Archive for December, 2014

5 Side Effects of Radical Prostatectomy You Don’t Hear Much About

December 27, 2014

Andrew Siegel MD  12/27/14

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Having your prostate removed is a highly effective means of curing prostate cancer. Unfortunately, because of the prostate’s “precarious” location—smack in a busy area at the crossroads of the urinary and genital tracts, connected to the bladder on one end, the urethra on the other end, touching on the rectum, and nestled behind the pubic bone in a well-protected nook of the body—it’s removal has the potential for causing some unwanted and undesirable side effects.

Trauma to nerves, blood vessels, and muscular tissue during surgery can potentially compromise sexual function and urinary control. Generally, patients are informed about ED, urinary incontinence, the possibility of the surgery failing to cure the cancer and the risk of rectal injury. However, there are other possible complications that may affect your sexual quality of life that are often glossed over, perhaps because they are not considered that important in the grand scheme of cancer care.

Note that there are many men who undergo radical prostatectomy and experience absolutely no complications whatsoever, achieving “trifecta” status: a PSA (Prostate Specific Antigen) that is undetectable, full urinary control and intact erectile function. A small percentage of men experience significant urinary incontinence whereas many men will experience mild urinary incontinence. Many men note a decline in their ability to obtain and maintain an erection after the radical prostatectomy. What about the side effects that often go less mentioned?

Additional sexually related side effects that may occur including the following:

  • Ejaculation of urine at the time of sexual climax
  • Urinary leakage with sexual stimulation
  • Altered sensation of climax
  • Pain with climax
  • Penile shortening and deformity

 

Ejaculation of Urine at Sexual Climax

After radical prostatectomy, ejaculations are typically “dry” because of the removal of the structures that supply the contents of the ejaculate: prostate gland, seminal vesicles and the clipping of the sperm ducts. However, some men after radical prostatectomy may ejaculate urine at the time of sexual climax. This can be a nuisance and embarrassment to both the patient and his partner. This problem is most prevalent during the first year after prostatectomy and tends to improve with time.

Coping strategies are urinating before sex and/or using a condom or constrictive penile loop that pinches the urethra closed. Pelvic floor muscle training can strengthen the levator ani muscle, which contributes strongly to the voluntary urinary sphincter.

Urinary Incontinence at the Time of Sexual Stimulation

Urinary leakage is not always restricted to the moment of ejaculation as some patients can have it with foreplay. Once again, this is a potential bother and embarrassment to both patient and partner. Like ejaculation of urine, this issue is most commonly experienced during the first year after radical surgery and thereafter tends to improve.

Altered Sensation of Climax

Most men after radical prostatectomy will experience an altered perception of climax. Some will experience diminished pleasure, often with a feeling of diminished intensity of orgasm. Some are bothered by the dry climax. On occasion, one loses the ability to climax. In rare instances, a patient after radical prostatectomy will notice an increase in orgasm intensity.

Pain With Climax

Up to 20% of men after radical prostatectomy will experience discomfort or pain with climax, which is often perceived in the penis, testes or the rectum. With time both the intensity and frequency of pain usually decrease, although a small percentage of men will have persistent pain that persists beyond several years following the surgery.

Penile Shortening and Deformity

After radical prostatectomy, it is common to experience an alteration in penile size with a decrease in flaccid length, erectile length and erectile girth. The loss in penile length occurs during the first several months after the radical prostatectomy and whether the situation is reversible seems unlikely.

The shortening is likely based on factors including loss of urethral length, nerve and blood vessel damage and the presence of erectile dysfunction with its associated “disuse atrophy.” Lack of regular erections results in less oxygen delivered to the penile smooth muscle and elastic fibers with subsequent scarring and hence shortening.

The solution is to resume sexual activity as promptly as conceivable after surgery, pursuing “penile rehabilitation” to help avoid disuse atrophy. Pelvic floor exercises, oral medications of the Viagra class, the vacuum suction device, and penile injection therapy have proven to be helpful.

Up to 15% of men after radical prostatectomy will experience a penile deformity resulting in what appears to be a “waistband” or alternatively a penile curvature with erections.

Bottom Line: The potential sexual side effects from radical prostatectomy aside from ED may be bothersome and adversely affect one’s quality of life.

Reference: Frey AU, Sonksen J, Eode M: Neglected Side Effects After Radical Prostatectomy: A Systematic Review. J Sex Med 2014; 11:374-385

 

Wishing you the best of health and a peaceful upcoming 2015,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.

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Are You Cocky (Cock-y)?

December 20, 2014

Andrew Siegel, MD  12/20/14

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On Cockiness

The word cocky (derivatives cockily and cockiness) is defined as “conceited or arrogant, especially in a bold or impudent way.” Cocksure (derivatives cocksurely and cocksureness) is defined as “presumptuously or arrogantly confident.”

Being able to function well sexually contributes to your masculine identity and behavior and is responsible for a “swagger” that permeates positively into all areas of your life. Body confidence promotes mind confidence just as mind confidence promotes body confidence. There is good reason that the words “cocky” and “cocksure” mean possessing a great deal of confidence.

 Slang Terms For The Penis

There are an abundance of slang terms for the penis. Some are vulgar, others less so. The most popular are “dick” and “cock.” The “w” words “wang,” “wiener,” and “willy” are popular. There are the descriptive words: “manhood,” “member,” “package,” “tool,” “unit,” “prick,” “pecker,” and “dong.” Let’s not forget the name words “Johnson” and “Peter.” There is the medical term pudendum” and its derivative “pud.” There are the Yiddish slang terms, “schlong” (slang for snake) and “putz,” often used in a derogatory sense. On the international scene, “lad” is Irish, “todger” is Australian/UK origin, and “schwanz” is German, literally meaning tail. When I was a urology resident, we used the term schwanz quite often, although I’m not sure quite why, it just sounded like an appropriate term, and was subtler and smoother than the harsher terms “dick” and “cock.”

Slang Terms For Erections

There is no scarcity of slang words for an erection. The most popular are the descriptive terms “hard-on” and “boner,” but “chubby,” “stiffy” and “Mr. Happy” are reasonably popular as well. Then there are the metaphors: “wood,” “rod,” “joystick,” “pony” and “pitching a tent.”

Constriction Devices

Cock rings—a.k.a. constriction devices, tension rings and erection rings—are tourniquet variants that are placed around the circumference of the base of the erect penis with the intention of providing constrictive pressure to stop the exit of blood to help maintain erectile rigidity.

Constrictive devices are sometimes used to treat ED, particularly when the underlying cause is veno-occlusive disease, the ability to obtain a rigid erection, but its premature loss because of failure of blood to be trapped appropriately. As a urologist I have often prescribed the Actis adjustable loop for patients with venous-occlusive disease or “venous leak.” Additionally, constrictive devices are often used in conjunction with vacuum suction devices, to trap the blood pulled into the penis by virtue of the vacuum.

Cock rings are also used recreationally to enhance the rigidity of erections or at times as a sex toy. Caution must always be taken when using a device that chokes off blood flow. Although they can enhance rigidity and sexual pleasure, they can also cause discomfort, a cold and dusky penis, an unstable (floppy) erection because of failure of the device to create rigidity of the deep roots of the penis, and can make ejaculation impossible. One of the biggest issues with  rings is that they provide constrictive pressure that affects only the pendulous outer half of the penis without compressing the inner penile roots, which are “where the money is” in terms of providing erectile rigidity.

Want To Know A Little Secret?

You actually have a natural, built-in ring that you can tap into at will and use in lieu of a constriction device!

Two of the pelvic floor muscles are compressor muscles that function to impede the exit of blood from the penis and maintain erectile rigidity and high penile inflation pressures. The two important pelvic floor muscles involved with rigidity are the bulbocavernosus (BC) and ischiocavernosus (IC) muscles, located in the perineum, the area between the scrotum and the anus. The BC and IC muscles cover, support and compress the inner aspects of the erection chambers of the penis and when engaged during sex stabilize the erect penis and decrease the return of blood to help maintain penile rigidity, extraordinary penile blood pressures and a skyward-pointing erection. At the time of climax, they contract rhythmically and are responsible not only for maximal erectile rigidity at the time of ejaculation but also provide the muscle power behind ejaculation. The classic 1909 Gray’s Anatomy textbook aptly labeled the IC the “erector penis.”

How To Optimize Function Of Your Natural Ring?

Pelvic floor muscle exercises to improve the strength, tone and endurance of the pelvic floor muscles will maximize erectile rigidity and durability. If you want to be confident (cocky) in the bedroom, you might consider preparing, just as you would for any other athletic event. The preliminary results from our ongoing clinical trial with the Private Gym male pelvic floor muscle training program have shown that not only does the program improve erectile dysfunction, but also optimizes function in those men who do not have erectile dysfunction, with “confidence” being the one parameter that was most consistently reported as improved.

Wishing you the best of health and a wondeful holiday,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.

Erectile Rigidity: “A Perfect Storm”

December 13, 2014

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Andrew Siegel MD   12/13/14

**Note: Although the following blog is written primarily for men, it is equally relevant to females. Since the penis and clitoris are homologous organs, whenever you see “penis” you can substitute “clitoris.”

Last week’s blog reviewed how the penis is one of the most “magical” of organs—how it is uniquely capable of transforming its shape, size and constitution in a matter of nanoseconds. The take home message was that the remarkable upsurge is possible because inflow of blood to the penis is maximized while outflow is minimized, resulting in penile blood pressures that far exceed arterial blood pressure.

Rigid erections can only occur when there is a “perfect storm” of events. First, the arterial blood flow to the penis needs to increase substantially (pre-penile event). Second, smooth muscle within the arteries and the spongy sinuses of the erectile chambers of the penis must relax to allow engorgement with blood (penile event). Third, the pelvic floor muscles must engage to turn the swollen penis into a rigid penis (post-penile event). The blood pressure in the penis resulting from the inflow of blood alone–in the absence of the contribution from the pelvic floor muscles–cannot exceed systolic blood pressure, so the pelvic floor muscles play a vital role with respect to penile rigidity and durability of erections.

So, when erections go south, it comes down to failure in one or more of the three events,  pre-penile, penile, or post-penile.

 

Pre-penile ED

The problem lies within the arterial blood supply to the pelvis, which is not capable of delivering enough blood flow to fill the penis. Typically, the pelvic arteries are clogged with fatty plaque (atherosclerosis), which is often due to an unhealthy lifestyle: poor diet, physical inactivity, being overweight and use of tobacco. Diabetes is a very common cause of impaired blood flow (although it also affects the nerve supply in an adverse way). Insufficient blood flow may also occur because of the blood pressure lowering effect of blood pressure medications.

Solution to Pre-penile ED: Lifestyle “angioplasty”— getting down to “fighting” weight, adopting a heart-healthy (and penis-healthy diet), exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—all common sense measures to improve all aspects of health in general and blood vessel health in particular.

 

Penile ED

The problem lies within the penis itself. Because of poorly functioning smooth muscle within the arteries and spongy sinuses of the erectile chambers, the penis cannot properly swell up with blood. This smooth muscle cannot relax enough to allow blood flow to inflate the penis and pinch off the venous drainage. This failure of relaxation of the smooth muscle in the penile arteries and spongy sinuses parallels the failure of relaxation of smooth muscle in our arteries that causes high blood pressure (“essential” hypertension). Loss of this smooth muscle and scarring can also happen with aging, following prostate cancer surgery, from Peyronie’s disease or because of disuse atrophy.

Solution to Penile ED: Age-related malfunctioning smooth muscle and scarring is a difficult issue to manage. However, lifestyle measures can be helpful as well as adopting a “use it or lose it” attitude towards erectile function—exercising the penis via regular sexual activity will actually help its continued functioning and health of the smooth muscle of the penile arteries and spongy sinuses.

 

Post-Penile ED

 The problem is weakened pelvic floor muscles. These feeble muscles are incapable of compressing the roots of the penis sufficiently to increase the blood pressure in the penis to the levels needed for full erectile rigidity.

Solution to Post-Penile ED: Pelvic floor muscle training to improve the strength, tone and endurance of the pelvic floor muscles will optimize erectile rigidity and durability.

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: http://www.MalePelvicFitness.com

Co-creator of Private Gym pelvic floor muscle training program for menhttp://www.PrivateGym.com  

Nature’s Brilliant Design: Erection Hydraulics

December 6, 2014

Andrew Siegel, MD  12/6/14

shutterstock_side view manjpeg

shutterstock_femalebluepelvic

Humans are hardwired for two basic functions: survival and reproduction. Nature’s forces have made the reproductive process a pleasurable one, and by so doing have ensured the greatest likelihood of reproduction being successful. What a clever bait and switch scheme in which in the seeming pursuit of a feel-good activity—determined by this evolutionary sleight of hand—we have been hoodwinked into reproducing!

The goal of reproduction is the fusion of DNA from two individuals to perpetuate the species. The penis functions as a “pistol” to inject the DNA into the female’s reproductive tract. A flaccid penis is unable to complete this task, as the process demands penetration.

Many mammals—including the gorilla and chimpanzee—have a bone in the penis (the baculum), which functions to keep the penis hard enough for vaginal penetration and injection of the DNA. (There is also a bone in the clitoris called the os clitoridis.) However, the human penis is boneless (as is the human clitoris). While we can debate whether or not this is a good thing, it certainly helps to keep the penis hidden during the workday!

Creating a “Bone” Where One Doesn’t Exist

So what did nature do to overcome this challenging design problem: how do you create bone-like rigidity in a boneless organ?

The answer lies in hydraulics—using blood as a hydraulic mechanism—not the typical use of blood, which is for the transportation of oxygen, carbon dioxide, hormones, nutrients, and wastes to and from our organs. This use of blood as a hydraulic mechanism for erections—both penile erections in men and clitoral erections in women—is nothing short of brilliant…our bodies having evolved to use blood the way a tire uses air, to inflate deflated organs to allow them to function!

Another example of an animal that uses hydraulic action is the jumping spider, which uses blood forced into the legs to straighten them out to facilitate powerful jumps, avoiding the need for muscular legs that are bulky and clearly not spider-like.

Erection hydraulics requires a special means of regulating flow. To do so, the inflow needs to turn on like a gushing faucet and the outflow needs to shut off like a plugged drain in a sink. This is not the usual state of affairs for blood flow to an organ, which typically requires a relatively small amount of inflow to meet basic metabolic needs and an equal amount of outflow, creating a dynamic state of equilibrium. An erection demands that the arteries of the penis function as high-pressure faucets (inflow increasing many times over baseline) and the penile veins to close off completely.

So how has our body evolved this capacity?

The penis is a marvel of design and engineering, capable of increasing its blood flow by a factor of 40-50 times over baseline! This surge happens within seconds and is accomplished by relaxation of the smooth muscle within the arteries supplying the erection chambers and within the erectile sinuses of the erectile chambers. This is not the case of non-genital organs, in which blood flow can be increased upon demand (for example, to our muscles when exercising), but not anywhere to this extent.

Now for a little deviation off course for some interesting trivia:

  1. The spongy tissue in the erectile chambers is virtually identical to the spongy tissue in our facial sinuses. (My pathologist buddy claims that he can’t tell the difference under a microscope.)
  2. When this spongy tissue in the penis or clitoris becomes congested with blood, an erection occurs; when it happens in ours facial sinuses it is known as sinus congestion or a stuffed nose.
  3. The spongy tissue in the erectile chambers is surrounded by connective tissue known as the tunica albuginea, the second toughest connective tissue in our bodies, the toughest being the dura mater that surrounds our brains and spinal cords.
  4. A side effect of the ED meds like Viagra is nasal congestion…now you understand why.
  5. Prolonged erections (priapism) are often treated with the same medications used to treat a stuffed nose, e.g., phenylephrine.

The Important Role of the Pelvic Muscles

So, under the right circumstances the penis becomes swollen (tumescent) with blood. How has our body evolved the capacity to trap the blood so it does not return to the circulation? How does the penis go from swollen to rock-hard rigid?

First, as the sinuses within the erectile chambers fill with blood, they pinch off the veins, which traps blood in the penis. Second, nature—in its typical brilliant way—has designed a means of increasing the blood pressure in the erectile chambers to sky-high levels by means of a “muscular tourniquet” that not only chokes off the exit of blood, but with each squeeze of this specialized muscle, causes a surge of blood with increased filling of the erectile chambers, the end result being bone-like rigidity.

What are the names of these specialized muscles and what muscle group are they part of?

These are the ischiocavernosus and bulbocavernosus muscles (man’s best friends, but equally helpful to the ladies out there) that are part of the group of muscles known as the pelvic floor muscles, which form the floor of the important group of muscles known as the “core” muscles.

When a man has a rigid erection, contracting these muscles will lift up the erection and point it majestically towards the heavens, thank you pelvic floor muscles. You knew that your core muscles were important, but did you realize that the “boner” that you take for granted is based upon well-functioning core muscles?  Ditto for the firm clitoris in the female.

Maintaining & Strengthening Your Pelvic Muscles

So, take good care of your pelvic floor muscles and they will take care of you! Keep them fit, just as you do your other muscles. With aging and lack of physical activity the pelvic muscles become lax, so by increasing the strength, tone, power, and endurance of the pelvic muscles through exercise, you will optimize your erectile rigidity. Moreover, the pelvic muscles assist in delaying ejaculation. Weak pelvic floor muscles can impair the ability to delay ejaculation and voluntary contraction of the pelvic floor muscles can help control ejaculation. When flexed, the pelvic muscles assist in short-circuiting premature ejaculation. Learn more about how you can strengthen and maintain these critical muscles at www.privategym.com

Enough of my prose…time to finish with a poem I have written for the occasion:

The Muscles Of Love

Limber hip rotators,

A powerful cardio-core,

But forget not

The oft-neglected pelvic floor

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com – now available on Amazon as well as Private Gym website