Circumcision: Everything You Need To Know

Circumcision is the surgical removal of the foreskin of the penis. The foreskin is the layer of skin that covers the glans (head of the penis).

This procedure can be performed in newborns, older children, or adults. Circumcision is the most common surgery among males.

This article explains why the surgery is performed, its risks and benefits, and expectations during and after surgery.

Why Are Circumcisions Performed?

The purpose of circumcision is to surgically remove the foreskin of the penis. The foreskin is the layer of skin that covers the head of the penis.

Generally, circumcisions are performed during the newborn period. But they can also be performed at any time during a person's life.

Circumcisions may be performed for religious, cultural, or medical reasons. Currently, the world's highest circumcision rates are in:

• United States
• Muslim-majority countries
• South Korea
  

Religious

Circumcision is embedded in the Muslim and Jewish faith. In the Jewish faith, circumcisions are performed on the eighth day of life by a religious person, known as a mohel, trained in circumcision. Jewish circumcisions are performed during a ceremony called a brit milah or bris.

Medical

Medical reasons for circumcision include the following.

• Phimosis: A condition where you can not retract the foreskin (pull it back)
• Paraphimosis: Foreskin becomes trapped behind the glans and can not be pulled back into position
• Balanoposthitis: Inflammation of the foreskin and glans
• Balanitis xerotica obliterans: Chronic inflammatory skin disease of the penis
• Preputial neoplasms: Penile cancer
• Excessive skin
• Tears in the frenulum: Small tag of skin under the penis between the foreskin and the shaft

The health benefits of circumcision include:

• Reduces bacteria under the foreskin
• Decreases risk of urinary tract infection
• Decreases risk of sexually transmitted infections in adults
• May decrease the risk of HIV
• Potentially decreases the risk of penile cancer
• Decreases the risk of cervical cancer and some infections in female partners
  

Risks of Circumcision

As with any surgical procedure, there are several potential risks associated with undergoing circumcision. In addition, some people are not good candidates for circumcision.

Contraindications

Contraindications for a circumcision procedure can be grouped into four areas.

• Family history of bleeding disorders: Healthcare providers should screen circumcision candidates for a family history of bleeding disorders, such as hemophilia and thrombocytopenia.
• Congenital malformations: Infants born with abnormalities such as hypospadias (a birth defect of the urinary tract), chordee (bent penis), or webbed or buried penis are not eligible for neonatal circumcision.
• Insufficient penis size: Premature infants often have a smaller penis in diameter or length. A micropenis is a contraindication.
• Inadequate age or health of infant: Infants must be at least 12 hours of age and have urinated a significant amount at least once.

Risks

While most risks are relatively minor and treatable, early complications may include:

• Pain
• Bleeding
• Swelling
• Inadequate skin removal

Late post-operative risks include:

• Wound infection
• Pain
• Urinary retention
• Meatal stenosis (opening at the tip of the penis becomes narrower)
• Meatal ulcer
• Fistula
• Sexual dysfunction
• Edema (swelling) of the glans penis
• Loss of penile sensitivity
• Hematoma formation (abnormal pooling of blood from a ruptured blood vessel)
• Poor cosmesis (cosmetic appearance)
• Tearing of sutures

While a circumcision procedure is relatively minor, serious complications can occur. Serious but rare complications include excessive bleeding and possible amputation of the glans.

How to Prepare

Preparing for surgery can be a scary and uncertain time. After the initial appointments, the surgeon will give you a list of instructions that you should follow before the procedure.

If this is an outpatient adult circumcision, you can expect a preoperative call or appointment with a member of your surgeon's staff. They will go over your scheduled arrival time and any other instructions.

These instructions will include what medications your should take or pause before the procedure. They will also tell you what time to stop consuming food and liquids.

Location

For infants, circumcisions are often done while a newborn is still in the hospital.

Adult circumcisions are performed in a hospital as an outpatient procedure. They may also be done at a same-day surgery center.

What to Wear

Newborns wear a hospital gown and diaper before the procedure. These will be removed once the patient is placed on the surgical table.

Adult circumcision patients should dress in loose-fitting clothing. You will change into a hospital gown when you arrive.

Food and Drink

All patients, regardless of age, are usually not allowed to eat or drink immediately before the procedure. This is called NPO, an abbreviation of the Latin term nil per os, which means "nothing by mouth."

Your surgeon will give you specific instructions about when to stop eating and drinking at a pre-operative appointment. They may also call to remind you the day before the procedure.

Medications

Your surgeon will discuss all medications with you before the surgery. Be sure to bring a list of your medications to pre-operative appointments. You should know:

• Dosage
• How often you take the medication
• When you last took it

Don't forget to include all vitamins and supplements in your list of medications. These may have side effects when combined with anesthesia and the medications used during and after the procedure.

On the morning of your surgery, take only the medications your doctor tells you to take. Then, take them with just enough water to swallow them comfortably. 

What to Bring

Here is a list of important items you may want to bring with you on the day of your scheduled adult circumcision:

• Comfortable, loose-fitting clothing, robe, and rubber-backed, non-skid slippers
• Personal care products, such as a toothbrush and toothpaste
• Storage containers for glasses, contact lenses, and dentures
• Insurance card and personal ID card
• Emergency contact information
• A copy of your legal paperwork, such as your healthcare proxy or living will
• A complete list of all the medications and supplements you currently take
• A cane, walker, or wheelchair if you use them
• Earplugs and eye mask
• Reading material
• Cell phone charger
• Pillow or blanket

You should not bring:

• Valuables
• Jewelry
• Watches
• Credit cards
• Cash
• Laptop

What to Expect on the Day of Surgery

The surgical team will bring your newborn to a separate room for the procedure.

Adults who undergo the procedure will report to the outpatient surgery department. You will be discharged several hours after the procedure.

Report to the hospital at the prescheduled arrival time. Once there, you will change into a hospital gown. It is helpful to have someone at the hospital for support and to drive you home.

Before the Surgery

Hospital newborn circumcision takes only a few minutes. However, the process of getting a baby ready can take longer.

Before the procedure, your child's physician will speak to you and obtain consent. They will go over the risks and benefits of the surgery.

The following health professionals may perform circumcision:

• Pediatrician
• Obstetrician
• Neonatologist
• Family medicine doctor
• Nurse practitioner
• Physician's assistant
• Surgeon
• Urologist

You will meet with a member of the anesthesia team and the surgical team. They will go over the procedure with you and ask you to sign consent forms.

This photo contains content that some people may find graphic or disturbing.

See Photo

During the Procedure

The doctor will place your newborn on a special table before the procedure. The surgical technique varies depending on the healthcare provider. However, all follow the same basic steps:

• The penis and foreskin are cleaned.
• A special clamp is attached to the penis, and the foreskin is then cut and removed.
• After the procedure, gauze with petroleum jelly is placed over the wound. This will protect it from rubbing against the diaper.

The most common surgical techniques include:

• Gomco clamp
• Plastibell device
• Mogen clamp

Adult circumcisions are less common and are generally done under general or local anesthesia. A urologist performs them. Adult circumcisions are performed using one of two techniques:

• Dorsal slit technique
• Sleeve technique

After the Procedure

After a newborn circumcision, you'll either see a visible incision or an attached Plastibell device. In addition, your child's doctor will instruct you to continue to place petroleum jelly on the tip of the penis after every diaper change. This will prevent the diaper from sticking to the healing area.

After a Plastibell circumcision, the plastic rim is left on the penis as it heals. The Plastibell will fall off by itself in five to eight days.

Immediately after an adult circumcision, your doctor will clean the area with sterile water. They will then wrap it with petroleum jelly and sterile gauze or Xeroform petrolatum gauze.

You can remove the initial dressing 24 to 48 hours after surgery. Wear loose-fitting briefs and gently wash the surgical area daily with non-perfumed soap.

Recovery

Recovery after circumcision is relatively easy. Most patients suffer minor, if any, complications.

Your doctor may advise Tylenol (acetaminophen) for pain relief. In addition, you should take it easy for several days following the procedure.

Healing

It's important to be able to identify complications from the procedure. Call the doctor right away if you or your child experience:

• Bleeding that is not stopping
• More than a quarter-size amount of blood on the diaper
• Redness that gets worse or does not go away after seven to 10 days
• Fever
• Other signs of infection, such as swelling, discharge getting worse, or pus-filled blisters
• Not peeing normally within 12 hours after the circumcision
• Dark or black discoloration
• Consistent redness
• Skin adhering to the glans

Coping With Recovery

Newborns often do not have any problems coping after surgery. Adults, on the other hand, should avoid intercourse and masturbation for four to six weeks after the procedure to avoid infection and skin breakdown.

Possible Future Surgeries

The need for future surgeries is rare. If there is an additional need, it is often cosmetic. Urologists usually perform circumcision revisions.

Summary

Circumcision removes the loose skin, called "foreskin," from the glans (head) of the penis. The surgery is a common newborn procedure in the U.S., but adults can undergo the procedure, too.

Circumcision is an outpatient procedure. Your doctor will send you or your child home on the same day. The procedure is very quick, often lasting only a few minutes. Afterward, you should apply petroleum jelly to the wound as it heals and watch for signs of infection.

A Word From Verywell

Circumcisions are often performed for religious or cultural reasons. But they may also be performed for medical reasons. If you are considering circumcision for yourself or your child, be sure to discuss the benefits and risks with your healthcare provider.