Archive for April, 2016

Female Sex-Related Urinary Leakage

April 29, 2016

Andrew Siegel MD 4/30/16

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I have previously written on the topic of male urinary leakage during sexual excitement and climax: https://healthdoc13.wordpress.com/tag/climacturia/.  This entry covers the issue in females.

“Coital incontinence” is the medical term for leakage of urine that occurs during sexual intercourse. This involuntary loss of urine can occur either at the time of vaginal penetration, during the act of intercourse itself or during orgasm. It can be a devastating problem that affects one’s emotional, psychological, and social well being. This is not a topic that many women feel comfortable discussing with their physicians and therefore is under-reported and under-studied. It is important to know that coital incontinence is a manageable situation. 

A healthy sexual response involves being “in the moment,” free of concerns and worries. Women who develop coital incontinence often become mentally distracted during sexual activity, preoccupied with their lack of control over their problem, fear of leakage during intercourse and concerns about what consequences this might have on their partner’s sexual experience. This can cause a feeling of being unattractive and unsexy and an overall negative perception of body image, which can affect sex drive, arousal, sexual fulfillment and ability to orgasm. In addition to being embarrassing, it often results in women withdrawing from participating in sexually intimate situations, which can have a harmful effect on relationships.

There are two distinct forms of coital incontinence: leakage with penetration/intercourse and leakage with climax.

Leakage With Vaginal Penetration or During Intercourse

Leakage with penetration typically occurs in women with weakened pelvic support, often in women with a condition known as a cystocele (a.k.a. dropped bladder), in which the bladder sags to a variable extent through a weakness in its structural support such that the it enters into the vaginal space and at times can emerge outside the vaginal opening. This condition often causes an anatomical kink, resulting in symptoms of urinary obstruction including a weak, slow, intermittent stream and incomplete bladder emptying. Many women with dropped bladders need to use their fingers to manually push the bladder back into its normal anatomical position in order to straighten out the kink to be able to urinate effectively. What happens at the time of penetration is that the penis displaces the bladder back into its normal anatomic position and “unkinks” the urethra, resulting in a gush of urinary leakage.  Urinary leakage can also occur for the same underlying reason after penetration–during the act of intercourse itself– as penile thrusting shifts the bladder position and straightens out the urethra.  Either situation does not make for a happy couple.

Leakage With Sexual Climax

Leakage with sexual climax usually happens because of an involuntary contraction of the bladder that occurs along with the contraction of the other pelvic muscles during orgasm. With climax, there is a rhythmic contraction of the pelvic floor muscles, anal sphincter, urethral sphincter and several of the core muscles. This form of urinary leakage–often with large volumes of urinary incontinence– in many cases is due to an overactive bladder, a bladder that “contracts without its owner’s permission” causing symptoms including urinary urgency, frequent urinating and urgency incontinence.

Who Knew? “Squirting.” At the time of climax, some women are capable of “ejaculating” fluid. The nature of this fluid has been controversial, thought by some to be excess lubrication and others to be  glandular secretions (from Bartholin’s and/or Skene’s glands). There are certain women who “ejaculate” very large volumes of fluid at climax and scientific studies have shown this to be urine released because of an involuntary bladder contraction that accompanies orgasm.

How To Prevent Coital Incontinence:

  • Empty your bladder as completely as possible before sex.
  • If you have a dropped bladder, manually push the bladder back in to optimize your bladder emptying before sex.
  • Decrease fluid and caffeine intake for several hours prior to sex.
  • Experiment with sexual positions that put less pressure on the bladder.
  • Do pelvic floor muscle exercises (Kegels) on a regular basis to strengthen the voluntary urethral sphincter muscle; additionally, pelvic floor training can benefit cystoceles and overactive bladders.
  • Get in the best physical shape possible and exercise regularly (Pilates and yoga emphasize core strength and can be particularly helpful).
  • Medications: two classes of bladder relaxant medications used for overactive bladder can be helpful for incontinence that occurs with climax.

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo (paperback edition will be available May 2016).

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food   

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

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The Pelvic (Kegel) Revolution

April 23, 2016

Andrew Siegel MD  4/23/16

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(photo above: Dr. Arnold Kegel, Gladser Studio, 1953)

A Brief Recap from Last Week

In the 1940s, the seminal work of Los Angeles gynecologist Dr. Arnold Kegel resulted in pelvic floor exercises achieving the stature and acclaim that they deserved. His legacy is the name that many use to refer to pelvic exercises—“Kegels” or “Kegel exercises.” Despite Kegel’s pelvic regimen proving effective for many female pelvic issues (pelvic relaxation, vaginal laxity and sexual issues, urinary leakage, etc.) what came to be referred to as Kegel exercises in the post-Kegel era had little resemblance to what he so brilliantly described in his classic series of medical articles sixty-five years ago. His regimen incorporated a critical focus and intensity that were unfortunately not upheld in most of the pelvic floor muscle training programs that followed his reign.

The Pelvic (Kegel) Revolution

After years of “stagnancy” following the transformative work of Dr. Arnold Kegel, there is a resurgence of interest in the pelvic floor and in the benefits of pelvic floor training. In 2016, we are in the midst of a pelvic floor “sea change” that is gaining momentum and traction. There is increasing recognition of pelvic floor dysfunction (when pelvic floor function goes awry) as the root cause for a variety of pelvic issues including pelvic organ prolapse, stress urinary incontinence, overactive bladder, sexual dysfunction and pelvic pain syndromes. There is an evolution in progress with respect to management of pelvic floor dysfunction, including “smart” pelvic floor muscle programs that are tailored to the specific pelvic floor dysfunction, the advent of a host of novel, high-technology pelvic floor training resistance devices and the expanding use of a specialty niche of physical therapy—pelvic floor physical therapy.  Of note, pelvic floor physical therapy has been popular in Europe for many years and it is only recently that its utility has been recognized in the USA. (I am grateful for the wonderful services provided by my pelvic physiotherapy colleagues who have been so helpful and beneficial for many of my patients with pelvic floor dysfunctions.)

It is my belief that the next few years will bear witness to continued advances in pelvic floor muscle training and focus that will restore pelvic training to the classic sense established by Arnold Kegel—a “renaissance” to a new era of “pelvic enlightenment.” Books such as The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health (www.TheKegelFix.com) introduce new-age, next-generation pelvic programs—progressive, home-based, tailored exercise programs consisting of strength, power and endurance training regimens—designed and customized for each specific pelvic floor dysfunction. 2016 will usher in the availability of high quality follow-along pelvic training programs, e.g., the PelvicRx (www.PelvicRx.com)—a comprehensive, interactive, FDA-registered training regimen accessible via DVD or streaming. Furthermore, based upon Dr. Kegel’s perineometer resistance device, technological advances have resulted in the emergence of numerous pelvic floor muscle training devices, many of which are sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. Although most provide the same basic functionality—insertion into the vagina, connection to a smartphone app, biofeedback and tracking—each has its own unique features. This market for resistance devices is evolving at a remarkably rapid pace.

Another major refinement is the concept of functional pelvic fitness—teaching patients how to put their pelvic knowledge and skills to real life use with practical and actionable means of applying pelvic muscle proficiency to daily tasks and common everyday activities, an area that has been sorely neglected in the past, with prior emphasis solely on achieving a conditioned pelvic floor.

An additional element of the pelvic revolution is the increasing awareness and acceptance by the urological-gynecological-gastrointestinal community of the concept that stress and other psychosocial factors can give rise to physical complaints such as pelvic floor tension myalgia, a condition in which the pelvic floor muscles exist in an over-contracted, painful state. At one time, this diagnostic entity was not even a consideration; however, an understanding of this condition is slowly gaining recognition and traction and there is a burgeoning understanding that many pelvic pain issues (interstitial cystitis/chronic pelvic pain syndrome, prostatitis, irritable bowel syndrome, fibromyalgia, endometriosis, etc.) can, in actuality, be manifestations of pelvic floor hyper-contractility and over-tensioning.

Pelvic floor physical therapy has become and will continue to be increasingly in vogue. This specialized branch of physical therapy that deals with pelvic floor issues treats a wide range of pelvic floor dysfunctions ranging the gamut from pelvic muscle weakness to pelvic muscle over-tensioning. Pelvic floor physical therapy sessions can be of great help for those with pelvic floor dysfunctions and it is clear that patients do better with supervised regimens than they do without. Pelvic physical therapy is particularly useful for pelvic pain syndromes. In France, the government subsidizes the cost of post-partum pelvic training (“La rééducation périnéale après accouchement”), including up to 20 sessions of pelvic PT intended to tone and “re-educate” the postnatal pelvic muscles.

The final piece of the pelvic revolution is the broadening appreciation that pelvic floor muscle training in males is no less important than in females, potentially beneficial in the management of stress urinary incontinence that follows prostatectomy, overactive bladder, post-void dribbling, erectile dysfunction, premature ejaculation and pelvic pain due to pelvic muscle spasm.

Future Considerations

Demand for the management of pelvic floor disorders will increase over the next decade. There is major growth opportunity for services that utilize non-physician providers (nurse practitioners, physician assistants and physical therapists) to teach patients pelvic muscle training and other behavioral treatments.

If Arnold Kegel were alive today, in all likelihood he would take great pleasure and pride in the breath of life being infused into his seminal work following decades of dormancy. His legacy and the fertile ground and transformative changes nurtured by his pioneering efforts will result in the continued empowerment of patients, with improvement in their pelvic health and quality of life.

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo (paperback edition will be available May 2016).

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food   

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women.   Use code “UROLOGY10” at checkout for 10% discount. 

 

A Brief History of Kegel Exercises

April 16, 2016

Andrew Siegel MD  4/16/16

This first piece (of a two-part entry) reviews the history of pelvic floor training from antiquity up to 2015. The second piece (the 4/23/16 entry) is a discussion of the Kegel “renaissance” and “revolution” that is underway. This “sea change” in pelvic floor medicine that is currently evolving in the urology/gynecology medical community will most certainly permeate into the mainstream in the near future.

Muscles_of_the_male_perineum-Gray406Gray408

His and hers pelvic floor muscles (Dr. Henry Gray, Gray’s Anatomy, 1918, public domain)

The pelvic floor muscles have long been recognized as instrumental for their roles in  pelvic organ support, healthy sexual functioning and for their contribution to urinary and bowel control. They also contribute to core stability and postural support. The pelvic muscles anatomically and functionally link the female pelvic organs—the vagina, uterus, bladder and rectum—and also affect the independent function of each. Pelvic muscle “dysfunction” (when the pelvic muscles are impaired and not functioning properly) in females can contribute to pelvic organ prolapse and vaginal looseness, urinary and bowel control problems, sexual issues and pelvic pain (tension myalgia). Pelvic floor dysfunction in males can play a role in the urinary incontinence that follows prostate cancer surgery, dribbling of urine after the completion of urination, erectile dysfunction, ejaculation issues and pelvic pain.

Pelvic floor muscle fitness is vital to healthy pelvic functioning and pelvic muscle training therefore plays an important role in the management of many pelvic conditions. Pelvic muscle training has the potential of not only treating pelvic floor dysfunction, but also delaying and preventing its onset.

Pelvic floor exercises date back over 6000 years ago to Chinese Taoism. The Yogis of ancient India practiced pelvic exercises, performing rhythmic contractions of the anal sphincter muscle (one of the pelvic floor muscles). Hippocrates and Galen described pelvic exercises in ancient Greece and Rome, respectively, where they were performed in the baths and gymnasiums and were thought to promote longevity as well as general health, sexual health and spiritual health.

However, for millennia thereafter, pelvic floor exercises fell into the “dark.” Fast-forward to the 1930s when Margaret Morris, a British physical therapist, described pelvic exercises as a means of preventing and treating urinary and bowel control issues. In the 1940s, the seminal work of Dr. Arnold Kegel resulted in pelvic floor exercises achieving the stature and acclaim that they deserved. Dr. Kegel wrote four classic articles that put the pelvic floor muscles and the concept of training them to achieve pelvic fitness “on the map.” Kegel’s legacy is the actual name that many use to refer to pelvic exercises—“Kegels” or “Kegel exercises.” Kegel determined that a successful program must include four elements: muscle education, feedback, resistance, and progressive intensity. He stressed the need for pelvic floor muscle training as opposed to casual exercises, emphasizing the importance of a diligently performed routine performed with the aid of an intra-vaginal device known as a perineometer to provide both resistance (something to squeeze against) and biofeedback (to ensure that the exercises were being done properly).

Despite Kegel’s pelvic regimen proving effective for many female pelvic issues, what is currently referred to as Kegel exercises bears little resemblance to what he so brilliantly described in his classic series of medical articles sixty-five years ago. His regimen incorporated a critical focus and intensity that are unfortunately not upheld in most of today’s programs.

In the post-Kegel era, we have experienced a regression to the Dark Ages with respect to pelvic training. Easy-to-follow pelvic exercise programs or well-designed means of enabling pelvic exercises to improve pelvic floor health have been sorely lacking in availability. The programs that are out there typically involve vague verbal instructions and a pamphlet suggesting a several month regimen of ten or so pelvic contractions squeezing against no resistance, to be done several times daily during “down” times. These static programs typically do not offer more challenging exercises over time. Such Kegel “knockoffs” and watered-down, adulterated versions—even those publicized by esteemed medical institutions—are lacking in guidance, feedback and rigor, demand little time and effort and often ignore the benefit of resistance, thus accounting for their ineffectiveness. With women often unable to identify their pelvic muscles or properly perform the training, outcomes are less than favorable and the frustration level and high abandonment rate with these regimens is hardly surprising.

Bottom Line: In the post-Kegel era, pelvic floor muscle training has been an often ignored, neglected, misunderstood, under-respected and under-exploited resource.

Coming next week: The Kegel Revolution

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 The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle (paperback and Apple iBooks, B&N Nook and Kobo editions will be available in May 2016).

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food   

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx.

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women.   Use code UROLOGY10 at checkout for 10% discount. 

Antibiotics: Double-Edged Swords

April 9, 2016

Andrew Siegel MD  4/9/16

…A break from my typical “pelvic health” entries to briefly review these miraculous medications that are of both great benefit and detriment to humans and humankind. Beginning next week, I segue to the topic of “female pelvic health.”

IMG_1761

The 19th century –the “century of hygiene”–was marked by improved public health and sanitation, which saved more lives than any other cause.   The 20th century–the “century of medicine”– witnessed the development of antibiotics, vaccines, medications, chemotherapy, etc.  The 21st century could aptly be labeled the “century of resistance,” as overuse/misuse/abuse of antibiotics has resulted in the emergence of highly resistant “superbugs” that are one of the world’s most pressing public health problems. 

Ten Indisputable Facts Regarding Antibiotics

  1. Antibiotics are indispensable assets and essential weapons in the fight against bacterial pathogens, in many cases proving lifesaving.
  2. Antibiotics have dramatically improved human quality and quantity of life.
  3. Antibiotics arguably are the medication class that has been most abused, overused and/or used inappropriately (although pain medications are right up there as well).
  4. When prescribed for non-bacterial infections, e.g., the common cold and other viral upper respiratory infections, antibiotics not only provide absolutely no benefit, but also can be detrimental.
  5. Antibiotics can induce allergic reactions and many other side effects including tendon weakness and rupture associated with the use of Ciprofloxacin and other members of its class.
  6. Antibiotics destroy healthy bacteria along with pathogenic bacteria, causing adverse effects due to the change in the population of the bacterial ecosystem: yeast infections; infection/inflammation of the colon (colitis) caused by overgrowth of Clostridium difficile; and the selection of “superbugs” that are resistant to antibiotic treatment.
  7. Antibiotic overuse in farm animals–the number one consumer of antibiotics– has contributed in a major way to the surge in these “superbugs.”  Resistance is of particular concern in children because they have the highest demand for antibiotic use and fewer choices since some antibiotics cannot be safely used in children.
  8. On an annual basis 2,000,000 Americans acquire antibiotic-resistant infections;            23,000 die from them.
  9. 50% of outpatient antibiotic prescriptions in the USA are considered unnecessary.
  10. Antibiotics are often prescribed inappropriately because patients “demand” them and the “path of least resistance” is often for physicians to prescribe them.

Bottom Line:  Antibiotics are a powerful component of the medical armamentarium against disease, but are double-edged swords that must be used judiciously and appropriately.  (So the next time a patient with a cold asks me to prescribe a Z-Pak, you know what the answer will be!)

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 The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health– available on Amazon Kindle as of today: 

http://www.amazon.com/dp/B01E0NAPTS

Trailer for The Kegel Fix

https://www.youtube.com/watch?v=uHZxoiQb1Cc

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: http://www.MalePelvicFitness.com 

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx.

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store that is home to quality urology products for men and women.  Don’t forget to use code UROLOGY10 at checkout for 10% discount. 

Breast Lift, Face Lift…Prostate Lift

April 1, 2016

Andrew Siegel MD 4/2/16

“Prostate lift” a.k.a. “Urolift,” is a new rather clever means of improving a man’s ability to urinate when it is compromised by obstruction of the urinary channel because of enlarged lateral prostate lobes.

Prostate 101

The prostate is a male reproductive organ that produces prostate fluid, a milky liquid that serves as a nutrient vehicle for sperm. Similar to the breast, the prostate consists of glands that produce this milky fluid and ducts that convey the fluid into the urethra (urine and semen channel). The prostate completely surrounds the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between the prostate and the urethra can potentially be the source of many troubles for the aging male.

The Enlarging Prostate

Benign prostatic hyperplasia (BPH) is one of the most common conditions of the aging male  often causing bothersome lower urinary tract symptoms (LUTS)—urinary frequency, urgency, nighttime urination, weak and intermittent stream and the sensation of incomplete bladder emptying—that affect quality of life by interfering with normal daily activities and sleep patterns. The relationship between BPH and LUTS is complex because not all men with BPH develop LUTS, and LUTS are neither specific to nor exclusive to BPH. Urinary tract infections, prostate cancer, urethral scar tissue, and impaired bladder contractility (underactive bladder) are other problems that can mimic BPH.

Why Does The Prostate Enlarge?

Aging, genetic, and hormonal factors cause the prostate gland to gradually enlarge, with the process typically starting at about 40 years of age. As the prostate grows (hypertrophies), it puts pressure on the urethra, much
 as a hand squeezing a garden hose can affect the flow through the hose. Although larger prostates tend to cause more of this “crimping” than smaller prostates, this relationship is not precise.

UroLift (Prostate Urethral Lift)

UroLift is a new, minimally invasive means of treating prostate obstruction using a cystoscope (a small telescope that is positioned in the urethra to view the urethra, prostate and bladder) to place implants within the prostate to compress the obstructing prostate tissue. It opens the urethra so that the prostate no longer blocks the outflow of urine. It does so while leaving the prostate intact, not requiring cutting, heating, lasering or removal of prostate tissue. It is advantageous because of reduced bleeding and the preservation of erectile and ejaculatory function. It is important to know that it is not applicable to all men with prostate enlargement as it is only appropriate for certain prostate anatomies and sizes.

The technique uses mechanical compression of the encroaching lateral lobes of the prostate, creating an open channel. The implants are similar in action to molly bolts, resulting in crimping and tufting of the prostate tissue. The implants are deployed under direct visual guidance at the 2 o’clock and 10 o’clock positions using a needle that houses the components of the implant. The needle is passed through the full thickness of the prostate and upon retraction of the needle, the prostate capsule is engaged by a nitinol tab that is attached to an adjustable suture. The suture is placed under tension and a stainless steel urethral end piece is attached to the suture, securing the compression. Between two and ten implants may be used, depending on the size of the prostate gland.

Urolift color with text 2

Because the procedure does not remove tissue and avoids thermal energy, it has minimal  — if any– adverse effects on erectile and ejaculatory function, a major advantage over many of the alternative treatments of BPH, both medical and surgical. Minor side effects include short-term urinary burning, urgency and blood in the urine. The procedure was pioneered in Australia in 2005, received FDA approval in 2013 and Medicare approval in 2016.

Bottom Line: The UroLift is a clever new procedure that is effective in alleviating the annoying symptoms of prostate obstruction in men with certain prostate anatomies and sizes.  It alleviates obstruction without removing tissue by compressing the obstructing lateral (side) prostate lobes and does so without adversely affecting sexual or ejaculation function. 

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 and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store that is home to quality urology products for men and women.  Use code UROLOGY10 at check out for 10% discount.