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CHAPTER 9

The Lowdown on Lube

WOMEN REPORT THEY USE LUBE TO MAKE sex more fun, to try something new, and to make sex more comfortable. It’s also important to use lubricant with condoms as it reduces condom breakage—and no, saliva does not count, as it’s not a great lube. Despite what you may see in the movies, I’d skip honey. I’ve seen some irritating consequences.

According to a 2014 survey, 65 percent of women reported using lubricant at some point, and 20 percent said they had used lube within the last thirty days.

There are medical conditions that cause vaginal dryness, so if you’ve never needed lubricant before and all of a sudden you feel like your ecosystem has switched from garden to desert, it is worth checking out with your health care provider. The most common cause is menopause, but other causes of vaginal dryness include a yeast infection, breastfeeding, hormonal birth control that doesn’t have estrogen (for example, the Depo-Provera injection and the implant Nexplanon), and muscle spasm around the vagina (the tightness causes more friction, and it can be perceived as dryness).

I hear from women that some male partners “don’t like” lubricant or say it affects their erection. It’s only a few milliliters of lube (far less than an ounce), so it’s not exactly as if his penis is encased in pudding. I’m no urologist, but if he uses this “too wet” excuse, then either he doesn’t know what an excited vagina feels like or he could be projecting his medical condition, typically erectile dysfunction, onto you.

Vaginal lubrication is part of the sexual response cycle and can vary from day to day and from partner to partner. The amount of foreplay and penetration will also affect what you need. Sometimes your mind is raring to go and your body hasn’t quite caught up yet, so a boost from a bottle can get you there faster.

Whatever the reason, lube is your friend! I think of lubricant in the way I think of glasses—some people have always needed them, some of us need glasses as we age, and some just need glasses for reading. No one is judgy about glasses.

Remember, it’s not how you got to the party, it’s that you were at the party and had a good time!

The Choices

The lube section at the drugstore or online can be overwhelming, as there are a lot of options—even more so at specialty sex shops. However, at many sex shops you have a lube docent who can provide details on all of their offerings.

There are several categories of lube: water based, silicone, hybrid (silicone and water), oil based, and pure oil (think olive or coconut). Silicone lubricants stay around longer on the tissues versus water-based lubes, so you may need to reapply less and they can be used in the shower or bath. Some people find silicone harder to clean up than water based. Oil also has a lot of staying power and many people prefer the feel, but it can also stain sheets. Water-based lubricants are the easiest to clean up. All of these lubes are fine for anal sex.

Some people really care about the feel of their lube—sensation is very personal. I find there are two main tactile components to consider: the slip and the tackiness. Others are more bothered by the cleanup factor, some find taste an issue, and there are those who don’t care as long as it is wet and gets the job done! The great thing about lube is you get to be Goldilocks and try a few so you can figure out your preference.

In addition to feel and cleanup factor, it’s also important to make sure your lubricant doesn’t irritate the vaginal tissues or negatively affect the healthy bacteria. The World Health Organization (WHO) has guidelines for water-based lubricants. Specifically, they recommend a pH of 3.5–4.5 (the same as the vaginal pH) and an osmolality of less than 380 mOsm/kg (the concentration of molecules in water; low osmolality means fewer molecules and high osmolality means more).

The osmolality of vaginal secretions is 260–280 mOsm/kg. If the osmolality of the lube is higher, it can pull water out of vaginal tissues, potentially causing irritation and increasing microtrauma, and theoretically increasing the risk of contracting an STI if exposed. The WHO recommends against lubricants with osmolality greater than 1,200 mOsm/kg. These recommendations don’t apply to silicone and pure oil lubes as they don’t have water, so there is no pH (pH is a measurement of hydrogen atoms in water) and no osmolality.

You also want to consider condom compatibility. Specifically, oil-based lubricants can weaken latex condoms. Silicone and water-based are fine. You can use any lubricant with polyurethane condoms. Sex toy compatibility can be an issue, with silicone lubricants potentially degrading silicone sex toys, so always follow the manufacturer’s recommendations for lube choice. Silicone lubricants typically have the same basic ingredients: cyclomethicone and dimethicone.

As brands may switch ingredients, it is always important to check the label. There are some specific ingredients that you should know more about in terms of safety:

• GLYCERIN (WHICH IS GLYCEROL) AND PROPYLENE GLYCOL: Preservatives in many water-based lubricants. They have a high osmolality, and so the WHO recommends total glycerol content should be less than 8.3 percent. As yeast can potentially use glycerin /propylene glycol as a food source, it is possible they could contribute to yeast infections. High-glycerin lubes can also irritate and be mistaken for a yeast infection.

• PARABENS: Preservatives found in some water-based lubricants. They are endocrine disruptors, meaning they can act like a hormone on tissues with a potentially negative effect, although the amount used in lubricant is considered safe. Oxygen can be dangerous for the lungs when it is 100 percent pure (the 17 percent in air is obviously not), so the dose is what matters safety-wise. For perspective, many plants are endocrine disruptors, like lavender and cannabis (marijuana), and people conveniently forget about those even though studies have raised safety concerns. Parabens have been well tested regarding allergic reactions and are an unlikely cause of irritation.

• CHLORHEXIDINE GLUCONATE: Also a preservative. In one study it killed all the good bacteria, so it is best to avoid.

• POLYQUATERNIUM: A preservative that may increase HIV-1 replication. There are not enough studies to say this is definitive, but until more data appears, the WHO suggests it go on the pass list.

• WARMING LIQUIDS, OR COOLING OR “TINGLING” LUBES: The active ingredient can be a higher concentration of propylene glycol, alcohol, botanicals, menthol, or even capsaicin (what makes chili peppers burn, and this definitely can feel like it burns when it contacts the vagina!). Some of these can irritate and others, like menthol, are untested in the vagina, so we don’t know much. “Natural” or “plant-based” does not mean safe.

• HYDROXYETHYLCELLULOSE: Part of the “slip” in some water-based lubes. Some organic lubes tout this as natural because it is plant derived, but it’s in many conventional lubricants as well, so it is not a special or rare lube ingredient. It can also be used by yeast as a food source.

• “NATURAL” OR “ORGANIC” LUBES: Marketing terms. All water-based lubricants contain preservatives, so “natural” does not mean preservative free. One lube even advertises about preservatives that they have “just enough for safety, not enough for harm.” I don’t think any manufacturer is trying to harm—they don’t want bacteria to grow. I personally hate that kind of shade in advertising because it is meant to distract from the fact that the self-titled “natural” manufacturer appears to be offering exactly the same thing as the “conventional” product.

• OIL BASED: Contain different oils, such as almond oil, sunflower seed oil, and shea butter. Some have beeswax and vitamin E. Each brand will have a proprietary blend.

• COOKING OILS: Such as olive oil or coconut oil. One study linked oils with a higher incidence of colonization with yeast, but another study with olive oil in postmenopausal women revealed no negative effects. For many years, doctors recommended Crisco, and that seemed well-tolerated, but that contains a trans fat, which is unhealthy (see chapter 7). While it is unlikely to be absorbed, the idea of putting an oil linked with heart disease anywhere in your body seems counterintuitive. While coconut oil has not been studied, I’ve had lots of patients use it over the years, and I don’t remember one complaint.

• PETROLEUM JELLY: Has been associated with bacterial vaginosis in at least two studies when used as a lubricant. Give it a pass.

Do I Need a Special Lubricant to Get Pregnant?

Studies in the lab (in vitro studies) have suggested some lubricants could affect sperm function; however, the results are conflicting—sometimes the sperm-friendly lubricant stopped the sperm swimming, and in other studies the same lubricant did not. Some data suggests that glycerin in concentrations higher than 10 percent could be part of the issue, but honestly the data is all over the place. Olive oil, canola oil, and mineral oil have also been studied, and only olive oil seemed to have a negative effect on sperm in the lab. Some people have wondered if the parabens found in some lubes can damage sperm, but there is really no evidence to support that claim.

There are lubricants that advertise as sperm safe; however, a study that followed women attempting to get pregnant found no difference in pregnancy rates between women who used a sperm-friendly lubricant and those who did not.

That’s weird, you say! Well, coating sperm with lubricant in a petri dish is quite different from what happens in the vagina. Keep in mind that saliva also reduces sperm motility, and no one is telling couples who want to get pregnant to avoid oral sex.

What should you do? For the average person trying to get pregnant, the science behind special lubricant seems iffy at best, but avoiding a lubricant with a high glycerin content is best for your vagina, so avoid those regardless.

The “sperm-friendly” lubricants are typically more expensive, so you can probably give them a pass unless you are diagnosed with an infertility problem related to sperm function or your fertility doctor makes a specific recommendation—it is possible that even a minor impact from a lubricant might be an issue for sperm with very poor motility.

BOTTOM LINE

• It is not abnormal to need lubricant to enjoy sex.

• If a male partner says lube affects his sexual performance he, not you, should see a doctor.

• Avoid water-based lubricants with an osmolality > 1,200 mOsm/kg.

• Hydroxyethylcellulose, an ingredient in both “natural” and “conventional” lubes, may be associated with yeast infections.

• There is no good data to suggest that “sperm-friendly” lubricants are needed for a couple who does not have male-factor infertility.