Archive for September, 2020

Strengthening the Muscles of Penile Rigidity and Ejaculation

September 26, 2020

Andrew Siegel MD   9/26/2020

We are approaching the end of Prostate Cancer Awareness Month. 200,000 men will be diagnosed in the USA in 2020; the disease prevalence is 1 in 9 men overall and 1 in 6 in African American men. Prostate cancer causes NO symptoms in its earliest stages, so please consider seeing your physician yearly for a prostate exam and PSA blood test, the means of early detection. When diagnosed early on in its course, prostate cancer is eminently treatable.  In honor of awareness month, for the 5-day period from today through September 30, my book: PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families will be available as a free Kindle e-book on Amazon.

Today’s entry addresses the muscles vital for a fully rigid penile erection and for the ability to ejaculate forcefully. Although not external muscles of “glamour” (like the pectorals, biceps and triceps) they are certainly the muscles of “amour.” 

The Muscles of Love

 Limber hip rotators, a powerful cardio-core,

But forget not the oft-neglected pelvic floor


Erections are all about hydraulics: increased penile inflow and restriction of penile outflow of blood.  After blood inflow has inflated the erectile chambers, closure of penile veins traps the blood in the penis, resulting in a plump and full—but not rigid—erection, with a blood pressure (BP) around systolic BP (120 mm or so).  Bone-like rigidity is only achievable by virtue of the pelvic floor muscles (hereafter referred to as “PFM”), that engage to act as a “muscular tourniquet” that further limit the exodus of blood.  Furthermore, with each contraction of these specialized muscles, an additional surge of blood flows into the erectile chambers, causing penile high blood pressure (> 200 mm) and a rigid erection.

The penis is the only place in the body where hypertension is expected and necessary and this occurs by virtue of the action of the PFM.  Anywhere else in the body these kind of blood pressures would be considered a hypertensive crisis and a medical emergency.

See where this gets you: Next time you have an erection that won’t quit, tell your partner that you are having a hypertensive crisis of your penis and that you are in dire need of help!

When you have a full erection, stand up and contract you PFM and you will see and feel blood surge into the penis and the angle of the penis become more skyward. The PFM are responsible for this ability to lift one’s erect penis up and down as they are contracted and relaxed.


Half of penile length is exposed and visible and the other half is internal and invisible and referred to as the “penile roots.”  The penile roots stabilize the erect penis so that it remains rigid and skyward-angling and maintains its “posture,” similar to how the roots of a tree stabilize the trunk, branches and leaves, so that the tree is not uprooted when exposed to the elements such as wind and rain. The penis requires this foundational support not only to enable erectile rigidity, but also to maintain stability despite exposure to the “elements”—the substantial forces associated with sexual activity—that can torque and buckle the penis. Without functioning penile roots, the penis would remain limp, dangling with gravity and with a slouching posture at best.


The penile roots are enveloped by two of the superficial PFM, the ischiocavernosus (IC) and the bulbocavernosus (BC).


Male pelvic floor muscles including superficial (ischiocavernosus, bulbocavernosus, transverse perineal muscles, external anal sphincter) and deep (levator ani) components, Attribution of this image: Openstax / CC BY

The “erector” muscle is the IC muscle. The IC surrounds the inner, deeper portion of the erectile bodies and its relaxed state, acts as an internal strut that helps anchor the deepest aspect of the erectile bodies to the pelvic bones. The IC stabilizes the erect penis and compresses the erectile bodies, decreasing the return of blood to foster penile blood pressures in the hypertensive range that allow the penis to have bone-like penile rigidity. At the time of climax, it contracts rhythmically and is responsible for maximal erectile rigidity at the time of ejaculation

The “ejaculator” muscle is the BC muscle. The BC surrounds the inner, deeper portion of the urethra. In its relaxed state, it acts as an internal strut that helps anchor the deepest, internal aspect of the penis. When the muscle is contracted actively after urination, it compresses the urethra to expel (ejaculate) the last few drops of urine that sit in the deep urethra. During sex, it helps support and engorge the spongy erectile body that surrounds the urethra and the head of penis. At the time of climax, it is responsible for the expulsion of semen by virtue of its strong rhythmic contractions.


The PFM—unseen and behind-the-scenes, obscured from view, often unrecognized and misunderstood—have other vital functions in addition to erection and ejaculation. They straddle the gamut of being critical for what may be considered the most pleasurable and refined of human pursuits—sex (superficial PFM)—but equally integral to what may be considered the basest of human activities—urinating and moving one’s bowels (deep PFM).  The deep PFM strongly contribute to the sphincter function of the bladder and the bowel.  As part of the core group of muscles, their structure and function also affect body posture, the lower back and the hips.


When the PFM are functioning sub-optimally,  the potential for full erectile rigidity and forcible ejaculation is lost.  Like other skeletal muscles, the PFM can undergo “disuse atrophy,” becoming thinner, flabbier and less functional with aging, weight gain, sedentary lifestyles, poor posture, chronic straining and other forms of trauma, including pelvic surgery (e.g., prostatectomy) and pelvic radiation.

Dorey et al published an article in the BJU that demonstrated the effectiveness of PFM exercises for erectile dysfunction (ED), but also suggested an association between the occurrence of ED and post-void dribbling (PVD).  How fascinating—ED and PVD are linked and parallel problems, one sexual and the other urinary—both being manifestations of PFM weakness, and both treatable by PFM training. 


As with other skeletal muscles, positive adaptive changes can be made to the PFM if they are trained. Exercising them properly can enhance sexual health, maintain sexual health, help prevent the occurrence of erectile dysfunction (ED), and help manage ED.  Specifically, pelvic floor exercises can be beneficial with respect to the following spectrum of issues: ED, dribbling ejaculation, premature ejaculation, stress urinary incontinence, overactive bladder, post-void dribbling and bowel urgency and incontinence.


One of the challenges of pelvic floor training is that these muscles are mysterious, and many men do not know where their PFM are located, what they do, how to exercise them, and what benefits training may confer. Many men don’t even know that they have PFM, particularly since they are internal muscles concealed from view.  Because they are out of sight, they are often out of mind and not considered when it comes to exercise and fitness. However, they deserve serious respect as they are responsible for vital functions that can be enhanced by training.


The most expedient means of achieving pelvic strengthening is using a well-designed, follow-along program.  The Private Gym offers such a program in a basic 4-week format and a more intense 8-week format that offers resistance. Both programs are available in DVD or streaming format with the purpose of increasing the strength and endurance of the PFM.  These programs provide the necessary education, guidance, training, and feedback to confirm the engagement of the proper muscles and are structured so that repetitions, contraction intensity and contraction duration are gradually increased over the course of the program, progression being the key to optimizing pelvic strength and endurance.

The reader is also referred to a book I wrote on the topic of male pelvic floor training: MALE PELVIC FITNESSOptimizing Sexual and Urinary Health.

10 Ways to Ensure That You Are Properly Contracting Your PFM

  1. Gaze down: The base of your penis retracts inwards towards the pubic bone as you contract your PFM.
  2. Gaze down: The testes rise towards the groin as you contract your PFM.
  3. When you place your index and middle fingers in the midline between the scrotum and anus you feel the PFM tighten as you contract them.
  4. You can pucker your anus as you contract your PFM. The anus tightens and pulls up and in, known as the “anal wink.”
  5. You get a similar feeling as when ejaculating when you contract your PFM rhythmically.
  6. When you touch your erect penis, you feel the erectile chambers surge with blood as you contract your PFM.
  7. You can make your erect penis elevate (lift and point) as you contract your PFM.
  8. You can stop your urinary stream completely when you contract your PFM.
  9. You can push out the last few drops of urine that remain after completing urination when you contract your PFM.
  10. After pursuing PFM training you notice improved erections, ejaculation and urinary control

Bottom Line: PFM conditioning is beneficial to any man (and woman for that matter).  The PFM are vital to genital and urinary health and serve an essential role in sexual, urinary and bowel wellness in both genders.  A fit and trained pelvic floor in men can help improve and or prevent erectile dysfunction, ejaculation issues, and urinary and bowel control issues. 

Wishing you the best of health,

2014-04-23 20:16:29


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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.  This blog is excerpted from the Sexual Function section of Prostate Cancer 20/20.

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health