Circumcision, which is one of the most frequently performed surgical procedures in our country and in the world, is still an important medical problem. 25% of men worldwide are circumcised for religious, cultural or medical reasons. 60% of all newborns in the USA and nearly 100% in South Korea are circumcised. In our country, circumcision is a religious and social request and is widely practiced in almost all boys.
The history of circumcision dates back to about 15,000 years ago. It is also known that circumcision is practiced by different cultures and independently of each other. For example, when Christopher Columbus discovered the Americas, he found that many natives were circumcised. The first written and pictorial evidence about circumcision dates back to BC. It is an ancient Egyptian papyrus and wall painting from 2300 BC. Here, there are findings showing that circumcision was practiced as a tradition.
The debate about the necessity of this surgical procedure, which is the most performed in history and today, by whom, when and how it should be performed is perhaps one of the most interesting discussions in the medical literature.
The person who will perform the circumcision must be an expert and have a good knowledge of the anatomy and physiology of the penis. Showing the necessary surgical care during circumcision can lead to important complications. At the beginning of these complications are bleeding, infection, permanent damage to the urinary tract and penis, and incorrect circumcisions. Incomplete sterilization, use of the same instruments, and lack of sufficient knowledge about surgical technique increase the incidence of these complications. As a matter of fact, hundreds of children apply to our hospitals with complications after circumcision every year in our country. Another important aspect of circumcision is its effects on child psychology. Unfortunately, adequate education is not given to children and families in this regard. It is essential to make preliminary preparations for the circumcision of the child and to perform the circumcision in appropriate environments. It should not be forgotten that the child, who is negatively affected psychologically, may have some problems that may reflect on his sexual life in the future. Circumcision is generally performed on children after the age of 6-7 in our country.
Recently, circumcision performed in the neonatal period has become more common with its advantages such as ease of surgical procedure and care, rapid wound healing in the baby and not causing psychological trauma. Although circumcision can be performed at any age, circumcision should not be performed unless it is compulsory in children aged 2-4, since identity development is egocentric and incompatible, or if it will be done, it should be performed under general anesthesia. An important issue that should be emphasized here is the importance of performing the circumcision procedure under general anesthesia. Local anesthesia must be abandoned as soon as possible in terms of both surgical procedure and psychological effects. Moreover, local anesthesia is more risky than general anesthesia, contrary to the general belief. Because it is possible for the substance used as a local anesthetic to cause spasm in the penile vessels and even cause the loss of the penis. In addition, it is much more useful and contemporary to apply a surgical procedure without causing this fear and excitement to the child. As a matter of fact, circumcision under local anesthesia is accepted as a medical error in many countries around the world. Of course, one of the main problems that should be emphasized is the “mass circumcision” campaigns. In such campaigns, all the rules that must be followed in circumcision are violated, both as a surgical procedure and psychologically. As a matter of fact, more complications occur after such campaigns. Moreover, we know that in 1997, the General Directorate of Treatment Services of the Ministry of Health banned mass circumcisions.
As can be seen, circumcision is a small but important surgical intervention. In cases where the necessary importance is not given, it can cause significant and permanent negative effects in human life. Here, we, the experts, have an important job to do. Families and children need to be properly educated. It is important to emphasize the importance of performing circumcision under general anesthesia and in hospital conditions and to make it attractive to families. Today, there can be no acceptable justification for performing circumcision in inappropriate places and conditions by people who do not have anatomical, physiological and psychological knowledge.
Newborn circumcision
The most frequently asked question regarding circumcision is not whether circumcision is necessary or not, but what age is the most ideal for circumcision. It has been revealed that they spend very comfortably after circumcision, which is applied in the newborn period, that is, in the first month after birth. The necessity of neonatal circumcision has been discussed for a long time. It is suggested that it can be more beneficial because it eliminates the psychological and early childhood problems caused by the child between the ages of 3-6 and circumcision. Currently, 60% of newborn circumcision is performed in the USA.
In studies conducted on 40,000 male infants, the rate of urinary tract infection was found to be 7% in uncircumcised children and 0.7% in circumcised infants. It has been shown that uncircumcised children are 8-15 times more likely to catch urinary tract infection compared to the circumcised group. Circumcision performed in the newborn period also completely eliminates the occurrence of diseases such as stenosis at the tip of the foreskin, strangulation of the pipi head with the foreskin, and inflammation of the foreskin, which may develop in childhood.
In addition, circumcision performed in the neonatal period has some advantages as a surgical intervention. This period can be completed in about 10 minutes with the help of an anesthetic cream (emla) applied 45 minutes before the circumcision procedure, with the help of a device called “bell” among the people, or with the classical surgical method. Since this procedure is performed as a result of the compression of the foreskin between two metal parts in the bell method, there is no need for additional stitches. The vessels in the newborn foreskin are smaller and bleeding problems are almost never seen. Post-circumcision care is very easy and recovery is fast.
Bell method
There is no need to apply general anesthesia for circumcision in newborn babies. Therefore, the baby does not need to be hungry. When the procedure is performed on a full stomach, the baby is much more peaceful and calm during and after the procedure. However, contrary to the thesis that used to be wrong, newborn babies also feel pain. For this reason, local anesthesia should be applied with a fine needle for circumcision. The newborn baby is seen by the circumcised doctor on the 3rd day after circumcision and can be bathed on the 5th day. The placed sutures dissolve on their own and fall off, the sutures do not need to be removed.
Although neonatal circumcision is a very simple and risk-free operation, it is a surgical procedure. Therefore, there may be various complications with a rate of less than 1% during and after the procedure. The main ones are; infection, insufficient circumcision, narrowing of the foreskin, skin adhesions and bleeding.
Neonatal circumcision should not be performed in premature infants, infants with a family history of hemophilia or other blood disease, infants with congenital pipi anomaly, and infants who are currently ill.
