Dr. Evan Goldstein, founder of Bespoke Surgical, specializes in gay men’s sexual health and wellness.
We asked him how to be the best bottom we can be.
HUSH: How can we ensure a bottoming life that is abundant, happy, joyful, long, and pleasant — how can we ensure bottoming longevity?
Dr. Goldstein: The key to bottoming longevity, I think first, is for people to understand the anatomy and to really truly understand its function. I break down bottoming into three different categories: how are people preparing for sex, how are people actually engaging sexually, and then what is the aftercare. When I look at an anal region I'm thinking about three things: form, function, and aesthetics. And so, taking that before, during, and after and putting it together with form, function, and anatomy. It really starts to build bottoming empowerment. Really understanding those dynamics and how they interplay, can be preventative from an injury perspective, or from complications, which then increases people's longevity.
H: What are your expertly crafted tips to prepare to bottom for an hour, or for a whole night?
G: Number one is to really know your body. I work a lot with people to pre-dilate pre-lubricate, using toys to gradually stretch the skin and the muscle. Number two is thinking not anally, but thinking whole body. When I think of anal health I think of gut health — whether that’s using fiber, or just understanding what diet works for you. Obviously when it’s Taco Tuesday, you may not be bottoming, but the goal is for you to understand that it's a whole body approach. Lastly I think less is more, in terms of preparation. I see a lot of people over-douche, they're not using substantiated methods, they're really not doing the right things, and that in itself causes so much damage, even before one has sex.
H: What are three elements that are necessary for a healthy douching practice?
G: If you don't need to douche, don't douche. It's understanding that it's not just local treatment, we're talking about gut health. That means increasing one's fiber,knowing what diet is better from a pre-bottoming perspective, and making sure that one is hydrated and fully evacuating. I also tell people to use a toy to prove to yourself that, 9 times out of 10, you're actually going to be clean. If you know your anatomy, shit usually does not hang out where we're having sex. So, if you've done the fiber, and you're eating right and you're using diet and exercise, and you're in a regular routine, 9 times out of 10 most people will actually be clean.
H: What are the signs of an unhealthy douching practice?
G: An unhealthy douching practice, to me, is one that takes a ridiculously long time. You know, it really should be an in and out, 10 minute thing that we do to prove that you are indeed clean.
H: At what point does bottoming become dangerous? Is there too big?
G: It's very multifactorial. I think that I've seen people taking small things that have been taking it in a way where the angle is wrong, and then they get into injury. I've seen people that have taken what I think is like the biggest thing possible and you're like, wow, how did they take that? I think it's really understanding your own anatomy. Also understanding your own pelvis, and your size. If you have a smaller pelvis clearly the muscles and the skin are not going to relax as much. I tell people that toys are like, the best thing for all of us because [they] really allow you to understand where the restriction is. The ass is not overly complicated. It's two things: its skin, and its muscle. So, when someone says oh my god that's too big! you need to say okay well is this too big because my muscle can't relax? Is it too big because the skin will not accommodate it? If you're thinking it's too big. It probably is too big.
H: What advice do you have for someone who is too tight to comfortably bottom?
G: If someone is too tight to bottom, I usually start by giving them a protocol for dilating: using small toys, and gradually working their way up. We usually talk about understanding the anatomy of skin and muscle, and making sure that they're really well lubricated, and over four to six weeks, get them into a better state from a bottoming perspective. If someone is using those small and medium toys, and they're having significant pain, I usually suggest they come to the office. Let me look inside, and see what is truly going on. Is there an undiagnosed hemorrhoid? Is there an actual fissure? We fix it so that I can get you into a better space from a bottoming perspective. Some people, the mind-body is an issue, and just giving Botox in the office gives some relaxation where it needs to be, which then allows people to kind of flow through the bottoming protocol.
H: How can we treat some of the most common bottoming-related ailments? What’s the quickest way to get back on the bottoming circuit after an incident?
G: When there's initial injury from bottoming I usually recommend a couple of things. The first thing I always say is stop bottoming. To treat some of the more common bottoming ailments, I usually bring the non-surgical options first. I suggest cocoa butter suppositories that soothe the area, most people use them at night before they go to bed, and then after they shit, just to help with soothing. I also love stool softeners just to get the bowel movements super easy. Epsom salt baths are really great, they soothe the area. When you then look at the extremes — when it's not getting better with those conservative managements — then I usually am going to have to do some surgical intervention.
H: What is one thing you wish more people knew about their asshole?
G: One thing that I wish more people knew more about their assholes is the fact that you can't go from nothing to something big. People feel as if they should just be able to bottom out of the gates, and they don't understand why it doesn't work. And so the key, for me, when I think of injury prevention is to actually know the right way to bottom, and to understand their own asshole. That, in and of itself, will help mitigate any risk of injury and/or problems.