Archive for June, 2014

What Is Loneliness And How Can Spirituality Help?

June 28, 2014

Blog # 160

This week’s topic is a guest blog authored by Michael Isaacs.

Michael Isaacs

LCSW, NCPsyA, JD, Berkeley, Ca.

Published in the 2014 winter edition of The Association of Psychotherapy and Spirituality

As I pondered the trait and meaning of loneliness, I was reminded of the words of former United States Supreme Court Justice Douglas. He was having trouble defining the meaning of the term “pornography.” The question before the Court in this particular case was whether the actions involved were legal or illegal. He wrote famously that he could not define it, but “he knew it when he saw it.”

I realized that the Justice Douglas comment would not be enough to satisfy my quest or the curiosity of my readers as to nature of loneliness. But it does illustrate the difficulty of pinning the word down to an exact explanation.

So, I popped open my dictionary and here are some of the feelings described: sad or depressed because of the lack of friends or companionship; feeling desolate, remote, or isolated; destitute of sympathy, friendliness, or support; and standing by ones self or apart.

What can be said is that loneliness is not pleasant. Most of us have experienced its pain in varying degrees such as not being in a relationship or breakup from a relationship. The grief after the death of a partner can be another example where one can experience severe   loneliness And even in the best of relationships there are times when one feels not understood and not listened to and feels all alone and lonely.

What also can be said is that in our society loneliness is pervasive. As the Beatles song chimes: “All those lonely people, where do they all come from?”

Though all of us have moments of loneliness, my experience is that loneliness more frequently occurs in certain mental conditions. Included are those suffering social anxiety, low self-esteem, introversion, shyness, trauma, various addictions, depression, and being brought up in dysfunctional families.

Generally speaking, I have not encountered much loneliness in my life. However, when I was single in my twenty-age bracket, even though I did not feel consciously lonely, I did have a fear of loneliness. I had many dreams where I had intense anguish where in my dream state I was myself middle aged and did not have a wife and children. During my second psychoanalysis many years later I realized that my not feeling lonely was a   repression and a denial of the truth that in fact I was quite lonely in my childhood due to parental emotional distancing.

So, can spirituality help heal loneliness?

Definitely yes, but this depends on one’s conception of spirituality. For me I have a broad definition of spirituality. It includes any thought or deed evidenced by such virtues as compassion, selflessness, love, integrity, forgiveness, wisdom, and truth whether in or out of a religion or spiritual involvement.

Speaking from my vantage point, my involvement on spiritual paths has been an important factor (there have been other factors as well) leading me to much companionship and connection. There was study with spiritual teachers. I have experienced deep companionship with fellow seekers- individually and in groups. This spiritual involvement also motivated me to serve others in my professional life and in the community. I do not know why I started and continued on spiritual paths. One might call it karma, grace, or luck. It was a natural flow, which just evolved. In any event, my spiritual studies and quest over a lifetime was and has been for me a key antidote to loneliness.

I would say that I am a mystic whose goal is to have an experience of God. My concept of God is a universal loving creative principle, the infinite invisible, the soul of the universe. A psychoanalyst that I admire wrote that to him God is the cosmic principle of Love-Intelligence. My goal in meditation is to realize my identity and oneness with this spirit. Even glimpses of realization of oneness can activate for anyone a love of God, love of man, and love of self. Wow! As I see it these ideals are the highest opportunity to prevent or deal with loneliness. Love of God brings us an entity to love. Love of man brings us connection, compassion and empathy with others. It means we can with authenticity think or say to others “Namaste”- the soul of me greets the soul of you. Love of self means we feel lovable and deserving of another’s love. Self-esteem is elevated.

But what about the loneliness of others who are not like fellow traditional spiritual seekers and me? What about atheists, agnostics, and those that have no knowledge or interest in religion, spirituality, metaphysics, or anything not material? How can they be helped with bouts of loneliness?

My answer is in accord with my broad definition of spirituality as I described above in this article. That is, spirituality includes any thought or deed evidenced by such virtues as compassion, selflessness, love, integrity, forgiveness, wisdom, and truth, whether in or out of a religion or spiritual seeking. Anyone suffering from loneliness that moves or is moved to one or more of these virtues can be helped to cope with the condition.

There are many examples of how non-believers by their very acts embody spirituality, which can counter loneliness. Lonely people can get out of their box and serve others, such as volunteering at soup kitchens or various charities. Underlying the motivation to start individual psychotherapy or other self-growth groups is a spiritual yearning for connection and companionship.

Anyone who has moments of compassion or love for other humans or animals has a spiritual base. Simply smiling at someone you pass on the street can bring you a moment of spiritual peace from the love you are extending. And there often is a return smile indicating to you that the other is receiving your love. No loneliness here at the moment. Finding a lost wallet with loads of money and returning it to the owner reveals the spiritual virtues of integrity, empathy, and honesty.

Many creative artists certainly do not consider themselves spiritual but without their knowing it they are opening up channels to universal soul faculties. Their passion for their talents can be tantamount to a companionship of sorts, which not only can keep them from loneliness, but also be a boon to those in society who share a similar companionship from experiencing their artistry.

So, indeed, spirituality, either directly or indirectly, can help one minimize or cope with loneliness.

Andrew Siegel, M.D.

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”:

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


What You Don’t Know About Penile Erections, But Should

June 21, 2014

Blog #158

Although there are many who don’t care to know the details of how things function as long as they are functioning well, there are others who are curious about what’s “under the hood.” This blog, largely excerpted from my new book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health, is for those who are interested in what is actually happening down there one encounters a sexually stimulating situation.

A penis is a mechanical device and, as with any machine, it is important to understand how it works before it can be used and its operation mastered. In order to begin to understand how a penis works, the names and functions of its parts must first be learned.

The control center for erections is housed within the cerebral cortex (brain), of immense importance to our sexuality and what can be considered to be the “governor” of erections and sexuality. The brain can initiate erections in the absence of tactile (touch) stimulation and in direct response to sights, sounds or smells that are perceived as erotic. It might be a quick glance at someone who is smoldering hot, a sexy and sultry voice, or the alluring scent of perfume. The stimuli need not be external, as even a thought can initiate an erection.

There are several “centers” in our brain that integrate sexual functioning and erections. Studies have demonstrated that electrical stimulation of these brain centers can induce erections, and disease processes that involve these areas can cause ED. There are also several spinal cord erection centers and illnesses that involve these spinal areas can also cause ED.

The cerebral cortex is the site where the sensations of sexual arousal are experienced and processed. The brain then sends nerve signals to the erectile nerves, the cavernosal nerves, which are also stimulated by direct sensory contact, including foreplay or the act of sexual intercourse itself.

Bottom Line: The brain is the master control unit of sexuality.

There are three types of erections: psychogenic, reflex, and nocturnal. Psychogenic erections are on the basis of sights, sounds or smells. Nerve impulses travel from the brain to the spinal cord centers to the penis to produce an erection. Reflex erections occur in response to direct tactile stimulation of the penis. Nerve impulses travel from the penis to the spinal cord centers. Nocturnal erections have a unique mechanism controlled in thebrainstem and occur during REM (rapid eye movement) sleep. Most healthy men have 3-6 nocturnal erections while sleeping, each lasting about 10-15 minutes.

Bottom Line: Erections can originate from the following: erotic thoughts; stimulation of our senses of vision, hearing and/or smell; and direct touch. Nocturnal erections have a unique brainstem origin.

Who Knew? When the urinary bladder is full, it stimulates the same sacral nerves that are involved with penile sensation and erection. Because the bladder and the penis share a common nerve supply, when the bladder is distended, an erection may occur, often referred to in slang terms as a “piss hard-on.”

Who Knew? Some men ejaculate spontaneously during sleep while in REM sleep. These “wet dreams” or more formally, “nocturnal emissions,” demonstrate the central role that the brain plays with respect to both erections and ejaculation.

The erectile apparatus of the penis consists of three spongy erectile cylinders that run the length of the entire penis, both internally and externally: the solitary corpus spongiosumthat contains the urethra and forms the glans penis, and the paired erectile cylinders called the corpora cavernosathat are anchored internally to the pelvic bones and extend to the glans. These erectile cylinders communicate with each other and are enclosed in a fibrous sheath, the tunica albuginea. Erectile rigidity is on the basis of blood flowing into and being trapped in the penis.

Bottom Line: The penis obtains its bone-like rigidity (hence the term boner) by virtue of blood filling and inflating the spongy tissue within the three cylinders of the penis (corpora), similar to air inflating the tire of a car

Who Knew? It only takes 2 ounces or so of blood to inflate the average flaccid penis into a fully erect one.

Who Knew? The penis of many mammals has an “os penis,” a bone coursing through the penis to facilitate sexual intercourse by maintaining penile rigidity at all times.

Who Knew? When dogs copulate, the canine penis is not erect at the time of penetration. By virtue of the os penis, the penis can enter the vagina. After penetration, swelling of the erectile tissue at the penile base occurs. With vaginal contraction, the canine penis locks inside the female. The locking functions to decrease leakage of semen after ejaculation.

Who Knew? Pigs have a rather oddly shaped penis that twists into a corkscrew during erection, a shape that bears an uncanny resemblance to the coiled tail of the pig. Thrusting creates a motion that can best be described as semi-rotary. Not surprising, the female pig has a corkscrew-shaped cervix.

The penis can be thought of as an extension of the principal artery of our body, the aorta. In fact, one can think of the penis as a “dangling” aorta. The aorta gives rise to the common iliac artery, which gives rise to the internal iliac artery, which gives rise to the internal pudendal artery, which gives rise to the penile artery that divides into the dorsal artery (to the glans), the bulbourethral artery (to the corpus spongiosum) and the cavernous artery (which supplies the helicine arteries to the erectile tissues).

Bottom Line: The penis is essentially an extension of our blood vessels.

The corpora contain sinusoids(small sinuses that consist of spongy, vascular tissue) that have a very rich blood supply. In a sexually stimulating situation, the sinusoids of the corpora become engorged with blood, resulting in an erection.

Who Knew? Under the microscope, the tissues of the corpora appear virtually identical to the tissue of our nasal sinuses.

Vascular smooth muscle exists both in the penile arterial walls as well as the sinusoids. In the flaccid state, this smooth muscle is contracted, allowing only a minimal amount of arterial inflow, sufficient to meet the basic needs and nutritional demands of the penis. During this flaccid state, the sinusoids are closed while the venules (small veins that conduct blood out of the penis) remain open. In terms of oxygenation, the flaccid penis is filled with venous blood, while the erect penis is filled with arterial blood.

Bottom Line: The erectile tissue of the penis consists of sinuses, which under the circumstances of stimulation, become “congested” with blood.

Who Knew? The penis behaves as a vein when flaccid and an artery when erect.

Who Knew? Viagra, Levitra, Cialis and Stendra cause nasal stuffiness as a side effect since they act on the facial sinuses as much as they do on the sinuses of the corpora, causing congestion in both.

Who Knew? One of the treatments for priapism—an unwanted, persistent, painful erection—is an injection of neo-synephrine directly into the corpora. This is the very same medication that we squirt into our noses to relieve nasal congestion, aka nose drops.

Under the circumstance of erotic or tactile stimulation, the cavernosal nerverelays a chemical message to the cavernosal arteries to dilate (increase in diameter and pour in blood) and a message to the smooth muscle of the corpora to relax, allowing blood to fill the corpora. The cavernosal nerves release the neurotransmitter nitric oxide, the main chemical mediator of erections. The nitric oxide increases the release of another chemical known as cGMP (cyclic guanosine monophosphate)within the smooth muscle of the corpora. This causes relaxation of the smooth muscle of the small arteries and dilates the sinusoids within the erectile bodies. The sinusoids become “congested” with blood, causing engorgement and tumescence with an increase in penile length and girth. The small veins directly under the tunica albuginea (located between the tunica albuginea and the sinusoids) become compressed, reducing venous outflow. As the penis gets increasingly engorged, the tunica gets stretched to capacity, which occludes the small veins within the tunica itself, helping to maintain the erection.

Bottom Line: In an erotic situation, nerves to the penis release a chemical that increases blood flow to the penis, flooding blood into the sinusoids, filling the corpora and resulting in an erection. As the erection gets fuller, penile veins are compressed, limiting the exit of blood and enhancing the erection. The penis lengthens, thickens, and rises, resulting in quite the “proud soldier.

At this point, the blood pressure within the corpora cavernosa is about the same as arterial blood pressure, over 100 millimeters of mercury. Ultimately, with the contraction of the bulbocavernosus (BC) and ischiocavernosus (IC) muscles, the pressure inside the corpora cavernosa rises to way above systolic blood pressure (the numerator in our blood pressure reading), creating a rock-hard erection. The corpora cavernosa become rigid while the corpus spongiosum and glans become full and spongy plump. The blood pressure in the corpus spongisum and glans is only a fraction of that in the corpora cavernosum as a result of the tunical covering of the former being much thinner than that of the latter.

Bottom Line: PFM contractions, by further trapping blood in the penis, cause rock-hard erectile rigidity.

Who Knew? At the time of a fully rigid erection, the penile blood pressure is off the charts high. If our systemic blood pressure were this high, it would be considered an emergency situation—a hypertensive crisis—with the potential for a heart attack, stroke or rupturing of an aneurysm (weakness of the wall of an artery). Who knew that penile hypertension is what allows us to have bone-hard rigidity? The next time you have a rigid erection, tell your partner that you have penile hypertension and that you need “intervention.” See where that gets you!

The pudendal nerveprovides the nerve supply (sensation and contraction) to the ischiocavernosus (IC)and bulbocavernosus (BC) muscles. Contraction of the IC and BC muscles enhances penile rigidity and engorgement of the glans. The IC muscle contraction is primarily involved in generating a rock-hard erection while the BC muscle contraction maximizes engorgement of the corpus spongiosum and glans and is the motor of ejaculation, an event that occurs when the BC contracts rhythmically at the time of climax.

Bottom Line: The IC muscle generates a rock-hard erection while the BC muscle engorges the corpus spongiosum and glans and contracts rhythmically at the time of ejaculation.

The corpus spongiosum and glans essentially behave as an arterio-venous shunt (a connection between an artery and a vein) during an erection, until the point that the BC muscle compresses venous return sufficiently to cause full engorgement of the glans and corpus spongiosum. When fully engorged, the corpus spongiosum functions to “pressurize” the urethra, which will facilitate forceful ejaculation.

In summary, for an erection to occur, three events need to take place. There must be an increase in arterial blood flow to the corpora. Relaxation of vascular and corporal smooth muscle has to occur. Finally, venous outflow has to decrease in order to trap blood within the corpora. The seemingly simple process of getting an erection is actually an incredibly complex event requiring integrated functioning of the brain, nerves, blood vessels, and hormones. The thrust of the matter is that it is really nothing short of a stunning orchestration.

Bottom Line: For an erection to occur, penile blood flow has to increase, the smooth muscle in the walls of the penile blood vessels and sinuses must relax, and venous outflow needs to decrease, thus trapping blood in the penis.

After ejaculation, the enzyme PDE (phosphodiesterase)is released. This chemical can be considered the main chemical controller of flaccidity—this degrades cGMP, resulting in a return to the flaccid state by a reversal of the aforementioned chemical mechanisms. Viagra, Cialis, Levitra, and Stendra work by inhibiting PDE.

Bottom Line: After ejaculation, the penis becomes flaccid from a reversal of the chemical mechanisms that created the erection.


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”:

On Kindness, Compassion and Perspective

June 14, 2014

Blog # 157

I have never been much of a fan of inspirational and motivational books, with the exceptions that follow. Two of the authors whom I find brilliant, engaging and thought provocative are David Foster Wallace (DFW), author of Infinite Jest and George Saunders (GS), author of Tenth of December. Both delivered noteworthy and inspirational addresses to graduating college students. DFW’s commencement address was to the class of 2005 at Kenyon College and GS’s convocation address was to the 2014 graduating class at Syracuse University. The speeches have been immortalized in the form of short books, both of which I keep at my bedside table, and pick up periodically to reread. The messages conveyed are meaningful and well, grounding, …helping me to achieve perspective. DFW’s book is This Is Water: Some Thoughts, Delivered on a Significant Occasion, about Living a Compassionate Life; GS’s book is Congratulations By The Way: Some Thoughts On Kindness.

I highly recommend listening to DFW and GS deliver their respective addresses. It will be well worth a thirty minute or so investment of your time! (DFW: 23 minutes; GS: 12 minutes); they are on YouTube at the following sites:

These addresses share much in common, being chock full of wisdom and providing simple, yet powerful messages that strike a chord deep within our hearts. They resonate with our human longing to lead lives that are less self-centered and arrogant, and more compassionate, kinder, richer and filled with love.

DFW’s key points are the following:

o   The most obvious, ubiquitous and important realities are often the ones that are hardest to see and talk about.

o   Our default setting is that we are at the center of the universe and we “see and interpret everything through the lens of self.

o   Those who can adjust their natural default setting are often described as being “well-adjusted,” which he suggests is not an accidental term.

o   “The most dangerous thing about an academic education is that it enables our tendency to over-intellectualize…to get lost in abstract thinking instead of simply paying attention to what’s going on in front of us—instead of paying attention to what’s going on inside us.

o   It is extremely difficult to stay alert and attentive instead of getting hypnotized by the constant monologue inside our heads.

o   Learning how to think really means learning how to exercise some control over how and what we think…being conscious and aware enough to choose what we pay attention to and to choose how to construct meaning from experience.

o   The real value of a liberal arts education is about how to keep from going through our comfortable, prosperous, respectable adult lives dead, unconscious, a slave to our heads and our natural default setting of being uniquely, completely, imperially alone, day in and day out.

o   The freedom of real education is that we get to consciously decide what has meaning and what doesn’t.

o   Everybody worships—the only choice we get is what to worship… an outstanding reason for choosing a spiritual-type thing to worship is that pretty much everything else we worship—money and things, our own body and beauty and sexual allure, power, our intellect—will eat us alive.

o   The really important kind of freedom involves attention, and awareness, and discipline, and effort, and being able to truly care about other people and to sacrifice for them, over and over, in myriad petty little unsexy ways, every day.

GS’s key points are the following:

o   His main regrets in life are “failures of kindness”…those moments when another human being was there in front of him, suffering and he responded… mildly, reservedly, sensibly.

o   Our failures of kindness are due to built in “Darwinian confusions”: that one’s personal story is the main and most interesting story, the only story; that an individual is separate from the universe; and life is permanent.

o   We don’t really believe these Darwinian confusions, but we live by them, causing us to prioritize our needs over those of others, even though what we really want in our hearts is to be less selfish, more aware and present, more open and more loving.

o   The avenue to achieving these goals is education, immersion in a work of art, meditation, frank talks with friends, prayer, meditation, spirituality.

o   There is a natural tendency for becoming less selfish with aging, as self diminishes and love increases.

In my collection of quotations, I found one by Albert Einstein that is relevant to this discussion:

“A human being is part of a whole, called by us the universe, a part limited bytime and space. He experiences himself, his thoughts and feelings, as something separated from the rest—a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest us. Our task must be to free ourselves from this prison by widening our circles of compassion to embrace all living creatures and the whole of nature in its beauty.”

The sage messages conveyed by David Foster Wallace, George Saunders and Albert Einstein serve as reality checks that we are indeed mortal and largely insignificant specks in the grand universe, despite the fact that we often fantasize that we are immortal and are the key actors in the play called “Life.” Introspection, kindness and compassion are capable of connecting the insignificant specks into a whole that is so much more meaningful than the sum of its parts. Happy Father’s Day weekend to all!


Andrew Siegel, M.D.

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”:

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


Penile Erection Geometry

June 7, 2014




(Illustration credited to Dr. Henry Gray, Gray’s Anatomy of the Human Body, 20th edition, original publication 1918, public domain)

Blog # 156

A flaccid penis is soft like a marshmallow and dangles limply from its attachment to the pubic bone. With stimulation, the penis fills, firms, and increases in length and girth, as tumescence turns to rigidity. Not only does the penis undergo a metamorphosis into a rigid erection, but it also starts angling up towards the heavens—majestically pointing towards the sky, a marvel of human hydraulic engineering in defiance of the laws of gravity. At its extreme, the erect penis can touch the abdominal wall. A young man’s erection can easily support the weight of a towel.

Who Knew? Birthday and New Year’s Eve party blowouts—those party toys that when blown unfurl and extend outwards—are a useful means of thinking about erections. In the flaccid state, the erectile cylinders are very similar to the party blowout when it is not being blown into; in the erect state, the erectile cylinders are comparable to the party blowout when it is being blown into.  In the flaccid state, there is an acute bend at the junction of the external and internal penis. With a rigid erection, this acute angle is lost and the external penis develops an obtuse angle relative to the internal penis.

Analogous to penile size, there is a great amount of variability in the angle of the erect penis relative to the body (the pubo-penile angle). Like belly buttons that can be “outies” or “innies,” erections can be “uppies” or “outies,” depending on a number of factors. “Flagpoles” can be vertical, horizontal, or any angle in between.

Who Knew? In summer camp there was always that smart aleck camper who cited a complex equation of the physics of erection intensity, involving the “angle of the dangle,” “the heat of the meat,” “the direction of the erection,” “the dimension of the extension,” “the torque of the pork,” etc. Who knew that there was actually validity to some of these factors in determining the angle of erection!

The pubo-penile angle is determined by the following factors: the tension in the suspensory ligaments of the penis; the attachments of the penis to the pelvic bones; the size of the penis; the extent of the erection; and the tone and strength of the ischiocavernosus (IC) and bulbocavernosus (BC) muscles.

The suspensory ligaments support and maintain the erect penis in an upright position, essentially anchoring the base of the penis to the pubic bone. The tighter the ligaments are, the greater the potential upward angulation of the erect penis.

Who Knew? In an effort to increase penile length, some surgeons perform a procedure in which the suspensory ligaments of the penis are cut. What this actually does is to expose some of the internal penis, allowing more of the penis to hang outside the body. The price one pays for this sleight of hand is that one’s erection will no longer point majestically to the heavens. Essentially, one gains a bit of flaccid length and loses angle—robbing your Peter to pay Paul, literally!

As the suspensory ligaments provide support and anchorage of the external penis from above, so the attachments of the erectile cylinders to the pelvic bones provide support and anchorage of the internal penis from below. Every individual has different anatomy, and the variations in pelvic anatomy and support can engender variations in erectile angulation. In general, the more firm and secure the attachments are from below, the greater the potential foundation of support and the greater the potential upward angulation of the erect penis.

Who Knew? The internal, concealed penis that is attached to the pelvic bones can be thought of as the roots of a tree. Similarly, the external penis can be considered in terms of the trunk of a tree. Without a solid root system—the foundation—no tree can assume a tall and erect stature. But with a solid foundation, the penis, like the tree, has the support to point high to the heavens.

Penile size is generally inversely proportional to the potential for upward angulation. Largely due to the force of gravity, there is a tendency for less upward angulation with longer and heavier penises.

Conceptually easy to understand, if flaccid is considered a 0% erection and full rigidity is 100%, the greater the magnitude and extent of the erection, the greater the upward angulation.

There are two particularly important pelvic floor muscles called the bulbocavernosus (BC) and ischiocavernosus (IC) muscles. These muscles are crucial to male sexual function. There are a total of 3 erectile cylinders that form the bulk of the tissue of the penis. The solitary erectile cylinder known as the “corpus spongiosum” (“spongy body”) runs from the perineum (the area between the scrotum and anus)” through the length of the penis to the “glans,” the head of the penis. Its innermost, protuberant portion is known as the “bulb.” The corpus spongiosum contains the urethra (urinary channel) and during sexual stimulation, the corpus spongiosum and the glans become swollen and plump. The BC is the muscle that covers the penile “bulb.” The “corpora cavernosa” (“cave-like bodies”) are the paired erectile cylinders are responsible for rigid erections. The IC refers to the muscle that covers the inner, deep aspects of the corpora cavernosa.

Bulbocavernosus and ischiocavernosus muscle strength can factor strongly into erectile angulation. A voluntary contraction of the BC and IC muscles will cause the erect penis to deflect in an upwards direction. As the BC and IC muscles are flexed, one can easily observe movement of the external penis towards the heavens as the increased blood filling of the erectile cylinders nudges the external penis up. The better the tone and conditioning the BC and IC muscles, the greater the potential upward angulation of the erect penis.

We must accept what nature has given us regarding our suspensory ligaments, our attachments of the penis to the pelvic bones, and the size of our penises. However, the factors that we can modify are the extent of our erections and the strength of our IC and BC muscles. So if we want to maximize our pubo-penile angle, PFM exercises become of paramount importance

An erection needs to be hard enough to penetrate, but flexible enough to be able to negotiate the various “acrobatic” requirements of different sexual positions. So, although an erection that points to the heavens is a wonderful phenomenon, one that is so angled to the extent that it is inflexible will not help one’s performance in the bedroom.

Who Knew? The vagina is shaped like a banana, with its innermost and deepest part angling downwards toward the sacral bones. In order to accommodate female anatomy and position, a penis needs to be both rigid and flexible at the same time—“flexible rigidity,” to use an oxymoronic phrase. If one has a highly angled, inflexible erection, sexual positions such as the reverse cowgirl or woman on top leaning backwards can be painful and can potentially inflict damage to the penis, as well as prove uncomfortable for the woman.


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”: