Attitudes and practices regarding circumcision in Turkey

The effect of nursing interventions with therapeutic play and video animations prepared with psychodrama technique in reducing fear, anxiety, and pain of children at male circumcision: A randomized controlled study

OBJECTIVE

This research was carried out to reduce the fear, anxiety and pain of 4-6 age circumcised children with therapeutic play and video animation interventions.

METHODS

This research was conducted as a randomized controlled study between November 2019 and April 2021. Using block randomization, 30 (n = 30) children were assigned to the control group, 30 (n = 30) to the therapeutic puppet group and 30 (n = 30) to the video animation group. Before the circumcision surgery, therapeutic puppet and video animation interventions were applied to children with scenario prepared with psychodrama technique. Fear, anxiety, and pain findings of children before and after surgery were determined.

RESULTS

The fear and anxiety scores of the children were similar before the nursing intervention in all groups, and that the fear and anxiety scores of therapeutic puppet play and video animation intervention groups had statistically lower than the control group after nursing intervention. The pain scores of the children from the therapeutic puppet play and video animation groups had lower pain scores than the control group after surgery (F = 5.24, p = 0.007).

CONCLUSIONS

Therapeutic play and video animation intervention can be effective in reducing fear and anxiety of children aged 4-6 before and after circumcision surgery.

Effects of Comfort-Oriented Nursing Care Based on the Comfort Theory on Perioperative Anxiety and Fear in Children Undergoing Surgical Circumcision: RCT

PURPOSE

This study explored the effect of comfort-oriented nursing care based on comfort theory on reducing perioperative anxiety and fear in children undergoing surgical circumcision.

DESIGN

Randomized controlled trial.

METHOD

The study was completed with the participation of children circumcised in a hospital in Turkey using the same surgeon, anesthesia, and surgical technique. A total of 120 children meeting the inclusion criteria and providing consent to participate in the study were randomly divided into two equal groups. The study was conducted between June and September 2019. The intervention group received comfort-oriented nursing care based on the comfort theory. The control group received routine nursing care. Data were collected using the Children's Anxiety Meter-State and Children's Fear Scale. Outcome variables were determined at seven measurement points, including baseline, five intermediate points, and at the follow-up visit on the 10th postoperative day.

RESULTS

A statistically significant difference in the fear of the group receiving comfort-oriented nursing care based on comfort theory was noted compared with the control group.

CONCLUSION

Comfort-oriented nursing care based on the comfort theory was effective in reducing perioperative anxiety and fear among children undergoing surgical circumcision. This study is important given that comfort-oriented nursing care based on the comfort theory may be applied to those receiving care in pediatric surgery.

Impact of Migration and Acculturation on Turkish Men Who Have Sex with Men in Germany: Results from the 2010 European MSM Internet Survey

To examine the impact of migration and acculturation of Turkish men who have sex with men (MSM) to Germany, using data from the European MSM Internet Survey (EMIS-2010), on measures of acculturation including circumcision status, internalized homonegativity (IH), HIV/STI knowledge, sexual orientation, outness, HIV-testing, and sexual behaviors. We compared four groups of MSM: MSM born and residing in Germany who had completed the questionnaire in German (n = 38,915), MSM born and residing in Germany, with a father or mother born in Turkey (n = 97), MSM residing in Germany who were born in Turkey or whose parents were born in Turkey (n = 262), and MSM who were born and residing in Turkey and who completed the questionnaire in Turkish (n = 1,717). Data showed that there were significant dose-response curves between level of migration and several outcome variables. As exposure to Germany increased, MSM had lower IH, higher HIV/STI knowledge, increased outness, and were less likely to be circumcised. There were similar significant findings with regard to sexual HIV risk behavior (condomless anal intercourse with partners of unknown (or sero-discordant) HIV status). Data were consistent with acculturation over generations in immigrant groups in MSM migrating from Turkey to Germany. Integration includes both cultural aspects (circumcision) and integration into a more homopositive gay environment (IH, outness, increased HIV/STI knowledge), and sexual HIV risk behavior. Migration and associated acculturation may constitute a risk change for HIV/STI and mental health issues associated with IH and outness.

Circumcision Knowledge and Opinions of Primary Healthcare Workers: The Case of Turkey

This study evaluates the knowledge levels and opinions of Islamic primary healthcare workers regarding the medical indications of circumcision, its mode of application, contraindications, and possible complications together with the current literature. Our study was conducted with the participation of 400 healthcare personnel having Islamic faith and working in primary healthcare centers in Kahramanmaras. Data were collected through in-person interviews with healthcare workers who completed our questionnaire consisting of 52 questions and designed based on a literature review. SPSS 21 was used to evaluate the collected data statistically. Findings were considered statistically significant if the p-value was lower than 0.05. We evaluated these participants in terms of their levels of knowledge on circumcision. None of the participants had a very high knowledge level. In correlation analysis, it was detected that age (r = 0.194, p < 0.001) and duration of employment in the profession (experience) (r = 0.164, p = 0.001) were positively correlated with knowledge level. Those who found circumcision necessary mostly justified its necessity due to medical benefits (n = 321, 80.3%) and/or religious obligations (n = 242, 60.5%). Our study demonstrates the importance of providing information about circumcision, including the information from the current literature, to primary healthcare workers together with theoretical training and practice both during their formal training and after graduation in Turkey.

The effects of sound-and-light toy as a distraction method on pain and physiological parameters in infants regarding circumcision procedure

Background/Aim: Circumcision is a common surgical procedure and a cause of pain and stress for infants. Nurses are in a key role for providing pain relief through implementation of non-pharmacological practices for pain management. This study aimed to assess the impact of distraction using a sound- and light-producing toy on pain and physiological parameters in infants regarding circumcision procedure. Methods: This randomized controlled study was conducted with infants between six months and two years of age who presented to a private circumcision clinic. The sample consisted of 60 infants randomly allocated into intervention (n = 30) and control (n = 30) groups. During the procedure, the mothers of the infants in the intervention distracted the infants with the toy for 15 min. Infants in the control group were accompanied by their mothers during the procedure and did not receive any additional intervention other than the standard care. Data were collected using a questionnaire and the face, legs, activity, cry, consolability (FLACC) pain scale. Data were assessed using descriptive statistical analyses and parametric tests. Results: Infants in the intervention and control groups were similar in terms of current and gestational ages, lengths, weights, and maternal and paternal ages and showed no differences in terms of physiological parameters before and after the procedure (P > 0.05). Post-operative pain scores were lower in infants exposed to the toy with light- and sound than that in the infants in the control group; however, no significant difference between groups was found (P > 0.05). Conclusion: Considering the effect of sound- and light-producing toys on causing a reduction in pain severity, it may be recommended to use distracting practices by nurses to reduce/relieve pain associated with circumcision.

The effect of virtual reality glasses against the fear of circumcision: A randomized controlled trial

Background/Aim: Circumcision is an invasive operation that male children undergo in our country and some others. During this process, the child can experience fear, anxiety, and pain simultaneously. As a randomized controlled VR study, this research was conducted to determine the effect of virtual reality (VR) glasses on reducing fear/anxiety and pain during circumcision in children. Methods: The study was conducted on 125 children (6-11 years old). The same healthcare team performed the circumcision of the children in both groups. The children were randomly split into VR and control groups. The children in the VR group, just before the circumcision, watched their preferred cartoon film via VR glasses. No additional procedure was applied to the children in the control group except for ordinary procedures in the hospital. The fear and pain status measured by Wong-Baker Faces Pain Rating Scale and Children Fair Scale of all the children were evaluated before and after the operation by the child, parents, and the observer. Descriptive statistics, chi-square, and t-tests analyzed the data. Results: There was no significant difference between the groups regarding demographic characteristics such as age, BMI, previous hospitalization, and anesthetic drug used before the procedure of the children included in the study. Preoperative (VR = 1.03 (0.18), control = 1.05 (0.22)) and pre-procedural (VR = 2.61 (1.02), control = 2.33 (1.22)) fear levels were also similar (P > 0.05). After the procedure, it was determined that the mean duration of the procedure (365.36 (64.73) sec), crying time (21.31 (41.74) sec), and fear scores (0.36 (0.68)) of the children in the VR group were lower (P < 0.001). However, pain mean scores were similar (P > 0.05). Conclusion: It is thought that watching a cartoon with VR glasses during the circumcision operation may be effective in reducing the child's fear level, crying, and operation time.

Critical evaluation of contrasting evidence on whether male circumcision has adverse psychological effects: A systematic review

OBJECTIVE

To conduct the first systematic review critically examining evidence on whether early male circumcision has short- and long-term adverse psychological effects.

METHODS

We searched PubMed, EMBASE, SCOPUS, Cochrane Library, and Google Scholar.

RESULTS

Twenty-four studies with original data met the inclusion criteria. These comprised 11,173 total males, 4340 circumcised in infancy and 6908 uncircumcised. Nineteen were rated 1+, 2++ or 2+, and 5 were rated 2- by SIGN criteria. Neonatal circumcision, particularly without anesthetic, increased vaccination pain response, but had little effect on breastfeeding or cognitive ability. Studies reporting associations with sudden infant death syndrome, autism, alexithymia and impaired sexual function and pleasure had design flaws and were rated 2-. Sexual arousal, touch, pain, and warmth thresholds measured by quantitative sensory testing were not diminished in neonatally circumcised men. Neonatal circumcision was not associated with empathy in men, contradicting the hypothesis that procedural pain causes central nervous system changes. After correcting all associations with socioaffective processing parameters for multiple testing only higher sociosexual desire, dyadic sexual libido/drive, and stress remained significant. The relatively greater sexual activity found in circumcised men might reflect reduced sexual activity in uncircumcised men overall owing to pain and psychological aversion in those with foreskin-related medical conditions (reverse causality). Most studies employed case-control designs with limited follow-up. Studies beyond childhood were prone to confounding.

CONCLUSION

The highest quality evidence suggest that neonatal and later circumcision has limited or no short-term or long-term adverse psychological effects.

Evaluation of maternal preferences for neonatal male circumcision in Enugu Nigeria

BACKGROUND

Although circumcision in male neonates is one of the most common procedures performed in neonatal surgery, mothers' preferences concerning the aspects of circumcision are not well-known. Since mother is the likely parent to present child for circumcision, her preferences should be given adequate consideration.

OBJECTIVES

The objective of this study is to evaluate maternal preferences for neonatal male circumcision in Enugu.

METHODOLOGY

A cross-sectional study where questionnaire was distributed by the researchers to consenting pregnant women attending antenatal clinics in two teaching hospitals in Enugu. Data analysis was performed using the SPSS. The results presented as means, percentages and tables. Test for significance was done using the Chi-square test.

RESULTS

Four hundred and sixty-one pregnant women participated in the study. Ninety-five percent (438/461) wanted circumcision and 83.5% (385/461) wanted it on or before the 8^th day of life. The reasons were cultural/religious in 69% (302/447). Fifty-four percent (250/461) had no preferences as to methods, but for those who had, Plastibell was most preferred method in 28% (129/461) while 76% (235/309) preferred circumcision to be done in hospital. In 49.2% (227/461) preferred personnel were nurses but 79.6% (367/461) wanted doctors to attend to post-circumcision complications. In 79.2% (365/461), mothers will not insist on the use of anaesthesia for circumcision. Mothers with circumcised husbands were significantly more willing to circumcise a male child (P = 0.0018). Higher educational status of mother was significantly related to willingness to insist on the use of anaesthesia (P = 0.046) and use of analgesics after circumcision (P = 0.001).

CONCLUSIONS

Most mothers prefer neonatal male circumcision by nurses, while preferring doctors for post-circumcision complications. These choices are not affected by parents' educational status. Mothers with circumcised husbands accepted circumcision more than those with uncircumcised husbands. Higher maternal education encourages anaesthesia during circumcision and post-circumcision analgesia.

Paediatric lichen sclerosus et atrophicus: A retrospective analysis of 38 paediatric patients

BACKGROUND

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory cutaneous disease.

AIM

To evaluate the characteristics of paediatric LSA patients in Turkey.

MATERIAL AND METHODS

Data for patients aged <18 years who were diagnosed with LSA by a paediatric dermatologist were retrospectively reviewed. Patient demographic characteristics, clinical features, disease duration, the vitamin D level, accompanying diseases, presence of atopy, therapeutic approach and treatment response were recorded.

RESULTS

The study included 38 patients, of whom 35 (92.1%) were female and 3 (7.9%) were male. Mean age at onset of disease was 6.4 ± 3.3 years in females versus 3.1 ± 2.6 years in males. Mean diagnostic delay was 20.6 ± 28.9 months in females and 2 ± 1.7 months in males. In 28 (80%) patients the time from onset of lesions to diagnosis was ≥3 months. The majority (76.3%) of the patients were asymptomatic, whereas five had itching, two had itching and burning, and two had pain. Among the females, 12 (34.3%) and 23 (65.7%) presented with isolated extragenital and anogenital involvement + extragenital lesions, respectively. All three males had isolated extragenital involvement. The most commonly recommended treatments were topical calcineurin inhibitors and calcipotriol/betamethasone ointment. Accompanying diseases were as follows: alopecia areata (n = 2); atopic dermatitis (n = 2); vitiligo (n = 2); ulcerative colitis and juvenile idiopathic arthritis (n = 1); Hashimoto's thyroiditis (n = 1). Among the 28 patients whose vitamin D level was measured, 24 (85.7%) had vitamin D deficiency.

CONCLUSION

LSA can be asymptomatic in the majority of affected children. Diagnostic delay was noted in 80% of the study's LSA patients, highlighting the lack of awareness of the condition among parents and clinicians.

The effect of virtual reality on mothers' anxiety during children's circumcision: A randomized controlled study

AIM

The aim of this study was to evaluate the effect of use of virtual reality headsets on mothers' anxiety, by distracting their attention, during their child's circumcision procedure.

DESIGN

This was a randomized controlled intervention study.

METHODS

The study used a pretest and posttest design and was carried out between April 15, 2019, and June 30, 2019, with 60 participants (n = 30 intervention and n = 30 control group). The data were collected using a personal information form, the State Anxiety Inventory and Faces Anxiety Scales. In the study, the participants in the intervention group watched videos through a virtual reality headset.

RESULTS

The socio-demographic characteristics of the intervention group and control group were similar in the pretest, except for the educational level. After the intervention, the intervention group's mean scores on the Faces Anxiety Scale, heart rate and respiration rates were significantly lower than those of the control group, but the difference between the mean State Anxiety Inventory scores was insignificant.

CONCLUSION

Distraction using videos produced by virtual reality headsets is effective in reducing mothers' moderate level anxiety. It is recommended that further studies should be conducted in different ambulatory surgery procedures.

Muslim mothers mainly saw circumcision in terms of religion or tradition but wanted it to be carried out medical professionals

AIM

This study assessed the relationship between the education level of Muslim Turkish mothers whose sons had been circumcised and their views on circumcision.

METHODS

Interviews based on 20 close-ended questions were carried out in the Çukurova region of southern Turkey between June 2015 and September 2016. The participants were 1497 Muslim Turkish mothers whose sons had been circumcised and who were recruited using convenience sampling in schools, hospitals and public spaces.

RESULTS

Most (82%) of the mothers saw circumcision as a religious and traditional requirement, 64% mentioned the health benefits and 48% mentioned cosmetic appearance. The majority (80%) were performed by health organisations, with two-thirds (66%) expressing this preference. Most circumcisions were at school age (38%), which was about 6 years of age plus at the time of the study, and there were no complications in 79% of cases. Higher education levels were associated with views that circumcision was an important surgical procedure, it decreased the risk of urinary tract infections, it should be performed in hospitals and the foreskin did not prevent sexual intercourse.

CONCLUSION

Circumcision was mainly seen as a religious and traditional ritual, and more highly educated Turkish Muslim mothers were better informed about the health aspects.

Reported Male Circumcision Practices in a Muslim-Majority Setting

Introduction. Male circumcision is a recommended practice in Muslim tradition. It is important to ensure that this procedure is performed as safely as possible in these communities. Methods. Five hundred adult men and women with at least one male child less than 18 years were interviewed in Karachi, Pakistan, regarding details of their child's circumcision. The survey focused on actual and perceived delays in circumcision and perceptions about appropriate age and reasons and benefits and complications of the procedure. Circumcisions done after two months of age were defined as delayed. Results. Religious requirement was the primary reason for circumcision in 92.6% of children. However, 89.6% of respondents were of the opinion that circumcision had medical benefits as well. Half of the children (54.1%) had delayed circumcision (range 2.5 months to 13 years), even though 81.2% of parents were of the opinion that circumcisions should be done within 60 days of birth. Facility-delivered babies had less delay in circumcisions (49.1%) as compared to home-delivered babies (60.5%). Conclusion. Understanding the perceptions and practices around male circumcision can help guide national strategies for designing and implementing safe circumcision programs in Muslim-majority settings, with the potential to benefit an annual birth cohort of 20–25 million boys worldwide.

Anesthesia methods used by anesthetic specialists for circumcision cases. National survey study for Turkey

Objectives:

To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey.

Methods:

This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods.

Results:

The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%).

Conclusion:

Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision.

Psychological and sexual effects of circumcision in adult males

INTRODUCTION

Our aim was to investigate the psychological and sexual effects of circumcision in adult men, and analyze these changes following circumcision.

METHODS

We included 37 adults who applied to our clinic for circumcision and who did not have any psychiatric or urologic disorders and age-matched 30 controls in our study. Body Cathexis Scale (BCS), Liebowitz Social Anxiety Scale (LSAS), and Premature Ejaculation Diagnostic Tool (PEDT) were applied to the study group twice, once before and once three months after circumcision, and only once in the control group. Also, intravaginal ejaculation latency time (IELT) was noted and premature ejaculation (PE) evaluation was done. Intra- and intergroup comparisons were performed.

RESULTS

The two groups were similar with regard to demographic data. Comparison of preoperative BCS and LSAS scores with the scores of the control group showed significant differences (p=0.003, p<0.001, and p<0.001, respectively). However, postoperative scores were similar to the scores obtained in the control group (p=0.768, p>0.05, and p>0.05, respectively). Scores of all scales showed significant improvements postoperatively. Also, PEDT scores and IELT changes before and after circumcision were significant in the study group, but not when compared to the control group.

CONCLUSIONS

Our results indicated that social anxiety and anxiety levels decreased after circumcision in adult Turkish men, and their body gratification increased. We found that not being circumcised might negatively affect individuals in adulthood when it comes to body image and sexual satisfaction, however, both improve after circumcision.

Plastibell circumcision of 2,276 male infants: a multi-centre study

Introduction

The World Health Organization's manual on male circumcision listed Plastibell technique as a well-proven paediatric method with respect to the results and complications. Although, literatures abound on its wide acceptability, there are few multi-centered reports from this environment. The objective was to evaluate the cases of infant circumcision by Plastibell device from two medical institutions.

Methods

All consecutive infants who had Classical Plastibell Circumcision (PC) at the Federal Staff Medical Centre, Abuja and the Lagos State University Teaching Hospital, Ikeja between February 2011 and June 2015 were included in this cross-sectional study. The procedures were performed by surgical registrars and medical officers after ninety minutes of topical anesthesia to the penis. Data harvested from the standard proforma were analysed using Statistical Package for Social Science 20.0 for window.

Results

A total of 2,276 infants had classical PC within the study period. Their ages at circumcision ranged from 4 days to 3 months with a mean age of 17 days. Majority of the boys were circumcised at second week of life (n=1,394,61.2%). All the cases were performed for religious (53%) and cultural (47%)reasons. The most common Plastibell size deployed was 1.3cm (n=1,040, 45.7%) while 1.6cm was the least commonly used ring (n=10, 0.4%). The mean time for device to fall-off was 6 days (range 4-12 days). There was no correlation between the age at circumcision and Plastibell size. We recorded an overall complication rate of 1.1% with postoperative bleeding leading the pack (n=12, 48%). No case of urethrocutaneous fistula was seen. We detected 17 cases (0.7%) of distal hypospadias in whom circumcisions were postponed till the time of hypospadias repairs.

Conclusion

The main indication for infant circumcision in our environment was religious. The PC has good safety profile with few easily correctable early complications. Detailed attention to placement of ligature, selection of appropriate Plastibell size and adequate parental education are key to preventing post-procedure mishaps.

Non-therapeutic male circumcision performed on immigrant children from Africa in Spain

OBJECTIVES

To study the frequency, characteristics, and complications of non-therapeutic male circumcision on immigrant children from Africa in Spain.

METHODS

This descriptive study focused on primary care consultations conducted at 21 Aragon health centres during 2010 and 2011. The data were gathered through interviewer-administered questionnaires to the parents of African children. Sociodemographic variables were studied, along with others related to the practice of circumcision.

RESULTS

283 questionnaires were obtained. 98.93 % of the children had undergone or were planning to undergo circumcision. 68.2 % were circumcised. Circumcisions were most frequently performed during a vacation to the country of origin (67.04 %), especially so for the Maghreb population. The remaining circumcisions had been performed in Spain. Half of the circumcisions practiced in Spain were performed at home, and 84 % of these were performed on Gambian children.

CONCLUSIONS

The current study demonstrates that, in Aragon, Spain, almost all immigrant children from Africa have been or will be circumcised and that a considerable proportion has been circumcised at home by unqualified individuals. Gambians are particularly at risk of performing unsafe circumcision.

Religious circumcision, invasive rites, neutrality and equality: bearing the burdens and consequences of belief

The decision of the German regional court in Cologne on 26 June 2012 to prohibit the circumcision of minors is important insofar as it recognises the qualitative similarities between the practice and other prohibited invasive rites, such as female genital cutting. However, recognition of similarity poses serious questions with regard to liberal public policy, specifically with regard to the exceptionalist treatment demanded by certain circumcising groups. In this paper, I seek to advance egalitarian means of dealing with invasive rites which take seriously cultural diversity, minimise harm and place responsibility for the burdens and consequences of beliefs upon those who promote practices.

Knowledge, attitude and behaviour of boys and parents about circumcision

AIM

To determine the knowledge, attitude and behaviour of parents and previously circumcised early adolescent boys about circumcision.

METHODS

Half of the boys attending the sixth class of the primary school in our city centre and their parents were included in this cross-sectional, descriptive study. Questionnaires were prepared by the authors, which include 38 questions for parents and 25 questions for boys.

RESULTS

Sixty-six per cent of the students were circumcised at the age of 7 years and above, 26% between three and 6 years and 8% below 3 years of age. Forty-two per cent of boys were circumcised by a traditional circumciser and 64% were circumcised at home. Main reasons of circumcision for parents were religious purposes (79%) and health issues (51%). When the boys were asked about their thoughts during circumcision, they mostly stated that 'it was necessary to become a man' (58%) and 'it would hurt much' (50%). Thirty-eight per cent of boys were frightened during circumcision and 46% were worried. Boys circumcised in the 7 years and above age group were most content about their age of circumcision.

CONCLUSIONS

We consider that it is reasonable to wait up to an age at which the child could understand and participate in the decision of the concept and timing of circumcision.

Nontherapeutic male circumcision: tackling the difficult issues

INTRODUCTION

Male circumcision is the most commonly performed surgical procedure in the world. Circumcision may be performed to treat an underlying pathological process ("therapeutic circumcision"). However there may be religious, cultural, and social indications.

AIM

This article addresses the religious, cultural, social, and ethical issues surrounding nontherapeutic male circumcision (NTMC).

MAIN OUTCOME MEASURES

Any religious, social, cultural, or ethical issues relating to NTMC.

METHODS

Because of the absence of high level evidence, a concise literature review was undertaken to identify articles published between January 1990 and February 2009 summarizing current knowledge on NTMC.

RESULTS

There are complex religious, cultural, social, and prophylactic incentives for NTMC. The procedure may have associated clinical and psychosocial adverse events and raises such ethical issues as bodily integrity and consent. Because of the strength of the incentives for NTMC, there may be important implications in denying patients the procedure. Several important issues must be considered when introducing mass circumcision as a preventative strategy for HIV/AIDS.

CONCLUSION

When assessing whether NTMC will benefit or harm a patient, clinicians must take his religious, cultural, and social circumstances into account. Males requiring mandatory religious or cultural NTMC are likely to suffer significant harm if they do not receive circumcision and should be considered separately to males in general.

Newborn circumcision in Victoria, Australia: reasons and parental attitudes

OBJECTIVE

The objective of this study was to study the reasons why some parents continue to seek professional circumcision service for their newborn boys in Victoria, Australia, their attitudes towards newborn circumcision and their personal characteristics.

SUBJECTS AND METHODS

One hundred thirty-six parents (62 fathers and 74 mothers) who presented to the Melbourne Circumcision Centre between July and December 2007 were recruited. They represented the parents of 85 newborn boys. A questionnaire designed by the authors was completed by the parents before circumcision. The responses were tabulated and analysed.

RESULTS

The most common reasons for newborn circumcision were hygiene (77.9%), family tradition (57.4%) and medical reasons (36%). The most common perceived benefit was hygiene (95.6%). The most common concern was pain (79.4%). As the number of boys a mother had who were already circumcised increased, the age at circumcision of the newborn boy became earlier (P = 0.024). 41.2% of parents wished for further information to help them better make the decision before or at the time of childbirth in the hospital setting. 76.5% of parents would, 19.1% of parents were unsure and 4.4% would not recommend newborn circumcision by an experienced practitioner to other parents.

CONCLUSION

Some parents continue to circumcise their newborn boys for hygiene, family tradition and medical reasons in Victoria, Australia. Information about the pros and cons of newborn circumcision needs to be made more readily available to empower parents to make free, informed decisions.

Effects of childhood circumcision age on adult male sexual functions

The effects of childhood circumcision on male sexual function have been debated. However, there are no studies, to our knowledge, that assess the possible effects of childhood circumcision age on male sexual function. In an attempt to answer this question, we performed a prospective study to determine the possible relationship between circumcision age and male sexual function, using a validated questionnaire, the Golombok-Rust Inventory of Sexual Satisfaction. We found no relationship between childhood circumcision age and overall sexual function; however some specific domains of sexual function (i.e. avoidance and communication) seemed to be affected by the age at circumcision procedure in this cohort of sexually active males. In addition, prevalence of sexual dysfunction was higher, with premature ejaculation being the most common dysfunction in the survey. We concluded that childhood circumcision age might affect some domains of male sexual function in adulthood, but not the overall function.

Late complications of circumcision in Iran

Today, circumcision is the most commonly performed surgical procedure worldwide. Early and late complications may occur due to circumcision. To find the prevalence of late complications of circumcision, we studied 3,205 elementary-school boys aged 6-12 years in 2002. All of them were Iranian and Muslim. Nearly 3,125 of the boys have been circumcised. Most of the boys (2,214 boys) had been circumcised after 2 years of age. Moreover, most of them were operated by traditional circumcisers (43.49%). Late complications (7.39%) were reported in 231 boys. Excessive residual foreskin was seen in 113 children (3.6%). Excessive removal of skin was detected in 42 boys (1.3%), meatal stenosis in 29 boys (0.9%), granoloma in 22 boys (0.7%), penile rotation in 17 boys (0.5%), and 8 boys had secondary chordee (0.2%). The complication rate was not different between the neonatal circumcision and older groups. We suggested that circumcision should only be performed in medical institutions by suitably trained specialists.

Décalottage ou circoncision : quelle indication dans le phimosis ?

Phimosis remains a major question for mothers and induces a high number of consultations. However, large epidemiologic series have shown that congenital phimosis may disappear spontaneously in around 80% of cases with development and should'nt need any treatment before the age of five or six years old. Theses elements go against sociocultural habits which induce many circumcisions before the age of six. Corticoid treatment of phimosis seems to be very efficient to facilitate the disparition of phimosis. The aim of this literature review is to evaluate medical, socioeconomical and therapeutics aspects of phimosis. Based on these data, we recommend never to treat phimosis before the age of one year old, to wait as long as possible for spontaneous evolution of phimosis until the age of five years old, and, in case of non evolution of congenital phimosis or pathologic phimosis to use as first step treatment corticoid topics rather than surgical treatment.

Emotional effects of hypospadias surgery on Turkish boys

PURPOSE

The aim of this study is to investigate in Turkish boys the emotional effects of hypospadias repair before and after the optimal age for repair.

MATERIALS AND METHODS

Forty hypospadias patients treated in our department were included in this study. Group 1 consisted of 13 patients operated on at less than 30 months of age. Group 2 consisted of 27 patients operated on at over 30 months of age. Age at time of study, severity of hypospadias, age at repair and number of operations were evaluated for both groups retrospectively. Socio-economic and socio-demographic characteristics of these patients including place of residence, educational level of their parents and parental occupations were determined. The Turkish versions of the Children's Depression Inventory and the State-Trait Anxiety Inventory for Children A-State scale were used to evaluate the emotional effects of hypospadias surgery. For statistical analysis, the Mann-Whitney U test, Student's t test and Chi-squared test were used.

RESULTS

There was a significant difference in the age at repair between Groups 1 and 2. No significant differences existed in severity of hypospadias and number of operations between the two groups. All 40 patients had the same socio-economic and socio-demographic characteristics. Group 1 did not significantly differ from Group 2 in regard to the educational level of their parents and parental occupations. Age at repair, which was the only difference between the two groups, did not affect the level of depression and anxiety-state symptoms.

CONCLUSIONS

There is a close relationship between emotional effect of hypospadias surgery and age at repair. Possibility of depression and anxiety, which were dominating emotional symptoms among boys operated on for hypospadias, was found not to be high after the recommended age. It is concluded that, as hypospadias surgery creates a circumcised penis, the degree of emotional trauma is lower in Turkish boys than in other nationalities.

Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation

Untimely old, circumcision has elicited more controversy and war of words than any surgical procedure in history. Although previous claims of benefits like curing masturbation, gout, epilepsy, and even insanity were no doubt absurd, important research has shed light on real medical benefits of circumcision. In particular, the procedure has consistently shown to result in the decreased risk of debilitating and costly diseases such as HIV, cervical cancer, and infantile urinary tract infection. Because of advances in the understanding of the anatomy of the foreskin and pain conditioning in infants, prevailing attitudes have changed about anesthesia and analgesia during the procedure. This article objectively summarizes the bulk of significant medical literature over the last century to provide an accurate statement about what we know and what we do not know about neonatal circumcision, including its history, epidemiology, medical benefits, complications, contraindications, techniques, management for pain, and current controversies.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to describe the evolution of circumcision, to list the potential benefits of circumcision, to outline the various neonatal circumcision techniques, and to summarize the data on the use of analgesia for circumcision.