smooth because men want them to be smooth. And that's the same kind of words women are using when they're choosing to shave.

Dr. Ward: There's one interesting survey looking at Muslim women and they are getting some cultural teaching from the generations above them about the importance of shaving as part of a cultural norm. But I think that there's a difference between female genital cutting or mutilation and shaving in that generally the cuttings being done to young girls, you know, when they're not able to consent or participate or really understand what's happening to them and it's, you know, a choice being made by the mothers, grandmothers, fathers about their future behavior where shaving is that kind of an ongoing activity that women choose to do themselves, you know, except for modern lasers, less permanent. So something you have to continue to choose to engage in because the hair grows back.

Dr. Jones: So then we have this cultural shift in this country, and I'm assuming in Europe. When I first started practice, no one shaved, and then over a relatively short period of time I didn't see anyone with pubic hair practically anymore, anybody under 60. So you did some research in this area as to why do people do this?

Dr. Ward: I did. I think that I was starting to say that I've been doing this work for quite a while. And same experience, early days, nobody really was shaving everything and then everybody, young women, old women, conservative women, liberal women, kind of everybody felt obliged to shave or groom. And I'm going to use groom because, you know, shaving's only one method of removing hair, but not everybody shaves it all off.

But it seemed like everybody felt obliged to groom most all of their genitalia to some degree or another. You know, that was just something that I was curious about because typically those secondary sex characteristics, breasts, hips, chest hair, if you're a male, those are attractive and things you kind of want to exaggerate. And so this just seemed to be sort of the opposite of how we typically respond to secondary sex characteristics, is to try and remove it.

And I think one of the, you know, sort of feminist thoughts about genital grooming is it's giving you a prepubescent look and is there something wrong with that, that that's attractive? And so, yeah, I was really . . . I started to get really curious about why this would be appealing, to reduce your pubic hair. So yeah, that set me on a decade-long bunch of research about it, with a colleague of mine and I, we've collected some data about how people view both, you know, members of the same sex and members of the opposite sex with regard to their body hair because, you know, it's not only women who are grooming their genitals. Males are grooming as well.

So there's some researchers in the Midwest who surveyed both male and female college students, and 95% of men in her study were grooming their genital area as well as women. In our study, it was about 63% of men that were reducing their pubic hair. You know, it's become a concern for both men and women, which I think is also really interesting.

Dr. Jones: I remember toweling off my four-year-old who had been in the shower with his dad. And so I'm toweling him off and he turns around and points at his father and he said, "Dad, does it make you sad that you have hair down there?" And I'm like, "Does it make you sad?" So he thought maybe his dad might be sad that he had hair down there because he didn't and he didn't feel sad, therefore his dad must feel sad that he had hair down there.

But for women who have hair on their face and choose to remove it, they often do feel sad, the concept of feeling of low self-esteem or they feel like this isn't right and it isn't feminine. And so there are a lot of emotional overtones to hair on women's faces. I don't know that there's the same emotional overtones about pubic or axillary here. Do you think that's the case?

Dr. Ward: I don't currently. And, you know, I think one of the things is, you know, it probably is a fashion, as we've talked about a little bit in the '60s and the '70s, growing hair was one kind of fashion and now removing it is another. And so I think, you know, if I had anything to say about it, it's like maybe don't do the laser treatment because it may come back in style or as you go through menopause and it thins out, as you've mentioned, you may miss it and having lasered it off, you don't have the option to switch back as fashions change.

But at least for women right now, and if you are, you know, willing to accept some of the risks that we've talked about, interestingly there's a group that studied this and women who were grooming their genitalia actually that was associated with an increased interest in sex and also an increase participation in sex as well as higher female satisfaction scores and female genital self-image scores. You know, self-esteem is kind of an interesting thing where it's, you know, that difference between, you know, whatever is being held up as the ideal and where you see yourself relative to that ideal. And so, to that extent, I think being able to groom your hair down there is, you know, it's a relatively accessible way to conform to whatever the current standard of beauty is. And that does seem to fluctuate, as we said.

Dr. Jones: I'm still fixated on my domain, which is facial hair. As a reproductive endocrinologist, I focus, had many women come to me because of growth in their facial hair. And it is part of your outward and visible sign of who you are, whereas grooming privately can be a visible sign of who you are, depending on who you're sharing your visage with, but being out there in public with hair on your face is something that the majority of women are not really comfortable with it. At least not in my practice and I'd say not in general. Yeah.

Dr. Ward: No. I have vivid memories of my mother. She was in a nursing home in her final months of her life and she had a lot of health things to be concerned about, but when I would come to visit, the thing she wanted me to do was pluck her chin hairs.

Dr. Jones: Oh my sister and I have a pact if either have us stroke and we're not dead yet, we will do this for each other so no one will see what we've been doing privately for the last 70 years.

Dr. Ward: Right. I made quite an impression on me about just how deep that was for her.

Dr. Jones: Exactly. Exactly. Now, getting to the financial domain, you know, a shaver is not that expensive, but you can't just get any old shaver. I suppose you have to get these kinds of fancy pants shavers, but I would guess a waxing, or threading, or lotion, or sugaring or all these things you do, that costs money.

Dr. Ward: It does. And so here's an interesting, you know, just tidbit of information, is that razors, good razors are one of the things most commonly stolen from grocery stores and drug stores, which is why they are so tightly secured. Most every place keeps them behind lock and key or puts one of those tags on them because people are desperate enough to need to steal something, right? They steal razors. So that says something about the motivation to use them. So even, you know, the good razors are fairly expensive just to get a, you know, like a multi-blade sharp razor.

Dr. Jones: Yeah, yeah. I use mine for months. But I don't have much hair left, so it barely matters.

Dr. Ward: But yeah, you know, wax is, you know, it runs about $50 to $75 plus a tip.

Dr. Jones: And how often do you have to do it?

Dr. Ward: Probably about every four to six weeks. It grows back. So that can get really expensive. Laser treatment actually takes multiple visits because you have to go back. It only kills certain hairs in a certain phase of their growth. And so you have to go back every 6 to 12 weeks for a number of months, and that can cost women between $2,000 and $3,000 for thorough laser removal. You can go a couple of times and maybe thin it out.

I think for women trying to remove hair on their face, I would recommend laser or electrolysis, depending on how much hair you have because, you know, it is permanent or close to permanent. And especially if you have high contrast hair, so if you have dark hair on light skin, it's pretty effective and that might be worth the investment. But I think to treat a large area, it gets to be pretty expensive.

Dr. Jones: Right. To do your armpits, and your groin, and all your legs, and maybe your arms. And that's a commitment, but people tattoo their whole body. So I think people are used to paying a lot of money to do things to their skin that are painful. I don't get it, but it's not my job to get it. My job is just to listen and so . . .

Dr. Ward: Right? But I think, you know, I do talk to people about this. I think it's important to make sure that you investigate your practitioner and that they're qualified and experienced and if you're going to pursue this, I would definitely not look for the bargain basement prices but maybe pay a little extra for the person with good experience and good equipment.

Dr. Jones: Well, a lot of estheticians have to be licensed, and so they have certain training and they may be a licensed esthetician and so there may be some special ways that you want to clean your equipment and even when you're using the electrolysis needle, those all have to be very specially cleaned. And yeah, I think there are a few risks, and you want to go to someone who's a good practice.

Dr. Ward: Yeah. But yes, it can get to be expensive. I think, you know, if I were going to recommend a procedure to anybody, I would say to buy a men's beard trimmer. You can get those for fairly cheap, and they come with a range of kind of guards on them. So you can trim your hair to, you know, a shorter length without totally coming in contact with your skin and risking the cuts and abrasions and things.

Dr. Jones: Well, you know, as we think about who we are as children of God or gods or children of nature, what is your body meant to be and how do you see yourself? And I know all those religious, you know, those beautiful beauties in the Renaissance who are often, you know, religious or spiritual kinds of goddesses, they didn't have any hair, but when I think about being comfortable with your body and comfortable in being the person that you want to be on this earth, I guess if shaving is part of it, and I know that shaving is part of it for women on their face and, in fact, it makes it just equally as acceptable to shave other places, but how you come to one with yourself and who you are.

Dr. Ward: Yeah. You know, and so I, you know, after having spent 10 years really thinking probably more than many people do about all these different domains of what it means to groom this hair that, you know, as you mentioned, when we're talking about your pubic hair, in particular, that you're not really showing that to everybody who sees you, but usually to somebody that you have more of an intimate relationship with. And I've actually kind of come full circle about it. I think that one of the interesting things about being a hairless primate is that kind of very sensitive, exposed skin that we have as a feature of our unique lineage as a species and I think we sort of like exposed skin.

And so at the end of the day, I think if people enjoy the sensation of having their skin exposed and that that's enhancing their either, you know, whether it's their . . . and some of this research that we've mentioned talks about their interest in sex and their genital self-image of themselves and their ability to enjoy sex or that kind of being able to be really skin-to-skin with their partner and they can do this safely, I think that it's probably okay.

Dr. Jones: There is something as a woman myself about having my skin be smooth. It's just, I like my . . . on my arms or wherever, I like having my skin be smooth. And I can imagine that you could take that to your entire body except for your head hair although some women now are shaving all their head hair too. So there you go. And it's so intensely personal and our job is to not see the patients as we see them, but to try to see the patients they see themselves.

Dr. Ward: Yes.

Dr. Jones: Well, at this point, I'm going to lead out with a little haiku, unless, Katie, you wrote one, but I told you didn't have to.

Dr. Ward: Thank you. It would have been a limerick.

A limerick. Oh, my goodness. Okay. Well, we can always add a limerick, but here we go. Here we go is the seven domains of shaving haiku.

Little sprouts from skin
Hair today, gone tomorrow
The human rainbow

So thanks, everybody, for listening to the "7 Domains of Women's Health," the show, and if you're interested in any of our other shows and you haven't tuned into them, please, you can get them at womens7.com. That's W-O-M-E-N-S-7.com. And we have other podcasts that you want to wrap your head around, including men's health. So for everyone who's out there, stay safe, stay smooth. Thank you very much. Bye.