Sex With Emily - What Happens to Your Body During Anal (Surgeon Explains)

Episode Date: March 27, 2026

If you've ever avoided anal because it hurt, felt intimidating, or just had too many unanswered questions — you haven't had the right conversation yet. Whether you're completely new to backdoor play or you've been doing it for years without the proper foundation, most people are skipping the steps that actually make it feel good. And that's not a problem. That's an education problem. In this episode, I sit down with nationally renowned anal surgeon Dr. Evan Goldstein — founder of Bespoke Surgical and Future Method — for the most honest, shame-free breakdown of anal health and pleasure you're going to find anywhere. In this episode, you'll learn: • Why anal sex should never be painful, what's actually causing the pain, and the exact 4-6 week protocol that prepares your body the right way • The truth about douching, wet wipes, and why most people are unknowingly damaging their anal microbiome before sex even starts • How to navigate anal with hemorrhoids, skin tags, or past injuries — and what your options actually are when something goes wrong This episode is sponsored by... Try Promescent Delay Spray today and get 15% off your first order. Just go to www.promescent.com/swe More Dr. Emily:  • Shop With Emily! Explore Emily’s favorite toys, pleasure accessories, bedroom essentials, and more — designed to support your pleasure and confidence. Free shipping on orders $99+ (some exclusions apply).5 • Interested in 1:1 Coaching with Emily? Go to sexwithemily.com/coaching to apply!  • Sex With Emily Guides: Explore pleasure, deepen connections, and enhance intimacy using these Sex With Emily downloadable guides. • The only sex book you’ll ever need: Smart Sex: How to Boost Your Sex IQ and Own Your Pleasure • Want more? Visit the Sex With Emily Website • Let’s get social: Instagram | X | Facebook | TikTok | Threads | YouTube • Let’s text: Sign up here • Want me to slide into your email inbox? Sign Up Here for sex tips on the regular. Chapters: 0:00 - Intro 1:51 - Meet Dr. Evan Goldstein: Anal Surgeon & Founder of Bespoke Surgical 3:46 - Where Does the Taboo Around Anal Come From? 6:54 - The Three Pillars: How to Prepare, Play & Recover 8:07 - The 4 to 6 Week Dilating Protocol Every Beginner Needs 14:08 - Lube 101: Silicone vs. Water-Based & When to Use Each 15:55 - The Lube Shooter, Empowering the Bottom & Why You Can't Assume Your Partner Knows 16:57 - Douching: Why Water and Store-Bought Enemas Can Do More Harm Than Good 20:33 - Less Is More: Gut Health, Fiber & How to Douche the Right Way 23:27 - Aftercare: What to Do If You Tear or Have Pain 24:19 - Beginner Tips: Positions, Partner Communication & Choosing the Right Size 32:38 - Listener Q&A: Hemorrhoids, Skin Tags & Can You Still Have Anal Sex? 36:43 - Listener Q&A: Colon Surgery, Couples Starting Out & Sex Positions by State 42:14 - Why Wet Wipes Are Wrecking Your Microbiome (Anal and Vaginal) 44:45 - Five Quicky Questions with Dr. Goldstein Learn more about your ad choices. Visit megaphone.fm/adchoices

The goal for bespoke surgical was always, how do I empower the bottom? And by empowering the bottom, it's making sure that they're educated, making sure that they're doing everything right, and also assuming that nobody else knows what the fuck they're doing. You're listening to Sex with Emily. I'm Dr. Emily, and I'm here to help you prioritize your pleasure and liberate the conversation around sex. anal sex isn't as taboo as it once was, but many people are still too shy to talk about it. Well, today I'm talking with nationally renowned anal surgeon and expert Dr. Evan Goldstein about all things anal. Get ready for it. We talk about how to clean up before backdoor play. Did you know you can over-dush? Tips to enhance pleasure and the wide variety of things

to try while you're back there. We've got you covered. And remember, this is for all genders, interested in anal play. Dr. Evan gives tips in how to relax, toys that can help, and which loops are best for every act imaginable. We also break down loop shooters, love a loop shooter, how to minimize the risk of exposing yourself to STIs, and what to consider, regardless if you're a top or a bottom, you're giving or receiving, we got you. Please rate and review Sex with Emily. Wherever you listen to the show, it helps get the shot to more people, and it just takes you a few seconds to do it. You can just do it right now.

Look at your phone, look at your app that you're listening to this on and review us. We so appreciate it. You can also find me on Instagram, YouTube, TikTok, Twitter, or X, and Facebook, all the places. It's all at Sex with Emily.

All right, everyone, enjoy this episode. Okay, so if you've been listening to this show for a while, you know I'm not about random sex toys or gimmicks. I'm about tools that actually support your pleasure, your communication, and your connection. That's exactly why we created the Shop Sex with Emily store. Everything in there is curated by me and my team, and these are products I trust. I recommend to clients and would tell my friends about.

I do tell my friends about. It's what I talk about all the time. Whether you're exploring solo pleasure, looking to reconnect with a partner, or you really just want something body safe and beginner friendly. We've organized it so you don't feel overwhelmed. People love the dame pillow for supported sex. The Magic Wand Waterproof. Oh my God, it's so good.

Cray Vesper, massage candles, Joe flavored lube, we vibe touch, clitoral vibrators. there's just so many things on there because pleasure shouldn't be confusing. It should feel empowering. You can check it out at shop.com and find something that supports where you are right now or just click the link in the show notes. Also, keep an eye out for curated collections coming soon. I'm excited for my guest. He came highly recommended Dr. Evan Goldstein is a nationally renowned anal surgeon specializing in sexual health and wellness care in New York City. Dr. Goldstein has extensive experience, educating and shedding light.

on health care issues for both the LGBTQ community and straight audiences. He's also the founder and CEO of Bespoke Surgical and the co-founder of Future Method. Find more about Dr. Goldstein on social media at Dr. Evan Goldstein. Hey, Dr. Evan Goldstein, welcome to the show. So tell me about yourself. Thank you. Thank you. I started a practice called Beespoke Surgical about 12 years ago.

And I saw a huge need in the community. stemming from everything that you get asked all the time. And there really wasn't someone that was spearheading the movement of saying anal sex is totally appropriate and fine. How do we make sure that you are doing it as safely as possible with the appropriate education? And if something does go wrong, how do we now make sure we have professionals that are able to take care of it, both physically and then obviously mentally? Because there's so much. that combats both of that. And that was really the impetus of me starting this practice.

I just saw a huge gap in the services that was being delivered. And I was like, how do we just do it and create an environment that is destigmatizing, that doesn't create the taboo that's associated with it, make an environment that's warm and comfortable and inviting because people are really talking about. difficult topics and topics that are really, you know, true and dear to their heart. And that's really spearheaded this kind of anal movement. It's been kind of crazy. It is an anal movement what you're doing because, yeah, it is still very taboo, though. It's like the other thing that you do. Where do you think all the taboo comes from?

People always ask me that. Why do you think it's so taboo? I think that, again, it's probably the homophobic component. And the reality is that it feels so good. What's the problem? Especially as a man, I'll never have that honor of being a man and getting, having a prostate. But I feel like in the years I've been doing this, something I've noticed is it's still taboo and people still want to know what anal more than any other subject, which is why I'm so glad that you're here.

But also that straight men have started to come around on their own and just say, hey, I'm curious. I hear what you've been saying and maybe I should try it out. You know, maybe I should put a finger in there, a butt plan, you know, but there, it's, it's just in the last few years. So I don't know what you've been doing there, but we're all ready for it. I mean,

yeah, you know, I mean, I think that that has actually been such a huge push and help in terms of everything that we're doing at bespoke surgical and also at future method.

And we'll talk about that. I think the key component has been breaking down these stigmas in society. You know, I did a study early on in my career. And you know that what I do is a referral-based practice, right? You go to a, doctor, you say my ass is hurt, and then they send you to me. But the reality is that most doctors

still don't talk about sex. And they don't ask them on a general health physical of like, hey, are you sexually active? What type of sex are you engaging? Do you enjoy it? Are you happy? I mean, those are questions that people just never ask anybody. No, they don't. And then I said, well, if doctors aren't asking the questions, my business model is flawed, right? Because no one's going to refer because they're not actually asking the right questions. And so seven years ago, I hired a publicist and a PR team. And we said, you know what, let's create a mission. And the mission is how do we kind of use popular press and push the narrative so that people can get educated and hopefully explore sexually in new ways that they never actually knew was what they

wanted and or possible. And you're so right. I mean, the thing is, is when you look at where we've been successful, we've been successful in two areas, female-centered publications and straight, like Barstool Sports, Cosmo, Vogue. And it's interesting because those are, you know, pushing that narrative into the heterosexual world has actually helped us on the gay space because now people are talking about it and people are saying, wow, you know, yeah, I could actually enjoy this and I should offer this to my partner or partners and how do we do it safely. So it's been quite interesting. That is so interesting. You went in through the straight door to get to the back door. Don't you just love?

That's awesome. Okay, so what are all the things that people want to know about anal? Should we just start there? I mean, what I can say is off the top of my head, it's going to be painful. How do I clean for it? And you have so much great knowledge in this area. Sure. So when I first started practicing, I kind of broke things up into categories. And that's actually what those pillars are what is founded in terms of how I practice.

And it's how do you prepare for anal sex? How do you actually engage or play? And then what is the after-case? And so I think the misnomer of anal sex is painful. It's really, that shouldn't be the case. Anal sex should not be painful. You should not bleed. You should not be an excruciating pain.

That's just not how it should work. I think people think that you can go from nothing to something big very quickly and you can't. They always want to go from zero to anal. Totally. And there are definitely some people that are able to do it. But the majority cannot. And so I usually recommend doing a four to six week protocol of using toys. And it gets people, one, to know do they like it or do they find it pleasurable?

Two is it really starts for people to learn the pelvic floor and the anal anatomy. There's, it's not very complicated. There's two things in the ass. It's skin and it's muscle. That's it. And the key is, how do you get the, the skin to fully relax, and how do you get the muscle to relax? Now, if you think of skin, skin itself is very, very thin, especially in the ass. And so by using a toy or a butt plug

or a dilating kit, what you're doing is you're kind of strengthening the skin. And I tell people, it's like you and I going to the gym. If we're lifting weights, we get calluses on our hand. It's the same concept. The bar is creating a protective callous. If you're using a toy in your ass, a couple of times a week, in a very gradual progression, you're going to start creating good, healthy skin that is now strong enough to distend so that you can engage however and whatever you want. And so the process of dilating over four to six weeks allows for the skin to get fully comfortable with opening and then allows for you to understand the three different muscles that are there that sequentially need time to learn how to relax. And so I usually tell people it's a six-week

process and it's using three toys that come in like a set, small, medium, and large. And just like going to the gym, I tell people do it right when you're showering by yourself. You'll take the toy. a lot of lube and you'll just like going to the gym, give me two sets of 12. That's all you need to do. Two sets of 12 what? Like pulses or 12 minutes? No, in and out. So you're just going to go all the way in.

Hold it there until you hit a little resistance and then come back out. And each time that you go in and out, I usually tell people to relubricate it so that you're kind of understanding that loop needs to be 360 degrees around. And each time that you're going in and out, you're kind of applying the lube in that area, plus you're learning how to relax those three muscles. And it takes time. And with that said, it's really for people to understand the anatomy of, oh, okay, this is how I actually relax when I'm engaging.

And it takes time for the body because the neural mechanism is only really created for shitting. It's like, hey, how do I relax when I'm going to the bathroom? That's it. Now it's, okay, how do I take this to the next level and get to a point where I can fully receive what I want? So how do you explain that? So I can see them putting it in and taking it out. But how do you, is there a breath work that you explain to them when they're going in it out? How do they relax?

And the neuromuscular, like we're just, we're so used to tensing. So how do you get them to be like, relax? Yeah. Totally right. Well, the small toy is really small. So it becomes it's pretty easy to go in and out. Now, with that said, though, usually how when someone comes to the office and I'm doing an exam, I'm asking them to kind of push out. So I usually say, push out like you're going to take a shit. And what happens is they learn how to relax. And they're like, oh, that's interesting. And I say, yeah, when I'm pushing in the instrument or the toy, if you push out, it now allows for things to. And they're like, oh, that's interesting. And I say, yeah, when I'm pushing in the instrument or the toy, if you push out, it now allows for things to. to fully to open. And you can start to kind of work breaths into that. And, you know, there's yoga. There's pelvic floor therapy.

There's all these things that you learn. But the key is going until you hit resistance, holding the toy there, breathing, taking it back out, relubricating, and doing it again. And not to get frustrated because a lot of people will be like, oh, God, this is not happening. And they get really tense. And it says, okay, take, say, okay. that session is finished, try it again another time. And you'll start to see that over the next couple weeks, that you'll be able to start getting the small in without issues. And then you'll

always start with the small toy, gradually working to the medium, and then getting up to the large. And through there, you'll start to really see. Now, if you're bleeding, if you're having pain, if things aren't moving the way that you're thinking, then you should see somebody. because there's a lot of people that have predisposed issues, whether it's a hemorrhoid, whether it's a fissure, which is a tear, whether it's some extra skin that developed. I see a lot of post-pregnancy women that come to me with some hemorrhoidal skin tissue that causes them issues with just wiping, let alone or feeling sexy from vaginal sex, let alone on an anal perspective. So there's lots of things that may cause issues that if you're not, if things aren't gliding the way that you think that they should, then you should see somebody to make sure that we're all on the same page before you push it further. Well, who else would they see now? You're like the most, I feel like there should be nobody else.

If anything goes wrong with my anus, I'm getting on a plane to New York. That's, that's what I got to say about that. But yeah, because it's women, it's every, it's really, yeah, it's everybody with an anus. That's right. Which would be all of us. Are there toys that you recommend or you sell in your office? Yes. Online.

Yeah. So on my website bespoke surgical, like there's a lot of different toys that are there and different apparatuses to help. And then it goes over kind of why I think that they're really great. And also people can get the protocol as well on the website so that people can start doing what they need to to get to where they want. And that's bespoke surgical.com. But you guys can find that.

We'll put that in the show notes as well. Okay. So let's talk about loop for a minute because if someone asked me like, I got 30 seconds and they're like, give me your best tips for anal. I'm like, breathe, go slow, use lots of loop, right? That's kind of my thing if I'm like in a hurry. You know, then we talk about it. But the loop thing, it's like I'm like apply, reapply. I think silicone loop is the best for anal typically water base.

No one's got time for that to keep reapplying, reapplying, unless they're using toys. We have to use water base with toys. But is that pretty much what you recommend? Yeah, you know, I think that not all lubes is created equal. True. That's for sure. And a lot of people have reactions to certain lubricants. So you just got to really see.

Now, if I'm playing with toys on my own, I'm using water-based because it's just so much easier, easier to clean. And a lot of the toys can't support silicone. So you just got to be careful. If you use silicone with silicone, it actually eats away at some of the rubber and the silicone there. So I usually say for toys and you're not engaged. an anal, water-based lube is the best. If you're doing pure anal, I agree with you. I think psilocon has the best lubricity that is out there. With that said, I love toys before sex or

during sex because it's going to allow you to be pre-lubricated to be dilated the right way. You know, if you assume that somebody is that a top or someone that is inserting actually knows what they're doing, you're going to get hurt. So my. My whole shtick is if you are a bottom or receiving, you need to be so understanding of all these things so that you minimize your risk. And the way to do that is to, you can be submissive, but you can know, okay, how do I make sure that I dilate before? How do I make sure that I'm using the right lube and or what's called the lube shooter,

which is basically a syringe that sends the loophers. I love that. I love that. It's a game changer once you start using the right tools to get you where you want to go. And the assumption needs to be, and the goal for bespoke surgical was always, how do I empower the bottom? And by empowering the bottom, it's making sure that they're educated, making sure that they're doing everything right, and also assuming that nobody else knows what the fuck they're doing. Yeah. And if they're on the top, exactly.

The top doesn't know because they're a top. Like, they don't know that you need these things. Like, how would they know? You're right. We have to be our own best anal advocates. That's right. That's so true. So many times you want to just assume, like, I always just just assume my partners knew everything

because I didn't know anything, you know, before I had this as my career. Right, right. Came to find out that no one knows anything. They don't know shit. Literally. That's shit. The other question I get asked all the time is about douching. And I know you have some strong protocol around this, too.

And I wonder, like, I often say that the store-bought ones aren't so great. because there's the vinegar, whatever, what's in the other. But then, but then I heard you say in an interview, so I want to talk that water is great either. So please correct me. You know, one of the things in my practice at bespoke was I started to see people coming to me over and over with the same injury or the same STD. And then I started to break down into those categories of what, well, what are people actually doing? And a lot of people are using really huge bulbs to doche out and clean out. They're using shower hose. And so we started to look at, well, what are the differences that are causing problems? And there's three things. One is the solution that people are using is not correct, whether they're using water

or they're using a store-bought enema. And what happens is that when you use this, you're actually getting rid of your protective lining in the ass. It's like douching in the vagina, too. That's right. Same exact concept. And the water and the enema caused so much irritation internally that now you are predisposing yourself to HIV, STDEs, and injury. And so we said, okay, well, why don't we just develop something that is going to be safe? And that was the impetus of me creating a future method. And future method is all about that, which is like, how do we look at sex and the way that communities engage, and then how do we put products to support it? And so I said, okay, why don't we make this our mission? And the first product that we launched with was an appropriate anal douche

solution. And the solution is pH balanced, very similar to the vaginal side, which is how do we clean and give people what they want, that sexy feeling and clean, but without irritating the cells without causing damage. And so I said, okay, first thing, let's come up with a solution. So we did that. Second thing is, let's come up with appropriate education and an appropriate system, because I think people are actually over-douching. They're over-dushing. And then, right, I don't think that everybody needs a douche. If you know your natural cycle, like, if you've gone to the bathroom that day, you know, like, I don't think you have to every time people get so like, what about poop? And then I always say, well, it happens.

So throw a sheet down like it's messy. Yes, I agree. And I think that I'm so glad you mentioned that because the reality is that I think seven to eight out of ten people will not have shit anywhere near where you're having sex. And it's just people to understand anatomy. You know, where we're having anal is actually clean. It's when you're having the bowel movement, the crap moves into the anal area and then you shit it out. Right. But the rest of the anal.

of that is actually clean. And we talk a lot about instead of anal health, gut health, which is, how do you make sure you're eating right? How do we make sure we're doing nighttime fiber supplementation so that you shit first thing in the morning and it's like appropriate and it completely empties you? How do you use toys? And I tell people all the time, like prove it to yourself. Use a toy without douching on your own. And I bet you nine times out of 10, no poop whatsoever. Right. And so I think the stigma associated with it, your own internal stigma and also society's pressures make people want to doche. And so I said, okay, well, if we are going to douche, then how do you do it the right way? The right solution, also a much smaller bulb. Our bulb is smaller. Why? Well, because you really just need to clean very, very, like eight to 12 centimeters internally. You're not talking about a ridiculous, amount where you need to clean. That makes so much sense. Totally. So the key is like, how do you educate people the anatomy? And again, that's to blame for sexual education in our country, right?

Specifically, anal and gay sex. I mean, I hope in my lifetime that there'll be courses that are really sponsored by the appropriate governmental, you know, government. I know. I know. That's what I want to. I want it too for everybody. There's no sex education. And then with gay sex Yeah, I could see that you must have so many people coming in with injuries from years of just not, where would you go? You see porn and they're not showing you the whole thing. They're not showing you their dilators and building up. Nothing. There's nothing. So there's more harm. Yeah. Wow. I think this is such a great protocol. So this is what we're talking about is like having a healthy microbiome. Totally. You know, there's a couple of things. And there's a couple of things. And there's a couple of things. When you over douche, or are you using, you're actually altering the microbiome. And there's a specific bacteria that we know elevates. And when that elevates, you're susceptible to STDs, HIV, and injury. So the key is, how do we balance all of this?

I know what people want. They want a sexy ass that has no shit and is silky and playable. I know that. The issue is, how do we now make sure that people are doing it in a way that's not harmful? We do so many harmful things to ourselves, and then we just keep going, assuming it's going to get better. We don't want to ask our doctors because there's so much shame around it. So I love that your site has so much great education. I always say less is more with anal.

You need to think that in everything. It's like, how do I just create an environment that is going to be safe for everybody and also minimize as much risk as possible? because, you know, the ass itself is very thin walled. The pressures of sex are greater than really what a lot of that can sustain without you taking these precautions in the right way. And then also like, look, you are going to get hurt every once in a while and you are going to bleed and have some pain. And so the question is, okay, well, if that happens, how do I now take care of myself early on so that I don't have these long? long-term complications or see somebody that knows about sexual wellness that's specific to my

community. That makes so much sense. So what do you do for aftercare if you do have tears or just in general? I think that a lot of it is like a three to five day break of making sure the poops are soft. So add some stool softners. Ebs and salt baths are really great. I use these and love these suppositories, which have cocoa butter in them to kind of soothe the lining.

also even like a preparation age, both inside and out. And then after three to five days, you should start to see that like, you know, everything's getting better and improving. If things aren't, then the key is really making sure that you see somebody because there's so many things that we can do early on that doesn't need surgical treatment. Let's say that we've got people now interested and they're like, okay, I'm going to take the precautions. Are there any tips you have for beginner anal play?

Yeah. So, I mean, I think a couple of things. One is being in control, the first couple of sessions is so important. So a lot of it is just, you know, being on top, meaning have the person laid down, get them erect or whatever toy they're using. It depends on how you're engaging. And you're in control. You're sitting on it. You're trying to manipulate and try to see.

Don't let somebody get behind you. If somebody's behind you, they're going to kind of do their thing. And their thing is not really overtly the best. So the key is kind of, I think bringing in toys to foreplay is amazing. You know, especially like, fine. If you don't want to bring it in because you don't feel comfortable, do it literally right before. And again, like when you're douching, when you're cleaning out, if that's what you're doing, use a toy. It helps with getting rid of any extra liquid.

solution that you use, it'll also lubricate everywhere and get you kind of prepared to then do what you want to. I think you need to find somebody that is super fun, but also communicative, so that you can have a really, really good, like, hey, this is my first or, hey, this is what I want to do. And then can we kind of work together in a really good way where it may not be overtly crazy, sexy, but you're learning how to kind of manipulate in the way. to then get yourself into a good space with different positions, et cetera. So you've got to choose like a friend with benefit or a partner that is really, really understanding and trying to see.

And also, you know, don't go crazy big. You know what I'm saying? I know we all like big things. But, you know, choose wisely the size as well if you can. That can happen too. What you're saying is Tony Hill picture anal as someone coming in from behind. But I love what you're saying about it being on top and lowering yourself down. So you're in control.

Exactly. Missionary. That makes sense. And also any of the positions that you're facing the partner is actually a really good position because you can see the grimaces. You can see the pain. You can see the pleasure. You're kind of forced to communicate even if it's not verbally.

So like I usually tell people starting in that capacity is a really good way. And then once you kind of get yourself into a really good space, then great, then you could start to explore and be open to that. I also think that like using the toys, I usually tell people there's a dilator kits that I like. And then like, if you've passed that, then the next is kind of dildos, which I think are really great because they're lifelike. They'll give you a little bit of understanding of, oh, this is how I can actually relax to achieve what I want. So there is this kind of middle ground before you're kind of jumping on the real thing. Now, is it ever, going back to size, is it ever a case where it's just too big?

You're like, that's just no. Like, this is just a no, no, no. They text you pictures are like, Dr. Goldstein. That is the hardest thing to teach somebody, which is when to say no. I mean, even to my kids, right? You know, you're trying to like, in anything like, well, that's probably not a good idea, right? And so with that said, you really need to understand. And using the toys and the dildos will allow.

you to understand what you're capable of doing. Now, no matter what, there are definitely people that as they're using toys and dildos, they cause issues. It's painful. They feel burning. There's a little bit of a tear. And it becomes this restriction that doesn't allow them to engage with what they want. And there's certain things that I can do in the office and in an operating room to help people. A lot of people, their muscle is way too tight. I see people that, you know, we're a lot of Peloton users. We're doing a lot of squats. All these things create such beautiful butts, right?

Yeah. But they're actually getting so much muscle to happen anally. And so what you see is that they're not able to fully, fully relax. I see a lot of bodybuilders come to me because they have so much muscle built up anally that now when we say, okay, relax, they can't. And so I do a lot of Botox where I can inject Botox into certain muscles to give people that relaxation. Also, I give some under the skin line or actually bring people to the operating room to kind of open up both the muscle and the skin to now allow people to do what they want.

So using the toys and the dildos and kind of preparing allows for people to really see like, oh, well, maybe I do have something that's limiting me. And I do want to engage. Now, the muscle is really great. You can kind of work that in both capacities, tight and loose. But a lot of times it's the skin that's the limiting factor. And today I had a couple of Skype calls from people where, you know, they go to a surgeon and the surgeon basically cuts the muscle because they're like, oh, they're too tight.

But the reality is that, no, they were taking dick and toys before. it's actually the skin. And if you don't correct the skin issues, it's never going to actually heal. We'll be right back after a quick word about one of our sponsors. I feel like I give a lot of advice on how to have more and better orgasms. But something I also get asked about all the time is the worry of finishing too quickly. First of all, if this has happened to you or your partner, you are not alone. It's actually one of the most common sexual concerns for men.

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Because great sex isn't about rushing. It's about connection, pleasure, and really feeling good in your body. If you want to learn more about permissent delay spray, just go to permissent.com S-W-E to get 15% off your next order. That's P-R-O-M-E-S-C-E-N-T-S-W-E. Or just click the link in the show notes. This offer is only valid for new customers. So I have a question for you about the gay community.

So I'm, I always have, and I was talking to some of my gay friends about this, So like, oh, yeah, they're only bottoms or their only tops. But I'm wondering, like, I always say, like, if I had a prostate, I would definitely, like, take a gander and figure it out. Is it more like you just think, like, I'm just going to be a bottom or I'm just going to be a top? Like, you know, there are switches, but you think there would be more because it can feel good to everybody. So what is that? Do you think it's changing at all?

It is because, actually, my generation, I'm in the 40 to 60, right? So we're actually the first living out gay men ever. You know, you think about what generations before, they all died of HIV and AIDS, right? So what you're seeing is you're seeing a lot of people as they're aging. They're out of different, they're out of their older relationships or their erections aren't working so well. So now they're varying into other things. Now, my question is, and you kind of brought it up, which is when some,

someone comes to my office and I ask them, do you identify gay, straight, buy, whatever? And then they say, yes. I say, okay, do you engage anally? Do you consider yourself a top, first, bottom, if at all? And most of them like, oh, well, I'm a top. And then I usually say, well, are you a top because you're just like, that's not my thing? Or are you a top? Because when you tried to bottom, it was painful. It didn't feel good. And nine times out of 10, all of these tops want to take it up the ass. That's what I thought. I'm so glad in my own research,

I'm like, that makes no sense. Why would you only be a top? Right? Feel that. Right. Interesting. That makes so much sense. Of course.

Now, there are definitely going to be people that are on those. Like, hey, I want to do. This is who I am. And I totally get that and respect that. With that said, though, a lot. And I say, well, what if I were to make bottoming feel really good? What if I make it to the point where like you're like, I like, I like this? Like, would you do it?

And they're all like, hell yeah, I would do it. I may not do it like all the time, but I would definitely bring it into my world. And then also, you know, we did a couple of research studies on different cities. And like, you know, there are definitely cities that have way too many bottoms or have way too many tops. And so like, you know, if you become a little bit more versatile, you could actually kind of change your This is some education, I think, unique. Because I've just been talking to my friends about it and just asking it. So I think, yeah, it's just, we don't have the information.

Maybe it hurt once. Maybe there's still isn't, maybe you're gay and there's still some homophobia. Who knows? That's right. We actually got some questions that came in from our listeners that I would love you to help me answer. Okay, this is from Sarah in her 30s in Chicago. Hey, Dr. Emily, I started listening a month ago. I love your show.

Thanks for the help. I've learned a lot. Okay. So I have hemorrhoids, and I'm wondering, does that mean I should never have anal sex? They developed in my 20s. I'm about to be 40. They don't flare up much anymore. Hardly at all, but the skin tags are still there.

It's embarrassing. I've had some insecurity during sex just at the idea of them being seen. I've thought about having them removed. I'm gaining some confidence, though, really only recently since I started listening to your show. My friend with benefits has shown interest in tickling my butt hole when we shower together. So I've started to warm up to the idea, which I never would have before. He hasn't asked for anal sex. He just asks if it feels good when he tickles it.

I'm not sure if he's seen it. I imagine he has. It makes me nervous. Is it bad to consider sex if I've had hemorrhoids? So I guess she has skin tags and she's had a history. What do you think about this? So I think let's break it down into hemorrhoids first than skin tags. Okay.

Great. So hemorrhoids are there for reason. They're there to protect the ass. So when we're pooping or we're having sex, blood goes into those. hemorrhoids, which are these veins and acts like an airbag. It's like a cushion. And then blood leaves. If we're pushing too much, if we're constipated, if we're doing heavy lifting, if post-pregnancy, the mechanism of blood going and blood leaving can leave you with these extra skin or these hemorrhoids that flare up periodically. Now, if you have hemorrhoids,

The key is, no, if you're not bleeding, you're not having pain and you feel fine, using toys actually probably helps the hemorrhoids because most of the hemorrhoids happen because your ass is too tight. And so if you're able to fully relax, those hemorrhoids usually don't flare. So the key component is, yeah, I would say, look, if you have hemorrhoids and they're not bothering you, use some toys with good lubricant and seeing if indeed they become. an issue. Some people, they will and it flares up and like, all right, well, then maybe we need to tend to the hemorrhoids. But many people are able to use toys, dilate, stretch. The hemorrhoids never flare and they're good to go. So I would say using the toys with lube and going slow. Now, on the sexy side, a lot of people that I see, I do a lot of aesthetic work with how do we make things look prettier. And it's not even on an anal side because I have so many women that just are like,

Evan, I just feel gross just on a vaginal side because someone's going to see this or they feel it. And I just get so self-conscious. And there's lots of things that I can do to remove the extra skin that's there, aesthetically make it pleasing, plus also if we needed to take care of the hemorrhoid. The key is how do we make people feel sexy and then engage sexually however they want? And that can happen. It's just a matter of making sure that it aligns with their ultimate goals. Okay. Wow.

That's great. You can kind of fix anything then, really. Skin tag. You could remove skin tag easily. Yeah. And a lot of doctors won't remove the skin tags. And it's, you know, I kind of bridged plastic surgery and colorectal and I put it together. These guys, they don't think that skin tags are a problem.

They don't have the concept of like, well, just ignore it. Well, wait a second. I feel it every time I walk. I'm trying to wear a G-string for a sexy night. And I feel them and they're rubbing. I mean, all these things I know men and women can be an issue. And the answer is like, well, it shouldn't be an issue. And there are solutions that are out there.

Yeah. And now they have a place to go and feel safe to talk about it because no one wants to go into their doctor and say, I've got a skin tag in my anus. You must be busy. You really must be. Okay, this is from Shannon, 29 in Texas. And she says, hi, Dr. Emily.

I have a male friend who really wants to experience anal, but he had his colon removed. And he says his doctor said he can't have anal sex. What are your thoughts on this? Is there any possibility for him to experience anal pleasure? So it's a little bit of a complicated question because I don't know when they had the colon removed, which portion of the colon was removed, and did they put this person back together? So now, there are definitely people that I treat that had colon resections that do engage

anally, and they can. It really depends upon how they were put back together. If it was, let's say, a rectal tumor, and they remove that portion, when they put people back together, there's a staple line or a suture line very close into the ass. And so sometimes they're prohibitive of doing anal. With that said, a lot of times there's certain things that I can do to help to make sure that one, that the suture line is exactly what it should be strong enough to engage anal. We talk about different practices of making sure that they're prepared because if they lose a portion of their colon, sometimes they have a little bit more diarrhea and they can't hold their stools. So we talk on using emodium or tincture of opium or certain things to kind of slow their gut down so that they can engage anally the way that they want to.

I think that, you know, this is the typical straight doctor who is like, ah, you know, who the fuck? You don't need anal sex. I shouldn't be doing that shit anyway. You know what I'm saying? And the answer is no. He needs to be evaluated. there needs to be discussions to make sure that we're doing everything safely. But if somebody wants something up their ass, they should be able to do it.

Yes. And have them call me or email. We do a lot of these type stuff from all over to try to see if they're able to do what they want. Okay. Well, have a reach out. All right. Here's another question. Allison 24 in Georgia, dear Dr. Emily, my boyfriend and I want to try anal sex.

Neither of us have ever experienced with it. I know there are anal kits, toys, and loops for anal sex. But where do we start? What are your tips and suggestions for beginners? Yeah. So I think that it's great if both want to be involved in it and the more the merrier. I think that the key, like we said prior, was understanding the anatomy, understanding how do you gradually work with different sets of toys at bespoke surgical.com. We talk a lot about the protocols.

Also, it'll in our shop have different lubricants that we think are really important with loop shooters. and also these dialeting kits. And it goes over certain toys that I like and why I like them. And it gives people just an understanding of the right way to start out. And again, it's a good four to six weeks and using this as foreplay to see, first off, if you really enjoy it. And if you do, great, keep going. Most people, once you finish the four to six weeks, you're up to about the medium to large toy.

and then you can definitely start getting into anal. So check out the website and then obviously if there's more questions, I'm totally available. Okay, good. I love that. Okay, there's one more question I had for you because I want to know about your study you did on your site. People can find it at bespoke surgical.com about the most popular sex positions based on Google searches by state. So people love sex positions. They want to know.

And I was just interesting to find out, like, what are we doing in California? right. So we're doing the cliff diver, which I don't even know what I guess it looks familiar. And then like, okay, so you're, I don't know, tell me about the impetus for this survey and what went into it. What do we need to know about sex positions across America? Yeah. So, I mean, I think that it just, we do a lot of different studies and campaigns as it relates to sex. And we want to know, like, what are the favorite positions? What about different toys from different bondage to do. different, you know, sexual positions and different components to this. And so we run usually about four or five campaigns a year. And we do a lot of really interesting studies to try to figure

out across the country or across the world, how do we start? And it's all to kind of really destigmatize sex. And it's also interesting to see like in certain locations where it's really, really what you would think is like backcountry and nobody's engaging where you start to say, holy God, like, this is crazy. And you start to really develop and understanding that everybody is into anal and everybody is into sex. And now the key is, well, okay, it's all well and good behind closed doors. But how do we start bringing it to the forefront so that people are exposed and hopefully

over time, really the stigma and the taboo starts to diminish? Yeah. There's a rise in anal engagement. You might as well do it correctly. And let's minimize your pain and enhance your pleasure, which is what you're all about. Totally, totally. I think, you know, we spoke of obviously kind of the before. We spoke of the play of positions and lubricants. And then kind of the aftercare, you know, I think it's so interesting when you look at like people do so much for their face, right, in terms of facials and exfoliants and all these things. Well, the same thing should happen anal. You know, One thing I think I want all your listeners to know is wet wipes are terrible for you. Now, so many. Why? Why? I did not know that.

People are like, screw Goldstein. I'm going to use these wet wipes. Tell me why. A couple of things. One is when you think just moisture in general, that area is already too moist, too wet. Because it's where the sun doesn't shine. There's sweat that happens. We're sitting all day.

we're usually clothed. So when you're using wipes, a couple of things happen. One is the solution gets rid of the good bacteria. So again, we spoke of that microbiome. There's a balance. We have good and bad bacteria. And when you use wet wipes, what happens is you're getting rid of the good protective bacteria.

So you see a lot of irritation from fungus to even like a herpes outbreak or these sores. Even in my community, I start to see a lot of HPV and anal awards just from these wipes. And most people are using them. You know, look, the companies do so well in advertising. And everyone, oh, my God, I want to be so clean. But what you see is all of these complications from that. And so we speak a lot of, you know, toilet paper popping into the shower, bidetes, less of that chemical. And even if they say, oh, you know, it's chemical free, it's natural. well, no, it's not. It's moisture and the cloth that people are using, people are irritated in and of itself on that aspect. So you just got to be super careful with the wipe stuff. You know, periodically, once here and there is not a huge deal. But it's the regular usage of that that causes issues. Some people have them instead of toilet paper. They just have that. That's right. Don't do that. Okay. Even your anus, how about your vagina as well? So same component to it, you know? You know, the thing is, is that when we wipe with wipes, people are like, oh, great, I'm clean, and then they pull up their

underwear, and it's not dry. And so that moisture sits there all day and causes issues. So hits the wipes. I read all about you, and I've heard about you, and I think you're doing amazing work. And I feel like you've such a great niche here, the people, and it's our Ait. Like, everyone has one. Like, the fact that you're creating such these great products for everybody is really incredible. So congrats on all of your, all of your success. Oh, thank you. Thank you for being here. I have to ask you the five quicky questions we ask all of our guests. So just quick answers. Ready? Biggest turn on. Biggest turn on. Smooth. Biggest turn off. Hair. What makes good sex? Oh, God. What makes good sex? I think for play.

Something you tell your younger self about sex and relationships. I made so many errors as I was going through this. Just be true to who you are. Okay. What's the number one thing you wish everyone knew about sex? That anal sex shouldn't be painful and that it should be 100% pleasurable and the world should accept anal into their hearts. We still have so much work to do.

But I thank you. I mean, oh, my God, I listen to what you're doing out there. So congrats on all of that. And thanks for taking the time to support my mission and cause. And if you need anything, you know, forward. Any questions pop up? Yeah, totally. I'm all about it.

I'm all about. Where can be, we kind of threw out your site, but where can people find you? Just let us go to the best places. So bespoke surgical on all the Instagram, Facebook handles, or bespoke surgical.com, future method, future method.com,

and then the future method on Instagram. And then I kind of do anal, and my family life with my partner. We have two twin boys together. And that's on Dr. D.R. Evan Goldstein on Instagram handle. Okay. Great. Thank you for being here.

I so appreciate you. Oh, thank you. That's it for today's episode. Thank you so much for listening to Sex with Emily. And if you love the show, please like, subscribe, and leave a review wherever you get your podcast. And hey, share this with a friend or a partner. It might just spark.

something. It usually does. You can find me on Instagram, TikTok, YouTube, Facebook, and X. It's all at Sex with Emily. Oh, and I've been told I give really good email. So sign up at sex withemly.com for free guides and articles and more ways to prioritize your pleasure.