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The Savvy Woman’s Guide to Buying a Lubricant
Excerpted from Slip Sliding Away: Turning Back the Clock on Your Vagina – A Gynecologist’s Guide to Eliminating Post-Menopause Dryness and Pain
By Lauren Streicher, MD
When it comes to purchasing a vaginal lubricant, most women resort to one of two strategies. Either they grab the first product they see, then stock up on shampoo and deodorant to hide the fact that vaginal lubricant is the only thing on their list in case they run into someone they know, or they grab a product they have seen advertised. Women willing to linger often pick the brand that promises the most. Inevitably, the results are disappointing.
The truth of the matter: Not all lubricants are created equal. Here is what it is supposed to do.
A lubricant is defined as a substance that provides a slippery barrier between a penis or toy and vaginal tissue. Lubricants do not change or heal tissue. A lubricant decreases friction. Period.
There are three basic categories of commercially available lubes: water-based, silicone-based, and oil-based. Hybrid lubes combine water and silicone.
Water is interesting in that it can be really slippery (think slipping on a thin pool of it as you step out of the shower), but if there is a lot of friction, water can make things tacky or sticky. In addition to the fact that water-based lubes tend to be gloppy and sticky and simply don’t last very long, most popular water-based lubes can, with continued use, damage and dehydrate vaginal tissue. Here's why:
Most water-based lubes contain glycerin and other additives to keep things on the slippery side. Another ingredient often found in many, but not all, water-based lubes is a preservative known as propylene glycol. Glycerin, propylene glycol and other additives often found in water-based lubricants increase a product’s osmolality.
A quick trip back to seventh grade science is needed to understand why this is a problem (I’ll keep this short).
Osmolality is the measure of dissolved particles per unit of water in a solution. Water has an osmolality of zero. The vagina normally has a low osmolality, around 300 mOsmol/kg, so you want whatever you’re using to be as close as possible to that number.
If you put a lubricant with a high osmolality in the vagina, the vaginal cells will push water outside of the cells in an attempt to maintain a low vaginal osmolality. So, lubricants with high osmolality not only dry out tissue (the opposite of what you are trying to accomplish!) but also increase the chance of irritation and infection because the tissue becomes damaged. Hence, the irritation, burning and itching that many women experience with regular use of many popular water-based lubricants.
It’s truly shocking how many of the most popular lubricants have a sky-high osmolality. There are newer lubricants that have a low osmolality, but you need to look for them. As a sweeping generalization, if a lubricant does not list its osmolality, it probably is off-the-charts high.
Many women avoid lubricants with glycerin because they think they will cause yeast infections, and they avoid parabens because they are concerned they will cause cancer (not true). The reason to avoid water-based lubes with these additives is that along with the additives comes a high osmolality.
What About pH?
If the goal of a vaginal lubricant is to be as close as possible to vaginal secretions in terms of osmolality, then it stands to reason that a lubricant should also have a pH in the neighborhood of about 3.5-5.0 to maintain a healthy microbiome.
Silicone lubricants do not have a pH value because they have no water. Water-based lubricants vary in pH, and like osmolality, rarely advertise the pH level unless it is low. Having said that, pH is less of an issue when choosing a lubricant because unlike osmolality, which is often in the sky-high tissue-damaging range, the pH of most lubricants is between 3.0 and 6.0. Having said that, if you are someone that gets frequent bacterial vaginosis, you should make sure your lubricant is not the culprit that is killing off the healthy lactobacilli.
The tradeoff of using low-osmolality water-based lubes is that, although they are nonirritating to vaginal tissue, they may not be slippery enough or last long enough. (All of those osmolality-increasing additives are what make them slippery.) Silicone lubricants, on the other hand, are very slippery, long- lasting and nonirritating. In addition to being far more slippery than a water-based lubricant, silicone lubricants do not have osmolality or pH issues because they do not require preservatives or other irritating ingredients.
Silicone lubricants do not destroy latex and are condom-compatible. Because they don’t break down in water, they are by far the best choice if you like having sex in the sauna, tub or shower. A word of caution: If you are a fan of sex in the shower, beware that silicone lube on your shower floor translates to a high risk of slipping and falling. Try explaining that one to the paramedics!
The downside to silicone lubricants is that they are generally more expensive. But remember: A little bit goes a long way, and your vagina is worth it! Another minor negative is that for those without a flesh-and-blood man on hand, silicone lubes have the potential to react with silicone vaginal toys. Prolonged contact can cause the toy to become gummy or sticky, and in some cases, they can cause the silicone covering to swell and become misshapen. An easy workaround is to put a condom over your toy to protect it or simply wash the toy as soon as you are finished using it.
So, where do you get silicone lubricants? Your local drugstore does carry them, but because of the higher price point, they may not have a huge selection. The internet is also a great way to find a selection of silicone lubes. Just be sure to specify silicone vaginal lubricant in your search or you are likely to come up with products meant for your carburetor.
There are a handful of commercial lubricants that are oil-based rather than silicone- or water-based. Oil-based lubricants are not condom-compatible. They are also … oily. Some women like them because they are thinner and feel more like the real deal. Although there are no studies that actually compare the various types of lubes, I have yet to have a patient tell me that an oil-based lube lasted as long or was as slippery as a silicone product.
Getting It Where It Needs to Go
Most products come with excruciatingly detailed instructions even when it is pretty obvious how they should be used. You really don’t need to be told to rinse the shampoo out of your hair, but the back of the shampoo bottle always tells you specifically to do so.
Lubricant, on the other hand, comes instruction-free despite the fact that a lot of women are not really sure when or how to use it. When you are in “the moment” is probably not the best time to try to figure it out.
First, I suggest you remove the packaging and put the lube in a handy place well in advance of when you expect to use it. You don’t want to go on the hunt. Once you are in the moment, if there is any chance — any chance! — that you will be dry and you think you are going to need some lubricant, do not try to have intercourse without applying it to “see how it goes.” I can guarantee it is not going to go well. And once you try to experience the agony of sandpaper sex, it’s pretty much game over. Your vagina is not stupid, which means that the muscles surrounding the vagina will go into protective mode to prevent another painful attempt. When pelvic muscles spasm and tighten, the vaginal opening will be constricted, and the tissue will become even drier than usual. Once that happens, you can pretty much forget it. A bathtub full of lube is not going to help.
So, slather the lubricant on you and your partner (or toy) before you start. The worst that will happen is that it will be too slippery. The easiest approach is to put a generous amount of lube on your (or his) fingers and apply it to the opening of your vagina. Coat his penis in it as well. (I guarantee he will like this part.) His penis will be the delivery system to the inside of your vagina.
Cannabidiol for Your Vag?
Cannabidiol (CBD) is in your smoothies, your chocolate, and your muscle balm — why not your lube? CBD lubes claim to not only decrease pain and irritation but also to increase libido and the ability to have an orgasm. I have even seen claims that CBD applied to the vagina will eliminate post-traumatic stress disorder (PTSD) from prior sexual trauma.
Here's the problem. There is no research. None. Zip. Any "research" that is cited is generally marketing research or anecdotal testimonials, not scientific research. A typical marketing campaign reads, "We gave CBD lube to 50 women, and 98% of them said it was awesome!" It sounds convincing, but in my world, you need to give lube to hundreds of women and do what is known as a “blinded” comparison, meaning 505 get lube with CBD, 50% get lube without CBD, and then you see if the CBD group has a benefit over the non-CBD group.
In the absence of data, I'm not recommending CBD lube, but I am not not recommending CBD lube.
Here's what is known:
What if You Are Using a Prescription Product to Help With Lubrication?
Many women who use one of the products I discuss in subsequent chapters assume they will no longer need a lubricant. That is not necessarily the case. Even if you are using an estrogen product, dehydroepiandrosterone (DHEA) or ospemifene, or you have had vaginal laser treatments, most women still need the slippery stuff.
IS THIS NORMAL? OB/GYN EDITION
OB/GYNs are familiar with the awkward asks. Lauren Streicher, MD, shares the questions she’s asked most on hot flashes, incontinence and painful sex.
TREATING VAGINAL DRYNESS AFTER BREAST CANCER
Non-hormonal treatment for vaginal dryness is especially helpful for women who have had treatment for breast cancer.
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