Archive for February, 2014

Man Kegel Exercises

February 22, 2014

Blog # 142

As a urologist, I have expertise in both male and female pelvic health as opposed to gynecologists who treat only women. When I reflected on the similarities and differences of the male and female pelvis, genitalia and pelvic floor, I came to some important conclusions. It occurred to me that in terms of development, the male and female genitalia are incredibly similar with respect to their embryological origin. Additionally, the pelvic floor muscles (PFM) are virtually identical in both genders. Exercises of these pelvic floor muscles for purposes of improving sexuality, urinary control and pelvic support are widely known and acknowledged in the female population; in fact, women are instructed to do these “Kegel” exercises during and after pregnancy. So, why not for men?

Hmmmm…identical origin of genital tissues, the same exact muscles, documented effectiveness of these exercises for women’s pelvic health…what’s the missing link? The missing link is that if they are so beneficial for females, why have they virtually been ignored when it comes to the male population? Hey: What’s good for the goose is good for the gander. More specifically, what is good for the female goose is equally good for the male goose. PFM exercises are gender-neutral, having the same meaningful potential in males that they have proven to have in females but for some reason, have been largely neglected and remain an unexploited and powerful resource.

In the 1940s, Dr. Kegel—a gynecologist from Los Angeles—popularized pelvic floor muscle (PFM) exercises in females in order to help improve sexual and urinary health after childbirth. I think it is fair to state that most adult women have heard of and many have practiced these exercises, known as “Kegels.”  In brief, when a woman does a Kegel contraction, she voluntarily contracts the muscles that surround the urethra, vagina, and rectum. As a result, the urethra gets pinched, the vagina tightens up, and the rectum gets squeezed.

Kegel pelvic floor muscle exercises are by no means a new concept, Hippocrates and Galen having described it in Ancient Greece and Rome respectively, where they were performed in the baths and gymnasiums. Strengthening these muscles was thought to promote general and sexual health, spirituality, and longevity

Men have the very same pelvic floor muscles that women do and an equivalent capacity for exercising them, with a parallel benefit and advantage to urinary and sexual health. Nonetheless, the male PFM have yet to receive the recognition that the female PFM have, although from a functional standpoint are of vital importance, certainly as critical to male genital-urinary health as they are to female genital-urinary health. When a man contracts his pelvic floor muscles, he voluntarily tightens the muscles that surround the urethra and rectum, which enables him to stop his urinary stream and tighten his anus. Under the circumstances of having an erection, when the PFM are engaged, the penis will lift skywards towards the heavens. Unfortunately, however, most men are unfamiliar with pelvic floor muscle exercises and it is the rare man who has performed them. Even many physicians are unaware of the pelvic floor muscles and their potential benefits for men.

In terms of anatomy, the male and female external genitalia at the earliest stages of embryological development are identical. That is, one and the same, duplicate, a carbon copy of each other. No “his” and “hers,” only “hers” and “hers.” Add testosterone (the male sex hormone), to the recipe and presto, the primitive male genitals transform into a penis and scrotum. In the presence of testosterone the genital tubercle (a midline swelling) becomes the penile shaft and head; the urogenital folds (two vertically-oriented folds of tissue below the genital tubercle) fuse and become the urethra and part of the penile shaft; and the labio-scrotal swellings (two vertically-oriented bulges outside the urogenital folds) fuse and become the scrotum. In the female embryo, the absence of testosterone causes the genital tubercle to become the clitoris, the urogenital folds to become the inner lips (labia minora), and the labio-scrotal swellings to become the outer lips (labia majora).

Essentially then, the penis and the clitoris are the same structure, as are the scrotum and outer labia.  How fascinating it is that female external genitalia are the “default” model.  In other words, female external genitalia form in the absence of testosterone, and not in the active presence of female hormones.

Similarly, the PFM are virtually identical in both genders, as can be clearly seen in the images that follow (credit to Dr. Henry Gray, Gray’s Anatomy of the Human Body, 20th edition, originally published in 1918; public domain).  Compare the bulbocavernosus muscle in the male with that of the female and the ischiocavernosus muscle in the male and the female. The only real difference is that the BC muscle in the female is split around the vagina.

ImageImageImageImage

In summary, we have identical origin of genital tissues, same exact muscles, and well-documented effectiveness of these exercises for women’s pelvic health. So why do we never hear about PFM exercises for male pelvic health? If the genital and PFM anatomy is virtually “the same” in both genders, as is the supportive, sphincter and sexual functions of the PFM, then why should PFM exercises be any less beneficial for males than females? The bottom line is that pelvic floor muscle exercises in the male have the same meaningful potential that they have proven to have in females, but for some reason, have been ignored, neglected and remain an untapped yet valuable resource.

My objective is to bring to the forefront an awareness of the male pelvic floor muscles and an understanding of the numerous benefits of tapping into their capacity for optimizing and improving sexual and urinary function. My ultimate goal is to help male pelvic fitness achieve the same traction and status as female pelvic fitness has, as did Dr. Arnold Kegel for females. To be continued…

Andrew Siegel, M.D.

Much of this material was excerpted from Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014. www.MalePelvicFitness.com

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Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

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Snippety Snip: Should You Get a Vasectomy???

February 15, 2014

Changed the URL

Our Greatest Wealth Is Health

Blog # 141

Screen Shot 2014-02-14 at 4.30.30 PM

(Image designed by Jeff Siegel)

With February 14, 2014 having just passed—a day filled with roses and chocolates—it is interesting to note that there are those who believe that it is a vasectomy that makes the ultimate Valentine’s Day gift!  If you are comfortable with the size of your family, tired and unhappy with birth control, or you have determined that you do not want to have more children, than a vasectomy may be a consideration. Every year, half a million men in the USA decide to have a vasectomy as a means of permanent birth control.  Vasectomy is the most effective means of contraception, second only to abstinence. During a vasectomy, each vas deferens, aka, vas (the tube that transports sperm) is cut and sealed, preventing the sperm from being present in the semen. It is a simple, safe, and time-honored means of achieving permanent…

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Snippety Snip: Should You Get a Vasectomy???

February 15, 2014

Blog # 141

Screen Shot 2014-02-14 at 4.30.30 PM

(Image designed by Jeff Siegel)

With February 14, 2014 having just passed—a day filled with roses and chocolates—it is interesting to note that there are those who believe that it is a vasectomy that makes the ultimate Valentine’s Day gift!  If you are comfortable with the size of your family, tired and unhappy with birth control, or you have determined that you do not want to have more children, than a vasectomy may be a consideration. Every year, half a million men in the USA decide to have a vasectomy as a means of permanent birth control.  Vasectomy is the most effective means of contraception, second only to abstinence. During a vasectomy, each vas deferens, aka, vas (the tube that transports sperm) is cut and sealed, preventing the sperm from being present in the semen. It is a simple, safe, and time-honored means of achieving permanent male fertility control.

The female version of a vasectomy is a tubal ligation  (blocking the fallopian tubes to prevent pregnancy). This is an effective technique as well; however, vasectomy is a skin-deep procedure versus a tubal ligation, a much more invasive procedure because it requires going into the abdomen. Additionally, a vasectomy can be performed under local anesthesia with or without intravenous sedation whereas tubal ligation requires general anesthesia, and there exists a simple test for the effectiveness of vasectomy, but no such tests for tubal ligations (aside from a costly and uncomfortable x-ray test).  Vasectomy is safer and cheaper than a tubal ligation. Something else to consider is that the one-time cost of a vasectomy may prove less expensive over time than the cost of other birth control methods including oral contraceptives and condoms.   In general, insurance companies are very willing to cover vasectomy for no reason other than they are less expensive to their bottom line than are more pregnancies.

Basic anatomy:  The testicles are responsible for sperm production.  After sperm cells are manufactured, they ascend into the epididymis, a comet-shaped structure located behind the testicles. From the epididymis arises the vas deferens that runs up the groin in the spermatic cord, then courses behind the bladder where its terminal end forms the ejaculatory duct. This duct empties into the urethra, the channel that conducts urine and semen through the penis.

Consultation:  Before considering a vasectomy, it is important to have an initial consultation with a urologist, the surgeon who performs this procedure. This includes a medical history and physical examination that is brief and painless, with ample time allotted for a detailed discussion about the vasectomy process and for answering any questions that you or your spouse might have.

Procedure: Vasectomy is considered to be a minor surgical procedure, which is typically performed in the office or ambulatory surgery setting. It usually takes 20 minutes or so to perform. It can be done under local anesthesia with or without intravenous sedation. It has been my experience that intravenous sedation makes the procedure much more comfortable for the patient and easier for the surgeon.  With sedation, you will be conscious yet calm and comfortable while monitored under the expert care of an anesthesiologist.

After sedation is established, the scrotum is shaved and cleansed.  The area is draped with sterile surgical towels so that only a small area of skin is exposed.  Local anesthesia is administered and via two tiny punctures in the scrotum, the vas is accessed.   There are many different ways to interrupt the sperm flow—I prefer removing a ½ inch segment of vas, doubly clipping each end, and using cautery to seal the edges. The small puncture in the skin may be closed with a suture that will dissolve, or alternatively, skin glue.  The vas specimens are sent out to a pathologist for standard review.

Recovery:   Restrictions of activities for the first 24 hours will reduce the chance of swelling, bruising, bleeding, and pain.  An application of an ice pack to the scrotum intermittently for the first 24 hours—20 minutes on and 20 minutes off—is effective to help reduce swelling. Mild discomfort is typical and is best treated with an anti-inflammatory such as ibuprofen. Wearing elastic, supportive jockey shorts is helpful to keep the scrotum immobilized. It is normal to experience swelling, minor pain, and spotting from the incision for several days. It is important to restrict heavy lifting and exercise for approximately 5-7 days, but the activities of daily living including walking, stair climbing, working and sex can be resumed as soon as you are feeling well enough.

Follow-Up: It is imperative to obtain a semen analysis to ensure absence of sperm in the semen. It can take weeks to months until all the sperm are cleared, but typically after 20 or so ejaculations most men will no longer have sperm in the semen.  It is very important to continue using contraception until the sperm count is determined to be zero.

Risks: 

  • Temporary bleeding, bruising, pain.
  • Ongoing pain due to congestive epididymitis—on occasion the epididymis can become painfully swollen with sperm congestion, which is usually easily treated with ibuprofen and rest
  • Infection—very rare because the scrotum has such a wonderful blood supply
  • Sperm granuloma—a small, hard lump that feels like a bead at the end of the divided vas; this forms when sperm leak from the severed vas and inflame the surrounding tissue. This is usually treated with rest and ibuprofen and, on rare occasions, surgery is required to remove it.
  •  Recanalization (leading to failure of the procedure)—this is when the cut ends of the vas deferens grow back together and you regain fertility, an extremely rare situation occurring in approximately 1/1000 patients.

Q & A (I have collated the ten most commonly asked questions by patients regarding their vasectomy.)

Q.  Will my testicles still make sperm after my vasectomy?

A.  Yes; but your body absorbs and disposes of them.

 

Q.  Will I notice a difference in my ejaculate volume?

A.  Since the sperm only contributes a small amount of the seminal volume, there should be no noticeable difference in the volume of the semen.

 

 Q. Does vasectomy protect me against sexually transmitted diseases?

 A. No, no, no…I repeat no!  Use protection!

 

 Q.  Is sex different after vasectomy?

 A.  Generally no, although some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex after vasectomy is more relaxed and enjoyable than ever before.

 

Q.  Does vasectomy affect my ability to get an erection or change the way I urinate?

A. No.

 

Q.  Does vasectomy affect my testosterone level?

A. No.

 

Q.  Is vasectomy reversible?

A.  It is reversible with the best results achieved in the initial 10 years following vasectomy. Vasectomy reversal is a complicated procedure requiring general anesthesia and microscopic reconnection of the blocked vas deferens. It typically takes several hours to perform.  It’s a big deal whereas a vasectomy is a little deal.

 

Q.  A few years ago I heard that vasectomy could cause prostate cancer–is that true?

A.  Vasectomy does not cause prostate cancer; however, men who undergo vasectomies have relationships with urologists, the specialists who are attuned to prostate issues, and therefore, men who undergo vasectomy are more likely to undergo prostate cancer screening and diagnosis than the average man who does not see a urologist.

 

 Q. Why should I bother with sedation? How about just local anesthesia?

 A.  I never met a patient who enjoyed having a needle placed into his scrotum and local anesthetic injected; with sedation, there will be no awareness of that happening.  Furthermore, with the inevitable anxiety that patients experience concerning surgery on their genitals, there is typically a reflex contraction of several muscles (cremaster and dartos muscles) that effectively lift the testicles high in the scrotum and sometimes into the groin, making the procedure technically more difficult. The sedation promotes emotional and physical relaxation and makes the procedure technically so much easier for the surgeon and so much more pleasant for the patient.=

   

Q. How does one do a semen analysis?

A.  It involves masturbating into a specimen cup.  Place the cup into a paper bag and bring it to the designated lab along with the prescription for the semen analysis. Try to get it to the lab as quickly as possible.  The specimen will be studied under the microscope for the presence of sperm. 

HAPPY VALENTINE’S DAY!!!

Andrew Siegel, M.D.

Blog subscription: A new blog is posted every week. A direct link to be able to receive the blogs in the in box of your email is the following where you need to click on “sign me up!”

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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014.  www.MalePelvicFitness.com

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity  (free electronic download) www.findyourfountainofyouth.com 

Facebook Page: Our Greatest Wealth Is Health;  Please visit page and “like”: www.facebook.com/promisceating

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You Tube page: www.youtube.com/incontinencedoc

 

Pelvic Floor Muscle Exercises: Becoming the Master of Your Pelvic Domain

February 12, 2014

Andrew Siegel, M.D.  Blog # 59

I have had numerous requests to reblog this, so based upon popular demand, here it is…

The pelvic floor muscles (PFM)—popularized by Dr. Arnold Kegel—are key muscles that are essential to the health and well being of both women and men.  These muscles do not get a great deal of respect, as do the glamour muscles of the body including the pectorals, biceps and triceps; however, they should garner such respect because, although hidden from view, they are responsible for some very powerful and beneficial functions, particularly when trained.

The PFM compose the floor of our “core” muscles.  Our core is a cylinder of muscles of our torso that function as an internal corset.  They surround the inner surface of the abdomen, providing stability.  These muscles are referred to in Pilates as the “powerhouse”; Tony Horton, guru of the P90x exercises series, uses the term “cage.”  The major muscle groups in this core are the following: in the front the transversus abdominis and rectus abdominis; on the sides the obliques; in the back the erector spinae; the roof is the diaphragm; the base are the PFM.  These muscles stabilize the torso during dynamic movements and provide the wherewithal for body functions including childbirth; coughing; blowing our noses; equalizing the pressure in our ears when we are exposed to a change in air pressure as when we travel on airplanes; passing gas; moving our bowels; etc.

Core strength provides us with good posture, balance, support of the back and stabilization and alignment of the spine, ribs and pelvis. The core muscles are a “missing link” when it comes to fitness, often neglected at the expense of the limb muscles.   Tremendous core strength is evident in dancers, swimmers, and practitioners of yoga, Pilates and martial arts.  The core stabilizes the trunk while the limbs are active, enabling us to put great effort into limb movements—it is impossible to use the arms and legs effectively in any athletic endeavor without a solid core to act as a platform to push off.   An example of static core function is standing upright in gale force winds—the core helps stabilize the body so that the winds do not cause a loss of balance or posture. An example of dynamic core function is running up flight of stairs, resisting gravity while maintaining balance and posture.

POP QUIZ (answer below): CAN YOU NAME AN ANIMAL THAT HAS TREMENDOUS CORE STRENGTH?

The PFM form the base of the pelvis and represent the floor of the core muscles.  They provide support to the urinary, genital and intestinal tracts.  There are openings within the PFM that allow the urethra, vagina, and rectum to pass through the pelvis to their external openings.  There are two layers of muscles: the deep layer is the levator ani (literally, “lift the anus”) and coccygeus muscle.   The levator ani consists of the iliococcygeus, pubococcygeus, and puborectalis.  The superficial layer is the perineal muscles. These consist of the transverse perineal muscles, the bulbocavernosus and ischiocavernous muscles, and anal sphincter muscle.

The PFM have a resting muscle tone and can be voluntarily and involuntarily contracted and relaxed.  A voluntary contraction of the PFM will enable interruption of the urinary stream and tightening of the vagina and anus.  An involuntary (reflex) contraction of the PFM occurs, for example, at the time of a cough to help prevent urinary leakage.  Voluntary relaxation of the PFM occurs during childbirth when a female voluntarily increases the abdominal pressure at the same time the PFM are relaxed.

The PFM have three main functions: supportive, sphincter, and sexual. Supportive refers to their important role in securing our pelvic organs in proper position. Sphincter function allows us to interrupt our urinary stream, tense the vagina, and pucker the anus and rectum upon contraction of the PFM.  In terms of female sexual function, the PFM tightens the vagina, helps maintain and support engorgement and erection of the clitoris, and contracts rhythmically at the time of orgasm.  With respect to male sexual function, the PFM helps maintain penile erection and contracts rhythmically at the time of orgasm, facilitating ejaculation by propelling semen through urethra.

In men, the bulbocavernosus muscle surrounds the inner urethra. During urination, contraction of this muscle expels the last drops of urine; at the time of ejaculation, this muscle is responsible for expelling semen by strong rhythmic contractions.  In women, the bulbocavernosus muscle is divided into halves that extend from the clitoris to the perineum and covers the erectile tissue that is part of the clitoris.  The ischiocavernosus muscle stabilizes the erect penis or clitoris, retarding return of blood to help maintain engorgement.

The PFM can get weakened with aging, obesity, pregnancy, chronic increases in abdominal pressure (due to straining with bowel movements, chronic cough, etc.), and a sedentary lifestyle. 

The strength of the PFM can be assessed by inserting an examining finger in the vagina or rectum, after which the patient is asked to contract their PFM. The Oxford grading scale is used, with a scale ranging from 0-5:

0—complete lack of response

1—minor fluttering

2—weak muscle activity without a circular contraction or inward and upward     movement

3—a moderate contraction with inner and upward movement

4/5—a strong contraction and significant inner and upward movement

PFM exercises are used to improve urinary urgency, urinary incontinence, pelvic relaxation, and sexual function. The initial course of action is to achieve awareness of the presence, location, and nature of these muscles.  The PFMs 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. To gain awareness of the PFM, interrupt your urinary stream and be cognizant of the muscles that allow you to do so.  Alternatively, a female can place a finger inside the vagina and try to tighten the muscles so that they cinch down around the finger. When contracting the PFMs, the feeling will be of your “seat” moving in an inner and upward direction, the very opposite feeling of bearing down to move your bowels.  A helpful image is movement of the pubic bone and tailbone towards each other. Another helpful mental picture is thinking of the PFMs as an elevator—when PFMs are engaged, the elevator rises to the first floor from the ground floor; with continuing training, you can get to the second floor.

Once full awareness of the PFM is attained, they can be exercised to increase their strength and tone.  The good news is that you do not need to go to a gym, wear any special athletic clothing, or dedicate a great deal of time to this.  As a test, perform as many contractions of your PFM as possible, with the objective of a few second contraction followed by a few second relaxation, doing as many repetitions until fatigue occurs.  The goal is to gradually increase the length of time of contraction of the PFMs and the number of repetitions performed. Working your way up to 3 sets of up to 25 repetitions, 5 seconds duration of contraction/5 seconds relaxation, is ideal.  These exercises can be done anywhere, at any time, and in any position—lying down, sitting, or standing.  Down time—traffic lights, standing in check-out lines, during commercials while watching television, etc.—are all good times to integrate the PFM exercises.  Expect some soreness as the target muscles will be overloaded at first, as in any strength-training regimen.  It may take 6-12 weeks to notice a meaningful difference, and the exercises must be maintained because a “use it or lose it” phenomenon will occur if the muscles are not exercised consistently, just as it will for any exercise.

With respect to incontinence and urgency, recognize what the specific triggers are that induce the symptoms.   Once there is a clear understanding of what brings on the urgency or incontinence, immediately prior to or at the time of exposure to the trigger, rhythmically and powerfully contract the PFM—“snapping” or “pulsing” the pelvic floor muscles repeatedly—this can often be a means of pre-empting or terminating both urgency and leakage.   This benefit capitalizes on a reflex that involves the PFMs and the bladder muscle—when the bladder muscle contracts, the PFM relaxes and when the PFM contracts, the bladder muscle relaxes. So, in order to relax a contracting bladder (overactive bladder), snap the PFM a few times and the bladder contraction dissipates.  Stress incontinence can improve as well, because of increased resistance to the outflow of urine that occurs as a result of increased PFM tone and strength.

By improving the strength and conditioning of the PFM, one may expect to reap numerous benefits. Urinary control will improve, whether the problem is stress incontinence, urgency, or urgency incontinence. Post-void dribbling (leaking small amounts of urine after completing the act of voiding) will also be aided. Furthermore, improvement or prevention of bowel control issues will accrue.  Some improvement in pelvic organ prolapse may result, and PFM exercises can certainly help stabilize the situation to help prevent worsening.  PFM toning can also improve sexual performance in both genders.  When a female masters her pelvic floor, she acquires the ability to “snap” the vagina like a shutter of a camera, potentially improving sexual function for herself and her partner.  Similarly, when a man becomes adept at PFM exercises, erectile rigidity and durability as well as ejaculatory control and function can improve. For both sexes, PFM mastery can improve the intensity and quality of orgasms. In terms of quality of life, PFM exercises are really as important—if not more so—than the typical resistance exercises that one does in a gym.

ANSWER TO QUESTION: Can you name an animal that has tremendous core strength?

Dolphins—essentially all core with rudimentary limbs.

Much more info on this subject will be available with the April1, 2014 release of my new book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health www.MalePelvicFitness.com

Facebook Page: Men’s Pelvic Health

Please visit page and “like”: www.facebook.com/malepelvicfitness

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Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity  (free electronic download) www.findyourfountainofyouth.com 

Facebook Page: Our Greatest Wealth Is Health

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New Drug For Peyronie’s Disease: Xiaflex

February 8, 2014

Blog #140

Peyronie’s Disease is an inflammatory condition of the penis that causes a curved penis, creating a deformed and often uncomfortable erection that can dramatically interfere with one’s sexual health. It is not uncommon, with an estimate of 65,000-120,000 cases per year in the USA with only a small fraction treated. Although it can manifest at any age, it most commonly occurs in the 50-60 year old population.

Peyronie’s disease can cause pain with erections; penile angulation; the presence of a penile scar that can be felt as a hard lump under the skin; a visual indentation of the penis described as an hour-glass deformity; and failure of the penis to properly fill with blood, causing poor erections.

The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is physically impossible.  The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring. Although the scarring is physical, it often has psychological ramifications, causing anxiety and depression.

The good news is that the FDA just approved a promising new non-surgical option for treating Peyronie’s. Xiaflex—aka collagenase—derived from the bacterium clostridium histolyticum, had previously been approved for Dupuytren’s contracture, an similar situation to Peyronie’s that occurs on the hand, causing a scarring of the tissue beneath the skin of the palm and fingers, making it very difficult to straighten one’s the fingers. This new medication functions as a “chemical knife” capable of dissolving collagen, the main constituent of scar tissue.

Xiaflex, indicated for men with an angulation of 30 degrees or more, is injected directly into the scar tissue after which the area is massaged and modeled to disrupt the scar tissue and mold the penis.  One course of treatment may involve as many as eight injections. Injection of this medication can be highly effective, but is not without side effects that may include bruising, swelling, pain and possibly rupture of the erectile cylinder of the penis causing a penile fracture.

Surgical procedures for Peyronie’s will generally result in greater improvements in the curvature than will the Xiaflex injections, but pose much greater risks of complications such as erectile dysfunction, changes in penile sensation and penile shortening.

Bottom Line: When scar tissue occurs on an area of the body that moves or expands it affects form as well as function, which can be disabling… thus, the significant impairment with Peyronie’s disease and Dupuytren’s contracture. It comes down to scar tissue in a bad place. Xiaflex is a promising new treatment, an interesting drug capable of dissolving scar tissue, obtained from the Clostridium bacteria.

Andrew Siegel, M.D.

Blog subscription: A new blog is posted every week. A direct link to be able to receive the blogs in the in box of your email is the following where you need to click on “sign me up!”

https://healthdoc13.wordpress.com/?blogsub=confirming#subscribe-blog

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014. www.MalePelvicFitness.com

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity  (free electronic download) www.findyourfountainofyouth.com 

Facebook Page: Our Greatest Wealth Is Health 

Please visit page and “like”: www.facebook.com/promisceating

Facebook Page: Men’s Pelvic Health  

Please visit page and “like”: www.facebook.com/malepelvicfitness

You Tube page: www.youtube.com/incontinencedoc

Sex and the Mediterranean Diet

February 1, 2014

Blog # 139

Sexuality is a very important part of our human existence, both for purposes of procreation as well as pleasure.  Although not a necessity for a healthy life, the loss or diminution of sexual function may result in loss of self-esteem, embarrassment, a sense of isolation and frustration, and even depression. Therefore, for many of us it is vital that we maintain our sexual health. Loss of sexual function further exacerbates progression of sexual dysfunction—the deficiency of genital blood flow that often causes sexual dysfunction produces a state of poor oxygen levels (hypoxia) in the genital tissues, which induces scarring (fibrosis) that further compounds the problem.  So “use it or lose it” is a very relevant statement when it comes to sexual function, as much as it relates to muscle function.

Healthy sexual function for a man involves a satisfactory libido (sex drive), the ability to obtain and maintain a rigid erection, and the ability to ejaculate and experience a climax. For a woman, sexual function involves a healthy libido and the ability to become aroused, lubricate adequately, to have sexual intercourse without pain or discomfort, and the ability to achieve an orgasm.   Sexual function is a very complex event contingent upon the intact functioning of a number of systems including the endocrine system (produces sex hormones), the central and peripheral nervous systems (provides the nerve control) and the vascular system (conducts the blood flow).

A healthy sexual response is largely about adequate blood flow to the genital and pelvic area, although hormonal, neurological, and psychological factors are also important.  The increase in the blood flow to the genitals from sexual stimulation is what is responsible for the erect penis in the male and the well-lubricated vagina and engorged clitoris in the female. Diminished blood flow—often on the basis of an accumulation of fatty deposits creating narrowing within the walls of blood vessels—is a finding associated with the aging. This diminution in blood flow to our organs will negatively affect the function of all of our systems, since every cell in our body is dependent upon the vascular system for delivery of oxygen and nutrients and removal of metabolic waste products.  Sexual dysfunction is often on the basis of decreased blood flow to the genitals from pelvic atherosclerosis, the accumulation of fatty deposits within the walls of the blood vessels that bring blood to the penis and vagina.

Sexual dysfunction may be a sign of cardiovascular disease. In other words, the quality of erections in a man and the quality of sexual response in a female can serve as a barometer of cardiovascular health. The presence of sexual dysfunction can be considered the equivalent of a genital stress test and may be indicative of a cardiovascular problem that warrants an evaluation for arterial disease elsewhere in the body (heart, brain, aorta, peripheral blood vessels).  The presence of sexual dysfunction is as much of a predictor of cardiovascular disease as is a strong family history of cardiac disease, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson has expanded the initials E.D. (Erectile Dysfunction) to mean Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries), Early Detection (of cardiovascular disease), and Early Death (if missed). The bottom line is that heart healthy is sexual healthy.

Many adults are beset with Civilization Syndrome, a cluster of health issues that have arisen as a direct result of our sedentary lifestyle and poor dietary choices.  Civilization Syndrome can lead to obesity, high blood pressure, and elevated cholesterol and can result in such health problems as diabetes, heart attack, stroke, cancer, and premature death.  The diabetic situation in our nation has become outrageous—20 million people have diabetes and more than 50 million are pre-diabetic, many of whom are unaware of their pre-diabetic state! It probably comes as no surprise that diabetes is one of the leading causes of sexual dysfunction in the United States.

Civilization Syndrome can cause a variety of health issues that result in sexual dysfunction.  Obesity (external fat) is associated with internal obesity and fatty matter clogging up the arteries of the body including the arteries which function to bring blood to the genitalia.  Additionally, obesity can have a negative effect on our sex hormone balance (the balance of testosterone and estrogens), further contributing to sexual dysfunction. High blood pressure will cause the heart to have to work harder to get the blood flowing through the increased resistance of the arteries. Blood pressure lowering medications will treat this, but as a result of the decreased pressure, there will be less forceful blood flow through the arteries.  Thus, blood pressure medications, although very helpful to prevent the negative effects of hypertension—heart attacks, strokes, etc.—will contribute to sexual dysfunction.  High cholesterol will cause fatty plaque buildup in our arteries, compromising blood flow and contributing to sexual dysfunction.  Tobacco constricts blood vessels and impairs blood flow through our arteries, including those to our genitals. Smoking is really not very sexy at all!  Stress causes a surge of adrenaline release from the adrenal glands. The effect of adrenaline is to constrict blood vessels and decrease sexual function.  In fact, men with priapism (a prolonged and painful erection) are often treated with penile injections of an adrenaline-like chemical.

A healthy lifestyle is of paramount importance towards the endpoint of achieving a health quality and quantity of life.  Intelligent lifestyle choices, including proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and stress reduction are the initial approach to treating many of the diseases that are brought on by poor lifestyle choices.  Sexual dysfunction is often in the category of a medical problem that is engendered by imprudent lifestyle choices.  It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices.  Simply by pursuing a healthy lifestyle, Civilization Syndrome can be prevented or ameliorated, and the myriad of medical problems that can ensue from Civilization Syndrome, including sexual dysfunction, can be mitigated.

In terms of maintaining good cardiovascular health (of which healthy sexual function can serve as a proxy), eating properly is incredibly important—obviously in conjunction with other smart lifestyle choices. Fueling up with the best and most wholesome choices available will help prevent the build up of fatty plaques within blood vessels that can lead to compromised blood flow. Poor nutritional decisions with a diet replete with fatty, nutritionally-empty choices such as fast food, puts one on the fast tract to clogged arteries that can make your sexual function as small as your belly is big!.

A classic healthy food lifestyle choice is the increasingly popular Mediterranean diet.  This diet, the traditional cooking style of the countries bordering the Mediterranean Sea including Spain, France, Greece, Cyprus, Turkey, Southern Italy, and nearby regions, has been popular for hundreds of years. The Mediterranean cuisine is very appealing to the senses and includes products that are largely plant-based, such as anti-oxidant rich fruits and vegetables, whole grains, nuts, seeds and legumes.  Legumes—including peas, beans, and lentils—are a wonderful source of non-animal protein.  Soybeans are high in protein, and contain a healthy type of fat.  Soy is available in many forms— edamame (fresh in the pod), soy nuts (roasted), tofu (bean curd), and soymilk. Fish and poultry are also mainstays of the Mediterranean diet, with limited use of red meats and dairy products.  The benefits of fish in the diet can be fully exploited by eating a good variety of fish.  Olive oil is by far the principal fat in this diet, replacing butter and margarine. The Mediterranean diet avoids processed foods, instead focuses on wholesome products, often produced locally, that are low in saturated fats and high in healthy unsaturated fats. The Mediterranean diet is high in the good fats (monounsaturated and polyunsaturated) which are present in such foods as olive, canola and safflower oils, avocados, nuts, fish, and legumes, and low in the bad fats (saturated fats and trans fats).  The Mediterranean style of eating provides an excellent source of fiber and anti-oxidants.  A moderate consumption of wine is permitted with meals.

Clearly, a healthy diet is an important component of a healthy lifestyle, the maintenance of which can help prevent the onset of many disease processes.  There are many healthy dietary choices, of which the Mediterranean diet is one.  A recent study reported in the International Journal of Impotence Research (Esposito, Ciobola, Giugliano et al) concluded that the Mediterranean diet improved sexual function in those with the Metabolic Syndrome, a cluster of findings including high blood pressure, elevated insulin levels, excessive body fat around the waist and abnormal cholesterol and triglyceride levels.  35 patients with sexual dysfunction were put on a Mediterranean diet and after two years blood test markers of endothelial function and inflammation significantly improved in the intervention group versus the control group. The intervention group had a significant decrease in glucose, insulin, low-density lipoprotein cholesterol (LDL—the “bad” cholesterol), triglycerides, and blood pressure, with a significant increase in high-density lipoprotein cholesterol (HDL—the “good” cholesterol).  14 men in the intervention group had glucose intolerance and 6 had diabetes at baseline, but by two years, the numbers were reduced to 8 and 3, respectively.

Why is the Mediterranean diet so good for our hearts and sexual health?  The Mediterranean diet is high in anti-oxidants—vitamins, minerals and enzymes that act as “scavengers” that can mitigate damage caused by reactive oxygen species.  Reactive oxygen species (also known as free radicals) are the by-products of our metabolism and also occur from oxidative damage from environmental toxins to which we are all exposed.  The oxidative stress theory hypothesizes that, over the course of many years, progressive oxidative damage occurs by the accumulation of the chemicals the accumulation of reactive oxygen species engender diseases, aging and, ultimately, death.  The most common anti-oxidants are Vitamins A, B-6, B-12, C, E, folic acid, lycopene and selenium.  Many plants contain anti-oxidants—they are concentrated in beans, fruits, vegetables, grain products and green tea.  Brightly colored fruits and vegetables are good clues as to the presence of high levels of anti-oxidants—berries, cantaloupe, cherries, grapes, mango, papaya, apricots, plums, pomegranates, tomatoes, pink grapefruit, watermelon, carrots, broccoli, spinach, kale, squash, etc.—are all loaded with anti-oxidants as well as fiber. A Mediterranean diet is also high in omega-3 fatty acids, a type of polyunsaturated fat present in oily fish including salmon, herring, and sardines.  Nuts—particularly walnuts—have high omega-3 fatty acid content.  Research has demonstrated that these “good” fats have numerous salutary effects, including decreasing triglyceride levels, slightly lowering blood pressure, and decreasing the growth rate of fatty plaque deposits in the walls of our arteries (atherosclerosis), thus reducing the risk of cardiovascular disease, stroke, and other medical problems. Mediterranean cooking almost exclusively uses olive oil, a rich source of monounsaturated fat, which can lower total cholesterol and LDL cholesterol while increasing HDL cholesterol. It is also a source of antioxidants including vitamin E.  People from the Mediterranean region generally drink a glass or two of red wine daily with meals. Red wine is a rich source of flavonoid phenols—a type of anti-oxidant—which protects against heart disease by increasing HDL cholesterol and preventing blood clotting, similar to the cardio-protective effect of aspirin.

The incorporation of a healthy and nutritious diet, such as the Mediterranean diet, is a cornerstone for maintaining good health in general, and vascular health, including sexual health, in particular.  The Mediterranean diet—my primary diet and one that I have incorporated quite naturally since it consists of the kinds of foods that I enjoy—is colorful, appealing to the senses, fresh, wholesome, and one that I endorse with great passion. Maintaining a Mediterranean dietary pattern has been correlated with less cardiovascular disease, cancer, and sexual dysfunction.  And it is very easy to follow.  It contains “good stuff”, tasty, filling, and healthy, with a great variety of food and preparation choices—plenty of colorful fresh fruit and vegetables, a variety of fish prepared in a healthy style, not fried or laden with heavy sauces, healthy fats including nuts and olive oil, limited intake of red meat, a delicious glass of red wine.  It’s really very simple and satisfying.  Of course the diet needs to be a part of a healthy lifestyle including exercise and avoidance of harmful and malignant habits including smoking, excessive alcohol, and stress.  So if you want a sexier style of eating, I strongly recommend that you incorporate the Mediterranean diet into your lifestyle.  Intelligent nutritional choices are a key component of physical fitness and physical fitness leads to sexual fitness.

Andrew Siegel, M.D.

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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014. www.MalePelvicFitness.com

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:www.promiscuouseating.com

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity  (free electronic download) www.findyourfountainofyouth.com

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