Posts Tagged ‘penis’

Urethral Lozenge To Treat E.D.: What You Need to Know

May 5, 2018

Andrew Siegel MD   5/5/18

In Greek and Roman mythology, the muses were the goddess daughters of Zeus and Mnemosyne who presided over the arts and sciences. The term is now used to refer to a source of inspiration for a creative artist.  Today’s entry discusses a different kind of muse, technically M.U.S.E., an acronym for “medical urethra system/suppository for erection.” For men suffering with E.D., M.U.S.E. can be a source of inspiration for better quality erections.

In a practical approach to ED, vasodilating drugs (those that expand blood vessels and increase blood flow) can be considered to be third-line treatments for ED. MUSE is formulated as a urethral lozenge (suppository) that when absorbed functions to increase penile blood flow and induce an erection.

MUSE (Medical urethral system for erection) consists of alprostadil (prostaglandin E1) vasodilator pellets—available in 125, 250, 500, and 1000 microgram dosages—that are placed into the urinary channel after urinating.  Absorption occurs through the urethra into the adjacent erectile chambers, inducing increased penile blood flow and potentially an erection.

IMG_8823

Image above is the MUSE applicator with the MUSE pellet contained within

One of the problems with MUSE is that it is placed in the urethra, which has little to no role in erectile function, although it is surrounded by one of the erectile chambers (corpus spongiosum) that gets plump, although not rigid at the time of an erection. The neighboring paired erectile chambers (corpora cavernosa) are the two bodies that become rigid at the time of an erection. MUSE relies on the medication being locally absorbed from the urethra, into the corpus spongiosum and then into the corpora cavernosa.

Why did Willie Sutton rob banks?  Because that’s where the money is.  When it comes to erections, the money is in the corpora cavernosa.  Using MUSE is like robbing the building next to the bank.  Because it relies on absorption to an adjacent structure, the dosage required is significantly higher than when the medication is injected directly into the corpus cavernosum (penile injection therapy).  You may need to use a 1000 microgram pellet in the urethra, whereas if injected you might only need 10 micrograms. MUSE is effective in about 30-40% of men, working in about 15 minutes or so and resulting in an erection lasting for about an hour.

How to use MUSE:

Note: An applicator delivers the medicated pellet into the tip of the penis. It should be inserted after urinating, which functions to lubricate the urethra and make the administration easier.  The pellet is formulated to dissolve in the small amount of urine remaining in the urethra after urination.

  1. After the applicator is removed from the foil pouch, remove the protective cover from the applicator stem. The medicated pellet is visible because the applicator is transparent.
  2. Put the penis on full stretch and gently compress the head of the penis to straighten and open the urethra.
  3. Gently insert the applicator in the urethra to the level of the collar of the applicator.
  4. Push down on the button on the top of the applicator and hold for a few seconds to deploy the pellet.
  5. Gently rock the applicator from side to side to separate the pellet from the applicator tip and then remove the applicator and inspect to ensure release of the pellet.
  6. Holding the penis upright and stretched, kneed the penis between your hands for at least 10 seconds; if you feel a burning sensation, continue to kneed the penis until it subsides.
  7. Replace the cover on the applicator, place it in the opened foil pouch and discard.
  8. Stand up or walk around for 10 minutes or so while the erection is developing. Voila!

Side effects include urethral burning, aching in the penis, testicles, perineum and legs, redness of the penis and minor urethral bleeding or spotting.

Bottom Line: MUSE is another tool in the urologist’s erectile dysfunction toolbox.  Although it is not highly effective and its means of administration (via a urethral lozenge) may be distasteful to many, nonetheless it can be a means of improving ED for men who do not respond to lifestyle measures and the oral ED medications. 

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”:  www.HealthDoc13.WordPress.com

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

Cover

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

 

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Eat Your Way To Better Sex

March 31, 2018

Andrew Siegel MD   3/31/18

images

Thank you, Max Pixel, for image above of a healthy salmon and salad meal (maxpixel.freegreatpicture.com)

You are what you eat…

Our cells and tissues require food for energy to fuel our body functions.   Equally as important, nutrients present in foods serve as the building blocks of our cells and our tissues during the process of remodeling, restructuring and refashioning–that occurs in all tissues including the genitals–as old cells are replaced by new cells.  While optimal sexual functioning is based on many factors, it is important to recognize that food choices play a definite role. What we eat—or don’t eat—can certainly impact our sex lives, and this is equally applicable to both men and women, even though this entry is geared towards men.

Sex is important…

Although not a necessity for a healthy life, sexuality is an important part of our human existence. Healthy male sexual function requires an adequate sex drive, the ability to obtain and maintain a reasonably rigid erection, and the capacity to ejaculate and experience a climax. When sexual functioning goes south, the aftermath can be a loss of confidence and self-esteem, embarrassment, a sense of isolation, frustration and, at times, depression. There is a good reason the word “cocksure” means possessing a great deal of confidence.

Sex is complicated…

Sexual functioning is complex and dependent upon a number of systems working in tandem– the endocrine system (which produces hormones); the central and peripheral nervous systems (which provide executive function and nerve control); the vascular system (which conducts blood flow); the smooth muscles (erectile tissue within the arteries and sinuses of the erectile chambers); and the skeletal muscles (the pelvic floor muscles that help maintain high penile blood pressures necessary for erectile rigidity).

A canary in your trousers…

Sexual function is an indicator of underlying cardiovascular health– Poor erections can be a warning sign that an underlying problem exists. On the other hand, the presence of rigid and durable erections is an indicator of overall cardiovascular health. Since the penile arteries are generally rather small (diameter 1-2 mms) and the coronary (heart) arteries larger (4 mms), it stands to reason that if vascular disease is affecting the tiny penile arteries, it may affect the larger coronary arteries as well—if not now, then at some time in the future. In other words, the fatty plaques that compromise blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus erectile dysfunction may be considered a genital “stress test.”

A marvel of engineering…

A healthy sexual response is largely about blood flow to the genital and pelvic area. The penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge happening within seconds and responsible for the remarkable physical transition from flaccid to erect. This is accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. Pelvic muscle engagement and contraction help prevent the exit of blood from the penis, enhancing penile rigidity and creating penile blood pressures that far exceed normal blood pressure in arteries. For good reason, Gray’s Anatomy textbook over 100 years ago referred to one of the key pelvic floor muscle as the “erector penis.”

Like well-inflated tires…

Blood flow to the penis is analogous to air pressure within a tire: if there is insufficient pressure, the tire will not properly inflate and will function sub-optimally; at the extreme, the tire may be completely flat. Furthermore, slow leaks (that often occur with aging and failure of the smooth muscle within the penile arteries and erectile tissues to relax) promote poor function.  As your car declines in performance if it is dragging around too much of a load, so your penis can function sub-optimally if you are carrying excessive weight.

Obesity steals your manhood…

Abdominal fat (beer belly) is not just fat, but is a hormonally active organ that is chock full of the enzyme that converts the male hormone testosterone to the female hormone estrogen. Less testosterone translates to less sex drive and more estrogen often promotes man-boob development.  Obese men are also more likely to have fatty plaque deposits that clog blood vessels–including the arteries to the penis–making it more difficult to obtain and maintain erections. As the belly gets bigger, the penis appears smaller, lost in the protuberant roundness of a large midriff and the abundant pubic fat pad.  It is estimated that there is a 1 inch loss in apparent penile length for every 35 lb. of weight gain. So, if your sex drive is lagging, your penis is difficult to find, your man-boobs are prominent and your erections are not up to par, it may be time to rethink your lifestyle habits.

Those were the days, my friend, but now…

Do you remember the days when you could achieve a rock-hard erection—majestically pointing upwards—simply by seeing an attractive woman or thinking some vague sexual thought? Chances were that you were young, active, and had an abdomen that somewhat resembled a six-pack. Perhaps now it takes a great deal of physical stimulation to achieve an erection that is barely firm enough to be able to penetrate. Maybe penetration is more of a “shove” than a ready, noble, and natural access. Maybe you need pharmacological assistance to make it possible.  If this is the case, it is probable that you are carrying extra pounds, have a soft belly, and are not physically active. When you’re soft in the middle, you will probably be soft where it counts.  A flaccid penis is entirely consistent with a flaccid body and a hard penis is congruous with a hard body.

The Golden Rule: Treat your penis well and it will treat you well…

Healthy lifestyle choices are vital towards achieving optimal quality and quantity of life. It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices. These include healthy eating habits, keeping your weight down, exercising, sleeping adequately, drinking alcohol in moderation, avoiding tobacco and minimizing stress.

Bad choices…

Studies have shown that apart from known lifestyle risk factors, dietary practices such as decreased intake of vegetables and fruit and increased intake of unrefined and processed foods, dairy and alcohol are strongly associated with sexual difficulties in young men. Poor dietary choices with meals full of calorie-laden, nutritionally-empty selections (e.g., fast food, processed foods, excessive sugars or refined anything), puts one on the fast track to obesity and clogged arteries that can make your sexual function as small as your belly is big.

Good choices…

Healthy eating is important, obviously in conjunction with other smart lifestyle choices. Maintaining a healthy weight and fueling up with wholesome, natural, and real foods will help prevent weight gain and the build-up of harmful plaque deposits within blood vessels. Healthy fuel includes vegetables, fruits, legumes, nuts, whole grains and fish. Animal products (meats and dairy) should be eaten moderately and when indulging, lean cuts are healthiest. A Mediterranean-style diet is ideal for optimizing health and minimizing sexual dysfunction and heart disease. Rich in vegetables, fruits, whole grains, legumes, olive oil and lean protein sources (fish and chicken vs. red meat), the Mediterranean diet has been shown to improve sexual function, perhaps by alterations in glucose and fat metabolism and increasing anti-oxidant defenses, arginine levels and nitric oxide activity.

Bottom Line: If you want a “sexier” lifestyle, start with a “sexier” style of eating that will improve your overall health and make you feel better, look better and enhance your sexual function.  Smart nutritional choices are a key component of sexual fitness.

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”:  www.HealthDoc13.WordPress.com

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

Cover

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

 

 

 

 

Love Muscles Illustrated

December 23, 2017

Andrew Siegel MD  12/23/17

Hermes Butchart Gardens, Victoria

Above photo of Hermes I took this past summer at Butchart Gardens, Victoria, Canada 

In this entry, words will be kept to a minimum because the illustrations tell most of the story.  The images of the superficial pelvic floor muscles (muscles of love) that follow derive from the 1918 edition of Gray’s Anatomy of the Human Body (public domain), modified by Uwe Gille.

Whether you are male or female, two vital muscles — bulbocavernosus (BC) and ischiocavernosus (IC— have an intimate relationship with your genitals and are the “motor” that drives their function.  Without them, your penis or vagina would be non-functional putty!  Notice how remarkably similar the muscles are in both genders, the only difference being that the BC muscle is split in women, divided by the vagina.

Factoid: The relationship of the BC and IC muscles to the vagina and penis parallels the relationship between the diaphragm and the lungs. Without a functioning diaphragm to move the lungs, your lungs would be non-functional bags of air. 

Male BC (top) and IC muscles (bottom)

Bulbospongiosus-Male

Ischiocavernosus-male

 

 

 

 

 

 

 

 

 

  • Transform “plump” penis to “rigid” penis by compressing erectile chambers (responsible for penile high blood pressure)
  • Enables you to move your erect penis up and down at will
  • Stabilizes erect penis so it stays rigid and skyward-angled
  • Contract at climax and responsible for forcible expulsion of semen

Factoid: The only place in the body it is desirable to have high blood pressure is the penis. The BP at the time of full rigidity is > 200 mm, the 80-100 mm increase over systolic BP achieved by virtue of contraction of these muscles.

 

 

 

 

Female BC (top) and IC muscles (bottom)

Bulbospongiosus-Female

Ischiocavernosus-female

 

 

 

 

 

 

 

 

  • Increase pelvic blood flow during arousal, contributing to lubrication and plumping of vulva
  • Transform clitoris from flaccid to erect
  • Enables tightening vagina at will
  • Contract at the time of climax contributing to physical sensation of orgasm

Factoid: Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible BC and IC muscles.

 

 

 

Bottom Line: In men, these muscles function as the “erector penis” and “ejaculator penis.”  In women, these muscles function as the “erector clitoris,” “constrictor vagina,” and “climaxer maximus.”  Whether you are female or male, optimize the function of these muscles by doing Kegel exercises and make sure you do them properly: Male Kegel Book; Female Kegel Book.  To quote Sam Sneed, “Exercise puts brains in your muscles,” totally appropriate to these vital muscles that govern sexual function. 

Wishing you the best of health, a merry Christmas and a wonderful 2018!

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”:  www.HealthDoc13.WordPress.com

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

Cover

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

 

 

 

“Size” Should Never Outrank “Service”

November 11, 2017

Andrew Siegel MD  11/11/2017

As I stood in the gateway line during the painful process of boarding an airplane, I caught sight of a poster ad stating the following: “Size should never outrank service.” This referred to the smaller size regional jets that offer amenities including first-class, Wi-Fi, etc. Later, I saw another poster ad for the same airline stating: “How fast the flight goes isn’t always up to pilot.” As a physician interested in sexual/pelvic health and language, I found these sentences with double meanings amusing and entertaining.  The ultimate phallic structure is an aircraft and aeronautics provides a rich metaphor for male sexual function, the topic of today’s entry.  

Large and clunky

Airbus_A380-861,_Airbus_Industrie_AN2032144

By Oleg V. Belyakov – AirTeamImages [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0), CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL 1.2 (http://www.gnu.org/licenses/old-licenses/fdl-1.2.html)%5D, via Wikimedia Commons

Small and nimble

800px-F-15_vertical_deploy

Above image, public domain

 

Terms that apply to aeronautics and sexual function

Aircraft: a machine capable of flight—the penis

Pilot: the person who occupies the cockpit and controls the aircraft—the possessor of the penis

Cockpit (I really like this word!): the front of the fuselage where the pilots sit—the head of the penis

Fuselage: the body of the aircraft—the shaft of the penis

Horizontal and vertical stabilizers of the tail:  aircraft parts that provide stability to keep it flying straight—the pelvic floor muscles that stabilize and support the penis

Flight: the process of flying that includes a launch, a flight pattern and a landing—a sexual encounter

Launch: the takeoff—obtaining an erection

Flight pattern: the aircraft’s movement after takeoff—the sexual act

Landing: the conclusion and most difficult part of the flight, which requires skill, precision and timing to perform competently — ejaculation/orgasm

 Cruising Altitude: the altitude at which most of a flight is flown in route to a destination—a fully rigid erection

Jet fuel: fuel designed for use in an aircraft—in erectile terms, penile blood flow

Fuel line: the means by which fuel is pumped from the storage tanks to the engine—the penile arteries

Thrust: the propulsive force of an aircraft—the surging power of the erect penis

Throttle: a device for controlling the flow of fuel to an aircraft’s engine—the nerves that control the smooth muscle within the penile arteries and within the erectile tissue

Failure to Launch: a condition in which the aircraft is unable to get airborne—erectile dysfunction

Emergency landing: unanticipated landing before the scheduled arrival time—premature ejaculation

Aborted Landing: when an aircraft is about to land, but the pilot halts the landing and regains altitude deferring the landing—delayed ejaculation

Ground Time: the amount of down time between landing and the next flight—refractory period

Mayday: distress signal indicative of a significant problem with the aircraft or flight—a major sexual failure

Bottom Line:  Aeronautics provides an excellent metaphor for male sexual function.  The pilot can be accorded better control, longer flight times, higher altitudes, as well as launching a second flight with less ground time by attending to a few key measures. Although it is impossible to convert a F-15 Eagle (pictured above) into an Airbus A380 (pictured above), it is a fact that size should never outrank service!  Bigger is not always better as function often trumps form. 

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”:  www.HealthDoc13.WordPress.com

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

Cover

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.

 

 

 

10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

October 14, 2017

 Andrew Siegel MD   10/14/17

A penis is a special organ—a man’s joy, if not pride—and certainly one of his most prized, appreciated and cherished possessions, to which he has a significant attachment. As multifunctional as a Swiss Army knife, it allows him to stand to urinate (an undervalued capability), rises and firms to the occasion to allow for sexual penetration, and ejaculates genetic material–the means to perpetuate the species. A marvel of hydraulic engineering, within nanoseconds of sexual stimulation it is uniquely capable of increasing its blood flow 50 times over baseline, transforming its shape and size. Penis magic!

Each and every penis is unique.  As variable as snowflakes, they come in every size, shape and color. Beyond “size matters”—often a source of male preoccupation—men are often obsessed, if not preoccupied, with the appearance of their genitals.  In my interactions with patients, concerns are often voiced about symmetry, color, pigmentation, angulation, spots, blemishes, vein patterns, shrinkage and other oddities. Unless you are in the habit of closely inspecting other men’s genitals (as urologists are), you are unlikely to realize how common and completely normal most of these genital variations are.

 10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

  1. Penis leans to one side

left or right

No human is perfectly symmetrical and the flaccid penis rarely hangs perfectly centered. Wherever your penis naturally lies when you are clothed—whether left or right—is not indicative of your political leaning or left vs. right-sided brain predominance and is of absolutely no significance or consequence whatsoever!

Interesting trivia: “Throckmorton’s sign” is a term used jokingly by medical students, residents and attending physicians. A positive Throckmorton sign is when the penis points to the side of the body where the pathology is, e.g., if a man is getting surgery for a right groin hernia and the penis points to the right side. The Throckmorton sign indicates the proper side of the pathology at least 50% of the time!  Operating room humor! 

  1. Slight penile curvature when erect

pixabay banana

Thank you Pixabay, for image above

Again, although perfect symmetry may be desirable, the norm for the erect penis is not to be perfectly straight. There is often a subtle bend to the left, right, up or down.  Some men have a penis that has a banana-like curvature. Slight bends—considered totally normal—are to be distinguished from Peyronie’s disease, a condition in which there is significant angulation due to scarring of the sheaths of the erectile chambers. It is a potentially serious condition that can cause painful erections and erectile dysfunction.

  1. One testicle hangs lower

pixabay plumsThank you Pixabay, for image above

If you ever wondered why one of your testes is slightly bigger or heavier and hangs lower than the testes on the other side, you are in good company. Paralleling women with breast asymmetry, the vast majority of men have testes asymmetry, so your mismatched gonads are perfectly normal.

  1. Dark genital skin

Hyperpigmentation (darkening) of the median raphe (the line running from anus to perineum to scrotum to undersurface of penis) and other areas of the penis is extremely common.  In fact, it is normal for the penile skin color to be darker than other areas of the body, because of the effect of sex hormones on the cells that produce pigment (melanocytes).  The circumcision line, as well, is often deeply pigmented.

  1. Freckles, moles and skin tags

pixabay spottedThank you Pixabay, for image above

The penis is covered by skin–just like the rest of the body–and is therefore subject to common benign skin growths, including moles, freckles and skin tags. These are generally harmless and usually do not require any treatment unless desired for cosmetic reasons. However, if you have a growth that changes in size, color or texture, you should have it checked out because penile cancers do occur on occasion.  Skin tags are small fleshy protuberances and can be confused with genital warts, so if you have any doubt, get checked.

  1. Other penis and scrotal bumps and lumps

Pearly penile papules are raised “pearly” bumps that appear around the corona (the base of the head of the penis). They consist of one or more rows of small, fleshy, yellow-pink or transparent, smooth bumps surrounding the penile head. They are benign and do not cause harm, but sometimes are treated for cosmetic reasons, usually with freezing or lasering.

Pearly_Penile_Papules_Front

Pearly penile papules, By AndyRich48 (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)%5D, via Wikimedia Commons

Sebaceous glands produce oil that nourishes the hair follicles of the genitals. These glands appear as numerous small yellowish bumps on the scrotum and penile base.  In some men, they are prominent and referred to as sebaceous gland hyperplasia.  At times, they can exist without a hair follicle even being present.  Regardless, they are a normal occurrence.  See public domain image below–a.k.a. Fordyce spots.

Fordyces_spot_closeup.public domain. jpg

  1. Scattered scrotal spots

Angiokeratomas are benign purplish skin growths with a scaly surface that are not uncommonly present on the scrotum. They consist of dilated thin-walled blood vessels with overlying skin thickening. These skin lesions can occasionally bleed and also cause fear and anxiety since they can resemble more serious problems such as melanoma. If in any doubt, get it checked out.

Angiokeratoma_of_the_Scrotum_5

Scrotal angiokeratomas, By Jlcarter2 (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or   CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

  1. Veiny vanity

Every man has a unique penile venous pattern, the anatomy as unpredictable as the distinctive venous anatomy of the hand and wrist. In some men, the veins are twisted and prominent and in other men they are barely noticeable.  No matter what the pattern, venous anatomy is highly variable and individualized and is normal.

  1. Loose skin

Unlike most other skin on the body that is more tightly attached, penile skin is loosely attached to underlying tissues, allowing for expansion with erections. Since the physical state of the penis can vary from totally flaccid to totally rigid, when the penis is fully deflated, the skin may appear to be somewhat floppy and redundant, which is absolutely normal.  Scrotal skin often becomes increasing lax with the aging process, such that the testicles typically hang quite low in the elderly male, paralleling the common situation of pendulous breasts of the elderly female.

10. Shrinkage

Penile size in an individual is quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” can be provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves temporary reduced blood circulation.  Don’t worry, that sorry and spent looking penis can magically be revived with some TLC!

Bottom line: If you have an imperfect penis…welcome to the club!  No penis or scrotum is perfect.  Far from being an object of beauty, genital imperfections are the norm, so there is no need for feeling self-conscious. Just be happy that your little “fella” can function properly and enjoy his own happiness from time to time! Function over form!

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”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

 

Game Plan for Men’s Healthy Sexual Functioning

September 30, 2017

Andrew Siegel MD 9/30/17

man-and-woman-1464255_1920

Thank you, Pixabay, for image above.

Functioning well in the bedroom–like health in general–should never be taken for granted. During early adulthood it rarely, if ever, crosses our minds that at sometime in the future many body functions decline, including sexual function.  However, the truth of the matter is that paralleling general health and fitness, maintaining our sexual health and fitness takes some effort to avoid the almost inevitable deterioration in function.  Today’s entry reviews a “game plan” for maintaining healthy sexual functioning into our golden years.

  • Know the Fundamentals

For better or worse, penile erections are not on the basis of a bone in the penis, as they are in many mammals.  Erections occur when pressurized blood inflates the erectile chambers of the penis. The erect penis has blood pressure in excess of 200 mm (extreme hypertension), giving rise to bone-like rigidity and hence the slang term, boner.

The penis is a marvel of hydraulic engineering, uniquely capable of increasing its blood flow 50 times over baseline within nanoseconds of sexual stimulation, transforming its shape and size. This is accomplished by smooth muscle relaxation within the penile arteries and within the sinuses of the erectile chambers.

Once blood inflates the erectile chambers, closure of penile veins and contractions of the pelvic floor muscles effectively trap the pressurized blood in the penis and maintain the penile hypertension necessary for a sustained erection.

  • Know the Stats

The Massachusetts Male Aging Study showed that after age 40 there is a decline in all aspects of sexuality.  Erectile dysfunction (ED) is present in about 40% of men by age 40 with an increase in prevalence of about 10% for each decade thereafter. Although there are many causes of ED, the common denominator is insufficient blood flow to fill the erectile chambers of the penis, or alternatively, sufficient inflow but poor venous trapping, both often caused by a decline in smooth muscle relaxation with aging.

  • Know the Score

Performance ability with every physical activity declines as we get older and this explains why most professional athletes are in their twenties or thirties. Although everything eventually goes to ground, hopefully it will happen slowly. Young men can achieve a rock-hard erection simply by seeing an attractive woman or thinking a vague sexual thought. As we get older, it is not uncommon for erotic thoughts or sights to no longer be enough to provoke an erection, with the need for direct touch. Some of the common male sexual changes that occur with aging are: diminished sex drive; decreased rigidity and durability of erections; decrease in volume, force, and arc of ejaculation; decreased orgasm intensity; and an increased recovery time before being able to get a second erection.  

  • Know the Opponents: Gluttony and Sloth

A healthy weight and healthy eating habits, exercise, adequate quality and quantity of sleep, tobacco avoidance, use of alcohol in moderation, stress avoidance, and a balanced lifestyle will optimize sexual potential.  Abide by the golden rule of the penis: “Treat your penis nicely and it will be nice to you in return; treat your penis poorly and it will rebel.

  • Fuel for Performance

A healthy diet will reduce the risk of sexual dysfunction. Eat a variety of wholesome natural foods including fresh vegetables and fruit, plenty of fiber, lean protein sources, legumes and healthy fats including nuts, avocados and olive oil. Avoid eating processed foods and minimize sugar, refined carbohydrates and highly saturated animal fats.

  • Stay in Peak Form

Try to achieve “fighting weight” to maximize your performance in the sexual arena.

  • Train for Performance

Exercising—including cardio, core, and strength training—is vital for health in general and sexual health in particular. When it comes to sexual health, it is vital to focus on the all-important pelvic floor muscles (PFM). PFMT (pelvic floor muscle training) will help optimize erectile function and prevent/treat ED.

To understand why PFMT can help your performance in the bedroom, it is necessary to have some understanding of what the PFM do. When you have an erection, the bulbocavernosus muscle and ischiocavernosus muscles engage. Contractions of these muscles not only help prevent the exit of blood from the penis, enhancing rigidity, but also increase blood flow to the penis—with each contraction of these muscles, a surge of blood flows into the penis. Additionally, they act as powerful struts to support the roots of the penis (like the roots of a tree), the foundational support that, when robust, will allow a more “skyward” angling erection (like the trunk of a tree).  The bulbocavernosus muscle also is the “motor” of ejaculation, contracting rhythmically at the time of sexual climax and forcing semen out of the urethra.

Increasing the strength, tone and condition of these muscles through PFMT will allow them to function in an enhanced manner—namely more powerful contractions with more penile rigidity and stamina as well as improved ejaculatory issues, including premature ejaculation.

  • Talk to your Coach

Visit the PelvicRx website where you can purchase a male pelvic floor training DVD and have a private chat session with a pelvic floor trainer.

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”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in dire need of bridging.

Author of:

 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

Co-creator of the male pelvic floor training DVD: PelvicRx

 

 

 

The Fickle Phallus

June 10, 2017

Andrew Siegel MD  6/10/17

3 screw icon square

 

The penis is a fickle and temperamental friend who can be volatile, unpredictable and even hot-headed at times.  He has many states of existence, ranging from as shrunken and soft as a marshmallow to a “proud soldier”– rock-hard with exquisite posture. Between deflated and inflated, there are an infinite number of intermediate states, dependent on the dynamic balance between the closing and opening mechanisms of the blood flow to the penile erectile chambers.  It is important to understand that the same physiology applies to female genitals and clitoral function. 

The Autonomic Nervous System: The Network Ultimately Responsible for this

The autonomic nervous system controls “unconscious” body functions, including heart rate, breathing, digestion and contributes in a large way to regulate sexual function.

Heart rate and contraction are dynamic, changing moment-to-moment, even beat-to-beat, since they are “governed” by two competing halves of the autonomic nervous system.  The two systems—sympathetic and parasympathetic—are in a constant tug-of-war based upon external stimuli and one’s interpretation of them.

The sympathetic nerves respond to threats, fears and anxieties —an agitated state of mind and blood vessel tone—with the classic flight-or-fight response, which accelerates heart rate, heart contractility, respiratory rate, blood pressure and constricts arteries throughout the body.  The sympathetic system boots up when one is presented with a sudden anxiety-provoking event, such as being in a near-miss car accident.

On the other hand, the other half of the autonomic nervous system is the parasympathetic nervous system—the calmer and more relaxed state of mind and blood vessel tone—which slows down heart rate and respiratory rate, reduces heart contractility and lowers blood pressure by dilating arteries. The parasympathetic system is the system that predominates when we are not in situations that provoke fear and anxiety, governing many day-to-day bodily functions.

The_Autonomic_Nervous_System

Above image from Wikipedia, in public domain

 

Erectile function is complex and based upon many factors, both physical and psychological, but the ultimate determinant is chemistry that drives penile blood flow or lack thereof.  The state of the penis (flaccid vs. rigid vs. any intermediate state) at any given moment is based upon the balance between sympathetic (contractile) and parasympathetic (relaxant) factors. As the cardio-vascular system function is predicated upon the predominance of sympathetic versus parasympathetic stimulation, so the function of the peno-vascular system is predicated upon the predominance of sympathetic versus parasympathetic function. After all, the penis can be considered to be an extension of the vascular system that can be referred to as the “dangling aorta.”

Penile erection occurs with activation of parasympathetic (nitric oxide-cyclic guanosine phosphate pathway) nerves, which foster the relaxation of the penile arterial smooth muscle and the smooth muscle of the erectile tissue and inhibition of contractile mechanisms, all of which cause blood to rush into and inflate the penile erectile chambers.

Alternatively, penile flaccidity occurs with activation of sympathetic (norepinephrine pathway) nerves, which foster the contraction of the penile arterial smooth muscle and the smooth muscle of the erectile tissue and inhibition of relaxing mechanisms, all of which causes blood to exit and deflate the penile erectile chambers.

Sympathetic nervous system activity causing increased smooth muscle tone in erectile tissue is likely involved in the occurrence of psychological as well as in cardiovascular erectile dysfunction.

The bottom line is that the state of penile inflation at any given moment is highly influenced by the balance between sympathetic and parasympathetic function. High sympathetic activity causes a shriveled and decompressed penis, while high parasympathetic activity an erect and rigid penis. This is the very reason why one needs to have a relaxed temperament in order to perform sexually and also explains why anxiety can doom erectile function. A perfectly healthy 21-year-old with absolutely normal “plumbing” can be doomed to sexual failure if performance anxiety creates such a high sympathetic tone state. Similarly, a 50-year-old man who uses Viagra to increase penile blood flow and help obtain a rigid erection can have the beneficial effect of the medicine neutralized by a highly anxious state of mind.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

Putting Some “Lead” In Your Pencil: A Fix For The “Innie” Penis

April 29, 2017

Andrew Siegel MD   4/28/2017

pencil pixbay

Thank you, Pixabay, for image above

As Multi-Functional as a Swiss Army Knife

The penis is an extraordinary organ with urinary, sexual and reproductive functions. The possession of a penis endows man with the ability to stand to urinate and direct his urinary stream, a distinct advantage over the clumsy apparatus of the fairer sex that generates a spraying, poor-directed stream that demands sitting down on a toilet seat. The advantage of being able to stand to urinate (and keep one’s body appropriately distanced from the horrors of many public toilets) is priceless. Although man does not often have to employ this, the capability (when necessary) of urinating outside is another benefit of our design.  Many find the outdoor voiding experience pleasing, observing the pleasant sounds and visuals of a forceful stream striking our target (often a tree) with finesse, creating rivulets and cascades to show for our efforts.

Getting beyond the urinary, the most dramatic penis magic is its ability to change its form in a matter of seconds, morphing into an erect “proud soldier” and enabling the wherewithal for vaginal penetration and with sufficient stimulation, for ejaculation.  All that fun, but really serving the purpose of the passage of genetic material and ultimately the perpetuation of our species…reproductive wizardry!

The water tap that could turn into a pillar of fire.”

Eric Gill

tap pixabay

pixabay pillar

Thank you, Pixabay, for images above

 

The Sometimes Cruel Process of Aging Does Not Spare the Penis

 “Getting older is an honor and a privilege, but getting old is a burden.”

Beverly Radow (my aunt, who will turn 90-years-old this year)

Long after our reproductive years are over and fatherhood is no longer a consideration, most men still wish to be able to achieve a decent-enough erection to have sexual intercourse.  As well, we still desire to be able to urinate standing upright with laser-like urinary stream precision.

However, the ravages of time (and poor lifestyle habits) can wreak havoc on penile anatomy and function.  Many middle-aged men typically gain a few pounds a year, ultimately developing a bit of a pubic fat pad–the male equivalent of the female mons pubis– and before you know it the penis appears shorter and becomes an “innie” as opposed to an “outie.”  In actuality, penile length is usually more-or-less preserved, with the penis merely hiding behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. This is why having a plus-sized figure is not a good thing when it comes to size matters.

Useful Factoid: The Angry Inch…It is estimated that there is a one-inch loss in apparent penile length with every 35 lbs. of weight gain.

One of the problems with a shorter and more internal penis is that the forceful and precise urinary stream of yesteryear gives way to a spraying and dribbling-quality stream that can drip down one’s legs, spray over the floor and onto one’s feet (and even at times towards or on the gentleman next to you at the urinal!).

Almost Useless Factoid: Water Sports…Turkey vultures pee on themselves to deal with the heat of the summer on their dark feathers, since they lack sweat glands.  By excreting on their legs, the birds use urine evaporation to cool themselves down in the process of “urohidrosis.”  Unless you are a turkey vulture, peeing on yourself or others is rather undesirable!

The solution to having a recessed penis that is often hidden from sight and has lost its aiming capabilities is to sit on the toilet bowl to urinate, joining the leagues of our female companions who are “stream-challenged” because of their anatomy.

With aging (and poor lifestyle habits) also comes declining sexual function and activity as rigid erections going by the wayside.  However, like any other body part, the penis needs to be used on a regular basis—the way nature intended—in order to maintain its health. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile erectile tissues can occur, resulting in a de-conditioned and smaller penis that does not function like it used to.

Factoid: Disuse Atrophy…If one goes too long without an erection, collagen, smooth muscle, elastin and other erectile tissues may become compromised, resulting in a loss of penile length and girth and limiting one’s ability to achieve an erection.  Conversely, sexual intercourse on a regular basis protects against ED issues and the risk of ED is inversely related to the frequency of intercourse.

The point I am trying to hammer home is that aging, weight gain and poor lifestyle habits often render men with penises that are:

  1. Shrunken and recessed
  2. Unreliable in terms of ability to pee straight, requiring sitting down on the toilet bowl like women
  3. Unreliable with respect to sexual function

Factoid: Point 1 + Point 2 + Point 3 = EMASCULATION (depriving man of his male role and identity)

What To Do?

The first step is to keep one’s body (and penis) as healthy as possible via intelligent lifestyle choices. These include the following: smart eating habits; maintaining a healthy weight; engaging in exercise (including pelvic floor muscle training); obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction. The use of ED medications on a low-dose, daily basis can sometimes help all 3 issues.

In the event that the aforementioned means fail to correct the problem, a virtually sure-fire way of rectifying all three issues is by a simple surgical procedure.  Malleable penile implants (penile rods) are surgically placed into each erectile chamber of the penis (the two inner tubes of the penis that under normal circumstances fill with blood to create an erection). The implants act as skeletal framework for the penis (“bones” of the penis). Two USA companies, Coloplast and AMS (American Medical Systems) manufacture the rods that are in current use. They are very similar with subtle differences.

464x261_GenesisColoplast Genesis implant

AMS Spectra

American Medical Systems Spectra implant

The implant procedure of these two stiff-but-flexible rods into the erectile chambers of the penis is performed by a urologist on an outpatient basis.  Like shoes, the penile rods come in a variety of lengths and widths and fundamental to the success of the procedure is to properly measuring the dimensions of the erectile chambers in order to obtain an ideal fit. The small incision needed to implant the rods is closed with sutures that dissolve on their own. Healing typically takes about 6 weeks, after which sexual relations can be initiated.

An erection suitable for penetration and sexual intercourse is available 24-7-365, simply by bending the penis up. The penis is angled down for concealment purposes. It is flexible enough to be comfortably flexed up or down, while rigid enough for intercourse, the best of all worlds.

Print

Penile rods in action, bent down for concealment and up for urination and sex

Bottom Line:  It is not uncommon for aging, weight gain and unhealthy lifestyle factors to conspire to compromise penile anatomy and function with respect to apparent penile size, urinary stream precision and erectile rigidity.  This leaves one emasculated with a penis that is often concealed, shortened and habitually limp, impeding the ability to have sexual intercourse, as well as a spraying quality urinary stream necessitating sitting to urinate.  If lifestyle improvement measures do not correct the situation, literally and figuratively “putting some lead in your pencil” using a simple malleable penile implant can “kill three birds with one stone.” (I could not resist the very mixed metaphor.)  Confidence can be restored with the conversion of the “innie” penis to an “outie,” the ability to resume sexual intercourse and the reestablishment of a directed, non-spraying stream to permit standing to urinate.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

Erection “Destiny”

December 24, 2016

Andrew Siegel MD  12/24/2016

Uninformed, uneducated and unprepared for the aging process, one has little choice but to passively observe and accept the gradual changes that unfold over time.  The purpose of this entry is to inform, educate and prepare you for the expectations of sexual function as you age.  Sadly, it is often not a pretty picture as aging can be unkind and Father Time does not spare sexual function.

Although erectile dysfunction (ED) is not inevitable, with each passing decade, more and more men join the ED club. All aspects of sexuality decline, although sexual interest suffers the least depreciation, leading to a swarm of men who are eager, but unable–a most frustrating combination. With aging there is typically less sexual activity, and with less sexual activity “disuse atrophy” in which the de-conditioned penis becomes smaller in stature and, in a vicious cycle, even less functional. The senior years also bear witness to the testicles dangling loosely like pendulous breasts of elderly women. Time and gravity are cruel conspirators.

shutterstock_side view manjpeg

A Few Definitions

Erection: The rigid state of the penis under circumstances of sexual stimulation.

Destiny: What the future has in store for you.

Erection Destiny: What the future has in store for your erection capabilities.

What Might Be In Store In The Future

The general trends that follow are structured by decade. Individuals may vary significantly from others in their age group, as “chronological” age is not the ultimate factor and may be trumped by “functional” age.  This guide was crafted after many years spent in the urology trenches, working the front line with thousands of patient interactions.

Age 18-30: Your sexual appetite is prodigious and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the scent of her perfume, merely the thought of her can fully arouse you. You get erections even when you don’t want them…if there was only a way to bank these for later in life! You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense, forceful and powerful. When you arise from sleep, it is not just you that has arisen, but also your penis.

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

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

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

Age 50-60: Sex is still important to you and your desire is still there, but is typically diminished. Your erection can still be respectable and functional, but is not the majestic sight that it once was, and touch is often necessary for full arousal. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. A dribbling-quality ejaculation occurs with diminished volume and force, begging the question of why you are “drying up.” Orgasms are less intense and at times it feels like nothing much happened—more “firecracker” than “fireworks.” Getting a second erection is difficult, and you may find much more delight in sleeping rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity…sometimes just reserved for the weekends.

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

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

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

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

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

Sometimes A Cigar Is More Than A Cigar

Although changes in sexual function are virtually inevitable with the aging process, a decline is sexual function can also be a “canary in the trousers”—an indicator that a underlying medical problem exists that is of greater significance than the ED. In other words, erection quality can serve as a barometer of cardiovascular health– rigid and durable erections a gauge of good cardiovascular health and ED often a clue of poor cardiovascular health. Since the blood flow to the small penile arteries (diameter 1-2 millimeters) is often compromised in ED, the larger coronary arteries (4 millimeters) may be affected as well—if not now, then at some point in the not-to-distant future. For this reason, men with ED should have a medical evaluation seeking arterial disease elsewhere in the body.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

Men Are From Mars, Women From Venus, But There’s Not Much Difference Between A Vagina And A Penis

December 10, 2016

Andrew Siegel MD 12/10/2016

What is it that most distinguishes a male from a female? The obvious answer is the genitals, with the penis/scrotum having a vastly different appearance from a vagina/vulva.  Despite the male and female genitals being the feature that most characterizes the difference between a male and female, there are striking similarities. The genitals of both sexes are biologically homologous– similar in structure and having a common embryological origin–with development into male versus female based simply on the hormonal environment at the time of development.  Today’s entry discusses the similarities (as opposed to the differences) between the genitals and the “homologues,” the specific anatomical structures that are of common embryological origin and are more alike than are commonly recognized. 

Whether one develops a penis or a vagina is determined at the moment the sperm penetrates the egg. The egg contains an X chromosome and the sperm either an X or Y chromosome. When the coupling results in an XX, the blueprint for female development is established; when the coupling results in an XY, the blueprint for male development is established. The bottom line is that the father determines the sex of the child.

Several weeks later, when the fertilized egg has turned into an embryo, the external genitals are identical. Female genitals are the “default” model, which will remain female, absent the presence of the male hormone testosterone (T). T is activated to dihydrotestosterone (DHT) that causes conversion of what would be a vulva and vagina into a penis and scrotum. Biochemical magic! The bottom line is that the developing embryo will remain female unless T/DHT are available to masculinize the external genitals.

In the young embryo there are three key genital structures: the “tubercle,” the “folds” and the “swellings.” In the absence of T/DHT, the genital tubercle (a midline swelling) develops into a clitoris. The urogenital folds (two vertically-oriented folds of tissue below the genital tubercle) become labia minora (inner lips). The labio-scrotal swellings (two vertically-oriented bulges outside the urogenital folds) fuse to become labia majora (outer lips). In the presence of T/DHT the genital tubercle morphs into a penis, the urogenital folds become the urethra and part of the penile shaft and the labio-scrotal swellings fuse to become a scrotum.

Genital Homologues

The penis is the homologue of the clitoris. Both structures are highly sensitive organs with a tremendous concentration of nerve fibers and contain erectile tissue (corpora) that enables them to expand in size and rigidity with stimulation. Both the penis and clitoris have a head (glans) and shaft and deep internal roots. Both are covered with a layer of skin that can be pulled back to expose the underlying anatomy. In the male this is referred to as the foreskin, which is the homologue of the female clitoral hood.

penile-clitoral_structure

Comparison of penis (left) and clitoris (right)–note similar shape and internal structure, Attribution: Esseh, Wikipedia Commons

The male scrotal sac is the homologue of the female labia majora. The raphe (the seam that runs vertically up the perineum, scrotum and penis) is the homologue of the pudendal cleft (the slit between the labia) in the female.

vulva_vs_scrotum

 

Comparison of vulva (left) and scrotum (right); note similarity of outer labia to scrotum and female pudendal cleft to male raphe,  by Richiex (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D, via Wikimedia Commons

The male prostate gland is the homologue of the female Skene’s glands. Both produce fluid that is released at the time of sexual climax. The male Cowper’s glands are the homologue of the female Bartholin’s glands, both of which secrete fluid at the time of sexual stimulation, pre-ejaculate fluid in the male and vaginal lubrication fluid in the female.

 

male_anatomy_en-svg

Male anatomy, note prostate gland and Cowper’s glands, by Male_anatomy.png: alt.sex FAQ derivative work: Tsaitgaist (Male_anatomy.png) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)%5D, via Wikimedia Commons

skenes_gland-svenska

Note Skene’s gland and Bartholin’s glands openings below and to side of urethra and vagina respectively, by Nicholasolan (Skenes gland.jpg) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/2.5-2.0-1.0)%5D, via Wikimedia Commons

Bottom Line: As different as female and male anatomy are, so they are similar.  The study of comparative genital anatomy and embryological origin is fascinating.  Next week’s entry addresses when this process of differentiation into male versus female goes awry, leading to “ambiguous” genitalia, and how the study of one such particular genetic defect led to the creation of a billion dollar blockbuster drug in common use for purposes of shrinking enlarged prostates and growing hair in men with male pattern baldness.   

Wishing you the best of health,

2014-04-23 20:16:29

www.AndrewSiegelMD.com

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

Andrew Siegel MD practices in Maywood, NJ.  He is board-certified in both 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.

Dr. Siegel is the author ofTHE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health (www.TheKegelFix.com) and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health (www.MalePelvicFitness.com).