Archive for November, 2015

5 Things Every Woman Should Know About Her Man’s Pelvic Health

November 28, 2015

Andrew Siegel MD   11/28/15

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(Attribution: Pier-Luc Bergeron, A happy couple and a happy photographer; no changes made, https://www.flickr.com/photos/burgtender/4910841630)

Since this is Thanksgiving weekend and a broadly celebrated family holiday, I cannot think of a better time to blog about how wives/girlfriends/partners can help empower their men’s pelvic health.

  1. His Erections
  2. Prostate Cancer
  3. Bleeding
  4. Testes Lumps/Bumps
  5. Urinary Woes

 

Erectile Dysfunction: A “Canary in the Trousers”

If his erections are absent or lacking in rigidity or sustainability, it may just be the “tip of the iceberg,” indicative of more serious underlying medical problems. The quality of his erections can be a barometer of his cardiovascular health. Since penile arteries are tiny (diameter of 1-2 millimeters) and heart arteries larger (4 millimeters), it stands to reason that if vascular disease is affecting the penile arteries, it may affect the coronary arteries as well—if not now, then perhaps soon in the future. Since fatty plaque deposits in arteries compromise blood flow to smaller blood vessels before they do so to larger arteries, erectile dysfunction may be considered a genital “stress test.”

Bottom Line: If your man is not functioning well in the bedroom, think strongly about getting him checked for cardiovascular disease. His limp penis just may be the clue to an underlying more pervasive and serious problem.

Prostate Cancer

One in seven American men will develop prostate cancer in their lifetimes and most have no symptoms whatsoever, the diagnosis made via a biopsy because of an elevated or accelerated PSA (Prostate Specific Antigen) blood test and/or an abnormal rectal exam that reveals an asymmetry or lump. Similar to high blood pressure and glaucoma, prostate cancer causes no symptoms in its earliest phases and needs to be actively sought after.

With annual PSA testing, he can expect a small increase each year correlating with prostate growth. A PSA acceleration by more than a small increment is a “red flag.” The digital exam is simply the placement of a gloved, lubricated finger in the rectum to feel the size, contour and consistency of the prostate gland, seeking hardness, lumps or asymmetry that can be a clue to prostate cancer. It is not unlike the female  pelvic exam.

Bottom Line:  As breast cancer is actively screened for with physical examination and mammography, so prostate cancer should be screened for with PSA and digital rectal exam. In the event that prostate cancer is diagnosed, it is a treatable and curable cancer. Not all prostate cancers demand treatment as those with favorable features can be followed carefully, but for other men, treatment can be lifesaving.

Bleeding

Blood in the urine can be visible or only show up on dipstick or microscopic exam of the urine. Blood in the urine should also be thought of as a “red flag” that mandates an evaluation to rule out serious causes including cancers of the kidney and bladder. However, there are many causes of blood in the urine not indicative of a serious problem, including stones, urinary infections and prostate enlargement.

Blood in the semen is not uncommonly encountered in men and usually results from a benign inflammatory process that is usually self-limited, resolving within several weeks. It is rarely indicative of a serious underlying disorder, as frightening as it is to see blood in the ejaculate. Nonetheless, it should be checked out, particularly if it does not resolve.

Bottom Line: If blood is present when there should be none—including visible blood in the urine, blood stains on his undershorts or blood apparent under the microscope—it should not be ignored, but should be evaluated. If after having sex with your partner you notice a bloody vaginal discharge and you are not menstruating, consider that it might be his issue and make sure that he gets followed up.

Testes Lumps and Bumps

Most lumps and bumps of the testes are benign and not problematic. Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20s, striking men at the peak of life. The excellent news is that it is very treatable, especially so when picked up in its earliest stages, when it is commonly curable.

A testicular exam is a simple task that can be lifesaving. One of the great advantages of having his gonads located in such an accessible locale—conveniently “gift wrapped” in the scrotal satchel—is that it makes them so easy to examine. This is as opposed to your ovaries, which are internal and not amenable to ready inspection. This explains why early testes cancer diagnosis is a cinch as opposed to ovarian cancer, which most often presents at an advanced stage. In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle. It most often does not cause pain, so his absence of pain should not dissuade him from getting an abnormality looked into.

Your guy should be doing a careful exam of his testes every few weeks or so in the shower, with the warm and soapy conditions beneficial to an exam. If your man is a stoic kind of guy who is not likely to examine himself, consider taking matters into your own hands—literally: At a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.

Bottom Line: Have the “cajones” to check his cajones. Because sperm production requires that his testes are kept cooler than core temperature, nature has conveniently designed mankind with his testicles dangling from his mid-section. There are no organs in the body—save your breasts—that are more external and easily accessible. If your man is not willing to do self-exams, at a moment of intimacy do a “stealth” exam under the guise of affection—it just might be lifesaving.

Urinary Woes

Most organs shrink with the aging process. However, his nose, ears, scrotum and prostate are the exceptions, enlarging as he ages. Unfortunately, the prostate is wrapped precariously around the urinary channel and as it enlarges it can constrict the flow of urine and can cause a host of symptoms. These include a weaker stream that hesitates to start, takes longer to empty, starts and stops and gives him the feeling that he has not emptied completely. He might notice that he urinates more often, gets up several times at night to empty his bladder and when he has to urinate it comes on with much greater urgency than it used to. He might be waking you up at night because of his frequent trips to the bathroom. Almost universal with aging is post-void dribbling, an annoying after-dribble.

Bottom Line: It is normal for him to experience some of these urinary symptoms as he ages. However, if he is getting up frequently at night, dribbling on the floor by the toilet, or has symptoms that annoy him and interfere with his quality of life, it is time to consider having him looked at by your friendly urologist to ensure that the symptoms are due to benign prostate enlargement and not other causes, to make sure that no harm has been done to the urinary tract and to offer treatment options.

Wishing you the best of health and a wonderful Thanksgiving weekend,

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.

You Can’t Think It Up, But You Can Think It Down

November 21, 2015

Andrew Siegel MD   11/21/15

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(Above fortune from Chinese fortune cookie relevant to this discussion.)

Q: What is the most powerful sex organ?

A: If you think it is the erect and throbbing penis, you are incorrect. The BRAIN is the bossman and the most influential force driving sexuality. The penis is a mere buck private soldier that responds and bends to the will of the five-star general and commander-in-chief of sexuality, the central nervous system.

Despite the authority and assertive presence of the brain, it is only under rare circumstances that it is capable of willing the limp penis to become erect. Some form of touch or erotic stimulation is most often necessary to get the erection process going, with the exception of nighttime-related erections associated with a phase of sleep known as REM (Rapid Eye Movement).

If the central nervous system cannot will the limp penis to become erect, it certainly can will the erect penis to become limp or will the limp penis to remain limp. This is the case with performance anxiety, a classic instance of the powerful mind-body connection. In this circumstance, stress or anxiety causes the output of high levels of adrenaline, which functions to constrict penile blood flow and erectile smooth muscle relaxation, resulting in a limp penis.

The central nervous system is the commander-in-chief of sexuality, but it demands working the way it likes to work, i.e., naturally, unhindered and unburdened by cognitive thought. Conscious and willful thought clearly can interfere with the smooth function of the central nervous system. When conscious thought enters the picture, the ability to perform many complex movements goes south. Much the same as a golf swing or any action like using a fork to feed yourself or walking down a flight of stairs, when it comes to sexuality, the brain works best when it is working subconsciously. Overthinking is the enemy of any complex motor activity. With all of these examples, one needs to be in the moment and engaged in the activity without conscious thought, in order to enable a smooth execution.

The moment one starts overthinking, the complex motion is virtually destined to be flawed. The golf swing is a classic example, with a poor shot almost guaranteed if one has too many swing thoughts that confound execution and performance. For the non-golfers, try walking down a flght of stairs at a good clip, stating to yourself in your inner voice each step in the process and you will likely trip up. When you are in a sexual situation, if you focus on thinking about your sexual function or lack thereof or reliving a previous problem, then your performance will most often be doomed to failure.

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(Thank you, Pixabay for image above)

Too much thought is capable of empowering self-fulfilling prophecies and bringing them to fruition. If one has had erection issues and in a passionate moment starts thinking, assessing, evaluating and analyzing, he is almost certain to be incapable of obtaining or maintaining an erection. Likewise, if one suffers with premature ejaculation and his thought pattern becomes obsessively focused on this possibility instead of being in the moment and enjoying the situation, he is almost certain to ejaculate way sooner than desired. The same is true with the rarer but equally disturbing problem of delayed ejaculation. Focusing on trying to make oneself ejaculate will most often bring on the inability to ejaculate.

Masters and Johnson coined the term spectatoring, an intense self-focus during sexual interactions as opposed to immersing oneself in the sensory aspects of the sexual experience. Essentially, spectatoring is observing and monitoring yourself having sex as if you were a third party, often accompanied by an anxious internal, self-conscious dialogue with concerns about some aspect of your sexual performance. It is being a spectator instead of the player and it will DESTROY your game.

The solution to spectatoring is to “be present” and “in the moment,” totally immersing yourself in the experience without observation or conscious internal thoughts. When you lose yourself in the sensations and do not allow thoughts to interfere with the process, you maximize your chances for an optimal performance. When distracting thoughts uncontrollably float into the present like dark clouds in the sky, take a deep breath, exhale slowly and allow the thoughts to pass and return to a state of being present.

Bottom Line: Overthinking is the enemy of complex actions, including erections and ejaculation. Allow the central nervous system to do what it does so well– subconsciously– without trying to help things along with deliberate thought.  Let instinct prevail over conscious thought–you cannot make it happen, you have to let it happen. There is an  time and place for conscious thought, but it is not in the heat of the moment in the bedroom.  Be present without thought of the past or future. 

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.

Limping Along

November 14, 2015

Andrew Siegel MD   11/14/15

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(Above image courtesy of: Blausen.com staff. “Blausen gallery 2014“. Wikiversity Journal of MedicineDOI:10.15347/wjm/2014.010ISSN 20018762.)

This  entry is intended to be unisex, since both genders are equally susceptibility to clogged arteries and impaired blood flow to muscles and other vital organs (a.k.a., ischemia).  Although sexual dysfunction resulting from compromised pelvic blood flow is outwardly more obvious in the male with the inability to achieve an erection or difficulty in obtaining or maintaining an erection, females as well can suffer with sexual consequences to a similar degree with impaired arousal, lubrication and climax.

Male sexual response is so evident, conspicuous and literally palpable, a binary system with a digital “one” or “zero” response, whereas female sexuality is to all appearances so much less obvious and so much more subtle and nuanced. However, this framing of human sexual response is off target as the female sexual response results in genital anatomical changes as profound as those that occur in males, just less apparent. Under normal circumstances, the vagina is no more “primed” for sex than is a flaccid penis, the un-stimulated vagina being merely a potential space with the vaginal roof and floor in direct contact. However, when stimulated, the vaginal walls lubricate and the vagina expands, lengthens and widens in order to accommodate an erect penis, changes that are as dramatic as the transition of a flaccid penis to an erect penis.  

Because the primary driver of the human sexual response is BLOOD FLOW, females can be as susceptible as males to compromised circulation and can “limp” in the bedroom just as much as males can. It’s just not as ovvious and apparent. Furthermore, both genders are susceptible to limping in the street. 

In terms of ambulation, many people limp instead of walk because of peripheral arterial disease (PAD), a medical condition in which the arteries in the legs clog due to a buildup of fatty plaque. This impairs blood flow and the delivery of oxygen and nutrients to muscles and other tissues, giving rise to pain when exercise increases the muscle’s demand for oxygen.

PAD commonly occurs on the basis of poor lifestyle–obesity, diabetes, an unhealthy diet, a sedentary existence and often the use of tobacco. When muscles are denied the increased blood flow required with the demands of movements such as walking or exercisizing, pain and limping result, known as claudication, from the Latin “claudeo,” meaning “to limp.”

Claudication often does not demonstrate itself until there is significant blockage–usually about a 70% restriction– to arterial flow. It occurs because of insufficient oxygen to the leg muscles causing the buildup of lactic acid, which causes discomfort and pain. Claudication typically responds to stopping movement, which resolves the pain.

Claudication is by no means limited to the leg muscles, but can happen to any muscle in the body. “Claudication” of the heart muscle—which occurs when the coronary arteries are compromised—is known as angina. “Claudication” of the brain—which occurs when the carotid arteries are compromised—can give rise to mini-strokes or transient ischemic attacks (TIA). “Claudication” of the penis—which occurs when the penile arteries are clogged with years of accumulation of fatty plaque—is known as erectile dysfunction (ED), a.k.a., when the penis limps along.

Sexual dysfunction in either gender can be a warning sign that an underlying medical problem exists, the quality of sexual response serving as a barometer of cardiovascular health. When it comes to men, the presence of rigid and durable erections is an indicator of overall cardiovascular health, and conversely, the presence of ED can be a clue to poor cardiovascular health. For this reason, men with ED should consider undergoing a basic medical evaluation seeking arterial disease elsewhere in the body (heart, brain, aorta, and peripheral blood vessels). Since the penile arteries are generally rather small—1 to 2 millimeters in diameter—and the coronary (heart) arteries are about 4 millimeters in diameter, it stands to reason that if vascular disease is affecting the tiny penile arteries, it may well be soon affecting the larger coronary arteries as well. The presence or absence of erections may thus be considered a genital “stress test.”  The same applies to females who are limping in the bedroom.

The presence of ED is as much of a predictor of cardiovascular disease as is a strong family history of cardiac problems, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson expanded the meaning of the initials ED to: Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries); Early Detection (of cardiovascular disease); and Early Death (if missed).

Bottom Line: Heart-healthy and blood vessel-healthy is sexual-healthy (and vice versa). If you do not care to limp when you walk or be limp in the bedroom, commit to a healthy lifestyle. Minimizing the buildup of fatty arterial plaque will prevent claudication everywhere in the body. To do so requires weight management, healthy eating, regular exercise, avoiding tobacco, etc. And if you are already limping (whether it is on the sidewalk or the bedroom), a lifestyle “angioplasty”—cleaning up your unhealthy lifestyle habits—can help reverse the problem.  This applies equally to both men and women. 

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.

The Clitoris and Clitoral Priapism

November 7, 2015

Andrew Siegel, MD    11/7/15

Pompeii_Priapus_2

(Fresco of PriapusCasa dei VettiiPompeii, in public domain)

The clitoris is the female version of the penis. However, the clitoris is a much more subtle and mysterious organ, a curiosity to women and men alike. It is similar to the penis in that it becomes engorged when stimulated and because of its concentration of nerve fibers, is the site where most orgasms are triggered. On rare occasions, the clitoris can become rigidly engorged for a prolonged time, a painful condition known as clitoral priapism.

Clitoral Anatomy and Function 101

The clitoris is an organ that has as its express purpose sexual function, as opposed to the penis, which is both a sexual, urinary and reproductive organ. This erectile organ is the hub of female sensual focus and is the most sensitive erogenous zone of the body, playing a vital role in sensation and orgasm.

Similar to the penis, the clitoris is composed of an external visible part and internal, deeper, “invisible” parts. The inner parts of the clitoris are known as crura (legs), which are shaped like a wishbone with each side attached to the pubic arch as it descends and diverges. The visible part is located above the opening of the urethra, where the inner labia join together. Like the penis, it has a glans (head) and shaft (body), and is covered by a hood of tissue that is the female equivalent of the prepuce (foreskin). The glans of the clitoris, typically only the size of a pea, is a dense bundle of sensory nerve fibers, thought to have greater nerve density than any other body part. Much the same as the penis, the clitoris houses paired erectile chambers that contain spongy sinuses that engorge with blood at the time of sexual stimulation, resulting in a clitoral erection.

With the increase in genital and pelvic blood flow that occurs with sexual stimulation, the penile and clitoral shafts thicken and lengthen accompanied by swelling of the glans. Two of the superficial pelvic floor muscles—the bulbocavernosus and ischiocavernosus –-engage and compress the crura of the clitoris and penis, fundamental to maintaining engorgement and clitoral and penile blood pressures that are in excess of systemic blood pressures.

Priapism

The word priapism is derived from Priapus, the name of the Greek and Roman mythological God of fertility. He is commonly portrayed in classical artwork as having a disproportionately huge penis.

Engorgement and rigidity—whether penile or clitoral—is an ingenious hydraulic design and feat of nature. On occasion the system fails and the engorgement/erection does not subside. This condition is known as priapisman unwanted, persistent, painful engorgement that is not on the basis of sexual stimulation. It has the potential risk of damaging the anatomy such that future engorgement and erectile function can be compromised.

Although priapism is much more commonly a male problem, it occasionally involves the female clitoris. Clitoral priapism is an emergency situation in which there is clitoral shaft engorgement and swelling resulting in clitoral, vulvar and perineal pain. Similar to penile priapism, there are many different underlying causes including blood and nerve disorders or side effects from prescribed or recreational medications.

Doppler ultrasound can be useful to check the flow in the arteries to the erectile chambers. Treatment may involve injection of a blood vessel constricting medicine directly into the erectile chambers. Surgical treatment sometimes becomes necessary, usually “shunting” techniques to promote drainage of blood. In one such shunting procedure, a surgical opening is made between the head of the clitoris and the erectile chambers to create an avenue for the exit of the blood.

Bottom Line: Clitoral priapism is a rare occurrence in which there is prolonged clitoral engorgement/erection resulting in swelling and pain. Like penile priapism, this is not s problem that should be ignored. Prompt medical attention can manage the situation and help prevent the possiblity of sexual dysfunction resulting from scarring and impaired erectile capacity.

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.