WASHINGTON — Gel lubrication to ease the pain of vaginal speculum insertion does not adversely affect the quality or viability of cervical samples, William Griffith, M.D., reported at the annual meeting of the Association of Reproductive Health Professionals.
The results of his randomized study of 3,460 Pap smears and 5,535 combination DNA probe assays appear to refute dogma long etched in textbooks that warns clinicians to beware of gel lubrication because of purported interference with cervical microbiology or with interpretation of a Pap smear.
The study found no statistically significant difference in the integrity of samples when vaginal insertion was aided by a dime-sized dab of a water-soluble bacteriostatic gel lubricant, compared with samples in which water was used as a lubricant, Dr. Griffith of the University of Texas Southwestern Medical Center in Dallas said.
He cited data suggesting that the pain of speculum insertion may lead women to delay pelvic exams—87% reporting it a “significant barrier”—and called for efforts to minimize that pain. Dr. Griffith said he had no financial interest in the bacteriostatic gel product.
The study included 9,500 women, 20-44 years old, who underwent pelvic examinations involving a vaginal speculum from July 2003 to February 2004 at a rural family planning clinic. Each of the 8 months was randomly designated as a “gel month” or a “water month,” and the assigned lubrication method was used on all patients that month. A total of 6,538 women had a Pap smear or a DNA assay to screen for sexually transmitted disease, or both.
There were 20 unsatisfactory Pap smear samples among 1,828 women screened during the gel months (1·1%), compared with 24 unsatisfactory samples among 1,632 women screened during the water lubricant months (1·5%). The difference between groups was not statistically significant.
In addition, the type of speculum lubricant did not affect chlamydia and gonorrhea detection rates.
Chlamydia was detected in 44 of 2,909 patients (1·5%) screened by combination DNA probe during the gel months and 28 of 2,626 patients (1·1%) screened during the water months, resulting in equal detection rates.
Gonorrhea detection rates were also similar: No cases of gonorrhea were detected among patients examined during the gel lubricant months, compared with 3 (0·1%) during the water lubrication months.