Female pubic hair removal and adverse urogenital health outcomes: a systematic review and meta-analysis

Introduction Female pubic hair removal is a widespread practice shaped by aesthetic, cultural, and hygienic factors, with rising global prevalence, particularly in Western countries. Recent studies link extreme or frequent removal to adverse outcomes such as sexually transmitted infections, urinary tract infections, and vaginal microbiota alterations, yet the absence of evidence-based clinical guidelines limits consistent professional recommendations. Objective This systematic review and meta-analysis evaluated the scientific evidence on the urogenital effects of female pubic hair removal and aimed to develop evidence-based recommendations for safer clinical and hygienic practices. Methods A systematic search of Scopus, PubMed, Web of Science, EBSCO, ScienceDirect, and ProQuest was conducted following PRISMA guidelines. Studies published between 2020 and 2025, in English or Spanish, addressing female pubic hair removal and its urogenital effects were included; fifteen studies met the inclusion criteria. Methodological quality was assessed using Joanna Briggs Institute tools, and pooled effect estimates were calculated using a random-effects (DerSimonian–Laird) model. The review was prospectively registered in PROSPERO (CRD420251138298). Results Fifteen studies were included (11 analytical cross-sectional, 3 prospective cohort/longitudinal, and 1 qualitative) across diverse geographical regions. The pooled random-effects odds ratio was 2.15 (95% CI: 1.16–3.98), indicating a significant association between pubic hair removal and adverse outcomes, including sexually transmitted infections, urinary tract infections, vulvovaginal infections, and human papillomavirus. Heterogeneity was high (I² = 94.7%), reflecting variability in exposure definitions, diagnostic methods, and study populations. Conclusions Frequent or complete pubic hair removal was associated with increased odds of urogenital complications and may disrupt vaginal microbiota balance. As all the studies included were observational, these associations should not be interpreted as causal, and may reflect confounding by sexual behaviour, hygiene practices, and socioeconomic status. Evidence on laser hair removal remains limited and mixed: uncontrolled data suggests reduced mechanical trauma compared with shaving, yet laser procedures have also been linked to HPV positivity, likely reflecting inadequate device disinfection rather than a genuine safety advantage. Laser removal should therefore not be endorsed as inherently safer without emphasizing strict sterilization protocols. Clinicians should counsel patients on these risks in a culturally sensitive, non-judgmental manner, favouring less aggressive grooming practices where possible.