Tales From the Tail — When Pelvic Floor Therapy Isn’t the Cure
Client’s Tale.
I am a 30 year old gay male who has taken it up the ass for years and years without any issues… until about two years ago. One night, I took a rather large cock that ended up literally fucking me up. I’ll save you the details, but it definitely felt like a tear. After I hopped off and did some at home care, I saw a gastroenterologist, who placed me on some creams to help heal my rear. It definitely did improve the immediate pain, but it did NOTHING to help having sex. Every time anything was placed in my hole, I’d instantly feel the same spasm pain. I had to walk away from so many beautiful tops. Do you know what it’s like to lose your hole?
After that, I got into acupuncture and also started seeing a local physical pelvic floor therapist, hoping they would get rid of that horrific spasm sensation. My routine was two times a week for many months, but still no complete resolution. I even got local injections — a kind of steroid or saline to let the muscles relax and chill out — into my pelvic floor and only saw minimal improvements that would last for just the first few days. I was a frustrated bottom to say the least.
My therapist had told me to go see Dr. Goldstein at Bespoke Surgical nearly a year ago, but of course I didn’t listen. There was so much shit going on in my life at that time and then the pandemic started. Fast forward nearly 11 months to the other week when I finally had my formal evaluation with Dr. Goldstein. Not only did he confirm that I have had a chronic spasm in the area, but also an entire inside full of anal warts! Holy shit! Butt wait — there’s more. He also found internal hemorrhoids and a chronic anal tear called a fissure. What I found especially interesting to learn was that the pelvic floor spasm seems to be the consequence of all these fucking things put together. We did the routine STD swabs and visual exam, and in a week I will have surgery to begin to correct everything.
There is a lot going through my mind right now and my self confidence is definitely at a low point. I’m beginning to really think about how my love for bottoming has taken priority over really evaluating how I engage and what steps I can take to make sure my ass is always happy, not just from being pleased, but also from being healthy. Regardless, I am so grateful to start the healing process with the hopes of at least living my life the way I want. Wish me luck!
My Discussion.
Let’s start at the top (for a change): if anyone tells you that you have a pelvic floor dysfunction, please make sure you get every orifice in that region checked — inside and out. Why? Because the body is a reactive organism. That means that most muscular dysfunction stems from an inciting ailment. Take the above client. Everyone was only treating the anal spasm — rightfully so — since obviously it had become so incapacitating. But the algorithm is to analyze its origin. Change the way you are thinking. Sure, it’s quick and easy to target treatments. But try taking a step back and analyze what systems can be malfunctioning. Then, see the appropriate specialists to help rule in or rule out all the potential diagnoses.
Through a simple look inside via an anoscope utilizing microscopy, this visualization allowed me to understand why the spasm had developed in the first place. Yes, years ago that larger-than-life partner of his tore him up. That was the first hit. With that tear, the muscle reflexively spasms. At that time, once a tear happens, the inflammation and irritation that ensues also becomes the inoculum for the HPV virus (in other words: it causes anal warts). Now you have a chronic fissure with spasm and HPV. The spasm leads to difficulty defecating, with more pressure needed to adequately evacuate. This pressure then leads to dilated veins (aka hemorrhoids) and then the viscous cycle is complete: constant irritation, pressure, and spasm. It just cycles and cycles, up and down, without an end in sight. It makes sense once you understand the body’s chemistry. Obviously, the key is to break this cycle. But you can’t just attempt to correct it by targeting the spasm with acupuncture and pelvic floor therapy.
Yes, pelvic floor therapy helps, but if you don’t treat the initial pathologies, the local treatment of anal tightness only marginally helps alleviate the symptoms. And simply alleviating the symptoms won’t allow someone to truly take it up the ass pain free again.
I know doctors have the best intentions for their clients, but I constantly see far too many people suffering for years on end without an appropriate, formal initial evaluation. I always tell people how important it is for them to demand a thorough understanding of everything they’re going through and not to just accept a chronic diagnosis by their doctor. Do your homework and research and if any questions persist, reach out to a specialist who is well-versed in positive change. Never stop asking why.
The client who shared their story here is scheduled for removal of the anal warts, along with treatment of the fissure and administration of Botox to the muscles. He does have considerable hemorrhoids, but with the warts and the fissure/spasm, a staged approach needs to be taken. The hope here is that if we relieve that spasm, the hemorrhoids may actually resolve on their own and/or minimize in severity. I know this client is happy to finally have the right diagnosis and I’m looking forward to helping him back onto the saddle in the coming months (per his request).
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