(045) A PHYSICIAN'S GUIDE TO LUBRICANT FOR SEX
Authors: Vanderschee R , Kostov S 
Published: June 2024

Abstract

Introduction
Lubricant use during sexual activity has numerous benefits, minimal harms, and can play a role in managing common concerns in primary care. However, navigating evidence-based conversations about lubricant use can be challenging since there is a lack of easily accessible and reliable information. As a result, physicians are often hesitant to discuss the topic and can only offer anecdotal advice.

Objective
To review literature on lubricants used during sexual activity to (1) inform the development of an inclusive and practical evidence-based tool for physicians to help incorporate patient-specific recommendations for lubricants into clinical practice, and (2) create accessible materials for patients.

Methods
We conducted a scoping review of peer-reviewed literature using the Arksey and O’Malley framework. Using relevant keywords, we searched two electronic databases, one search engine, and reference lists for articles published in 2003 and onward. Articles generated were manually reviewed for relevance with further inclusion criteria: (1) identifies patient populations most likely to benefit from using lubricant during sexual activity, (2) addresses benefits and drawbacks of different lubricant classes, or (3) describes ingredients in or properties of lubricants that may cause harm. All sexually active individuals were deemed eligible for inclusion in the study, with no restrictions placed on location, age, gender, or sexual orientation. Following the completion of our scoping review, we used an evidence-based approach to develop a clinical practice tool and patient handout. During their development and to validate our findings, family physicians, nurses, psychologists specializing in sexual concerns, and sexual health educators provided iterative review.

Results
27 articles were deemed eligible for inclusion in our scoping review. Results showed lubricant use to be especially beneficial for patients who (1) experience dryness, pain, or sexual dysfunction during any type of sex, (2) are at a higher risk of STI transmission (by reducing condom breakage), or (3) want to reduce the risk of having an unplanned pregnancy (by reducing condom breakage). There are three main types of lubricant available: oil, water, and silicone-based. Oil-based lubricant is not recommended since it is incompatible with latex condoms and is more likely to irritate genital epithelium and negatively impact genital microbiota. When comparing silicone and water-based lubricant, silicone-based lubricant lasts longer but is more difficult to wash off. Silicone-based lubricant is not compatible with silicone-based sex toys, whereas water-based lubricant is compatible with all types of sex toys. Water-based lubricant is also more likely than silicone-based lubricant to contain potentially irritating ingredients and properties, such as glycerol, propylene glycol, parabens, or a high osmolality. For patients who are struggling with infertility, most lubricants should be avoided as they can negatively affect sperm motility and viability.

Conclusions
Numerous patients can benefit from lubricant use during sexual activity. In particular, silicone and water-based lubricant without harmful additives or properties are recommended. Our guide on lubricants will assist physicians in identifying patients who may benefit from using lubricant and incorporating patient-specific recommendations into clinical practice. This, in addition to our patient handout, will help to improve discussions between patients and healthcare providers regarding sexual well-being and lubricant use.

Disclosure
No.