Archive for May, 2015

What’s Up And Coming In Male Sexual Dysfunction?

May 30, 2015

Andrew Siegel MD  5/30/15

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Technological advances and innovations have occurred in the field of sexual medicine. Trending and novel approaches to ED will be reviewed and my comments will follow (in blue).

Many treatments for ED are essentially “Band-Aids” that do not correct the problem at its root cause, but manage the problem on an on-demand basis, typically beneficial for one sexual encounter. This is the case with all of the new technologies that will be discussed with the exception of pelvic floor muscle training (PFMT) and shockwave therapy, both of which provide an ED management that can be rehabilitative or curative.

Exercises To Improve Your Sexual Function

You go to the gym for cardiovascular health and strength training, but who thinks about the important group of muscles that contribute to erectile rigidiity, erectile durability, and healthy ejaculatory function?  Pelvic floor muscle training (PFMT) is a natural, safe, non-invasive means of empowering men, improving many sexual and urinary conditions. These exercises will gradually achieve the status, traction and common use in men as Kegel exercises have in women through PFMT programs like Private Gym (www.PrivateGym.com).  PFMT can help fix one of the common underlying factors that contribute to ED—poorly functional pelvic floor muscles. Impaired pelvic floor muscles promote the outflow of penile blood from the erectile chambers and result in lower erectile blood pressures and softer erections.

PFMT is strongly trending to become a routine first-line approach for the management of male sexual dysfunction. I predict that in the near future, many men with healthy sexual function will use PFMT to maintain healthy function and to help prevent  typical age-related declines, just as exercise in general is used to maintain health and wellness and slow the aging process.

External Penile Support Devices

The Erektor, manufactured by Global Life Technologies (www.erektorforlife.com), is an externally applied mechanism that provides length and rigidity to the penis. It is worn during intercourse in order to permit sufficient rigidity for penetration. It consists of two cylindrical rings attached to a rigid rod that is customized to one’s penile length. The penis is stretched and placed within the rings and the rod sits on the undersurface of the penis.

Think scaffolding…Functional, but not much of a crowd pleaser! What is she going to think? Great name, though…Erektor.

The Penile Cast is an external cast that the penis is placed into to gain the ability to penetrate. It provides rigidity to the shaft and some sensation is possible through cutouts.

Think hollow dildo. She’d probably prefer using this one alone, without you attached to it!

Penile Vibrator

Penile vibratory stimulation is a means of provoking an erection in men who suffer with ED. Additionally, it is a mechanism to provoke ejaculation in men who have a spinal cord injury rendering them incapable of ejaculating. Developed by Reflexonic (www.reflexonic.com), the Viberect was FDA approved for ED in 2011. The device has two arms that are placed in contact with the penile shaft that apply the vibrations, and the vibratory stimulation will cause an erection and ultimately ejaculation.

The company was kind enough to send me a sample device, which I have in the office. It is somewhat bulky and cumbersome, appearing like an oversized stapler. It is a bit on the noisy side, but effectively causes an erection and ejaculation. Perhaps the next generation will be smaller and quieter. It may prove useful in penile rehabilitation after radical prostatectomy.

Penile Shockwave Therapy

Shockwaves are acoustic waves carrying energy that can be focused and targeted. For many years, urologists have used shockwave therapy to pulverize kidney stones. Low intensity shockwave therapy is a novel treatment for ED that when applied to the penis causes cellular micro-trauma and mechanical stress, which causes growth of new blood vessels and improved blood flow.

It has been used in the treatment of chronic wounds, neuropathy, cardiac disease and has been recently trialed for ED. A pilot study in humans applied the shockwaves to five separate sites on the penis resulting in an increase in rigidity and durability of erections using the International Index of Erectile Function as a metric. An additional study showed positive short-term effects in men who previously responded well to oral ED medications. Clinical trials have shown both subjective improvement in ED as well as objective increased penile blood flow and erectile rigidity. Shockwave therapy has the potential of altering one of the underlying causes of the ED, poor arterial inflow of blood.

Intriguing, with promising results from preliminary trials with further clinical investigation necessary and need for optimal treatment protocols to be determined.

Impulse Magnetic Therapy

Certain types of magnetic fields are capable of enhancing blood circulation and increasing cellular oxygen uptake. Magnetic stimulation thus has the potential for inducing increased blood flow to the penis with studies suggesting that magnetic field therapy can improve ED.

Also interesting, with promising results from preliminary trials with further clinical investigation necessary and the need for intensity, frequency and duration protocols to be established.

Tissue Engineering

There is abundant ongoing research in the field of creating—in the lab—biological substitutes to replace injured, diseased or malfunctioning tissues and organs. Although the future appears encouraging, as of now there are no bioengineered tissue substitutes applicable to poorly functioning or damaged penile tissues.

Not ready for prime time when it comes to the penis.

Nanotechnology (Nanoparticle Delivery System)

Nanoparticles are packaged molecules—comparable in size to viruses—that can encapsulate biologically active materials, such as the oral ED medications or nitric oxide, the chemical mediator of erections. A gel that contains such nanoparticles can be applied to the skin of the penis to achieve an erection. This has the potential advantage of the active medication being delivered to the target organ and not distributed throughout the body, avoiding side effects. To date this technology has only been tested in laboratory animals.

Any word preceded by “nano-“ sounds very cutting edge and high tech! Great concept, but who knows? Human clinical trials need to be performed. Testing has resulted in excellent quality erections in our rat friends.

Endovascular Treatment

One cause of ED is blockage of pelvic arteries by fatty deposits, which do not permit sufficient blood flow to achieve an erection. Endovascular treatment is a non-invasive therapy of focal vascular lesions (small and localized areas of arteries that are clogged), an alternative to open surgery to bypass obstructed vessels. A drug-eluting stent (a device that not only bypasses an obstruction, but also releases medication) is placed in a blocked internal pudendal artery. The stent elutes Zotarolimus, a medication that is used to prevent the artery from reblocking. An initial clinical trial has shown improvement in ED in appropriate patients with focal vascular lesions.

In a patient with arteriogenic ED due to pudendal artery blockage, this may prove advantageous, just as drug-eluting stents have been beneficial for coronary artery blockages that would otherwise have required open coronary bypass. The jury is still out, with expanded clinical trials necessary.

The “P-Shot”

Named after the Greek God of Fertility, the Priapus Shot or the “P-Shot” claims to increase the size of the penis by 10-20% and produce harder and longer lasting erections. Platelet rich plasma (PRP) is extracted from the patient’s own blood and injected into the penis. The patient is required to use a penis pump over the course of the treatment. The premise is that growth factors in the PRP promote the growth of new blood vessels to the penis. Providers of the P-Shot claim it is the most significant advancement in cosmetic surgery in decades.

The claims are anecdotal, hypothetical, with little scientific research and evidence supporting them. The jury is still out on this one, but it sure sounds interesting.

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-founder of Private Gym: http://www.PrivateGym.com–available on Amazon and 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.

 

Peyronie’s Disease: Not the Kind of Curve You Want

May 23, 2015

Andrew Siegel MD  5/23/15

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(Thank you, Pixabay, for above image)

Peyronie’s Disease is an inflammatory condition of the penis that causes curvature and an uncomfortable or painful erection. It is not uncommon– 65,000-120,000 cases per year in the USA–with only a small fraction of those who have the disease actually seeking treatment. Although it can occur at any age, it most commonly is seen in 50-60 year-olds. Essentially, it is scar tissue in a bad location, which sabotages the ability to obtain a straight and rigid erection, resulting in a dramatic interference with one’s sexual and psychological health.

Why Is Penile Curvature Called Peyronie’s Disease?

Most people assume that Peyronie’s disease is named after poor Monsieur Peyronie, who not only was afflicted with the disease, but also was further disgraced by having the disease named after him. The truth of the matter is that Peyronie’s disease is named after the French surgeon, de la Peyronie, who first described it in 1743.

How Do You Know If You Have Peyronies?

Peyronie’s Disease causes fibrous, inelastic “plaques” of the sheath surrounding the erectile chambers that reside within the penis. This results in deformities of the penis during erections, including the presence of a hard lump(s), shortening, curvature and bending, narrowing, a visual indentation of the penis described as an hour-glass deformity and pain with erections as well as less rigid erections.  Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse. The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is impossible. The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring. Although the scarring is physical, it often has psychological ramifications, causing anxiety and depression.

What Causes It And What Can You Expect In The Future?

The underlying cause of Peyronies is unclear, but is suspected to be penile trauma—perhaps associated with excessive bending and buckling from sexual intercourse—that activates an abnormal scarring process. During acute Peyronies, erections are painful and there is an evolving scar, curvature and deformity. The chronic phase occurs up to 18 months or so after initial onset and at which time the pain and inflammation resolve, the curvature and deformity stabilize, and often erectile dysfunction is noted. Peyronie’s regresses in about 15% of men, progresses in 40% of untreated men, and remains stable in 45% of men. Many men become very self-conscious about the appearance of their penis and the limitations it causes, and they may avoid sex entirely.

Is Peyronie’s Treatable?

Treatment options include oral medications, topical agents, injections of medications into the scar tissue, shock wave therapy, and surgery. Upon initial diagnosis, most men are started on oral Vitamin E, 400 IU daily, as this has the potential to soften the scar tissue causing the plaque. Many of the aforementioned treatments are not particularly effective because scar tissue is a challenging problem. Erectile dysfunction can be often be managed with ED medications.

Xiaflex—a.k.a. collagenase—derived from the clostridium bacteria, is the newest treatment for Peyronies. It has been used for years for Dupuytren’s contracture, a similar situation to Peyronie’s that occurs on the hand, causing a scarring of the tissue beneath the skin of the palm and fingers, making it very difficult to straighten one’s fingers. Xiaflex functions as a “chemical knife” by dissolving collagen, the main constituent of scar tissue. It is typically used for men with an angulation of 30 degrees or more. It is injected directly into the scar tissue after which the area is massaged and modeled to disrupt the scar tissue and mold the penis. One course of treatment may involve as many as eight injections. Injection of this medication can be highly effective, but is not without side effects including bruising, swelling, pain and possibly rupture of the erectile chamber of the penis causing a penile fracture.

If there is an unsatisfactory response to conservative managements, a penile implant may be appropriate. This can manage the dual problems of erectile dysfunction and penile angulation. If erections are adequate, but angulation prevents intercourse, options include doing a “nip and tuck” opposite the plaque in an effort to make expansion more symmetrical. Although this technique is effective in improving the angulation, it does so at the cost of penile shortening. Other more complex procedures involve incising or removing the scar tissue and using grafting material to replace the tissue defect.

Bottom Line: When scar tissue occurs on an area of the body that moves, expands or acts as a channel, it affects function as well as form. Thus a scarred elbow can impact mobility, scarred lungs can disturb breathing, a scarred bile duct can cause jaundice and scarred erectile chambers can cause Peyronie’s. The good news is that mild Peyronie’s does not need to be treated and if more severe forms occur that interfere with one’s quality of life, there are effective means to treat it.  

Resources:

www.peyroniesassociation.org

www.askaboutthecurve.com

www.menshealthPD.com

Wishing you the best of health and a great Memorial Day weekend!

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-founder of Private Gym: http://www.PrivateGym.com–available on Amazon and 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.

Use Your Pelvic Floor To Overcome Over-Active Bladder

May 16, 2015

Andrew Siegel MD  5/16/15

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Over-Active Bladder (OAB) is urinary urgency (the sudden and urgent desire to urinate) and frequency (urinating too often, which can be during both awake and sleep hours), with or without urgency incontinence (urinary leakage associated with the urgent desire to urinate). It is often due to involuntary contractions of the bladder in which the bladder squeezes—inappropriately so—without its “owner’s” permission. Although it can occur without provocation, it is commonly triggered by positional changes such as going from sitting to standing, exposure to running water, approaching a bathroom, and when placing the key in the door to one’s home.

The American Urological Association guidelines for OAB recommend pelvic floor muscle (PFM) training as first-line therapy for OAB because voluntary PFM contractions can effectively inhibit involuntary bladder contractions and squelch the urgency and urgency incontinence.

Bladder Physiology 101

In order to effectively tap into the powers of the pelvic floor, a basic understanding of bladder function is necessary. During urine storage, the bladder muscle is in a relaxed (non-contracting state) and the urinary sphincters (contributed to by the PFM muscles), responsible for urinary control, are engaged (contracted). During urine emptying, the bladder muscle contracts and the sphincter muscles relax synchronously. This “antagonistic” relationship between the bladder muscle and the PFMs can be used to the advantage of those suffering with OAB. Since people with OAB often have bladders that contract involuntarily causing the symptoms of urgency and frequency, a means of getting the bladder to relax is to intentionally engage the PFMs to benefit from the reflex relaxation of the bladder that occurs with voluntary contraction of the PFMs.

The PFM-Bladder Reflex

This is a very useful and practical reflex that you can easily access. This reflex is unique because it can be engaged voluntarily and because it results in the relaxation of a muscle as opposed to its contraction. Anyone who has ever experienced an urgent desire to urinate or move one’s bowels will find this reflex of great practical use. When the reflex is deployed, it will result in relaxation of both the urinary bladder and rectum and a quieting down of the urgency.

How To Use The Reflex To Your Advantage

When you feel the sudden and urgent desire to urinate, pulse the PFMs five times, briefly but intensely. When the PFM are so deployed, the bladder muscle reflexively relaxes and the feeling of intense urgency should disappear. Likewise, when the PFM are so deployed, the rectum relaxes and the feeling of intense bowel urgency should diminish. This reflex is a keeper when you are stuck in traffic and have no access to a toilet!

PFM training helps stimulate the inhibitory reflex between the PFMs and the bladder muscle. A PFM training program will stimulate your awareness of the PFM and enable you to isolate them and increase their strength, tone, and endurance. The inhibitory reflex will become more robust and you will develop an enhanced ability to counteract urgency, frequency and urgency incontinence. Urgency can often be diminished and the urgency incontinence can often be abolished.

Getting beyond inhibiting urgency after it occurs is preventing it from occurring in the first place. In order to do so, it is important to recognize the specific triggers that induce the urgency, frequency or incontinence: hand washing, key in the door, rising from sitting, running water, entering the shower, cold or rainy weather, etc. Prior to exposure to a trigger, rapid flexes of the PFM can preempt the involuntary bladder contraction before it has a chance to occur.

Bottom Line: There are many treatments available for OAB, including decreasing your fluid and caffeine intake, bladder re-training, oral medications, Botox injections into the bladder and neuro-stimulation. As a first-line approach, tap into the powers of your PFM and harness the natural reflex in which involuntary bladder contractions can be inhibited or prevented by engaging your PFM.

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.

Eyes Wide Open: Genital Mindfulness

May 9, 2015

Andrew Siegel MD 5/9/15

Pay careful attention to your body, including your genitals. Erectile function (or lack) is a barometer of your overall health and a bellwether for disease as well as an indicator of cardiovascular health.

Iris_-_right_eye_of_a_girl

Be Mindful

Observe your penis in both flaccid and erect states. Carefully watch and listen to your urinary stream. Keep an eye on  your urine and semen. It sounds strange, but by doing so you will gain insight into your general and pelvic health. Don’t forget to examine your testicles periodically when showering, feeling for lumps, bumps or asymmetry.

Skin Matters

Are there any rashes or skin lesions on the penis or scrotum? The genital skin—like the rest of our skin—can be subject to allergic responses, infections and cancers.

Power Tool No More?

Are you “limping” in the bedroom with less rigid and durable erections? This may be a sign of a problem with the cardiovascular system. The penile arteries are smaller than the coronary arteries of the heart and narrow before those of the heart have an opportunity to do so, so ED can be a predictor of a more generalized disease process involving other blood vessels.

Sex Drive Gone South?

Are you more interested in baseball than in sexual matters? If so, it may be time for a libido check and an evaluation of your testosterone level, as T is the “governor” of sex drive.

Erection Curved like a Banana?

Has your formerly straight erection gone “rogue”? Does it appear curved like a banana or is it angled like a periscope? Is there an area of narrowing that looks like a “waist” giving it an “hourglass” appearance? If so, you may have Peyronie’s disease, scarring of the sheath of the erectile cylinders of the penis causing a painful curvature.

Dribbling Instead of Shooting?

Did your previously powerful and intense ejaculation morph into a weak sputter of a small volume of semen with diminished intensity? If this is the case, you may have weakened pelvic floor muscles.

What’s That?

Is there a discharge from your urethra? If so, you might have a urethral infection/inflammation known as urethritis or other sexually transmitted infection. If you have not ejaculated in some time, it is possible that there will be a milky white discharge at the time of a bowel movement as the prostate is “milked” by the act of defecation.

Funky Colored Urine?

Urine color ranges from clear to amber, depending upon your state of hydration. When well hydrated, your urine will look clear or very pale yellow, like light American beer. When dehydrated, your urine becomes very concentrated, appearing dark amber, like a strong German beer.

Fresh bleeding in the urinary tract makes the urine appear bright red whereas old blood appears tea or cola-colored. In either case, blood in the urine is abnormal and should be investigated to ensure that the bleeding is not on the basis of a serious condition such as bladder or kidney cancer.

Excessive vitamin B intake can result in light orange urine. Overconsumption of beets, blackberries, and rhubarb can sometimes impart a red color to urine. Cloudy urine may be indicative of a urinary tract infection, but can also occur when one’s diet consists of foods high in phosphates.

When urine is occasionally foamy or sudsy, it is considered to be normal. When it occurs consistently, it can be a sign of protein in the urine, often indicative of kidney disease.

Funky Smelling Urine?

A sweet smell may indicate diabetes. A foul odor may be on the basis of a urinary infection or the intake of certain foods, e.g., asparagus. Vitamin intake can also cause the urine to have an unpleasant odor. Vitamins B and C are water soluble and therefore not stored in the body and any excess above what is necessary for the body’s use is excreted in the urine. Malodorous urine that has a fecal odor may indicate a bad urinary infection or possibly an abnormal connection between the colon and the bladder known as a fistula. This happens most commonly from diverticular disease of the colon and when it occurs, there is often air in the urine as well.

Does It Burn?

If urination is painful, it may indicate a urethral or urinary infection.

Can’t Put Out a Fire Anymore?

When you observe your flow, does it hesitate before it gets going? Is the stream weak and split into several streams or sprays like a spigot? Does it start and stop and seem to take forever to empty? When you have to go, do you have little warning and a tremendous desire to urinate? Are you leaking urine before you get to the toilet? Do you have an after-dribble? Does the sound of your urination that once was like the rapids of a powerful river now sound like a meek creek? If so, you may have plumbing issues on the basis of prostate enlargement, scar tissue in the urethra, or an overactive or underactive bladder.

Bloody Show?

Blood in the semen can literally scare the “daylights” out of you. However, the majority of men with “hematospermia” have a benign inflammation of the prostate that is not a serious problem, often as innocuous as a nosebleed.

Bottom Line: Scrutinize your genitals to discover much about your health.

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.

Pelvic “Trauma” From Cycling And Other Saddle Sports: What To Do

May 2, 2015

Andrew Siegel, MD  5/2/15

1995_Fremont_Solstice_parade_nude_cyclist_01

(Nude cyclist 1995 Fremont Solstice Parade…thank you Wikipedia Commons)

 When sitting on a saddle—whether a bike seat, motorcycle seat, horse, etc.—one places a great deal of body weight on the perineum (area between genitals and anus), putting anatomy that is usually protected into a vulnerable position. Prolonged time in the saddle can compress vital genital nerves and arteries and traumatize the pelvic floor muscles (PFMs) that are essential for erectile and clitoral rigidity. The scrotum and the inner aspect of the penis (penile roots anchored to the pelvic bones) as well as the labia and inner aspect of the clitoris can be compressed as well. Over time, with repeated stress to the pudendal nerve and artery, PFMs and penile root, damage may lead to sexual dysfunction.

Cycling, in particular, has the potential for wreaking pelvic havoc. The downward force of the cyclist’s weight while tilting forward on the saddle generates extreme pressure on the perineum that pinches the pudendal nerve and artery against the pubic arch. Both the duration and the magnitude of compression are factors in determining the degree of trauma. Moreover, many cyclists are lean and their limited body fat does not provide padding that could potentially offer some relief from saddle pressure. Cycling-related sexual dysfunction has multiple factors involved including the geometry and hardness of the saddle, the anatomical variations of the individual, the amount of time spent in the saddle, the cyclist’s weight, the intensity of the effort, and the style of sitting, which is nuanced and variable.

Wide Enough, Flat Enough, Firm Enough

The saddle nose is the part of the bike seat that is especially dangerous. Greater saddle width and the absence of a saddle nose have been the most important factors in preventing compression. If the saddle is not wide enough to support the ischial tuberosities (sit bones), body weight is borne by the perineum. It is important for a saddle to be flat enough because if there is too much curvature, the center of the saddle can push up into the perineum and cause compression. Additionally, it is important that a saddle is firm enough. Gel saddles actually cause more trauma than unpadded saddles by virtue of the body sinking into the soft padding. The reduced surface area of saddles with a narrow cutout can actually increase the extent of the pressure (on the edges of the cutout); however, for those cyclists who find that if they have a saddle that is sufficiently wide, flat and firm yet remains uncomfortable, they may need a cutout to help relieve some of the discomfort.

Numerous factors influence compression. A horizontal or downward-pointing saddle position causes less pressure. Heavier riders exert more pressure on their saddles than lighter riders. Lower handlebars may worsen the situation by forcing the rider to lean forward, putting more body weight on the perineum. As a cyclist goes from sitting upright to the bent over aerodynamic position, the torso and pelvis rotate forward and the sit bones are lifted off the saddle surface, shifting more weight onto the perineum. This is clearly a superior position for racing, but inferior for one’s genital health!
 On the other extreme, when standing on the pedals, there is no pressure. Mountain bikes cause a greater degree of sexual dysfunction than road bikes, likely because of the additional hammering and vibrational trauma from cycling over rough terrain; however, this is balanced to some extent by the use of suspension mechanisms, the increased time spent out of the saddle and more frequent dismounts.

Kegels For Your Pelvic Health: Resuscitate Your Genitals

Dr. Arnold Kegel popularized PFM exercises to improve female sexual and urinary health after childbirth. His legacy lives on with the exercises that bear his name—Kegel exercises. Men have the same PFM as do women and an equivalent capacity for exercising them, with parallel benefits to urinary and sexual health. Saddle sport participants can tap into their PFMs to pump some “life” back into their compromised genitals after a long ride.

Similar to using a bike pump to inflate tires so that they are well pressurized, with each contraction of the PFM, blood pumps into the genital tissues to help “resuscitate” them.

PFM training can be valuable to help lessen pelvic trauma from saddle sports. PFM training increases the strength, tone, and endurance of the PFMs and can ease saddle compression. Aside from committing to an exercise regimen, the practical application is to actively squeeze the PFMs for 1-2 seconds repeated 3-5 times, before, during and after cycling. Most cyclists will periodically take a break from sitting in the saddle by standing up and this provides a perfect opportunity to take the pressure off the perineum and to do a few PFM contractions to restore genital blood flow.

Keys To Reducing Risk Of Sexual Dysfunction

  1. Wear well-padded shorts. 

  2. Shift from sitting to standing every 10 minutes or so, and if numbness and tingling occur, shift position or stand more often. 

  3. 
Sit back firmly on your sit bones and not on your perineum: as you shimmy from nose towards rear saddle, you can feel the proper engagement. 

  4. Invest in an ergonomic saddle tailored to your anatomy—make sure it is wide enough to support your sit bones, firm enough so that your perineum doesn’t sink and flat enough so that you don’t slide and that it doesn’t wedge up under your perineum.

  5. Adjust seat and handle bar height and angle to minimize compression. 

  6. Do PFM contractions periodically while cycling and PFM exercises when not cycling. 

  7. If you start having sexual issues, seek help! 


Bottom Line: Cycling and other saddle sports may contribute to both male and female sexual dysfunction, especially for serious participants who spend prolonged time in the saddle. Pay careful attention to your perineum, a most valuable piece of human real estate.

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.