What's an Anal Pap Smear And Do I Need One?

What is a Pap smear? A Pap smear or Pap test (short for Papanicolaou test) is when a healthcare provider (gently) scrapes cells from the wall of the cervix or anal canal and sends them to a lab to be examined for abnormal cell growth that could indicate cancer. Anal and cervical cancers develops slowly, beginning with minor cell changes, so they can be caught early and greatly increase the chance of survival.

Why would I need an anal Pap? Because of human papillomavirus (HPV), a sexually transmitted infection, which causes the majority of anal, penile, and cervical cancers. 

Who needs to get one? Standards aren't yet well established as to who should be getting an anal Pap smear. Unfortunately, this probably means your general practitioner isn’t going to recommend you get one unless you specifically ask for it. According to the Cancer Network, 95 percent of HIV-positive men who have sex with men already have anal HPV — the virus that causes anal cancer — as do approximately 65 percent of HIV-negative gay and bi men. Unlike HIV, which is transmitted through bodily fluids, HPV is spread through skin-to-skin contact, so using condoms is only partially successful in preventing transmission. Factors that increase the risk of anal cancer include multiple sex partners, and use of drugs, alcohol, or tobacco. 

It should be routine testing. There are a growing number of physicians who are arguing that anal Pap tests should become part of routine screening for gay and bi men since anal cancer is a rising cause of illness and death among men who have sex with men, especially those who are HIV-positive. Being HIV-positive increases the risk of HPV infection and vice versa. Anal HPV can leave lesions on surface tissue of the anus, leaving it more vulnerable to the HIV virus. The recommendation is that all gay and bi men, especially those who are living with HIV, be tested every one to three years. 

What about women? Because transgender women have HIV and HPV rates that are similar, and in some cases higher, than gay or bi men, it would stand to reason they should also hew to the same rigorous screenng recommdations. When comes to cisgender women, Dr. Rebecca C. Brightman, an ob-gyn, told Cosmo that if woman is HPV-positive and having anal sex she should also be considered for an anal Pap.

So, how do I get it? Talk honestly with your doctor about your sexual practices. If you think you should be considered for the test, speak up, and explain why. Don't be afraid to talk about sex with your doctor; s/he's likely to have heard it all before. Ultimately, you are responsible for your health. So don't let your doctor's ignorance or resistance come between you and a test that could catch anal cancer before it turns deadly.