Dr. J. Scott Ries Pap Study Gleans National Attention...
A study by J. Scott Ries, M.D., has gained national attention.  His study, "Can lubricant from a vaginal speculum be identified on a pap smear?" has been referenced in Obstetrics and Gynecology,  November 2002 (Volume 100, Number 5) and referenced on WebMD; posted on MedScape; and cited in an article on eFamily Practice News.  

ABSTRACT
"Can lubricant from a vaginal speculum be identified on a pap smear?"

Objective: 
It is widely taught that use of a lubricant on a vaginal speculum may interfere with the Pap smear. However, careful examination of the literature fails to reveal objective evidence to support this teaching. This pilot study was designed to determine whether water soluble gel applied to a vaginal speculum when obtaining a Pap smear is detectable upon cytologic examination. 

Design: 
A prospective randomized, controlled trial. 

Setting: A Residency-based Family Practice Center (FPC) in Indiana 

Patients: 
Women presenting for routine Pap smear were invited to participate if they were >18, had not undergone hysterectomy, and were not currently pregnant or menstruating. Participating subjects were randomly assigned to receive either a lubricated (n=25) or non-lubricated (n=25) vaginal speculum during the examination. 

Intervention: Cytologic evaluation of Pap smears obtained using either a nonlubricated vaginal speculum (control), or a vaginal speculum coated with a water soluble lubricant (PDI^â Sterile Lubricating Jelly).

Main Outcome Measures: 
Each pap smear was independently evaluated by 4 senior level cytotechnologists blinded to whether obtained with a control or a lubricated speculum. Two of the four cytotechnologists were provided samples of lubricant fixed onto a slide for comparison purposes. Each cytotechnologist reported for each slide: 1) Is there evidence of lubricant on this slide; and 2) If present, does the lubricant interfere with your ability to interpret the slide? 

Results: 
Overall, cytotechnologists reported lubricant as "present" in 40% of the slide readings (81/200, p = 0.786). However, the reports of lube "present" were as likely to occur on smears obtained with non-lubricated (control) speculums as they were with lubricated speculums (39/81 vs. 42/81 respectively, p = 0.773). Having comparison slides of lube fixed upon a slide did not improve the likelihood of reporting lubricant as present on a control versus lubricated speculum smear (p = 0.156). When reported as lubricant present, "interference" was reported in 23% of the readings (19/81) . However, reports of "interference" were also as likely to occur with smears obtained using a non-lubricated speculum as with lubricated methods (p = 0.1285). 

Conclusion: Lubricant applied to a vaginal speculum cannot be reliably detected on a pap smear. While further study needs to be done to investigate any potential effect of lubrication on diagnosis categorization, initial evidence does not support the dogma of lubrication interfering with the ability to interpret the slide.

For more information about this study, please email iufammed@iupui.edu.

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