Why You Probably Need an Anal Pap Smear

Pap smears are a common part of gynecological health, but growing research suggests that gay and bi men should be having them as well. Here's what you need to know.

What is an anal Pap smear?
An anal Pap smear or Pap test is when a health care provider collects cells from the wall of the anal canal and sends them to a lab to be examined for abnormal cell growth that could indicate cancer. Anal cancer develops slowly, beginning with minor cell changes, so it can be caught early, which greatly increases chances of survival.

Why would I need one?
The main reason to get an anal Pap test is to determine if the human papillomavirus (HPV), a widespread sexually transmitted infection, has sparked anal cancer, pre-cancerous cell growth, or lesions on the tissue of the anus that make you more vulnerable to HIV and other STIs. 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. HPV may be symptomless. Factors that increase the risk of anal cancer include multiple sex partners or use of drugs, alcohol, or tobacco. Being HIV-positive increases the risk of HPV infection and vice versa. According to the Cancer Network, 95 percent of HIV-positive men who have sex with men already have anal HPV, as do approximately 65 percent of HIV-negative gay and bisexual men. (Note: There is now a vaccine for HPV available.)

Who needs to get an anal Pap?
Standards aren't yet well established, unfortunately, which probably means your general practitioner isn't going to recommend you get one unless you specifically ask for it.

But there's a growing number of physicians arguing Pap tests should be part of routine screenings for anyone who has anal sex. As with HIV, the receptive partners are at the greatest risk, but anal cancer is a rising cause of illness and death among all men who have sex with men, especially those who are HIV-positive. If a woman is having anal sex, she should also be getting a regular anal Pap.

How often do I need an anal Pap?
Again, standards haven't been well established. But the recommendation is that all who practice anal sex, especially those who are living with HIV or HPV, be tested every one to three years.