History and Cultural Significance of Circumcision

The origins of circumcision date back thousands of years. The procedure is even depicted in ancient Egyptian reliefs. Today, besides being a religious ritual for Jewish and Muslim communities, it is also common in certain regions of Africa for HIV prophylaxis.

Who is Circumcision Recommended For?

• Phimosis (Tight Foreskin): In cases where the foreskin cannot be retracted, the risk of urinary tract infections increases.
• Paraphimosis: The foreskin becomes trapped behind the glans after retraction, cutting off blood flow.
• Recurrent Balanitis / Balanoposthitis: Preferred for hygiene in patients experiencing frequent inflammation.
• Infants with Urinary Tract Infections: May be recommended, especially with co-existing anomalies like vesicoureteral reflux.

What is the Suitable Age Range for Circumcision?

• 0–2 Months: Healing is fast in the newborn period, and pain is less severe.
• 6 Months–6 Years: Considered appropriate from a child psychology perspective.
• 7–12 Years: Awareness increases during school age; adaptation to anesthesia is important.
• Adolescents and Adults: Can be performed due to medical necessity or personal preference; the healing process may take a bit longer.

What Are the Circumcision Methods?

Conventional Surgical Sutured Method

Classic knife and suture technique; cautery is used for bleeding control.

Sutureless (Stapler/Clamp) Techniques

Applied with devices like Plastibell, Tara Clamp, Alis Clamp; wound healing can be faster.

Laser-Assisted Circumcision

Incision is made by heat effect, bleeding is minimal; however, device cost is high.

Electrocautery Cutting

Vessel coagulation is achieved by the heat of the cautery; surgeon’s experience is important.

How is Circumcision Performed According to Age?

Infant (Newborn) Circumcision

Newborn circumcision is a surgical procedure performed within the first 24 hours to 2 months after birth. During this period, healing is rapid, the wound line is small, and the risk of infection is low; additionally, the infant does not consciously experience the trauma of surgery.

In newborns, local anesthesia (penile block) is often sufficient; pain control is supported by comforting methods like breastfeeding and oral saccharin.

• Ring systems are common in operations: The skin is compressed with a sterile plastic ring, and the excess part is cut; the ring falls off on its own in 5-7 days.
• The classic cautery-suture technique involves electrocautery for bleeding control and fine absorbable sutures.

The newborn infant is usually discharged 1-2 hours after the procedure.

Child Circumcision (6 Months – 12 Years)

What is Child Circumcision?

In this age group, the procedure is still considered “childhood”; psychological preparation is important. It can be performed for medical reasons (e.g., phimosis) or cultural ceremonies.

Anxiety is more pronounced in children; therefore, mild sedation + local anesthesia is often preferred, while some centers use general anesthesia.

Sutured Conventional Method: The prepuce is cut in a linear fashion, bleeding is coagulated, and closed with 4-0/5-0 absorbable sutures.

Stapler/Clamp Systems: These devices can reduce the need for sutures; surgical time is short but proper patient selection is crucial.

Children are usually discharged on the same day or the next day; the first dressing change is done within 24 hours.

Adult Circumcision (13 Years and Older)

Circumcision in adolescence or adulthood can be performed for medical or personal reasons such as phimosis, recurrent balanoposthitis, difficulty with hygiene, or reducing the risk of sexually transmitted infections. The healing time is longer compared to infants, and the risk of bleeding is relatively higher.

In adults, general anesthesia or a combination of sedo-analgesia + local anesthesia is frequently used.

• Classic Cautery-Suture Technique: Excess skin is removed, bleeding is coagulated, and closed with sutures; care is taken to avoid leaving excess skin.
• Laser-Assisted Cutting: While bleeding is minimal with thermal heat, the cost is high, and long-term data is limited.

Adults are advised 1-2 days of rest after the procedure; stitches typically dissolve or are removed in 10-14 days. Sexual activity is usually permitted after 4-6 weeks.

Anesthesia Options

• Local Anesthesia: Frequently preferred for infants and young children.
• Sedation + Local: Pain control is enhanced in a lightly sedated state.
• General Anesthesia: Suitable for children with high anxiety and adults.

What are the Advantages of Circumcision?

When listing the potential benefits of circumcision, it is important not to make definitive treatment promises:

• May reduce the risk of urinary tract infections.
• May facilitate hygiene.
• May lower the risk of penile cancer.
• May reduce certain sexually transmitted infections, including HIV.

What are the Possible Risks of Circumcision?

As with any surgical procedure, there is a possibility of complications with circumcision:

• Bleeding or hematoma.
• Infection.
• Insufficient/uneven skin removal.
• Meatal stenosis (especially in newborn circumcisions).

Does Circumcision Negatively Affect Sexuality?

Current scientific data indicates that circumcision does not show a negative long-term effect on sexual function (libido, erection quality, orgasm, ejaculation control) and sexual satisfaction; in most men, the level of function is maintained, and some parameters may even show improvement.

A recent review from 2023, summarizing more than 40 studies including randomized controlled trials, concluded that “there is no evidence that male circumcision increases the risk of sexual dysfunction.”

A multi-center study in Kenya with 2 years of follow-up found no difference in erection, pain during penetration, or general satisfaction scores between circumcised and uncircumcised arms.

Systematic reviews emphasize that penile sensitivity measurements (vibration, heat, touch threshold) are similar or minimally variable; psychological factors may influence perception.

Some studies have reported increased ejaculation control and partner satisfaction after circumcision; however, this finding has not been replicated in all studies.

Possible Exceptions and Considerations

Surgical complications (excessive/insufficient skin removal, scarring, meatal stenosis) can rarely lead to pain or tension problems during erection.

Temporary reduction in sensitivity or sensory changes due to nerve ending regeneration may be felt in the postoperative period; these usually return to normal within a few months.

Changes in body image can have a positive or negative impact on a person’s sexual confidence; cultural and individual factors are important.

In summary, there is no strong evidence that circumcision, when performed with standard surgical techniques by an experienced team, permanently impairs sexual function. Nevertheless, as with any surgical procedure, individual differences and the risk of complications should be considered; the decision should be made in consultation with a physician.

Circumcision Aftercare and Recovery

The primary goal is to minimize the risk of infection:

• Daily dressing: Antiseptic solution and antibiotic ointment.
• Pain management: Paracetamol or ibuprofen can be used at the physician’s prescribed dose.
• Bathing permission: Warm water showers are generally allowed after 48 hours.
• Clothing choice: Loose diapers for infants, loose cotton shorts for children are recommended.
• Follow-up appointment: A medical examination must be performed on the date recommended by the surgeon.

Legal Regulations Regarding Circumcision

In our country, circumcision must be performed by a physician or a health professional certified by the Ministry, in a healthcare facility. “Under-the-counter” practices significantly increase the risk of serious complications.