Archive for December, 2015

What To Expect of Your Erections As You Age…20’s, 30’s, 40’s and Beyond

December 26, 2015

Andrew Siegel,  MD  12/26/15

I have written more than 250 blogs, this being the overwhelming most popular one with 50,000 plus views in 2015.  I am therefore reposting this as an encore final entry of 2015. 

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It is shocking how ill prepared we are for aging. Nobody informs us exactly what to expect with the process, so we just sit back and observe the changes as they unfold, dealing with them as best we can. Although educational books are available on many topics regarding other expected experiences, such as “What To Expect When You’re Expecting,” I have yet to see “The Manual of Man,” explaining the changes we might expect to experience as time goes on. Some day I wish to author a book like that, but for the time being I will blog on what to anticipate with male sexual function as time relentlessly marches on.

“But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.”

Tom Hickman, God’s Doodle: The Life and Times of the Penis

Aging can be unkind and Father Time does not spare your sexual function. Although erectile dysfunction (ED) is not inevitable, with each passing decade, there is an increasing prevalence of it. Present in some form in 40% of men by age 40 years, for each decade thereafter an additional 10% join the ED club. All aspects of sexuality decline, although libido (sexual interest and drive) suffers the least depreciation, leading to a swarm of men with eager “big heads” and apathetic “little heads,” a most frustrating combination indeed.

With aging often comes less sexual activity, and with less sexual activity often comes disuse atrophy, in which the penis actually becomes smaller. Additionally, with aging there is often weight gain, and with weight gain comes a generous fat distribution in the pubic area, which will make the penis appear shorter. With aging also comes scrotal laxity and testicles that hang down loosely, like the pendulous breasts of an older woman. Many of my older patients relate that when they sit on the toilet, their scrotum touches the toilet water. So, the penis shrinks and the testicles hang low like those of an old hound dog…Time and gravity can be cruel conspirators!

So, what can you expect of your sexual function as you age? I have broken this down by decade with the understanding that these are general trends and that you as an individual may well vary quite a bit from others in your age group, depending upon your genetics, lifestyle, luck and other factors. There are 30-year-old men who have sexual issues and 80-year-old men who are veritable “studs,” so age per se is not the ultimate factor.

You may wonder about the means by which I was able to craft this guide. I was able to do so through more than 25 years spent deep in the urology trenches, working the front line with thousands of patient interactions. My patients have been among my most important teachers and have given me a wealth of information that is not to be found in medical textbooks or journals, nor taught in medical school or during urology residency. Furthermore, I am a 50-something year-old man, keenly observant of the subtle changes that I have personally witnessed, but must report that I am still holding my own!

Age 18-30: Your sexual appetite is prodigious and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might just be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the smell of her perfume, merely the thought of her can arouse you fully. You get erections even when you don’t want them…if there was only a way to bank these for later in life!  You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense and you are capable of ejaculating an impressive volume of semen forcefully with an arc-like trajectory, a virtual comet shooting across the horizon. When you arise in the morning from sleep, it is not just you that has arisen, but also your penis that has become erect in reflex response to your full bladder, which can make emptying your bladder quite the challenge, with the penis pointing up when you want to direct its aim down towards the toilet bowl.

It doesn’t get better than this…you are an invincible king… a professional athlete at the peak of his career! All right, maybe not invincible…you do have an Achilles heel…you may sometimes ejaculate prematurely because you are so hyper-excitable and sometimes in a new sexual situation you have performance anxiety, a mechanical failure brought on by the formidable mind-body correction, your all-powerful mind dooming the capabilities of your perfectly normal genital plumbing.

Age 30-40: Things start to change ever so slowly, perhaps even so gradually that you barely even notice them. Your sex drive remains vigorous, but it is not quite as obsessive and all consuming as it once was. You can still get quality erections, but they may not occur as spontaneously, as frequently and with such little provocation as they did in the past. You may require some touch stimulation to develop full rigidity. You still wake up in the middle of the night with an erection and experience “morning wood.” Ejaculations and orgasms are hardy, but you may notice some subtle differences, with your “rifle” being a little less powerful and of smaller caliber. The time it takes to achieve another erection after ejaculating increases. You are that athlete in the twilight of his career, seasoned and experienced, and the premature ejaculation of yonder years is much less frequent an occurrence.

Age 40-50: After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion you had two decades earlier. You can usually get a pretty good quality erection, but it now often requires tactile stimulation and the rock-star rigidity of years gone by gives way to a nicely firm penis, still suitable for penetration. The gravity-defying erections don’t have quite the angle they used to. At times you may lose the erection before the sexual act is completed. You notice that orgasms have lost some of their kick and ejaculation has become a bit feebler than previous. Getting a second erection after climax is not only difficult, but also may be something that you no longer have any interest in pursuing. All in all though, you still have some game left.

Age 50-60: Sex is still important to you and your desire is still there, but is typically diminished. Your erection can still be respectable and functional, but is not the majestic sight to behold that it once was, and touch is necessary for full arousal. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. Your orgasms are definitely different with less intensity of your climax, and at times, it feels like nothing much happened—more “firecracker” than “fireworks.” Ejaculation has become noticeably different—the volume of semen is diminished and you question why you are “drying up.” At ejaculation, the semen seems to dribble with less force and trajectory; your “high-caliber rifle” is now a “blunt-nosed handgun.” Getting a second erection after climax is difficult, and you have much more interest in going to sleep rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity…sometimes just reserved for the weekends.

Age 60-70: “Sexagenarian” is bit of a misleading word…this is more apt a term for the 18-30 year-old group, because your sex life doesn’t compare to theirs…they are the athletes and you the spectators. Your testosterone level has plummeted over the decades, probably accounting for your diminished desire. Erections are still obtainable with some coaxing and coercion, but they are not five star erections, more like three stars, suitable for penetration, but not the flagpole of yonder years. They are less reliable, and at times your penis suffers with attention deficit disorder, unable to focus and losing its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime and early morning erections become rare occurrences. Climax is, well, not so climactic and explosive ejaculations are a matter of history. At times, you think you climaxed, but are unsure because the sensation was so un-sensational. Ejaculation may consist of a few drops of semen dribbling out of the end of the penis. Your “rifle” has now become a child’s plastic “water pistol.” Seconds?…thank you no …that is reserved for helpings on the dinner table! Sex is no longer a recreational activity, but an occasional amusement.

Age 70-80: When asked about his sexual function, my 70-something-year-old patient replied: “Retired…and I’m really upset that I’m not even upset.”

You may still have some remaining sexual desire left in you, but it’s a far cry from the fire in your groin you had when you were a younger man. With physical coaxing, your penis can at times be prodded to rise to the occasion, like a cobra responding to the beck and call of the flute of the snake charmer. The quality of your erections has noticeably dropped, with penile fullness without that rigidity that used to make penetration such a breeze. At times, the best that you can do is to obtain a partially inflated erection that cannot penetrate, despite pushing, shoving and manipulating every which way. Spontaneous erections have gone the way of the 8-track player. Thank goodness for your discovery that even a limp penis can be stimulated to orgasm, so it is still possible for you to experience sexual intimacy and climax, although the cli-“max” is more like a cli-“min.” That child’s “water pistol”…it’s barely got any water left in the chamber.

Age 80-90: You are now a member of a group that has an ever-increasing constituency—the ED club. Although you as an octogenarian may still be able to have sex, most of your brethren cannot; however, they remain appreciative that at least they still have their penises to use as spigots, allowing them to stand to urinate, a distinct competitive advantage over the womenfolk. (But even this plus is often compromised by the aging prostate gland, wrapped around the urinary channel like a boa constrictor, making urination a challenging chore.) Compounding the problem is that your spouse is no longer a spring chicken. Because she been post-menopausal for many years, she has a significantly reduced sex drive and vaginal dryness, making sex downright difficult, if not impossible. If you are able to have sex on your birthday and anniversary, you are doing much better than most. To quote one of my octogenarian patients in reference to his penis: “It’s like walking around with a dead fish.”

Age 90-100: To quote the comedian George Burns: “Sex at age 90 is like trying to shoot pool with a rope.” You are grateful to be alive and in the grand scheme of things, sex is low on the list of priorities. You can live vicariously through pleasant memories of your days of glory that are lodged deep in the recesses of your mind, as long as your memory holds out! Penis magic has gone the way of defeated phallus syndrome. So, when and if you get an erection, you never want to waste it!

Wishing you a healthy, peaceful, happy (and sexy) 2016,

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. Coming soon 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.

Botox: For A “Gladder” Bladder

December 19, 2015

Andrew Siegel MD   12/19/15

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You are probably aware of Botox used for improving the cosmetic appearance of facial wrinkles. When injected into frown lines Botox paralyzes facial muscles resulting in creases, furrows and grooves disappearing and presto, you look a decade younger! Botox has numerous medical uses that go beyond improving one’s appearance. It is commonly used to improve internal body functions, e.g., injecting it into the bladder muscle to improve symptoms of overactive bladder (OAB).

Making Lemonade From Lemons

Botox is derived from the most poisonous substance known to man—botulinum toxin. This neurotoxin is produced by the Clostridium bacterium, responsible for botulism. Botulism is a rare but serious illness that can result in paralysis. Botulinum toxin, when used in minute quantities in a derivative known as Botox, is a magically effective and powerful potion.

How It Works

Botox is a neuromuscular blocking agent that weakens or paralyzes muscles. Beyond cosmetics, it can be beneficial for a variety of medical conditions that have in common some form of localized muscle over-activity. Its uses generally involve conditions with muscle spasticity, involuntary muscle contractions, excessive sweating and eyelid or eye muscle spasm.

Botox For The Bladder

Overactive bladder (OAB) syndrome consists of the symptoms of urinary urgency (the sudden desire to urinate), with or without urgency incontinence (urinary leakage associated with urgency), usually accompanied by frequent urination during both awake and sleep hours. OAB has been described as the “bladder squeezing without your permission to do so.”

When injected into the muscle of the bladder,  Botox treats the “wrinkles,” the thick muscle bands known in medical jargon as trabeculation, which are typically present in conditions that cause obstruction to the outflow of urine or bladder overactivity.  By temporarily paralyzing a portion of the bladder muscle, OAB symptoms can improve dramatically. 

Botox can be used in both genders.  It is usually a second line treatment for those who have not responded well or have been intolerant to oral bladder relaxant medications.  The goal of Botox is to  effectively treat persistent and disabling urinary urgency, frequency and urgency incontinence.  Botox is FDA approved in the USA in a 100 unit dose for overactive bladder and  200 unit dose for overactive bladder associated with neurological conditions.

Bladder Botox injection is a brief office procedure usually done under light sedation. It involves placing a cystoscope into the bladder and injecting  Botox into numerous sites in the bladder via a needle that fits through the cystoscope. The entire procedure takes 10 minutes or so.

Preparing for Bladder Botox/ Expectations 

  1. Stop blood thinner medications one week before Botox.
  2. Antibiotics are started 2 days before and continued for 2 days after.
  3. You may experience blood-tinged urine, burning with urination and pelvic pain for a day or so after the procedure.
  4. You may experience difficulty urinating and feel that you are not emptying completely; if so, this may require a catheter or temporarily learning how to do self-catheterization.
  5. It may take a week or two to notice improvement. Although Botox is highly effective, it is not so in everyone.
  6. Follow up urinalysis and check of the post-void residual volume (how much urine is left in the bladder after voiding) in two weeks.
  7. Botox should last 6-9 months or so. After the improvement wears off, the injection can be repeated. If ineffective or only partially effective, the Botox dosage can be increased.

Bottom line: Botox, a  neurotoxin produced by Clostridium that causes paralysis, can be beneficial when injected into virtually any muscle in the body that is in a state of hyper-contraction and spasticity.  It has found utility for a variety of medical conditions, particularly for the treatment of overactive bladder symptoms.

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.

Viberect Medical Stimulation Device For ED

December 13, 2015

Andrew Siegel MD   12/13/15

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Our greatest wealth is health and an important part of overall health is sexual health, a topic I have been blogging on for a number of years.

My entry on 9/19/15 reviewed medical use of vibrational devices: https://healthdoc13.wordpress.com/2015/09/19/medical-use-of-vibrational-stimulation-devicesand-more-2/.

My entry on 12/5/15 was on the topic of using vibratory nerve stimulation in conjunction with pelvic floor muscle exercises in men undergoing prostate surgery in order to hasten recovery of sexual function: https://healthdoc13.wordpress.com/2015/12/05/erection-recovery-program/.

Of note, this non-pharmacological program Erection Recovery Program is equally appropriate for any man who wishes to improve erectile function, regardless of the underlying cause.

Viberect is the first FDA certified medical male vibratory nerve stimulation system for erectile dysfunction. Dual vibration heads stimulate the pudendal nerve and induce nitric oxide release that causes a penile erection and with continued stimulation, ejaculation and orgasm.

The Viberect is available without a prescription and I am pleased to announce that Reflexonic (the manufacturer) has offered my readers a 15% discount (good through February 29, 2016) using discount code VIBERECT20 at checkout.

To learn more about Viberect: http://www.viberect.com

Wishing you the best of health,

2014-04-23 20:16:29

Vaginismus: Too Tight Not Right

December 12, 2015

Andrew Siegel MD   12/12/15

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Vaginismus is a medical condition in which a woman’s vagina is unable to be penetrated despite her desire to be receptive to vaginal intercourse. There are often both physical and emotional factors that underlie this disorder. Spasticity of the vaginal and pelvic floor muscles as well as fear and anxiety issues are typically present. Vaginismus has significant psychological ramifications, negatively influencing self-image and potentially undermining and destroying relationships.

Even though vaginismus was initially described in the medical literature over 150 years ago, it remains a misunderstood, under-diagnosed and under-treated disorder. It renders the sufferer either unable to be vaginally penetrated or able to be penetrated, but at the cost of experiencing severe pain. This can occur whether the vaginal penetration is via a finger, tampon, at the time of a gynecological exam or with sexual intercourse. This condition causes embarrassment and frustration and is not a topic that most women are readily willing to discuss with their physician, friends or family members.

The precise underlying causes of vaginismus remain unknown, although possible contributing elements may be a history of sexual molestation,  a traumatic pelvic examination or gynecological procedure at a young age, strict sexual constraints, religious factors and excessive fear of sexual intercourse, sexually transmitted infections and pregnancy.

Men who attempt to have sexual intercourse with women suffering with vaginismus often describe “hitting a wall” or “absence of a hole down there,” reflecting the excessive tone and spasticity of the vagina and pelvic musculature.  Pelvic examination of a woman suffering with vaginismus usually demonstrates that the muscles surrounding the entry to the vagina are in spasm, akin to a tightly clenched fist.

Understandably, after attempts at unsuccessful sexual intercourse, women with vaginismus often develop an aversion to sex because of actual pain as well as anticipated pain. This sets up a vicious cycle in which emotional fear fuels more physical spasticity, further exacerbating the problem.

Fortunately, vaginismus is a manageable condition.  Treatments address both the physical and emotional aspects of the problem and include the following: vaginal dilators; pelvic floor physical therapy; sexual counseling; psychotherapy; hypnotherapy; cognitive behavioral therapy; and Botox. Combination treatment that is tailored to the specifics and nuances of the situation and individual are the most effective means of fostering vaginal and pelvic relaxation and improving this condition.

The idea behind vaginal dilation is to gradually and incrementally stretch the vagina and allow the patient to become comfortable with penetration. There are many dilation regimens varying with respect to the size of the dilators used and the length of time the dilators are retained, with some programs having the patient sleep with the dilators in place. If successful, transition to sexual intercourse can proceed.

Pelvic floor physical therapy via physical therapists who specialize in pelvic floor issues can be extremely helpful and effective, particularly trigger point release combined with pelvic floor muscle stretching and lengthening techniques to increase the flexibility of the pelvic muscles.

Psychological approaches include psychotherapy and cognitive behavioral therapy. Psychotherapy attempts to uncover deep and often unconscious motivations for feelings and behavior. Cognitive behavioral therapy aims to train the mind to replace dysfunctional thoughts, perceptions and behavior with more realistic or helpful ones in order to modify fear of vaginal penetration and avoidance behavior. 

Botox is broadly used in many medical disciplines to temporarily paralyze spastic musculature. For vaginismus, Botox is injected into the spastic vaginal muscle and adjacent pelvic floor muscles and seems to be a promising treatment.

As opposed to the chronicity of vaginismus, penis captivus is a rare acute condition in which a male’s erect penis becomes acutely stuck within a female’s vagina. It is theorized to be on the basis of intense contractions of the pelvic floor muscles, causing the vaginal walls to clamp down and entrap the penis. It usually is a limited event and after female orgasm and male ejaculation, withdrawal becomes possible. However, at times it requires emergency medical attention with a couple showing up in the emergency room tightly connected like Siamese twins.

Bottom Line:  A well-toned vagina is highly desirable from the standpoint of sexual health as well as pelvic health.  Having a fit vagina and pelvic floor muscles will often prevent pelvic organ prolapse and urinary incontinence and contribute to a healthy and enjoyable sex life. Vaginismus is an unusual–but treatable– medical problem in which the vagina and pelvic muscles are so tight that the vagina  cannot be penetrated.  The mind-body connection plays a key role in the development of this condition, which is so much more than simply a physical issue.  Vaginismus can have devastating psychological and emotional consequences, creating a vicious cycle that perpetuates the problem. 

Reference: PT Pacik: Understanding and Treating Vaginismus: a multimodal approach, International Urogynecology Journal (2014) 25:1613-1620

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 and coming along nicely 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.

Erection Recovery Program

December 5, 2015

Andrew Siegel MD   12/5/15

Reviresco – (Latin, re- + viresco) “I become green or verdant again”; “I am renewed or revived.”

Outliving Your Penis

It is very possible that you will “outlive” your penis. It will always be there for you in terms of a “spigot” to allow you the privilege of standing up to aim your urinary stream with reasonable accuracy, although this too suffers the ravages of time. However, in terms of being able to obtain or maintain an erection, your penis may perish decades before you do, for a variety of reasons.

The focus of today’s blog is ED due to prostate cancer treatment, although it is equally relevant to any man suffering with ED for any reason.  Having one’s prostate removed is a highly successful means of curing prostate cancer.  However, despite advances in technical and surgical approach, trauma to nerves, blood vessels, and muscular tissue during surgery can compromise sexual function, with ED being the most common complication.  The effect of radical prostatectomy on the penis is not unlike the effect of a stroke on the brain: in both situations a neuro-vascular (nerve/blood vessel) event occurs that may profoundly disturb function.  90% of men experience some degree of ED in the early post-surgery recovery period. The good news is that there are effective “rehab” and even “prehab” methods to optimize preservation and return of sexual function.  

Even if your penis has “expired” in terms of becoming rigid, it is still capable of being stimulated to ejaculation and orgasm, a phenomenon eventually discovered by many men. This is a small consolation (pun intended) for suffering with ED.

If your penis is not completely lifeless, it may be impaired such that you can obtain an erection, but lose it prematurely, or you can obtain at best a partially firm, non-penetrable erection. As if having a crippled penis were not severe enough punishment, to add insult to injury one of the consequences of lack of erections and sexual inactivity is further compromise of the future potential for erections. In other words, you need to obtain erections in order to maintain erections.

Use It Or Lose It

Erections not only provide the capacity for penetrative sex, but also serve to keep the erectile chambers (erectile smooth muscles and vascular sinus tissues) richly oxygenated, elastic and functioning. If one goes too long without an erection, damage to this erectile apparatus can result in penile atrophy (shrinkage) and compromised function. In a vicious cycle, the poor blood flow from disuse induces scarring and further damage to erectile smooth muscle and sinus tissues that often gives rise to venous leakage (rapid loss of erections as blood cannot be properly trapped within the erectile chambers). The bottom line is that in the absence of regular erections, one will likely lose length, girth and function, with the penis hobbled by its inability to properly trap blood.

As an aside, one of the functions of sleep erections—the spontaneous nocturnal erections that occur during REM (rapid eye movement) sleep in healthy men—is to maintain the erectile chambers in good working order. As sleep has an important restorative function for the human body, so sleep erections have a vital restorative function for the human penis.

Penile Resurrection

Achieving erections when they fail to occur by natural means is vital for sexual “resurrection” (l like the sound of this word—say it slowly). In time, the nerves that were “stunned” and/or injured by radical prostatectomy will usually heal and during this convalescing time, obtaining erections will help preserve erectile tissue. The implication is that even if you are sexually inactive, if you anticipate being sexually active in the future, you need to keep the penis and erectile apparatus fit.

Many urologists recommend penile “rehabilitation” when healed up after radical prostatectomy. Traditional rehab involves a combo of pills, injections and vacuum therapy, a.k.a. vacuum suction device (VSD). Some men use one, two or all three of these rehab strategies.

The oral ED medications (Viagra, Levitra, Cialis, and Stendra) can help maintain penile blood flow and provide the benefits that derive from maintaining tissue oxygenation. However, they are double-edged swords as they cannot be used in the face of certain medical conditions, have side effects, are expensive (costing about $40 per pill) and are not effective in all comers.

For those who do not respond to pills, the next step is often penile injections. Vasodilator drugs are injected directly into the erectile chambers to induce an erection. A mixture of one or more medications is often used for this purpose. Unfortunately–despite its effectiveness–many men are not fond of putting a needle in their penis and often nix this means of treatment.

The VSD is the third traditional rehab element. Starting 6 weeks or so after surgery and pursued for 10 minutes daily, the VSD mechanically engorges the penis in an effort to keep the erectile chambers healthy.

The Erection Recovery Program

“Prehab” is a means of pre-rehabilitation that is started shortly after the diagnosis of prostate cancer, during the time period when one awaits being operated upon. Instead of waiting for after-the-fact rehab, prehab intends to maximize sexual function before surgery in an effort to hasten recovery of erectile function after surgery. Committing to the erection recovery program before the trauma of surgery permits one to go into the operation optimally prepared.

The Erection Recovery Program combines two non-pharmacological, non-invasive tools—vibratory nerve stimulation and pelvic floor muscle training—to stimulate the nerves that produce erections and to strengthen the muscles that contribute to erectile rigidity, respectively. The traditional rehab program can be highly effective; however, it addresses primarily blood flow, a vital element of erectile physiology, while not focusing on nerve stimulation and pelvic floor/perineal muscle function, important contributors to the erectile process.

Vibratory-tactile nerve stimulation in men was originally conceived (pun intended) for spinal cord injured patients who desired to father children but were incapable of doing so because of their inability to ejaculate. However, vibro-tactile nerve stimulation is equally effective in inducing erection as well as ejaculation/orgasm in the non-spinal cord injured population and its use has been expanded to the general male population.

The pelvic floor/perineal muscles activate at the time of sexual stimulation, compressing the deep roots of the penis and fostering hypertensive blood pressures in the erect penis in excess of 200 mm, responsible for rock-hard rigidity. Pelvic floor muscle training has been used to bolster the strength, power and endurance of these muscles in order to optimize erectile rigidity and durability. Without well functioning pelvic floor/perineal muscles, full rigidity will not occur.

Oral meds, injection and/or vacuum therapy help prevent erectile tissues from losing elasticity and becoming scarred and less functional from the absence of erections. Similarly, nerve stimulation and pelvic floor/perineal muscle training help maintain the integrity of the erectile tissues as well as help prevent the pelvic floor/perineal muscles from atrophying in the absence of erections.  By keeping the pelvic floor/perineal muscles fit, when erections ultimately do return, function can be optimized.

The combination of nerve stimulation and pelvic floor muscle strengthening is a powerful alliance that is prescribed “prehab” as well as after radical prostatectomy to shorten the time it takes to recover erections. Its merits are its simplicity, safety, efficiency and the fact that it is actually pleasurable to pursue. It does not preclude the use of the traditional rehab program, which can be used in conjunction with the Erection Recovery Program.

Specifically, the Erection Recovery Program consists of the Viberect nerve stimulation device and the Pelvic Rx pelvic floor muscle training program. Viberect, manufactured by Reflexonic, is an FDA-certified hand-held penile vibro-tactile nerve stimulation device that triggers erection and ultimately ejaculation. The Pelvic Rx program, manufactured by Adult Fitness Concepts, is a FDA-registered, comprehensive, interactive follow-along exercise program to increase pelvic floor muscle strength, tone, power, and endurance. Basic Training strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises, while Complete Training provides maximum opportunity for gains via resistance equipment.

Bottom Line: 

The critical principle for erectile recovery is achieving an erection for at least several times weekly during the recovery period after prostate surgeryPenile vibro-tactile nerve stimulation coupled with pelvic floor muscle training is a synergistic combination that promotes initiation and maintenance of erections, respectively. 

This Erection Recovery Program is used prehab (prior to radical prostatectomy) and continued after surgery.  It offers a non-pharmacological option for erection recovery, but can also be used in conjunction with traditional penile rehab programs that use medications.  The Erection Recovery Program is also appropriate for any man who wants to improve sexual function, regardless of the underlying cause.  

To obtain the Erection Recovery Program:

http://www.viberect.com/erection-recovery-program-combo-pack.html

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.