What happens during a circumcision? Here's what to know about the procedure.

Male circumcision is considered the oldest, most frequently performed surgery in the world, yet it remains controversial. According to Dr. Greg Marchand, an ob-gyn at the Marchand Institute for Minimally Invasive Surgery, “the benefits and drawbacks of circumcision are widely debated as infants cannot have a say in the matter.”

Circumcisions are sometimes performed as part of religious rituals using specific faith traditions. However, many parents have a lot of questions regarding circumcision outside of religious contexts.

What happens during a circumcision?

A circumcision is performed by surgically removing the foreskin of the penis, Marchand tells Yahoo Life.

The most common way to perform a circumcision is to use metal clamps, known as Gomco or Mogen clamps, “to shield the skin of the shaft of the penis from the foreskin so that you can easily cut off the foreskin,” Marchand explains. During the procedure “the baby is generally held down for this using a ‘circumstraint,’ or circumcision restraint board,” he says. The circumstraint has Velcro straps to hold the baby still so the infant cannot interfere with the procedure. Circumcision is “very quick” and “should take less than one minute,” Marchand says.

Another way of performing circumcisions is by using a Plastibell. In Plastibell circumcisions, “instead of surgically removing the foreskin by cutting, a wire is pulled tight around the penis on top of a plastic bell, and then you must wait several days for the tissue to die off and for the foreskin to fall off,” Marchand says. Plastibell is not as popular as using clamps, but it “has the benefit of not needing a sharp scalpel to perform,” so some parents are more comfortable using this method, he notes. Plastibell also “does not require some of the sterile equipment the other techniques require, so it may be more convenient for some facilities,” he adds.

When are circumcisions performed?

While circumcisions can be performed at any age, Marchand says it's ideal to do the procedure in the baby's first two weeks of life, preferably “as soon as possible after birth.” This is because “as the child grows, circumcisions become more difficult and require more anesthetic," he says. Marchand notes, however, that if the baby does not receive a vitamin K shot at birth, circumcisions may need to be delayed to reduce the chances of bleeding.

Who performs a circumcision?

Outside of a religious ceremony, physicians usually perform circumcisions. On newborns, Marchand says that typically the procedure is done by an ob-gyn or a pediatrician.

There are some exceptions, however. Marchand says that in some states other medical professionals such as nurse practitioners or physicians’ assistants can perform circumcisions. Occasionally babies born with a penile abnormality are circumcised by a urologist with specialized training. If an older child or adult is being circumcised, the procedure is usually performed by a general surgeon or urologist, Marchand says.

What are the benefits of circumcision?

Some parents choose to circumcise their baby because of religious or cultural traditions. Others choose the procedure because it offers several health benefits. Dr. Kimiyo Harris-Williams, a pediatrician at Children’s Hospital New Orleans, emphasizes that the American Academy of Pediatrics has found that the benefits of circumcision outweigh the risks.

Circumcisions “certainly make hygiene easier” and may reduce infections in the area, Marchand adds. In uncircumcised males, an infection of the foreskin, called posthitis, can occur. “In many of these cases, the man needs to undergo a circumcision later in life, which is very painful and requires general anesthesia to tolerate,” he says.

According to Harris-Willams, circumcisions may prevent urinary tract infections (UTI), acquisition of HIV, transmission of some sexually transmitted infections (STI) and penile cancer. The French medical journal La Presse Médicale reports that circumcision can also help prevent transmission of human papillomavirus (HPV) and reduce the risk of cervical cancer in female partners.

Is the baby anesthetized during circumcision?

Marchand says that in order to prevent pain “most facilities anesthetize the penis with an injection of numbing medication on each side of the penis prior to the procedure.” According to Marchand, there is some disagreement about whether completely numbing the penis is necessary because “babies can’t tell or remember how much the procedure hurts. He explains that in the past some doctors used to think that “oral sugar water could be sufficient anesthesia for the procedure, as it distracts the baby,” but that most physicians today completely numb the penis during the circumcision.

What is recovery like?

Marchand says that following Gomco and Mogen circumcisions, “healing is easy and no specific care is needed.” He says that following the procedure, “a bandage is placed on the glans of the penis, and it will heal normally without any specific care.” A Plastibell circumcision, meanwhile, should not "need any care until it falls off with the foreskin,” as long as there are no complications.

Following both types of circumcisions, babies are able to urinate normally. “The Plastibell, which remains in place for several days, has holes on the top to allow urine to escape into the diaper,” Marchand says.

What are the risks of circumcision?

Marchand says that even though circumcision with clamps is a very simple surgical procedure, there can be complications. “There might be some bleeding or spotting in the diaper for up to two days, although this “very rarely” requires follow-up care, he says. On the rare occasions that bleeding does need to be addressed, Marchand says that cauterization is used.

When circumcisions with clamps are performed incorrectly, Marchand says that there can be additional complications. These include infection, damage to the penis or the need for a second circumcision. But he notes that “these are extremely rare in experienced hands." Marchand adds that he has performed hundreds of circumcisions and has “never had a complication with a circumcision ever.”

There are also risks to circumcisions using a Plastibell. Marchand says that “it is possible to gravely injure a penis if you don't know what you are doing," and he does not recommend using a Plastibell due to the increased risks. He notes that using a Plastibell can also be stressful for parents and result in unnecessary ER visits. In his experience, “about half the time the mother becomes afraid by the appearance of the necrosing, or falling off, foreskin and goes to the ER" even if the wound is healing as it should, he says.

When it comes to deciding whether or not to pursue circumcision, Harris-Willams says that “parents should weigh the health benefits based on their own religious, cultural and personal preferences." Although there are clear medical benefits, she says that this alone “may not outweigh these other considerations for individual families.”