Sexually-Active Gay Men: Here's What to Ask at Your Annual Physical


The end of the year or the start of a new one is typically called the "annual physical" season as most are trying to take advantage of the benefit of no-cost physicals provided by most insurance coverage. The good news for most of us is that if you are insured, it's very likely your annual physical is 100 percent covered by insurance. The better news is that many types of diseases and cancers can be caught early in the annual physical with many treatment options that will not impact your life too drastically.

However, many men don't actually undergo an annual physical or have one done properly, especially if they have a history or exclusively have sex with men (MSM). HIV-positive or HIV-negative, every human should be availing themselves to an annual physical. I do so regularly and as such caught a very early stage anal cancer caused by a tear and HPV prior infection. My primary care doctor, who happens to be gay, routinely performs things like pap smears on my anus and comprehensive blood panels to check everything from impact of my PrEP meds on my kidneys to PSA levels which can be early warning sign of prostate and other cancers. Like in my situation, my affliction was caught very early, cured with outpatient surgery, and didn't even require chemo or radiation.

If you are planning or scheduling your annual physical, here's what you should be asking or expecting from the doctor, according to leading gay gastroenterologist Dr. Carlton Thomas.

What are the basics every person should be getting assessed at their annual physicals?
Bring up any specific concerns about any symptoms you might be experiencing. A good thorough physical exam with age specific checks for testicular, rectal, and prostate issues. Labs including CBC (complete blood cell count), CMP (comprehensive metabolic panel that looks at liver and kidney markers as well as electrolytes and glucose), thyroid studies, Prostate Specific Antigen (PSA) depending on age and family history, and lipid panel to look at your cholesterol and triglycerides. I also recommend testosterone levels. Discuss any age-appropriate cancer screening such as colonoscopy for colon cancer screening starting at age 45 or sooner if you have symptoms or a family history of colon cancer.

What are additional “must have” tests for men who have sex with men?
Blood HIV panels including viral load and T cell counts if positive; Hep A, B, and C; syphilis studies — look for antibody titer changes if you were previously infected to check for reinfection — and herpes studies if unknown.

Urine tests help detect the very common and prevalent gonorrhea and chlamydia. Throat swabs and rectal swabs will also detect gonorrhea and chlamydia depending on how you play sexually. Anal Pap smears will help detect HPV and anal dysplasia, especially if you are HIV-positive due to the dramatically increased risk of anal cancer in HIV-positive men who also have HPV.

What vaccines should MSM discuss with their doctors?
Here’s the checklist you should bring to each physical:
• Hep A (if rimming is part of your sexual routine)
• Hep B (if you’ve encountered blood or other body fluids)
• Meningitis
• HPV (now approved up to age 45)
• Mpox
• Age-appropriate pneumonia and shingles
• Covid and flu updates if needed

What other common specialists should MSM discuss with primary care doctors to possibly add to one's medical team?
Some primary care doctors will redirect PrEP to prevent HIV and HIV-positive care to infectious disease specialists. If you are 45 and older and have not had a colonoscopy, then you should be referred to a gastroenterologist (GI) for colonoscopy screenings. Regular dermatologist screenings for the annual mole patrol and early skin cancer detection. Proctologists should be added for issues surrounding hemorrhoids, anal fissure (tears in the butt lining), and anal wart care. Urologists for anything concerning genital and urinary functions.

Why is it important for men to be open and honest with their doctor about their sexual preferences and habits, even if embarrassing?
Your doctor needs to know what you do so they can make sure you get the tests, vaccines, and screening care you need. For instance, if they don’t know you bottom or have a history of bottoming, they don’t know to check you for potentially precancerous cells in your anal canal or to check rectal swabs for gonorrhea and chlamydia.

What else should we know in undergoing our annual physicals?
Don’t be embarrassed to be honest. We have seen and heard it all. Don’t be shy about being examined. Your medical and personal information is always kept confidential due to HIPPA laws.

Follow Dr. Carlton on Instagram @doctorcarlton.