Metzitzah B'Peh has received a great deal of media attention because of recent scandals. Is Metzitzah B'Peh required for Orthodox circumcision? How do we reconcile this practice in the Age of AIDS? This selection of articles from contributors attempts to wrestle with the questions and crisis surrounding Metzitzah B'Peh.
Metzitzah B'Peh--Oral Law? by Philip L. Sherman
There are three steps to performing a Berit Milah. Milah, the excision of the foreskin; periah, the drawing back (or removal) of the secondary layer of skin, the mucosal membrane; and metzitzah. Metzitzah is the drawing of the blood from the wound following the ritual circumcision. The source is found in the Mishnah, Shabbat 19:2. "One performs all the necessary steps for the milah on Shabbat: One circumcises, draws back (or tears) the secondary layer of skin (the mucosal membrane, periah), suctions, and bandages the wound with cumin powder." It was believed at that time that there was a positive health benefit to the child.
The basic understanding of the Talmud is that metzitzah is not part of the actual mitzvah of Berit Milah. It is performed to prevent any health hazard to the child after the circumcision. Continue reading
AIDS and Circumcision, by Rabbi J. Simcha Cohen
At the Brit Milah, the Mohel (person who performs the circumcision) is required to suction the blood of the open wound. This process is called metzitzah. Traditionalists insist that the Mohel actually place his mouth on the wound and physically ingest blood, which is subsequently discarded. This is termed metzitzah b’peh. A modern method, sanctioned by a number of Halachic scholars, is to utilize a tube or gauze so that the process of suctioning blood takes place without the Mohel putting his mouth on an open wound or taking any blood into his mouth. Most Hasidic scholars decry this process as an unwarranted change in the traditional ritual of circumcision. Continue reading
Rabbinic Consultations: The Case for Specialist Rabbis, by Rabbi Dr. Henry "Ronnie" Hasson
Medically, circumcisions are done routinely in these situations without adverse events, and there is therefore no justification to delay the circumcision. Within this category, is also the question of metzitzah. In brief, after the circumcision is complete, there is a tradition that the mohel sucks some blood out from the incision site. For convenience this was done with direct suction from the mohel's mouth without a barrier. This procedure was done for medical reasons that are no longer valid. On the contrary, it is currently medically beneficial not to perform this procedure at all, especially without a barrier, as there is risk of infection from the procedure. This is especially true in situations where the mohel may be infected with the herpes virus and may transmit this to the child. Unfortunately, doctors are rarely consulted prior to the procedure, and rabbis are asked to make the decision on whether this procedure should be performed and how it should be performed. Without the proper precautions, we have seen many cases of children being infected and developing seizures. This is sometimes a permanent condition caused by this procedure. It seems ironic that a procedure that the rabbis instituted to protect our children is now having the opposite effect; yet rabbis who are not trained in the specialty of infectious diseases can not make a sound decision without consultation with an expert in the field. Continue reading