Posts Tagged ‘orgasm’

Are You “Cliterate”? (Do You Have A Good Working Knowledge Of The Clitoris?)

March 18, 2017

Andrew Siegel MD  3/18/17

The clitoris—possessed by all female mammals—is a complex and mysterious organ. Even the word itself–and the way it rolls off the tongue as it is pronounced–is a curiosity.  Many men (and women as well) are relatively clueless (“uncliterate”) about this unique and fascinating female anatomical structure.  The greatest challenge of achieving cliteracy is that so much of this mysterious lady part is subterranean–in the nether regions, unexposed, under the surface, obscured from view–and therefore difficult to decipher.  

The intention of this entry is to enable understanding of what is under the (clitoral) hood, literally and figuratively. Regardless of gender, a greater knowledge and appreciation of the anatomy, function and nuances of this special and unique biological structure will most certainly prove to be useful.  In general terms, proficiency and command of geography and landmarks on the map is always helpful in directing one to arrive at the proper destination.  Consider this entry a clitoral GPS.

 

Klitoriswurzel,_Klitoris,_Klitorisschenkel

The clitoris is mostly subterranean–what you see is merely the “tip of the iceberg.”  The white lines indicate the “rest of the iceberg.”

(By Remas6 [CC0], via Wikimedia Commons)

Mountainous and Hilly Female Terrain

The vulva (the external part of the female genital anatomy) consists of hilly terrain. It is well worth learning the “lay of the land” so that it can be traversed with finesse. The mons pubis (pubic mound) is the rounded and prominent mass of fatty tissue overlying the pubic bone, derived from the Latin “mons,” meaning “mountain.” Located beneath the lower part of the mons is the upper portion of the clitoris.  The word clitoris derives from the Greek “kleitoris,” meaning “little hill.”

Mons_pubis_jpg

Lower abdomen, mons pubis and pudendal cleft

By Wikipicturesxd (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)%5D, via Wikimedia Commons

The Epicenter of Female Sexual Anatomy

The clitoris is arguably the most vital structure involved with female sexual response and sexual climax. It is the only human organ that exists solely for pleasure, the penis being a multi-tasker with reproductive and urinary roles as well as being a sexual organ. However, I would argue that nature had much more than simply pleasure in mind when it came to the design of the clitoris, with the ultimate goal being reproduction and perpetuation of the species.  If sex was not pleasurable, there would little incentive for it and pregnancies would be significantly fewer. Think about non-human mammals—what would be their motivation to reproduce if sex were not pleasurable? (Male chimps and female chimps do not sit down together and plan on having a family!)  So, pleasure is the bait and reproduction is the switch in nature’s clever scheme.

The clitoris, like the penis, consists largely of spongy erectile tissue that is rich in blood vessels. The presence of this vascular tissue results in clitoral swelling with sexual arousal, causing clitoral fullness and ultimately a clitoral “erection.”

Penile-Clitoral_Structure

Comparison of penis (left) and clitoris (right), each largely composed of spongy, vascular, erectile tissue

By Esseh (Self-made. Based on various anatomy texts.) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/2.5-2.0-1.0)%5D, via Wikimedia Commons

Clitoral size is highly variable from woman to woman—certainly as much as penile size. A very large clitoris can resemble a very small penis.

Interesting trivia: The female spotted hyena, squirrel monkey, lemur, and bearcat all have in common a very large clitoris referred to as a “pseudo-penis.”  When erect, it appears like the male’s penis and is used to demonstrate dominance over other clan members.  

The most sensitive part of the clitoris is the “head,” which is typically about the size of a pencil eraser and located at the upper part of the vulva where the inner lips meet. Despite its small size, the head has a dense concentration of nerve endings, arguably more than any other structure in the body. Like the penis, the head is covered with a protective hood known as the “foreskin.”

The head is really the “tip of the iceberg” because the vast majority of the clitoris is unexposed and internal. The clitoris (again like the penis) has a “shaft” (although it is internal) that extends upwards towards the pubic bone. The extensions of the shaft are the wishbone-shaped “legs” that turn downwards and attach to the pubic arch as it diverges on each side. Beneath the legs on either side of the vaginal opening are the clitoral “bulbs,” sac-shaped erectile tissues that lie beneath the outer vaginal lips. With sexual stimulation, these bulbs become full, plumping and tightening the vaginal opening.

One can think of the legs and bulbs as the roots of a tree, hidden from view and extending deeply below the surface, fundamental to the support and function of the clitoral shaft and head above, comparable to the tree’s trunk and branches.

vulva

Image above by OpenStax College – Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30148635, no changes made to original

The Clitoral Response

With sexual arousal and stimulation, the clitoris engorges, resulting in thickening of the clitoral shaft and swelling of the head. With increasing clitoral stimulation, a clitoral erection occurs and ultimately the clitoral shaft and head withdraw from their overhanging position (clitoral “retraction”), pulling inwards against the pubic bone (like a turtle pulling its head in).

Interesting trivia: The blood pressure within the clitoris at the time of a clitoral erection is extremely high, literally at hypertensive (high blood pressure) levels. This is largely on the basis of the contractions of the pelvic floor/perineal muscles that surround the clitoral legs and bulbs and force pressurized blood into the clitoral shaft and head. The only locations in the body where hypertension is normal and, in fact, desirable are the penis and clitoris.

Why The Pelvic Floor Muscles Are Vital To Female Sexual Health And Clitoral Function

During arousal the pelvic floor muscles help increase pelvic blood flow, contributing to vaginal lubrication, genital engorgement and the transformation of the clitoris from flaccid to softly swollen to rigidly engorged.  The pelvic floor muscles enable tightening of the vagina at will and function to compress the deep roots of the clitoris, elevating clitoral blood pressure to maintain clitoral erection. At the time of climax, they contract rhythmically.  An orgasm would not be an orgasm without the contribution of these important muscles.

 

Bulbospongiosus-Female

Bulbocavernosus muscle (pelvic floor muscle that supports and compresses the clitoral bulbs)

 

Ischiocavernosus-female

Ischiocavernosus muscle (pelvic floor muscle that supports and compresses the clitoral legs)

(Above two images are in public domain, originally from Gray’s Anatomy 1909)

During penetrative sexual intercourse, only a small percentage of women achieve enough direct clitoral stimulation to achieve a “clitoral” orgasm, as this is usually restricted to women with larger clitoral head sizes and shorter distances from the clitoris to the vagina. Depending on sexual position and angulation of penetration, the penis is capable of directly stimulating the clitoral head and shaft, typically in the missionary position when there is direct pubic bone to pubic bone contact. However, vaginal penetration and penile thrusting does directly stimulate the clitoral legs and bulbs and the thrusting motion can also put rhythmic traction on the labia, which can result in the clitoris getting pulled and massaged.

Interesting trivia: Magnetic resonance (MR) studies have shown that a larger clitoral head size and shorter distance from the clitoris to the vagina are correlated with an easier ability to achieve an orgasm.

The clitoris plays a key role in achieving orgasm for the majority of women. An estimated 70% of women require clitoral stimulation in order to achieve orgasm. Some women require direct clitoral stimulation, while for others indirect stimulation is sufficient. Only about 25% of women are capable of achieving orgasm via vaginal intercourse alone.

With increasing sexual arousal and stimulation, physical tension within the genitals gradually builds and once sufficient intensity and duration of sexual stimulation surpasses a threshold, involuntary rhythmic muscular contractions of the pelvic floor muscles, the vagina, uterus and anus occur, followed by the release of accumulated erotic tension and a euphoric state. Thereafter, the genital and clitoral engorgement and congestion subside, muscle relaxation occurs and a peaceful state of physical and emotional bliss and afterglow become apparent.

Clitoral orgasms are often described as a gradual buildup of sensation in the clitoral region culminating in intense waves of external muscle spasm and release. In contrast, vaginal orgasms are described as slower, fuller, wider, deeper, more expansive and complex, whole body sensations. The truth of the matter is that all lady parts are inter-connected and work together, so grouping orgasm into “clitoral” versus “vaginal” is an arbitrary distinction. Most women report that both clitoral and vaginal stimulation play roles in achieving sexual climax, but since the clitoris has the greatest density of nerves, is easily accessible and typically responds readily to stimulation, is the fastest track to sexual climax for most women.

There is a clitoral literacy movement that is gaining momentum. Please visit:

http://projects.huffingtonpost.com/cliteracy for more information on the clitoris and this campaign to foster awareness of this curious organ.

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 (much of the material from this entry was excerpted from this book)

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Ejaculation: His and Hers

March 12, 2016

Andrew Siegel, MD   3/12/2016

One of the advantages of the specialty of urology is that it encompasses patients of both genders, unlike gynecology, which strictly involves females. Since I am board certified in Urology as well as in Female Pelvic Medicine, my practice allows me to have an equal balance of male and female patients. This gives me the opportunity to appreciate comparative male and female pelvic anatomy and function, which in reality are remarkably similar–a fact that may surprise you.

 A Few Brief Words on the Embryology of the Genitals.

Who Knew? Female and male external genitals are remarkably similar. In fact, in the first few weeks of existence as an embryo, the external genitals are identical.

The female external genitals are the “default” model, which will remain female in the absence of the male hormone testosterone. In this circumstance, the genital tubercle (a midline swelling) becomes the clitoris; the urogenital folds (two vertically-oriented folds of tissue below the genital tubercle) become the labia minora (inner lips); and the labio-scrotal swellings (two vertically-oriented bulges outside the urogenital folds) fuse to become the labia majora (outer lips).

Gray1119

(Comparison of genital anatomy,  1918 Gray’s Anatomy, Dr. Henry Gray, public domain)

In the presence of testosterone, the genital tubercle morphs into the penis; the urogenital folds fuse and become the urethra and part of the shaft of the penis; and the labio-scrotal swellings fuse to become the scrotal sac.  So, the clitoris and the penis are essentially the same structure, as are the outer labia and the scrotum.                                                                                              

Ejaculation

Ejaculation is the expulsion of fluids at the time of sexual climax. The word “ejaculation” derives from ex, meaning out and jaculari, meaning to throw, shoot, hurl, cast. We are all familiar with male ejaculation, an event that is obvious and well understood and well studied. However, female ejaculation is a mysterious phenomenon and a curiosity to many and remains poorly understood and studied.

Male Ejaculation

Men often “dribble” before they “shoot.” The bulbo-urethral glands, a.k.a. Cowper’s glands, are paired, pea-sized structures whose ducts drain into the urethra (urinary channel). During sexual arousal, these glands produce a sticky, clear fluid that provides lubrication to the urethra. (These glands are the male versions of Bartholin’s glands in the female, discussed below).

Once a threshold of sexual stimulation is surpassed, men reach the “point of no return,” in which ejaculation becomes inevitable. Secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. Shortly thereafter, the bladder neck pinches closed while the prostate and seminal vesicles contract and the pelvic floor muscles (the bulbocavernosus and ischiocavernosus) spasm rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen out in a pulsatile and explosive eruption. Ejaculation is the physical act of expulsion of the semen, whereas orgasm is the intense emotional excitement and climax, the blissful emotions that accompany ejaculation.

Male_anatomy

(Male Internal Sexual Anatomy, permission CC BY-SA 3.0, created 18 April 2009)

What’s in the Ejaculate?

Less than 5% of the volume is sperm and the other 95+% is a cocktail of genital secretions that provides nourishment, support and chemical safekeeping for sperm. About 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid that has a lubrication function. The average ejaculate volume is 2-5 milliliters (one teaspoon is the equivalent of 5 milliliters).

Who Knew?  While a huge ejaculatory load sounds desirable, in reality it is correlated with having fertility issues. The sperm can literally “drown” in the excess seminal fluid.

Female Ejaculation

This is a much less familiar subject than male ejaculation and a curiosity to many. Only a small percentage of women are capable of expelling fluid at the time of sexual climax.

The nature of this fluid is controversial, thought by some to be excessive vaginal lubrication and others to be glandular secretions. Although the volume of ejaculated fluid is typically small, there are certain women who ejaculate very large volumes of fluid at climax. Expulsion of fluid at climax may come from four possible sources: vaginal secretions; Bartholin’s glands; Skene’s glands; and the urinary bladder.

Skenes_gland

(Skene’s and Bartholin’s Glands, created 22 January 2007, original uploader Nicholasolan  en.wikipedia, Permission: CC-BY-SA-2.5, 2.0, 1.0; GFDL-WITH-DISCLAIMERS; CC-BY-S)

During female arousal and sexual stimulation, the vaginal walls lubricate with a “sweating-like” reaction as a result of the increased blood flow to the genitals and pelvic blood congestion, creating a slippery and glistening film. The amount of this lubrication is highly variable. Some women with female ejaculation can release some of this fluid at the time of climax by virtue of powerful contractions of the vaginal and pelvic floor muscles.

Bartholin’s glands are paired, pea-size glands that drain just below and to each side of the vaginal opening. They are the female versions of the male bulbo-urethral glands and during sexual arousal they secrete small drops of fluid, resulting in moistening of the opening of the vagina.

Skene’s glands (para-urethral glands) are paired glands that drain just above and to each side of the urethral opening. They are the female homologue of the male prostate gland and secrete fluid with arousal.

Scientific studies have shown that those women who are capable of ejaculating very large volumes are actually having urinary incontinence due to an involuntary contraction of the urinary bladder that accompanies orgasm. This is often referred to as “squirting.”

Bottom Line: In the animal kingdom (including human beings), sex is a clever “bait and switch” scheme. In the seeming pursuit of a feel-good activity, in reality—determined by nature’s evolutionary sleight of hand—participants are hoodwinked into reproducing. The ultimate goal of the reproductive process is the fusion of genetic material from two individuals to perpetuate the species.

The penis functions as a “pistol” to place DNA deeply into the female’s reproductive tract with ejaculation a necessity for the process. Similarly, the female genitals need to be sufficiently lubricated to optimize this process and the combination of vaginal lubrication from enhanced blood flow contributed to by Skene’s and Bartholin’s secretions will optimize nature’s ultimate goal.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

 

 

 

 

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

February 13, 2016

Andrew Siegel MD  2/13/2016

800px-Fireworks4_amk

(Fireworks, 8/2007, author AngMoKio)

In the arena of male sexual dysfunction (MSD), ejaculation problems play second fiddle to erectile dysfunction (ED). Today’s entry explores common issues with ejaculation other than premature ejaculation, which I have previously addressed: https://healthdoc13.wordpress.com/tag/premature-ejaculation/

What my patients tell me: 

“It takes me too long.”

 “I can’t ejaculate.”

 “It happens, but not much fluid comes out.”

 “It just dribbles out with no force.”

 “I barely know that it happened; I just don’t get the same feeling that I used to.”

One would think that MSD is the same as ED, which seems to get all the press. However, MSD is more complex and all-encompassing than having soft or short-lived erections, which is just one aspect of MSD. Sex drive (libido) is an important part of the picture. Ejaculation is another vital component. With regard to ejaculatory issues, premature ejaculation (rapidly achieving climax) gets all the attention. However, there are other ejaculatory issues that contribute in a major way to MSD.

The processes of having an erection and ejaculating are separate, even though they usually occur at the same time. However, it is possible to have a rock-hard erection and be unable to ejaculate, and conversely, to ejaculate with a limp penis. Regardless, it sure is nice when the two processes harmonize. All things being equal, with a good quality erection, ejaculation will be more satisfying.

Why is ejaculation better with a rigid erection than without?

The urethra (tube within the penis that conducts semen) is the “barrel” of the penile “rifle.” It is surrounded by spongy erectile tissue called the corpora spongiosum (“spongy body”) which constricts and pressurizes the “barrel” to optimize ejaculation and promote the forceful expulsion of semen, the “ammo.” The word ejaculation derives from ex, meaning out + jaculari, meaning to throw, shoot, hurl, cast for a good reason!

Additionally, the pelvic floor muscles play a key role in the process of ejaculation. The bulbocavernosus (BC) is a compressor muscle that surrounds the spongy body and at the time of ejaculation it contracts rhythmically, sending wave-like pulsations rippling down the urethra to forcibly propel the semen in an explosive eruption, providing the horsepower for forceful ejaculation. This BC muscle engages when you have an erection and becomes maximally active at the time of ejaculation.

Issues with ejaculation are extremely common complaints among middle-aged and older men. These are often bothersome and distressing, and include the following:

  • Delayed ejaculation
  • Absent ejaculation
  • Skimpy ejaculation volume
  • Weak ejaculation force and arc
  • Diminished ejaculatory sensation

Ejaculatory problems often correlate with aging, weight gain, the presence of lower urinary tract symptoms and ED. The older you are, the heavier you are, the more that you are having problems with urination and obtaining/maintaining an erection, the greater the likelihood that you will also have ejaculatory problems. This is often on the basis of an age-related decline of sensory nerve function as well as weakened pelvic floor muscles. Additionally, aging reproductive glands produce less fluid and the ducts that drain genital fluids can obstruct. Furthermore, medications that are used to treat prostate enlargement can profoundly affect ejaculatory volume.

So What’s The Big Deal Anyway?

Most men do not appreciate meager, lackadaisical-quality ejaculations and orgasms. Sex is important and getting a rigid erection is vital, but the culmination—ejaculation and orgasm—is equally important. We may be 40, 50, 60 years old or older, but we still want to point and shoot like we did when we were 20 and desire to retain that intensely pleasurable feeling of yesteryear.

Delayed Ejaculation

I have previously addressed this topic:

https://healthdoc13.wordpress.com/2015/02/21/im-almost-there-what-you-need-to-know-about-delayed-ejaculation/

Absent Ejaculation

This is part of the spectrum of delayed ejaculation, except in this instance, climax is never achieved. Alternatively, it happens with surgical removal of the reproductive organs, as occurs with radical prostatectomy or radical cystectomy for prostate and bladder cancer, respectively.  It can also occur in the presence of  neuropathy, e.g., with diabetes and other neurological disorders. In these circumstances, orgasm can still be experienced, although ejaculation is absent.

Skimpy Ejaculation Volume

This is very common with aging as the reproductive organs “dry out” to some extent. It also happens with certain medications that either reduce reproductive gland secretions (Proscar, Avodart) or cause some of the ejaculate to go backwards into the urinary bladder (Flomax, Rapaflo, Uroxatral).

Weak Ejaculation Force, Arc and Sensation

What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated in a arc several feet in length gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis.  These issues clearly correlate with aging, weakened pelvic floor muscles and ED.

Bottom Line: In addition to sex drive issues, erectile dysfunction and premature ejaculation, there are a spectrum of other male sexual problems that are bothersome and distressing.  With aging, weight gain and weakening of the pelvic floor muscles, ejaculation and orgasm often become less spirited, with diminished volume, force and trajectory. However, there are solutions!

 To Optimize Ejaculation:

  1. Maintain a healthy lifestyle: good eating habits, healthy weight, engage in exercise, obtain adequate sleep, consume alcohol in moderation, avoid tobacco and minimize stress.
  1. Pelvic floor muscle training: Whereas a weakened BC muscle may result in semen dribbling with diminished force or trajectory, a strong BC can generate powerful contractions to forcibly ejaculate semen. Keep the BC and the other pelvic floor muscles fit through pelvic floor muscle exercises.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

What To Expect of Your Erections As You Age…20’s, 30’s, 40’s and Beyond

December 26, 2015

Andrew Siegel,  MD  12/26/15

I have written more than 250 blogs, this being the overwhelming most popular one with 50,000 plus views in 2015.  I am therefore reposting this as an encore final entry of 2015. 

shutterstock_side view manjpeg

It is shocking how ill prepared we are for aging. Nobody informs us exactly what to expect with the process, so we just sit back and observe the changes as they unfold, dealing with them as best we can. Although educational books are available on many topics regarding other expected experiences, such as “What To Expect When You’re Expecting,” I have yet to see “The Manual of Man,” explaining the changes we might expect to experience as time goes on. Some day I wish to author a book like that, but for the time being I will blog on what to anticipate with male sexual function as time relentlessly marches on.

“But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.”

Tom Hickman, God’s Doodle: The Life and Times of the Penis

Aging can be unkind and Father Time does not spare your sexual function. Although erectile dysfunction (ED) is not inevitable, with each passing decade, there is an increasing prevalence of it. Present in some form in 40% of men by age 40 years, for each decade thereafter an additional 10% join the ED club. All aspects of sexuality decline, although libido (sexual interest and drive) suffers the least depreciation, leading to a swarm of men with eager “big heads” and apathetic “little heads,” a most frustrating combination indeed.

With aging often comes less sexual activity, and with less sexual activity often comes disuse atrophy, in which the penis actually becomes smaller. Additionally, with aging there is often weight gain, and with weight gain comes a generous fat distribution in the pubic area, which will make the penis appear shorter. With aging also comes scrotal laxity and testicles that hang down loosely, like the pendulous breasts of an older woman. Many of my older patients relate that when they sit on the toilet, their scrotum touches the toilet water. So, the penis shrinks and the testicles hang low like those of an old hound dog…Time and gravity can be cruel conspirators!

So, what can you expect of your sexual function as you age? I have broken this down by decade with the understanding that these are general trends and that you as an individual may well vary quite a bit from others in your age group, depending upon your genetics, lifestyle, luck and other factors. There are 30-year-old men who have sexual issues and 80-year-old men who are veritable “studs,” so age per se is not the ultimate factor.

You may wonder about the means by which I was able to craft this guide. I was able to do so through more than 25 years spent deep in the urology trenches, working the front line with thousands of patient interactions. My patients have been among my most important teachers and have given me a wealth of information that is not to be found in medical textbooks or journals, nor taught in medical school or during urology residency. Furthermore, I am a 50-something year-old man, keenly observant of the subtle changes that I have personally witnessed, but must report that I am still holding my own!

Age 18-30: Your sexual appetite is prodigious and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might just be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the smell of her perfume, merely the thought of her can arouse you fully. You get erections even when you don’t want them…if there was only a way to bank these for later in life!  You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense and you are capable of ejaculating an impressive volume of semen forcefully with an arc-like trajectory, a virtual comet shooting across the horizon. When you arise in the morning from sleep, it is not just you that has arisen, but also your penis that has become erect in reflex response to your full bladder, which can make emptying your bladder quite the challenge, with the penis pointing up when you want to direct its aim down towards the toilet bowl.

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

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

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

Age 50-60: Sex is still important to you and your desire is still there, but is typically diminished. Your erection can still be respectable and functional, but is not the majestic sight to behold that it once was, and touch is necessary for full arousal. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. Your orgasms are definitely different with less intensity of your climax, and at times, it feels like nothing much happened—more “firecracker” than “fireworks.” Ejaculation has become noticeably different—the volume of semen is diminished and you question why you are “drying up.” At ejaculation, the semen seems to dribble with less force and trajectory; your “high-caliber rifle” is now a “blunt-nosed handgun.” Getting a second erection after climax is difficult, and you have much more interest in going to sleep rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity…sometimes just reserved for the weekends.

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

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

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

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

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

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

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

The Clitoris and Clitoral Priapism

November 7, 2015

Andrew Siegel, MD    11/7/15

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(Fresco of PriapusCasa dei VettiiPompeii, in public domain)

The clitoris is the female version of the penis. However, the clitoris is a much more subtle and mysterious organ, a curiosity to women and men alike. It is similar to the penis in that it becomes engorged when stimulated and because of its concentration of nerve fibers, is the site where most orgasms are triggered. On rare occasions, the clitoris can become rigidly engorged for a prolonged time, a painful condition known as clitoral priapism.

Clitoral Anatomy and Function 101

The clitoris is an organ that has as its express purpose sexual function, as opposed to the penis, which is both a sexual, urinary and reproductive organ. This erectile organ is the hub of female sensual focus and is the most sensitive erogenous zone of the body, playing a vital role in sensation and orgasm.

Similar to the penis, the clitoris is composed of an external visible part and internal, deeper, “invisible” parts. The inner parts of the clitoris are known as crura (legs), which are shaped like a wishbone with each side attached to the pubic arch as it descends and diverges. The visible part is located above the opening of the urethra, where the inner labia join together. Like the penis, it has a glans (head) and shaft (body), and is covered by a hood of tissue that is the female equivalent of the prepuce (foreskin). The glans of the clitoris, typically only the size of a pea, is a dense bundle of sensory nerve fibers, thought to have greater nerve density than any other body part. Much the same as the penis, the clitoris houses paired erectile chambers that contain spongy sinuses that engorge with blood at the time of sexual stimulation, resulting in a clitoral erection.

With the increase in genital and pelvic blood flow that occurs with sexual stimulation, the penile and clitoral shafts thicken and lengthen accompanied by swelling of the glans. Two of the superficial pelvic floor muscles—the bulbocavernosus and ischiocavernosus –-engage and compress the crura of the clitoris and penis, fundamental to maintaining engorgement and clitoral and penile blood pressures that are in excess of systemic blood pressures.

Priapism

The word priapism is derived from Priapus, the name of the Greek and Roman mythological God of fertility. He is commonly portrayed in classical artwork as having a disproportionately huge penis.

Engorgement and rigidity—whether penile or clitoral—is an ingenious hydraulic design and feat of nature. On occasion the system fails and the engorgement/erection does not subside. This condition is known as priapisman unwanted, persistent, painful engorgement that is not on the basis of sexual stimulation. It has the potential risk of damaging the anatomy such that future engorgement and erectile function can be compromised.

Although priapism is much more commonly a male problem, it occasionally involves the female clitoris. Clitoral priapism is an emergency situation in which there is clitoral shaft engorgement and swelling resulting in clitoral, vulvar and perineal pain. Similar to penile priapism, there are many different underlying causes including blood and nerve disorders or side effects from prescribed or recreational medications.

Doppler ultrasound can be useful to check the flow in the arteries to the erectile chambers. Treatment may involve injection of a blood vessel constricting medicine directly into the erectile chambers. Surgical treatment sometimes becomes necessary, usually “shunting” techniques to promote drainage of blood. In one such shunting procedure, a surgical opening is made between the head of the clitoris and the erectile chambers to create an avenue for the exit of the blood.

Bottom Line: Clitoral priapism is a rare occurrence in which there is prolonged clitoral engorgement/erection resulting in swelling and pain. Like penile priapism, this is not s problem that should be ignored. Prompt medical attention can manage the situation and help prevent the possiblity of sexual dysfunction resulting from scarring and impaired erectile capacity.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

How To Make Orgasms More Orgasmic

July 3, 2015

Andrew Siegel MD  7/3/15

Public domain image, royalty free stock photo from www.public-domain-image.com

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

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

What’s An Orgasm?

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

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

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

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

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

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

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

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

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

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

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

2014-04-23 20:16:29

AndrewSiegelMD.com

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

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

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

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

“Un-Juiced”: When Ejaculation Goes South

March 27, 2015

Andrew Siegel MD   3/21/15

shutterstock_side view manjpeg

There is scarce medical literature on ejaculatory problems aside from those of ejaculatory timing issues (premature and delayed ejaculation) and hematospermia (blood in the semen). Despite being given short shrift in medical academia, not a day goes by in my clinical urology practice where I do not see at least several patients who complain of declining ejaculation function.

What Is The Origin Of The Word “Ejaculation”?

Ejaculation derives from ex, meaning “out”  and jaculari, meaning “to throw, shoot, hurl, cast.”

Trivia: You do not need an erection to ejaculate and achieve an orgasm. A limp penis cannot penetrate, but is eminently capable of ejaculation and orgasm.

If  “Semen” Or “Ejaculate” Is Too Medical For You:

The most popular slang is “cum.” It originates from the expression “come to climax” shortened to “come” and ultimately to “cum,” but not to be confused with the Latin “cum,” e.g., I graduated summa cum laude or the word meaning “along with being,” e.g., my basement-cum-gym! “Jizm,” “jism,” and “jizz” are also popular and are not to be confused with other         “–ism” words that mean a doctrine, e.g., socialism and capitalism! We cannot forget “splooge,” “spooge,” “spunk,” “wad,” “nut,” “load” and “man juice.”

What Happens To Ejaculation As We Age?

Ejaculation and orgasm often become less intense, with diminished force, trajectory and volume of semen. What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated in an arc several feet in length gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis.

Fact: I have never heard a patient complain that his penis is too large, nor have I ever heard anyone protest that his ejaculate volumes are too abundant.

Fact: The pervasive porn industry–where many male stars are hung like horses and whose penises seem capable of ejaculating flooding pools of semen– has given the average guy a bit of a complex.

So What’s The Big Deal?

Men don’t appreciate meager, lackadaisical-quality ejaculations and orgasms. Sex is important to many of us and getting a good quality rigid erection is foremost, but the culmination—ejaculation and orgasm—is equally vital. We may be 40 or 50 years old or older, but we still want to point and shoot like we did when we were 20. As the word origin indicates, we desire to be able to shoot out, hurl or cast like an Olympian Master Blaster and we yearn for that intensely pleasurable feeling of yesteryear.

Ejaculation Science 101

Sexual climax consists of three phases—emission, ejaculation, and orgasm. When the intensity and duration of sexual stimulation surpasses a threshold, emission occurs, in which secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. During ejaculation the pelvic floor muscles contract rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen in a pulsating and explosive eruption. Orgasm is the intense emotional excitement that accompanies the physical act of ejaculation.

Big Head Versus Little Head

Ejaculation is an event that takes place in the penis; orgasm occurs in the brain. The process of emission and ejaculation is actually a very complex and highly coordinated neurological event involving several specific centers in the brain (amygdala, thalamus and other areas), spinal cord and peripheral nervous system.

What’s Makes Up The Reproductive Juices?

Less than 5% of the volume of semen is actually sperm and the other 95+% is a cocktail of genital juices that provide nourishment, support and safekeeping for sperm. 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid (pre-come) that has a lubrication function.

What’s Normal Volume?

The average ejaculate volume is 2-5 cc (one teaspoon is the equivalent of 5 cc). While a huge ejaculatory load sounds like a good thing, in reality it can cause infertility. The sperm can literally “drown” in the excessive seminal fluid.

Why Does The Seminal Tank Dry With Aging?

As we age, there are changes in the reproductive organs, particularly the prostate gland, one of the few organs in the body that enlarges as we get older. The aging prostate and seminal vesicles produce less fluid; additionally the ducts that drain the genital fluids can become blocked. In many ways, the changes in ejaculation parallel the changes in urination experienced by the aging male. Many medications that are used to treat prostate enlargement profoundly affect ejaculatory volume. Additionally, the pelvic floor muscles—which play a vital role in ejaculation—weaken with aging.

What About Those Pelvic Floor Muscles?

The pelvic floor muscles play a key role in ejaculation. The bulbocavernosus muscle (BC) is the motor of ejaculation, which supplies the “horsepower.” The BC surrounds the inner, deepest portion of the urinary channel. It is a compressor muscle that during sex engorges the spongy erection chamber that surrounds the urethra and also engorges the head of penis. At the time of climax, the BC expels semen by virtue of its strong rhythmic contractions, allowing ejaculation to occur and contributing to orgasm. A weakened BC muscle may result in semen dribbling with diminished force or trajectory, whereas a strong BC can generate powerful contractions that can forcibly ejaculate semen at the time of climax. 

How To Get The Juices Flowing Again?

Pelvic floor muscle training can be useful to improve the dynamics of ejaculation. The stronger the BC, the better the capacity for engorgement of the erection chamber that envelopes the urethra and the higher the ejaculatory horsepower, resulting in optimized urethral pressurization and ejaculation. The intensified ejaculation resulting from a robust BC can enhance the orgasm that accompanies the physical act of ejaculation.

Wishing you the best of health,

2014-04-23 20:16:29

AndrewSiegelMD.com

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

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

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

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

10 Myths About Kegel Exercises: What You Need to Know

November 14, 2014

Andrew Siegel, M.D.

 

shutterstock_orange gu tract closeup

 

shutterstock_femalebluepelvic

 

Myth: Kegels are just for the ladies.

Truth: Au contraire…men have essentially the same pelvic floor muscles as do women and can derive similar benefits to sexual, urinary, and bowel health.

 

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

Truth: If you can stop your stream, it is indeed proof that you are contracting the proper set of muscles. However, this is just a means of feedback to reinforce that you are employing the right muscles, but the bathroom should not be your Kegel muscle gymnasium.

 

Myth: You should do Kegel exercises as often as possible.

Truth: Pelvic floor muscle exercises strengthen and tone the pelvic floor muscles and like other muscle-strengthening routines, should not be performed every day. Pelvic exercises should be done in accordance with an intelligently designed plan of progressively more difficult and challenging exercises that require rest periods in order for optimal muscle growth and response.

 

Myth: You can and should do Kegels anywhere (while stopped in your car at a red light, waiting in line at the check out, while watching television, etc.)

Truth: Exercises of the pelvic floor muscles, like any other form of exercise, demand gravitas, focus, and isolation of the muscle group at hand. 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 cannot integrate the exercises into the activities of daily living.

 

Myth: Holding the pelvic floor muscles tight all the time is desirable.

Truth: Not a good idea…the pelvic floor muscles have natural tone to them and when you are not actively engaging and exercising them, they should be left to their own natural state. There exists a condition—tension myalgia of the pelvic floor muscles—in which there is spasticity, tightness and pain due to excessive tension of these muscles. Pelvic floor training in this circumstance must be done with caution in order to avoid aggravating the pain, but maximal muscle contraction can induce maximal muscle relaxation, a meditative state between muscle contractions.

 

Myth: Focusing on your core is enough to ensure pelvic floor muscle fitness.

Truth: The pelvic floor muscles do form the floor of the “core” group of muscles and get some workout whenever the core muscles are exercised. However, for maximum benefit, specific focus needs to be made on the pelvic floor muscles. In Pilates and yoga, there is an emphasis on the core group of muscles and a collateral benefit to the pelvic floor muscles, but this is not enough to achieve the full potential fitness of a regimen that focuses exclusively on the pelvic muscles.

 

Myth: Kegel exercises do not help.

Truth: Au contraire…pelvic floor muscles have proven to help a variety of pelvic maladies in each gender. In females, pelvic floor muscle training can help urinary and bowel incontinence, pelvic relaxation, and sexual dysfunction. In males, pelvic floor muscle training can help incontinence (stress incontinence that follows prostate surgery, overactive bladder, and post void dribbling), erectile dysfunction, premature ejaculation and other forms of ejaculatory dysfunction as well as help bowel incontinence and tension myalgia of the pelvic floor.

 

Myth: Kegels are only helpful after a problem surfaces.

Truth: No, no, no. As in any exercise regimen, the best option is to be proactive and not reactive in order to maintain muscle mass and strength in order to prevent problems from arising before they have an opportunity to do so. Pelvic floor muscle training done during pregnancy can help prevent pelvic issues from arising in females and pelvic muscle training in males can likewise help prevent the onset of a variety of sexual and urinary maladies. There is no better time than the present to start pelvic exercises to delay or prevent symptoms.

 

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

Truth: No, “use it or lose it” applies here as it does in any muscle-training regimen. Muscles adapt positively to the stresses and resistances placed upon them and so they adapt negatively to a lack of stresses and resistances. “Disuse atrophy” is a possibility with all muscles, including the pelvic floor muscles.

 

Myth: It is easy to learn how to isolate and exercise the pelvic floor muscles.

Truth: No, not the case at all. Studies have shown that over 70% of women who think they are doing pelvic floor muscle exercises properly are actually contracting other muscles, typically the rectus, the gluteal muscles, and the adductor muscles of the thigh. One of the greatest challenges is that there have been no well-designed, easy-to-follow pelvic muscle training programs…UNTIL NOW! The Private Gym Company was established after recognizing that there was an unmet need for a means by which a pelvic floor muscle-training program could be made accessible and available in the home setting. This comprehensive, interactive, follow-along exercise program is available on DVD…PrivateGym.com.

 

Myth: Kegels can adversely affect your sex life.

Truth: Absolutely not… In both genders, pelvic floor muscle training has been found to improve sexual function. The pelvic floor muscles play a critical role in both female and male sexuality, supporting clitoral and penile erections as well as ejaculation in males and orgasm in both genders.

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

“Urgasm”

March 22, 2014

Blog # 146  Andrew Siegel, MD

As I defined it in the urban dictionary, “urgasm” is when urine is ejaculated at the time of the male sexual climax.  

http://www.urbandictionary.com/define.php?term=urgasm&defid=7516472

The penis has a dual role as a urinary organ allowing “directed” urination that permits men to stand to urinate, and a sexual and reproductive organ that, when erect, allows the penis to penetrate the vagina and release semen. Although urinary and sexual functions are discrete and separate, their interplay is complex and treatment for prostate cancer with surgery or radiation can muddle the distinction.

Semen or seminal fluid is what comprises the ejaculate.  Less than 5% of the volume is actually sperm and the other 95+% is a cocktail of genital secretions that helps provide nourishment, support and chemical safekeeping for sperm cells. About 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid that has a lubrication function. The average ejaculate volume is 2-5 milliliters (one teaspoon is the equivalent of 5 milliliters).

“Climacturia” is the medical term for leakage of urine during orgasm, but I much prefer the term that I have coined, a combination of the words “urine” and “orgasm” into “urgasm.” What happens is that urine is “ejaculated” instead of semen. This is a not uncommon occurrence in men treated for prostate cancer with radical prostatectomy, which removes those organs largely responsible for semen production, the prostate and the seminal vesicles. It also can occur after radiation as a treatment for prostate cancer. Even though it is urine that is ejaculated and not semen, the sensation usually remains the same. Urine is generally sterile, so there is limited potential for spreading an infection to a partner.

Urinary incontinence (the inadvertent) leakage of urine, often associated with exertional activities, is commonly present in men complaining of urgasm. After radical prostatectomy, it is typically stress incontinence, leakage with exercise, coughing, bending over, sudden movements, etc. The presence of stress incontinence is a key risk factor for the occurrence of urgasm. However, some men have stress incontinence in the absence of urgasms and other men have urgasms in the absence of stress incontinence.

Urgasm can be quite distressing to the man who experiences it, as well as his partner, who might not appreciate the “golden shower.” Urinating immediately prior to engaging in sexual activity can be very helpful, it being imperative to empty the bladder as completely as possible. Pelvic floor exercises—aka Kegels—very helpful in the management of stress incontinence—may prove helpful in terms of improving urgasm.  Pelvic floor muscle contractions are the body’s natural mechanism to facilitate expelling the urethral contents. When contracted, the bulbocavernosus muscle (BC)—the body’s urethral “stripper”—compresses the deep, internal aspect of the urethra, displacing the urine within outwards. The 1909 Gray’s Anatomy refers to the BC muscle the “ejaculator urine.” Pelvic floor muscle training can foster a powerful BC muscle to help increase the capability to empty the urethra. If you are experiencing urgasm, vigorously contract the BC muscle several times after completing urination in order to empty the urethra. If necessary, this can be supplemented by manual compression and milking of the urethra in an effort to get every drop out before engaging in sexual intercourse.

Bottom LineEjaculation of urine is a not uncommon occurrence following treatment for prostate cancer, particularly removal of the prostate gland. It can be a vexing problem to the patient and partner, but can be improved with simple measures, focusing on gaining facility of the bulbocavernosus muscle, one of the important pelvic floor muscles.

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.

Trailer for new book: http://www.youtube.com/watch?v=1L9QgKzoG7E&list=UUjIg8sIxJ1AYGjOD0kAKPWQ

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

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

Sex and the Mediterranean Diet

February 1, 2014

Blog # 139

Sexuality is a very important part of our human existence, both for purposes of procreation as well as pleasure.  Although not a necessity for a healthy life, the loss or diminution of sexual function may result in loss of self-esteem, embarrassment, a sense of isolation and frustration, and even depression. Therefore, for many of us it is vital that we maintain our sexual health. Loss of sexual function further exacerbates progression of sexual dysfunction—the deficiency of genital blood flow that often causes sexual dysfunction produces a state of poor oxygen levels (hypoxia) in the genital tissues, which induces scarring (fibrosis) that further compounds the problem.  So “use it or lose it” is a very relevant statement when it comes to sexual function, as much as it relates to muscle function.

Healthy sexual function for a man involves a satisfactory libido (sex drive), the ability to obtain and maintain a rigid erection, and the ability to ejaculate and experience a climax. For a woman, sexual function involves a healthy libido and the ability to become aroused, lubricate adequately, to have sexual intercourse without pain or discomfort, and the ability to achieve an orgasm.   Sexual function is a very complex event contingent upon the intact functioning of a number of systems including the endocrine system (produces sex hormones), the central and peripheral nervous systems (provides the nerve control) and the vascular system (conducts the blood flow).

A healthy sexual response is largely about adequate blood flow to the genital and pelvic area, although hormonal, neurological, and psychological factors are also important.  The increase in the blood flow to the genitals from sexual stimulation is what is responsible for the erect penis in the male and the well-lubricated vagina and engorged clitoris in the female. Diminished blood flow—often on the basis of an accumulation of fatty deposits creating narrowing within the walls of blood vessels—is a finding associated with the aging. This diminution in blood flow to our organs will negatively affect the function of all of our systems, since every cell in our body is dependent upon the vascular system for delivery of oxygen and nutrients and removal of metabolic waste products.  Sexual dysfunction is often on the basis of decreased blood flow to the genitals from pelvic atherosclerosis, the accumulation of fatty deposits within the walls of the blood vessels that bring blood to the penis and vagina.

Sexual dysfunction may be a sign of cardiovascular disease. In other words, the quality of erections in a man and the quality of sexual response in a female can serve as a barometer of cardiovascular health. The presence of sexual dysfunction can be considered the equivalent of a genital stress test and may be indicative of a cardiovascular problem that warrants an evaluation for arterial disease elsewhere in the body (heart, brain, aorta, peripheral blood vessels).  The presence of sexual dysfunction is as much of a predictor of cardiovascular disease as is a strong family history of cardiac disease, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson has expanded the initials E.D. (Erectile Dysfunction) to mean Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries), Early Detection (of cardiovascular disease), and Early Death (if missed). The bottom line is that heart healthy is sexual healthy.

Many adults are beset with Civilization Syndrome, a cluster of health issues that have arisen as a direct result of our sedentary lifestyle and poor dietary choices.  Civilization Syndrome can lead to obesity, high blood pressure, and elevated cholesterol and can result in such health problems as diabetes, heart attack, stroke, cancer, and premature death.  The diabetic situation in our nation has become outrageous—20 million people have diabetes and more than 50 million are pre-diabetic, many of whom are unaware of their pre-diabetic state! It probably comes as no surprise that diabetes is one of the leading causes of sexual dysfunction in the United States.

Civilization Syndrome can cause a variety of health issues that result in sexual dysfunction.  Obesity (external fat) is associated with internal obesity and fatty matter clogging up the arteries of the body including the arteries which function to bring blood to the genitalia.  Additionally, obesity can have a negative effect on our sex hormone balance (the balance of testosterone and estrogens), further contributing to sexual dysfunction. High blood pressure will cause the heart to have to work harder to get the blood flowing through the increased resistance of the arteries. Blood pressure lowering medications will treat this, but as a result of the decreased pressure, there will be less forceful blood flow through the arteries.  Thus, blood pressure medications, although very helpful to prevent the negative effects of hypertension—heart attacks, strokes, etc.—will contribute to sexual dysfunction.  High cholesterol will cause fatty plaque buildup in our arteries, compromising blood flow and contributing to sexual dysfunction.  Tobacco constricts blood vessels and impairs blood flow through our arteries, including those to our genitals. Smoking is really not very sexy at all!  Stress causes a surge of adrenaline release from the adrenal glands. The effect of adrenaline is to constrict blood vessels and decrease sexual function.  In fact, men with priapism (a prolonged and painful erection) are often treated with penile injections of an adrenaline-like chemical.

A healthy lifestyle is of paramount importance towards the endpoint of achieving a health quality and quantity of life.  Intelligent lifestyle choices, including proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and stress reduction are the initial approach to treating many of the diseases that are brought on by poor lifestyle choices.  Sexual dysfunction is often in the category of a medical problem that is engendered by imprudent lifestyle choices.  It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices.  Simply by pursuing a healthy lifestyle, Civilization Syndrome can be prevented or ameliorated, and the myriad of medical problems that can ensue from Civilization Syndrome, including sexual dysfunction, can be mitigated.

In terms of maintaining good cardiovascular health (of which healthy sexual function can serve as a proxy), eating properly is incredibly important—obviously in conjunction with other smart lifestyle choices. Fueling up with the best and most wholesome choices available will help prevent the build up of fatty plaques within blood vessels that can lead to compromised blood flow. Poor nutritional decisions with a diet replete with fatty, nutritionally-empty choices such as fast food, puts one on the fast tract to clogged arteries that can make your sexual function as small as your belly is big!.

A classic healthy food lifestyle choice is the increasingly popular Mediterranean diet.  This diet, the traditional cooking style of the countries bordering the Mediterranean Sea including Spain, France, Greece, Cyprus, Turkey, Southern Italy, and nearby regions, has been popular for hundreds of years. The Mediterranean cuisine is very appealing to the senses and includes products that are largely plant-based, such as anti-oxidant rich fruits and vegetables, whole grains, nuts, seeds and legumes.  Legumes—including peas, beans, and lentils—are a wonderful source of non-animal protein.  Soybeans are high in protein, and contain a healthy type of fat.  Soy is available in many forms— edamame (fresh in the pod), soy nuts (roasted), tofu (bean curd), and soymilk. Fish and poultry are also mainstays of the Mediterranean diet, with limited use of red meats and dairy products.  The benefits of fish in the diet can be fully exploited by eating a good variety of fish.  Olive oil is by far the principal fat in this diet, replacing butter and margarine. The Mediterranean diet avoids processed foods, instead focuses on wholesome products, often produced locally, that are low in saturated fats and high in healthy unsaturated fats. The Mediterranean diet is high in the good fats (monounsaturated and polyunsaturated) which are present in such foods as olive, canola and safflower oils, avocados, nuts, fish, and legumes, and low in the bad fats (saturated fats and trans fats).  The Mediterranean style of eating provides an excellent source of fiber and anti-oxidants.  A moderate consumption of wine is permitted with meals.

Clearly, a healthy diet is an important component of a healthy lifestyle, the maintenance of which can help prevent the onset of many disease processes.  There are many healthy dietary choices, of which the Mediterranean diet is one.  A recent study reported in the International Journal of Impotence Research (Esposito, Ciobola, Giugliano et al) concluded that the Mediterranean diet improved sexual function in those with the Metabolic Syndrome, a cluster of findings including high blood pressure, elevated insulin levels, excessive body fat around the waist and abnormal cholesterol and triglyceride levels.  35 patients with sexual dysfunction were put on a Mediterranean diet and after two years blood test markers of endothelial function and inflammation significantly improved in the intervention group versus the control group. The intervention group had a significant decrease in glucose, insulin, low-density lipoprotein cholesterol (LDL—the “bad” cholesterol), triglycerides, and blood pressure, with a significant increase in high-density lipoprotein cholesterol (HDL—the “good” cholesterol).  14 men in the intervention group had glucose intolerance and 6 had diabetes at baseline, but by two years, the numbers were reduced to 8 and 3, respectively.

Why is the Mediterranean diet so good for our hearts and sexual health?  The Mediterranean diet is high in anti-oxidants—vitamins, minerals and enzymes that act as “scavengers” that can mitigate damage caused by reactive oxygen species.  Reactive oxygen species (also known as free radicals) are the by-products of our metabolism and also occur from oxidative damage from environmental toxins to which we are all exposed.  The oxidative stress theory hypothesizes that, over the course of many years, progressive oxidative damage occurs by the accumulation of the chemicals the accumulation of reactive oxygen species engender diseases, aging and, ultimately, death.  The most common anti-oxidants are Vitamins A, B-6, B-12, C, E, folic acid, lycopene and selenium.  Many plants contain anti-oxidants—they are concentrated in beans, fruits, vegetables, grain products and green tea.  Brightly colored fruits and vegetables are good clues as to the presence of high levels of anti-oxidants—berries, cantaloupe, cherries, grapes, mango, papaya, apricots, plums, pomegranates, tomatoes, pink grapefruit, watermelon, carrots, broccoli, spinach, kale, squash, etc.—are all loaded with anti-oxidants as well as fiber. A Mediterranean diet is also high in omega-3 fatty acids, a type of polyunsaturated fat present in oily fish including salmon, herring, and sardines.  Nuts—particularly walnuts—have high omega-3 fatty acid content.  Research has demonstrated that these “good” fats have numerous salutary effects, including decreasing triglyceride levels, slightly lowering blood pressure, and decreasing the growth rate of fatty plaque deposits in the walls of our arteries (atherosclerosis), thus reducing the risk of cardiovascular disease, stroke, and other medical problems. Mediterranean cooking almost exclusively uses olive oil, a rich source of monounsaturated fat, which can lower total cholesterol and LDL cholesterol while increasing HDL cholesterol. It is also a source of antioxidants including vitamin E.  People from the Mediterranean region generally drink a glass or two of red wine daily with meals. Red wine is a rich source of flavonoid phenols—a type of anti-oxidant—which protects against heart disease by increasing HDL cholesterol and preventing blood clotting, similar to the cardio-protective effect of aspirin.

The incorporation of a healthy and nutritious diet, such as the Mediterranean diet, is a cornerstone for maintaining good health in general, and vascular health, including sexual health, in particular.  The Mediterranean diet—my primary diet and one that I have incorporated quite naturally since it consists of the kinds of foods that I enjoy—is colorful, appealing to the senses, fresh, wholesome, and one that I endorse with great passion. Maintaining a Mediterranean dietary pattern has been correlated with less cardiovascular disease, cancer, and sexual dysfunction.  And it is very easy to follow.  It contains “good stuff”, tasty, filling, and healthy, with a great variety of food and preparation choices—plenty of colorful fresh fruit and vegetables, a variety of fish prepared in a healthy style, not fried or laden with heavy sauces, healthy fats including nuts and olive oil, limited intake of red meat, a delicious glass of red wine.  It’s really very simple and satisfying.  Of course the diet needs to be a part of a healthy lifestyle including exercise and avoidance of harmful and malignant habits including smoking, excessive alcohol, and stress.  So if you want a sexier style of eating, I strongly recommend that you incorporate the Mediterranean diet into your lifestyle.  Intelligent nutritional choices are a key component of physical fitness and physical fitness leads to sexual fitness.

Andrew Siegel, M.D.

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

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

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

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