Posts Tagged ‘male pelvic fitness’

No Erections Without A Solid Base

May 27, 2017

Andrew Siegel MD  5/27/2017  Happy Memorial Day Weekend!

A flagpole needs a solid base of support in order to stand tall and not be felled by the elements.  One that is poorly mounted will falter as soon as the wind picks up or other adverse circumstances surface.  This is analogous to a tree and its root system with no tree able to stand tall and bear the elements without a deep and powerful root system.  In both cases, the hidden, behind-the-scenes support system is equally important to the exposed product.

at20op_-03__topflight-telescoping-20ft-flagpole_1_1.jpg

Flagpole base

Exposed_mango_tree_roots

Exposed roots of a mango tree, by Aaron Escobar [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

…And so it is with the penis. Like the flagpole and the tree that require a solid base of support, the penis also necessitates a sturdy foundation in order to be able to morph into a “proud soldier,” tall and erect in posture.  This foundation also enables the ability to maintain this rigid stability despite exposure to the “elements”– the substantial torquing and buckling forces the penis is subjected to at the time of sexual activity.

* Thank you to Paul Nelson–friend, colleague and president of the Erectile Dysfunction Foundation and launcher of FrankTalk.org–who came up with the clever  flagpole analogy.

What You See is Not What You Get

Half the penis is exposed and half is hidden.  The visible portion of the penis (pendulous penis) is the external half.  The internal half (infrapubic penis) lies under the surface and is known as the penile roots or in medical speak, the crura. Like the roots of a tree or the base of a flagpole responsible for foundational support, the roots of the penis stabilize and support the erect penis so that it stays rigid and skyward-angling with excellent “posture.”  Without functioning penile roots, the penis would remain limp, would dangle in accordance with gravity and have slouching posture at best.

4extintpenis

Illustration above by Christine Vecchione from “Male Pelvic Fitness: Optimizing Sexual & Urinary Health”

The penile roots are enveloped by two pelvic floor muscles, the BC (bulbocavernosus) and the IC (ischiocavernosus).  These rigidity muscles compress the roots of the penis, causing backflow of pressurized blood into the penis.  In a sexual situation, these muscles engage and contract, forcing blood within the roots of the penis into the external penis.  Not only is pressurized blood pushed into the external penis promoting rigidity, but also the contractions of these muscles causes the clamping of venous outflow—a tourniquet-like effect—that results in penile high blood pressure and full-fledged rigidity.  These muscles are also responsible for ejaculation—rhythmically compressing the urethra (urinary channel that runs through the penis) at the time of climax to cause the expulsion of semen.

Factoid: It is the BC and IC muscles that are responsible for the ability to lift one’s erect penis up and down (wag the penis) as they are contracted and relaxed.

00001Illustration above by Christine Vecchione from “Male Pelvic Fitness: Optimizing Sexual & Urinary Health”

The BC and the IC muscles together with the transverse perineal muscles and the levator muscles are collectively known as the pelvic floor muscles, a muscular hammock located between scrotum and anus  (“inner taint”). Although unseen and behind-the-scenes, hidden from view, these often unrecognized and misunderstood muscles have vital functions in addition to erection and ejaculation, including urinary and bowel control. As part of the core group of muscles, they affect posture, the lower back and the hips.

Take home message: The pelvic floor muscles are the rigidity muscles, necessary for transforming the stimulated penis that becomes plump into a rock-hard penis. When these muscles are not functioning optimally, one loses the potential for full rigidity.

Factoid: An erection—defined in hydraulic terms—is when the penile blood inflow is maximized while outflow is minimized, resulting in an inflated and rigid penis. The pressure in the penis at the time of an erection is sky-high (greater than 200 millimeters), the only organ in the body where high blood pressure is both acceptable and necessary for healthy functioning. This explains why blood pressure pills are the most common medications associated with erectile dysfunction.

Bottom Line: Neither flagpole, tree nor penis can be firmly supported without a solid foundation.  The penile roots and the pelvic floor muscles that surround them are the foundation.  Not only do these muscles support the deep roots of the penis, but they are also responsible for the high penile blood pressures responsible for erectile rigidity and are the motor power underlying ejaculation.  The IC muscle should be known as the “erector muscle” and the BC muscle the “ejaculator muscle.” Although not muscles of glamour, they are certainly muscles of “amour.”

Straddling the gamut of being vital for what may be considered the most pleasurable and refined of human pursuits—sex—they are equally integral to what may be considered the basest of human activities—bowel and bladder function.  These hidden muscles deserve serious respect and are capable of being intensified by training in order to improve and often prevent sexual, urinary and bowel issues. Why not consider exercising your erector and ejaculator muscles, as you do for so many other muscle groups in the body?

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

Co-creator of the PelvicRx male pelvic floor exercise program: http://www.PelvicRx.com

 

 

 

 

 

Advertisements

12 STEPS TO OVERCOMING “OVER-ACTIVE” BLADDER (OAB)

May 6, 2017

Andrew Siegel MD  5/6/17 (my daughter’s 18th birthday!)

For most people, the urinary bladder is a cooperative and obedient organ, behaving and adhering to its master’s will, squeezing only when appropriate. However, some people have bladders that are unruly and disobedient, acting rashly and irrationally, squeezing at inappropriate times without their master’s permission. This condition is referred to as “overactive bladder” or OAB for short. This problem can occur in both women and men, although it is more common in females.

Picture1

“Gotta go,” the urinary urgency that is the hallmark of OAB

8. UUI

Image above (artist Ashley Halsey from “The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health”) illustrates a bladder contracting involuntarily, leading to urinary leakage

OAB (http://www.njurology.com/overactive-bladder/) is a common condition often due to one’s bladder contracting (squeezing) at any time without warning.  This involuntary bladder contraction can give rise to the symptoms of urgency, frequency (daytime and nighttime) and urgency incontinence. The key symptom of OAB is urinary urgency (a.k.a. “gotta go”), the sudden and compelling desire to urinate that is difficult to postpone.

Although OAB symptoms can occur without specific provocation, they may be triggered by exposure to running water, cold or rainy weather, hand-washing, entering the shower, positional changes such as arising from sitting, and getting nearer and nearer to a bathroom, particularly at the time of placing the key in the door to one’s home.

An evaluation includes a urinalysis (dipstick exam of the urine), a urine culture (test for urinary infection) if indicated, and determination of the post-void residual volume (amount of urine left in bladder immediately after emptying). A 24-hour voiding diary (record of urination documenting time and volume) is an extremely helpful tool.  Urodynamics (test of storage and emptying bladder functions), cystoscopy (visual inspection of inside of bladder), and renal and bladder ultrasound (imaging tests using sound waves) may also prove helpful.

The management of OAB is challenging, yet rewarding, and necessitates a partnership between patient and physician. Successful treatment requires a willing, informed and engaged patient with a positive attitude. Management options for OAB range from non-invasive strategies to pills to surgery. It is sensible to start with the simplest and least invasive means of treatment and progress accordingly to more aggressive and invasive treatments if there is not a satisfactory response to conservative measures.  Behavioral treatments are first-line: fluid management, bladder training, bladder control strategies, pelvic floor muscle training and lifestyle measures.  Behavioral therapies may be combined with medication(s), which are considered second-line treatment. Third-line treatments include neuromodulation (stimulating specific nerves to improve OAB symptoms) and Botox injections into the urinary bladder.

References that will help the process include the following:

Book: THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health www.TheKegelFix.com

Book: MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health www.MalePelvicFitness.com

DVD: Easy-to-use, follow-along, FDA-registered pelvic training program that includes a detailed instruction guide, an interactive DVD and digital access to the guided training routines: www.PelvicRx.com

12 Steps To Overcoming OAB

The goal of the 12 steps that follow is to re-establish control of the urinary bladder.  Providing that the recommendations are diligently adhered to, there can be significant improvement, if not resolution, of OAB symptoms.

  1. FLUID AND CAFFEINE MODERATION/MEDICATION ASSESSMENT  Symptoms of OAB will often not occur until a “critical” urinary volume is reached, and by limiting fluid intake, it will take a longer time to achieve this volume. Try to sensibly restrict your fluid intake in order to decrease the volume of urinary output. Caffeine (present in tea, coffee, colas, some energy drinks and chocolate) and alcohol increase urinary output and are urinary irritants, so it is best to limit intake of these beverages/foods.  Additionally, many foods—particularly fruits and vegetables—have hidden water content, so moderation applies here as well.  It is important to try to consume most of your fluid intake before 7:00 PM to improve nocturnal frequency. Diuretic medications (water pills) can contribute to OAB symptoms. It is worthwhile to check with your medical doctor to see if it is possible to change to an alternative, non-diuretic medication. This will not always be feasible, but if so, may substantially improve your symptoms.
  2. URGENCY INHIBITION Reacting to the first sense of urgency by running to the bathroom needs to be substituted with urgency inhibition techniques. Stop in your tracks, sit, relax and breathe deeply. Pulse your pelvic floor muscles rhythmically (see below) to deploy your own natural reflex to resist and suppress urgency.
  3. TIMED VOIDING (for incontinence) Urinating by the “clock” and not by your own sense of urgency will keep your bladder as empty as possible. By emptying the bladder before the critical volume is reached (at which urgency incontinence occurs), the incontinence can be controlled.  Voiding on a two-hour basis is usually effective, although the specific timetable has to be tailored to the individual in accordance with the voiding diary.  Such “preemptive” or “defensive” voiding is a very useful technique since purposeful urinary frequency is more desirable than incontinence.
  4. BLADDER RETRAINING (for urgency/frequency) This is imposing a gradually increasing interval between voids to establish a more normal pattern of urination. Relying on your own sense of urgency often does not give you accurate information about the status of your bladder fullness.  Urinating by the “clock” and not by your own sense of urgency will keep your voided volumes more appropriate. Voiding on a two-hour basis is usually effective as a starting point, although the specific timetable has to be tailored to the individual, based upon the voiding diary.  A gradual and progressive increase in the interval between voiding can be achieved by consciously delaying urinating.  A goal of an increase in the voiding interval by 15-30 minutes per week is desirable.  Eventually, a return to more acceptable voiding intervals is possible.  The urgency inhibiting techniques mentioned above are helpful with this process.
  5. BOWEL REGULARITY Avoidance of constipation is an important means of helping control OAB symptoms. Because of the proximity of the rectum and bladder, a full rectum can put pressure on the bladder, resulting in worsening of urgency, frequency and incontinence.
  6. PELVIC FLOOR MUSCLE TRAINING (PFMT)  *All patients need to understand the vital role of the pelvic floor muscles (PFM) in inhibiting urgency and frequency and preventing urge leakage.  PFMT voluntarily employs the PFM to help stimulate inhibitory reflexes between the pelvic floor muscles and the bladder.  Rhythmic pulsing of the PFM can inhibit an involuntary contraction once it starts and prevent an involuntary contraction before it even begins. Initially, one must develop an awareness of the presence, location, and nature of the PFM and then train these muscles to increase their strength and tone.  These are not the muscles of the abdominal wall, thighs or buttocks.  A simple means of recognizing the PFM for a female is to insert a finger inside her vagina and squeeze the PFM until the vagina tightens around her finger.  A simple means of identifying the PFM for either gender is to start urinating and when about half completed, to abruptly stop the stream. It is the PFM that allows one to do so. It is important to recognize the specific triggers that induce urgency, frequency or incontinence and prior to exposure to a trigger or at the time of the perceived urgency, rhythmic pulsing of the PFM–“snapping” the PFM several times–can either preempt the abnormal bladder contraction before it occurs or diminish or abort the bladder contraction after it begins.  Thus, by actively squeezing the PFM just before and during these trigger activities, the urgency can be diminished and the urgency incontinence can often be avoided.

oab

Schematic diagram above illustrates the relationship of the contractile state of the bladder muscle to the contractile state of the PFM. Note that a voluntary PFM contraction can turn off an involuntary bladder contraction (+ symbol denotes contraction; – symbol denotes relaxation)

7. LIFESTYLE MEASURES: HEALTHY WEIGHT, EXERCISE, TOBACCO CESSATION   The burden of excess pounds can worsen OAB issues by putting pressure on the urinary bladder. Even a modest weight loss may improve OAB symptoms.  Pursuing physical activities can help maintain general fitness and improve urinary control. Lower impact exercises–yoga, Pilates, cycling, swimming, etc.–can best help alleviate pressure on the urinary bladder by boosting core muscle strength and tone and improving posture and alignment. The chemical constituents of tobacco constrict blood vessels, impair blood flow, decrease tissue oxygenation and promote inflammation, compromising the bladder, urethra and PFM.  By eliminating tobacco, symptoms of OAB can be improved. 

8.  BLADDER RELAXANT MEDICATIONS A variety of medications are useful to suppress OAB symptoms. It may take several trials of different medications or combinations of medications to achieve optimal results. The medications include the following: Tolterodine (Detrol LA), Oxybutynin (Ditropan XL), Transdermal Oxybutynin (Oxytrol patch), Oxybutynin gel (Gelnique), Trospium (Sanctura), Solifenacin (Vesicare), Darifenacin (Enablex) and Fesoterodine (Toviaz).  The most common side effects are dry mouth and constipation.  These medications cannot be used in the presence of urinary or gastric retention or uncontrolled narrow-angle glaucoma.  The newest medication, Mirabegron (Myrbetriq), has a different mechanism of action and fewer side effects.

9.  BIOFEEDBACK This is an adjunct to PFMT in which electronic instrumentation is used to relay feedback information about your PFM contractions.  This can enhance awareness and strength of the PFM.

10.  BOTOX TREATMENT This is a simple office procedure in which Botox is injected directly into the bladder muscle, helping reduce OAB symptoms by relaxing those areas of the bladder into which it is injected. Botox injections generally will last for six to nine months and are covered by Medicare and most insurance companies.

11.  PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) This is a minimally invasive form of neuromodulation in which a tiny acupuncture-style needle is inserted near the tibial nerve in the ankle and a hand-held stimulator generates electrical stimulation with the intent of improving OAB symptoms. This is done once weekly for 12 weeks.

12.  INTERSTIM This is a more invasive form of neuromodulation in which electrical impulses are used to stimulate and modulate sacral nerves in an effort to relieve the OAB symptoms. A battery-powered neuro-stimulator (bladder “pacemaker”) provides the mild electrical impulses that are carried by a small lead wire to stimulate the selected sacral nerves that affect bladder function.

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.

“Doc, My Penis Is Shrinking”

October 8, 2016

Andrew Siegel MD  10/8/16

cuixes_de_lapol%c2%b7lo_de_pinedo

Image above: Roman copy of Apollo Delphinios by Demetrius Miletus at the end of the second century (Attribution: Joanbanjo (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons)

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

Factoid: It is estimated that with every 35 lbs. of weight gain, there is one-inch loss in apparent penile length.

The 9-letter word every man despises: S-H-R-I-N-K-A-G-E, immortalized by Jason Alexander playing the character George in the Seinfeld series. Jerry’s girlfriend Rachel catches a glimpse of naked George after he has stepped out of a swimming pool. Suffice it to say that George’s penis was in a “non-optimized” state. George tries to explain: “Well I just got back from swimming in the pool and the water was cold.” Jerry makes the diagnosis: “Oh, you mean shrinkage” and George confirms: “Yes, significant shrinkage.”

Penis size has not escaped our “bigger is better” American mentality where large cars, homes, breasts,  buttocks and mega-logos on shirts are desirable and sought-after assets. The pervasive pornography industry–where many male stars are “hung like horses”– has given the average guy a bit of an inferiority complex.

Factoid: The reality of the situation is that the average male has an average-sized penis, but in our competitive society, although average is the norm, average curiously has gotten a bad rap.

Adages concerning penile size and function are common, e.g., “It’s not the size of the ship, but the motion of the ocean.” Or even better, as seen on a poster in a gateway while boarding an airplane: “Size should never outrank service.” The messages conveyed by these statements have significant merit, but nonetheless, to many men and women, size plays at least some role and many men have concerns about their size. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort.

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

Penile Stats

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that flaccid length does not necessarily predict erect length and can vary depending upon many factors. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

With all biological parameters—including penis size—there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. Some men are phallically-endowed, some phallically-challenged, with most somewhere in the middle of the road. In a study of 3500 penises published by Alfred Kinsey, average flaccid length was 8.8 centimeters (3.5 inches). Average erect length ranged between 12.9-15 centimeters (5-6 inches). Average circumference of the erect penis was 12.3 centimeters (4.75 inches). As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (and mother).

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

Factoid: “Supersize Me.” In order to make their genitals look larger, the Mambas of New Hebrides wrap their penises in many yards of cloth, making them appear massive in length. The Caramoja tribe of Northern Uganda tie weights on the end of their penises in efforts to elongate them.

“Acute” Shrinkage

Penile size in an individual can be quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” is a real phenomenon provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves blood circulation.

Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s peripheral anatomy to help maintain blood flow and temperature to the vital core. This principle is used when placing ice on an injury, as the vasoconstriction will reduce swelling and inflammation. Similarly, exposure to heat causes vasodilation (expansion of arterial flow), the reason why some penile fullness can occur in a warm shower.

Nervous states and anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in numerous effects, including a flaccid penis. In fact, when the rare patient presents to the emergency room with an erection that will not quit, urologists often must inject an adrenaline-like medication into the penis to bring the erection down.

Hitting it hard in the gym or with any athletic pursuit demands a tremendous increase in blood flow to the parts of the body involved with the effort. There is a “steal” of blood flow away from organs and tissues not involved with the athletics with “shunting” of that blood flow to the organs and tissues with the highest oxygen and nutritional demands, namely the muscles. The penis is one of those organs from which blood is “stolen”—essentially “stealing from Peter to pay Paul” (pun intended!)—rendering the penis into a sad, deflated state. Additionally, the adrenaline release that typically accompanies exercise further shrinks the penis.

Cycling and other saddle sports—including motorcycle, moped, and horseback riding—put intense, prolonged pressure on the perineum (area between scrotum and anus), which is the anatomical location of the penile blood and nerve supply as well as pelvic floor muscles that help support erections and maintain rigidity.  Between the compromise to the penile blood flow and the nerve supply, the direct pressure effect on the pelvic floor muscles, and the steal, there is a perfect storm for a limp, shriveled and exhausted penis. More importantly is the potential erectile dysfunction that may occur from too much time in the saddle.

“Chronic” Shrinkage

Like any other body part, the penis needs to be used on a regular basis—the way nature intended—in order to maintain its health. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile erectile tissues can occur, resulting in a “de-conditioned,” smaller and often temperamental penis.

Factoid: If you go for too long without an erection, smooth muscle, elastin and other tissues within the penis may be negatively affected, resulting in a loss of penile length and girth and negatively affecting ability to achieve an erection.

Factoid: Scientific studies have found that sexual intercourse on a regular basis protects against ED and that the risk of ED is inversely related to the frequency of intercourse. Men reporting intercourse less than once weekly had a two-fold higher incidence of ED as compared to men reporting intercourse once weekly.

Radical prostatectomy as a treatment for prostate cancer can cause penile shrinkage. This occurs because of the loss in urethral length necessitated by the surgical removal of the prostate, which is compounded by the disuse atrophy and scarring that can occur from the erectile dysfunction associated with the surgical procedure. For this reason, getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shrinkage on the basis of scarring of the erectile tissues that prevents them from expanding properly.  For more on this, see my blog on the topic:

https://healthdoc13.wordpress.com/2015/05/23/peyronies-disease-not-the-kind-of-curve-you-want/

Medications that reduce testosterone levels are often used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage. Having a low testosterone level from other causes will also contribute to a reduction in penile size.

Are There Herbs, Vitamins or Pills That Can Increase Penile Size?

Do not waste your resources on the vast number of heavily advertised products that will supposedly increase penile size but have no merit whatsoever.  Realistically, the only medications capable of increasing penile size are the oral medications that are FDA approved for ED. Daily Cialis will increase penile blood flow and by so doing will increase flaccid penile dimensions over what they would normally be; the erect penis may be larger as well because of augmented blood flow.  Additionally, for many men this will restore the capability of being sexually active whereas previously they were unable to obtain a penetrable erection, thus allowing them to “use it instead of losing it” and maintain healthy penile anatomy and function.

Is Penile Enlargement Feasible Through Mechanical Means?

It is possible to increase penile size using tissue expansion techniques. The vacuum suction device uses either a manual or battery-powered source to create a vacuum in a cylinder into which the penis is placed. The negative pressure pulls blood into the penis, expanding penile length and girth. A constriction ring is placed around the base of the penis to maintain the erection. The vacuum is used to manage ED as well as a means of penile rehabilitation and is also used prior to penile implant surgery to increase the dimensions of the penis and allow a slightly larger device to be implanted than could be used otherwise. It can also be helpful under circumstances of penile shrinkage.

vsd

Vacuum Suction Device

The Penimaster Pro is a penile traction system that is approved in the European Union and Canada for urological conditions that lead to shortening and curvature of the penis. In the USA it is under investigation by the FDA. It is a means of using mechanical stress to cause penile tissue expansion and enlargement.

penimaster

Penimaster Pro

What’s The Deal With Penile Enlargement Surgery?

Some men who would like to have a larger penis may consider surgery. In my opinion, penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky and not ready for prime time. Certain procedures are “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone, bulking agents, tissue grafts and other implantable materials. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis. Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

What’s Up With Penile Transplants?

The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to a recipient whose penis was damaged beyond repair in an accident. Subsequently, there have been several transplants done for penile trauma.  Hmmm, now here is a concept for penile enlargement!

What To Do To Avoid Shrinkage issues?

  • Accept that cold, stress and athletics will cause temporary shrinkage
  • Be aware that cycling and other saddle sports can cause shrinkage as well as erectile dysfunction: wear comfortable and protective shorts; get measured for a saddle with an appropriate fit; frequently rise up out of the saddle, taking the pressure off the perineum
  • Eat a healthy diet and stay physically active to maintain a lean physique
  • Use it or lose it: stay sexually active
  • Do pelvic floor exercises (a.k.a. Man Kegels): visit http://www.MalePelvicFitness.com
  • “Rehab” the penis to avoid disuse atrophy after radical prostatectomy: oral ED meds, pelvic floor muscle training, vibrational stimulation, vacuum suction device, penile injection therapy; consider “pre-hab” before the surgery
  • Seek urological care for Peyronie’s disease

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

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

http://www.TheKegelFix.com

E-book available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback available via websites. Author page on Amazon:

http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix

https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx, Vacuum Suction Devices and many other quality products can be obtained at http://www.UrologyHealthStore.com. Use promo code “UROLOGY10” at checkout for 10% discount. 

How To Raise Your Testosterone, Naturally

September 3, 2016

Andrew Siegel MD  9/3/2016

17373-men-and-women-performing-aerobic-exercises-pv

(CDC/Amanda Mills from Public Health Image Library)

Two weeks ago, my entry was about the medication Clomid–a nice alternative to testosterone replacement therapy. What about a non-pharmacological, natural approach to raising testosterone levels?

Testosterone (T) is produced mostly in the testes, although the adrenal glands also manufacture a small amount. T has a critical role in male development and physical characteristics. It promotes tissue growth via protein synthesis, having “anabolic” effects including building of muscle mass, bone mass and strength, and “androgenic” (masculinizing) effects at the time of puberty. With the T surge at puberty many changes occur: penis enlargement; development of an interest in sex; increased frequency of erections; pubic, axillary, facial, chest and leg hair; decrease in body fat and increase in muscle and bone mass, growth and strength; deepened voice and prominence of the Adam’s apple; occurrence of fertility; and bone and cartilage changes including growth of jaw, brow, chin, nose and ears and transition from “cute” baby face to “angular” adult face. Throughout adulthood, T helps maintain libido, masculinity, sexuality, and youthful vigor and vitality. Additionally, T contributes to mood, red blood cell count, energy, and general “mojo.”

The amount of T made is regulated by the hypothalamus-pituitary-testicular axis, which acts like a thermostat to regulate the levels of T. Healthy men produce 6-8 mg testosterone daily, in a rhythmic pattern with a peak in the early morning and a lag in the later afternoon.  Low T levels can be low based upon testicular problems or hypothalamus/pituitary problems, although the problem most commonly is due to the aging testicle’s inability to manufacture sufficient levels of T. T levels gradually decline—approximately a 1% decline each year after age 30—sometimes giving rise to symptoms. These symptoms may include the following: fatigue; irritability; decreased cognitive abilities; depression; decreased libido; ED; ejaculatory dysfunction; decreased energy and sense of well-being; loss of muscle and bone mass; increased body fat; and abnormal lipid profile. A simple way to think about the effect of low T is that it accelerates the aging process.

Lifestyle factors are strongly associated with variations in testosterone (T) levels, with healthy lifestyles correlating with higher levels of T and unhealthy lifestyles with lower levels.  Some physicians regard T level as a laboratory marker of male physical health.

One of the key factors responsible for some of the decline in T that accompanies aging is excessive body fat. In fact, there is an inverse relationship between obesity and T levels, with increased body mass index (BMI) correlating with decreased T.

Factoid: Every 5-point increase in BMI translates to a 10% dip in T–an equivalent decline as would typically occur with 10 years of aging.

Fatty tissue – particularly visceral abdominal fat (the “beer belly”) – contains an abundance of metabolically active factors and hormones including aromatase, an enzyme which functions to convert T to the female sex hormone estrogen. Men with large bellies consequently are often found to have lower T levels and higher estrogen levels, which can result in “emasculation” with loss of sex drive, diminished erections, the disturbing loss of penile length and the presence of gynecomastia (man boobs)

Factoid: In addition to the decline in T, for every 35 lb. weight gain there is a 1-inch loss in apparent penile length because of the pubic fat pad that hides the penis.  

The good news is that weight loss will increase T levels and is capable of improving all of the aforementioned signs and symptoms. This has been demonstrated with all means of  weight loss, ranging from caloric restriction to bariatric surgery.

Another important lifestyle factor associated with variations in T levels is the extent of one’s physical fitness. Exercise is clearly associated with higher T levels. The degree of potential increase in T is related to both the quantity and quality of exercise. In general, the more time invested in moderate intensity exercise, the greater the increase in T.  As important as aerobic exercise is for health, resistance exercise is superior in terms of increasing T.

Bottom Line:  To optimize your T level, maintain a healthy weight and engage in an exercise program emphasizing resistance training.  If you are obese and sedentary, it is likely that you have low T, a situation that can be reversed with a modification to a healthier lifestyle. 

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

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

The Mystique Of The Pelvic Floor Muscles (PFM)

August 27, 2016

Andrew Siegel MD 8/27/16

1.core muscles

 Note that PFM form floor of the “barrel” of core muscles. Illustration by Ashley Halsey from THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Our bodies are comprised of a variety of muscle types: There are the glamour, overt, seen-and-be-witnessed muscles that offer no secrets, the “what you see is what you get” muscles. Then there are muscles that are shrouded in secrecy, hidden from view, veiled from sight, concealed and covert. The pelvic floor muscles (PFM) are in the latter category.

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, the genital and anal zones often fail to command the respect and attention that other areas of our bodies command. Frequently ignored and/or neglected, this locale rarely sees the light of day and most people never think about exercising the important functional muscles in this anatomical sector.

Most women and men can probably point out their “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (PFM) are located? For that matter, who even knows what they are and how they contribute to pelvic health? Think for a moment about the PFM…How essential—yet taken for granted—are sphincter control, support of your pelvic organs and, of course, their key contribution to sexual function?

Unlike the glitzy, for show, external, mirror-appealing glamour muscles, the PFM are humble muscles that are unseen and behind the scenes, often unrecognized and misunderstood. Cloaking increases mystique, and so it is for these PFM, not only obscured from view by clothing, but also residing in that most curious of nether regions—the perineum—an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the PFM, which straddle the gamut of being vital for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

The PFM are hidden gems that work diligently behind the scenes and on a functional basis you would be much better off having “chiseled” PFM as opposed to having “ripped” external muscles.” Tapping into and harnessing the energy of the PFM—those that favor function over form, “go” rather than “show”—is capable of providing significant benefits. The PFM are the floor of the core muscles and seem to be the lowest caste of the core muscles; however, they deserve serious respect because they are responsible for very powerful functions, particularly so when intensified by training. The PFM are among the most versatile muscles in our body, contributing to the support of our pelvic organs, control of bladder and bowel, and sexual function. Although the PFM are not muscles of glamour, they are muscles of “amour.”

Bottom Line: You can’t see your PFM in the mirror. Because they are out of sight and out of mind, they are often neglected or ignored, but there is great merit in exercising vital hidden muscles, including the heart, diaphragm and PFM. This goes for men as much as it does for women, since in both genders these muscles provide vital functions and are capable of being enhanced with training.

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

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

 

On Beer Bellies, Heart Disease And Sexual Function

July 30, 2016

Andrew Siegel MD  7/30/16

fat

 

A bit of fat is good…but not too much

Having some fat on our bodies is not a bad thing, as long as it is not excessive. Fat serves a number of useful purposes: it cushions internal organs; it provides insulation to conserve heat; it is a means of storing energy and fat-soluble vitamins; it is part of the structure of the brain and cell membranes; and it is used in the manufacturing process of several hormones.

All fat is not created equal…It’s all about location, location, location.

Not all fat is the same. It is important to distinguish between visceral fat and subcutaneous fat. Visceral fat–also referred to as a “pot belly” or “beer belly”– is internal fat located deep within the abdominal cavity. Subcutaneous fat–also known as “love handles,” “spare tires,” “muffin top,” or “middle-age spread”–is superficial fat located between the skin and the abdominal wall. In addition to the physical distribution of the fat being different, so is the nature of the fat. Although neither type is particularly attractive, visceral fat is much more hazardous to one’s health than subcutaneous fat since it increases the risk of heart disease, diabetes and metabolic disturbances. Subcutaneous fat is inactive and relatively harmless and generally does not contribute to health problems.

Factoid: A beer belly is called a beer belly for good reason. One of the real culprits in cultivating visceral fat is drinking liquid carbs, whether they are sweetened beverages (sodas, iced tea, lemonade, sports drinks, etc.), fruit juices such as orange, grapefruit, grape, cranberry, etc., or alcoholic beverages. These liquid carbs have no fiber and are essentially pre-digested, stimulating an insulin surge and rapid storage as fat. It is always better to eat the fruit rather than drink the juice, since the fruit is loaded with fiber that fills you up and slows the absorption process and contains abundant phytonutrients. You would have to eat 3 oranges to get the same sugar and calorie load as drinking a glass of OJ, and it is hardly possible to do that.

Visceral fat essentially is a metabolically active endocrine “organ” that does way more than just create an unsightly protrusion from our abdomens. It produces numerous hormones and other chemical mediators that have many detrimental effects on all systems of our body. So, fat is not just fat. Visceral fat ought to have a specific name, as do other endocrine organs (thyroid gland, adrenal gland, thymus gland, etc.). This name should convey the dangerous nature of this “gland.” I suggest “die-roid” gland because of its dire metabolic consequences, including risk of diabetes, cardiovascular disease, low testosterone, erectile dysfunction (ED) and premature death.

When a patient walks into the office and the first thing I observe is a protuberant and bulging belly, a siren goes off screaming “metabolic syndrome, metabolic syndrome, metabolic syndrome.”

Factoid: Anybody with a big belly is pre-diabetic, if not diabetic already.

“Metabolic syndrome” is a cluster of risk factors that are dangerous to one’s health. These include visceral obesity as defined by waist circumference (men > 40 inches; women > 35 inches), elevated blood sugar (> 100 mg/dL), high blood pressure (> 130/85 mm), elevated triglycerides (>150 mg/dL) and low HDL cholesterol (the good cholesterol): (men < 40 mg/dL; women < 50 mg/dL).

Sexual dysfunction

Beer belly and metabolic syndrome are highly associated with low testosterone and poor erection and ejaculation function. The fatty tissue present in obese abdomens contains abundant amounts of the enzyme aromatase, which converts testosterone to estrogen—literally emasculating obese men. So, visceral fat can steal away our masculinity, male athletic form and body composition, mojo, strength, as well as the ability to obtain and maintain a good quality erection.

ED serves as a good proxy for cardiac and general health. The presence of ED is as much of a predictor of heart disease as is a strong family history, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson expanded the initials ED to mean: Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries); Early Detection (of heart disease); and Early Death (if missed).

Factoid: The penis can function as a “canary in the trousers.” Since the penile arteries are generally rather small (diameter of 1- 2 mm) and the coronary (heart) arteries larger (4 mm), it stands to reason that if vascular disease is affecting the tiny penile arteries and causing ED, it may affect the larger coronary arteries as well—if not now, then at some time in the future. In other words, the fatty plaque that compromises blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus ED may be considered a genital “stress test.”

“Fatal retraction”

While the penis can genuinely shrink for a variety of reasons, most of the time it is a mere illusion—a sleight of penis. Obesity causes a generous pubic fat pad that will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding or buried behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. Yet another reason to remain lean!

Trivia: It is estimated that for every 35 lbs. of weight gain, there is a one-inch loss in apparent penile length.

What does this all mean?

  • Visceral fat is a bad, metabolically-active form of fat that is highly correlated with metabolic syndrome, diabetes, heart disease and sexual dysfunction.
  • ED often occurs in the presence of “silent” heart disease (no symptoms) and serves as a marker for increased risk for heart disease (as well as stroke, peripheral artery disease and death) often occurring 3-5 years before heart disease manifests. Early detection of ED provides an opportunity to decrease the risk of heart disease and the other forms of blood vessel disease.  ED has a similar or greater predictive value for heart disease as do traditional factors including family history, prior heart attack, tobacco use and elevated cholesterol. The greater the severity of the ED, the greater the risk and extent of heart disease and blood vessel disease.
  • Intensive lifestyle intervention has the potential for reversing visceral obesity, metabolic syndrome and sexual dysfunction. This lifestyle intervention involves achieving a healthy weight, losing the belly fat, healthy eating, regular exercise, smoking cessation, moderation of alcohol intake, stress management, etc.
  • The good news about visceral fat is that it is so metabolically active that with the appropriate lifestyle measures it can readily melt away, as opposed to subcutaneous fat, which is tenacious and can be virtually impossible to lose.

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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

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

To What Lengths Man Will Go For A Larger Penis

July 16, 2016

Andrew Siegel MD 7/16/16

elephant penisPhoto taken by one of my patients (notice 4 legs, trunk and a most substantial appendage)

Many men feel insecure regarding their penis size, particularly so with our super-sized American bigger-is-better culture. The pornography industry has not helped the plight of the average-endowed male. 

Sometimes a “cigar is just a cigar,” but sadly the penis represents way more than what it presents at face value. Going beyond sexuality, it symbolizes confidence, swagger and self-esteem. It is understandable why the words “cocksure” and “cocky” mean possessing self-assurance.

Some men desire to be the alpha males in the pecking order with a substantial locker room presence. Other men desire only to possess a formidable bedroom presence. Still others desire to be enormous under all circumstances. Interestingly, women in general are considerably less concerned with penile size than men.

Many men who are “ordinary” in genital dimensions would prefer to be not so middle-of-the-road.  This entry reviews a new type of penile implant designed to convert the average penis into a mighty one.  *** My intent is not in any way to endorse the use of this implant, only to educate the public about its existence. 

Penile Stats

With all biological parameters there is a bell curve with a wide range of variance. Most are clustered in the middle with outliers at either end of the curve. Penis size is no exception, with some phallically-endowed, some challenged, but most in middle range. In a study of 3500 men published by Alfred Kinsey, the average flaccid penis length was 3.5 inches and the average erect penis length ranged between 5-6 inches. The average circumference of the erect penis measured 4.75 inches.

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

Penile Enlargement Surgery

In general, penile enhancement surgery to date has been risky, ineffective and not ready for prime time. Certain “sleight of penis” procedures including cutting the penile suspensory ligaments, disconnecting and moving the attachment of the scrotal sac to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” (inner) 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.

New Type of Penile Enlargement…The “Penuma”

Paralleling the cosmetic surgical concept of breast, buttock, calf and chin implants, an enterprising Beverly Hills urologist named James Elist has devised a silicone penile sheath implant that can substantially enhance penile girth and length.

Unlike the implantable penile prostheses that have been used for years for men with erection problems—implanted within the erectile chambers of the penis to allow a hydraulic erection—the Penuma implant is used for purposes of penile enlargement and is implanted superficially in the penis. Essentially, a silicon sheath shaped like a hot dog bun is placed under the skin of the penis, wrapped around and encircling about 80% of the penis, leaving an area of the underside of the penis unexposed. The device immediately expands the penis by about 2-2.5 inches in length and girth. The final expansion results may not be evident until 6 months or so because further stretching will occur over time.

Penuma

The Penuma Implant

The device received FDA clearance in 2004. Dr. Elist has implanted over 1000 Penumas and claims a 95% success rate. The device is available in three sizes—large, extra-large and extra-extra-large. In order to be able to have the device implanted one must be circumcised. The Penuma implant procedure is done on an outpatient basis in less than one hour and the surgical fee is $13,000.  As with implantations of all foreign devices into the body, there is the potential for infections, device breakage, skin perforation, pain and other issues. 

Bottom Line: The Penuma implant is an intriguing urological plastic surgical concept, but the jury is still out. Dr. Elist has been the sole implanter to date and there are no long-term clinical studies, but you must give him credit for creative thinking and innovative design.

For more information on this procedure, visit Dr. Elist’s website: http://www.drelist.com/penile-enlargement-surgery/

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

I welcome suggestions for blog topics!  Please contact me if you have ideas.

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

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

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

12 MYTHS ABOUT KEGEL EXERCISES

July 9, 2016

Andrew Siegel MD 7/9/16

A “myth” is a widely held but false belief or idea. With respect to Kegel pelvic floor exercises, there are many such myths in existence. The goal of this entry is to straighten out these false notions and misconceptions and provide indisputable truths and facts about pelvic floor exercises. Much of this entry is excerpted from my new book THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health. (www.TheKegelFix.com)

 Facts_Myths.svg

(attribution Nevit Dilmen, 2015)

 

Myth 1: The best way to do Kegels is to stop the flow of urine.

Fact: If you can stop your stream, it is proof that you are contracting the proper muscles. However, this is just a means of feedback to reinforce that you are employing the pelvic floor muscles. The bathroom should not be your Kegel gymnasium!

Myth 2: Do Kegel exercises as often as possible.

Fact: Kegel exercises strengthen and tone the pelvic floor muscles and like other muscle-conditioning routines should not be performed every day. Kegel exercises should be done in accordance with a structured plan of progressively more difficult and challenging exercises that require rest periods in order for optimal muscle growth and response.  Three to four times weekly is sensible. 

Myth 3: Do Kegels anywhere (stopped at a red light, waiting in line at the supermarket, while watching television, etc.).

Fact: Exercises of the pelvic floor muscles—like any other form of exercise—demand attention, mindfulness and isolation of the muscle group. Until you are able to master the exercise regimen, it is best that the exercises be performed in an appropriate venue, free of distraction, which allows single-minded focus and concentration. This is not to say that once you achieve mastery of the exercises and a fit pelvic floor that you should not integrate the exercises into activities of daily living. That, in fact, is one of the goals.

Myth 4: The best way to do a Kegel contraction is to squeeze your PFM as hard as possible.

Fact: A good quality Kegel contraction cycles the pelvic floor muscles through a full range of motion from maximal relaxation to maximal contraction. The relaxation element is as critical as the contraction element. As vital as “tone and tighten” are, “stretch and lengthen” are of equal importance. The goal is for pelvic muscles that are strong, toned, supple and flexible.

Myth 5: Keeping the Kegel muscles tightly contracted all the time is desirable.

Fact: This is not a good idea. The pelvic muscles have a natural resting tone to them and when you are not actively engaging and exercising them, they should be left to their own natural state. “Tight” is not the same as “strong.” There exists a condition—pelvic floor muscle tension myalgia—in which there is spasticity, extreme tightness and pain due to excessive tension of these muscles.

Myth 6: Focusing on your core muscles is sufficient to ensure Kegel fitness.

Fact: No. The Kegel muscles are the floor of the “core” group of muscles and get a workout whenever the core muscles are exercised. However, for maximal benefit, focus needs to be placed specifically on the Kegel muscles. In Pilates and yoga, there is an emphasis on the core muscles and a collateral benefit to the pelvic muscles, but this is not enough to achieve the full potential fitness of a regimen that isolates and intensively exercises the Kegel muscles.

Myth 7: Kegel exercises do not help.

Fact: Oh yes they do! Kegel exercises have been medically proven to help a variety of pelvic maladies including pelvic relaxation, sexual dysfunction and urinary and bowel incontinence. Additionally, pelvic training will improve core strength and stability, posture and spinal alignment.

Myth 8: Kegels are only helpful after a problem arises.

Fact: No, no, no. As in any exercise regimen, the best option is to be proactive and not reactive. It is sensible to optimize muscle mass, strength and endurance to prevent problems from surfacing before they have an opportunity to do so. Kegel exercises pursued before getting pregnant will aid in preventing pelvic issues that may arise as a consequence of pregnancy, labor and delivery. If you strengthen your pelvic floor muscles when you are young, you can help avoid pelvic, urinary and bowel conditions that may arise as you age. Strengthen and tone now and your body will thank you later.

Myth 9: You can stop doing Kegels once your muscles strengthen.

Fact: Not true…the “use it or lose it” principle applies here as it does in any muscle-training regimen. Just as muscles adapt positively to the stresses and resistances placed upon them, so they adapt negatively to a lack of stresses and resistances. “Disuse atrophy” is a possibility with all muscles, including the Kegel muscles. “Maintenance” Kegels should be used after completing a course of pelvic muscle training.

Myth 10: It is easy to learn how to isolate and exercise the Kegel muscles.

Fact: Not the case at all. A high percentage of women who think they are doing Kegel exercises properly are actually contracting other muscles or are bearing down and straining instead of drawing up and in. However, with a little instruction and effort you can become the master of your pelvic domain.

(Note well: During June office visits I saw a nurse practitioner, a personal trainer and a physical therapist in consultation for pelvic issues.  None of them knew how to properly contract their pelvic muscles and needed to be instructed…and these are people in the know!)

Myth 11: Kegels are bad for your sex life.

Fact: Just the opposite! Kegels improve sexual function as the pelvic muscles play a critical role in genital blood flow and lubrication, vaginal tone, clitoral erection and orgasm. Kegels will enhance your sex life and his as well. A strong pelvic floor will enable you to “hug” his penis as energetically as you can hug his body with your arms!

Myth 12: Kegels are just for women.

Fact: Au contraire…men have essentially the same pelvic muscles as do women and can reap similar benefits from Kegels with respect to pelvic, sexual, urinary and bowel health. For more information on this topic, refer to Male Pelvic Fitness: Optimizing Sexual and Urinary Health (www.MalePelvicFitness.com).

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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

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

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

July 1, 2016

Andrew Siegel MD  7/1/2016

IMG_1457(1)

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

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

How the Penis Erects

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

How the Penis Becomes Flaccid

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

ED Meds

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My Take

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

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

$$$$$

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

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

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

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

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

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

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

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

July 1, 2016

Andrew Siegel MD   7/1/16

IMG_1457(1)

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

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

How the Penis Erects

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

How the Penis Becomes Flaccid

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

ED Meds

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My Take

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

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

$$$$$

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

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

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

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

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

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

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