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Here’s the sitch: Lubricant use among men who have sex with men (MSM) is a growing need here in the U.S. Not only can lubricants decrease cell wall damage (score), it can ease those pesky concerns about the condom breaking. Without the use of lube you start to work your way down a not-so-slippery (pun intended) slope.
Lubricants & Condom Breakage
Research suggests that the use of additional water-based lubricants is pretty darn important for anal intercourse. Here's why: The risk of condom breakage during this type of intercourse is high...and nobody wants that. In one study, when a water-based lubricant was used alongside a lubricated condom, the breakage rate was 3% whereas it was 21.4% when no additional lubricant was used. Lesson learned? Water-based lubricants are better at preventing breakage than no lube at all. Plain and simple.
Safety Issues of Lubricants Among MSM
Sex without lubrication can damage the epithelium (the epithelium is the thin membrane of mucosal cells lining the rectum, anus, mouth, nose and vagina). That’s a major issue; the epithelium keeps the vast majority of unfriendly bacteria, fungi and viruses out of the body. And if this tissue is damaged, the epithelial cells and the chemical bonds that hold them together can fray, causing the protective system to break down.
Now this is an easy fix, because more moisture prevents epithelial cell damage during rectal and vaginal intercourse. But here’s the tricky part: Several recent studies suggest that instead of protecting epithelial cells, the formulation of certain lubricants may actually compromise the integrity of the cells. Hyperosmolar lubricants – those with a high concentration of glycol - can also cause epithelial damage to occur. Particularly relevant to MSM, the effect of hyperosmolity has been shown to be more damaging when lubricants are used rectally. The problem with epithelial damage is the increased risk of infection – particularly HIV and STIs.
Polyquarternium is a group of chemicals commonly found in personal care products. It is of concern for lubricants because a study conducted by the Population Council found that four lubricants (Astroglide Liquid, Astroglide Warming Liquid, Astroglide Glycerin & Paraben-free Liquid and Astroglide Silken Secret) with a common ingredient of polyquaternium significantly enhanced HIV-1 replication when compared with other lubricants in the study that did not contain polyquarternium compounds. The WHO has recommended that polyquaternium is best avoided in personal lubricants, particularly in products intended for use by high-risk populations.
Rectal pH :
The rectum has a fairly neutral pH of 7. Higher pH levels are more supportive of HIV survival, so the WHO recommends a rectal lubricant of about 5.5 to 7 for rectal use. However, because of the different optimal pH level in the vagina, lubricants for vaginal use should be about 4.5. To reconcile the difference, the WHO recommends all lubricants to be formulated with a pH of 7 or less, which also maximizes the preservation of water-based lubricants.
How Does This Apply to You?
While the scientific babble and numbers may seem confusing or may be hard to digest, the information is critical to both your overall health and your sexual health. Important enough that they should impact your purchases when it comes to buying lube: You should try to purchase lubricants of pH 7 or less, the glycerol concentration of the lubricants you purchase should not exceed 9.9% mass fraction, and you should use water-based lubricants to decrease chances of condom breakage and epithelial damage.
 Golombok R, Harding R, Sheldon J. An evaluation of a thicker verses standard condom with gay men. AIDS, 2001, 15:245- 250.
 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; 195:703–710.
 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 Research and Human Retroviruses, 2011, 27(9):1019-1024.
 2012 Advisory Note: "Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360.”