Aims: Discomfort during sexual activity is common after breast cancer. Vaginal estrogens are effective but commonly avoided due to systemic absorption. Despite the large commercial market for vaginal lubricants, no randomized studies have compared products.
Methods: In a randomized, double-blind, AB/BA crossover design, participants used each lubricant for four weeks. Participants completed daily sexual activity diaries. For each episode using lubricant, participants reported details of lubricant application and discomfort, as well as highest level of discomfort using a 100-mm visual analogue scale (VAS).
Results: On average, women reported 6.5 sexual episodes during water-based and 7.4 during silicone-based treatment. For nearly all episodes, participants reported using lubricant on the vulva, vagina or both. Women reported vulvar discomfort during 42.0% of episodes using water-based lubricant, and 24.8% of episodes using silicone-based lubricant (p=0.07), and vaginal discomfort during 60.0% of episodes using water-based and 47.3% of episodes using silicone-based lubricant (p=0.2). Women reported internal pain on initial penetration for 66.1% of episodes involving vaginal penetration using water-based lubricant, and 54.2% of those with silicone-based lubricant (p=0.2). The average VAS pain score was 28.03 (95% CI 20.34-35.74) per episode using water-based lubricant, and 18.56 (95% CI 12.84-24.28; p=0.05) using silicone-based (p=0.06).
Conclusions: All aspects of sexual discomfort measured with episode-based activity diaries were more common with water- than silicone-based lubricant, but no differences reached statistical significance. Sexual discomfort was very common even with lubricant use.