Post-Electrosurgery Concerns: Managing Anal Warts and Bleeding

After electrosurgical treatment for anal warts?

Hello Dr.
Hou, I underwent electrosurgery to remove warts in February of this year.
Four weeks after the surgery, I had sexual intercourse with a friend, and during anal intercourse, there was a significant amount of bleeding (this had not occurred before the electrosurgery).
I thought it might be due to the wound not being fully healed, so I refrained from sexual activity for three months.
Recently, I resumed sexual activity, but during the first anal intercourse, there was again a significant amount of bleeding.
I am unsure if this situation is related to the previous electrosurgery or if it is simply due to not having anal intercourse for a long time.
This issue is very concerning for me, as my partner often gets frightened by the amount of bleeding (even though I personally do not feel any particular discomfort; I just feel a bit uncomfortable at first after not having anal intercourse for a long time, but it goes away).
Additionally, I have a small recurrence of warts near my anus.
My primary care physician (not the surgeon who performed the procedure) said that there is no need for an internal examination with an anoscope because the warts only occur near the anal opening.
However, the surgeon who performed my procedure always used an anoscope for internal examination, which makes me a bit worried.
Should I consider seeing another doctor for an examination? Lastly, regarding the small recurrence of warts, can they be treated solely with topical medication? If topical treatment is an option, can it be done at a regular clinic, or does it need to be at a regional hospital or higher level to have the necessary medications? If I see a dermatologist, will they be able to apply the treatment to the deeper areas (as I can feel 1-2 small bumps just inside the anal opening)? The cost of Wartec is quite high; if it were just a monthly treatment, it would be manageable, but multiple treatments would be financially burdensome.
I have consulted two colorectal specialists and one infectious disease doctor, but they each have different opinions, which is quite confusing for me.
Should I consider switching to a dermatologist? Is the treatment of warts more within the expertise of dermatology?

Chris, 20~29 year old female. Ask Date: 2010/05/16

Dr. Hou Yongji reply Surgery

1.
Regarding bleeding after anal intercourse, it may be related to previous electrosurgical procedures or a prolonged absence of anal intercourse, necessitating further examination for a definitive diagnosis.
It is recommended to have the surgeon who performed your procedure conduct the examination.
2.
Typically, genital warts are transmitted through direct contact and are primarily found on the skin, with rectal mucosal involvement being rare.
Therefore, an anoscopy is usually not required.
However, if you believe an anoscopy is necessary, you can consult the surgeon who performed your procedure for a detailed examination.
3.
Generally, if the genital warts are larger than 5 mm, topical treatment may be attempted.
This treatment is usually administered by the patient themselves or with the assistance of friends or family, as very few clinics or hospitals provide topical treatment services.
It is advisable for you or your relatives or friends to assist in applying the medication.
4.
Dermatology is indeed more specialized in this area, so please consult a dermatologist for evaluation and treatment.
Wishing you good health.

Reply Date: 2010/05/16

More Info

After undergoing electrosurgery for anal warts, experiencing significant bleeding during anal intercourse can understandably be concerning. It is essential to address this issue with a comprehensive understanding of the healing process and the potential implications of your symptoms.

Firstly, it is not uncommon for patients to experience bleeding after anal surgery, particularly if the area has not fully healed. The electrosurgery you underwent may have left delicate tissue that is still in the process of recovery. Engaging in anal intercourse too soon after surgery can lead to trauma to the healing tissue, resulting in bleeding. If you have not engaged in anal intercourse for an extended period, the tissue may also be more sensitive, which could contribute to the bleeding. It is crucial to allow adequate time for healing, which can vary from person to person, and to consult with your healthcare provider about when it is safe to resume sexual activities.

Regarding the recurrence of anal warts, it is essential to follow up with your healthcare provider. While your current doctor may not see the need for an internal examination with an anoscope, it is understandable to seek a second opinion if you feel uncertain. An anoscope can provide a more thorough assessment of the anal canal and rectum, ensuring that any warts or lesions that may not be visible externally are identified and treated appropriately.
As for the treatment of the small warts that have recurred, topical treatments can be effective. However, the choice of treatment should be guided by a healthcare professional. While some clinics may offer topical treatments, it is advisable to seek care from a specialist, such as a dermatologist or a proctologist, who can provide the appropriate medications and guidance. Treatments like imiquimod or podofilox are commonly used for external warts, but their effectiveness can vary based on the location and extent of the warts.

If cost is a concern regarding treatments like Wartec, discussing this with your healthcare provider is essential. They may be able to suggest alternative treatments or generic options that are more affordable. Additionally, some clinics may offer sliding scale fees based on income, which could help alleviate the financial burden.

In summary, it is crucial to prioritize your healing process after electrosurgery and to communicate openly with your healthcare providers about your symptoms and concerns. If bleeding persists or worsens, or if you have any doubts about the treatment plan, seeking a second opinion is always a valid option. Remember that managing anal warts and ensuring proper healing requires a collaborative approach with your healthcare team, and addressing your concerns about treatment options and costs is an important part of that process.

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