Dr. Dick,
My roommate had his man check-up the other day, and the doc did an anal Pap. What's an anal Pap!?
- Anal Andy

Dear Andy,

Thanks for your great question! The anal Pap collects a sample of cells from the anus. This is similar to the "female" Pap smear which looks for abnormal cells on the cervix. The purpose of the Pap test is to check for cell changes caused by HPV (Human Papilloma Virus)--the virus that can cause genital and oral warts, and certain types of cancers.

Most MSM (Men who have Sex with Men) who are HIV-positive have HPV in the anal canal, and over half of MSM who are HIV-negative have HPV in the anal canal. So why aren't all gay men getting anal Paps? For a couple of reasons! First, lots of gay men have HPV infection that never causes health problems or cell changes. Even if they do have cell changes, most of these changes return to normal within two years. Secondly, in part because these cell changes may be temporary, medical providers aren't sure what to do with an abnormal anal pap.

In fact, the medical community is divided on whether anal Paps should be done at all. There isn't enough data yet, and there are currently no nationally endorsed guidelines for performing anal Paps. As you might have guessed, most insurance policies don't cover them. Still, the anal Pap may be an important test for some patients. If you have a history of receptive anal intercourse, or if you have HIV and your medical provider finds masses when doing a digital anal exam (checking inside the anus with a gloved finger), they might do an anal Pap.

HOW DOES AN ANAL PAP WORK? A cotton swab moistened with water is carefully placed 2-3 inches into the anus. The swab is rotated 360 degrees while slowly being removed over a period of 15-30 seconds. Cells from the swab are then analyzed in a lab to check for cell changes. If abnormal cells are found, your medical provider might perform more tests, or recommend treatment.

There are other options for screening for pre-cancers and cancers linked with HPV. Your medical provider can perform a digital rectal exam (inserting their finger in your rectum to feel for masses) and a visual inspection with anoscopy (that means inserting a small clear plastic scope that is about 4 inches long into the anus to look at the mucosa). If they find a mass or abnormality they will send you for either high-resolution anoscopy or to a colorectal surgeon. Another option for screening is high-resolution anoscopy. This is similar to regular anoscopy but the medical provider uses a large microscope to look for abnormal cells; they also apply a liquid that helps the abnormal cells show-up better for inspection.

Remember, HPV is very common. Still, there are some things you can do to reduce your chances of getting HPV:


• HPV is an extremely common STD. If you are 26 or younger, get vaccinated. The Gardasil vaccine is approved for men and women aged 26 and under. If you are older than 26, or know that you've had HPV in the past, the vaccine may still be an option for you to help prevent getting infected with a different strain of the virus. Talk with your medical provider for more information.
• Oral sex condoms are non-lubricated and flavored. Add some water-based or silicone-based lube inside the condom to increase sensation for your partner. Put some flavored lube on the outside of the condom to make it a juicier experience for you.
• Deep throating can hurt the tissue of your throat, which can make you more likely to pick up an STD. Use an oral sex condom if you are deep throating.
• Dams are made of latex or polyurethane (for our friends who have latex allergies), and placed over the anus or vagina to shield one another from fluids, sores, and skin-to-skin contact. You can also get Hepatitis A and intestinal parasites from rimming, because you might touch feces (poop) with your mouth. Like condoms, dams should be used once, and then thrown away.
• Having HIV increases the risk of HPV infection, and vice versa. Make testing a regular part of your healthcare. If you test positive for an STD, connect with a medical provider right away for treatment. Click for a list of testing sites in King County: Testing in Seattle/King County
• Talk to your partners about what, if any kinds of protection you want to use, and the last time you were tested. It may seem awkward at first, but you might be surprised how well-received the conversation is.
• Alcohol, tobacco, and drugs can increase the risk of HPV. Consider harm reduction strategies for reducing use of these products. Even cutting out one drink per evening can make a difference for your health!

Take care,

Dr. Dick

For more HPV basics, check out my article Bumping and Grinding.

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