The circumcision procedure

Circumcision is one of the most frequently performed surgical operations in the United States. It is a very safe procedure and it is extremely rare for complications or infection to occur.  

The operation involves removing the fold of skin that surrounds the head of the penis along with the mucous membrane underlining this skin.  This leaves the skin covering the penile shaft intact but exposes the head—the “glans”—of the penis.  

There are 3 main instruments used for performing circumcisions in the U.S.

1. The Mogen clamp—the traditional instrument used at a brit milah ceremony
2. The Gomco clamp—very commonly used in hospitals
3. The Plastibell—This is a plastic bell-shaped cap that covers the head of the penis and is secured with a string

The initial steps of the circumcision procedure are similar regardless of which instrument is selected.

The first step is for the mohel to grasp the already anesthetized skin (see following chapter on “Anesthesia”) surrounding the head of the penis/glans using the tip of a small clamp.  The mohel then separates this skin from its adhesions to the underlying glans. The now loosened foreskin is then pulled up over the head of the penis, clamped at the point where it is to be excised, and cut off above the clamp with a scalpel.  

The clamp is then released, allowing the skin covering the shaft of the penis to return to its normal position.  There is usually scant or no bleeding because the skin just below where the incision is made has had its blood vessels sealed by the pressure of the instrument used. The only after-care needed is an application of an ointment to the part of the diaper that will touch the penis every time the diaper is changed for the five days following the circumcision. This will be soothing for the baby and will keep the diaper from sticking.

The Mogen clamp consists of two strips of silver-plated metal connected at one end by a screw and at the other by a hinge.  There is an indentation on the baby’s side of the clamp to protect the head of the penis.  It is a safe, easy-to-use instrument that allows for a quick and almost bloodless circumcision.

The instrument employed for the actual cutting of the skin is almost always a sterile scalpel blade.  Traditionally mohels used “izmails” or special razor-sharp two-sided knives which were handed down from generation to generation of mohels.  In Biblical times sharpened stones were used to perform ritual circumcision.  Exodus 4:25 relates how Moses’s wife Zipporah uses a stone to circumcise Moses’ son; in Joshua 5:2 God tells Joshua to “make sharp knives out of flint for yourselves and circumcise the children of Israel”. 

Whereas traditionally the sandek held the baby on his lap with the baby’s legs apart while the mohel performed the circumcision, most mohels today—especially physician mohels—are more comfortable having the baby placed on a “Circumstraint”—a specially molded piece of plastic with indentations corresponding to a baby’s body shape. The baby’s legs are restrained with Velcro straps, thus largely immobilizing the baby’s genital area. 

Once secured in the Circumstraint, the mohel cleans off the genital area with an antiseptic solution, and performs the circumcision while saying:

The mohel then dresses the circumcised penis with an ointment-impregnated wrap, puts the baby in a diaper, and hands the baby to his mother.