Andrew Siegel MD 3/13/15
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.
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.
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,
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 men: http://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.
Tags: Andrew Siegel MD, Arnold Kegel MD, disuse atrophy, erection, male pelvic fitness, PDE5 inhibitors, pelvic floor muscle, pelvic floor muscle exercises, penile injections, penile rehab, penile rehabilitation, penis, Private Gym, radical prostatectomy, vacuum device