Preferences and practices related to vaginal lubrication: Implications for microbicide acceptability and clinical testing

Background: Research on vaginal microbicides for HIV prevention is progressing rapidly; the first large-scale effectiveness trials were launched in 2004. The majority of candidate microbicides are formulated as gels, which will act as lubricants when used during sex. Preferences and practices regarding lubrication during sex, therefore, likely influence microbicide acceptability and use. Researchers seek to maximize consistent and correct use of candidate microbicides during clinical trials to enable valid estimates of product effectiveness, and if proven effective, microbicides will be widely used only if acceptable. Methods: We conducted a comprehensive literature review and interviewed 13 key informants from nine countries in Africa, Asia, Latin America, and North America. Results: We found that norms and practices regarding lubrication during sex exist in many different countries. Despite significant variation, common themes emerged. In the majority of countries, women's genital hygiene is highly valued, and women are expected to achieve a moderate amount of vaginal lubrication during sex that is neither excessive nor inadequate. Women may try to achieve this by engaging in a wide variety of vaginal practices. Conclusions: Even though some informants expressed concerns about the acceptability of lubricating microbicides in some settings, they thought that microbicides should be developed, that women and men may be willing to accept a certain level of increased lubrication in exchange for protection from HIV, and that lubricating microbicides may be considered more acceptable when perceived as genital hygiene products. Recommendations are made on how to take vaginal practices into account during clinical testing of microbicides.