Frequently Asked Questions
How is an HRA performed?
  1. You will rest comfortably on your left side in a fetal position on the exam table.
  2. A digital rectal exam will be performed using a special numbing gel while feeling for any lumps or bumps.
  3. A clear plastic scope called an anoscope will be inserted a few inches.
  4. A vinegar soaked gauze swab will be inserted into your bottom through the anoscope.
  5. The anoscope will be removed and the vinegar soaked gauze will stay inside for 2 minutes.
  6. The vinegar soaked gauze may be a little irritating, which is caused from the vinegar.
  7. After two minutes, the vinegar soaked gauze is removed and the anoscope will be reinserted.
  8. The microscope is then positioned so the anal canal lining is magnified using a surgical microscope.
  9. You will feel a brushing sensation as more vinegar and iodine is applied with a small cotton swab.
  10. The vinegar and iodine help define abnormal cells or lesions so that biopsies can be taken.
  11. If a biopsy (small sample of tissue) is taken, you usually will not feel it. Most biopsies are taken from the area where the outside skin meets the inside rectal skin and there aren’t many nerve endings. You may feel a small pinch or a tug but most people do not feel anything.
  12. After the entire internal anal canal is examined, the anoscope is removed.
  13. Next, the skin around the anal opening (perianal) needs to be examined. A vinegar soaked piece of gauze is tucked next to the opening and left to soak for a minute.
  14. After a minute, the perianal skin will be examined under magnification with the surgical microscope. If any abnormal skin lesions are seen, the lesion will be numbed with an injection and then biopsied.