#21 Does Lubricant reduce the adequacy of the PAP test?
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- Water soluble lubricant on speculum versus tap water.
- No difference in quality of cytology.
- 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
- No difference in PAP test adequacy.
- 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