HOME HELP CONTACT US FEEDBACK SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Related articles in CFP Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tsang, N. Articles by Osmun, W.E. Search for Related Content PubMed PubMed Citation Articles by Tsang, N. Articles by Osmun, W.E.

Smear tactics

A more comfortable Papanicolaou test

Papanicolaou tests are basic procedures in a woman’s preventive care. Cervical screening is meant to evaluate recognizable precancerous lesions that are treatable if detected early. It is recommended that all sexually active women be initially screened annually for 3 normal results, then every 3 years until 3 normal results are obtained after menopause.

Problem

Fear of pain has been found to bar adolescent women from attending for a Pap test.¹ It is important to make patients feel as comfortable as possible for what can be an intrusive and uncomfortable procedure.

Question

It has long been taught that lubricant should not be used to gather the specimen, as lubrication was thought to interfere with the quality of the specimen. It was recommended that the speculum be warmed and lubricated with water only.² However, it has been the experience at our clinic that metal speculums without lubricant increased the patient’s discomfort. A straw poll revealed that most of the clinic’s physicians had begun using small amounts of lubricant despite what they had been taught. None of them had had specimens returned as being unsatisfactory because of this practice. As such, we reviewed literature to find support for what had become our standard of care. Does lubrication interfere with the quality of the specimen?

Literature review

We found 4 studies in the literature that supported our practice and none that did not. Patients were randomized in 1 study to either gel or water at the time of presentation.³ In a Texan study, speculums were lubricated depending on the month,⁴ which was randomly selected. In another study, different clinics were randomized to use gel or water as a lubricant.⁵ One study left the choice of lubrication to the attending physician.⁶ A recent study examined the specimen quality with gel versus water, as well as patient discomfort.⁷ In all studies, the pathologists were blinded to whether gel or water was being used.

The number of slides analyzed varied: 182 (Harer et al),³ 3460 (Griffith et al),⁴ 8534 (Amies et al),⁵ 615 (Tavernier et al),⁶ and 70 (Gilson et al).⁷ No study found any differences in the slide results. In addition, the study by Griffith et al looked at the result of testing for Chlamydia trachomatis and Neisseria gonorrhea. No difference was found for C trachomatis results. Unfortunately, the numbers for N gonorrhea were too small to analyze.

In the study by Gilson et al, the only paper that looked at discomfort levels,⁷ no difference was found in discomfort scores with the use of gel. However, the numbers were low in this study and the Pap test was performed twice, initially with water only and then the patients were examined again with gel or water as a lubricant. As well, there were small numbers of postmenopausal patients.

Conclusion

Both our experience and the literature support lubricating speculums with a dime-sized spot of gel in the performance of Pap tests. While it is our feeling that this practice decreases discomfort for the patient, a recent paper found that the use of gel did not reduce discomfort or pain during the procedure. Further study needs to be done. However, clinicians can be reassured that the use of gel does not adversely affect specimen quality.

References

1. Kahn JA, Chiou V, Allen JD, Goodman E, Perlman SE, Emans SJ. Beliefs about Papanicolaou smears and compliance with Papanicolaou smear follow-up in adolescents. Arch Pediatr Adolesc Med 1999;153(10):1046-54.[Abstract/Free Full Text]
2. Hacker NF, Moore HJ, Gambone JC. Essentials of obstetrics and gynecology. 4 ed. Philadelphia, Pa: WB Saunders Ltd; 2004. p. 14.
3. Harer WB, Valenzuela G Jr, Lebo D. Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears. Obstet Gynecol 2002;100:887-8.[Medline]
4. Griffith WF, Stuart GS, Gluck KL, Heartwell SF. Vaginal speculum lubrication and its effects on cervical cytology and microbiology. Contraception 2005;72(1):60-4.[Medline]
5. Amies AE, Miller L, Lee S, Koutsky L. The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis. Obstet Gynecol 2002;100:889-92.[Medline]
6. Tavernier LA, Connor PD, Gates D. Water vs gel lubrication for cervical cytology specimens. J Fam Pract 2003;52(9):701-4.[Medline]
7. Gilson M, Desai A, Cardoza-Favarato G, Vroman P, Thornton JA. Does gel affect cytology or comfort in the screening Papanicolaou smear? J Am Board Fam Med 2006;19(4):340-4.[Abstract/Free Full Text]

Related articles in CFP:

Changing fear

Diane Kelsall
CFP 2007 53: 791. [Full Text]  

Changer la peur

Diane Kelsall
CFP 2007 53: 791. [Full Text]  

This article has been cited by other articles:

				S. Lofsky and R. Howlett Rules of engagement Can Fam Physician, November 1, 2007; 53(11): 1883 - 1884. [Full Text] [PDF]

This Article Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Related articles in CFP Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tsang, N. Articles by Osmun, W.E. Search for Related Content PubMed PubMed Citation Articles by Tsang, N. Articles by Osmun, W.E.