Vaginal lubrication

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Left: The shaved vulva unaroused. Right: Vaginal lubrication sometimes becomes visible after sexual arousal. Female sexual arousal.JPG
Left: The shaved vulva unaroused.
Right: Vaginal lubrication sometimes becomes visible after sexual arousal.

Vaginal lubrication is a naturally produced fluid that lubricates the vagina. Vaginal lubrication production increases significantly during sexual arousal in anticipation of sexual intercourse. [1] Vaginal dryness is the condition in which this lubrication is insufficient, and sometimes artificial lubricants are used to augment it. Without sufficient lubrication, sexual intercourse can be painful. The vaginal lining has no glands, and therefore the vagina must rely on other methods of lubrication. Plasma from the vaginal walls due to vascular engorgement is considered to be the chief lubrication source, and the Bartholin's glands, located slightly below and to the left and right of the introitus (vaginal opening), also secrete mucus to augment vaginal wall secretions. Near ovulation, cervical mucus provides additional lubrication.

Contents

Mechanism

Composition

Vaginal lubrication fluid is a plasma transudate which diffuses across the vaginal wall. Composition varies with length of arousal. [1]

During arousal, vaginal lubrication, also sometimes called "arousal fluid", is produced. This is clear, thin, and slippery. It typically only lasts up to an hour. [2] [3] [4] It can sometimes be confused with cervical mucus. [4]

Production

The human vagina is serviced by nerves that respond to vasoactive intestinal polypeptide (VIP). [1] As a result, VIP induces an increase in vaginal blood flow accompanied by an increase in vaginal lubrication. The findings suggest that VIP may participate in the control of the local physiological changes observed during sexual arousal: genital vasodilation and increase in vaginal lubrication. [5] Neuropeptide Y is also involved in producing it. [1] [6]

Vaginal dryness

Insufficient lubrication or vaginal dryness can cause dyspareunia, which is a type of sexual pain disorder. While vaginal dryness is considered an indicator for sexual arousal disorder, vaginal dryness may also result from insufficient excitement and stimulation or from hormonal changes caused by menopause (potentially causing atrophic vaginitis), pregnancy, or breast-feeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sexual intimacy. Vaginal dryness can also be a symptom of Sjögren syndrome (SS), a chronic autoimmune disorder in which the body destroys moisture-producing glands.

Certain medications, including some over-the-counter antihistamines, as well as life events such as pregnancy, lactation, menopause, aging or diseases such as diabetes, will inhibit lubrication. Medicines with anticholinergic or sympathomimetic effects will dry out the mucosal or "wet" tissues of the vagina. Such medicines include many common drugs for allergenic, cardiovascular, psychiatric, and other medical conditions. Oral contraceptives may also increase or decrease vaginal lubrication.

In seemingly rare cases, selective serotonin reuptake inhibitors (SSRIs) have been reported to cause a long-lasting iatrogenic disorder known as post-SSRI sexual dysfunction, the symptoms of which include reduced vaginal lubrication in females.

Vaginal dryness affects 3-43% of women, and it is more common in after menopause. [1] Post-menopausal women produce less vaginal lubrication and reduced estrogen levels may be associated with increased vaginal dryness. [7]

Management strategies

Hormonal

Estrogen treatments are considered the gold standard for managing vaginal dryness. [8] They are available in systemic and vaginal forms, with systemic estrogen addressing multiple issues such as vasomotor symptoms and osteoporosis, albeit with a higher risk profile. [9] Vaginal estrogen, which includes creams, pills, rings, and inserts, is more commonly prescribed due to its lower risk. DHEA (prasterone) is a promising alternative that enhances vaginal health with minimal side effects and does not significantly alter hormone levels. [8] Testosterone therapy is also an option, though it is off-label and lacks FDA-approved formulations, with limited data on its efficacy and safety.

Non-Hormonal

The treatment of vaginal dryness includes over-the-counter (OTC) options of vaginal lubricants and moisturizers, non-estrogenic prescription treatments, laser and ultrasound devices, as well as lifestyle changes. [8] [10] Non-hormonal vaginal lubricants and moisturizers, which have minimal side effects and are easy to obtain, are the primary recommendation, especially for those contraindicated for hormone treatments. [11] They aim to mimic natural vaginal conditions and provide temporary relief during intercourse, while regular use of moisturizers helps maintain moisture. Prescription treatments include non-estrogenic options for women who can't use estrogen. Ospemifene is a notable FDA-approved medication for vaginal dryness and discomfort, although concerns about long-term safety remain. Vaginal laser therapy and ultrasound devices, are emerging options, particularly for those who do not respond to traditional methods. While initial results appear promising, evidence for their long-term efficacy is still limited. [12] Lifestyle modifications can also alleviate vaginal dryness; quitting smoking, reducing alcohol intake, and maintaining a healthy weight are beneficial. [8] Additionally, regular sexual activity can enhance tissue health and moisture levels, further aiding in symptom relief.

Dry sex

Some people practice dry sex, which involves the removal of vaginal lubrication in some way. [13] The rationale for the practice seems to be for cleansing purposes and to enhance the sexual pleasure of the penetrating partner. [14] However, besides making sexual intercourse painful for the female, [15] the practice is believed to increase the risk of transmitting sexually transmitted infections for both partners, [15] such as HIV, with which the risk of transmission is increased by lacerations in the vaginal tissue resulting from the lack of lubrication. [16]

See also

Related Research Articles

<span class="mw-page-title-main">Cervix</span> Lower part of the uterus in the female reproductive system

The cervix or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the time of Hippocrates, over 2,000 years ago. The cervix is approximately 4 cm long with a diameter of approximately 3 cm and tends to be described as a cylindrical shape, although the front and back walls of the cervix are contiguous. The size of the cervix changes throughout a woman's life cycle. For example, during the fertile years of a woman's reproductive cycle, females tend to have a larger cervix in comparison to postmenopausal females; likewise, females who have produced offspring have a larger sized cervix than females who have not produced offspring.

<span class="mw-page-title-main">Vagina</span> Part of the female reproductive tract

In mammals and other animals, the vagina is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix. The vaginal introitus is normally partly covered by a thin layer of mucosal tissue called the hymen. The vagina allows for copulation and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle.

<span class="mw-page-title-main">Menopause</span> Time when menstrual periods stop permanently

Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of reproduction. It typically occurs between the ages of 45 and 55, although the exact timing can vary. Menopause is usually a natural change related to a decrease in circulating blood estrogen levels. It can occur earlier in those who smoke tobacco. Other causes include surgery that removes both ovaries, some types of chemotherapy, or anything that leads to a decrease in hormone levels. At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone. While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine. Menopause is the opposite of menarche, the time when a girl's periods start.

Dyspareunia is painful sexual intercourse due to somatic or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

<span class="mw-page-title-main">Irritation</span> State of inflammation

Irritation, in biology and physiology, is a state of inflammation or painful reaction to allergy or cell-lining damage. A stimulus or agent which induces the state of irritation is an irritant. Irritants are typically thought of as chemical agents but mechanical, thermal (heat), and radiative stimuli can also be irritants. Irritation also has non-clinical usages referring to bothersome physical or psychological pain or discomfort.

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

<span class="mw-page-title-main">Vaginal ring</span> Medical device

Vaginal rings are polymeric drug delivery devices designed to provide controlled release of drugs for intravaginal administration over extended periods of time. The ring is inserted into the vagina and provides contraception protection. Vaginal rings come in one size that fits most people.

Hypoestrogenism, or estrogen deficiency, refers to a lower than normal level of estrogen. It is an umbrella term used to describe estrogen deficiency in various conditions. Estrogen deficiency is also associated with an increased risk of cardiovascular disease, and has been linked to diseases like urinary tract infections and osteoporosis.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, quality, and amount of discharge varies between individuals, and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain.

Sex and drugs refers to the influence of substances on sexual function and experience. Sex and drugs date back to ancient humans and have been interlocked throughout human history. Sexual performance is known as the execution of the act of sex and the quality of sexual activity. This includes elements such as libido, sexual function, sensation. Drugs are termed as any chemical substance that produces a physiological and or psychological change in an organism. Drugs categorized as psychoactive drugs, antihypertensive drugs, antihistamines, cancer treatment, and hormone medication have a significant impact on sexual performance. Various drugs result in different effects, both positive and negative. Negative effects may include low libido, erection issues, vaginal dryness and anorgasmia. Positive effects usually address these issues, overall enhancing sexual performance and contributing to a more enjoyable sexual experience. It is crucial to know that the impact of drugs on sexual performance varies among individuals, especially among different genders.

A vaginal disease is a pathological condition that affects part or all of the vagina.

Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy used to treat symptoms associated with female menopause. Effects of menopause can include symptoms such as hot flashes, accelerated skin aging, vaginal dryness, decreased muscle mass, and complications such as osteoporosis, sexual dysfunction, and vaginal atrophy. They are mostly caused by low levels of female sex hormones that occur during menopause.

Vaginal estrogen is a form of estrogen that is delivered by intravaginal administration. Vaginally administered estrogens are thereby exerting their effects mainly in the nearby tissue, with more limited systemic effects compared to orally administered estrogens. It will not protect against osteoporosis. With perhaps the exception of the Femring, it also will not alleviate the hot flashes and hormonal imbalance caused by menopause.

<span class="mw-page-title-main">Ospemifene</span> Chemical compound

Ospemifene is an oral medication indicated for the treatment of dyspareunia – pain during sexual intercourse – encountered by some women, more often in those who are post-menopausal. Ospemifene is a selective estrogen receptor modulator (SERM) acting similarly to an estrogen on the vaginal epithelium, building vaginal wall thickness which in turn reduces the pain associated with dyspareunia. Dyspareunia is most commonly caused by "vulvar and vaginal atrophy."

<span class="mw-page-title-main">Atrophic vaginitis</span> Medical condition

Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to low estrogen levels. Symptoms may include pain during penetrative sex, vaginal itchiness or dryness, and an urge to urinate or burning with urination. It generally does not resolve without ongoing treatment. Complications may include urinary tract infections. Atrophic vaginitis as well as vulvovaginal atrophy, bladder and urethral dysfunctions are a group of conditions that constitute genitourinary syndrome of menopause (GSM). Diagnosis is typically based on symptoms.

<span class="mw-page-title-main">Postcoital bleeding</span> Non-menstrual vaginal bleeding during or after sexual intercourse

Postcoital bleeding (PCB) is non-menstrual vaginal bleeding that occurs during or after sexual intercourse. Though some causes are with associated pain, it is typically painless and frequently associated with intermenstrual bleeding.

<span class="mw-page-title-main">Vaginal epithelium</span> Inner lining of the vagina

The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie upon the basal layer, and the superficial layer is the outermost layer of the epithelium. Anatomists have described the epithelium as consisting of as many as 40 distinct layers of cells. The mucus found on the epithelium is secreted by the cervix and uterus. The rugae of the epithelium create an involuted surface and result in a large surface area that covers 360 cm2. This large surface area allows the trans-epithelial absorption of some medications via the vaginal route.

Vaginal stenosis is an abnormal condition in which the vagina becomes narrower and shorter due to the formation of fibrous tissue. Vaginal stenosis can contribute to sexual dysfunction, dyspareunia and make pelvic exams difficult and painful. The lining of the vagina may also be thinner and drier and contain scar tissue. This condition can result in pain during sexual intercourse or a pelvic exam. Vaginal stenosis is often caused by radiation therapy to the pelvis, an episiotomy, or other forms of surgical procedures. Chemotherapy can also increase the likelihood of developing vaginal stenosis. Vaginal stenosis can also result from genital reconstructive surgery in people with congenital adrenal hyperplasia.

<span class="mw-page-title-main">Cervical drug delivery</span> Drug delivery methodology

Cervical drug delivery is a route of carrying drugs into the body through the vagina and cervix. This is a form of localized drug delivery that prevents the drugs from impacting unintended areas of the body, which can lower side effects of toxic drugs such as chemotherapeutics. Cervical drug delivery has specific applications for a variety of female health issues: treatment of cervical cancer, pregnancy prevention, STD prevention, and STD treatment. 

<span class="mw-page-title-main">Vaginal introital laxity</span> Medical condition

Vaginal introital laxity is a symptom of pelvic floor dysfunction characterised by a sensation of looseness at vaginal external opening, also known as the vaginal introitus. Possible causes include pelvic organ prolapse (POP), post-pregnancy and vaginal delivery and menopause. Consequences may include experiencing sexual dysfunction, ranging from dyspareunia, increased vaginal “wind” to overactive bladder (OAB). These consequences may lead to adverse significant impacts on women’s sexual health, body image and quality of life. Vaginal laxity is often underreported, with approximately 80% of women not seeking treatment or discussing their concerns.

References

  1. 1 2 3 4 5 Pastor, Zlatko (2013-07-01). "Female Ejaculation Orgasm vs. Coital Incontinence: A Systematic Review". The Journal of Sexual Medicine. 10 (7): 1682–1691. doi:10.1111/jsm.12166. ISSN   1743-6109. PMID   23634659.
  2. ↑ "Cervical Mucus Monitoring | Time to Conceive". www.med.unc.edu. Retrieved 2021-12-22.
  3. ↑ "Getting wet: cervical fluid vs. arousal fluid vs. discharge". helloclue.com. Retrieved 2021-12-22.
  4. 1 2 "Cervical Mucus Monitoring | Time to Conceive". www.med.unc.edu. Retrieved 2024-09-23.
  5. ↑ Ottesen, B.; Pedersen, B.; Nielsen, J.; Dalgaard, D.; Wagner, G.; Fahrenkrug, J. (September 1987). "Vasoactive intestinal polypeptide (VIP) provokes vaginal lubrication in normal women". Peptides. 8 (5): 797–800. doi:10.1016/0196-9781(87)90061-1. PMID   3432128.
  6. ↑ Levin, Roy J (November 2003). "The ins and outs of vaginal lubrication". Sexual and Relationship Therapy. 18 (4): 509–513. doi:10.1080/14681990310001609859. ISSN   1468-1994.
  7. ↑ "SEXUALITY IN OLDER WOMEN AND THEIR PARTNERS: AGE-RELATED FACTORS THAT IMPACT SEXUAL FUNCTIONING". sexualityandu.ca. 2008. Retrieved 10 August 2010.
  8. 1 2 3 4 Mark, J. K. K.; Samsudin, S.; Looi, I.; Yuen, K. H. (2024-05-03). "Vaginal dryness: a review of current understanding and management strategies". Climacteric. 27 (3): 236–244. doi:10.1080/13697137.2024.2306892. ISSN   1369-7137. PMID   38318859.
  9. ↑ Lázaro-Carrasco de la Fuente, Jesús; Cuerva González, Marcos; González Rodríguez, Silvia; Delgado Marín, Juan Luis; Cuevas Castillo, Carmen; Nieto Magro, Concepción (2022). "Early Effect of 0.005% Estriol Vaginal Gel on Symptoms and Signs of Vulvovaginal Atrophy". Journal of Menopausal Medicine. 28 (2): 60–69. doi:10.6118/jmm.21038. ISSN   2288-6478. PMC   9452593 . PMID   36070871.
  10. ↑ Benini, Vittoria; Ruffolo, Alessandro; Casiraghi, Arianna; Degliuomini, Rebecca; Frigerio, Matteo; Braga, Andrea; Serati, Maurizio; Torella, Marco; Candiani, Massimo; Salvatore, Stefano (2022-06-06). "New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review". Medicina. 58 (6): 770. doi: 10.3390/medicina58060770 . ISSN   1648-9144. PMC   9230595 . PMID   35744033.
  11. ↑ Potter, N.; Panay, N. (2021-01-02). "Vaginal lubricants and moisturizers: a review into use, efficacy, and safety". Climacteric. 24 (1): 19–24. doi:10.1080/13697137.2020.1820478. ISSN   1369-7137. PMID   32990054.
  12. ↑ Athanasiou, Stavros; Pitsouni, Eleni; Douskos, Athanasios; Salvatore, Stefano; Loutradis, Dimitrios; Grigoriadis, Themos (February 2020). "Intravaginal energy-based devices and sexual health of female cancer survivors: a systematic review and meta-analysis". Lasers in Medical Science. 35 (1): 1–11. doi:10.1007/s10103-019-02855-9. ISSN   0268-8921. PMID   31396795.
  13. ↑ International Family Planning Perspectives, Volume 24, Number 2, June 1998, Vaginal Drying Agents and HIV Transmission by Karen E. Kun.
  14. ↑ Ray, Sunanda; Gumbo, Nyasha; Mbizvo, Michael (28 May 1996). "Local Voices: What Some Harare Men Say about Preparation for Sex". Reproductive Health Matters. 4 (7): 34–45. doi: 10.1016/s0968-8080(96)90004-x . JSTOR   3775349.
  15. 1 2 "Concern voiced over "dry sex" practices in South Africa". www.cirp.org.
  16. ↑ Hyena, Hank (10 December 1999). ""Dry sex" worsens AIDS numbers in southern Africa". Salon.
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