Effect of Lubricant Use on Cervicovaginal Cytology – What's the Evidence?

To determine if the use of lubricating gel on the speculum during the cervicovaginal cytology examination interferes with the results obtained, as well as whether it reduces reported discomfort in patients.

Data sources

A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, with a search in the Pubmed/Medline, Scielo, Cochrane Library, Embase databases of articles published between January 2011 and May 2022. The keywords used were cytology, speculum, lubricant, result, and pain.

Selection of studies

The initial search resulted in 306 articles, of which were excluded three because they were duplicates, 257 after reading the title and abstract and 41 after reading the full text. Thus, five articles were selected for the study: four randomized clinical trials and one metanalysis.

Data collection

The selection of articles was performed by two investigators. The 5 selected articles were read in full and submitted to a comparative analysis.

Data synthesis

Screening through cervicovaginal cytology allows for early diagnosis and reduction of associated mortality, but the procedure can be associated with pain. A small amount of aqueous lubricating gel in the speculum can be used to reduce the discomfort associated with performing cervicovaginal cytology.

Conclusion

The use of lubricating gel in the speculum does not seem to be associated with a change in the cytology result and reduces the discomfort associated with its insertion into the vagina.

Keywords
Cytology; Speculum; Lubricant; Result; Pain

Ref	E	Target population and study design	Results/Conclusions	Limitations	EL
1	RCT	Aqueous lubricant vs. control n = 1,580. Age: 20–72 years Conventional cytology	A small quantity of aqueous lubricant diminishes reported pain by women in childbearing Age and postmenopausal without altering the results of the cytology.	No evidence on other lubricant types.	1
2	RCT	Aqueous lubricant vs. water n = 400 Age: 23–67 years Conventional and liquid-based cytology	A small quantity of aqueous lubricant in the speculum does not affect cytology results and significantly diminishes reported pain during speculum insertion in postmenopausal women but not in childbearing Age.	No evidence on other lubricant types.	1
3	RCT	Aqueous lubricant vs. water n = 120 Age: 18–50 years Liquid-based cytology	The use of lubricant gel was correlated with less pain in speculum insertion, without altering cytology results.	Small sample size; no postmenopausal women included; no evidence on other lubricant types.	1
4	RCT	Liquid petrolatum topical vs. control n = 83. Age: 15–44 years Liquid-based cytology	A small quantity of liquid petrolatum topical used as a lubricant did not alter cytology results, nor did it significantly improve reported discomfort.	Small sample size; exam performed by a wide range of physicians; few patients tested positive for epithelial lesion; no evidence on other lubricant types.	1
5	MA	7 studies Rates the impact of lubricant use in CVC's result and in reported pain during speculum insertion Conventional cytology	The use of aqueous lubricant does not interfere with ratio of unsatisfactory results of conventional CVC, neither does it significantly alleviate discomfort felt during procedure.	Clinical and statistic heterogeneity of included studies.	2

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[1] Address for correspondence Diana Magalhães dos Santos, Family Medicine Resident, Unidade de Cuidados de Saúde Personalizados Chaves I-B, Rua Enfermeiro Carvalho – Campo da Feira, 5400-159 Chaves (e-mail: dmsantos@arsnorte.min-saude.pt).