Circumcision in children: Health risks, proper timing, and the origins of religious tradition

With the closing of schools, many families are planning circumcisions for their children. However, circumcision should not be viewed merely as a traditional ceremony or a summer program that families have been putting off. From a medical perspective, circumcision is a surgical procedure that involves intervention in body tissue; therefore, its timing, the environment in which it is performed, the expertise of the person performing it, and the child's health status must all be evaluated together.

A point that experts particularly emphasize is that a brief pediatric surgery examination before the circumcision should not be skipped. This examination not only assesses suitability for the procedure but can also ensure the early detection of certain congenital urological anomalies. In assessments shared by Associate Professor Hakan Kocaman, a Pediatric Surgery Specialist at Memorial Göztepe Hospital, it is emphasized that families should not neglect expert supervision by viewing circumcision as a simple procedure.

CIRCUMCISION AS A MEDICAL PROCEDURE

It is not accurate to say that "every age is suitable" for circumcision. Both the child's physical development and psychological development must be taken into account. In medical evaluations, the period before age 2 or the period after age 6 may be considered more appropriate. The reason for this is that before age 2, the child's conscious awareness is limited; whereas the 2-4 age range is a sensitive period during which body perception begins to develop. If a circumcision is to be planned after age 6, it is important to prepare the child for the process, reduce their anxiety, and consider their psychological state.

One of the primary situations where circumcision can cause health problems is when it is performed under inappropriate conditions. A non-sterile environment, incorrect technique, inadequate pain control, failure to follow post-operative care, or failure to notice an existing anatomical problem in the child can increase the risk of complications. Bleeding, infection, delayed wound healing, difficulty urinating, deformity, and, rarely, more serious surgical problems can occur. Therefore, downplaying circumcision as a "minor procedure" is misleading for families.

One of the most critical reasons for a pre-circumcision examination is the detection of hypospadias. Hypospadias, colloquially known as "prophet's circumcision" (peygamber sünneti), is a congenital anomaly that occurs when the urinary tract ends in a lower region rather than at the tip of the penis. In this case, the foreskin may be one of the surgical tissues required for future corrective surgery. Therefore, performing an uncontrolled circumcision on a child with hypospadias can reduce future treatment options and complicate the surgical process.

There are some signs that families should pay attention to: the foreskin appearing excessive on the top and lacking on the bottom; the urinary opening not being located at the tip of the penis but lower down; the presence of a curvature in the penis; or the urine stream not appearing normal may require consulting a physician. It is stated that hypospadias can be seen in approximately one out of every 200-300 male births. For this reason, a detailed evaluation is important, especially for children scheduled for circumcision.

HISTORICAL AND RELIGIOUS BACKGROUND OF CIRCUMCISION

The origin of circumcision cannot be reduced to a single religion or a single society. Although its exact beginning is unknown, it is accepted that the practice dates back to very ancient times and carried different meanings in Ancient Egyptian and Near Eastern societies. Throughout history, circumcision has been interpreted at times as cleanliness, at times as a transition to puberty, at times as belonging to a community, and at times as an indicator of religious identity.

In Judaism, circumcision carries a central religious meaning as a sign of the covenant between God and Abraham. The circumcision of male children on a specific day is one of the most visible practices of this tradition. In Christianity, especially after early debates, circumcision was not seen as a mandatory requirement of the faith, and the practice largely ceased to be a religious obligation.

In Islam, the place of circumcision has been shaped more through the tradition of Abraham, hadiths, the concept of fitra (innate nature), and the practice of the Prophet. There is no explicit and detailed command in the Quran regarding the circumcision of male children; however, different evaluations have been made regarding the ruling of circumcision in Islamic legal schools. Some approaches view it as a strong sunnah, while others see it as a more binding religious duty. In practice, circumcision has become a part of religious identity, family tradition, and social acceptance in many Muslim societies.

This historical background is important for understanding the decisions of families; however, religious or cultural justification does not eliminate the requirements for medical safety. Since a permanent surgical procedure will be performed on the child's body, families must make a balanced and informed decision between traditional expectations and the child's right to health. Today, this issue is also discussed under ethical headings such as the medical benefit-harm balance and the child's consent.

CHECKLIST FOR FAMILIES

When the decision for circumcision is made, the first step is for the child to be evaluated by a physician specializing in pediatric surgery or pediatric urology. The examination should review not only whether the circumcision can be performed, but also the child's anatomical structure, accompanying illnesses, history of bleeding, medications used, and the appropriate anesthesia method for the procedure.

• - An expert examination must be performed before circumcision; congenital anomalies such as hypospadias must be ruled out.
• - It must be clarified where, under what conditions, and by whom the procedure will be performed.
• - The child's age and psychological preparation should be taken into account; frightening narratives should be avoided.
• - Clear information should be obtained from the physician regarding anesthesia, pain control, and post-operative care.
• - If there is bleeding, fever, severe pain, or difficulty urinating in the post-circumcision period, a doctor should be consulted without delay.

Circumcision is generally a day-case surgical procedure. When the appropriate technique and conditions are provided, children can often return home after a few hours of observation. However, this does not mean that the procedure is risk-free. It is recommended to rest for the first 24 hours, follow the medication and care practices recommended by the doctor, keep the area clean and dry, choose comfortable clothing, and avoid the sea or pool until healing is complete.

In conclusion, circumcision is a decision that families should address not only out of tradition, religion, or social pressure, but within the framework of medical knowledge, expert evaluation, and the child's best interest. Choosing the right timing and the right physician is decisive both for preventing potential health problems and for the child to go through this process more safely.

News Source: 12punto