The effects of total laser pubic hair removal on sexual functions, body perception and self-esteem in women

Abstract

Objectives: Both males and females carried out pubic hair removal by various methods usually for visual/aesthetic or psychosexual reasons. The aim of the present study was to evaluate self-esteem, body image and sexual functions of women before and after total laser pubic hair removal (TLPHR) which is frequently being prefered due to its long-lasting effects. Methods: A total of 45 sexually active women between 20 and 50 years of age who underwent total laser pubic hair removal were included in the study. The sociodemographic features, Female Sexual Function Index (FSFI), Rosenberg Self Esteem Scale (RSES), Body Cathexis Scale (BCS), Beck Depression Inventory (BDI) of the participants were assessed before the first session and after the 6th session of TLPHR procedure. Results: Total RSES, total BCS scores and the 40th item of the BCS score significantly decreased after the TLPHR procedure (p < 0.001). Total FSFI scores and also FSFI subscales of desire, arousal, lubrication and satisfaction scores were significantly increased after TLPHR (p < 0.001). Conclusion: Our study results demonstrated that self-esteem, genital and total body image, sexual desire, sexual arousal and sexual satisfaction was improved after TLPHR procedure. Wider sampled studies examining the effects of laser pubic hair removal on individual, relational and psychosocial issues in both males and females are needed.

Full text

The effects of total laser pubic hair removal on sexual
functions, body perception and self-esteem in women
Mustafa Murat Aydos1, Sinay Önen2, Efe Önen1
1Department of Urology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
2Department of Psychiatry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
ABSTRACT
Objectives: Both males and females carried out pubic hair removal by various methods usually for
visual/aesthetic or psychosexual reasons. The aim of the present study was to evaluate self-esteem, body image
and sexual functions of women before and after total laser pubic hair removal (TLPHR) which is frequently
being prefered due to its long-lasting effects.
Methods: A total of 45 sexually active women between 20 and 50 years of age who underwent total laser pubic
hair removal were included in the study. The sociodemographic features, Female Sexual Function Index (FSFI),
Rosenberg Self Esteem Scale (RSES), Body Cathexis Scale (BCS), Beck Depression Inventory (BDI) of the
participants were assessed before the first session and after the 6th session of TLPHR procedure.
Results: Total RSES, total BCS scores and the 40th item of the BCS score significantly decreased after the
TLPHR procedure (p< 0.001). Total FSFI scores and also FSFI subscales of desire, arousal, lubrication and
satisfaction scores were significantly increased after TLPHR (p< 0.001).
Conclusion: Our study results demonstrated that self-esteem, genital and total body image, sexual desire,
sexual arousal and sexual satisfaction was improved after TLPHR procedure. Wider sampled studies examining
the effects of laser pubic hair removal on individual, relational and psychosocial issues in both males and
females are needed.
Keywords: Pubic, Rosenberg, hair removal, self-estem, laser
Address for correspondence: Efe Önen, MD., University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Department of
Urology, Mimar Sinan Mah., Emniyet Cad., Yıldırım, 16310 Bursa, Turkey
E-mail: drefeonen@gmail.com, Fax: +90 224 366 0416
Copyright © 2019 by The Association of Health Research & Strategy
Available at http://dergipark.gov.tr/eurj
The European Research Journal 2019;0(0):0-0
oth males and females carried out pubic hair re-
moval for many reasons for over the centuries.
Modern pubic hair removal is often done for
visual/aesthetic or psychosexual reasons rather than
for health reasons. [1]. Women are willing to remove
their pubic hair for the reasons like hygiene, sexual at-
tractiveness, sexual enhancement, religious-social be-
liefs and before any gynecological examination [2, 3].
Also by removing pubic hair women are found to have
higher levels of body shame, self consciousness and
self objectification [4]. In addition to this some re-
searches proposes males prefer sexual partners to be
hairless [5]. Anecdotal reports indicate that pubic hair
removal provide increased aesthetic appearance and
increased tactile sensitivity of the genitals such as the
clitoris, but unfortunately there is insufficient scien-
tific data to support this view [1]. Moreover, unwanted
hair loss might be an extremely distressing condition
and might cause reduction of self-esteem, well-being
and sexuality which was previously demonstrated in
B
ORIGINAL ARTICL E
e-ISSN: 2149-3189
DOI: 10.18621/eurj.513297
Received: January 16, 2019; Accepted: February 7, 2019; Published Online: February 11, 2019
Early Online
The European Research Journal Volume Issue 2019 1

Eur Res J 2019;0(0):0-0 Effect of total laser pubic hair removal on sexual functions, body perception and self-esteem
women treated for breast cancer and women with hy-
potrichosis [6, 7].
razor blade, waxing, plucking, bleaching, depila-
tory creams, electrolysis, laser therapy are the most
known methods for pubic hair removal [2]. Shaving
and waxing are the most common methods of genital
hair removal wherefore they are cheap and easy to ap-
plicate. Because of avoiding frequent side effects and
having longer persistence, the number of women who
prefer laser depilation is increasing nowadays. Not
only pubic hair removal is recommended by Islam as
a tradition of hygiene, but also total pubic hair removal
performed to put forth femininity for sexuality in
Turkish population [8]. Although in many countries
the number of women who have genital grooming is
increasing, total pubic hair removal is still the most
preferred modality in our country for these reasons.
In several studies, sexual intercourse and sexual satis-
faction frequency correlated with total pubic hair re-
moval, particularly in young women. This practice has
an interesting psychosexual basis that has not yet been
fully explored in sexual medicine. The aim of the pres-
ent study was to compare self-esteem, body image and
sexual functions of women before and after total laser
pubic hair removal (TLPHR) procedure.
METHODS
The present cross-sectional study comprised of 45
women who underwent laser depilation for pubic hair
removal between June 2018 and Nowember 2018 at a
referral private clinic and our clinic. Sexually active
women between 20 and 50 years of age who
volunteered to participate and did not have any
psychiatric diagnosis were included in the study.
Ethics committee approval was obtained from the
local ethics committee of Bursa Yuksek Ihtisas
Training and Research Hospital (ID:2011-KAEK-25
2018/06-15). And all the women gave written consent,
were seen by a doctor at entry to the study.
Participants were asked to fill in self-administered
questionnaires before and after the laser depilation
sessions. Laser depilation sessions was performed by
a 755 nm diode laser once a month. Participants
fulfilled the Female Sexual Function Index (FSFI),
Rosenberg Self Esteem Scale (RSES), Body Cathexis
Scale (BCS), Beck Depression Inventory (BDI) before
the first session and after the 6th session of TLPHR
procedure. BMI was calculated by dividing weight (in
kilograms) by height (in meters squared). Since
increased body weight and depressive disorder may
affect self-esteem, body image and sexual functioning,
women with a BMI below 18.5 and above 25 and with
a BDI score above 17 were excluded from the study.
Instruments
Sociodemographic Data Form
This form was developed by the researchers and
contained questions directed at determining the
women's sociodemographic characteristics including
age, height, weight, marital status, education level,
occupation, economic status, medical illness, smoking
status, alcohol and drug use.
Female Sexual Function Index (FSFI)
FSFI questionnaire was created by Rosen et al. for
the assessment of female sexual functioning [9]. The
instrument was validated and adapted to Turkish
population by Öksüz and Malhan [10]. Based on
clinical interpretations of a principal components
analysis, a 6-domain structure was identified including
sexual desire, arousal, lubrication, orgasm,
satisfaction, and pain. Participants completed the
instrument by choosing the option that best described
their situation. Each question was associated with a
value corresponding to the degree of gratification of
the participant. A score of ‘0’ indicates no sexual
activity in the last four weeks, and the others are
numbered from 1 to 5 on an incremental scale.
Rosenberg Self-Esteem Scale (RSES)
RSES is a 10-item likert type scale which was
developed by Morris Rosenberg in 1965 to evaluate
global self-worth by measuring both positive and
negative feelings about one’s self [11]. In our country,
reliability and validity studies of the scale were
performed by Korkmaz [12]. The score received from
the first 10 items is evaluated as high self-esteem for
a total score of 0-1, average self-esteem for a total
score from 2-4, and low for 5-6. Lower scores indicate
higher levels of self-esteem [12].
The Body Cathexis Scale (BCS)
It is a 40-item scale which was developed by
Secord and Jourand in 1953 to measure the level of
2The European Research Journal Volume Issue 2019

Eur Res J 2019;0(0):0-0 Aydos et al
body satisfaction and attitude to body image [13]. The
reliability and validity of Turkish version was
performed by Hovardaoğlu and Özdemir in 1990 [14].
The items are in a 5-point likert type scale that ranges
from 1 = I don't like at all to 5 = I really like. The
lowest possible score from the scale is 40 and the
highest is 200 and higher scores indicate less
satisfaction from the body parts. The Cronbach alpha
coefficient obtained from this tool in our study was
determined to be 0.85.
Beck Depression Inventory (BDI)
BDI is a self-report scale consisting of 21 items
which is used to evaluate physical, emotional,
cognitive and motivational symptoms of depression
[15]. Validity and reliability of Turkish version of BDI
was performed by Hisli Şahin [16]. The total score
vary between 0-63, and the cut-off value is accepted
as 17.
Statistical Analysis
Statistical analysis was performed using SPSS for
Windows version 20.0 (SPSS Inc., Chicago, IL, USA).
The data were analyzed for normal distribution of
continuous variables using histograms and the
Shapiro-Wilk test. The normally distributed
continuous variables were reported as mean ± standard
deviation (SD). Categorical variables were reported as
frequencies and percentages. To examine the
differences between before and after the laser
procedure, the continuous covariates were analyzed
based on paired samples t test and Wilcoxon signed-
rank tests.
RESULTS
The mean age of the study group was 34.1 ± 4.3
years. Thirty-seven (82.2%) women were employed
and 31 (68.9%) women had high education level. All
women were heterosexual and sexually active with a
partner. Thirty-five (77.8%) women were married and
7 (15.6%) were single. The mean BMI of the study
group was 21.9 ± 2.8 kg/m2. The sociodemographic
features of the study group is given in Table 1.
The mean BDI score was 8.9 ± 4.6 before the first
session of TLPHR and there was no statistically
significant change in BDI scores after the procedure
(p
> 0.05). The mean RSES scores of the study group
were 2.3 ± 0.7 before and 1.4 ± 0.5 after TLPHR. The
mean RSES change was statistically significantly
decreased after the laser sessions (p< 0.001). Total
BCS scores were 174.42 ± 17.32 before and 156 74 ±
16.22 after the procedure (p< 0.001). Especially the
BCS scale 40th item, which indicates the satisfaction
from genital organs, was evaluated separately and
statistically significantly decreased score was found
after the TLPHR procedure (p< 0.001) (Table 2).
The mean total FSFI scores of participants were
26.2 ± 3.4 before TLPHR and 32.5 ± 3.9 after TLPHR
procedure. Total FSFI scores significantly increased
after the laser depilation (p< 0.001). FSFI subscales
of desire, arousal, lubrication and satisfaction scores
were significantly increased after TLPHR (p< 0.001).
The mean scale scores before and after TLPHR
procedure are given in Table 3.
DISCUSSION
The present study evaluated the alteration of self-
esteem, body image and sexual functions of women
who was applied total laser pubic hair removal. Our
study results demonstrated that self-esteem, genital
and total body image, sexual desire, sexual arousal and
The European Research Journal Volume Issue 2019 3
Table 1. Demographic characteristics (n = 45)
Age (mean ± SD)
34 ± 4.3
Marital Status, n (%)
Single
Married
Widowed/Divorced
7 (15.6)
35 (77.8)
3 (6.6)
Education Level, n (%)
Literate
Primary School
High School
University
4 (8.9)
10 (22.2)
15 (33.3)
16 (35.6)
Economic status, n (%)
Low
Average
High
8 (17.8)
20 (44.4)
17 (37.8)
BMI (kg/m2) (mean ± SD)
21.9 ± 2.8
BMI = Body mass index
!

Eur Res J 2019;0(0):0-0 Effect of total laser pubic hair removal on sexual functions, body perception and self-esteem
sexual satisfaction of study population was improved
after TLPHR procedure.
Regular cleaning and grooming of the pubic hair
is an important doctrine in Muslim societies. Thus, the
hygiene of the pubic area and to be hair-free before
sexual intercourse, is a cultural and religious
expectation both for women and their spouses that can
affect the sexual functions and marital adjustment of
the couple. Muallazaziz et al. [8] reported that laser
was the third preferred hair removal method among
muslim women according to their study results. Also
in a study with a larger Turkish population laser pubic
hair removal was indicated to be preferred by 16.8%
of the participants [17]. Although it is not the most
commonly used method but the increased tendency to
prefer LPHR for pubic hair removal in recent years
was the reason for the preference of LPHR method in
the present study.
4The European Research Journal Volume Issue 2019
Table 2. The FSFI scores of the volunteers before and after the laser
hair removal procedure
Mean ± SD
p value
FSFI total
Before TLPHR
After TLPHR
26.2 ± 3.4
32.5 ± 3.9
< 0.001
Desire
Before TLPHR
After TLPHR
3.7 ± 0.4
5.2 ± 0.7
< 0.001
Arousal
Before TLPHR
After TLPHR
3.9 ± 0.3
5.1 ± 0.5
< 0.001
Lubrication
Before TLPHR
After TLPHR
4.5 ± 0.7
5.6 ± 0.8
< 0.001
Orgasm
Before TLPHR
After TLPHR
4.1 ± 0.6
5.5 ± 0.8
> 0.05
Satisfaction
Before TLPHR
After TLPHR
4.3 ± 0.7
5.4 ± 1.1
< 0.001
Pain
Before TLPHR
After TLPHR
5.5 ± 0.9
5.4 ± 1.2
> 0.05
FSFI =!Female Sexual Function Index, TLPHR = Total Laser Pubic Hair Removal
!
Table 3. RSES, BCS, BDI scores before and after the TLPHR procedure
Before TLPHR
After TLPHR
p value
RSES total
2.3 ± 0.7
1.4 ± 0.5
< 0.001
BCS
174.42 ± 17.32
156.74 ± 16.22
< 0.001
BCS (40th item)
2.39 ± 0.25
1.77 ± 0.14
< 0.001
BDI
8.9 ± 4.6
9.0 ± 4.8
0.91
Data are show as mean±standard deviation. RSES = Rosenberg Self Esteem Scale, BCS = Body Cathexis
Scale, BDI = Beck Depression Inventory, TLPHR = Total laser pubic hair removal
!

Eur Res J 2019;0(0):0-0 Aydos et al
The study of Sangiorgi et al. [18] showed that
Brazilian women who are satisfied with the
appearance of their own genitalia have a stronger
preference for complete removal of pubic hair.
Herbenick et al. [19] indicated similar results in their
study with 2451 women. In a study of DeMaria et al.
[20] which was carried on with 663 female
participants who had been removing pubic hair, it was
demonstrated that women who were hair-free had a
significantly more positive genital self-image than
women with at least some hair on their genitals. In our
study there was an improvement in the genital body
image of women after total laser pubic hair removal
(TLPHR) procedure, supporting previous findings.
Hirsutism is defined in females as male type
terminal hair growth and distribution occurring in
approximately 60% of cases with Polycystic Ovary
Syndrome (PCOS) [21, 22]. Previous studies have
reported that women who have PCOS are more prone
to depression, anxiety and have lower self-esteem,
negative body image, and psychosexual dysfunction
[23, 24]. Clayton et al. [25] evaluated the impact of
laser hair removal among hirsute women with PCOS
and suggested that laser treatment reduced the severity
of facial hair, depression and anxiety and improved
quality of life over the 6-month study period. Our
study results support the previous findings that the
decrease of unwanted body hair provide an
improvement in body image and sexual functions, and
result in an increase in the one’s self-esteem.
In a study of Herbenick et al. [19] 2451 women
between the ages of 18-65 were compared in terms of
pubic hair removal type and sexual dysfunction, and
found that women who had done total pubic hair
removal had higher scores of total FSFI, desire,
arousal, lubrication, pain and sexual satisfaction than
women with no hair removal and partial hair removal.
Also Bercaw-Pratt et al. [26] point to association
between complete depilation and greater sexual
activity. According to our study results, total FSFI
score and desire, arousal, lubrication and satisfaction
subscale scores were significantly increased after
TLPHR compared to baseline scores. These findings
show that there is a prominent improvement in both
sexual functions and sexual satisfaction of the
participants after TLPHR procedure. The increase in
both sexual desire and sexual arousal might be
attributed to the previous asseverations claiming that
pubic hair removal provide increased aesthetic
appearance and increased tactile sensitivity of the
clitoris.
A study of DeMaria et al. [2] revealed that there was
no significant differences between body esteem scores
among low-income Hispanic, Black, and White
women who were current groomers compared to those
who were not [2]. In contrary our findings indicate an
improvement in the body image and satisfaction in
women after total laser pubic hair removal (TLPHR)
procedure. This contradiction between the results of
the studies can be attributed to the fact that the
participants in our study have higher income levels,
and increased economic status may be related to the
more importance given to the body image and the
increase in expectations on aesthetic issues.
Limitations
This study had several limitations. First, it was
limited to mid/high-income women seeking at our
clinic in the Bursa region and therefore studying in
wider groups could provide more effective results. The
cohort of this study could be accepted as a
representation of a Muslim society; thus, our findings
may not be generalized to other religious, ethnic and
cultural populations.
CONCLUSION
The present study findings indicate that body
satisfaction, self-esteem and sexual functions improve
after total laser pubic hair removal in women. The
results of the study will be valuable for future studies
investigating psychosocial-sociocultural effects of
pubic hair removal such as quality of life,
psychosocial functionality and marital adjustment.
Also more studies with larger groups of patients are
required about this topic.
Conflict of interest
The authors disclosed no conflict of interest during
the preparation or publication of this manuscript.
Financing
The authors disclosed that they did not receive any
grant during conduction or writing of this study.
The European Research Journal Volume Issue 2019 5

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Eur Res J 2019;0(0):0-0 Effect of total laser pubic hair removal on sexual functions, body perception and self-esteem
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