Anatomy of a Circumcision

Illustration by Kagan McLeod and Jonathon Rivait

No matter who performs a circumcision—an obstetrician at the hospital, or a mohel at a bris—the operation is more or less the same every time. So how does it work?

First comes anesthetic, at least in the hospital. Some mohels use none, and simply work fast. Others administer a few drops of sugary syrup or sweet wine to help distract and sedate the baby. Still others use a topical cream. Doctors, as well as some medical-school-trained mohels, sometimes administer a penile block, a set of anesthetic injections. The first needle goes in under the pubic bone, where the nerves are. One or more injections follow, and those subsequent needles “go into numbed areas,” says Dr. Jed Kaminetsky, a urologist.

Now the cutting begins. The opening at the tip of the foreskin is stretched and held open, usually with surgical clamps. Then the doctor or mohel makes a snip up the center of the foreskin with a pair of surgical scissors, peeling the two halves back to make a flat sheet of skin. At this early stage of life, the foreskin is attached to the underlying skin by thin membranes, and has to be picked away, typically with a little sticklike tool.

From there, most circumcisions are performed with one of three instruments. The Mogen clamp—similar to the traditional rabbi’s tool known as a Mogen shield—clasps the flattened foreskin between two wide, flat pieces of metal, and a scalpel is run along their face to trim away the foreskin.

Another option, the Plastibell, is a small sleeve that’s slipped over the tip of the penis, under the foreskin. The cutter simply ties a tight suture all the way around the base of the foreskin, cinching it against the plastic cylinder. Then the excess skin is trimmed off with surgical scissors, and the Plastibell’s handle is snapped off and discarded. The tie stays in place; so does the Plastibell. Over the next several days, the remaining bit of foreskin withers and falls off, taking the string and Plastibell with it.

Then there’s a more complex device called the Gomco clamp. It’s a stainless-steel gizmo that allows the doctor or mohel to pull up the foreskin around a steel cap, tie it taut, and then slice neatly around the penile head.

After the procedure, parents should check for bleeding every half-hour for the first few hours. There’s usually some swelling, which goes down after a week or so. Parents should also check for fevers, which can indicate an infection, and keep an eye out for yellowish pus or any other evidence that the wound isn’t healing properly. Most important, though, is plain old hygiene. Change diapers frequently, to keep the wound from getting contaminated, and add a dab of Vaseline to the scab each time so it doesn’t stick to the diaper.

Anatomy of a Circumcision