The effect of using lubricant for vaginal speculum insertion on the rate of unsatisfactory results of Pap smear: a systematic review and meta-analysis.
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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.
期刊介绍：
BMC Women''s Health is an open access, peer-reviewed journal that considers articles on all aspects of the health and wellbeing of adolescent girls and women, with a particular focus on the physical, mental, and emotional health of women in developed and developing nations. The journal welcomes submissions on women''s public health issues, health behaviours, breast cancer, gynecological diseases, mental health and health promotion.
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