Anal Botox patients explain how the procedure improved their sex lives

• Some doctors are injecting Botox into their patients' rectums for more pleasurable anal sex.
• Insider spoke with a rectal surgeon, Dr. Evan Goldstein, and two of his patients.

Face down on an exam table, a man spread his butt cheeks, then braced for impact.

"You're about to feel a pinch," New York City-based anal surgeon Dr. Evan Goldstein, told the 29-year-old as he plunged a syringe containing 20 units of Botox into his rectum.

The man, who works in the design industry in New York City, had gotten facial Botox before, but was particularly excited for the anal variety due to his 10-year stretch of anal sex woes.

"I tried butt plugs, dildos, having anal sex with boyfriends, and it just wouldn't work. It was excruciatingly painful to the point that I almost passed out a bunch of times," said the man, who requested to remain anonymous to protect his identity at work.

Now, a year after his first injection, the man sees Goldstein for Botox injections every six months, which his insurance covers. He says he's living in his sexual "renaissance" era because he's no longer overwhelmed with sex-related anxiety.

Goldstein, the man's doctor, told Insider that the procedure can be a "game changer" for anyone who wants to have more pleasurable anal sex. It's also useful for those who want to "go further" with anal play, like by deepening penetration with toys and fists, and patients recovering from anal injury surgeries due to tears, hemorrhoids, or fissures, Goldstein said.

Botox's off-label uses include more pleasurable anal sex

Botox for below the belt is nothing new. In 2017, writer Brian J. Moylan discussed his experience with "anal rejuvenation," which included rectal Botox, for New York magazine.

Botox, or botulism toxin, is an injectable drug that temporarily freezes muscles by blocking nerve signals that allow them to contract, according to the American Society of Plastic Surgeons.

Typically used for fine lines and wrinkles on the face, medical professionals also use it to reduce severe underarm sweat, prevent chronic migraines, and stop incontinence. Before the FDA approved these uses in 2020, they were considered "off-label," which is the category anal Botox currently falls under.

The 29-year-old man said he'd noticed his friends chatting more and more about anal Botox over the years, and recently name-dropping Goldstein. When a mutual friend agreed to connect them, the man figured he had nothing to lose.

Before injecting a patient, Goldstein does a consultation to understand what's causing muscle tightness, since a person's neural wiring or muscle makeup, or a combination, could be to blame. He does an anorectal manometry test, placing a small tube into a patient's rectum, to figure this out and decide how much Botox they might need.

To do them, Goldstein first inserts a small clear tube into the anus and shines a light to reveal the internal sphincter, which is what expands and contracts during anal penetration. Then, he goes in for the injections, doing them at four different points in the internal sphincter.

Goldstein said he injects men and women with anal Botox, but the majority of his patients are gay men. Still, anyone whose test results show that their rectum and anal sphincters are extremely tight could benefit from the procedure, which loosens those muscles enough for penetration without loosening them so much a patient poops their pants, said Goldstein.

The injections can help with anal tears and fissures too

Another of Goldstein's patients, a 30-year-old man, tried anal Botox as part of his healing regimen after anal surgery.

For a three-month period, the man noticed blood in his underwear and and pain after bottoming during anal sex, he told Insider. Abstaining from sex seemed to be the only thing that helped, so the man looked for answers online. After speaking with few doctors in his area, he went with Goldstein, saying his focus on gay men's health and his matter-of-fact beside manner made him feel at ease.

Goldstein performed anal surgery, removing a hemorrhoid, then gave the man four shots of anal Botox to help with the recovery process, since the injections have muscle-relaxing effects. Typically, Goldstein gives anal Botox patients a total of 100 units, separated into five injections.

After, the man went to a few weekly check-ups and had a three-month recovery period of no sex. During that time, he used butt plugs, as instructed by Goldstein, to "train" his butthole for sex. Once he was cleared to partake again, the man said that anal sex felt just as good as it had before his pain began.

Though insurance often covers the cost of anal Botox, Goldstein charges $1,500 per session without insurance, plus $400 for the office visit and $1,000 for the pre-injection anorectal manometry test. He typically sees patients every three months for more Botox.

Side effects include mild flu-like symptpoms and minor bleeding

Goldstein said people interested in anal Botox should be cautious of who they see for the procedure.

Even though it takes just a few minutes to complete, it also requires pre-procedure tests to rule out other issues that anal Botox can't fix, he said. Those include large anal tears and fissures and hemorrhoids that may require surgery.

After someone gets anal Botox, they're likely to be more gassy than usual, Goldstein said. Other side effects include a small amount of bleeding and mild flu-like symptoms, according to doctors at the University of Michigan Medical School.