The Procedure of the Brit Milah

Contrary to common belief, the Brit Milah is a short and almost painless procedure. When done by an expert Mohel, it will usually take less than 60 seconds with minimal discomfort to the child. Here are the five steps of how a proper Brit Milah is done:

The Procedure

     1) Hafrada - Preparing the baby: Before the circumcision, the mohel checks the infant and ensures that he is fit for the procedure. The Mohel will sterilize the area of the Brit and use a probe to clear the foreskin from dirt and smegma. The Mohel may use this opportunity to apply pain-relief ointment or the like. This step is typically done before the Brit ceremony. 

     2) Milah - Circumcision: The Mohel uses a scalpel (called an Izmel) to remove the foreskin. The Mohel will usually use a shield, called a Mogen, that holds the foreskin in place while he makes the incision.

     3) Priah - Revealing the Glans: After the outer-layer of the foreskin is removed, the Mohel will reveal the glans (head) of the penis by depressing the forskin's inner-layer.

     4) Metzitza - Drawing the Blood: The Mohel then performs Metzitza, which involves drawing a small amount of blood from the wound and surrounding area. 

     5) Chavisha - Bandaging: Finally, the Mohel applies a sterile bandage with ointments to the wound to protect it and aid in the healing process.

Is it Painful?

A common misconception is that the baby experiences a great deal of pain from circumcision. In truth, the performance of ritual circumcision on an infant is almost painless for the child. In contrast, the method of circumcision practiced in most hospitals today uses a Gomco clamp to crush the skin and seal the blood vessels, giving an almost bloodless circumcision but with great and extended pain to the infant.

The Brit Milah is performed using a finely honed blade of surgical steel and a non-constricting guard (the Mogen) which is placed over the foreskin. The procedure involves the removal of a small piece of skin – no flesh or muscle is cut at all.

The statement that circumcision is almost painless to the child is not made lightly. Indeed, it has happened that while performing a circumcision on an adult, the local anesthetic has not taken effect. This occurs in rare cases where the patient is immune to the anesthesia. In one particular case, the patient experienced absolutely no pain from the circumcision itself. After the circumcision was completed, he inquired as to when the procedure would begin. It was only when the attending surgeon attempted to tie off the blood vessels and to suture the skin, that he made it known in a most vocal manner that the anesthetic had not taken. Since a newborn does not require sutures and does not need the blood vessels to be tied, he does not experience this pain. In addition, it should be noted that the nerves in a newborn on the eighth day are not fully developed.

If this true, why then does the infant cry? A newborn will tend to cry as soon as his diaper is opened and he is uncovered. This may be due to a need to feel enclosed or merely due to feeling cold. If one pays careful attention one will see that the baby starts to cry before any procedure has actually been performed. Notice also, that the infant stops crying shortly after the procedure and then usually falls asleep. The discomfort experienced by the infant afterwards is mainly due to the dressing on the wound, which is foreign to the child. 

Scalpel or Clamp?

The most preferable instrument for Brit is called an ‘Izmel’, a well-polished razor sharp surgical knife. When using this instrument in accordance to Halacha - Jewish law - the actual circumcision is instantaneous and almost painless.

Some physicians and untrained Mohels have taken to using a clamp method because it is easy to use and can be performed by a non-skilled individual. Unlike the razor-work of an Izmel, commonly-used clamps completely crush the skin, nerve endings and blood vessels in a lengthy procedure causing extreme pain and trauma to the child.

Jewish law prohibits the use of a clamp for ritual circumcision, for two primary reasons:

     1) Ritual: An essential part of the Bris ritual is ‘Dam Brit’ – blood of the covenant. The clamp tends to cause complete homeostasis as it crushes the skin. 

     2) Pain: The clamp causes much undue pain to the child, which is prohibited.

In 2000, the FDA issued a warning about circumcision clamps, which it said can cause laceration, hemorrhage, penile amputation, and urethral damage.

Although there may be medical benefits as well, a Jewish person’s reason for performing circumcision is a ritual one as a commandment by God and as a sign of God. Jewish law governs the procedural method of ritual circumcision, requiring a quick and almost painless method for the circumcision.

Many urologists and trained surgeons consider the traditional method of circumcision: “A simplified and expeditious method with excellent results and low complication”.

For more on the differences between hospital circumcision and ritual circumcision performed by a Mohel, see here.