Archive for March, 2014

Children, Healthy Role Models and the School Environment

March 28, 2014

The following blog is a guest blog, written by Audrey Zeitouni Lasky, retired New York State Certified teacher grades 7-12 who has a Master of Science in Secondary Education and is a National Academy of Sports Medicine Certified Personal Trainer, and for a woman in her fifties has the most ripped 6-pack imaginable.

As Americans we have experienced many wonderful and exciting technological advancements in the 21st century, however those advancements have now been marred given the fact that so many of our children and adolescents  are unable to function normally, either physically or mentally and learning for many youngsters has become obstructed by a myriad of negative and destructive influences. As a former secondary education classroom teacher in New York suburban schools I was quite literally on the “front lines” of the war on childhood obesity.

In order for children to truly thrive, their environment must be conducive to it. In order for them to learn and later function in what now has become an increasingly complex society, it is imperative that the school atmosphere be one that is safe, healthy and nurturing. This includes but is not limited to children and adolescents seeing and interacting with proper role models throughout the school day.

Children are heavily influenced by those around them and while in most cases school officials and personnel cannot control the environment outside the school setting, they most certainly have the power to control what takes place on school property.

It is time for educators both inside and outside the classroom to do what is right for the health and well-being of the child which includes a return to professional and what I term “health-driven” conduct on the part of the school administration, faculty and staff.

How many of you over the age of 50 (as I am) can remember the names of your teachers? I will bet that not only do you remember most of their names, but I am certain that so many of them had a profound and mostly positive effect on you during the course of your K-12 education. A return to that professional classroom environment of yesteryear which includes a policy of no eating or drinking during class (except for water when needed on hot days) would be a tremendous start. This would also include administrative offices within the school building where children are often present throughout the day. It is highly disruptive to the continuity and effectiveness of the lesson when the air is filled with the stench of junk food and the smell of the remaining garbage afterwards.

I am going to “borrow” the title of one of my favorite books by Dr. Andrew Siegel, “Promiscuous Eating”.  Engaging in constant, often mindless eating throughout the school day does indeed fall into the category of “Promiscuous Eating”. Teachers have the power to be excellent role models for our children. Students must never see their teachers eating during class time when they are supposed to be teaching and therefore not wholly focused on their students. This sets a very bad example particularly when we as a nation are experiencing not only an obesity epidemic but also a multitude of other very serious health issues as result of not only overeating but eating so much junk. Food, especially junk food, must never be used as a “pacifier” for students with disciplinary issues. In addition, during the school day, faculty, administrators and staff must never return to the school building from break periods reeking of cigarette smoke. Again this sets a very bad example for our youth. Although a child may live in a household where smoking and unhealthy eating take place, the school environment and a professional and dedicated staff can often make a profound difference in the life of a child. You would be very upset if your physician were eating a greasy pizza and smoking while examining you or giving you the results of lab tests. That would be unprofessional to say the least!

During my tenure as a grade 7-12 foreign language teacher, I was required to teach a unit on food as part of the curriculum. I also taught a sixth grade French and Spanish twelve week immersion program. As a reward for studying hard, I arranged for special field trips to world cafés where students learned to order meals in French or Spanish. This was special. The students looked forward to it and it was appropriate as part of their foreign language and cross-cultural education. Additionally I invited students who were well-behaved into my classroom during their lunch period and mine for extra help at which time I provided fresh fruit slices and sparkling water. The students appreciated the extra help and loved the fresh fruit as well as the “fancy water with bubbles” as they called it. For some students the fiber in the apple skin would be the most fiber they consumed in any given day. This is unacceptable. School districts can help remedy the situation by taking the following steps:

1-    Enact a rule that eating will only take place during school breakfast programs and lunch periods within the cafeteria walls with school-based administrators enforcing this rule and also setting a good example themselves.

2-    Understand that the major reason that so many students need to use the restroom so often is the result of all the gastro-intestinal difficulties which students experience during the course of the school day particularly in the afternoon. The ridiculous food choices currently available in most schools are undoubtedly the culprit.

3-    Completely remove the “junk” from the cafeteria and replace it with daily deliveries of berries, apples, bananas, red grapes, oranges etc. Students will choose food over hunger in a heartbeat and will soon realize just how satisfying healthy eating can be just as my students did. Frozen berries for example are available year round and can be thawed and served as a much better option than chips and candy.

4-    Consult Dr. Robert H. Lustig’s Book, “The Fat Chance Cookbook” as a model for meals students will certainly find appetizing.

5-    When any school board of education crony declares they can’t afford to offer healthy, tangy, zesty, grilled, sautéed and steamed vegetables, lean protein and fruit, then stand up and shout the following: WE CAN’T AFFORD NOT TO ANYMORE! There will not be enough cardiologists and endocrinologists to treat the coronary artery disease, hypertension, diabetes, etc!

I also consistently modeled a physically active lifestyle for my students. They could plainly see that I exuded lots of energy upon arrival at school and were curious to know how this was possible first thing in the morning. I would explain my daily cardiovascular and anaerobic exercise routine which I also incorporated into my foreign language lesson plans. As required by the New York State Dept of Education I also taught all the sports and fitness-related vocabulary and phrases and integrated total physical response activities with full body Simon Says for active foreign language acquisition. The experience was virtually a Phys Ed class conducted in French and Spanish. As far as the English version of regularly scheduled Physical Education and Health classes are concerned it is now time to explore alternate and more effective solutions for reaching grades K-12. Those teaching these subjects in particular need to look and act the part in order to make a lasting impression on children and adolescents. A teacher who practices what he or she preaches is paramount in order to effect positive changes in the life and well being of a student. Oftentimes when there is no proper role model at home, the teacher must then take on that role. Perhaps a requirement that Health and Physical Education teachers also become certified nutritionists and certified fitness professionals by nationally recognized and accredited bodies would be prudent. This would benefit not only the child, but also the educator. 67% of Americans meet the criteria for being overweight and one third of those Americans meet the criteria for being obese. It is time to stop this epidemic in its tracks and “model” healthy living for the sake of our children and their children.

Audrey Zeitouni Lasky

San Francisco, California


Andrew Siegel, M.D.

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

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

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) 

Amazon page:

For more info on Dr. Siegel:



March 22, 2014

Blog # 146  Andrew Siegel, MD

As I defined it in the urban dictionary, “urgasm” is when urine is ejaculated at the time of the male sexual climax.

The penis has a dual role as a urinary organ allowing “directed” urination that permits men to stand to urinate, and a sexual and reproductive organ that, when erect, allows the penis to penetrate the vagina and release semen. Although urinary and sexual functions are discrete and separate, their interplay is complex and treatment for prostate cancer with surgery or radiation can muddle the distinction.

Semen or seminal fluid is what comprises the ejaculate.  Less than 5% of the volume is actually sperm and the other 95+% is a cocktail of genital secretions that helps provide nourishment, support and chemical safekeeping for sperm cells. About 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid that has a lubrication function. The average ejaculate volume is 2-5 milliliters (one teaspoon is the equivalent of 5 milliliters).

“Climacturia” is the medical term for leakage of urine during orgasm, but I much prefer the term that I have coined, a combination of the words “urine” and “orgasm” into “urgasm.” What happens is that urine is “ejaculated” instead of semen. This is a not uncommon occurrence in men treated for prostate cancer with radical prostatectomy, which removes those organs largely responsible for semen production, the prostate and the seminal vesicles. It also can occur after radiation as a treatment for prostate cancer. Even though it is urine that is ejaculated and not semen, the sensation usually remains the same. Urine is generally sterile, so there is limited potential for spreading an infection to a partner.

Urinary incontinence (the inadvertent) leakage of urine, often associated with exertional activities, is commonly present in men complaining of urgasm. After radical prostatectomy, it is typically stress incontinence, leakage with exercise, coughing, bending over, sudden movements, etc. The presence of stress incontinence is a key risk factor for the occurrence of urgasm. However, some men have stress incontinence in the absence of urgasms and other men have urgasms in the absence of stress incontinence.

Urgasm can be quite distressing to the man who experiences it, as well as his partner, who might not appreciate the “golden shower.” Urinating immediately prior to engaging in sexual activity can be very helpful, it being imperative to empty the bladder as completely as possible. Pelvic floor exercises—aka Kegels—very helpful in the management of stress incontinence—may prove helpful in terms of improving urgasm.  Pelvic floor muscle contractions are the body’s natural mechanism to facilitate expelling the urethral contents. When contracted, the bulbocavernosus muscle (BC)—the body’s urethral “stripper”—compresses the deep, internal aspect of the urethra, displacing the urine within outwards. The 1909 Gray’s Anatomy refers to the BC muscle the “ejaculator urine.” Pelvic floor muscle training can foster a powerful BC muscle to help increase the capability to empty the urethra. If you are experiencing urgasm, vigorously contract the BC muscle several times after completing urination in order to empty the urethra. If necessary, this can be supplemented by manual compression and milking of the urethra in an effort to get every drop out before engaging in sexual intercourse.

Bottom LineEjaculation of urine is a not uncommon occurrence following treatment for prostate cancer, particularly removal of the prostate gland. It can be a vexing problem to the patient and partner, but can be improved with simple measures, focusing on gaining facility of the bulbocavernosus muscle, one of the important pelvic floor muscles.

Andrew Siegel, M.D.

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

Trailer for new book:

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

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)

Amazon page:

For more info on Dr. Siegel:

Man Kegels (Pelvic Floor Muscle Exercises for Men)-Part 2

March 15, 2014

Andrew Siegel MD, Blog# 145


The photo above was taken by a pharmaceutical rep friend who discovered this phallic carving among the Roman ruins in Fez, Morocco.

The following is largely excerpted from my forthcoming book, Male Pelvic Fitness: Optimizing Sexual and Urinary Health, available in April 2014:

With respect to sexuality, medical publications—and more specifically the urological literature—rarely, if ever make mention of targeted exercise as a means of optimizing function or helping to treat a dysfunction. The preeminent urology textbook, Campbell’s Urology, a 4000 page, 4-volume tome, devotes precisely one paragraph to the use of pelvic floor muscle exercises in the management of male sexual dysfunction and makes no mention of its use in maximizing sexual function.

Despite numerous studies and research demonstrating the effectiveness of targeted pelvic exercises, they have been given short shrift. Part of the reason for this is simply that there has never been an easy-to-follow exercise program or well-designed means of facilitating pelvic floor muscle training in men. Instead, there is an emphasis on oral medications, urethral suppositories, penile injections, vacuum devices and penile implants. In the United States we have a pharmacology-centric medical culture—“a pill for every ill”—with aggressive prescription writing by physicians and a patient population that expects a quick fix.

It is shameful that traditionally there has been such little emphasis on lifestyle improvement—healthy diet, weight management, exercising, and avoidance of tobacco, excessive alcohol and stress—as a means of preventing and improving sexual dysfunction.

In addition to general lifestyle measures, specific exercises targeted at the pelvic floor can confer great benefits to pelvic health and fitness, an important element of overall health and fitness. The pelvic floor muscles (PFM) are critical to healthy  sexual function and achieving fitness in this domain is advantageous on many levels: to enhance sexual health; to maintain sexual health; to help prevent the occurrence of sexual dysfunction in the future; and to aid in the management of sexual dysfunction. PFM exercises should be considered first-line treatment of sexual dysfunction and a safe and natural self-improvement approach ideally suited to the male population, including the baby boomers, generation X, and generation Y.  PFM fitness can serve as an effective means to help keep the boomers “booming.”

I do not mean to downplay and disparage the role of medications and other options in managing sexual dysfunction. The availability of that magic blue pill in April 1998—Viagra—was a seminal moment in the world of male sexual dysfunction that enabled for the first time a simple and effective means of treating erectile dysfunction (ED).  On the polar opposite end of the treatment spectrum—but of no less importance—was the development and refinement of the penile implant, used in severe cases of ED unresponsive to less invasive options.

But why should we not initially try to capitalize on simpler, safer, and more natural solutions and consider, for example, using a targeted exercise program or medications in conjunction with a targeted exercise program?  Sexual function is all about blood flow to the penis and pelvis.  And what better way to enhance blood flow than to exercise?  We engage in exercise programs for virtually every other muscle group in the body.  Working out our PFM can result in a strong, robust and toned pelvic floor, capable of supporting and sustaining sexual function to the maximum.

Physical therapy is a well-accepted discipline that is commonly used for disabilities and rehabilitation after injury or surgery.  The goal of a physical therapy regimen is to promote mobility, functional restoration and quality of life. A targeted PFM exercise regimen can be considered the equivalent of genital and pelvic physical therapy with the goal of increasing the bulk, strength, power and function of the PFM.

The PFM can be thought of as a vital partner to our sexual organs, whose collaboration is an absolute necessity for optimal sexual functioning, little different than the relationship between the diaphragm muscle and the lungs. The role of the PFM in sexual function has been vastly undervalued and understated. The hard truth is that a well-conditioned pelvic floor that can be vigorously contracted and relaxed at will is often capable of improving sexual prowess and functioning as much as fitness training can enhance athletic performance and endurance.

Such targeted exercises confer advantages that go way beyond the sexual domain. These often-neglected muscles are vital to our genital-urinary health and wellness and serve an essential role in urinary function, bowel function and prostate health.  Additionally, they are important contributors to lumbar stability, spinal alignment and the prevention of back pain. Specifically, PFM exercises can be beneficial with respect to the following spectrum of issues: erectile dysfunction; orgasmic dysfunction; premature ejaculation; urinary incontinence; overactive bladder; post-void dribbling; pelvic pain due to levator muscle spasm; bowel urgency and incontinence; and in mitigating damage incurred from saddle sports including cycling, motorcycling and horseback riding.

The PFM, comprised of muscles that form a muscular shelf that spans the gap between our pelvic bones, form the base of our “core” muscles.  Our core muscles are the “barrel” of muscles in our midsection.  The top of our core is our diaphragm, the sides are our abdominal, flank, and back muscles, and the bottom of the barrel are our PFM.

The core muscles, including the PFM, are not the glitzy muscles of the body—not those muscles that are for show. Our core muscles are often ignored and do not get much respect, as opposed to the external glamour muscles of our body, including the pectorals, biceps, triceps, quadriceps, latissimus, etc.  In general, muscles that have such “mirror appeal” are not those that will help in terms of sexual and urinary function. Our core muscles are the hidden gems that work diligently behind the scenes—the muscles of major function and not so much form—muscles that have a role that goes way beyond movement, which is the cardinal task of a skeletal muscle.  On a functional basis, we would be much better off having a “chiseled” core as opposed to having “ripped” external muscles, as there is no benefit to having all “show” and no “go.”

The pelvic floor seems to be the lowest caste of the core muscles—the musculus non grata, if you will kindly accept my term. The PFM, however, do deserve serious respect because, although concealed from view, they are responsible for some very powerful and beneficial functions, particularly so when intensified by training.  Although the PFM are not muscles of glamour, they are our muscles of “amour.”

Who Knew? Having “ripped” external glamour muscles might help get your romance going, but having a chiseled core and conditioned PFM will help keep it going…and going…and going!

The female pelvic floor muscles, exercises for which were popularized by gynecologist Dr. Arnold Kegel, have long been recognized as an important structural and functional component of the female pelvis. But who has ever heard of the male pelvic floor?  The male pelvic floor has been largely unrecognized and relegated as having far less significance than the female pelvic floor.  Yet from a functional standpoint, these muscles are of vital importance, certainly as critical to male genital-urinary health as they are to female genital-urinary health.

The PFM, as with other muscles in the body, are subject to the forces of adaptation.  Unused as they are intended, they can suffer from “disuse atrophy.” Used appropriately as designed by nature, they can remain in a healthy structural and functional state. When targeted exercise is applied to them, particularly against the forces of resistance, their structure and function, as that of any other skeletal muscle, can be enhanced.

The key responsibility of most of our skeletal muscles is for joint movement and locomotion. The core muscles in general, and the PFM in particular, are exceptions to this rule.  Although the core muscles do play a role with respect to movement, of equal importance is their contribution to support, stability, and posture. Consider that the pelvic floor muscles, particularly the superficial PFM, have an essential function in the support, stability and “posture” of the penis.  They should be considered the hidden “jewels” of the pelvis.

Who Knew? If you want your penis to have “outstanding” posture and stability, you want to make sure that your PFM are kept fit and well-conditioned.

The PFM have three main functions that can be summarized by three S’s: support, sphincter, and sex. Support refers to their important role in securing our pelvic organs—the urinary, genital and intestinal tracts—in proper anatomical position. Sphincter function allows us to interrupt our urinary stream and pucker the anus and contributes in a major way to urinary and bowel control.  These vital responsibilities are generally taken for granted until something goes awry. With regard to sexual function, the PFM are active during erection and ejaculation.  They cause a surge of penile blood flow that helps maintain a rigid penile erection throughout sexual activity and at the time of orgasm, contract rhythmically, enabling ejaculation by propelling semen through the urethra.

The PFM can become atrophied, flabby and poorly functional with aging, weight gain, a sedentary lifestyle, saddle sports and other forms of injury and trauma, chronic straining, and surgery.  Sexual inactivity can lead to their loss of tone, texture, and function.  However, PFM integrity and optimum functioning can be maintained into our golden years with attention to a healthy lifestyle, an active sex life, and PFM training, particularly when such exercises are performed against progressive resistance.  The goal of such a regimen is the attainment of broader, thicker and firmer PFM and maintenance and/or restoration of function.

The PFM may physically be the bottom of the barrel of our core, but functionally they are furthermost from the bottom of the barrel.  For those who are already functioning well, an intensive PFM training program—as with any good fitness regimen—can impart better performance, increased strength (rigidity), improved endurance (ejaculatory control), and decreased recovery time (the amount of time it takes to achieve another erection).  Keeping the PFM supple and healthy can help prevent the typical decline in function that accompanies the aging process. On so many domains, diligently practiced PFM exercises will allow one to reap tangible rewards, as they are the very essence of functional fitness—training one’s body to handle real-life situations and overcome life’s daily obstacles.

Andrew Siegel, M.D.

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

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

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) 

Amazon page:

For more info on Dr. Siegel:

Preventing Chronic Diseases

March 8, 2014

Blog # 144   Andrew Siegel and William Stewart

Bill Stewart, a 67 year-old friend of mine who has participated in countless full marathons and is passionate about living a healthy lifestyle, sent the following note to me that I want to disseminate because it is spot-on (it is edited to a very minimal extent):

“I got back from Boston this weekend after a very depressing week with my sister, whom I’ve always looked up to.  Just a few years ago she had language skills beyond most Americans; now she has skills at about age 5-6 level, but with significantly less recent memory than children those ages.  I toured an assisted care facility with my sister, which actually exceeded my expectations.  But this is certainly not a place I ever want to be in! 

I am now seeing most of my contemporaries having issues with chronic diseases to a greater or lesser degree, which, I believe could have been avoided or delayed to a later stage in life.  Most people work so hard and really look forward to the day they retire, but, unfortunately for most, retirement becomes one filled with chronic disease, accelerated physical decline, and endless visits to the doctor’s office, hospitalizations with surgical procedures, and gobs of drugs that may help alleviate their conditions, but often cause other conditions. 

I take the attitude that we’re given one period of up to 100 years of life on this earth, and with health it can be a joy, but without health the joy is diminished or gone.  I do believe that the majority of people, barring a particularly bad set of genes, can live an active and happy (or relatively happy) life to within a few years of their genetic clock expiring, whether it be at age 75, 80, 90 or 100 – but not in the prevailing culture of bad food and sedentary habits. 

There is a very vocal minority who are pointing the right way, such as Andy, Dr. Mark Hyman, Dr. Oz, Pastor Rick Warren (The Daniel Plan – an interesting motivator here, maybe not for everyone), etc.  But they are going against some very powerful special interests that make lots of money from the status quo – most physicians, health insurers, big pharma, big agriculture, food processors, fast food industry.  And unfortunately, the US government, for the most part, supports and encourages this. With heavyweight lobbyists representing these industries (many of whom were formerly gov’t officials regulating these industries!), it’s an uphill battle. I think at some point government will realize that Medicare and Medicaid can’t keep expanding because it will totally break the government budgets.  For example, the government now supports and encourages biotech drugs that cost $500,000 or more a year per patient; this is simply not sustainable. But currently it’s very difficult for the government to fund, support, or even encourage studies of preventive strategies because there is not much money to be made from these (but there could be huge savings!!!).

I looked up Dr. Robert Lustig and he had a great video on his web site about high fructose corn syrup and the damage that it does to the body (Sugar, The Bitter Truth). It is a bit technical and somewhat long (about an hour, but fascinating).  And the story he gives about Coca-Cola is really amazing.  I watched the winter Olympics and, of course, Coke presented itself as synonymous with 20th century American culture (this is really nauseating!). There is a Coca-Cola Beverage Institute for Health and Wellness, which I find particularly amusing. 

To my way of thinking, early 50 to mid 60 year-olds are at an age when most people’s health can be “saved”, so to speak, by modifying their habitual exercise and diet behavior before chronic illnesses take a firm hold; I’m really at the back end when, for the most part, the chronic illnesses are in firm command and people are really resistant to changing their habits.”

So what are the key elements for avoiding chronic diseases and living a long, healthy and happy life?  The following summary is excerpted from my first book: Finding Your Own Fountain of Youth: The Essential Guide to Maximizing Health, Wellness, Fitness & Longevity:

  • Maintain an active, purposeful, and meaningful existence—for many this means continuing to work in some capacity or involvement in other endeavors that create purpose—this allows one to structure one’s time effectively and maintain a sense of community.
  • Make a long-term commitment to ample exercise and physical activity.  Stay mentally engaged and passionate about interests and hobbies such as: reading, travel, games, art, music, crafts, pets, sports, etc., etc., etc.
  • Fuel yourself with the healthiest diet possible.
  • Avoid self-abusive behavior—junk food, obesity, tobacco, excessive alcohol, excessive sun exposure, undue risks—maintain an “everything in moderation” attitude.
  • Maintain close ties with family and friends—put great effort into your marriage/primary relationship, as it is a vital contributor to aging well.
  • Have an optimistic and grateful attitude—a cheery, happy, and upbeat disposition, a sense of hope about what the future will bring, and a good sense of humor.
  • Learn to deal positively with stress.
  • Counter life’s inevitable losses, changes, and vicissitudes with adaptation.
  • Practice preventive maintenance and avail yourself of all the advances medicine and technology have to offer.
  • Care about yourself, respect yourself, invest in yourself—LIVE and LIVE well!

Andrew Siegel, M.D.     Our Greatest Wealth Is Health

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

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

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)


Amazon page:

For more info on Dr. Siegel:

Female Genital Mutilation (FGM): Why??

March 1, 2014

Blog # 143   Andrew Siegel MD

The juxtaposition of the words “genital” and “mutilation” disturbs me greatly. Regardless of gender, the concept of inflicting serious damage on a person’s genitals or, for that matter any body part, conflicts strongly with the Hippocratic oath that physicians pledge, and is incompatible with the tacit oath of humanity that each of us incorporates during our actualization process as human beings.

You probably cannot imagine the scenario of having non-medical personnel come into your home and use crude and unsterile equipment to cut off some or all of the penis and scrotum of your young sons, on the basis of tradition and ritual.  Sadly, however, the practice of the female equivalent of this is precisely what happens to young girls in many African nations.

Female Genital Mutilation (FGM) is an ancient cultural ritual currently practiced in 28 African nations, Yemen, Iraqi Kurdistan, and within immigrant communities. Certain countries have an extremely high prevalence of this, involving more than 90% of their female population: Djibouti; Egypt; Eritrea; Guinea; Mali; and Somalia.

It is thought that FGM originated millenniums ago in ancient Egypt and thereafter became an entrenched social-cultural-religious tradition. Religion is most often invoked as the underlying explanation for this practice; however, cleanliness and “improved” health are other justifications that are often touted. Additionally, removing the clitoris is seen to be a means of curbing a woman’s libido. The most extreme form of FGM, infibulation (see below), is seen as proof of virginity, the presence of which is of significant importance in many of the countries where FGM is practiced.

The practice was known as female circumcision until the 1980s and gradually the more appropriate term female genital mutilation took hold—a descriptive moniker—because it is truly a genital-deforming “operation.”  Because of emigration to Western nations in Europe and the USA, physicians are now confronting women who have undergone these ritual procedures and suffer with medical complications.

FGM is defined by the World Health Organization (WHO) as “a procedure that involves partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons.”

FGM is classified into 4 types:

(In boldface I have delineated the male equivalent of the FGM procedures—can you imagine for one moment these being cultural norms?)

Type Ia-removal of clitoral hood (Male equivalent is a circumcision.)

Type Ib-partial or total removal of the clitoris and hood (Male equivalent is partial or total removal of the penis.)

Type II: in addition to the type I surgery on the clitoris, parts of the labia minora  (inner lips) or the entire labia minora are removed. At times, this involves removing all of the labia majora  (outer lips).  (Male equivalent is removal of the penis and partial removal of the scrotum.)

Type III: This is known as infibulation—cutting the labia minora and majora and sewing them together with or without removal of the clitoris, thereby sealing the vulva, leaving only a tiny opening for urination/menstruation. (Male equivalent is total removal of the penis and total removal of the scrotum.)

When infibulation is performed, the closure must ultimately be re-opened to allow for sexual intercourse and for childbirth. Pregnancy in women who have undergone infibulation represents a difficult challenge.

Type IV: this includes all other kinds of female genital circumcision done for nonmedical reasons including pricking, piercing, scraping, and burning the labia or the vagina.

FGM is most often carried out by nonmedical staff and occurs outside the confines of a hospital setting without anesthesia or hygienic conditions. The procedure is typically performed in the home setting by a village elder experienced in performing the procedure. Most of the time, it is done in early childhood, commonly before age 5. Unsterile, crude objects are routinely used as cutting implements. Wounds are often closed with thread or with agave or acacia thorns. Uniquely, medical professionals most commonly perform the procedure in Egypt, the country that has the highest prevalence of FGM.

In 2012, the U.N. General Assembly voted unanimously to condemn this practice. It is actually outlawed in most of the countries in which it is practiced, but the laws are poorly enforced. Fortunately, there has been a gradual but steady movement to stop this practice in many countries, but the procedure is far from being extinct. The most common reason given for continuing the practice today is for purposes of “social acceptance.”

The medical complications of FGM include recurrent urinary infections; difficulties with urination, menstruation and possibly pregnancy; and abnormal, debilitating connections between the vagina and the urinary bladder (fistula). FGM can lead to heavy bleeding, severe pain, painful sexual intercourse and the potential for transmission of infections, hepatitis, and HIV. Psychological problems are another major potential consequence of FGM.

If one objectively considers male circumcision, it is nothing other than a form of male genital mutilation (Yes, I have been mutilated). It is well adopted among the Jewish and Muslim populations for religious/cultural reasons and has been practiced for so many generations such that it is considered a meme and a cultural norm, and for many an aesthetic necessity with the natural, uncircumcised penis appearing unattractive to those whom accept circumcision as a convention (however, it is worth mentioning that there are some true, significant health benefits to circumcision, which is not the case with FGM). My point is that I can come to understand “strange” ritual practices that we are socialized to accept; however, my limit of tolerance is at circumcision. I might, perhaps, be able to accept circumcision’s female equivalent—removal of the clitoral foreskin—if it was a time-honored societal norm. That stated, any form of FGM beyond this should never be condoned by society—it is nothing short of assault and battery with potentially horrific physical and psychological consequences.

References: Female Genital Circumcision/Mutilations: Implications For Female Uro-Gynecological Health.   International Uro-gynecological Journal “2013” 24:2021–2027

Andrew Siegel, MD

For more info on Dr. Siegel:

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