A careful anal exam is an important part of a yearly physical. A digital rectal examination and anoscopy should be performed whenever there are rectal symptoms such as pain, bleeding, itching or hemorrhoidal complaints. All hemorrhoids, inflammation and local anal disease should be examined by a physician with a special interest in anal or rectal disease. And all lesions in the area should be biopsied no matter how benign-looking they are. In HIV+ patients an anal Pap smear; anoscopy if Pap smear is abnormal. Anal Pap smear: A large cotton swab is gently placed about 1¬Ω to 2 in. (4 to 5 cm) in the anus and rotated as it is withdrawn to obtain samples of tissue for analysis.
