Posts Tagged ‘erections’

Game Plan for Men’s Healthy Sexual Functioning

September 30, 2017

Andrew Siegel MD 9/30/17


Thank you, Pixabay, for image above.

Functioning well in the bedroom–like health in general–should never be taken for granted. During early adulthood it rarely, if ever, crosses our minds that at sometime in the future many body functions decline, including sexual function.  However, the truth of the matter is that paralleling general health and fitness, maintaining our sexual health and fitness takes some effort to avoid the almost inevitable deterioration in function.  Today’s entry reviews a “game plan” for maintaining healthy sexual functioning into our golden years.

  • Know the Fundamentals

For better or worse, penile erections are not on the basis of a bone in the penis, as they are in many mammals.  Erections occur when pressurized blood inflates the erectile chambers of the penis. The erect penis has blood pressure in excess of 200 mm (extreme hypertension), giving rise to bone-like rigidity and hence the slang term, boner.

The penis is a marvel of hydraulic engineering, uniquely capable of increasing its blood flow 50 times over baseline within nanoseconds of sexual stimulation, transforming its shape and size. This is accomplished by smooth muscle relaxation within the penile arteries and within the sinuses of the erectile chambers.

Once blood inflates the erectile chambers, closure of penile veins and contractions of the pelvic floor muscles effectively trap the pressurized blood in the penis and maintain the penile hypertension necessary for a sustained erection.

  • Know the Stats

The Massachusetts Male Aging Study showed that after age 40 there is a decline in all aspects of sexuality.  Erectile dysfunction (ED) is present in about 40% of men by age 40 with an increase in prevalence of about 10% for each decade thereafter. Although there are many causes of ED, the common denominator is insufficient blood flow to fill the erectile chambers of the penis, or alternatively, sufficient inflow but poor venous trapping, both often caused by a decline in smooth muscle relaxation with aging.

  • Know the Score

Performance ability with every physical activity declines as we get older and this explains why most professional athletes are in their twenties or thirties. Although everything eventually goes to ground, hopefully it will happen slowly. Young men can achieve a rock-hard erection simply by seeing an attractive woman or thinking a vague sexual thought. As we get older, it is not uncommon for erotic thoughts or sights to no longer be enough to provoke an erection, with the need for direct touch. Some of the common male sexual changes that occur with aging are: diminished sex drive; decreased rigidity and durability of erections; decrease in volume, force, and arc of ejaculation; decreased orgasm intensity; and an increased recovery time before being able to get a second erection.  

  • Know the Opponents: Gluttony and Sloth

A healthy weight and healthy eating habits, exercise, adequate quality and quantity of sleep, tobacco avoidance, use of alcohol in moderation, stress avoidance, and a balanced lifestyle will optimize sexual potential.  Abide by the golden rule of the penis: “Treat your penis nicely and it will be nice to you in return; treat your penis poorly and it will rebel.

  • Fuel for Performance

A healthy diet will reduce the risk of sexual dysfunction. Eat a variety of wholesome natural foods including fresh vegetables and fruit, plenty of fiber, lean protein sources, legumes and healthy fats including nuts, avocados and olive oil. Avoid eating processed foods and minimize sugar, refined carbohydrates and highly saturated animal fats.

  • Stay in Peak Form

Try to achieve “fighting weight” to maximize your performance in the sexual arena.

  • Train for Performance

Exercising—including cardio, core, and strength training—is vital for health in general and sexual health in particular. When it comes to sexual health, it is vital to focus on the all-important pelvic floor muscles (PFM). PFMT (pelvic floor muscle training) will help optimize erectile function and prevent/treat ED.

To understand why PFMT can help your performance in the bedroom, it is necessary to have some understanding of what the PFM do. When you have an erection, the bulbocavernosus muscle and ischiocavernosus muscles engage. Contractions of these muscles not only help prevent the exit of blood from the penis, enhancing rigidity, but also increase blood flow to the penis—with each contraction of these muscles, a surge of blood flows into the penis. Additionally, they act as powerful struts to support the roots of the penis (like the roots of a tree), the foundational support that, when robust, will allow a more “skyward” angling erection (like the trunk of a tree).  The bulbocavernosus muscle also is the “motor” of ejaculation, contracting rhythmically at the time of sexual climax and forcing semen out of the urethra.

Increasing the strength, tone and condition of these muscles through PFMT will allow them to function in an enhanced manner—namely more powerful contractions with more penile rigidity and stamina as well as improved ejaculatory issues, including premature ejaculation.

  • Talk to your Coach

Visit the PelvicRx website where you can purchase a male pelvic floor training DVD and have a private chat session with a pelvic floor trainer.

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”:

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 dire need of bridging.

Author of:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Co-creator of the male pelvic floor training DVD: PelvicRx





Penile Shockwaves To Improve Erections

June 24, 2017

Andrew Siegel MD   6/24/17

Storz image DUOLITH_SD1_ultra_URO_003Thank you Storz Medical and Robert Remington ( for above image of a shock wave unit used for the treatment of erectile dysfunction; note treatment of both the external (left side of image) and internal aspects of the penis (right side of image)

Shockwaves are acoustic vibrations that carry energy, e.g. the sound waves generated by clapping your hands. Compression and expansion of a medium creates a mechanical force that can be put to practical use. Since the 1980s, urologists have used focused shockwave therapy to pulverize kidney stones, revolutionizing their treatment.  A much tamer form of shockwaves–low energy shockwave therapy–is a new treatment for erectile dysfunction.  When applied to the penis, shock wave therapy causes cellular micro-trauma and mechanical stress, stimulating the growth of new blood vessels and nerve fibers that ultimately improves penile blood flow and erectile function. The long and the short of it is that the physical energy from shockwaves can be tapped into to cause a benefit that can prove advantageous in the bedroom.  

Shockwave therapy–which triggers renewed circulation and induces structural changes that can regenerate and remodel damaged tissues–been used for many medical purposes:

  • chronic wounds
  • neuropathy
  • cardiac disease
  • plantar fasciitis
  • tennis elbow

Shockwave Treatment for Erectile Dysfunction

Erection quality is all about pressurized blood filling and remaining in the erectile chambers of the penis. Although erectile dysfunction (E.D.) typically has many underlying causes, some of the key reasons are aging and lifestyle-related changes in penile arterial blood flow as well as alterations in the integrity of penile erectile tissue. Most treatments for E.D. to date—pills, urethral suppositories, injection therapy, and prosthetic implants—do not treat the underlying cause of the problem nor modify the natural history of the disease.   Penile shockwave therapy can be considered “revolutionary,” since it is a disease-modification paradigm, ultimately changing the health of the erectile tissues and improving penile blood flow .

Penile shocks stimulate penile circulation via growth of new blood vessels, growth of new nerve fibers (neural regeneration), stem cell activation and cellular proliferation, and protein synthesis. On a molecular level, the cell membrane, mitochondria and endoplasmic reticulum respond the most profoundly to shockwaves.  As the cells are mechanically stressed, multiple adaptive pathways triggered, inducing structural changes that are capable of regenerating  and remodeling penile tissue.

In research carried out by Dr. Tom Lue, shockwave therapy was used to treat diabetic rats that had the arteries and nerves responsible for erections surgically tied off. Cellular activation, regeneration of erectile tissue (smooth muscle and endothelial cells), and improved penile blood flow and erectile function was clearly demonstrated.

The pilot human study on penile shockwaves for E.D. was performed in 2010 by Yoram Vardi. 20 patients were treated twice weekly for three weeks, with application of shockwaves to five separate sites on the penis.  This study showed a meaningful increase in erectile rigidity and durability of erections using the International Index of Erectile Function (IIEF) as a metric with improved overall satisfaction and ability to penetrate. An additional study showed positive short-term effects in men who previously had responded well to oral erectile dysfunction medications.  To date, clinical trials have shown both subjective improvement in erectile dysfunction as well as objective increased penile blood flow and erectile rigidity.  In a large randomly controlled trial with over 600 subjects, the average improvement in IIEF was a significant 6.4.

Treatment variables include the shockwave energy, number of shocks delivered, the sites treated and duration of the treatment. For E.D., low energy shockwaves that are less focused than those used for kidney stone fragmentation are used.  Too little energy has proven ineffective, while too much energy can actually kill cells, resulting in scarring and erectile dysfunction.  There seems to be a “sweet spot” in terms of the energy level that will optimize erectile function that is generally about 2-10% of the power of shockwave therapy for kidney stones.  A recent study used ten once-weekly treatment sessions.  During each session, 600 shocks were applied to the erectile chambers of both the internal and external penis with a total of 6000 shocks applied over the course of the 10-week period.  The procedure was found to be well tolerated aside from a slight pricking or vibrating sensation that is perceived during the delivery of the shockwaves.

Bottom Line: Low energy penile shockwave therapy is an exciting new treatment option for men with E.D.  Safe and well tolerated, it works by causing mechanical stress and trauma to erectile tissues, stimulating the growth of new blood vessels and nerve fibers and potentially enabling penile tissue to regain the ability for spontaneous erection.  It uniquely modifies the disease, unlike most traditional E.D. treatments that function as “Band-Aids.”  Further clinical investigation is necessary to determine optimal treatment protocols.  It is highly likely that in the near future, low energy penile shockwave therapy will be approved by the FDA for the treatment of E.D.

For more information on Sonicwave technology from STORZ see FullMast website.

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”:

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

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

Co-creator of the PelvicRx male pelvic floor exercise program:

Kegel Exercises To PREVENT Pelvic Floor Dysfunction

August 29, 2015

Andrew Siegel MD   8/29/15


“Prepare and prevent, not repair and repent.”

Restoring function of injured muscles is a well-established principle in sports medicine, orthopedics, plastic surgery and physical medicine and rehabilitation. The premise is simple: a traumatized or injured muscle is treated with rehab and training to accelerate tissue healing and restore working order. Many of the “baby boomers” demographic (age 51-69)—striving to retain their fitness and youth through exercise and “weekend warrior” activities that promote cardiac health but at the same time, musculoskeletal injuries—understand this concept well.

Dr. Arnold Kegel applied this principle to the female pelvic floor muscles to improve muscle strength and function in women after childbirth. Obstetrical “trauma” (9 months of pregnancy, tough labor and delivery of a 9 lb. baby) can cause pelvic floor dysfunction—urinary and bowel control issues, looseness of the vagina and its support tissues with descent of the bladder, uterus and rectum, and altered sexual function.

This principle has also been applied to men with pelvic floor muscle issues to improve urinary, bowel, erectile and ejaculatory health. Obviously, men do not suffer the acute pelvic floor muscle trauma of childbirth that women do, but they can develop pelvic floor muscle dysfunction from aging, weight gain, pelvic surgery (radical prostatectomy, colon surgery, etc.), a sedentary lifestyle, disuse atrophy, participation in saddle sports including cycling, etc.

An Ounce Of Prevention Is Worth A Pound Of Cure

Why not a radically different approach and instead of fixing pelvic floor dysfunction, try to prevent it? Unfortunately, we have a “reactive” oriented medical culture in the USA that does not emphasize prevention, but “repair.”  Another hurdle is that many people prefer having broken things fixed as opposed to making the effort to avoid breaking them in the first place.

So, if obstetrical trauma to the pelvic floor often brings on pelvic floor muscle dysfunction and its urinary, gynecological, bowel and sexual consequences, why not consider starting pelvic floor muscle training well before pregnancy, perhaps at the time of the first gynecological visit? And if aging, surgery and other factors contribute to male pelvic floor muscle dysfunction and its urinary, bowel and sexual consequences, why wait for the system to malfunction? Why not strengthen and tone the pelvic floor muscles when a man is young and healthy to prevent the predictable age-related decline?

Did You Know? The concept of pelvic floor muscle training BEFORE radical prostatectomy for treatment of prostate cancer is rapidly gaining traction and implementation. Instead of waiting to “rehab” the pelvic muscles after the fact, the concept is to “prehab” them. 

Many of us apply wellness principles through regular exercise—aerobic pursuits for cardiovascular health and strength training to maintain muscle tone, integrity and function—so why neglect the pelvic floor? We work out in the gym not only to achieve better fitness, but also to maintain fitness and prevent age-related losses in strength, flexibility, endurance, etc.

Preventive Pelvic Health Paradigm

Why passively accept the seemingly inevitable, when one can be proactive instead of reactive and can address the future problem before it becomes a problem? Why wait until function becomes dysfunction? Whether male or female, the new paradigm is preventive pelvic health. The goal is to avoid, delay, or minimize the decline in pelvic function that accompanies aging and that is accelerated by pelvic muscle trauma and injury, surgery, obesity and disuse atrophy.

Bottom Line: You have the ability to positively influence your health destiny. Instead of being reactive and waiting for your pelvic health to go south, be proactive to ensure your continuing urinary, bowel and sexual health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive pelvic floor muscle program into your exercise regimen. Much like a vaccine, it will help to prevent a disease that you hopefully will never get.

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: Available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:  In the works is The Kegel Fix: Recharging Female Sexual, Pelvic and Urinary Health.

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

How To Make Orgasms More Orgasmic

July 3, 2015

Andrew Siegel MD  7/3/15

Public domain image, royalty free stock photo from

This is a timely blog topic for July 4th weekend, celebrated across the USA with fireworks!

The human body is a most remarkable machine. The more it is pushed towards its limits, the more it adapts and the stronger it becomes. When it comes to sex, the body reacts similarly—when the muscles that play a vital role in sexual function are toned and strengthened, the body becomes capable of experiencing more explosive and intense orgasms. Exercising your pelvic muscles—a.k.a. Kegel exercises—just might be the most rewarding workout that you aren’t doing. These exercises aren’t just for the ladies anymore. Men, it’s time to get with the program.

What’s An Orgasm?

Simply put, an orgasm is the sexual excitement, pleasure, and euphoric state accompanying the release of accumulated sexual tension.

A medical definition of the male orgasm is the climax that occurs once sufficient intensity and duration of sexual stimulation surpasses an ejaculatory “threshold.” Sexual climax consists of three phases—emission, ejaculation, and orgasm. When a certain threshold of sexual stimulation is surpassed, emission occurs, in which secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. During ejaculation the pelvic floor muscles contract rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen in a pulsating and explosive eruption. Orgasm is the intense emotional excitement that accompanies the physical act of ejaculation. Technically speaking, orgasm takes place in the brain, whereas ejaculation takes place in the penis, although the fact that an orgasm is a mind-body experience blurs the distinction.

For women, an orgasm occurs once sufficient intensity and duration of sexual stimulation surpasses a threshold that induces rhythmic muscular contractions of the pelvic floor muscles, as well as the vagina, uterus and anus, resulting in intense emotional excitement and a blissful state that accompanies the physical act of muscular contractions and release. In some women, Skene’s gland (the female equivalent of the male prostate gland) contractions induce the release of their secretions, referred to as “female ejaculation.”

How Can Fitness And Kegel Exercises Improve The Quality Of Orgasms?

Sex is all about movement and motion, a kinetic chain that demands aerobic fitness as well as strong core muscles and external hip rotators. This fitness optimizes the smooth, efficient and coordinated integration of pelvic thrusting and lateral hip rotation.

The floor of the core—the pelvic floor muscles—is of critical importance to penile and clitoral erections, ejaculation and orgasm. The other core muscles and the external hip rotators are involved with the kinetics and movements of sex, but the pelvic floor muscles are distinctive as they directly involve the penis and clitoris. The pelvic floor muscles anatomically support the erect penis and clitoris, cause a surge of blood flow to the genitals, and have a profound involvement in ejaculation and orgasm. They are the “motor” of ejaculation, which by virtue of their strong rhythmic contractions, drive ejaculation and contribute to orgasm.

Kegel exercises increase the strength, tone, power, and endurance of the pelvic floor muscles. Strengthening these muscles maximizes pelvic blood flow, penile and clitoral erectile rigidity, and orgasms, since the pelvic floor muscles when contracting rhythmically at climax provide the muscle power behind the physical aspect of orgasm. Pelvic floor muscle strength and proficiency is also a helpful means of improving ejaculatory control because command of the pelvic floor can help delay ejaculation. Additionally, these exercises can help increase the volume, force, trajectory (arc) and pleasurable sensation of ejaculation.

When it comes to orgasms, the pelvic floor muscles make the magic happen. Toned pelvic floor muscles are capable of generating powerful contractions that can forcibly ejaculate semen at the time of the male climax and can equally help optimize and prolong the female climax.

What Is The Best Means of Exercising One’s Pelvic Floor Muscles?

Effective muscle training derives from understanding pelvic floor muscle anatomy and function, the ability to isolate the muscles, a means of feedback to ensure that the proper muscles are being exercised, progressive intensity over time with the use of resistance to maximize muscle growth and adaptation, and allowing for the appropriate recovery time.

Wishing you the best of health and a wonderful July 4th holiday,

2014-04-23 20:16:29

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback:  Work in progress is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

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

The Private Gym program is the go-to means of achieving pelvic floor muscle strength, tone, power, and endurance. It is a comprehensive, interactive, easy-to-use, medically sanctioned and FDA registered follow-along exercise program that builds upon the foundational work of Dr. Arnold Kegel. It is also the first program designed specifically to teach men how to perform the exercises and a clinical trial has demonstrated its effectiveness in fostering more rigid and durable erections, improved ejaculatory control and heightened orgasms.

Peyronie’s Disease: Not the Kind of Curve You Want

May 23, 2015

Andrew Siegel MD  5/23/15


(Thank you, Pixabay, for above image)

Peyronie’s Disease is an inflammatory condition of the penis that causes curvature and an uncomfortable or painful erection. It is not uncommon– 65,000-120,000 cases per year in the USA–with only a small fraction of those who have the disease actually seeking treatment. Although it can occur at any age, it most commonly is seen in 50-60 year-olds. Essentially, it is scar tissue in a bad location, which sabotages the ability to obtain a straight and rigid erection, resulting in a dramatic interference with one’s sexual and psychological health.

Why Is Penile Curvature Called Peyronie’s Disease?

Most people assume that Peyronie’s disease is named after poor Monsieur Peyronie, who not only was afflicted with the disease, but also was further disgraced by having the disease named after him. The truth of the matter is that Peyronie’s disease is named after the French surgeon, de la Peyronie, who first described it in 1743.

How Do You Know If You Have Peyronies?

Peyronie’s Disease causes fibrous, inelastic “plaques” of the sheath surrounding the erectile chambers that reside within the penis. This results in deformities of the penis during erections, including the presence of a hard lump(s), shortening, curvature and bending, 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. The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is impossible. The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring. Although the scarring is physical, it often has psychological ramifications, causing anxiety and depression.

What Causes It And What Can You Expect In The Future?

The underlying cause of Peyronies is unclear, but is suspected to be penile trauma—perhaps associated with excessive bending and buckling from sexual intercourse—that activates an abnormal scarring process. During acute Peyronies, erections are painful and there is an evolving scar, curvature and deformity. The chronic phase occurs up to 18 months or so after initial onset and at which time the pain and inflammation resolve, the curvature and deformity stabilize, and often erectile dysfunction is noted. Peyronie’s regresses in about 15% of men, progresses in 40% of untreated men, and remains stable in 45% of men. Many men become very self-conscious about the appearance of their penis and the limitations it causes, and they may avoid sex entirely.

Is Peyronie’s Treatable?

Treatment options include oral medications, topical agents, injections of medications into the scar tissue, shock wave therapy, and surgery. Upon initial diagnosis, most men are started on oral Vitamin E, 400 IU daily, as this has the potential to soften the scar tissue causing the plaque. Many of the aforementioned treatments are not particularly effective because scar tissue is a challenging problem. Erectile dysfunction can be often be managed with ED medications.

Xiaflex—a.k.a. collagenase—derived from the clostridium bacteria, is the newest treatment for Peyronies. It has been used for years for Dupuytren’s contracture, a similar situation to Peyronie’s that occurs on the hand, causing a scarring of the tissue beneath the skin of the palm and fingers, making it very difficult to straighten one’s fingers. Xiaflex functions as a “chemical knife” by dissolving collagen, the main constituent of scar tissue. It is typically used for men with an angulation of 30 degrees or more. It is injected directly into the scar tissue after which the area is massaged and modeled to disrupt the scar tissue and mold the penis. One course of treatment may involve as many as eight injections. Injection of this medication can be highly effective, but is not without side effects including bruising, swelling, pain and possibly rupture of the erectile chamber of the penis causing a penile fracture.

If there is an unsatisfactory response to conservative managements, a penile implant may be appropriate. This can manage the dual problems of erectile dysfunction and penile angulation. If erections are adequate, but angulation prevents intercourse, options include doing a “nip and tuck” opposite the plaque in an effort to make expansion more symmetrical. Although this technique is effective in improving the angulation, it does so at the cost of penile shortening. Other more complex procedures involve incising or removing the scar tissue and using grafting material to replace the tissue defect.

Bottom Line: When scar tissue occurs on an area of the body that moves, expands or acts as a channel, it affects function as well as form. Thus a scarred elbow can impact mobility, scarred lungs can disturb breathing, a scarred bile duct can cause jaundice and scarred erectile chambers can cause Peyronie’s. The good news is that mild Peyronie’s does not need to be treated and if more severe forms occur that interfere with one’s quality of life, there are effective means to treat it.  


Wishing you the best of health and a great Memorial Day weekend!

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: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:

Co-founder of Private Gym:–available on Amazon and Private Gym website

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

Eyes Wide Open: Genital Mindfulness

May 9, 2015

Andrew Siegel MD 5/9/15

Pay careful attention to your body, including your genitals. Erectile function (or lack) is a barometer of your overall health and a bellwether for disease as well as an indicator of cardiovascular health.


Be Mindful

Observe your penis in both flaccid and erect states. Carefully watch and listen to your urinary stream. Keep an eye on  your urine and semen. It sounds strange, but by doing so you will gain insight into your general and pelvic health. Don’t forget to examine your testicles periodically when showering, feeling for lumps, bumps or asymmetry.

Skin Matters

Are there any rashes or skin lesions on the penis or scrotum? The genital skin—like the rest of our skin—can be subject to allergic responses, infections and cancers.

Power Tool No More?

Are you “limping” in the bedroom with less rigid and durable erections? This may be a sign of a problem with the cardiovascular system. The penile arteries are smaller than the coronary arteries of the heart and narrow before those of the heart have an opportunity to do so, so ED can be a predictor of a more generalized disease process involving other blood vessels.

Sex Drive Gone South?

Are you more interested in baseball than in sexual matters? If so, it may be time for a libido check and an evaluation of your testosterone level, as T is the “governor” of sex drive.

Erection Curved like a Banana?

Has your formerly straight erection gone “rogue”? Does it appear curved like a banana or is it angled like a periscope? Is there an area of narrowing that looks like a “waist” giving it an “hourglass” appearance? If so, you may have Peyronie’s disease, scarring of the sheath of the erectile cylinders of the penis causing a painful curvature.

Dribbling Instead of Shooting?

Did your previously powerful and intense ejaculation morph into a weak sputter of a small volume of semen with diminished intensity? If this is the case, you may have weakened pelvic floor muscles.

What’s That?

Is there a discharge from your urethra? If so, you might have a urethral infection/inflammation known as urethritis or other sexually transmitted infection. If you have not ejaculated in some time, it is possible that there will be a milky white discharge at the time of a bowel movement as the prostate is “milked” by the act of defecation.

Funky Colored Urine?

Urine color ranges from clear to amber, depending upon your state of hydration. When well hydrated, your urine will look clear or very pale yellow, like light American beer. When dehydrated, your urine becomes very concentrated, appearing dark amber, like a strong German beer.

Fresh bleeding in the urinary tract makes the urine appear bright red whereas old blood appears tea or cola-colored. In either case, blood in the urine is abnormal and should be investigated to ensure that the bleeding is not on the basis of a serious condition such as bladder or kidney cancer.

Excessive vitamin B intake can result in light orange urine. Overconsumption of beets, blackberries, and rhubarb can sometimes impart a red color to urine. Cloudy urine may be indicative of a urinary tract infection, but can also occur when one’s diet consists of foods high in phosphates.

When urine is occasionally foamy or sudsy, it is considered to be normal. When it occurs consistently, it can be a sign of protein in the urine, often indicative of kidney disease.

Funky Smelling Urine?

A sweet smell may indicate diabetes. A foul odor may be on the basis of a urinary infection or the intake of certain foods, e.g., asparagus. Vitamin intake can also cause the urine to have an unpleasant odor. Vitamins B and C are water soluble and therefore not stored in the body and any excess above what is necessary for the body’s use is excreted in the urine. Malodorous urine that has a fecal odor may indicate a bad urinary infection or possibly an abnormal connection between the colon and the bladder known as a fistula. This happens most commonly from diverticular disease of the colon and when it occurs, there is often air in the urine as well.

Does It Burn?

If urination is painful, it may indicate a urethral or urinary infection.

Can’t Put Out a Fire Anymore?

When you observe your flow, does it hesitate before it gets going? Is the stream weak and split into several streams or sprays like a spigot? Does it start and stop and seem to take forever to empty? When you have to go, do you have little warning and a tremendous desire to urinate? Are you leaking urine before you get to the toilet? Do you have an after-dribble? Does the sound of your urination that once was like the rapids of a powerful river now sound like a meek creek? If so, you may have plumbing issues on the basis of prostate enlargement, scar tissue in the urethra, or an overactive or underactive bladder.

Bloody Show?

Blood in the semen can literally scare the “daylights” out of you. However, the majority of men with “hematospermia” have a benign inflammation of the prostate that is not a serious problem, often as innocuous as a nosebleed.

Bottom Line: Scrutinize your genitals to discover much about your health.

Wishing you the best of health,

2014-04-23 20:16:29

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback:  

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

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

Are You Cocky (Cock-y)?

December 20, 2014

Andrew Siegel, MD  12/20/14

shutterstock_side view manjpeg

On Cockiness

The word cocky (derivatives cockily and cockiness) is defined as “conceited or arrogant, especially in a bold or impudent way.” Cocksure (derivatives cocksurely and cocksureness) is defined as “presumptuously or arrogantly confident.”

Being able to function well sexually contributes to your masculine identity and behavior and is responsible for a “swagger” that permeates positively into all areas of your life. Body confidence promotes mind confidence just as mind confidence promotes body confidence. There is good reason that the words “cocky” and “cocksure” mean possessing a great deal of confidence.

 Slang Terms For The Penis

There are an abundance of slang terms for the penis. Some are vulgar, others less so. The most popular are “dick” and “cock.” The “w” words “wang,” “wiener,” and “willy” are popular. There are the descriptive words: “manhood,” “member,” “package,” “tool,” “unit,” “prick,” “pecker,” and “dong.” Let’s not forget the name words “Johnson” and “Peter.” There is the medical term pudendum” and its derivative “pud.” There are the Yiddish slang terms, “schlong” (slang for snake) and “putz,” often used in a derogatory sense. On the international scene, “lad” is Irish, “todger” is Australian/UK origin, and “schwanz” is German, literally meaning tail. When I was a urology resident, we used the term schwanz quite often, although I’m not sure quite why, it just sounded like an appropriate term, and was subtler and smoother than the harsher terms “dick” and “cock.”

Slang Terms For Erections

There is no scarcity of slang words for an erection. The most popular are the descriptive terms “hard-on” and “boner,” but “chubby,” “stiffy” and “Mr. Happy” are reasonably popular as well. Then there are the metaphors: “wood,” “rod,” “joystick,” “pony” and “pitching a tent.”

Constriction Devices

Cock rings—a.k.a. constriction devices, tension rings and erection rings—are tourniquet variants that are placed around the circumference of the base of the erect penis with the intention of providing constrictive pressure to stop the exit of blood to help maintain erectile rigidity.

Constrictive devices are sometimes used to treat ED, particularly when the underlying cause is veno-occlusive disease, the ability to obtain a rigid erection, but its premature loss because of failure of blood to be trapped appropriately. As a urologist I have often prescribed the Actis adjustable loop for patients with venous-occlusive disease or “venous leak.” Additionally, constrictive devices are often used in conjunction with vacuum suction devices, to trap the blood pulled into the penis by virtue of the vacuum.

Cock rings are also used recreationally to enhance the rigidity of erections or at times as a sex toy. Caution must always be taken when using a device that chokes off blood flow. Although they can enhance rigidity and sexual pleasure, they can also cause discomfort, a cold and dusky penis, an unstable (floppy) erection because of failure of the device to create rigidity of the deep roots of the penis, and can make ejaculation impossible. One of the biggest issues with  rings is that they provide constrictive pressure that affects only the pendulous outer half of the penis without compressing the inner penile roots, which are “where the money is” in terms of providing erectile rigidity.

Want To Know A Little Secret?

You actually have a natural, built-in ring that you can tap into at will and use in lieu of a constriction device!

Two of the pelvic floor muscles are compressor muscles that function to impede the exit of blood from the penis and maintain erectile rigidity and high penile inflation pressures. The two important pelvic floor muscles involved with rigidity are the bulbocavernosus (BC) and ischiocavernosus (IC) muscles, located in the perineum, the area between the scrotum and the anus. The BC and IC muscles cover, support and compress the inner aspects of the erection chambers of the penis and when engaged during sex stabilize the erect penis and decrease the return of blood to help maintain penile rigidity, extraordinary penile blood pressures and a skyward-pointing erection. At the time of climax, they contract rhythmically and are responsible not only for maximal erectile rigidity at the time of ejaculation but also provide the muscle power behind ejaculation. The classic 1909 Gray’s Anatomy textbook aptly labeled the IC the “erector penis.”

How To Optimize Function Of Your Natural Ring?

Pelvic floor muscle exercises to improve the strength, tone and endurance of the pelvic floor muscles will maximize erectile rigidity and durability. If you want to be confident (cocky) in the bedroom, you might consider preparing, just as you would for any other athletic event. The preliminary results from our ongoing clinical trial with the Private Gym male pelvic floor muscle training program have shown that not only does the program improve erectile dysfunction, but also optimizes function in those men who do not have erectile dysfunction, with “confidence” being the one parameter that was most consistently reported as improved.

Wishing you the best of health and a wondeful holiday,

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: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:

Private Gym: -available on Amazon as well as Private Gym website

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

30 Interesting Kegel Facts

November 8, 2014

Kegel Facts

Andrew Siegel MD (11/8/14)



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

Wishing you the best of health,

2014-04-23 20:16:29


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: – now available on Amazon

The Penis: A Feat of Brilliant Engineering

May 10, 2014

Blog #153

The penis, when functioning properly, is a proud soldier, a term used when I was a urology resident at University of Pennsylvania and rotating through pediatric urology at Children’s Hospital of Philadelphia (CHOP). Numerous penile reconstructive procedures were performed at CHOP for congenital birth defects that caused the penis to have a disfiguring curvature and an abnormally located urethral opening. The term “proud soldier” was used in the context of the excellent results after repair. I admire that nickname—it signifies a warrior, peacekeeper, man-at-arms, standing tall at attention, saluting, noble, confident and majestic.

Who Knew? A sect of wandering, ascetic Hindu holy men of India known as the Sadhu believe that God dwells in the penis.

Who Knew? “Wood in the womb.” Male fetuses have erections in utero as demonstrated by prenatal ultrasounds. Maybe that “kicking” that brings a smile of baby-pride to pregnant mom’s face is not really kicking at all!

Men have a special bond with their most curious appendage—arguably their most precious accessory—which truly is a remarkably versatile organ that adapts to the environment as the situation demands. When we don’t need it, it remains flaccid, out-of-sight, concealed and low in profile. However, on demand, our cooperative friend will readily rise to the occasion and assume the gravity-defying role of proud soldier. There are not many other organs in the body that demonstrate such a great versatility in terms of the physical changes between “inactive” and “active” states.

Who Knew?

Q. What organ in the body when stimulated will increase its size fourfold?

A. If you were thinking the penis, you are going to be very disappointed, but wouldn’t that be nice! The correct answer is the pupil of the eye, which will dilate from 2 millimeters in diameter in bright light to 8 millimeters in dark, as governed by the iris.

The penis is an organ of convenience. Like a good friend, it is always there for us—at arm’s length away—and provides us with the luxury of being able to empty our bladders with laser-like precision in the standing position when the need arises. I think it is fair to say that most women are quite envious of our capacity for such a directed urinary stream, which proves to be a very handy benefit that allows us to remain a healthy distance away from the toilet in the circumstance of unpleasant public bathrooms. It also enables us to duck behind a tree and readily empty our bladders on a golf course or on the side of a highway—al fresco style—when there is no bathroom available.

Who Knew? Hypospadias is a medical condition in which the urethra does not open at the appropriate place at the tip of the penis, but can open anywhere on the undersurface of the penis. In its most severe form, it can open on the perineum, the area between the scrotum and anus. This condition causes us to lose our competitive gender advantage of “directed” urinating. The good news is that pediatric urologists can repair hypospadias such that the urethral opening is repositioned at its normal location.

The penis is an amazingly multifunctional structure—no less so than a Swiss army knife—with an impressive ability to multi-task, having an array of functions, including urinary, sexual and reproductive. Eric Gill, the British sculptor, articulated the multi-tasking function of the penis with the following statement: “The water tap that could turn into a pillar of fire.” The penis wears many “hats” that can be summarized by the four P’s. It permits us to pee with a directed urinary stream. When erect, it enables vaginal penetration and sexual intercourse. Ejaculation deposits semen in the vagina, with the passage of genetic material and ultimately, the perpetuation of the species.

What an astonishingly clever biological design in which sexual enjoyment is linked with the act of reproduction. We think we’re pursuing pleasure, but what we are actually getting is reproduction— nature’s ultimate bait and switch scheme that ensures perpetuation of the species. If sex were not such a pleasurable act, there would be little incentive to have it. In this regard, it is much like eating—under the guise of pleasure and satisfying hunger, we are actually fueling ourselves with nutrition that ensures nature’s endpoint of perpetuation of the individual.

Who Knew?  “Penile Couture.” Men from the Ketengban tribe in the highlands of New Guinea, who are otherwise naked, wear decorative sheaths on their penis called “phallocarps.” They are made from a variety of different materials, often in vibrant colors, and vary in ornamentation and size, being similar in many respects to our neckties.


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

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”: