Elektif erkek sünneti; Medikolegal tartışmalar ve güncel literatür

Abstract

Elektif erkek sünneti(EES) hakkında bazı medikolegal tartışmalar vardır. Amerikan Pediatri Akademisi’nin (AAP) 2012 yılındaki raporuna göre, yeni doğan erkek sünnetinin tıbbî faydaları risklerinden fazladır. AAP’nin bu raporu, EMC hakkındaki tartışmalara yeni bir boyut kazandırmıştır. Bu rapor, sün­netin etik ve yasal bir müdahale olmadığını söyleyen çevreler tarafından eleştirilmiştir. Ancak, mevcut literatür AAP’nin bu raporu­nu doğrulamaktadır. ES, üriner enfeksiyon­lar, fimozis, balanit, kandidiyaz, yüksek riskli HPV enfeksiyonu, HIV, genital ülser, sifiliz, trikomonas vaginalis, mikoplazma genitali­um, herpes simpleks virüs tip 2, şankroid, pe­nil kanser, prostat kanseri ve serviks kanseri riskini anlamlı derecede azaltıyor iken, seksü­el fonksiyonlar üzerinde de olumsuz bir etki yapmamaktadır. EMC için önerilen yaş 0-1 yıldır. Çünkü infantil MC’de komplikasyonlar daha az, iyileşme daha hızlı ve maliyet daha avantajlıdır. Bu dönemdeki sünnetin ruh sağ­lığı açısından da bir riski bulunmamaktadır. İnfantil MC’nin komplikasyonları % 0,2-0,3 civarındadır ve bunların çoğu da genellikle minimal müdahalelerle önlenebilmektedir. Eğer 0-1 yaş arasında sünnet yapılmamış ise kastrasyon fobisi nedeniyle 3-6 yaş arasında sünnetten kaçınılmalı ve çocuğun 7-10 yaşına ulaşması beklenmelidir.

Keywords

• Erkek sünneti,enfeksiyon,kanser,cinsel fonksiyon,ruh sağlığı,komplikasyon

Elective male circumcision; Medicolegal discussions and current literature

Abstract

There are some medicolegal discussion about elective male circumcision(EMC). According to the report of the American Academy of Pediatrics (AAP) in 2012, the health benefits of newborn MC outweigh the risks. This report of the AAP has given a new dimension to the discussion about MC. This report has been criticized by circles who say circumcision is not an ethical and legal intervention. However, the current literature confirms this report of the AAP. While MC significantly reduces the risks of urinary tract infections, phimosis, balanitis, candidiasis, high-risk HPV infection, HIV, genital ulcer disease, syphilis, trichomonas vaginalis, mycoplasma genitalium, herpes simplex virus type 2, shancroid, penile cancer, prostate cancer and cervical cancer, it does not negatively affect on sexual functions. MC also affects mental health positively in populations where circumcision is prevalent because of traditions and beliefs. The recommended age for MC is 0-1 years. Because, the complications are less, the healing is faster, and the cost is more advantageous in infantile MC. There is also no risk of circumcision in this period in terms of mental health. MC complications in infancy are around 0,2-0,3% and most of them are usually prevented with minimal intervention. If MC is not performed between 0-1 age it should be avoided between 3-6 years of age due to castration phobia and the boy should be expected to reach the age of 7-10 years. 

Keywords

• Male circumcision,infection,cancer,sexual function,mental health,complication

References

1. 1. Bossio JA, Pukall CF, Steele S. A review of the current state of the male circumcision literature. J Sex Med. 2014 Dec;11(12):2847-64. doi: 10.1111/jsm.12703. Epub 2014 Oct 6.
2. 2. Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J et al. Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr. 2016 Mar 1;14:4. doi: 10.1186/s12963-016-0073-5.eCollection 2016.
3. 3. Morris BJ, Wiswell TE. Circumcision and lifetime risk of urinary tract infections: A systematic review and metaanalysis.J Urol 2013;189:2118–24.
4. 4. Morris BJ, Bailis SA, Wiswell TE. Circumcision rates in the United States: Rising or falling? What effect might the new affirmative pediatric policy statement have? Mayo Clin Proc 2014;89:677–86.
5. 5. Blank S, Brady M, Buerk E, Carlo W, Diekema D, Freedman A et al. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012 Sep;130(3):e756-85. doi: 10.1542/peds.2012-1990. Epub 2012 Aug 27.
6. 6. Van Howe RS. Response to Vogelstein: How the 2012 AAP Task Force on circumcision went wrong. Bioethics. 2018 Jan;32:77-80. doi: 10.1111/bioe.12363. Epub 2017 Jul 9.
7. 7. Svoboda JS, Adler PW, Van Howe RS. Circumcision Is Unethical and Unlawful. J Law Med Ethics 2016 Jun;44:263-82.doi: 10.1177/1073110516654120.
8. 8. Frisch M, Aigrain Y, Barauskas V, Bjarnason R, Boddy SA, Czauderna P et al. Cultural bias in the AAP’s 2012 Technical Report and Policy Statement on male circumcision. Pediatrics 2013 Apr;131:796-800. doi: 10.1542/peds.2012- 2896. Epub 2013 Mar 18.

9. 9. Canning DA. Re: Circumcision policy statement. J Urol. 2013 Oct;190:1378. doi: 10.1016/j.juro.2013.06.094.Epub 2013 Jul 3.
10. 10. Simpson E, Carstensen J, Murphy P. Neonatal circumcision: new recommendations & implications for practice. Mo Med 2014;111:222-30.
11. 11. Brady MT. Newborn Male Circumcision with Parental Consent, as Stated in the AAP Circumcision Policy Statement, Is Both Legal and Ethical. J Law Med Ethics 2016 Jun;44:256-62. doi: 10.1177/1073110516654119.
12. 12. Morris BJ, Klausner JD, Krieger JN, Willcox BJ, Crouse PD, Pollock N. Canadian Pediatrics Society position statement on newborn circumcision: a risk-benefit analysis revisited. Can J Urol 2016;23:8495-8502.
13. 13. Morris BJ, Kennedy SE, Wodak AD, Mindel A, Golovsky D, Schrieber L et al. Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy. World J Clin Pediatr. 2017 Feb 8;6:89-102. doi: 10.5409/wjcp.v6.i1.89. eCollection 2017 Feb 8.
14. 14. Hines JZ, Ntsuape OC, Malaba K, Zegeye T, Serrem K, Odoyo-June E et al. Scale-Up of Voluntary Medical Male Circumcision Services for HIV Prevention - 12 Countries in Southern and Eastern Africa, 2013-2016. MMWR Morb Mortal Wkly Rep. 2017 Dec 1;66(47):1285-1290. doi: 10.15585/mmwr.mm6647a2.
15. 15. Ngcobo S, Wolvaardt JE, Bac M, Webb E. The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis. PLoS One. 2018 Jan 19;13:e0190795. doi: 10.1371/journal.pone.0190795. eCollection 2018.
16. 16. Castellsagué X, Bosch FX, Muñoz N, Meijer CJ, Shah KV, de Sanjose S et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 2002; 346: 1105-1112 [PMID: 11948269 DOI:10.1056/NEJMoa011688.
17. 17. Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P. Effects of circumcision on male sexual function: debunking a myth? J Urol 2002;167:2111-2.
18. 18. Morris BJ, Krieger JN. Does male circumcision affect sexual function, sensitivity, or satisfaction?-a systematic review. J Sex Med. 2013 Nov;10:2644-57. doi: 10.1111/jsm.12293. Epub 2013 Aug 12.
19. 19. Tian Y, Liu W, Wang JZ, Wazir R, Yue X, Wang KJ. Effects ofcircumcision on male sexual functions: a systematic review and meta-analysis. Asian J Androl 2013; 15: 662-666.
20. 20. Fink KS, Carson CC, DeVellis RF. Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol 2002;167:2113-16.
21. 21. Bleustein CB1, Fogarty JD, Eckholdt H, Arezzo JC, Melman A. Effect of neonatal circumcision on penile neurologic sensation. Urology 2005;65:773-7.
22. 22. Cox G, Krieger JN, Morris BJ. Histological Correlates of Penile Sexual Sensation: Does Circumcision Make a Difference? Sex Med. 2015 Jun;3:76-85. doi: 10.1002/sm2.67.
23. 23. Bronselaer GA, Schober JM, Meyer-Bahlburg HF, T’Sjoen G, Vlietinck R, Hoebeke PB. Male circumcision decreases penile sensitivity as measured in a large cohort. BJU Int. 2013 May;111:820-7. doi: 10.1111/j.1464-410X.2012.11761.x. Epub 2013 Feb 4.
24. 24. Wolff I, May M, Hoschke B, Brookman-May S. Male circumcision is not associated with an increased prevalence of erectile dysfunction. Asian J Androl. 2014 Jul-Aug;16:652-3.doi: 10.4103/1008-682X.125908.
25. 25. Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N et al. Fine-touch pressure thresholds in the adult penis. BJU Int 2007; 99: 864–9.
26. 26. Kigozi G, Watya S, Polis CB, Buwembo D, Kiggundu V, Wawer MJ et al. The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda. BJU Int 2008 Jan;101:65-70.
27. 27. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-5.
28. 28. Laumann EO, Nicolosi A, Glasser B, Paik A, Gingell C, Moreira E et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 2005;17:39-57.
29. 29. Senkul T, Iseri C, Sen B, Karademir K, Saracoglu F, Erden D.Circumcision in adults: effect on sexual function. Urology 2004;63:155-8.
30. 30. Namavar MR, Robati B. Removal of foreskin remnats in circumcised adults for treatment of premature ejaculation. Urol Ann 2011;3:87-92.
31. 31. Yang L, Ruan LM, Yan ZJ, Chen Y, Wang GY, Ji YX. Sexual function and mental state in patients with redundant prepuce or phimosis. Zhonghua Nan Ke Xue 2010;16:1095-7.
32. 32. Gallo L, Perdona S, Gallo A. The role of short frenulum and the effects of frenulectomy on premature ejaculation. J Sex Med 2010;7:1269-76.
33. 33. Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M. A multinational population survey of intravaginal ejaculation latency time. J Sex Med 2005;2:492- 7.
34. 34. El Bcheraoui C, Zhang X, Cooper CS, Rose CE, Kilmarx PH, Chen RT. Rates of adverse events associated with male circumcision in US medical settings, 2001 to 2010. JAMA Pediatr 2014;168:625–34.
35. 35. Morris BJ, Waskett JH, Banerjee J, Wamai RG, Tobian AA, Gray RH et al. A ‘snip’ in time: what is the best age to circumcise? BMC Pediatr 2012;12:1–15.
36. 36. Schoen EJ, Colby CJ, To TT. Cost analysis of neonatal circumcision in a large health maintenance organization. J Urol 2006; 175: 1111-1115.
37. 37. Yu H, Wier LM, Elixhauser A. Hospital stays for children,2009. Hospital Cost Utilization Project (HCUP), Statistical Brief #118. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb118.jsp. Accessed 3 Mar 2014.
38. 38. Kacker S, Frick KD, Gaydos CA, Tobian AA. Costs and effectiveness of neonatal male circumcision. Arch Pediatr Adolesc Med 2012; 166: 910-918.
39. 39. Kalkan M, Şahin C, Toraman AR, Turkan S. A comparison of sense of self and self-esteem in uncircumcised men over the age of 20 to those who were circumcised during childhood. Turk J Urol 2010;36:411-417.
40. 40. Aydogmus Y, Semiz M, Er O, Bas O, Atay I, Kilinc MF. Psychological and sexual effects of circumcision in adult males. Can Urol Assoc J. 2016 May-Jun;10:E156-E160. Epub 2016 May 12.
41. 41. Yavuz M, Demir T, Doğangün B. The effect of circumcision on the mental health of children: A Review. J Turk Psychiatry 2012;23:63-70.
42. 42. Şahin F, Beyazova U, Aktürk A. Attitudes and practices regarding circumcision in Turkey. Child: Care, Health and Development 2003;29:275-80.
43. 43. Yılmaz E, Batılsam E, Basar MM, Basar H. Psychological trauma of circumcision in the phallic period could be avoided by using topical steroids. Int J Urol 2003;10:651-6.
44. 44. Öztürk OM. Ritual circumcision and castration anxiety. Psychiatry 1973;36:49-60.
45. 45. Nunberg H. Circumcision and the problems of bisexuality. Rev Psicoanal 1952;9:55-122.
46. 46. Sari N, Büyükünal SN, Zülfikar B. Circumcision ceremonies at the Ottoman palace. J Pediatr Surg 1996;31:920-4.
47. 47. Diekema DS. Physician Dismissal of Families Who Refuse Vaccination: An Ethical Assessment. J Law Med Ethics. 2015 Fall;43:654-60. doi: 10.1111/jlme.12307.