Issues that can result from bottoming
—a physician’s perspective

with Dr. Evan Goldstein

Everybody is talking about anal sex … but are they really talking about it? During a Smart Sex, Smart Love podcast, Evan Goldstein, DO, a nationally renowned anal surgeon, talks candidly about anal sex, and how to do it successfully and experience a new heightened level of pleasure, while keeping it safe and clean.He started his surgical practice about 10 years ago focusing on everything anal. Dr. Goldstein is considered the preeminent expert and thought leader in this field, bringing the important issues surrounding sexual health to the forefront for all communities, and eliminating the stigma attached to anal sex.Through working with a wide spectrum of individuals, he has learned they want to talk about anal sex but are uncomfortable starting the conversation.People don’t understand the positive experience this can be. When they are ready to “talk about ass,” as he says, there are a few most frequently asked questions, such as “isn’t the anus dirty?” Or, “is it safe?” Or, “is one person submissive?” Another question is about toys – “should we use them, will they get stuck, how do I know what size to use …?”First, it is all about sexual desire; about enjoying your sex life. Anal sex can take you to that next level of pleasure you haven’t experienced before, he finds.Second, people just need some education before they attempt anal sex for the first time to make sure the experience is safe, injury-free and fun.Some simple anatomy lessons will help. So will information about the right toys to use, the right lube to use, the dilating process, how to douche adequately, and how to learn how to relax certain muscles so you can enjoy the experience fully.

Anal sex can, and should be, very sexy, not mechanical.

00:00

Through and you are good to go. Welcome to smart sex smart love. We’re talking about sex goes beyond the taboo and talking about love goes beyond the honeymoon. My guest today is Dr. Evan Goldstein, a nationally renowned Angel surgeon and the founder and CEO of but I’m going to have to start over what is best book I meant to ask you Oh sure.

00:23

A bespoke surgical is just just means that we tailor to each individual but it’s called bespoke

00:32

bespoke. Okay, I meant to ask you that before. Alright, I’m gonna do it again. Welcome to smart sex smart love. We’re talking about sex goes beyond the taboo and talking about love goes beyond the honeymoon. My guest today is Dr. Evan Goldstein, a nationally renowned Angel surgeon and the founder of CEO dammit off today. Ah, Daniel just have to get I’ll do it again. Welcome to smart sex smart love. We’re talking about sex goes beyond the taboo and talking about love goes beyond the honeymoon. today’s podcast title is introduction to bottoming a physician’s perspective. My guest today is Dr. Evan Goldstein, a nationally renowned Angel surgeon and the founder and CEO of bespoke surgical, the leading private practice in New York City specializing in an elite standard of sexual health and wellness care. His practice caters to a wide range of clientele. But the majority of his patients are LGBTQ plus, Dr. Goldstein, also the founder of a co founder of future method and innovative sex care brand, that is the result of Dr. Goldstein’s years of experience working with his clients and understanding their sexual needs. He’s considered a preeminent expert and thought leader in the field, committing to edge committed to education and awareness, not only bringing the important issues surrounding sexual health to the forefront, but also eliminating the stigma attached to anal engagement. In order to relate to a wider audience. Dr. Goldstein leaves the medical jargon behind and communicates in a straightforward direct breaking down taboos, and allowing for conversation on open discussion. He also published in many media outlets, including nbc.com, GQ, Men’s Health, cosmopolitan, Forbes and many others. He was named New York City’s top LGBTQ plus business leader by Crain’s New York, in 2020. That’s great credentials. It’s great having you here, Dr. Goldstein. Oh, thanks for having me. How are you? I’m great. How’s it going for you tonight? Oh, good. Everything’s great, ready to talk about ass or what? Ready to talk about and I’m gonna tell you the irony of this. I am probably one of the minority i think but of gay men that have never had anal sex. I’ve never done it. I’ve never received it. It doesn’t interest me. But I’m going to talk about it for two episodes with you. Perfect. All right, maybe at the end, we’ll, we’ll get you to convert crap. You know, I’ve always been told that. Well, you have a lot to say about it. So let’s start. Let’s just first talk about your sexual practice your surgical practice, preferences. You describe it as an elite standard of sexual health and wellness. Will you speak on that?

03:19

Yeah, sure. So I started bespoke surgical about 10 years ago, because I saw that there was a huge need in the community. People weren’t going beyond just HIV care. There was so much more to Gay Men’s life, that I started to realize, well, wait a second, what happens if somebody gets injured or what happens if I’m a top and I want to start engaging and becoming more about them, how and who and what. And then I realized that there’s actually nobody out there, there’s nobody that is talking about the narrative is being honest with the way people engage, not D stigmatizing, not creating taboos and making things worse, but really opening up Pun intended the world to allow people to do what they want to do when they want to do it and know that they have someone to support it. And that was the birth of my baby, right. And so what we do is we do a lot of preventative care. We do a lot of sexual analytics of understanding what people want sexually, and then I do a lot of surgeries. Whether it’s correcting people because they’ve gotten injured doing something or someone like you that says it’s not interesting to me. I feel pain every time working with people to kind of connect the brain of Hey, I do want to engage sexually, but the physical of there’s certain things that are restricting me to do that. I really it’s been pretty amazing.

04:56

I like what you’re saying, especially in the beginning when I remember Queer as Folk in the 90s. You know, we watched it and then Brokeback Mountain, they make gay sex look so easy like, Oh, you just do this. And then and I remember, you know, I had a lot of straight clients that would say they feel shamed by the media because they make it look easy. And I never related to that, because you never saw images like that.

05:17

Totally, totally. And I think that, you know, it’s it’s a rough life being a bottom, you know, yeah, there’s a lot of things that can go wrong. And there’s a lot of preparation. And there’s a lot of stigma, even within our own community relates to how clean or how dirty or what’s acceptable and what’s not, some of its founded and most of its not, but the reality is, is, well, if I am committing myself to engaging in a certain way, how do I make sure that what and how and when they’re doing it is as safe as possible, so that they are not harming themselves. And then obviously, anybody else that they’re engaging with?

05:58

I like it. And I like you ending the stigma. Because you know that that terrible joke, I don’t even know if it’s still around. Who pays for the wedding? The father of the bottom? I mean, it’s like, he’s often looked at as feminine. And it’s so awful, really, isn’t it?

06:10

Totally. I mean, I think that, you know, the best thing for our communities is everyone, racecar drivers and football and all this people coming out and realizing that there’s a it’s not the fam submissive bottom, I tell people all the time that that’s so antiquated. And it’s kind of racist in a Yeah, in a way. I mean, I think the key component is his sexual desire and sexual positioning doesn’t equate anything to any of that, that we’re talking about. So it’s, it’s really trying to de stigmatize all of that. So people just move on and enjoy their sex lives the way that they want to.

06:52

Now, given that you’re in New York, do you have straight men also that come in who bottom?

06:56

Totally, I have, I’d say about 80 to 85% of my practice, gay men, and more and more straight women and men coming in. Okay, I think that a lot of that is that there are definitely straight men that do engage annually and have anal play in some capacity. Yes, and a lot of post pregnancy, women are dealing with kind of surgical issues, that they lose their sexy, whether it’s just vaginal sex, or, and or anal. And a lot of angel is very in right now, you know, even in all, you know, When, when, when you look at the media, you know, Teen Vogue, and Vogue and Cosmo, and everybody’s talking about anal sex. And so it’s like this like, thing, you know, and thankfully, you know, my practice, and what we’ve been doing is, is now reaping the benefits of everybody talking about it. Yeah. The reality is that everybody has an ass, everybody shits through it, and many people want to take things out bit. And so the question is, how do we just do it in the safest way possible?

08:01

Yeah. You know, one of my taglines that I’ve made up as a sex therapist is because a lot of straight guys do like pegging to be pegged, being only penetrated. And they come in, and therapists tell them they’re gay, or bi. They think they’re gay, or by the wives think they are gay or bi. And I say to them, Listen, your anus doesn’t have a sexual orientation. It doesn’t know whether it’s gay, straight, or bi. It’s an anus, and it’s as a prostate. That’s it.

08:24

Exactly. And I think that that’s the key is people don’t understand that, you know, there’s so much positive sensations as it becomes Why do you think bottoms bottom? It’s it? Obviously, there’s something to it? Yes. Right. You know, there’s a positive to it. So I think that, and let me tell you, when the straight guys first experience a prosthetic orgasm, the way that it should be by pegging and being stimulated, it’ll get you to beyond places from an orgasm perspective, that, you know, that’s the reason why people were talking about it, because yeah, there’s some positive with it.

09:00

So how do you start these conversations with your clients? I mean, they’re coming in starting, is that right? Or do you, you know,

09:06

I think, you know, building a practice over these years, you start to see what works and what doesn’t, right. I think just similar to what you’re doing, you have to have an environment that’s inviting, even before they come to the office. So, you know, our online platforms of registering, you know, minimizing all the paperwork, making sure that like our staff is accustomed to understanding that someone may be gender non conforming, or someone you know, where they fall in these lines, and just making it easy. It’s already a shitty topic, literally. Right. And, and so people and when people are talking about the ass, they, they just can’t or they just it or they or they go through this problem year in and year out and like they’re like, I know I should be doing something about it. I should be doing but you don’t why? because Americans you know, don’t talk about sex and they don’t talk about anal and so you know, and And that becomes how do we as practitioners break down those barriers just so that people feel comfortable to make an appointment? Right? Yes. And then obviously, when they come to first of all, most people know who I am, because they’ve, they’ve kind of googled around and and when they know that I’m gay, and I’m out and I take it up the ass. They’re like, Oh, okay, they’re like, you know, I can be quite frank and communicative of who I am, what I want to be sexually. I think that that’s the first part. But believe me, I see all comers. You know, I see people that come to me and they’re shaking. And I say, Okay, I’ll start the conversation. And I’ll start simple stuff like medical problems and detailed histories. And are you on medication. And once we start kind of getting through all the nuts and bolts of this, then I’m able to kind of say, okay, where are we? Where are we with? shitting? Where are we with sex. And by the time that we’re there, we’re kind of, they’re finally feeling comfortable, like, hey, okay, this is what I need to do to move forward.

11:01

You know, this is really revealing to even for me, because you see gay men talking about it all. It seems like gay men are talking about it all the time. But they’re not really are they? They’re not. Yeah, you know, I

11:11

mean, like, we always joke and my partner and I, whenever we go to a dinner party, and someone says, oh, what does Evan do? What do you do admin, and then everyone goes, Oh, shit, everybody’s gonna start talking. And it’s true that everyone at the table is like, oh, man, my ass hurts right now, or see you or these things. So I think that it is a conversation piece, but to initiate the conversation is still very, very difficult for many.

11:40

So let’s get right to it. So what do you recommend? When you say a list of things people should discuss before they try bottoming? What are they?

11:48

I think the first thing is for people to understand anatomy. You know, if you think of the assets not overtly complicated, its skin and its muscle. And whenever you are doing, whether shitting or having sex, the key is well is the skin opening up is the muscle relaxing, and to what degree right? If someone’s having pain, Anneli, most of the time, the muscle and the skin is a little too tight. And every time that they’re doing it, they’re tearing, or causing hemorrhoids or some issues. So I think, understanding that there’s muscle and their skin, understanding that we need the skin to fully relax, and that there are three sets of muscles in the ass. There’s two of them that you and I control, meaning if you screwed if I tell you to squeeze your ass right now, you’re squeezing two out of the three muscles. Oh, the third muscle is one that you and I don’t have much control over. And that’s the one whether you’re tapping somebody where you’re having sex, and you’re like, Why won’t this person relax, and they’re like, I’m trying to relax, I’m trying to relax. Well, it’s usually that second kind of ring of muscle that takes time to fully relax, because you don’t have much control over it.

13:02

And that’s the one that will suck up. Like if you put something up there that you can’t retrieve. Right? That’s a nightmare. That is a nightmare. That

13:10

is true that that’s where it closes kind of on its own without your without you choosing to do so. And then obviously it can lend itself to complications. Some obviously, you can’t engage in, or others, like you said, things get stuck in there. I think the notion that people think anal sex should be painful. You know, people think that pain is normal. And the answer is that no pain is not normal. will think that bleeding during anal sex is okay. Like no bleeding during anal sex means that there’s something not right. Yeah. Whether you’re doing incorrectly or cleaning and we’ll get to that or whether you’re you’re having a terror hemorrhoid or something that’s causing it, but there shouldn’t be pain, there shouldn’t be bleeding. People think that you can go from nothing up your ass to something huge in Right, right. They’re like, Oh, no, tonight, I’ll be out bottom, it’ll be fine. Like, no, hold on a second, the bottoms that are bottoming bottom all the time. And when they’re bottoming all the time, it allows things to fully dilate and stretch and open and do what it needs to do on command. But if it’s, hey, I’m going from nothing and I’m going to something huge, then there is going to be injury, and there’s going to be issues and that’s why we talk a lot about using toys and dilating and doing it on your own like right before you shower in the shower using a dilating kit. We have bespoke surgical started a shop on our website. More so to educate people. I you know, I put products out there all the time, and it’s all well and good. We want to sell product but the key for me was five people always ask me Well, what loops do I use and what dilators do you recommend and how do I position it? What do I do so I kind of put my protocol of how do I go? So this is something for you, because you’re the big old top there is, how do we go over four to six weeks from nothing to actually having sex. And the dilating process is about that four to six weeks, you do about a week or two of just the small toy, trying to get the skin and the muscle to learn to relax, but also to get it to strengthen. And what do I mean by that skin is very fragile there. So I equated to you and I going to the gym. If we’re lifting weights with the bar, we’ll get some calluses from the bar on the insides of our hand, right? It’s the same concept. With the toy, I want the skin to start getting stronger, and more dispensable, so that when we’re having sex, or when we’re using toys, or fists, those pressures can be so great that we don’t want the skin or the muscle to have issues. So it takes time. So one to two weeks of the small toy, one to two weeks of always starting with the small, but then going to the medium, and then working your way up. And then I always tell people after about four to six weeks, if you feel like hey, you know what, I’m feeling sexy, I’m not bleeding. I’m not in pain. I’m feeling good. Then I could say, Okay, now we’re ready to have sex. How are we going to do that? Well, you’re going to use the toys, either before sex or insects as foreplay, we’re gonna Then have you sit on that where you’re not going to be submissive. Even if you want to be submissive. The first couple of roles you need to kind of be positioning yourself. Most people are on top, working it to see what works, what doesn’t learn your anatomy, learn your pelvis, and figure out then how to make it sexy and not mechanical. But making sure that your mind is constantly analyzing, how do I just make this more pleasurable, but also safer from a risk perspective?

17:02

That makes total total sense? Yeah, yeah. First of all, I want to clarify, I’m not a top I’m not a bottom.

17:08

So I actually coined the term side. And we have a Facebook group. So I don’t I don’t identify either way. And I don’t know. You know, it’s it’s not erotic. For me. It doesn’t even sound erotic. But I don’t know if it’s because one I remember Dear Abby, in the 70s had this thing about anal sex. And she said, You have to be careful your anal walls will cave in over.

17:28

Do you ever hear that?

17:30

Yeah, that’s not true. It’s, Well, a couple things. It’s more of this prolapse, that happens, what happens is, is that when people were having a lot of sex, or with big toys, big cogs or the fifth thing, what can happen is the muscle and basically starts to not function where it comes back to be it tight. And so some people love it actually, where they prolapse and they create those rosebuds. And but it’s a very, very short halflife. With that, because what happens is, is that all of a sudden, it starts to get beyond that. And it starts to prolapse and come out way too much where sometimes you can’t get it back into where it needs to. You need surgery, it can be quite catastrophic. And he and I don’t know if you’re seeing this too, but I see a lot of younger generations, 20 year old 20 fives, that are into fisting very early on. Yeah. And they don’t have the education to support that as what’s the right way to do it and not. And what they’re doing is they’re coming to see me in their late 20s with prolapse already. And then you start to say, God, what can we do to educate, create narratives, I want people to fist and do what they want. But there’s certain things that you could do while you’re engaging in that type of sex to combat all those complications.

18:53

That’s so important. Nobody, I’ve never heard somebody talk about that ever. You’re the first person? It’s crazy, right? No, yes. What about you talking here about diet and exercising that can affect preparation for anal sex? What does that like?

19:08

Yeah, I think the key component for us is people are so stigmatized from shit on the deck, right? It’s like, Yeah, right. Like, yeah. And in our in our society is like, you need to be cleaned, or you’re going to be completely shamed. Now, that’s bullshit, right? I mean, and so first of all, I remember having a straight colorectal doctor, give us a lecture. And he was like, if we line up 10 people here, and we don’t ask them to do Sure, clean out and we just have sex with all of them. And we see who’s dirty or not. eight out of 10 will be completely clean, regardless, and the reason is, is that where we engage annually, shit isn’t there. So understanding anatomy, meaning When we’re ready to go to the bathroom, the stool is way high, it’s in what’s called the sigmoid colon nowhere near where you’re going to go with an average anal sex. When we feel the urge to go to the bathroom, the stool moves into the rectum. And then we shut it out. We reality is that that area is is most of the time clean. So the key for people to understand is, well, how do I know that but prove it to yourself, use toys without cleaning yourself, and show yourself Oh, wow, I am really clean. When we’re doing we’re causing lots of issues, and higher risk HIV transmission, higher risk STDs when you look at the microbiome, or altering the microbiome by using water and solutions that are not suitable for this. So when I talk about probiotics, and diet and exercise and fiber, I’m trying to bring kind of whole body gut health into the mix, not just anal health, because if you’re just doing anal health, you’re overdoing just that connotation. So the key for me is to say, Okay, how do we look at your diet? How do we look at exercise? How do we add fiber so that you are putting yourself into that eight out of 10 times position where you’re actually clean. And then if you do want to do Shin clean out, it’s again, understanding that less is more. And that was the impetus. And we’ll get into it probably in the next of why I started a future method. But future method is all about positive practices for all communities, specifically the anal. And it’s looking to say, Well, if we are going to douche, which 70 to 80% of our community does, how do we now put a put a product out there that is going to be safe? Yeah, that is going to not cause all of these alterations of the microbiome and higher incidences of issues and make it sexy? Because the reality is, is that it should be sexy, and there should be a lot of really feel good products that we have specifically geared towards our communities. Because why the fuck not? We deserve it. Yeah. Right. And that was the impetus for future method and the analytics of how do we analyze the before sex, the during and the after, to make sure that we’re trying to minimize risk in anything that we do maximizing pleasure, and just making it the best scenario methodology that we can. Yeah,

22:38

I mean, that for sure is not talked about. And even though I don’t have anal sex, like my friends are always talking about it. And, of course, my clients have to and I’ve never heard someone talk about Duchenne and that increasing the chances for HIV infection or other STI is right, because you’re tearing and you’re, you’re really and you know, the interesting thing is that I don’t think STDs and HIV happened from sex, I honestly think it’s the bottom that is primed incorrectly, the transmission happens, meaning when you look at it, and we work really a lot with a lot of different universities and and and P and scientists that study this. But if we would align up 10 people, and we swab them annually, we could actually know from their swabs, whether or not they have anal sex. The reason is, there’s this increase in a certain bacteria that happens from overdoing from lube and from sex. And that increase in bacteria causes detriment in that area, it’s basically raw. And the more you’re doing, some people use a shower shot, or they’ll use other ways or these big bulbs to clean out. But what’s happening is, is that as you’re distending, and you’re using the wrong solution, you’re basically taking away the protective lining in that area. So now it’s raw, and you don’t even know that it’s raw, now you have sex, and then boom, that’s where the STDs, the HIV and the irritations can happen. So the key component is trying to make sure that we’re Dushan correctly or if at all, if you don’t need to don’t. We’re saying use lubricants in a way that you’re dilating and stretching before you even have sex. So we know that the entire anal canal is lubricated appropriately, spit is not a good lubricant, and oils and stuff are not good, they cause more irritation. So you really want to kind of look at all of these to know that like, well, if I’ve been doing all of these you’re gonna see and reap all the benefits in a positive way to minimize any adverse outcomes.

24:51

It just drives me nuts that in Brokeback Mountain, he uses spit and that was allowed in movies movies are so goddamn fake.

24:58

I think that you know, the problem that I see See also is, which, which irks me a lot is, you know, people view credibility with how many followers you have on Instagram or YouTube, I see a lot of sex educators who have no credentials other than that they have a big following. And they’re putting out all of this information that is completely not valid and scientific at all. And then people take that, and that’s just doing everybody a disservice. I guess that, again, what works for one may not work for the other. But the reality is that there is a right and a wrong way. And if we are taking on this in the right narrative, it’s really holding everybody accountable to make sure that we as a community are are voicing what is and should be, and porn shouldn’t be what people think is a standard practice. Yeah,

25:57

I’ve done so many podcasts on that. What do you what would you like to say? We’re gonna have to stop it a little bit? Something we did not touch on that you want to make sure listeners hear? Yeah, I

26:07

think that the thing from my perspective is for people to know that there are people like me out there in the world, that do provide this type of service, I do a lot of Skype calls, we do through email or Instant Messenger, that, you know, I, there’s a really me in New York, and there’s nobody else in the world that’s kind of doing what we’re doing. And so the key for me is, you know, I just had a couple of Skype calls from London and Dubai and, and, and all of these places, I want people to realize that the world is has moved way beyond just shitting out the ass. And so you know, that the colorectal surgeons, the practitioners all across the world, like, we need to change our methodologies as to how we approach our patients. And if you don’t know, the right way, know that someone like me exists, so that you can point somebody in the right way. Yes, that of me having to see second and third opinions after they’ve had surgeries. And everything’s fucked up. And, and for no other reason than that it was not the appropriate management. So I think that nowadays with the internet and everything that’s going on and accessibility, know what you who you are, what you want, and know who’s actually able to deliver that care.

27:34

You really do talk in a straightforward and direct manner. And I love that. I love it. It’s the way it should be. Where can people find you?

27:42

Yeah, sure. It’s so bespoke surgical, all the channels. That’s where I intermix my ass daily as stuff with my kids and my partner and that life on Dr. Evan Goldstein, and then future method is the future method on Instagram and future method on all the other platforms and check it out. And I think the key for us is, across all those three is creating narratives that kind of allow people to feel more comfortable in the space.

28:13

Thank you, Dr. Goldstein, for joining me on smart sex smart love. And I do look forward to talking with you again soon. And learning more about future method as you’ve just addressed. And for my listeners, if you want to hear more of my podcasts, you can just go to smart sex smart, love calm, and you can also follow me on Twitter, tik tok, Instagram and Facebook at Dr. Joe court. That’s j oekrt.com. And if you liked this podcast, rate it and review it and I’ll see you soon. Perfect