Tales From the Tail — When Friction During Anal Sex Rubs You the Wrong Way

Dr. Evan Goldstein
4 min readJul 13, 2021


Client’s Tale.

I feel discomfort while I’m bottoming. Nothing crazy, but enough to make me avoid anal sex at nearly all costs. Independently, I recently began experiencing some other gastrointestinal issues that prompted a colonoscopy. The findings were not overly helpful, but after the procedure, I wound up developing an anal tear called a fissure. Shit happens, right? But fuck me! What a literal pain in the ass. I went back to the doctor who then referred me to a local colorectal surgeon. This doc placed me on suppositories and creams. Unfortunately, my situation wasn’t getting any better. Actually, it seemed to get worse. The pain and bleeding continued and, over time, extra skin (what seemed like a scar) developed in the same region as the tear.

I was losing my mind and nothing was improving my situation. Fortunately, I eventually found Dr. Goldstein, and we Skyped since I was not in the New York area. Although I was super reluctant about any surgical intervention, at this point, enough was enough. I was being completely dismissed by my original physicians and I was at my wits’ end. So I flew to New York for an in-person consultation with Dr. G, knowing that surgery the following day was a possibility (convenient, right?).

In the office, Dr. G took a look inside and out and could appreciate the chronic tear and scarring and, more importantly, an extra tissue growth internally. Long story short: it looked like the friction of that growth during the colonoscopy was pushed and pulled, enough to force a traumatic tear in my hole. Go figure. Bringing it back full circle, it appeared this was also what had been my limiting factor as it relates to anal sex. I underwent the procedure and although there was a rough recovery period, my hole is repairing itself fine and soon it’ll be ready for its reopening — literally. Sure, I’m frustrated by what I thought was just a routine colonoscopy, but I’m putting the past behind me (no pun intended) and I’m excited for what lies ahead (or on top) of me. IYKYK.

My Discussion.

Friction, friction, friction! Sometimes, something so simple can cause so much trauma to the ass. We attempt to minimize friction by using lubricants. I hope you listen to all of my anal rants, where I implore you to prepare for bottoming by using butt plugs to help dilate and pre-lubricate. This in and of itself will help diminish higher pressures during actual sex. Next, learn your anatomy to full open in the right way. Then, understand better positioning as it relates to offsetting these pressures. I can go on and on about how forceful anal sex is, regardless of how gentle you may be. Butt I won’t. I think you get the point (or at least I hope so).

We speak of many things you can do to help mitigate or even eliminate traumatic outcomes. However, there are innate anatomical issues that may actually be the culprit that causes pain, bleeding, spasm, and/or just limitations during anal sex. Remember: anal sex shouldn’t be painful.

This patient had what’s called a hypertrophic papillae, which is totally benign. It’s simply a growth that can range from small to large in size, about 3–4 cm into the anal canal. However, believe it or not, a colonoscopy is no different than penetration. There’s an in and out movement that creates pressure, which clearly pushed and pulled this growth with such force that it caused an anal tear (aka a fissure). It totally sucks and didn’t remedy itself with non-surgical treatment options. Realistically, it needed surgery from the get-go to eventually allow him the ability to bottom safely and without pain. The simple removal of this client’s extra tissue and then cleaning up the fissure line, with Botox to reduce the muscular pressures, allows for appropriate healing and engagements.

A hole is a hole. And many things can create friction in that hole. We want a smooth anal pipe — fully lubricated and relaxed without any obstructions. Skin tags, hemorrhoids, these hypertrophic papillae, anal glands, etc.— they all create unnecessary friction that, when enough force is created, may limit our daily bowel movements and sexual desires.

This story brings to light what I do every single day. I analyze anatomical aberrations that, in essence, create and withstand forces. We visualize them (anoscopy), we measure them (anal manometry), and we combine that information with your presenting symptoms (anal pain, pressure, spasm, bleeding, etc.). With all this information, we are able to synthesize a plan that allows for corrective medical and surgical options, all in the name of bottoming. No taboo. No stigma. Just good old fashioned fucking. And why not, right? I created Bespoke Surgical because of my passion for community-specific corrective actions like these.

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