The different uses of lubricants pertaining to intimacy, condoms, pessaries, and other medical devices

This informal CPD article, ‘The different uses of lubricants’, was provided by Pelvic Angel Training, specialists in providing experienced pessary advice and support to women. They offer evidence-based pessary courses.

Vaginal dryness is a common issue that can affect women of all ages, but it tends to become more prevalent and pronounced during and after menopause. The decrease in oestrogen levels is a primary cause of vaginal dryness. It can have a significant impact on the quality of life for affected individuals.

Reduced Quality of Life: The physical and emotional challenges associated with vaginal dryness can lead to a reduced overall quality of life. Women may avoid social activities, exercise, or even intimacy due to the discomfort and pain.

Discomfort and Pain: Vaginal dryness can cause discomfort and even pain during everyday activities, such as walking, sitting, and exercising. This can make it challenging to carry out regular tasks and lead to a decreased quality of life.

Sexual Function: Vaginal dryness can significantly impact sexual function. It can make penetrative intercourse painful and uncomfortable, leading to decreased sexual desire and satisfaction. In some it can lead to tearing of the vaginal lining due to atrophy.

Psychological and Emotional Impact: Living with the discomfort and pain caused by vaginal dryness may lead to anxiety, depression, and a decreased overall sense of well-being. Women may feel embarrassed or self-conscious about their condition, leading to buying over the counter products which may not be the right products.

Sleep Disturbances: Some women may experience sleep disturbances due to discomfort, itching and pain, further affecting their overall well-being and quality of life.

There are various treatment options available for vaginal dryness, including hormone therapy, over-the-counter moisturizers and lubricants, and lifestyle modifications, but knowing which product to invest in is difficult which is why it's essential to consult a healthcare professional who can provide guidance and recommend appropriate treatments or strategies to address this issue.

Lubrication

Not all lubricants are equal, and in this ever-growing evolution for producers to fight for their spot in this growing industry of commercial slippery emollients not all are regulated, leaving consumers vulnerable to increased candida growth, bacterial vaginosis and unwanted pregnancies.

The application of lubricants

Different lubricants have different uses and to mix them could pose an internal disaster where the user may blame anything except the lubricant, due to the unknowing of the potential hazards prior to use.

It is important to use the correct type of lubricant with the correct pH balance within to ensure there would be no disruption to the pH of the vagina or anus, which are different and both require different types of lubrication.

The vaginal pH is more acidic and typically a range of 3.8 to 4.5 and may change slightly during different stages of the menstrual cycle. If the pH balance is disrupted it can lead to an increased risk of infections. So, the recommendation for a vaginal lubricant would have a pH of 4-4.5

The pH of the anus is typically more neutral or slightly alkaline and ranges from 6.5 to 7.5 which is closer to the neutral factor of 7. A recommendation for anal lubricate would have a pH of 5.5 – 7

Water based lubricants

Water-based lubricants are generally compatible with all types of condoms, latex, polyurethane, polyisoprene and silicone products.

The effectiveness and longevity of water-based lubricants may vary among different brands and formulations. Some may dry out more quickly than others, so you may need to reapply them during extended sexual activities.

 E-Stimulators for pelvic floor stimulation

It is recommended to use electro-conductive water-based gels that are specifically designed for E-stim applications. These conductive gels are formulated to enhance electrical conductivity between the electrodes and the skin, allowing the device to work as intended without the risk of skin irritation or burning. Using silicone or oil-based lubricants with E-stim devices can create an insulating barrier, reducing the effectiveness of the stimulation and potentially causing issues with the device's function and may lead to skin damage.

Oil and silicone lubricants

Silicone-based lubricants are long-lasting and do not evaporate or absorb into the skin quickly. They can be a good choice for activities that require extended lubrication, without the use of silicone, rubber or latex products.

Oil lubricant properties are not compatible with rubber, latex, silicone and the chemical reactions can make products swell and split causing damage to the product.

Some silicone lubricants are compatible with some latex condoms, it’s always recommended to see the manufacturer recommendations first.

In cases of using oil-based lubricants with condoms, it may weaken and split the condom leading to an unwanted pregnancy or and STD.

Drawing attention to possible irritants

Glycerine is hygroscopic and is a common ingredient in many personal lubricants and is generally recognized as safe for use in intimate products. It's often used because of its moisturizing properties, which can help reduce friction and discomfort during sexual activity. However, there have been concerns raised where the level of glycerine is more than 20% may contribute irritation of the vaginal lining and lubricants which contain more than 40% glycerine may contribute to cellular structure breakdown. It is worth noting that most reputable practises in the formulation of personal lubricants the concentration is lower than 10%. The effects of personal lubricants can vary from individual to individual.

Nonoxynol-9 (N-9) is a spermicide which is used in some lubricants and contraceptive products. N-9 ingredient in lubricants may cause microtears in the vaginal and anal areas resulting in irritation and discomfort, with an increased risk of infection.

Home oils

Coconut oil, Petroleum jelly (Vaseline), olive oil, baby oil:

These may create a breeding ground for common vaginal bacterium, such as Bacteria vaginosis and yeast infections. They are emollients and can remain inside the body for up to 24 hours. They are not compatible with rubber, latex or silicone products.

Water based lubricant randomized trial

A randomized trial on the effectiveness and safety of 5 water-based personal lubricants

Santiago Palacios, MD, Sarah Hood, Bsc,, Temitayo Abakah-Phillips, Bsc, Nina Savania, Bsc, Michael Krychman, MD, MPH, FACOG  : Published The Journal of Sexual Medicine, 2023, 20, 498–506.

‘Vaginal dryness has a significant impact on quality of life in pre- and postmenopausal women, as it affects everyday activities and can have a major impact on sexual function, pleasure, and satisfaction. There is a range of commercially available lubricants with different properties, yet WHO guidance recommends that patients use lubricants that are physiologically similar to natural vaginal secretions and are “body friendly” in regard to pH and osmolality. However, reducing the osmolality of lubricants is often challenging as manufacturers must be careful to ensure that any reductions in the emollients used, such as glycerine or propylene glycol, do not affect the physical properties and performance of the lubricant. In this investigation, all tested water-based lubricants, including those formulated to be biochemically friendly with optimized osmolality and pH, were clinically proven to be well tolerated and efficacious and to have a good safety profile for their primary intended purpose of relieving discomfort associated with vaginal dryness. There were no significant differences between the previously existing formulation of higher osmolality (lubricant A) and lubricants of lower osmolality and pH (lubricants B-E), indicating that when formulated to be consistent with WHO guidance on osmolality, the lubricants tested in this study were not compromised in terms of their efficacy and safety.’

‘In a systematic review, Kennedy et al described an observational study in which lubricant use was associated with improved outcomes for dyspareunia and vaginal dryness in female survivors of breast cancer.’

Conclusion of this trial

‘The 5 water-based lubricants under investigation can be considered effective and have a good safety profile when used for the relief of intimate discomfort associated with vaginal dryness. Beyond relief of vaginal dryness, the results of this investigation show that the lubricants assessed can enhance the overall sexual experience and sexual function in women'.

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