Anal-yzing the Anus, the Final Frontier

Thanks to a new generation growing up on TikTok and other social media, discussions on mental health, sexual activity and body-shaming are getting more normal by the day. Heck, people even seem happy to wax lyrical about their sex toys and fetishes, too. So why is there still stigma about the butthole?

Evan Goldstein, D.O., and his team at Bespoke Surgical are helping to shift that conversation.

"Anal is the final frontier," Goldstein, Bespoke CEO and founder, explained by phone from his New York City office. "People don't want to talk about it. It's taboo. But when they have problems, they don't know where to go, and ordinary doctors have no idea. We need to destigmatize the issue."

In this effort, Bespoke Surgical offers such services for the anus as restoration, cleansing and aesthetics, including bleaching and microneedling. Goldstein has received clients from all over the world who have one of two requests: to heal any issues back there or to improve their backdoor appearance.

Anyone can do anal

Goldstein saw a healthcare need in the gay community more than a decade ago but quickly realized such an important mission as destigmatizing care should involve everyone.

"I started out as a general surgeon and specialized in anal and sexual wellness," he said. "I was starting to see these repeat issues and started changing protocols. Really, it was all about treating people to get to s**t the right way and also the sexual desires they want. Now we provide a safe space to discuss their desires and pitfalls."

The "pitfalls" Goldstein referred to can be both functional and aesthetic. It's his goal to get patients to understand it's OK to have and engage in sexual desires involving anal play, as well as learn how to functionally receive the object they want, be that toys, a penis or even a fist.

"If you don't have that confidence, it can ruin relationships sexually and it can be even catastrophic if you're a bottom," he said.

Goldstein is also the co-founder of Future Method, a line of products including washes, creams and pre/probiotics that offer a holistic approach to prepare and care for your booty in the bedroom, according to its website.

"We break down sex into what happens before, preparing for it and aftercare—the preventive stuff. That was the impetus of starting Future Method," Goldstein said.

Goldstein's work may speak more to the gay male community on first listen, but he has worked with clients of all genders. Along with men looking for bleachings, he's also worked with postpartum women and trans clients.

Anal aesthetics

Goldstein's work as a surgeon includes restoration and reconstruction of anuses. Restoration focuses on issues such as fissures, hemorrhoids, warts and tags, whereas reconstruction repairs the form, function and cosmetic appearance. These services can include tightening or loosening the sphincter muscles and can aid in correcting any issues from previous surgeries.

"As we age and have sex, we can become looser," Goldstein explained. "The anus gets more elastic over time."

For aesthetic procedures, Bespoke Surgical offers anal bleaching, chemical peels, microneedling and laser hair removal, plus procedures that target butt acne.

"These procedures really depend on the person," Goldstein said. "They may not feel sexy anymore if it's discolored or they think there's too much hair. I always say that these are 30 percent mental but 70 percent functional issues with patients."

Anal safety

Even if anal chat isn't the talk of the town, a lot goes on back there that shouldn't really be ignored—more than just the obvious bowel movement.

"We like to play there, we insert things, we like to eat there," he said. "Yes, there is a lot going on in a lot of ways."

With all that activity, not everything goes as planned, and if people continue to believe dangerous myths, Goldstein believes they only put themselves in danger.

"In terms of anal sex, people will think that some bleeding or pain is normal," he began. "It is not. Sex from back there can and should still be pleasurable. Second, anal bottoms think they can go taking something big right away. If you have never been to that specific size, you have to shape it into you and relax into that and learn how it feels. An ass isn't just open for someone to take and enter."

Anal awareness

At the end of the day, Goldstein wants to help folks look after their anus—properly. Part of that means teaching the general public more about themselves and how to become friends with their butts.

"We want to raise awareness and work toward destigmatizing the hole," he said.

While not everyone can get to New York for his services, Goldstein advised people to educate themselves and discuss potential issues with their primary care physicians. Proper care begins with a willingness to discuss sexual practices and how they intertwine with overall health.

"We just want to make sure we are getting you to that healthy and confident place," he said.

For people who want to get a bleach job or hair removal, he encouraged them to embrace what they want and go for it.

"People may say, 'Who the f**k cares what it looks like?' but some people do," Goldstein explained. "And if the appearance of their hole bothers them, there are ways to work on that to help give them that comfort and confidence, too."