WHAT IS CIRCUMSTANCE?
Circumcision in the medical literature is the process of cutting the skin at the tip of the penis, that is, the preputium, which is defined as circumcision in our country. Circumcision is one of the most frequently performed surgical procedures in childhood in Turkey. For this reason, it is a subject that is spoken a lot in the society and there is no information pollution and no fixed idea about who should do it at what age and with what kind of anesthesia. For this reason, the most basic thing to know about circumcision is that circumcision is a Surgical Procedure that takes longer than many interventions. For this reason, it is extremely important to perform the circumcision under sterile conditions in hospital conditions, with the appropriate anesthesia method, by appropriate surgeons, in order to eliminate the side effects that may occur afterwards and that may last a lifetime.
WHEN SHOULD CIRCUMSTANCE BE DONE?
The first 3-4 of life. The squamous cells keratinize and form smegma. The growth and erection of the penis and the formation of infant smegma allow the two epithelial surfaces to gradually separate from each other. The foreskin can be retracted in only 4% of newborns. In only 50% of newborns, the foreskin can be pulled enough to see the hole where the pee comes from. At 6 months, only 20% of these babies can see the head of the penis. By the age of 3, this rate increases to 90%. While trying to retract the foreskin, children are often misdiagnosed as lice (phimosis).
After the 2nd month, circumcision can be recommended because organ development is fully formed, recovery is rapid in infancy, and pain localization cannot be performed. Circumcision should not be performed in children between the ages of 2/6, if there is no surgical indication, since sexual identity is established. Fear of castration may occur with unnecessary surgical procedures performed during this period. After the age of 6, circumcision can be performed at any age.
Since circumcision is also considered as a commercial issue in Turkey, it is very open to abuse. For this reason, infant and child circumcision is frequently encountered without a real surgical reason.
WHERE and WHO?
Circumcision is an important surgery, so it is the best option to perform it in hospital conditions and operating rooms, like any surgery. Today, circumcision is still performed with local anesthesia in many health institutions, but there has been a consensus that the type of anesthesia to be used in children and babies whose social intelligence is not mature enough in recent years should be general anesthesia.
Therefore, charlatans who tell people that general anesthesia is bad and that hospitals are not suitable for circumcision should not be trusted for commercial reasons.
The possibility of complications is very high due to the fact that the necessary emotional and technical care is not shown to every child in mass circumcisions, the sterile environment is not provided, and it is perceived as an entertainment rather than surgical intervention, so mass circumcision feasts are extremely objectionable practices.
Who Should Perform the Circumcision?
Ideally, circumcision should be performed by pediatric surgeons or pediatric urologists, that is, by physicians experienced in circumcision. It is the branch of Pediatric Surgery that knows children most closely and undertakes their treatment most frequently. For this reason, it is the most correct approach for circumcision to be performed by pediatric surgeons.
HOW SHOULD CIRCUMSTANCE BE DONE?
Circumcision is basically a plastic operation that shapes an organ that the child will use all his life. Therefore, it should be performed with minimal psychotrauma with the help of anesthesia in hospital conditions by doctors who have knowledge of penile anatomy and will not allow complications to occur.
Circumcision Indications
Hernia (Phimosis): The foreskin cannot be retracted physiologically in newborns and infancy. However, in our country, true phimosis may occur with bleeding, tearing or chronic infection in the foreskin due to retraction of the foreskin during this period, among the public in general and with wrong medical referrals. These are usually acquired causes, besides poor hygiene and excessive scar tissue after circumcision can lead to true phimosis.
Paraphimosis: If the narrow ring at the tip of the foreskin is forced backwards on the head of the penis, edema, difficulty in urination and severe pain occur in the head of the penis. If this situation cannot be corrected manually, circumcision is absolutely necessary under appropriate conditions.
Balanoposthitis: It is an infection of the penile skin and foreskin. Mostly, pus formation is found. It is beneficial to circumcise after the treatment.
Chronic urinary tract infection: The most common infection under 1 year old is urinary tract infection in male infants. Circumcision can be recommended for babies who have frequent episodes of infection.
Congenital uropathologies: It is beneficial to perform circumcision in children with congenital kidney and bladder diseases.
WHAT ARE THE BENEFITS OF CIRCUMSTANCE?
1- Elimination of infection attacks, paraphimosis, penile infection risks that may occur due to phimosis.
2- Circumcised children have fewer urinary tract infections.
3- Cutting the foreskin ensures that this area remains clean.
4- Uncircumcised men are more likely to get sexually transmitted diseases.
It is suggested that the risk of cervical cancer is reduced in the partners of circumcised people.
5- Penile cancer is mostly seen in societies where circumcision is not performed.
6- Socio-cultural reasons.
In conclusion, in order to keep our children away from surgery and psychotrauma that may occur after circumcision, such procedures should be performed under anesthesia in the operating room environment, keeping in mind that circumcision is a penile surgeon. There are doctors who mislead our society with purely commercial concerns about anesthesia, but it should be known; “Anesthesia”, which prevents you from feeling pain while you are undergoing surgery, ensures your comfort and ensures that your life is guaranteed, is the “Major RIGHT” of our children as well as you.
