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A nurse guides me through the eerily sterile halls of NYU Langone Hospital into a big room dense with bulky machinery and six medical staff in starch blue gowns. There is a solitary long table in the center, dressed in thick wax paper and topped with a purple styrofoam pillow. As I approach the operating station, I instinctively go to lay face down — it is butt surgery, after all — but no, the anesthesiologist turns me around so my eyes stare up into hers.
“Just something to relax you,” she says, after putting my IV in.
Three hours later, I wake up in a different room, with no memory of what happened in the interim. “Oh, hello!” the nurse at my bedside exclaims. “Everything was a success,” she quickly affirms. And there it was, after ten years of unsuccessful bottoming attempts, I woke up from surgery one Tuesday morning with a newly dilated sphincter, now medically cleared to receive during sex with ease. “It should no longer be a challenge,” the colorectal surgeon tells me with a cheeky smile when he comes to check on me a few minutes later.
Botox, it turns out, doesn’t just work miracles on the face.
“Well, I’m not necessarily a top by choice,” I said on a date a few years prior to this procedure. “In fact, I want to bottom for you.” I explained to this Hinge Guy — who by the way had lied about his height and didn’t have the sense of style to match the edgy Brooklyn neighborhood we both lived in. “I’ve just never been able to take more than half a finger without profuse bleeding.”
“Well, have you tried poppers?” he said. “Yes,” I replied.
“You probably just haven’t met the right guy,” this badly dressed Hinge boy said.
“No, I have had sex with a lot, lot of men,” I promised him.
“It’ll be different with me. I’ll prep you, I’ll go at your pace. We’ll take our time together,” he said. I paused, inhaled, and said, “I don’t know how to tell you this, but I have a clinically tight a**hole.”
He stopped speaking and stared at me while he assessed if he had heard me correctly. His expression changed from puzzled to intrigued to impressed (beguiled, perhaps?) before returning to doubt. “Just let me try.” Sigh.
In my almost ten years of a sexually active lifestyle, I had never been able to bottom, and certainly not due to a lack of trying. In every attempt, I’d wince from immense pain upon initial entry and begin to bleed if something proceeded further anyways. It wasn’t sexy and it certainly didn’t feel good. And so, I made my peace with it: I would be a top until the day I died. Who needed the bottoming experience so many of my friends cheered about? I trained myself not to want it until, at 22 years old, I couldn’t resist it any longer.
After exclusively dating a man we’ll call Julian for over a year, I was overcome by the feeling that I was depriving our relationship of a deeper intimacy by never having bottomed for him. One night, after three glasses of wine and a serendipitous low-intake diet, I hatched a plan and told him I wanted to try. “I don’t want to hurt you,” Julian said, glancing down at his crotch. We both knew he had anything but a starter penis. What’s the worst that could happen? I thought.
I ended up in the emergency room that night. Despite plenty of prep, poppers, and patience, I was torn open, bloody with fissures beyond control. The attending doctor applied a steroid ointment and set me up to see a colorectal surgeon the next morning.
“Here’s the inside of your butt!” the colorectal doctor said as he slapped an X-ray of my intestines on an LED-backlit screen. He pointed to my sphincter: “It’s smaller than what the average person has.” I looked on in awe. “Well, not necessarily ‘smaller,’ but it won’t open to do what you’re trying to do.” Slightly bashful, I asked if this was my bottoming prophecy, forever making it out of the question for me. Medically assigned top, I pictured my Grindr bio reading. But no, the doctor said, there was something he could do to try to enlarge my sphincter.
A “lateral sphincterotomy” was what he recommended. He said it was a small procedure to make a small incision on my sphincter, granting it the capabilities to allegedly accept or expel anything with ease. The colorectal surgeon said he performs about two to three of them a week. “Think about it,” he said.
And I did, for about four years. In that time, I moved out of the American South and made my way to New York City, where I later learned the colorectal doctors here seem to have a bit more familiarity with using an anus for sex than those in the South. In those four years, I had also largely retreated away from the prospect of bottoming. I had answers to why it couldn’t happen, but the possibility of a resolution felt cumbersome: Between navigating health insurance obstacles, taking time off for recovery, and having intimate conversations with non-queer people about the surgery, would any of it be worth it?
On another night kissed by alcohol — this time, whiskey sours — I went home with a bearded man who enticed me with not only his captivating charisma, but also his self-proclaimed topping knowledge. He was a physician —what kind, I don’t remember — but he said he’d be able to properly navigate my diagnosis. A solid attempt later, there I was again, met with the same fate I had years ago, bloody, embarrassed, and desperate for steroid cream. I saw a colorectal doctor as soon as I could.
“There are three types of bottoms,” Dr. Evan Goldstein, CEO of Bespoke Surgical, anal surgeon, and author of the queer-centered anal sex guide Butt, Seriously tells me. (I interviewed Goldstein for this story, but I am not his patient.).
In his book, Dr. Goldstein playfully identifies these three types as: “Anus Maximus,” which describes about 39% of the patients he sees who can “open [their] hole easily and accommodate whatever length or girth [they] desire,”; “Anus Mediocris,” encompassing about 52% of his patients who “experience some pains in the initial stages of anal sex,” but can sometimes bottom successfully depending on the circumstances and size of entering mass; and then “Anus Nope-us,” about 9% of his patients who have never been able to bottom successfully, frequently bleed, and cannot dilate their sphincters on their own.
From my own NYC-based colorectal doctor — let’s call him Dr. Butt — I learned that I fell somewhere at the low end of Anus Mediocris and beginning of Anus Nope-us.
Dr. Butt looked at me in horror when I first shared that I had been recommended a lateral sphincterotomy. He said this was a last-resort procedure and should not be advised to patients struggling with bottoming, maybe for patients with severe hemorrhoid issues. According to Dr. Butt, a lateral sphincterotomy is irreversible and sometimes results in incontinence. It can perform miracles for someone who suffers from severe constipation, but for people who are seeking it to bottom with ease, it could make things worse, opening them up to the possibility of anal infections and a higher chance of developing fistulas.
“Most people don’t need a sphincterotomy,” Goldstein tells me, arguing that anal doctors who recommend the procedure often do so because they measure success in treating anal discomfort by the ease of what’s coming out — not what’s coming in.
In his book, Goldstein shared that he himself was a victim of an “ill-advised” partial sphincterotomy. To begin bottoming, Goldstein first needed another surgery to correct his previous sphincterotomy before beginning anal botox injections. “In just a few weeks, I’d reached the top of my anal game,” he writes.
Botox? “Yes, botox,” Dr. Butt told me during our consultation. I looked at him, deeply confused. In all I had ever heard about botox, I assumed it was an injection to shrink muscles never to dilate them.
“Sex is not overtly complicated. It’s skin and muscle,” Goldstein explains. “Many people are able to relax their muscle, but their skin won’t fully open. The pressures of sex can then cause an anal fissure which is a tear.” He explained that the botox paralyzes the sphincter muscles and prevents them from contracting, bringing people “into the range that we need for [them] to actually dilate.” After this, patients can then better train their sphincters to dilate with toys or other people and expand it for sustained future sexual use. (Yes, I did walk away from my surgery with a homework assignment.)
At first, I felt overcome with anxiety when Dr. Butt explained the botox procedure, discouraged by the idea that something was wrong with me and feeling a renewed hate of my body for not opening up the way I wished it could. Why couldn’t I be in the 39% or even close to the 52%? Dr. Butt and I sat in a moment of silence while I evaluated the anal botox prospect. Several seconds passed.
He rested a hand on my shoulder and said, “If you want to bottom, there is nothing wrong with that and we can make it happen.” I held onto each of these words tightly and even today, they are forever ingrained into my brain. Throughout my years of feeling restricted in what I could do in bed, constrained by the assumption I would forever be unable to bottom, this was the first time anyone had assured me in my sexual desires and supported me in a journey to fulfill them.
I asked Dr. Butt — and later Dr. Goldstein — what might cause someone to be in the “Anus Nope-us” category and both shared there are certainly some elements of genetics involved. Family members who have a history of hemorrhoids could be one indicator, they say. But it could also be trauma-induced, stress-induced, or just how your body is shaped. “People born with prostates also have naturally tighter sphincters,” Goldstein says. “How tight that sphincter is or isn’t is truly different for everyone.”
I never expected receiving 100 injections of Botox into my sphincter to be such a deeply emotional experience, but there I sat in NYU Langone Hospital, staring up at the white popcorn ceiling, feeling like a wholly different person, bottom-capable by my own choice.
At first, I felt inclined to keep the procedure a secret. I already felt stigmatized for pursuing queer sex, so why open myself up to more shame by talking about a series of injections I had to make it easier? But in the days following my surgery, I found myself sharing the news with everyone I knew, from unsuspecting strangers at gay bars to friend’s new partners I was meeting for the first time. Shockingly, many had a related story. One whispered into my ear he had botox injections just three weeks ago and another pulled out their phone to schedule an appointment with my doctor on the spot. For others, there was a shared discomfort at first, but soon, they too reveled in my excitement: After 10 years, I could bottom! Shout it from the rooftops!
It wasn’t fair to anyone to hide this surgery in shame because it is that very shame that pushes too many of us into painful bottoming experiences. It’s what tells us that “yeah, bottoming is always going to hurt,” when nearly 61% of us need some form of training or support to reach a level of comfort and joy, according to Goldstein. From having a clinically tight asshole to writing about my dilated sphincter on the internet, here I am, 100 units of botox in, ready to have the sex I want to because now, I can.
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