Posts Tagged ‘flaccid’

The Fickle Phallus

June 10, 2017

Andrew Siegel MD  6/10/17

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The penis is a fickle and temperamental friend who can be volatile, unpredictable and even hot-headed at times.  He has many states of existence, ranging from as shrunken and soft as a marshmallow to a “proud soldier”– rock-hard with exquisite posture. Between deflated and inflated, there are an infinite number of intermediate states, dependent on the dynamic balance between the closing and opening mechanisms of the blood flow to the penile erectile chambers.  It is important to understand that the same physiology applies to female genitals and clitoral function. 

The Autonomic Nervous System: The Network Ultimately Responsible for this

The autonomic nervous system controls “unconscious” body functions, including heart rate, breathing, digestion and contributes in a large way to regulate sexual function.

Heart rate and contraction are dynamic, changing moment-to-moment, even beat-to-beat, since they are “governed” by two competing halves of the autonomic nervous system.  The two systems—sympathetic and parasympathetic—are in a constant tug-of-war based upon external stimuli and one’s interpretation of them.

The sympathetic nerves respond to threats, fears and anxieties —an agitated state of mind and blood vessel tone—with the classic flight-or-fight response, which accelerates heart rate, heart contractility, respiratory rate, blood pressure and constricts arteries throughout the body.  The sympathetic system boots up when one is presented with a sudden anxiety-provoking event, such as being in a near-miss car accident.

On the other hand, the other half of the autonomic nervous system is the parasympathetic nervous system—the calmer and more relaxed state of mind and blood vessel tone—which slows down heart rate and respiratory rate, reduces heart contractility and lowers blood pressure by dilating arteries. The parasympathetic system is the system that predominates when we are not in situations that provoke fear and anxiety, governing many day-to-day bodily functions.

The_Autonomic_Nervous_System

Above image from Wikipedia, in public domain

 

Erectile function is complex and based upon many factors, both physical and psychological, but the ultimate determinant is chemistry that drives penile blood flow or lack thereof.  The state of the penis (flaccid vs. rigid vs. any intermediate state) at any given moment is based upon the balance between sympathetic (contractile) and parasympathetic (relaxant) factors. As the cardio-vascular system function is predicated upon the predominance of sympathetic versus parasympathetic stimulation, so the function of the peno-vascular system is predicated upon the predominance of sympathetic versus parasympathetic function. After all, the penis can be considered to be an extension of the vascular system that can be referred to as the “dangling aorta.”

Penile erection occurs with activation of parasympathetic (nitric oxide-cyclic guanosine phosphate pathway) nerves, which foster the relaxation of the penile arterial smooth muscle and the smooth muscle of the erectile tissue and inhibition of contractile mechanisms, all of which cause blood to rush into and inflate the penile erectile chambers.

Alternatively, penile flaccidity occurs with activation of sympathetic (norepinephrine pathway) nerves, which foster the contraction of the penile arterial smooth muscle and the smooth muscle of the erectile tissue and inhibition of relaxing mechanisms, all of which causes blood to exit and deflate the penile erectile chambers.

Sympathetic nervous system activity causing increased smooth muscle tone in erectile tissue is likely involved in the occurrence of psychological as well as in cardiovascular erectile dysfunction.

The bottom line is that the state of penile inflation at any given moment is highly influenced by the balance between sympathetic and parasympathetic function. High sympathetic activity causes a shriveled and decompressed penis, while high parasympathetic activity an erect and rigid penis. This is the very reason why one needs to have a relaxed temperament in order to perform sexually and also explains why anxiety can doom erectile function. A perfectly healthy 21-year-old with absolutely normal “plumbing” can be doomed to sexual failure if performance anxiety creates such a high sympathetic tone state. Similarly, a 50-year-old man who uses Viagra to increase penile blood flow and help obtain a rigid erection can have the beneficial effect of the medicine neutralized by a highly anxious state of mind.

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

Penile Implants

February 27, 2016

Andrew Siegel MD 2/27/16

With respect to male sexual dysfunction,  implantation of a penile prosthesis is a highly effective procedure capable of restoring erectile function in those men who do not respond to simpler treatment measures.  In many ways it is as quality-of-life-restoring as a total knee replacement is to one suffering with arthritis, converting a penile “cripple” into a functional male with restored erections and resolution of the psychological and emotional devastation resulting from loss of manhood.

There are two principles that can be pretty much applied to all situations in life:

  1. If it ain’t broke, don’t fix it. (Pardon the English.)
  2. If it is broken, try the simple and conservative before the complex and aggressive.

These concepts are commonly applied to medical issues in general and male sexual dysfunction in specific.  If erections are satisfactory, no treatment is necessary (but maintaining a healthy lifestyle will sure help keep things that way).   However, if erections are flimsy and feeble, the following sensible tiered strategy is in order:

First-Line Approach

Lifestyle makeover. This includes a heart-healthy (and penis-healthy) diet, getting down to “fighting” weight, exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc. Aside from general exercises (cardio, core, strength training, flexibility), specific pelvic floor muscle exercises (“man-Kegels”) are beneficial to improve the strength, power and endurance of the penile “rigidity” muscles.

Second-Line Approach

ED meds/Penile vibratory stimulation therapy/Penile pump.  Viagra, Cialis, Levitra and Stendra are pharmacological options.  As an alternative to medications, penile vibratory nerve stimulation (Viberect device) can be an effective means of helping resurrect erectile function. Alternatively, the vacuum suction device is a means of drawing blood into the penis to obtain an erection; the system uses a constriction band to maintain the erection.

Third-Line Approach

Urethral suppositories/Penile injection therapy. Suppositories are medicated pellets that are placed in the urethra (urinary channel) that  increase penile blood flow and induce an erection. Penile injections of vasodilator medications do the same and more effectively so, but require the medication to be injected directly into the penile erectile chambers. (Blog on this subject forthcoming next week.)

Fourth-Line Approach

Penile implant. This is a device made of synthetic materials that is surgically implanted under anesthesia, typically on an outpatient basis. It is totally internal, with no visible external parts and aims to provide sufficient penile rigidity to permit vaginal penetration. For the right man under the appropriate circumstances the penile implant can be a life changer.

There are two types of penile implants: semi-rigid and inflatable. I liken the difference between these two implants to the distinction between a Volkswagon and Mercedes, both effective and functional, but one with many more “bells and whistles.”

A semi-rigid penile implant (a.k.a. malleable implant) is a “static” implant that always remains rigid, not unlike the os penis (penis bone) present in many primates, except that this implant can be hinged. It is bent upwards to put it to use and is bent downwards to conceal it. It consists of two cylinders that are implanted within the penile erectile chambers through a small incision.

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(Coloplast semi-rigid penile implant)

The advantage of the semi-rigid implant is its simplicity, the fact that it is less expensive than an inflatable device and its utility for handicapped patients with dexterity issues or those who have limited reaches. Its disadvantage is that it cannot go from a flaccid state to an inflated state as can the inflatable penile implant, thus creating some potential issues with concealment. Furthermore, by virtue of the constant pressure of the implant on the soft tissues of the penis, it can be more uncomfortable than the inflatable variety and has the potential for thinning the penile flesh.

The inflatable penile implant (IPP) is a “dynamic” device designed to mimic the characteristics of a normal erection, with the capacity to inflate and deflate by virtue of a self-contained hydraulic system. Dual cylinders (inner tubes) are implanted in the erectile chambers. The length of the erectile chambers is precisely measured in order to size the implant properly, similar to measuring the size of your feet in order to ensure a good shoe fit. A control pump is implanted in an accessible area of the scrotum. The third element is the reservoir, which contains the fluid necessary for inflation. The reservoir is typically implanted behind the pubic bone or within the abdominal wall. Tubing connects the control pump to the cylinders and to the reservoir.

Titan Touch product anatomy

(Coloplast inflatable penile implant)

When an erection is desired in a man who has an IPP implanted, the scrotal control pump is repeatedly squeezed, which transfers saline from the reservoir into the penile cylinders. As the cylinders fill, an erection develops and with each consecutive squeeze, more fluid is flows into the cylinders, creating a more rigid erection of wider girth. The erection will remain until the release bar on the control pump is activated.   After the completion of sexual intercourse, by activating this release bar, the fluid in the cylinders returns to the reservoir where it is again stored, returning the penis to its flaccid state. Some IPPs are designed to increase in girth only, whereas others can increase in length and girth.

IPPs have been available for over forty years and have been improved remarkably over the years. The current devices are well-engineered, sophisticated,  highly effective devices. Penile sensitivity, sex drive and ability to ejaculate are essentially unchanged following an IPP implantation. It is important to know that unlike a normal erection, the IPP erection does not result in swelling of the head of the penis nor the erectile tissue surrounding the urethra. Nonetheless, it results in a penetrable and durable erection that can restore sexual function in a man who is incapable of achieving an erection.

Advantages of the IPP are its ability to inflate and deflate, creating no issues with concealment. The penis can be kept inflated for as long as desired, whether it be 60 seconds or 60 minutes and will not deflate after ejaculation, unlike what typically occurs under normal circumstances. Disadvantages include its additional expense (although it is usually covered by insurance), the fact that it requires some degree of manual dexterity to operate, and the fact that it is more susceptible to mechanical malfunction than the semi-rigid variety because of its complexity.

Bottom Line: The penile implant is a fourth-line approach for ED that is a highly effective means of providing erectile rigidity on demand, capable of restoring sexual function in a man who is incapable of achieving a functional erection.

Thank you to the Coloplast Corporation for providing the images.

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. 

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.

You Can’t Think It Up, But You Can Think It Down

November 21, 2015

Andrew Siegel MD   11/21/15

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(Above fortune from Chinese fortune cookie relevant to this discussion.)

Q: What is the most powerful sex organ?

A: If you think it is the erect and throbbing penis, you are incorrect. The BRAIN is the bossman and the most influential force driving sexuality. The penis is a mere buck private soldier that responds and bends to the will of the five-star general and commander-in-chief of sexuality, the central nervous system.

Despite the authority and assertive presence of the brain, it is only under rare circumstances that it is capable of willing the limp penis to become erect. Some form of touch or erotic stimulation is most often necessary to get the erection process going, with the exception of nighttime-related erections associated with a phase of sleep known as REM (Rapid Eye Movement).

If the central nervous system cannot will the limp penis to become erect, it certainly can will the erect penis to become limp or will the limp penis to remain limp. This is the case with performance anxiety, a classic instance of the powerful mind-body connection. In this circumstance, stress or anxiety causes the output of high levels of adrenaline, which functions to constrict penile blood flow and erectile smooth muscle relaxation, resulting in a limp penis.

The central nervous system is the commander-in-chief of sexuality, but it demands working the way it likes to work, i.e., naturally, unhindered and unburdened by cognitive thought. Conscious and willful thought clearly can interfere with the smooth function of the central nervous system. When conscious thought enters the picture, the ability to perform many complex movements goes south. Much the same as a golf swing or any action like using a fork to feed yourself or walking down a flight of stairs, when it comes to sexuality, the brain works best when it is working subconsciously. Overthinking is the enemy of any complex motor activity. With all of these examples, one needs to be in the moment and engaged in the activity without conscious thought, in order to enable a smooth execution.

The moment one starts overthinking, the complex motion is virtually destined to be flawed. The golf swing is a classic example, with a poor shot almost guaranteed if one has too many swing thoughts that confound execution and performance. For the non-golfers, try walking down a flght of stairs at a good clip, stating to yourself in your inner voice each step in the process and you will likely trip up. When you are in a sexual situation, if you focus on thinking about your sexual function or lack thereof or reliving a previous problem, then your performance will most often be doomed to failure.

stupid-487043_1920

(Thank you, Pixabay for image above)

Too much thought is capable of empowering self-fulfilling prophecies and bringing them to fruition. If one has had erection issues and in a passionate moment starts thinking, assessing, evaluating and analyzing, he is almost certain to be incapable of obtaining or maintaining an erection. Likewise, if one suffers with premature ejaculation and his thought pattern becomes obsessively focused on this possibility instead of being in the moment and enjoying the situation, he is almost certain to ejaculate way sooner than desired. The same is true with the rarer but equally disturbing problem of delayed ejaculation. Focusing on trying to make oneself ejaculate will most often bring on the inability to ejaculate.

Masters and Johnson coined the term spectatoring, an intense self-focus during sexual interactions as opposed to immersing oneself in the sensory aspects of the sexual experience. Essentially, spectatoring is observing and monitoring yourself having sex as if you were a third party, often accompanied by an anxious internal, self-conscious dialogue with concerns about some aspect of your sexual performance. It is being a spectator instead of the player and it will DESTROY your game.

The solution to spectatoring is to “be present” and “in the moment,” totally immersing yourself in the experience without observation or conscious internal thoughts. When you lose yourself in the sensations and do not allow thoughts to interfere with the process, you maximize your chances for an optimal performance. When distracting thoughts uncontrollably float into the present like dark clouds in the sky, take a deep breath, exhale slowly and allow the thoughts to pass and return to a state of being present.

Bottom Line: Overthinking is the enemy of complex actions, including erections and ejaculation. Allow the central nervous system to do what it does so well– subconsciously– without trying to help things along with deliberate thought.  Let instinct prevail over conscious thought–you cannot make it happen, you have to let it happen. There is an  time and place for conscious thought, but it is not in the heat of the moment in the bedroom.  Be present without thought of the past or future. 

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.

The Many Moods Of The Penis

August 25, 2015

Andrew Siegel, MD  8/25/15

There was a terchnical problem with the previous uploading of this blog, so I apologize if you have already received it.

phases of moon

(Thank you and credit for image above, which is in original form, created by Rafa Castillo; https://www.flickr.com/photos/rafa_castillo/5935864125)

The penis is a very moody organ–it can be temperamental, volatile, excitable, up and down, unpredictable and hot-headed at times.  Like the moon, it has many phases of existence, with a multitude of different states, ranging from soft as a marshmallow to hard as a rock. Between deflated and rigid, there are an infinite number of intermediate states, dependent on the dynamic balance between the constricting and relaxing mechanisms of the blood flow to the erectile chambers of the penis.  Human sexual response is all about “vasocongestion” a.k.a., blood flow.

When the mechanisms that regulate inflow and outflow are not functioning properly, problems may occur, ranging from absent erections to poor erections to satisfactory erections that do not last, to prolonged erections that do not quit (priapism).

The penis is a marvel of human hydraulic engineering with four recognizable “phases”:

  • Flaccid phase—On a scale of 0-100% inflated, this is 0-10%. The penis is lackluster and droopy, with enough blood flow to maintain tissue oxygenation and nutritional and metabolic demands. Since the penis is an organ of both sexual and urinary function, thankfully the flaccid state still allows its owner to enjoy the advantage of standing to urinate.

ad-70507_1280Did you know? The flaccid penis is incapable of penetration, but is fully capable of being stimulated to ejaculation and orgasm.

  • Tumescent phase—On a scale of 0-100% inflated, this is 10%-75%. The penis is softly swollen and engorged, but not stiff. It is in the process of being inflated, gradually filling and plumping as blood is pumped into and trapped within the erectile chambers. Like a New Year’s Eve party blowout, the toy that when blown unfurls and extends outwards, so does the tumescent penis as it becomes inspired and shows some spirit, lifting somewhat from its dangling position.
  • Penetration capable phaseOn a scale of 0-100% inflated, this is about 75%-80% or so. The penis has become firmer, but not rigid and is competent to penetrate, although it may require some manipulation to do so. It is animated and peppy and starts to elevate a bit more.
  • Rigid phaseOn a scale of 0-100% inflated, this is 90%-100%. The penis is as stiff as if it had a bone within. The rock-hard penis makes penetration effortless. The energetic, eager and confident penis now defies gravity, proudly pointing towards the horizon, if not the heavens, when its owner assumes the standing position.

fuel-40193_1280

Factors That Lead to Penile Inflation

  • Sensual erotic excitement: sight of a beautiful woman; scent of perfume; sexy whisper; taste of a kiss; soft touch
  • Genital touch: direct stimulation
  • Brain induced erotic stimulation: thoughts, memories, fantasies
  • Dreaming: unique brainstem mediated mechanism that occur during REM (rapid eye movement) phase sleep
  • Spontaneous: occurs for a combination of factors or unknown factors
  • Reflex: full bladder
  • Warm environment: hot bath or shower
  • Gravity: standing upright as opposed to lying down (similar to veins in your arm popping out when arm is lower than heart).

Factors That Lead to Penile Deflation

  • Absence of sexual stimulation
  • Medical issues that interfere with hormones, arterial inflow, venous outflow, nerve supply to penis, smooth muscle in erectile chambers, pelvic floor muscles
  • Medications that interfere directly with blood flow or act centrally on the brain
  • Adrenaline-fueled constriction of penile blood vessels: stress hormone released by fear, anxiety, fighting, fleeing, performance anxiety, etc.
  • Cold exposure (cold shower, bath, swimming, etc.–remember George from the “shrinkage” Seinfeld episode?)
  • Exercise: creates a “steal” of blood flow to large muscles that demand it and away from “unessential” organs
  • Cycling: blood vessels, nerves and pelvic muscles take a beating from compression “trauma”

Hard Science

Note: The following is a brief summary of the science of erections, which may be TMI for many, but will help you understand penis magic.

A limp penis is the state when the arteries and smooth muscle within the erectile chambers are in a constricted state. Penile swelling occurs when stimulation results in increased arterial inflow and relaxation of erectile smooth muscle, permitting filling and expansion of the erectile chambers. The magic chemical that governs this is nitric oxide, present within penile nerves and penile blood vessels. Nitric oxide is what makes it all happen.

 Did you know? Nitric oxide is manufactured from arginine, which is why some feel that arginine supplements may be good for the erectile process; however, the jury is not out on this.

With stimulation, nitric oxide is activated and gets into the smooth muscle cells of the penile arteries and erectile smooth muscle of the erectile chambers where it activates GMP (guanosine monophosphate), which causes the smooth muscle to relax and blood to pour in. This smooth muscle relaxation results in penile blood pressure becoming equal with systolic blood pressure and an engorged penis, plump but not rigid.

Once engorgement occurs, rigidity will follow after the pelvic floor muscles engage. There is no bone in the human penis as there is in many mammals, so nature has evolved a clever trick to generate rigidity using highly pressurized blood.

 Is nature brilliant? Pressurize a liquid to obtain almost a solid state. It’s like freezing water to turn it into ice!

To achieve maximal penile rigidity, penile blood pressure must exceed systolic pressure (the top number of your blood pressure) by 100 millimeters of mercury. This means a penile blood pressure above 220 must be achieved for the average man!

 Did you know? The penis is the only place in the body where high blood pressure is desirable and necessary for proper function. A hypertensive penis is an erect penis and a happy penis. This explains why blood pressure pills are the most common medications associated with erection difficulties.

How does one achieve a hypertensive penis? This is where the “rigidity” muscles come into play. In response to penile stimulation, the pelvic floor muscles (ischiocavernosus and bulbocavernosus) that surround the deep roots of the penis contract rhythmically, clamping venous outflow and compressing the deep roots of the penis, pushing more blood into the erect penis, resulting in penile high blood pressure and full-fledged rigidity. Without the rigidity muscles, the penis would be plump at best.

Did you know?  Would you like to see your rigidity muscles in action?  Stand upright when you have an erection and contract your pelvic floor muscles and watch the penis lift up towards the sky…penis magic! 

After ejaculation, an enzyme known as PDE5 (phosphodiesterase type 5) inactivates the GMP, ending the party, as rigidity dwindles to tumescence to flaccidity. Viagra, Cialis, Levitra and Stendra are PDE5 inhibitors that prevent the inactivation of GMP.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

The Many Moods Of The Penis

August 5, 2015

Andrew Siegel, MD   8/22/15

phases of moon

(Thank you and credit for image above, which is in original form, created by Rafa Castillo; https://www.flickr.com/photos/rafa_castillo/5935864125)

The penis is a very moody organ–it can be temperamental, volatile, excitable, up and down, unpredictable and hot-headed at times.  Like the moon, it has many phases of existence, with a multitude of different states, ranging from soft as a marshmallow to hard as a rock. Between deflated and rigid, there are an infinite number of intermediate states, dependent on the dynamic balance between the constricting and relaxing mechanisms of the blood flow to the erectile chambers of the penis.  Human sexual response is all about “vasocongestion” a.k.a., blood flow.

When the mechanisms that regulate inflow and outflow are not functioning properly, problems may occur, ranging from absent erections to poor erections to satisfactory erections that do not last, to prolonged erections that do not quit (priapism).

The penis is a marvel of human hydraulic engineering with four recognizable “phases”:

  • Flaccid phase—On a scale of 0-100% inflated, this is 0-10%. The penis is lackluster and droopy, with enough blood flow to maintain tissue oxygenation and nutritional and metabolic demands. Since the penis is an organ of both sexual and urinary function, thankfully the flaccid state still allows its owner to enjoy the advantage of standing to urinate.

ad-70507_1280Did you know? The flaccid penis is incapable of penetration, but is fully capable of being stimulated to ejaculation and orgasm.

  • Tumescent phase—On a scale of 0-100% inflated, this is 10%-75%. The penis is softly swollen and engorged, but not stiff. It is in the process of being inflated, gradually filling and plumping as blood is pumped into and trapped within the erectile chambers. Like a New Year’s Eve party blowout, the toy that when blown unfurls and extends outwards, so does the tumescent penis as it becomes inspired and shows some spirit, lifting somewhat from its dangling position.
  • Penetration capable phaseOn a scale of 0-100% inflated, this is about 75%-80% or so. The penis has become firmer, but not rigid and is competent to penetrate, although it may require some manipulation to do so. It is animated and peppy and starts to elevate a bit more.
  • Rigid phaseOn a scale of 0-100% inflated, this is 90%-100%. The penis is as stiff as if it had a bone within. The rock-hard penis makes penetration effortless. The energetic, eager and confident penis now defies gravity, proudly pointing towards the horizon, if not the heavens, when its owner assumes the standing position.

fuel-40193_1280

Factors That Lead to Penile Inflation

  • Sensual erotic excitement: sight of a beautiful woman; scent of perfume; sexy whisper; taste of a kiss; soft touch
  • Genital touch: direct stimulation
  • Brain induced erotic stimulation: thoughts, memories, fantasies
  • Dreaming: unique brainstem mediated mechanism that occur during REM (rapid eye movement) phase sleep
  • Spontaneous: occurs for a combination of factors or unknown factors
  • Reflex: full bladder
  • Warm environment: hot bath or shower
  • Gravity: standing upright as opposed to lying down (similar to veins in your arm popping out when arm is lower than heart).

Factors That Lead to Penile Deflation

  • Absence of sexual stimulation
  • Medical issues that interfere with hormones, arterial inflow, venous outflow, nerve supply to penis, smooth muscle in erectile chambers, pelvic floor muscles
  • Medications that interfere directly with blood flow or act centrally on the brain
  • Adrenaline-fueled constriction of penile blood vessels: stress hormone released by fear, anxiety, fighting, fleeing, performance anxiety, etc.
  • Cold exposure (cold shower, bath, swimming, etc.–remember George from the “shrinkage” Seinfeld episode?)
  • Exercise: creates a “steal” of blood flow to large muscles that demand it and away from “unessential” organs
  • Cycling: blood vessels, nerves and pelvic muscles take a beating from compression “trauma”

Hard Science

Note: The following is a brief summary of the science of erections, which may be TMI for many, but will help you understand penis magic.

A limp penis is the state when the arteries and smooth muscle within the erectile chambers are in a constricted state. Penile swelling occurs when stimulation results in increased arterial inflow and relaxation of erectile smooth muscle, permitting filling and expansion of the erectile chambers. The magic chemical that governs this is nitric oxide, present within penile nerves and penile blood vessels. Nitric oxide is what makes it all happen.

 Did you know? Nitric oxide is manufactured from arginine, which is why some feel that arginine supplements may be good for the erectile process; however, the jury is not out on this.

With stimulation, nitric oxide is activated and gets into the smooth muscle cells of the penile arteries and erectile smooth muscle of the erectile chambers where it activates GMP (guanosine monophosphate), which causes the smooth muscle to relax and blood to pour in. This smooth muscle relaxation results in penile blood pressure becoming equal with systolic blood pressure and an engorged penis, plump but not rigid.

Once engorgement occurs, rigidity will follow after the pelvic floor muscles engage. There is no bone in the human penis as there is in many mammals, so nature has evolved a clever trick to generate rigidity using highly pressurized blood.

 Is nature brilliant? Pressurize a liquid to obtain almost a solid state. It’s like freezing water to turn it into ice!

To achieve maximal penile rigidity, penile blood pressure must exceed systolic pressure (the top number of your blood pressure) by 100 millimeters of mercury. This means a penile blood pressure above 220 must be achieved for the average man!

 Did you know? The penis is the only place in the body where high blood pressure is desirable and necessary for proper function. A hypertensive penis is an erect penis and a happy penis. This explains why blood pressure pills are the most common medications associated with erection difficulties.

How does one achieve a hypertensive penis? This is where the “rigidity” muscles come into play. In response to penile stimulation, the pelvic floor muscles (ischiocavernosus and bulbocavernosus) that surround the deep roots of the penis contract rhythmically, clamping venous outflow and compressing the deep roots of the penis, pushing more blood into the erect penis, resulting in penile high blood pressure and full-fledged rigidity. Without the rigidity muscles, the penis would be plump at best.

Did you know?  Would you like to see your rigidity muscles in action?  Stand upright when you have an erection and contract your pelvic floor muscles and watch the penis lift up towards the sky…penis magic! 

After ejaculation, an enzyme known as PDE5 (phosphodiesterase type 5) inactivates the GMP, ending the party, as rigidity dwindles to tumescence to flaccidity. Viagra, Cialis, Levitra and Stendra are PDE5 inhibitors that prevent the inactivation of GMP.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

Nature’s Brilliant Design: Erection Hydraulics

December 6, 2014

Andrew Siegel, MD  12/6/14

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shutterstock_femalebluepelvic

Humans are hardwired for two basic functions: survival and reproduction. Nature’s forces have made the reproductive process a pleasurable one, and by so doing have ensured the greatest likelihood of reproduction being successful. What a clever bait and switch scheme in which in the seeming pursuit of a feel-good activity—determined by this evolutionary sleight of hand—we have been hoodwinked into reproducing!

The goal of reproduction is the fusion of DNA from two individuals to perpetuate the species. The penis functions as a “pistol” to inject the DNA into the female’s reproductive tract. A flaccid penis is unable to complete this task, as the process demands penetration.

Many mammals—including the gorilla and chimpanzee—have a bone in the penis (the baculum), which functions to keep the penis hard enough for vaginal penetration and injection of the DNA. (There is also a bone in the clitoris called the os clitoridis.) However, the human penis is boneless (as is the human clitoris). While we can debate whether or not this is a good thing, it certainly helps to keep the penis hidden during the workday!

Creating a “Bone” Where One Doesn’t Exist

So what did nature do to overcome this challenging design problem: how do you create bone-like rigidity in a boneless organ?

The answer lies in hydraulics—using blood as a hydraulic mechanism—not the typical use of blood, which is for the transportation of oxygen, carbon dioxide, hormones, nutrients, and wastes to and from our organs. This use of blood as a hydraulic mechanism for erections—both penile erections in men and clitoral erections in women—is nothing short of brilliant…our bodies having evolved to use blood the way a tire uses air, to inflate deflated organs to allow them to function!

Another example of an animal that uses hydraulic action is the jumping spider, which uses blood forced into the legs to straighten them out to facilitate powerful jumps, avoiding the need for muscular legs that are bulky and clearly not spider-like.

Erection hydraulics requires a special means of regulating flow. To do so, the inflow needs to turn on like a gushing faucet and the outflow needs to shut off like a plugged drain in a sink. This is not the usual state of affairs for blood flow to an organ, which typically requires a relatively small amount of inflow to meet basic metabolic needs and an equal amount of outflow, creating a dynamic state of equilibrium. An erection demands that the arteries of the penis function as high-pressure faucets (inflow increasing many times over baseline) and the penile veins to close off completely.

So how has our body evolved this capacity?

The penis is a marvel of design and engineering, capable of increasing its blood flow by a factor of 40-50 times over baseline! This surge happens within seconds and is accomplished by relaxation of the smooth muscle within the arteries supplying the erection chambers and within the erectile sinuses of the erectile chambers. This is not the case of non-genital organs, in which blood flow can be increased upon demand (for example, to our muscles when exercising), but not anywhere to this extent.

Now for a little deviation off course for some interesting trivia:

  1. The spongy tissue in the erectile chambers is virtually identical to the spongy tissue in our facial sinuses. (My pathologist buddy claims that he can’t tell the difference under a microscope.)
  2. When this spongy tissue in the penis or clitoris becomes congested with blood, an erection occurs; when it happens in ours facial sinuses it is known as sinus congestion or a stuffed nose.
  3. The spongy tissue in the erectile chambers is surrounded by connective tissue known as the tunica albuginea, the second toughest connective tissue in our bodies, the toughest being the dura mater that surrounds our brains and spinal cords.
  4. A side effect of the ED meds like Viagra is nasal congestion…now you understand why.
  5. Prolonged erections (priapism) are often treated with the same medications used to treat a stuffed nose, e.g., phenylephrine.

The Important Role of the Pelvic Muscles

So, under the right circumstances the penis becomes swollen (tumescent) with blood. How has our body evolved the capacity to trap the blood so it does not return to the circulation? How does the penis go from swollen to rock-hard rigid?

First, as the sinuses within the erectile chambers fill with blood, they pinch off the veins, which traps blood in the penis. Second, nature—in its typical brilliant way—has designed a means of increasing the blood pressure in the erectile chambers to sky-high levels by means of a “muscular tourniquet” that not only chokes off the exit of blood, but with each squeeze of this specialized muscle, causes a surge of blood with increased filling of the erectile chambers, the end result being bone-like rigidity.

What are the names of these specialized muscles and what muscle group are they part of?

These are the ischiocavernosus and bulbocavernosus muscles (man’s best friends, but equally helpful to the ladies out there) that are part of the group of muscles known as the pelvic floor muscles, which form the floor of the important group of muscles known as the “core” muscles.

When a man has a rigid erection, contracting these muscles will lift up the erection and point it majestically towards the heavens, thank you pelvic floor muscles. You knew that your core muscles were important, but did you realize that the “boner” that you take for granted is based upon well-functioning core muscles?  Ditto for the firm clitoris in the female.

Maintaining & Strengthening Your Pelvic Muscles

So, take good care of your pelvic floor muscles and they will take care of you! Keep them fit, just as you do your other muscles. With aging and lack of physical activity the pelvic muscles become lax, so by increasing the strength, tone, power, and endurance of the pelvic muscles through exercise, you will optimize your erectile rigidity. Moreover, the pelvic muscles assist in delaying ejaculation. Weak pelvic floor muscles can impair the ability to delay ejaculation and voluntary contraction of the pelvic floor muscles can help control ejaculation. When flexed, the pelvic muscles assist in short-circuiting premature ejaculation. Learn more about how you can strengthen and maintain these critical muscles at www.privategym.com

Enough of my prose…time to finish with a poem I have written for the occasion:

The Muscles Of Love

Limber hip rotators,

A powerful cardio-core,

But forget not

The oft-neglected pelvic floor

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: http://www.MalePelvicFitness.com

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

Penile Erection Geometry

June 7, 2014

 

 

Gray406

(Illustration credited to Dr. Henry Gray, Gray’s Anatomy of the Human Body, 20th edition, original publication 1918, public domain)

Blog # 156

A flaccid penis is soft like a marshmallow and dangles limply from its attachment to the pubic bone. With stimulation, the penis fills, firms, and increases in length and girth, as tumescence turns to rigidity. Not only does the penis undergo a metamorphosis into a rigid erection, but it also starts angling up towards the heavens—majestically pointing towards the sky, a marvel of human hydraulic engineering in defiance of the laws of gravity. At its extreme, the erect penis can touch the abdominal wall. A young man’s erection can easily support the weight of a towel.

Who Knew? Birthday and New Year’s Eve party blowouts—those party toys that when blown unfurl and extend outwards—are a useful means of thinking about erections. In the flaccid state, the erectile cylinders are very similar to the party blowout when it is not being blown into; in the erect state, the erectile cylinders are comparable to the party blowout when it is being blown into.  In the flaccid state, there is an acute bend at the junction of the external and internal penis. With a rigid erection, this acute angle is lost and the external penis develops an obtuse angle relative to the internal penis.

Analogous to penile size, there is a great amount of variability in the angle of the erect penis relative to the body (the pubo-penile angle). Like belly buttons that can be “outies” or “innies,” erections can be “uppies” or “outies,” depending on a number of factors. “Flagpoles” can be vertical, horizontal, or any angle in between.

Who Knew? In summer camp there was always that smart aleck camper who cited a complex equation of the physics of erection intensity, involving the “angle of the dangle,” “the heat of the meat,” “the direction of the erection,” “the dimension of the extension,” “the torque of the pork,” etc. Who knew that there was actually validity to some of these factors in determining the angle of erection!

The pubo-penile angle is determined by the following factors: the tension in the suspensory ligaments of the penis; the attachments of the penis to the pelvic bones; the size of the penis; the extent of the erection; and the tone and strength of the ischiocavernosus (IC) and bulbocavernosus (BC) muscles.

The suspensory ligaments support and maintain the erect penis in an upright position, essentially anchoring the base of the penis to the pubic bone. The tighter the ligaments are, the greater the potential upward angulation of the erect penis.

Who Knew? In an effort to increase penile length, some surgeons perform a procedure in which the suspensory ligaments of the penis are cut. What this actually does is to expose some of the internal penis, allowing more of the penis to hang outside the body. The price one pays for this sleight of hand is that one’s erection will no longer point majestically to the heavens. Essentially, one gains a bit of flaccid length and loses angle—robbing your Peter to pay Paul, literally!

As the suspensory ligaments provide support and anchorage of the external penis from above, so the attachments of the erectile cylinders to the pelvic bones provide support and anchorage of the internal penis from below. Every individual has different anatomy, and the variations in pelvic anatomy and support can engender variations in erectile angulation. In general, the more firm and secure the attachments are from below, the greater the potential foundation of support and the greater the potential upward angulation of the erect penis.

Who Knew? The internal, concealed penis that is attached to the pelvic bones can be thought of as the roots of a tree. Similarly, the external penis can be considered in terms of the trunk of a tree. Without a solid root system—the foundation—no tree can assume a tall and erect stature. But with a solid foundation, the penis, like the tree, has the support to point high to the heavens.

Penile size is generally inversely proportional to the potential for upward angulation. Largely due to the force of gravity, there is a tendency for less upward angulation with longer and heavier penises.

Conceptually easy to understand, if flaccid is considered a 0% erection and full rigidity is 100%, the greater the magnitude and extent of the erection, the greater the upward angulation.

There are two particularly important pelvic floor muscles called the bulbocavernosus (BC) and ischiocavernosus (IC) muscles. These muscles are crucial to male sexual function. There are a total of 3 erectile cylinders that form the bulk of the tissue of the penis. The solitary erectile cylinder known as the “corpus spongiosum” (“spongy body”) runs from the perineum (the area between the scrotum and anus)” through the length of the penis to the “glans,” the head of the penis. Its innermost, protuberant portion is known as the “bulb.” The corpus spongiosum contains the urethra (urinary channel) and during sexual stimulation, the corpus spongiosum and the glans become swollen and plump. The BC is the muscle that covers the penile “bulb.” The “corpora cavernosa” (“cave-like bodies”) are the paired erectile cylinders are responsible for rigid erections. The IC refers to the muscle that covers the inner, deep aspects of the corpora cavernosa.

Bulbocavernosus and ischiocavernosus muscle strength can factor strongly into erectile angulation. A voluntary contraction of the BC and IC muscles will cause the erect penis to deflect in an upwards direction. As the BC and IC muscles are flexed, one can easily observe movement of the external penis towards the heavens as the increased blood filling of the erectile cylinders nudges the external penis up. The better the tone and conditioning the BC and IC muscles, the greater the potential upward angulation of the erect penis.

We must accept what nature has given us regarding our suspensory ligaments, our attachments of the penis to the pelvic bones, and the size of our penises. However, the factors that we can modify are the extent of our erections and the strength of our IC and BC muscles. So if we want to maximize our pubo-penile angle, PFM exercises become of paramount importance

An erection needs to be hard enough to penetrate, but flexible enough to be able to negotiate the various “acrobatic” requirements of different sexual positions. So, although an erection that points to the heavens is a wonderful phenomenon, one that is so angled to the extent that it is inflexible will not help one’s performance in the bedroom.

Who Knew? The vagina is shaped like a banana, with its innermost and deepest part angling downwards toward the sacral bones. In order to accommodate female anatomy and position, a penis needs to be both rigid and flexible at the same time—“flexible rigidity,” to use an oxymoronic phrase. If one has a highly angled, inflexible erection, sexual positions such as the reverse cowgirl or woman on top leaning backwards can be painful and can potentially inflict damage to the penis, as well as prove uncomfortable for the woman.

 

Andrew Siegel, MD

www.AndrewSiegelMD.com

 

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

www.MalePelvicFitness.com

 

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

www.healthdoc13.wordpress.com

 

Penis Size: Does It Matter?

May 17, 2014

Blog #154

As I was walking through the gateway on my way to board an airplane, I saw a poster advertisement stating the following: Size should never outrank service, referring to the smaller size regional jets that now offer first-class, wi-fi and more. I recently saw another poster ad for the same airline stating: How fast the flight goes isn’t always up to pilot. I find these double entendres quite amusing and entertaining.

With all biological parameters, there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. Penis size is no exception, with some of us phallically endowed, some phallically challenged, but most of us somewhere towards the center. In a study of 3500 penises published by Alfred Kinsey, the average flaccid length was 8.8 centimeters (3.5 inches). The average erect length ranged between 12.9 -15 centimeters (5-6 inches). The average circumference of the erect penis was 12.3 centimeters (4.75 inches).

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that there is no clear cut correlation between ethnicity and penis size. Flaccid length does not necessarily predict erect length and can vary depending upon emotional state and ambient temperature. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

Some women prefer men who are formidably hung, just like some men prefer women with large breasts. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort, particularly if cervical contact occurs. The long and the short of it are summarized in the adage, “It’s not the size of the ship, but the motion of the ocean.

Who Knew? “Genital Genetics.” As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (or mother). In actuality, it is the roll of the genetic dice and how the inherited blueprint that determines physical traits interacts with the local hormonal environment.

Who Knew? Hung like a horse—forget about it! The blue whale has the mightiest genitals of any animal in the animal kingdom: penis length is 8-10 feet; penis girth is 12-14 inches; ejaculate volume is 4-5 gallons; and testicles are 100-150 pounds. Hung like a whale!

Who Knew? On the subject of penis size, one of my favorite things to do when driving on the highway and seeing some idiot in a Lamborghini driving hazardously from lane to lane at about 95 miles an hour is not to flash him my middle finger, but to show him my hand with my thumb and index finger separated about 1 inch apart to indicate to him what I think is the likely size of his penis.

Who Knew? “Men are from Mars, Women from Venus.” Leonardo Da Vinci had an interesting take on perspectives: “Woman’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.”

Who Knew? There are a bunch of “amenities” that accompany the aging process, one of which is “presbyopia” or farsightedness, which demands reading glasses. They are a real nuisance, never around when you need them and always getting lost. But one thing I have observed is that if you forget to take them off when you get up to relieve your full bladder, when you glance down, you see a rather large “member,” thanks to the magic of magnification. I am currently wearing 1.5 power; perhaps it’s time for 2.0!

Who Knew? There is no correlation between penis size and shoe size, hand size or nose size.

Who Knew? “Where’s Woody?” Three of the most common words I hear in my urology practice are the following: “Doc, I’m shrinking.”

Who Knew? Part of the problem is the pervasive pornography industry, where many male stars are endowed like the centaur, the mythological creature with the head and torso of man and the lower body of a horse. This has given the average guy a bit of an inferiority complex.

Many men complain of “shrinkage,” which is a very real phenomenon on the basis of blood flow. The typical circumstances evoking this are exposure to cold weather or cold water, the state of being nervous, and athletic pursuits. The mechanism in all cases involves blood circulation. Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s periphery to help maintain core temperature. This is the very reason one places ice on an injury as the vasoconstriction will reduce swelling and inflammation.

It stands to reason that exposure to heat will cause vasodilation (expansion of arterial flow) and this is the very reason that some penile tumescence (state of fullness without rigidity) can occur in a warm shower. Nervous states or anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in a flaccid penis. Participation in vigorous athletic activity “steals” blood flow to the organs that need the oxygen and nutrients the most, namely the muscles, at the expense of organs like the penis.

Who Knew? Do you remember the Seinfeld episode in which Jerry’s girlfriend Rachel sees George naked after George steps out of a swimming pool?

 Rachel: “Oh my God, I’m really sorry.”

George: “I was in the pool; I was in the pool.”

George to Jerry: “Well I just got back from swimming in the pool and the water was cold.”

Jerry: “Oh, you mean shrinkage.”

George: “Yes, significant shrinkage.”

As mentioned, truly not a day goes by in my practice when I fail to hear the following complaint from a patient: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrink from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis, if you will. Weight gain and obesity will cause a generous pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.” Lose the fat and presto…the penis reappears. Having a plus-sized figure is just not a good thing when it comes to man-o-metrics.

Who Knew? “Fatal Retraction.” It is estimated that for every 35 lbs. of weight gain, there will be a one-inch loss in apparent penile length.

Who Knew? “Penile Dysmorphic Disorder,” very much paralleling “Body Dysmorphic Disorder,” is a condition in which one’s image of their penis is at odds with reality. Typically, one envisions himself as small when in fact he is quite within the normal range and an obsessive focus on this issue creates a great deal of psychological stress.

Who Knew? “Koro” (“head of the turtle” in Malay) is a cultural form of psychological panic that occurs predominantly in East Asian men. Those who suffer from this delusional disorder are terrified that their genitals will retract into their bodies and take extreme measures to prevent this from occurring.

The erectile cylinders of the penis are essentially our “erector sets,” consisting of three inner tubes within the penis that are composed of vascular (consisting of blood vessels) smooth muscle and sinuses that fill with blood upon sexual stimulation. An erection is on the basis of blood expanding these cylinders to the point of penile rigidity. Like any other muscle, the muscle of the penis needs to be used on a regular basis, the way nature intended for it to be used. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile smooth muscle can occur. In a vicious cycle, any loss of sexual function can lead to further progression of the problem. Poor genital blood flow produces a state of poor oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the sexual dysfunction.

Radical prostatectomy, the surgical removal of the entire prostate gland as a treatment for prostate cancer, can cause penile shortening by virtue of the removal of the prostate gland. The resultant gap in the urethra because of the removed prostate is repaired by sewing the bladder to the urethra with a consequent loss of urethral length. Penile shortening can be compounded by the disuse atrophy and scarring that can occur as a result of the erectile dysfunction associated with the surgical procedure, which sometimes can damage the nerves that are responsible for erections. Getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shortening because of scarring of the erectile cylinders that prevents them from expanding properly.

Androgen deprivation therapy is a means of suppressing the male hormone testosterone, typically used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage.

Who Knew? Penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky, ineffective and not ready for prime time. Certain procedures are what I call “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone and other tissue grafts. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis—certainly a far cry from a “proud soldier” and more like a “wounded warrior.” Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

Who Knew? The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to the recipient, whose organ was damaged beyond repair in an accident. Hmmm, now there is a concept for penile enlargement.

Andrew Siegel, MD

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

www.MalePelvicFitness.com

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

www.healthdoc13.wordpress.com

 

 

“Elective” Male Sexual Dysfunction: How We Are Eating Ourselves Limp

June 11, 2011

“It is like a firstborn son—you spend your life working
for him, sacrificing everything for him, and at the
moment of truth, he does just as he pleases.”

Gabriel Garcia Marquez, Love In The Time Of Cholera

 

Two weeks ago, my blog dealt with the relationship between overeating/obesity and urinary incontinence/pelvic organ prolapse in females. In fairness to the male gender, today’s essay will be how overeating/obesity affects our manhood and vitality. What we eat—or don’t eat—can directly affect our sex lives! While the achievement of good sexual function is predicated upon many factors, it must be recognized that the particular diet we choose plays a definite role in its attainment.

Sexuality is a very important part of our human existence, both for purposes of procreation as well as pleasure. Healthy sexual function involves a satisfactory 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, the loss or diminution of sexual function can result in loss of self-esteem, embarrassment, a sense of isolation and frustration, and even depression. Therefore, for many of us, it is vital that we maintain our sexual health.
On a functional level, sexuality is a very complex event dependent upon a number of systems, including the endocrine system (which produces sex hormones); the central and peripheral nervous systems (which provide nerve control); and the vascular system (which conducts blood flow). A healthy sexual response is, at its physical essence, largely about adequate blood flow to the genital and pelvic area. Increased blood flow to the genitals from sexual stimulation is responsible for the penis going from a flaccid to an erect state. Blood flow to the penis is analogous to air pressure in a tire: if there is not enough air, thereby causing the tire to be improperly inflated, the tire works less optimally and may even suffer a flat!
The penis is a rather amazing, multifunctional organ that has a role as a urinary organ allowing directed urination that permits men to stand to urinate, and a sexual and reproductive organ that when erect, allows the rigid penis the ability to penetrate the vagina and function as a conduit for release of semen into the vagina. No other organ in the body demonstrates such a great versatility in terms of the physical changes between its “inactive” versus “active” states! The penis has an abundant supply of vascular smooth muscle, and like every other muscle in the body, “use it or lose it” is relevant when it comes to the sexual domain. Disuse atrophy can occur if the penis is not used the way it was designed to be, and this often results in patients complaining of penile shrinkage.
Erectile dysfunction is a common problem, occurring in millions of American men. About one-third of the male population over age 60 is unable to achieve an erection suitable for intercourse. However, erectile dysfunction is NOT an inevitable consequence of the aging process as there are many elderly men who have intact sexual function.
Diminished blood flow occurs most commonly on the basis of an accumulation of fatty plaque deposits within the walls of blood vessels. As we age, physiological and lifestyle factors combine to increase this plaque build-up, causing a significant narrowing of many of the body’s blood vessels. The resultant decrease in blood flow to our organs negatively affects the functioning of all of our systems, since every cell in our body is dependent upon the vascular system for delivery of vital oxygen and nutrients and removal of metabolic waste products. Pelvic atherosclerosis, the accumulation of fatty deposits within the walls of the arteries that bring blood to the penis, will compromise blood flow to the genitals and incite sexual dysfunction.
The presence of erectile dysfunction can be considered the equivalent of a genital stress test and may be indicative of a cardiovascular problem that warrants an evaluation for arterial disease elsewhere in the body (heart, brain, aorta, peripheral blood vessels). In other words, the quality of erections can serve as a barometer of cardiovascular health and those who can get hard attacks are unlikely to get heart attacks. The presence of sexual dysfunction is as much of a predictor of cardiovascular disease as is a strong family history of cardiac disease, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson has expanded the initials E.D. (Erectile Dysfunction) to mean Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries), Early Detection (of cardiovascular disease), and Early Death (if missed). The bottom line is that heart healthy is sexual healthy.

Many adults in the USA are beset with Civilization Syndrome, a cluster of health issues that have arisen as a direct result of our poor dietary choices and sedentary lifestyle. Civilization Syndrome can lead to obesity, high blood pressure, elevated cholesterol, and can result in such health problems as diabetes, heart attack, stroke, cancer, and premature death. The diabetic situation in our nation—often referred to as “diabesity” has become outrageous and it probably comes as no surprise that diabetes is one of the leading causes of sexual dysfunction in the United States.
Obesity (external fat) is associated with internal obesity and fatty matter clogging up the arteries of the body including the pudendal artery, which supplies blood to the penis. Additionally, obesity can have a negative effect on our sex hormone balance (the balance of testosterone and estrogens), further contributing to sexual dysfunction. The fatty tissue present in our obese abdomens contains abundant amounts of the enzyme aromatase—functioning to convert testosterone to estrogen—literally emasculating us! High blood pressure will cause the heart to have to work harder to get the blood flowing through the increased resistance of the arteries. Blood pressure lowering medications will treat this, but as a result of the decreased pressure, there will be less blood flow through the pudendal arteries. Thus blood pressure medications, although very helpful to prevent the negative affects of hypertension—heart attacks, strokes, etc.—will contribute to sexual dysfunction. High cholesterol will cause fatty plaque buildup in our arteries, compromising blood flow and contributing to sexual dysfunction. Tobacco constricts blood vessels and impairs blood flow through our arteries. Smoking is really not very sexy at all! Stress causes a surge of adrenaline release from the adrenal glands. The effect of adrenaline is to constrict blood vessels and decrease sexual function. Hence, the physiologic explanation for the common occurrence of performance anxiety. Interestingly, men with priapism (a prolonged and painful erection) are often treated with penile injections of an adrenaline-like chemical to bring down the erection.
Obesity is stealing away one of our most precious resources—the ability to obtain and maintain good quality erections. Remember the days when you could achieve a rock-hard erection—majestically pointing towards the sky—simply by seeing an attractive woman or thinking some vague sexual thought? Chances were that you were young, active, and perhaps had an abdomen that somewhat resembled a six-pack. The loss in function is often so gradual and insidious that it barely gets noticed. Maybe it takes a great deal of physical stimulation to achieve an erection 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 “daddy’s little helper”—a little blue pill (Viagra), or yellow pill (Cialis), or orange pill (Levitra), to get the blood flowing.

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 down below. A flaccid penis is entirely consistent with a flaccid body and a hard penis is congruous with a hard body. Perhaps when you are standing naked in the shower and you gaze down towards your feet, all you see is the protuberant roundness of your large midriff, obscuring the glorious sight of your manhood. Perhaps you’re wondering where your penis is hiding. In most cases, the abundant pubic fat pad that occurs coincident with weight gain obscures the penis, what I like to refer to as the “turtle effect.” If your pubic fat pad makes your penis difficult to find, your man-boobs are competitive with your wife’s breasts, and your libido and erections are just not performing up to par, it may be just time to rethink your lifestyle habits!
So, where does this leave us? It leaves us with what should by now be obvious: a healthy lifestyle is of paramount importance towards the endpoint of achieving an optimal quality and quantity of life. Intelligent lifestyle choices, including proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and stress reduction are the initial approach to treating many of the diseases caused by poor health decisions. Sexual dysfunction is in the category of a medical problem that is brought on by unwise lifestyle choices. It should come as no surprise that the initial approach to managing it is to improve lifestyle choices. By simply improving one’s daily habits, Civilization Syndrome can be ameliorated or even prevented, and the various medical problems that often follow, including sexual dysfunction, can be mitigated.
In terms of maintaining good cardiovascular health—and thus healthy sexual function—eating properly is incredibly important, obviously in conjunction with other smart lifestyle choices. Maintaining a healthy weight and fueling up with wholesome and natural foods will help prevent the build-up of harmful plaque deposits within blood vessels that can lead to compromised blood flow to the penis as well as every other organ. Poor dietary choices with a meal plan replete with calorie-laden, nutritionally-empty selections (e.g., fast food or processed or refined anything), puts one on the fast tract to clogged arteries that can make your sexual function as small as your belly is big!
If you want a “sexier” lifestyle, first start with a “sexier” style of eating that will help you feel better, look better and optimize your sexual, emotional and psychological well-being. Smart nutritional choices are a key component of sexual fitness. Exercise is a fundamentally important component of maintaining good sexual health and partners well with healthy eating. At times, even with the achievement of a very healthy lifestyle, erectile dysfunction can still persist. Under these circumstances, there are numerous excellent treatment modalities available, and the reader is referred to the following links below for more information.

 

 

I have done a number of educational videos on the subject of erectile dysfunction. These are intended for mature adults only as they contain language and images of a graphic and sexual nature and viewer discretion is advised.

Introduction to erectile dysfunction: http://www.youtube.com/watch?v=AQW1HFwBuPc

Anatomy: http://www.youtube.com/watch?v=zPwaXTTfnd8

Penis size: http://www.youtube.com/watch?v=g65bq7CuUyI

Causes of erectile dysfunction: http://www.youtube.com/watch?v=f6N34G11Saw

Treatment part 1: http://www.youtube.com/watch?v=fuhPGharax0

Treatment part 2: http://www.youtube.com/watch?v=Rd47zIQEGcA

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: http://www.PromiscuousEating.com. It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living. It is also available on Amazon Kindle.

Andrew L. Siegel, M.D.