Archive for December, 2014

A Two-Minute Solution To Solving Your Lack of Orgasms

December 28, 2014

If asked the young women readers, if I could give you a pill that would reduce your loss of urine, improve the muscle and strength in your pelvis and increase your chances of reaching an orgasm, would you like a prescription? Every woman I ask about this medication always says yes they would like a prescription. Now if I told them, it wasn’t a pill but it was a simple exercise that they could do for just two minutes a day, that they could do anywhere, at almost any time, which would accomplish those above objectives many of the women would say no, not interested. How about writing for that pill?

Let me introduce you to Kegel exercises. Kegel exercises are an easy way of strengthening both your vaginal wall muscles and the muscles that control urination and bowel movements (which can also reduce the effects of urinary incontinence.

Older women and women who have had children are especially at risk of weakened pelvic floor muscles.

All you have to do is contract and release the muscles in the pelvic area, squeezing them for 5-10 seconds and then relaxing for 5 seconds each time.

The most important thing is to locate the muscles you’re trying to strengthen, and to get used to the sensation of exercising them. The best way of doing this is to try to stop your urine mid-flow when you go to the restroom. If you do this successfully then you’ve found the muscles you’re looking for.

I suggest that you repeat the cycle of contracting and relaxing ten times per session, and try to fit in three sessions per day which should take you just two minutes. This shouldn’t be difficult as, going to the gym, using weights, doing push-ups or lunges. Honestly, these exercises can be done anywhere, at anytime, without anyone even realizing you’re doing them.

If done properly, you should notice a difference (enhanced sensation during sex and less leakage) in 4-6 weeks.

According to sex experts, it’s not just women who can benefit from Kegel exercises: “Pelvic floor exercises can also benefit men with problems such as erectile dysfunction (difficulty getting or keeping an erection), premature ejaculation, or difficulty with urination.

Bottom Line: A Kegel a day may just keep the doctor away and put a little zing in your sex life. Try it for a few weeks and if you aren’t completely satisfied, I’ll refund your money! ☺

For more information on Kegel exercises go to my website:

http://neilbaum.com/articles/pelvic-exercises-for-women-kegel-exercise

or go to YouTube.com for a video on the same subject

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Male Infertility-Some Low Cost Practical Solutions

December 27, 2014

Infertility is a common problem affecting many American couples. One-third are due to the woman who may have a gynecologic problem, one-third due to male factor, and one-third due to a combination of both the man and the woman. This blog will discuss the treatment and solutions for male factor infertility.

Keeping Mobile Phone in Pocket
A finding by some researchers at the University of Exeter in England showed that keeping mobile phone in the front pocket which is near the scrotum could affect sperm quality. They found out that exposure to cell phone radiation lowers sperm motility or movement by 8% and viability of the sperm by 9%. This finding is still a controversial one but it would be safer to keep away mobile phones from the pocket as much as possible. Therefore, my recommendation is to keep your mobile phone out of your trouser pocket. I also suggest that you do not text holding your phone at waist level.

Heavy Drinking
It is said that alcohol affects the body’s ability to absorb zinc which is a nutrient vital for healthy sperm. It’s still unclear what quantity of alcohol is bad but it’s advisable to stay away from it as much as possible, especially heavy drinking.

Oxidative Stress
Another thing that can cause male infertility is oxidative stress. This is linked to lifestyle factors such as obesity, diet, pollutants, smoking and alcohol. Taking antioxidant supplements such as vitamin E, vitamin C, folic acid etc. is said to increase fertility.

Poor Diet
A healthy diet will help maintain a healthy sperm count and an poor diet otherwise. It is advisable that men eat foods that will guarantee the general health of the body such as fresh fruits and vegetables, whole grains, and a minimum of red meat.

Excessive Exercise
Exercise is good for the body but its excess especially when it is combined with body building steroids can decrease the production of testosterone and thereby lower sperm count.

Frequent Sex
Too much sex can decrease the quality of sperm cells. It is advised that couples wishing to conceive should limit intercourse to every two or three days.

Exposure To Heat
Heat from laptops, wearing tight underpants and other things that could increase the temperature around the testicles could cause low sperm count. As much as possible, it is advised that the general crotch area should be kept cool and men use boxer underwear.

Untreated Infection
When STIs are not treated on time, it could result in infertility. Chlamydia infection, gonorrhea, mumps etc can affect fertility and even cause sterility.

Exposure to Pesticides and other Chemicals
It has been found that exposure to harmful chemicals can affect sperm quality and quantity. Agricultural workers and fumigators in Nigeria need to be mindful of this. Some other chemicals like paints, adhesives and coatings have also been found to double the risk of fertility problems. Men working with chemicals are therefore advised to wear the appropriate protective gear and reduce their exposure to the chemicals as much as possible.

Doping
Sniffing drugs like cocaine and cannabis can impair fertility in males. It is said that cannabis seems to have a dramatic effect on sperm quality. Some prescribed drugs can also affect fertility; it is advised that a man seeking to conceive should consult the doctor before taking any drug.

Bottom Line: Other things that could cause male infertility include stress, aging, radiation (x-rays, radiotherapy etc.), and obesity. With this understanding, it would be wise for men especially those seeking offspring to take note of the things that could be responsible for infertility so that they can play their part in making sure they also reproduce in life.

Why Sex Is Good For You?

December 27, 2014

Sexual intimacy has been associated with having a heart attack, contacting a sexually transmitted disease (STD) or having an unplanned pregnancy. However there are some significant health benefits for engaging in regular sex.

Immune Boosting

Eating well, getting enough sleep, and getting vaccinated are all important in boosting your immune system. Add regular sex to these and you have a great immune system that defends your body against infective organisms. This is because research has shown that those that are sexually active had a higher blood level of certain antibodies than those that were not so active sexually and these antibodies help you fend off infections.

Bladder control for women

About 30% of women will have urinary incontinence at one time or the other in their lives. This is when a person passes urine without intending to. Studies have shown that women who had sex regularly were less likely to develop urinary incontinence as sex helps strengthen their pelvic muscles which is important for bladder control.

Lowers Blood Pressure

People who had more sex have been found to have a lower blood pressure compared to others, ensuring that they stay healthy. One study found that those who regularly had sex had a lower blood pressure compared to those who did not.

Sex is good exercise

It’s been found that on the average, you burn about five calories per minute while having sex. This can be a good source of exercise for those that hardly have time to exercise. The benefits of exercise are quite numerous and sex delivers some of those benefits. For a reference, jogging one mile burns about 100 calories.

Reduces Risk for Heart Attack

Men who had sex regularly were found to have a 50% lesser risk of developing a heart attack. This is not only because it raises your heart rate which is great; it also keeps your sex hormone, estrogen and testosterone, in balance which are important hormones and their balance can help avoid conditions such as osteoporosis and heart disease.

Better Sleep

You may have noticed that you sleep better after sex. This is because the hormone prolactin and melatonin is usually released after an orgasm. This hormone helps with relaxation and the feeling of sleepiness.

Reduces Stress

The arousal associated with sex is great in easing stress. This is because your brain releases some chemicals that help in exciting your entire body. Sex can also help stimulate happiness and boosts self-esteem.

Reduces Pain

Sex can help reduce the feeling of pain. Sex helps release a hormone, endorphins, which are much more potent than morphine, that usually raises your pain threshold. Sexual stimulation can combat chronic pain such as the pain associated with arthritis.

Bottom Line: Sexual intimacy is a healthy activity for consenting adults. This blog provides many of the reasons to engage in sexual activity.

Vasectomy Reversal After A Vasectomy

December 27, 2014

I am often asked if a vasectomy can be reversed. Most often a man divorces, has a new wife and they wish to have children in their new marriage. Can the vasectomy be reversed?

Normally, sperm – the male reproductive cells that fertilize a woman’s egg – are made in the testicle. Sperm travel away from the testicle through a tube called the vas deferens. There is one vas deferens for each testicle. The vas deferens connect with a reservoir where the sperm is held, ready to be leave the reservoir during sex. The sperm also mixes with secretions from the prostate gland that keep the sperm alive. When the sperm is ejaculated, it travels through another tube, the urethra, inside the penis and is deposited in the woman’s vagina at the cervix or the “gatekeeper” to the uterus.

A vasectomy cuts or blocks the vas deferens. Once the vas deferens is blocked, sperm cannot pass from the testicle to the reservoir where semen and secretions from the prostate gland are stored.

After a vasectomy, a man continues to have normal ejaculations of semen, but the ejaculate no longer contains sperm. This can only be discerned if the ejaculate is examined under a microscope.

In a traditional vasectomy, the surgeon uses a scalpel to make small incisions in the skin of the scrotum near the base of the penis to reach both vas deferens. (The scrotum is the fleshy sac that contains the testicles.) The vas deferens are cut or blocked to prevent sperm from traveling. The incisions in the scrotum are then closed with two or three small stitches.

In my practice, I perform the no-scalpel, no-needle vasectomy, which is less painful, has less bleeding and fewer complications. The surgeon makes one or two tine openings about the size of an eraser to access the vas deferens.

The puncture is widened slightly, then the surgeon cuts or blocks each vas deferens.

The puncture site can be covered with a tiny dressing. No stitches are needed.
A vasectomy is intended to produce permanent sterilization. Special microsurgery can reverse a vasectomy and restore fertility in some cases. Vasectomy reversal is a delicate, expensive procedure. And it is only successful in about 60 to 70 percent of cases.

New Baby? Your Little Darling May Just Impact Your Sex Life

December 20, 2014

Many women experience sexual problems after giving birth. This blog will discuss the issues and concerns associated with childbirth and its impact on a woman’s sexual functioning.

Most obstetricians\gynecologists recommend that women avoid vaginal intercourse for at least six week after delivery. Sexual function may not return to prepregnancy levels for up to six months following delivery. The causes are the mother’s concerns about caring for a new baby, breastfeeding, fatigue, pain during attempted or actual intercourse, postpartum depression, pelvic floor problems, urinary incontinence and body image issues.

Sexuality in pregnancy is different in every woman. The frequency of sex may change and sexual enjoyment may decline during pregnancy. However, the good news is that relationship satisfaction remains unchanged. Many women experience a decline in sexual activity during the first trimester of pregnancy as a result of fatigue, fear of causing a miscarriage, breast tenderness, and nausea. The third trimester is also a time of diminished sexual activity due to overall physical discomfort.

Many women may avoid sex and orgasms because of the mistaken fear of causing bleeding, infection, injury to the fetus, premature labor, or breaking the bag of water (amniotic sac) too early. It is true that penetrative vaginal intercourse and orgasms should be avoided if there is imminent danger of a miscarriage in the second and third trimester. Women need to know that amniotic fluid and a thick cervical plug that makes it unlikely that the fetus will experience any pressure or impact from vaginal penetration protect the fetus.

Pregnancy and child delivery may be a difficult time for the partner. Changes in sexual activities and stress about new family obligations make take an emotional or physical toll on the partner. Couples should make every effort to communicate their feelings in a sensitive but honest fashion. The partner may also benefit with a discussion to a friend, doctor, or a counselor about feelings during this time.

Bottom Line: Pregnancy and childbirth are a special time for the mother and her partner. Sexual intimacy can be an important part of life during pregnancy and after the baby is born. If you have concerns about engaging in sexual intimacy before and after delivery over your baby, speak to your doctor.

Urinary Incontinence-Don’t Suffer In Silence

December 20, 2014

Urinary incontinence is one of life’s most embarrassing problems. Millions of American women suffer from incontinence in silence. I see dozens of women every month with this problem and so many of them have been wearing pads and diapers for years because they were too embarrassed to bring up the problem with their physician. This blog will discuss the problem and why it is important to see a physician to get treatment.

There are millions of people who deal with the embarrassing and disruptive effects of urinary incontinence, yet it’s a health secret that is rarely discussed. Contrary to what a lot of people think, urinary incontinence is not a normal sign of aging. Yes, it is more common in older men and women but you don’t have to live with the problem as treatments are available.

There are several reasons for urinary incontinence, but for women, one of the most common is weakened muscles in the pelvic floor.
A woman’s body goes through many changes during a lifetime and weakness or injury to muscles in the pelvic floor can cause health issues for women of all ages. The group of muscles in the pelvic floor can be affected by aging, childbirth, posture or injury. This loss of support of the pelvic muscles can result in incontinence, pelvic pain, or pain with intercourse.

Weakened pelvic floor muscles can be strengthened with Kegel exercises. (see my website, http://www.neilbaum.com, for more information on Kegel exercises). For the problem of urgency and frequency and urge incontinence or overactive bladder, there are effective medications to treat this condition. Finally, for women with both kinds of incontinence due to weakened pelvic muscles, they can be treated successfully with physical therapy.

If you answer yes to any of these questions, you should speak to your physician as help is available:
Do you usually get a strong urge to urinate?
Do you always make it to the bathroom on time?
Do you leak urine when you sneeze or cough?
Do you leak urine during physical activity?
Do you get up more than once per night to urinate?
Do you feel heaviness in the pelvic area?

Bottom Line: If you’ve been keeping urinary incontinence a secret, you’re not alone. You don’t have to accept it. Help is available. Talk to your doctor.

Pelvic Pain-Perhaps There Is Light At The End of The Tunnel of Love

December 19, 2014

This blog will discuss the condition of vaginismus or severe pelvic pain which makes it difficult and often impossible for a woman to engage in pleasurable sexual intimacy. I will also discuss some of the common treatment options for this condition.

Vaginismus is caused by contraction of the muscles around the vagina making penetration difficult or impossible. Often the problem is caused by anxiety or worsened by the anticipation of pelvic pain. If a woman focuses on pelvic pain, her ability to concentrate on the pleasurable sensations of sexual intimacy may be affected, and often her sex drive will decline. This will perpetuate her pain, as decreased sexual excitement may lead to less vaginal lubrication and tight, contracted vaginal muscles, all of which may increase the unpleasant friction in the vagina during sexual intimacy. Emotional anxiety, which often results from painful sex, may have a negative impact on the sexual relationship. Sexual pain creates a vicious cycle, which needs to be addressed from multiple perspectives in order to be resolved.

Treatment often requires a referral to a physical therapist. Physical therapists are trained to provide treatment to restore function, facilitate movement, and most importantly, to relieve pain. Pelvic floor physical therapy is often helpful in the treatment of sexual problems in women.

A physical therapist may prescribe vaginal dilators to help overcome penetration anxiety and also to help gradually stretch the vaginal opening. Dilators are usually provided in a gradual manner starting with the smallest dilator that does not cause the woman any pain or discomfort.

Another treatment option is pelvic floor biofeedback. This involves the insertion of probe into the vagina. The probe measures the activity of the pelvic floor muscles and displays the activity on a computer monitor. The woman is able to visualize the activity of her vaginal muscles and learn to relax them as well as strengthen, stabilize, and coordinate the muscles that are used during sexual intimacy.

Finally electrical stimulation with a low voltage current can be useful to teach coordinated contraction of vaginal and pelvic musculature, and is useful in providing pain relief.

Bottom Line: Vaginismus is a terrible condition that results in loss of enjoyment in sexual intimacy, can impair a relationship between a woman and her partner, and can even lead to depression. Speak to your doctor and consider a referral to a physical therapist to help put the zing back into your bedroom.

Depressed? Don’t Let Your Medication Steal Your Sex Life

December 19, 2014

Depression is a ubiquitous problem in the United States. Many of those who suffer from depression take anti-depressant medication and experience the side effect of sexual problems related to the medication to treat their depression. While sexual dysfunction is a frequent symptom of depression itself and successful treatment might eliminate it, antidepressants may exacerbate sexual dysfunction or even cause it in people whose sex life was previously fine. In fact, sexual dysfunction is a common side effect of all classes of antidepressants. This blog will discuss the relationship of sexual dysfunction in men and women who use anti-depressants and what are some of the solutions for those problems.

Fortunately, the news is not all bad. Experts have devised six main ways to address antidepressant-induced sexual dysfunction, and one or more of these approaches may work for you. For example, a study published in the Journal of the American Medical Association showed that Viagra (sildenafil) improved symptoms in more than half of men with antidepressant-induced sexual dysfunction.

The Effects of Antidepressants on Sexual Function
Antidepressants can affect almost all aspects of one’s sex life. First, it can diminish interest in and desire for sex. In men, it frequently causes erectile dysfunction (an inability to achieve or sustain an erection), and in women, it may cause vaginal dryness and decreased sensation in the genitals. Lastly, in both sexes, antidepressants can result in a difficulty or inability to achieve orgasm.
Sexual dysfunction caused by any factor, including antidepressants, can have effects that range far beyond the bedroom, including psychological distress and a decrease in self-esteem and overall quality of life. These effects cause many people to stop taking their antidepressants: Up to 90% of patients who experience antidepressant-induced sexual dysfunction stop taking their antidepressants prematurely.
How do you know if your antidepressant is causing sexual problems? Experts say that the trouble is probably the result of the medication if a person who did not previously have sexual dysfunction experiences problems within two to three months of beginning antidepressant treatment.

Who Is at Risk and From Which Antidepressants?
While anyone taking an antidepressant may experience sexual dysfunction, certain people are more susceptible. These include people who are over age 50, married, or smokers; who don’t have a full-time job or college education; who take additional medications or a high dosage of antidepressants; who have another health condition that can cause sexual dysfunction (for example, diabetes or prostate disease); and who felt that sexual enjoyment was not important prior to taking antidepressant medication.
Reports show that anywhere from 30% to 70% of people who take antidepressants experience sexual dysfunction. Because these reports did not all measure sexual dysfunction in the same way, however, it has been difficult to compare rates from one report to another.

What To Do
You and your doctor can treat antidepressant-induced sexual dysfunction in six main ways. However, do not make any changes in your treatment regimen without first consulting your physician.

1 Choose an antidepressant medication with a low rate of sexual side effects. If you are sexually active and have numerous risk factors for antidepressant-induced sexual dysfunction, your doctor may consider prescribing Wellbutrin, which has one of the lowest rates of sexual side effects. If you are already taking an antidepressant, switching to one with a low rate of sexual side effects may improve these symptoms. However, switching must be done carefully to minimize the risk of relapse or a withdrawal reaction from the first drug. Also, there is a chance that the new antidepressant will be less effective than the first or will cause other side effects. 

2 Wait to see if sexual side effects abate. One study found that antidepressant-induced sexual dysfunction improved somewhat in about a fifth of patients within six months of beginning treatment. Antidepressant-induced sexual dysfunction rarely disappears completely without treatment but may diminish to a point that is acceptable to the patient.
3 Change the time you take your antidepressant medication. If your symptoms involve a difficulty or inability to achieve orgasm, taking the medication after sexual activity may be helpful. For example, if you are most likely to engage in sexual activity in the evening, take the antidepressants just before falling asleep. Blood levels of the drug will be lowest the following night, and the extent of side effects also should be lowest at this time.
4 Reduce the dosage. A decrease in the dosage of medication may allow some people to regain satisfactory sexual function. However, lowering the amount of antidepressant taken each day may cause withdrawal reactions (particularly in people taking Paxil, Zoloft, and Effexor XR, which are cleared from the body quickly) or an increase in depressive symptoms. People who use this approach need to develop a plan with their doctor and should be monitored closely.
5 Take drug holidays. A “drug holiday” involves taking a short break from your antidepressant. Some evidence shows that taking periodic two-day breaks from antidepressant treatment can lower the rate of sexual side effects during the drug holiday without increasing the risk of a relapse or recurrence of depressive symptoms. For example, in one study, taking medication Sunday through Thursday and skipping Friday and Saturday allowed participants to have improved sexual functioning 50% of the time on weekends with no overall worsening of mood. This approach worked with quick-clearing drugs (Zoloft and Paxil) but not with Prozac, which clears slowly from the body. Potential risks of drug holidays include relapse and withdrawal reactions. 

Add another medication. Various medications can be added to your antidepressant regimen to combat sexual dysfunction; the medication with the best evidence reported in the medical literature is Viagra.

Some reports suggest that the herbal extract Ginkgo biloba may be helpful, but do not take it without consulting your doctor. Ginkgo not only has known side effects, but it may also have unknown side effects, and the product may be contaminated or lack potency.

Bottom Line: Sexual problems are common with the use of anti-depressants. You don’t need to suffer in silence. If you are taking anti-depressants and experience sexual side effects, speak to your physician as help is available and modifications in your medications may just solve your problem and put you “back in the saddle” again!

No-Scalpel, No-Needle Vasectomy-The Prime Cut

December 8, 2014

Most practices are impacted at the end of the year by the rush of patients who have met their deductibles. In Urology, aside from patients wanting to get stones busted (Lithotripsy), scrotal issues addressed, and an occasional prostate; by far and away, the number of vasectomies that are done in December is at least 4-5 times the number that our offices perform during any of the other months. The following is intended for any questions that you may have regarding vasectomy and is based on more than 5,000 vasectomies I have performed over 30 years of urologic practice.

Vasectomy Facts

1. Average time for the procedure is 6-8 minutes.

2. Patients are not given any narcotics as Aleve or Advil are sufficient for any discomfort. Less than 1 in 100 patients require a narcotic prescription.

3. Patients are offered the option of Valium 20 mg. to take prior to the procedure with instructions to have a driver.

4. 95% of the men who come in for a vasectomy consult go on to have the procedure.

5. The biggest fear is of someone they do not know holding sharp instruments and working on their scrotum while they are awake. Because of proper education, including an article given to all patients prior to have the procedure, men need not worry about the vasectomy impacting their sexual function.

6. The sperm make up only 5% of the ejaculatory volume so no noticeable change in the semen volume.

7. Rarely men will be seen following the procedure for some discomfort and typically, it is related to some inflammation or small hematoma and Tylenol or Advil are more than adequate.

8. Because of the way the procedure is performed, it is very rare to see a scrotal hematoma, which can occur and creates a small swelling of the scrotum. This occurs most often in men who do not heed the advice of going home, lying down and keeping ice on the incision.

10. Occasionally, a question is asked regarding sperm banking and this can be done in a facility in one of the infertility clinics in the area.

11. Vasectomy reversal is a formal surgical procedure that can take anywhere from 1-1/2 to 2 hours to perform. Through a scrotal incision, the testicle and spermatic cords are brought into the surgical field. The ends of the vas identified, freshened up and scar tissue removed and an operating microscope is used to perform a surgical closure using typically anywhere from 7-0 to 9-0 permanent suture. Success rates for vasectomy reversal is approximately 75% within the first 10 years and drops to about 30% after 10 years.

Anatomy

The vas deferens is a small tube approximately 3 mm (1\8 inch) in diameter that carries sperm from the testicle up into the body where it unites with the seminal vesicles and stores the sperm until ejaculation when the semen is deposited in the vagina in order to fertilize an egg and start the process of conception.

No Scalpel Procedure

Following anesthetizing the skin in the mid-section of the scrotum with a device that deposits the anesthetic without the use of a needle. Then a single puncture is made about 1\4 of inch in length in the middle of the scrotum. Each vas is occluded with very small titanium clip. No sutures or stitches are required. The patient lies on the table for a few minutes and then goes home and lays flat in bed for a few hours using ice over the scrotum for 45 minutes out of every hour until going to sleep.

Office visits

A vasectomy consultation is always performed before the procedure for a number of reasons:

1. To explain the procedure to the patient.

2. To allay fears, address misconceptions, and put the patient at ease.

3. To ensure anatomically that there are no problems with performing the vasectomy which include an extremely large patient with small scrotum, prior evidence of infection, and to screen for extremely anxious patients who probably would not tolerate the procedure being performed in the office under local anesthesia.

4. Pre-procedure instructions are given including the need to shave all the hair on the scrotum preferably the night before.

5. Men are given a prescription for Valium, which they should take 30-45 minutes before the procedure. If the man takes the Valium pill, then he will need a ride home as he should not drive a car after using Valium.

6. Post-procedure instructions are given including the need to go home and stay off his feet and keep ice on for two days. Sexual intercourse can begin typically 3-4 days post- procedure. Additionally the men are instructed to return for a follow-up visit. It takes approximately 15 ejaculations to clear all sperm from the portion of the vas above the legation of the vas.

6. Typically, a man makes a follow-up appointment at 6-8 weeks although the record is one week, but he wasn’t married! They are also informed of the 1 in 1500 chance of reconnection of the vas.

Summary

The majority of men have the procedure performed on Thursday or Friday, spend the weekend resting with ice, return to work on Monday and are back to regular activity including intercourse by Wednesday or Thursday of the following week.

Bottom Line: Having done more than 5,000 vasectomies, I can think of very few men who would not be willing to undergo the procedure again or recommend it to a friend. Certainly, in comparison to tubal ligation, which requires general anesthetic, it is a much simpler, less costly and less painful form of sterilization.
Don’t hesitate to give me a call if you have any questions about vasectomy or go to my website to view a video on vasectomy: http://neilbaum.com/videos/vasectomy