PubMed Update on How Medical Profession Views Circumcision

Compliments of Dr. Morris…

On Tuesday, April 8, 2014 9:32 PM, Brian Morris <brian.morris@sydney.edu.au> wrote:

New York Times
Circumcision Benefits Outweigh Risks, Study Reports
By NICHOLAS BAKALAR
April 7, 2014, 10:38 am
As well as the New York Times, the article in Mayo Clinic Proceedings below also led to over 50 other news reports, including NBC and CBS television in the USA and in newspapers and online news services in the USA and other countries.
Mayo Clin Proc. 2014 Mar 28. pii: S0025-6196(14)00036-6. doi: 10.1016/j.mayocp.2014.01.001. [Epub ahead of print]

Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?

  • 1School of Medical Sciences, University of Sydney, Sydney, NSW, Australia. Electronic address: brian.morris@sydney.edu.au.
  • 2People Incorporated, St Paul, MN.
  • 3Center for Neonatal Care, Orlando, FL.

Abstract

The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision prevalence and a higher burden of diseases that can be ameliorated by circumcision.
Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
PMID:
24702735
[PubMed - as supplied by publisher]
Clin Obstet Gynecol. 2014 Mar 28. [Epub ahead of print]
Primary Strategies for HPV Infection and Cervical Cancer Prevention.
  • 1*Departments of Family and Geriatric Medicine, Obstetrics and Gynecology, Bioengineering, Epidemiology and Population Health, Health Promotion and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky; †Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Abstract
Counseling messages for tobacco cessation, condom use, circumcision, and selective choice in the number of sexual partners can help reduce the risk of cervical cancer. Other sexual behavioral and reproductive risk factors for cervical cancer are a younger age at first intercourse and at first full-term pregnancy as well as increasing duration of combined hormonal oral contraceptive use. Micronutrients and supplements can reduce the risk of human papillomavirus infection, persistence, progression, and regression. Some human papillomavirus infections can be prevented by vaccination. Cervical cancer is best prevented by screening.
PMID:
24686336
[PubMed - as supplied by publisher]
This article appeared under “male circumcision” as a keyword
AIDS Educ Prev. 2014 Apr;26(2):170-84. doi: 10.1521/aeap.2014.26.2.170.
Making the cut: evidence-based lessons for improving the informed consent process for voluntary medical male circumcision in Swaziland and Zambia.
Abstract
The informed consent (IC) process for voluntary medical male circumcision (VMMC) was evaluated in Zambia and Swaziland as VMMC programs scaled up. In-depth interviews (IDIs) were conducted with clients 1 week after surgery to explore understanding of IC and gauge how expectations of MC surgery compared to actual experiences. In Zambia, key opinion leaders (KOLs) were also interviewed. Some clients equated written IC with releasing the clinic from liability. Most clients felt well prepared for the procedure, although many were surprised by the level of pain experienced during anesthesia and postsurgery. Clients were highly motivated to adhere to wound care, but some were overwhelmed by extensive instructions. Adolescents described barriers to accessing follow-up care and the need for support in overcoming adult gatekeepers. KOLs indicated that IC is not well understood in poorly educated communities. Results led to concrete programmatic changes, including revised patient education materials and more effective anesthesia for longer-lasting pain relief.
PMID:
24694330
[PubMed - in process]
PLoS One. 2014 Apr 4;9(4):e92015. doi: 10.1371/journal.pone.0092015. eCollection 2014.

Indices to Measure Risk of HIV Acquisition in Rakai, Uganda.

  • 1Rakai Health Sciences Program, Entebbe, Uganda; Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
  • 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
  • 3Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America.
  • 4Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
  • 5Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America.
  • 6Makerere University College of Health Sciences, Kampala, Uganda.
  • 7Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America; Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.

Abstract

INTRODUCTION:

Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed gender-specific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda.

METHODS:

We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike’s information criterion (AIC) as the stopping rule. Model discrimination was determined using Harrell’s concordance index (c index). Model calibration was determined graphically. Nomograms were used to present the final prediction models.

RESULTS:

We used samples of 7,497 women and 5,783 men. 342 new infections occurred among females (incidence 1.11/100 person years,) and 225 among the males (incidence 1.00/100 person years). The final model for men included age, education, circumcision status, number of sexual partners, genital ulcer disease symptoms, alcohol use before sex, partner in high risk employment, community type, being unaware of a partner’s HIV status and community HIV prevalence. The Model’s optimism-corrected c index was 69.1 percent (95% CI?=?0.66, 0.73). The final women’s model included age, marital status, education, number of sex partners, new sex partner, alcohol consumption by self or partner before sex, concurrent sexual partners, being employed in a high-risk occupation, having genital ulcer disease symptoms, community HIV prevalence, and perceiving oneself or partner to be exposed to HIV. The models optimism-corrected c index was 0.67 (95% CI?=?0.64, 0.70). Both models were well calibrated.

CONCLUSION:

These indices were discriminative and well calibrated. This provides proof-of-concept that population-based HIV risk indices can be developed. Further research to validate these indices for other populations is needed.
PMID:
24704778
[PubMed - in process]

Had dermal-fat, seeking AlloDerm

March 8, 2014

HI DR. REED ,
MY NAME IS Darwich G. , I AM FROM EGYPT ( DO YOU STILL REMEMBER ME ) BACK IN 1998 I UNDERWENT LENGTHENING AND WIDENING WITH DERMAL FAT GRAFTS , NOW I    AM CONSIDERING GIRTH ENHANCEMENT WITH ALLO DERM THE DERMAL GRAFTS SEEMS TO HAVE DECREASED ON ONE SIDE OF THE SHAFT AND ON THE BOTTOM OF MY PENIS ,MY QUESTION IS CAN  ALLO DERM BE USED IN CONJUNCTION WITH ALREADY PLACED DERMAL GRAFTS?  BECAUSE I WANT TO GAIN MORE  IN GIRTH,   AND I DO ,NT WANT TO LOSE  MY DERMAL GRAFTS. 

                                          THANK YOU DR, REED.                                                                                                                                                                                             I HOPE ALL IS WELL AND PLEASE EXTEND MY GREETING TO THE  WONDERFUL ANNE AND ALL THE STAFF LOOKING FORWARD TO BE HEAR FROM YOU,

DARWICH

March 9, 2014

Good morning Darwich,

Thank you for your continued interest in what we do.

The best way to advise is to see you at the office.

If I can lift a substantial amount of skin and adnexa (underlying connective tissue which includes good vascularity ideally, yes it can be done.

Please call Anne on Monday and set up a complimentary visit.

Have a restful weekend,

Harold M. Reed, M.D.
305-865-2000

Status post circumcision with rubber mechanical device and unsightly scar

March 5, 2014

Dear Dr. Reed,

Can you perform circumcision revision?

I would like to remove a strip of skin formed from circular scar tissue, 5-7 mm width.

The last circumcision was performed over a year ago by a mechanical device – a rubber ring. A wound was infected on the perimeter. After treatment I feel discomfort in this area.

Thank you.

Vernon

March 7, 2014

Good afternoon Vernon,

Thank you for your interest in what we do.  We have performed over 7500 cosmetic circumcisions and revisions in the past 35 years and usually do several cases every week.  Removing a strip 5 to 7 mm. wide is a fairly easy assignment, and I assume that there is sufficient laxity of the skin so that your erections will not be too tight.

Your penis is one of the most important functional and cosmetic features of your body.  Our patients know that and fly in from all over the world.  March is a promotional month.  Please call Anne for special pricing.  Be assured we will show you every courtesy.

All the best,

Harold M. Reed, M.D.

305-865-2000

BXO and phimosis, double whammie. Ready for adult circumcision.

March 8, 2014

Dear Dr. Reed,

Saw your web-site http://www.penisdoctor.com/   Impressed.

I have some questions regarding the services you offer in regards with adult male circumcision. To begin let me tell you about what I need, I am a 24 year old male with lifelong acquired phimosis through BXO. I have had prescribed Triamcinolone Acetonide in the past when I first began to search for a way to get rid of my phimosis which had absolutely no effect. to get to the point, I need a circumcision but it’s very unlikely for me to have it under local anesthesia. I need this surgery as soon as possible. How can we begin the process?

My telephone number 786-

Adam

March 8, 2014

Good morning Adam,

That is our experience as well.  Once the delicate elastic fibrils of your foreskin are destroyed through repeated inflammation and tearing, they do not regenerate.

Let the head of your penis see the light of day once and for all.  Hygienically you’ll be a lot happier. Consider adult circumcision.

Sincerely,

Harold M. Reed, M.D.
305-865-2000

How soon are you available for adult circumcision?

March 3, 2014

Dear Dr. Reed,

I was wondering how long in advance is required to book a circumcision surgery?

Nels

Good afternoon Nels,

Thank you for your interest in what we do.  We have availabilities

most weeks.

We have performed over 7500 cosmetic circumcisions and revisions

in the past 35 years and usually do several cases every week.

Your p.nis is one of the most important functional and cosmetic features

of your body.  Our patients know that and fly in from all over the world.

March is a promotional month.  Please call Anne for special pricing.

We have done sons of physicians, brothers, religious circumcisions,

men who have not seen the heads of their penis for 20 years! This

is your circumcision and we do it the way you want with respect

to 4 parameters.

Please don’t be like the patient who writes: “Dr. Reed I just got circumcised

(elsewhere) two days ago, and my result was not what i expected. I was

wondering when i recover can i get a consultation with you.”

Photos sent and received.  Unspoken comment: “disaster zone.”

Be assured we will show you every courtesy.

All the best,

Harold M. Reed, M.D.

305-865-2000

Ignoring a “penile wart.” Penile Cancer Rates Soar as Circumcision Rates Go Down

By Dr_Reed on February 24th, 2014

Ignoring a growing “penile wart.”   Penile Cancer Rates Soar

On Thursday, February 20, 2014 8:32 PM, Brian Morris <brian.morris@sydney.edu.au> wrote:

  • Penis cancer rates soar

    KIMBERLY GILLAN
    WEDNESDAY, FEBRUARY 19, 2014
     
    The rise in the number of sexually transmitted infections (STIs) and a 
    decrease in rates of childhood circumcision is believed to be the 
    cause of a rise in rates of cancer of the penis in the past 30 years.
    In Victoria, 20 men per year are diagnosed with penis cancer.

    What it’s like to have penis cancer

    UK man Nigel Smith told the Daily Mail that a sexual health clinic misdiagnosed him with a genital wart that they said would disappear over time.
    When it didn’t, he hid it from his wife by sleeping in the spare bedroom for a year and saying it was because he snored too much.
    In 2011, he was eventually diagnosed with penile cancer and the 58-year-old underwent surgery to remove part of his penis.
    “If my GP had sent me to a urologist rather than a sex clinic, the cancer could have been diagnosed at stage one and treated,” he said.
    “By the time I saw a urologist, the cancer was stage three –– one stage away from terminal. I’m now in temporary remission but there’s a 50/50 chance that the disease will return as a secondary cancer –– maybe in my lungs or liver.”
    Smith is now considering reconstruction surgery.
    “Every time I go to the toilet I have a painful reminder of what’s happened, so it’s hard to put things behind me,” he said.
    “The sexual side of my marriage has ended. I’m 60 but I’m a young 60! It shouldn’t be the end yet. The psychological impact of it all is massive. It’s more traumatic than anyone who hasn’t been through this can know.”
    Smith encouraged other men in this situation to be open about their symptoms.
    “I didn’t talk about my symptoms for so long and hid them from my wife,” he said.
    “It’s a man thing; we ignore things and hope they’ll go away. If you find something, you need to get it looked at.”
    The new research was published in the journal Cancer Causes Control.

    Penile cancer, says Cancer Research UK tends to present in about 500 cases in the UK every year.

    Uncircumcised penis: Penile cancer is much less common in men who have been circumcised soon after birth.
    Men who have not been circumcised may find it more difficult to pull back the foreskin enough
    to clean thoroughly underneath resulting in poor hygiene.
    Reference:
    Arya, M et al (2013). Long-term trends in incidence, survival and mortality of primary penile cancer in England. Cancer Causes Control.
    Cancer Causes Control. 2013 Dec;24(12):2169-76. doi: 10.1007/s10552-013-0293-y. Epub 2013 Oct 8.

    Long-term trends in incidence, survival and mortality of primary penile cancer in England.

    Abstract

    PURPOSE:

    Few population-based studies exist of long-term trends in penile cancer. We report incidence and mortality trends in England over the 31 years 1979-2009 and survival trends over the 40 years 1971-2010.

    METHODS:

    We calculated annual incidence and mortality rates per 100,000 by age and calendar period. We estimated incidence and mortality rate ratios for cohorts born since 1890, and one- and five-year relative survival (%) by age and deprivation category.

    RESULTS:

    A total of 9,690 men were diagnosed with penile cancer during 1979-2009. Age-standardized incidence rates increased by 21 %, from 1.10 to 1.33 per 100,000. Mortality rates fell by 20 % after 1994, from 0.39 to 0.31 per 100,000. Survival analyses included 11,478 men diagnosed during 1971-2010. Five-year relative survival increased from 61.4 to 70.2 %. Five-year survival for men diagnosed 2006-2010 was 77 % for men aged under 60 years and 53 % for men aged 80-99 years. The 8 % difference in five-year survival (66-74 %) between men in the most affluent and most deprived groups was not statistically significant.

    CONCLUSIONS:

    The 21 % increase in penile cancer incidence in England since the 1970s may be explained by changes in sexual practice, greater exposure to sexually transmitted oncogenic human papilloma viruses, and decreasing rates of childhood circumcision. Improvement in survival is likely due to advances in diagnostic, staging and surgical techniques. There is a need for public health education and potential preventative strategies to address the increasing incidence.
    PMID:

     24101363

    [PubMed - in process]

“I suffer from Phimosis”

February 22, 2014

Hello, I believe I suffer from phimosis (foreskin not large enough to extract forehead of penis?)and am interested in an adult circumcision procedure. What would be the process necessary to begin discussing undergoing the op? Thanks in advance  Reynaldo

February 22, 2014

Good morning Reynaldo,

Thank you for your interest in what we do.  Your pen.is is one of the most important cosmetic and functional features of your body.  Please see photos (before and after) of some of the phimotic patients we have treated…   figures 11 – 16.  http://www.penisdoctor.com/photo-circumcision.htm

We have performed over 7500 cosmetic circumcisions and revisions in the past 35 years and usually do several cases every week.
We have done sons of physicians, brothers, religious circumcisions, men who have not seen the heads of their penis for 20 years! This is your circumcision and we do it the way you want with respect to 4 parameters.   Please don’t be like the patient done elsewhere who writes: “Dr. Reed I just got circumcised two days ago and my result was not what i expected. I was wondering when i recover can i get a consultation with you.” Photos sent and received (unspoken comment “disaster zone”)

March is a promotional month.  Call Anne at the office for details and mention you have received this letter.  Be assured we will show you every courtesy,

Best,

Harold M. Reed, M.D.
305-865-2000

Does adult circumcision hurt

February 17, 2014

Dear Dr. Reed,

Getting more anxious as I approach the day this March.  You’ve done 1000?s of adult circumcisions.  What is your best advice. Should I be on tranquilizers?

Randy

Good morning Randy,

Everyone’s experience is somewhat different but to give you a general idea, we apply a numbing cream for 15 minutes before we start, so you won’t feels the needle stick of local anesthesia. Then we wait another 15 minutes for the anesthetic to work.  We massage the shaft to make sure the anesthetic is well distributed.  Surely that doesn’t hurt.  You could have IV sedation if you wish, but then next question would be, “sure it doesn’t hurt now, but what happens after the anesthesia wears off?”  I’ll be happy to order Xanax for you which you could take the night before and on the morning of your procedure.  Really not necessary.

The anesthesia lasts for about 3 to 4 hours.  Steristrips, and a double layered wrap keep bruising under control.  I will see you the next day and the day after if need be.  I may loosen the outer wrap the next day if too tight.  Honestly, I think you’ll be fine.  After all is said and done, you’ll get on the back of the line to obtain your bragging rights.  “I had an adult circumcision and it really didn’t hurt.”

Harold M. Reed, M.D.
Diplomate, American Board of Urology

 

#Phalloplasty with injectable silicone, a good idea?

What is your opinion on silicone injections to the penis?

Francis

Dear Francis,

Please look at http://www.penisdoctor.com/silicone.htm

I am reminded of a video of Mr. Bean dressed in a clergyman’s frock and he tells the story of JoAnne who approached him many years ago and said “Father, what is the position of the church on felatio?  And he said, “Joanne truthfully, I do not know what felatio is.  And she proceeded to show me.”

16 years almost to the day passed since that incident and lo and behold Louisa approached him and says Father what is the position of the church on felatio, and he says, “we’ll truthfully Louisa, I really don’t know what felatio is.”.

The only difference is I don’t wear a frock and I don’t have to wait 16 years between questions. While I don’t how God given knowledge as to how many silicone injections are given to the penis with happy results, but we sure do see a lot of unhappy campers and photographic examples are posted on http://www.penisdoctor.com/silicone.htm   I could show more photos, but am reluctant to embarrass any doctor who would readily recognize that is his patient.

The problem with injecting any fluid or slurry into the penis whether it is silicone, liposuctioned fat, or polymethyl methacrylate (PMMA) – (pejoratively called Duco cement) is that fluid tends to seeks planes of least tissue resistance and even though you mold the additive, the moment you turn your back, if the underside of the penis near the head has loose skin for example, that’s where a lot of it will wind up.

Also more is not better, because the extrinsic pressure of the fluid against the blood vessels of the penis only reduces blood flow.  This is a set up for poor wound healing and possible infection,  Your wonderful immune system, oxygen, and antibiotics  that the doctor may have employed travel in your blood stream. If the flow is marginalized, not so good

We use AlloDerm because the thickness is uniform and the girth enhancement provided is a gradual process as the AlloDerm becomes hydrated over a few days.

Having said that, penile implants made of silicone that go inside the corpora (erectile bodies), not under the skin,  breast implants made of silicone, chin implants made of silicone all seem to have a fairly good success rate, but not injections directly under the skin.   I think this technique falls outside the safety zone for the reasons I have mentioned.

Hoping this is of help,

Harold M. Reed, M.D.
Senior Member of the American Urological Association
Board Certified Urologist
Founding Member of Phalloplasty Surgeons
Founding Member of Sexual Society of North America
Society of Genito-Urinary Reconstructive Surgeons

 

Status post adult circumcision with bumps and uneven look

February 16, 2014

Dear Dr. Reed,

Dr. Reed, I was circumcised loosely over 4 months ago in Boston by a urologist. I am 23 years old, and the scar line is uneven with large bumps on one side and the bottom of the penis. It looks terrible, and nothing has gotten better about it since. I hate looking at it. I was circumcised because the foreskin would not retract fully and sex was painful. I would love to come down to Miami to get a revision done to get rid of these bumps, as I heard that you’re the best at what you do. Please call me directly and I would be happy to talk to you to set something up!   Was looking for something more like http://www.penisdoctor.com/

Attached are the pictures of the outcome of my circumcision.  The consultation fee should arrive tomorrow in the mail.

Anthony

Good morning Anthony,

About one out of every 4 cases we do is a revision, not dissimilar to your situation.

When I was a resident, an attending urologist was about to do a circumcision and he said to the operating room nurse, “what time is it?”  She looked a little peeved because the clock was right on the wall for all to see.  Deferentially she said ” It is 8:30, doctor.”

Upon completion of the case, the urologist said again, nurse what time is it, and containing herself she said “Doctor, it is 8:45 AM.”  The urologist then said “do you mean I just did a circumcision in 15 minutes?”

When I looked at the patient my unspoken thought was (it looked like it was done in 15 minutes).

Insurance companies typically allow 250 to 300 for an adult circumcsion.  Most likely your procedure will last close to an hour if revision has to be done all the way around.  Wrinkles have to be undermined, puckers released or excised, realignment in the central raphe may be needed, infrastructure supporting connective tissue (the dartos layer)  may have to be re-established under the incision line etc.

You have a friend in Bay Harbor Islands,

Harold M. Reed, M.D.
1111 Kane Concourse  # 311
Bay Harbor Islands, Fl 33154-2041
305-865-2000