Reviewer ’s rep ort 
 
Title: Practices and complications of pubic hair removal among Saudi women  
 
Version: 1 Date: 18 Dec 2017  
 
Reviewer: Thomas W. Gaither  
 
Reviewer's report:  
 
This is a cross -sectional survey study o f a convenience sample of Saudi women investigating 
pubic hair grooming practices and correlates of complications. I think the study sample and 
religious/cultural aspect of this study is both novel and interesting. However, I do believe that the 
paper requ ires extensive modification before it should be published. In particular, I do not 
believe the conclusions are backed by the methodology. This is a convenience sample and it is 
difficult to say that this population represents the entire Saudi population.  
 
Abstract - 
- When presenting averages and then a range in parenthesis, please clarify if this is the range, 
interquartile range, 1 standard deviation, etc.  
 
- I don't think you need to use the word "self -reported" multiple times as we know this was a 
surve y. You can just say women reported…  
 
- Complications should be defined in the abstract  
 
Background  
- The authors present a nice summary of the literature  
 
- I believe the knowledge gap surrounding pubic hair removal and religion is both novel and 
interest ing  
 
Methods  
- Line 55 -56 "The self -complete survey…" should be self -completed  
 
- Complications should be defined in the methods (i.e. how was this assessed?)  
 
- Is there any idea of how many women refused to take the survey? This should be added in 
the methods section if so.  
 
- The authors should mention this was a convenience sample  
 
- It is unclear how the authors created their regression models. How were the predictors 
chosen? Did they model ANY complication (yes versus no)? Did they perform univariable 
analysis and then a multivariable analysis. I would have compared the population who had a 
complication compared to those without a complication to start.  
 
- Also there is literature on injuries associated with pubic hair grooming. Did the authors 
consider any of these to include in their multivariable analysis?  
Truesdale et al, 2017  
https://www.ncbi.nlm.nih.gov/pubmed/28813560   
- For example, did the authors find that frequency is associated with complications?  
 
- It is unclear what the authors mean by "advice on removal"  
 
- As the entire questionnaire is in English and I do not understand Arabic, how can we be sure 
that the questionnaire measured what it was intended to measure? Was it pre -tested in any 
way?  
 
Results  
- I find it incredible that only 22 refused to participate out of 422! This may represent cultural 
differences than where I am in from in the US  
 
- Do all the women report removing their pubic ha ir? This should be mentioned in the results 
section.  
 
- In Table 1, is the 6.9 after the age the standard deviation? Please clarify in the table  
 
- The authors present a "combination" at the end of each section in the table. Does this mean 
that the 134 in the table who use razor blades, ONLY use razor blades?  
 
- Sugaring is an uncommon practice in the US and this could be explained further in the 
methods/discussion  
 
- I'm curious what sort of treatments did the patients need? This is unclear and potentially a 
serious flaw to outcome ascertainment  
 
- The authors should show the results of the multivariable analysis in a table. I think testing 
frequency of removal and complications would be interesting.  
 
- Although the majority of women did not report religion as a reason for pubic hair removal, 
100% of participants groomed their pubic hair! This is well beyond what is reported in the 
US. Thus, I believe that cultural/religious factors are a reason for the high prevalence of 
grooming.  
 
- Molluscum contagiosum is  two words  
 
- I'm not 100% sure what the age of grooming initiation is in Western cultures; however, I 
find that the numbers presented by the authors to be inaccurate. I believe that 18 is too high.  
https://www.ncbi.nlm.nih.gov/pubmed/22088314   
Although I  do believe that an average age of 13 is still lower than Western cultures.  
 
Conclusions  
- How confident are the authors that this sample of women represents ALL Saudi women? 
This was a convenience sample in a gynecology clinic. Can we really conclude tha t one in 
five Saudi women have experienced a pubic hair grooming related complication?  
Are the methods appropriate and well described?  
If not, please specify what is req uired in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please  explain in your comments to the authors.  
 
No 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
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