Archive for August, 2015

Kegel Exercises To PREVENT Pelvic Floor Dysfunction

August 29, 2015

Andrew Siegel MD   8/29/15

shutterstock_v162886

“Prepare and prevent, not repair and repent.”

Restoring function of injured muscles is a well-established principle in sports medicine, orthopedics, plastic surgery and physical medicine and rehabilitation. The premise is simple: a traumatized or injured muscle is treated with rehab and training to accelerate tissue healing and restore working order. Many of the “baby boomers” demographic (age 51-69)—striving to retain their fitness and youth through exercise and “weekend warrior” activities that promote cardiac health but at the same time, musculoskeletal injuries—understand this concept well.

Dr. Arnold Kegel applied this principle to the female pelvic floor muscles to improve muscle strength and function in women after childbirth. Obstetrical “trauma” (9 months of pregnancy, tough labor and delivery of a 9 lb. baby) can cause pelvic floor dysfunction—urinary and bowel control issues, looseness of the vagina and its support tissues with descent of the bladder, uterus and rectum, and altered sexual function.

This principle has also been applied to men with pelvic floor muscle issues to improve urinary, bowel, erectile and ejaculatory health. Obviously, men do not suffer the acute pelvic floor muscle trauma of childbirth that women do, but they can develop pelvic floor muscle dysfunction from aging, weight gain, pelvic surgery (radical prostatectomy, colon surgery, etc.), a sedentary lifestyle, disuse atrophy, participation in saddle sports including cycling, etc.

An Ounce Of Prevention Is Worth A Pound Of Cure

Why not a radically different approach and instead of fixing pelvic floor dysfunction, try to prevent it? Unfortunately, we have a “reactive” oriented medical culture in the USA that does not emphasize prevention, but “repair.”  Another hurdle is that many people prefer having broken things fixed as opposed to making the effort to avoid breaking them in the first place.

So, if obstetrical trauma to the pelvic floor often brings on pelvic floor muscle dysfunction and its urinary, gynecological, bowel and sexual consequences, why not consider starting pelvic floor muscle training well before pregnancy, perhaps at the time of the first gynecological visit? And if aging, surgery and other factors contribute to male pelvic floor muscle dysfunction and its urinary, bowel and sexual consequences, why wait for the system to malfunction? Why not strengthen and tone the pelvic floor muscles when a man is young and healthy to prevent the predictable age-related decline?

Did You Know? The concept of pelvic floor muscle training BEFORE radical prostatectomy for treatment of prostate cancer is rapidly gaining traction and implementation. Instead of waiting to “rehab” the pelvic muscles after the fact, the concept is to “prehab” them. 

Many of us apply wellness principles through regular exercise—aerobic pursuits for cardiovascular health and strength training to maintain muscle tone, integrity and function—so why neglect the pelvic floor? We work out in the gym not only to achieve better fitness, but also to maintain fitness and prevent age-related losses in strength, flexibility, endurance, etc.

Preventive Pelvic Health Paradigm

Why passively accept the seemingly inevitable, when one can be proactive instead of reactive and can address the future problem before it becomes a problem? Why wait until function becomes dysfunction? Whether male or female, the new paradigm is preventive pelvic health. The goal is to avoid, delay, or minimize the decline in pelvic function that accompanies aging and that is accelerated by pelvic muscle trauma and injury, surgery, obesity and disuse atrophy.

Bottom Line: You have the ability to positively influence your health destiny. Instead of being reactive and waiting for your pelvic health to go south, be proactive to ensure your continuing urinary, bowel and sexual health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive pelvic floor muscle program into your exercise regimen. Much like a vaccine, it will help to prevent a disease that you hopefully will never get.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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.  In the works is The Kegel Fix: Recharging Female Sexual, Pelvic and Urinary Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon.

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The Many Moods Of The Penis

August 25, 2015

Andrew Siegel, MD  8/25/15

There was a terchnical problem with the previous uploading of this blog, so I apologize if you have already received it.

phases of moon

(Thank you and credit for image above, which is in original form, created by Rafa Castillo; https://www.flickr.com/photos/rafa_castillo/5935864125)

The penis is a very moody organ–it can be temperamental, volatile, excitable, up and down, unpredictable and hot-headed at times.  Like the moon, it has many phases of existence, with a multitude of different states, ranging from soft as a marshmallow to hard as a rock. Between deflated and rigid, there are an infinite number of intermediate states, dependent on the dynamic balance between the constricting and relaxing mechanisms of the blood flow to the erectile chambers of the penis.  Human sexual response is all about “vasocongestion” a.k.a., blood flow.

When the mechanisms that regulate inflow and outflow are not functioning properly, problems may occur, ranging from absent erections to poor erections to satisfactory erections that do not last, to prolonged erections that do not quit (priapism).

The penis is a marvel of human hydraulic engineering with four recognizable “phases”:

  • Flaccid phase—On a scale of 0-100% inflated, this is 0-10%. The penis is lackluster and droopy, with enough blood flow to maintain tissue oxygenation and nutritional and metabolic demands. Since the penis is an organ of both sexual and urinary function, thankfully the flaccid state still allows its owner to enjoy the advantage of standing to urinate.

ad-70507_1280Did you know? The flaccid penis is incapable of penetration, but is fully capable of being stimulated to ejaculation and orgasm.

  • Tumescent phase—On a scale of 0-100% inflated, this is 10%-75%. The penis is softly swollen and engorged, but not stiff. It is in the process of being inflated, gradually filling and plumping as blood is pumped into and trapped within the erectile chambers. Like a New Year’s Eve party blowout, the toy that when blown unfurls and extends outwards, so does the tumescent penis as it becomes inspired and shows some spirit, lifting somewhat from its dangling position.
  • Penetration capable phaseOn a scale of 0-100% inflated, this is about 75%-80% or so. The penis has become firmer, but not rigid and is competent to penetrate, although it may require some manipulation to do so. It is animated and peppy and starts to elevate a bit more.
  • Rigid phaseOn a scale of 0-100% inflated, this is 90%-100%. The penis is as stiff as if it had a bone within. The rock-hard penis makes penetration effortless. The energetic, eager and confident penis now defies gravity, proudly pointing towards the horizon, if not the heavens, when its owner assumes the standing position.

fuel-40193_1280

Factors That Lead to Penile Inflation

  • Sensual erotic excitement: sight of a beautiful woman; scent of perfume; sexy whisper; taste of a kiss; soft touch
  • Genital touch: direct stimulation
  • Brain induced erotic stimulation: thoughts, memories, fantasies
  • Dreaming: unique brainstem mediated mechanism that occur during REM (rapid eye movement) phase sleep
  • Spontaneous: occurs for a combination of factors or unknown factors
  • Reflex: full bladder
  • Warm environment: hot bath or shower
  • Gravity: standing upright as opposed to lying down (similar to veins in your arm popping out when arm is lower than heart).

Factors That Lead to Penile Deflation

  • Absence of sexual stimulation
  • Medical issues that interfere with hormones, arterial inflow, venous outflow, nerve supply to penis, smooth muscle in erectile chambers, pelvic floor muscles
  • Medications that interfere directly with blood flow or act centrally on the brain
  • Adrenaline-fueled constriction of penile blood vessels: stress hormone released by fear, anxiety, fighting, fleeing, performance anxiety, etc.
  • Cold exposure (cold shower, bath, swimming, etc.–remember George from the “shrinkage” Seinfeld episode?)
  • Exercise: creates a “steal” of blood flow to large muscles that demand it and away from “unessential” organs
  • Cycling: blood vessels, nerves and pelvic muscles take a beating from compression “trauma”

Hard Science

Note: The following is a brief summary of the science of erections, which may be TMI for many, but will help you understand penis magic.

A limp penis is the state when the arteries and smooth muscle within the erectile chambers are in a constricted state. Penile swelling occurs when stimulation results in increased arterial inflow and relaxation of erectile smooth muscle, permitting filling and expansion of the erectile chambers. The magic chemical that governs this is nitric oxide, present within penile nerves and penile blood vessels. Nitric oxide is what makes it all happen.

 Did you know? Nitric oxide is manufactured from arginine, which is why some feel that arginine supplements may be good for the erectile process; however, the jury is not out on this.

With stimulation, nitric oxide is activated and gets into the smooth muscle cells of the penile arteries and erectile smooth muscle of the erectile chambers where it activates GMP (guanosine monophosphate), which causes the smooth muscle to relax and blood to pour in. This smooth muscle relaxation results in penile blood pressure becoming equal with systolic blood pressure and an engorged penis, plump but not rigid.

Once engorgement occurs, rigidity will follow after the pelvic floor muscles engage. There is no bone in the human penis as there is in many mammals, so nature has evolved a clever trick to generate rigidity using highly pressurized blood.

 Is nature brilliant? Pressurize a liquid to obtain almost a solid state. It’s like freezing water to turn it into ice!

To achieve maximal penile rigidity, penile blood pressure must exceed systolic pressure (the top number of your blood pressure) by 100 millimeters of mercury. This means a penile blood pressure above 220 must be achieved for the average man!

 Did you know? The penis is the only place in the body where high blood pressure is desirable and necessary for proper function. A hypertensive penis is an erect penis and a happy penis. This explains why blood pressure pills are the most common medications associated with erection difficulties.

How does one achieve a hypertensive penis? This is where the “rigidity” muscles come into play. In response to penile stimulation, the pelvic floor muscles (ischiocavernosus and bulbocavernosus) that surround the deep roots of the penis contract rhythmically, clamping venous outflow and compressing the deep roots of the penis, pushing more blood into the erect penis, resulting in penile high blood pressure and full-fledged rigidity. Without the rigidity muscles, the penis would be plump at best.

Did you know?  Would you like to see your rigidity muscles in action?  Stand upright when you have an erection and contract your pelvic floor muscles and watch the penis lift up towards the sky…penis magic! 

After ejaculation, an enzyme known as PDE5 (phosphodiesterase type 5) inactivates the GMP, ending the party, as rigidity dwindles to tumescence to flaccidity. Viagra, Cialis, Levitra and Stendra are PDE5 inhibitors that prevent the inactivation of GMP.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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.  In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon

Pelvic Floor Muscle Exercises: A Vital Part Of Any Balanced Exercise Program

August 15, 2015

Andrew Siegel MD  8/15/15

Project_Yoga_Richmond_1

Image above: Credit to Eli Christman (https://www.flickr.com/photos/gammaman/7170043719/ CC BY 2.0 http://creativecommons.org/licenses/by/2.0, via Wikimedia Commons)

We hear much about the importance of strengthening our “core” muscles. Most core exercise programs focus on the abdominal, hip, and back muscles. However, there are deeper core muscles that form the floor of the core muscles–-the pelvic floor muscles—that are often neglected, particularly by men. These muscles play a vital role in sexual, urinary, and bowel health and in maintaining proper form, balance and posture during virtually any and every form of exercise. Incorporating a pelvic floor muscle program into your workout routine will be to your benefit. 

The Pelvic Floor Muscles

The pelvic floor muscles are not the well-respected, glitzy, for show, mirror-appealing, external glamour muscles. However, these hidden and often-ignored pelvic muscles are hidden gems that work diligently behind the scenes—muscles of major function and not so much form—that have a role that goes way beyond the joint movement and locomotion function of the external muscles. Although concealed, the pelvic muscles have powerful and beneficial functions, particularly so when intensified by training.

Although not our muscles of glamour, they are our muscles of “amour,” and have a profoundly important role in sexual, urinary, and bowel function as well as in supporting our pelvic organs.

Use Them Or Lose Them

The pelvic floor muscles, as with other muscles in the body, are subject to adaptation. Unused as intended, they can suffer from “disuse atrophy,” becoming thin, flabby and poorly functional as happens with aging, weight gain, a sedentary lifestyle, poor posture and other forms of injury and trauma, chronic straining, and surgery. Used appropriately as designed by nature, they can remain healthy in structure and function. When targeted exercise is applied to them, particularly against the forces of resistance, they can be enhanced. Diligently practiced pelvic exercises will allow one to reap tangible rewards, as having fit pelvic muscles is the essence of functional fitness.

Pelvic Floor Muscle Training: In Isolation and Integrated With Other Workouts

There are two means of working out the pelvic floor muscles: in isolation and integrated. In order to become the master of your pelvic domain, it is initially important to isolate the pelvic floor muscles. Once pelvic floor muscle competence is established, pelvic exercises can then be integrated into other exercise routines and workouts. In real life, muscles do not work in isolation but rather as part of a team, the pelvic muscles being no exception. The pelvic floor muscles often contract in conjunction with the other core muscles—particularly the transversus abdominis—in a mutually supportive and synergistic fashion. In fact, many Pilates and yoga exercises emphasize consciously contracting the pelvic muscles simultaneously with the other core muscles during exercise routines.

Engaging the pelvic floor muscles while doing squats, lunges, etc., serves not only to integrate the lower regions of the core and provide optimal support and “lift” of the floor of the core, but also as a means of exercising the mind-body connection.  It is important to avoid over-exertion of the pelvic floor muscles and awareness directed towards this region is sufficient without the necessity for a forceful contraction.

Dynamic exercises in which complex body movements are coupled with core and pelvic stabilization—such as squats and deadlifts—enhance non-core as well as core strength and function to the maximum. The core muscles, including the pelvic floor, stabilize the trunk when our limbs are active, enabling us to put great effort into limb movements. It is impossible to use the arm and leg muscles effectively in any athletic endeavor without engaging a solid core as a platform from which to push off (think martial arts). Normally this happens without conscious effort, but with some focus and engagement, the core and pelvic floor contraction can be optimized. The stronger the platform, the more powerful the potential push off that platform can be.

Pelvic Contractions To Counteract Intense Training Regimens

Weight training and other forms of intensive exercise result in tremendous increases in abdominal pressure. This force is largely exerted downwards towards the pelvic floor, particularly when exercising in the standing position, when gravity also comes into play. Engaging the pelvic floor during such efforts will help counteract the vector of downwards forces exerted on the pelvic floor.

Knack Maneuver

Many females and certain males (particularly after radical prostatectomy) suffer with stress urinary incontinence, a spurt-like urinary leakage that occurs at times of increased abdominal pressure such as with sports and other high impact activities including jumping and kickboxing. For years, urologists and gynecologists have advocated the “knack” maneuver to counteract this, a technique in which the pelvic muscles are braced and briskly engaged at the time or just before any activity that triggers the stress incontinence. When practiced diligently, this can ultimately become an automatic behavior.

Bottom Line: The pelvic floor muscles are out of sight and therefore out of mind. However, these muscles that form the floor of the core are fundamental to many important body functions (sex, urinary and bowel). Pelvic floor muscle conditioning will not only help keep these functions in working order, but also is a vital component to the performance of complex movements that require engagement and stabilization of the core muscles.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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.  In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon.

10 Tips to Keep Your Manhood Manly

August 8, 2015

Andrew Siegel, MD  August 8, 2015

shutterstock_orange gu tract

10 Tips to Keep Your Penis Healthy and Functional

The penis is truly a unique and remarkable organ—one of the only body parts capable of dramatically altering its shape, size, and constitution in nanoseconds. Imagine if our brains or biceps were that responsive, morphing into uber versions of themselves at the appropriate times—like Popeye’s biceps in response to spinach—we would be superheroes!

Trivia: The penis is not the only body part capable of such magic…there is one other organ that when stimulated will change its size fourfold, an even more impressive feat than what the penis is capable of!  Do you have any idea what this organ is?   (Answer at end of blog)

Penis Magic

Under the right circumstances, your penis becomes a proud warrior, a soldier standing tall at attention, saluting, noble, confident and majestic. With enough stimulation, it ferociously spits out DNA, capable of turning eggs into humans. Penis magic!

Your penis should command a great deal of respect–like any unpaired body organ that has no mate to kick in when there is engine failure–including the brain, heart, liver and pancreas. Yet the penis is not an organ that is treated with much respect.  It doesn’t see much light of day or fresh air. It is periodically liberated briefly from its incarceration to allow the bladder to drain or to be cleansed when showering. On occasion it is wrapped up in a suffocating rubber suit and inserted into dark and mysterious places. At other times it is “assaulted” by its owner–wacked, smacked and choked into submission.

Many naively assume that their penis will continue to perform its duties and responsibilities, day after day, year after year. Despite all your penis does for you, most are remiss in providing it sufficient nurture and care.  Without proper attention to its health and well being, it is destined to become less functional with each passing decade. Many chronic conditions are associated with its declining function, including obesity, the metabolic syndrome, diabetes, cardiovascular disease, tobacco use, etc.  What these conditions have in common is a “pro-inflammatory” state that results in dysfunction of the important cells that line blood vessels (endothelial cells), decreased levels of the vital chemical mediator of erections (nitric oxide) and oxidative stress with decreased levels of anti-oxidants and increased levels of free radicals.

The good news is that with some effort, you can maintain healthy functioning until your golden years. Like your car, your penis requires care and preventive maintenance to keep it running trouble-free.  Getting beyond maintenance, you can actually enhance your sexual health and performance, optimizing its function. The following are the top ten means of keeping your penis healthy:

1. Don’t carry extra pounds  

Just as your car suffers a decline in performance if it is dragging around too much of a load, so you penis will function sub-optimally if you are carrying excessive weight. Obesity steals your manhood and reduces male hormone levels. Abdominal fat converts the male hormone testosterone to the female hormone estrogen. Obese men are more likely to have fatty plaque deposits that clog blood vessels, including the arteries to the penis, making it more difficult to obtain and maintain good-quality erections. Additionally, as your belly gets bigger, your penis gets smaller.

2. Use high octane, performance fuel

Put a tiger in your tank with wholesome, natural and real foods that help prevent weight gain and the build-up of harmful plaque deposits within blood vessels. Healthy fuel includes vegetables, fruits, legumes, nuts, whole grains and fish.  Animal products including lean meats and dairy should be eaten in moderation, avoiding processed foods and refined grains. The Mediterranean-style diet is an excellent one for minimizing both sexual dysfunction and heart disease. Poor fuel choices include calorie-laden and nutritionally empty processed and fast foods, which often lead to clogged arteries and poor erections.

3. Minimize stress

Stress and anxiety cause the release of the hormones adrenaline and cortisol. Being nervous causes adrenaline-fueled performance anxiety on the basis of adrenaline constricting blood vessels, which negatively impacts erections. Excessive cortisol secretion drives one’s appetite, causing the accumulation of belly fat.

4. Eliminate toxins, particularly tobacco

You don’t want to put toxins in your tank. In addition to causing cancer, chemicals in tobacco narrow blood vessels, impair blood flow, decrease the supply of oxygen and promote inflammation, compromising every organ in your body, the penis being no exception.

5. Minimize toxins such as alcohol

In small amounts, alcohol can alleviate anxiety and act as a vasodilator (increasing blood flow) and can actually improve sexual function, but in large amounts it can be a major risk factor for erectile dysfunction.

6. Give it a rest

Too much time on the road without sufficient rest is not good for your body or your car. Both you and your vehicle require garage time. Ample sleep serves a vitally important restorative function. Sleep deprivation causes a disruption in endocrine, metabolic, and immune function, resulting in decreased levels of leptin (appetite suppressant), increased ghrelin levels (appetite stimulant), increased cortisol, and increased glucose levels (higher amounts of sugar in the bloodstream). If you are exhausted, your penis is going to be weary as well.

7. Hit the road regularly

Take that vehicle out for a nice ride on a regular basis. Use your body as it was meant to. Exercise has a remarkably positive effect on sexual function, in addition to reducing stress, improving mood, preventing fatigue, and increasing energy. It reduces risk for diabetes, heart disease, stroke, high blood pressure, some cancers, osteoporosis, chronic medical problems, and physical disability. Exercise makes the heart a better and stronger pump, the blood vessels more elastic, and the muscles more efficient at extracting oxygen. Exercises that work out the muscles involved in sex—the core muscles, the external rotators of the hip, and the all-important pelvic floor muscles—will improve bedroom performance.

The pelvic floor muscles play a vital role with erections and ejaculation. When you are sexually stimulated, the pelvic floor muscles activate to maintain penile rigidity and a skyward angling erection. These muscles are not only responsible for getting the stimulated penis from a tumescent state (plump with blood) to a bone-like rigid state, but also for maintaining that rigid state and for being the “motor” of ejaculation.

8. Stay active

Use it or lose it. You can help keep your penis in good shape by using it regularly as nature intended it to be used. Studies have clearly demonstrated that men who are more active sexually tend to have fewer problems with erections as they age.

9. Maintain healthy relationships

It takes two to tango, so relationship harmony factors strongly into good sexual functioning just as discord and interpersonal issues can profoundly contribute to sexual issues. The mind-body connection is of immense importance to sexual function.

10.  Preventive maintenance

 You bring your vehicle in regularly for oil and filter changes, tire rotations, and other means of preventing trouble, so do the same for your body with regular visits to your doctor to perform whatever tests are necessary to preempt issues before they become problematic. If you are having problems with your favorite organ, it is time to consult your friendly urologist.

Bottom Line: The Golden Rule of the Penis: “Do unto your penis as you would have your penis do unto you.”…In other words, treat your penis kindly and it will return the favor; treat your penis poorly and it will rebel.  First-line therapy for erectile dysfunction is lifestyle changes and a proactive approach will keep you functioning smoothly for many years.  

Q. What organ in the body when stimulated will change its size fourfold?

 A. The pupil of the eye will dilate from 2 millimeters in diameter in bright light to 8 millimeters in dark, as governed by the iris.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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.  In the works is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon

The Many Moods Of The Penis

August 5, 2015

Andrew Siegel, MD   8/22/15

phases of moon

(Thank you and credit for image above, which is in original form, created by Rafa Castillo; https://www.flickr.com/photos/rafa_castillo/5935864125)

The penis is a very moody organ–it can be temperamental, volatile, excitable, up and down, unpredictable and hot-headed at times.  Like the moon, it has many phases of existence, with a multitude of different states, ranging from soft as a marshmallow to hard as a rock. Between deflated and rigid, there are an infinite number of intermediate states, dependent on the dynamic balance between the constricting and relaxing mechanisms of the blood flow to the erectile chambers of the penis.  Human sexual response is all about “vasocongestion” a.k.a., blood flow.

When the mechanisms that regulate inflow and outflow are not functioning properly, problems may occur, ranging from absent erections to poor erections to satisfactory erections that do not last, to prolonged erections that do not quit (priapism).

The penis is a marvel of human hydraulic engineering with four recognizable “phases”:

  • Flaccid phase—On a scale of 0-100% inflated, this is 0-10%. The penis is lackluster and droopy, with enough blood flow to maintain tissue oxygenation and nutritional and metabolic demands. Since the penis is an organ of both sexual and urinary function, thankfully the flaccid state still allows its owner to enjoy the advantage of standing to urinate.

ad-70507_1280Did you know? The flaccid penis is incapable of penetration, but is fully capable of being stimulated to ejaculation and orgasm.

  • Tumescent phase—On a scale of 0-100% inflated, this is 10%-75%. The penis is softly swollen and engorged, but not stiff. It is in the process of being inflated, gradually filling and plumping as blood is pumped into and trapped within the erectile chambers. Like a New Year’s Eve party blowout, the toy that when blown unfurls and extends outwards, so does the tumescent penis as it becomes inspired and shows some spirit, lifting somewhat from its dangling position.
  • Penetration capable phaseOn a scale of 0-100% inflated, this is about 75%-80% or so. The penis has become firmer, but not rigid and is competent to penetrate, although it may require some manipulation to do so. It is animated and peppy and starts to elevate a bit more.
  • Rigid phaseOn a scale of 0-100% inflated, this is 90%-100%. The penis is as stiff as if it had a bone within. The rock-hard penis makes penetration effortless. The energetic, eager and confident penis now defies gravity, proudly pointing towards the horizon, if not the heavens, when its owner assumes the standing position.

fuel-40193_1280

Factors That Lead to Penile Inflation

  • Sensual erotic excitement: sight of a beautiful woman; scent of perfume; sexy whisper; taste of a kiss; soft touch
  • Genital touch: direct stimulation
  • Brain induced erotic stimulation: thoughts, memories, fantasies
  • Dreaming: unique brainstem mediated mechanism that occur during REM (rapid eye movement) phase sleep
  • Spontaneous: occurs for a combination of factors or unknown factors
  • Reflex: full bladder
  • Warm environment: hot bath or shower
  • Gravity: standing upright as opposed to lying down (similar to veins in your arm popping out when arm is lower than heart).

Factors That Lead to Penile Deflation

  • Absence of sexual stimulation
  • Medical issues that interfere with hormones, arterial inflow, venous outflow, nerve supply to penis, smooth muscle in erectile chambers, pelvic floor muscles
  • Medications that interfere directly with blood flow or act centrally on the brain
  • Adrenaline-fueled constriction of penile blood vessels: stress hormone released by fear, anxiety, fighting, fleeing, performance anxiety, etc.
  • Cold exposure (cold shower, bath, swimming, etc.–remember George from the “shrinkage” Seinfeld episode?)
  • Exercise: creates a “steal” of blood flow to large muscles that demand it and away from “unessential” organs
  • Cycling: blood vessels, nerves and pelvic muscles take a beating from compression “trauma”

Hard Science

Note: The following is a brief summary of the science of erections, which may be TMI for many, but will help you understand penis magic.

A limp penis is the state when the arteries and smooth muscle within the erectile chambers are in a constricted state. Penile swelling occurs when stimulation results in increased arterial inflow and relaxation of erectile smooth muscle, permitting filling and expansion of the erectile chambers. The magic chemical that governs this is nitric oxide, present within penile nerves and penile blood vessels. Nitric oxide is what makes it all happen.

 Did you know? Nitric oxide is manufactured from arginine, which is why some feel that arginine supplements may be good for the erectile process; however, the jury is not out on this.

With stimulation, nitric oxide is activated and gets into the smooth muscle cells of the penile arteries and erectile smooth muscle of the erectile chambers where it activates GMP (guanosine monophosphate), which causes the smooth muscle to relax and blood to pour in. This smooth muscle relaxation results in penile blood pressure becoming equal with systolic blood pressure and an engorged penis, plump but not rigid.

Once engorgement occurs, rigidity will follow after the pelvic floor muscles engage. There is no bone in the human penis as there is in many mammals, so nature has evolved a clever trick to generate rigidity using highly pressurized blood.

 Is nature brilliant? Pressurize a liquid to obtain almost a solid state. It’s like freezing water to turn it into ice!

To achieve maximal penile rigidity, penile blood pressure must exceed systolic pressure (the top number of your blood pressure) by 100 millimeters of mercury. This means a penile blood pressure above 220 must be achieved for the average man!

 Did you know? The penis is the only place in the body where high blood pressure is desirable and necessary for proper function. A hypertensive penis is an erect penis and a happy penis. This explains why blood pressure pills are the most common medications associated with erection difficulties.

How does one achieve a hypertensive penis? This is where the “rigidity” muscles come into play. In response to penile stimulation, the pelvic floor muscles (ischiocavernosus and bulbocavernosus) that surround the deep roots of the penis contract rhythmically, clamping venous outflow and compressing the deep roots of the penis, pushing more blood into the erect penis, resulting in penile high blood pressure and full-fledged rigidity. Without the rigidity muscles, the penis would be plump at best.

Did you know?  Would you like to see your rigidity muscles in action?  Stand upright when you have an erection and contract your pelvic floor muscles and watch the penis lift up towards the sky…penis magic! 

After ejaculation, an enzyme known as PDE5 (phosphodiesterase type 5) inactivates the GMP, ending the party, as rigidity dwindles to tumescence to flaccidity. Viagra, Cialis, Levitra and Stendra are PDE5 inhibitors that prevent the inactivation of GMP.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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.  In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon

Vibrators and Kegels: Not Just For The Ladies

August 1, 2015

Andrew Siegel MD   8/1/2015

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At least 30 million men in the USA suffer with erectile dysfunction (ED) and with longevity on the rise, more and more men will have sexual issues. Traditional ED treatments focus on increasing blood flow to the penis, which is essential to erectile function.  However, other vital contributing factors include the roles of the nervous system and the pelvic floor muscles, which can now be tapped into to our advantage, thanks to emerging technologies.

Traditional Management of Erectile Dysfunction

Most conventional forms of management of ED focus on enhancing penile blood flow. This can be achieved via a variety of pharmaceuticals– oral ED medications (Viagra, Levitra, Cialis, Stendra), penile urethral suppositories (M.U.S.E.–alprostadil) and penile injection therapy (Caverject, Edex, Bimix, Trimix, etc.). The vacuum suction device is a mechanical means of filling the penis with blood, using a manual or battery-powered vacuum. Negative pressure engorges the penis with blood and a constriction ring placed around the base of the penis maintains the erection by trapping the blood.

Despite the emphasis on manipulating blood flow to the penis to manage ED, it is important to understand that erections are much more than simply a vascular (blood flow) event. Obtaining and maintaining an erection is a nerve-blood vessel-muscle event, dependent upon functioning nerves that provide sensation and muscle contraction, proper spinal cord and brain function; intact artery and vein blood supply to the penis; and well-functioning erectile smooth muscle within the penis and erectile skeletal muscles surrounding the roots of the penis. In addition to nerves, blood vessels and muscles essential to the process, additional influencing factors are hormones and the psycho-emotional state of the individual. All elements are integrated and provide the functional basis for an erection.

 Deconstructing the Erection Process

Obtaining and maintaining a rigid erection results from a complex interplay of the following elements within the human body:

Nerves: When the penis is stimulated by touch, sensory nerves (dorsal nerve and perineal nerve, which join up to form the pudendal nerve) relay this information to spinal cord centers, which reflexively (via the cavernous nerves) relay to the penile arteries the message to increase blood flow, resulting in the penis engorging with blood. Tactile stimulation of the penis is also conveyed directly to the brain, enhancing this reflex response. Brain-induced erotic stimulation (visual cues, sounds, smells, touch, thoughts, memories, etc.) leads to further stimulation of the penis via cavernous nerve stimulation from excitatory pathways that descend from the brain. The bulbo-cavernosus reflex is important in terms of initiating and maintaining an erection (governed by sensory and motor branches of the pudendal nerve): with stimulation of the head of the penis, there is a reflex contraction of the pelvic floor muscles that causes more blood to be pushed into the penis.

Blood vessels: The cavernous nerve stimulation causes the arteries to the penis and those within the vascular sinuses (erectile tissue) of the penis to substantially increase blood flow.

Smooth muscle: The erectile smooth muscle within the sinuses relaxes to allow filling of the sinuses with blood. Veins that drain the sinuses are occluded, trapping blood within the sinuses. This smooth muscle relaxation results in penile blood pressure becoming equal with systolic blood pressure and an engorged penis, plump but not rigid.

Skeletal muscle: There is no bone in the human penis as there is in many mammals, so nature has evolved a brilliant trick to generate erectile rigidity—the use of readily available blood as a pressure medium under sky-high pressures. To achieve maximal penile rigidity, penile blood pressure must exceed systolic pressure by 100 mm of mercury. This means a penile blood pressure in excess of 220 mm must be achieved for the average man. The penis is the only place in the body where high blood pressure is desirable and necessary for proper function! A hypertensive penis is an erect penis and a happy penis! This explains why blood pressure pills are the most common medications associated with ED.

How exactly does one achieve a hypertensive penis? This is where the “rigidity” muscles come into play, the ischiocavernosus and bulbocavernosus pelvic floor muscles muscles that surround the deep roots of the penis. In response to penile stimulation via the bulbocavernosus reflex, these muscles contract rhythmically, clamping venous outflow and squeezing the deep roots of the penis, pushing more blood into the erect penis, resulting in penile high blood pressure and full-fledged rigidity. Without the rigidity muscles, the penis would be engorged, but not rigid.

Hormones: Testosterone is “male rocket fuel.” A normal level of testosterone is important in terms of both sex drive and the facilitation of erections, although it is possible to obtain erections even in the face of low testosterone levels.

Psycho-emotional factors: Psychological and emotional status has a significant effect on erectile function. Mood, stress levels, interpersonal and relationship issues, etc.—acting via the mind-body connection and the release of a “cocktail” of neurochemicals—can influence erectile function for better or worse. Stress, for example, induces the adrenal glands to release a surge of adrenaline. Adrenaline constricts blood vessels, which has a negative effect on erections, the basis for the common occurrence of adrenaline-fueled performance anxiety.

The Down Side of Traditional Erectile Dysfunction Treatments

Medications undoubtedly can be very helpful for ED. However, they are expensive and are getting increasingly so, have side effects and there are a number of clinical situations in which they cannot be used. Other issues are lack of spontaneity and the need for chronic use. Pills are easy to swallow, but many men find the thought of inserting a suppository in their urethras or putting a sharp needle in their penis less than satisfactory.

Vacuum suction devices do not permit rigidity of the roots of the penis and therefore cause a pivoting and unstable erection. The skin of the penis can become cool and dusky because of the constriction ring, which can be uncomfortable and impede ejaculation. As of July 1, 2015, the vacuum device and accompanying tension ring were statutorily excluded from Medicare coverage and thus not payable when billed to Medicare.  Since the vacuum suction device is no longer covered by Medicare it has become a costly alternative.

These treatments that deal only with the blood flow component of erections neglect the important contributions of nerve stimulation and the “rigidity” muscles.

 New Treatment Options Beyond Drugs & Pumps

An alternative strategy is to focus on nerve stimulation and the rigidity muscles.

Vibratory genital stimulation has been used successfully for many years to enhance sexual response and induce climax in females, so why should it be any different for the male gender? Vibrators applied to the penis have traditionally been used for spinal cord injured patients who wish to father children, but cannot ejaculate. The use of vibratory genital stimulation has recently been expanded to ED, impaired rigidity, sexual dysfunction after radical prostatectomy and orgasmic/ejaculation issues.

Viberect, made by Reflexonic, is an FDA-certified hand-held penile vibratory stimulation device useful for triggering erection and ejaculation. It provides simultaneous stimulation of the genital nerves at both the dorsal (top) and ventral (bottom) surfaces of the penis. Penile vibratory stimulation stimulates the reflex between the penis and the spinal cord (pudendal-cavernosal reflex), resulting in tumescence (gradual filling of the penis with arterial blood). Penile vibratory stimulation of the head of the penis also contributes to erectile rigidity via inducing rhythmic contractions of the ischiocavernosus and bulbocavernosus via the bulbocavernosus reflex. By enhancing the bulbocavernosus reflex and triggering neural activity in the brain, spinal cord and peripheral nerves, vibratory stimulation provokes erection and ultimately, ejaculation.

Pelvic floor muscle training—which has also been used successfully in females for years—is capable of optimizing function of the male “rigidity” pelvic floor muscles. The Private Gym program, made by Adult Fitness Concepts, is the go-to means of increasing pelvic floor muscle strength, tone, power, and endurance. It is a comprehensive, interactive, easy-to-use, medically sanctioned and FDA-registered follow-along exercise program that builds upon the foundational work of Dr. Arnold Kegel. It is the first program of its kind designed specifically to teach men exactly how to perform the exercises. A clinical trial has demonstrated its effectiveness in fostering more rigid and durable erections, improved ejaculatory control and heightened orgasms. The Basic Training program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises, while the Complete Training program provides maximum opportunity for gains via resistance equipment.

Both the Viberect and the Private Gym are unique sexual management tools—approaches that go beyond the conventional blood flow enhancement treatments of ED—that work on different aspects of the many facets of erectile physiology. Combining use of the Viberect and the Private Gym is a partnership with great harmony and synergy that works on both the initiation of erection via Viberect’s ability to stimulate neurovascular cavernous reactivity as well as the maintenance of erection via Private Gym’s ability to enhance venous occlusion, penile blood pressure and durability of erectile rigidity. Using the Viberect – Private Gym combination does not in any way preclude using additional therapies such as the aforementioned medications. Both Viberect and Private Gym are safe, non-invasive, sustainable and cost-effective treatments with the Viberect costing $299 and the Private Gym $99.

 Preparing For and Recovering From Radical Prostatectomy

Having your prostate removed is an effective means of curing prostate cancer. Unfortunately, because of the prostate’s precarious location – – at the crossroads of the urinary and genital tracts, connected to the bladder on one end, the urethra on the other, touching upon the rectum, and nestled behind the pubic bone in a well-protected nook of the body – – it’s removal has the potential for causing unwanted and undesirable side effects.

Oftentimes, urologists are more focused on removing the prostate cancer (and saving the patient’s life) than spending time educating patients on how to minimize the negative effects of the surgery. Prior to and after radical prostatectomy, by using the combination of nerve stimulation in conjunction with strengthening the pelvic floor muscles, negative side effects can be greatly reduced.

It can take several years to recover maximal sexual function after radical prostatectomy. Post-prostatectomy ED seems to be on the basis of many factors including trauma to nerves, blood vessels, and muscular tissue that can compromise sexual function (and urinary control). The poor tissue oxygenation that results from the penis being flaccid for long periods of time can cause loss of erectile smooth muscle function, scarring and venous leakage (a condition in which there is rapid loss of an erection as blood is not properly trapped within).

Penile rehabilitation (“rehab”) is commonly used to get the blood flowing and maintain penile tissue oxygenation and elasticity, expediting erectile recovery. Treatment modalities that have been used for rehab include oral medications, urethral suppositories, penile injections and the vacuum suction device.

The partnership of Viberect neural stimulation and Private Gym pelvic muscle training is a welcome addition to the penile “rehab” regimen. Viberect stimulates the nerves that help induce an erection, while Private Gym strengthens the muscle system that powers, supports, and controls erectile rigidity. This combined treatment provides a safe, non-invasive, natural solution without side effects and does not preclude the use of traditional ED management.

Furthermore, using the Viberect and Private Gym together before and after prostate surgery can have a significant positive psychological impact on the patient. Once diagnosed with prostate cancer, men often have anywhere from four to eight weeks before surgery. This period of waiting and worrying about the upcoming surgery is often a very emotional and psychologically disruptive time. The same is true during the recovery process. Using Private Gym and Viberect enables patients to take an active role in preparing for surgery as well as facilitating recovery in the post-operative period, empowering them throughout the process.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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.  In the works is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

Viberect: http://www.Reflexonic.com-available on Amazon as well as Viberect website