Posts Tagged ‘vagina’

Vaginal Tone: How Tight Is Right?

June 11, 2016

Andrew Siegel, M.D.   6/10/16

IMG_1544

The strength and firmness of the vagina is largely determined by the strength and tone of the pelvic floor muscles .  As a urologist who treats many female pelvic problems, questions about vaginal tightness and tone are not infrequently raised by concerned patients.  It is important to distinguish strength from tone.  A condition exists in which the pelvic floor muscles are tight and over-toned (“hypertonic”), yet weak, inflexible and with an impaired ability to relax after a contraction.  This is a pathological condition of the pelvic floor muscles which can give rise to pelvic pain, sexual dysfunction and numerous other symptoms.

The Effect of Vaginal Delivery

The most compelling factor affecting vaginal form is vaginal childbirth.  A recent article from the British Journal of Obstetrics and Gynecology (Kamisian et al, 2015; 122:867-872) studied the relationship between childbirth and vaginal dimensions in women presenting with urinary control issues and pelvic organ prolapse. The average measurement of the vaginal opening (obtained upon abdominal straining) was 29 cm² in women who had vaginal deliveries versus 21.5 cm² in women who had not delivered vaginally. Having more than one child did not further increase the size of the vaginal opening in a significant way. Bottom Line: The researchers concluded that there are clearly anatomical differences present in women who have delivered vaginally versus those who have not and that most of the stretching effect of vaginal childbirth is related to the first delivery.

 The Vagina: A Mysterious But Amazing Place

Trivia: The word “vagina” derives from the Latin word for “sheath,” a cover for the blade of a knife or sword. The word “penis” derives from the Latin word for “tail.”

Although for many people–both women and men–the vagina is a dark and mysterious place, it is impressive how versatile and multifunctional an organ it is. The vagina wears many “hats,” functioning as an entryway for the penis during sexual intercourse, an inflow pathway and receptacle for semen, an outflow pathway for menstruation and a birth canal. The elasticity of the vagina is extraordinary, with an astonishing ability to stretch to accommodate a baby’s head and then return to a relatively normal caliber. That stated, pregnancy, labor and delivery–particularly vaginal deliveries of large babies–has the potential to profoundly affect the anatomy and function of the vagina and its supportive pelvic muscles.  Although not inevitable, this can result in vaginal laxity (looseness) and other pelvic floor dysfunctions including pelvic organ prolapse (dropped bladder and other pelvic organs), stress urinary incontinence (urinary leakage with coughing, sneezing and physical exertion) and sexual issues.

Trivia: Elective C-section (no labor) is generally protective against vaginal laxity, whereas emergency C-section (after prolonged labor) is equally as potentially damaging to the vaginal support system as is vaginal delivery.

Is Your Vagina Toned/Tight Enough?

If you have ever wondered if your vagina is toned enough and how it might compare with others, you are by no means alone. Like penis size for men, this can be a source of concern and anxiety for many women. A “fit” vagina and pelvic floor is a desirable physical attribute, correlating with youthful vitality, better sexual function for women and their partners and less risk for pelvic organ prolapse and stress urinary incontinence.

Trivia: Leonardo Da Vinci observed that while women generally desire the size of a man’s genitals to be as large as possible, men typically desire the opposite for a woman’s genitals.

Vaginal tone is strongly impacted by the strength and tone of the pelvic floor (Kegel) muscles, but is also influenced by the strength and tone of the muscle layers of the vagina itself. Vaginas come in all sizes and shapes and run the gamut from being very snug to very loose. The vast majority of vaginas are between these too extremes,  “toned sufficiently.” On one extreme, the vagina and pelvic muscles can be so snug that the vagina cannot be penetrated, a medical condition known as vaginismus, which can be a devastating physical and emotional problem. It is an extreme form of pelvic floor tension myalgia, a pelvic pain syndrome referred to earlier resulting from pelvic floor muscles that are chronically over-tensioned. Extremely narrow and tight vaginas are also common in the elderly population that is not sexually active, on the basis of disuse atrophy and the lack of hormone stimulation that accompanies menopause.

On the other hand, the vagina, pelvic floor muscles and other connective tissue support can be so lax that the vagina gapes open, allowing one or more of the pelvic organs to fall into the space of the vagina and at times, outside of the vagina. This can also give rise to other pelvic issues having to do with sexual function and urinary/bowel control. Laxity can lead to difficulties with retaining the penis with vaginal intercourse, retaining tampons and in achieving orgasm.  Vaginal laxity can also result in the vagina filling up with water while bathing and vaginal passage of air (vaginal flatulence). The perception of having a loose vagina can lead to self-esteem issues.

 The Role of Vaginal Tone In Sexual Function

To reiterate, vaginal fitness is an important factor in terms of sexual function and is largely determined by pelvic floor muscle strength and tone. Vaginal laxity is caused by weakened pelvic muscles, vaginal muscles and connective tissue that no longer provide optimal vaginal support. Women with a lax vagina who are sexually active may complain of less satisfying sexual intercourse with diminished sensation for themselves and their partners with an impairment in “accommodating” the penis, with the vagina “surrounding” the penis rather than firmly “squeezing” it.

Under normal circumstances, sexual intercourse results in indirect clitoral stimulation. The clitoral shaft moves rhythmically with penile thrusting by virtue of penile traction on the inner vaginal lips, which join together to form the hood of the clitoris. However, if the vaginal opening is too wide to permit the penis to put sufficient traction on the inner vaginal lips, there can be decreased clitoral stimulation and less satisfaction in the bedroom.

Trivia: George Carlin did a routine about women who have a special gift with the strength, tone and finesse of their vaginas and pelvic floor muscles that I will attempt to paraphrase. He referred to the vaginas of these women as “snapping,” which he defined as “quick muscular control and vaginal elasticity that can grab ahold of you.”  What he was actually describing was women with excellent command of their pelvic floor muscles. 

 So How Tight Is Right?

Dr. Arnold Kegel in the 1940s invented a device called a perineometer that was inserted into the vagina to record the pelvic floor muscle contractile strength.  There are numerous sophisticated measurement devices that exist today.

A simple means is the digital method (a finger in the vagina) to assess your pelvic muscle strength. Do so supine (lying down, face up) with knees bent and slightly parted. Use a hand-held mirror to get a visual of your vulva. The inner vaginal lips should be closed and touching, appearing like a shut clamshell. A sign of vaginal laxity is when the lips are parted like an open clamshell. Another sign of laxity is a reduction in the distance from the bottom part of the vaginal opening to the anus (the perineum). A more severe sign of vaginal laxity is gaping lips with a pink bulge (pelvic organ prolapse) emerging between the lips. Take a look while pushing and straining your abdominal muscles—as if you are pushing out a baby—as a “vaginal stress test.”

Gently place a lubricated finger of one hand in the vagina and contract your pelvic muscles, squeezing around the finger and trying to lift it upwards and inwards, ensuring that you are not contracting your gluteal (butt), rectus (abdomen) or adductor (inner thigh) muscles. Do this by placing your other hand on each of these other muscle groups, in turn, to prove to yourself that these muscles remain relaxed.

Grade your strength using the modified Oxford grading scale, giving yourself a number between 0-5. Note that the Oxford system is what physicians use and it is relatively simple when done regularly by those with experience performing pelvic exams. It is granted that since this assessment is subjective and is not your specialty, you may find it challenging, but do your best, as your goal is to get a general sense of your pelvic strength.

Oxford Grading of Pelvic Strength

0—complete lack of contraction

1—minor flicker

2—weak squeeze (without a circular contraction or inner and upward movement)

3—moderate squeeze (with some inner and upward movement)

4—good squeeze (with moderate inner and upward movement)

5—strong squeeze (with significant inner and upward movement)

What To Do About Vaginal Laxity

If you are unhappy with your vaginal tone, do not despair. Pelvic floor exercises (a.k.a. Kegels) can and will often help improve the situation. Achieving a well-conditioned pelvic floor will optimize vaginal tone, pelvic organ support and sexual, urinary and bowel function as well as positively impact core strength and stability, posture and spinal alignment.

Bottom Line:  A firm and fit vagina is desirable from the standpoint of pelvic, sexual and general health.  Having well-conditioned pelvic floor muscles can help prevent and treat vaginal laxity, pelvic organ prolapse, urinary and bowel control issues as well as contribute to a healthy and enjoyable sex life. Just as you make an effort to keep your external muscles in good shape, It makes sense to apply a similar effort to these important internal muscles.

Please check out the following 3 minute video entitled “Why Kegel?”:

https://www.youtube.com/watch?v=kclY1vY3wG8

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

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

The Kegel Fix trailer: 

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

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. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

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

 

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The Clitoris: What’s Under The Hood?

May 7, 2016

Andrew Siegel MD 5/7/16

The clitoris is a complex and mysterious organ possessed by all female mammals. Many men (as well as a fair share of women) are clueless (“uncliterate”) about this curious, unique and fascinating structure. The intent of this entry is to provide a primer of useful knowledge so that you can understand what is under the (clitoral) hood, literally and figuratively.  Advances in imaging—especially magnetic resonance (MR)—have provided a much clearer understanding of clitoral anatomy. Whether you are a female or a male, a greater knowledge and appreciation of the anatomy, function and nuances of this special female body part will most certainly prove useful and beneficial. 

Female External Genital Anatomy

The clitoris is part of the vulva, the outer part of the female genitals. The vulva consists of the mons, outer lips, inner lips, vestibule, vaginal opening, urethral opening and the star of the show–the clitoris.

5. vulva 

(Female external genital anatomy, from The Kegel Fix, credit to illustrator Ashley Halsey)

Clitoral Geography: Mountains, Hills and Earthquakes

The vulva is home to some hilly and bumpy terrain that is well worth gaining familiarity with so it can be traversed with finesse. The word mons derives from Latin meaning “mountain” because it is the rounded and prominent fatty tissue overlying the pubic bone. The word clitoris derives from the Greek “kleitoris” meaning “little hill.”

An earthquake is the shaking of the Earth’s surface caused by the sudden release of energy resulting from movements within the earth’s crust that creates seismic waves. If a female orgasm is thought of as an “earthquake,” the clitoris is the “epicenter.” The head of the clitoris—typically only the size of a pea—is an extraordinarily dense bundle of sensory nerve fibers.

 Pleasure (and Reproduction)

The clitoris is central to the female sexual response and sexual climax, the only human organ that exists solely for pleasure, although nature has secondary motives. The clitoris is a vital part of the anatomical design used for nature’s clever “bait and switch” trick, in which the pursuit of a pleasurable activity drives reproduction of the human species and the perpetuation of life. In the mammalian kingdom, if reproduction was not associated with sexual pleasure, how much sexual activity do you think would actually occur?

Male and Female Comparative Genital Anatomy

It might surprise you how remarkably similar the female and male external genitals are. In fact, in the first few weeks of embryonic existence, the external genitals are identical. The female embryo’s external genitals are the “default” model that will remain female in the absence of masculinizing hormones. The female clitoris and the male penis are essentially the same structure, as are the female outer lips and the male scrotum. In fact, there is not much difference in appearance between a very large clitoris and a very small penis.

Although the clitoris is the female equivalent of the penis, it is exclusively a sexual organ, whereas the penis is a urinary, sexual and reproductive organ. Like the penis, the clitoris is largely composed of erectile tissue that upon arousal and stimulation engorges with blood and with increasing stimulation becomes erect. After sexual climax, the clitoris returns to its normal relaxed state.

Interesting trivia: The female spotted hyena, squirrel monkey, lemur, and bearcat all have in common a very large clitoris. When erect, it appears very similar to the male’s penis and is used to demonstrate dominance over other members of their clans. It is referred to as a “pseudo-penis.”

The Tip of the Iceberg, But Far From Frigid

 Most of the clitoris is hidden and internal. Commonly misrepresented as a “bean” or “button,” the external nub is the clitoral head, merely the “tip of the iceberg.” The iceberg metaphor is an apt one in terms of anatomy, but is off target with respect to what a clitoris is—the seat of female genital passion—with its head having a greater concentration of nerve endings than any other body part, a far cry from “ice.”

Clitoral Anatomy

The glans (head) is the external and visible part of the clitoris. It is located just above the opening of the urethra. The remainder of the clitoris is internal and consists of the clitoral shaft (body) and its extensions, known as crura (legs). The prepuce (foreskin), a hood of skin formed by the inner vaginal lips, covers the clitoral shaft.

clitoris

(Anatomy of the vulva and the clitoris by OpenStax College – Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30148635, no changes made to original)

The crura are wishbone-shaped and are attached to the pubic arch as it diverges on each side. The shaft and crura contain erectile tissue, consisting of spongy sinuses that become engorged with blood at the time of sexual stimulation, resulting in clitoral engorgement and erection. Beneath the crura on either side of the vaginal opening are the clitoral bulbs, sac-shaped erectile tissues that lie beneath the outer vaginal lips. With sexual stimulation, they become full, plumping and tightening the vaginal opening.

One can think of the crura and bulbs as similar to the roots of a tree, hidden from view and extending deeply below the surface, yet fundamental to the support and function of the clitoral shaft and head above, comparable to the tree’s trunk and branches.

Pelvic Floor Muscles

These important muscles are critical to sexual function in general and clitoral function in particular. They control the voluntary tightening and relaxing of the vagina, increase genital blood flow, support clitoral erection and contract rhythmically at the time of orgasm. Two of the pelvic floor muscles are especially vital to clitoral function: the ischiocavernosus and bulbocavernosus muscles that surround the crura and the bulbs, respectively. They stabilize the deep roots of the clitoris and compress the roots when engaged, increasing genital blood flow and maintaining clitoral erection, since their compressions push blood from the roots back towards the shaft and glans.

3. superficial and deep PFM

(Female pelvic floor muscles, from The Kegel Fix, credit to illustrator Ashley Halsey)

The pelvic floor muscles strongly contribute to the transformation of the clitoris from flaccid to softly swollen to rigid. By compressing the roots of the clitoris, they elevate blood pressure within the clitoris to maintain clitoral swelling and erectile rigidity. At the time of climax, these muscles contract rhythmically, and an orgasm would not be an orgasm without the contribution of these muscles working together with the clitoris.

Interesting trivia: The blood pressure within the clitoris at the time of a clitoral erection is hypertensive (high blood pressure) range, accounting for the rigidity. This is largely on the basis of the contractions of the aforementioned pelvic floor muscles. The only regions of the body where hypertension is desirable are the penis and clitoris.

Sexual Function And The Clitoris

With arousal and sexual stimulation, the clitoral erectile tissue engorges, resulting in clitoral shaft thickening and swelling of the glans. With increasing clitoral stimulation, clitoral retraction occurs, in which the clitoral shaft and glans withdraw from their overhanging position, pulling inwards against the pubic bone.

When a sufficient threshold of sexual stimulation is reached, climax occurs with contraction of the pelvic floor muscles, vagina, urethra, uterus and anus.

The clitoris plays a central role in orgasm for the majority of women and for most, clitoral stimulation is necessary to achieve orgasm. Some women require direct clitoral stimulation, while for others indirect stimulation is sufficient; about 25% are capable of achieving orgasm via vaginal intercourse alone. Vaginal intercourse often results in indirect clitoral stimulation since the crura and bulbs flank the vaginal opening and these inner parts of the clitoris are stimulated with penetrative thrusting.

Interesting trivia: Magnetic resonance studies have shown that a larger clitoral head size and shorter distance from the clitoris to the vagina are correlated with an easier ability to achieve a vaginal orgasm.

There is a clitoral literacy movement that is gaining momentum. Please visit:

http://projects.huffingtonpost.com/cliteracy for more information on the clitoris and this campaign to foster awareness of this curious organ.

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 THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo (paperback edition will be available soon).

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food   

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. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

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

 

 

 

 

 

 

Ejaculation: His and Hers

March 12, 2016

Andrew Siegel, MD   3/12/2016

One of the advantages of the specialty of urology is that it encompasses patients of both genders, unlike gynecology, which strictly involves females. Since I am board certified in Urology as well as in Female Pelvic Medicine, my practice allows me to have an equal balance of male and female patients. This gives me the opportunity to appreciate comparative male and female pelvic anatomy and function, which in reality are remarkably similar–a fact that may surprise you.

 A Few Brief Words on the Embryology of the Genitals.

Who Knew? Female and male external genitals are remarkably similar. In fact, in the first few weeks of existence as an embryo, the external genitals are identical.

The female external genitals are the “default” model, which will remain female in the absence of the male hormone testosterone. In this circumstance, the genital tubercle (a midline swelling) becomes the clitoris; the urogenital folds (two vertically-oriented folds of tissue below the genital tubercle) become the labia minora (inner lips); and the labio-scrotal swellings (two vertically-oriented bulges outside the urogenital folds) fuse to become the labia majora (outer lips).

Gray1119

(Comparison of genital anatomy,  1918 Gray’s Anatomy, Dr. Henry Gray, public domain)

In the presence of testosterone, the genital tubercle morphs into the penis; the urogenital folds fuse and become the urethra and part of the shaft of the penis; and the labio-scrotal swellings fuse to become the scrotal sac.  So, the clitoris and the penis are essentially the same structure, as are the outer labia and the scrotum.                                                                                              

Ejaculation

Ejaculation is the expulsion of fluids at the time of sexual climax. The word “ejaculation” derives from ex, meaning out and jaculari, meaning to throw, shoot, hurl, cast. We are all familiar with male ejaculation, an event that is obvious and well understood and well studied. However, female ejaculation is a mysterious phenomenon and a curiosity to many and remains poorly understood and studied.

Male Ejaculation

Men often “dribble” before they “shoot.” The bulbo-urethral glands, a.k.a. Cowper’s glands, are paired, pea-sized structures whose ducts drain into the urethra (urinary channel). During sexual arousal, these glands produce a sticky, clear fluid that provides lubrication to the urethra. (These glands are the male versions of Bartholin’s glands in the female, discussed below).

Once a threshold of sexual stimulation is surpassed, men reach the “point of no return,” in which ejaculation becomes inevitable. Secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. Shortly thereafter, the bladder neck pinches closed while the prostate and seminal vesicles contract and the pelvic floor muscles (the bulbocavernosus and ischiocavernosus) spasm rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen out in a pulsatile and explosive eruption. Ejaculation is the physical act of expulsion of the semen, whereas orgasm is the intense emotional excitement and climax, the blissful emotions that accompany ejaculation.

Male_anatomy

(Male Internal Sexual Anatomy, permission CC BY-SA 3.0, created 18 April 2009)

What’s in the Ejaculate?

Less than 5% of the volume is sperm and the other 95+% is a cocktail of genital secretions that provides nourishment, support and chemical safekeeping for sperm. 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).

Who Knew?  While a huge ejaculatory load sounds desirable, in reality it is correlated with having fertility issues. The sperm can literally “drown” in the excess seminal fluid.

Female Ejaculation

This is a much less familiar subject than male ejaculation and a curiosity to many. Only a small percentage of women are capable of expelling fluid at the time of sexual climax.

The nature of this fluid is controversial, thought by some to be excessive vaginal lubrication and others to be glandular secretions. Although the volume of ejaculated fluid is typically small, there are certain women who ejaculate very large volumes of fluid at climax. Expulsion of fluid at climax may come from four possible sources: vaginal secretions; Bartholin’s glands; Skene’s glands; and the urinary bladder.

Skenes_gland

(Skene’s and Bartholin’s Glands, created 22 January 2007, original uploader Nicholasolan  en.wikipedia, Permission: CC-BY-SA-2.5, 2.0, 1.0; GFDL-WITH-DISCLAIMERS; CC-BY-S)

During female arousal and sexual stimulation, the vaginal walls lubricate with a “sweating-like” reaction as a result of the increased blood flow to the genitals and pelvic blood congestion, creating a slippery and glistening film. The amount of this lubrication is highly variable. Some women with female ejaculation can release some of this fluid at the time of climax by virtue of powerful contractions of the vaginal and pelvic floor muscles.

Bartholin’s glands are paired, pea-size glands that drain just below and to each side of the vaginal opening. They are the female versions of the male bulbo-urethral glands and during sexual arousal they secrete small drops of fluid, resulting in moistening of the opening of the vagina.

Skene’s glands (para-urethral glands) are paired glands that drain just above and to each side of the urethral opening. They are the female homologue of the male prostate gland and secrete fluid with arousal.

Scientific studies have shown that those women who are capable of ejaculating very large volumes are actually having urinary incontinence due to an involuntary contraction of the urinary bladder that accompanies orgasm. This is often referred to as “squirting.”

Bottom Line: In the animal kingdom (including human beings), sex is a clever “bait and switch” scheme. In the seeming pursuit of a feel-good activity, in reality—determined by nature’s evolutionary sleight of hand—participants are hoodwinked into reproducing. The ultimate goal of the reproductive process is the fusion of genetic material from two individuals to perpetuate the species.

The penis functions as a “pistol” to place DNA deeply into the female’s reproductive tract with ejaculation a necessity for the process. Similarly, the female genitals need to be sufficiently lubricated to optimize this process and the combination of vaginal lubrication from enhanced blood flow contributed to by Skene’s and Bartholin’s secretions will optimize nature’s ultimate goal.

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. 

 

 

 

 

Vaginismus: Too Tight Not Right

December 12, 2015

Andrew Siegel MD   12/12/15

IMG_1544

Vaginismus is a medical condition in which a woman’s vagina is unable to be penetrated despite her desire to be receptive to vaginal intercourse. There are often both physical and emotional factors that underlie this disorder. Spasticity of the vaginal and pelvic floor muscles as well as fear and anxiety issues are typically present. Vaginismus has significant psychological ramifications, negatively influencing self-image and potentially undermining and destroying relationships.

Even though vaginismus was initially described in the medical literature over 150 years ago, it remains a misunderstood, under-diagnosed and under-treated disorder. It renders the sufferer either unable to be vaginally penetrated or able to be penetrated, but at the cost of experiencing severe pain. This can occur whether the vaginal penetration is via a finger, tampon, at the time of a gynecological exam or with sexual intercourse. This condition causes embarrassment and frustration and is not a topic that most women are readily willing to discuss with their physician, friends or family members.

The precise underlying causes of vaginismus remain unknown, although possible contributing elements may be a history of sexual molestation,  a traumatic pelvic examination or gynecological procedure at a young age, strict sexual constraints, religious factors and excessive fear of sexual intercourse, sexually transmitted infections and pregnancy.

Men who attempt to have sexual intercourse with women suffering with vaginismus often describe “hitting a wall” or “absence of a hole down there,” reflecting the excessive tone and spasticity of the vagina and pelvic musculature.  Pelvic examination of a woman suffering with vaginismus usually demonstrates that the muscles surrounding the entry to the vagina are in spasm, akin to a tightly clenched fist.

Understandably, after attempts at unsuccessful sexual intercourse, women with vaginismus often develop an aversion to sex because of actual pain as well as anticipated pain. This sets up a vicious cycle in which emotional fear fuels more physical spasticity, further exacerbating the problem.

Fortunately, vaginismus is a manageable condition.  Treatments address both the physical and emotional aspects of the problem and include the following: vaginal dilators; pelvic floor physical therapy; sexual counseling; psychotherapy; hypnotherapy; cognitive behavioral therapy; and Botox. Combination treatment that is tailored to the specifics and nuances of the situation and individual are the most effective means of fostering vaginal and pelvic relaxation and improving this condition.

The idea behind vaginal dilation is to gradually and incrementally stretch the vagina and allow the patient to become comfortable with penetration. There are many dilation regimens varying with respect to the size of the dilators used and the length of time the dilators are retained, with some programs having the patient sleep with the dilators in place. If successful, transition to sexual intercourse can proceed.

Pelvic floor physical therapy via physical therapists who specialize in pelvic floor issues can be extremely helpful and effective, particularly trigger point release combined with pelvic floor muscle stretching and lengthening techniques to increase the flexibility of the pelvic muscles.

Psychological approaches include psychotherapy and cognitive behavioral therapy. Psychotherapy attempts to uncover deep and often unconscious motivations for feelings and behavior. Cognitive behavioral therapy aims to train the mind to replace dysfunctional thoughts, perceptions and behavior with more realistic or helpful ones in order to modify fear of vaginal penetration and avoidance behavior. 

Botox is broadly used in many medical disciplines to temporarily paralyze spastic musculature. For vaginismus, Botox is injected into the spastic vaginal muscle and adjacent pelvic floor muscles and seems to be a promising treatment.

As opposed to the chronicity of vaginismus, penis captivus is a rare acute condition in which a male’s erect penis becomes acutely stuck within a female’s vagina. It is theorized to be on the basis of intense contractions of the pelvic floor muscles, causing the vaginal walls to clamp down and entrap the penis. It usually is a limited event and after female orgasm and male ejaculation, withdrawal becomes possible. However, at times it requires emergency medical attention with a couple showing up in the emergency room tightly connected like Siamese twins.

Bottom Line:  A well-toned vagina is highly desirable from the standpoint of sexual health as well as pelvic health.  Having a fit vagina and pelvic floor muscles will often prevent pelvic organ prolapse and urinary incontinence and contribute to a healthy and enjoyable sex life. Vaginismus is an unusual–but treatable– medical problem in which the vagina and pelvic muscles are so tight that the vagina  cannot be penetrated.  The mind-body connection plays a key role in the development of this condition, which is so much more than simply a physical issue.  Vaginismus can have devastating psychological and emotional consequences, creating a vicious cycle that perpetuates the problem. 

Reference: PT Pacik: Understanding and Treating Vaginismus: a multimodal approach, International Urogynecology Journal (2014) 25:1613-1620

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 and coming along nicely 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.

The Curious Use of Genital and Anal Slang

October 24, 2015

Andrew Siegel MD   10/24/15

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

asshole_emoticon_by_marynightshade

(Asshole Emoticon, by marynightshade; no changes made Link: http://marynightshade.deviantart.com/art/Asshole-Emoticon-13248436  Licensed under a Creative Commons Attribution—Share Alike 3.0 License)

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

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

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

The weather “sucks.”

This situation is so “fucked” up.

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

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

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

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

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

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

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 Make Orgasms More Orgasmic

July 3, 2015

Andrew Siegel MD  7/3/15

Public domain image, royalty free stock photo from www.public-domain-image.com

This is a timely blog topic for July 4th weekend, celebrated across the USA with fireworks!

The human body is a most remarkable machine. The more it is pushed towards its limits, the more it adapts and the stronger it becomes. When it comes to sex, the body reacts similarly—when the muscles that play a vital role in sexual function are toned and strengthened, the body becomes capable of experiencing more explosive and intense orgasms. Exercising your pelvic muscles—a.k.a. Kegel exercises—just might be the most rewarding workout that you aren’t doing. These exercises aren’t just for the ladies anymore. Men, it’s time to get with the program.

What’s An Orgasm?

Simply put, an orgasm is the sexual excitement, pleasure, and euphoric state accompanying the release of accumulated sexual tension.

A medical definition of the male orgasm is the climax that occurs once sufficient intensity and duration of sexual stimulation surpasses an ejaculatory “threshold.” Sexual climax consists of three phases—emission, ejaculation, and orgasm. When a certain threshold of sexual stimulation is surpassed, emission occurs, in which secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. During ejaculation the pelvic floor muscles contract rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen in a pulsating and explosive eruption. Orgasm is the intense emotional excitement that accompanies the physical act of ejaculation. Technically speaking, orgasm takes place in the brain, whereas ejaculation takes place in the penis, although the fact that an orgasm is a mind-body experience blurs the distinction.

For women, an orgasm occurs once sufficient intensity and duration of sexual stimulation surpasses a threshold that induces rhythmic muscular contractions of the pelvic floor muscles, as well as the vagina, uterus and anus, resulting in intense emotional excitement and a blissful state that accompanies the physical act of muscular contractions and release. In some women, Skene’s gland (the female equivalent of the male prostate gland) contractions induce the release of their secretions, referred to as “female ejaculation.”

How Can Fitness And Kegel Exercises Improve The Quality Of Orgasms?

Sex is all about movement and motion, a kinetic chain that demands aerobic fitness as well as strong core muscles and external hip rotators. This fitness optimizes the smooth, efficient and coordinated integration of pelvic thrusting and lateral hip rotation.

The floor of the core—the pelvic floor muscles—is of critical importance to penile and clitoral erections, ejaculation and orgasm. The other core muscles and the external hip rotators are involved with the kinetics and movements of sex, but the pelvic floor muscles are distinctive as they directly involve the penis and clitoris. The pelvic floor muscles anatomically support the erect penis and clitoris, cause a surge of blood flow to the genitals, and have a profound involvement in ejaculation and orgasm. They are the “motor” of ejaculation, which by virtue of their strong rhythmic contractions, drive ejaculation and contribute to orgasm.

Kegel exercises increase the strength, tone, power, and endurance of the pelvic floor muscles. Strengthening these muscles maximizes pelvic blood flow, penile and clitoral erectile rigidity, and orgasms, since the pelvic floor muscles when contracting rhythmically at climax provide the muscle power behind the physical aspect of orgasm. Pelvic floor muscle strength and proficiency is also a helpful means of improving ejaculatory control because command of the pelvic floor can help delay ejaculation. Additionally, these exercises can help increase the volume, force, trajectory (arc) and pleasurable sensation of ejaculation.

When it comes to orgasms, the pelvic floor muscles make the magic happen. Toned pelvic floor muscles are capable of generating powerful contractions that can forcibly ejaculate semen at the time of the male climax and can equally help optimize and prolong the female climax.

What Is The Best Means of Exercising One’s Pelvic Floor Muscles?

Effective muscle training derives from understanding pelvic floor muscle anatomy and function, the ability to isolate the muscles, a means of feedback to ensure that the proper muscles are being exercised, progressive intensity over time with the use of resistance to maximize muscle growth and adaptation, and allowing for the appropriate recovery time.

Wishing you the best of health and a wonderful July 4th holiday,

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.  Work in progress is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Co-creator of Private Gym pelvic floor muscle training program for men: http://www.privategym.com—also available on Amazon.

The Private Gym program is the go-to means of achieving pelvic floor muscle strength, tone, power, and endurance. 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. Arnold Kegel. It is also the first program designed specifically to teach men how to perform the exercises and a clinical trial has demonstrated its effectiveness in fostering more rigid and durable erections, improved ejaculatory control and heightened orgasms.