Tools for Practice

#21 Does Lubricant reduce the adequacy of the PAP test?

Does the use of small amount of water soluble lubricant on the speculum reduce the adequacy of the PAP test?

A small amount of water-soluble lubricant on a speculum does not reduce the quality of the PAP test and probably does not affect microbiologic results. Adequacy of liquid-based PAP tests may be minimally affected or not at all.  

CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

Join Now

Already a CFPCLearn Member? Log in

The largest randomized controlled trial (RCT)1: 2,906 patients.  
  • Water soluble lubricant on speculum versus tap water. 
  • No difference in quality of cytology. 
Four smaller RCTs:  
  • 70 to 400 patients: No difference in PAP test adequacy.2-5 
  • Two investigated and found pain scores significantly lower in the lubricant group4,5 (example, mean score on visual analogue scale 1.4 in the lubricant group and 2.2 in the water group, p<0.01).4 
Quasi-randomized, 3,460 PAP tests.6 
  • No difference in PAP test adequacy. 
Conventional cervical cytology smears (glass slide) were used in most studies.1-3,5,6  A meta-analysis of these trials plus another quasi-RCT found no difference on PAP test adequacy or pain scores.7    Context:    
  • One study found “more than the usual amount of gel” could affect PAP test adequacy by applying an additional 1-1.5 cm ‘ribbon’ of gel directly to the cervical os before sampling.8   
    • Clinicians don’t do this, and it is not applicable to regular practice. 
  • One RCT assessed lubricant influence on liquid-based PAP tests and found no effect, although it may have been underpowered.5 
  • Two retrospective cohorts using liquid-based cytology found: 
    • More unsatisfactory smears when lubricant was used (4.3% versus 1.8%, p=0.01).9 
    • Obscuring material causing misinterpretation of PAP results on 0.4%: ~half may have been related to lubricant use.10 
  • Two studies applied lubricant directly into liquid-based cervical cytology samples:11,12  
    • One reported reduced cell counts, but impact on adequacy was not assessed/reported.11 
    • The second demonstrated no impact on liquid-based PAP test outcomes.12 
  • One RCT also examined if lubricant affected testing for Chlamydia and found no effect after 5,535 samples.6 (Gonorrhea too uncommon to assess.) 
    • A laboratory study demonstrated that gel mixed with Chlamydia and Gonnorrhea cultures did not impact plating or diagnosis.13   
reviewed dec 6 2017 by ricky

Latest Tools for Practice

#348 How to Slow the Flow III: Tranexamic acid for heavy menstrual bleeding (Free)

In premenopausal heavy menstrual bleeding due to benign etiology, does tranexamic acid (TXA) improve patient outcomes?
Read 0.25 credits available

#347 Chlorthali-D’OH!: What is the best thiazide diuretic for hypertension?

Which thiazide diuretic is best at reducing cardiovascular events in hypertension?
Read 0.25 credits available

#346 Stress Urinary Incontinence: Pelvic floor exercises or pessary? (Free)

How effective are pelvic floor exercises or pessaries for stress urinary incontinence?
Read 0.25 credits available

This content is certified for MainPro+ Credits, log in to access


  • Christina Korownyk MD CCFP
  • G. Michael Allan MD CCFP
  • Noah Ivers MD CCFP

1. Amies AM, Miller L, Lee SK, et al. Obstet Gynecol. 2002; 100:889-92.

2. Harer WB, Valenzuela G Jr, Lebo D. Obstet Gynecol. 2002; 100:887–8.

3. Gilson M, Desai A, Cardoza-Favarato G, et al. Am Board Fam Med. 2006; 39:340–4.

4. Hill DA, Lamvu G. Obstet Gynecol. 2012; 119(2 Pt 1):227-31.

5. Uygur D, Guler T, Yayci E, et al. J Am board Fam Med. 2012; 25(6):798-804.

6. Griffith WF, Stuart GS, Gluck KL, et al. Contraception. 2005; 72:60–4.

7. Pergialiotis V, Vlachos DG, Rodolakis A, et al. J Low Genit Tract Dis. 2015;19(1):55-61.

8. Charoenkwan K, Ninunanahaeminda K, Khunamornpong S, et al. Acta Cytol. 2008; 52:654-8.

9. Köşüş A, Köşüş N, Duran M, et al. Arch Gynecol Obstet. 2012; 285(6):1599-602.

10. AbdullGaffar B, Kamal MO, Khalid M, et al. J Low Genit Tract Dis. 2010; 14(1):22-8.

11. Holton T, Smith D, Terry M, et al. Cytopathology. 2008; 19:236-43.

12. Hathaway JK, Pathak PK, Maney R. Obstet Gynecol. 2006; 107:66–70.

13. Kozakis L, Vuddamalay J, Munday P. Sex Transm Infect. 2006 Jun; 82(3):263-4.

Authors do not have any conflicts of interest to declare.