Truth and Friction: Is Your Vaginal Lubricant Helping or Hurting Your Pelvic Health?

In Pelvic Health by Melinda FontaineLeave a Comment

By Melinda Fontaine

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:

KY Jelly

OsmolalitypHIngredients to watch:
2007 mOsm/kg4.55Glycerin, 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.

 

Good Clean Love

OsmolalitypHIngredients to watch:
240 mOsm/kg4.73Aloe 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.

 

Slippery Stuff

OsmolalitypHIngredients to watch:
13 mOsm/kg6.89 highnone

Slippery stuff is a silcone-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. 

 

Sliquid Organic H2O

OsmolalitypHIngredients to watch:
106 mOsm/kg4.0-4.4Aloe 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.

 

Babelube

OsmolalitypHIngredients to watch:
19 mOsm/kg6.78No 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.

 

Replens 

OsmolalitypHIngredients to watch:
2011 mOsm/kg2.95Glycerin

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. 

 

Yes Vaginal Moisturizer 

OsmolalitypHIngredients to watch:
250 mOsm/kg4.15Water

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.

 

Pre-Seed

OsmolalitypHIngredients to watch:
502 mOsm/kg7.3Methylparaben, 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:

  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

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