Posts Tagged ‘Peyronie’s disease’

Thankful for Tough Tissues: Big Head/ Little Head

August 4, 2018

Andrew Siegel MD   8/4/2018

Midas penis in cage

Image above from Phallological Museum in Reyjkavik that I recently visited

 

The toughest connective tissues in the human body, exclusive of bone and teeth (in order of strength) are:

  1. Dura mater (of brain and spinal cord)
  2. Tunica albuginea (of penis and clitoris)

Is it not fitting that the two toughest and hardiest connective tissues in the human body are located in the brain and genitals, providing protection and support to arguably two of our most vital and important human possessions? 

The hardest organs in the body are bones (calcium and other minerals) and teeth (enamel), but when it comes to connective tissue, the brain and penis/clitoris reign supreme. The brain and spinal cord are enveloped and protected by the dura mater (Latin, “hard mother”), the robust outermost membrane. The erectile chambers of the penis (and the clitoris, although on a miniaturized scale) are covered with a tough fibrous envelope called the tunica albuginea (Latin, “white membrane”).

The White Membrane

The tunica albuginea consists mostly of collagen with a sprinkling of elastin to allow it to stretch. It has an important role in maintaining both penile and clitoral erections.  When a penis is flaccid the tunica is 2 mm or so thick and with an erection it stretches to 0.25 to 0.5 mm thick.  At the time of erectile rigidity, the blood pressure in the penis exceeds 200 mm of mercury, the only place in the body where hypertension is desirable and necessary for proper function. The tunica albuginea supports the penis at these times of penile hypertension, allowing for full erectile rigidity and durability and protecting the penis against injury from the torquing and buckling stresses of sexual intercourse.

Acute Trauma to the White Membrane

On rare occasions, the tunica surrounding the erectile chambers of the penis ruptures under the force of a strong blow to the erect penis, a situation referred to as a penile fracture. It is not unlike the tire of a car being driven forcibly into a curb, resulting in a gash in the tread and deflation from the blow out. Such an acute blunt traumatic injury rarely occurs to the non-erect penis by virtue of its mobility, flaccidity, and 2 mm thick tunica. However, when the penis is rigid, there is peak tension and stretch on the white membrane. The leading cause of penile fractures is vigorous sexual intercourse, most often when the penis slips out of the vagina and strikes the perineum (area between the vagina and anus). She “zigs,” he “zags,” and a miss-stroke occurs of sufficient force as to rupture the white membrane.

Fracture can also occur under the circumstance of rolling over or falling onto the erect penis as well as any other situation that inflicts damage to the erect penis, such as walking into a wall in a poorly illuminated room or forcible masturbation.

Penile fracture is a medical emergency, and prompt surgical repair is necessary to maintain erectile function and minimize scarring of the erectile chambers that could result in permanent penile bending and angulation.

Chronic Trauma to the White Membrane

Chronic traumatic injuries to the white membrane are often asymptomatic for many years. Just the simple act of obtaining a rigid erection puts tremendous compression stress forces on the white membrane and the potential for micro-trauma to it increases exponentially when one inserts his 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 torquing 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 membrane, ultimately resulting in Peyronie’s disease.  This often manifests with a hard lump, shortening, curvature, narrowing, a visual indentation of the penis described as an hour-glass deformity, pain with erections and less erectile rigidity. 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.

Bottom Line:  The human body is nothing short of amazing and should be accorded the greatest respect. We should be grateful for our dura mater and tunica albuginea that protect and allow function of our brains and penises/clitorides, respectively.  Given the service that our penises provide, it is surprising that penile fracture and Peyronie’s disease are not more common than they actually are.

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

New video on female pelvic floor exercises:  Learn about your pelvic floor

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5 Reasons Your Penis May Be Shrinking

July 7, 2018

Andrew Siegel MD   7/7/18

Today’s entry is not about the moment-to-moment changes in penis size based upon ambient temperature and level of arousal, but to permanent alterations in penile length and girth that can occur for a variety of physical reasons. The preservation of penile dimensions is contingent upon having healthy, well-oxygenated, supple and elastic penile tissues that are used on a regular basis for the purposes nature intended.

 sculpture emasculated Reykjavik

Above photo I recently shot in Reykjavik, Iceland

Penis size is a curiosity and fascination to men and women alike. An ample endowment is often associated with virility, vigor, and sexual prowess.   There is good reason that the words “cocky” and “cocksure” mean possessing confidence.

What’s normal?

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. The penis is no exception, with some men phallically endowed, some phallically challenged, but most somewhere in the middle. Alfred Kinsey studied 3500 penises and found that the average flaccid length was 8.8 centimeters (3.5 inches), the average erect length ranged between 12.9 -15 centimeters (5-6 inches) and the average circumference of the erect penis was 12.3 centimeters (4.75 inches).

Who cares?

Interestingly, 85% or so of women are perfectly satisfied with their partner’s penile size, while only 55% of men are satisfied with their own penis size.

5 Reasons for a Shrunken Penis

  1. Weight gain: Big pannus/small penis

The ravages of poor lifestyle habits wreak havoc on penile anatomy and function.  The big pannus (“apron” of abdominal fat) that accompanies weight gain and especially obesity cause a shorter appearing penis.  In actuality, most of the time penile length is intact, with the penis merely buried in the fat pad.  It is estimated that for every 35 lbs of weight gain, there is a one-inch loss in apparent penile length.

The shorter appearing and more internal penis can be difficult to find, which causes less precision of the urinary stream that sprays and dribbles, often requiring the need to sit to urinate. Additionally, the weight gain and poor lifestyle give rise to difficulty achieving and maintaining erections.  This shorter and less functional penis and the need to sit to urinate is downright emasculating.

Solution: Lose the fat and presto…the penis reappears and urinary and sexual function improve.

  1. Disuse atrophy: Use it or lose it

Like any other organ in the body, the penis needs to be used on a regular basis, as nature intended.  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. In a vicious cycle, loss of sexual function can lead to further progression of the problem as poor genital blood flow causes low oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the problem.

Solution: Exercise your penis by being sexual active on a regular basis, just as you maintain your general fitness by going to the gym or participating in sports.

  1. Peyronie’s disease: Scar in a bad place

Peyronie’s disease is scarring of the covering sheaths of the erectile chambers. It is thought to be due to the cumulative effects of chronic penile micro-trauma.  The scar tissue is hard and inelastic and prevents proper expansion of the erectile chambers, resulting in penile shortening, deformity, angulation and pain. In the early acute phase—that can evolve and change over time—most men notice a painful lump or hardness in the penis when they have an erection as well as a bent or angulated erect penis. In its more mature chronic phase, the pain disappears, but the hardness and angulation persist, often accompanied by penile shortening and narrowing where the scar tissue is that gives the appearance of a “waistband.”  Many men as a result of Peyronies will have difficulty obtaining and maintaining an erection.

Peyronies can also occur as a consequence of a penile fracture, an acute traumatic injury of the covering sheath of the erectile chamber.  This most commonly happens from a pelvic thrusting miss-stroke during sexual intercourse when the erect penis strikes the female perineum or pubis and ruptures.  This is an emergency that requires surgical repair to prevent the potential for Peyronie’s disease.

Solution: If you notice a painful lump, a bend, shortening and deformity, see a urologist for management as the Peyronies is treatable once the acute phase is over and the scarring stabilizes.  If you experience a penile fracture after a miss-stroke—marked by an audible pop, acute pain, swelling and bruising—head to the emergency room ASAP.

  1. Pelvic surgery

After surgical removal of the prostate, bladder or colon for management of cancer, it is not uncommon to experience a decrease in penile length and girth.  This occurs due to damage to the nerves and blood vessels to the penis that run in the gutter between the prostate gland and the colon. The nerve and blood vessel damage can cause erectile dysfunction, which leads to disuse atrophy, scarring and penile shrinkage.

In particular, radical prostatectomy—the surgical removal of the entire prostate gland as a treatment for prostate cancer—can cause penile shortening. The shortening is likely based on several factors. The gap in the urethra (because of the removed prostate) is bridged by sewing the bladder neck to the urethral stump, with a consequent loss of length from a telescoping phenomenon.  Traumatized and impaired nerves and blood vessels vital for erections give rise to erectile dysfunction. The lack of regular erections results in less oxygen delivery to penile smooth muscle and elastic fibers with subsequent scarring and shortening, a situation discussed above (disuse atrophy).

Solution: Resuming sexual activity as soon as possible after radical pelvic surgery will help “rehabilitate” the penis and prevent disuse atrophy. There are a number of effective penile rehabilitation strategies to get “back in the saddle” to help prevent disuse atrophy.

  1. Anti-testosterone treatment

“Androgen deprivation therapy” is a common means of suppressing the male hormone testosterone, used as a form of treatment for prostate cancer. Because testosterone is an important hormone for maintaining the health and the integrity of the penis, the low testosterone levels resulting from such therapy can result in penile atrophy and shrinkage.

Solution: This is a tough one.  Because of the resulting low testosterone levels, most men have a diminished sex drive and simply lose interest in sex and “use it or lose it” becomes challenging. Furthermore, many men on this therapy have already had a radical prostatectomy and or pelvic radiation therapy, so often have compromised erections even before using androgen deprivation therapy. Anecdotally, I have had a few patients who have managed to pursue an active sex life and maintain penile stature with the use of Viagra or other medications in its class. 

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

 

 

When Sex Hurts (and Pain Replaces Pleasure)

February 24, 2018

Andrew Siegel MD    2/24/2018

Sex should be pleasurable and enjoyable, but sadly, that is not always the case.  Dyspareunia is doctor-speak for difficult or painful sexual intercourse, derived from dys, meaning “difficult” and the Greek term pareunos, meaning “lying with.” Although more typically a female complaint, dyspareunia does not spare the male gender.

ouch-147868_1280

Thank you Pixabay for image above

A Mechanistic View of Sexual Intercourse

A mechanical view of sexual intercourse is that it is an activity that involves moving parts that need to be lubricated and fit together properly for optimal function.  The “piston” component of an engine moves up and down within the “cylinder,” requiring appropriate fitting together of these component parts and sufficient lubrication to avoid excessive friction among the moving parts. “Piston clearance” is the clearance or gap between piston and cylinder.  If piston clearance is too small, the piston can “seize” inside the cylinder on expansion. If the pistons fits too tightly within the cylinder, it can result in excessive friction and damage to the cylinder wall.  The bottom line is that problems can arise if the piston does not properly fit the cylinder or if there is inadequate lubrication of contact points.

 Causes of Female Dyspareunia

  • Size discrepancy with partner – The vagina is an incredibly accommodating organ capable of tremendous stretch and expansion—think vaginal delivery of a 10-lb. baby—so this is relatively rare, but a woman with petite anatomy who couples with an outsized male can be a formula for pain. A lengthy penis can strike the cervix or vaginal fornix and a penis with formidable girth may prove excessive for a narrow vagina, resulting in “collision dyspareunia.”
  • Vaginal scarring – Scar tissue from pelvic or vaginal surgery, birth trauma, or poor healing of episiotomies can alter vaginal anatomy and make sexual intercourse painful and challenging.
  • Menopause – Estrogen nourishes and nurtures the genital tissues.  Declining levels of estrogen after menopause cause the vaginal walls to thin, become more fragile and less supple, and the amount of vaginal lubrication to diminish.
  • Infection – Vaginitis (vaginal infections), bacterial cystitis (bladder infection), interstitial cystitis, pelvic inflammatory disease, and infections of the paraurethral (Skene’s glands) can all give rise to pain.
  • Endometriosis –The lining tissue within the uterus called the endometrium can implant outside the uterus, causing painful intercourse.
  • Hypertonic pelvic floor – This is a condition–also called vaginismus– in which the pelvic floor muscles are taut and over-tensioned and fail to relax properly, which can cause painful intercourse, if sex is even possible.
  • Vulvodynia – This is a condition marked by hypersensitive vulvar tissues that are extremely tender to touch.
  • Loss of vaginal lubrication –  This can happen from menopause (natural or from surgery), side effects of medications, breast-feeding, as well as insufficient foreplay.
  • Disuse atrophy – Use it or lose it; if one has not been sexually active for prolonged times, there can be loss of tissue integrity and vaginal atrophy.   Staying sexually active keeps one’s anatomy toned and supple.
  • Urethral diverticulum – This is an acquired outpouching from the urethra channel that can cause a cystic mass in the vagina that can result in pain with sex.
  • Psychological/emotional – “The mind suffers…the body cries out.” Emotionally or physically traumatic sexual experiences can negatively affect future sexual experiences.

Causes of Male Dyspareunia

Urologists sometimes refer to male dysparenuia as “his-pareunia–not a legitimate medical word, but to the point!

  • Infections —Infections of the prostate (prostatitis) and urethra (urethritis) can cause pain with ejaculation.
  • Peyronie’s disease – Scarring of the sheath of the erectile cylinders gives rise to an angulated and often painful penis, particularly so with erections.
  • Phimosis — This is a condition is which the foreskin is tight and cannot be drawn back, leading to inflammation, pain and swelling.
  • Tethered frenulum — The frenulum is a narrow band of tissue that attaches the head of the penis to the shaft; at times it can tear during sexual intercourse, causing bleeding and pain.
  • Penile enlargement procedures – Efforts to “bulk up” the penis with injections of fat, silicone and other tissue or prosthetic grafts can result in an unsightly, lumpy, discolored, and painful penis.
  • Improperly sized penile implants – Penile implants can be lifesavers for the sexually non-functional or poorly functional male, but need to be sized precisely, like shoes for one’s feet.  If too large, they can result in penile pain and pain with sex.
  • Her issues causing his pain – Mesh exposure is a condition in which a mesh implant–used in females to help support dropped pelvic organs and to cure stress urinary incontinence–is “exposed” in the vagina, which feels on contact like sandpaper and can result in both female and male dyspareunia.

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, Apple 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

 

The Penis Pump (Vacuum Erection Device): What You Need To Know

April 8, 2017

Andrew Siegel MD  4/8/17

The vacuum erection device (VED) is an effective means of inducing a penile erection suitable for sexual intercourse–even in difficult to treat men who have diabetes, spinal cord injury, or after radical prostatectomy for prostate cancer.  The device is also useful in the post-operative period following radical prostatectomy to maintain penile length and girth. It has some utility in Peyronie’s disease patients in order to improve curvature, pain and maintain penile dimensions. It can be used prior to penile prosthesis surgery in order to enhance penile length and facilitate the placement of the largest possible implant.  

VED

Image Above: Vacuum Erection Device (obtainable via UrologyHealthStore.com–use promo code UROLOGY 10 for 10% discount and free shipping)

Introduction

Tissue expansion is local tissue enlargement in response to a force that can be internal or external.  Internal tissue expansion occurs naturally with pregnancy, weight gain and the presence of slow growing tumors. Plastic surgeons commonly tap into this principle by using implantable tissue expanders prior to breast reconstructive surgery.

The VED uses the principle of external tissue expansion by using negative pressures applied to the penis to stretch the smooth muscle and sinuses of the penile erectile chambers. The resultant influx of blood increases tissue oxygenation, activates tissue nutrient factors, mobilizes stem cells, helps prevent tissue scarring and cellular death and, importantly, induces an erection.

There are many commercially available VEDs on the market, which share in common a cylinder chamber with one end closed off, a vacuum pump and a constriction ring.  The penis is inserted into the cylinder chamber and an erection is induced by virtue of a vacuum that creates negative pressures and literally sucks blood into the erectile chambers of the penis. To maintain the erection after the vacuum is released, a constriction ring is applied to the base of the penis.  The end result is a rigid penis capable of penetrative intercourse.

Interesting factoid: Similarly designed vacuum suction devices are available for purposes of nipple and clitoral stimulation.

Brief History of VED

In 1874, an American physician named  John King came up with the concept of using a glass exhauster to induce a penile erection. The problem with the device was the loss of the erection as soon as the penis was withdrawn from the exhauster. In 1917 Otto Lederer introduced the first vacuum suction device.  After many years of quiescence, the VED was popularized by Geddins Osbon and named “the Erecaid device.” Currently, the VED is a popular mechanical means of inducing an erection that does not utilize medications or surgery.

Nuts and Bolts of VED Use

The VED is prepared by placing a constriction ring over the open end of the cylinder. A water-soluble lubricant is applied to the base of the penis to achieve a tight seal when the penis is placed into the cylinder.  Either a manual or automatic pump is used to generate negative pressures within the cylinder, which pulls blood into the penis, causing fullness and ultimately rigidity. Once full rigidity is achieved, the constriction ring is pushed off the cylinder onto the base of the penis. Importantly, the ring should never be left on for more than 30 minutes to minimize the likelihood of problems. After the sexual act is completed, the constriction ring must be removed.

Interesting Factoid: The VED can be used alone or in combination with other forms of treatment for ED, including pills (Viagra, Levitra and Cialis), penile injection therapy and penile prostheses.

Pluses and Minuses of the VED

A distinct advantage of the VED is that it is a simple mechanical treatment that does not require drugs or surgery.  Disadvantages are the need for preparation time, which impairs spontaneity.  Another disadvantage is the necessity for wearing the constriction device, which can be uncomfortable and can cause “hinging” at the site of application of the constriction ring resulting in a floppy penis (because of lack of rigidity of the deep roots of the penis) as well as impairing ejaculation. Other potential issues are temporary discomfort or pain, coolness, numbness, altered sensation, engorgement of the penile head, and black and blue areas.

VED After Radical Prostatectomy

Erectile function can be adversely affected by radical prostatectomy with recovery taking months to years. The VED can be used to enhance the speed and extent of sexual recovery after surgery, minimize the decrease in penile length and girth that can occur, and enable achievement of a rigid erection suitable for sexual intercourse.  Clinical studies have clearly demonstrated that VED use after prostatectomy helps maintain existing penile length and prevents loss of length.

Bottom Line:  The VED is one of the oldest treatments for ED that remains in contemporary use.  It works by creating negative pressures that cause an influx of blood into the penile erectile chambers resulting in penile expansion and erection.  Although effective even in difficult to treat populations, the attrition rate is high, perhaps because of the cumbersome nature of the device and the preparation regimen and time involved. However, the VED is an important part of the “erection recovery program” (penile rehabilitation) after prostatectomy, second only to oral ED pills in use for this purpose. It is particularly vital in the preservation and restoration of penile anatomy and size.  It also is useful in ED related to other radical pelvic surgical procedures including colectomy for colon cancer. It remains a viable alternative in men not interested or responsive to ED pills or penile injections and those not interested in surgery.

There are many different VED systems on the market. The Urology Health Store (www.UrologyHealthStore.com) has a nice selection of VEDs (use promo code UROLOGY 10 for 10% discount and free shipping).

** The Urology Health Store  is offering live video VED instructional classes via Skype, Go-To-Meeting or FaceTime.  These classes are available by appointment from 1PM-3PM, U.S. Eastern Time, Monday-Friday.  Call 301-378-8433 for appointment.  No purchase is necessary to take the class.

Excellent resource: 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

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

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

FullSizeRender-2

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

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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.