EP 1:34: The Art & Science of Bottoming

Yeah, well, let's talk about it. So, I kind of, you know, erections basically come from 2 things. One is your mindset, right? So, sex is 90% between the ears. Yeah, we all, you know, it's in the brain. So, absolutely, I think meth can affect you in that sense, right? So—

Welcome to the After Meth Podcast. This is your host, Dr. Dallas Bragg, a former crystal meth addict, now sobriety coach. Join me on my mission to increase awareness around the epidemic of crystal meth among the gay male population and create a repository of resources for current and past addicts, as well as and especially for their loved ones. This is The Aftermeth. Trigger warning: this podcast will contain discussions pertaining to drug and alcohol misuse. If you feel triggered to use or relapse, please call SAMHSA's National Hotline at 1-800-662-HELP. Also, if you are new in your sobriety journey, and you feel like you could be triggered by discussions around drug, alcohol, and sex misuse, please do not listen to this podcast. All right, now on with the show. Welcome back to the Aftermath Podcast. We have an interesting episode today. I am talking to That Prostate Doctor, if you want to find him on, uh, Instagram and TikTok, today about all kinds of butt stuff and dick stuff that we would— that we need to know. Um, I've been looking forward to this interview for quite a while. I really loved this, uh, gentleman's TikTok page when I saw it. I learned a lot, and that says something. You know, I think we can all learn on TikTok, but some of the stuff we learn is irrelevant. But you're, you're really out there helping people, Tom. So if you could introduce yourself, Thomas.

Yes, well, thank you very much, uh, Dallas. You can call me Tom. Um, I'm very, very thankful to be on this podcast. I've been— I've listened to one of yours before, and I, I also learned a lot from it, and, uh, that was great. So, uh, just to give you guys my background, I'm from Indiana originally. But I moved to California for medical school. I went there, I went to UCSF in San Francisco for medical school, and then I went to UCLA for my urology residency. So I am now doing a sort of special fellowship after urology residency, and I'm kind of branding it an LGBT urology fellowship where I'm doing reconstructive surgery as well as You know, men's health, so erectile dysfunction, but in particular, uh, studying bottoming. So everything anal sex, uh, what kind of makes it pleasurable, what kind of makes it painful, and how do certain problems affect it? Things like prostate cancer or an enlarged prostate or things like that.

Hmm. Yeah, it was funny. This is so such a dumb thing for me to admit, but when on your TikTok, when you said receptive anal intercourse, I was like, what is that? I was like, oh, receptive anal intercourse. That's bottoming. Yeah.

Yeah. Well, it's funny because a lot of people get it like, I want to make sure we're talking about the receptive partner because when people say anal sex, sometimes people think it's like the top, you know, the insertive partner putting it in there. And, and I have been focusing on the receptive person. And in the medical language and medical literature, we call it receptive anal intercourse. Whereas, you know, colloquially, we just call it bottoming.

Right. I'm going to— maybe we should change that, those titles to our— I'm an insertion. I'm an inserter. I'm a receiver. I love that. Well, first thing we want to do is a wellness check-in. So I just wanted to ask you how you're doing today, Tom. What's your wellbeing like?

My wellbeing is great. I have an academic day today, so I'm not in the clinic. I'm not in the operating room. So it's kind of a peaceful day and I feel relaxed and also I feel excited about talking today.

Good. I'm gonna ask you what, what made you decide to go into urology in the first place?

Well, urology is, it's very much a cultural thing. So urologists are kind of known as like the fun surgeons. And I, the reason why I like surgery so much is that people come in with this acute or one problem that we can take them to the operating room and it fixes them. And seeing people get like better right away is very, very gratifying. Like, for example, I saw somebody in with like a— when I was very young in my training, had a kidney stone. They were like dying of pain. We like took them to the operating room, we took the kidney stone out, and then they're like the happiest person ever. So there's a little bit of gratification that I got Early on by seeing people how well they respond to surgery. But I think the other thing that really drew me to it in particular was that you know when I when I saw somebody get a prostatectomy for the first time, I was like wow, what are the implications here? Like the sexual implications made it that much more interesting. It's like wow, we're going to take out this cancer, but at the same time we're going to give them like erectile dysfunction and they may leak urine and. And then like, there's a lot of social issues that are involved in urology that it does kind of take a special person to kind of deal with. And even just like talking to people about, you know, erections and, and their sexual and their sex life, but also at the same time being a surgeon. So it kind of, it kind of meshed so much of the things that I found interesting and what, you know, drew me to the field.

Yeah. Yeah. Yeah. So in your clinical experience, I'm going to bring it right back to meth, of course, since we're on The Aftermath. In your clinical experience, what are you seeing in terms of complications of using crystal meth?

Well, I've unfortunately seen quite a few. Um, it usually ends up being— by the time they call me, like, again, the urologist, you know, the surgeon, there's usually something Like there's been an injury to the genitalia. So either people have put things into the bladder through the urethra, they've torn the urethra, you know, their priapism where the erection is too long because of either meth use and trimix together where the erection won't come down. So there's been a few injuries, usually injuries, priapism that I've seen where people come in with injuries. The other one, big one is cock rings. So, you know, people put on cock rings during a meth bender, they, and they, you know, are just going at it for a long period of time, a whole weekend, and they like never took it off. And I've seen somebody lose all their penile skin from that, just because this, the skin died because there was no blood flow there anymore. So And, and unfortunately, in all these injuries that I'm talking about, if you kind of probe the patient, they will say, you know, you know, I was using meth at the time.

Yeah, you're probably at the point now where you probably knew already.

You do, you kind of do. It's when you see a certain injury, it's like, you know, this didn't just happen. Like, they're like, how, you know, how did you leave a cock ring on for 72 hours? Like, you know, as a physician, that's just not kind of normal. So you kind of know that there must have been some substance involved.

Yeah, yeah, yeah. Guys, take your cock rings off, please.

Your skin will die.

Oh my God. Oh, that's awful. So I know that you're talking about damage to the urethra. That's got to be from sounding. Is that right?

Yeah, yeah. So sounding is basically where people put you know, objects, usually rods into the urethra for sexual pleasure. And one thing I always remind people is, you know, I get it in some sense because the urethra is erectile tissue. It expands when you have an erection. So it also carries some erogenous sensation. But yes, but it can go astray, I guess you could say, where people are putting objects in, they can't get them out. One time, some— I I actually fished out a Bic pen out of someone's bladder. Another time, believe it or not, I fished out a bullet. They were like playing with bullets and the bullet fell in and they couldn't get it back out, so we had to go in and, you know, get it, get it out.

So, yeah, and it's, you know, as you all know, your inhibitions, your judgment all goes out the window when you're on meth, and you wanna, you wanna get as much stuff in there sometimes.

Yeah, I mean, it sounds like to me it's like a way to chase intensity, I think, or I'm not so sure. But it— but a lot of people say that, you know, it's like, oh, it's— this was fun before. Now I tried this. It's kind of like, I don't know, like a staircase you're kind of just walking up of trying to get that next level intensity. And, you know, again, I have this one patient who, you know, he tried small things in his urethra, and then it just kind of gradually got a little bit bigger and bigger. And it's become a huge problem.

Yeah, yeah.

Wow.

So it's common, um, with all of us who use meth that we can't get hard. You mentioned trimix. You know, I've personally seen guys being rushed to the emergency room with trimix, you know, putting too much in. Listen, we can't judge things when, when we're using meth. And like you said, we're always chasing the next high. Um, what can we do? What can we do that's even worse than this, or, you know, more exciting than this? Um, and that's what drives us to do all kinds of, of dark things. And again, I want to say, and, and Tom has said this a lot of times already before we even recorded, is that we're not yucking anybody's yum. We're not trying to shame you. This is a podcast about safety, right? And, and, and still having fun in a healthy way. Um, but anyway, a lot of us experience erectile dysfunction during meth use, but it's also long-lasting. Um, you know, for me, it lasted— it lasted several years into sobriety because you take the meth away, you're taking the sex away and the libido. But where do you— where does this damage, you think, comes from in terms of it? For me, Because you watch hours and hours of porn. I could watch 5 seconds of porn and have an erection. But I'd be with someone that I'm really turned on by, but I still couldn't get hard. It's got to be in the head.

Yeah, well, let's talk about it. So I kind of, you know, erections basically come from 2 things. One is your mindset, right? So sex is 90% between the ears. Yeah, we all, you know, it's in the brain. So absolutely, I think meth can affect you in that sense, right? So you're, you know, every— you're so stimulated that almost anything, right, can kind of make you aroused and give you a— give you an erection. The second thing that causes erections, of course, is healthy vasculature. Okay. So in fact, when people actually have erectile dysfunction, you know, in their 40s, in their 40s, when they're 40, 45, That's actually like a check engine light for your heart. So there's been really good studies that show that people who have like, and I'm talking organic erectile dysfunction, not psychological ED, which we can make that distinction. And how do you figure out which one you got? But, um, but if you really have organic erectile dysfunction, it's a check engine light. Um, there's really good evidence that 5, 10 years later, you're at higher risk for a heart attack than the general population because it's these medium-sized vessels that are damaged that we've— so we first notice it in the erections that then later can cause, you know, or this is the same process that causes heart disease. So there's— I think of erectile dysfunction in those 2 categories, right? So psychological ED as well as sort of vascular dysfunction. And I imagine, you know, know, injecting methamphetamine, which is a huge stimulant, can raise people's blood pressure, cause damage to vessels over time. So there may be an actual physiologic component to it. But again, there's probably also a very large psychological component.

Yeah, I know meth is a vasostrictor. Is that a word? Yeah, yeah, yeah. Yeah, so psychologically, so for instance with me, um, I would wake up every morning with like, like the hardest raging hard-on ever. Um, and so I knew something— it worked. Is that, is that, is that a way to, to distinguish whether or not psychological or—

Yeah, you nailed it on the head. It's like you already went to training. But, but basically it's the nocturnal erection. So And when you're no longer waking up with any erections in the middle of the night, that's when I really start to think of like, is this sort of organic ED, like vascular compromise, things like that? Um, but absolutely. So people will— I— that's like one of the first questions I ask people when they come in for erectile dysfunction. I say, do you ever wake up with an erection? And they'll say, yes, I do. But when I'm with this ex-partner, I just can't, you know, get it up, or I can for a little bit, but I actually just— it goes down with time. And those, when I hear those, that sort of, that sort of speak, that reminds me a lot more of psychological ED than it is sort of organic ED. So that's the nocturnal erections are really a really key point.

Okay. And if it's psychological, that's something that, that's out of your, your expertise, I'm assuming.

Now we can talk about it. I mean, okay, so, you know, psychological ED, you know, it often happens, you know, the classic is, oh, you know, I can get an erection with my mistress, but I can't get an erection with my wife anymore. You know, that's all right if we have to be like the straight, you know, urology ways that we kind of learn about these things, right? But that's sort of the thing. It's like, okay, I'm getting aroused in one context, But I'm not getting aroused in the other. And I kind of think of it as like, I read a book once where they called it like the stimulators versus the brakes. Have you heard that before?

No.

Where there's some things that really stimulate you. And that's like, you know, a hot guy, you know, pornography, you know, being in the right mood, like all those things kind of stimulate your erection. But there are also all these things that put a brake towards your erection. And sometimes we have to lift our foot off the brake. for us to go forward. So, things like depression, anxiety, performance anxiety. Performance anxiety is a huge one where it's like you're constantly thinking like, am I enough for this guy? You know, and all that stuff is just like constantly putting on the brakes. It's like, no wonder you can't get an erection because all of these thoughts are putting the brakes on your arousal. So, I think of these stimulators versus brakes and A lot of people to overcome psychological ED, they're just so focused on the stimulators. They're like, okay, well, maybe I need a little bit of a hotter guy, or maybe I need some drugs, or maybe I need, you know, porn in the background. Maybe I, you know, all these things, which does help, but they're ignoring all of the breaks.

Hmm. That makes me think about and I'll probably get added at added for this, um, is that the opening up the relationship once you get to a certain point, um, you're not doing it for me anymore, let's bring more people in. Um, not to say that that's every time, but I wonder if that's bypassing the real issue.

You know, it's a really great thing, a really great topic, and I'm so glad you brought this up. And it— if we could get personal, it's, it's what happened in my last relationship, you know. Um, we We were actually having a lot of issues. You know, we didn't— the emotional intimacy went down. And then it's like, well, sex was kind of boring, blah, blah, blah. So like, let's just open it up, right? And unfortunately, we see this a lot in the gay community. And I don't have any issue with open relationships, but it's often how and in what context was the relationship opened, right? And this opening up a relationship. having sex with a new partner that you haven't had sex— like, you know, if you've been having sex with the same person for 5 years, and then all of a sudden— and you're getting ED maybe— and then all of a sudden you're with this new partner, well, it's fun, it's exciting, it's novel. Uh, these are all the great stimulators that are gonna, you know, get that— no wonder your erection is working just great, you know. So, um, but if you want to get that erection working with your other partner, you got to think about like, you know, why do I have this resentment? Or, you know, maybe whatever else is going on within the relationship. That maybe you're not addressing?

Yeah, yeah, I think that's some good questions to ask.

Yeah.

And we're— I think sometimes we get defensive in saying, you're, you know, you're judging me or slut-shaming me or whatever. But it sounds like to me, if you're putting in a lot of stimulators, but you still have the brakes on, that you may, you may move forward, but you're, you're, you're still not— really, your momentum is, is not there, right? Psychologically.

Correct. I agree with that. Yeah, it's like, and at what point do you kind of burn out? You know, it's just like, you have this huge brake on, but you're just like revving up, revving up, revving up. And when is it going to be enough until you start focusing on these brakes, right? Of like, gosh, maybe I am depressed. Oh gosh, maybe I— maybe it's my body image. I don't like how my body looks now that I'm 10 years older. Like, there's There's so many other things that are, you know, pushing the brakes down that if you don't address, you may be, you may be missing the, you know, the forest for the trees sort of thing.

Yeah, yeah, yeah. You know, I want to say to the listeners here from my own experience is that, you know, I was always in my head so much about not being able to have an erection. But the more I sorted through my recovery, the, the closer I became to everything working properly down there. The more that I worked on, I think, a stimulator for myself was my self-image, um, my feelings of being not enough, um, guilt, shame, all of that, that you really— is really the hard work in recovery. Um, the, the reward for that, for me, was, you know, spontaneous erections.

Yeah.

And it started with nocturnal erections, right? Like, I, I, for a while, I never had one. It was like I thought I was dead down there. And a lot of us do when we come out of a meth addiction. We feel broken, um, numb, uh, down there. Um, and so it started for me, it started with waking up with an erection. But the more that I gained my self-confidence, the more that I didn't ask questions like, am I pleasing this person? Do they notice me? Do they, you know, and thing too is, for me, there's a pressure of being the, the inserter, the top, you know, in terms of going long enough.

Mm-hmm.

And, you know, we watch porn and we see these guys taking a dick for, you know, an hour or whatever, and some of these receptives, the bottoms— I'm having fun with that for some reason— but these receptors You know, they're insatiable. They like— they want it for hours and hours. And so there's this pressure that goes on on both sides, and that, that it just affects the dick so directly. Um, but you're, you know, you're, you're sub— uh, category or specialty is bottoming.

Mm-hmm.

And, and what I'm interested in too is how it affects somebody bottoming. Like opening up, or opening up or closing up and not, not having pain and not being able to perform as a bottom because they're in their head. What do you think about— what do you know about that?

Well, I think we're starting to learn. I mean, not to have another term for pathology when it comes to gay sex, but it's like that there is a sort of performance anxiety when it comes to bottoming. And for sure, When people are in their head about any sort of sexual act, you know, whether it be the insertive partner, the top of like, oh, I gotta last long. But it's also all the same things, but as the bottom, right? And it's like, you know, is my hole clean enough, right? That's a common one that people will like be thinking about during sex that make them kind of clench. Another one, a huge one, is actually internalized homophobia. So You know, people will be like, you know, not only am I gay, but I'm the bottom, you know, it's like, it's like a double hit sort of thing where people— so some people will be like, oh gosh, I can't believe I'm doing this. You know, it's like, these thoughts are kind of constantly in their head. That again causes them to kind of clench up and report pain. There's been several studies now that I'm pretty convinced that internalized homophobia for sure causes pain during receptive anal intercourse. So, you know, that's a, that's a, that's a common one. And then of course, it's just like the dynamic of the partner. It's like, you know, am I pleasing him? Is my, is my hold tight enough or loose enough? And, you know, all these things that are going through people's head that I think inhibits their ability to fully relax.

I'm wondering how many total tops actually are just ashamed of being gay.

Yeah, I mean, I'm sure, I'm sure there are, you know, people always say, you know, it's not, it's not gay if you top. But no, I don't know if you've heard of that before. But, you know, you know, so there certainly is, is that, but when you have someone like that, then, then go to bottoming, I'm telling you, they, they They'll report a lot of pain, and they probably do have a lot of pain. But it certainly can get into and get in your head.

Interesting, interesting. Well, there's a question about that too. Later, I'll ask. Well, let's let's stick with bottoming for a second. Part of what you said on your TikTok page that I found found interesting is the is rectum sensation. And how the rectum learns. Can you talk about that a little bit?

Yeah. So it's no surprise, I guess, that when people first bottom, like their first 10 times, first 20 times, the common thing that people will report is that they feel like they have to poop. And it's not, you know, no one else— you haven't had anything else in there besides poop, right? So your rectum thinks that there's maybe poop inside there. And The rectum is actually really smart. It has these baroreceptors on it that can detect things like gas versus solids, which is why you kind of know, like when you know, when your rectum's full, but it's just gas, you kind of know that it's just a fart and you can like go in the corner and like let it out versus you know that it's stool, right? Because it feels different. Like it feels like a solid piece of material. You're like, okay, wait, no, no, this is not stool. I got to go to the bathroom and take a poop, right? What's interesting with bottoming is that when people— this has been a, you know, a thing that I've heard over and over again— is that it feels at the beginning like you have to poop. But once you pair it with sex, you know, over and over again, and, you know, you, you learn to kind of like it, over time that sensation goes away. So it's almost like the brain adapts to, you know, this isn't a fart, this isn't you know, stool. This is this third thing, which is actually a penis or a dildo or whatever else. And the rectum kind of adjusts that sensation to be more erogenous than it is, you know, oh, this is like, I feel like I have to poop. And I don't know, you know, at what point that switches for people. Because I also have heard some people say, you know, it always feels like I've had to poop, and I've never made that switch. And I don't know the answer for those people, but I will say after a good few times, a lot of people say that, that, that sensation that they have to poop goes away.

Yeah, yeah. And I'm guessing when you're high on meth— I'm just thinking about, you know, when I was, when I was on meth, I bottomed a lot out of sheer— because I had to. Um, And I just— and maybe I'm wrong here, but I just didn't remember feeling a lot of sensation.

Mm-hmm.

You know, it was just the act of it. I think that turned me on. I don't, I don't know. I wonder, I'm just wondering about people high on meth, if, if they're— if the pleasure is actually in the actual anus, or if it's the pleasure of the act of receiving it.

You know, again, 90% of sex is psychological, you know, so there is so much of like pleasing the partner, you know, you know, doing stuff that is taboo that kind of gets you off. But if I can ask you a personal question, we can defer this if you don't want to respond.

Yeah, ask me anything.

But did, did you ever bottom outside of using meth?

Yeah, yeah. So I'll take you on a little tour here. But so I, I did. I came out when I was 36.

Okay.

And I'd never had sex with a man. Um, and so I— the first time that I, I was like, I was, I was coming out and I was like, you know, before I leave my wife and destroy, you know, burn my life down, I want to know if I'm going to like this. And so I tried my fingers in the shower and it felt awful, you know, because again, it's— this made me think about what you're saying, is I think my rectum thinks there's a turd in there, you know. And so I was like, I don't know if I'm gonna like this. Then I tried it again, but I was thinking about a celebrity.

Okay.

I'm getting embarrassed for some reason, um, but I— when I was closeted, I used to have to think about Justin Timberlake to come.

Okay.

And so I, I tried the fingers in that instance, and I liked it.

Mm-hmm.

Um, and so then I tried this, the full-on thing of meeting up with a guy. Um, yeah, and he didn't even use lube, just used spit. But it felt amazing, like the whole thing felt amazing. But I actually, you know, bled even after.

Okay.

But I left there saying, yeah, this is it. This is, this is for me. So I, when I first came out, because I had topped, you know, for all those years— I was married for 12 years. Um, I, uh, was a big bottom, you know, that's all I wanted to do at first. Um, and so then, you know, when meth came along, it just— yeah, so, so I did enjoy it. But I will tell you now, in, in recovery, I don't enjoy it. I, I don't feel like it. I don't know, it just doesn't feel the same to me. Um, I don't like being receiving. I, I don't, I don't know what it is. I don't know if it's psychological or not. Part of it is the fact that my dick works again, you know, so it works, I'm going to use it, right? Um, but the other part is I just don't— it just doesn't feel the same. And in my mind, I feel like it's This is awful. I feel like it's been used, you know, in, in the meth, you know, and, and as a meth addict, I had sex with hundreds, hundreds of men. And so I'm like, is it, is it worn out? Is it used? Does it— has it lost its shape? I don't know.

Yeah.

So there's the— there's a long answer to your question.

And I love it. And I, I, you know, I just thank you so much for sharing with me about this because it's, you know, it's some of these— the reason why I love talking about this stuff is that it's so personable. And a lot of times people have never really— when I ask them like, well, what feels good about bottoming? People are like, shit, I've never even— I've never even thought about that response, you know. So I, I thank you for sharing that with me. Because so many people, you know, when it comes to our pelvises, we just don't— we kind of ignore that. And we don't really know kind of like how to describe sensation, which is what I'm trying to help people because some people like certain sensation over others. And if we can figure that out for them, actually bottoming changes a lot. And so I really kind of like what you said about all these things. And, you know, I, for sure, I'm curious if it's a pain factor, because, you know, one thing I have seen in my experience with talking to people about bottoming, in particular with meth, is that it can get Kind of rough. And it can get, you know, again, you can, you know, who knows, was there maybe some damage or things like that that occurred? And so I've heard this before, I guess you could say, from people who've had a history of meth, and now they have some sort of chronic pelvic pain. And it inhibits them from enjoying bottoming. So I don't, I don't need to put it back onto you. But do you have any comment about that?

Well, I, I will say, I will say it is painful. Um, um, it's more painful than it seemed to be, it used to be. And let me tell you something too, is that what I'm correlating right now is coming out of a meth addiction, I lost trust in men.

Mm-hmm.

And I lost a lot of An idea of sex was perverted and, um, it changed. Um, I restricted, you know, I became— and when I did have sober sex, um, I did not want a blowjob. I did not want you— do not try to rim me, you know, don't do anything to me.

Mm-hmm.

I'm going to do whatever it is, you know, I'm going to give. I didn't want to receive. So there was a lot of I think there's a lot of trauma there. And I'm wondering if that has affected my ability to enjoy bottoming.

It definitely could be. And I, you know, it's, it's, it sounds like it, it sounds like you didn't want to receive from anything, right? It's like you wanted to have that control. And you wanted to, you know, not, not have it be done onto you. And I can't speak for you, but it is a possibility, right, for there to be something there. In terms of those experiences that have then kind of traumatized you. And I will say a history of trauma, this is outside of anything meth, but we have looked into this of a history of trauma. There does tend to be more pelvic pain in these patients. And we call it kind of chronic prostatitis. But what it probably is is like this hypertonic pelvic floor. So there's these group of muscles that go right by the rectum, and there's a big group of muscles that are around the anus. And these are skeletal muscles, so you can control them just like you can control your arm muscles or anything like that. And what happens is when people get— have trauma to the area, these muscles get extremely tight.

Hmm.

Um, just like when you have trauma— if you have a hurt shoulder, the muscles around your shoulder become hypertonic. They're— they become really sore and tight. And the one way that you help after you have like shoulder surgery is that you go to physical therapy and you stretch and you strengthen these muscles. This sort of same paradigm needs to be done in the pelvis, but everyone overlooks it because these are, these are skeletal muscles that are wrapping around the rectum, wrapping around the prostate and wrapping around the anus. And they can get hypertonic. And there is this thing called pelvic floor physical therapy, where people can go and to learn how to stretch and relax these muscles. And it can really, really drastically change the experience for people when it— not only when it comes to, you know, bottoming, but also just like chronic pelvic pain in general. So I just wanted to kind of put a plug out there for that because Sometimes the reason why people have issues with bottoming is because they actually have a hypertonic pelvic floor.

Yeah, it's interesting that you say that because so this relationship I'm in is new, um, and I had avoided relationships because of my erectile dysfunction, especially, uh, being a top. Um, but you know, I got involved with somebody I really Like, and he's a bottom, total bottom. Um, and so there was something about like the first time we had sex, um, we were having— so it was the same thing every time. I'd get really hard, if I could get it hard, um, and then as we were having sex, it would stop. It would wither or go limp or whatever.

Mm-hmm.

And I figured out that it's because I was associating having sex with the guy never coming back. Because in sobriety, I would have first dates, I would have sex on first dates, and then never see them again. As in meth addiction, I would never see them again after the baggie was gone, right? And so for some reason, he intuitively knew this during and stopped me, and he just said like, I'm not going anywhere. When he said that, I immediately got an erection.

Wow.

Immediately. Yeah, erection. Yeah, just him saying that.

Yeah.

And, and then at the same time, I noticed when I was going for a walk that I was holding— I was doing a Kegel constantly, holding it so tight back there.

Yeah.

As I walked and through, and through my day. Like, now I'm constantly having to release my muscles back there. So, you know, There's something there, right?

Yeah, 100%. Dallas, I think you have a hypertonic pelvic floor, or you did, you know, like, uh, like 100%. This, this hypertonic pelvic floor also can cause problems with ED because it disrupts the blood flow, right?

Mm-hmm.

And so I've sent people— I've seen people who've gotten better with erections just by doing pelvic floor physical therapy. And the fact that you're saying like, oh my God, I've, I've been doing a Kegel for, you know, who, for who knows how long.

Yeah.

This happens with a lot of people that they're just like constantly clenching down there and it's causing havoc in their lives. It's pain with pooping, pain at rest, erectile dysfunction. It's a huge problem that— and it's actually not so difficult to treat. It's like learning how to relax the muscle. So it's, it's really, really great. And you know, the other thing that made me think of when you were talking about this was When people do have psychological ED, meaning that, you know, you have an erection, but you kind of lose it in the middle of play. One trick that I have found to be really helpful, and I learned this from some book, was try to be intimate without using the erection. Just do it, you know, go through, go through the whole thing. And, you know, kiss, make out, touch each other, all these things. And just like, if you get an erection, great. If you don't get an erection, great. Continue to do it. Do it for half an hour. Take the erection off the table. And that allows people, for whatever reason, to connect, to be more intimate, to be more honest. And then, like you said, it's like maybe there was something that you were worried about, like, this guy's gonna leave me, that he finally said. And then it's like, boom, erection came back. So yeah, that's just like something I wanted to put out there.

Yeah. Well, he's probably going to kill me for sharing this, but so the last time we were together, we did that in terms of— so we had a whole night, like we took a bath together, right? And I— it was a very intimate bath. And then I'm— then I gave him a massage. This was like 4 hours of no sex, but just intimacy, talking, you know, all that stuff. Um, and then then it was time to, you know, we came to, to having sex, and I was— it happened, you know, it happened. And, um, to the point where then it was him who had the issue in terms of all of a sudden it was painful.

Hmm.

His muscles were retracted, were retracting, and he was saying that there was something about the thought of not being an open bottom for me. You know, this whole time that we've been having conversations, it's been all about me and my performance. And this one time I was, I was in it that night. Like, I was ready. I was ready to wear him out, you know.

Yeah.

And he— but he couldn't do it, which to me, I felt bad for him, but I also was like, yes, it's not me, it's not my problem this time. But so the question that I think— one of the questions, one of the questions is, is that how do you get out of your head when it's, you know, when your muscles are, are, are restrictive that way during sex? How do you get out of your head and release those? What is the— is that a temporary hypertonic pelvic floor, or is that just a psychological clenching?

Well, I mean, I— it's both, right? So you can have like an actual hypertonic pelvic floor that you really need to learn how to stretch those muscles. But it can also like people with anxiety or like, again, this performance anxiety or they're just not sure. They're like, there you can clench these muscles, right? So one of the things that helps the best to kind of first stretch these muscles is to kind of like lay down on the bed and just do diaphragmatic breathing. So you just like take really deep breaths with your diaphragm and that actually slowly stretches out the pelvic floor muscles. And just like taking a few like deep breaths actually can help stretch those muscles. You know, in the moment, it may not seem so sexy to be like, hold on a second, let me lay down on the floor and do all these stretching. One thing that some people do, they actually have a lot of problem with this, is they, one, they can regularly stretch their pelvic floor, which is like something you can do off the side. But if you know you're going to have sex, is that you can put in these small little just rectal dilators. So they're like basically small little dildos that you can put in there and just kind of do some deep breathing exercises while, while it's in there to kind of loosen up the anus, the pelvic floor before then you go in and take like something larger like a penis, right?

Mm-hmm.

Some people like will communicate with their partner and be like, hey, you have to like eat me out or finger or whatever. But I'll tell you, a lot of people don't like fingering. And I remember you saying that you did it once and you're just like, nah, this ain't for me because the finger, it's just the anus doesn't accommodate a finger like a vagina does. And I think, I think we kind of see fingering so much from like the straight world and some people love fingering, don't get me wrong. But there's a lot of men out there who don't like fingering because the nail that like just the way it gets in there, it just, it's just something about it just doesn't feel right. Feel all that great. So, you know, some people use fingering in order to prepare, but other people, you know, just a small little rectal dilator, some deep breathing exercises before you do it, and see if that helps.

A rectal dilator. Mm-hmm. All right. Can you get that on Amazon?

Yeah, you can just Google it. Rectal dilator. They come in all shapes and sizes. Back in the day, we just call them dildos. Yeah, but, uh, but they do actually have these things called rectal dilators that are like really little small little things that, you know, you can, you can, you know, gradually, uh, go up if you want. Or like I said, if you have like a little small dildo, it's literally the same thing.

Yeah, yeah. Okay, so some people would say just do poppers, which is a discussion that we had too that night. Um, yeah, he said, well, maybe I could do poppers. I know you've talked about poppers a lot. What do you— yeah, what do you recommend there?

Yeah. Oh gosh, how much time do we have? Poppers are so interesting. And if you look at like sort of the epidemiologic data of who uses poppers and who doesn't, so we don't have any sort of physiologic evidence that when you do poppers, you know, that it actually relaxes the muscles. But We know that poppers makes you like immediately kind of like more horny, makes you kind of want it more. And, you know, from a lot of people's experiences that they've said, they say it just helps relax them. So, you know, I think you could try poppers. But the thing, there's a lot of things that I don't kind of like about poppers. One is that it vasodilates you. So it lowers your blood pressure and makes your heart go beat really, really fast. So you should never use poppers with erectile dysfunction medications, because you can really drop your blood pressure to something that's dangerously low and also really put you at risk for heart problems. And unfortunately, people mix poppers and ED meds all the time, right? So, you know, poppers, I think, could help, but I kind of worry about like, do you want to build up a tolerance that each time you bottom, you need to use poppers? I, like I said, I'm not a— I don't want to yuck on somebody's yum. And if you want to try and do poppers every once in a while, go for it. I've used poppers, okay? Like, I, I know the feeling, okay? So I'm not saying that's the thing, but I'm— what I'm more curi— what curious— I'm curious about really is people who use poppers every single time. And if you look at the data, and this is our data that we've collected on over 1,100 people, if you look at the people who use poppers either always or, or often with bottoming. These people do not report more pleasure during bottoming, and they do not report less or more pain than anyone else. The thing— the high popper users are people who have a lot of sexual partners and who have bottomed a lot. And I think there's some reasons for this. One, as you've just been in the gay community longer and longer, you're bound to be around poppers. There's bound to be somebody that you hook up with and is like, here, take— why don't you try poppers? And then you try it, right? And I think poppers has a lot more to do with the stimulation and breaking than it has to do with anything else. So people are hooking up with a bunch of people, right? And they're trying to intensify the experience, right? Or they're trying to get into it, right? You're meeting with somebody for the first time. And, you know, you're just like, okay, how do I boost this up? That you'd use— you use poppers. It— what poppers does is it pushes on the gas pedal, right? It makes you really into it, makes you really horny, and it, you know, puts you into the mindset of it. So I don't know, that's my spiel about poppers is that I don't think people who are using poppers all the time are actually having— are having any more or less pleasure or pain than anyone else.

Yeah, yeah. I wonder if it's sometimes a shortcut to, to opening up the anus when you, you know, you may have internalized homophobia or you don't want to wait to work for it, you know, just opens it up. I don't know.

100%.

Yeah, I— for me, it makes me go even more limp.

Well, of course. Yeah, I mean, it's a, it's a vasodilator. It's gonna, it's gonna take your bloodstream away from away from your erection. So yeah, absolutely, it goes the opposite effect for erections.

Yeah. Did you see any— did you see any correlation between, or maybe you didn't study that, poppers and meth users?

That's a great question. We looked at some polysubstance stuff, but not right into that kind of great detail. I will say if we want to talk about this same study, we did ask about methamphetamine. And we looked at— we categorized people as like high frequency, like either always or or often using meth with bottoming. And the main thing, there was a few things. One, lower education. So if you were, you know, lower educated, like high school degree or lower, you're more likely to use meth. So that definitely highly correlated with education status. And the other thing that it highly correlated was pain. So for sure, that which is what we had talked about kind of previously, was that these high-frequency meth users report a lot of pain during bottoming and a lot of pain after.

Hmm. Yeah. Hmm. Interesting. But you don't know where the pain's coming from?

Not at this time. Yeah, I think we need more. We need more studies to kind of get at the nuance of that. But if we— the way that we ask the question, so some of the questions are, you know, a sore anus after bottoming, or pain with pooping after bottoming, or pain with insertion, you know, right when it goes in, or I had to take a break during bottoming because of the pain. Those are the ways in which they responded higher.

Yeah, yeah. Well, before we get into your current study, because I do want to make sure we get there, Um, there was a couple of questions that were submitted. Yeah, when I sent a message out, one of them was— you've already answered— was how do I get out of my head, right? Um, and you know, a lot of that, now that I'm thinking about it, could have been— I could have helped, the partner could help with that too, like reassurance, like he helped with me, right?

100%.

Yeah. Um, okay, so The other question is, how much is too much douching? Mm-hmm.

Good question. Yeah. So, okay, so again, we're trying to figure all this out. So, you know, stay with me. And every 5 years, hopefully we'll have a better and better update on how to answer these questions. So 70% of people douche, okay, out of this 1,100-people survey that we did, 70% of people do douche before bottoming. So it is a very, very common thing that people do. The most common reason— sorry, the most— if you want to correlate it with like, you know, social factors, the biggest reason why people douche, or the, uh, it's highly related to your relationship status. Let me just say it that way. Okay, so people who are single and meeting people, you know, hooking up and that sort of thing, are much, much more likely to douche than people who are in monogamous long-term relationships. And that probably has a lot to do with, you know, comfort with your partner. Oh gosh, if there's a little bit of a mess, it doesn't really matter. Like those sorts of things. But there is a lot of shame by having stool in the rectum. And it's to me baffling a little bit because it's like the rectum has stool in it. So I—

Yeah.

That's like something— it's one of my participants called it like the shitty kitty, you know? It's like, it's just kind of like an occupational hazard. You know, that sort of thing. But regardless, so, you know, there has been some studies relating douching to rectally transmitted sexually transmitted infections. So, you know, chlamydia, gonorrhea, HIV, etc. And the thought is, is that if you, if you douche, it actually disrupts the epithelial barrier of the rectum, and that this disruption you know, makes it easier for microbes to kind of get in, in, in the bloodstream and actually cause an actual clinical infection. So, um, for sure there is this association, and it's been in quite a lot of studies that people who are— who douche are at higher risk. But you also have to look— I always ask, I always put it in this way, is like, how do you get an STI? Is you sleep with somebody with an STI. Okay, it's that simple, right?

Yeah.

It's that simple. Um, knowing the status of your partner. And, you know, people who are douching are often sleeping with a lot of different people, so there is a little bit of a confounder there as well. So maybe it's not all the douching, right? It's, you know, who you're sleeping with. Um, so that's kind of an important factor. And, you know, how much is too much? You know, I, I, like I said, I don't know the answer, but I do know one thing that you can do to help reduce the amount of douching you need, and that is fiber. So psyllium husk in particular. So the powder is way better than the pills. They try to sell all this fancy, like, Pure for Men and all this stuff to kind of like upgrade, like how much, you know, try to upcharge the gay community. Sure. Just go and get some Metamucil.

Yeah.

It helps really sop up the poop so that you have these nice thick logs. And you don't really have a lot of kind of like residue. And there's a lot of people who come up with this regimen for themselves where they have these nice clean bowel movements where they don't have to douche at all, or if they have to douche, it's less.

Yeah. Yeah. Interesting. Because I've heard that and I just saw a TikTok recently with this guy who was saying that he doesn't have to douche that much and he held up a, you know, a bottle or a container of Metamucil.

Yeah.

Um, yeah, and I've heard other people say that too. So yeah, Metamucil on a daily basis, I guess. Yeah, could reduce it, huh?

Yeah, psyllium husk, which is the main ingredient. Yeah.

Yeah, yeah, interesting. Okay. Um, how might my preparation— I don't know if you can answer this or not— how might my preparation be different when comparing routine intercourse versus more, um, intense play? And so he's referring to fisting, I'm sure. Yeah, fisting, fisting and/or cum dumps. And so what we're seeing is a rise in sober kink and sober fetish.

Yeah.

And so they're getting— we have guys getting back into fisting, which, you know, we had a little talk about fisting before we recorded in terms of the dangers of fisting while you're inebriated or high on meth. Um, but would you— I guess his question is, would you prepare differently for that?

Well, um, I do have a few people I've talked to who do like to fist, and they do a lot bigger clean out. Um, and some people actually clean out from the top down and not just the bottom up. So what I mean by that is taking like, uh, MiraLAX or polyethylene glycol or, um, magnesium citrate. So basically the things that people take before colonoscopy, right, where it just kind of cleans out the entire gut.

Yeah.

Um, so that's one thing that some people do. I mean, the other thing, the gold standard of course, is just enemas. So people, you know, clean out the rectum before, um, but you got to use kind of a larger volume to kind of clean out all the way kind of up and around. Um, so certainly I think a lot of this has to do with trial and error and, and being with partners that you feel comfortable with. And, you know, if, if there's some mess that happens, like, you know, it's— it can happen. I think we all have to work on reducing the shame of that because, yeah, again, the, the, the first function of the anus and the rectum is to get poop out, you know, on a regular basis. And we want that to be for everybody, you know. So, um, so, you know, I don't really have like a formula necessarily for somebody who wants to clean out more deeply. But again, I will say fiber is— fiber is your go-to for, for anything to keep the stools kind of consistently coming out.

Yeah, yeah. There is a question about, um, emotional intimacy versus hookups in terms of the, the, um, bottoming pleasure. And I, I think you talked about that too, on your TikTok, didn't you? Did you look at how emotional intimacy affects your ability to enjoy bottoming?

Well, actually, the, the study that I'm currently doing now, we are, we are 100% looking at emotional intimacy and bottoming. But if you look at other studies, how people report pleasure is very highly correlated with emotional intimacy with your partner. There was a really cool study that said, like, what's love got to do with it? And if you actually loved your partners, you say that you loved your partner and your partner loved you, your pleasure and how you report pleasure is actually much higher than other people. So I think emotional intimacy has a huge role in how we experience pleasure of sex because again, 90% of sex is between the ears. So, um, it's kind of like this like deepening way to connect with people. Um, uh, you know, and having said that, you know, what, what, what about when you're with a hookup, right? So you don't, you know, tell your whole life story to a hookup and I, and I I get that. And there's not a lot of emotional intimacy there. But I think what people ride on when they're hooking up is that stimulatory pathway. So they're like really aroused because it's something new, it's novel, it's, you know, and that allows so much pleasure to be given as well. So there, that's a route towards pleasure as well as like sort of the new novelty taboo, all that stuff. But I think when you're, when you're specifically with a partner, That emotional intimacy is a key portion of how people experience pleasure.

Yeah. And I want to point out, when you're with someone and you're partying in meth, you do share your life story. For the most part, you do get what you think and feel is intimate in terms of everything opens up down there. You take meth, I mean, typically you know, there's, there's no problem of, oh, I can't take that. It's more, you know, can't you shove something else in there kind of thing. And so what I think it, it's important for us to know in recovery is that that was a shortcut to intimacy. And, and what, what you're looking at is when you take meth, it takes away your, um, your, your self-shame, and it takes away all the intrusive thoughts about yourself, and it takes away Um, you know, all the insecurities. And that's one of the big reasons you're opened up down there.

Mm-hmm.

You know, and so if you think about that in recovery, you're going to open up down there again, but you have to do the work to resolve the insecurities and the intrusive thoughts and the things that you think about yourself. And you can enjoy sex again, but you have to do that work first. Mm-hmm.

Yeah, it really reminds me, the word that came to mind when you were saying all that stuff was vulnerability. It's like when you're on this meth bend with somebody else, you and that other person are really vulnerable together. Like, you know, you're not really modest. You're like, you know, you're showing each other the most intimate parts of yourself and you're exploring and there's no judgment, right? There's like zero judgment in the room.

Yeah.

And it reminds me so much of what you, of just like being vulnerable with your partner. Um, and it's a lot harder. It's hard to be vulnerable with your partner when you're sober or, you know, just in general. And, and so it's, it's just, I, I appreciate what you said.

Yeah. Yeah. And that's a part of rebuilding your sexual template in recovery is being vulnerable because it's intimacy. It's rebuilding intimacy. And we immediately think intimacy means sex. But really, it's— this is what I was telling the client today— is go to, go to some friends and begin being vulnerable. Share things that are uncomfortable.

Hmm.

Share things that you don't— wouldn't tell anyone else. And when you start to do that, you are practicing intimacy with someone else. And that's going to help you practice intimacy with a romantic partner down the road. Um, and that's going to, I think, alleviate a lot of these— the problem— the, like— and I've seen it myself in my own life, the erectile dysfunction, um, and, and the bottoming dysfunction. Yeah, rectum dysfunction, I guess you could say.

Yeah, rectile.

Um, yeah, rectile. Um, okay, so can you tell us a little bit about your study and how we could get involved if we want to? Yeah, if you're open to that.

Yeah, thank you. So we basically created a medical questionnaire that assesses people's sensation during bottoming. And the main reason for this is so that, you know, you know how you go into the doctor's office and they ask you fill out some of these questionnaires and stuff. And we're trying to, we're trying to figure out a way to measure this, not, not in a way that it's perfect, but a way that we can at least understand a little bit about people's pleasure, pain, urinary and bowel symptoms that they have during bottoming. And the purpose of this is so that we can better track how certain diseases and treatments impact it. So think of somebody who has prostate cancer. You know, if, if we measure, you know, like, how is his bottoming before prostate cancer treatments, we'll have a way to quantify how is his bottoming after prostate cancer treatments, so that we can better figure out which treatments are better, you know, for other people. So Anyways, the current study is, it's pretty, it's pretty straightforward. You do an interview with me, and we talk about your bottoming history. And we talk about your medical history and your surgical history. It feels a little bit like you're at the doctor's office. That's about 15 minutes. And then they fill out our survey. And the survey in general takes about 8 minutes to complete. So in total, it's about a 25-minute experience. We're hoping to get about 150 people for this. And so far, we just have recruited 70. So, we still have a little bit of ways to go. And, we actually are giving everyone $25 Amazon gift cards just to say thank you for your time.

Nice.

So, thankfully, we got some funding for the study. So, we're giving it to the participants. And, to be eligible, you have to either have attempted Or had bought or done bottoming within the last 6 months. So we kind of want to avoid some recall bias. So if you've, you know, oh, I last bottomed 5 years ago, and it was really bad, I think it's hard for you to remember exactly what those sensations were like. So you have to have done it within the last 6 months, either attempted or actually done it. And we're really looking for people who have some issue, you know, so either it's painful, either there's a lack of pleasure. Either there's bleeding, either there's like prolapse, or you have some sort of prostate problem that you feel like it's kind of like getting in the way, hemorrhoids, fissures, anything like that.

Yeah.

And if you want to get involved, um, you can always email me. So, um, thatprostatedoctor@gmail.com, and I'm sure we'll put it somewhere so people can have access to it. But all they have to do is email me and say that they're interested in the research and I'll get them plugged in.

Yeah. Okay, yeah, we'll put your email in the show notes for sure. Great. And, and your TikTok page and your— all your social media as well, um, because it's very, it's very informational. Yeah. So I know you're in the middle of this study, um, so maybe you're not thinking ahead, but what are some other areas that you would like to study that really piques your interest?

For sure, um, I want to be able to like I said, quantitatively decide how certain treatments impact bottoming and put bottoming— I want to put bottoming— I want to destigmatize it is the main thing within the medical community. So here, one common thing is somebody gets a fissure, which is a tear in the anus, they go and see a colorectal surgeon, the colorectal surgeon says, hey, don't bottom, you know, and that's just not the response. Like, that's not affirming, it's not going to be, you know, people are going to go off and do it. It's just not the right way to do it. So anyways, I want to try to figure that out. I want to destigmatize that. You know, I'd also really like to study of how anal sex impacts the PSA. So PSA is a blood draw that we use to measure people for prostate cancer risk. And there's all these Reddit subforums and all these things that say like, don't have anal sex before you get your PSA drawn. Um, so I want to do a study about that. That's going to be a future thing where basically we just, you know, measure someone's PSA before and after, you know, bottoming and see does it actually clinically affect the PSA. Um, because otherwise, you know, it could put— it could be that gay men are actually higher risk of going to get like prostate biopsies unnecessarily because their PSA is, you know, relatively abnormally high, but But just, it was just from bottoming. It actually really wasn't because they have prostate cancer. So there's some work there that needs to be done. But, you know, in general, I just like, I'm kind of interested in all things like, you know, LGBT health, and in particular, you know, urology. But those are some things in the near future that I'm probably going to try to do.

Yeah. Great, great. So, Tom, what have I not asked? Probably, there's probably a lot of things I didn't ask. What have I not asked that you would like to see mentioned here? Anything?

You know, I can't think of anything. I mean, I think we had a very, very comprehensive discussion. We talked about erectile dysfunction, we talked about bottoming, we talked about meth, we talked about the psychology of erections and psychology of sex and Um, all the things that I, you know, could talk your ear off if we had enough time. So I— there's not one thing that I'm like bursting in, in, you know, in the seams to, to talk about.

Yeah, good. Okay, great. Thank you. Thank you for joining us today. I thank you for your channel, um, and the information you're putting out there. Um, it's very, it's very needed in this community, and I love the fact that you are hoping to help the bias, you know, to fight against the bias, because there's so, you know, we have so many biases already.

I know.

Um, you know, and if you're a meth addict, you're already facing that, right? And if you're gay and, um, and now, and you're a bottom, and yeah, and maybe you have HIV, I mean, you have all this, all of this working against you, you know?

Yeah.

So yeah. All right guys, if you want to connect, you know that you can come, you can comment on the YouTube channel because there is— you want to watch this, we're on YouTube. You want to listen to it, you know, wherever you listen to your favorite podcast. But you can comment on Spotify and you can comment on YouTube, or you can just email me a question or email Tom a question if you want to join in the conversation. We also have a Facebook group where you can, uh, really join in on a daily basis on all sorts of topics. We, we talk about topics every single day in the Facebook group, and we also provide support to one another. Um, and we have people who are sober for a long time, but we also have people who are right in the midst of a meth addiction who just need to sometimes just reach out and know they're not alone. And so that, that community is the After Meth Community. Um, just search it on Facebook pages and you will find us. All right, guys, we will see you next week. Thank you.