The result of my biopsy identified pre-cancerous cells, and treatment would be necessary. The cherry on top of this HPV sundae–I also had a fistula in the lining of my rectum.
“A what?” I asked, immediately returning his call. In a rather pre-occupied tone, I was told: “A fistula is an abnormal passage that sometimes forms from the anal canal to the skin near the anus. Several factors can cause fistulas. They are relatively common, but I’m going to refer you to a specialist who can better explain things to you.”
The next stop on my HPV Ass train was to see Dr. Stephanie Chan, Doctor of Oncology at Mt. Sinai Hospital. Oncology is a branch of medicine that deals with the study and treatment of tumors. Dr. Chan also specialized in issues and diseases of the anus. (Who voluntarily chooses this as a profession??) Walking into an oncology office is always weird for me, but stepping in as a patient is downright frightening. I likened the waiting room to the lobby of a five-star roach motel in a macabre sense: people walk in, not everyone walks out.
I sat, leafing through a magazine, oblivious to its contents, lost inside my thoughts: “Did God get my updated prayer sheet?” “Is there a prayer back-log?” “Would passing through Sunday mass now and again move things on a bit?”
“Mr. Rockford?” a voice asked from the other side of a grand oak doorway. “This way, please.” As I walked through the doorway, the nurse asked, “Is there anyone else with you?” “No,” I said. “Should there be?” “Not at all, but most people usually bring a friend or family member for support or to ask questions,” she said, shuffling me into a waiting room. “Sorry. Just me,” I said, reminding myself of just how alone and lonely I was feeling. The two are not the same, but today, I was both. “Disrobe, please. Opening towards the back, and Dr. Chan will be with you shortly,” the nurse said, quietly closing the door.
While changing, I couldn’t help but notice that this was a vast and pimped-out examination room, resembling more of a movie set than an oncology office. Everything was wired and connected to something. There were several types of high-resolution cameras on booms and the kind of super-bright, adjustable lights that you see in operating rooms. Mounted upon one wall was a high-definition 54-inch flat-screen TV, great for movie watching. Before I could remember my Netflix password, there were two quick knocks before the exam room door swung open.
“Mr. Rockford? I’m Dr. Chan.”
I don’t know what I was expecting an oncologist who specializes in looking up people’s poop-shoots to look like, but this wasn’t it. Dr. Chan was Chinese, gay, and vertically –challenged enough that she could almost be considered a ‘little person.’ Picture a very short, stocky, Asian dyke with a linebacker’s build and a rich, baritone voice who spoke perfect English and wasn’t much for small talk. I seriously doubt that “Stephanie” was her given name, but I’m the one whose ass is hanging out, and she’s the one with the degree, so my note to self was STFU.
“Mr. Rockford,” she bellowed, “I’ve read your chart and spoken with both your primary care physician and your pathologist. I examined your slides. It appears that you have some anal cell dysplasia and a fistula that needs attention. I’m going to need to take a look, so please lie on the exam table while Linda (nurse) adjusts the cameras,“ she said.
At that moment, a VERY high definition video feed of my butt-hole hovered above me on the large television screen. Dr. Chan continued, “I don’t know if you’re aware of this, Mr. Rockford, but Mt. Sinai is a teaching hospital. So if it’s ok with you, several of our oncology interns are going to be observing your exam today.” “Uh…ok,” I muttered as five wide-eyed interns filed in, eager to get a front-row look. A few moments after slathering some KY jelly onto her doll-sized hand and barreling towards my anus, I could feel Dr. Chan knocking at the back door. As if she were surprised, she said, “Try and relax, Mr. Rockford, you’re so tight.” “Could I get that in writing?” I asked. The joke landed with the interns, not so much with Stephanie. “Rough room,” I thought.
What followed was a very extensive, detailed, dynamic, and humiliating public viewing of my colon and rectal tissue. I’ve always thought it best to leave an audience wanting more, but in this case, I just wanted the audience to go. Eventually, Dr. Chan and I sat down for a little one on one. “Mr. Rockford, I’m not one for small talk, so with your permission, I’ll cut to the chase,” she said. Not at all waiting for my response, Stephanie kept rolling, “Aside from the fistula, you’re dealing with a type of anal dysplasia in your rectal tissue, resulting from an HPV infection. If left untreated, the chances are that the tissue will become cancerous. Have you heard of the actress Farrah Fawcett?” “Of course!” I snipped. My anxiety level was skyrocketing. “Farrah Fawcett died of anal cancer. I don’t want to die like Farrah Fawcett, and I don’t want to die on the toilet, so what do I do?”
“Well…” Dr. Chan continued, “Ideally, we would schedule you for a surgical procedure requiring anesthesia. Once you’re under, I’ll sew up the fistula. Then we’ll torch the infected anal and rectal tissue, destroying anything suspicious. The procedure is very effective. I will be honest and tell you that the days following surgery are not pleasant, but the upshot is you’ll emerge with a bright, new, shiny anus.” “Would I be getting the male version of Vaginal Rejuvenation?” I asked. “I wouldn’t necessarily phrase it that way but, you’re not wrong,” she said. “As for your toilet issue, my guess would be to consult a plumber,” she said with a wink. My God! An Asian, mini-me-sized linebacker lesbian who possessed Barry White’s voice, with a sense of humor?! This woman was indeed an anomaly of biblical proportions.
I scheduled the surgical procedure, and I was on my way to a cancer-free, brand new butt-hole. I was happy to learn that the surgery was a one-day, in-out procedure (no pun intended). Upon consultation with my anesthesiologist, I made sure to request the maximum dosage allowed by law.
Before being wheeled into the operating room, I was put into an ass up, face down pre-surgical position. As the nurse locked my gurney into place, I noticed that Dr. Chan’s surgical assistant was one of the most beautiful men I had ever seen. And there I was, ass up, face down and sucking up anesthesia as fast as I could, anxious to commit this entire ordeal to that of a bad, bad dream. Post-surgery, I woke up from the anesthesia on my back, wearing a pair of disposable mesh underwear that were surprisingly hot, in a fetish sort of way. I managed to talk the attending male nurse into scoring me an extra pair. Once I was alert and proved that I could urinate on my own, I was released with a complimentary bag of lidocaine and stool softener.
Dr. Chan wasn’t lying when she said the post-surgery recovery would not be awesome. It was downright excruciating, requiring much more lidocaine and stool-softener than anyone would have thought. Frankly, after the first few post-surgery bowel movements, my toilet bowl looked like the site of the St. Valentine’s Day massacre. But in the end (pun intended), it was worth it. As of this writing, thanks to annual check-ups and adequate education, I am cancer-free. Had I not had a doctor who knew my sexual orientation and history and knew the risks of HPV in gay men, I doubt I would still be here today.
I’m thankful to share my experience with you in the hopes that you, too, will become more aware of HPV and be pro-active in getting yourself and those around you tested.
The medical field, in general, is not trained or encouraged to test men for HPV or HPV-related issues. If your PCP isn’t gay or doesn’t regularly treat members of the gay community, consider switching doctors. Straight male doctors are likely to be less informed and less interested in pushing for or scheduling men for Pap smears/HPV screenings. Often, physicians aren’t up to date with the specific challenges that the gay community faces. Many insurance companies do not advocate or cover HPV screening for men regularly unless prescribed by a physician. It’s essential to consult with your physician and insurance company to find the most cost-effective way to receive the proper medical care you pay for and deserve. It’s vital to openly discuss your sexual orientation, HIV status, and sexual activity with your doctor. When both parties are well informed, a more comprehensive healthcare strategy can be devised. This open two-way conversation does not happen often enough.
The bottom (pun not intended) line: All sexually active people will get HPV at some time in their lives if not receiving an HPV vaccine. Although most HPV infections go away on their own, without causing problems, HPV can lead to genital warts or cancer. Men who have sex with men should receive regular HPV screening via pap-smear. HIV+ individuals should get tested every 1-3 years, and HIV – individuals should be tested every three years. HPV is the most common sexually transmitted virus. Yet, most young gay men do not fully grasp their risk for HPV infection due to a lack of healthcare providers’ information. Don’t become a statistic. Educate yourself and those you love about HPV.
The most tragic deaths are those that are preventable. Be smart. Get tested. Thank you for reading. Until next time.