CNS: 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.

One of the desired products for anal health and hygiene is the one which can protect people who have receptive anal sex from contracting STIs including HIV, such as rectal microbicides.

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.

Currently under development, rectal microbicides research sadly began much later than that of vaginal microbicides. However now, not only vaginal microbicides are being tested for rectal safety and efficacy but some researchers are even exploring potent candidates for rectal microbicides research.

Jim Pickett, who co-founded the International Rectal Microbicides Advocacy (IRMA) and is the Director of Advocacy, AIDS Foundation of Chicago, agrees: "We have to recognize that these are human needs of people and they must be able to connect to these products [anal health and hygiene products, including rectal microbicides when available after research]." Jim strongly articulated that these anal health and hygiene products must not be medically projected instead should be marketed and made available in a manner so as to be able to connect to the people for whom they are made.

Dr Cranston made a strong case to raise awareness about anal health and hygiene among people practicing receptive anal sex, and develop safe and effective products that can serve the need too. He cited the example of products that line the shelves in shopping malls on vaginal health and hygiene, and similarly it should become acceptable one day in near future to have anal health and hygiene products, said Dr Cranston.