One of the most common questions we encounter in our clinical life is: “When should I have my child circumcised?”.
You can find a lot of content on social media on this subject. In this section of the Pediatric Surgeon’s Journal, I explained which age is the best time for circumcision.
Circumcision debate is a never-ending topic in our society. Should circumcision be done or not? Are there any harm? Does it have advantages?
When you become a pediatric surgeon, these questions never stop. I am not going to tell you the answers to these questions today. In our country, more than ninety percent of men are circumcised due to various reasons such as religion, tradition and health. Therefore, the most appropriate timing of circumcision is a frequently asked question to us. So our topic is the timing of circumcision.
Some suggest different time intervals, highlighting the psychological effects of circumcision, while others highlighting the post-surgical recovery process. Let me try to explain it to you based on the publications I found in the literature. You can find all the publications I will mention here as a source at the bottom.
In a prospective study on the sexual activities of adults being circumcised at different ages in childhood, no statistically significant difference was found between the groups.
In another study, including 302 adults, which investigated the psychosexual effects of circumcision in the phallic period (3-6 years), no significant findings were found, and it was concluded that circumcision in this period did not have a psychosexual effect on adults.
Then, adults circumcised in the neonatal period were compared with uncircumcised adults, and when the somatosensors on the glans, that is, on the head of the penis, were compared, no statistically significant change was noticed. In other words, contrary to the rumors that there may be loss of sensation in the head of the penis after newborn circumcision, there is no difference in both groups. It is possible to increase the examples of articles that write that there is no relationship between the age of circumcision and sexual function.
It is stated that uncircumcised children in the Turkish population are badly affected, embarrassed and disturbed by their own body image. There are articles stating that children do not feel like they belong to this society because of the social stress they feel. This creates the following question in my mind: Should the child be circumcised before he has these negative feelings?
If circumcision is a part of community rituals and practices, the child will not perceive this situation as a threat; On the contrary, there are those who suggest that he will see it as a reward when he is aware of it, his self-confidence will increase and he will understand that he is a part of the society, and for this he should be circumcised at an age where he can perceive all these.
Now, when I look at all these publications, I am convinced that circumcision in our country will not create a problem in the future. Then the question is: At what age can circumcision surgery be performed most easily?
If we examine the complication rates after circumcision in scientific articles, it is stated that the complication rate, which is 0.02-6% in the neonatal period, increases 20 times between the ages of 1-9 and 10 times after the age of 10.
n fact, it is recommended that families who think that it is more appropriate for their child to decide for circumcision on their own, should be informed that as the age of circumcision increases, the incidence of complications is much higher, the feeling of discomfort will be higher and it will heal in a longer time.
In addition, due to its protective effect from sexually transmitted diseases, the importance of being circumcised before a sexually active life begins is emphasized.
We have published in a study we conducted with 1000 parents, that the least problem was seen after neonatal circumcision. Parents are most influenced by their relatives in the timing of circumcision, they state that they do not pay much attention to social media in the selection of circumcision age. However, when questioned later, all parents think that they made the wrong decision about the age of circumcision as high as 40%.
We found the highest dissatisfaction rate in the older age group. Interestingly, although it was not the group with the most complications, the families who preferred circumcision after the age of 6 were the group that regretted the circumcision the most.
We found that the highest satisfaction rate was 96% after newborn circumcision.
I think this information is enough. You can find what I have told, the views of psychiatrists and psychologists, the effects of circumcision on sexual life and much more in my book titled “The Story of Male Circumcision”, which I try to tell in a narrative way.
This was a bit like product placement, but it is a very elaborate book. I want it to meet many people.
What are we doing as a result?
In my opinion, the most beautiful and unproblematic circumcision period is the newborn period. Of course, you definitely need to find a doctor, that is, a pediatric surgeon, who is used to touching babies. The period called newborn is the first month of life. The first two weeks are very comfortable, the third week is getting harder, the fourth week is more difficult as the baby’s awareness increases. After one month, the newborn period is over. Therefore, we give this information to those who give birth in another hospital and prefer to come to us for circumcision.
If circumcision is not performed in the newborn period, we do not recommend circumcision until 1 year old. The reason is that babies are very swollen like Michelin babies during this period. During this period, the penis can be buried in the adipose tissue, and minor problems can be seen during the recovery period.
Like a year old, walking and running begins, adipose tissue decreases. From this period to the age of 3, it can be a suitable period again.
Although it is said that there is no harm in being circumcised in the phallic period, we do not do it between the ages of 3-6, with the advice of psychologists and psychiatrists. Suitable for any age up to then adolescence.Morning erections that start with puberty can cause a more difficult post-surgical process.
Yes, we have come to the end of a long journey. Please click like if you want to watch the video, subscribe, follow us on Instagram.
And stay happy.
Prof. Dr. Egemen Eroğlu
October 2021
References:
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Baskin LS: Neonatal Circumcision: Risks and benefits. https://www.uptodate.com/contents/neonatal-circumcision-risks-and-benefits?search=neonatal%20circumcision&source=search_result&selectedTitle=2~98&usage_type=default&display_rank=2#H1
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Özen MA , Eroğlu E: Sünnetin ebeveyn geri bildirimi ve tıbbi sonuçlar açısından değerlendirilmesi. Çoc. Cer. Derg. 2019;33(2):65-71 doi:10.5222/JTAPS.2019.65982 Cuceloglu EA, Hosrik ME, Ak M, Bozkurt A. The effects of age at circumcision on premature ejaculation. Turk Psikiyatr Derg. 2012;23:99–107.
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Armagan A, Silay MS, Karatag T, Akman T, Tepeler A, Ersoz C, et al. Circumcision during the phallic period: does it affect the psychosexual functions in adulthood? Andrologia. 2014;46:254–7.
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Bleustein CB, Fogarty JD, Eckholdt H, Arezzo JC, Melman A. Effect of neonatal circumcision on penile neurologic sensation. Urology. 2005;65:773–7.
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Aydur E, Gungor S, Ceyhan ST, Talimaz L, Baser I: Effects of childhood circumcision age on adult male sexual functions. Int J Impot Res 19:424-431, 2007.
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Banuelos Marco B, Garcia Heil JL. Circumcision in childhood and male sexual function: a blessing or a curse? Int J Impot Res 2020 Sep 29. Epub 2020 Sep 29.
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Yavuz M, Demir T, Dogangün B. The Effect of circumcision on the mental health of children: a review. Turk Psikiyatri Dergisi. 2012;23:63–70.
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El Bcheraoui C, Zhang X, Cooper CS, et al. Rates of adverse events associated with male circumcision in U.S. medical settings, 2001 to 2010. JAMA Pediatr 2014; 168:625.
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Morris BJ, Waskett JH, Banerjee J, et al. A ‘snip’ in time: what is the best age to circumcise? BMC Pediatr 2012; 12:20.