Posts Tagged ‘erection’

Putting Some “Lead” In Your Pencil: A Fix For The “Innie” Penis

April 29, 2017

Andrew Siegel MD   4/28/2017

pencil pixbay

Thank you, Pixabay, for image above

As Multi-Functional as a Swiss Army Knife

The penis is an extraordinary organ with urinary, sexual and reproductive functions. The possession of a penis endows man with the ability to stand to urinate and direct his urinary stream, a distinct advantage over the clumsy apparatus of the fairer sex that generates a spraying, poor-directed stream that demands sitting down on a toilet seat. The advantage of being able to stand to urinate (and keep one’s body appropriately distanced from the horrors of many public toilets) is priceless. Although man does not often have to employ this, the capability (when necessary) of urinating outside is another benefit of our design.  Many find the outdoor voiding experience pleasing, observing the pleasant sounds and visuals of a forceful stream striking our target (often a tree) with finesse, creating rivulets and cascades to show for our efforts.

Getting beyond the urinary, the most dramatic penis magic is its ability to change its form in a matter of seconds, morphing into an erect “proud soldier” and enabling the wherewithal for vaginal penetration and with sufficient stimulation, for ejaculation.  All that fun, but really serving the purpose of the passage of genetic material and ultimately the perpetuation of our species…reproductive wizardry!

The water tap that could turn into a pillar of fire.”

Eric Gill

tap pixabay

pixabay pillar

Thank you, Pixabay, for images above

 

The Sometimes Cruel Process of Aging Does Not Spare the Penis

 “Getting older is an honor and a privilege, but getting old is a burden.”

Beverly Radow (my aunt, who will turn 90-years-old this year)

Long after our reproductive years are over and fatherhood is no longer a consideration, most men still wish to be able to achieve a decent-enough erection to have sexual intercourse.  As well, we still desire to be able to urinate standing upright with laser-like urinary stream precision.

However, the ravages of time (and poor lifestyle habits) can wreak havoc on penile anatomy and function.  Many middle-aged men typically gain a few pounds a year, ultimately developing a bit of a pubic fat pad–the male equivalent of the female mons pubis– and before you know it the penis appears shorter and becomes an “innie” as opposed to an “outie.”  In actuality, penile length is usually more-or-less preserved, with the penis merely hiding behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. This is why having a plus-sized figure is not a good thing when it comes to size matters.

Useful Factoid: The Angry Inch…It is estimated that there is a one-inch loss in apparent penile length with every 35 lbs. of weight gain.

One of the problems with a shorter and more internal penis is that the forceful and precise urinary stream of yesteryear gives way to a spraying and dribbling-quality stream that can drip down one’s legs, spray over the floor and onto one’s feet (and even at times towards or on the gentleman next to you at the urinal!).

Almost Useless Factoid: Water Sports…Turkey vultures pee on themselves to deal with the heat of the summer on their dark feathers, since they lack sweat glands.  By excreting on their legs, the birds use urine evaporation to cool themselves down in the process of “urohidrosis.”  Unless you are a turkey vulture, peeing on yourself or others is rather undesirable!

The solution to having a recessed penis that is often hidden from sight and has lost its aiming capabilities is to sit on the toilet bowl to urinate, joining the leagues of our female companions who are “stream-challenged” because of their anatomy.

With aging (and poor lifestyle habits) also comes declining sexual function and activity as rigid erections going by the wayside.  However, 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 and smaller penis that does not function like it used to.

Factoid: Disuse Atrophy…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.  Conversely, sexual intercourse on a regular basis protects against ED issues and the risk of ED is inversely related to the frequency of intercourse.

The point I am trying to hammer home is that aging, weight gain and poor lifestyle habits often render men with penises that are:

  1. Shrunken and recessed
  2. Unreliable in terms of ability to pee straight, requiring sitting down on the toilet bowl like women
  3. Unreliable with respect to sexual function

Factoid: Point 1 + Point 2 + Point 3 = EMASCULATION (depriving man of his male role and identity)

What To Do?

The first step is to keep one’s body (and penis) as healthy as possible via intelligent lifestyle choices. These include the following: smart eating habits; maintaining a healthy weight; engaging in exercise (including pelvic floor muscle training); obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction. The use of ED medications on a low-dose, daily basis can sometimes help all 3 issues.

In the event that the aforementioned means fail to correct the problem, a virtually sure-fire way of rectifying all three issues is by a simple surgical procedure.  Malleable penile implants (penile rods) are surgically placed into each erectile chamber of the penis (the two inner tubes of the penis that under normal circumstances fill with blood to create an erection). The implants act as skeletal framework for the penis (“bones” of the penis). Two USA companies, Coloplast and AMS (American Medical Systems) manufacture the rods that are in current use. They are very similar with subtle differences.

464x261_GenesisColoplast Genesis implant

AMS Spectra

American Medical Systems Spectra implant

The implant procedure of these two stiff-but-flexible rods into the erectile chambers of the penis is performed by a urologist on an outpatient basis.  Like shoes, the penile rods come in a variety of lengths and widths and fundamental to the success of the procedure is to properly measuring the dimensions of the erectile chambers in order to obtain an ideal fit. The small incision needed to implant the rods is closed with sutures that dissolve on their own. Healing typically takes about 6 weeks, after which sexual relations can be initiated.

An erection suitable for penetration and sexual intercourse is available 24-7-365, simply by bending the penis up. The penis is angled down for concealment purposes. It is flexible enough to be comfortably flexed up or down, while rigid enough for intercourse, the best of all worlds.

Print

Penile rods in action, bent down for concealment and up for urination and sex

Bottom Line:  It is not uncommon for aging, weight gain and unhealthy lifestyle factors to conspire to compromise penile anatomy and function with respect to apparent penile size, urinary stream precision and erectile rigidity.  This leaves one emasculated with a penis that is often concealed, shortened and habitually limp, impeding the ability to have sexual intercourse, as well as a spraying quality urinary stream necessitating sitting to urinate.  If lifestyle improvement measures do not correct the situation, literally and figuratively “putting some lead in your pencil” using a simple malleable penile implant can “kill three birds with one stone.” (I could not resist the very mixed metaphor.)  Confidence can be restored with the conversion of the “innie” penis to an “outie,” the ability to resume sexual intercourse and the reestablishment of a directed, non-spraying stream to permit standing to urinate.

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as 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 that is in such dire need of bridging.

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

Erection “Destiny”

December 24, 2016

Andrew Siegel MD  12/24/2016

Uninformed, uneducated and unprepared for the aging process, one has little choice but to passively observe and accept the gradual changes that unfold over time.  The purpose of this entry is to inform, educate and prepare you for the expectations of sexual function as you age.  Sadly, it is often not a pretty picture as aging can be unkind and Father Time does not spare sexual function.

Although erectile dysfunction (ED) is not inevitable, with each passing decade, more and more men join the ED club. All aspects of sexuality decline, although sexual interest suffers the least depreciation, leading to a swarm of men who are eager, but unable–a most frustrating combination. With aging there is typically less sexual activity, and with less sexual activity “disuse atrophy” in which the de-conditioned penis becomes smaller in stature and, in a vicious cycle, even less functional. The senior years also bear witness to the testicles dangling loosely like pendulous breasts of elderly women. Time and gravity are cruel conspirators.

shutterstock_side view manjpeg

A Few Definitions

Erection: The rigid state of the penis under circumstances of sexual stimulation.

Destiny: What the future has in store for you.

Erection Destiny: What the future has in store for your erection capabilities.

What Might Be In Store In The Future

The general trends that follow are structured by decade. Individuals may vary significantly from others in their age group, as “chronological” age is not the ultimate factor and may be trumped by “functional” age.  This guide was crafted after many years spent in the urology trenches, working the front line with thousands of patient interactions.

Age 18-30: Your sexual appetite is prodigious and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the scent of her perfume, merely the thought of her can fully arouse you. You get erections even when you don’t want them…if there was only a way to bank these for later in life! You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense, forceful and powerful. When you arise from sleep, it is not just you that has arisen, but also your penis.

It doesn’t get better than this…you are an invincible king… a professional athlete at the peak of his career! All right, maybe not invincible…you do have an Achilles heel—you may sometimes ejaculate prematurely because you are so hyper-excitable and at times in a new sexual situation you have performance anxiety, a mechanical failure brought on by your all-powerful mind dooming the capabilities of your exceptional plumbing.

Age 30-40: Changes occur ever so slowly, perhaps so gradually that they are barely noticeable. Your sex drive remains vigorous, but not as obsessive and all consuming as it once was. You can still get quality erections, but they may not occur as spontaneously, as frequently and with such little provocation as they did previously. You may require some touch to develop full rigidity. You still wake up in the middle of the night with an erection and experience “morning wood.” Ejaculations and orgasms are hardy, but you may notice some subtle differences, with your “rifle” being a little less powerful and of smaller caliber. The time it takes to achieve another erection after ejaculating increases. You are that athlete in the twilight of his career, seasoned and experienced, with the premature ejaculation of yonder years occurring much less frequently.

Age 40-50: After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion you had two decades earlier. You can usually get a pretty good-quality erection, but it now often requires touch and the rock-star rigidity of years gone by gives way to a firm penis, still suitable for penetration. The gravity-defying erections don’t have quite the upward angle they used to. At times you may lose the erection before the sexual act is completed. You notice that orgasms have lost some of their kick and ejaculation has become feebler than previously. Getting a second erection after climax is not only more difficult, but also may be something that you no longer have much interest in. All in all though, you still have some game left.

Age 50-60: Sex is still important to you and your desire is still there, but is typically diminished. Your erection can still be respectable and functional, but is not the majestic sight that it once was, and touch is often necessary for full arousal. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. A dribbling-quality ejaculation occurs with diminished volume and force, begging the question of why you are “drying up.” Orgasms are less intense and at times it feels like nothing much happened—more “firecracker” than “fireworks.” Getting a second erection is difficult, and you may find much more delight in sleeping rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity…sometimes just reserved for the weekends.

Age 60-70: “Sexagenarian” is a misleading word…more apt a term for the 18-30 year-old group, because your sex life doesn’t compare to theirs—they are the athletes and you the spectators. Your testosterone level has plummeted over the decades, probably accounting for your diminished desire. Erections are still obtainable with some coaxing, but they are not five star erections, more like three stars, suitable for penetration, but not the rigid flagpole of yonder years. They are less reliable, and at times your penis suffers with “attention deficit disorder,” unable to focus and losing its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime, and early morning erections become rare occurrences. Climax is not so climactic and explosive ejaculations are a matter of history. At times, you think you climaxed, but are unsure because the sensation was un-sensational. Ejaculation is down to a mere dribble. Seconds?…no thank you…that is reserved for helpings on the dinner table! Sex is no longer a recreational activity, but an occasional amusement.

Age 70-80: When asked about his sexual function, my 70-something-year-old patient replied: “Retired…and I’m really upset that I’m not even upset.”

You may still have some lingering sexual desire left in you, but it’s a far cry from the fire in your groin that you had when you were young. With physical coaxing and coercion, your penis can at times be prodded to rise to the occasion, like a cobra responding to the beck and call of the flute of the snake charmer. The quality of erections has noticeably dropped, with penile fullness without the rigidity that used to make penetration such a breeze. At times, the best that you can do is to obtain a partial erection that cannot penetrate, despite pushing, shoving and manipulating. Spontaneous erections have gone the way of the 8-track player. Thank goodness for discovering that even a limp penis can be stimulated to climax, so it is still possible for you to experience sexual intimacy, although the cli-“max” is more like a cli-“min.”

Age 80-90: You are now a full-fledged member of a group that has an ever-increasing constituency—the ED club. Although you as an octogenarian may still be able to have sex, most of your brethren cannot; however, they remain appreciative that at least they still have their penises to use as spigots, allowing them to stand to urinate, a distinct competitive advantage over the womenfolk. Compounding the problem is that your spouse is no longer a spring chicken and because she has likely been post-menopausal for many years, she has a significantly reduced sex drive and vaginal dryness, making sex downright difficult, if not impossible. If you are able to have sex on your birthday and anniversary, you are doing much better than most. To quote one of my octogenarian patients in reference to his penis: “It’s like walking around with a dead fish.”

Age 90-100: To quote the comedian George Burns: “Sex at age 90 is like trying to shoot pool with a rope.” You are grateful to be alive and in the grand scheme of things, sex is low on the list of priorities. You can live vicariously through pleasant memories of your days of glory that are lodged deep in the recesses of your mind, as long as your memory holds out. When and if you do get an erection, you never want to waste it!

Sometimes A Cigar Is More Than A Cigar

Although changes in sexual function are virtually inevitable with the aging process, a decline is sexual function can also be a “canary in the trousers”—an indicator that a underlying medical problem exists that is of greater significance than the ED. In other words, erection quality can serve as a barometer of cardiovascular health– rigid and durable erections a gauge of good cardiovascular health and ED often a clue of poor cardiovascular health. Since the blood flow to the small penile arteries (diameter 1-2 millimeters) is often compromised in ED, the larger coronary arteries (4 millimeters) may be affected as well—if not now, then at some point in the not-to-distant future. For this reason, men with ED should have a medical evaluation seeking arterial disease elsewhere in the body.

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

“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. 

Viagra, Levitra, Cialis or Stendra: Which ED Med Is Right For You?

July 1, 2016

Andrew Siegel MD  7/1/2016

IMG_1457(1)

Cartoon by my patient/artist Ben Blank given to me shortly after  Viagra became available in 1998.  It says it all!

There are lots of options available if you are having erection problems. In my humble opinion, healthy lifestyle measures should always be considered first-line: weight management, healthy eating, exercise (including cardio, strength, core and pelvic floor), sufficient sleep, avoidance of tobacco, excessive alcohol and excessive stress, etc. With respect to ED medications, there are now many choices. Today’s entry will discuss which of the ED meds is best for you.

How the Penis Erects

In an erotic situation, nerves to the penis release nitric oxide that then causes the release of cGMP, resulting in blood flooding into the erectile chambers of the penis, the basis of an erection. As the erection gets fuller, penile veins become compressed, limiting the exit of blood and ultimately the pelvic floor/perineal muscles engage to cause maximal erectile rigidity.

How the Penis Becomes Flaccid

After ejaculation, the enzyme PDE-5 (phosphodiesterase) is released, the chemical mediator of flaccidity. It results in decreased levels of cGMP, resulting in a loss of the erection and a return to flaccid status.

ED Meds

The ED medications include Viagra, Cialis, Levitra and Stendra. They work by inhibiting PDE-5 and are known as PDE-5 inhibitors. Effective for many men with ED, they result in enhanced erectile function, sexual satisfaction and quality of life.

They are taken orally, require some time to get absorbed and necessitate sexual stimulation to work effectively. Although they can result in some increase in penile fullness (tumescence) without sexual stimulation, sexual stimulation is a must in order to induce a fully rigid erection.

Although effective for many men, they will not work for everyone.  If there is significant nerve or vascular compromise to the penis, they will likely be ineffective. It is important to know that the same ED drug at the same dose may work variably depending on the particular time and situation, sometimes more effectively than at other times since there are so many factors that determine erectile rigidity.

Men who are taking nitrates of any kind should never use the ED meds or serious consequences may result, including a dramatic drop in blood pressure (Remember Jack Nicholson in “Something’s Gotta Give”?). All of these ED drugs are metabolized in the liver for breakdown by the body.

Viagra (Sildenefil) This was the first of the group, released in 1998. Dosed at 25, 50 or 100 mg, the half-life (the amount of time it takes for the blood level of the drug to drop by 50%) is about 4 hours. It is taken on demand and kicks in in 15-60 minutes and remains active for 4 or more hours.

Viagra trivia:  Viagra was discovered by chance. Pfizer scientists conducted a clinical trial with an experimental medicine that causes blood vessels to dilate in an effort to treat high blood pressure and chest pain. The medication did not work particularly well for the intended purposes, but had a side effect in that it dramatically improved erections. When the study ended, the participants were profoundly disturbed that the drug was no longer available. The rest is history.

More Viagra trivia: The name Viagra was born as a fusion of the words “vigor” (physical strength) and “Niagara” (the most powerful waterfall in North America).

Even more Viagra trivia: Viagra is not only used for ED. A 20 mg dose is effective for children with pulmonary hypertension, a condition in which the blood vessels in the lungs have abnormally high blood pressures.

The most common side effects of Viagra are headache, facial flushing, upset stomach, and nasal stuffiness. Less frequent side effects are temporary changes in color vision, sensitivity to light, and blurry vision.

Levitra (Vardenefil) This drug came to market in 2003 and is very similar to Viagra, available in 10 mg and 20 mg doses. The effectiveness and side effect profile is similar to Viagra; however, there are no reports of visual distortions as side effects. It is taken on demand and has an onset of about 25 minutes and has a half-life of about 4 hours and remains active for 4 or more hours.

Levitra trivia: The name Levitra derives from “elevate”; in French “le” indicates masculinity and “vitra” suggests vitality.

More Levitra trivia: Levitra is also formulated in a minty, dissolves-in-your-mouth 10mg formulation called Staxyn.

Cialis (Tadalafil) This was FDA approved in 2003 and is available in 2.5, 5, 10, and 20 mg doses. The effectiveness and side effect profile is similar to Viagra. Uniquely, Cialis has a long duration of action that has earned it the nickname “the weekender” as it can be taken on Friday evening and remain effective for the remainder of the weekend without the need for an additional dose. This affords a considerable advantage in terms of spontaneity. Cialis is either taken on demand (usually 10 or 20 mg, although 5 mg can be effective as well) or on a daily basis (2.5 or 5 mg) and has an onset of 15-45 minutes and remains active for 36 or more hours.

Cialis trivia: Cialis is also approved to treat children with pulmonary hypertension.

In 2012, daily Cialis (2.5 and 5 mg) was FDA approved for the management of urinary symptoms due to benign prostate enlargement.

Cialis, on occasion, can cause backaches and other muscle aches. Cialis is not affected by eating fatty meals, which can slow the absorption of the alternative ED meds.

Stendra (Avanafril) This was FDA approved in 2012. Available in 50, 100 and 200 mg doses, it has the advantage of a rapid onset of action. It is taken on demand and has an onset of about 10 minutes and remains active for 6 or more hours. It seems to have lower rates of hypotension when nitrates are co-administered.

Stendra trivia:  The name Stendra probably is a derivative of the word “extends.”

My Take

I have been in urology practice since 1988 and have plenty of clinical experience managing ED with these meds. In my opinion, Viagra 100 mg is the most potent of the group, but will also incur the most side effects, particularly facial flushing and potentially a nasty headache. Levitra is very similar in most respects to Viagra. Cialis is overall the best of the bunch because of its long duration, the spontaneity factor, the ability to take it with a fatty meal and its dual utility of helping urination as well as sexual function. The downside to Cialis is the occasional muscle aches. Stendra’s rapid onset gives it a small advantage.

Many men are capable of functioning satisfactorily without any of these medications, but find that taking a “recreational dose” of Cialis 5 mg enhances erectile capability and takes 20 years or more off the functional age of the penis. It is particularly useful for those with performance anxiety.

$$$$$

These drugs have gradually increased in price to the point where they are ridiculously expensive, unaffordable for many. None of the ED meds are yet generic. They typically retail for $40 or more per pill.

Tip of the Day: Viagra 20 mg (for pulmonary hypertension in children) is now generic and significantly less expensive than the branded variety and can be used for ED (taking up to 5 pills) at significant savings.

Bottom Line: The arrival of this class of medication in 1998 revolutionized the management of erectile dysfunction. Each of the available ED medications in this class is effective in improving erectile dysfunction issues for most men. There are subtle differences among the four that provide potential advantages and disadvantages. Trial and error will determine what works best for your needs.

Wishing you the best of health and a wonderful Independence Day weekend,

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. 

Viagra, Levitra, Cialis, Stendra: Which One Is Right For You?

July 1, 2016

Andrew Siegel MD   7/1/16

IMG_1457(1)

                     Cartoon by my patient/artist Ben Blank given to me shortly after  Viagra became available in 1998.  It says it all!

There are lots of options available if you are having erection problems. In my humble opinion, healthy lifestyle measures should always be considered first-line: weight management, healthy eating, exercise (including cardio, strength, core and pelvic floor), sufficient sleep, avoidance of tobacco, excessive alcohol and excessive stress, etc. With respect to ED medications, there are now many choices. Today’s entry will discuss which of the ED meds is best for you.

How the Penis Erects

In an erotic situation, nerves to the penis release nitric oxide that then causes the release of cGMP, resulting in blood flooding into the erectile chambers of the penis, the basis of an erection. As the erection gets fuller, penile veins become compressed, limiting the exit of blood and ultimately the pelvic floor/perineal muscles engage to cause maximal erectile rigidity.

How the Penis Becomes Flaccid

After ejaculation, the enzyme PDE-5 (phosphodiesterase) is released, the chemical mediator of flaccidity. It results in decreased levels of cGMP, resulting in a loss of the erection and a return to flaccid status.

ED Meds

The ED medications include Viagra, Cialis, Levitra and Stendra. They work by inhibiting PDE-5 and are known as PDE-5 inhibitors. Effective for many men with ED, they result in enhanced erectile function, sexual satisfaction and quality of life.

They are taken orally, require some time to get absorbed and necessitate sexual stimulation to work effectively. Although they can result in some increase in penile fullness (tumescence) without sexual stimulation, sexual stimulation is a must in order to induce a fully rigid erection.

Although effective for many men, they will not work for everyone.  If there is significant nerve or vascular compromise to the penis, they will likely be ineffective. It is important to know that the same ED drug at the same dose may work variably depending on the particular time and situation, sometimes more effectively than at other times since there are so many factors that determine erectile rigidity.

Men who are taking nitrates of any kind should never use the ED meds or serious consequences may result, including a dramatic drop in blood pressure (Remember Jack Nicholson in “Something’s Gotta Give”?). All of these ED drugs are metabolized in the liver for breakdown by the body.

Viagra (Sildenefil) This was the first of the group, released in 1998. Dosed at 25, 50 or 100 mg, the half-life (the amount of time it takes for the blood level of the drug to drop by 50%) is about 4 hours. It is taken on demand and kicks in in 15-60 minutes and remains active for 4 or more hours.

Viagra trivia:  Viagra was discovered by chance. Pfizer scientists conducted a clinical trial with an experimental medicine that causes blood vessels to dilate in an effort to treat high blood pressure and chest pain. The medication did not work particularly well for the intended purposes, but had a side effect in that it dramatically improved erections. When the study ended, the participants were profoundly disturbed that the drug was no longer available. The rest is history.

More Viagra trivia: The name Viagra was born as a fusion of the words “vigor” (physical strength) and “Niagara” (the most powerful waterfall in North America).

Even more Viagra trivia: Viagra is not only used for ED. A 20 mg dose is effective for children with pulmonary hypertension, a condition in which the blood vessels in the lungs have abnormally high blood pressures.

The most common side effects of Viagra are headache, facial flushing, upset stomach, and nasal stuffiness. Less frequent side effects are temporary changes in color vision, sensitivity to light, and blurry vision.

Levitra (Vardenefil) This drug came to market in 2003 and is very similar to Viagra, available in 10 mg and 20 mg doses. The effectiveness and side effect profile is similar to Viagra; however, there are no reports of visual distortions as side effects. It is taken on demand and has an onset of about 25 minutes and has a half-life of about 4 hours and remains active for 4 or more hours.

Levitra trivia: The name Levitra derives from “elevate”; in French “le” indicates masculinity and “vitra” suggests vitality.

More Levitra trivia: Levitra is also formulated in a minty, dissolves-in-your-mouth 10mg formulation called Staxyn.

Cialis (Tadalafil) This was FDA approved in 2003 and is available in 2.5, 5, 10, and 20 mg doses. The effectiveness and side effect profile is similar to Viagra. Uniquely, Cialis has a long duration of action that has earned it the nickname “the weekender” as it can be taken on Friday evening and remain effective for the remainder of the weekend without the need for an additional dose. This affords a considerable advantage in terms of spontaneity. Cialis is either taken on demand (usually 10 or 20 mg, although 5 mg can be effective as well) or on a daily basis (2.5 or 5 mg) and has an onset of 15-45 minutes and remains active for 36 or more hours.

Cialis trivia: Cialis is also approved to treat children with pulmonary hypertension.

In 2012, daily Cialis (2.5 and 5 mg) was FDA approved for the management of urinary symptoms due to benign prostate enlargement.

Cialis, on occasion, can cause backaches and other muscle aches. Cialis is not affected by eating fatty meals, which can slow the absorption of the alternative ED meds.

Stendra (Avanafril) This was FDA approved in 2012. Available in 50, 100 and 200 mg doses, it has the advantage of a rapid onset of action. It is taken on demand and has an onset of about 10 minutes and remains active for 6 or more hours. It seems to have lower rates of hypotension when nitrates are co-administered.

Stendra trivia:  The name Stendra probably is a derivative of the word “extends.”

My Take

I have been in urology practice since 1988 and have plenty of clinical experience managing ED with these meds. In my opinion, Viagra 100 mg is the most potent of the group, but will also incur the most side effects, particularly facial flushing and potentially a nasty headache. Levitra is very similar in most respects to Viagra. Cialis is overall the best of the bunch because of its long duration, the spontaneity factor, the ability to take it with a fatty meal and its dual utility of helping urination as well as sexual function. The downside to Cialis is the occasional muscle aches. Stendra’s rapid onset gives it a small advantage.

Many men are capable of functioning satisfactorily without any of these medications, but find that taking a “recreational dose” of Cialis 5 mg enhances erectile capability and takes 20 years or more off the functional age of the penis. It is particularly useful for those with performance anxiety.

$$$$$

These drugs have gradually increased in price to the point where they are ridiculously expensive, unaffordable for many. None of the ED meds are yet generic. They typically retail for $40 or more per pill.

Tip of the Day: Viagra 20 mg (for pulmonary hypertension in children) is now generic and significantly less expensive than the branded variety and can be used for ED (taking up to 5 pills) at significant savings.

Bottom Line: The arrival of this class of medication in 1998 revolutionized the management of erectile dysfunction. Each of the available ED medications in this class is effective in improving erectile dysfunction issues for most men. There are subtle differences among the four that provide potential advantages and disadvantages. Trial and error will determine what works best for your needs.

Wishing you the best of health and a wonderful Independence Day weekend,

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. 

Concussions: Big Head/Little Head

March 19, 2016

Andrew Siegel MD 3/19/16

Earlier this week, Jeff Miller (N.F.L. senior VP for health and safety policy) officially acknowledged the link between football and chronic traumatic encephalopathy, the degenerative brain disease found in many former players.  In this entry, the important topic of chronic traumatic brain injuries is reviewed with a segue into chronic traumatic penis injuries.

Who Knew? The athletic “cup” provides protection to the male genitals for those participating in sports including baseball, hockey, soccer and boxing. The cup was devised years before the first protective helmet for heads was developed. This gives you some insight into men’s priorities!

Traumatic brain injuries

Concussions resulting from contact sports and their sequelae of traumatic brain injuries have emerged as a hot topic. Football, boxing, soccer, hockey, rugby, lacrosse, mixed martial arts, etc., clearly incur risks for head trauma. Years ago, it was the expectation of athletes “to grin and bear it” after violently striking their heads in pursuit of victory. (I remember well when my son played football as a youngster in the competitive state of Pennsylvania, where an ambulance waited on the sidelines ready to transport unconscious 8 to 10 year-old boys to the ER. That ambulance did not sit idle for long.)

Today, sports-induced concussions have been brought to the forefront with all of the hubbub about athletes collapsing after hitting their heads and news about former NFL players suing over brain injuries. The movie “Concussion” ushered this subject to the big screen. Fortunately, positive changes are being made, with “concussion medicine” becoming a specialty discipline and concussion protocols put into force for many organized sports at the high school and college levels.

The human brain weighs about 3 pounds, is gelatinous in consistency and contains about 100 billion neurons. Nature has given us a remarkably thick skull to protect the delicate structure within. The brain literally “floats” in fluid within the skull. When the skull accelerates or decelerates rapidly—as occurs in a direct strike—the skull movement is abruptly arrested, but the brain continues in motion, twisting and bouncing within the skull, which can result in brain micro-trauma.

538px-Concussion_mechanics.svg (Modified version of Image: Skull and brain normal human.svg by Patrick J. Lynch, medical illustrator, Creative Commons Attribution 2.5 License 2006)

A concussion is currently defined as a motion injury of the brain. When I was in medical school, a concussion was defined as a transient loss in consciousness, but the truth of the matter is that less than 10% of concussions involve loss of consciousness. 90% of concussions manifest with symptoms including headaches, light sensitivity, nausea, vomiting, incoordination, disorientation, and abnormally slow reflexes and thinking.

It is unusual for a single concussion to result in long-term issues, as concussions are recoverable injuries if identified and treated properly. However, multiple concussions repeated over a course of many years– commonplace occurrences among athletes participating in contact sports– leave participants susceptible to chronic traumatic brain injuries including chronic traumatic encephalopathyAlzheimer’sParkinson’s disease and other forms of dementias.

How does this relate to the penis?

Sexual intercourse–which by definition is the forceful collision of two bodies– is no less of a contact sport than any of the aforementioned athletic endeavors. In parallel with traumatic brain injuries (big head), the penis (little head) is another anatomical zone that can get banged up over time. By the time a man is in his 50’s, he has likely had sex thousands of times, and as pleasurable as sex is, in reality it can be quite a traumatic event. Between self-inflicted and partnered pounding, hammering, pummeling and other abuse through self-manipulation and penetrative intercourse, respectively, it’s a wonder that the appendage doesn’t fall off!

Acute trauma is rare, but on occasion superficial veins can rupture, resulting in penile bruising and swelling that gets patients into my office in a real hurry. Rarer and more dramatic is the fractured penis that occurs when he “zigs” and she “zags,” resulting in a forceable miss-stroke and a serious injury that requires emergency surgery (previously covered in another blog: https://healthdoc13.wordpress.com/2015/01/24/breaking-bad-what-you-need-to-know-about-penile-fracture/)

dsc014431

(The image to the side is a photo I snapped of a statue of a man with a broken penis in Alcazar Palace in Seville, Spain.)

As opposed to acute trauma, chronic trauma to the penis is a not uncommon occurrence that is most often asymptomatic for many years. Just the act of obtaining a rigid erection puts tremendous compression stress forces on the penis. The outer sheath enveloping the erectile chambers of the penis—the tunica albuginea (white tunic)—is second only to the lining of the brain—the dura mater—in terms of its being the toughest tissue in the body. It is subjected to tremendous forces when the penis is erect because of the hypertensive blood pressures within the erectile chambers, well in excess of 200 millimeters mercury at full rigidity.

The potential for micro-trauma to the white tunic increases exponentially when one inserts that erect penis into a vagina and two parties move, bump and grind, creating intense shearing stress forces on the penis.  Certain positions angulate the penis and create more potential liability for injury than others. Even gentle sex can be rough with a single act of intercourse resulting in hundreds of thrusts with significant rotational, axial and torqueing strains and stresses placed upon the erect penis with the potential for subtle buckling injuries. Repeat performance perhaps a few times a week for many decades and by the time a man is in his 50s, on a cumulative basis, traumatic penile injuries—often asymptomatic in their developmental stages—can cause scarring to the white tunic and “chronic traumatic penopathy.”

Scarring to the white tunic can be problematic, resulting in deformities of the penis during erections, including the presence of a hard lump, shortening, curvature, narrowing, a visual indentation of the penis described as an hour-glass deformity and pain with erections as well as less rigid erections.  Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse.  This is known as Peyronie’s Disease, which fortunately only occurs in about 5% of men and is a treatable condition.  This topic has previously been covered:  https://healthdoc13.wordpress.com/2015/05/23/peyronies-disease-not-the-kind-of-curve-you-want/.

Bottom Line: The following relationship analogy sums it up: Chronic traumatic encephalopathy is to athletes who participate in contact sports is to concussions as is chronic traumatic penopathy is to sexually active males is to buckling trauma during intercourse.  Experts in the field of  “concussion medicine” want to spread the following advice: “Protect your brain – you only get one of them.” To this I add: “Protect your penis—you only get one of them. No matter what your game, be careful and proceed with caution!

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

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

 

 

 

 

 

 

Penile Injection Therapy: A Small Prick For A Bigger One

March 5, 2016

Andrew Siegel MD 3/5/2016

In 1983, at the American Urological Association meeting in Las Vegas, an event occurred that forevermore changed the field of male sexual dysfunction. Giles Brindley, a British physiologist, appeared from behind the podium and dropped his trousers, revealing to the audience his erection that had been induced by the injection of a medication directly into his penis. Commented one authority: “Farther down the Strip, Seigfried and Roy were making a white Bengal tiger disappear, and two circus aerialists—one sitting on the other’s shoulders—were traversing a tightrope without a net. But even in Vegas they’d never seen a show like this.” Few medical breakthroughs have had the dramatic effect that Brindley’s demonstration had, solidifying the principle that an erection is caused by smooth muscle relaxation in the erectile sinus tissues of the penis.

 

When first-line (healthy lifestyle) and second-line measures (ED meds, vibrational stimulation, penile pump)  are not sufficient in restoring erectile rigidity, penile injection therapy can be an effective and safe third-line option.

Penile injections of vasodilator drugs (medications that promote penile blood inflow) are beneficial for a wide range of medical conditions associated with ED. Vasodilator drugs injected directly into the penile erectile chambers bypass psychological, neurological, and hormonal factors and act locally on the erectile sinus tissues, causing blood to pour into the erectile chambers, inducing a rigid erection on demand. Injection therapy can be useful in ED due to psychological, neurological and hormonal causes as well as in men with some degree of blood vessel disease due to fatty plaque blocking arterial inflow. These injectable medications are the only such drugs that are capable of initiating an erection—in other words, achieving an erection without sexual stimulation.

A tiny needle is used to inject the medication into the side of the penis, directly into one of the paired penile erectile chambers. An erection usually occurs within 5-30 minutes and lasts for a variable amount of time, depending on the dosage of the medication. Injection-induced erections do not interfere with one’s ability to ejaculate or experience an orgasm.

Alprostadil (Caverject, Edex) is a commonly used vasodilator that increases penile blood flow and relaxes arterial and erectile sinus smooth muscle in the erectile chambers, resulting in a rigid erection. A combination of medications is often used to obtain optimal results. This combination is known as Trimix and consists of three drugs: Alprostadil, Papaverine and Phentolamine.

Who Knew? In 1982, French vascular surgeon Dr. Ronald Virag discovered the effect of Papaverine on erections when he mistakenly infused it into the penis, thinking he was administering saline. The patient immediately developed an erection and Dr. Virag realized that a new treatment for ED was possible.

Patients interested in using penile injection therapy are taught how to do the procedure during a urological office visit, at which time a test dose is administered. It is not a difficult technique to learn, although it requires some degree of dexterity. After learning the technique, the medication can be self-administered on demand. It often requires some trial and error to get the dosage just right so that the erection lasts an appropriate amount of time, in accordance with individual needs. With practice, one rapidly becomes skilled in the technique—not unlike learning to use contact lenses.

Side effects can be pain, bruising, scarring and prolonged erections. The most common side effect is a dull ache that is usually mild and tolerable. This typically happens with Alprostadil more commonly than with Trimix. A bruise may occur at the injection site and is best prevented by applying compression on the injection site for several minutes following the injection. Occasionally, a small lump can develop at the site of repeated injections and rarely penile scarring may be a consequence.

On occasion, a prolonged erection (priapism) may occur. It is undesirable to have an erection that lasts for more than four hours. If this occurs, it may require the injection of a medication to reverse the effects of the vasodilator drug and decrease penile blood flow in order to bring the erection down. This is safest done in an ER setting where cardiac monitoring can be performed.

Who Knew? Many male stars in the adult film industry use Trimix in order to achieve the erectile rigidity and durability necessary for their performances.

Sadly, there are some unscrupulous medical groups who prey on unsuspecting and vulnerable ED patients, often offering injection therapy without discussion of alternative treatments and charging patients exorbitant fees for medications such as Trimix.. See the following LA Times article concerning this:

http://articles.latimes.com/2011/apr/07/local/la-me-boston-medical-20110404

The reality is that medications such as Trimix can be obtained via prescription from your urologist at reputable compounding pharmacies for very reasonable fees. It should not cost an arm and a leg to obtain a rigid penis!

Technique of Penile Injection

Preliminary tips:

  • Shave the base of the penis to make the process easier.
  • If possible, immediately before injecting, manipulate the penis to obtain some penile blood flow and filling.  The procedure will be easier with a plumper penis.
  • Avoid injecting into superficial veins.
  • The injection only needs to be done on one side even though there are two injection chambers, since they communicate.
  • Vary the injection site to avoid scarring.
  • Do not inject more than three times weekly.

 

Triple-P_Injection

(Author: Post Prostate, Source: Own work; 16 March 2013)

  1. If you are right-handed, use your left thumb to protect the 12 o’clock position (penile nerves) and your left index finger to protect the 6 o’clock position (urethral channel). If you are left-handed, use your right thumb to protect the 12 o’clock position (penile nerves) and your right index finger to protect the 6 o’clock position (urethral channel).
  2. Use an alcohol swab to cleanse the base of the penis in order to prevent infections and then set aside the swab and save.
  3. Holding the prefilled syringe like a pen, in dart-like fashion penetrate the skin of the penis at a right angle, passing the needle as far as it will go. The site should be between the 1 o’clock and 3 o’clock position for a righty and 9 o’clock and 11 o’clock position for a lefty. The base of the shaft is the easiest location for the injection; however, because the erectile chambers run all the way to the head of the penis, any shaft location is acceptable for the injection site.
  4. Inject the full contents of the syringe by applying pressure to the plunger.
  5. Remove the syringe and use the alcohol swab to apply pressure to the injection site for several minutes.
  6. Observe your penis becoming increasingly rigid and the rest is up to you!

Bottom Line:  Penile injection therapy can be an effective and safe option for restoring erectile function when first and second-line measures are not sufficient.

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

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

 

 

 

 

 

 

 

 

 

When You Can GET It Up, But Can’t KEEP It Up

February 20, 2016

Andrew Siegel MD 2/20/16

Lost In Evolution

Many mammals have a bone in the penis (os penis) that maintains constant penile stiffness. This is the case with primates including gorillas and chimpanzees, but–for better or for worse– is not the case with human males. The good thing about having an os penis is that there is no such thing as ED in primates, as males are “ever ready.”  The bad thing is having a 24/7/365 “boner,” literally and figuratively. Furthermore, having a bone in the penis makes it much more susceptible to injuries such as a fracture of the penis.

The Human Penis

The human penis is a highly evolved and unique organ comprised of 3 cylindrical chambers that contain erectile sinus tissue. These cylinders run the length of the external and internal aspects of the penis. The main “erectile apparatus” consists of the paired cavernous chambers with the ischiocavernosus muscle (IC) that surrounds and supports them. The auxiliary “erectile apparatus” is the head of the penis (glans) with the solitary spongy erectile chamber that envelops the urinary channel and the bulbocavernosus muscle (BC) that surrounds and supports it. The IC and BC muscles are two of the all-important pelvic floor muscles that provide supportive, sphincteric and sexual functions.

The paired cavernous erectile chambers become rigid at the time of sexual stimulation and provide the wherewithal for vaginal penetration. The head of the penis and spongy chamber provide additional plumpness and fullness, but not rigidity.

Corporal Bodies And Glans Clean

Blue arrows point to paired cavernous chambers that become rock-hard with stimulation. Red arrow points to solitary spongy chamber and yellow arrow to head of penis, both of which become plump with stimulation. (From Gray’s Anatomy of the Human Body, 20th Edition, original publication 1918, public domain)

12muscles

IC and BC muscles that surround the inner aspects of the cavernous chambers and spongy chamber respectively.  These pelvic muscles support the roots of the penis and when they contract they push pressurized blood into the external penis, creating rock-hard rigidity. (Illustration by Christine Vecchione from “Male Pelvic Fitness: Optimizing Sexual & Urinary Health”)

Did you know that penile erectile sinus tissue is virtually identical to nasal sinus tissue? …  IDENTICAL: a pathologist would be hard pressed (no pun intended!) to tell the difference between the two under a microscope.  Congested sinuses =  penile erection. The oral ED medications increase blood flow to both the nasal and penile sinuses and thus commonly cause sinus congestion as a side effect.   

Clever Mother Nature

Nature evolved a brilliant alternative to the os penis for human males. In the absence of such a practical bone,  nature capitalized on principles of hydraulics. Blood—not used for its typical purpose (transporting oxygen and other nutrients)—is pressurized to create rock-hard penile rigidity. This process has 3 requirements:

  1. arterial inflow of blood to the penis
  2. relaxation of the smooth muscle within the erectile sinus tissue to allow the penis to inflate
  3. trapping blood to maintain the erection

The blood trapping mechanism is incompletely deciphered, but our current understanding is that as the erectile sinus tissue becomes swollen with blood, the vessels that conduct blood away are pinched closed. The IC and BC muscles also play a key role by tourniquet-like compression of the inner erectile chambers, forcing pressurized blood into the erectile chambers. Penile high blood pressure in excess of 200 mm– the only place in the body where hypertension is desirable and necessary –is what is responsible for penile rock-hard rigidity.

Did you know that Dr. Gray of Gray’s Anatomy 1909 textbook referred to the IC muscle as the “erector” muscle and the BC as the “ejaculator” muscle?

Observe Your IC and BC Muscles In Action

The next time you get an erection, stand up and observe your penis. Vigorously contract your IC and BC muscles (by tightening up the anus) and observe what happens as more hydraulic fuel (blood) surges into the penis: the erect penis should lift up and point to the heavens above…pelvic floor muscle magic!

Erectile Dysfunction

ED can result from a problem in any of the three hydraulic requirements. If you cannot obtain an erection, it is most often due to impaired arterial blood flow to the penis or to a problem with the smooth muscle of the sinus tissue, which fails to relax appropriately and thus will not allow penile inflation. Similar to high blood pressure—which is commonly due to arterial smooth muscle becoming stiffer—failure of relaxation of the smooth muscle within the erectile sinus tissue is often an age-related problem.

If you can achieve an erection but lose it prematurely, it is often due to two causes: One is venous leakage of blood from the sinuses. The other is weakened IC and BC muscles. Unfortunately, there is not a lot that can be done about age-related impaired functioning of the erectile sinus tissue that promotes venous leakage.  However, healthy lifestyle measures will optimize function of the erectile sinus tissue and smooth muscle.  This includes the following: good eating habits, maintaining a healthy weight, engaging in exercise, obtaining adequate sleep, consuming alcohol in moderation, avoiding tobacco and minimizing stress.  The good news is that the IC and BC muscles are capable of being strengthened to improve their form and function, improving the blood trapping mechanism to enhance erectile rigidity and durability.  This is possible through Kegel exercises, a.k.a. pelvic floor muscle training programs (see below).

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.

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

February 13, 2016

Andrew Siegel MD  2/13/2016

800px-Fireworks4_amk

(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.

Eating Yourself Limp

January 2, 2016

Andrew Siegel MD   1/2/16

Central_Obesity_008.jpg

Today’s entry is on the topic of how overeating and obesity affect one’s manhood and vitality (this holds true for female sexual function as well).  While optimal sexual function is based on many factors, it is important to recognize that our food choices play a definite role. What we eat—or don’t eat—impacts our sex lives.  It’s a new  year– a fresh start–and time for many resolutions, which often involve weight loss and a healthier lifestyle.  Yet another benefit of becoming leaner and fitter is improved sexual function. 

Sexuality is an important part of our human existence. Healthy sexual function involves a good libido, the ability to obtain and maintain a rigid erection and the ability to ejaculate and experience a climax. Although not a necessity for a healthy life, diminished sexual function can result in loss of self-esteem, embarrassment, a sense of isolation and frustration and even depression.

Sexual functioning is complicated and dependent upon a number of systems working in tandem– the endocrine system (which produces hormones); the central and peripheral nervous systems (which provide nerve control); the vascular system (which conducts blood flow); and the musculo-skeletal system (specifically the pelvic floor muscles that help maintain the high blood pressures in the penis necessary for erectile rigidity).

Sexual function is a good indicator of underlying cardiovascular health. A healthy sexual response is largely about blood flow to the genital and pelvic area. The penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge happening within seconds and responsible for the remarkable physical transition from flaccid to erect. This is accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. Pelvic muscle engagement and contraction help prevent the exit of blood from the penis, enhancing penile rigidity and creating penile blood pressures that far exceed normal blood pressure in arteries. For good reason, Gray’s Anatomy textbook over 100 years ago referred to one of the key pelvic floor muscle as the “erector penis.”

Blood flow to the penis is analogous to air pressure within a tire: if there is insufficient pressure, the tire will not properly inflate and will function sub-optimally; at the extreme the tire may be completely flat. Furthermore, slow leaks (that often occur with aging and failure of the smooth muscle within the penile arteries and erectile tissues to relax) promote poor function.

Just as your car suffers a decline in performance if it is dragging around too much of a load, so you penis will function sub-optimally if you are carrying excessive weight. Obesity steals your manhood and reduces male hormone levels. Abdominal fat converts the male hormone testosterone to the female hormone estrogen. Obese men are more likely to have fatty plaque deposits that clog blood vessels–including the arteries to the penis–making it more difficult to obtain and maintain good-quality erections. Additionally, as your belly gets bigger, your penis appears smaller, lost in the protuberant roundness of your large midriff and the abundant pubic fat pad.

Remember the days when you could achieve a rock-hard erection—majestically pointing upwards—simply by seeing an attractive woman or thinking some vague sexual thought? Chances were that you were young, active, and had an abdomen that somewhat resembled a six-pack. Perhaps now it takes a great deal of physical stimulation to achieve an erection that is barely firm enough to be able to penetrate. Maybe penetration is more of a “shove” than a ready, noble, and natural access. Maybe you need pharmacological assistance to make it possible.

If this is the case, it is probable that you are carrying extra pounds, have a soft belly, and are not physically active. When you’re soft in the middle, you will probably be soft where it counts.  A flaccid penis is entirely consistent with a flaccid body and a hard penis is congruous with a hard body. If your is penis difficult to find, if you have noticed man-boob development, and your libido and erections are not up to par, it may be time to rethink your lifestyle habits.

Healthy lifestyle choices are of paramount importance towards achieving an optimal quality and quantity of life. It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices. These include proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and minimizing stress.

Eating properly is incredibly important, obviously in conjunction with other smart lifestyle choices. Maintaining a healthy weight and fueling up with wholesome and natural and real foods will help prevent weight gain and the build-up of harmful plaque deposits within blood vessels. Healthy fuel includes vegetables, fruits, legumes, nuts, whole grains and fish. Animal products—including lean meats and dairy—should be eaten in moderation. The Mediterranean-style diet is an excellent one for minimizing both sexual dysfunction and heart disease. Poor dietary choices with meals full of calorie-laden, nutritionally-empty selections (e.g., fast food, processed foods, excessive sugars or refined anything), puts one on the fast tract to obesity and clogged arteries that can make your sexual function as small as your belly is big.

Bottom Line: If you want a “sexier” lifestyle, start with a “sexier” style of eating that will improve your overall health and make you feel better, look better and enhance your sexual function.  Smart nutritional choices are a key component of sexual fitness. If you are carrying the burden of too many pounds, now is the perfect time to start on the pathway towards better health and reversing the sexual dysfunction that has been brought on by poor lifestyle choices. 

Wishing you a healthy, peaceful, happy (and sexy) 2016,

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. Coming soon is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Author of Promiscuous Eating: Ending Our Self-Destructive Relationship With Food: http://www.PromiscuousEating.com

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.