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Bobby Box and Dr. Evan Goldstein answer all frequently asked questions about having an anal botox

Can’t Get Your Booty to Relax? Try Anal Botox

Last Updated: Mar 31, 2023 / By Bobby Box

What is anal botox? Should you inject your butthole for better anal sex? In this edition of the Queeries, Bobby Box spoke to anal surgeon Dr. Evan Goldstein about botoxing for pain and pleasure.

I will confess that I'm no stranger to Botox. As an expressive 33-year-old gay man, I deemed it necessary to indulge in preventative Botox to proactively cease wrinkles from forming before they appear. From the first prick of the needle, I was hooked, and I continue booking timely appointments to keep my face sufficiently frozen and expressionless. (Kidding! Well, kind of.)

Now facial Botox is nothing new. Every gay knows of it, whether they've had it done themselves, or admire a Real Housewife or an aging pop star who's done too much of it. However, what you may not know is that there is a particularly effective "off-label" use for Botox that can be greatly beneficial for bottoms.

I discovered this myself after a traumatic sexual experience involving a Prince Albert piercing, which resulted in formal surgery and a lengthy and painful recovery. Once I was fully healed, I had a sizable internal scar that made bottoming painful to the point that I thought I would never be able to take another toy or penis in the can again. I was absolutely devastated.

After some thorough research and enlightening chat with my favorite anal specialist and surgeon, Dr. Evan Goldstein of Bespoke Surgical and Future Method, I learned that Botox could assist with my injury-prone hole. Fortunately, in my case, I just needed to commit to some dilation exercises to make the scar more pliable, even still, Botox would have greatly assisted in these efforts.

If you're curious to learn more about how an anal Botox can make bottoming a more comfortable feat, find everything you could possibly want to know, with the generous assistance of the incomparable Dr. Goldstein, below.


You probably have a pretty good sense of what Botox is, but if you're considering having it injected into your precious b-hole, I figured a more detailed description might be helpful.

Botox is the brand name for OnabotulinumtoxinA, a toxin produced by the same microbe that causes botulism, which is a life-threatening type of food poisoning (who knew!). These toxins work to block signals that cause muscles in the injection site to contract, temporarily paralyzing them.

By preventing the contraction of these muscles, there is less strain on the skin, which decreases the formation of wrinkles when the toxin is used cosmetically. Botox usually begins working three to five days after treatment, and patients will see full results after seven to 10 days. Results will typically last between three to four months.


Since Botox works by relaxing muscles, you can probably guess how it can benefit an uptight bumhole.

Goldstein says that only one-third of the bottoming population can fully open their holes and receive penetration without any issues. The other two-thirds, however, experience varying degrees of difficulty bottoming due to functional limitations like pain, spasms, and being unable to relax.

It's not uncommon for patients to visit Goldstein's office when they've courted a new partner with a large penis and cannot comfortably bottom, or ambitious folks who want to graduate to fisting but have reached a plateau in capacity.

ANSWERED: How to prepare for anal fisting

Others may request Botox treatments to heal more quickly and comfortably after an anal-related surgery, like those for anal warts, hemorrhoids, chronic fissures, and gland issues.

The resulting scars from these surgeries can make the sphincter muscles more tense and twitch, causing excessive strain and tightness, specifically in the internal sphincter muscle, which also happens to be the area most will experience resistance, discomfort, or pain when bottoming. This is the muscle the Botox is injected into.

Some fear or apprehension toward such treatment is understandable, but research on anal Botox has been overwhelmingly positive. One study found that the treatment is 89 percent effective in patients with chronic fissures, and another, which followed up with patients five years after their treatment, deduced that it was also "safe and effective in long-term follow-ups."

RELATED: Everything you need to know about anal fissure and anal sex

Now, if you, like me, considered that this treatment may also make it easier to shit yourself, one study found that only two of the 38 patients in their research experienced "minor incontinence" and reported that it resolved quickly. So can it happen? Yes, but it's temporary. Is it likely? No.

Goldstein assures that people should not experience incontinence issues if the Botox is administered correctly, though he confesses some complain about having a bit more gas or get the sense that they have to go to the bathroom more often. "I tell people in the first few weeks after getting Botox: if you feel like you have to shit, go shit! At least until you are able to know when you really don't have to go."


Now you might be curious about what's involved with the procedure. The anal botox is performed with the patient in the lateral position, meaning they're laying on your side.

The patient is fully clothed, with their pants and underwear pulled down so their butt is exposed. An anoscope, which is a small-diameter tube that opens the anal canal, is inserted so the internal sphincter muscle can be isolated.

The muscle then receives four injections circumferentially: anterior and posterior (front and back) as well as the left and right, the process takes three to five minutes. "By measuring these pressures through anal manometry ahead of time, we can understand how many units of Botox are required to obtain the end results we are looking for," Goldstein says.

Most people will receive 60-100 units of Botox, with roughly 15 to 25 units in each quadrant of the muscle. For comparison's sake, the forehead typically requires anywhere from 10 to 30 units.

For most, this process is repeated two or three times, four months apart. This will allow the patient to achieve full relaxation, allowing them to reach their bottoming goals. To assist in these efforts, Goldstein recommends patients also engage in dilation exercises to achieve the best result. Our glass anal dilator set and anal training kit and education set are both excellent tools for doing so.

Use an anal dilator to exercise your sphincter after having an anal botox injection

Botox takes a full week to start working, so Goldstein recommends patients start dilating about three to five days post-injection. Over the following four to six weeks, patients should purchase and work through a dilation set, starting from small, then working to medium, and finally to large. After conquering the largest toy in the set, a patient should be able to engage comfortably in receptive anal sex.

"The key, when we start, is to prevent the Botox from wearing off," Goldstein says. "By staying consistent, it gives us the time needed to dilate and engage anally, which allows for full cooperation of the anal musculature."


Each anal Botox treatment lasts roughly three to four months, and after two to three rounds, your booty is reassessed to determine if further injections are necessary. Goldstein assures that after their third appointment, most will be able to achieve things with their holes that they may never have thought possible.

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