Tales from the Tail — Anal Health Isn’t Just Skin Deep

Dr. Evan Goldstein
3 min readDec 9, 2021

Client’s Tale.

This motherfucker should be short and sweet. My ass had a large skin tag toward the back of my hole. I decided to see a surgeon where I live and they were able to remove it in their office under some mild, local anesthesia. All good, right? Nope.

I never felt like it was done correctly and within a few weeks’ time, it came back and boy was it a pain in my ass — literally! I went back to the same surgeon, who told me it would improve with creams and lotions, but that clearly didn’t happen.

I found myself doing research to find a surgeon who might be better suited to fix my asshole when I stumbled across Dr. Goldstein from Bespoke Surgical on social media. He seemed to take a unique approach to anal health and the reviews were all promising, so I immediately reached out to get a consultation.

When I got there, he took one look and immediately knew what was wrong. He spoke of what he refers to as the ‘tip of the iceberg’ phenomenon. The skin tag was connected to an internal hemorrhoid/tear that needed more formal excision and treatment. He also spoke about using Botox as part of the surgery, which would help with the healing.

After the surgery was done, I was given an anal dilation protocol to help strengthen the skin and muscle (a must for those who bottom). Although I don’t usually take it up the ass, the dilation work helped show me how pleasurable anal play can be if you do it right, and now I know bottoming is at least on the table. And the best part? Now that table is free of any lumps and bumps!

In speaking with Dr. Goldstein, he showed me that he takes a more detailed approach to his surgical procedures. Unfortunately, most surgeons only see the simple, external concerns and it’s only when you understand a pathology’s origin that you can truly determine the appropriate treatment. This should have been done from the get-go, but, alas, there no need to look behind — only forward (no pun intended).

My Discussion.

Just the tip. Sometimes that’s a good thing, but other times it’s not. Unfortunately, too many doctors only evaluate the external components of an anal ailment and think it’s a simple 1, 2, 3 excision and you’ll be back on the horse in no time. I routinely see clients looking for second or third opinions, and other times I see clients looking for reconstructive surgery after a failed attempt at what seemed like a simple, straightforward skin tag removal.

Sometimes, “simple”, “straightforward”, and “skin tag removal” don’t belong in the same sentence because often times there’s more to it than meets the (brown) eye. To help clarify and educate everyone, anal skin tags develop as a consequence of something else. An action creates an unwanted reaction. In this case, anal pressures become elevated, whether that’s from defecating, weight lifting, and/or anal play. Dilated veins (hemorrhoids) and overlying skin tearing (anal fissures) can develop from increased pressure. The constant push and pull motion can not only affect the functionality, causing pain, bleeding, and irritation, but also the aesthetics, causing one to become self conscious of the way our holes look.

The point of this tale is to bring awareness to the fact that the simple snip that many doctors perform, both dermatologists and proctologists alike, may not be the correct approach. A full examination — both internally and externally — along with muscle evaluation, is critical to determine what’s truly causing this literal pain in your ass (not to mention a potentially unsightly skin tag).

While some cases only require a simple fix, it’s important to come at this knowing that the ass is finicky. In order to get the results we want, both functionally and aesthetically, we need to make sure the initial approach is the most appropriate one. And as an aside — who wants to go through the healing process two or three times?!

If there’s anything you take from today’s tale, I hope it’s that you understand how I approach the process of surgical correction, and that every action has a reaction, not just in life, but especially in anal sex.

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