Guide for parents of uncircumcised children
What is circumcision?
Circumcision is the process of surgically removing about 3/4 of the foreskin, which is called the preputium in medical language, which surrounds the tip of the penis, and expose the tip. It is most applied for religious reasons, especially in Islam and Judaism. Circumcision may also be required for various medical reasons, such as narrowing of the foreskin tip and frequent urinary tract infections.
By what methods is it done?
- Bell method: The foreskin is compressed between two age-appropriate metal plates and the outer part is cut. It is non-bleeding and is often preferred for circumcision of newborn babies.
- Laser or cautery method: It is the cutting of the foreskin with these electrical tools. It is not recommended as it can be dangerous in unqualified hands and cause permanent disability.
- Surgical method: It is traditionally done by cutting the ends surgically and sewing the ends together. This is the most widely accepted method that we also use.
At what age should it be done?
Although controversial, the generally accepted view is that it should be done before the age of two or after the age of six. It is argued that between these ages, children are affected negatively, especially psychologically, and they think that this is a punishment given to them by their parents. Of course, medical necessity conditions such as urination problems and frequent urinary infections may require it at any age. In terms of the psychological development of children who have been circumcised in this age range for emergency reasons, it will be beneficial to do it under anesthesia in a way that they will not remember it. Although there are different opinions about circumcision in the newborn period, there are increasing numbers of people suggesting that it should be done especially in the first two weeks of life to benefit from the rapid recovery feature of the baby. It should not be forgotten that newborn circumcision should be done especially in competent hands.
Where should it be done?
It would be the right choice to perform the surgical procedure for an organ that is given great importance by the society, in hospital conditions and even in the operating room. General anesthesia will both protect the child psychologically and shorten the recovery period. Undoubtedly, this is a comfortable and more humane approach. In local anesthesia; Regardless of the conditions and age, the child experiences great fear and panic because of the injection to his penis. These moments are remembered by the child with fear throughout his life.
Which circumcision should be preferred with local anesthesia or general anesthesia?
It is beneficial for all children to be circumcised, except for babies up to six months old. Since the risks related to anesthesia are higher than at other ages and the nerves of the penile region are not fully sensitive to pain six months ago, circumcision can also be performed under local anesthesia. However, the anesthesia applied during circumcision is a milder procedure than the anesthesia used in normal surgeries. The risk of anesthesia is lower since the drugs necessary for muscle relaxation, which cause the events that people fear after anesthesia, are not needed here. The circumcision of the children, who are relieved of the psychological comfort of the children and the pressure of being held by someone from their hands and arms, can be done more carefully by the doctor who performs the procedure.
How should the child be prepared for the operation?
The decision of circumcision should be taken together with children who can understand. The subject should be explained in a simple way that the child can understand, without allowing the child to be misinformed by his environment and friends, and the time between speaking and circumcision should be kept short. Before the operation, it should be examined by the relevant physician. Thus, the surprises that may be encountered during the operation (such as congenital circumcision-hypospadias) will be avoided and the necessary blood tests will be requested, and the child and family will have the opportunity to learn the details about the operation firsthand.
What are the diseases that can occur in uncircumcised children?
- Foreskin inflammatory diseases (balanitis).
- Kidneys may be affected by infection of the urine collected under the foreskin (pyelonephritis).
- Foreskin stenosis (phimosis). This situation requires immediate circumcision. Because the child, who cannot fully urinate, can cause diseases up to kidney failure due to the accumulation of urine.
- Because the foreskin is long and narrow, the skin runs back and suffocates the glans (paraphimosis). This is a situation that requires urgent circumcision. If the head of the penis is not circumcised, gangrene occurs because of blood loss.
- Benign and malignant tumors are more common in uncircumcised patients. Cervical cancer is more common in women whose spouses are uncircumcised.
What should families be warned about before circumcision?
- Circumcision should not be performed in the presence of hypospadias, which is known as congenital circumcision or circumcised prophet among the people. Because in these patients, the urinary hole is not where it should be. This situation needs to be corrected with surgery. The foreskin is used in the operations to be performed.
- If there is a blood disease or bleeding disease in the family, the child should not be circumcised without consulting a doctor, even if he has no complaints. Children who have a history of bleeding for a long time after a fall or tooth extraction, who have large swelling and bruises after an injection or after a blow, and children who occasionally have spontaneous gum or nose bleeding should be circumcised after blood tests are performed.
- Chronic (chronic) diseases in the family, previous significant diseases (for example, requiring hospitalization) and surgeries should also be known by the physician who will perform the intervention. Dangerous situations can be prevented by taking necessary precautions before circumcision in patients with problems.
How should the care after circumcision be?
After the circumcision, the healing of the skin is usually in the first 3-4 days.
However, it may take a week for the used sutures to melt and the swelling and redness in the tissues to disappear completely. An antibiotic ointment is usually recommended to protect the fresh wound after circumcision. It may also be necessary to use a pain reliever for the first 2 days. If circumcision was performed in a clean environment such as the operating room, antibiotics are generally not required. Since child urine is a germ-free liquid, wetting the foreskin or dressing while the child is urinating does not pose a risk in terms of wound healing and infection development. Since absorbable sutures are used during the circumcision process, there is no need for suture removal. If there is no problem in skin healing after circumcision, children can take a bath after 4-5 days.
Can diapers be used after circumcision, what should be worn?
There is no problem in tying the diapers of children whose diapers are tied immediately after circumcision. For older children, protected circumcision underwear can be recommended. Generally, children can easily wear their underwear after taking a bath after circumcision.
What should be considered when coming home after circumcision?
The most important problem after circumcision is bleeding. For this, families should pay attention to their children, especially for the first 24 hours. There may be some redness of the dressing, swelling and a slight bruise. If the bleeding is continuous, if the child has trouble urinating or if there is swelling more than normal, it should be taken to the doctor for a check-up. If there is a fever and the pain does not go away within 24 hours despite the medications given, a doctor's control is required.