Dr. Reed,

Will my vasectomy remain as effective if my wife is taking fertility enhancing meds?    She does not know about my procedure. And I DO NOT want her to get pregnant.

Chason

Hi Chason,

This question is a little sad because it suggests there may be some marital discord at least along these lines, and deception is anti-love in my opinion.

If you have a vasectomy, and most modern day urologists would ask for your wife’s consent for medical legal reasons, and your semen is checked at intervals, and contains no sperm, the progeny won’t be yours.

Yes, that has come up.

Sincerely,

Harold M. Reed, M.D.

Hi Dr. Reed,

I am a female to male transsedxual patient, 7 years on Testosterone. 5 years post-op top surgery. Legally male in the state of Ohio.
Specific Question: Do you perform testicular implants as a procedure by itself. I typically take a long time to heal and do not want to complicate my healing by having multiple procedures at once. I’m ideally looking to have the scrotoplasty/implants done first and then decide on whether meta or phalloplasty is a better option for myself.

Sincerely, Seth

Good afternoon Seth,

Yes, we can. The attached may be of some help.  Please see  http://srsmiami.com/photography-f2m.html and http://penisdoctor.com/photo6.htm for photographic examples of our work.

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

I had phalloplasty in 1995. Results were good for about ten years but I now have a lumpy and distorted penis (especially during erections) from the fat injection nodules now having moved around. Do you remove those or do any penis reconstruction. I know that several West Coast Doctors do this.

However, I live much closer to your area and wanted to see if you have experience in this area. I have some digital pix that I could forward to you, if that might help.    Donald

Good morning Donald,

Thank you for our interest in what we do.

Please visit our web-sites http://penisdoctor.com/
and http://srsmiami.com/ (the latter not so much for
you) but you’ll see we specialize in genital reconstructive
surgery.

We are very familiar with FF nodules and their removal.

Ideally an incision should never be made on top or even on the sides of the penis, exception the circumcision line.

The attached is posted only for interest and some pre-op suggestions.

If you believe I am the doctor for you, please initiate a consultation over the phone with our office by sending us your name, address, and telephone number in an envelope along with a check for 250. 

We’ll get started ASAP.  We’ll have a lot to talk about.

Cordially,

Harold M. Reed
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Florida 33154
305-865-2000

I would like inquire about a dorsal slit reversal. Is it possible? if it is, will the outcome be just like an intact penis with all the foreskin restored?  Please give details regarding the costs of operation and recovery period.  Thanks in advance.   Matthew.

Good morning Matthew,

As you may know, a dorsal slit is a longitudinal release of the foreskin on the top side which opens the phimotic ring and usually results in a waddle of skin under the head and distal shaft.  Not that pretty, but often convenient when the patient may not be a suitable candidate for circumcision, such as  a gent with a severe penile infection.   A circumcision could be done secondarily.

Thank you for your interest in what we do.  Several thought come to mind.  Reversal is possible with some caveats.

A dorsal slit is usually done by a crushing clamp technique to reduce bleeding followed by an incision over the crushed area.   The edges are then oversewn to prevent delayed bleeding.  This reduces the amount of foreskin available to reconstruct unless you were very generously endowed to begin with.

Normal for men is a preputial ring at the end of the foreskin which upon reconstruction is the weak point and could lead to tearing with erections.  So while an attempt can be made to do this, there is no guarantee everything will be smooth sailing afterwards.

Fee for reconstruction 1500.    You will need to be on an anti-erection medication for 6 weeks.

Cordially,

Harold M. Reed
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Florida 33154
305-865-2000

Re: anti-erectile medication for circumcisions?

PROCIRCORG@yahoogroups.com,

It seems that the occurrence of erections will prevent an adult man from getting an ultra tight circumcision, otherwise there will be suture marks from pulling during healing.

Are there any safe, reversible methods to block erections for a couple of months to let the wound heal?

Kendall

Hi Kendall.

Thank you for your interesting question. First let’s talk about overly tight circumcisions. Two “no-no’s”. You don’t want it that tight you see lifting of the peno-pubic angle or raising of the pubic skin to meet the needs of the penis, nor do you want your scrotum drawn into the base of your penis creating a peno-scrotal web.

Next for those patients who request tight circumcision, the use of steri strips, left on for about 12 days should suffice. Also plan on being on bed rest for 2 days, after circumcision, in that wound separation is seldom caused by an erection alone, but more often by a simultaneous collection of fluid under the skin which impedes good wound healing. We mean being in bed within 8 to 10 minutes after the patient leaves our office. If the patient lives beyond that distance, he has to stay at a nearby motel. No shopping at the Mall or weddings for the next few days.

Lasting we do procedures such as foreskin reconstruction and after the first stage, have to bury the penis under the scrotum and of course, erections are to be avoided. For that spironolactone 100 mg twice a day (avoid high potassium foods) is what we recommend. This is an anti-testosterone drug. 

To control nocturnal erections, the use of the old styled Sudafed (pseudoephedrine) 2, 30 mg tablets every 6 hours is helpful. Please read the brochure, can cause elevated blood pressure, etc.

Incidentally in our operating room, the patient gets a hand-held mirror and we make the circ is as tight as the patient wants (of course avoiding extremes, that will come back to bite us)

Hope that gets you off to a good start.

Harold M. Reed, M.D.

Thank you for your interest in what we do, over 5,500 procedures relating to circumcisions and/or phimosis.    Kevin

Good morning Kevin,

Please keep this in mind, if you have a phimosis, all unhealthy non-stretching tissue has to be removed or you will need a dorsal slit.   If you have scarred prepuce left, that will not retract over the rim of the glans for daily hygiene.  What you may wind up with could resemble a partial circumcision.  Also keep in mind the remaining prepuce normally swells quite a bit after surgery, and you will need a Q-tip for a few weeks to cleanse the inner recessed area.    But yes, it can be done.

Harold M. Reed, M.D.

305-865-2000

I have HPV diagnosed 6 months ago. Just thought circumcision could be a help, since im not circumcised and am struggling with new warts after every treatment (podofilox) -Is that goin to help me? -either way, is there something more efficient than podofilox? surgery???? thank you    Ernest

Dear Ernest,

We have performed over 5500 cosmetic circumcisions in the past 35 years and usually do several cases every week.  We have also had a fair amount of experience treating penile warts and do not use podofilox for the reasons you state.

Our preferred treatment is figuration and if you are having sexual contact with an individual who has HPV, this access has to be thought of a causative.  We often combine circumcision with fulguration of some warts.   In that there are seeds in the penile skin that have yet to germinate, after fulguration expect some new growth for a while.  You will need followup  fulguration under local for that.

We do ask that you stay for one, ideally 2 days at the Baltic Hotel (advanced tourist class) and I will see you there daily.

Cordially,

Harold M. Reed, M.D.

I recently had an improperly performed circumcision, resulting in misalignment of the midline raphe and the line of the frenulum (frenulum was removed). The glans is rotated to the left in relation to the shaft. There is also a bunching up of skin on the left side. I am quite distressed about it, and would like to know how soon before I can get it redone. The procedure was done 4 weeks ago, and the wound has healed, but of course there is still scarring. I really would not want to wait too long to have it repaired. What is your suggestion? I’ve heard very good things about you. I hope you can assist me. Thank you in advance for your help.

Raymond

Hi Raymond,

A circumcision is perhaps the highest cosmetic calling given to a urologist. 

Please wait a good 3 months before any revision is done as the tissues need to soften and achieve optimal healing.  You bring to us a work list at that time and we’ll revise every item that is feasible.  What you mention so far should easily be correctable.

We do several circumcisions and a few revisions here every week, as we enjoy a reputation for excellence and exactitude when it comes to cosmetically performed adult circumcisions.  We operate within tolerances of 1/32″ or about 1/2 mm.

Pain is virtually non-existent among our patients.  They smile as they leave the office, and by and large remain free of discomfort as evidenced by our followup contact with them.

Cordially,

Harold M. Reed, M.D.

305-865-2000

I was wondering if my husband can get a circumcision at the age of 26? He has a penis that is curved, will it be a problem? But also a problem is he has this bed wetting issue that has been occuring for the past few years. He does this every month or so. He eats healthy and he doesn’t drink caffeine drinks. What can be the cause of this? It happens when he dreams bad stuff he says and he can’t get out of his dreams… he wakes up wet.   

Nancy

Hi Nancy,

Thanks for your E-mail inquiry and visiting our web-site http://penisdoctor.com/circumcision.htm.

A circumcision is perhaps the highest cosmetic calling given to a urologist.  
However, we must be mindful of two other important issues, penile curvature and bed wetting (enuresis).  Just to digress one of the most memorable cases in the past 31 years of practice was a bed wetting adult executive type man who had received the million dollar work up from others to ascertain exactly what his problem was.  The answer was later revealed to me.  He was sleeping on a water mattress with a very small pin hole in it, that would never leak unless about a 200 pound man and wife were on top and maybe doing things.  A web-site about bed-wetting in adults is http://www.nafc.org/bladder-bowel-health/bedwetting-2/adult-bedwetting/  One approach is timed voidings, getting up in the middle of the night by alarm clock if needed, and restriction of fluids after 6 PM

Before his circumcision is done, at least we would like to know if he wishes correction for curvature, has he received prior treatment with medication, etc.?  Please check out our penile curvature (Peyronie’s) website  http://penisdoctor.com/peyronies.htm

With kindest regards,

Harold M. Reed, M.D.

I have been interested in PE for quite some time but have put it off until I found the right procedure for girth. I stumbled across a Dr Lim I believe is his name (?). He performs a ‘flap’ surgery that carries more blood to the penis over time. He says the more you stay erect over this period of time the larger it becomes and stays that large. Have you heard of this? What do you think and have you tried this? They say it can be combined with other forms of girth enhancement such as alloderm or dermal grafts etc. What do you think about PLGA Scaffolds and the Elist implant as compared to the other forms of girth enhancements? My penis is average size but I would feel more secure if it were bigger especially in girth. I know I don’t want fat inserted. Thanks for your time.

Tyrole

Hi Tyrole,

I have never heard of him, honestly and the technique of flap surgery is not used by any urologist I know of.    Try to get some more background information, such as articles, photos etc.

We do know of PLGA scaffolds and the “implant” technique and do not recommend this.  I have seen others install PLGA scaffolds and the product is vey friable (tears easily) like an old dried-out sponge that turns to dust when rubbed the wrong way.  Unless great care is taken it may fall apart during installation.  Also be wary of simultaneous surgery.  The results can be anywhere from lackluster, to disastrous.   AlloDerm which we have used for 15 years is very reliable when properly installed.  AlloDerm can be installed via a tunnel and drag technique, for PLGA scaffolds the entire penile shaft skin (as a rule) has to be degloved and sewn back together again.

More involved.

Sincerely,

Harold M. Reed, M.D. FICS

Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America