The “Bottom” Line On Anal w/ Dr. Evan Goldstein

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The misnomer of anal sex is painful. That shouldn't be the case. Anal sex should not be painful. I think people think that you can go from nothing to something big very quickly and you can't.

They always want to go from zero to anal totally.

And there are definitely some people that are able to do it, but the majority cannot.

Look into his eyes. They're the eyes of a man obsessed by sex. Eyes that mock our sacred institutions. Bedroom eyes, they call them in a bygone day.

You're listening to Sex with Emily. I'm Dr. Emily, and I'm here to help you prioritize your pleasure and liberate the conversation around sex. Anal sex isn't as taboo as it once was, but many people are still too shy to talk about it. Well, today I'm talking with nationally renowned anal surgeon and expert Dr. Evan Goldstein about all things anal. Get ready for it. We talk about how to clean up before backdoor play. Did you know you can over douche tips to enhance pleasure and the wide variety of things to try While you're back there, we've got you covered. And remember, this is for all genders interested in anal play. Dr. Evan gives tips on how to relax, toys that can help, and which lubes are best for every act imaginable. We also break down lube shooters, Love a loop shooter, how to minimize the risk of exposing yourself to STIs, and what to consider, regardless if you're a top or a bottom, you're giving or receiving, we got you. Also, if you want more information on this, just check out our website. We have an FAQ on sex with emily.com. how do I prepare for anal sex? And we also have an article, the Do's and Don'ts of Anal Sex Sex. All right. Intentions with Emily. Love setting an intention before the show. I think about what I would love you to learn in this episode, and I want you to join me in doing the same. What do you want to get out of the episode? My intention is to set you up for success, whether you're just thinking about trying anal play or you've been enjoying it for years. Remember, if you'd like to ask me a question, the easiest way to do it is sexwithemily.com askemily. All you gotta do is include your name, your gender identity, your location, your age, and how you listen to the show. And yes, you can change your name. Oh, and stay tuned because I'm working on starting up the Sex with Emily hotline again. So you can call and leave me a voicemail with your question and soon we'll have a number you can call into and talk to me again live. Cuz I miss you. You can find me on all social media. It's at Sex with Emily. All right, everybody, enjoy the show.

I'm excited for my guest. He came highly recommended. Dr. Evan Goldstein is a nationally renowned anal surgeon specializing in sexual health and wellness care in New York City. Dr. Goldstein has extensive experience educating and shedding light on healthcare issues for both the LGBTQ community and straight audiences. He's also the founder and CEO of Bespoke Surgical and the co founder of Future Method. Find more about Dr. Goldstein on social media at Dr. Evangeldstein. Hey, Dr. Evan Goldstein, welcome to the show. So tell me about yourself.

Thank you. Thank you. I started a practice called bespoke surgical about 12 years ago, and I saw a huge need in the community, all stemming from everything that you get asked all the time. And there really wasn't someone that was spearheading the movement of saying anal sex is totally appropriate and fine. How do we make sure that you are doing it as safely as possible with the appropriate education? And if something does go wrong, how do we now make sure we have professionals that are able to take care of it both physically and then obviously mentally? Because there's so much that combats both of that. And that was really the impetus of me starting this practice. I just saw a huge gap in the services that was being delivered and I was like, how do we just do it and create an environment that is destigmatizing, that doesn't create the taboo that's associated with it? Make an environment that's warm and comfortable and inviting because people are really talking about difficult topics and topics that are really true and dear to their heart. And that's really spearheaded this kind of anal movement. It's been kind of crazy.

It is an anal movement, what you're doing, because, yeah, it is still very taboo though. It's like the other thing that you do. Where do you think all the taboo comes from? People always ask me that. Why do you think it's so taboo?

I think that again, it's probably the homophobic component. And the reality is that it feels so good.

What's the problem? Especially as a man, I'll never have that honor of being a man and getting, having a prostate. But I feel like in the years I've been doing this, something I've noticed is it's still taboo and people still want to know about anal more than any other subject, which is why I'm so glad that you're here. But also that straight men have started to come around on their own and just say, hey, I'm curious. I hear what you've been saying and maybe I should try it out, you know, maybe I should put a finger in there, a butt plug, you know, but it's, it's just in the last few years, so I don't know what you've been doing there, but we're all ready for it.

I mean, yeah, you know, I mean, I think that that has actually been such a huge push and help in terms of everything that we're doing at Bespoke Surgical and also at Future Method, and we'll talk about that. I think the, the key component has been breaking down these stigmas in society. You know, I did a study early on in my career and you know that what I do is a referral based practice, right? You go to a doctor, you say, my ass is hurt, and then they send you to me. But the reality is, is that most doctors still don't talk about sex. And, and they don't ask them on, on a general health physical of like, hey, are you sexually active? What type of sex? Are you engaging? Do you enjoy it? Are you happy? I mean, those are questions that people just never ask anybody.

No, they don't.

And then I said, well, if doctors aren't asking the questions, my business model is flawed. Right. Because no one's going to refer because they're not actually asking the right questions. And so seven years ago I hired a publicist and a PR team and we said, you know what, let's create a mission. And the mission is how do we kind of use popular press and push the narrative so that people can get educated and hopefully explore sexually in new ways that they never actually knew was what they wanted and, or possible. And you're so right. I mean, the thing is, when you look at where we've been successful, we've been successful in two areas, Female centered publications and straight like barstool, sports, Cosmo, Vogue. And it's interesting because those are, you know, pushing that narrative into the heterosexual world has actually helped us on the gay space because now people are talking about it and people are saying, wow, you know, yeah, I could actually enjoy this and I should offer this to my partner or partners and how do we do it safely? So it's been quite interesting.

That is so interesting. You went in through the straight door to get to the back door. Don't you just love. Exactly. Okay, so what are all the things that people want to know about anal? Should we just start there? I mean, what I can say off the top of my head, it's going to be painful. How do I clean for it? And you have so much great knowledge in this area.

Sure. So when I first started practicing, I kind of broke things up into categories and that's actually what those pillars are, what is founded in terms of how I practice and it's how do you prepare for anal sex, how do you actually engage or play? And then what is the aftercare?

I think the misnomer of anal sex is painful. It's really. That shouldn't be the case. Anal sex should not be painful. You should not bleed, you should not be in excruciating pain. That's just not how it should work. I think people think that you can go from nothing to something big very quickly and you can't.

They always want to go from zero to anal.

Totally. And there are definitely some people that are able to do it, but the majority cannot. And so I usually Recommend Doing a 4 to 6 week protocol of using toys. And it gets people one, to know do they like it or do they find it pleasurable. 2 Is it really starts for people to learn the pelvic floor and the anal anatomy. There's, there's, it's not very complicated. There's two things in the ass. It's skin and it's muscle. That's it. And the key is how do you get the skin to fully relax and how do you get the muscle to relax? Now if you think of skin, skin itself is very, very thin, especially in the ass. And so by using a toy or a butt plug or a dilating kit, what you're doing is you're kind of strengthening the skin. And I tell people it's like you and I going to the gym. If we're lifting weights, we get calluses on our hand. It's the same concept. The bar is creating a protective callus. If you're using a toy in your ass a couple of times a week, in a very gradual progression, you're going to start creating good, healthy skin that is now strong enough to distend so that you can engage however and whatever you want. And so the process of dilating over four to six weeks allows for the skin to get fully comfortable with opening and then allows for you to understand the three different muscles that are there that sequentially need time to learn how to relax. And so I usually tell people it's a six week process and it's using three toys that come in like a set, small, medium and large. And just like going to the gym, I tell people, do it right when you're showering by yourself, you'll take the toy, a lot of lube, and you'll just like going to the gym. Give me two sets of 12. That's all you need to do.

Two sets of 12. What, like pulses or 12 minutes?

No, in and out. So he's going to go all the way, hold it there until you hit a little resistance and then come back out. And each time that you go in and out, I usually tell people to re lubricate it so that you're kind of understanding that lube needs to be 360 degrees around. And each time that you're going in and out, you're kind of applying the lube in that area. Plus you're learning how to relax those three muscles. And it takes, it takes time, you know. And with that said, it's really for people to understand the anatomy of oh, okay. This is how I actually Relax when I'm engaging. And it takes time for the body because the neural mechanism is only really created for shitting. It's like, hey, how do I relax when I'm going to the bathroom? That's it. Now it's okay. How do I take this to the next level and get to a point where I can fully receive what I want?

So how do you explain that? So I could see them putting it in and taking it out. But how do you, is there a breath work that you explain to them when they're going in and out, how do they relax? Because in the neuromuscular, like we're just, we're so used to tensing. So how do you get them to be like, that's right, relax.

Yeah, totally. Right. Well, the small toy is really small. So it becomes, it's pretty easy to go in and out. Now with that said though, usually how when someone comes to the office and I'm doing exam, I'm asking them to kind of push out. So I usually say push out like you're going to take a shit. And, and what happens is they learn how to relax and they're like, oh, that's interesting. And I said, yeah. When I'm pushing in the, the, the instrument or the toy, if you push out, it now allows for things to fully to open and you can start to kind of work breaths into that. And you know, there's yoga, there's pelvic floor therapy, there's all these things that you learn. But the key is going until you hit resistance, holding the toy there, breathing, taking it back out, re lubricating and doing it again. And not to get frustrated because a lot of people will be like, oh God, this is not happening. And they get really tense and it says, okay, take, say okay, that session is finished, try it again another time. And you'll start to see that over the next couple weeks that you'll be able to start getting the small in without issues. And then you'll always start with the small toy. Gradually working to the medium and then getting up to the large and through there. You'll start to really see. Now if you're bleeding, if you're having pain, if things aren't moving the way that you're thinking, then you should see somebody because there's a lot of people that have predisposed issues, whether it's a hemorrhoid, whether it's a fissure, which is a tear, whether it's some extra skin that developed. I see a lot of post pregnancy women that Come to me with some hemorrhoidal skin tissue that causes them issues with just wiping, let alone or feeling sexy from vaginal sex, let alone on an anal perspective. So there's lots of things that may cause issues that if you're not. If things aren't gliding the way that you think that they should, then you should see somebody to make sure that we're all on the same page before you push it further.

Who else would they see now you're like the most. I feel like there should be nobody else. If anything goes wrong with my anus, I'm getting on a plane to New York. That's, that's, that's what I got to say about that. But yeah, because it's women. It's every. It's really. Yeah, it's. It's everybody with an anus.

That's right.

Which would be all of us. Are there toys that you recommend or you sell in your office or online?

Yeah, so, so on. On my website. Bespoke surgical. Like there's a lot of different toys that are there and different apparatuses to help. And then it goes over kind of why I think that they're really great. And also people can get the protocol as well on the website so that people can start doing what they need to to get to where they want.

And that's bespokesurgical.com. but you guys can find that. We'll put that in the show notes as well. Okay, so let's talk about lube for a minute because someone asked me like, I got 30 seconds and they're like, give me your best tips for anal. I'm like, breathe, go slow, use lots of lube. Right. That's kind of my thing. If I'm like in a hurry, you know, then if we talk about it. But the lube thing, it's like I'm like, apply, reapply. I think silicone lube is the best for anal, Typically water based. No one's got time for that to keep reapplying. Reapplying. Unless they're using toys. We have to use water based with toys. But is that pretty much what you recommend?

Yeah, you know, I think that not all lube is created equal. True, that's for sure. And a lot of people have reactions to certain lubricants. So you just gotta really see now if I'm playing with toys on my own, I'm using water based because it's just so much easier, easier to clean. And a lot of the toys can't support silicone so you just got to be careful if you use silicone, with silicone, it actually eats away at some of the rubber and the silicon there. So I usually say for toys and you're not engaging in anal, water based lube is the best. If you're doing pure anal, I agree with you. I think silicon has the best lubricity that is out there. With that said, I love toys before sex or during sex because it's going to allow you to be pre lubricated to be dilated the right way. You know, if you assume that somebody, is that a top or someone that is inserting actually knows what they're doing, you're going to get hurt. So my whole shtick is if you are a bottom or receiving, you need to be so understanding of all these things so that you minimize your risk. And the way to do that is to, you can be submissive, but you can know, okay, how do I make sure that I dilate before? How do I make sure that I'm using the right lube and. Or what's called a lube shooter, which is basically a syringe that sells the shooters I love. Oh, it's, it's, it's a game changer. Once you start using the right tools to get you where you want to go. And the assumption needs to be. And the goal for bespoke surgical was always, how do I empower the bottom? And by empowering the bottom, it's making sure that they're educated, making sure that they're doing everything right. And also assuming that nobody else knows what the fuck they're doing.

Yeah. And if they're on the top. Exactly. The top doesn't know because they're a top. Like, they don't know that you need these things. Like, how would they know? You're right. We have to be our own best anal advocates.

That's right, dad. That's right.

That's so true. So many times we want to just assume. Like I always just assume my partners knew everything because I didn't know anything, you know, before I had this as my career.

Right, right.

Came to find out that no one knows anything.

They don't know shit.

Literally stick around after the break. Dr. Goldstein gives his top tips for cleaning up before analyzing.

So the other question I get asked all the time is about douching. And I know you have some strong protocol around this too. And I wonder, like, I often say that the store bought ones aren't so great because there's the vinegar, whatever, what's in them? Of The. But then, but then I heard you say in an interview, so I want to talk. That water isn't great either. So.

Yeah, please. Correct. So, you know, one of the things in my practice at Bespoke was I started to see people coming to me over and over with the same injury or the same std. And then I started to break down into those categories of well, what are people actually doing? And a lot of people are using really huge bulbs to douche out and clean out. They're using shower hoses. And so we started to look at, well, what are the differences that are causing problems? And there's three things. One is the solution that people are using is not correct, whether they're using water or they're using a store bought enema. And what happens is, is that when you use this, you're actually getting rid of your protective lining in the ass.

It's like douching in the vagina too.

That's the same exact concept. And the water and the enema cause so much irritation internally that now you are predisposing yourself to, to HIV, STDs and injury. And so we said, okay, well why don't we just develop something that is going to be safe? And that was the impetus of me creating Future Method. And Future Method is all about that, which is like, how do we look at sex and the way that communities engage and then how do we put products to support it? And so I said, okay, why don't we make this our mission? And the first product that we launched with, which was an appropriate anal douche solution. And the solution is pH balanced very similar to the vaginal side, which is how do we clean and give people what they want, that sexy feeling and clean but without irritating the cells, without causing damage. And so I said, okay, first thing, let's come up with a solution. So we did that. Second thing is let's come up with appropriate education and an appropriate system. Because I think people are actually over douching.

They're over douching. And then. Right. I don't think that everybody needs a douche if you know your natural cycle. I'm glad you said gone to the bathroom that day. You know, like I don't think you have to every time people get so like, what about poop? And then I always say, well, it happens. So throw sheet down like it's messy.

Yes, I agree. And I think that, I'm so glad you mentioned that because the reality is, is that I think 7 to 8 out of 10 people will not have shit Anywhere near where you're having sex. And it's just people to understand anatomy, you know, where we're having anal is actually clean. It's when you're having the bowel movement, the crap moves into the anal area and then you shit it out.

Right.

But the rest of that is actually clean. And we talk a lot about instead of anal health, gut health, which is how do you make sure you're eating right? How do we make sure we're doing nighttime fiber supplementation so that you shit first thing in the morning and it's like appropriate and it completely empties you. How do you use toys? And I tell people all the time, like, prove it to yourself. Use a toy without douching on your own. And I bet you nine times out of ten, no poop whatsoever.

Right.

And so I think the stigma associated with it, your own internal stigma and also society's pressures make people want to douche. And so I said, okay, well, if we are going to douche, then how do you do it the right way, the right solution? Also a much smaller bulb. Our bulb is smaller. Why? Well, because you really just need to clean very, very like 8-12 cm internally. You're not talking about a ridiculous amount where you need to clean.

That makes so much sense.

Totally. So the key is, like, how do you educate people the anatomy? And again, that's to blame for sexual education in our country. Right. Specifically anal and gay sex. I mean, I hope in my lifetime that there'll be courses that are, you know, really sponsored by the appropriate government. You know, government.

I know. I hope that's what I want too. I want it too, for everybody. There's no sex education. And then with gay sex. Yeah, I could see that. You must have so many people coming in with injuries from years of just not. Where would you go. You see porn and they're not showing you the whole thing. They're not showing you their dilators and building up nothing. There's nothing. So there's more harm. Yeah. Wow. I think this is such a great protocol. So this is what we're talking about is like the having a healthy microbiome.

Totally. You know, there's a couple of things and there's some stuff coming out that you'll see on, on the future method side of biome stuff. And we, we know a couple of things. When you over douche or you're using water, you're actually altering the microbiome. And there's a specific bacteria that we know elevates. And when that elevates you're susceptible to STDs, HIV and injury. So the key is, how do we balance all of this? I know what people want. They want a sexy ass that has no shit and is silky and playable. I know that. The issue is how do we now make sure that people are doing it in a way that's not harmful.

We do so many harmful things to ourselves and then we just keep going, assuming it's going to get better. We don't want to ask our doctors because there's so much shame around it. So I love that your site has so much greater education.

I always say less is more. With anal you need to think that in everything. It's like, how do I just create an environment that is going to be safe for everybody and also minimize as much risk as possible because, you know, the ass itself is very thin walled. The pressures of sex are greater than really what a lot of that can sustain without you taking these precautions in the right way. And then also like, look, you are going to get hurt every once in a while and you are going to bleed and have some pain. And so the question is, okay, well if that happens, how do I now take care of myself early on to so that I don't have these long term complications or see somebody that knows about sexual wellness that's specific to my community?

That makes so much sense. So what do you do for aftercare if you do have tears or just in general?

I think that a lot of it is like a three to five day break of making sure the poops are soft. So add some stool softeners. Epsom salt baths are really great. I use these and love these suppositories which have cocoa butter in them. Soothe the lining also, even like a preparation age both inside and out. And then after three to five days you should start to see that like, you know, everything's getting better and improving. If things aren't, then the key is really making sure that you see somebody because there's so many things that we can do early on that doesn't need surgical treatment.

Let's say that we've got people now interested and they're like, okay, I'm going to take the precautions. Are there any tips you have for beginner anal?

Yeah, so I mean, I think a couple of things. One is being in control. The first couple of sessions is so important. So a lot of it is just, you know, being on top, meaning have the person lay down, get them erect or whatever toy they're using. It depends on how you're Engaging and you're in control. You're sitting on it. You're trying to manipulate and try to see. Don't let somebody get behind you. If somebody's behind you, they're going to kind of do their thing. And their thing is not really over the best. So the key is kind of. I think bringing in toys to foreplay is amazing, you know, especially, like, you know, fine, if you don't want to bring it in because you don't feel comfortable, do it literally right before and again, like when you're douching, when you're cleaning out, if that's what you're doing, use a toy. It helps with getting rid of any extra liquid solution that you use. It'll also lubricate everywhere and get you kind of prepared to then do what you want to. I think you need to find somebody that is super fun but also communicative so that you can have a really, really good, like, hey, this is my first, or, hey, this is what I want to do. And then can we kind of work together in a really good way where it may not be overtly crazy sexy, but you're learning how to kind of manipulate in the way to then get yourself into a good space with different positions, et cetera. So you got to choose like a friend with benefit or a partner that is really, really understanding and trying to see. And also, you know, don't go crazy big, you know what I'm saying? I know we all like big things, but, you know, choose wisely the size as well, if you can.

That's right. That can happen too, people. Well, what you're saying is Tony, he'll picture anal as someone coming in behind. But I love what you're saying about it being on being on top and lowering yourself down so you're in control. Missionary now makes sense.

And also any of the positions that you're facing, the partner is actually a really good position because you can see the grimaces, you can see the pain, you could see the pleasure. You can kind of. You're kind of forced to communicate, even if it's not verbally. So, like, I usually tell people, starting in that capacity is a really good way. And then once you kind of get yourself into a really good space, then great, then you could start to explore and be open to that. I also think that, like, using the toys, I usually tell people there's a dilator kits that I like. And then, like, if you've passed that, then the next is kind of dildos, which I think are really great because they're lifelike. They'll give you a little bit of understanding of, oh, this is how I can actually relax to achieve what I want. So there is this kind of middle ground before you're kind of jumping on the real thing.

Now, is it ever we're going back to size. Is it ever a case where it's just too big? You're like, that's just. No. Like, this is just a. No, no, no. They, like, text you. Pictures are like, Dr. Goldstein. Right.

That is the hardest thing to teach somebody, which is when to say no. I mean, even to my kids. Right. I mean, you know, you try to, like, in anything, like, well, that's probably not a good idea. Right. And so, with that said, you really need to understand. And using the toys and the dildos will allow you to understand, like, what you're capable of doing now, no matter what. There are definitely people that, as they're using toys and dildos, they cause issues. It's painful. They feel burning. There's a little bit of a tear, and it becomes this restriction that doesn't allow them to engage with what they want. And there's certain things that I can do in the office and in an operating room to help people. A lot of people, their muscle is way too tight. I see people that, you know, we're a lot of peloton users. We're doing a lot of squats. All these things create such beautiful butts, right?

Yeah.

But they're actually getting so much muscle to happen anally. And so what you see is that they're not able to fully, fully relax. I see a lot of bodybuilders come to me because they have so much muscle built up anally that now when we say, okay, relax, they can't. And so I do a lot of Botox, where I can inject Botox into certain muscles to give people that relaxation. Also, I give some under the skin line or actually bring people to the operating room to kind of open up both the muscle and the skin to now allow people to do what they want. So the using the toys and the dildos and kind of preparing allows for people to really see, like, oh, well, maybe I do have something that's limiting me, and I do want to engage now. The muscle is really great. You can kind of work that in both capacities, tight and loose. But a lot of times, it's the skin that's the limiting factor. And today I had a couple of Skype calls from people where they go to a surgeon, and the surgeon basically cuts the muscle because they're like, oh, they're too tight. But the reality is that, no, they were taking dick and toys before. It's actually the skin, and if you don't correct the skin issues, it's never going to actually heal.

Be right back after this quick word from our sponsors. When we come back, Dr. Goldstein and I answer your listener questions.

So I have a question for you about the gay community. So I'm. I always have. And I was talking to some of my gay friends about this. They're like, oh, yeah, they're. They're only bottoms or they're only tops. But I'm wondering, like, I always say, like, if I had a prostate, I would definitely, like, take a gander and figure it out. Is it more like you just think, like, I'm just going to be a bottom or I'm just going to be at top? Like, I know there are switches, but you'd think there would be more because it can feel good to everybody. So what is that about? Do you think it's changing at all or.

It is, because actually, my generation, I'm in the 40 to 60, right? So we're actually the first living out gay men ever. You know, you think about what generations before they all died of HIV and aids.

Exactly.

So what you're seeing is you're seeing a lot of people as they're aging. They're out of different. They're out of their older relationships, or their erections aren't working so well. So now they're varying into other things. Now my question is, and you kind of brought it up, which is when someone comes to my office and I ask them, do you identify gay, straight, bi, whatever? And then they say, yes. I say, okay, do you engage anally? Do you consider yourself a top versus bottom, if at all? And most of them, like, oh, well, I'm a topic. And then I usually say, well, are you a top? Because you're just like, that's not my thing. Or are you a top because when you tried to bottom, it was painful. It didn't feel good. And nine times out of 10, all of these tops want to take it up the ass.

That's what I thought. I'm so glad. In my own research, I'm like, that makes no sense. Why would you only be a top? Right?

Feel that? Right.

Interesting. That makes so much sense.

Of course, now there are definitely going to be people that are on those like, hey, I want to. This is who I am. And I. And I totally get that and respect that. With that said, though, A lot. I. And I say, well, what if I were to make bottoming feel really good? What if I make it to the point where, like, you're like, I like this. Like, would you do it? And they're all like, hell, yeah, I would do it. I may not do it, like, all the time, but I would definitely bring it into my world. And then also, you know, we did a couple of research studies on different cities, and, like, you know, there are definitely cities that have way too many bottoms or have way too many tops. And so, like, you know, if you become a little bit more versatile, you could actually kind of change your.

This is some education I think you need, because I've just. I've just been talking to my friends about it, just asking it. So I think, yeah, it's just we don't have the information. Maybe it hurt once. Maybe. Maybe there still isn't. Maybe you're gay and there's still some homophobia. Who knows?

That's right.

We actually got some questions that came in from our listeners that I would love you to help me answer. Okay. This is from Sarah, in her 30s in Chicago. Hey, Dr. Emily. I started listening a month ago. I love your show. Thanks for the help. I've learned a lot. Okay, so I have hemorrhoids, and I'm wondering, does that mean I should never have anal sex? They developed in my 20s. I'm about to be 40. They don't flare up much anymore, hardly at all. But the skin tags are still there. It's embarrassing. I've had some insecurity during sex just at the idea of them being seen. I've thought about having them removed. I'm gaining some confidence, though. Really? Only recently since I started listening to your show, my friend with benefits has shown interest in tickling my butthole when we shower together. So I've started to warm up to the idea, which I never would have before. He hasn't asked for anal sex. He just asks if it feels good when he tickles it. I'm not sure if he's seen it. I imagine he has. It makes me nervous. Is it bad to consider sex if I've had hemorrhoids? So I guess she has skin tags and she's had a history. What do you think about this?

So I think let's break it down into hemorrhoids first, then skin tags.

Great.

So hemorrhoids are there for a reason. They're there to protect the ass. So when we're pooping or we're having sex, blood goes into Those hemorrhoids, which are these veins and acts like an airbag, it's like a cushion. Then blood leaves if we're pushing too much, if we're constipated, if we're doing heavy lifting, if post pregnancy, the mechanism of blood going and blood leaving can leave you with these extra skin or these hemorrhoids that flare up periodically. Now, if you have hemorrhoids, the key is no, if you're not bleeding, you're not having pain, and you feel fine, using toys actually probably helps the hemorrhoids because most of the hemorrhoids happen because your ass is too tight. And so if you're able to fully relax, those hemorrhoids usually don't flare. So the key component is, yeah, I would say look, if you have hemorrhoids and they're not bothering you, use some toys with good lubricant and seeing if indeed they become an issue. Some people, they will. And it flares up and like, all right, well, then maybe we need to tend to the hemorrhoids. But many people are able to use toys, dilate, stretch, the hemorrhoids never flare and they're good to go. So I would say using the toys with lube and going slow. Now, on the sexy side, a lot of people that I see, I do a lot of esthetic work with, how do we make things look prettier? And it's not even on an anal side because I have so many women that just are like, Evan, I just feel gross just on a vaginal side because someone's going to see this or they feel it and I just get so self conscious. And there's lots of things that I can do to remove the extra skin that's there aesthetically, make it pleasing. Plus, also, if we needed to take care of the hemorrhoid, the key is, how do we make people feel sexy and then engage sexually however they want? And that can happen. It's just a matter of making sure that it aligns with their ultimate goals.

Okay. Wow, that's great. You can kind of fix anything then, really. Skin tag, you can remove skin tag.

Easily, but yeah, and a lot of doctors won't remove the skin tags. And it's, you know, I kind of bridged plastic surgery and colorectal and I put it together. These guys, they don't think that skin tags are a problem. You know, they don't have the concept of like, well, just ignore it. Well, wait a second. I feel it every time I walk. I'm wearing I'm trying to wear a G string for a sexy night, and I feel them and they're rubbing. I mean, all these things. I know men and women can be an issue, and the answer is like, well, it shouldn't be an issue. And there are solutions that are out there.

Yeah. And they now they have a place to go and feel safe to talk about it, because no one wants to go into their doctor and say, I've got a skin tag in my anus. You must be busy. You really must be. Okay. This is from Shannon, 29, in Texas. And she says, hi, Dr. Emily. I have a male friend who really wants to experience anal, but he had his colon removed. And he says his doctor said he can't have anal sex. What are your thoughts on this? Is there any possibility for him to experience anal pleasure?

So it's a little bit of a complicated question because I don't know when they had the colon removed, which portion of the colon was removed, and did they put this person back together? Now, there are definitely people that I treat that had colon resections that do engage anally, and they can. It really depends upon how they were put back together. If it was, let's say, a rectal tumor and they remove that portion. When they put people back together, there's a staple line or a suture line very close into the ass. And so sometimes they're prohibitive of doing anal. With that said, a lot of times there's certain things that I can do to help to make sure that one, that the suture line is exactly what it should be, strong enough to engage anally. We talk about different practices of making sure that they're prepared because if they lose a portion of their colon, sometimes they have a little bit more diarrhea and they can't hold their stools. So we talk on using Imodium or tincture of opium or certain things to kind of slow their gut down so that they can engage anally the way that they want to. I think that this is the typical straight doctor who is like, ah, you know, who the fuck? You don't need anal sex. You shouldn't be doing that shit anyway. You know what I'm saying? And the answer is no. He needs to be evaluated. There needs to be discussions to make sure that we're doing everything safely. But if somebody wants something up their ass, they should be able to do it.

Yes.

And have them call me or email. We do a lot of Skype stuff from all over to try to see if. If they're able to do what they want.

Okay, we'll have her reach out. All right, here's another question. Allison, 24 in Georgia. Dear Dr. Emily, my boyfriend, I want to try anal sex. Neither of us have ever experienced with it. I know there are anal kits, toys, and loops for anal sex, but where do we start? What are your tips and suggestions for beginners?

Yeah, so I think that it's great if both want to be involved in it, and the more the merrier. I think that the key, like we said prior, was understanding the anatomy, understanding how do you gradually work with different sets of toys? At BespokeSurgical.com, we talk a lot about the protocols. Also, it'll in our shop have different lubricants that we think are really important with loop shooters and also these dilating kits. And it goes over certain toys that I like and why I like them. And it gives people just an understanding of the right way to start out. And again, it's a good four to six weeks. And using this as foreplay to see first off, if you really enjoy it and if you do great, keep going. Most people, once you finish the four to six weeks, you're up to about the medium to large toy. And then you can definitely start getting into anal. So check out the website and then obviously if they, you know, if there's more questions, I'm totally available.

Okay, good. I love that. Okay, there's one more question I have for you because I, I want to know about your study you did on your site. People can find it@bespokesurgical.com about the most popular sex positions based on Google searches by state. So people love sex positions. They want to know. And I was just interested to find out, like, what are we doing in California? Right. So we're doing the Cliff Diver, which I don't even know what I. I guess it looks familiar. And then like, okay, so you're. I don't. Tell me about the impetus for this survey and what went into it. What, what do we need to know about sex positions across America?

Yeah, so, I mean, I think that it just. We do a lot of different studies and campaigns as it relates to sex. And we want to know, like, what are the favorite positions? What about different toys? From different bondage to different, you know, sexual positions and different components to this. And so we run usually about four or five campaigns a year. And we do a lot of really interesting studies to try to figure out across the country or across the world, how do we start? And it's all to kind of really de. Stigmatize sex. And it's also interesting to see, like, in certain locations where it's really, really what you would think is, like, back country and nobody's engaging, where you start to see, holy God, like, this is crazy. And you start to really develop an understanding that everybody is into anal and everybody is into sex. And now the key is, well, okay, it's all well and good behind closed doors, but how do we start bringing it to the forefront so that people are exposed? And hopefully, over time, really, the stigma and the taboo starts to diminish.

Yeah, there's a rise in anal engagement. You might as well do it correctly. And let's minimize your pain and enhance your pleasure, which is what you're all about.

Totally, totally. And I think, you know, we spoke of, obviously, kind of the. Before, we spoke of the play of positions and lubricants and then kind of the aftercare. You know, I think it's so interesting when you look at, like, people do so much for their face, right, in terms of facials and exfoliants and all these things. Well, the same thing should happen anally. You know, one thing I think I want all your listeners to know is wet wipes are terrible for you. Now, so many.

Why? Why? I did not know that.

People are like, screw, Goldstein. I'm going to use these.

Wet wipes are just like, even. What about the ones that are made for. Tell me why.

A couple of things. One is, when you think just moisture in general, that area is already too moist, too wet, because it's where the sun doesn't shine, there's sweat. That happens. We're sitting all day. We're usually clothed. So when you're using wipes, a couple of things happen. One is the solution gets rid of the good bacteria. Again, we spoke of that microbiome. There's a balance. We have good and bad bacteria. And when you use wet wipes, what happens is you're getting rid of the good protective bacteria. You see a lot of irritation from fungus to even a herpes outbreak or these sores. Even in my community, I start to see a lot of HPV and anal warts just from these wipes. And most people are using them. Look, the companies do so well in advertising, and everyone's like, oh, my God, I want to be so clean. But what you see is all of these complications from that. And so we speak, a lot of toilet paper popping into the shower, bidets. Less of that chemical. And even if they say, oh, you know, it's chemical, Free. It's natural. Well, no, it's not. It's moisture. And the cloth that people are using, people are irritated in and of itself on that aspect. So you just got to be super careful with the wipe stuff. You know, periodically, once here and there is not a huge deal.

Right.

But it's the regular usage of that that causes issues.

Some people have them instead of toilet paper. They just have that.

That's right.

Don't do that. Okay. Even your anus. How about your vagina as well?

So same component to it, you know. You know, the thing is, is that when we wipe with wipes, people are like, oh, great, I'm clean. And then they pull up their underwear and they're, it's not dry. And so that moisture sits there all day and causes issues. So it's the wipes.

Wow.

Second is, you know, I, we, we have future method. Came out with an anal exfoliant because I started to see like post sex people with silicone lube. It's so hard to get off. Right. Even your sheets, right?

Yes.

But with that, I was like, well, wait a second, if you're showering, why don't we just come up with an exfoliant that just gets rid of the excrement, the silicone lube, but also kind of like soothes it, polishes it and creates this kind of first aid in the area. Because we know that even if you feel great, that there's definitely friction and irritation. So. So we said, okay, well, let's do that. We came up with the button body anal exfoliant, which we absolutely love with our signature scent. And then I said, okay, well, well, now that we're done, how do we come up with a lotion that is like this first aid to the ass? Right. You cleaned it, now it's dry. How do we come up? But again, it took us a while because a lot of the lotions create too much moisture. And so we want it fast on but fast dry. We want the soothing capability in the first aid component, but we don't want any excess.

I read all about you and I've heard about you and I think you're doing amazing work. And I feel like you're such a great niche here that people and it's our ain't it like everyone has one. Like, the fact that you're creating such these great products for everybody is really incredible. So congrats on all of your, all of your success.

Oh, thank you.

Thank you for being here. I have to ask you the five quickie questions. We Ask all of our guests. So just quick answers. Ready? Biggest turn on.

Biggest turn on. Smooth.

Smooth. Biggest turnoff.

Hair.

What? No hair. What makes good sex?

Oh, God. What makes good sex? I think foreplay.

Something you tell your younger self about sex and relationships.

I made so many errors as I was going through this. Just be true to who you are.

Okay. What's the number one thing you wish everyone knew about sex?

That anal sex shouldn't be painful and that it should be 100% pleasurable and the world should accept anal into their hearts.

I'm down. Is it still illegal in states? Isn't it? There's some states.

It's crazy. Or even countries. I mean, come on. We still have so much work to do. But I thank you. I mean, oh, my God. I listen to what you're doing out there. So congrats on all of that.

Thank you.

And thanks for taking the time to support my mission and cause. And if you need anything, you know, forward. Any questions, pop up.

Yeah, totally. I'm all about it. I'm all about where can be. We kind of threw out your site, but where else? Where can people find you? Just let us know.

Bespoke surgical on all the Instagram facebook handles or bespokesurgical.com future method. Future method.com and then the future method on Instagram. And then I kind of do anal and my family life with my partner. We have two twin boys together, and that's on Dr. Dr. Evan Goldstein on Instagram handle.

Okay, great. Thank you for being here. I so appreciate you.

Oh, thank you. Thank you.

That's it for today's episode. Thanks for listening to Sex with Emily. Be sure to, like, subscribe and give us a review. Wherever you listen to podcasts and share this with a friend or a partner, believe me, if you got something out of this episode, they will, too. We release two to three episodes a week. Find me at Instagram, YouTube, Facebook, and Twitter. It's all sexwithemily. If you'd like to ask me a question about sex or dating relationships, email me feedbackexwithemily.com or sexwithemily.com askemily and check out my website. We have so many great articles diving deep into topics like how do I have multiple orgasms? How do I last longer? Bed? How do I stop thinking about my ex? What sex toy should I try? And so much more. Sign up for weekly emails. I've been told I give really good emails. I do. Was it good for you? Email me feedbackexwithemily.com there's one overlooked mineral behind better sleep, sharper focus, stronger muscles and a healthier heart. And at least half of us aren't getting enough Most people don't realize they're running low on one of the most vital minerals for human health. Magnesium. And here's the thing, no single form of magnesium can deliver all of its benefits. That's exactly why Qualia Magnesium plus was created with 10 highly bioavailable forms of magnesium plus over 70 essential minerals. It provides total magnesium support, helping you sleep better, think clearer, move stronger and feel your best every day. And honestly, when you're less stressed and more energized, your intimacy and desire naturally benefit too. Sure, magnesium can help you sleep, but Qualia Magnesium plus goes beyond that. It's a whole body nourishment for how you think, move, connect and feel. More than just a sleep supplement, it's a foundation for daily well being which absolutely supports a healthier sex life. Getting enough magnesium from food alone is harder than ever due to depleted soils and chronic stress and our body's reduced ability to absorb it as we age. Well, Qualia's Magnesium plus formula is non gmo, vegan, gluten free and designed so all the ingredients work together for comprehensive magnesium support. And personally, I've been taking Qualia Magnesium plus in the evenings and I really notice calmer nights and clear mornings and just feeling more grounded in my body, which always makes intimacy feel more accessible and enjoyable. It's become such an easy part of my nightly routine. Experience the most trusted magnesium for your purity, potency and performance. Go to qualialife.comsexwithemily for 50% off. And here's a bonus use the code Sex with Emily for an additional 15 off your order. That's Q-U a L I a life.com sexwithemily thanks for Qualia for sponsoring this episode.