Re: Very High/Very Tight–what are the practical limits?
Hi Dr. Reed…
I recognize that everyone’s penis is different and the same thing can’t be
done for everyone, so my questions may be unduly vague… But I was wondering,
given your “average” customer asking for a very high/very tight circ, where does
the inner/outer scar line tend to be on the shaft when erect? 1/8 of the way
down, 1/4, 3/8, 1/2, etc.? Does the removal of the frenulum allow for a lower
scar line? Does a revision (on an infant circ) offer a lower line than one
being done for the first time on an un-circ’d male?
Obviously, you know what’s best in not making it too tight. The general
consensus is that it shouldn’t be too tight (which makes sense) but someone else
mentioned (in message 2769) that a slight pull on the abdomen skin can be a good
thing as it helped pull the sulcus. Do you agree? Also, what defines an
“extreme” high/tight circ (that you wouldn’t do)–one that is more likely to
cause an undesirable outcome–and an unhappy patient?
Thanks!
Good afternoon Will,
Taking your thoughtful questions in the order posed…
1. Some foreskins are longer than others, and some have a tight preputial ring which has to be discarded, lest a waist banding occurs. Assuming the skin is typical, high could be close to half way up. Of course, this will give you more post operative swelling which could take a few months to resolve and less protection against communicable disease including penile warts, papilloma virus, HIV, etc.
My bias is that if on erection the penile pubic junction is triangulated or lifted, the circumcision is overly tight, and this is difficult to correct. There is nothing magical about high and tight, nor has any study ever shown such patients enjoy sex more than those with a normal circumcision.
Lastly, some patients who request adult circumcision have had years of chronic sin inflammation and the typical loose septa which relate to skin mobility are overly tight, so even if the foreskin is pulled up by its bootstraps so to speak, this will not translate into a pleasing result unless the doctor actually undermines the skin and “resets” it like a skin graft.
Lots of things to consider.
2. The removal of the frenulum usually allows for the skin on the underside to be pulled with the same tension as that on top, but does not especially relate to being able to do low or high better.
3. Lastly I was involved as an expert witness for a patient who almost had a buried penis from an overzealous circumcision, and he was not at all happy.
For me, moderation always makes the most sense.
Harold M. Reed, M.D.
305-865-2000
— In PROCIRCORG@yahoogroups.com, “Will Smith” wrote: