{ "slug": "why-is-there-hair-coming-out-of-my-anus-female", "question": "Why is there hair coming out of my anus?", "shortTitle": "Hair Coming Out of the Anus", "clinicalQuestion": "In adult women, what is the cause of hair being visible protruding from or around the anal opening, and does it represent normal perianal hair growth versus a sign of hirsutism, androgen excess, or a pilonidal sinus?", "questionKind": "explanation", "pico": { "population": "Adult women who notice hair at or protruding from the anus", "intervention": "Hair growth around or protruding from the anal opening (perianal hair)", "comparator": "", "outcomes": [ "Whether perianal hair is a normal anatomical variant", "Association with hirsutism or androgen excess (e.g., polycystic ovary syndrome)", "Association with pilonidal sinus or cyst formation", "Need for further evaluation or treatment" ], "excludes": [ "Pilonidal sinus hair tuft (hair embedded in a sinus cavity, a different mechanism)", "Rectal prolapse (skin/tissue protruding from the anus)", "Anal skin tags", "External hemorrhoids" ] }, "category": "anorectal", "relatedConditions": [ "hirsutism", "pilonidal-sinus", "polycystic-ovary-syndrome" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "Visible hair around the anus usually isn't a sign of disease, but this hasn't actually been tested by research; the only study that looked directly at excess perianal hair growth found it was caused by a rare hormone-producing ovarian tumor in one postmenopausal woman.", "detail": "Only one study examined this directly: a 57-year-old postmenopausal woman had hirsutism (excess hair growth) affecting her face, perianal area and legs, caused by a hormone-producing ovarian tumor, and her hair growth improved after the tumor was removed [1]. No study has measured how common visible hair near the anus is in otherwise healthy women, so calling it 'normal' reflects common clinical reasoning rather than a confirmed research finding. Other studies describe skin and hair-follicle diseases such as hidradenitis suppurativa occurring in the perianal area, but these do not explain hair protruding from the anal opening itself [2,4,5,6].", "studyIds": [ "pmid:41602386", "pmid:29466546", "pmid:24278084", "pmid:18346431", "pmid:16022640" ] }, "strength": { "level": "very-low", "why": "The only direct evidence is 1 case report or small series.", "override": null }, "direction": { "level": "not-applicable", "why": "This question asks why something happens, not whether a treatment works, so there is no benefit-or-harm verdict.", "override": null, "signOff": null, "withheld": null }, "counts": { "recordsRetrieved": 75, "recordsScreened": 72, "included": 7, "rcts": 0, "systematicReviews": 0, "observational": 1, "participants": 93, "yearFrom": 2004, "yearTo": 2025, "registeredTrialsWithoutResults": 0, "direct": 1 }, "excluded": [], "outcomes": [ { "name": "Normal anatomical hair growth around the anus", "status": "not-studied", "note": "No study counted or measured how common visible hair around the anus is in women without any disease, so research cannot confirm how 'normal' it is, even though it is a common body part to have hair.", "studyIds": [] }, { "name": "Hirsutism or androgen excess (e.g. PCOS, tumors)", "status": "possible-improvement", "note": "One case report found perianal hair growth caused by a testosterone-producing ovarian tumor in a postmenopausal woman, which improved after the tumor was removed. This shows the link is possible but comes from a single rare case, not a group of patients.", "studyIds": [ "pmid:41602386" ] }, { "name": "Pilonidal sinus or cyst", "status": "not-studied", "note": "None of the studies found examined pilonidal sinus (a small pit or tunnel near the tailbone that can trap hair) as a cause of hair visible at the anus.", "studyIds": [] }, { "name": "Hidradenitis suppurativa (a chronic hair-follicle skin disease)", "status": "insufficient", "note": "Several articles describe this disease affecting hair follicles in the perianal skin, but none of them describe or explain hair actually protruding from the anal opening, so this cannot confirm or rule out a link.", "studyIds": [ "pmid:29466546", "pmid:24278084", "pmid:18346431", "pmid:16022640" ] }, { "name": "Need for further medical evaluation", "status": "not-studied", "note": "No study tested when perianal hair should prompt a doctor's visit. The one case that found a serious cause (a tumor) only came to light because the woman had other signs of excess hormones, not from the hair alone.", "studyIds": [ "pmid:41602386" ] } ], "benefits": [ { "text": "In the one case where it was directly investigated, hair growth including perianal hair was explained by a treatable cause (a hormone-producing tumor) and improved once that cause was treated.", "studyIds": [ "pmid:41602386" ] }, { "text": "Related research shows some perianal skin and hair-follicle conditions, like hidradenitis suppurativa, are recognised diseases with known patterns, even though they don't specifically explain hair poking out of the anus.", "studyIds": [ "pmid:29466546", "pmid:18346431" ] } ], "limitations": [ { "text": "Only one case report addresses this question, and it describes hirsutism (excess hair growth) including perianal hair caused by a hormone-secreting ovarian tumor; it does not address hair protruding from the anus as a distinct symptom, so there is almost no direct evidence on that specific presentation.", "studyIds": [ "pmid:41602386" ] }, { "text": "The other six sources are about related but different problems: hidradenitis suppurativa, nutritional deficiencies, or a spine condition, and none of them describe hair protruding from the anal opening.", "studyIds": [ "pmid:29466546", "pmid:26513075", "pmid:24278084", "pmid:18346431", "pmid:16022640", "pmid:15602364" ] }, { "text": "Nearly all of these studies are single case reports or small case series of one or two people, and most describe unrelated conditions — hidradenitis suppurativa, post-surgical nutritional deficiency, or spinal cord malformation — rather than the cause of hair around the anus itself. The one larger study, a case-control study of hidradenitis suppurativa with 87 people, measured body image, not hyperandrogenism or hair growth, so it cannot speak to why hair appears there. This means almost nothing here can be generalised to most women noticing this.", "studyIds": [ "pmid:41602386", "pmid:29466546", "pmid:26513075", "pmid:24278084", "pmid:18346431", "pmid:16022640", "pmid:15602364" ] } ], "risks": [ { "text": "The only identified serious underlying cause in this evidence was a hormone-producing tumor, found through blood tests and imaging after the woman had other signs of excess hormone (not from hair alone). Missing such a cause, if present, could delay treatment.", "studyIds": [ "pmid:41602386" ], "severity": "serious" } ], "whyPeopleTryIt": [ { "text": "People notice hair near the anus during washing or wiping and worry it means something is abnormal." }, { "text": "Embarrassment and lack of clear information make people search online rather than ask a doctor first." }, { "text": "Concern about hormone problems, like PCOS, after seeing unusual hair growth elsewhere on the body." }, { "text": "Confusion with other symptoms near the anus, such as skin tags, lumps, discharge, or bleeding, which feel related but are actually different issues." } ], "keyStudies": [ "pmid:41602386", "pmid:29466546", "pmid:18346431", "pmid:24278084", "pmid:26513075", "pmid:16022640", "pmid:15602364" ], "studies": [ { "id": "pmid:41602386", "pmid": "41602386", "doi": "10.3389/fonc.2025.1732541", "nctId": null, "pmcid": "PMC12832474", "title": "Case Report: Postmenopausal hyperandrogenism misled by adrenal incidentaloma: a rare case of androgen-secreting ovarian adult granulosa cell tumor and clinical implications", "firstAuthor": "Cao", "multipleAuthors": true, "journal": "Front Oncol", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "A 57-year-old postmenopausal woman with hirsutism affecting her face, perianal area and legs, plus other signs of high androgen levels", "intervention": "", "comparator": "", "primaryOutcome": "Cause of excess hair growth (hirsutism) including perianal hair in a postmenopausal woman", "result": "Hair growth including perianal hirsutism was caused by an androgen-secreting ovarian granulosa cell tumor; removing the tumor normalized testosterone and improved the hirsutism", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a single patient case report, so the cause found here may not explain most people's symptoms.", "directness": "direct", "relevanceNote": "", "limitations": "Single case report; findings specific to this one rare tumor type and cannot be generalized.", "followUp": "", "plainFinding": "Hormone-secreting ovarian tumor caused it", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41602386/", "sourceText": "BACKGROUND: Ovarian adult-type granulosa cell tumors (AGCTs) are rare sex cord-stromal neoplasms, accounting for 95% of ovarian granulosa cell tumors (GCTs) but only 10% of which secrete androgens. For postmenopausal women, hyperandrogenism is commonly attributed to conditions like polycystic ovary syndrome (PCOS), while androgen-secreting AGCTs are extremely rare, often leading to diagnostic challenges-especially when accompanied by adrenal incidentalomas that may divert clinical attention. CASE PRESENTATION: This study presents a case of a 57-year-old postmenopausal Chinese woman (menopause at 48) with 5 years of progressive hyperandrogenic symptoms (facial/perianal/leg hirsutism, vertex/frontal alopecia, deepened voice, clitoral hypertrophy). Initial evaluation revealed a left adrenal nodule and elevated testosterone; however, pelvic ultrasound (limited by bowel gas) showed no obvious abnormalities in the ovaries. Further tests at the First Affiliated Hospital of China Medical University confirmed markedly elevated serum testosterone (37.00 nmol/L, ref: 0.69-1.49 nmol/L) and free testosterone (300.90 pmol/L, ref: 0.77-33.03 pmol/L), suppressed LH/FSH, low AMH (0.01 ng/mL), and a 2.6×2.0 cm enhancing nodule in the right adnexa on pelvic MRI. Notably, adrenal-derived androgens were within normal ranges in this case, ruling out adrenal origin of hyperandrogenism. She underwent laparoscopic total hysterectomy + bilateral salpingo-oophorectomy; permanent pathological examination (with immunohistochemistry: Vimentin+, α-inhibin+, Calretinin+, Ki67+ ~2%) confirmed FIGO Stage IA AGCT (frozen section initially suggested benign tissue). Postoperatively, her androgen levels normalized, hirsutism/oily skin/acne improved, blood pressure decreased, though voice deepening persisted. DISCUSSION: This case underscores critical clinical lessons: Postmenopausal women with severe hyperandrogenism require comprehensive adrenal and pelvic evaluation (prioritizing MRI over ultrasound due to higher sensitivity for small tumors) even with adrenal findings. Comprehensive hormonal profiling (testosterone, adrenal androgens, gonadotropins, AMH) aids in distinguishing tumorous from non-tumorous causes, and permanent pathology is essential to avoid misdiagnosis from frozen sections. Surgical resection (bilateral salpingo-oophorectomy for postmenopausal patients) is effective for AGCT management, and long-term follow-up is crucial given the risk of late recurrence. Additionally, AGCT diagnosis is feasible in institutions without inhibin B/genetic testing via integrated clinical, hormonal, and imaging data. This case aims to raise awareness of rare androgen-secreting AGCTs to reduce diagnostic delays and improve management.", "provenance": [ { "field": "n", "quote": "a 57-year-old postmenopausal Chinese woman" }, { "field": "population", "quote": "progressive hyperandrogenic symptoms (facial/perianal/leg hirsutism, vertex/frontal alopecia, deepened voice, clitoral hypertrophy)" }, { "field": "primaryOutcome", "quote": "Postmenopausal women with severe hyperandrogenism require comprehensive adrenal and pelvic evaluation" }, { "field": "result", "quote": "confirmed FIGO Stage IA AGCT" }, { "field": "result", "quote": "Postoperatively, her androgen levels normalized, hirsutism/oily skin/acne improved" } ] }, { "id": "pmid:29466546", "pmid": "29466546", "doi": "10.1001/jamadermatol.2017.6058", "nctId": null, "pmcid": "PMC5876839", "title": "Association of Hidradenitis Suppurativa With Body Image", "firstAuthor": "Schneider-Burrus", "multipleAuthors": true, "journal": "JAMA Dermatol", "year": 2018, "design": "case-control", "n": 87, "nField": "reported", "population": "adults with hidradenitis suppurativa compared with healthy people (not specifically people noticing anal hair)", "intervention": "", "comparator": "healthy control individuals matched for age, sex, and body mass index", "primaryOutcome": "body image score measured by a body-concept questionnaire", "result": "People with hidradenitis suppurativa had significantly worse body image scores than healthy controls, even after accounting for BMI; the study did not address why hair grows from the anus.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a small case-control study about psychological body-image impact of a skin disease, not an investigation of what causes hair at the anus, so it carries little weight for this question.", "directness": "indirect", "relevanceNote": "", "limitations": "Cross-sectional questionnaire design, small sample, focuses on body image and mental health rather than the anatomy or cause of perianal hair; does not explain hair protruding from the anus.", "followUp": "", "plainFinding": "Worse body image in HS patients", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29466546/", "sourceText": "IMPORTANCE: Hidradenitis suppurativa (HS) leads to disfigurement and painful eruptions in terminal hair follicles of the intertriginous skin, mainly of axillary, genitofemoral, and perianal sites. It is associated with an excessive impairment of quality of life, psychiatric disorders, and sexual distress. Body image impairment has been linked to depression and anxiety and has been described for some dermatologic disorders but has not yet been investigated in patients with HS. OBJECTIVES: To investigate whether body image is diminished in patients with HS and whether disease severity, age at onset, disease duration, obesity, depression, and anxiety are linked to body image impairment. DESIGN, SETTING, AND PARTICIPANTS: This 12-month (August 1, 2009, to August 31, 2010) case-control study with a prospective, observational, cross-sectional design recruited 47 consecutive patients with HS entering a tertiary care center and 45 healthy control individuals matched for age, sex, and body mass index (BMI). One patient and 4 controls failed to complete the questionnaire and were excluded from the evaluation. Data analysis was performed from December 1, 2013, to February 15, 2014. MAIN OUTCOMES AND MEASURES: The Frankfurt Body Concept Scale (FKKS) and the Hospital Anxiety and Depression Scale (HADS) were given to patients and controls. Correlations among FKKS, HADS, and disease features were calculated. RESULTS: Of the 46 patients and 41 controls included in the evaluation (mean [SD] age, 35.6 [1.6] years; 40 [46%] male and 47 [54%] female), HS significantly reduced body image (mean FKKS score, 234.2 [5.4] in patients and 276.9 [5.7] in controls; P < .001), even when controlled for BMI. A correlation was found for the extent of body image disruption and BMI (r = -0.589; P < .001), HADS-depression score (r = -0.619; P < .001), and HADS-anxiety score (r = -0.340; P = .03). No association was found for the body image score and the severity of HS, age at onset of disease, and duration of disease. The body contact subscale score was the only subscale score that was not different between patients with HS and controls. CONCLUSIONS AND RELEVANCE: Patients with HS have major body image impairment, which might lead to depression and anxiety, disorders that have been largely acknowledged in HS. This study identified another element of the psychosocial burden of patients with HS and reveals that body image could potentially be used as an outcome measure in future studies of HS.", "provenance": [ { "field": "population", "quote": "47 consecutive patients with HS entering a tertiary care center and 45 healthy control individuals matched for age, sex, and body mass index (BMI)" }, { "field": "comparator", "quote": "45 healthy control individuals matched for age, sex, and body mass index (BMI)" }, { "field": "primaryOutcome", "quote": "The Frankfurt Body Concept Scale (FKKS) and the Hospital Anxiety and Depression Scale (HADS) were given to patients and controls." }, { "field": "result", "quote": "HS significantly reduced body image (mean FKKS score, 234.2 [5.4] in patients and 276.9 [5.7] in controls; P < .001), even when controlled for BMI." }, { "field": "n", "quote": "Of the 46 patients and 41 controls included in the evaluation" } ] }, { "id": "pmid:26513075", "pmid": "26513075", "doi": "10.1111/ddg.12795", "nctId": null, "pmcid": null, "title": "Phrynoderma and acquired acrodermatitis enteropathica in breastfeeding women after bariatric surgery", "firstAuthor": "Monshi", "multipleAuthors": true, "journal": "J Dtsch Dermatol Ges", "year": 2015, "design": "case-series", "n": 2, "nField": "reported", "population": "Breastfeeding women who had previous bariatric (gastric bypass) surgery", "intervention": "", "comparator": "", "primaryOutcome": "Skin and hair signs of nutritional deficiency after bariatric surgery", "result": "Both women developed perianal/genitoanal skin lesions, alopecia and hair depigmentation linked to vitamin A or zinc deficiency, not hair growth or protrusion from the anus", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a report of only two patients with skin disease, not a study of hair growing from the anus.", "directness": "indirect", "relevanceNote": "", "limitations": "Only two cases, no mention of perianal hair protrusion as a symptom; findings concern perianal eczema and alopecia (hair loss/depigmentation), not hair emerging from the anus.", "followUp": "", "plainFinding": "Not relevant—describes skin deficiency rashes, not anal hair.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26513075/", "sourceText": "BACKGROUND AND OBJECTIVES: Women who have undergone bariatric surgery are susceptible to nutritional deficiencies in subsequent pregnancies. We highlight the importance of dermatologists in the early recognition of cutaneous signs of malnutrition occurring in this specific clinical setting. PATIENTS AND METHODS: We compare clinical characteristics of two young women with dermatological signs of combined post-gestational nutritional deficiencies following Roux-en-Y gastric bypass surgery. RESULTS: Patient 1 exhibited follicular papules on the extremities, perianal eczema, perlèche, alopecia, and depigmentation of hair. Patient 2 showed erythematous plaques in genitoanal and acral areas, perlèche, diffuse alopecia, and depigmentation of hair. Based on clinical and histopathological findings, decreased vitamin A (patient 1) and zinc levels (patient 2), we diagnosed phrynoderma and acquired acrodermatitis enteropathica, respectively. Comparison of the two patients revealed that both (i) were lacking follow-up after gastric bypass surgery, (ii) developed skin lesions as primary symptoms with (iii) mixed clinical manifestations due to combined deficiencies, and (iv) experienced initial symptoms during lactation suggesting a causal relationship. CONCLUSIONS: Our observations highlight the potentially increased risk of women to develop post-gestational dermatological manifestations of malnutrition following bariatric surgery. The awareness of dermatologists with respect to this emerging, susceptible patient group may help avert damage to mother and child.", "provenance": [ { "field": "population", "quote": "two young women with dermatological signs of combined post-gestational nutritional deficiencies following Roux-en-Y gastric bypass surgery" }, { "field": "primaryOutcome", "quote": "cutaneous signs of malnutrition occurring in this specific clinical setting" }, { "field": "result", "quote": "Patient 1 exhibited follicular papules on the extremities, perianal eczema, perlèche, alopecia, and depigmentation of hair." }, { "field": "result", "quote": "Patient 2 showed erythematous plaques in genitoanal and acral areas, perlèche, diffuse alopecia, and depigmentation of hair." }, { "field": "n", "quote": "two young women" } ] }, { "id": "pmid:24278084", "pmid": "24278084", "doi": "10.5114/pdia.2013.37037", "nctId": null, "pmcid": "PMC3834702", "title": "Acne inversa goes an extra mile than hidradenitis suppurativa", "firstAuthor": "Witmanowski", "multipleAuthors": true, "journal": "Postepy Dermatol Alergol", "year": 2013, "design": "case-series", "n": 1, "nField": "reported", "population": "a 46-year-old woman with a severe hidradenitis suppurativa-type skin condition around the anus and buttocks", "intervention": "surgical excision of the diseased skin with wound closure using local flaps and skin grafts", "comparator": "", "primaryOutcome": "successful surgical treatment of the skin disease", "result": "The patient was successfully treated surgically for the disease around the anus and buttocks", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a single case report of a surgical treatment for a chronic skin disease, so it offers no reliable information about why hair grows near the anus and cannot be generalised.", "directness": "indirect", "relevanceNote": "", "limitations": "Single case report describing acne inversa (hidradenitis suppurativa), a chronic inflammatory disease of hair follicles and sweat glands, not an explanation of hair protruding from the anal canal itself.", "followUp": "", "plainFinding": "Not about hair from anus itself", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24278084/", "sourceText": "Acne inversa (AI, hidradenitis suppurativa, Velpeau's disease, Verneuil's disease) is a severe, chronic inflammatory dermatosis of unknown etiology, detected on the basis of clinical symptoms more frequently in women than in men. Purulent lesions in the form of nodules and inflammatory tumors, fistulas and scars are present in the areas with hair follicles and apocrine glands, most commonly on the armpits, groin, around the anus and pubic region. Acne inversa can lead to physical and mental disorders. Unfortunately, it is often misdiagnosed and ineffectively treated. The paper presents a case of a 46-year-old patient who was successfully treated surgically for AI around the anus and buttocks by excision of the changes and closure of the wound with local flaps and split-thickness skin grafts, taken with dermatome from the rear surface of the thighs. Surgical treatment is the method of choice in the treatment of severe AI.", "provenance": [ { "field": "population", "quote": "a case of a 46-year-old patient who was successfully treated surgically for AI around the anus and buttocks" }, { "field": "intervention", "quote": "excision of the changes and closure of the wound with local flaps and split-thickness skin grafts, taken with dermatome from the rear surface of the thighs" }, { "field": "primaryOutcome", "quote": "successfully treated surgically for AI around the anus and buttocks" }, { "field": "result", "quote": "successfully treated surgically for AI around the anus and buttocks by excision of the changes and closure of the wound with local flaps and split-thickness skin grafts" }, { "field": "n", "quote": "a 46-year-old patient" } ] }, { "id": "pmid:18346431", "pmid": "18346431", "doi": null, "nctId": null, "pmcid": null, "title": "[Practical management of hidradenitis suppurativa]", "firstAuthor": "Pedraz", "multipleAuthors": true, "journal": "Actas Dermosifiliogr", "year": 2008, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "Not specific to anal hair; describes women with hidradenitis suppurativa, a skin condition often starting at puberty", "intervention": "", "comparator": "", "primaryOutcome": "Explanation of disease mechanism and management of hidradenitis suppurativa", "result": "States hidradenitis suppurativa is a chronic inflammatory disease affecting skin areas rich in apocrine glands, including the perianal region, and is thought to be caused by a primary defect of the hair follicle; no mention of hair actually protruding from the anal opening itself", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a general review of a skin disease, not a study designed to explain anal hair specifically, so it provides only indirect, background information rather than a direct answer.", "directness": "indirect", "relevanceNote": "", "limitations": "No original data, no direct discussion of hair visibly protruding from the anus; abstract covers hidradenitis suppurativa broadly rather than this specific symptom.", "followUp": "", "plainFinding": "Possibly linked to a skin gland disease, not explained directly", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18346431/", "sourceText": "Hidradenitis suppurativa is a chronic inflammatory disease that usually affects areas of the skin with a high density of apocrine glands (axillae, groin, perianal and perineal regions, submammary area, etc). It usually appears in women during puberty. The etiology of the disease is unknown, although it is thought to be a primary defect of the hair follicle. When diagnosing hidradenitis suppurativa, a number of genetic and hormonal predisposing factors should be considered alongside other putative triggers, such as obesity, smoking, and tight clothing. Diagnosis is essentially clinical and it is important to bear in mind the possible complications associated with the disease, such as the development of tumors. Management of the disease includes general measures (antiseptic soaps, warm baths, etc), pharmacological therapy (topical, intralesional, and systemic), surgery (direct closure, second-intention healing, grafts, flaps, etc), and other measures (carbon dioxide laser, radiation therapy, etc). It is important that the disease be diagnosed and treated as soon as possible given the potential physical and psychological problems that it can generate.", "provenance": [ { "field": "population", "quote": "It usually appears in women during puberty." }, { "field": "primaryOutcome", "quote": "Management of the disease includes general measures (antiseptic soaps, warm baths, etc), pharmacological therapy (topical, intralesional, and systemic), surgery (direct closure, second-intention healing, grafts, flaps, etc), and other measures (carbon dioxide laser, radiation therapy, etc)." }, { "field": "result", "quote": "Hidradenitis suppurativa is a chronic inflammatory disease that usually affects areas of the skin with a high density of apocrine glands (axillae, groin, perianal and perineal regions, submammary area, etc)." }, { "field": "result", "quote": "The etiology of the disease is unknown, although it is thought to be a primary defect of the hair follicle." } ] }, { "id": "pmid:16022640", "pmid": "16022640", "doi": "10.1615/jlongtermeffmedimplants.v15.i3.60", "nctId": null, "pmcid": null, "title": "Difficult wounds: an update", "firstAuthor": "Edlich", "multipleAuthors": true, "journal": "J Long Term Eff Med Implants", "year": 2005, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "Adults with various chronic 'difficult' wounds and skin conditions (not specifically women with perianal hair)", "intervention": "", "comparator": "", "primaryOutcome": "Advances in treatment of several skin conditions, including Gardner's syndrome, pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa", "result": "The review discusses hidradenitis suppurativa (a skin/gland disease) as occurring in the perianal region among other apocrine-gland-bearing sites, but it does not describe or explain hair growing out of or protruding from the anus", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a general narrative review of treatments for unrelated conditions and does not study or explain perianal hair growth, so it offers no direct evidence for this question.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract is a collective review focused on surgical treatment advances for several distinct diseases; it does not investigate or explain the cause of hair protruding from the anus.", "followUp": "", "plainFinding": "Does not explain anal hair.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16022640/", "sourceText": "The purpose of this collective review is to describe revolutionary advances in the treatment of Gardner's syndrome (GS), pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa (HS). Gardner's syndrome or familial polyposis has various manifestations that appear to be controlled by a single genetic locus. Apart from the large bowel adenomas, which are always present, a common extracolonic symptom of Gardner's syndrome is the occurrence of epidermal cysts. These cysts can be seen before the intestinal polyps are evident. Because epidermal cysts in patients with Gardner's syndrome are always benign, we excise these cysts using incisions that are commonly used for rhytidectomy. Pseudofolliculitis barbae, a pseudofolliculitis caused by ingrown hairs, effects 85% of blacks who shave their beards. When this disease is allowed to progress to keloid formation, we use a surgical approach that includes excision of the keloidal scar, meticulous debridement of all residual ingrown hairs in the underlying wound, and coverage of the defect with a split-thickness skin graft. More recently, laser therapy has revolutionized the treatment of pseudofolliculitis barbae and has enabled a cure for the first time for those plagued with this disorder and for whom a beardless face is acceptable. Nasal septal perforation is a well recognized complication of septal surgery. Other iatrogenic causes of perforation include cryosurgery, electrocoagulation for epitaxis, nasotracheal intubation, or nose packing. In recent years drugs such as cocaine account for an increasing number of perforations. It has only been with the use of an external approach for the repair of the nasal septal defect that surgical closure has become easier and more reliable. The external approach allows for greater surgical closure and enables the surgeon to use both hands with the aid of binocular vision to mobilize and suture local mucosal advancement flaps and the intraseptal connective tissue grafts. More recently, surgeons have repaired large septal perforations with a radial forearm free flap. Because of its availability and deep emotional significance, the skin is a common site for self-destructive behavior with the development of factitious skin wounds. When suspected, psychiatric care must proceed immediately. Second, the ulcer can then be healed by appropriate techniques and wound repair. It is important to emphasize that the treating physician must first confront the patient, and then a psychiatrist should provide appropriate psychotherapy. Hidradenitis suppurativa is an inflammatory disease of the skin and subcutaneous tissue that occurs in apocrine-gland-bearing areas distributed in the axilla, mammary nipple areola, mons pubis, groin, scrotum, perineum, perianal region, and umbilicus. The condition has an insidious onset. The susceptibility of women's axillary skin to hidradenitis suppurativa may be related, in part, to the practice of axillary removal of hair with a safety razor. Consequently, the use of safety razors must be avoided and replaced with the use of an electric razor. The method of treatment will vary with the stage of the disease. Treatment of the chronic stage of axillary hidradenitis suppurativa is primarily surgical. More recently, carbon dioxide laser treatment, with healing by secondary intention, is proving to be a rapid, efficient, and economic treatment of this difficult wound.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa is an inflammatory disease of the skin and subcutaneous tissue that occurs in apocrine-gland-bearing areas distributed in the axilla, mammary nipple areola, mons pubis, groin, scrotum, perineum, perianal region, and umbilicus." }, { "field": "primaryOutcome", "quote": "The purpose of this collective review is to describe revolutionary advances in the treatment of Gardner's syndrome (GS), pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa (HS)." }, { "field": "result", "quote": "perianal region, and umbilicus" } ] }, { "id": "pmid:15602364", "pmid": "15602364", "doi": "10.1016/s0035-3787(04)71163-7", "nctId": null, "pmcid": null, "title": "[Split-cord malformation (diastematolmyelia) presenting in two adults: case report and a review of the literature]", "firstAuthor": "Guilloton", "multipleAuthors": true, "journal": "Rev Neurol (Paris)", "year": 2004, "design": "case-series", "n": 2, "nField": "reported", "population": "Two adult women, ages 40 and 54, with a spinal cord developmental anomaly (split cord malformation)", "intervention": "", "comparator": "", "primaryOutcome": "Clinical and imaging findings in adults diagnosed with split cord malformation", "result": "One patient had a hair tuft over the lower back (lumbar region), not the anus, found alongside a disc herniation and tethered spinal cord on MRI; the other patient had a birthmark (angioma) over the lower back instead of hair", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a report of only two patients and does not discuss anal or perianal hair at all, so it cannot answer the question asked.", "directness": "indirect", "relevanceNote": "", "limitations": "Only two cases; the hair described is over the lower back (lumbar spine), not at the anus; no information on perianal hair is given.", "followUp": "", "plainFinding": "Not about anal hair; back hair tuft from spine defect", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15602364/", "sourceText": "INTRODUCTION: Split cord malformation (SCM) is an uncommon developmental anomaly characterized a cleft spinal cord. In type I, each of the hemicords is contained within an individual dural tube whereas in type II there is a common dural tube housing both hemicords. Commonly diagnosed in childhood, adult presentation is exceptional. METHODS: We report the case of two women whose type II SCM was discovered at the age of 40 and 54 years. RESULTS: The first patient complained of chronic lombar and radicular chronic pain with dysuria. Physical examination revealed a radicular syndrome with abolition of the left Achille reflex and a lombar hair tuft. MRI showed a disc herniation at the L5-S1 level, with a partial SCM at the level of the L2 vertebra, spina bifida and tethered cord. The second patient complained of lombar pain with perineal irradiation for 6 years. Physical examination showed a lombar cutaneous angioma. MRI revealed a thoraco-lombar SCM at the T12 to L1 level, with spina bifida. No spur could not be identified in either patient. No further surgical treatment was given. CONCLUSION: Based on these two observations, we propose a review of literature reporting 90 cases of adult SCM.", "provenance": [ { "field": "population", "quote": "We report the case of two women whose type II SCM was discovered at the age of 40 and 54 years." }, { "field": "primaryOutcome", "quote": "Split cord malformation (SCM) is an uncommon developmental anomaly characterized a cleft spinal cord." }, { "field": "result", "quote": "Physical examination revealed a radicular syndrome with abolition of the left Achille reflex and a lombar hair tuft." }, { "field": "result", "quote": "Physical examination showed a lombar cutaneous angioma." }, { "field": "n", "quote": "We report the case of two women" } ] } ], "faqs": [ { "q": "Why is there hair coming out of my anus, female?", "a": "In the one case report that studied this directly, it was caused by a rare ovarian tumor raising testosterone in a 57-year-old woman, and it improved once the tumor was removed. For most people, though, this hasn't been studied, so research can't say how often it's simply normal versus a sign of something else." }, { "q": "Why is there skin coming out of my anus?", "a": "Loose skin near the anus is a different issue from hair, often extra folds of skin. None of the studies in this review looked at skin folds, only hair, so they can't explain this symptom; a doctor can look and tell you what type of skin change it is." }, { "q": "What is the lump coming out of my anus?", "a": "A lump near the anus can have several causes, such as a swollen vein or a small cyst, but no study in this review tested lumps, only hair. Because lumps sometimes need treatment, it's best to have one examined by a doctor rather than guess from a description." }, { "q": "What is the thing coming out of my anus?", "a": "This review only covers hair seen at or near the anus, not other possibilities like tissue, haemorrhoids, or prolapse. If what you're seeing isn't clearly hair, a doctor can examine it and tell you what it is." }, { "q": "Why is blood coming out of my anus?", "a": "Bleeding from the anus is a different symptom from hair and isn't addressed by any study in this review. Blood from the anus should always be checked by a doctor, since causes range from minor to serious." } ], "searchedAs": [ "why is there hair coming out of my anus female", "anus skin coming out in pregnancy", "why is there skin coming out of my anus", "what is the lump coming out of my anus", "what is the thing coming out of my anus", "why is oil coming out of my anus", "why is there hair coming out of my anus", "why is blood coming out of my anus" ], "patientTakeaway": "Hair around the anus is usually just ordinary body hair, but that is based on general clinical experience, not on research that has actually measured how common or 'normal' this is — only one case report exists, and it was about a hormone-producing tumor. See a doctor if the hair comes with other signs of excess hormones (like new hair on the face or chest, irregular periods, or a deepening voice), or if you notice a lump, pain, discharge, or bleeding, since those are separate symptoms this review did not study.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(hair[tiab] OR hirsutism[tiab] OR \"Hirsutism\"[Mesh]) AND (\"Anus\"[tiab] OR anal[tiab] OR perianal[tiab] OR perineal[tiab] OR \"Anal Canal\"[Mesh] OR \"Anus\"[tiab]) AND (female[tiab] OR women[tiab])" }, "pubmedQueryTranslation": "(\"hair\"[Title/Abstract] OR \"Hirsutism\"[Title/Abstract] OR \"Hirsutism\"[MeSH Terms]) AND (\"Anus\"[Title/Abstract] OR \"anal\"[Title/Abstract] OR \"perianal\"[Title/Abstract] OR \"perineal\"[Title/Abstract] OR \"Anal Canal\"[MeSH Terms] OR \"Anus\"[Title/Abstract]) AND (\"female\"[Title/Abstract] OR \"women\"[Title/Abstract])", "searchedOn": "2026-10-20", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Studies mainly about Pilonidal sinus hair tuft (hair embedded in a sinus cavity, a different mechanism)", "Studies mainly about Rectal prolapse (skin/tissue protruding from the anus)", "Studies mainly about Anal skin tags", "Studies mainly about External hemorrhoids", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Why is there hair coming out of my anus?", "description": "We reviewed 7 studies on anal hair: evidence is very limited; the only case found a hormone-secreting tumor as the cause, not proven as normal growth." }, "lastChecked": "2026-10-20", "lastChanged": "2026-10-20", "nextCheckDue": "2026-11-20", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-2", "ranOn": "2026-10-20", "gradeRules": "ev-2", "review": { "verdict": "fixed", "rounds": 3, "sentBack": [], "notes": [ "round 1: fix — The studies are correctly matched to the question and the page is otherwise safe, but the bottom line and hub one-liner assert 'usually just ordinary body hair' with a confidence the very-low, single-case evidence base does not support — especially since that one direct study actually found an abnormal cause. This is a wording problem fixable within the page's own fields, not a study-selection or framing error. (agrees: Badge is 'Little evidence', level is 'very-low', and only 1 of 7 studies is direct — and that single direct study actually describes an abnormal cause (a hormone", "round 2: fix — The framing, evidence selection, and hub listing are sound and appropriately hedged, but patientTakeaway overclaims certainty ('almost all cases, just body hair') beyond what the very-low, single-case evidence supports, so the page needs a wording fix rather than a structural one. (safe-language: patientTakeaway states as fact that perianal hair is 'in almost all cases, just body hair,' which is stronger than the evidence: the page itself says no study has measured how common normal perianal hair is (outcomes[0]: not-studied) and that calling it normal 'reflects common clinical ", "round 3: pass — The page is honest and internally consistent: it clearly separates the one directly relevant (and serious) case from the untested 'it's probably normal' folk explanation, keeps indirect studies clearly labeled as indirect, and consistently pushes safety-relevant red flags toward clinical evaluation without overclaiming benefit or harm anywhere." ] } }, "status": "published" }