Slippery When Wet: Is your lubricant causing pelvic pain, infections, or fertility problems?

In Female Pelvic Pain, Vulvodyniaby Melinda Fontaine9 Comments

 

By: Melinda Fontaine

Lube is great!  It adds moisture and decreases friction, but how do you pick from the multitude of different personal lubes on the market? Which one is the safest?  Goop recently asked the same questions in response to watching an episode of Grace and Frankie in which Frankie makes her own lube.  I have noticed a number of my patients can have very strong reactions to lubes including pain infection and fertility issues.  Let’s take a look at what we are putting in our bodies.  

 

What’s the Difference Between Moisturizers and Lubricants?

It’s all based on how long it is intended to stay in the body.  Vaginal moisturizers are made to stay in the body for longer than 60 minutes, and are applied every 1-3 days to alleviate dryness.  Vaginal moisturizers are classified as Medical Devices by the Medicines and Healthcare products Regulatory Agency because they last so long, which means they have been tested for safety and efficacy. They last so long because they contain polymers to adhere water to the vaginal lining. Lubricants are made to be used short term during sex. Some may be better than others for various activities.

 

Which Lube can I use with condoms or toys?

Lubricants may be water-, silicone-, mineral oil-, or plant-based.  Water-based lubricants are non-staining, easy to wash off, and safe to use with all condoms and toys.  Silicone-based lubricants are thicker and tend to hang around longer, so they are preferred by women who are past menopause or don’t want their lube to disappear too quickly. However, silicone-based lube required soap and water to get off and should not be used on silicone toys because it will basically dissolve the toy.  Oil-based lubricants are least likely to irritate vaginal or anal tissues but cannot be used with condoms because they will break, and should not be used with toys because it will coat them in oil and prevent them from ever getting clean. Plant based-lubes, such as aloe vera are generally considered safe.

 

Can I Get an Infection from Lube?

Products, such as KY Jelly, Replens, Gynol II, and Astroglide leave you vulnerable to infection because they kill the good bacteria, lactobacilli, that keep you healthy. You may have noticed that everyone is talking about probiotics to replenish the good bacteria in our gut.  Our vaginas and rectums also have good bacteria that play a vital role in our health. An important type of good bacteria called lactobacillus maintains a good pH in the vagina and prevents bacterial vaginosis.   Low estrogen levels (as occur post menopause, postpartum, and after prolonged use of oral contraceptives) also reduce the vaginal pH and can lead to infection. Healthy vaginal pH is 3.8-4.5, and rectal pH is about 7.0. A good lube would have a pH value similar to your tissues or slightly higher.  

 

What is Osmolality and What Does it Have to Do with Lube?

Osmolality is the concentration, or how many solutes are present in the lube. Products with high osmolality lead to damage of the tissues lining the vagina or rectum, causing irritation and leaving the tissues vulnerable to infection².  The World Health Organization (WHO) recommends osmolalities of less than 380 mOsm/kg, or at most 1200 mOsm/kg.  For example, Astroglide Liquid has an osmolality of 8064 and should be avoided.  Lubes with osmolalities less than 316 mOsm/kg showed no adverse effects and include Good Clean Love, Slippery Stuff, Sliquid, Babelube, Probe, and Femglide. Silicone-, Plant, and Oil-based lube are also less likely to irritate, but their osmolality cannot be measured. See the figure for some common water-based lubricants with their osmolalities and pH values³.

lube image 2

 

What Else Could Be in My Lube?

Parabens, glycols, microbicides, and preservatives in many personal lubricants and moisturizers are also concerning.  Most lubricants list the ingredients on the package, so you can find out what is in your lube. 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, so they are used in many lubes, such as Durex Play Feel, ID Glide, and Pjur Woman Nude.  Too much glycol can lead to vulnerability to herpes simplex virus 2, bacterial vaginosis, and yeast infections¹. The WHO advises that glycerol should be less than 9.9% mass fraction and propylene glycol should be less than 8.3% mass fraction³. 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 HIV². Chlorhexidine is a preservative associated with a 100-fold increased susceptibility to chlamydia¹ and is in KY Jelly and Astroglide.

 

How Does Lube Affect Fertility?

Some products, such as Astroglide, KY Jelly, and Replens, make it hard for little swimmers to swim, while sperm-friendly lubes (Pre-Seed and Yes Baby) have no effect². Low pH and high osmolality decrease sperm motility. The best conditions for sperm survival is pH 7.2-8.5 and osmolality 270-360 mOsm/kg. Interestingly, studies done on couples trying to conceive did not find a difference in fertility between couples who did and did not use lube¹.

 

What Lube Do you Recommend for People with Pelvic Pain?

Lubes that cause damage and irritation to the lining of the vagina or rectum can create pelvic pain or make existing pain worse.  

  • Pure coconut oil or aloe vera are the least irritating, but remember oil cannot be used with condoms.
  • Silicone-based lubes without the above listed preservatives would be my second choice for someone with pelvic pain and can be used with condoms.  
  • Of the water-based lubes tested, Good Clean Love, Slippery Stuff, and Sliquid Organic are the safest.  
  • For couples trying to conceive, I recommend Yes Baby Sperm-Friendly Lubricant.
  • For, anal play, a lube should have a higher pH, so I would choose Yes But Anal Lube.
  • Lastly, in order to avoid tissue damage and infection, everyone should steer clear of the ever popular KY Jelly and Astroglide.

 

Every person has different preferences and tolerances, so experiment a little to find out what works for you.  If you are plagued by recurrent infections or chronic pain, it might be worthwhile as Dr. Maggie Ney suggests, to take a break from all lubricant to see if it improves.  

References

1. 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

2. 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

3. 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

 

Comments

  1. My pelvic physiotherapist recommends Zestra. It’s great because it is lubido enhancing and works well as a water based nontoxic lubricant in menopausal women with history of vulvar vedtibulitis abd chronic pelvic pain.

  2. A local naturopath says coconut oil can disrupt vaginal flora, so does not recommend it.
    Any comments?

    1. Author Melinda Fontaine says:

      “Coconut oil has some anti-microbial properties, so yes, it can disrupt vaginal flora. Each person will respond differently, so for some people, coconut oil will work great. If you are having difficulties with vaginal flora, try stopping all lube for a while to see if that is contributing.”

      1. since using coconut oil I have been free of yeast infections, which previously I’d suffered form regularly.

  3. Thanks Melinda,
    Such an informative and enlightening article written with great data and a fun sense of humor…. love it !
    Katie Beckham

  4. Really enjoyed this write-up. Was wondering if I could include the graph you’ve created in a presentation?

  5. I found this article extremely helpful. Thank you. It has made me reconsider my own clinical practice & the advice I sometimes give. Thank you!
    Victoria

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