Aesthetic Circumcision

What Is Aesthetic Circumcision?

Circumcision means surgically removing the piece of skin (the prepuce, or foreskin) that covers the tip of the penis (the glans). It is performed for religious or cultural beliefs or for medical reasons.
During normal penile development, the glans and the foreskin are attached. Up to the age of five, this adhesion is normally present in 75% of children, and the rate decreases over time. In addition, nodular structures with a whitish appearance that feel as if they are inside the foreskin may be felt on the penis of young boys. This is called smegma. Smegma is a completely physiological formation. It results from the accumulation of oily secretions on the inner side of the foreskin, which has not yet separated from the glans because of the adhesion. It regresses over time. No effort should be made to retract the foreskin in order to clean it.

What Are the Benefits of Circumcision?

Circumcision still remains the surgical procedure about which there is the most debate. The general view is that circumcision reduces the risk of penile and cervical cancer (cancer of the cervix in women), sexually transmitted diseases, primarily AIDS, and urinary tract infections.

When Is Circumcision Performed?

Around the world, circumcision is most often performed for religious or cultural beliefs. However, there are also various medical conditions in which circumcision is necessary.

Relative reasons that call for circumcision:

• Balanitis (inflammation of the head of the penis) or balanoposthitis (inflammation of the head of the penis together with the foreskin)

• Phimosis

• Paraphimosis

• A very long foreskin

• For protective purposes in regions where AIDS and similar diseases are widespread

• For protection against penile cancer

• For protection in children who have frequent urinary tract infections due to a problem in the urinary tract

• After penile injuries (trauma)

The condition that definitely requires circumcision is phimosis resulting from balanitis xerotica obliterans and recurrent attacks of balanitis/balanoposthitis. Balanitis xerotica obliterans is a chronic, scarring skin disease that can be seen in 1.5% of boys and may affect the foreskin, the head of the penis and sometimes the external urinary opening. Its cause is not fully known.

When Should Circumcision Be Performed?

There is no clear data on the timing of circumcision. However, when circumcision is medically necessary, it can be performed at any time. Apart from medical necessity, circumcision performed for religious or cultural reasons is best not performed between the ages of 1.5 and 4, which is considered unfavorable for the child's psychological development. Another important point is the anesthetic method chosen for the procedure. After the age of six, in a child who is well prepared psychologically (if he can understand why and how the procedure will be done), circumcision can be performed with regional numbing (local anesthesia). In younger children, to prevent the child from being psychologically affected during circumcision, it may be postponed to a later age or, if it is to be performed, doing it under light anesthesia will be more comfortable for both the child and the surgeon. In children younger than two or three years, it should preferably be performed under anesthesia. Although it is claimed that circumcision can be performed without anesthesia in the newborn period (the first few days), local anesthesia must be applied in this period as well, and general anesthesia should be preferred

How Is Circumcision Performed?

Several methods have been described. In one of them, the foreskin is clamped with a ring-shaped plastic device and the skin is expected to fall off on its own after a few days. The other methods involve surgical removal of the skin. In surgical circumcision, the incision line is sutured. These are self-dissolving sutures that do not need to be removed later. In circumcision performed in the newborn period with a special bell-shaped device, sutures may not be needed.

What Problems Can Occur After Circumcision?

Problems after circumcision are rare. However, some problems that do occur can be serious enough to cause permanent problems in the child's life. Problems after circumcision can be seen in 1–7% of cases. The most common problems are bleeding, wound infection, removal of too much or too little skin, and narrowing of the external urinary opening. However, very rarely, problems such as very serious bleeding, amputation of the head of the penis, or damage to the urinary tract may also occur. The main factors behind such problems include failure to follow surgical hygiene rules during circumcision, the procedure being performed by unqualified people, lack of bleeding control, lack of care for the head of the penis or the urinary tract, and mass circumcisions. Problems are rare after circumcisions performed under appropriate conditions in a healthcare facility.
The most common issue in the early period after circumcision is bleeding from the incision, even if in small amounts. In this case, a firm and tight dressing applied over the incision almost always solves the problem. When this is not effective, the bleeding vessel may need to be found and tied off. Another problem is the scab lifting off when the dressing is removed after circumcision, with a small amount of bleeding. This bleeding is usually self-limiting, and the best way to avoid it is to wait for the dressing to fall off on its own. Not opening the dressing for 3 days after circumcision and, at the end of the third day, taking a sitz bath for about 10–15 minutes a day in a basin of lukewarm water containing a small amount of antiseptic solution is enough for the dressing to fall off on its own. In addition, applying a thin layer of antibiotic cream over the wound (for 5–7 days) will also be helpful. Another issue encountered is pain lasting 2–3 days after circumcision. There is no harm in using painkillers during this period. Wound infection after circumcision is not common. In the rare cases where it occurs, the problem is easily resolved with topical and oral antibiotics.