Archive for the ‘Ejaculatory dysfunction’ Category

Kegel Exercises for Men

April 25, 2010

Kegel exercises have been helpful for women with urinary incontinence and have been used for years with favorable success.  Recently, these same exercises have been useful for men suffering from erectile dysfunction, urinary incontinence, and premature ejaculation.

This article will review the purpose of Kegel exercises and how they are effective for treating erectile dysfunction, premature ejaculation, and dribbling after urination.

Kegel exercises focus on the muscles of the pelvic floor, which supports the bladder, the prostate gland and the bowel and is made up of layers of muscle that stretch from the tailbone at the back to the pubic bone in front.  Exercising these muscles will increase the support of the prostate gland, the bladder, and improve the blood supply to the penis, and increase the tone of the urinary sphincter or the muscle that surround the urethra and helps control urination.

By regularly performing Kegel exercises men report improvement in their erections and even in the quality of their orgasms.  A European study surveyed 55 men with an average age of 59 who had erectile dysfunction.  The study demonstrated that 40 per cent of the men regained normal erectile function and 35.5 per cent improved.  Perhaps the most dramatic finding was the improvement resulting from pelvic floor exercises compared to the use of Viagra – the results were the same.

Approximately 10% of men will have some mild urinary incontinence after surgical removal of their prostate gland for prostate cancer.  This is usually temporary and subsides after several months.  The period of incontinence can be significantly shortened if the men practice Kegel exercises before the surgery and immediatley after the surgery.

Pelvic floor rehabilitation is also effective for premature ejaculation, the condition when ejaculation occurs within seconds after vaginal penetration.  This is a condition that is very common and is a source of anxiety and disappointment for the man who has the problem and also for his partner.  Men who do Kegel exercises can expect a 50% improvement in time from vaginal penetration to ejaculation.

How to find and use the muscles of the pelvic floor

The pubococcygeal muscle and other muscles in the pelvis support the bladder, prostate gland, the urinary sphincter which is responsible for control of urination.  As men age, or after surgery, especially for prostate gland surgery, these muscles become weakened and men will have problems controlling urination and\or erectile dysfunction.  This group of muscles can be strengthened by performing Kegel exercises.

In men, this exercise lifts up the testicles, also strengthening the cremaster muscle, as well as the anal sphincter, as the anus is the main area contracted when a Kegel is done. This is because the pubococcygeus muscle begins around the anus as well as around  the urinary sphincter.

How to find the pelvic floor muscles

To find your pelvic floor muscles, you should sit or lie comfortably with the muscles of your thighs, bottom and stomach relaxed.  You should then tighten the ring of muscle around your anus without squeezing your bottom. To feel these muscles, try to stop your flow of urine mid-stream, and then restart it.  Although the exercises have to be learned (possibly over a matter of days), with practice they can be carried out while watching TV or while waiting for the light to turn from red to green.

Getting started

First, go to the bathroom and empty your bladder.  Next tighten the pelvic floor muscles as if you were preventing gas from escaping from your rectum and hold for a count of 10.  Then relax the pelvic muscles completely for a count of 10.  Repeat this cycle 9 more times.  Do this same exercise 3 times a day (morning, afternoon, and night).

You can also identify the pubococcygeus muscle when you are urinating over a toilet by starting and stopping the flow of urine.  You can do the same exercise when you are not urinating.

You can do these exercises at any time and any place. Most people prefer to do the exercises while lying down or sitting in a chair. After 4 – 6 weeks, most people notice some improvement. It may take as long as 3 months to see a major change.

Bottom Line:  Erectile dysfunction, premature ejaculation, and dribbling after urination are all amenable to strengthening the pelvic floor muscles.  This can be accomplished by performing Kegel exercises.  Remember a Kegel 3 times a day, keeps the doctor away!

Treatment of the Enlarged Prostate Gland With Laser Therapy

April 25, 2010

The prostate gland is a walnut sized organ below the bladder, which surrounds the urethra.  For reasons not completely understood, the prostate gland begins to grow around age 50 and causes symptoms affecting urination.  The enlarged prostate gland is a non-cancerous condition that affects nearly 14 million men over age 50.

The symptoms of the enlarged prostate include frequency of urination, getting up at night to urinate, urgency to urinate, decrease in the force and caliber of the urine stream and feeling that the bladder is not emptying.

The treatment for enlarged prostate includes medication to shrink the prostate gland or to relax the muscles in the prostate to relieve the obstruction.  Surgical therapy includes transurethral resection of the prostate (TURP) or open surgery for very large prostate glands. Recently laser therapy has become available for treating the enlarged prostate gland and is considered minimally invasive therapy.

Laser therapy is a procedure performed with a small fiber that is inserted into the urethra, the tube in the penis that allows urine to go from the bladder to the outside of the body.  The fiber delivers high-powered laser energy, which quickly heats the prostate tissue, which causes the tissue to dissolve or vaporize.  This process is continued until all of the enlarged prostate tissue has been removed. The end result is a wide-open channel for urine to pass through the urethra.

Laser therapy can be performed in a hospital outpatient center or an ambulatory treatment center.  Usually no overnight stay is required.  However, in some cases when a patient comes from a great distance, has associated medical problems such as heart disease, diabetes, or severe hypertension, or is in frail condition, an overnight stay may be recommended.

After the procedure

Most men will go home within a few hours after treatment. If a tube or catheter was inserted after the procedure, it will usually be removed the next day after the procedure.

Most patients experience marked improvement in their urinary symptoms immediately after the procedure.  This improvement typically occurs within the first 24 hours after the procedure.  However, the past medical history, health condition and other factors can influence treatment recovery.

Some men may experience mild discomfort such as slight burring during urination and small amounts of blood in the urine for a week or two.  Also, depending upon the condition of a man’s bladder, he may experience greater frequency and urge to urinate.  This will resolve over time as the bladder adjusts now that the obstruction has been removed.

There is no change in a man’s sexual function after the procedure.  His ability to engage in sexual intimacy after the procedure is unchanged.  Most men can begin sexual activity two weeks after the procedure.  Approximately 25% of men will have a decreased or absence of ejaculation at the time of orgasm.  The fluid is still there but goes backwards into the bladder and passes in the urine the next time the man urinates.

What are the risks of the laser procedure?

Every medical treatment may have side effects.  The same is true for the laser treatment.  The most common side effects include:  blood in the urine, bladder spasms, and urgency of urination.  These symptoms are usually temporary and will subside in a few days or weeks.

Bottom Line: Enlarged prostate gland is a common condition that affects most men after age 50.  Treatment options include medications, surgery and minimally invasive treatment using lasers.  The laser treatment produces a rapid improvement in urine flow, a quick return to normal activities, short or no hospitalization.

When Your Urine Turns Red

April 13, 2010

Most men have an ejaculate (the fluid that contains the sperm) that is white and slightly cloudy.  When it turns red, it is a frightening occurrence.  Hematospermia, or blood in the ejaculate, is a symptom that provokes great anxiety in patients due to fears of malignancy or sexually transmitted diseases. For most men, hematospermia is not a serious, life-threatening condition.

One could think of blood in the semen in almost the same way one would think of blood in nasal mucus when one has a bad cold or sinus infection. It certainly is a sign of problems, but it’s nothing to panic about. Seeking a medical opinion is highly recommended in any instance.

Most men with hematospermia usually report brownish to red discoloration of the ejaculate. More than 90% of patients have no prior genitourinary symptoms or significant factors in their history. The ages range from 14 to 75, with an average age in the late 30’s. It is not uncommon, however, for it to affect men between the ages of 30 and 40. About 90% of men who have had hematospermia will have repeated episodes.

The cause is not specifically known and is poorly understood. Most commonly, it results from nonspecific inflammation of the urethra, prostate and/or seminal vesicles.

In about 50% of patients the cause of hematospermia is not clearly understood or known. Semen originates from multiple organs, including the testicles, epididymis, vas deferens, seminal vesicles, and prostate. Most of the semen comes from the seminal vesicles and prostate and it is probably from these two organs that most hematospermia cases originate.

Infections or inflammation of the organs listed above account for most of the other causes. Cancers are rarely causative and account for a very small percentage of hemospermic diagnoses.

With the introduction of ultrasound-guided prostate biopsies, we are seeing a large number of patients — about a third of the patients who received the test — with hematospermia after the biopsy.

Patients with hematospermia are usually categorized into one of two groups. The primary hematospermia group is where the patient’s only symptom is blood in the ejaculate. This means that there is no blood in the urine (neither visually nor under a microscope). Also, the patient has no symptoms of urinary irritation or infection and the physical exam is completely unremarkable. Patients who have this type of hematospermia with no other findings are essentially found to have no other problem. The condition is “self-limited”, which means it will go away in time without treatment. About 17% of patients will have one episode and no recurrence.

Secondary hematospermia is when the cause of bleeding is known or suspected, such as immediately after a prostate biopsy, in the presence of a urinary or prostate infection, or cancer. Unusual causes include tuberculosis, parasitic infections and any diseases that affect blood clotting such as hemophilia and chronic liver disease. Patients who have hematospermia associated with symptoms of urinary infection or visual and/or microscopic blood in the urine require a complete urologic evaluation.

Most men with hematospermia are in their 30’s and the problem almost always subsides spontaneously, usually within several weeks. Hematospermia may be associated with infection, but is rarely secondary to malignancy. Patients that have persistent hematospermia for longer than three weeks should undergo further urologic evaluation to identify the specific cause.

The physical exam should include a genital and rectal exam, as well as a blood pressure test. Hypertension can be associated with hematospermia. Some urologists recommend transrectal ultrasounds to look for stones and cysts in the prostate, seminal vesicles and ejaculatory ducts. This may also help rule out prostate cancer.

Other urologists recommend cystoscopy because hematospermia can be secondary to urethral and prostatic pathology. Overall, hematospermia almost always resolves spontaneously and rarely is associated with significant urinary pathology. In a Japanese study, less than 1% of patients had prostate cancer associated with hematospermia.

Hematospermia can be a very frightening occurrence to any male, but in the end, most of these patients are found to have no abnormalities and require no therapy. Hematospermia is prone to continue on and off, but it is usually self-limited and carries no increased risk of any other disease, nor is the patient felt to be putting his sexual partner at risk. To reiterate; malignant cancers of the testicles and prostate are very rarely associated with hematospermia.

Bottom line-hematospermia is a frightening condition that suggests a mild inflammation of either the prostate gland or seminal vesicles.  No treatment or use of medication will result in return of the semen to its normal color.  If you have this condition, check with your doctor or your urologist.

EjD, Ejaculatory Dysfunction-The New Sexual Dysfunction

April 11, 2010

Millions of men suffer from EjD or ejaculatory dysfunction.  The most common variety is premature ejaculation followed by retarded ejaculation or not being able to achieve an orgasm.  Another less common EjD is retrograde ejaculation or seminal fluid going back into the bladder instead of exiting the penis at the time of orgasm.  This article will discuss the three common EjD conditions and what can be done to resolve them.

It is estimated that one-third of American men suffer from premature ejaculation or ejaculation within seconds of vaginal penetration.  This is of great concern and embarrassment to those who experience this malady.

One folk remedy that is available to all men is self-stimulation or masturbation. Having repeated orgasms will bring on delayed ejaculation in nearly every man. The best premature ejaculation tip is to double the number of orgasms a man has per week. And if that doesn’t work, double it again.  Now isn’t that a great assignment?

Another method that requires cooperation with the partner or significant other is the “pull out technique.” This consists of having sex for a few minutes then pulling out and stopping for a few minutes to postpone orgasm.

Another method is to decrease the stimulation of the penis using desensitizing cream such as topical xylocaine.  Also, using one or more condoms can decrease the sensation and can prolong ejaculation.

When these non-pharmacologic techniques are ineffective there are medications that can help prolong the time from penetration to ejaculation. Selective serotonin reuptake inhibitors, or SSRIs — are known to cause delayed ejaculation.  Using an SSRI four to six hours before intercourse, men prone to premature ejaculation can last longer.

Delayed ejaculation (or retarded ejaculation) affects a much smaller number of men.  With this problem, men cannot reach orgasm at all, at least not with a partner.  It is most common associated with aging where more stimulatin is required for a man to reach an orgasm with advancing years because the nerve endings in the penis become less sensitive.  Delayed ejaculation may be caused by medicines – like antidepressants– are common culprits.

Retrograde ejaculation is the least common of the ejaculation problems. Retrograde ejaculation can be caused by diabetes, nerve damage, and various medications such as alpha-blockers like Flomax, which are used to treat enlargement of the prostate gland. Retrograde ejaculation is harmless and won’t interfere with the feeling of orgasm. (It can also make for an easy post-sex clean-up.) But since it does affect fertility, some men may need treatment if their partners are trying to get pregnant.

Bottom Line

EjD is a common medical condition that can be overcome.  Be open and communicate with doctor and share your concern with your partner.  Don’t suffer in silence and let the tension mount up and compounding the problem.  Most men with some advice and perhaps some medication from their doctor can overcome this problem.  This translates to less worry and more sex.  Who could ask for anything more?