Part 2 of a 2-Part Series that appears in Women's Healthcare Journal, Annual Primary Care Edition:  2011

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I cannot tell you how many times I have seen young women in my office who are distressed over needing to use vaginal lubricants during lovemaking. Each of these women believes that something is wrong with her body or that if she were more “into” her partner, her natural vaginal secretions would be more plentiful. I explain that most women use lubricants and that this need is perfectly normal. Am I right?

Yes, you are right. The vast majority of women, irrespective of age or reproductive status, use some form of lubricant and/or moisturizer during sexplay. In Part 1 of this 2-part series, I reviewed the dynamics of vaginal lubrication at rest and during female sexual response, and I provided explanations for altered vaginal lubrication. The purpose of Part 2 is to review simple techniques to facilitate sexual comfort with lubricants and moisturizers.

The who and why of lubricants

Although the amount of moisture or dryness that a woman and her partner prefer during sexplay may vary among couples, cross-cultural research suggests that most women consider a moderate amount of vaginal wetness as facilitative for satisfying sex. Nationally representative studies of women across the lifespan suggest that up to 62% of all women use or have used lubricants during sexual activities.1

Women use lubricants for a variety of reasons. The literature on vulvovaginal atrophy points out that perimenopausal and postmenopausal women, lactating women, breast cancer survivors, and women on chemotherapy or other medications that decrease mucous membrane secretions can all benefit from the sexual comfort afforded them by using lubrication.

This literature focuses on dryness, tightness, pain, and discomfort as the impetus for lubricant use.2 However, a recent study of more than 2400 women aged 18-68 years focused on the use of lubricants as a source of added sexual pleasure, not just as a means to prevent pain. The study, published in The Journal of Sexual Medicine, showed that the use of water- or silicone-based lubricants, when compared with no-added-lubrication, was associated with higher ratings of pleasure and satisfaction for self-stimulation and for penile–vaginal sexual activity. In addition, water-based lubricant use, comparedwith no lubricant use, was associated with higher ratings of sexual pleasure and satisfaction for penile.anal sexual activities.3

Lubricants versus moisturizers

Vaginal lubricants are meant to be applied at the vaginal or anal entrance prior to sexual activity to facilitate intromission. The lubricant can also be applied to a partner’s genitals to minimize friction and facilitate glide. When used correctly, lubricants can prevent irritation and decrease the incidence of mucosal fissuring, postcoital burning, vaginitis, and cystitis. Because lubricants remain on the surface of the skin, they may need to be reapplied several times during sexual activity.

Water-based lubricants are usually recommended as a first-line choice because they are often nonirritating, inexpensive, readily available over the counter (OTC), and easy to wash off with warm water.  Silicone-based lubricants tend to be more expensive but may be favored because they last longer before reapplication is needed. Petrolatum-based lubricants are not recommended because they can denigrate latex condoms and often have an unpleasant odor.
Lubricants are usually packaged in liquid or gel form, or as suppositories that melt when exposed to body temperature. Lubricant ingredients range from being 100% organic and paraben-, glycerin-, and preservative-free (eg, Good Clean Love) to containing fragrance, glycerin, parabens, flavors, and warming or cooling additives (eg: KY Warming).4

If a woman has sensitive skin or allergies or is unsure which lubricant to use, it is often a safe choice to use a hypoallergenic brand or one similar to the lubricant used in her GYN office (if it has caused no previous irritation). It is controversial whether lubricants containing glycerin, petrolatum, or warming additives contribute to vaginitis, but women with chronic Candida infections are usually advised to refrain from using them.2,3

Another non-hormonal class of sex-enhancing agents is vaginal moisturizers. These OTC products are packaged in applicators containing polycarbophil or silicone gel and are intended to be used 2-3 times per week at bedtime. The purpose of a vaginal moisturizer is to maintain vaginal pH balance, mucous membrane hydration, health, and comfort for up to 2-3 days (irrespective of the timing or occurrence of sexual activity). For some women, use of a vaginal moisturizer decreases the need for vaginal lubricants. For others, particularly breast, anal, and GYN cancer survivors, co-administration of a vaginal moisturizer (.3 times per week) and a vaginal lubricant (used just prior to intercourse) is recommended.

One vaginal moisturizer, Replens, has been evaluated in several small research studies. Some study results have suggested that Replens increases maturation of the vaginal epithelium, improves the morphology of epithelial cells, reduces the occurrence of bacterial vaginosis, and provides symptom relief similar to that provided by vaginal estrogen cream.5-7 Other vaginal moisturizers (Me Again) contain hyaluronic acid and vitamin E. Hyaluronic acid stimulates a tissue’s ability to retain water. Early studies suggest that moisturizers containing these ingredients relieve symptoms of vulvovaginal atrophy while decreasing vaginal pH to healthy levels.8 For women concerned about preservatives, paraben, glycerin, or other additives, Emerita Personal Moisturizer (available online) is an organic option.9

The newest offering in the lubricant/moisturizer market is Luvena.10 This hybrid lubricant and moisturizer contains prebiotic ingredients and enzymes proven to help restore a healthy pH to the vagina and eliminate dryness, odor, and pruritus. Several small studies have suggested that Luvena may be a useful adjuvant in decreasing recurrent vaginitis infections, as well as in creating a moist and comfortable vaginal environment.

Vaginal health is an important component of a womanfs overall health. Regular sexual activity, done either independently or with a partner, has been shown to contribute to a woman’s wellness. By educating women about the use of vaginal lubricants and moisturizers, for the purposes of decreasing discomfort and/or increasing pleasure, nurse practitioners can help women maintain their vaginal and sexual health.

References

1. Herbenick D, Reece M, Sanders SA, et al. Women’s vibrator use in sexual partnerships: results from a nationally representative survey in the United States. J Sex Marital Ther. 2010;36(1):49-65.
2. Krychman ML. Vaginal estrogens for the treatment of dyspareunia. J Sex Med. 2011;8(3):666-674.
3. Herbenick D, Reece M, Sanders SA, Dodge B, et al. Association of lubricant use with womenfs sexual pleasure, sexual satisfaction and genital symptoms: a prospective daily diary study. J Sex Med. 2011;8(1):202-212.
4. Carter J, Goldfrank D, Schover LR. Simple strategies for vaginal health promotion in cancer survivors. J Sex Med. 2011;8(2):549-559.
5. Nachtigall LE. Comparative study: Replens versus local estrogen in menopausal women. Fertil Steril. 1994; 61(1):178-180.
6. van der Laak, LA, de Bie LM, de Leeuw H, de Wilde PC. The effect of Replens on vaginal cytology in the treatment of postmenopausal atrophy: cytomorphology versus computerised cytometry. J Clin Pathol. 2002;55(6):4446-4451.
7. Wu JP, Fielding SL, Fiscella K. The effect of polycarbophil gel (Replens) on bacterial vaginosis: a pilot study. Eur J Obstet Gynecol Reprod Biol. 2007;130(1):132-136.
8. Me Again website. Lake Pharmaceutical Products, Inc. http://lakeconsumer.com/meagain.html
9. Emerita website. http://www.emerita.com/products/sexual-lubricants/feminine-personal-moisturizer/
10. Luvena website. http://www.luvenacare.com/