Anal Health Q&A with Dr. Evan Goldstein

[00:00:00] Michael Diiorio: One.

Hello, everyone. Welcome to Gay Men Going Deeper, a podcast by the Gay Men’s Brotherhood, where we talk about personal development, mental health, and sexuality. Today, I’m your host. My name is Michael Diario. I am a life and wellness coach specializing in sexuality, relationships, and self-confidence.

And today I’m excited to shine some light on a very taboo and heavily stigmatized topic, anal health.

Joining me is Dr. Evan Goldstein, whose mission is to upend myths, defend taboos, and educate us all on better anal sex and anal health. Thanks for joining us today, doctor Evan.

[00:00:37] Dr. Evan Goldstein: Oh, thanks for having me. I appreciate it.

[00:00:39] Michael Diiorio: Yeah. So, I want to tell the audience a little bit about why I really wanted to do this episode.

I know all too well that when you’re feeling insecure about your bum, you do not feel sexy or confident. It negatively impacts the way you show up in your sex life, your dating, and your relationships, and I do not want that for you. Regular listeners of this podcast know that we definitely want to empower and educate our audience here. Okay?

So, I also know from personal experience that it can be very embarrassing to talk about issues that are happening in your butt, such as perhaps hemorrhoids or anal fissures, bleeding, and even mishaps that happen during sex. I have been there, my friends, and I think a lot of us have. But because of this taboo around anything anal, we don’t really talk about it. Instead, I found that it’s a lot easier to go down the Google rabbit hole to find answers. But what I’ve noticed when I’ve done that is that it’s actually quite hard to find answers that are both scientifically accurate and judgment free.

So, as I said, our goal here today is to educate and empower you to. To take care of that delicious booty of yours so that you can feel more confident.

Now, instead of our usual setup for the podcast, we’re actually going to be doing something a bit different. We’re doing a Q and a format today. So, I asked my Instagram followers to submit all their anal health questions to my insta. And answering those questions is Doctor Evan Goldstein, the leading anal health expert in the US, founder of the future method, and one of the few surgeons in the world whose practice bespoke surgical is dedicated to treating and restoring the human butt. So again, welcome, Doctor Evan. Thank you for coming on here today to answer our questions 100%.

[00:02:26] Dr. Evan Goldstein: I’m super excited. Thanks for inviting me.

[00:02:29] Michael Diiorio: Yeah. Okay, before we get into the questions, Doctor Evan, I’m dying to ask, and I think our viewers might want to know as well. How exactly does one become an anal health expert? Can you share that journey with us?

[00:02:41] Dr. Evan Goldstein: Yeah, sure. So, I never thought I would be doing what I’m doing now, honestly, I think, you know, I was training to be a heart surgeon. I was actually in fellowship for hearts, and I was miserable. I came out later in life. I came out in my thirties. I have a partner now of 18 years. We have two twin boys aged twelve together. And so during this, when I was going through heart surgery and miserable, and I wasn’t out and I wasn’t really connected to who I was, I finally came out, realized that I was miserable doing heart surgery, and realized that I can do whatever I want. What can I actually do? And when I started to really look at the community, I started to realize that there was a huge need.

Where do people go if they get injured? Where do people go that they don’t have the sexual education that they should have in terms of preparing for anal, enjoying anal. What if things go wrong? And that was what spearheaded bespoke surgical. Because I said, wait a second. There’s no place that exists that should be destigmatizing. Take away the taboo. Create an environment where people from all over the world know that they can come to an office and explore themselves from a desired perspective, to now have discussions to say, hey, this is what I want to do. This is what I can’t do. This is what I want to improve and create that. And that was really the birth. But you don’t get trained in it. Nobody in the world knows. How do you take care of an ass as it relates to. From anal intercourse? So, you have to start analyzing the community. Like, where do things go wrong? Why do people present to me with certain things? How do I start to think differently? And that was the birth of bespoke, which then led into future method, which is all about products to support the way we engage. And then obviously also. But seriously, which is a book that comes out in a couple of weeks, which is all about that, which is, how do I put all of that together so that now we can really educate the masses so that they don’t wind up in my office with tearing or hemorrhoids or bleeding or anal pain and allow them to kind of the fruits of their labor?

[00:05:15] Michael Diiorio: Per to say, yeah, that’s great. I love that. And it speaks so much to my experience as well as a gay man who does enjoy anal sex. Um, for those of you who are listening to us and not watching us, I’m happy you mentioned it, doctor. Evan, the book. I am actually, at the time of this release, the book will have been released and we’re going to put the link. Oh, perfect for you. Yeah, it’s great. I’m about. I’m on page 167. I’m on chapter seven right now. But for those of you who can’t see Doctor Evans screen, I’ll say it again. The book is called, but seriously, the definitive guide to anal health, pleasure and everything in between.

And so, I’m actually on the chapter on douching, which is great, because it brings us to our first question. Okay, so the questions remain anonymous. I’ll just read them out loud.

The first question is, is it true that douching too much is bad for you? And if so, is it possible to change your diet so you don’t have to douche as much?

[00:06:11] Dr. Evan Goldstein: Yes, yes and yes, and I’ll explain. I think douching in and of itself is an irritant. People don’t understand the difference between using a water or an enema. Now, both of them actually cause a lot of inflammation. The people think that water is free, water is clean and clear. So, hey, how can it mess with my insides? But the reality is, is that it interferes with the way that cells work. So, there are many people that are using water, are overdosing with either a shower hose or a large bulb, or are just doing it so many times that now we’ve actually created an environment that changes the microbiome. So, we have good bacteria, we have bad bacteria, but together they’re in equilibrium. When you are douching, we alter that microbiome, we alter that equilibrium. And now you set the stage for potential complications, like higher risk of STD’s, HIV anal injuries. Because it alters the cell. It basically washes and cleans you. But it makes the cells in there lose its abilities to function. What happens is the cell dies. The mucus layer, the protective lining starts to get washed away. And now you are basically raw, and most of us are having raw sex, that now it sets the stage for problems. So, yes, the key for me is like, I own a douche company. It’s called future method and we’ll talk about it. But I don’t want you to douche. I want you to use fiber. I want you to use pre and probiotics. I want you to use diet and exercise and create an environment where just like a dog, you go to the restroom. It’s solid and soft and easy. And you don’t have residual, you don’t have to wipe or your wiping is the least amount, because then that translates to the anal cavity, where we’re having run of the mill anal sex, being clean. Or that if you are douching five, six times that you could start titrating down to less. So, I think, again, the person that’s bringing the question is, it’s totally dead on. I mean, I think the key for people is to understand, one, that we’re doing damage with douching. I get why people want to douche. I get it. But the key is, how do we bring fiber and pre and probiotics with future method? We’re the first ever pre and probiotic that replenishes the anal microbiome, which is what we need. I always tell people, if you and I go on the street and we swab ten random people, I can tell who takes it up the ass from their anal swab because there’s an overgrowth of a certain bacteria from douching, from water-based lubes, from sex in and of itself. So, the key is, how do we minimize that change? How do we replenish the normal good bacteria and mitigate all of these risks that we were talking about now, future method, we came up with a solution, either a liquid-based solution or a powdered version, where for every 4oz of water, you put one packet of powder to neutralize that water. And instead of it being water and an enema, it’s somewhere in the middle where it cleans, but it doesn’t fuck with the microbiome. It doesn’t create that environment to cause change in that space. So, I always say less is more with anal sex in everything, especially with douching. And you’re right. How do you look at everything that you’re doing? And I say, titrate one thing at a time, because if you’re doing, oh, I’m going to add fiber, I’m going to add a pre and probiotic, I’m going to decrease my douching. You’re never gonna know what works. So, it’s always stay with what you know and then say, okay, I’m gonna do one thing differently over the next three to four times that I’m engaging, whether it’s lowered my douche amount, whether it’s adding a supplement, whatever that is, to offset some of that.

[00:10:43] Michael Diiorio: Yeah, thank you. I love that you’re providing so many different options because I think for a lot of people, myself included, again, is like, there’s a lot of pressure and anxiety when, you know, he’s pulling out and you’re like, oh, God, oh, God, oh, God, oh, God. Like, I hope. I hope it’s clean. I hope there’s no residual or mess. And that comes with a lot of pressure. So, if you’re prepping ahead of time for me, I didn’t know for a long time that there were other methods besides douching. So, I’m really happy to hear that there are some things.

[00:11:09] Dr. Evan Goldstein: Yeah. And I think one of the things I always say is, I like the dilating kit test, and I’ll explain that. So, when we talk about anal, people think you can go from nothing to dick right away. And the reality is, is that most people can’t. About a third of people can do that. Two thirds of us bottoms can’t do that. You actually need to prepare, you need to dilate, you need to stretch, and you need to work that. And I’m sure with some of your questions, we’ll go deeper, literally into that. But I like the glass kit. To have you do that when you’re not douching so that you’re able to, and I tell people, prepare a shower, you’re gonna clean you. You’re gonna dilate yourself before you get in the shower. Show yourself that eight times out of ten, even if you don’t douche, that you’re going to be clean. And the key is, even when you’re douching, after you’re douching, use a toy. It helps with pre dilating, it helps with pre lubricating, but it also helps that psyche, like you’re talking about, to say, hey, I am clean. And how do you start building that confidence into it? And everybody’s body is different, and we speak a lot of inflammatory bowel disease or irritable bowel, or, I ate a weird meal. Can I. Bottom. What are the things you’re gonna have to kind of put together? Well, wait a second. Self-exploration is so key because at the end of the day, it allows you to know how your body reacts to food, diet, supplements, dilating, douching. It is complicated, but the key is to kind of work with yourself to come up with a scenario so that when the dick gets pulled out of your ass, that you are, like, super happy, super clean, and in a good space.

[00:13:00] Michael Diiorio: Yeah, completely agree. One thing I want to say as well is your book. I don’t have a hard copy of it. I have it on a PDF, so I can’t show the audience right now, but there are a lot of really great diagrams, and the appendix has fiber rich foods that you could have. So again, you do offer a lot of options, and I love that you made it very simple. For someone like me who’s not a science kid, not a bad at all. You make it very easy and understandable.

[00:13:24] Dr. Evan Goldstein: Oh, thank you.

[00:13:26] Michael Diiorio: Okay, let’s go into the next question. This is another common one. The question is, I want to try bottoming, but I’m scared about the pain. Are butt plugs really necessary for someone who’s trying anal for the first time?

[00:13:40] Dr. Evan Goldstein: Yeah. So, I think a couple of things. This goes into the myth and the taboo section a lot. But seriously, it’s, first of all, anal sex shouldn’t be painful unless you want pain in your sex life.

Sex should not be painful. You shouldn’t bleed. You shouldn’t have issues associated with that. And that’s where we were talking about understanding your own pelvis and understanding your anatomy. And this is probably a good time for me to chat. In the book, we go over details, and we give diagrams to kind of really give you an understanding of what type of anatomy you have. But everybody has an ass. And in everybody’s ass, there’s two components with sacs. One is skin, and then the other is muscle. There are three sets of muscles, two on the outside, one on the inside. So, let’s talk about muscles first. If you and I or our listeners are squeezing your asshole, you’re squeezing right now. Two out of the three. The third one, the one deeper, is called the internal sphincter. That’s the biggest muscle, the thickest muscle that we have, and you and I don’t have much control over that. And when we were talking about one third versus two thirds, two thirds of people don’t have control over that. Only one third do. And what does that mean? It means that you now need to learn, how do we get the muscles to work in unison, and how do we get the muscles to learn how to relax on their own? So, we speak of muscles, and then we speak of skin. So, if we have muscle that needs to relax, the skin needs to open.

If there’s a discrepancy, the muscles are too tight, the skin won’t relax. What starts to happen? People can tear, which are called anal fissures, or they can develop a hemorrhoid, which is swelling of a vein, or they could develop pain, bleeding, and all of these issues. So, the key is for us with using toys. Now, they mentioned using a butt plug. I’m not a huge fan of butt plugs. To start with sex, most butt plugs are not ergonomic, and they don’t sit in the right space to actually work the skin and the muscle. So, with future method, we came up with a glass dilating kit. And the kit is a small medium into large. And I like glass because it’s weighted to allow us to actually stretch the skin and the muscle. Also, you’re able to use whatever lube you want, water based, hybrid silicone, all of that super easy to clean. And they come as small, medium, and large. And what they’re doing is they’re opening the hole as a unit, saying, how do we, like a sliding glass door open the skin and the muscles all in this unison approach. Now, with that said, if someone comes to my office and they’re like, I want to engage in anal, it’s about a six-week protocol of using these toys. Now, that’s in the book. And it’ll go over and it’ll say, okay, how do you use the small toy for the first two weeks? And even if you could think you can go to the medium size, just sticking with the small, why? Because we’re working muscle memory. We’re working. How does your mind connect to your ass? What anatomy do you have? And it takes time for you to realize, oh, this is how I relax my whole while I’m pushing in the toys, and it just takes time. And so most people do two weeks of just the small toy, two to three times a week, just like you’re going to the gym. Give me two sets of ten. It’s not, hey, I need to shove it in and leave it in. It doesn’t work like that. And so by starting with the small, then going into the medium, and then going from small medium into large, you start to see the progress. And through that, you’re able to start to understand your own anatomy, because you still may have pain or there still may be some bleeding. And the reality is, in the book, we talk of, okay, what are common symptoms? What are common approaches that can be done for over the counter management? And then what if things go wrong? What do you need to do? Many people need to come into my office. We do a test on the muscle. I do a lot of work with anal botox to relax that third muscle we spoke about. We do physical therapy. Sometimes someone has a chronic condition that in order for them to get too anal, I need to do surgery first. And so we talk a lot about this in the book because a lot of people don’t have access to come to see me. It’s how do you learn to get into anal, and how do you learn to get into anal safely for your anatomy, and then how do you define what that success is or not? And then what’s the next steps to do if you fail? So, going back to this, I know this is long winded butt plugs are ergonomically to sit up higher. They don’t open the skin and the muscle. They’re basically sitting in the anal canal. And butt plugs are really meant for positive sensations to allow you to get better off in your sex. They’re not meant for preparing you to get fully into anal correctly. Does that answer the question?

[00:19:13] Michael Diiorio: Yeah, I think so. I think you did a great job answering it. And I’m not at the part yet about anal botox. We’ll get to that later. Um, yeah, but I had a question, actually, about the lube. Um, there’s a lot of talk out there. You know, the difference between water and silicone, in your professional opinion, is there? Is there one that’s better for us?

[00:19:30] Dr. Evan Goldstein: I think for anal, silicon-based lube is still the best. First of all, it’s the best lubricity. It stays on point of where we need it to. You can obviously shower play. You could do many other components with silicone. Now I get why people don’t want to use silicon. It’s harder to really get off your ass. Also extend sheets and can cause issues. So, I usually say for run of the mill toy experimentation with dilators and toys, obviously, water-based lube, I’m totally fine with using. I think for run of the mill, average sex penetrative component, I’m still a big silicone. The problem with water based is that you start getting back into the same component with water. For douching. They’re in a scale, they’re in a wrong range. And so, what happens is that they’re the wrong ph. They caused the microbiome to change. So now you have someone that’s douching with water that then uses a water-based lubricant, and you could start seeing how it compounds the issue and causes potential problems in that space.

[00:20:41] Michael Diiorio: Yeah, I can have to switch because for the reasons you just mentioned, staining all my sheets, I switched back from silicone to water. But now, after this, I might go back.

[00:20:51] Dr. Evan Goldstein: Yeah. See how it rolls. And everybody has their own likes. And even within the framework, some people like different brands, or some others work well with different toys. Everyone’s going to have to play with what they feel. But just understanding that, I still think that silicone-based lube in that space is the way to go.

[00:21:10] Michael Diiorio: Awesome. Thank you. Okay, let’s go off into our next question.

He says, I love to bottom, but I’m worried that I’m overusing it. What can I do to keep it tight and intact?

[00:21:23] Dr. Evan Goldstein: Yeah. So, looseness, elasticity. People talk a lot about it. I rarely see it, honestly, I see it in people that have traumatic episodes where they tear something or it was a rape situation or a chem sex component, where all of a sudden there is some trauma in the space. I rarely see fisters coming to the office because a lot of them communicate. They all kind of are in a really great situation where they’re able to now understand their anatomy. It’s a different group. Right. So, I start seeing looseness in people that are engaging in extreme sex. A lot of sex very early on. Nowadays, a lot of the younger kids are feeling, which is great, right. They feel so fluid and so able to explore and have fun, but they’re bottoming before their muscles are fully developed. So, it’s good because it allows them to dilate correctly. But it also can lead to a lot of what I see where people are doing larger toys and or fisting early on in their career that could lead to these complications. So, I tell people a couple of things. The days that you are doing dilating with toys or with sex, the other days you should be doing contracting. So just like going to the gym, put a small toy up there and squeeze on the toy. Hold it. Three, two, one. Relax. Do it again. And each time you will see that just like going to the gym. Give me two sets of ten. Right. A couple of times a week. And that’s basically a kegel. Now, in my office, there’s a machine that we use which is called an emsela. E m s e l l a for our listeners. Now, this is basically doing 12,000 kegels in 28 minutes. And you sit on the machine fully clothed. But what it does is it really contracts not only the external anal muscles, but the internal anal and rectal muscles. So, there are definitely people. I take care of a lot of porn stars that periodically will come into the office and sit on a machine like this to improve the contractility in that space. Obviously, I do surgery for people that it doesn’t work where we have a hemorrhoid or they are loose in certain locations. How do I tighten and pull in? So, I usually try and break it up into three buckets. Can you do things kind of on your own with key goals and better understanding of the anatomy? Can you do things in the office with physical therapy and a machine like the amsella, or do I need to do surgery because there’s something that is inhibiting or worsening that laxity and that’s where the surgical approach comes in.

[00:24:19] Michael Diiorio: Now, I’m dying to know, is this machine only something we can find in a doctor’s office?

[00:24:24] Dr. Evan Goldstein: Yeah, but a lot of it is dermatology or plastic surgery. A lot of women use it for vaginal tightness, for post pregnancy. A lot of people post prostatectomy or with bladder issues, with pelvic floor dysfunction that have leakage or urinary issues. Again, and same thing. If someone has gas issues where they’re leaking or they have some leakage, these are all related to the pelvic floor, so it’s definitely around. They’re accessible.

[00:24:55] Michael Diiorio: Yeah. I think the theory with this question is that as someone ages, because I guess the skin on our face changes, it’s understandable to think, oh, maybe the skin down there gets a bit looser as well. Is there any truth to that?

[00:25:09] Dr. Evan Goldstein: Yeah, I think that the nice thing is that when you look at facial skin, the muscles are so thin in the face to create these motions. Right. Of different emotions that you’re able to do anally. The muscles are quite thick and the pelvic floor has a basket that really supports that. So, I think that what I see more of is if someone is having sex and they develop a hemorrhoid or they develop a skin tag from a tear, or there’s something else that’s in that space, then, yes, you could start to see skin changes, muscle changes or other components to it. But the reality is that if you’re doing things correctly, with dilating appropriately, douching correctly, using the right lube, seeing a practitioner once a year for appropriate evaluations and doing all this, we shouldn’t get you to that point of you being in this kind of danger zone.

[00:26:05] Michael Diiorio: And what kind of practitioner would that be?

[00:26:09] Dr. Evan Goldstein: Obviously, the goal is to try to find someone that understands your world from a primary care practitioner. A lot of them don’t do thorough anoscopic exams. They’re just doing STD screening and pap smears, which look at HPV. You want to try to find a proctologist or an anal surgeon that does what I do with sexual wellness, you want a lot of good evaluations inside and out. We do a camera once a year. We do swabs. I have you see our physical therapist. We wind up doing a test on the muscle. There’s what’s called an anal manometry. Test, which we do a lot of, which allows us to know which type of bottom you are. Will you be able to get to where you need to be with dilating, or do I need to do other things to get you there? Or on the looseness question, are you too elastic and going in the wrong direction? And how do we catch that? Early on, I’m hoping that through this book and through kind of what we’re doing with podcasting, and thank you for doing what you do, is that we’re also educating practitioners, right. That they’re able to say, hey, or people that are going into medicine or surgery to say, this is of interest. We need more people like this globally. How do we look at the community and kind of put people in all these directions? That is also in the book, which allows people to ask the right questions, not feel shameful, understand access to this type of care, and then take it from there.

[00:27:42] Michael Diiorio: Yeah, that’s great. When I was reading this, I was actually thinking, oh, my gosh, if you were in Toronto, where I’m located, I’d be on your table, like, saying, hey, can you. Can you tell what’s going on back there? But you’re in New York, right?

[00:27:53] Dr. Evan Goldstein: I’m in New York, but I do a lot of Zoom stuff. I see a lot of people from Canada. I see people from all over the world. You’d think London, Australia, all these places would have this type of care, and they don’t. So, a lot of times I do a Zoom call, give the education, and then if something, then some people fly in and then they fly back out. It just kind of depends on what. What they need.

[00:28:14] Michael Diiorio: Awesome. So, going back to this question, is this where anal Botox would come in? Like, when. What is it exactly? And when would you use that?

Yeah.

[00:28:23] Dr. Evan Goldstein: So anal Botox is really to relax that muscle. So, if someone that’s listening to us is trying the dilators or they’ve always had painful anal sex, the key for us is to, is it a muscle issue? Is it a skin issue? Is it a scar or some kind of pre issue that is there? Right. Extra skin, a cut that happened from shitting incorrectly or the first time with sex, all those types of things. So, the realistic approach is by using a dilating kit, you’re starting to see, can you train that muscle? I usually tell people, think of, like, you get, like a big catalog in the mail and it has that big rubber band on it, and you try to take that rubber band off and it’s like, shit, you can’t get it off because the rubber band is so resistant. Okay. That, in a lot of people, is their internal muscle. And what happens is the second something enters, the muscle clamps down and gets too tight. So, what happens is sex becomes like, that’s not happening, or you can’t relax fully and you don’t feel comfortable. That is where dilating correctly and understanding your anatomy or anal Botox comes into play. Anal botox relaxes that third muscle we were speaking about. And what it does is it doesn’t relax it completely. So, you’re not shitting on the street. You may have a little bit more gas in the beginning until you understand, but what it does is it takes the pressure off. So instead of your reflex of shit, someone’s coming in my ass. Now I’m super tight. It takes that away, and then it allows you to actually start dilating correctly, stretching that rubber band. So, in the beginning, the rubber band only opens here. Now we’re able to, with the Botox, get it to start stretching. And it’s the same concept. Botox lasts for about three to four months. You don’t need to do it forever. Some people like it, and we do it for a long time, but most people need two to three sessions of anal botox. I do it in the office. You don’t need to be sleeping. Many practitioners do it sleeping. I don’t know why. Maybe that’s just how they were trained. But the reality is, it’s an in-office procedure. And what it does is it starts to work fully in a week. And so most people I do it, they let it kick in, and then they start the dilating protocol. And now what we’re doing is we’re really able to get that muscle to become much more responsive. And over 6912 months of repeated work, now, when the Botox wears off, that muscle is now much more responsive and able to relax without the Botox. Does that make sense?

[00:31:15] Michael Diiorio: Yeah, it kind of sounds like training wheels on a bike.

[00:31:18] Dr. Evan Goldstein: Exactly, 100%. And the problem is our body, the mechanism of our body is not to take dick. Unfortunately, for two thirds of people, the reflex is contraction. The reflex is pain. Get out of my ass. How do we now offset that and do it in the right way? And that’s really where the book is I’m super proud of, because it starts to now do what we’re doing, which is for people to get the education that they never got, understand? How do they analyze their own selves? And then how do we come up with a plan? Because if you want dick in your ass you should have dick in your ass. And what are we going to do to achieve that? Because at the end of the day, we only have one life. And if you are someone that wants that in your relationship, or you can’t find relationships because they are not successful, because you can’t bottom. There are so many things that we can do nowadays that it’s a game changer.

[00:32:21] Michael Diiorio: Yeah. And this is exactly why I wanted to have you on this podcast, Doctor Evan. Thank you for that. Um, before we go to the next question, you had talked a little bit about the. The type of bottom you are. Now, I know what that means from having read the book, but for those out there who have not read it yet, can your kind of briefly tell us what the types of bottoms are?

[00:32:39] Dr. Evan Goldstein: Yeah, I mean, we labeled them in the book kind of Maximus, you know, nopus and potential. Right. But basically, there’s three sets. And we’ve studied this with our anal manometry examinations in the office. And, you know, I see 90 people a week in the office. I do ten to 15 surgeries. And when you start seeing that much ass and that much sexual engagement, you start to come up with population, community-based understanding. And so, a third of people are able to fully control. And for our listeners, think about if you were topping somebody and they’re able to fully open their ass for you to go enter. That is about a third of people in the world can do that. And that is those people have really minimal injury. They’re able to relax. They’re able to understand how to engage that in the correct way. So that’s a third of people. Two thirds of people can’t do that. They can’t fully relax. And that in that two thirds, half of people can train themselves understanding their anatomy, using the dilators and learning how to stretch in a good way. And then half of that two thirds can’t. They either need anal, Botox, or I need to do something with physical therapy and surgery to assist to allow them to get to. And again, it’s. Is it a muscle issue? Is it a skin issue? Is it a neurological, psychological connection? Right. It’s all of those pieces. And I say I do 60% functional work; I do 40% mental work. And that is a huge component of what we do, which is to figure out all of those pieces to now set the stage for success in where you want to go.

[00:34:39] Michael Diiorio: I love that. And the mental work. I love that you said that. I think the mental work is part of having read this book and this podcast is, I think as people have the knowledge, which otherwise would just be like a vague cloud of, I don’t know, or something I heard from my friends, friend, friend. But as you actually get that education from someone like you, it actually does impact your physical. Like that. Knowing impacts the way you show up. You feel a bit more confident. You know what’s going on. You have words and vocabulary where you didn’t before. And that’s super important.

[00:35:11] Dr. Evan Goldstein: I think it’s trying to, like you said even before, empower the bottom, right? You could be submissive but still be in control, right? Control for me is you being educated, right? You understanding your anatomy and how it functions, you being able to understand, okay, you know, sometimes we don’t know what dick is coming through the grinder door, right. You don’t know what necessarily. And so many times the picture and the dick don’t match up with what you think it is. Right? So again, I always say sometimes you have to look at the dick and be like, that’s not going in my ass. And know when to say no because you don’t want to have these injuries. Or the other way around is to say, okay, this is how I’m going to navigate that versus this. These are the positions that I’m going to use first for this person versus someone that I’ve engaged with multiple times together with. And again, I think that that’s the empowerment side of it. You don’t know what you don’t know. And the reality is, is that most of our education was so piss poor, specifically in anal sex, specifically in gay anal sex, which is why this book and what I do in the office, I think, resonates globally, which is to say it’s about fucking time. Right? And how do we take ownership of ourselves, especially in Toronto, when you say, like, well, I don’t have access to this type of care. Well, we need to demand it. Right? You need to look at for practitioners that are going to talk about sexual issues with you and that you feel comfortable with. And we break that down in this book also, which is, what do I ask in the office? What should you ask and what should you demand in the healthcare, wherever you are? Because the reality is that if we don’t start pushing this in the right direction, we’re never going to get to the end game of having access.

[00:37:08] Michael Diiorio: Yeah, and thank you for that. And I haven’t got to that part of the book yet, but I’m really excited for it. Yeah. And I mean, just from my perspective and probably most of our listeners out there, my sex education when it came to anal sex was zero. Formally, everything was by experiment, trial, and a lot of error. Or hearing it from so and so and so and so, or watching it on porn, which isn’t always realistic.

[00:37:32] Dr. Evan Goldstein: That’s right. Totally. 100%.

[00:37:35] Michael Diiorio: Okay, let’s go to our next question. This one’s a longer one, and there’s probably a lot of different ways you can take it in, but let me just read it, then we can go piece by piece.

[00:37:43] Dr. Evan Goldstein: Sure.

[00:37:44] Michael Diiorio: Okay. Every time I bottom, it takes so long to recover because I get fissures. Now, I also have skin tags down there that make me feel self-conscious because they look like hemorrhoids. What can I do to recover faster?

It’s a lot here.

[00:38:00] Dr. Evan Goldstein: Yeah. So, realistically, if there are skin tags that are there, they need to be removed. And the problem is, it’s all about friction. Sex is all about friction. One, muscle, two skin, three scar and or extra appendages. Right. Which is the skin tag in this space. So, you can imagine if someone has a skin tag every time they’re having sex, that skin tag is being pushed in and pushed out. And so what happens is it creates friction. I say think about the best holes in the world. The best holes are basically pipes. There’s nothing that is blocking. You. Put the lube in the pipe, and you are able to do what you need to. If the muscle is too tight, if the skin doesn’t open enough, if there’s these chronic fissures and extra skin in that space, it’s all friction. And so no matter how much lube you use, no matter how much botox we do, no matter how much pre dilating, when you have these chronic fissures with extra tissue, they need to be removed. Now, you can put band aids on the situation by trying glass dilators, by doing anal, Botox, by trying to. But it’s just putting a band aid on the situation. So, from someone that comes to me that says, hey, I have extra skin, and I’m fissuring, and my recovery is a problem, that is what’s called a chronic fissure. Now, fissures are tears. What happens? Let’s say you and I are having sex. You’re topping me. I feel pain, I’m bleeding, I tear. Now, that tear, in theory, should heal nicely, but it’s not like any other tear on your body. When we shit, when we try to have sex, the tear keeps opening. So, the body produces scar tissue, and that scar tissue then grows out. It grows that extra skin as a protectant. So, the problem is it protects people because they’re able to shit better. But with sex, the pressures of sex are that much greater that it opens the scar again and becomes a vicious cycle. So, this listener, you know, you can slide into my DM’s, you can. I can cook you up. Give me a zoom. I’ll, you know, you can take a picture, send it to me, I can tell you. But it sounds exactly that the skin tag needs to be removed. The reason why the skin tag formed needs to be cleaned. We probably need to do anal, botox or something to help on the muscular side. And then I need to set the stage for that new scar. The new scar, to form, to form correctly. It doesn’t form in a shitty way. It heals correctly and there’s no extra skin in that space. And that’s an important thing of what I do with surgery. People are like, oh, well, isn’t it just going to happen again? And you say, no. If you create the right incision and you do the right things to help with pressure, and you’re doing things as you’re healing correctly, you’re able to get the skin, the scar, the muscle and all of it to start working again so that sex is not painful and having problems.

[00:41:29] Michael Diiorio: Yeah, and you explained Fisher’s really well and the tag part. But what about hemorrhoids? How are those different?

[00:41:36] Dr. Evan Goldstein: So, hemorrhoids are from pressure. Think about airbags, hemorrhoids, everyone has them. So, when someone says, oh, I have hemorrhoids, I’m like, yeah, everybody does. Symptomatic hemorrhoids, bleeding, prolapsing, where they’re going in and out, or they formed extra skin, those are from symptomatic issues. Hemorrhoids develop from pressure. What does that mean? I’m sitting too long on a chair, I’m pushing too much when I go to the bathroom because I’m constipated, I’m lifting incorrectly. When I’m doing squats and kettlebells at the gym, I’m doing peloton, huge biker. And the way that my positioning is, my pelvic floor has too much pressure. I’m having sex with not the right lube, or I’m pushing too much and my muscles are too tight. Any of that creates more pressure. Anally, when there’s more pressure now, more blood goes to those hemorrhoids and they can cause problems. They basically are sending more blood to the airbag because they know the pressure is elevated for whatever act we’re talking about. But the more blood that goes there potentially can cause problems. The blood can clot. So, you get like a grape that’s there. That’s called a clotted hemorrhoid. It can stretch the skin so that now you’re getting those skin tags, it can stretch internally, where now the mechanism of that hemorrhoid is faulty. And now people with douching and with sex start bleeding or feel swollen and irritated. So, all of these things play into this.

And so, again, from a hemorrhoid perspective, it’s analyzing your own pressures, making sure you’re shitting correctly, you’re not sitting too long on the bowl, you’re adding fiber, you’re drinking enough water, you’re shitting the right way. There’s so much. And again, that’s where we go a lot into the book, which is to really define all of those aspects of what I would say, activities of daily living that we normally are doing. And then obviously, sex, from my world, in our community, is part of that. And how do we now do all these things and analyze it correctly? And if there are issues, how do you know how to take care of it by yourself? Or do you need to see somebody to get you where you want to be?

[00:44:05] Michael Diiorio: Yeah. And actually, Doctor Evan, there was quite a few questions about those two things. Mainly, I would say, the fissures and the hemorrhoids.

[00:44:14] Dr. Evan Goldstein: Yeah.

[00:44:14] Michael Diiorio: Is that something you see a lot of?

[00:44:16] Dr. Evan Goldstein: Oh, my God. I mean, most of my days are that. I think a couple things. External fissuring. Just make sure people don’t use wet wipes. Wet wipes are terrible. I know why and so many people hate me for saying it, but they cause micro tears. And what they do is, especially in our gay space and anal space, they have a higher incidence of developing herpes and HPV anal warts from using the wipes. What they do is it fucks with the microbiome, similar to Duchenne. And so what happens is we have good bacteria and bad bacteria, but they’re in equilibrium annually in that space. When you’re using wipes, whether it’s the liquid, whether it’s the fabric, whether it’s the solution, all of that, I don’t know. Or whether it’s moisture in there. But something changes that, and then it allows. It really causes more of that issue as it relates to fissuring and problems associated with it. Again, so if someone has these, like, small little micro tears that happens from sex, think about is the lube causing it? Am I irritated from the lube? Am I using wet wipes? Am I over wiping? What are the things that you can do to prevent that from happening? Some people have herpes, oral herpes. And we lick, we rub, we suck, we fuck, we do all the fun things, and you can get that anally. So sometimes even just doing local herpes management allows for those minimal micro tears to not become macro and limiting. So, again, I talk a lot about all this stuff to really give people, because, again, this is stuff people just don’t talk about.

[00:45:55] Michael Diiorio: Right. Yeah. And that’s why we’re here. When I was reading this, I was actually, last night, I was on that chapter, you gave a lot of really good best practices about pooping. Um, and I was like, ooh, yikes. Like, oh, I do that. I did that. Like, especially the over wiping. Right. Like, in my. And using what you just said, the wet wipes, in my attempt to be clean.

[00:46:13] Dr. Evan Goldstein: Right.

[00:46:13] Michael Diiorio: Because obviously, like we talked about, you really want to be clean. I can be very thorough. And what I’ve learned is, apparently, we’re supposed to pat, not wipe. And I was like, oh, I’ve been doing it wrong for a long time.

[00:46:23] Dr. Evan Goldstein: Yeah, yeah, no, totally. And I think, you know what’s also cool is that, like, in the book, we talk about, even if you’re not getting into anal, like, how do you be a good top. How do you be a really good person to understand the anatomy so that when you are topping someone, that you’re able to get to where you want to be and to do it safely again, because at the end of the day, it’s the kind of lock and key component, which is, how do we do it in a really synchronized fashion. And in that we call them top tips, we go over a lot of different approaches. For people to think that it’s not only for and how many tops would love to bottom, but they don’t because it’s painful or mentally, they just can’t get there. This is also another book that I think would be suitable for that.

[00:47:11] Michael Diiorio: Yeah. This book is for not just bottoms, but it is for everyone, including women, by the way. Yeah.

[00:47:16] Dr. Evan Goldstein: Yeah. 100%. I do a lot of post pregnancy and hetero guys that are getting much more into kind of anal play. We have a lot of work to do with the hetero guys. But. But with that being said, you know, it’s.

[00:47:28] Michael Diiorio: It’s.

[00:47:28] Dr. Evan Goldstein: It’s a. It’s a mission, that’s for sure.

[00:47:30] Michael Diiorio: Yeah.

Okay. And then one more thing about the hemorrhoids. For people out there who. Who are suffering with them, what would you like is there something they can do at home to help?

[00:47:41] Dr. Evan Goldstein: So, I grade hemorrhoids. Most of them are graded 1234. That’s basically for internal hemorrhoids. And you have to kind of understand one and two grade. We’re able to modify better pooping fiber supplementation, water, squatty potties, sitting on the bowl. Correctly analyzing your shitting habits using toys can help hemorrhoids because a lot of the hemorrhoids come from people that their muscles are too tight. So, by using a toy and dilating and stretching, we’re getting the mechanism to start to work, especially with shitting. A lot of the hetero guys that don’t want to engage anally at all for pleasure, I have them do toy stuff because it helps work. Same thing. Anal botox helps with hemorrhoids. If we’re getting to hemorrhoid level three or four, I probably need to do something surgically, either removing the tag and the hemorrhoid associated with that, or rubber banding it or doing anal Botox or doing something to help with that. Hemorrhoids are there for a good reason, but if the mechanism has failed and gotten to the point of no return, then we need to do something, because every time you douche and have sex and create friction, those hemorrhoids can get swollen and irritated, which now limits, obviously, what we’re talking about.

[00:49:04] Michael Diiorio: When you’re. Well, for someone out there who maybe hasn’t had as much experience looking at holes as you do, which is probably everybody, our holes, I think, are very difficult because unlike your dick, you can see it, you can investigate it, you can look at it, you can play with it. You know, it’s there. Like getting back there. Like, I mean, I have to, like, take a mirror and a phone and sometimes take a picture so I can zoom in. Like, it’s really, really tough. But if you don’t know what you’re looking at, then again, it makes it so much harder. So how can someone tell what’s going on down there if they feel something, like perhaps a tag and think, oh, is that a hemorrhoid or a tag?

[00:49:36] Dr. Evan Goldstein: Yeah, I think that it’s quite difficult. I think you’re right. The selfie mode with, you know, really concocting and changing your body and positioning to get that picture is not easy. I think, again, when you feel something, is it a tag? And more so is the, what is the tag coming from? And so many people come to me like, oh, I have a hemorrhoid and it’s a skin tag from a fissure or vice versa. And so, I think the key is through pictures, through video, I get so many DMs with people’s asses. Like, what’s this? Obviously, we’re looking at, is it an HPV anal wart? Is it an ulceration that’s there? Is it a skin reaction? Is it just an extra piece of skin that developed from an old hemorrhoid or a fissure? But when we start to kind of look at how people engage, what are their limitations? What is their sexual history? Was there any incidence of x, y, and z? We’re able to start putting the pieces together. Also, hemorrhoids are mostly left and right.

They’re not front and back, usually front towards the penis, which is what I call anterior or me. 06:00. And in the book, we have a whole way to kind of discuss this, or versus 12:00. Most people, if they have extra skin in the front or the back, it’s from a tear. Hemorrhoids are usually left and right, so that’s where people can kind of analyze and see. But a lot of it is going to see somebody. And if it is indeed an issue, how do we just make sure you have the right access to that type of care?

[00:51:10] Michael Diiorio: Yeah, fully agreed. Okay. I know we’re running out of time, so I want to get to another question here. When it comes to fisting and using large toys, what are the best ways to prevent a prolapse?

[00:51:23] Dr. Evan Goldstein: Yeah, I think it’s proper mechanics, right? It’s being communicative and going very, very slowly in the progress, just like our dilating kit with future method. And what we talk about in the book is small into medium, medium into large. And then we also, when this launches, it will also be launched with what’s called a cone device, which is basically kind of like a traffic cone that has different levels on it to allow people to learn how to stretch the skin and the muscle together in a really good way. But with that being said, it will allow people to start getting into bigger toys. And then it’s same concept. Okay, how do we do a small, medium, and large in a bigger toy where we’re gradually working the tissue? Where I see injury or prolapse is where people go from nothing to something big too quickly. And then there was injury. If we’re going incrementally on both sides, the dilating side, and then the contraction side, I usually don’t see that. And that’s were coming to the office or speaking or listening to what we’re doing or buying the book and reading, you’re able to start saying, okay, how do I go there? But then how do I, the rest of the day, bring myself back into the rhythm of what we need? Remember, the ass is contracted 99.9% of the day, so it’s kind of doing already what we need it to, to stay in line. Right. So, a lot of what people are talking about, we talk about in the myth section, we talk about in kind of, how do you approach this? But I think through going through the book and understanding your anatomy and where it plays into it and then saying, okay, if I’m going to extreme, how do I now go to contraction mode and bring it in? And that’ll go over all that in the book?

[00:53:15] Michael Diiorio: Yeah, yeah, that’s great. And with respect to the prolapse, is it also possible that it could be caused by not just size, but frequency? So, let’s say someone who is on the receiving end of, like, a train, could that perhaps cause it?

[00:53:28] Dr. Evan Goldstein: Totally. I think, again, you know, it all depends on your anatomy. The prolapse side is more pressure. People love prolapse. A lot of people love the rose budding aspect of that. And what they’re doing is there’s a really fine line between a good prolapse that stays good versus it going into a bad pace. And again, I think that that’s also some people love prolapse. So, some of our listeners want that. How do you keep that? By measuring the pressures with prolapse, by allowing it to get to where they need to be. They’re able to now see, how do we keep that? It’s all about pressure. If you’re pushing so much, if when you’re ejaculating, you’re really pushing your pelvic floor too much, what’s going to happen over time is it’s going to create that prolapse because you’re stretching the muscles too much in that space. And again, that’s were understanding the anatomy and how to play into that again. And if you think if it’s your kink to prolapse, it’s all well and good, but let’s have a discussion to know. Okay. These are the days that I’m prolapsing. These are the days that I’m working to not get it so that it’s a full prolapse and having problems, because when you have problems beyond that, it can become catastrophic, where you can need surgery, and that surgery itself may not allow you to bottom further.

[00:54:51] Michael Diiorio: That would be terrible.

Okay. One last question. This is for me, but anyone else who’s probably with me on this, can you give us some tips for people who have a doctor like I do, but maybe aren’t used to advocating for themselves, like the way you had been talking about with respect to anal sex.

[00:55:09] Dr. Evan Goldstein: I think it’s just that I think, you know, you have to create this environment where you’re driving the ship and you need to just say if there’s an issue, you know, if someone’s talking about, hey, do you smoke? Do you drink? What type of drugs do you use? You could start to say, oh, can I also talk to you about my sexual history?

You know, you didn’t ask me about, you know, I had chlamydia last year. Let’s talk about that. You know, I enjoy bottoming. This is how I engage. These are the acts that I really like to do. I don’t use condoms. I use condoms. I think a lot of it is also with prep and or doxypep, which is using antibiotics as a prevention post is kind of push that. Like, if you don’t want to go to, hey, I take fists up my ass and love to shove coke bottles up there. First you can start to say, hey, can we talk about, like, prep and or my or doxypep? And, like, lead into that? And then they’ll be like, well, why? You say, well, these are the certain acts. Can I talk to you about the certain sexual acts that I enjoy or these are the sexual acts I would love to do, but I can’t because I’m having this happen to me. Can you help me? What are the things, blah, blah, blah. I think when you’re reading through the book, especially when it goes through kind of all the questions that I ask each individual client of mine and patient, I think you can take that with you to now create that confidence. And the reality is, like, you have to demand it. And if you don’t feel comfortable with that doctor, then that’s not the right doctor. Because at the end of the day, we need to be able to literally open up and say, this is my kinks, my desires, and this is how I want to live my life. And you want someone to be like, and for me, I don’t care what you do. I mean, I care. I want your risk to be as low as possible, but whatever you get off at, whatever you want, whatever you want to do, I am like, totally cool. I’m like, okay, how do we do that? And how do we do that with the least amount of risk so that you can keep doing that for the rest of your life.

[00:57:08] Michael Diiorio: Yeah, I completely agree. At the end of the day, it’s your health and you have to take ownership of that. It’s your health, your sex life, your pleasure, and potentially your pain. But you have to own that and really take responsibility for it 100%. Okay. Doctor Evan, this has been very helpful for a lot of people, I’m sure, and very insightful. Where can they find you? And where can they find your book?

[00:57:32] Dr. Evan Goldstein: Sure. So. But seriously, but seriously.com, it’s on all the different Amazons to Barnes and noble and all the other components. So, check it out there also on Instagram. For me, doctor, Dr. Evan Goldstein is my Instagram handle. It’s kind of my world of two kids and a partner with anal, with. I’m a big music guy, so it’s a lot of mix in that. And then obviously the two brands that I work and started bespoke surgical, which is the surgical practice that’s on all channels. And then futuremethod.com on Instagram, it’s the future method. And you can check out everything.

[00:58:11] Michael Diiorio: Great. I’m going to put all of these in the show notes. So, if you’re watching us, listen to us. Just check the show notes and it’ll all be there. Doctor Evan, it’s been a pleasure. Thank you so much for joining us today and hopefully we’ll see you again.

[00:58:21] Dr. Evan Goldstein: Oh, thank you so much. I appreciate it.

[00:58:24] Michael Diiorio: Okay. For our viewers and listeners, thanks for joining us on this episode. If you have any questions or comments, please leave them in the YouTube comments. We will be reading them there, or I’ll be reading them at least. You can also follow us on Instagram. I’ll put that in the show notes as well. And I want to thank you guys for joining us today. And we’ll see you on the next episode. Bye.