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5 Things Every Woman Should Know About Her Man’s Pelvic Health

November 28, 2015

Andrew Siegel MD   11/28/15

4910841630_d096720d0d_o (1)

(Attribution: Pier-Luc Bergeron, A happy couple and a happy photographer; no changes made, https://www.flickr.com/photos/burgtender/4910841630)

Since this is Thanksgiving weekend and a broadly celebrated family holiday, I cannot think of a better time to blog about how wives/girlfriends/partners can help empower their men’s pelvic health.

  1. His Erections
  2. Prostate Cancer
  3. Bleeding
  4. Testes Lumps/Bumps
  5. Urinary Woes

 

Erectile Dysfunction: A “Canary in the Trousers”

If his erections are absent or lacking in rigidity or sustainability, it may just be the “tip of the iceberg,” indicative of more serious underlying medical problems. The quality of his erections can be a barometer of his cardiovascular health. Since penile arteries are tiny (diameter of 1-2 millimeters) and heart arteries larger (4 millimeters), it stands to reason that if vascular disease is affecting the penile arteries, it may affect the coronary arteries as well—if not now, then perhaps soon in the future. Since fatty plaque deposits in arteries compromise blood flow to smaller blood vessels before they do so to larger arteries, erectile dysfunction may be considered a genital “stress test.”

Bottom Line: If your man is not functioning well in the bedroom, think strongly about getting him checked for cardiovascular disease. His limp penis just may be the clue to an underlying more pervasive and serious problem.

Prostate Cancer

One in seven American men will develop prostate cancer in their lifetimes and most have no symptoms whatsoever, the diagnosis made via a biopsy because of an elevated or accelerated PSA (Prostate Specific Antigen) blood test and/or an abnormal rectal exam that reveals an asymmetry or lump. Similar to high blood pressure and glaucoma, prostate cancer causes no symptoms in its earliest phases and needs to be actively sought after.

With annual PSA testing, he can expect a small increase each year correlating with prostate growth. A PSA acceleration by more than a small increment is a “red flag.” The digital exam is simply the placement of a gloved, lubricated finger in the rectum to feel the size, contour and consistency of the prostate gland, seeking hardness, lumps or asymmetry that can be a clue to prostate cancer. It is not unlike the female  pelvic exam.

Bottom Line:  As breast cancer is actively screened for with physical examination and mammography, so prostate cancer should be screened for with PSA and digital rectal exam. In the event that prostate cancer is diagnosed, it is a treatable and curable cancer. Not all prostate cancers demand treatment as those with favorable features can be followed carefully, but for other men, treatment can be lifesaving.

Bleeding

Blood in the urine can be visible or only show up on dipstick or microscopic exam of the urine. Blood in the urine should also be thought of as a “red flag” that mandates an evaluation to rule out serious causes including cancers of the kidney and bladder. However, there are many causes of blood in the urine not indicative of a serious problem, including stones, urinary infections and prostate enlargement.

Blood in the semen is not uncommonly encountered in men and usually results from a benign inflammatory process that is usually self-limited, resolving within several weeks. It is rarely indicative of a serious underlying disorder, as frightening as it is to see blood in the ejaculate. Nonetheless, it should be checked out, particularly if it does not resolve.

Bottom Line: If blood is present when there should be none—including visible blood in the urine, blood stains on his undershorts or blood apparent under the microscope—it should not be ignored, but should be evaluated. If after having sex with your partner you notice a bloody vaginal discharge and you are not menstruating, consider that it might be his issue and make sure that he gets followed up.

Testes Lumps and Bumps

Most lumps and bumps of the testes are benign and not problematic. Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20s, striking men at the peak of life. The excellent news is that it is very treatable, especially so when picked up in its earliest stages, when it is commonly curable.

A testicular exam is a simple task that can be lifesaving. One of the great advantages of having his gonads located in such an accessible locale—conveniently “gift wrapped” in the scrotal satchel—is that it makes them so easy to examine. This is as opposed to your ovaries, which are internal and not amenable to ready inspection. This explains why early testes cancer diagnosis is a cinch as opposed to ovarian cancer, which most often presents at an advanced stage. In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle. It most often does not cause pain, so his absence of pain should not dissuade him from getting an abnormality looked into.

Your guy should be doing a careful exam of his testes every few weeks or so in the shower, with the warm and soapy conditions beneficial to an exam. If your man is a stoic kind of guy who is not likely to examine himself, consider taking matters into your own hands—literally: At a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.

Bottom Line: Have the “cajones” to check his cajones. Because sperm production requires that his testes are kept cooler than core temperature, nature has conveniently designed mankind with his testicles dangling from his mid-section. There are no organs in the body—save your breasts—that are more external and easily accessible. If your man is not willing to do self-exams, at a moment of intimacy do a “stealth” exam under the guise of affection—it just might be lifesaving.

Urinary Woes

Most organs shrink with the aging process. However, his nose, ears, scrotum and prostate are the exceptions, enlarging as he ages. Unfortunately, the prostate is wrapped precariously around the urinary channel and as it enlarges it can constrict the flow of urine and can cause a host of symptoms. These include a weaker stream that hesitates to start, takes longer to empty, starts and stops and gives him the feeling that he has not emptied completely. He might notice that he urinates more often, gets up several times at night to empty his bladder and when he has to urinate it comes on with much greater urgency than it used to. He might be waking you up at night because of his frequent trips to the bathroom. Almost universal with aging is post-void dribbling, an annoying after-dribble.

Bottom Line: It is normal for him to experience some of these urinary symptoms as he ages. However, if he is getting up frequently at night, dribbling on the floor by the toilet, or has symptoms that annoy him and interfere with his quality of life, it is time to consider having him looked at by your friendly urologist to ensure that the symptoms are due to benign prostate enlargement and not other causes, to make sure that no harm has been done to the urinary tract and to offer treatment options.

Wishing you the best of health and a wonderful Thanksgiving weekend,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

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Is There A Better Way To Manage Erectile Dysfunction Than “Doping”?

October 3, 2015

Andrew Siegel, MD    10/3/15

IMG_1457(1)

(My patient Ben Blank, a talented artist and cartoonist, gave me the cartoon shown above in 1998 when Viagra first became available.  It is hanging in one of my exam rooms)

Erectile dysfunction is usually caused by a combination of many factors, including lifestyle, medical issues, medications, impaired blood flow, nerve damage, pelvic muscle weakness, stress and psychological conditions.

Managing any medical problem should employ a sensible strategy trying the simplest, safest, and least expensive alternatives first. If unsuccessful, more aggressive, complicated and invasive options can be entertained.

For example, when a patient presents with arthritis, he or she is not offered a total knee replacement from the get-go (at least I hope not!). In accordance with the aforementioned strategy, managing knee arthritis should start with rest and anti-inflammatory medications and proceed, if necessary, down the pathway of exercise/physical therapy, arthroscopy, endoscopic knee surgery, and ultimately if all else fails, under the proper circumstances, to prosthetic joint replacement.

A Sensible and Practical Approach To Erectile Dysfunction

A similar approach should be applied to managing erectile dysfunction. Unfortunately, however, many patients and physicians alike seek the “quick fix” and ignore many treatments that can help prevent or reverse the condition.

I like to adhere to the following principles to manage sexual dysfunction:

  1. Provide education (verbal and in writing) so informed decisions can be made.
  2. Try simple and conservative solutions before complex and aggressive ones.
  3. If it isn’t broken, don’t fix it: “First do no harm.”
  4. Healthy lifestyle is crucial: “Genes load the gun, but lifestyle pulls the trigger.” Lifestyle improvement measures are of paramount importance.

“Doping” is common among athletes, who use illicit drugs to enhance their athletic performance. In my urology practice, many of my patients “dope”—with legal drugs—in an effort to improve their sexual performance. Is there not a better and more natural way than starting with performance-enhancing drugs from the get-go?

Don’t get me wrong, the oral meds for ED (Viagra, Levitra, Cialis and Stendra) are “revolutionary” additions to the limited resources we once had to treat ED. Although far from perfect—expensive, contraindicated with certain cardiac conditions and for those on nitrate medications, associated with some annoying side effects, and not effective in everyone—nonetheless, for many men they are highly effective in creating a “penetrable” erection.

These drugs are commonly used as the first-line approach to ED. As useful as they are, I contend that “doping” should not be first-line treatment, but should be reserved for situations in which the simple and natural first-line interventions fail to work.

Since erections are nerve/blood vessel/erectile smooth muscle/pelvic skeletal muscle events, optimizing erection capability involves doing what you can to have healthy nerves, blood vessels and muscles. How does one keep their tissues and organs healthy? The first-line approach is commonsense—getting in the best physical (and emotional) shape possible. This might mean a lifestyle makeover to get down to “fighting” weight, adopting a heart-healthy (and penis-healthy diet), exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—measures that will improve all aspects of health in general and blood vessel health in particular.

Focused pelvic floor muscle exercises improve the strength and endurance of the male “rigidity” muscles that surround the deep roots of the penis.

Since intact and functioning nerves are fundamental to the erectile process, activation of the nerves via penile vibratory stimulation can be an effective means of resurrecting erectile function.

The vacuum suction device—a.k.a., the penis pump—is a means of drawing blood into the penis to obtain an erection and enable penetration.

Second-line treatments are the well-established oral medications for ED. Although Viagra, Levitra, Cialis and Stendra all have the same mechanism of action, there are nuanced differences in potency, time to onset, duration of action, side effects, etc., so it may take some trial and error to find out which works best for you. Cialis uniquely is approved for both ED and prostate issues, so can be an excellent choice if you have both sexual and urinary issues.

Third-line alternatives include urethral suppositories and penile injection therapy. Suppositories are absorbable pellets that are placed in the urethra that act to increase penile blood flow. Injections do the same, but are injected directly into the penile erectile chambers.

Fourth-line treatment is the prosthetic penile implant. One variety is a semi-rigid non-inflatable device and another is a hydraulic inflatable device. They are implanted surgically within the erectile chambers and can be deployed on demand to enable sexual intercourse. For the right man, under the right circumstances, the penile implant is a life changer—as magical as a total knee replacement can be—converting a penile “cripple” into a functional male. However, it is vital to understand that the implant is a fourth-line approach, and less invasive options should be exhausted before its consideration.

Bottom Line: Sadly, our medical culture and patient population often prefer the quick fix of medications or surgery rather than the slow fix of lifestyle measures. A sensible approach to most medical issues—including ED—should be the following:

  • Get educated about all treatment options.
  • Explore the simplest, safest, and least expensive alternatives first.
  • Before considering medications to improve performance, think about committing to a healthy lifestyle and getting into optimal physical shape, including exercising the rigidity muscles of the penis and using vibratory nerve stimulation.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

What’s Your Favorite Nerve?…How ‘Bout The Pudendal?

September 26, 2015

Andrew Siegel MD   9/26/15

13357-vintage-illustration-of-the-human-nervous-system-pv

(Image above is public domain illustration of the human nervous system)

We all have favorite colors (I’m partial to blue and green) and numbers (3 does it for me), but favorite nerves? Who has a favorite nerve? I submit that you have a favorite nerve, but just don’t know it!

There are many nerves within the human body and there are quite a few of vital importance. They do their jobs quietly, diligently, efficiently, behind the scenes. They are usually taken for granted and most of us have no awareness of them unless their function becomes impaired–as might happen when they become inflamed, traumatized, injured or diseased–giving rise to a host of neurological symptoms.

The system of nerves is essentially a massive network of “wires” that conduct and transmit electro-chemical impulses from the brain and spinal cord to and from every cell in the body. In order for nerves to work effectively, they need some “breathing room” so that they can function unimpeded.

We often become aware of our nerves when they are compressed, temporarily altering their function and giving rise to numbness, pins and needles sensation, etc. It happens to me when I sleep with my arms folded across my chest (ulnal nerve compression from arm flexion) causing me to wake up with a funny sensation involving the outside of my hand and pinky finger and the outer part of the ring finger. It occurs when I go out on a long bike ride, causing a tingly sensation in my right hand (ulnal and radial nerve compression from wrist hyperextension), despite wearing padded gloves. Similarly, I experience genital numbness (pudendal nerve compression from the bike seat), even though I wear padded bike shorts and have a fitted saddle. It also tends to happen when I sit for a lengthy period of time on the “porcelain throne” engaged with reading material, causing my lower legs and feet to “go to sleep” (sciatic nerve compression). Driving for a long period of time also irritates my sciatic nerve, causing an achy sensation in my butt, which runs down the back of my thigh, a good reason to periodically stretch out.

So What Is Your Favorite Nerve?

The cranial nerves are good candidates—those that derive directly from the brain and are responsible for sight, hearing, smell, balance, swallowing, smiling, etc. Most every medical school learns the following cranial nerve mnemonic: On Old Olympus Towering Tops, A Fin And German Viewed Some Hops— the first letter of each word representing the first letter of the 12 cranial nerves: Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory Vestibular Nerve, Glossopharyngeal, Vagus, Spinal Accessory, Hypoglossal. The 31 spinal nerves are certainly contenders as well—they originate directly from the spinal cord and provide sensation and the ability to use our muscles, indisputably key functions.

How About The Pudendal Nerve?

The pudendal nerve should be considered one of our dearest and fondest. It is the main nerve of the perineum—that valuable, but often unappreciated bit of human real estate located between the scrotum and the anus in the male and the vagina and the anus in the female. This nerve provides sensation to the penis and scrotum of the male and the clitoris, vulva and vagina of the female. In both males and females it provides sensation to the perineum and anal area and enables contraction of the pelvic floor muscles and voluntary continence muscles–the external urinary and anal sphincters. Its function is imperative for sexual arousal, clitoral and penile erection, ejaculation and orgasm.

Who Knew? The term pudendal derives from the Latin “pudenda,” meaning “the shameful parts.” Sadly, our culture has strong puritanical roots.

Who Knew? In the early 19th century, Benjamin Alcock, a prominent Irish anatomist, first described the existence of the pudendal nerve and the channel in which it travels, known as “Alcock’s canal.”  Alcock sure is a fitting name for the man who discovered the nerve responsible for penile sensation, ejaculation and orgasm!

The Human Sexual Response

In accordance with Masters and Johnson’s classic findings, the human sexual response can be can be distilled down to increased genital and pelvic blood flow (the primary reaction) and muscle tensioning (the secondary reaction). Orgasm is the release from the state of increased blood flow and tensioned muscles. It is pudendal nerve stimulation that initiates the process of increased genital/pelvic blood and pelvic muscle tensioning. At the time of orgasm the pudendal nerve is what drives the rhythmic contraction of the pelvic floor muscles.

With sexual stimulation of the genitals, sensory nerves that form the pudendal nerve relay to spinal cord centers, which reflexively relay the electrochemical message to increase genital and pelvic blood flow, resulting in female lubrication and clitoral engorgement and male penile erection. The nervous system also relays directly to sexual centers in the brain, including the hypothalamus, hippocampus, amygdala, thalamus, brainstem etc., enhancing this reflex response. Brain-induced erotic stimulation (visual cues, sounds, smells, touch, thoughts, memories, etc.) leads to further genital stimulation via excitatory pathways that descend down from the brain to the genitals.

The bulbo-cavernosus reflex (governed by sensory and motor branches of the pudendal nerve) is important in initiating and maintaining erection: with stimulation of the head of the penis or clitoris,  a reflex contraction of the pelvic floor muscles increases genital blood flow, enhancing penile rigidity and clitoral engorgement.

Bottom Line: Nerves are required for all body functions and some are indispensible. Although there are more important nerves than the pudendal nerve–such as the vagus nerve, which commands unconscious body processes such as heart rate and digestion–the pudendal nerve just might be your favorite! Without a functioning pudendal nerve, your genitals would be numb, sex would be impossible, your pelvic organs would hang unsupported and you would be diapered because of absent bladder and bowel control.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Medical Use of Vibrational Stimulation Devices…And More

September 19, 2015

Andrew Siegel, MD   9/19/15

Dolly's_House_Museum_vibrator

(Image above  is antique vibrator in Dolly’s House Museum in Ketchikan, Alaska. Copied under the terms of the GNU Free Documentation License, Author Wknight94, August 2009)

Vibrators are far more than erotic toys used to enhance female sexual pleasure. Their prevalence of use in the male population is catching up to that of females. It is becoming a more conventional practice for physicians to recommend their use as a component in the management of many forms of sexual dysfunction for both genders.

The origin of vibrational devices dates back to Victorian times, when masturbation was considered to be a deviant behavior, particularly so for women. In the late 1800s, the diagnosis of “female hysteria” was commonly entertained. This was a vague symptom complex consisting of anxiety, insomnia, irritability, fainting, outbursts, excessive sexual desire, etc. It was often managed with pelvic and genital manipulation (“medicinal massage”) by physicians in an effort to bring a patient to “hysterical paroxysm” (a.k.a., orgasm). This typically dramatically relieved the “hysteria” symptoms and this practice of “physician-assisted paroxysm” became entrenched in both European and American medical practice. It proved to be lucrative for physicians and a socially acceptable means of sexual fulfillment for multitudes of women, greatly appreciative of services rendered and readily willing to return for regular office treatments.

The medical community that delivered such treatments often became afflicted with fatigue that developed as a consequence of overuse of their hands. The vibrator was invented as an electro-mechanical medical device to facilitate the treatment of “hysteria” and preserve the cramped and achy fingers of physicians. It was a welcome advance that efficiently brought patients to “hysterical paroxysm,” allowing physicians to treat more patients. With the advent of this device, what sometimes took an hour and was not always successful could be accomplished in a matter of minutes. In 1880, a British physician, Dr. Joseph Mortimer, patented the electric vibrator. It was originally referred to as Granville’s hammer. In 1883, he wrote a book on the subject entitled: “Nerve-Vibration and Excitation as Agents in the Treatment of Functional Disorder and Organic Disease.”

Vibrational devices became popular outside the medical community when electricity became available in American homes. As these devices became commercially available, women began buying them for personal use. In the early 1900s, they were advertised and sold in many popular women’s magazines and catalogs and were eventually called “personal massagers” as a means of to make them more socially acceptable. The era of “physician-assisted paroxysm” came to an abrupt end.

What Goes Around Comes Around

Modern vibrators are battery-powered or plug-in handheld “sexual enrichment aids” that generate vibratory pulsations of a variety of amplitudes and frequencies, intended to enhance sexual stimulation in both females and males. They can be used externally and/or internally to facilitate arousal, sexual pleasure and orgasm. Their popularity has increased markedly over time and they are now readily displayed and sold in mainstream retail outlets.

In the earliest years of vibrational devices, they were used under the domain of the medical community with subsequent use dominated by individuals for recreational use. This has turned full circle, as it has become an increasingly acceptable practice for medical practitioners to recommend vibrational devices as a means of treating sexual dysfunction. Vibrator use is now recognized as a bona fide tool in the armamentarium to help manage both female and male sexual dysfunction, including arousal disorders, erectile dysfunction and difficulty achieving orgasm.

For a number of years, vibrator use in males was predominantly for the spinal cord injured population that desired to father children but could not ejaculate. When a vibrator is applied to the head of the penis of a spinal cord injury patient, it initiates a reflex erection and subsequently ejaculation and thus became an accepted means of gathering semen in order to perform insemination. (It will also do the same for men without spinal cord injuries.)

In recent years, a medical penile vibratory stimulation device specifically designed for male anatomy has become available. The device consists of dual vibrators for the purpose of providing vibration stimulation to both the top and bottom surfaces of the penis. It is prescribed for many forms of male sexual dysfunction, including difficulty obtaining and maintaining an erection, rigidity issues, ejaculatory and orgasmic dysfunction and erectile dysfunction occurring after prostate surgery. It is now being use in conjunction with pelvic floor training prior to prostate surgery in order to help prevent the sexual and urinary side effects that may ensue after prostate removal.

 Female Vibrator Use

A medical study of almost 4000 women showed vibrator use in 53%. With respect to demographics, married women are more apt to partake than single women and their use in lesbian women is more prevalent than heterosexual women and greater in Caucasian women than African-American or Hispanic women. Vibrator use correlates with education level with the more educated using vibrators more commonly than the less educated population. Those who attend religious services more regularly are less likely to be users than those who attend services less regularly.

Vibrators are frequently used in solo as well as partnered sexual activities. 46% of females use vibrators during masturbation, 41% during foreplay or sex play with a partner and 37% during sexual intercourse. Of those females who use vibrators, 84% have used them for clitoral stimulation and 64% for vaginal stimulation. Negative side effects from vibrator use are occasional and mild and include numbness, pain, irritation, inflammation, swelling, and rarely tears or cuts. Women who use vibrators experience more positive sexual function in terms of desire, arousal, lubrication, pain, and orgasm. Vibrator use is correlated with other health promoting behaviors.

Male Vibrator Use

About 50% have used one during their lifetime, 10% within the last month, 15% in the past year and 20% more than one year ago. Women play a pivotal role in driving vibrator use in men: 40% of men have used a vibrator during sexual play or foreplay with a partner, 36% during sexual intercourse and 17% during solo masturbation.

In a survey of 1000 men who were questioned about why they used vibrators, the most common reply was “for fun,” followed by “to spice up my sex life,” “curiosity,” “to help my partner orgasm,” and “upon the request of a sexual partner.” A small percentage of men use vibrators to facilitate their own orgasm.

Men who use vibrators report less sexual dysfunction than non-users, scoring higher on four of five domains of the most common index used for erectile dysfunction (International Index of Erectile Function). Slightly higher proportions of gay and bisexual men use vibrators as opposed to heterosexual men.

Bottom Line: Vibrator use is a healthy, safe and well-established practice that has contributed to sexual enhancement in more than half of American women and often their partners. In both genders, vibrator use correlates positively with healthy sexual functioning and other health-promoting behaviors. Vibrators have found their way into the current medical armamentarium, prescribed by physicians and offering a non-pharmacological option to the management of many forms of sexual dysfunction on both men and women. Their latest utility is in combination with pelvic floor muscle training in men before prostate cancer surgery.

References:

Herbenick D, Reece M, Sanders S, Dodge P, Ghassemi A, Fortenberry D. Prevalence and Characteristics of Vibrator Use by Women in the United States: Results From a Nationally Representative Study, Journal of Sexual Medicine, 2009; 6: 1857-1866

Reece M, Herbenick D, Sanders S, Dodge P, Ghassemi A, Fortenberry D. Prevalence and Characteristics of Vibrator Use by Men in the United States, Journal of Sexual Medicine 2009; 6:1867-1874.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Urinary Infections In Women

September 12, 2015

Andrew Siegel, MD    9/12/2015

shutterstock_femalebluepelvic

Bladder infections (a.k.a., cystitis) are common among women. Acute cystitis is a bladder infection that typically causes the following symptoms: pain/burning, frequent urination, and urinary urgency (“gotta go”). Additional symptoms that may occur are the following: urinating small volumes, bleeding and urinary incontinence (leakage). Microscopic inspection of urine usually shows bacteria, white blood cells and red blood cells.  80-90% of cystitis is caused by Escherichia coli, 5-15% by Staphylococcus and the remainder by less common bacteria including Klebsiella, Proteus, and Enterococcus.

The occasional occurrence of cystitis is a nuisance and oftentimes uncomfortable, but is usually easily treated with a short course of oral antibiotics. When bladder infections recur time and again, it becomes a major source of inconvenience and suffering for the patient and it becomes important to fully investigate the source of the recurrence.

Bladder infections occur when bacteria gain access to the urinary bladder, which normally does not have bacteria present. The short female urethra and the proximity of the urethra to the vagina and anus are factors that predispose to cystitis.

For an infection to develop, the vagina and urethra usually have to be colonized with the type of bacteria that can cause an infection (not the normal healthy bacteria that reside in the vagina), these bacteria must ascend into the bladder, and these bacterial must latch onto bladder cells.

Offense and Defense

Whether or not an infection develops is based upon the interaction of protective mechanisms (“defense”) and bacterial factors (“offense”). “Defense” factors include the following:

  • An acidic vagina, which inhibits the growth of infection-causing bacteria while promoting the growth of “good” bacteria such as lactobacilli
  • The unique layer that protects the bladder lining
  • Immune cells in the urine that prevent bacteria from sticking to the bladder cells
  • The dilution action of urine production and the flushing effect of urinating

Bacterial “offense” factors include in following:

  •  Tentacle-like structures that promote the attachment of bacteria to bladder cells
  • The capability of bacteria to evolve and develop resistance to antibiotics

Bladder Infections in Young Women

Women aged 18-24 years old have the greatest prevalence of bladder infections and sex is usually a key factor, hence the term “honeymoon cystitis.”

The following are risk factors for bladder infections:

  • A new sexual partner
  • Recent sexual intercourse
  • Frequent sexual intercourse
  • Spermicides, diaphragms and spermicide-coated condoms (which can increase vaginal and urethral colonization with E. Coli)

Bladder Infections in Older Women

Cystitis is common after menopause, based upon the following factors:

  • Female hormone (estrogen) deficiency, which causes a change in the bacterial flora of the vagina such that EColi replaces Lactobacilli
  • Age-related decline in immunity
  • Incomplete bladder emptying
  • Urinary and fecal leakage (incontinence), often managed with pads, which remain moist and contaminated and can promote movement of bacteria from the anal area towards the urethra
  • Diabetes (particularly when poorly controlled, with high levels of glucose in the urine that can be thought of as “fertilizer” for bacteria)
  • Neurological diseases that impair emptying or cause incontinence
  • Pelvic organ prolapse
  • Obesity
  • Poor hygiene

Complicated Infections

A urinary infection is considered complicated if:

  • It involves the upper urinary tracts (kidneys)
  • You are pregnant
  • Bacteria are resistant to antibiotics
  • There is a structural abnormality of the urinary tract
  • It occurs in immune-compromised patients including diabetics
  • It occurs in the presence of a foreign body such as a urinary catheter or stone

If It’s Not an Infection, What Is It?

It is important to distinguish a symptomatic urinary infection from asymptomatic bacteriuria, urethritis, vaginitis, and Painful Bladder Syndrome (PBS)/Interstitial Cystitis (IC).

  • Asymptomatic bacteriuria, common in elderly and diabetics, is the presence of bacteria within the bladder without causing an infection. This does not require treatment, which is futile and promotes selection of resistant bacteria. It should be treated only in pregnant women, in patients undergoing urological-gynecological surgical procedures, and in those undergoing prosthetic surgery (total knee replacement, etc.).
  • Urethritis is an infection in the urethra
  • Vaginitis is a vaginal infection
  • PBS/IC is a chronic inflammatory condition of the bladder that can mimic the symptoms of cystitis.

Diagnosis and Treatment

The diagnosis of cystitis is by urinalysis and culture. A urine specimen is obtained after cleansing the vaginal area and collection of a mid-stream specimen. At times, catheterization is necessary to obtain a specimen. Dipstick is the fastest and least expensive means of screening for an infection, but it is not very accurate, whereas microscope exam is much more accurate. The definitive test is urine culture and sensitivity, which will demonstrate the type of bacteria, the quantitative count, and those antibiotics that are most likely to be effective.

Treatment is antibiotics to eradicate the bacteria. In the case of recurrent cystitis, it is important to do an evaluation to rule out a structural cause. This generally involves imaging, often an ultrasound (using sound waves to obtain an image of the urinary tract), and a cystoscopy (a visual inspection of the urethra and bladder with a flexible scope). This will check the entire urinary tract, including the kidneys and bladder. Findings may be a dropped bladder, a stone within the urinary tract, a urethral stricture (a narrowing in the channel leading out of the bladder that causes an obstruction), a urethral diverticulum (a pocket connected to the urethra), or a fistula (abnormal connection between the colon and bladder), etc.

 Antibiotic Options For Those With Recurrent Urinary Infections

  • Patient-initiated treatment: a short course of antibiotics when the symptoms first occur. It is useful to first test your urine using a dipstick (although not perfect, it is great for home screening) when the symptoms of cystitis arise. This has proven to be safe, economical and effective.
  • Sexual prophylaxis: A single dose of antibiotic just before or after sexual activity if the infections are clearly sexually related
  • Daily antibiotic prophylaxis: A single dose of antibiotic is taken on a prophylactic basis every evening or every other evening to prevent recurrent cystitis.

Pearls To Help Keep Cystitis At Bay

  • Stay well hydrated to keep the urine dilute: “The solution to pollution is dilution.”
  • Wipe in a top-to-bottom motion after urination or bowel movementsAt minimum, urinate every four hours while awake to avoid an over-distended bladder.
  • Maintain a healthy weight.
  • Urinate after sex.
  • If infections are clearly sexual related, an antibiotic taken before or right after sex can usually preempt the cystitis.
  • If you are diabetic, maintain the best glucose control possible.
  • Seek urological consultation for recurrent infections to check for an underlying and correctable structural cause.
  • Methenamine: This chemical is broken down into formaldehyde, which can kill bacteria.
  • Cranberry extract: Cranberries contain proanthocyanidins that inhibit bacteria from adhering to the bladder cells. There are formulations of cranberry extract available to avoid the high carbohydrate load of cranberry juice.
  • Probiotics such as Lactobacillus: These bacteria promote healthy colonization of the vagina, production of hydrogen peroxide that is toxic to bacteria, maintenance of acidic urine, induction of an anti-inflammatory response in bladder cells, and inhibition of attachment between bacteria and the bladder cells.
  • D-Mannose: This sugar can inhibit bacteria from adhering to the bladder cells.
  • Estrogen cream: Applied vaginally, this can help restore the normal vaginal flora as well as uro-genital tissue integrity and suppleness.
  • Vaccination: Currently in research phases, the concept is an oral vaccine or vaginal suppository capable of providing immunity against the typical strains of bacteria that cause infections.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Sexuality and Aging: Sex Dies Hard

September 5, 2015

Andrew Siegel, MD   9/5/15

Affectionate old couple with the wife holding on lovingly to the husband's face. Focus on the husband's eyes. Concept: Elderly love.

(Image attribution: Ian MacKenzie—Flickr– licensed under Creative Commons attribution 2.0 generic license)

“Sexy”—“desirable,” “seductive,” “alluring,” “sensual,” “erotic,” etc.—is a term applied primarily to attractive young people. As we age, we are somehow considered less “sexy”; however, at any age sexiness, sexuality and/or sex (call it what you will) is an important part of life for both women and men who desire closeness and intimacy that is often expressed through sexual means.

Many people have negative attitudes, prejudices and discomfort when considering the sexuality of older people, with a prevailing notion that older people should be asexual. Think about how biased and disparaging are the terms “dirty old man” and “cougar,” referring to older men and women, respectively, with healthy libidos. The thought of one’s parents having sex is disturbing and cringe-worthy for many. How about the notion of one’s grandparents sharing an intimate moment? Why is it so disconcerting to imagine the passionate coupling of aging bodies that have lost youthful suppleness? Why are the adjectives that often come to mind regarding elder sex “ugh”, “creepy,” “repulsive,” etc.?

When I asked my 16-year-old daughter to describe her thoughts on her parents having sex, her response was “disgusting.” When asked about her grandparents, she replied “gross.”

Sexuality is so much more than an act of physical pleasure. For men, it is emblematic of potency, virility, fertility, and masculine identity. For women, it represents femininity, desirability and vitality. For both genders, sex is an expression of physical and emotional intimacy, a means of communication and bonding that occurs in the context of skin-to-skin, face-time contact that gives rise to happiness, confidence, self-esteem and quality of life. In addition to sexual health being an important part of overall health, it also provides comfort, security and ritual that permeate positively into many other areas of our existence.

Time is relentless and the years creep by with great momentum until one day you are 50-years-old and you question how this is possible. However, no matter what our chronological age is, our drive, enthusiasm, spirit and need for physical and emotional and intimacy remain largely intact. Understandably, sex in the golden years is not always possible because of medical issues, absence of a partner or declining sexual interest. However, medical progress in the field of human sexuality has made it possible to maintain sexual activity until an advanced age.

Means Of Staying Sexually Active Until Old Age

First-line strategy is lifestyle “management” (healthy eating, maintaining a desirable weight, regular exercise, avoidance of stress, moderate alcohol intake, sufficient sleep, avoidance of tobacco, etc.). Physical interventions include pelvic floor muscle training and vibratory stimulation (useful for both genders) and the vacuum suction device. Pelvic floor muscle training improves the strength and endurance of the pelvic floor muscles—the “rigidity” muscles that surround the roots of the penis and the clitoris—enhancing penile and clitoral erections, pelvic blood flow and optimizing the muscles that engage at the time of orgasm. Vibratory stimulation triggers the reflex between the genitals and the spinal cord, enhancing genital blood flow and inducing contractions of the pelvic floor muscles. By stimulating this reflex and triggering nerve activity in the brain, spinal cord and peripheral nerves, vibratory stimulation is capable of inducing penile and clitoral erections and ejaculation/orgasm. The vacuum suction device—a.k.a., the penis pump—is a means of drawing blood into the penis to obtain an erection and enable sexual intercourse.

There are a host of pharmacological interventions available including hormone therapy–testosterone replacement therapy for men and estrogen replacement therapy for women. There are numerous oral medications for erectile dysfunction (ED) including Viagra, Levitra, Cialis and Stendra. Other alternatives for men with ED include urethral suppositories, penile injections and penile implants. Suppositories are pellets that are placed in the urethra that act to increase penile blood flow. Injections do the same, although they are injected directly into the erectile chambers. Penile implants are semi-rigid non-inflatable or hydraulic inflatable devices that are implanted surgically within the erectile chambers and can be deployed on demand to enable sexual intercourse.

Addyi (Flibanserin) is a new oral medication for diminished libido. It is currently being marketed largely to females, but is purportedly effective for both sexes. FDA approved on August 18, 2015, it is the first prescription for diminished sex drive, a drug that has been referred to as “pink Viagra.”

Despite all of the advances made in the field of sexual dysfunction, cost has become a major issue. On July 1, 2015, Medicare decreed that they would no longer pay for the vacuum suction device. For almost the past decade, Medicare has not covered the oral ED medications. They have become a very expensive commodity, averaging more than $35 per pill! Many private insurance companies are following suit, with little interest in financing the sex lives of those insured. Whether the government and private insurers should or should not underwrite the cost of maintaining sexual function is arguable. Certainly, as important as sex is, there are other health issues that are more pressing. However, no one can deny the importance of a healthy sex life as a means of maintaining wellness and quality of life.

Bottom Line: As one proceeds through life, he or she comes to the realization that their inner spirit and driving force remains intact, even though there are obvious age-related declines in their physical appearance and function. The notion that sexuality loses importance as we age is incorrect and antiquated. The common practice of sexual ageism should be abandoned. Being able to function sexually means so much more than the physical act of bodies coupling. Physical and emotional intimacy is ageless.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Kegel Exercises To PREVENT Pelvic Floor Dysfunction

August 29, 2015

Andrew Siegel MD   8/29/15

shutterstock_v162886

“Prepare and prevent, not repair and repent.”

Restoring function of injured muscles is a well-established principle in sports medicine, orthopedics, plastic surgery and physical medicine and rehabilitation. The premise is simple: a traumatized or injured muscle is treated with rehab and training to accelerate tissue healing and restore working order. Many of the “baby boomers” demographic (age 51-69)—striving to retain their fitness and youth through exercise and “weekend warrior” activities that promote cardiac health but at the same time, musculoskeletal injuries—understand this concept well.

Dr. Arnold Kegel applied this principle to the female pelvic floor muscles to improve muscle strength and function in women after childbirth. Obstetrical “trauma” (9 months of pregnancy, tough labor and delivery of a 9 lb. baby) can cause pelvic floor dysfunction—urinary and bowel control issues, looseness of the vagina and its support tissues with descent of the bladder, uterus and rectum, and altered sexual function.

This principle has also been applied to men with pelvic floor muscle issues to improve urinary, bowel, erectile and ejaculatory health. Obviously, men do not suffer the acute pelvic floor muscle trauma of childbirth that women do, but they can develop pelvic floor muscle dysfunction from aging, weight gain, pelvic surgery (radical prostatectomy, colon surgery, etc.), a sedentary lifestyle, disuse atrophy, participation in saddle sports including cycling, etc.

An Ounce Of Prevention Is Worth A Pound Of Cure

Why not a radically different approach and instead of fixing pelvic floor dysfunction, try to prevent it? Unfortunately, we have a “reactive” oriented medical culture in the USA that does not emphasize prevention, but “repair.”  Another hurdle is that many people prefer having broken things fixed as opposed to making the effort to avoid breaking them in the first place.

So, if obstetrical trauma to the pelvic floor often brings on pelvic floor muscle dysfunction and its urinary, gynecological, bowel and sexual consequences, why not consider starting pelvic floor muscle training well before pregnancy, perhaps at the time of the first gynecological visit? And if aging, surgery and other factors contribute to male pelvic floor muscle dysfunction and its urinary, bowel and sexual consequences, why wait for the system to malfunction? Why not strengthen and tone the pelvic floor muscles when a man is young and healthy to prevent the predictable age-related decline?

Did You Know? The concept of pelvic floor muscle training BEFORE radical prostatectomy for treatment of prostate cancer is rapidly gaining traction and implementation. Instead of waiting to “rehab” the pelvic muscles after the fact, the concept is to “prehab” them. 

Many of us apply wellness principles through regular exercise—aerobic pursuits for cardiovascular health and strength training to maintain muscle tone, integrity and function—so why neglect the pelvic floor? We work out in the gym not only to achieve better fitness, but also to maintain fitness and prevent age-related losses in strength, flexibility, endurance, etc.

Preventive Pelvic Health Paradigm

Why passively accept the seemingly inevitable, when one can be proactive instead of reactive and can address the future problem before it becomes a problem? Why wait until function becomes dysfunction? Whether male or female, the new paradigm is preventive pelvic health. The goal is to avoid, delay, or minimize the decline in pelvic function that accompanies aging and that is accelerated by pelvic muscle trauma and injury, surgery, obesity and disuse atrophy.

Bottom Line: You have the ability to positively influence your health destiny. Instead of being reactive and waiting for your pelvic health to go south, be proactive to ensure your continuing urinary, bowel and sexual 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 muscle program into your exercise regimen. Much like a vaccine, it will help to prevent a disease that you hopefully will never get.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: Available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com.  In the works is The Kegel Fix: Recharging Female Sexual, Pelvic and Urinary Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon.

The Many Moods Of The Penis

August 25, 2015

Andrew Siegel, MD  8/25/15

There was a terchnical problem with the previous uploading of this blog, so I apologize if you have already received it.

phases of moon

(Thank you and credit for image above, which is in original form, created by Rafa Castillo; https://www.flickr.com/photos/rafa_castillo/5935864125)

The penis is a very moody organ–it can be temperamental, volatile, excitable, up and down, unpredictable and hot-headed at times.  Like the moon, it has many phases of existence, with a multitude of different states, ranging from soft as a marshmallow to hard as a rock. Between deflated and rigid, there are an infinite number of intermediate states, dependent on the dynamic balance between the constricting and relaxing mechanisms of the blood flow to the erectile chambers of the penis.  Human sexual response is all about “vasocongestion” a.k.a., blood flow.

When the mechanisms that regulate inflow and outflow are not functioning properly, problems may occur, ranging from absent erections to poor erections to satisfactory erections that do not last, to prolonged erections that do not quit (priapism).

The penis is a marvel of human hydraulic engineering with four recognizable “phases”:

  • Flaccid phase—On a scale of 0-100% inflated, this is 0-10%. The penis is lackluster and droopy, with enough blood flow to maintain tissue oxygenation and nutritional and metabolic demands. Since the penis is an organ of both sexual and urinary function, thankfully the flaccid state still allows its owner to enjoy the advantage of standing to urinate.

ad-70507_1280Did you know? The flaccid penis is incapable of penetration, but is fully capable of being stimulated to ejaculation and orgasm.

  • Tumescent phase—On a scale of 0-100% inflated, this is 10%-75%. The penis is softly swollen and engorged, but not stiff. It is in the process of being inflated, gradually filling and plumping as blood is pumped into and trapped within the erectile chambers. Like a New Year’s Eve party blowout, the toy that when blown unfurls and extends outwards, so does the tumescent penis as it becomes inspired and shows some spirit, lifting somewhat from its dangling position.
  • Penetration capable phaseOn a scale of 0-100% inflated, this is about 75%-80% or so. The penis has become firmer, but not rigid and is competent to penetrate, although it may require some manipulation to do so. It is animated and peppy and starts to elevate a bit more.
  • Rigid phaseOn a scale of 0-100% inflated, this is 90%-100%. The penis is as stiff as if it had a bone within. The rock-hard penis makes penetration effortless. The energetic, eager and confident penis now defies gravity, proudly pointing towards the horizon, if not the heavens, when its owner assumes the standing position.

fuel-40193_1280

Factors That Lead to Penile Inflation

  • Sensual erotic excitement: sight of a beautiful woman; scent of perfume; sexy whisper; taste of a kiss; soft touch
  • Genital touch: direct stimulation
  • Brain induced erotic stimulation: thoughts, memories, fantasies
  • Dreaming: unique brainstem mediated mechanism that occur during REM (rapid eye movement) phase sleep
  • Spontaneous: occurs for a combination of factors or unknown factors
  • Reflex: full bladder
  • Warm environment: hot bath or shower
  • Gravity: standing upright as opposed to lying down (similar to veins in your arm popping out when arm is lower than heart).

Factors That Lead to Penile Deflation

  • Absence of sexual stimulation
  • Medical issues that interfere with hormones, arterial inflow, venous outflow, nerve supply to penis, smooth muscle in erectile chambers, pelvic floor muscles
  • Medications that interfere directly with blood flow or act centrally on the brain
  • Adrenaline-fueled constriction of penile blood vessels: stress hormone released by fear, anxiety, fighting, fleeing, performance anxiety, etc.
  • Cold exposure (cold shower, bath, swimming, etc.–remember George from the “shrinkage” Seinfeld episode?)
  • Exercise: creates a “steal” of blood flow to large muscles that demand it and away from “unessential” organs
  • Cycling: blood vessels, nerves and pelvic muscles take a beating from compression “trauma”

Hard Science

Note: The following is a brief summary of the science of erections, which may be TMI for many, but will help you understand penis magic.

A limp penis is the state when the arteries and smooth muscle within the erectile chambers are in a constricted state. Penile swelling occurs when stimulation results in increased arterial inflow and relaxation of erectile smooth muscle, permitting filling and expansion of the erectile chambers. The magic chemical that governs this is nitric oxide, present within penile nerves and penile blood vessels. Nitric oxide is what makes it all happen.

 Did you know? Nitric oxide is manufactured from arginine, which is why some feel that arginine supplements may be good for the erectile process; however, the jury is not out on this.

With stimulation, nitric oxide is activated and gets into the smooth muscle cells of the penile arteries and erectile smooth muscle of the erectile chambers where it activates GMP (guanosine monophosphate), which causes the smooth muscle to relax and blood to pour in. This smooth muscle relaxation results in penile blood pressure becoming equal with systolic blood pressure and an engorged penis, plump but not rigid.

Once engorgement occurs, rigidity will follow after the pelvic floor muscles engage. There is no bone in the human penis as there is in many mammals, so nature has evolved a clever trick to generate rigidity using highly pressurized blood.

 Is nature brilliant? Pressurize a liquid to obtain almost a solid state. It’s like freezing water to turn it into ice!

To achieve maximal penile rigidity, penile blood pressure must exceed systolic pressure (the top number of your blood pressure) by 100 millimeters of mercury. This means a penile blood pressure above 220 must be achieved for the average man!

 Did you know? The penis is the only place in the body where high blood pressure is desirable and necessary for proper function. A hypertensive penis is an erect penis and a happy penis. This explains why blood pressure pills are the most common medications associated with erection difficulties.

How does one achieve a hypertensive penis? This is where the “rigidity” muscles come into play. In response to penile stimulation, the pelvic floor muscles (ischiocavernosus and bulbocavernosus) that surround the deep roots of the penis contract rhythmically, clamping venous outflow and compressing the deep roots of the penis, pushing more blood into the erect penis, resulting in penile high blood pressure and full-fledged rigidity. Without the rigidity muscles, the penis would be plump at best.

Did you know?  Would you like to see your rigidity muscles in action?  Stand upright when you have an erection and contract your pelvic floor muscles and watch the penis lift up towards the sky…penis magic! 

After ejaculation, an enzyme known as PDE5 (phosphodiesterase type 5) inactivates the GMP, ending the party, as rigidity dwindles to tumescence to flaccidity. Viagra, Cialis, Levitra and Stendra are PDE5 inhibitors that prevent the inactivation of GMP.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: Available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com.  In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon

10 Tips to Keep Your Manhood Manly

August 8, 2015

Andrew Siegel, MD  August 8, 2015

shutterstock_orange gu tract

10 Tips to Keep Your Penis Healthy and Functional

The penis is truly a unique and remarkable organ—one of the only body parts capable of dramatically altering its shape, size, and constitution in nanoseconds. Imagine if our brains or biceps were that responsive, morphing into uber versions of themselves at the appropriate times—like Popeye’s biceps in response to spinach—we would be superheroes!

Trivia: The penis is not the only body part capable of such magic…there is one other organ that when stimulated will change its size fourfold, an even more impressive feat than what the penis is capable of!  Do you have any idea what this organ is?   (Answer at end of blog)

Penis Magic

Under the right circumstances, your penis becomes a proud warrior, a soldier standing tall at attention, saluting, noble, confident and majestic. With enough stimulation, it ferociously spits out DNA, capable of turning eggs into humans. Penis magic!

Your penis should command a great deal of respect–like any unpaired body organ that has no mate to kick in when there is engine failure–including the brain, heart, liver and pancreas. Yet the penis is not an organ that is treated with much respect.  It doesn’t see much light of day or fresh air. It is periodically liberated briefly from its incarceration to allow the bladder to drain or to be cleansed when showering. On occasion it is wrapped up in a suffocating rubber suit and inserted into dark and mysterious places. At other times it is “assaulted” by its owner–wacked, smacked and choked into submission.

Many naively assume that their penis will continue to perform its duties and responsibilities, day after day, year after year. Despite all your penis does for you, most are remiss in providing it sufficient nurture and care.  Without proper attention to its health and well being, it is destined to become less functional with each passing decade. Many chronic conditions are associated with its declining function, including obesity, the metabolic syndrome, diabetes, cardiovascular disease, tobacco use, etc.  What these conditions have in common is a “pro-inflammatory” state that results in dysfunction of the important cells that line blood vessels (endothelial cells), decreased levels of the vital chemical mediator of erections (nitric oxide) and oxidative stress with decreased levels of anti-oxidants and increased levels of free radicals.

The good news is that with some effort, you can maintain healthy functioning until your golden years. Like your car, your penis requires care and preventive maintenance to keep it running trouble-free.  Getting beyond maintenance, you can actually enhance your sexual health and performance, optimizing its function. The following are the top ten means of keeping your penis healthy:

1. Don’t carry extra pounds  

Just as your car suffers a decline in performance if it is dragging around too much of a load, so you penis will function sub-optimally if you are carrying excessive weight. Obesity steals your manhood and reduces male hormone levels. Abdominal fat converts the male hormone testosterone to the female hormone estrogen. Obese men are more likely to have fatty plaque deposits that clog blood vessels, including the arteries to the penis, making it more difficult to obtain and maintain good-quality erections. Additionally, as your belly gets bigger, your penis gets smaller.

2. Use high octane, performance fuel

Put a tiger in your tank with wholesome, natural and real foods that help prevent weight gain and the build-up of harmful plaque deposits within blood vessels. Healthy fuel includes vegetables, fruits, legumes, nuts, whole grains and fish.  Animal products including lean meats and dairy should be eaten in moderation, avoiding processed foods and refined grains. The Mediterranean-style diet is an excellent one for minimizing both sexual dysfunction and heart disease. Poor fuel choices include calorie-laden and nutritionally empty processed and fast foods, which often lead to clogged arteries and poor erections.

3. Minimize stress

Stress and anxiety cause the release of the hormones adrenaline and cortisol. Being nervous causes adrenaline-fueled performance anxiety on the basis of adrenaline constricting blood vessels, which negatively impacts erections. Excessive cortisol secretion drives one’s appetite, causing the accumulation of belly fat.

4. Eliminate toxins, particularly tobacco

You don’t want to put toxins in your tank. In addition to causing cancer, chemicals in tobacco narrow blood vessels, impair blood flow, decrease the supply of oxygen and promote inflammation, compromising every organ in your body, the penis being no exception.

5. Minimize toxins such as alcohol

In small amounts, alcohol can alleviate anxiety and act as a vasodilator (increasing blood flow) and can actually improve sexual function, but in large amounts it can be a major risk factor for erectile dysfunction.

6. Give it a rest

Too much time on the road without sufficient rest is not good for your body or your car. Both you and your vehicle require garage time. Ample sleep serves a vitally important restorative function. Sleep deprivation causes a disruption in endocrine, metabolic, and immune function, resulting in decreased levels of leptin (appetite suppressant), increased ghrelin levels (appetite stimulant), increased cortisol, and increased glucose levels (higher amounts of sugar in the bloodstream). If you are exhausted, your penis is going to be weary as well.

7. Hit the road regularly

Take that vehicle out for a nice ride on a regular basis. Use your body as it was meant to. Exercise has a remarkably positive effect on sexual function, in addition to reducing stress, improving mood, preventing fatigue, and increasing energy. It reduces risk for diabetes, heart disease, stroke, high blood pressure, some cancers, osteoporosis, chronic medical problems, and physical disability. Exercise makes the heart a better and stronger pump, the blood vessels more elastic, and the muscles more efficient at extracting oxygen. Exercises that work out the muscles involved in sex—the core muscles, the external rotators of the hip, and the all-important pelvic floor muscles—will improve bedroom performance.

The pelvic floor muscles play a vital role with erections and ejaculation. When you are sexually stimulated, the pelvic floor muscles activate to maintain penile rigidity and a skyward angling erection. These muscles are not only responsible for getting the stimulated penis from a tumescent state (plump with blood) to a bone-like rigid state, but also for maintaining that rigid state and for being the “motor” of ejaculation.

8. Stay active

Use it or lose it. You can help keep your penis in good shape by using it regularly as nature intended it to be used. Studies have clearly demonstrated that men who are more active sexually tend to have fewer problems with erections as they age.

9. Maintain healthy relationships

It takes two to tango, so relationship harmony factors strongly into good sexual functioning just as discord and interpersonal issues can profoundly contribute to sexual issues. The mind-body connection is of immense importance to sexual function.

10.  Preventive maintenance

 You bring your vehicle in regularly for oil and filter changes, tire rotations, and other means of preventing trouble, so do the same for your body with regular visits to your doctor to perform whatever tests are necessary to preempt issues before they become problematic. If you are having problems with your favorite organ, it is time to consult your friendly urologist.

Bottom Line: The Golden Rule of the Penis: “Do unto your penis as you would have your penis do unto you.”…In other words, treat your penis kindly and it will return the favor; treat your penis poorly and it will rebel.  First-line therapy for erectile dysfunction is lifestyle changes and a proactive approach will keep you functioning smoothly for many years.  

Q. What organ in the body when stimulated will change its size fourfold?

 A. The pupil of the eye will dilate from 2 millimeters in diameter in bright light to 8 millimeters in dark, as governed by the iris.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: Available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com.  In the works is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon

A Lemon A Day Keeps The Urologist Away

July 25, 2015

Andrew Siegel MD  July 25, 2015

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The Northeast USA has recently experienced oppressively hot weather –sizzling, steaming, scorching, sultry hot. This extreme weather has the same significance to urologist as a frigid and icy winter to an orthopedist–a harbinger of busier office hours. Ice drives patients with fractures in to see their bone specialists, but heat drives patients with kidney stones in to see their urologists. Summer is the “high season” for kidney stones, often brought on by dehydration from the stifling heat. The hotter the temperature, the greater the prevalence of kidney stones. To help prevent this very common and extremely painful condition, it is important to stay well hydrated by drinking lots of fluids. A sign of good hydration is dilute-appearing urine, which looks more like lemonade as opposed to apple cider, or for the beer drinkers, light American beer versus a rich, dark European brew. Lemons, being citrus fruits, contain citrate in high concentration, a well-known inhibitor of kidney stones.

I’m puzzled why the word “lemon”—representing such a lovely fruit—is often used with negative connotations, referring to a poorly functioning car or a challenging situation that can be overcome, turning “lemon into lemonade.” I suppose it’s because of its natural tartness. But au contraire, the lemon is a citrus superstar that is appealing to all of the senses…to the eyes with its vibrant sunshine color and oval shape, to the nose with its distinctive citrus aroma and to the sense of touch with its firm, textured outer peel and juicy, segmented inner flesh and to the sense of taste, with its unique tart and acidic flavor.

Lemons are low calorie nutritional powerhouses.  In addition to citrate, lemons contain fiber, potassium, copper, calcium, flavonoids, B vitamins, folate and other phytochemicals. Lemons are packed with Vitamin C, a formidable anti-oxidant that helps slow oxidative damage that occurs via the accumulation of byproducts of metabolism and damage from environmental toxins. This accumulation is called reactive oxygen species (also known as free radicals) and contributes to diseases, aging and ultimately death.

Squeeze one-quarter or one-half of a fresh lemon into water or seltzer on the rocks for a refreshing, extremely low-calorie, delicious drink that is so much better for you than sweetened beverages such as sodas, fruit juices and sports drinks. This serves as a powerful tonic for preventing kidney stones. Urologists often prescribe medications containing citrate to help prevent stones, but why not try the natural, first-line approach at ramping up levels of citrate before trying the pharmaceutical approach?

In addition to being an awesome fruit that is great squeezed into a drink, lemon juice is wonderful on fish, in chicken dishes and in salad dressings. Lemons are often used as an ingredient for aromatherapy and in cleansing products as well. If you have ever visited Italy, particularly the Amalfi Coast region, you probably recall an abundance of citrus groves and a lemon-based liqueur called Limoncello available everywhere.

Bottom Line: If an apple a day keeps the doctor away, then a lemon a day keeps the urologist away! 

Wishing you the best of health,

2014-04-23 20:16:29

AndrewSiegelMD.com

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