The Surgeon General of Bottoming

“Andy was like, ‘Who gives a shit? If you have an anal problem, you’ll just go to an anal surgeon. Why does it have to be a gay surgeon?’ But I thought it really mattered, so I started to look around to find out who was taking care of people surgically if something goes wrong, and who was educating this population,” he says. “I realized nobody was doing it, so I said, ‘Fuck it, I don’t care if I fix someone’s heart or I fix their ass, as long as I’m helping.’” Dr. Goldstein hung up a shingle for Bespoke Surgical.

Fifteen years later, he sees 90 patients and performs 15 surgeries a week. His Instagram bio includes the words “vintage Porsche collector.”

But in the early days, he worried about the viability of his business plan. Despite the fact that there were a lot of people in need of anal care and education, not many people were talking about it. “I did a study early on in my career,” he says, “and what I found was that even 92% of gay providers were not talking about gay sex with their patients.” That meant Bespoke Surgical might not work—he needed doctors to refer their patients to him, which they weren’t going to do if they hadn’t properly identified what was causing issues for their patients, or factored their patients’ goals for painless and pleasurable anal sex into treatment.

At the time, he says, he had no specific training relevant to what he was trying to do, because such training didn’t exist. But he quickly found success by relying on his surgical training and listening to his patients. “These techniques have evolved because I looked at the community and said, for example, ‘Oh, you want to take that thing, but you can only take this thing. So, I need to create more room—how are we going to do that?’” he says. “Can I create more room by giving you anal Botox? By having you do physical therapy and using different toys to stretch a bit more? Or do we need to try a surgery to get you into a good space?” Years of refinement went into developing a six-week anal dilation plan designed to help the two-thirds of the population he says can’t easily engage in anal sex. He worked with trans-fem patients to understand how estrogen therapies thin out the skin of the anus in a way that can make sex fraught.

Connecting the dots on common patient issues made him realize how harmful many common practices were. In particular, he saw problems caused by pre-sex douching. This led him to wonder why there weren’t better, safer products on the market, which in turn inspired him to create a better washing device, which became the first product launched by Dr. Goldstein’s second venture, the sexual-wellness company Future Method.

Open dialogue with patients and the public also allows him to educate about best practices when it comes to anal health and anal sex. “If you start to answer your own questions, now, suddenly, you’re able to take care of all of it,” he says. And Dr. Goldstein has much wisdom to impart. He says most people are ill-informed when it comes to the ways in which diet and hygiene influence anal health and anal sex. “People don’t know how to poop,” he says, adding that they also don’t know that things like wet wipes are a no-no, that they need to be showering at night after presumably having a bowel movement sometime during the day, or that loose-fitting clothing will help the area breathe.

If that sort of information is interesting to you, Butt Seriously has much more. That’s a message he says hasn’t always been easy to get out. Publicity around the book can sometimes be a hard sell. He’s limited by what he can casually discuss in many media spaces. “I can’t talk about gay sex, I can’t talk about anal sex,” he says.

But be believes that if people were engaging in all kinds of more-open conversations around sex and health, it could change lives.

“Why didn’t my mother say to me, ‘Evan, what type of sex are you thinking about?’ I missed out on so much by hiding who I was,” he says, “and I think about how many people don’t get to experience their true selves.”

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