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

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

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

 

 

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“Preventive” Kegels: A Cutting-Edged Concept

August 25, 2018

Andrew Siegel MD  8/25/18

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

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

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

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

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

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

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

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

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

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

Shockwave Therapy for Erectile Dysfunction: New and Exciting

August 18, 2018

Andrew Siegel MD  8/18/2018

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

 

Picture1

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

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

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

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

 

Understanding Female Sexual Fluids

August 11, 2018

Andrew Siegel MD  8/11/2018

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

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

Skenes_gland-svenska.jpg

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

 

Vaginal secretions

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

Skene gland secretions…the female “prostate”

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

Bartholin gland secretions…the female “bulbourethral” glands

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

Bladder and urethra

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

Cover

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

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

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

 

Thankful for Tough Tissues: Big Head/ Little Head

August 4, 2018

Andrew Siegel MD   8/4/2018

Midas penis in cage

Image above from Phallological Museum in Reyjkavik that I recently visited

 

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

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

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

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

The White Membrane

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

Acute Trauma to the White Membrane

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

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

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

Chronic Trauma to the White Membrane

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

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

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

July 28, 2018

Andrew Siegel MD  7/28/2018

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

 

elvie

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

 

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

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

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

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

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

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

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

Do you really need to use a resistance device? 

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

Which resistance device will work best for you?

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

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

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

 

 

 

 

 

 

Female Pelvic Floor Muscle Resistance Training

July 21, 2018

Andrew Siegel MD   7/21/2018

30D6603200000578-3429696-image-m-59_1454495206349-678x381

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

 

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

–JV Luck, Air Surgeon’s Bulletin, 1945

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

–Mark Peterson, PhD

Resistance

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

Applying resistance training to the pelvic floor muscles

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

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

PFMT resistance tools

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

Vaginal Weights

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

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

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

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

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

Electro-Stimulation Devices

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

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

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

Simple PFMT Resistance Devices

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

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

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

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

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

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

Cover

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

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

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

 

Male Fountain of Youth in a Pill

July 14, 2018

Andrew Siegel MD 7/14/2018

fountain-of-youth-sign-st-augustine

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

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

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

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

Prostate Cancer Prevention Trial

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

This trial was based on two facts:

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

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

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

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

proscar-tablet.jpg

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

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

 IMG_7168

 

IMG_7169 

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

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

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

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

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

 

 

 

5 Reasons Your Penis May Be Shrinking

July 7, 2018

Andrew Siegel MD   7/7/18

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

 sculpture emasculated Reykjavik

Above photo I recently shot in Reykjavik, Iceland

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

What’s normal?

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

Who cares?

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

5 Reasons for a Shrunken Penis

  1. Weight gain: Big pannus/small penis

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

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

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

  1. Disuse atrophy: Use it or lose it

Like any other organ in the body, the penis needs to be used on a regular basis, as nature intended.  If one goes too long without an erection, collagen, smooth muscle, elastin and other erectile tissues may become compromised, resulting in a loss of penile length and girth and limiting one’s ability to achieve an erection. In a vicious cycle, loss of sexual function can lead to further progression of the problem as poor genital blood flow causes low oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the problem.

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

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

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

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

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

  1. Pelvic surgery

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

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

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

  1. Anti-testosterone treatment

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

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

Wishing you the best of health!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

Ladies, If You Leak When You Exercise

June 30, 2018

Andrew Siegel MD  6/30/18

Exercise is of vital importance to physical and psychological health, reduces risk for diabetes, cardiovascular disease and cancer, is a great stress reducer and improves muscle strength, endurance, coordination and balance. It is an important factor in maintaining a healthy weight, decreasing body fat, increasing longevity and decreasing mortality. All good!girl-woman-sport-photographer-train-recreation-1165198-pxhere.com (1).jpg

image above, Creative Commons

Urinary incontinence is an annoying condition that women experience much more commonly than do men.  One of the main types is leakage with physical activities and exercise, a.k.a. stress urinary incontinence (SUI). When a woman suffers from SUI it often acts as a barrier to exercising because no one wants to be put in the embarrassing and inconvenient situation of wetting themselves every time they jump, bounce or move vigorously. Some women adapt by modifying the types of exercise that they participate in, while others give up completely on exercising, an omission that can contribute to poor physical and psychological health, a greater risk for medical issues, weight gain, etc.

What physical activities cause leakage?

The most common exercises that provoke SUI are high impact, vertical deceleration activities in which there is repeated contact with a hard surface with both feet simultaneously, e.g. skipping, trampoline, jumping jacks, jumping rope, running and jogging.

Other physical activities that commonly provoke SUI are exercises that combine dynamic abdominal and pelvic movements, e.g., burpees, squats, sit ups and weight bearing exercises, e.g., weighted squats, overhead kettle bell swings, etc.  The classic weight lifting style exercises are occasional triggers of SUI.

Activities that cause SUI (in order of those most likely to provoke the SUI)

  1. Skipping
  2. Trampoline
  3. Jumping jacks
  4. Running
  5. Jogging
  6. Box jumps
  7. Burpees
  8. Squats
  9. Sit ups
  10. Weighted squats
  11. Kettle bell swings
  12. Dead lifts
  13. Push ups
  14. Wall balls
  15. Shoulder press
  16. Clean and jerk
  17. Snatch
  18. Bench press
  19. Rowing

 So, what to do?

Many women figure out the means to improve or diminish the problem.  Common sense measures include urinating immediately before exercising and if possible taking washroom breaks during the activity (not always possible and inconvenient).  Even so, most women do not empty the bladder 100%, so if 1-2 ounces remain after emptying, there is still plenty of urine to potentially leak.  Other adaptive measures are fluid restriction (not particularly healthy before vigorous activity, risking dehydration).  Wearing a protective pad or incontinence tampon is certainly a way around the problem (although not ideal).  Another strategy is to modify one’s exercise program, such as reducing the duration, frequency or intensity of the activity.  Avoiding high impact exercises entirely and substituting them with activities that involve less impact is another possibility. However, these are adaptive and coping mechanisms and not real solutions.

There is a better solution

Urologists–particularly those like myself who have expertise in female pelvic medicine–can help manage the condition of stress urinary incontinence.  First line treatment is  Kegel pelvic floor exercises that—when done properly (as they are often not) with the right program—can often significantly improve the situation.

New video on pelvic floor exercises.

If a concerted effort at a Kegel program fails to sufficiently improve the situation, a 30-minute outpatient procedure called a mid-urethral sling is a highly effective means of treating the exercise incontinence.

Bottom Line: Physical activities most likely to induce urinary leakage are high impact exercises including skipping, trampoline, jumping jacks, jump rope and jogging.  Coping mechanisms and adaptive behaviors include fluid restriction (not healthy before exercise), urinating before activities (reasonable), taking breaks from exercise to urinate (inconvenient), pads (ugh), dialing down the intensity of exercising, modifying type of exercise or complete avoidance of exercising (undesirable).  If coping and adaptive behaviors are not effective, consider seeing a urologist who focuses on incontinence.  The goal of treatment is to be able to return to the physical activities that you enjoy without the fear of urinary leakage.   

Excellent resource: Urinary leakage during exercise: problematic activities, adaptive behaviors, and interest in treatment for physically active Canadian women: E Brennand, E Ruiz-Mirazo, S Tang, S Kim-Fine, Int Urogynecol J (2018)29: 497-503

Wishing you the best of health and a happy 4th of July holiday!

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