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Tales from the Tail: (Internal Fistulotomy for Bottoms)

January 08, 2019 by Dr. Evan Goldstein

Client’s Tale

Every time I take a dick up my ass, I get this burning sensation. Small, big, wrist-thick, you fucking name it, it’s all irritating. I have done everything in an attempt to mitigate this sensation: constantly changing to different lubricants, trying different brands when using condoms, and also swapping out all of my toys to so-called “improved materials”. No bueno. The burn is always present and is so fucking annoying that I just can’t bottom. But more than just a nuisance, it has ruined a previous relationship and has become such a mental mind-fuck that I am literally screwed (and not in a good way)!

At my wits end, I found myself Googling around and found Dr. Goldstein and Bespoke Surgical. Actually, my friend recommended him, as well, which was a coincidence, but it seems as if he truly understands our bottoming world. Oh, and I forgot to mention that I did see my primary doctor, who then referred me to a Gastroenterologist, who then referred me to a Proctologist each and every one of them assuring me “nothing is wrong”. But I knew that was so far from the truth, which is why I made an appointment to see Dr. Goldstein, hoping to get some resolution.

Dr. Goldstein and I spoke for quite some time and it seemed as if he really understood what I was going through, both the physical and the mental ramifications of the problem. He disclosed that he has seen this same exact situation over and over again, going undiagnosed by many physicians who lack the truest understanding of our community and how it engages. Through an anoscopic exam (a small camera with a microscope just inside the asshole), at first glance, everything looked totally normal. After this, he stuck his finger up there and he was able to isolate exactly where my pain was at the 6 o’ clock position. We took another look with the camera and there was a small hole about 3 cm from the rim. What the hell was this hole?!

We discussed that there are these glands in all of us that secrete some mucus to lubricate our stools and, for some reason, sometimes these glands actually form deeper pockets. Now, for shitting, that’s all good. But what I took from the discussion was that when douching and having sex, all these excrements basically clog the gland and the pouch, causing swelling and irritation. Then you guessed it, the burning occurs. Totally fucked up. And the best part? Many people have this, but it’s for those who bottom that it becomes a real issue.

So did it ever get resolved? You bet and all it took was a 10 minute procedure. Dr. Goldstein opened up the gland and its pocket to close that region. He used a probe in a retrograde fashion to open up and obliterate that space. It’s left open and scars in nicely to form a smooth orifice. And who doesn’t want a smooth orifice? Well, that little pouch was a pain in my ass (literally) and without it there, I experienced no more fucking burning. I couldn’t believe that that little thing caused such a large inconvenience. Dr. Goldstein and his IFB (Internal Fistulotomy for Bottoms) procedure cured me and I couldn’t be happier. Recovery time was a few weeks and then I was back to bottoming burn free after 4 weeks. I wanted to write on this issue because I know I’m not the only one who has this issue, nor is it simply a psychological roadblock. Let’s talk about it and see someone who not only truly gets it, but also can actually correct the issue at hand. Amazing work, my friend.

My Discussion

Who would think that such a small pocket would cause so many catastrophes for our community? But if you think about it, it totally makes sense. The more ass I look in, the more I am able to see that there is a condition plaguing the bottoming world and it’s interfering and limiting the pleasures of anal sex for many.

Let’s break it down. It’s basically like a small parachute about 3-4cm into the anal canal. There can be one or up to four scattered in quadrants. With normal , you shouldn’t have any issues and everything should go smoothly. Yet with douching and fucking, the repeated in-and-out gets excrement and the like stuck in the chute. It festers and billows, which causes irritation and localized pain that then prevents any enjoyment. Many actually can pinpoint the exact location of the ailment. Yet this needs to be differentiated from an anal tear, otherwise known as a fissure. Fissures mostly present themselves with localized pain and bleeding, more at the 6 or 12 o’clock position (front and back of the anus) and a little bit more on the rim as far as location. These also wax and wane with some good and some bad times, yet with the internal fistula (parachute), it’s usually something that occurs every time you bottom.

As discussed above, it’s actually a quick and easy procedure, as is the recovery. It’s more of an inconvenience since no one can actually make the appropriate diagnosis. Most people go from physician to physician only to be left without any helpful diagnosis. It’s beyond frustrating, even for me!

But the reality is, you are not crazy and what you feel is indeed a common ailment in our community, and the best thing of all is that it can be easily eradicated. As I have seen more and more clients presenting themselves with these bottoming symptoms, I felt like enough is enough, it must be documented. People need to be aware of all possibilities, specifically in our anal world. Don’t settle for the “I don’t know” or the “you’re all good!” Neither of these are appropriate answers. As I always say, we must demand more from our physicians, specifically LGBTQ+ affirmative care.

Stay in touch on Instagram: me and Bespoke Surgical.

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About the Author

Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical. Dr. Goldstein has extensive experience educating and shedding light on health care issues relating to the gay community, and has been published in several national publications including The Advocate, OUT Magazine, Vice, Refinery 29, NY Mag and more.

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