HPV Vaccinations & Anal Pap Smears for Gay Men

What do I need to know about HPV as a gay man? Let’s talk about anal Pap smears.

It’s a common misconception that HPV Pap smears are only available to women*, leading many men* to believe that there’s no reliable testing method for them. However, a full HPV evaluation should be standard during everyone’s yearly physical examination. Notably, for gay men and those who engage anally, the virus can be detected with both an anal swab and Pap smear.

Since the majority of us are both oral and anal individuals, oral testing should be done as well, and can allow for yearly surveillance with prevention of developing oral cancers. In theory, the vaccine would be protective on this front, as well.

How exactly is HPV contracted and what are common symptoms?

HPV is the most prevalent sexually transmitted infection in the U.S., with up to 14 million people infected yearly. It is transmitted simply via skin-to-skin contact, which means all the things we love to do—licking, rubbing, kissing, and fucking (with or without condoms)—come with risk. Most people do get exposed at some point in their lives, yet are not even aware of it.

A minority of individuals can develop some manifestations of the infection, the most common being anal or genital warts, which one will notice when new bumps develop in the genital or oral region and/or bleeding and itching occurs in the affected area. These symptoms should warrant a comprehensive internal and external anal evaluation by a professional who specializes in gay men’s health.

Is the HPV vaccination right for everyone?

Understanding one’s subtypes of the virus allows for better characterization of which specific strains of HPV one is harboring. With this, the Gardasil vaccine currently has 9 subtypes of protection, specifically high-risk types 16 and 18—the two that have been linked to the development of anal cancers. If you are tested and negative for any of the subtypes in the vaccine, then the vaccine would be protective and should be obtained.

Other factors that should be taken into account when determining whether or not the HPV vaccination is right for you are as follows:

• If you are a bottom, more friction and injury occur where the virus could be spread

• How old and sexually active you are to determine not only risk of contraction, but also subsequent development of anal issues associated

• If you are in an open relationship in which the risk of new exposure of the different HPV types would be elevated

How much do HPV vaccinations cost?

Despite the availability of the HPV vaccination, the biggest obstructions to obtaining the three-shot series are lack of both physician and individual knowledge, as it pertains to the subject, as well as cost (between $200-$300 a shot), since insurance companies only cover for the ages of 26 and younger. Although the full vaccination can cost you up to $900, we urge all gay men to take the best preventative measure possible given the prevalence of the disease in the LGBT community.

What should I do if I’m diagnosed with HPV?

A diagnosis of HPV can lead some people to feel as though they should get “HPV” tattooed across their forehead, but there is really no need for such an extreme declaration (this ain’t no Scarlet Letter)! You should not feel dirty, shameful, or demeaned in any way. And, most importantly, you should not feel for one second as if you are restricted to being a top or are in any way less entitled to being a bottom.

The human papillomavirus (HPV) is relatively commonplace in our gay community, and its very existence, unfortunately, leads to medical, emotional, and sexual ramifications. Through all my years as a medical provider, I have found that people are too quick to internalize their diagnosis and feel guilt and embarrassment. I cannot stress enough that HPV is not meant to define you or to criticize your sexual habits.

What are HPV treatment options?

Treatment can consist of localized creams for external disease, freezing or burning of both internal and external lesions (depending on the extent, either in the office or an operating theatre), or a combination of both modalities. All should be followed by the HPV vaccine if you have not already obtained it.

I tell clients that anal warts are like “barnacles on the tail of a whale.” The whale doesn’t even know that they exist. If it did, the whale would easily flick them off. The same goes for warts on the top layer of cells of our ass—the body doesn’t know they exist. The above treatment modalities allow your body to create an immune response as a defense against recurrence and the possibility of cancer development.

Once one has completed treatment, I cannot stress the importance of serial follow-up. In the immediate period following infection, standard evaluation should occur every three months for continued surveillance. Then, over time, this can be relaxed to only once a year. Aggressive early management allows for complete eradication, which limits recurrence.

* reference to cisgender men and women

Header image illustrated by Marcy Gooberman

Must be looooooove on the braaaaain 🧠. Or was that s£x? 👀🤭 Our brains are our largest s£x organs and sometimes they get a little sad, hyperactive, anxious, or overwhelmed. You won’t always be in the mood for s£x and that’s okay! Keep communication with your partner open and ongoing, check in with yourself and your mental health, and lean on the support of a trusted therapist or doctor if you need some extra guidance. 🫶🏽 Anything you would add?

I mean 😏

It is not wrong nor should it feel shameful to ✨seek pleasure.✨ I think those of us who grew up more religious were taught that you should always be in service of others and giving of yourself rather than concerned with our own needs or passions. While it is wonderful to be generous with giving (and can in fact be a source of pleasure), it should be equally encouraged to pursue your own pleasure — it whatever form it may take! It may feel self-indulgent, but why is that a bad thing? Pleasure boosts our mental health. It helps us cope with a difficult world, with anxiety, depression, and stress. It makes us feel good! It gives us something to look forward to. Pleasure helps us connect with others and with ourselves. Pleasure (as long as it is not at the expense of someone else’s safety or well-being) should be a priority, for our joy and for our health. It really is so important! Where do you find pleasure? I personally love a good massage… 💆🏽‍♀️

It’s time for a talk, friend. Let’s be clear, you nor your partner ever has to do *anything* you’re not comfortable with. That said, if it’s something you enjoy and that’s pleasurable to you, it’s okay to ask your partner for it! They can say no, but if they invalidate your pleasure, much less expect you to do something they won’t do?? The ball is then in your court to decide if this is the partner for you. You deserve someone who cares about and prioritizes your pleasure. Who is thrilled to be acquainted with your body, all of it! S-x can be vulnerable to talk about, but when you do…it’s so much better. 👅 included. Ask your partner what their hesitations are and have a *conversation.* Maybe they’re nervous, intimidated, or struggling with shame. Maybe they’re down to try other things you would enjoy and build up to it. The point is, it shouldn’t just be automatically dismissed. You can decide what’s right for you and what makes you feel aroused, validated, and appreciated. Whatever you do, don’t internalize their rejection. Your body is beautiful, desirable, and definitely worthy of pleasure. 😋🥰

A UK study published in the International Urogynecology Journal found that only 46% of participants correctly identified that a female has 3 holes in the external genitalia. 😬 Not great. We’re taught so desperately little about our bodies and so discouraged from exploring them that we don’t even know what we’ve got going on down there! Understanding your own anatomy (and getting educated on your partner’s anatomy) can boost pleasure 1000x!! So take a mirror, use your hands, and get comfy exploring! 🪞🕵🏽‍♀️ And if you really want to get informed (and inspired 😉), head to our website for our basics on pleasure and anatomy. What do you think? Could YOU correctly label a diagram of what lies beneath?

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