We would like the reader to close their eyes for a few seconds-imagine the birth of your son, imagine him being taken away shortly after birth for a routine circumcision (the most common medical procedure in the us and worldwide) and imagine a doctor telling you shortly thereafter that a horrific (a 1 in a million complication ensued) a slippage event during the removal of the foreskin occurred, puncturing the femoral artery. and he didn’t make it. Now also imagine being that doctor, who just finished medical school perhaps and was finally entering into the reality of a lifelong dream, of saving lives-he could not save that 1-day old infant but instead played an active role in his death. Now imagine being told, that these incidents occur exceedingly far more frequently than 1/million, and this could have been prevented with a device that costs about 6 dollars to make. Through a visceral thought experiment, readers are invited to imagine the unimaginable: the loss of a newborn due to a preventable surgical error, and the parallel trauma experienced by the physician involved. The narrative underscores the frequency and severity of such incidents, challenging the assumption that they are exceedingly rare. It introduces a low-cost, purpose-built device designed to eliminate the risk of slippage events during circumcision. More than a technical solution, it represents a paradigm shift—protecting not only infants, but also families and clinicians from lifelong psychological harm. This work advocates for the integration of simple, effective innovations into standard practice to prevent tragedy and preserve the integrity of care.

The oldest mention of circumcisions can be found as a biblical reference, where it was established as a prominent practice in the Abrahamic lineage, and has since become a cultural inheritance, see Figure 1 [1] [2] . The Hebrew Bible, particularly in Genesis, mentions that Abraham was commanded by God to circumcise himself and his descendants, establishing it as a covenant between God and the Israelites [2] - [4] . In contrast early Christians, including the Apostle Paul, argued against the use and need of circumcision for followers of Jesus and because of these differing opinions the Council of Jerusalem (around 50 CE) decided that Gentile population did not require circumcision [1] - [4] .

Historically, circumcision has been a strong component of Jewish identity and religious practice; known as Brit Milah, is carried out on the eighth day of life [2] [3] . However, it also has had an impact in other communities as it was practiced among some Canaanite and Phoenician communities in the ancient East. Additionally, Aboriginal Australian groups also practiced circumcision, these practices were linked to initiation rites and social norms. Circumcision appears to have been practiced in ancient Egypt as well, as early as 2300 BCE, with the practice of this rudimentary procedure depicted in Egyptian tombs and described in historical records. In Islam, in the Sunnah population in particular, circumcision is often recommended rather than required and often performed for cultural, and hygienic reasons, in infancy or early childhood [2] . Other communities, the Greeks, for example, did not practice circumcision-review of their early literature shows that the practice was viewed at with disdain, and at best with curiosity. Lastly, in some African cultures, circumcision is part of initiation rites and traditional practices [2] [5] . These early practices and varying traditions have led largely to the vast array of cultural preferences seen today [2] [5] .

In the modern era, circumcision during the neonatal stage has become popular in Western countries due to its perceived health benefits, including improved hygiene-particularly the prevention chronic soft tissue infections [4] [6] [7] . Additionally, studies suggest additional benefits such as a reduced risk of urinary tract infections and sexually transmitted infections [7] - [9] . Recently, however, the medical necessity for neonatal circumcisions has become controversial with arguments focusing on the ethical and cultural considerations given what controversial medical data available to refute its need [10] [11] . Notably, recent studies in the United States have argued against the medical benefits as minimal and not sufficient to overcome the ethical dilemma of performing an unnecessary, potentially risky and harmful surgical procedure on a non-consenting newborn [8] [10] [12] . Although for largely cultural reasons the US had seen a large portion of parents electing to circumcise their newborn these ethical stances continue to evolve the conversation, with advocates for, arguing strongly for informed parental choice and respect for cultural and religious traditions, while critics emphasize bodily autonomy and potential lifelong risks [11] [12] . Moreover, in most European and Asian countries, neonatal circumcision is less common and often performed for religious or cultural reasons rather than routine practice [8] [12] . In contrast, circumcision remains widespread in Jewish and Islamic communities, and it is continually practiced in some African cultures as part of initiation rites.

This table presents a comparative overview of the potential medical, psychological, and ethical risks and benefits associated with neonatal circumcision. It includes short-term and long-term considerations, highlighting both individual and public health perspectives. The data reflect current literature and clinical consensus, while acknowledging ongoing debate and variability in outcomes across populations.

Most circumcision, are performed during the neonatal stage, the procedure involves the surgical removal of the foreskin, or, the flap of skin covering the glans (head) of the penis, from an infant’s penis. Currently, there are various techniques are used, including the Gomco clamp, Plastibell device, and Mogen clamp, with the Gomco clamp method largely making up the bulk of these [14] [15] . The choice of method usually depends on the medical provider’s training practices and the preferences/comfortability [14] . The Gomco clamp was developed in the early 20th century by Dr. David G. Gomco and has become the most widely adopted method due to its effectiveness and simplicity. Since its introduction into the medical field, the Gomco clamp has undergone refinements and in the United States, it is now considered a standard tool for neonatal circumcision [14] . Favorability of this technique is due to users’ control of precision, which minimizes bleeding risk, when used properly. However, like all surgical procedures, it carries inherent risks and requires skilled physicians with significant clinical experience to achieve optimal aesthetic outcomes [14] [15] .

The structure of the surgical instrument itself consists of a metal clamp and a bell-shaped structure that fits over the glans (head) of the penis. In its entirety it includes a base plate, a clamping mechanism, and a bell (a rounded metal part that shields the glans), which varies in size, matches to individual penis size [15] . Mechanistically, during the procedure, a size appropriate bell is placed over the glans of the penis, and the foreskin is pulled over the bell. The clamp is then applied, compressing the foreskin against the bell. Once in correct placement and secure a cutting blade is used to remove the foreskin around the clamp. The clamp’s design helps minimize bleeding by compressing the foreskin’s blood vessels before cutting. In this assembled form, this process ensures that the glans is protected and that the cut is clean, with a perceived aesthetic benefit, from a cultural perspective. After cutting of the foreskin, the clamp is removed, and any remaining tissue is trimmed. The wound is then dressed to promote healing and the infant is monitored for any immediate complications, such as bleeding.

Neonatal circumcisions are performed during the first or second day of life, with parental consent [16] . Ethical concerns arise about the infant’s ability to consent and the potential for irreversible outcomes, including deformity, or in rare cases even death [16] [17] . Though most of the non-medical community have come to understand circumcision as a benign, trivial procedure, it is in fact a surgical procedure that is not itself without risk [16] - [18] . Critics argue that infants cannot consent to the procedure and question the ethics of performing surgery on a non-consenting individual, especially given the risks [18] . In a consenting adult, the choice to undergo any invasive procedure is weighed against the health benefits. The health benefits of circumcision are still largely debated and even in those that do believe they exist, some still argue that the benefits do not justify routine circumcision for the sake of aesthetics and cultural preference [17] . Various medical organizations, including the American Academy of Pediatrics (AAP), provide guidelines on circumcision. The AAP acknowledges potential health benefits but emphasizes that the decision should be made by parents in consultation with healthcare providers [19] . Additionally, critics argue for alternative methods that are non-invasive and available; these include procedures such as preputioplasty: an non-surgical procedure that involves widening the opening of the foreskin rather than removing it and can also be used to treat phimosis, see Table 1 [17] [18] .

Informed consent involves providing individuals with the necessary information to make a voluntary and knowledgeable decision about medical procedures, in terms that they can understand. For neonates, parents or guardians make those decisions as this population cannot consent themselves. Neonates cannot express their preferences or understand the implications of medical procedures chosen on their behalf. This raises questions about whether it is ethical for parents to consent to procedures that might not be medically necessary. In addition, bodily autonomy refers to the right of an individual to make medical choices regarding their own bodies. For adults, this principle is clear, however when applied to infants who cannot express their own wishes, this becomes controversial [19] . Performing procedures on infants without their consent raises ethical questions about the respect for their future autonomy and choices- and most notably, the impact of irreversible physical changes made on their behalf. For these reasons, clearly, medical procedures should be justified by a well-defined and documented clinical benefit or necessity. Unnecessary, unrequired procedures still pose risks without providing significant benefits, all of this is exacerbated yet even more when patients cannot consent for themselves, such as is the case with neonatal circumcisions. The term “unnecessary” often pertains to procedures that are not urgently required for the infant’s health or well-being [20] .

While parents may have the right to make decisions, there is a debate about whether this authority should extend to procedures that are not medically necessary and could potentially cause harm [21] . The psychological impact of medical procedures on infants is challenging to measure directly, but there is concern about potential long-term effects. There is debate about whether infants might experience psychological distress or impact later in life from procedures performed without their consent [20] . Decisions made on behalf of infants can have long-term implications for their autonomy and personal preferences as they grow older.

Ethical concerns arise when procedures are performed primarily for cultural or non-medical reasons without clear, immediate health benefits. Towards these efforts the main goal of this editorial is to summarize the most up to date documented benefits of neonatal circumcisions so that parents may weight these against or with cultural and or religious beliefs. Many cultures and religions have established practices, such as circumcision, that hold significant meaning. Respecting these practices is an important aspect of ethical medical care. Balancing respect for cultural and religious beliefs with the principle of minimizing harm and ensuring informed decision-making can be challenging. Ethical medical practice involves weighing the potential risks and benefits of a procedure. Risks should be minimized, and benefits should outweigh any potential harm. If a procedure carries risks [17] but provides little or no medical benefit, its ethical justification becomes questionable. For neonatal circumcision, which has both potential benefits and risks, the necessity of the procedure is debated and yet cultural and religious preferences must also be respected and acknowledged [22] . Healthcare providers must navigate these concerns while ensuring that decisions are made with the infant’s best interests in mind. Parents generally have the authority to make decisions about their child’s medical care, including cultural and religious practices [22] . The ethical issue revolves around making irreversible decisions that may affect the individual’s future autonomy and personal preferences. Various medical organizations have established guidelines to ensure ethical practices in neonatal care, including considerations for circumcision and other non-urgent procedures [22] . For these reasons, every effort should be made by guiding medical organizations to make incorporate all safety measures available, the standard of care. Guidelines generally emphasize the importance of informed consent, parental education, and careful consideration of the necessity and risks of procedures [23] . Open communication between healthcare providers and parents is essential to ensure that decisions are made with full understanding of the potential risks and benefits. Healthcare providers should provide comprehensive information about the procedure, including risks, benefits, and alternatives, and ensure that parents make an informed decision that prioritizes the infant’s best interests.

The medical device described in this manuscript is the intellectual property of Mimir’s Well-ness. All proprietary technologies, designs, and associated documentation are owned exclusively by Mimir’s Well-ness and are protected under applicable intellectual property laws. Use or reproduction of these materials without explicit written permission is prohibited.