Approach to lubricant use for sexual activity

Abstract

Objective

To present health care providers with an inclusive, evidence-based framework to identify patients who may benefit from lubricant use during sexual activity, and assist patients in selecting a lubricant tailored to their specific needs.

Sources of information

A MEDLINE, PubMed, Google Scholar, and Google search was performed for white and grey literature published from 2003 to 2024. Interdisciplinary experts in sexual health also conducted an iterative review.

Main message

Lubricant use during sexual activity has numerous benefits, minimal harms, and can play a role in managing many common sexual health concerns encountered in primary care. However, counselling on lubricant use can be challenging due to a lack of accessible, evidence-based clinical tools. Consequently, clinicians are often hesitant to discuss lubricant use and can only offer anecdotal advice. Lubricant use is especially beneficial for patients using condoms or experiencing dryness, pain (eg, dyspareunia), or dysfunction during sex. There are 3 main types of lubricants available: oil-, silicone-, and water-based products. For patients who use condoms or who experience recurrent vaginal infections or irritation, silicone- or water-based lubricants are recommended, which are free of harmful ingredients and are within recommended osmolality and pH ranges.

Conclusion

Lubricant use during sexual activity can enhance sexual well-being across diverse patient populations. This review summarizes evidence and provides practical tools to help clinicians integrate counselling on lubricant use into routine sexual health discussions.

Case description

Mx. A, a 45-year-old patient (pronouns they/them, assigned female at birth) presents for a periodic health examination. Their menses are regular, and they are sexually active with a new, cisgender male partner. They engage in receptive vaginal and anal intercourse, and occasionally use sex toys. The patient and their partner recently tested negative for sexually transmitted infections (STIs). Their partner has had a vasectomy. The patient has regular visits with the clinic’s chronic disease nurse. Their weight and diabetes are well managed since starting semaglutide 1 year ago. Their other chronic conditions—including irritable bowel syndrome, anxiety, and attention deficit hyperactivity disorder—remain stable. However, the patient reports frequent bacterial vaginosis infections. Their other medications include sertraline, lisdexamfetamine, and rosuvastatin.

What additional questions would be helpful for a comprehensive sexual history?

Sources of information

We conducted a scoping review following the Arksey and O’Malley framework.¹ Our search strategy included MEDLINE, PubMed, Google, Google Scholar, UpToDate, and manual reference screening for white and grey literature published from 2003 to 2024. Sources were manually reviewed using the following inclusion criteria: identifies patient populations most likely to benefit from lubricant use during sexual activity, addresses benefits and drawbacks of different lubricant classes, or describes properties of, or ingredients in, lubricants that may cause harm. We had no restrictions for study participants (ie, geographic location, age, gender, sexual orientation, or type of sexual activity). Commercially funded work was excluded.

Fifty-three sources met inclusion criteria. Data on product accessibility, cost, and ingredients were collected through systematic online and in-person market research. We received feedback from family physicians, gynecologists, psychologists specializing in sexual concerns, and sexual health educators during manuscript development.

Main message

People of all ages, genders, and sexual orientations use, or are open to using, lubricants during sexual activity to enhance comfort and enjoyment.^2-4 Using lubricants during sexual activity offers several benefits, including managing dryness, dyspareunia, and symptoms of sexual dysfunction.^2-4 Condom-compatible lubricants can also reduce friction and the risk of condom tears, potentially reducing STIs and unplanned pregnancy.^3,5

Genital dryness, dyspareunia, and sexual dysfunction are common concerns in primary care.⁶ However, the personal nature of sexual health, combined with fear of stigma associated with diverse sexual practices, often hinders important discussions between patients and health care providers (HCPs).⁷ Some clinicians may also avoid exploring sexual concerns, perceiving them as either irrelevant or outside their scope of practice. To deliver comprehensive, patient-centred care, HCPs should adopt an inclusive, non-judgmental, trauma-informed approach with all patients when engaging in conversations about sexual health.

If concerns regarding genital dryness, dyspareunia, or sexual dysfunction arise, a targeted history and physical examination (including a pelvic or anal examination) should be performed, alongside relevant investigations, to establish a diagnosis. HCPs should offer multimodal management options tailored to the patient’s diagnosis and preferences. These may include psychotherapy, pelvic floor physiotherapy, initiation of pharmacotherapy, or adjustments to existing medications—in addition to recommending lubricant use during sexual activity. However, there is a dearth of accessible, evidence-based tools to help clinicians identify commercially available lubricants and advise patients on how to use them properly. Consequently, HCPs encounter another barrier in their capacity to counsel patients on using lubricants for sexual activity. This review bridges this gap by offering a clinical resource to guide patient-centred discussions about how lubricants can improve sexual well-being.

Individuals most likely to benefit from lubricant use during sexual activity. Lubricant use during sexual activity particularly benefits patients experiencing genital dryness, irritation, superficial dyspareunia (ie, vaginal, anal, or penile pain during intercourse), or sexual dysfunction.^2,4,8 These are common complaints, particularly for patients with associated factors (Table 1).^9-34 Current evidence indicates that vaginal dryness affects up to 15% of premenopausal and 90% of postmenopausal women, while approximately two-thirds of women will experience dyspareunia during their lifetime.^8,17 Vulvodynia, a major cause of superficial (entry) vaginal dyspareunia, has a reported incidence rate of 17%.¹⁷ Among men in a sexual minority, anal-receptive dyspareunia shows a point prevalence of 14% and lifetime prevalence of 61%.¹² To better identify and address these concerns, clinicians should routinely assess lubricant use when obtaining a sexual history from patients with the factors listed in Table 1.^9-34

Table 1.

Patient factors associated with a higher prevalence of genital symptoms (dryness, irritation, or superficial vaginal, anal, penile dyspareunia) in relation to type of sexual intercourse

TYPE OF SEXUAL INTERCOURSE	PATIENT FACTORS
All types (anal, vaginal, penile)	Mental health concerns: past sexual harassment or abuse, anxiety, depression, gender dysphoria6,9-11 Partnership-related factors: inadequate foreplay or arousal, genital size incompatibility4,9,10,12 Intercourse involving non-lubricating receptive anatomy (rectum or neovagina)10,11 Past history of perineal or pelvic surgery; or phalloplasty, metoidioplasty, or vaginoplasty9,11-13 Genital dermatoses: lichen sclerosus, psoriasis, lichen planus, contact dermatitis9,14,15
All receptive types (anal and vaginal)	Gastrointestinal conditions: irritable bowel syndrome,9 inflammatory bowel disease (Crohn disease or ulcerative colitis),7,10 levator ani syndrome9,16 Postpartum (greatest prevalence associated with assisted vaginal delivery and emergency operative delivery)10,17 Anorectal conditions: anismus, hemorrhoids, rhagades, or fissures9,16,17
Vaginal (receptive)	Vulvovaginal atrophy or genitourinary syndrome of menopause (naturally, surgically, or chemically induced)7,18 Superficial vulvar pain conditions: vulvar vestibulitis, vaginitis, vulvitis, vaginismus, vulvodynia, Bartholin gland infection17 Comorbidities predisposing vaginal dryness, atrophy, or irritation: multiple sclerosis,18 diabetes,18 chronic heart failure,18 polycystic ovary syndrome,19 endometriosis,20 Parkinson disease,21 fibromyalgia,22 hypothalamic hypogonadism,18 hyperprolactinemia,7 rheumatoid arthritis,18 systemic lupus erythematosus,18 recurrent candida infections,9 Sjögren syndrome,9 hypertension,23 pulmonary hypertension,24 acquired brain injuries,25 Hashimoto’s thyroiditis,26 chronic kidney disease,27 epilepsy,28 human immunodeficiency virus29 Medications predisposing vaginal dryness: oral contraception, testosterone, gonadotropin-releasing hormone inhibitors, aromatase inhibitors, antihistamines, decongestants, anticholinergics, antimuscarinics, selective serotonin reuptake inhibitors, mood stabilizers, antiemetics, antacids, anxiolytics, antihypertensives, diuretics, muscle relaxants, sedatives, antipsychotics, stimulants6,11,18 Active pregnancy or breastfeeding9,30 Interstitial, recurrent, or postcoital cystitis, and lower urinary tract symptoms.9,16,17 Cancer (especially breast, endometrial, and cervical cancer), radiation, or chemotherapy6,31,32 Recurrent Candida infections9 Chronic alcohol or nicotine use33 Fibrous, cribriform, septate, or circinate hymen9
Anal (receptive)	Chronic constipation or diarrhea10 Prostate cancer and its treatments10,12
Penile (insertive)	Penile conditions: erectile dysfunction,7,12 premature or delayed ejaculation,4,9 soft glans syndrome,4 Peyronie disease,4 penoscrotodynia14 Foreskin conditions: phimosis, frenulum breve, torn frenulum, balanitis, posthitis, balanoposthitis34 Chronic pelvic pain syndrome or prostatitis16

Classes of lubricants used for sexual activity. Lubricants are categorized into 3 main classes based on their formulation: oil-based, including both petroleum and natural oils, silicone-based, and water-based. Table 2 outlines the key features of each class and lists commonly available lubricants in Canada by brand name and cost.^4-6,18,35-48

Table 2.

Comparison of the features of oil-, silicone-, and water-based lubricants, including formulation pros and cons, cost or accessibility, and examples of lubricants available in Canada

SEXUAL LUBRICANT CLASS	FORMULATION PROS	FORMULATION CONS	COST (PER 100 mL)*	EXAMPLES†
Oil-based	Longer lasting than water-based lubricants Common household items	May irritate the vulva and vagina Petroleum-based oils may increase risk of bacterial vaginosis and vaginal candidiasis Incompatible with latex, porous plastics, and rubbers Needs to be washed off with soap and water and can be difficult to properly clean off many items used in the genital area Can stain fabric	$0.33-$29.90	Baby oil Kitchen oils (eg, coconut, vegetable, canola, olive, avocado) Petroleum jelly or Vaseline® 2:1 massage oil and personal lubricant
Silicone-based	Hypoallergenic, no irritation or damage to genital epithelium Longest lasting Slippery sensation	Incompatible with silicone Some find it too slippery Flammable Needs to be washed off with soap and water Can stain fabric	$10.83-$49.09	Astroglide® Premium Silicone Personal Lubricant Durex® Real Feel® Lubricant JO® Premium Personal Lubricant #LUBELIFE Silicone-Based Lubricant ONE® LUX® Replens™ Silky Smooth Natural Lubricant Skyn® All Night Long™ Sliquid® Silver Premium Uberlube® Silicone-Based Lubricant Wet® Luxury Collection™ Platinum
Water-based	No irritation or damage to genital epithelium when free of harmful ingredients‡ Easiest lubricant type to clean up Does not stain fabric	May contain harmful or irritating ingredients‡,§ Some formulations§ do not follow recommended osmolality and pH ranges‖‖ Can dry out quickly and become sticky	Most types: $4.92-$38.00 Fertility-friendly lubricants: $59.30-$69.98	Suitable for vagina‖‖ ALOE CADABRA® Natural Aloe Good Clean Love®: (Almost Naked® Personal Lubricant, Bio-Nude™ Ultra Sensitive Personal Lubricant) Sliquid®# (H2O, Sassy, Organic Natural) YES® WB Water-Based Lubricant IRIS Personal Lubricant Suitable for rectum‖‖ Slippery Stuff® Personal Lubricant Gel Fertility friendly‖‖ Pre-Seed™¶ Silicone and water hybrids Sliquid®# (Silk, Organic Silk)

PEG-8—polyethylene glycol-8.

^*Data on commercially available products, including their accessibility, cost, and ingredients, were collected through market research in Canadian retailers in Edmonton, Alta, and online from amazon.ca, travelingtickletrunk.com, and forloversonly.ca in July and August 2023.

^†Silicone-based, water-based, silicone and water hybrid-based, and fertility-friendly lubricants included in this table are free of harmful ingredients,^‡ fall within recommended osmolality and pH ranges,^‖‖ and are easily accessible (other than when indicated^¶,#).^5,7,40,44-48

^‡Harmful or irritating ingredients can include glycols (eg, glycerine or glycerol, propylene glycol, and PEG-8), parabens, chlorhexidine, nonoxynol-9, oils, petroleum, dyes, fragrance, flavour (with nutritive sweeteners), and ones with warming, stimulating, or numbing properties.^5-7,18,40-42

^§Common brands with water-based formulations that contain harmful ingredients^‡ or are outside of recommended pH or osmolality ranges include^‖‖ Durex^®, KY^®, Replens™, ID^® Glide, Pjur^®, Trojan™, and Astroglide^®.^4,5,7,40

^‖‖Water-based lubricants should have an osmolality of <1200 mOsm/kg and a pH of approximately 4.0 to 4.5 for vaginal intercourse and 5.5 to 7 for anal intercourse.^5,40 Fertility-friendly lubricants should have a pH of 7.2 to 8.5 and osmolality of 270 to 360 mOsm/kg.⁴³

^¶PreSeed™ contains no potentially harmful ingredients or properties,^‡ except for methylparaben and propylparaben.

^#Osmolality of Sliquid^® Sassy, Organic Natural, Silk, and Organic Silk unknown.

Water-based lubricants are compatible with all materials found in items commonly used in the genital area, whereas oil- and silicone-based lubricants are incompatible with certain materials (Table 3).^{5,6,35,39,49-51} For instance, oil-based lubricants can damage latex items such as condoms, and silicone-based lubricants can degrade silicone-containing devices, including sex toys, menstrual cups, and pessaries.^6,39,50,51

Table 3.

Compatibility of oil-, silicone-, and water-based lubricants with various materials present in items commonly used in the genital area: This table summarizes general recommendations only. Many items designed for genital use are unregulated and their material composition may be unavailable to consumers. To determine lubricant compatibility, it is important to consult manufacturer information when possible.

ITEM TYPE	LATEX AND POLYISOPRENE	POLYURETHANE, NITRILE, AND LAMBSKIN	SILICONE	POROUS PLASTICS AND SYNTHETIC RUBBERS*	GLASS, CERAMIC, METAL, AND NONPOROUS PLASTICS
Common items	Condoms	Condoms	Sexual devices or toys Menstrual cups Pessaries	Sexual devices or toys Vaginal contraceptive rings	Sexual devices and toys Genital piercings
Oil-based	Incompatible	Compatible	Compatible	Incompatible	Compatible
Silicone-based	Compatible	Compatible	Incompatible	Compatible	Compatible
Water-based	Compatible	Compatible	Compatible	Compatible	Compatible

^*Examples include, but are not limited to, thermoplastic rubber, thermoplastic elastomer, thermoplastic styrene, polyvinyl chloride jelly rubber, and cyberskin. Items containing a plastic-silicone blend (such as estradiol vaginal rings) are incompatible with both oil- and silicone-based lubricants.

Oil-based lubricants are commonly used during sexual activity, and HCPs frequently recommend them despite limited evidence evaluating their effects. Evidence suggests some oil-based lubricants can irritate the genital epithelium and disrupt genital microbiota.^4,6,18,36-38 Multiple clinical studies have linked petroleum jelly to an increased risk of bacterial vaginosis, while recent data indicate that baby oil may increase the risk of vaginal candidiasis.^36-38 The literature on the effects of coconut oil on genital and urogenital microbiota in vitro presents mixed findings, and evidence regarding its impact in vivo remains scarce.^52,53 Oil-based lubricants are also difficult to clean, posing a nuisance and potentially increasing infection risk.

For patients who use latex condoms or who experience recurrent vaginal infections or irritation, the authors recommend the use of silicone- or water-based lubricants—which are free of harmful ingredients and within recommended osmolality and pH levels outlined in the next section—rather than oil-based lubricants.

Clinicians should review the characteristics of each of the 3 lubricant classes (Table 2)^4-6,18,35-48 and inquire about the devices their patients use in the genital area (Table 3)^{5,6,35,39,49-51} to help them choose an appropriate lubricant.

Additives, osmolality, pH, and fertility. Certain water-based lubricant formulations can damage or irritate the genital epithelium or disrupt urogenital microbiota, increasing the risk of STIs and urogenital infections (eg, bacterial vaginosis, candidiasis, and urinary tract infections).^18,40,43 Patients experiencing irritation or frequent urogenital infections should avoid lubricants containing certain ingredients including glycols (eg, glycerine or glycerol, propylene glycol, and polyethylene glycol–8 [PEG-8]), parabens (eg, methylparaben, propylparaben, and butylparaben), chlorhexidine, and spermicides (eg, nonoxynol-9).^5,7,18,40 In addition, these patients should also avoid lubricants containing colour or dyes, fragrance, flavour (with nutritive sweeteners such as glucose and sucrose), as well as products with warming, stimulating, or numbing and desensitizing properties.^6,18,41,42

Water-based lubricants should have an osmolality of less than 380 mOsm/kg (or <1200 mOsm/kg if options are limited) and a pH of approximately 4.0 to 4.5 for vaginal intercourse, or 5.5 to 7.0 for anal intercourse.^5,40 Although these values are typically unavailable to consumers, avoiding glycols can help achieve more physiologically appropriate osmolality levels.⁵ Table 2 lists examples and prices of silicone-based, water-based, and silicone-water hybrid formulations available in Canada.^4-6,18,35-48 These formulations do not contain the aforementioned additives or properties, and they follow the recommended osmolality and pH ranges.

Most lubricants adversely affect sperm motility and viability, so individuals experiencing challenges with infertility may wish to avoid lubricants entirely.¹⁸ However, for people trying to conceive who prefer using lubricants, fertility-friendly options—namely those with a pH between 7.2 and 8.5, osmolality of 270 to 360 mOsm/kg, and without glycerine or glycerol—are recommended (Table 2).^4-6,18,35-48

Case resolution

Recognizing that Mx. A has multiple factors that may increase their chances of experiencing genital dryness and discomfort during sexual activity (Table 1),^4,6,7,9-34 you ask about these symptoms. They report chronic difficulties with what they perceive as inadequate vaginal lubrication and challenges with anal lubrication, which have occasionally led them to avoid penetrative intercourse. Their discomfort is improved with petroleum jelly use, but they find that it is difficult to clean off their sex toys. They are hesitant to explore using other lubricants after experiencing vaginal and anal irritation with the use of a popular water-based personal lubricant.

Mx. A consents to a trauma-informed genito-pelvic examination that reveals normal, premenopausal vulvovaginal mucosa and minimal vaginal discharge. After reviewing the findings, you reassure Mx. A that, while no single diagnosis accounts for their symptoms, their existing conditions and medications may be contributing.

You inform them that certain commercially available, water-based lubricants contain potentially irritating ingredients, and instead recommend using specific silicone-based, water-based, and hybrid formulations free of these irritants (Table 2).^4-7,18,35-48 You caution against the use of oils for genital lubrication due to both incompatibility with certain sex toys and potential increased risk of recurrent bacterial vaginosis.

After comparing the properties of different formulations (Table 2^4-6,18,35-48 and Table 3^{5,6,35,39,49-51}), Mx. A elects to trial a water-based lubricant for its ease of cleaning and universal compatibility with sex toys. They also note that silicone-containing formulations are longer lasting and offer a more slippery sensation, and plan to try this option if they continue to experience dryness and discomfort during penetrative intercourse. You share a patient handout (Figure 1)^{2-8,18,35,37-42,49-51} with Mx. A and proactively discuss how perimenopausal changes may exacerbate their symptoms in the coming years, advising follow-up for reassessment if needed.

Figure 1.

Patient information handout on lubricants used for sexual activity

Conclusion

When taking a sexual history, clinicians should routinely assess patients’ sexual function, enjoyment, discomfort, STI risk, and condom use. If any concerns emerge in these areas, HCPs should specifically inquire about lubricant use during sexual activity (Figure 2). Figure 1 provides a patient-friendly information handout to guide lubricant selection.^{2-8,18,35,37-42,49-51}

Figure 2.

Flowchart for health care providers to guide conversations regarding lubricant use for sexual activity

Editor’s key points

• ▸ This review discusses the benefits of lubricant use for sexual activity in the context of the many products available and lack of evidence-based clinical tools that hinder discussions on this topic between patients and health care providers (HCPs).

• ▸ Oil-, silicone-, and water-based lubricants are the 3 main classes of these products. There are important considerations to make when recommending a lubricant, such as its compatibility with various materials present in items commonly used in the genital area and patient factors impacting its use.

• ▸ Lubricant use is part of a broader discussion of a patient’s sexual health, and HCPs should adopt an inclusive, non-judgmental, trauma-informed approach with all patients when engaging in these conversations.

Points de repère du rédacteur

• ▸ Cette révision traite des bienfaits de l’utilisation d’un lubrifiant pour l’activité sexuelle dans le contexte des nombreux produits sur le marché et du manque d’outils cliniques fondés sur des données probantes, ce qui entrave les discussions à ce sujet entre les patients et les professionnels des soins de santé (PSS).

• ▸ Les lubrifiants à base d’huile, de silicone et d’eau sont les 3 principales classes de ces produits. Il y a des éléments importants à considérer dans la recommandation d’un lubrifiant, notamment sa compatibilité avec divers ingrédients présents dans les produits communément utilisés sur les parties génitales et les facteurs relatifs aux patients qui influent sur leur utilisation.

• ▸ L’utilisation d’un lubrifiant fait partie d’une discussion plus large sur la santé sexuelle des patients, et les PSS devraient adopter une approche inclusive, dénuée de jugement et éclairée par les traumatismes avec tous les patients lorsque de telles conversations ont lieu.