“I identify as more of a top, but I’ve always wanted to bottom more,” says Cesar Razza, 31. In the past, Razza had avoided bottoming because of the pain he had experienced while doing it. Then he heard about anal Botox. When he met his current partner, who also identifies as a top, he decided to give it a shot. “Now,” Raza says, “we’ve been able to have incredible sex. There’s been no pain at all.”
Traditionally done to heal anal fissures (small tears in the tissue that lines the anus), anal Botox relaxes the internal anal sphincter muscle, which allows for more pleasurable anal sex. (There are alternatives to Botox, like Dysport, which works similarly.)
Anal Botox is only just starting to become accessible for this purpose. “It’s unlikely that outside of New York or Los Angeles you’d find many colorectal or GI providers administering Botox in general, and even less so for the purpose of better and safer anal sex,” says Carlton Thomas, MD, a gastroenterologist and host of the Butt Honestly podcast. “One of my patients had to fly out of the country to get [anal Botox] for his anal fissure in Puerto Vallarta, which is a popular ‘gay hub.’”
As anal Botox, which requires four injections and lasts about four months, does become more common, it’s important to have the facts, including knowing who is and isn’t a good fit for it, how it works, the risks involved, and what to keep in mind when finding someone to administer it. Here’s everything you need to know.
How anal Botox works
First, a little anatomy lesson. Dr. Thomas explains that there are two types of butthole muscles: the internal sphincter and the external sphincter. “The internal sphincter works involuntarily; we can’t control it,” he says. But we can control the external sphincter, tightening it, for example, when you want to hold in gas. He says that anal Botox is usually injected in the internal sphincter, the muscles we can’t control.
Diego Marines Copado, MD, a colon and rectal surgeon at Houston Methodist, says that anal Botox is one of a few different ways to treat anal fissures, or tears on the lining of the anus, near the opening. These tears, both doctors say, can be a result of straining to poop or anal sex. (Women can sometimes get anal fissures through childbirth, too.) By relaxing the sphincter, anal Botox “allows it to heal,” Dr. Thomas says.
Evan Goldstein, DO, an anal surgeon and founder of Bespoke Surgical, which specializes in gay men’s sexual health and wellness, says that he was already giving anal Botox to help anal tears heal when he started to think about how it could be used as a preventive measure. “People were telling me they had these limitations that don’t allow them to have really great sex. Using anal Botox therapeutically can improve that,” he says.
Besides making anal sex more pleasurable, Dr. Goldstein says it reduces the risk of sexually transmitted diseases. He explains that if someone is tight and having anal sex, this makes fissures more likely. Having tears on your anus increases the risk of infection.