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.

as im going to be flying in from the UK. im going to be limited on how long i can stay in america for i was just wondering how long do you thing i should wait between having the two stages of surgery ie 4 weeks 6 weeks or longer? im eager to get as much done in one sitting as im going to be traveling a long way to have the procedures im intrested in…. and then  if the wait is only 4 weeks between surgerys…i could stay in the states in stead of flying home and then back???????
 
scrotal altreation (turkey neck pushed back?)
left testical enlargement
head glans enlargement
lengthening
and widening
and may be some pubic fat removal?
 
i know these can not all be perforemed at the one sitting (surgery) so i just wanted to know how much you think we could do at one go  and then how long before i can have the otheres completed??
 
ie stage 1 = glans enlargement,lengthening,widening and scrotol pushing back under the shaft?             then       stage 2 = fat pad lipo,testicular enlargemnt
 
im not looking for monster girth only a very modest increase of say 1″ all over,thanks again good doctor  Brian

Good morning Brian,

Lengthening, insertion of left testicular implant, and perhaps release of penile scrotal web, could be done at the same time.  Girth enhancement and glans enhancement need to be done separately as insertion of AlloDerm  works like a fixative to reduce length gains produced by traction.

Pubic liposuction could be done with either of these procedures, but is not advised as the transient lymphatic injury impacts on wound healing of the penis and scrotum. To do a proper job think of the pubic fat pad as an inverted U which extends down into the scrotum along side the penis.   This needs to go also. Tenderness for a few weeks in  that area, may cause you to procrastinate on use of traction,  which ideally should be done within a few days after surgery to maintain exteriorization of the penis.

Please understand the results in length are 35% me (with surgery) and 65% you (with traction).  To gain  an inch in erect length you would need to apply traction for am minimum of 6 months. 

Don’t rush to have the second stage done as you will obviate the potential gains with length enhancement.

You are spending a lot of hard earned money and we wish to have  as many assurances in place you will have a gratifying result.

Cheers,

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

 

 

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.