Circumcision for Children and Adults in Bursa, Turkey

What is circumcision?

Circumcision is the surgical removal of the foreskin (prepuce) that covers the head of the penis (glans). In Turkey, circumcision is mostly performed as a religious and cultural tradition; it may also be needed as treatment in certain medical conditions.

Whatever the reason, circumcision is a surgical procedure. It should therefore be performed by a doctor after an examination of the penis, under sterile conditions, with appropriate anaesthesia and in a healthcare facility where possible complications can be dealt with.

When is circumcision medically necessary?

Phimosis

Phimosis is the inability to pull the foreskin back over the head of the penis. In infancy and early childhood this is usually natural (physiological phimosis) and resolves by itself as the child grows; the foreskin should not be forcibly retracted. Scar tissue at the tip of the foreskin, ballooning of the foreskin when passing urine, recurrent inflammation or difficulty passing urine are considered pathological phimosis. In children, a steroid cream recommended by the doctor may be tried first; circumcision is recommended if there is no response or if scar tissue has developed.

Recurrent balanitis (inflammation of the head of the penis)

Recurrent inflammation of the head of the penis and the foreskin causes redness, swelling and discharge. When it keeps recurring despite good hygiene and medication, circumcision is a treatment option.

Paraphimosis

This is when a retracted foreskin cannot be brought forward again and constricts the head of the penis. It is an emergency; the first step is to try to return the foreskin to its position by hand. Circumcision may then be recommended to prevent recurrence.

Other reasons

Chronic skin conditions affecting the foreskin such as lichen sclerosus, selected boys with a urinary tract anomaly who have recurrent urinary tract infections with fever, and certain lesions of the foreskin are also among the medical reasons for circumcision.

Circumcision for religious and cultural reasons

The same medical rules apply to circumcision performed for religious or cultural reasons without a medical necessity: an examination of the penis beforehand, a sterile setting, appropriate anaesthesia and follow-up after the procedure. Although there are studies suggesting that circumcision may reduce the risk of certain infections, the decision to circumcise is made by considering the family’s preference and the child’s health together.

Why is an examination essential before circumcision?

In some congenital conditions, the foreskin is used as tissue in a later reconstructive operation. For this reason, the following conditions must be ruled out before circumcision:

• Hypospadias: The urinary opening is not at the tip of the head of the penis but somewhere lower down.
• Epispadias: The urinary opening is on the upper side of the penis.
• Buried penis and a web of skin between the penis and the scrotum (webbed penis)
• Congenital penile curvature
• A very small penis (micropenis)

In these conditions, circumcision is postponed and, if necessary, planned together with the reconstructive operation. In addition, if there is a history of a bleeding disorder, a bleeding disease in the family, an active infection or general health problems, an additional assessment is carried out before the procedure. For more information, see the pediatric urology page.

Timing of circumcision

From a medical point of view, there is no fixed age for circumcision that applies to everyone. The timing is decided by considering the following factors together:

• Whether there is a medical reason for circumcision
• The child’s general health and need for anaesthesia
• Whether the anatomy of the penis is normal
• The family’s preference and the child’s developmental stage

If circumcision is being considered in the newborn period, the baby should be healthy and born at term, and the anatomy of the penis should have been assessed by examination; in babies born prematurely or with health problems, circumcision is postponed. When there is a medical necessity, circumcision can be performed at any age.

Anaesthesia options

• Local anaesthetic: The area is numbed with an injection at the base of the penis. This is usually sufficient in adults and older children who can cooperate.
• Sedation: The patient is made sleepy and relaxed; it is usually used together with a local anaesthetic.
• General anaesthesia: Preferred in young children for whom it is difficult to keep still during the procedure, and administered by an anaesthetist.

The anaesthetic method is decided together with the family after examination and an anaesthetic assessment. Whichever method is chosen, painkillers may be needed after the procedure.

Circumcision techniques

The most commonly used method is conventional surgical circumcision: an appropriate amount of foreskin is removed, bleeding is controlled and the skin edges are joined with fine, self-dissolving stitches. Some clamp and ring methods are also used. A scalpel, cautery or other energy sources may be used to cut the tissue; what matters more than the name of the method is that the procedure is performed under sterile conditions, removing the right amount of skin and with bleeding control. The technique is chosen according to the patient’s age and anatomy.

Preparing for circumcision

• At the examination before circumcision, the doctor asks about the child’s general health, medications, allergies and any bleeding disease in the family; blood tests are requested if needed.
• If general anaesthesia or sedation is planned, the child needs to fast for a certain period beforehand; the time is given in advance.
• Explaining to the child what will happen in calm, honest language appropriate to their age helps to reduce fear and anxiety. Rather than unrealistic promises such as “it won’t hurt at all”, it is better to explain that any pain will be controlled with medicine.
• The procedure may be postponed in children with signs of illness (fever, cough, diarrhoea).
• Loose, comfortable clothing should be prepared in advance for the first days after the procedure.

Aftercare

• The dressing is usually removed within 1–2 days; after that, gentle washing with lukewarm water is allowed.
• The ointment recommended by the doctor is applied regularly to prevent the nappy or underwear from sticking to the wound.
• Swelling and bruising of the head of the penis in the first days are normal.
• The yellowish-white, moist layer that forms on the head of the penis is a natural part of healing and should not be mistaken for infection; it should not be forcibly cleaned off.
• Dissolvable stitches usually fall out by themselves within 1–3 weeks.
• Loose, comfortable clothing should be worn; children should take a break from cycling and rough play for a while.
• Adults are advised to avoid sexual intercourse and masturbation until the wound has healed completely (usually a few weeks).

Possible complications

Although circumcision is a commonly performed procedure, like any surgical procedure it carries some risks:

• Bleeding: The most common early complication; it can usually be controlled with simple measures.
• Infection: May show itself through increasing redness, swelling, foul-smelling discharge and fever.
• Meatal stenosis: Narrowing of the urinary opening over time, especially in children; noticed as a thin or upward-spraying urine stream.
• Removal of too much or too little skin, skin adhesions and skin bridges
• Rarely, serious injury involving the urethra

In the event of severe or persistent bleeding, fever, inability to pass urine or a change in the colour of the head of the penis, seek medical help without delay.

Adult circumcision

In adults, circumcision is mostly performed because of phimosis, recurrent balanitis, lichen sclerosus, tearing of the foreskin during intercourse or personal preference. The procedure is usually performed under local anaesthetic and the patient goes home the same day. A return to desk work is often possible within a few days. In patients with diabetes, good blood sugar control is important for wound healing.

The possible link between circumcision and premature ejaculation is one of the topics investigated in scientific studies. The study “Can circumcision be a risk factor in premature ejaculation?” (Revista Internacional de Andrología, 2014), co-authored by Op. Dr. Mücahit Kabar, examined this question. Such studies do not prove a cause-and-effect relationship; people with premature ejaculation need to be assessed separately. For details, see the premature ejaculation page.

Circumcision in Bursa, Turkey

Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He has published scientific studies on proximal hypospadias repair and circumcision. In Bursa (Nilüfer), at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00), he carries out the examination before child and adult circumcision and plans the procedure in a hospital setting.

Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. Families and patients travelling from abroad, including those spending the holidays in Turkey, can book the examination in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). For questions before you travel, you can send a message via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.