Archive for April, 2015

10 Things You Can Do To Prevent a Limp Penis

April 25, 2015

I have had many requests to reblog this one, so here you go!

Our Greatest Wealth Is Health

Andrew Siegel MD Blog # 168

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

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Kidney Cysts: What You Need To Know

April 25, 2015

Andrew Siegel MD  4/25/15

Kidney cysts, a.k.a. renal cysts, are balloon-like sacs that are fluid filled and are located within or attached to the kidney. The vast majority of renal cysts are not symptomatic nor dangerous and are discovered incidentally on imaging studies (ultrasound, computerized tomography, or magnetic resonance imaging) done for reasons unrelated.  Renal cysts are very common, occurring in about 25% of adults over age 40 and 50% of adults over age 50.  They can be variable in size, ranging from smaller than a pea to larger than a cantaloupe.

Most renal cysts are simple cysts. They are spherical in shape, have a very thin wall, are filled with fluid, do not contain septa (divisions within the walls), calcifications, or solid parts and do not enhance (take up contrast) on imaging studies. They have the appearance of variable-sized water balloons, are benign, and simply need to be followed as they will rarely evolve into a problematic situation. Although large cysts may become symptomatic by compressing adjacent organs, this is unusual. Only very rarely do simple cysts require treatment or intervention. Ultrasound (sonography) is a non-invasive technique that does not require radiation nor contrast injection and is used for determining the number, location, and size of cysts and is also an excellent means of following them over time.

The following image is an ultrasound of a simple renal cyst:

sono-cysts

Although most renal cysts are simple benign cysts, there are more complicated cysts, on occasion being a cystic malignancy of the kidney. If a cyst has a thickened wall or the presence of internal components (septa), calcifications, or it enhances with contrast, it is not classified as a simple cyst, but as a complex cyst.

The current classification of renal cysts is the Bosniak system, named after Dr. Morton Bosniak, the radiologist who devised this system:

I   Simple benign cyst with a thin wall and no septa, calcifications, or solid components. It is the tissue density of water and does not enhance with contrast. Malignancy potential: 0%.

II Benign cyst that may contain hairline septa. Calcification may be present in the wall or septa, but does not enhance with contrast. Malignancy potential: 0-10%.      

IIF (F for follow-up) Cyst that may contain hairline septa. Minimal enhancement may be seen in the wall or septa and may contain calcifications. No soft tissue enhancing elements present. Malignancy potential: 5-25%.      

III Cystic mass that has thickened irregular walls or septa in which enhancement is present. These need to be explored surgically, although some will prove to be benign, including hemorrhagic cysts, chronic infected cysts, and multi-loculated cystic nephroma, while some will be malignant including cystic renal cell carcinoma. Malignancy potential: >50%.      

IV   Clearly malignant cystic masses that contain enhancing soft tissue components. These include cystic carcinomas and require surgical removal. Malignancy potential: > 90% .     

Bottom Line: The vast majority of renal cysts are found incidentally and are simple benign cysts that will never cause symptoms or problems. They are easily followed up with ultrasound and rarely require intervention.

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:

http://www.PrivateGym.com 

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.

Stress No More: A First-Line Approach To Stress Urinary Incontinence (SUI)

April 18, 2015

Andrew Siegel MD   4/18/15

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(Thank you for image above, Pixabay)

What Is SUI?

SUI is urinary leakage provoked by physical activities including sneezing, coughing, bending, lifting, exercising, and positional change. It men it most commonly occurs following radical prostatectomy for prostate cancer, although it can also occur after surgery done for benign prostate conditions. In women it most often occurs due to obstetrical “trauma” from pregnancy, labor and delivery, particularly prolonged labor and vaginal delivery of large babies, although it can also occur from any chronic increase in abdominal pressure (cough, constipation, etc.).

Main Brakes And Emergency Brakes

The urinary sphincters are the specialized muscles that provide urinary control. The main sphincter is composed of smooth muscle and is located at the bladder neck (where the urinary bladder and urethral channel meet) and is designed for sustained control. The auxiliary sphincter—located further downstream and comprised of skeletal muscle and contributed to by the pelvic floor muscles (PFM)—is designed for emergency control. I liken the main sphincter to the brakes of a car and the auxiliary sphincter to the emergency brakes.

Male SUI

In a man, when the main urinary sphincter (internal sphincter) is damaged as a consequence of surgery, the bladder neck is typically scarred in a fixed open position that no longer has the elasticity and suppleness to provide urinary control. Urinary control becomes dependent upon the auxiliary urinary sphincter (external sphincter). However, the auxiliary system is not designed for sustained contraction and although there is constant tone to this muscle, one can only achieve a relatively brief intense contraction.

Female SUI

In a female, the problem is not typically due to damage to the sphincter muscle as much as it is to weakened connective tissues that no longer can provide adequate support and a “backboard’ to the urethra.

The Cough Reflex

The cough reflex is a reflex contraction of the PFM when we cough. This squeezes the urethra and helps prevent urinary leakage. This is nature’s way of protecting us from leaking urine when there is a sudden increase in abdominal pressure, guarding us against cough-related SUI.

Aha! Nature is telling us something here and it is a good rule to always listen carefully to what wise Mother Nature tells us. Nature is informing us that a contraction of our PFM will help prevent SUI. So let’s build upon this and exercise our PFM to increase their strength, tone, and endurance.

Tapping Into The Power Of The PFM

We can replicate the cough reflex—voluntarily—when we are in situations other than coughing that provoke SUI. So, aside from just engaging in a PFM training regimen to increase PFM strength, tone and endurance, we can apply our improved PFM facility to the real life situation of SUI on an on-demand basis. In order to do so, we need to be attentive to the specific triggers that provoke the SUI. By actively squeezing the PFM immediately prior to the trigger exposure, the SUI can be prevented. For example, if changing our position from sitting to standing provokes SUI, doing a brisk PFM contraction when transitioning from sitting to standing should help control the problem. Bracing the PFMs immediately prior to an activity that precipitates the problem can be a highly effective means of managing SUI. When practiced diligently, it can ultimately become an automatic behavior.

Numerous scientific studies have shown the benefits of post-radical prostatectomy PFM training in helping to achieve an early return of urinary control and improving in the severity of incontinence in men. Many studies have also demonstrated the benefits of post-partum PFM training in facilitating an early return of urinary control and improving the severity of SUI in women.

To take it to the next level, committing to PFM training prior to undergoing prostate surgery in males or before pregnancy, labor and delivery in females, may prevent the occurrence of SUI.

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:

http://www.PrivateGym.com 

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.

 

The Muscles Of Love

April 11, 2015

Andrew Siegel MD   4/11/14

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Limber hip rotators,

A powerful cardio-core,

But forget not

The oft-neglected pelvic floor

Three Important Muscle Groups

Sex is an activity that involves many muscles that coordinate with seamless efficiency. Three muscle groups are vital for sexual functioning—core muscles, which maintain stability and enable pelvic thrusting; external hip rotators, which enable outward rotation of the thighs; and the floor of the core muscles—the pelvic floor muscles (PFM)which support erectile rigidity in men and clitoral erection in women and contract rhythmically at the time of orgasm in both men and women. When these muscles are in tiptop shape, sexual function will be optimized. Obviously, cardiac (aerobic) conditioning is a prerequisite for any endurance athletic endeavor, including “sexercise.”

The All-Important Core: The Missing Link

The core muscles are the cylinder of torso muscles that surround the innermost layer of the abdomen and function as an internal corset and shock absorber. In Pilates they are known as the “powerhouse,” as they provide a much greater contribution to overall strength than do our limbs. Our core provides stability, alignment and balance and allows the peripheral muscles an effective springboard from which to push off and work effectively.

The major muscle groups in the 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; and the floor consists of the pelvic floor muscles. These are both stabilizers that maintain the spine and pelvis in alignment and movers as they rotate the torso and extend (straighten) and flex (bend) the spine.

The core muscles are a “missing link” when it comes to fitness, often neglected at the expense of other muscles. Tremendous core strength is evident in dancers, swimmers, and practitioners of yoga, Pilates and martial arts. It is impossible to use our arms and legs effectively in any athletic endeavor without engaging a solid core. Likewise, it is not possible to use our genitals effectively during sexual activity without engaging our core muscles. One can think of the core as the “sexual engine.” A stronger core results in greater sexual “horsepower” and more powerful pelvic thrusting.

Hip Rotators

Rotation of our hips is a vital element of sexual movement. The external rotators are a group of muscles responsible for lateral rotation of our femur (thigh) bone in the hip joint: piriformis, gemellus superior and inferior, obturator internus and externus, and quadratus femoris. My medical school anatomy professor referred to this group as the “muscles of copulation.” The gluteals and the ilio-psoas deserve mention as well, because of their important contribution to external rotation.

The Floor Of The Core

The pelvic floor muscles (PFMs) make up the floor of the core. The deep layer is the levator ani (“lift the anus”), consisting of the pubococcygeus (PC muscle), puborectalis, and iliococcygeus muscles. The superficial layer is the bulbocavernosus (BC), the ischiocavernous (IC), the transverse perineal muscles (TPM), and the anal sphincter muscle.

The PFM muscles are of critical importance to sexual function. The other core muscles and the hip rotators deal with the kinetics and movements necessary for sex, as optimal sexual functioning demands a powerful sexual engine that enables coordinated pelvic thrusting and hip rotation. However, the PFM are distinctive as they directly involve the genitals. The BC and IC muscles engage at the time of sexual activity, stabilizing 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. In the female, these muscles are responsible for clitoral erections and contract rhythmically at the time of orgasm.

Movement And Motion

Unless we are dealing with Tantric techniques, sex is all about movement and motion—it is a kinetic chain, a series of coordinated events in action. It involves the smooth and efficient integration of your core muscles and external rotators in which both pelvic thrusting and lateral rotation of the hips work effectively together to forge a well-choreographed, dance-like motion.

Q. Why did Willie Sutton rob banks?

A. Because that’s where the money is. When it comes to sex, the PFM are where the money is.

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

Pubic Fashion: What Happened To Hair Down There?

April 4, 2015

Andrew Siegel MD   4/5/15

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(Thank you, Pixabay for the above image)

If you don’t know what a merkin and an escutcheon are, read on!

For many of us, it is important that we look and feel attractive and appealing. We dress in a certain way with this in mind. Underneath our clothes, our skin is sometimes used as a canvas for tattoo artwork, nails are painted, makeup is applied, hair is straightened, curled, colored, styled, etc., and we are further accessorized with jewelry. Our genitals are no exception, as tattoos, piercings, and hair have become fashion adornments. Interestingly, for much of the female population, not a hair on the body is left in its wild and natural state—styled hair on the head, plucked and threaded eyebrows, curled eyelashes and removal of leg, underarm and often pubic hair. Hair has spawned a mega-zillion dollar industry in terms of salons, grooming products, coloring, waxing, and plastic surgical and dermatological procedures including hair transplants, laser procedures, etc.

The topic of hair in general and pubic hair in particular is not particularly important in the grand scheme of health and wellness.  However, hair is a curious, strange, and peculiar accessory and we are so in the thick of it that we rarely give it a second thought, but when we do so, it begs many questions.

Why does hair grow only at certain body locations, but not at others? What makes hair at a particular area of our body grow or fall out at a specific time in life?  Why will certain hairs grow to indefinite lengths—like the hair on our head—as opposed to hairs that grow to a fixed length, like eyelashes or hair on the arms or legs? Why do some people have straight hair and others have curly locks and ringlets? Why do aging men often lose hair where they want it and grow it where they don’t—out of their nostrils and ears with exaggerated eyebrow growth? Why does hair turn gray? What is the purpose of hair, anyway? Is body hair a vestige from our evolution from furry primates whose hair perhaps served as an insulating coat? Why are some of us as wooly as apes, some of us as bare as babies, and most of us somewhere in between?

Clearly, genetics plays a key role.  Our inherited blueprint programs skin cells to grow hair in terms of what (color and quality or hair), when (to start and stop growing), where, and how much. This blueprint is modified by external and internal factors including our nutritional and hormonal status.

What’s the deal with pubic hair? It—like the tropical rain forests and polar ice caps—has gone missing…at least for many people. What happened to the days of the “bush,” when the pubic area had a “pelt” growing on it, perhaps giving rise to the slang term “beaver”? Nowadays, some prefer waxing in Brazilian fashion, others shave, some trim, still others prefer a landing strip or other clever design shape, and yet others prefer au natural.

Clearly, genital grooming reflects fads, fashion trends and popular culture. What and who sets these standards? Is it that human beings are a civilized lot and body hair represents the uncivilized, feral animal beast? Or is it the porn industry where most stars have pubic fleeces that are shorn, if not waxed, to better showcase in hi-def every nook and cranny of their exposed genitals? Alternatively, is it that hair is thought of as a masculine accessory and being hairless is a means of maintaining femininity? However, “man-grooming” and “man-scaping” have also become mainstream, not only with respect to the pubic region, but also with regards to chest and back hair. Many men direct as much attention towards body hair grooming as is applied to the coif on their heads.

Factoid: During the Middle Ages, women often shaved their pubic hair because of the prevalence of lice and for reasons of personal hygiene, thereby creating demand for a pubic hair wig called a merkin. Similarly, prostitutes would often wear such a wig to hide the signs of STIs, particularly syphilis.

Factoid: Escutcheon is defined as a shield or emblem bearing a coat of arms, but in days of old, was used by physicians to describe the pattern of distribution of pubic hair—generally triangular in the female and rhomboid in the male. The trending pubic hairstyle of less is more has rendered this term and component of the physical exam obsolete.

Dr. Scott Butler and team authored an article on pubic hair preferences that was published in the January 2015 Journal of Sexual Medicine. Their study involved 1100 college students and concluded that genital grooming and pubic hair removal are common practices. Women were motivated to remove pubic hair for the following reasons: sexual attractiveness; cleanliness; comfort; social norms of their peer group; sexual enhancement; and increased feeling of femininity. Men were motivated for: cleanliness; sex appeal; and body definition/muscularity.

Although more than half of college age men preferred female partners to be hairless, most women preferred their partners to be trimmed, but not hairless. 96% of women and 87% of men reported engaging in some to total pubic hair removal in the prior 4 weeks. College students perceive grooming and removal as normative for their peer group. Total hair removal is correlated with younger age, heterosexual orientation, white race, and being in a relationship.

Bottom Line: Hair is a curious and mysterious ornament. Trends in hairstyles are by no means limited to the head, as pubic hair has become a site of individual self-expression and fashion. The cultural, social and anthropological underpinnings that are the basis for grooming preferences are fascinating.

I’m generally a prose kind of guy, but occasionally a brief rhyme strikes my fancy:

 Some prefer it bare,

Others like it spare,

Still others, all there.

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.