A closed-method surgery in which the foreskin (preputium) is surgically removed for cultural-religious or medical reasons; performed at appropriate ages from newborns to adults.
Indication
- Planned circumcision for cultural or religious reasons
- Phimosis — inability to retract the foreskin, causing difficulty with urination
- Paraphimosis — the foreskin getting trapped behind the glans, causing edema and strangulation
- Recurrent balanitis/balanoposthitis (inflammation of the foreskin and glans)
- Preventive intervention in selected infants with a history of recurrent urinary tract infection
- Local skin diseases of the foreskin (e.g., balanitis xerotica obliterans/lichen sclerosus)
Preparation
- Pre-procedure examination evaluates penile anatomy (anomalies such as buried penis, hypospadias)
- In newborns and infants, additional tests are usually not needed; in older children and adults, blood tests may be requested
- In children planned for general anesthesia, the 6-8 hour fasting rule is applied
- Medications that increase bleeding tendency, such as aspirin, are reviewed with the physician
- The chosen method (classical surgery, clamp/device, laser) and type of anesthesia are discussed with the family beforehand
How it's performed
- The area is cleaned with antiseptic and a sterile drape is applied
- Local anesthesia (typically in adults), sedation, or general anesthesia (commonly in children) is used depending on age
- The foreskin is marked under traction; it is removed at the appropriate level by classical surgery, clamp, or device/laser methods
- Bleeding vessels are controlled by cauterization or ligation
- The inner and outer leaflets of the foreskin are sutured with fine absorbable sutures
- Antibiotic ointment and a thin dressing are applied; total time is typically 15-30 minutes
Post-procedure
- Same-day discharge is usual after 1-2 hours of observation
- Age-appropriate paracetamol/ibuprofen is recommended for pain in the first 24-48 hours
- Dressing changes and wound care are performed per physician instructions; absorbable sutures do not need to be removed
- Healing usually takes 7-10 days in newborns and infants and 2-3 weeks in older children and adults
- Sexual intercourse is not recommended for 4-6 weeks in adults; heavy physical activity, swimming pools, and the sea are avoided for 2-3 weeks in children
- Severe bleeding, fever, foul-smelling discharge, or inability to urinate require emergency evaluation
Risks
- Early bleeding (the most common complication, 1-2%)
- Wound infection — rarely seen with appropriate care
- Glans (penile head) sensitivity or transient color changes
- Removal of too little or too much skin; rarely a need for revisional surgery
- Narrowing at the urethral meatus (meatal stenosis) — rare in the long term
- Anesthesia reactions (especially careful evaluation in children planned for general anesthesia)
FAQ
What is the most appropriate age for circumcision?
Medically, the most preferred periods are the newborn period (first month) and preschool age (under 3 years or after 6 years). The 3-6 year range is considered psychologically more sensitive; the decision is made by the family and physician together.
What is the difference between newborn and older-child circumcision?
In newborns, the procedure is generally performed quickly under local anesthesia, healing takes 7-10 days, and general anesthesia is not required. In older children and adults, general anesthesia or sedation may be needed, healing takes longer, and psychological preparation is more important.
Is sexual life affected after circumcision?
Full healing takes 4-6 weeks after circumcision in adults. Erection and sexual pleasure are preserved in most men; some patients may report sensitivity changes. In general, no significant sexual dysfunction is expected.
Is laser circumcision better than other methods?
There is no single method — laser, clamp, plastibell, or classical surgery — that has clear superiority over the others. The appropriate method is decided based on age, anatomy, and physician experience.
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