January 20, 2012
Dear Dr. Reed,
I’m a 35-year-old male and interested in getting circumcised, partly for aesthetic and partly for non-pressing medical reasons. Unfortunately, there’s very little
systematically collected information in circulation to make an informed decision about the procedure’s safety. Would you be able to answer some questions for me to help me decide whether this is the
right step for me? All the following questions are in regard to circumcisions and/or removal of the frenulum performed on adults or teenagers: – What number of circumcisions did you perform in the
course of your career? How often did you remove the frenulum? – How often did you have patients expressing dissatisfaction with the outcome, and for what reasons? (and I realize in cosmetic surgery
some patients are unhappy no matter what) – How often do you experience outcomes with problems in appearance? Let’s take as problematic anything like sutures clearly visible without looking
for them and worse. – What adverse events did you experience?
Orson
Dear Orson,
Please don’t worry about mailing lists, as I would be at risk of losing my license if I divulged names of even prospective patients. Occasionally interesting questions are placed on our blog with your name of course changed and any personal data deleted.
My position is that for most men who practice good hygiene and are at very low risk for sexually communicative diseases, a circumcision is certainly not medically necessary. 80% of our patients do it as a matter of choice. 20% had chronic inflammatory problems that have not responded to conservative measures.
Taking your thoughtful questions in the order posed…
What number of circumcisions did you perform in the
course of your career?6500. Last week we did 4.
How often did you remove the frenulum?80% of our patients say remove it, of the 20% that say “no”, 80% of those later come back and say “doctor, now remove it.”
How often did you have patients expressing dissatisfaction with the outcome, and for what reasons? (and I realize in cosmetic surgery some patients are unhappy no matter what)Some patients may heal with defects that need to be revised such as an areas of separation perhaps secondary to a rip-roaring erection. We take care of that gratis, usually in 3 months after complete
wound healing. Our patients tend to be very fussy; that’s why they are coming to me.
How often do you experience outcomes with problems in appearance?We have not had patients fill out followup surveys, so from their point of view unable to comment. Not often, fair to say. Two reasons are: A. we discuss the 4 options before circumcision, and B. you are given a hand held mirror to watch the operation in progress and comment. Before we apply the dressing, we ask if it is the way you wanted.
Let’s take as problematic anything like sutures clearly visible without looking.You will have about 30 to 40 very small sutures visible after surgery which are rapidly absorbable. But we recommend those be removed in 12 days to avoid cross hatch marks.
Here is letter we send to prospective patients…
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.
We have performed over 6500 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”)
Be assured we will show you every courtesy,
All the best,
Harold M. Reed, M.D.
305-865-2000
Thanks a lot for your responses. Unfortunately from the form below in your email I saw that my original email got cut off for some reason, probably a length limit on your Web form. I had been traveling over Christmas and didn’t have the text of my original email, thus the delay in my response. Plus, it’s ski season…
Let me send the questions that got cut off again and also add some questions for clarification. I know that I’m probably imposing a greater request on your time with these questions than most prospective patients would and very much appreciate your patience–but then again, there is frustratingly little in the literature about the safety of the procedure, and you have done it often enough so as to have statistically significant answers. I’m fairly committed to doing the procedure, but I feel it’d be rather irresponsible to enter into elective surgery without some quantitative grasp on the risks and outcomes.
Safety / outcomes
What percentage (I understand you don’t necessarily collect this systematically–what interests me is the rough size of the number) express dissatisfaction about outcomes? What are the most common complaints?
What percentage comes back for corrections?
How often did you experience adverse events? List the most common and the most serious ones and the final outcomes with their respective frequencies (a rough estimate is fine–the question is not 5 or 6 patients but 5 or 50).
Have you ever had claims for damages, been involved in litigation or arbitration, paid a settlement, been subject to regulatory review, or been subject to criminal proceedings relating to your work? If so, what was the reason and what was the outcome?
Practical
In terms of arranging the surgery with the least time off work, what would be the best way to arrange it around a weekend? A holiday weekend, perhaps?
What downtime should I expect for active sports like skiing, horseback riding, etc.?
Thanks a lot!
Orson
January 23, 2012
Good morning Orson,
Thank you for your second battery of questions.
After your careful reflection if you wish additional information, be assured I am available for consultation.
Safety / outcomesWhile questionnaires have not been sent out to patients and some may harbor thoughts that are not shared unless solicited, I can say most are satisfied with the outcome. Our most common complication is wound separation which usually reconstitutes and this could be secondary to a rip roaring erection or the patient that refuses to stay at a very nearby hotel but insists driving home even for 30 minutes.
What percentage (I understand you don’t necessarily collect this systematically– what interests me is the rough size of the number) express dissatisfaction about outcomes?
What are the most common complaints?
What percentage comes back for corrections?All our local patients come back and are followed of course. Nature and normal wound healing takes care of minor healing problems. The underside is more predisposed to
swelling because the skin is looser. About 10% of our patients will have some revision performed. You can rightly assume all of our patients are very fussy and are looking
for a near-perfect result, not a journeyman circumcision.
How often did you experience adverse events? List the most common and the most serious ones and the final outcomes with their respective frequencies (a rough estimate is fine–the
question is not 5 or 6 patients but 5 or 50).One could say if a patient requires a revision or touch up, maybe they wanted the circumcision tighter, or one area healed with a hypertrophic scar, they the incidence could be 10%
Have you ever had claims for damages, been involved in litigation or arbitration, paid a settlement, been subject to regulatory review, or been subject to criminal proceedings
relating to your work? If so, what was the reason and what was the outcome?Florida operates under the government-in-the-sunshine law. Physician profiling disclosed about me can be found on http://ww2.doh.state.fl.us/irm00profiling/searchform.asp
Practical
In terms of arranging the surgery with the least time off work, what would be the best way to arrange it around a weekend? A holiday weekend, perhaps?
Please call Anne our amiable office manager, regarding scheduling.
What downtime should I expect for active sports like skiing, horseback riding, etc.?
In that incisions do not regain full tensile strength until 8 weeks, we would advise no sports with the potential for straddle or genital injuries until then.
Sincerely,
Harold M. Reed, M.D.
305-865-2000