Have you ever had an anal fistula or fissure? If so, it’s probably not something you were keen to tell the whole world about. There remains a lot of stigma and embarrassment when it comes to anal health.
One person who wants to help tackle that is Queer Eye’s Jonathan Van Ness.
Last December, during one of his tour appearances in Louisville, Kentucky, Van Ness shared with the audience that he’d recently had a fistula. He didn’t go into great detail and didn’t plan to talk more about it. However, now that he’s recovered, he began to think how taboo it is to talk about such health issues.
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He decided to devote an episode of his Getting Curious podcast to the subject of fistulas (an “evil Kellyanne Conway of an ailment”) and general anal health.
“I wasn’t going to talk about it but then I realized, we need to talk about anal health, because it affects so many people whether you indulge in anal sex or not,” Van Ness says on the show.
To help him, he is joined by Dr. Evan Goldstein, an expert in all matters butt-related. Goldstein is also the founder of Bespoke Surgical and Co-founder of Future Method, which produces products to support good butt health.
In an Instagram post to promote the show, Van Ness says he was “so stressed” late last year that he “grew a second butthole called a fistula.”
What is a fistula?
If you have little knowledge about fistulas and fissures, here are the basics.
A fissure is a fancy word for a tear. It’s when the lining of your anus tears or if there’s an open sore inside you. You can feel pain, especially when going to the bathroom, and you may notice some blood.
Many times, a fissure will heal itself over time. Still, you’re best avoiding sexual activity while it heals and taking steps to prevent constipation. Fissures that don’t heal on their own may require surgery.
A fistula can be more problematic than a fissure. It’s often due to a blocked gland or abscess that forms near the anal opening. This fills up with pus. When the pus drains away, it can leave a small channel behind. This is the fistula. These can be simple tunnels that connect the anus and skin, or more complex tunnels that branch off in different directions.
Surgery is often required to fix anal fistulas. There is also a chance they can return, requiring repeat surgery.
Douching
Van Ness and Goldstein go into a deep dive about fistulas, with Van Ness asking the type of questions that may play on many gay men’s minds.
“Do you think the way I douched gave me a fistula?” Van Ness asks Goldstein.
“It could be,” admits Goldstein, adding that there are many reasons why people might develop a fistula.
“So is douching bad?” asks Van Ness.
“No matter what you or I say, people are going to douche,” says Goldstein. However, he goes on to suggest that when people are playing solo with toys they don’t douche first.
“I want people to see that regardless of what you’re eating, eight out of ten times you will actually be clean. People think that stool is stored in the anal canal, and it’s not.”
Goldstein says that too much douching can upset the delicate bacterial environment of your anus, so it’s best to avoid douching too often or using too much liquid. He also discusses the best time to take fiber supplements (at night) but to avoid taking them at the same time as other medications, such as HIV meds (something Van Ness expresses concern about).
Goldstein talks about best toilet practices, such as avoiding straining too much or sitting too long. Eating plenty of fiber will also help avoid hard stools and constipation.
Skincare
They also talk about anal skincare.
Van Ness asks if the thin skin around the anus can be made stronger.
“Yes,” says Goldstein, suggesting that people use exfoliants, shower before bed, use a hairdryer to dry themselves down there to prevent fungal issues, and then potentially use a moisturizer.
It’s refreshing to hear two queer men talk matter-of-factly and informatively about butt health. Dr Goldstein’s main advice is that if you think you have a problem, don’t delay in seeing a doctor. Having an abscess drained and acquiring antibiotics is far preferable to allowing a fistula to develop, which may involve more invasive surgical treatment further down the line.
Check out the conversation below.
winemaker
Good to know about this health and medical issue as many are afaid to speak with their doctor about this. That said some things are best kept private and not to be discussed or revealed in public, this being one of trhem. My late mother had a saying that’s timeless: “classy people don’t air their dirty laundry in public”. This subject definitely is personal and is best discussed with your doctor for further information and if necesaary, treatment.
inbama
I bet you have to change the sheets after Goldstein.
Kangol2
Listen to Dr. Goldstein. He’s one of the top docs for gay/bi/trans men in NYC and has spoken and written extensively about anal and genital health.