The Best Lube: Research and What to Avoid

When I first started having sex, my partner and I knew little about lube. We were lured in by warming lubes and other novelty lubes. Initially, I was only familiar with what was in the drugstore or shops in the mall; I never thought to look for lube at a sex shop.

Over time, I realized that I didn’t particularly like the lubes that I had tried, but I figured that there weren’t better options. I consider myself a smart consumer, but I thought that the drugstore gel lube was the best I was going to find.Years later, I realized that I was so wrong. Characteristics like osmolality, pH, and ingredients all affect the safety and comfort of lube.

This post is aimed at providing a detailed explanation and including research findings on the characteristics of lube. Future posts will be less technical, but I feel it is important to share this information and cite sources for further reading.

The Research

While I was wrong that there were no better options, most drugstore lubes are not ideal when pH and osmolality recommendations are considered. Manufacturers are usually not upfront about either of these metrics. In addition, some influencers and companies opportunistically sweep in to take advantage of disinformation and distrust, resulting in fearmongering. Most consumers don’t even know what lube is made of, but these ingredients matter.

Although most women use lube infrequently, it is generally used by women to decrease discomfort and pain and increase pleasure. Most women in the U.S. (65%) have used lube, and 20% have used it in the past 30 days[1]. Men who have sex with men also frequently use lube[2].

A healthy vagina is colonized by “good” bacteria called Lactobacilli. When the balance of bacteria is changed, and Lactobacilli are found in low numbers, the vagina becomes more prone to different infections, particularly bacterial vaginosis[3]. Bacterial vaginosis has been linked to increased susceptibility to a number of infections, including sexually transmitted infections.

Some lubes can disrupt the vaginal microbiome or damage vaginal or rectal tissue, resulting in irritation or even infections. If you wonder what lube you can use to avoid yeast infections or bacterial vaginosis (BV), and the information below can help you. If you’re unsure what is causing irritation, the information below can also help you figure out what lube ingredients you may want to avoid.

Ingredients

Water-based lubes can contain many ingredients, including preservatives, humectants (or moisturizers), and thickeners. Preservatives can include microbicides that prevent bacterial growth. Humectants can prevent the lube from drying out too quickly and can provide a slippery feel. Thickening ingredients can help change the texture to be thicker or gel-like.

Some of these ingredients can be harmful or irritating to vaginal or anal tissue. It’s possible that you won’t have a negative reaction to certain ingredients, but if you are experiencing irritation, discomfort, or vaginal infections, these ingredients could be the culprit.

Water-based lubes, which dry more quickly than silicone- or oil-based lubes, contain moisturizers or humectants to prevent evaporation. These humectants are used commonly in skincare products, but vaginal and anal tissue have different needs than ordinary facial or body skin.

Humectants

Humectants are moisturizers commonly used in personal care products such as skincare products.

Commonly used humectants in lube include glycerol/glycerin(e), and propylene glycol. Glycerol or glycerin(e) is a sugar byproduct (or sugar alcohol). Propylene glycol is a common ingredient in personal care products.

Glycerol and propylene glycol can be problematic particularly when found in large quantities in a water-based lube, making these lubes hyperosmolar (see below). Glycerine and propylene glycol in lube were also associated with an increase in HSV-2 (herpes) in an animal study[4]. In higher concentrations, propylene glycol has been associated with contact dermatitis and allergic reactions[5].

Hyaluronic acid is a humectant that naturally occurs in the skin and is frequently used in skincare products. Hyaluronic acid has been found to be safe and effective for resolving vulvar and vaginal pain in postmenopausal women and cancer survivors[6]. It is more commonly found in vaginal moisturizers, but it is also found in lubes such as Sutil Luxe and Sutil Rich. In some cases, hyaluronic acid can be found in its salt forms, sodium hyaluronate and potassium hyaluronate.

Preservatives

Polyquarternium

The World Health Organization (WHO) indicates that polyquarternium-containing lubes may allow HIV-1 to replicate more quickly. Specifically, researchers found a link between HIV-1 replication and the compounds polyquarternium-15 and MADQUAT[7]. Although polyquaternium compounds are different, the WHO recommends that lubes containing polyquarternium be avoided until further research is conducted[8].

Microbicides

Microbicides, like the spermicide nonoxynol-9 (commonly used in Trojan condoms), can be harmful to vaginal and anal tissue. Nonoxynol-9 is known to be associated with an increased risk of contracting HIV-1[9]. In an animal study, nonoxynol-9 was associated with increased risk of HSV-2 (herpes)[10]. Nonoxynol-9 has also been shown to reduce the growth of healthy Lactobacilli bacteria[11].

Chlorhexidine gluconate is commonly used in antiseptic mouthwashes and in surgical lubricants, but it is also occasionally used in lube (including some of the most common drugstore lubes). In a recent study, lubes containing chlorhexidine gluconate were found to diminish the growth of healthy Lactobacilli bacteria[12]. Chlorhexidine gluconate also can damage mucosal surfaces[13] and in an animal study, it both increased vaginal sensitivity and increased susceptibility to chlamydia[14].

Parabens

Parabens are preservatives commonly used in cosmetics and food. While it is not clear that parabens are harmful in small amounts, they resemble a weak estrogen. Currently, there is no evidence that parabens cause cancer or disrupt hormones in human beings[15]. Many women who are survivors of breast cancer avoid estrogens and may avoid parabens out of an abudance of caution. Parabens are relatively non-allergenic, but a small percentage of the population is allergic to parabens[16]. If you don’t feel comfortable using parabens, there are many lubes that are paraben-free.

Other Ingredients

Benzocaine

Benzocaine is used in desensitization and numbing lubes. While it can be used for penis desensitization to increase the length of intercourse, it should be avoided for anal sex. Anal numbing lubes are commonly sold at novelty stores and some sex shops to ease discomfort and pain with anal sex. These lubes can be harmful[17]! Pain during anal sex can indicate that something is wrong – for example, tearing or tissue damage. Instead, anal discomfort than be avoided by preparing for anal using toys and using lubes that are thicker, or silicone based.

Carrageenan

Carrageenan is a seaweed-derived ingredient commonly used to thicken foods and drinks. It is also a potent inhibitor of HPV[18], and some studies have found that a proprietary carrageenan lubes (Divine 9) can help prevent HPV transmission[19].

pH

pH, which you may remember from chemistry class, is the measure of how acidic of basic a water-based solution is. When shopping for lube, this means that only water-based (and hybrid) lubes will have a pH value. At the same time, lubes that aren’t water-based can still raise vaginal pH – oil-based lubes can raise vaginal pH[20].

A healthy pre-menopausal[21] vagina has an acidic pH of 3.8 to 4.5[22], while the rectum is closer to a neutral pH of 7. Unfortunately, some manufacturers don’t seem to take vaginal pH into consideration when producing lube. This is unfortunate, because an increase in vaginal pH can result in bacterial vaginosis and trichomoniasis infections[23]

The World Health Organization recommends that vaginal lube have a pH of around 4.5 or less, while anal lube should have a pH in the range of 5.5 to 7[24].

Osmolality

Osmolality refers to the concentration of particles in a solution. In this case, the concentration of lube is measured in milliosmoles per kilogram of water (mOsmol/kg).

Lube will first come into contact with the vagina or rectum through the epithelial layer – the uppermost layer that lines the vagina and rectum. Lubes that have a similar osmolality to vaginal fluid are called iso-osmolal. Other lubes may have a lower osmolality (hypo-osmolal) or a higher osmolality (hyperosmolal). In the case of vaginal use, use of a hyperosmotic lube can result in water being sucked out of vaginal tissues, resulting in a drying effect.

Hyperosmolal lubes have been found to cause damage to both rectal[25] [26] and vaginal[27] [28] [29] [30] tissue. This damage can result in both 1) increased susceptibility to sexually transmitted infections and 2) a decrease in the friendly lactobacilli bacteria that can help protect the vagina against infection.

In a review of studies that measured the osmolality of 44 common lubricants, researchers found that 86% were hyperosmolal[31]. Across these studies, only a few lubes were both at an appropriate pH and hypo-osmolal or iso-osmolal, particularly for vaginal use. Unfortunately, osmolality is not something that can be measured at home, and most manufacturers don’t provide osmolality values. Many hyperosmolar lubricants are hyperosmolar because they contain a large quantity of glycerin and/or propylene glycol[32], so the placement of these ingredients in a lube’s ingredient list could be a clue that it may be hyperosmolar.

Other resources

References:

[1] Debby Herbenick et al., “Women’s Use and Perceptions of Commercial Lubricants: Prevalence and Characteristics in a Nationally Representative Sample of American Adults,” Journal of Sexual Medicine 11, no. 3 (March 1, 2014): 642–52, https://doi.org/10.1111/jsm.12427.

[2] Marjan Javanbakht et al., “Preference and Practices Relating to Lubricant Use during Anal Intercourse: Implications for Rectal Microbicides,” Sexual Health 7, no. 2 (2010), https://doi.org/10.1071/SH09062.

[3] S. S. Witkin and I. M. Linhares, “Why Do Lactobacilli Dominate the Human Vaginal Microbiota?,” BJOG: An International Journal of Obstetrics and Gynaecology, 2017, https://doi.org/10.1111/1471-0528.14390.

[4] Thomas R. Moench et al., “Microbicide Excipients Can Greatly Increase Susceptibility to Genital Herpes Transmission in the Mouse,” BMC Infectious Diseases 10 (November 18, 2010), https://doi.org/10.1186/1471-2334-10-331.

[5] Soogan C Lalla et al., “Patch Testing to Propylene Glycol: The Mayo Clinic Experience,” Dermatitis 29, no. 4 (2018), https://journals.lww.com/dermatitis/Fulltext/2018/07000/Patch_Testing_to_Propylene_Glycol__The_Mayo_Clinic.6.aspx.

[6] Junya Chen et al., “Evaluation of the Efficacy and Safety of Hyaluronic Acid Vaginal Gel to Ease Vaginal Dryness: A Multicenter, Randomized, Controlled, Open-Label, Parallel-Group, Clinical Trial,” Journal of Sexual Medicine 10, no. 6 (2013), https://doi.org/10.1111/jsm.12125; Jeanne Carter et al., “A Single-Arm, Prospective Trial Investigating the Effectiveness of a Non-Hormonal Vaginal Moisturizer Containing Hyaluronic Acid in Postmenopausal Cancer Survivors,” Supportive Care in Cancer 29, no. 1 (2021), https://doi.org/10.1007/s00520-020-05472-3.

[7] Othell Begay et al., “Identification of Personal Lubricants That Can Cause Rectal Epithelial Cell Damage and Enhance HIV Type 1 Replication in Vitro,” AIDS Research and Human Retroviruses 27, no. 9 (2011), https://doi.org/10.1089/aid.2010.0252.

[8] World Health Organization, “Use and Procurement of Additional Lubricants for Male and Female Condoms: WHO/UNFPA/FHI360: Advisory Note” (World Health Organization, 2012), https://apps.who.int/iris/bitstream/handle/10665/76580/WHO_RHR_12.33_eng.pdf?sequence=1&isAllowed=y.

[9] Lut Van Damme et al., “Effectiveness of COL-1492, a Nonoxynol-9 Vaginal Gel, on HIV-1 Transmission in Female Sex Workers: A Randomised Controlled Trial,” Lancet 360, no. 9338 (September 28, 2002): 971–77, https://doi.org/10.1016/S0140-6736(02)11079-8.

[10] Moench et al., “Microbicide Excipients Can Greatly Increase Susceptibility to Genital Herpes Transmission in the Mouse.”

[11] Dong Wook Park et al., “The Effects of Vaginal Lubricants on the Human Vagina: An in Vitro Analysis,” Clinical and Experimental Obstetrics and Gynecology 46, no. 3 (2019), https://doi.org/10.12891/ceog4671.2019.

[12] Pawel Laniewski et al., “Clinical and Personal Lubricants Impact the Growth of Vaginal Lactobacillus Species and Colonization of Vaginal Epithelial Cells: An in Vitro Study,” Sexually Transmitted Diseases 48, no. 1 (2021), https://journals.lww.com/stdjournal/Fulltext/2021/01000/Clinical_and_Personal_Lubricants_Impact_the_Growth.11.aspx.

[13] Rebecca M. Brotman et al., “Rapid Fluctuation of the Vaginal Microbiota Measured by Gram Stain Analysis,” Sexually Transmitted Infections 86, no. 4 (2010): 297–302, https://doi.org/10.1136/sti.2009.040592.

[14] Sharon L. Achilles et al., “Microbicide Efficacy and Toxicity Tests in a Mouse Model for Vaginal Transmission of Chlamydia Trachomatis,” Sexually Transmitted Diseases 29, no. 11 (2002), https://doi.org/10.1097/00007435-200211000-00007.

[15] Raphael J. Witorsch and John A. Thomas, “Personal Care Products and Endocrine Disruption: A Critical Review of the Literature,” Critical Reviews in Toxicology, 2010, https://doi.org/10.3109/10408444.2010.515563; Mark G. Kirchhof and Gillian C. de Gannes, “The Health Controversies of Parabens.,” Skin Therapy Letter 18, no. 2 (2013).

[16] Anthony F Fransway et al., “Parabens,” Dermatitis 30, no. 1 (2019), https://journals.lww.com/dermatitis/Fulltext/2019/01000/Parabens.2.aspx.

[17] Kelli Acciardo, “4 Harmful Lube Ingredients You Should Avoid At All Costs | Prevention,” Prevention, 2016, https://www.prevention.com/sex/g20482085/personal-lubricant-ingredients-to-avoid/.

[18] Christopher B. Buck et al., “Carrageenan Is a Potent Inhibitor of Papillomavirus Infection,” PLoS Pathogens 2, no. 7 (2006): 0671–80, https://doi.org/10.1371/journal.ppat.0020069.

[19] Dianne Marais et al., “The Effectiveness of Carraguard, a Vaginal Microbicide, in Protecting Women against High-Risk Human Papillomavirus Infection,” Antiviral Therapy 16, no. 8 (2011): 1219—1226, https://doi.org/10.3851/imp1890; Aixa Rodríguez et al., “In Vitro and in Vivo Evaluation of Two Carrageenan-Based Formulations to Prevent HPV Acquisition,” Antiviral Research 108 (2014): 88–93, https://doi.org/https://doi.org/10.1016/j.antiviral.2014.05.018.

[20] Rachel Mantock, “Lube Can Alter Vaginal PH. Here’s What to Look for on the Label,” The Femedic, 2019, https://thefemedic.com/sexual-health/lube-can-alter-vaginal-ph-heres-what-to-look-for-on-the-label/.Mantock.

[21] Kelly M. Tucker et al., “Vaginal PH: A Simple Assessment Highly Correlated with Vaginal Morphology and Symptoms in Postmenopausal Women,” Menopause 25, no. 7 (2018), https://doi.org/10.1097/GME.0000000000001081.

[22] Stephanie Watson, “Vaginal PH Balance: Normal Levels, Correcting Unbalanced PH & More,” Healthline, 2019, https://www.healthline.com/health/womens-health/vaginal-ph-balance.

[23] Ana Raquel Cunha et al., “Characterization of Commercially Available Vaginal Lubricants: A Safety Perspective,” Pharmaceutics 6, no. 3 (2014), https://doi.org/10.3390/pharmaceutics6030530.

[24] World Health Organization, “Use and Procurement of Additional Lubricants for Male and Female Condoms: WHO/UNFPA/FHI360: Advisory Note.”

[25] Edward J. Fuchs et al., “Hyperosmolar Sexual Lubricant Causes Epithelial Damage in the Distal Colon: Potential Implication for HIV Transmission,” Journal of Infectious Diseases 195, no. 5 (March 1, 2007): 703–10, https://doi.org/10.1086/511279.

[26] Begay et al., “Identification of Personal Lubricants That Can Cause Rectal Epithelial Cell Damage and Enhance HIV Type 1 Replication in Vitro.”

[27]Els Adriaens and Jean Paul Remon, “Mucosal Irritation Potential of Personal Lubricants Relates to Product Osmolality as Detected by the Slug Mucosal Irritation Assay,” Sexually Transmitted Diseases 35, no. 5 (2008), https://doi.org/10.1097/OLQ.0b013e3181644669.

[28]Seyoum Ayehunie et al., “Hyperosmolal Vaginal Lubricants Markedly Reduce Epithelial Barrier Properties in a Three-Dimensional Vaginal Epithelium Model,” Toxicology Reports 5 (2018), https://doi.org/10.1016/j.toxrep.2017.12.011.

[29] Charlene S. Dezzutti et al., “Is Wetter Better? An Evaluation of Over-the-Counter Personal Lubricants for Safety and Anti-HIV-1 Activity,” PLoS ONE 7, no. 11 (November 7, 2012), https://doi.org/10.1371/journal.pone.0048328.

[30] Park et al., “The Effects of Vaginal Lubricants on the Human Vagina: An in Vitro Analysis.”

[31] Seyoum Ayehunie et al., “Hyperosmolal Vaginal Lubricants Markedly Reduce Epithelial Barrier Properties in a Three-Dimensional Vaginal Epithelium Model,” Toxicology Reports 5 (2018): 134–40, https://doi.org/10.1016/j.toxrep.2017.12.011.

[32] Lauren K. Wolf, “Studies Raise Questions about Safety of Personal Lubricants,” Chemical and Engineering News 90, no. 50 (2012).

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