Lacy thongs - Sexy or health hazard?
Lacy thongs - Sexy or health hazard? |
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Key words: underwear, clothing, vulvitis
Summary
We aimed to see if there was any association between vulval symptoms or pathology and the style and material of underwear worn or the associated use of panty liners. 100 unselected women attending the Department of Genitourinary Medicine in Newcastle completed a brief questionnaire.
Thongs were the most popular underwear worn in those aged 24 years and under, with briefs being favoured overall. Cotton was the most popular material. 22% of women surveyed had experienced symptoms associated with their underwear – the commonest at fault being thongs and lacy materials. Thong wearers were more likely to attend for a check-up or as a contact of a Sexually Transmitted Infection (STI). The sample size was too small to draw absolute conclusions and although thongs do not appear to pose a health hazard the nature of panties worn or the use of panty liners should be considered in women presenting with external genital or perigenital symptoms.
Introduction
During the summer of 2000 several nursing and medical staff within our department became aware of a new trend. A number of women had attended with vulval soreness and perigenital folliculitis. Some of these women volunteered that they considered that their symptoms may be related to the wearing of thongs. A thong consists of a narrow strip of material running through the natal cleft as opposed to a panel of material covering all or part of the glutei employed in most types of underwear including briefs. It was also observed that any soreness or folliculitis had arisen where the skin was in close contact with the thong, especially around the anal and vaginal introitus. It has been suggested for many years now that the wearing of tight and nylon underwear can be associated with pruritus vulvae. Tight fitting underwear could prevent normal evaporation of vaginal discharge at the introitus causing a constant moistness to the vulval and perineal regions with redness and soreness 1,2. It has been reported that vulvovaginitis was less common in the 1940’s and 1950’s when loose underwear similar to boxer shorts were commonly worn 3. Other studies have looked at undergarments as a possible fomite for infection, leading to vulvitis. Candida species have been cultured from underwear following machine washing of the garments with detergent, but they have not been found to be a source of reinfection 4,5. Human papillomavirus carried on undergarments may increase the risk of reinfection 6. Certain conditions such as bacterial vaginosis and trichomoniasis may also be implicated 3. We could find no previous research into the style or type of underwear worn and its association with vulval pathology or symptoms. To address this, information was collected by questionnaire and assessed with other clinical and personal data.
Methods
Data was collected through questionnaires handed out randomly to 100 women attending the Department of Genitourinary Medicine in Newcastle as shown in Table 1.
Information from their clinic records regarding age, reason for attendance, presenting symptoms and diagnosis were then matched with that from the questionnaires. Statistical calculations were by X2 -test with Yates’ correction using Epi-Info version 6.
Results
The age range of women was 16 to 51 years with a mean age of 24 years.
Underwear - style, materials and panty liners
The majority of women wore briefs, 54 compared with 37 regular thong wearers. Nine wore a mixture of both and were therefore excluded from the analysis of underwear style. The younger age group (those aged under 25) were slightly more likely to wear thongs, 30 compared to 27 brief wearers, a trend that reversed with increasing age. No women admitted to wearing no underwear, although we have heard this is an increasing trend on weekend nights in Newcastle (to prevent a visible panty line, allegedly). Cotton was the most
popular material in both the brief and the thong groups used by 60 women regularly with 30 choosing man-made materials. Ten wore a mixture of materials and were excluded from the material analysis. Ten women stated that they regularly wore panty liners.
Bikini-line treatments.
Shaving (48) was the most popular way of tackling the bikini-line, followed by waxing (17), then cream treatments (16). Fifteen women preferred the natural look. Some women used more than one method. Thong wearers were more likely to wax (12) than brief wearers (five), (X2 =6.31, p=0.012) and brief wearers were more likely to opt for the natural look (11) compared with only four thong wearers (not statistically significant).
Underwear and presenting infection or condition
The relationships between the style of underwear worn, its material and the use of panty liners are shown in Table 2 & 3.
Underwear - association with or without symptoms
More women attending for a check-up with no symptoms wore thongs (11) than briefs (six), (X2 = 3.86 p=0.049). There was no statistical difference in women who were diagnosed with no treatable condition following examination and negative swab results (41% of thong wearers Vs 26% of brief wearers) A total of six contacts were seen of which three wore briefs (5.6% of brief group) and three wore thongs (8.1% of thong group), but this was not statistically significant. Information of vulval symptoms was obtained from clinic cards. Women presenting with symptoms of vulval itching, soreness or superficial dyspareunia were more likely to wear briefs (n=17, 31.5% of brief wearers) than thongs (n=seven, 18.9% of thong wearers). There was also no difference in the material of the underwear worn and symptoms (cotton-14, man-made-10).
Patients` observation and comments
Seventy-eight women stated they had not observed any soreness with any particular underwear, however 22 women stated they had and gave extra comments on their questionnaire. Eleven had observed irritation and soreness associated with thongs.
"Thong sometimes irritable and causes discomfort."
"Occasionally with a thong because they can rub and be ill-fitting."
There were 12 comments on material with 11 stating lace and man-made materials had caused problems ranging from rashes, thrush, sweat and general irritation. Only one woman stated that cotton underwear caused her discomfort.
"When I wear knickers with frilly bits round the leg holes it sometimes rubs my legs and makes them sore."
"Lace usually causes tender skin and even rashes. Also so do some man-made fibre briefs and thongs".
"Anything but cotton is a big NO! I also can’t wear tights – gets too hot and v. uncomfortable."
Discussion
Compared to briefs, the material of a thong lies within the natal cleft, ie between the buttocks, and onto the vaginal and anal introitus. Friction within this area resulting from the small surface area and the garment seams could theoretically result in symptoms of soreness in these sites. However in this study it appears that brief wearers were slightly more likely to have a diagnosis of vulvitis, folliculitis, candidosis and complain of vulval symptoms than thong wearers. Cotton users were also more likely to have candidosis and vulval symptoms than those using man-made materials. These observations are likely to arise from the patient’s choice in avoiding products associated with recurrent vulval discomfort rather than the wearing of cotton briefs. Twenty-two per cent of women had noticed symptoms associated with thongs and man-made material, particularly lace, however the majority of women had no problems. Thong wearers were no more likely to be diagnosed with an STI than brief wearers. However they were more likely to attend for a check-up concerned that they may have been exposed to an STI. Secondly there was also a trend towards more thong than brief wearers attending as a contact of a STI. This may be explained by the younger age range of thong wearers with 12 women attending for a screen under the age of 25 years and only five attending over 25 years. The increase in vulvitis in panty-liner users recorded requires further evaluation as only small numbers are included but may be causal. The increase in bacterial vaginosis within this group, is likely to be a response rather than a cause due to embarrassment of having an increased malodorous discharge. Although over a fifth of women in our survey complained of symptoms associated with specific underwear we found no clinical evidence suggesting one type of underwear was superior to another - therefore if you’ve experienced no problems yourself and you like your cotton briefs or prefer the thong option – go ahead! Despite the small numbers in this study we have shown some trends that are statistically significant and have emerged that may be worth further investigation on a larger population. This is with regard to underwear and the presence of at
least one STI. Until then it is worth considering not only the material of underwear worn, but also its style when women complain of vulval symptoms with no obvious cause.
Acknowledgements: The authors would like to thank Sister Pauline Handy, the nursing and other medical staff in the Department of Genitourinary Medicine at Newcastle General Hospital for all their hard work in obtaining the completed questionnaires.
References
1. Ward GD, Sutherst JR. Pruritus vulvae. Br Med J 1973;860:243.
2. McFarlane CN. Pruritus vulvae. Br Med J. 1973;865:553.
3. Turner M. Panty hose-pants disease. Am J Obstet Gynaecol 1991;164:1366.
4. Rashid S, Collins M, Corner J, Morton RS. Survival of Candida albicans on fabric after laundering. British J of Venereal Diseases 1984;60:277-80.
5. Rashid S, Kennedy RJ, Collins M. A study of candidosis: the role of fomites. Genitourinary Medicine 1991;67:137-142.
6. Bergeron C, Ferenczy A, Richart R. Underwear: Contamination by human papillomaviruses. Am J Obstet Gynecol 1990;162:25-9.
Contributors: RP had the idea for the study. JH and RP designed the study. JH designed the questionnaires and analysed the data. JH and RP were involved with the writing of the paper.
Competing interests: None declared.
Address for manuscript correspondence: J Hussey, 3 Stuart Court, Kingston Park, Newcastle, NE3 2QF
Funding: None required.
Table 1: Questionnaire.
We are doing a small study within the GUM department to assess if the type of underwear worn by women can result in any problems such as rashes or soreness. We would be grateful if you could complete this short questionnaire.
Which of the following do you most regularly wear?
Briefs
Thong
No underwear
Other
What material are they normally made from?
100% cotton
Mixed man-made fibres
Do you wear panty liners on a regular basis?
Yes
No
Do you regularly do any of the following to your bikini line?
Shave
Wax
Use cream removers
Have you noticed any soreness associated with any particular underwear? – please give a few details
Many Thanks!
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