This article was medically reviewed by Dr. Justin Lehmiller, a social psychologist, researcher and award-winning educator. For more information:
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There are many reasons somebody may experience a mishap when engaging in receptive anal intercourse, many of which stem from a lack of education. Was anyone even told anal sex was a possibility in school, let alone how to do it in a safe and pleasurable way? This then leads us to seek education in other places, like porn, where we rarely witness proper protocol because porn is created for entertainment, not educational purposes.
I always remember the time an adult film actor told me learning about sex through porn is like learning to drive through films like The Fast and the Furious. It’s a perfect analogy, considering the type of sex we see in porn is not the type of sex most of us (including the actors themselves) engage in.
All of this is to say that if we were given a proper education on anal sex, there would likely be far fewer mishaps, less pain, and more pleasure. Of course, the same could be said for almost any kind of sex—the better educated we are about it, the better equipped we’ll be to have positive experiences with it.
Anal sex is a high-pressured act with significant forces at play, which creates the potential for it to be quite traumatic. The anus and anal cavity encompass the internal mucosal linings, the surrounding skin and muscles, and the nerves and blood vessels that supply the area, each of which can be restrictive and limiting. What this means is that if someone goes beyond their capacity (i.e., their hole is opened up too wide or with too much force), any of these components can tear or develop other complications.
As someone who has personally been torn to the point that it required surgery, I can tell you the recovery process is long and painful. Even after you’ve healed, you still have to put in work to make anal sex comfortable again.
Dr. Evan Goldstein, proctologist, anal surgeon and founder and CEO of Bespoke Surgical, a sexual health practice that specializes in gay men’s sexual health and wellness, says anal scarring is super common and a frequent ailment he deals with at his surgical practice.
Numerous things, including bottoming, improper and frequent douching, and even not using enough of or the wrong kind of lubricants during anal sex, can potentially cause anal scarring. However, he says scarring can also come from surgical procedures that are performed to treat anal warts (which are quite prevalent), chronic tears (aka anal fissures), and/or dilated veins (aka hemorrhoids.)
“When we think of a hole that functions properly, we need to remember that the skin and muscle in the area function independently, but work together,” Goldstein says. “If we add scarring, that synchronized motion is ruined. The scar fuses the muscle and the skin together. When we ask for it to fully open, unfortunately, either the overlying scar will not accommodate or the underlying muscle won’t fully relax. These restrictions then lead to chronic pain, local tearing and/or prevents you from having pleasurable anal sex as a bottom.”
Scar itself is weak and restrictive, but for anal sex and the pressures that come with it, it needs to be the direct opposite: strong and pliable. “Within 8 weeks of one’s post-op recovery, I advise patients to begin using toys and doing local pelvic floor physical therapy to help shape and mold that scar into a bottoming machine,” Goldstein says. “Most surgeons out there, unfortunately, miss this mark completely because all they’re looking to do is address the pathology at hand without the context of whether or not someone engages in anal sex.”
My surgeon “missed the mark” by a long shot. I was given zero advice (or a follow-up appointment, for that matter) and had to begin the recovery process on my own. Thankfully, I reached out to Goldstein, who helped coach me through. The first step was to start dilating and using toys to help restructure that scar.
“When it comes to toys, I love a glass dilator set because it allows for more rigidity in its dedicated work,” Goldstein says. “The in-and-out motion and concentrating on the scar lines that are causing you issues will hopefully strengthen and become more elastic over time, which will then allow improvement when you bottom.”
The key when dilating is to determine the scar’s severity and then experiment by using dilation toys to see if you can overcome any restrictions from anal scarring. As with most things anal, start gentle and slow, with copious amounts of lube (many people prefer silicone lube for this activity because it is “slicker” and longer-lasting). Insert the toy, moving it in each direction (left, right, front and back) and work the skin and muscle in the region of your scarring. By adhering to this process, the scar will hopefully soften up and allow itself to expand in a normal way.
Other strategies to employ engaging in sex are to use toys to help dilate prior to sex and pre-lube the anus. Regarding the latter, try a lube shooter, which coats in and around your anus and rectum, which doesn’t often happen if you just slap some lube on the insertive partner.
Choose your first position wisely. Find one that is easiest on the scar and, from there, experiment with more advanced positions as your skin and muscles become more relaxed. For example: if your scarring is towards the back of the anal canal, doggy may actually feel worse, as the penis and/or toy are directly hitting that scar line. Starting out, you may find that being on top is easier because you can more easily control depth and speed, allowing you to customize the experience to your needs.
“The key is to understand not only which positions are better suited for your scarring, but also how to offset your pelvic angle or your partner’s height and thrusting in a way that improves pleasure and minimizes discomfort,” Goldstein says.
If issues still arise (most people should know within four weeks or so of doing the toy work) then a full inside and out exam is warranted. “Sometimes, I need to do in office procedures to aid the scar, which may include adding Botox into the skin or muscle to help with more formal relaxation,” he says. “However, if the scarring is beyond these simpler solutions, I’ll need to do a formal surgery to open up those scar lines.”
While a severe injury and scarring might make it seem like your bottoming career is over, it doesn’t have to be. Thankfully, there are surgeons like Goldstein who understand and advocate for folks who engage in anal sex, offering shame-free solutions that can restore our holes to their former glory.
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