Guide to Preventing Anal Injuries During Sex by Dr. Evan Goldstein

Guide to Preventing Anal Injuries During Sex by Dr. Evan Goldstein

It really is true–some people were born to be bottoms. By this, I mean, it has to do with the skin and muscles within our assholes and our ability to fully relax those muscles on demand. Seriously! That said, the majority of us, unfortunately, can’t just open up without training first for the ride of our lives. The good news? With the proper tools and plenty of practice, almost anyone can bottom. And when you follow this guide, you’ll be on your way to preventing anal injuries during sex. Before we start, it’s important to know that it takes time–about 4-6 weeks. Good things come to those who wait (literally), and we promise it’ll be worth it. Let’s dive in.

Anal Dilation

Invest in a proper anal dilation/plug kit with three graduated sizes, as well as some high quality water-based or toy-safe lube. Your exercise routine will look like this: for 3–5 minutes on 2–3 days each week, starting with the smallest plug, apply gobs of lube (there’s no such thing as too much) to both your toy and your ass. Try pushing the plug into your hole until you feel pressure from the muscles in your ass. Once you hit resistance, stop and hold it there for three seconds. Try to consciously relax to allow the plug inside of you and then slowly remove the plug once you hit resistance — all in one continuous motion. Pro tip: the shower is a great place for these exercises because the warm water will help you relax, and it makes for easy cleanup!

You’ll want to repeat all these steps 12–15 times per set and perform two sets in each session. While it’s natural to feel initial discomfort, you shouldn’t feel pain, so stop if you do, stop, give it a day or two, and then try again. After two weeks of using the small plug, it’s time to graduate to the next size for another two weeks. Most people can move onto the real thing after this, but if your partner is above average (in length and/or girth), I recommend an additional two weeks using the largest plug. The purpose is to strengthen the skin during stretching and also allow the muscle memory to start understanding relaxation.


When you douche, the goal is simple: cleanse your rectum to get rid of any lingering poop that may still be present in there. Believe it or not, certain methods of douching can cause harm in and of itself. You don’t want to irritate, disrupt, or cause trauma to the cells in your rectum by using tap water, a shower hose, or an enema. That’s why I developed the Future Method Anal Douche, the first-of-its-kind formula specifically to help prepare for anal sex. It’s an isotonic formula, which means it’s compatible with our body’s natural composition. More commonly used products, like tap water and store-bought enemas, can irritate the lining of the rectum and affect your anal microbiome, disrupting the normal balance of the good bacteria and bad bacteria that resides there. As a result, there’s a chance that micro-cuts and tears can happen, along with other significant complications. This only gets compounded with the immense pressures your rectum will endure during sex itself. This is a bad combination!


There is no such thing as too much lube. And I can’t stress enough–stay away from spit! The best lube for anal sex is silicone lube. The anus does not self-lubricate, so it is important to have an abundance of lube to prevent discomfort and minimize the chance of tearing (also known as fissures). The slickness and endurance of silicone are unmatched. Also, stay away from warming lubes because they are a known irritant and weren’t meant for anal sex. Desensitizing lubes should also be avoided as they can mask localized anal issues, such as anal tears and hemorrhoids, without you even knowing it. It’s not until after the sensation wears off, and the session is over that one feels the wrath of pain.


Whether you’re using poppers for their euphoric effects or to help relax (read: loosen things up) your hole, I caution people that they shouldn’t use poppers as a way to do something their body couldn’t do without them. In other words, poppers should only be used to enhance or supplement your bottoming experience if and only if you have already proven to yourself that you are able to successfully engage anally without them. Unfortunately, while exhilarating, poppers can numb the user to pain associated with tearing and trauma, resulting in anal fissures and hemorrhoids. Also, medical researchers have evidence that abuse of poppers causes a decrease in oxygen flow to your brain (mainly the cerebral cortex and cerebellum).


When you understand there is a science to sex, you realize that the hardest part about anal sex isn’t minimizing injury and maximizing pleasure (yes, pun intended). My goal is to help empower bottoms and arm them (and tops!) with the education to prepare and care for their booties as best they can.

About the author:

Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical, the leading private practice in New York City, specializing in an elite standard of sexual health and wellness care for the modern gay male. As the preeminent expert and thought leader in the field, Dr. Goldstein is committed to education and awareness—not only bringing the important issues surrounding gay sexual health to the forefront but also eliminating the stigmas attached to it. Dr. Goldstein is also the co-founder of Future Method, a first-of-its-kind sex care brand specifically created for anal sex, inspired by his medical practice and his client’s needs.