Before the circumcision begins, the baby's stomach is lavaged (pumped) clear, as a precaution against him vomiting over his own operation.
Few, if any, babies are given general anaesthetic prior to circumcision. In fact general anaesthetic and EMLA cream are both contraindicated for newborns.
Note the position of the baby's corona, less than half way along his penis, which gives some indication of the large size of his foreskin relative to his penis.
Dorsal Penile Nerve Block (DPNB) is given in three injections. While it numbs the dorsal surface, the frenulum is innerveted from below by the perineal nerve - so even "anaesthetised" babies often scream when their frenulum is being cut. "Discomfort" is a euphemism for pain, which is not just post-operative, but peri-operative (throughout and after the operation). While the AAP recommends local anaesthetic, it is still used in only a minority of cases. The injections wear off after the operation, and other analgesics must be given.
All this attention to the penis tends to cause an erection. One video of a circumcision shows the doctor's gloved fingers stroking the baby's penis, apparently in order to cause one (because it does). The baby's foreskin does not retract because it is usually attached to the glans. To immediately follow this pleasure with searing pain seems likely to set up a confusing connection in his erotic make-up. It would not be surprising if sado-masochism resulted.
"Retraction" is very much a euphemism. In some boys, the foreskin may only need to be retracted, but in most, a probe must be pushed around between the foreskin and the glans, tearing the synechia away. That accounts for the raw, bloody appearance of the glans shown here and in the following pictures. If this is done wrongly it can cause a variety of damage, such as urethral fistula, a second opening to the urethra. This process may also tear the baby's frenulum, resulting in a variable loss of erogenous tissue.
The penis must be left in the clamp (haemostat) for a minute to ensure that crushing of the tissues and exclusion of blood is complete. It is at this point that the doctor is in danger of cutting off the baby's glans, or part of it. More recently, bone forceps have been used instead of the clamp. In freehand circumcisions, that danger is much greater; when a bell is used to cover the glans, it is less. Note that the actual cutting is not shown.
The sides of the wound adhere to each other. If they are not prevented, they will later adhere to the raw glans, creating skin bridges. A circumcised penis, contrary to popular opinion is not "maintenance free".
The small cut edge of the shaft skin not apposed to mucosa will produce an unaesthetic tag when it heals.
Or large points of bleeding. Haemorrhage is one complication of circumcision, and a baby can lose a fatal proportion of his blood with terrifying rapidity. He only has a breakfast-cupful - 300ml. A baby is deemed to need a transfusion after losing 10% of that - 30ml, about a serving-spoonful.
Note first the blood on the surgeon's fingers.
The amount of "excess" mucosa trimmed is at the doctor's whim. This determines whether the circumcision will be low or high. If (s)he then choses to trim more outer skin, that will determine whether it is loose or tight, though he may have no idea what the consequences of his actions to the adult will be. It is also at this point that he may decide to take more of the frenulum, with unpredictible effects on the man's sexual functioning.
Note the additional blood on the surgical drapes.
... and the beginning of the penis's owner's life with it. The raw appearance of the glans is particularly clear here. The shaft has already begun to swell below the stitches.
This sequence does not of course show the follow-up care required, nor the outcome in the man. You may see some outcomes at these pages;