Archive for April, 2018

What’s Your E.Q. (Erection Quotient)?

April 28, 2018

Andrew Siegel, M.D.  4/28/18

shutterstock_side view manjpeg

The S.H.I.M. test is the “Sexual Health Inventory for Men.”  It is a simple 5 question test that urologists use to subjectively test for the presence and extent of erectile dysfunction (ED).  It is commonly used metric for screening, diagnosing and determining the severity of ED in clinical practice and research.  It is very useful before prostate cancer surgery to obtain a baseline appraisal of the presence, rigidity, durability and functionality of one’s erection.

 

Go ahead and test your own erection quotient.  For each question, note your answer by circling the number that best describes your function.
 Add the numbers together and refer to the table below to see what your score may mean.

Over the past 6 months:

How do you rate your confidence that you could get and keep an erection?

  1. Very low
  2. Low
  3. Moderate
  4. High
  5. Very high

When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

  1. Almost never/never
  2. A few times (less than half)
  3. Sometimes (about half)
  4. Most times (much more than half)
  5. Almost always

During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

  1. Almost never/never
  2. A few times (less than half)
  3. Sometimes (about half)
  4. Most times (much more than half)
  5. Almost always

During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

  1. Almost never/never
  2. A few times (less than half)
  3. Sometimes (about half)
  4. Most times (much more than half)
  5. Almost always

 When you attempted sexual intercourse, how often was it satisfactory for you?

  1. Almost never/never
  2. A few times (less than half)
  3. Sometimes (about half)
  4. Most times (much more than half)
  5. Almost always

 

SHIM scoring:

The SHIM score is the numerical sum of the responses to the 5 items.

22-25: No erectile dysfunction

17-21: Mild erectile dysfunction

12-16: Mild to moderate erectile dysfunction

8-11: Moderate erectile dysfunction

5-7: Severe erectile dysfunction

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2-Piece Penile Prosthesis for Erectile Dysfunction

April 21, 2018

Andrew Siegel MD  4/21/2018

Penile prostheses are surgically implanted devices that create on-demand penile rigidity to enable sexual intercourse. There are two major types: semi-rigid and inflatable.  Today’s entry explores a third option, a 2-piece unit that can be considered a hybrid between the simple 1-piece semi-rigid device and the more complex 3-piece inflatable device.  (All images are courtesy of AMS Men’s Health Boston Scientific).

The semi-rigid penile prosthesis is a 1-piece device that always remains rigid and is bent upwards for sex and bent downwards for concealment purposes. It consists of two malleable rods that are implanted within the erectile chambers through a small incision.

Advantage: simple, effective, no dexterity required, no need for control pump or reservoir, “ever-ready” for sex.   Disadvantage: always rigid, concealment can be tricky, 24-7 erection can make the tip of the penis sore.                                                                              

The inflatable penile prosthesis (IPP) is 3-piece device designed to mimic a normal erection, with the capacity to inflate and deflate via a self-contained hydraulic system. The inflatable cylinders are implanted within the penile erectile chambers. A control pump is implanted in the scrotum for easy access and the fluid-containing reservoir is implanted behind the pubic bone or behind the abdominal muscles. Erections are obtained by pumping the control pump several times, which transfers fluid from the reservoir to the cylinders and voila, a rigid erection is obtained that will remain so until the deflate mechanism on the control pump is used to transfer the fluid back from the cylinders to the reservoir.

Advantage: closes mimics normal erection, highly effective, concealment not issue Disadvantage: more complex and although well-engineered, has higher malfunction rate than semi-rigid alternative, requires dexterity.

Ah, but there is a third option that is somewhat of a hybrid between the 1-piece malleable rods and the 3-piece inflatable device. It is an inflatable 2-piece unit that offers the benefits of the 3-piece device with the simplicity of the 1-piece device. By eliminating the reservoir as a separate component, it provides advantages to both the patient as well as the implanting urologist. It is called the Ambicor and is a product of the American Medical Systems Men’s Health division of Boston Scientific.

AMS Ambicor product imageThe Ambicor device (see image above)  incorporates the reservoir into the inner part of the inflatable cylinders as opposed to a separate reservoir with the 3-piece device. The Ambicor cylinders are composed of inner and outer silicone tubes with a woven fabric in between.  The Ambicor is a pre-filled hydraulic device comes in 3 different widths and in an assortment of lengths, so that any man can be appropriately sized.

Operating the Ambicor: Inflation is achieved by compressing the pump implanted into the scrotum, which transfers fluid from the built-in reservoirs in the proximal cylinders (seated in the deep, inner penis) to the distal part of the cylinders (seated in the external, outer part of the penis). The device is deflated by simply bending the cylinders for 10 seconds or so, which triggers a release valve that returns the fluid from the distal cylinders to the proximal cylinders.

2

 

 

3

The Ambicor is particularly advantageous in certain circumstances: patients who have had extensive abdominal/pelvic surgery in whom implanting an abdominal reservoir might present challenges and complications; those with poor manual dexterity, since it is easier to inflate and deflate than the 3-piece alternative; and patients with kidney transplants or anticipated transplants in the future (kidney transplants are positioned in  the pelvis, close by to where the reservoirs of penile prostheses are placed).  The Ambicor is not ideal in patients with Peyronie’s disease or scarred, short penises (less natural appearance when deflated because the firm tip of device does not deflate) or long and narrow penises (in this situation there is less support on the axis of the penis that can cause buckling and trigger deflation).

Advantage: mimics normal erection, effective, limited dexterity required, no abdominal reservoir required.  Disadvantage: spontaneous deflation (from triggering deflation mechanism during sex), spontaneous inflation when there is scarring of erectile chambers, not ideal in those with short penises or long and narrow penises.

Bottom line: When simpler measures fail to cure ED, penile prostheses are an excellent option. The surgical implantation is an outpatient procedure done under anesthesia that requires only a small incision.  The different prostheses vary in design and complexity (1, 2 and 3-components), but all aim to give the user a reliable erection on demand. The Ambicor, manufactured by American Medical Systems Men’s Health division of Boston Scientific, can be considered a hybrid between the simple but limited functionality of the 1-piece semi-rigid device and the complex and greater functionality of the 3-piece inflatable device. In appropriately selected patients the Ambicor has proven to be reliable and user-friendly with high rates of patient and partner satisfaction.  

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 PelvicRx

 

“Butterflies” In Your Penis: What You Need To Know About Performance Anxiety/E.D.

April 14, 2018

Andrew Siegel MD   4/14/18

“It is like a firstborn son—you spend your life working for him, sacrificing everything for him, and at the moment of truth he does just as he pleases.”

Gabriel Garcia Marquez, Love In the Time of Cholera

“The penis does not obey the order of its master, who tries to erect or shrink it at will. Instead, the penis erects freely while its master is asleep. The penis must be said to have its own mind, by any stretch of the imagination.”

Leonardo da Vinci

 

brain-303186_1280.png

The brain is the biggest and most important sex organ, the “conductor of the orchestra

( Thank you, Pixabay, for image above)

 

Every man at one time or another may experience a situational erection problem due to  circumstances. As intoxicating and exciting as a new relationship can be, situational erection problems are not uncommonly experienced because of the anxiety and concerns that can surface when encountering a new sexual partner.  Additional contributing factors can be other life stresses, fatigue, too much alcohol consumption, recreational drugs, etc.

Men are human beings and not robots that can always function on command. It is not always easy to “stand and deliver” and, unquestionably, the lion’s share of the sexual “burden” is on the male.  In the circumstance of failure to achieve a good quality erection in a new sexual situation, it is not a matter of insufficient male rocket fuel (testosterone), poor sexual desire,  malfunctioning plumbing or sexual orientation.  It’s all about chemistry and by this I do not mean the attraction and spark kind of chemistry between two individuals.

The brain is the most important sex organ and the mind-body connection is profound. One’s emotional state drives the release of a “cocktail” of chemicals that can make or break their ability to perform any pursuit, whether it is giving a speech, sports or in the bedroom. When it comes to the bedroom, one’s internal “biochemical environment” at any given moment in time can chemically promote a bone-hard erection or, at times, no erection at all.  The problem is not with the hardware, but with the software!

Performance anxiety is nothing other than stage fright—the stage the bedroom—due to emotional stress (whether conscious or subconscious) that causes the release of adrenaline, the “flight or fright” chemical that causes tightening of blood vessels and restriction of blood flow to the penis.

Adrenaline is an amazing chemical to have onboard when you are in precarious situation, such as being chased by a lion in the jungle. It causes your pupils to dilate, blood pressure to rise and pulse and breath to quicken.  This stress hormone that is churned out by the adrenal glands prepares you to confront the danger in a turbo-charged state so that you can react optimally.  However, adrenaline causes a restriction of blood flow to non-vital organs including the penis, so that blood flow can be directed to where it best serves one to deal with the precarious situation. The point is that stress does not belong in the same sentence as sex, and when it does, it is a formula for a losing situation. For some men, the stress of having to wear a condom can doom the erection to failure.

Fact: On the occasion that a man has a prolonged erection (a.k.a. priapism) that lasts for more than four hours, an adrenaline-like drug is injected directly into the erectile chambers of the penis to cause the erection to subside. 

The chemistry of erections and performance anxiety

The chemistry of erections: With erotic stimulation or touch, the erectile nerves release nitric oxide, which in turn causes the release of cGMP. This causes the erectile chamber arteries to expand and blood to gush into the penis and also causes the smooth muscle of the erectile chambers to relax, allowing space for blood to fill the erectile chambers.  The chemistry of defeat: If enough adrenaline is present, the erectile arteries will narrow and the smooth muscle of the erectile chambers will contract. The presence of enough adrenaline trumps the presence of nitric oxide and cGMP.

The psychology of performance anxiety

What goes on in the man’s mind: Performance anxiety often “gets in the head” of the man plagued with it.   Excessively focusing and dwelling on the issue further decreases the likelihood of obtaining a rigid erection by creating a self-fulfilling prophecy of failure. When entering a sexual situation preoccupied with anxiety and doubts, one often ends up being a spectator of his own performance (Masters and Johnson referred to this as “spectatorating”), instead of being in the moment and present as one needs to be to be able to function properly, often dooming one’s erectile potential.

What goes on in the female’s mind: As they say, “It takes two to tango.”  Another big problem is the partner’s interpretation of the man’s inability to obtain and/or maintain an erection. The partner, confronted with the poorly functioning male, commonly thinks—erroneously– that the root of the problem is that the man does not sufficiently care for her,  find her attractive or that her sexual allure and proficiency is lacking.

So, the male not only has performance anxiety, but often experiences secondary anxiety from being consumed by the problem, creating a “vicious cycle.”  And the female now has anxiety and concerns about her looks, her skills in the bedroom, his feelings, the future of the relationship, etc.  This is clearly not a good combination for the start of a healthy relationship!  The truth of the matter is that the root of the problem is neither the man’s plumbing, his sexual orientation, nor his feelings about his partner and it is not a question of the female’s attractiveness, allure or sexual prowess.

Bottom Line: Performance anxiety is a common form of emotional stress that can be experienced with a new sexual partner.  Enter adrenaline in high enough levels and an erection will never occur, or if it does so, will rapidly be lost. Adrenaline may be your friend in life and death situations, but not in the bedroom!  Although oral ED medications (Viagra, Cialis, etc.) can chemically kick-start and often help counter performance anxiety and break the vicious cycle that has been established, adrenaline is such a powerhouse chemical that it can sometimes even doom an erection in a man who has taken performance-enhancing drugs.

The female in the relationship should understand that she is not the cause of the problem and she should not hold herself nor her partner accountable, which serves to further exacerbate the stress and anxiety.  Rather, she should stay calm, be understanding and supportive and realize that once her partner becomes more comfortable with the relationship, the anxiety and the problem will most often magically disappear.

Finally, it is important to understand that other common sexual issues, including premature ejaculation and delayed ejaculation, elicit virtually the identical psychological and emotional responses from both male and female partners as does performance anxiety.

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

 

 

 

Pre-Cancerous Prostate Conditions: What To Do?

April 7, 2018

Andrew Siegel MD 4/7/18

A prostate biopsy is usually done because of a PSA (prostate specific antigen) elevation, PSA acceleration, abnormal prostate exam or abnormal MRI. The biopsy results can range from benign to malignant. There is a gray area between these two extremes, consisting of pre-malignant conditions. What follows is a brief review of two pre-cancerous conditions, HGPIN and ASAP and how to minimize the risk of developing prostate cancer. 

Basic Prostate Histology 101

Microscopically, the prostate gland is organized like a tree with a major trunk draining each prostate lobe, served by many ducts which progressively branch out into smaller and smaller ducts. At the end of each duct is an acinus (Latin, meaning berry), which is similar to a leaf at the end of a tree branch. Acini are lined by cells that secrete prostatic fluid, a nutrient vehicle for sperm that is an important component of semen. Each acinus is surrounded by a basement membrane that separates the cells that do the secreting from the surrounding structures.

Image below: benign prostate tissue

512px-Nodular_hyperplasia_of_the_prostate

Attribution: By Nephron (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D, via Wikimedia Commons

Prostate biopsies are usually prompted by prostate cancer screening with PSA blood testing and digital rectal examination.  PSA elevation, PSA acceleration, abnormal prostate examination, abnormal prostate MRI, or follow up for prostate cancer or prostate precancerous conditions are the reasons why biopsies are performed.  There are four possible pathological outcomes from undergoing a prostate biopsy:

  1. benign
  2. HGPIN (High Grade Prostate Intra-Epithelial Neoplasia)
  3. ASAP (Atypical Small Acinar Proliferation)
  4. prostate cancer

What is HGPIN?

HGPIN is an acronym for High Grade Prostate Intra-Epithelial Neoplasia. The incidence of HGPIN between 0.6% and 24% of biopsies. It is a microscopic abnormality marked by an abnormal appearance and proliferation of cells within ducts and acini, but the abnormal cells do not extend beyond the basement membrane to other parts of the prostate (as occurs with prostate cancer).  HGPIN is considered a pre-malignant precursor lesion to prostate cancer.

Current recommendations for men who are found to have one site of HGPIN (unifocal HGPIN) are to follow-up as one would follow for a benign biopsy, with annual digital rectal exam and PSA.  However, if there are multiple biopsies indicating HGPIN (multifocal HGPIN), a repeat biopsy should be done in 6-12 months, with focused sampling of identified areas and adjacent sites. The more cores containing HGPIN on initial prostate biopsy, the greater the likelihood of cancer on subsequent biopsies. The risk for prostate cancer following the diagnosis of multifocal HGPIN is about 25%.

What is ASAP?

ASAP is an acronym for Atypical Small Acinar Proliferation. The incidence of ASAP ranges between 5% and 20% of biopsies. It is a microscopic abnormality marked by a collection of prostate acini that are suspicious but not diagnostic for prostate cancer, falling below the diagnostic “threshold.” The risk for cancer following the diagnosis of ASAP on re-biopsy is approximately 40%. All men with ASAP should undergo re-biopsy within 3 to 6 months, with focused sampling of identified areas and adjacent sites.

 Measures to Reduce Risk of Prostate Cancer

  1. Maintain a healthy weight, as obesity has been correlated with an increased risk for prostate cancer occurrence, recurrence, progression and death. Research suggests a link between a high-fat diet and prostate cancer. In men with prostate cancer, the odds of metastasis and death are increased about 1.3-fold in men with a BMI of 30-35 and about 1.5-fold in men with a BMI > 35. Furthermore, carrying the burden of extra weight increases the complication rate following treatments for prostate cancer.
  2. “Eat food. Not too much. Mostly plants.” Eat realfood and avoid refined, over-processed, nutritionally-empty foods and be moderate with the consumption of animal fats and dairy. Processed meats and charred meats should be avoided.  A healthy diet should include whole grains and plenty of vegetables and fruits, particularly those that contain powerful anti-oxidants, vitamins, minerals and fiber. Vibrantly colorful fruits such as berries (strawberries, blackberries, blueberries and raspberries) contain abundant anthocyanins. Tomatoes and tomato products are rich in lycopenes. Cruciferous vegetables (broccoli, cauliflower, Brussel sprouts, kale and cabbage) and dark green leafy vegetables are fiber-rich and contain lutein and numerous healthy phytochemicals.  A healthy diet should include protein sources incorporating fish, lean poultry and plant-based proteins such as legumes, nuts, and seeds. Include fish that have anti-inflammatory omega-3 fatty acids, e.g., salmon, sardines, and trout. Healthy fats (preferably of vegetable origin, e.g., olives, avocados, seeds and nuts) are preferred.  An ideal diet that is both heart-healthy and prostate-healthy is the Mediterranean diet.
  3. Avoid tobacco and excessive alcohol intake. Tobacco use has been associated with more aggressive prostate cancers and a higher risk of progression, recurrence and death.
  4. Stay active and exercise on a regular basis. Exercise has been shown to lessen one’s risk of developing prostate cancer and to decrease the death rate of those who do develop it. If one does develop prostate cancer, he will be in better physical shape and have an easier recovery from any intervention necessary to treat the disease.  Exercise positively influences energy metabolism, oxidative stress and the immune system.  Aerobic exercise should be done at least every other day with resistance exercise two to three times weekly.  Pelvic floor muscle exercises benefit prostate health by increasing pelvic blood flow and lessening the tone of the sympathetic nervous system (the part of the nervous system stimulated by stress), which can aggravate lower urinary tract symptoms. Additionally, pelvic floor muscle exercises strengthen the muscles surrounding the prostate so that if one develops prostate cancer and requires treatment, they will experience an expedited recovery of urinary control and sexual function.
  5. Get checked out! Be proactive by seeing your doctor annually for a digital rectal exam and a PSA blood test. Abnormal findings on these screening tests are what prompt prostate biopsies, the definitive means of diagnosing prostate cancer. The most common scenario that leads to a diagnosis of prostate cancer is a PSA acceleration, an elevation above the expected incremental annual PSA rise based upon the aging process.
  6. Finasteride and Dutasteride, commonly used to treat benign prostate enlargement and male pattern hair loss, reduce the risk of prostate cancer and may be used for those at high risk, including men with a strong family history or those with pre-cancerous biopsies. These medications lower the PSA by 50%, so anyone taking this class of meds will need to double their PSA to approximate the actual PSA. If the PSA does not drop, or if it goes up while on these meds, it is suspicious for undiagnosed prostate cancer. By shrinking benign prostate growth, these medications also increase the ability of the digital rectal exam to detect an abnormality.

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