Archive for May, 2014

Use It Or Lose It: The Wow of Human Plasticity and Adaptation

May 30, 2014

Blog # 156

Think for a momentabout orthodontics. Braces are applied to one’s imperfect teeth and ever so gradual increasing resistance is implemented over time and, presto, in a couple of years, the teeth are perfectly straight and beautiful.

Exposing our bodies to the right “environment” on a long-term basis can positively affect not only our external appearance, but also more importantly, our internal health. Conversely, exposing our bodies to the wrong environment on a long-term basis can negatively affect our external appearance and internal health.

Essentially, the cells and tissues of our bodies—including our muscles, bones, brains, and every other organ—are endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to environmental changes. What it comes down to is that our human body is an adaptation machine.

Our composition is “fluid” as opposed to “static,” and our tissues are constantly being remodeled, restructured and refashioned in adaptive responses occurring in accordance to the forces, stresses, resistances and demands placed upon them. This plasticity is an amazing phenomenon and permits our tissues to maintain normal function when burdened with adverse “resistances.” Conversely, we can tap into this powerful resource by purposely challenging our tissues with the appropriate resistances to enable them to perform at extreme high levels of function.

An example of our bodies’ attempt to maintain normal function when burdened with adverse resistances is benign enlargement of the prostate gland.  Almost inevitably, all aging males experience this gradual growth of this curious gland wrapped around our urethral channels. As a result of this “crimp” on the urethra, the resistance to the flow of urine gradually increases. However, the bladder muscle adapts by hypertrophying (getting more muscular). The bladder ever so slowly changes from a thin and smooth muscle to a thick and rough muscle in order to generate the higher pressures necessary to enable getting the urine out through the impeded urethral passageway. The unsuspecting individual with this condition may experience no symptoms for quite some time because of this natural compensation. However, compensation cannot occur indefinitely as there are natural limits on this plasticity, so one day he may be unable to urinate because the bladder hypertrophy has become maxed out, yet the prostate growth and increased resistance continues relentlessly, resulting in a condition known as acute urinary retention.

Another example of our bodies’ attempt to maintain normal function when burdened with adverse resistances is hypertension, which totally parallels the situation with the prostate and the bladder. High blood pressure creates an environmental situation for the heart in which it needs to work harder to pump blood because of the increased resistance created within the walls of the arteries. Consequently, the muscle fibers of the heart hypertrophy, resulting in a larger and more muscular and powerful heart that can continue to pump blood effectively through the resistance of the high arterial pressure. The problem is that the “compensated” heart is subject to problems such as angina, arrhythmias and heart failure, and can get to the point—similar to the urinary bladder—where it decompensates and fails. Exercising the heart is desirable, but this is not the kind of exercise you want your heart to have

The powerful resource of plasticity and adaptability can positively and purposely be tapped into by challenging our tissues to adapt to the appropriate environmental changes (resistances) to enable our tissues to perform at extreme high levels of function. One type of resistance that is most beneficial is exercise.

Exercise is all about adaptation. The SAID principle (Specific Adaptation to Imposed Demands) posits that our body will adapt—in neuromuscular, mechanically, and metabolic terms—to the specific demands that are placed on it. This is the very reason why both endurance and resistance exercises get easier the more effort we put into doing them. Asthe body is subjected to gradual and progressive “overloads,” the heart, lungs and muscles adapt and a “new normal” level of fitness is achieved. It comes down to the fact that our muscles are plastic and capable of hypertrophy (growth) or atrophy (shrinkage) depending on the environment to which they are exposed.

I enjoy recreational cycling, but to date this season have not spent as much time in the saddle as I would have liked. I’ve been out for a number of 20-mile rides but last weekend went out with a friend for a hilly 50 miles. The last 10 miles were extremely difficult, as my body had not yet adapted to that kind of challenge; clearly I don’t have my cycling “legs” back yet. My heart and lungs were not the issue, but my glutes and quads were not up to the beating and challenge…but they will be in due time. Just as the marathon runner who gradually builds up to running the distance, so it is with every endurance sport

Adaptation to exercise is applicable to all aspects of fitness: cardiovascular or aerobic fitness in which the heart and lungs adapt to endurance efforts; musculo-skeletal fitness in which our muscles and underlying bony framework adapt to bearing loads and working against resistance, leaving our muscles sinewy, strong and toned; core strength, which is fitness of our torso muscles that allows us to maintain good posture, stability, balance and coordination as well as serving as a platform for efficient use of our arms and legs; and flexibility fitness in which our muscles are elastic, limber, supple and more resistant to injury.

Our bodies demand physical activity in order to function optimally. For example, our bones require weight bearing and biomechanical stresses in order to stay well mineralized and in peak functional condition, as bone mineralization is stimulated by the stresses brought on by a variety of movements. The same holds true for every organ in our body to maintain maximal functioning—they need to be employed and put into the service for which they were designed

“Use it or lose it.” As much as our bodies adapt positively to resistance, so they will adapt negatively to a lack of resistance. For example, after wearing a cast on one’s arm for 6 weeks, there is noticeable wasting of the arm muscles, known as “disuse atrophy.” Contrast this with the opposite scenario—exercising one’s arms by doing curls on a regular basis—which will result in an obvious hypertrophy of the arm muscles. When our bodies are sedentary—for example on the basis of a severe injury requiring bed rest—there is a rapid demineralization and thinning of our bones. Spinal cord injured patients who are paralyzed undergo just such a rapid demineralization. Astronauts who spend time in zero gravity (which takes all biomechanical forces away from the bones) experience a remarkably fast demineralization and risk not only thin bones—as does anybody with rapid demineralization— but also of developing kidney stones from the calcium mobilized from the bones. The process of adaptation is not limited to our muscles and bones, but involves each and every internal organ, including the kidneys, liver, pancreas, brain, etc. That is why it is so important to expose our bodies to positive “resistances” and not to “negative” resistances.

Our central nervous system is constantly being remodeled in response to environmental exposure. The brain’s neurons undergo anatomical changes and reorganization of their networks with new neural connections in response to new situations or environmental changes (learning). Through the processes of “neuroplasticity” and adaptation, learned behaviors actually modify the electrical hardwiring of the brain, which is dynamic and constantly subject to revision. Synaptic “sculpting” facilitates learning and synaptic “pruning” occurs when patterns are not repeated. Thus is explained on a biological basis how learning occurs.

Bottom line: Humans are bestowed with an amazing and magical capacity for plasticity and adaptation, which can be transformative when used to our advantage and benefit. Expose our bodies to positive cognitive and physical nourishment and they will be carved into beautiful, highly functioning machines. Expose our bodies to negative forces or absence of positive forces and they will falter into ugly, poorly functioning, maladaptive machines.


Andrew Siegel, MD

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.


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”:


Getting Up At Night Gets Me Down: Nighttime Urinating

May 24, 2014

Blog #155

Getting up once to relieve your bladder during sleep hours is usually not particularly troublesome. However, when it happens two or more times, it can negatively impact one’s quality of life because of sleep disruption, daytime fatigue, an increased risk of fatigue-related accidents and an increased risk of fall-related nighttime injuries. Fatigue has a negative effect on just about everything, even influencing us to mindlessly eat.

Nocturia is the medical term for the need to awaken from sleep to urinate. One’s natural response is to think urinary bladder problem and seek a consultation with a urologist, the type of doctor who specializes in the urinary system. Although nocturia manifests itself via the bladder and much of the time is a urological issue, it is often not a bladderproblem. Rather, the kidneys are frequently culprits in contributing to the condition.

The kidneys are remarkable organs that can multitask like no other. They not only filter blood to remove waste products, but are also responsible for other vital body functions: They are in charge of maintaining the proper fluid volume within our blood stream. They regulate the levels of our electrolytes including sodium, potassium, chloride, etc. They keep our blood pH (indicator of acidity) at a precise level to maintain optimal function. They are key players in the regulation of blood pressure. Furthermore—and unbeknownst to many—they are responsible for the production of several important hormones: calcitrol (calcium regulation), erythropoietin (red blood cell production), and renin (blood pressure regulation). The kidneys regulate our blood volume by concentrating or diluting our urine depending on our state of hydration. When we are over-hydrated, the kidneys dilute the urine to rid our bodies of excess fluid, resulting in virtually clear urine. When we are dehydrated, the kidneys concentrate urine to preserve our fluid volume, resulting in very concentrated urine that can look as dark as apple cider.

Nocturia correlates with aging and the associated decline in kidney function and decreased ability to concentrate urine. Although having an enlarged prostate may certainly contribute to nocturia, it is obviously much more complicated than this since women do not have prostates and nocturia is equally prevalent in men and women. As simple as getting up at night to urinate sounds, it is actually a complex condition often based upon multiple factors that require careful evaluation in order to sort out and treat appropriately. When a urology consultation is sought, our goal is to distinguish between urological and non-urological causes for nighttime urinating. It often comes down to one of three factors: nighttime urine production by the kidneys; capacity of the urinary bladder; and sleep status. In the elderly population, excessive nighttime urine production is a factor almost 90% of the time.

Nocturia can ultimately be classified into one or more of 5 categories: global polyuria (making too much urine, day and night); nocturnal polyuria (making too much urine at night); reduced bladder capacity; sleep disorders; and circadian clock disorders (problems with our bio-rhythms). Global polyuria can result from excessive fluid intake from overenthusiastic drinking or from dehydration from poorly controlled diabetes mellitus (sugar diabetes). The pituitary gland within our brain manufactures an important hormone responsible for water regulation. This hormone is ADH—anti-diuretic hormone—and it works by giving the message to the kidneys to concentrate urine. Diabetes insipidus is a disease of either kidney origin—in which the kidneys do not respond to ADH—or pituitary origin—in which there is deficient secretion of ADH. In either case, lots of urine will be made, resulting in frequent urination, both daytime and nighttime. Medications including diuretics, SSRIs (selective serotonin reuptake inhibitors), calcium blockers, tetracycline and lithium may induce global polyuria.

Nocturnal polyuria may be on the basis of excessive fluid intake, especially diuretic beverages including caffeine and alcohol, a nocturnal defect in the secretion of ADH, and unresponsiveness of the kidneys to the action of ADH. Congestive heart failure, sleep apnea and kidney insufficiency may also play a role. Certain conditions result in accumulation of fluids in tissues of the body such as the legs (peripheral edema); when lying down to sleep, the fluid is no longer under the same pressures as determined by gravity, and returns to the intravascular (within the blood vessels) compartment. It is then subject to being released from the kidneys as urine. Such conditions include heart, kidney and liver impairment, nephrotic syndrome, malnutrition and venous stasis. Circadian clock disorders cause reduced ADH secretion or activity, resulting in dilute urine that causes nocturia.

Nocturia may also be caused by primary sleep disorders including insomnia, restless leg syndrome, narcolepsy, and arousal disorders (sleepwalking, nightmares, etc.)

There are numerous urological causes of reduced bladder capacity. Any abnormal process that occurs within the bladder can irritate its delicate lining, causing a reduced capacity: bladder infections, bladder stones, bladder cancer, bacterial cystitits, radiation cystitis, and interstitial cystitis. An overactive bladder—a bladder that “squeezes without its owner’s permission”—can cause nocturia. Some people have small bladder capacities on the basis of scarring, radiation, or other forms of damage. Prostate enlargement commonly gives rise to nocturia, as can many neurological diseases that often have profound effects on bladder function. Incomplete bladder emptying can give rise to frequent urination since the bladder is already starting out on a bias of being partially filled. This problem can occur with prostate enlargement, scar tissue in the urethra, neurologic issues, and bladder prolapse.

The principal diagnostic tool for nocturia is the frequency-volume chart (FVC), a simple test that can effectively guide diagnosis and treatment. This is a 24-hour record of the time of urination and volume of urination, requiring a clock, pencil, paper and measuring cup. Typical bladder capacity is 10–12 ounces with 4–6 urinations per day. Reduced bladder capacity is a condition in which frequent urination occurs with low bladder capacities, for example, 3–4 ounces per void. Global polyuria is a condition in which bladder volumes are full and appropriate and the frequency occurs both daytime and nighttime. Nocturnal polyuria is nocturnal urinary frequency with full and appropriate volumes, with daytime voiding patterns being normal.

Lifestyle modifications to improve nocturia include the following: preemptive voiding before bedtime, intentional nocturnal and late afternoon dehydration, salt restriction, dietary restriction of caffeine and alcohol, adjustment of medication timing, use of compression stockings with afternoon and evening leg elevation, and use of sleep medications as necessary.

Urological issues may need to be managed with medications that relax or shrink the prostate when the issue is prostate obstruction, and bladder relaxants for overactive bladder. For nocturnal polyuria, synthetic ADH (an orally disintegrating sublingual tablet) in dosages of 50-100 micrograms for men and 25 micrograms for women can be highly effective.

Bottom Line: Nocturia should be investigated to determine its cause, which may often in fact be related to conditions other than urinary tract issues. Nighttime urination is not only bothersome, but may also pose real health risks. Chronically disturbed sleep can lead to a host of collateral wellness issues.

Andrew Siegel, MD

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.

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”:

Penis Size: Does It Matter?

May 17, 2014

Blog #154

As I was walking through the gateway on my way to board an airplane, I saw a poster advertisement stating the following: Size should never outrank service, referring to the smaller size regional jets that now offer first-class, wi-fi and more. I recently saw another poster ad for the same airline stating: How fast the flight goes isn’t always up to pilot. I find these double entendres quite amusing and entertaining.

With all biological parameters, there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. Penis size is no exception, with some of us phallically endowed, some phallically challenged, but most of us somewhere towards the center. In a study of 3500 penises published by Alfred Kinsey, the average flaccid length was 8.8 centimeters (3.5 inches). The average erect length ranged between 12.9 -15 centimeters (5-6 inches). The average circumference of the erect penis was 12.3 centimeters (4.75 inches).

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that there is no clear cut correlation between ethnicity and penis size. Flaccid length does not necessarily predict erect length and can vary depending upon emotional state and ambient temperature. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

Some women prefer men who are formidably hung, just like some men prefer women with large breasts. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort, particularly if cervical contact occurs. The long and the short of it are summarized in the adage, “It’s not the size of the ship, but the motion of the ocean.

Who Knew? “Genital Genetics.” As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (or mother). In actuality, it is the roll of the genetic dice and how the inherited blueprint that determines physical traits interacts with the local hormonal environment.

Who Knew? Hung like a horse—forget about it! The blue whale has the mightiest genitals of any animal in the animal kingdom: penis length is 8-10 feet; penis girth is 12-14 inches; ejaculate volume is 4-5 gallons; and testicles are 100-150 pounds. Hung like a whale!

Who Knew? On the subject of penis size, one of my favorite things to do when driving on the highway and seeing some idiot in a Lamborghini driving hazardously from lane to lane at about 95 miles an hour is not to flash him my middle finger, but to show him my hand with my thumb and index finger separated about 1 inch apart to indicate to him what I think is the likely size of his penis.

Who Knew? “Men are from Mars, Women from Venus.” Leonardo Da Vinci had an interesting take on perspectives: “Woman’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.”

Who Knew? There are a bunch of “amenities” that accompany the aging process, one of which is “presbyopia” or farsightedness, which demands reading glasses. They are a real nuisance, never around when you need them and always getting lost. But one thing I have observed is that if you forget to take them off when you get up to relieve your full bladder, when you glance down, you see a rather large “member,” thanks to the magic of magnification. I am currently wearing 1.5 power; perhaps it’s time for 2.0!

Who Knew? There is no correlation between penis size and shoe size, hand size or nose size.

Who Knew? “Where’s Woody?” Three of the most common words I hear in my urology practice are the following: “Doc, I’m shrinking.”

Who Knew? Part of the problem is the pervasive pornography industry, where many male stars are endowed like the centaur, the mythological creature with the head and torso of man and the lower body of a horse. This has given the average guy a bit of an inferiority complex.

Many men complain of “shrinkage,” which is a very real phenomenon on the basis of blood flow. The typical circumstances evoking this are exposure to cold weather or cold water, the state of being nervous, and athletic pursuits. The mechanism in all cases involves blood circulation. Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s periphery to help maintain core temperature. This is the very reason one places ice on an injury as the vasoconstriction will reduce swelling and inflammation.

It stands to reason that exposure to heat will cause vasodilation (expansion of arterial flow) and this is the very reason that some penile tumescence (state of fullness without rigidity) can occur in a warm shower. Nervous states or anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in a flaccid penis. Participation in vigorous athletic activity “steals” blood flow to the organs that need the oxygen and nutrients the most, namely the muscles, at the expense of organs like the penis.

Who Knew? Do you remember the Seinfeld episode in which Jerry’s girlfriend Rachel sees George naked after George steps out of a swimming pool?

 Rachel: “Oh my God, I’m really sorry.”

George: “I was in the pool; I was in the pool.”

George to Jerry: “Well I just got back from swimming in the pool and the water was cold.”

Jerry: “Oh, you mean shrinkage.”

George: “Yes, significant shrinkage.”

As mentioned, truly not a day goes by in my practice when I fail to hear the following complaint from a patient: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrink from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis, if you will. Weight gain and obesity will cause a generous pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.” Lose the fat and presto…the penis reappears. Having a plus-sized figure is just not a good thing when it comes to man-o-metrics.

Who Knew? “Fatal Retraction.” It is estimated that for every 35 lbs. of weight gain, there will be a one-inch loss in apparent penile length.

Who Knew? “Penile Dysmorphic Disorder,” very much paralleling “Body Dysmorphic Disorder,” is a condition in which one’s image of their penis is at odds with reality. Typically, one envisions himself as small when in fact he is quite within the normal range and an obsessive focus on this issue creates a great deal of psychological stress.

Who Knew? “Koro” (“head of the turtle” in Malay) is a cultural form of psychological panic that occurs predominantly in East Asian men. Those who suffer from this delusional disorder are terrified that their genitals will retract into their bodies and take extreme measures to prevent this from occurring.

The erectile cylinders of the penis are essentially our “erector sets,” consisting of three inner tubes within the penis that are composed of vascular (consisting of blood vessels) smooth muscle and sinuses that fill with blood upon sexual stimulation. An erection is on the basis of blood expanding these cylinders to the point of penile rigidity. Like any other muscle, the muscle of the penis needs to be used on a regular basis, the way nature intended for it to be used. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile smooth muscle can occur. In a vicious cycle, any loss of sexual function can lead to further progression of the problem. Poor genital blood flow produces a state of poor oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the sexual dysfunction.

Radical prostatectomy, the surgical removal of the entire prostate gland as a treatment for prostate cancer, can cause penile shortening by virtue of the removal of the prostate gland. The resultant gap in the urethra because of the removed prostate is repaired by sewing the bladder to the urethra with a consequent loss of urethral length. Penile shortening can be compounded by the disuse atrophy and scarring that can occur as a result of the erectile dysfunction associated with the surgical procedure, which sometimes can damage the nerves that are responsible for erections. Getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shortening because of scarring of the erectile cylinders that prevents them from expanding properly.

Androgen deprivation therapy is a means of suppressing the male hormone testosterone, typically used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage.

Who Knew? Penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky, ineffective and not ready for prime time. Certain procedures are what I call “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone and other tissue grafts. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis—certainly a far cry from a “proud soldier” and more like a “wounded warrior.” Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

Who Knew? The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to the recipient, whose organ was damaged beyond repair in an accident. Hmmm, now there is a concept for penile enlargement.

Andrew Siegel, MD

The aforementioned is largely excerpted from my new book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.

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”:



The Penis: A Feat of Brilliant Engineering

May 10, 2014

Blog #153

The penis, when functioning properly, is a proud soldier, a term used when I was a urology resident at University of Pennsylvania and rotating through pediatric urology at Children’s Hospital of Philadelphia (CHOP). Numerous penile reconstructive procedures were performed at CHOP for congenital birth defects that caused the penis to have a disfiguring curvature and an abnormally located urethral opening. The term “proud soldier” was used in the context of the excellent results after repair. I admire that nickname—it signifies a warrior, peacekeeper, man-at-arms, standing tall at attention, saluting, noble, confident and majestic.

Who Knew? A sect of wandering, ascetic Hindu holy men of India known as the Sadhu believe that God dwells in the penis.

Who Knew? “Wood in the womb.” Male fetuses have erections in utero as demonstrated by prenatal ultrasounds. Maybe that “kicking” that brings a smile of baby-pride to pregnant mom’s face is not really kicking at all!

Men have a special bond with their most curious appendage—arguably their most precious accessory—which truly is a remarkably versatile organ that adapts to the environment as the situation demands. When we don’t need it, it remains flaccid, out-of-sight, concealed and low in profile. However, on demand, our cooperative friend will readily rise to the occasion and assume the gravity-defying role of proud soldier. There are not many other organs in the body that demonstrate such a great versatility in terms of the physical changes between “inactive” and “active” states.

Who Knew?

Q. What organ in the body when stimulated will increase its size fourfold?

A. If you were thinking the penis, you are going to be very disappointed, but wouldn’t that be nice! The correct answer is the pupil of the eye, which will dilate from 2 millimeters in diameter in bright light to 8 millimeters in dark, as governed by the iris.

The penis is an organ of convenience. Like a good friend, it is always there for us—at arm’s length away—and provides us with the luxury of being able to empty our bladders with laser-like precision in the standing position when the need arises. I think it is fair to say that most women are quite envious of our capacity for such a directed urinary stream, which proves to be a very handy benefit that allows us to remain a healthy distance away from the toilet in the circumstance of unpleasant public bathrooms. It also enables us to duck behind a tree and readily empty our bladders on a golf course or on the side of a highway—al fresco style—when there is no bathroom available.

Who Knew? Hypospadias is a medical condition in which the urethra does not open at the appropriate place at the tip of the penis, but can open anywhere on the undersurface of the penis. In its most severe form, it can open on the perineum, the area between the scrotum and anus. This condition causes us to lose our competitive gender advantage of “directed” urinating. The good news is that pediatric urologists can repair hypospadias such that the urethral opening is repositioned at its normal location.

The penis is an amazingly multifunctional structure—no less so than a Swiss army knife—with an impressive ability to multi-task, having an array of functions, including urinary, sexual and reproductive. Eric Gill, the British sculptor, articulated the multi-tasking function of the penis with the following statement: “The water tap that could turn into a pillar of fire.” The penis wears many “hats” that can be summarized by the four P’s. It permits us to pee with a directed urinary stream. When erect, it enables vaginal penetration and sexual intercourse. Ejaculation deposits semen in the vagina, with the passage of genetic material and ultimately, the perpetuation of the species.

What an astonishingly clever biological design in which sexual enjoyment is linked with the act of reproduction. We think we’re pursuing pleasure, but what we are actually getting is reproduction— nature’s ultimate bait and switch scheme that ensures perpetuation of the species. If sex were not such a pleasurable act, there would be little incentive to have it. In this regard, it is much like eating—under the guise of pleasure and satisfying hunger, we are actually fueling ourselves with nutrition that ensures nature’s endpoint of perpetuation of the individual.

Who Knew?  “Penile Couture.” Men from the Ketengban tribe in the highlands of New Guinea, who are otherwise naked, wear decorative sheaths on their penis called “phallocarps.” They are made from a variety of different materials, often in vibrant colors, and vary in ornamentation and size, being similar in many respects to our neckties.


The aforementioned is largely excerpted from my new book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.

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”:

Investment Advice

May 3, 2014

Blog # 152

This blog is a new iteration of a previous posting from 2013, but modified significantly and certainly worthy of reiteration!


It is advisable not to take investment advice from a physician, but nonetheless I have some hot tips for the purpose of making you richer.

Q: What is the most important asset in your life? Who owns that asset? Specifically, what durable capital asset is the most valuable investment you can make?

A: The most valuable investment is your health, because without that, you’ve got nothing at all. Your health is your wealth, and we can refer to it as health-wealth.

When health is absent, wisdom cannot reveal itself, art cannot become manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied.”… Herophilus

Health is our most valuable possession.” …Hippocrates

Life without health is not worth living.” …Plato

Protecting and developing health must rank even above that of restoring it when it is compromised. … Huang-Di (the emperor who laid the foundation for traditional Chinese medicine 4500 years ago)

Many of us make an effort to save for retirement, earmarking funds for IRAs, 401K plans and other retirement vehicles in preparation for when we will no longer be working and will need to tap our savings to live…and hopefully, we will be living for many years after retirement, perhaps reaching the human potential of 100 years or so. First we need the health and wellness to have the quality of life to enjoy our golden years and second we need the financial wherewithal to thrive economically for the (hopefully) many years of retirement. Ralph Waldo Emerson summarized it in five words: “The first wealth is health.”

Sweat equity is the contribution of time and effort that is fundamental to the success of a business. Projecting its use to the health arena, I propose that we have Sweat Equity Accounts—aka, Fitness Accounts. The principles of obtaining and maintaining a fitness account parallel those of a retirement account:

  • Have a plan. Understand the need for and the importance of your account. If you invest wisely, it will create great health wealth.
  • Pay yourself first. Commit to it automatically, guaranteeing that it is a priority not to be tampered with. This will ensure regular deposits to build your fitness nest egg.
  • Slow and steady approach. A moderate amount of investment capital (exercise), deposited to the account on a diligent and regular basis, will ultimately allow for complete funding.
  • Long-term perspective. The greater the investment in terms of time invested, the larger the nest egg builds. The commitment to this plan needs to be a lifetime endeavor. No gimmicky investments, shortcuts, tricks or instant rewards! No nonsense!
  • Seek counseling. Not everyone is capable of managing his or her own portfolio, so seek the services of a professional advisor (personal trainer or fitness instructor). Their services will be well worth their cost.
  • Diversify. Deposit into your account a broad range of investments (aerobic and endurance activities, weight training, core, flexibility exercises, etc.).
  • Eliminate debt. Pay down and eliminate debt (excessive body weight and the burden of bad lifestyle choices) and reap the benefits of becoming debt free.
  • Start early. The earlier you begin accruing savings, the more time available to work the magic of compounding, when the investment returns themselves earn further returns. You will earn returns in the form of “interest and dividends” (improved quality of life) and “capital gains” (longer quantity of life). If you failed to start early, don’t waste another minute.

Your contributions to your account will ultimately make you “healthy-wealthy.” When sickness or disease inevitably surfaces, you will be well equipped to strike the noblest of fights because of your years of investment in your most valuable capital asset.

Andrew Siegel, M.D.

Please check out my brand new book:  Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook); paperback coming soon.