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Am Fam Physician. 2003;67(4):810

Almost all textbooks on gynecology state that no vaginal lubrication should be used when screening for cervical abnormalities to avoid contaminating Papanicolaou (Pap) smears. Because they found no scientific evidence for this dogma, Harer and colleagues studied the effect of lubrication on Pap smear quality at a large regional gynecology clinic.

All patients receiving Pap smears were invited to participate in the study except those with known cervical cancer or active vaginal bleeding. Patients were randomly assigned to either the “lubricant” group or the control group. In the examination of control patients, only water was used on the speculum. Patients in the intervention group were examined with a lubricated speculum, and the introitus was manually examined with lubricated, gloved fingers before speculum insertion. Smears were taken using the same technique in both groups and interpreted by technicians who were not aware of the patient assignment in the study.

The study was terminated early because, after the first 182 patients, only four unsatisfactory smears had been reported. Two of these were in the lubricated group and two in the control group. The authors conclude that use of a water-soluble lubricant does not contaminate Pap smears and is important in providing patient comfort and ease of examination. They urge that lubricant use become standard treatment and that the teaching and practice of speculum insertion without lubrication be abandoned.

In a similar study published in the same journal, the rate of unsatisfactory smears using lubricant was 1.4 percent in 1,440 patients attending public family planning clinics. This was identical to the rate in control patients using only water on the speculum.

editor's note: On behalf of all women—thank goodness for the results of these studies! Seriously, how many more of our mandated practices increase patient discomfort and have no evidence of benefit? There is enormous scope for pragmatic research of routine aspects of the practice of medicine. It is hoped that family practice will step up with research in both academic centers and practice research networks to improve patient care. Research does not have to be life-saving or dramatic to make significant differences for patients and practitioners.—A.D.W.

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