Table of ContentsView AllTable of ContentsPurpose of an Anal Pap SmearBefore the TestDuring the TestInterpreting Anal Pap Smear ResultsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Purpose of an Anal Pap Smear
Before the Test
During the Test
Interpreting Anal Pap Smear Results
Frequently Asked Questions
If the lab finds abnormal cells, further testing is necessary. The anal Pap does not test for colon or rectal cancer. The anal Pap smear is the counterpart of thecervical Pap smear, named after George Papanicolaou, the Greek doctor who invented the test in the 1940s.
This article explains the anal Pap smear purpose and screening guidelines. It also covers what to expect during the test and how to prepare.
Pornpak Khunatorn / Getty Images
The anal Pap smear screens for changes insquamous cellsthat line the anus as well as the cervix.Changes in these cells may suggest that cancer is likely to develop or that cancer has already developed.
Of the hundreds of strains of HPV, the two most often associated with anal cancer are HPV 16 and HPV 18. Both are targets of theHPV vaccine.
Who Should Have an Anal Pap?
No national organization has issued routine anal cancer screening guidelines for the general population. However, becausepeople living with HIVare most at risk of HPV infection, the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA) does recommend that certain people living with HIV have anal Pap smears:
The American Cancer Society (ACS) includes additional groups that are at increased risk of anal cancer:
In addition, anal cancer is more common among people who are over 50, as well as people who smoke.
The ANCHOR StudyIn order to pin down screening guidelines for people who have HIV, the NCI is conducting a nationwide study of those with high-grade squamous intraepithelial lesions (HSILs), the type that can develop into cancer. Enrolled subjects will be treated or monitored every six months for a minimum of five years.ANCHORstands for Anal Cancer HSIL Outcomes Research.
The ANCHOR Study
In order to pin down screening guidelines for people who have HIV, the NCI is conducting a nationwide study of those with high-grade squamous intraepithelial lesions (HSILs), the type that can develop into cancer. Enrolled subjects will be treated or monitored every six months for a minimum of five years.ANCHORstands for Anal Cancer HSIL Outcomes Research.
There is nothing you will need to do to prepare for an anal Pap smear. However, there are a number of things you shouldnotdo beforehand to ensure accurate results. During the 24 hours before having an anal Pap smear, do not:
If for any reason you do not adhere to any of these guidelines, call your provider to ask if you should reschedule your test.
Timing
The actual Pap smear will take about five minutes, but you’ll need to block off more time than that. Schedule your day to account for travel to and from the testing site, possible paperwork when you arrive (particularly if you are seeing the provider who will perform the screening for the first time), and waiting.
Timing TipWhen you call to make your appointment, ask if there are certain days or times of day during which there is likely to be no wait or at least a very short wait.
Timing Tip
When you call to make your appointment, ask if there are certain days or times of day during which there is likely to be no wait or at least a very short wait.
Location
An anal Pap smear takes place in an exam room of a healthcare provider’s office, hospital, or clinic. The room will contain equipment you’re familiar with (a blood pressure cuff, for example, and tongue depressors and other items). If you’re a woman and a gynecologist will be performing your anal Pap smear, the exam table will be outfitted with stirrups.
What to Wear
You will need to remove your clothing from the waist down and put on a medical gown for the test, so you may want to think about that when you dress. Women might choose to wear a dress or a skirt so all they need to take off are shoes and underwear, for instance. Medical exam rooms tend to be chilly so you may want to wear or bring a pair of socks.
Cost and Health Insurance
Health insurance often doesn’t cover anal Pap smears. If you have insurance, check the details of your plan or ask a representative if your screening will be covered. If not, you will need to pay out of pocket for the procedure.
You’ll also have to pay for anal cancer screening yourself if you have Medicaid nor Medicare, as neither covers the test. Ask your healthcare provider’s office for an estimate of how much it will cost.
What To Bring
Bring your insurance card and co-pay (if you have one) with you to the appointment. If you’re having any anal or rectal symptoms, such as pain or discharge, write down the details to share with the healthcare provider. Jot down any questions you may have about the procedure or anal cancer in general as well.
If the provider is one you’ve never seen before, you may be asked to bring your medical records.
Pre-Test
When you arrive for your anal Pap smear, you will check in with a receptionist. If it’s your first visit to the healthcare provider’s office or clinic, you may have to fill out new new-patient forms, including a medical history. You may need to stay in the waiting room for a while.
When it’s time for your test, a member of the office staff will escort you to the room where it will be performed. You’ll be given a medical gown and instructed to undress from the waist down before putting it on. They’ll then leave the room to give you privacy while you change. Feel free to leave your socks on if you think you will get cold.
The healthcare provider will ask you to get into position for the test. The most common position is lying on the left side with the knees drawn up toward the chest, but other positions are acceptable, depending on the practitioner’s preference.
Throughout the Test
To perform the anal Pap smear, the healthcare provider will move the hospital gown out of the way. They will gently widen the area around your anus with one hand and with the other insert a moistened swab with a synthetic tip approximately two to three inches into your anus.
They will rotate the swab 360 degrees, pressing it slightly against your skin in order to pick up a cell sample. Continuing to rotate the swab, they will slowly withdraw it. This may cause mild discomfort, but it should take no more than 30 seconds for the clinician to collect enough cells, after which they will cover you with the gown and instruct you to sit up slowly.
Cell samples from the anus must be prepared within 15 seconds of being collected or they may dry out, according to theUniversity of California, San Francisco.
Post-Test
Your anal Pap smear cell samples will be sent to a lab, where technicians will examine them under a microscope in order to identify cellular changes that may indicate cancer. It will take about two weeks to get results.
If abnormal cells are found, depending on the grade you may need to be monitored or you will be asked to come in for further testing, which can include adigital anal exam(exam of your anus using gloved hands), a biopsy, or ananoscopy.
An anoscopy is a test in which a small light instrument called an anoscope is inserted into the anus in order to illuminate the skin lining the anus and rectum. Often, a high-resolution anoscopy (HRA) will be recommended for a follow-up to an abnormal anal Pap. This type of anoscopy is done with a high-resolution instrument and can be more precise than a regular anoscopy.
Sometimes an anoscopy is done in conjunction with a biopsy.
A Word From Verywell
It’s normal to feel anxious before, during, and after an anal Pap smear, especially because it is in a sensitive and private area of your body. But chances are, your anal Pap test will be a quick and relatively easy experience.
Stay calm and remember that this is just a screening tool, not a diagnostic test. Even if you receive positive results on your anal Pap smear, that doesn’t mean that you have or will develop cancer. Often, abnormal lesions resolve on their own and do not become cancerous.
Anal Pap smears do not test for HPV strains. Instead, they detect cell changes that may result from HPV infection. Currently, the only FDA-approved HPV test is a cervical Pap smear.Learn MoreHealth Disparities in HPV-Related Cancers
Anal Pap smears do not test for HPV strains. Instead, they detect cell changes that may result from HPV infection. Currently, the only FDA-approved HPV test is a cervical Pap smear.
Learn MoreHealth Disparities in HPV-Related Cancers
There is no special preparation required for an anal Pap smear. However, it may help to know what to expect. For the test, you will undress from the waist down. Then, while you lie on your side with your knees drawn up, a healthcare provider will insert a swab several inches into your anus to collect cell samples. The procedure is painless and takes less than a minute.Learn MoreWhat Is a Digital Rectal Exam?
There is no special preparation required for an anal Pap smear. However, it may help to know what to expect. For the test, you will undress from the waist down. Then, while you lie on your side with your knees drawn up, a healthcare provider will insert a swab several inches into your anus to collect cell samples. The procedure is painless and takes less than a minute.
Learn MoreWhat Is a Digital Rectal Exam?
Learn MoreHow To Get Medical Test Results
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Leeds IL, Fang SH.Anal cancer and intraepithelial neoplasia screening: A review.World J Gastrointest Surg. 2016;Jan 27; 8(1): 41–51. doi:10.4240/wjgs.v8.i1.41
Hosseini MS, Khosravi D, Farzaneh F, et al.Evaluation of anal cytology in women with history of abnormal pap smear, cervical intraepithelial neoplasia, cervical cancer and high risk hpv for anogenital dysplasia.Asian Pac J Cancer Prev. 2018;19(11):3071–3075. doi:10.31557/APJCP.2018.19.11.3071
Centers for Disease Control and Prevention.How many cancers are linked with HPV each year?
American Cancer Society.Can Anal Cancer Be Found Early?
American Medical Association.Use of chaperones. code of medical ethics opinion 1.2.4.
American Academy of Family Physicians.Human papilloma virus (HPV).
Anal Cancer Foundation.Living with Anal Cancer/Prevention.University of California, San Francisco.Anal Cancer Information.
Anal Cancer Foundation.Living with Anal Cancer/Prevention.
University of California, San Francisco.Anal Cancer Information.
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