Archive for September, 2018

All Fat Is Not Created Equal

September 29, 2018

Andrew Siegel MD  9/29/2018

www.maxpixel.net-Obesity-Weight-Obese-Fat-Heavy-Overweight-3313923

Thank you, Max Pixel for image above

My next few entries concern weight and diet. Clearly, obesity is unhealthy on many levels and I do not encourage anyone to carry excess pounds. However, fat can be advantageous under certain circumstances: see below 12 Benefits to Being Overweight (to be taken tongue in cheek).  Next week’s entry (to be taken seriously) will discuss a healthy eating style that  effectively can improve your shape and shred excess pounds that I am excited to share with you.

Some fat is good, but not too much

Having some fat on our bodies is actually a good thing, as long as it is not excessive. Fat serves a number of useful purposes: it cushions internal organs; it provides insulation to conserve heat; it is a means of storing energy and fat-soluble vitamins; it is part of the structure of the brain and cell membranes; and is used in the manufacture of certain hormones.

All fat is not created equal

Not all fat is the same. It is important to distinguish between visceral fat and subcutaneous fat.  Visceral fat–also referred to as a “pot belly” or “beer belly”– is  fat deep within the abdominal cavity that surrounds the internal organs.  Subcutaneous fat–also known as “love handles,” “spare tires” or “muffin top”– is present between the skin and the abdominal wall. In addition to the physical distribution of the fat being different, so is the nature of the fat. Although neither type is particularly attractive, visceral fat is much more of a health hazard than is subcutaneous fat since its presence increases the risk of heart disease, diabetes and metabolic disturbances.  This is as opposed to subcutaneous fat, which is inactive and relatively harmless and generally does not contribute to health problems.

 

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Thank you Pixabay, for above image of visceral obesity (“beer belly”)–NOT GOOD FOR ONE’S HEALTH

OLYMPUS DIGITAL CAMERA

Image above, subcutaneous fat (“muffin top”), Attribution: Colin Rose from Montreal, Canada–MIGHT NOT BE THAT ATTRACTIVE, BUT GENERALLY NOT A HEALTH ISSUE

 

A beer belly is called a beer belly for good reason. One of the real culprits in the formation of visceral fat is drinking liquid carbs, whether sweetened beverages including sodas, iced tea, lemonade, sports drinks, etc., fruit juices such as orange, grapefruit, cranberry, etc., and alcoholic beverages.  Liquid carbs have no fiber and are essentially pre-digested, stimulating a massive insulin surge and rapid storage as fat. It is much healthier to eat the real fruit rather than drink the juice, since the product in its original form is loaded with fiber that fills you up and slows the absorption process and also contains abundant phytonutrients.  You would have to eat 3 oranges to get the same sugar and calorie load as drinking a glass of OJ, and it is hardly possible to do that.

Visceral fat is a metabolically active endocrine “organ” that does way more than just create an unsightly appearance. It produces numerous hormones and other chemical mediators that have many detrimental effects on all systems of our body.  So, fat is not just fat. Visceral fat ought to have a specific name, as do other endocrine organs (thyroid gland, adrenal gland, etc.). This name should convey the dangerous nature of this “gland.”  I suggest “die-roid” gland because of its dire metabolic consequences, including risk of metabolic syndrome, diabetes, heart disease and premature death.

The good news about visceral fat is that it is metabolically active so that with the appropriate lifestyle modifications it can readily melt away, as opposed to subcutaneous fat, which is tenacious and can be extremely difficult to lose.

12 benefits to being overweight

  1. Less prominent crow’s feet, wrinkles and nasal-labial folds
  2. More comfort in the cold winter months because of more insulation
  3. More likely to survive hypothermia if your ship should sink in icy waters or your plane goes down on a snow-laden mountaintop
  4. Better buoyancy in the water
  5. Better survival when stranded on a desert island because of the fat (stored energy) that will keep you sustained and alive long after the thin people have perished
  6. Less osteoporosis (bone thinning) because of the weight-bearing that keeps bones mineralized
  7. Strength because of all that weight-bearing—think NFL offensive linemen
  8. Built-in airbag for better survival of traumatic motor vehicle crashes and other forms of trauma
  9. More comfortable when sitting on tailbone or lying on vertebra because of better padding
  10. More stable footing under conditions of gale-force winds
  11. Curvier, more voluptuous bodies
  12. Cuddlier, like a teddy bear!

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:

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

 

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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Sculpt Your Bod

September 22, 2018

Andrew Siegel MD  9/22/2018

David by Michelangelo Florence Galleria dell'Accademia

David by Michelangelo Florence Galleria dell’Accademia

Image above by Jörg Bittner Unna [CC BY 3.0  (https://creativecommons.org/licenses/by/3.0)%5D, from Wikimedia Commons”

Dad bod is a slang term in popular culture referring to a body shape particular to middle-aged men. The phrase has been adopted in U.S. culture as a celebration of this particular type of physique, with references generally skewing toward a positive and light-hearted tone. This masculine body type is a unique cross between muscular and overweight physiques.” ….Wikipedia

You can think of your body as a dynamic piece of sculpture, capable of being modified at will by you—the artist—who has some definite say regarding its appearance.  This human sculpture is not static and fixed in composition, but forever evolving, continually being remodeled, restructured and refashioned in accordance with the availability of building materials, how they are used, and in response to the cut of the chisel or lack thereof.

Every human being starts with a unique block of matter that has certain fixed structural features—based upon what was inherited from one’s parents—but other aspects that are capable of being modified, for better or worse. Since the sculpture is dynamic and constantly being restructured, one can think of the “sculpting materials” as one’s diet and energy intake and of the “actions of the chisel” as exercise and physical activity.

For the optimally-shaped sculpture, it is vital to use the finest sculpting materials in the proper quantities, i.e., a diet that is both wholesome and nutritious—”real” food that is not over-refined, over-processed, and nutritionally-empty—and provides the right balance of calories to satisfy metabolic demands, but not so much that the excess energy is stored as fat.  A calorie-rich, nutrient-poor, typical Western diet overloaded with processed foods will result in a bloated sculpture with over-ample proportions.

The actions of the chisel are equally—if not more—important to the sculpted product as are the proper quality and quantity of sculpting materials.  The chisel—when properly and deftly applied—will remove extraneous materials in a proportionate manner and nicely shape and fashion the sculpture. The chisel represents the cumulative total of exercise, physical activities and bio-mechanical forces, resistances, and stresses applied to the sculpture.

At any given moment in time the sculpture’s appearance is the living record of the lifetime integrated sum total of nutritional input, energy expenditure, exercise and physical activity. Obviously, this is a gross simplification; this entire schema ignores the other internal and external elements that contribute to our physique, including a lifetime of metabolic and hormonal factors, trauma, injury, disease, aging, environmental factors, etc.  Nonetheless, the artist has some genuine say in the shape of the sculpture and it is a matter of what and how much we eat or don’t and what kind of and how much we exercise and stay physically active or don’t that figures prominently in the ultimate form of the sculpture.

With some applied discipline, the artist is capable of changing the appearance of the sculpture for the better, or without discipline the artist is capable of changing the appearance of the sculpture for the worse. The proper quality and quantity of sculpting materials will give rise to a pleasing appearance of the sculpture when veiled with clothing, but it is the actions of the chisel that provide the attractive sculpted and chiseled appearance when the sculpture is unveiled.

Losing weight makes you look good in clothes,

Exercise makes you look good naked.

As I am giving thought to the human-as-sculpture metaphor, I am at the Jersey shore relaxing in a beach chair under an umbrella, gazing into the surf and observing a myriad of different bodies—of varying sizes, shapes and forms—walking by.  Some are rail thin, some sinewy and muscular, many overweight and far too many are obese.  I can’t help but think that each and every one of us has the power to sculpt their bodies—certainly to some extent—and that prior to making the decision to put a food item in our mouth– or not– or engage in physical activity– or not–a tiny bit of thought about what effect that may or may not have on our body as sculpture might be in order.

 

IMG_1268

fat david

Image above attribution: Stupid.photos: https://www.flickr.com/photos/27248028@N02/2627052650; no changes made to image

With the creative touch of the chisel and other sculpting tools, Michelangelo transformed a solid block of marble into the magnificently sculpted David. You, too, can wield the power of the artist and optimize your body’s form (and function for that matter), understanding that the process will be a slow, steady and gradual evolution.  While the initial motivation may be vanity, the deeper reward will be improved health and fitness.

Upon returning from an awesome vacation in Iceland where I had certainly enjoyed the gorgeous terrain as well as the lamb, arctic char and beer, I felt an uncomfortable (and unattractive) roll in my mid-section.  I could certainly “pinch more than an inch”—more like 4 inches—and this, in combination with my tightening pants, both repulsed and motivated me.  Starting in June, I made a concerted effort with both “sculpture materials” and the “actions of the chisel” to modify the “dad bod” and whittle myself back into optimal shape. Clearly, this kind of effort that becomes more challenging as we get older. I tried to maintain the healthy diet that I genuinely enjoy— Mediterranean-style—and ate clean, lean and mostly green, actively avoiding (as much as feasible) cheese and other animal fats (replacing them with fats from seafood, olives/olive oil, avocado, nuts, seeds, etc.).  On the avoid list were cookies, cake, candy and other sweets. I never drink carbs (sodas, juices, sports drinks, sweetened tea, lemonade, etc.) with the exception of alcohol (in moderation). I stepped up the exercise, doing a balance of cardio, core and strength training. Without a great deal of difficulty, I managed to drop the pounds and carve the body for the better and my daughters now describe my physique as “partial dad bod,” which might be the best I will ever be able to do, although I will continue to challenge that in the 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

 

 

 

 

 

 

 

 

Female Urethral Prolapse: What You Need to Know

September 15, 2018

Andrew Siegel MD  9/15/2018

Operative_gynecology_-_(1906)_(14780430391)

Image above from Howard Kelly, Operative Urology, 1906, public domain

Urethral prolapse is a circumferential eversion (when the inside turns out) of the innermost lining of the urethra (urinary channel) through the urethral opening. It is similar to pulling your lower lip down and your upper lip up, exposing the moist inner surface of the lip that is normally not exposed, except that it occurs in 360-degree fashion and involves the urethral opening.  It is a uncommon condition that is often misdiagnosed, but is seen fairly commonly by urologists like myself who have expertise in female urology.

It occurs in two distinct populations, prepubescent women, most commonly of African-American background, and post-menopausal Caucasian women. It typically causes a gradually enlarging mass near the urethral opening and vaginal or urinary bleeding. On examination, a hemorrhagic, donut-shaped vaginal mass is seen surrounding the urethra.  It can give rise to painful urination and abnormal urinary patterns. At times the inner tissue that is turned outwards can result in swelling and choking off of its blood supply, resulting in tissue death of the prolapsed tissue from strangulation.  This appears as a dark purple or black rosebud configuration.

CRIU2016-1802623.001

Image above: strangulated urethral prolapse, Case Rep Urol. 2016; 2016: 1802623.

One theory as to the cause of urethral prolapse is separation or lack of cohesion of the two muscle layers of the urethra and an alternative theory is the post-menopausal lack of estrogen that gives rise to lax pelvic muscles, tissue atrophy, and poor urethral support.

Conservative management involves the local application of topical estrogen. Topical antibiotics can be used if an infection is present and warm baths are used for symptomatic relief.  Efforts are made to “reduce” the prolapse, manipulating it so that the inside lining is pushed back in.

If symptoms do not improve or resolve, if the patient cannot urinate because of the prolapse or if there is tissue death, surgery is indicated.  Reparative surgery involves circumferential excision of the prolapsed tissue with suturing of the urethral lining to the vagina, a highly effective outpatient procedure that I typically need to do only a handful of times per year.

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

 

 

 

 

 

What is Urology?

September 8, 2018

Andrew Siegel MD   9/8/2018

Fact: Chances are that if you haven’t yet seen a urologist, you will at some point in your life.  Sooner or later human plumbing problems surface!

 

900px-Urinary_System_(Male)

Image above by-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)%5D, from Wikimedia Commons

Male_reproductive_tract

Male Reproductive System

Image above by Sheldahl [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)%5D, from Wikimedia Commons

“Urology” (“uro”—urinary tract and “logos”—study of) is a surgical specialty concerned with the diagnosis and treatment of diseases of the urinary tract in females and of the urinary and genital tracts in males. Urology uses both medical and surgical strategies to treat a variety of conditions and employs many minimally-invasive technologies including fiber-optic endoscopy that enables visualization of the entire inner lining of the urinary tract, as well as ultrasound, lasers, laparoscopy and robotics.  Today’s entry explores what urologists do, how they are trained, and demographics.

Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health. Organs under the “domain” of urology include the adrenal glands, kidneys, the ureters (tubes connecting the kidneys to the urinary bladder), the urinary bladder and the urethra (the channel that conducts urine from the bladder to the outside).  The male reproductive organs include the testicles, epididymides (structures located above and behind the testicles where sperm mature and are stored), vas deferens (sperm duct), seminal vesicles (the structures that produce the bulk of semen), prostate gland and, of course, the scrotum and penis.  The reproductive and urinary tracts are closely connected, and disorders of one oftentimes affect the other…thus urologists are referred to as “genitourinary” specialists.

There is overlap in what urologists do with other medical and surgical disciplines, including nephrology (doctors who specialize in medical diseases of the kidney); oncology (cancer specialists); radiation oncology (radiation cancer specialists); radiology (imaging); gynecology (female genital specialists); and endocrinology (hormone specialists).

Urologists treat many serious and potentially life-threatening illnesses, particularly cancers of the genital and urinary tracts. In the United States, prostate cancer accounts for almost 20% of new cancer cases in men, bladder cancer for 7%, and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine) for 5%.  Testicular cancer is relatively rare but is also under the treatment domain of urologists.  Urologists treat women with kidney and bladder cancer, although the prevalence of these cancers is much less so in females.

Common reasons for a referral to a urologist are the following: blood in the urine, whether visible or picked up on a urinalysis; blood in the semen, an elevated PSA (Prostate Specific Antigen) or an accelerated PSA over time; prostate enlargement; irregularities of the prostate on digital rectal examination; urinary difficulties ranging from urinary incontinence to the inability to urinate (urinary retention) and urinary tract infections.

Urologists manage a variety of non-cancer issues. Kidney stones, which can be extraordinarily painful, are especially prevalent in the hot summer months. Infections are a large part of urology practice and can involve the bladder, kidneys, prostate, testicles and epididymis. Sexual dysfunction is a very common condition managed by the urologist—under this category is erectile dysfunction, ejaculation problems, and libido and testosterone issues. Urologists treat not only male infertility, but also create male infertility when it is desired by performing voluntary male sterilization (vasectomy).  Urologists are responsible for caring for many scrotal issues including testicular pain and swelling.

Training to become a urologist involves attending 4 years of medical school following college and 1–2 years of general surgery training followed by 4 years of urology residency. Thereafter, many urologists like myself pursue additional sub-specialty training in the form of a fellowship that can last anywhere from 1–3 years.  Urology board certification can be achieved if one graduates from an accredited residency and passes a written exam and an oral exam and has an appropriate log of cases that are reviewed by the board committee.  Thereafter, one must maintain board certification by participating in continuing medical education and passing recertification exams.  Becoming board certified is the equivalent of a lawyer passing the bar exam.

In addition to obtaining board certification in general urology, there are two specialties in which specialty board certification can be obtained—pediatric urology, which is the practice of urology limited to children, and female pelvic medicine and reconstructive surgery (FPMRS), which involves female urinary incontinence, pelvic organ prolapse and other urological/gynecological issues.

Urology is largely a male specialty, although women have been entering the urological workforce with increasing frequency because female students now comprise more than 50% of the United States medical school population. There are approximately 10,000 practicing urologists in the USA, of which about 500 are women. The aging population will demand more urological services; this coupled with the aging of the urological workforce and the contraction of the number of practicing urologists due to retirement does not bode well for the balance of supply and demand in the forthcoming years.  Hopefully, there will be enough urologists to provide the urological care to those that need it.

finger-2

The index finger (nice and narrow) of yours truly, one of the most vital instruments used by the urologist

 

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

When Ejaculation Goes South

September 1, 2018

Andrew Siegel MD   9/1/2018

Ejaculation issues can be bothersome and distressing and sometimes even relationship-threatening. Most men do not particularly care for meager, weak-intensity ejaculation and orgasm, or if the process occurs too rapidly, or too slowly, or not at all. Functioning sexually—the ability to achieve a reasonable erection, ejaculate, climax and satisfy one’s partner—retains its importance no matter what our age.

Penis art

Artwork above is photo taken of drawing in Icelandic Phallological Museum in Reykjavik

 

The word ejaculation (from ex, meaning “out” and jaculari, meaning “to throw, shoot, hurl, cast”) is defined as the discharge of semen from the urethral channel, usually accompanied by orgasm.

A Few Words on the Science of Ejaculation

Nerve input from the brain and the penis is integrated in the spinal ejaculatory center. Ejaculation occurs after sufficient intensity and duration of sexual stimulation passes an “ejaculatory” threshold—the “point of no return.”  The phases of ejaculation are emission and expulsion.  Emission releases pooled reproductive gland secretions into the urethra and expulsion propels these secretions via rhythmic contractions of the pelvic floor muscles.

The spinal ejaculatory center is controlled mainly by the neurotransmitters serotonin and dopamine. Serotonin inhibits ejaculation whereas dopamine facilitates it. One’s balance of these neurotransmitters is determined by genetics and other factors including age, stress, illness, medications, etc.

The processes of obtaining a rigid erection and ejaculating are separate, even though they typically occur at the same time. When the two processes harmonize, ejaculation is more satisfying.  This is so because the urethra functions as the “barrel” of the penile “rifle,” surrounded by spongy erectile tissue that constricts and pressurizes the “barrel” to optimize ejaculation and promote the forceful expulsion of semen.

Fact: It is possible to have a rock-hard erection and be unable to ejaculate, and conversely, to be able to ejaculate with a flaccid penis.

The pelvic floor muscles play a key role in ejaculation. The bulbocavernosus muscle engages when one has an erection and becomes maximally active at time of ejaculation. It is a compressor muscle that surrounds the spongy erectile tissue that envelops the urethra and contracts rhythmically at the time of ejaculation, sending wave-like pulsations rippling down the urethra to forcibly propel the semen, providing the power behind ejaculation.

Ejaculation Problems

Although premature ejaculation is often a problem of younger men, many of the other ejaculation issues correlate with aging, weight gain, the presence of prostate symptoms and erectile dysfunction. As we age, there is a decline of sensory nerve function, weakening of pelvic floor muscles, and diminished fluid production by the reproductive glands. Furthermore, medications and surgery that are used to treat prostate issues can profoundly affect ejaculation.

“It happens too fast”

Premature ejaculation (PE) is a condition in which sexual climax occurs before, upon, or shortly after vaginal penetration, prior to one’s desire to do so, with minimal voluntary control. It is the most common form of ejaculatory dysfunction. It often happens in less than one minute and leads to dissatisfaction, distress and frustration of the sufferer and his partner.

In a study of over 1500 men, The Journal of Sexual Medicine reported that the average time between penetration and ejaculation for a premature ejaculator was 1.8 minutes, compared to 7.3 minutes for non-premature ejaculators.

PE can be psychological and/or physical and can occur because of over-sensitive genital skin, hyperactive reflexes, extreme arousal or infrequent sexual activity. Other factors are genetics, guilt, fear, performance anxiety, inflammation and/or infection of the prostate or urethra, and can be related to the use of alcohol or other substances. It is very typical among men during their earliest sexual experiences.

PE can be lifelong or acquired and sometimes occurs on a situational basis. Lifelong PE is thought to have a strong biological component. Acquired PE can be biological, based on inflammation/infection of the reproductive tract or psychological, based upon situational stressors. PE can sometimes be related to erectile dysfunction, with the rapid ejaculation brought on by the desire to climax before losing the erection.

A variety of measures can be used to overcome PE. Slowing the tempo requires one to develop awareness of the sensation immediately before ejaculation. By slowing the pace of pelvic thrusting and varying the angle and depth of penetration before the “point of no return” is reached, the feeling of imminent ejaculation can dissipate. If slowing the tempo is not sufficient to prevent the PE, one may need to pause and stop thrusting so that the ejaculatory “urgency” goes away. Once the sensation subsides, thrusting is resumed. The squeeze technique, originated by Masters and Johnson, consists of withdrawal before ejaculation, squeezing the penile head until the feeling of ejaculation passes, after which intercourse is resumed. Although effective, it requires interruption and a cooperative partner. Pelvic floor muscle contractions are a less cumbersome alternative to the squeeze technique. Thrusting is paused temporarily and a sustained pelvic muscle contraction is performed, essentially an internal “squeeze” (without the external hand squeeze) that short-circuits the PE.

Other methods include using thick condoms to decrease sensitivity, or alternatively, topical local anesthetics can be applied to the penis before intercourse. Another desensitization technique is more frequent ejaculation, since PE tends to be more pronounced after longer periods of sexual abstinence. Pre-emptive masturbation prior to engaging in sexual intercourse may help achieve this. Erectile dysfunction medications can be helpful for acquired PE that is due to erectile dysfunction and certainly can help achieve a second erection after climax. Selective serotonin re-uptake inhibitors, commonly used for depression, anxiety, etc., have a side effect of substantially delaying ejaculation and are often used effectively for PE.

“It takes too long”

Delayed ejaculation (DE) is a condition in which ejaculation occurs only after a prolonged time following penetration. Some men are unable to ejaculate at all, despite having a rigid and durable erection.

DE can be problematic for both the delayed ejaculator and his partner, resulting in frustration, exhaustion, and soreness and pain for both partners. The sexual partner often feels distress and responsibility because of the implication that the problem may be their fault and that they are inadequate in terms of attractiveness or enabling a climax. The combination of not being able to achieve sexual “closure,” the inability to enjoy the mutual intimacy of ejaculation, and denying the partner the gratification of knowing that they can bring their man to climax is a perfect storm for a stressful relationship. As tempting as it is to think that DE is an asset in terms of pleasing your partner, a “marathon” performance has major shortcomings.

Interestingly, some men with this condition can ejaculate in an appropriate amount of time with masturbation. As well, some men can ejaculate in a normal time frame with manual or oral stimulation from their partner although they cannot do so with vaginal sexual intercourse.

Underlying medical conditions can factor in: hypothyroidism is strongly associated with delayed ejaculation, whereas hyperthyroidism is associated with premature ejaculation. Since serotonin and dopamine as well as other hormones and chemicals are involved with ejaculatory control, any drug that modifies their levels may affect ejaculation timing. As stated previously, selective serotonin re-uptake inhibitors delay can substantially delay or prevent ejaculation in a man without pre-existing ejaculation issues. Various neurological conditions that disrupt the communication between the spinal ejaculatory center and the brain/penis can also cause this type of ejaculatory dysfunction.

Fact: As with so many sexual dysfunctions, excessive focus on the problem instead of allowing oneself to be “in the moment” can create a self-fulfilling prophecy of failure.  In other words, if one goes into a sexual situation mentally dwelling and consumed with the problem, it is likely that this may spur on the problem. This goes for both premature and delayed ejaculation.

One solution is to avoid ejaculation for several days prior to intercourse, the same line of reasoning used for managing premature ejaculation by masturbating immediately before intercourse. Sexual counseling using sensate focus therapy has proven to be of benefit to some patients with DE.

“Ejaculation doesn’t happen”

Absent ejaculation happens with surgical removal of the male reproductive organs, as occurs with radical prostatectomy and radical cystectomy for prostate and bladder cancer, respectively. It can also occur in the presence of neurological disorders. In these circumstances, orgasm can still be experienced, although the ejaculation is “dry.”

 “Not much fluid comes out”

Skimpy ejaculatory volume is common with aging, as the reproductive organs “dry out” to some extent. It also occurs with commonly used prostate medications that either reduce reproductive gland secretions or cause the semen to be ejaculated backwards into the urinary bladder, a.k.a.,retrograde ejaculation. Even though ejaculation is backwards, the sensation tends to be unchanged.

“It dribbles out without force or much of a pleasant sensation”

What was once the ability to forcefully ejaculate a substantial volume of semen in an arc several feet in length associated with an intense orgasm gives way to a lackluster experience with a small volume of semen weakly dribbled out of the penis. These issues clearly correlate with aging, weakened pelvic floor muscles and erectile dysfunction.

Ways to Optimize Ejaculation

  • Healthy lifestyleWholesome and nutritious eating habits and maintaining a healthy weight, regular exercise, adequate sleep, alcohol in moderation, avoidance of tobacco, and stress management will help keep all organs and tissues functioning well, including the ejaculatory “apparatus.”
  • Pelvic floor muscle training: Strong pelvic floor muscles under good voluntary control can help control the timing of ejaculation as well as enable powerful contractions to forcibly ejaculate semen. Readers are directed to the Male Pelvic Fitness book that I wrote and the PelvicRx DVD (interactive DVD and digital access) that I co-created as excellent resources for learning how to properly pursue pelvic floor muscle training.  For more detailed and scientific information on the topic of pelvic floor training, please see a review article I wrote for the Gold Journal of Urology: Pelvic floor training in males: Practical applications.

Fact: The “ejaculator” muscle is the bulbocavernosus muscle,  also responsible for expelling the last few drops of urine after emptying your bladder.  Many men have both erection/ejaculation issues as well as an after-dribble of urination, called post-void dribbling.  Whip the bulbocavernosus into shape and you can improve all functions of the muscle. Note in image below (from 1909 Gray’s Anatomy, public domain) how this muscle surrounds the deep, inner part of the channel that conducts urine and semen.  When strengthened, this muscle will be you BFF in the bedroom!

Bulbospongiosus-Male

Ejaculator muscle (in red)

  • Breathe deeply and slowly: During sexual activity there is a tendency for shallow and rapid breathing or breath holding because of excitement and increasing sexual tension. Depth and rhythm of breathing can affect ejaculation with deep, full breaths optimal.
  • Stay sexually active: All body parts need to be used on a regular basis, including our reproductive organs. Keep the erectile and ejaculatory muscles fit by using them as nature intended.

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

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