Archive for March, 2018

Eat Your Way To Better Sex

March 31, 2018

Andrew Siegel MD   3/31/18

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Thank you, Max Pixel, for image above of a healthy salmon and salad meal (maxpixel.freegreatpicture.com)

You are what you eat…

Our cells and tissues require food for energy to fuel our body functions.   Equally as important, nutrients present in foods serve as the building blocks of our cells and our tissues during the process of remodeling, restructuring and refashioning–that occurs in all tissues including the genitals–as old cells are replaced by new cells.  While optimal sexual functioning is based on many factors, it is important to recognize that food choices play a definite role. What we eat—or don’t eat—can certainly impact our sex lives, and this is equally applicable to both men and women, even though this entry is geared towards men.

Sex is important…

Although not a necessity for a healthy life, sexuality is an important part of our human existence. Healthy male sexual function requires an adequate sex drive, the ability to obtain and maintain a reasonably rigid erection, and the capacity to ejaculate and experience a climax. When sexual functioning goes south, the aftermath can be a loss of confidence and self-esteem, embarrassment, a sense of isolation, frustration and, at times, depression. There is a good reason the word “cocksure” means possessing a great deal of confidence.

Sex is complicated…

Sexual functioning is complex and dependent upon a number of systems working in tandem– the endocrine system (which produces hormones); the central and peripheral nervous systems (which provide executive function and nerve control); the vascular system (which conducts blood flow); the smooth muscles (erectile tissue within the arteries and sinuses of the erectile chambers); and the skeletal muscles (the pelvic floor muscles that help maintain high penile blood pressures necessary for erectile rigidity).

A canary in your trousers…

Sexual function is an indicator of underlying cardiovascular health– Poor erections can be a warning sign that an underlying problem exists. On the other hand, the presence of rigid and durable erections is an indicator of overall cardiovascular health. Since the penile arteries are generally rather small (diameter 1-2 mms) and the coronary (heart) arteries larger (4 mms), it stands to reason that if vascular disease is affecting the tiny penile arteries, it may affect the larger coronary arteries as well—if not now, then at some time in the future. In other words, the fatty plaques that compromise blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus erectile dysfunction may be considered a genital “stress test.”

A marvel of engineering…

A healthy sexual response is largely about blood flow to the genital and pelvic area. The penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge happening within seconds and responsible for the remarkable physical transition from flaccid to erect. This is accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. Pelvic muscle engagement and contraction help prevent the exit of blood from the penis, enhancing penile rigidity and creating penile blood pressures that far exceed normal blood pressure in arteries. For good reason, Gray’s Anatomy textbook over 100 years ago referred to one of the key pelvic floor muscle as the “erector penis.”

Like well-inflated tires…

Blood flow to the penis is analogous to air pressure within a tire: if there is insufficient pressure, the tire will not properly inflate and will function sub-optimally; at the extreme, the tire may be completely flat. Furthermore, slow leaks (that often occur with aging and failure of the smooth muscle within the penile arteries and erectile tissues to relax) promote poor function.  As your car declines in performance if it is dragging around too much of a load, so your penis can function sub-optimally if you are carrying excessive weight.

Obesity steals your manhood…

Abdominal fat (beer belly) is not just fat, but is a hormonally active organ that is chock full of the enzyme that converts the male hormone testosterone to the female hormone estrogen. Less testosterone translates to less sex drive and more estrogen often promotes man-boob development.  Obese men are also more likely to have fatty plaque deposits that clog blood vessels–including the arteries to the penis–making it more difficult to obtain and maintain erections. As the belly gets bigger, the penis appears smaller, lost in the protuberant roundness of a large midriff and the abundant pubic fat pad.  It is estimated that there is a 1 inch loss in apparent penile length for every 35 lb. of weight gain. So, if your sex drive is lagging, your penis is difficult to find, your man-boobs are prominent and your erections are not up to par, it may be time to rethink your lifestyle habits.

Those were the days, my friend, but now…

Do you remember the days when you could achieve a rock-hard erection—majestically pointing upwards—simply by seeing an attractive woman or thinking some vague sexual thought? Chances were that you were young, active, and had an abdomen that somewhat resembled a six-pack. Perhaps now it takes a great deal of physical stimulation to achieve an erection that is barely firm enough to be able to penetrate. Maybe penetration is more of a “shove” than a ready, noble, and natural access. Maybe you need pharmacological assistance to make it possible.  If this is the case, it is probable that you are carrying extra pounds, have a soft belly, and are not physically active. When you’re soft in the middle, you will probably be soft where it counts.  A flaccid penis is entirely consistent with a flaccid body and a hard penis is congruous with a hard body.

The Golden Rule: Treat your penis well and it will treat you well…

Healthy lifestyle choices are vital towards achieving optimal quality and quantity of life. It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices. These include healthy eating habits, keeping your weight down, exercising, sleeping adequately, drinking alcohol in moderation, avoiding tobacco and minimizing stress.

Bad choices…

Studies have shown that apart from known lifestyle risk factors, dietary practices such as decreased intake of vegetables and fruit and increased intake of unrefined and processed foods, dairy and alcohol are strongly associated with sexual difficulties in young men. Poor dietary choices with meals full of calorie-laden, nutritionally-empty selections (e.g., fast food, processed foods, excessive sugars or refined anything), puts one on the fast track to obesity and clogged arteries that can make your sexual function as small as your belly is big.

Good choices…

Healthy eating is important, obviously in conjunction with other smart lifestyle choices. Maintaining a healthy weight and fueling up with wholesome, natural, and real foods will help prevent weight gain and the build-up of harmful plaque deposits within blood vessels. Healthy fuel includes vegetables, fruits, legumes, nuts, whole grains and fish. Animal products (meats and dairy) should be eaten moderately and when indulging, lean cuts are healthiest. A Mediterranean-style diet is ideal for optimizing health and minimizing sexual dysfunction and heart disease. Rich in vegetables, fruits, whole grains, legumes, olive oil and lean protein sources (fish and chicken vs. red meat), the Mediterranean diet has been shown to improve sexual function, perhaps by alterations in glucose and fat metabolism and increasing anti-oxidant defenses, arginine levels and nitric oxide activity.

Bottom Line: If you want a “sexier” lifestyle, start with a “sexier” style of eating that will improve your overall health and make you feel better, look better and enhance your sexual function.  Smart nutritional choices are a key component of sexual fitness.

Wishing you the best of health!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

 

 

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Kegels-on-Demand: Use Them As Needed

March 24, 2018

Andrew Siegel MD   3/24/2018

The concept of pelvic floor muscle training is not just to develop a strong and flexible pelvic floor, but also to put that capacity into practical use.  By knowing how to use your pelvic floor in real-life situations, you can improve your quality of life and many pelvic floor-related issues that may have surfaced over the years. This is the  essence of “functional fitness.”   Although this entry is primarily geared towards females, Kegels-on-demand on equally useful for men who have overactive bladder, stress incontinence, tension myalgia and premature ejaculation.

shutterstock_femalebluepelvic

 

Putting Your Pelvic Floor Muscle Training Into Action: Kegels-on-demand

Functional pelvic fitness is the practical and actionable means of applying pelvic floor muscle (PFM) proficiency to common everyday activities to improve pelvic function. This encompasses the knowledge of how to contract and relax PFM muscles through their full range of motion in the real world (as opposed to isolated, out-of-context contractions), when to do so, how often do so and why to do so.  For many women, this is the essence of PFMT–having stronger and more durable PFM to improve their quality of life.  These purposeful and consciously applied PFM contractions are not intended as exercise or training—although they will secondarily serve that purpose—but as management of the various pelvic floor dysfunctions at the times and moments that the problems become apparent.  When practiced diligently, these targeted PFM contractions can ultimately become automatic and reflex behaviors.

“Gotta” Go: Urgency Management

When you feel the sudden and urgent desire to urinate or move your bowels, snap your PFM several times, briefly but intensively. When your PFM are so engaged, the bladder muscle reflexively relaxes and the feeling of intense urgency should disappear. Understand that this is most effective when the bladder or bowels are not full, but are contracting involuntarily.

Staying Dry

For urgency incontinence, prior to exposure to the specific provoking trigger—hand washing, key in the door, running water, entering the shower, cold or rainy weather, etc.—snap your PFM rapidly several times to preempt the involuntary bladder contraction before it occurs (or diminish or abort the bladder contraction after it begins).

With respect to stress urinary incontinence (SUI), by actively contracting the PFM immediately before exposure to the activity that prompts the SUI, the incontinence can be improved or prevented. For example, if changing position from sitting to standing results in SUI, do a brisk short duration PFM contraction prior to and when transitioning from sitting to standing to brace the PFM and pinch the urethra shut.

Keeping Your Insides In

If you have pelvic organ prolapse (POP) and have defined activities that cause the prolapsed pelvic organ to drop or protrude—often standing, bending or straining—engage the PFM prior to or during these triggers. If you need to manually reduce the POP (by pushing the prolapse in with your fingers), after doing so, consciously engage the PFM to maintain the prolapsed pelvic organ in its proper anatomical position.

Better Sex for You and Your Partner

Integrate your newfound PFM powers in the bedroom and intensify your sensation as well as his by tightening your vaginal “grip” around his penis during sexual intercourse.  Alternatively, you can pulse your PFM rhythmically while pelvic thrusting or pulse your PFM without pelvic thrusting, the snapping providing penile stimulation in the absence of active thrusting.

As you develop increasing PFM proficiency, you may be able to selectively contract individual PFM in isolation, simultaneously, or in such a sequence that can result in a titillating experience for both you and your partner. You may be able to develop as much fine motor control of your vagina as you have of your fingers and hands! At the time of sexual climax, focus on the involuntary rhythmic contractions of your PFM and try to heighten the experience by explosively contracting them.

Try This: “Pompoir” is a technique in which a woman contracts her PFM rhythmically to stimulate the penis without the need for pelvic motion or thrusting. Women who diligently practice Kegel training can develop powerful PFM and become particularly adept at this, resulting in extreme vaginal “dexterity” and the ability to refine pulling, pushing, locking, gripping, pulsing, squeezing and twisting motions, which can provide enough stimulation to bring a male to climax. 

Relaxing the High-strung Pelvic Floor

If you suffer with tension myalgia of the PFM, focus on consciously unclenching the PFM over the course of your day. Be particularly aware of the natural PFM relaxation that occurs when urinating or moving your bowels and strive to replicate that feeling of PFM release.

 Limber hip rotators,

A powerful cardio-core,

But forget not

The oft-neglected pelvic floor.

 

Wishing you the best of health!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

 

Integrating Kegels With Other Exercises

March 17, 2018

Andrew Siegel MD     3/17/2018

Initially, it is important to isolate the pelvic floor muscles (PFM) and exercise them while not actively contracting any other muscle groups. Once PFM mastery is achieved, PFM exercises can then be integrated into other exercise routines, workouts and daily activities.

No Muscle is an Island

In real life, muscles do not work in isolation, but rather as part of a team. The PFM are no exception, often contracting in conjunction with the other core muscles in a mutually supportive way, co-activating to maintain lumbar-pelvic stability, help prevent back pain and contribute to pelvic tone and strength.

The core muscles—including the PFM—stabilize the trunk when the limbs are active, enabling powerful limb movements. It is impossible to use arm and leg muscles effectively in any athletic endeavor without engaging a solid core as a “platform” from which to push off. Normally this happens without conscious effort; however, with focus and engagement, the core and PFM involvement can be optimized. The stronger the core platform, the more powerful the potential push off that platform will be, resulting in more forceful arm and leg movements. Thus, maximizing PFM strength has the benefit of optimizing limb power.  Core training that exercises the abdominal/lumbar/pelvic muscles as a unit improves the PFM response. Many Pilates and yoga exercises involve consciously contracting the PFM together with other core muscles during exercise routines.

Integrating PFMT with Other Exercises

Dynamic exercises in which complex body movements are coupled with core and PFM engagement provide optimal support and “lift” of the PFM, enhance non-core as well as core strength and heighten the mind-body connection. When walking, gently contract your PFM to engage them in the supportive role for which they were designed, which will also contribute to good posture. Consciously contract the PFM when standing up, climbing steps, doing squats and lunges, marching, skipping, jumping, jogging, and dancing.  When cycling, periodically get up out of the saddle and contract your PFM to get blood flowing to the compressed pelvic muscles and perineum.

Integrating PFMT with Weight Training: “Compensatory” Pelvic Contractions

Weight training and other forms of high impact exercise result in tremendous increases in abdominal pressure. This force is largely exerted downwards towards the pelvic floor, particularly when exercising in the standing position, when gravity comes into play, potentially harmful to the integrity of the PFM.  Engaging the PFM during such efforts will help counteract the downward forces exerted on the pelvic floor.  “Compensatory” PFM contractions, in which the PFM are contracted in proportion to the increased abdominal pressure, are effective in balancing out the forces exerted upon the pelvic floor.

Wishing you the best of health!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

 

 

Chronic Testes Pain

March 7, 2018

Andrew Siegel MD    3/7/2018

New Jersey is shut down because of the impending Nor’easter, surgery and office hours are cancelled, so I have plenty of free time and am going to post this entry today rather than on Saturday morning.

Orchialgia is medical-speak for chronic testes (ball) pain, defined as constant or intermittent pain perceived in the testicles, lasting for 3 or more months and interfering with one’s quality of life.  It is a not uncommon problem of men of all ages, but is more frequently seen in young adults.  It certainly keeps us busy in the office…some morning sessions seem like “ball clinics”!

Testes 101

4.0.4

Image above, public domain from Wikipedia

The testes are paired, oval-shaped organs that are housed in the scrotal sac. They have two functions, testosterone and sperm production.  Encased within the tough and protective cover of the testes (tunica albuginea) are tiny tubes called seminiferous tubules which make sperm cells.  The testes also contain specialized cells called Leydig cells that produce testosterone.  Sperm from the testes travels to the epididymis for storage and maturation. The epididymis empties into the vas deferens, which conducts sperm to the ejaculatory ducts.

The testes are suspended in the scrotal sac via the spermatic cord, a “rope” of tissue containing connective tissue, the vas deferens, the testes arteries, veins, lymphatics, and nerves. The spermatic cord is enveloped by tissues that are extensions of the connective tissue coverings of three of the abdominal core muscles. The most important of these coverings surrounding the spermatic cord is the cremaster muscle, which elevates the testes in a northern direction when it contracts.

The scrotal sac has several roles, packaging the testes as well as aiding in their function by regulating their temperature. For optimal sperm production, the testes need to be a few degrees cooler than core temperature.  The dartos muscle within the scrotal wall relaxes or contracts depending on the ambient temperature, allowing the testes to elevate or descend to help maintain this optimal temperature. Under conditions of cold exposure, the dartos contracts, causing the scrotal skin to wrinkle and to bring the testicles closer to the body.  When exposed to heat, dartos relaxation allows the testicles to descend and the scrotal skin to smoothen.

Good news/bad news:

The good news about the testes location dangling between one’s legs is is ready and easy access for examination, unlike the female counterpart (ovaries), which are within the abdomen.  This is one reason why testes cancer is so much easier to diagnose at an early stage than ovarian cancer.

The bad news is that their precarious location dangling between one’s legs as well as their delicate packaging in the thin sac makes them subject to trauma and injury.

Chronic orchialgia

Chronic testes pain can be caused by numerous different conditions and it is important to rule out the following possibilities:

  • Infection: An infection of the testes (orchitis), epididymis (epididymitis), both (epididymo-orchitis), or the spermatic cord (funiculitis). Infections can be bacterial, viral, and at times inflammatory without an actual infection.
  • Tumor: A benign or malignant mass of the testes or epididymis.
  • Groin hernia: A prolapse of intra-abdominal contents through a weakness in the connective tissue support of the groin.
  • Torsion: A twist of the testes or one of the testes or epididymal appendages.
  • Hydrocele: An excess fluid collection in the sac surrounding the testes.
  • Spermatocele: A cyst resulting from a blockage of one of the sperm ducts within the epididymis.
  • Varicocele: Varicose veins of the spermatic cord.
  • Trauma: Injury.
  • Prior operations: Groin hernias are most commonly associated with chronic testes pain; less commonly, vasectomies and any other type of groin or pelvic surgery.
  • Referred pain: Pain perceived in the testes, but originating elsewhere, e.g., a kidney stone that has dropped into the ureter, or a lower spine issue affecting the nerves to the testes.
  • Tendonitis: There are numerous muscles with tendons that insert into the pubic bone region that can be subject to injury and inflammation.
  • Pelvic floor muscle tension myalgia: Excessive muscle tension in these muscles can cause pelvic pain, including pain in the testes.
  • Idiopathic: This fancy medical term means that we are clueless about the origin of the pain. Unfortunately, many men have idiopathic orchialgia, a distressing and frustrating experience for both patient and urologist.

Evaluation

The evaluation of the patient with chronic testes pain includes a detailed history, a careful examination of the scrotal contents, groin and prostate, if necessary, as well as a urinalysis and possibly urine culture. It is helpful to obtain an ultrasound of the scrotum, a study which utilizes sound waves to image the testicle and epididymis. On occasion, it is warranted to obtain imaging studies of the upper urinary tract and pelvis and possibly a CT or MRI of the spine if there is back or hip pain.

Management

The management of chronic testis pain is directed at the underlying cause, although unfortunately this cannot always be precisely determined. Often, a course of antibiotics may prove helpful even if the physical findings are indeterminate.  Anti-inflammatory medications such as Advil and ibuprofen are often useful in the short-term management. Supportive, elastic jockey shorts as well as local application of a heating pad can be helpful. At times, amitriptyline or Neurontin can be helpful for neurologically-derived pain.  If the source of the pain is felt to be tension myalgia, referral to a pelvic floor physical therapist can be beneficial.  A referral to a pain specialist, typically an anesthesiologist who focuses on this discipline, can be advantageous.

An injection of a local anesthetic into the spermatic cord (spermatic cord block) can be a useful diagnostic test and a means of alleviating the pain.  If spermatic cord block proves successful in relieving the pain, it may be necessary to surgically denervate the spermatic cord, a procedure in which the nerve fibers in the spermatic cord are divided.  Under extremely rare circumstances, removal of the epididymis or the testicle is necessary. Often chronic testis pain remains elusive with the source undetermined and is thought to be similar to other chronic inflammatory conditions.

Wishing you the best of health,

2014-04-23 20:16:29

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

 

Nuts and Bolts of Pelvic Floor Muscle Training: Part 4

March 3, 2018

Andrew Siegel MD   3/3/2018

There are few, if any, pelvic programs in existence targeted for specific pelvic floor dysfunctions, as what you will generally find is a “one-size-fits-all” approach.

What follows are focused pelvic training programs, each designed for the nuances of the specific pelvic dysfunction at hand.  I have designed a general program as well as programs for poor pelvic muscle endurance, stress urinary incontinence (SUI), overactive bladder (OAB), pelvic organ prolapse (POP)/vaginal laxity, sexual/orgasm issues, bowel incontinence and pelvic pain. These programs have been carefully crafted based on my specialized training in pelvic medicine and surgery, clinical experience, interactions with physical therapists, exercise/fitness experts, Pilates and yoga instructors, and most importantly, my patients.

 General PFMT Program

The general program is a balanced program that incorporates strength and endurance training.  It is intended for women who are found to have poor PFM strength or poor strength and endurance on the preliminary testing. It is also appropriate for women without specific pelvic issues who wish to pursue a PFM exercise program to make their PFM stronger, more durable and to help prevent the onset of pelvic floor issues.

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each week try to step up the intensity of the PFM contractions and duration of the short contractions; allot equal time to relaxing phase as contracting phase; refer back to previous pages if you need a refresher on snaps, shorts and sustained.

 Week 1: snaps x20; 2-5 second shorts x15; 10 second sustained x1 = 1 set 

 Week 2: snaps x30; 2-5 second shorts x20; 10 second sustained x2 = 1 set 

 Week 3: snaps x40; 2-5 second shorts x25; 10 second sustained x3 = 1 set 

 Week 4: snaps x50; 2-5 second shorts x30; 10 second sustained x3 = 1 set 

Week 5 and on: Advance to resistance training. However, if you were severely challenged by this non-resistance program or cannot or prefer not to use resistance—which requires the placement of a device in your vagina—you can continue this as a “maintenance” program, consisting of the Week 4 regimen performed twice weekly (as opposed to every other day).

 PFMT for Poor PFM Endurance

This program is designed for those with satisfactory PFM strength (Oxford grades 3-5), but poor endurance. The number of contractions performed and contraction duration are gradually increased over the course of the training program as adaptation occurs.

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; allot equal time to relaxing phase as contracting phase.

 Week 1: snaps x15; 2 second shorts x15; 6 second sustained x1 = 1 set 

 Week 2: snaps x25; 3 second shorts x20; 8 second sustained x2 = 1 set 

 Week 3: snaps x35; 4 second shorts x25; 10 second sustained x3 = 1 set 

 Week 4: snaps x50; 5 second shorts x30; 10 second sustained x4 = 1 set 

 Week 5 and on: Advance to resistance training.  If you found yourself severely challenged by this non-resistance program or cannot/prefer not to use resistance (which requires the placement of a device in your vagina), you can continue this as a “maintenance” program consisting of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for POP/Vaginal Laxity

Endurance training is especially relevant for those with POP and poor vaginal tone. Focusing on sustained contractions will benefit the slow twitch endurance PFM fibers that are the prime contributors to pelvic tone and support. 

 Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each successive week, work on stepping up the intensity of the PFM contractions; allot equal time to relaxing phase as contracting phase.

 Week 1: snaps x20; 2-5 second shorts x15; 10 second sustained x1 = 1 set 

 Week 2: snaps x30; 2-5 second shorts x20; 10 second sustained x2 = 1 set 

 Week 3: snaps x40; 2-5 second shorts x25; 10 second sustained x3 = 1 set 

 Week 4: snaps x50; 2-5 second shorts x30; 10 second sustained x4 = 1 set 

 Week 5 and on: Advance to resistance training.  However, if you were severely challenged by this non-resistance program or cannot or prefer not to use resistance—which requires the placement of a device in your vagina—you can continue using this as a “maintenance” program, which will consist of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for Sexual/Orgasm Issues

The PFM contract intensively at the time of climax with each contraction lasting about 0.8 of a second, about how long snaps last. A series of vigorous snaps is precisely the PFM contraction pattern experienced at the time of orgasm. If you have issues with achieving an orgasm or with orgasm intensity, this natural contraction pattern is replicated in this program, which focuses on high-intensity pulses of the PFM (snaps) that benefit the fast twitch explosive fibers.  Endurance training is also important for sexual function since sustained contractions benefit the slow twitch endurance PFM fibers that contribute to pelvic support and vaginal tone.    

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each week work on stepping up the intensity of the snap PFM contractions; allot equal time to relaxing phase as contracting phase.

Week 1: snaps x30; 2-5 second shorts x15; 10 second sustained x1 = 1 set 

Week 2: snaps x40; 2-5 second shorts x20; 10 second sustained x2 = 1 set 

Week 3: snaps x50; 2-5 second shorts x25; 10 second sustained x3 = 1 set 

Week 4: snaps x60; 2-5 second shorts x30; 10 second sustained x4 = 1 set 

Week 5 and on: Advancing to the resistance training.  However, if you were severely challenged by this non-resistance program or cannot/prefer not to use resistance—which requires the placement of a device in your vagina—you can continue using this as a “maintenance” program, consisting of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for SUI

Strength and power training are critical for managing SUI, with the power element (i.e., how rapidly you can maximally contract your PFM) vital in order to react quickly to SUI triggers.  Focusing on moderate intensity contractions that last for several seconds (shorts) will benefit SUI, as this type of PFM contraction deployed prior to and during any activity that induces the SUI will help prevent its occurrence.  Attention directed to these short contractions will allow earlier activation of the PFM with SUI triggers, as well as increased contraction strength and durability to counteract the sudden increase in abdominal pressure that induces SUI.  Effort applied to sustained contractions is equally important since the slow twitch endurance PFM fibers are prime contributors to pelvic tone and pelvic support of the urethra, which promote urinary continence.

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each successive week try to step up the PFM contraction intensity as well as the activation speed (how long it takes to get to peak intensity); allot equal time to relaxing phase as contracting phase.

Week 1: snaps x20; 5 second shorts x15; 10 second sustained x1 = 1 set 

Week 2: snaps x30; 5 second shorts x20; 10 second sustained x2 = 1 set 

Week 3: snaps x40; 5 second shorts x25; 10 second sustained x3 = 1 set 

Week 4: snaps x50; 5 second shorts x30; 10 second sustained x4 = 1 set 

Week 5 and on: Advance to resistance training.  However, if you were severely challenged by this non-resistance program or cannot or prefer not to use resistance—which requires the placement of a device in your vagina—you can continue this as a “maintenance” program, which consists of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for OAB and Urinary/Bowel Incontinence

Focusing on high-intensity pulses of the PFM (snaps) will benefit the fast twitch explosive fibers that are critical for inhibiting urinary and bowel urgency/urgency incontinence. These snaps will generate increased PFM strength and power to enhance the inhibitory reflex between PFM and the bladder/bowel, permitting a speedy reaction to urgency and facilitating the means to counteract urinary and bowel urgency, frequency and incontinence. Of equal importance is endurance training of the slow twitch, fatigue-resistant fibers that contribute to baseline tone of the voluntary urinary and bowel sphincters.

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each successive week try to step up the intensity of the PFM contractions; allot equal time to relaxing phase as contracting phase.

Week 1: snaps x20; 2-5 second shorts x15; 10 second sustained x1 = 1 set 

Week 2: snaps x30; 2-5 second shorts x20; 10 second sustained x2 = 1 set 

Week 3: snaps x40; 2-5 second shorts x25; 10 second sustained x3 = 1 set 

Week 4: snaps x50; 2-5 second shorts x30; 10 second sustained x4 = 1 set 

Week 5 and on: Advance to resistance training.  However, if you were severely challenged by this non-resistance program or cannot/prefer not to use resistance (which requires the placement of a device in your vagina), you can continue using this as a “maintenance” program, which will consist of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for Pelvic Pain Due to Tension Myalgia: “Reverse” PFMT

Focusing on the relaxing aspect of the PFM contraction/relaxation cycle is the key to “down-train” the PFM from their over-tensioned, knot-like state. Those with over-contracted and over-toned PFM will not benefit from the typical strengthening PFMT done for most PFM dysfunctions—and can actually worsen their condition—so the emphasis here is on the relaxation phase of the PFM. This is “reverse” PFMT, conscious unclenching of the PFM in which the PFM drop and slacken as opposed to rise and contract. Reverse PFMT strives to stretch, relax, lengthen and increase the flexibility of the PFM. 

“Reverse” Kegels can be a confusing and difficult concept, particularly because these exercises demand conscious relaxation of the PFM, which only occurs subconsciously in real life. Recall that the PFM have a baseline level of tone and that complete PFM relaxation only occurs at the time of urination, bowel movements, passing gas or childbirth. 

To make this easier to understand, think of a PFM contraction on a scale of 0-10, with 0 being complete relaxation and 10 being maximal contraction. I have arbitrarily chosen 2 as the baseline level of PFM tone.  In reverse Kegel exercises you strive to go from 2 to 0 as opposed to standard exercises in which the effort is to go from 2 to 10.  When you urinate, move your bowels or pass gas, the PFM relax to a level of 0, so this is the feeling that you should strive to replicate, while continuing to breathe regularly without straining or pushing.  A deep exhalation of air will facilitate PFM relaxation, as it does for other muscle groups.

Perform the following: A very gentle PFM contraction to initiate PFM engagement, followed by deep relaxation and release of the PFM lasting as long as the contraction; 3 sets; one-minute break between each set; do 3-4 times weekly.

Week 1: reverse snaps x20; reverse 2-5 shorts x15; reverse 10 second sustained x1 = 1 set 

Week 2: reverse snaps x30; reverse 2-5 shorts x20; reverse 10 second sustained x2 = 1 set 

Week 3: reverse snaps x40; reverse 2-5 shorts x25; reverse 10 second sustained x3 = 1 set 

Week 4: reverse snaps x50; reverse 2-5 shorts x30; reverse 10 second sustained x3 = 1 set 

Week 5 and on: There is no role for using resistance exercises for tension myalgia. Continue using this program as a “maintenance” program, consisting of the Week 4 regimen done twice weekly (as opposed to every other day). Make a concerted effort at keeping the PFM relaxed at all times, not just while pursuing the PFMT program.

…To be continued.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

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These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx