via Citizen News, by Bobby Ramakant

For how long will anal health and hygiene be neglected?

“It is high time that anal health [and hygiene] comes out of the closet” said Dr Ross Cranston, Assistant Professor, University of Pittsburgh, USA. Dr Cranston was referring to the multitude of anal health complications people practicing receptive anal intercourse are likely to be dealing with in their lives and very little quality care and products that exist to relieve them. Dr Cranston was speaking at the International Microbicides Conference (M2012) in Sydney, Australia. According to the UNAIDS, United Nations joint programme on HIV/AIDS, men-who-have-sex-with-men (MSM) are at a high risk of HIV around the world.

Many countries such as those in Africa who had earlier reported no significant HIV rates in people with same sex behaviour, have reported alarming HIV rates in recent past.

Although ‘anal’ and ‘rectal’ words are used as synonyms, but they aren’t same – and rather refer to different parts biologically. Anal canal is distinct from rectal canal with a unique set of diagnosis. Rectal canal is made up of columnar epithelial cells and anal canal is made up of stratified epithelial cells. Anal canal is also a high pressure environment with about 77 mmHg pressure when sphincters are resting and 180 mmHg pressure when sphincters constrict. In contrast, pressure in human vagina is 0 mmHg in resting phase.

Anal canal is very sensitive to hot, cold, wet, dry, light touch, pin prick, distension, pleasure or pain, however rectal canal is only sensitive to distension, pleasure or pain.
The incidence of adverse events in rectal microbicides studies is quite high with 11% symptoms and signs of anal adverse events in anal canal and 13% in rectal canal. These adverse events include prolapsing haemorrhoids (piles), anal fissure, anal fistula, anal abscess, anal warts, anal or rectal canal cancers, fungal infections, herpes simplex virus (HSV) infection, or sexually transmitted infections (STIs).

The need for right awareness in healthcare providers and their appropriate training is acute as often anal adverse events are misdiagnosed or ill-treated.

The awareness level in people (men and women) who reported to practice receptive anal intercourse was abysmally low. Zero per cent of such respondents had knowledge related to their anal cancer risk, and just half of them knew about HSV. Awareness certainly needs to be upped in people practicing receptive anal sex.

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More safety data needed on lubricants used in anal sex

There is a growing realization that there is a significant issue of HIV acquisition through anal intercourse not only for men who have sex with men (MSM) who are clearly very visible HIV high risk group but increasingly for women who may be exposed to the virus through anal intercourse with their male partners. Also in recent studies, most people (men and women) who practice anal intercourse reported using some kind of a lubricant (such as gel, cream, or saliva among others).
So when the ongoing rectal microbicides research yields a safe and effective rectal microbicide towards later half of this decade, then rectal microbicide could be added to these lubricants as most people practicing anal intercourse are already comfortable with using lubricants, said Professor (Dr) Ian McGowan, Co-Chair of International Microbicides Conference (M2012) in Sydney, Australia; Professor, University of Pittsburgh School of Medicine, and co-principal investigator, Microbicide Trials Network (MTN).

Rectal microbicides are products that could take the form of gels or lubricants – being developed to reduce a person’s risk of HIV or other sexually transmitted infections (STIs) through anal receptive sex.

“What we have seen at this conference is that there is a growing evidence of MSM populations in African nations and HIV rates are alarmingly high in them” said Dr McGowan.
As per published data, not only MSM, there are number of women as well who reported to have anal sex. According to the data from a study in San Francisco, US, very high lubricant use was reported (89%) among those MSM who were practicing anal intercourse, said Dr Shauna Stahlman from Department of Epidemiology, University of California, Los Angeles (UCLA).

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article’s content, whether in support or in opposition.]