Posts Tagged ‘genital-urinary health’

Man Kegels (Pelvic Floor Muscle Exercises for Men)-Part 2

March 15, 2014

Andrew Siegel MD, Blog# 145

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The photo above was taken by a pharmaceutical rep friend who discovered this phallic carving among the Roman ruins in Fez, Morocco.

The following is largely excerpted from my forthcoming book, Male Pelvic Fitness: Optimizing Sexual and Urinary Health, available in April 2014:

With respect to sexuality, medical publications—and more specifically the urological literature—rarely, if ever make mention of targeted exercise as a means of optimizing function or helping to treat a dysfunction. The preeminent urology textbook, Campbell’s Urology, a 4000 page, 4-volume tome, devotes precisely one paragraph to the use of pelvic floor muscle exercises in the management of male sexual dysfunction and makes no mention of its use in maximizing sexual function.

Despite numerous studies and research demonstrating the effectiveness of targeted pelvic exercises, they have been given short shrift. Part of the reason for this is simply that there has never been an easy-to-follow exercise program or well-designed means of facilitating pelvic floor muscle training in men. Instead, there is an emphasis on oral medications, urethral suppositories, penile injections, vacuum devices and penile implants. In the United States we have a pharmacology-centric medical culture—“a pill for every ill”—with aggressive prescription writing by physicians and a patient population that expects a quick fix.

It is shameful that traditionally there has been such little emphasis on lifestyle improvement—healthy diet, weight management, exercising, and avoidance of tobacco, excessive alcohol and stress—as a means of preventing and improving sexual dysfunction.

In addition to general lifestyle measures, specific exercises targeted at the pelvic floor can confer great benefits to pelvic health and fitness, an important element of overall health and fitness. The pelvic floor muscles (PFM) are critical to healthy  sexual function and achieving fitness in this domain is advantageous on many levels: to enhance sexual health; to maintain sexual health; to help prevent the occurrence of sexual dysfunction in the future; and to aid in the management of sexual dysfunction. PFM exercises should be considered first-line treatment of sexual dysfunction and a safe and natural self-improvement approach ideally suited to the male population, including the baby boomers, generation X, and generation Y.  PFM fitness can serve as an effective means to help keep the boomers “booming.”

I do not mean to downplay and disparage the role of medications and other options in managing sexual dysfunction. The availability of that magic blue pill in April 1998—Viagra—was a seminal moment in the world of male sexual dysfunction that enabled for the first time a simple and effective means of treating erectile dysfunction (ED).  On the polar opposite end of the treatment spectrum—but of no less importance—was the development and refinement of the penile implant, used in severe cases of ED unresponsive to less invasive options.

But why should we not initially try to capitalize on simpler, safer, and more natural solutions and consider, for example, using a targeted exercise program or medications in conjunction with a targeted exercise program?  Sexual function is all about blood flow to the penis and pelvis.  And what better way to enhance blood flow than to exercise?  We engage in exercise programs for virtually every other muscle group in the body.  Working out our PFM can result in a strong, robust and toned pelvic floor, capable of supporting and sustaining sexual function to the maximum.

Physical therapy is a well-accepted discipline that is commonly used for disabilities and rehabilitation after injury or surgery.  The goal of a physical therapy regimen is to promote mobility, functional restoration and quality of life. A targeted PFM exercise regimen can be considered the equivalent of genital and pelvic physical therapy with the goal of increasing the bulk, strength, power and function of the PFM.

The PFM can be thought of as a vital partner to our sexual organs, whose collaboration is an absolute necessity for optimal sexual functioning, little different than the relationship between the diaphragm muscle and the lungs. The role of the PFM in sexual function has been vastly undervalued and understated. The hard truth is that a well-conditioned pelvic floor that can be vigorously contracted and relaxed at will is often capable of improving sexual prowess and functioning as much as fitness training can enhance athletic performance and endurance.

Such targeted exercises confer advantages that go way beyond the sexual domain. These often-neglected muscles are vital to our genital-urinary health and wellness and serve an essential role in urinary function, bowel function and prostate health.  Additionally, they are important contributors to lumbar stability, spinal alignment and the prevention of back pain. Specifically, PFM exercises can be beneficial with respect to the following spectrum of issues: erectile dysfunction; orgasmic dysfunction; premature ejaculation; urinary incontinence; overactive bladder; post-void dribbling; pelvic pain due to levator muscle spasm; bowel urgency and incontinence; and in mitigating damage incurred from saddle sports including cycling, motorcycling and horseback riding.

The PFM, comprised of muscles that form a muscular shelf that spans the gap between our pelvic bones, form the base of our “core” muscles.  Our core muscles are the “barrel” of muscles in our midsection.  The top of our core is our diaphragm, the sides are our abdominal, flank, and back muscles, and the bottom of the barrel are our PFM.

The core muscles, including the PFM, are not the glitzy muscles of the body—not those muscles that are for show. Our core muscles are often ignored and do not get much respect, as opposed to the external glamour muscles of our body, including the pectorals, biceps, triceps, quadriceps, latissimus, etc.  In general, muscles that have such “mirror appeal” are not those that will help in terms of sexual and urinary function. Our core muscles are the hidden gems that work diligently behind the scenes—the muscles of major function and not so much form—muscles that have a role that goes way beyond movement, which is the cardinal task of a skeletal muscle.  On a functional basis, we would be much better off having a “chiseled” core as opposed to having “ripped” external muscles, as there is no benefit to having all “show” and no “go.”

The pelvic floor seems to be the lowest caste of the core muscles—the musculus non grata, if you will kindly accept my term. The PFM, however, do deserve serious respect because, although concealed from view, they are responsible for some very powerful and beneficial functions, particularly so when intensified by training.  Although the PFM are not muscles of glamour, they are our muscles of “amour.”

Who Knew? Having “ripped” external glamour muscles might help get your romance going, but having a chiseled core and conditioned PFM will help keep it going…and going…and going!

The female pelvic floor muscles, exercises for which were popularized by gynecologist Dr. Arnold Kegel, have long been recognized as an important structural and functional component of the female pelvis. But who has ever heard of the male pelvic floor?  The male pelvic floor has been largely unrecognized and relegated as having far less significance than the female pelvic floor.  Yet from a functional standpoint, these muscles are of vital importance, certainly as critical to male genital-urinary health as they are to female genital-urinary health.

The PFM, as with other muscles in the body, are subject to the forces of adaptation.  Unused as they are 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.

The key responsibility of most of our skeletal muscles is for joint movement and locomotion. The core muscles in general, and the PFM in particular, are exceptions to this rule.  Although the core muscles do play a role with respect to movement, of equal importance is their contribution to support, stability, and posture. Consider that the pelvic floor muscles, particularly the superficial PFM, have an essential function in the support, stability and “posture” of the penis.  They should be considered the hidden “jewels” of the pelvis.

Who Knew? If you want your penis to have “outstanding” posture and stability, you want to make sure that your PFM are kept fit and well-conditioned.

The PFM have three main functions that can be summarized by three S’s: support, sphincter, and sex. Support refers to their important role in securing our pelvic organs—the urinary, genital and intestinal tracts—in proper anatomical position. Sphincter function allows us to interrupt our urinary stream and pucker the anus and contributes in a major way to urinary and bowel control.  These vital responsibilities are generally taken for granted until something goes awry. With regard to sexual function, the PFM are active during erection and ejaculation.  They cause a surge of penile blood flow that helps maintain a rigid penile erection throughout sexual activity and at the time of orgasm, contract rhythmically, enabling ejaculation by propelling semen through the urethra.

The PFM can become atrophied, flabby and poorly functional with aging, weight gain, a sedentary lifestyle, saddle sports and other forms of injury and trauma, chronic straining, and surgery.  Sexual inactivity can lead to their loss of tone, texture, and function.  However, PFM integrity and optimum functioning can be maintained into our golden years with attention to a healthy lifestyle, an active sex life, and PFM training, particularly when such exercises are performed against progressive resistance.  The goal of such a regimen is the attainment of broader, thicker and firmer PFM and maintenance and/or restoration of function.

The PFM may physically be the bottom of the barrel of our core, but functionally they are furthermost from the bottom of the barrel.  For those who are already functioning well, an intensive PFM training program—as with any good fitness regimen—can impart better performance, increased strength (rigidity), improved endurance (ejaculatory control), and decreased recovery time (the amount of time it takes to achieve another erection).  Keeping the PFM supple and healthy can help prevent the typical decline in function that accompanies the aging process. On so many domains, diligently practiced PFM exercises will allow one to reap tangible rewards, as they are the very essence of functional fitness—training one’s body to handle real-life situations and overcome life’s daily obstacles.

Andrew Siegel, M.D.

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in April 2014.

www.MalePelvicFitness.com

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity  (free electronic download) www.findyourfountainofyouth.com 

Amazon page: amazon.com/author/andrewsiegel

For more info on Dr. Siegel: http://www.about.me/asiegel913

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Man Kegel Exercises

February 22, 2014

Blog # 142

As a urologist, I have expertise in both male and female pelvic health as opposed to gynecologists who treat only women. When I reflected on the similarities and differences of the male and female pelvis, genitalia and pelvic floor, I came to some important conclusions. It occurred to me that in terms of development, the male and female genitalia are incredibly similar with respect to their embryological origin. Additionally, the pelvic floor muscles (PFM) are virtually identical in both genders. Exercises of these pelvic floor muscles for purposes of improving sexuality, urinary control and pelvic support are widely known and acknowledged in the female population; in fact, women are instructed to do these “Kegel” exercises during and after pregnancy. So, why not for men?

Hmmmm…identical origin of genital tissues, the same exact muscles, documented effectiveness of these exercises for women’s pelvic health…what’s the missing link? The missing link is that if they are so beneficial for females, why have they virtually been ignored when it comes to the male population? Hey: What’s good for the goose is good for the gander. More specifically, what is good for the female goose is equally good for the male goose. PFM exercises are gender-neutral, having the same meaningful potential in males that they have proven to have in females but for some reason, have been largely neglected and remain an unexploited and powerful resource.

In the 1940s, Dr. Kegel—a gynecologist from Los Angeles—popularized pelvic floor muscle (PFM) exercises in females in order to help improve sexual and urinary health after childbirth. I think it is fair to state that most adult women have heard of and many have practiced these exercises, known as “Kegels.”  In brief, when a woman does a Kegel contraction, she voluntarily contracts the muscles that surround the urethra, vagina, and rectum. As a result, the urethra gets pinched, the vagina tightens up, and the rectum gets squeezed.

Kegel pelvic floor muscle exercises are by no means a new concept, Hippocrates and Galen having described it in Ancient Greece and Rome respectively, where they were performed in the baths and gymnasiums. Strengthening these muscles was thought to promote general and sexual health, spirituality, and longevity

Men have the very same pelvic floor muscles that women do and an equivalent capacity for exercising them, with a parallel benefit and advantage to urinary and sexual health. Nonetheless, the male PFM have yet to receive the recognition that the female PFM have, although from a functional standpoint are of vital importance, certainly as critical to male genital-urinary health as they are to female genital-urinary health. When a man contracts his pelvic floor muscles, he voluntarily tightens the muscles that surround the urethra and rectum, which enables him to stop his urinary stream and tighten his anus. Under the circumstances of having an erection, when the PFM are engaged, the penis will lift skywards towards the heavens. Unfortunately, however, most men are unfamiliar with pelvic floor muscle exercises and it is the rare man who has performed them. Even many physicians are unaware of the pelvic floor muscles and their potential benefits for men.

In terms of anatomy, the male and female external genitalia at the earliest stages of embryological development are identical. That is, one and the same, duplicate, a carbon copy of each other. No “his” and “hers,” only “hers” and “hers.” Add testosterone (the male sex hormone), to the recipe and presto, the primitive male genitals transform into a penis and scrotum. In the presence of testosterone the genital tubercle (a midline swelling) becomes the penile shaft and head; the urogenital folds (two vertically-oriented folds of tissue below the genital tubercle) fuse and become the urethra and part of the penile shaft; and the labio-scrotal swellings (two vertically-oriented bulges outside the urogenital folds) fuse and become the scrotum. In the female embryo, the absence of testosterone causes the genital tubercle to become the clitoris, the urogenital folds to become the inner lips (labia minora), and the labio-scrotal swellings to become the outer lips (labia majora).

Essentially then, the penis and the clitoris are the same structure, as are the scrotum and outer labia.  How fascinating it is that female external genitalia are the “default” model.  In other words, female external genitalia form in the absence of testosterone, and not in the active presence of female hormones.

Similarly, the PFM are virtually identical in both genders, as can be clearly seen in the images that follow (credit to Dr. Henry Gray, Gray’s Anatomy of the Human Body, 20th edition, originally published in 1918; public domain).  Compare the bulbocavernosus muscle in the male with that of the female and the ischiocavernosus muscle in the male and the female. The only real difference is that the BC muscle in the female is split around the vagina.

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In summary, we have identical origin of genital tissues, same exact muscles, and well-documented effectiveness of these exercises for women’s pelvic health. So why do we never hear about PFM exercises for male pelvic health? If the genital and PFM anatomy is virtually “the same” in both genders, as is the supportive, sphincter and sexual functions of the PFM, then why should PFM exercises be any less beneficial for males than females? The bottom line is that pelvic floor muscle exercises in the male have the same meaningful potential that they have proven to have in females, but for some reason, have been ignored, neglected and remain an untapped yet valuable resource.

My objective is to bring to the forefront an awareness of the male pelvic floor muscles and an understanding of the numerous benefits of tapping into their capacity for optimizing and improving sexual and urinary function. My ultimate goal is to help male pelvic fitness achieve the same traction and status as female pelvic fitness has, as did Dr. Arnold Kegel for females. To be continued…

Andrew Siegel, M.D.

Much of this material was excerpted from Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014. www.MalePelvicFitness.com

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