Screening for Anal Dysplasia


Anal Pap Smears

What is an anal pap smear?
An anal pap smear is a screening test for anal cancer similar to a cervical pap smear looking for cervical cancer for women.

How is an anal pap smear obtained?
A small sample of cells is collected from the transitional area between the rectum and the anus with a small thin swab inserted in the anus and painlessly rubbed within the anal canal. The sample is then examined under a microscope to identify any abnormal changes in the cells. Some cell changes may be precursors to anal cancer.

Who should have an anal pap smear?

  • Anyone living with HIV.
  • Men who have sex with men.
  • High risk persons with rectal symptoms: mass, bleeding, pain.

How often should I have a pap smear?

  • If the anal pap smear is normal and you have HIV, then: repeat pap smear in one year.
  • If the anal pap smear is normal and you do not have HIV, then: repeat pap smear in two to three years.
  • If your anal pap smear is not normal, you will need a high resolution anoscopy exam to look for any area(s) of abnormality causing the abnormal pap result. Sometimes these areas are not visible to the naked eye.

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High Resolution Anoscopy

What is high resolution anoscopy?
This procedure uses a magnifying scope to examine the anal canal and external anal area for abnormal tissue. Often this is done to evaluate an abnormal anal pap smear and to find the source of the abnormality.

How is an anal biopsy performed?
During a high resolution anoscopy a small, thin clear tube called an anoscope is inserted into your anal canal with lubrication and numbing jelly. A wooden cotton swab soaked in a mild acedic solution is inserted through the anoscope and left in the anal canal for one minute. The anoscope will be removed first. Then the cotton swab is removed and the lubricated anoscope is reinserted to look inside the anal canal.

The colposcope helps magnify tissue features to help the provider identify areas of abnormal tissue. A small sample of tissue is then removed from the abnormal area. The sample is smaller than a grain of rice. The entire procedure takes about 30 minutes, although the actual biopsy takes a few seconds.

What can I expect?
You may feel a cramp of pinch during the biopsy. Many people do not feel the biopsy. You may notice a scant amount of bleeding with a bowel movement or wiping for a couple days.

What are the risks?
Most often there are not serious side effects from this procedure. Complications such as bleeding or infection are rare but can occur.

Preparing for your procedure:
Call the office if you are taking a prescription blood thinner. This is generally a "come as you are" procedure. Ideally, however, one day prior to your procedure, please do not have anal receptive intercourse, place any toys or objects into your anus, use douches or enemas, or apply any creams or medications into your anus.

After your procedure:
Unless instructed otherwise, you should:

  • Avoid anal receptive intercourse for at least 48 hours.
  • Avoid inserting any toys or objects into your anus for at least 48 hours.

Call the clinic if you experience:

  • Heavy bleeding
  • Chills
  • Fever of more than 101
  • Abdominal pain

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Anal Biopsy

What is an anal biopsy?
An anal biopsy is the removal of a small sample of tissue from within the anal canal.

How is an anal biopsy performed?
During a high resolution anoscopy a small, thin clear tube called an anoscope is inserted into your anal canal with lubrication and numbing jelly. A wooden cotton swab soaked in a mild vinegar solution is inserted through the anoscope and left in the anal canal for one minute. The anoscope will be removed first. Then the cotton swab is removed and the lubricated anoscope is reinserted to look inside the anal canal.

The colposcope helps magnify tissue features to help the provider identify areas of abnormal tissue. A small sample of tissue is then removed from the abnormal area. The sample is smaller than a grain of rice. The entire procedure takes about 30 minutes, although the actual biopsy takes a few seconds.

What can I expect?
You may feel a cramp of pinch during the biopsy. Many people do not feel the biopsy. You may notice a scant amount of bleeding with a bowel movement or wiping for a couple days.

What are the risks?
Most often there are not serious side effects from this procedure. Complications such as bleeding or infection are rare but can occur.

Preparing for your procedure:
Call the office if you are taking a prescription blood thinner. This is generally a "come as you are" procedure. Ideally, however, one day prior to your procedure, please do not have anal receptive intercourse, place any toys or objects into your anus, use douches or enemas, or apply any creams or medications into your anus.

After your procedure:
Unless instructed otherwise, you should:

  • Avoid anal receptive intercourse for at least 48 hours.
  • Avoid inserting any toys or objects into your anus for at least 48 hours.

Call the clinic if you experience:

  • Heavy bleeding
  • Chills
  • Fever of more than 101
  • Abdominal pain

   [Back to Anal Dysplasia]