I am hiv+ for over 13 years. Upon recent internal examination, my doctor has discovered that my rectum has evidence of hyperplasia and leukoplakia. He wants to do a couple of biopsies. Having had surgeries and excisions in this area before, i know from experience that they can be very painful and bothersome for a considerable time period. Should i be requesting a far less invasive procedure such as a PAP smear or is a biopsy the standard? what is the difference? is one better than the other? thanks for your help. Don

Dear Don:

You ask a great question-- which is better a PAP smear or a biopsy of your butt? A PAP smear is really a screening tool. With a PAP smear, your provider inserts a swab into your butt, removes the cells lining the area, and sends them for an analysis. This is very akin to the cervical PAP smear which has prevented many many women from dying of cervical cancer. If the PAP smear shows abnormal cells, i.e. pre-cancer cells, then the next step is to have someone look up you butt and take biopsies and treat any abnormalities appropriately.

In your case, you have already been diagnosed with areas of hyperplasia and leukoplasia. Unfortunately only a biopsy will tell you and your provider what lies beneath. Although you could have just a painless PAP smear done, you run the risk of having the PAP smear under-report a cancer.

So in short,

PAP smear-- best for screening. A PAP smear tells providers whom they should recommend for further evaluation.

Biopsy-- best for getting an accurate diagnosis.

Good luck! I agree that surgeries and excisions can be bothersome. Not having the surgeries and having to deal with the consquences (i.e., untreated cancer) can be even more bothersome.