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Speculum Lubrication Does Not Affect Pap Smear Results

Findings from two studies dispel as myth a long-held belief in gynecologic practice.

Classically, gynecologists are trained to avoid lubrication of the vaginal speculum in the belief that lubrication might adversely affect Pap smear results. In these 2 studies, investigators tested this axiomatic practice.

Harer and colleagues randomly assigned 182 patients presenting for Pap smears to speculum insertion with lubrication using either warm water or 2 to 3 cc of a water-soluble lubricant. Cytopathologists were not informed of which slides were from which group of participants. Four unsatisfactory smears were found: 2 from patients in the lubricant group and 2 from patients in the warm-water group. No significant difference in Pap smear results was found.

In a similar study with similar objectives, Amies and colleagues randomized clinicians in 5 public-health family-planning clinics either to apply a water-soluble gel to the posterior blade of the speculum before insertion (2 clinics) or to use no lubricant or only water for speculum insertion (3 clinics). Of the 1440 Pap smears in which lubricant was used, 1.4% were unsatisfactory, and 90.4% were normal. Of the 1466 Pap smears in which no lubricant or water was used, 1.3% were unsatisfactory, and 90.2% were normal. These differences were not significant. Furthermore, the percentage of Pap smears with atypical squamous cells of undetermined significance, squamous intraepithelial lesions, or atypical endometrial cells did not differ significantly between the groups. At the 2 lubricant-use clinics, there were no significant differences between Pap findings in which lubricant was used and findings during the 6 months before and 6 months after use.

Comment: Clearly, these findings dispel as myth a long-held belief in gynecologic practice. Many women avoid undergoing Pap smears for fear of pain, and clinicians should make every effort to minimize the discomfort.

— Sandra Ann Carson, MD

Published in Journal Watch Women's Health December 17, 2002

Citation(s):

Harer WB et al. Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears. Obstet Gynecol 2002 Nov; 100:887-8.

• Medline abstract (Free)

Amies A-ME et al. The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis. Obstet Gynecol 2002 Nov; 100:889-92.

• Medline abstract (Free)