Digital anorectal exam - DARE

The provider will look at the anus and perianal region (area around the anus) for hemorrhoids, fissures, or fistulae. Then your provider will put on a glove and insert a lubricated finger into the anal canal and rectum to palpate and feel for any suspicious irregularities. In women, this exam may be done at the same time as a pelvic exam.

You may feel mild discomfort during this test.

This test can be done:

• To find the presence of any abnormalities such as polyps, or irregular lumps or masses in the anorectal region.
• For early diagnosis of cancer in people at high risk of anal cancer. This may include women with prior HPV infections, people with HIV, or people who have a weak immune system (immunocompromised) such as solid organ transplant recipients.

People with HIV who have anal symptoms should undergo DARE if they are:

• Men who have sex with men.
• Transgender women, who are below the age of 35.
• Others below the age of 45.

People under the age of 35 who show signs of anal cancer during DARE should undergo standard anoscopy to further investigate the findings.

People under the age of 35 who do not show signs of anal cancer during DARE should repeat the test in 1 year.

Adults with HIV should undergo annual screening for anal cancer regardless of symptoms, this includes:

• Men who have sex with men, who are age 35 and older.
• Transgender women who are age 35 and older.
• All other people with HIV ages 45 and older.

DARE may also be performed to check for recurrence of anal cancer after chemotherapy and radiation treatment is given.

A normal finding means your provider did not detect any problem during the exam. However, this test does not rule out all problems.

An abnormal result may be due to:

Pre-cancer (dysplasia) or invasive cancer in the perianal or anorectal region.

Several non-cancer abnormalities may be found such as:

• Benign growths such as polyps, skin tags, anal warts, or others
• Internal or external hemorrhoids
• Lesions or ulcers in the anorectal canal
• Anal fissures
• Anal fistulae
• Perianal abscesses
• Scarring from any previous anal or rectal surgery, etc.

DARE is safe with no major risks involved. Some people may feel mild pain or discomfort, or slight bleeding during the exam especially if they have hemorrhoids or fissures in the anal area.

If you are planning to have an anal test for HPVs or sexually transmitted infections, consider it before undergoing DARE. The lubricant used during DARE may interfere with the test results.

Rarely, in people with severe anal pain, sedation or anesthesia may be given to perform the test.

DARE

Clinicalinfo.HIV.gov website. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human?view=full. Updated July 9, 2024. Accessed September 26, 2024.

Downs JM, Kulow B. Anal diseases. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 129.

Madoff RD, Melton GB. Diseases of the rectum and anus. In: Goldman L, Cooney K, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 131.

Stier EA, Clarke MA, Deshmukh AA, et al. International Anal Neoplasia Society's consensus guidelines for anal cancer screening. Int J Cancer. 2024;154(10):1694-1702. PMID: 38297406 pubmed.ncbi.nlm.nih.gov/38297406/.

Surrell JA. Clinical anorectal anatomy and digital examination. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 129.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.