Archive for September, 2015

What’s Your Favorite Nerve?…How ‘Bout The Pudendal?

September 26, 2015

Andrew Siegel MD   9/26/15

13357-vintage-illustration-of-the-human-nervous-system-pv

(Image above is public domain illustration of the human nervous system)

We all have favorite colors (I’m partial to blue and green) and numbers (3 does it for me), but favorite nerves? Who has a favorite nerve? I submit that you have a favorite nerve, but just don’t know it!

There are many nerves within the human body and there are quite a few of vital importance. They do their jobs quietly, diligently, efficiently, behind the scenes. They are usually taken for granted and most of us have no awareness of them unless their function becomes impaired–as might happen when they become inflamed, traumatized, injured or diseased–giving rise to a host of neurological symptoms.

The system of nerves is essentially a massive network of “wires” that conduct and transmit electro-chemical impulses from the brain and spinal cord to and from every cell in the body. In order for nerves to work effectively, they need some “breathing room” so that they can function unimpeded.

We often become aware of our nerves when they are compressed, temporarily altering their function and giving rise to numbness, pins and needles sensation, etc. It happens to me when I sleep with my arms folded across my chest (ulnal nerve compression from arm flexion) causing me to wake up with a funny sensation involving the outside of my hand and pinky finger and the outer part of the ring finger. It occurs when I go out on a long bike ride, causing a tingly sensation in my right hand (ulnal and radial nerve compression from wrist hyperextension), despite wearing padded gloves. Similarly, I experience genital numbness (pudendal nerve compression from the bike seat), even though I wear padded bike shorts and have a fitted saddle. It also tends to happen when I sit for a lengthy period of time on the “porcelain throne” engaged with reading material, causing my lower legs and feet to “go to sleep” (sciatic nerve compression). Driving for a long period of time also irritates my sciatic nerve, causing an achy sensation in my butt, which runs down the back of my thigh, a good reason to periodically stretch out.

So What Is Your Favorite Nerve?

The cranial nerves are good candidates—those that derive directly from the brain and are responsible for sight, hearing, smell, balance, swallowing, smiling, etc. Most every medical school learns the following cranial nerve mnemonic: On Old Olympus Towering Tops, A Fin And German Viewed Some Hops— the first letter of each word representing the first letter of the 12 cranial nerves: Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory Vestibular Nerve, Glossopharyngeal, Vagus, Spinal Accessory, Hypoglossal. The 31 spinal nerves are certainly contenders as well—they originate directly from the spinal cord and provide sensation and the ability to use our muscles, indisputably key functions.

How About The Pudendal Nerve?

The pudendal nerve should be considered one of our dearest and fondest. It is the main nerve of the perineum—that valuable, but often unappreciated bit of human real estate located between the scrotum and the anus in the male and the vagina and the anus in the female. This nerve provides sensation to the penis and scrotum of the male and the clitoris, vulva and vagina of the female. In both males and females it provides sensation to the perineum and anal area and enables contraction of the pelvic floor muscles and voluntary continence muscles–the external urinary and anal sphincters. Its function is imperative for sexual arousal, clitoral and penile erection, ejaculation and orgasm.

Who Knew? The term pudendal derives from the Latin “pudenda,” meaning “the shameful parts.” Sadly, our culture has strong puritanical roots.

Who Knew? In the early 19th century, Benjamin Alcock, a prominent Irish anatomist, first described the existence of the pudendal nerve and the channel in which it travels, known as “Alcock’s canal.”  Alcock sure is a fitting name for the man who discovered the nerve responsible for penile sensation, ejaculation and orgasm!

The Human Sexual Response

In accordance with Masters and Johnson’s classic findings, the human sexual response can be can be distilled down to increased genital and pelvic blood flow (the primary reaction) and muscle tensioning (the secondary reaction). Orgasm is the release from the state of increased blood flow and tensioned muscles. It is pudendal nerve stimulation that initiates the process of increased genital/pelvic blood and pelvic muscle tensioning. At the time of orgasm the pudendal nerve is what drives the rhythmic contraction of the pelvic floor muscles.

With sexual stimulation of the genitals, sensory nerves that form the pudendal nerve relay to spinal cord centers, which reflexively relay the electrochemical message to increase genital and pelvic blood flow, resulting in female lubrication and clitoral engorgement and male penile erection. The nervous system also relays directly to sexual centers in the brain, including the hypothalamus, hippocampus, amygdala, thalamus, brainstem etc., enhancing this reflex response. Brain-induced erotic stimulation (visual cues, sounds, smells, touch, thoughts, memories, etc.) leads to further genital stimulation via excitatory pathways that descend down from the brain to the genitals.

The bulbo-cavernosus reflex (governed by sensory and motor branches of the pudendal nerve) is important in initiating and maintaining erection: with stimulation of the head of the penis or clitoris,  a reflex contraction of the pelvic floor muscles increases genital blood flow, enhancing penile rigidity and clitoral engorgement.

Bottom Line: Nerves are required for all body functions and some are indispensible. Although there are more important nerves than the pudendal nerve–such as the vagus nerve, which commands unconscious body processes such as heart rate and digestion–the pudendal nerve just might be your favorite! Without a functioning pudendal nerve, your genitals would be numb, sex would be impossible, your pelvic organs would hang unsupported and you would be diapered because of absent bladder and bowel control.

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 (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator 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: www.PrivateGym.com or Amazon.

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Medical Use of Vibrational Stimulation Devices…And More

September 19, 2015

Andrew Siegel, MD   9/19/15

Dolly's_House_Museum_vibrator

(Image above  is antique vibrator in Dolly’s House Museum in Ketchikan, Alaska. Copied under the terms of the GNU Free Documentation License, Author Wknight94, August 2009)

Vibrators are far more than erotic toys used to enhance female sexual pleasure. Their prevalence of use in the male population is catching up to that of females. It is becoming a more conventional practice for physicians to recommend their use as a component in the management of many forms of sexual dysfunction for both genders.

The origin of vibrational devices dates back to Victorian times, when masturbation was considered to be a deviant behavior, particularly so for women. In the late 1800s, the diagnosis of “female hysteria” was commonly entertained. This was a vague symptom complex consisting of anxiety, insomnia, irritability, fainting, outbursts, excessive sexual desire, etc. It was often managed with pelvic and genital manipulation (“medicinal massage”) by physicians in an effort to bring a patient to “hysterical paroxysm” (a.k.a., orgasm). This typically dramatically relieved the “hysteria” symptoms and this practice of “physician-assisted paroxysm” became entrenched in both European and American medical practice. It proved to be lucrative for physicians and a socially acceptable means of sexual fulfillment for multitudes of women, greatly appreciative of services rendered and readily willing to return for regular office treatments.

The medical community that delivered such treatments often became afflicted with fatigue that developed as a consequence of overuse of their hands. The vibrator was invented as an electro-mechanical medical device to facilitate the treatment of “hysteria” and preserve the cramped and achy fingers of physicians. It was a welcome advance that efficiently brought patients to “hysterical paroxysm,” allowing physicians to treat more patients. With the advent of this device, what sometimes took an hour and was not always successful could be accomplished in a matter of minutes. In 1880, a British physician, Dr. Joseph Mortimer, patented the electric vibrator. It was originally referred to as Granville’s hammer. In 1883, he wrote a book on the subject entitled: “Nerve-Vibration and Excitation as Agents in the Treatment of Functional Disorder and Organic Disease.”

Vibrational devices became popular outside the medical community when electricity became available in American homes. As these devices became commercially available, women began buying them for personal use. In the early 1900s, they were advertised and sold in many popular women’s magazines and catalogs and were eventually called “personal massagers” as a means of to make them more socially acceptable. The era of “physician-assisted paroxysm” came to an abrupt end.

What Goes Around Comes Around

Modern vibrators are battery-powered or plug-in handheld “sexual enrichment aids” that generate vibratory pulsations of a variety of amplitudes and frequencies, intended to enhance sexual stimulation in both females and males. They can be used externally and/or internally to facilitate arousal, sexual pleasure and orgasm. Their popularity has increased markedly over time and they are now readily displayed and sold in mainstream retail outlets.

In the earliest years of vibrational devices, they were used under the domain of the medical community with subsequent use dominated by individuals for recreational use. This has turned full circle, as it has become an increasingly acceptable practice for medical practitioners to recommend vibrational devices as a means of treating sexual dysfunction. Vibrator use is now recognized as a bona fide tool in the armamentarium to help manage both female and male sexual dysfunction, including arousal disorders, erectile dysfunction and difficulty achieving orgasm.

For a number of years, vibrator use in males was predominantly for the spinal cord injured population that desired to father children but could not ejaculate. When a vibrator is applied to the head of the penis of a spinal cord injury patient, it initiates a reflex erection and subsequently ejaculation and thus became an accepted means of gathering semen in order to perform insemination. (It will also do the same for men without spinal cord injuries.)

In recent years, a medical penile vibratory stimulation device specifically designed for male anatomy has become available. The device consists of dual vibrators for the purpose of providing vibration stimulation to both the top and bottom surfaces of the penis. It is prescribed for many forms of male sexual dysfunction, including difficulty obtaining and maintaining an erection, rigidity issues, ejaculatory and orgasmic dysfunction and erectile dysfunction occurring after prostate surgery. It is now being use in conjunction with pelvic floor training prior to prostate surgery in order to help prevent the sexual and urinary side effects that may ensue after prostate removal.

 Female Vibrator Use

A medical study of almost 4000 women showed vibrator use in 53%. With respect to demographics, married women are more apt to partake than single women and their use in lesbian women is more prevalent than heterosexual women and greater in Caucasian women than African-American or Hispanic women. Vibrator use correlates with education level with the more educated using vibrators more commonly than the less educated population. Those who attend religious services more regularly are less likely to be users than those who attend services less regularly.

Vibrators are frequently used in solo as well as partnered sexual activities. 46% of females use vibrators during masturbation, 41% during foreplay or sex play with a partner and 37% during sexual intercourse. Of those females who use vibrators, 84% have used them for clitoral stimulation and 64% for vaginal stimulation. Negative side effects from vibrator use are occasional and mild and include numbness, pain, irritation, inflammation, swelling, and rarely tears or cuts. Women who use vibrators experience more positive sexual function in terms of desire, arousal, lubrication, pain, and orgasm. Vibrator use is correlated with other health promoting behaviors.

Male Vibrator Use

About 50% have used one during their lifetime, 10% within the last month, 15% in the past year and 20% more than one year ago. Women play a pivotal role in driving vibrator use in men: 40% of men have used a vibrator during sexual play or foreplay with a partner, 36% during sexual intercourse and 17% during solo masturbation.

In a survey of 1000 men who were questioned about why they used vibrators, the most common reply was “for fun,” followed by “to spice up my sex life,” “curiosity,” “to help my partner orgasm,” and “upon the request of a sexual partner.” A small percentage of men use vibrators to facilitate their own orgasm.

Men who use vibrators report less sexual dysfunction than non-users, scoring higher on four of five domains of the most common index used for erectile dysfunction (International Index of Erectile Function). Slightly higher proportions of gay and bisexual men use vibrators as opposed to heterosexual men.

Bottom Line: Vibrator use is a healthy, safe and well-established practice that has contributed to sexual enhancement in more than half of American women and often their partners. In both genders, vibrator use correlates positively with healthy sexual functioning and other health-promoting behaviors. Vibrators have found their way into the current medical armamentarium, prescribed by physicians and offering a non-pharmacological option to the management of many forms of sexual dysfunction on both men and women. Their latest utility is in combination with pelvic floor muscle training in men before prostate cancer surgery.

References:

Herbenick D, Reece M, Sanders S, Dodge P, Ghassemi A, Fortenberry D. Prevalence and Characteristics of Vibrator Use by Women in the United States: Results From a Nationally Representative Study, Journal of Sexual Medicine, 2009; 6: 1857-1866

Reece M, Herbenick D, Sanders S, Dodge P, Ghassemi A, Fortenberry D. Prevalence and Characteristics of Vibrator Use by Men in the United States, Journal of Sexual Medicine 2009; 6:1867-1874.

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 (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator 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: www.PrivateGym.com or Amazon.

Urinary Infections In Women

September 12, 2015

Andrew Siegel, MD    9/12/2015

shutterstock_femalebluepelvic

Bladder infections (a.k.a., cystitis) are common among women. Acute cystitis is a bladder infection that typically causes the following symptoms: pain/burning, frequent urination, and urinary urgency (“gotta go”). Additional symptoms that may occur are the following: urinating small volumes, bleeding and urinary incontinence (leakage). Microscopic inspection of urine usually shows bacteria, white blood cells and red blood cells.  80-90% of cystitis is caused by Escherichia coli, 5-15% by Staphylococcus and the remainder by less common bacteria including Klebsiella, Proteus, and Enterococcus.

The occasional occurrence of cystitis is a nuisance and oftentimes uncomfortable, but is usually easily treated with a short course of oral antibiotics. When bladder infections recur time and again, it becomes a major source of inconvenience and suffering for the patient and it becomes important to fully investigate the source of the recurrence.

Bladder infections occur when bacteria gain access to the urinary bladder, which normally does not have bacteria present. The short female urethra and the proximity of the urethra to the vagina and anus are factors that predispose to cystitis.

For an infection to develop, the vagina and urethra usually have to be colonized with the type of bacteria that can cause an infection (not the normal healthy bacteria that reside in the vagina), these bacteria must ascend into the bladder, and these bacterial must latch onto bladder cells.

Offense and Defense

Whether or not an infection develops is based upon the interaction of protective mechanisms (“defense”) and bacterial factors (“offense”). “Defense” factors include the following:

  • An acidic vagina, which inhibits the growth of infection-causing bacteria while promoting the growth of “good” bacteria such as lactobacilli
  • The unique layer that protects the bladder lining
  • Immune cells in the urine that prevent bacteria from sticking to the bladder cells
  • The dilution action of urine production and the flushing effect of urinating

Bacterial “offense” factors include in following:

  •  Tentacle-like structures that promote the attachment of bacteria to bladder cells
  • The capability of bacteria to evolve and develop resistance to antibiotics

Bladder Infections in Young Women

Women aged 18-24 years old have the greatest prevalence of bladder infections and sex is usually a key factor, hence the term “honeymoon cystitis.”

The following are risk factors for bladder infections:

  • A new sexual partner
  • Recent sexual intercourse
  • Frequent sexual intercourse
  • Spermicides, diaphragms and spermicide-coated condoms (which can increase vaginal and urethral colonization with E. Coli)

Bladder Infections in Older Women

Cystitis is common after menopause, based upon the following factors:

  • Female hormone (estrogen) deficiency, which causes a change in the bacterial flora of the vagina such that EColi replaces Lactobacilli
  • Age-related decline in immunity
  • Incomplete bladder emptying
  • Urinary and fecal leakage (incontinence), often managed with pads, which remain moist and contaminated and can promote movement of bacteria from the anal area towards the urethra
  • Diabetes (particularly when poorly controlled, with high levels of glucose in the urine that can be thought of as “fertilizer” for bacteria)
  • Neurological diseases that impair emptying or cause incontinence
  • Pelvic organ prolapse
  • Obesity
  • Poor hygiene

Complicated Infections

A urinary infection is considered complicated if:

  • It involves the upper urinary tracts (kidneys)
  • You are pregnant
  • Bacteria are resistant to antibiotics
  • There is a structural abnormality of the urinary tract
  • It occurs in immune-compromised patients including diabetics
  • It occurs in the presence of a foreign body such as a urinary catheter or stone

If It’s Not an Infection, What Is It?

It is important to distinguish a symptomatic urinary infection from asymptomatic bacteriuria, urethritis, vaginitis, and Painful Bladder Syndrome (PBS)/Interstitial Cystitis (IC).

  • Asymptomatic bacteriuria, common in elderly and diabetics, is the presence of bacteria within the bladder without causing an infection. This does not require treatment, which is futile and promotes selection of resistant bacteria. It should be treated only in pregnant women, in patients undergoing urological-gynecological surgical procedures, and in those undergoing prosthetic surgery (total knee replacement, etc.).
  • Urethritis is an infection in the urethra
  • Vaginitis is a vaginal infection
  • PBS/IC is a chronic inflammatory condition of the bladder that can mimic the symptoms of cystitis.

Diagnosis and Treatment

The diagnosis of cystitis is by urinalysis and culture. A urine specimen is obtained after cleansing the vaginal area and collection of a mid-stream specimen. At times, catheterization is necessary to obtain a specimen. Dipstick is the fastest and least expensive means of screening for an infection, but it is not very accurate, whereas microscope exam is much more accurate. The definitive test is urine culture and sensitivity, which will demonstrate the type of bacteria, the quantitative count, and those antibiotics that are most likely to be effective.

Treatment is antibiotics to eradicate the bacteria. In the case of recurrent cystitis, it is important to do an evaluation to rule out a structural cause. This generally involves imaging, often an ultrasound (using sound waves to obtain an image of the urinary tract), and a cystoscopy (a visual inspection of the urethra and bladder with a flexible scope). This will check the entire urinary tract, including the kidneys and bladder. Findings may be a dropped bladder, a stone within the urinary tract, a urethral stricture (a narrowing in the channel leading out of the bladder that causes an obstruction), a urethral diverticulum (a pocket connected to the urethra), or a fistula (abnormal connection between the colon and bladder), etc.

 Antibiotic Options For Those With Recurrent Urinary Infections

  • Patient-initiated treatment: a short course of antibiotics when the symptoms first occur. It is useful to first test your urine using a dipstick (although not perfect, it is great for home screening) when the symptoms of cystitis arise. This has proven to be safe, economical and effective.
  • Sexual prophylaxis: A single dose of antibiotic just before or after sexual activity if the infections are clearly sexually related
  • Daily antibiotic prophylaxis: A single dose of antibiotic is taken on a prophylactic basis every evening or every other evening to prevent recurrent cystitis.

Pearls To Help Keep Cystitis At Bay

  • Stay well hydrated to keep the urine dilute: “The solution to pollution is dilution.”
  • Wipe in a top-to-bottom motion after urination or bowel movementsAt minimum, urinate every four hours while awake to avoid an over-distended bladder.
  • Maintain a healthy weight.
  • Urinate after sex.
  • If infections are clearly sexual related, an antibiotic taken before or right after sex can usually preempt the cystitis.
  • If you are diabetic, maintain the best glucose control possible.
  • Seek urological consultation for recurrent infections to check for an underlying and correctable structural cause.
  • Methenamine: This chemical is broken down into formaldehyde, which can kill bacteria.
  • Cranberry extract: Cranberries contain proanthocyanidins that inhibit bacteria from adhering to the bladder cells. There are formulations of cranberry extract available to avoid the high carbohydrate load of cranberry juice.
  • Probiotics such as Lactobacillus: These bacteria promote healthy colonization of the vagina, production of hydrogen peroxide that is toxic to bacteria, maintenance of acidic urine, induction of an anti-inflammatory response in bladder cells, and inhibition of attachment between bacteria and the bladder cells.
  • D-Mannose: This sugar can inhibit bacteria from adhering to the bladder cells.
  • Estrogen cream: Applied vaginally, this can help restore the normal vaginal flora as well as uro-genital tissue integrity and suppleness.
  • Vaccination: Currently in research phases, the concept is an oral vaccine or vaginal suppository capable of providing immunity against the typical strains of bacteria that cause infections.

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 (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator 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: www.PrivateGym.com or Amazon.

Sexuality and Aging: Sex Dies Hard

September 5, 2015

Andrew Siegel, MD   9/5/15

Affectionate old couple with the wife holding on lovingly to the husband's face. Focus on the husband's eyes. Concept: Elderly love.

(Image attribution: Ian MacKenzie—Flickr– licensed under Creative Commons attribution 2.0 generic license)

“Sexy”—“desirable,” “seductive,” “alluring,” “sensual,” “erotic,” etc.—is a term applied primarily to attractive young people. As we age, we are somehow considered less “sexy”; however, at any age sexiness, sexuality and/or sex (call it what you will) is an important part of life for both women and men who desire closeness and intimacy that is often expressed through sexual means.

Many people have negative attitudes, prejudices and discomfort when considering the sexuality of older people, with a prevailing notion that older people should be asexual. Think about how biased and disparaging are the terms “dirty old man” and “cougar,” referring to older men and women, respectively, with healthy libidos. The thought of one’s parents having sex is disturbing and cringe-worthy for many. How about the notion of one’s grandparents sharing an intimate moment? Why is it so disconcerting to imagine the passionate coupling of aging bodies that have lost youthful suppleness? Why are the adjectives that often come to mind regarding elder sex “ugh”, “creepy,” “repulsive,” etc.?

When I asked my 16-year-old daughter to describe her thoughts on her parents having sex, her response was “disgusting.” When asked about her grandparents, she replied “gross.”

Sexuality is so much more than an act of physical pleasure. For men, it is emblematic of potency, virility, fertility, and masculine identity. For women, it represents femininity, desirability and vitality. For both genders, sex is an expression of physical and emotional intimacy, a means of communication and bonding that occurs in the context of skin-to-skin, face-time contact that gives rise to happiness, confidence, self-esteem and quality of life. In addition to sexual health being an important part of overall health, it also provides comfort, security and ritual that permeate positively into many other areas of our existence.

Time is relentless and the years creep by with great momentum until one day you are 50-years-old and you question how this is possible. However, no matter what our chronological age is, our drive, enthusiasm, spirit and need for physical and emotional and intimacy remain largely intact. Understandably, sex in the golden years is not always possible because of medical issues, absence of a partner or declining sexual interest. However, medical progress in the field of human sexuality has made it possible to maintain sexual activity until an advanced age.

Means Of Staying Sexually Active Until Old Age

First-line strategy is lifestyle “management” (healthy eating, maintaining a desirable weight, regular exercise, avoidance of stress, moderate alcohol intake, sufficient sleep, avoidance of tobacco, etc.). Physical interventions include pelvic floor muscle training and vibratory stimulation (useful for both genders) and the vacuum suction device. Pelvic floor muscle training improves the strength and endurance of the pelvic floor muscles—the “rigidity” muscles that surround the roots of the penis and the clitoris—enhancing penile and clitoral erections, pelvic blood flow and optimizing the muscles that engage at the time of orgasm. Vibratory stimulation triggers the reflex between the genitals and the spinal cord, enhancing genital blood flow and inducing contractions of the pelvic floor muscles. By stimulating this reflex and triggering nerve activity in the brain, spinal cord and peripheral nerves, vibratory stimulation is capable of inducing penile and clitoral erections and ejaculation/orgasm. The vacuum suction device—a.k.a., the penis pump—is a means of drawing blood into the penis to obtain an erection and enable sexual intercourse.

There are a host of pharmacological interventions available including hormone therapy–testosterone replacement therapy for men and estrogen replacement therapy for women. There are numerous oral medications for erectile dysfunction (ED) including Viagra, Levitra, Cialis and Stendra. Other alternatives for men with ED include urethral suppositories, penile injections and penile implants. Suppositories are pellets that are placed in the urethra that act to increase penile blood flow. Injections do the same, although they are injected directly into the erectile chambers. Penile implants are semi-rigid non-inflatable or hydraulic inflatable devices that are implanted surgically within the erectile chambers and can be deployed on demand to enable sexual intercourse.

Addyi (Flibanserin) is a new oral medication for diminished libido. It is currently being marketed largely to females, but is purportedly effective for both sexes. FDA approved on August 18, 2015, it is the first prescription for diminished sex drive, a drug that has been referred to as “pink Viagra.”

Despite all of the advances made in the field of sexual dysfunction, cost has become a major issue. On July 1, 2015, Medicare decreed that they would no longer pay for the vacuum suction device. For almost the past decade, Medicare has not covered the oral ED medications. They have become a very expensive commodity, averaging more than $35 per pill! Many private insurance companies are following suit, with little interest in financing the sex lives of those insured. Whether the government and private insurers should or should not underwrite the cost of maintaining sexual function is arguable. Certainly, as important as sex is, there are other health issues that are more pressing. However, no one can deny the importance of a healthy sex life as a means of maintaining wellness and quality of life.

Bottom Line: As one proceeds through life, he or she comes to the realization that their inner spirit and driving force remains intact, even though there are obvious age-related declines in their physical appearance and function. The notion that sexuality loses importance as we age is incorrect and antiquated. The common practice of sexual ageism should be abandoned. Being able to function sexually means so much more than the physical act of bodies coupling. Physical and emotional intimacy is ageless.

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 (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator 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: www.PrivateGym.com or Amazon.