Jewish males are traditionally circumcised on the eighth day after birth. However, if the procedure was not performed on the eighth day, it is to be carried out later. In fact, the first circumcision in the bible, that of Avraham, was performed when he was an adult (Genesis 17:24). The decision to undergo circumcision demonstrates ones recognition of the significance of being a member of the Jewish nation and highlights ones commitment to tikkun olam, partnering with God in the perfection of the world.
Brit Milahon the eighth day after birth is a simple procedure that can be performed by a properly trained individual (not necessarily a doctor), without anesthesia and hospitalization. Adult circumcision, on the other hand, is a significant surgical procedure. Even so, the concern many uninformed candidates have about the procedure and recovery is misplaced. The factual information that follows is meant to minimize your fears and alleviate stress during the period leading up to and following the procedure. Jewish tradition attaches great importance to the health of every human, and sees it as a religious obligation to do the brit milah according to accepted medical guidelines that govern similar surgical procedures.
Please note: The following description is relevant for men who were never circumcised. A man who was circumcised previously need not undergo an additional circumcision. Rather, it is customary for him to have hatafat dam habrit – the trickling of blood – a simple procedure that can be performed by an experienced mohel, not necessarily a doctor.
Who and When?
Israel, surgeons certified by an inter-ministerial committee that supervises mohalim may perform a brit milah on an adult. The committee is comprised of representatives of The Ministry of Health and the Ministry of Religion. Doctors they certify combine medical expertise with knowledge of halacha, traditional Jewish practice. (Outside of Israel, it is more difficult, but no less important, to find a doctor familiar with halacha.)
The procedure takes place in hospital operating rooms certified by the Ministry of Health.
Preparations for the Procedure:
• Medical certificate – Before the procedure is performed, you must ask your family doctor (or pediatrician) for a physical exam and blood tests. The tests should include a blood count and a measure of blood clotting. The doctor will then issue a certificate that you can safely undergo the procedure, and will refer you to an appropriate hospital.
• Hospital arrangements – You should contact a hospital that works with your Kupat Cholim (medical insurance fund) well in advance to set a date for the procedure, and to arrange for someone to be with you during the circumcision, if you so desire.
• Designing the ceremony – If you would like to emphasize the traditional-ceremonial aspect of the Brit Milah – prepare for this in advance. For example, you may invite friends and family to the first part of the ceremony.
The Day of the Brit
Fasting: You will probably be told to come to the hospital after having fasted (both fluids and solids) for about six hours before the operation. This is especially important if you are to undergo a general anesthesia.
Packing: Remember to bring: an identifying document, your doctor’s certificate that you are fit to have the procedure, results from your blood tests, wine and a wine-cup (for the ceremonial blessings), the text of the ceremony for your guests.
People Present During the Procedure
The staff in the operating room during the procedure will include the surgeon, the anesthesiologist and the operating staff. Some (not all) hospitals also allow you to bring someone of your choice to accompany you. When an infant is circumcised, the sandak (godfather) holds the baby on his knees and secures his legs during the circumcision. For an adult circumcision, the sandak has a different role, and he can sit next to you, hold his hands by your head, cheer you up, and so on. This must be coordinated with the operating staff in advance!
With children until about 10 years of age, the procedure is done under general anesthetic. When it comes to adults, this decision depends on the surgeon. The anesthesia is administered by injection with a very small needle. While lying on the operating table you will feel a few pricks, and after that the doctor will make sure that the area is in fact numb.
The person to be circumcised lies in the operating room on the operating table, and the staff starts the preparations for the circumcision. The preparations include disinfecting the area, and sometimes shaving and injecting the anesthetic. You may feel cold or shaky, but not pain. The doctor removes the foreskin and then closes the blood vessels that were cut, and stitches up the sides of the cut to each other. The stitch is usually sewn with dissolving thread that should dissolve within two to three weeks, so there is no need to have stitches taken out. The doctor usually puts a bandage over the wound, which can be removed after a day or two at the Kupat Cholim. Alternatively, you could go back to the operating doctor for a follow-up check. After the brit you will be transferred to the outpatient unit for a few hours. When you leave the medical center you will be given an official release form and a medical certificate allowing you to rest at home for the next few days.
The adult circumcision is a rare combination of a religious ceremony and a medical procedure. The ceremony varies from place to place and depends largely on hospital policy. If you have any preferences-insist on them! As opposed to the ceremony for an infant, where the baby’s father, the mohel, and others read most of the verses (psukim) and blessings (brachot), in an adult ceremony the person being circumcised is the active party, and he says most of the texts.
Before entering the operating room, the first part of the ceremony is said. If relatives or friends accompany you, you can say the psukim aloud and they repeat some of them after you. These psukkim describe the Jewish belief in one eternal G-d, and ask Him for success and salvation.
After the Brit
Children: Children usually wake up from the general anesthetic crying a lot. The crying is not a result of pain, since in addition to the general anesthetic, the doctor also numbs the area of the circumcision with a local anesthetic that only wears off after a few hours. During the first hour the child will calm down. For the next few days you can give the child painkillers, such as Acamol, according to the dosage your doctor recommends.
Adults: The local anesthetic wears off after a few hours, depending on the amount of numbing fluid injected. You may take painkillers, such as Acamol and Optalgin according to dosage recommended by your doctor. After 24 hours you will probably be able to function normally and feel little – if any – unusual pain. Nonetheless, it is recommended that you rest during the next few days. You should wait a month after the procedure before engaging in sexual activity, unless your doctor has otherwise directed you. You may also experience spontaneous erections, especially when waking up, which can cause pain.
Side Effects: Common side effects include puffiness of the ‘crown’ of the penis, bruising on the penis and a yellowish-white discharge. These side effects usually subside after two-three weeks and are no cause for concern.
Unusual Side Effects: In the event that the wound is bleeding extensively or there is a massive collection of blood under the stitches, causing the penis to puff up extensively – you should to go back to the medical center where the circumcision took place, or to the emergency room. If you have a fever of over 38 degrees Celsius – you should call your doctor. If you cannot reach your doctor, you should go to the emergency room.