Wanting to find a reason to chicken out of anoscope

Hello, Mollymaude. If you don't want a procedure done or don't want the person scheduled to do it, just say, "No". Medical care is just like any other consumer service where you pick what's done to your body. If you can find a provider to do as you wish, go for it!

My local colorectal surgeon didn't do an anal pap until I specifically asked him to. I am being treated by Memorial Sloan Kettering Cancer Center in NYC, mainly because I can't abide the local MDs' provincial attitudes.

I don't know about high resolution vs regulations and scope, but I didn't find it painful.  Just relatively minor discomfort.    It was easier than expected.  If you can find a good provider , preferably high resolution, it might be a good additional monitoring tool.

I've never had an HRA or an anal pap; neither are mentionned in the NCCN Guiudelines, although I think  in some places (ie dysplasia clinics at UCSF and other places they are performed)  Some of the women that post at Blogforacure.org (the anal cancer forum have had HRA; I believe that they sought them out on their own and it was not  prescribed by their doctors.

https://www.analcancerfoundation.org/ the foundation has information on anascopies and a list of Drs who perform them.  I have found one or two articles these procedures and the pros and cons of using them for screening.  

Screening, Surveillance, and Treatment of Anal Intraepithelial Neoplasia Kevin C. Long, MD1 Raman Menon, MD1 Amir Bastawrous, MD1 Richard Billingham, MD1 1 Swedish Colon and Rectal Clinic, Swedish Medical Center Department of Surgery, Seattle, Washington Clin Colon Rectal Surg 2016;29:57–64. Address for correspondence Kevin C. Long, MD, Swedish Colon and Rectal Clinic, Swedish Medical Center Department of Surgery, Seattle, Washington Clin Colon Rectal Surg 2016;29:57–64. Address for correspondence Kevin C. Long, MD, Swedish Colon and Rectal Clinic, 1101 Madison Street, Suite 510, Seattle, WA 98104 (e-mail: kevin.long@swedish.org).

Clin Colon Rectal Surg. 2016 Mar;29(1):57­64. doi: 10.1055/s­0035­1570394. Screening, Surveillance, and Treatment of Anal Intraepithelial Neoplasia. Long KC , Menon R , Bastawrous A , Billingham R . Abstract The prevalence of anal intraepithelial neoplasia has been increasing, especially in high­risk patients, including men who have sex with men, human immunodeficiency virus positive patients, and those who are immunosuppressed. Several studies with long­term follow­up have suggested that rate of progression from high­grade squamous intraepithelial lesions to invasive anal cancer is ∼ 5%. This number is considerably higher for those at high risk. Anal cytology has been used to attempt to screen high­risk patients for disease; however, it has been shown to have very little correlation to actual histology. Patients with lesions should undergo history and physical exam including digital rectal exam and standard anoscopy. High­resolution anoscopy can be considered as well, although it is of questionable time and cost­effectiveness. Nonoperative treatments include expectant surveillance and topical imiquimod or 5­fluorouracil. Operative therapies include wide local excision and targeted ablation with electrocautery, infrared coagulation, or cryotherapy. Recurrence rates remain high regardless of treatment delivered and surveillance is paramount, although optimal surveillance regimens have yet to be established. anal intraepithelial neoplasia; carcinoma; human papillomavirus