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An overzealous circumcision.  Definetely the underside cannot be too tight lest the scrotum be drawn into the penile shaft.  If there is looseness post circumcision on the underside, chances are the circumference is too loose and this requires a longitudinal incision to gather in the sides, not more circumcsion.

Here’s the letter…

Hello.  I’ve got a question.  I am 28 yrs old.  I weigh 210 lb. and am 5 ft. 8.  I was circumcised when I was 20 yrs. old.  I thought the procedure went okay.  The cut looked alright, but I noticed that the doctor left my frenulum.  I don’t remember if I opted for this or not.  Within the last few years however, I have put on 50 to 60 pounds and I’ve noticed that my penis feels a bit tight.  Is tightness weight related?  I am having 2 problem areas.
 
  #1 When I am erect my scrotum seems to hang higher and pull forward so that I’m not getting full range of my shaft.  When I was uncircumcised and 150 lbs. I could grip the base of my shaft and my hand would come into contact with my pubic area.  Now the base of my hand seems to come into contact with my scrotum. 
 
  #2 I feel like my frenulum prevents me from a full retraction of shaft skin because its tethered to the glans (perhaps pulling my scrotum forward as well during erections).  My glans don’t bend down or anything, but I still feel some tightness between the glans and the top of my shaft.  If I have a (frenectomy?) won’t that loosen that V shaped skin on the underside of my shaft thus loosening more of my shaft skin relieving any forward tension of my scrotum when erect and allowing for a better retraction of shaft skin particularly the underside of the shaft. 
 
FYI, I saw a urologist in my town about my tightness concern.  He recommended that I leave it alone because he thought my penis looked normal and thought I wouldn’t like the scarring that could result from a frenectomy.  He seemed convinced that weight loss would help.  He also recommended that I get a 2nd opinion. 

In that the head of the penis is liked a cocked cap more on the top than the bottom, for this reason,  less tissue need be removed on the underside.  Or another way of saying it is, the underside needs more skin, and if there is a little extra, the weight of scrotum pulls that down.

Harold M. Reed, M.D.

I am Randall from Australia and have monitored yahoo groups for some time now. I am interested in coming over for circumcision. I also have a second little one on the way thus am also interested in a future reversable vasectomey however only 26 years old. Can these two procedures both be combined into a days surgery keeping in mind I have to travel the globe. Can I simply refer yself to you for this surgery or do I need to see a doctor and if so do I need referals for both ocedures or just one. I am very interested in seeing if having both these in a day is possible and wouldn’t be too much trauma for the area. I am also interested in having the frenulum completely carved out for smooth underside and excessive scrotum webbing removed and tidied up also. I am after a tight circumcision that leaves about 1.5cm of inner skin.
 
What sort of prices would I be looking at and how far ahead do I need to book?
 
Many thanks,
Randall

 

Hi Randall,

We would be delighted to do simultaneous cosmetic circumcision and bilateral vasectomy.  If you are married we would  appreciate a note from your wife saying she agrees.

Given that you are 26 years old, with good height weight conformation, and in good health (not on any medications), you do not need a referral.We would be glad to evaluate you for penile scrotal web, a phenomenon which is seen more frequently on circumcised men owing to excessive pulling or removal of tissue on the under side of the penis.

A tight circumcision is no problem and you will be given a hand held mirror to evaluate work in progress.

You may exercise some caution regarding the remnant of only 1.5 cm of inner skin in that when a small circle has to be worked into a larger circle them may be a tendency for puckers, but there are techniques to avoid this such as taking out a V-dart on the underside of your pigmented (outer) skin.

We are seeing quite a few Australians here every year. Anticipate that we will show you every courtesy.

All the best ,

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

 

 

 

Penoscrotal or peno-scrotal or penile-scrotal web or “turkey neck” as said in the vernacular gives the illusion of shorter penile length and often causes some irritation during penetration especially with tugging on hairs and drawing in of the scrotum into the vagina.  This often occurs because of an overzealous circumcision where too much skin is removed on the underside drawing the scrotum onto the shaft of the penius.

The remedy is resection of the peno-scrotal web.  Although some authors favor a Z plasty we have seen these patients and for me it looks like the mark of Zoro on the penile shaft and scrotum.

I believe our approach is more cosmetic because the penile incision remains in the midline as an extension of the raphe, and the scrotal incisions even on a fresh post op are difficult to discern.

Our fee is $250 for consultation. The charge for release of peno-scrotal web and reconstruction including local anesthesia and use of the facility is an additional $2500.

Please do look at our photgraphic example and see if you agree, back to normal.

Harold M. Reed, M.D.