Ask the Experts About LGBT Health
Q: Anal Pap Smears and adolescent males
I am a primary care provider at a high school-based health center and see several gay adolescents for their health care needs. I am wondering if we should start doing screening anal pap smears and what guidelines/criteria should we use? For example, for adolescent females, we start cervical paps 3 years after sexual initiation or by age 21. Would you recommend anything along these guidelines for adolescent males?
A: Response from Dr. Makadon
Dear Colleague,
I think you are raising a good question about use of anal pap smears in adolescents. At the moment, unfortunately, most of what we do regarding anal pap smears is based on analogy to use of cervical pap smears in women, but not on evidence based on research on men. My way of thinking about it is that it makes sense, but the link between HPV and anal cancer has not been proven in men yet. Thus there is controversy about whether to do this at all. See the response I posted in Pap Smears for Men . I would do this if someone is HIV infected, but can only site the speculative literature on what to do in other men. Sorry I cannot be more specific. This is a great example of why we need more research in LGBT health.
Thanks for writing.
Best,
Harvey Makadon
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Forum Experts
 Harvey J. Makadon, MD is Clinical Professor of Medicine at Harvard Medical School and Director of Education and Training at The Fenway Institute at Fenway Health in Boston. He is a member of the Division of General Medicine at Beth Israel Deaconess Medical Center and is the lead editor of The Fenway Guide to LGBT Health, published by the American College of Physicians in 2007. He has long been involved in developing both educational and clinical programs to serve gay, lesbian, bisexual and transgender populations.  Patricia Raney, MD, is a staff physician at Fenway Health in Boston, Massachusetts. She is a graduate of the University of Massachusetts Medical School and is Board Certified in Family Medicine. Her clinical interests include women's health and wellness, primary care, preventive care and the health concerns of lesbians, bisexual women and transgender people. On a more personal note, she is an avid stone carver. |
