Original research
Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears

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Abstract

OBJECTIVE:

To test the hypothesis that lubrication of the vaginal introitus and external speculum does not adversely affect Papanicolaou interpretation.

METHOD:

One hundred eighty-two patients presenting for Papanicolaou smears as part of their visit were randomly assigned to have either only warm water or a water soluble lubricant to assist speculum insertion. Cytotechnicians and pathologists were blind to the cohort from which smears were obtained.

RESULTS:

Two unsatisfactory smears were found among 93 patients with the lubricant and two were found among 89 using only warm water. No significant difference was found using the t test for continuous variables and χ2 for categoric variables.

CONCLUSION:

Use of a water soluble lubricant on the vaginal introitus and external speculum facilitates examination with no adverse effect on Papanicolaou smear interpretation.

Section snippets

Materials and methods

The Arrowhead Regional Medical Center Institutional Review Board approved this study. Women presenting to the Arrowhead Regional Medical Center Women’s Health Clinic who would have Papanicolaou smears as part of their visits were invited to participate. Patients with known untreated cervical cancer or active bleeding were excluded. The study was carried out between July and October 1999. All patients gave informed consent and were seen by the regularly assigned residents and faculty. A

Results

After we finished studying the first 182 patients of 200 attending our clinic (91.5% participation), we reviewed our data because we realized that we rarely got an unsatisfactory reading. Therefore, we would need 10,000 patients to demonstrate some statistical but clinically meaningless difference. Demographic data regarding age, gravidity, parity, and ethnicity are shown in Table 1. No gross lubricant was seen on the slides. The low numbers of unsatisfactory slides were similar in both groups

Discussion

The move to evidence-based practice supports challenging dogma such as the avoidance of lubricant before performing a Papanicolaou smear. The ACOG technical bulletin Cervical Cytology: Evaluation and Management of Abnormalities1 falls short of condoning use of lubricant, stating that “care should be taken to avoid contaminating the slide with lubricant.” Lubrication of the introitus and speculum facilitates speculum insertion without impairing smear quality.

Patient comfort and satisfaction are

References (1)

  • Cervical cytologyEvaluation and management of abnormalities. ACOG technical bulletin no. 183

    (1993)

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