At risk of turning this into a research-based article again, I am putting this note up front to remind myself to keep it as personal as I can, as part of the August 2026 Writing Prompts 😉 I will be sharing more about treatment for AIN 3 (Anal Intraepithelial Neoplasia 3) and my experiences with it, namely with Imiquimod and anal excision.
Do note that this article contains a lot of info about poop, so if that grosses you out — then you need to read more about it, because it’s just a normal human bodily function that’s essential in keeping you alive and healthy 😉 Right, now on to the fun bits 😛
*Disclaimer: This article is meant for educational purposes, and is based on my personal experiences as a patient. I am not a doctor, and nothing in this article should be substituted for medical advice. Please consult your own doctor before changing or adding any new treatment protocols. This post may also contain affiliate links. It will cost you nothing to click on them. I will get a small referral fee from purchases you make, which helps with the maintenance of this blog. Read our Privacy Policy page for more information. Thank you!
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What is AIN 3? — A Brief Overview
To put it in the simplest of terms, AIN are pre-cancerous cells in the anal region. According to the Anal Cancer Foundation, “anal precancers (also known as Anal Intraepithelial Neoplasia or AIN) are growths and/or changes in the skin cells in the anal region”. There are various grades of AIN, ranging from one to three; grade three is the stage just before anal cancer.
AIN is mostly caused by HPV (human papillomavirus). I recall being advised against taking the HPV vaccine when I was a teenager, due to the doctor’s concerns about blood clots or bleeding, as I have Antiphospholipid Syndrome (a blood clotting autoimmune disorder). I regret that decision to not take it back then, as I am taking the vaccine now anyway (more about that in a bit). Then again, back in those days the HPV vaccine wasn't as advanced as it is now, so I guess it is what it is.
A Few Brief Notes About HPV — the Culprit of AIN 3
- HPV is not only one virus — there are in fact, more than 200 types of HPV.
- Up to 85% of the human population would have had an HPV infection in their lifetime, with many people not even knowing that they have it.
- For 90% of people, the body fends off the infection on its own, so I guess I’m just that unlucky immunocompromised girl.
- There are 12 high-risk HPV strains which can lead to cancer.
- The types of cancers that you can get include: anal, cervical, oropharyngeal (throat), penile, vaginal, and vulvar.
- HPV16 and HPV18 alone contribute to 70% of cervical cancer cases globally.
How Do They Test for HPV?
During a pap smear (Papanicolaou test), your gynaecologist will take cell samples from your cervix to check for cell changes. This is different from an HPV test, which is used to specifically check for the HPV virus. However, these are often done together as co-tests.
It is essential for females with a cervix to get their pap smears done regularly in order to catch early signs of cervical cancer. According to Crifase and Parker (2025) and the Cleveland Clinic (2024a), the current guidelines for pap smear and HPV tests are:
- Females between 21 to 29 years old: every 3 years.
- Females between 30 to 65 years old: every 3 years. If done as a pap smear and HPV co-test, then every 5 years.
- Females older than 65 years of age: Not necessary if you’ve never had abnormalities in your cervical screenings or cervical cancer, and if you’ve had three consecutive pap smear tests in the past 10 years that were unremarkable (yes, that’s a good thing in medical terms!).
The HPV Vaccine Can Still be Helpful Even if You’re Already Infected
I took my first dose of the HPV vaccine before the surgery, even though I already have a few of the HPV strains. Ironically, I don’t have HPV 16 or 18, which are the two most dangerous strains in terms of cancer risk (Cho et al., 2024). It says ‘others’ in my report.
Anyway, according to both my gynaecologist and infectious disease doctor, the HPV vaccine may still confer some benefits. What it can still do, despite already being infected, is to aid the body in its fight against the viruses, prevent other variants from taking hold, and/or prevent the same type of reinfection post surgery (Pruski et al., 2025a; Scherer et al., 2016). In some patients, remission has been observed as well, especially if they are younger in age (Pruski et al., 2025b).
Types of HPV Vaccinations
Note that there are a few different types of HPV vaccines; each of them cover different strains (always HPV16 and HPV18, then other strains as well according to risk). In the two studies done by Pruski et al. (2025a; 2025b), the latest HPV vaccination, Gardasil-9, was used. The ‘9’ indicates that it is a nine-valent vaccine, meaning that it protects against nine types of HPV strains.
HPV Vaccinations in Singapore
In Singapore, two types of HPV vaccinations are available — HPV2 (Cervarix), and HPV9 (Gardasil-9). The former is available to all females, and the latter to both males and females. Cervarix is offered to all Secondary 1 and 2 students as part of school-based vaccinations, and free for females up to 17 years of age — so don’t miss out on it. You certainly don’t want your anus, cervix or vulva burned and sliced up like mine.
Do note that whilst Cervarix is subsidised, you need to pay out-of-pocket for Gardasil-9. I would totally recommend going with Gardasil-9 though, as it protects you from another 20% of cancer-causing HPV strains.
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My Symptoms for AIN 3
For me, it started out as a small growth in the anal area.I had assumed it was just a haemorrhoid or scarring from it, as I get them quite frequently due to thin, fragile skin from long-term steroid medications used to control my autoimmune diseases. My anal skin is able to tear from a simple bowel movement, so I apply medication (Rectogesic / glyceryl trinitrate 0.2% w/w) on the anal fissures almost every day, as it’s a non-stop ripping affair. My sexy life.
During my oesophageal surgery last June 2025, the upper gastrointestinal surgeon took a biopsy of the lump, since I was passed out from the general anaesthesia anyway. The bad news was, it did indeed turn out to be something more sinister.
I Also Needed Surgery for CIN 3 & VIN 3 Previously — Which are All Related to HPV
CIN 3 stands for “Cervical Intraepithelial Neoplasia Grade 3”, which is like AIN 3, but in the cervix instead. VIN 3 stands for “Vulvar Intraepithelial Neoplasia Grade 3", which occurs on the vulva. I had laser surgery done about a decade or so ago to burn those precancerous cells away, and the surgeon did a fantastic job. The skin healed up with minimal scarring, which was my biggest fear. Now, they are returning as grade 1 again, so it’s a matter of watching and waiting.
And if you were wondering — yes, getting skin lasered off your vulva hurts. I remember squatting by the bed to work for weeks, as that was the only comfortable position. Tip: pouring water whilst peeing helps a lot (pee is slightly acidic, after all). Probably the same sort of advice as for postpartum women, really.
It’s important to get your pap smears and related tests done to detect these pre-cancerous cells early on. My oncology gynaecologist also examines my vulval and cervical surfaces for any changes in the skin on a regular basis — such as strange lumps or discoloration.
Types of Treatment for AIN 3
There are a few types of surgeries that can be used as treatment for AIN 3. According to Weis (2013), these are the treatment options for AIN 3, which are still mostly relevant up to date (also see: Benson et al., 2023):
- Surgical excision (cutting out/removing infected areas)
- Infrared coagulation ablation
- HRA (high-resolution anoscopy)-guided electrocautery ablation
- CO2 laser fulguration
- Topicals (fluorouracil or imiquimod creams)
- Topical trichloroacetic acid and bichloroacetic acid (cytotoxic therapies)
For me, they decided that anal excision would be most suitable, I’m guessing due to the location, manifestations, and type of cells I had. Before that, we also tried the topical, Imiquimod.
My Experience with Imiquimod, a Non-invasive Treatment for AIN 3
Imiquimod is an immune response modifier that is used to treat conditions such as warts, actinic keratosis, and in my case, AIN. It works by stimulating the immune system in response to these conditions, with the hope that the AIN reduces in grade severity. It comes in the form of a cream in single dose packs, and I had to apply it 3 times a week, before giving the skin a break; it is a harsh medication, after all.
For me, the side effects were bad itching, and some soreness. But what was most annoying about Imiquimod is that you can’t apply more of it should you need to use the bathroom again after that. The advice is to use it before bedtime, but the problem is that I not only am an insomniac, but I have gastrointestinal issues ever since the oesophageal surgery. So that means that many of my nights are spent interrupted by vomiting or diarrhoeal episodes. Anyway, I tried my best to keep the cream in place until 8 hours later, when you should wash it off.
Sad to Say, Imiquimod Didn’t Work for Me
There was no harm in trying Imiquimod for me even though it might have stimulated my autoimmune diseases because it’s non-invasive, which is considerably much better than needing to do any surgery at all. Sad to say, it didn’t seem to do much, and my AIN remained as AIN 3.
Another issue when it comes to dealing with AIN 3 is that it’s a rather ‘grey zone’ diagnosis, especially since I do not know what HPV strains I have, and all the specific locations they’re at. As a patient, you can either choose to watch and wait, or do preventative surgery. In the words of my surgeon, “if we do go ahead with the surgery, it would be like going in blind”.
However, she also told me that I would need a stoma bag for life in the worst case scenario — that is the main issue I wanted to avoid, so I decided to go ahead with the surgery. I really don’t need more permanent health issues piling up — I have enough from head to toe as it stands.
Preparing for Anal Excision Surgery
As someone who lives with Antiphospholipid Syndrome, I need to bridge from warfarin to low molecular weight heparin (LMWH) / Clexane before and after any surgery, no matter how minor it might be. Otherwise, I run the risk of clotting or bleeding, or both.
Apart from that, I also needed to attend a pre-op assessment. During this assessment, the doctors and anaesthetists run through your medications with you to see if any of them need to be paused for the surgery (these are often immunosuppressants, for fear of infections).
Since it was a ‘minor’ operation, I had to take all my medications as per usual, except for my emergency verapamil (for PSVT / arrhythmia). Nurses will also explain to you how to wash yourself just before the surgery, which includes a disinfecting shower gel, and a fleet enema (saline laxative) to clear out your bowels on the same day itself.
A Horrible Pre-op Experience with Clueless Staff at SGH
My experience with the pre-op team was horrible. They were so disorganised, and the junior anaesthetist did not even know how to bridge the warfarin to Clexane properly. My nurse from my regular hospital had to talk to her over the phone. In addition, she was wearing her lanyard with her name tag tossed behind her back, until I insisted on writing down her name. Very unprofessional. Over the years, I must say that my tolerance for incompetent medical staff has become extremely limited. Yes, I am becoming that cranky middle-aged, jaded patient.
When I went to collect my medications at the pharmacist later, I had to go home empty-handed after waiting for 1.5 hours, because apparently the prescription wasn't correct.
What is Anal Excision Surgery for AIN 3 Like?
The surgery was planned to last for 2h 45mins. The nurse who checked me in at the same-day admission centre confiscated my mobile phone and gave it to my parents, as she said that I couldn’t bring it in. However, every other patient in the waiting area was on their phones when I went in. It was ‘lucky’ that I was extremely exhausted, and spent the 2 – 3 hour wait time dozing off in a cold, hard chair. Otherwise, I would just have been sat on my ass doing absolutely nothing. I didn’t even have any paper to write on, or scribble or doodle.
When they finally came for me, the anaesthetist in charge told me that she had read my file, and noted that I was a high-risk patient (nothing new). She also warned me that I should not get any other surgeries done after this, until I had done the open heart surgery to fix my mitral valve stenosis. This is because general anaesthesia can cause heart rhythm problems, and I already have PSVT, combined with a heart valve disease. She also inserted an arterial line into my wrist to monitor my blood pressure, so she could react more immediately if she needed to mid-op.
I liked her a lot, as she seemed to know what she was saying and doing, was willing to explain procedures, and patient with other staff on the operating team as well.
An Invalidating Experience with My Surgeon
However, I never saw my surgeon at all; she came into the operating theatre only after I had passed out from the GA. When I was supposed to see her in the clinic two weeks later, she handed me off to her colleague instead as well. I will be changing doctors after this, as I find this invalidating, and an unacceptable level of patient care. I have many questions to ask, I am in horrible pain, and I need some level of accountability on their end.
The Complications for Any Surgery Due to My Chronic Illnesses & Heart Diseases
Whilst anal excision for AIN 3 is normally a day surgery, I was kept under observation for a night as the anaesthetist was worried that my heart rhythm might go haywire. Thankfully, it was okay, even though the nurses weren’t very helpful at all.
I kept wetting the bed as they had injected a numbing anaesthesia to my entire anal and vulval area. They wouldn’t let me use a commode as my blood pressure was too low — but really it was my personal normal, which is in the 90s range. I was frustrated and snappy — just let me pee so I don't wet the bed and need to sleep on it, damnit. I think fundamentally what I was most upset about was them not trusting that I know my own body well enough.
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Confined to Bed Rest the First Week After Surgery — with Lots of Blood, Sweat & Poop
Just like with my oesophageal surgery, the surgeon hadn’t warned me of the full range of possible side effects post-operation. She had only said I might get strictures and tissue scarring, I’m guessing as long-term issues from the surgery. But gosh, the short-term side effect of faecal incontinence was the worst, as I couldn’t hold anything in at all. I was basically leaking poop 24/7, and had to constantly clean up after myself even in the middle of the night, in a mess, and in pain.
The prophylactic antibiotics were necessary, but contributed to the diarrheal effect as well. They were also a higher dosage than what I was used to, so it was pretty much just trying to survive with lots of electrolytes the first week (and pad changing).
In addition, my period came a day after the surgery (it seems to have a knack for showing up at the worst times all the time). So it was all a bloody mess, quite literally.
The Second Week was No Less Draining — Perhaps Even More so
The second week was no better. The faecal incontinence was just as bad, even after the course of antibiotics had ended. In fact, it might have been worse as I had become malnourished and severely fatigued from the endless loss of fluids and lack of sleep. My INR wasn’t going up, which indicated that nutrients from food were probably not being absorbed in the gut, and the blood thinners weren’t having an effect.
I needed to be pushed around in a wheelchair when I went for other medical appointments, as I had become too weak to even walk. I felt drained and wouldn’t have been surprised if I looked ghastly pale, as that was how I felt on the inside, too. And of course, I had to go clean up in the bathroom outside too, as the faecal incontinence doesn’t care where you are, or how inconvenient it may be. Luckily, I had packed a ton of wet wipes, sprays, and creams.
Anchoring Rituals to Help with Healing & Restoring Balance
Even though I was in a rather weakened state, I decided to go for my lymphatic drainage appointment a bit after two weeks. I just thought that it might be healing for my body, even though I had to drag myself there with my trusty walking stick.
The night after the lymphatic drainage was actually the first time since the surgery that I started to feel a little better, so I suppose it did make a difference. Out of all the physical therapies I’ve tried, I’ve found lymphatic drainage to be one of the most helpful, despite the gentleness of the strokes.
In addition to the lymphatic drainage, my therapist also helped to loosen the knotted up muscles in my face, jaw, and neck. I have TMJ disorder issues and grind my teeth violently at night, so the muscles in my neck are particularly tight.
She said that everything in the body is connected, so the orofacial pain can contribute to pain in the lower parts of my body, too. I believe her, as I too believe that everything in the body is interconnected. In fact, I think doctors need to collaborate more across specialisations, and stop viewing the body as ‘clean cut, sliced up parts’.
In Conclusion to My Experience & Treatment for AIN 3
So there we have it — I had expected the pain, but wasn’t prepared for the torrent of poop, malnourishment, and fatigue linked to it. I do have some baseline level of Irritable Bowel Syndrome (IBS), but I know that many in the chronic illness community probably experience this on a frequent basis, especially those with conditions such as Irritable Bowel Disease (IBD), Celiac Disease, Crohn’s Disease, gluten intolerance, Short Bowel Syndrome, and more.
I have my fingers crossed that the faecal incontinence is temporary. If you live with such issues as well, I would love to hear your best coping or poop management tips in the comments below. If you like, you can also share your funniest, most embarrassing or most painful experiences. Thanks for reading my disgusting entry this month 😉 I’m pooped for now (sorry I just had to 😆).
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- Anal Cancer Foundation. (n.d.). Anal intraepithelial neoplasia: Anal precancer (AIN) signs, symptoms & treatment. Retrieved 1 August 2026, from https://www.analcancerfoundation.org/what-is-anal-cancer/anal-pre-cancer/
- Benson, A. B., Venook, A. P., Al-Hawary, M. M., Azad, N., Chen, Y.-J., Ciombor, K. K., Cohen, S., Cooper, H. S., Deming, D., Garrido-Laguna, I., Grem, J. L., Hecht, J. R., Hoffe, S., Hubbard, J., Hunt, S., Hussan, H., Jeck, W., Johung, K. L., Joseph, N., … Stehman, K. (2023). Anal carcinoma, version 2.2023, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 21(6), 653–677. https://doi.org/10.6004/jnccn.2023.0030
- British Association Of Dermatologists. (2026, February). Imiquimod cream. https://www.bad.org.uk/pils/imiquimod-cream
- Cancer Research UK. (2025, August 26). Vulval intraepithelial neoplasia (VIN). https://www.cancerresearchuk.org/about-cancer/vulval-cancer/vulval-intraepithelial-neoplasia
- Centers for Disease Control and Prevention. (2024, July 9). Clinical overview of HPV. https://www.cdc.gov/hpv/hcp/clinical-overview/index.html
- Cho, E. H., Park, M.-S., Woo, H.-Y., Park, H., & Kwon, M.-J. (2024). Evaluation of clinical usefulness of HPV-16 and HPV-18 genotyping for cervical cancer screening. Journal of Gynecologic Oncology, 35(6). https://doi.org/10.3802/jgo.2024.35.e72
- Cleveland Clinic. (2024a, August 19). Pap smear. https://my.clevelandclinic.org/health/diagnostics/4267-pap-smear
- Cleveland Clinic. (2024b, September 19). Lymphatic drainage massage. https://my.clevelandclinic.org/health/treatments/21768-lymphatic-drainage-massage
- Cleveland Clinic. (2025, June 4). Cervical dysplasia. https://my.clevelandclinic.org/health/diseases/15678-cervical-intraepithelial-neoplasia-cin
- Crifase, C., & Parker, J. (2025, June 22). Preventing cervical cancer: Best practices in pap and HPV testing. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470165/
- Cutaneous Lymphoma Foundation. (n.d.). Imiquimod. Retrieved 1 August 2026, from https://www.clfoundation.org/imiquimod
- Mayo Clinic. (2026, February 1). Imiquimod (topical route). https://www.mayoclinic.org/drugs-supplements/imiquimod-topical-route/description/drg-20067474
- Ministry of Health Singapore. (n.d.). Protect yourself against cervical cancer. Retrieved 31 July 2026, from https://vaccine.gov.sg/hpv
- National Cancer Institute. (2024, August 2). Cervical cancer causes, risk factors, and prevention. https://www.cancer.gov/types/cervical/causes-risk-prevention
- National Cancer Institute. (2025, May 9). HPV and cancer. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer
- National University Hospital. (2024, May 16). Anal fissures. https://www.nuh.com.sg/health-resources/diseases-and-conditions/anal-fissures
- Pruski, D., Millert-Kalińska, S., Jach, R., & Przybylski, M. (2025). Effect of vaccination against HPV in the HPV-positive patients not covered by primary prevention on the disappearance of infection. Scientific Reports, 15(1), 12642. https://doi.org/10.1038/s41598-025-92861-5
- Pruski, D., Millert-Kalińska, S., Jach, R., Żurawski, J., & Przybylski, M. (2025). Impact of vaccinating adult women who are HPV-positive or with confirmed cervical SIL with the 9-valent vaccine—A systematic review. Viruses, 17(10), 1377. https://doi.org/10.3390/v17101377
- Scherer, E. M., Smith, R. A., Gallego, D. F., Carter, J. J., Wipf, G. C., Hoyos, M., Stern, M., Thurston, T., Trinklein, N. D., Wald, A., & Galloway, D. A. (2016). A single human papillomavirus vaccine dose improves B cell memory in previously infected subjects. EBioMedicine, 10, 55–64. https://doi.org/10.1016/j.ebiom.2016.06.042
- Weis, S. E. (2013). Current treatment options for management of anal intraepithelial neoplasia. OncoTargets and Therapy, 6, 651–665. https://doi.org/10.2147/OTT.S38217
- World Health Organization. (2024, March 5). Human papillomavirus and cancer. https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer
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