When Waxing May Look Like an STD
Dangers of Vaginal Waxing
Removal of pubic hair is a common practice. Various studies state that 70% of young adult and adolescent women shave or wax their genitals and 87% of women ages 16 to 40 have removed their pubic hair at some point in their lifetime.[1,2] This practice is more common among sexually active women. There are various ways to remove pubic hair, including physical vs. chemical depilators, such as waxing, shaving, and laser hair removal. Waxing, in particular, poses more hazard than shaving. Waxing requires a professional or an at-home kit, both with different risks.
Increased Risk of Contracting Infections & STDs
Waxing carries an increased risk of infections, including sexually transmitted diseases (STDs), as it creates an open area of skin, and can result in bleeding. The bleeding indicates trauma to the skin, allowing organisms like bacteria, fungi, or viruses to enter through the damaged skin. But even without bleeding, tiny tears in the skin usually occur with waxing. These micro-tears allow infections and STDs to enter the body through the skin. This could be secondary to increased sexual activity of women who wax, or it could be due to the impact waxing has on the vaginal skin, which is discussed below.
Folliculitis: The Most Common Infection
Folliculitis is a common minor infection of a hair follicle that may occur after shaving or waxing any part of the body. Usually an ingrown hair will develop first, which presents as a small, itchy, red bump. Ingrown hairs develop, because a thin layer of skin grows on top of the follicle; as the growing hair below is weak, it is unable to break through the thin skin on top. If the ingrown hair is irritated by sweat, friction from underwear, or picking, bacteria will be introduced causing an infection of the hair follicle. This will look like a pimple—a red, painful, or itchy bump with white pus inside. While folliculitis is common, it is important for patients to understand the risks of picking or irritating these bumps because more severe bacterial infections can occur with such manipulation.
Other Bacterial Infections
Due to the trauma caused by waxing, bacteria can easily enter the skin if the area is not kept clean. If bacteria enters into the tissue just beneath the skin, cellulitis can develop. If the bacteria spread further down to the fascia of the muscle, a life-threatening condition called necrotizing fasciitis can develop. It can also spread via circulation to other areas of the body. While these infections do not commonly occur from pubic hair waxing, they are possible if the region is not properly cleansed. Staphylococcus and Streptococcus are two commonly identified bacteria associated with localized skin infections, but can yield more serious problems if they get deeper than the skin. Although severe bacterial infections from waxing are uncommon, if a person is immunocompromised, they are at greater risk of developing a severe infection after vaginal waxing.
Molluscum contagiosum (MC) is a virus commonly identified on the hands, feet, or trunk of children. However, in the adult population, MC is considered an STD since it is spread through direct contact and its presentation in adults is most commonly on the genital region. It presents with numerous small, painless, flesh-colored papules or nodules that have a small dimple in the center. Of all of the STDs, MC is the most common skin infection associated with waxing. Multiple cases of MC after genital waxing are documented in the literature. It is thought that waxing disrupts the skin layers giving the MC virus and the human papilloma viruses (HPV) better entry into the skin.
Genital Warts: Human Papillomavirus (HPV)
Genital warts are caused by the human papilloma virus (HPV). These warts are flesh-colored and painless; they can be big or small, flat or raised, and may appear in clusters. Shaving is one specific risk factor for contracting HPV and developing genital warts. The act of shaving removes the superficial layer of the stratum corneum, allowing viruses like HPV and MC to gain access. Waxing is another process that removes the stratum corneum, increasing the risk of developing MC or genital warts.
Herpes: Herpes Simplex Virus (HSV)
Although contracting herpes or HSV from waxing is uncommon, it can occur if individuals are immunocompromised and if the equipment used for waxing has been exposed to the virus. Anyone with genital herpes and has a current herpes outbreak should not undergo waxing (at home or at a professional salon), as the virus spreads easily through direct contact. Individuals with an active infection are at higher risk of spreading it to others, and to other areas of their own skin. Additionally, immunocompromised individuals should be cautious when choosing to wax at a public facility.
Burn Injuries from Wax
Waxing requires wax to be heated to high temperatures. While professionals know the safest ways to heat wax, individuals with at-home waxing kits are at a significant risk of burn injury from overheating wax. Some wax temperatures have been recorded as high as 108.5˚C (227.3˚F). To put this into perspective, the skin will burn at a temperature as low as 44˚C (109.4˚F), while more severe burns can occur when the temperature is greater than 80˚C (176˚F). Waxing by professionals poses a similar risk, simply due to the necessity of heating wax, however, no cases have been described.
Most of the burn injuries from wax occur due to re-heating at-home wax in a microwave. When these injuries occur, they are severe. Many require a burn center to care for the burn. In some cases, people require skin grafting. Vaginal waxing poses a greater risk due to the thinner skin of some parts of the genital region.
Darkening of the Skin
Hair removal in the form of shaving or waxing causes irritation. This irritation can cause inflammation which ultimately leads to a darkening of the skin, called post-inflammatory hyperpigmentation. It can also result from overheating the skin. Secondary skin darkening is more common in darker skinned individuals, and should be considered prior to shaving or waxing.
How to Decrease Side Effects
Prior to Hair Removal
Use a new razor blade each time you shave. This will ensure the razor blade is free of potential bad bugs that could create an infection. A new razor blade is also sharper, causing less irritation to the hair follicle below and the skin.
Patients should properly clean the skin prior to any form of hair removal and use an antibacterial soap in the area to prevent bacteria or viruses from entering small tears resulting from the hair removal process.
If patients are waxing at home, they should follow the instructions on the waxing kit. The temperature is the most dangerous part, so patients should be careful not to microwave the wax more than once. If a patient chooses to go to a salon, spa or some professional for formal waxing, stress the importance of a reputable establishment.
After Hair Removal
The area should be immediately washed after removing the hair whether waxing or shaving. Cold water will relieve some of the pain of waxing, but ensure the patient cleans the area properly once the pain subsides. If there is some hair remaining after waxing, advise the patient to not go back over the area with more wax as this will cause more irritation. Simply tweeze the area.
Patients should not try to shave or wax the moment the hair begins to grow back. If the hair is too short, it will cause increased irritation during shaving. If too long or too short, waxing simply will not work. Remind your patients that the skin experiences trauma each time hair is removed, so it needs time to heal after a waxing.
Waxing Is Not As Glamorous As It Seems
There are numerous risks with waxing. Ingrown hairs, infections, STDs, post-inflammatory pigmentation, and burns can all occur. If removing pubic hair is a must, a great alternative to waxing is laser hair removal. It is important for patients to speak with a healthcare professional regarding proper pubic hair removal prior to starting a regimen. It is also important to note that the dangers or vaginal waxing also apply to genital waxing in men. Similar risks apply!
- Bercaw-Pratt JL, Santos XM, Sanchez J, et al. The incidence, attitudes and practices of the removal of pubic hair as a body modification. J Pediatr Adolesc Gynecol.2012;25(1):12-14; PMID: 22088314 https://www.ncbi.nlm.nih.gov/pubmed/22088314.
- DeMaria AL, Flores M, Hirth JM, et al. Complications related to pubic hair removal. Am J Obstet Gynecol.2014;210(6):528 e521-525; PMID: 24486227 https://www.ncbi.nlm.nih.gov/pubmed/24486227.
- Herbenick D, Hensel D, Smith NK, et al. Pubic hair removal and sexual behavior: findings from a prospective daily diary study of sexually active women in the United States. J Sex Med.2013;10(3):678-685; PMID: 23237246 https://www.ncbi.nlm.nih.gov/pubmed/23237246.
- Osterberg EC, Gaither TW, Awad MA, et al. Correlation between pubic hair grooming and STIs: results from a nationally representative probability sample. Sex Transm Infect.2017;93(3):162-166; PMID: 27920223 https://www.ncbi.nlm.nih.gov/pubmed/27920223.
- Khanna N, Chandramohan K, Khaitan BK, et al. Post waxing folliculitis: a clinicopathological evaluation. Int J Dermatol.2014;53(7):849-854; PMID: 24134338 https://www.ncbi.nlm.nih.gov/pubmed/24134338.
- Dendle C, Mulvey S, Pyrlis F, et al. Severe complications of a "Brazilian" bikini wax. Clin Infect Dis.2007;45(3):e29-31; PMID: 17599301 https://www.ncbi.nlm.nih.gov/pubmed/17599301.
- Desruelles F, Cunningham SA, Dubois D. Pubic hair removal: a risk factor for 'minor' STI such as molluscum contagiosum? Sex Transm Infect.2013;89(3):216; PMID: 23512968 https://www.ncbi.nlm.nih.gov/pubmed/23512968.
- Schmidtberger L, Ladizinski B, Ramirez-Fort MK. Wax on, wax off: pubic hair grooming and potential complications. JAMA Dermatol.2014;150(2):122; PMID: 24553837 https://www.ncbi.nlm.nih.gov/pubmed/24553837.
- Chang AC, Watson KM, Aston TL, et al. Depilatory wax burns: experience and investigation. Eplasty.2011;11:e25; PMID: 21625616 https://www.ncbi.nlm.nih.gov/pubmed/21625616.
- Zoumaras J, Kwei JS, Vandervord J. A case review of patients presenting to Royal North Shore Hospital, with hair removal wax burns between January and November 2006. Burns.2008;34(2):254-256; PMID: 17716822 https://www.ncbi.nlm.nih.gov/pubmed/17716822.
- Evans RL, Marriott RE, Harker M. Axillary skin: biology and care. Int J Cosmet Sci.2012;34(5):389-395; PMID: 22612735 https://www.ncbi.nlm.nih.gov/pubmed/22612735.