PSA: The #1 Essential for Successful Anal Sex

Dr. Evan Goldstein
3 min readJun 15, 2021

What’s the most important requirement for enjoyable, pleasurable, and successful bottoming? Is it the skin in the anal canal accepting what is being inserted into it or is it the underlying muscle in your anal canal that must fully relax? Could it be both? I’ll ask you another question. Let’s say, during my initial consultation, I found out that the asshole-in-question (literally) had previously been able to be successfully penetrated without any issues (and with all of the pleasures they sought)? Does that help you decide whether it’s a skin issue or a muscle issue?

Believe it or not, it’s all in the details of your sexual history. If someone tells me that they were taking toys and dick without issues up until an unfortunate incident, then 9 times out of 10, it’s going to be a skin issue. The overlying skin just can’t open up and accommodate like it used too. And that’s usually caused by scar tissue formation from the inciting event. Skin hits a maximal capacity and then, if you go beyond that, it splits.

Why do I mention this scenario?

Because I want you to think of the sexual mechanics and physics at play every time you, well, play. The forces behind anal sex are extraordinary, therefore, both the skin and muscle need to absorb and disperse that force to help prevent injury. The most common ailment I see is an anal tear or what’s called an anal fissure. The pressures elevate beyond its capacity and the skin splits as a result. Painful? Yes. Annoying? For sure. Treatable? Well, it depends on who you see.

First, when a doctor doesn’t question your sexual history and how you play in the bedroom, there’s no way for them to fully understand your situation, and, as a result, it can be extremely difficult to find an appropriate resolution. On Mondays, I Skype with clients from all of over the world and most of the conversations have some of the above elements in their story. But the common thread is the misunderstanding of how skin and scar, along with friction, affect how we bottom. One thing to point out, though: I don’t blame you. I blame the inadequate educational and medical systems, along with inept practitioners, that fail to educate us on sexual health and practices.

Next, let’s talk treatment. Botox alone or cutting the muscle in one location (lateral internal sphincterotomy) are two options for a muscle pathology. But because you’ve taken dick for years without issues and you’ve opened up that muscle above and beyond fine — small, big, and huge dick alike all worked amazingly — means that it’s not a muscle issue. Yes, the muscle might be tighter during the injury at hand. It reacts to its surroundings, that’s for sure. But it’s reactive, which means that if you tend and treat the primary problem at hand, the muscle will release its contractility. That’s what an ass does — it contracts. Just approaching the muscle alone will do nothing for your situation.

Here’s another way to think about it: many times, the skin and scar form extra tissue called a skin tag. Most skin tags are large and with each thrust of a cock, there’s pushing and pulling of that extra skin and scar tissue. Do you think that’s good? Fuck no, it’s not. The pressures of anal sex are so great, causing more and more friction, that once again, the skin splits, causing pain and bleeding. Oh yeah, and prevents you from bottoming.

This shit ain’t hard to understand. However, the majority of our medical and surgical practitioners simply weren’t educated about this (and still are) or aren’t willing to truly grasp the above concept, no matter how many times it’s presented to them by their clients. Therefore, the responsibility falls on you! Hopefully, you are using Google to scour the internet, looking for anal fissure and sex solutions, and come upon one of our blog posts discussing these topics. We’re constantly trying to educate everyone on the proper sexual and surgical mechanics required for complete resolution of injuries and pathologies. You shouldn’t have to live with bleeding, pain, and scar formation in the anal area and with specific and appropriate techniques, it finally can. It’s my mission!

Don’t forget to stay in touch on Instagram: me and Bespoke Surgical.