Archive for August, 2018

“Preventive” Kegels: A Cutting-Edged Concept

August 25, 2018

Andrew Siegel MD  8/25/18

prevention                        Attribution: Alpha Stock Images – http://alphastockimages.com/

“People whose diseases are prevented as opposed to cured may never really appreciate what has been done for them. Zimmerman’s law: Nobody notices when things go right.” …Walter M. Bortz II, M.D.

“To guard is better than to heal, the shield is nobler than the spear!”                                  …Oliver Wendell Holmes

Achieving a fit pelvic floor by strengthening and toning the pelvic muscles is a first line approach that can improve a variety of pelvic maladies in a way that is natural, easily accessible and free from harmful side effects. Although it is always desirable to treat the symptoms of pelvic floor dysfunction, it is another dimension entirely to take a proactive approach by strengthening the pelvic muscles to prevent pelvic floor dysfunction.

Pregnancy, labor, childbirth, aging, menopause, weight gain, gravity, straining and chronic increases in abdominal pressure take a toll on pelvic anatomy and function and can adversely affect vaginal tone, pelvic organ support, urinary and bowel control and sexual function.  Humans have a remarkable capacity for self-repair and pelvic issues can be dealt with after the fact, but why be reactive instead of being proactive?  Why not attend to future problems before they actually become problems? Isn’t a better approach “an ounce of prevention is worth a pound of cure”? Why not pursue a strategy to prevent pelvic floor dysfunction instead of fixing it, not allowing function to become dysfunction in the first place?

To be the “devil’s advocate,” the answers to the aforementioned questions posed may be:

  1. Why bother at all, since pelvic issues may never surface.
  2. Being proactive takes work and effort and many humans do not have the motivation and determination required to pursue and stick with any exercise program.
  3. If I put in the effort and pelvic issues never surface, how do I even know that it was my efforts that prevented the problem.

In the USA, over 350,000 surgical procedures are performed annually to treat two of the most common pelvic floor dysfunctions—stress urinary incontinence and pelvic organ prolapse.  Estimates are that by the year 2050, this number will rise to more than 600,000.  These sobering statistics provide the incentive for changing the current treatment paradigm to a preventive pelvic health paradigm with the goal of avoiding, delaying or diminishing deterioration in pelvic floor function.

If birth trauma to the pelvic floor often brings on pelvic floor dysfunction as well as urinary, bowel, gynecological and sexual consequences, why not start pelvic training well before pregnancy? This runs counter to both our repair-based medical culture that is not preventive-oriented and our patient population that often opts for fixing things as opposed to preventing them from occurring.

Realistically, pelvic training prior to pregnancy will not prevent pelvic floor dysfunction in everyone.  Unquestionably, obstetrical trauma (9 months of pregnancy, labor and vaginal delivery of a baby that is about half the size of a Butterball turkey, repeated several times) can and will often cause pelvic floor dysfunction, whether the pelvic muscles are fit or not!  However, even if pelvic training does not prevent all forms of pelvic floor dysfunction, it will certainly impact it in a very positive way, lessening the degree of the dysfunction and accelerating the healing process. Furthermore, mastering pelvic exercises before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery and the effortless resumption of the exercises in the post-partum period, as the exercises were learned under ideal circumstances, prior to pelvic injury. Since there are other risk factors for pelvic muscle dysfunction aside from obstetric considerations, this preventive model is equally applicable to women who are not pregnant or never wish to become pregnant.

Preventive health is commonly practiced with respect to general physical fitness. We work out not only to achieve better fitness, but also to maintain fitness and prevent losses in strength, flexibility, endurance, balance, etc.  In this spirit, I encourage those of you who are enjoying excellent pelvic health to maintain this health with a preventive pelvic training program.  For those working to improve your pelvic health, continue forward on the journey.  Regardless of whether your goal is treatment or prevention, a pelvic training program will allow you to honor your pelvic floor and become empowered from within.

Bottom Line: You can positively affect your own pelvic health destiny.  It is better not to be reactive and wait for your pelvic health to go south, but to be proactive to ensure your continuing sexual, urinary and bowel health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive pelvic floor training program into your exercise regimen—it’s like a vaccine to prevent a disease that hopefully you will never get.

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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Shockwave Therapy for Erectile Dysfunction: New and Exciting

August 18, 2018

Andrew Siegel MD  8/18/2018

Shockwaves—acoustic vibrations that carry energy—have been used for many years to pulverize kidney stones, revolutionizing their treatment.  A much tamer form of shockwaves — “low intensity shockwave therapy”  (L.I.S.T.)— is an exciting new treatment for erectile dysfunction (ED). 

 

Picture1

Thank you Storz Medical and Robert Remington (RemingtonMedical.com) for above image of a shock wave unit used for the treatment of erectile dysfunction; note treatment of both the external (left side of image) and internal aspects of the penis (right side of image)

Erections occur when there is sufficient penile inflow of blood at high enough pressures to create rigidity, coupled with a functioning blood trapping mechanism to promote durability. Most men with ED have blood flow issues (vascular ED), resulting in compromised erectile rigidity and durability.

Erectile health is based upon obtaining erections on a regular basis. “Use it or lose it” applies to the penis as it does to so many tissues of the body.  When ED occurs, disuse of the penis perpetuates the loss of function and deterioration of erectile tissues, so the earlier in the course of ED that treatment is initiated the better.

The majority of treatments for ED — pills, suppositories, injections, penile implants, etc.  — function as “Band-Aids,” as they do not treat the root cause of the problem, which most commonly has to do with compromised blood flow.  Penile shockwave therapy uniquely is capable of modifying the underlying cause of the ED, improving the penile circulation that is responsible for erections. When applied to the penis, shock waves cause micro-trauma and mechanical stress, stimulating the growth of new blood vessels and nerve fibers and structural changes that can regenerate and remodel damaged erectile tissues, ultimately improving penile blood flow and erectile function.

Acoustic therapy works best for those with vascular ED, commonly seen with diabetes, high cholesterol, obesity, high blood pressure, metabolic syndrome, cardiovascular disease, etc.  It works best for those men with mild to moderate ED that has responded reasonably well to the oral ED medications, including Viagra, Cialis, etc. Acoustic therapy is advantageous in that it is a restorative and regenerative therapy that treats the cause and not just the symptoms, triggering natural repair mechanisms by increasing penile blood flow.  It is safe, non-invasive, virtually painless and has a success rate of about 70% in improving or resolving ED, restoring firmer and more durable erections.

The new treatment is now available in our office. It takes 15 minutes or so per session and is typically done once weekly for 6 weeks. It is well tolerated, causing only a slight pricking or vibrating sensation.  Many men notice an improvement within three weeks of initiating the course of therapy.  Unfortunately, it is not yet approved by the FDA, although it is highly likely that it will be in the near future.

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

 

Understanding Female Sexual Fluids

August 11, 2018

Andrew Siegel MD  8/11/2018

Women are capable of releasing a “cocktail” of genital fluids during sexual activity. Controversy exists regarding the nature, volume, and composition of these secretions and their mechanisms of expulsion. Today’s entry delves into the origins of female sexual fluids—vaginal, glandular (Skene and Bartholin glands) and the urinary bladder—and the means of their release.  In the image below, the anatomical structures in boldface are those responsible for the genital fluids.

Image below: note Swedish “slida” is vagina (literally “sheath”); note Skenes and Bartholins gland  openings, “urinrorsmynning” = urethra; “klitoris” = clitoris

Skenes_gland-svenska.jpg

Attribution of image above: By Nicholasolan (Skenes gland.jpg) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5 (https://creativecommons.org/licenses/by-sa/2.5)%5D, via Wikimedia Commons

 

Vaginal secretions

Lubrication that originates from the vagina is an ultra-filtrate of blood resulting from the increased blood flow and pelvic congestion that happens with erotic and tactile stimulation. The surge of blood to the genitals at the time of arousal results in the seeping of this natural lubrication fluid. There is often a substantial drop in the amount of vaginal lubrication that occurs after menopause with the sudden cessation of estrogen production by the ovaries.  By the way, if you are interested in testing your knowledge of female anatomy, visit: how high is your vaginal I.Q.?

Skene gland secretions…the female “prostate”

The Skene glands (a.k.a. para-urethral glands) are homologous to the male prostate gland.  These paired glands are located within the top wall of the vagina near the urethra and drain into the urethra and to tiny openings near the urethral opening (see image above). At the time of sexual climax, they can release a small amount of fluid into the urethra, paralleling the male release of prostate fluid at the time of ejaculation.

Bartholin gland secretions…the female “bulbourethral” glands

The Bartholin glands (a.k.a. greater vestibular glands) are paired, pea-size structures located in the superficial perineal pouch.  These glands open below and to the sides of the vagina (see image above).  They are homologous to the male bulbourethral glands that produce a clear, sticky fluid that lubricates the male urethra, often referred to as “pre-cum.”  The Bartholin glands secrete mucus that functions to provide lubrication to the inner labia that helps moisten the opening into the vagina.

Bladder and urethra

Because of the anatomical proximity of the bladder and urethra to the vagina, urine stored in the urinary bladder can be involuntarily released at the time of sexual activity.  Urine can be expelled during initial vaginal penetration, in the midst of the act of sexual intercourse, or at the time of sexual climax.

Urinary discharge that occurs during initial vaginal penetration and/or during sexual intercourse often occurs because of the presence of the penis in the vagina that displaces and elevates the bladder (anatomically situated directly above the vagina) and the massaging effect of penile thrusting.  This is not uncommonly seen in women who have either stress urinary incontinence, the involuntary leakage of urine with exercising, coughing, sneezing, etc., or bladder prolapse, a condition in which weakened bladder support allows descent of the bladder into the vaginal space.

Urine can also be involuntarily expelled from the urethra at the time of sexual climax.  For many women it is unpleasant, highly frustrating and embarrassing  situation for which they seek treatment, a condition known as coital incontinence. This orgasmic release of urine often occurs in women who suffer with overactive bladder, a condition in which the bladder contracts without its owner’s permission (a.k.a., involuntary bladder contractions).  For other women, the release of urine at the time of climax is viewed positively, correlated with intensive sexual arousal and a powerful and cathartic orgasm.  Under these circumstances, this situation is known as “squirting.”

(Excellent reference: Differential diagnostics of female “sexual” fluids: a narrative review   Z Pastor and R Chimel, Intern Urogynecological Journal (2018) 29:621-629)

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

 

Thankful for Tough Tissues: Big Head/ Little Head

August 4, 2018

Andrew Siegel MD   8/4/2018

Midas penis in cage

Image above from Phallological Museum in Reyjkavik that I recently visited

 

The toughest connective tissues in the human body, exclusive of bone and teeth (in order of strength) are:

  1. Dura mater (of brain and spinal cord)
  2. Tunica albuginea (of penis and clitoris)

Is it not fitting that the two toughest and hardiest connective tissues in the human body are located in the brain and genitals, providing protection and support to arguably two of our most vital and important human possessions? 

The hardest organs in the body are bones (calcium and other minerals) and teeth (enamel), but when it comes to connective tissue, the brain and penis/clitoris reign supreme. The brain and spinal cord are enveloped and protected by the dura mater (Latin, “hard mother”), the robust outermost membrane. The erectile chambers of the penis (and the clitoris, although on a miniaturized scale) are covered with a tough fibrous envelope called the tunica albuginea (Latin, “white membrane”).

The White Membrane

The tunica albuginea consists mostly of collagen with a sprinkling of elastin to allow it to stretch. It has an important role in maintaining both penile and clitoral erections.  When a penis is flaccid the tunica is 2 mm or so thick and with an erection it stretches to 0.25 to 0.5 mm thick.  At the time of erectile rigidity, the blood pressure in the penis exceeds 200 mm of mercury, the only place in the body where hypertension is desirable and necessary for proper function. The tunica albuginea supports the penis at these times of penile hypertension, allowing for full erectile rigidity and durability and protecting the penis against injury from the torquing and buckling stresses of sexual intercourse.

Acute Trauma to the White Membrane

On rare occasions, the tunica surrounding the erectile chambers of the penis ruptures under the force of a strong blow to the erect penis, a situation referred to as a penile fracture. It is not unlike the tire of a car being driven forcibly into a curb, resulting in a gash in the tread and deflation from the blow out. Such an acute blunt traumatic injury rarely occurs to the non-erect penis by virtue of its mobility, flaccidity, and 2 mm thick tunica. However, when the penis is rigid, there is peak tension and stretch on the white membrane. The leading cause of penile fractures is vigorous sexual intercourse, most often when the penis slips out of the vagina and strikes the perineum (area between the vagina and anus). She “zigs,” he “zags,” and a miss-stroke occurs of sufficient force as to rupture the white membrane.

Fracture can also occur under the circumstance of rolling over or falling onto the erect penis as well as any other situation that inflicts damage to the erect penis, such as walking into a wall in a poorly illuminated room or forcible masturbation.

Penile fracture is a medical emergency, and prompt surgical repair is necessary to maintain erectile function and minimize scarring of the erectile chambers that could result in permanent penile bending and angulation.

Chronic Trauma to the White Membrane

Chronic traumatic injuries to the white membrane are often asymptomatic for many years. Just the simple act of obtaining a rigid erection puts tremendous compression stress forces on the white membrane and the potential for micro-trauma to it increases exponentially when one inserts his erect penis into a vagina and two parties move, bump and grind, creating intense shearing stress forces on the penis. Certain positions angulate the penis and create more potential liability for injury than others. Even gentle sex can be rough with a single act of intercourse resulting in hundreds of thrusts with significant rotational, axial and torquing strains and stresses placed upon the erect penis with the potential for subtle buckling injuries.

Repeat performance perhaps a few times a week for many decades and by the time a man is in his 50s, on a cumulative basis, traumatic penile injuries—often asymptomatic in their developmental stages—can cause scarring to the white membrane, ultimately resulting in Peyronie’s disease.  This often manifests with a hard lump, shortening, curvature, narrowing, a visual indentation of the penis described as an hour-glass deformity, pain with erections and less erectile rigidity. Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse.

Bottom Line:  The human body is nothing short of amazing and should be accorded the greatest respect. We should be grateful for our dura mater and tunica albuginea that protect and allow function of our brains and penises/clitorides, respectively.  Given the service that our penises provide, it is surprising that penile fracture and Peyronie’s disease are not more common than they actually are.

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