cosmetic

Circumcision: Everything You Need to Know

By Dr. Adeeb Alshahrour · August 4, 2023

Circumcision is the surgical removal of the foreskin, the sleeve of skin covering the head of the penis. It is one of the oldest and most common procedures performed anywhere in the world — and one of the most argued about.

This guide covers what the procedure actually involves, how pain is controlled, what the evidence says about benefits and risks, how recovery works day by day, and the genuine arguments on both sides. It is written for parents deciding for a newborn and for adults considering the procedure for themselves.

Why circumcision is performed

In the United States, circumcision is most often an elective decision made by parents for religious, cultural, or family reasons, not a medical necessity. It is a long-standing religious obligation in Jewish and Muslim communities and a cultural norm in many others.

It is also performed for genuinely medical reasons at any age:

Phimosis — a foreskin that cannot be retracted, causing pain, difficulty urinating, or recurrent inflammation.
Paraphimosis — a retracted foreskin trapped behind the glans. This is a urological emergency.
Recurrent balanitis or balanoposthitis — repeated inflammation or infection of the glans and foreskin.
Recurrent urinary tract infections, particularly in infants with an underlying urinary tract abnormality.

The distinction matters. A medically indicated circumcision is treatment. An elective newborn circumcision is a parental choice, and it deserves to be made with accurate information rather than assumption.

What the American Academy of Pediatrics actually says

The most frequently misquoted position in this whole subject. In its 2012 policy statement, the American Academy of Pediatrics concluded that the health benefits of newborn male circumcision outweigh the risks — but that those benefits are not great enough to recommend universal newborn circumcision. The AAP's position is that the decision belongs to parents, in light of their own religious, ethical, and cultural beliefs, and that the procedure should be covered by insurance when families choose it.

Two things follow from that, and both are frequently lost:

Nobody with authority is telling you that you must circumcise.
Nobody with authority is telling you that it is harmful when performed properly with adequate pain control.

The AAP also states plainly that adequate analgesia should be provided whenever circumcision is performed. That is not optional, and it is the single most important quality question to ask your provider.

What to expect during the procedure

Pain control — ask about this first

You may read that circumcision "is performed under anesthesia." That is what should happen, but it is not a universal guarantee, and historically many newborn circumcisions were performed with inadequate pain relief. Ask directly what will be used. The accepted options are:

Dorsal penile nerve block — a local anesthetic injection, the most effective option and the one most commonly recommended.
Ring block — local anesthetic infiltrated circumferentially around the shaft; comparably effective.
Topical anesthetic cream (such as lidocaine-prilocaine) — less effective on its own, and it must be applied well in advance to work.
Sucrose on a pacifier and swaddling are useful comfort measures for newborns, but they are not a substitute for a nerve block.

Older children and adults are typically treated under local anesthesia, sometimes with sedation or general anesthesia depending on age and circumstances.

The steps

Consultation and consent — medical history, examination, and a discussion of the risks, benefits, and alternatives. Certain conditions, such as hypospadias, mean a newborn circumcision should be deferred.
Anesthesia — the block is placed and given time to take full effect before anything else happens.
Antisepsis — the area is cleaned and draped sterile.
Removal of the foreskin — using one of the techniques below.
Hemostasis and dressing — bleeding is controlled and the wound is dressed, usually with petroleum gauze.
Observation — the patient is watched for bleeding and, in newborns, for normal urination before discharge.

The techniques

Gomco clamp — a metal bell and clamp compress the foreskin to control bleeding before it is removed with a scalpel. A long-standing standard for newborns.
Mogen clamp — a slotted clamp; fast, and widely used in ritual and clinical settings.
Plastibell — a plastic ring is placed over the glans and the foreskin tied off over it. Nothing is clamped afterwards: the ring and the devitalised tissue separate and fall away on their own, typically within 5 to 10 days. Common in infants.
ShangRing — a two-ring device used mainly in adolescent and adult circumcision programs; the device is removed after roughly a week.
Conventional surgical (sleeve or dorsal slit) — freehand excision with sutures. Standard for older children and adults, and for revisions.

A note on "laser circumcision." Procedures marketed under this name generally do not use a true surgical laser at all — they use an electrocautery or thermal cautery device to cut and seal simultaneously. The name is a misnomer that persists in advertising. If a clinic offers "laser circumcision," ask exactly what instrument is used. Cautery techniques require particular care in infants, and the marketing claim of a "bloodless, painless laser" is not an accurate description of the procedure.

Benefits: what the evidence supports

Circumcision has real, measurable benefits. They are also frequently overstated. Here is where the evidence actually stands:

Urinary tract infections in infancy. The best-established benefit. Circumcision reduces the risk of UTI in male infants by roughly a factor of ten. But the baseline risk is low — around 1% in uncircumcised boys — so in absolute terms roughly 100 circumcisions prevent one UTI. The benefit is far greater for infants with a known urinary tract abnormality.
HIV acquisition. Three randomised controlled trials in sub-Saharan Africa found that circumcision reduced female-to-male HIV transmission by approximately 50–60%, which is why WHO and UNAIDS recommend voluntary medical male circumcision in high-prevalence settings. This does not transfer directly to the United States, where prevalence and transmission patterns differ, and the trials did not show protection for men who have sex with men. Circumcision is not a substitute for condoms.
Other sexually transmitted infections. Evidence supports a reduced risk of HPV, herpes simplex type 2, and genital ulcer disease. Evidence for syphilis, gonorrhea, and chlamydia is weaker or inconsistent.
Penile cancer. Invasive penile cancer is rare in the United States (roughly 1 per 100,000 men per year) and is less common in circumcised men. Because the disease is so rare, the absolute benefit is very small.
Cervical cancer in female partners. Reduced HPV carriage is associated with lower cervical cancer risk in partners. HPV vaccination is a far more direct and effective intervention for that.
Phimosis and balanitis. Circumcision eliminates the risk of phimosis and substantially reduces recurrent balanitis.

What the evidence does not support: a meaningful protective effect against prostate cancer. Some studies have suggested an association, but the data are inconsistent and confounded, and this should not factor into the decision.

Risks and complications

Complication rates for newborn circumcision performed by trained providers are low — on the order of 0.2% to 2%, with most complications minor and easily treated. Rates are higher when the procedure is performed later in life or outside a clinical setting.

Bleeding — the most common complication. Usually minor and controlled with pressure. Ask about any family history of bleeding disorders beforehand.
Infection — uncommon with sterile technique; watch for spreading redness, warmth, pus, or fever.
Adhesions and skin bridges — the residual skin adhering to the glans. Often resolves on its own; occasionally needs a minor procedure.
Meatal stenosis — narrowing of the urethral opening, appearing months to years later. Reported in a minority of circumcised boys.
Too much or too little skin removed — a cosmetic or functional outcome that may require revision.
Buried or trapped penis — more likely in infants with significant suprapubic fat.

Sensitivity and sexual function. This is genuinely contested. Some studies report reduced fine-touch sensitivity of the glans; large studies of sexual satisfaction and function have generally found no significant difference. Anyone who tells you the evidence is settled in either direction is overstating it.

Recovery and aftercare

Newborns

Most of the healing happens in the first week to ten days.

Expect a yellowish film over the healing glans within a couple of days. This is granulation tissue, part of normal healing — it is not pus and should not be scrubbed off.
Cleaning — plain warm water at each diaper change. Avoid soap on the wound, wipes containing alcohol or fragrance, and any scrubbing.
Dressing — apply petroleum jelly generously at every diaper change for the first several days so the wound does not stick to the diaper. With a Plastibell, do not apply ointment unless your provider directs it, and never pull on the ring — let it separate on its own.
Comfort — swaddling, feeding, and a loose diaper. Ask your provider before giving any pain medication to a newborn.
Bathing — sponge baths until the wound has healed, or as directed.

Older children and adults

Time off — plan on 2 to 3 days of rest; most adults return to desk work within a few days.
Pain — expect soreness for several days. Acetaminophen or ibuprofen is usually sufficient. Ice packs over clothing, in short intervals, help with swelling.
Clothing — snug, supportive underwear reduces movement and swelling. Avoid loose boxers early on.
Activity — no heavy lifting, cycling, swimming, or strenuous exercise for about two weeks.
Sexual activity and masturbation — avoid entirely for four to six weeks, or until cleared. This is the instruction people most often ignore and most often regret.
Erections — nocturnal erections are uncomfortable in the first week and can pull at the sutures. This is normal and settles.

Call your provider if you see

Bleeding that soaks through a dressing or does not stop with ten minutes of gentle pressure
Spreading redness, warmth, swelling, or foul-smelling discharge
Fever — in an infant under 3 months, any temperature of 100.4°F (38°C) or higher is an emergency
No urination for 8 to 12 hours after the procedure
A Plastibell ring that has not separated after 10 to 14 days, or that slips onto the shaft
Pain that worsens rather than improves after the first few days

Circumcision and hygiene

Hygiene is the most-cited benefit and the most exaggerated one. Both statements below are true at the same time:

An uncircumcised penis can be kept perfectly clean. It requires gently retracting the foreskin and rinsing with warm water — no soap needed under the foreskin, which is easily irritated.
Circumcision removes the warm, moist space where smegma, moisture, and bacteria collect, so it makes hygiene simpler and reduces the risk of balanitis and smegma buildup.

One point for parents that matters more than any of this: do not retract an infant's foreskin. In newborns the foreskin is naturally fused to the glans and separates on its own, often not until several years of age and sometimes not until puberty. Forcing it causes pain, scarring, and can create the very phimosis it was meant to prevent. Wash the outside only.

The debate, fairly stated

This is a decision where reasonable, informed people disagree. Both cases deserve to be stated honestly.

The case for:

Measurable reductions in infant UTI, HIV and some STI acquisition, phimosis, and penile cancer.
Complication rates are lowest in the newborn period, and healing is fastest then.
For many families it is a religious obligation or a matter of cultural identity and continuity, which is a legitimate reason in its own right.
If it is going to be done at all, doing it in infancy avoids a more involved procedure, general anesthesia, and a longer recovery later.

The case against:

Bodily autonomy. An infant cannot consent to a permanent, irreversible alteration. This is the strongest argument against elective newborn circumcision, and it is an ethical argument that no amount of medical data answers.
The absolute benefits are small in a developed country with good hygiene, healthcare access, HPV vaccination, and condom use.
Every surgical procedure carries risk, and this one is usually not medically necessary.
Most European medical bodies do not recommend routine newborn circumcision, and several have argued against it — a real difference of professional opinion, not a fringe view.

Our position is straightforward: we perform circumcision competently and with proper anesthesia for families who choose it, we do not pressure anyone toward it, and we would rather you decide with the actual numbers in front of you than with either side's rhetoric.

Preparing for the procedure

Consultation — medical history, medications, bleeding disorders in the family, and an examination to confirm the anatomy is suitable.
Timing for newborns — usually within the first few days of life, once feeding and vitamin K administration are established. Premature or unwell infants are deferred.
Fasting — required only if sedation or general anesthesia is planned; your provider will tell you.
Medications — blood thinners and some supplements may need to be paused. Do not stop a prescribed medication without instruction.
Transport — arrange a ride if you are having sedation.
At home beforehand — have petroleum jelly, gauze, acetaminophen or ibuprofen, and supportive underwear ready.

Circumcision at the Women's Health Center of Chicago

Dr. Adeeb Alshahrour performs circumcision for newborns, children, and adults at our Chicago practice, with appropriate anesthesia in every case, and speaks Arabic, English, and Spanish with patients directly.

Read about our circumcision service
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Medical disclaimer

This article is general health information, not medical advice for any individual. Decisions about circumcision should be made in consultation with your own clinician, who can assess the specific circumstances. If you are dealing with a paraphimosis, an infant who has not urinated after the procedure, or bleeding that will not stop, seek care immediately rather than reading further.