Posts Tagged ‘Peyronie’s disease’

Penis Stretching (Traction Therapy): What You Should Know

February 4, 2017

Andrew Siegel MD  2/4 /17

“Tissue expansion” is a well-accepted concept employed in several medical disciplines for the purpose of gradually expanding specific anatomical parts, most commonly used in plastic and reconstructive surgery.  Traction therapy—a.k.a. mechanical transduction—involves the application of pulling forces to tissues in order to incrementally expand them.  The traction ultimately leads to cellular proliferation and formation of new collagen. Successful tissue expansion mandates adequate pulling forces with sufficient time of traction application and treatment duration. Traction so applied to body parts for extended periods of time will result in gradual lengthening and expansion, and the penis is no exception.

traction

Image above: Two nursing sisters erect traction apparatus for a patient’s leg in the Orthopaedic Ward of No. 2 RAF General Hospital in Algiers, 1944-1945

http://media.iwm.org.uk/iwm/mediaLib//52/media-52315/large.jpg

 

Penile traction is capable of lengthening or straightening the penis using mechanical pulling forces. It has become an increasingly popular option based upon its relative noninvasive nature, the side effects associated with alternative treatments, and the general difficulties in managing conditions that result in penile shortening. The biophysics of penile traction involves mechanical forces and stresses that are capable of positively affecting cellular and tissue growth.

Penile traction therapy has potential clinical use in a number of urological circumstances, including for purposes of penile lengthening, as primary management of Peyronie’s disease, as an secondary treatment after other forms of management for Peyronies (including the injection of medications into Peyronie’s scar tissue and surgery for Peyronies), and finally, prior to penile prosthesis implant surgery to optimize penile length at the time of the implantation. Penile traction necessitates a compliant patient willing to devote the time and effort to the relatively long treatment period required for effective lengthening.

For more information on Peyronie’s disease, refer to my previous blog entry: https://healthdoc13.wordpress.com/2015/05/23/peyronies-disease-not-the-kind-of-curve-you-want/

Situations That May Benefit From Penile Traction

  • Small penis stature
  • Penile dysmorphic disorder: a preoccupation with penis size, often related to the subjective perception of small penis size that has no objective basis
  • Penile shortening due to radical prostatectomy
  • Penile shortening and angulation due to Peyronie’s disease
  • Peyronie’s patients who have had injection therapy with medications (collagenase, verapamil, interferon, etc.) or surgery for Peyronie’s, as adjunctive treatment to optimize results
  • Prior to inflatable penile implantation to enable implantation of the largest possible prosthesis

 What Are The Commercially Available Penile Traction Devices?

  • FastSize Penile Extender (FastSize Medical, Aliso Viejo, CA)
  • Andro-Penis (Andromedical, Madrid, Spain)
  • Golden Erect Extender (Ronas Tajhiz Teb, Tehran, Iran)
  • SizeGenetics (GRT Net Services Inc., Gresham, OR)
  • Vimax Extender (OA Internet Services, Montreal, Canada)
  • ProExtender (Leading Edge Herbals, Greeley, CO)
  • PenimasterPro (MSP Concept, Berlin, Germany)

All of the aforementioned devices are similar in principle. For specific information on any product, a Google search will provide detailed information on each product and exactly how it is used.

The most sophisticated and best-engineered device is the PenimasterPro. For more information on this device: https://www.penimaster.com   (Available through www.urologyhealthstore.com use code “Urology 10” for 10% discount and free shipping.)

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Image above: PenimasterPro

Bottom Line: Penile traction is a minimally invasive, relatively new option for managing conditions associated with shortened penile length. Studies have demonstrated the ability of traction therapy to modestly increase penile length without changing girth. It is capable of improving the penile curvature and shortening associated with Peyronie’s disease, particularly when initiated early during the acute phase, as well as following surgery or injection therapy. It also has utility in optimizing penile length prior to penile implant surgery and for the management of any condition causing penile shortening. It does require a dedicated and compliant user willing to wear the traction device for extended periods of time in order to achieve satisfactory lengthening. 

Resources for this entry:

External Mechanical Devices and Vascular Surgery for Erectile Dysfunction. L Trost, R Munarriz, R Wang, A Morey and L Levine: J Sex Med 2016; 13:1579-1617

Penile Traction Therapy for Peyronie’s Disease: What’s the Evidence? MF Usta and T Ipeckci: Transational Andrology and Urology 2016; 5(3):303-309

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

 

 

 

“Doc, My Penis Is Shrinking”

October 8, 2016

Andrew Siegel MD  10/8/16

cuixes_de_lapol%c2%b7lo_de_pinedo

Image above: Roman copy of Apollo Delphinios by Demetrius Miletus at the end of the second century (Attribution: Joanbanjo (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons)

Not a day goes by in my urology practice when I fail to hear the following complaint from a patient: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrivel from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis, if you will. Weight gain and obesity cause a generous pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter and retrusive. However, penile length is usually intact, with the penis merely hiding behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. Having a plus-sized figure is not such a good thing when it comes to size matters, as well as many other matters.

Factoid: It is estimated that with every 35 lbs. of weight gain, there is one-inch loss in apparent penile length.

The 9-letter word every man despises: S-H-R-I-N-K-A-G-E, immortalized by Jason Alexander playing the character George in the Seinfeld series. Jerry’s girlfriend Rachel catches a glimpse of naked George after he has stepped out of a swimming pool. Suffice it to say that George’s penis was in a “non-optimized” state. George tries to explain: “Well I just got back from swimming in the pool and the water was cold.” Jerry makes the diagnosis: “Oh, you mean shrinkage” and George confirms: “Yes, significant shrinkage.”

Penis size has not escaped our “bigger is better” American mentality where large cars, homes, breasts,  buttocks and mega-logos on shirts are desirable and sought-after assets. The pervasive pornography industry–where many male stars are “hung like horses”– has given the average guy a bit of an inferiority complex.

Factoid: The reality of the situation is that the average male has an average-sized penis, but in our competitive society, although average is the norm, average curiously has gotten a bad rap.

Adages concerning penile size and function are common, e.g., “It’s not the size of the ship, but the motion of the ocean.” Or even better, as seen on a poster in a gateway while boarding an airplane: “Size should never outrank service.” The messages conveyed by these statements have significant merit, but nonetheless, to many men and women, size plays at least some role and many men have concerns about their size. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort.

Leonardo Da Vinci had an interesting take on perspectives: “Woman’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.”

Penile Stats

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that flaccid length does not necessarily predict erect length and can vary depending upon many factors. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

With all biological parameters—including penis size—there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. Some men are phallically-endowed, some phallically-challenged, with most somewhere in the middle of the road. In a study of 3500 penises published by Alfred Kinsey, average flaccid length was 8.8 centimeters (3.5 inches). Average erect length ranged between 12.9-15 centimeters (5-6 inches). Average circumference of the erect penis was 12.3 centimeters (4.75 inches). As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (and mother).

Factoid: Hung like a horse—forget about it! The blue whale has the mightiest genitals of any animal in the animal kingdom: penis length is 8-10 feet; penis girth is 12-14 inches; ejaculate volume is 4-5 gallons; and testicles are 100-150 pounds. Hung like a whale!

Factoid: “Supersize Me.” In order to make their genitals look larger, the Mambas of New Hebrides wrap their penises in many yards of cloth, making them appear massive in length. The Caramoja tribe of Northern Uganda tie weights on the end of their penises in efforts to elongate them.

“Acute” Shrinkage

Penile size in an individual can be quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” is a real phenomenon 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 blood circulation.

Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s peripheral anatomy to help maintain blood flow and temperature to the vital core. This principle is used when placing ice on an injury, as the vasoconstriction will reduce swelling and inflammation. Similarly, exposure to heat causes vasodilation (expansion of arterial flow), the reason why some penile fullness can occur in a warm shower.

Nervous states and anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in numerous effects, including a flaccid penis. In fact, when the rare patient presents to the emergency room with an erection that will not quit, urologists often must inject an adrenaline-like medication into the penis to bring the erection down.

Hitting it hard in the gym or with any athletic pursuit demands a tremendous increase in blood flow to the parts of the body involved with the effort. There is a “steal” of blood flow away from organs and tissues not involved with the athletics with “shunting” of that blood flow to the organs and tissues with the highest oxygen and nutritional demands, namely the muscles. The penis is one of those organs from which blood is “stolen”—essentially “stealing from Peter to pay Paul” (pun intended!)—rendering the penis into a sad, deflated state. Additionally, the adrenaline release that typically accompanies exercise further shrinks the penis.

Cycling and other saddle sports—including motorcycle, moped, and horseback riding—put intense, prolonged pressure on the perineum (area between scrotum and anus), which is the anatomical location of the penile blood and nerve supply as well as pelvic floor muscles that help support erections and maintain rigidity.  Between the compromise to the penile blood flow and the nerve supply, the direct pressure effect on the pelvic floor muscles, and the steal, there is a perfect storm for a limp, shriveled and exhausted penis. More importantly is the potential erectile dysfunction that may occur from too much time in the saddle.

“Chronic” Shrinkage

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,” smaller and often temperamental penis.

Factoid: If you go for too long without an erection, smooth muscle, elastin and other tissues within the penis may be negatively affected, resulting in a loss of penile length and girth and negatively affecting ability to achieve an erection.

Factoid: Scientific studies have found that sexual intercourse on a regular basis protects against ED and that the risk of ED is inversely related to the frequency of intercourse. Men reporting intercourse less than once weekly had a two-fold higher incidence of ED as compared to men reporting intercourse once weekly.

Radical prostatectomy as a treatment for prostate cancer can cause penile shrinkage. This occurs because of the loss in urethral length necessitated by the surgical removal of the prostate, which is compounded by the disuse atrophy and scarring that can occur from the erectile dysfunction associated with the surgical procedure. For this reason, getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shrinkage on the basis of scarring of the erectile tissues that prevents them from expanding properly.  For more on this, see my blog on the topic:

https://healthdoc13.wordpress.com/2015/05/23/peyronies-disease-not-the-kind-of-curve-you-want/

Medications that reduce testosterone levels are often used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage. Having a low testosterone level from other causes will also contribute to a reduction in penile size.

Are There Herbs, Vitamins or Pills That Can Increase Penile Size?

Do not waste your resources on the vast number of heavily advertised products that will supposedly increase penile size but have no merit whatsoever.  Realistically, the only medications capable of increasing penile size are the oral medications that are FDA approved for ED. Daily Cialis will increase penile blood flow and by so doing will increase flaccid penile dimensions over what they would normally be; the erect penis may be larger as well because of augmented blood flow.  Additionally, for many men this will restore the capability of being sexually active whereas previously they were unable to obtain a penetrable erection, thus allowing them to “use it instead of losing it” and maintain healthy penile anatomy and function.

Is Penile Enlargement Feasible Through Mechanical Means?

It is possible to increase penile size using tissue expansion techniques. The vacuum suction device uses either a manual or battery-powered source to create a vacuum in a cylinder into which the penis is placed. The negative pressure pulls blood into the penis, expanding penile length and girth. A constriction ring is placed around the base of the penis to maintain the erection. The vacuum is used to manage ED as well as a means of penile rehabilitation and is also used prior to penile implant surgery to increase the dimensions of the penis and allow a slightly larger device to be implanted than could be used otherwise. It can also be helpful under circumstances of penile shrinkage.

vsd

Vacuum Suction Device

The Penimaster Pro is a penile traction system that is approved in the European Union and Canada for urological conditions that lead to shortening and curvature of the penis. In the USA it is under investigation by the FDA. It is a means of using mechanical stress to cause penile tissue expansion and enlargement.

penimaster

Penimaster Pro

What’s The Deal With Penile Enlargement Surgery?

Some men who would like to have a larger penis may consider surgery. In my opinion, penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky and not ready for prime time. Certain procedures are “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone, bulking agents, tissue grafts and other implantable materials. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis. Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

What’s Up With Penile Transplants?

The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to a recipient whose penis was damaged beyond repair in an accident. Subsequently, there have been several transplants done for penile trauma.  Hmmm, now here is a concept for penile enlargement!

What To Do To Avoid Shrinkage issues?

  • Accept that cold, stress and athletics will cause temporary shrinkage
  • Be aware that cycling and other saddle sports can cause shrinkage as well as erectile dysfunction: wear comfortable and protective shorts; get measured for a saddle with an appropriate fit; frequently rise up out of the saddle, taking the pressure off the perineum
  • Eat a healthy diet and stay physically active to maintain a lean physique
  • Use it or lose it: stay sexually active
  • Do pelvic floor exercises (a.k.a. Man Kegels): visit http://www.MalePelvicFitness.com
  • “Rehab” the penis to avoid disuse atrophy after radical prostatectomy: oral ED meds, pelvic floor muscle training, vibrational stimulation, vacuum suction device, penile injection therapy; consider “pre-hab” before the surgery
  • Seek urological care for Peyronie’s disease

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

E-book available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback available via websites. Author page on Amazon:

http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix

https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx, Vacuum Suction Devices and many other quality products can be obtained at http://www.UrologyHealthStore.com. Use promo code “UROLOGY10” at checkout for 10% discount. 

Penile Curvature: How To Dissolve Peyronie’s Scar

March 26, 2016

Andrew Siegel MD  3/26/16

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Peyronies Disease is an inflammatory condition of the penis that causes penile curvature and an uncomfortable or painful erection.  Scarring of a region of the sheath surrounding the erectile chambers of the penis (tunica albuginea) occurs, sabotaging the ability to obtain a straight and rigid erection with the potential for dramatically interfering with one’s sexual and psychological health. The scarring causes the presence of a hard lump(s), penile shortening, narrowing, curvature, a visual indentation of the penis described as an “hourglass” deformity, and painful, less rigid erections.

Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functionally and anatomically correct rigid erection suitable for intercourse. The curvature can range from a very minor, barely perceptible deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is impossible. The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scar tissue.

Although it can occur at any age, Peyronies most commonly occurs in 50-60 year-olds. The underlying cause is suspected to be chronic penile trauma, associated with bending and buckling following years of sexual intercourse. This type of injury activates an abnormal scarring process with an acute phase characterized by painful erections and an evolving scar, curvature and deformity and a chronic phase marked by resolution of pain and inflammation, stabilization of the curvature and deformity, and, not uncommonly, ED. The chronic phase typically occurs up to 18 months or so after the initial onset of symptoms.

Collagenase (Xiaflex) is an enzyme capable of dissolving scar tissue. It is derived from the clostridium bacteria and has been used for years for Dupuytren’s contracture, a similar situation to Peyronie’s that occurs on the hand, causing scarring of the tissue beneath the skin of the palm and fingers, making it challenging to straighten one’s fingers. Collagenase functions as a “chemical knife” capable of dissolving collagen, the main constituent of scar tissue. It is used for men with Peyronie’s disease and a penile angulation of 30 degrees or greater. The goal of treatment is disrupting the scar tissue and decreasing the curvature of the erect penis.

The injections are performed in an office setting by a urologist with Peyronie’s expertise. One course of treatment may involve as many as four treatment cycles, with each cycle consisting of two injections of collagenase directly into the scar tissue, each spaced 1-3 days apart. A few days after the second injection, the penis is manipulated, massaged and molded in order to “model” it into a straighter version of itself. Thereafter, the patient performs self-stretching of the flaccid penis three times daily for 6 weeks or so. Gentle self-straightening is also performed on a daily basis if spontaneous erections allow one to do so. The endpoint is achieving as straight a penis as possible with an angulation of less than 15 degrees. One treatment cycle may be repeated as many as four times.

Injection of Xiaflex can be highly effective, but is not without side effects including the expected results of an injection into tissue including bruising, swelling and mild-moderate pain. On rare occasions, a rupture of the erectile chamber of the penis (penile fracture) can occur. It is advisable to wait two weeks after the second injection of each treatment cycle before resuming sexual activity, provided the pain and swelling have subsided.

Auxilium/Endo, the pharmacological company that provides Xiaflex, has an excellent patient counseling tool that is available at the following site:

http://xiaflexrems.com/downloads/RMX-00014-XIAFLEX-REMS-Patient-Guide-(Patient-Counseling-Tool)-for-PD-(5).pdf

Bottom Line: Peyronie’s Disease, like Dupuytren’s contracture, is the presence of scar tissue in a very “operative” area of the body that can interfere with function and reduce one’s quality of life. Collagenase (Xiaflex) is a scar-dissolving chemical derived from bacteria that can reduce this scar tissue and vastly improve function and quality of life.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

Concussions: Big Head/Little Head

March 19, 2016

Andrew Siegel MD 3/19/16

Earlier this week, Jeff Miller (N.F.L. senior VP for health and safety policy) officially acknowledged the link between football and chronic traumatic encephalopathy, the degenerative brain disease found in many former players.  In this entry, the important topic of chronic traumatic brain injuries is reviewed with a segue into chronic traumatic penis injuries.

Who Knew? The athletic “cup” provides protection to the male genitals for those participating in sports including baseball, hockey, soccer and boxing. The cup was devised years before the first protective helmet for heads was developed. This gives you some insight into men’s priorities!

Traumatic brain injuries

Concussions resulting from contact sports and their sequelae of traumatic brain injuries have emerged as a hot topic. Football, boxing, soccer, hockey, rugby, lacrosse, mixed martial arts, etc., clearly incur risks for head trauma. Years ago, it was the expectation of athletes “to grin and bear it” after violently striking their heads in pursuit of victory. (I remember well when my son played football as a youngster in the competitive state of Pennsylvania, where an ambulance waited on the sidelines ready to transport unconscious 8 to 10 year-old boys to the ER. That ambulance did not sit idle for long.)

Today, sports-induced concussions have been brought to the forefront with all of the hubbub about athletes collapsing after hitting their heads and news about former NFL players suing over brain injuries. The movie “Concussion” ushered this subject to the big screen. Fortunately, positive changes are being made, with “concussion medicine” becoming a specialty discipline and concussion protocols put into force for many organized sports at the high school and college levels.

The human brain weighs about 3 pounds, is gelatinous in consistency and contains about 100 billion neurons. Nature has given us a remarkably thick skull to protect the delicate structure within. The brain literally “floats” in fluid within the skull. When the skull accelerates or decelerates rapidly—as occurs in a direct strike—the skull movement is abruptly arrested, but the brain continues in motion, twisting and bouncing within the skull, which can result in brain micro-trauma.

538px-Concussion_mechanics.svg (Modified version of Image: Skull and brain normal human.svg by Patrick J. Lynch, medical illustrator, Creative Commons Attribution 2.5 License 2006)

A concussion is currently defined as a motion injury of the brain. When I was in medical school, a concussion was defined as a transient loss in consciousness, but the truth of the matter is that less than 10% of concussions involve loss of consciousness. 90% of concussions manifest with symptoms including headaches, light sensitivity, nausea, vomiting, incoordination, disorientation, and abnormally slow reflexes and thinking.

It is unusual for a single concussion to result in long-term issues, as concussions are recoverable injuries if identified and treated properly. However, multiple concussions repeated over a course of many years– commonplace occurrences among athletes participating in contact sports– leave participants susceptible to chronic traumatic brain injuries including chronic traumatic encephalopathyAlzheimer’sParkinson’s disease and other forms of dementias.

How does this relate to the penis?

Sexual intercourse–which by definition is the forceful collision of two bodies– is no less of a contact sport than any of the aforementioned athletic endeavors. In parallel with traumatic brain injuries (big head), the penis (little head) is another anatomical zone that can get banged up over time. By the time a man is in his 50’s, he has likely had sex thousands of times, and as pleasurable as sex is, in reality it can be quite a traumatic event. Between self-inflicted and partnered pounding, hammering, pummeling and other abuse through self-manipulation and penetrative intercourse, respectively, it’s a wonder that the appendage doesn’t fall off!

Acute trauma is rare, but on occasion superficial veins can rupture, resulting in penile bruising and swelling that gets patients into my office in a real hurry. Rarer and more dramatic is the fractured penis that occurs when he “zigs” and she “zags,” resulting in a forceable miss-stroke and a serious injury that requires emergency surgery (previously covered in another blog: https://healthdoc13.wordpress.com/2015/01/24/breaking-bad-what-you-need-to-know-about-penile-fracture/)

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(The image to the side is a photo I snapped of a statue of a man with a broken penis in Alcazar Palace in Seville, Spain.)

As opposed to acute trauma, chronic trauma to the penis is a not uncommon occurrence that is most often asymptomatic for many years. Just the act of obtaining a rigid erection puts tremendous compression stress forces on the penis. The outer sheath enveloping the erectile chambers of the penis—the tunica albuginea (white tunic)—is second only to the lining of the brain—the dura mater—in terms of its being the toughest tissue in the body. It is subjected to tremendous forces when the penis is erect because of the hypertensive blood pressures within the erectile chambers, well in excess of 200 millimeters mercury at full rigidity.

The potential for micro-trauma to the white tunic increases exponentially when one inserts that erect penis into a vagina and two parties move, bump and grind, creating intense shearing stress forces on the penis.  Certain positions angulate the penis and create more potential liability for injury than others. Even gentle sex can be rough with a single act of intercourse resulting in hundreds of thrusts with significant rotational, axial and torqueing strains and stresses placed upon the erect penis with the potential for subtle buckling injuries. Repeat performance perhaps a few times a week for many decades and by the time a man is in his 50s, on a cumulative basis, traumatic penile injuries—often asymptomatic in their developmental stages—can cause scarring to the white tunic and “chronic traumatic penopathy.”

Scarring to the white tunic can be problematic, resulting in deformities of the penis during erections, including the presence of a hard lump, shortening, curvature, narrowing, a visual indentation of the penis described as an hour-glass deformity and pain with erections as well as less rigid erections.  Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse.  This is known as Peyronie’s Disease, which fortunately only occurs in about 5% of men and is a treatable condition.  This topic has previously been covered:  https://healthdoc13.wordpress.com/2015/05/23/peyronies-disease-not-the-kind-of-curve-you-want/.

Bottom Line: The following relationship analogy sums it up: Chronic traumatic encephalopathy is to athletes who participate in contact sports is to concussions as is chronic traumatic penopathy is to sexually active males is to buckling trauma during intercourse.  Experts in the field of  “concussion medicine” want to spread the following advice: “Protect your brain – you only get one of them.” To this I add: “Protect your penis—you only get one of them. No matter what your game, be careful and proceed with caution!

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

 

 

 

 

 

 

Peyronie’s Disease: Not the Kind of Curve You Want

May 23, 2015

Andrew Siegel MD  5/23/15

banana-25239_640

(Thank you, Pixabay, for above image)

Peyronie’s Disease is an inflammatory condition of the penis that causes curvature and an uncomfortable or painful erection. It is not uncommon– 65,000-120,000 cases per year in the USA–with only a small fraction of those who have the disease actually seeking treatment. Although it can occur at any age, it most commonly is seen in 50-60 year-olds. Essentially, it is scar tissue in a bad location, which sabotages the ability to obtain a straight and rigid erection, resulting in a dramatic interference with one’s sexual and psychological health.

Why Is Penile Curvature Called Peyronie’s Disease?

Most people assume that Peyronie’s disease is named after poor Monsieur Peyronie, who not only was afflicted with the disease, but also was further disgraced by having the disease named after him. The truth of the matter is that Peyronie’s disease is named after the French surgeon, de la Peyronie, who first described it in 1743.

How Do You Know If You Have Peyronies?

Peyronie’s Disease causes fibrous, inelastic “plaques” of the sheath surrounding the erectile chambers that reside within the penis. This results in deformities of the penis during erections, including the presence of a hard lump(s), shortening, curvature and bending, narrowing, a visual indentation of the penis described as an hour-glass deformity and pain with erections as well as less rigid erections.  Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse. The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is impossible. The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring. Although the scarring is physical, it often has psychological ramifications, causing anxiety and depression.

What Causes It And What Can You Expect In The Future?

The underlying cause of Peyronies is unclear, but is suspected to be penile trauma—perhaps associated with excessive bending and buckling from sexual intercourse—that activates an abnormal scarring process. During acute Peyronies, erections are painful and there is an evolving scar, curvature and deformity. The chronic phase occurs up to 18 months or so after initial onset and at which time the pain and inflammation resolve, the curvature and deformity stabilize, and often erectile dysfunction is noted. Peyronie’s regresses in about 15% of men, progresses in 40% of untreated men, and remains stable in 45% of men. Many men become very self-conscious about the appearance of their penis and the limitations it causes, and they may avoid sex entirely.

Is Peyronie’s Treatable?

Treatment options include oral medications, topical agents, injections of medications into the scar tissue, shock wave therapy, and surgery. Upon initial diagnosis, most men are started on oral Vitamin E, 400 IU daily, as this has the potential to soften the scar tissue causing the plaque. Many of the aforementioned treatments are not particularly effective because scar tissue is a challenging problem. Erectile dysfunction can be often be managed with ED medications.

Xiaflex—a.k.a. collagenase—derived from the clostridium bacteria, is the newest treatment for Peyronies. It has been used for years for Dupuytren’s contracture, a similar situation to Peyronie’s that occurs on the hand, causing a scarring of the tissue beneath the skin of the palm and fingers, making it very difficult to straighten one’s fingers. Xiaflex functions as a “chemical knife” by dissolving collagen, the main constituent of scar tissue. It is typically used for men with an angulation of 30 degrees or more. It is injected directly into the scar tissue after which the area is massaged and modeled to disrupt the scar tissue and mold the penis. One course of treatment may involve as many as eight injections. Injection of this medication can be highly effective, but is not without side effects including bruising, swelling, pain and possibly rupture of the erectile chamber of the penis causing a penile fracture.

If there is an unsatisfactory response to conservative managements, a penile implant may be appropriate. This can manage the dual problems of erectile dysfunction and penile angulation. If erections are adequate, but angulation prevents intercourse, options include doing a “nip and tuck” opposite the plaque in an effort to make expansion more symmetrical. Although this technique is effective in improving the angulation, it does so at the cost of penile shortening. Other more complex procedures involve incising or removing the scar tissue and using grafting material to replace the tissue defect.

Bottom Line: When scar tissue occurs on an area of the body that moves, expands or acts as a channel, it affects function as well as form. Thus a scarred elbow can impact mobility, scarred lungs can disturb breathing, a scarred bile duct can cause jaundice and scarred erectile chambers can cause Peyronie’s. The good news is that mild Peyronie’s does not need to be treated and if more severe forms occur that interfere with one’s quality of life, there are effective means to treat it.  

Resources:

www.peyroniesassociation.org

www.askaboutthecurve.com

www.menshealthPD.com

Wishing you the best of health and a great Memorial Day weekend!

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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

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

Co-founder of Private Gym: http://www.PrivateGym.com–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.

Eyes Wide Open: Genital Mindfulness

May 9, 2015

Andrew Siegel MD 5/9/15

Pay careful attention to your body, including your genitals. Erectile function (or lack) is a barometer of your overall health and a bellwether for disease as well as an indicator of cardiovascular health.

Iris_-_right_eye_of_a_girl

Be Mindful

Observe your penis in both flaccid and erect states. Carefully watch and listen to your urinary stream. Keep an eye on  your urine and semen. It sounds strange, but by doing so you will gain insight into your general and pelvic health. Don’t forget to examine your testicles periodically when showering, feeling for lumps, bumps or asymmetry.

Skin Matters

Are there any rashes or skin lesions on the penis or scrotum? The genital skin—like the rest of our skin—can be subject to allergic responses, infections and cancers.

Power Tool No More?

Are you “limping” in the bedroom with less rigid and durable erections? This may be a sign of a problem with the cardiovascular system. The penile arteries are smaller than the coronary arteries of the heart and narrow before those of the heart have an opportunity to do so, so ED can be a predictor of a more generalized disease process involving other blood vessels.

Sex Drive Gone South?

Are you more interested in baseball than in sexual matters? If so, it may be time for a libido check and an evaluation of your testosterone level, as T is the “governor” of sex drive.

Erection Curved like a Banana?

Has your formerly straight erection gone “rogue”? Does it appear curved like a banana or is it angled like a periscope? Is there an area of narrowing that looks like a “waist” giving it an “hourglass” appearance? If so, you may have Peyronie’s disease, scarring of the sheath of the erectile cylinders of the penis causing a painful curvature.

Dribbling Instead of Shooting?

Did your previously powerful and intense ejaculation morph into a weak sputter of a small volume of semen with diminished intensity? If this is the case, you may have weakened pelvic floor muscles.

What’s That?

Is there a discharge from your urethra? If so, you might have a urethral infection/inflammation known as urethritis or other sexually transmitted infection. If you have not ejaculated in some time, it is possible that there will be a milky white discharge at the time of a bowel movement as the prostate is “milked” by the act of defecation.

Funky Colored Urine?

Urine color ranges from clear to amber, depending upon your state of hydration. When well hydrated, your urine will look clear or very pale yellow, like light American beer. When dehydrated, your urine becomes very concentrated, appearing dark amber, like a strong German beer.

Fresh bleeding in the urinary tract makes the urine appear bright red whereas old blood appears tea or cola-colored. In either case, blood in the urine is abnormal and should be investigated to ensure that the bleeding is not on the basis of a serious condition such as bladder or kidney cancer.

Excessive vitamin B intake can result in light orange urine. Overconsumption of beets, blackberries, and rhubarb can sometimes impart a red color to urine. Cloudy urine may be indicative of a urinary tract infection, but can also occur when one’s diet consists of foods high in phosphates.

When urine is occasionally foamy or sudsy, it is considered to be normal. When it occurs consistently, it can be a sign of protein in the urine, often indicative of kidney disease.

Funky Smelling Urine?

A sweet smell may indicate diabetes. A foul odor may be on the basis of a urinary infection or the intake of certain foods, e.g., asparagus. Vitamin intake can also cause the urine to have an unpleasant odor. Vitamins B and C are water soluble and therefore not stored in the body and any excess above what is necessary for the body’s use is excreted in the urine. Malodorous urine that has a fecal odor may indicate a bad urinary infection or possibly an abnormal connection between the colon and the bladder known as a fistula. This happens most commonly from diverticular disease of the colon and when it occurs, there is often air in the urine as well.

Does It Burn?

If urination is painful, it may indicate a urethral or urinary infection.

Can’t Put Out a Fire Anymore?

When you observe your flow, does it hesitate before it gets going? Is the stream weak and split into several streams or sprays like a spigot? Does it start and stop and seem to take forever to empty? When you have to go, do you have little warning and a tremendous desire to urinate? Are you leaking urine before you get to the toilet? Do you have an after-dribble? Does the sound of your urination that once was like the rapids of a powerful river now sound like a meek creek? If so, you may have plumbing issues on the basis of prostate enlargement, scar tissue in the urethra, or an overactive or underactive bladder.

Bloody Show?

Blood in the semen can literally scare the “daylights” out of you. However, the majority of men with “hematospermia” have a benign inflammation of the prostate that is not a serious problem, often as innocuous as a nosebleed.

Bottom Line: Scrutinize your genitals to discover much about your health.

Wishing you the best of health,

2014-04-23 20:16:29

AndrewSiegelMD.com

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

www.HealthDoc13.WordPress.com

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

http://www.MalePelvicFitness.com

Co-creator of Private Gym pelvic floor muscle training program for men:

http://www.PrivateGym.com 

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

5 Side Effects of Radical Prostatectomy You Don’t Hear Much About

December 27, 2014

Andrew Siegel MD  12/27/14

shutterstock_orange gu tract closeup

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

Trauma to nerves, blood vessels, and muscular tissue during surgery can potentially compromise sexual function and urinary control. Generally, patients are informed about ED, urinary incontinence, the possibility of the surgery failing to cure the cancer and the risk of rectal injury. However, there are other possible complications that may affect your sexual quality of life that are often glossed over, perhaps because they are not considered that important in the grand scheme of cancer care.

Note that there are many men who undergo radical prostatectomy and experience absolutely no complications whatsoever, achieving “trifecta” status: a PSA (Prostate Specific Antigen) that is undetectable, full urinary control and intact erectile function. A small percentage of men experience significant urinary incontinence whereas many men will experience mild urinary incontinence. Many men note a decline in their ability to obtain and maintain an erection after the radical prostatectomy. What about the side effects that often go less mentioned?

Additional sexually related side effects that may occur including the following:

  • Ejaculation of urine at the time of sexual climax
  • Urinary leakage with sexual stimulation
  • Altered sensation of climax
  • Pain with climax
  • Penile shortening and deformity

 

Ejaculation of Urine at Sexual Climax

After radical prostatectomy, ejaculations are typically “dry” because of the removal of the structures that supply the contents of the ejaculate: prostate gland, seminal vesicles and the clipping of the sperm ducts. However, some men after radical prostatectomy may ejaculate urine at the time of sexual climax. This can be a nuisance and embarrassment to both the patient and his partner. This problem is most prevalent during the first year after prostatectomy and tends to improve with time.

Coping strategies are urinating before sex and/or using a condom or constrictive penile loop that pinches the urethra closed. Pelvic floor muscle training can strengthen the levator ani muscle, which contributes strongly to the voluntary urinary sphincter.

Urinary Incontinence at the Time of Sexual Stimulation

Urinary leakage is not always restricted to the moment of ejaculation as some patients can have it with foreplay. Once again, this is a potential bother and embarrassment to both patient and partner. Like ejaculation of urine, this issue is most commonly experienced during the first year after radical surgery and thereafter tends to improve.

Altered Sensation of Climax

Most men after radical prostatectomy will experience an altered perception of climax. Some will experience diminished pleasure, often with a feeling of diminished intensity of orgasm. Some are bothered by the dry climax. On occasion, one loses the ability to climax. In rare instances, a patient after radical prostatectomy will notice an increase in orgasm intensity.

Pain With Climax

Up to 20% of men after radical prostatectomy will experience discomfort or pain with climax, which is often perceived in the penis, testes or the rectum. With time both the intensity and frequency of pain usually decrease, although a small percentage of men will have persistent pain that persists beyond several years following the surgery.

Penile Shortening and Deformity

After radical prostatectomy, it is common to experience an alteration in penile size with a decrease in flaccid length, erectile length and erectile girth. The loss in penile length occurs during the first several months after the radical prostatectomy and whether the situation is reversible seems unlikely.

The shortening is likely based on factors including loss of urethral length, nerve and blood vessel damage and the presence of erectile dysfunction with its associated “disuse atrophy.” Lack of regular erections results in less oxygen delivered to the penile smooth muscle and elastic fibers with subsequent scarring and hence shortening.

The solution is to resume sexual activity as promptly as conceivable after surgery, pursuing “penile rehabilitation” to help avoid disuse atrophy. Pelvic floor exercises, oral medications of the Viagra class, the vacuum suction device, and penile injection therapy have proven to be helpful.

Up to 15% of men after radical prostatectomy will experience a penile deformity resulting in what appears to be a “waistband” or alternatively a penile curvature with erections.

Bottom Line: The potential sexual side effects from radical prostatectomy aside from ED may be bothersome and adversely affect one’s quality of life.

Reference: Frey AU, Sonksen J, Eode M: Neglected Side Effects After Radical Prostatectomy: A Systematic Review. J Sex Med 2014; 11:374-385

 

Wishing you the best of health and a peaceful upcoming 2015,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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

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

Private Gym: http://www.PrivateGym.com -available on Amazon as well as 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.

Penis Size: Does It Matter?

May 17, 2014

Blog #154

As I was walking through the gateway on my way to board an airplane, I saw a poster advertisement stating the following: Size should never outrank service, referring to the smaller size regional jets that now offer first-class, wi-fi and more. I recently saw another poster ad for the same airline stating: How fast the flight goes isn’t always up to pilot. I find these double entendres quite amusing and entertaining.

With all biological parameters, there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. Penis size is no exception, with some of us phallically endowed, some phallically challenged, but most of us somewhere towards the center. In a study of 3500 penises published by Alfred Kinsey, the average flaccid length was 8.8 centimeters (3.5 inches). The average erect length ranged between 12.9 -15 centimeters (5-6 inches). The average circumference of the erect penis was 12.3 centimeters (4.75 inches).

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that there is no clear cut correlation between ethnicity and penis size. Flaccid length does not necessarily predict erect length and can vary depending upon emotional state and ambient temperature. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

Some women prefer men who are formidably hung, just like some men prefer women with large breasts. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort, particularly if cervical contact occurs. The long and the short of it are summarized in the adage, “It’s not the size of the ship, but the motion of the ocean.

Who Knew? “Genital Genetics.” As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (or mother). In actuality, it is the roll of the genetic dice and how the inherited blueprint that determines physical traits interacts with the local hormonal environment.

Who Knew? Hung like a horse—forget about it! The blue whale has the mightiest genitals of any animal in the animal kingdom: penis length is 8-10 feet; penis girth is 12-14 inches; ejaculate volume is 4-5 gallons; and testicles are 100-150 pounds. Hung like a whale!

Who Knew? On the subject of penis size, one of my favorite things to do when driving on the highway and seeing some idiot in a Lamborghini driving hazardously from lane to lane at about 95 miles an hour is not to flash him my middle finger, but to show him my hand with my thumb and index finger separated about 1 inch apart to indicate to him what I think is the likely size of his penis.

Who Knew? “Men are from Mars, Women from Venus.” Leonardo Da Vinci had an interesting take on perspectives: “Woman’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.”

Who Knew? There are a bunch of “amenities” that accompany the aging process, one of which is “presbyopia” or farsightedness, which demands reading glasses. They are a real nuisance, never around when you need them and always getting lost. But one thing I have observed is that if you forget to take them off when you get up to relieve your full bladder, when you glance down, you see a rather large “member,” thanks to the magic of magnification. I am currently wearing 1.5 power; perhaps it’s time for 2.0!

Who Knew? There is no correlation between penis size and shoe size, hand size or nose size.

Who Knew? “Where’s Woody?” Three of the most common words I hear in my urology practice are the following: “Doc, I’m shrinking.”

Who Knew? Part of the problem is the pervasive pornography industry, where many male stars are endowed like the centaur, the mythological creature with the head and torso of man and the lower body of a horse. This has given the average guy a bit of an inferiority complex.

Many men complain of “shrinkage,” which is a very real phenomenon on the basis of blood flow. The typical circumstances evoking this are exposure to cold weather or cold water, the state of being nervous, and athletic pursuits. The mechanism in all cases involves blood circulation. Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s periphery to help maintain core temperature. This is the very reason one places ice on an injury as the vasoconstriction will reduce swelling and inflammation.

It stands to reason that exposure to heat will cause vasodilation (expansion of arterial flow) and this is the very reason that some penile tumescence (state of fullness without rigidity) can occur in a warm shower. Nervous states or anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in a flaccid penis. Participation in vigorous athletic activity “steals” blood flow to the organs that need the oxygen and nutrients the most, namely the muscles, at the expense of organs like the penis.

Who Knew? Do you remember the Seinfeld episode in which Jerry’s girlfriend Rachel sees George naked after George steps out of a swimming pool?

 Rachel: “Oh my God, I’m really sorry.”

George: “I was in the pool; I was in the pool.”

George to Jerry: “Well I just got back from swimming in the pool and the water was cold.”

Jerry: “Oh, you mean shrinkage.”

George: “Yes, significant shrinkage.”

As mentioned, truly not a day goes by in my practice when I fail to hear the following complaint from a patient: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrink from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis, if you will. Weight gain and obesity will cause a generous pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.” Lose the fat and presto…the penis reappears. Having a plus-sized figure is just not a good thing when it comes to man-o-metrics.

Who Knew? “Fatal Retraction.” It is estimated that for every 35 lbs. of weight gain, there will be a one-inch loss in apparent penile length.

Who Knew? “Penile Dysmorphic Disorder,” very much paralleling “Body Dysmorphic Disorder,” is a condition in which one’s image of their penis is at odds with reality. Typically, one envisions himself as small when in fact he is quite within the normal range and an obsessive focus on this issue creates a great deal of psychological stress.

Who Knew? “Koro” (“head of the turtle” in Malay) is a cultural form of psychological panic that occurs predominantly in East Asian men. Those who suffer from this delusional disorder are terrified that their genitals will retract into their bodies and take extreme measures to prevent this from occurring.

The erectile cylinders of the penis are essentially our “erector sets,” consisting of three inner tubes within the penis that are composed of vascular (consisting of blood vessels) smooth muscle and sinuses that fill with blood upon sexual stimulation. An erection is on the basis of blood expanding these cylinders to the point of penile rigidity. Like any other muscle, the muscle of the penis needs to be used on a regular basis, the way nature intended for it to be used. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile smooth muscle can occur. In a vicious cycle, any loss of sexual function can lead to further progression of the problem. Poor genital blood flow produces a state of poor oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the sexual dysfunction.

Radical prostatectomy, the surgical removal of the entire prostate gland as a treatment for prostate cancer, can cause penile shortening by virtue of the removal of the prostate gland. The resultant gap in the urethra because of the removed prostate is repaired by sewing the bladder to the urethra with a consequent loss of urethral length. Penile shortening can be compounded by the disuse atrophy and scarring that can occur as a result of the erectile dysfunction associated with the surgical procedure, which sometimes can damage the nerves that are responsible for erections. Getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shortening because of scarring of the erectile cylinders that prevents them from expanding properly.

Androgen deprivation therapy is a means of suppressing the male hormone testosterone, typically used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage.

Who Knew? Penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky, ineffective and not ready for prime time. Certain procedures are what I call “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone and other tissue grafts. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis—certainly a far cry from a “proud soldier” and more like a “wounded warrior.” Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

Who Knew? The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to the recipient, whose organ was damaged beyond repair in an accident. Hmmm, now there is a concept for penile enlargement.

Andrew Siegel, MD

The aforementioned is largely excerpted from my new book: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.

www.MalePelvicFitness.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

 

 

New Drug For Peyronie’s Disease: Xiaflex

February 8, 2014

Blog #140

Peyronie’s Disease is an inflammatory condition of the penis that causes a curved penis, creating a deformed and often uncomfortable erection that can dramatically interfere with one’s sexual health. It is not uncommon, with an estimate of 65,000-120,000 cases per year in the USA with only a small fraction treated. Although it can manifest at any age, it most commonly occurs in the 50-60 year old population.

Peyronie’s disease can cause pain with erections; penile angulation; the presence of a penile scar that can be felt as a hard lump under the skin; a visual indentation of the penis described as an hour-glass deformity; and failure of the penis to properly fill with blood, causing poor erections.

The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is physically impossible.  The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring. Although the scarring is physical, it often has psychological ramifications, causing anxiety and depression.

The good news is that the FDA just approved a promising new non-surgical option for treating Peyronie’s. Xiaflex—aka collagenase—derived from the bacterium clostridium histolyticum, had previously been approved for Dupuytren’s contracture, an similar situation to Peyronie’s that occurs on the hand, causing a scarring of the tissue beneath the skin of the palm and fingers, making it very difficult to straighten one’s the fingers. This new medication functions as a “chemical knife” capable of dissolving collagen, the main constituent of scar tissue.

Xiaflex, indicated for men with an angulation of 30 degrees or more, is injected directly into the scar tissue after which the area is massaged and modeled to disrupt the scar tissue and mold the penis.  One course of treatment may involve as many as eight injections. Injection of this medication can be highly effective, but is not without side effects that may include bruising, swelling, pain and possibly rupture of the erectile cylinder of the penis causing a penile fracture.

Surgical procedures for Peyronie’s will generally result in greater improvements in the curvature than will the Xiaflex injections, but pose much greater risks of complications such as erectile dysfunction, changes in penile sensation and penile shortening.

Bottom Line: When scar tissue occurs on an area of the body that moves or expands it affects form as well as function, which can be disabling… thus, the significant impairment with Peyronie’s disease and Dupuytren’s contracture. It comes down to scar tissue in a bad place. Xiaflex is a promising new treatment, an interesting drug capable of dissolving scar tissue, obtained from the Clostridium bacteria.

Andrew Siegel, M.D.

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

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Peyronie’s Disease: What You Need To Know

December 28, 2012

Andrew Siegel. MD    Blog # 88

Peyronie’s Disease   is an inflammatory condition of the penis that causes scarring of the sheath surrounding the paired erectile cylinders within the penis.  As a result of this scarring, when an erection occurs, there is asymmetrical expansion of these erectile cylinders resulting in a penile curvature/angulation.  Peyronie’s causes a deformed and often uncomfortable erection that can dramatically interfere with a male’s sexual health.

Scar formation on the sheath of the erectile cylinders can cause pain with erections; penile curvature during erections; the presence of a penile scar or “plaque” that can be felt as a hard lump under the skin; a visual indentation of the penis described as an hour-glass deformity; and failure of the erectile bodies to properly fill with blood, causing erections of poor rigidity. Penile pain, curvature/angulation, and poor expansion of the erectile cylinders collectively can contribute to difficulty in having a functional and anatomically correct rigid erection suitable for satisfactory intercourse. The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is physically impossible.  The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring.

 

The angulation results from the scarring of the sheath of the erectile cylinders that, upon engorgement with blood, expand in an asymmetrical fashion. This situation is analogous to placing a piece of cellophane tape on a child’s balloon and then inflating it—where the tape (scar) is, the balloon cannot expand properly, resulting in an angulation at the point of the tape placement.

The prevalence of Peyronie’s is roughly 5% of the male population with a mean age of 57 years old. The underlying cause of Peyronie’s is unclear, but is suspected to be penile trauma, perhaps associated with vigorous sexual intercourse. The acute phase is characterized by painful erections and an evolving scar, curvature and deformity. The chronic phase that typically occurs a year or so after initial onset is characterized by absence of pain, stable deformity, and possible erectile dysfunction. Peyronie’s regresses spontaneously in about 15% of men, progresses in 40% of untreated men, and remains stable in 45% of men. Many men—understandably so—become very self-conscious about the appearance of their penis and the limitations it causes, and they avoid sex entirely.

Various treatment options include oral medications, topical agents, injections, shock wave therapy, and surgery.  Upon initial diagnosis, most men are started on oral Vitamin E, 400 IU daily, as this has the potential to soften the scar tissue causing the plaque. Unfortunately, however, none of the non-surgical options have proven to be very effective, because the essence of the issue is scar tissue in a very bad location.   This scarring sabotages the ability to obtain a straight and rigid erection. Erectile dysfunction can be managed with one of the oral E.D. medications including Viagra, Levitra, or Cialis.

If there is no response to conservative management of erectile dysfunction, a penile implant may be appropriate—this can manage the dual problems of erectile dysfunction and penile angulation. If erections are adequate, but angulation precludes intercourse, options include procedures that attempt to neutralize the angulation effect of the plaque by doing a nip and tuck opposite the plaque in an effort to make expansion more symmetrical.  Although this technique is effective in improving the angulation, it does so at the cost of some penile shortening, and I have yet to find a man who is pleased with losing penile length. Other more complex procedures involve incising or removing the scar tissue and using grafting material to replace the tissue defect.

Bottom Line: When scar tissue is only an anatomic consideration but not a functional consideration, it may be cosmetically unappealing, but is actually not such a bad situation.  However, when scar tissue occurs on an area of the body that moves, expands or acts as a conduit, it affects form as well as function, which is not a good thing. Thus a scarred elbow can impact mobility of the joint, scarred lungs can disturb breathing dynamics, a scarred bile duct can cause jaundice and scarred erectile cylinders can cause Peyronie’s disease. Unfortunately, it comes down to scar tissue in a bad place.

Resources:

www.peyroniesassociation.org

www.askaboutthecurve.com

www.menshealthPD.com

Andrew Siegel, M.D.

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

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