The Lowdown on Lubricants

Water - based, oil - based, organic, natural, silicone - based, fertility, anal speciality lubricants – how’s a girl to choose?

We’ve come a long way from using Vaseline, skin moisturizer or (eek!) nothing at all as personal lubricant during uncomfortable intercourse. However, the newer, premium brands on the market render the same analysis paralysis I suffer from when choosing toothpaste. Do I get the charcoal, whitening, or tartar control? Or in the case of lube – is it the chocolate – flavoured, warming, cooling or glow in the dark?

The best lubricants can transform a woman’s experience, desire and pain levels when chosen correctly. Have you seen my post on why women have pain during sex? The worst lubricants, however, have been linked with infertility, increased risk of developing cancer, and increased susceptibility to HIV.

65% of women reported current use of lubricants during sexual activities

What are personal lubricants?

Personal lubricants are over-the-counter products used to enhance sexual pleasure with intercourse or sexual acts, reduce friction between body parts or sex toys, and decrease pain during intercourse. Approximately 65% of women reported current use of lubricants during sexual activities. Women have reported higher levels of satisfaction and pleasure when lubricants are used – for many of my patients, this can be life – changing.

The female sexual response and lubrication

Vaginal dryness can result from ageing of the vaginal tissue, menopause, breastfeeding, medications, diabetes, IBS, Crohn’s disease, and the side effects of chemotherapy. To comprehend the link between female arousal and vaginal lubrication, the crucial role of the clitoris must be explored. Stimulation of the clitoris sends nerve signals up the sacral nerves (in your tailbone), which brings more blood flow to the vulva, vagina and clitoris, causing them to swell. This increased pressure on the capillaries (tiny blood vessels) pushes fluid from the vaginal walls into the vagina, or what we know as lubrication or being “wet.” More clitoral stimulation actually causes the deeper muscles of the pelvic floor (levator ani) to contract, in turn causing the upper end of the vagina to open up to 7cm, while the lower end of the vagina narrows as the superficial pelvic floor muscles (near the opening) contract faster. These pelvic floor muscle spasms or convulsions occur around 5 - 15 times every 0.8 seconds, while the vaginal length increases to an average of 10cm. While the increased natural secretions and vaginal dimension changes are more accommodating to a penis or toy – here’s a little known fact – it can take 30 – 45 minutes to achieve this state of full arousal! In summary – don’t skip the foreplay!

Why most lubricants are dangerous

The lubricant market is unregulated, and many brands do not list all the ingredients. Some of the worst brands (often used in the medical community) can damage vaginal cells, unbalance pH, slow sperm motility, and increase the risk of UTIs and thrush. In 2012, the U.S. National Library of Medicine and the National Institute of Health reported that “lubricant products may increase vulnerability to STI’s when the protective lining of the rectum or the vagina becomes damaged - one of the body’s normal defence mechanisms is weakened.” The vaginal canal has a balance of good bacteria and (a little) bad bacteria. Bacterial vaginosis, a common type of vaginal infection, occurs when there are less good vaginal bacteria (i.e. lactobacillus) and more bad vaginal bacteria. KY Jelly, for example, contains Chlorhexidine Gluconate which has been found is some studies to destroy Lactobacillus.

PH – your skin and vagina are not the same

PH stands for potential hydrogen, and is a measure of how acidic or alkaline a substance is. While the range is from 0 (very acidic) to 14 (very alkaline), your skin, on average, prefers a pH of 5.5 for the skin’s acid mantle to protect against bacteria, pollution, allergens, etc. The vagina prefers an acidic environment – somewhere between 3.8 – 4.5. The pH needs to stay acidic for lactobacilli – the good bacteria - to kill invading pathogens into the vagina, like yeast and bacterial vaginosis. A lubricant stating that it is “pH balanced” should be matched to the more acidic nature of the vagina, not the skin’s surface.

Why osmolality is crucial

Osmolality is the concentration of dissolved particles in a product. The vaginal cells constantly react to introduced chemicals to maintain the balance as a defence mechanism to stop invading pathogens. The vaginal secretions have an osmolality of 260 – 290 – while most lubricants vary between 1000 -10 000. A hyperosmolar lubricant will force the vaginal (or rectal) cells to work harder to create harmony. Lubricants containing large amounts of glycerin and propylene glycol keep the lubricant “wet,” thus stopping the lubricant from evaporating quickly. The mucous cells then push water out to try and dilute the lubricant – leading to a drying of the cells. This leads to a higher risk of the cells shrivelling and detaching from the vaginal walls, thus weakening the vagina’s defence system. If the osmolality of the lubricant is too low, the vaginal cells will absorb the fluid from the lubricant, leading to cytolysis (cell rupture). The sweet spot? Osmolality of 380 – 1200 is recommended.

Saliva as lubricant

If your partner has an active herpes lesion, using their saliva to make things slick could leave you with genital herpes – any sexually transmitted infection (STI) in the throat or mouth can be transmitted to the genitals through saliva, and vice versa. It is the most common way genital herpes is contracted - even if you don't see an oral cold sore, the virus can still be transmissible to the genitals - as can gonorrhoea, chlamydia, HPV, syphilis, and trichomoniasis. The risk of developing a yeast infection or bacterial vaginosis rises when you introduce saliva into the vagina, as the bacteria and enzymes can upset the vaginal microbiome. Research concerning saliva and slower sperm motility has been poor – the suggestion that saliva slows sperm speed has not been proved.

What to avoid

· GLYCERIN – a humectant (helps retain moisture) which draws moisture up into skin layers and slows or prevents excessive drying. This has been linked with an increase in osmolality in the vaginal canal. As a sugar alcohol, it can be food for nasty microbes, leading to increased yeast infections.

· PROPYLENE GLYCOL (a petrochemical that increases osmolality) - Propylene glycol is a synthetic liquid substance that absorbs water, and is generally found in water – based lubricants. The Food and Drug Administration (FDA) has classified propylene glycol as an additive that is "generally recognized as safe" for use in foods, cosmetics and drugs. Sensitivities to propylene glycol are individual and may cause vaginal dryness as it can absorb water from the vaginal cells.

· NONOXYNOL 9 (a spermicide) - makes cell membranes more permeable allowing pathogens to enter, kills good bacteria and causes irritation. In addition to being a powerful spermicide, it also damages the cell lining of the vagina and rectum, thus increasing the risk of HIV infection. Nonoxynol-9, surprisingly, is still used on condoms today.

· CHLORHEXIDINE GLUCONATE – an antibacterial found in KY Jelly and mouthwash – meaning it can also kill the good vaginal bacteria.

· PETROLEUM OIL – These are often found in flavoured or warming lubricants, tend to be thick and therefore coat the vaginal walls for longer, leading to bacteria overgrowth and an altered vaginal pH. Not all lubricants state petroleum as an ingredient – but as a general rule, stay away from Vaseline and baby oil.

· POLYQUATERNIUM-15 – studies have linked an increase in transmission of HIV to this additive.

· BENZOCAINE – this local numbing agent is often found in anal lubricants, and is marketed for chronic pain sufferers. It is also stated to prolong male orgasm by preventing premature ejaculation. Due to its numbing effects, it can lead to irritation and potential injury to the delicate vaginal and anal tissue as a result of over-stretching.

· PARABENS – preservatives which are effective in killing bacteria and fungi. Studies have shown they may be endocrine disruptors and act in an estrogen-like fashion, causing hormone disruption and even breast cancer. According to the FDA, however, the jury is still out on this one - “At this time, we do not have information showing that parabens as they are used in cosmetics have an effect on human health.”

· PHENOXYETHANOL - (used as an alternative to parabens) can irritate eyes and skin and depress nervous system

Water - based

Water – based lubricants are the most widely – used, inexpensive, readily available and was probably your first lubricant for these exact reasons (think KY Jelly). Although they can be used with latex condoms and silicone toys, water – based lubricants are not recommended for:

· women in a hypo – oestrogenized period (i.e. breastfeeding, menopausal) as these have a tendency to dry out faster during use

· sex acts performed in water (bath, hot tub, pool, etc) due to its high dissolvability

· anal use as they may damage rectal cells (speciality water or silicon – based anal lubricants are available)

· any flavoured, tingling and warming lubricants as they contain glycerin and sugar, known to cause or exacerbate yeast infections.

· generally contain propylene glycol preservatives which can affect the osmolality (see above)

Silicon - based

Silicon – based lubricants (i.e. Pjur Premium) can be used in water – based sex acts as they do not absorb into the mucous membranes, last longer than water – based lubricants and generally have a lower osmolality. Caution must be noted as:

· some silicone lubricants cannot be used with latex condoms

· silicone can break down silicone – do not use with silicone sex toys or other silicone – based devices

Oil – based and kitchen oils

Fun fact – condoms cannot be used with oil – based lubricants as oil can break down latex condoms. Many contain glycerine and petroleums – even premium brands such as Yes OB (oil – based, a personal recommendation) are not recommended to use with condoms.

The jury is out on using household oils, such as coconut and olive oils, as lubricant. Exposure to light and storage at room temperature can increase the concentration of toxic peroxides and inflammatory chemicals. While typically self – cleaning, new research has shown that the vagina cannot naturally expel coconut and olive oil, increasing the risk of vaginal infections.

Baby – making lubricant

Don’t make the mistake of confusing a non-spermicidal lubricant (doesn’t kill sperm) with a fertility-friendly lubricant (encourages sperm motility and doesn’t destroy sperm DNA). Ingredients that are harmful to sperm include glycerol, parabens, an osmolality greater than 400 mOsm/kg, and a pH less than 7. Note - an increase in cervical mucus occurs during ovulation, shifting the vagina to a more alkaline pH, allowing sperm a chance to survive for up to 48 hours inside the female reproductive system. Hence the lubricant should either list the pH value, or state that the pH matched to cervical mucus. Replens, Pre – seed and ConcievePlus are recommended fertility – friendly lubricants for baby – making.

The ideal lubricant

· is iso-osmotic (same osmolality of the vagina) and keeps the cells in perfect harmony

· has the same pH as the vagina (3.5-7)

· does not contain any of the chemicals listed above in the “what to avoid” section

· is organic

· has few ingredients

Unsure of which lubricant is right for you? Book an appointment today in Rowville or Mount Waverley.

References

1. Dezzutti CS, Brown ER, Moncla B, Russo J, Cost M, et al. (2012) Is Wetter Better? An Evaluation of Over-the-Counter Personal Lubricants for Safety and Anti-HIV-1 Activity. 2012; 7(11). doi:10.1371/journal.pone.0048328

· McInerney, K. A., et al. (2018). Lubricant use during intercourse and time-to-pregnancy: A prospective cohort study. Bjog. doi: 10.1111/1471-0528.15218

· Sandhu RS, Wong TH, Kling CA and Chohan KR. In-vitro effects of coital lubricants and synthetic and natural oils on sperm motility. Fertil Steril 2014; 101:941-944.

· Steiner AZ, Long DL, Tanner C and Herring AH. Effect of Vaginal Lubricants on Natural Fertility. Obstet Gynecol 2012; 120:44-51.