Genitourinary syndrome of menopause (GSM) is a group of symptoms that encompasses vulvovaginal atrophy (VVA), and affects more than half of all postmenopausal females. There are many etiologies that may cause GSM-like symptoms including declining hormone levels, post partum lactation, medications, and certain medical illnesses. GSM is often under-recognized by both the woman and her health care professional. VVA can cause a constellation of signs and symptoms including irritation, pain burning, and itchiness. Although systemic and local hormonal treatment is often recommended, many women may decline their use or opt for a more conservative approach. Numerous women are opting for over-the-counter products for their dryness solutions, including moisturizers, lubricants, and vulvar washes to help manage these symptoms. There is a lot of consumer confusion concerning these products, and with a plethora of varieties on the market, it is easy for the woman to get confused concerning type of products and the additives and chemical that maybe found within them. This review article summarizes the common characteristics of vaginal moisturizers, lubricants, washes, and dispels some of the misperceptions concerning common chemical/additives found in these products. It is important for the reader to note that trade names of several over-the-counter products are mentioned throughout the manuscript and this should not be interpreted as a specific product endorsement.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance
Palacios S. Managing Urogenital Atrophy Maturitas. 2009;63:315–8.
Portman DJ, Gass ML. Vulvovaginal atrophy terminology consensus conference panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s sexual health and the North American Menopause Society. Climateric. 2014;17:557–63.
Parish SJ, Nappi R, Kingsberg SA, et al. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. Int J Women’s Health. 2013;5:437–47.
Wysocki S, Kingsberg S, Krychman M. Management of vaginal atrophy: implications from the REVIVE survey; clinical medicine insights. Reprod Health. 2014;8:23–30.
Krychman ML. Vaginal estrogens for the treatment of dyspareunia. J Sex Med. 2011 Mar;8(3):666–74.
Herbenick D, Reece M, Hensel D, Sanders S, Jozkowski K, Fortenberry JD. Association of lubricant use with women’s sexual pleasure, sexual satisfaction, and genital symptoms: a prospective daily diary study. J Sex Med. 2011;8:202–12.
Birnholtz JC. Sexual lubricants promoting health and pleasure. Medical Aspects of Human: Sexuality; 1998.
Edwards D, N. P. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric. 2016;19(2):151–61. doi:10.3109/13697137.2015.1124259.
Carter J, Goldrank D, Schover L. Simple strategies for vaginal health promotion in cancer survivors. Journal of Sexual Medicine. 2011;8:549–59.
Bygdeman M, Swahn ML. Replens versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women. Maturitas. 1996;23:259–63.
Nachtigall LE. Comparative study: replens versus local estrogen in menopausal women. Fertility Sterility. 1994;61:178–80.
Van der Laak JA, de Bie LM, de Leeuw H, et al. The effects of replens on vaginal cytology in the treatment of postmenopausal atrophy: cytomorphology versus computerized cytometry. J Clin Pathol. 2002;55(6):446–51.
Caswell M, Kane M. Comparison of the moisturization efficacy of two vaginal moisturizers: pectin versus polycarbophil technologies. J Cosmet Sci. 2002;53(2):81–7.
Loprinzi CL, Abu-Ghazaleh S, Sloan JA, et al. Phase III randomized double-blind study to evaluate the efficacy of a polycarbophil-based vaginal moisturizer in women with breast cancer. J Clin Oncol. 1997;15(3):969–73.
Ekin M, Yasar L, Savan K, Temur M, Uhri M, Gencer I, Kıvanç E. The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial. Arch Gynecol Obstet. 2010;283(3):539–43.
Costantino D, Guaraldi C. Effectiveness and safety of vaginal suppositories for the treatment of the vaginal atrophy in postmenopausal women: an open, non-controlled clinical trial. Eur Rev Med Pharmacol Sci. 2008;12:411–6.
Fevola MJ, Gentner L, Ahmad N, Librizzi JJ. Getting intimate with polymers: personal lubricants. Cosmetics and Toiletries. 2008;123:59–68.
Schmid-Wendtner M-H, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Appl Ski Physiol. 2006;19:296–302.
• Chen J, Geng L, Song X, H. L, Giordan N, O. L. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. 2013;Volume 10(Issue 6):1575–84. This article is important as it illustrates that there are some important components that should be included in intimate vaginal products. Women must read labels to be aware what is included and what other potential caustic ingedients should be avoided.
Bailey AJ. Collagen and elastin fibres. J Clin Path. 31(Suppl. (Roy. Coll. Path.), 12):49–58.
Karpuzoglu E, Holladay SD, Gogal Jr RM. Parabens: potential impact of low-affinity estrogen receptor binding chemicals on human health. J Toxicol Environ Health B Crit Rev. 2013;16:321–35.
Nohynek GJ, Borgert CJ, Dietrich D, Rozman KK. Endocrine disruption: fact or urban legend? Toxicol Lett. 2013;223:295–305.
Harvey PW, Everett DJ. Significance of the detection of esters of p-hydroxybenzoic acid (parabens) in human breast tumours. J Appl Toxicol. 2004;24:1–4.
Accessed on August 4th 2016. Website:ACS: http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/antiperspirants-and-breast-cancer-risk
Dezzutti CS, Brown ER, Moncla B, Russo J, Cost M, Wang L, et al. Is wetter better? An evaluation of over-the-counter personal lubricants for safety and anti-HIV-1 activity. PLoS One. 2012;7(11):e48328. doi:10.1371/journal.pone.0048328.
Cunha AR, Machado RM, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, das Neves J, Palmeira-de-Oliveira R. Characterization of commercially available vaginal lubricants: a safety perspective. Pharmaceutics. 2014;6:530–42. doi:10.3390/pharmaceutics6030530.
Fashemi B, Delaney ML, Onderdonk AB, Fichorova RN. Effects of feminine hygiene products on the vaginal mucosal biome. Microb Ecol Health Dis. 2013;24. doi:10.3402/mehd.v24i0.19703 .eCollection 2013
Adriaens E, Remon JP. Mucosal irritation potential of personal lubricants relates to product osmolality as detected by the slug mucosal irritation assay. Sex Transm Dis. 2008;35:512–516. 14.
Wang et al. Rectal microbicides: clinically relevant approach to the design of rectal specific placebo formulations. AIDS Res Ther. 2011;8:12.
Fuchs EJ, Lee LA, Torbenson MS, et al. Hyperosmolar sexual lubricant causes epithelial damage in the distal colon: potential implication for HIV transmission. Journal of Infectious Disease. 2007;195:703–10.
Begay O, Jean-Pierre N, Abraham CJ, et al. Identification of personal lubricants that can cause rectal epithelial cell damage and enhance HIV type 1 replication in vitro. AIDS Res Hum Retrovir. 2011;27(9):1019–24.
World Health Organization. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360 advisory note 2012 [7 July 2015]. http://apps.who.int/iris/bitstream/10665/76580/1/WHO_RHR_12.33_eng.pdf
Moench TR, Mumper RJ, Hoen TE, Sun M, Cone RA. Microbicide excipients can greatly increase susceptibility to genital herpes transmission in the mouse. BMC Infect Dis. 2010;10:331.
Cunha AR, Machado RM, Palmeira-de-Oliveira A, Martinez de-Oliveira J, das Neves J, Palmeira-de-Oliveira R. Characterization of commercially available vaginal lubricants: a safety perspective. Pharmaceutics. 2014;6:530–42.
Steiner AZ, Long DL, Tanner C, Herring AH. Effect of vaginal lubricants on natural fertility. Obstet Gynecol. 2012;120:44–51.
Kutteh WH, Chao CH, Ritter JO, Byrd W. Vaginal lubricants for the infertile couple: effect on sperm activity. Int J Fertil Menopausal Stud. 1996;41:400–4.
Anderson L, Lewis SE, McClure N. The effects of coital lubricants on sperm motility in vitro. Hum Reprod. 1998;13:3351–6.
Sandhu RS, Wong TH, Kling CA, Chohan KR. In vitro effects of coital lubricants and synthetic and natural oils on sperm motility. Fertil Steril. 2014;101:941–4.
Ellington J, Daugherty S. Prevalence of vaginal dryness in trying to conceive couples. Fertil Steril. 2003;79(Supp 2):21–2.
Frishman GN, Luciano AA, Maier DB. Evaluation of Astroglide, a new vaginal lubricant: effects of length of exposure and concentration on sperm motility. Fertil Steril. 1992;58(2):630–59.
Agarwal A, Deepinder F, Cocuzza M, Short RA, Evenson DP. Effect of vaginal lubricants on sperm motility and chromatin integrity: a prospective comparative study. Fertil Steril. 2008;89:375–9.
Mowat A, Newton C, Boothroyd C, Demmers K, Fleming S. The effects of vaginal lubricants on sperm function: an in vitro analysis. J Assist Reprod Genet. 2014;31:333–9 http://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems/vaginal-and-vulvar-comfort-lubricants-moisturizers-and-low-dose-vaginal-estrogen.
Conflict of Interest
Jamie Patterson and Leah Millheiser declare that they have no conflict of interest. Michael L. Krychman reports grants from NERI and Evidera; has served as advisor and speaker for Shionogi and Sermonix; and has received fees as consultant for Uniderm, Rickett Benckiser, and Pfizer.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Female Sexual Dysfunction and Disorders
About this article
Cite this article
Patterson, J., Millheiser, L. & Krychman, M.L. Moisturizers, Lubricants, and Vulvar Hygiene Products: Issues, Answers, and Clinical Implications. Curr Sex Health Rep 8, 213–221 (2016). https://doi.org/10.1007/s11930-016-0091-0
- Vulvar hygiene products
- Genitourinary syndrome of menopause
- Vulvovaginal atrophy