Posts Tagged ‘radical prostatectomy’

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

 

 

 

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“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. 

Robotics In Urology

January 23, 2016

Andrew Siegel, MD 1/23/16

The word “robot” was coined by a Czech playwright almost a century ago, derived from “robota,” meaning “forced labor.”  Now used routinely, robotics represents a significant engineering advance that has been rapidly adopted by urologists since its inception 15 years ago.  Before the availability of this technological breakthrough, major urological surgical procedures were performed through large incisions with poorer visualization, more blood loss, less precision, more pain and longer hospital stays and recovery.

With the advent of laparoscopy (“keyhole”) surgery done via small portals and thereafter the development and refinement of surgical robotics, many advantages have accrued. Major surgical procedures can be performed less invasively, with a reduction in blood loss, a brighter, sharper and magnified visual field for the surgeon, less pain and faster recovery. The robot has been put to use for prostate, bladder, kidney and adrenal surgery as well as for severe cases of female pelvic organ prolapse. Robotic technology has been beneficial in helping urologists remove diseased organs as well as in facilitating reconstructive urological procedures. Robots do not perform the surgery independent of the surgeon!  The urologist with a dedicated team of assistants harnesses the powers of the robot for the benefit of the patient, the robotic technology an extraordinary example of human-machine symbiosis.

Initially, portals are placed by small incisions that leave only small scars and cause limited pain. Through one of these portals, a camera is inserted to obtain an optically magnified, three dimensional, high definition view of the surgical field. The camera can be manipulated, zoomed, rotated, etc. Robotic instruments that are mounted on the robot’s arms are inserted through the portals. These include electric cautery used to cut and coagulate tissue, scissors, forceps, scalpels, needle holders and other surgical tools.

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(The operative field with robotic instruments mounted on robotic arms)

The surgeon sits at a console remote from the patient and controls and maneuvers the miniaturized robotic instruments while viewing the operation in real time. An advantage of sitting at the console is that it is a very comfortable, ergonomically favorable position that minimizes the postural fatigue that often accompanies standing up for traditional open surgery. The surgeon’s fingers are inserted into surgical joysticks that provide control of the instruments by using natural hand and wrist movements, with the system capable of “motion scaling,”  converting the surgeon’s movements to precise, tremor-free robotic micro-movements.  In addition to hand controls the surgeon uses foot pedals to control the camera, focus, electro-cautery and coagulation.  Seven degrees of freedom (each direction a joint can move is a degree of freedom) are provided at the instrument tips. 540 degrees of pivoting provide greater maneuverability than is possible with the human hands or laparoscopic instruments.

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(Dr. Mutahar Ahmed seated at the console performing a robotic prostatectomy)

Robot-assisted laparoscopic prostatectomy is the surgical approach of choice for removing a cancerous prostate gland, allowing the surgeon the benefits of markedly better vision and maneuverability, very refined precision in the dissection of delicate tissue and facilitation of suturing. Because of these advantages, in addition to less bleeding, less post-operative pain and shorter hospital stays, there are improved outcomes in terms of urinary incontinence and erectile dysfunction as compared with the open approach.

Bottom Line: Surgical robotics is a revolutionary technological advance that has been rapidly adopted by urology, general surgery, gynecology, cardio-thoracic, pediatric and ear-nose-throat surgeons. It affords numerous advantages including surgeon comfort and ergonomics, high quality 3D vision, motion scaling, enhancement of surgeon dexterity and elimination of tremors, which translates to numerous benefits and advantages to the patient.

Exactly one year ago,  New Jersey Center for Prostate Cancer & Urology (NJCPCU) and Bergen Urological Associates (BUA) merged practices.  The main office is located at 255 W. Spring Valley Avenue in Maywood, New Jersey. The combined group consists of  8 urologists, a physician’s assistant and nurse practitioner. The merger brings together the exceptional robotic skills of the NJCPCU urologists (having pioneered robotic prostatectomy in New Jersey and having performed more than 7000 such procedures) with the urological expertise and experience of the BUA urologists.

RoboticUrology.com                                                                                                BergenUrological.com

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

Erection Recovery Program

December 5, 2015

Andrew Siegel MD   12/5/15

Reviresco – (Latin, re- + viresco) “I become green or verdant again”; “I am renewed or revived.”

Outliving Your Penis

It is very possible that you will “outlive” your penis. It will always be there for you in terms of a “spigot” to allow you the privilege of standing up to aim your urinary stream with reasonable accuracy, although this too suffers the ravages of time. However, in terms of being able to obtain or maintain an erection, your penis may perish decades before you do, for a variety of reasons.

The focus of today’s blog is ED due to prostate cancer treatment, although it is equally relevant to any man suffering with ED for any reason.  Having one’s prostate removed is a highly successful means of curing prostate cancer.  However, despite advances in technical and surgical approach, trauma to nerves, blood vessels, and muscular tissue during surgery can compromise sexual function, with ED being the most common complication.  The effect of radical prostatectomy on the penis is not unlike the effect of a stroke on the brain: in both situations a neuro-vascular (nerve/blood vessel) event occurs that may profoundly disturb function.  90% of men experience some degree of ED in the early post-surgery recovery period. The good news is that there are effective “rehab” and even “prehab” methods to optimize preservation and return of sexual function.  

Even if your penis has “expired” in terms of becoming rigid, it is still capable of being stimulated to ejaculation and orgasm, a phenomenon eventually discovered by many men. This is a small consolation (pun intended) for suffering with ED.

If your penis is not completely lifeless, it may be impaired such that you can obtain an erection, but lose it prematurely, or you can obtain at best a partially firm, non-penetrable erection. As if having a crippled penis were not severe enough punishment, to add insult to injury one of the consequences of lack of erections and sexual inactivity is further compromise of the future potential for erections. In other words, you need to obtain erections in order to maintain erections.

Use It Or Lose It

Erections not only provide the capacity for penetrative sex, but also serve to keep the erectile chambers (erectile smooth muscles and vascular sinus tissues) richly oxygenated, elastic and functioning. If one goes too long without an erection, damage to this erectile apparatus can result in penile atrophy (shrinkage) and compromised function. In a vicious cycle, the poor blood flow from disuse induces scarring and further damage to erectile smooth muscle and sinus tissues that often gives rise to venous leakage (rapid loss of erections as blood cannot be properly trapped within the erectile chambers). The bottom line is that in the absence of regular erections, one will likely lose length, girth and function, with the penis hobbled by its inability to properly trap blood.

As an aside, one of the functions of sleep erections—the spontaneous nocturnal erections that occur during REM (rapid eye movement) sleep in healthy men—is to maintain the erectile chambers in good working order. As sleep has an important restorative function for the human body, so sleep erections have a vital restorative function for the human penis.

Penile Resurrection

Achieving erections when they fail to occur by natural means is vital for sexual “resurrection” (l like the sound of this word—say it slowly). In time, the nerves that were “stunned” and/or injured by radical prostatectomy will usually heal and during this convalescing time, obtaining erections will help preserve erectile tissue. The implication is that even if you are sexually inactive, if you anticipate being sexually active in the future, you need to keep the penis and erectile apparatus fit.

Many urologists recommend penile “rehabilitation” when healed up after radical prostatectomy. Traditional rehab involves a combo of pills, injections and vacuum therapy, a.k.a. vacuum suction device (VSD). Some men use one, two or all three of these rehab strategies.

The oral ED medications (Viagra, Levitra, Cialis, and Stendra) can help maintain penile blood flow and provide the benefits that derive from maintaining tissue oxygenation. However, they are double-edged swords as they cannot be used in the face of certain medical conditions, have side effects, are expensive (costing about $40 per pill) and are not effective in all comers.

For those who do not respond to pills, the next step is often penile injections. Vasodilator drugs are injected directly into the erectile chambers to induce an erection. A mixture of one or more medications is often used for this purpose. Unfortunately–despite its effectiveness–many men are not fond of putting a needle in their penis and often nix this means of treatment.

The VSD is the third traditional rehab element. Starting 6 weeks or so after surgery and pursued for 10 minutes daily, the VSD mechanically engorges the penis in an effort to keep the erectile chambers healthy.

The Erection Recovery Program

“Prehab” is a means of pre-rehabilitation that is started shortly after the diagnosis of prostate cancer, during the time period when one awaits being operated upon. Instead of waiting for after-the-fact rehab, prehab intends to maximize sexual function before surgery in an effort to hasten recovery of erectile function after surgery. Committing to the erection recovery program before the trauma of surgery permits one to go into the operation optimally prepared.

The Erection Recovery Program combines two non-pharmacological, non-invasive tools—vibratory nerve stimulation and pelvic floor muscle training—to stimulate the nerves that produce erections and to strengthen the muscles that contribute to erectile rigidity, respectively. The traditional rehab program can be highly effective; however, it addresses primarily blood flow, a vital element of erectile physiology, while not focusing on nerve stimulation and pelvic floor/perineal muscle function, important contributors to the erectile process.

Vibratory-tactile nerve stimulation in men was originally conceived (pun intended) for spinal cord injured patients who desired to father children but were incapable of doing so because of their inability to ejaculate. However, vibro-tactile nerve stimulation is equally effective in inducing erection as well as ejaculation/orgasm in the non-spinal cord injured population and its use has been expanded to the general male population.

The pelvic floor/perineal muscles activate at the time of sexual stimulation, compressing the deep roots of the penis and fostering hypertensive blood pressures in the erect penis in excess of 200 mm, responsible for rock-hard rigidity. Pelvic floor muscle training has been used to bolster the strength, power and endurance of these muscles in order to optimize erectile rigidity and durability. Without well functioning pelvic floor/perineal muscles, full rigidity will not occur.

Oral meds, injection and/or vacuum therapy help prevent erectile tissues from losing elasticity and becoming scarred and less functional from the absence of erections. Similarly, nerve stimulation and pelvic floor/perineal muscle training help maintain the integrity of the erectile tissues as well as help prevent the pelvic floor/perineal muscles from atrophying in the absence of erections.  By keeping the pelvic floor/perineal muscles fit, when erections ultimately do return, function can be optimized.

The combination of nerve stimulation and pelvic floor muscle strengthening is a powerful alliance that is prescribed “prehab” as well as after radical prostatectomy to shorten the time it takes to recover erections. Its merits are its simplicity, safety, efficiency and the fact that it is actually pleasurable to pursue. It does not preclude the use of the traditional rehab program, which can be used in conjunction with the Erection Recovery Program.

Specifically, the Erection Recovery Program consists of the Viberect nerve stimulation device and the Pelvic Rx pelvic floor muscle training program. Viberect, manufactured by Reflexonic, is an FDA-certified hand-held penile vibro-tactile nerve stimulation device that triggers erection and ultimately ejaculation. The Pelvic Rx program, manufactured by Adult Fitness Concepts, is a FDA-registered, comprehensive, interactive follow-along exercise program to increase pelvic floor muscle strength, tone, power, and endurance. Basic Training strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises, while Complete Training provides maximum opportunity for gains via resistance equipment.

Bottom Line: 

The critical principle for erectile recovery is achieving an erection for at least several times weekly during the recovery period after prostate surgeryPenile vibro-tactile nerve stimulation coupled with pelvic floor muscle training is a synergistic combination that promotes initiation and maintenance of erections, respectively. 

This Erection Recovery Program is used prehab (prior to radical prostatectomy) and continued after surgery.  It offers a non-pharmacological option for erection recovery, but can also be used in conjunction with traditional penile rehab programs that use medications.  The Erection Recovery Program is also appropriate for any man who wants to improve sexual function, regardless of the underlying cause.  

To obtain the Erection Recovery Program:

http://www.viberect.com/erection-recovery-program-combo-pack.html

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

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

July 11, 2015

Andrew Siegel, MD  7/11/15

shutterstock_orange gu tract

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

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

Side Effects of Prostate Cancer Surgery

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

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

The Importance of Strengthening the Pelvic Floor Muscles

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

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

The Principles of Arnold Kegel

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

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

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

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

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

4. Resistance adds a dimension that further challenges the growth of your pelvic floor muscles. Working your pelvic muscles against resistance rapidly escalates their strength and endurance, since muscle growth occurs in direct proportion to the demands and resistances placed upon them, a basic principle of muscle physiology.  It is similar to the difference between doing arm curls without weights versus with weights.

How To Strengthen the Pelvic Floor Muscles

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

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

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

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.  In the works is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

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

Penile Rehabilitation (Penile “Rehab”)

March 13, 2015

Andrew Siegel MD   3/13/15

shutterstock_side view manjpeg

Penile rehab is probably not what you think. It is not a place where “misbehaved” penises go to get reformed and restored to normalcy. 

Although the term “rehab” has a bit of a negative connotation–a place and a process by which one attempts to reclaim their lives from the grip of a drug, alcohol or other addiction–it should, however, be thought of in a positive sense as a means of regaining strength, skills and normalcy after not only an addiction, but also an injury, illness, or surgery.

Rehab can take many forms: physical (physical therapy to treat an injury or help recover mobility and strength after surgery), occupational (to recover the ability to perform daily activities), speech (to recover comprehension of language, speaking, reading and writing), cardiac (after a serious cardiac event or surgery) and pulmonary (to improve breathing).

What Does This Have To Do With The Penis?

Some abdominal and pelvic surgical procedures—including removal of the prostate, the bladder, and the colon—can result in a penile dysfunction in which it becomes difficult to obtain or maintain an erection. Similarly, pelvic radiation therapy and pelvic injuries can negatively affect one’s sexual function.

The problem is that if you go for too long without an erection, penile smooth muscle and other tissues may be damaged, resulting in a loss of penile length and girth and further compounding the ED. Like every other body part, your penis needs to be used the way nature intended. A marvel of engineering, the penis is uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge of blood flow happening within seconds and accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. An erect penis not only gives you the capacity for penetrative sex, but also serves to keep the penile muscles and tissues richly oxygenated, elastic and functioning well.

Interestingly, studies have demonstrated that sex on a regular basis protects against ED and 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. (Am J Med 2008 July; 121(7): 592-596).

In the absence of regular erections, disuse atrophy (wasting away with a decline in anatomy and function) can occur. In a vicious cycle, the poor blood flow resulting from disuse produces a state of poor oxygen levels in the penile tissues, that, in turn, can induce scarring, which further decreases sexual function. This is where the concept of penile rehab comes into play. Rehab the penis after surgical, radiation or physical trauma to get it back into a functional state.

So What Is Penile Rehab?

Penile rehab is a process by which you attempt to recover erectile function after surgery, radiation or injury that compromises your sexual function. This is most commonly used after surgery or radiation for prostate cancer, but is also relevant for other major pelvic surgeries as well as pelvic injuries. There are numerous techniques for penile rehab (in order of least invasive to most invasive): exercises, vacuum, pills and injections.

Pelvic Floor Muscle (PFM) Exercises

This is physical therapy for the penis, which should be a first-line approach because of its safety, non-invasiveness, and minimal expense.

When the pelvic floor muscles contract, they increase blood flow to the penis, specifically by the actions of the two superficial pelvic floor muscles—the bulbocavernosus (BC) and ischiocavernosus (IC) muscles that become engaged at the time of an erection. Contractions of these PFMs prevent the exit of blood from the penis, enhancing penile rigidity. With every contraction of the BC and IC muscles, a surge of blood flows into the penis. Additionally, these muscles act as powerful struts to support the roots of the penis, the foundational support that allows a more “skyward” angling erection. Increasing the strength, tone and conditioning of these muscles will enhance their function, resulting in more powerful contractions and more penile rigidity and stamina. PFM exercises can serve as a powerful tool to help reignite erectile function.

Vacuum Suction Device

This is a mechanical means of producing an erection in which the penis is placed in a plastic cylinder that is connected to a manual or battery-powered vacuum. The negative pressure created by the vacuum literally sucks blood into the penis, creating a state of engorgement.

PDE5 inhibitors: Viagra, Levitra, Cialis, Stendra

Viagra (Sildenefil). Available in three doses—25, 50, and 100 mg—it is taken on demand and will produce an erection in most men within 30-60 minutes if they are sexually stimulated, and will remain active for up to 8 hours.

Levitra (Vardenefil). Available in 5, 10, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra.

Cialis (Tadalafil). Available in 2.5, 5 mg, 10mg, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra. It has duration of about 36 hours that has earned it the nickname “the weekender.” In 2012, daily lower doses of Cialis were FDA approved for the management of urinary symptoms due to benign prostate enlargement.

Stendra (Avanafil). Similar to Viagra, it is available in 50, 100 and 200 mg doses. It has the advantage of a rapid onset.

Penile Injections

Injections of these vasodilators (medicines that increase blood flow) directly into the erectile chambers of the penis induce an erection. Caverject and Edex (Prostaglandin E1) are commonly used for this purpose.  Side effects can be pain, bruising, scarring and prolonged erections. At times, a combination of medications needs to be used to obtain optimal results; this combination is known as Trimix and consists of Papaverine, Phentolamine, and Alprostadil.

Thinking Forward

Adaptation of skeletal muscle is an accepted scientific precept and if you have ever had your arm or leg in a cast, you can understand the detrimental effect of disuse on muscle tone and strength. The corollary is that if you have ever done weight training, you understand the beneficial effect of resistance training on muscle tone and strength.

So, instead of thinking of penile rehab as a means of getting back function after surgery, radiation or injury, how about thinking of it as a means of preventing the inevitable decline in function that accompanies aging? Or to take it another level, think of rehab as a means of optimizing the blue-ribbon function that you may be fortunate enough to already have.  I’m not suggesting using invasive methods such as the vacuum, pills, or injections, but about pursuing exercises that can improve dysfunction, optimize current function and maintain future function.

 

Wishing you the best of health,

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-creator of Private Gym pelvic floor muscle training program for menhttp://www.PrivateGym.com Gym-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 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.

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.

Use Your X or Lose It

November 1, 2014

Andrew Siegel, MD

Use X or lose it…X can be anything–you fill in the blank–your muscles, your brain, your bones, your sexual function.

The cells and tissues of our bodies—including muscles, bones, brains, and every other organ—are endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to the environment they are exposed to. What it comes down to is that our human body is an “adaptation machine.”   Our composition is “fluid” as opposed to “static,” and our tissues are constantly being remodeled, restructured and refashioned in adaptive responses that occur in accordance to the forces, stresses, resistances and demands placed upon them. This plasticity is an amazing phenomenon that can be tapped into by purposely challenging our tissues with the appropriate resistances to enable them to perform at extreme high levels of function.

Today’s blog is a discussion of use X or lose it in the context of male sexual function.

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

Your penis needs to be utilized the way nature intended, just like every other body component…and that means not just to direct your urinary stream with laser-like precision! Your penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge of blood flow happening within seconds and accomplished by relaxation of the smooth muscle within your penile arteries and erectile tissues. When your penis is erect, not only is rigidity achieved, but the erection also serves to keep your penile muscles and tissues richly oxygenated, elastic and functioning well. The dramatic increase in penile blood flow that occurs with an erection enhances subsequent erectile performance via the release of nitric oxide, one of the important chemical mediators of erections.

In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of your penile smooth muscle and erectile tissues can occur. In a vicious cycle, the poor blood flow resulting from lack of use produces a state of poor oxygen levels in the penile tissues, that, in turn, can induce scarring, which can further compound sexual dysfunction.

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.  (Am J Med 2008 July;121(7): 592-596).

Radical prostatectomy, the surgical removal of the prostate gland for treatment of prostate cancer, can cause penile shortening. 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 thought to be on the basis of a telescoping phenomenon. Erectile dysfunction associated with damage to the nerves that are responsible for erections further compounds the shortening by causing disuse atrophy and scarring. For this reason, getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

A Few Words on Adaptation

Your muscles and other tissues are capable of hypertrophy (growth) or atrophy (shrinkage), depending upon the environment to which they are subject to. Exposure to a stimulating and active “environment” on a long-term basis can positively affect not only your external appearance, but also more importantly, your internal health. Conversely, exposure to a non-stimulating, sedentary environment on a long-term basis can negatively affect your external appearance and internal health.

Every cell, tissue and organ of your body is endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to environmental changes. It deserves repeating that your body and its parts are “fluid” as opposed to “static” and are constantly being remodeled, restructured and refashioned in adaptive responses occurring in accordance to the forces, stresses, resistances and demands placed upon it.

Use It or Lose It

Our bodies demand physical activity in order to function optimally. For example, our bones require weight bearing and biomechanical stresses in order to stay well mineralized and in peak functional condition, as bone mineralization is stimulated by the stresses brought on by a variety of movements. The same holds true for every organ in our body—to maintain maximal functioning they need to be put into the service for which they were designed. As much as our bodies adapt positively to resistance, so they will adapt negatively to a lack of resistance. For example, after wearing a cast on one’s arm for 6 weeks, there is noticeable wasting of the arm muscles, nothing other than disuse atrophy. This phenomenon will occur to any body part not used in the manner for which it was designed.

Beyond Using It

The magic of plasticity and adaptability can be tapped into by challenging your body to adapt to resistances to enable it to perform at extreme levels of function. Exercise is about the adaptation—in neuromuscular, mechanical, and metabolic terms—to the specific demands that are placed on it. As your body is subjected to gradual and progressive “overload,” adaptation occurs and a “new normal” level of fitness is achieved.

Your pelvic floor muscles play an important role during erections, activating and engaging to help maintain penile rigidity and a skyward angling erection. There is good reason that the 1909 Gray’s Anatomy labeled one of the pelvic floor muscles the “erector penis.” Numerous studies have documented the benefits of male Kegel exercises in the management of ED.

Participating in a pelvic floor muscle training program can be a very useful tool to improve ED. It will sharpen your awareness of your pelvic floor muscles and enable you to isolate them and increase their strength, tone, and endurance. As your pelvic floor muscles become more robust, erections will improve accordingly. A comprehensive program such as the Private Gym includes a basic series of progressive male Kegel exercises without resistance followed by the use of resistance equipment to maximize pelvic floor muscle strengthening and performance. The pelvic muscles—like any other muscle in your body—will gradually and progressively adapt to the load placed upon them and will strengthen in accordance with the resistance.

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Elston Howard was a New York Yankee who invented the batting “donut,” a circular lead weight that slides onto baseball bats and is used by on-deck batters. This added weight during practice swings is useful for stretching, enhancing bat speed and strength training; additionally, it makes the bat feel very light once it comes time to step up to the plate and remove the weight. Howard employed the resistance principle to heighten power—use the weighted bat in practice and when it comes time to step up to the plate, you’re going to perform better.

 

batting donut on bat

 

This principle will work on your “bat,” too—utilize resistance training in practice and when it comes time to “step up to the plate,” you’re going to perform better. Resistance training turns conditioning into a weapon that is capable of producing “outstanding” erections, maximizing endurance, and  boosting one’s confidence.

Bottom line: You can lose it, maintain it, or optimize it by not using it, using it, or subjecting it to exercise and resistance training, respectively. You are bestowed with an amazing and magical capacity for plasticity and adaptation, which can be transformative when used to your advantage and benefit.

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

Note: As Arnold Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so I am working towards the goal of popularizing pelvic floor muscle exercises in males. This year I published a review article in the Gold Journal of Urology entitled Pelvic Floor Muscle Training in Men: Practical Applications to disseminate the importance and applications of these exercises to my urology colleagues. I wrote Male Pelvic Fitness: Optimizing Sexual and Urinary Health, a book intended to educate the non-medical population. I, along with my partner David Mandell and our superb pelvic floor team, co-created the Private Gym male pelvic floor exercise DVD and resistance program.

For more info on the book: www.MalePelvicFitness.com

For more info on the Private Gym: www.PrivateGym.com

 

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

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“Urgasm”

March 22, 2014

Blog # 146  Andrew Siegel, MD

As I defined it in the urban dictionary, “urgasm” is when urine is ejaculated at the time of the male sexual climax.  

http://www.urbandictionary.com/define.php?term=urgasm&defid=7516472

The penis has a dual role as a urinary organ allowing “directed” urination that permits men to stand to urinate, and a sexual and reproductive organ that, when erect, allows the penis to penetrate the vagina and release semen. Although urinary and sexual functions are discrete and separate, their interplay is complex and treatment for prostate cancer with surgery or radiation can muddle the distinction.

Semen or seminal fluid is what comprises the ejaculate.  Less than 5% of the volume is actually sperm and the other 95+% is a cocktail of genital secretions that helps provide nourishment, support and chemical safekeeping for sperm cells. About 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid that has a lubrication function. The average ejaculate volume is 2-5 milliliters (one teaspoon is the equivalent of 5 milliliters).

“Climacturia” is the medical term for leakage of urine during orgasm, but I much prefer the term that I have coined, a combination of the words “urine” and “orgasm” into “urgasm.” What happens is that urine is “ejaculated” instead of semen. This is a not uncommon occurrence in men treated for prostate cancer with radical prostatectomy, which removes those organs largely responsible for semen production, the prostate and the seminal vesicles. It also can occur after radiation as a treatment for prostate cancer. Even though it is urine that is ejaculated and not semen, the sensation usually remains the same. Urine is generally sterile, so there is limited potential for spreading an infection to a partner.

Urinary incontinence (the inadvertent) leakage of urine, often associated with exertional activities, is commonly present in men complaining of urgasm. After radical prostatectomy, it is typically stress incontinence, leakage with exercise, coughing, bending over, sudden movements, etc. The presence of stress incontinence is a key risk factor for the occurrence of urgasm. However, some men have stress incontinence in the absence of urgasms and other men have urgasms in the absence of stress incontinence.

Urgasm can be quite distressing to the man who experiences it, as well as his partner, who might not appreciate the “golden shower.” Urinating immediately prior to engaging in sexual activity can be very helpful, it being imperative to empty the bladder as completely as possible. Pelvic floor exercises—aka Kegels—very helpful in the management of stress incontinence—may prove helpful in terms of improving urgasm.  Pelvic floor muscle contractions are the body’s natural mechanism to facilitate expelling the urethral contents. When contracted, the bulbocavernosus muscle (BC)—the body’s urethral “stripper”—compresses the deep, internal aspect of the urethra, displacing the urine within outwards. The 1909 Gray’s Anatomy refers to the BC muscle the “ejaculator urine.” Pelvic floor muscle training can foster a powerful BC muscle to help increase the capability to empty the urethra. If you are experiencing urgasm, vigorously contract the BC muscle several times after completing urination in order to empty the urethra. If necessary, this can be supplemented by manual compression and milking of the urethra in an effort to get every drop out before engaging in sexual intercourse.

Bottom LineEjaculation of urine is a not uncommon occurrence following treatment for prostate cancer, particularly removal of the prostate gland. It can be a vexing problem to the patient and partner, but can be improved with simple measures, focusing on gaining facility of the bulbocavernosus muscle, one of the important pelvic floor muscles.

Andrew Siegel, M.D.

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

Trailer for new book: http://www.youtube.com/watch?v=1L9QgKzoG7E&list=UUjIg8sIxJ1AYGjOD0kAKPWQ

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

Available on Amazon in Kindle edition

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity  (free electronic download) www.findyourfountainofyouth.com

Amazon page: amazon.com/author/andrewsiegel

For more info on Dr. Siegel: http://www.about.me/asiegel913