Original research
The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis1 ,

https://doi.org/10.1016/S0029-7844(02)02348-7Get rights and content

Abstract

OBJECTIVE:

Nonlubricated plastic specula can adhere to the vaginal introitus and cause discomfort with pelvic examination. We wanted to see if application of water-soluble gel lubricant to the plastic vaginal speculum would change the unsatisfactory cervical cytology diagnosis rate.

METHODS:

Five public health family planning clinic sites were randomized to either water-soluble gel or water only as lubricant during speculum examination for cervical cytology collection. The pathologists were unaware of the assignment of lubricant use. The cumulative rates of cervical cytology diagnoses were calculated for 6 months before, 6 months during, and 6 months after the intervention.

RESULTS:

From July 1998 through December 1999, 8534 Papanicolaou smears were collected, with 1440 using gel lubrication from January 1999 through June 1999. Rates of unsatisfactory smears for lubricant use clinics were 1.4% during use of lubricant and 1.4% without use (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.6, 1.8). Rates of unsatisfactory smears for lubricant use versus nonlubricant use clinics during the gel intervention period were 1.4% versus 1.3% (OR 1.1; 95% CI 0.6, 2.0). There were no significant differences for the rates of atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or atypical glandular cells of undetermined significance within or between lubricant and nonlubricant clinics for each 6-month period. There were no cases of invasive cancer.

CONCLUSION:

The use of a small amount of water-soluble gel lubricant on the outer inferior blade of the plastic vaginal speculum does not change cervical cytology results in a young, reproductive-age population.

Section snippets

Materials and methods

Approval for the study was granted by the institutional review board of the University of Washington. The study was conducted from July 1998 through December 1999 at five Public Health Seattle King County family planning clinics. The clinics were randomized by drawing names from an envelope labeled for assignment to either water-soluble gel lubricant or no lubricant except tap water for all speculum examinations for cervical cytology specimen collection during the intervention period. The sites

Results

Results of a review of MEDLINE during January 1998 back to 1966 using the key words “gel,” “speculum,” “lubrication,” “Pap smear,” “cervical cytology,” and “pelvic exam” revealed only one study12 assessing the effect of gel lubrication on Papanicolaou smear interpretation. A total of 8534 Papanicolaou smears were collected from all five clinics during the entire study period. From July 1, 1998 to December 31, 1998 and from July 1, 1999 to December 31, 1999, 5628 Papanicolaou smears were

Discussion

The Bethesda system requires that Papanicolaou preparations must include enough cells to cover 10% of a slide.13 If 75% of the epithelial cells are obscured by blood, inflammation, or artifact, the slide is considered unsatisfactory. Multiple variables have been studied and have been shown to affect the rate of unsatisfactory smears, including: presence of menses, hormonal contraceptive use,14 genital atrophy,15 use of the cytobrush,16 experience of the provider,17, 18, 19, 20 individual

References (21)

There are more references available in the full text version of this article.

Cited by (0)

LK and S-KL received funding support from the National Institutes of Health (grants CA34493 and AI38383).

1

The authors thank the Public Health Seattle King County Family Planning Program for its invaluable assistance.

View full text