Include lubricants in sexual health dialogue

When discussing sexual health with patients, does lubricant use come up in the conversation? Such discussion might be helpful. An Indiana University study involving 2,453 women ages 18-68 indicates that lubricant use during sexual activity alone or with a partner contributed to higher ratings of pleasurable and satisfying sex.1 Lubricant use also reduces the likelihood of vaginal tearing, which can increase risk for HIV and other sexually transmitted diseases (STDs).

Why is it important that reproductive health clinicians discuss lubricant use?

Researchers from Indiana University's Center of Sexual Health Promotion have conducted a wide range of studies focusing on lubricant use. Researchers have found that men and women, but particularly women, are confused about lubrication, says Michael Reece, PhD, MPH, center director and associate professor in the Indiana University School of Health, Physical Education, & Recreation.

"Clinicians have a particularly important role to play by asking women about their lubrication, particularly when individuals complain of pain or other discomforts during or after sexual intercourse," states Reece. "By discussing with women and their male partners that perhaps an additional lubricant may be helpful will help to normalize their use."

While personal lubricants have been recommended to women to improve the comfort of sexual intercourse and to reduce the risk of vaginal tearing, little data are available on women's use of lubricants or associated vaginal symptoms. In the new research, scientists looked at women who used one of six different water- or silicone-based lubricants.1

Data indicate that side effects were rarely associated with lubricant use. Vaginal tearing occurred during less than 1% of vaginal intercourse events, and genital pain was reported in less than 5% of intercourse acts when lubricant was used.

The take-away message for clinicians is that lubricants add to women's sexual pleasure and satisfaction, for masturbation and sexual intercourse, and are rarely associated with genital side effects, says Debby Herbenick, PhD, MPH, the center's associate director and lead author of the study. Center scientists plan to look at preferences for lubricants and genital symptoms in response to lubricants among women with vulvodynia and women who are prone to chronic yeast infections.

What about use of lubricants with condoms? Indiana University researchers performed a separate study involving 1,834 men to look at the use of lubricants during vaginal intercourse. The study involved 8,876 coital events, 46.8% of which involved the use of a latex condom and 24.7% of which involved the use of a lubricant.2

Researchers found that lubricant was added to the external tip of the condom after penile application (22.5%), directly in or around the partner's vagina (16.2%), and to both the condom and vagina (16.2%). The addition of lubricant to condoms was more likely during intercourse with a spouse than with a noncommitted partner; during intercourse events of longer duration; when a female partner applied the condom to the partner's penis; and when a female partner used a contraceptive vaginal ring, intrauterine device, or spermicidal jelly/foam as a method of contraception.2

What are some common myths that patients may have when it comes to lubricant use? Reece lists two:

Women are supposed to lubricate naturally.

This might be the case for many women, but some women find it necessary to add additional lubrication for solo or partnered sexual behaviors, says Reece. The use of a lubricant during sexual interaction can have important outcomes in terms of supporting comfort during intercourse, helping to prevent tissue damage, and also adding to the comfort of using condoms, he observes.

All lubricants are the same.

"There has been an explosion of lubricants in the retail marketplace, and it can be confusing," says Reece. "Sexually active individuals need to explore different lubricants and find the one that is most comfortable for them, and always be sure that the lubricant is compatible with condoms."

Unlike water-based lubricants such as K-Y Jelly, oil-based lubricants such as petroleum jelly, baby oil, and hand lotions can reduce latex condom integrity and might facilitate condom breakage.3 Patients using oil-based lubricants might mistake them for water-based lubricants because they readily wash off with water. Talk about the need for water-based lubricants with latex condoms, and counsel patients to make sure that condoms are lubricated adequately before use and that lubrication is added periodically once sex has begun.4

References

  1. Herbenick D, Hensel DJ, Jozkowski K, et al. Clinical and sexual outcomes following women's use of lubricants during sexual activity. Presented at the 137th annual meeting of the American Public Health Association. Philadelphia; November 2009.
  2. Reece M, Hensel DJ, Herbenick D, et al. Adding lubricant to condoms during vaginal intercourse: An event level analysis. Presented at the 137th annual meeting of the American Public Health Association. Philadelphia; November 2009.
  3. Warner L, Steiner MJ. Male condoms. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 19th revised edition. New York City: Ardent Media; 2007.
  4. Rural Center for AIDS/STD Prevention. Condom Breakage: Possible Causes and Avoidance. Fact sheet. Accessed at www.indiana.edu/~aids/factsheets/factsheet19v2.pdf.