Archive for January, 2017

Male Sexual Enhancement Supplements: Don’t Waste Your Money

January 28, 2017

Andrew Siegel MD  1/28/17

During my urology clinic hours at least one patient a day–if not more–shows me a recently purchased bottle of herbal supplements slated as beneficial for “sexual health.”  The composition of these products often includes one or more of the following: arginine, ginko biloba, horny goat weed, maca, yohimbine, etc. After I have had a chance to look at the product and its ingredients the following question is typically posed: “Any good, doc?”  I often reply with: “Don’t waste your money, you’re getting stiffed.”  (Pun intended.)

snake-oil

Image above from Wikipedia Commons, public domain

 

The male herbal enhancement business is billion dollar in scale, one that preys upon the desperation of men willing do anything to improve/enhance the dimensions of their penis and sexual function. Unfortunately, many men believe erroneously that supplements are natural and innocuous solutions to an array of sexual issues. The truth of the matter is that most sexual enhancement products are ineffective and make false claims. Of those that do have some beneficial effects, many contain small amounts of the chemicals used in legitimate ED medications without that being indicated on the label. The problem is that the quantity of added Viagra, Cialis, etc., is unknown and the origin a mystery, often counterfeit and/or produced in unregistered and unregulated labs. An additional problem is that the presence of these legitimate medicines in the herbal product makes the supplement dangerous to a segment of the population in which their usage is contraindicated.

Because these products are “supplements,” they are not under the domain of the FDA and therefore not subject to the regulation and scrutiny normally directed towards FDA approved pharmaceutical products. Furthermore, when a problem surfaces with one of these herbal products, the FDA will do no more than issue consumer alerts and request a voluntary recall.

Bottom Line: When it comes to male sexual enhancement supplements, save your resources, which would be much better spent elsewhere. Now that there is a generic 20 mg formulation of Viagra available (Sildenafil), you can get “stiff” without being “stiffed.” See your urologist for an ED consultation instead of heading to the Internet or convenience store to hunt for ineffective herbal products that are often tainted and contaminated.

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

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Testosterone Update 2017: Untangling The Web

January 21, 2017

Andrew Siegel, MD   1/21/17

Testosterone deficiency (TD) is a not uncommon male medical condition marked by characteristic symptoms and physical findings in the face of low levels or low activity of testosterone (T). TD is most often seen in men above the age of 50 years and is a frequent reason for why men make appointments with urologists.

t

What are the 3 best predictors of TD?

1. Decreased sex drive

2. Erectile dysfunction (ED)

3. Decreased frequency of morning erections

T is a hormone that is essential to male vitality. TD can affect the function of many different organ systems and negatively impact one’s quality of life. Its signs and symptoms can vary greatly. Since T regulates the male sexual response—including desire, arousal, erections, ejaculation and orgasm—sexual dysfunction is a common component of TD and is often the presenting symptom. Low T can give rise to diminished libido, altered penile rigidity, decreased morning and nocturnal erections, decreased ejaculate volume and has been associated with delayed ejaculation. Other common symptoms are decreased energy and vigor, fatigue, muscle weakness, increased body fat, depression and impaired concentration and cognitive ability. Common signs are weight gain, visceral obesity (increased waist circumference), decreased muscle mass and bone density, decreased body and pubic hair, gynecomastia (male breast development) and anemia.

TD is often seen in men with chronic diseases including obesity, diabetes, metabolic syndrome, osteoporosis, HIV infection, opioid drug abuse, and chronic steroid usage.

Why does TD occur?

TD can result from a problem with the ability of the testes to produce T, or alternatively, because of an issue with the hypothalamus or pituitary gland in which there is inadequate production of the hormones that trigger testes production of T. At times there is adequate T, but impairment of T action because of inability of T to bind to the appropriate receptors. Additionally, increased levels of sex hormone binding globulin (SHBG), a molecule that binds T, can result in decreased levels of “available” T despite normal T levels.

Not an Exact Science

It is important to note that not everybody who has a low T level will have characteristic signs and symptoms and also that it is possible to have signs and symptoms of TD with a normal T level.

 Checking for TD should be done under the circumstance of a male complaining of any of the aforementioned symptoms and signs. Shortcomings of measuring T levels are results that can vary from laboratory to laboratory, a lack of a consistent and clinically relevant reference range for T, the variability of T levels depending on time of day that levels are drawn (values are highest in the early morning) and the fact that it is the free T and not the total T (TT) that is “available” to most tissues. T circulates in the blood mainly bound to proteins (SHBG and albumin). It is free T and albumin-bound T that are tissue “available” and active.

If TT and/or free T are low, the levels of the pituitary hormones luteinizing hormone (LH) and prolactin (P) levels should be obtained to distinguish between a pituitary versus a testes issue. Symptomatic men with a TT < 350 are candidates for treatment. A 3-6 month trial of treatment may also be considered in men with symptoms and signs, but without definitive TD on lab testing since there is no absolute T level that will reliably distinguish who will or will not respond to treatment.

T and Prostate Cancer

Although testosterone deprivation has proven effective in treating advanced prostate cancer, there is no evidence to support that treatment of TD with T will increase the risk of prostate cancer. Studies indicate that if T < 250, increasing levels of T will stimulate prostate growth, but once T > 250, a saturation point (threshold) is reached with further increases in T causing little or no additional prostate growth.

T and Cardiac Disease

 A broad review of many articles fails to support the view that T use is associated with cardiovascular risks. In fact, the weight of evidence suggests that treating TD offers cardiovascular benefits.

T and Fertility

T causes impaired sperm production as T is a natural contraception and T replacement should not be used in men desiring to initiate a pregnancy.

TD Treatment

There are numerous different means of T treatment. T pills are not a satisfactory option since testosterone is inactivated in its pass through the liver. There is a buccal formulation that is placed and absorbed between the gum and cheek. There are numerous skin formulations including patches and gels. These skin formulations are commonly used, but are expensive, carry the risk of transference to children, spouses, and pets, and can cause skin irritation. They have the advantage of flexible dosing, easy administration, and immediate decrease in T levels after stopping treatment. Long-acting T pellets can be implanted in the fatty tissue of the buttocks, generally effective for 3 to 4 months or so. The insurance hoops that are required to get this formulation approved and covered have proven to be a major challenge. T injections are also commonly used, typically using a slowly absorbed “depot” injection that, depending on the dosage, can last 1-3 weeks. There is also a very long-acting formulation that, like the T pellets, requires a very taxing process to gain insurance approval.

As an alternative to T replacement, clomiphene citrate is a selective estrogen receptor modulator that when taken on a daily basis will increase both testosterone levels and sperm count by stimulating natural testes production. Human chorionic gonadotropin (hCG) can be used as well. Advantages are that they stimulate natural testosterone production and do not impair sperm count.

Adverse Effects of T Treatment

Careful monitoring is imperative for anybody on T treatment. T levels must be checked in order to assure levels in the proper range. Prostate exams and PSA levels are used to monitor the prostate gland and a periodic blood count is performed to ensure that one’s red blood cell count does not becoming too elevated, which can incur the risk of developing blood clots.

It is important to understand that external T will suppress whatever natural T is being made by the testes, since the body recognizes the T and the testes loses its stimulation to produce both T and sperm. Long term T use can cause atrophy (shrinkage) of the testes.

Ongoing Treatment

Those patients who are experiencing benefits of T treatment can have periodic “holidays” of discontinuation to reassess the continued need for the treatment.

Excellent resource: Diagnosis And Treatment Of Testosterone Deficiency: Recommendations From The Fourth International Consultation For Sexual Medicine, Journal of Sexual Medicine 2016; 13:1787 – 1804

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

6 Ways To Keep Your Vagina Youthful

January 14, 2017

Andrew Siegel  MD    1/14/2016

shutterstock_145680893

The vagina and vulva of a young healthy adult has a different appearance (as well as functional ability) than that of a female after menopause. After menopause—with its dramatic reduction in estrogen production—the female genital tissues no longer have the availability of the hormone that keeps the genital tissues vital.  Age-related changes of the vulva and vagina occur on the basis of the ravages of time and lack of estrogen-stimulation following menopause. The vagina becomes thinner, dryer, and less elastic with diminished length and width, lubrication potential and expansive ability.  This can give rise to symptoms including vaginal dryness, irritation, burning with urination and pain and bleeding with sexual intercourse. All in all this adds up to diminished quality of life.

Menopause is a significant risk factor for the occurrence of anatomical and functional changes that result from reduced levels of the female hormone estrogen. The vestibule (plate of tissue upon which open the vagina and urethra), vagina, urethra and base of the urinary bladder have abundant estrogen receptors that are no longer stimulated, resulting in diminished tissue elasticity and integrity. The labia become less robust, the vaginal opening retracts and the vaginal walls thin and lose the “tread”(rugae) that is typical of youth. The skin of the vulva becomes paler, thinner and more fragile. Because of this array of changes, the aging vagina can have difficulty lubricating and in accommodating a penis, resulting in painful sexual intercourse, a situation that affects more than two-thirds of post-menopausal women.

Often accompanying the physical changes of menopause are diminished sexual desire, arousal and ability to achieve orgasm. Pain, burning, itching and irritation of the vulva and vagina—particularly after sexual intercourse—are common. Urinary changes include burning with urination, frequency and urgency and recurrent urinary infections. Prior to menopause, healthy bacteria reside in the vagina. After menopause, this vaginal bacterial ecosystem changes, which can predispose one to urinary tract infections.

Considering that nature’s ultimate “purpose” of sex is for reproduction, perhaps it is not surprising that when the body is no longer capable of producing offspring, changes occur that affect the anatomy and function of the sexual apparatus.

The aging vagina was at one time referred to with disparaging terms including “atrophic vaginitis,” “vulvar and vaginal atrophy,” and “senile atrophy.” There are many such hurtful and cruel labels for female issues, including “frigid” for women who have difficulty in achieving sexual climax as opposed to the clinical term “anorgasmic.” A much kinder, although technical term for the aging vagina is “genitourinary syndrome of menopause” (GSM).

6 Ways To Keep Your Vagina Youthful:

  1. Stay Sexually Active Regular sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse. Vaginal penetration increases pelvic and vaginal blood flow, which optimizes lubrication and elasticity. Orgasms tone and strengthen the pelvic floor muscles that support vaginal function. “Use it or lose it” is the rule.  Be sure to use plenty of lubrication if vaginal dryness is an issue.
  1. Pelvic Floor Exercises   Pelvic floor muscles play a vital role with respect to sexual, urinary and bowel function as well as the support of the pelvic organs. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) to help maintain pelvic blood flow, sexual function, pelvic support and urinary/bowel control. The pelvic floor muscles play a vital role with respect to all aspects of sexual function, including arousal, lubrication, clitoral and vulvar engorgement and sexual climax.
  1. Consider Topical Estrogen Replacement   This is a means of achieving the advantages that estrogen provides to the genital issues using a cream formulation that is applied locally. There is minimal absorption and it therefore avoids the vast majority of adverse effects that can occur from oral hormone replacement therapy. A small dab of Premarin or Estrace cream placed in the vagina three or four nights per week prior to sleep can restore vaginal suppleness and increase tissue integrity. This will help improve lubrication, pain with intercourse, urinary control issues and can help prevent urinary infections.
  1. See Your Gynecologist   You bring your car in for annual preventive maintenance to a mechanic, so do the same for your lady parts.! Your gynecologist is on your team with a goal of keeping you and your vagina healthy. Gynecologists have some new tools at their disposal to combat GSM, including lasers that can be applied to the vestibule for purposes of skin resurfacing and restoration.
  1. Healthy Lifestyle   It is desirable to keep every cell and tissue in your body healthy via intelligent lifestyle choices. These include: smart eating habits; maintaining a healthy weight; engaging in exercise; obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction.
  1. Avoid Excessive Time In The Saddle Bicycle riding, as well as any other activity that places prolonged pressure on the “saddle” of the body (including motorcycle, moped, and horseback riding), are potential causes of impaired genital function. Although this is rarely a problem for the casual or recreational cyclist, it can be a real issue for women who spend many hours weekly in the saddle. When cycling, intense pressure is applied to the perineum (area between vulva and anus), the area of the body that can be considered to be “the heart” of the blood and nerve supply to the vagina and pelvic floor muscles.

Bottom Line: All things eventually get old, including vaginas and vulvas. We are not in control of the aging process and sooner or later Father Time reigns supreme. However, by adhering to some commonsense advice you can maintain vaginal youth and vitality for many years.

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

 

The Female Love Muscles

January 7, 2017

Andrew Siegel MD 1/7/16

Optimal muscle functioning is integral to sexual activity. There would be no “jump” in the term “jump one’s bones” without fit muscles that permit the coordinated movements and muscle contractions that are necessary to engage in sexual coupling.

The following is a short poem I have composed about the muscles of love:

 Limber hip rotators,

A powerful cardio-core,

But forget not

The oft neglected pelvic floor.

Sex is a physical activity involving numerous muscles that coordinate with seamless efficiency. Sexual activity demands movement, a synchronized kinetic chain integrating core muscles and external hip rotators in which both pelvic thrusting and outward rotation of the hips work effectively together to forge a choreographed motion. It is a given that cardiac (aerobic) conditioning is a prerequisite for any endurance athletic endeavor, including SEX-ercise.

Three muscle groups are vital for optimal sexual function—core muscles, which maintain stability and provide a solid platform to enable pelvic thrusting; external hip rotators, which rotate the thighs outward and are the motor behind pelvic thrusting; and the floor of the core muscles—pelvic floor muscles (PFM), which provide pelvic tone and support, permit tightening and relaxing of the vagina, support clitoral erection, and contract rhythmically at the time of climax. When these three groups of muscles are in tiptop shape, sexual function is optimized.

The core muscles are a cylinder of torso muscles that surround the innermost layer of the abdomen. They function as an internal corset and shock absorber. In Pilates they are aptly referred to as the “powerhouse,” providing stability, alignment and balance, but also allowing the extremity muscles a springboard from which to push off and work effectively. It is impossible to use your limbs without engaging a solid core and, likewise, it is not possible to use your genitals effectively during sex without engaging the core muscles.

Who Knew? According to the book “The Coregasm Workout,” 10% of women are capable of achieving sexual climax while doing core exercises. It most often occurs when challenging core exercises are pursued immediately after cardio exercises, resulting in core muscle fatigue. 

Rotation of your hips is a vital element of sexual movement. The external rotators are a group of muscles responsible for lateral (side) rotation of your femur (thigh) bone in the hip joint. My medical school anatomy professor referred to this group of muscles as the “muscles of copulation.” Included in this group are the powerful gluteal muscles of your buttocks.

Who Knew? Not only do your gluteal muscles give your bottom a nice shape, but they also are vital for pelvic thrusting power.

The PFM make up the floor of the core. The deep layer is the levator ani (“lift anus”), consisting of the pubococcygeus, puborectalis, and iliococcygeus muscles. These muscles stretch from pubic bone to tailbone, encircling the base of the vagina, the urethra and the rectum. The superficial layer is the bulbocavernosus, ischiocavernosus, transverse perineal muscles and the anal sphincter muscle.

The following two illustrations are by Ashley Halsey from The Kegel Fix:

2.deep PFM 3. superficial and deep PFM

The PFM are critical to sexual function. The other core muscles and hip rotators are important with respect to the movements required for sexual intercourse, but the PFM are unique as they directly involve the genitals. During arousal they help increase pelvic blood flow, contributing to vaginal lubrication, genital engorgement and the transformation of the clitoris from flaccid to softly swollen to rigidly engorged. The PFM enable tightening the vagina at will and function to compress the deep roots of the clitoris, elevating blood pressure within the clitoris to maintain clitoral erection. An orgasm would not be an orgasm without the contribution of PFM contractions.

Who Knew? Pilates—emphasizing core strength, stability and flexibility—is a great source of PFM strength and endurance training. By increasing range of motion, loosening tight hips and spines and improving one’s ability to rock and gyrate the hips, Pilates is an ideal exercise for improving sexual function.

PFM Training to Enhance Sexual Function: The Ultimate Sex-ercise

The PFM are intimately involved with all aspects of sexuality from arousal to climax. They are highly responsive to sexual stimulation and react by contracting and increasing blood flow to the entire pelvic region, enhancing arousal. Upon clitoral stimulation, the PFM reflexively contract. When the PFM are voluntarily engaged, pelvic blood flow and sexual response are further intensified. During climax, the PFM contract involuntarily in a rhythmic fashion and provide the muscle power behind the physical aspect of an orgasm. The bottom line is that the pleasurable sensation that one perceives during sex is directly related to PFM function and weakened PFM are clearly associated with sexual and orgasmic dysfunction.

PFM training improves PFM awareness, strength, endurance, tone and flexibility and can enhance sexual function in women with desire, arousal, orgasm and pain issues, as well as in women without sexual issues. PFM training helps sculpt a fit and firm vagina, which can positively influence sexual arousal and help one achieve an orgasm. PFM training results in increased muscle mass and more powerful PFM contractions and better PFM stamina, heightening the capacity for enhancing orgasm intensity and experiencing more orgasms as well as increasing “his” pleasure. PFM training is an excellent means of counteracting the adverse sexual effects of obstetrical trauma. Furthermore, PFM training can help prevent sexual problems that may emerge in the future.  Tapping into and harnessing the energy of the PFM is capable of improving one’s sexual experience. If the core muscles are the “powerhouse” of the body, the PFM are the “powerhouse” of the vagina.

Bottom Line: Strong PFM = Strong climax. The PFM are more responsive when better toned and PFM training can revitalize the PFM and instill the capacity to activate the PFM with less effort. PFM training can lead to increased sexual desire, sensation, and sexual pleasure, intensify and produce more orgasms and help one become multi-orgasmic. Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible PFM. Having fit PFM in conjunction with the other core muscles and the external hip rotators translates to increased self-confidence.

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Much of the content of this entry was excerpted from his recently published book The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health: http://www.TheKegelFix.com

He is also the author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com