Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know (Part 3)

January 20, 2018

Andrew Siegel MD  1/20/18

This entry, written for both women as well as men, is intended to enable one to do a proper contraction of  the pelvic floor muscles (PFM), a task easier said than done.  A means of self-assessment of PFM strength and stamina is offered. 

Image Below: The Pelvic Floor Muscles (Male left; Female right)

1116_Muscle_of_the_Perineum

Attribution: URL: https://cnx.org/contents/FPtK1zmh@8.108:b3YG6PIp@6/Axial-Muscles-of-the-Abdominal
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016 

Do It Right

PFM exercises (Kegel exercises) must be done properly to reap benefits. Many think they are doing these pelvic contractions correctly, but actually are contracting the wrong muscles, an explanation of why their efforts may have failed to improve their clinical situation. In both women and men, PFM exercises involve pulling inwards and upwards, lifting and elevating.  In females, this will result in tightening the urethral, vaginal and anal openings and in males tightening the anus and if done at the time of an erection, elevating the erect penis.  Proper pelvic contractions are the very opposite of straining. One strains to move their bowels, whereas one “Kegels” to accomplish the opposite—to tighten up the sphincters to NOT move their bowels; in fact, PFM contractions are a means of suppressing bowel urgency (as well as urinary urgency).

How do you know if you are contracting your PFM properly?

For the Ladies: 6 Ways to Know That You Are Properly Contracting Your PFM

  1. When you see the base of your clitoris retract and move inwards towards your pubic bone.
  2. When you see your perineum (area between vagina and anus) move up and in.
  3. When you see the anus contract (“anal wink”) and feel it tighten and pull up and in.
  4. When you can stop your urinary stream completely.
  5. When you place your index and middle fingers on your perineum and you feel the contraction.
  6. When you place a finger in your vagina, you feel the vaginal “grip” tighten.

 

 

For the Gentlemen: 6 Ways to Know That You Are Properly Contracting Your PFM

  1. When you see the base of your penis retract inwards towards the pubic bone and the testes rise up towards the groin.
  2. When you place your index and middle fingers in the midline between the scrotum and anus and you feel the PFM contractions.
  3. When you see the anus contract (“anal wink”) and feel it tighten and pull up and in.
  4. When you get the same feeling as you do when you are ejaculating.
  5. When you touch your erect penis and feel the penile erectile chambers surge with blood and you can make the penis lift upwards when you are in the standing position.
  6. When you can stop your urinary stream completely.

Fact:  Vince Lombardi stated: “Practice doesn’t make perfect, perfect practice makes perfect.”  This is wholly applicable to PFM training. Do it right or don’t do it!

Assessing Your PFM: Note that this is used primarily for women

There are many fancy ways of testing your PFM, but the simplest is by using tools that everyone owns—their fingers.  Digital palpation (a finger in the vagina, or alternatively the anal canal) is the standard means of testing the contraction strength of the PFM. The other methods are visual inspection, electromyography (measuring electrical activity of the PFM), perineometry (measuring PFM contractile strength via a device that is inserted into the vagina or anus) and imaging tests that assess the lifting aspects of the PFM, such as ultrasound and magnetic resonance imaging.

Assessment of your PFM evaluates PFM strength and endurance.  PFM strength can be self-assessed in the supine position (lying down, face up) with your knees bent and parted. Gently place a lubricated finger of one hand in the vagina (or alternatively the anal canal) and contract your PFM, lifting upwards and inwards and squeezing around the finger. Keep your buttocks down in contact with the surface you are lying on. Ensure that you are not contracting your gluteal (butt), rectus (abdomen) or adductor (inner thigh) muscles. Do this by placing your other hand on each of these other muscle groups, in turn, to prove to yourself that these muscles remain relaxed during the PFM contraction.

Rate your PFM strength using the modified Oxford grading scale, giving yourself a grade ranging from 0-5.  Note that the Oxford system is what many physicians use and it is relatively simple when done regularly by those who are experienced performing pelvic exams. Granted that this is not your area of expertise, so you may find this challenging. However, do your best to get a general sense of your baseline PFM strength.

Oxford Grading of PFM Strength

0—complete lack of contraction

1—minor flicker

2—weak squeeze

3—moderate squeeze

4—good squeeze

5—strong squeeze

Next test your PFM endurance. Do as many PFM contractions as possible, pulsing the PFM rapidly until fatigue sets in (the failure point where you cannot do any more contractions).  After you have recovered, contract the PFM for several seconds followed by relaxing them for several seconds, doing as many repetitions until fatigue occurs. Finally, do a single PFM contraction and hold it for as long as you can.

Record your Oxford grade and the maximum number of pulses, maximum number of several second contractions and the duration of the sustained hold as baseline measurements. These will be useful to help assess your progress. Initially, it is likely that your PFM will be weak and lack endurance capacity.

Coming soon…The Nuts and Bolts of Pelvic Floor Muscle Training.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following pelvic floor health books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

 

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

 

 

 

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Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know (Part 2)

January 13, 2018

Andrew Siegel MD    1/13/2018

This entry, written for both males and females, will help you develop pelvic floor muscle (PFM) awareness and build PFM muscle memory.  

Image below: Male PFM (left); Female PFM (right)

 

1116_Muscle_of_the_Perineum

Attribution: URL: https://cnx.org/contents/FPtK1zmh@8.108:b3YG6PIp@6/Axial-Muscles-of-the-Abdominal
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016

PFM Education and Awareness

Fact: Studies have clearly shown that most women with pelvic issues referred for PFM training are unable to perform a proper PFM contraction. Almost all demonstrate weak PFM strength regardless of age, ethnicity or diagnosis. Most males are clueless about PFM training, many not even realizing that they have this set of important muscles. 

Physical therapists and physical medicine and rehabilitation experts have used functional restoration to effectively manage injured skeletal muscles. This strategy can likewise be applied to weakened and poorly functional PFM. The principles involve segregation, guidance and progression.  Segregation is an awareness of PFM anatomy and function with the ability to isolate the PFM by contracting them independently of other muscles. Guidance refers to the instructions necessary to learn how to properly engage and train the PFM.  Progression refers to the incrementally more challenging exercises over the course of the PFM training regimen that result in PFM growth and improvement.  Again, exercise is about adaptation, so increasing repetitions and intensity is mandatory to achieve results. The goal is for fit PFM—strong, yet flexible, equally capable of powerful contractions as well as full relaxation.

Initially, one must become aware and mindful of the presence, location and nature of the PFM.  A good starting point is what the PFM are not: they are NOT the muscles of the abdomen, thighs or buttocks, but are the saddle of muscles that run from the pubic bone in front to the tailbone in back.

The PFM have a resting tone, even though you are not typically aware of it. They can be contracted and relaxed at will: a voluntary contraction of the PFM will enable interruption of the urinary stream and tightening of the anal canal and an involuntary (reflex) contraction of the PFM occurs, for example, at the time of a cough. Relaxation of the PFM occurs during urination or a bowel movement.

Dr. Arnold Kegel described a PFM contraction as “a squeeze around the pelvic opening with an inward lift.” With a proper PFM contraction, the perineum (the area between vagina and anus in females and scrotum and anus in males) pulls in and lifts in an upwards direction.  This is a “drawing in and up,” which is the very opposite feeling of “bearing down” to move one’s bowels.  For females, one method of getting the feel for doing a proper PFM contraction is to initially tighten the vagina, secondly the anus, and thirdly lift up the perineum.

Fact: Kay Crotty, a pelvic floor physiotherapist in the UK, feels that it is initially easier to learn to contract your PFM by concentrating on just the back PFM (anal sphincter).  She discovered that women who tighten their PFM while focused on both the front PFM (vaginal) and back PFM do better quality PFM contractions than those who tighten their PFM focused on just the front PFM. 

There are many mental images that can be useful in understanding PFM contractions. One is to think of the pubic bone and tailbone moving towards each other. Another helpful picture is to imagine the PFM as an elevator—when the PFM are engaged, the elevator rises upwards to the first floor from the ground floor; with continued training, the elevator rises to the second floor.  Alternatively, for females, envision that you are lifting a ping pong ball with your vagina and pulling it deep inside you. Another means is to mentally visualize that you are removing a tampon from your vagina and as you pull on the string you try to resist and hold the tampon in.

There are simple “biofeedback” techniques that can be helpful as well. After emptying your bladder about halfway, try to interrupt your urinary stream for a few seconds while you focus on the PFM that allow you to do so. Then resume and complete urination.  The feeling should be that of clenching and unclenching the vagina, urethra and anus in females and the anus and urethra in males.  Another method for females is to place a finger in your vagina and contract your PFM: the feeling should be of your vagina having a firm grip around your finger; alternatively, in either gender one can place a finger in the anus and when the PFM are contracted, the feeling should be of the anus having a firm grip around your finger.

Building Muscle Memory

It is important to understand how one becomes adept at using muscles.  This is relevant to gaining competence in any new physical activity and will be applied specifically to acquiring the skills to perform well-executed PFM contractions.

There are four stages of motor learning.  (I learned this as it pertained to the mechanics of a golf swing, but it is equally relevant to mastering contracting the PFM.)

Stage 1. Unconscious/incompetent

There is no awareness of the motion and it cannot be capably performed. It is challenging to make the connection between your brain and your PFM because the PFM under most circumstances are used involuntarily (without conscious awareness). This connection is not intuitive and must be taught.

Fact: The connections between brain and PFM consist of sensory and motor nerves. The PFM contain sensors known as “proprioceptors” that detect stretch, position and motion and convey this information to the brain via sensory nerves. Motor nerves originate in the brain and enable the PFM to contract.

Stage 2. Conscious/incompetent

Awareness of the motion is learned, but the motion cannot be competently performed.

Stage 3. Conscious/competent

Awareness of the motion is established and with sufficient practice the motion can be competently performed.

Stage 4. Unconscious/competent

With continued practice, the brain-PFM connection and muscle memory become well established and the motion can be performed reflexively (without conscious thought or effort).

…To be continued next week with a discussion on the execution of a proper PFM contraction and self-assessment of  your PFM strength and stamina.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

 

 

 

Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know

January 6, 2018

Andrew Siegel MD  1/6/2017

Happy New Year!  At this time, many of us are trying to execute New Year’s resolutions.  Topping the list of most resolutions is getting into good physical shape.  A vital piece of this is pelvic floor fitness; in fact, pelvic floor muscle training was among the top five exercises recommended for general health and fitness in a recent Harvard Medical School report.

The next series of blog entries, written for both men and women, will enable you to achieve pelvic floor fitness.  Remember, Kegels are not just for the ladies!  This first entry discusses the fast and slow twitch muscle fibers that determine pelvic floor muscle (PFM) function, the adaptation principle and the distinction between strength, power and stability.  

Image below: Male PFM (left) and female PFM (right); notice their similarity.

1116_Muscle_of_the_PerineumAttribution: URL: https://cnx.org/contents/FPtK1zmh@8.108:b3YG6PIp@6/Axial-Muscles-of-the-Abdominal  Version 8.25 from the Textbook, OpenStax Anatomy and Physiology, 
Published May 18, 2016

Muscles 101

Muscles provide shape to our bodies and allow for movement, stability and maintenance of posture.  Most skeletal muscles come in pairs and cross bony joints—when one group contracts, it causes bending of that joint and when the opposing group contracts, it causes straightening of that joint (e.g., biceps/triceps).  When each contract equally, the joint is in a neutral position. The human body has three types of muscles—skeletal muscles that provide mobility and stability, smooth muscles that line the arteries, bladder, intestine, etc., and the unique cardiac muscle of the heart.  Muscles are composed of fibers that contract (shorten and tighten) and relax (lengthen and loosen).

The PFM are skeletal muscles that are comprised of fast twitch and slow twitch muscle fibers. Fast twitch fibers predominate in high contractile muscles that fatigue rapidly and are used for fast-paced muscle action, e.g., sprinting.  Slow twitch fibers predominate in endurance muscles, e.g., marathon running. The PFM have a constant tone (low level of involuntary contraction) because of the presence of slow twitch fibers. The fast twitch fibers allow for voluntary contraction. The PFM fibers are 70% slow twitch, fatigue-resistant, endurance muscles to maintain constant muscle tone (e.g., sphincter function and pelvic support) and 30% fast twitch, capable of rapid and powerful contractions (e.g., sexual climax, interrupting the urinary stream and tightening the anus).

Fact:  Aging causes a decline in the function of the fast twitch fibers, but tends to spare the slow twitch fibers.   

Muscle mass is in a dynamic state, a constant balance between growth and breakdown. With aging, muscle fiber wasting occurs as muscle breakdown exceeds muscle growth, adversely affecting function. Strength training reduces muscle wasting by increasing muscle bulk through enlargement of muscle fibers. This is true of all skeletal muscles, the PFM being no exception.

Adaptation Principle

Muscles are remarkably responsive to the stresses placed upon them.  Muscle growth only occurs in the presence of progressive overload, which causes compensatory structural and functional changes, a.k.a. adaptation. This explains why exercises get progressively easier in proportion to the effort put into doing them.  As muscles adapt to the stresses placed upon them, a “new normal” level of fitness is achieved.  Another term for adaptation is plasticity. Skeletal muscles are “plastic,” capable of growth or shrinkage depending on the environment to which they are exposed.

The PFM behave similarly to other skeletal muscles in terms of their response to exercise or lack thereof.  In accordance with the adaptation principle, it is advisable to increase number of repetitions and contraction intensity to build muscle PFM strength, power and endurance.  As much as our muscles adapt positively to resistance, so they will adapt to the absence of stress and resistance, resulting in smaller, weaker and less durable muscles.

Fact: Use It or Lose It. With a conditioning regimen, the PFM will thrive, optimizing their function.  When the PFM are neglected, they will weaken, impairing their function.   

Strength, Power and Stability

The goal of PFM training is to maximize the trio of PFM strength, power and stability. Strength is the maximum amount of force that a muscle can exert. With time and effort, PFM contractions become more robust, helping sexual function and improving one’s ability to neutralize stress urinary incontinence, overactive bladder and pelvic organ prolapse in females.  In males, command of one’s pelvic floor muscles can improve sexual, urinary and prostate health.  Power is a gauge of strength and speed (muscle force multiplied by the contraction speed), a measure of how rapidly strength can be expressed, of great benefit to sexual health and the ability to react rapidly to urinary/bowel urgency and stress urinary incontinence. Stability helps maintain vaginal tone, urinary and bowel sphincter function and pelvic organ support as well as contributing to the “backboard” that helps prevent stress urinary incontinence.

To be continued… Next week’s entry provides information on the process of building muscle PFM memory and how to develop PFM awareness.

Wishing you the best of health!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

 

Scrotal Sac Slack

December 30, 2017

Andrew Siegel MD   12/30/17

It is “scrotum-tightening December cold” outside, a most opportune time to blog about scrotal laxity and “long balls.”  Anyway, a  few weeks ago the topic was vaginal labial hypertrophy, so to be fair to the male gender today’s entry deals with a parallel issue, the low-hanging scrotal sac. A complaint voiced not infrequently by my middle-aged and older patients is that their testicles hang loosely, similar to the pendulous breasts of older women. At times, men complain that when they are seated on the toilet, their scrotum actually touches the water. Ouch!

In Curb Your Enthusiasm, S06E07, Larry ends up in the ER because he caught his testicles in the fly of his underwear and was diagnosed with “long balls.” https://www.youtube.com/watch?v=gmHf_1kqJc0

In summer camp, one of the traditional songs sung by campers (to the tune of the children’s song Do your ears hang low?) was the following:

Do your balls hang low?
Do they wobble to and fro?
Can you tie ’em in a knot?
Can you tie ’em in a bow?
Can you throw them over your shoulder
Like a continental soldier?
Do your balls hang low?

 I don’t know what the summer camp fascination with low-hanging balls was all about, but another song (to the tune of Italian love song That’s Amore) had the following lyrics:

When your balls hit the floor like a B-54 it’s a rupture.

Scrotal science 101

Figure_28_01_02Attribution of image above: By OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)%5D, via Wikimedia Commons

In early fetal development the testicles originate in the abdomen and by full-term they  descend south into the scrotum (the sac that houses the testicles).  At puberty, the testes increase in size substantially; with the increase in testes size there is a proportional increase in scrotal size, the scrotum being a very expansive cavity.

The scrotum has several roles, enveloping and protecting the testes as well as aiding in their function by regulating their temperature. For optimal sperm production, the testes need to be a few degrees cooler than core temperature; the dartos muscle within the scrotal wall relaxes or contracts depending on the ambient temperature, allowing the testes to elevate or descend to help maintain this optimal temperature. Under conditions of cold exposure, the dartos contracts, causing the scrotal skin to wrinkle and to bring the testicles closer to the body.  When exposed to heat, dartos relaxation allows the testicles to descend and the scrotal skin to smoothen.

The testes are suspended via the spermatic cord, a rope-like “cord” of tissue that traverses the groin and contains the life supply of the testes.  Both the testes and spermatic cord are covered by tissues that are extensions of the connective tissue coverings of three of the abdominal core muscles. The most important of these coverings surrounding the spermatic cord is the cremaster muscle, which elevates the testes north when it contracts.

Factoid: The cremasteric reflex is a reflex elevation of the testes from the scrotum to the groin when the upper thigh is gently stroked. The reflex is brisk in children and becomes weaker with aging.   

Why does scrotal laxity occur?

The combined factors of the weight of the testes, gravity and time cause a continued southward journey of the testes throughout life, particularly so as collagen and elastin connective tissues weaken and scrotal skin (like skin everywhere else) becomes less supple. With aging, there is also loss of muscle strength of the dartos and cremaster muscles, causing scrotal relaxation and looser hanging testes, respectively. Years ago, a common hernia repair (Shouldice technique) that was in vogue stripped the spermatic cord of cremaster muscle, rendering the testicle on the side of the repair to be “dangly.”

What are symptoms of scrotal laxity?

Aside from the wet scrotum scenario when seated on a toilet bowl, since the low-hanging testes is much less protected, it is more vulnerable to trauma and irritation than the well-supported testes. The low-hanging testes is susceptible to injury when one sits down and discomfort when one participates in cycling, motorcycling, horseback riding and other sports. The low-hanging testes can cause hygienic issues as well as embarrassment and the desire not to be seen naked by a sexual partner, in a locker room or even at the beach in a bathing suit.

Factoid: Nutcracker Suite.  A common complaint voiced by patients is a testicle getting crushed when getting into and sitting down in an automobile.

Factoid: The scrotum may hang so low that when one passes wind, the testicles may become airborne like a kite flying erratically in a sudden gust! 

What to do about scrotal laxity

Try to maintain a healthy lifestyle, stay in good physical shape and keep your core muscles fit.  Get in the habit of wearing briefs or boxer briefs, many of which are highly supportive like cycling shorts, as opposed to boxers.

If scrotal laxity has caused anatomical, functional or psychological concerns, know that there are effective surgical procedures to remedy the problem. Reducing the size of scrotum is known in medical speak as reduction scrotoplasty, a.k.a. scrotal lift.  There are a variety of techniques used to tailor and re-contour the excessive scrotal skin, with the goals of elevating the testes, eliminating the redundant scrotal sac tissue, minimizing scarring and retaining natural pigmentation.

Bottom Line: Time and gravity can be cruel conspirators when it comes to testes and scrotal support.  Although scrotal laxity is not a significant medical issue, it can result in quality of life and self-esteem issues.  If  you find your scrotum becoming waterlogged, testicles airborne, or have other functional and/or cosmetic concerns, reduction scrotoplasty (scrotal lift) is an effective procedure to improve the cosmetic appearance and resolve the annoying symptoms.  This is a procedure that can be performed by a urologist on an outpatient basis.

Final factoid: Testes self-examination.  There are no organs in the body—save the breasts—that are more external and easily accessible to examination than the testes.  Unlike the ovaries, the testes are “gift wrapped” in the scrotal sac and can easily be and should be checked periodically for lumps and bumps. Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20s, striking men at the peak of life.  Take advantage of this accessibility to do regular exams—it just might be lifesaving.

Wishing you the best of health in 2018,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx

 

Love Muscles Illustrated

December 23, 2017

Andrew Siegel MD  12/23/17

Hermes Butchart Gardens, Victoria

Above photo of Hermes I took this past summer at Butchart Gardens, Victoria, Canada 

In this entry, words will be kept to a minimum because the illustrations tell most of the story.  The images of the superficial pelvic floor muscles (muscles of love) that follow derive from the 1918 edition of Gray’s Anatomy of the Human Body (public domain), modified by Uwe Gille.

Whether you are male or female, two vital muscles — bulbocavernosus (BC) and ischiocavernosus (IC— have an intimate relationship with your genitals and are the “motor” that drives their function.  Without them, your penis or vagina would be non-functional putty!  Notice how remarkably similar the muscles are in both genders, the only difference being that the BC muscle is split in women, divided by the vagina.

Factoid: The relationship of the BC and IC muscles to the vagina and penis parallels the relationship between the diaphragm and the lungs. Without a functioning diaphragm to move the lungs, your lungs would be non-functional bags of air. 

Male BC (top) and IC muscles (bottom)

Bulbospongiosus-Male

Ischiocavernosus-male

 

 

 

 

 

 

 

 

 

  • Transform “plump” penis to “rigid” penis by compressing erectile chambers (responsible for penile high blood pressure)
  • Enables you to move your erect penis up and down at will
  • Stabilizes erect penis so it stays rigid and skyward-angled
  • Contract at climax and responsible for forcible expulsion of semen

Factoid: The only place in the body it is desirable to have high blood pressure is the penis. The BP at the time of full rigidity is > 200 mm, the 80-100 mm increase over systolic BP achieved by virtue of contraction of these muscles.

 

 

 

 

Female BC (top) and IC muscles (bottom)

Bulbospongiosus-Female

Ischiocavernosus-female

 

 

 

 

 

 

 

 

  • Increase pelvic blood flow during arousal, contributing to lubrication and plumping of vulva
  • Transform clitoris from flaccid to erect
  • Enables tightening vagina at will
  • Contract at the time of climax contributing to physical sensation of orgasm

Factoid: Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible BC and IC muscles.

 

 

 

Bottom Line: In men, these muscles function as the “erector penis” and “ejaculator penis.”  In women, these muscles function as the “erector clitoris,” “constrictor vagina,” and “climaxer maximus.”  Whether you are female or male, optimize the function of these muscles by doing Kegel exercises and make sure you do them properly: Male Kegel Book; Female Kegel Book.  To quote Sam Sneed, “Exercise puts brains in your muscles,” totally appropriate to these vital muscles that govern sexual function. 

Wishing you the best of health, a merry Christmas and a wonderful 2018!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx

 

 

 

Kidney Cysts: To Worry Or Not?

December 16, 2017

Andrew Siegel M.D.  12/16/17

You may have had some sort of chest or abdominal imaging study and you were told that you have one or more cysts in your kidney(s). Is this any reason for concern?

Kidney cysts, a.k.a. renal cysts, are round sacs filled with fluid located within or attached to the kidney. Most are not symptomatic nor dangerous and are discovered incidentally on imaging studies (ultrasound, computerized tomography, or magnetic resonance imaging) done for other reasons.

Renal cysts are common, occurring in 25% or so of adults over age 40 and 50% of adults over age 50. They are quite variable in size, ranging from smaller than a pea to larger than a cantaloupe.  Most are defined as simple cysts: spherical, thin walled, fluid-filled, without septa (internal divisions), without calcification, without solid parts, and do not take up contrast on imaging studies. Although large cysts may become symptomatic by compressing adjacent organs, this is extremely unusual. Only under the rarest of circumstances do simple cysts require treatment or intervention.

Note: In my more than 25 year urology career I have only needed to remove simple cysts in two patients.  Both were slender women, one with a cyst so large that it distorted her abdomen, as if she was pregnant.  The other woman had the cyst located behind her stomach, displacing her stomach upwards towards her abdominal wall such that every time she ate, she could actually see the bolus of food moving from her stomach down her intestine.

Ultrasound (sonography) is a non-invasive imaging technique that does not require radiation nor contrast injection and is used for determining the number, location, and size of cysts and is also an excellent means of following cysts over time.

The following image is an ultrasound of a simple renal cyst:

Renal_cyst_ultrasound_110303120332_1218020

Attribution: © Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D, via Wikimedia Commons

Although most renal cysts are classified as simple cysts, there are cysts in the kidney that may be more complex, and on occasion a cyst can be malignant. If a cyst has a thick wall, internal components (septa), calcifications, or it enhances with contrast, it is not classified as a simple cyst, but as a complex cyst.

Renal cyst classification uses the Bosniak system, named for Dr. Bosniak, the radiologist who devised it:

I   Simple benign cyst: Hairline-thin and smooth wall and no septa, calcifications, or solid components. It has the tissue density of water and does not enhance with contrast. Malignancy potential: highly unlikely.

II Mildly complex benign cyst: May contain a few hairline septa, calcification may be present in the wall or septa, but no enhancement with contrast. Malignancy potential: 0-10%.      

IIF (F = follow-up) Moderately complex cyst: May contain hairline septa, minimal enhancement may be seen in the wall or septa and may contain calcifications. No soft tissue enhancing elements present. Malignancy potential: 5-25%.      

III Indeterminate complex cyst: Cystic mass that has thickened irregular walls or septa in which enhancement is present; should be explored surgically, although some will prove to be benign, including hemorrhagic cysts, chronic infected cysts, and multi-loculated cystic nephroma, while some will be malignant including cystic renal cell carcinoma. Malignancy potential: >50%.      

IV Complex cystic mass: Malignant cystic masses that have thickened and irregular walls and septa that enhance and also contain enhancing soft tissue components. These include cystic carcinomas and require surgical removal. Malignancy potential: > 90%.     

Bottom Line: The vast majority of renal cysts are picked up incidentally (on imaging studies done for other reasons) and are simple benign cysts (Bosniak I) that will never cause symptoms or problems. They are amenable to follow up with ultrasound and rarely require intervention. The answer to the question about whether or not to worry about cysts is usually: “Not to worry.”

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

Labial Hypertrophy (Large Vaginal Lips): What You Should Know

December 9, 2017

Andrew Siegel MD   12/9/2017

Presenting oneself in a physically positively way is important to many women (as it is to many men).  Coiffed hair, nicely-applied makeup, polished nails, attractive clothing and a physically fit body are pieces of the overall picture. The appearance of one’s genitals—although private and hidden—is often perceived as an important feature as well. 

Interestingly, one’s perception of what features make for attractive genitals is strongly influenced by one’s culture.  In the United States (and many other Western countries) the most desirable look is petite vaginal lips, whereas in certain Eastern countries including Japan the “winged butterfly” is the preferred appearance. In some regions of Sub-Saharan Africa, intentional inner lip stretching and manipulation are commonly performed, since large lips are prized and considered highly desirable.  

 

Labial Anatomy 101

miguel ferig, wikipedia commons 

Miguel Ferig, Wikipedia Commons (LM labia majora; VV vaginal vestibule; Lm labia minora; C clitoris; U urethra; V vagina; H hymen; A anus)

The vaginal lips (labia) are parts of the female external genitalia (vulva).  Within the outer lips (labia majora) are two soft, thin, hairless skin folds known as inner lips (labia minora), which surround the entrance to the vagina. A furrow on each side separates the inner labia from the outer labia. The upper part of each inner lip unites to form the clitoral foreskin (clitoral hood) 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. The labia have a generous nerve and blood supply, which during sexual arousal results in substantial swelling and congestion.

Size Matters

There is tremendous variety in vulval appearance, size, shape and pigmentation among women.  The inner lips can range from petite, narrow, barely visible structures to wide, butterfly-appearing lips that can extend well beyond the outer lips and dangle downwards, as illustrated in collage below.

Vagina collage public domain

“Vagina Collage”  (public domain)

Large inner lips , a.k.a. labial hypertrophy (see image below) can affect one or both lips and, although there is no exact consensus, is defined as when the inner lips extend beyond the outer lips.  In a British study of 50 women, inner lip length (top to bottom) averaged 6.1 cm (2.4 inches), ranging from 2 – 10 cm (0.8 – 4 inches); depth (width) averaged 2.2 cm (0.9 inch), ranging from 0.7 – 5 cm (0.3 – 2 inches).

Labia_minora_2009

By Schamlippen (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

Factoid: Intentional labial stretching is a widespread practice in many countries in Sub-Saharan Africa, resulting in significant lip enlargement as deep as 20 cm (8 inches) and low hanging lips (pendulous labia).  See image below.

Khoisan.apron, public domain

Khoisan apron–Khoisan women with pendulous lips visible (public domain)

Symptoms  

Having generously-sized lips is an anatomical variant that is most often harmless and should be considered more of a cosmetic issue than a medical problem.  However, large lips can cause a number of symptoms, including discomfort as a result of compression and rubbing from tight fitting clothes and exercising.  It can also cause irritation, painful sexual intercourse (particularly upon penetration), hygienic issues and on occasion a lip can get caught in a zipper (ouch!).  Psychologically, large lips can be a source of embarrassment, self-esteem issues and concerns about the presence of a “bulge” in the underwear and with tight fitting clothes.

Factoid: Some women with particularly oversized inner lips need to fold them and tuck them within the vagina to minimize the external protuberance.

What to Do?

If your inner lips are outsized but not causing concerns, there is no need for worry.  However, if there are anatomical, functional or psychological concerns, you should know that there are effective surgical procedures to remedy the problem.  Reducing the size of the lips is known in medical speak as “reduction labiaplasty.”  There are a variety of techniques to tailor and re-contour the lips, with the goals of resolving the issues that prompted the surgery, minimizing scarring and retaining the natural lip pigmentation.

Julie W pre- VP, PP, LP

Above photo, before labiaplasty (and other pelvic reconstructive procedures), (c) Michael P. Goodman MD, used with permission

Julie W 2 mos posyt LP wedge, rch, pp.

Above photo, after labiaplasty, (c) Michael P. Goodman MD, used with permission

Bottom Line: Although “loose lips sink ships,” labial hypertrophy is rarely a significant medical issue, but rather can occasionally foster a combination of cosmetic, anatomical, functional and psychological concerns.  Anthropologically speaking, what is considered attractive is highly variable across cultural lines, with some cultures favoring the petite look, others butterfly-style, wide lips, and still others practicing intentional stretching to create oversized and pendulous lips.  Reduction labiaplasty is an effective surgical procedure that can improve the cosmetic appearance of the lips and resolve the accompanying physical and emotional issues. 

Reference: Labia minora hypertrophy: causes, impact on women’s health, and treatment options, Gulia et al, Int Urogynecol J (2017) 28:1453-1461

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

6 Reasons You May Be Peeing Too Often (That Do Not Require A Urologist)

December 2, 2017

Andrew Siegel MD  12/2/2017

512px-Manneken_Pis_Brussel

Photo of Mannekin Pis in Brussels by Pbrundel (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

Some Necessary Basic Science

The kidneys are the paired organs that regulate urine production. They function by  filtering waste and excess volume from the blood and excreting these as urine. The volume of excretion by the kidneys is based upon several factors: One key factor is your state of hydration—for example, if you have not consumed enough liquid (state of dehydration) there will be scant urine production that is very concentrated appearing (amber color).  On the other hand, if you have over-consumed fluid (state of over-hydration), there will be abundant urine production that is very dilute (like water).  Another important factor determining volume of excretion is the effect of two hormones that regulate kidney function: Anti-diuretic hormone (ADH) is a pituitary hormone that restricts urine production (in order to maintain blood volume and blood pressure), whereas atrial natriuretic peptide (ANP) is a heart muscle hormone that increases urine production and inhibits ADH (in order to decrease blood volume and blood pressure).

ADH Trivia:

  • It is also known as Vasopressin, since it causes arteries to contract
  • It is sometimes used for shock (with severely low blood pressures) and also to stop gastro-intestinal bleeding
  • Certain cancers and other disorders can cause a syndrome called Inappropriate Secretion of ADH in which excessive ADH is produced, resulting in the kidneys over-concentrating urine, causing fluid and electrolyte imbalance, muscle cramps, confusion and convulsions
  • There is a biorhythmic pattern to ADH production, with less ADH production while sleeping, sometimes giving rise to  frequent nocturnal urination. Some people have very suppressed ADH production while asleep and therefore do most of their urinating during sleep hours and minimal urinating during the day.  This can be treated with administration of synthetic ADH.
  • Bedwetting in children is often treated with synthetic ADH

 

6 Reasons You May Be Peeing Too Frequently

  1. Too Much Fluid Intake

As obvious as this one is, it is often overlooked by the over-zealous drinker. As mentioned above, the kidneys play a vital role in fluid regulation and blood pressure.  If you drink excessive volumes of any fluid (this goes for consuming foods high in water content, especially fruit and veggies), you will be making frequent trips to the bathroom to relieve yourself, generally full volumes of dilute-appearing urine. All too often I see patients in the office with urinary urgency and frequency who are never without their water bottle…everything in moderation!

  1. Too Much Caffeine and/or Alcohol

Caffeine (present in coffee, tea, colas, many sports and energy drinks and chocolate) is a diuretic, meaning it makes you urinate.  Similarly, alcohol has a diuretic-like effect (by inhibiting ADH). So, if you are running to the bathroom after drinking a Starbuck’s Venti or alternatively, after drinking 3 beers at the sports bar, it is not a shocker!

  1. Diuretics (water pills)

Many people are on diuretic medications, often for high blood pressure, fluid collection in the ankles and legs (edema) and congestive heart failure.  These medications (some of which are very potent), are geared to make you pee a lot to reduce fluid volumes and blood pressure. So, if you are on Hydrochlorthiazide, Lasix, etc., and are peeing up a storm, it’s not a bladder or prostate problem, but simply the medication doing its job!

  1. Diabetes Mellitus (mellitus meaning sweet)

When diabetes is poorly controlled, high levels of blood sugar cause sugar to spill in the urine, which causes a diuretic-like effect.  In fact, many undiagnosed diabetics present to the urologist with urinary frequency and a dipstick of their urine reveals the presence of glucose and makes the diagnosis of diabetes.  Once diabetic control is achieved, the frequency dramatically improves.  If you have diabetes that is not well-controlled and are peeing hourly, the first visit should be to the internist or endocrinologist to get the diabetes finely tuned.

Certain diabetic medications (SGLT-2 Inhibitors) function by eliminating excess blood sugar in the urine, causing the same diuretic effect and therefore have the side effect of inducing urinary frequency.  These medications include Jardiance, Invokana and Farxiga.

     5. Diabetes Insipidus (insipidus meaning tasteless)

This is a rare cause of frequent urination of large volumes of dilute urine caused by either the failure of production of ADH by the pituitary or alternatively, the ineffectiveness of this hormone in inducing the kidneys to restrict water excretion.

  1. Obstructive Sleep Apnea (OSA)

OSA is a chronic medical disorder that adversely affects sleep, health and quality of life. Repeated complete or partial interruptions of breathing during sleep occur due to mechanical obstruction of the upper airway passage.

Labored efforts to breathe against an obstructed airway result in negative pressures in the chest. This increases the volume of venous blood that returns to the heart, causing distension of the right heart chambers.  The heart responds to this distension as a false sign of fluid volume overload, with the hormonal response of ANP secretion. As a result of the ANP secretion, high volumes of urine are produced during sleep, resulting in sleep-disruptive nighttime urination. There may be as many as 6 or more nighttime awakenings to urinate. When OSA is treated it results in a significant improvement, if not complete resolution of the frequent nocturnal urinating.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx

 

 

The Female O: What You Need To Know

November 25, 2017

Andrew Siegel MD   11/25/2017

Happy Thanksgiving weekend to all!  Among the items to be grateful for are food, shelter, family, friends and of course, love–in all its aspects.  What follows are some (hopefully illuminating) words on the female sexual climax.

alphabet-150778_1280.png

Thank you, Pixabay, for image above

The word “orgasm” is derived from New Latin orgasmus and Greek orgasmós, meaning “to swell; to be excited.”  Defining orgasm is hardly necessary for anyone who has ever experienced one (and if you haven’t, Meg Ryan did a fine rendition in the movie “When Harry Met Sally”!), but it is worth reviewing some of the different medically-oriented definitions:

Kinsey: The expulsive discharge of neuromuscular tension at the peak of sexual response.

Masters and Johnson: A brief episode of physical release from the vaso-congestion and myotonic increment developed in response to sexual stimuli.

John Money: The zenith of sexual-erotic experience characterized as voluptuous rapture or ecstasy occurring simultaneously in the brain/mind and the genitalia. Irrespective of its locus of onset, the occurrence is contingent upon reciprocal intercommunication between neural networks in the brain, above, and the genitalia below, and it does not survive their disconnection by the severance of the spinal cord, but is able to survive even extensive trauma at either end.

Definition quoted at a sexual urology meeting I attended: A variable transient peak sensation of intense pleasure creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions and myotonia that resolves the sexually induced vaso-congestion and myotonia, generally with an induction of well-being and contentment. 

Whoa…That last one is ridiculously technical and complex!

A simple definition is the following: A release of muscle tension accompanied by pelvic pulsations at the peak of sexual excitement that follows sexual arousal, which is marked by genital swelling, muscle tension, erect nipples, increased heart rate, heart contractility, blood pressure and breathing rate and skin flushing.

The are many descriptor terms used to describe what may happen during an orgasm: pulsations, contractions, spasms, goosebumps, shivers, hot flashes, flushing, tingling, perspiration, moaning, building, swelling, flowing, flooding, spreading, spurting, shooting, throbbing, pulsating, shuddering, trembling, quivering.

In terms of achieving orgasm, the most important organ is not a throbbing, erect penis or a pulsating, lubricated vagina, but the brain—the master organ and “governor” of sexuality.  It is capable of fostering an earth-shattering, consciousness-altering, explosive mind-body experience, but is equally capable of dooming a sexual experience to failure. It is a given that in order to have a positive sexual experience, the brain and mind must cooperate with the body.  Emotions, memories, thoughts, perceptions and sensations contribute vitally to the sexual experience.

Pathway to Sexual Climax

Accompanying arousal and sexual stimulation is increased pelvic blood flow that induces vaginal lubrication and congestion and engorgement of the vulva, vagina and clitoris.  The “orgasmic platform” is the Masters and Johnson’s term for the outer third of the vagina with engorged inner lips, which they considered to be the “base” of pelvic blood congestion. With increasing stimulation and arousal, physical tension within the genitals gradually builds and once sufficient intensity and duration of sexual stimulation surpass a threshold, involuntary rhythmic muscular contractions occur of the pelvic floor muscles, the vagina, uterus and anus, followed by the release of accumulated erotic tension and a euphoric state. Thereafter, the genital engorgement and congestion subside, muscle relaxation occurs and a peaceful state of physical and emotional bliss and afterglow become apparent.

The pelvic floor muscles contract rhythmically during climax: a total of 10-15 contractions typically occur, with the first 3-5 contractions occurring at 0.8-second intervals after which the interval between contractions lengthens and the intensity of the contractions decreases. However, orgasm is not only a genital response, but also a total body reaction causing numerous muscles to go into involuntary spasm, including the facial muscles resulting in grimacing, hand and foot muscles resulting in finger and toe curling, and numerous skeletal muscles that tense prior to release. Additionally, pupils dilate, skin flushes and the clitoral head retracts.

Clitoral vs. Vaginal Orgasm

Most women report that both clitoral and vaginal stimulation play important roles in achieving sexual climax. However, the clitoris has the greatest density of nerves, is easily accessible and typically responds readily to stimulation, so for most women is the fastest track to sexual climax. It is estimated that 70% of women require clitoral stimulation to achieve orgasm.  Clitoral orgasms are often described as a buildup of sensation in the clitoral region with intense waves of external muscle spasm and release. In contrast, vaginal orgasms are described as slower, fuller, wider, deeper, more expansive, complex, pervasive whole-body sensation.

Orgasms can be triggered via different neural pathways–clitoral orgasms via the pudendal nerves and vaginal orgasms via both the pudendal nerves that provide the nerve supply to the more superficial aspect of the vagina and the hypogastric and pelvic splanchnic nerves that provide the supply to the deeper aspect of the vagina.

The truth of the matter is that lady parts are all inter-connected and work together, so grouping orgasm into clitoral versus vaginal is arbitrary and artificial.  Penetrative sexual intercourse results in indirect clitoral stimulation as the clitoral shaft moves rhythmically with penile thrusting by virtue of penile traction on the inner lips, the lips of which join together to form the hood of the clitoris. Furthermore, the “legs” and “bulbs” of the clitoris—the deep anatomy that extends below the surface—are stimulated by vaginal penetration. Upward movement in the missionary position in which there is pubic bone to pubic bone contact provides direct clitoral stimulation as well.

Anatomical variations can affect ability to achieve sexual climax. Clitoral size and the distance of the clitoris to the vaginal opening differ among women. Women whose clitoris is closer to the vaginal opening are more likely to report orgasms from sexual intercourse. Women who have difficulty or cannot achieve orgasm often have a smaller clitoral head.

Orgasms can at times be achieved by non-genital stimulation. Some women can climax simply by erotic thoughts, others by breast stimulation or foot massage.  At the time of climax, some women are capable of “ejaculating” fluid. The nature of this fluid has been controversial, thought by some to be hyper-lubrication and others to be glandular secretions (Bartholin’s and/or Skene’s glands). There are certain women who “ejaculate” very large volumes of fluid at climax and studies have shown this to be urine released due to involuntary bladder contractions that can accompany sexual climax.

Wishing you the best of health and a wonderful Thanksgiving weekend,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

Stress Urinary Incontinence (SUI)—Gun and Bullet Analogy

November 18, 2017

Andrew Siegel MD   11/18/17

With all the violence and senseless shootings in the USA, I hate to even mention the words “guns” and “bullets,” but they do offer a convenient metaphor to better understand the concept of stress urinary incontinence

Stress urinary incontinence (SUI) is a spurt-like leakage of urine at the time of a sudden increase in abdominal pressure, such as occurs with sneezing, coughing, jumping, bending and exercising. It is particularly likely to occur when upright and active as opposed to when sitting or lying down, because of the effect of gravity and the particular anatomy of the bladder and urethra. It is common in women following vaginal childbirth, particularly after difficult and prolonged deliveries.  It also can occur in men, generally after prostate surgery for prostate cancer and sometimes after surgical procedures done for benign prostate enlargement. 7. SUIIllustration above by Ashley Halsey from The Kegel Fix

Although not a serious issue like heart disease, cancer, etc., SUI nonetheless can be debilitating, requiring the use of protective pads and often necessitating activity limitations and restrictions of fluid intake in an effort to help manage the problem. It  certainly can impair one’s quality of life.

The root cause of SUI is typically a combination of factors causing damage to the bladder neck and urethra or their support mechanisms.  In females, pelvic birth trauma as well as aging, weight gain, chronic straining and menopausal changes weaken the pelvic muscular and connective tissue support.  In males this can occur after radical prostatectomy, although fortunately with improved techniques and the robotic-assisted laparoscopic  approach, this happens much less frequently than it did in prior years.

An effective means of understanding SUI is to view a bladder x-ray (done in standing upright position) of a person without SUI and compare it to a woman or man with SUI.  The bladder x-ray is performed by instilling contrast into the urinary bladder via a small catheter inserted into the urethra.

A healthy bladder appears oval in shape because the bladder neck (situated at the junction of the bladder and urethra) is competent and closed at all times except when urinating, at which time it relaxes and opens to provide urine flow.  An x-ray of the bladder of a woman or man with SUI will appear oval except for the 6:00 position (the bladder neck) where a small triangle of contrast is present (representing contrast within the bladder neck).  This appears as a “funnel” or a “widow’s peak.” With coughing or straining, there is progressive funneling and leakage.

normal bladder

Above photo is normal oval shape of contrast-filled bladder of person without SUI

female sui relaxAbove photo is typical funneled shape of contrast-filled bladder of female with SUI

male suiAbove photo is typical funneled shape of contrast-filled bladder of male with SUI following a prostatectomy

female sui strainAbove photo shows progressive funneling and urinary leakage in female asked to cough, demonstrating SUI 

 

The presence of urine within the bladder neck region is analogous to a bullet loaded within the chamber of a gun.  Essentially the bladder is “loaded,” ready to fire at any time when there is a sudden increase in abdominal pressure, which creates a vector of force analogous to firing the gun.

What to do about SUI?

Conservative management options include pelvic floor muscle training to increase the strength and endurance of the muscles that contribute to bladder and urethra support and urinary sphincter control.  Surgical management includes sling procedures (tape-like material surgically implanted under the urethra) to provide sufficient support and compression.  Sling procedures are available to treat SUI in both women and men.  An alternative is urethral bulking agents, injections of materials to bulk up and help close the leaky urethra. On occasion, when the bladder neck is rendered incompetent  resulting in severe urinary incontinence, implantation of an artificial urinary sphincter may be required to cure or vastly improve the problem.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.