Circumcision is the surgical removal of the foreskin (prepuce) covering the glans of the penis, using various surgical techniques. Normally a circumcision removes the foreskin to the level where the glans is completely exposed. Removal of the foreskin is an operation that requires surgical expertise. For this reason, it should be performed by a specialist physician in a hospital environment. Circumcision can be performed at many different ages for many different reasons. Today, most of the individuals who are circumcised are boys between the ages of 1 and 10, but adult individuals can also be circumcised. There is no age for circumcision. It is an operation performed at the individual's own request.

Why is circumcision performed?

Circumcision is the oldest known human surgical procedure in the world. Circumcision can be performed for many different reasons, including cultural, religious or hygienic reasons. In some societies, circumcision is a cultural and traditional practice and members of those societies circumcise their boys as part of their cultural heritage. Circumcision is compulsory in some religions and recommended in others. While circumcision is obligatory in Judaism, it is a recommended practice in Islam. Regardless of all these reasons, there are also individuals who get circumcised for the sake of their physical health. The most important benefit of circumcision is hygiene. Removal of the foreskin and thus exposing the glans of the penis has many benefits in terms of health and hygiene. Examples of conditions where circumcision is considered medically necessary include phimosis (a condition of the male foreskin where the skin is tight and unable to retract back behind the head of the penis, or meatal stenosis).

What are the contraindications for circumcision?

Hypospadias is a birth defect in which the opening of the urethra is located on the underside of the penis instead of the tip. To treat this condition, the foreskin is used to restore the urethra to its anatomical position. For this reason, individuals with hypospadias should undergo treatment first. After treatment, circumcision can be performed if deemed necessary. Individuals who have had difficulty with or an allergic reaction to anesthesia should be circumcised only after necessary testing. Individuals with hereditary urinary tract and reproductive diseases should first receive the necessary treatment. Not only circumcision but also all other surgical operations pose a serious risk for individuals with hemophilia, bleeding tendency and blood clotting problems.

What is the ideal age for circumcision?

Circumcision age is one of the factors that affect the risk of complications that may occur during the operation. Although there is no ideal circumcision age in medical terms, the timeframe recommended by physicians is the first 1 month after birth mainly because:

●       recovery after surgery is faster in newborns, and

●       newborns do not experience any psychological trauma as they are too young to understand and remember this process in the future.

Circumcision between 2 and 5 years of age may cause psychological problems in the child.

What are the surgical methods for circumcision?

Today, circumcision is mostly performed in sterile environments such as hospitals. As in every surgical operation, attention should be paid to hygiene in circumcision. In the past, circumcision used to be performed by non-physicians in non-sterile environments, not in a hospital and under the control of a physician as it is today. Complications such as infection, excessive or inadequate foreskin removal were common. Today, there are several surgical circumcision methods that eliminate the risk of these complications, including:

●       Sleeve Method: This method is frequently preferred by many surgeons. The borders of the area to be circumcised are marked with a pencil before starting the operation. The foreskin is removed with the help of a scalpel. Then the remaining skin pieces are sutured and the operation is completed.

●       Gomco Clamp Method: This method is generally preferred in newborn circumcisions. The Gomco clamp is a device that protects the glans and has 4 parts. In this method, the foreskin is retracted with clamps to break away any adhesions between the glans and the foreskin. Next the cutting line is determined and the bell of the Gomco clamp is placed over the glans. The operation is completed after all other necessary procedures are performed. The aesthetic appearance after surgery is very good.

●       Plastibell Method: The Plastibell method is one of the techniques generally used in neonatal circumcisions. The Plastibell comprises a plastic bell and a string. The procedure can be performed under local or general anesthesia at the discretion of your specialist physician. Inappropriate placement of the plastic bell may result in insufficient foreskin removal. Healing in circumcisions performed with a proper Plastibell circumcision technique is shorter than in other methods, and it provides satisfactory results in aesthetic terms.

●       Mogen Clamp Method: In this technique, the edges of the foreskin are elevated and the V-shaped clamp is placed at the desired location assuring that the glans is positioned below the clamp before the foreskin is removed. Incorrect placement of the clamp may result in asymmetric skin removal or even amputation of the glans.

●       Dorsal Slit Method: In this technique, the foreskin is incised with a 12 o’clock slit to stop bleeding, exposing the glans without removing any tissue. It is not an aesthetically acceptable method. This technique is therefore used only in individuals with paraphimosis (foreskin trapped behind the corona of the glans). If the foreskin is removed after dorsal slit, the procedure can be performed by seeing the glans. The technique can safely be used to treat significant phimosis.

Recovery of a circumcised adult is different from that of an infant. While infants have a shorter and painless recovery, it takes longer and is more painful in adults. There is usually no need for wound dressing after the operation. Edema (swelling) can be observed at the glans in the first three days of the procedure. This may be accompanied with some redness. Bedrest can promote a faster recovery. Some individuals may experience postoperative bleeding, in which case you should consult a physician right away. While it may vary from person to person, individuals can usually resume their daily activities within a maximum of 10 days.

What are the benefits of circumcision?

Circumcision is one of the most important measures that an individual can take to protect their physical health. The benefits of circumcision can be listed as follows:

●       In general terms, circumcision is essential for a healthy penis. In uncircumcised penises, germs can accumulate under the foreskin, causing various infections.

●       Circumcision reduces the risk of penile cancer. Uncircumcised men are more likely to develop this type of cancer than circumcised men.

●       Circumcision has been found to protect men from many sexually transmitted diseases, including HIV.

●       Problems such as stenosis of the foreskin (phimosis) can be seen in uncircumcised penises. Due to this stenosis, the foreskin cannot retract sufficiently, which increases the possibility of infection at the glans. This problem can be solved by removing the narrow skin with circumcision.

●       Although urinary tract infections are rare in males, uncircumcised individuals are more likely to get this type of infection compared to circumcised individuals.

Along with the benefits of circumcision, there are also certain complications that may develop during the procedure, as with every other surgery. These complications may include the following:

●       Various infections may develop. To prevent this, utmost attention must be paid to sterility and hygiene during and after the operation.

●       Complications such as bleeding risk and difficulty to stop bleeding may be encountered.

●       In rare cases, some mistakes may occur on part of the surgeon. These mistakes may include excessive or inadequate foreskin removal.

●       Individuals should be able to urinate normally 12 hours after surgery. Problems with urination may rarely be encountered, in which case you should see a doctor right away.

Circumcision is a surgical procedure. Therefore, it is very important for individuals to be well informed and have sufficient awareness of circumcision. It should be known that circumcision should only be performed by a specialist physician in a sterile hospital environment. If a child is to be circumcised, a specialist physician should be consulted first. The operation should be performed only if found appropriate by the physician. It is crucial that you take the right steps and seek expert support for a healthy and trouble-free circumcision.

References

1. https://dergipark.org.tr/tr/pub/muskutd/issue/38576/407231
2. https://dergipark.org.tr/tr/download/article-file/1218706