According to a new study, three in 10 women feel no pain during a vaginal exam when the speculum is smeared with gel, while only one in 10 is pain-free when water, the conventional lubricant, is used.

Earlier research shows using a gel won't interfere with test results, said Dr. Oz Harmanli, an ob-gyn at Baystate Medical Center in Springfield, Massachusetts, who was not involved in the new work.

"It just makes sense to use it," he told Reuters Health. "Most gynecologists should do it."

Dr. D. Ashley Hill, who worked on the study, said it's important for physicians to make the exam as comfortable as possible for women.

"I worry that if ladies have an uncomfortable experience they won't come back, and they could be missing something important," such as a sexually transmitted disease or cancer, he told Reuters Health.

Hill, an ob-gyn at the University of Central Florida College of Medicine in Orlando and the medical director of the Loch Haven ob-gyn group, said textbooks and medical schools teach doctors and other providers to use water to lubricate the speculum, the device used to open the vagina.

Many women complain that it's an uncomfortable procedure, he said, and he wanted to test whether a gel could make it less painful.

Hill asked 119 women to rate their level of pain on a 10-point scale as he inserted the speculum. For half of the women, chosen at random, he used water, and for the other half, gel.

The gel group reported less pain, a 1.4 on the scale compared to 2.15 for the water group.

The difference was small, and Hill said it is be difficult to tell whether the women would actually be able to detect the pain reduction.

"What makes me think that difference (in pain) is real is the one-third of women who marked that they didn't feel any pain at all," Hill said. These women had the gel.

In contrast, just one tenth of women felt no pain from the speculum when it was sprayed with water.

"Now we can say, 'Look, you actually are hurting them, not a lot more, but when you're inserting the speculum with water only it's more painful.' This study confirms that," Harmanli said.

Harmanli said that physiologically, gel should reduce friction and be more compatible with the vagina.

"I cannot insert anything inside a vagina without lubricant. I know my patients appreciate it," Harmanli said.

But other physicians may not agree.

Hill and his colleague write in the journal Obstetrics and Gynecology that there's a belief that gel could interfere with Pap smear testing and screening for sexually transmitted diseases, preventing health care providers from using it.

He said there's evidence showing that gel does not affect the test results, and all 75 Pap smear tests that were involved in his study had no interference from the gel.

"I want doctors and midwives and nurse practitioners to see there's no reason to do a speculum exam without lubricant," he said.

Women can also be proactive about making their experience as comfortable as possible.

"If I were a patient, I would ask my doctor, 'Hey, could you put a little gel on the speculum?' I don't think any doctor would balk," Hill said.

SOURCE: Obstetrics & Gynecology, February, 2012.

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