By Melinda Fontaine, DPT, PHRC Walnut Creek
You may have read my last blog on lube, Slippery When Wet, but when I read it again recently, I realized I have more to say now. 65% of women report using personal lubricant in the last month, and why wouldn’t you? Lube makes everything better, simply because it makes things more slippery. That being said, not all lubes are equal. How does one choose? There is a wide range of lube types and qualities. Some lubes are better suited for vaginal use, rectal use, or use with toys or condoms. The ingredients in your lube can help or harm your tissues, affecting your health in various ways. Let’s take a closer look and compare some common ones head on!
The main categories of lube are water-based, silicone-based, and oils. Aloe vera has also been popping up as a popular base in natural lubes. All lubes are intended for short term use during sexual activities. Personal moisturizers, on the other hand, keep moisture in the genitals for greater than 60 minutes. We will look at some personal moisturizers along with lubes. Water-based lubes are generally cheap and easy to find. They are easy to clean up, but can dry out quickly. Silicone-based lubes are longer lasting and harder to wash off, which also means they are great for playing in the shower. Oils may be natural, like coconut or olive oil, or synthetic, like mineral oil. Natural oils are long lasting and safe for oral play. They also might foster yeast infections in some women. Synthetic oils are more irritating and harder to clean off. Aloe vera is safe for the body. The only drawbacks are that it has a shorter shelf life and can be more pricey. If you will be using a condom, avoid oil-based lube. Silicone and oil lubes are also not safe for most toys.
To evaluate a water-based lube, look at pH (a measure of how acidic it is). And for all lubes, look at osmolality (a measure of how concentrated it is) and the ingredient list for irritating additives. A lube’s pH should be close to the pH of the body’s tissues, which means 3.8-4.5 for vaginal use and 7.0 for rectal use. A pH much lower than recommended makes us vulnerable to infections, such as bacterial vaginosis. Similarly, a high osmolality also damages tissues and allows infection to grow. The World Health Organization (WHO) recommends osmolalities of less than 380 mOsm/kg. Lube with osmolalities less than 316 mOsm/kg were shown to be safe. Silicone-, Plant-, and Oil-based lubes are also less likely to irritate tissues, but their pH cannot be measured.
When I see words in any ingredient list that I do not recognize and have lots of letters, I become suspicious. Here are a few that are trouble-makers:
Glycerin or Glycerol make lubes sticky and can feed yeast. One study found injury to the tissues from Glycerol leads to vulnerability to STIs and HIV. The WHO advises that glycerol should be less than 9.9% mass fraction.
Parabens are preservatives and are similar to the female sex hormone, estrogen. It has been suggested that they may disrupt the endocrine system function in both sexes, and they have been detected in breast tumors.
Glycols are molecules responsible for maintaining moisture. Too much glycol can lead to vulnerability to herpes simplex virus 2, bacterial vaginosis, and yeast infections. The WHO advises that propylene glycol should be less than 8.3% mass fraction.
Nonoxynol-9 is a compound added to lubes, such as Gynol II, for contraception because it kills sperm. It also damages the vaginal and rectal lining and increases risk for herpes and HIV.
Chlorhexidine gluconate kills off healthy bacteria. It is a preservative and microbicide associated with a 100-fold increased susceptibility to chlamydia.
Cyclomethicone, cyclopentasiloxane and cyclotetrasiloxane are found in some silicone lubes and have been linked to uterine cancer and reproductive harm in mice.
Let’s take a look at some common lubes:
| Osmolality | pH | Ingredients to watch: |
| 2007 mOsm/kg | 4.55 | Glycerin, Chlorhexidine Gluconate, Methylparaben |
KY Jelly has an osmolality that is over five times the recommended value! It’s pH is actually not bad for vaginal tissues. It also has ingredients linked to increased vulnerability to infection and disease and hormone disorders. It is safe for use with condoms and toys.
| Osmolality | pH | Ingredients to watch: |
| 240 mOsm/kg | 4.73 | Aloe Vera |
Good Clean Love makes a good, safe, water based lubes. The chemistry shows that it has a pH and osmolality similar to vaginal tissues, which means it will not damage tissues or make us vulnerable to infection, like some harsher products. It also has aloe vera, which is a great moisturizer. We use this in the clinic for transvaginal pelvic floor physical therapy.
| Osmolality | pH | Ingredients to watch: |
| 13 mOsm/kg | 6.89 high | none |
Slippery stuff is a water-based lube. While pH is on the higher side, the osmolality and ingredient list is safe. We use this in the clinic for transvaginal pelvic floor physical therapy.
| Osmolality | pH | Ingredients to watch: |
| 106 mOsm/kg | 4.0-4.4 | Aloe vera |
Sliquid Organic H2O has osmolality and pH well within the recommended zone for vaginal use. It has no ingredients identified as dangerous, and it’s organic, vegan and cruelty free. It is safe for use with condoms and toys.
| Osmolality | pH | Ingredients to watch: |
| 19 mOsm/kg | 6.78 | No red flags |
Babelube is a water based lube with a super low/very good osmolality and a pH that works great for anal tissues. It is also safe with condoms and toys.
| Osmolality | pH | Ingredients to watch: |
| 2011 mOsm/kg | 2.95 | Glycerin |
Replens is a vaginal moisturizer, but its osmolality is off the charts high! Its pH is too low to allow the good bacteria to survive. That plus the glycerine in it places users at risk for infections.
| Osmolality | pH | Ingredients to watch: |
| 250 mOsm/kg | 4.15 | Water
Aloe Vera |
Yes Vaginal Moisturizer has an osmolality and pH that match vaginal tissues. It is a water-based moisturizer that has aloe vera.
If trying to conceive, the best conditions for sperm survival and motility is pH 7.2-8.5 and osmolality 270-360 mOsm/kg.
| Osmolality | pH | Ingredients to watch: |
| 502 mOsm/kg | 7.3 | Methylparaben, Propylparaben |
Pre-Seed advertises itself as a fertility friendly lube. It has a good pH for sperm and an osmolality a little above the range. It also contains two parabens.
I asked my colleagues to share a few of their favorite non-water based lubes and here are the top runners:
Uberlube and Pjur Silicone are great for long lasting lubrication and are safe to use with latex or polyisoprene condoms, but cannot be used with silicone toys. Desert Harvest’s Aloe Glide is an all natural aloe vera-based lube with no scary ingredients and a low osmolality of 308mOsm/kg. It is also safe to use with latex or polyisoprene condoms. Coconut oil is popular as a lube because it does not dry out, melts at body temperature, is edible, can also be used as a personal moisturizer, and is cheap. However, it cannot be used with condoms and some toys, and it may feed yeast infections. Some lubes are also adding CBD. Foria makes a coconut oil-based CBD lube, and Kush Queen makes a water based CBD lube. There are many possible benefits to adding CBD to lube, but I’m waiting to collect more research before I can pass judgement. The right lube and moisturizer are one part of the physical therapy treatment plan for patients with pelvic pain.
Additional Information:
Would you like to see Melinda’s entire presentation? Head over to our Instagram
and check out her 20 minute video on IGTV!
References:
- Edwards D & Panay N (2016) Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?, Climacteric 19:2, 151-161, doi: 10.3109/13697137.2015.1124259
- Dezzutti CS, et al. (2012) Is wetter better? An evaluation of over-the-counter personal lubricants for safety and anti-HIV-1 activity. PLoS ONE 7(11): e48328. doi:10.1371/journal.pone.0048328
- World Health Organization. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI (2012) http://apps.who.int/iris/bitstream/10665/76580/1/WHO_RHR_12.33_eng.pdf
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Hi Great article! Thanks.
Great comparison of different lubricants with pH and osmolality. Super helpful for providers and patients to have resources like this.
Thanks for sharing this
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