Posts Tagged ‘Erectile rigidity’

What’s Your E.Q. (Erection Quotient)?

April 28, 2018

Andrew Siegel, M.D.  4/28/18

shutterstock_side view manjpeg

The S.H.I.M. test is the “Sexual Health Inventory for Men.”  It is a simple 5 question test that urologists use to subjectively test for the presence and extent of erectile dysfunction (ED).  It is commonly used metric for screening, diagnosing and determining the severity of ED in clinical practice and research.  It is very useful before prostate cancer surgery to obtain a baseline appraisal of the presence, rigidity, durability and functionality of one’s erection.


Go ahead and test your own erection quotient.  For each question, note your answer by circling the number that best describes your function.
 Add the numbers together and refer to the table below to see what your score may mean.

Over the past 6 months:

How do you rate your confidence that you could get and keep an erection?

  1. Very low
  2. Low
  3. Moderate
  4. High
  5. Very high

When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

  1. Almost never/never
  2. A few times (less than half)
  3. Sometimes (about half)
  4. Most times (much more than half)
  5. Almost always

During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

  1. Almost never/never
  2. A few times (less than half)
  3. Sometimes (about half)
  4. Most times (much more than half)
  5. Almost always

During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

  1. Almost never/never
  2. A few times (less than half)
  3. Sometimes (about half)
  4. Most times (much more than half)
  5. Almost always

 When you attempted sexual intercourse, how often was it satisfactory for you?

  1. Almost never/never
  2. A few times (less than half)
  3. Sometimes (about half)
  4. Most times (much more than half)
  5. Almost always


SHIM scoring:

The SHIM score is the numerical sum of the responses to the 5 items.

22-25: No erectile dysfunction

17-21: Mild erectile dysfunction

12-16: Mild to moderate erectile dysfunction

8-11: Moderate erectile dysfunction

5-7: Severe erectile dysfunction


Erectile Rigidity: “A Perfect Storm”

December 13, 2014


Andrew Siegel MD   12/13/14

**Note: Although the following blog is written primarily for men, it is equally relevant to females. Since the penis and clitoris are homologous organs, whenever you see “penis” you can substitute “clitoris.”

Last week’s blog reviewed how the penis is one of the most “magical” of organs—how it is uniquely capable of transforming its shape, size and constitution in a matter of nanoseconds. The take home message was that the remarkable upsurge is possible because inflow of blood to the penis is maximized while outflow is minimized, resulting in penile blood pressures that far exceed arterial blood pressure.

Rigid erections can only occur when there is a “perfect storm” of events. First, the arterial blood flow to the penis needs to increase substantially (pre-penile event). Second, smooth muscle within the arteries and the spongy sinuses of the erectile chambers of the penis must relax to allow engorgement with blood (penile event). Third, the pelvic floor muscles must engage to turn the swollen penis into a rigid penis (post-penile event). The blood pressure in the penis resulting from the inflow of blood alone–in the absence of the contribution from the pelvic floor muscles–cannot exceed systolic blood pressure, so the pelvic floor muscles play a vital role with respect to penile rigidity and durability of erections.

So, when erections go south, it comes down to failure in one or more of the three events,  pre-penile, penile, or post-penile.


Pre-penile ED

The problem lies within the arterial blood supply to the pelvis, which is not capable of delivering enough blood flow to fill the penis. Typically, the pelvic arteries are clogged with fatty plaque (atherosclerosis), which is often due to an unhealthy lifestyle: poor diet, physical inactivity, being overweight and use of tobacco. Diabetes is a very common cause of impaired blood flow (although it also affects the nerve supply in an adverse way). Insufficient blood flow may also occur because of the blood pressure lowering effect of blood pressure medications.

Solution to Pre-penile ED: Lifestyle “angioplasty”— getting down to “fighting” weight, adopting a heart-healthy (and penis-healthy diet), exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—all common sense measures to improve all aspects of health in general and blood vessel health in particular.


Penile ED

The problem lies within the penis itself. Because of poorly functioning smooth muscle within the arteries and spongy sinuses of the erectile chambers, the penis cannot properly swell up with blood. This smooth muscle cannot relax enough to allow blood flow to inflate the penis and pinch off the venous drainage. This failure of relaxation of the smooth muscle in the penile arteries and spongy sinuses parallels the failure of relaxation of smooth muscle in our arteries that causes high blood pressure (“essential” hypertension). Loss of this smooth muscle and scarring can also happen with aging, following prostate cancer surgery, from Peyronie’s disease or because of disuse atrophy.

Solution to Penile ED: Age-related malfunctioning smooth muscle and scarring is a difficult issue to manage. However, lifestyle measures can be helpful as well as adopting a “use it or lose it” attitude towards erectile function—exercising the penis via regular sexual activity will actually help its continued functioning and health of the smooth muscle of the penile arteries and spongy sinuses.


Post-Penile ED

 The problem is weakened pelvic floor muscles. These feeble muscles are incapable of compressing the roots of the penis sufficiently to increase the blood pressure in the penis to the levels needed for full erectile rigidity.

Solution to Post-Penile ED: Pelvic floor muscle training to improve the strength, tone and endurance of the pelvic floor muscles will optimize erectile rigidity and durability.


Wishing you the best of health,

2014-04-23 20:16:29


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”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Co-creator of Private Gym pelvic floor muscle training program for men  

Exercise Your Penis…REALLY?

September 2, 2014

Andrew Siegel M.D.   Blog # 170


Your penis is an organ that wears many hats. It directs your urinary stream with sometimes laser-like precision (although this precision goes to pot as you age); when erect it allows for vaginal penetration; and at the time of climax, it permits passage of sperm to reproduce the species. Pretty remarkable in terms of its multi-functionality and handiness, similar to a Swiss Army knife, but really so much better! In terms of sexuality and fertility, the ability to achieve an erection is a must, and this is predicated on an adequate penile blood flow, which is the “rocket fuel” of penile erections.

Your ability to obtain penile rigidity is a matter of hydraulics—maximizing inflow of blood while minimizing outflow. I need to get a bit medical to explain this: Your penis contains 3 erection chambers that fill with blood. They are composed of sinuses, virtually identical to our nasal sinuses, and an erection occurs when the sinuses become congested with blood. Blood inflow is caused by smooth muscle relaxation in the penile arteries and in the sinuses. As the sinuses fill up, they compress the penile veins to block the outflow of blood. And hence you have a tumescent penis, plump, but not yet rigid.

So how do you go from plump to rigid? The pelvic floor muscles are the key players in the transformation from a tumescent penis to a rigid penis. They compress the deep, inner part of your penis, creating rigidity by aiding closure of veins and by elevating the blood pressure within your penis so that it is well above systolic blood pressure. An erect penis is a hypertensive penis (really a very good thing), and it is this tremendous pressure that causes bone-like rigidity. If this penile blood pressure at the time of a rigid erection were experienced in the arteries of your body, it would be considered a hypertensive crisis! So, the only organ in the body in which high blood pressure is not only healthy, but also desirable, is your penis.

With aging, the smooth muscle of all of our arteries tends to become stiffer and less able to relax, resulting in high blood pressure (a very bad thing) for many of us. The penis is not spared, as the smooth muscle of the penile arteries and sinuses stiffens and is less able to relax. Unfortunately, stiff smooth muscle in the penis does not lead to a stiff penis…in fact, quite the opposite. Additionally, our pelvic floor muscles weaken with age, like many of our skeletal muscles. Between the smooth muscle stiffening and the weakened pelvic floor muscles, we have the perfect storm for ED.

Where are your pelvic floor muscles? They are located between the scrotal sac and the anus, the saddle region where your body is in contact with a bicycle seat. In the 1940s, gynecologist Dr. Arnold Kegel popularized pelvic floor muscle exercises (“Kegels”) in women to improve their sexual and urinary health. Men have similar pelvic floor muscles and an equivalent capacity for exercising them, with parallel benefits to sexual and urinary health. It’s high time that we demand equal pelvic rights!

Male pelvic floor muscle exercises date back to ancient times, having been described in ancient Greece and Rome by Hippocrates and Galen respectively. Performed in the baths and gymnasiums, these exercises were thought to promote general and sexual health, spirituality and longevity.

Most men are unfamiliar with pelvic floor muscles exercises, let alone with their pelvic floor muscles. Unfortunately, many physicians are not very knowledgeable regarding the pelvic floor and the benefits of fitness in this area, and do not see themselves as instructors of pelvic floor muscle training. Regrettably, our medical culture—heavy on prescription writing and surgery—does not typically promote lifestyle improvement and exercise programs such as pelvic floor training. I would like to explain to you why such exercises are well worth your time and effort.

There is exercise and then there is EXERCISE; for example, there is walking (moving is good) and then there is running with interval training (a great workout). When it comes to exercising your skeletal muscles, using resistance training—working against an opposing force—stresses your muscles to enhance strength, tone, power, durability and responsiveness. By gradually and progressively overloading the muscles working against the resistance, they will adapt by getting bigger and stronger. Imagine repetitively doing arm curls without weights as compared to doing curls with weights, in which case the added resistance will rapidly and effectively create muscle growth and accelerated strength.

Kegels 101 involves repetitions of pelvic floor contractions without resistance. How do you accelerate to Kegels 401—pelvic floor muscles with resistance? Dr. Kegel designed a resistance device for women called a “perineometer” that was inserted into the vagina to provide a means of squeezing against something and a way to measure the strength of the squeeze. Men don’t have a vagina, but they do have a rectum, and one way to do resistance training is to use a perineometer placed in the rectum. Not a very appetizing thought though, is it?

Remember that your pelvic floor muscles engage when you have an erection. When you contract these muscles, your penis magically lifts up towards the heavens with each contraction. Since the pelvic floor muscles govern this upward deflection, they can be challenged to lift up more than just the weight of your penis.

And thus was born the concept of the Private Gym resistance workout for men. Whereas the Private Gym’s Basic Training program strengthens the pelvic floor muscles with a series of progressive male Kegel exercises without resistance.


The Resistance Program uses resistance equipment to maximize pelvic floor muscle strengthening. The equipment consists of an ergonomic weighted base and magnetic weights that attach to the base. It is placed on your erect penis, which is raised up and down by contracting the pelvic floor muscles in accordance with the follow-along DVD program, subjecting the pelvic floor muscles to resistance. Your muscles will gradually and progressively adapt to the load placed upon them and will strengthen in accordance with the resistance



When one first hears about progressive resistance training for the penis, their reflex reaction is often: Are you kidding? Really? Seriously? REALLY? Weights for the penis? You must be joking! No way. When Dr. Arnold Kegel in the late 1940’s first proposed his concept of the perineometer that gets placed in the vagina in order to do progressive resistance exercises, he likely received many similar responses from both his patients as well as his medical colleagues. What, shove that up my vagina and squeeze? And this was the 1940’s, decades before the sexual revolution!

If one can discard their conservative prejudices and carefully consider the principle of resistance training for skeletal muscle adaptation, they will realize that resistance training for the pelvic muscles is no different than resistance training for any other skeletal muscle, a bona fide means of creating strength and endurance. Resistance training is a “boner-fide” (sorry—I couldn’t help myself) means of maximizing your pelvic floor muscle growth.

In terms of resistance training of the penis, the Private Gym clearly is superior and more user friendly and less invasive than using a rectal resistance device, with the limitation that it can only be used in those men who can obtain a sufficiently rigid erection, whether naturally, or with the help of pills such as Viagra, Levitra, Cialis and Stendra.

The Private Gym Company was established after recognizing that there was an unmet need for a means by which a pelvic floor muscle-conditioning program could be made accessible and available in the home setting. The premise behind the Private Gym is to help achieve pelvic floor fitness and optimize sexual and urinary health.

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.

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 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. 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. The Private Gym resistance turns conditioning into a weapon that is capable of producing “outstanding” erections, maximizing stamina, and tremendously boosting one’s confidence.

Bottom Line: Resistance training is utilized for creating strength and endurance for every group of skeletal muscles in the body, and the pelvic floor muscles should be no exception. The pelvic floor muscles are skeletal muscles and, just like the biceps and pectorals, they will adapt in a positive way to the resistance (load) placed upon them.


Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel, M.D.

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”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Private Gym: