Archive for March, 2015

“Un-Juiced”: When Ejaculation Goes South

March 27, 2015

Andrew Siegel MD   3/21/15

shutterstock_side view manjpeg

There is scarce medical literature on ejaculatory problems aside from those of ejaculatory timing issues (premature and delayed ejaculation) and hematospermia (blood in the semen). Despite being given short shrift in medical academia, not a day goes by in my clinical urology practice where I do not see at least several patients who complain of declining ejaculation function.

What Is The Origin Of The Word “Ejaculation”?

Ejaculation derives from ex, meaning “out”  and jaculari, meaning “to throw, shoot, hurl, cast.”

Trivia: You do not need an erection to ejaculate and achieve an orgasm. A limp penis cannot penetrate, but is eminently capable of ejaculation and orgasm.

If  “Semen” Or “Ejaculate” Is Too Medical For You:

The most popular slang is “cum.” It originates from the expression “come to climax” shortened to “come” and ultimately to “cum,” but not to be confused with the Latin “cum,” e.g., I graduated summa cum laude or the word meaning “along with being,” e.g., my basement-cum-gym! “Jizm,” “jism,” and “jizz” are also popular and are not to be confused with other         “–ism” words that mean a doctrine, e.g., socialism and capitalism! We cannot forget “splooge,” “spooge,” “spunk,” “wad,” “nut,” “load” and “man juice.”

What Happens To Ejaculation As We Age?

Ejaculation and orgasm often become less intense, with diminished force, trajectory and volume of semen. What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated in an arc several feet in length gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis.

Fact: I have never heard a patient complain that his penis is too large, nor have I ever heard anyone protest that his ejaculate volumes are too abundant.

Fact: The pervasive porn industry–where many male stars are hung like horses and whose penises seem capable of ejaculating flooding pools of semen– has given the average guy a bit of a complex.

So What’s The Big Deal?

Men don’t appreciate meager, lackadaisical-quality ejaculations and orgasms. Sex is important to many of us and getting a good quality rigid erection is foremost, but the culmination—ejaculation and orgasm—is equally vital. We may be 40 or 50 years old or older, but we still want to point and shoot like we did when we were 20. As the word origin indicates, we desire to be able to shoot out, hurl or cast like an Olympian Master Blaster and we yearn for that intensely pleasurable feeling of yesteryear.

Ejaculation Science 101

Sexual climax consists of three phases—emission, ejaculation, and orgasm. When the intensity and duration of sexual stimulation surpasses a threshold, emission occurs, in which secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. During ejaculation the pelvic floor muscles contract rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen in a pulsating and explosive eruption. Orgasm is the intense emotional excitement that accompanies the physical act of ejaculation.

Big Head Versus Little Head

Ejaculation is an event that takes place in the penis; orgasm occurs in the brain. The process of emission and ejaculation is actually a very complex and highly coordinated neurological event involving several specific centers in the brain (amygdala, thalamus and other areas), spinal cord and peripheral nervous system.

What’s Makes Up The Reproductive Juices?

Less than 5% of the volume of semen is actually sperm and the other 95+% is a cocktail of genital juices that provide nourishment, support and safekeeping for sperm. 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid (pre-come) that has a lubrication function.

What’s Normal Volume?

The average ejaculate volume is 2-5 cc (one teaspoon is the equivalent of 5 cc). While a huge ejaculatory load sounds like a good thing, in reality it can cause infertility. The sperm can literally “drown” in the excessive seminal fluid.

Why Does The Seminal Tank Dry With Aging?

As we age, there are changes in the reproductive organs, particularly the prostate gland, one of the few organs in the body that enlarges as we get older. The aging prostate and seminal vesicles produce less fluid; additionally the ducts that drain the genital fluids can become blocked. In many ways, the changes in ejaculation parallel the changes in urination experienced by the aging male. Many medications that are used to treat prostate enlargement profoundly affect ejaculatory volume. Additionally, the pelvic floor muscles—which play a vital role in ejaculation—weaken with aging.

What About Those Pelvic Floor Muscles?

The pelvic floor muscles play a key role in ejaculation. The bulbocavernosus muscle (BC) is the motor of ejaculation, which supplies the “horsepower.” The BC surrounds the inner, deepest portion of the urinary channel. It is a compressor muscle that during sex engorges the spongy erection chamber that surrounds the urethra and also engorges the head of penis. At the time of climax, the BC expels semen by virtue of its strong rhythmic contractions, allowing ejaculation to occur and contributing to orgasm. A weakened BC muscle may result in semen dribbling with diminished force or trajectory, whereas a strong BC can generate powerful contractions that can forcibly ejaculate semen at the time of climax. 

How To Get The Juices Flowing Again?

Pelvic floor muscle training can be useful to improve the dynamics of ejaculation. The stronger the BC, the better the capacity for engorgement of the erection chamber that envelopes the urethra and the higher the ejaculatory horsepower, resulting in optimized urethral pressurization and ejaculation. The intensified ejaculation resulting from a robust BC can enhance the orgasm that accompanies the physical act of ejaculation.

Wishing you the best of health,

2014-04-23 20:16:29

AndrewSiegelMD.com

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”: www.HealthDoc13.WordPress.com

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

Co-creator of Private Gym pelvic floor muscle training program for men: www.PrivateGym.com Gym—also available on Amazon

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.

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5 Things You Can Do To Cure Post-Void Dribbling (PVD)

March 20, 2015

Andrew Siegel MD 3/21/15

“No matter how much you shake and dance,

The last few drops end up in your pants.

PVD

PVD is “after-dribbling” of urine that is more annoying and embarrassing than serious. Although it commonly occurs after age forty, it can happen to men at any age.  Immediately or shortly after completing urination, urine that remains pooled in the urethra (tubular channel that conducts urine) drips out, aided by gravity and movement.

One specific pelvic floor muscle (PFM) is responsible for ejecting the contents of the urethra, whether it is urine after completing urination or semen at the time of sexual climax. With aging and loss of PFM strength and tone, both PVD and ejaculatory dysfunction may occur. The specific muscle responsible for ejecting the contents of the urethra is the bulbocavernosus muscle, which compresses the deep, inner portion of the urethra to function as the “urethral stripper.” In fact, the 1909 Gray’s Anatomy textbook referred to this muscle as the “ejaculator urine.”

Factoid: Dr. Grace Dorey published the landmark article in the British Journal of Urology that proved the effectiveness of PFM exercises for erectile dysfunction (ED), but also demonstrated an association between the occurrence of ED and PVD. She essentially showed that ED and PVD are linked and parallel issues, one sexual and the other urinary—both manifestations of PFM weakness, and both treatable by PFM exercises.

Factoid: Dr. Grace Dorey wrote the foreword to my book, Male Pelvic Fitness: Optimizing Sexual and Urinary Health. She also serves as a board member at Private Gym and helped design the Private Gym male pelvic floor training program for men.

What To Do About PVD?

  • PFM training has been proven to be an effective remedy for PVD, with the premise that a more powerful BC muscle will help the process of ejecting the contents of the urethra. Not only will PFM training optimize emptying the urethra, but it also has collateral benefits of improving erections and ejaculation.
  • Try not to rush urination. Urologists interpret “Haste makes waste” as “Haste makes PVD.”
  • When you are finished urinating, vigorously contract your PFMs to displace the inner urethra’s contents. By actively squeezing the PFM by using the Private Gym “rapid flex” technique—3-5 quick pulsations—the last few drops will be directed into the toilet and not your pants.
  • If necessary, PFM contractions can be supplemented with manually compressing and stripping the urethra, but this is usually unnecessary since the PFM—particularly when conditioned—are eminently capable of expelling the urethral contents. To strip the urethra, starting where the penis meets the scrotum, compress the urethra between your thumb on top of the penis and index and middle fingers on the undersurface and draw your fingers towards the penile tip, “milking” out any remaining urine.
  • Gently shake the penis until no more urine drips from the urethra. Apply a tissue to the tip of the penis to soak up any residual urine.

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: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

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

Penile Rehabilitation (Penile “Rehab”)

March 13, 2015

Andrew Siegel MD   3/13/15

shutterstock_side view manjpeg

Penile rehab is probably not what you think. It is not a place where “misbehaved” penises go to get reformed and restored to normalcy. 

Although the term “rehab” has a bit of a negative connotation–a place and a process by which one attempts to reclaim their lives from the grip of a drug, alcohol or other addiction–it should, however, be thought of in a positive sense as a means of regaining strength, skills and normalcy after not only an addiction, but also an injury, illness, or surgery.

Rehab can take many forms: physical (physical therapy to treat an injury or help recover mobility and strength after surgery), occupational (to recover the ability to perform daily activities), speech (to recover comprehension of language, speaking, reading and writing), cardiac (after a serious cardiac event or surgery) and pulmonary (to improve breathing).

What Does This Have To Do With The Penis?

Some abdominal and pelvic surgical procedures—including removal of the prostate, the bladder, and the colon—can result in a penile dysfunction in which it becomes difficult to obtain or maintain an erection. Similarly, pelvic radiation therapy and pelvic injuries can negatively affect one’s sexual function.

The problem is that if you go for too long without an erection, penile smooth muscle and other tissues may be damaged, resulting in a loss of penile length and girth and further compounding the ED. Like every other body part, your penis needs to be used the way nature intended. A marvel of engineering, the penis is uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge of blood flow happening within seconds and accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. An erect penis not only gives you the capacity for penetrative sex, but also serves to keep the penile muscles and tissues richly oxygenated, elastic and functioning well.

Interestingly, studies have demonstrated that sex on a regular basis protects against ED and the risk of ED is inversely related to the frequency of intercourse. Men reporting intercourse less than once weekly had a two-fold higher incidence of ED as compared to men reporting intercourse once weekly. (Am J Med 2008 July; 121(7): 592-596).

In the absence of regular erections, disuse atrophy (wasting away with a decline in anatomy and function) can occur. In a vicious cycle, the poor blood flow resulting from disuse produces a state of poor oxygen levels in the penile tissues, that, in turn, can induce scarring, which further decreases sexual function. This is where the concept of penile rehab comes into play. Rehab the penis after surgical, radiation or physical trauma to get it back into a functional state.

So What Is Penile Rehab?

Penile rehab is a process by which you attempt to recover erectile function after surgery, radiation or injury that compromises your sexual function. This is most commonly used after surgery or radiation for prostate cancer, but is also relevant for other major pelvic surgeries as well as pelvic injuries. There are numerous techniques for penile rehab (in order of least invasive to most invasive): exercises, vacuum, pills and injections.

Pelvic Floor Muscle (PFM) Exercises

This is physical therapy for the penis, which should be a first-line approach because of its safety, non-invasiveness, and minimal expense.

When the pelvic floor muscles contract, they increase blood flow to the penis, specifically by the actions of the two superficial pelvic floor muscles—the bulbocavernosus (BC) and ischiocavernosus (IC) muscles that become engaged at the time of an erection. Contractions of these PFMs prevent the exit of blood from the penis, enhancing penile rigidity. With every contraction of the BC and IC muscles, a surge of blood flows into the penis. Additionally, these muscles act as powerful struts to support the roots of the penis, the foundational support that allows a more “skyward” angling erection. Increasing the strength, tone and conditioning of these muscles will enhance their function, resulting in more powerful contractions and more penile rigidity and stamina. PFM exercises can serve as a powerful tool to help reignite erectile function.

Vacuum Suction Device

This is a mechanical means of producing an erection in which the penis is placed in a plastic cylinder that is connected to a manual or battery-powered vacuum. The negative pressure created by the vacuum literally sucks blood into the penis, creating a state of engorgement.

PDE5 inhibitors: Viagra, Levitra, Cialis, Stendra

Viagra (Sildenefil). Available in three doses—25, 50, and 100 mg—it is taken on demand and will produce an erection in most men within 30-60 minutes if they are sexually stimulated, and will remain active for up to 8 hours.

Levitra (Vardenefil). Available in 5, 10, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra.

Cialis (Tadalafil). Available in 2.5, 5 mg, 10mg, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra. It has duration of about 36 hours that has earned it the nickname “the weekender.” In 2012, daily lower doses of Cialis were FDA approved for the management of urinary symptoms due to benign prostate enlargement.

Stendra (Avanafil). Similar to Viagra, it is available in 50, 100 and 200 mg doses. It has the advantage of a rapid onset.

Penile Injections

Injections of these vasodilators (medicines that increase blood flow) directly into the erectile chambers of the penis induce an erection. Caverject and Edex (Prostaglandin E1) are commonly used for this purpose.  Side effects can be pain, bruising, scarring and prolonged erections. At times, a combination of medications needs to be used to obtain optimal results; this combination is known as Trimix and consists of Papaverine, Phentolamine, and Alprostadil.

Thinking Forward

Adaptation of skeletal muscle is an accepted scientific precept and if you have ever had your arm or leg in a cast, you can understand the detrimental effect of disuse on muscle tone and strength. The corollary is that if you have ever done weight training, you understand the beneficial effect of resistance training on muscle tone and strength.

So, instead of thinking of penile rehab as a means of getting back function after surgery, radiation or injury, how about thinking of it as a means of preventing the inevitable decline in function that accompanies aging? Or to take it another level, think of rehab as a means of optimizing the blue-ribbon function that you may be fortunate enough to already have.  I’m not suggesting using invasive methods such as the vacuum, pills, or injections, but about pursuing exercises that can improve dysfunction, optimize current function and maintain future function.

 

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: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

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

Gone In 60 Seconds: What You Need To Know About Premature Ejaculation

March 7, 2015

Andrew Siegel MD  3/7/15

stopwatch-153398_1280 

(Thank you Pixabay for above image)

 

Be sure that you do not sail too fast and leave your mistress behind.

—Ovid

 

What Is Premature Ejaculation?

Premature ejaculation (PE) is a condition in which sexual climax occurs before, upon, or shortly after vaginal penetration, prior to one’s desire to do so, with minimal voluntary control. It is the most common form of male sexual dysfunction.   “Rapid” ejaculation may be a kinder term than “premature” ejaculation.

The key features are:

  • Brief time to ejaculation (often less than one minute)
  • Lack of control over ejaculation
  • Sexual dissatisfaction, distress and frustration of sufferer and partner.

How Long Should It Take To Climax?

In a study of over 1500 men, The Journal of Sexual Medicine reported that the average time between penetration and ejaculation for a premature ejaculator was 1.8 minutes, compared to 7.3 minutes for non-premature ejaculators.

Another study of 500 couples across five countries reported results ranging from 33 seconds to 44 minutes with the median being 5.4 minutes.

What Causes PE?

PE can be psychological and/or biological and can occur because of over-sensitive genital skin, hyperactive reflexes, extreme arousal or infrequent sexual activity. Other factors are genetics, guilt, fear, performance anxiety, inflammation and/or infection of the prostate or urethra and also can be related to the use of alcohol or other substances.

PE occurs in up to 30% of men, involving all ages, ethnicities, and socio-economic groups. PE can cause embarrassment, frustration and loss of self-confidence and can be devastating to a relationship. It is very typical among men during their earliest sexual experiences.

Who Knew? “Coming Attractions.” One can always use the excuse that being “fast and furious” occurred because of the tremendous attraction and turn-on of your smoking hot partner. However, this trump card can only be played once or twice before it gets very old.  

PE can be lifelong or acquired and sometimes occurs on a situational basis. Lifelong PE is thought to have a strong biological component. Acquired PE can be biological, based on inflammation/infection of the reproductive tract or psychological, based upon situational stressors. PE can sometimes be related to ED, with the rapid ejaculation brought on by the desire to climax before losing the erection.

Emphasis on ejaculation as the focal point of sexual intercourse tends to increase the performance anxiety that can initiate the problem. Once PE has occurred and established itself, fear of and mental preoccupation with the issue can actually induce the unwanted rapid ejaculation, creating a vicious cycle.

How Does One Overcome PE?

Diversionary Thoughts: Non-erotic mental diversionary tactics (concentrating on thoughts other than ejaculating) may prevent PE. Baseball, work, counting backwards, etc., are examples of such thoughts, but these are rarely effective and diminish the pleasure of sexual intimacy.

Down Tempo: This requires one to develop a mindfulness of the sensation immediately before ejaculation. By slowing the pace of pelvic thrusting and varying the angle and depth of penetration before the “point of no return” has passed, the feeling of imminent ejaculation may dissipate.

Pause-Start Method: If slowing the tempo is not sufficient to prevent the PE, one may need to stop thrusting completely while maintaining penetration in order for the ejaculatory “urgency” to go away. Once the sensation to ejaculate subsides, pelvic thrusting may be resumed.

Squeeze Technique: Originated by Masters and Johnson, as imminent ejaculation approaches, the penis is withdrawn and the head of the penis is squeezed until the feeling of ejaculation passes, after which intercourse is resumed. Although effective, it requires sexual interruption, is cumbersome and demands a very cooperative partner.

Pelvic Floor Muscle Training: Contracting one’s pelvic floor muscles is a less cumbersome alternative to the Master and Johnson technique. Instead of the clunky and obvious squeeze technique, a more subtle and discreet method is to slow the pace of intercourse, pause the pelvic thrusting and do a sustained pelvic muscle contraction. This is an internal “squeeze” without the external hand squeeze and can achieve the same goal, short-circuiting the premature ejaculation. With sufficient practice and the achievement of “muscle memory,” this process can become easier and the problem of PE improved, particularly with commitment to a pelvic floor muscle training program.

Decreasing Sensitivity: One method of doing so is by using thick condoms. Alternatively, local anesthetics in the form of topical creams, gels, and sprays can desensitize the penis. These include Lidocaine cream or gel, Lidocaine and Prilocaine (EMLA cream) or Lidocaine spray (Promescent) that are applied before intercourse. Another desensitization technique is increasing the frequency of ejaculation since PE tends to be more pronounced after longer periods of sexual abstinence. By masturbating prior to engaging in sexual intercourse, the PE may be controlled.

Erection Pills: Viagra, Levitra, Cialis and Stendra, which are commonly used for ED, can have a role in the treatment of men with acquired PE that is due to ED.

SSRI Anti-depressants: These selective serotonin reuptake inhibitors can substantially delay ejaculation. One is generally started on a low dose, with an increase in dosage as necessary. Once an effective dosage is achieved, the medication can be used on a situational basis, several hours prior to sexual intercourse.

Counseling: Since PE can be on a psychological basis, it may be beneficial to seek the counsel of a sexual therapist. This can be done in conjunction with some of the aforementioned techniques to hasten the resolution of the PE.

Bottom Line:   Although not life-threatening, PE is a common and distressing quality of life problem that is sometimes relationship-threatening.  The good news is that there are a number of effective treatment options available, so one need not suffer with the problem.   

 

Wishing you the best in health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”: www.HealthDoc13.WordPress.com

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

Private Gym Male Pelvic Floor Muscle Training  Program: 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 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.