Archive for October, 2015

Your Bike May Cause Your Erections To Take a Hike

October 28, 2015

There are many cause of impotence or ED but one of the most common in younger men is bike riding. This blog will discuss the relationship of bike riding to ED and what can be done to prevent problems with bikers erections.

Bicycle seat neuropathy is one of the more common injuries reported by cyclists. The injuries and symptoms are due to the cyclist supporting his or her body weight on a narrow seat, and they are believed to be related to either vascular and\or neurologic injury to the pudendal nerve.

A wide frequency range has been reported for bicycle seat neuropathy, but it is believed to be underreported.

 A study of cyclists who ride for long period of time noted that 22% reported symptoms of either numbness or pain in the pudendal area. 21% reported penile numbness, with 6% cyclists reporting symptoms that lasted longer than 1 week. In addition, 13% reported symptoms of impotence, some men having experienced symptoms for longer than 1 week, and a smaller number reported impotence lasting longer than 1 month.

The cause of bicycle seat neuropathy has been attributed to several different events. One study hypothesized that compression of the pudendal nerve as it passes through the Alcock canal causes the condition. The Alcock canal is enclosed laterally by the ischial bone and medially by the fascial layer of the obturator internus muscle. The pudendal nerve exits the canal ventrally, below the symphysis pubis, and innervates the penis and perineal regions.

Long-distance cycling results in the indirect transmission of pressure onto the perineal nerve within the Alcock canal. Bicycle seat neuropathy is due to temporary and transient injury to the dorsal branch of the pudendal nerve secondary to compression of the nerve between the bicycle seat and the symphysis pubis.

Bicycle seat design (eg, shape) may be the major extrinsic factor for the development of bicycle seat neuropathy. Results of computer modeling showed that wider bicycle seats that support the ischial tuberosities or sit bones decrease pressure on the perineal area. Other studies have also demonstrated the effect bicycle seat design has on penile blood flow.

A recreational or elite cyclist who complains of numbness or impotence after cycling is the typical presentation of bicycle seat neuropathy. The amount of time the athlete spent cycling before the onset of symptoms is variable; however, studies have focused upon longer distance, multiday rides. Use of a stationary bicycle has also been reported as a cause of bicycle seat neuropathy.

Medical issues and complications include continued injury or insult to the area, resulting in continuation of the neuropathy and long-term sequelae such as impotence. Reevaluate the patient after making changes to the bicycle or riding style or after decreasing the training volume to ensure that improvement in symptoms is occurring. Continued symptoms despite changes in the bicycle seat position and training volume may indicate a different source of the symptoms and should warrant reevaluation by the physician.

The mainstay of treatment of bicycle seat neuropathy is the adjustment of the bike seat and bike position, such as tilting the nose of the seat down or lowering the seat height to relieve pressure off the perineum. Other recommendations include having the rider change the style of riding (eg, change positions more frequently or stop riding more frequently).

Newer bicycle seats with a split nose or a center cutout may also help to reduce the prevalence of neuropathy by limiting compression on the perineal area (see below). Some of the newer seats reduced perineal pressure by approximately 50%.

Bottom Line: Bike riding is a very popular form of exercise and recreation. However, long rides can affect a man’s potency and increase the risk of ED. I suggest that if you experience numbness after a long bike ride that you check your seat and speak to someone at the bike shop about a new seat that takes the pressure off of your sit bones so there is less compression of your nerves and blood supply to the penis.

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Nitrous Oxide for Outpatient Urologic Conditions

October 28, 2015

Today many procedures are being done in the office setting rather than in the hospital. By using nitrous oxide there is less pain and discomfort. This blog will discuss the use of nitrous oxide as a safe sedation for office procedures.

Nitrous oxide is commonly used in anesthesia; its use improves the quality and safety of induction of anesthesia, facilitates faster recovery and reduces costs compared to procedures performed in the office or the ambulatory treatment center.

Nitrous oxide or laughing gas as it is commonly known was first synthesized by Joseph Priestley in 1772. It was initially used as a dental analgesic forty years after this and has been used extensively in a wide range of surgical procedures for both sedation and analgesia.

The exact mechanism of action of nitrous oxide is unknown, but its effects take place within the pain centers of the brain and spinal cord. It is thought to have an effect on the Gamma Aminobutyric Acid (GABA) cells increasing inhibition of nerve cells causing drowsiness and sleep.  It also is related to the release of endogenous neurotransmitters such as opioid peptides and serotonin. The release of these neurotransmitters is thought to activate descending pain pathways that inhibit pain transmission.

Nitrous oxide has a role in some of the following procedures:

In dentistry, nitrous oxide is frequently used to decrease the pain and anxiety associated with procedures. It is commonly delivered by a nasal mask in combination with oxygen.

Other indications

Although not standard practice, additional described uses may include colonoscopy, sigmoidoscopy, laser procedures, obstetrical labor pain, ophthalmic procedures, emergency medical care of patients in accidents and during ambulance transport, and minor invasive medical procedures, including joint injections.


There are certain situations where the use of nitrous oxide is contra-indicated.  For example, in patients who have undergone recent eye surgery, involving gas bubble insertion (vitrectomy), as there is a risk that the nitrous oxide will diffuse into the bubble, causing the bubble to expand and cause injury to the eye.

Nitrous oxide can cause a rise in intra-cranial pressure, so it should not be used in cases of head injury and it must never be used if the patient has any conditions where air is trapped in the body and expansion would be dangerous, for example:

  • pneumothorax
  • abdominal distension
  • suspected intestinal obstruction
  • bullous emphysema
  • middle ear procedures
  • following a recent dive
  • maxillo-facial injuries,
  • impaired consciousness,
  • intoxication


When used properly, nitrous oxide is a very safe inhalational anesthetic gas. Complications up to and including death have been described. They are relatively uncommon with standard medical and dental use.

Adverse effects that may be associated with nitrous oxide include post procedure nausea and vomiting (PONV)

Short-term impairment in mental performance, manual dexterity, and audiovisual senses has been described with nitrous oxide use. This is not common and most patients can walk out of the office without assistance and even drive themselves home especially if they have not received any other sedatives like Valium or Ativan.

Bottom Line: Nitrous oxide is a very safe to provide sedation during office urologic procedures. It reduces the pain and anxiety of the procedure. For more information speak to your urologist.

Woman Can Turn On Just Like Men-Addyi, Female Viagra

October 27, 2015

Women have been waiting for decades to catch up with men in the area of intimacy with their partners. Men have been fortunate that Viagra, Cialis, and Levitra have worked wonders for millions of American men. Today there is a female Viagra, called Addyi or flibanserin that is helping women with a decreased sexual desire.

Experts are calling Addyi, the so-called “female Viagra” that’s become the first-ever FDA-approved pill for hypoactive sexual desire disorder, a revolution for women’s sexual health.

The approval of Addyi is the most important advancement in female sexual health since the oral contraceptive was approved in 1960.

It validates women’s right to treatment for sexual problems and their right to sexual health. Let the truth be told that Addyi validates that there is as much biology as psychology with regard to women’s sexual function and this is the same for men.
Addyi also known as the “little pink pill,” doesn’t work the same way that Viagra does in men. Instead of affecting blood flow to the genitals, as Viagra does, Addyi targets certain serotonin receptors in the central nervous system within the brain —similar to how anti-depression medications target other receptors — in order to improve sexual desire.

Until Addyi there were no FDA-approved drugs that targeted low sexual desire in either men or women. The FDA’s approval of Addyi to the breakthrough in men’s sexual health research when Viagra was first approved in 1998. Before then, doctors told men that erectile dysfunction was all in their heads and the only treatment offered men was testosterone which was seldom effective. Now, in 2015, we accept that there are physical reasons such as diabetes, heart disease, and hundreds of medications that result in men not being able to obtain or sustain erections. Addyi’s introduction to the marketplace could do the same for the estimated 5.5 million to 8.6 million U.S. women suffering from hypoactive sexual desire disorder, meaning a chronic lack of interest in sex.

Addyi was originally formulated as an anti-depressant. While it failed to treat depression, researchers noticed that it did increase sexual desire. Sprout Pharmaceuticals then tested it for safety and effectiveness in more than 11,000 women before winning the recent FDA approval. In three randomized studies women who took Addyi had between one-half to one more satisfying sexual event per month on average than women who took placebo pills. It also increased sexual desire as compared to the placebo, as well as lowered distress related to sexual desire dysfunction.

Although the root causes of low sexual desire in women include relationship issues and changing hormone levels due to aging.

The drug’s side effects, which include severely low blood pressure and loss of consciousness if taken with alcohol, are comparable to the side effects of psychoactive medications that were able to win FDA approval far more easily than Addyi. The most common side effects were dizziness, sleepiness, nausea and fatigue, which is why the pill is recommended for use before bed.

Bottom Line: Women with decreased sexual desire now have a medication that may solve that problem. Addyi has now been approved by the FDA for the treatment of low sexual desire in women. For more information, speak to your physician.

Using Nitrous Oxide For Outpatient Urologic Procedures

October 27, 2015

A significant number of men are concerned about the pain associated with a vasectomy. Sedation using nitrous oxide, delivered via the disposable Nitrouseal(R) mask and breathing circuit and a standard nitrous Flowmeter, offers an excellent way to provide a safe, anxiety-free, vasectomy experience to those who are afraid of the pain and the discomfort.

Sedation with nitrous oxide is often mistakenly thought to induce sleep. In fact, most sedatives allow the patient to stay awake during the procedure. Sleepiness is a side effect of some medications, but nitrous oxide and oral conscious sedation only work to calm anxiety throughout the vasectomy procedure.

Sedation with nitrous oxide is popular because it does not require an IV, meaning no injections, no anxiety and no pain. Nitrous works so effectively that often the patient doesn’t even remember having the procedure. Safety and compliance are two important aspects of treatment, so sedation offers the individual the best option.

Whatever the form of sedative, it is a good idea to be accompanied by a caregiver. Most of the time if nitrous oxide is used the man can leave the office and drive himself home.

Here are some advantages associated with nitrous sedation during a vasectomy:

  • Anxiety is alleviated
  • Few side effects
  • More can be accomplished during each visit
  • No needles
  • No pain
  • Safe-used by Dentists for decades
  • Procedures take less time
  • Inexpensive
  • wears off rapidly

What kinds of sedatives are available?

The most popular types of sedatives are nitrous oxide and oral conscious sedation. Different levels of sedation (mild, moderate and deep) can be utilized depending on individual needs. Before administering any sedative, I will take a full medical history of the man, taking note of any current medications, allergies, or side effects from any medications.

Here is an overview of some of the most common types of dental sedatives:

Nitrous Oxide

Nitrous oxide, or “laughing gas,” is used as a mild sedative. It is delivered through the  Nitrouseal(R) face mask which can be held by the man during the procedure.  Nitrous oxide is administered throughout the entire procedure. Nitrous oxide elevates the general mood and can evoke a general sense of well-being. Most importantly, it relieves anxiety and reduces pain during the procedure. In addition, some tingling and numbness may be felt. There are few side effects associated with nitrous oxide, and it has been safely used in dentistry for many years.

Oral Conscious Sedation

Oral conscious sedation is an excellent choice for people who fear needles. Oral medication is provided prior to treatment in order to induce a moderate state of sedation. Though oral sedatives do not cause sleep, they usually dull the senses. This means that most patients cannot remember the pain, smells or noises associated with the procedure. Usually, a dose of medication is taken 30-40 minutes prior to the appointment, and then nitrous oxide may be added during the procedure as required.

What types of drugs are used in oral conscious sedation?

Most of the drugs used in sedation dentistry are classified as benzodiazepines. Benzodiazepines reduce anxiety, muscle spasms, insomnia and seizures. Each medication has a different half-life, meaning that the effects last for varying amounts of time. The estimated length of the procedure determines which type of drug is going to be most effective.

I will often use Valium.  This sedative has amnesic properties and a long half-life. I recommend you take the medication 30-45 minutes before the procedure and request that you have a ride home if you take the Valium.

If you have questions or concerns about sedation for a vasectomy, please contact me or my  office.

Put Pumpkin On Your Holiday Table-Your Prostate Will Thank You

October 25, 2015
From The Daryl and Luellen Berger Halloween Display

From The Daryl and Luellen Berger Halloween Display

It’s holiday season and time to carve a pumpkin for Halloween and have pumpkin pie for Christmas.  If the only thing you have ever done with pumpkin is carve it and fill it with a candle, you are not alone. Many people tend to think of pumpkins as little more than just a holiday decoration or a pie filling, but you may want to rethink this plump orange plant.  It has wonderful medicinal value that you might want to know before carving that pumpkin and discarding the seeds the pulp from this veritable medicine chest of good nutrition.

Pumpkin is an extremely nutrient dense food, meaning it is chock-full of vitamins and minerals but low on calories. There are many creative ways pumpkin can be incorporated into your diet, including desserts, soups, salads, preserves and even as a substitute for butter. Next time pumpkin season comes around, don’t carve it, cook it up and eat it!

Consuming one cup of cooked, canned pumpkin would provide well over 100% of your daily needs for vitamin A, 20% of the daily value for vitamin C, 10% or more for vitamin E, riboflavin, potassium, copper and manganese at least 5% for thiamin, B-6, folate, pantothenic acid, niacin, iron, magnesium, and phosphorus.

Of course, using fresh pumpkin and preparing it yourself will give you the most health benefits, so steer clear of canned pumpkin pie mix, as canned pumpkin has added sugars, syrups, etc. For the best nutritional value pumpkin should have only one ingredient: pumpkin.

Consuming fruits and vegetables of all kinds has long been associated with a reduced risk of many lifestyle-related health conditions. Many studies have suggested that increasing consumption of plant foods like pumpkin decreases the risk of obesity and overall mortality, diabetes, heart disease and promotes a healthy complexion and hair, increased energy, overall lower weight.

Pumpkin is one of the best-known sources of beta-carotene, a powerful antioxidant known to give orange vegetables and fruits their vibrant color and which is converted to vitamin A in the body. Consuming foods rich in beta-carotene may reduce the risk of developing certain types of cancer, offer protection against asthma and heart disease, and delay aging and body degeneration.

Blood pressure: Eating pumpkin is good for the heart! The fiber, potassium and vitamin C content in pumpkin all support heart health. Consuming adequate potassium is almost as important as decreasing sodium intake for treatment of hypertension (high-blood pressure). Other foods that are high in potassium include cantaloupe, pineapple, tomatoes, oranges, spinach and bananas.

Increased potassium intakes are also associated with a reduced risk of stroke, protection against loss of muscle mass, preservation of bone mineral density and reduction in the formation of kidney stones.

Cancer: One particular type of cancer where research has shown a positive benefits of a diet rich in beta-carotene is prostate cancer, according to a study conducted by the Harvard School of Public Health’s Department of Nutrition.5 Beta-carotene has also been shown to have an inverse association with the development of colon cancer in the Japanese population.

Eye Health: The antioxidants vitamin C, vitamin E and beta-carotene (all of which pumpkin has) have been shown to support eye health and prevent degenerative damage.

A higher intake of all fruits (3 or more servings per day) has also been shown to decrease the risk of and progression of age-related macular degeneration.

Fertility: For women of child-bearing age, consuming more iron from plant sources such as spinach, beans, pumpkin, tomatoes, and beets appear to promote fertility, according Harvard Medical School’s Harvard Health Publications. The vitamin A in pumpkin (consumed as beta-carotene then converted to vitamin A in the body) is also essential during pregnancy and lactation for hormone synthesis.

Immunity: Plant foods like pumpkins that are high in both vitamin C and beta-carotene offer an immunity boost from their powerful combination of nutrients.

A nice sedative:  Why does everyone take a nap after a heavy Thanksgiving meal?  It is the tryptophan in the pumpkin which raises melatonin and induces sleep.

Bottom Line:  Pumpkin is good for you and good for your prostate, too.  Enjoy the holiday.

Men You Don’t Have To Depend on Depends After Prostate Surgery

October 24, 2015

Many men after prostate surgery will have a problem of urinary incontinence. The good news is that it is usually temporary and lasts only a few days or weeks. However, after prostate cancer surgery, the incontinence may be worse and last for a longer period of time. Help is available. Men can use Kegel exercises, which are the same exercises, that women use who have a problem of losing urine.

About 30 percent of prostate cancer patients nationally are affected by incontinence a year after surgery, and another 14 percent still feel the effects after five years.

Urinary incontinence has been shown to cause significant distress in men following prostate cancer treatments. Men become reclusive and even depressed if they have incontinence. Men are afraid to travel or attend other social gatherings because there may not be a restroom nearby.

A study from the Cleveland clinic detailed results from 244 men randomly assigned to one of three approaches to reduce leakage and manage symptoms.

The first two approaches offered the men one session of biofeedback-assisted pelvic exercises and six biweekly sessions—either in a peer support group or by phone—to learn how to self-manage their symptoms. In the biofeedback sessions the men learned how to perform Kegel exercises.

In the third approach, men received information and a doctor’s directions for care or sought information on their own.

By the third month, the first two methods—biofeedback, plus support group or telephone contact—showed better results. The number of leakage episodes decreased.

At the last assessment at six months, the men receiving biofeedback and support recorded the greatest reduction in leakage amount.

For more information on Kegel exercises please go to my website, or copy and paste this into your browser:

Bottom Line: urinary leakage can be depressing for both men and women. Help is available. Just remember, a Kegel a day can keep the doctor away!