Family Health Guide

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Circumcision Procedure

A medical circumcision is performed, most often in a hospital, in the first few days of life on full-term infants unless health concerns prevent it. In America, although Muslim parents usually choose circumcision for religious reasons, they often opt for a medical procedure. Jewish ritual circumcision must be done by a specially trained, ritual circumciser called a mohel in a ceremony called a bris.

Medical Neonatal Circumcision

A doctor, often your pediatrician, OB-GYN, or attending physician, will cleanse the penis and surrounding area. She’ll then use a local anesthetic, which might be a nerve or ring block (both injectable) or a topical cream (most commonly EMLA, a prescription cream containing lidocaine applied 90 minutes to an hour before the procedure). Talk to your doctor about which anesthetic she uses and why. The baby’s legs must be restrained so he can’t kick or wiggle during the procedure. Your doctor will use a special ring (called a Plastibell) or a clamp (usually a Gomco or Mogen clamp) to separate the foreskin from the penis and then remove it. Afterward, the penis is covered in antibiotic ointment or petroleum jelly and loosely wrapped with sterile gauze. The procedure should take less than 10 minutes.

Jewish Ritual Circumcision

Jewish ritual circumcision, called a bris or brit milah, signifies a religious covenant and must take place as part of a religious ceremony on the child’s eighth day of life, unless health concerns prevent it (mohels always delay circumcisions on premature or low–birth-weight babies). A medical circumcision cannot substitute for a bris. The bris is performed by a mohel, or ritual circumciser, trained in both the procedure and Jewish law. It may be done at home or in a synagogue or social hall, in the presence of family and friends. A mohel’s technique is different from a surgeon’s: Clamps are forbidden; instead a butterfly-shaped shield protects the glans while the mohel removes the foreskin with a sharp scalpel. (In a bris, all membrane below the corona of the penis must be removed, which is not necessary in a medical circumcision.) Mohels are permitted by Jewish law to use anesthetic creams such as EMLA, which parents can obtain from their pediatricians, unless their mohel is also an MD, as some are. Mohels may also give the baby a sugar-water solution, in addition to an anesthetic, to help relieve discomfort. Some ultra-orthodox mohels draw a small amount of blood from the penis using their mouths in a practice called metzitzah b'peh, which is strongly discouraged by more modern Jews, as well as the medical community, due to the potential for infection. Five people, usually including grandparents, perform honorary roles, carrying the baby and holding him before and after the circumcision.