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Best Water-Based Lubricants – Use chemistry to pick the safest and most comfortable water-based lubricant for you and your Valentine

Best Water-Based Lubricants –

Use chemistry to pick the safest and most comfortable water-based lubricant for you and your Valentine

By Julianne Simpson, PT, DPT

 

Happy Valentine’s Day! You and your valentine may use lubricant during intercourse to increase glide and comfort or to decrease the risk of a condom breaking. There are three main types of lubricants on the market: water-based, silicone, and oil based. (Side note – oil can make condoms break. Don’t use oil with condoms!). This blog post focuses on water-based lubricants.

There is a wide array of lubricants on the market of varying quality and comfort. How on earth do you select the best lubricant? As a pelvic physical therapist, I use water-based lubricants for exams and treatment and have turned to chemistry to help me select the best and safest lubricants for my patients.

Two main chemistry factors play into lubricant’s ability to work well with your body: osmolality and pH. I will discuss osmolality first. Osmolality has to do with water crossing membranes and molecules dissolved in that water. A higher osmolality fluid has more solutes dissolved in it. If you are thinking of a cup of muddy water, a darker, muddier cup has higher osmolality than a cup of clearer water with just a small amount of mud in it. In the blue image, the drop on the left has higher osmolality. Osmolality governs the movement of fluids across a membrane. If the amount of solutes is the same on either side of a membrane, fluids won’t cross the membrane. We don’t want water to leave the cells of the epithelium (the top layer of tissues) in the vagina or rectum.

If a lubricant is hypo-osmolar, it causes water to move into cells which could cause bursting. If it is hyper-osmolar, it causes water to leave cells and can reduce the size of individual cells and therefore reduce the thickness of protective membranes in our vagina or rectum. If a lubricant is iso-osmolar, no fluid will cross cell walls. Ideally, lubricants would be iso-osmolar. See image with pink cells to illustrate osmolality.

Hypo osmolar lubricants can cause cells to swell and possibly burst.
Aaah isoosmolar lubricant. Fluids stay where they should.

If your lubricant’s osmolality does not match the osmolality of the tissues that it will be touching, skin irritation, burning, or micro trauma can occur. Vaginal, rectal and semen osmolality is about ~300 mOsm/kg, so ideally lubricants match this. The problem is that a LOT of the most common commercially available lubricants are hyper-osmolar which can cause disruption of the protective membranes inside our vaginas or rectums. See here for a list of lubricants with osmolality (and pH).

Going back to high school chemistry, pH is a measure of how acidic or basic something is. A low number means more acidic, a high number is more basic. The range is 0 to 14 with 7 being neutral. The pH in the vagina and rectum aid in

Hyper osmolar lubes cause water to leave cells and can damage our protective layer.

maintaining the microflora colonies which are critical for vaginal or rectal health. The microflora live best in a consistent pH. For the vagina, this is between 3.5 to 4.5. (slightly acidic). This rises to 6-7 post-menopausally. For the rectum this is ~7 (neutral). This means that it may make sense to use a different lubricant for vaginal vs rectal use.

So which lubes are the best? You can find tables on the web with several commercially available lubricants on Women’s Voices. For vaginal use, my current choice, what I use in the clinic, is Good Clean Love’s Almost Naked. For rectal use Yes But is my current favorite. Osmolality and pH are appropriate for rectal use. Slippery Stuff is slightly hypo-osmolar (26) but pH (6.7) is good for rectal use.

Which lubes should I avoid? According to the WHO, anything with an osmolality of 380 or less is OK to use until more iso-osmolar lubes are available.5 This pamphlet by Smitten Kitten has great graphics to show visually where lubes fall in terms of osmolality and pH. Generally, avoid anything warming, anything with fragrance or flavor.

Remember – it is not normal to feel pain or discomfort during sex! If you are feeling pain or discomfort during sex, one of Movement System’s Pelvic Health Physical Therapists may be able to help. See our Physical Therapists in our South Lake Union/ Seattle, Mercer Island or Gig Harbor locations.

Enjoy your Valentine’s Day with safer and more comfortable lubes!

 

Julianne Simpson, PT, DPT, holds a BA from Oberlin College and a Doctorate of Physical Therapy from Eastern Washington University. A general orthopedic and pelvic health therapist, she is passionate about helping people move more and empowering her patients to live healthier lives. She dreams of raising kind children, cycling over the Alps and surfing in Alaska.

 

References:

  1. Begay O, Jean-Pierre N, Abraham CJ, et al. Identification of personal lubricants that can cause rectal epithelial cell damage and enhance HIV type 1 replication in vitro. AIDS Res Hum Retroviruses. 2011;27(9):1019–1024. doi:10.1089/AID.2010.0252
  2. Cunha AR, Machado RM, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, das Neves J, Palmeira-de-Oliveira R. Characterization of commercially available vaginal lubricants: a safety perspective. Pharmaceutics. 2014;6(3):530–542. Published 2014 Sep 22. doi:10.3390/pharmaceutics6030530
  3. Ayehunie S, Wang YY, Landry T, Bogojevic S, Cone RA. Hyperosmolal vaginal lubricants markedly reduce epithelial barrier properties in a three-dimensional vaginal epithelium model. Toxicol Rep. 2017;5:134–140. Published 2017 Dec 16. doi:10.1016/j.toxrep.2017.12.011
  4. https://badvibes.org/whats-in-your-lube/the-science-of-lubricants/
  5. https://cdn.shopify.com/s/files/1/2673/6210/files/Meeting_Report_Global_Consultation_on_Personal_Lubricants.pdf?13135841663524039071=&utm_campaign=Email%20%233%20%28KvvHPM%29&utm_medium=email&utm_source=SHWI%20Patient%20Referral%20Welcome%20Flow%20&_ke=eyJrbF9lbWFpbCI6ICJqa3NpbXBzb25AbW92ZW1lbnRzeXN0ZW1zcHQuY29tIiwgImtsX2NvbXBhbnlfaWQiOiAiSDlYcEZFIn0%3D
  6. https://badvibesdotorg.files.wordpress.com/2015/12/lube-guide-every-body-edition.pdf. All images except photographs come from here.

 

 

 

How to Not Pee Your Pants When Laughing – Cure Incontinence with Advice from a Pelvic Health Physical Therapist on Pelvic Floor Muscle Training (aka Kegels)


How to Not Pee Your Pants When Laughing –
Cure Incontinence with Advice from a Pelvic Health Physical Therapist on Pelvic Floor Muscle Training (aka Kegels)
by Julianne Simpson, DPT

A whopping 25-45% of women experience urinary incontinence in their lifetime1. Even though it is common, leaking when you sneeze, jump, cough or on your way to the bathroom is NOT normal! A new review article says that pelvic floor muscle training (PFMT), as prescribed by a physical therapist, can cure or reduce incontinence.2 

There are three main types of urinary incontinence: stress (urine loss with cough, sneeze, jump or laugh), urge (difficulty making it to the bathroom on time with strong urge) and mixed (combination of stress and urge incontinence). The study authors found that PFMT can help all three types of urinary incontinence. 

Female pelvic floor muscles

If you are looking for your pelvic floor muscles, you can find them at the bottom of your pelvis. These muscles stop the flow of urine, feces and gas and support your bladder, uterus and rectum. No surprise here, but both women and men have pelvic floor muscles. PFMT involves contracting and then relaxing the pelvic floor muscles, sometimes called doing Kegel (KEY-gul) exercises. These muscles can be weakened by inactivity, pregnancy or childbirth. Like any muscle, they become stronger and larger with exercise. The authors of the review suspect that larger muscles are more effective at closing off the urethra, the tube urine takes from your bladder out of your body. In addition, the stronger muscles could provide better support to the bladder, reducing movement with jumping or sneezing. 

According to the study, PFMT can change women’s lives. Women with all types of urinary incontinence experienced improvement in their quality of life. That’s more women out running, laughing and coughing with dry underpants! The women in the PFMT groups (vs the control groups) with: 

  • Stress urinary incontinence were eight times more likely to report their incontinence cured  
  • Urge urinary incontinence were two times more likely to report cure or improvement.  
  • Any type of urinary incontinence were five times more likely to report cure.  

The authors conclude, 

We can be confident that PFMT can cure or improve symptoms of stress urinary incontinence and all other types of urinary incontinence. 

A quick side note: PFMT can also help men and can reduce fecal and gas incontinence. Ask your physical therapist with a specialty in pelvic health for more information. Please watch here for upcoming blog posts with advice from a pelvic health physical therapist for men and strategies to reduce fecal and gas incontinence! 

If you are experiencing incontinence of any type, a pelvic health physical therapist is your best choice to help train your pelvic floor muscles. These specially trained physical therapists are experts at assessing pelvic floor muscles along with helping you with the critical integration of the pelvic floor with your entire movement system. A pelvic health physical therapist at Movement Systems will listen to you and collaborate with you to get you back to meaningful activities without leaking, whether it’s walking the dog, CrossFit, lifting your child or gardening, even if you sneeze!

 

Julianne Simpson, DPT, holds a BA from Oberlin College and a Doctorate of Physical Therapy from Eastern Washington University. A general orthopedic and pelvic health therapist, she is passionate about helping people move more and empowering her patients to live healthier lives. She dreams of raising kind children, cycling over the Alps and surfing in Alaska.

 

References:
1 Abrams,P, Cardozo, L, Wagg, A, Wein, A. (Eds) Incontinence 6th Edition (2017). ICI-ICS. International Continence Society, Bristol UK, ISBN: 978-0956960733.
2 Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub4.