Pubic Hair and the Urinary and Vaginal Microbiome
Condition: Healthy
Study type: Interventional

Summary: 
      This research study seeks to find if there is a connection between the presence of pubic hair
      and the type of bacteria that live in the vagina and bladder.
    

Detailed description: 
      Urinary tract infections (UTIs) are the most common bacterial infections. In 2007, in the
      United States alone, there were an estimated 10.5 million office visits for UTI symptoms
      (constituting 0.9% of all ambulatory visits) and 2-3 million emergency department visits.
      UTIs are significantly more common in women and are a leading cause of urogynecology
      referrals. In women, the vagina plays a key role in the pathogenesis of UTIs. The initial
      step in the pathogenesis of UTI is colonization of the vaginal opening and peri-urethra with
      uropathogens from the intestinal microbiota, followed by ascension of uropathogens via the
      urethra to the bladder and sometimes the kidneys to cause infection. Thus, understanding
      factors that affect the microbiota of the vagina is key to understanding the pathogenesis of
      UTI. Likewise, since Wolfe et al published the first evidence of a urinary microbiome in
      2012, there has been growing interest in whether the content of this microbiome could
      correlate with symptoms of the lower urinary tract. The urinary microbiome has been shown to
      correlate with symptoms of urgency incontinence but to date, there is no data on whether the
      composition of the urinary microbiome is associated with any change in risk for UTIs. If the
      urinary microbiome could play a role in the acquisition of clinical infection, then the
      factors that affect the microbiome of the bladder would be important in preventing UTIs. One
      plausible and modifiable factor that may change the vaginal and urinary microbiome is the
      presence of pubic hair. Hair in other parts of the body (nose, ears, eyebrows) traps and
      stops the passage of pathogens into our mucous membranes. Additionally, the sebum produced by
      hair follicles is bacteriostatic. However, some form of pubic hair grooming is performed by
      the majority of pre-menopausal women (83%) and 62% of women between age 18-40 report having
      removed ALL of their pubic hair at one point in life. This is predominantly done by using
      non-electric razors (61%) but other women use lasers, waxing and depilatory creams.
      Fifty-nine percent of women who perform pubic hair removal report their primary reason is to
      improve hygiene. However, there is no data that this practice changes hygiene, with the
      exception of preventing pubic hair lice. On the contrary, pubic hair removal has been
      associated with skin injury leading to inoculation of bacteria and viruses. In a recent
      cross-sectional study of pubic hair and sexually transmitted infections, researchers found
      that frequent pubic hair grooming was correlated with a higher risk for sexually transmitted
      infections (STIs). This preliminary work raises the question of whether the presence of pubic
      hair affects the vaginal or urinary microbiome, thereby changing a woman's risk of infection
      in either organ. Furthermore, specific pelvic floor disorders (PFDs) including painful
      bladder syndrome and urgency urinary incontinence have been associated with specific
      microbiome profiles. Therefore, by falsely attempting to maintain pelvic health through
      grooming practices, women might inadvertently be exposing themselves to PFDs mediated by
      changes in their urinary or vaginal microbiomes. The aim of this study is to address this
      question through a pilot study of urinary and vaginal microbiomes in women with and without
      pubic hair AND in the same woman with and without pubic hair.
    

Intervention name(s): No pubic hair; Pubic Hair
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Natural pubic hair to fully removed pubic hair; Removed pubic hair to natural pubic hair
Allocation: Non-Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: pubic hair; grooming; urinary tract symptoms; vaginitis