The bottom line is that we need to open up about our bums

We don’t talk about our bums enough. No, I should be more specific. We don’t talk about our anuses enough. It’s the most intimate part of our body, and it’s connected with some of our most private and vulnerable moments. And yet when it comes to our anus, most of us are completely in the dark.

Take anal hygiene, for example. We talk about washing our bodies and hair with designer scrubs and shampoos because that’s socially acceptable. But very few of us can talk openly about anal hygiene and about how most of us get it very wrong.

Toilet paper is full of bleaches, dyes and preservatives and can cause major skin irritation. And when we have problems with our bottoms, people get overzealous and rub and scratch them more, and they can get into terrible states.

The warning signs for anal cancer are often ignored until it’s too late.Credit: Getty Images

My opinion? Toilet paper – whether bright white and three-ply or off-grey and recycled – is largely unnecessary. For optimal cleanliness and anal health, we should be normalising bidets or toilet bowl attachments in Australian bathrooms.

As one of Australia’s few specialists in the area of anal cancer – running the only anal cancer clinic on the eastern seaboard – I have a front-row seat to how our embarrassment and shame about this most intimate part of our bodies has real-life consequences. Because of society’s unspoken taboos, it’s hard to imagine a condition more stigmatising and more difficult to deal with on a psychological level than anal cancer.

It’s a condition that most people with the disease find deeply embarrassing. Many of my patients don’t even tell their friends and relatives what’s going on. If they do, they’ll describe it as “bowel” or “colon” cancer because they just can’t bring themselves to share their true condition. What an unfathomably isolating and difficult extra burden that must be to bear in addition to their cancer diagnosis.

The embarrassment factor is why people experiencing the early signs of anal cancer often ignore them until it’s too late. Many of my patients have cancerous tumours at least five centimetres in length, with associated pain and bleeding before they can admit they have a problem. It’s also part of the reason why some GPs will make a misdiagnosis – for example, prescribing haemorrhoid cream to treat an itchy or uncomfortable anus when closer inspection is required – simply because they (or they suspect their patient) just doesn’t want to look “down there”.

Toilet paper is full of bleaches, dyes, and preservatives and can cause major skin irritation.Credit: Getty Images

My antidote to this overwhelming cloak of silence and shame about this most devastating disease? Let’s normalise talking about anuses. I will go anywhere and talk to any audience about anuses and staying healthy.

Humour is often the key. My YouTube page is called “Seventh Planet” (spoiler: it’s Uranus). My email avatar is a peach. At the annual Sydney Mardi Gras Fair Day, I have a stall with “George” – a latex dummy with an artificial anus – and invite passers-by to put on some gloves, grab some lube, and insert their fingers into George to try to detect internal lumps and bumps. Hilarity often ensues.

On one occasion, I was invited to a gay nudist event in western Sydney. I stood, fully clothed, surrounded by 100 young, naked gay men in and around a swimming pool while I told them about how to check themselves and what symptoms to watch out for.

We reach hundreds of at-risk men and spread a message of prevention by making it a fun thing. Anal cancer is almost entirely preventable among high-risk groups through screening. Vaccinations for HPV (human papillomavirus) – the cause of anal cancer – will slowly make the disease a thing of the past for most young Australians who receive it while at school.

While anal cancer is rare in the general population, in certain population subgroups – such as gay men or people living with HIV or other immunity problems – the rates of anal cancer are up there with bowel, prostate and breast cancer.

I would love to see a commitment from federal and state governments to fund targeted screening for these groups. But that’s only half the battle. If we introduced screening tomorrow, I wouldn’t have the team needed to manage the deluge of cases that would flow.

I have 400 people on my small clinic’s waiting list. If I did nothing else, it would take nine months to clear. I’m 67. I would like to start thinking about retirement, but there’s no one to take my place. We need to also start bringing on a new generation of trained specialists.

But in the meantime … can we start being more open about our anuses?

Professor Richard Hillman is one of Australia’s few specialists treating anal cancer. He runs the anal cancer clinic at St Vincent’s Hospital in Sydney.

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