The Conversation No One's Having About Lube
There is a particular kind of silence that surrounds certain women's health topics. Not the silence of ignorance exactly, but of assumption. We assume that vaginal dryness is a menopause problem. We assume that not getting wet means not being turned on. We assume that lube is a last resort, a stopgap, something you reach for when something has gone wrong. And we assume, perhaps most damagingly of all, that the products available to us are safe simply because they exist on a shelf. On almost every count, we are mistaken.
This is an attempt to clear that up, with the help of a pelvic health physiotherapist, a functional hormone nutritionist, and a founder who reviewed 47 lubricants so that you don't have to.
Who Actually Experiences This
The menopause narrative has done women a significant disservice. Yes, oestrogen decline, which typically accelerates in perimenopause, is one of the most common drivers of vaginal dryness. "Oestrogen maintains the thickness and moisture of vaginal tissue," explains Pippa Campbell, functional hormone nutritionist and founder of Pippa Campbell Health. "As levels decline, the tissue thins and lubrication reduces." But to frame this as exclusively a midlife concern is to leave a large and varied group of women without language for their experience.
Edel McCann, sexual wellness coach, pelvic health physiotherapist and clinical lead at LETO Woman in London as well as the sexual wellness coach at Vacation Vibes, sees the full picture in her clinic. "Vaginal dryness can affect people across many life stages, not just menopause. We see it in postpartum mothers, people on hormonal contraception, those breastfeeding, people undergoing cancer treatments, and even younger patients under chronic stress or with certain autoimmune conditions." Hormonal contraception is a particularly underacknowledged driver: it can reduce hormone levels in some individuals, affecting tissue hydration and elasticity, and it rarely gets flagged unless the patient raises it directly.
Campbell adds a nutritional dimension that most women are never told about. "The pill depletes nutrients that can affect vaginal tissue, zinc, magnesium and B vitamins," she explains. "Women with a long history of hormonal contraception can go into perimenopause with lower nutrient reserves, which affects how their tissues respond to hormonal changes." It is a compounding picture, quietly accumulating over years.
The postpartum window is similarly under-discussed. Low oestrogen during breastfeeding is a common and temporary cause of dryness, but because it sits in a period already saturated with other physical and emotional demands, it often goes unnamed and unaddressed.
The Arousal Myth
The assumption that not getting wet means not being aroused is one of the most persistent and damaging misconceptions in women's sexual health. It conflates a complex neurovascular process with a simple emotional signal and leaves women feeling broken when the two don't align.
"Lubrication is a neurovascular response, not a simple reflection of desire," McCann explains. "It depends on increased blood flow to vaginal tissues and activation of parasympathetic, rest and digest pathways. If that response is dulled, due to hormonal shifts, stress, pain, medications, or pelvic floor tension, the tissues simply don't produce the same fluid exchange." Desire and physical response are two separate systems. They can, and frequently do, operate independently of one another.
The nervous system plays a significant role here that rarely enters the conversation. "The pelvic sexual response is highly dependent on parasympathetic activation," McCann says. "Stress, anxiety, trauma history, or feeling emotionally unsafe can shift the body into a sympathetic, fight or flight state, which inhibits blood flow to genital tissues and reduces lubrication, even when psychological desire is present. The body is essentially prioritising safety over sexual response." Chronic stress, cognitive overload, and emotional depletion are, in this sense, directly embodied.
The pelvic floor compounds this further. McCann notes that overactivity, chronic holding and tension in the pelvic muscles can inhibit arousal responses by reducing blood flow and neural signalling to surrounding tissue. "Many people interpret this discomfort as something to push through," she says, "when it's often a sign the tissue or nervous system needs more support." Using devices or engaging in sex with insufficient lubrication in this context doesn't just cause discomfort in the moment, over time, repeated microtrauma can reinforce pain pathways and deepen the problem.
The Ingredient Problem
If the conversation around who needs lube is incomplete, the one around what's in most lubes is almost entirely absent. Lauren Short, founder of Ples J'our, spent months reviewing 47 different lubricants when she was developing her brand. What she found was not reassuring.
"When I sat down and reviewed all of the products, I was genuinely shocked. 71% of them contained harmful or toxic ingredients that shouldn't be used on such an absorbent, sensitive part of the body." The foundational issue, she explains, is that vaginal and vulvar tissue is mucosal, significantly more permeable than the skin on your arms or legs. Whatever comes into contact with it has the potential to be absorbed.
The offenders she flags most urgently are glycerin, parabens, and certain silicone compounds. Glycerin,used to give lubricant its gel-like texture, can feed candida, explaining why so many women report yeast infections after using mainstream formulations. It is also a significant contributor to what Short calls hyperosmolality. "The World Health Organization recommends water-based lubricants stay under 380 mOsm/kg to match the natural osmolality of vaginal tissue," she says, "but most mainstream brands sit between 3,000 and 9,000 mOsm/kg, up to thirty times more concentrated than your own body." The result is a product that pulls water out of your cells rather than adding to your comfort, the opposite of what it promises.
Parabens, found in a large proportion of conventional products, are endocrine disruptors that can bind to hormone receptors and interfere with regulation. Given that hormonal balance is already central to lubrication, as both McCann and Campbell make clear, introducing additional endocrine disruption into the equation is particularly counterproductive. Cyclopentasiloxane compounds (labelled D4, D5 or D6) common in silicone lubricants have been classified by the UK and EU as persistent and bioaccumulative, with ongoing questions in the research around reproductive effects.
The vaginal microbiome is another casualty of poorly formulated products. "It's a finely tuned, self-balancing ecosystem that maintains the right level of acidity and protects the environment from harmful bacteria," Short explains. Conventional lubricants can disrupt it in three main ways: the dehydrating effect of hyperosmolar formulations on the epithelial barrier and its bacterial communities; antimicrobial preservatives that kill indiscriminately; and chemical irritants like fragrance and propylene glycol that alter the local chemistry. The downstream consequences extend well beyond momentary irritation. Microbiome disruption is linked to recurrent bacterial vaginosis, recurrent yeast, increased susceptibility to UTIs and STIs, and, in emerging research, fertility outcomes.
On coconut oil, which is frequently recommended as a natural alternative, Short is measured. It is meaningfully better than a hyperosmolar product full of parabens, she concedes, but it comes with caveats: it is not latex-compatible, its lauric acid content can disrupt the vaginal microbiome in susceptible women, and its occlusive texture means it doesn't rinse out easily, trapping bacteria and moisture in ways that aren't ideal for prolonged use. Some women find it works well. Others don't. Most won't know until they try.
Short's shorthand for label-reading: look for a short ingredient list. A clean water-based lubricant can be made with under ten ingredients, sometimes fewer than six. Instant red flags include anything ending in -paraben, fragrance or parfum, propylene glycol, chlorhexidine gluconate, glycerin, and warming or tingling claims; those sensations are produced by mildly inflaming tissue.
The Nutritional Dimension
Perhaps the least expected part of this conversation is what you eat. Campbell sees the connection between nutrition and vaginal tissue health as consistently underestimated and backed by evidence that most women never encounter.
"Vitamin E has the strongest direct evidence for vaginal tissue health and lubrication," she says. "Vitamin A keeps epithelial cells functioning well. Zinc supports tissue repair." The omega fatty acids we associate with skin hydration work by the same mechanism for mucosal tissue, oily fish and evening primrose oil both have evidence for supporting moisture at the cellular level. Cruciferous vegetables, broccoli, rocket, cauliflower all support healthy oestrogen metabolism. Fermented foods feed the gut microbiome, which in turn influences the hormonal environment that vaginal tissue depends on.
Phytoestrogens are worth particular attention. "Flaxseed and fermented soy contain phytoestrogens that help maintain moisture in vaginal tissue," Campbell notes, "and legumes provide both fibre and phytoestrogen support." These aren't dramatic interventions but they're the kind of foundational dietary patterns that quietly maintain the hormonal and tissue environment over time.
Hydration matters, but Campbell is careful not to oversimplify. "Oestrogen decline is the primary driver of vaginal dryness in perimenopause and water alone does not compensate for that." Electrolyte balance, magnesium, sodium, potassium, is as relevant as fluid intake. Women can be drinking enough water and still have dry mucous membranes if those minerals are depleted.
When to Seek Help
McCann is direct: persistent dryness that is painful, recurring, or affecting quality of life warrants professional support rather than patient acceptance. "In some cases, dryness may be linked to underlying skin conditions such as lichen sclerosus or lichen planus, which require very different treatment approaches." A GP is the right first step, with onward referral to a gynaecologist to rule out hormonal or medical causes. Specialist vulval dermatologists, dedicated vulval clinics, and pelvic health physiotherapists can all contribute, often most effectively working in combination.
The wider point is this: lube is not a last resort, and needing it says nothing about desire, arousal, or the adequacy of a sexual experience. At its best, it is a considered, informed choice, one that deserves the same intelligence and scrutiny we're increasingly bringing to everything else we put on, and in, our bodies. The conversation has been quiet for too long.
Words by Eleanor Hoath for The Well Edit with experts Edel McCann, Lauren Short and Pippa Campbell
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