Archive for April, 2017

Putting Some “Lead” In Your Pencil: A Fix For The “Innie” Penis

April 29, 2017

Andrew Siegel MD   4/28/2017

pencil pixbay

Thank you, Pixabay, for image above

As Multi-Functional as a Swiss Army Knife

The penis is an extraordinary organ with urinary, sexual and reproductive functions. The possession of a penis endows man with the ability to stand to urinate and direct his urinary stream, a distinct advantage over the clumsy apparatus of the fairer sex that generates a spraying, poor-directed stream that demands sitting down on a toilet seat. The advantage of being able to stand to urinate (and keep one’s body appropriately distanced from the horrors of many public toilets) is priceless. Although man does not often have to employ this, the capability (when necessary) of urinating outside is another benefit of our design.  Many find the outdoor voiding experience pleasing, observing the pleasant sounds and visuals of a forceful stream striking our target (often a tree) with finesse, creating rivulets and cascades to show for our efforts.

Getting beyond the urinary, the most dramatic penis magic is its ability to change its form in a matter of seconds, morphing into an erect “proud soldier” and enabling the wherewithal for vaginal penetration and with sufficient stimulation, for ejaculation.  All that fun, but really serving the purpose of the passage of genetic material and ultimately the perpetuation of our species…reproductive wizardry!

The water tap that could turn into a pillar of fire.”

Eric Gill

tap pixabay

pixabay pillar

Thank you, Pixabay, for images above

 

The Sometimes Cruel Process of Aging Does Not Spare the Penis

 “Getting older is an honor and a privilege, but getting old is a burden.”

Beverly Radow (my aunt, who will turn 90-years-old this year)

Long after our reproductive years are over and fatherhood is no longer a consideration, most men still wish to be able to achieve a decent-enough erection to have sexual intercourse.  As well, we still desire to be able to urinate standing upright with laser-like urinary stream precision.

However, the ravages of time (and poor lifestyle habits) can wreak havoc on penile anatomy and function.  Many middle-aged men typically gain a few pounds a year, ultimately developing a bit of a pubic fat pad–the male equivalent of the female mons pubis– and before you know it the penis appears shorter and becomes an “innie” as opposed to an “outie.”  In actuality, penile length is usually more-or-less preserved, with the penis merely hiding behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. This is why having a plus-sized figure is not a good thing when it comes to size matters.

Useful Factoid: The Angry Inch…It is estimated that there is a one-inch loss in apparent penile length with every 35 lbs. of weight gain.

One of the problems with a shorter and more internal penis is that the forceful and precise urinary stream of yesteryear gives way to a spraying and dribbling-quality stream that can drip down one’s legs, spray over the floor and onto one’s feet (and even at times towards or on the gentleman next to you at the urinal!).

Almost Useless Factoid: Water Sports…Turkey vultures pee on themselves to deal with the heat of the summer on their dark feathers, since they lack sweat glands.  By excreting on their legs, the birds use urine evaporation to cool themselves down in the process of “urohidrosis.”  Unless you are a turkey vulture, peeing on yourself or others is rather undesirable!

The solution to having a recessed penis that is often hidden from sight and has lost its aiming capabilities is to sit on the toilet bowl to urinate, joining the leagues of our female companions who are “stream-challenged” because of their anatomy.

With aging (and poor lifestyle habits) also comes declining sexual function and activity as rigid erections going by the wayside.  However, like any other body part, the penis needs to be used on a regular basis—the way nature intended—in order to maintain its health. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile erectile tissues can occur, resulting in a de-conditioned and smaller penis that does not function like it used to.

Factoid: Disuse Atrophy…If one goes too long without an erection, collagen, smooth muscle, elastin and other erectile tissues may become compromised, resulting in a loss of penile length and girth and limiting one’s ability to achieve an erection.  Conversely, sexual intercourse on a regular basis protects against ED issues and the risk of ED is inversely related to the frequency of intercourse.

The point I am trying to hammer home is that aging, weight gain and poor lifestyle habits often render men with penises that are:

  1. Shrunken and recessed
  2. Unreliable in terms of ability to pee straight, requiring sitting down on the toilet bowl like women
  3. Unreliable with respect to sexual function

Factoid: Point 1 + Point 2 + Point 3 = EMASCULATION (depriving man of his male role and identity)

What To Do?

The first step is to keep one’s body (and penis) as healthy as possible via intelligent lifestyle choices. These include the following: smart eating habits; maintaining a healthy weight; engaging in exercise (including pelvic floor muscle training); obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction. The use of ED medications on a low-dose, daily basis can sometimes help all 3 issues.

In the event that the aforementioned means fail to correct the problem, a virtually sure-fire way of rectifying all three issues is by a simple surgical procedure.  Malleable penile implants (penile rods) are surgically placed into each erectile chamber of the penis (the two inner tubes of the penis that under normal circumstances fill with blood to create an erection). The implants act as skeletal framework for the penis (“bones” of the penis). Two USA companies, Coloplast and AMS (American Medical Systems) manufacture the rods that are in current use. They are very similar with subtle differences.

464x261_GenesisColoplast Genesis implant

AMS Spectra

American Medical Systems Spectra implant

The implant procedure of these two stiff-but-flexible rods into the erectile chambers of the penis is performed by a urologist on an outpatient basis.  Like shoes, the penile rods come in a variety of lengths and widths and fundamental to the success of the procedure is to properly measuring the dimensions of the erectile chambers in order to obtain an ideal fit. The small incision needed to implant the rods is closed with sutures that dissolve on their own. Healing typically takes about 6 weeks, after which sexual relations can be initiated.

An erection suitable for penetration and sexual intercourse is available 24-7-365, simply by bending the penis up. The penis is angled down for concealment purposes. It is flexible enough to be comfortably flexed up or down, while rigid enough for intercourse, the best of all worlds.

Print

Penile rods in action, bent down for concealment and up for urination and sex

Bottom Line:  It is not uncommon for aging, weight gain and unhealthy lifestyle factors to conspire to compromise penile anatomy and function with respect to apparent penile size, urinary stream precision and erectile rigidity.  This leaves one emasculated with a penis that is often concealed, shortened and habitually limp, impeding the ability to have sexual intercourse, as well as a spraying quality urinary stream necessitating sitting to urinate.  If lifestyle improvement measures do not correct the situation, literally and figuratively “putting some lead in your pencil” using a simple malleable penile implant can “kill three birds with one stone.” (I could not resist the very mixed metaphor.)  Confidence can be restored with the conversion of the “innie” penis to an “outie,” the ability to resume sexual intercourse and the reestablishment of a directed, non-spraying stream to permit standing to urinate.

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

Bladder Cancer Treatment With TB Vaccine

April 22, 2017

Andrew Siegel MD  4/22/17

The use of tuberculosis vaccine (a.k.a. bacillus Calmette-Guerin or BCG) to treat bladder cancer is one of the great success stories in the history of using the immune system to combat cancer. For 40 years, BCG has been recognized as the standard of care for high-grade, superficial bladder cancer and carcinoma-in-situ (CIS), a flat but high-grade bladder cancer. The use of BCG is responsible for significantly reducing bladder cancer progression and recurrence.

IMG_2097

Image above: BCG in powdered form that needs to be reconstituted

bladder-ca

Image above: Typical appearance of a superficial bladder cancer

 

Bladder cancer has a strong tendency to recur, despite cystoscopy-guided complete removal of visible tumors (using a “telescope” placed within the bladder via the urethra). This approach can only treat obvious and visible tumors, with the real possibility that there are additional tumors present that are not yet visible (microscopic), since bladder cancer is a “field” disease—capable of occurring anywhere within the bladder lining. One of the rationales for using a medication like BCG is that it is a liquid formulation that is instilled in the bladder and will bathe all inner surfaces of the bladder. I often use the analogy of plucking out dandelions in your lawn individually as opposed to using a weed spray with respect to the difference between bladder tumor resection (cystoscopic surgical removal) and using a BCG-like medication.

A Brief History of BCG

BCG is a unique strain of “weakened” mycobacterium bovis (cow tuberculosis bacterium) developed by Albert Calmette and Camille Guerin at the Pasteur Institute in Lille, France in 1921 as a tuberculosis vaccine. At the time of its development, there was a growing recognition of the relationship between the immune system and cancer. In 1929, it was discovered that BCG might also have a role in the treatment of cancer when autopsy findings in TB patients were correlated with a reduced prevalence of cancers. Early investigators found that mice given BCG were protected against cancers that were implanted. In 1975, Dr. Jean deKernion at UCLA reported a melanoma that had spread to the bladder that was eliminated by direct injection of BCG into the melanoma. In 1976, Alvaro Morales successfully instilled BCG inside the bladder to treat bladder cancer and after clinical trials it was FDA approved for use within the bladder in 1990…The rest is history.

How It Works

BCG activates the immune system and triggers an inflammatory response that destroys bladder cancer cells. A good response to BCG immunotherapy requires a patient with an immune system capable of mounting a cellular immune response. It is accomplished by infusing a sufficient quantity of BCG so that it has direct contact with cancer cells.

How It Is Used

BCG is instilled directly within the urinary bladder.  One cycle is a once per week treatment for 6 weeks.  A full course is two cycles, followed by maintenance therapy. Typically the BCG treatment is initiated two weeks or so following the bladder tumor resection to allow the bladder time to heal. BCG is placed inside the urinary bladder using a narrow catheter. Retaining it for two hours is ideal and rotating body position is important so that all areas of the bladder are adequately bathed with the BCG.

Side Effects of BCG

Low-grade fever, urinary urgency, frequency, burning and blood in the urine are typical symptoms, often indicative of the immune response being mounted.   Occasionally, flu-like symptoms may occur, including fever, chills, cough, muscle and joint aches. When severe symptoms occur, BCG concentration can be reduced to 1/3, 1/10, 1/30, or even 1/100th of a dose to prevent escalating side effects.

 Tips For Patients Receiving BCG

  • Avoid drinking any fluids for at least 2 hours and avoid caffeine-containing products for at least 4 hours prior to bladder instillation in order to be able to retain the BCG for a full 2 hours after the instillation and to avoid diluting the concentration of the BCG.
  • Rotate your body in order to bathe all surface areas of the bladder with the BCG (supine, left, right, prone).
  • Care should be used when urinating after the BCG is instilled to avoid contaminating one’s hands or genitals with the BCG. Men should sit to urinate to reduce the likelihood of self-contamination. Hands and genitals should be thoroughly washed afterwards, and household bleach should be added to the toilet immediately after urination. The bleach should stand for 15 minutes before flushing to deactivate the BCG.

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

YouTube site: http://www.YouTube.com/incontinencedoc

Vidscrip site (for short educational videos): http://www.Vidscrip.com/andrewsiegel

Pessaries To Treat Pelvic Organ Prolapse: What You Need To Know

April 15, 2017

Andrew Siegel MD    4 /15 /17

A pessary is a vaginal insert that is used to help provide pelvic support in women with vaginal prolapse of the urogenital organs, a.k.a. pelvic organ prolapse (POP). Pessaries are available in a variety of sizes and shapes and when positioned in place within the vagina, function as “struts” to help keep the prolapsing pelvic organ(s) in proper anatomical position. They are ideal for older patients who have medical issues that preclude surgical treatment and for women who opt for non-surgical management.  Pessaries need to be removed periodically in order to clean them.  Some are designed to permit sexual intercourse.

A Few Words on POP

POP is a common condition in which there is weakness of the pelvic muscles and connective tissues that provide pelvic support, allowing one or more of the pelvic organs to move from their normal positions into the potential space of the vaginal canal and, at its most severe degree, outside the vaginal opening. POP is an important issue in women’s health, with an increasing prevalence correlating with extended longevity. Two-thirds of women who have delivered children vaginally have anatomical evidence of POP (although many are not symptomatic) and 10-20% will need to undergo a corrective surgical procedure. The true prevalence of POP is not known because of the large number of women who do not seek medical care for the problem.

POP is not life threatening, but can be a distressing and disruptive problem that negatively impacts quality of life. Despite how common an issue it is, many women are reluctant to seek help because they are too embarrassed to discuss it with anyone or have the misconception that there are no treatment options available or fear that surgery will be the only solution.

POP may involve any pelvic organ including the urinary, intestinal and gynecological tracts. The bladder is the organ that is most commonly involved in POP. POP can vary from minimal descent—causing few, if any, symptoms—to major descent—in which one or more of the pelvic organs prolapse outside the vagina at all times, causing significant symptoms. The degree of descent varies with position and activity level, increasing with the upright position and/or exertion and decreasing with lying down and resting, as is the case for any hernia.

POP can give cause a variety of symptoms, depending on which organ is involved and the extent of the prolapse.  The most common complaints are the following: a vaginal bulge or lump, the perception that one’s insides are falling outside, and vaginal “pressure.”  Because POP often causes vaginal looseness in addition to one or more organs falling into the space of the vaginal canal, sexual complaints are common, including painful intercourse, altered sexual feeling and difficulty achieving orgasm as well as less partner satisfaction.

3 Options to Manage POP

  1. Conservative
  2. Pessaries
  3. Surgery (Pelvic Reconstruction) 

Conservative treatment options for POP include pelvic floor muscle training (for details on pelvic muscle training for POP see http://www.TheKegelFix.com), modification of activities that promote the POP (heavy lifting and high impact exercises), management of constipation and other circumstances that increase abdominal pressure, weight loss, smoking cessation and consideration for hormone replacement, since estrogen replacement can increase tissue integrity and suppleness.

Pessary Basics

A pessary is a non-surgical option for treating POP, used with the goal of improving quality of life, body image, and bladder, bowel and sexual function. Pessaries are made of soft and pliable hypoallergenic plastic or silicone and can successfully alleviate symptoms of POP in 85% of those who use them.  About 50% or so of women who trial pessaries continue to use them for the long term, with discontinuation typically occurring in those who cannot retain the pessary, those experiencing discomfort or pain, those who desire surgery, and those who are incapable of inserting and removing them.

It is important to know that pessaries are not successful in all women with POP.  They tend to fail in women with significantly enlarged vaginal openings, in which case the pessary can fall out with effort and exertion. Factors associated with a higher risk for failure are younger age, obesity, and weak pelvic floor muscles.

For Whom is a Pessary Appropriate?

  • Older women who are not candidates for surgery
  • Anyone who desires non-surgical management of their POP
  • For those who need to delay surgery, wish to defer surgery or simply desire to trial one prior to surgery

1-Pessary Image

Image Above: A Potpourri of Pessaries

What Types of Pessaries Are Available?

For Mild-Moderate POP

The ring pessary (7:00 position of image above) is the simplest and most commonly used pessary that has the least side effects.  It is widely employed because of its ease of insertion, good vaginal fit and allowance for sexual intercourse without removing it.  A variation of the ring pessary is one with central support. The oval pessary is a variation of the ring used in narrow vaginas.  The Shaatz pessary (4:00 position of image above) is another variation. The incontinence dish pessary (5:00 position of image above) is used for stress urinary incontinence and mild POP.  A variation of this comes with a central support.

For Moderate-Severe POP

The Gellhorn pessary (3:00 position of image above) is used for greater degrees of POP than the pessaries described in the paragraph above, which are typically used for mild-moderate POP.  It tends to produce the greatest degree of vaginal discharge because of its shape.   The Hodge pessary has wires that can be manually shaped to fit the nuances of one’s anatomy. The Gehrung pessary (10:00 position of image above) also has wires that allow it to be manually shaped.  The donut pessary (center position of image above) is soft allowing it to be compressed for insertion, even with its bulk.  The cube pessary (9:00 position of image above) comes with a tie to help with its removal.

What Are Side Effects Of Pessaries?

The most common side effects are vaginal discharge and vaginitis (vaginal irritation or infection).  Occasionally, vaginal ulcerations can occur because of abrasive contact of the pessary with the delicate lining of the vagina.

How Does One Get Fitted For A Pessary?

A pelvic exam is performed prior to the fitting in order to help determine the proper size and type.  A properly fitted pessary should be large enough to function optimally, but not so large that it causes pressure or discomfort. It should be possible to insert a finger between the pessary’s outer rim and the wall of the vagina.

Usually a ring pessary (size 2, 3, or 4) is initially trialled.  It comes in 9 sizes, ranging from 2.00-4.00 in 0.25 increments.  If unsuccessful, a Gellhorn (size 2, 2.25, 2.5, or 2.75), cube or other model is utilized, depending upon particular circumstances. The largest pessary that is comfortable is placed and the patient is asked to walk and strain to ensure that it remains in proper position.  Motivated patients can be taught how to remove, clean and reinsert it. Typically, removal is done once weekly prior to sleeping, with reinsertion the following morning.  For the less motivated patient, the gynecologist can remove, clean and replace the device every three months or so.

Bottom Line: Pessaries are a non-surgical alternative to help provide pelvic support in women with pelvic organ prolapse.  They are available in a variety of sizes and shapes and need to be fitted and sized to the particulars of one’s anatomy.  They fold and compress to facilitate insertion and removal.  They are ideal for older patients who have medical issues that preclude surgical treatment.  If pessaries fail to improve the POP or cannot be retained or are poorly tolerated, a surgical procedure–pelvic reconstruction–can be performed to remedy the problem.  

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 Penis Pump (Vacuum Erection Device): What You Need To Know

April 8, 2017

Andrew Siegel MD  4/8/17

The vacuum erection device (VED) is an effective means of inducing a penile erection suitable for sexual intercourse–even in difficult to treat men who have diabetes, spinal cord injury, or after radical prostatectomy for prostate cancer.  The device is also useful in the post-operative period following radical prostatectomy to maintain penile length and girth. It has some utility in Peyronie’s disease patients in order to improve curvature, pain and maintain penile dimensions. It can be used prior to penile prosthesis surgery in order to enhance penile length and facilitate the placement of the largest possible implant.  

VED

Image Above: Vacuum Erection Device (obtainable via UrologyHealthStore.com–use promo code UROLOGY 10 for 10% discount and free shipping)

Introduction

Tissue expansion is local tissue enlargement in response to a force that can be internal or external.  Internal tissue expansion occurs naturally with pregnancy, weight gain and the presence of slow growing tumors. Plastic surgeons commonly tap into this principle by using implantable tissue expanders prior to breast reconstructive surgery.

The VED uses the principle of external tissue expansion by using negative pressures applied to the penis to stretch the smooth muscle and sinuses of the penile erectile chambers. The resultant influx of blood increases tissue oxygenation, activates tissue nutrient factors, mobilizes stem cells, helps prevent tissue scarring and cellular death and, importantly, induces an erection.

There are many commercially available VEDs on the market, which share in common a cylinder chamber with one end closed off, a vacuum pump and a constriction ring.  The penis is inserted into the cylinder chamber and an erection is induced by virtue of a vacuum that creates negative pressures and literally sucks blood into the erectile chambers of the penis. To maintain the erection after the vacuum is released, a constriction ring is applied to the base of the penis.  The end result is a rigid penis capable of penetrative intercourse.

Interesting factoid: Similarly designed vacuum suction devices are available for purposes of nipple and clitoral stimulation.

Brief History of VED

In 1874, an American physician named  John King came up with the concept of using a glass exhauster to induce a penile erection. The problem with the device was the loss of the erection as soon as the penis was withdrawn from the exhauster. In 1917 Otto Lederer introduced the first vacuum suction device.  After many years of quiescence, the VED was popularized by Geddins Osbon and named “the Erecaid device.” Currently, the VED is a popular mechanical means of inducing an erection that does not utilize medications or surgery.

Nuts and Bolts of VED Use

The VED is prepared by placing a constriction ring over the open end of the cylinder. A water-soluble lubricant is applied to the base of the penis to achieve a tight seal when the penis is placed into the cylinder.  Either a manual or automatic pump is used to generate negative pressures within the cylinder, which pulls blood into the penis, causing fullness and ultimately rigidity. Once full rigidity is achieved, the constriction ring is pushed off the cylinder onto the base of the penis. Importantly, the ring should never be left on for more than 30 minutes to minimize the likelihood of problems. After the sexual act is completed, the constriction ring must be removed.

Interesting Factoid: The VED can be used alone or in combination with other forms of treatment for ED, including pills (Viagra, Levitra and Cialis), penile injection therapy and penile prostheses.

Pluses and Minuses of the VED

A distinct advantage of the VED is that it is a simple mechanical treatment that does not require drugs or surgery.  Disadvantages are the need for preparation time, which impairs spontaneity.  Another disadvantage is the necessity for wearing the constriction device, which can be uncomfortable and can cause “hinging” at the site of application of the constriction ring resulting in a floppy penis (because of lack of rigidity of the deep roots of the penis) as well as impairing ejaculation. Other potential issues are temporary discomfort or pain, coolness, numbness, altered sensation, engorgement of the penile head, and black and blue areas.

VED After Radical Prostatectomy

Erectile function can be adversely affected by radical prostatectomy with recovery taking months to years. The VED can be used to enhance the speed and extent of sexual recovery after surgery, minimize the decrease in penile length and girth that can occur, and enable achievement of a rigid erection suitable for sexual intercourse.  Clinical studies have clearly demonstrated that VED use after prostatectomy helps maintain existing penile length and prevents loss of length.

Bottom Line:  The VED is one of the oldest treatments for ED that remains in contemporary use.  It works by creating negative pressures that cause an influx of blood into the penile erectile chambers resulting in penile expansion and erection.  Although effective even in difficult to treat populations, the attrition rate is high, perhaps because of the cumbersome nature of the device and the preparation regimen and time involved. However, the VED is an important part of the “erection recovery program” (penile rehabilitation) after prostatectomy, second only to oral ED pills in use for this purpose. It is particularly vital in the preservation and restoration of penile anatomy and size.  It also is useful in ED related to other radical pelvic surgical procedures including colectomy for colon cancer. It remains a viable alternative in men not interested or responsive to ED pills or penile injections and those not interested in surgery.

There are many different VED systems on the market. The Urology Health Store (www.UrologyHealthStore.com) has a nice selection of VEDs (use promo code UROLOGY 10 for 10% discount and free shipping).

** The Urology Health Store  is offering live video VED instructional classes via Skype, Go-To-Meeting or FaceTime.  These classes are available by appointment from 1PM-3PM, U.S. Eastern Time, Monday-Friday.  Call 301-378-8433 for appointment.  No purchase is necessary to take the class.

Excellent resource: External Mechanical Devices and Vascular Surgery for Erectile Dysfunction.  L Trost, R Munarriz, R Wang, A Morey and L Levine: J Sex Med 2016; 13:1579-1617

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

DON’T Exercise Your Pelvic Muscles… TRAIN Them

April 1, 2017

Andrew Siegel MD  4/1/2017

“Exercise” is not the same as “training” and “pelvic floor exercises” (“Kegels”) are not the same as “pelvic floor training.”

1116_Muscle_of_the_Perineum (1)

Male (left) and female (right) pelvic floor muscles–By OpenStax [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)%5D, via Wikimedia Commons

To anybody interested in the nuances of exercise science, “exercising” and “training” are as different as apples and oranges. Don’t get me wrong—they are both healthy and admirable pursuits and doing any form of physical activity is far superior to being sedentary. However, exercise is more of being “in the moment,” a “here and now” physical activity– the short view. On the other hand, training is a well-planned and thought out process pursued towards the achievement of specific long-term goals– the long view. Every workout in a training program can be thought of as an incremental steppingstone in the process of muscle adaptation to achieve improvement or enhancement of function. The ultimate goal of a training program is being able to apply in a practical way the newly fit and toned muscles to daily activities—functional fitness—in order to achieve a better performance (and when it comes to the pelvic floor muscles, an improved quality of life.)

Muscle training is all about adaptation. Our muscles are remarkably adaptable to the stresses and loads placed upon them. Muscle growth will only occur in the presence of progressive overload, which causes compensatory structural and functional changes. That is why exercises get progressively easier in proportion to the effort put into doing them.  As muscles adapt to the stresses placed upon them, a “new normal” level of fitness is achieved. Another term for adaptation is plasticity–our muscles are “plastic,” meaning they are capable of growth or shrinkage depending on the environment to which they are exposed.

One obvious difference between pelvic floor muscles and other skeletal muscles is that the pelvic muscles are internal and hidden, which adds an element of challenge not present when training the visible arm, shoulder and chest muscles. However, the pelvic floor muscles are similar to other skeletal muscles in terms of their response to training. In accordance with the adaptation principle, incrementally increasing contraction intensity and duration, number of repetitions and resistance will build pelvic muscle strength, power and endurance.

The goal for pelvic floor muscle training is for fit pelvic muscles—strong yet flexible and equally capable of powerful contractions as well as full relaxation. The ultimate goal for pelvic floor muscle training—a goal that often goes unmentioned–is the achievement of “functional pelvic fitness.”  Pelvic floor muscle training really is the essence of functional fitness, training that develops pelvic floor muscle strength, power, stamina and the skill set that can be used to improve and/or prevent specific pelvic functional impairments including those of a sexual, urinary, or bowel nature and those that involve weakened pelvic support resulting in pelvic organ prolapse.

With occasional exceptions, most women and men are unable to perform a proper pelvic muscle contraction and have relatively weak pelvic floor strength. In my opinion, pelvic training programs should therefore initially focus on ensuring that the proper muscles are being contracted and on building muscle memory. It is fundamental to learn basic pelvic floor anatomy and function and how to isolate the pelvic muscles by contracting them independently of other muscles. Once this goal is achieved, pelvic training programs can be pursued.

Programs need to be able to address the specific area of pelvic weakness, e.g., if strength is the issue, emphasis on strength training is in order, whereas if stamina is the issue, focus on endurance training is appropriate. Furthermore, programs need to be designed for specific pelvic floor dysfunctions, with “tailored” training routines customized for the particular pelvic health issue at hand, whether it is stress urinary incontinence, overactive bladder, pelvic organ prolapse, sexual/orgasm issues, or pelvic pain. Aligning the specific pelvic floor dysfunction with the appropriate training program that focuses on improving the area of weakness and deficit is fundamental since each pelvic floor dysfunction is associated with unique and specific deficits in strength, power and/or endurance.

It is easiest to initially train the pelvic floor muscles in positions that remove gravity from the picture, then advancing to positions that incorporate gravity. It is sensible to begin with the simplest, easiest, briefest pelvic contractions, then advance to the more challenging, longer duration contractions, slowly and gradually increasing exercise intensity and degree of difficulty.

In my opinion, the initial training should not include resistance, which should be reserved for after achieving mastery of the basic training that provides the foundation for pelvic muscle proficiency.

Bottom Line: If you are serious about improving or preventing a pelvic floor dysfunction, you need to do pelvic floor muscle training as opposed to pelvic floor exercises. There are numerous differences including the following:

  • Training is motivated by specific goals and purposes while exercise is done for its own sake or for more general reasons
  • Training requires a level of focus and intensity not demanded by exercise
  • Training requires a plan
  • Training can be a highly effective means of improving and preventing pelvic floor dysfunction

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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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