There are many differences between us, but if there’s anything we all have in common, it’s an anus. Why, then, are we so confused about how to have fun with them? In our bi-weekly column, Getting Anal About Anal, a rotating cast of sex workers, physicians and self-proclaimed “bottom supremes” will share their advice and musings on the body’s most mysterious pleasure-hole.
If you’re into anal but have butt-related concerns about things like tightness, hemorrhoids or pleasure, 20 minutes in a doctor’s office with a well-lubed catheter in your ass could significantly improve your sex life.
It’s called an “anorectal manometry” exam, and it’s less scary than it sounds: Once the catheter is inside, doctors ask their patients to perform a series of muscle exercises — contract, relax, cough… you get the gist. Generally, these exams — normally doled out by gastroenterologists — are used to treat pelvic floor issues, incontinence and other decidedly unsexy issues. They hardly have a horny reputation, but one anal surgeon is determined to change this for good.
As the founder of the New York City-based, anal plastic surgery practice Bespoke Surgical, Evan Goldstein is somewhat of a butthole connoisseur. In his eyes, these unglamorous exams are the key to a better anal sex life, and he’s willing to spread the gospel. “There’s a science of sex, but before I started my practice, I found that it had been largely absent from medicine, especially when it comes to anal,” he tells me, explaining that this is still often the case today.
As a result, practitioners gather very little butthole-related data on their patients — and consequently, anal sex lives have been suffering. Not only does this lead to reluctance to openly discuss sexual health, it means plenty of us don’t know what anal sex should feel like, how painful it shouldn’t be (if you’re using plenty of lube and taking it slowly, it should feel good) and how to maintain optimum anal health. For example, regular anal sex brings increased risks of hemorrhoids and fissures — not exactly sexy, but knowing this, and getting checked out accordingly, can keep you, your butthole and your partners happy.
The solution lies in that aforementioned, slippery catheter, which contains a probe embedded with pressure sensors. By spending about 20 minutes inspecting the area with this lubed-up probe, practitioners can learn all there is to know about a patient’s back passage. “From tightness to elasticity to just the basics of defining normalcy for each individual, having this understanding is paramount to the betterment of our butts,” Goldstein explains.
So, where does anal sex come into play?
Well, as Goldstein summarizes in a blog post, plenty of bottoms think their hole is “just right” — in other words, that they know their ass inside and out. Yet buttholes change over time, especially for dedicated bottoms. “As we age and continue to engage, or we go for bigger penises, bigger toys or longer sessions, certain changes happen,” he tells me. Minor loss of control over pelvic floor muscles is a common one, and this can cause issues like fecal incontinence — which could make anal as you get older feel nerve-racking or challenging. Regular butthole exams can help to gauge these changes, and figure out how any one patient’s definition of “normal” changes over time.
Moreover, by nailing down specifics on tightness and elasticity, practitioners like Goldstein can recommend all kinds of butthole procedures to keep that sphincter tight and primed for even the most hardcore of bottoming sessions. These procedures can include butthole Botox, or even beautification surgeries. There are even a rising number of non-surgical options to treat various anal sex-related issues, like the BTL EMSELLA — an electromagnetic treatment for incontinence that can also be used to strengthen pelvic floor muscles.
In short, anorectal manometry exams are a way to help patients truly understand their butts so they don’t become literal pains in the ass. “The ass is super important, and anal sex plays an integral role in so many people’s lives,” concludes Goldstein.
Doesn’t that alone make it worthy of a little TLC?