The Slippery Slope of Reporting Sex Research: Anal Sex & Lubricants

I’ve been telling people how to have safe anal sex for a long time and one consistent bit of information is that you need to use a lubricant. Lube makes anal sex feel better and reduces the risk of hurting delicate tissues, so it’s one of the key factors when exploring anal play. Imagine my surprise when I saw a link to an article on Carnal Nation with the headline New Research: Using Lube for Anal Sex May Increase STI & HIV Risk. Before I start talking about the problem with these and other headlines, I want to summarize the research.

First, there was a study that looked at statistical patterns among sexually transmitted infection (STI) rates and found that people using lube for anal sex were more likely to have a rectal STI. However we’re talking about a difference between 17 people out of 145 lube users who tested positive for a rectal STI compared to just seven people out of the 156 who said they did not use a lubricant. So while the difference in the percentages (11.7% v. 5.1%) seems significant, it’s a really small sample and this trend would need to be confirmed with a larger population.

Also, the study controlled for “gender, HIV status, city, condom use, and number of sex partners in the past month” but as far as I can tell, didn’t include data on how many times someone had had anal intercourse. Since lubrication makes anal sex feel better, it’s possible that people who do it without lube are less likely to engage in it, especially if they find it painful. STI risk is affected by how much you do something, as well as what you do.

Then, there’s a study that looked at the effects of various lubricants on the cells lining the rectum. According to this research, some lubricants cause damage by causing the cell walls to burst due to a higher concentration of salts and sugars relative to the cell. OK, that’s basic biology. The research looked at 6 brands of lubricants (Astroglide, Elbow Grease, ID Glide, KY Jelly, Wet Platinum, and PRÉ) because those were the ones that were most commonly used, according to a survey. The water-based lubes had the biggest effects on the cells, while Wet Platinum (which is silicone based) and PRÉ (which is balanced to avoid this) had the least.

The problem here is that these brands offer different formulas- some are water-based with glycerin, some are water-based without glycerin, some are oil-based, some are silicone, and some are blends. So we don’t yet have enough information to be able to do anything with this information. According to the Science Daily report, “In future studies, the researchers hope to determine the effect that different lubricants have on susceptibility to HIV infection in tissues.” I’m going to guess that they probably used the glycerin-based formulas since those are the most common, and if so, that means that we don’t have any idea about glycerin-free lubricants.

Also, this research was done in a lab, rather than in real life. It’s pretty common for the real-life findings to be rather different that what people discover in laboratory settings.

Now, I’m not surprised to hear that the chemical composition of a lubricant can have an effect on the cells of the rectum. And I and my colleagues at Good Vibrations, we’re going to be following this closely so we can make sure we’re offering the best products and the most accurate information available. We’ve already been recommending silicone lubes for anal sex because they don’t dry out. Plus, lubricants help make condoms more effective and feel better, which decreases STI risk.

But the thing that I think is getting lost in all of this is that this research shows that some lubricants may increase the risk for STI transmission. And yet, here are some of the headlines I pulled from google news:

As has been noticed many times before with other stories, many of these reports are simply re-posts of the same press releases, a “news” practice that has been eroding the quality of information, even as it increases how much information we have available. And none of the articles that I’ve seen mention the limits of the research. Instead, they all make the same sweeping statements that are guaranteed to incite as much fear as possible.

This is the slippery slope of the shortening news cycle- get the article out quickly and don’t worry if it’s not accurate. With all of the false sex information already out in the world, we really don’t need more. These headlines are likely to make people less likely to use lube, which can cause discomfort and pain during anal sex.

If you do a little homework (like googling International Rectal Microbicide Advocates, the organization that did the initial work on this), you’ll see a report that says:

What do we know about the rectal safety of sexual lubricants?

In addition to the studies released at M2010, a few others have assessed the relative safety of sexual lubricants, though not always looking at rectal safety specifically. These studies looked at:

* Using in vitro and mouse assays to determine cellular toxicity, increased risk of HSV-2 infection, and epithelial sloughing caused by lubricants
* Testing the osmolarity of lubricants
* Using slug mucosal irritation assays to evaluate mucosal irritation caused by lubricants

The question remains: what do all of these studies tell us? We’re not sure. We still don’t know what assays should be used to determine the rectal safety of lubricants. Furthermore, even when studies find a wide range of values for their safety markers, we still don’t know to what extent—if any—some of these markers might indicate a higher risk of HIV transmission.

Relatively high levels of cellular toxicity, mucosal irritation, cell damage caused by hyperosmolar or hypo-osmolar products, inflammation, or epithelial sloughing could in theory increase the risk of HIV infection. However, this remains to be proven.

It is important to keep in mind that:

* Some level of inflammation and irritation occurs naturally in rectal mucosa, even among healthy individuals;
* Anal intercourse itself, as well as enemas and douching, causes some transient damage; and
* Rectal epithelium regenerates quickly after minor damage or sloughing.

We must be able to compare normal levels of inflammation, irritation, cell damage and epithelial sloughing that occur among healthy individuals and those that are a result of AI (note: anal intercourse). The question then becomes: does AI with lubes cause increased levels, similar levels, or lower levels of these markers compared to AI without lubes? Even if we were to find that some lubes cause higher levels of disruption, we would still need to investigate whether this translates into a higher risk for HIV transmission.

These questions remain to be answered, and we are still left with little data that can be translated into useful information that the public can use to make choices about lubricants. One thing to consider: if lubricants increase the use of condoms, that is probably a more important factor in preventing HIV transmission than any potential risk from lubes. For the moment, the use of lubes compatible with condoms is still considered to be an important risk-reduction tool for rectal transmission of HIV, and is likely to remain so. One day we may have valuable information on the relative safety of different lubricants, allowing users to make better informed decisions about which products they use.

So the best information that we have at this point is that we don’t have a lot of information. This is very preliminary research and there’s no reason to jump to conclusions. It’s really easy to panic, especially when the headlines are scary. So take a deep breath and relax. Come to think of it, that’s good advice when reading scary news and when having anal sex.

Update: according to this report by veteran HIV prevention writer Gus Cairns, the first study did control for number of partners and the differences in percentages is statistically significant. Thanks to Liz Highleyman for the tip (see her comment below). While this is clearly very early in the long process of research, it seems to me that this might shake up the lubricant manufacturers. Since there’s more access to info and openness around sex, I hope that testing for safety for anal sex lubes will be easier. We need products that are effective and safe.

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15 Responses so far.

  1. Dimitry says:

    fantastic writeup, Charlie! What a poorly controlled study they based these headlines off of – sad. A well-controlled study that involves human-human contact is what’s needed, and they sampled people without looking at frequency of sexual encounters, compositions of different lubes, length of the encounters, nothing! UUUGH.

  2. There are a lot of factors missing in the study, but the biggest question that came to my mind when I first read this was how well bacteria grow in water or oil based lubes versus silicone lubes. We cross contaminate lube all the time with our grubby hands. More often than not, our hands or fingers come into contact with lube before our genitals do. Irritation or concurrent infection (even a mild easily clearing infection) makes your risk of an STI go up.

    I think of this because it comes into play with my cosmetics. There’s a reason why I don’t share my liquid eyeliner with anyone else and I make it a point to throw it out after a year. I know that it’s been collecting bacteria and getting pink eye sucks as would a rectal STI. These products don’t have an infinite shelf life and we’re using them around sensitive mucous membranes. We aren’t always as diligent about throwing out that grimy bottle of lube stored in a dark place at room temperature as we should be.

  3. Charlie says:

    That is a great point and one that is often left out of the mix. Thanks for that. And since bacteria usually can’t grow in silicone lubes, since there’s nothing for them to eat, that may help explain why these products had a different effect.

  4. Charlie says:

    Fair enough. And at the same time, I think you’re missing part of what I was saying.

    I get that the headline “New Research: Using Lube for Anal Sex May Increase STI & HIV Risk” and the opening sentence “The findings of two studies presented this week at the 2010 International Microbicides Conference in Pittsburgh indicate that using lubricants for anal sex may increase the receptive partner’s risk for contracting sexually transmitted infections (STIs), including HIV.” are in the conditional sense. And I agree that they’re factually true.

    And yet, from personal experience as a sex educator, I have a strong expectation that many people will interpret this as “lubes cause STIs.” I’ve seen it with this sort of thing before- people will filter what they hear when it comes to any topic, and especially when it comes to sex. While I certainly don’t hold you responsible for the general lack of reading comprehension or critical thinking skills, I think that it’s important to keep that in mind. I’m not surprised to hear that “it never occurred to [you] to question the conventional wisdom of using lubricants to facilitate anal sex”. And I also won’t be surprised to hear that other people who don’t have your level of knowledge will respond differently. For that matter, I expect that some of the many people who argue that anal sex is bad/sinful/dirty/disgusting will see the headline and say, “see! I always knew that was a bad thing to do.” While one purpose of a headline is to grab attention and possibly entice people to read further, a lot of people won’t but they’ll remember the headline and base an opinion on it.

    It’s really easy to say that a writer needs to assume a basic level of comprehension and I’m certainly not suggesting that you need to coddle your readers. I do think one needs to see how things like this fit into a larger picture and choose language that reflects that. Given the appalling state of education and the common lack of critical thinking skills, combined with sex-negativity, inaccurate sex information, and myths & fears around anal sex, I would have gone with something like “Using Some Lubes for Anal Sex May Increase STI & HIV Risk” or “The findings of two studies presented this week at the 2010 International Microbicides Conference in Pittsburgh indicate that using some lubricants for anal sex may increase…” Of course, since I’m a sex educator, that’s my lens.

    And you’re right- I made a sweeping statement about the various news articles that didn’t fully reflect your careful use of language. I’ve fixed that and I appreciate your pointing it out to me. My frustration with the impact of confusing language on people’s level of knowledge around sex got the better of me. I’ll also fix it on the GV site.

  5. Brian Flaherty says:

    Thank you for this – I’ve been trying to write this very response in my head since I read about the research – I’m still very interested in reading the research itself. Reading the headlines, we’ve been fearing hearing sex ed. & health teachers saying things like “well, if you’re going to have anal sex, be safe & whatever you do, DON’T use lube.”

    And so many thanks

  6. Liz Highleyman says:

    Here’s a post from veteran HIV prevention writer Gus Cairns, who actually attended the session in question (rather than just going from a press release:

    He says the study did control for number of acts of anal sex. And, like Tim says, the association was statistically significant. I would agree that this study doesn’t mean people should stop using lube, but at the least should spur further research. Sex educators used to push nonoxynol 9 too, before both laboratory & human studies found it to be harmful with frequent use.

  7. Charlie says:

    Thanks for finding that link- in all of the looking around that I did, I hadn’t come across that one. While this is clearly very early in the long process of research, it seems to me that this might shake up the lubricant manufacturers. Since there’s more access to info and openness around sex, I hope that testing for safety for anal sex lubes will be easier. We need products that are effective and safe.

  8. […] News also covered these studies as well as Charlie Glickman from […]

  9. Jolene says:

    I really questioned their research methods when I heard about this. I’m taking a research course right now and it has made me even more critical than I already am!! Good blog. Thanks. 🙂

  10. Charlie, thank you for this blog post! As a sex educator, I’ve gotten a few people asking me about this very article, and it is a HUGE help to be able to point them in the direction of this blog post. You are a wonderful writer, and I could not phase my response better then this.

  11. Lawrence Lessig says:

    My colleague Lee Baker and I have written a book on the benefits of anal sexuality and other forms of non-traditional sexual practices. Without plugging our book, we interviewed both gay and straight couples, and found the degree of satisfaction reported was independent of sexual orientation. Many respondents reported that the intensity of their orgasms and emotional bonding were actually greater after anal sex than after traditional, genital sex. The decline of societal barriers against anal sex and other forms of non-traditional sexuality has liberated more people to enjoy anal sexuality in all its manifestations.

  12. Charlie says:

    I’d love to know more about your book. Drop me a note here and let’s chat!

  13. mallory says:

    Lee, I am trying to find the book I have seen you mention several times. I know you aren’t trying to plug your book but rather simply give additional insight, but would you mind sharing the title? I’d like to read it. Thanks 🙂

  14. mallory says:

    Lawrence, I apologize. I referred to you as your colleague.

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