The Gemara in Masechet Shabbat, Daf 133 goes through the different steps that takes place at a Brit Milah (Bris/Circumcision.) First is the actual incision which is called the ‘Milah’. Second, there is ‘Peria’, which is the procedure of uncovering the place of the incision. (For more information, see the Daily Halacha entitled "The Two Stages of Circumcision at Brit Milah.") Once these 2 steps are complete, the Mohel (person performing the Milah) then performs a procedure known as ‘Metzitza’.

Metzitza is when the Mohel uses his mouth to suck and extract blood from the wound and/or surrounding tissue. The Gemara says that a Mohel is endangering the life of the child if he refuses to do Metzitza, and the Mohel must consequently be relieved of his duties.

Some of the greatest debates in Halacha have been over the issue of Metzitza. Throughout the generations there have been controversies about whether or not Metzitza is still prevalent, and if so how to perform it. The Sde Chemed (Rabbi Haim Hezkiah Medini 1832-1904) wrote an expansive Teshuva on this subject. His writing is considered an encyclopedic work containing opinions brought down by over 200 Poskim. The question mostly discussed was about whether or not using a tube is permissible in the process of Metzitza. Some hold that using one’s mouth is not mandatory and that sucking through a tube would be acceptable practice. But according to the majority of Poskim, and as written in a Proclamation about 100 years ago, signed by the Sephardic chief Rabbi, HaRav Jacob Shaul Eliashar (1817-1906), and by the Asheknaz Chief Rabbi, Rav Shmuel Salant (1816–1909), the appropriate method for Metzitza is directly by mouth and not by use of a Keli such as a tube.

Rabbi Moshe Feinstein was asked this question. People told him that we need to be concerned about babies who might be infected, who might in turn bring illness to the Mohel. Rabbi Feinstein answered this saying [listen to the audio clip for the exact quote] that no danger shall come upon a Mohel who performs Metzitza B’Peh (by Mouth), because he is involved in performing a Miztvah which is L’Shem Shamayim (for the sake of G-d.) Later on, Rav Moshe Feinstein actually signed his name to a proclamation to uphold this custom of performing Metzitza directly via the mouth.

There are certain cases where there is concern about some transmitted diseases. This question was brought to Rav Yosef Shalom Eliashiv, shlit’a, one of the foremost Poskim in Israel. His answer was to have the child take a blood test to check for these diseases. If the test results showed no AIDS, then Metzitza should be performed by mouth.

But, for those Mohels who want to use a tube, for fear of being exposed to disease, they have what to rely on, based on the many Poskim who permit the use of a tube. But in general, the proper way and the custom of the Jewish people for hundreds of years based on hundreds of Poskim, is to make Metzitza by mouth.

It should be pointed out that the Mohel himself must be careful that he does not have any disease or infection when performing the Milah. He may not perform a Milah under such condition because he may infect the child. In fact, to prevent possible transmission of diseases or infection, it is customary for the Mohel to cleanse his mouth before Metzitza with a disinfectant.

It is unfortunate in today’s society, that the media portrays Metzitza as a barbaric ritual that should be stopped. Just a few months ago, there was a campaign by officials in the state of New York to ban Metzitza altogether. But according to the majority of Poskim, this must not be stopped, and Lechatchila, extraction directly by mouth is the appropriate and preferred manner of Metzitza.

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