The effect of using lubricant for vaginal speculum insertion on the rate of unsatisfactory results of Pap smear: a systematic review and meta-analysis
In brief
Water-based lubricant does not raise unsatisfactory Pap smear rate
A meta-analysis of 14 studies involving 18,681 women found that using lubricant during speculum insertion did not significantly change the proportion of unsatisfactory Pap smears (overall odds ratio about 1.1). Randomized trials showed no effect, while observational data hinted at a possible increase but with low certainty. Pain-relief benefits remain unclear, and larger high-quality trials are needed.
- Journal
- BMC women's health (Q1)
- Published
- 14 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Mohammad Roodsarabi, Parvaneh Mirabi, Zeynab Farhadi, Mouloud Agajani Delavar, Hajar Pasha
- PMID
- 42443870
- DOI
- 10.1186/s12905-026-04674-x
Why clinicians should know about it
- Picked for Reproductive Medicine (top studies of the week, 19 July 2026).
- Picked for Obstetrics and Gynecology (top studies of the week, 19 July 2026).
Abstract
BACKGROUND: Cervical cancer affects approximately 620,000 women annually and remains a leading cause of cancer mortality, particularly in low-resource settings. This meta-analysis evaluates whether lubricant use during vaginal speculum insertion affects unsatisfactory cytologic results in Pap smear procedures. METHODS: We systematically searched WoS/ISI, PubMed/MEDLINE, Scopus, Google Scholar, and Cochrane databases. RCTs and cohort studies were analysed in separate subgroup analyses per Cochrane Handbook recommendations. Quality was assessed using the Newcastle-Ottawa Scale and Cochrane RoB 2 tool; evidence certainty was rated via GRADE. Sensitivity analyses and publication bias assessment (funnel plots, Egger's test) were performed. RESULTS: Of 2,112 identified records, 14 studies comprising 18,681 women (7,757 lubricant; 10,924 control) met inclusion criteria (Cohen's Kappa = 0.79). Overall, water-based lubricant did not significantly affect unsatisfactory Pap smear rates (OR = 1.14, 95% CI: 0.90-1.44; P = 0.280; I² = 38.74%). Subgroup analysis confirmed no significant impact in RCTs (OR = 0.83, 95% CI: 0.58-1.16; P = 0.253; I² = 0%), while cohort studies showed a borderline trend toward increased rates (OR = 1.37, 95% CI: 0.98-1.90; P = 0.062; I² = 59.98%). A non-significant trend toward pain reduction was observed (SMD = - 0.77, 95% CI: -1.55 to 0.01; P = 0.054); however, extreme heterogeneity (I² = 94.21%) precludes reliable interpretation. CONCLUSIONS: Lubricant use does not compromise Pap smear adequacy based on RCT evidence of moderate certainty; the borderline cohort trend is of low certainty and should be interpreted with caution. Pain evidence is inconsistent and highly heterogeneous; no clinical recommendation regarding patient comfort can be made. Large-scale standardized RCTs examining LSIL/HSIL detection are warranted. These findings support cautious guideline consideration of lubricant use pending higher-certainty evidence.
Abstract as published, via PubMed.
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