Diabetes And Urological Health

August 12, 2017

Andrew Siegel MD  8/12/17

Your taste buds may crave sugar (glucose), but the rest of your body sure doesn’t!

A common presenting symptom of undiagnosed diabetes is frequent urination because of the urine-producing effect of glucose in the urine. People with such urinary frequency will often consult a urologist (urinary tract specialist) erroneously, thinking that the problem is kidney, bladder or prostate in origin, when in actuality it is the sugar in the urine that is the source of the problem.

Because of this urinary frequency presentation of diabetes, urologists often have the opportunity to make the initial diagnosis and refer the patient for appropriate care. Similarly, many uncircumcised men who have foreskin problems–particularly when the foreskin becomes stuck down over the head of the penis and will not retract (phimosis)–have undiagnosed diabetes. A simple dipstick of urine in conjunction with the typical presenting symptoms of frequent daytime and nighttime urination and/or foreskin issues directs the proper diagnosis.

Diabetes has detrimental effects on all body systems, with the urinary and genital systems no exception. Today’s entry reviews the impact of diabetes on urological health. Many urological problems occur as a result of diabetes, including urinary infections, kidney and bladder conditions, foreskin issues and sexual problems.  Additionally, diabetes increases the risk of kidney stones. Although many of the same urinary issues that are present in diabetics commonly also occur with the aging process (in the absence of diabetes), the presence of diabetes hastens their onset and severity.  Diabetes can have catastrophic consequences including the following: heart disease, stroke, blindness, kidney failure requiring dialysis and vascular disease resulting in amputations.

Wickipedia public domain copy

Thank you, Wikipedia, for the above public domain image

Diabetes 101

Diabetes is a disease in which blood glucose levels are elevated. Glucose is the body’s main fuel source, derived from the diet.  Insulin, a hormone secreted by the pancreas, is responsible for moving glucose from the blood into the body’s cells so that life processes can be fueled. In diabetes, either there is no insulin, or alternatively, plenty of insulin, but the body cannot use it properly. Without functioning insulin, the glucose stays in the blood and not the cells that need it, resulting in potential harm to many organs.

Two distinct types of diabetes exist. Type 1 is an autoimmune condition in which the body’s immune system destroys insulin-producing cells, severely limiting or completely stopping all insulin production.  It is often inherited and is responsible for about 5% of diabetes. It is managed by insulin injections or an insulin pump.

Type 2 diabetes is caused by overeating and sedentary living and is responsible for 95% of diabetes. This form of diabetes is caused by insulin resistance, a condition in which the body cannot process insulin and is resistant to its actions. Anybody with excessive abdominal fat is on the pathway from insulin resistance towards diabetes.  Type 2 diabetes is a classic example of an avoidable and “elective” chronic disease that occurs because of an unhealthy lifestyle.

Sad, but true: Chances are that if you have a big abdomen (“visceral” obesity marked by internal fat) you are pre-diabetic. This leaves you with two pathways: the active pathway – cleaning up your diet, losing weight and getting serious about exercise, in which this potential problem can be nipped in the bud. However, if you take the passive pathway, you’ll likely end up with full-blown diabetes.

Common presenting symptoms of diabetes are frequent urination, thirst, extreme hunger, weight loss, fatigue and irritability, recurrent infections, blurry vision, cuts that are slow to heal, and tingling or numbness in the hands or feet.

Complications of diabetes occur because of chronic elevated blood glucose and consequent damage to blood vessels and nerves.  Diabetes accelerates atherosclerosis, a condition in which fatty deposits occur within the walls of arteries, compromising blood flow and the delivery of oxygen and nutrients to tissues. Diabetic “small blood vessel” disease can lead to retinopathy (visual problems leading to blindness), nephropathy (kidney damage leading to dialysis), and neuropathy (nerve damage causing loss of sensation).  Diabetic “large vessel disease” can cause coronary artery disease, stroke, and peripheral vascular disease.  Diabetes increases the risk of infections because of poor blood flow and impaired function of infection-fighting white blood cells.

Diabetes and the bladder

Many diabetics have urological problems on the basis of the neuropathy that affects the bladder.  These issues include impaired sensation in which the bladder becomes “numb” and the patient gets no signal to urinate as well as impaired bladder contractility in which the bladder muscle does not function properly, causing inability to empty the bladder completely.  Other diabetics develop involuntary bladder contractions (overactive bladder), causing urinary urgency, frequency and incontinence.

Diabetes and the kidneys

Diabetes is the most common cause of kidney failure, accounting for almost half of all new cases. Even with diabetic control, the disease can lead to chronic kidney disease, kidney failure and the need for dialysis or kidney transplantation.

Diabetes and urinary/genital Infections

Diabetics have more frequent urinary tract infections than the general population because of factors including improper functioning of the infection-fighting white blood cells, glucose in the urine (a delightful treat for bacteria) and compromised blood flow. Diabetics have a greater risk of asymptomatic bacteriuria and pyuria (the presence of white cells and bacteria in the urine without infection), cystitis (bladder infections), and pyelonephritis (kidney infections).  Impaired bladder emptying further complicates the potential for infections.  Diabetics have more serious complications of pyelonephritis including kidney abscess, emphysematous pyelonephritis (infection with gas-forming bacteria), and urosepsis (a very serious systemic infection originating in the urinary tract requiring hospitalization and intravenous antibiotics).  Fournier’s gangrene (necrotizing fasciitis) is a soft tissue infection of the male genitals that often requires emergency surgery (that can be disfiguring) and has a very high mortality rate.  Over 90% of patients with Fournier’s gangrene are diabetic. Diabetic patients also have an increased prevalence of infections with surgical procedures, particularly those involving prosthetic implants, including penile implants, artificial urinary sphincters, and mesh implants for pelvic organ prolapse.

Diabetes and the foreskin

Balanoposthitis is medical speak for inflammation of the head of the penis and foreskin. As mentioned previously, a tight foreskin that cannot be pulled back to expose the head of the penis (phimosis) can be the first clinical sign of diabetes in uncircumcised men. At least 25% of men with this problem have underlying diabetes.  It is common for these men to have fungal infections under the foreskin because of the risk factors of a warm, moist, dark environment in conjunction with the presence of glucose in the urine. The good news is that phimosis and fungal infections often respond nicely to diabetic control.

Who Knew? I learned from a patient of mine that this issue is referred to in slang as “sugar dick.”

Diabetes and sexual function

Sexual functioning is based upon good blood flow and an intact nerve supply to the genitals and pelvis.  Diabetics often develop sexual problems (in fact, diabetes is the most common cause of erectile dysfunction) because of the combination of neuropathy and blood vessel disease.  Men commonly have a reduced sex drive and have difficulty achieving and maintaining erections.  Diabetes increases the risk of erectile dysfunction threefold.  Diabetes has clearly been linked with testosterone deficiency, which can negatively impact sex drive and sexual function.  Because of the neuropathy, many diabetic males have retrograde ejaculation, a situation in which semen goes backwards into the bladder and not out the urethra.  Female diabetics are not spared from sexual problems and commonly have reduced desire, decreased arousal and sexual response, vaginal lubrication issues and painful sexual intercourse.

Diabetic management

With Type 2 diabetes it is vital to modify lifestyle, including dietary changes that avoid diabetic-promoting foods and replacement with healthier foods in order to have appropriate sugar control to help prevent diabetic complications. Diabetics should refrain from high glycemic index foods (those that are rapidly absorbed) including sugars and refined white carbohydrates and instead should consume high-fiber vegetables, fresh fruits, and whole-grain products.  Regular exercise is equally as important as healthy eating, and the combination of healthy eating, physical activity, and weight loss can often adequately address Type 2 diabetes.

When lifestyle measures cannot be successfully implemented or do not achieve complete resolution, there are different classes of medications that can be used to manage the diabetes. However, lifestyle modification should always be the initial approach, since lifestyle (in large part) caused the problem and is capable of improving/reversing it.  At times, when diet, exercise and drugs are unable to control the diabetes, bariatric (weight loss) surgery may be needed to control and even potentially eliminate the diabetes.

Bottom Line:  Diabetes is a serious chronic illness with potentially devastating complications. Type 1 diabetes is relatively rare and unavoidable, but is manageable with insulin replacement. Type 2 diabetes is epidemic and its prevalence has increased dramatically coincident with the expanding American waistline. It can be improved/reversed through integration of healthy eating habits, weight management, and exercise. Lifestyle modifications can be amazingly restorative to general, urological and sexual health and overall wellbeing. After all, our greatest wealth is health.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

Amazon page for Dr. Siegel’s books

 

 

Urology 101:  Much More Than “Pecker Checking”!

August 5, 2017

Andrew Siegel MD  8/5/17

CME2P

I am a second-generation urologist. It is unlikely that there will be a third-generation urologist as my oldest child is a film-maker, my middle child works in tech marketing and my youngest is off to college later this month, intent on becoming a child psychologist. After she spent a day in the office with me, she told me that the experience caused her to have post-traumatic stress disorder!

As a youngster, I attended summer camp in New Hampshire at Camp Moosilauke . My friends made fun of my father’s profession, referring to him as a “pecker checker.”  Today’s entry is a brief review of what urology really is and what urologists do for a living. One thing is for sure…sooner or later most everyone will need the service of a urologist. 

“Urology” (uro—urinary tract and logos—study of) is the branch of medicine that deals with the diagnosis and treatment of diseases of the urinary tract in males and females and of the reproductive tract in males. The urinary organs under the “domain” of urology include the kidneys, the ureters (tubes connecting the kidneys to the urinary bladder), the urinary bladder, and the urethra (channel that conducts urine from the bladder to the outside).  These body parts are responsible for the production, storage and release of urine.

The male reproductive organs under the “domain” of urology include the testes, epididymis (structures above and behind the testicle where sperm mature and are stored), vas deferens (sperm duct), seminal vesicles (structures that produce the bulk of semen), prostate gland and, of course, the scrotum and penis.  These body parts are responsible for the production, storage and release of reproductive fluids.  The reproductive and urinary tracts are closely connected, and disorders of one oftentimes affect the other…thus urologists are referred to as “genitourinary” specialists.

Urology is a balanced specialty– urologists treat men and women, young and old, from pediatric to geriatric.  Whereas most physicians are either medical doctors or surgeons, a urologist is both, with time divided between a busy office practice and the operating room.  Although most urologists are men, more and more women than every before have been entering the urological workforce.

Factoid: My pathway to urology was 4 years of college, 4 years of medical school, 2 years of general surgery residency, 4 years of urology residency and 1 year of specialty fellowship in pelvic medicine and reconstructive urology.  I started practicing at age 33.

Factoid: Becoming board certified is the equivalent of a lawyer passing the bar exam. There are three possible board certifications in urology: general urology, pediatric urology, and female pelvic medicine and reconstructive surgery.  Thereafter, one must maintain board certification by participating in continuing medical education and pass a recertification exam every ten years.  I am dually certified in general urology as well as female pelvic medicine.  The common problems I take care of in my female pelvic medicine practice are urinary incontinence (stress urinary incontinence and overactive bladder), pelvic organ prolapse and recurrent urinary tract infections

Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health.  Urological surgery involves operating on patients with potentially life-threatening illnesses, particularly cancers of the genital and urinary tracts.  In terms of new cancer cases per year in American men, prostate cancer is number one accounting for almost 30% of cases; bladder cancer is number four accounting for 6% of cases; and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine) is number six accounting for 5% of cases.  Urologists are also the specialists who treat testicular cancer.  Urologists also treat women with kidney and bladder cancer, although the prevalence of these cancers is much less in women than in males.

Urology has always been on the cutting edge of surgical advancements (no pun intended) and urologists use minimally invasive technologies including fiber-optic scopes to view the entire inside of the urinary tract, as well as ultrasound, lasers, laparoscopy and robotics.  There is overlap in what urologists do with other medical and surgical disciplines, including nephrology (doctors who specialize in medical diseases of the kidney); oncology (medical cancer specialists); radiation oncologists (radiation cancer specialists); radiology (imaging); gynecology (female specialists); and endocrinology (hormone specialists).

Common reasons for a referral to a urologist include: blood in the urine, whether it is visible or picked up on a urine test; an elevated or an accelerated PSA (Prostate Specific Antigen); prostate enlargement; irregularities of the prostate on digital rectal examination; and urinary difficulties ranging the gamut from urinary leakage to the inability to urinate (urinary retention).

Urologists manage a variety of other issues. Kidney stones, which can be extraordinarily painful, keep us very busy, especially during the hot summer months when dehydration is more common. Infections are a large part of our practice and can involve the bladder, kidneys, prostate, testicles and epididymis.  Sexual dysfunction is a very common condition that occupies much of the time of the urologist—under this category are problems with obtaining and maintaining an erection, problems of ejaculation, and testosterone issues. Urologists treat not only male infertility, but also create male infertility when it is desired by performing voluntary male sterilization (vasectomy).   Urologists are responsible for caring for scrotal issues including testicular pain and swelling. Many referrals are made to urologists for blood in the semen.

 

RUPNOK

 

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

Amazon page for Dr. Siegel’s books

Percutaneous Tibial Nerve Stimulation (PTNS) For Overactive Bladder (OAB)

July 29, 2017

Andrew Siegel MD   7/29/17

ptns-v2@2x

PTNS therapy is a non-drug, non-surgical option to treat OAB symptoms including urinary urgency, frequency and urgency incontinence. PTNS consists of 12 weekly sessions in the office, followed by a maintenance regimen. During each 30-minute session, a thin needle electrode is placed into the ankle region and is connected to an external electrical stimulator. Up to 80% of patients improve with minimal, if any, side-effects.

OAB

Overactive bladder is a common and annoying condition present in both females and males marked by episodes of urinary urgency, frequency and, at times, incontinence. A variety of methods can be used to improve symptoms and quality of life, including the following: behavioral modifications, bladder retraining, pelvic floor muscle training, bladder relaxant medications and Botox injections.  Although medications are commonly used for OAB, the problem is that side effects and expense often limit their continued usage.

Neuromodulation

An effective alternative is neuromodulation, the least invasive technique of which is known as PTNS.  PTNS uses a thin, acupuncture-style needle placed in the ankle that is attached to a hand-held device that generates electrical stimulation.  This is a significantly less invasive means of neuromodulation than is Interstim, which requires implantable wire electrodes to be placed in the spine and continuous electrical stimulation with an implantable battery-powered pulse generator. In both instances, the sacral plexus—responsible for regulating bladder and pelvic floor function—is “modulated” by the electrical stimulation, causing a beneficial effect with improvement of OAB symptoms. With PTNS, the electrical stimulation travels up the tibial nerve to the sacral plexus, whereas with Interstim, the sacral plexus is directly stimulated by electrodes.

Nuts and Bolts of PTNS

PTNS involves once weekly visits to the office for 12 weeks, 30 minutes per session.  It can be performed on both female and male patients.

At each session, the patient is seated comfortably with the treatment leg elevated and supported.  A fine caliber needle electrode—similar to an acupuncture needle—is inserted into the inner ankle in the vicinity of the tibial nerve.  A grounding surface electrode is placed as well.  An adjustable electrical pulse is applied to the needle electrode via an external pulse generator. Activation of the tibial nerve is confirmed with a sensory (mild sensation in ankle or sole) and/or a motor (toe flex/fan or foot extension) response. Thereafter, the power of electrical stimulation is adjusted to an appropriate level and the 30-minute session begins. The patient can read, listen to music, nap, meditate, etc.

Clinical Response

Improvement in OAB symptoms often occurs by session 6, sometimes sooner. Patients who respond well to the 12-week protocol may require occasional maintenance treatments.  70-80% of patients will achieve long-term improvement in OAB symptoms. PTNS incurs minimal risks with the most common side effects being mild pain and skin irritation where the needle electrode is placed.

Insurance

PTNS is covered by most insurances, including Medicare.  PTNS cannot be used in patients with pacemakers or implantable defibrillators, those prone to excessive bleeding, those with nerve damage or women who are pregnant or planning to get pregnant during the treatment period.

YouTube on PTNS

“My PTNS” educational program

My nurse practitioner and I will be giving a seminar (free of charge) on PTNS on 7PM on Thursday, September 14, 2017 at the Marriott Hotel, 138 New Pehle Avenue, Saddle Brook, NJ.  Light refreshments will be served.  Space is limited, so if interested, please call 201-487-8866 to reserve a spot.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

Amazon page for Dr. Siegel’s books

 

 

Maintaining Masculinity With Aging

July 21, 2017

Andrew Siegel MD  7/21/17

“Time has a nasty way with human materials.”…Zadie Smith

“The reality of our bodies is that they are born and grow and in time suffer and decline.”  …Senator Ben Sasse

Bona Lane

No matter how old, most men wish to be able to travel down this road until their final breath.

Although the term masculinity may be better understood conceptually than described in words, it can be defined as possessing positive qualities traditionally associated with men: virility, drive, strength, vigor, resiliency, confidence, self-sufficiency, etc. Carried to an extreme, it can sometimes be associated with alpha behaviors including aggression, hyper-sexuality and supreme authority. Certainly, masculinity implies a certain “swagger” that clearly is unique from femininity. Sadly, aging and natural deterioration gradually rob men of many masculine attributes with the ultimate result–at some point in time–infirmity and frailty.

The Inevitable Loss of Horsepower

Our bodies-as-machines slowly lose their maximal horsepower and morph into less performative and functional machines.  The realities and challenges that accompany reaching senior years–the anatomical and functional deterioration that affect every organ system–are a direct blow to masculinity. A central premise of masculinity is having a strong and fit body; however, aging is at direct odds with masculinity because of the loss of bone and muscle mass, slower healing, accumulation of injuries and the occurrence of disease processes, resulting in declining strength and fitness.

All systems go to ground, as eventually we do. The senses–vision, hearing, taste, smell, touch–slowly rust away. Locomotion, nervous system, urinary system, bowel system, cognition and memory deteriorate. There is a good reason that athletes are considered “old” in their thirties. Rigidity of erections, the literal totem of masculinity, declines in proportion to age in years.

The silver lining is that although the degenerative process is inevitable and there will come a time when frailty will ensue, with the combination of strength training, cardiovascular conditioning, core and balance work, this process can be deferred substantially. Thinned bones, wasted muscles and hunched posture can be largely prevented by proactive and preemptive strikes against their onset.

I have an amazingly fit and cognitively intact 95-year-old patient who goes to the gym three times a week.  He lamented to me that because of an injury he was unable to work out for a few weeks and as a result he felt flabby and listless.

Retirement: Death with Benefits

At some point in the aging process, retirement from work becomes a reality for the vast majority of men.  Leaving work is one of the more challenging aspects of aging as our careers can often be considered “masculine” experiences from a primal perspective, since our roles as “hunter”—“warrior”—“gatherer” provide for our families.  Aside from financial resources, works provides benefits on so many levels—engendering a sense of usefulness and purpose, identity, dignity, self-worth, achievement, recognition, respect, (particularly self-respect), status and influence.  Furthermore, work also provides connection, collaboration and networking that are central to the human experience.  There is something special about having purpose and being productive, both of which give real meaning to one’s existence and help maintain vitality. This does not necessarily involve continuing to work full-time and compromising our fun and leisure activities, but rather achieving a healthy balance between work and play with part-time work, an encore career, volunteering, etc.

As a urologist with many years of clinical experience, I can attest to the fact that one of the shared attributes of my older patients who have aged well (Youthful Elderly Persons, a.k.a. Yeppies) is that they have NOT retired, often working well into their eighties and beyond.

Mitigate Risks

Typically associated with “masculinity” is risk-taking behavior.  Men are more likely than women to engage in activities such as smoking, heavy drinking, fast driving without seat belts, participating in sports with high injury rates, etc.  However, as we age, continued participation in such activities will not help the masculine cause, so at some point those who wish to maintain their masculinity will need to curtail unhealthy lifestyle activities and tailor sport participation in such a way as to maximize benefits, but minimize risks, for example, playing doubles tennis instead of singles.

Masculine to be Feminine

Masculinity often entails “alpha” behavior, which typically implies stoicism and self-reliance, in contrast to the female gender that is generally more emotive, communicative and willing to seek help from others. This translates to less preventive health care as men tend to be more reactive than proactive.  Furthermore, it generally leads to men having less meaningful and more superficial relationships than our female counterparts. This cool and independent alpha manner does not foster the skillset necessary to deal with many of the unpleasant circumstances that often accompany aging. It behooves men to seek preventive health care as well as nourish internal health by developing deeper and more meaningful relationships with our significant other, children, family and friends. We are a species who exists to coexist and connect and it is this social web that provides a safety net for us, valuable always, but particularly so when isolation, depression, fear, anxiety, etc., strike.

Bottom LineThe aging process gradually and insidiously erodes “masculinity.” Continuing to work in some capacity, working out regularity, working towards minimizing high-risk activities and maintaining a healthy lifestyle, and working “inwards”—fighting the culturally-based stoicism and self-reliance that runs counter to humans as highly social creatures–in concert can preserve “masculine capital” to an advanced age.  Although aging can be considered the “enemy” and will ultimately prevail, it is all about the possibilities as opposed to the limitations of the process.

Thank you to Rick Siegel–my brother–for suggesting an entry on this topic, based upon reading a Wall Street Journal article from 2/27/17: “Need To Redefine Masculinity As We Get Older” by Dana Wechsler Linden.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Co-creator of the PelvicRx male pelvic floor muscle training DVD.

 

 

 

Sex And The Female Pelvic Floor Muscles

July 15, 2017

Andrew Siegel MD   7/15/17

The vagina and clitoris are the stars of the show, but the pelvic floor muscles are the behind-the-scenes “powerhouse” of these structures. The relationship between the pelvic muscles and the female sexual organs is similar to that between the diaphragm muscle and the lungs, the lungs as dependent upon the diaphragm for their proper functioning as the vagina and clitoris are on the pelvic muscles for their proper functioning.  The bottom line is that keeping the pelvic muscles fit and vital will not only optimize sexual function and pleasure, but will also benefit urinary, bowel and pelvic support issues as well as help prevent their onset. 15606-illustrated-silhouette-of-a-beautiful-woman-or

Image above, public domain

Size Matters

While penis size is a matter of concern to many, why is vaginal size so much less of an issue?  The reason is that penises are external and visible and vaginas internal and hidden. The average erect penis is 6 inches in length and the average vagina 4 inches in depth, implying that the average man is more than ample for the average woman. The width of the average erect penis is 1.5 inches and the width of the average vaginal opening is virtually zero inches since the vagina is a potential space with the walls touching each other at rest. However, the vagina is a highly accommodative organ that can stretch, expand and adapt to the extent that 10 pound babies can be delivered vaginally (ouch!).

More important than size is the strength and tone of the vaginal and pelvic floor muscles. Possessing well-developed and fit vaginal and pelvic floor muscles is an asset in the bedroom, not only capable of maximizing your own pleasure, but also effective in optimally gripping and “milking” a penis to climax.  Additionally, when partner erectile dysfunction issues exist, strong pelvic floor muscles can help compensate as they can resurrect (great word!) a penis that is becoming flaccid back to full rigidity.

Female Sexuality

Sex is a basic human need and a powerful means of connecting and bonding, central to the intimacy of interpersonal relationships, contributing to wellbeing and quality of life. Healthy sexual functioning is a vital part of general, physical, mental, social and emotional health.

Female sexuality is a complex and dynamic process involving the interplay of anatomical, physiological, hormonal, psychological, emotional and cultural factors that impact desire, arousal, lubrication and climax. Although desire is biologically driven based upon internal hormonal environment, many psychological and emotional factors play into it as well. Arousal requires erotic and/or physical stimulation that results in increased pelvic blood flow, which causes genital engorgement, vaginal lubrication and vaginal anatomical changes that allow the vagina to accommodate an erect penis. The ability to climax depends on the occurrence of a sequence of physiological and emotional responses, culminating in involuntary rhythmic contractions of the pelvic floor muscles.

Sexual research conducted by Masters and Johnson demonstrated that the primary reaction to sexual stimulation is vaso-congestion (increased blood flow) and the secondary reaction is increased muscle tension.  Orgasm is the release from the state of vaso-congestion and muscle tension.

Pelvic Muscle Strength Matters

Strong and fit pelvic muscles optimize sexual function since they play a pivotal role in sexuality. These muscles are highly responsive to sexual stimulation, reacting by contracting and increasing blood flow to the pelvis, thus enhancing arousal.  They also contribute to sensation during intercourse and provide the ability to clench the vagina and firmly “grip” the penis. Upon clitoral stimulation, the pelvic muscles reflexively contract.  When the pelvic muscles are voluntarily engaged, pelvic blood flow and sexual response are further intensified.

The strength and durability of pelvic contractions are directly related to orgasmic potential since the pelvic muscles are the “motor” that drives sexual climax. During orgasm, the pelvic muscles contract involuntarily in a rhythmic fashion and provide the muscle power behind the physical aspect of an orgasm. Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible pelvic muscles. The take home message is that the pleasurable sensation that you perceive during sex is directly related to pelvic muscle function. Supple and pliable pelvic muscles with trampoline-like tone are capable of a “pulling up and in” action that puts bounce into your sex life…and that of your partner!

Factoid:  “Pompoir” is the Tamil, Indian term applied to extreme pelvic muscle control over the vagina. With both partners remaining still, the penis is stroked by rhythmic and rippling pulsations of the pelvic muscles. “Kabbazah” is a parallel South Asian term—translated as “holder”—used to describe a woman with such pelvic floor muscle proficiency.  

Pelvic Floor Dysfunction

As sexual function is optimized when the pelvic floor muscles are working properly, so sexual function can be compromised when the pelvic floor muscles are not working up to par (pelvic floor muscle “dysfunction”).  Weakened pelvic muscles can cause sexual dysfunction and vaginal laxity (looseness), undermining sensation for the female and her partner. On the other hand, overly-tensioned pelvic muscles can also compromise sexual function because sexual intercourse can be painful, if not impossible, when the pelvic muscles are too taut.

Vaginal childbirth is one of the key culprits in causing weakened and stretched pelvic muscles, leading to loss of vaginal tone, diminished sensation with sexual stimulation and impaired ability to tighten the vagina.

Pelvic organ prolapse—a form of pelvic floor dysfunction in which one or more of the pelvic organs fall into the vaginal space and at times beyond the vaginal opening—can reduce sexual gratification on a mechanical basis from vaginal laxity and uncomfortable or painful intercourse. The body image issues that result from vaginal laxity and pelvic prolapse are profound and may be the most important factors that diminish one’s sex life. As the pelvic floor loses strength and tone, there is often an accompanying loss of sexual confidence.

Urinary incontinence—a form of pelvic floor dysfunction in which there is urinary leakage with coughing, sneezing and physical activities (stress incontinence) or leakage associated with the strong urge to urinate (urgency incontinence or overactive bladder)—can also contribute to an unsatisfying sex life because of fears of leakage during intercourse, concerns about odor and not feeling clean, embarrassment about the need for pads, and a negative body image perception. This can adversely influence sex drive, arousal and ability to orgasm.

A healthy sexual response involves being “in the moment,” free of concerns and worries. Women with pelvic floor dysfunction are often distracted during sex, preoccupied with their lack of control over their problem as well as their perception of their vagina being “abnormal” and what consequences this might have on their partner’s sexual experience.

Pelvic Floor Training

Pelvic floor muscle training is the essence of “functional fitness,” a workout program that develops pelvic muscle strength, power and stamina. The goal is to improve and/or prevent specific pelvic functional impairments that may be sexual, urinary, bowel, or involve altered support of the pelvic organs.

Many women exercise regularly but often neglect these hidden–but vitally important muscles– that can be optimized to great benefit via the right exercise regimen.  The key is to find the proper program, and for this I refer you to your source for everything Kegel: The KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

 

Urethral Compression Devices To Manage Male Urinary Incontinence

July 8, 2017

Andrew Siegel MD  7/8/17

Male urinary leakage can often be cured or significantly improved with behavioral treatments, pelvic exercises, medications, or surgery. However, there are times when incontinence cannot be satisfactorily addressed by these means. Furthermore, there are circumstances in which medications or surgery cannot be considerations and situations in which patients want only simple and basic management.

This entry reviews the following male urinary incontinence appliances: “Dribblestop,” “Regain,” “Acticuf,” and “Urostop.” They all have in common a pinching mechanism that is applied to the urethra, similar to squeezing your penis between thumb and forefinger to prevent urinary leakage. The goal of using these devices is to stop the urinary leakage while keeping the blood circulation to the penis intact and maintaining a comfortable fit. This can be accomplished because only a minimum amount of pressure on the urethra is required to stop the unwanted flow of urine.

Dribblestop is a foam-padded, lightweight plastic clamp for men with moderate to severe leakage. It works by applying compression pressure to the top and bottom of the penis to pinch the urethra closed.  The device is worn just behind the head of the penis. A set contains two clamps that are held together by adjustable links (of 3 varying lengths) to calibrate the urethral compression.  The compression can be further fine-tuned by choosing one of two notches on the clamps.

dribblestop

Dribblestop 

 

Regain is a flexible plastic compression device for men with mild to moderate leakage. It consists of upper and lower arms connected by hinges. A foam pad that compresses the urethra is present on the lower arm and an elastic Velcro strap is attached to the upper arm. The penis is placed through the central opening and the device is bent to envelop the penis. The elastic strap is wrapped around to hold the device in place and to apply light pressure to the underside of the penis.  It is available in 3 sizes: small (penile circumference < 2.5 inches), medium (2.5 – 4 inches), and large (> 4 inches).  A package contains 3 devices, each providing about one week’s usage.

regain

Regain

regain2

Regain deployed

 

Acticuf is a disposable pouch for mild-moderate urinary leakage. It is an absorbable pocket closed on the deep end that has a mouth that opens and closes to contain the penis and compress the urethra.  The pouch is held horizontally between thumb and forefinger and squeezed to open it. The penis is inserted in the pouch as deeply as possible and the Acticuf mouth snugs down on the penis.  It can be loosening up by squeezing and releasing the compression mechanism a few times. It should be repositioned every 3-4 hours or so and not worn while sleeping.  It should be removed and discarded when saturated. A set consists of 10 pouches.

acticuff

Urostop is used for preventing urinary leakage that occurs at the time of sexual activity, whether during foreplay, intercourse or climax.  It consists of an adjustable tension silicone loop that is cinched down to occlude the urethra.  It is placed at the base of the penis prior to sex. The ring is slid down until it is adjacent to the ends of the loop and the erect penis is placed within the loop and the device is slid down to the penile base.  The end of the tubing without the ball is pulled to achieve the desired tension. The device should not be left on for more than 30 minutes. To remove the device, the end of the tubing with the ball is pulled.  Only water soluble lubricants should be use and it should be cleaned with soap and water after each use.  The device should be replaced after 6 months of use or sooner if it shows signs of wear and tear.

Urostop

Urostop

These urethral compression devices and many more urology products for men and women can be purchased online or via telephone from The Urology Health Store.   Shipping to the continental USA is free with orders over $50 and 10% discount can be obtained with promo code: “Urology10”

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

Femicushion: Conservative Management Of Pelvic Organ Prolapse

July 1, 2017

Andrew Siegel MD  7/1/17

Medical trivia: Did you know that July 1 is the transitional day in which medical students become interns, interns become residents, residents become fellows, and residents and fellows become attending physicians? It is typically a day of mass confusion in the hospital. For this reason, it is always better to be treated in June than July!

Pelvic organ prolapse (POP) is a common female condition due to weakened pelvic anatomical support.  It results in one or more of the pelvic organs falling into the vaginal space, and at times, outside of the vaginal opening.  Several of my previous entries have covered the topic of POP and its treatment:

Introduction to POP

More about POP

A pessary is an internal device available in different sizes and shapes that is placed within the vagina to keep the fallen pelvic organ in its proper anatomical position. I reviewed pessaries in a previous blog entry: The basics of pessaries

Today’s entry is on Femicushion, a newly available soft cushion that functions as an external pessary, which offers the advantage of not needing to be positioned deeply within the vagina as is a standard pessary.  This device is ideal for women who cannot or do not want to have surgery for their POP and are not thrilled with the concept of wearing an internal pessary.

femicushion posicionado

The Femicushion is composed of washable, medical-grade silicon and is available in three sizes based upon the anatomy of the vaginal opening.

img116tk3503_1

After the POP is “reduced” (the prolapsed pelvic organ is pushed back into its normal anatomical position), the appropriately sized Femicushion is placed just within the vaginal opening. Its presence prevents the fallen pelvic organ from descending outside the vaginal opening.

IMG_1397

Once in place, it is maintained in proper position with a special pad with Velcro that is attached to adjustable undergarments (all washable):

Femicushion

The Femicushion is designed to be worn during the day and removed at night. It is washed upon removal, to be worn the following day.

The Femicushion causes less complications than an internal pessary, since it is external and is removed and cleaned on a daily basis, reducing the risk for vaginitis and bleeding. Furthermore, it eliminates forgetting to remember the presence of the internal pessary that can give rise to erosions and other serious medical issues.

Dr. Sophia Souto and colleagues performed a pilot study of the Femicushion concluding that it is an effective means of alleviating POP symptoms and improving the quality of life of women suffering with POP.  Dr. Souto was kind enough to send me all of the images used in today’s entry.  For an excellent reference on the topic, see the following article published by Dr. Souto et al: Femicushion: A new pessary generation – pilot study for safety and efficacy.  Pelviperineology 2016: 35: 44-47

The Femicushion device can be purchased online at the Urology Health Store: Use “Urology 10” code for 10% discount and free shipping.

http://www.UrologyHealthStore.com

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com  

 

Penile Shockwaves To Improve Erections

June 24, 2017

Andrew Siegel MD   6/24/17

Storz image DUOLITH_SD1_ultra_URO_003Thank you Storz Medical and Robert Remington (RemingtonMedical.com) for above image of a shock wave unit used for the treatment of erectile dysfunction; note treatment of both the external (left side of image) and internal aspects of the penis (right side of image)

Shockwaves are acoustic vibrations that carry energy, e.g. the sound waves generated by clapping your hands. Compression and expansion of a medium creates a mechanical force that can be put to practical use. Since the 1980s, urologists have used focused shockwave therapy to pulverize kidney stones, revolutionizing their treatment.  A much tamer form of shockwaves–low energy shockwave therapy–is a new treatment for erectile dysfunction.  When applied to the penis, shock wave therapy causes cellular micro-trauma and mechanical stress, stimulating the growth of new blood vessels and nerve fibers that ultimately improves penile blood flow and erectile function. The long and the short of it is that the physical energy from shockwaves can be tapped into to cause a benefit that can prove advantageous in the bedroom.  

Shockwave therapy–which triggers renewed circulation and induces structural changes that can regenerate and remodel damaged tissues–been used for many medical purposes:

  • chronic wounds
  • neuropathy
  • cardiac disease
  • plantar fasciitis
  • tennis elbow

Shockwave Treatment for Erectile Dysfunction

Erection quality is all about pressurized blood filling and remaining in the erectile chambers of the penis. Although erectile dysfunction (E.D.) typically has many underlying causes, some of the key reasons are aging and lifestyle-related changes in penile arterial blood flow as well as alterations in the integrity of penile erectile tissue. Most treatments for E.D. to date—pills, urethral suppositories, injection therapy, and prosthetic implants—do not treat the underlying cause of the problem nor modify the natural history of the disease.   Penile shockwave therapy can be considered “revolutionary,” since it is a disease-modification paradigm, ultimately changing the health of the erectile tissues and improving penile blood flow .

Penile shocks stimulate penile circulation via growth of new blood vessels, growth of new nerve fibers (neural regeneration), stem cell activation and cellular proliferation, and protein synthesis. On a molecular level, the cell membrane, mitochondria and endoplasmic reticulum respond the most profoundly to shockwaves.  As the cells are mechanically stressed, multiple adaptive pathways triggered, inducing structural changes that are capable of regenerating  and remodeling penile tissue.

In research carried out by Dr. Tom Lue, shockwave therapy was used to treat diabetic rats that had the arteries and nerves responsible for erections surgically tied off. Cellular activation, regeneration of erectile tissue (smooth muscle and endothelial cells), and improved penile blood flow and erectile function was clearly demonstrated.

The pilot human study on penile shockwaves for E.D. was performed in 2010 by Yoram Vardi. 20 patients were treated twice weekly for three weeks, with application of shockwaves to five separate sites on the penis.  This study showed a meaningful increase in erectile rigidity and durability of erections using the International Index of Erectile Function (IIEF) as a metric with improved overall satisfaction and ability to penetrate. An additional study showed positive short-term effects in men who previously had responded well to oral erectile dysfunction medications.  To date, clinical trials have shown both subjective improvement in erectile dysfunction as well as objective increased penile blood flow and erectile rigidity.  In a large randomly controlled trial with over 600 subjects, the average improvement in IIEF was a significant 6.4.

Treatment variables include the shockwave energy, number of shocks delivered, the sites treated and duration of the treatment. For E.D., low energy shockwaves that are less focused than those used for kidney stone fragmentation are used.  Too little energy has proven ineffective, while too much energy can actually kill cells, resulting in scarring and erectile dysfunction.  There seems to be a “sweet spot” in terms of the energy level that will optimize erectile function that is generally about 2-10% of the power of shockwave therapy for kidney stones.  A recent study used ten once-weekly treatment sessions.  During each session, 600 shocks were applied to the erectile chambers of both the internal and external penis with a total of 6000 shocks applied over the course of the 10-week period.  The procedure was found to be well tolerated aside from a slight pricking or vibrating sensation that is perceived during the delivery of the shockwaves.

Bottom Line: Low energy penile shockwave therapy is an exciting new treatment option for men with E.D.  Safe and well tolerated, it works by causing mechanical stress and trauma to erectile tissues, stimulating the growth of new blood vessels and nerve fibers and potentially enabling penile tissue to regain the ability for spontaneous erection.  It uniquely modifies the disease, unlike most traditional E.D. treatments that function as “Band-Aids.”  Further clinical investigation is necessary to determine optimal treatment protocols.  It is highly likely that in the near future, low energy penile shockwave therapy will be approved by the FDA for the treatment of E.D.

For more information on Sonicwave technology from STORZ see FullMast website.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

Co-creator of the PelvicRx male pelvic floor exercise program: http://www.PelvicRx.com

How High Is Your V.I.Q. (Vaginal Intelligence Quotient)?

June 17, 2017

Andrew Siegel MD  6/17/2017

You may know your I.Q., but do you know your V.I.Q.?  Let’s begin with a test of your knowledge of lady parts and determine your “Vaginal Intelligence Quotient” or V.I.Q.  See how many of 8 female genital structures you can properly identify. Answers are at end of this blog entry.  Note that there is one anatomical part that virtually no one gets right.  (Thank you Michael Ferig, Wikipedia Commons).

vulva_hymen_miguelferig

 

The Female Nether Parts

The female nether parts are a mystery zone to a surprising number of women, who often have limited knowledge of the inner workings of their own genital anatomy. Many falsely believe that the “pee hole” and “vagina hole” are one and the same. The truth is that the terrain between a female’s thighs is more complicated than one would think…. three openings, two sets of lips, mounds, swellings, glands, erectile tissues and very specialized muscles. While female anatomy may be mysterious to many women, many men are downright clueless and would be well served to learn some basic anatomy. Learn lady parts…knowledge is power!

“The vagina is a place of procreative darkness, a sinister place from which blood periodically seeps as if from a wound.”

“Even when made safe, men feared the vagina, already attributed mysterious sexual power – did it not conjure up a man’s organ, absorb it, milk it, spit it out limp?”

–Tom Hickman from “God’s Doodle”

The names of several lady parts begin with the letter “V”—vulva, vagina and vestibule. What could be a better choice since the area (the vulva) is V-shaped?

pixabay-v

Thank you Pixabay for image above

The Vulva 

The vulva is the outside part of the female genitals. It consists of the mons pubis, labia majora, labia minora, vestibule, vaginal opening, urethral opening and clitoris.

The mons is the triangular mound that covers the pubic bone, consisting of hair-bearing skin and underlying fatty tissue. It extends down on each side to form the labia majora, folds of hair-bearing skin and underlying fatty tissue that surround the entrance to the vagina. Within the labia majora are two soft, hairless skin folds known as labia minora, which safeguard the entrance to the vagina. The upper part of each labia minora unites to form the clitoral hood (prepuce or foreskin) at the upper part of the clitoris and the frenulum (a small band of tissue that secures the clitoral head to the hood) at the underside of the clitoris.

Figure_28_02_02

(Anatomy of the vulva and the clitoris by OpenStax College – Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30148635, no changes made to original)

The Vestibule

The vestibule is the “entryway,” an area located between the inner lips that contains the entrances to the vagina and the urethra. Urine exits from the urethral opening on the vestibule and not from the vaginal opening. There is a small amount of vestibule tissue that separates the urethral opening from the vaginal opening.

 The Vagina

The word “vagina” intelligently derives from the Latin word for “sheath,” a cover for the blade of a knife or sword. Most women (and men) falsely think of the vagina as the external female genitals. The external lady parts are the VULVA as opposed to the VAGINA, which is internal.

 The Clitoris

The word clitoris derives from the Greek “kleitoris,” meaning “little hill.” The clitoris is uniquely an erectile organ that has as its express purpose sexual function, as opposed to the penis, which is a “multi-tasking” sexual, urinary and reproductive organ. The clitoris is the center of female sensual focus and is the most sensitive erogenous zone of the body, playing a vital role in sensation and orgasm. If an orgasm can be thought of as an “earthquake,” the clitoris can be thought of as the “epicenter.” The head of the clitoris, typically only the size of a pea, is a dense bundle of sensory nerve fibers thought to have greater nerve density than any other body part.

Like the penis, the clitoris is composed of an external visible part and an internal, deeper, invisible part. The inner part is known as the crura (legs), which are shaped like a wishbone with each side attached to the pubic arch as it descends and diverges. The visible part is located above the opening of the urethra, near the junction point of the inner lips. Similar to the penis, the clitoris has a glans (head), a shaft (body) and is covered by a hood of tissue that is the female equivalent of the prepuce (foreskin).  The glans is extremely sensitive to direct stimulation.

The shaft and crura contain erectile tissue, consisting of spongy sinuses that become engorged with blood at the time of sexual stimulation, resulting in clitoral engorgement and erection. The clitoral bulbs are additional erectile tissues that are sac-shaped and are situated between the crura. With sexual stimulation, they become full, plumping and tightening the vaginal opening. The crura and bulbs can be thought of as the roots of a tree, hidden from view and extending deeply below the surface, yet fundamental to the support and function of the clitoral shaft and clitoral glans above, which can be thought of as the trunk of a tree.

When the clitoris is stimulated, the shaft expands with accompanying swelling of the glans. With increasing stimulation, clitoral retraction occurs, in which the clitoral shaft and glans withdraw from their overhanging position, pulling inwards against the pubic bone.

The clitoris is a subtle and mysterious organ, a curiosity to many women and men alike. It is similar to the penis in that it becomes engorged when stimulated and because of its concentration of nerve fibers, is the site where most orgasms are triggered. Clitorises, like penises, come in all different sizes and shapes. In fact, a large clitoris does not appear much different from a small penis. The average length of the clitoral shaft including the glans is 0.8 inches (range of 0.2-1.4 inches). The average width of the clitoral glans is 0.2 inches (range of 0.1-0.4 inches).

The clitoris becomes engorged and erect during sexual stimulation. Two of the pelvic floor muscles—the bulbocavernosus (BC) and ischiocavernosus (IC)—engage and contract and compress the deep internal portions of the clitoris, maintaining blood pressures within the clitoral erection chambers to levels that are significantly higher than systemic blood pressures.

The bulbocavernosus reflex is a contraction of the BC and IC muscles (and other pelvic floor muscles including the anal sphincter) that occurs when the clitoris is stimulated. This reflex is important for maintaining clitoral rigidity, since with each contraction of the BC and IC muscles there is a surge of blood flow to the clitoris, perpetuating clitoral engorgement and erection.

 

vulva_hymen_miguelferig

Thank you Michael Ferig, Wikipedia Commons, for illustration above

Answers to Anatomy Quiz:

LM: labia majora (outer lips); VV: vaginal vestibule; Lm: labia minora (inner lips);  C: clitoris; U: urethra (urinary channel); V: vagina; H: hymenal ring (remnant of membrane that partially covered vaginal opening); A: anus (butthole)

Your V.I.Q.:

0 correct:  Vaginally feeble

1-2 correct: Vaginally deficient

3-4 correct: Vaginally average

5-6 correct: Vaginally superior

7 correct: Vaginally gifted

8 correct: Vaginal Genius…as sharp as a seasoned gynecologist!

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com (much of the content from today’s entry was excerpted from The Kegel Fix)

The Fickle Phallus

June 10, 2017

Andrew Siegel MD  6/10/17

3 screw icon square

 

The penis is a fickle and temperamental friend who can be volatile, unpredictable and even hot-headed at times.  He has many states of existence, ranging from as shrunken and soft as a marshmallow to a “proud soldier”– rock-hard with exquisite posture. Between deflated and inflated, there are an infinite number of intermediate states, dependent on the dynamic balance between the closing and opening mechanisms of the blood flow to the penile erectile chambers.  It is important to understand that the same physiology applies to female genitals and clitoral function. 

The Autonomic Nervous System: The Network Ultimately Responsible for this

The autonomic nervous system controls “unconscious” body functions, including heart rate, breathing, digestion and contributes in a large way to regulate sexual function.

Heart rate and contraction are dynamic, changing moment-to-moment, even beat-to-beat, since they are “governed” by two competing halves of the autonomic nervous system.  The two systems—sympathetic and parasympathetic—are in a constant tug-of-war based upon external stimuli and one’s interpretation of them.

The sympathetic nerves respond to threats, fears and anxieties —an agitated state of mind and blood vessel tone—with the classic flight-or-fight response, which accelerates heart rate, heart contractility, respiratory rate, blood pressure and constricts arteries throughout the body.  The sympathetic system boots up when one is presented with a sudden anxiety-provoking event, such as being in a near-miss car accident.

On the other hand, the other half of the autonomic nervous system is the parasympathetic nervous system—the calmer and more relaxed state of mind and blood vessel tone—which slows down heart rate and respiratory rate, reduces heart contractility and lowers blood pressure by dilating arteries. The parasympathetic system is the system that predominates when we are not in situations that provoke fear and anxiety, governing many day-to-day bodily functions.

The_Autonomic_Nervous_System

Above image from Wikipedia, in public domain

 

Erectile function is complex and based upon many factors, both physical and psychological, but the ultimate determinant is chemistry that drives penile blood flow or lack thereof.  The state of the penis (flaccid vs. rigid vs. any intermediate state) at any given moment is based upon the balance between sympathetic (contractile) and parasympathetic (relaxant) factors. As the cardio-vascular system function is predicated upon the predominance of sympathetic versus parasympathetic stimulation, so the function of the peno-vascular system is predicated upon the predominance of sympathetic versus parasympathetic function. After all, the penis can be considered to be an extension of the vascular system that can be referred to as the “dangling aorta.”

Penile erection occurs with activation of parasympathetic (nitric oxide-cyclic guanosine phosphate pathway) nerves, which foster the relaxation of the penile arterial smooth muscle and the smooth muscle of the erectile tissue and inhibition of contractile mechanisms, all of which cause blood to rush into and inflate the penile erectile chambers.

Alternatively, penile flaccidity occurs with activation of sympathetic (norepinephrine pathway) nerves, which foster the contraction of the penile arterial smooth muscle and the smooth muscle of the erectile tissue and inhibition of relaxing mechanisms, all of which causes blood to exit and deflate the penile erectile chambers.

Sympathetic nervous system activity causing increased smooth muscle tone in erectile tissue is likely involved in the occurrence of psychological as well as in cardiovascular erectile dysfunction.

The bottom line is that the state of penile inflation at any given moment is highly influenced by the balance between sympathetic and parasympathetic function. High sympathetic activity causes a shriveled and decompressed penis, while high parasympathetic activity an erect and rigid penis. This is the very reason why one needs to have a relaxed temperament in order to perform sexually and also explains why anxiety can doom erectile function. A perfectly healthy 21-year-old with absolutely normal “plumbing” can be doomed to sexual failure if performance anxiety creates such a high sympathetic tone state. Similarly, a 50-year-old man who uses Viagra to increase penile blood flow and help obtain a rigid erection can have the beneficial effect of the medicine neutralized by a highly anxious state of mind.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com