Lube and the Vaginal Microbiome: A Love Story?
I bet you’ve heard of your gut microbiome, but did you know your vagina has one too? My mentor in medical school called it “a self cleaning oven” as the vagina typically knows how to keep itself clean and healthy. It doesn’t need extra douches, soaps or other products up inside there as those might cause an imbalance. So what do we do when we use lubrication?
Let’s talk about it.
How does the vaginal microbiome work?
Unlike the gut microbiome, the vagina has only one bacterial species in there - Lactobacillus species - but they work hard to keep the ecosystem running smoothly and at an acidic pH. That’s right, the vagina likes to be acidic to kill off pathogens. The vagina should be at a pH of 3.5-4.5. It requires estrogens to do this!
When you have healthy levels of estrogens, they tell the cells in the vagina to mature and proliferate thus accumulating something called ‘glycogen’ when the old cells essentially exfoliate off and break apart. The lactobacillus bacteria and an enzyme called a-amylase help convert glycogen into lactic acid. This lactic acid helps continue to exfoliate and break apart the old cells AND keep it acidic so the lactobacillus thrive and opportunistic pathogens can’t adhere to the vaginal wall or set up shop in there.
It should be a happy cycle that goes round and round!
What about vaginal dryness?
You have two glands just inside your vaginal opening called Bartholin glands. They help produce lubrication on the daily to keep things healthy and increase production to help with sexual arousal. You also make mucus through your cervix (the opening to your uterus).
If your estrogen levels drop (like in menopause) or there is a disruption with the pH or lactobacillus, you might experience infections, itchiness, pain with sex, dryness, or full on tissue thinning called atrophy.
How does lube affect my vagina?
Well, that’s pretty personal. You might already have a favorite that works great!
But, have you ever used a random store-bought lubrication and afterwards, your vagina felt WORSE! Maybe a little itchy or off? Be wary of lubricants that are synthetically scented, colored, glycerin (sugars), or come in different flavors. Even strong preservatives like propylene glycol might upset your vaginal balance.
Coconut oil, almond oil, vitamin E, and other natural oils (such as pure rose oil) seem to be pretty common in more natural, cleaner oil-based lube options. I was talking with well-known microbiologist, Kiran Krishnan, who said to be careful with coconut oil as it has antimicrobial properties. However, in doing some digging in the literature and online, it appears that using a high quality virgin coconut oil where you are very careful about not contaminating the bottle is pretty okay for most women! Of course, don’t use it if you’re allergic or sensitive to coconut oil. Also, don’t use coconut oil with latex condoms - they might break!
Similar rules apply to almond oil or vitamin E - you want a pure, organic, high quality oil! Please don’t use them if you have allergies or are sensitive to either.
If you need a more water based lubrication, look for ones that are aloe based.
Lastly, remember the vagina is ACIDIC! If you’re using a lubrication from a company, check their site to see if they test the pH. Ideally you want it in the 3.5-4.5 range!
What about estrogens as a lube?
No. Nope. Definitely not.
You’re probably using lubrication to enhance sexual play. If another person is involved, they don’t need all that extra estrogen on their skin!
However, you can talk with your healthcare provider about using vaginal estrogens (and even DHEA) to improve overall vaginal health in the case of dryness, like in menopause. But, treat the vaginal hormones as a therapy - not a substitute for lube.
Have fun!
Reference:
Amabebe E, Anumba DOC. The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Frontiers in Medicine. 2018;5(181). doi:https://doi.org/10.3389/fmed.2018.00181
Hung KJ, Hudson PL, Bergerat A, Hesham H, Choksi N, Mitchell C. Effect of commercial vaginal products on the growth of uropathogenic and commensal vaginal bacteria. Scientific Reports. 2020;10(1). doi:https://doi.org/10.1038/s41598-020-63652-x