Do 98% of women hover over public toilet seats?

January 4, 2013

Dear Cecil:

A friend and I have been arguing about female squeamishness in public washrooms. He claims he read somewhere that 98 percent of women refuse to have contact with the toilet and instead hover above the seat. I said this was ridiculous, and the women I have asked agree. However, I’m working with a small dataset. My friend refuses to back down, insisting he got this factoid from a scientifically reputable source, although naturally he’s unable to produce it. What’s the straight dope?

Cecil replies:

Your friend got the numbers a little messed up, but yes, a claim along these lines appeared in a scientifically reputable source. My initial reaction, like yours, was to scoff. However, as the Teeming Millions know, the ridiculous is often the gateway to knowledge. Let’s see what we can learn.

The source of your friend’s claim is undoubtedly an article entitled “Crouching Over the Toilet Seat; Prevalence Among British Gynaecological Outpatients and its Effect Upon Micturition” by K.H. Moore et al, published in the British Journal of Obstetrics and Gynaecology in 1991. Moore and associates surveyed 528 women attending gynecology clinics in northern England and found that only two percent said they’d sit directly on a public toilet seat.

That’s not to say 98 percent were hoverers; 12 percent would sit once they’d covered the seat with paper. The remaining 85 percent, though … well, the paper says “crouched” rather than “hovered,” a poor choice of terms in my opinion, but we’ll come back to that. Anyway, 37 percent did this even when at a friend’s house.

Views on the above phenomenon may be categorized as follows:

1. This is bad. That was basically the British Journal of Obstetrics and Gynaecology’s take. An accompanying editorial note pointed out the consequences of crouching: “[U]rine flow rate … was decreased by 21 percent and [retained urine] volume more than doubled.” The immediate concern was that crouching would throw off evaluation of urinary tract problems, and to my mind the whole notion suggests an unhealthy mental state.

2. This is ridiculous. My main sources here are (a) Ms. Adams and (b) respondents to a poll we posted on the Straight Dope Message Board. Ms. Adams, who considers herself to be in the mainstream of American womanhood, said she spread tissue on public toilet seats until about ten years ago, hovering only in cases of dire necessity; now she just sits.

Of the 145 respondents to the SDMB poll, 83 percent said they’d sit on a public toilet seat without any paper covering (presumably after wiping it where needed). Only seven percent reported they would use a paper cover or toilet tissue, seven percent might hover depending on circumstances, and only three percent hovered consistently. This may be an expression of the icy resolve for which SDMB women are known, or reveal a difference between British and American customs; it could be, too, that the Moore study reflected the norm for its time, and the women of 2012 are made of sterner stuff than the delicate flowers of 1991.

I point out there’s no urgent need to avoid contact with toilet seats, assuming you don’t have open wounds or the like. Microbiologist Charles Gerba, whose work on “toilet plume” was discussed here years ago, found toilet seats were the least germy of 15 household locations he analyzed.

But never mind all that. We need to consider one last option:

3. Squatting, if not necessarily crouching or hovering, is good. We New World provincials need to understand that sitting on a porcelain throne is not how most of the world does its business. “Squat toilets,” which can range from a hole in the ground to a floor-mounted bowl with flushing apparatus, are common in Asia, the Middle East, and Africa. They even make appearances in Europe, where, like good public transport, universal health care, and tolerance of same-sex marriage, they strike American visitors as foreign, creepy, and wrong.

True, sitting toilets now account for the majority of accommodations in Japan (using technology that makes the average American fixture look like a tin can), and no doubt this increasingly will be the case elsewhere. However, some claim the squat toilet makes for a superior eliminative experience. The sensitive need read no further, but a small-scale 2010 experiment comparing the abdominal pressure needed to defecate from the sitting, sitting-and-leaning-forward, and squatting positions found squatting produced the optimal angle, requiring 20 percent less pressure than sitting. Research suggests excessive strain in this regard can lead to diverticulitis, stroke, and cardiac arrest — let’s not forget Elvis quite likely died in mid-effort.

This isn’t to defend hovering, as distinct from squatting — attending to nature’s call while suspended two inches above a toilet seat is physically taxing and surely the worst of both worlds. Use of an ordinary squat toilet also has its drawbacks. Nonetheless — and I realize this is the same reasoning typically employed by Fox News pundits — it's closer to how we’ve mostly done things for the past million years.

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References

Chou, Eric Chieh-Lung et al. “Women Urinate in the Standing Position Do Not Increase Post-Void Residual Urine Volumes” Neurourology and Urodynamics 29 (2010):1299–1300.

Erel, Serap et al. “Risk factors special to Eastern Culture for the Development of Anal Fissure” Bratisl Listy 110.11 (2009): 710-712.

Inamasu, Joji and Miyatake, Satoru “Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles” Environ Health Prev Med Published online, 9 September, 2012.

Moore, K. H. et al. “Crouching Over the Toilet Seat: Prevalence Among British Gynaecological Outpatients and its Effect on Micturation” Br. J. Obstet. Gynaecol 98 (1991): 569-570.

Mullick, Abir and Kumar, Ashok “Research and Design of a Cultural Product: Inclusive Design of a Squat Latrine” Proceedings of the Human Factors and Ergonomics Society, 56th Annual Meeting (2012): 615-619.

Rane, A. and Corstiaans, A. “Does micturition improve in the squatting position?” Journal of Obstetrics and Gynaecology 28.3 (April, 2008): 317 – 319.

Sakakibara, Ryuli et al. “Influence of Body Position on Defecation in Humans” Lower Urinary Tract Symptoms 2 (2010): 16-21.

Straight Dope Message Board Poll: http://boards.straightdope.com/sdmb/showthread.php?t=675511

Unsal, Ali and Cimentepe, Ersin. “Voiding Position does not Affect Uroflowmetric Parameters and Post-void Residual Urine Volume in Healthy Volunteers” Scand J Urol Nephrol 38 (2004): 469-471.

Wang, Kefang and Palmer, Mary H. “Development and Validation of an Instrument to Assess Women’s Toileting Behavior Related to Urinary Elimination Preliminary Results” Nursing Research 60.3 (May/June 2011): 158-164.

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