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The Elephant in the Room is Cancer. Tea is the Relief Conversation Provides.
The Elephant in the Room is Cancer. Tea is the Relief Conversation Provides.
Genito-What? Genitourinary Syndrome of Menopause Part II: Navigating the Mystery of Moisturizers And The Land of Lubricants
Welcome to Part II of our series all about genitourinary syndrome of menopause (GSM)—the sneaky but significant side effect you’ve never heard of! If you haven’t read Part I, I’d suggest going back and starting there. It’s a good intro into our current convo because it gets into the nitty gritty of what GSM is and why it can develop in adolescents and young adults (AYAs) after cancer. But in case you’re on a time crunch, here’s a quick recap:
IF I’M HAVING SYMPTOMS, WHERE DO I BEGIN?
Today, we’re focusing on vaginal moisturizers and personal lubricants—two overthe- counter products that are typically recommended first for cancer survivors experiencing mild or moderate GSM symptoms.10,24 For many survivors, these non-prescription options are a safe and effective way to manage the bothersome symptoms commonly associated with GSM like dryness, itching, irritation, and pain.
DO I NEED A MOISTURIZER, A LUBRICANT, OR BOTH?
Vaginal moisturizers and personal lubricants often get confused with one another or lumped in the same category. However, they serve different purposes and work best when they are used as intended. Broadly speaking, vaginal moisturizers are for maintenance, and personal lubricants are for lovin’. Let’s spend some time demystifying these differences.
VAGINAL MOISTURIZERS
Vaginal moisturizers are non-hormonal products that are meant to be used on a regular basis to help improve and maintain genital tissue health and reduce annoying symptoms over time. They are a good option for people who are dealing with daily discomforts like dryness, itching, and irritation regardless of sexual activity.8,13
Moisturizers work by retaining moisture and rehydrating genital tissues. They are typically water-based and include substances with humectant properties that attract and hold water, as well as bio-adhesive properties that help the product adhere and absorb into the tissues.13,29,32 Over time, the regular use of moisturizers can increase the fluid content at a cellular level and also balance pH levels in the vagina 12,28 (more on this later).
Hyaluronic Acid
Some vaginal moisturizers contain hyaluronic acid (HA). HA is a natural substance found throughout the body, including the genital and urinary tissues. HA plays a role in tissue moisture, strength, and flexibility, 23 as well as tissue healing and repair.23, 29 Interestingly, the low estrogen levels associated with GSM may decrease the production of natural HA.23 HA moisturizing products have been shown to be effective in cancer populations,10,16 and initiating the use of a HA vaginal moisturizing product early in treatment could help prevent and reduce the severity of GSM symptoms caused by cancer treatments.23
Vitamin E
Vitamin E has also been identified as a product that can be used to manage vulvovaginal dryness and GSM symptoms for cancer survivors.8,21,22,24 Vitamin E itself is not a moisturizing ingredient, but it works by sealing in moisture which helps tissues feel less dry.5 On a product ingredient list, Vitamin E may be listed as tocopheryl acetate.
Some professionals recommend the use of Vitamin E in combination with other moisturizing products or ingredients, rather than just by itself.5 Others suggest that natural oils like Vitamin E and coconut oil should only be used externally on the vulvar tissues, rather than placed in the vagina.20 We’ll talk a bit more about oil-based products in the lubricant section below.
HOW DO I USE A VAGINAL MOISTURIZER?
Use It Often
Remember, the trick to reaping the benefits of a moisturizer is routine use. Vaginal moisturizers are products that are meant to be used regularly to help maintain hydration and improve symptoms. Frequency of use is individualized and depends on symptom severity. Instructions on a product package may suggest an application frequency of one to three times per week. However, more frequent application is often needed for symptom relief in cancer survivors.8,10,22 You may find that when you begin a vaginal moisturizing regimen, you need to apply daily or almost daily, but as your genital tissues retain more moisture and get healthier, you may be able to decrease to three to five times per week.
Apply at Bedtime
Some vaginal moisturizers are applied to the inside of the vagina using an applicator (kind of like placing a tampon). Others come as a capsule or suppository that you place with your fingers and leave in to slowly dissolve. Applying the moisturizer at bedtime will help it to stay put and absorb as you sleep, otherwise it tends to leak out of the vagina and can get a little messy.8
Spread the Love
The outer genital tissues that make up your vulva, including the opening to the vagina, the labia (the inner and outer skin folds surrounding your vaginal opening), and the clitoris also experience tissue changes with GSM and can benefit from moisture application. 8,10 Include these tissues in your regular moisturizing routine as well!
Combine with Tissue Massage
A step-by-step program developed by A Woman’s Touch5 pairs the application of a moisturizing product to the vulva and vagina with massage techniques. This can facilitate absorption of the moisture, promote healthy blood flow to the area, and improve the stretch and flexibility of the tissues. Detailed instructions can be found on their website. This routine can greatly improve the health and comfort of the area after four to six weeks.5
Play the Long Game
Again, I can’t stress enough that commitment is important! It takes time for your tissues to respond and begin the healing process, and continued application is required for continued symptom relief and management.
PERSONAL LUBRICANTS
Personal lubricants are products that are meant to be used on-demand or as-needed, usually with sexual activity and touch.10 Their purpose is not to impact long-lasting moisture or tissue healing, but instead to temporarily improve the natural slip-and-slide lubrication needed to reduce friction, prevent tissue trauma, and reduce discomfort during sex. Plus, getting sexy with lubes is just plain fun! Using personal lubricants can increase sexual pleasure and make it easier to have an orgasm.25 Who could say no to that?
There are several categories of lubricants: water-based, silicone-based, and oil-based.
Water-Based Products
Water-based personal lubricants are the most common. Because they’re made with water, these products will eventually absorb into the skin and can get a little sticky or tacky (sometimes before the fun is over). Benefits of water-based products include easy cleanup from the skin, non-staining on bedding and sheets, and compatibility with condoms and sex toys. 8, 25
Silicone-Based Products
Silicone-based lubricants have many benefits. They feel slicker and less sticky (a little goes a long way), and they’re waterproof. They last longer than water-based products because they’re not water-soluble and won’t get absorbed into the skin. 8 This also means that the product will have to be washed off the skin to be removed. Silicone products are not moisturizing, but they can help to seal in moisture. 5 They are typically condomcompatible but should not be used with silicone sex toys. Examples of the materials used in these products include dimethicone and vinyl dimethicone, cyclomethicone, and phynyl trimethicone. Silicone products are usually well-tolerated and were found to be preferred by cancer survivors in one study. 17
Hybrid Products
Lubricants that are water-silicone blends are called hybrid products. They are kind of the best of both worlds, because they pair the moisturizing and hydrating effects of water-based lubes with the slick, long-lasting properties of silicone. They are generally condom-compatible and can be used with silicone sex toys. 4, 8
Oil-Based Products
Mineral oil, baby oil, and petroleum jelly (Vaseline) are not recommended for use as personal lubricants, as they can cause tissue irritation and are associated with an increased risk of vaginal infections. 8, 9, 25 Opinions regarding the use of plant-based natural oils, however, are a bit more conflicting. Olive oil and coconut oil have been identified as products that can be used as personal lubricants or vaginal moisturizers. 8,25 However, with just a little digging, you will find they are both recommended, (7, 11, 19, 22) and not recommended, (4, 5, 20) depending on the source. So, what to do? Concerns with plant oils, as with mineral oils, are that they might be irritating and could increase the risk for infections.14 Coconut oil, for example, has some antimicrobial properties which could theoretically harm healthy bacteria in the vagina,4 disrupting the pH balance and possibly increasing infection risk.20 Yet, whether or not this concern is warranted is unclear.18 If you are interested in using a natural oil as a lubricant or moisturizer, talk with your provider before beginning the regimen. Be aware that oil-based products are NOT compatible with latex condoms, but can be used with polyurethane-based condoms. 32
HOW TO USE LUBRICANTS
Using personal lubes is easy—just apply as much as you want or need to your vulva and vagina prior to sexual touch. It’s also helpful to apply lubricant to any body part or toy (fingers, penis, vibrator, etc.) prior to activities that include penetration. Personal lubricants can be used with partnered or solo sexual play. If you are using a barrier method like a condom, make sure it’s compatible with your lubricant of choice!
A couple quick things to note. One, lubricant properties can negatively impact sperm,13,28 so if you are using a lubricant when you are trying to conceive, find a lube that has been determined to be sperm-friendly by the U.S. Food and Drug Administration (FDA). Also, using a personal lubricant is a must for any activities that include anal penetration.
PERTINENT PRODUCT PROPERTIES
With water-based products (both moisturizers and lubricants), there are a couple of important chemical properties that should be considered when you’re making your selection: the product’s pH level and its osmolality value. (Products that do not contain water, like silicone-based and oil-based lubes, are not impacted by these chemical properties).
Because brands are likely not going to advertise their osmolality or pH levels on their packaging, you can check for your brand’s values online, or use online resources to help choose a brand within the recommended pH and osmolality levels.
Acidity Level (pH)
Premenopausal levels of estrogen support healthy Lactobacilli bacteria in the vagina. These bacteria hang out and produce lactic acid, creating a naturally acidic environment at a pH level of about 3.8-4.5.28 This acidity is beneficial because it’s hostile to a lot of problematic microbes and may reduce the risk of sexually transmitted infections (STIs).31
If the number of acid-producing Lactobacilli decreases in the vagina, this can increase the vaginal pH (because less Lactobacilli equals less lactic acid). A decrease in Lactobacilli can happen to peeps who have low levels of estrogen due to treatment-induced menopause. It may also occur if you regularly use a lube or moisturizer made with ingredients that are harmful to Lactobacilli (see below).
This is what makes understanding your product’s properties and ingredients so important! This is also why regularly using a moisturizer that balances pH levels can help with vaginal health.
Osmolality
There is evidence that products with high osmolality are associated with cell damage and mucosal irritation31 and are toxic to Lactobacilli. 25 Highly osmolar products can be drying and may cause symptoms like genital burning or itching.13 Tissue damage caused by hyperosmolar products also increases the risk for infection. 31,32
To prevent these risks, the World Health Organization (WHO) recommends using products with values as close to the osmolality of normal vaginal secretions as possible (which is about 260-380 mOsm/kg). However, because there are so few commercially available products that meet this recommendation, they’ve determined that anything with a value under 1,200 mOsm/kg is acceptable. 32 Frustratingly, a majority of available products still don’t meet this parameter, and some of the more popular brands far exceed the limit (up to eight times!). Take a gander online at which brands are the biggest offenders according to the WHO 32 and others.13
WHAT’S IN MY PRODUCT, AND WHY DOES IT MATTER?
Not all products are created equal. We just reviewed that many of the additives included in lube and moisturizer recipes greatly influence the product’s chemical properties, and that the pH and osmolality for many commercially available products are nowhere near the levels recommended by the WHO. Here, we’ll talk about two common types of additives that get a lot of attention. Also accompanying this article is a (non-exhaustive) list of other not-so-sexy ingredients that might be found in these products.
Glycols
The most common glycols in these products include propylene glycol and glycerin (also referred to as glycerol),32 as well as glycerol monolaurate.28 Some experts note that glycerin-containing products may increase the risk for vaginal yeast infections4,8,28 while others report that evidence supporting this concern is lacking.6,26 However, these ingredients will definitely increase the osmolality of products.
The bottom line is that glycols are in a LOT of these products and may be tolerated without issues by some people. However, if you are using a product containing glycols such as glycerin and are struggling with yeast infections or an imbalance of vaginal flora called bacterial vaginosis, or if you are at risk for STIs, you may want to consider switching.
Parabens
Parabens have been used widely as a preservative in cosmetics and personal hygiene products, the food and pharmaceutical industries, and with vaginal moisturizers and personal lubricants.15 They protect against microbial contamination, thus increasing the shelf-life of products. There is concern that they may have a carcinogenic (cancer-causing) effect.28 However, parabens have not been directly linked to an increased risk of breast cancer,1 and the FDA maintains that there is no data to suggest that they negatively impact health.15
Despite a lack of evidence supporting detrimental or adverse health effects of these chemicals, research is ongoing, and some experts recommend that cancer survivors use vaginal moisturizers and personal lubricants that are paraben-free.28 Parabens can be easily identified on a product ingredient list; just look for anything ending with “-paraben.”Examples include methylparaben, ethylparaben, butylparaben, and propylparaben.
THE BOTTOM LINE
Ultimately, it may take a few tries for you to find a vaginal moisturizer or a personal lubricant that works for you:
STAY TUNED…
When used as indicated, vaginal moisturizers and personal lubricants can be really effective against mild to moderate symptoms associated with GSM. But what if your GSM symptoms are more severe, or what if you’ve tried these products but are still having challenges? This will be the topic for Part III, coming up next time!
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NOT-SO-SEXY INGREDIENTS
The ingredients in products that you use on your body shouldn’t be a mystery! Scan the ingredient list of any moisturizer or lube you pick up, and consider passing on it if any of the following are included:2,3,4,28,27,31,32
REFERENCES/BIBLIOGRAPHY:
A full list of references used for this article can be found here.
Elephants and Tea is a trademark of the Steven G. Cancer Foundation, a registered 501(c)(3) nonprofit under federal tax guidelines.
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