Circumcision is the most common and oldest surgical procedure in the world. The purpose of this procedure is to remove the tissue at the tip of the penis and ensure that the head of the penis remains outside. There are hundreds of scientific articles published in international medical journals on this subject, and as a result, the benefits of circumcision are listed as follows; reducing the transmission of sexually transmitted diseases, preventing urinary tract infections, reducing the risk of penile cancer, eliminating this problem in those who have phimosis (narrow foreskin) and difficulty urinating, reducing the risk of cervical cancer in the spouse of a circumcised man, reducing inflammation of the tip of the penis. We can list the questions that may come to mind on this subject as follows.
Question 1: The tip of my child's penis is closed (there is phimosis), should I open the skin backwards?
Answer 1:THIS IS AN ACTION WE DEFINITELY DO NOT RECOMMEND. In approximately 95% of newborn boys, the foreskin is too narrow and the glans cannot be brought out. This is called phimosis in medicine. However, this is a normal (physiological) situation. In this case, families try to open this skin by pulling it back, sometimes with the suggestions they hear from the environment and sometimes unfortunately with the advice of a doctor. After this movement, the glans penis sometimes becomes compressed, strangled, gangrene develops (paraphimosis) and urgent circumcision is required. There is normal (physiological) phimosis and abnormal (pathological) phimosis. In this case, circumcision should be performed as soon as possible due to medical necessity.
Question 2: How can I understand whether phimosis is normal or abnormal (pathological)
Answer 2:The simplest method is to watch the child peeing. If he can pee at a certain speed and thickness (a countercurrent), then there is nothing to worry about. However, if he urinates drop by drop and the skin at the tip of his penis swells like a balloon while urinating, then he has pathological phimosis and needs to be circumcised as soon as possible. IN BOTH CASES, IT IS WRONG TO TRY TO OPEN THE SKIN BY PULLING IT BACK.
Question 3: When is the most appropriate age for circumcision?
Answer 3: In some cases, circumcision is mandatory and regardless of the age of the child; If there is recurrent urinary tract infection, pathological phimosis, congenital In some kidney and urinary tract problems. If one of these is not available and circumcision is performed for traditional or religious reasons, the ideal age is the first 6 months. During this period, the child's awareness is very low and his/her mobility is also low. Wound healing is also better. The second best period is between 6-24 months. Again, since the baby is in diapers during this period, wound healing and care are very easy. We do not recommend circumcision between the ages of 2-6 due to the possibility of some psychological problems, although rare. It can be performed at any time after the age of 6.
Question 4: Is newborn (first 1 month) circumcision harmful?
Answer: 4: The neonatal period is the best period for wound healing. Therefore, it is a recommended time. However, it is beneficial to skip the first 1-week period so that the child reaches the required weight and his own immune system develops. Other advantages of the newborn period: It has a low rate of complications (undesirable situations) such as bleeding and infection, and is easy to maintain. However, it is very important that the circumcision performed during this period is performed by competent people. The relatively small penis and foreskin need to be well adjusted. If it is not performed by qualified people, excess tissue is usually left during this period and this may require circumcision again.
Question 5: Should I have the circumcision performed under local anesthesia?
Answer 5: Circumcision can be performed with both general (sleeping) and local (by injecting around the penis) anesthesia. The most important factor here is the child's age and, if he is old enough to perceive it, his psychological preparation. While local anesthesia is sufficient especially in the first 6 months, the choice should be made by evaluating the condition of the baby or child in later periods. Families are generally very afraid of general anesthesia and do not want to have it. However, there are two important points that need to be explained here: 1- The drugs used in local anesthesia are not 100% harmless, as with every drug. So they also have low serious risks. Even the mildest medications we use at home have a long list of side effects in their leaflets. 2- We surgeons operate on patients of all ages under general anesthesia for hours for medical reasons. Moreover, general anesthesia surgery performed during circumcision It is a much milder form of anesthesia than the anesthesia we use repeatedly. Therefore, there is no big difference between general and local anesthesia in terms of risk percentages. Both are below one in a thousand.
Question 6. What kind of problems may arise during or after the circumcision procedure?
Answer 6: This Although the list is quite long, these rates are quite low in circumcisions performed by competent people and we never encounter most of them. We can count them as follows; Bleeding at the wound site, infection, insufficient circumcision, curvature of the penis, formation of a second urinary hole, narrowing of the urinary hole, cutting off the head of the penis.
Question 7: My child is circumcised from birth. Should I get circumcised again?
Answer 7: "Hypospadias", popularly known as "the Prophet's circumcision" or "congenitally circumcised", is a congenital anomaly seen in boys. Children born with this problem must undergo surgical intervention and circumcision should definitely NOT be performed before the surgical procedure.
Question 8: Who should perform the circumcision?
Answer 8: In the past, circumcision was commonly performed in our country by health officials, popularly known as circumcisers, or by people who did not receive any health training but learned by watching. However, in accordance with the "Circular on Circumcision Practices" of the Ministry of Health, circumcision can only be performed by doctors in our country as of 01/01/2015. Since there is no training on this subject in medical faculty, branches that have received circumcision training should be preferred during specialty training. Among these, it would be appropriate to prefer other surgical branches that are trained in this field, especially urology and pediatric surgery.
Question 9: How is post-circumcision care performed?
Answer 9: There are many different circumcision methods and their care varies depending on the method. Therefore, detailed information on this subject will be given by your doctor. However, to give general information, babies with diapers can be diapered and no additional care is required. In older children, if a dressing is applied after circumcision, this dressing is removed after 1-2 days and no other care is required. You can take a bath after the 1st day and from the first day There is no harm in walking or walking around. Nowadays, since circumcision is performed by doctors under sterile conditions, it is not necessary to use antibiotics. It is sufficient to use the dose of painkillers recommended by your doctor for 2 days after the procedure.
Question 10. When can you swim in the pool or the sea after circumcision?
Answer 10:There is no period recommended by evidence-based medicine on this issue. Each doctor's recommendation may be different or different durations may be found on websites. In our clinic, we recommend that you can swim in the sea after 1 week and swim in the pool after 2 weeks.
Question 11: Is circumcision performed with laser or cautery safe?
Answer 11:Although laser devices can be used in many procedures and surgeries in the medical field, there is no laser system in circumcision. This is a term that is misused among the public. In fact, it is an electrically operated device called cautery, used to cut and stop bleeding. However, it is not correct to perform circumcision with the cautery device used in routine surgeries. A device called thermocautery, which is produced for circumcision, should be used to cut and burn with heat, not electric current. Circumcisions performed with circumcision cautery are also safe. However, especially in the neonatal period and partially buried penises, there is a high risk of the skin closing over the glans again in circumcisions performed with cautery. In this case, re-circumcision may be required. As an advantage, the risk of bleeding is very low. We surgeons generally prefer classical surgical methods.
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