Circumcision

• The main goal in both stitched and clip methods is to remove the excess foreskin. In both methods, the foreskin is surgically removed by cutting. In the clip method, the skin to be cut is first held and then cut. The clip principle has been used for years in cutting the umbilical cord of babies. Circumcision with the clip method is actually the adaptation of this principle to the penis. The principle of clipping and cutting the tissues brings the following advantages.
• The most important advantage of the clip method over sutured circumcision is that the complication rates, namely the risks, are significantly lower. The biggest risk after sutured circumcision is bleeding. Bleeding after sutured circumcision usually requires stitches again. Bleeding is not expected as long as the clip is attached. In short, the clip method significantly reduces the risk of bleeding.
• The risk of infection is also extremely low in the clip method.
• Another important advantage of the clip method over sutured circumcision is that there is no suture and no open wound in this method. The clip brings the cut wound edges together, and the wound remains in a closed environment under the plastic. Since the wound has no contact with the outside, meaning there is no open wound, it does not require dressing after circumcision. In sutured circumcision, it is necessary to pay close attention to the wound, especially in the first 48 hours. Proper wound care and dressing are very important after sutured circumcision. In the clip method, no wound care or dressing is required after circumcision. Each dressing causes a lot of stress and pain in the child. One of the most important advantages is that there is no need for wound care in the clip method.

IDEAL CIRCUMCISION AGE

1. The ideal age for circumcision is a highly controversial issue. While some psychiatrists find circumcision between the ages of 1-6 inconvenient, some do not recommend the age range of 2-4. On the other hand, the connection between circumcision performed in this age range (phallic period), which psychiatrists and psychologists insistently emphasize, and the psychological effects that will occur in later ages has not been revealed for more than 100 years. Most of the existing studies compare the fear experienced by children of different age groups only during the circumcision process. In other words, there is no study with long-term follow-up comparing the psychological problems faced by children who are circumcised between the ages of 1-6 and those who are circumcised at the age of 7 years and later. When such a study is conducted, it may be concluded that circumcision performed after the age of 6, when consciousness develops rapidly and the child is ready for school, is psychologically more inconvenient.
2. There is another contradictory aspect of the age limit determined by psychiatrists. Children’s recognition and adoption of their sexual identity are completed by the age of 6 years. A boy who has completed the age of 6 has accepted himself as a man and has adopted his sexual organ as it is. After this period, this age group is much more sensitive to changes in the shape of the genitals. Those who think that their penis will be cut completely during circumcision, who think that they will become a girl after circumcision, who ask how to urinate, who say “I want my old penis” even 3-4 months after circumcision are children over 6 years old. As a matter of fact, a 2012 article investigating the long-term effects of circumcision age showed that children who were circumcised after the age of 7 faced more sexual problems than those who were circumcised before the age of 7 [Cüceloğlu EA, Hoşrik ME, Ak M, Bozkurt A: The Effect of Circumcision Age on Premature Ejaculation. Turkish Journal of Psychiatry. 2012; 23(2): 99-107].
3. In this study, the rate of premature ejaculation in the future was found to be higher in children who were circumcised after the age of 7. Researchers emphasized that circumcision should be performed before 7 years of age, and if possible within the first 3 years after birth. Although this study, which was conducted with a limited number of patients, is a pioneering research, the ideal age of circumcision will be further clarified with large comparative studies to be conducted in the coming years. However, according to the available preliminary data, psychiatrists will change their minds in the coming years and say, “After the sexual identity is established – that is, after the age of 7 – do not get circumcised!” It wouldn’t be surprising if they do.
4. As a result, we do not have sufficient scientific data on the ideal age of circumcision. No one knows exactly the ideal age for circumcision. All discourses are theory or thesis. In my personal opinion, circumcision should be done as early as possible. It is the end of circumcision before the child’s consciousness develops much, abstract thinking begins, and especially before interaction with schoolmates begins. There are enormous differences between the reactions of children who go to school and those who do not. Circumcision stories or ‘axe’ jokes heard at school terrify children. It should never be forgotten that circumcision causes more or less psychological trauma in children. It is not clear at what age this effect is or whether it is permanent. Families who want to stay away from all these discussions and do not want to take risks in terms of psychological effects have only one option: to choose the infancy period for circumcision. In the light of these reasons, we think that the ideal circumcision should be done at 0-6 months of age. Many children have urinary tract infections and calcifications in the fungus due to urine during infancy. In order to prevent such diseases, early circumcision will be beneficial.

• The neonatal period is when our body has the highest capacity for cell renewal, production, and development. Newborn circumcision for a healthy baby heals much faster, with a significantly lower likelihood of surgical and psychological complications.

• The skin removed during circumcision covers the tip of the penis and the urethra. Under this skin, an airless area forms, accumulating dirt and secretions in contact with urine. Without regular cleaning, this creates a potential breeding ground for infections. It may also contribute to the transmission of sexually transmitted diseases. Especially in children, the foreskin may adhere and narrow, potentially blocking urine flow and leading to penile issues. The foreskin, known as paraphimosis, can become stuck and disrupt blood flow in the penis. Circumcision, by removing this skin, provides protection against these problems.  

• Local or general anesthesia can be applied in circumcision. Given that the plastic clip method is a very short (5-6 minutes) surgical procedure, local anesthesia is more suitable for the comfort of the patient.

• There is no difference in terms of the technique between clip-on and stitched circumcisions. In both methods, the foreskin is cut using a scalpel. The distinction lies in the absence of stitches in the clip-on method; instead, clips are used.
• The clip method has been applied worldwide for 60 years and in Turkey for 30 years. Currently, 70-80% of circumcisions in Turkey utilize the clip method. This method is more practical, time-efficient, easier, and aesthetically pleasing due to the absence of stitches. The clip procedure takes approximately 5-6 minutes, while the stitched circumcision is more complex and takes 25-30 minutes.

• After the clip is removed, recovery occurs within 7 to 10 days.

• Babies who wear diapers can be put in diapers immediately after the circumcision. The diaper you put on should be the same one your baby uses; don’t use loose diapers for comfort.

• Clothed Circumcision Panties for babies using diapers are very effective in protecting the circumcision area. Families who prefer not to use cloth circumcision panties can use cardboard cups as a protector.
• Circumcision panties for older children are very effective in protecting the circumcision area. Families who choose not to use circumcision panties can use cardboard cups as a protector.

• Can the clip come off on its own?

• Under normal conditions, the clip does not come off by itself.
• In rare cases, a unilateral or bilateral clip may release, particularly in young infants with early recovery. This is not a significant concern; it indicates a speedy recovery. It’s important not to allow the baby to touch his penis when the diaper is opened. Although the clip does not come off on its own, pulling it increases the likelihood of detachment. Due to the foreskin’s weakness, the baby has the strength to remove the clip. Having someone hold the baby’s hand during diaper changes can be helpful. 

• Circumcision has no specific season. Circumcisions performed using the clip method can be done in any season.
• The reason circumcisions are often done in summer is sociological rather than medical.
• The primary reason is the closure of schools. A child circumcised in summer does not miss school.
• Additionally, the return of expatriates to their homes for summer vacation provides a good opportunity for communal support during circumcision.
• Medically, there is no difference between summer and winter. In fact, temperatures that are not excessively hot are more suitable for a distressed child.

• Social reasons play a crucial role in this decision. These periods are chosen based on the demands of traditions and to ensure minimal disruption to the child’s school life. Medically, circumcision has no specific season.

• Clip-on circumcision is performed with a scalpel, as in sutured circumcision. Laser is not used.

• Some of the aesthetic errors related to the skin and incomplete circumcision can be corrected. However, correcting urinary tract injuries, penile body, and glans injuries may require a chain of serious operations. In some cases, correction may not be possible and could lead to organ loss.

• Circumcision is a serious surgical intervention. Considering the psychological approach, anesthesia technique, and risks, only doctors should perform surgery in terms of aesthetics and technique. Serious and lasting disabilities resulting from this seemingly straightforward procedure are quite common.

• If a small amount is smeared onto the clip, it can be wiped with wet wipes or wet cotton.
• If there is too much poop on the clip, the clip area and the baby’s bottom can be washed with warm, clear water. It’s crucial to avoid using soap and shampoo, as they may cause the clip to slip.