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New Year, New A**

January 06, 2021 by Dr. Evan Goldstein

Year in and year out, especially during the holiday season, I make an attempt to play Santa–listening to all my client’s naughty (and nice) bedroom wish lists. And just like Santa’s sled, our asses break down every now and again. But while Santa may cheer “Ho! Ho! Ho!”, Bespoke Surgical treats anal injuries (and whatever else may bring you into our office) with an open mind and without fear of judgment. So for our first blog of the year, I thought what better way to end it than with a listicle of reasons why an asshole (said lovingly, of course) would come see us at Bespoke Surgical. Without further ado, let’s dive right in.

1. Anal Fissures

An anal tear or fissure is the #1 reason why someone comes into my office. The elevated pressures of anal sex combined with the trauma to both the muscle and overlying skin create a localized tear. Though it’s quoted that 80% of fissures heal with conservative management, that data is driven from the heterosexual population, which only thinks of the ass as an exit-only hole. For those who engage in anal receptive sex, most experience continual ripping, especially during anal sex, which then limits their ability to do just that. The good news is that we have pioneered specialized surgical techniques for immediate and complete resolution of anal fissures at Bespoke Surgical.

2. Anal Skin Tags

These funny looking things can not only play a huge part in how our assholes look, but can also create significant friction in the area while being penetrated during anal sex. Even if you don’t bottom, skin tags can make wiping a pain in the ass after you’ve gone #2, leaving a constant feeling of irritation and rawness. For all those doctors out there who say, “Oh, why do you care how your butt looks? No one is seeing it!” is so passe. Many people do care and many people do seek treatment. It’s not just about improving their sex life, but also about their everyday activities (like simply going to the bathroom!).

3. Hemorrhoids

Hemorrhoids are dilated veins that can present themselves both internally and/or externally. They can lead to bleeding, itchiness, and/or overall swelling in the region. The acute irritations may resolve with conservative management, such as stool softeners, Epsom salt baths, and localized steroid creams. But when you’ve had them for years, much like fissures, with daily defecation and regular anal sex, many people experience recurring hemorrhoids that really mess with their overall wellbeing. Removal can be both functional and aesthetic, as many do not truly love the bloomed look, regardless of what Troye Sivan says. Sure, some people get turned on by how rosebuds look, but in reality, hemorrhoids are really only meant to act as protective airbags for the pressures this area endures.

4. Anal Abscesses

These are nothing more than pimples in a bad spot. They can occur simply from going #2 or, more commonly, during anal sex, especially when there’s a potential STD present. These little glands get clogged and irritated, causing a localized infection. The swelling hurts like nothing else, especially if it lies within one of the surrounding muscles. The pain is the kind of pain you wouldn’t wish upon anyone. Unfortunately, if you find yourself with an anal abscess, you’ll need to see an experienced anal surgeon to drain it correctly. How and where your surgeon pops this pimple is imperative for long-term success because there’s a 50/50 chance that you could develop an anal fistula.

5. Anal Fistulas

After an anal abscess is strategically drained, there’s a chance it’ll develop into what’s called an anal fistula. These are connections or tunnels running from an anal gland inside your ass (about 4-5 cm from your rim) to the external drainage point or pimple head that had developed originally. This tunnel can be simple, placed just under the skin, or complex, situated throughout one or several localized muscles. Regardless, anal fistulas will need surgical corrections and can be difficult to manage–for both the patient and the surgeon. The constant drainage and/or the irritation and the smell are not pretty…

6. Anal Gland Irritation

Similar to an anal abscess and/or anal fistula, this is where the gland simply gets irritated. This could be from sex, going to the bathroom, or just luck of the draw, where the anal gland fluctuates between feeling all good and experiencing localized pain. This is a tough one for many doctors to diagnose, leading most on a long search for a successful resolution. It’s key to come at this with an understanding that you can have a supposedly “normal” anatomy, yet still develop the above sequelae.

This localized sub-acute infection leads to pain, swelling, and muscle spasm that creates just enough irritation to make anal sex unpleasurable. Sure, we can all handle some pain every now and again, but I want to ask you: Why? A simple opening of these improperly evolved glands will lead to fruitful and pain-free anal play, where all the consequences that may have arisen before just disappear.

7. Anal Spasm

Are you a tight ass? I know I am, unfortunately. Butt seriously–many of us are actually too tight to bottom. The good news, though, is that it’s not impossible to loosen up. Nowadays, we can measure all of our anal pressures via a localized test called anal manometry. With this, combined with our comprehensive internal and external anal examination, we can actually isolate the muscles that are exhibiting limited mobility and develop for you a routine to train those muscles to allow you to engage in anal play. Strategic dilation and anal Botox are paramount to your anal future and the results are incredible. Up and up, we say, or better yet–up and in!

8. Anal Looseness

Do you feel loose as a goose? Or maybe the orgasmic sensations have diminished over the years (for you and/or your partner), or, worse yet, was there a moment during sex in which you heard or felt a *pop*? The anal musculature is complex and not limitless. You can definitely go beyond its capacity, which can cause both short-term and long-term effects. Thankfully, we have preventative strategies at Bespoke Surgical, from simple at-home kegel exercises to in-office pelvic floor therapy with our physical therapist, and even a machine called the Emsella, which simulates thousands of kegels in just a few minutes.

9. Anal Bleaching

Yes, anal bleaching is a thing and, no, it’s not just for porn stars. Unfortunately, our asses don’t typically see the sun (though anal sunning has become a thing of late). Regardless, darkened spots or rings of hyperpigmentation can be present and for those who have undergone anal surgery, scarring and/or the loss of pigment can arise. For those who engage in anal play, both function and aesthetics are of the highest importance.

Anal bleaching varies based on each individual’s needs, from lasering to professional peels, and possibly the addition of at-home lotions. We all have varying skin types that, when blended with appropriate techniques by a professional, can create incredible outcomes. The best course of action is to see an ass specialist who can align your goals with realistic expectations based on what current treatments are available.

10. Laser Hair Removal

Pretty self-explanatory, right? Not quite. The ass is special (no duh) and needs to be treated as such. We see so many laser hair specialists who treat everything but the asshole itself. Sure, there are many butt cheeks that are, for the most part, hairless. But sometimes you find yourself in bed with Moses and he wants to part your cheeks like the Red Sea, only to find a forest living in between them. That’s why this specific region needs special attention.

The skin in the anal area varies so much, but one thing is consistent: the texture is beyond thin and fragile. Also, with differing pigmentation, seeing a specialist who knows the right settings for each skin tone is key to getting the desired outcome. Lastly, less is more in this region, which means we need to take things slow and steady so that we achieve what we set out to do without any complications. Now you know why anal laser hair removal isn’t just ordinary laser hair removal.

11. Body Chemical Peels

So the skin around your backside is delicate and sensitive: sometimes it needs a little extra care. An anal chemical peel, performed by a skilled anal surgeon, involves using gentle chemical solutions to exfoliate and rejuvenate the skin in that area. It’s not about vanity – it’s about addressing issues like hyperpigmentation, scarring, or even certain skin conditions.

Butt chemical peels promote the shedding of old, damaged skin cells, encouraging the growth of new, healthier ones. This can help alleviate discomfort, improve skin texture, and address specific concerns. It’s like a targeted spa treatment for your butt, providing therapeutic benefits beyond just aesthetics. So, if your derrière needs some extra attention, a butt + body chemical peel might be just the solution for a healthier and happier backside.


Even though I constantly say that the ass is not overly complicated–it’s just skin and muscle–it doesn’t mean that plenty can’t go wrong. It takes a true expert to handle one of the most delicate regions of your body. And while it’s a shame evolution hasn’t realized that the asshole isn’t just an exit anymore, there are plenty of ways to care for and play with this beautiful erogenous zone.

So how do we best work with what we got? It starts with educating yourself on anatomy and sexual function–the things none of us ever learned in school or from our parents. Once we understand our asshole and its functions, we can tackle the preventative approaches that help us to minimize any potential complications. Injury will happen, sure, especially if we are bottoming, so make sure you have access to either our practice at Bespoke Surgical or one like it that can provide you nonjudgmental and affirmative specialized care if you have questions or something goes wrong.

We take huge pride in the progress we’ve made to bring anal play into the spotlight, being thought leaders who are providing much-needed education, as well as medical and surgical solutions for the betterment of all bottoms. Your bottoms have always been and will always be at the top of our minds. Let’s put 2020 behind us and kick off 2021 with a clean slate. Thank you, truly, for allowing us to do what we do. Bottoms up, everyone!

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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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