Biomedical versus cultural constructions of abnormality: the case of idiopathic hirsutism in the United States

Psychosocial and financial impact of facial hair among female patients of hirsutism: A cross-sectional study

BACKGROUND

Literature on psychosocial impact, financial burden, and worry in hirsute females with facial hair is limited.

OBJECTIVE

To assess psychosocial impact and financial burden, worry among females with hirsutism.

METHODS

In this cross-sectional, questionnaire based observational study, 50 females with hirsutism having facial hair were interviewed and provided with questionnaires examining the psychosocial impact and financial burden. Psychosocial impact in participants was assessed by the Dermatology Life Quality Index (DLQI) questionnaire, and the financial burden was evaluated using a composite financial burden score. Self-reported financial worry was also calculated.

RESULTS

A total of 50 completed DLQI surveys and financial burden surveys were taken for analysis. The mean DLQI of 50 hirsute females was 15.98 ± 5.79. The mean value of financial burden score was 0.98 ± 1.45, and financial worry was 1.5 ± 0.90. There were 16% of total hirsute females who commonly used trimming/ shaving and Laser therapy as a treatment modality followed by 12% females who did not use any treatment modality for their facial hair. There were 10% females who used waxing and followed by 6% who used a combination of waxing, trimming, and bleaching for managing facial hair. The financial burden impact of laser therapy was significant (p = 0.013) among all treatment modalities.

CONCLUSION

The present study concludes that hirsutism poses a very large effect or psychosocial impact on hirsute females with a significant financial burden with laser therapy as compared to other treatment modalities.

"It's not very feminine to have a mustache": Experiences of Danish women with polycystic ovary syndrome

This article explores women's lived experiences with polycystic ovary syndrome (PCOS) on the basis of semistructured interviews with 21 Danish women. It provides insights about the problems that they experienced and how they coped with PCOS. The interviews revealed that they were highly influenced by society's femininity norms. Many of them perceived their bodies as "different" because of the symptoms of PCOS, namely, hirsutism. They used different strategies to live up to body ideals and cope with the symptoms. However, hirsutism had a decisive negative influence on the women's everyday lives, particularly with regard to male partners and sexual relations.

"It is always on my mind": women's experiences of their bodies when living with hirsutism

Many women suffer from excessive hair growth, often in combination with polycystic ovarian syndrome (PCOS). It is unclear how hirsutism influences such women's experiences of their bodies. Our aim is to describe and interpret women's experiences of their bodies when living with hirsutism. Interviews were conducted with 10 women with hirsutism. We used a qualitative latent content analysis. Four closely intertwined themes were disclosed: the body was experienced as a yoke, a freak, a disgrace, and as a prison. Hirsutism deeply affects women's experiences of their bodies in a negative way.

Women living with facial hair: the psychological and behavioral burden

OBJECTIVE

While unwanted facial hair is clearly distressing for women, relatively little is known about its psychological impact. This study reports on the psychological and behavioral burden of facial hair in women with suspected polycystic ovary syndrome.

METHODS

Eighty-eight women (90% participation rate) completed a self-administered questionnaire concerning hair removal practices; the impact of facial hair on social and emotional domains; relationships and daily life; anxiety and depression (Hospital Anxiety and Depression Scale); self-esteem (Rosenberg Self-esteem Scale); and quality of life (WHOQOL-BREF).

RESULTS

Women spent considerable time on the management of their facial hair (mean, 104 min/week). Two thirds (67%) reported continually checking in mirrors and 76% by touch. Forty percent felt uncomfortable in social situations. High levels of emotional distress and psychological morbidity were detected; 30% had levels of depression above the clinical cut off point, while 75% reported clinical levels of anxiety; 29% reported both. Although overall quality of life was good, scores were low in social and relationship domains--reflecting the impact of unwanted facial hair.

CONCLUSION

Unwanted facial hair carries a high psychological burden for women and represents a significant intrusion into their daily lives. Psychological support is a neglected element of care for these women.

'Hirsutism': a psychological analysis

Hirsutism, i.e. 'excess' body hair in the 'male' distribution, is a medical term applied only to women. Although associated with social and psychological difficulties including anxiety, social avoidance and a confusion of gender identity and although it raises important gender issues, there has been little systematic study. No prior research has focussed on the relationship between women's perceived degree of hirsutism and psychological distress. A survey of 53 women with polycystic ovary syndrome (PCOS), which often produces 'excess' hair growth, was carried out to assess any psychological consequences of perceived hirsutism. Results indicated raised levels of psychological distress overall, but no significant relationships between perceived hirsutism and distress. Four semi-structured interviews were then conducted to facilitate more in-depth exploration of hirsute women's experience. Analysis suggested idealized cultural norms for hair growth prevail and excess hair growth contributes to gender inconsistencies and feelings of deviance and stigma. Effective concealment of hair growth and 'passing' for normal appear to facilitate relatively high levels of functioning and allows idealized cultural norms to be maintained.

Quality of life of hirsute women

Hirsutism is recognized to cause profound distress in affected women, due to cosmetic and psychosexual implications. It was evaluated in the present study by methods found to be valid and reliable in psychosomatic research. Fifty women with hirsutism belonging to the spectrum of disorders from idiopathic hirsutism to polycystic ovary syndrome, after complete medical work-up, underwent the same psychometric evaluation as 50 healthy non-hirsute women, matched for sociodemographic variables. Hirsute women had a Ferriman and Gallwey score ranging from 8 to 19. Psychometric evaluation for quality of life was carried out by the following methods: (a) Kellner's Brief Problem List, a 12 item self-rating list of psychosocial problems; (b) Kellner's Symptom Rating Test (SRT), a 46 item self-rating scale that yields a total score of distress as well as six subscales (anxiety, depression, somatic symptoms, anger-hostility, cognitive and psychotic symptoms); and (c) Marks' Social Situations Questionnaire (SSQ), a 30 item self-rating scale concerned with social phobia. Patients with hirsutism displayed significantly higher social fears at the SSQ than controls (P < 0.01). They also showed more anxiety (P < 0.01) and psychotic symptoms (P < 0.01) at the SRT, whereas there were no significant differences in depression, somatization, anger-hostility and cognitive symptoms. These results suggest that the complex management of hirsute women, in addition to pharmacological and/or cosmetic measures, may require specific psychotherapy.