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Scratching your anal area causes further irritation and may worsen the itching instead of providing relief. Your skin in this area is sensitive, and your nails are much stronger than your skin. Scratching with your fingernails may cause skin damage or an infection. If the itch-scratch cycle persists, it can lead to extreme discomfort, soreness and burning.

The skin in your perianal area is sensitive. Scented soaps, powders, lotions, creams and ointments can cause an allergic reaction. You may also irritate your skin if you wipe with rough toilet paper or use a rough washcloth or hot water to clean the area.

Anal fissures are tears in the lining of your anus or anal canal (the opening through which poop passes out of your body). Trauma to the area is the leading cause of anal fissures. Trauma may include constipation, straining while pooping, long periods of diarrhea, anal sex or anal stretching.

Genital warts are a type of sexually transmitted infection. The disease causes small bumps or growths (warts) to form in and around your genitals and perianal area. Genital warts may also cause mild bleeding, discomfort and a burning sensation.

Beginner anal users should never start with extreme anal toys. When using extreme anal toys always start with smaller anal sex toys and work your way up to using bigger extreme anal toys. Applying a large amount of lubricant is essential when using a large anal sex toy and make sure to engage in foreplay beforehand to ensure your body is fully relaxed.

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Your physician may order a test to determine if an infection or a parasite is present. If a cause still cannot be determined, you may need to see a dermatologist or proctologist. In some cases, the cause of anal itching is never diagnosed. Instead, different treatment plans are explored until a solution is found.

While this infection is not particularly dangerous, it can be transmitted easily - particularly between people in the same household. Prescription medication is extremely effective, but in most cases the entire household must be treated at the same time to completely eliminate the infection. A primary care physician will be able to prescribe this medication; specialists or urgent care is not needed.

Most susceptible are men who have sexual contact with men; women who have had cervical cancer; and anyone who has engaged in anal intercourse, had anal warts, or is HIV positive. Smoking and lowered immunity are also factors.

Anal itching can be caused by many things, such as stool or urine that remains on the skin after using the restroom. Hemorrhoids may cause itching as they heal after a bowel movement. Partially healed anal fissures and pinworms, a parasite affecting children from consumption of unsanitary food, can also cause itchiness.

Itchiness and burning are common symptoms of external hemorrhoids and anal fissures. Microabrasions can occur with excessive diarrhea. Itchiness and burning may also be a sign of a sexually transmitted illness. There are many other causes; if the itching and burning continue, seek medical evaluation.

An itchy and bleeding anus may be a sign of an anal fissure. This is a small tear in the skin of the anus when a hard stool overstretches the anus. It may cause blood on the stool, in the toilet bowl, or on the toilet paper. If you are experiencing anal (or rectal) bleeding with no known cause, you should seek medical attention.

Our study confirmed that vaccinating males improved outcomes in all subgroups, even if uptake was correlated with factors that also affect choice of sexual partner. However, we also found that in this situation including males in vaccination programs tended to further concentrate disease in particular subgroups and increase between-group differences in outcomes, even if uptake is uniform in males. In these situations, decision-makers may face a trade-off between reducing inequalities versus reducing the levels of disease overall. It would likely then be important to take into account the highly setting-specific factors of who the subgroups are, their relative advantage and disadvantage overall, their other risk factors, and the potential alternative uses of resources, and whether the inequality is avoidable or not. That is, decision makers would need to take into account whether or not the inequalities represent inequity in a particular setting, given that inequity is often and additionally defined as inequality which is avoidable and unfair [33]. For example if infections were likely to become more concentrated in subgroups that were already disadvantaged, or in females less likely to attend cervical screening and thus at higher risk of cervical cancer, including males may be seen as less favorable than alternative interventions (including, for example, interventions to achieve higher uptake in the disadvantaged subgroups). Conversely, reducing HPV infections further in a particular subgroup could be beneficial if individuals in that group are otherwise disadvantaged, or less likely to be screened. We could not and have not examined inequity per se in this generalized assessment, because this would require consideration of setting-specific issues. Setting-specific analyses could incorporate measures which have been proposed to quantify inequity, rather than inequality, such as the concentration index, which could not be used here as they require subgroups to be ordered according to a gradient of socioeconomic status or advantage [40].

We have used the post-vaccination rate of new HPV infections as a proxy for disease risk in different subgroups, since it provides an outcome which is comparable for males and females. The current analysis does not simulate long term outcomes of infections, such as cancer. This is because the risk of developing an HPV-related cancer depends on a range of further factors; in particular cervical cancer risk would be strongly influenced by cervical screening behavior. The specific impact on cervical cancer would also depend on whether variations in uptake are correlated with screening uptake, and the direction of the relationship. For example in the United States, HPV vaccine uptake is higher in areas where screening coverage is higher [46], whereas in New Zealand some ethnic groups with lower screening coverage have higher HPV vaccine uptake [45], [47], We have also only modelled one HPV type, HPV16, in this analysis. HPV16 is associated with the highest risk of oncogenesis in humans and this approach is consistent with other exploratory model-based analyses [10], and done on the basis that analyses for other types would give qualitatively similar results.

A previous study by Malagón et al[31] assessed the population-level impact of disparities in vaccine uptake if vaccine uptake differed according to level of sexual activity (i.e. number of partnerships and age at initiation), whereas we performed a complementary assessment of the effects of differences in vaccine uptake according to any factor that influences the choice of specific partner(s). Our results were similar in finding that pronounced heterogeneities in vaccine uptake may affect the population-level impact of HPV vaccination programs. Our finding that including males tended to increase inequality relative to a female-only program differed from the findings of the previous study; however this particular finding from Malagón et al[31] was based on a scenario with uniform uptake across subgroups where inequalities were driven by varying herd effects in the subgroups resulting from their different levels of sexual behaviour (since even uniform uptake in females increased inequality). While there were differences in the precise behavioural subgroups modelled and factors associated with vaccine uptake between the two studies, an exploratory analysis suggested that another reason for the different findings was that different measures were used to quantify inequality. One measured the absolute level and distribution of disease between groups, whereas the other measured the relative impact of vaccination. Information about the exploratory analysis and a more detailed discussion of these issues are available in Supplementary Material (see Exploratory Analyses in File S1).

Supporting text and tables.Table S1. Subgroup size and vaccine uptake in coverage scenarios modelled. Table S2. Summary of main results in exploratory analysis, by sex, coverage scenario and program type. Additional Analyses Performed - Sensitivity Analyses and Exploratory Analyses.

We also thank the investigators of the Australian Study of Health and Relationships and the Australian Social Science Data Archive for provision of data on sexual behavior in Australia,