Circumcision removes the foreskin, the retractable sleeve of skin covering the head (glans) of the penis. The specific technique depends on the patient’s age. Newborns are typically circumcised using a clamp or ring device in a procedure lasting about 10 minutes, while older children and adults undergo a surgical excision under stronger anesthesia that takes 30 to 60 minutes.
How the Area Is Numbed
No circumcision should be done without pain control. For newborns, the most common approach is an injection of local anesthetic at the base of the penis, which blocks the nerves supplying the foreskin. A numbing cream or lidocaine gel applied directly to the skin is sometimes used as a supplement or alternative. The injection takes a few minutes to reach full effect before the procedure begins.
Adults and older children receive either a local anesthetic injection (similar to what a dentist uses), regional anesthesia that numbs a larger area, or general anesthesia depending on the surgeon’s recommendation and the patient’s preference.
Newborn Circumcision: Three Common Devices
Nearly all newborn circumcisions use one of three devices. Each works differently, but all follow the same basic logic: separate the foreskin from the glans, protect the glans, crush or clamp the skin to prevent bleeding, then cut away the excess tissue.
Gomco Clamp
The doctor first makes a small cut along the top of the foreskin to create enough room to expose the glans. A metal bell is placed over the glans like a protective cap, and the foreskin is pulled up and over it. A flat base plate fits around the bell, and a top piece is tightened down, squeezing the foreskin between the plate and the bell. This stays in place for about five minutes, compressing the tissue enough to seal off blood vessels. The foreskin above the clamp is then cut away with a scalpel, and the entire device is removed.
Plastibell Device
This method also starts with a small incision to free the foreskin. A plastic ring (the Plastibell) is placed over the glans beneath the foreskin, and a string is tied tightly around a groove in the ring. The string cuts off blood supply to the foreskin above it. Excess skin is trimmed, and the handle of the device is snapped off, leaving the plastic ring in place. The ring falls off on its own within 7 to 10 days as the tissue heals underneath.
Mogen Clamp
The Mogen clamp is the simplest of the three. After the foreskin is freed from the glans, the doctor holds the foreskin with instruments at the 3 and 9 o’clock positions and slides it into a narrow, slit-shaped clamp. The clamp is closed for 60 to 90 seconds, crushing the tissue to prevent bleeding. The foreskin beyond the clamp is cut with a scalpel, and the clamp is removed. This technique is typically the fastest.
Adult Circumcision: Surgical Techniques
Adults have more tissue and larger blood vessels, so the procedure requires actual surgical excision and suturing rather than a clamp device. Two traditional methods are most common.
Dorsal Slit Method
The surgeon identifies the corona, the ridge where the glans meets the shaft, and determines how much foreskin to remove. A lengthwise cut is made along the top of the foreskin from the opening toward the glans, extending about 75 percent of the way to the corona. This opens the foreskin like a flap. The skin is then held away from the shaft and trimmed around its base with surgical scissors. Blood vessels are tied off or sealed, and the remaining skin edges are closed with absorbable stitches placed every 4 to 7 millimeters apart.
Sleeve Resection
This technique is considered more precise cosmetically. The surgeon marks two circular incision lines: one on the outer foreskin near the corona, and one on the inner foreskin about a centimeter behind the corona. Both incisions are made, creating a “sleeve” of tissue between them. That sleeve is peeled away and removed. The two cut edges are then stitched together with absorbable sutures. Because the surgeon controls both incision lines independently, this method gives more control over how much inner and outer skin is removed.
Stapler Circumcision
A newer option uses a disposable circular stapling device. The device is positioned over the foreskin, and in a single action, it cuts the tissue and places a ring of small metal staples that seal the wound edges together. This eliminates the need for hand-sewn stitches and significantly shortens the procedure time. The staples are typically removed at a follow-up visit.
What Happens During Recovery
Healing follows a predictable timeline regardless of the method. Swelling, bruising, and minor bleeding are normal for the first one to two weeks. The glans will be very sensitive initially because it has been protected by the foreskin and is now exposed. This sensitivity eases over several weeks as the skin adjusts. Dissolvable stitches, when used, break down on their own within two to six weeks. Full healing takes four to six weeks, sometimes longer.
Erections during the healing period can cause tightness or discomfort at the incision site. This typically improves over the first few months as scar tissue becomes more flexible.
Caring for the Wound
For newborns, aftercare is straightforward. Gently wash the area with plain warm water at each diaper change and pat it dry. Apply a generous layer of petroleum jelly over the circumcision site before closing the diaper to keep the healing skin from sticking to the fabric. Fasten diapers loosely to reduce pressure. If gauze was placed over the area, it will likely come off when the baby urinates. Soaking it with warm water helps loosen it without pulling. Avoid soap, hydrogen peroxide, and alcohol on the wound, as all three slow healing.
For adults, the principles are similar: keep the area clean, avoid soaking in baths or pools until the wound is fully healed, and wear supportive, snug underwear to minimize movement and friction. Most surgeons recommend avoiding sexual activity for at least four to six weeks.
Complication Rates
Circumcision is one of the most common surgical procedures worldwide, and serious complications are rare. For newborns, the complication rate is roughly 2 to 6 per 1,000 procedures. The most common issues are minor bleeding and localized infection, followed by cosmetic concerns like uneven skin removal. Severe complications, including serious infection, damage to the glans, or buried penis from scar tissue, are very uncommon.
Timing matters. The complication rate increases about 20-fold for boys circumcised between ages one and nine, and about 10-fold for those circumcised after age 10, compared to the newborn period. This is one reason most medical guidelines favor performing the procedure in the first few weeks of life if the family has chosen to proceed.
Why Families Choose Circumcision
The American Academy of Pediatrics reviewed evidence through 2010 and concluded that the health benefits of newborn circumcision outweigh the risks, though not enough to recommend it universally. Documented benefits include a reduced risk of urinary tract infections in young boys, lower rates of certain sexually transmitted infections later in life, and easier genital hygiene. The AAP’s position is that the procedure should be available to families who want it and covered by health insurance, with the final decision left to parents based on their own cultural, religious, and personal values.