All Things Anal – An Interview With Dr. Evan Goldstein from ‘Future Method’

Ever wonder how to have successful, pleasurable, anal where mind and matter are aligned? Dr. Evan Goldstein, anal surgeon at Bespoke Surgical and Co-Founder of the brand ‘Future Method’ sat down with Kimberly, afterglow’s Content and Marketing Manager, to discuss all things anal. 

After seeing that there was a large community of people, and not just in the gay community, not receiving care that Dr. Goldstein believed to be of the utmost importance for sexual pleasure, Dr. Goldstein set out on a mission. He wondered, how do we make sure that people are educated on anal? How do we make sure that people, if they get injured, have a safe space and place to go? How do we look at the mental and the physical aspects of anal and put those together to allow people to be who they are, with whomever, using whatever they want? All with specifically an anal perspective. 

As an out gay man, much of Dr. Goldstein’s work is a response to the lack of love and education his community has received throughout history. He is passionate about giving to the anal community, no matter one’s sexuality or gender, in a manner that fosters dialogue and creates conversation. His goal is to impact people’s lives in a way that is completely positive and sitting down with afterglow is a part of that mission.

More of a listener? Follow along with the audio version.

 

Kimberly: How did you really discover your passion for this? What was kind of the catalyst to get you going on this?

Dr. Evan Goldstein: I ask myself that fucking question all the time. Can we curse on this? 

Kimberly: Ya it’s totally fine.

Dr. Evan Goldstein: So I never really thought I would be going into this field. I was actually training to be a cardiac surgeon and hated it. I was in a relationship with a woman before I had my own kind of turmoil of who I was sexually and what I wanted to achieve, and how do I want it to be happy. And so during my surgical training, I was going through all of this myself, and I finally met Andy, my partner of 17 years. We have two kids together, and through that, obviously, you’re exploring your own self.

“You start to kind of ask questions and you say, well, shit, why don’t physicians talk about sex or someone’s sexuality?”

 

Or talk in a way that is very open and have conversations that are appropriate and have dialogue and solutions to real simple things, well I call it simple things, and I was miserable doing heart surgery.

“One day I said, okay, I’m done with this. What can I do? And I said, Look, I’m an out gay male. There are gay issues. There are anal issues, who’s tackling those issues?”

 

I didn’t care do I do facial surgery? Do I do test surgery? Do I do ass surgery? I couldn’t care what I was doing, as long as I was impacting people’s lives in a way that was completely positive. So I really saw a huge need in the communities to fill that void. How do we talk about it? How do we educate? How do we come up with medical and surgical solutions to issues? How do we think aesthetically, instead of people saying, oh, who cares how it looks?

Well, a lot of people care how it looks and how do we come up with bridging plastic surgery and anal surgery and that was really the birth of bespoke surgical and kind of what I was doing and what we continue to do this day.

Kimberly: I love that! That’s great. Also, that you know, you can connect to it on a personal level I think is really great. So now, kind of getting to some fun things. What are, off the top of your head, some basic do’s and don’ts of anal play that you feel are often overlooked?

Dr. Evan Goldstein:

“Obviously people see porn, and they don’t really see the before of how do you prepare the right way and I break up sex into kind of three different categories.”

 

How do you prepare for sex? How do you engage sexually? And then what’s the aftercare? All of those components and if you think of the ass itself, it’s not overly very complicated. It’s two components, its muscle and its skin. How do we get the muscle to fully relax? How do we get the skin to fully open? If there is a disconnect between those, we can potentially have injuries.

A tear, which is called an anal fissure, or a hemorrhoid can develop, or a gland that is inside can get infected. There’s lots of consequences to that. The key component is for people to really understand their anatomy so that they’re very specific and successful in what they’re trying to do.

For a lot of women, what happens is the skin is very, very thin to begin with, anally. And a lot of these guys, or a lot of the approaches, are going from nothing to sticking something huge in there. People feel like oh, yeah, like you should be able to take it.

No, it’s not like a vagina. It doesn’t self lubricate. It doesn’t open to capacity right away. It takes time. If someone comes to the office, and they’re like, I want to engage anally, it’s at least six weeks of using toys and understanding the anatomy! A lot of people they’re like, oh, like, I shit totally fine. I could use toys totally fine, but then the second someone gets behind me, my ass closes completely. You say okay, how do we start to connect the neural complexes in a way that allows you to fully relax in the way that you want to? 

The key component is not only understanding the anatomy, but understanding your own anatomy. There are three sets of muscles in everybody’s ass. If you squeeze your ass right now, you’re squeezing two out of the three. The third one is the one that most people don’t have control over. That’s the one when the partner is like, I can’t get in and you’re like, Yeah, but I’m fucking relaxed. Why can’t you get in? Well, that third one is the one that is closed or not fully relaxing. Those are the concepts to understand.

We put people through a protocol of using toys. A small dilating kit comes with small, medium and large you start with the small and over one to two weeks you’re working from just the small toy to the medium toy, and then from the medium to the large and that’s what kind of breaks down the six week protocol, but what you’re doing is you are getting the skin to become a little tougher, so that it’s able to open without tearing. You’re getting the muscles to fully understand how you truly, truly relax and get yourself into a good space. All of these things are so important and then you start learning different positions of what works better or not. Let’s say you do the six week protocol and you’re like tonight’s the night. I want to get fucked and have sex and enjoy myself. 

“I would say the key is foreplay. It is bringing in the toys into sex play either before you’re engaging or during and you’re using the toys to not only dilate, stretch the muscle and the skin, but pre lubricate, kind of set the stage for success.”

 

Like the first position I would choose is basically on top right? I wouldn’t let the guy or the girl or what get behind because the reality is that they’re not really concentrating on “Oh, hey, let’s go gentle. Oh, hey, let’s get these muscles to relax” they just want in and they want to start riding. So a lot of this is kind of setting the stage as it relates to the dilating protocol. 

Again, some of the things that I think about is during this protocol, you start analyzing, Oh, am I eating the right things? Am I douching correctly? Do I actually need to douche? So some of the things to think about is, first of all, for people that are listening, obviously people engage anally a lot of people douche and clean out beforehand, and a lot of people are doing it the incorrect way.

They’re using water or enemas and that themselves can cause irritation. They are using way too much, either through like a shower hose or a big bowl. And many people are doing it too many times. What happens is, the lining inside gets irritated and you wouldn’t necessarily know it because you can’t see in there. But what it does is it raises the incidence of sexually transmitted diseases meaning HIV, STDs, irritation fissures, a lot of this. Some people just from douching have their hemorrhoids swell and then they can’t engage anally because they feel pain or irritation. A lot of this was the impetus of starting ‘Future Method’. 

‘Future Method’ I co-founded and it’s all about products to support how we engage. So it’s educating everybody, but it’s saying okay, if we are going to douche, how do we douche with the right substance, a solution that’s not toxic, that’s silky, it doesn’t dry you out? Also, how do we work with a bowl that is smaller and more refined in a way to minimize, because the goal is less is more in anal, which is don’t irrigate too much. The diet should be appropriate.

A lot of people do fiber supplementation at night before they go to bed. We have a three and a probiotic that specifically for anal sex replenishes the bacteria. So the goal for all of the do’s and don’ts is for us to kind of first define anatomy, allow people to understand that it is a work in progress, and then analyzing how do I mix fiber pre- and probiotics and eat correctly so that I’m shitting easily, can do less douching that I still feel sexy and comfortable, to then start the dilating, and then work into sex. 

Kimberly: This kind of leads into anal sexual health questions that I have for you. So I’d like to kind of dive into those if that’s alright because I think you kind of touched on a lot of them, but I’d really like to know a bit more? So for example, how do you feel diet plays a role in you know, sex safety?

Dr. Evan Goldstein: So I think a couple of things, you know, for a lot of people there’s a lot of shame behind poop, unfortunately. And you know, the reality is, it creates a lot of pressure on the bottom, but it also creates a lot of shame and issues associated with that.

“So the goal is to say, “look, I’d love for there not to be shame and I’d love for tops to be more understanding” but the reality is that we have to really meet the people where they are.”

 

And if they’re consciously thinking of, “hey, I’m going to over douche or I need to do this or I’m going to starve myself.” The key is for us to say no, that’s not necessary. The goal for us is for you to understand that actually, with you shitting normally, eight out of 10 times you’ll probably be completely clean for run of the mill anal sex. prove it to yourself, use a toy without cleaning yourself. 

You will see that most of the time you will actually be completely clean now because of society and the stigmas, even our own internal stigmas, a lot of people are over douching. So the goal is to say okay, in our diet, if we’re doing soluble fibers, if we’re adding lean proteins, if we’re adding fiber supplementation, if we’re adding pre and probiotics, all of these things start to, first of all forget anal sex, it makes the biome and your life feel much better. Right?

So how do we meet people there and then how do we then say, Okay, now for an anal sex perspective, the goal is by eating right, by supplementing right, and staying nutritionally sound, you’re now having better routine bowel movements that now sex becomes better, but also your preparation just becomes less. How do you now use that to aid? 

All of this is like you figuring out your body, there’s some people that eat dairy and their shits are perfect. And then if I eat it, I’m like, shitting 10 times. With that said, this is not like, Oh, I’m telling you and you have to follow this. This is just analyzing your world to be like, I used a toy the other day, and I was really dirty. Why was I dirty? What did I eat the night before? What am I doing?

Because the goal is to meet you where you are, I don’t want stigmas, I don’t want judgment, but I also want to be realistic that we live in a world where there’s judgment and stigmas. Yeah, how do we break those down, but also do it in a way that allows people all the right tools to kind of place them into their lives to better their sex world?

Kimberly: Yeah, big time! I definitely think that a lot of people will feel nervous to engage in anal sex especially, in heterosexual relationships where they’ll be nervous to engage in it because they feel not as comfortable with this person, and then something bad happens and something comes out. I think reducing that shame to where someone, when that does happen, instead of feeling embarrassed – It’s like okay, what did I eat before this that possibly caused that and then getting really in tune with your body? I really liked that.

Dr. Evan Goldstein: It’s not that there’s no right answer because I get a lot of hate mail from people that are like, “Oh, you’re making more stigmas. You’re raising more awareness on issues that maybe people didn’t think about” and it’s such a hard place to be, literally. People come into the office every day and this is a real issue. It’s not to say that we’re trying to continuously raise these issues to bring more shame to this but the reality is there is a lot of shame involved in this even Body Dysmorphia, eating habits, all of these things. And the issue is how do you fine tune that and balance that to allow people to live successful bottoming lives? But also healthy, overt lives all together?

Kimberly: Yeah, absolutely! Kind of a more basic sexual health question regarding anal is how do you recommend people clean both before and after anal sex?

Dr. Evan Goldstein:

“So it really depends on you, right! Everyone’s anal sex is different.”

 

Some may just be anallingus and external play. Some would be fingers and toys and others obviously, full penetration. All of those have different components to how you actually clean. So if it’s pure, just anallingus and external, I think just showering and cleaning and getting kind of any excrement that’s there just externally is probably well and good. We started through future method, an anal exfoliant, that is a butt and body scrub, specifically for the anal and that is before and after. The before was exactly this, which is how do I prepare myself so that I’m clean and you feel comfortable and you feel sexy?

The exfoliant has these two sized particles that really work towards kind of gently exfoliating and then kind of polishing the area with a small scent that keeps it so that you feel sexy, and that your partners are able to lick and play and do and a lot of this also was even for the aftercare which was I used a lot of lube or you there’s cum and excrement and whatnot. How do we get that off? Because silicone based lube, which is what I really like for anal sex because I think the lube itself has the best lubricity and the best dispersion around the area, It’s hard to get off your skin. It’s not easy. By using a scrub that’s dedicated for that, it gets rid of it, It polishes, and then it really kind of rehabbed if there’s any micro tears. 

We also came up with an anal soothing cream, a butt and body soothing cream, specifically for this, which is maybe you do have a little bit of sore spot before sex or after sex? How do you clean the right way? Nourish and replenish and then put in a specific lotion that helps you get into a good space and that’s just kind of external use. Now obviously, internal is the fiber, the fiber supplementation, the probiotics in the diet. I would really tell people when you’re starting off, don’t use douching in toy work. I usually tell people to do it when they’re showering. Turn the shower on, you feel comfortable, you’re more relaxed. It’s like going to the gym give me two or three days of a week of using the toys with a couple of days off in between. And just like going to the gym, give me two to three sets of 12. That’s all I need going in, coming back out, never forcing it.

“Glass is so great with the lubricity it also helps with the friction in a way that is so specific. And also you could use any type of lube with glassware.”

 

A lot of the other toys you have to use a toy safe lube and it doesn’t really get you into a good groove with going from the toys into sex. So use a toy on your own and see that like holy shit I’m actually pretty clean. And then obviously the goal from us with ‘Future Method’ is to say okay, how do we use the right substance? So a liquid that is specific for anal cleansing, not water, which is what’s called hypoosmolar enemas, which are hyperosmolar. They’re on two ends of the spectrum, and we need to be kind of in the middle to make sure that we don’t cause issues with the cells and the microbiome. And that’s very similar to water based lubes.

A lot of these companies are throwing water base loops out like oh, it’s organic. Oh, it works really well. It’s safe for you. Well, the reality is that most water based lubes are not. They are out of the range that’s supposed to be a lot of them when they become organic, they lose the lubricity they take out this thing called glycerin, well, glycerin is what is the essence of lube. And so when you take out and you start putting in oils and other components, you now really mess with that spectrum of where it should be. And also it fucks with the lubricity and it wears away in a way that where, especially anally, it’s not lubricating. You need to stop using it. Use the right lube. That’s such a huge proponent of not only the glass toys but silicone based lubes that really helped to work in that capacity.

Kimberly: So you don’t recommend someone douching with just straight water?

Dr. Evan Goldstein: I don’t. The reality is that water is so accessible. People look at water and see that it’s clear and clean, and they think that it should be used. Now, soon enough, with ‘Future Method’, we’re coming out with something – and I can’t tell you yet, but I think it is going to be a game changer. But with that being said, the goal is for people to understand that less is more. Even if you say hey, I don’t want to buy a product, I want to just use water, then it’s now thinking about how to use fiber probiotics, like diet, to minimize as much water as possible so that I don’t cause more and more irritation. 

The anatomy is really interesting to think about. Shit is really higher. So what happens is that when you’re ready to have a bowel movement, the poop moves to the anal canal. You feel it. You’re like, oh, I need to shit, you go to the bathroom. Now that area where penis toys etc. is going to go, that is a conduit. Meaning after you poop, that area is gone of stool. There’s no stool there anymore.

So what happens is a lot of these people are douching and what they’re doing is they’re getting the liquid up higher than what they need to and then what it’s doing is basically acting like an enema. It’s eliciting a bowel movement. So the very, very common theme is someone will say, Oh, I douche twice and I’m clean. I’m gonna do it one more time just to make sure. And then they’re dirty and they’re like, oh fuck, here I go and then it’s an hour routine. And you say no, the reality is, if you understand anatomy, and we’re just trying to get the area where the actual action is happening. It’s less water, it’s less volume, it’s less amount of times and it’s using more diet, exercise and supplementation so they don’t have that issue happening.

Kimberly: That’s really interesting. All right, then what advice would you give someone looking for their first anal sex toy because I know you said that you’re a huge fan of the glass. And I know there’s like different types of glass as well. Can you go a bit more into detail on kinds of ranges. Maybe someone who has never explored it before. Maybe, someone who’s kind of done it, but maybe hasn’t really done it, right?

Dr. Evan Goldstein: Yeah, so I think you’re right, all toys are definitely not created equal. So whether you’re using glass or metal or silicone, you just need to make sure that it’s compatible with the lube that you’re using. I like an appropriate anal dilator KIT, first to get people into a good groove to understand their anatomy. They’re basically like traffic cones that you sit on in a way that allows for the skin and the muscle to slowly be opened in a controlled fashion. I always say, even if you’re experienced or you’re like, hey, I want to put this toy in that’s like a life size, big old penis, I would say I would first always start with the dilated kit. Why?

Because it starts to work the three sets of muscles and the skin the same way the right way to start. It puts the loop 360 degrees around. I also love these things called lube shooters, which are basically syringes that you shoot the lube up into the rectal and anal canal so that the entire area is really well lubricated. So when someone says, oh, well, what toys, the realistic picture is that most toys are great. I’m all good for all of that. But it’s how do you get to accept that toy? That is the most important and using the dilators as a gauge of girth, length is not so much of a major issue because I always tell like it’s the landing and the takeoff that’s the problem. Meaning it’s really the first six centimeters in anyone’s ass that is the major issue – the skin, the three sets of muscles. Once you go beyond that, that’s why people are like, I don’t understand fisting how are people able to fist?

Well, the reality is, once you go beyond those muscles, the sky’s the limit, the rectum and the anal Canal and the sigmoid colon can get quite big, normally. With any issues now, think about my fist and my wrist. Realistically the base of my wrist, and the actual arm is no bigger than a penis or a big toy. It’s the initial entry of using your hand using your fist to gain access. So the goal is how do you use the toys, a dilating kit first – small, medium, large – then knowing the size of the large, how do you look at the next set of toys that you want to make sure you are not jumping too much from a girth perspective and that you’re using them in a way that starts for you to understand your own anatomy. Does that make sense?

Kimberly: Yeah, definitely.

Dr. Evan Goldstein: So it’s hard for me to say when we look at trusted brands or stores, I mean, we work closely with Hustler and we work closely with many of the other different components of stores that are out there. A lot of them are selling the same thing. Some of them are safe, some of them are not. I’m not the one to tell you if you want a toy and that is appealing to you that it’s not safe. I’m someone that’s trying to tell you, okay, how do you work up to that in a safe way so that you could accept it and feel comfortable in the way that they’re trying to get to. With that said, I think over time we’re going to see a lot more oversight in toys.

That’s what we’re trying to do with ‘Future Method’ and the science of sex of what we’re doing is to try to say these toys are grade A, these toys are B, these are C. Why? So that’s to really be educated so that they know the shortcomings or the after effects or the long term difficulties in use with these.

Kimberly: Yeah, yeah, I like that. You had made a comment about that third muscle and I’m really intrigued. You said that it’s easy to kind of get in control of those first two because that’s what you’re typically using but then that third muscle, to get connected to that is it a mixture between kind of the mental and also a dilating kit?

Dr. Evan Goldstein: Yeah. Like all those muscles. One thing for people to understand is that muscles are interesting. Like, if you engage a muscle and you let’s say you put some pressure on that muscle. I usually tell people when they’re going in, go in til you hit resistance. Let’s say that’s the first time going in with a lot of lube. You hit resistance, hold it there, three, two, one. What that is doing is it’s causing that muscle to sense that something is there, and that it actually needs to relax. And so what you’ll notice is each time you’re going out through that protocol, you’re getting the first sets of muscles to realize that we’re asking it to relax, you’re then getting the second set, and then finally, the third set.

Now, sometimes that third set in people is so tight meaning a lot of people are doing peloton or Pilates, or they’re doing squats or they’re building so much muscle booty wise that the pelvic floor also gets strengthened to the point where sometimes that muscle is too tight. And no matter what you’re doing with dieting, you find it difficult to relax or there’s pain or irritation. With that said, we do physical therapy. There’s a ton of pelvic floor therapists across the world that work with that tissue to try to see with manual reflexology, are you able to get those muscles in your mind to work in the right way? I do a lot of work with Botox where you can give Botox Anally, specifically that third muscle to take that out of the equation. So the other two are really working so you’re not shitting on the street. You may have a little bit more gas, the fruity. You’re just learning how to deal with that. But by taking that third muscle out of the equation, we could now really get the rubber band to start to focus on what we’re trying to do.

The reality is that this is a muscle like none other and just like going to the gym. One day we work the bicep to strengthen the bicep. The other day, we’re working the bicep by lengthening it by stretching it in a way that now counteracts the contractility, why? Because it starts to make muscles function better. And you could do what you want with that. And so similar types, I tell people, especially a lot of people that are into crazy heavy lifting, like the days that you’re doing crazy squat work, either that night or the next day. You really should be doing anal dilation. So now you’re able to keep the rubber band. I want it tight during the daytime. And I want it allowed to be open during sex time. Those types of things for people to think about.