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If Hayat goes out to eat, she’ll choose a table far away from other diners, ideally by a door or open window. She likewise tries to avoid people at the cinema or on planes, even if it means paying extra – whatever it takes to avoid being too close to others.
She chalks it up to a persistent past insecurity. “I still have that paranoia … It’s just in my head, because of everything I went through.”
For more than a decade, 66-year-old Hayat lived with bromhidrosis: chronic body odour. Though the term applies to BO from any cause, including poor hygiene, it is more typically driven by a bacterial imbalance or other health issue.
For those individuals, it’s not a question of bathing more often, or switching to a higher-strength deodorant: their body is working against them, and the impact can be ruinous. “Fifteen minutes after a shower, they’ve already started smelling,” says Chris Callewaert, a senior research fellow at Ghent University, Belgium, and one of the few scientists in the world specialising in body odour.
Callewaert describes bromhidrosis as a natural bodily process gone awry, most typically involving the apocrine glands. These are concentrated around the armpits, breasts and groin, and secrete lipids, steroids and proteins. This sweat itself is odourless; BO is produced by the natural bacteria on the skin and inside the hair follicles as they digest the fatty secretion.
In people with apocrine bromhidrosis – that is to say, abnormal or abnormally offensive body odour – some aspect of that process is out of balance, says Callewaert. They may have overactive apocrine glands, perhaps, or an overabundance of specific “smelly bacteria”.
Body odour can come on abruptly: with puberty, a change to the microbiome, a disease affecting the metabolism, or even as a side-effect of medication. But once established, it can prove difficult to shift, Callewaert says. “It’s often multifactorial, and not easy to perceive the deeper origin or to fix it. Sometimes people have been stuck with this for many, many years.”
In Hayat’s case, she developed bromhidrosis along with hyperhidrosis – excessive and uncontrollable sweating, a distinct but often coexistent condition – during menopause. In 2007, when she was 48, she had an ovary removed, which disrupted her oestrogen production. “After that, life started to change. It was absolutely disruptive,” she says.
She was constantly overheated, “burning inside” even during New York’s freezing winters. On the subway, she would be wearing a sleeveless top and sandals, her hair dripping wet from sweat, while other commuters were in heavy coats, boots and scarves. “People were looking at me like I was crazy,” she says.
That was only half of it. She also smelled – from her armpits, under her breasts, her groin. Her fellow New Yorkers did not hold back from letting her know. Some covered their noses as she passed, or moved away from her. “Those were the polite ones,” Hayat says. Others verbally abused her; more than once, she was harassed off the train. “It was awful, a total nightmare.”
Hayat understood the strong reactions: “It’s normal – you don’t want to be next to anybody who smells bad.” But over-the-counter and prescription remedies made no difference. Hayat estimates that she spent thousands of dollars searching fruitlessly for relief. “At one point I was seeing endocrinologists, gynaecologists, general cardiologists … I had a whole team, trying to find out what was going on in my body.”
There is no set diagnostic threshold at which bad BO becomes bromhidrosis, which makes it difficult to estimate how common it is. A 2024 review described it as prevalent, at least in the west, and taking a “significant” toll on patients’ social and psychological wellbeing. Yet there is very little focused attention on the condition or specialised support.
“It is underserved,” says Angela Ballard, a registered nurse and communications director for the International Hyperhidrosis Society (IHS). The US-based organisation was founded in 2003 to advocate for the estimated 4.8% of people who live with uncontrollable sweating, but has expanded its focus to include bromhidrosis and body odour, given the frequent overlap and lack of other resources.
“There is not a lot of information, and I think that’s sort of indicative. People are ashamed,” Ballard says. “They don’t talk about it with their healthcare providers, even their friends.”
The stigma over BO persists despite it being a natural part of life, from puberty to pregnancy and beyond. According to the IHS, an estimated 50% of the 1.6m women entering menopause annually in the US alone experience increased underarm sweat and odour.
Ballard says a diagnosis of bromhidrosis is tied to “the level of distress it’s causing a person”, and its effect on their wellbeing and day-to-day function: “How much is this impacting your self-esteem, your confidence, your social life?”
There are strategies that can help with alleviating the odour, she says – from the straightforward (using antibacterial soap, avoiding certain fabrics, improving laundry practices) to the unexpected (laser hair removal or waxing, which limit sites for bacteria, and Botox, which reduces sweat production) and, increasingly, hi-tech.
The miraDry, for instance, is an FDA-approved handheld microwave device that destroys the sweat glands, odour glands and hair follicles in the armpits, and has proved to be effective at managing hyperhidrosis, and sometimes bromhidrosis too.
But, often, even a combination of strategies can only do so much to improve the smell. Meanwhile, managing the social anxiety, second-guessing and paranoia is a separate concern. “You feel like people are judging you, that they think it’s your fault, when you’ve perhaps tried everything,” Ballard says. “It can really spiral.”
The toll can be far-reaching. “People will choose jobs where they can work from home, or skip certain social occasions where their odour could be more apparent … You may hesitate to hug someone or get too close to other people.”
Having been diagnosed with hyperhidrosis as a child, Ellie, 30, began struggling with body odour as she got older. She had wanted to pursue teaching, “but I just couldn’t imagine standing in front of a room full of students all sweaty, fearing smelling bad,” she says.
She now works as an accounting assistant. “There were several career paths I wanted to pursue but didn’t.” She considers herself fortunate to not have been so affected in her intimate relationships.
Many people with bromhidrosis report it negatively affecting their confidence and success in dating, but Ellie says her husband, who has known her since she was a teenager, has always been “completely unfazed”. She was, however, very nearly dissuaded from having children, for fear of passing on her conditions.
But Ellie now has a young daughter: “While excessive sweating and body odour is extremely unfortunate, it is not a reason to not want to live. Even if I do end up passing this down, I will be the best advocate possible for my daughter.”
With doctors having been, generally, “pretty dismissive”, Ellie has developed her own coping strategies, such as wearing only cotton socks and never leaving the house without a full change of clothes on hand. “I swear I’ve tried every deodorant on the market.”
Added to the frustrations and challenges of managing her bromhidrosis are other people’s assumptions – that she is either oblivious to how she smells, or wilfully not doing anything about it. “Don’t think we don’t realise. Odds are, we’re trying everything we can to mask it, and get rid of it, but sometimes there is no way.”
Callewaert’s research has found that people who know or fear that they have BO are actually more attentive to personal hygiene than others. But, he says, the anxious striving to get on top of bromhidrosis can worsen the problem by further imbalancing the microbiome and stoking the production of sweat. “They have stress and, as such, they have odour, and because they have odour, they have more stress: it’s self-enforcing.”
Over time, bromhidrosis can become as much a psychological issue as a physiological one. People with the condition often self-isolate, exacerbating the negative effect on wellbeing, and they might develop anxiety or depression, says Callewaert: “On average, their quality of life is lower.”
Faced with “embarrassing situations and mistreatment”, Hayat organised her life around managing others’ discomfort. Aged 50, she learned to drive and got a car so that she might bypass public transport – no mean feat in New York – and began flying business class for the extra space. “Economically, it was a sacrifice, but for my wellbeing, it was perfect to be as far away as I could from people,” Hayat says.
Her family thought she was behaving irrationally and told her she didn’t even smell: “They used to say: ‘It’s all in your head.” But Hayat didn’t feel that she could trust them over the feedback she was getting in public, “because they love me”.
The experience went so far as to test Hayat’s faith: she says she often turned to the Bible in search of solace and answers. “It was really frustrating: ‘Why me? Why do I have to go through this? What did I do?’”
Her world shrank. “Before menopause, I used to go to the theatre, the movies, to clubs to dance, to restaurants … I stopped all of that.” For more than a decade, she did not go anywhere other than work.
The office was difficult enough. Hayat’s colleagues knew she had a medical condition, but were far from sympathetic, she says. A younger co-worker made a show of using a room spray in Hayat’s presence; she overheard another pair of colleagues talking about her, waving their hands in front of their noses.
Hayat says that her working environment became so hostile that she considered suicide. But eventually, she sought help from her employer’s human resources department, which moved swiftly to find her a spot far from those colleagues and gave her the option of taking action against them for bullying. She declined, but “they made me feel really supported”.
Later in her career, Hayat took advantage of advances in remote working, such as telephone meetings and Zoom calls. She also became more adept at managing her sweating and stress, and with it the smell: “I found ways to survive.”
The strict social penalty against having body odour is worsened by the casualness and flippancy with which the topic is often treated. Even doctors can be dismissive, instructing patients to simply apply more deodorant. “People are being brushed off very easily [because] ‘it’s not life-threatening’,” says Callewaert.
That doesn’t just discount the real suffering of living with bromhidrosis: a subtle change in body odour has been associated with diabetes, Parkinson’s disease and cancer, he says. “Knowing that body odour can be a symptom for underlying diseases, it’s a real sign that needs to be picked up.”
In most cases, however, strong BO stems from the microbiome and poor gut health. A stronger and more offensive body odour is linked to diets high in meat and fast food, and low in vegetables. “Leading a healthy lifestyle will help in smelling better,” Callewaert says. High stress is also a factor.
With the microbiome makeup often stubborn to shift, progress can be slow. Even using antiperspirants and deodorant can exacerbate odour, he says, killing beneficial bacteria while encouraging the more stress-resistant, “smelly” kind to bounce back stronger and more numerous.
At best, these “underarm cosmetics” – widespread only since the mid-20th century – are a short-term solution, Callewaert says. He argues that their use has led to worse BO at the population level, together with the trends, at least in the west, for poor nutrition, high stress and unhealthy guts. So Callewaert – who publicly styles himself as “Dr Armpit” – has been developing what he hopes might prove a silver bullet to BO: his own range of patented probiotic deodorants.
In the meantime, Ballard calls for greater understanding of body odour as a natural product of bacteria on our skin, and compassion for people who might be struggling to keep it in check. Instead of leaping to the assumption that someone who smells must be skipping showers, we might consider their experience, she says.
“Maybe they have bromhidrosis, and it took a lot for them to get out the door to go to work and live their lives. Maybe they have another medical condition, and they have to take medication that has changed their body odour. Or maybe they’re going through menopause … You can notice that you smell something, and stop before the judgment.”
For Hayat, recently retired, the bullying she experienced over her bromhidrosis affected her wellbeing as much as the condition itself. After a decade of the menopause wreaking havoc, her symptoms began to ease. “It got better, thank God,” she says fervently. “It’s still not 100% managed – it’s just that I learned to get by.”
She, too, urges compassion – after all, no one is above body odour. “You can be smelling like roses now, but eventually, for whatever reason, your body’s gonna change.”
All case studies’ names have been changed
In the UK and Ireland, Samaritans can be contacted on freephone 116 123. In the US, you can call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
