Posts Tagged ‘pelvic floor exercises’

Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know

January 6, 2018

Andrew Siegel MD  1/6/2017

Happy New Year!  At this time, many of us are trying to execute New Year’s resolutions.  Topping the list of most resolutions is getting into good physical shape.  A vital piece of this is pelvic floor fitness; in fact, pelvic floor muscle training was among the top five exercises recommended for general health and fitness in a recent Harvard Medical School report.

The next series of blog entries, written for both men and women, will enable you to achieve pelvic floor fitness.  Remember, Kegels are not just for the ladies!  This first entry discusses the fast and slow twitch muscle fibers that determine pelvic floor muscle (PFM) function, the adaptation principle and the distinction between strength, power and stability.  

Image below: Male PFM (left) and female PFM (right); notice their similarity.

1116_Muscle_of_the_PerineumAttribution: URL:  Version 8.25 from the Textbook, OpenStax Anatomy and Physiology, 
Published May 18, 2016

Muscles 101

Muscles provide shape to our bodies and allow for movement, stability and maintenance of posture.  Most skeletal muscles come in pairs and cross bony joints—when one group contracts, it causes bending of that joint and when the opposing group contracts, it causes straightening of that joint (e.g., biceps/triceps).  When each contract equally, the joint is in a neutral position. The human body has three types of muscles—skeletal muscles that provide mobility and stability, smooth muscles that line the arteries, bladder, intestine, etc., and the unique cardiac muscle of the heart.  Muscles are composed of fibers that contract (shorten and tighten) and relax (lengthen and loosen).

The PFM are skeletal muscles that are comprised of fast twitch and slow twitch muscle fibers. Fast twitch fibers predominate in high contractile muscles that fatigue rapidly and are used for fast-paced muscle action, e.g., sprinting.  Slow twitch fibers predominate in endurance muscles, e.g., marathon running. The PFM have a constant tone (low level of involuntary contraction) because of the presence of slow twitch fibers. The fast twitch fibers allow for voluntary contraction. The PFM fibers are 70% slow twitch, fatigue-resistant, endurance muscles to maintain constant muscle tone (e.g., sphincter function and pelvic support) and 30% fast twitch, capable of rapid and powerful contractions (e.g., sexual climax, interrupting the urinary stream and tightening the anus).

Fact:  Aging causes a decline in the function of the fast twitch fibers, but tends to spare the slow twitch fibers.   

Muscle mass is in a dynamic state, a constant balance between growth and breakdown. With aging, muscle fiber wasting occurs as muscle breakdown exceeds muscle growth, adversely affecting function. Strength training reduces muscle wasting by increasing muscle bulk through enlargement of muscle fibers. This is true of all skeletal muscles, the PFM being no exception.

Adaptation Principle

Muscles are remarkably responsive to the stresses placed upon them.  Muscle growth only occurs in the presence of progressive overload, which causes compensatory structural and functional changes, a.k.a. adaptation. This explains why exercises get progressively easier in proportion to the effort put into doing them.  As muscles adapt to the stresses placed upon them, a “new normal” level of fitness is achieved.  Another term for adaptation is plasticity. Skeletal muscles are “plastic,” capable of growth or shrinkage depending on the environment to which they are exposed.

The PFM behave similarly to other skeletal muscles in terms of their response to exercise or lack thereof.  In accordance with the adaptation principle, it is advisable to increase number of repetitions and contraction intensity to build muscle PFM strength, power and endurance.  As much as our muscles adapt positively to resistance, so they will adapt to the absence of stress and resistance, resulting in smaller, weaker and less durable muscles.

Fact: Use It or Lose It. With a conditioning regimen, the PFM will thrive, optimizing their function.  When the PFM are neglected, they will weaken, impairing their function.   

Strength, Power and Stability

The goal of PFM training is to maximize the trio of PFM strength, power and stability. Strength is the maximum amount of force that a muscle can exert. With time and effort, PFM contractions become more robust, helping sexual function and improving one’s ability to neutralize stress urinary incontinence, overactive bladder and pelvic organ prolapse in females.  In males, command of one’s pelvic floor muscles can improve sexual, urinary and prostate health.  Power is a gauge of strength and speed (muscle force multiplied by the contraction speed), a measure of how rapidly strength can be expressed, of great benefit to sexual health and the ability to react rapidly to urinary/bowel urgency and stress urinary incontinence. Stability helps maintain vaginal tone, urinary and bowel sphincter function and pelvic organ support as well as contributing to the “backboard” that helps prevent stress urinary incontinence.

To be continued… Next week’s entry provides information on the process of building muscle PFM memory and how to develop PFM awareness.

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 men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx





5 Kegel Exercise Mistakes You Are Probably Making

October 21, 2017

Andrew Siegel MD 10/21/17

Do it right or don't do it

I have always been fond of this sentiment, the words of which were immortalized for me on a coffee mug courtesy of then 10-year-old Jeff Siegel (my son).  This statement holds true for everything in life, including pelvic floor exercises. 

Dr. Arnold Kegel (1894-1981), a gynecologist who taught at USC School of Medicine,  popularized pelvic floor muscle exercises to improve the sexual and urinary health of women following childbirth. His legacy is the pelvic exercise that bears his name—Kegels.

“Do your Kegels” is common advice from many a gynecologist (and from well-intentioned friends and family), particularly after a difficult childbirth has caused problems “down there.”  These pelvic issues include urinary leakage, drooping bladder, and stretching of the vagina such that things look and feel different and sex is just not the same.

“Do your Kegels” is sensible advice since this strengthens the pelvic floor muscles that support the pelvic organs, contribute to urinary and bowel control, and are intimately involved with sexual function. Developing strong and durable pelvic floor muscles is capable of improving, if not curing, these pelvic issues. Unfortunately, mastery of the pelvic floor is not as easy as it sounds because these muscles are internal and hidden and most often used subconsciously (unlike the external glamour muscles that are external and visible and used consciously).  

  The Kegel problem is threefold:

  1. Many women do not know how to do a proper Kegel contraction.
  2. Of those that can do a proper Kegel contraction, most do not pursue a Kegel exercise training program.
  3. Even those women who do know how to do a proper Kegel contraction and pursue a Kegel exercise training program are rarely, if ever, taught the most important aspect of pelvic muscle proficiency: how to put the Kegels to practical use in real-life situations  (“Kegels-on-demand”).

If a Kegel pelvic floor contraction is done incorrectly, not only will the pelvic issue not be helped, but actually could made worse. Only doing pelvic muscle contractions without pursuing a well-designed pelvic floor muscle training program is often an invitation to failure. Finally, if “Kegels-on-demand” to improve pelvic issues are not taught, it is virtually pointless to learn a proper contraction and complete a program, since the ultimate goal is the integration of Kegels into one’s daily life to improve quality. 

How does one do a proper Kegel pelvic contraction?  Simply stated, a Kegel is an isolated contraction of the pelvic floor muscles that draw in and lift the perineum (the region between vagina and anus). The feeling should be of this anatomical sector moving “up” and “in.”

5 Common Kegel Exercise Mistakes

Mistake # 1: Holding Your Breath

Breathe normally.  The Kegel muscles are the floor of the core group of muscles, a barrel of central muscles that consist of the diaphragm on top, the pelvic floor on the bottom, the abds in front and on the sides, and the spinal muscles in the back. Holding your breath pushes the diaphragm muscle down and increases intra-abdominal pressure, which pushes the pelvic floor muscles down, just the opposite direction you want them moving.

Mistake # 2: Contracting the Wrong Muscles

When I ask patients to squeeze their pelvic floor muscles during a pelvic exam, they often contract the wrong muscles, usually the abdominals, buttocks or thigh muscles. Tightening up the glutes is not a Kegel!  Others squeeze their legs together, contracting their thigh muscles.  Still others lift their butts in the air, a yoga and Pilates position called “bridge.” The worst mistake is straining and pushing down as if moving one’s bowels, just the opposite of a Kegel which should cause an inward and upward lift.

Fact: I have found that even health care personnel—those “in the know,” including physical therapists, personal trainers and nurses—have difficulty becoming adept at doing Kegels. 

Sadly, there is a device on the market (see below) called the “Kegel Pelvic Muscle Thigh Exerciser,” a Y-shaped plastic device that fits between your inner thighs such that when you squeeze your thighs together, the gadget squeezes closed. This exerciser has NOTHING to do with pelvic floor muscles (as it strengthens the adductor muscles of the thigh), serving only to reinforce doing the wrong exercise and it is shameful that the manufacturer mentions the terms “Kegel” and “pelvic muscle” in the description of this product.


Learning to master one’s pelvic floor muscles requires an education on the details and specifics of the pelvic floor muscles, learning the proper techniques of conditioning them and finally, the practical application of the exercises to one’s specific issues.

Mistake # 3: Not Using a Kegel Program

Kegel exercises can potentially address many different pelvic problems—pelvic organ prolapse, sexual issues, stress urinary incontinence, overactive bladder/bowel, and pelvic pain due to excessive pelvic muscle tension.  Each of these issues has unique pelvic floor muscle shortcomings.  Doing casual pelvic exercises does not compare to a program, which is a home-based, progressive, strength, power and endurance training regimen that is designed, tailored and customized for the specific pelvic floor problem at hand. Only by engaging in such a program will one be enabled to master pelvic fitness and optimize pelvic support and sexual, urinary and bowel function.

Mistake # 4: Impatience

Transformation does not occur overnight!  Like other exercise programs, Kegels are a “slow fix.”  In our instant gratification world, many are not motivated or enthused about slow fixes and the investment of time and effort required of an exercise program, which lacks the sizzle and quick fix of pharmaceuticals or surgery. Realistically, it can take 6 weeks or more before you notice improvement, and after you do notice improvement, a “maintenance” Kegel training regimen needs to be continued (use it or lose it!)

Mistake # 5: Not Training for Function (“Kegels-on-Demand”)

Sadly, most women who pursue pelvic training do not understand how to put their newfound knowledge and skills to real life use. The ultimate goal of Kegels is achieving functional pelvic fitness, applying one’s pelvic proficiency to daily tasks and common everyday activities so as to improve one’s quality of life.  It is vital, of course, to begin with static and isolated, “out of context” exercises, but eventually one needs to learn to integrate the exercises on an on-demand basis (putting them in to “context”) so as to improve leakage, bladder and pelvic organ descent, sexual function, etc.

Bottom Line: Kegel pelvic floor muscle exercises are a vastly under-exploited and misunderstood resource, despite great potential benefits of conditioning these small muscles.  In addition to improving a variety of pelvic issues (urinary and bowel leakage, sexual issues, dropped bladder, etc.), a strong and fit pelvic floor helps one prepare for pregnancy, childbirth, aging and high impact sports.  The Kegel Fix book is a wonderful resource that teaches the reader how to do proper Kegels, provides specific programs for each unique pelvic issue, and reveals the specifics of “Kegels-on-demand,” how to put one’s fit pelvic floor and contraction proficiency to practical use in the real world.

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 men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.



Kegels: One Size Does Not Fit All!

October 7, 2017

Andrew Siegel MD   10/7/17


Athletes use a variety of fitness and strength-training programs to maximize their strength and endurance. A one-size-fits-all approach—the same exercise regimen applied to all—is clearly not advantageous because of the varying functional requirements for different sports.  Specific, targeted and individualized exercise programs are used to enhance and optimize performance, depending upon the particular sport and individual athlete. The ultimate goal of training is “functional fitness,” the achievement of strength, power, stamina and the skill set to improve performance and prevent specific functional impairments (injuries).

Pelvic floor dysfunction is a broad term applied to the scenario when the pelvic muscles and connective tissues are no longer functioning optimally.  This gives rise to pelvic issues including pelvic organ prolapse, urinary and bowel incontinence, sexual dysfunction and pelvic pain syndromes.  A one-size-fits-all Kegel pelvic floor muscle exercise approach has traditionally been used to manage all forms of pelvic floor dysfunctions. For many years, patients who were thought to be able to benefit from Kegels were handed a brochure with instructions to do 10 repetitions of a 10-second Kegel contraction followed by 10 rapid contractions, three times daily.

Are their shortcomings with this one-size-fits-all approach?  Clearly, the answer is yes. A one-size-fits-all approach lacks the nuance necessary to properly tackle the different types of pelvic floor dysfunction. Aligning the pelvic floor dysfunction with the appropriately tailored training program that focuses on improving the area of weakness is vitally important, since each pelvic floor dysfunction is associated with unique and specific deficits in pelvic muscle strength, power and/or endurance. One size does not fit all!

After decades of “stagnancy” following the 1940s transformative work of Dr. Arnold Kegel—the physician who was singularly responsible for popularizing pelvic floor exercises in women after childbirth–there has been a resurgence of interest in pelvic floor training. I am humbled and honored to have contributed to this “pelvic renaissance” with the publication of the short paperback book The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health, which introduces home-based, progressive, tailored exercises consisting of strength, power and endurance pelvic training regimens customized for each specific pelvic floor problem.

The initial goal of pelvic floor muscle training is muscle adaptation, the process by which pelvic muscle growth occurs in response to the demands placed it, with adaptive changes occurring in proportion to the effort put into the exercises. More challenging exercises are needed over time in order to continue the growth process that occurs as “new normal” levels of pelvic fitness are established. This translates into slowly and gradually increasing contraction intensity, duration of contractions, number of repetitions and number of sets.  The “plasticity” of the pelvic muscles require continued training, at minimum a “maintenance” program after completion of a course of pelvic training.

Although the short-term goal of pelvic floor muscle training is adaptation, the long-term goal is the achievement of functional pelvic fitness.  The vast majority of women who are taught Kegel exercises are not instructed how to put them into practical use. Go figure!  This concept of functional pelvic fitness is the actionable means of applying pelvic conditioning to daily tasks and real-life common activities. This is the essence of Kegel pelvic floor training—not simply to condition the pelvic floor muscles, but to apply this conditioning and proficiency in such a way and at the appropriate times so as to improve quality of one’s life.   These Kegels-on-demand—as I refer to them—can be lifesavers and quite a different take on Kegels, as opposed to static, isolated, out of context exercises.

Important Nuances and Details of Pelvic Training

Contraction intensity: This is the extent that the pelvic muscles are squeezed, ranging from a weak flicker of the muscles to a robust and vigorous contraction. High intensity contractions build muscle strength, whereas less intensive, but more sustained contractions, build endurance.

Contraction Type: Pelvic contractions vary in duration. It is relatively easy to intensively contract the pelvic muscles for a brief period, but difficult to maintain that intensity for a longer duration contraction. Snaps are rapid, high intensity pulses that take less than one second per cycle of contracting and relaxing. Shorts are slower, less intense squeezes that can last anywhere from two to five seconds. Sustained are less intense squeezes that last ten seconds or longer.

Relaxation duration: The amount of time the pelvic muscles are unclenched between contractions.

Repetitions: The number of contractions performed in a single set.

Set: A unit of exercise.

Strength: The maximum amount of force that a pelvic muscle can exert.

Power: The ability to rapidly achieve a full intensity contraction, which is a measure of contraction strength and speed–in other words, how quickly strength can be expressed.  Power is fostered by rapidly and explosively contracting the pelvic muscles.

Endurance (stamina): This is the ability to sustain a pelvic contraction for a prolonged time and the ability to perform multiple contractions before fatigue sets in.

Range of motion: The cycle of full pelvic contraction (muscle shortening) to complete relaxation (muscle lengthening).  This is vital in pelvic muscle training because the goal is not only to increase strength, power and endurance, but also flexibility, which is accomplished by bringing the muscle through the full range of motion.

Bottom Line:  A one-size-fits-all Kegel pelvic floor exercise program does not suit all women with pelvic floor dysfunction. To obtain optimal results, pelvic training must be tailored to the specific dysfunction. The achievement of functional pelvic fitness is one of the key goals (“key-goals”… get it?) of Kegel exercises and of the Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.  Finally, it is important to know that pelvic exercises are appropriate not only for women suffering with the aforementioned pelvic floor dysfunctions, but also for those who wish to maintain healthy pelvic functioning and prevent future problems.

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”:

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 dire need of bridging.

For informative information on pelvic floor muscle training, please consult the following books by the author:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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


The Kegel Fix is written for educated and discerning women who care about health, well-being, fitness, nutrition and enjoy feeling confident, sexy and strong.  The book has separate chapters on each of the pelvic floor dysfunctions and provides a specific, targeted pelvic floor training regimen for each.


Kegels Go Hollywood: From Ben Wa Balls To The Elvie Pelvic Trainer

February 26, 2017

Andrew Siegel MD  2/26/17

I do not ordinarily compose more than one blog entry per week, but Kegels Go Hollywood presented itself and is worthy of a timely discussion.

Photo below by Ivan Bandura [CC BY 2.0 (, via Wikimedia Commonsoscars_for_sale_6952722855

And the Oscar goes to….


Arnold Kegel MD (Gladser Studio, 1953)

“Fifty Shades of Grey” and “Fifty Shades of Darker” are not my cup of tea, although I confess to having read the first book to see what all the fuss was about.  According to The New Yorker reviewer Anthony Lane, the current “Fifty Shades of Darker” movie is lacking in thrills, “unless you count the nicely polished performance from a pair of love balls.” The movie popularizes the use of Ben Wa Balls, which apparently spend most of their time settled deeply in the vagina of female character Anastasia Steele (Dakota Johnson).


 Ben Wa Balls

Included in the swag bag of high-end gifts at tonight’s Oscars is a pelvic floor training device called the “Elvie.” Manufactured in the UK, Elvie is a sophisticated wearable, egg-shaped, waterproof, flexible device inserted vaginally. Pelvic floor muscle contraction strength is measured and sent via Bluetooth to a companion mobile app on a smartphone that provides biofeedback to track progress. Five-minute workouts are designed to lift and tone the pelvic floor muscles. The app includes a game designed to keep users engaged by trying to bouncing a ball above a line by clenching their pelvic floor muscles. The carrying case also serves as a charging device. Cost is $199 (


Elvie Pelvic Training Device 

I have worked with the company that manufactures Elvie and recently wrote a blog for the Elvie website on the topic of “Myths about the pelvic floor.” To access, go to:

As a physician, urologist, author and pelvic floor muscle training advocate, I am quite pleased by the newfound awareness and popularity accorded pelvic floor muscle training, a highly beneficial means of improving/maintaining pelvic, sexual, urinary and bowel health–despite its popularization in Hollywood.

Benefits of Pelvic Floor Muscle Training

The vagina has its own set of intrinsic muscles (within its wall), which are further layered with the pelvic floor muscles (external to the vaginal wall). An intense pelvic floor muscle workout—albeit a pleasurable one made possible through devices like Ben Wa Balls or the Elvie—accords some real advantages to the participant. A stronger and better toned pelvic floor increases vaginal blood flow, lubrication, orgasm potential and intensity, the ability to clench the vagina as well as partner pleasure, overall increasing the potential for sexual gratification.  Of no less importance, a powerful pelvic floor also improves urinary and bowel control. Keeping the pelvic floor fit can prevent the onset of many sexual, urinary, bowel and other pelvic issues that may emerge with the aging process.

Love Balls 101

Motion-induced friction applied to the vaginal wall is one of the key factors leading to sexual pleasure.  Ben Wa Balls provide such friction and can be thought of as erotic toys as well as medical devices that are used to train the pelvic floor and vaginal muscles. When exercise can be made pleasurable—not unlike playing tennis as opposed to working out in the gym—it unquestionably provides significant advantages.

There are numerous variations in terms of Ben Wa ball size (usually one to two inches in diameter), weight, shape, composition and number of balls. Some are attached to a string, allowing tugging on the balls to add more resistance. Another type has a compressible elastic covering that can be contracted down upon. Still others vibrate. There are some upscale varieties that are carved into egg shapes from minerals such as jade and obsidian.

Ben Wall Balls are classified under the general heading of vaginal weights, devices that are placed in the vagina and require pelvic floor muscle engagement in order that they remain in position and not fall out when the user is upright, providing resistance to contract down upon.

Ben Wa balls are not unlike vaginal cones, which consist of a set of weights that are of identical shape but vary in their actual weight. Initially, one places a light cone in the vagina and stands up and walks about, allowing gravity to come into play. Pelvic floor contractions are required to prevent the cone from falling out. The intent is to retain the weighted cone for fifteen minutes twice daily to improve pelvic strength.  Gradual progression to heavier cones challenges the pelvic floor and vaginal muscles to improve strength and tone. Ben Wa balls can be thought of as sexy versions of the vaginal cones.

vaginal-conesVaginal Cones


Sophisticated Pelvic Training Devices Like Elvie

There are many pelvic resistance devices on the market—some basic and simple, like Ben Wa balls and vaginal cones—but many newer ones are a “high tech” and sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. More information will follow about these complex devices in future blog entries.

Bottom Line: Pelvic floor muscle training can be done with or without resistance devices like Ben Wa balls, vaginal cones, and the more sophisticated devices such as the Elvie.  The use of resistance devices adds a dimension beyond what is achievable by contracting one’s pelvic muscles without resistance (against air).  From a medical and exercise physiology perspective, muscles increase in strength in direct proportion to the demands placed upon them and resistance exercise is one of the most efficient ways to stimulate muscular and metabolic adaptation.

The slang term “pussy” is often used to connote “weak” and “ineffectual.”  Anastasia Steele’s “vagina of steel” fashioned by using Ben Wa Balls as a vaginal resistance device clearly shows that this does not have to be the case!

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”:

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  This book is written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.

The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback, all accessible via the following website: The e-book offers discretion, is less expensive, is delivered immediately, saves the trees, has adjustable fonts, as well as numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources. Enjoy!

6 Ways To Keep Your Vagina Youthful

January 14, 2017

Andrew Siegel  MD    1/14/2016


The vagina and vulva of a young healthy adult has a different appearance (as well as functional ability) than that of a female after menopause. After menopause—with its dramatic reduction in estrogen production—the female genital tissues no longer have the availability of the hormone that keeps the genital tissues vital.  Age-related changes of the vulva and vagina occur on the basis of the ravages of time and lack of estrogen-stimulation following menopause. The vagina becomes thinner, dryer, and less elastic with diminished length and width, lubrication potential and expansive ability.  This can give rise to symptoms including vaginal dryness, irritation, burning with urination and pain and bleeding with sexual intercourse. All in all this adds up to diminished quality of life.

Menopause is a significant risk factor for the occurrence of anatomical and functional changes that result from reduced levels of the female hormone estrogen. The vestibule (plate of tissue upon which open the vagina and urethra), vagina, urethra and base of the urinary bladder have abundant estrogen receptors that are no longer stimulated, resulting in diminished tissue elasticity and integrity. The labia become less robust, the vaginal opening retracts and the vaginal walls thin and lose the “tread”(rugae) that is typical of youth. The skin of the vulva becomes paler, thinner and more fragile. Because of this array of changes, the aging vagina can have difficulty lubricating and in accommodating a penis, resulting in painful sexual intercourse, a situation that affects more than two-thirds of post-menopausal women.

Often accompanying the physical changes of menopause are diminished sexual desire, arousal and ability to achieve orgasm. Pain, burning, itching and irritation of the vulva and vagina—particularly after sexual intercourse—are common. Urinary changes include burning with urination, frequency and urgency and recurrent urinary infections. Prior to menopause, healthy bacteria reside in the vagina. After menopause, this vaginal bacterial ecosystem changes, which can predispose one to urinary tract infections.

Considering that nature’s ultimate “purpose” of sex is for reproduction, perhaps it is not surprising that when the body is no longer capable of producing offspring, changes occur that affect the anatomy and function of the sexual apparatus.

The aging vagina was at one time referred to with disparaging terms including “atrophic vaginitis,” “vulvar and vaginal atrophy,” and “senile atrophy.” There are many such hurtful and cruel labels for female issues, including “frigid” for women who have difficulty in achieving sexual climax as opposed to the clinical term “anorgasmic.” A much kinder, although technical term for the aging vagina is “genitourinary syndrome of menopause” (GSM).

6 Ways To Keep Your Vagina Youthful:

  1. Stay Sexually Active Regular sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse. Vaginal penetration increases pelvic and vaginal blood flow, which optimizes lubrication and elasticity. Orgasms tone and strengthen the pelvic floor muscles that support vaginal function. “Use it or lose it” is the rule.  Be sure to use plenty of lubrication if vaginal dryness is an issue.
  1. Pelvic Floor Exercises   Pelvic floor muscles play a vital role with respect to sexual, urinary and bowel function as well as the support of the pelvic organs. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) to help maintain pelvic blood flow, sexual function, pelvic support and urinary/bowel control. The pelvic floor muscles play a vital role with respect to all aspects of sexual function, including arousal, lubrication, clitoral and vulvar engorgement and sexual climax.
  1. Consider Topical Estrogen Replacement   This is a means of achieving the advantages that estrogen provides to the genital issues using a cream formulation that is applied locally. There is minimal absorption and it therefore avoids the vast majority of adverse effects that can occur from oral hormone replacement therapy. A small dab of Premarin or Estrace cream placed in the vagina three or four nights per week prior to sleep can restore vaginal suppleness and increase tissue integrity. This will help improve lubrication, pain with intercourse, urinary control issues and can help prevent urinary infections.
  1. See Your Gynecologist   You bring your car in for annual preventive maintenance to a mechanic, so do the same for your lady parts.! Your gynecologist is on your team with a goal of keeping you and your vagina healthy. Gynecologists have some new tools at their disposal to combat GSM, including lasers that can be applied to the vestibule for purposes of skin resurfacing and restoration.
  1. Healthy Lifestyle   It is desirable to keep every cell and tissue in your body healthy via intelligent lifestyle choices. These include: smart eating habits; maintaining a healthy weight; engaging in exercise; obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction.
  1. Avoid Excessive Time In The Saddle Bicycle riding, as well as any other activity that places prolonged pressure on the “saddle” of the body (including motorcycle, moped, and horseback riding), are potential causes of impaired genital function. Although this is rarely a problem for the casual or recreational cyclist, it can be a real issue for women who spend many hours weekly in the saddle. When cycling, intense pressure is applied to the perineum (area between vulva and anus), the area of the body that can be considered to be “the heart” of the blood and nerve supply to the vagina and pelvic floor muscles.

Bottom Line: All things eventually get old, including vaginas and vulvas. We are not in control of the aging process and sooner or later Father Time reigns supreme. However, by adhering to some commonsense advice you can maintain vaginal youth and vitality for many years.

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”:

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

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


10 Ways To Maintain Sexual Fitness

December 31, 2016

Andrew Siegel MD  12/31/16


(Thank you, Pixabay, for image above)

It is fundamental to understand that your genitals are not separate and independent entities, but part and parcel of your body as a whole. If your health is compromised by illness or poor lifestyle, you should not expect your penis or vagina to function any better than rest of your body, but in parallel with your general health. If you are overweight, “malnourished” on the basis of a poor diet, do not challenge your body with regular exercise, use tobacco, consume too much alcohol, are over-stressed, sleep deprived, etc., your sexual function will likely suffer in concordance with your general health. The bottom line is that general health drives genital health and that healthy sexual functioning is an excellent marker of general health.


Sex is a healthy and natural part of life.  A healthy sexual relationship is an important part of an overall healthy relationship, “cementing” the bond between those in the relationship.

Whether male or female, the concept of “sexual fitness” has recently come into vogue. The idea is that sexual health is related to overall health and that optimal functioning in the bedroom can only be achieved with an  healthy state of mind and body and that the root cause of declining sexual performance is  when general health is compromised.

Blood flow is our lifeline and defines our existence. The key to life is the unimpeded flow and delivery of oxygen and nutrients to every cell and tissue in the body to maintain proper function.  Cardiovascular health is thus imperative for general and sexual health and when blood flow is jeopardized, both general health and sexual function will suffer.

Cardiovascular fitness is based upon maintaining a healthy weight, consuming a nutrient-rich diet (lean proteins, abundant fruit, vegetables, legumes and avoidance of nutrient-poor processed foods, excessive sugar and refined foods, etc.), daily activity and exercise (including aerobic, resistance, core and pelvic floor), avoiding excessive stress, getting sufficient sleep and avoidance of toxins including tobacco and excessive alcohol. Negative behaviors pursued on a chronic basis can sap one’s health and vitality that is critical to sexuality.

Our human ability to perform physically—in any domain—declines as we age, explaining why most professional athletes are in their twenties or thirties. Sexual function is no exception, with sexual response generally declining gradually over time, most often predicated upon impaired blood flow and altered function of the cells and tissues that comprise the genitals.

One option is to wait for your sex life to go south and then be “reactive,” incorporating healthy lifestyle measures in an effort to reverse the damage. A better approach is to be “proactive” with attention to the following ten recommendations.

10 Ways To Maintain Sexual Fitness

  1. Maintain a Healthy Weight  This will help prevent fatty deposits that clog up your blood vessels, including the arterial supply to the penis and vulva/vagina.
  1. Eat Healthy  The bottom line is that you want your body running on premium fuel. Nutritionally wholesome, natural foods will help prevent the build-up of harmful fatty deposits that compromise genital blood flow. Poor dietary choices with 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 sexual response. Excessive cortisol secretion drives appetite and causes the accumulation of the bad belly fat (as opposed to fat under the skin).
  1. Eliminate Tobacco Tobacco contains nicotine and a cocktail of toxins that impairs blood flow and decreases the supply of oxygen, as well as promotes inflammation, compromising every organ in your body, including those vital for sexual function.
  1. Alcohol in Moderation  In small amounts, alcohol can alleviate anxiety and act as a vasodilator (increasing blood flow), but in large amounts it can be a major risk factor for sexual dysfunction. Everything in moderation!
  1. Sleep Tight  Sleeping has a critical restorative function. During this important downtime there is an increased rate of tissue growth and a decreased rate of tissue breakdown, vital for maintaining the integrity of our cells and tissues. Sleep deprivation causes a disruption in endocrine, metabolic, and immune function, resulting in increased appetite, increased cortisol, and higher amounts of sugar in the bloodstream. If you are exhausted, your genitals will be equally weary.
  1. Exercise   Exercise has a robust effect on sexual function through stress busting, mood improvement, fatigue reduction, increase of energy and better quality sleep. It reduces risk of diabetes, heart disease, stroke, high blood pressure, some cancers, osteoporosis, chronic medical problems, and physical disability. It improves muscular strength and tone, reduces body fat and helps weight control. It makes your heart a better and stronger pump, your blood vessels more elastic, and your muscles better able to use 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 bedroom performance. 
  1. Pelvic Floor Muscle Exercises The pelvic floor muscles play a vital role with respect to all aspects of sexual function, from arousal to climax. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) in improving sexual function.
  1. Stay Sexually Active   Keep your genitals fit by using them on a regular basis for the purpose they were designed for. In other words, stay sexually active as nature intended! Sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse. Regular sexual activity increases pelvic and genital blood flow and optimizes tissue health and elasticity, while orgasms tone and strengthen the pelvic floor muscles“Disuse atrophy” is a condition when the genitals adapt to not being used, with tissue wasting, genital shrinkage and weakness of the pelvic floor muscles. Use it or lose it!
  2. Maintain a Healthy Relationship.  It takes two to tango, so relationship harmony plays strongly into healthy sexual functioning just as discord and interpersonal issues profoundly contribute to sexual dysfunction.

Note that sexual intercourse in and of itself is a great form of general exercise because of the kinetics involved and the demands on the cardiovascular system, core, pelvic floor and other skeletal muscles. Of the “10 ways to maintain sexual fitness,” staying sexually active covers 6 of them (maintaining a healthy relationship, staying sexually active, pelvic floor exercises, general exercise, sleeping tight and minimizing stress).

Bottom Line: The “Golden Rule”: Treat your genitals kindly (in terms of a healthy lifestyle) and the favor will be returned; treat your genitals poorly and they will rebel. The proactive approach will keep you functioning smoothly for many years. General health and fitness will foster sexual health and fitness, and staying sexually active is a vital means of maintaining general health and fitness.

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”:

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

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


The Little Muscles That Could: The Mysterious Muscles You Should Be Exercising

November 5, 2016

Andrew Siegel MD 11/5/2016

This entry was a feature article in the Fall 2016 edition of BC The Magazine: Health, Beauty & Fitness.

(A new blog is posted weekly. To receive the blogs via email go to the following link and click on “email subscription”:


Image above: female pelvic floor muscles, illustration by Ashley Halsey from The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health


Image above: male pelvic floor muscles, illustration by Christine Vecchione from Male Pelvic Fitness: Optimizing Sexual and Urinary Health

There are over 600 muscles in the human body and they all are there for good reasons. However, some are more critical to health and survival than others. In the class rank it is a no-brainer that the heart muscle is valedictorian, followed by the diaphragm. What may surprise you is that the pelvic floor muscles (a.k.a. Kegel muscles) rank in the top ten of the hierarchy.

The pelvic floor muscles are a muscular hammock that make up the floor of the “core” muscles. They are located in the nether regions and form the bottom of the pelvis. They are among the most versatile muscles in the body, equally essential in both women and men for the support of the pelvic organs, bladder and bowel control and sexual function. Because they are out of sight they are frequently out of mind and often not considered when it comes to exercise and fitness. However, without functional pelvic muscles, our pelvic organs would dangle and we would be diapered and asexual.

Our bodies are comprised of a variety of muscle types: There are the glamour, for show, mirror-appeal, overt, seen and be witnessed muscles that offer no secrets—“what you see is what you get”—the biceps, triceps, pectorals, latissimus, quadriceps, etc. Then there are muscles including the pelvic floor muscles that are shrouded in secrecy, hidden from view, concealed and covert, unseen and behind the scenes, unrecognized and misunderstood, favoring function over form, “go” rather than “show.” Most of us can probably point out our “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (pelvic floor muscles) are located? For that matter, who even knows what they are and how they contribute to pelvic health?

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, this “saddle” region of our bodies (the part in contact with a bicycle seat)—often fails to attain the respect and attention that other zones of our bodies command. Cloaking increases mystique, and so it is for these pelvic muscles, not only obscured by clothing, but also residing in that most curious of regions–an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the pelvic floor muscles, which straddle the gamut of being critical for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

The deep pelvic floor muscles span from the pubic bone in front to the tailbone in the back, and from pelvic sidewall to pelvic sidewall, between the “sit” bones. The superficial pelvic floor muscles are situated under the surface of the external genitals and anus. The pelvic floor muscles are stabilizers and compressors rather than movers (joint movement and locomotion), the more typical role that skeletal muscles such as these play. Stabilizers support the pelvic organs, keeping them in proper position. Compressors act as sphincters—enveloping the urinary, gynecological and intestinal tracts, opening and closing to provide valve-like control. The superficial pelvic floor muscles act to compress the deep roots of the genitals, trapping blood within these structures and preparing the male and female sexual organs for sexual intercourse; additionally, they contract rhythmically at the time of sexual climax. Although the pelvic floor muscles are not muscles of glamour, they are certainly muscles of “amour”!

Pelvic floor muscle “dysfunction” is a common condition referring to when the pelvic floor muscles are not functioning properly. It affects both women and men and can seriously impact the quality of one’s life. The condition can range from “low tone” to “high tone.” Low tone occurs when the pelvic muscles lack in strength and endurance and is often associated with stress urinary incontinence (urinary leakage with coughing, sneezing, laughing, exercising and other physical activities); pelvic organ prolapse (when one or more of the female pelvic organs falls into the space of the vagina and at times outside the vagina); and altered sexual function, e.g., erectile dysfunction or vaginal looseness.  High tone occurs when the pelvic floor muscles are over-tensioned and unable to relax, giving rise to a pain syndrome known as pelvic floor tension myalgia.

A first-line means of dealing with pelvic floor dysfunction is getting these muscles in tip-top shape. Tapping into and harnessing their energy can help optimize pelvic, sexual and urinary health in both genders. Like other skeletal muscles, the pelvic muscles are capable of making adaptive changes when targeted exercise is applied to them. Pelvic floor training involves gaining facility with both the contracting and the relaxing phases of pelvic muscle function. Their structure and function can be enhanced, resulting in broader, thicker and firmer muscles and the ability to generate a powerful contraction at will—necessary for pelvic wellbeing.

Pelvic floor muscle training can be effective in stabilizing, improving and even preventing issues with pelvic support, sexual function, and urinary and bowel control. Pursuing pelvic floor muscle training before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery; it will also allow for the effortless resumption of the exercises in the post-partum period in order to re-tone the vagina, as the exercises were learned under ideal circumstances, prior to childbirth. Similarly, engaging in pelvic training before prostate cancer surgery will facilitate the resumption of urinary control and sexual function after surgery. Based upon solid exercise science, pelvic floor muscle training can help maintain pelvic integrity and optimal function well into old age.

Bottom Line: Although concealed from view, the pelvic floor muscles are extremely important muscles that deserve serious respect. These muscles are responsible for powerful and vital functions that can be significantly improved/enhanced when intensified by training. It is never too late to begin pelvic floor muscle training exercises—so start now to optimize your pelvic, sexual, urinary, and bowel health.

Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel MD practices in Maywood, NJ. He is dual board-certified in urology and female pelvic medicine/reconstructive surgery and is Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and attending urologist at Hackensack University Medical Center. He is a Castle Connolly Top Doctor New York Metro area and Top Doctor New Jersey. He is the author ofTHE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health ( and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health ( He is co-creator of PelvicRx, an interactive, FDA-registered pelvic floor muscle-training program that empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance, this program helps improve sexual function and urinary function. In the works is the female PelvicRx pelvic floor muscle training for women. Visit: to obtain PelvicRx. Use promo code “UROLOGY10” at checkout for 10% discount.

How to Best Prepare For And Recover From Prostate Cancer Surgery: What You Need to Know

July 11, 2015

Andrew Siegel, MD  7/11/15

shutterstock_orange gu tract

Having your prostate removed is an effective means of curing prostate cancer. Unfortunately, because of the prostate’s “precarious” location – – at the crossroads of the urinary and genital tracts, connected to the bladder on one end, the urethra on the other, touching upon the rectum, and nestled behind the pubic bone in a well-protected nook of the body – – it’s removal has the potential for causing unwanted and undesirable side effects.

By strengthening the all-important pelvic floor muscles prior to and after surgery, patients can reduce the negative effects of the surgery with respect to urinary control and sexual function. 

Side Effects of Prostate Cancer Surgery

Trauma to nerves, blood vessels, and muscular tissue during surgery can compromise sexual function and urinary control. A small percentage of men will experience significant urinary incontinence, whereas most men will experience mild leakage initially, which will gradually improve over time. Many note a decline in their ability to obtain and maintain an erection after the surgery, particularly during the initial healing phase.

Additional sexual-related side effects that may occur include urinary leakage with foreplay and arousal; ejaculation of urine at the time of sexual climax; less intense orgasms and possibly pain with climax; a change in penile size with a decrease in length,  and girth; and possibly a penile deformity.

The Importance of Strengthening the Pelvic Floor Muscles

Numerous studies have shown the benefits of pelvic floor muscle training after prostate surgery in terms of a hastening the recovery of urinary control and significantly improving the severity of the incontinence.  Studies have also demonstrated the beneficial impact of such training on the recovery of erectile function with respect to how long the ED lasts and how severe it is.

Because of the potential urinary and sexual side effects of radical prostatectomy, it is prudent to commit to a program of Kegel pelvic floor exercises both before and after the prostate surgery. It makes sense to become proficient in these exercises proactively – – before the trauma of surgery – – so you go into the operation armed with precise knowledge and awareness of the pelvic floor muscles as well as with their strength, power and endurance optimized.

The Principles of Arnold Kegel

A quality pelvic floor muscle training program should adhere to the 4 principles promoted by Arnold Kegel, the namesake of pelvic floor muscle training:

  1. Muscle education
  2. Biofeedback
  3. Progressive intensity 
  4. Resistance

1. Muscle education is an understanding of your pelvic floor muscle anatomy and function.  Most men are clueless as to where their pelvic floor muscles are, what they do, how to exercise them, and what benefits they confer. In fact, many men don’t even know that they have pelvic floor muscles!  Muscle education will give you the wherewithal to develop muscle memory—the development of the nerve pathway from your brain to your pelvic floor muscles.

2. Feedback is a means of confirming that you are exercising the proper muscles.

3. Progressive intensity. Over the course of time, you gradually increase reps (number of repetitions), intensity of contraction and duration of contraction. Progression is the key to increasing your pelvic floor muscle strength and endurance. Additionally, it allows you to measure and monitor you progress and witness your increased capabilities over time.

4. Resistance adds a 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.  It is similar to the difference between doing arm curls without weights versus with weights.

How To Strengthen the Pelvic Floor Muscles

D.I.Y.: One possibility is a D.I.Y. (Do It Yourself) program, but the problem lies in sticking with it and seeing it through in order to reap meaningful results.  D.I.Y. Kegels lack the foundational background and means of isolating and exercising the PFM in a progressively more challenging fashion. It is like handing someone a set of weights and expecting them to engage in a program without the essential knowledge and principles of anatomy and function, specific exercise routine and supervision to go along with the equipment, dooming them to most certain failure.

Physical Therapy: Pelvic floor physical therapy is the other extreme from D.I.Y.  This involves using the services of a physical therapist who specializes in the pelvic floor. I liken the pelvic floor physiotherapist to a “personal trainer” for the pelvic floor muscles. Pelvic floor physiotherapists have the training, tools and wherewithal to educate and instruct those in need. The down side is that physical therapy usually has to be done onsite at a physical therapy center and is both time-consuming and expensive with variable insurance coverage, depending on the carrier.

The “Private Gym” Pelvic Floor Muscle Training Program: This program gives one the advantages and benefits of pelvic floor physical therapy training, but in a D.I.Y. environment.  In many ways, it is like the highly successful P90X home training program, which I am a big fan of.  The Private Gym is the go-to means of gaining pelvic floor muscle proficiency for men who are scheduled for prostate cancer surgery and wish to train in a comfortable home environment with minimal expense.  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. Kegel. The Basic Training program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises, while the Complete Training program provides maximum opportunity for gains via resistance equipment.

It is recommended that the Complete Training program be used in preparation for prostate surgery because of the importance of using resistance to maximize the strength of the pelvic floor muscles. The Basic Training program can be started once sufficiently healed from surgery, with gradual progression to Complete Training at the appropriate time.

A clinical trial of the Private Gym program showed dramatic increases in the magnitude of pelvic floor muscle contractions, vastly exceeding measurements in the control group. The study demonstrated better quality erections, orgasms, ejaculatory control and sexual pleasure with a striking improvement in sexual confidence in virtually all participants. The study not only proved improved erectile function in men with mild ED, but it also showed enhanced erections and ejaculation in men without ED, with the resistance program expediting the results beyond the capacity of the non-resistance program. For more details about the results of the clinical trial please visit:

Bottom Line:  “Failure to prepare is preparing to fail.”  Before embarking on prostate surgery, make every effort to get in the best general physical shape as well as achieve the best pelvic fitness possible. Yet another reason to exercise, eat properly, and maintain a healthy lifestyle are the advantages that accrue when you get ill and need surgery. A prepared pelvic floor will do wonders in helping to recover erections and urinary control.

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: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:  In the works is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Private Gym: -available on Amazon as well as Private Gym website

You Can’t Make It Bigger

June 13, 2015

Andrew Siegel MD   6/13/15


(New Jerseyans might recognize the lighthouse at Barnegat Bay)

Male Body Insecurity

In “Searching for Sex,” in The Sunday Review of the January 24, 2015 NY Times, Seth Stephens-Davidowitz studied Google online searches and observed: “The degree of a man’s worry about his genitals is profound.”  He concluded: “We are so busy judging our own bodies that there is little energy left over to judge other people’s, and maybe if we worried less about sex, we’d have more of it.”

Men Google more questions about their penises than any other body part. For every 100 questions about their genitals, there are 67 for the heart, 57 for the eyes and 40 for the head. One of the most commonly searched subjects is how to make one’s penis bigger, which seems to be primarily a male concern, because for every search women make regarding penis size, men make 170 searches. Of the top 10 questions about “my penis,” nine involve size, the first and second being “how to make my penis bigger” and “how to make my penis longer,” respectively. Interestingly, women have nearly as many concerns about their vaginas as men do about their penises. They want to know how to shave it, tighten it and how to improve its taste and scent. 

Sexual Enhancement Products

Not a day goes by where I am not bombarded with spam messages in my email inbox advertising drugs that claim to increase penis size. Additionally, not an office session happens in my urology practice when I don’t have at least several patients ask me about these products or bring in a print ad to ask my opinion.

The Internet is overrun with male “sexual enhancement” products that claim not to improve one’s sexual function but to increase the size of one’s penis. They capitalize on male body insecurity, which has created a huge market for these products, with hordes of men willing to pay top dollar for claims that are misleading and underhanded and products that are often mislabeled, contaminated and falsely advertised. The New York Attorney General recently accused four major retailers (GNC, Target, Walgreens and Walmart) of selling fraudulent and potentially dangerous herbal supplements and demanded that the products be removed. Unfortunately, such supplements are exempt from the stringent regulatory oversight applied to prescription drugs, which require reviews of a product’s safety and effectiveness before it goes to market. Do not waste your money!

What The FDA Has To Say

Although the FDA does not have the jurisdiction and regulatory powers over “natural” and “herbal” supplements that they have over prescription medications, they have still managed to restrain unscrupulous companies. According to physicians and federal experts, these products with claims that they can enlarge one’s penis are not only deceptive, but also potentially dangerous. The FDA has issued numerous public warning notifications in an effort to curb the sale of these often-tainted products and supplements. They have notified consumers that many of the products contain sildenafil, a.k.a. Viagra. The unknowing consumption of sildenafil can pose major health risks including precipitous drops in blood pressure in men on nitrate medications, which are commonly used for cardiac conditions.

You Can’t Make It Bigger, But You Can Make It Better

Okay gentleman, let’s do a reality check. Mother nature determined that you were to have a penis with its size determined by the genetic blueprint you inherited from your parents. You can’t make your penis bigger any more than you can make yourself taller…it is what it is. Nature is nature, but don’t forget about nurture. We do have some say in the way it functions, just as we have some say in what kind of physical shape our bodies are in and how they function.

How To Make It Better:

  • Use It Or Lose It. Your penis needs to be utilized the way nature intended. Erections keep your penile smooth muscles and tissues richly oxygenated, elastic and functioning well. Sexual intercourse on a regular basis protects against ED.
  • Maintain A Healthy Lifestyle. A healthy diet, a trim weight, keeping fit through balanced exercise (cardio, resistance, core, stretching), avoiding tobacco, avoiding excessive alcohol and managing stress are the keys to a healthy lifestyle.
  • Exercises Specifically Geared For Sexual Function. The penis contains smooth muscle, which can only be “exercised” through achieving erections. However, the pelvic floor muscles (PFM) that engage at the time of sexual activity are skeletal muscles; the ischiocavernosus PFM is the “erector” muscle and the bulbocavernosus PFM is the “ejaculator” muscle. Participating in a male Kegel exercise program such as the Private Gym will increase the strength, tone, and endurance of the PFMs, enhancing erectile and ejaculatory function and capacity.

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: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:

Co-founder of Private Gym:

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the 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 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 maximum 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




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…


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


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