Circumcision

Circumcision is the removal of the skin fold at the tip of the penis, which closes the urine exit hole and creates a closed space in that area. Since ancient times, it has been applied in different societies as a requirement of tradition or as a prerequisite in some religions. It is understood that even in primitive times, its medical benefits could not be fully explained, but the practical benefits of circumcision were noticed and spread.

Benefits of Circumcision

The circumcised skin covers the tip of the penis and the urethra. And under this skin, an airless, dirt and secretion accumulates and an area in contact with urine is formed. For this reason, if it is not cleaned regularly, it creates a suitable ground for the formation of infection. It can be a carrier for sexually transmitted diseases. Especially in children, the foreskin may stick and its tip may narrow. It can block urine output. It can cause penile abscesses. The foreskin, which we call paraphimosis, can get stuck and disrupt the blood flow in the penis. Removal of this skin by circumcision provides protection against the problems we mentioned.

What is the Best Age for Circumcision, Why?

This is a controversial topic. The important thing here is that the child is psychologically ready for this intervention and that he is of age and thought to understand this change in his body correctly. In the process of the child's psychological development, it is considered that the age between 2 years and 7 years is not appropriate. At all ages, circumcision should be performed under general anesthesia, which we also call sedation, without turning it into a trauma for the child and without allowing him to experience fear. Age is not important in terms of surgical success and wound healing process.

Which Periods Do Families Prefer Most For Circumcision (February Holiday, Summer Holiday etc.) Why?

Social reasons are decisive in this choice. These periods are suitable for the requirements of tradition and for the school life of the child not to be affected. Medically, circumcision has no season.

At What Ages Should It Not Be Done, Why?

Not recommended between 2 years and 7 years old, unless there is a medical emergency and necessity. It is thought that the psychological development of children in this age group may be affected. This possibility exists at any age. For this reason, it is necessary to perform circumcision under light general anesthesia, which we call sedation, without turning it into a trauma for the child and without allowing him to experience fear.

What Are The Health Problems That Can Be Seen İn The Uncircumcised?

The circumcised skin covers the tip of the penis and the urethra. And under this skin, an area without air, dirt and secretions accumulates, in contact with urine. For this reason, if it is not cleaned regularly, it creates a suitable ground for the formation of infection. It can be a carrier for sexually transmitted diseases. Especially in children, the foreskin may stick and its tip may narrow. It can block urine output. It can cause penile abscesses. The foreskin, which we call paraphimosis, can get stuck and disrupt the blood flow in the penis. Removal of this skin by circumcision provides protection against the problems we mentioned.

Who Should Do the Circumcision?

Circumcision is a serious surgical intervention. In terms of psychological approach, anesthesia technique and risks, surgery should be performed by well-trained professionals in terms of aesthetics and technique. Serious permanent disability due to this seemingly simple procedure is quite common.

What are the Importance and Benefits of Doing it in a Hospital Environment?

An infection-free sterile field is essential for every surgical procedure. Equipment to maintain sterility should be equipment. There should be a team and equipment that can urgently and effectively intervene in complications that may develop due to surgery and anesthesia. Ideally, it should be done in operating room conditions.

How is circumcision performed?

After the numbness of the penis and the cleaning of the surgical area are provided, the adhesions of the skin fold to be removed are opened and the cutting line is determined. The skin fold that covers the tip of the penis is cut with scissors or a scalpel. Bleeding is controlled with self-melting thin threads or bipolar sensitive cautery. The skin is stitched with thin threads that dissolve on their own.

What are the Developments and Innovations in Circumcision Surgery?

There is no difference other than the material advantages brought by technology. The anesthetic agents we use are much safer, the suture materials we use are less allergenic, dissolve faster and without leaving a trace. Although not very common, some devices called circumcision clavis or bells have been produced and are in use. These do not require stitches, but the device remains attached to the penis for up to 2 days.

Anesthesia Should Be Given, Why And How Should An Anesthesia Be Given?

Circumcision can be performed under local or general anesthesia (sedation). While making the choice here, the age of the child and, more importantly, the possibility of circumcision to cause fear, stress and trauma on the child are taken into consideration. Circumcision can be performed under local anesthesia if awareness did not occur 6 months before or if the child is mature enough to understand and accept the situation. In other cases, general anesthesia should be preferred both in order not to upset the child and in terms of the success and quality of the sensitive surgery.

How Long Is the Recovery Process?

Most of the time, even a dressing is not required after the procedure, sometimes a small dressing can be placed. After 48 hours, this dressing can be removed and a bath can be taken. It may be necessary to use painkillers for the first two days. Slight swelling at the tip of the penis is expected and returns to its normal appearance within 2 weeks.

Is There a Possibility to Correct the Wrong Circumcision Later?

Some of the aesthetic errors related to the skin and incomplete circumcision can be corrected. However, correcting urinary tract injuries, penile body and glans injuries may require a chain of serious operations. Sometimes it may not be possible to correct, it may lead to organ loss.

Should Laser be Used in Circumcision, Why?

Along with technology, there has been a negative development for circumcision. Soldering iron started to be used in circumcision. In this system, which is called "laser circumcision" among the people, but has nothing to do with it, the skin is cut with an electrically heated wire. With the effect of heat, the veins burn and bleeding is not seen. However, using a soldering iron on the penis, which is sensitive in terms of blood supply and sensory nerves, can cause permanent damage.

What Should Be Considered After the Circumcision Operation?

Although rare, delayed bleeding may occur after circumcision. The patient should contact his doctor.

In Which Situations Can Circumcision Be Inconvenient?

Circumcision is a surgical procedure and should be performed in full health. If there is no urgent reason, cold etc. should be done after conditions have improved. The most important condition in which circumcision should not be performed is the presence of hypospadias. In this case, which is popularly known as the "sunnah of the prophet", the urine exit hole is not where it should be from birth. This abnormality must be corrected so that the child does not experience problems in his later life. And in this correction, it may be necessary to use the circumcised and discarded skin. In this case, it should be done together with circumcision correction surgery.