Jewish circumcision

Mohels often use some sort of device to keep the glans from being severed.

In Jewish tradition, boys are circumcised on their 8th day of life. The circumcision is conducted by a traditional circumciser called a mohel in a ritual known as a bris. There are three stages in how a traditional Jewish circumcision is performed; these are milah, peri'ah, and metsitsah b'peh.

Milah

The penis after original milah.

The first stage of a ritual circumcision, the initial cut, is called milah in Hebrew. The Hebrew word for "covenant," is brit in the Sephardic pronunciation now used in Israel, or bris in the Ashkenazic pronunciation used over the centuries by European Jews outside of Spain and Portugal, hence the terms brit milah, or bris milah. Most Jewish Americans are familiar with the term "bris," as in "They're having the bris tomorrow." The term bris is well known, but few Jews realize that it means "covenant" rather than circumcision.

Originally, Jewish circumcision, or "milah" only involved the removal of just the tip of the foreskin. This was realized by pulling the loose edge of the foreskin up through a protective device and slicing it off.

The result was a penis that still retained much of the foreskin, with just the tip of the glans protruding.

Peri'ah

At birth, the foreskin is adhered to the glans like a nail to a finger. Peri'ah (a Hebrew word that means "opening") is a second stage that was later added to the original milah procedure, which involves ripping the adhering mucous membrane from the glans, and removing foreskin as far as the base of the glans (AKA the corona) so that it is completely and permanently exposed.

This stage of Jewish circumcision was implemented in the 2nd century by hardline rabbis who wanted to make it difficult for Jewish men to restore. It was customary for Greek athletes at the time to compete naked, and Jewish men were stretching out their foreskins to match their Greek counterparts, from at least as early as the 2nd century BCE.

Metzitzah b'peh

A mohel performing metzitzah b'peh on a newly circumcised infant.

Metzitzah b'peh (a word that means "sucking" in Hebrew) is a third stage of a traditional Jewish circumcision, although nowadays it is perfomed by only a few rigorously Orthodox mohels. In this stage, the mohel sucks on the bleeding penis of the infant with his mouth; this is claimed to reduce bleeding, though the origin and initial significance of this practice is unclear.

In the recent past, it was realized that some mohels were transmitting tuberculosis and syphilis by oral contact with freshly wounded penises, so a modified version of metzitzah b'peh has been introduced, where mohels suck blood through a glass tube, in order to avoid direct contact with the penis.

In 2005, a mohel in New York was found to have infected three newborns with herpes via metzitzah b'peh, one of whom subsequently died. The Health Commissioner of the day, Thomas R. Frieden, basically pardoned Yitzchok Fischer, the mohel in question, and no further action was to be done regarding getting Orthodox leaders to abandon metzitzah b'peh. Frieden's open letter to the Jewish community can be read here.

Defenders of metzitzah b'peh say that there is no proof that it spreads disease at all. In Rockland County, where Fischer lives in the Hasidic community of Monsey, he had been barred from performing oral suction, but the state health department retracted a request it had made to him to stop the practice. And in New Jersey, where he has done some of his 12,000 circumcisions, health authorities have been silent.

According to the Fischer's lawyer, there was no "conclusive proof" that he had spread herpes, and that he should be allowed to continue the practice. According to the mohel, the twin who died and the Staten Island boy both had herpes-like rashes before they were circumcised and were seen by a pediatrician who approved their circumcision (Fischer knew there was a problem and yet he continued?).

How Jewish and non-Jewish circumcision differ

Aside from the ritual aspect, the end result is the same in Jewish and non-Jewish circumcision.

Infant circumcision as it is known in the United States was modeled after the Jewish ritual, in particular, the way the foreskin is completely removed to permanently expose the glans. Although the surgical result is indistinguishable, there are differences in the way that Jewish and non-Jewish circumcision is performed.

Firstly, a Jewish ritual circumcision requires the recitation of appropriate liturgy. According to Jewish religious law, the circumcision surgery by itself is of no validity. A circumcision performed by a doctor at a hospital is not considered valid according to Jewish law; a rabbi would have to inspect the circumcision to see that it is acceptable, and then would have to draw a drop of blood in order for the circumcision to be considered valid.

Secondly, the manner in which the circumcision is performed is different. A mohel will pull as much skin forward as possible through a protective device that is supposed to keep the glans from being severed, and slice it off in a single cut.

A hospital circumcision is more intensive, employing the use of different clamps and devices, such as the Gomco clamp or Plastibell. In the most common procedure, the foreskin is first forcibly separated from the glans with a blunt object; it is then cut lengthwise and pulled through the clamp that will crush the foreskin before it is sliced off. When doctors use a Plastibell device, the foreskin is cut lengthwise in over to fit it over the device; the doctor then uses a string to tie off the foreskin, crushing it against the device. As in peri'ah, all flesh from the base of the glans up to the tip is removed.

It is notable that sometimes mohels may also double as physicians, and perform circumcisions on non-Jewish babies at hospitals using the tools that they use on Jewish boys. The Mogen clamp is a medical device created for use in hospitals, but it was modeled after a traditional barzel device used by mohels.

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  The foreskin is forcibly separated from the glans (a mohel traditionally does this with his fingernails). At hospitals, a clamp device is shoved between the glans and the foreskin; all of the foreskin up to the arrows is removed.
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  Pictured: Mogen device.
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  Pictured: Traditional barzel device.