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Am Fam Physician. 2006;74(1):165-166

More than 10,000 new cases of cervical cancer were diagnosed in the United States in 2004, and about 4,000 women died from this disease. Fear of pain during pelvic examination has been identified as the principal reason for adolescents not to obtain cervical cancer screening or attend follow-up appointments. However, conventional teaching cautions that use of lubricant during pelvic examination can cause artifacts in cytologic specimens and lead to inaccurate results. Because improved patient comfort could increase use of screening, Hathaway and colleagues evaluated the effect of lubricant on cervical cytology, adequacy of specimens, and secondary diagnoses.

Patients attending for routine Papanicolaou (Pap) smears were asked for their permission to have two specimens collected. The specimens were allocated randomly to a contamination or control group. Specimens in the contamination group were coated with 0.5 mL of a water-based lubricant by a blinded third party before being processed as usual. Each specimen was interpreted by two cytotechnologists. Suspicious or controversial specimens were examined by a third cytotechnologist and a cytopathologist. All persons evaluating the specimens were blinded to the randomization.

A total of 400 specimens were collected from 200 women. Identical results for the contaminated and control specimens were reported for 185 women. Of the 15 sample pairs with dissimilar results, six were reported as normal for the contaminated sample and abnormal for the control; five were reported as abnormal for the contaminated sample but normal for the control; and four were reported as abnormal in both specimens but with different levels of dysplasia. One pair was read as unsatisfactory for the contaminated sample but normal for the control, and one control sample was reported to be unsatisfactory, whereas the contaminated specimen was reported as normal.

The rate of disagreement between samples in the study was 7.5 percent, which is similar to a previously published estimate of 6.3 percent. The incidence of abnormal specimens and the proportion of samples containing endocervical cells were similar in both sets of specimens. The researchers found no difference in diagnosis of vaginal infection between the two sets of samples.

The authors conclude that water-based lubricant does not affect specimen quality in Pap screening or in the diagnosis of vaginal infections. This confirms other reports. Further studies are needed to determine whether water-based lubricants can reduce the discomfort of pelvic examinations, but the authors state that if pain can be decreased safely, new practices should be instituted.

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