[Question #1782] Anal Condyloma Surgery

42 months ago
This is my third and hopefully last question. My parents have found out and encourage me to use their plan, so I now only really have once concern before I set up a surgery date. I've heard from other online sources that some people who get laser removal are left with scaring, desensitivity, or decreased pleasure or ability to have anal sex. Warts in one spot in particular, around the area under in the ears of the sphincter that's next to the perinium, seems very sensitive in an almost pleasureable way, and I'm worried removal will affect my ability to have anal sex in the future by either damaging nerve endings, decreasing the thickness of the membrane, or covering the area with scars. So I'd like to ask what the common and rare side effects of anal wart removal surgery typically are, and wether there are any incidents where patients have complained that their surgery had altered their ability to either have or enjoy anal sex. Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome back. Your question arrived while I was logged in. Most users shouldn't expect nearly real-time replies!

I'm glad your parents are on board and that the insurance issue is resolved. (Without being too overtly political, I hope adult children's coverage continues under whatever becomes of Obamacare under the non-leadership of our so-called president.) (That wasn't too political, was it? OK, a little bit...)

Unfortunately, however, this forum is not the best source for these specific questions. Neither Dr. Hook nor I, nor our clinics, do rectal warts surgery. We have no experience with these details, and I cannot say anything about the frequency of scarring, desensitivity, or future anal sex. My general belief is that most patients recover fully and don't have ongoing problems with sexual function -- at least, I don't recall any clinic patients with such complaints, after my clinic referred them to proctologists or colon and rectal surgeons. But I can't say more -- I'll check to see if Dr. Hook has more information, but don't count on it. You'll do better to have a frank conversation about it with your surgeon. Also, don't hesitate to ask him or her for referral to another surgeon for a second opinion on this, perhaps including information on the specific surgery s/he would recommend.

Sorry I can't be more helpful. Best wishes--  HHH, MD


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42 months ago
Thanks for your help! I'll be sure to talk to my surgeon before I set a date. Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Dr. Hook reminds me to say that surgical outcomes often depend on the experience of the surgeon. Before deciding on a specific surgeon, ask direct questions about how often and how many anorectal wart removal procedures they have done. In general, the more the better. You can also ask frequency of side effects and complications, but answers are more difficult to judge. We also advise gay men among our clinic patients to consult with local gay rights or social support agencies, which exist in most if not all urban areas. Those in your area likely will be able to recommend surgeons with the greatest experience and satisfaction of previous patients -- including their sensitivity to their patients' lifestyles and sexual orientation. You may have already done much of this sort of homework.
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42 months ago
So I did talk with my colorectal surgeron. She said there was no way the warts would ever go away on their own and could possibly turn cancerous, hence why she recomends all anal warts get removed immediately. However, when I asked her about sideeffects she said that some damage to sensitivity is to be expected and that anal stenosis is a possible consequence of multiple surgeries, which is usually needed anyway since the warts come back very often for these types of surgeries. I'm at a loss of what to do. I was under the impression if I waited long enough they'd go away on their own, but she seemed very vehement that this wouldn't happen. That leaves surgery, but with all the awful sideffects I'm scared to have it. Is anal stenosis an easily treateable condition if it crops up, or will it be a permanant disability?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
With apology, I cannot help with these questions. First, as I said above, I am not a surgeon and have absolutely no experience counseling patients on these issues. This kind of care is not provided in STD clinics or by most STD specialists. Second, even if I had that experience, I couldn't help. This is not a health care delivery service. We provide general information and sometime guidance, but we cannot and will not advise persons about medical care decisions. As I suggested above, your best bet probably is to ask for referral to another colorectal surgeon or proctolotist for a second opinion; or perhaps find a physician with lots of experience treating gay men, who should be pretty easy to identify in most urban areas.

I will say that your surgeon is simply wrong about the natural history of anorectal warts, or you misunderstood. Such physicians see a very biased sample of patients:  the ones with spontaneous resolution of warts do not need or seek their services. And many of their patients have first tried several non-surgical treatments first, so they mostly see the minority who don't respond or with unusually long lasting warts.

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42 months ago
This is a link to the ASCRS page that my colorectal surgeon told me to check https://www.fascrs.org/patients/disease-condition/anal-warts-and-anal-dysplasia-expanded-information which says that anal warts will not go away on their own. I've seen this sited on a lot of other colorectal surgeon websites, using the exact same wording so I assume they all got it from this source. I really don't want to have anal surgery and risk losing my ability to enjoy anal sex, but I don't want to wait for them to go away on their own when they won't and might cause cancer.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
As I have said, it simply is untrue that warts do not clear up on their own. They do. As I also said, information from surgeons who treat anorectal warts often does not reflect the true spectrum of disease. There are numerous other sources about genital warts that you probably should explore, including CDC (www.cdc.gov/std) and the American Sexual Health Association (www.ashasexualhealth.org). But this is not a debate and I'm not going to discuss it further.

I would also say you are overreacting to possible but probably unlikely side effects of the recommended surgery. If I were in your circumstances, I would go ahead with surgery as recomended.

That concludes this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about your anal warts and their treatment will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tend to prolong users' anxieties; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

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