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:
- Lubricant Use May Raise HIV Infection Risk During Anal Sex
- Lubricant with anal sex may raise HIV risk during anal sex
- Lubricants may increase disease risk of anal sex, studies show
- Risk of sexually transmitted disease three times higher when lubricant used …
- Lubricant Use Might Increase Risk of Sexually Transmitted Infections
- Use of Lubricants With Anal Sex Could Increase Risk of HIV
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.
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.