Tales from the Tail — What to Do If You Have a Loose Anus

Dr. Evan Goldstein
Apr 10, 2018 · 6 min read

Client’s Tale

Let’s set the stage a bit. I usually have a full yearly anal examination with consultation, both external and internal evaluation with what’s called an anoscope, and STD screening with an anal Pap smear (done via basically a scraping using q-tips). From my knowledge on its use, it seems to prevent anal cancers, which are prevalent in the gay community. With that, I was at the appointment at Bespoke Surgical and me and Dr. Goldstein were doing the anal examination. I proceeded to get into the left side fetal position and Dr. Goldstein began the exam. Before I knew it, the exam was completed — both swabs and an internal and external evaluation were performed. I embarrassingly admitted that, unfortunately, I didn’t feel any of it. Though Dr. Goldstein was great to give me cues as to what was being done, I didn’t even know that the evaluation had actually commenced. I, of course, was jokingly poking fun at myself, but right away my mind went to me possible being too “loose”.

After the exam, I did have enough courage to bring up the above stated facts and we spoke at length on the issue. Come to think of it, it’s interesting because, over the past few years, I have had several instances with partners where not only did they make mention of my non-stimulatory asshole, but also it was hard for me to keep an erection, let alone get off. I had attributed my erectile dysfunction more to my age, but actually I am able to top and masturbate without issues. So I asked, “Do we think my looseness (better known as ‘elasticity’) is a hindrance to my bottoming world?”

The remainder of the visit, we highlighted many different perspectives on the issue and, after further research and self-realization, I came to conclusion that if I wanted — which I did — to continue with anal play at the highest level, something needed to be done. We spoke of at-home or gym pelvic exercises to assist musculature growth, consultation and treatment with a certified pelvic floor therapist, better anal intercourse techniques, and, finally, surgical options to assist my dilemma.

We re-evaluated my progress over the subsequent months and even though their was some improvement, it was still very sub-par and truly impacting my sex life. I decided to undergo a tightening procedure of both the muscles and extra skin folds to assist in enhancing both me and my partner’s overall sexual experience. Some of my friends said I was fucking crazy, but I gotta tell you — the looseness was fucking with my head and overall sexual identity — and not in a good way. Something needed to be done. And in the end, it was the best thing I fucking did.

The surgery and the initial healing sucked big time. But within 6 weeks time, we were already back to the pelvic floor work and I could feel and see such a huge difference. I remember my first sexual experience with my new hole, and fuck, what an orgasm for both of us! I let him breed me and his warm liquid felt like it was in my soul. I was just right behind him — in ejaculating that is — and I felt like my twenty-five year old self again. So good a feeling, I asked to do it again.

It has been 9 months since the surgery and I must say, I should have done this corrective procedure years ago. Total fucking game-changer. I am now back to being solely a bottom. Fuck, yeah!

My Discussion

I spend a lot of time educating my clients on the right way to begin engaging as a bottom, but after years of anal play, something else many bottoms are concerned with is the possibility of loosening up their sphincters too much. So this begs the question: is this a legit concern and, if so, what steps can be taken to prevent a loose anus?

Unfortunately, a loose anus is a real possibility, especially if people push their sphincter’s boundaries of relaxation. Most of the people who experience a loss of function tend to like bigger toys or penises, and/or engage in fisting. All of these factors can definitely, in due time, cause the anus to loosen itself beyond repair.

What Causes a Loose Anus?

Being able to open up to receive a toy or penis is a skill that has nothing to do with increased distensibility or how most describe as having a “loose anus” and instead, has everything to do with mind over matter and anal sphincter control. Honing into this skill set — being able to control the reflex — and modulate to the degree of maximal pleasure is a true art and takes practice. However, when someone engages in fisting and/or any excessive dilation, this is when someone opens themselves up (no pun intended) to the possibility of a loose anus. This is because one can stretch the muscles beyond recoil, causing damage. Our muscles are normally able to relax to a degree and it definitely has a maximal capability of opening. If one pushes beyond the boundaries excessively one time or beyond the boundaries over one’s lifetime, it can lead to a loose anus. Also of note, specifically within the LGBTQ+ community, enema use and/or distention from long-term cleansing can also cause “looseness”. If one actually needs any cleansing at all, the intent should be: less distention and more gentle irrigation.

Basic Symptoms

All of the ramifications depend on the degree of elasticity. It can range from decreased sensation during anal intercourse/play for you and your partner to more extreme symptoms, like gas or fecal incontinence and/or a sensation that one’s insides are prolapsing. The goal is to understand all of the issues surrounding the increased elasticity, with prevention and/or regular monitoring to improve outcomes.

Butt Plugs

With that said, when I recommend that my clients use butt plugs to assist relaxation while preparing to bottom, the opposite can be done as well. In other words, you should use butt plugs to tighten and strengthen the muscle around the plug, just like you would at the gym working out your biceps. A few times a week of contraction work will go a long way when it comes to muscle preservation. Proper techniques and muscle hypertrophy with these tips should set you straight (but don’t worry — not that straight!). In addition, gluteal work with squats and kettle bells can set up muscular growth and/or stability.

When Is it Time to See a Doctor?

As mentioned, though, sometimes using a butt plug simply isn’t enough. Which leads us to the next question: at what point is it time for someone to go see a doctor? And what type of expertise should the doctor have in order to be able to provide the best remedy for a loose anus?

If you have tried all of the above without improvement, seeing a physician with extensive knowledge on anal intercourse with all of its ins and outs is imperative. The intricacies of the science of bottoming is quite vast and since we only have one asshole, correct initial management is a must. It all starts with an appropriate and detailed non-biased sexual history. During a full external and internal evaluation, a lot of information can be obtained, assessing for whether or not there is a functional abnormality, like hemorrhoids, skin tags, or muscular laxity leading to the lack of coaptation. Full muscle evaluation in both a relaxed and contracted state provides more useful information, especially functional.


With all of this, one can understand form, function, and the aesthetic issues surrounding a loose anus, with planning appropriate corrective actions. The mainstay is medical optimization, plus or minus pelvic floor therapy or surgical corrective approaches tailored to each client’s needs. A tighter hole with more control can lead to normalization of defecation, no sudden accidents, an improvement in sexual stimulation, and overall wellness for both you and your partner(s).

Check out more on our website.

Stay in touch on Instagram: me and Bespoke Surgical.

Dr. Evan Goldstein

Written by

NY | LA Gay Surgeon discussing ASS: A\rt, S\cience, and S\ex www.bespokesurgical.com/

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