Even Extra Virgin Olive Oil Belongs on Your Orzo, NOT in Your Orifice!

Perhaps two-thirds of American women have used a commercially-sold vaginal lubricant, whether to cope with vaginal dryness or just to make sex more pleasurable. Most commercial lubricants are either water-based or silicon-based. It is also quite common for women to use petroleum jelly or various types of oil (olive oil, canola oil, almond oil) as a lubricant for sex. After cancer treatment, women who have become menopausal or have had radiation therapy to the pelvic or genital area often have severe problems with vaginal dryness and pain during sex. Women want to know what kinds of products are safe and effective.

Why do women need a lubricant at all? The vagina has a natural cleansing system. The lining is a mucous membrane, and before menopause, it protects itself by producing fluid that eventually drips out of the vagina, taking offending bacteria, dead skin cells, etc. with it. During sexual arousal, the cells lining the vagina produce the clear, slippery fluid that makes intercourse comfortable. The normal pH of the vagina is between 3.5 and 4.5, slightly acidic, allowing healthy lactobacilli to flourish. After menopause (or damage from radiation therapy), the pH of the vagina rises, becoming less acid. The vaginal lining produces far less fluid in general, or during sexual excitement. Lactobacilli may be replaced by unfriendly types of bacteria (E. coli or gardnerella) that cause infections in the vagina. After menopause, women are also more likely to get yeast infections (candida) or infections with the parasite trichomonas (trich). A good vaginal lubricant or moisturizer should not only make the vagina moist and slippery, but should ideally bring the vagina’s pH back to 3.5-4.5.

Common wisdom among gynecologists and sex therapists has long been to advise against using oils or petroleum jelly in the vagina. For one thing, oils can damage latex condoms. However, some clinicians still tell women to use oils, especially since water- and silicon-based lubricants may not be enough by themselves to make sex pain-free. A group in Australia actually designed a small study with 25 breast cancer survivors who had pain during sex. They had the women use Replens®, a vaginal moisturizer gel that women put in the vagina several times a week, plus visits to a physical therapist specializing in helping women work with muscle tension that can contribute to pain during sex, and lastly, olive oil as a sexual lubricant. Some commercial lubricants that do contain oil claim that theirs are plant-based or organic—factors totally unimportant to safety in the vagina. One study followed 143 women for a year, testing their vaginal health and asking what products they used. Women who used oils were far more likely to have yeast infections (44%) than women who did not (5%). Women who used petroleum jelly were more than twice as likely as others to have bacterial vaginal infections. So even if your olive oil is extra, extra virgin, use it on your food, not in your vagina!

Commercial water- or silicon-based vaginal lubricants are certainly healthier than oils or petroleum jelly. However, the vaginal lining has many small blood vessels. Chemicals or drugs that you put in your vagina can be rapidly absorbed into your bloodstream (a good reason not to use marijuana suppositories either!). Unfortunately, the Food and Drug Administration (FDA) has not paid much attention to safety issues for commercial products used as vaginal lubricants or moisturizers. Most do not meet best standards for their pH. Many contain preservatives that can be harmful:

Category

Names

Reason to be Concerned

Parabens

methylparaben, ethylparaben, propylparaben, butylparaben, and heptylparaben

Act like a weak estrogen in some tissues; considered safe in small amounts by FDA; Fears about parabens are probably exaggerated, but it may present a valid concern for women with hormone-sensitive cancer

Glycerin

glycerol, glycerol monolaureate, polyethylene glycol, propylene glycol

Damages the cells lining the vagina or anal canal; Makes women more likely to get yeast infections and possibly also genital herpes

Chlorhexidene

chlorhexidine gluconate

Kills the “good” lactobacilli, increasing the risk of vaginal infections

Polyquaternium

polyquaternium-15

May help HIV multiply

 

Even more upsetting, many commercial water-based products are way outside of the limits for something called osmolality. The cells lining the vagina contain water. A lubricant that is too high in osmolality actually pulls water out of these cells, leaving the lining even dryer and more likely to get small tears during sexual activity. The recommended osmolality for a vaginal product should be 380 mOsm/kg or less. Anything above 380 is not ideal, but many commercial water-based lubricants even exceed the World Health Organization’s upper limit of 1,200 mOsm/kg. It is not easy to find out the osmolality of a lubricant. Laboratory tests that have been published in scientific journals often come up with different results for the same product. One resource is Smitten Kitten, a company selling healthy sex toys and aids that has done some of its own testing. They suggest Good Clean Love™ Almost Naked, Sliquid® Organics Natural, and Babelube™. However, it is also not possible to check their lab’s reliability.

One solution is to use a silicone-based lubricant, since osmolality is not an issue for them. However, they can be more expensive than water-based lubricants (though you usually need less), can damage silicone sex toys, and can stain fabric.

For women who have vaginal dryness after cancer treatment, I often find that a lubricant during sex is helpful, but is not enough to prevent pain. My colleagues and I have had better results having women use a vaginal moisturizer (a gel put inside the vagina) regularly, at least 3 times a week. Then a water-based or silicone-based lubricant can be added when having partner sex, using a vaginal dilator, or a sex toy. Just be aware of the issues in using a silicone-based lubricant on a dilator or sex toy made of silicone. Lubricants are one very crucial ingredient in having a pain-free sex life after cancer!

This educational material is intended for informational purposes only and is not intended to replace, or substitute for, professional advice, counseling, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a condition. Never disregard professional advice or delay in seeking treatment because of something you have read in this educational material.

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