BACKGROUND: Pilonidal disease is a common, disruptive condition in adolescents. We studied the effects of pilonidal disease on adolescents by gender. STUDY DESIGN: Prospectively collected data on demographics, mental health comorbidities, disease severity, hirsutism, disease-related quality of life impact, interventions, and outcomes were retrieved from a Pilonidal Care Clinic REDCap database and were analyzed by gender. RESULTS: Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male. Average age at disease onset was 14.8 years for females and 16.9 years for males (p-value <
0.001). The incidence of mental health comorbidities was similar in females compared to males (17 % vs 16 %
p-value = 0.268) but females had a higher incidence of diagnosed anxiety (15 % vs 10 %
p-value = 0.005). Females were less likely to be hirsute than males (32 % vs 79 %
p-value <
0.001), and were more likely to have fine hair in their gluteal crease (51 % vs 5 %
p-value <
0.001). Females presented with lower disease severity than males (mild: 68 % vs 47 %, moderate: 22 % vs 33 %, and severe: 3 % vs 10 %
p-value <
0.001), and were less likely to have undergone prior operation (3 % vs 8 %
p-value <
0.001). However, disease-related quality of life impact was more severe for females than males in 5 of 6 domains examined including: pain (5 vs 3
p-value <
0.001), embarrassment (4 vs 3
p-value = 0.021), ability to play sports (2 vs 1
p-value = 0.01), disruption of routine (4 vs 3
p-value = 0.024) and disturbance to school, work, or activities (3 vs 2
p-value = 0.004). More females underwent pit picking on their first clinic visit (33 % vs 27 %
p-value = 0.011) and incision and drainage (6 % vs 3 %
p-value = 0.01), with similar rates of laser follicle ablation (53 % vs 55 %
p-value = 0.45). CONCLUSION: The prevalence of pilonidal disease is much higher in females than previously reported. Pilonidal disease has different impacts on females than males including: earlier onset, higher incidence of anxiety, and greater disease-related impact on quality of life, despite lower disease severity on presentation. Tolerance of clinic treatments is comparable between genders. TYPE OF STUDY: Retrospective, cohort study. LEVEL OF EVIDENCE: III.