Circumcision,

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Circumcision is one of the most common surgical procedures in men. Circumcision, which has been done for traditional and religious reasons since ancient times; It has been the subject of many publications with its medical aspect, besides studies reporting its benefits, articles highlighting its complications and bringing the ethical aspect to the agenda due to the lack of conscious choice of the child have entered the literature. Pro-circumcision and anti-circumcision platforms were formed, and both groups did not evaluate each other objectively and did not evaluate all scientific data objectively. accused of being speculative. For this reason, discussions and scientific studies on the subject still continue.

For what medical reasons is circumcision performed?

Circumcision is applied as a therapeutic surgical procedure or to prevent some clinical conditions.

For therapeutic purposes:

the foreskin adheres tightly to the glans penis and prevents urination,

recurrent episodes of infection of the glans penis and foreskin,

squeezing of the foreskin behind the glans penis in the form of a tight ring.

For protection:

sexually transmitted diseases,

penile cancer

cervical cancer in partner

protection from childhood urinary infections

the aim of providing better genital hygiene.

In which situations is circumcision inconvenient?

bleeding disorder disease

Hypospadias (urinary hole under the penis)

buried (hidden) penis

benefits

According to studies that concluded that circumcision is beneficial for health; Circumcised men are more advantageous than uncontested men in terms of infancy urinary infections, penile cancer, penile dermatoses, HPV virus infection (hence the development of cervical cancer in the partner), Chlamydia infection in the partner.

In recent years, studies have also been published that conclude that circumcision contributes up to 50-60% in protection from HIV. However, this issue has led to other discussions: HIV prevention It has been emphasized that there are cheaper and more effective alternative methods, and that the risk of transmission of the disease still continues if the man who has intercourse with an infected partner does not use a condom, even if he is circumcised.

Complications

In general, mild to moderate complication rates were reported as 1.7-7.6% and serious complication rates around 0.2%, adding that these mostly mild complications can be treated within hours or days. It has also been reported that complication rates vary significantly depending on the type and degree of education of the circumcised person, or whether he is uneducated.

Circumcision is a surgical procedure and bleeding (1%), infection (0.2-0.4%), and hematoma are the most anticipated complications in the postoperative period. Secondary phimosis, glanular adhesions and need for secondary surgery, poor cosmetics due to inappropriate technique, inclusion cysts are other complications. Serious complications such as urethra (external urinary tract) injury, glans amputation (penis head rupture) have also been reported.

Meatitis and meatal stenosis also occur in 8-31% of circumcised children. It is thought that these may occur due to the rubbing of the bare penis head against the diaper and direct contact with urine after circumcision. Meatitis is treated with topical antibiotics, while meatal stenosis may require minor surgery.

Timing

Circumcision as a surgical procedure can be performed whenever there is a medical indication. Risk factors should be taken into account when considering it for protection purposes. Childhood urinary infections are 3-7 times more common in uncircumcised children than in circumcised children, and this risk is more pronounced in the first year of life. Therefore, if it is to be done, it would be appropriate to prefer this period. If the goal is better protection from sexually transmitted diseases, it can be done just before the start of sexual life. Since penile cancer is already a very rare condition and circumcision is almost always performed in childhood, there is no information on how circumcision postponed until adulthood affects the risk of this pathology.

On the other hand, circumcision between the ages of 3 and 6 years may cause oedipal fixations, and because of the fact that in the phallic stage of psychosexual development, the child’s entire attention is focused on the genital organ, it becomes his most valuable asset, and even has a constant fear of something bad happening to him (castration anxiety). It is recommended not to perform surgical procedures on the genital organ during this period unless it is necessary. However, there is no study in the literature comparing the adults who were circumcised during the phallic period with those who were circumcised outside this period in terms of psychiatric and urological aspects. In fact, it would be very difficult to design such a study and obtain healthy results. Our own observation in the Pediatric Urology outpatient clinic is that boys in this age group make great efforts to avoid genital examination. A forced circumcision under local anesthesia is very likely to be perceived as punishment by the child. On the other hand, general anesthesia will only make the child unaware of the procedure, and will not prevent him from noticing the pain in his genitals, bandage and shortening of the penis after waking up. For this reason, we inform the families who applied to our clinic for traditional circumcision and recommend postponing the circumcision until the age of 6 in children in the phallic stage. There is no doubt that psychosexual development will show individual differences and the age range mentioned above may shift from case to case earlier or later.

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