Using the ultrasound for therapeutic heat in PE

THE IMPORTANCE OF THE HEAT

Before stepping into the ultrasound therapy induced tissue heating we need to know the fundamentals of using therapeutical heat, heating tissue in general or just warming up.

Using constant heat has been an important catalyst for the gains in PE.
Anecdotal findings from the PE community show that the continuous heating has been providing gains for many, being the PE method which ever they have happened to chosen.
Studies indicate that raising collagenous tissue temperature by 3°C (moderate heating) from the baseline induces increased elasticity in the stretched tissues.
Going further up to 4- 8 °C (vigorous heating) above the resting temperature the magic starts to happen when the therapeutic heat starts to allow plastic deformation of collagen by thermal mechanisms.

After passing the threshold of 40°C the thermal transition is allowing permanent lengthening on tissues while stretched. Some percentage of the elongation reached during the heat never reverse back to the previous length.
Continuing to do this after few exercises we are getting longer penises. There is the magic.

Here are some excerpts and further interpretations from studies originally referred in the book: Science of flexibility by Michael Alter. It is the collection of highlights we should understand using any method of PE.

When connective tissue is stretched within therapeutic temperatures ranging 102 to 110 F (38.9- 43.3 C), the amount of structural weakening produced by a given amount of tissue elongation varies inversely with the temperature. This is apparently related to the progressive increase in the viscous flow properties of the collagenous when it is heated. (Warrent et al (1971,1976)

The mechanism behind this thermal transition may be destabilization inter-molecular bonding or enhanced viscous flow properties of the collagenous tissues, possibly allowing elongation to occur with less structural damage. (Rigby 1964)

Raising the temperature of tendon above 103 F(39,7 C) increases the amount of permanent elongation that results from the initial stretching. (Laban 1962, Lehmann et al . 1970)
Above 104F (40 C) occurs thermal transition of the microstructure of the collagen, significantly enhancing the viscous stress-relaxation of collagenous tissue and allowing greater plastic deformation during stretch. (Mason and Rigby 1964, Rigby et al 1959)

According to Sapega et al (1981), stretching connective tissue at elevated temperature the condition which under the tissue cools down affects the elongation that remains after tensile stress is removed. They based their hypothesis on Lehmann et al. (1970) , which found that after heated tissue is stretched , maintaining tensile force during cooling down significantly increasing the relative proportion of plastic deformation compared with unloading the tissue while its temperature still high.

They also speculated that cooling the tissue before releasing allows the collagenous micro-structure to re-stabilize more toward its new stretched length.
However (Hardy and Woodal 1998) have questioned benefits the aided cooling while tension. Applying cold while tension it diminished all the gains made in flexibility with every study group.
Therefor applying ice during cool down is not necessary and possibly even counterproductive.

With the above citations I am trying to say that operating at 40- 43 C , the tissues are able to go through plastic deformation by some degree at strains well below sub-failure proportions otherwise needed to cause plastic deformation at the same rate. Plastic deformation meaning permanent gains.
This permanent elongation is produced with lesser degree of structural or cellular damages with a lower stresses (load, time under load) needed with stretching the tissues below therapeutic heat temperatures.

Therapeutic heat is producing as a side product increased metabolic rate, enzymatic effects and enhanced healing rate. Increased enzymatic activity has been seen in tissues at 39-43C (102-109F).
Enzyme activity rates begin decreasing beyond 45C and to cease completely at 50C (122F).
Any increase in enzyme rate will increase the cellular biochemical processes and the uptake of oxygen resulting in accelerated healing.
Increase of tissue temperature shifts the oxygen-hemoglobin dissociation curve to the further which means releasing more oxygen for tissue repair.
Hemoglobin releases twice as much O2 when tissue temperature is 41C (106F), than at resting temperature.

Manko007 has tested infrared lamp to rise the urethral temperature to 100°F (37.8°C) in 10 minutes going further I recall never exceeding the 104°F (40°C). The trial was interrupted because of some issues. Further trials should be made to confirm the efficiency rate.

He has also demonstrated far infrared (FIR) pad to rise the urethral temperature up to ~ 97.5°F (36.3°C) in 10 minutes and reaching the peak at 105°F (40.5°C) in 20 minutes.

With ultrasound we have demonstrated several times being able to reach the mean temperature of 105°F (40.5- 40.8°C) in just 4 to 10 minutes under application. Peak temperatures being up to 44°C. Skin temperature raising only marginally at any phase of the exercise.

Heating via conduction fails because the fact that the skin temperature needed to heat the inside parts of the shaft raises up to the level of discomfort and pain. Standing the pain would of course lead to skin burnt and other adverse issues.
No matter if we are using the infrared lamp, hot bath or whatever source the skin comes the restricting element not allowing to raise the temperature at the tunica level high enough. There is reasonable doubt that by any form of conductive heating method will elevate urethral temperature to the therapeutic heat level.
Penis Is a great cooler which we can easily find out if you were to put a urethral or other ways invasive temperature monitoring element inside our shaft.

There is no doubt which being the superior heating method. US is in another league and all others should be considered as a secondary heat source.
The effective way of applying the US energy and the even distribution of the heat comes from experience. It is still unlikely the user being able to keep the mean temperature perfectly up in the whole unit without using the temperature indicator.

This is of course clearly the hindsight of using any of the heat sources in general. Not knowing the penile core temperature, we can get fooled in to thinking the heat is enough especially with the excessive skin heating methods.

The skin temperatures during the US application can´t be taken as a reliable indicator of the penile core temperatures since the heat builds from inside the tissues absorbing
the energy mostly at the half depth of the penetration of the ultrasonic beam. We can be reachinghigh internal temperatures still to have only slightly elevated skin temperature.

Conclusive tests has not been produced enough using the skin temperature as a indicator but theinitial results suggest that the correlations between has not been confirmed.

The dermal layers in penis are very efficient on neutralizing any heating efforts by the natural thermo regulatory mechanism, dermal layers having the independent from the erectile portions blood supply system.
Not to mention trying to heat the septum which may be the most resisting portion for the gains to come for many of us. To heat the septum there is absolutely no way other than ultrasound available at the moment.

This could be explaining why some of the great gainers amongst us have benefited from the traditional heat sources other left without the gains despite dangerously high skin temperatures they have been exposing themselves. They have managed to heat the tunica and their base ligaments enough and not being restricted by the excessively stiff and non-elastic septum or collagenous thickenings.

RF heating and laser therapy technologies are developing, and in the future, I believe there could be better possibilities to heat which ever dept we like other dimensions staying at lower temperatures.

- The main safety notions in the manuals tells not to use ultrasound on reproductive organs or intestines.

- Therefor DO NOT point the transducer beam towards TESTIS, PROSTATE OR YOUR INTESTINES OR THE ANUS.

- AVOID CONTACT of any kind on testis with the transducer head.

- Treating the base of the penis or the cruras of the penis use the 3MHz instead of 1MHz if possible.

- Transducer should be constantly moving.

- DO NOT USE TRANSDUCER STATIONARY.

- Circulate the transducer head around the target for maximum of 10 seconds and move outside the area just treated in circulating pattern. The patterns overlapping slightly.

- Not to immediately visit same spot with the transducer head area to allow the possible excessive temporary peak temperature drops down.

- Not to use more than 2.0w/ cm^2 intensity with the knowledge available at this point.

- Several sources indicate that the intensity can come intolerable for many at 2.5w/cm^2 especially using 3MHz US application.

- Total of 20 minutes application with 1.6- 2,0 w/cm^2 intensity can be considered to be relatively safe as the build up to + 40° C takes time up to 10 minutes which after the duration limitations comes safety issue depending of the temperature value.

- There is very little actual knowledge of any total time limitations for the ultrasound therapy applications.

- After the 10 minutes application temperature tends to stabilize at the desired level.

- With a transducer having bigger than 1:4 beam non-uniformity ratio (BNR) it is recommendable to stay at low as possible intensity still heating the penis. BNR tells the non-uniformity of the ultrasonic beam, the ratio between he highest intensity in an ultrasonic beam and the output reported on the meter.

The bigger the ratio the greater the uncontrollable peak intensities outside the labelled uniform beam intensity.

- Don´t use above 3.0 w/cm^2 intensity in any case. Above the intensity the probability of the adverse effects raises significantly

- These are applications made for professional use therefor you should self-educate yourself on the topic before incidentally risking your health.

- Be aware of the risks involved with the unappropriated and irresponsible use.

You are using the ultrasound application with a considered risk on the site not recommended by the machine manufacturers.

We have run several tests by Manko007 and myself measuring the urethral temperature as a guidance for developing both efficiency and with a growing interest for the safety as well.
Results seem to indicate that we can reach mean temperature greater than 40° C peak temperatures being up to 44° C. Resting penile core temperatures measured inside the urethra seem to be low, varying between 32,5° to 34.5° C.

It takes time to reach the +40° C temperature up to 8-12 minutes with 1.6w/cm^2 1 MHz application. The temperature will stabilize at the 40-41° C range the mean temperature not easily rising any further after achieving it. Increasing the intensity to 2.0 w/cm^2 the time needed comes down couple of minutes. After the mean temperature has exceeded the
3 MHz with the same intensities is capable of even faster heating rate but at the 6-8 minutes range the efficiency settles to be very similar.

Peak temperatures reached during tests drop down significantly once the transducer is removed.
The drop at the temperatures above 40° C have been repeatedly shown to be in the range of 0,5 to 1 C ° in 10 seconds. That would mean if we accidentally reach temporary peak temperature of 44° C once the transducer is constantly moving, the localized peak temperature drops down to 40° C in the safety limits. More of this on later posts.
After the application is removed there remains the 10 minute “therapeutic window” known in the physical therapy applications. Penile tissues take approximately 10 minutes to cool down to slightly above the normal resting temperature. During the cooldown the temperature drops initially really fast and stabilize to show a decelerating decay. The cooling rate is significantly higher than shown in studies with muscular tissues.

What we have here is a natural safety feature build in our manly units both resisting the temperature rise at certain threshold and the ability to cool down significantly at such a short time. But we cannot rely on it, we need to know the limitations and the application should be always used cautiously.

Here are included test runs published to date with the monitored urethral temperatures.
To be noted Mankos results are monitored with a single measuring spot using the transducer treating the penis circulating mostly at the near area of the thermometer. Tests run by me are done with two measuring spots inside the urethra circulating the transducer for the whole shaft area of the penis.

Ultrasound for penile therapeutic temperatures

Ultrasound heating for penile therapeutic temperature part 2

US warmup and cooldown charts and data table

Biophysical effects of ultrasound are traditionally separated into thermal and nonthermal effects.
In this post we concentrate on non-thermal safety aspects.

In the world of physical therapy it is known that the ultrasound appears to have a low risk of harm in the hands of skilled physical therapists, but the expectation of therapeutic benefit is also low.

Most of the non-thermal safety issues arise when cavitation or microstreaming has occurred.
Acoustic streaming is mostly caused by the cavitation and either of them are most probably not occurring in therapeutic use of our application.

To made them appear stationary application is needed most likely for minimum from 20 seconds to minutes at one place not moving the transducer. Keeping the constant movement not sticking at one place more than few seconds and keeping the times under therapy not longer than necessary have not seem to cause cavitation in studies in vivo.

The appearance of cavitation is proportional to both intensity level and the time under stationary application.
I emphasize both cavitation and the acoustic streaming to be the most likely sources for any negative effects US use may produce.
There are more possible ways of ultrasound affecting living tissue like cellular stress mechanisms due direct action of the compressional, tensile, and shear stresses and radiation pressure changes etc. But the main concern when talking about non-thermal effects is the possible cavitation and the consequencies of it.

Effects on blood carries another concerns especially when using US within clamping as there are some studies indicating the possibility of lysis of erythrocytes in vivo.
Also there is possibility to cause "blood flow stasis" during standing ultrasound wave especially if there happens to be a reflector causing it. 3MHz ultrasound have been reported to cause blood cells grouping into bands during the stasis. Damages in endothelial linings of the vessels affected by the stasis could occur but mainly being reversible. Again like in many other possible damages no permanent damages has been found.

There is a lot of contradicting info indicating that ultrasound application could cause damages by many routes and as many routes to start the repairing activities the sum being neutral.
We can be relatively convinced that the adverse non-thermal biophysical effects are not the main risk we should be concerned, being very unlikely to be to cause problems in therapy form we have started. More of a safety issue is the ability to detect and handle thermal risks involved.
The intensities and the frequencies we are using have been in physical therapy use for decades. These are the frequencies and intensities having the majority of the studies available concentrating

If we use the transducer stationary keeping it focused in one spot for extended times those may start to occur due cavitation and or acoustic (micro)streaming.
If the damages happen at the mitochondrial level more time is needed for healing and some portion of the damages could be irreversible.
In any case avoiding every day treatment and taking days off can be considered as a practical safety procedure. The way the actual therapy is applied is the priority one safety precaution there is.

These links get you to the basics of the Ultrasound induced biophysical effects and two of them giving the most clear view on if the cavitation or micro-streaming ever occurs in our application.

Anyone starting to use these ultrasound applications should educate themselves to know these applications not being any passive warm-up methods. This is an active tool for PE potential to cause damage like any other PE tool does.

A Review of Therapeutic Ultrasound: Biophysical Effects
Review of Therapeutic Ultrasound: Biophysical Effects | Physical Therapy | Oxford Academic

Environmental Health Criteria - Ultrasound
https://apps.wh o.int/iris/bits … 9FF5?sequence=1

Overview of Therapeutic Ultrasound Applications and Safety Considerations
Overview of Therapeutic Ultrasound Applications and Safety Considerations

As we already know the biophysical effects of ultrasound are separated into thermal and nonthermal effects.
This post is fully concentrated on thermal effects safety aspects.

The therapeutic heat during the ultrasound session in PE is of course the main effect what we are after.
Reaching inner penis temperatures of 39.7- 43.3 ⁰ C includes the risk of temporary overheating.
Therefor it is necessary to act cautiously when increasing the intensity of the application.
Managing safe application means also using the constantly moving transducer handling techniqueto avoid hot spots emerging.

The link provided below is for the review evaluating the risk exposure of the thermal mechanismfor ultrasound‐induced biological effects.
Safe exposure time calculations based on this study forms the time bracket not to exceedwith the given temperature, if we don´t like to take a increased risk on thermally caused cell
degradation and cellular damage.

SAFE APPLICATION TIMES FOR GIVEN TEMPERATURE
Here T is in °C and application time t is in seconds, and for which there have been no significant
adverse biological effects observed due to temperature values smaller than or equal seen in this
chart.

T (°C)___t (sec)___T (°F)
46,0 _____7,5 ____114,8
45,5 ____10,6____113,9
45,0 ____15,0____113,0
44,5 _____21,5____112,1
44,0 ____30,7____111,2
43,5 ____42,5____110,3
43,0 _____59,0____109,4
42,5 ____119,0____108,5
42,0 ____238,0____107,6
41 5 ____ 476,0____106,7
41,0 ____ 950,0____105,8
40,5 ____1897,0____104,9
40,0 ____3785,0____104,0

For the reasons not excluded from penile heating circumstances it is recommendable that we
should keep an extra safety margin within these limits above.

Despite having made a series of test runs measuring urethral temperatures the info we have on
heating performance is not excluding the possibility of having hot spots elsewhere on the shaft.

We should also stay on the safe side keeping the ultimate safety limit at 45 °C not to exceed it in any circumstances.

Up to 45 °C the enzymatic and metabolic rates continue to increase and at 45 °C the adverse biophysical effects start to happen.
Especially seen after enzymatic reactions have reached the peak they start to rapidly decrease exceeding the threshold temperature.
Staying below this the penis has the natural ability also to cool down within the safety limits once the application has been removed.

The penis has the human body thermo regulatory mechanism kicking in resisting to easily exceed the mean temperature of 41 °C with 1.6 – 2.0 w/cm^2 applications stabilizing the temperature despite the occasional peaks. Thermally induced analgesic effect on nerves should also be taken in consideration during high risk-profile PE applications. There is controversial indications on studies concerning the analgesia. Some frequencies are known to non-thermally sensitize neural effects opposite to analgesic effect caused thermally.

If someone still not convinced about the safety of the non-thermal or thermal biophysical effects of ultrasonic application then he should use it having 4 days of rest between the applications.

It is the suggested time needed for non-mitochondrial cellular damages to heal.
If we are stupid enough to use the transducer stationary keeping it focused in one spot for extended times those may start to occur for sure.
If the damages emerge to happen at the mitochondrial level more time is needed and some portion of the damage could be irreversible.

All in all ,with the responsible and educated use the ultrasound is relatively safe with our application targeting the 39.7- 43.3 °C range of therapeutic heat.

As a summary doing everything patiently and respecting the risks, we are not going to accidentally cook our penises and drop them off well done.

The Risk of Exposure to Diagnostic Ultrasound in Postnatal Subjects
https://onlinel ibrary.wiley.co … m.2008.27.4.517

To be later continued with practical examples

Good

Thank you for all the research. There is a lot of information there and some very interesting points.

I saw infrared heat mentioned above and was wondering your thoughts or suggestions on stretching in an infrared sauna? I have access to one and temperature sits steadily at 148 F.

If you like to hear the truth I think you enjoy the infrared sauna more treating your penis non -PE fashion.
Additionaly you can find that all temperature rise will increase elasticity. If it is turned into gains remains a question.

Thermal effects are the result of the absorption and attenuation of the sound waves in the tissues.
As ultrasound waves are absorbed by the tissue, the vibrational energy is converted to heat. With the absorption, the waves are attenuated, the amplitude of the wave decreasing as a function of the distance traveled through the tissue.

The rate at which ultrasound is absorbed in the tissues can be approximately determined by the half value depth - this is the tissue depth at which 50% of the ultrasound delivered at the surface has been absorbed.
The figures used for these estimates are average values in that it absolute values will vary with the thickness of various tissues (e.g. skin, fat, muscle etc).

The average 1/2 value depth of 3MHz ultrasound is at 2.5cm and that of 1MHz ultrasound as 4.0 cm.
The table included shows in the red column how much of the intensity is left at different depths pointed in the top row of the columns.
Blue and black columns show the transducer intensity for the calculated functional intensity at given depth.

Taking in consideration the nature of the longish thin object and the heating rate variations at different depths we can´t be targeting the heat very precisely at any depth. At least it is challenging.
Targeting the heating mostly at certain depth it is possible with underwater application or using ultrasound standoffs aka ultrasound gel pads to adjust the beam penetration depth.

In physical therapy effective US treatment is generally considered to be applied to an area not more than 2 to 3 times the area of the of the transducer ERA (effective transducer area).
For musco-ligamentous tissues have been estimated the rate of temperature increase in C/ min:

For 1MHz 0.2C/min / (1w/cm^2) and for 3MHz 0.6 C / min / (1w/cm^2)

For the area above using 1MHz US application the theoretical calculation looks like this:
0.2 x Intensity (W/cm2) x treatment time in minutes = Degrees C of Temperature Increase

Respectively for the 3MHz application :
0.6 x Intensity (W/cm2) x treatment time in minutes = Degrees C of Temperature Increase

Heating with 1.6 cm^2 intensity by 1 MHz the time needed for 6 degrees elevation (34 -> 40C) the needed time is:
=6 / (0.2 x 1.6)
= 18,75 minutes

Which of course does not fit anywhere near into reality we have tested measuring urethral temperatures.

The difficulty on calculating the ultrasound dose has major flaws as the temperature raise remains un-monitored in practically every physical therapy application.
This has been recognized in the medical environment and for the accurate dose calculations, the measurable data of the treated target tissues is inevitable because of the absorption capability differences in different tissues. Which is exactly what we are doing by the test series with urethral temperatures.

Treating the entire exposed shaft in my case has the area of 14 times the transducer ERA and taking in the
consideration that the time needed for 6 degrees increase has been average of 10 minutes. These variables
changing the equation:

Rate of temperature increase in C/ min = 6 / 10 x 1.6

= 0,375 C / min / (1w/cm^2)

Let´s find the rating in Manko´s case heating ½ or 1/3 of the shaft area(A) with similar
dimensions elevating the temperature for 6 degrees in 3.5 minutes with 2w/cm^2 1 MHz:

=( 6/( 3,5x 2 )) x ½ (or 1/3)
= 0.28 to 0.42 C / min / (1w/cm^2)
= AVG 0.35 C / min / (1w/cm^2)

These are the rough estimations for the Heating Rate of the ultrasound efficiency because of the lack of data to be more accurate and confirm the results.
Treated areas have not been accurately measured, making it impossible to compare findings more precisely.

The very cautious assumption of the average efficiency of the heating would provide the calculation for 1MHz:

0.36 x Intensity (W/cm2) x treatment time in minutes = Degrees C of Temperature Increase

Forming the universal Heating Rate Calculation for our purpose I suggest to taking the volume of the penis as a variable.
If we were to calculate the volume of the treated area we could make correlations between heating sessions of the complete shaft or the precise region near only.

It would take in account the volumetric mass of the heated penis with the absorption rate characteristics our manly unit have.

Here is the stretched flaccid shaft volume based estimation for the heating rate with 1MHz for the entirely treated shaft length based on my studies alone:

= 0.375 C/ min/ 1w/cm^2 / V
= 0.375 C/ min/ 1w/cm^2 / 149 cm^3
= 0.00251 C/ min/ 1w/cm^2 / cm^3

Leading us to the equation:

0.00251 x Intensity (W/cm2) x treatment time in minutes x volume in cm^3 = Degrees C of Temperature Increase

Further tests should correct accuracy of the estimated Heating Rate in the future.

At the moment we have to abstain on giving any estimation on efficiency rate of 3MHz applications.
The initial results seem to indicate that the efficiency is not three fold the 1MHz as the theories claim.

Rate of Temperature Increase in Human Muscle During 1 MHz and 3 MHz Continuous Ultrasound
https://www.jos pt.org/doi/pdf/ … t.1995.22.4.142

Evidence-based application of therapeutic ultrasound
https://pdhther apy.com/wp-cont … -Course-PDF.pdf

Was there any discomfort going above 104f when you guys were doing urethral temperature readings?

No discomfort for me because of the tempereratures of 104- 105F.
At 106- 108 F it starts to be at discomfort level quickly reducing when the transducer is removed to another region. Not causing any pain though.
These are not excact observations as I have not made notes about the feelings during. I guess Manko did at one of his trials, maybe you should look at there.

There are few reasons for discomfort which I can identify.

Poor contact being the main thing causing sudden peak intensities felt pinching. Therefor we need to use lots of conductive gel. Secondly we need to secure the transducer skin contact.
Transducer head with large ERA can be a problem all of the effective radiating area not being in close contact with the skin.

The quality of the transducer can be one thing. Transducer with big BNR value can form huge localized peak intensities. Transducer having more than 4:1 BNR ratio can be causing these pinching feelings time to time. The one I am using has the ratio maximum of 5:1 an I am not feeling these pinches in every session and ususally only at the thinnest part of the shaft.
8:1 ratio is considered to be harmful. If the ratio is 5:1 the peak intensity at 1.6 w/cm^2 can be 8w/ cm^2 on random location of the transducer area. Localized at the small area and lasting only for short bursts at time. Huge enough to form hotspots I guess.

Thanks, I was hoping there would be more discomfort when getting into dangerous territory. Sometimes by the end of my routine, I start to feel some pretty hot temperatures at the transducer when using a hot washcloth on the opposite side of my penis. I suppose I should bite the bullet and test with a urethral thermometer to get a better idea of what my machine is doing in different settings.

I just started a new cycle after taking a couple of weeks off. I was a little surprised I measured 1/4” shorter after the break, but my girth seemed to increase by 1/8”. It may have been the bundled stretches I started implementing at the end of the last cycle, but who knows…

Good summary Kyrpa. Is your intent to discuss in this thread the techniques of US heat, or log various test procedures and results? Or discuss the theory surrounding the observations?