 The investigators hypothesize that men having sex with mens digital anal exam DAE findings will have moderate or substantial agreement with a nurse practitioner DAE for detecting an anal abnormality defined as condylomas, hemorrhoids, fissures, and malignant tumors. As a secondary hypothesis the investigator believe a partner-assisted DAE conducted within a couple will have better agreement with the nurse practitioner DAE than will a self-DAE conducted by a single person. 