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.

 

 

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“Size” Should Never Outrank “Service”

November 11, 2017

Andrew Siegel MD  11/11/2017

As I stood in the gateway line during the painful process of boarding an airplane, I caught sight of a poster ad stating the following: “Size should never outrank service.” This referred to the smaller size regional jets that offer amenities including first-class, Wi-Fi, etc. Later, I saw another poster ad for the same airline stating: “How fast the flight goes isn’t always up to pilot.” As a physician interested in sexual/pelvic health and language, I found these sentences with double meanings amusing and entertaining.  The ultimate phallic structure is an aircraft and aeronautics provides a rich metaphor for male sexual function, the topic of today’s entry.  

Large and clunky

Airbus_A380-861,_Airbus_Industrie_AN2032144

By Oleg V. Belyakov – AirTeamImages [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0), CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL 1.2 (http://www.gnu.org/licenses/old-licenses/fdl-1.2.html)%5D, via Wikimedia Commons

Small and nimble

800px-F-15_vertical_deploy

Above image, public domain

 

Terms that apply to aeronautics and sexual function

Aircraft: a machine capable of flight—the penis

Pilot: the person who occupies the cockpit and controls the aircraft—the possessor of the penis

Cockpit (I really like this word!): the front of the fuselage where the pilots sit—the head of the penis

Fuselage: the body of the aircraft—the shaft of the penis

Horizontal and vertical stabilizers of the tail:  aircraft parts that provide stability to keep it flying straight—the pelvic floor muscles that stabilize and support the penis

Flight: the process of flying that includes a launch, a flight pattern and a landing—a sexual encounter

Launch: the takeoff—obtaining an erection

Flight pattern: the aircraft’s movement after takeoff—the sexual act

Landing: the conclusion and most difficult part of the flight, which requires skill, precision and timing to perform competently — ejaculation/orgasm

 Cruising Altitude: the altitude at which most of a flight is flown in route to a destination—a fully rigid erection

Jet fuel: fuel designed for use in an aircraft—in erectile terms, penile blood flow

Fuel line: the means by which fuel is pumped from the storage tanks to the engine—the penile arteries

Thrust: the propulsive force of an aircraft—the surging power of the erect penis

Throttle: a device for controlling the flow of fuel to an aircraft’s engine—the nerves that control the smooth muscle within the penile arteries and within the erectile tissue

Failure to Launch: a condition in which the aircraft is unable to get airborne—erectile dysfunction

Emergency landing: unanticipated landing before the scheduled arrival time—premature ejaculation

Aborted Landing: when an aircraft is about to land, but the pilot halts the landing and regains altitude deferring the landing—delayed ejaculation

Ground Time: the amount of down time between landing and the next flight—refractory period

Mayday: distress signal indicative of a significant problem with the aircraft or flight—a major sexual failure

Bottom Line:  Aeronautics provides an excellent metaphor for male sexual function.  The pilot can be accorded better control, longer flight times, higher altitudes, as well as launching a second flight with less ground time by attending to a few key measures. Although it is impossible to convert a F-15 Eagle (pictured above) into an Airbus A380 (pictured above), it is a fact that size should never outrank service!  Bigger is not always better as function often trumps form. 

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.

 

 

 

6 Ways To Reduce Risk for Pelvic Problems: Urinary Leakage, Dropped Bladder & Sexual Issues

November 4, 2017

Andrew Siegel MD  11/4/17

shutterstock_femalebluepelvic

Ease into this topic with a write-up by Melanie Hearse about altered vaginal anatomy after childbirth and what to do and not to do about it, from BodyandSoul.com Australia: This woman has a warning about ‘fixing’ your downstairs after birth.

Our health culture in the USA is largely reactive as opposed to proactive.  Undoubtedly, a better model is prevention as opposed to intervention.  Attention to a few basic measures can make all the  difference in your pelvic health “destiny”:

  • Maintain a healthy lifestyle. Weight gain and obesity increase the occurrence of urinary control problems, dropped bladder, sexual, and other pelvic issues. Follow the advice of Michael Pollan: “Eat food. Not too much. Mostly plants.”  Consume a nutritionally-rich diet with abundant fruits and vegetables (full of anti-oxidants, vitamins, minerals and fiber) and real food, versus processed and refined food products.  A healthy diet (quality fuel) is essential for ongoing tissue repair, reconstruction and regeneration. Stay physically active, obtain sufficient sleep, manage stress as best as possible, avoid tobacco (an awful habit, with chronic cough contributing to pelvic floor issues) and consume alcohol moderately.  Physical activity should include aerobic (cardio), strength, flexibility and core training (yoga, Pilates, etc.), the latter of which is especially helpful in preventing pelvic issues since the pelvic floor muscles form the floor of the core. A recent Harvard Medical School health report entitled “Best exercises for your body” recommended swimming, Tai chi, strength training, walking and Kegel exercises.
  • Prepare before pregnancy. Pregnancy, labor and vaginal delivery are the most compelling risk factors for pelvic floor issues. Commit to healthy lifestyle measures and pelvic floor muscle training as detailed above even before considering pregnancy in order to prevent/minimize the onset of pelvic issues that commonly follow pregnancy and childbirth.  The following article, written by Corynne Cirilli for Refinery 29 on October 6, addresses this issue in detail and is well worth reading: Why Aren’t We Talking About Pre-Baby Bodies?
  • Pelvic floor muscle training. Kegel exercises to increase pelvic muscle strength and endurance are vital to prevent pelvic floor issues. The Kegel Fix is a paperback book that guides you how to do Kegel contractions properly, provides specific training programs for each pelvic issue and teaches you how to put this skill set into practical use—Kegels “on demand.”
  • Avoid constipation and other forms of chronic increased abdominal pressure. Chronic constipation (bowel “labor”) can be as damaging to the pelvic floor as vaginal deliveries. Coughing, sneezing, heavy lifting (particularly weight training) and high impact sports all increase abdominal pressures, so take measures to suppress coughing, treat allergies to minimize sneezing and not overdo weight training and high-impact sports.
  • Consider vaginal estrogen therapy. After menopause, topical estrogen can nourish and nurture the vaginal and pelvic tissues that are adversely affected by the cessation of estrogen production. Low dose topical therapy can be effective with minimal systemic absorption, providing benefits while avoiding systemic side effects.
  • Get checked! Be proactive by periodically seeing your physician for a pelvic exam. It is best to diagnose a problem in its earliest presentation and manage it before it becomes a greater issue.

Bottom Line: Prepare and prevent rather than repair and prevent!

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 individuals who care about health, well-being, fitness and nutrition and enjoy feeling strong and confident.

 

 

How Much Water Do You Really Need To Drink?

October 28, 2017

Andrew Siegel MD   10/28/17

drinking-water-filter-singapore-1235578_640

Thank you Pixabay for above image

Many sources of information (mostly non-medical and of dubious reliability) dogmatically assert that humans need 8-12 glasses of water daily to stay hydrated and thrive. Today’s entry addresses the question of how much water you really need to drink in order to stay healthy.

Fact: Many take the 8-12 glass/day rule literally and as a result end up in urologists’ offices complaining of urinary urgency, frequency and often leakage. Clearly, the 8-12 rule is not appropriate for everyone! The truth of the matter is that although some urinary issues are brought on or worsened by insufficient fluid intake, including kidney stones and urinary infections, other urinary woes are brought on or worsened by excessive fluid intake, including the aforementioned “overactive bladder” symptoms.

Fact: Many foods have high water content and can be a significant source of water intake. In general, the healthier the diet (the more the fruit and veggie intake) the higher amount of dietary water.  For example, melons, citrus fruit, peaches, strawberries and raspberries are about 90% water, with most fruits over 80% water.  The same holds true for vegetables, with lettuce, tomatoes, cucumbers, celery, radishes and zucchini comprised of about 95% of water, with most veggies over 85% water.

Water is a vitally important component of our bodies, promoting optimal organ and cellular functioning, temperature regulation, nutrient and waste transportation, joint lubrication,  and facilitating the thousands of chemical reactions occurring within our bodies. 60% of our body weight is water, two-thirds of which is within our cells and one-third of which is in blood and tissues between cells. For a 165 lb. man, that translates to 100 lb. of water weight. For a 125 lb. woman, that translates to 75 lb. of water weight.

Our body needs water “equilibrium,” with water intake balancing water losses.  Most people need a total of 65-80 ounces daily, although this can vary greatly depending upon one’s size, the ambient temperature and level of physical activity.  Again, water intake comes from beverages and foods consumed, with many foods containing a great deal of water, particularly fruits and vegetables as mentioned, so the 65-80 ounces includes this source. Water losses are “sensible,” consisting of water in the urine and stool, and “insensible,” from skin (evaporation and sweating) and lungs (moisture exhaled).

The formula that doctors use for figuring out daily fluid requirements—especially useful for hospitalized patients not eating or drinking who depend totally on intravenous fluids—is 1500cc (50 ounces) for the first 20 kg (44 lb.) of weight, and an additional 200cc (7 ounces) for each additional 10 kg (22 lb.) of weight.  So, for a 125 lb. woman the daily fluid requirement is 2250 cc (75 ounces).  For a 165 lb. man, the daily requirement is 2600 cc (87 ounces).  It is important to understand that the 75 ounces of fluid requirement for the woman and the 87 ounce fluid requirement for the man in this example includes both beverages and food. If one has a very healthy diet with lots of fruits and vegetables, there will obviously be less need for drinking water and other beverages.

Fact: Caffeinated beverages (coffee, tea, colas, many energy and sports drinks and other sodas) as well as alcohol both have diuretic effects, causing you to urinate more volume than you take in. So, if you consume caffeine or alcohol, you will end up needing additional hydration to maintain equilibrium.

The other important factors with respect to water needs are ambient temperature and activity level. If you are reading or doing other sedentary activities in a cool room, your water requirements are significantly less than someone exercising vigorously in 90-degree temperatures.

Humans are extraordinarily sophisticated and well-engineered “machines.”  Your body lets you know when you are hungry, ill, sleepy and thirsty.  Paying attention to your thirst is one of the best ways of maintaining good hydration status.  Another great method is to pay attention to your urine color.  Depending on your hydration status, urine color can vary from deep amber to as clear as water.  If your urine is dark amber, you need to drink more as a lighter color is ideal and indicative of satisfactory hydration.

Some advantages of staying well-hydrated:

  • Avoids dehydration and all its consequences (this is pretty obvious)
  • Dilution of urine helps prevent kidney stones
  • Dilution of urine helps prevent urinary infections
  • Helps bowel regularity
  • Maintains hydrated and supple, less wrinkled skin
  • Helps keep weight down because of the filling effect of drinking; also, thirst can be confused with hunger and some people end up eating when they should be hydrating

Disadvantages:

  • Makes you urinate a lot, which is not good for those with overactive bladder symptoms

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.

 

 

5 Kegel Exercise Mistakes You Are Probably Making

October 21, 2017

Andrew Siegel MD 10/21/17

Do it right or don't do it

I have always been fond of this sentiment, the words of which were immortalized for me on a coffee mug courtesy of then 10-year-old Jeff Siegel (my son).  This statement holds true for everything in life, including pelvic floor exercises. 

Dr. Arnold Kegel (1894-1981), a gynecologist who taught at USC School of Medicine,  popularized pelvic floor muscle exercises to improve the sexual and urinary health of women following childbirth. His legacy is the pelvic exercise that bears his name—Kegels.

“Do your Kegels” is common advice from many a gynecologist (and from well-intentioned friends and family), particularly after a difficult childbirth has caused problems “down there.”  These pelvic issues include urinary leakage, drooping bladder, and stretching of the vagina such that things look and feel different and sex is just not the same.

“Do your Kegels” is sensible advice since this strengthens the pelvic floor muscles that support the pelvic organs, contribute to urinary and bowel control, and are intimately involved with sexual function. Developing strong and durable pelvic floor muscles is capable of improving, if not curing, these pelvic issues. Unfortunately, mastery of the pelvic floor is not as easy as it sounds because these muscles are internal and hidden and most often used subconsciously (unlike the external glamour muscles that are external and visible and used consciously).  

  The Kegel problem is threefold:

  1. Many women do not know how to do a proper Kegel contraction.
  2. Of those that can do a proper Kegel contraction, most do not pursue a Kegel exercise training program.
  3. Even those women who do know how to do a proper Kegel contraction and pursue a Kegel exercise training program are rarely, if ever, taught the most important aspect of pelvic muscle proficiency: how to put the Kegels to practical use in real-life situations  (“Kegels-on-demand”).

If a Kegel pelvic floor contraction is done incorrectly, not only will the pelvic issue not be helped, but actually could made worse. Only doing pelvic muscle contractions without pursuing a well-designed pelvic floor muscle training program is often an invitation to failure. Finally, if “Kegels-on-demand” to improve pelvic issues are not taught, it is virtually pointless to learn a proper contraction and complete a program, since the ultimate goal is the integration of Kegels into one’s daily life to improve quality. 

How does one do a proper Kegel pelvic contraction?  Simply stated, a Kegel is an isolated contraction of the pelvic floor muscles that draw in and lift the perineum (the region between vagina and anus). The feeling should be of this anatomical sector moving “up” and “in.”

5 Common Kegel Exercise Mistakes

Mistake # 1: Holding Your Breath

Breathe normally.  The Kegel muscles are the floor of the core group of muscles, a barrel of central muscles that consist of the diaphragm on top, the pelvic floor on the bottom, the abds in front and on the sides, and the spinal muscles in the back. Holding your breath pushes the diaphragm muscle down and increases intra-abdominal pressure, which pushes the pelvic floor muscles down, just the opposite direction you want them moving.

Mistake # 2: Contracting the Wrong Muscles

When I ask patients to squeeze their pelvic floor muscles during a pelvic exam, they often contract the wrong muscles, usually the abdominals, buttocks or thigh muscles. Tightening up the glutes is not a Kegel!  Others squeeze their legs together, contracting their thigh muscles.  Still others lift their butts in the air, a yoga and Pilates position called “bridge.” The worst mistake is straining and pushing down as if moving one’s bowels, just the opposite of a Kegel which should cause an inward and upward lift.

Fact: I have found that even health care personnel—those “in the know,” including physical therapists, personal trainers and nurses—have difficulty becoming adept at doing Kegels. 

Sadly, there is a device on the market (see below) called the “Kegel Pelvic Muscle Thigh Exerciser,” a Y-shaped plastic device that fits between your inner thighs such that when you squeeze your thighs together, the gadget squeezes closed. This exerciser has NOTHING to do with pelvic floor muscles (as it strengthens the adductor muscles of the thigh), serving only to reinforce doing the wrong exercise and it is shameful that the manufacturer mentions the terms “Kegel” and “pelvic muscle” in the description of this product.

kegeler

Learning to master one’s pelvic floor muscles requires an education on the details and specifics of the pelvic floor muscles, learning the proper techniques of conditioning them and finally, the practical application of the exercises to one’s specific issues.

Mistake # 3: Not Using a Kegel Program

Kegel exercises can potentially address many different pelvic problems—pelvic organ prolapse, sexual issues, stress urinary incontinence, overactive bladder/bowel, and pelvic pain due to excessive pelvic muscle tension.  Each of these issues has unique pelvic floor muscle shortcomings.  Doing casual pelvic exercises does not compare to a program, which is a home-based, progressive, strength, power and endurance training regimen that is designed, tailored and customized for the specific pelvic floor problem at hand. Only by engaging in such a program will one be enabled to master pelvic fitness and optimize pelvic support and sexual, urinary and bowel function.

Mistake # 4: Impatience

Transformation does not occur overnight!  Like other exercise programs, Kegels are a “slow fix.”  In our instant gratification world, many are not motivated or enthused about slow fixes and the investment of time and effort required of an exercise program, which lacks the sizzle and quick fix of pharmaceuticals or surgery. Realistically, it can take 6 weeks or more before you notice improvement, and after you do notice improvement, a “maintenance” Kegel training regimen needs to be continued (use it or lose it!)

Mistake # 5: Not Training for Function (“Kegels-on-Demand”)

Sadly, most women who pursue pelvic training do not understand how to put their newfound knowledge and skills to real life use. The ultimate goal of Kegels is achieving functional pelvic fitness, applying one’s pelvic proficiency to daily tasks and common everyday activities so as to improve one’s quality of life.  It is vital, of course, to begin with static and isolated, “out of context” exercises, but eventually one needs to learn to integrate the exercises on an on-demand basis (putting them in to “context”) so as to improve leakage, bladder and pelvic organ descent, sexual function, etc.

Bottom Line: Kegel pelvic floor muscle exercises are a vastly under-exploited and misunderstood resource, despite great potential benefits of conditioning these small muscles.  In addition to improving a variety of pelvic issues (urinary and bowel leakage, sexual issues, dropped bladder, etc.), a strong and fit pelvic floor helps one prepare for pregnancy, childbirth, aging and high impact sports.  The Kegel Fix book is a wonderful resource that teaches the reader how to do proper Kegels, provides specific programs for each unique pelvic issue, and reveals the specifics of “Kegels-on-demand,” how to put one’s fit pelvic floor and contraction proficiency to practical use in the real world.

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.

 

 

10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

October 14, 2017

 Andrew Siegel MD   10/14/17

A penis is a special organ—a man’s joy, if not pride—and certainly one of his most prized, appreciated and cherished possessions, to which he has a significant attachment. As multifunctional as a Swiss Army knife, it allows him to stand to urinate (an undervalued capability), rises and firms to the occasion to allow for sexual penetration, and ejaculates genetic material–the means to perpetuate the species. A marvel of hydraulic engineering, within nanoseconds of sexual stimulation it is uniquely capable of increasing its blood flow 50 times over baseline, transforming its shape and size. Penis magic!

Each and every penis is unique.  As variable as snowflakes, they come in every size, shape and color. Beyond “size matters”—often a source of male preoccupation—men are often obsessed, if not preoccupied, with the appearance of their genitals.  In my interactions with patients, concerns are often voiced about symmetry, color, pigmentation, angulation, spots, blemishes, vein patterns, shrinkage and other oddities. Unless you are in the habit of closely inspecting other men’s genitals (as urologists are), you are unlikely to realize how common and completely normal most of these genital variations are.

 10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

  1. Penis leans to one side

left or right

No human is perfectly symmetrical and the flaccid penis rarely hangs perfectly centered. Wherever your penis naturally lies when you are clothed—whether left or right—is not indicative of your political leaning or left vs. right-sided brain predominance and is of absolutely no significance or consequence whatsoever!

Interesting trivia: “Throckmorton’s sign” is a term used jokingly by medical students, residents and attending physicians. A positive Throckmorton sign is when the penis points to the side of the body where the pathology is, e.g., if a man is getting surgery for a right groin hernia and the penis points to the right side. The Throckmorton sign indicates the proper side of the pathology at least 50% of the time!  Operating room humor! 

  1. Slight penile curvature when erect

pixabay banana

Thank you Pixabay, for image above

Again, although perfect symmetry may be desirable, the norm for the erect penis is not to be perfectly straight. There is often a subtle bend to the left, right, up or down.  Some men have a penis that has a banana-like curvature. Slight bends—considered totally normal—are to be distinguished from Peyronie’s disease, a condition in which there is significant angulation due to scarring of the sheaths of the erectile chambers. It is a potentially serious condition that can cause painful erections and erectile dysfunction.

  1. One testicle hangs lower

pixabay plumsThank you Pixabay, for image above

If you ever wondered why one of your testes is slightly bigger or heavier and hangs lower than the testes on the other side, you are in good company. Paralleling women with breast asymmetry, the vast majority of men have testes asymmetry, so your mismatched gonads are perfectly normal.

  1. Dark genital skin

Hyperpigmentation (darkening) of the median raphe (the line running from anus to perineum to scrotum to undersurface of penis) and other areas of the penis is extremely common.  In fact, it is normal for the penile skin color to be darker than other areas of the body, because of the effect of sex hormones on the cells that produce pigment (melanocytes).  The circumcision line, as well, is often deeply pigmented.

  1. Freckles, moles and skin tags

pixabay spottedThank you Pixabay, for image above

The penis is covered by skin–just like the rest of the body–and is therefore subject to common benign skin growths, including moles, freckles and skin tags. These are generally harmless and usually do not require any treatment unless desired for cosmetic reasons. However, if you have a growth that changes in size, color or texture, you should have it checked out because penile cancers do occur on occasion.  Skin tags are small fleshy protuberances and can be confused with genital warts, so if you have any doubt, get checked.

  1. Other penis and scrotal bumps and lumps

Pearly penile papules are raised “pearly” bumps that appear around the corona (the base of the head of the penis). They consist of one or more rows of small, fleshy, yellow-pink or transparent, smooth bumps surrounding the penile head. They are benign and do not cause harm, but sometimes are treated for cosmetic reasons, usually with freezing or lasering.

Pearly_Penile_Papules_Front

Pearly penile papules, By AndyRich48 (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)%5D, via Wikimedia Commons

Sebaceous glands produce oil that nourishes the hair follicles of the genitals. These glands appear as numerous small yellowish bumps on the scrotum and penile base.  In some men, they are prominent and referred to as sebaceous gland hyperplasia.  At times, they can exist without a hair follicle even being present.  Regardless, they are a normal occurrence.  See public domain image below–a.k.a. Fordyce spots.

Fordyces_spot_closeup.public domain. jpg

  1. Scattered scrotal spots

Angiokeratomas are benign purplish skin growths with a scaly surface that are not uncommonly present on the scrotum. They consist of dilated thin-walled blood vessels with overlying skin thickening. These skin lesions can occasionally bleed and also cause fear and anxiety since they can resemble more serious problems such as melanoma. If in any doubt, get it checked out.

Angiokeratoma_of_the_Scrotum_5

Scrotal angiokeratomas, By Jlcarter2 (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or   CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

  1. Veiny vanity

Every man has a unique penile venous pattern, the anatomy as unpredictable as the distinctive venous anatomy of the hand and wrist. In some men, the veins are twisted and prominent and in other men they are barely noticeable.  No matter what the pattern, venous anatomy is highly variable and individualized and is normal.

  1. Loose skin

Unlike most other skin on the body that is more tightly attached, penile skin is loosely attached to underlying tissues, allowing for expansion with erections. Since the physical state of the penis can vary from totally flaccid to totally rigid, when the penis is fully deflated, the skin may appear to be somewhat floppy and redundant, which is absolutely normal.  Scrotal skin often becomes increasing lax with the aging process, such that the testicles typically hang quite low in the elderly male, paralleling the common situation of pendulous breasts of the elderly female.

10. Shrinkage

Penile size in an individual is quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” can be provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves temporary reduced blood circulation.  Don’t worry, that sorry and spent looking penis can magically be revived with some TLC!

Bottom line: If you have an imperfect penis…welcome to the club!  No penis or scrotum is perfect.  Far from being an object of beauty, genital imperfections are the norm, so there is no need for feeling self-conscious. Just be happy that your little “fella” can function properly and enjoy his own happiness from time to time! Function over form!

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.

 

Kegels: One Size Does Not Fit All!

October 7, 2017

Andrew Siegel MD   10/7/17

shutterstock_femalebluepelvic

Athletes use a variety of fitness and strength-training programs to maximize their strength and endurance. A one-size-fits-all approach—the same exercise regimen applied to all—is clearly not advantageous because of the varying functional requirements for different sports.  Specific, targeted and individualized exercise programs are used to enhance and optimize performance, depending upon the particular sport and individual athlete. The ultimate goal of training is “functional fitness,” the achievement of strength, power, stamina and the skill set to improve performance and prevent specific functional impairments (injuries).

Pelvic floor dysfunction is a broad term applied to the scenario when the pelvic muscles and connective tissues are no longer functioning optimally.  This gives rise to pelvic issues including pelvic organ prolapse, urinary and bowel incontinence, sexual dysfunction and pelvic pain syndromes.  A one-size-fits-all Kegel pelvic floor muscle exercise approach has traditionally been used to manage all forms of pelvic floor dysfunctions. For many years, patients who were thought to be able to benefit from Kegels were handed a brochure with instructions to do 10 repetitions of a 10-second Kegel contraction followed by 10 rapid contractions, three times daily.

Are their shortcomings with this one-size-fits-all approach?  Clearly, the answer is yes. A one-size-fits-all approach lacks the nuance necessary to properly tackle the different types of pelvic floor dysfunction. Aligning the pelvic floor dysfunction with the appropriately tailored training program that focuses on improving the area of weakness is vitally important, since each pelvic floor dysfunction is associated with unique and specific deficits in pelvic muscle strength, power and/or endurance. One size does not fit all!

After decades of “stagnancy” following the 1940s transformative work of Dr. Arnold Kegel—the physician who was singularly responsible for popularizing pelvic floor exercises in women after childbirth–there has been a resurgence of interest in pelvic floor training. I am humbled and honored to have contributed to this “pelvic renaissance” with the publication of the short paperback book The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health, which introduces home-based, progressive, tailored exercises consisting of strength, power and endurance pelvic training regimens customized for each specific pelvic floor problem.

The initial goal of pelvic floor muscle training is muscle adaptation, the process by which pelvic muscle growth occurs in response to the demands placed it, with adaptive changes occurring in proportion to the effort put into the exercises. More challenging exercises are needed over time in order to continue the growth process that occurs as “new normal” levels of pelvic fitness are established. This translates into slowly and gradually increasing contraction intensity, duration of contractions, number of repetitions and number of sets.  The “plasticity” of the pelvic muscles require continued training, at minimum a “maintenance” program after completion of a course of pelvic training.

Although the short-term goal of pelvic floor muscle training is adaptation, the long-term goal is the achievement of functional pelvic fitness.  The vast majority of women who are taught Kegel exercises are not instructed how to put them into practical use. Go figure!  This concept of functional pelvic fitness is the actionable means of applying pelvic conditioning to daily tasks and real-life common activities. This is the essence of Kegel pelvic floor training—not simply to condition the pelvic floor muscles, but to apply this conditioning and proficiency in such a way and at the appropriate times so as to improve quality of one’s life.   These Kegels-on-demand—as I refer to them—can be lifesavers and quite a different take on Kegels, as opposed to static, isolated, out of context exercises.

Important Nuances and Details of Pelvic Training

Contraction intensity: This is the extent that the pelvic muscles are squeezed, ranging from a weak flicker of the muscles to a robust and vigorous contraction. High intensity contractions build muscle strength, whereas less intensive, but more sustained contractions, build endurance.

Contraction Type: Pelvic contractions vary in duration. It is relatively easy to intensively contract the pelvic muscles for a brief period, but difficult to maintain that intensity for a longer duration contraction. Snaps are rapid, high intensity pulses that take less than one second per cycle of contracting and relaxing. Shorts are slower, less intense squeezes that can last anywhere from two to five seconds. Sustained are less intense squeezes that last ten seconds or longer.

Relaxation duration: The amount of time the pelvic muscles are unclenched between contractions.

Repetitions: The number of contractions performed in a single set.

Set: A unit of exercise.

Strength: The maximum amount of force that a pelvic muscle can exert.

Power: The ability to rapidly achieve a full intensity contraction, which is a measure of contraction strength and speed–in other words, how quickly strength can be expressed.  Power is fostered by rapidly and explosively contracting the pelvic muscles.

Endurance (stamina): This is the ability to sustain a pelvic contraction for a prolonged time and the ability to perform multiple contractions before fatigue sets in.

Range of motion: The cycle of full pelvic contraction (muscle shortening) to complete relaxation (muscle lengthening).  This is vital in pelvic muscle training because the goal is not only to increase strength, power and endurance, but also flexibility, which is accomplished by bringing the muscle through the full range of motion.

Bottom Line:  A one-size-fits-all Kegel pelvic floor exercise program does not suit all women with pelvic floor dysfunction. To obtain optimal results, pelvic training must be tailored to the specific dysfunction. The achievement of functional pelvic fitness is one of the key goals (“key-goals”… get it?) of Kegel exercises and of the Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.  Finally, it is important to know that pelvic exercises are appropriate not only for women suffering with the aforementioned pelvic floor dysfunctions, but also for those who wish to maintain healthy pelvic functioning and prevent future problems.

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 dire need of bridging.

For informative information on pelvic floor muscle training, please consult the following books by the author:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

Cover

The Kegel Fix is written for educated and discerning women who care about health, well-being, fitness, nutrition and enjoy feeling confident, sexy and strong.  The book has separate chapters on each of the pelvic floor dysfunctions and provides a specific, targeted pelvic floor training regimen for each.

 

Game Plan for Men’s Healthy Sexual Functioning

September 30, 2017

Andrew Siegel MD 9/30/17

man-and-woman-1464255_1920

Thank you, Pixabay, for image above.

Functioning well in the bedroom–like health in general–should never be taken for granted. During early adulthood it rarely, if ever, crosses our minds that at sometime in the future many body functions decline, including sexual function.  However, the truth of the matter is that paralleling general health and fitness, maintaining our sexual health and fitness takes some effort to avoid the almost inevitable deterioration in function.  Today’s entry reviews a “game plan” for maintaining healthy sexual functioning into our golden years.

  • Know the Fundamentals

For better or worse, penile erections are not on the basis of a bone in the penis, as they are in many mammals.  Erections occur when pressurized blood inflates the erectile chambers of the penis. The erect penis has blood pressure in excess of 200 mm (extreme hypertension), giving rise to bone-like rigidity and hence the slang term, boner.

The penis is a marvel of hydraulic engineering, uniquely capable of increasing its blood flow 50 times over baseline within nanoseconds of sexual stimulation, transforming its shape and size. This is accomplished by smooth muscle relaxation within the penile arteries and within the sinuses of the erectile chambers.

Once blood inflates the erectile chambers, closure of penile veins and contractions of the pelvic floor muscles effectively trap the pressurized blood in the penis and maintain the penile hypertension necessary for a sustained erection.

  • Know the Stats

The Massachusetts Male Aging Study showed that after age 40 there is a decline in all aspects of sexuality.  Erectile dysfunction (ED) is present in about 40% of men by age 40 with an increase in prevalence of about 10% for each decade thereafter. Although there are many causes of ED, the common denominator is insufficient blood flow to fill the erectile chambers of the penis, or alternatively, sufficient inflow but poor venous trapping, both often caused by a decline in smooth muscle relaxation with aging.

  • Know the Score

Performance ability with every physical activity declines as we get older and this explains why most professional athletes are in their twenties or thirties. Although everything eventually goes to ground, hopefully it will happen slowly. Young men can achieve a rock-hard erection simply by seeing an attractive woman or thinking a vague sexual thought. As we get older, it is not uncommon for erotic thoughts or sights to no longer be enough to provoke an erection, with the need for direct touch. Some of the common male sexual changes that occur with aging are: diminished sex drive; decreased rigidity and durability of erections; decrease in volume, force, and arc of ejaculation; decreased orgasm intensity; and an increased recovery time before being able to get a second erection.  

  • Know the Opponents: Gluttony and Sloth

A healthy weight and healthy eating habits, exercise, adequate quality and quantity of sleep, tobacco avoidance, use of alcohol in moderation, stress avoidance, and a balanced lifestyle will optimize sexual potential.  Abide by the golden rule of the penis: “Treat your penis nicely and it will be nice to you in return; treat your penis poorly and it will rebel.

  • Fuel for Performance

A healthy diet will reduce the risk of sexual dysfunction. Eat a variety of wholesome natural foods including fresh vegetables and fruit, plenty of fiber, lean protein sources, legumes and healthy fats including nuts, avocados and olive oil. Avoid eating processed foods and minimize sugar, refined carbohydrates and highly saturated animal fats.

  • Stay in Peak Form

Try to achieve “fighting weight” to maximize your performance in the sexual arena.

  • Train for Performance

Exercising—including cardio, core, and strength training—is vital for health in general and sexual health in particular. When it comes to sexual health, it is vital to focus on the all-important pelvic floor muscles (PFM). PFMT (pelvic floor muscle training) will help optimize erectile function and prevent/treat ED.

To understand why PFMT can help your performance in the bedroom, it is necessary to have some understanding of what the PFM do. When you have an erection, the bulbocavernosus muscle and ischiocavernosus muscles engage. Contractions of these muscles not only help prevent the exit of blood from the penis, enhancing rigidity, but also increase blood flow to the penis—with each contraction of these muscles, a surge of blood flows into the penis. Additionally, they act as powerful struts to support the roots of the penis (like the roots of a tree), the foundational support that, when robust, will allow a more “skyward” angling erection (like the trunk of a tree).  The bulbocavernosus muscle also is the “motor” of ejaculation, contracting rhythmically at the time of sexual climax and forcing semen out of the urethra.

Increasing the strength, tone and condition of these muscles through PFMT will allow them to function in an enhanced manner—namely more powerful contractions with more penile rigidity and stamina as well as improved ejaculatory issues, including premature ejaculation.

  • Talk to your Coach

Visit the PelvicRx website where you can purchase a male pelvic floor training DVD and have a private chat session with a pelvic floor trainer.

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 dire need of bridging.

Author of:

 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

Co-creator of the male pelvic floor training DVD: PelvicRx

 

 

 

Menopause: Impact on Nether Regions

September 23, 2017

Andrew Siegel MD  9/23/17

Symptoms_of_menopause_(raster)

Image above by Mikael Häggström (Own work) [CC0], via Wikimedia Commons

Menopause is the cessation of estrogen production by the ovaries.  It typically occurs at about age 51-years-old, so most women can expect to live another thirty or more years following this event. Many bodily changes occur with menopause, with the urinary and genital systems undergoing sudden and, at times, dramatic changes due to the absence of estrogen stimulation.

The constellation of symptoms related to menopause used to be referred to as “atrophic vaginitis” or “vulvo-vaginal atrophy.” However, these terms were considered disparaging, hurtful and cruel, especially the words “atrophic” and “atrophy,” which imply wasting away through lack of nourishment. Also, the “-itis” designation incorrectly implied inflammation or infection. A more politically correct, medically accurate, less embarrassing and more acceptable term was proposed by the International Society for the Study of Women’s Sexual Health and the North American Menopause Society: “Genitourinary Syndrome of Menopause (GSM).”

“Genitourinary Syndrome of Menopause”–  I don’t particularly care for this term because of its length, the fact that it sounds way too clinical, and implication that menopause causes a medical “syndrome” or “disease” as opposed to a natural, physiological, age-appropriate, virtually universal situation.  Why not label the constellation of symptoms related to menopause as “menopausal symptoms and signs”?

The female hormone (estrogen)-stimulated vagina of a young adult female has a very different appearance from that of a female after menopause. The vestibule, vagina, urethra and base of the urinary bladder have abundant estrogen receptors that are no longer stimulated after menopause, resulting in diminished tissue elasticity and integrity.  Age-related changes of the vulva and vagina can lead to dry, thinned and brittle tissues with loss of vaginal length and width, lubrication potential and expansive ability. Considering that nature’s ultimate purpose of sex is for reproduction, perhaps it is not surprising that when the body is no longer capable of producing offspring, changes occur that affect the anatomy and function of the genital organs.

Symptoms and Signs of Menopause

General

  • Hot flashes
  • Night sweats
  • Sleep disturbances
  • Mood changes and fluctuations

Vulva

  • Thinning/loss of elasticity of labia and underlying fatty tissues
  • Diminished tissue sensitivity
  • Paler, thinner and more fragile vulvar skin
  • Increase in vulvar skin issues and vulvar pain, burning, itching and irritation

 Vagina

  • Thinning of the vaginal wall
  • Loss of vaginal ruffles and ridges
  • Shortened vaginal dimensions
  • Looseness of  the vaginal opening
  • Increased vaginal pH (less acid environment)
  • Increased vaginal colonization by colon bacteria and more frequent vaginal infections

 Sexual

  • Diminished sex drive
  • Vaginal dryness
  • Diminished arousal
  • Diminished lubrication
  • Diminished ability to achieve orgasm
  • Tendency for painful sexual intercourse

 Urinary 

  • Thinning of the urethral wall and tissues adjacent to the urethra
  • Urinary infections: Before menopause, healthy bacteria reside in the vagina; after menopause, the vaginal bacterial ecosystem changes to colon bacteria, which can predispose to infections.
  • Overactive bladder symptoms: urinary urgency, frequency, urgency incontinence
  • Stress urinary incontinence (urinary leakage with sneezing, coughing, exercise and exertion)
  • Urethral caruncles (benign fleshy outgrowths at the urethral opening)

What to do?

If the symptoms and signs of menopause are not bothersome, nothing need be done. In fact, many women relish not having menstrual periods and tolerate menopause uneventfully.  However, if one’s quality of life is adversely affected, consideration can be made for hormone replacement therapy, particularly if the menopausal symptoms are disruptive and debilitating.

Hormone Replacement

Systemic hormone therapy is available in the form of pills, skin patches, sprays, creams and gels. It can be effective in managing bothersome menopausal symptoms when used for the short-term. Estrogen alone is used in women who have had a hysterectomy, whereas estrogen and progesterone in those who have a uterus. The potential side effects of systemic therapy include an increased risk for heart disease, breast cancer and stroke.

Vaginal hormone therapy is available in creams, rings and tablets. The advantage of  locally-applied estrogen is that it can help manage menopausal pelvic floor issues with minimal absorption into the body and minimal potential systemic effects, as would be expected from oral hormone replacement therapy. It can be helpful for painful intercourse, overactive bladder, stress urinary incontinence, pelvic organ prolapse and recurrent urinary tract infections. Additionally, because estrogen restores suppleness to the vaginal tissues, it can be very useful both before and after vaginal surgical procedures (most commonly for stress urinary incontinence and pelvic organ prolapse).

Note: I commonly prescribe topical estrogen therapy, typically a small dab applied vaginally prior to sleep three times weekly.  It has proven helpful and effective in a variety of circumstances.

Kegel Exercises

Clinical studies have demonstrated that Kegel exercises can effectively improve certain domains of sexual function, particularly arousal, orgasm and satisfaction. This is not surprising given that the pelvic floor muscles are essential to arousal and orgasm, with weakness in these muscles resulting in reduced pelvic and vaginal blood flow and lack of adequate lubrication, painful intercourse and difficulty achieving climax.  Furthermore, Kegel exercises can be effective in the management of overactive bladder, stress urinary incontinence, and pelvic organ prolapse.

Stay Sexually Active: Use it or Lose it

Sexual intercourse can be painful after menopause because of anatomical and functional changes that result in difficulty in accommodating a penis.  This is particularly the case if one has not been sexually active on a regular basis.  Sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse. Vaginal penetration increases pelvic and vaginal blood flow, optimizing lubrication and elasticity, while orgasms tone and strengthen the pelvic floor muscles that support vaginal functionLubricants can be used for women experiencing vaginal dryness and painful intercourse.

Lifestyle Modification

Pursuing a healthy lifestyle can provide some degree of relief from menopausal symptoms. These measures include a maintaining a healthy weight, a diet emphasizing plant-based proteins, fruits and vegetables, moderate exercise, sufficient quantity and quality of sleep, caffeine reduction, tobacco cessation and alcohol in moderation.

Bottom Line: Menopause is an inevitable part of the aging process with the absence of menstrual periods a welcome change for many women.  However, the cessation of estrogen production can cause a host of symptoms and consequences, particularly affecting the urinary and genital organs.  If symptoms are bothersome, there are numerous means by which to improve them. 

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.

 

Practical Approach To Erectile Dysfunction

September 16, 2017

Andrew Siegel MD  9/16/17

shutterstock_side view manjpeg

ED is a highly prevalent condition and a common reason for a urology consultation.  A pragmatic approach to its diagnosis and treatment–the topic of today’s entry–has always worked well for my patients.  A practical approach starts with simple and sensible measures, and only in the event that these are not successful, proceeding with more complex and involved strategies, dividing management options into four tiers of complexity. 

 Principles to managing male sexual issues are the following:

  • If it ‘ain’t broke,’ don’t fix it: “First do no harm.”
  • Educate to enable informed decisions: “The best prescription is knowledge.”
  • Try simple, conservative options before complex and aggressive ones: “Simple is good.”
  • Healthy lifestyle is vital: “Genes load the gun, but lifestyle pulls the trigger.”

Questions that need to be asked in order to evaluate ED include the following:

AS and DM

  • How long has your problem been present?
  • Was the onset sudden or gradual?
  • How is your sexual desire?
  • How is your erection quality on a scale of 0-5 (0 = flaccid; 5 = rigid)?
  • Can you achieve an erection capable of penetration?
  • Is your problem obtaining an erection, maintaining an erection, or both?
  • Is your problem situational? Consistent? Variable?
  • Are nocturnal, early morning and spontaneous erections present?
  • Do you have a bend or deformity to the erect penis?
  • How confident are you about your ability to complete the sexual act?
  • Are there ejaculation issues (rapid, delayed, painful, inability)?
  • Do you have symptoms of low testosterone?
  • What treatments have been tried?

Of equal relevance are medical, nutritional, exercise and surgical history, medications, and use of tobacco, alcohol and recreational drugs.  A tailored physical includes blood pressure, pulses and an exam of the penis, testes and prostate.  Basic lab tests including urinalysis, serum glucose, HbA1c, lipid profile and testosterone.

Information derived from the evaluation as described above will provide a working diagnosis and the ability to formulate a treatment approach.  Although a nuanced and individualized approach is always best, four lines of treatment for ED are defined—from simple to complex—in a similar way that four lines of treatment can be considered for arthritis.  For arthritis of the knee, for example, first-line therapy is weight loss to lessen the mechanical stress on the joint, in conjunction with physical therapy and muscle strengthening exercises. Second-line therapy is anti-inflammatory and other oral medications that can help alleviate the pain and inflammation. Third-line therapy is injections of steroids and other formulations.  Fourth-line therapy is surgery.

If the initial evaluation indicates a high likelihood that the ED is largely psychological/emotional in origin, referral to a qualified psychologist/counselor is often in order.  If the lab evaluation is indicative of low testosterone, additional hormone blood tests to determine the precise cause of the low testosterone are done prior to consideration for treatment aimed at getting the testosterone in normal range.  If the lab evaluation demonstrates unrecognized or poorly controlled diabetes or a risky lipid and cholesterol profile, appropriate medical referral is important.

Practical treatment of ED


elephant penis
 Credit for photo above goes to one of my patients; note the 7 prodigious appendages!

First-line: Lifestyle makeover

 A healthy lifestyle can “reverse” ED naturally, as opposed to “managing” it. ED can be considered a “chronic disease,” and as such, changes in diet and lifestyle can reverse it, prevent its progression and even prevent its onset.

My initial approach is to think “big picture” (and not just one particular aspect of the body working poorly).  Since sexual functioning is based upon many body components working harmoniously (central and peripheral nerve system, hormone system, blood vessel system, smooth and skeletal muscles), the first-line approach is to do what nurtures every cell, tissue and organ in the body. This translates to getting down to “fighting” weight, adopting a heart-healthy and penis-healthy diet (whole foods, nutrient-dense, calorie-light, avoiding processed and refined junk foods), exercising moderately, losing the tobacco habit, consuming alcohol in moderation, managing stress (yoga, meditation, massage, hot baths, whatever it takes, etc.), and getting adequate quantity and quality of sleep. Aside from general exercises (cardio, core, strength and flexibility training), specific pelvic floor muscle exercises (“man-Kegels”) are beneficial to improve the strength, power and endurance of the penile “rigidity” muscles.

If a healthy lifestyle can be adopted, sexual function will often improve dramatically, in parallel to overall health improvements. Many medications have side effects that negatively impact sexual function. A bonus of improved lifestyle is potentially allowing lower dosages or elimination of medications (blood pressure, cholesterol, diabetic meds, etc.), which can further improve sexual function.

“The food you eat is so profoundly instrumental to your health that breakfast, lunch and dinner are in fact exercises in medical decision making.”  Thomas Campbell MD

 

healthy meal

Above: A nice, healthy meal consisting of salmon, salad, veggies and quinoa

 

fat belly

Above: Not the kind of belly you want–visceral obesity is a virtual guarantee of pre-diabetes–if not diabetes–and greatly increases one’s risk of cardiovascular disease, including ED

Bottom line: Drop pounds, eat better, move more, stress less, sleep soundly = love better!

Second-line: ED pills and mechanical devices

In my opinion, the oral ED medications should be reserved for when lifestyle optimization fails to improve the sexual issues. This may be at odds with other physicians who find it convenient to simply prescribe meds, and with patients who want the quick and easy fix.  However, as good as Viagra, Levitra, Cialis and Stendra may be, they are expensive, have side effects, are not effective for every patient and cannot be used in everyone, as there are medical situations and medications that you might be on that preclude their use. In the second-line category, I also include the mechanical, non-pharmacological, non-surgical devices, including the Viberect and the vacuum suction devices.

Viagra (Sildenefil). Available in three doses—25, 50, and 100 mg—it is taken on demand and once swallowed, it will increase penile blood flow and produce an erection in most men within 30-60 minutes if they are sexually stimulated, and will remain active for up to 8 hours.

 Levitra (Vardenefil). Similar to Viagra, it is available in 5, 10, and 20 mg doses. Its effectiveness and side effect profile is similar to Viagra.

Cialis (Tadalafil).  Available in 2.5, 5 mg, 10mg, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra. Its duration of action is approximately 36 hours, which has earned it the nickname of “the weekender.” Daily lower doses of Cialis are also FDA-approved for the management of urinary symptoms due to benign prostate enlargement.

Stendra (Avanafil). Similar to Viagra, it is available in 50, 100 and 200 mg doses. Its advantage is rapid onset.

Vacuum suction device                                                                                                                          This is a mechanical means of producing an erection in which the penis is placed within a plastic cylinder connected to a manual or battery-powered vacuum. The negative pressure engorges the penis with blood and a constriction band is temporarily placed around the base of the penis to maintain the erection.

Viberect device                                                                                                                               Initially employed as a means of triggering ejaculation in men with spinal cord injuries using vibrational energy, it has achieved wider use in provoking erections in men with ED. The device has dual arms that are placed in direct contact with the penile shaft. The vibratory stimulation will cause an erection and ultimately induce ejaculation.

Third-line: Vasodilating (increase blood flow) urethral suppositories and penile injections

These drugs are not pills, but other formulations (suppositories and injections) that increase penile blood flow and induce an erection.

M.U.S.E. (Medical urethral system for erection).  This is a vasodilator pellet—available in 125, 250, 500, and 1000 microgram dosages—that is placed into the urinary channel after urinating.  Absorption occurs through the urethra into the adjacent erectile chambers, inducing increased penile blood flow and potentially an erection.

Caverject and Edex (Prostaglandin E1) are vasodilators that when injected directly into the erectile chambers result in increased blood flow and erectile rigidity. After one is taught the technique of self-injection, the medication can be used on demand, resulting in rigid and durable erections.  A combination of medications can be used for optimal results– this combination is known as Trimix and consists of Papaverine, Phentolamine, and Alprostadil.

Fourth-line: Penile implants

There are two types of these devices that are surgically implanted into the erectile chambers under anesthesia, most often on an outpatient basis. Penile implants are totally internal, with no visible external parts, and aim to provide sufficient penile rigidity to permit vaginal penetration.

The semi-rigid device is a simple one-piece flexible unit consisting of paired rods that are implanted into the erectile chambers. The penis with implanted flexible rods is bent up for sexual intercourse and bent down for concealment. The inflatable device is a three-piece unit that is capable of inflation and deflation. Inflatable inner tubes are implanted within the erectile chambers, a fluid reservoir is implanted behind the pubic bone and a control pump in the scrotum, adjacent to the testes. When the patient desires an erection, he pumps the control pump several times, which transfers fluid from the reservoir to the inflatable inner tubes, creating a hydraulic erection which can be used for as long as desired. When the sexual act is completed, he deflates the mechanism via the control pump, transferring fluid back to the reservoir.

Penile implants can be a life changer for a man who cannot achieve a sustainable erection. They provide the necessary penile rigidity to have intercourse whenever and for however long that is desirable.

 

Wishing you the best of health,

2014-04-23 20:16:29

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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.