Does Lubricant Increase HIV Risk?

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The use of lubricants can make sexual penetration all the more pleasurable while significantly reducing the risk of condom breakage. In recent years, however, there have been suggestions that certain lubricants can, in fact, increase the risk of HIV, either by weakening the structure of latex condoms or causing cellular damage to the fragile tissues that line the vagina or rectum. The question is, how real is either of these claims?

Types of Lubricants

Water-based lubricants have long been recommended for both anal and vaginal sex, the use of which can lower the condom failure rate to roughly three percent versus 21 percent or when no lubricant is used. By contrast, oil-based lubricants—such as baby oil, mineral oil, petroleum jelly, or vegetable shortening (i.e., Crisco)—are known to rapidly degrade the integrity of latex, often within minutes, increasing the potential for condom breakage. For this reason alone, oil-based lubricants should always be avoided.

Another recommended option, silicone-based lubricants, boasts high viscosity levels and minimal impact on latex integrity. While not as commonly available as water-based lubricants, silicone lubricants are generally considered safe although there is only limited clinical data to support this, particularly in regards to anal sex.

There are also glycol-based lubricants, in which either glycerine or propylene glycol is added to traditional water-based lubricants. These organic compounds act as humectants, preventing evaporation to ensure long-lasting slipperiness, and are generally considered safe for use.

STI Risk

Since 2002, there have been a number of studies that warned of the impact of personal lubricants on the delicate epithelial cells that line the vagina and rectum. One such study investigated the use of nonoxynol-9, a detergent commonly used as a spermicidal agent to block HIV transmission in women.

The study, which included commercial sex workers in Thailand and Africa, showed that the frequent use of nonoxynol-9 nearly doubled the risk of HIV, compared to women in the placebo group. Epithelial damage and vaginal ulceration were commonly noted among the nonoxynol-9 users, too.

Similar results were seen when investigating the impact of nonoxynol-9 on rectal tissues, with many experiencing a stripping away of rectal tissues and even rectal bleeding in some cases. As a result of these studies, nonoxynol-9-containing lubricants are not recommended for women at high risk for HIV.

The concerns, however, are not limited only to lubricants containing nonoxynol-9. Since as far back as 2006, investigators have been looking at lubricants that are considered to be hyperosmolar, meaning that they affect the exchange of fluids in cells, drawing out water and causing them to become brittle and weak. In doing so, they increase the potential for infection by allowing sexually transmitted infections (STIs) a direct route through the cellular barriers meant to impede them.

One well-published study, developed as part of the UCLA Microbicide Development Program, examined the risk among heterosexual couples engaging in anal sex.

According to the research, couples who consistently used personal lubricants for anal sex had a nearly three-fold increased risk of chlamydia and gonorrhea when compared to occasional or infrequent users.

The majority of users (61 percent) used water-based products, while 20 percent used silicone lubricants, 15 percent used oil-based lubricants, and seven percent used a numbing lubricating agent. Of the 421-patient cohort, 229 were male and 192 were female. The investigation, presented in 2012, neither explored HIV nor any other STI.

HIV Transmission Risk

Another study, published in 2012, looked into the impact of different lubricants on rectal tissues and concluded, not surprisingly, that the risk varied by product. Some products demonstrated increased hyperosmolarity due to high concentrations of salt and carbohydrates while others were shown to be iso-osmolar, wherein levels of salt and other ingredients had little to no impact on cells.

Of the 14 products investigated, two water-based, iso-osmolar lubricants (Good Clean Love and PRÉ) and two silicone lubricants (Wet Platinum and Female Condom 2) showed the least adverse impact. Products containing chlorhexidine (commonly used in disinfectants and cosmetics) were seen to cause the greatest damage.

Despite evidence of cellular toxicity, the researchers concluded that there was absolutely no evidence that personal lubricants increased HIV risk.

According to the study, any epithelial trauma caused by a lubricant was likely not sufficient enough to potentiate HIV transmission. Additionally, there was little change to tissue permeability after lubricant use.

Neither of the two studies suggests that lubricants be avoided, as this could potentially cause even greater trauma to vaginal/rectal tissues while increasing the likelihood of condom failure. Further investigations will likely focus on identifying the compounds and/or additives in lubricants that may be harmless or harmful to tissues.

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By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.