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

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

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.

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.

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