Does Gel Affect Cytology or Comfort in the Screening Papanicolaou Smear?

Abstract

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...

Association of Speculum Lubrication with Pain and Papanicolaou Test Accuracy

“…Because our study group included a relatively high number of postmenopausal women, the overall significant effect of gel application can be explained by the effectiveness in this subgroup. The reason for the nonsignificant results of Gilson et al 13 in discomfort rating regarding lubricant gel use may be the low number of postmenopausal women in their study (the group included 10 postmenopausal and 60 premenopausal women).…”

“…In the study by Gilson et al, 13 a numeric pain scale was used to investigate the discomfort level of patients. They used a dry speculum to obtain Pa- panicolaou test specimens in 70 patients.…”

Effects of Gel Lubricant on Cervical Cytology

“…[4][5][6][7] However, it has also been shown that lubrication of the external surfaces of the speculum blades with a small amount of gel does not significantly reduce patient discomfort during speculum examination. 8 Although increasing the amount of gel lubricant should reduce the discomfort associated with speculum insertion, data are lacking concerning the effects on the Pap smear from contamination of the cervix by greater than normal amounts of gel lubricant. The aim of this study was to explore those effects by determining the proportion of unsatisfactory Pap smears and the discordance in diagnoses between gel-contaminated smears and uncontaminated smears from the same patients.…”

Impact of Bimanual Vaginal Examination on Pap Smear Test Results

“…They found that it had no negative effect on the cytological evaluation of cervicovaginal smear, and that stated that it might be used for the comfort of the patient if she chooses (9). Moreover, it was proposed that bimanual examination could be carried out by using gel if the cervix was not visible with a speculum (9).…”