In 2010, Tom G* went to see a surgeon about getting skin tags removed around his anus. As a sexually active gay man, this wasn’t just a routine cleanup—more like a fresh coat of paint on a bed and breakfast with frequent visitors. Ultimately, the surgeon he saw not only removed them, but took internal hemorrhoids and anal dysplasia, or precancerous cells, along with them.
But Tom said the surgeon was more aggressive than he needed to be and didn’t consider that his butthole was also a sexual organ. “It was horrific,” the 48-year-old said. “I was on the sofa for three months in horrible pain. It was six years ago, and I still can’t have anal sex comfortably, which has destroyed 50 percent of my sexuality. I can’t explain the emotional toil it took on me.”
About a year ago, Tom found Dr. Evan Goldstein, the founder of Bespoke Surgical and a leading practitioner in the burgeoning field of anal rejuvenation. “I told him, ‘Look, if I can’t get fucked, at least make my butthole look pretty,’” Tom said. And he did.
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Anal has always been the prime rib of the sexual buffet for gay men, but over the past few decades, it’s gone from hetero taboo to nearly passé. And as the normalization of ass play grows, a rising class of doctors and dermatologists are focusing their practice on America’s butts, offering everything from aesthetic procedures like tag removal and bleaching to anal tightening, botox to aid in sexual play and more.
Goldstein, in private practice for seven years with offices in New York and LA, said that most of his clients—largely gay men—come to him for aesthetic reasons. But he also handles lots of procedures that aren’t just about making asses pretty enough to eat off of, as it were. He emphasized that aesthetic concerns can often be chalked up to undiagnosed medical problems. “I’m looking at the symptoms they’ve developed and what’s going on internally and externally, and why they’re having this and what pathology is associated with that,” Goldstein said.
Those root causes often turn out to be things like hemorrhoids, anal warts, abscesses or fistulas, and cracks in the anus called fissures—issues usually covered by insurance. What sets Goldstein apart is the follow-up care he can offer as a doctor with experience treating gay men. After a typical anal rejuvenation, he said patients normally experience a few days of pain, followed by a couple weeks of wince-inducing poops. Then, during a series of follow-up visits, Goldstein’s patients work with fingers, toys, and butt plugs to make sure that everything is safe, comfortable, and pain-free when it comes to bedroom play. They’re normally back to butt fucking in two to three months.
For those complaining of a “loose” hole, fixing many of those underlying problems will naturally tighten one’s anus; when you remove one or more pieces of the anal pie, as it were, its circumference will naturally be smaller when it’s repaired. And incisions are made internally, of course, so that nobody getting close enough for a taste will see the scarring.
For a patient like Tom, whose previous procedure left him too tight for bottoming, Goldstein performed a surgical dilation to open him up and slightly widen the anal canal. “I can take a small to average sized penis now,” Tom said. “I used to be able to take a wrist-sized cock before my [botched] surgery. I was pretty talented back there.” For patients who have trouble bottoming, Goldstein also offers anal botox, which paralyzes the sphincter muscles and makes it easier to take something a bit bigger.
Goldstein said his private practice really started booming about five years ago, when patients started asking for more “lickable, playable” holes. Anal rejuvenation now accounts for about 90 percent of his business. Dr. Zuri Murrell, a colon and rectal surgeon based in Southern California, said he started paying attention to the aesthetics of surgeries he performed around 2009, and now boasts that a full fifth of his practice consists of rejuvenation services, with a client base near evenly split between (mostly gay) men and women.
“When I started practicing, some of my proctology patients were embarrassed, and they would ask if can I make it look nice and chuckle,” Murrell said. But now, he said, many of his patients approach him without functional anal issues at all.
Since anal rejuvenation isn’t something he was taught in med school, Murrell said he’s established some of his own protocols in practice, especially around anal bleaching and techniques to reduce scarring. He’s had success using light radio frequency ablation, a procedure often used for vaginal rejuvenation, in the anus—a procedure that uses a heated probe to increase tightness in surrounding tissues. And he’s also employed a procedure that stimulates collagen production to tighten the anus; that’s a technique usually reserved for patients with incontinence, but one that applies well for sexual purposes, too.
Another option to resurface and tighten the anus uses laser treatments, something that dermatologist Dr. Jessie Cheung does out of her office in Willowbrook, Illinois, just outside of Chicago. Lasers will not only remove discoloration, lumps and bumps, but a probe can also be inserted that will tighten the butthole. It’s the same procedure used in the back door that audiences have seen Real Housewives get done on camera in the front door.
John Treadwell, a patient educator at Cheung’s office, said that the tightening and beautification procedures they offer usually run between $1,500 and $2,500, and as procedures focused on aesthetics are usually entirely elective, they’re not covered by insurance. “The most common complaint is that they’ve been in a relationship with a partner that may have been larger, and they feel that they’re stretched inside and out and they can’t give the pleasure to the partner that they’re currently with,” he said.
He said that Cheung often sees patients from other parts of the Midwest or the South because there aren’t nearby doctors who are comfortable handling such sensitive topics. And Treadwell, who is gay, said that having a team with greater understanding of your experience is important. “A gay male wants to talk to a gay male about this,” he said.
Goldstein, who is gay and married with two children, feels the same. “I don’t know how you could be hetero and provide this type of service,” he said. Sometimes, he said, a client’s problems bottoming don’t need surgical interventions—they just need more coaching on how to do things right. Call him the bottom whisperer.
Murrell thinks there needs to be less stigma overall when discussing the ass. “One of my offices is in West Hollywood, so I have a lot of gay patients,” he said. “Many tell me I’m the best gay friendly doctor in West Hollywood. How sad is it that you still need a category that’s ‘gay friendly’ in West Hollywood? That is a sad indictment on the rest of the country.”
Treadwell, for his part, is a walking testament to Cheung’s services. “People know where I work,” he said. “If I’m ass up somewhere, it needs to look good.”
* Name abbreviated to protect anonymity.
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