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Sex with Dr. Jess


May 27, 2021

Anal Play: Positions, Prep & Pleasure!

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Backdoor play can be highly erotic, but it can also be uncomfortable if you don’t know how to prep and play. Surgeon and sexual health expert, Dr. Evan Goldstein, joins us to share his expertise so that you can enjoy even more pleasure — before, during and after anal sex. He answers a range of questions including:

  • How can we make anal sex more pleasurable for first timers?
  • What positions are best?
  • Can anal sex stretch/damage the anus or rectum?
  • What’s normal when it comes to poop?
  • What is Future Method and how can it help with preparing for anal sex?
  • What is anal training and why is it important?
  • How can you facilitate relaxation before you start to play?
  • What is the structure of the butt in terms of musculature and why is important to get to know your own butt?

Follow Dr. Goldstein’s Instagram and check out Bespoke Surgical to learn more about his practice.

And a reminder, Masturbation May is almost over but our new partner – an all audio streaming platform is running a 99 cent special. Have a listen and let us know what you think!

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Rough Transcript:

This is a computer-generated rough transcript, so please excuse any typos. This podcast is an informational conversation and is not a substitute for medical, health or other professional advice, diagnosis or treatment. Always seek the services of an appropriate professional should you have individual questions or concerns.

Anal Play: Positions, Prep & Pleasure!


You’re listening to the Sex with Dr. Jess podcast. Sex and relationship advice you can use tonight.

Brandon (00:15):

Welcome to the podcast. I’m your co-host Brandon Ware, with my always lovely other half Dr Jess, surrounded by a table full of dongs.

Jess (00:26):

Why are you laughing so hard?

Brandon (00:28):

Because I just said that we are surrounded by a massive table full of all sorts of sex toys. Like ridiculous amounts.

Jess (00:35):

Dongs on dongs dongs. Yeah I’ve been receiving massive shipments of sex toys over the last couple of weeks because of this new show I’m hosting with TSC and CityTV in Canada. So it’s a shopping channel type show. TSC doesn’t stand for The Shopping Channel. It stands for Today’s Shopping Choice. But that’s a whole other thing, but anyhow it’s like the Home Shopping Network in the States but it’s here in Canada and it’s a sex toy show and it’s Friday nights at midnight. And it’s interestingly not on TSC , its on CityTV, which is a regular national network so folks can definitely check it out. But these boxes of sex toys I’ve been receiving, their massive. I can fit in these boxes. So my whole office, the floor, the desk, the chairs covered in sex toys from LoveHoney from Shots America from Lelo, from Womanizer, from Romp, Arcwave, from We-Vibe, from High on Love and then some. So there’s kind of I feel like Ariel, is that her name? In the little mermaid. Where I’m like, “look at this stuff, isn’t it neat? I got dildos and anal plugs aplenty.”

Brandon (01:48):

I like that’s where your mind goes, to a Disney film. Only ours is about dongs and butt plugs and lube and all sorts of sex toys.

Jess (01:55):

But she says, ‘how many wonders can one cavern hold? Looking around here, she’s got everything.”

Brandon (02:05):

The lyrics here really jive with what you’ve got going on.

Jess (02:08):

Right? She had who’s its and what’s its galore. She even had a thingamabobs. I feel like there should be a sex toy called a thingamabob. Anyhow, I wasn’t intending to plug my new show, but do check it out. CityTV Fridays at midnight. And you can watch the replay at a very handy website: Just check the link in my show notes and in my profile. That’ll be a lot easier. But it’s anyhow. I’m excited because I’m surrounded by wands and pleasure air toys and a toy called Greedy Girl from LoveHoney, as well as some finger vibes, some vibrating butt plugs, anal training kits, the Arcwave Ion. I’ve got everything here. And here’s the thing: I have to try them all because I don’t want to sell toys that I haven’t used, but at the same time there are hundreds of toys in here right now and I don’t know where we’re going to keep them. I need to find a storage solution. And I’ve seen other people in my field use like shoe bags to store, sort of hanging on the back of their door to store their dildos. But I have too many so we got to figure that out, but it is an exciting environment around here. All good vibes and I’m also really excited to remind you about a new partnership that I’ve recently formed, or we’ve recently formed with Femtasy. And Femtasy is an audio only streaming service with short erotic stories, and because my seduction style is audial, you know I love this concept. And all the stories are ethically produced, a huge variety, you have hundreds and hundreds to choose from and it is Masturbation May as you know so Femtasy is running a special. They’ve dropped their prices and full access is 99 cents a month or $9.99 annually. So listen if you wanna explore your fantasies, or learn more about how fantasies developed. Because I think it’s hard for many of us to tap into our fantasy. I’m pretty sure. Brandon only has one.

Brandon (04:03):

Yeah, as somebody who is creatively challenged when it comes to coming up with new fantasies, I really do appreciate the fact that I can listen to these in advance. And then incorporate them into perhaps some other new fantasies.

Jess (04:16):

You mean the things I wanna hear.

Brandon (04:18):

Yeah pretty much.

Jess (04:19):

Yeah so you can use it with yourself or use it to teach your partner. A really good place to start, so even if you just want to kinda take some time out for yourself and escape reality, you can check out some of the recordings for free as well at And if you like them, take advantage of their Masturbation May offer and hopefully Brandon will expand his fantasies beyond the one.

Brandon (04:47):

It was real bad before I started listening.

Jess (04:51):

I’m not complaining, it was fine. There’s just this one fantasy that he likes to talk about and it’s been years.

Brandon (04:57):

Works for me.

Jess (05:00):

It’s a direct path. All right, let’s dive in today’s topic: anal pleasure. We are going to be talking anal sex, douching, anal positions, prostatitis, anal training, toys and much more with an anal surgeon. Dr. Evan Goldstein is an anal surgeon, sexual health and wellness expert, and the founder of Bespoke Surgical, as well as Future Method, a science based sex care brand. Thanks so much for joining us today Doc.

Dr. Evan Goldstein (05:31):

Thank you so much for having me.

Jess (05:33):

Right, I have to ask: what made you decide to become an anal surgeon? I’m thinking back to a Seinfeld license plate. Brandon, do you remember that license plate?

Brandon (05:40):

I do. I believe it was ASSMAN. Wasn’t that the episode where Jerry, somebody, wasn’t it the ass man?

Jess (05:50):

I think it was there one of their fathers. And I just remember it right now when I said anal surgeon, but you have a different story and I think a really meaningful one. So tell us how you got into this field.

Dr. Evan Goldstein (05:59):

You know, I was actually kind of cloned to be more into the heart field, and I was doing heart surgery, I actually matched at a prestigious institution and I hated it. And it was interesting because in my career, I finally came out. I came out late, I was married to a woman first. There was a lot of kind of me, trying to figure out who the hell I was and obviously surgery itself was, and still is a boys club. And so finally, when I was training, I said you know I’m not happy. I’m not me, I wanna be who I am. And I met Andy, my current partner of fifteen years and we were in Napa and I was drinking and I saw the world and I said “God. You know I don’t want to do this. This is not right. I don’t wanna be in this field.” And I remember walking away from it and I was walking down fifth avenue looking at all the museums, looking at all the happy people and I said “How can I do something that is impactful? How can I do something that is not death and dying?” Because it just didn’t bode with my personality, and also “How do I give back to the community?” And then I really started to see that there was no access to appropriate sexual care, let alone in the gay space. But this was back ten years ago, just nobody was talking about sex. Nobody was like, “what happens if you get injured from sex? Who do you go to, and who actually understands the intricacies of all of these different communities?” And I started googling, I started looking, and I realized that nobody’s doing and/or if they’re attempting to doing it, they don’t understand specifically the gay community and all the ins and outs — literally — of sex, and that was kind of the birth of Bespoke Surgical. And they don’t train you in sexual surgery. It’s not even on their radar. And early on in my career, I realized that doctors don’t even talk about sex. Because I did a study that showed that 92% percent of even gay physicians will not talk about their client, or their patients sexual habits. And I said, “well, it’s never gonna work for me. I need to actually go direct.” And that was when I hired a publicist, PR firm, and I said, “let’s just start talking about all the issues as it relates to community based sex. And then, boom, all of a sudden it started to kind of evolve into worldwide situation, where people in so many amazing countries that are so advanced in technologies are actually flying to my office because nobody will actually fix them the way that they want. And so it’s really spawned to this crazy amazing world for me that I’m so thankful that even we’re here today, and you and I can kind of talk and spread the word.

Jess (8:48):

Awesome. Now you, in addition to your practice which is obviously highly specialized, you are also the founder of Future Method and I actually received a box of Future Method. But I haven’t got to open it, because I just got it. So can you tell us about future method?

Dr. Evan Goldstein (9:03):

Yes, so over the past 7 years of seeing client after client, I see 75 people a week, I do about fifteen surgeries a week. And when you see that much ass, you start to see the same common ailments that happen over and over. And I said “well, why is this?” And I breakdown sex into three different categories. Okay, one is the before sex. The “how do I prepare for sex?” The other is kind of the during, “how am I actually playing?” And then obviously the aftercare. With that being said, I started to look and see what products are there. What products are people using to prepare, play, and care? And the reality is that none of them are scientifically found at all. And actually specifically in the gay community, they’re using a ton of water, enema’s, that actually strip the lining of your protective layer. So what happens, and I honestly think that the HIV crisis, and STD’s are not actually from sex. It’s from how people prepare for sex. It basically primes them so that there’s so much irritation internally, that now the sexual act transfers the bacteria, or the virus etc. And so our first product that we launched with was an appropriate anal cleansing solution, meaning PH balanced, it doesn’t destroy the microbiome, it cleans you, makes you feel sexy. It doesn’t dry you out like water, it leaves a little barrier of protection so that when you place lube on there, it’s now ready to rock and roll. And the key was, anything that we ever do from a Future Method brand is always bringing science into the product. How do we now think of sex differently? When you look at sex and sexual products, they haven’t changed in years, from a protective respective. And 75% of gay men don’t use condoms. So if people don’t use condoms, well what are we doing as a society to figure out other ways to minimize risk? And that was the birth of Future Method, which was like, “wait a second. We have so many scientists, we have so many educators, we know the problem. How do we put everyone together into a solution based practice?” And that is Future Method and all the products that are out.

Jess (11:28):

So the before care involves this cleansing. Is it an enema, is it a douche, is it something different than those two things?

Dr. Evan Goldstein (11:34):

Yes. So let’s clarify, so when people use an enema, an enema is really for constipation. So I haven’t shit, I need to poop, I can’t go. How do I get enough water into the bowel so that I’m able to move? Now, people definitely use enema solutions to douche and that is very, very, toxic when you look at the spectrum of kind of douching substances, right? People use water, people use enemas and some people they use it in a bowl. They’ll also use it in like what’s called a shower shots, so it’s a shower hose that’s basically like a colonic. And thats for really deep cleaning, and all these, whether you’re using water, or you’re using an enema, they’re not in the range of the cells. So what happens is the cell comes in contact with that solution, and then it destroys that cell. What we really need is, we need a solution that’s PH balanced, that’s what’s called isotonic, that hits the cell, it cleans the cell, but it doesn’t irritate the cell. And so whether someone’s douching with water or using an enema over time you’re causing this reaction to happen. And I get society pressures, I mean, everybody wants to be clean, you have you know, the society pressures, you have your own internal pressures. And I bet you eight out of ten, people don’t need to clean themselves out if they’re eating correctly, diet is high in fibre, or taking fibre supplementations and their pooping in a regular routine, realistically, you don’t need to douche. And I tell people to prove it, use toys by yourself in a shower before you even douche, and show yourself that like, “Oh actually, I’m super clean.” And the goal for me is ‘less is more’. So yes, I have a products company, and yes I want you to buy products, but the reality is, that if I can make you buy less product and I could make you more educated on the right way to use those products, that to me is what we’re trying to do at Future Method.

Jess (13:42):

So okay, that’s really helpful. So I’m curious about poop. And here’s the thing: I talk about all these different things, threesomes, group sex, all these things, and anal no problem, but I hate talking about poop. Brandon knows it, my friends know it. My two best friends love to talk about poop, always begging me to come on the podcast and I think harass me to talk about poop. But let’s talk about what is pooping regularly. So you said diet matters, obviously a high fibre diet. How often should we be pooping, what should our poop look like? And I’m just gonna sit back and sweat.

Brandon (14:12):

I remember, there was one thing that I remember from my college years. Is that, and I am not a physician at all, nowhere close, but they said if you poop, it should be the consistency of toothpaste. That’s what I remember from college.

Jess (14:26):

Is this still true?

Dr. Evan Goldstein (14:27):

I think that the way I equate pooping is like a dog. If you ever see a dog poop, it’s like actually really a nice thing. They like you know, it comes out, they don’t really need to wipe right? It comes out easy. They’re really not overly pushing too much. They listen to their body. They’re like “oh this time I need to go poop. Great let me go outside and do it.” And that’s similar to how humans should be. Now with that said and Western diets, everything is really off. There’s no right answer to this. I think that it’s people understanding that we should listen to our bodies, you the urge to go to the bathroom, you should go. If it’s not coming out, it’s not forcing it, it’s not pushing it. It’s drink a water, drink some juice, go for a walk, if you feel the urge again, do it again. And it shouldn’t be anything other than a good yoga pose of like, you know, really good, deep breathing to relax the pelvic floor. The consistency should be soft but congeal. Oh, she’s sweating. She’s really sweating.

Jess (15:37):

I don’t like thinking about poop!

Dr. Evan Goldstein (15:39):

It should be easy. But everybody has a different routine and a lot of females, they’ll instead of every day, it’ll be every other, or every third day. It just kind of depends on your body, but the key is to try to keep the consistency, that it’s more kind of form, and it’s more of like the less wiping, you know I think there is a Seinfeld episode that the one wiper, or the two wipe, or twenty wiper, you know where, if you’re doing one or two wipes and it’s clean, that’s a pretty good shit. If it’s more than that then you have to start saying, “okay. Can I add fibre? Can I tweak things? How do I make things easier?”

Brandon (16:20):

I feel like I was just given permission to now go into the bathroom, do fourteen circles, squat, and go. That’s the dog poop thing.

Jess (16:29):

Are you gonna call me? Call me to come to pick it up though?

Brandon (16:32):

I’d love that, I’d love for that, that’d be great.

Jess (16:34):

I don’t wanna do that. Okay, so you’re talking about prepping for anal, let’s get into anal. I think some people are concerned about doing damage with anal, with all you know, stretching the muscles, but you explain otherwise in terms of what our body’s natural state is, that we don’t really have to worry about that?

Dr. Evan Goldstein (16:49):

Yeah, I think the key is extremes, right? The times that I see people have injuries are, yes, the run of the mill bottoming. It’s usually like not preparing the right way, or positions that are a little bit different. But a lot of it has to do more with consistent toys or really big, big, big, in terms of fists and moving beyond the normal state of how an ass functions, right? If you think of run of the mill anal sex, 99.9% of the day we are completely contracted. The ass and all of its muscles are closed. Now, also many of us are doing a lot more with exercising with Peleton etc., where it’s compounded even more than that. And I tell people if you go to a trainer, if he’s doing biceps one day, he’s actually doing triceps the other, why? Well he wants to stretch the bicep, and it’s the same concept anally. When you are contracted so much, actually it’s very beneficial to learn how to relax the pelvic floor, and doing that with anal, with toys, with kind of dilating, allows for us to really learn a better mechanism of fully opening when we need to, i.e. sex and pooping, but also now really feeling contracted and pulling in. Now anal, I usually tell people you can’t go from nothing to something big right away. It just, that’s just not how it works. I think the key with anal is to understand completely your anatomy. It’s not very complicated. There’s skin and there’s muscle, that’s it. And there’s 3 sets of muscles, 2 of them you and I contract, meaning if you and I just squeezed our asshole right now, what you’re squeezing is to 2 of the 3 muscles. That 3rd muscle is 1 that you and I don’t have much control over, and so a lot of people tell me, “I’m trying to get in and I can’t fully relax. I’m trying to get in and it won’t fully open.” That’s that 3rd muscle, that all day is in a contracted state and what we’re trying to do is learn how to kind of release that so that now you can do things. And I tell people, “Start with an an anal training kit.” We write a lot about different toys that we like, specifically that fit the scientific bill, and that’s on our website, if you click on “shop”. It’ll have all the different reasons why I choose certain toys. Now, dilating should be actually over six weeks. So it’s really time, 2 or 3 times a week. What you’ll do is you’ll go in, just like going to the gym, give me 2 sets of 12. Doesn’t need to be sexual. You could do it in the shower, you could bring obviously your partners involved, etc.etc., just understanding, “How do I really learn the entire muscle mechanism, to start to really get where we want to?” And you need to think of “How do we get the skin to fully relax? How do we get the muscle to relax behind it?” And also not only get relaxed but get everything strong enough to sustain the pressures of sex. The pressures of sex are that much greater than pooping so the mechanism of all of this, isn’t always there. So the key is, how do we now use these toys and understand anatomy in a very gradual way to strengthen the skin, allow the muscle to relax, and then for you to really be more in tune with the anatomy of that region.

Jess (20:26):

I really appreciate that you’re talking about this over a period of time. Because sometimes I’ll do that, there’s this huge trade show in Canada called “The Everything To Do With Sex” and The Taboo Show. And I do these 20 minute lightning talks, and of course like one of the big ones is anal. All of them show up, especially straight couples. The guys show up thinking they’re going to learn how to have anal tonight, that I’m gonna teach them. And I you know, there are a couple of things. One, I tell them that it takes time. Number two, you want to try it on yourself, right? I’d rather put my pinkie finger up myself than somebody’s penis. But the third one, I don’t know if you’ll agree with me on this, is that you should not be putting something in someone else’s butt unless you’ve also put something in your own butt, right? Like, it doesn’t have to be the same thing, but to be totally unfamiliar and think that you can’t possibly put something up your own, but you can shove your penis or strap on up somebody else’s seems absurd. You don’t have to love it, you don’t have to do it all the time, but at least to become familiar with those muscles. And I have a question about the muscles, you said there are 3 muscles. Can you tell us what those are? Are they all sphincters? What are they called?

Dr. Evan Goldstein (21:28):

Yes so, the sphincters are there’s 2 superficial, one is called ‘superficial external anal sphincter,’ and then the other is an ‘internal sphincter. And there’s definitely more muscles, but these are the 3 that are the limiting factor from an anal perspective. And they’re all circular. The internal sprinter is pretty thick. So like I do a lot of botox work with muscles to relax the muscle and we’re giving about hundred units. So a hundred units is a lot, like when people are doing facial they’re doing like four units per little quadrant. And anally, the muscle is that thick, that in order for you to paralyze that muscle you get up to between 60 to 100 units of botox. Now, I think that I would love the world, everybody to take it up the ass, at least once, to see how it rolls. What I do at Bespoke Surgical and Future Method is try to empower the bottom to anticipate that the top knows nothing about anal. And because again, like with app based meetups and hookups, sometimes you don’t know what you’re going to get. You hope that that guy took it up the ass at some point and understands to go slow and take it easy and work it. But like for me, let’s say I’m meeting a random, I would use a toy before they come over. First off, I think it’s good form of habit of like, making sure that you’re clean, if you are using kind of a douche substance, making sure that all of it is gone and that the there’s no more liquid inside. Two, is allowing things to be pre-dilated so that the muscle and the skin are already relaxed in a good state, so that you’re able to position yourself better to bring risk down. Also re-lubricating is awesome. I am a huge proponent of these things called ‘lube shooters’ there basically syringes that you could shove the lube all the way up there and the reason is that anally, it’s not self lubricating. It’s not the vagina. And so with that being said, using toys before sex, or using it in foreplay, allowing the muscles and skin to fully relax, but also allowing 360 degrees of the lubricant, now puts you into a good state of, “Okay. Now I want this person inside me.” And you need to set yourself up for success. You could be submissive by still being in control, and I talk about that all the time. A lot of people assume that if you’re a bottom, you have to be submissive, and that’s bullshit. There’s many ways that you can flow. You don’t need to be that. With that said, I would say first positions are, the bottom is actually sitting on top, in control, actually facing partner or the hookup so that you could read each other in a way of like “oh shit that hurts” or “oh I really like that.” And not be so out there that you’re not in control, because you know a lotta stuff can go wrong and especially if you’re not educated and you don’t understand kind of the ways and means of the ass, it can lead to a lot of detriment and then you won’t enjoy the pleasures that we all love.

Brandon (24:38):

So I have a question about, you mentioned using a toy before a partner comes over, and kind of relaxing, pre-dilating. How long does that relaxation last though? Because if use a toy 3 or 4 or 5 hours before you have sex, is that just kind of get you into the head space or to relax the muscles, or like you’re gonna be relaxed?

Jess (24:56):

All that is a long time to plan for sex. Is that what you do for me? 3, 4 hours?

Brandon (25:01):

That’s how long, that is how long I’m planning in advance.

Jess (25:04):


Brandon (25:05):

Yes, psychologically, just like to get into the mood.

Dr. Evan Goldstein (25:09):

I think that it definitely changes per hookup and also depending upon anally, how you are. Meaning, I really want people 2-3 times a week regardless of them having sex, for them to use toys and dilate, and learn really to relax that muscle in a really great space. So I don’t have the right answer for you. I mean, I think that a lot of people five to six hours before are still trying in their mind to prepare for that hookup by saying, “Okay. How am I gonna make sure I’m not dirty? How am I gonna make sure I smell good? How do I make sure that everything is functioning?” And so with that said, muscle is pretty smart. It has a memory of knowing, “Okay here I am. I want to be dilated.” And then the rest of the evening before you know, you’re out for dinner whatever it is, it’s still pretty prime, that you’re able to get there quicker in terms of being relaxed. And now I also want people to use the toys in a contraction phase. Meaning, let’s say you’re doing 12 dilating. I do want you at points to actually squeeze on the small toy and hold it there, 3, 2, 1. Like doing a kegal, to try for you to understand like, “I could actually control that muscle the same way I would kind of reset my back muscle, so I’m making sure that I’m sitting straight up.” All of those things you can learn but we never were taught, and you never really tapped into the neural mechanism to truly understand the right way to shit and the actual right way to have anal sex.

Jess (26:43):

You mentioned positions, and people of course are very curious about positions. You mentioned that if you’re newer to it, you probably want to be on top as the penetrated partner, you want to be looking at your partner, whoever you’re with, so that you can communicate. What are some more advanced positions, are there positions that help to relax the pelvic floor to facilitate entry? And then finally, you did mention earlier I think, positions and injuries. So I’d love for you to just give us a bit of a rundown.

Dr. Evan Goldstein (27:10):

I mean, I looked at all those position charts. There’s like holy gun, there’s so many different kinds. I think that the key also is like don’t always use a toy the same position. Use the toys in a position that you would, and you’ll start to see like “oh this one pushes it a little bit too forward and I feel it,” let’s say it’s a woman, “I feel it more vaginally and it hurts me, versus other positions.” The pelvic floor is very, very interesting. You know you can tweak it in certain ways and it also depends upon the height of you, the height of your partner, or partners, and you start to kind of play a little bit more, where each position for you, I may say it’s more advanced but for someone else, they’re like, “oh,” and it slips in right away and feels the best. So I think it’s thinking now differently, of like, “ok. Where’s my pelvic floor? Where’s my position? Where’s my partner? How big are they? Are they using a toy, strap on?” All of those things. Now, obviously doggy style, especially men love that position from a top perspective, right? It’s just like what we think of dominance, and kind of taking over and control. With that said, there’s a lot of room for error in that position, and especially depending upon how high or low the penetrative partner is, and the positioning of that, also you know in men, the cock is pointing up most of the time and so depending upon which way the pelvis is, it could start hitting kind of the back wall, front wall, and cause more pain. Sometimes people get prostatitis and get a lot of issues from that. So I wish I had more of like, each position breakdown but I think it’s more of experimentation, also using toys and feeling, also choosing partners wisely. Where you’re able to say, “let’s switch this up, I don’t know why it’s just not feeling right.” Or having kind of like, a little bit of a play by play. Doesn’t have to be all the time. And I don’t want you to think of me every time that you’re like having sex, “What would Evan do?” I think it’s when you try a new position, you need to be communicative during that first session, in order to get yourself into a really great space to minimize risk.

Jess (29:30):

I’m really glad you said that, because every body is angled differently. Even let’s say doggy, what if you’re down below, what if you’re up high? We always say this with the vaginal canal right? We have different tilts. If you’re using a curved toy, or a curved penis, that can make a difference. So people have to tune into their bodies. My trick for relaxation, and anal, and anything either new or challenging, or that could potentially be painful — of course anal sex is not intended to be painful, if you’re relaxed, if you’re using lube, if you’re turned on — my trick is orgasm. Like if I have an orgasm first, I’ll kind of say yes to anything, right? You want me to eat a cheeseburger with my feet? I can do that. You want to have anal? I can do that, because it’s just, it’s a flood of chemicals in the body, you have all these muscular contractions and I think of it as progressive relaxation right? So you know in meditation, you tense up, in order to differentiate between that tense feeling and that relaxed feeling. Same thing for orgasm right? You’re having these intense contractions, and then it’s followed by this deep state of relaxation. I was wondering if, for people with penises, because you tend to ejaculate when you orgasm, I know that’s not always the case, do you have clients or patients who practice non ejaculatory orgasms in order to get themselves into this state?

Dr. Evan Goldstein (30:39):

Yes I see a ton of people. And I think that whether you want to do that or not, the key is at some point to always get off. Now what happens is that you produce, let’s say you know, I’m being penetrated and I decided to keep edging myself and feel all of those endorphins, and I’m not getting off right? And some people can’t get off from bottoming. They do emotionally and they’re happy that their partners are doing what they’re doing, but they actually, a lot of people can’t cum and ejaculate with somebody inside them. With that said though, you really need to make sure at some point that you release all of those prostatic juices, because what can happen is it gets so big, like a balloon, and then it doesn’t ever deflate. So what happens over time, as you can get a lot of irritation, inflammation, sometimes people get contraction where the pelvic floor just feels too tight, and a lot of that is that thing called ‘prostatitis.’ So regardless, you can definitely edge and keep yourself going and say “hey, this is what I wanna do.” Perfect, but at the end of the day or at the end of that session, however you need to release yourself, you should, because if not, over time it can become detrimental.

Jess (31:52):

Quickly, can you explain to us what prostatitis is, how it’s caused?

Dr. Evan Goldstein (31:57):

Sure, so the prostate is a gland that secretes a lot of fluid so that when the sperm is traveling through to head out, it picks up a lot of this fluid so that it can travel easier. With that said, it can produce a lot, so like pre-cum. A lot of pre-cum is prostate juice. It’s clear, it’s very viscous, if you kind of are using it, you can actually use some of it like lubricant. That itself becomes massive. Meaning, there’s a lot, and if you think of the sperm, the sperm in an ejaculate is actually not the biggest volume. The actual prostate juices are, and so that mechanism is clearly that you’re releasing, and that you’re having an ejaculatory orgasm. Prostate itself, it produces that fluid, and if you keep hitting it okay, with a toy, or a penis, or whatever, if you’re being penetrated there, it’s gonna keep swelling and swelling and producing more fluid. At some point, you need that to completely go back to its normal size and that fluid be gone and then the mechanism happens again. But if you leave it there what happens is now it’s full of this fluid. The fluid becomes stagnant. It becomes old, sometimes when people are ejaculating, It’s like brownish, yellow. That is kind of older fluid that’s basically in the prostate. And you need to, even if you don’t feel sexy, most guys should be getting off at least 2-3 times a week regardless, because you need to move this pump. If you’re not moving the pump it becomes stagnant, stale, it kind of lays there.

Jess (33:32):

Okay, and I don’t want to overstate, but of course, I’ve seen these studies that show a positive correlation between multiple ejaculations when you’re younger, and I guess I should say negative correlation, but anyhow a lower incidence of prostate cancer when you’re older. And so you’re saying that these ejaculations helps with the prostate health?

Dr. Evan Goldstein (33:49):

Yes, totally. And the key is, you know, if you’re holding it in, if you’re not having sex, and you’re in downturn. What’s happening there, is that you can develop this inflammation there called prostatitis. And it’s painful. Sometimes you need antibiotics. Sometimes it can become so chronic that the prostate doesn’t function the right way that it’s supposed to, and it becomes this chronic ailment where people are limiting their sex. It’s painful, they have spasms in the pelvic floor, is just not a fun situation.

Jess (34:19):

Okay, and the solution of course is that you can go jerk yourself off. You don’t have to find a partner. You don’t have to use this as a way to tell your partner, “Hey I need this.” You’ve got Pamela Anderson right? And we need a a male gendered, what do we have for the for the hand, the hand, Brandon?

Brandon (34:47):

I’ll have to come up with something.

Jess (34:37):

All right, well we’ll work on that. This is so helpful. I really appreciate all of your commentary around communication, around the need for lube, around the need for training, for both tops and bottoms, and how it can take weeks and weeks to use dilators and get used to penetration. Even though you have these great products from Future Method, you’re also saying folks don’t necessarily, not everybody needs them right? Our obsession with being clean is what’s in our heads, and of course you’re meeting your patients where they are, but we might also want to reconsider whether or not we always need those. And this focus on prep, during, and follow up, makes so much sense to me. It’s not just this thing you do because you saw anal in porn, or you think it’s what you should do based on your gender identity or sexual orientations. This is really really great. Really appreciate your time Dr. Goldstein.

Dr. Evan Goldstein (35:23):

I just want to say one thing. I see a lot of sex experts talk about with toys, putting a toy inside and leaving it in, okay. That does nothing to help the skin and the muscle. Because what’s happening, is the skin and the muscle is going around that toy and not actually doing what you’re intended to do by using the toy in a way that is constantly moving and is constantly opening and closing the muscle and skin. So I tell people, I actually don’t love people leaving toys in, because what happens is the muscle and the hemorrhoids tissue, they’re the veins, they start to swell. And then when you try to get the toy out, a lot of people it causes tears, it causes irritation, and you’re not actually trying to do what it’s intended to do. So the motion of toys is, I’m going in and coming out. I’m constantly pushing so that the muscles are actually opening, and then coming back to its state. Opening and coming back. If you put the toys that most people are talking about, the muscle goes around the toy in it stays completely contracted for 5, 10, 15 minutes. And that’s not actually doing what we’re trying to do so. I think, you know looking on our website at, we have a protocol of different toys, and why we like it. Also it gives you the six-week protocol of, this is the right way to start bringing toys into your world. And obviously on the Future Method side, it’s really looking at things scientifically. The sex world is not regulated. You need to be very, very, careful with what people are saying and doing and really do your homework. Decide all right well, what companies are starting to bring scientific rationale into everything that we’re doing? And it’s about time that we hold everybody accountable, even the medical space because they all know sexual education as it relates to being a physician in specific communities. So I applaud you guys too for kind of constantly bringing these topics to light and so on. Thank you for having me.

Jess (37:36):

It’s our pleasure. So folks can check that out at to learn more about how to actually use these toys so really appreciate that. Thanks for joining us today.

Dr. Evan Goldstein (37:46):

Thank you guys so much.

Jess (37:48):

And thank you for tuning in, be sure to check out our sponsor, and keep your questions coming because next week we’re going to be answering a whole bunch. So wherever you’re at folks, hope you’re having a great one.


You’re listening to the Sex with Dr. Jess podcast. Sex and relationship advice you can use tonight.