Tales From the Tale — I’m a Straight Guy and I See a Gay Anal Surgeon

Client’s Tale

I am a heterosexual male in my fifties, and although I haven’t had anal sex, I have had a bunch of things stuck up my ass. Sadly, not for pleasure. See, for the past two years, on and off, I’ve had a chronic anal condition that has brought me to pelvic floor physical therapy. And what happens during those sessions? I lie on my side while he dilates my asshole. If you’ve had the kind of chronic pain and anal spasms that I have, you would do anything to get rid of this agony, too.

Lets start from the beginning. Two years ago, I underwent a right-sided hemorrhoidectomy — the surgical removal of the excess tissue and hemorrhoid with suturing — by a prominent Upper East Side surgeon in NYC, along with lasering of the left smaller hemorrhoid. I decided to go through with the surgery because it got to the point where every bowel movement would be accompanied by bleeding. It had definitely reached the point of no return and formal surgical treatment was the last resort. The procedure seemed to be standard, as my surgeon had pointed out as I awoke from my anesthesia daze. However, I had quite a bit of pain then and it continued to be excruciating over time. I anticipated I would have pain to some degree, but holy-fucking-shit. Torture doesn’t even begin to describe what I felt. The brunt of the issue lasted one full week and then slowly started to morph into my current situation, which, if you remember, has gone on for two years. That’s not for my lack of trying, though.

Here’s what would happen: I would take a shit, and then, as the last piece would hit the bowl, my anal muscles would spasm and then I’d get pain associated with it. I can feel the exact spot where it originates — it’s more so on the right, where they did my surgical procedure, through to a less degree at another spot on the left. I’ve had so many doctors evaluate and examine me with no success. I, of course, went back to the original doctor, who had looked inside my ass many times, before and after surgery, and even he said that everything looked super normal. Well, it sure as fuck didn’t feel normal.

I was then referred to a pelvic floor practice for local shots and therapy. Sure, there would be some days of relief after only some manipulation — needle treatment or toys and fingers up my hole. But then, a few days post-treatment — boom — the same shit would happen. Literally! This has been going on for two years and is the goddam bane of my existence. My quality of life is so low, beyond my wildest expectations. One of the docs at the therapy practice wanted me to get another opinion and recommended I see Dr. Evan Goldstein at Bespoke Surgical. I Googled him right away, as I do all my practitioners, and, although he has a cult queer following, all I was thinking about was getting my situation resolved.

After the usual 20 minutes of me describing my saga of my last two years of hell, Dr. Goldstein examined me and, within two seconds of his internal anoscopic and digital exam, touched both the left and right-sided spots and said, “This is where your pain is, right?” It was that easy to diagnose, yet for two years, no one knew a fucking thing. We spoke of the issue — an internal anal fistula, which is sort of like a tunnel that had developed from where they had done the formal surgical removal of the hemorrhoid. This then formed a small pocket, where shit — literally — would get stuck, causing localized irritation and then my anal spasms. I was in shock. We spoke about the treatment options and then he swabbed me for Covid-19 as a part of the preoperative assessment. In two days, we were in the operating room. Just like we discussed, he found the culprit and also treated it appropriately by opening the formed tunnel and then placing Botox in the internal muscle to allow for relaxation. Immediately I could feel relief from the pressure. Sure, I had local anesthesia and Botox on board at that time, but my first shit was still extraordinarily pleasant.

I am super optimistic about the future state of my anal affairs and have told Dr. Goldstein many times that if this truly does solve my issue, I will forever be indebted to him. Fingers crossed, anus tight. Here’s to my (w)hole recovery.

My Discussion

Over and over, I see the same ailments and this client’s tale is no different. The limitation for other surgeons is actually two-fold. First, they mostly only look with the naked eye and not a formal, high-powered microscope. Secondly, the actual internal examination may look normal at first, but if you ask the right questions, the diagnosis is sometimes right under your fingertips — literally. I have developed most of my knowledge through years of working with the queer community first and then expanding to everyone who engages anally. Seeing at least 75 asses a week has provided me with the insight and awareness to truly make a difference. That, in and of itself, wakes me up every morning, providing me the daily drive for existence.

Believe it or not, what happened to this particular client is actually no different than what happens to those who overdouche. Inside, about 4 cm into everyone’s ass, there are these glands that secrete some mucus to lubricate our stools as they pass through our holes. These glands are like little pockets and sometimes things can get blocked up. Overdouching can put constant strain on these glands, causing the tunnel to actually get bigger and deeper. This sets the stage for local irritation or infection, and eventually you can develop an abscess, have a higher incidence of STDs, or even develop debilitating anal spasms (like this client). These glands are right on top of our internal sphincter and once they become irritated, these muscles tighten or spasm. This pain is constant and really fucking annoying. Chronic pain, in general, is annoying and debilitating, but it’s especially bothersome with the ass because the pelvic floor moves all day long — we contract it while sitting, standing, exercise, walking, etc.

These local gland irritations make sense, and since the practitioner or the patient can pinpoint the exact location, it should be easy for a diagnosis to be made. But most doctors fall short of being able to connect the dots. It looks normal, so how could something be wrong? I don’t even need to do an examination to come up with a diagnosis. I can just tell from someone’s sexual history. And the surgical treatment is just as easy. The irritated gland gets probed from the inside with a tiny instrument and is then opened up. The pocket is removed, cleaned out, and cauterized to encourage everything to close. Depending on whether or not there is muscle in that pocket will determine where and when I use Botox. But really, most are administered Botox to help reset the anal spasm that occurred in the first place. The opened wound will scar over in due time and will close that pocket that had developed. What we’re left with is a normal orifice without any potential irritants. Defecation and anal play should be pain-free from here on out.

All it takes is a 10 minute procedure to take care of two years of chronic, agonizing pain. Seeing patients who go through years and years of misdiagnosis breaks my heart. I hope that by sharing this tale, I can help both patients and practitioners understand that this type of common ailment exists and there’s an easy way to fix it. The key is listening to your clients and understanding how different communities engage sexually. And if someone is constantly complaining about pain or discomfort after a surgical procedure, clearly something is causing this chronic condition. If you don’t know how to fix it, that’s OK. But then you should know someone who can.

I’ve said this once and I’ll say it again — it’s so important to see a doctor who asks the right questions and who also evaluates each community individually. How we engage sexually will have potential complications that are unique. Most times, especially when it comes to sex, one size does not fit all. Anal pain is not normal, whether you’re just trying to poop or engaging in fisting (and everything in between — no pun intended). And if it’s impeding your quality of life, know that it doesn’t have to because there are solutions out there. Come and see us or someone else who practices community-based anal care.

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

NYC Gay Surgeon discussing ASS: A\rt, S\cience, and S\ex www.bespokesurgical.com/