I first noticed the mild pain when douching one evening before a winter sex party. Later, during sex, the pain returned, enough to give me pause–a couple weeks go by and it doesn’t go away. I considered the possibilities for my discomfort. 1) An anal fissure from fucking or not douching with enough lube. 2) Hemorrhoids, which I’ve had in the past and can cause pain. 3) STDs, which technically includes 4) My biggest fear: anal warts.
Having been diagnosed with HPV once before, I hoped it was as easy as 1, 2, 3. The removal process wasn’t a procedure I was eager to repeat. I’d had the HPV vaccine, yes, but since PreP’s introduction I’ve used condoms less frequently. Aside from that, HPV can spread from the simple act of foreplay. Was it too much to hope that I was one of the lucky few who–like herpes sufferers–could go for years without any flare-ups or symptoms?
The Uncaring Caregiver
One month later, I was ushered by my gastroenterologist into the office of “Dr. K,” a proctologist with a thriving practice at a major Manhattan hospital. I explained that I ruled out the most common STDs and the pain was still present during sex and douching. Dr. K then laid me on my side for examination. The gloves, the lubed finger, the uncomfortable probing of my butthole. Despite all these things, I was a good patient, even after he put in a little clear plastic stretcher–you know, to get a better look. After what feels like 20 seconds–or an eternity–he declared his diagnosis.
“Yes, I see warts. You have lots of them, and scarring, and hemorrhoids. But mainly warts.”
“Okay,” I quickly replied, my worst fears confirmed, “Can we set up a time to get them burned or frozen off?”
Dr. K explained that first he would need to do a proper anoscopy, and then we could burn them off. “Okay,” I agreed “Let’s do it.” The only facility with the anoscope he uses was at his other office. Not very convenient for me, especially when the next opening was five weeks away. It was frustrating but perhaps expected given the dire state of the US healthcare system. What was unexpected was how little empathy he seemed to have for his confused patient. A patient who had just been told he had a myriad of butt problems and would have to wait over a month to be treated. I tried to ask follow-up questions about safety and partner notification, but was given nothing but confusing responses. When I tried to clarify his points, he seemed frustrated with me for asking so many questions. It was probably a sign of what was to come.
Five weeks later, I sat in Dr K’s office. Ready to remove some warts, and with some healing, replace them with dicks. You can imagine my surprise when Dr. K explained this visit was only to reconfirm his initial evaluation, and perhaps burn a few off if he deemed them easy to do so. Otherwise, it would require anesthesia and another visit.
Disappointed after waiting so many weeks, I nonetheless hopped on the bench, got in position and allowed this man to open me up again. “Relax,” he told me, as he pointed to the screen projecting my insides, a red dye test to the affected area, and warts he claimed to see. “Scaling,” as he called it. Warts so great in number they coalesce into a sort of wart wall. How deeply mortifying.
He offered to burn a few off right then and there, but didn’t offer any type of anesthesia–not even topical. The burning metal wand fired up, he made his first attempt with success. Maybe, I thought, I can get this all done here without having to be put under. Then he went for a wart deeper inside.
That’s the sound one makes when being burned internally. Dr. K seemed unsympathetic, saying that’s what the additional appointment was for. The general attitude of he and his assistants, I sensed, was you deserve this. That’s not my gay shame speaking, either, it’s because I saw them for who they were–upselling shame mongers hungry to bill my insurance plan for everything it has. Nevermind that I suffered subpar sexual health treatment most of my life, or that now I required painful, expensive procedures. No, shame was helpful for them, shame increased their business. It was time for me to get a second opinion.
Finding Doctor Right
That’s how I first met Dr. Evan Goldstein, a gay proctologist and anal surgeon whose Bespoke Medical practice is acclaimed for its scientific methodology and alternative treatment approaches. After confirming that Dr. Goldstein would take my insurance, I made an appointment and was seen within a week.
Having a gay doctor makes all the difference. I learned that years ago when I left my straight therapist for a gay male doctor. I was reminded again, sitting in Dr. Goldstein’s well-furnished office. He brought me into his exam room and once again I removed my pants and underwear, and turned on my side. Dr. Goldstein explored, first with his finger, then with a scope. At each step he explained what was to happen next. He understood that the process was uncomfortable and intimate, and knew that I’d just come from a horrible experience with a doctor who preferred to keep me confused, in the dark.
After Dr. Goldstein took a closer look, he told me I could put my shorts on and return to his office. The diagnosis came as a complete surprise. “You don’t have warts,” he insisted. I was shocked. But what about Dr. K’s diagnosis? What about the anoscopy, the red dye, the scaling, the needing to be knocked out for the great burning?
“I didn't see any warts. I didn’t feel any. I don’t see anything that warrants concern or a medical procedure.” And it all made sense: the pain I felt in February? Gone. I didn’t even experience it when he did the probe. In fact, the last pain I felt in my butt was the burning that Dr. K inflicted on me–without cause, I was then learning, as the fury built up inside me.
I returned to the anoscope and the dye. How could one doctor make such a precise diagnosis and have it turn out to be untrue? Dr. Goldstein explained that so many use acids and dyes to better understand the anal architecture and that he always finds that very subjective. “What I think is a Picasso, you think is Renoir.” Dr. Goldstein explained. As a result, just like in prostate surgery, specialists created a grid system of biopsying so that regardless of what you think, you must abide by the standards.
Dr. Goldstein implemented that into his practice of mapping the anal canal in a specific way regardless of staining. What was more likely, he shared, was that there are certain cells that fuse together, whether from scarring or tissue changes as a result of things like hemorrhoids or getting deep dicked on the regular. Those are the things that can be seen or shown to a patient on a dye-filled anoscopy screen. A patient like me would have no idea whether they were in fact anal warts, or not.
Dr. Goldstein takes a pap smear to test for HPV. It’s a worry for me, as there is a cancer-causing type and a previous colonoscopy saw the removal of a precancerous adenoma. I realized then that Dr. K never even offered to give me an anal pap smear, and my anger increased.
Dr Goldstein insisted–as I know–that most everyone has some form of HPV and that even if it did come back as high risk, it’s not something that I need to be ashamed of or carry around like a scarlet letter. “You can go out and enjoy yourself,” he insisted, and I felt like breaking down in tears. He encouraged me to read an article he wrote for The Advocate on HPV and to email him with any further questions, which I took him up on in the coming weeks with ease and no sense of frustration.
I left Dr. Goldstein’s office in a daze, simultaneously grateful, stunned, and angry. Grateful, of course, because I didn't have warts, and to finally have a butt doctor who I trusted. Stunned because I couldn’t believe I spent so many months, beyond anxious, and denying myself sex. And lastly angry at Dr. K, who treated me like an easy mark–an anxious slut he could bill by ordering him to have a surgery for something that didn’t exist.
A week after our appointment, Dr. Goldstein called me with the results of my anal pap. Yes, I had HPV cells detected, but there were no cancerous HPV cells. And of course, no warts, that diagnosis held. Dr. Goldstein recommended monitoring the area and coming back in three months for a follow-up check up. In the interim, I’ve done some feeling around myself, and I have to agree, I don’t feel anything remotely resembling a wart. And weirdly, there’s no pain anymore. Was it all a bad dream? If so, I consider myself lucky to have woken up just in time, saved by my own instincts and a gay doctor who views bottoming and anal pleasure as necessary components to a well-rounded life.