Information About Circumcision and Ceremony

Circumcision is a common, minor surgical procedure. It is generally an elective procedure done for religious, cultural, or cosmetic reasons. There are 3 similar methods for performing a circumcision: use of a plastic bell, use of a Mogen clamp, and use of a Gomco clamp. The Mogen clamp is what is used most commonly by a mohel/et. I use the Gomco clamp per my medical training. I have been using this method since 2000. I use sterilized equipment in the hospital and will do the same for your son in your home.

Before performing the circumcision, I will do a brief and targeted physical examination of his genitalia to be sure there are no medical contraindications. I do insist that your son has been seen by his physician after birth to make sure he is healthy enough to undergo circumcision. He must have received an intramuscular injection of Vitamin K after birth as prophylaxis against hemorrhagic disease of the newborn. There should be no family history of any bleeding disorders.

There are medical benefits to circumcision. These include a reduction in urinary tract infections, almost complete elimination of the risk of penile cancer, and a decreased rate of sexually transmitted diseases. There is no medical evidence that circumcision affects sexual function or the ability to feel pleasure.

There are risks to any medical procedure including circumcision. The most common risk is bleeding which is why I insist on Vitamin K and no family history of a bleeding disorder. Other risks include infection, taking too much or too little foreskin, buried penis, damage to surrounding structures, and poor cosmetic outcome such as asymmetry, skin tags, or skin bridges. The likelihood of one of these occurring is <1%.

Infants do have the ability to feel pain although he will not have any memory of this procedure. The pain can be significantly reduced with pharmacologic and non-pharmacologic methods.  I recommend that he be fed just prior to the procedure. A full belly usually allows him to sleep during the circumcision.  I will use a dorsal penile nerve block using a lidocaine injection. It takes just 5 minutes to take effect. The lidocaine does cause a burning sensation upon injection that dissipates within seconds. I recommend using a pacifier dipped in milk or formula or sugar water or kosher wine during the circumcision as it will soothe him. Tylenol (acetaminophen) can be used one or two times after the procedure if he seems fussy. Even with pain control, he may cry. It is usually related to the restrained position he must be in and all the activity during the ceremony.  A quiet room where he can be cuddled and fed immediately after the ceremony will help him feel much better.

The ceremony on the eighth day of life can be tailored to suit the family's wishes. The three main components of a berit mila include the circumcision, the naming of the infant, and the festive meal. There are several Hebrew blessings that I incorporate into the service to make the ceremony meaningful to each family. We can discuss these prior to the ceremony to include the parts your family will appreciate. There are several roles that can be filled by honored guests including Kvatter (brings the infant into the room), Sandeks (hold and soothe infant during the circumcision), candle lighter,  and presenter to Elijah's chair. Please click on the family information button under the FORMS tab to see the available roles.

Katie Simon, MD