Aesthetic Circumcision

When should circumcision be performed?

There is no definitive data regarding the timing of circumcision. However, when circumcision is medically necessary, it can be performed at any time. For non-medical, religious, or cultural reasons, it is recommended not to perform circumcision between the ages of 1.5 and 4, as it may be detrimental to the child's psychological development. Another important point is the choice of anesthetic method during the procedure. After the age of six, circumcision can be performed with local anesthesia if the child is psychologically well-prepared and can understand why and how the procedure will be done. In younger children, circumcision can be postponed to an older age to avoid psychological effects or, if performed, should be done under superficial anesthesia for both the child and the surgeon’s comfort. For children under the age of two or three, circumcision should be performed under anesthesia. Although it is suggested that circumcision can be performed without anesthesia during the newborn period (the first few days), local anesthesia should always be applied during this period, and general anesthesia should be preferred.

How is circumcision performed?

There are several defined methods for performing circumcision. In one method, the foreskin is tightened with a plastic ring-like device, and the skin is expected to fall off naturally after a few days. Other methods involve surgically removing the foreskin. In surgical circumcision, sutures are placed along the incision line. These sutures are self-dissolving and do not need to be removed later. In the newborn period, circumcision can be performed using a special bell-shaped device, which may not require suturing.

What complications can occur after circumcision?

Complications after circumcision are rare. However, some issues may be serious enough to cause permanent problems in the child's life. Post-circumcision complications occur in 1-7% of cases. The most common problems include bleeding, wound site infection, removal of too much or too little skin, and narrowing of the external urethral opening. However, very rarely, serious complications such as severe bleeding, cutting of the glans penis, and damage to the urinary tract can occur. The main factors contributing to such issues include failure to follow surgical cleanliness rules during the procedure, performing the circumcision by unqualified individuals, inadequate control of bleeding, lack of attention to the glans penis or 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 post-circumcision period is mild bleeding from the incision site. In this case, a firm and tight dressing applied over the incision site almost always resolves the problem. If this is not effective, it may be necessary to locate and ligate the bleeding vessel. Another issue is the removal of the dressing after circumcision, which can cause the scab to come off, leading to slight bleeding. This bleeding usually resolves on its own, and the best approach to avoid it is to allow the dressing to fall off naturally. It is recommended not to remove the dressing for the first three days after circumcision. On the third day, a sitz bath with warm water containing a small amount of antiseptic solution for 10-15 minutes per day is sufficient for the dressing to fall off naturally. Additionally, applying a thin layer of antibiotic cream over the wound site (for 5-7 days) will be beneficial. Another common issue is pain for 2-3 days after circumcision. During this period, there is no harm in using pain-relieving medications. Wound infections are not common after circumcision. In the rare cases that an infection occurs, local and oral antibiotics can easily resolve the issue.