Archive for July, 2018

Female Pelvic Floor Muscle Resistance Training Part 2: Sophisticated PFMT Devices

July 28, 2018

Andrew Siegel MD  7/28/2018

Following last week’s entry that reviewed the basic resistance devices, today’s entry reviews some of the more complex pelvic floor muscle (PFM) resistance devices.  These are complex and often expensive devices that provide resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. Many provide specific PFM training programs to follow for optimal results. This entry reviews a the most popular devices.

 

elvie

Above image is of the Elvie, one of the more sophisticated pelvic training devices (Elvie.com)

 

Lovelife Krush: Made by sex technology company OhMiBod, this is a dumbbell-shaped device that you insert vaginally and connect via Bluetooth to a companion app TASL (The Art and Science of Love).  Its voice-guided training program tracks PFM contraction pressure, endurance and number of reps and provides vibrational stimulation as you perform the exercises. Cost is $129 (Lovelifetoys.com/lovelife-krush).

kGoal:  Its name is a play on the word “Kegel.” It is an interactive “smart” device that consists of an inflatable and squeezable plastic “pillow” that is attached to an external handle.  It provides feedback, resistance and tracking. You insert the pillow in your vagina and inflate or deflate it with a button control to obtain a good fit.  When you contract your PFM properly, the device vibrates to give you biofeedback. The kGoal app can be downloaded on your smartphone and connected to the device via Bluetooth. The interface provides a guided workout including pulses, 5-second holds and slow and deliberate holds. It provides visual and auditory feedback and tracks your progress. The device measures the strength of your vaginal contractions and at the end of a workout you receive a score of 1-10 to help monitor your progress. Cost is $149 (Minnalife.com).

Vibrance Kegel Device: This biofeedback tool can be set at different resistance levels and provides audio guidance and coaching.  It consists of a pressure-sensitive element that you insert in your vagina.  When you contract your PFM properly, it delivers mild vibrational pulsations.  It has three different training sheaths of increasing stiffness that provide graduated levels of resistance for different training intensities. Cost is $165 (VibrancePelvicTrainer.com).

Elvie:  Manufactured in the UK, Elvie is a wearable, egg-shaped, waterproof, flexible device that you insert in your vagina. Your PFM contraction strength is measured and sent via Bluetooth to a companion mobile app that provides biofeedback to track progress. Five-minute workouts are designed to lift and tone the PFM.  The app includes a game designed to keep users engaged by bouncing a ball above a line by clenching their PFM. The carrying case also serves as a charging device. Cost is $199 (Elvie.com).

PeriCoach:  Manufactured in Australia, PeriCoach is a vaginal device that measures PFM contraction strength, which is relayed to your smartphone via Bluetooth to a companion mobile app. It provides a guided exercise program, data monitoring and audio-visual biofeedback. It is available only by prescription. Cost is $299 (PeriCoach.com).

InTone: This device must be prescribed by a physician and is specifically for stress urinary incontinence and overactive bladder. It combines voice-guided PFM exercises with visual biofeedback and electro-stimulation. It consists of an inflatable vaginal probe that provides resistance and measures PFM contractile strength. The probe is attached to a handle and a separate control unit furnishes the guided program and biofeedback. An illuminated bar graph displays the strength of your PFM contractions and objective data to track your progress. Exercise sessions are 12 minutes in length. Cost is $795 (Incontrolmedical.com).

As reported in the International Journal of Urogynecology, a 3-month clinical trial of the InTone device resulted in significant subjective and objective improvements in patients with stress incontinence and overactive bladder.

Do you really need to use a resistance device? 

You can strengthen your PFM and improve/prevent pelvic floor dysfunction without using resistance, so it is not imperative to use a device that is placed in the vagina in order to derive benefits from PFMT. Some women are unwilling or cannot place a device in the vagina. However, using resistance is the most efficient means of accelerating the muscle adaptive process as recognized and espoused by Dr. Kegel, since muscle strengthening occurs in direct proportion to the demands placed upon the muscle.  There is a real advantage to be derived from squeezing against a compressible device as opposed to against air. Furthermore, the biofeedback that many of the resistance devices provide is invaluable in ensuring that you are contracting your PFM properly and in tracking your progress.

Which resistance device will work best for you?

There are many resistance devices available in a rapidly changing, competitive and evolving market. Most of the sophisticated training devices provide the same basic functionality—insertion into the vagina, connection to a smartphone app, and biofeedback and tracking—although each device has its own special features. The goal is to find a device that is comfortable and easy to use.  Some devices are more medically-oriented whereas others are more sex toy-oriented.  Each has unique bells and whistles, some offering programs with guidance and coaching and a few incorporating games to make the PFMT process entertaining. I urge you to visit the website of any device that you might be interested in to obtain more information. Read their reviews in order to make an informed choice as to which product is most appropriate for you.

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

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

 

 

 

 

 

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Female Pelvic Floor Muscle Resistance Training

July 21, 2018

Andrew Siegel MD   7/21/2018

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            Kim Anami started the trend of vaginal weightlifting; visit her website at http://www.kimanami.com

 

 “In the preservation or restoration of muscular function, nothing is more fundamental than the frequent repetition of correctly guided exercises instituted by the patient’s own efforts.  Exercise must be carried out against progressively increasing resistance, since muscles increase in strength in direct proportion to the demands placed upon them.”

–JV Luck, Air Surgeon’s Bulletin, 1945

“Resistance exercise is one of the most efficient ways to stimulate muscular and metabolic adaptation.”

–Mark Peterson, PhD

Resistance

Resistance training is a means of strength conditioning in which work is performed against an opposing force. The premise of resistance training is that by gradually and progressively overloading the muscles working against the resistance, they will adapt by becoming bigger and stronger. Pelvic floor muscle training (PFMT) using resistance optimizes pelvic floor muscle (PFM) conditioning, resulting in more power, stability and endurance and the functional benefits to pelvic health that accrue. It also helps to rebuild as well as maintain PFM mass that tends to decrease with aging.

Applying resistance training to the pelvic floor muscles

Resistance is easy to understand with respect to external muscles, e.g., it is applied to the biceps muscles when you do arm curls with dumbbells. Resistance training can be applied to the PFM by contracting your PFM against a compressible device placed in your vagina.  Its presence gives you a physical and tangible object to squeeze against, as opposed to basic training, which exercises the PFM without resistance. Resistance PFMT is similar to weight training—in both instances, the adaptive process gradually but progressively increases the capacity to do more reps with greater PFM contractility and less difficulty completing the regimen. In time, the resistance can be dialed up, accelerating the adaptive process.

In the late 1940s, Dr. Arnold Kegel devised the perineometer that enabled resistance PFM exercises. It consisted of a pneumatic vaginal chamber connected by tubing to a pressure manometer.  This device provided both a means of resistance and visual biofeedback. The chamber was inserted into the vagina and the PFM were contracted while observing the pressure gauge (calibrated from 0-100 mm mercury). With training, the PFM strength increased in proportion to the measured PFM contractions.

PFMT resistance tools

There are many PFM resistance devices on the market and my intention is to provide information about what is available, but NOT to endorse any product in particular. What follows is by no means a comprehensive review of all products. Some are basic and simple, but many of the newer ones are “high tech” and sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. I classify the devices into vaginal weights, electro-stimulation devices, simple resistance devices and sophisticated resistance devices.  Within each category, the devices are listed in order of increasing cost.

Vaginal Weights

These weighted objects are placed in the vagina and require PFM engagement in order that they stay in position. They are not intended to be used with any formal training program but do provide resistance to contract down upon.

Vaginal Cones: These are a set of cones of identical shape but variable weights.  Initially, you place a light cone in your vagina and stand and walk about, allowing gravity to come into play. PFM contractions are required to prevent the cone from falling out. The intent is to retain the weighted cone for fifteen minutes twice daily to improve the strength of the PFM.  Gradual progression to heavier cones challenges the PFM.  (Search “vaginal cones” as there are several products on the market.)

Word of advice: Be careful not to wear open-toed shoes when walking around with the weighted cones…a broken toe is a possible complication!

Ben Wa Balls:  These are similar to vaginal cones but appear more like erotic toys than medical devices. There are numerous variations on the theme of weighted balls that can be inserted in your vagina, available in a variety of different sizes and weights.  Some are attached to a string, allowing you to tug on the balls to add more resistance. Another type has a compressible elastic covering that can be squeezed down upon with PFM contractions. Still others vibrate. There are some upscale varieties that are carved into egg shapes from minerals such as jade and obsidian. (Search “Ben Wa Balls.”)

Kim Anami is the queen of vaginal kung fu, a life and sex coach who advocates vaginal “weightlifting” to help women physically and emotionally “reconnect” to their vaginas and become more in tune with their sexual energy. Her weightlifting has included coconuts, statues, conch shells, etc.  According to her, vaginal weightlifting increases libido, lubrication, orgasm potential and sexual pleasure for both partners.                                                                                                                       

Electro-Stimulation Devices

These devices work by passive electrical stimulation of the PFM.  Electrical impulses trigger PFM contractions without the necessity for active engagement.  Many clinical studies have shown that electro-stimulation in conjunction with PFMT offers no real advantages over PFMT alone. Like the electrical abdominal belts that claim to tone and shape your abdominal muscles with no actual work on your part, these devices seem much better in theory than in actual performance.

Intensity: This is a battery-powered erotic device that looks like the popular “rabbit” vibrator sex toy.  It consists of an inflatable vaginal probe that has an external handle. It has contact points on the probe that electro-stimulate the PFM and vibrators for both clitoral and “G-spot” stimulation. It has 5 speeds and 10 levels of stimulation. Cost is $199 (Pourmoi.com).

ApexM:  This device is intended for use by patients with stress urinary incontinence.  It consists of an inflatable vaginal probe and control handle. It is inserted inside the vagina, inflated it for a snug fit and powered on.  Electric current is used to induce PFM contractions. The intensity is increased until a PFM contraction occurs, after which the device is used 5-10 minutes daily. Cost is $299 (Incontrolmedical.com).

Simple PFMT Resistance Devices

These are basic model, inexpensive resistance devices. They consist of varying physical elements that you place in your vagina to give you a tangible object to contract your PFM upon. They provide biofeedback to ensure that you are contracting the proper muscles. Some offer progressive resistance while others only a single resistance level.

These devices can be used in conjunction with the specific programs that were specified in a previous blog entry.  To do so, repeat the 4-week program for your specific pelvic floor dysfunction while incorporating these devices into the regimen. You may discover that the 4-week programs using the devices that offer progressive resistance become too challenging as you dial up the resistance level. If this is the case, you can continue with the first week’s program while increasing the resistance over time. Customize and modify the programs to make them work for you, as was recommended for the tailored programs without using resistance.

Educator Pelvic Floor Exercise Indicator:  This is a tampon-shaped device that you insert into your vagina. It is attached to an external arm that moves when you are contracting the PFM properly, giving you positive feedback. Cost is $32.99 on Amazon (Neenpelvichealth.com).

Gyneflex: This is a flexible V-shaped plastic device that is available in different resistances. You insert it in your vagina (apex of the V first) and when you squeeze your PFM properly, the external handles on each limb of the V close down, the goal being to get them to touch. Cost is $39.95 (Gyneflex.com). The Gyneflex is similar in form and function to hand grippers that increase grip strength. 

Pelvic Toner:  Manufactured in the UK, this is a spring-based resistance device that you insert into your vagina.  It has an external handle and two internal arms that remain separated, so the device must be held closed and inserted. When your hold is released the device springs open and, by contracting your PFM, you can close the device. It offers five different levels of resistance. Cost is 29.99 British pounds (Pelvictoner.co.uk).

Magic Banana: This is a PFM exerciser that consists of a loop of plastic and silicone tubing joined on a handle end. The loop is inserted in the vagina and squeezed against.  When the PFM are contracted properly, the two arms of the loop squeeze together. Cost is $49.99 (Magicbanana.com).

KegelMaster: This is a spring-loaded device that you insert in your vagina and is squeezed upon. It has an external handle with a knob that can be tightened or loosened to provide resistance by clamping down or separating the two arms of the internal component. Four springs offer different levels of resistance. Cost is $98.95 (Kegelmaster.com).

Kegel Pelvic Muscle Thigh ExerciserThis is a Y-shaped plastic device that fits between your inner thighs.  When you squeeze your thighs together, the gadget squeezes closed. This exerciser has NOTHING to do with the PFM as it strengthens the adductor muscles of the thigh, serving only to reinforce doing the wrong exercise and it is shameful that the manufacturer mentions the terms “Kegel” and “pelvic muscle” in the description of this product.

To be continued next week, with a review of sophisticated PFMT resistance devices.

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

Cover

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

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

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

Male Fountain of Youth in a Pill

July 14, 2018

Andrew Siegel MD 7/14/2018

fountain-of-youth-sign-st-augustine

Thank you http://www.goodfreephotos.com for the image above

I only believe in prescribing (and taking) medications when absolutely necessary,  after simpler measures have been tried (usually lifestyle modification) and have failed to improve the issue and when advantages outweigh disadvantages.  That stated, there is one medication in particular that can lop off a number of years in terms of its positive effect on male form and function.  Requirements for any medication are twofold—safety and effectiveness.  Recent studies conducted over the course of twenty years confirm the safety and effectiveness of this medication. The chief investigator presented his long-term findings at the 2018 American Urological meeting in San Francisco and called the findings of the study “transformational.”

Aging can be unkind and Father Time is responsible for a host of changes that occur with the aging process. The aging male often suffers with an enlarging prostate gland that can cause annoying urinary symptoms as the enlargement crimps the flow of urine. Aging is also a key risk factor for the occurrence of prostate cancer. As we know all too well, aging also often causes the loss of one’s youthful full head of hair, leaving a balding and shiny scalp subject to sunburn and often managed by combovers or shaving one’s head.

What if I told you that there is a drug that can shrink the prostate and often alleviate the symptoms of prostate enlargement?  That would be considered a good drug.  What if I told you that it could also reduce the risk of prostate cancer?  Now we’re talking excellent drug.  Finally, what if I told you that it could reverse male pattern baldness?  Now we are talking exceptional drug.  This drug not only exists, but also is generic, inexpensive and yours truly is proof of its success!

Prostate Cancer Prevention Trial

The Prostate Cancer Prevention Trial was a clinical experiment that tested whether the drug finasteride (brand name Proscar) could prevent prostate cancer. The medicine works by blocking the activation of testosterone to DHT (dihydrotestosterone).

This trial was based on two facts:

  1. Prostate cancer does not occur in the absence of testosterone
  2. Men born without the enzyme that converts testosterone to its activated form DHT do not develop benign or malignant prostate growth (nor hair loss, for that matter).

This 7-year study enrolled almost 20,000 men who were randomly assigned to finasteride or placebo. The study was terminated early because men in the finasteride arm of the study were found to have a 25% risk reduction for prostate cancer.  The original study in the 1990s also demonstrated a slight increase in aggressive prostate cancer in the finasteride arm.  This negative finding resulted in a “black box” warning from the FDA, as a result of which many men were frightened about the prospect of using the drug.

Recent follow-up on the original clinical trial (median follow-up > 18 years) presented at the 2018 American Urological Association meeting found 42 deaths from prostate cancer in the finasteride arm and 56 in the placebo arm. The study concluded that finasteride clearly reduces the occurrence of prostate cancer and that the initial concerns regarding high grade prostate cancer were unfounded.

Prostates in those treated with finasteride were 25% smaller at the end of the study as opposed to the prostates in the placebo group. Finasteride (and other medications in its class) lower prostate specific antigen (PSA) by 50%, so any man on this class of medications will need to have his PSA doubled to estimate what the PSA would be if not taking the medication.

proscar-tablet.jpg

When my thinning hair progressed to the point that I had a sunburn on my crown, I started using Propecia (a.k.a. finasteride). In a matter of a few years I had a full regrowth of hair. After the Prostate Cancer Prevention Trial report revealed a 25% risk reduction for prostate cancer with finasteride use, I was strongly motivated to continue using the drug, particularly since my father had been diagnosed with prostate cancer at age 65 (he is thriving over two decades later).

The 2 photos are proof of my fine head of hair, thank you finasteride

 IMG_7168

 

IMG_7169 

 The bottom line is that finasteride (Proscar and Propecia) and dutasteride (Avodart) can help prevent prostate cancer, shrink the prostate gland, improve lower urinary tract symptoms due to prostate enlargement, help prevent the need for prostate surgery and grow hair on one’s scalp… a fountain of youth dispensed in a pill form if ever there was one!

For more information on the fascinating tale of how this drug was developed–one of the most interesting backstories on drug development–see my entry: Girl at Birth, Boy At Puberty…and A Blockbuster Drug.

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

New video on female pelvic floor exercises:  Learn about your pelvic floor

On the topic of “fountain of youth,” my first foray into writing was Finding Your Own Fountain of Youth: The Essential Guide to Health, Wellness, Fitness & Longevity.  If you see me as a patient and ask for a copy, it’s yours for free.  Alternatively, if you would like to download a free copy in PDF format, visit www.AndrewSiegelMD.com and click on “books.”

 

 

 

5 Reasons Your Penis May Be Shrinking

July 7, 2018

Andrew Siegel MD   7/7/18

Today’s entry is not about the moment-to-moment changes in penis size based upon ambient temperature and level of arousal, but to permanent alterations in penile length and girth that can occur for a variety of physical reasons. The preservation of penile dimensions is contingent upon having healthy, well-oxygenated, supple and elastic penile tissues that are used on a regular basis for the purposes nature intended.

 sculpture emasculated Reykjavik

Above photo I recently shot in Reykjavik, Iceland

Penis size is a curiosity and fascination to men and women alike. An ample endowment is often associated with virility, vigor, and sexual prowess.   There is good reason that the words “cocky” and “cocksure” mean possessing confidence.

What’s normal?

With all biological parameters, there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. The penis is no exception, with some men phallically endowed, some phallically challenged, but most somewhere in the middle. Alfred Kinsey studied 3500 penises and found that the average flaccid length was 8.8 centimeters (3.5 inches), the average erect length ranged between 12.9 -15 centimeters (5-6 inches) and the average circumference of the erect penis was 12.3 centimeters (4.75 inches).

Who cares?

Interestingly, 85% or so of women are perfectly satisfied with their partner’s penile size, while only 55% of men are satisfied with their own penis size.

5 Reasons for a Shrunken Penis

  1. Weight gain: Big pannus/small penis

The ravages of poor lifestyle habits wreak havoc on penile anatomy and function.  The big pannus (“apron” of abdominal fat) that accompanies weight gain and especially obesity cause a shorter appearing penis.  In actuality, most of the time penile length is intact, with the penis merely buried in the fat pad.  It is estimated that for every 35 lbs of weight gain, there is a one-inch loss in apparent penile length.

The shorter appearing and more internal penis can be difficult to find, which causes less precision of the urinary stream that sprays and dribbles, often requiring the need to sit to urinate. Additionally, the weight gain and poor lifestyle give rise to difficulty achieving and maintaining erections.  This shorter and less functional penis and the need to sit to urinate is downright emasculating.

Solution: Lose the fat and presto…the penis reappears and urinary and sexual function improve.

  1. Disuse atrophy: Use it or lose it

Like any other organ in the body, the penis needs to be used on a regular basis, as nature intended.  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. In a vicious cycle, loss of sexual function can lead to further progression of the problem as poor genital blood flow causes low oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the problem.

Solution: Exercise your penis by being sexual active on a regular basis, just as you maintain your general fitness by going to the gym or participating in sports.

  1. Peyronie’s disease: Scar in a bad place

Peyronie’s disease is scarring of the covering sheaths of the erectile chambers. It is thought to be due to the cumulative effects of chronic penile micro-trauma.  The scar tissue is hard and inelastic and prevents proper expansion of the erectile chambers, resulting in penile shortening, deformity, angulation and pain. In the early acute phase—that can evolve and change over time—most men notice a painful lump or hardness in the penis when they have an erection as well as a bent or angulated erect penis. In its more mature chronic phase, the pain disappears, but the hardness and angulation persist, often accompanied by penile shortening and narrowing where the scar tissue is that gives the appearance of a “waistband.”  Many men as a result of Peyronies will have difficulty obtaining and maintaining an erection.

Peyronies can also occur as a consequence of a penile fracture, an acute traumatic injury of the covering sheath of the erectile chamber.  This most commonly happens from a pelvic thrusting miss-stroke during sexual intercourse when the erect penis strikes the female perineum or pubis and ruptures.  This is an emergency that requires surgical repair to prevent the potential for Peyronie’s disease.

Solution: If you notice a painful lump, a bend, shortening and deformity, see a urologist for management as the Peyronies is treatable once the acute phase is over and the scarring stabilizes.  If you experience a penile fracture after a miss-stroke—marked by an audible pop, acute pain, swelling and bruising—head to the emergency room ASAP.

  1. Pelvic surgery

After surgical removal of the prostate, bladder or colon for management of cancer, it is not uncommon to experience a decrease in penile length and girth.  This occurs due to damage to the nerves and blood vessels to the penis that run in the gutter between the prostate gland and the colon. The nerve and blood vessel damage can cause erectile dysfunction, which leads to disuse atrophy, scarring and penile shrinkage.

In particular, radical prostatectomy—the surgical removal of the entire prostate gland as a treatment for prostate cancer—can cause penile shortening. The shortening is likely based on several factors. The gap in the urethra (because of the removed prostate) is bridged by sewing the bladder neck to the urethral stump, with a consequent loss of length from a telescoping phenomenon.  Traumatized and impaired nerves and blood vessels vital for erections give rise to erectile dysfunction. The lack of regular erections results in less oxygen delivery to penile smooth muscle and elastic fibers with subsequent scarring and shortening, a situation discussed above (disuse atrophy).

Solution: Resuming sexual activity as soon as possible after radical pelvic surgery will help “rehabilitate” the penis and prevent disuse atrophy. There are a number of effective penile rehabilitation strategies to get “back in the saddle” to help prevent disuse atrophy.

  1. Anti-testosterone treatment

“Androgen deprivation therapy” is a common means of suppressing the male hormone testosterone, used as a form of treatment for prostate cancer. Because testosterone is an important hormone for maintaining the health and the integrity of the penis, the low testosterone levels resulting from such therapy can result in penile atrophy and shrinkage.

Solution: This is a tough one.  Because of the resulting low testosterone levels, most men have a diminished sex drive and simply lose interest in sex and “use it or lose it” becomes challenging. Furthermore, many men on this therapy have already had a radical prostatectomy and or pelvic radiation therapy, so often have compromised erections even before using androgen deprivation therapy. Anecdotally, I have had a few patients who have managed to pursue an active sex life and maintain penile stature with the use of Viagra or other medications in its class. 

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