Does lubrication of the vaginal speculum reduce pain during a gynecologic oncology examination?

Effects of speculum lubrication on cervical smears for cervical cancer screening: A double blind randomized clinical trial

BACKGROUND

Speculum lubrication may help to reduce the pain experienced during Pap-smear collection and hence increase uptake of cervical cancer screening and repeat testing, but there are fears of its interference with cytological results.

AIM

To determine and compare the adequacy of cervical cytology smears and the mean pain scores of women undergoing cervical cancer screening with or without speculum lubrication.

METHODS

This was a randomised controlled study of 132 women having cervical cancer screening at a tertiary hospital in Nigeria. Sixty-six participants were randomly assigned to the 'Gel' and 'No Gel' groups, respectively. Pap smears were collected from each participant with a lubricated speculum ('Gel group') or a non-lubricated speculum ('No Gel group'). The primary outcome measures were the proportion of women with unsatisfactory cervical cytology smears and the mean numeric rating scale pain scores, while the secondary outcome measures were the proportion of women who were willing to come for repeat testing and the cytological diagnosis of Pap-smear results.

RESULTS

The baseline socio-demographic variables were similar in both groups. There was no significant difference in the proportion of unsatisfactory cervical smear results between the two groups (13.6% vs. 21.2%, p = 0.359). However, the mean pain scores were significantly lower in the gel group than in the no gel group (45.04 vs. 87.96; p<0.001). An equal proportion of the participants in each group (90.9% vs. 90.9%; p > 0.999) were willing to come for repeat cervical smears in the future.

CONCLUSION

Speculum lubrication did not affect the adequacy of cervical smears but significantly reduced the pain experienced during pap smear collection. Also, it did not significantly affect the willingness to come for repeat cervical smears in the future.

TRIAL REGISTRATION

The trial was registered with the Pan-African Clinical Trial Registry with a unique identification and registration number: PACTR2020077533364675.

[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]

OBJECTIVE

To provide guidelines for the pelvic clinical exam in gynecology and obstetrics.

MATERIAL AND METHODS

A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.

METHODS

The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology.

RESULTS

The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature.

CONCLUSIONS

The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.

Practice Bulletin No. 168: Cervical Cancer Screening and Prevention

The incidence of cervical cancer in the United States has decreased more than 50% in the past 30 years because of widespread screening. In 1975, the rate was 14.8 per 100,000 women. By 2011, it decreased to 6.7 per 100,000 women. Mortality from the disease has undergone a similar decrease from 5.55 per 100,000 women in 1975 to 2.3 per 100,000 women in 2011 (1). The American Cancer Society (ACS) estimated that there would be 12,900 new cases of cervical cancer in the United States in 2015, with 4,100 deaths from the disease (2). Cervical cancer is much more common worldwide, particularly in countries without screening programs, with an estimated 527,624 new cases of the disease and 265,672 resultant deaths each year (3). When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed (4, 5).New technologies for cervical cancer screening continue to evolve, as do recommendations for managing the results. In addition, there are different risk-benefit considerations for women at different ages, as reflected in age-specific screening recommendations. In 2011, the ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) updated their joint guidelines for cervical cancer screening (6), as did the U.S. Preventive Services Task Force (USPSTF) (7). Subsequently, in 2015, ASCCP and the Society of Gynecologic Oncology (SGO) issued interim guidance for the use of a human papillomavirus (HPV) test for primary screening for cervical cancer that was approved in 2014 by the U.S. Food and Drug Administration (FDA) (8). The purpose of this document is to provide a review of the best available evidence regarding the prevention and early detection of cervical cancer.

Speculum Lubrication and Patient Comfort: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

The aim of the study was to examine the effect of water-based gel lubrication in decreasing discomfort during speculum examination.

MATERIALS AND METHODS

Searches of standard databases were performed. Randomized controlled trials comparing speculums lubricated with water-based gel to no lubrication or water alone in women undergoing gynecologic examinations were included. Selected studies were required to report on the outcome of discomfort experienced during the examination. Six studies met the criteria. Two reviewers independently performed the search and excluded articles that did not meet the inclusion criteria. The primary outcome was change in the visual analog scale (VAS) measure of discomfort. Pooled mean differences and 95% confidence interval (CI) were calculated and heterogeneity was assessed.

RESULTS

Five studies, totaling 2,383 subjects, each noted a significant decrease in the VAS score with use of lubrication. Pooling all studies, the VAS score with lubrication changed -0.87 (95% CI = -1.22 to -0.53, 6 studies, 2,453 subjects). Studies measured discomfort at different points in the examination and noted significant decreases with insertion (mean difference, -0.98; 95% CI = -1.13 to -0.83, 5 studies, 2,383 subjects), opening (mean difference, -1.52; 95% CI = -2.43 to -0.61, 3 studies, 1,864 subjects), and extraction (mean difference, -0.97; 95% CI = -1.29 to -0.65, 2 studies, 284 subjects). These significant decreases were consistent in subgroups of premenopausal, postmenopausal, gynecologic oncology, and radiation therapy patients.

CONCLUSIONS

Water-based gel lubrication decreased discomfort for women undergoing a plastic speculum examination in all populations studied.