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.
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
Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity (free electronic download) www.findyourfountainofyouth.com
You Tube page: www.youtube.com/incontinencedoc
Tags: Andrew Siegel MD, Arnold Kegel, bulbocavernosus muscle, clitoris, Galen, genital-urinary health, gynecologist, Hippocrates, ischiocavernosus muscle, Kegel exercises, labia majorum, levator ani, Male pelvic floor exercises, penis, pubococcygeus, scrotum, testosterone, urologist