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

Bakker, Ronan MD; Peng, Katherine MD; Chelmow, David MD

Journal of Lower Genital Tract Disease: January 2017 - Volume 21 - Issue 1 - p 67–72
doi: 10.1097/LGT.0000000000000272
Original Research Articles: Vagina and Vulva

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.

The use of water-based gel lubrication decreases patient discomfort during speculum examination.

Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, VA

Reprint requests to: David Chelmow, MD, VCU School of Medicine, 1101 E Marshall Street, PO Box 980034, Richmond, VA 23298. E-mail:

The authors have declared they have no conflicts of interest.

The study was a meta-analysis using deidentified previously published aggregate data. It did not use human as research subjects and did not require international review board review.

Copyright © 2017 by the American Society for Colposcopy and Cervical Pathology