Pubic Hair and the Urinary and Vaginal Microbiome

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.

Inclusion Criteria:

- Pre-menopausal women between the ages of 18-50

- English-speaking

- Women with either natural growth/distribution of pubic hair or complete removal of
pubic hair through a reversible process.

- Women who do not feel they have urinary or vaginal health problems and are not seeking
care for these issues

- Women must be willing and able to complete study documentation and study procedures.

Exclusion Criteria: Women will be excluded for any of the following:

- Hair has been removed through an irreversible process like laser or electrolysis

- Patient feels they have bothersome urinary or pelvic floor conditions for which they
are seeking care (for example: vaginal prolapse, frequent urinary incontinence,
chronic pelvic pain, bladder pain)

- Patient plans on having any type of surgery in the next 2 months (due to likely
antibiotic use)

- Patient has a history of a transplant and is on immunosuppression

- Patient has cancer for which she is currently getting chemotherapy or radiation

- Currently taking or has taken antibiotics in the last 7 days for any reason

- Patient has symptoms of a urinary tract or vaginal infection or is found on exam or
culture to have a urinary tract infection or vaginal infection

- Patient is pregnant or breastfeeding

- Patient has douched in the last 48 hours

- Patient has had intercourse in the last 48 hours

- Patient is currently menstruating