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J Behav Health
System atic Review of Prevalence, Attitude, Practices of Pubic Hair Remova l (PHR) activities
Journal Name : J ournal of Behavioral Health
Manuscript ID : 57-1567006953
Manuscript Type : Review Article
Submi ssion Date : 28-Aug-2019
Abstract : Background and Objectives - The PHR practices are common around the world, for long the internet has
been source of information, which is usually avialble from blogs, forums, soc ial media. A lot of
misinformation, mis guidance is resulted because of lack of scientifically published literature providing proper
information on the P HR practices. We undertook s ystematic review of existing population based studies to
understand the prevalence, attitude, pract ices of PHR in published literature. Methods - We searched for
population based studies across the globe for prevalence, attitude and practice of PHR in study participants
on electronic databases (PubMed, Google Scholar, J-Gate, Medline). A total of 307 titles were identified on
which 9 were considered eligible for the study. Descriptive analysis was carried on the 9 identified s tudy to
know the prevalence, attitude and practices of PHR. Results - The prevalence of PHR at least once was
75%, Friends(73%) were the prime motivators to init iate the first PHR activity . P ersonal Hygiene(69%) was
cited as the most c ommon driver for regular PHR activit y. Shaving using Razor blade(58%) was the most
common mode of PHR and Abrasion(34%) was the most common complication. Conclusions - Pubic Hair
Removal is a common practice among both males and females, the practic e is initiated and propelled mostly
through personal preferences. The current need is to undertake population based s tudies, specif ically in
developing countries and present the evidence backed information on do's and don'ts for optimum PHR
experience with minimal complic ations.
Keywords : Pubic Hair removal, Attitude, P ractices
For your que stions pl ease send messa ge to info@sco peme d.com
Title of the article: Systematic Review of Prevalence, Attitude, Practices of Pubic Hair
Removal (PHR) activities.
Abstract:
Background and Objectives - The PHR practices are common around the world, for long the
internet has been source of information, which is usually avialble from blogs, forums, social media. A
lot of misinformation, misguidence is reuslted because of lack of sicentifically published literature
providing proper information on the PHR practices. We undertook systmeatic review of exisitng
population based studies to understand the prevlaence, attitude, practices of PHR in published
literautre.
Methods - We searched for population based studies across the globe for prevalence, attitude and
practice of PHR in study paprticpiants on electronic databases (PubMed, Google Scholar, J-Gate,
Medline). A total of 307 titles were identified on which 9 were considered eligible for the study.
Descriptive analysis was carried on the 9 identified study to know the prevalence, attitude and
practices of PHR.
Results – The prevalence of PHR atleast once was 75%, Friends(73%) were the prime motivators to
intiaite the first PHR activity. Personal Hygiene(69%) was cited as the most common driver for regular
PHR activity. Shaving using Razor blade(58%) was the most common mode of PHR and Abrasion(34%)
was the most common complication.
Conclusions – Pubic Hair Removal is a common practice among both males and females, the practice
is initiated and propelled mostly through personal preferences. The current need is to undertake
population based studies, specifically in developing countries and present the evidence backed
information on do’s and don’ts for optimum PHR experience with minimal complications.
Key-words: Pubic Hair removal, Attitude, Practices
Key Messages: The researchers form developing countries must proactively initiate studies to
understand the prevalence, attitude and practices associate with PHR rather than market forces and
lay information leads to misguidance of general population leading to increased complication related
to PHR.
Abstract Page
Introduction:
The practice of hair removal from different body parts and areas is common across cultures(1,2). The
practice of removing pubic hair is quite evident from artistic depictions, paintings, religious text
recommending removal of pubic hairs(1). The Pubic Hair Removal (PHR) practices were associated in
middle ages with regular hygiene, specifically to avoid pubic lice(1,3). The PHR practice is common all
round world yet there exist a lot of conflicting lay literature, mostly in forms of health blogs, discussion
forums, social media(4–9). This misguides young adults, teens to experiment with their body hair, using
multiple products, injuries and complications while shaving hairs in inaccessible areas of body. The
debate on complete, partial or non-removal of pubic hairs is long drawn without any conclusive
evidence supporting either of the school of thoughts. The published literature link increased risk of
sexually transmitted diseases. A cross sectional study by Meike et.al(10) published 2017, found a
correlation between partial or complete PHR using razor with potential risk factor for the development
of genital inflammation, vulvar dysplasia, and malignancies. Another study by Armstrong et al(3) in
2006 linked decreased prevalence of pubic lice with waxing of pubic area. The literature has evidence
supporting and against the PHR practices. Thus we planned to undertake systematic review of
prevalence, attitude and practices of public hair removal activities across gender around the globe.
Objective – The objective of this study is to
a.) Systematically access the prevalence of PHR practices from existing literature
b.) Presents the analysis of attitudes and practice related to PHR practices form existing literature
Text
Materials and Methods:
The systematic review followed structured format outlined in Cochrane Handbook for systematic
reviews(11).
Criteria for Selection of Studies for this review – Population based cross-sectional, cohort, studies
investigating on prevalence, attitude, practices related to PHR across the globe, irrespective of study
settings, age, gender of respondents; published in peer reviewed journals in English language and
published between year 2000 to 2018 were considered for this systematic review. The articles related
to PHR due to medical reasons were excluded.
The review considered only studies published in peer reviewed journals to include information only
from valid sources. The timeline of including studies published in last 20 years was established,
considering the prevalence, attitude and practices change from generation to generation. The studies
published in last 20 years are likely to present information applicable to current prevalence, attitude
and practices.
Search Methods and Data Collection analysis - We searched in four electronic databases (PubMed,
Google Scholar, J-Gate, Medline). We used Medical Subject Heading (MeSH) terms like Personal
Grooming, Personal Hygiene, Pubic Hair, Pubic Hair Removal, Pubic Hair Depilation, Prevalence,
Attitude, Practice, were used with Boolean operators “OR, AND” appropriately.
Author AP and PV were involved in initial search build-up. Total 307 articles were identified through
database search. 76 duplicate records were removed. 231 records were screened for abstract for title,
year of publication, language and 212 were records were excluded from the review. 14 articles were
assessed for eligibility. 5 articles were excluded for not satisfying inclusion criteria. Total 9 studies were
included for descriptive analysis. Two authors AP and PV independently assessed the methodological
quality of the included studies using Strengthening the Reporting of Observational Studies in
Epidemiology (STROBE)(12); any disagreements were resolved with consultation of third author DN.
The flowchart explaining the study selection process according to Preferred Reporting Items for
Systematic Reviews and Meta-analysis (PRISMA) statement(13) is provided in Figure 1.
Results:
The results of these studies are grouped as prevalence, attitudes, and practices. Total nine studies
were included for the review(14–22). All the nine studies(14–22) reported prevalence of PHR amongst
study population. Six studies reported on PHR attitude(14–17,21,22). Six studies reported on PHR
practices(15,17–19,21,22).
Of the nine studies eight studies were form United Sates of America (14–20,22) and one study was
from Saudi Arabia(21). Two studies were conducted on male participants only (15,19), one study
included both male and female participants(16), Six studies were conducted on female participants
only(14,17,18,20–22). Mean age of male participants was 21.4 (SD 3.6) and mean age of female
participants was 23.72 (SD 5).
Prevalence – All studies reported prevalence of ever grooming of pubic area using razor, scissors, wax
or any other technique. One study by Rouzi et al. was removed from the analysis at the study
population included only women participants, ever reported grooming of pubic area. Overall
prevalence across both the gender was 75%, the prevalence amongst male population was 74.14% and
76.32% amongst female population.
Attitude - Under the attitude we present the list of factors that acted as motivation behind PHR
practice when undertaken for first time. One study on female volunteers attending gynaecology clinic
in US(14) reported Friends (73%) as the biggest motivator for undertaking PHR practice for first time.
Another study on Saudi women visiting genecology department of the university hospital in Saudi
Arabia(21) reported Immediate family (Mother/Elder sister) as the prime motivator (84%) for the PHR
practiced first time ever. A study on male volunteers from university in United states(15) reported
Friends (40%) as the as the biggest motivator for undertaking PHR practice for first time.
A study on male and female volunteers from two US Universities(16) reported, 24% females undertook
first ever PHR due to partner recommendation while 60% males undertook first ever.
We investigated the reasons that promote regular pubic hair removal; Personal Hygiene (69%) was the
most reason for the studies reported from United States(14–20,22). For Study reported from Saudi
Arabia(21), Combination Reasons (66%) was mentioned as most common reason. Other commonly
mentioned reasons were Better Sexual Appeal (54%), Better Sexual Experience (51%) and Better Body
Definition (51%). When stratified by gender, Hygiene (71%) and Better Sexual Appeal (69%) were the
most common reasons for regular PHR among males. Whereas Hygiene (68%) and Better Body
definition (50%) was the most common reason for regular PHR among females.
Practices - The most common method of PHR was Razor Blade (58%), followed by electric razor
(20.32%). Other preferred methods were Hair Removal Creams (22%), Trimers and Scissors (15%),
Waxing (6.3%). When Stratified by gender; Shaving using razor blade was the most method across both
the genders. We also compiled list of complications resulted due to PHR practices, that are reported
in the studies. Abrasion (34.16%) was the most commonly reported complication, followed by Ingrown
hair (24.53%), Wax and Razor Burns (19.3%), Minor Cuts and Nicks (18.4%), Itching (15.5%), Rash
(15.6%). Among Males, Abrasion (48.8%) was most common complication, followed by Ingrown Hairs
(32%), Rash (29.8%), Wax and Razor Burns (27.4%), Minor Cuts and Nicks (26.7%). Among females,
Ingrown hairs (20.8%) was the most common complication, followed by Abrasion (19.45%), Itching
(15.5%), Minor Cuts and Nicks (14.35%), Rash (8.6%).
One study on women(18) reported that 3.9% of its study population sought healthcare professional,
while one study on men(19) in United States. The study on Saudi women(21) reported 17% female
participants seeking medical help for their PHR related complications.
Discussion:
Our review showed that, the crude prevalence of ever PHR reported from published literature (mostly
from United States) is 75% with prevalence not varying between genders. Friends were the most
common influencers for initiating PHR amongst study participants. Hygiene was the most common
reason cited for regular PHR practice. Razor Blade was the popular method and Abrasion was the most
commonly reported complication.
A study by Craig et al.(2) reviewed PHR data from Human Relations Area Files’ database, eHRAF World
Cultures. The results from the study indicate hygiene as the most common reason cited for PHR, similar
to our findings. The most common method was Plucking, followed by Shaving. In our study Shaving
was the most common method. Another study by Hodges et al.(23) mentioned Hygiene as the prime
reason for PHR practices amongst women. The study reported Shaving using razor blade as the most
common mode of PHR, similar to our study findings.
Our search found no relevant population based studies from Asia, Africa on the prevalence, attitudes,
practices related to PHR. However, many developing countries including India has seen a sharp rise in
sales of shaving products and accessories(24). The lack of studies from developing countries clearly
indicates the existing knowledge gap in person hygiene, grooming and hair removal areas. The sheer
number of products available in market for hair removal and grooming indicate the increased yet
hidden prevalence of PHR practices in developing countries. The amount of lay information available
from internet in forms of blogs, discussion forums, social media will add to confusion of individuals
engaging in first time PHR practice. The published literature also, doesn’t present a clear picture of
do’s and don’ts for optimum PHR experience with minimal complications. The papers by Trager et
al.(25), Hodges et al.(23) present the best practices to adopt and pitfalls to avoid during PHR practice,
however these practices and pitfalls are derived from population based studies conducted in United
States mostly. The generalisability of these recommendation to Asian, African, Middle Eastern
population remains questionable.
The strength of this study were; this was the first attempt made to our knowledge to systematically
review population based studies to understand the prevalence, attitude and practice of PHR among
the males and females across the world. This review was the first attempt to point out existing
knowledge gap in PHR.
The limitations of this study were; the study didn’t cover the changes in PHR prevalence, attitude and
practices in sexually active and inactive individuals. The review was limited to PHR practices in males
and females only and didn’t review the PHR practices in transgender. The review didn’t look at the
changes in prevalence, attitude, practice of PHR with age, sexual orientation.
To conclude, the PHR is very common practice across males and females, peer pressure plays a key
role as initiator, whereas hygiene promotes regular PHR. Most complications arising due to PHR are
not presented for medical help and Shaving remains the most popular mode.
References:
1. Ramsey S, Sweeney C, Fraser M, Oades G. Pubic Hair and Sexuality: A Review. The Journal of
Sexual Medicine. 2009 Aug;6(8):2102–10.
2. Craig LK, Gray PB. Pubic Hair Removal Practices in Cross-Cultural Perspective. Cross-Cultural
Research. 2019 Apr;53(2):215–37.
3. Armstrong NR. Did the “Brazilian” kill the pubic louse? Sexually Transmitted Infections. 2006 Jun
1;82(3):265–6.
4. 5 Ways to Groom Your Pubic Hair, Ranked From Best to Worst [Internet]. Health.com. [cited
2019 Aug 2]. Available from: https://www.health.com/sexual-health/best-pubic-hair-removal
5. Best Way to Remove Pubic Hair at Home with Minimal Pain [Internet]. Healthline. [cited 2019
Aug 2]. Available from: https://www.healthline.com/health/best-way-to-remove-pubic-hair
6. How to Remove or Trim Pubic Hair [Internet]. Venus. [cited 2019 Aug 2]. Available from:
https://www.gillettevenus.com/en-us/womens-shaving-guide/how-to-shave/how-to-get-rid-of-
pubic-hair/
7. Manscaping for Guys: Designs, Removal Tips, Aftercare, and More [Internet]. Healthline. [cited
2019 Aug 2]. Available from: https://www.healthline.com/health/mens-health/manscaping-
pubic-hair-tips
8. Pubic Hair Removal, How to Remove Pubic/Vagina Hairs, Vagina Waxing | Veet [Internet]. [cited
2019 Aug 2]. Available from: https://www.veet.co.in/hair-removal/clearing-your-pubic-area-
the-best-methods-to-use/
9. Removing Pubic Hair [Internet]. Center for Young Women’s Health. 2013 [cited 2019 Aug 2].
Available from: https://youngwomenshealth.org/2013/08/22/removing-pubic-hair/
10. Schild-Suhren M, Soliman AA, Malik E. Pubic Hair Shaving Is Correlated to Vulvar Dysplasia and
Inflammation: A Case-Control Study. Infectious Diseases in Obstetrics and Gynecology.
2017;2017:1–5.
11. Chandler J, Higgins JP, Deeks JJ, Davenport C, Clarke MJ. Cochrane Handbook for Systematic
Reviews of Interventions. :50.
12. ISSM_STROBE_Checklist.pdf [Internet]. [cited 2019 Aug 5]. Available from:
https://www.elsevier.com/__data/promis_misc/ISSM_STROBE_Checklist.pdf
13. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010
Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials.
Journal of Clinical Epidemiology. 2010 Aug 1;63(8):e1–37.
14. Bercaw-Pratt JL, Santos XM, Sanchez J, Ayensu-Coker L, Nebgen DR, Dietrich JE. The Incidence,
Attitudes and Practices of the Removal of Pubic Hair as a Body Modification. Journal of Pediatric
and Adolescent Gynecology. 2012 Feb;25(1):12–4.
15. Boroughs M, Cafri G, Thompson JK. Male Body Depilation: Prevalence and Associated Features
of Body Hair Removal. Sex Roles. 2005 May;52(9–10):637–44.
16. Butler SM, Smith NK, Collazo E, Caltabiano L, Herbenick D. Pubic Hair Preferences, Reasons for
Removal, and Associated Genital Symptoms: Comparisons Between Men and Women. The
Journal of Sexual Medicine. 2015 Jan;12(1):48–58.
17. DeMaria AL, Berenson AB. Prevalence and correlates of pubic hair grooming among low-income
Hispanic, Black, and White women. Body Image. 2013 Mar;10(2):226–31.
18. DeMaria AL, Flores M, Hirth JM, Berenson AB. Complications related to pubic hair removal.
American Journal of Obstetrics and Gynecology. 2014 Jun;210(6):528.e1-528.e5.
19. Gaither TW, Truesdale M, Harris CR, Alwaal A, Shindel AW, Allen IE, et al. The Influence of
Sexual Orientation and Sexual Role on Male Grooming‐Related Injuries and Infections. The
Journal of Sexual Medicine. 2015 Mar;12(3):631–40.
20. Herbenick D, Schick V, Reece M, Sanders S, Fortenberry JD. Pubic Hair Removal among Women
in the United States: Prevalence, Methods, and Characteristics. The Journal of Sexual Medicine.
2010 Oct;7(10):3322–30.
21. Rouzi AA, Berg RC, Turkistani J, Alamoudi R, Alsinani N, Alkafy S, et al. Practices and
complications of pubic hair removal among Saudi women. BMC Women’s Health [Internet].
2018 Dec [cited 2019 Aug 1];18(1). Available from:
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0661-6
22. Rowen TS, Gaither TW, Awad MA, Osterberg EC, Shindel AW, Breyer BN. Pubic Hair Grooming
Prevalence and Motivation Among Women in the United States. JAMA Dermatology. 2016 Oct
1;152(10):1106.
23. Hodges AL, Holland AC. Prevention and Treatment of Injuries and Infections Related to Pubic
Hair Removal. Nursing for Women’s Health. 2017 Aug;21(4):313–7.
24. Chennai S. STATUS REPORT ON SAFETY RAZOR BLADES INDUSTRY. :75.
25. Trager JDK. Pubic Hair Removal—Pearls and Pitfalls. Journal of Pediatric and Adolescent
Gynecology. 2006 Apr;19(2):117–23.
Conflicts of Interest – None
Figures and Tables
Figure 1. Study Identification and selection process for the review
Records Identified through
database search (n = 307)
Records After Duplicate
Removal (n = 231)
Duplicates
(n = 76)
Titles and Abstracts
Screened (n = 231)
Full Text Articles assessed
for eligibility (n = 14)
Articles included for
descriptive analysis (n = 9)
Records Excluded
(n = 212)
Full text articles not
satisfying inclusion criteria
(n = 5)
Table 1. Prevalence of PHR – details form the included studies
Study
Year of
Publicat
ion
Sample
Size
Prevalence
(%)
Gender
Country
Mean
Age
SD
Age
Bercaw Pratt et al.
(14)
2012
171
70.4
Females
USA
15.6
1.9
Michael Boroughs et
al. (15)
2005
100
74.7
Males
USA
22.04
4.75
Scott Buttler et al.
(16)
2015
671
69.45
Males
and
Females
USA
20.3
2.02
439
63.32
USA
20.3
2.02
De Maria et al. (17)
2013
1677
91.9
Females
USA
#
#
De Maria et al. (18)
2015
333
86.80
Females
USA
#
#
Gaither et al. (19)
2015
3176
84.4
Males
USA
22
4.2
Herbenik et al. (20)
2013
2354
55.6
Females
USA
32.69
9.18
Rouzi et al. (21)
2018
400
100
Females
Saudi
Arabia
26.3
6.9
Rowen et al.(22)
2016
3372
83.8
Females
USA
#
#
# - Not reported in Mean (SD) format
Table 2. Attitude of PHR - details form the included studies.
Study
Gend
er
Factors for first initiation
of PHR (%)
Factors promoting regular PHR (%)
Friends
Family
Media
Television
Hygiene
Body
Definition
Sex appeal
Sex
experience
Religion
Others
Bercaw Pratt et al. (14)
F
73
43
15
16
Not Reported
Michael Boroughs et al.
(15)
M
40
23
21
20
75
39
69
32
0
11
Scott Buttler et al. (16)
F
Not Reported
73
79
86
83
0
4
Scott Buttler et al. (16)
M
Not Reported
67
64
69
70
0
2
De Maria et al. (17)
F
Not Reported
73
41
26
18
0
11
Rouzi et al. (21)
F
7
84
5
0
9
19
0
0
5
66
Rowen et al.(22)
F
Not Reported
59
32
21
0
0
46
Table 3. Practices of PHR (Methods) - details form the included studies
Study
Gende
r
Methods of PHR (%)
Razor
Blade
Electric
Razor
Cream
Scissors
Laser
Wax
Others
Michael Boroughs et
al. (15)
M
70.7
32
54.7
26.7
0
6.7
29.3
De Maria et al. (17)
F
66.07
0
15.9
19.79
2.7
13.9
0
De Maria et al. (18)
F
89.5
15.1
16
11.8
0.6
7.2
0
Gaither et al. (19)
M
25
40.5
0
12.8
0
1
0
Rouzi et al. (21)
F
35.5
2
1.5
2
8.7
4.5
6
Rowen et al.(22)
F
61
12
0
17.5
0.7
4.6
0
Table 4. Practices of PHR (Complications) - details form the included studies
Study
Gender
Complications (%)
Rash
Itching
Cuts
Abrasion
Infection
Ingrown hairs
Michael Boroughs et al. (15)
M
0
0
26.7
29.3
0
32
De Maria et al. (17)
F
0
0
0
0
0
0
De Maria et al. (18)
F
13.2
21.1
18.4
36.7
4.9
32.7
Gaither et al. (19)
M
29.8
0
0
68.3
2.5
0
Rouzi et al. (21)
F
4
9.9
10.3
2.2
0
8.9
Table 5. Methodological Quality of Studies Included in the Review
Study
Specific Objective
Study
Design
Metho
d of
partici
pant
selecti
on
descri
bed
Data Source
Efforts to
address
source of
bias
Explanation on
Sample Size
Estimation
Generalisability of Study findings
Bercaw Pratt et al. (14)
To evaluate the
incidence, attitudes, and
practices of the removal
of pubic hair as a body
modification
Cross
Sectional
Study
Yes
Gynaecolog
y clinic
No
No
Can be generalized to young
adolescent girls with White,
Indian, Hispanic ethnicity;
with similar
sociodemographic
characteristics
Michael Boroughs et al.
(15)
To estimate the
prevalence of
body depilation in a
sample of men, to
determine the reasons
for body depilation and
the methods used
to reduce and remove
body hair, and to assess
the social and affective
variables related to body
depilation.
Cross
Sectional
Study
Yes
University
Students
No
No
Can be generalized to young
adult males with White,
Hispanic, African, Asian
ethnicity with similar
sociodemographic
characteristics
Scott Buttler et al. (16)
To assess the pubic
hair removal and
grooming practices of
college
Cross
Sectional
Study
Yes
University
Students
Large
sample
size
No
Can be generalized to young
adult males and females with
White, Hispanic, African,
Asian ethnicity with similar
students, as well as
identify reasons for
choosing a Pubic Hair
Removal particular pubic
hair style, preferences
for sexual partner’s
pubic hair, and possible
health outcomes
associated with common
genital grooming and
pubic hair removal
practices
sociodemographic
characteristics
De Maria et al. (17)
To describe pubic hair
grooming behaviours
and the extent to which
grooming was related to
demographic
characteristics and
sexual activity in a large
sample of low-income
Hispanic, non-Hispanic
Black, and non-
Hispanic White women.
Cross
Sectional
Study
Yes
Health
Clinics
Large
sample
size
No
Can be generalized to women
of Hispanic ethnicity with
similar sociodemographic
characteristics
De Maria et al. (18)
To report on pubic hair
removal practices,
complications, and
characteristics
associated with
complications among a
clinical sample of low
income, racially diverse
women
Cross
Sectional
Study
Yes
Health
Clinics
No
No
Can be generalized to women
of Hispanic, African and White
ethnicity with similar
sociodemographic
characteristics
Gaither et al. (19)
To characterize the
influence of sexual
orientation and sexual
role on grooming
behaviour, injuries,
and infections in men in
the United States
Cross
Sectional
Study
Yes
General
Population
Study
quality
control
measure
s were
taken
No
Can be generalized to Males
with similar
sociodemographic
characteristics
Herbenik et al. (20)
To assess demographic,
affective, relational,
situational, and
behavioural factors
related to women’s
pubic hair removal.
Cohort
Yes
General
Population
Study
quality
control
measure
s were
taken
No
Can be generalized to Females
with similar
sociodemographic
characteristics
Rouzi et al. (21)
To examine
pubic hair removal
practices and prevalence
of its complications
among Saudi women
living in Jeddah, Saudi
Arabia.
Cross
Sectional
Study
Yes
Health
Clinics
Study
quality
control
measure
s were
taken
No
Can be generalized to Women
from Middle east with similar
sociodemographic
characteristics
Rowen et al.(22)
To characterize current
pubic hair grooming
practices in the United
States
Cross
Sectional
Study
Yes
General
Population
Study
quality
control
measure
s were
taken
Yes
Can be generalized to Females
with similar
sociodemographic
characteristics