At Bummed, we believe anorectal health doesn’t exist in a vacuum which is why we’ve teamed up with Daye, specialists in gynaecological health, to explore the connections between vaginal and anorectal health that don’t get nearly enough airtime.
Let’s talk about HPV. Not in the “here’s a scary statistic, go see your doctor” way but in the “this is genuinely interesting, a little unexpected, and completely worth knowing” way.
Because here’s the thing most people aren’t told: HPV is not just a cervical health issue. It moves between body sites. And where it moves to, specifically the anal region, is exactly where Bummed spends most of its time. So consider this a collaboration that was always going to happen.
First: what actually is HPV?
Human papillomavirus is the most common sexually transmitted infection in the United States. Around 42 million Americans between the ages of 15 and 59 are living with a disease-associated HPV infection at any given time and most of them have no idea. The virus is almost always asymptomatic. You carry it, your immune system (in most cases) clears it, and life goes on.
There are over 200 strains of HPV; around 40 infect the genital and throat area. Think of them in two groups. Low-risk strains – mainly types 6 and 11 – are responsible for the majority of genital warts. High-risk strains – there are 12 confirmed oncogenic types, led by HPV 16 and 18 – are the ones that, in certain conditions, can drive abnormal cell changes and eventually cancer. HPV 16 alone accounts for around 50% of cervical cancers worldwide.
The reassuring part: most HPV infections clear on their own within two years. The part worth paying attention to is when they don’t – when a high-risk strain sticks around in a tissue environment where it can cause damage.
Which brings us to the part most people are never told.
HPV doesn’t just affect the cervix
HPV is linked to cancers of the cervix, vagina, vulva, penis, throat and anus. Around 91% of anal cancers are caused by HPV, most of them by HPV 16.
Here’s the stat that tends to stop people mid-scroll: anal squamous cell carcinoma is now more common in women than in men in the United States – 1.5 cases per 100,000 women versus 1.0 per 100,000 men, and the incidence is rising faster in women (2.9% per year) than in men (2.1%). Anal cancer is not primarily a story about men who have sex with men, as the outdated framing goes. It’s a gynaecological health story too.
For anyone with a history of HPV-driven changes in the cervix, vulva or vagina, the risk is considerably higher – some studies put it at four to sixteen times that of the general population. Around 30% of women with high-grade cervical or vulval abnormalities have concurrent high-grade changes in the anal region.
How HPV gets from vagina to anus (without any help from you, and sometimes with)
No one puts this in the sexual health clinic leaflet, but here it is.
HPV can move between body sites through autoinoculation which just means the virus transferring itself from one area to another on the same body. The vaginal opening and the anus are anatomically close, a few centimetres apart. Vaginal secretions containing HPV regularly come into contact with the perineum (the skin between the vagina and anus). From there, the virus doesn’t have far to travel.
Research has confirmed this: women with a genital HPV infection have more than four times the risk of developing a subsequent anal infection, and the relationship runs in both directions. Crucially, anal HPV in women doesn’t require a history of receptive anal sex to occur.
There’s also a hygiene angle almost no one talks about. A study published in Cancer Epidemiology found that in women with a prior history of HPV-driven gynaecological changes, wiping back-to-front after using the toilet was associated with nearly double the prevalence of high-risk anal HPV and more than three times the risk of confirmed anal abnormalities on biopsy. The mechanism is simple: back-to-front wiping physically carries vaginal secretions towards the anal canal. Wiping front-to-back, or dabbing, was associated with lower risk.
This is not a hygiene judgment. It’s just anatomy and biology doing their thing. PSA: wiping front-to-back also helps reduce your risk of UTIs.
The vaginal microbiome: your built-in defence system
Here’s where it gets genuinely interesting and where the science has moved a lot in recent years.
Your vaginal microbiome is the community of bacteria living in the vagina. A healthy one is dominated by Lactobacillus bacteria, particularly a strain called Lactobacillus crispatus, and it turns out this has a real, measurable effect on your body’s ability to clear HPV.
How? A few ways. L. crispatus produces lactic acid, which keeps vaginal pH below 4.5 – an environment that directly inactivates HPV particles and makes it harder for the virus to take hold. It also produces hydrogen peroxide and other antimicrobial compounds that keep disruptive bacteria in check. It strengthens the epithelial barrier (the lining of cells that HPV needs to penetrate to cause damage) and damps down the chronic inflammation that allows high-risk HPV to quietly persist and progress.
The flip side is also well-established. A low-Lactobacillus microbiome, the kind associated with bacterial vaginosis (BV), is significantly linked to a higher chance of acquiring HPV, a lower chance of clearing it, and a higher chance of it progressing to precancerous changes. BV itself is extremely common and often symptomless.
The clinical evidence is building too. A randomised controlled trial published in Scientific Reports in 2025 (Lomeo et al.) found that women given oral L. crispatus M247 achieved an HPV clearance rate of 60% – compared to 31.8% in the control group. These numbers aren’t revolutionary on their own (spontaneous HPV clearance within a year runs at roughly 50–77%), but the direction is clear: a healthier microbiome environment meaningfully shifts the odds in your favour.
For a deeper dive into HPV and how the vaginal microbiome connects to it, Daye has a full illustrated guide here.
What you can actually do with this
None of this is meant to alarm you. HPV is common, manageable, and increasingly preventable. Here’s where to start:
Get vaccinated, if you haven’t. Gardasil 9 is an HPV vaccine recommended from age 11–12, with catch-up recommended through age 26, and an option through age 45 with shared clinical decision-making. It protects against nine HPV strains, including the high-risk types 16 and 18, and can prevent up to 90% of HPV-attributable cancers. If you haven’t had it, it’s worth asking about.
Keep up with cervical screening. Current guidelines recommend primary HPV testing every five years, from ages 25 to 65. Cervical screening doesn’t screen for anal HPV, but it’s a key part of knowing your status.
Know your microbiome. Daye’s Vaginal Microbiome Test is an at-home screen that uses a tampon – insert it for 20 minutes, send it back – to measure your Lactobacilli levels alongside bacteria associated with BV, yeast, and fertility-related pathogens. It won’t tell you whether you have HPV (HPV testing isn’t yet available through Daye in the US, though it’s coming soon), but it can tell you whether your microbiome is in a protective state or one that increases vulnerability to viral persistence. For anyone with a history of HPV-driven gynecological changes, that’s genuinely useful information to have.
The Vaginal Microbiome Test is intended for general wellness purposes. In order to confirm a diagnosis, always consult a health provider. You can book a consultation through Daye’s aftercare platform.
Use condoms – they’re not a perfect HPV barrier, but they help more than people think. HPV is transmitted by skin-to-skin contact, including areas a condom doesn’t cover, so condoms don’t fully prevent transmission. But the evidence is robust: a landmark NEJM study (Winer et al., 2006) found that consistent condom use reduced HPV transmission to female partners by around 70%, and was associated with faster regression of existing cervical lesions. They’re not a substitute for vaccination or screening – they’re additive.
If you smoke, stop. Smoking is one of the best-established cofactors for high-risk HPV persistence and progression to cervical cancer – it’s not just an HPV-acquisition issue, it’s what tips a clearable infection into a problematic one. Tobacco-derived carcinogens have been measured directly in cervical mucus, and the IARC classifies smoking as a cause of cervical cancer in HPV-positive women. Current smokers with high-risk HPV have roughly twice the risk of cervical cancer compared with non-smokers, with a clear dose-response. If you carry HPV, this is one of the few risk factors fully in your control.
Think about wiping direction. This feels almost too mundane to mention, but the research backs it up. Based on the study cited above, front-to-back or dabbing may be preferable to back-to-front for anyone with a history of HPV – it reduces the mechanical transfer of vaginal secretions towards the anal canal.
If you have a history of high-grade cervical or vulval disease, talk to your doctor about anal screening. This conversation doesn’t happen often enough. If you’ve had CIN3, vulval or vaginal HSIL, or you are immunocompromised, ask specifically about anal cytology. Current guidelines support screening in these groups, but you typically need to ask for it.
When symptoms warrant more attention
Anal symptoms like bleeding, persistent itching, pain, a lump, changes in bowel habits are easy to chalk up to haemorrhoids, and most of the time that assumption will be right. But because early anal cancer is often asymptomatic, and because it shares symptom overlap with common benign conditions, anything persistent is worth taking seriously rather than waiting out.
This is exactly where we come in. Bummed was built to give people accessible, stigma-free anorectal care without the six-week specialist waitlist – an online consultation with our clinical team, prescription treatment delivered to your door, and no need to explain yourself. If something feels off down there, we’re here.
The bottom line
HPV is extremely common, mostly cleared without incident, and increasingly preventable. But it doesn’t respect anatomical boundaries, it’s influenced by the health of your vaginal microbiome, and its relationship to anal health is something the healthcare system largely fails to communicate. Knowing this, screening where you can, and being straightforward with your providers about your history: that’s what actually being your own health advocate looks like.
This article is for educational purposes only and does not constitute medical advice. Please speak with a qualified healthcare provider about HPV screening, cervical screening recommendations, and anal health.