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They do use lubrication. It's very cold. The procedure isn't comfortable at all but it's also usually not painful (not true for all women and not true all the time for most women, the muscles sometimes have a mind of their own). Most doctors are trained to be mindful of their patients' needs but occasionally you get someone who clearly doesn't get it. One time I was in pain and was told flatly that that's impossible. So it's always scary and stressful going in, because you just never know.
I also find that they always use like three times as much lubrication as is needed, so when it's all over you can continue to feel cold and uncomfortable and wet with it all slowly oozing out as you walk out of the clinic.
Damn, it baffles (but not surprise) me how women still can have such a shitty medical xperience with doctors not believing them. Also I had not considered the continues discomfort from the lube after the procedure.