News from NAMS: The Latest on Lubes and Moisturizers

For nigh onto 30 years, the North American Menopause Society has encouraged research into and disseminated information about all things menopause. It’s the hub of the wheel for healthcare professionals and individuals alike seeking the latest scientific information and objective advice about “the change.”

One presentation at this year’s annual meeting in October struck me as particularly apropos for MiddlesexMD readers—part refresher course; part new information. So I’d like to pass it along.

In a wide-ranging talk, Dr. Nick Panay, a gynecologist from Great Britain, explored current understanding of that most common and persistent problem of menopause: painful sex due to vaginal dryness. He reminded us that lots of women will suffer from it (about half of women at some point in life), and that many won’t mention it to their doctors. He encouraged healthcare workers to ask: “If you don’t ask, women often won’t volunteer the information.”

So far, so good, but ground that’s been covered.

Everyone likes sex better with good lubrication, he said, and women often expect their bodies to lubricate adequately, just like they did “before,” so when they inevitably don’t, it’s a real buzzkill for sex.

This state of affairs can be tackled in many ways—topical estrogen, Osphena, Intrarosa, and the good old stand-by, moisturizers and lubricants. According to Dr. Panay, moisturizers and lubes can provide relief from vaginal dryness, but they don’t address the underlying cause, which is loss of estrogen. Only estrogen can do that.  

Turns out, however, that a couple additional considerations might affect how your body reacts to a specific moisturizer and/or lubricant, depending on its ingredients. In this report, Dr. Panay mentions three physical characteristics of the vagina that might be altered by components in what we put there.

  • pH balance. A healthy vagina is slightly acidic with a pH value between 3.8 and 4.5. Ideally, whatever lubricant or moisturizer you use should be close to those values to retain the vagina’s protective bacterial balance.
  • Osmolality. This is a fancy concept that refers to the amount of particles dissolved in a liquid. High osmolality has a lot of “stuff;” low osmolality doesn’t. The way this works in the vagina is that, ideally, equilibrium is reached between vaginal cells and the moisturizer or lube, depending on its osmolality. When the osmolality is off-kilter, it either draws water from vaginal cells or over-moisturizes them, either of which could cause changes in the vagina. In a test of several products on slugs, for example (yes, like you see pictured below), which as we know are all about moisture and mucus, products that were hyper-osmolalic (high levels of particles) irritated the slugs a lot.
  • Additives. Ingredients like glycols, parabens, and preservatives, which are found in some products can also irritate the vaginal lining, kill good bacteria, and increase susceptibility to infection.

Ideally, says Dr. Panay, the lube/moisturizer you use should be as close to vaginal mucosa as possible—a product that is “optimally balanced in terms of both osmolality and pH and is physiologically most similar to natural vaginal secretions.”

slug like those used for testingTrouble is that the ingredients in a moisturizer or lubricant aren’t always listed on the label and identifying those with correct osmolality and pH levels is fairly impossible for the average user, especially since a product with a good pH level might have bad osmolality numbers. Dr. Panay shared the results for several dozen products available worldwide, and we were happy to see that YES VM, a moisturizer, and YES WB, a lubricant, both scored very well in the testing (we shouldn’t be too surprised, since they’re both very popular in our shop).

So what’s the practical application for all of this new data? For us at MiddlesexMD, we’ve got some new criteria for vetting and recommending products from our shop (sadly, Dr. Panay’s tests couldn’t include every product currently available). We hope that makers of moisturizers and lubricants will take these new findings into account in their formulations, and we can now ask for data on osmolality in addition to pH levels when we evaluate products.  

For you, keep in mind that lubes and moisturizers are the first line of attack in making sex comfortable (or possible) and in keeping vaginal tissue flexible and moisturized. According to Dr. Panay, this is true even if you use topical estrogen or another drug, such as Osphena or Intrarosa. Choose your products carefully, looking for high-quality products that are free of glycol, parabens, and other additives.

Pay attention to any increase in vaginal irritation or infections. Your lubricant or moisturizer could be contributing. Don't give up on lubes or moisturizers, though: Try another product or formulation that’s a better match for your pH and is providing the right amount of moisture to your tissues.

Q: Is there a “natural” replacement for Premarin?

In a sense, the most “natural” replacement for lost estrogen is estrogen, which is a prescription product (like Premarin or Estrace vaginal cream, Estring, Vagifem, or the non-estrogen Osphena).

You asked. Dr. Barb answered.If, for a number of reasons, you prefer not to take that path, the next-best option is to maintain vaginal tissues by using a moisturizer regularly, two to three times a week. Moisturizers are designed to bring more moisture--no surprise--into the vagina to prevent the progressive dryness that occurs in menopause with the absence of estrogen.

Both Emerita and Prevaleaf Oasis are natural vaginal moisturizers.

One more option might be an oral nutritional supplement, Stronvivo, which some research shows improves vaginal moisture. It does this by improving blood flow, and that circulation also supports tissue health.

 

 

April 07, 2016

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Q: Is my vaginal moisturizer causing yeast infections?

Q&A on women's sexual healthWhat you describe is "clumps" of discharge, which might be consistent with a yeast infection except that you have no other symptoms  (redness or itching, for example). It's also unlikely that this is skin cells sloughing. What's most likely is that you're having a reaction to some of the ingredients of the moisturizer: I'd recommend that you try another variety and see if you have the same symptoms. 

Women typically see maintenance results in four to six weeks of twice-a-week application of vaginal moisturizers. And I do recommend the use of moisturizers! Moisturizers and lubricants are the simplest steps women can take to maintain vaginal tissue and comfort during intimacy.

Q: Are hydrogenated oils in moisturizers a concern?

You say you’ve been using Replens regularly, and have noticed that hydrogenated palm oil is among the ingredients. You’ve heard that hydrogenated fats are unhealthy, and wonder whether you should be concerned.

You’re right to be concerned about ingesting hydrogenated palm oil in food products, especially if you have elevated cholesterol and triglycerides. As an ingredient for a topical product, though, like a vaginal moisturizer, the oil is safe and won’t affect your lipids. Applied to the surface of your skin or tissues, the moisturizer is not absorbed into your bloodstream.

Keep using that moisturizer! Keeping tissues health goes a long way toward comfort and enjoyment.