0:03

You're

0:04

listening to the Sex and Psychology Podcast,

0:06

the sex ed you never got in school and won't

0:09

get anywhere else. I am your host,

0:11

Dr. Justin Lehmiller. I am a social psychologist

0:14

and research fellow at the Kinsey Institute and

0:16

author of the book Tell Me What You Want, the

0:18

Science of Sexual Desire and How It Can Help

0:21

You Improve Your Sex Life. In

0:24

recent years, anal sex has become an increasingly

0:26

common sexual activity. More

0:29

and more people report having tried it, it

0:31

has become a staple of modern pornography, and

0:34

discussions about it are on the rise in popular

0:36

media. Notably, however,

0:38

it's a subject that continues to be ignored

0:40

in almost all sex education, which

0:43

means that people generally have to learn about it

0:45

all on their own. And it turns out that

0:47

there's a bit of a learning curve. So

0:50

let's discuss the ins and outs of anal

0:52

sex. In today's show, we're

0:54

going to explore how to approach this activity

0:56

in ways that are safe and pleasurable, why

0:59

some people find it to be painful and what

1:01

you can do about that, as well as some

1:03

common myths and misconceptions surrounding

1:05

this sexual activity. My guest

1:07

today is Dr. Thomas Gaither, a physician

1:10

who is currently finishing up his urology residency

1:12

at UCLA. In addition

1:14

to conducting research on LGBT health and

1:16

sexual medicine, he is an active TikTok

1:19

creator teaching the masses about sexual

1:21

health. You can find him on TikTok

1:23

at thatprostatedoc. I

1:26

can't wait for this conversation. Stick

1:28

around and we're going to jump in right after the break.

1:33

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2:29

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2:31

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2:33

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2:35

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2:37

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2:40

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2:43

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and Instagram. Thank you for supporting sex

2:54

science. Hi,

2:58

Tom, and welcome to the Sex and Psychology

3:00

Podcast.

3:01

Hi, Justin. How's it going? It's going

3:03

well. Thank you so much for making the time to speak with

3:05

me. So you are a physician

3:08

finishing up your residency in urology, and

3:11

one of the main things that you research is anal

3:13

sex. And you also run a popular

3:15

TikTok account where you break down the data

3:17

and research for your viewers. So

3:20

let me start by asking, how did you get

3:22

into the world of sexual medicine in the first place?

3:25

And why focus on anal sex?

3:28

Yeah, that's a great question. You go

3:30

to many years of medical school just to

3:32

focus on anal sex. I've had a

3:35

wide range of responses to

3:37

that. But in general, the

3:39

main reason why I've decided to study

3:42

that is because there

3:44

are so many things, so many different types of surgeries

3:46

that we do in urology that

3:48

I think can impact it, but we have no

3:51

idea on actually how it really

3:53

does it. It's just such a hidden

3:56

taboo subject that nobody really wants

3:58

to focus on. in urology,

4:01

we have a lot to do with erection,

4:03

erection, erection, and everyone wants to make sure that the erections

4:06

are rocking and rolling, but nobody

4:08

has really paid attention to the other side

4:11

of things and how so many

4:13

of our procedures could possibly

4:15

affect it. And so that's really what

4:17

initially drew me into it was that I think

4:20

that there was a true need and people

4:22

wanted information about it, but

4:24

really didn't have a doctor to go to about

4:26

it. Yeah,

4:27

thanks for sharing that. And I

4:29

think it's so true that in the world of medicine

4:31

in general, the anus generally

4:33

isn't viewed as a sexual organ.

4:36

People tend to think about it more in terms

4:39

of bowel function and obviously

4:41

that's important. But for example, if

4:43

you think about the world of proctology

4:45

and when people go in for treatments for hemorrhoids

4:48

and other things like that, their main focus

4:50

is preserving bowel function,

4:52

not thinking about how that organ

4:54

might play a role in sexual function for some people.

4:57

And so I think it is really important to have

4:59

people like you in the field who are studying this because

5:01

a heck of a lot of people engage in natal

5:03

activities, right?

5:04

Absolutely. And it's funny that you break this

5:07

up because I'm actually, as part of my research,

5:09

one of my mentors is a colorectal surgeon.

5:11

And you know, she says that

5:13

they see people all the time who have receptive

5:16

anal intercourse and have maybe issues with

5:18

it, but they kind of throw their hands up

5:20

in the air and they're not really sure what to do. They scope

5:23

them, they do a good exam, and then they're saying,

5:25

hey, I can't find anything that I can do. So

5:28

good luck sort of thing. And she's

5:30

been phenomenal as a mentor as well,

5:32

just to give her a sort of anatomic and

5:35

surgical lens to the work. But

5:37

it is another important thing that

5:39

even proctologists, even colorectal surgeons,

5:42

they are all about maximizing bowel

5:44

function, but they really don't have any

5:47

training or understanding on, you know, what

5:49

is the role of anal rectal sexual function?

5:52

Yeah. And so that's why we need the data. We need

5:54

to know what are people using it for? What are the

5:56

issues that they might experience? How can we best help

5:58

them? So again,

5:59

have people like you in the field who are collecting

6:02

our data on this. So we're going

6:04

to be talking about the ins and outs of anal

6:06

sex today, as well as some common myths and misconceptions.

6:10

Let's begin with who does it, you know,

6:12

who's into this activity. And there's

6:14

a common stereotype that anal sex

6:17

is quote unquote gay sex, but

6:19

we know that's not true. So tell us a little

6:21

bit about who's practicing this activity

6:24

and what we know about how common it is.

6:27

Well, the best data that's been out,

6:29

I think is was maybe about five or six years

6:31

ago, is a national study actually out of

6:33

IU, where they asked people

6:35

about all different types of sexual practices.

6:38

And it was a nationally representative

6:40

sample of people 18 to 65. And you know,

6:42

they found about 40% of women in the United

6:47

States have had receptive

6:50

anal intercourse sometime in their lifetime.

6:52

And for men, this was about 10%.

6:56

Now, we do know that the percentage

6:58

of gay and bisexual men is probably

7:00

anywhere from four to six percent, which

7:02

is not 10%. So we know

7:05

that there are people of all

7:07

orientations that are undergoing

7:09

receptive anal intercourse. And what

7:11

I like to try to remind people is that receptive

7:13

anal intercourse or anal play, whatever

7:16

anal sex, it's a behavior,

7:18

it's not a sexual orientation. And

7:20

there's a lot of people who practice

7:22

it outside of the gay world. And

7:24

there's actually, believe it or not, a lot of gay men

7:27

who don't like it. Like I said, it's

7:29

a behavior, it's a tool, it's a one way

7:31

in which to have sex, but it's not the only way.

7:33

Yeah,

7:34

and I appreciate you bringing all that up. I actually

7:37

did an episode a little while back with Dr. Joe

7:39

Court, who has written extensively

7:41

about gay and bisexual men who identify

7:44

as sides, you know, these are men who

7:46

have sex with men who aren't into anal sex,

7:48

right? So that idea of anal

7:50

sex as gay sex just isn't true

7:53

at all. And actually, most of the people in this world

7:55

are practicing it are heterosexual adults.

7:57

So it's a much more common activity than being

7:59

a gay person. people might think it is, and it's practiced by people

8:02

of all genders and sexual

8:04

orientations. And it's something that seems to

8:06

be on the rise. I mean, if you look at data going

8:08

back a few decades, it's a practice

8:10

that is becoming increasingly common, which

8:12

is another reason why we need more data

8:15

on it. So yeah, again, there's

8:17

still a lot that we don't know, but it is becoming

8:19

an increasingly common sexual practice. Now,

8:23

let's talk about people's reasons or motivations

8:25

for having anal sex, particularly as

8:27

the receptive partner or bottom, is there

8:29

sometimes called because that's where most

8:32

of your work in this area has fallen. Now,

8:34

intuitively, people would probably guess

8:37

that somebody who's engaging in that activity

8:39

or pursuing it does so because they find

8:42

it to be pleasurable. But in your research,

8:44

that's not the only reason that emerged. So

8:47

tell us a little bit about why people

8:49

engage in this activity and what they're getting

8:51

out of it.

8:52

Yeah, that was the first thing that we kind of started

8:54

with, you know, because there wasn't a whole

8:56

lot of medical research on the

8:59

anatomic reasons why I mean, pleasure

9:01

and pain and all of the stuff with anal sex.

9:04

We started off with just talking to people

9:06

and just did qualitative interviews and

9:08

focus groups and one on one interviews. And

9:10

that was one of the main questions we asked people, it's like,

9:12

why are you doing this? Why would anybody want to do

9:15

this sort of thing? And, and overwhelmingly,

9:17

the number one thing that people say, as you said, was

9:19

pleasure, they found it to be pleasurable.

9:22

And that's the reason why they continue

9:24

to do it. But there's a lot of other

9:26

reasons why people do engage it. One

9:28

of the other big reasons was that they wanted

9:30

to give their partner pleasure. And

9:33

that was a motivating factor for a lot

9:35

of people that it, you know, somehow

9:37

enhanced their relationship, it enhanced

9:39

their sexuality, and they wanted to give their

9:41

partner pleasure. However,

9:44

another group of people said that,

9:46

you know, they never really had a desire

9:49

to be the insertive partner. But there was something

9:51

about like, either they have erectile

9:54

dysfunction, or they just, they

9:56

never really liked being an insertive

9:58

partner. And so they which tended

10:00

towards bottoming. Another

10:03

reason why some people are introduced to it is

10:05

because they had surgery or they

10:07

had some sort of prostate problem. We

10:09

did talk to somebody who had

10:12

come out later in life and he was always

10:14

the insertive partner and he had his

10:16

prostate removed. And unfortunately then

10:19

he had a lot of erectile issues. And

10:21

so he's like, heck, I wanna still have sex. Let's

10:24

try being the receptive partner. And

10:26

then he found that he really, found it to

10:28

be pleasurable. That was one of the reasons

10:30

that brought him into bottoming

10:33

was because of his erectile issues.

10:36

Yeah, so it can be about your own pleasure. It could

10:38

be about your partner's pleasure. It could be about

10:41

function related issues or just personal preferences.

10:44

I think I remember reading in your research that for

10:46

some people it also felt validating

10:48

to them in terms of their gender role

10:50

or expression or identity. And so, there

10:53

could be all different kinds of things that might motivate

10:55

people to want to engage in any

10:57

given sexual behavior, not just anal

10:59

sex, but if you look more broadly, like why

11:01

do people do anything when it comes to sex? Yes,

11:03

pleasure is one of the big reasons there at

11:05

the top of the

11:06

list, but we're not so simple

11:08

when it comes to sex. It's not always just about

11:11

your own pleasure or just about having

11:13

an orgasm because we get so much more

11:15

from sex than just that physical pleasure.

11:18

Now, something else I saw in your research

11:20

is that, well, yes, a lot of people report

11:22

pleasurable sensations during receptive anal

11:24

sex. There are also a number of other

11:27

sensations that many of them reported experiencing

11:29

as well. So besides pleasure,

11:32

what are some of the other things that someone might feel

11:34

during anal sex?

11:36

Well, the most glaring one that everyone talks

11:38

about is pain and overall

11:41

I want to emphasize that the majority of people who

11:44

have anal sex actually don't have

11:46

a lot of pain. They figure it out throughout

11:48

the years with lubrication or

11:51

communication, how to accommodate

11:54

some sort of a phallus

11:56

or toy with a sort of minimal

11:58

pain, but pain can... certainly

12:00

a sensation that you experience. And

12:03

from talking to people, people

12:05

typically feel pain at different

12:07

times. The first point of pain,

12:10

of course, is the moment of insertion. So

12:12

when the penis sort of first goes in,

12:14

you know, there's a lot of stretching of the

12:16

anus. There can even be stretching of the pelvic

12:18

floor, which is a little bit farther in. And

12:20

just like with any muscle, if you stretch

12:23

a muscle too fast, it can be painful.

12:26

So pain is definitely one. And then the other type of

12:28

pain is just pain at other times

12:31

during receptive intercourse. And

12:33

that can be, you know, sort of friction or

12:36

lack of lubrication. Or if

12:38

the, you know, penis is rather long, it can kind

12:40

of get up near the sigmoid. And that

12:43

can kind of give you the sort of punched in the gut sort

12:45

of feeling. So definitely

12:47

pain is one thing. And that's something that we're

12:49

still trying to work out of, you know, how do

12:51

we tease out someone's pain? And

12:54

how do we make that better for them? But

12:56

just was with anything in the pelvis, other

12:58

sensations are like the urge to pee. So

13:01

the bladder is right above the

13:03

prostate. And if you have a full bladder during

13:06

anal sex, you can sort of feel that

13:08

sensation. And the

13:10

other big one is the urge to poop. So

13:12

especially when people are first engaging

13:15

in receptive anal intercourse, they

13:17

get a big urge to have

13:19

to defecate. And their brain

13:22

sort of hasn't registered that

13:24

this is not poop. And so some people,

13:26

especially at the beginning, don't like it because

13:29

they get this sensation that they have to poop.

13:32

Yeah, so it can be a range of sensations.

13:35

There can be pleasure. There can be some of these other things

13:37

at the same time. But since pain

13:39

is something that some people experience during this activity,

13:42

let's talk about that a little bit more. So

13:45

what should someone do if they're experiencing

13:47

pain during anal

13:49

sex or afterwards? When

13:51

should you be concerned about it? And do you have any

13:54

tips on like how to address that or how

13:56

to reduce or minimize pain?

13:58

Yeah, well, the first question I ask

14:00

anybody who's having pain with receptive

14:02

anal intercourse is how many times

14:05

have you done it in your lifetime? So

14:07

people who are have less than 10 experiences

14:10

versus people who've had done it 500,

14:13

1000 times are going to, I think about them completely

14:15

differently. So if you're first

14:17

having anal sex and you're

14:19

having pain, the first thing I think about are

14:21

you having enough lubrication? Are

14:23

you giving enough time to allow

14:26

some accommodation? So when the penis

14:28

first goes in there, you have to have some

14:30

moments before you just kind of go to pound town,

14:33

sort of say, where there is some

14:35

accommodation of the muscles and things

14:37

are appropriately stretched. And

14:39

that has a lot to do with communication. So who

14:42

is your partner? Is this somebody random

14:44

that you met off the internet? Is this somebody who

14:46

you've been with for, you know, some time?

14:48

It's kind of about talking to people. I

14:51

remember one person from my interview, he always

14:53

used to say, I had a lot of pain when

14:55

it first went in. So I learned that

14:57

the best way for me to deal with it is just

14:59

to sit on it so that he could have control

15:03

throughout the process, as opposed to somebody else

15:05

kind of just shoving it in sort of willy

15:07

nilly. So there's an aspect

15:09

of control, there's an aspect of speed.

15:12

And of course, there's an aspect of lubrication.

15:14

Now, if you're somebody who's had anal

15:16

sex for years and years and years and years, then you

15:18

haven't had pain with it. And now all of a sudden

15:21

you were having some pain. That

15:23

is something that I'd be concerned about and

15:25

something that I would like people to come

15:27

and see people like me. Because

15:29

one thing that we're starting to realize is that

15:32

men with enlarged prostates actually

15:34

have more pain with receptive anal

15:36

intercourse than not. People

15:39

often think of the prostate as a maybe pleasure

15:41

center. But it turns out if the prostate

15:44

is enlarged, it can have less room

15:46

in the rectum that there was before. And

15:48

people do complain of pain. The other

15:51

thing that you can possibly be is like

15:53

a hypertonic pelvic floor. So

15:55

there's muscles all over the body, but there are of course

15:58

muscles in the pelvis. those

16:00

muscles are tight or hypertonic

16:02

is another word for that, something

16:05

like stretching or pelvic floor

16:07

physical therapy might be

16:09

ways in which that pain can be reduced.

16:12

Yeah, I appreciate you making that distinction between

16:14

pain associated with beginners versus

16:17

pros when it comes to this activity because

16:19

you might be dealing with a very different set

16:21

of issues there. And there are

16:23

a lot of people who have tried receptive

16:26

anal intercourse like once or twice

16:28

and just say it's not for them because it was

16:30

painful. But maybe it was because

16:32

they just weren't approaching it in a way that allowed

16:35

the possibility to experience pleasure

16:37

because they just tried to go too

16:39

quickly, right? And you know, that's something

16:41

that where I think porn sometimes gives

16:43

people the wrong idea is like you just kind

16:46

of stick it in and go and you can have

16:48

long hard fast sessions. And it's like,

16:51

you know, the reality of how people

16:53

might do this is very different from what you might see

16:55

on film. And so if you're trying to replicate

16:58

something else that you've seen, that might not be at

17:00

all what works for your body.

17:02

This actually reminds me of a study that

17:04

what they did in women in Europe,

17:07

where they asked them, everyone who had had

17:09

anal intercourse, and why did you

17:11

discontinue it. And the main

17:13

reason why people said that they didn't want

17:15

to do it again is because it was so excruciating

17:17

the first time. And it's really

17:20

interesting that when they studied and

17:22

they surveyed these women, only one

17:24

third of the women had used any lubrication.

17:27

So for the women out there, I mean, the

17:29

anus and the rectum is not naturally lubricated

17:32

for either men or women. So lubrication

17:35

is a huge component.

17:37

Yeah, lubrication is definitely

17:40

key. As you mentioned, also communication

17:42

is really important. I think there's also an

17:44

element of sometimes people just

17:47

aren't a great fit for one another genitally,

17:49

you know, sometimes, and I made this point before

17:52

on the podcast, sometimes your eyes

17:54

are bigger than your holes are, right? And

17:56

when you live in a society or culture that

17:58

sort of puts the...

17:59

this value on extra

18:02

large penis size, you

18:04

might find that visually that's

18:07

appealing to you, but practically

18:09

like having sex with that might

18:11

not work for you. And so, you know, that's

18:13

another thing to add into the mix. Sometimes when people

18:15

are experiencing pain, well, maybe it's because

18:17

you're with a partner who just is exceptionally

18:20

large. And, you know, if you want to

18:22

try and have sex with them in a way that is going to be

18:24

pleasurable, you might have to approach it very differently,

18:27

very slowly work up to

18:29

it, build up to it, because yeah, not all

18:31

penises are interchangeable by any stretch

18:34

of the imagination. Yeah, that's

18:36

pun intended, yes. Now,

18:39

a question I've heard from a lot of folks over

18:41

the years is whether receptive anal

18:44

sex causes long-term damage to

18:46

the body. And specifically, some

18:48

people have asked whether engaging in this activity

18:50

frequently can lead to things like

18:52

incontinence or other problems back there.

18:55

And I think you've done some research that can speak to

18:57

this. So what can you tell us about whether

18:59

there's any association between frequency

19:01

of anal sex and anal problems?

19:05

This is so important. And I want

19:07

to sideline talking about

19:09

sexually transmitted infections or, you

19:11

know, HIV, things like that, because we

19:13

kind of know what causes that. And

19:16

that is sort of sleeping with a lot

19:18

of people or it has a lot to do with more of the

19:20

partner than your own anatomy. So

19:22

I just wanted to talk about the long-term

19:24

effects of just like having something

19:27

inside your anus and rectum for many,

19:29

many years. And we surveyed

19:31

people and we asked them, you know, how many times

19:33

in your life have you bottomed? And we had

19:35

people who just said, hey, I just done it three times.

19:38

The people who've done it well over 500 into

19:40

the thousands. And,

19:42

you know, the one thing that we do think

19:45

anal sex puts you at risk for is anal

19:47

fissures. And anal fissures are basically

19:50

small tears in the anus that

19:52

usually heal on their own, but sometimes

19:55

do require some help along with,

19:57

you know, colorectal surgeons, but in general.

20:00

general, as your number of bottoming

20:02

experiences has increased, the prevalence

20:04

of anal fissures increased

20:06

as well. But we didn't find

20:09

anything else correlated with the

20:11

amount of times that people had anal sex. So

20:14

like an enlarged prostate, prostate cancer,

20:16

rectal cancer, we even looked

20:19

at hemorrhoids. So people had the same

20:21

number of hemorrhoids. Hemorrhoids

20:23

are really from constipation and straining

20:25

with voiding. It's almost like pressure going the other way,

20:28

not pressure going in. So there's

20:30

a big misconception that anal sex causes

20:32

hemorrhoids. And I would love for people

20:34

to realize that hemorrhoids is not from anal sex,

20:36

it's actually more from your diet and your

20:38

water intake and your fiber intake.

20:42

Now we didn't specifically ask about

20:44

fecal incontinence and I wish that we

20:46

would have. Now there are some studies

20:48

that have looked at it, these like sort of big database

20:51

studies. There was a small

20:53

relationship between lifetime

20:56

exposure to anal sex and

20:58

fecal incontinence but the severity

21:01

of fecal incontinence wasn't really measured

21:03

and there's a lot of issues when you have these

21:05

sort of big database studies and codes

21:07

for incontinence as opposed to actually

21:10

examining the patients and figuring out is this something

21:13

that is really affecting your quality of life. So

21:15

I think the jury is still out

21:17

there for whether or not it causes

21:20

fecal incontinence. I will say I don't

21:22

think that it, I can't imagine

21:24

it'd be a huge thing because the effect size was so small

21:27

in that study but I do think that's something

21:29

that we still need to look out for in study.

21:31

And I think that's also where some

21:33

of these studies might not be very well equipped to answer

21:36

these questions because they're just asking the

21:38

question so generally like, have you

21:40

engaged in receptive anal intercourse or how many times

21:43

have you done it? It doesn't really look

21:45

at what is the nature of the way that you're

21:47

participating in this activity and does

21:50

that include things like fisting or

21:52

you know the insertion of particularly large things

21:55

into the anus and are you using lube

21:57

and you know are you going for particularly

21:59

prolonged sessions and you know so

22:02

there can be so many different things going on there

22:04

that it's I think kind of hard to say like

22:06

here this activity is linked to

22:08

this particular outcome when you don't know anything

22:10

about the nature of the way people are engaging

22:13

in it and you know based on the data that

22:15

I've seen for people who are inserting particularly

22:18

large things and they're not using lube and they're going

22:20

fast and all these other sorts of things

22:23

that's where you might have a greater risk of some

22:25

of those outcomes but the way that most people

22:27

are practicing this activity odds of

22:29

those things happening would seem to be pretty low.

22:32

Yes I agree and we talked to a lot of people

22:34

even in our focus groups who had had sex anal

22:37

sex for you know 20 30 40 years and really none

22:41

of them were talking about having fecal

22:43

incontinence but that's his anecdotal

22:46

evidence so we do need more more work

22:48

in the area but at least

22:50

for that what we had shown and you know the

22:52

only thing that really stood out was it was anal

22:54

fissures.

22:55

Yeah I think it's also important to recognize

22:58

that every person every body is different

23:00

and so some people might be more susceptible

23:02

to problems than others and that's where it's also important

23:05

to know your own body, pay attention if

23:07

you're experiencing things like pain because

23:09

the answer is you know sometimes very

23:11

different for different people in terms of the

23:13

way that they might want to approach activities to protect

23:16

preserve their health. Now for

23:18

someone who is a beginner to anal sex what

23:21

do they need to know right so as we were just

23:23

mentioning it's not as simple as like

23:25

lube up and go right so give us a

23:28

little beginner's guide to this activity

23:30

and for the recommendations that you have

23:32

would they be similar for pretty much everyone

23:35

regardless of gender or are there

23:37

different considerations for different

23:39

people?

23:40

Yeah this is great I mean I think in general

23:43

whatever you may be in sort of male

23:46

or female the approach to anal sex

23:48

is going to be pretty similar. I think

23:50

the first thing you got to know is

23:53

that it may not be that what

23:55

you anticipated it to be when you

23:57

first start out. A lot of people who I've

23:59

talked to Say that their best

24:01

time was not their first time and I don't

24:03

want to discourage people or encourage

24:05

people It's kind of whatever you want to do But but

24:08

I think the best thing is to do it with somebody who

24:10

you can communicate with I think that's very

24:12

very important and Really trying to

24:14

listen to your body The other thing

24:16

I would say is I think it would probably be best

24:19

to do it sober You know not not

24:21

within a sort of any other substance I was on

24:23

board and that you can really listen

24:26

to your body because if if your body

24:28

is giving you signals They says hey, this

24:30

feels like a tearing or this feels like

24:32

a sensation that is not good

24:34

for me It's okay to stop, you know,

24:37

and that's a great time to to bring that up

24:39

But of course lubrication is very very important,

24:41

but that that partner I think is going to be really

24:44

important I think for your very first time

24:46

or first few times also important to

24:48

just be sober So you could really listen

24:50

to your body and hear

24:52

what it's trying to tell you

24:55

Yeah, you know sober sex is

24:57

underrated because so many people

24:59

you know Not just with anal sex but

25:02

with any sexual activity often feel like they

25:04

can only do it When they're in an altered

25:06

state because they might have sexual hang-ups themselves

25:08

or they feel awkward or uncomfortable talking about

25:10

sex And then when you introduce something

25:13

like anal sex into the equation And

25:15

you're in an altered state whether from alcohol

25:17

or other drugs then as you mentioned

25:20

Yeah, you might not be tuned into the sensations

25:23

And you might not pick up as much on

25:25

markers of pain because you've got dull sensations

25:28

generally and that's where you can run

25:30

into potential injuries and other problems that

25:32

arise because You think that you can

25:35

go longer and do more than you really

25:37

should have been doing But you weren't paying attention

25:39

to what your body was saying. So yeah, it's thinking

25:42

about what is your state going in? Also

25:45

that issue of lubrication and communication

25:47

you might also consider things like dilation,

25:49

right? So maybe practicing

25:52

warming up a little bit beforehand so

25:54

that you're in

25:55

a more relaxed state and things go a

25:57

little bit smoother Right. So there's a lot of things

25:59

to consider It's not as simple as just like,

26:02

hey, let's get in bed together and go. Like,

26:04

and that's where I think porn also gives people this misleading

26:06

idea. If they don't see any of that prep work,

26:09

communication about boundaries, places

26:11

where people might stop and take a break, reapply,

26:13

lube, like, it's not like what you

26:15

see in porn.

26:17

That reminds me a little bit of the prep work too.

26:19

So many people talk about what they do to prepare for

26:21

a receptive anal intercourse. I didn't even really mention

26:23

it, but certainly some people use these

26:26

sort of small dilators or small dildos

26:28

to kind of get the anus and the rectum prepared

26:31

beforehand. And another thing that a

26:33

lot of people do is, you know, what do you do about stool

26:36

and stool burden? There's a lot

26:38

of fear and a lot of shame around stool.

26:41

And there's a lot of different ways

26:43

that people do to prepare and probably

26:45

could have a whole podcast just on how

26:47

to clean the rectum of stool. But,

26:49

you know, there's a lot of things that people do, whether

26:51

that be douching or really a high

26:53

fiber diet, lots of water intake

26:56

that people do to limit the amount

26:59

of stool in the rectum. But there's a lot

27:01

of people out there too in my research who

27:03

did nothing. And again, that had a lot

27:05

to do with what kind of relationship they were in

27:07

with their partner.

27:09

Yeah. Let me ask you a question

27:11

about being a sex educator who

27:13

focuses on anal sex. So you talk about this

27:15

on TikTok and, you know, it's

27:18

not necessarily the most friendly platform

27:20

for sex educators in general, particularly

27:23

if you're talking about an issue like anal sex. So how

27:25

do you navigate being a sex

27:27

educator on social media without having your content

27:30

censored or shadow banned? I mean, you can never

27:33

eliminate that risk completely, but tell us a little

27:35

bit about how you navigate that.

27:37

It's, you know, when I first

27:39

made my first video, I didn't

27:41

expect that many people to watch it. And

27:44

it kind of went in there was my very first video,

27:46

I posted like 80,000 people had watched it.

27:48

And I, you know, once you get that

27:50

many viewers, you're going to get the whole bell

27:52

curve of people who are praising

27:55

you and people who think that this is the most

27:57

disgusting thing, like you're going to

27:59

hell. I can't believe you wasted

28:01

all that time, the medical

28:04

degree, you know, I've had people say

28:06

there's not enough cancer to cure anymore,

28:09

like, you know, you hear it all. But

28:11

what kind of motivates me more is really when

28:13

people say, when I see people like I never

28:15

had any idea that this was, this

28:17

is the first time I've heard a doctor talk

28:19

about something that's so affirming to my identity,

28:22

or like I wish I had a doctor like you 10 years

28:25

ago. So all that stuff kind of really

28:27

motivates me. I think when it comes

28:29

to navigating the negatives around

28:31

that, I just kind of use it for more content

28:34

like when people say like, oh, this is unnatural. I

28:36

mean, I think that there's so many arguments against

28:38

that. I mostly try to use it

28:41

as all press is good press in a certain sense.

28:44

Now, in terms of censorship, I've been pretty lucky.

28:46

I think on TikTok, you know, I

28:48

coded everything is like receptive anal intercourse.

28:51

And there was only one of my videos when I was talking

28:54

about marijuana use and bottoming

28:56

where that it actually got shut down by them. But

28:59

then I had to basically write to them and

29:01

said, hey, this is educational. And then they actually

29:03

uploaded it. So I've been fairly

29:05

fortunate when it comes to like the censorship

29:07

of thing. But I definitely have been

29:10

in, you know, the ways of negative comments.

29:13

Yeah, welcome to the club. Yeah,

29:15

sure. One of the hazards of being a sex

29:18

educator on social media. Well,

29:20

we have much more to say on the subject of anal sex,

29:22

including the growing popularity of an activity

29:25

known as pegging. And we're going to dive into that

29:27

in the next episode.

29:29

Thank you so much for this amazing conversation, Tom.

29:31

It was a pleasure to have you here. Can you please

29:33

tell my listeners where they can go to learn more about

29:35

you and your work?

29:36

Well, thank you, Justin. It is a pleasure and an honor

29:38

to be here. Majority of people can, you

29:41

know, follow me on TikTok, thatprostatedoctor.

29:44

And

29:44

I also my sort of email as

29:46

well, thatprostatedoctor at gmail.com.

29:49

Feel free to email me if you have

29:51

a research idea or want to be a part of the research.

29:54

I'd love to hear from you.

29:55

So, thank you, Justin. And I'll

29:57

be sure to include the link in the show notes. So

29:59

thank you. Thank you again so much for your time. It was great to have

30:01

you here and thank you to my listeners. To

30:04

keep up with new episodes of this podcast, visit my

30:06

website, sexandpsychology at sexandpsychology.com

30:10

or subscribe on your favorite platform or I hope you'll

30:12

take a moment to rate and review the show. You

30:14

can also follow me on the socials for daily sex research

30:17

updates. I'm on Instagram at Justin

30:19

J. Lameller and everywhere else. So

30:22

be sure to check out my books, tell me what you want. Thanks

30:25

again for listening.

30:31

I'm Justin J. Lameller

30:34

and I'll see you next time.