Circumcision is the surgical removal of the foreskin, the sleeve of skin that covers the head (glans) of the penis. The procedure takes different forms depending on age, but the core mechanics are the same: separate the foreskin from the glans, cut off the excess skin, and manage bleeding so the wound can heal cleanly. For newborns, the whole process typically takes about 10 minutes. For adults, it’s a longer operation with stitches and a more involved recovery.
What the Foreskin Is
The foreskin begins forming during the third month of fetal development, when a fold of skin grows outward from the base of the glans and gradually extends to cover it. In newborns, the foreskin is naturally fused to the glans, similar to how a fingernail is attached to the nail bed. This fusion separates on its own over the first several years of life. During circumcision, the foreskin must first be gently freed from the glans before it can be removed.
How the Three Main Devices Work
Nearly all newborn circumcisions in the United States use one of three devices. Each one protects the glans from injury while removing the foreskin, but they do it in slightly different ways.
Gomco Clamp
A metal bell is placed over the glans and under the foreskin, then the foreskin is pulled up and over the bell. A flat base plate and a rocker arm compress the foreskin tightly against the bell, cutting off blood flow. After five minutes of compression, the surgeon uses a scalpel to trim away the foreskin above the clamp. The crushed skin edges are then gently peeled off the bell with sterile gauze. The compression time is what stops the bleeding; by the time the clamp comes off, the tissue has sealed.
Mogen Clamp
This is a simpler, faster device that looks like a pair of flat-jawed pliers with a narrow 3-millimeter slit. The foreskin is pulled forward past the glans and slid into the slit, with the curved side of the clamp facing down to shield the glans. The clamp is squeezed shut, crushing the skin for 60 to 90 seconds. The excess foreskin above the clamp is then cut away with a scalpel, and the clamp is removed. The shorter compression time makes this the quickest of the three methods.
Plastibell
This device works on a completely different principle. A plastic ring is placed over the glans and under the foreskin, then a string is tied tightly around a groove in the ring, cinching the foreskin against it. The excess skin beyond the string is trimmed, and the handle of the device is snapped off, leaving only the small plastic ring in place. Over the next week or so, the tissue trapped under the string loses its blood supply, dies, and falls off along with the ring. Parents sometimes find this approach less alarming because there’s no open wound at the time of the procedure, though the ring does need to fall off on its own.
How Adult Circumcision Differs
When circumcision is performed on an adult or older child, the approach changes significantly. The foreskin has long since separated from the glans, so there’s no need to free it manually, but the tissue is thicker and has a larger blood supply. Adults receive local anesthesia (an injection at the base of the penis to numb the area) or, in some cases, general anesthesia. The surgeon typically makes two incisions, one on the outer surface of the foreskin and one on the inner surface, removes the skin between them, and closes the wound with dissolvable stitches. This “sleeve” technique gives more precise control over how much tissue is removed.
Newborns also receive pain management, usually a topical numbing cream or a nerve block injection, though the procedure itself is structurally simpler because the tissue is thinner and more pliable.
Why Circumcision Is Done
Circumcision is performed for a mix of medical, cultural, and personal reasons. On the medical side, the clearest indication is pathological phimosis, a condition where scar tissue forms a tight ring at the opening of the foreskin, preventing it from retracting. This is different from the normal tightness that children have before the foreskin naturally separates. Signs of pathological phimosis include a visible ring of scarring at the foreskin’s tip, a foreskin that was once retractable but no longer is, or a pinhole-narrow opening that causes the foreskin to balloon during urination.
Pathological phimosis is most commonly caused by repeated forceful attempts to retract the foreskin before it’s ready. Doctors usually try a course of steroid cream for six to twelve weeks before recommending surgery. If the cream doesn’t improve the condition, circumcision becomes the standard treatment. Recurrent urinary tract infections are another medical reason circumcision may be recommended.
Large clinical trials in East Africa found that circumcision reduces the risk of female-to-male HIV transmission by approximately 60%. This led the World Health Organization and the CDC to endorse voluntary medical circumcision as a prevention strategy in regions with high HIV prevalence. In everyday settings in the United States, families more often choose circumcision based on cultural or religious tradition, family preference, or hygiene considerations rather than HIV risk specifically.
What Recovery Looks Like
For newborns, healing takes about 10 days. During that time, the penis will look swollen and red, and you may notice a yellowish film at the tip. This film is normal and part of the healing process, not a sign of infection. For adults, recovery is longer: most people heal within two to three weeks, though full recovery can take up to six weeks.
For infants, the main aftercare task is applying petroleum jelly to the glans and the area around the urinary opening after every diaper change. This serves two purposes: it keeps the raw tissue from sticking to the diaper, and it protects the newly exposed urinary opening from irritation. Research suggests continuing this for about six months to reduce the risk of meatal stenosis, a narrowing of the urinary opening that can develop when the glans is exposed to constant friction from diapers.
Adults are typically advised to avoid sexual activity and strenuous exercise for several weeks while the stitches dissolve and the incision site heals. Loose-fitting underwear and keeping the area clean and dry help prevent complications.
Risks and Complications
Circumcision is one of the most common surgical procedures in the world, and serious complications are uncommon. In one cohort study of nearly 500 boys, about 5% of children and 8% of neonates experienced some form of complication, most of them minor.
Bleeding is the most frequent early problem, occurring in roughly 2% of cases. It’s usually controlled with direct pressure or a small additional stitch. Infection is rare, affecting less than 1% of patients. The most common late complication is meatal stenosis, the narrowing of the urinary opening mentioned above, which occurred in about 3% of cases in the same study (4.2% in neonates, 1.6% in older children). Meatal stenosis may not appear for months or even years after the procedure. Signs include a thin, deflected urine stream or straining to urinate.
Warning signs that something isn’t healing properly include a fever above 100°F (38°C), bleeding that doesn’t stop with gentle pressure, foul-smelling discharge or pus, chills, or a baby who hasn’t urinated within 12 hours of the procedure.