What Happens to Your Body During Anal (Surgeon Explains)

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.

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.

Anel 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-douch 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 loops are best for

every act imaginable.

We also break down loop shooters, love a loop shooter, how to minimize the risk of exposing

yourself to STIs, and what to consider regardless of your top or bottom, your giving or receiving,

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All right, everyone.

Enjoy this episode.

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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 health care 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.

One more about Dr. Goldstein on social media at Dr. Evan Goldstein.

Hey Dr. Evan Goldstein, welcome to the show.

So tell me by 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 move, and it's been kind of crazy.

It is an anal movement, what you're doing, because 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 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 wanting to want to eat more than any other subject, which is why

I'm so glad that you're here.

But also that straight man 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.

Maybe I should put a finger in there, but it's just in the last few days.

So I don't know what you can do in 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 a future

method.

And we'll talk about that.

Yeah.

I think 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 that most doctors still don't talk about sex and they don't ask them

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, is when you look at where we've been successful, we've been successful

in two areas, female centered publications and straight, like bar stool sports, cosmo,

and it's interesting because those are 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, 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 it?

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 is 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.

How do you prepare for anal sex?

How do you actually engage or play and then what is the after care?

And so 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 an 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 four to six week protocol of using toys.

Okay.

And it gets people one to know, do they like it?

Are they, did they find it pleasurable?

Two 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 descend

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 you're just going to go all the way in, 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-lube or arcade 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 time.

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 can 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

it 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

an exam, I'm asking them to kind of push out.

So I usually say, push out like you're going to take a shift.

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 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.

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 of 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 hemorrhoid 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, that 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 there anything goes wrong with my anus, I'm getting out of plane to New York.

That's what I got to say about that.

But yeah, because it's women, it's really, yeah, it's everybody with an anus, which would

be all of us.

Are there toys that you recommend or you sell in your office or online?

Yeah, so on, on my website, it's both 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 loop 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 loop, right?

That's kind of my thing if I'm like in a hurry, you know, and then if we talk about it,

but the loop thing, it's like, I'm like, apply, reapply.

I think silicone loop 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 loop is created equal.

That's true.

Sure.

And a lot of people have reactions to certain looper cans, so you just got to 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 then

the end of the silicone there.

So I usually say for toys and you're not engaging in anal, water based loop is the best.

If you're doing pure anal, I agree with you.

I think silicone 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 at a top or someone that is inserting actually

knows what they're doing, you're going to get hurt.

So my whole stick is if you are at 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 what's called a lube shooter, which

is basically a syringe that sends the lube off?

I love that.

Oh, 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.

That's right.

So many times you 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, but can't

to find out that no one knows anything.

It'll know shit.

It'll know shit.

It'll know shit.

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

blinds aren't so great, because there's the vinegar, whatever, whatever, what's in

them with that.

But then, but then I heard you say an interview, so I want to talk that water is a great

either.

So, yeah.

Yeah.

So, you know, one of the things that 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 do shout 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 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, exactly.

That's right.

Concept.

And the water and the enema cause so much irritation internally that now you are predisposing

yourself 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 a 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 was an appropriate anal douche solution.

And the solution is pH balance, 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.

Okay.

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, like if you go into 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.

People throw a 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

seven to eight out of ten people will not have shit anywhere near where you're having

sex.

And it's just people that 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.

And 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 douche 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 eight to twelve centimeters

internally.

And we'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 being mad at me?

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 governmental, you know, government.

I know.

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 the future method side of biome stuff.

And we know a couple of things.

When you overduce where 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 injuries.

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 great 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 minimizes much risk as possible because the acid 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, OK, well, if that happens,

how do I now take care of myself early on 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's 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, ebbs and salt baths are really great.

I use these and love these suppositories which have cocoa butter in them to kind of

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 play?

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 dosing, when you're cleaning out,

if that's what you're doing, use the 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've 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,

I'm saying, I know we all like big things,

but you know, choose wisely the size as well.

If you can.

That can happen to people.

Well, what you're saying is Tony, he'll picture Anelus,

someone coming in from behind.

But I love what you're saying about it being on, being on top

and lowering yourself down so you're in control.

So it's a missionary that makes sense.

I know so 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 can see the pleasure, 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 thing 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.

The text you pictures are like,

Dr. Goldstein, that right?

And that is the hardest thing to teach somebody,

which is when to say no.

I mean, even to my kids, right?

I was like, it ain't 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?

But they're actually getting so much muscle

to happen annually.

And so what you see is that they're not able

to fully, fully relax.

I see a lot of body builders come to me

because they have so much muscle built up annually

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.

We'll be right back after a quick word

about one of our sponsors.

So I feel like I give a lot of advice

on how to have more and better orgasms.

But something I also get asked about all the time

is the worry of finishing too quickly.

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Well, so I have a question for you

about the gay community.

So I'm, I always have it.

I was talking to some of my gay friends about this.

They're like, oh yeah, 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 a top?

Like, I don't 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

in the 40 to 60s, right?

So we're actually the first living out gay men ever.

You know, you think about what generation before

they all died of HIV and AIDS, right?

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,

by whatever?

And then they say, yes, I say, okay, do you engage annually?

Do you consider yourself a top, first, bottom, if at all?

And most of them like, oh, well, I'm a top.

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 at a 10, all of these tops

want to take it up the ass.

That's what I thought.

I'm so glad you're like, in my own research,

I'm like, that makes no sense.

Why would you only be a top?

Right?

That's right, right.

Interesting.

That makes so much sense.

Of course.

Now, there are definitely going to be people

that are upon those.

I'm like, hey, I want to, this is who I am.

And I totally get that and respect that.

With that said though, a lot, and I say,

well, what if I were to make bottoming feel really good?

What if I make it to the point where, like,

I like this, like, would you do it?

And they're all like, hell yeah, I would do it.

I mean, I do it like all the time,

but I would definitely bring it into my world.

And then also, we did a couple of research studies

on different cities.

And like, 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 experience.

This is an education.

I think unique, because I've just,

I've just been talking to my friends about it and just asking it.

So I think, yeah, it's just, we don't have the information.

Maybe it hurt once.

Maybe there's still, 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.

Well, 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 asked 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 to have 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.

Okay, great.

Hemorrhoids are there for 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.

And 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 leading, 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, 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 aesthetic 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 they're like,

Evan, I just feel gross just on a vaginal side

because someone's gonna 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, 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 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 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 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.

So now there are definitely people that I treat

that had colon resections that do engage annually

and they can't.

It really depends upon how they were put back together.

If it was, let's say a rectal tumor

and they removed that portion,

when they put people back together,

there's a staple line or a suture line

very close into the S.

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 annually.

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 emotium or tincture of opium

or certain things to kind of slow their gut down

so that they can engage annually

the way that they want to.

I think that this is the typical straight doctor

who is like, ah, who the fuck?

You don't need anal sex.

I shouldn't be doing that shit anyway.

You know what I'm saying?

Any answers?

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.

Have them call me or email.

We do a lot of things from all over to try to see

if they're able to do what they want.

Okay, well, have a reach out.

All right, here's another question.

Alison, 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 bespoke-surgical.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 diluting 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 there's more questions

and totally available.

Okay, good, I love that.

Okay, there's one more question I have for you

because I want to know about your study you did

on your site, people can find it at bespoke-surgical.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

what are we doing in California, right?

So we're doing the cliff diver,

which I don't even know,

I guess it looks familiar.

And then like, okay, so you're,

I don't know, tell me about the impetus for this survey

and what we didn't do it.

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 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 destigmatize 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 say, 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 annually, you know,

one thing I think I want all your listeners to know

is wet wipes are terrible for you.

That's so many.

So that why, why, I did not know that.

But if you were like, screw goldstein,

I'm gonna use these wet wipes.

All wipes, tell me why.

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.

This 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.

So 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.

So you see a lot of irritation from fungus

to even like a herpes outbreak or these sorts,

even in my community, I start to see a lot of HPV

and it ain't awards just from these wipes.

And most people are using them, look,

the companies do so well in advertising

and they're 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,

the days, less of that chemical.

And even if they say, oh, 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's not a huge deal.

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,

the thing is that when we wipe with wipes,

people are like, oh, great, I'm clean

and then they pull up their underwear and it's not dry.

And so that moisture sits there all day and causes issues.

So it's the wipes.

I ran all about you and I've heard about you

and I think you're doing amazing work

and I feel like you've such a great niche here

that people, and it's our aided, 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 success.

And thank you.

Thank you for being here.

I have to ask you the five quicky questions

we ask all of our guests.

So just quick answers, ready?

Biggest turn on.

Biggest turn on, smooth.

Smooth, biggest turn off.

Hair.

What bit, no hair?

What makes good sex?

Oh God, what makes good sex?

I think for play.

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.

OK, 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.

We still have so much work to do, but I thank you.

I mean, oh my god, I listened to what you're doing out there.

So congrats on all of that.

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.

Where can we kind of throw out your site?

But where can people find you?

Just let us know.

Sure, sure.

Bespoke surgical on all the Instagram baseball candles

or bespoke surgical dot com.

Future method, future method dot 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. D.R. Evan Goldstein on Instagram handle.

OK, great.

Thank you for being here.

I so appreciate you.

Thank you. Thank you.

That's it for today's episode.

Thank you so much for listening to Sex with Emily.

And if you love the show, please like, subscribe,

and leave a review wherever you get your podcasts.

And hey, share this with a friend or a partner.

It might just spark something.

It usually does.

You can find me on Instagram, TikTok, YouTube,

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It's all at Sex with Emily.

Oh, and I've been told I give really good email.

So sign up at sex with Emily dot com for free guides and articles

and more ways to prioritize your pleasure.

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