Bleeding is the most commonly encountered complication of circumcision. The expected blood loss during neonatal circumcision is just a few drops (easily handled with one 4 x 4 " gauze pad), so bleeding that exceeds this expectation is a complication.

Fortunately, almost all cases of bleeding with neonatal circumcision are very mild. In many cases, bleeding can be controlled by applying direct pressure to the site for a minute or two. At times, the addition of a Gelfoam® wrap can speed clot formation and stop the cut edge from oozing. (Gelfoam® is an absorbable gelatin sponge that promotes blood clot formation).

In rare cases when the frenular artery is bleeding, pressure and gel foam may not be sufficient and a small "figure of eight" suture may be required. Because of the close proximity of the urethra to the ventral surface of the penis, great care must be taken with any clamping or suturing in this area. Too aggressive measures can lead to necrosis of the fragile tissue and the creation of a urethrocutaneous fistula.

The most devestating reports of bleeding (leading to blood transfusion or death) during or after circumcision occur in boys who have underlying blood dyscrasias, so it is critical to inquire specifically about a family history of bleeding disorders before considering the procedure.

Of the three commonly used techniques (Gomco, Mogen, and Plastibell), the Plastibell has the lowest incidence of bleeding as the suture remains in place for a few days after the procedure. With both clamp devices (Gomco and Mogen), hemostasis is dependent on the adequacy of the crush injury.

It should be noted that tissue edema puts increased stress on a crushed edge and can lead to oozing, so care should be taken during the procedure to minimize trauma of the sensitive foreskin. Keeping the instrument used to remove adhesions in the plane of tissue between the glans and the foreskin and avoiding rubbing against the underside of the skin is one useful way to minimize edema.