Posts Tagged ‘ejaculatory dysfunction’

10 Reasons For Men To Kegel

June 4, 2016

Andrew Siegel, M.D. 6/4/16

The pelvic floor muscles—a.k.a. the Kegel muscles—are internal, hidden and behind-the-scenes muscles, yet they are vital to a healthy life. There are numerous advantages to keeping them fit and robust with pelvic floor exercises.  Last week’s entry detailed why this is the case for females and today’s will explain how and why are equally beneficial for males.  As the saying goes: “What’s good for the goose is good for the gander,” and when it comes to the pelvic floor, this is an absolute truth.  Kegel popularized these exercises for females and it is my intent to do the same for men!   If you would like more information on pelvic floor muscle training in men, visit AndrewSiegelMD.com, the opening page of which has the link to a review article I wrote for the Gold Journal of Urology on the topic. 

 

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  10 REASONS FOR MEN TO DO KEGEL EXERCISES 

  1. To improve/prevent erectile dysfunction.
  1. To improve/prevent premature ejaculation.
  1. To improve/prevent ejaculatory dysfunction (skimpy ejaculation volumes, weak ejaculation force and arc, diminished ejaculatory sensation).
  1. To improve/prevent post-void dribbling (that annoying after-dribble of urine that occurs after finishing urinating).
  1. To improve/prevent stress urinary incontinence (leakage with coughing, sneezing, exercise, etc.) that may occur following prostate surgery.
  1. To improve/prevent urinary and bowel urgency (“gotta go”) and urinary and bowel urgency incontinence (inability to get to the bathroom on time to prevent an accident).
  1. To improve/prevent pelvic pain due to pelvic floor tension myalgia by learning how to relax your pelvic floor muscles.
  1. To help prevent pelvic impairments from high impact sports and saddle sports (e.g., cycling, motorcycling and horseback riding).
  1. To improve core strength, posture, lumbar stability, alignment and balance.
  1. To maintain good health and youthful vitality.

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. 

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The Pelvic (Kegel) Revolution

April 23, 2016

Andrew Siegel MD  4/23/16

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(photo above: Dr. Arnold Kegel, Gladser Studio, 1953)

A Brief Recap from Last Week

In the 1940s, the seminal work of Los Angeles gynecologist Dr. Arnold Kegel resulted in pelvic floor exercises achieving the stature and acclaim that they deserved. His legacy is the name that many use to refer to pelvic exercises—“Kegels” or “Kegel exercises.” Despite Kegel’s pelvic regimen proving effective for many female pelvic issues (pelvic relaxation, vaginal laxity and sexual issues, urinary leakage, etc.) what came to be referred to as Kegel exercises in the post-Kegel era had little resemblance to what he so brilliantly described in his classic series of medical articles sixty-five years ago. His regimen incorporated a critical focus and intensity that were unfortunately not upheld in most of the pelvic floor muscle training programs that followed his reign.

The Pelvic (Kegel) Revolution

After years of “stagnancy” following the transformative work of Dr. Arnold Kegel, there is a resurgence of interest in the pelvic floor and in the benefits of pelvic floor training. In 2016, we are in the midst of a pelvic floor “sea change” that is gaining momentum and traction. There is increasing recognition of pelvic floor dysfunction (when pelvic floor function goes awry) as the root cause for a variety of pelvic issues including pelvic organ prolapse, stress urinary incontinence, overactive bladder, sexual dysfunction and pelvic pain syndromes. There is an evolution in progress with respect to management of pelvic floor dysfunction, including “smart” pelvic floor muscle programs that are tailored to the specific pelvic floor dysfunction, the advent of a host of novel, high-technology pelvic floor training resistance devices and the expanding use of a specialty niche of physical therapy—pelvic floor physical therapy.  Of note, pelvic floor physical therapy has been popular in Europe for many years and it is only recently that its utility has been recognized in the USA. (I am grateful for the wonderful services provided by my pelvic physiotherapy colleagues who have been so helpful and beneficial for many of my patients with pelvic floor dysfunctions.)

It is my belief that the next few years will bear witness to continued advances in pelvic floor muscle training and focus that will restore pelvic training to the classic sense established by Arnold Kegel—a “renaissance” to a new era of “pelvic enlightenment.” Books such as The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health (www.TheKegelFix.com) introduce new-age, next-generation pelvic programs—progressive, home-based, tailored exercise programs consisting of strength, power and endurance training regimens—designed and customized for each specific pelvic floor dysfunction. 2016 will usher in the availability of high quality follow-along pelvic training programs, e.g., the PelvicRx (www.PelvicRx.com)—a comprehensive, interactive, FDA-registered training regimen accessible via DVD or streaming. Furthermore, based upon Dr. Kegel’s perineometer resistance device, technological advances have resulted in the emergence of numerous pelvic floor muscle training devices, many of which are sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. Although most provide the same basic functionality—insertion into the vagina, connection to a smartphone app, biofeedback and tracking—each has its own unique features. This market for resistance devices is evolving at a remarkably rapid pace.

Another major refinement is the concept of functional pelvic fitness—teaching patients how to put their pelvic knowledge and skills to real life use with practical and actionable means of applying pelvic muscle proficiency to daily tasks and common everyday activities, an area that has been sorely neglected in the past, with prior emphasis solely on achieving a conditioned pelvic floor.

An additional element of the pelvic revolution is the increasing awareness and acceptance by the urological-gynecological-gastrointestinal community of the concept that stress and other psychosocial factors can give rise to physical complaints such as pelvic floor tension myalgia, a condition in which the pelvic floor muscles exist in an over-contracted, painful state. At one time, this diagnostic entity was not even a consideration; however, an understanding of this condition is slowly gaining recognition and traction and there is a burgeoning understanding that many pelvic pain issues (interstitial cystitis/chronic pelvic pain syndrome, prostatitis, irritable bowel syndrome, fibromyalgia, endometriosis, etc.) can, in actuality, be manifestations of pelvic floor hyper-contractility and over-tensioning.

Pelvic floor physical therapy has become and will continue to be increasingly in vogue. This specialized branch of physical therapy that deals with pelvic floor issues treats a wide range of pelvic floor dysfunctions ranging the gamut from pelvic muscle weakness to pelvic muscle over-tensioning. Pelvic floor physical therapy sessions can be of great help for those with pelvic floor dysfunctions and it is clear that patients do better with supervised regimens than they do without. Pelvic physical therapy is particularly useful for pelvic pain syndromes. In France, the government subsidizes the cost of post-partum pelvic training (“La rééducation périnéale après accouchement”), including up to 20 sessions of pelvic PT intended to tone and “re-educate” the postnatal pelvic muscles.

The final piece of the pelvic revolution is the broadening appreciation that pelvic floor muscle training in males is no less important than in females, potentially beneficial in the management of stress urinary incontinence that follows prostatectomy, overactive bladder, post-void dribbling, erectile dysfunction, premature ejaculation and pelvic pain due to pelvic muscle spasm.

Future Considerations

Demand for the management of pelvic floor disorders will increase over the next decade. There is major growth opportunity for services that utilize non-physician providers (nurse practitioners, physician assistants and physical therapists) to teach patients pelvic muscle training and other behavioral treatments.

If Arnold Kegel were alive today, in all likelihood he would take great pleasure and pride in the breath of life being infused into his seminal work following decades of dormancy. His legacy and the fertile ground and transformative changes nurtured by his pioneering efforts will result in the continued empowerment of patients, with improvement in their pelvic health and quality of life.

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– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo (paperback edition will be available May 2016).

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food   

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 code “UROLOGY10” at checkout for 10% discount. 

 

A Brief History of Kegel Exercises

April 16, 2016

Andrew Siegel MD  4/16/16

This first piece (of a two-part entry) reviews the history of pelvic floor training from antiquity up to 2015. The second piece (the 4/23/16 entry) is a discussion of the Kegel “renaissance” and “revolution” that is underway. This “sea change” in pelvic floor medicine that is currently evolving in the urology/gynecology medical community will most certainly permeate into the mainstream in the near future.

Muscles_of_the_male_perineum-Gray406Gray408

His and hers pelvic floor muscles (Dr. Henry Gray, Gray’s Anatomy, 1918, public domain)

The pelvic floor muscles have long been recognized as instrumental for their roles in  pelvic organ support, healthy sexual functioning and for their contribution to urinary and bowel control. They also contribute to core stability and postural support. The pelvic muscles anatomically and functionally link the female pelvic organs—the vagina, uterus, bladder and rectum—and also affect the independent function of each. Pelvic muscle “dysfunction” (when the pelvic muscles are impaired and not functioning properly) in females can contribute to pelvic organ prolapse and vaginal looseness, urinary and bowel control problems, sexual issues and pelvic pain (tension myalgia). Pelvic floor dysfunction in males can play a role in the urinary incontinence that follows prostate cancer surgery, dribbling of urine after the completion of urination, erectile dysfunction, ejaculation issues and pelvic pain.

Pelvic floor muscle fitness is vital to healthy pelvic functioning and pelvic muscle training therefore plays an important role in the management of many pelvic conditions. Pelvic muscle training has the potential of not only treating pelvic floor dysfunction, but also delaying and preventing its onset.

Pelvic floor exercises date back over 6000 years ago to Chinese Taoism. The Yogis of ancient India practiced pelvic exercises, performing rhythmic contractions of the anal sphincter muscle (one of the pelvic floor muscles). Hippocrates and Galen described pelvic exercises in ancient Greece and Rome, respectively, where they were performed in the baths and gymnasiums and were thought to promote longevity as well as general health, sexual health and spiritual health.

However, for millennia thereafter, pelvic floor exercises fell into the “dark.” Fast-forward to the 1930s when Margaret Morris, a British physical therapist, described pelvic exercises as a means of preventing and treating urinary and bowel control issues. In the 1940s, the seminal work of Dr. Arnold Kegel resulted in pelvic floor exercises achieving the stature and acclaim that they deserved. Dr. Kegel wrote four classic articles that put the pelvic floor muscles and the concept of training them to achieve pelvic fitness “on the map.” Kegel’s legacy is the actual name that many use to refer to pelvic exercises—“Kegels” or “Kegel exercises.” Kegel determined that a successful program must include four elements: muscle education, feedback, resistance, and progressive intensity. He stressed the need for pelvic floor muscle training as opposed to casual exercises, emphasizing the importance of a diligently performed routine performed with the aid of an intra-vaginal device known as a perineometer to provide both resistance (something to squeeze against) and biofeedback (to ensure that the exercises were being done properly).

Despite Kegel’s pelvic regimen proving effective for many female pelvic issues, what is currently referred to as Kegel exercises bears little resemblance to what he so brilliantly described in his classic series of medical articles sixty-five years ago. His regimen incorporated a critical focus and intensity that are unfortunately not upheld in most of today’s programs.

In the post-Kegel era, we have experienced a regression to the Dark Ages with respect to pelvic training. Easy-to-follow pelvic exercise programs or well-designed means of enabling pelvic exercises to improve pelvic floor health have been sorely lacking in availability. The programs that are out there typically involve vague verbal instructions and a pamphlet suggesting a several month regimen of ten or so pelvic contractions squeezing against no resistance, to be done several times daily during “down” times. These static programs typically do not offer more challenging exercises over time. Such Kegel “knockoffs” and watered-down, adulterated versions—even those publicized by esteemed medical institutions—are lacking in guidance, feedback and rigor, demand little time and effort and often ignore the benefit of resistance, thus accounting for their ineffectiveness. With women often unable to identify their pelvic muscles or properly perform the training, outcomes are less than favorable and the frustration level and high abandonment rate with these regimens is hardly surprising.

Bottom Line: In the post-Kegel era, pelvic floor muscle training has been an often ignored, neglected, misunderstood, under-respected and under-exploited resource.

Coming next week: The Kegel Revolution

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– newly available on Amazon Kindle (paperback and Apple iBooks, B&N Nook and Kobo editions will be available in May 2016).

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food   

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

When Ejac-“elation” Becomes Ejac-“frustration”

February 13, 2016

Andrew Siegel MD  2/13/2016

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(Fireworks, 8/2007, author AngMoKio)

In the arena of male sexual dysfunction (MSD), ejaculation problems play second fiddle to erectile dysfunction (ED). Today’s entry explores common issues with ejaculation other than premature ejaculation, which I have previously addressed: https://healthdoc13.wordpress.com/tag/premature-ejaculation/

What my patients tell me: 

“It takes me too long.”

 “I can’t ejaculate.”

 “It happens, but not much fluid comes out.”

 “It just dribbles out with no force.”

 “I barely know that it happened; I just don’t get the same feeling that I used to.”

One would think that MSD is the same as ED, which seems to get all the press. However, MSD is more complex and all-encompassing than having soft or short-lived erections, which is just one aspect of MSD. Sex drive (libido) is an important part of the picture. Ejaculation is another vital component. With regard to ejaculatory issues, premature ejaculation (rapidly achieving climax) gets all the attention. However, there are other ejaculatory issues that contribute in a major way to MSD.

The processes of having an erection and ejaculating are separate, even though they usually occur at the same time. However, it is possible to have a rock-hard erection and be unable to ejaculate, and conversely, to ejaculate with a limp penis. Regardless, it sure is nice when the two processes harmonize. All things being equal, with a good quality erection, ejaculation will be more satisfying.

Why is ejaculation better with a rigid erection than without?

The urethra (tube within the penis that conducts semen) is the “barrel” of the penile “rifle.” It is surrounded by spongy erectile tissue called the corpora spongiosum (“spongy body”) which constricts and pressurizes the “barrel” to optimize ejaculation and promote the forceful expulsion of semen, the “ammo.” The word ejaculation derives from ex, meaning out + jaculari, meaning to throw, shoot, hurl, cast for a good reason!

Additionally, the pelvic floor muscles play a key role in the process of ejaculation. The bulbocavernosus (BC) is a compressor muscle that surrounds the spongy body and at the time of ejaculation it contracts rhythmically, sending wave-like pulsations rippling down the urethra to forcibly propel the semen in an explosive eruption, providing the horsepower for forceful ejaculation. This BC muscle engages when you have an erection and becomes maximally active at the time of ejaculation.

Issues with ejaculation are extremely common complaints among middle-aged and older men. These are often bothersome and distressing, and include the following:

  • Delayed ejaculation
  • Absent ejaculation
  • Skimpy ejaculation volume
  • Weak ejaculation force and arc
  • Diminished ejaculatory sensation

Ejaculatory problems often correlate with aging, weight gain, the presence of lower urinary tract symptoms and ED. The older you are, the heavier you are, the more that you are having problems with urination and obtaining/maintaining an erection, the greater the likelihood that you will also have ejaculatory problems. This is often on the basis of an age-related decline of sensory nerve function as well as weakened pelvic floor muscles. Additionally, aging reproductive glands produce less fluid and the ducts that drain genital fluids can obstruct. Furthermore, medications that are used to treat prostate enlargement can profoundly affect ejaculatory volume.

So What’s The Big Deal Anyway?

Most men do not appreciate meager, lackadaisical-quality ejaculations and orgasms. Sex is important and getting a rigid erection is vital, but the culmination—ejaculation and orgasm—is equally important. We may be 40, 50, 60 years old or older, but we still want to point and shoot like we did when we were 20 and desire to retain that intensely pleasurable feeling of yesteryear.

Delayed Ejaculation

I have previously addressed this topic:

https://healthdoc13.wordpress.com/2015/02/21/im-almost-there-what-you-need-to-know-about-delayed-ejaculation/

Absent Ejaculation

This is part of the spectrum of delayed ejaculation, except in this instance, climax is never achieved. Alternatively, it happens with surgical removal of the reproductive organs, as occurs with radical prostatectomy or radical cystectomy for prostate and bladder cancer, respectively.  It can also occur in the presence of  neuropathy, e.g., with diabetes and other neurological disorders. In these circumstances, orgasm can still be experienced, although ejaculation is absent.

Skimpy Ejaculation Volume

This is very common with aging as the reproductive organs “dry out” to some extent. It also happens with certain medications that either reduce reproductive gland secretions (Proscar, Avodart) or cause some of the ejaculate to go backwards into the urinary bladder (Flomax, Rapaflo, Uroxatral).

Weak Ejaculation Force, Arc and Sensation

What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated in a arc several feet in length gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis.  These issues clearly correlate with aging, weakened pelvic floor muscles and ED.

Bottom Line: In addition to sex drive issues, erectile dysfunction and premature ejaculation, there are a spectrum of other male sexual problems that are bothersome and distressing.  With aging, weight gain and weakening of the pelvic floor muscles, ejaculation and orgasm often become less spirited, with diminished volume, force and trajectory. However, there are solutions!

 To Optimize Ejaculation:

  1. Maintain a healthy lifestyle: good eating habits, healthy weight, engage in exercise, obtain adequate sleep, consume alcohol in moderation, avoid tobacco and minimize stress.
  1. Pelvic floor muscle training: Whereas a weakened BC muscle may result in semen dribbling with diminished force or trajectory, a strong BC can generate powerful contractions to forcibly ejaculate semen. Keep the BC and the other pelvic floor muscles fit through pelvic floor muscle exercises.

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.

“Un-Juiced”: When Ejaculation Goes South

March 27, 2015

Andrew Siegel MD   3/21/15

shutterstock_side view manjpeg

There is scarce medical literature on ejaculatory problems aside from those of ejaculatory timing issues (premature and delayed ejaculation) and hematospermia (blood in the semen). Despite being given short shrift in medical academia, not a day goes by in my clinical urology practice where I do not see at least several patients who complain of declining ejaculation function.

What Is The Origin Of The Word “Ejaculation”?

Ejaculation derives from ex, meaning “out”  and jaculari, meaning “to throw, shoot, hurl, cast.”

Trivia: You do not need an erection to ejaculate and achieve an orgasm. A limp penis cannot penetrate, but is eminently capable of ejaculation and orgasm.

If  “Semen” Or “Ejaculate” Is Too Medical For You:

The most popular slang is “cum.” It originates from the expression “come to climax” shortened to “come” and ultimately to “cum,” but not to be confused with the Latin “cum,” e.g., I graduated summa cum laude or the word meaning “along with being,” e.g., my basement-cum-gym! “Jizm,” “jism,” and “jizz” are also popular and are not to be confused with other         “–ism” words that mean a doctrine, e.g., socialism and capitalism! We cannot forget “splooge,” “spooge,” “spunk,” “wad,” “nut,” “load” and “man juice.”

What Happens To Ejaculation As We Age?

Ejaculation and orgasm often become less intense, with diminished force, trajectory and volume of semen. What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated in an arc several feet in length gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis.

Fact: I have never heard a patient complain that his penis is too large, nor have I ever heard anyone protest that his ejaculate volumes are too abundant.

Fact: The pervasive porn industry–where many male stars are hung like horses and whose penises seem capable of ejaculating flooding pools of semen– has given the average guy a bit of a complex.

So What’s The Big Deal?

Men don’t appreciate meager, lackadaisical-quality ejaculations and orgasms. Sex is important to many of us and getting a good quality rigid erection is foremost, but the culmination—ejaculation and orgasm—is equally vital. We may be 40 or 50 years old or older, but we still want to point and shoot like we did when we were 20. As the word origin indicates, we desire to be able to shoot out, hurl or cast like an Olympian Master Blaster and we yearn for that intensely pleasurable feeling of yesteryear.

Ejaculation Science 101

Sexual climax consists of three phases—emission, ejaculation, and orgasm. When the intensity and duration of sexual stimulation surpasses a threshold, emission occurs, in which secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. During ejaculation the pelvic floor muscles contract rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen in a pulsating and explosive eruption. Orgasm is the intense emotional excitement that accompanies the physical act of ejaculation.

Big Head Versus Little Head

Ejaculation is an event that takes place in the penis; orgasm occurs in the brain. The process of emission and ejaculation is actually a very complex and highly coordinated neurological event involving several specific centers in the brain (amygdala, thalamus and other areas), spinal cord and peripheral nervous system.

What’s Makes Up The Reproductive Juices?

Less than 5% of the volume of semen is actually sperm and the other 95+% is a cocktail of genital juices that provide nourishment, support and safekeeping for sperm. 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid (pre-come) that has a lubrication function.

What’s Normal Volume?

The average ejaculate volume is 2-5 cc (one teaspoon is the equivalent of 5 cc). While a huge ejaculatory load sounds like a good thing, in reality it can cause infertility. The sperm can literally “drown” in the excessive seminal fluid.

Why Does The Seminal Tank Dry With Aging?

As we age, there are changes in the reproductive organs, particularly the prostate gland, one of the few organs in the body that enlarges as we get older. The aging prostate and seminal vesicles produce less fluid; additionally the ducts that drain the genital fluids can become blocked. In many ways, the changes in ejaculation parallel the changes in urination experienced by the aging male. Many medications that are used to treat prostate enlargement profoundly affect ejaculatory volume. Additionally, the pelvic floor muscles—which play a vital role in ejaculation—weaken with aging.

What About Those Pelvic Floor Muscles?

The pelvic floor muscles play a key role in ejaculation. The bulbocavernosus muscle (BC) is the motor of ejaculation, which supplies the “horsepower.” The BC surrounds the inner, deepest portion of the urinary channel. It is a compressor muscle that during sex engorges the spongy erection chamber that surrounds the urethra and also engorges the head of penis. At the time of climax, the BC expels semen by virtue of its strong rhythmic contractions, allowing ejaculation to occur and contributing to orgasm. A weakened BC muscle may result in semen dribbling with diminished force or trajectory, whereas a strong BC can generate powerful contractions that can forcibly ejaculate semen at the time of climax. 

How To Get The Juices Flowing Again?

Pelvic floor muscle training can be useful to improve the dynamics of ejaculation. The stronger the BC, the better the capacity for engorgement of the erection chamber that envelopes the urethra and the higher the ejaculatory horsepower, resulting in optimized urethral pressurization and ejaculation. The intensified ejaculation resulting from a robust BC can enhance the orgasm that accompanies the physical act of ejaculation.

Wishing you the best of health,

2014-04-23 20:16:29

AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in your email in box 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: http://www.MalePelvicFitness.com

Co-creator of Private Gym pelvic floor muscle training program for men: www.PrivateGym.com Gym—also available on Amazon

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 muscle 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 maximal opportunity for gains through its patented resistance equipment.

5 Things You Can Do To Cure Post-Void Dribbling (PVD)

March 20, 2015

Andrew Siegel MD 3/21/15

“No matter how much you shake and dance,

The last few drops end up in your pants.

PVD

PVD is “after-dribbling” of urine that is more annoying and embarrassing than serious. Although it commonly occurs after age forty, it can happen to men at any age.  Immediately or shortly after completing urination, urine that remains pooled in the urethra (tubular channel that conducts urine) drips out, aided by gravity and movement.

One specific pelvic floor muscle (PFM) is responsible for ejecting the contents of the urethra, whether it is urine after completing urination or semen at the time of sexual climax. With aging and loss of PFM strength and tone, both PVD and ejaculatory dysfunction may occur. The specific muscle responsible for ejecting the contents of the urethra is the bulbocavernosus muscle, which compresses the deep, inner portion of the urethra to function as the “urethral stripper.” In fact, the 1909 Gray’s Anatomy textbook referred to this muscle as the “ejaculator urine.”

Factoid: Dr. Grace Dorey published the landmark article in the British Journal of Urology that proved the effectiveness of PFM exercises for erectile dysfunction (ED), but also demonstrated an association between the occurrence of ED and PVD. She essentially showed that ED and PVD are linked and parallel issues, one sexual and the other urinary—both manifestations of PFM weakness, and both treatable by PFM exercises.

Factoid: Dr. Grace Dorey wrote the foreword to my book, Male Pelvic Fitness: Optimizing Sexual and Urinary Health. She also serves as a board member at Private Gym and helped design the Private Gym male pelvic floor training program for men.

What To Do About PVD?

  • PFM training has been proven to be an effective remedy for PVD, with the premise that a more powerful BC muscle will help the process of ejecting the contents of the urethra. Not only will PFM training optimize emptying the urethra, but it also has collateral benefits of improving erections and ejaculation.
  • Try not to rush urination. Urologists interpret “Haste makes waste” as “Haste makes PVD.”
  • When you are finished urinating, vigorously contract your PFMs to displace the inner urethra’s contents. By actively squeezing the PFM by using the Private Gym “rapid flex” technique—3-5 quick pulsations—the last few drops will be directed into the toilet and not your pants.
  • If necessary, PFM contractions can be supplemented with manually compressing and stripping the urethra, but this is usually unnecessary since the PFM—particularly when conditioned—are eminently capable of expelling the urethral contents. To strip the urethra, starting where the penis meets the scrotum, compress the urethra between your thumb on top of the penis and index and middle fingers on the undersurface and draw your fingers towards the penile tip, “milking” out any remaining urine.
  • Gently shake the penis until no more urine drips from the urethra. Apply a tissue to the tip of the penis to soak up any residual urine.

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.

10 Myths About Kegel Exercises: What You Need to Know

November 14, 2014

Andrew Siegel, M.D.

 

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Myth: Kegels are just for the ladies.

Truth: Au contraire…men have essentially the same pelvic floor muscles as do women and can derive similar benefits to sexual, urinary, and bowel health.

 

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

Truth: If you can stop your stream, it is indeed proof that you are contracting the proper set of muscles. However, this is just a means of feedback to reinforce that you are employing the right muscles, but the bathroom should not be your Kegel muscle gymnasium.

 

Myth: You should do Kegel exercises as often as possible.

Truth: Pelvic floor muscle exercises strengthen and tone the pelvic floor muscles and like other muscle-strengthening routines, should not be performed every day. Pelvic exercises should be done in accordance with an intelligently designed plan of progressively more difficult and challenging exercises that require rest periods in order for optimal muscle growth and response.

 

Myth: You can and should do Kegels anywhere (while stopped in your car at a red light, waiting in line at the check out, while watching television, etc.)

Truth: Exercises of the pelvic floor muscles, like any other form of exercise, demand gravitas, focus, and isolation of the muscle group at hand. 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 cannot integrate the exercises into the activities of daily living.

 

Myth: Holding the pelvic floor muscles tight all the time is desirable.

Truth: Not a good idea…the pelvic floor muscles have natural tone to them and when you are not actively engaging and exercising them, they should be left to their own natural state. There exists a condition—tension myalgia of the pelvic floor muscles—in which there is spasticity, tightness and pain due to excessive tension of these muscles. Pelvic floor training in this circumstance must be done with caution in order to avoid aggravating the pain, but maximal muscle contraction can induce maximal muscle relaxation, a meditative state between muscle contractions.

 

Myth: Focusing on your core is enough to ensure pelvic floor muscle fitness.

Truth: The pelvic floor muscles do form the floor of the “core” group of muscles and get some workout whenever the core muscles are exercised. However, for maximum benefit, specific focus needs to be made on the pelvic floor muscles. In Pilates and yoga, there is an emphasis on the core group of muscles and a collateral benefit to the pelvic floor muscles, but this is not enough to achieve the full potential fitness of a regimen that focuses exclusively on the pelvic muscles.

 

Myth: Kegel exercises do not help.

Truth: Au contraire…pelvic floor muscles have proven to help a variety of pelvic maladies in each gender. In females, pelvic floor muscle training can help urinary and bowel incontinence, pelvic relaxation, and sexual dysfunction. In males, pelvic floor muscle training can help incontinence (stress incontinence that follows prostate surgery, overactive bladder, and post void dribbling), erectile dysfunction, premature ejaculation and other forms of ejaculatory dysfunction as well as help bowel incontinence and tension myalgia of the pelvic floor.

 

Myth: Kegels are only helpful after a problem surfaces.

Truth: No, no, no. As in any exercise regimen, the best option is to be proactive and not reactive in order to maintain muscle mass and strength in order to prevent problems from arising before they have an opportunity to do so. Pelvic floor muscle training done during pregnancy can help prevent pelvic issues from arising in females and pelvic muscle training in males can likewise help prevent the onset of a variety of sexual and urinary maladies. There is no better time than the present to start pelvic exercises to delay or prevent symptoms.

 

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

Truth: No, “use it or lose it” applies here as it does in any muscle-training regimen. Muscles adapt positively to the stresses and resistances placed upon them and so they adapt negatively to a lack of stresses and resistances. “Disuse atrophy” is a possibility with all muscles, including the pelvic floor muscles.

 

Myth: It is easy to learn how to isolate and exercise the pelvic floor muscles.

Truth: No, not the case at all. Studies have shown that over 70% of women who think they are doing pelvic floor muscle exercises properly are actually contracting other muscles, typically the rectus, the gluteal muscles, and the adductor muscles of the thigh. One of the greatest challenges is that there have been no well-designed, easy-to-follow pelvic muscle training programs…UNTIL NOW! The Private Gym Company was established after recognizing that there was an unmet need for a means by which a pelvic floor muscle-training program could be made accessible and available in the home setting. This comprehensive, interactive, follow-along exercise program is available on DVD…PrivateGym.com.

 

Myth: Kegels can adversely affect your sex life.

Truth: Absolutely not… In both genders, pelvic floor muscle training has been found to improve sexual function. The pelvic floor muscles play a critical role in both female and male sexuality, supporting clitoral and penile erections as well as ejaculation in males and orgasm in both genders.

 

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