Broken Bottom

Friday, August 21, 2015


Dear Patrick: I’m a young gay man who is a bottom. I was recently diagnosed with anal fissures. They are very painful and have not responded to the usual treatment—which amounts to keeping them clean and leaving them alone to see if they will close up and heal. I’ve taken a couple of courses of antibiotics to curb infection, and the pills gave me stomach pain, nausea, and diarrhea. Now it looks like I will need surgery to close the fissures. My doctor has warned me that this could result in incontinence. He told me this right before the appointment was over and I left the office in a state of shock, then wound up crying hysterically on the bus home. Just one more nelly boy having a fit in public. God, I felt like such a cliché.

I remember the first time I ever got fucked. I told myself, you are making a big mistake. But it was the only thing he wanted to do to me, and I was so proud and happy to have gotten the attention of a handsome man. I didn’t want him to leave me all alone in my bed. It wasn’t easy to take. I was scared, and it hurt, and he wasn’t very patient with me. I was afraid to tell him how much of a beginner I was. But even if I had, I don’t think it would have made much of a difference in how he used my body.

Now I am dealing with this painful, humiliating medical problem. I am all alone, still, with no boyfriend to help me. I feel so ashamed of myself and my sexuality. And I feel very angry with the men who hurt me then left me to cope with the result of their damaging me. I don’t even know if I want to have sex any more.

This doesn’t seem to me like a very good frame of mind to go into surgery. My doctor on the national health service is not gay, of course, and seems pretty judgmental. Can you help me to get into a better state of mind and heart?—Broken Bottom


Dear Broken Bottom: So many things are going on here! Let’s slow down and take the time to look at all of these issues. First of all, anal fissures (tearing in the lining of the rectum) are very common. But nobody talks about them because of our widespread negativity about our buttholes. Few of us could be as cheerfully tender toward the ass as the poet Muriel Ruykeyser, who expressed gratitude for “The useful shit that is our clean clue to what we need” (“Despisals”). Most of the time, anal fissures are caused by straining during constipation, not by the rectal trauma of painful anal sex. They usually, as you point out, heal on their own. But once in a while, they get infected or they are in a location that keeps being opened up when the patient has to use the bathroom. That’s when doctors consider a surgical intervention.

Your doctor’s warning that you could become incontinent was, I think, one of those “informed consent” lists of possible negative outcomes that they always give you to sign before an operation. While it is true a giraffe may fall out of the sky and bite your big toe off, it is unlikely. These operations have been performed for many, many years, and they have a very high rate of success, without causing incontinence. I am angry and disturbed on your behalf that your doctor did not take the time to give you a more reasonable picture of what you could expect from treatment.

Such powerful shame is operating here! First, we have the huge amount of scorn a homophobic and sex-negative society lays on “sodomy.” (Vaginal penetration is so normal, it can just be referred to as “sex.” But those weird things gay people do have special names in Latin.) Anal sex has been widely practiced by heterosexuals since time immemorial, if only as a form of birth control. The idea that it is “gay sex” is baloney, but the straight world has never been very good at copping to its own hypocrisy.

I’m not sure why the hatred of gay men and anal sex has led to the precept that a bottom has to get fucked in a hurry. During therapy, I have had grown men cry when they considered the idea of asking a top to slow down and give their bodies time to be aroused enough to enjoy penetration. There is enormous fear that another man will not care enough about you to prevent injury, and that you have to accept the risk of being hurt in order to keep his attention. But this is terrible for your self-esteem as well as for your asshole. A man who can think only of his own hard cock needs to be sent home to jerk off. He doesn’t deserve the company of a cooperative orifice.

The need for love and approval is not shameful. It is a human need that connects us to one another and to the web of life. There are probably many reasons why you are facing this surgery all alone. But I think that could change. The first step is to see yourself as a person who deserves to be loved. If you insist on that ground rule, if you don’t allow other people to exploit you, your relationships with others will change. This will probably sound like a corny line out of a greeting card, but I will say it anyway: Love can only find us if we create a road for it to travel by.

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