3. How to do the Milah:[1]
4. Introduction:

Disclaimer: The process of circumcision is a unique medical surgical procedure which may only be performed by an expert Mohel who has studied both the Halachic as well as the medical aspect, and has gained experience as to how it is practicality to be performed in a valid and safe manner. Below is a mere general overview of the process of the circumcision according to Jewish law. Finer details of the process, as well as various different techniques that are used by different Mohalim, is beyond the scope of this Halacha, and can be studied and reviewed from the sources found in the footnote.

The Anatomy:[2] First and foremost, to understand the process of the circumcision one must understand the anatomy of the skin of the penis. Upon birth, the head of the penis [known in Hebrew as the Atara, and in medical terminology as the glans] naturally contains three layers of skin. The first most external layer is known as the foreskin, which is a thick, flexible and retractable piece of skin that surrounds and covers the entire glans head, and is a continuation of the skin that covers over the entire shaft of the penis [i.e. shaft skin]. In Halachic terms this skin is known as the Arla skin. In medical terms it is referred to as the prepuce.[3] Under the foreskin is a thin membrane of skin which rests directly over the glans or head and is independent from the skin of the prepuce. In Halachic terms this skin is known as the Peria skin. In medical terms, it is referred to as the epithelium of the glans. Finally, we have the layer of skin of the actual head or glans. During the process of circumcision, the entire foreskin which covers the glans is removed. Likewise, the epithelium of the glans is removed. The removal of the foreskin is known as the Mila while the removal of the epithelium of the glans is known as the Peria. The Peria must be performed independently after the cutting of the foreskin and not simultaneous with the cutting of the foreskin.[4]

Using anesthetic: In general, the Poskim[5] have negated the use of local or general anesthetic for the sake of the circumcision with exception to extraordinary circumstances.

 

1. The three stages of the Mitzvah:

The Mitzvah of Mila consists of three main stages or parts:

1. Mila
2. Peria
3. Metzitza

1. The Mila process:[6]

1. Hafrada: Generally today, although not Halachically required, the custom is to separate the epithelium of the glans from the glans prior to the circumcision. This is done for medical and procedural reasons, including to ease the performance of the Peria and help with the healing.
2. Tefisa:[7] Prior to the circumcision, the Eiver is slightly hardened, and the foreskin is grasped and stretched above the head or glans [i.e. Atara] to prepare it for cutting away from the glans for reasons of safety to prevent injury. One includes with it some of the skin of the Peria. Enough of the foreskin must be pulled up and cut so the child is considered probably circumcised. This refers to the entire foreskin that covers the glans up until it’s ring.
3. Mogen: The foreskin that was grasped and stretched above the glans is then held in place using a specially made protective clamp [i.e. Mogen] which ensures that only this area of skin will be cut and prevents injury to the glans Chas Veshalom. There exist various different types of clamps, with some more tight than others, which prevent blood from coming out. Many of these more tight clamps have been prohibited by Gedolei Haposkim to be used due to various reasons.[8]
4. Blessings: The blessing over the circumcision is now recited by the Mohel. See chapter 9 Halacha 22!
5. Cutting of Mila:[9] After the blessing is recited, the foreskin that covers over the Atara and has been positioned above the Atara with the use of the clamp is now severed until the Atara becomes revealed. It is to be cut from the outer side of the clamp. There are different approaches regarding how the cutting is to take place, with some saying that it should be a form of pressing down with a knife [i.e. Derisa] and others saying it should be done with sliding the knife [i.e. Holacha]. Some say that one should do the cutting from below to above and not from above to below.
6. Blessing of father: At this stage, the father recites the blessing prior to the Peria. See chapter 9 Halacha 22!

1. The Peria process:[10]

When: Immediately after the foreskin is cut, the Mohel is to quickly perform the Peria.[11] The Peria must be performed independently after the cutting of the foreskin and not simultaneous with the cutting of the foreskin.[12] [This comes to negate those who have modernized and reformed the order of the circumcision by performing both the Mila and Peria simultaneously, by cutting them both at the same time.[13]]

Using nail: [14] The Peria is to be performed by the Mohel using his nail [and not by the use of scissors or any other utensil[15]]. [The Mohel uses two of his nail to cut the thin membrane covering the Atara glans until the skin of the glans becomes visible. This is done by entering the nails in between the membrane and glans. There are various methods of how this tearing of the membrane skin is to take place using the nails and as to the order of entering the nails.]

Tearing skin: The skin must be actually torn and it does not suffice to simply stretch it below the glans. After the skin is torn it is then stretched and folded over the shaft below the glans.

1. The Metzitzah process:[16]

Immediately after the Peria is done, the Mohel is to quickly perform the Metzitza.[17] The Metzitza is to be performed by the Mohel sucking the Mila until blood comes out from all the inner areas of the limb.[18] [By a circumcision [sucking the blood of the circumcised area] was only permitted because [lack of doing so] poses danger.] Any Mohel who refuses to perform the Metzitza is to be fired.[19]

With the mouth:[20] The Metzitza is an integral part of the Mitzvah of circumcision and must be performed specifically with the mouth. It may not be performed using a tube. A Mohel who refuses to perform the Metzitza with his mouth and desires to use a tube to do so, is not to be allowed to circumcise.[21] [Nonetheless, if it is not possible to perform the Metzitza with his mouth, such as due to refusal of the parents to permit a circumcision to take place with it, then it is better for the Metzitza to be performed using a tube then for it to not be performed at all. In such an event, one is to use a glass tube which contains a small ball of cotton that has a disinfection agent absorbed in it.[22]]

Wine:[23] Some are accustomed to place wine in their mouth prior to performing the Metzitza. Others do so only after the Metzitza, and others actually pour it onto the Mila prior to performing the Metzitza.

Spitting the blood into earth:[24] The blood that is sucked into the mouth by the Mohel during the process of Metzitza is to be spat into earth or sand. [Practically, it is spit into the earth or sand that is already prepared in a cup for the sake of burying the foreskin.]

1. The bandaging process:[25]

At the conclusion of the circumcision the area is bandaged after the application of medicinal ointment of which its purpose is both to help stop the bleeding, as well as to protect it from infection and help it heal. Its purpose is also to ensure that the membrane of the glans does not stretch back up over the glans and remains over the shaft. [Prior to bandaging the area, one is to ensure that the membrane has not accidentally reached over the glans and that the entire glans is exposed. Likewise, is to make sure that there is no leftover foreskin that has yet to be removed. There are various methods in how the bandaging is done and regarded which ointments to use.]

1. Leftover pieces of the foreskin:[26]

After the circumcision there at times remains pieces of the foreskin. At times these pieces invalidate the Mitzvah from being fulfilled. In other times, these pieces of skin do not invalidate the fulfillment of the Mitzvah, even though they are initially required to be removed. This depends on how much of the foreskin his remained. In all cases of question and doubt one is to consult with a Mohel.

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[1] See Michaber Y.D. 264:3; Mila Sheleima chapter 4; Pesakim Uteshuvos 264:10-23; See Encyclopedia Talmudit Vol. 46 Erech Mila p. 432-441; 462-483

[2] See Pesakim Uteshuvos 264:10

[3] The foreskin contains both an outer and inner part. In medical terms, the inner part is referred to as the inner foreskin, or inner mucosa or preputial mucosa. While the outer part is referred to as the outer foreskin, or outer mucosa. In general, both of the skins are referred to as being part the foreskin or prepuce, and hence the foreskin or prepuce contains two parts, an outer layer, and an inner layer. Both of these parts are cut off during the circumcision.

[4] Michaber ibid “and afterwards do Peria”; Rambam Mila 2:2; Zohar 1:13; Igros Kodesh 15:92; Sefer Mal Velo Para of Rav Mnashe Klein; Shevach Baris 18:6

[5] See Pesakim Uteshuvos 264:16 footnotes 132-133; Igros Kodesh 15:344; Likkutei Sichos 10:48

[6] See Pesakim Uteshuvos 264:10; See Encyclopedia Talmudit Vol. 46 Erech Mila p. 432-441; 462-469

[7] See Aruch Hashulchan 264:17

[8] See Igros Moshe Y.D. 2:119; Shulchan Menachem 5:130-132; Poskim in Pesakim Uteshuvos 264:10 footnote 11

[9] See Pesakim Uteshuvos 264:11

[10] Michaber Y.D. 264:4; See Pesakim Uteshuvos 264:12-13; See Encyclopedia Talmudit Vol. 46 Erech Mila p. 409-413 footnotes 81-122; 469-471

[11] Siddur Admur; Michaber Y.D. 264:3;  Kuntrus Hasiddur of Gra”ch Na”ah 11; Shevach Baris 18:6

[12] Michaber ibid “and afterwards do Peria”; Rambam Mila 2:2; Zohar 1:13; Igros Kodesh 15:92; Heichal Menachem 3:244; Shulchan Menachem 5:130; Sefer Mal Velo Para of Rav Menashe Klein; Shevach Baris 18:6

[13] See Pesakim Uteshuvos 264:13; Igros Kodesh 15:92

[14] Michaber ibid

[15] Bnei Tziyon 88 that performing it with one’s nails is a tradition from our forefathers which goes all the way back to Moshe, and is similar to the tradition of the identity of the four species used on Sukkos; See Pesakim Uteshuvos 264:13

[16] Michaber Y.D. 264:3; 328:53; Admur 328:54; 331:1; Shabbos 133b; Shevach Baris 18:6; Pesakim Uteshuvos 264:14-15; See Encyclopedia Talmudit Vol. 46 Erech Mila p. 472-476

[17] Siddur Admur; Michaber Y.D. 264:3;  Kuntrus Hasiddur of Gra”ch Na”ah 11; Shevach Baris 18:6

[18] Michaber Y.D. 264:3; Admur 328:54; 331:1; Shabbos 133b

The reason for Metzitza: Metzitza must be performed in order to suck out the blood from the distanced areas of the limb in order to prevent danger to the child. [Michaber Y.D. 264:3; Admur 328:54; 331:1; Shabbos 133b] See also Pesakim Uteshuvos 264:13 footnotes 108-111

[19] Michaber ibid

[20] See Binyan Tziyon 23;24; Maharam Shick Y.D. 244; Mahariy Asad Y.D. 258; Tzafnas Paneiach 2:152; Sdei Chemed Kuntrus Hametzitza; Igros Kodesh Rashab 1:387; Igros Kodesh 3:176; 15:92; Shulchan Menachem 5:132; Shevach Baris 18:6 ; Pesakim Uteshuvos 264:15 in length

No known health risk: Experience from the past thousands of years shows that there is no worry of danger involved in performing the Metzitza directly with one’s mouth. [Igros Kodesh Rashab 1:387 based on Meishiv Nefesh; Maharam Shick ibid]

[21] Igros Kodesh Rashab 1:387

[22] Igros Kodesh 15:341; Kefar Chabad vol. 708 p. 166; ; Sdei Chemed; Chasam Sofer; See Pesakim Uteshuvos 264:15 footnotes 122-124

[23] Pesakim Uteshuvos 264:13 footnotes 113-116

[24] Rama  Y.D. 260:10; Maharil Hilchos Mila; Levush 260; Shevach Habris 18:6; See Pesakim Uteshuvos 265:25

[25] See Michaber Y.D. 264:3; Admur 331:1; Shabbos 133b; Pesakim Uteshuvos 264:16; See Encyclopedia Talmudit Vol. 46 Erech Mila p. 476-477

[26] See Michaber Y.D. 264:5; Admur 331:2; Pesakim Uteshuvos 264:17-20; See Encyclopedia Talmudit Vol. 46 Erech Mila p. 432-441; 477-483