Table 4.

Description of studies included in the values and preferences review¹

Study	Location	Population Description	Study design	Sample size (N)	Key results
Carballo-Diéguez 200022	USA: New York City	318 Latino MSM; 307 were given a survey about sexual practices and 11 participated in a focus group regarding a theoretical microbicidal anal gel	Multi method: structured survey and focus group	318	Participants did not care about the flavour, smell, or colour of a theoretical microbicidal lubricant, but were concerned about how long it would be effective (if applied prior to sex) and the dose needed for effectiveness without interfering with sexual pleasure.
Clark 201323	Peru: Lima	560 MSM recruited from Lima STI and HIV testing sites or through STI screening outreach programmes	Qualitative: in depth individual and group interviews	560	MSM engaged in receptive sex preferred using lubricants for sex more than those engaged in insertive sex. Some preferred the pain of “dry” sex because of their partner’s pleasure. MSM who also had sex with women did not find it as acceptable to use lubricant with female partners and primarily did so with male partners. Most participants preferred commercial lubricants provided by local pharmacies or clinics over substitutes such as saliva, body fluids, or household products but would use these alternatives if commercial lubricant was not readily available.
Dodge 201517	USA: national	Self-identified gay (n = 307) and bisexual (n = 25) adult participants in the 2012 National Survey of Sexual Health and Behaviour (NSSHB) who reported sexual behaviours with other male partners during their last sexual encounter	Quantitative: cross-sectional study	712	Primary reasons for using lubricants were to make sex more comfortable (68.8%), to reduce pain during sex (49.9%), and to increase pleasure during sex (40.9%). Other reasons included easier/faster/higher-quality orgasms, to make sex more wet or fun, to enhance foreplay, and to reduce the chances of the condom drying out.
Duby 201624	South Africa, Uganda, Zimbabwe	88 women from South Africa (n = 20), Uganda (n = 22) and Zimbabwe (n = 26), who formerly participated in VOICE, an HIV prevention trial of two antiretroviral oral tablets and a vaginal gel. Mean age = 28.6, age range 20–40	Qualitative: in-depth interviews	88	Lubricants were used for penile-anal intercourse to make sex clean, fast, easy insertion; not used because some (e.g. Vasoline) may degrade latex and lead to condom breakage.
Herbenick 201125	USA	Adult women (N = 2453) from the U.S. Mean age = 32.69, age range 18–68; most (85.4%) described their ethnicity as White; most (86.5%) self-identified as heterosexual.	Quantitative: prospective cohort following for 5 weeks with randomisation and double-blinding pre-post design (given lubricants as the intervention)	2453	Among penile – vaginal sex events, participants’ self-reports on measures of sexual pleasure and sexual satisfaction were significantly higher for events that included the use of a water-based lubricant or silicone-based lubricant compared with no lubricant use. For penile – anal events, ratings of sexual pleasure and satisfaction were significantly higher for events associated with water-based lubricant over no lubricant. All lubricant types were associated with significantly higher sexual pleasure and satisfaction scores for solo sex events, with no difference between lubricant types.
Herbenick 201426	USA: national	Data focused on adult women from a subset of the 2012 National Survey of Sexual Health and Behaviour 2012 NSSHB. Mean age: 46.8, age range: 18–91. Participants were primarily white, non-Hispanic (66.5%) and identified as heterosexual (93.6%).	Quantitative: cross-sectional study	1559	The most common reason why women first started using lubricant was to “make sex more comfortable” (42.9%, n = 438). For women ages 18–39, however, the most commonly endorsed reason was “for fun”. “To enhance foreplay” and “curiosity” were also commonly reported. The most common perception was that a lubricant “makes sex more comfortable” (85.1%, n = 839). Over half agreed that lubricant use during sexual activities “makes sex feel better” and “makes it easier to feel aroused.” Less than 15% of the participants perceived lubricants to be only for older people.
Hickey 201627	Australia	38 women having a history of breast cancer, being sexually active with symptoms of vaginal dryness or pain during sexual activity, willingness to be randomised and try both products, willingness to keep a sexual activity diary, and having a normal Pap smear in the previous 2 years. Mean age = 53.1.	Quantitative: randomised, double-blind, crossover trial (given lubricants as the intervention)	38	The majority of women reported that lubricants improved sexual experience and they would continue to use them. Silicone-based lubricants were generally preferred over water-based lubricants.
Javanbakht 201028	multi-country (107) [specific countries not specified: North America; Europe; Latin America/Caribbean; Asia; Oceania; Other]: internet	6124 men and women who reported anal intercourse (AI) in the past 6 months, from North America (70%). Male (93%) respondents were older than female respondents (7%), with 55% of men being aged 35 years and older compared with 31% of women.	Quantitative: cross-sectional study (Internet based survey)	6124	Reasons for not using lubricants during AI including that they used saliva or vaginal fluid instead, lack of lubricant availability, or a preference for dry sex. Almost all said that lubricant color/flavor/smell did not matter, or they preferred no color/flavor/smell. Dispensers with a “pop-up” lid or a pump were most preferred, followed by tubes, single-use packets, and containers with screw-top or snap-off lids.
Jones 200829	Zambia: Lusaka	155 HIV seropositive males, sexually active. Mean age: 37 years (Range: 21–62). 50% were unemployed, 27% worked part time. Ethnic groups included Bemba (27%), Nsenga, Ngoni, Tumbuka (26%), Tonga (14%), Lozi (15%), Mambwe, Namwanga (8%), and other ethnic groups (10%).	Quantitative: randomised trial without control groups and with assessments at baseline, monthly over 6 months and at 12 months (given lubricants as the intervention)	155	After 2 months of trial use, product ratings based on product selection and stated preference indicated that participants preferences remained fairly evenly distributed between suppositories, high-viscosity gel, and low-viscosity gel. Participants identified “ease of use,” “comfort,” and “increasing sexual pleasure” as the most important factors in product preference; being “fun” to use and “being in control” were considered “least important” factors. Two thirds of those sampled reported that both they and their partners “liked” the lubricants.
Jozkowski 201330	USA: Internet	Mean age = 32.69, age range = 18 - 68, median = 31.0. Participants were predominantly white (87.7%, N = 2095), heterosexual (88.2, N = 2121), and were married and living with their spouse (57.7%, N = 1395).	Quantitative: cross-sectional study	2451	Women reported positive perceptions of lubricant, with younger women (18–24 and 25–29) reporting less positive perceptions than older women (40–49). Most women liked sex to feel wet, reported their partners preferred sex to feel wet, and reported being most easily orgasmic when sex was wet. Negative perceptions were when lubricants were perceived as sticky.
Juraskova 20134	Australia	Adult female in a sexual relationship; amenorrheaic for at least 6 months or were taking aromatase inhibitors; had undergone adjuvant chemotherapy; and reported current symptoms of vaginal dryness and dyspareunia. Mean age: 51. Mean age at breast cancer diagnosis = 47.	Quantitative: prospective pilot study; time-series study across four time points (weeks 0, 4, 12, and 26) (given olive oil for lubricant as the intervention)	25	Overall, 76% of women found olive oil as a lubricant useful and all participants (100%) would recommend the intervention as a whole (Replents vaginal moisturiser, pelvic floor muscles, and olive oil) to other women with breast cancer who have similar problems.
Lee 201731	South Africa: Pretoria	81 male, mean age = 25.16, range 20–39. Most participants identified as gay. The sample also included biologically male participants who self-identified as “drag queen”, women or transgender.	Qualitative: in-depth interviews	81	Facilitators to condom and lubricant use included: access to free condoms, partner dynamics (distrust), and increased acceptability to openly carry condoms and lubricants. Barriers included sexual initiation, issues with accessibility and availability, being in the heat of the moment, alcohol and drug use, partner dynamics, namely partner distrust again, and group sex.
Montgomery 200932	Zimbabwe, South Africa	2523 in the intervention arm, and 2522 in the control arm. Age distribution <=24: 38.4%, 25–34: 39.1%, >=35: 22.5%. 58.9% of the participants are married. Lifetime # of sexual partners, mean (range):2.24(1–30). Age at first sex, mean (range):18.04 (10–31).	Quantitative: randomised controlled trial with 3 arms (diaphragm, gel and condoms (intervention) arm, or condoms-only (control) arm.)	5023	Only 1% of participants mentioned problems with the gel, including perceived burning or itchiness, increased discharge or wetness, or partner not liking the feeling of the gel during sex.
Reece 201433	USA: national	1510 adult US males, mean age = 46.13, age range: 18–89. 67.3% participants were white, non-Hispanic with a sizable minority of participants indicating that they were black, nonHispanic (10.7%), or Hispanic (15.2%). Most identified as heterosexual (93.6%).	Quantitative: cross-sectional study	1510	Reasons for lubricant use included to make sex more comfortable, for fun (especially men aged 18–49), curiosity (especially men aged 18–49), partner preference for lubricant, to make sex more pleasurable, to reduce discomfort/pain during sex, makes it easier to feel aroused, makes sex feel better, makes it easier to have an orgasm. 10% of participants perceived that lubricants are only for older people
Rojanapithayakorn 199534	Thailand: Ratchaburi, Ban Pong District and Damnoen Saduak District of Ratchaburi Province	female sex workers mean age = 22, age range 14 - 34. The average length of time the participant had worked in sex entertainment establishments (SEs) was 2.2 years. The participants had an average of 3.4 clients per day.	Quantitative; three time points (weeks 0 (before lubricant)), 1 (after 1week of lubricant as the intervention), and 8 (follow up 8 weeks later)	week 0: 134; week 1: 111; week 8: 58	About 95% of those interviewed expressed interest in using the water-soluble lubricant on a regular basis, because it reduced the time clients needed to ejaculate, reduced vaginal pain and discomfort and reduced condom breakage. More than 70% said the majority of their clients found using lubricants made condom use more enjoyable.
Romijnders 201535	Tanzania: Dar es Salaam and Tanga	300 MSM, median age: 23 (IQR: 21–28); employed (81.3%); 58.3% self-identified as gay or homosexual, while 36.0% as MSMW	Quantitative: cross-sectional study	300	Reasons for using lubricants included that it feels better during anal sex and that it prevents condom tears or lesions during anal sex. Reasons for not using lubricant included availability (looking for lubricants only as the need arises, difficult to find, expensive). Only 8.7% disliked using lubricant.
Sahin-Hodoglugil 201136	Multi-country (2): South Africa: Durban, Johannesburg; Zimbabwe: Harare	Sexually active, 18–49-year-old, HIV-negative women from five clinics. Women in FGD (n = 105): age: 18–24 years = 36 (36.5%); 25–34 years = 44 (42.3%); 35–49 years = 22 (21.2%). Women whose male partners participated (n = 41): age: 18–24 years = 14 (34.2%); 25–34 years = 21 (51.2%); 35–49 years = 6 (14.6%).	Qualitative: focus group discussions and in-depth interviews women (14 FGD) and 41 male partners (7 FGD plus 10 IDI) (given lubricants as part of intervention)	105	The gel was very well accepted and easily used by participants. Benefits included being seen as a product that increased sexual pleasure and stimulation for women, and relief from vaginal dryness and pain during intercourse. Only two men reported dissatisfaction with the gel as they preferred a dry vagina. Gendered sexual norms meant men had control over when/how often to have sex and what methods to use, and male sexual satisfaction was a larger theme than women’s sexual satisfaction.
Sanders 201837	USA: Jackson, Mississippi	173 women recruited from an STI clinic engaged in penile-vaginal sex within the past three months. Mean age = 27.16, median age = 24, age range = 18–63. Most women identified as Black/African American (85.9%), with 4.7% identifying as White and the remainder not indicating a racial identity.	Quantitative: cross-sectional study	173	The majority of women were willing to experiment with condoms and lubricant. Lubricants were generally found to increase sexual pleasure. Negative perceptions of lubricants included when the lubrication amount was not enough to last until sex ended or maintain sexual satisfaction, or that lubrication “turned them off”.
Schick 201538	USA: national	145 lesbian – and bisexually identified women and most recent sexual partner was a female. Age 18–24: 15.2%; 25–29: 21.1%; 30–39: 15.2%; 40–49: 18.9%; 50–59: 24.6%; 60+: 5.0%. 57.0% White/Non-Hispanic; 22.0% Black/Non-Hispanic; 10.9% Hispanic. 75.1% lesbian/homosexual; 24.9% bisexual.	Quantitative: cross-sectional study	145	Reasons for lubricant use included to make sex more comfortable, self or partner did not produce enough natural lubrication, reduce pain/discomfort during sex, increase pleasure during sex, and improve ability to orgasm/time to achieve orgasm/quality of orgasm. 65% agreed or strongly agreed that lubricant use improved their ability to orgasm, time to achieve orgasm, and quality of orgasm.
Steiner 199439	USA: North Carolina (Raleigh, Durham and Chapel Hill)	268 couples, median age is slightly over 30 years (females: 31 years, males: 32 years) with a high level of formal education (median: females: 14.5 years, males: 15 years), predominately Caucasian (female: 85%, males: 84%).	Quantitative: pre-post study (Given lubricant as part of intervention)	536: 268 couples	Couples preferred the water-based lubricant over the oil-based lubricant (p < 0.001). When no additional lubricant was compared to the oil-based lubricant, couples preferred no additional lubricant (p < 0.001). When the comparison was between no additional lubricant and the water-based lubricant, they preferred the water-based lubricant (p < 0.001).
Sutton 201240	Canada: internet	122 adult women. Dyspareunia group (n = 61), self-reported pain during or after penetrative intercourse, at least 50% of the time, for a 6-month duration, mean age = 29.85, 77% heterosexual; Control group (n = 61) reported no history or current chronic dyspareunia, mean age = 30.42, 77% heterosexual.	Quantitative: cross-sectional study	122 (61 control group, 61 dyspareunia group)	Lubricants were used to prevent or reduce pain, especially for women with dyspareunia. Reasons for not using lubricant were that it was not perceived as needed. Lubricants were used for masturbation or at the beginning of foreplay. Participants preferred water-based lubricants versus one with flavor, or lubricants with a tingling or warming sensation.

As described in WHO guideline on self-care interventions for health and well-being⁴⁷