One morning, not very long ago, I woke up to discover that small growth clusters had begun to appear around the base of my penis and testicular area. I panicked and did what anyone with a medical mystery to solve would do – I ran straight to Google. There is a reason we should never self-diagnose ourselves using Google. Based on my findings, by late afternoon, I was almost ready to fly to a village in Kenya to participate in a questionable study of a rare jungle rot that makes your dick fall off. I settled for a more rational and less expensive option by making an appointment with the clinic.
After a relatively quick show-and-tell, sitting in a rolling desk chair, my doctor asked: “What do you know about HPV?” “About as much as I know about changing a transmission, nothing,” I said. “Well, you have it. Human papillomavirus is a virus that causes genital warts and other things,” he replied. “I’d like to schedule you for a Pap smear next week if it’s alright with you,” he said. “A what?” I said as my jaw dropped a little. I felt hot, as blood rushed to my face in embarrassment. “I thought a Pap smear was something to do with menopause and old ladies,” I quipped. “I may be over forty, but I still have a dick. You’ve seen it.”
Whenever I get nervous or uncomfortable, I tend to make jokes to break the tension and hide my inner panic. Usually, healthcare workers are overworked, have heard it all before, and are short on both time and humor. Mine was no different.
Unamused, he continued. “The lining of the cervix and anus are similar. The same type of test is used to examine the anus for cancer or precancerous cell changes.” Still scribbling and scratching on his clipboard, he ended with, “You’re probably fine, but I want to take a look, just to be sure. See you next week.”
And with a flourish of his pen, he tossed me my intake form, then vanished down a hallway of treatment rooms.
“Anal cancer.” Really? I couldn’t get those words out of my head. Dazed, I scheduled my follow-up appointment and made my way out of the building. I kept thinking of Farrah Fawcett and how she died from anal cancer. Sure, I’d love to meet one of Charlie’s Angels, but not up there with other angels. Not yet.
Having genital warts is one of the un-sexiest experiences imaginable. Having them treated is just as bad. There I stood, in the middle of the examination room, with my johnson hanging out, partially “hidden” behind a transparent curtain. At the same time, a nurse, armed with a cryo-gun, fired liquid nitrogen at the viral-spreading, sex-stopping motherfuckers until they froze to death. The satisfaction of watching the unsightly growths wither and fall off did little to mend the holes blown through my dignity and self-esteem.
All sexually active people will get human papillomavirus (HPV) at some time in their life if they don’t get the HPV vaccine. Some people develop signs and symptoms, some don’t, and there is no way to tell who will and who won’t. HPV is the most common sexually transmitted virus, so why don’t we know more about it? Most men don’t know much about HPV because we’re never told much about HPV. By and large, HPV is seen as a “woman’s issue”–no cervix, no problem–proving to be a deadly assumption. The reality is that research and advancements in medicine have proven that HPV and men who have sex with other men (MSM) has become a BIG problem. HPV is responsible for over 90% of anal cancers but can also cause cancer in the head, throat, and PENIS. Yet, currently, there isn’t an approved HPV test for men.
For men, testing, called “screening” to check for HPV or HPV-related disease before there are signs or symptoms, is not recommended by the CDC and isn’t typically covered by insurance; therefore, many healthcare professionals ignore the procedure. Healthcare providers who specialize in treating the gay community, however, know better and offer anal Pap tests to men who may be at increased risk of anal cancer, including men who are HIV+ or men who have anal sex (that’s you, yes?). My anal Pap smear was every bit as awkward as I thought it might be. But nothing compared to what was ahead. An anal Pap smear, also called anal cytology, is the process of collecting cells from the anus to be examined under a microscope in search of cellular changes that can lead to cancer development.
The entire procedure took less than a minute. Lying in a fetal position, with my ass hanging off the examination table, Dr. Love lubed me up with some low-grade lubricant, slid an extra-large Q-tip up my poop shoot, and gave it a couple of spins. As he snapped off his gloves between sentences, he said “We’ll have the lab results in a couple of days.” *Snap* “If we find anything, I’ll call you. “ And the door closed behind him. A person can spread HPV with or without a condom through anal or vaginal sex, oral sex, as well as close skin-to-skin contact, without showing any signs or symptoms.
All men should be concerned about HPV but gay men in particular. Current estimates are that HIV negative MSMs are 20 times more likely, and HIV positive MSMs are up to 40 times more likely to be diagnosed with anal cancer than our straight counterparts.
In the days following my Pap smear, Don Julio and I made the rounds of gay bars in the Hell’s Kitchen Fruit Loop, telling anyone who would listen about my experience and the importance of getting screened for HPV. The topic doesn’t exactly sound like fodder for witty happy hour conversation — but it was. As my jokes improved with every re-telling, I briefly considered taking my act to the Catskills. I won’t lie – I was funny.
Then I heard the voicemail, not funny: “Ryan, your labs came back from the Pap smear; we found something. I need to take a closer look.” “A closer look” meant undergoing a High-Resolution Anoscopy (HRA), which uses magnification to obtain a more detailed view of the anal canal.
This procedure was similar to the Pap smear: fetal position, ass out, inadequate lubrication but instead of a gigantic Q-tip, there was the insertion of a High-Res magnifying camera to inspect my anorectal junction (where the rectum meets the anal canal) for precancerous changes in the cells of the anus. Trust me, these are not the ass pix you will find on Grindr. Lying on my side, waiting for something to happen, I couldn’t help myself. I had to ask, “Do I have cancer?” His reply was very matter-of-fact, “All I can tell you right now is that you have HPV. HPV isn’t cancer, but it can cause changes in the body that, if left untreated, can lead to cancer. When caught early enough, it’s completely curable. Your lab results detected some suspicious tissue, so we’re going to take a look and take a few biopsies if necessary.” So much for pillow talk.
A biopsy is when a doctor removes a small amount of tissue to examine under a pathologist’s microscope. Other tests can suggest that cancer is present, but only a biopsy can make a diagnosis. The HRA revealed that I did indeed have enough significant changes in my anal canal (anal dysplasia) to warrant several biopsies. (Heavy sigh.) “I’m going to take a few samples,” he said, reaching for a dollop of numbing cream. Re-focusing his eyes back onto the camera, he said, “You may feel a slight…”
“Ow!” I blurted out reflexively. “Pinch,” he said, repressing a slight giggle. Imagine if Edward Scissorhands was your proctologist and was snipping off pieces of your butt hole from the inside. Yep. Sounds terrible, feels worse. Again, snapping off his purple gloves in perfect sync to his dialogue: *Snap* “It’s going to take the pathologist a day or so to get back to me.” *Snap* “Try not to worry. Better safe than sorry, right? I’ll call you.” More scribbling and scratching with his pen, then, “Chat soon, Ry.” And he was gone.
It’s times like that when having a boyfriend would come in handy. I didn’t have anyone I could vent to, no one to make awkward jokes with, and no one to hold my hand and listen to how horrifically scared I was. There was no one to tell me, “It’s going to be alright.”
For days, my mind raced. Unlike before, this time, I didn’t tell a soul about what I was going through. Self-deprecating humor is one thing; pity parties are something else. I’m good at compartmentalizing my problems, keeping them under lock and key. Of course, we ask one another daily, “How are you?” But no one gives a shit, so why bother mentioning it? On the outside, I like to look composed and in control, even when I’m an emotional catastrophe on the inside.
My subconscious kept free-throwing ideas into my head — Cancer runs in my family. My father died of cancer; now he’s an angel. Farrah Fawcett was an Angel and worked for a man named Charlie. I have an alcoholic uncle named Charlie. Was this all connected in some way? I didn’t want to die. And, I really didn’t want to die of anal cancer. It’s just not glamorous.
Before learning of HPV, my biggest non-death wish was not to die on the toilet. For all the incredible joy and talent they gave to the world, anytime anyone mentions Elvis Presley or Judy Garland, in the back of my mind, I always think: “Died on the toilet.” I immediately updated my Please God prayer list to include “Not die on the toilet” AND “Not die of anal cancer”.
Two days later, another voicemail: “Ryan, your biopsy results are back. Please call me as soon as possible.” TO BE CONTINUED…