Archive for August, 2014

Manhood: You Can’t Make it Bigger, but You Can Make it Stronger with Man Kegels

August 27, 2014

The following is a guest blog written by David Mandell, entrepreneur and cofounder of The Private Gym, a company whose mission is to provide men with the means of learning Kegel exercises in order to become masters of their pelvic floor and improve their pelvic health.


Let’s face the facts. Life isn’t fair. The sooner we realize this as human beings, the better – – since it enables us to begin to prepare for what’s to come.

Everything starts and ends with genetics. How do we know this? Well, here’s the scientific analysis: How often have you been told, “You’re acting just like your father?” I hear this at least once a week from my wife, mother, and even my mother-in-law. As you can imagine, it isn’t always a compliment. What is my father’s typical response? “It’s cultural, get used to it.” There’s also a genetic component to that, but that’s another discussion.

Will your child excel at the violin? Well, is there anyone with any musical talent in the family? Want to know what the woman you’re dating will look like in 30 years? Check out her mother. It’s about as close to a crystal ball as you can get. Body shape, facial structure, intelligence, talents, abilities, it almost all relates back to your genetic makeup. And, yes . . . the size of a man’s penis is also dictated by genetics

There is no single aspect of the human body that plays such a critical role in defining a man’s identity as his penis. How do we know this? Take me, for example. If I had a very large penis, during my dating years, I would have worn clear pants with an internal glowing chamber that highlighted my manhood. It’s even possible I would still wear them today on special occasions and national holidays.

So how do you combat genetics? It isn’t easy with the basic scientific remedies available to most of us. You can study hard in school, outwork your competition in your professional career, and eat right and exercise to transform your body.

I’m not going to debate whether it is possible to enlarge your penis. There are all sorts of medieval-looking torture devices that will stretch out your manhood. However, these products are not mainstream and never will be—and in fact, many really don’t work. Just ask the Mayo Clinic:

And the herbal supplements that claim to make your penis bigger? Just think for a minute about how absurd this is. If there was a pill – – any pill – – that actually made your penis bigger, it would be given to men at birth. The father would insist upon it – – no matter what the cost. “Forget about the Gerber Life College Fund, he needs that penis growing pill now.”

Just like a pill won’t make you taller, it also won’t increase the size of your penis. So, save your money.

I’m not here to argue that size doesn’t matter – – it does, given our whole discussion to this point. However, the strength of your penis matters just as much – – if not more.

How hard your erection is and how long you are able to perform impacts your partner’s sexual experience more than the size of your penis alone. This is a fact.

Unlike genetics, the strength of your penis – – and the pelvic muscles that support the penis – – is something you can control. You can workout your penis with Kegel exercises for men. Regardless of your age or condition, strengthening your pelvic muscles will have a direct impact in improving your sexual performance and reproductive health.

However, if you won the genetic lottery and are blessed with a large penis, you are not immune to potential problems lurking just below the surface. In fact, you may be even more at risk as you age. One of the only downsides of a large penis – – I’ve been told – – is that it is hard to keep it really hard. In fact, it takes more pelvic muscle strength to hold blood in the penis and ensure rigidity. As the pelvic muscles weaken over time, loss of rigidity may become even more of an issue for the well-endowed male.

So what can you do? Start now, and begin working out one of your most important muscle systems. Men of all ages – – whether completely healthy or experiencing sexual, urinary or bladder conditions – – can learn all about the importance of your pelvic muscles and how to exercise them at Also, Dr. Andrew Siegel, one of the nation’s leading urologists and co-founder of Private Gym, teaches you about these muscles in his new book, Male Pelvic Fitness, Optimizing Your Sexual and Urinary Health.


David Mandell

President and CEO of the Private Gym


Wishing you the best of health,

2014-04-23 20:16:29

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”:


10 Things You Can Do To Prevent a Limp Penis

August 19, 2014

Andrew Siegel MD Blog # 168

It’s great to have a penis…so handy, convenient and multifunctional! As many an older man will attest to, even when erections become mere memories, the penis will still allow you to stand up to urinate—an absolute joy—and a distinct competitive advantage over the female gender. To borrow from a cartoon by an artist named Collins, “Men have elevated peeing to an art form best expressed perhaps on a snowy landscape, a wall or a steam grate. Superior pressure control and the multidirectional penis make the men the masters of urination. Women on the other hand with their small bladders and clumsy apparatus find it very difficult to pee without creating a frightful mess…no precision accuracy here.” As fabulous as it is having a “spigot” for controlled urination, it is even better when you can maintain “penis magic” to old age and observe the transformative process by which the limp penis alters its shape, size and constitution in nanoseconds, rising in defiance of gravity to majestic rigidity.

Our ability to perform physically—in any domain—declines as we get age, explaining why most professional athletes are in their twenties or thirties. In terms of sexual function, when you were young you could achieve a rock-hard erection simply by seeing an attractive woman or thinking a sexual thought. As the years go by, erotic thoughts or sights are no longer enough, as you need direct touch and stimulation. Your sexual interest can skid and your erections may become softer and less durable with less intense orgasms and meager, dribbling-quality ejaculation. When you were young, you could get a second erection with a short recovery time (refractory period) but as you get older, refractory period may be days in length.

What to do? Should you be reactive and wait for your sex life to go south or should you take measures to ensure your continuing sexual health? Why not take a proactive approach? “An ounce of prevention is worth a pound of cure” rings very true for nearly all health issues, and so it does when it comes to sexual function.

  1. Maintain a Healthy Weight If you are overweight, you are more likely to have fatty plaque deposits, which clog up your blood vessels, including the artery to the penis. Abdominal fat converts your male hormone testosterone to the female hormone estrogen, literally emasculating you and causing development of man boobs.  Obesity steals away your manhood, male athletic form and body composition, mojo, strength, and one of your most precious resources—the ability to obtain and maintain a good-quality erection.
  1. Eat Healthy Fueling with nutritionally wholesome and natural foods will help you prevent the build-up of harmful plaque deposits within your blood vessels that compromises blood flow to the penis. Poor dietary choices with meals that are calorie-laden, nutritionally-empty selections (e.g., fast, processed, or refined foods) puts you on the fast tract to clogged arteries that can make your sexual function as small as your belly is big.
  1. Minimize Stress Stress causes the release of the hormones adrenaline and cortisol. Adrenaline narrows blood vessels, which has a negative effect on erections. If you ever have experienced performance anxiety it was because of adrenaline release in response to nervousness. Excessive cortisol secretion, which helps drives your appetite, causes the accumulation of the bad belly fat (as opposed to fat under the skin).


  1. Eliminate Tobacco Tobacco narrows your blood vessels, impairs blood flow, decreases the supply of oxygen, and also promotes inflammation, compromising every organ in your body.
  1. Alcohol in Moderation In small amounts, alcohol can alleviate anxiety and act as a vasodilator (increasing blood flow) and can actually improve erectile function, but in large amounts it can be a major risk factor for erectile dysfunction. Everything in moderation!


  1. Sleep Well Sleeping has a vitally important restorative function as your brain and body requires this important down time. During sleep, there is an increased rate of tissue growth and synthesis, and a decreased rate of tissue breakdown. Sleep deprivation causes a disruption in endocrine, metabolic, and immune function, resulting in decreased levels of leptin (your appetite suppressant), increased ghrelin levels (your appetite stimulant), increased cortisol, and increased glucose levels (higher amounts of sugar in the bloodstream). If you are exhausted, your penis is going to be weary as well.


  1. Exercise Exercise can have an amazingly positive effect on your sexual function through stress busting, mood improvement, fatigue reduction, increase of energy and better quality sleep. Long term it will reduce your risk for diabetes, heart disease, stroke, high blood pressure, some cancers, osteoporosis, chronic medical problems, and physical disability. Let’s not forget improvement in muscular strength and tone, reduction of body fat and help with weight control. Exercise makes your heart a better and stronger pump, your blood vessels more elastic, and your muscles better able at using oxygen. Exercises that work out the muscles involved in sex—the core muscles, the external rotators of the hip, and the all-important pelvic floor muscles—will improve your performance.B e careful with saddle sports like cycling and horseback riding, which may contribute to sexual dysfunction, particularly for those who spend prolonged time the saddle. This can cause compression damage to that very valuable human real estate located between your scrotum and anus that contains the nerves, blood vessels, and muscles that are vital to your sexual health. 


  1. Pelvic Floor Muscle Exercises The pelvic floor muscles play a vital role with respect to both erections and ejaculation. When you are sexually stimulated, the pelvic floor muscles activate and engage to help maintain penile rigidity and a skyward angling erection. These muscles are not only responsible for getting the stimulated penis from a tumescent state (plump with blood) to a state of bone-like rigidity, but also for maintaining that rigid state and for being the “motor” of ejaculation. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) in the management of erectile dysfunction. The Private Gym is a comprehensive, interactive, follow-along exercise program that helps men strengthen the pelvic floor muscles that support sexual health.It is the first line of defense against the onset of erectile dysfunction and can assist in reversing its occurrence. It is a safe, easy-to-use, natural, medically sanctioned and FDA registered means of targeting and strengthening the all-important pelvic floor muscles.


  1. Use It (or Lose It) Keep your penis fit by using it regularly for the purpose it was designed for—in other words, stay sexually active! Scientific studies have clearly demonstrated that men who are more sexually active tend to have fewer problems with erectile dysfunction as they age.
  2. Maintain a Healthy Relationship It takes two to tango, so relationship harmony factors strongly into good sexual functioning just as discord and interpersonal issues can profoundly contribute to ED. The mind-body connection is of immense importance to sexual function and the “big head” is equally important to the “little head.”

Bottom Line: The “Golden Rule of the Penis”: Treat your penis kindly (in terms of a healthy lifestyle) and it will return the favor; treat your penis poorly and it will rebel. The proactive approach will keep you functioning smoothly for many years, and hopefully will keep you out of my office for erection issues, although please don’t forget to get your prostate and PSA (Prostate Specific Antigen) checked!


Wishing you the best of health,

2014-04-23 20:16:29

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, iBooks, Nook, Kobo) and paperback:

Private Gym website for pelvic floor instructional DVD and resistance training equipment:

What To Expect of Your Erections As You Age…20’s, 30’s, 40’s and Beyond

August 11, 2014


Andrew Siegel MD Blog # 167


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It is shocking how ill prepared we are for aging. Nobody informs us exactly what to expect with the process, so we just sit back and observe the changes as they unfold, dealing with them as best we can. Although educational books are available on many topics regarding other expected experiences, such as “What To Expect When You’re Expecting,” I have yet to see “The Manual of Man,” explaining the changes we might expect to experience as time goes on. Some day I wish to author a book like that, but for the time being I will blog on what to anticipate with male sexual function as time relentlessly marches on.

 “But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.”

Tom Hickman God’s Doodle: The Life and Times of the Penis

Aging can be unkind and Father Time does not spare your sexual function. Although erectile dysfunction (ED) is not inevitable, with each passing decade, there is an increasing prevalence of it. Present in some form in 40% of men by age 40 years, for each decade thereafter an additional 10% join the ED club. All aspects of sexuality decline, although libido (sexual interest and drive) suffers the least depreciation, leading to a swarm of men with eager “big heads” and apathetic “little heads,” a most frustrating combination indeed. With aging often comes less sexual activity, and with less sexual activity often comes disuse atrophy, in which the penis actually becomes smaller.

Additionally, with aging there is often weight gain, and with weight gain comes a generous fat distribution in the pubic area, which will make the penis appear shorter. With aging also comes scrotal laxity and testicles that hang down loosely, like the pendulous breasts of an older woman. Many of my older patients relate that when they sit on the toilet, their scrotum touches the toilet water. So, the penis shrinks and the testicles hang low like those of an old hound dog…Time and gravity can be cruel conspirators!

So, what can you expect of your sexual function as you age? I have broken this down by decade with the understanding that these are general trends and that you as an individual may well vary quite a bit from others in your age group, depending upon your genetics, lifestyle, luck and other factors. There are 30- year old men who have sexual issues and 80-year old men who are veritable “studs,” so age per se is not the ultimate factor.

You may wonder about the means by which I was able to craft this guide. I was able to do so through more than 25 years spent deep in the urology trenches, working the front line with thousands of patient interactions. My patients have been among my most important teachers and have given me a wealth of information that is not to be found in medical textbooks or journals, nor taught in medical school or during urology residency. Furthermore, I am a 50-something year-old man, keenly observant of the subtle changes that I have personally witnessed, but must report that I am still holding my own!

Age 18-30: Your sexual appetite is prodigious and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might just be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the smell of her perfume, merely the thought of her can arouse you fully. You get erections even when you don’t want them…if there was only a way to bank these for later in life! You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense and you are capable of ejaculating an impressive volume of semen forcefully with an arc-like trajectory, a virtual comet shooting across the horizon. When you arise in the morning from sleep, it is not just you that has arisen, but also your penis that has become erect in reflex response to your full bladder, which can make emptying your bladder quite the challenge, with the penis pointing up when you want to direct its aim down towards the toilet bowl. It doesn’t get better than this…you are an invincible king… a professional athlete at the peak of his career! All right, maybe not invincible…you do have an Achilles heel…you may sometimes ejaculate prematurely because you are so hyper-excitable and sometimes in a new sexual situation you have performance anxiety, a mechanical failure brought on by the formidable mind-body correction, your all-powerful mind dooming the capabilities of your perfectly normal genital plumbing.

Age 30-40: Things start to change ever so slowly, perhaps even so gradually that you barely even notice them. Your sex drive remains vigorous, but it is not quite as obsessive and all consuming as it once was. You can still get quality erections, but they may not occur as spontaneously, as frequently and with such little provocation as they did in the past. You may require some touch stimulation to develop full rigidity. You still wake up in the middle of the night with an erection and experience “morning wood.” Ejaculations and orgasms are hardy, but you may notice some subtle differences, with your “rifle” being a little less powerful and of smaller caliber. The time it takes to achieve another erection after ejaculating increases. You are that athlete in the twilight of his career, seasoned and experienced, and the premature ejaculation of yonder years is much less frequent an occurrence.

Age 40-50: After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion you had two decades earlier. You can usually get a pretty good quality erection, but it now often requires tactile stimulation and the rock-star rigidity of years gone by gives way to a nicely firm penis, still suitable for penetration. The gravity-defying erections don’t have quite the angle they used to. At times you may lose the erection before the sexual act is completed. You notice that orgasms have lost some of their kick and ejaculation has become a bit feebler than previous. Getting a second erection after climax is not only difficult, but also may be something that you no longer have any interest in pursuing. All in all though, you still have some game left.

Age 50-60: Sex is still important to you and your desire is still there, but is typically diminished. Your erection can still be respectable and functional, but is not the majestic sight to behold that it once was, and touch is necessary for full arousal. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. Your orgasms are definitely different with less intensity of your climax, and at times, it feels like nothing much happened—more “firecracker” than “fireworks.” Ejaculation has become noticeably different—the volume of semen is diminished and you question why you are “drying up.” At ejaculation, the semen seems to dribble with less force and trajectory; your “high-caliber rifle” is now a “blunt-nosed handgun.” Getting a second erection after climax is difficult, and you have much more interest in going to sleep rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity…sometimes just reserved for the weekends.

Age 60-70: “Sexagenarian” is bit of a misleading word…this is more apt a term for the 18-30 year-old group, because your sex life doesn’t compare to theirs…they are the athletes and you the spectators. Your testosterone level has plummeted over the decades, probably accounting for your diminished desire. Erections are still obtainable with some coaxing and coercion, but they are not five star erections, more like three stars, suitable for penetration, but not the flagpole of yonder years. They are less reliable, and at times your penis suffers with attention deficit disorder, unable to focus and losing its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime, and early morning erections become rare occurrences. Climax is, well, not so climactic and explosive ejaculations are a matter of history. At times, you think you climaxed, but are unsure because the sensation was so un-sensational. Ejaculation may consist of a few drops of semen dribbling out of the end of the penis. Your “rifle” has now become a child’s plastic “water pistol.” Seconds?…thank you no …that is reserved for helpings on the dinner table! Sex is no longer a recreational activity, but an occasional amusement.

Age 70-80: When asked about his sexual function, my 70-something-year-old patient replied: “Retired…and I’m really upset that I’m not even upset.” You may still have some remaining sexual desire left in you, but it’s a far cry from the fire in your groin you had when you were a younger man. With physical coaxing, your penis can at times be prodded to rise to the occasion, like a cobra responding to the beck and call of the flute of the snake charmer. The quality of your erections has noticeably dropped, with penile fullness without that rigidity that used to make penetration such a breeze. At times, the best that you can do is to obtain a partially inflated erection that cannot penetrate, despite pushing, shoving and manipulating every which way. Spontaneous erections have gone the way of the 8-track player. Thank goodness for your discovery that even a limp penis can be stimulated to orgasm, so it is still possible for you to experience sexual intimacy and climax, although the cli-“max” is more like a cli-“min.” That child’s “water pistol”…it’s barely got any water left in the chamber.

Age 80-90: You are now a member of a group that has an ever-increasing constituency—the ED club. Although you as an octogenarian may still be able to have sex, most of your brethren cannot; however, they remain appreciative that at least they still have their penises to use as spigots, allowing them to stand to urinate, a distinct competitive advantage over the womenfolk. (But even this plus is often compromised by the aging prostate gland, wrapped around the urinary channel like a boa constrictor, making urination a challenging chore.) Compounding the problem is that your spouse is no longer a spring chicken. Because she been post-menopausal for many years, she has a significantly reduced sex drive and vaginal dryness, making sex downright difficult, if not impossible. If you are able to have sex on your birthday and anniversary, you are doing much better than most. To quote one of my octogenarian patients in reference to his penis: “It’s like walking around with a dead fish.”

Age 90-100: To quote the comedian George Burns: “Sex at age 90 is like trying to shoot pool with a rope.” You are grateful to be alive and in the grand scheme of things, sex is low on the list of priorities. You can live vicariously through pleasant memories of your days of glory that are lodged deep in the recesses of your mind, as long as your memory holds out! Penis magic has gone the way of defeated phallus syndrome. So, when and if you get an erection, you never want to waste it!

Stay tuned for my next blog, coming next week: The solution to age-related decline in sexual function: 10 Things You Can Do To Prevent a Limp Penis

Wishing you the best of health and erections that last a lifetime,

2014-04-23 20:16:29

      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, iBooks, Nook, Kobo) and paperback:

Private Gym website for pelvic floor instructional DVD and resistance training equipment:

Getting in Touch with Your Inner Penis

August 5, 2014


Andrew Siegel MD Blog # 166




When I use the term “inner penis,” I am not referring in a new age meditative kind of way to the unexpressed, indiscernible, and unacknowledged spiritual-mental-emotional drive underpinning male sexuality (although that is a good topic for another day). Nah, not at all… I am referring to the physical, not metaphysical, literal inner part of the penis. Did you have any clue that one half of the penis is actually internal while the other half is external, that is, what you see? So, with this newfound knowledge, if you are ever in a situation where someone infers that your penile stature is less than imposing, you can confidently state that you are well hung, but internally!

Why do we have an inner penis at all? It seems to be such a waste of human flesh, doesn’t it? Well, it is not a waste and is actually very clever engineering—we have an inner penis for the same reason a house has a foundation and a tree has roots. Without solid foundational support, we would never be able to support a rigid erection, angling proudly up towards the heavens. If the purpose of the penis was only to conduct urine and there was no need for erectile rigidity, there would be no need for such support. However, in order to defy gravity and stand tall and proud at the appropriate times, the penis must have strong roots. If a house had a weak foundation, it could easily blow down in a storm and if a tree has a poor root system, a gust of wind could level it, and so robust penile foundational support is a necessity for supporting a rigid erection and allowing it to survive in the “stormy turbulence” it may encounter with sexual activity, a virtual tornado (hopefully) if you will.

Let’s briefly study the anatomy of the penis: The pendulous penis (hanging like a pendulum) is the external and visible portion of the penis, which, again, represents only about half of the penile length. The penile shaft extends from the base of the penis (where the penis attaches to the body in the pubic region) to the glans (the head of the penis, derived from the Latin word for acorn). The infrapubic penis (“below” the pubic bone) is the inner, hidden, deeper aspect of the penis that extends down the pubic bones on each side. The crura are the deep penile roots, which are secured to the bones and provide the internal support necessary for an erection.

The bulk of the tissue of the penile shaft is composed of three erection chambers that contain spongy, vascular erectile tissue: the paired corpora cavernosa (cave-like bodies) and the single corpus spongiosum (spongy body). Although they are individual cylinders, the corpora cavernosa are interconnected and communicate. The corpora cavernosa run parallel down the shaft of the pendulous penis, and diverge at the level of the inner component of the penis, forming the crura that are anchored to the pelvic bones. The urethra (channel that conducts urine and semen) is enveloped by the corpus spongiosum, which begins in the perineum (area between the scrotum and anus), where it expands to form the bulb and extends to and forms the glans penis. It lies in the groove between the corpora cavernosa.

If you imagine your body to represent the penis, your legs are your crura, your torso is the external penis, and your head is the glans. In order for your torso and head to stand tall and erect, you need your legs planted firmly in the earth; otherwise, your torso would crumble to the ground.

Important and intimately connected allies of your inner penis are the pelvic floor muscles, which work with the erection chambers of the penis. The two important pelvic floor muscles involved with sexual function are the bulbocavernosus (BC) and ischiocavernosus (IC) muscles. The BC surrounds the inner, deeper portion of the urethra and covers and compresses the bulb of the penis. It is really a compressor muscle, so I call it the urethral compressor. In its relaxed state, it acts as an internal strut that helps anchor the deepest, internal aspect of the penis. When the muscle is contracted actively after urination, it compresses the urethra to expel the last few drops of urine that remain in the deep urethra. During sex, it helps support the tumescent (swollen) corpus spongiosum and glans. At the time of climax, this muscle is responsible for the expulsion of semen by virtue of its strong rhythmic contractions, allowing ejaculation to occur and contributing to orgasm. The classic 1909 textbook Gray’s Anatomy aptly labeled the BC muscle as “ejaculator urine.”

The paired IC muscles cover and compress each corpus cavernosum of the penis. They, too, are really compressor muscles, so I call them the corporal compressors. In their relaxed state, they act as internal struts that help anchor the deepest aspect of the corpora—the crura—to the perineum. The IC stabilize the erect penis and compress the corpora, decreasing the return of blood to help maintain penile rigidity and sky-high blood pressures in the penis. At the time of climax, they contract rhythmically and are responsible for maximal erectile rigidity at the time of ejaculation. The 1909 Gray’s Anatomy aptly labeled the IC “erector penis.”

I like to think of the BC and IC muscles together as the levator penis since when contracted, they cause an upward deflection of the erect penis. You have the capacity to “point” your penis by virtue of your BC and IC muscles.



So there it is…you are now in touch with your inner penis and knowledge is power. Your inner penis and your pelvic floor muscles that compress it at the time of an erection are essential for optimal erectile rigidity and performance. Keep your pelvic floor muscles fit with targeted pelvic floor muscle exercises and your inner and outer penis will be grateful.

Wishing you the best of health,

Andrew Siegel, M.D.

2014-04-23 20:16:29


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, iBooks, Nook, Kobo) and paperback:

Private Gym website where pelvic floor instructional DVD and resistance training equipment are now available: