Archive for January, 2015

PSA Absurdity

January 31, 2015

Andrew Siegel MD   1/31/15


(Image designed  by Abby Cycotte for WAPC)

Prostate cancer is the most commonly diagnosed cancer in males (excluding skin cancers)—paralleling breast cancer in females in many ways—with an estimated 233,000 new cases diagnosed in 2014. Over the latest 5-year period for which data is available, the death rate for prostate cancer decreased based upon improved early detection and treatment. There are 3 million prostate cancer survivors in the USA. The vast majority of prostate cancers are diagnosed by Prostate Specific Antigen (PSA) screening, a simple blood test.

Prostate cancer screening with PSA has been the subject of intense controversy and debate, a controversy that I—as a practicing urologist—don’t quite get. A major backlash against screening occurred in 2012. It started with the United States Preventive Services Task Force (USPSTF) grade “D” recommendation against PSA screening and their call for total abandonment of the test. Of note, there was not a single urologist on the committee. The same organization had previously advised that women in their 40’s should not undergo routine mammography, setting off another blaze of controversy. As a busy clinical urologist for almost three decades, I was deeply disturbed by their recommendation.

In 2013 the American Urological Association (AUA) issued guidelines recommending against PSA testing before age 55, with testing every other year between ages 55-69 and then only after “informed decision making,” a discussion between physician and patient weighing benefits and harms.

AUA Guideline Statements:

  1. Do not screen men under age 40.
  2. Do not screen men age 40-54, unless high risk (family history or African American), in which case decision should be individualized.
  3. Screen men 55-69 after informed decision making.
  4. Screening interval of “two years or more” may be preferred to annual screening to reduce harms of screening.
  5. Do not screen men older than 70 or any man with life expectancy less than 10-15 years, although some men in excellent health may benefit from screening.

When these guidelines came out, I was in disbelief and shock. Why did the AUA—whose mission statement is “to promote the highest standards of urological clinical care through education, research and in the formulation of health care policy”—kowtow on this vital issue?

Further fueling the controversy and confusion is the lack of consensus among professional groups including the European Association of Urology, the National Comprehensive Cancer Network and the Prostate Cancer World Congress. Uncertainty in the lay press has prompted both patients and physicians to question PSA testing and recommendations for prostate biopsy.

Is there really any harm in screening? Screening provides information and there are no side effects aside from whatever complications may ensue from drawing a small amount of blood. There are potential side effects from prostate biopsy (although they are few and far between) and certainly there are potential side effects with treatment; however, it seems that both the USPSTF and the AUA have confused screening with treatment. The potential side effects of active treatment should not influence the diagnosis of prostate cancer by the proper means. “Treatment or non-treatment decisions can be made once the cancer is found, but not knowing about it in the first place surely burns bridges.”—Dr. Jay Smith

I ardently disagree with the assertions of the task force and the AUA. Urologists, radiation oncologists, and medical oncologists (those physicians who are in the “trenches” and take care of prostate cancer on a daily basis) understand how devastating prostate cancer can be and the importance of early detection.

So what has been the upshot of this controversy? What has happened is that instead of proceeding directly to prostate biopsy, many more men with an elevated or accelerated PSA are having repeat PSA testing (often fractionated to determine free PSA/total PSA), the PCA-3 urine test and a prostate MRI. If the regulatory agencies had cost savings on their agenda, they have failed miserably as more testing (that incurs a significant expense) is being done than ever before.

Busy urologists are seeing more and more indecision and equivocation among primary care physicians who are confronted with patients who want screening, but guidelines that suggest that it is not necessary. Despite the USPSTF recommendations and AUA guidelines, urologists are actually seeing more referrals for elevated PSA than ever before.

Hard Facts:

  1. PSA screening has resulted in downward stage migration—detecting prostate cancer in an early and curable stage, before it spreads and becomes incurable. If these guidelines are adhered to, we will most certainly give back the gains we have made and experience a reverse stage migration and a return to the pre-PSA era when up to 20% of men presented with advanced disease.
  2. PSA testing unequivocally reduces metastatic prostate cancer (cancer that has spread) and death from prostate cancer: USA death rates from prostate cancer have fallen 4% annually since 1992, five years after introduction of PSA testing.
  3. Rigid guidelines unfortunately do not allow for a nuanced and individualized approach to early prostate cancer detection. PSA has many shortcomings, but used intelligently and appropriately will continue to save lives.
  4. Baseline PSA testing for men in their 40’s is useful for predicting the future of prostate cancer.
  5. Not permitting men age 40-55 the opportunity for screening denies them the potential to diagnosis a disease that is potentially lethal; this population has a long life expectancy and therefore the greatest need for early diagnosis and curative treatment.
  6. Older men in good health with over a 10-year life expectancy should not be denied PSA testing simply on the basis of their age.
  7. 95% of male urologists and 80% of primary care physicians have annual PSA screening—clearly, those in the know feel that screening is beneficial.
  8. Death from prostate cancer is unpleasant, often involving painful metastases to the spine and pelvis and not uncommonly, kidney and bladder outlet obstruction; our charge as urologists is to try to not let this scenario come to fruition.

When interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging, risk assessment and monitoring of prostate cancer patients. Marginalizing this important test does a great disservice to those who may benefit from early prostate cancer detection.

I have practiced urology in both the pre-PSA era and the post-PSA era. In my early years of training, it was not uncommon be called to the emergency room to treat men who could not urinate, who on digital rectal exam were found to have rock-hard prostate glands and imaging studies that showed diffuse spread of prostate cancer to their bones—metastatic prostate cancer with a grim prognosis. In the post-PSA era, that scenario—fortunately—occurs on an extremely infrequent basis thanks to PSA screening. The vast majority of men who present that way these days are those who have opted NOT to obtain a screening PSA as part of their annual physical exams.

Bottom Line: The downside of screening is over-detecting low-risk prostate cancer that may never prove to be problematic, but may result in unnecessary treatment with adverse consequences. The downside of not screening is under-detecting aggressive prostate cancer, with adverse consequences from necessary treatment not being given. We need to separate screening from treatment and screen smarter.”—Dr. Judd Moul

The major challenge for those of us who treat prostate cancer is to distinguish between clinically significant and clinically insignificant disease and to decide the best means of eradicating clinically significant disease to maintain quantity and quality of life. Not all prostate cancers require active treatment and not all prostate cancers are life threatening. The decision to proceed to active treatment is one that men should discuss in detail with their urologists to determine whether active treatment is necessary, or whether surveillance may be an option, appropriate in selected men with low-risk prostate cancer (low PSA; minimum number of biopsies showing cancer; low-grade cancer as determined by the pathologist). Those at greater risk can be managed appropriately (surgery or radiation) and many cured, avoiding the potential for progression of cancer and painful metastases and death.

“PSA is the best screening test we have for prostate cancer, and until there is a replacement for PSA, it would be unconscionable to stop it. Contrary to the USPSTF report, compelling evidence shows that PSA screening reduces prostate cancer deaths. This evidence needs to be shared with the public.”
–Dr. William Catalona

The Samadi Challenge For Prostate Cancer

Dr. David Samadi, Chief of Prostate Robotic Surgery at Lenox Hill Hospital, has created a challenge to women, since they are the proactive gender in terms of understanding the importance of health risks, screening and routine checkups and are often the driving force in men’s health.  Men are much more reluctant to engage with the health care system than women—particularly preventive health care—and Dr. Samadi sees women playing a pivotal role in encouraging men to focus on prostate health. On a larger scale, he sees women as ideal advocates and champions to help raise global awareness for prostate cancer. The Samadi Challenge involves women learning the risk factors for prostate cancer, improving the lifestyles of the men in their lives, encouraging men to have annual screening and in the case of being diagnosed with prostate cancer, urging men to seek appropriate treatment. Dr. Samadi launched a FaceBook page: “Women for Prostate Health,” a means to help women initiate a conversation about prostate health.

Wishing you the best of health,

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:

Co-founder of Private Gym:–available on Amazon and Private Gym website



Breaking Bad: What You Need To Know About Penile Fracture

January 24, 2015

Andrew Siegel MD   1/24/15

The French term for a broken penis is faux pas du coit. Everything sounds more elegant in French, oiu? Call it what you want, this is one mishap you want to avoid!


(I took the above photo at Alcazar Palace in Seville, Spain)

What Is It?

Penile fracture is a rare urological emergency that requires prompt surgical repair. It is a dramatic occurrence that most often happens during sexual intercourse in which the tough sheath surrounding the erection chambers of the penis ruptures under the force of a strong blow to the erect penis. It is similar to the tire of a car being driven forcibly into a curb, resulting in a gash in the tread and an immediate flat tire. Even though there is no bone in the human penis, the term fracture is appropriate because the outer sheath cracks, resulting in a broken erection chamber of the penis.

How Does It Happen?

A flaccid penis is rarely traumatized. However, when a penis is erect, there is major tension on the sheath surrounding the erectile chambers. A penile fracture occurs when this outer tunic—already under internal stretch and tension by virtue of the expansion of the erection chambers—is further subjected to external blunt trauma. This usually occurs with vigorous sexual intercourse, most often when the penis slips out of the vagina and strikes the perineum (area between the vagina and anus) or the pubic bone, resulting in a buckling injury.

In other words, she “zigs” and he “zags,” and a forcible miss-stroke occurs, which ruptures the outer sheath housing the erection chambers. Fracture can also with rough masturbation, rolling over or falling onto the erect penis, and walking into a wall in a poorly lit room.

In Iran the practice of Taqaandan (Kurdish “to click”) is a cause of penile fractures. This is the practice of creating an audible click by bending the erect penis, comparable to cracking one’s knuckles, but not as harmless.

How Do You Know If You Have Fractured Your Penis?

It is a dramatic event…A popping sound occurs as the outer sheath ruptures, followed by excruciating pain, rapid loss of the erection, and purplish discoloration and extreme swelling of the penis, as the blood within the erection chambers escapes through the rupture site into the soft tissues of the penis.

MRI is useful to show the site, extent and anatomy of the fracture. Prompt repair in the operating room is important to maintain erectile function and minimize scarring of the erection chambers that could result in angulated erections. An injury to the urethra that accompanies the tear in the erectile sheath occurs in a small percentage of men. Even with immediate surgical repair, up to 20% of men will experience a penile curvature with erections and more than 30% will experience ED.

Bottom Line: Penile fracture most commonly occurs from a miss-stroke during sexual intercourse. Prompt attention with surgical repair is very important to help prevent sexual issues.

Wishing you the best of health,

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: -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.

Mystique of the Pelvic Floor Muscles

January 17, 2015

Andrew Siegel, MD  1/17/15

The pelvic floor muscles (PFMs) are shrouded in secrecy, hidden, veiled, concealed and covert, unseen and behind the scenes, unrecognized and misunderstood. In the following few paragraphs, I  will attempt to demystify them. 


Perineal Muscles Male IC Female Perineum IC

The images above are of the male and female perineum, showcasing the all-important ischiocavernosus muscle, one of the PFMs that is vital to sexual function. (Thank you to 1909 Gray’s Anatomy for the images.)


Why Do We Exercise?

We are motivated to exercise for a variety of reasons. Some work out to optimize their physique and beach body (vanity motivation). Others exercise to feel well, to deal with stress, to keep their weight down and to maintain health and longevity (health motivation). Still others exercise for the pure fun, enjoyment and challenge of participating in sports (recreational motivation). Some partake for all of the above reasons. Unquestionably, then, on many levels it is desirable to be aerobically conditioned, flexible and have fit muscles.

Show Vs. Go Muscles

Regardless of the motivation for exercise, the goal is to obtain toned and performance-ready muscles. Our bodies are comprised of a variety of muscle types: There are the glamour, for show, mirror-appeal, overt, seen and be witnessed muscles that offer no secrets—what you see is what you get—the biceps, triceps, pectorals, lats, quads, etc. Then there are muscles including the pelvic floor muscles (PFMs) that are shrouded in secrecy, hidden from view, veiled from sight, concealed and covert, unseen and behind the scenes, unrecognized and misunderstood.

Cloaking increases mystique, and so it is for these pelvic muscles, not only obscured from view by clothing, but also residing in that most curious of nether regions—the perineum—an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the PFM, which straddle the gamut of being vital for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

Tapping into and harnessing the energy of the muscles of the pelvic floor—those that favor function over form, go rather than show—is capable of providing the erotic capital that translates into sexual confidence.  It won’t give you George Clooney good looks, sex appeal and charm but it will help impart sexual fitness and competence.

Why Bother Exercising Muscles Of Function Vs. Form?

The core muscles—with the exception of the rectus (6-pack muscle)—are the muscles for “go,” the non-glitzy muscles of the body that are often ignored and disrespected, as opposed to the external glamour muscles. In general, muscles with mirror appeal are vital for movement function but are not important for many other body functions. Our core muscles are the hidden gems that work diligently behind the scenes and on a functional basis we would be much better off having a “chiseled” core as opposed to chiseled external muscles.”

The PFM are the floor of the core and seem to be the lowest caste of the core muscles; however, they deserve serious respect because although concealed from view they are responsible for some very powerful functions, particularly so when intensified by training. Although the PFM are not muscles of glamour, they are muscles of “amor.” Although having “ripped” external glamour muscles might help get your romance going, you will need to have a well-conditioned pelvic floor to keep it going!

The PFM are among the most versatile muscles in our body, contributing to the support of our pelvic organs, control of bladder and bowel, and sexual function. Unfortunately, because they are out of sight, they are often out of mind, and they are certainly muscles that you should be working out, but are probably not.

Why Did Willie Sutton Rob Banks?

He robbed banks because “that’s where the money is.” When it comes to sexual function, urinary and bowel control and the support of your pelvic organs, the PFM are where the money is. Without them your organs would dangle out of your pelvis and you would be rendered limp and diapered.

Bottom Line: Just because you can’t see them doesn’t mean they aren’t important. You can’t see your heart and diaphragm muscles either, yet many of us are committed to exercise to improve and maintain cardio-vascular health. Your PFM are the “heart of your pelvis” and need to be exercised to improve and maintain pelvic health.


Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in your email in box go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback:  

Co-creator of Private Gym pelvic floor muscle training program for men: 

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to 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 muscle 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 maximal opportunity for gains through its patented resistance equipment.

What You Don’t Know About Testosterone Treatment…and Perhaps A Better Option

January 10, 2015

Andrew Siegel MD  1/10/15

shutterstock_orange gu tract

The Magic Of T

You probably have heard a great deal about T (testosterone) and its extraordinary properties and indeed, for the symptomatic man who has low levels of T, boosting levels of this hormone can result in a remarkable improvement of energy, sexuality (sex drive, erections, ejaculation), masculinity, mood, body composition (muscle and bone mass), mental focus and other parameters. However, men considering T treatment need to understand that T is not a cure-all and must only be used under the circumstances of symptoms of low T and laboratory testing that shows low T. Most certainly, T has been over-marketed, over-prescribed and certain side effects have been understated. It is vital to understand the side effects of T before committing to treatment.

Some Necessary Science

Most T is made by the testicles. Its secretion is governed by the release of LH (luteinizing hormone) from the pituitary, the master gland within your brain. Some of T is converted to E (estradiol). E is the primary hormone involved in the regulation of the pituitary gland. Under the circumstance of adequate levels of T, E feeds back to the pituitary to turn off LH production. This feedback loop is similar to the way a thermostat regulates the temperature of a room in order to maintain a relatively constant temperature, shutting the heat off when a certain temperature is achieved, and turning it on when the temperature drops.

The Effects of Being on Long-Term Testosterone Replacement

So what happens when you have been on long-term T? This exogenous (external source) T, whether it is in the form of gels, patches, injections, pellets, etc., shuts off the pituitary LH by the feedback system described above so that the testes stop manufacturing natural T. Additionally, the testes production of sperm is stifled, problematic for men wishing to remain fertile. In other words, exogenous T is a contraceptive! Nearly all men will have some level of suppression of sperm production while on T replacement, less so with the gels vs. the injections or implantable pellets.

Thus, using T results in the testes shutting down production of natural T and sperm and after long-term T use, the testes can actually shrivel, becoming ghosts of their former functional selves. And if you stop the T after long-term use, natural function does not resume anytime quickly.  Although recovery of natural testosterone and sperm production after stopping T replacement usually occurs within 6 months or so, it may take several years and permanent detrimental effects are possible.  So, at the time that you are receiving the benefits of exogenous T, your natural T is shut off and you can end up infertile, with smaller testicles (testicular atrophy, in urology parlance)!

Is there an alternative for the symptomatic male with low T? Can you boost levels of T without shutting down your testes and developing shrunken, poorly functional gonads?

The answer is an affirmative YES, and one that Big Pharma does not want you to know. There has been such a medication around for quite some time. It has been FDA approved for infertility issues in both sexes and is available on a generic basis. In urology we have used it for many years for men with low sperm counts. But here is a little secret: this medication also raises T levels nicely, and does so by triggering the testes to secrete natural T. It works by stimulating the testes to make its own T rather than shutting them down. No marble-sized testes that have their function turned to the “off” mode, but respectable family jewels. The other good news is that treatment does not necessarily need to be indefinite. The testes can be “kicked” back into normal function, and at some point a trial off the medication is warranted.

The medication is clomiphene citrate, a.k.a, Clomid, and I will refer to it as CC. CC is an oral pill often used in females to stimulate ovulation and in males to stimulate sperm production. CC is a selective estrogen receptor modulator (SERM) and works by increasing the pituitary hormones that trigger the testes to produce sperm and testosterone. CC blocks E at the pituitary, so the pituitary sees less E and makes more LH and thus more T, whereas giving external T does the opposite, increasing E and thus the pituitary makes less LH and the testes stop making T.

Works Like A Charm

CCis usually effective in increasing T levels and maintaining sperm production, testes anatomy (size) and function. Its safety and effectiveness profile has been well established and minor side effects occur in proportion to dose and may include (in a small percentage of men): flushes, abdominal discomfort, nausea and vomiting, headache, and rarely visual symptoms. In general, those with the highest LH levels have the poorest response to CC, probably because they already have maximal stimulation of the testes by the LH.

Not FDA Approved For Low T

One issue is that CC is not FDA approved for low T, only for infertility. Many physicians are reluctant to use a medication that is not FDA approved for a specific purpose. It needs to be used “off label,” even though it is effective and less expensive than most of the other overpriced T products on the market.

Bottom Line: Treatment to boost T levels should only be done when one has genuine symptoms of low T and a low T level documented on lab testing. It is imperative to monitor those on such treatment on a regular basis. Using T to boost T can result in shutting down the testes and the possibility of atrophied, non-functional testes that do not produce sperm or natural testosterone. CC is an oral, less expensive alternative that stimulates natural T production.

A study from Journal of Urology (Testosterone Supplementation Versus Clomiphene Citrate: An Age Matched Comparison of Satisfaction and Efficiency. R. Ramasamy, JM Scovell, JR Kovac, LI Lipshultz in J Urol 2014;192:875-9) compared T injections, T gels, CC and no treatment. T increased from 247 to 504, 224 to 1104 and 230 to 412 ng/dL, respectively, for CC, T injections and gels. Men in all of the 3 treatment arms experienced similar satisfaction. The authors concluded that CC is equally effective as T gels with respect to T level and improvement in T deficiency-related clinical symptoms and because CC is much less expensive than T gels and does not harm testes size or sperm production, physicians should much more often consider CC, particularly in younger men with low T levels.

Wishing you the best of health,

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:

Co-creator of Private Gym pelvic floor muscle training program for men

Your BFF Muscles

January 3, 2015

Andrew Siegel, MD  1/3/2015

(For those not into current slang, BFF refers to “Best Friends Forever,” describing a long-standing friendship that will go on forever.)

** Although this blog is seemingly directed towards men, au contraire. This information is equally relevant to the ladies! Remember that the clitoris is the female counterpart to the penis and it is qualitatively the same, although smaller in stature, and the pelvic muscles that support the genitals are virtually the same.


(Thank you Gray’s Anatomy 1918 for above image of comparative embryology of male and female genitals.)


> 600 Muscles, But Some You Just Can’t Live Without

There are over 600 muscles in your body and let’s face it, they are all important. However, some muscles are more critical to your survival and well being than others. It’s a no-brainer that your heart muscle is valedictorian, followed by your diaphragm. Your heart pumps blood and your diaphragm moves air, functions essential to your existence and quantity of life. Not far down from the top of the list are your pelvic floor muscles (PFM), which provide support to your pelvic organs, allow urinary and bowel control and give you the means to function sexually. Without them you are nothing other than diapered and limp.

A Brief Review of Muscles

There are three kinds of muscles: cardiac (heart), smooth (arteries, intestine, bladder, etc.) and skeletal. Skeletal muscles have numerous different functions, acting as movers, stabilizers, and compressors.

Movers (such as your biceps) act across joints, which allows you to curl your arm up. Stabilizers (such as the multifidis of the back) enable you to maintain good posture and stability. Compressors (such as the rectus abdominis, obliques and transversus abdominis) squeeze the abdominal contents. Other compression muscles act as sphincters; wrapped around the urinary and intestinal tracts, they open and close to provide valve-like control.

Your BFF



(Thank you Gray’s Anatomy 1918 for images of male and female PFM)

Two of the PFM —the bulbocavernosus (BC) and ischiocavernosus (IC) muscles—are particularly beneficial for your sexual health. They function as movers, stabilizers and compressors. When your penis is erect, these are your friends that are responsible for lifting your penis up and down as you contract and relax them. They stabilize the erect penis so that it stays rigid and skyward-angling with excellent “posture.” They compress the deep roots of the penis, responsible for the transformation of the penis from plump to rigid and maintaining that rigidity; additionally, they compress the urethra (urinary channel that runs through the penis) rhythmically at the time of ejaculation.

The BC surrounds the inner, deeper portion of the urethra. I refer to it as the ejaculator. 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 (ejaculate) the last few drops of urine that sit in the deep urethra. During sex, it helps support the spongy erectile body that surrounds the urethra and the head of penis. At the time of climax, it is responsible for the expulsion of semen (ejaculation) by virtue of its strong rhythmic contractions.

The IC surrounds the inner, deeper portion of the erectile bodies, so I refer to it as the erector. In its relaxed state, it acts as an internal strut that helps anchor the deepest aspect of the erectile bodies to the pelvic bones. The IC stabilizes the erect penis and compresses the erectile bodies, decreasing the return of blood to foster penile blood pressures in the severe hypertensive range that allow the penis to have bone-like penile rigidity. At the time of climax, it contracts rhythmically and is responsible for maximal erectile rigidity at the time of ejaculation.

How to Turn Your Best Friends Into Super-Compressors

Use It Or Lose It. Keep your BC and IC muscles in shape by using them the way nature intended. Studies have clearly demonstrated that men who are more sexually active tend to have fewer problems with ED as they age.

Exercise Your BFF Muscles. The BC and IC muscles play a vital role with regards to both erections and ejaculation. Numerous studies have documented the benefits of pelvic exercises in the management of erectile dysfunction. But why wait for dysfunction to set in? Since sexual function inevitably declines with aging, whip your pelvic muscles into shape to help maintain your function. Take it even one step further: work out your pelvic muscles to achieve optimal function. As your pelvic floor muscles increase in strength, tone, and endurance, erections and ejaculation will improve accordingly. The pelvic muscles—like other muscles in your body—will gradually and progressively adapt to the load placed upon them and will strengthen in accordance with the resistance applied.

Bottom Line: If the core muscles are the “powerhouse” of the body, the pelvic floor muscles (floor of the core) are the “powerhouse” of the penis.  To maintain optimal “horsepower,” keep your pelvic floor muscles fit and toned. 


Wishing you the best of health,

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:

Co-creator of Private Gym pelvic floor muscle training program for men Gym-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 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.

Pelvic Floor Muscle Exercises: Becoming the Master of Your Pelvic Domain

January 1, 2015

Andrew Siegel, M.D. 1/1/15

First off, a healthy, happy and peaceful 2015 to all!  I have been writing and posting weekly blogs for almost four years now. This particular blog entry was my most popular one ever with over 500 views on the day it was released. So, with the arrival of the New Year with its emphasis on fitness and health resolutions, I thought it appropriate to repost it. 


The pelvic floor muscles (PFMs)—first described by Dr. Arnold Kegel—are key muscles that are essential to the health and well being of both women and men. These muscles do not get a great deal of respect, as do the glamour muscles of the body including the pectorals, biceps and triceps. The PFM should garner such respect because, although hidden from view, they are responsible for some very powerful and beneficial functions, particularly when trained.


(Thankyou to Pixabay for above image)


Our Core Muscles: A Missing Link

The PFMs compose the floor of our “core” muscles. Our core is a cylinder of torso muscles that function as an internal corset. They surround the inner surface of the abdomen, providing stability. These muscles are referred to in Pilates as the “powerhouse” and in the P90x exercises series, as the “cage.” The major muscle groups in this core are the following: in the front the transversus abdominis and rectus abdominis; on the sides the obliques; in the back the erector spinae; the roof is the diaphragm; the base are the PFMs. These muscles stabilize our torsos during dynamic movements and provide the wherewithal for body functions including childbirth; coughing; blowing our noses; equalizing the pressure in our ears when we are exposed to a change in air pressure as when we travel on airplanes; passing gas; moving our bowels; etc. If you want to be able to expectorate like Gaston in Beauty and the Beast, you need a good core!

Core strength provides us with good posture, balance, support of the back and stabilization and alignment of the spine, ribs and pelvis. The core muscles are a “missing link” when it comes to fitness, often neglected at the expense of the limb muscles.   Tremendous core strength is evident in dancers, swimmers, and practitioners of yoga, Pilates and martial arts. The core stabilizes the trunk while the limbs are active, enabling us to put great effort into limb movements—it is impossible to use the arms and legs effectively in any athletic endeavor without a solid core to act as a platform to push off.   An example of static core function is standing upright in gale force winds—the core helps stabilize the body so that the winds do not cause a loss of balance or posture. An example of dynamic core function is running up flight of stairs, resisting gravity while maintaining balance and posture.

Question (answer below): Can you name an animal that has incredible core strength?

The Pelvic Floor Muscles: Support, Sphincter and Sex

The PFMs form the base of the pelvis and represent the floor of the core muscles. They provide support to the urinary, genital and intestinal tracts. There are openings within the PFMs that allow the urethra, vagina, and rectum to pass through the pelvis to their external openings. There are two layers of muscles: the deep layer is the levator ani (literally, “lift the anus”) and coccygeus muscle. The levator ani consists of the iliococcygeus, pubococcygeus, and puborectalis. The superficial layer is the perineal muscles. These consist of the transverse perineal muscles, the bulbocavernosus and ischiocavernous muscles, and anal sphincter muscle.

The PFMs have a resting muscle tone and can be voluntarily and involuntarily contracted and relaxed. A voluntary contraction of the PFMs will enable interruption of the urinary stream and tightening of the vagina and anus. An involuntary (reflex) contraction of the PFMs occurs, for example, at the time of a cough to help prevent urinary leakage. Voluntary relaxation of the PFMs occurs during childbirth when a female voluntarily increases the abdominal pressure at the same time the PFMs are relaxed.

The PFMs have three main functions: supportive, sphincter, and sexual. Supportive refers to their important role in securing our pelvic organs in proper position. Sphincter function allows us to interrupt our urinary stream, tense the vagina, and pucker the anus and rectum upon contraction of the PFMs. In terms of female sexual function, the PFMs tightens the vagina, helps maintain and support engorgement and erection of the clitoris, and contracts rhythmically at the time of orgasm. With respect to male sexual function, the PFMs help maintain penile erection and contract rhythmically at the time of orgasm, facilitating ejaculation by propelling semen through urethra.

In men, the bulbocavernosus muscle surrounds the inner urethra. During urination, contraction of this muscle expels the last drops of urine; at the time of ejaculation, this muscle is responsible for expelling semen by strong rhythmic contractions. In women, the bulbocavernosus muscle is divided into halves that extend from the clitoris to the perineum and covers the erectile tissue that is part of the clitoris. The ischiocavernosus muscle stabilizes the erect penis or clitoris, inhibiting return of blood to help maintain engorgement.

The PFMs can get weakened with aging, obesity, pregnancy, chronic increases in abdominal pressure (straining with bowel movements, chronic cough, etc.), surgery, and a sedentary lifestyle

How Strong Is Your Pelvic Floor?

The strength of the PFMs can be assessed by inserting an examining finger in the vagina or rectum, after which one is asked to contract their PFMs tightly.

The Oxford grading scale is used, with a scale ranging from 0-5:

   0—complete lack of response

   1—minor fluttering

   2—weak muscle activity without a circular contraction or inward and upward movement

   3—a moderate contraction with inner and upward movement

  4/5—a strong contraction and significant inner and upward movement


Benefits Of PFM Training

PFM exercises are used to improve urinary urgency, urinary incontinence, pelvic relaxation, and sexual function. The initial course of action is to achieve awareness of the presence, location, and nature of these muscles. The PFMs are not the muscles of the abdomen, thighs or buttocks, but are the saddle of muscles that run from the pubic bone in front to the tailbone in back. To gain awareness of the PFM, interrupt your urinary stream and be cognizant of the muscles that allow you to do so. Alternatively, a female can place a finger inside the vagina and try to tighten the muscles so that they cinch down around the finger. When contracting the PFMs, the feeling will be of your “seat” moving in an inner and upward direction, the very opposite feeling of bearing down to move your bowels. A helpful image is movement of the pubic bone and tailbone towards each other. Another helpful mental picture is thinking of the PFMs as an elevator—when PFMs are engaged, the elevator rises to the first floor from the ground floor; with continuing training, you can get to the second floor.

Once full awareness of the PFM is attained, they can be exercised to increase their strength and tone. The good news is that you do not need to go to a gym, wear any special athletic clothing, or dedicate a great deal of time to this. As a test, perform as many contractions of your PFM as possible, with the objective of a few second contraction followed by a few second relaxation, doing as many repetitions until fatigue occurs. The goal is to gradually increase the length of time of contraction of the PFMs and the number of repetitions performed. Working your way up to 3 sets of up to 25 repetitions, 5 seconds duration of contraction/5 seconds relaxation, is ideal. These exercises can be done anywhere, at any time, and in any position—lying down, sitting, or standing. Down time—traffic lights, standing in check-out lines, during commercials while watching television, etc.—are all good times to integrate the PFM exercises. Expect some soreness as the target muscles will be overloaded at first, as in any strength-training regimen. It may take 6-12 weeks to notice a meaningful difference, and the exercises must be maintained because a “use it or lose it” phenomenon will occur if the muscles are not exercised consistently, just as it will for any exercise.

With respect to incontinence and urgency, recognize what the specific triggers are that induce the symptoms.   Once there is a clear understanding of what brings on the urgency or incontinence, immediately prior to or at the time of exposure to the trigger, rhythmically and powerfully contract the PFMs—“snapping” or “pulsing” them repeatedly—can often pre-empt or terminate both urgency and leakage.   This benefit capitalizes on a reflex that involves the PFMs and the bladder muscle—when the bladder muscle contracts, the PFM relaxes and when the PFM contracts, the bladder muscle relaxes. So, in order to relax a contracting bladder (overactive bladder), snap the PFMs a few times and the bladder contraction dissipates. Stress incontinence can improve as well, because of the increased resistance to the outflow of urine that occurs as a result of increased PFM tone and strength.

By improving the strength and conditioning of the PFMs, one may expect to reap numerous benefits. Urinary control will improve, whether the problem is stress incontinence, urgency, or urgency incontinence. Post-void dribbling (leaking small amounts of urine after completing the act of voiding) will also be aided. Furthermore, improvement or prevention of bowel control issues will accrue. Some improvement in pelvic organ prolapse may result, and PFM exercises can certainly help stabilize the situation to help prevent worsening. PFM toning can also improve sexual performance in both genders. When a female masters her pelvic floor, she acquires the ability to “snap” the vagina like a shutter of a camera, potentially improving sexual function for herself and her partner. Similarly, when a man becomes adept at PFM exercises, erectile rigidity and durability as well as ejaculatory control and function can improve. For both sexes, PFM mastery can improve the intensity and quality of orgasms. In terms of quality of life, PFM exercises are as important—if not more so—than the typical cardio and strength training exercises that one does in a gym.

Q.  Can you name an animal that has tremendous core strength?

A. Dolphins—essentially all core with rudimentary limbs.

Wishing you a wonderful 2015,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the inbox 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 Male Pelvic Floor Muscle Training DVD and Program: -available on Amazon as well as Private Gym website