Posts Tagged ‘disuse atrophy’

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

 

 

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“Doc, My Penis Is Shrinking”

October 8, 2016

Andrew Siegel MD  10/8/16

cuixes_de_lapol%c2%b7lo_de_pinedo

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. 

12 MYTHS ABOUT KEGEL EXERCISES

July 9, 2016

Andrew Siegel MD 7/9/16

A “myth” is a widely held but false belief or idea. With respect to Kegel pelvic floor exercises, there are many such myths in existence. The goal of this entry is to straighten out these false notions and misconceptions and provide indisputable truths and facts about pelvic floor exercises. Much of this entry is excerpted from my new book THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health. (www.TheKegelFix.com)

 Facts_Myths.svg

(attribution Nevit Dilmen, 2015)

 

Myth 1: The best way to do Kegels is to stop the flow of urine.

Fact: If you can stop your stream, it is proof that you are contracting the proper muscles. However, this is just a means of feedback to reinforce that you are employing the pelvic floor muscles. The bathroom should not be your Kegel gymnasium!

Myth 2: Do Kegel exercises as often as possible.

Fact: Kegel exercises strengthen and tone the pelvic floor muscles and like other muscle-conditioning routines should not be performed every day. Kegel exercises should be done in accordance with a structured plan of progressively more difficult and challenging exercises that require rest periods in order for optimal muscle growth and response.  Three to four times weekly is sensible. 

Myth 3: Do Kegels anywhere (stopped at a red light, waiting in line at the supermarket, while watching television, etc.).

Fact: Exercises of the pelvic floor muscles—like any other form of exercise—demand attention, mindfulness and isolation of the muscle group. Until you are able to master the exercise regimen, it is best that the exercises be performed in an appropriate venue, free of distraction, which allows single-minded focus and concentration. This is not to say that once you achieve mastery of the exercises and a fit pelvic floor that you should not integrate the exercises into activities of daily living. That, in fact, is one of the goals.

Myth 4: The best way to do a Kegel contraction is to squeeze your PFM as hard as possible.

Fact: A good quality Kegel contraction cycles the pelvic floor muscles through a full range of motion from maximal relaxation to maximal contraction. The relaxation element is as critical as the contraction element. As vital as “tone and tighten” are, “stretch and lengthen” are of equal importance. The goal is for pelvic muscles that are strong, toned, supple and flexible.

Myth 5: Keeping the Kegel muscles tightly contracted all the time is desirable.

Fact: This is not a good idea. The pelvic muscles have a natural resting tone to them and when you are not actively engaging and exercising them, they should be left to their own natural state. “Tight” is not the same as “strong.” There exists a condition—pelvic floor muscle tension myalgia—in which there is spasticity, extreme tightness and pain due to excessive tension of these muscles.

Myth 6: Focusing on your core muscles is sufficient to ensure Kegel fitness.

Fact: No. The Kegel muscles are the floor of the “core” group of muscles and get a workout whenever the core muscles are exercised. However, for maximal benefit, focus needs to be placed specifically on the Kegel muscles. In Pilates and yoga, there is an emphasis on the core muscles and a collateral benefit to the pelvic muscles, but this is not enough to achieve the full potential fitness of a regimen that isolates and intensively exercises the Kegel muscles.

Myth 7: Kegel exercises do not help.

Fact: Oh yes they do! Kegel exercises have been medically proven to help a variety of pelvic maladies including pelvic relaxation, sexual dysfunction and urinary and bowel incontinence. Additionally, pelvic training will improve core strength and stability, posture and spinal alignment.

Myth 8: Kegels are only helpful after a problem arises.

Fact: No, no, no. As in any exercise regimen, the best option is to be proactive and not reactive. It is sensible to optimize muscle mass, strength and endurance to prevent problems from surfacing before they have an opportunity to do so. Kegel exercises pursued before getting pregnant will aid in preventing pelvic issues that may arise as a consequence of pregnancy, labor and delivery. If you strengthen your pelvic floor muscles when you are young, you can help avoid pelvic, urinary and bowel conditions that may arise as you age. Strengthen and tone now and your body will thank you later.

Myth 9: You can stop doing Kegels once your muscles strengthen.

Fact: Not true…the “use it or lose it” principle applies here as it does in any muscle-training regimen. Just as muscles adapt positively to the stresses and resistances placed upon them, so they adapt negatively to a lack of stresses and resistances. “Disuse atrophy” is a possibility with all muscles, including the Kegel muscles. “Maintenance” Kegels should be used after completing a course of pelvic muscle training.

Myth 10: It is easy to learn how to isolate and exercise the Kegel muscles.

Fact: Not the case at all. A high percentage of women who think they are doing Kegel exercises properly are actually contracting other muscles or are bearing down and straining instead of drawing up and in. However, with a little instruction and effort you can become the master of your pelvic domain.

(Note well: During June office visits I saw a nurse practitioner, a personal trainer and a physical therapist in consultation for pelvic issues.  None of them knew how to properly contract their pelvic muscles and needed to be instructed…and these are people in the know!)

Myth 11: Kegels are bad for your sex life.

Fact: Just the opposite! Kegels improve sexual function as the pelvic muscles play a critical role in genital blood flow and lubrication, vaginal tone, clitoral erection and orgasm. Kegels will enhance your sex life and his as well. A strong pelvic floor will enable you to “hug” his penis as energetically as you can hug his body with your arms!

Myth 12: Kegels are just for women.

Fact: Au contraire…men have essentially the same pelvic muscles as do women and can reap similar benefits from Kegels with respect to pelvic, sexual, urinary and bowel health. For more information on this topic, refer to Male Pelvic Fitness: Optimizing Sexual and Urinary Health (www.MalePelvicFitness.com).

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

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 Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

Erection Recovery Program

December 5, 2015

Andrew Siegel MD   12/5/15

Reviresco – (Latin, re- + viresco) “I become green or verdant again”; “I am renewed or revived.”

Outliving Your Penis

It is very possible that you will “outlive” your penis. It will always be there for you in terms of a “spigot” to allow you the privilege of standing up to aim your urinary stream with reasonable accuracy, although this too suffers the ravages of time. However, in terms of being able to obtain or maintain an erection, your penis may perish decades before you do, for a variety of reasons.

The focus of today’s blog is ED due to prostate cancer treatment, although it is equally relevant to any man suffering with ED for any reason.  Having one’s prostate removed is a highly successful means of curing prostate cancer.  However, despite advances in technical and surgical approach, trauma to nerves, blood vessels, and muscular tissue during surgery can compromise sexual function, with ED being the most common complication.  The effect of radical prostatectomy on the penis is not unlike the effect of a stroke on the brain: in both situations a neuro-vascular (nerve/blood vessel) event occurs that may profoundly disturb function.  90% of men experience some degree of ED in the early post-surgery recovery period. The good news is that there are effective “rehab” and even “prehab” methods to optimize preservation and return of sexual function.  

Even if your penis has “expired” in terms of becoming rigid, it is still capable of being stimulated to ejaculation and orgasm, a phenomenon eventually discovered by many men. This is a small consolation (pun intended) for suffering with ED.

If your penis is not completely lifeless, it may be impaired such that you can obtain an erection, but lose it prematurely, or you can obtain at best a partially firm, non-penetrable erection. As if having a crippled penis were not severe enough punishment, to add insult to injury one of the consequences of lack of erections and sexual inactivity is further compromise of the future potential for erections. In other words, you need to obtain erections in order to maintain erections.

Use It Or Lose It

Erections not only provide the capacity for penetrative sex, but also serve to keep the erectile chambers (erectile smooth muscles and vascular sinus tissues) richly oxygenated, elastic and functioning. If one goes too long without an erection, damage to this erectile apparatus can result in penile atrophy (shrinkage) and compromised function. In a vicious cycle, the poor blood flow from disuse induces scarring and further damage to erectile smooth muscle and sinus tissues that often gives rise to venous leakage (rapid loss of erections as blood cannot be properly trapped within the erectile chambers). The bottom line is that in the absence of regular erections, one will likely lose length, girth and function, with the penis hobbled by its inability to properly trap blood.

As an aside, one of the functions of sleep erections—the spontaneous nocturnal erections that occur during REM (rapid eye movement) sleep in healthy men—is to maintain the erectile chambers in good working order. As sleep has an important restorative function for the human body, so sleep erections have a vital restorative function for the human penis.

Penile Resurrection

Achieving erections when they fail to occur by natural means is vital for sexual “resurrection” (l like the sound of this word—say it slowly). In time, the nerves that were “stunned” and/or injured by radical prostatectomy will usually heal and during this convalescing time, obtaining erections will help preserve erectile tissue. The implication is that even if you are sexually inactive, if you anticipate being sexually active in the future, you need to keep the penis and erectile apparatus fit.

Many urologists recommend penile “rehabilitation” when healed up after radical prostatectomy. Traditional rehab involves a combo of pills, injections and vacuum therapy, a.k.a. vacuum suction device (VSD). Some men use one, two or all three of these rehab strategies.

The oral ED medications (Viagra, Levitra, Cialis, and Stendra) can help maintain penile blood flow and provide the benefits that derive from maintaining tissue oxygenation. However, they are double-edged swords as they cannot be used in the face of certain medical conditions, have side effects, are expensive (costing about $40 per pill) and are not effective in all comers.

For those who do not respond to pills, the next step is often penile injections. Vasodilator drugs are injected directly into the erectile chambers to induce an erection. A mixture of one or more medications is often used for this purpose. Unfortunately–despite its effectiveness–many men are not fond of putting a needle in their penis and often nix this means of treatment.

The VSD is the third traditional rehab element. Starting 6 weeks or so after surgery and pursued for 10 minutes daily, the VSD mechanically engorges the penis in an effort to keep the erectile chambers healthy.

The Erection Recovery Program

“Prehab” is a means of pre-rehabilitation that is started shortly after the diagnosis of prostate cancer, during the time period when one awaits being operated upon. Instead of waiting for after-the-fact rehab, prehab intends to maximize sexual function before surgery in an effort to hasten recovery of erectile function after surgery. Committing to the erection recovery program before the trauma of surgery permits one to go into the operation optimally prepared.

The Erection Recovery Program combines two non-pharmacological, non-invasive tools—vibratory nerve stimulation and pelvic floor muscle training—to stimulate the nerves that produce erections and to strengthen the muscles that contribute to erectile rigidity, respectively. The traditional rehab program can be highly effective; however, it addresses primarily blood flow, a vital element of erectile physiology, while not focusing on nerve stimulation and pelvic floor/perineal muscle function, important contributors to the erectile process.

Vibratory-tactile nerve stimulation in men was originally conceived (pun intended) for spinal cord injured patients who desired to father children but were incapable of doing so because of their inability to ejaculate. However, vibro-tactile nerve stimulation is equally effective in inducing erection as well as ejaculation/orgasm in the non-spinal cord injured population and its use has been expanded to the general male population.

The pelvic floor/perineal muscles activate at the time of sexual stimulation, compressing the deep roots of the penis and fostering hypertensive blood pressures in the erect penis in excess of 200 mm, responsible for rock-hard rigidity. Pelvic floor muscle training has been used to bolster the strength, power and endurance of these muscles in order to optimize erectile rigidity and durability. Without well functioning pelvic floor/perineal muscles, full rigidity will not occur.

Oral meds, injection and/or vacuum therapy help prevent erectile tissues from losing elasticity and becoming scarred and less functional from the absence of erections. Similarly, nerve stimulation and pelvic floor/perineal muscle training help maintain the integrity of the erectile tissues as well as help prevent the pelvic floor/perineal muscles from atrophying in the absence of erections.  By keeping the pelvic floor/perineal muscles fit, when erections ultimately do return, function can be optimized.

The combination of nerve stimulation and pelvic floor muscle strengthening is a powerful alliance that is prescribed “prehab” as well as after radical prostatectomy to shorten the time it takes to recover erections. Its merits are its simplicity, safety, efficiency and the fact that it is actually pleasurable to pursue. It does not preclude the use of the traditional rehab program, which can be used in conjunction with the Erection Recovery Program.

Specifically, the Erection Recovery Program consists of the Viberect nerve stimulation device and the Pelvic Rx pelvic floor muscle training program. Viberect, manufactured by Reflexonic, is an FDA-certified hand-held penile vibro-tactile nerve stimulation device that triggers erection and ultimately ejaculation. The Pelvic Rx program, manufactured by Adult Fitness Concepts, is a FDA-registered, comprehensive, interactive follow-along exercise program to increase pelvic floor muscle strength, tone, power, and endurance. Basic Training strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises, while Complete Training provides maximum opportunity for gains via resistance equipment.

Bottom Line: 

The critical principle for erectile recovery is achieving an erection for at least several times weekly during the recovery period after prostate surgeryPenile vibro-tactile nerve stimulation coupled with pelvic floor muscle training is a synergistic combination that promotes initiation and maintenance of erections, respectively. 

This Erection Recovery Program is used prehab (prior to radical prostatectomy) and continued after surgery.  It offers a non-pharmacological option for erection recovery, but can also be used in conjunction with traditional penile rehab programs that use medications.  The Erection Recovery Program is also appropriate for any man who wants to improve sexual function, regardless of the underlying cause.  

To obtain the Erection Recovery Program:

http://www.viberect.com/erection-recovery-program-combo-pack.html

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.

Pelvic Floor Muscle Exercises: A Vital Part Of Any Balanced Exercise Program

August 15, 2015

Andrew Siegel MD  8/15/15

Project_Yoga_Richmond_1

Image above: Credit to Eli Christman (https://www.flickr.com/photos/gammaman/7170043719/ CC BY 2.0 http://creativecommons.org/licenses/by/2.0, via Wikimedia Commons)

We hear much about the importance of strengthening our “core” muscles. Most core exercise programs focus on the abdominal, hip, and back muscles. However, there are deeper core muscles that form the floor of the core muscles–-the pelvic floor muscles—that are often neglected, particularly by men. These muscles play a vital role in sexual, urinary, and bowel health and in maintaining proper form, balance and posture during virtually any and every form of exercise. Incorporating a pelvic floor muscle program into your workout routine will be to your benefit. 

The Pelvic Floor Muscles

The pelvic floor muscles are not the well-respected, glitzy, for show, mirror-appealing, external glamour muscles. However, these hidden and often-ignored pelvic muscles are hidden gems that work diligently behind the scenes—muscles of major function and not so much form—that have a role that goes way beyond the joint movement and locomotion function of the external muscles. Although concealed, the pelvic muscles have powerful and beneficial functions, particularly so when intensified by training.

Although not our muscles of glamour, they are our muscles of “amour,” and have a profoundly important role in sexual, urinary, and bowel function as well as in supporting our pelvic organs.

Use Them Or Lose Them

The pelvic floor muscles, as with other muscles in the body, are subject to adaptation. Unused as intended, they can suffer from “disuse atrophy,” becoming thin, flabby and poorly functional as happens with aging, weight gain, a sedentary lifestyle, poor posture and other forms of injury and trauma, chronic straining, and surgery. Used appropriately as designed by nature, they can remain healthy in structure and function. When targeted exercise is applied to them, particularly against the forces of resistance, they can be enhanced. Diligently practiced pelvic exercises will allow one to reap tangible rewards, as having fit pelvic muscles is the essence of functional fitness.

Pelvic Floor Muscle Training: In Isolation and Integrated With Other Workouts

There are two means of working out the pelvic floor muscles: in isolation and integrated. In order to become the master of your pelvic domain, it is initially important to isolate the pelvic floor muscles. Once pelvic floor muscle competence is established, pelvic exercises can then be integrated into other exercise routines and workouts. In real life, muscles do not work in isolation but rather as part of a team, the pelvic muscles being no exception. The pelvic floor muscles often contract in conjunction with the other core muscles—particularly the transversus abdominis—in a mutually supportive and synergistic fashion. In fact, many Pilates and yoga exercises emphasize consciously contracting the pelvic muscles simultaneously with the other core muscles during exercise routines.

Engaging the pelvic floor muscles while doing squats, lunges, etc., serves not only to integrate the lower regions of the core and provide optimal support and “lift” of the floor of the core, but also as a means of exercising the mind-body connection.  It is important to avoid over-exertion of the pelvic floor muscles and awareness directed towards this region is sufficient without the necessity for a forceful contraction.

Dynamic exercises in which complex body movements are coupled with core and pelvic stabilization—such as squats and deadlifts—enhance non-core as well as core strength and function to the maximum. The core muscles, including the pelvic floor, stabilize the trunk when our limbs are active, enabling us to put great effort into limb movements. It is impossible to use the arm and leg muscles effectively in any athletic endeavor without engaging a solid core as a platform from which to push off (think martial arts). Normally this happens without conscious effort, but with some focus and engagement, the core and pelvic floor contraction can be optimized. The stronger the platform, the more powerful the potential push off that platform can be.

Pelvic Contractions To Counteract Intense Training Regimens

Weight training and other forms of intensive exercise result in tremendous increases in abdominal pressure. This force is largely exerted downwards towards the pelvic floor, particularly when exercising in the standing position, when gravity also comes into play. Engaging the pelvic floor during such efforts will help counteract the vector of downwards forces exerted on the pelvic floor.

Knack Maneuver

Many females and certain males (particularly after radical prostatectomy) suffer with stress urinary incontinence, a spurt-like urinary leakage that occurs at times of increased abdominal pressure such as with sports and other high impact activities including jumping and kickboxing. For years, urologists and gynecologists have advocated the “knack” maneuver to counteract this, a technique in which the pelvic muscles are braced and briskly engaged at the time or just before any activity that triggers the stress incontinence. When practiced diligently, this can ultimately become an automatic behavior.

Bottom Line: The pelvic floor muscles are out of sight and therefore out of mind. However, these muscles that form the floor of the core are fundamental to many important body functions (sex, urinary and bowel). Pelvic floor muscle conditioning will not only help keep these functions in working order, but also is a vital component to the performance of complex movements that require engagement and stabilization of the core muscles.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

Penile Rehabilitation (Penile “Rehab”)

March 13, 2015

Andrew Siegel MD   3/13/15

shutterstock_side view manjpeg

Penile rehab is probably not what you think. It is not a place where “misbehaved” penises go to get reformed and restored to normalcy. 

Although the term “rehab” has a bit of a negative connotation–a place and a process by which one attempts to reclaim their lives from the grip of a drug, alcohol or other addiction–it should, however, be thought of in a positive sense as a means of regaining strength, skills and normalcy after not only an addiction, but also an injury, illness, or surgery.

Rehab can take many forms: physical (physical therapy to treat an injury or help recover mobility and strength after surgery), occupational (to recover the ability to perform daily activities), speech (to recover comprehension of language, speaking, reading and writing), cardiac (after a serious cardiac event or surgery) and pulmonary (to improve breathing).

What Does This Have To Do With The Penis?

Some abdominal and pelvic surgical procedures—including removal of the prostate, the bladder, and the colon—can result in a penile dysfunction in which it becomes difficult to obtain or maintain an erection. Similarly, pelvic radiation therapy and pelvic injuries can negatively affect one’s sexual function.

The problem is that if you go for too long without an erection, penile smooth muscle and other tissues may be damaged, resulting in a loss of penile length and girth and further compounding the ED. Like every other body part, your penis needs to be used the way nature intended. A marvel of engineering, the penis is uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge of blood flow happening within seconds and accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. An erect penis not only gives you the capacity for penetrative sex, but also serves to keep the penile muscles and tissues richly oxygenated, elastic and functioning well.

Interestingly, studies have demonstrated that sex on a regular basis protects against ED and 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. (Am J Med 2008 July; 121(7): 592-596).

In the absence of regular erections, disuse atrophy (wasting away with a decline in anatomy and function) can occur. In a vicious cycle, the poor blood flow resulting from disuse produces a state of poor oxygen levels in the penile tissues, that, in turn, can induce scarring, which further decreases sexual function. This is where the concept of penile rehab comes into play. Rehab the penis after surgical, radiation or physical trauma to get it back into a functional state.

So What Is Penile Rehab?

Penile rehab is a process by which you attempt to recover erectile function after surgery, radiation or injury that compromises your sexual function. This is most commonly used after surgery or radiation for prostate cancer, but is also relevant for other major pelvic surgeries as well as pelvic injuries. There are numerous techniques for penile rehab (in order of least invasive to most invasive): exercises, vacuum, pills and injections.

Pelvic Floor Muscle (PFM) Exercises

This is physical therapy for the penis, which should be a first-line approach because of its safety, non-invasiveness, and minimal expense.

When the pelvic floor muscles contract, they increase blood flow to the penis, specifically by the actions of the two superficial pelvic floor muscles—the bulbocavernosus (BC) and ischiocavernosus (IC) muscles that become engaged at the time of an erection. Contractions of these PFMs prevent the exit of blood from the penis, enhancing penile rigidity. With every contraction of the BC and IC muscles, a surge of blood flows into the penis. Additionally, these muscles act as powerful struts to support the roots of the penis, the foundational support that allows a more “skyward” angling erection. Increasing the strength, tone and conditioning of these muscles will enhance their function, resulting in more powerful contractions and more penile rigidity and stamina. PFM exercises can serve as a powerful tool to help reignite erectile function.

Vacuum Suction Device

This is a mechanical means of producing an erection in which the penis is placed in a plastic cylinder that is connected to a manual or battery-powered vacuum. The negative pressure created by the vacuum literally sucks blood into the penis, creating a state of engorgement.

PDE5 inhibitors: Viagra, Levitra, Cialis, Stendra

Viagra (Sildenefil). Available in three doses—25, 50, and 100 mg—it is taken on demand and will produce an erection in most men within 30-60 minutes if they are sexually stimulated, and will remain active for up to 8 hours.

Levitra (Vardenefil). Available in 5, 10, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra.

Cialis (Tadalafil). Available in 2.5, 5 mg, 10mg, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra. It has duration of about 36 hours that has earned it the nickname “the weekender.” In 2012, daily lower doses of Cialis were FDA approved for the management of urinary symptoms due to benign prostate enlargement.

Stendra (Avanafil). Similar to Viagra, it is available in 50, 100 and 200 mg doses. It has the advantage of a rapid onset.

Penile Injections

Injections of these vasodilators (medicines that increase blood flow) directly into the erectile chambers of the penis induce an erection. Caverject and Edex (Prostaglandin E1) are commonly used for this purpose.  Side effects can be pain, bruising, scarring and prolonged erections. At times, a combination of medications needs to be used to obtain optimal results; this combination is known as Trimix and consists of Papaverine, Phentolamine, and Alprostadil.

Thinking Forward

Adaptation of skeletal muscle is an accepted scientific precept and if you have ever had your arm or leg in a cast, you can understand the detrimental effect of disuse on muscle tone and strength. The corollary is that if you have ever done weight training, you understand the beneficial effect of resistance training on muscle tone and strength.

So, instead of thinking of penile rehab as a means of getting back function after surgery, radiation or injury, how about thinking of it as a means of preventing the inevitable decline in function that accompanies aging? Or to take it another level, think of rehab as a means of optimizing the blue-ribbon function that you may be fortunate enough to already have.  I’m not suggesting using invasive methods such as the vacuum, pills, or injections, but about pursuing exercises that can improve dysfunction, optimize current function and maintain future function.

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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-creator of Private Gym pelvic floor muscle training program for menhttp://www.PrivateGym.com Gym-available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to 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.

30 Interesting Kegel Facts

November 8, 2014

Kegel Facts

Andrew Siegel MD (11/8/14)

shutterstock_femalebluepelvic

 

  • Arnold Kegel (1894-1981) was a gynecologist who taught at the University of Southern California School of Medicine. He was singularly responsible in the late 1940s for popularizing pelvic floor exercises in women in order to improve their sexual and urinary health, particularly after childbirth. His legacy is the pelvic floor exercises that bear his name, known as “Kegels.”
  • Arnold Kegel invented a resistance device called the perineometer that was placed in the vagina to measure the strength of pelvic floor muscle contractions.
  • Arnold Kegel did not invent pelvic floor exercises, but popularized them in women. Pelvic floor muscle exercises have actually been known for thousands of years, Hippocrates and Galen having described them in ancient Greece and Rome, respectively, where they were performed in the baths and gymnasiums.
  • Kegel exercises are often used in women for stress incontinence (leakage with exercise, sneezing, coughing, etc.) and pelvic relaxation (weakening of the support tissues of the vagina causing dropped bladder, dropped uterus, dropped rectum, etc.).
  • Arnold Kegel wrote four classic articles: The Non-surgical Treatment of Genital Relaxation; Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles; Sexual Functions of the Pubococcygeus Muscle; The Physiologic Treatment of Poor Tone and Function of the Genital Muscles and of Urinary Stress Incontinence.
  • Kegel wrote: “Muscles that have lost tone, texture and function can be restored to use by active exercise against progressive resistance since muscles increase in strength in direct proportion to the demands placed upon them.”
  • Kegel believed that at least thirty hours of exercise is necessary to obtain maximal development of the pelvic floor muscles.
  • Kegel believed that surgical procedures for female incontinence and pelvic relaxation are facilitated by pre-operative and post-operative pelvic floor muscle exercises.
  • Kegel believed that well-developed pelvic muscles in females are associated with few sexual complaints and that “sexual feeling in the vagina is closely related to muscle tone and can be improved through muscle education and resistive exercise.” Following restoration of pelvic floor muscle function in women with incontinence or pelvic relaxation, he noted many patients with “more sexual feeling.”
  • Kegel believed that impaired function of the genital muscles is rarely observed in tail-wagging animals, suggesting that with constant movement of the tail, the pelvic floor muscles are activated sufficiently to maintain tone or to restore function following injury.
  • The pelvic floor muscles form the floor of the all-important core group of muscles.
  • The pelvic floor muscles are involved in 3 “S” functions: support of the pelvic organs; sphincter control of the bladder and the bowel; and sexual
  • Men have virtually the same pelvic floor muscles as do women with one minor variation: in men the bulbocavernosus muscle is a single muscle vs. in women it has a left and right component as it splits around the vagina.
  • Men can derive similar benefits from Kegel exercises in terms of improving their sexual and urinary health as do women.
  • Kegel exercises can improve urinary control in men, ranging from stress urinary incontinence that follows prostate surgery, to overactive bladder, to post-void dribbling.
  • Kegel exercises can improve sexual function in men, enhancing erections and ejaculation.
  • If the pelvic floor muscles are weak and not contracting properly, incontinence and sexual dysfunction can result. If they are hyper-contractile, spastic and tense, they can cause tension myalgia of the pelvic floor muscles, a.k.a. a “headache in the pelvis,” which often negatively affects sexual, urinary and bowel function.
  • The pelvic floor muscles contract rhythmically at the time of climax in both sexes. These muscles are the motor of ejaculation, responsible for the forcible ejaculation of semen at sexual climax. Kegel exercises can optimize ejaculatory volume, force and intensity.
  • The pelvic floor muscles have an important role during erections, activating and engaging to help maintain penile rigidity and a skyward angling erection. They are responsible for the transformation from a tumescent (softly swollen) penis to a rigid (rock-hard) penis. They exert external pressure on the roots of the penis, elevating blood pressure within the penis so that it is well above systolic blood pressure, creating a “hypertensive” penis and bone-like rigidity.
  • The Kegel muscles are located in the perineum, the area between the vagina and anus in a woman and between the scrotum and anus in a man.
  • The Kegel muscles are not the thigh muscles (adductors), abdominal muscles (rectus), or buttock muscles (gluteals).
  • You know you are doing Kegel exercises properly when you see the base of the penis retract inwards towards the pubic bone and the testicles rise up as you contract your Kegel muscles.
  • You know you are doing Kegel exercises properly when you can make your erect penis lift up as you contract your Kegel muscles.
  • You know you are doing Kegel exercises properly when you can interrupt your urinary stream as you contract your Kegel muscles.
  • The 1909 Gray’s Anatomy referred to one of the male Kegel muscles as the erector penis and another as the ejaculator urine, emphasizing the important role these muscles play in erections, ejaculation, and the ability to push out urine.
  • The pelvic floor muscles are 70% slow-twitch fibers, meaning fatigue-resistant and capable of endurance to maintain constant muscle tone (e.g., sphincter function), and 30% fast-twitch fibers, capable of active contraction (e.g., for ejaculation).
  • Kegel exercises are safe and non-invasive and should be considered a first-line approach for a variety of pelvic issues, as fit muscles are critical to healthy pelvic functioning.
  • The pelvic floor muscles are hidden from view and are a far cry from the external glamour muscles of the body. However, they deserve serious respect because, although not muscles with “mirror appeal,” they are responsible for powerful and beneficial functions, particularly so when intensified by training. Although the PFM are not muscles of glamour, they are our muscles of “amour.”
  • The Kegel muscles—as with other muscles in the body—are subject to the forces of adaptation. Unused as intended, they can suffer from “disuse atrophy.” Used appropriately as designed by nature, they can remain in a healthy structural and functional state. When targeted exercise is applied to them, particularly against the forces of resistance, their structure and function, as that of any other skeletal muscle, can be enhanced. Kegel exercises are an important component of Pilates and yoga.
  • As Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so Siegel (rhymes with Kegel) popularized pelvic floor muscle exercises in males in 2014, with a review article in the Gold Journal of Urology entitled: Pelvic Floor Muscle Training in Men: Practical Applications, a book entitled: Male Pelvic Fitness: Optimizing Sexual and Urinary Health, and his work co-creating the Private Gym male pelvic floor exercise DVD and resistance program.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com – now available on Amazon

Use Your X or Lose It

November 1, 2014

Andrew Siegel, MD

Use X or lose it…X can be anything–you fill in the blank–your muscles, your brain, your bones, your sexual function.

The cells and tissues of our bodies—including muscles, bones, brains, and every other organ—are endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to the environment they are exposed to. What it comes down to is that our human body is an “adaptation machine.”   Our composition is “fluid” as opposed to “static,” and our tissues are constantly being remodeled, restructured and refashioned in adaptive responses that occur in accordance to the forces, stresses, resistances and demands placed upon them. This plasticity is an amazing phenomenon that can be tapped into by purposely challenging our tissues with the appropriate resistances to enable them to perform at extreme high levels of function.

Today’s blog is a discussion of use X or lose it in the context of male sexual function.

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

Your penis needs to be utilized the way nature intended, just like every other body component…and that means not just to direct your urinary stream with laser-like precision! Your penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge of blood flow happening within seconds and accomplished by relaxation of the smooth muscle within your penile arteries and erectile tissues. When your penis is erect, not only is rigidity achieved, but the erection also serves to keep your penile muscles and tissues richly oxygenated, elastic and functioning well. The dramatic increase in penile blood flow that occurs with an erection enhances subsequent erectile performance via the release of nitric oxide, one of the important chemical mediators of erections.

In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of your penile smooth muscle and erectile tissues can occur. In a vicious cycle, the poor blood flow resulting from lack of use produces a state of poor oxygen levels in the penile tissues, that, in turn, can induce scarring, which can further compound sexual dysfunction.

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.  (Am J Med 2008 July;121(7): 592-596).

Radical prostatectomy, the surgical removal of the prostate gland for treatment of prostate cancer, can cause penile shortening. 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 thought to be on the basis of a telescoping phenomenon. Erectile dysfunction associated with damage to the nerves that are responsible for erections further compounds the shortening by causing disuse atrophy and scarring. For this reason, getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

A Few Words on Adaptation

Your muscles and other tissues are capable of hypertrophy (growth) or atrophy (shrinkage), depending upon the environment to which they are subject to. Exposure to a stimulating and active “environment” on a long-term basis can positively affect not only your external appearance, but also more importantly, your internal health. Conversely, exposure to a non-stimulating, sedentary environment on a long-term basis can negatively affect your external appearance and internal health.

Every cell, tissue and organ of your body is endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to environmental changes. It deserves repeating that your body and its parts are “fluid” as opposed to “static” and are constantly being remodeled, restructured and refashioned in adaptive responses occurring in accordance to the forces, stresses, resistances and demands placed upon it.

Use It or Lose It

Our bodies demand physical activity in order to function optimally. For example, our bones require weight bearing and biomechanical stresses in order to stay well mineralized and in peak functional condition, as bone mineralization is stimulated by the stresses brought on by a variety of movements. The same holds true for every organ in our body—to maintain maximal functioning they need to be put into the service for which they were designed. As much as our bodies adapt positively to resistance, so they will adapt negatively to a lack of resistance. For example, after wearing a cast on one’s arm for 6 weeks, there is noticeable wasting of the arm muscles, nothing other than disuse atrophy. This phenomenon will occur to any body part not used in the manner for which it was designed.

Beyond Using It

The magic of plasticity and adaptability can be tapped into by challenging your body to adapt to resistances to enable it to perform at extreme levels of function. Exercise is about the adaptation—in neuromuscular, mechanical, and metabolic terms—to the specific demands that are placed on it. As your body is subjected to gradual and progressive “overload,” adaptation occurs and a “new normal” level of fitness is achieved.

Your pelvic floor muscles play an important role during erections, activating and engaging to help maintain penile rigidity and a skyward angling erection. There is good reason that the 1909 Gray’s Anatomy labeled one of the pelvic floor muscles the “erector penis.” Numerous studies have documented the benefits of male Kegel exercises in the management of ED.

Participating in a pelvic floor muscle training program can be a very useful tool to improve ED. It will sharpen your awareness of your pelvic floor muscles and enable you to isolate them and increase their strength, tone, and endurance. As your pelvic floor muscles become more robust, erections will improve accordingly. A comprehensive program such as the Private Gym includes a basic series of progressive male Kegel exercises without resistance followed by the use of resistance equipment to maximize pelvic floor muscle strengthening and performance. The pelvic muscles—like any other muscle in your body—will gradually and progressively adapt to the load placed upon them and will strengthen in accordance with the resistance.

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Elston Howard was a New York Yankee who invented the batting “donut,” a circular lead weight that slides onto baseball bats and is used by on-deck batters. This added weight during practice swings is useful for stretching, enhancing bat speed and strength training; additionally, it makes the bat feel very light once it comes time to step up to the plate and remove the weight. Howard employed the resistance principle to heighten power—use the weighted bat in practice and when it comes time to step up to the plate, you’re going to perform better.

 

batting donut on bat

 

This principle will work on your “bat,” too—utilize resistance training in practice and when it comes time to “step up to the plate,” you’re going to perform better. Resistance training turns conditioning into a weapon that is capable of producing “outstanding” erections, maximizing endurance, and  boosting one’s confidence.

Bottom line: You can lose it, maintain it, or optimize it by not using it, using it, or subjecting it to exercise and resistance training, respectively. You are bestowed with an amazing and magical capacity for plasticity and adaptation, which can be transformative when used to your advantage and benefit.

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

Note: As Arnold Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so I am working towards the goal of popularizing pelvic floor muscle exercises in males. This year I published a review article in the Gold Journal of Urology entitled Pelvic Floor Muscle Training in Men: Practical Applications to disseminate the importance and applications of these exercises to my urology colleagues. I wrote Male Pelvic Fitness: Optimizing Sexual and Urinary Health, a book intended to educate the non-medical population. I, along with my partner David Mandell and our superb pelvic floor team, co-created the Private Gym male pelvic floor exercise DVD and resistance program.

For more info on the book: www.MalePelvicFitness.com

For more info on the Private Gym: www.PrivateGym.com

 

Use It Or Lose It: The Wow of Human Plasticity and Adaptation

May 30, 2014

Blog # 156

Think for a momentabout orthodontics. Braces are applied to one’s imperfect teeth and ever so gradual increasing resistance is implemented over time and, presto, in a couple of years, the teeth are perfectly straight and beautiful.

Exposing our bodies to the right “environment” on a long-term basis can positively affect not only our external appearance, but also more importantly, our internal health. Conversely, exposing our bodies to the wrong environment on a long-term basis can negatively affect our external appearance and internal health.

Essentially, the cells and tissues of our bodies—including our muscles, bones, brains, and every other organ—are endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to environmental changes. What it comes down to is that our human body is an adaptation machine.

Our composition is “fluid” as opposed to “static,” and our tissues are constantly being remodeled, restructured and refashioned in adaptive responses occurring in accordance to the forces, stresses, resistances and demands placed upon them. This plasticity is an amazing phenomenon and permits our tissues to maintain normal function when burdened with adverse “resistances.” Conversely, we can tap into this powerful resource by purposely challenging our tissues with the appropriate resistances to enable them to perform at extreme high levels of function.

An example of our bodies’ attempt to maintain normal function when burdened with adverse resistances is benign enlargement of the prostate gland.  Almost inevitably, all aging males experience this gradual growth of this curious gland wrapped around our urethral channels. As a result of this “crimp” on the urethra, the resistance to the flow of urine gradually increases. However, the bladder muscle adapts by hypertrophying (getting more muscular). The bladder ever so slowly changes from a thin and smooth muscle to a thick and rough muscle in order to generate the higher pressures necessary to enable getting the urine out through the impeded urethral passageway. The unsuspecting individual with this condition may experience no symptoms for quite some time because of this natural compensation. However, compensation cannot occur indefinitely as there are natural limits on this plasticity, so one day he may be unable to urinate because the bladder hypertrophy has become maxed out, yet the prostate growth and increased resistance continues relentlessly, resulting in a condition known as acute urinary retention.

Another example of our bodies’ attempt to maintain normal function when burdened with adverse resistances is hypertension, which totally parallels the situation with the prostate and the bladder. High blood pressure creates an environmental situation for the heart in which it needs to work harder to pump blood because of the increased resistance created within the walls of the arteries. Consequently, the muscle fibers of the heart hypertrophy, resulting in a larger and more muscular and powerful heart that can continue to pump blood effectively through the resistance of the high arterial pressure. The problem is that the “compensated” heart is subject to problems such as angina, arrhythmias and heart failure, and can get to the point—similar to the urinary bladder—where it decompensates and fails. Exercising the heart is desirable, but this is not the kind of exercise you want your heart to have

The powerful resource of plasticity and adaptability can positively and purposely be tapped into by challenging our tissues to adapt to the appropriate environmental changes (resistances) to enable our tissues to perform at extreme high levels of function. One type of resistance that is most beneficial is exercise.

Exercise is all about adaptation. The SAID principle (Specific Adaptation to Imposed Demands) posits that our body will adapt—in neuromuscular, mechanically, and metabolic terms—to the specific demands that are placed on it. This is the very reason why both endurance and resistance exercises get easier the more effort we put into doing them. Asthe body is subjected to gradual and progressive “overloads,” the heart, lungs and muscles adapt and a “new normal” level of fitness is achieved. It comes down to the fact that our muscles are plastic and capable of hypertrophy (growth) or atrophy (shrinkage) depending on the environment to which they are exposed.

I enjoy recreational cycling, but to date this season have not spent as much time in the saddle as I would have liked. I’ve been out for a number of 20-mile rides but last weekend went out with a friend for a hilly 50 miles. The last 10 miles were extremely difficult, as my body had not yet adapted to that kind of challenge; clearly I don’t have my cycling “legs” back yet. My heart and lungs were not the issue, but my glutes and quads were not up to the beating and challenge…but they will be in due time. Just as the marathon runner who gradually builds up to running the distance, so it is with every endurance sport

Adaptation to exercise is applicable to all aspects of fitness: cardiovascular or aerobic fitness in which the heart and lungs adapt to endurance efforts; musculo-skeletal fitness in which our muscles and underlying bony framework adapt to bearing loads and working against resistance, leaving our muscles sinewy, strong and toned; core strength, which is fitness of our torso muscles that allows us to maintain good posture, stability, balance and coordination as well as serving as a platform for efficient use of our arms and legs; and flexibility fitness in which our muscles are elastic, limber, supple and more resistant to injury.

Our bodies demand physical activity in order to function optimally. For example, our bones require weight bearing and biomechanical stresses in order to stay well mineralized and in peak functional condition, as bone mineralization is stimulated by the stresses brought on by a variety of movements. The same holds true for every organ in our body to maintain maximal functioning—they need to be employed and put into the service for which they were designed

“Use it or lose it.” As much as our bodies adapt positively to resistance, so they will adapt negatively to a lack of resistance. For example, after wearing a cast on one’s arm for 6 weeks, there is noticeable wasting of the arm muscles, known as “disuse atrophy.” Contrast this with the opposite scenario—exercising one’s arms by doing curls on a regular basis—which will result in an obvious hypertrophy of the arm muscles. When our bodies are sedentary—for example on the basis of a severe injury requiring bed rest—there is a rapid demineralization and thinning of our bones. Spinal cord injured patients who are paralyzed undergo just such a rapid demineralization. Astronauts who spend time in zero gravity (which takes all biomechanical forces away from the bones) experience a remarkably fast demineralization and risk not only thin bones—as does anybody with rapid demineralization— but also of developing kidney stones from the calcium mobilized from the bones. The process of adaptation is not limited to our muscles and bones, but involves each and every internal organ, including the kidneys, liver, pancreas, brain, etc. That is why it is so important to expose our bodies to positive “resistances” and not to “negative” resistances.

Our central nervous system is constantly being remodeled in response to environmental exposure. The brain’s neurons undergo anatomical changes and reorganization of their networks with new neural connections in response to new situations or environmental changes (learning). Through the processes of “neuroplasticity” and adaptation, learned behaviors actually modify the electrical hardwiring of the brain, which is dynamic and constantly subject to revision. Synaptic “sculpting” facilitates learning and synaptic “pruning” occurs when patterns are not repeated. Thus is explained on a biological basis how learning occurs.

Bottom line: Humans are bestowed with an amazing and magical capacity for plasticity and adaptation, which can be transformative when used to our advantage and benefit. Expose our bodies to positive cognitive and physical nourishment and they will be carved into beautiful, highly functioning machines. Expose our bodies to negative forces or absence of positive forces and they will falter into ugly, poorly functioning, maladaptive machines.

 

Andrew Siegel, MD

Author of 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”: http://www.healthdoc13.wordpress.com

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