Tuesday, December 30, 2008

Lubrication, Lubrication

Lubrication is perhaps the most important part of any form of play involving bodily orifices.  There is the do-it-yourself type of lubrication often employed by those who are beginning to experiment with various forms of sexual play, or those who are too embarrassed to visit the local drugstore or sex shop.  Generally speaking, this kind of lubrication is not recommended as it can either present the risk of introducing foreign substances into the body, cause irritation, or even injury - in fact I have seen one man try and use lithium grease!  

Some examples of homemade lubrication include:
  • Unsalted Butter
  • Crisco Shortening
  • Vaseline or petroleum jelly
  • Baby oil or mineral oil
Over the years, the wife and I have tried just about every conceivable lubricant on the market - some have stood the test of time, while some have come and gone.  Out of the ones we have tried, I will break them down into two groups: Drugstore/medical brands which are FDA approved, and Sex shop brands.  Both are generally safe, and each has their merits and drawbacks.  Generally, a good lubricant is suitable for all forms of play.

Speaking, most drugstore/medical brands are water-based, and wash off easily with water.  They contain ingredients which are for the most part benign, though some brands contain chlorohexine gluconate as a perservative.  Frequent use can present a problem for some women as glycerin can lead to vaginal yeast infections if used too frequently.  In terms of consistency, most are good for both vaginal and anal play.  Brands which can be found at your local pharmacy include:
  • K-Y
  • Surgilube
  • Taro Gel
  • Lubafax
The other category is adult store brands, some of which are sold in various pharmacies.  These vary greatly in terms of formulation, and consistency - which can be broken down into three subgroups - Water based, oil based, and silicone based.  In my opinion, I would avoid all oil based lubricants like the plague as they can coat the anus or vagina, and disrupt the natural processes.  Most silicone based lubricants are extremely slippery, but they suffer the drawback of being way too thin - for erotic massage they work fine however.  Another concern with short chain silicones is whether or not they have the ability to enter the bloodstream which has been subjected to debate although cimethicone is used in various FDA approved stomach remedies.  The only silicone based lubricant which I have found to be of adequate consistency is Pjur Original Gel Bodyglide.

The water-based category merits an explanation in itself.  This category comes in forms ranging from liquid to gel, and comes in flavors as well.  The water based lubricants are the safest category, and the most commonly used.  The general rule is - the thicker the better.  I have found that some brands do not keep their lubricity well with body heat, or break down easily with friction.  My top recommendations, are in the following order:
  1. Sex Grease
  2. Slippery Stuff Gel (Glycerin Free)
  3. Doc's Ultra Lube
  4. Colt Slick
  5. Adam & Eve Signature Lube
Brands which we have tried, and are simply absolute rubbish include:
  1. Maximus (Breaks down with friction and body heat)
  2. ID Glide
  3. System Jo products
  4. Moist
  5. Elbow Grease
There is also the category of lubricants with added ingredients, such as de-sensitizing  and warming gels.  Most de-sensitizing formulations contain benzocaine, which is good for introductory play, but often blunt the pleasure associated with BDSM play.  On the other hand, there are a number of warming formulations available, and most work very well for vaginal use.  I have yet to find any commercially available products good for anal use since the K-Y warming gel was reformulated without lactic acid two years ago - instead it contains propylene glycol which the body converts to lactic acid.  There are some products which contain menthol, however the concentration is too low to have an effect.  This is where I find that someone could come and fill an unmet need and such a product could be formulated with a non-toxic mild organic acid and/or menthol.  In medical litterature I came across a woman using Ben Gay and Vicks for this purpose - Not recommended!  Methyl Salicyclate and especially Camphor should never be taken internally as they can cause liver damage!

BDSM Safety 101

BDSM is a complex acronym that is often referred to as bondage, domination, and sadomasochism.  It encompasses a wide variety of activities, or "scenes" - dominance, submission, discipline, punishment, bondage, sexual roleplaying, sexual fetishism, sadomasochism, and power exchange.  Unlike sexual abuse, BDSM must always be safe, sane, and consensual.  

Sexual behavior can be placed on a continuum ranging from chastity, vanilla sex, all the way to edgeplay on the opposite end of the spectrum.  Edgeplay is perhaps what concerns me the most as an emergency medicine physician.  It can be separated into two categories: 
1. Edgeplay that poses an immediate risk of permanent harm or death.
2. Edgeplay that poses a delayed risk of permanent harm or death

The topic I am going to discuss first is the form that presents an immediate risk of permanent harm or death. In my career as an emergency medicine physician I have seen and treated examples of all the various forms of edgeplay mentioned below, with life altering consequences for the patient, and one death in the case of Breath play.  In several cases, it resulted in a trip to the operating room, followed by a hospital stay.  Examples of such play are:
  • Breathplay - poses a risk of asphyxiation
  • Castration - risk of hemorrhaging to death
  • Gunplay - the risk of accidental discharge
  • Penectomy - risk of hemorrhaging to death
  • Knifeplay and Cutting
  • Tongue splitting
  • Fire play
The second category of Edgeplay deals with a delayed risk of permanent injury or death.  Usually, in this case, patients present themselves to their primary care physician, or at the emergency room days or even years after engaging in dangerous sexual activity.  It frequently presents itself in the form of an infection, or some form of functional impairment.  Examples of this can include:
  • Extreme piercing
  • Urethral re-routes
  • Amputations
  • Scrotal suspension
These forms of edgeplay should never be part of any sane consensual BDSM scene - they are unsafe in any circumstance.  Only persons with adequate medical training know the locations of major blood vessels, and how to control bleeding.  Most individuals are also not trained on adequate sterilization techniques, making everything from bacterial infections to HIV in the realm of possibility.