Psychological Impact of Non-therapeutic Circumcision on School Boys

Year 2018, Volume: 71 Issue: 3, 238 - 243, 31.12.2018

Mete Özkıdık , Zeliha Ersoy Sayın Alper Coşkun , Mehmet Kazım Asutay , Tuncer Bahçeci , Ali Cansu Bozacı

Abstract

Objectives: Numerous studies have confirmed high stress levels associated with undergoing an operation in children. In this study we aimed to evaluate perceived stress levels of non-therapeutic circumcision in school boys.

Materials and Methods: One thousand hundred patients aged between 9 and 12 years have been invited to the study. The participants are divided into two groups as circumcised and non-circumcised. Socio-economical level and place of residence are also evaluated. Self administered Turkish Validation of Perceived Stress Scale for Children (PSS-C) was used to assess the perceived stress levels due to undergoing circumcision.

Results: One hundred and twenty-eight patients filled in the questionnare completely. Results confirmed a significantly higher score of perceived stress in circumcised population (p<0.001). There was no correlation with place of residence or socio-economical leve but the younger the patient, the higher the sum score of PSS-C (p<0.05).

Conclusion: Circumcision should be considered as a traumatic experience such as any surgical intervention for pediatric population. Despite religious and social beliefs, patients and parents should be informed about and be conscious of psychological effects of male circumcision.

Keywords

Boys , Circumcision , Perceived Stress , Psychological Trauma

Ethical Statement

Ethical approval was obtained from the local ethical committee in Şanlıurfa. In addition, all participants and their parents provided their written informed consent. Study Design: The study was conducted at Şanlıurfa Research and Training Hospital using a cross-sectional design. A total of 1500 patients aged between 9 and 12 years are invited to participate in the study. Patients who applied to the urology or pediatric urology outpatient clinics between 1 January 2017 and 1 January 2018 were enrolled. Three hundred forty seven patients are excluded owing to having other stressors, being circumcised more than 6 months ago, being a Syrian refugee or undergoing the intervention on non-hygienic conditions. A thousand one hundred and fifty-three participants are divided into two groups as circumcised and non-circumcised. Power analysis showed us that the sample size is sufficient to compare the two groups. (Alpha level: 0.95, p:0.05) Participants in both groups filled in the questionnare on their own to rule out parental effects. Measurements: Turkish validation of PSS-C which is was used to determine patient stress level (18). PSS-C is a questionnare designed for children to measure perceived stress due to subjective experiences independent of a specific context. There are two versions of PSS-C determined in the literature. Short version with 9 questions (19) and long version with 14 questions (17) are both reliable enough to evaluate perceived stress in children. Items on PSS-C are rated on a 4-point Likert scale (18) (0=Never, 1=A little, 2=Sometimes, 3=A lot). PSS-C sum scores range from 0 to 27 (18). Cronbach Alfa internal consistency reliability coefficient for The Turkish version of PSS-C is 0.76 (18). The test-retest reliability coefficient is 0.71 (18). Statistical Analysis: Means (M) and measures of standard deviations (SD) were calculated for PSS-C sum scores. Sample characteristics were analyzed with independent samples t-test (20). The participants were divided into three groups as 9≤10, 10≤11, 11≤12 respectively according to age, two groups as high and low according to socio-economic level, two groups as urban and rural according to residency to determine if the perceived stress levels of circumcision vary in different groups. In accordance with current literature, level of significance was set at p=0.05 to indicate statistically relevant differences (21). Statistical analyses were performed using the “Statistical Package for the Social Sciences Version 22” (22).

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Thanks

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Okul Çağında Erkek Çocuklarda Sünnetin Psikolojik Etkisi

Abstract

Amaç: Çocuklarda ameliyat olmanın ciddi strese yol açtığına dair çok sayıda çalışma bulunmaktadır. Biz bu çalışmada okul çağındaki erkek çocuklarda sünnetin yarattığı algılanan stres düzeyini değerlendirmeyi amaçladık.

Gereç ve Yöntem: Çalışmaya 9 ve 12 yaş arası toplam 1500 hasta çağrıldı. Katılımcılar sünnet olan ve olmayan olarak iki gruba bölündü. Sosyoekonomik düzey ve ikamet yeri de ayrıca değerlendirildi. Çocuklarda Algılanan Stres Düzeyi Ölçeği’nin (PSS-C) Türkçe validasyonu kullanılıp, kendilerinin doldurması şartıyla sünnet olmaya bağlı stres düzeyleri değerlendirildi.

Bulgular: Sünnet, çocukluk çağındaki her ameliyat için olduğu gibi travmatik bir tecrübe olarak görülmelidir. Dinsel ve kültürel değerlere rağmen, hastalar ve ebeveynleri sünnetin psikolojik etkilerinin farkında olmalı ve konu hakkında bilgilendirilmelidir.

Sonuç: Bin yüz yirmi sekiz hasta anketi tamamen doldurdu. Algılanan stres düzeyi sünnetli çocuklarda anlamlı düzeyde yüksek bulundu (p<0,001). İkamet yeri veya sosyo-ekonomik düzey ile bir ilişki bulunmadı ama çocuklarda yaş azaldıkça PSS-C skorunun arttığı görüldü (p<0,05).

Keywords

Erkek Çocuklar , Sünnet , Algılanan Stres , Psikolojik Travma

Ethical Statement

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