Posts Tagged ‘pelvic floor conditioning’

6 Ways To Reduce Risk for Pelvic Problems: Urinary Leakage, Dropped Bladder & Sexual Issues

November 4, 2017

Andrew Siegel MD  11/4/17


Ease into this topic with a write-up by Melanie Hearse about altered vaginal anatomy after childbirth and what to do and not to do about it, from Australia: This woman has a warning about ‘fixing’ your downstairs after birth.

Our health culture in the USA is largely reactive as opposed to proactive.  Undoubtedly, a better model is prevention as opposed to intervention.  Attention to a few basic measures can make all the  difference in your pelvic health “destiny”:

  • Maintain a healthy lifestyle. Weight gain and obesity increase the occurrence of urinary control problems, dropped bladder, sexual, and other pelvic issues. Follow the advice of Michael Pollan: “Eat food. Not too much. Mostly plants.”  Consume a nutritionally-rich diet with abundant fruits and vegetables (full of anti-oxidants, vitamins, minerals and fiber) and real food, versus processed and refined food products.  A healthy diet (quality fuel) is essential for ongoing tissue repair, reconstruction and regeneration. Stay physically active, obtain sufficient sleep, manage stress as best as possible, avoid tobacco (an awful habit, with chronic cough contributing to pelvic floor issues) and consume alcohol moderately.  Physical activity should include aerobic (cardio), strength, flexibility and core training (yoga, Pilates, etc.), the latter of which is especially helpful in preventing pelvic issues since the pelvic floor muscles form the floor of the core. A recent Harvard Medical School health report entitled “Best exercises for your body” recommended swimming, Tai chi, strength training, walking and Kegel exercises.
  • Prepare before pregnancy. Pregnancy, labor and vaginal delivery are the most compelling risk factors for pelvic floor issues. Commit to healthy lifestyle measures and pelvic floor muscle training as detailed above even before considering pregnancy in order to prevent/minimize the onset of pelvic issues that commonly follow pregnancy and childbirth.  The following article, written by Corynne Cirilli for Refinery 29 on October 6, addresses this issue in detail and is well worth reading: Why Aren’t We Talking About Pre-Baby Bodies?
  • Pelvic floor muscle training. Kegel exercises to increase pelvic muscle strength and endurance are vital to prevent pelvic floor issues. The Kegel Fix is a paperback book that guides you how to do Kegel contractions properly, provides specific training programs for each pelvic issue and teaches you how to put this skill set into practical use—Kegels “on demand.”
  • Avoid constipation and other forms of chronic increased abdominal pressure. Chronic constipation (bowel “labor”) can be as damaging to the pelvic floor as vaginal deliveries. Coughing, sneezing, heavy lifting (particularly weight training) and high impact sports all increase abdominal pressures, so take measures to suppress coughing, treat allergies to minimize sneezing and not overdo weight training and high-impact sports.
  • Consider vaginal estrogen therapy. After menopause, topical estrogen can nourish and nurture the vaginal and pelvic tissues that are adversely affected by the cessation of estrogen production. Low dose topical therapy can be effective with minimal systemic absorption, providing benefits while avoiding systemic side effects.
  • Get checked! Be proactive by periodically seeing your physician for a pelvic exam. It is best to diagnose a problem in its earliest presentation and manage it before it becomes a greater issue.

Bottom Line: Prepare and prevent rather than repair and prevent!

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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


These books are written for educated and discerning individuals who care about health, well-being, fitness and nutrition and enjoy feeling strong and confident.




30 Interesting Kegel Facts

November 8, 2014

Kegel Facts

Andrew Siegel MD (11/8/14)



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

Wishing you the best of health,

2014-04-23 20:16:29


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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Private Gym: – now available on Amazon

Kegel Exercises: GET WITH THE PROGRAM!

October 11, 2014

Andrew Siegel, M.D.

The problem with most D.I.Y. (Do It Yourself) pelvic floor exercise regimens is the same issue with any activity done without proper guidance—compliance—sticking with the plan and seeing it through long enough to reap meaningful results. In order to D.I.Y., you need some real sitzfleisch (my new favorite word)—literally “sit on your flesh”—staying power and perseverance. And if your program ain’t working, your sitzfleisch is going to rapidly peter out.

One of the greatest challenges is that there have been no well-designed, easy-to-follow pelvic muscle training programs. Being handed a pamphlet suggesting a several-month program of 10 Kegel muscle contractions squeezing against no resistance three times daily during down times—for example while stopped at a red light in your car—simply does not pass muster! These inadequate programs lack guidance, training, direction and the feedback to confirm the engagement of the proper muscles. It is not surprising that if you undertake one of these ineffective pelvic floor muscle exercise regimens, you will more than likely ultimately abandon them.

The bottom line is that you will be unlikely to commit to an ineffective regimen, and any regimen will be ineffective unless it is a well-designed program that adheres to the tenets promoted by Arnold Kegel, the namesake of pelvic floor muscle training. Kegel’s principles that are imperative to adhere to are the following: muscle education, biofeedback, progressive intensity and resistance.

Muscle education is an understanding of your pelvic floor muscle anatomy and function and precisely where in your body that these muscles are located. This will permit you to develop muscle memory—the development of the nerve pathway from your brain to your pelvic floor muscles, a.k.a. neuromuscular education in medical lingo.

Feedback is a means of confirming to you that the proper muscles are being exercised, important since studies have shown that over 70% of women who think they are doing pelvic floor muscle exercises properly are actually squeezing other muscles, typically the rectus (abs), gluteal (butt) and adductor (thigh) muscles. With respect to the male gender, most men have not a clue as to where their pelvic floor muscles are, but also what their pelvic floor muscles do, how to exercise them, and what benefits they confer. In fact, many men don’t even know that they have pelvic floor muscles.

Progressive intensity is an escalation of the exercise magnitude and degree of difficulty over time. In a graduated fashion, you increase repetition number, intensity of contraction and duration of contraction. This progression is the key to increasing your pelvic floor muscle strength and endurance. Additionally, it allows you to measure and monitor you progress by witnessing your increased capabilities over time.

Resistance adds a new dimension that further challenges the growth of your pelvic floor muscles. Working your pelvic muscles against resistance rapidly escalates their strength and endurance, since muscle growth occurs in direct proportion to the demands and resistances placed upon them, a basic principle of muscle physiology.

Dr. Kegel recognized that the process of pelvic floor muscle strengthening advances in phases starting with awareness of the pelvic muscles and slowly and progressively proceeding to muscle regeneration and ultimately restoration.

As a physician, I see many female patients who have tried Kegel exercises and report that they did not help the problem they were trying to improve. However, on examining them and testing the strength and integrity of their pelvic floor muscles, they are often found to be contracting the wrong muscles! On questioning them on their regimen they often relate that their gynecologist had at some time given them a single page handout detailing how to perform Kegel exercises.

NO, NO, NO!…this simply will not do. One needs to GET WITH THE PROGRAM and receive the proper training to make these exercises meaningful and purposeful. The vast majority of those who try Kegels do not use a program that provides the precise wherewithal to isolate and exercise the pelvic floor muscles in a progressively more challenging fashion. It’s the equivalent of giving someone a set of weights and expecting them to pursue a weight training regimen without giving them the exercise routine and supervision to go along with the hardware, dooming them to failure!

For pelvic floor muscle strengthening to be effective, it is critical to use a well-crafted, progressive instructional routine with the ultimate incorporation of a resistance device. This is now available for men with the release of the Private Gym ( for men, and the program for women is in the works.  Do it right or don’t do it… In order to do it right, you need to get with the program!


Wishing you the best of health,

2014-04-23 20:16:29

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Private Gym:


New Paradigm: Preventive Kegel Exercises (Pelvic Floor Muscle Training)

October 4, 2014

Andrew Siegel, M.D.

“To guard is better than to heal, the shield is nobler than the spear!”  Oliver Wendell Holmes

“Honor your pelvic floor–it has done a whole lot for you over the years.”

Restoration of the function of injured muscles is well established in the fields of sports medicine, orthopedics, plastic surgery and physical medicine and rehabilitation. A traumatized or injured muscle is treated with early active rehabilitation and muscle training to accelerate tissue healing and restore it back to working order.

Dr. Arnold Kegel popularized the application of this principle to the female pelvic floor muscles to improve muscle integrity and function in women after childbirth. Obstetrical trauma (9 months of pregnancy, labor and delivery of a 9 lb. baby out the vagina) can cause pelvic floor dysfunction. Pelvic floor dysfunction can cause incontinence (urinary and bowel control issues), pelvic relaxation (laxity of the vagina and its support tissues with descent of the pelvic organs including the bladder, uterus and rectum) and altered sexual function.

Likewise, this principle has been effectively applied to men with compromised pelvic floor muscle integrity and function in order to improve urinary, bowel, erectile, and ejaculatory health. Obviously, men do not suffer with the acute pelvic floor muscle trauma of childbirth that women do, but they can develop pelvic floor muscle dysfunction on the basis of aging, weight gain, a sedentary lifestyle, disuse atrophy, etc.

Don’t Allow Function to Become Dysfunction

Why not take a radically different approach and try to prevent pelvic floor dysfunction instead of fixing it? If you pardon the clichés, although “a stitch in time saves nine,” isn’t a better approach “an ounce of prevention is worth a pound of cure?”. Obstacles to implementing this paradigm are our very reactive and repair-oriented medical culture that does a poor job of being proactive and promoting prevention and our patient population that often prefers fixing things that go awry as opposed to making the effort to prevent them from occurring in the first place. The concept of promoting wellness as opposed to treating diseases is one that resonates powerfully with me.

So, if obstetrical trauma to the pelvic floor often brings on pelvic floor muscle dysfunction and its urinary, gynecological and sexual consequences, why not start pelvic floor muscle training well before pregnancy? And if aging and other factors contribute to male pelvic floor muscle dysfunction and its urinary, bowel and sexual consequences, why wait for the system to malfunction? Why not bolster and strengthen the pelvic floor muscles when one is young, hale and hearty to prevent the age-related decline that is so often predictable? Many of us do apply preventive and proactive means to our health through regular exercise—aerobic for cardiovascular health and strength training to maintain muscle tone, integrity and function.

Whether male or female, the new paradigm is preventive pelvic health. The goal is to preclude, delay, or mitigate the decline in pelvic function that accompanies aging and that is accelerated by pelvic muscle trauma and injury, obesity and disuse atrophy.

Maintaining healthy sexual functioning is important because it contributes to masculine and feminine identity and behavior and has an impact that extends way beyond the sexual domain, permeating positively into many areas of life. Sexual dysfunction—at least to some extent—will eventually surface in most of us and the prospect of this is unsettling.

So, why passively accept the seemingly inevitable, when one can be proactive instead of reactive and can address the future problem before it becomes a current problem? Why wait until function becomes dysfunction? This is a commonly practiced approach for general physical fitness. We work out in the gym not only to achieve better fitness, but also to maintain fitness and prevent age-related losses in strength, flexibility, endurance, etc.

In this spirit, I encourage men and women who are enjoying excellent sexual and urinary health to maintain their pelvic health via preventive PFMT. This preemptive strategy is an opportunity for those who are healthy-functioning to continue enjoying their healthy functioning and prevent, delay and/or mitigate the age-related changes as best as they can.

Bottom Line: You have the ability to affect your own health destiny. Don’t be reactive and wait for your pelvic health to go south. Be proactive to ensure your continuing sexual, urinary and bowel health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive PFMT program into your exercise regimen—it’s like a vaccine to prevent a disease that you hopefully will never get. As the saying goes: “Prepare and prevent, not repair and repent.”

Wishing you the best of health,

2014-04-23 20:16:29

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

Note: As Arnold Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so I am working towards the goal of popularizing pelvic floor muscle exercises in males. This year I published a review article in the Gold Journal of Urology entitled Pelvic Floor Muscle Training in Men: Practical Applications to disseminate the importance and applications of these exercises to my urology colleagues. I wrote Male Pelvic Fitness: Optimizing Sexual and Urinary Health, a book intended to educate the non-medical population. I, along with my partner David Mandell and our superb pelvic floor team, co-created the Private Gym male pelvic floor exercise DVD and resistance program.

For more info on the book:

For more info on the Private Gym:


Kegel and the Game “Telephone”

September 27, 2014

Andrew Siegel, M.D.

When I was in junior high school (yes, junior high…no such thing as middle school back in those dark ages!) we had parties and played silly games such as “spin the bottle” and “telephone.” In both games a group of us would sit in a circle, and with respect to the more sedate “telephone,” the first person would whisper a few sentences into the ear of the person sitting next to him or her. That person would repeat it to the next person, and so on around the circle. The last person would announce the message they heard. The message that the final person announced was virtually always very different and distorted from the original message, usually in a very funny way. My point is that the final “product” bore little, if any, relationship to the original, with each step in the communication process resulting in increasing adulteration.

And so it is with the exercise program that gynecologist Arnold Kegel popularized 65 years ago, with which the game “telephone” has seemingly been played. What is being bandied about now as Kegel exercises bears little to no resemblance of what Arnold Kegel described so brilliantly in his series of medical articles. As a consequence of this adulteration, current Kegels are often ineffective Kegels. Arnold Kegel died in 1981; if he were alive today to see the distortion and misinterpretation of his legacy, I am certain he would be unpleased.

I have carefully studied all of the medical journal articles that Arnold Kegel crafted in the late 1940s. In these scientific works, he explained his program of pelvic floor exercise that he used successfully on thousands of his female patients. I will happily provide PDF copies of Kegel’s articles to any reader interested in the classic, original, unadulterated works. I have distilled Kegel’s message to the following four principles:

  1. Muscle education with the development of the nerve pathway from brain to pelvic floor muscles.
  2. Feedback to confirm to the exerciser that the proper muscles are being used.
  3. Resistance that challenges the exerciser.
  4. Progressive intensity against resistance so that the exerciser can measure and monitor progress over time as pelvic floor muscle strength increases.

So, in accordance with the seminal work of Arnold Kegel, pelvic floor exercises should incorporate muscle education, biofeedback, resistance, and progressive intensity. Kegel recognized four phases of the process of pelvic floor muscle strengthening: “awareness, transitional, regeneration, and restoration.”

Now here is the problem—if you Google search “Kegel exercises” you will get over one million results, but virtually every exercise “program” that you read about—even those publicized by esteemed medical institutions—are knockoffs and meager dilutions of the rigorous resistive pelvic floor exercise regimen advocated by Arnold Kegel. These current programs require very little time, limited physical effort and most often lack in using the benefit of resistance.

Your search will often uncover a printable pamphlet suggesting a several month program of 10 contractions squeezing against no resistance to be done three times daily while stopped at a red light when driving your car or at other down times. What these current programs share in common is that guidance, training and direction are inadequate with programs lacking the feedback to confirm the engagement of the proper muscles. It is of no surprise that many who undertake these ineffective, bastardized pelvic floor muscle exercises ultimately abandon them as they fail to help the situation at hand. The recommendation of doing these exercises while multitasking is a recipe for certain failure. Properly executed pelvic floor exercises—like physical therapy—demands attention, focus and gravitas.

Exercise physiology has taught us that when it comes to muscle training, doing lots of sets with low resistance develops tone and definition, whereas doing fewer sets with maximum resistance builds strength and bulk. The same physiology can be applied to the hidden pelvic floor muscles. A successful exercise program mandates intensity to be successful as muscle adaptation will not occur unless the muscle is subjected to sufficient stresses and resistance.

Kegel devised the “perineometer,” a resistance device that enabled women to work out their pelvic floor muscles against the force of resistance. This device gave visual biofeedback regarding the engagement of the proper muscles and the actual strength of those muscles and allowed women to witness the gradual increase in the strength of their pelvic floor muscles. In terms of intensity, Kegel’s recommendation was “twenty minutes of exercise three times daily, with a total of at least 20-40 hours of progressive resistance exercises spread over 20-60 days, keeping records of maximum contractions each exercise period.” This is a far cry from any of the current programs that you will come across! Additionally, most exercise programs do not utilize a tool that parallels the essential role played by Kegel’s perineometer.

So many of the mainstream programs out there do not hold muster and are terribly ineffective. There is an enormous demand for effective pelvic floor muscle training programs, and the number of people who could potentially benefit from an effective program that adheres to the successful foundational principles laid down by Arnold Kegel is huge. So what to do?

And thus was born the concept of the Private Gym pelvic floor training program, developed through the collaborative efforts of an international team of experts including myself. The Private Gym’s Basic Training program strengthens the pelvic floor muscles with a series of progressive male Kegel exercises without resistance. The Resistance Program uses resistance equipment to maximize pelvic floor muscle strengthening. This program completely adheres to the foundational principles of Arnold Kegel, and then some. The Private Gym program incorporates muscle education, biofeedback, progressive intensity, and resistance. The new dimension added is progressive resistance, so that as pelvic floor muscle strength increases, the trainee can increase resistance accordingly. In other words, as your pelvic muscles get stronger, they can be challenged with increasing resistance. With Kegel’s perineometer, women worked out against the same resistance and over time were able to generate stronger contractions, but with the Private Gym resistance device, you not only develop strength by making progress against resistance, but ultimately increase the resistance in order to optimize the strength of the pelvic floor muscles.



And don’t worry ladies, our Private Gym for women program is in the works.

Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel, M.D.

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”:

Note: As Arnold Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so I am working towards the goal of popularizing pelvic floor muscle exercises in males. This year I published a review article in the Gold Journal of Urology entitled Pelvic Floor Muscle Training in Men: Practical Applications to disseminate the importance and applications of these exercises to my urology colleagues. I wrote Male Pelvic Fitness: Optimizing Sexual and Urinary Health, a book intended to educate the non-medical population. Finally and most importantly, I, along with my partner David Mandell and our superb pelvic floor team, co-created the Private Gym male pelvic floor exercise DVD and resistance program.

For more info on the book:

For more info on the Private Gym:




















Exercise Your Penis…REALLY?

September 2, 2014

Andrew Siegel M.D.   Blog # 170


Your penis is an organ that wears many hats. It directs your urinary stream with sometimes laser-like precision (although this precision goes to pot as you age); when erect it allows for vaginal penetration; and at the time of climax, it permits passage of sperm to reproduce the species. Pretty remarkable in terms of its multi-functionality and handiness, similar to a Swiss Army knife, but really so much better! In terms of sexuality and fertility, the ability to achieve an erection is a must, and this is predicated on an adequate penile blood flow, which is the “rocket fuel” of penile erections.

Your ability to obtain penile rigidity is a matter of hydraulics—maximizing inflow of blood while minimizing outflow. I need to get a bit medical to explain this: Your penis contains 3 erection chambers that fill with blood. They are composed of sinuses, virtually identical to our nasal sinuses, and an erection occurs when the sinuses become congested with blood. Blood inflow is caused by smooth muscle relaxation in the penile arteries and in the sinuses. As the sinuses fill up, they compress the penile veins to block the outflow of blood. And hence you have a tumescent penis, plump, but not yet rigid.

So how do you go from plump to rigid? The pelvic floor muscles are the key players in the transformation from a tumescent penis to a rigid penis. They compress the deep, inner part of your penis, creating rigidity by aiding closure of veins and by elevating the blood pressure within your penis so that it is well above systolic blood pressure. An erect penis is a hypertensive penis (really a very good thing), and it is this tremendous pressure that causes bone-like rigidity. If this penile blood pressure at the time of a rigid erection were experienced in the arteries of your body, it would be considered a hypertensive crisis! So, the only organ in the body in which high blood pressure is not only healthy, but also desirable, is your penis.

With aging, the smooth muscle of all of our arteries tends to become stiffer and less able to relax, resulting in high blood pressure (a very bad thing) for many of us. The penis is not spared, as the smooth muscle of the penile arteries and sinuses stiffens and is less able to relax. Unfortunately, stiff smooth muscle in the penis does not lead to a stiff penis…in fact, quite the opposite. Additionally, our pelvic floor muscles weaken with age, like many of our skeletal muscles. Between the smooth muscle stiffening and the weakened pelvic floor muscles, we have the perfect storm for ED.

Where are your pelvic floor muscles? They are located between the scrotal sac and the anus, the saddle region where your body is in contact with a bicycle seat. In the 1940s, gynecologist Dr. Arnold Kegel popularized pelvic floor muscle exercises (“Kegels”) in women to improve their sexual and urinary health. Men have similar pelvic floor muscles and an equivalent capacity for exercising them, with parallel benefits to sexual and urinary health. It’s high time that we demand equal pelvic rights!

Male pelvic floor muscle exercises date back to ancient times, having been described in ancient Greece and Rome by Hippocrates and Galen respectively. Performed in the baths and gymnasiums, these exercises were thought to promote general and sexual health, spirituality and longevity.

Most men are unfamiliar with pelvic floor muscles exercises, let alone with their pelvic floor muscles. Unfortunately, many physicians are not very knowledgeable regarding the pelvic floor and the benefits of fitness in this area, and do not see themselves as instructors of pelvic floor muscle training. Regrettably, our medical culture—heavy on prescription writing and surgery—does not typically promote lifestyle improvement and exercise programs such as pelvic floor training. I would like to explain to you why such exercises are well worth your time and effort.

There is exercise and then there is EXERCISE; for example, there is walking (moving is good) and then there is running with interval training (a great workout). When it comes to exercising your skeletal muscles, using resistance training—working against an opposing force—stresses your muscles to enhance strength, tone, power, durability and responsiveness. By gradually and progressively overloading the muscles working against the resistance, they will adapt by getting bigger and stronger. Imagine repetitively doing arm curls without weights as compared to doing curls with weights, in which case the added resistance will rapidly and effectively create muscle growth and accelerated strength.

Kegels 101 involves repetitions of pelvic floor contractions without resistance. How do you accelerate to Kegels 401—pelvic floor muscles with resistance? Dr. Kegel designed a resistance device for women called a “perineometer” that was inserted into the vagina to provide a means of squeezing against something and a way to measure the strength of the squeeze. Men don’t have a vagina, but they do have a rectum, and one way to do resistance training is to use a perineometer placed in the rectum. Not a very appetizing thought though, is it?

Remember that your pelvic floor muscles engage when you have an erection. When you contract these muscles, your penis magically lifts up towards the heavens with each contraction. Since the pelvic floor muscles govern this upward deflection, they can be challenged to lift up more than just the weight of your penis.

And thus was born the concept of the Private Gym resistance workout for men. Whereas the Private Gym’s Basic Training program strengthens the pelvic floor muscles with a series of progressive male Kegel exercises without resistance.


The Resistance Program uses resistance equipment to maximize pelvic floor muscle strengthening. The equipment consists of an ergonomic weighted base and magnetic weights that attach to the base. It is placed on your erect penis, which is raised up and down by contracting the pelvic floor muscles in accordance with the follow-along DVD program, subjecting the pelvic floor muscles to resistance. Your muscles will gradually and progressively adapt to the load placed upon them and will strengthen in accordance with the resistance



When one first hears about progressive resistance training for the penis, their reflex reaction is often: Are you kidding? Really? Seriously? REALLY? Weights for the penis? You must be joking! No way. When Dr. Arnold Kegel in the late 1940’s first proposed his concept of the perineometer that gets placed in the vagina in order to do progressive resistance exercises, he likely received many similar responses from both his patients as well as his medical colleagues. What, shove that up my vagina and squeeze? And this was the 1940’s, decades before the sexual revolution!

If one can discard their conservative prejudices and carefully consider the principle of resistance training for skeletal muscle adaptation, they will realize that resistance training for the pelvic muscles is no different than resistance training for any other skeletal muscle, a bona fide means of creating strength and endurance. Resistance training is a “boner-fide” (sorry—I couldn’t help myself) means of maximizing your pelvic floor muscle growth.

In terms of resistance training of the penis, the Private Gym clearly is superior and more user friendly and less invasive than using a rectal resistance device, with the limitation that it can only be used in those men who can obtain a sufficiently rigid erection, whether naturally, or with the help of pills such as Viagra, Levitra, Cialis and Stendra.

The Private Gym Company was established after recognizing that there was an unmet need for a means by which a pelvic floor muscle-conditioning program could be made accessible and available in the home setting. The premise behind the Private Gym is to help achieve pelvic floor fitness and optimize sexual and urinary health.

Adaptation of skeletal muscle is an accepted scientific precept and if you have ever had your arm or leg in a cast, you can understand the detrimental effect of disuse on muscle tone and strength. The corollary is that if you have ever done weight training, you understand the beneficial effect of resistance training on muscle tone and strength.

Elston Howard was a New York Yankee who invented the batting “donut,” a circular lead weight that slides onto baseball bats and is used by on-deck batters. This added weight during practice swings makes the bat feel very light once it comes time to step up to the plate and remove the weight. Howard employed the resistance principle to heighten power—use the weighted bat in practice and when it comes time to step up to the plate, you’re going to perform better. This principle will work on your “bat,” too—utilize resistance training in practice and when it comes time to “step up to the plate,” you’re going to perform better. The Private Gym resistance turns conditioning into a weapon that is capable of producing “outstanding” erections, maximizing stamina, and tremendously boosting one’s confidence.

Bottom Line: Resistance training is utilized for creating strength and endurance for every group of skeletal muscles in the body, and the pelvic floor muscles should be no exception. The pelvic floor muscles are skeletal muscles and, just like the biceps and pectorals, they will adapt in a positive way to the resistance (load) placed upon them.


Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel, M.D.

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”:

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10 Things You Can Do To Prevent a Limp Penis

August 19, 2014

Andrew Siegel MD Blog # 168

It’s great to have a penis…so handy, convenient and multifunctional! As many an older man will attest to, even when erections become mere memories, the penis will still allow you to stand up to urinate—an absolute joy—and a distinct competitive advantage over the female gender. To borrow from a cartoon by an artist named Collins, “Men have elevated peeing to an art form best expressed perhaps on a snowy landscape, a wall or a steam grate. Superior pressure control and the multidirectional penis make the men the masters of urination. Women on the other hand with their small bladders and clumsy apparatus find it very difficult to pee without creating a frightful mess…no precision accuracy here.” As fabulous as it is having a “spigot” for controlled urination, it is even better when you can maintain “penis magic” to old age and observe the transformative process by which the limp penis alters its shape, size and constitution in nanoseconds, rising in defiance of gravity to majestic rigidity.

Our ability to perform physically—in any domain—declines as we get age, explaining why most professional athletes are in their twenties or thirties. In terms of sexual function, when you were young you could achieve a rock-hard erection simply by seeing an attractive woman or thinking a sexual thought. As the years go by, erotic thoughts or sights are no longer enough, as you need direct touch and stimulation. Your sexual interest can skid and your erections may become softer and less durable with less intense orgasms and meager, dribbling-quality ejaculation. When you were young, you could get a second erection with a short recovery time (refractory period) but as you get older, refractory period may be days in length.

What to do? Should you be reactive and wait for your sex life to go south or should you take measures to ensure your continuing sexual health? Why not take a proactive approach? “An ounce of prevention is worth a pound of cure” rings very true for nearly all health issues, and so it does when it comes to sexual function.

  1. Maintain a Healthy Weight If you are overweight, you are more likely to have fatty plaque deposits, which clog up your blood vessels, including the artery to the penis. Abdominal fat converts your male hormone testosterone to the female hormone estrogen, literally emasculating you and causing development of man boobs.  Obesity steals away your manhood, male athletic form and body composition, mojo, strength, and one of your most precious resources—the ability to obtain and maintain a good-quality erection.
  1. Eat Healthy Fueling with nutritionally wholesome and natural foods will help you prevent the build-up of harmful plaque deposits within your blood vessels that compromises blood flow to the penis. Poor dietary choices with meals that are calorie-laden, nutritionally-empty selections (e.g., fast, processed, or refined foods) puts you on the fast tract to clogged arteries that can make your sexual function as small as your belly is big.
  1. Minimize Stress Stress causes the release of the hormones adrenaline and cortisol. Adrenaline narrows blood vessels, which has a negative effect on erections. If you ever have experienced performance anxiety it was because of adrenaline release in response to nervousness. Excessive cortisol secretion, which helps drives your appetite, causes the accumulation of the bad belly fat (as opposed to fat under the skin).


  1. Eliminate Tobacco Tobacco narrows your blood vessels, impairs blood flow, decreases the supply of oxygen, and also promotes inflammation, compromising every organ in your body.
  1. Alcohol in Moderation In small amounts, alcohol can alleviate anxiety and act as a vasodilator (increasing blood flow) and can actually improve erectile function, but in large amounts it can be a major risk factor for erectile dysfunction. Everything in moderation!


  1. Sleep Well Sleeping has a vitally important restorative function as your brain and body requires this important down time. During sleep, there is an increased rate of tissue growth and synthesis, and a decreased rate of tissue breakdown. Sleep deprivation causes a disruption in endocrine, metabolic, and immune function, resulting in decreased levels of leptin (your appetite suppressant), increased ghrelin levels (your appetite stimulant), increased cortisol, and increased glucose levels (higher amounts of sugar in the bloodstream). If you are exhausted, your penis is going to be weary as well.


  1. Exercise Exercise can have an amazingly positive effect on your sexual function through stress busting, mood improvement, fatigue reduction, increase of energy and better quality sleep. Long term it will reduce your risk for diabetes, heart disease, stroke, high blood pressure, some cancers, osteoporosis, chronic medical problems, and physical disability. Let’s not forget improvement in muscular strength and tone, reduction of body fat and help with weight control. Exercise makes your heart a better and stronger pump, your blood vessels more elastic, and your muscles better able at using oxygen. Exercises that work out the muscles involved in sex—the core muscles, the external rotators of the hip, and the all-important pelvic floor muscles—will improve your performance.B e careful with saddle sports like cycling and horseback riding, which may contribute to sexual dysfunction, particularly for those who spend prolonged time the saddle. This can cause compression damage to that very valuable human real estate located between your scrotum and anus that contains the nerves, blood vessels, and muscles that are vital to your sexual health. 


  1. Pelvic Floor Muscle Exercises The pelvic floor muscles play a vital role with respect to both erections and ejaculation. When you are sexually stimulated, the pelvic floor muscles activate and engage to help maintain penile rigidity and a skyward angling erection. These muscles are not only responsible for getting the stimulated penis from a tumescent state (plump with blood) to a state of bone-like rigidity, but also for maintaining that rigid state and for being the “motor” of ejaculation. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) in the management of erectile dysfunction. The Private Gym is a comprehensive, interactive, follow-along exercise program that helps men strengthen the pelvic floor muscles that support sexual health.It is the first line of defense against the onset of erectile dysfunction and can assist in reversing its occurrence. It is a safe, easy-to-use, natural, medically sanctioned and FDA registered means of targeting and strengthening the all-important pelvic floor muscles.


  1. Use It (or Lose It) Keep your penis fit by using it regularly for the purpose it was designed for—in other words, stay sexually active! Scientific studies have clearly demonstrated that men who are more sexually active tend to have fewer problems with erectile dysfunction as they age.
  2. Maintain a Healthy Relationship It takes two to tango, so relationship harmony factors strongly into good sexual functioning just as discord and interpersonal issues can profoundly contribute to ED. The mind-body connection is of immense importance to sexual function and the “big head” is equally important to the “little head.”

Bottom Line: The “Golden Rule of the Penis”: Treat your penis kindly (in terms of a healthy lifestyle) and it will return the favor; treat your penis poorly and it will rebel. The proactive approach will keep you functioning smoothly for many years, and hopefully will keep you out of my office for erection issues, although please don’t forget to get your prostate and PSA (Prostate Specific Antigen) checked!


Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel, M.D.

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

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

Private Gym website for pelvic floor instructional DVD and resistance training equipment:

Pilates and Male Pelvic Fitness: Part 2

April 12, 2014


Blog #149

Pilates is a discipline that has a strong foundation in core strength and pelvic floor conditioning. This blog is the second part of an interview of Catherine Byron, Pilates trainer and owner of CB Performance Pilates ( This material is excerpted from my forthcoming book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health. (now available in ebook format on Amazon; soon to be available on iBooks, Nook, and paperback)

Dr. Siegel: Can you elaborate on the mind-body connection?

Catherine Byron: Integrating “awareness” and the “mind-body” connection are key components to reaching your potential. The art of being in the moment, of involving the intellect with movement is the key to reaching one’s goals. Often, we are not living in the moment but are simply going through the motions, a condition known as “mindlessness.” Pilates is rooted in “mindfulness”—staying alert and aware in the present moment. Not only does Pilates educate a person about his anatomy, but also how to use it more efficiently.

Dr. Siegel: But doesn’t too much thinking interfere with our ability to do a physical task in a natural and fluid fashion?

Catherine Byron: During the rehabilitative/reconditioning phase of training, mindfulness is key. Over time, these patterns become natural and intuitive and the need to “think” about it will diminish. Initial “heightened” focus is part of the overall process 

Dr. Siegel: In your opinion, what constitutes fitness in general and pelvic fitness in specific?

Catherine Byron: Being physically fit has its roots in the foundations of stability, flexibility, strength and aerobic conditioning. Pilates adds spinal alignment, muscle balance and core strength. Throughout your book, you have emphasized the importance of blood flow to the pelvis, linking it to cardiovascular and penile health and function. Cardiovascular fitness is a foundational pillar of good health and should be a lifestyle habit that is incorporated into one’s existence. In terms of pelvic fitness, a simple formula is improve blood flow, improve function.

Dr. Siegel: What differences have you observed in working with men vs. women?

Catherine Byron: One of the main differences between men and women is range of motion. Most males do not have the degree of joint flexibility as do females, particularly around the hip region. Movement is directly related to this range of motion or flexibility. The more flexible a person is, the more they can “articulate,” meaning move the body with greater detail. For example, think of a ballerina in terms of how she moves. She has the ability to move her ribs and hips with petite, incremental articulations and singular, ratcheted movements as opposed to the chunky, massive movements of many men. The good news is that through stretching and Pilates, men can greatly improve their range of motion and muscle function and begin to perform pelvic movements with greater articulation. The resulting improved range of motion ultimately translates into awareness and improved control of your core, pelvic floor and all-importantorgan, the penis.

Dr. Siegel: How will your 10-step Pilates program improve male pelvic health?

Catherine Byron: The Pilates exercises will develop the deep stabilizers of the spine and improve pelvic movement. These muscle groups work to “hold” or “stabilize” the hips and spine in place. They greatly contribute to the strength and endurance requirements of pelvic movements. There are two types of muscles—movers and stabilizers. For example, your biceps muscle allows you to move your arm but does not work to stabilize any part of your body. Stabilizer muscles are located throughout the body and, in essence, hold you together so that you don’t collapse. In terms of pelvic fitness, Pilates focuses on the pelvic stabilizers. The pelvic floor muscles lift, support and stabilize our pelvic organs. Without the pelvic stabilizer muscles, we would all be wearing diapers. Unfortunately, over time, these lose elasticity and tend to collapse to some extent, which is why strengthening them is so vital.

Dr. Siegel: How does pelvic stabilization help sexual function?

Catherine Byron: Pelvic stabilization builds endurance of the pelvic floor muscles and surrounding core region. This directly equates to improved function, stamina and the length of time that the pelvic muscles can contract before they fatigue. An improved pelvic floor coupled with active pelvic floor muscle contractions will enhance sexual function by allowing a man greater control over his erections.

Dr. Siegel: What about breathing?

Catherine Byron: Breathing is literally the “lifeline” of the entire body. Inhalation brings a surge of oxygen to every cell of the body, fueling and providing energy. Exhalation is a necessary release not only of waste gases but also of physical tension. Holding one’s breath or a lack of coordinated and full breathing diminishes this fuel connection and can result in tense and rigid movements. Breathing is part of that mind-body connection and can help to maximize the integration of body, mind and spirit.

Dr. Siegel: What is the relationship between stability and flexibility?

Catherine Byron: Stability and flexibility can be likened to a tree’s roots and branches. The roots represent stability and the branches, flexibility. If either function is in greater measure than the other, an imbalance occurs. Pilates creates a body that is stable and flexible in equal measure. Over-development or under-development of one or both of these can lead to injury and dysfunction. Pilates exercises produce both length (flexibility) and strength in the muscles, creating a harmonious balance.

Dr. Siegel: What is a Pilates ring?

Catherine Byron: The Pilates ring, also called a Pilates “circle,” is a device used to activate the inner and outer muscles of the pelvis and pelvic floor. The ring is excellent at directly targeting and allowing one to develop the core muscles addressed in this book. For this reason, the 10-step program will require one. The ring is positioned inside or outside the hips, activating hard-to-reach stabilizers required for spinal, urinary and sexual health. Using this device will ignite the “hidden” muscle groups, rarely targeted in traditional gym style exercises.

In addition to strengthening the pelvic stabilizers, the 10-step program involves movement patterns so that muscle development will occur not only statically, but also dynamically during motion. While using the ring, movement in several planes of motion will function to develop the pelvic region in a balanced fashion. Creating balance in this region results in greater performance. Strengthening the front, back and sides of the hips is of vital importance because all are connected. Mastering movement withstabilization is our primary goal in order to enhance core strength and pelvic floor function to the maximum!

Dr. Siegel: What does Pilates offer men if they already know how to exercise their pelvic floor muscles including the bulbocavernosus, ischiocavernosus, and pubococcygeus muscles?

Catherine Byron: The 10-step Pilates exercises will maximize the strength and endurance of the pelvic floor muscles. This program will target and ignite the pelvic floor and will allow one to work the pelvic floor more deeply, effectively and efficiently.

Dr. Siegel: How is the 10-step exercise program geared towards men?

Catherine Byron: To reiterate, one of the main differences between men and women is the way in which they move. Women move with greater and more focused detail. It is easier for a woman to move her pelvis and tilt it one vertebra at a time as compared to a man whose pelvis is typically “thicker” and moves more in “chunks.” In addition, men tend to choose sports, exercises and hobbies that further exacerbate this bulky, heavy movement style. The result is a serious restriction of motion that can lead to diminished performance and potential injury.  For the 10-step program, along with step-by-step photos of the technique, please refer to Dr. Siegel’s book.


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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and now available in e-book on Amazon:

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

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Pilates and Male Pelvic Fitness

April 5, 2014


Blog #148

Pilates is a discipline that has a strong foundation in core strength and pelvic floor conditioning. This blog is an interview of Catherine Byron, Pilates trainer and owner of CB Performance Pilates ( This material is excerpted from my forthcoming book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health.

Dr. Siegel: What is Pilates?

Catherine Byron: Pilates is a system of exercises designed to strengthen the core. Pilates pays particular attention to spinal alignment and muscle balance. There are many ways to strengthen the core, but what makes Pilates exercises unique are the movement patterns through the spine, specifically articulating one vertebra at a time. As a result, the exercises are not only done with fine control and detail but also serve to strengthen the body evenly: they work both the front and back sides of the spine and, most importantly, include the pelvic floor. A regular gym approach to the core often targets the superficial (outer) muscles of the core while Pilates will target the spinal stabilizers (deepest layer), which attach to the vertebrae of the spine. In Pilates, a great deal of emphasis is placed on a person’s alignment, posture, and movement patterns.

Dr. Siegel: In your opinion, what constitutes the core?

Catherine Byron: The core is the trunk of the body—cut off the arms, legs, and head and what you have left is the core. The “foundation” or “primary core” is the area around the hips—the lumbar pelvic region.

Dr. Siegel: What does Pilates have to do with the male pelvic floor?

Catherine Byron: Pilates activates the pelvic floor muscles and the surrounding muscles that provide additional support for male pelvic function. In order to maximally benefit this area, the muscles have to be treated as a “team.” Similar to developing a sports team, you would never concentrate on only one player. Instead, you would focus on building the entire team. In much the same way with the human body, you never isolate and train individual muscles. If you can think of the complexity of the pelvic floor as a hammock that comes together to lift, you are going to engage that hammock and build up the endurance of the pelvic floor muscles. With Pilates, this area of the body is a specific target and, of course, because the nether parts are so intimately connected, this area is improved as well.

Dr. Siegel: Are Pilates exercises meaningful for male pelvic health?

Catherine Byron: As a certified trainer, fitness advocate, and owner of a Pilates studio, I can attest that no other core strengthening system compares with the conditioning program established by Joseph Pilates. For the very specific needs of the musculo-skeletal system of the male pelvis, these exercises are not merely a direct hit or even a home run, but a grand slam!

Dr. Siegel: Is Pilates good for sex?

Catherine Byron: I don’t think there is any other form of exercise that so directly targets the muscles used in sex. Pilates strengthens the exact muscles that are discussed in this book. During sex, there is a lot of pelvic movement. Moving the hips back and forth repeatedly requires more stamina than strength. Pilates-style exercises develop those muscles that function to stabilize and hold, the ones that provide endurance. Sex demands staying power of the backside of the pelvis, that is, the lower back region. In many exercise routines, there is way too much emphasis on the abdominals, developing the front side of the pelvis—the muscles that assist in the “pushing forward” phase. But the truth is, the more vital requirement is for the endurance of the lower back muscles that assist in the “pulling back” phase. It is the pulling back—the winding up so to speak—that is key to enable pushing forward. Also, muscle balance is an important prerequisite to proper movement and function. Balanced training of the entire pelvic region—the front, back, outside and inside—are essential for improved sexual performance. The 10-step program laid out at the end of this chapter will largely target these muscle groups.

Dr. Siegel: What are the key principles of Pilates?

Catherine Byron: Pilates principles are based on spinal alignment, muscle balance and core strength. Pilates emphasizes spinal alignment—properly positioning one’s hips, ribs, shoulders and head in their anatomically neutral positions. Pilates is a mind-body exercise—all movements are executed with control and strongly linked to breath. Pilates will develop a balanced body, meaning all muscle groups, on all sides of the body, are evenly developed. Core strength is stressed and the deep stabilizers of the spine are focused upon. Practicing these exercises will improve balance, stability, strength, and enhance flexibility through detailed articulation of all movements.

Dr. Siegel: As a Pilates instructor, what is your take on the human body?

Catherine Byron: As a fitness professional, I have 25 years of experience in observing the musculo-skeletal system of the human body in both its static (still) and functional (motion) states. I have always marveled at the human body and its well-conceived design. Nothing is happenstance as every bone, muscle, organ and system is perfectly engineered to harmonize with its counterparts. When this harmonious balance is disrupted, the body “speaks” by producing symptoms. It is through the understanding of these “symptoms” that we gain insight into not only our bodies but also ourselves.

Dr. Siegel: What symptoms occur when there is lack of balance or harmony?

Catherine Byron: Usually a stress point occurs, causing inflammatory conditions. Pain is a “shout out” by the body for attention. Many of the disorders described in this book can easily arise when the pelvic floor muscles and surrounding core area are not holding or functioning properly. When there is a lack of balance to the system or any kind of disruption occurs, “dis-ease” occurs.

Dr. Siegel: So how do we strive to achieve this balance?

Catherine Byron: Finding balance in our lives can be just as great a challenge as creating it in our bodies. The art of doing so comes with great discernment and requires the courage to be honest with ourselves as we determine what areas are in our power to change and what areas are not. It’s that age-old adage: we must accept what we cannot change and change what we can. You have clearly delineated the importance of recognizing what it is that we cannot change about our anatomy. Learning to accept what nature has given us is the first step towards the achievement of harmony with respect to our bodies and ourselves. The second step is identifying what changes can be made in order to improve one’s pelvic fitness as well as overall health and lifestyle.

Dr. Siegel: What can we change and what can’t we change?

Catherine Byron: You cannot change genetics. Your size, strength and even your flexibility to some degree are all dictated by hereditary factors. However, the specifics of your anatomy and how to properly use it can be taught and developed. By working with a professional trainer you can learn to retrain movement and function. My goal is to address those areas that can be changed through a 10-step Pilates-based program. The exercises are specially designed to empower you by improving pelvic health, strength and stability

Dr. Siegel: Before getting into the specifics of Pilates exercises, can you say a few words on general health and wellness?

Catherine Byron: Attitude and personal philosophy have a profound influence on our health. Before discussing the Pilates exercise program, there must first be a consideration of two major areas, lifestyle and mind-body connection. As a foundation for improving one’s health, it is imperative to be aware of our lifestyle habits. These include diet, exercise, sleep, stress management, attitude, etc. As you have acknowledged, it is important that diet and lifestyle be recognized as key players. When a physical disorder is traced back to its root cause, much of the time lifestyle and diet are implicated. In the quest towards health and fitness, introspection about one’s diet and lifestyle is a monumental step in the process of change and progress. If you want to improve, you must first be aware. Self-awareness is a fundamental prerequisite to self-improvement. Developing and refining the mind-body connection can be transformational and is capable of boosting an amateur athlete towards far greater levels if he has the right attitude and is willing to put in the time and effort.

To be continued next week.


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

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

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

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)

For more info on Dr. Siegel: