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Anal Dysplasia: Ending Stigma, Preventing Cancer

African American doctor talking to patient in office

Health issues that are linked to sexual activity and affect intimate parts of the body can be prone to stigmatization. One of these health issues is anal dysplasia, says Dr. Alen Voskanian, medical director of Cedars-Sinai Medical Group and head of the Dysplasia Clinic.

"When patients feel embarrassed, they sometimes avoid physicians and skip preventive or follow-up care," says Dr. Voskanian. "Anal dysplasia is one of the conditions that isn't sufficiently discussed because of stigma."

Headshot for Alen Voskanian, MD, MBA

Alen Voskanian, MD, MBA

Family Practice, Hospice & Palliative Medicine

Alen Voskanian, MD, MBA

Family Practice, Hospice & Palliative Medicine
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Accepting New Patients

"At the Dysplasia Clinic, we have several options to choose from so we can adapt the treatment to the patient's individual needs."


What is anal dysplasia?

Anal dysplasia, which is almost always caused by the human papillomavirus (HPV), occurs when some of the cells in your anal canal change.

"While these lesions are sometimes harmless and go away on their own, others can be dangerous and progress to anal cancer," says Dr. Voskanian. "To prevent this, high-grade lesions need to be removed, just like precancerous skin lesions do."

That may sound simple enough, but anal dysplasia is stealthy. The area is not visible, so lesions are rarely discovered by chance. Complicating things further, dysplasia often comes without symptoms. If signs do emerge, such as burning, itching or bleeding, they're easily misdiagnosed as hemorrhoids.

Dysplasia can go undetected until it has developed into anal cancer.



Who's at risk for anal dysplasia and anal cancer?

Men who have sex with men, sometimes referred to as MSM, are at particular risk for anal dysplasia and, subsequently, for anal cancer. Currently, the rate of anal cancer in the general population is two in 100,000. For HIV-negative men in this group, the number is 35 per 100,000, and it's more than twice that high for MSM who are HIV-positive.

While high-grade dysplasia will progress into anal cancer about 14% of the time, the odds go up significantly for patients who have risk factors. Those include older age, a history of smoking or immune suppression due to AIDS, says Dr. Voskanian.



How do I prevent it?

The best way to prevent anal dysplasia is not to get high-risk HPV in the first place. While condoms are the best way to prevent most sexually transmitted diseases, it's unclear how well they stop the transmission of HPV and the development of dysplasia.

The most powerful ally against HPV is Gardasil, a vaccine that's been available since 2006 and is recommended for everyone before the onset of adolescence. The Centers for Disease Control and Prevention recently expanded its recommendations, so the shot is available to people up to age 45.

"Many people think Gardasil is only for females because it was marketed for cervical cancer, but it's effective for preventing some of the common HPV types, especially strains related to anal, penile and vaginal cancers, as well as cancers of the throat," says Dr. Voskanian.

"If you're an adult and haven't been vaccinated, talk to your doctor to see if it makes sense for you.

Along with vaccination, getting regular checkups is one of the best things you can do if you're at risk. That means getting an anal cytology, which isn't as intimidating as it sounds.

The procedure, sometimes called an "anal Pap smear," involves swabbing the area so the doctor can collect a sample of cells and send it to the lab. If the results are normal, your healthcare provider will still want to keep an eye on things.



What if I'm diagnosed with anal dysplasia?

If the results of your anal cytology are unusual, the next step is a high-resolution anoscopy. The doctor inserts a small instrument into the anal canal and uses a dye that helps identify abnormal areas. The offending cells can be biopsied or removed there and then.

"At the Dysplasia Clinic, we have several options to choose from so we can adapt the treatment to the patient's individual needs," says Dr. Voskanian.

Like precancerous skin lesions, once the cells are removed, they can't pose a danger anymore—but you do have to keep monitoring the situation

"The anal canal isn't an area you can easily check out on your own, so make sure you show up to your follow-up appointments," says Dr. Voskanian, adding that HIV-positive men and women over age 25 should routinely get an anal cytology, as should HIV-positive MSM who are 40 or older.

Get screened and be candid

Once you've been treated for anal dysplasia, it's imperative to get regularly screened. Most of all, never hesitate to consult a healthcare professional and always be candid about your sexual history.

"There is no reason any medical condition should cause embarrassment," says Dr. Voskanian. "You have the right to a completely safe, judgment-free space and a doctor-patient relationships based on trust and honesty."