Tell Me About Vaginal Hyaluronic Acid
The low down on vaginal moisturizers
A lot of people are getting really good at spotting health scams on social media, hence the rapid response to the Kourtney Kardashian “your vagina could smell better” wellness gummies. If you don’t know, consider yourself blessed. If you must know, Kourtney is simply the latest person trying to mine patriarchal shame about the vagina for profit, meaning she’s nothing but a garden variety misogynist.
But lately I’ve been getting lots of tags about Revaree due to this post from Dr. Shieva Ghofrany, an OB/GYN, from her Instagram account @biglovefiercejuju. The post looks sponsored as she has tagged the manufacturer as a partner (I don’t have any issues with that, but it’s always good to point out). I’ve had many direct messages asking if this is a sketchy product, or if it’s the real deal?
It’s not sketchy, Revaree contains hyaluronic acid, and that can help many people with vaginal dryness and other symptoms of menopause.
Before we delve into it, the many questions I’ve received about this Instagram post underscores the issue with health information and Instagram, and really all social media platforms. There are so many scams, and many scams are EVEN promoted by doctors, how to distinguish between legitimate and grift?
It’s a struggle, and I guess that’s a big reason why I do what I do here on The Vajenda.
What is a Vaginal Moisturizer?
These are products that rehydrate vaginal tissues and provide protection from friction. They’re formulated to be bioadhesive, meaning they stay on the vaginal tissue for several days, and are meant to be used regularly, whether you are planning on being sexually active or not. This is very different from lube, which is used on demand and the effects go away relatively quickly.
Vaginal moisturizers are great products, and there has been a real boom in the market. When I wrote The Vagina Bible in 2019 and reviewed these products, there were only a few and now there are many to choose from. Vaginal moisturizers can be water based, silicone based, hyaluronic acid based, or oil based. They can help vaginal itching, dryness, discomfort, and pain with sex. In some studies some of these products perform as well or almost as well as low dose vaginal estrogen. Anecdotally, many of my patients have good success with these products. The biggest issue I see is not giving them enough time to work as it can take about 4 weeks to get to the point where it feels like the moisturizer is helping.
There is a growing trend of botanical add ons with vaginal moisturizers, and I would caution people here. Each additional botanical ingredient creates a potential for irritation or interference with the active ingredient or damaging the vaginal microbiome and invariably they are unstudied. I spent some time looking at Amazon reviews for different products, and my admittedly non-scientific conclusion is that products with added botanicals have more one star reviews, and most of these reviews mention burning with the product.
There are so many moisturizers to choose from and so many vaginal estrogen and DHEA products that I’m going to do a series of posts on them. This is the first in that series and here we will address hyaluronic acid based vaginal moisturizers.
What is Hyaluronic Acid?
Hyaluronic acid is a chemical found in skin and binds water, essentially helping skin retain moisture. It seems to be the new “it” chemical in a variety of skin care products. I use a hyaluronic acid serum on my face and it seems to make my skin look more hydrated (admittedly a totally non-scientific opinion). The theory is the same with vaginal use, basically, hyaluronic acid helps draw water into cells. Hyaluronic acid can’t penetrate the skin, so any benefit is from the surface, which is why it needs to be injected when used as a filler.
There are maybe a handful of studies with vaginal hyaluronic acid, and most are small and not the best quality (this is common with many over-the-counter products). But from the data we have, hyaluronic acid performs well compared with low dose vaginal estrogen (either 25 mcg vaginal estradiol tablets or estriol cream) when it comes to dryness and discomfort. Unlike estrogen, it probably won’t restore the vaginal microbiome (the colonies of bacteria normally present in the vagina that changes during menopause without estrogen), so whether it will prevent urinary tract infections as well as vaginal estrogen isn’t known.
The over the counter products typically have lactic acid or another acidifier to help maintain a pH of around 4.0, which is optimal for vaginal health and they have other ingredients that help them be bioadhesive.
Is hyaluronic acid better than other vaginal moisturizers? In one study, a hyaluronic acid product performed as well as one with polycarbophil (Replens, which is water based), but otherwise we have very little head to head data. Until we know more, I’d say this is a personal fit and feel situation. Some people love the feel of one skin care product and others hate it. Choices here are good.
Vaginal hyaluronic acid is either formulated as a suppository or as a gel that is inserted with an applicator. Some people like the no mess of the suppository and others like the feel of the gel and the fact that the gel can also be applied to the labia. Again, options are good, and again, there are no head to head data with suppositories versus gel.
Okay, so what product to try? I’ve listed the cost of some vaginal hyaluronic acid products below that don’t have added botanicals or other possibly sketchy additional ingredients. With some products, if you sign up for a regular subscription or buy more than one package at a time the price drops a bit. I went with the cost without a subscription for uniformity. Not every product is one package/tube per month, so I also broke it down to cost per dose and assume this is one dose/application every 3 days.
Some Additional Thoughts
HYALO GYN, Vagisil, and Good Clean Love all list their ingredients prominently, but for Revaree the other ingredients are lumped together as “semi-synthetic glycerides”, which I dislike. It makes it sound more “natural” than listing the chemical names.
Good Clean Love is the only product to prominently list their pH as well as their osmolality, which they say is between 250 and 400 mOs/kg. I appreciate this as osmolality is important. Osmolality is basically the concentration of the chemicals in the product in water, and when the osmolality is higher than the normal osmolality of vaginal secretion it can theoretically be drying and products with a very high osmolality can be irritating and even damage vaginal tissues. The normal osmolality of vaginal secretions is 260-280 mOs/kg and ideally the osmolality should be < 380 mOsm/kg. Products > 1,200 mOs/kg should be avoided.
I fucking HATE Vagisil. Hate them with all my heart and soul so it PAINS ME to recommend one of their products. Read more about my hatred that burns like the fire of a thousand suns here. Vagisil is the most prominent merchant of shame when it comes to telling women that vaginas stink, and they are even trying to get teens to buy into the patriarchal mentality of vaginas being hazmat worthy and should really smell like a creamsicle. However, putting my hatred aside, the Vagisil product is reasonably priced and unlike Revaree and HYALO GYN is available at drugstores and Target etc., meaning it’s easier to pick up. The Good Clean Love brand is also available at quite a few stores for in person pick up as well.
One thing that I like about HYALO GYN is when you are on their website there is no upselling for other products. Vagisil I’ve already addressed, but Bonafide, which makes Revaree, also sells a probiotic that they market specifically for vaginal odor, and I hate that messaging. The data on probiotics is all low quality, and I’ve stopped recommending them for prevention of bacterial vaginosis given what we know and their price. It’s a lot of money to ask people to spend based on iffy studies. Good Clean Love sells wipes and a homeopathic vaginal suppository for bacterial vaginosis (you can read about that here, but simply put, homeopathy is a scam). You should also know wipes keeps me in business as a vulvar expert as they’re a common source of irritation and I regularly see problems related to their use. I’m an expert in vulvar health and I would ONLY use a wipe if I had incontinence, and then it would be to facilitate clean up of urine and/or feces when I was out of the house. Wipes can be very helpful here, but otherwise they are not necessary and often are a source of irritation. There is no vaginal swill that you need to remove with a wipe, and if those with a penis can clean up after a bowel movement just fine without a wipe, how exactly does a vagina mess that up? The message of a wipe is that having a vagina is both gross and delicate and necessitates special clean up. It’s literally the patriarchy.
How to decide which product to use?
Does a suppository or gel appeal to you?
Do you want to take the product while traveling? A suppository won’t count as liquid for your carry on.
Is price a concern, considering this is something you may need to use for decades?
Do you want to be able to buy the product in a physical store, online, or both?
And of course, one might work better for you based on their individual formulations. If you like the idea of a suppository, you could buy one box of Revaree and one of HYALO GYN and try each for one month and then switch to the other for the next so you could see if the added cost is worth it to you. It may be, but then again, it may not.
Ultimately, how these products feel and perform is very personal. Also, the bioadhesive formulas and other ingredients likely have subtle differences, so if one burns or doesn’t seem to work for you, trying another one is probably worthwhile.
Anecdotally, I have patients who love Good Clean Love BioNourish, Vagisil ProHydrate Natural Feel, and HYALO GYN. Revaree is newer I think, so I don’t have any feedback to offer. Price-wise, it’s hard to beat Good Clean Love BioNourish and I like that they list their osmolality, I just wish they wouldn’t sell wipes.
And that’s what I know about hyaluronic acid vaginal moisturizers.
dos Santos CCM, Uggioni MLR, Colonetti T, et al. Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review. J Sex Med 2021;18:156-166.
Angelo Cagnacci, Dionisio Franco Barattini, Elena Casolati et. al. Polycarbophil vaginal moisturizing gel versus hyaluronic acid gel in women affected by vaginal dryness in late menopausal transition: A prospective randomized trial. Eur J Obstet Gynecol Reprod Biol 2022 Mar;270:239-245.
Ekin M, Yasar L, Kadir S, Muzaffer T, Mehmet U, Gencer I, Kivanc E. The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis: A randomized control trial. Archiv. Gynecol. Obstet. 283(3), 539–543 (2011).
Stute, Petra. Is Vaginal Hyaluronic ACid as effective as vaginla estrogen for vaginla dryness relief? Arch Gynecol Obstet (2013) 288:1199–1201
Thank you. This is helpful. If a person is on low-dose estrogen vaginal cream can they also use a moisturizer? My gyn doesn’t think it’s necessary, but my ladybits feel otherwise.
First, I love your news letter!!! Thanks for being a voice of reason.
Second, as an OB/GYN who serves a very poor population of women, these products are all out of reach. I find the best results and the best uptake with extra virgin coconut oil both as moisturizer and lube (if not using condoms of course). thanks