Dear Dr. Reed,

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.

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?

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!

 Owen

January 23, 2012

Good morning Owen,

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 / 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?

While questionnaires have not been sent out to patients and some may harbor some 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 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?

Possible.  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

Hello Dr. Reed,

I’ve been refereed to you by Pat. I am looking for a doctor to perform a circumcision on my 15 year old, he said he wants to do it for social reasons.. can you tell me a bit about the risks involved? 

Sanford

January 24, 2012

Good morning Sanford,

Thank you for your interest in what we do.

If your son is a mature lad, and can tolerate a local anesthetic with you present in  the room at all times, this is the best way and safest way to perform a circumcision.  At his age it is appropriate that he wishes to have it done, or if there are medical reasons he understands the necessity or desirability.

The risks generic to any circumcision are mentioned in  our informed consent posted on our web-site.  The most common complication is partial wound separation which usually reconstitutes without any additionally surgery.

The attached and what follows is the message we send out to prospective adult men.

 Be assured we will show you and your son every courtesy,
 

All the best,
 

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

What do you consider to be the best type of circumcision, and is there any truth about penis enlargement?

Manny

January 20, 2012

Good afternoon Manny,

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.

Yes, penile enhancement procedures do work for patients who follow the instructions. 

If you are also considering circumcision, please have that first as it will make applying traction a lot easier.

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

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

Dear Dr. Reed,

A bit of an upset within the pro-circumcision community. Your name was mentioned as the exponent of a particular opinion concerning circumcision style. I’d like to check whether you have been correctly quoted.   It’s the old high/low debate again. The opposing factions are lined up thus:   One group is saying, in effect, that all circumcisions should be in the ‘high’ style (ample retention of inner foreskin) because (a) that is more sensitive and (b) subsequent conversion to a ‘low’ style is a possibility whereas the converse (conversion low-to-high) is not.   The opposing opinion is that the ‘low’ style (minimum retention of inner foreskin) should be contemplated on a “where appropriate to the objective” basis. This second group do not express disagreement with the tenets (a) and (b) of the first group, but go on from that point to reason thus: If retention of inner foreskin enhances sensitivity, then it follows that removal of inner foreskin should reduce it. Such reduction may be beneficial especially in instances where the objective is to increase what is sometimes termed ‘latency time’. An instance would be a problem of premature ejaculation.   So:   [A] Do you ALWAYS rule out ‘low’ styles, and if so… why?

Gary

Good morning Gary,

Thank you for your interesting questions.

My position is:

1.  For most man who practice good hygiene and are monogamous, a circumcision is not a medically necessary operation.  Can 350,000 years of human evolution be all that wrong?

2.  Pre-mature ejaculation is as commonly seen in circumcised as in uncircumcised men.  This is confirmed in our practice and my training is that no studies have shown otherwise.

3.  Large studies involving perhaps 20,000 cohorts of men (Kaiser Permanente Clinic in California), circumcised versus non, show no difference in penile sensitivity as a rule.  True if a doctor cuts inappropriately deep, there can be nerve injury.  In our practice we believe “a circumcsion is about removing skin.”

4.  The problem with very low circumcsion is that the circumference near the coronal sulcus or neck” is narrower versus the main portion of the shaft and marrying 2 circle or ellipses of unequal circumference can result in puckers in the larger circle, unless a V-cut or some other remedy is employed to reduce the larger circle.

5.  Moderation is always a good idea, although we try if possible to accede to patient request.

6.  For the present, I think we can agree circumcsion will continue for some to remain an emotionally  charged subject, contexted and laden with misrepresentation and exaggeration.

7.  Yesterday did an 11 week old boy with a  huge tubular umbilical hernia (its size, the  diameter of a garden hose and stuck out about 2 inches, 5 cm.).  The mother has been told to follow this expectantly as it might recede.  He also had a pin point phimosis that barely admitted the tip of a fine malleable rounded edge probe.  Surprised that he could urinate at all.

I didn’t believe for one second the umbilical hernia will go away, nor would the phimosis.  Did an uneventful circumcsion using a Mogen clamp.

Sincerely,

Harold M. Reed, M.D.

305-865-2000

Dear Dr. Reed,

Penile Lengthening and Penile Widening and Glanular Enhancement and Circumcision. if wanted can this procedure be performed all at the same time?

Jerry

Good morning Jerry,

Please do not have simultaneous surgery as this is a blueprint for disaster or at best an inadequate length result.

You can have circumcsion first, or lengthening and then circumcsion to follow.   But always circumcision before girth enhancement. My preference is to save glans enhancement for last.

Please review our website http://www.penisdoctor.com/ for the answers to many commonly asked questions.  Our fees are also published there.

After reading the attached, 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, M.D.
Phalloplasty Services
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Florida 33154
305-865-2000

Hi Jerry,

I liked being called Uncle, by twins who were the product of a vasectomy reversal I did about 11 years ago. I get cards and photos from them every few months, see them in swim suits at competitors where their instructors tell them they need to be in the next higher age group to be better stimulated because they are too good, and seeing them at social functions at school with their proud Mom and Dad. They have been to my house several times, slept over, and photos of them chronicling their maturity are in our library. I get birthday calls from them every year.  Each one puts the other on the phone.

The first chance a doctor gets to do a reversal if properly done is his best chance. Some doctors say if there is a reappearance of sperm in the ejaculate, they have done well, but it is more than that. To produce naturally without costly artificial insemination, the count has to be sufficiently high and there has to be lots of active swimmers (the best indication the sperm are capable).  Circumcisions can go easy and they can result in untoward swelling and bruising.  I just don’t want any associated problems that might cause lots of patient activity, excessive visits etc. to interfere with a very delicate microscopic procedure.

This patient as I understand had a vasectomy 4 years ago, he is in next to the highest favored “age” related group for success. Why dowse his chances to have a great result. I have had numerous patients come back and say it has worked too well, please do another vasectomy. That’s what we want to hear.

Harold M. Reed, M.D.

Dear Dr. Reed,

Hi Dr. I am 44 years of ages, i am some what or kinda interesting do cricumcision, but i am very don’t know what to expected or healling. P.S. my is not that big very small about 3′, should i do or not thanks Dr.

Quang

December 2, 2011

Good morning Quang,

Thank you for your interest in what we do.  Your penis is one of the most important functional and cosmetic features of your body.

Oriental men may be smaller but still this is normal for you and 500,000 years of evolution and reproduction cannot be all that wrong.  Having a circumcision contrary to what you have been told, unless the foreskin is overly tight, will not enhance your length, but traction could and mention is made above in the attached.

Can’t say enough, for most men a circumcision is not medically necessary, but also true 85% of our circumcisions are done for patients who simply prefer to be circumcised.

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 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

 I am wondering what the rate is for satisfactory men? Can this be covered by Social Security, and is it possible to cover the head enough so that when erect it is still covered?

Salim

Good morning Salim,

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.

Circumcision when medically indicated is covered by Medicare.  The rate for men in the United States is possibly 65 to 70%, but please keep in mind for most men a circumcision is not medically necessary.  Yes, I can leave you with enough skin to cover a portion of your head.

Be assured we will show you every courtesy,
 
All the best,
 

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

Hello Dr. Reed.

I was reading some of the information on your website concerning Adult Circumcision and noted that you suggest a course of antibiotics during the post-op period. [Keflex 250 mg. #28, 1 tablet 4 times a day for the next 7 days]. Is the suggestion of these antibiotics absolutely necessary? The reason why I ask is that I was prescribed a course of antibiotics for another condition a number of years ago and, as a result, contracted c.difficile. Although the c.difficile is no longer present, I am under the belief that I am now at a higher risk of it returning should I take another course of antibiotics.

Thank you.

Raymond

November 19, 2011

Good morning Raymond,

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.

While we routinely employ an injection of gentamicin before the procedure as prophylaxis, as this is urological surgery and colonization of skin bacteria is common even if not clinically apparent and the Keflex you mention
for non-allergic patients, surely there are purists (in the medical profession) out there who would say antibiotics are not necessary routinely and confer the possibility of promoting an overgrowth of resistant organisms or even
desensitization of the human race to antibiotics now available when the cause could be justified ion another instance.

So in short, we can do you without antibiotics.  I have not seen a deep penile infection in any circumcision case we have performed.  Occasionally there is wound separation, but the inciting event was not an infection, rather a small collection of blood under the skin or a strong erection.

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