Use of gel vs. water resulted in a slight reduction in pain score on pelvic speculum exams in cisgender women without interfering with cervical cytology results. (1)
examinations can be uncomfortable for transgender men for a variety of
reasons. Virginal status or infrequent
penetration, vaginal atrophy due to hormone therapy, and psychological factors
may impair or even prevent a successful pelvic examination. Patients may have had past experiences that
were painful and may be reluctant to permit necessary pelvic screening or care.
Cisgender women undergoing pelvic examinations also may experience
discomfort. Historically providers have
been hesitant to use lubricating gel when collecting cervical cytology or
chlamydia testing specimens out of concern that gels may interfere with test
results, and have instead used water for speculum lubrication. However a growing body of evidence suggests
that certain lubricant products that do not contain carbomers do not
interfere with such tests. Investigators
aimed to evaluate the pain associated with pelvic speculum examinations using gel
lubricant as compared to water.
This was a single-blind randomized controlled trial of 119 women assigned to
either a gel (n=59) or water (n=60) group.
Pain scores were recorded on a 0-10 visual analog scale (VAS) after
insertion of the speculum, but before visualization of the cervix. Study size was determined based on a power
calculation to detect a VAS difference of 0.9, which has been shown in the
literature to be a threshold of clinical significance. Menopausal women, pregnant or recently parous
women as well as those with pelvic pathology were excluded. The overwhelming majority of subjects were
patients presenting for routine pelvic screening examinations. A single physician performed all
The gel group reported a statistically significant lower VAS score than the
water group (1.41 vs. 2.15, difference 0.74).
33.9% in the gel group reported a score of 0, vs. 10% in the water
group. None of the 35 gel or 38 water
patients who underwent cytology had unsatisfactory results.
The authors identified a statistically significant reduction in VAS scores when
using gel vs. water lubricant in routine pelvic examinations, with no observed
cases of unsatisfactory cytology results.
The findings do not cross the threshold of clinical significance. However these findings may have applicability
in transgender men who may have baseline higher pain scores than the study
group seen here; pain scores of 1-2 are remarkably low. As one’s pain climbs on the pain scale,
non-linear differences may be encountered which could cross the threshold of
clinical significance. In the very least
clinicians should be reassured by this and other data that using a small amount
of gel lubricant for pelvic examinations is reasonable and will not impact cytology
results if the gel used does not contain carbomers. Further study in populations
more likely to experience pain on pelvic speculum examination (transgender men,
menopausal women) would be useful.
1) Hill DA, Lamvu G. Effect of lubricating gel on patient comfort during vaginal speculum examination: a randomized controlled trial. Obstetrics & Gynecology. 2012;119(2, Part 1):227