Butt Seriously: Dr Evan Goldstein talks to QX about his new book and how you can look after your butt

Butt Seriously: The Definitive Guide to Anal Health, Pleasure and Everything In Between is a guide to all things anal. The book covers positions, toys, and training exercises and offers helpful advice for when things go wrong. Butt Seriously is designed to answer all those questions you may have felt too embarrassed to ask. Dr Evan Goldstein has a lifetime of personal and professional experience and has compiled all the medically accurate, scientifically-backed information you need to get your peach healthy and maximise your pleasure. He also busts the myths around anal sex that are holding you back. QX had a good chat with him about our butts. 

Tell us something about yourself.

My name is Dr Evan Goldstien, and I never thought I would be an anal surgeon. My career was destined for cardiac surgery and got derailed by me finally realizing who I was, thanks to my current partner of 18 years. I saw a huge need in the community to support the way we engage sexually, hence the birth of Bespoke Surgical. Andy and I have two boys together and live outside the city of New York. I couldn’t be any happier with where my career and personal life have taken me and also how this has benefited the anal communities at large.

What inspired you to write Butt Seriously, and what does the book cover?

Through my surgical practice, Bespoke Surgical, and my product company, Future Method, we saw a huge gap in sex ed, especially around anal sex. We were often faced with the same issues and same questions, whether at the practice, on social media, or in the media, because none of us learned the right way to prepare for and enjoy anal sex safely, as well as care for our bodies afterward. So many people turn to Google, Reddit, porn, and friends – not even their doctors know enough about how to have anal sex the right way – and I felt it was my duty to share the knowledge I have with the community at large. Sexual health and wellness play an integral role in your overall health and wellness, so it’s critical that we all can have the best sex lives possible, which starts with the basics.

Butt Seriously is an extension of my educational mission, a way of bringing my expertise and advice to the thousands who reach out but can’t get to me themselves. Whatever stage of anal exploration you’re in, whether you’re just curious or only getting started, or you consider yourself an anal sex expert, there is something useful for everyone to help you learn how to make whatever experience you’re looking for be the best it can be. The book is a comprehensive yet accessible review of all things anal, with emphasis on how to achieve your ideal form, function, and fuckability.

What are the common butt ailments that you see, especially amongst gay men?

The anal tissue is super thin, and when not exercised properly – i.e. dilation exercises, adequate lube, correctly douching – localized trauma, such as tearing (fissures) and dilated veins (hemorrhoids) are the most common ailments I see at my office. That’s why I’m always talking about how important it is to follow my dilation protocol, which takes about 6 weeks to complete, and to use copious amounts of lube during play (and spit doesn’t count). I love advocating for meaningful foreplay and pre-dilation. Using anal dilators and toys, like the glass dilation set from my company, Future Method, before or during sex helps to pre-dilate and pre-lubricate the anal canal, which sets the stage for decreased friction and, thus a decreased risk of injury. 

Feeling constipated is not conducive to good anal sex. Are there any tips on how to poo better? 

I’m always educating people on the importance of incorporating fiber supplements (and a naturally high-fiber diet) and synbiotics into your daily routine. That’s because together, they help bulk the stool, which makes for more complete bowel movements, thus addressing issues with constipation (think about how bulky and clean dogs poop), and help repair the damaged microbiome. The better our poops are, the more likely we are to have a clean and ready rectum (where anal play actually takes place), which either eliminates the need to douche altogether or reduces the time and effort it takes to douche. The reality is, most people are still looking for that extra boost of confidence that douching provides, so, our goal at Future Method is to offer a complete system – douching, fiber supplements, and pre+probiotics – that’s good for your butt and gut. 

Is douching a good idea before anal sex, or are there better ways to stay clean?

If done correctly, douching can provide someone with an extra boost of confidence that there won’t be any surprises during sex. But what most people don’t know is that being ready for anal sex isn’t just about douching. It’s starts with maintaining a high fiber diet and incorporating fiber supplements into your daily routine, making sure you stay hydrated, avoiding trigger foods (for most people, these can include foods that are high in sugars and fats, as well as artificial sugars, alcohol, coffee), and even including a daily pre+probiotic to ensure your gut is happy and healthy, too. When we started Future Method, our first product, which ended up becoming our hero product too, was a first-of-its-kind anal douche that allows you to feel confident, prepared, and sexy, all the while not disrupting the anal microbiome, unlike water and enemas. We know the more you douche with unsubstantiated products, the higher risk of irritation, and even sexually transmitted diseases and/or injury. But we also know high volumes and repetitive douching also makes a big negative impact. So, the key with douching is: less is more, and using a solution that’s been formulated to work with your body.

Do you have any advice on using dildos, and when is big, too big? And how safe is fisting?

I am all for people using toys. They’re a great way to engage in solo-play, as well as partner-play, foreplay, and for anal dilation. Using toys, more specifically anal dilators, allows for not only better dispersion of pressure and force, but also has one’s health and sexual well being in mind. It feels amazing, from all the positive nerve endings in the area. As for starters and stepping into the anal game, check out the FM anal glass dilators. Second, I am also a huge fan of silicone cones. If one understands anal anatomy, you need to take into consideration two things; anal muscle relaxation (there are three sphincters – two you control and one you don’t) and the overlying skin. 

I recommend starting with dilators, like the glass set we developed at Future Method, because they teach the anal muscles to understand how to fully relax, while also working the muscle memory to accommodate penetration. I also love cones because they focus more so on opening and toughening the skin. 

Once you feel comfortable, the sky’s the limit. People should choose toys that appeal to them and fit within their experience level (no pun intended). From differing shapes and sizes to vibrating and specific angulations, there are so many options out there. 

However, I am not a huge fan of large butt plugs that you leave in for extended periods of time. These do have the capacity to cause injuries and really should only be used by more experienced people. 

Knowing and respecting your limits is so important to help avoid injury. Discomfort can happen, but once you experience pain, that’s your body giving you a sign that something is wrong. If you see more than a few spots of blood or your symptoms persist, it’s time to see a doctor as you might have endured a fissure or another anal injury.

When it comes to fisting, it is definitely an extreme sport and a lot of people find it too extreme. There’s still so much stigma and taboo around fisting. Whether that’s because they think it’s going to stretch their asshole too much that they’re going to shit themselves (it won’t if it’s done correctly), that it’s going to be messy (it won’t if you prepare properly), or that it’s only for the kink/BDSM community (it’s not). 

But what might surprise people to learn is that the fisting community is by far one of the greatest in injury prevention. In my private practice, it’s more common to see someone with an anal issue who is new to anal sex, rather than someone who is a fisting aficionado. They are known to host classes to educate themselves and others on proper fisting techniques, and are incredibly patient on all levels. The key is making sure you are taking the right steps (and not rushing it) to get your skin and muscle to accommodate bigger toys and fists, and working with someone who knows exactly what they are doing, whether you’re a newbie or a seasoned pro. And everyone should know when enough is enough, or when to stop before a serious injury may arise.

If I find blood in my poo, how worried should I be, and do I need to go to the doctor?

Bleeding after anal sex is a common occurrence. The walls of the anus can tear during anal intercourse, resulting in anal fissures that bleed and feel uncomfortable. However, I’d like to emphasize that while it may be common, it is not normal. You should not be bleeding after every anal engagement.

Most people will notice spots of blood every now and then, if they regularly have anal sex. However, it should only be a couple drops of light pink blood, or discomfort that lasts no longer than two days. 

If bleeding does ensue, the first and most important thing is not to freak out. Stop having anal sex until your body heals. Having anal intercourse while you have an anal fissure can increase your risk of infection or could lead to further damage. Start with some over-the-counter remedies, stool softeners, and a suppository (Calmol-4), take Epsom salt baths and, obviously, abstain from anal intercourse. Things should improve over the next couple of days. If so, then ease back into bottoming again by starting with an anal dilator or butt plug as a test, making sure your ass is ready for full engagement. I recommend going to see a doctor if you have the following symptoms: severe, prolonged pain from the anus, severe abdominal cramping or pain, and/or if the bleeding does not stop. 

For those of us who are older, is there anything extra that we can do to look after our bums? 

I think everyone should do their best to work with what we’ve got. This starts with educating ourselves on anatomy and sexual function–the things none of us ever learned in school or from our parents. Once we understand our asshole and its functions, we can tackle the preventative approaches that help us to minimize any potential complications. Injury will happen, sure, especially if we are engaging in anal sex, so make sure you have access to doctors who can provide nonjudgmental and affirmative specialized care if you have questions or something goes wrong. I’m also a huge advocate of annual anal manometry testing, which measures the pressures of the anal sphincters and help us get a baseline of where your muscles are at, and whether we’re seeing an increase or decrease in their strength. From there, we can put together protocols to help keep things at their optimal performance. In my private practice, Bespoke Surgical, I also recommend my patients come in for a formal and complete sexual history review (the very first time), followed by updates or changes, and then a comprehensive physical exam. I perform an inside and out review – the internal exam is called an anoscopy, for which I use a microscope with a camera at the end – and it also includes a full STD panel and an anal pap smear to check for any precancerous changes. For people who engage in anal sex, our bums are incredibly important to us, which is why we must take care of them.

Butt Seriously: The Definitive Guide to Anal Health, Pleasure and Everything In Between by Dr Evan Goldsmith is published by August Books and is available on Kindle for £2.89 and in paperback for £13.79.