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Water versus gel lubricant for cervical cytology specimens.

Article Excerpt
Practice recommendations

* Gel should be considered a viable option in obtaining Pap smears to ease insertion, minimize discomfort, and perhaps help maintain regular interval sampling compliance. Physicians choosing to use gel should be careful to apply only a thin layer to the outer blades of the speculum.

* Because approximately two thirds of false-negative smears are related to inadequate sampling, be sure to obtain cells from the transformational zone, where cancer is known to develop.

The medical literature generally recommends moistening the speculum with water for performance of a Papanicolaou (Pap) test, because gel lubricants interfere with specimen analysis and assessment of vaginal secretions. (1,2) After an extensive literature search, we found little information that identified or substantiated the type or frequency of interference or distortion in analysis or assessment with regard to gel lubricants on cervical cytologic evaluation. The only study of gel lubricant use that we round recommended further study because surprisingly few Pap smears are rendered inadequate despite the high prevalence of gel use. (3)

Due to these findings and the lack of literature substantiating interference or distortion with gel lubricants, we investigated whether there is a difference in Pap smear obscuration rates with gel-lubricated vs water-lubricated speculum samples.

* METHODS

Target population

The target population consisted of all women who received Pap smears between 1995 and 1999 at the University of Tennessee Health Sciences Center HealthPlex Family Medicine Residency Program in Memphis, Tennessee. Pap smears were obtained by...