I have high grade anal dysplasia. My colorectal surgeon does a visual inspection every 4 months to see if there are changes. He does not do HRA and has never done an anal pap to see if I have developed into full blown cancer. Do you recommend an anal pap for people with dysplasia? IF so how often? SHould I be getting high resolution anoscopy done as well? I don't trust that a plain visual inspection of the perianal area is good enough to detect changes.

I agree that given high grade dysplasia was found already, more sensitive testing than visual inspection alone should be performed. You could start with an anal pap, but that is best performed by someone who knows what they are doing and has access to a lab that is familiar with interpreting the results.