(158) Hyperosmolar Lubricants Increase Risk of Bacterial Vaginosis and Lower Sexual Arousal in Sexually Active Women

Abstract Introduction Increasing sexual frequency is a well-known risk factor for bacterial vaginosis (BV), as the vaginal microbiome is repeatedly challenged and potentially disrupted. Many women turn to lubricants to manage the vaginal irritation and pain with penetration that commonly occur with BV. However, if lubricants exacerbate BV risk and increase vaginal irritation, they may over time condition women’s bodies to respond with lower arousal and potentially contribute to development of sexual dysfunction. Objective To test effects of lubricant composition on BV risk and sexual arousal in sexually active women. Methods Data were drawn from an ongoing randomized controlled trial; present analyses included 67 healthy premenopausal women with complete data on variables of interest. Participants completed three lab visits in which samples of their cervicovaginal fluid were collected, and at which they reported subjective arousal to an erotic film. At session 1, all participants received a probiotic kit that they used for three weeks to stabilize their vaginal microbiome. At session 2, participants were randomized to either an iso-osmolar or hyper-osmolar lubricant and instructed to use this product during partnered sex at least three times a week. Using a multiplex polymerase chain reaction (PCR) assay, we assessed presence of four microbial species in cervicovaginal fluid samples: BVAB1, BVAB2, Gardnerella vaginalis, and Atopobium vaginae. Scores on the PCR multiplex were summed to characterize BV risk (0 = no BV species, low risk; 4 = multiple BV species, high risk). We conducted repeated measures linear mixed models to test effects of randomized lubricant group on change in BV risk and change in subjective sexual arousal over time. Results There was a significant effect of treatment group on change in BV risk over time (B = 1.15, SE = 0.43, p = 0.007), and a marginally significant effect on change in self-reported sexual arousal (B = -2.37, SE = 1.22, p = 0.051). Follow-up specific contrasts revealed that among women assigned to the iso-osmolar lubricant condition, neither BV risk nor subjective sexual arousal substantially varied in response to increased sexual frequency. However, among women assigned to the hyperosmolar lubricant condition, following treatment assignment there was a significant increase in BV risk and parallel decrease in subjective sexual arousal. Conclusions Our findings suggest that iso-osmolar lubricants may protect against BV risk as women increase their frequency of partnered sex, while use of hyper-osmolar lubricants may increase BV risk. In turn, greater vaginal irritation and pain associated with BV may contribute to lower subjective sexual arousal over time in women who use hyperosmolar lubricants. Further work is needed to clarify the mechanism of these effects, and to assess generalizability to other populations (eg, postmenopausal women). Disclosure Yes, this is sponsored by industry/sponsor: Vaginal Biome Science (VBS). Clarification: Industry funding only - investigator initiated and executed study.