Posts Tagged ‘Pelvic health’

The Nuts and Bolts of Pelvic Floor Muscle Training (PFMT): Part 1

February 3, 2018

Andrew Siegel MD  2/3/18

I received intensive exposure to surgical aspects of pelvic health at UCLA School of Medicine, where I spent a year training in pelvic medicine and reconstructive surgery following completion of my urology residency at University of Pennsylvania School of Medicine. This background, coupled with my passion for health, fitness and the benefits of exercise, led to my interest in PFMT as a means of optimizing pelvic health and to avoid, or at times facilitate, surgical management of pelvic floor dysfunctions.  Is it traditional for a pelvic surgeon to espouse non-surgical treatments?  Not at all, but after decades in the urology/gynecology “trenches,” I have concluded that PFMT is a vastly unexploited resource that offers significant benefits.

Photo below: Yours truly on left with Dr. Shlomo Raz (UCLA professor who is “father” of female urology) on right (1988)

shlomo and andy


“Strength training improves muscle vitality and function.” These seven words embody a key principle of exercise physiology that is applicable to the PFM.


There is little to no consensus regarding the nuances and details of PFMT programs.  There is no agreement on the best position in which to do PFMT; the number of sets to perform; the number of repetitions per set; the intensity of PFM contractions; the duration of PFM contractions; the duration of PFM relaxation; and how often to do PFMT. The particulars of many PFMT routines are arbitrary at best. In fact, Campbell’s Urology—the premier textbook—concludes: “No PFMT regimen has been proven most effective and treatment should be based on the exercise physiology literature.”  

My goal is to take the arbitrary out of PFMT, providing thoughtfully designed, specifically tailored programs crafted in accordance with Dr. Arnold Kegel’s precepts, exercise physiology principles and practical concepts.

Dr. Kegel’s precepts are summarized as follows:

  • Muscle education
  • Feedback
  • Progressive intensity
  • Resistance

Exercise physiology principles as applied to PFMT include the following (note that there is some overlap with Dr. Kegel’s precepts and practical concepts):

  • Adaptation: The process by which muscle growth occurs in response to the demands placed upon the PFM, with adaptive change in proportion to the effort put into the exercises.
  • Progression: The necessity for more challenging exercises in order to continue the process of adaptive change that occurs as “new normal” levels of PFM fitness are established. This translates into slowly and gradually increasing contraction intensity, duration of contractions, number of PFM repetitions and number of sets.
  • Distinguishing strength, power and endurance training: Strength is the maximum amount of force that a muscle can exert; power is a measure of this strength factoring in speed, i.e., a measure of how quickly strength can be expressed. Endurance or stamina is the ability to sustain a PFM contraction for a prolonged time and the ability to perform multiple contractions before fatigue sets in. High intensity PFM contractions build muscle strength, whereas less intensive but more sustained contractions build endurance. Power is fostered by rapidly and explosively contracting the PFM.
  • “Use it or lose it”: The “plasticity” of the PFM—the adaptation in response to the specific demands placed on the muscles—requires continued training, at minimum a “maintenance” program after completion of a course of PFMT.
  • Full range of motion: The goal of PFMT is not only to increase strength, power and endurance, but also flexibility. This is accomplished by bringing the muscle through the full range of motion, which at one extreme is full contraction (muscle shortening), and at the other, complete relaxation (muscle lengthening). The exception to this is for muscles that are already over-tensioned, which need to be relaxed through muscle lengthening exercises.

Practical concepts encompass the following:

  • Initially training the PFM in positions that remove gravity from the picture, then advancing to positions that incorporate gravity.
  • Beginning with the simplest, easiest, briefest PFM contractions, then proceeding with the more challenging, longer duration contractions.
  • Slowly and gradually increasing exercise intensity and degree of difficulty.
  • Aligning the specific pelvic floor dysfunction with the appropriate training program that focuses on improving the area of weakness, since each pelvic floor dysfunction is associated with specific deficits in strength, power and/or endurance.

To be continued….

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 (the female version is in the works): PelvicRx




The Curious Use of Genital and Anal Slang

October 24, 2015

Andrew Siegel MD   10/24/15

* Warning:  This blog contains adult language that you may find offensive. 


(Asshole Emoticon, by marynightshade; no changes made Link:  Licensed under a Creative Commons Attribution—Share Alike 3.0 License)

What an…“asshole”; “dick”; “dickhead”; “bell end” (British variety of dickhead)

He’s such a “jerk-off”; “wanker” (British variety of jerk-off)

She’s a “cunt,” “pussy,” “twat” (British variety of pussy)

The weather “sucks.”

This situation is so “fucked” up.

The aforementioned nouns and verbs are used metaphorically with negative and disparaging intent. What these phrases have in common is that they employ slang terms that refer to either the anatomy of the genitals and anal area, or alternatively, to some element of sexual function.

It is a curiosity that it is the slang terms that are used for derogatory purposes, but the non-slang, proper anatomical terms are never used in this context. Who ever refers to another person as an anus, penis, glans penis, vagina, etc.? Or, he’s such a masturbator? Or, the weather is like oral stimulation of a man’s penis? Or, this situation is like having sexual intercourse?

This genital and anal anatomical region of concern is valuable, often unappreciated human real estate. I am puzzled as to how our slang language evolved to use anatomy and physiology of the nether region in such a pejorative sense. Perhaps it is the fact that our culture has strong underlying puritanical roots. The word pudendum, meaning genitals, derives from the Latin “pudenda,” meaning “shameful parts.” Certainly the fact that these are the most “private” areas of our body and the most “private” of body functions—the only anatomical regions and activities that are considered off limits and politically incorrect to expose or pursue, respectively, in public venues such as beaches—may explain why they are fodder for ridicule.

I think we have it all “ass backwards” (pun intended). Pelvic function—sexual, urinary and bowel—is truly remarkable and never appreciated until dysfunction sets in.

For many men—and women for that matter—the vagina is a dark and mysterious place, but an amazing and versatile structure if you consider that it is a sexual organ that allows entry of the penis, an inflow pathway and receptacle for semen, an outflow pathway for menstruation and a birth canal for the fetus. Vagina magic!

The penis is an equally extraordinary multifunctional organ—no less so than a Swiss army knife—with an impressive ability to multi-task, having an array of functions including urinary, sexual and reproductive. In the words of Eric Gill: “The water tap that could turn into a pillar of fire.” It allows man to urinate with a directed stream and when erect, it enables vaginal penetration and sexual intercourse. Ejaculation deposits semen in the vagina, with the passage of genetic material and ultimately the perpetuation of the species. Penis magic!

Last but not least, the anus is nothing short of brilliant, the “asshole” not only capable of distinguishing gas, liquid and solid, but also is the structure standing between you and diapers. I care for patients with the devastating problem of fecal incontinence and recently evaluated a youthful 50-something year-old woman who recounted to me her circumstance of standing in an elevator with others present when fecal material started dripping out of her bikini bottoms, without her awareness.

So, if you wish to address a contemptible person, call them a “shit” or a “shithead”—so much more appropriate and meaningful slang than calling them an “asshole.” (Thank you Greg Lovallo, MD and Jennifer Bonilla, MA for pointing out the true utility of the S-word as opposed to the other genital and anal slang words.)

Bottom Line: Your “asshole” is your close friend and should never be taken for granted. Likewise, the entire genital/anal region should be admired, respected and held in the highest of esteem and not ridiculed, belittled and vilified. Think about that the next time you call someone an “asshole,” “dick,” or “pussy.” Just sayin’.

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 (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

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

5 Amazing Reflexes Vital To Your Pelvic Health

February 7, 2015

Andrew Siegel MD  2/07/15


(Above image courtesy of Pixabay)

A reflex is an automatic response to a stimulus, an action that occurs without conscious thought. Many of us are familiar with the knee jerk reflex in which the knee straightens as a result of the quadriceps muscle contracting in response to the tendon of our kneecap being tapped with a reflex hammer.  There are 5 reflexes that you probably are not aware of, but are important to learn about since they are so vital to your urinary and sexual health.

Guarding Reflex

As the sphinx guards the entrance to the Great Pyramids, so the sphincter muscles guard the entrance to the urinary bladder. The voluntary sphincter muscle—the one that you have control of and are capable of contracting at will—is largely composed of the deep pelvic floor muscles (PFMs).

The deep PFMs are your friends, helping you store urine while the bladder fills up. Even when you are not actively squeezing the PFMs, they have a baseline tone, working to provide resistance that keeps you from leaking urine as the bladder becomes fuller. They only relax completely when you urinate.

The guarding reflex is the increase in the contraction strength of these “guarding” PFMs as the bladder gets fuller and fuller, with stronger PFM tone as the volume of urine in the urinary bladder increases.

Cough Reflex

This reflex is also your good buddy, one that increases the contraction of the PFMs when you cough—above and beyond their resting tone—preventing you from leaking urine. This is nature’s way of protecting you from leaking urine when there is a sudden increase in your abdominal pressure, as occurs with a cough. This protects against cough-related stress urinary incontinence.

Pelvic Floor Muscle-Bladder Reflex (PFM-BR)

This is a very useful and practical reflex that you can tap into. The PFM-BR is a unique reflex since you are capable of engaging this reflex voluntarily, resulting in the relaxation of a muscle as opposed to its contraction. Anyone who has ever experienced an urgent desire to urinate or move their bowels will find it of great practical use. When the reflex is deployed, it will result in relaxation of both the urinary bladder and rectum and a quieting of the urgency.

Here is how it works: When you feel the sudden and urgent desire to urinate, pulse the pelvic floor muscles (PFMs) five times—brief but intense contractions. When the PFM are so deployed, the bladder muscle reflexively relaxes and the feeling of intense urgency should disappear. Likewise, when the PFMs are so deployed, the rectum relaxes and the feeling of intense bowel urgency should diminish. This reflex is a keeper when you are stuck in traffic and have no access to a toilet!

Bulbocavernosus Reflex (BCR)

The bulbocavernosus muscle (BC) is one of the very important superficial PFMs. The BCR is a contraction of the bulbocavernosus and its mates, the ischiocavernosus (IC) muscles when the glans (head) of the penis in a male or the clitoris in a female is squeezed. This reflex is important for maintaining erectile rigidity, since with each contraction of the BC and IC muscles there is a surge of blood flow to the penis/clitoris, maintaining the high blood pressures within the erectile chambers necessary for engorgement of these organs. Sexual stimulation can be thought of as a chain of linked BCRs.

Double Reflex

Did you ever experience an urgent desire to urinate and find relief by squeezing the head of the penis? If so, you have discovered the linkage of two reflexes—the BCR coupled with the PF-MBR. Here is what happens: A strong urge to urinate occurs and is managed by squeezing the head of the penis, which makes the urgency dissipate. What is actually happening is that the squeeze of the penis triggers a PFM contraction via the BCR. In turn, the PFM contraction relaxes the bladder muscle via the PFM-BR and makes the urgency either improve or disappear. Reflex magic!

Cremasteric Reflex

The cremaster muscle surrounds the spermatic cord (the cord-like structure that contains the testicular blood supply, nerves, etc.). The cremasteric reflex occurs when the inner thigh is stroked and the testicle pulls up towards the groin via a contraction of the cremaster muscle. This is a brisk reflex in boys and tends to become less active with aging. It is a natural protective reflex that helps us avoid testicular injury when danger approaches, like a turtle pulling its head into its protective shell.

Bottom Line: The aforementioned reflexes are vital for your sexual and urinary health; knowing about them and how to tap into them can be to your advantage.


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:–available on Amazon and Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic 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.