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The Effect of Using Water-based Gel Lubricant During a Speculum Exam On Pap Smear Results

14 August 2010


Background: Cervical cancer is a pervasive yet preventable killer. Although routine screening exams are available to aid in the early detection of cervical cancer, women often avoid getting their routine annual screening exams. One explanation of this could be due to the discomfort of speculum exams. One way to minimize the discomfort of the speculum exam is to use gel-lubricant. However, there is much debate about whether lubricant obscures pap smear results or not.

Methods: Literature search conducted using MEDLINE-Ovid, JAMA, CINAHL (EBSCOhost), Evidence-Based Medicine Reviews Multifile and Evidence-Based Resources from the Joanna Briggs Institute using the following search terms: cervical and lubricant, Pap smear and lubricant. Bibliographies of research articles were searched for additional articles. The inclusion criteria were randomized control trials and cohort studies and included articles where women were receiving routine pap smears, providers were using pap smears that were collected using slide fixative or using liquid-based pap smear collection and using water-soluble gel lubricant. Women of all ages and fertility status were included.

Results: Searches yielded seven articles that were related to the clinical question. Six of seven articles found no statistically significant difference in the rate of unsatisfactory cervical cytology samples between water lubricant and gel-lubricant. Two of those six articles also found no difference in the ability to recognize LSIL, HSIL, ASCUS, or AGCUS in gel-contaminated samples. One article found a statistically significant increase in the number of unsatisfactory samples in the experimental group. They also found that the diagnosis of insidious pathology was missed in the experimental group.

Conclusion: The use of water-based gel lubricant does not increase the rate of unsatisfactory slides and does not inhibit the ability to recognize LSIL, HSIL, ASCUS or AGCUS specimens. These findings suggest that the use of lubricant may help to increase patient adherence to these screening recommendations while not compromising test accuracy. However, the literature suggests that too much lubricant could increase the rate of satisfactory slides and potentially cause the pathologist to miss a more insidious pathology. Ultimately, the potential for minimizing discomfort, and increasing patient compliance far outweighs the cost of lubricant that clinics may incur.


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