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Anal Dysplasia

Anal dysplasia is a pre-cancerous condition that occurs when the cells of the anal surface and canal (the last 2-3 inches of the intestinal tract) undergo abnormal changes. It is highly associated with genital human papilloma virus (HPV), a virus that is transmitted by intimate skin and sexual contact and commonly infects the vulva, vagina, and cervix. While not a gynecologic organ, the anus is visualized by the gynecologist every time a gynecologic exam is performed, which presents an opportunity to help detect an anal problem that might otherwise go unnoticed.

More often, anal dysplasia has no symptoms and has no signs that are palpable to the patient or visible to the physician on routine examination. However, when symptoms do develop, they may be similar to the symptoms of other common conditions, such as hemorrhoids or an infection.

Symptoms of anal dysplasia include:

  • Pain or pressure
  • Feeling a lump near the anus
  • Bleeding
  • Itching
  • Mucous discharge

Women who have a higher risk of developing anal dysplasia include those who have:

  • A genital HPV infection, especially with HPV subtype 16
  • An abnormal PAP test, whether or not there is a negative or positive HPV co-test
  • History of cervical, vaginal, or vulvar cancer
  • Anal sex without a condom
  • Anal warts (even though anal warts themselves don’t become pre-cancerous or cancerous)
  • Immunosuppression, especially those who have HIV or AIDS, or because they take medications that suppress the immune system, such as treatments for rheumatoid arthritis or organ transplant

Getting screened for anal dysplasia

There are no official national or international guidelines for anal HPV-related dysplasia, but experts agree that those at higher risk should be considered for screening. Screening begins with an anal PAP test. Just like the cervical PAP test, cells are collected so they can be evaluated under a microscope in a lab to check for abnormal cells and the presence of human papilloma virus (HPV).

Women with a combination of the above risk factors should be considered for anal dysplasia screening.

If an anal PAP test indicates abnormal cells or the presence of HPV, a referral is made for high-resolution anoscopy (HRA). HRA is a procedure by which a small diameter scope (anoscope), a light source with magnification, and acetic acid (vinegar) are used to closely examine the anal canal to look for abnormal areas that can then be biopsied and treated. HRA is typically performed by a gastroenterologist, proctologist, or colorectal surgeon.

The possibility of anal disease is one of the reasons why a gynecologist does a rectovaginal exam during an office visit

A rectovaginal exam (a rectal exam done at the same time as a vaginal bimanual pelvic exam) is regarded by many gynecologists as an additional good way to feel the female reproductive organs. It is also a reliable way to assess the female pelvis for a mass—uterine, ovarian, or of other origin, especially if it is located in the back of the pelvis—that can be missed by the usual vaginal bimanual pelvic exam.

A rectovaginal exam is also important in the evaluation of the anus and rectum. It could be very helpful if done when there are the following complaints:

  • There is blood in the stool
  • There is rectal bleeding
  • Bowel habits have changed for no known reason
  • There is rectal pain

We at Adaptive Gynecology can answer your questions about risk for anal dysplasia. We can help you determine if you are at higher risk and might benefit from an anal PAP and HPV test.

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