We conducted a scoping review following the Arksey and O’Malley framework.1 Our search strategy included MEDLINE, PubMed, Google, Google Scholar, UpToDate, and manual reference screening for white and grey literature published from 2003 to 2024. Sources were manually reviewed using the following inclusion criteria: identifies patient populations most likely to benefit from lubricant use during sexual activity, addresses benefits and drawbacks of different lubricant classes, or describes properties of, or ingredients in, lubricants that may cause harm. We had no restrictions for study participants (ie, geographic location, age, gender, sexual orientation, or type of sexual activity). Commercially funded work was excluded.

Fifty-three sources met inclusion criteria. Data on product accessibility, cost, and ingredients were collected through systematic online and in-person market research. We received feedback from family physicians, gynecologists, psychologists specializing in sexual concerns, and sexual health educators during manuscript development.

People of all ages, genders, and sexual orientations use, or are open to using, lubricants during sexual activity to enhance comfort and enjoyment.2-4 Using lubricants during sexual activity offers several benefits, including managing dryness, dyspareunia, and symptoms of sexual dysfunction.2-4 Condom-compatible lubricants can also reduce friction and the risk of condom tears, potentially reducing STIs and unplanned pregnancy.3,5

Genital dryness, dyspareunia, and sexual dysfunction are common concerns in primary care.6 However, the personal nature of sexual health, combined with fear of stigma associated with diverse sexual practices, often hinders important discussions between patients and health care providers (HCPs).7 Some clinicians may also avoid exploring sexual concerns, perceiving them as either irrelevant or outside their scope of practice. To deliver comprehensive, patient-centred care, HCPs should adopt an inclusive, non-judgmental, trauma-informed approach with all patients when engaging in conversations about sexual health.

If concerns regarding genital dryness, dyspareunia, or sexual dysfunction arise, a targeted history and physical examination (including a pelvic or anal examination) should be performed, alongside relevant investigations, to establish a diagnosis. HCPs should offer multimodal management options tailored to the patient’s diagnosis and preferences. These may include psychotherapy, pelvic floor physiotherapy, initiation of pharmacotherapy, or adjustments to existing medications—in addition to recommending lubricant use during sexual activity. However, there is a dearth of accessible, evidence-based tools to help clinicians identify commercially available lubricants and advise patients on how to use them properly. Consequently, HCPs encounter another barrier in their capacity to counsel patients on using lubricants for sexual activity. This review bridges this gap by offering a clinical resource to guide patient-centred discussions about how lubricants can improve sexual well-being.

Individuals most likely to benefit from lubricant use during sexual activity. Lubricant use during sexual activity particularly benefits patients experiencing genital dryness, irritation, superficial dyspareunia (ie, vaginal, anal, or penile pain during intercourse), or sexual dysfunction.2,4,8 These are common complaints, particularly for patients with associated factors (Table 1).9-34 Current evidence indicates that vaginal dryness affects up to 15% of premenopausal and 90% of postmenopausal women, while approximately two-thirds of women will experience dyspareunia during their lifetime.8,17 Vulvodynia, a major cause of superficial (entry) vaginal dyspareunia, has a reported incidence rate of 17%.17 Among men in a sexual minority, anal-receptive dyspareunia shows a point prevalence of 14% and lifetime prevalence of 61%.12 To better identify and address these concerns, clinicians should routinely assess lubricant use when obtaining a sexual history from patients with the factors listed in Table 1.9-34

Patient factors associated with a higher prevalence of genital symptoms (dryness, irritation, or superficial vaginal, anal, penile dyspareunia) in relation to type of sexual intercourse

Classes of lubricants used for sexual activity. Lubricants are categorized into 3 main classes based on their formulation: oil-based, including both petroleum and natural oils, silicone-based, and water-based. Table 2 outlines the key features of each class and lists commonly available lubricants in Canada by brand name and cost.4-6,18,35-48

Comparison of the features of oil-, silicone-, and water-based lubricants, including formulation pros and cons, cost or accessibility, and examples of lubricants available in Canada

Water-based lubricants are compatible with all materials found in items commonly used in the genital area, whereas oil- and silicone-based lubricants are incompatible with certain materials (Table 3).5,6,35,39,49-51 For instance, oil-based lubricants can damage latex items such as condoms, and silicone-based lubricants can degrade silicone-containing devices, including sex toys, menstrual cups, and pessaries.6,39,50,51

Compatibility of oil-, silicone-, and water-based lubricants with various materials present in items commonly used in the genital area: This table summarizes general recommendations only. Many items designed for genital use are unregulated and their material composition may be unavailable to consumers. To determine lubricant compatibility, it is important to consult manufacturer information when possible.

Oil-based lubricants are commonly used during sexual activity, and HCPs frequently recommend them despite limited evidence evaluating their effects. Evidence suggests some oil-based lubricants can irritate the genital epithelium and disrupt genital microbiota.4,6,18,36-38 Multiple clinical studies have linked petroleum jelly to an increased risk of bacterial vaginosis, while recent data indicate that baby oil may increase the risk of vaginal candidiasis.36-38 The literature on the effects of coconut oil on genital and urogenital microbiota in vitro presents mixed findings, and evidence regarding its impact in vivo remains scarce.52,53 Oil-based lubricants are also difficult to clean, posing a nuisance and potentially increasing infection risk.

For patients who use latex condoms or who experience recurrent vaginal infections or irritation, the authors recommend the use of silicone- or water-based lubricants—which are free of harmful ingredients and within recommended osmolality and pH levels outlined in the next section—rather than oil-based lubricants.

Clinicians should review the characteristics of each of the 3 lubricant classes (Table 2)4-6,18,35-48 and inquire about the devices their patients use in the genital area (Table 3)5,6,35,39,49-51 to help them choose an appropriate lubricant.

Additives, osmolality, pH, and fertility. Certain water-based lubricant formulations can damage or irritate the genital epithelium or disrupt urogenital microbiota, increasing the risk of STIs and urogenital infections (eg, bacterial vaginosis, candidiasis, and urinary tract infections).18,40,43 Patients experiencing irritation or frequent urogenital infections should avoid lubricants containing certain ingredients including glycols (eg, glycerine or glycerol, propylene glycol, and polyethylene glycol–8 [PEG-8]), parabens (eg, methylparaben, propylparaben, and butylparaben), chlorhexidine, and spermicides (eg, nonoxynol-9).5,7,18,40 In addition, these patients should also avoid lubricants containing colour or dyes, fragrance, flavour (with nutritive sweeteners such as glucose and sucrose), as well as products with warming, stimulating, or numbing and desensitizing properties.6,18,41,42

Water-based lubricants should have an osmolality of less than 380 mOsm/kg (or <1200 mOsm/kg if options are limited) and a pH of approximately 4.0 to 4.5 for vaginal intercourse, or 5.5 to 7.0 for anal intercourse.5,40 Although these values are typically unavailable to consumers, avoiding glycols can help achieve more physiologically appropriate osmolality levels.5Table 2 lists examples and prices of silicone-based, water-based, and silicone-water hybrid formulations available in Canada.4-6,18,35-48 These formulations do not contain the aforementioned additives or properties, and they follow the recommended osmolality and pH ranges.

Most lubricants adversely affect sperm motility and viability, so individuals experiencing challenges with infertility may wish to avoid lubricants entirely.18 However, for people trying to conceive who prefer using lubricants, fertility-friendly options—namely those with a pH between 7.2 and 8.5, osmolality of 270 to 360 mOsm/kg, and without glycerine or glycerol—are recommended (Table 2).4-6,18,35-48