Posts Tagged ‘adrenaline’

“Butterflies” In Your Penis: What You Need To Know About Performance Anxiety/E.D.

April 14, 2018

Andrew Siegel MD   4/14/18

“It is like a firstborn son—you spend your life working for him, sacrificing everything for him, and at the moment of truth he does just as he pleases.”

Gabriel Garcia Marquez, Love In the Time of Cholera

“The penis does not obey the order of its master, who tries to erect or shrink it at will. Instead, the penis erects freely while its master is asleep. The penis must be said to have its own mind, by any stretch of the imagination.”

Leonardo da Vinci

 

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The brain is the biggest and most important sex organ, the “conductor of the orchestra

( Thank you, Pixabay, for image above)

 

Every man at one time or another may experience a situational erection problem due to  circumstances. As intoxicating and exciting as a new relationship can be, situational erection problems are not uncommonly experienced because of the anxiety and concerns that can surface when encountering a new sexual partner.  Additional contributing factors can be other life stresses, fatigue, too much alcohol consumption, recreational drugs, etc.

Men are human beings and not robots that can always function on command. It is not always easy to “stand and deliver” and, unquestionably, the lion’s share of the sexual “burden” is on the male.  In the circumstance of failure to achieve a good quality erection in a new sexual situation, it is not a matter of insufficient male rocket fuel (testosterone), poor sexual desire,  malfunctioning plumbing or sexual orientation.  It’s all about chemistry and by this I do not mean the attraction and spark kind of chemistry between two individuals.

The brain is the most important sex organ and the mind-body connection is profound. One’s emotional state drives the release of a “cocktail” of chemicals that can make or break their ability to perform any pursuit, whether it is giving a speech, sports or in the bedroom. When it comes to the bedroom, one’s internal “biochemical environment” at any given moment in time can chemically promote a bone-hard erection or, at times, no erection at all.  The problem is not with the hardware, but with the software!

Performance anxiety is nothing other than stage fright—the stage the bedroom—due to emotional stress (whether conscious or subconscious) that causes the release of adrenaline, the “flight or fright” chemical that causes tightening of blood vessels and restriction of blood flow to the penis.

Adrenaline is an amazing chemical to have onboard when you are in precarious situation, such as being chased by a lion in the jungle. It causes your pupils to dilate, blood pressure to rise and pulse and breath to quicken.  This stress hormone that is churned out by the adrenal glands prepares you to confront the danger in a turbo-charged state so that you can react optimally.  However, adrenaline causes a restriction of blood flow to non-vital organs including the penis, so that blood flow can be directed to where it best serves one to deal with the precarious situation. The point is that stress does not belong in the same sentence as sex, and when it does, it is a formula for a losing situation. For some men, the stress of having to wear a condom can doom the erection to failure.

Fact: On the occasion that a man has a prolonged erection (a.k.a. priapism) that lasts for more than four hours, an adrenaline-like drug is injected directly into the erectile chambers of the penis to cause the erection to subside. 

The chemistry of erections and performance anxiety

The chemistry of erections: With erotic stimulation or touch, the erectile nerves release nitric oxide, which in turn causes the release of cGMP. This causes the erectile chamber arteries to expand and blood to gush into the penis and also causes the smooth muscle of the erectile chambers to relax, allowing space for blood to fill the erectile chambers.  The chemistry of defeat: If enough adrenaline is present, the erectile arteries will narrow and the smooth muscle of the erectile chambers will contract. The presence of enough adrenaline trumps the presence of nitric oxide and cGMP.

The psychology of performance anxiety

What goes on in the man’s mind: Performance anxiety often “gets in the head” of the man plagued with it.   Excessively focusing and dwelling on the issue further decreases the likelihood of obtaining a rigid erection by creating a self-fulfilling prophecy of failure. When entering a sexual situation preoccupied with anxiety and doubts, one often ends up being a spectator of his own performance (Masters and Johnson referred to this as “spectatorating”), instead of being in the moment and present as one needs to be to be able to function properly, often dooming one’s erectile potential.

What goes on in the female’s mind: As they say, “It takes two to tango.”  Another big problem is the partner’s interpretation of the man’s inability to obtain and/or maintain an erection. The partner, confronted with the poorly functioning male, commonly thinks—erroneously– that the root of the problem is that the man does not sufficiently care for her,  find her attractive or that her sexual allure and proficiency is lacking.

So, the male not only has performance anxiety, but often experiences secondary anxiety from being consumed by the problem, creating a “vicious cycle.”  And the female now has anxiety and concerns about her looks, her skills in the bedroom, his feelings, the future of the relationship, etc.  This is clearly not a good combination for the start of a healthy relationship!  The truth of the matter is that the root of the problem is neither the man’s plumbing, his sexual orientation, nor his feelings about his partner and it is not a question of the female’s attractiveness, allure or sexual prowess.

Bottom Line: Performance anxiety is a common form of emotional stress that can be experienced with a new sexual partner.  Enter adrenaline in high enough levels and an erection will never occur, or if it does so, will rapidly be lost. Adrenaline may be your friend in life and death situations, but not in the bedroom!  Although oral ED medications (Viagra, Cialis, etc.) can chemically kick-start and often help counter performance anxiety and break the vicious cycle that has been established, adrenaline is such a powerhouse chemical that it can sometimes even doom an erection in a man who has taken performance-enhancing drugs.

The female in the relationship should understand that she is not the cause of the problem and she should not hold herself nor her partner accountable, which serves to further exacerbate the stress and anxiety.  Rather, she should stay calm, be understanding and supportive and realize that once her partner becomes more comfortable with the relationship, the anxiety and the problem will most often magically disappear.

Finally, it is important to understand that other common sexual issues, including premature ejaculation and delayed ejaculation, elicit virtually the identical psychological and emotional responses from both male and female partners as does performance anxiety.

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

 

 

 

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“Doc, My Penis Is Shrinking”

October 8, 2016

Andrew Siegel MD  10/8/16

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Image above: Roman copy of Apollo Delphinios by Demetrius Miletus at the end of the second century (Attribution: Joanbanjo (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons)

Not a day goes by in my urology practice when I fail to hear the following complaint from a patient: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrivel from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis, if you will. Weight gain and obesity cause a generous pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter and retrusive. However, penile length is usually intact, with the penis merely hiding behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. Having a plus-sized figure is not such a good thing when it comes to size matters, as well as many other matters.

Factoid: It is estimated that with every 35 lbs. of weight gain, there is one-inch loss in apparent penile length.

The 9-letter word every man despises: S-H-R-I-N-K-A-G-E, immortalized by Jason Alexander playing the character George in the Seinfeld series. Jerry’s girlfriend Rachel catches a glimpse of naked George after he has stepped out of a swimming pool. Suffice it to say that George’s penis was in a “non-optimized” state. George tries to explain: “Well I just got back from swimming in the pool and the water was cold.” Jerry makes the diagnosis: “Oh, you mean shrinkage” and George confirms: “Yes, significant shrinkage.”

Penis size has not escaped our “bigger is better” American mentality where large cars, homes, breasts,  buttocks and mega-logos on shirts are desirable and sought-after assets. The pervasive pornography industry–where many male stars are “hung like horses”– has given the average guy a bit of an inferiority complex.

Factoid: The reality of the situation is that the average male has an average-sized penis, but in our competitive society, although average is the norm, average curiously has gotten a bad rap.

Adages concerning penile size and function are common, e.g., “It’s not the size of the ship, but the motion of the ocean.” Or even better, as seen on a poster in a gateway while boarding an airplane: “Size should never outrank service.” The messages conveyed by these statements have significant merit, but nonetheless, to many men and women, size plays at least some role and many men have concerns about their size. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort.

Leonardo Da Vinci had an interesting take on perspectives: “Woman’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.”

Penile Stats

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that flaccid length does not necessarily predict erect length and can vary depending upon many factors. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

With all biological parameters—including penis size—there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. Some men are phallically-endowed, some phallically-challenged, with most somewhere in the middle of the road. In a study of 3500 penises published by Alfred Kinsey, average flaccid length was 8.8 centimeters (3.5 inches). Average erect length ranged between 12.9-15 centimeters (5-6 inches). Average circumference of the erect penis was 12.3 centimeters (4.75 inches). As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (and mother).

Factoid: Hung like a horse—forget about it! The blue whale has the mightiest genitals of any animal in the animal kingdom: penis length is 8-10 feet; penis girth is 12-14 inches; ejaculate volume is 4-5 gallons; and testicles are 100-150 pounds. Hung like a whale!

Factoid: “Supersize Me.” In order to make their genitals look larger, the Mambas of New Hebrides wrap their penises in many yards of cloth, making them appear massive in length. The Caramoja tribe of Northern Uganda tie weights on the end of their penises in efforts to elongate them.

“Acute” Shrinkage

Penile size in an individual can be quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” is a real phenomenon provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves blood circulation.

Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s peripheral anatomy to help maintain blood flow and temperature to the vital core. This principle is used when placing ice on an injury, as the vasoconstriction will reduce swelling and inflammation. Similarly, exposure to heat causes vasodilation (expansion of arterial flow), the reason why some penile fullness can occur in a warm shower.

Nervous states and anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in numerous effects, including a flaccid penis. In fact, when the rare patient presents to the emergency room with an erection that will not quit, urologists often must inject an adrenaline-like medication into the penis to bring the erection down.

Hitting it hard in the gym or with any athletic pursuit demands a tremendous increase in blood flow to the parts of the body involved with the effort. There is a “steal” of blood flow away from organs and tissues not involved with the athletics with “shunting” of that blood flow to the organs and tissues with the highest oxygen and nutritional demands, namely the muscles. The penis is one of those organs from which blood is “stolen”—essentially “stealing from Peter to pay Paul” (pun intended!)—rendering the penis into a sad, deflated state. Additionally, the adrenaline release that typically accompanies exercise further shrinks the penis.

Cycling and other saddle sports—including motorcycle, moped, and horseback riding—put intense, prolonged pressure on the perineum (area between scrotum and anus), which is the anatomical location of the penile blood and nerve supply as well as pelvic floor muscles that help support erections and maintain rigidity.  Between the compromise to the penile blood flow and the nerve supply, the direct pressure effect on the pelvic floor muscles, and the steal, there is a perfect storm for a limp, shriveled and exhausted penis. More importantly is the potential erectile dysfunction that may occur from too much time in the saddle.

“Chronic” Shrinkage

Like any other body part, the penis needs to be used on a regular basis—the way nature intended—in order to maintain its health. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile erectile tissues can occur, resulting in a “de-conditioned,” smaller and often temperamental penis.

Factoid: If you go for too long without an erection, smooth muscle, elastin and other tissues within the penis may be negatively affected, resulting in a loss of penile length and girth and negatively affecting ability to achieve an erection.

Factoid: Scientific studies have found that sexual intercourse on a regular basis protects against ED and that the risk of ED is inversely related to the frequency of intercourse. Men reporting intercourse less than once weekly had a two-fold higher incidence of ED as compared to men reporting intercourse once weekly.

Radical prostatectomy as a treatment for prostate cancer can cause penile shrinkage. This occurs because of the loss in urethral length necessitated by the surgical removal of the prostate, which is compounded by the disuse atrophy and scarring that can occur from the erectile dysfunction associated with the surgical procedure. For this reason, getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shrinkage on the basis of scarring of the erectile tissues that prevents them from expanding properly.  For more on this, see my blog on the topic:

https://healthdoc13.wordpress.com/2015/05/23/peyronies-disease-not-the-kind-of-curve-you-want/

Medications that reduce testosterone levels are often used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage. Having a low testosterone level from other causes will also contribute to a reduction in penile size.

Are There Herbs, Vitamins or Pills That Can Increase Penile Size?

Do not waste your resources on the vast number of heavily advertised products that will supposedly increase penile size but have no merit whatsoever.  Realistically, the only medications capable of increasing penile size are the oral medications that are FDA approved for ED. Daily Cialis will increase penile blood flow and by so doing will increase flaccid penile dimensions over what they would normally be; the erect penis may be larger as well because of augmented blood flow.  Additionally, for many men this will restore the capability of being sexually active whereas previously they were unable to obtain a penetrable erection, thus allowing them to “use it instead of losing it” and maintain healthy penile anatomy and function.

Is Penile Enlargement Feasible Through Mechanical Means?

It is possible to increase penile size using tissue expansion techniques. The vacuum suction device uses either a manual or battery-powered source to create a vacuum in a cylinder into which the penis is placed. The negative pressure pulls blood into the penis, expanding penile length and girth. A constriction ring is placed around the base of the penis to maintain the erection. The vacuum is used to manage ED as well as a means of penile rehabilitation and is also used prior to penile implant surgery to increase the dimensions of the penis and allow a slightly larger device to be implanted than could be used otherwise. It can also be helpful under circumstances of penile shrinkage.

vsd

Vacuum Suction Device

The Penimaster Pro is a penile traction system that is approved in the European Union and Canada for urological conditions that lead to shortening and curvature of the penis. In the USA it is under investigation by the FDA. It is a means of using mechanical stress to cause penile tissue expansion and enlargement.

penimaster

Penimaster Pro

What’s The Deal With Penile Enlargement Surgery?

Some men who would like to have a larger penis may consider surgery. In my opinion, penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky and not ready for prime time. Certain procedures are “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone, bulking agents, tissue grafts and other implantable materials. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis. Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

What’s Up With Penile Transplants?

The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to a recipient whose penis was damaged beyond repair in an accident. Subsequently, there have been several transplants done for penile trauma.  Hmmm, now here is a concept for penile enlargement!

What To Do To Avoid Shrinkage issues?

  • Accept that cold, stress and athletics will cause temporary shrinkage
  • Be aware that cycling and other saddle sports can cause shrinkage as well as erectile dysfunction: wear comfortable and protective shorts; get measured for a saddle with an appropriate fit; frequently rise up out of the saddle, taking the pressure off the perineum
  • Eat a healthy diet and stay physically active to maintain a lean physique
  • Use it or lose it: stay sexually active
  • Do pelvic floor exercises (a.k.a. Man Kegels): visit http://www.MalePelvicFitness.com
  • “Rehab” the penis to avoid disuse atrophy after radical prostatectomy: oral ED meds, pelvic floor muscle training, vibrational stimulation, vacuum suction device, penile injection therapy; consider “pre-hab” before the surgery
  • Seek urological care for Peyronie’s disease

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 & Urinary Health http://www.MalePelvicFitness.com

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

http://www.TheKegelFix.com

E-book available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback available via websites. Author page on Amazon:

http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix

https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx, Vacuum Suction Devices and many other quality products can be obtained at http://www.UrologyHealthStore.com. Use promo code “UROLOGY10” at checkout for 10% discount. 

You Can’t Think It Up, But You Can Think It Down

November 21, 2015

Andrew Siegel MD   11/21/15

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(Above fortune from Chinese fortune cookie relevant to this discussion.)

Q: What is the most powerful sex organ?

A: If you think it is the erect and throbbing penis, you are incorrect. The BRAIN is the bossman and the most influential force driving sexuality. The penis is a mere buck private soldier that responds and bends to the will of the five-star general and commander-in-chief of sexuality, the central nervous system.

Despite the authority and assertive presence of the brain, it is only under rare circumstances that it is capable of willing the limp penis to become erect. Some form of touch or erotic stimulation is most often necessary to get the erection process going, with the exception of nighttime-related erections associated with a phase of sleep known as REM (Rapid Eye Movement).

If the central nervous system cannot will the limp penis to become erect, it certainly can will the erect penis to become limp or will the limp penis to remain limp. This is the case with performance anxiety, a classic instance of the powerful mind-body connection. In this circumstance, stress or anxiety causes the output of high levels of adrenaline, which functions to constrict penile blood flow and erectile smooth muscle relaxation, resulting in a limp penis.

The central nervous system is the commander-in-chief of sexuality, but it demands working the way it likes to work, i.e., naturally, unhindered and unburdened by cognitive thought. Conscious and willful thought clearly can interfere with the smooth function of the central nervous system. When conscious thought enters the picture, the ability to perform many complex movements goes south. Much the same as a golf swing or any action like using a fork to feed yourself or walking down a flight of stairs, when it comes to sexuality, the brain works best when it is working subconsciously. Overthinking is the enemy of any complex motor activity. With all of these examples, one needs to be in the moment and engaged in the activity without conscious thought, in order to enable a smooth execution.

The moment one starts overthinking, the complex motion is virtually destined to be flawed. The golf swing is a classic example, with a poor shot almost guaranteed if one has too many swing thoughts that confound execution and performance. For the non-golfers, try walking down a flght of stairs at a good clip, stating to yourself in your inner voice each step in the process and you will likely trip up. When you are in a sexual situation, if you focus on thinking about your sexual function or lack thereof or reliving a previous problem, then your performance will most often be doomed to failure.

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(Thank you, Pixabay for image above)

Too much thought is capable of empowering self-fulfilling prophecies and bringing them to fruition. If one has had erection issues and in a passionate moment starts thinking, assessing, evaluating and analyzing, he is almost certain to be incapable of obtaining or maintaining an erection. Likewise, if one suffers with premature ejaculation and his thought pattern becomes obsessively focused on this possibility instead of being in the moment and enjoying the situation, he is almost certain to ejaculate way sooner than desired. The same is true with the rarer but equally disturbing problem of delayed ejaculation. Focusing on trying to make oneself ejaculate will most often bring on the inability to ejaculate.

Masters and Johnson coined the term spectatoring, an intense self-focus during sexual interactions as opposed to immersing oneself in the sensory aspects of the sexual experience. Essentially, spectatoring is observing and monitoring yourself having sex as if you were a third party, often accompanied by an anxious internal, self-conscious dialogue with concerns about some aspect of your sexual performance. It is being a spectator instead of the player and it will DESTROY your game.

The solution to spectatoring is to “be present” and “in the moment,” totally immersing yourself in the experience without observation or conscious internal thoughts. When you lose yourself in the sensations and do not allow thoughts to interfere with the process, you maximize your chances for an optimal performance. When distracting thoughts uncontrollably float into the present like dark clouds in the sky, take a deep breath, exhale slowly and allow the thoughts to pass and return to a state of being present.

Bottom Line: Overthinking is the enemy of complex actions, including erections and ejaculation. Allow the central nervous system to do what it does so well– subconsciously– without trying to help things along with deliberate thought.  Let instinct prevail over conscious thought–you cannot make it happen, you have to let it happen. There is an  time and place for conscious thought, but it is not in the heat of the moment in the bedroom.  Be present without thought of the past or future. 

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.

Performance Anxiety (Stage Fright)

June 6, 2015

Andrew Siegel MD  6/6/15

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(Thank you, Wikipedia Commons for the use of the image above)

No matter how sexy you think sex is, it comes down to some very unsexy biology, chemistry and physics. I will briefly review the science of the male sexual response and how certain chemicals in the right place at the right time can cause you to be a real Romeo, or alternatively, doom you to having a soft-as-a-marshmallow, good-only-for-standing-up-when-you-pee penis.

“It is like a firstborn son—you spend your life working for him, sacrificing everything for him, and at the moment of truth he does just as he pleases.” Gabriel Garcia Marquez, Love In the Time of Cholera

“The penis does not obey the order of its master, who tries to erect or shrink it at will. Instead, the penis erects freely while its master is asleep. The penis must be said to have its own mind, by any stretch of the imagination.” Leonardo da Vinci

Sex Ain’t Simple Sex is a complicated event that depends upon a number of systems working together in harmony: The endocrine system (produces sex hormones), the central nervous system (where sensations of sexual arousal are experienced and processed), the peripheral nervous system (provides nerve control), the vascular system (blood flow) and the pelvic floor muscles (elevate penile blood pressure to provide rock-hard rigidity).

The Mind-Body Connection The mind-body connection is nothing short of profound and one’s emotional state—which obviously varies from moment to moment—is responsible for the release of a “cocktail” of internal chemicals that can make or break an erection, despite all of the aforementioned systems being in perfect working order. In other words, one’s internal “biochemical environment” at any given moment in time can influence these systems in such a way that may lead to a bone-hard erection or at times, no erection at all.

Stress—The Erection Killer Under certain circumstances—particularly stress—internal chemical release can cause a situational erection problem. Performance anxiety (stage fright—the stage usually being the bedroom) is often due to emotional stress that causes the release of adrenaline, the “flight or fright” chemical that causes tightening of blood vessels and restricts the blood flow to the penis. This is the same chemical that causes one’s pupils to dilate, blood pressure to rise and pulse and breath to quicken. Adrenaline is a great chemical to have onboard when you are in precarious situation, such as being chased by a lion in the jungle. By causing dilation of the pupils, a rise in pulse and blood pressure and rapid breathing, it prepares you to confront the danger in a turbo-charged state so that you can perform optimally. The last thing on your mind in this situation is sex, and by restricting blood flow to non-vital organs including the penis, blood flow is directed to where it will best serve you to get out of the precarious situation. So, stress does not belong in the same sentence as sex, and when it does, it is a formula for a losing situation. Emotional stress can have many causes including a new sexual partner, worry about getting an erection, guilt, work concerns, worry about child care or caretaking of parents, financial woes, unemployment, or life in general (who isn’t stressed?). For some men, the stress of having to wear a condom can cause the inability to obtain or loss of an erection, known as condom-associated erectile dysfunction.

Fact: On the rare occasion that a man has a prolonged erection (a.k.a. priapism), an adrenaline-like drug needs to be injected directly into the erectile chambers of the penis in order to cause the erection to subside. When anxiety strikes, adrenaline is precisely what dooms your erection. The adrenal glands pump out adrenaline, which circulates to all organs, including the penis, and presto, the blood flow to the penis is choked off and the erection is history.

The Chemistry Of Love With erotic stimulation or touch, the erectile chamber nerve (cavernosal nerve) releases nitric oxide, which in turn causes the release of cyclic guanosine monophosphate (cGMP). This causes the erectile chamber arteries (cavernosal arteries) to dilate and blood to gush into the penis and also causes the smooth muscle of the erectile chambers to relax, allowing space for blood to fill the chambers. You now have a plump penis, congested with blood. The pelvic floor muscles then engage and further increase the pressure within the erectile chambers, and voila, you have a rigid erection. After ejaculation, the enzyme phosphodiesterase (PDE) is released. PDE is the flaccidity chemical that by decreasing levels of cGMP, results in a return to the flaccid state by a reversal of the aforementioned chemical mechanisms. Viagra, Cialis, Levitra and Stendra work by inhibiting PDE.

Let’s say that you are emotionally stressed before entering an erotic situation or become stressed after it has started. Enter adrenaline in high enough levels and that erection will never occur or if it does so, will rapidly be lost. Adrenaline is your friend in life and death situations, but not in the bedroom!

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

Co-founder of Private Gym: http://www.PrivateGym.com–available on Amazon and Private Gym website The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.

Penis Size: Does It Matter?

May 17, 2014

Blog #154

As I was walking through the gateway on my way to board an airplane, I saw a poster advertisement stating the following: Size should never outrank service, referring to the smaller size regional jets that now offer first-class, wi-fi and more. I recently saw another poster ad for the same airline stating: How fast the flight goes isn’t always up to pilot. I find these double entendres quite amusing and entertaining.

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. Penis size is no exception, with some of us phallically endowed, some phallically challenged, but most of us somewhere towards the center. In a study of 3500 penises published by Alfred Kinsey, the average flaccid length was 8.8 centimeters (3.5 inches). The average erect length ranged between 12.9 -15 centimeters (5-6 inches). The average circumference of the erect penis was 12.3 centimeters (4.75 inches).

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that there is no clear cut correlation between ethnicity and penis size. Flaccid length does not necessarily predict erect length and can vary depending upon emotional state and ambient temperature. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

Some women prefer men who are formidably hung, just like some men prefer women with large breasts. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort, particularly if cervical contact occurs. The long and the short of it are summarized in the adage, “It’s not the size of the ship, but the motion of the ocean.

Who Knew? “Genital Genetics.” As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (or mother). In actuality, it is the roll of the genetic dice and how the inherited blueprint that determines physical traits interacts with the local hormonal environment.

Who Knew? Hung like a horse—forget about it! The blue whale has the mightiest genitals of any animal in the animal kingdom: penis length is 8-10 feet; penis girth is 12-14 inches; ejaculate volume is 4-5 gallons; and testicles are 100-150 pounds. Hung like a whale!

Who Knew? On the subject of penis size, one of my favorite things to do when driving on the highway and seeing some idiot in a Lamborghini driving hazardously from lane to lane at about 95 miles an hour is not to flash him my middle finger, but to show him my hand with my thumb and index finger separated about 1 inch apart to indicate to him what I think is the likely size of his penis.

Who Knew? “Men are from Mars, Women from Venus.” Leonardo Da Vinci had an interesting take on perspectives: “Woman’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.”

Who Knew? There are a bunch of “amenities” that accompany the aging process, one of which is “presbyopia” or farsightedness, which demands reading glasses. They are a real nuisance, never around when you need them and always getting lost. But one thing I have observed is that if you forget to take them off when you get up to relieve your full bladder, when you glance down, you see a rather large “member,” thanks to the magic of magnification. I am currently wearing 1.5 power; perhaps it’s time for 2.0!

Who Knew? There is no correlation between penis size and shoe size, hand size or nose size.

Who Knew? “Where’s Woody?” Three of the most common words I hear in my urology practice are the following: “Doc, I’m shrinking.”

Who Knew? Part of the problem is the pervasive pornography industry, where many male stars are endowed like the centaur, the mythological creature with the head and torso of man and the lower body of a horse. This has given the average guy a bit of an inferiority complex.

Many men complain of “shrinkage,” which is a very real phenomenon on the basis of blood flow. The typical circumstances evoking this are exposure to cold weather or cold water, the state of being nervous, and athletic pursuits. The mechanism in all cases involves blood circulation. Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s periphery to help maintain core temperature. This is the very reason one places ice on an injury as the vasoconstriction will reduce swelling and inflammation.

It stands to reason that exposure to heat will cause vasodilation (expansion of arterial flow) and this is the very reason that some penile tumescence (state of fullness without rigidity) can occur in a warm shower. Nervous states or anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in a flaccid penis. Participation in vigorous athletic activity “steals” blood flow to the organs that need the oxygen and nutrients the most, namely the muscles, at the expense of organs like the penis.

Who Knew? Do you remember the Seinfeld episode in which Jerry’s girlfriend Rachel sees George naked after George steps out of a swimming pool?

 Rachel: “Oh my God, I’m really sorry.”

George: “I was in the pool; I was in the pool.”

George to Jerry: “Well I just got back from swimming in the pool and the water was cold.”

Jerry: “Oh, you mean shrinkage.”

George: “Yes, significant shrinkage.”

As mentioned, truly not a day goes by in my practice when I fail to hear the following complaint from a patient: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrink from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis, if you will. Weight gain and obesity will cause a generous pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.” Lose the fat and presto…the penis reappears. Having a plus-sized figure is just not a good thing when it comes to man-o-metrics.

Who Knew? “Fatal Retraction.” It is estimated that for every 35 lbs. of weight gain, there will be a one-inch loss in apparent penile length.

Who Knew? “Penile Dysmorphic Disorder,” very much paralleling “Body Dysmorphic Disorder,” is a condition in which one’s image of their penis is at odds with reality. Typically, one envisions himself as small when in fact he is quite within the normal range and an obsessive focus on this issue creates a great deal of psychological stress.

Who Knew? “Koro” (“head of the turtle” in Malay) is a cultural form of psychological panic that occurs predominantly in East Asian men. Those who suffer from this delusional disorder are terrified that their genitals will retract into their bodies and take extreme measures to prevent this from occurring.

The erectile cylinders of the penis are essentially our “erector sets,” consisting of three inner tubes within the penis that are composed of vascular (consisting of blood vessels) smooth muscle and sinuses that fill with blood upon sexual stimulation. An erection is on the basis of blood expanding these cylinders to the point of penile rigidity. Like any other muscle, the muscle of the penis needs to be used on a regular basis, the way nature intended for it to be used. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile smooth muscle can occur. In a vicious cycle, any loss of sexual function can lead to further progression of the problem. Poor genital blood flow produces a state of poor oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the sexual dysfunction.

Radical prostatectomy, the surgical removal of the entire prostate gland as a treatment for prostate cancer, can cause penile shortening by virtue of the removal of the prostate gland. The resultant gap in the urethra because of the removed prostate is repaired by sewing the bladder to the urethra with a consequent loss of urethral length. Penile shortening can be compounded by the disuse atrophy and scarring that can occur as a result of the erectile dysfunction associated with the surgical procedure, which sometimes can damage the nerves that are responsible for erections. Getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shortening because of scarring of the erectile cylinders that prevents them from expanding properly.

Androgen deprivation therapy is a means of suppressing the male hormone testosterone, typically used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage.

Who Knew? Penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky, ineffective and not ready for prime time. Certain procedures are what I call “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone and other tissue grafts. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis—certainly a far cry from a “proud soldier” and more like a “wounded warrior.” Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

Who Knew? The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to the recipient, whose organ was damaged beyond repair in an accident. Hmmm, now there is a concept for penile enlargement.

Andrew Siegel, MD

The aforementioned is largely excerpted from my new book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.

www.MalePelvicFitness.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