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Lubricants for Sex Can Damage Cells, but Did Not Increase HIV Risk in Lab Study

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Certain sexual lubricant formulations are toxic to cells and can cause damage to the epithelial lining of the vagina or rectum, but this did not appear to facilitate HIV infection, researchers reported in the November 7, 2012, edition of the open-access journal PLoS ONE.

Several microbicide products designed to protect against HIV or other sexually transmitted infections, or to prevent pregnancy, also act as lubricants. Safer sex guidelines advise using water-based lubricants to help prevent condom breakage, or if a condom is not used, trauma due to friction. Oil-based products can erode condoms and cause them to break.

But lubricants that irritate the mucosa lining of the vagina or rectum could have the counterproductive effect of making cells more vulnerable to HIV entry. A study of women sex workers in Africa, for example, found that frequent application of the widely used spermicide nonoxynol 9 -- an ingredient in lubricated condoms and many lubricant gels -- caused vaginal lesions and was associated with a higher rate of HIV infection. Studies have also shown that some lubricants cause rectal epithelial damage.

Charlene Dezzutti from the Magee-Womens Research Institute at the University of Pittsburgh and colleagues affiliated with the Microbicide Trials Network (MTN) set out to test the safety of different types of sexual lubricants in a laboratory study.

They evaluated a panel of 14 over-the-counter and mail-order products. The selected lubes were identified as most commonly used in a survey of more than 6000 people. 10 products were water-based, 2 were oil-or lipid-based, and 2 were silicon-based. Among the water-based gels, 2 were nearly iso-osmolar (meaning they have a similar concentration of salts, proteins, and other particles as normal fluid within cells), 6 were hyper-osmolar (lower concentration of particles, which causes cells to draw in fluid, potentially to the bursting point), and 2 were hypo-osmolar (higher concentration of particles, which draws fluids out of cells and causes tissue to dry out).

Products tested:

Water-based iso-osmolar:PRÉ, Good Clean Love

Water-based hyper-osmolar: Astroglide, ID Glide, K-Y Jelly, Replens, Elbow Grease

Water-based hypo-osmolar: Slippery Stuff, Sliquid Organic

Lipid-based: Boy Butter H2O, Boy Butter Original

Silicone-based: Female Condom 2, Wet Platinum.

Nonoxynol-9 spermicide control: Gynol 2.

Lubricants were introduced into cell cultures and applied to "explants," or vaginal or anal mucosal tissue samples from biopsies, to assess safety. The lipid-based products could only be tested in the explants. They tested products' anti-HIV activity in cell cultures, and cervical explants were also exposed to HIV-1 in the presence of lubricants.

Results

  • The 2 nearly iso-osmolar water-based gels, and both silicone-based gels, were not toxic to epithelial cell lines or to cervical or colon-rectal tissues in explants.
  • The 2 lipid-based gels -- which are marketed for gay men -- caused damage to rectal tissue.
  • All hyper-osmolar water-based lubricants reduced tissue viability and caused sloughing of vaginal and rectal epithelial cells.
  • In contrast, nearly iso-osmolar water-based and silicon-based gels were not associated with significant cell toxicity or epithelial tissue damage.
  • Cervico-vaginal and rectal tissue showed similar susceptibility to damage.
  • 3 products (Gynol II, KY Jelly, and Replens) were toxic to Lactobacillus -- a type of bacteria that live in a healthy vagina -- likely attributable to chlorhexidine.
  • Most of the lubricants had no measurable anti-HIV activity.
  • 3 products (Good Clean Love, PRÉ,Replens) demonstrated modest anti-HIV activity in cell cultures.
  • None of the lubricants actually protected mucosal tissue from HIV infection, though 3 of them (Astroglide, Good Clean Love, Replens) appeared to slow down the process.
  • Despite cell damage, none of the products was associated with increased risk of HIV infection or accelerated viral replication in cells.

"These results show hyperosmolar lubricant gels were associated with cellular toxicity and epithelial damage while showing no anti-viral activity," the study authors concluded. "The 2 iso-osmolar lubricants, Good Clean Love and PRÉ, and both silicone-based lubricants, Female Condom 2 lubricant and Wet Platinum, were the safest in our testing algorithm."

Despite the lack of evidence of serious harm, they recommended that more research is needed to fully understand the safety of sexual lubricants and their effect on epithelial tissue.

"Much more work needs to be done to explore the safety of lubes," lead author Dezzutti stated in a press release issued by the Microbicide Trials Network. "This was an early study and the jury is still out as to whether hyperosmolar lubes cause damage to the epithelium that in conjunction with other processes, like inflammation, could increase susceptibility to HIV...The most important point for people to take away from this study is that condoms are still the best way to protect against HIV and that lubes should always be used with compatible condoms."

12/11/12

Reference

C. Dezzutti, ER Brown, B Moncla, et al.Is Wetter Better? An Evaluation of Over-the-Counter Personal Lubricants for Safety and Anti-HIV-1 Activity. PLoS ONE 7 (11):e48328. November 7, 2012 (Epub).

Other Sources

Microbicide Trials Network. Cell Damage Caused by Use of Certain Personal Lubricants Does Not Increase HIV Risk, According to Laboratory Study. Press release. November 7, 2012.

International Rectal Microbicide Advocates. Cell DamageCaused by Application of Certain Personal Lubricants Does Not Increase Risk of HIV Infection in Tissues Exposed to HIV in a Laboratory, According to a New Study. Blog post. November 7, 2012.