Purpose: Current medical training recommends obtaining cervical cytological specimens without the use of lubricating gel. The purpose of this study was to determine whether water-soluble lubricant gel affects cytologic outcomes in the screening Papanicolaou smear and patient comfort during vaginal speculum examination.Methods: The study was a randomized controlled trial performed at David Grant US Air Force Medical Center (Travis Air Force Base, CA). Participants were female patients at least 18 years old presenting for an annual Papanicolaou smear. Each patient, blinded to group assignment, consented to two consecutive Papanicolaou smears. The first Papanicolaou smear was performed without gel in all subjects as part of the "standard of care." Thirty control patients underwent a second examination with no gel, and 40 other patients had the second examination with gel. All patients rated the discomfort of each Papanicolaou smear on a numerical pain scale. Main outcome measures were cytologic discrepancies on standard glass slide samples and comfort differences regarding the use of gel lubrication. Fisher's exact test was used to interpret the effect of gel on cytology results. Student's t test was performed to compare the discomfort ratings for the second Papanicolaou smear in the GEL vs. the NO GEL groups.Results: There was no statistically significant difference between the number of inadequate Papanicolaou smears (P ‫؍‬ .50) nor in the discomfort level ratings in the GEL vs. the NO GEL groups (P ‫؍‬ .69). Conclusion: Speculum gel lubrication does not affect cervical cytology during the traditional Papanicolaou smear, nor does it provide significant alteration of patient discomfort. (J Am Board Fam Med 2006;19:340 -4.)The Papanicolaou smear is an effective and wellaccepted screening examination for the early detection of cervical cellular abnormalities. It has significantly decreased the morbidity and mortality from cervical cancer and is now a standard part of preventive health care for women of reproductive age.1,2 It is therefore important to get the most accurate and reliable cell specimens by using proper techniques.Despite its clinical importance, the Papanicolaou smear examination can be an awkward and unpleasant experience for many women. Physicians should thus be sensitive to this issue and take measures to make the smear as comfortable as possible for the patient.In medical training, students/residents are taught never to use water-soluble gel to lubricate the speculum in the collection process. 4,5 The presumable theory behind this teaching is that the gel may obscure the cellular preparation via gel overlay or altered uptake of dye in staining. However, a lack of literature exists to support this dogma, and recent literature refutes it. 6,7 Discussion with colleagues shows that many feel the use of gel lubricant allows for easier entry of the speculum into the vagina and that it is more comfortable for the patient.The goals of the current study were to formally investigate whether gel obscures cerv...

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