OB Guideline 33: Newborn Male Circumcision

Circumcision is the surgical removal of the foreskin of the penis. In the neonatal period, this is an elective procedure performed at the request of the parent(s).

Each institution will develop guidelines for circumcision, including:

• Contraindications, e.g., abnormal genital structure, prematurity
• Requirements for ascertaining normal physical examination of the infant prior to procedure
• Preparation for procedure, including obtaining consent (using a form specifically for circumcision)
• Time-out (surgical pause) is required prior to the procedure to confirm the patient and the presence of completed consent
• Pain relief: injection anesthetic, such as dorsal penile nerve block or subcutaneous ring block, is expected unless the parent declines; should the parent decline injection then use of a topical anesthetic agent may be considered; swaddling, oral sucrose, and acetaminophen administration may be considered for comfort of the newborn during the procedure but are not sufficient as a sole method of analgesia¹
• Documentation
• Qualifications of performing clinicians

Pediatric providers, obstetrical providers, and nurses should all be involved in the development/approval of guidelines.

Each institution will track short-term complications of the procedure, including the type of complication, the method of circumcision, and the performing clinician.

1. American Academy of Pediatrics; American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 8th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.