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is it painful to circumcised baby

By: Guest
Date: Fri-May-15-2009-
Response
3
I'm having a baby boy, and we have decided to have him circumcised. I've read in magazines that a local anesthetic is a good idea. My OB says it doesn't hurt much, in fact babies cry as much from being strapped down as they do from the actual circumcision. She also says that sticking a needle into the penis is painful and not without complications, so it is better to do it quick and easy, like it has always been done. What do you think?
[d] By: Guest
Date: Fri-May-15-2009
Response
3
What a preposterous idea that little boys don't feel pain when part of the penis is first ripped from the underlying tissue, crushed with a clamp, and then amputated! This procedure is performed on more than 1 million babies each year in the United States alone, and many of them receive nothing to prevent or treat the pain.

We have a long history of underestimating the abilities of babies. Not long ago, we doctors were taught that babies couldn't see. Doctors waved brightly colored toys in front of babies, and the infants did not respond. Doctors flicked their fingers in front of babies' eyes, and the infants did not blink. Mothers, of course, reported that their babies gazed into their eyes, but this was attributed to wishful thinking.

It was not babies' eyes that were the problem, but doctors' tests! When faces or targets (nipple shapes) were held in front of babies, they were fascinated. We now know that newborns see quite well -- albeit primarily in black and white. Their interests, though, in that precious newborn stage are highly focused on connecting with their parents and on feeding. We also know that their excellent senses of smell, taste, and hearing are even more sensitive than ours are. They can distinguish their mother's nursing pads from those of other nursing women by smell alone!

We would like to believe that babies don't feel pain and that their genitals are not sensitive to pain or pleasure. But this is simply not true. Both baby boys and girls have sensitive genitals. A mountain of evidence forces us to conclude that newborns who are circumcised without an anesthetic experience true pain accompanied by increased blood pressure, increased heart rate, decreased oxygen in the blood, and a surge of stress hormones (Pediatrics, 1983; 71:36-40). Their screams are cries of surgical pain without anesthesia.

Thankfully, babies recover from this trauma fairly quickly. Following the circumcision, most boys have a prolonged period of sleep and then are largely unavailable for bonding or social interaction for up to 24 hours afterward. But after 24 hours, their behavior is indistinguishable from their uncircumcised counterparts (Developmental and Behavioral Pediatrics, 1984; 5:246).

Mostly.

Recent evidence suggests that boys who were circumcised without any anesthetic experience more trauma (pain and fear) with each of their numerous routine childhood immunizations Lancet, 1997; 349:599-603). As if shots weren't intrusive enough! Most kids with cancer dislike the pokes more than the disease.

Good news for the millions of boys who will be circumcised in the future! Thankfully, if the choice is made to circumcise, several excellent, safe alternatives are now available to provide pain relief: EMLA cream is easy to use. When spread onto half the length of the penis 60 to 90 minutes prior to the procedure, this topical anesthetic provides moderate pain relief (New England Journal of Medicine, 1997; 336:1197-1201).

Dorsal penile nerve block (DNPB) involves two deep injections of lidocaine at the base of the penis. Despite the shots, this technique greatly reduces overall pain (Journal of Pediatrics, 1978; 92:998-1000). Bruising is the most common complication (Pediatrics, 1995; 95:705-708). Lasting problems almost never occur. The one truly unfortunate case in the medical literature, in which the flesh of the penis died, may have been from the circumcision technique rather than the nerve block (Anaesthesia and Intensive Care, 1984; 13:79-82).

Sugar water (or brandy) on a fingertip or pacifier may decrease crying. Acetaminophen may blunt the pain (Pediatrics, 1994; 93:641-646); however, these and other "home remedies" are insufficient for surgical pain, as anyone who has had an operation knows well.

Best is the subcutaneous ring block. Here, lidocaine is injected just under the skin in a ring around the shaft of the penis, about halfway back from the tip. Recent evidence suggests that it is more consistently powerful in preventing pain through all phases of the circumcision than either EMLA or DPNB (JAMA, 1997; 278:2157-2162). This technique is easy for doctors to learn--even those who have previously been nervous about anesthesia for circumcision. There are no reports in the medical literature of any complications. Topical anesthetics are now available in a variety of forms, such as creams, gels, and heat-activated patches.

I vigorously applaud the 1999 policy statement of the American Academy of Pediatrics, which states, "Analgesia is safe and effective in reducing the procedural pain associated with circumcision and, therefore, adequate analgesia should be provided if neonatal circumcision is performed." Circumcision Policy Statement (RE9850)

Julie, I too have heard the oft-repeated excuse that babies cry just as much when being strapped down as they do for the procedure. This may sometimes be true, but the restraint does not have as profound an effect on heart rate, blood pressure, oxygen saturation, and stress hormones. Nor does it continue to last for many hours (and in some ways, months) afterward.

That babies cry when they are undressed and forcibly restrained in an awkward, unnatural position on a hard, cold, plastic device is not a good argument against relieving their pain when having surgery. It is a good argument, though, for warm, soft, padded, cloth-covered holders to cradle them in a comfortable position while being circumcised. Such devices do make this a more humane experience (Pediatrics, 1997; 100(2):e3).

The foundation of being an excellent parent is learning to see life both from your own perspective and from your child's. You can begin now, even before your son is born, imagining the tranquil, muted sights and sounds inside your womb.

At each milestone, take a moment to experience it from both sides--the delight the first time your son smiles at you and gets you to smile back, the proud achievement of taking those first steps, the wonder and uncertainty of the first day of school. (Last night was my son's first junior high dance, complete with slow dancing!)

As you practice "biempathy" (my word for this creative double-vision), you will agree --

NO BOY SHOULD EVER AGAIN BE SUBJECTED TO THE TRAUMA OF CIRCUMCISION WITHOUT ADEQUATE MEASURES TO PREVENT AND TREAT PAIN. EVER.

[d] By: Guest
Date: Fri-May-15-2009
Response
3
The pain that a baby experiences during circumcision is worse than anything the average person is likely to experience in a lifetime. Sadly, there is nothing that can be done to eliminate this pain entirely. Studies show that anesthesia helps reduce pain to some extent, but it is powerless to make circumcision pain free.

The pain of circumcision can have serious complications. It is so severe that many babies stop breathing, vomit, and defecate in their agony. One recent study on the pain of circumcision was stopped after several infants, circumcised without anesthesia, experienced life-threatening breathing difficulties that included choking and apnea.[22] The shock of circumcision results in hysterical screaming, crying, and can produce dangerous complications, including rupture of the heart,[23] lungs,[24] and stomach.[25] Some babies are so severely traumatized by the experience that they fall into a semicomatose state. Some circumcisers still pretend that these babies are just falling asleep! Nothing could be further from the truth. No one falls asleep when his sex organs are being cut with a knife. Because he is tied down, a baby has no way to escape, no matter how much he thrashes. Going into a comalike state is one way for the baby to distance himself from his agony, but it has dangerous consequences for the brain, as you will read below.

When I was in medical school, I was taught to perform neonatal circumcisions without any anesthesia simply because it was commonly believed that the newborn was incapable of experiencing pain, and, even if he did, he would be unable to remember it. I accepted this because I had never heard of anyone remembering the trauma of being circumcised. Ethically, of course, we do not have the right to hurt another human being even if he won't remember the pain later.

It is unnecessary to be a university professor to understand that babies feel pain and are traumatized by circumcision. Just witness one -- if you dare -- and you will be convinced. You hardly need data collected by scientists to realize what those agonizing cries mean. You are a human being, capable of those same feelings. You know that even though the actual memory of the event may be lost, the trauma probably remains forever.

Many circumcisers still repeat the ludicrous myth that babies are unable to experience pain, even though they hear the screams of the babies. Many dismiss the evidence of their senses, and simply accuse the baby of being "fussy." It saddens me that members of my own profession could be so wrong, insensitive, and arrogant.

A mountain of objective scientific studies has irrefutably proved that babies do feel pain.[26] They feel it very acutely. In fact, it has now been conclusively established that babies feel pain more sharply than adults![27] Any mother who accidentally pokes her baby with a safety pin while changing diapers knows very well how sensitive babies are to pain. If a tiny pinprick can raise such a rush of pain and panic in a baby, imagine the baby's reaction to having a steel clamp crush the end of his penis or to having a scalpel slice it open.

Pain is serious. It is hardly something to be dismissed, laughed at, or ignored. Pain is hardly good for the soul, and it cannot "toughen" little boys. In fact, it has just the opposite effect. The severe pain of circumcision makes boys less able to tolerate even average levels of pain. A team of top-notch medical researchers working at the University of Toronto have proved in a series of studies that the pain of circumcision is so severe that it permanently damages the pain centers of the brain. Baby boys who have been circumcised suffer from an abnormally and artificially lowered pain threshold than genitally intact boys or baby girls. They react more strongly, violently, and hysterically to mildly painful experiences, such as vaccination injections.[28] Development neuropsychologist Dr. James Prescott suggests that circumcision can cause deeper and more disturbing levels of neurological damage, as well.[29] We must ask ourselves: What dangerous and dark message is being sent to the mind when the organ designed for experiencing pleasure becomes the source of unbearable pain? Dr. Prescott writes:

It is this writer's conviction that the extraordinary pain and trauma experienced through genital mutilations -- an organ and brain system that is designed for the experience of sexual pleasure and the expression of sexual love -- has permanently altered normative brain development for the normal expression of sexual pleasure and love. It is proposed that this genital pain has long-term developmental consequences for the ability of such individuals to differentiate pain from pleasure in love relationships and to develop intimate sexual relationships.

It is not without psychobiological consequence that the brain system, which is designed for the experience of pleasure and the expression of sexual love, is first encoded with extraordinary and excruciating pain. In such individuals, all subsequent acts or experiences of genital pleasure are experienced upon a background of genital pain that is now deeply buried in the subconscious unconscious brain.[30]

Pain is never a temporary experience. It persists even after the knife stops cutting. One powerful study performed at the University of Rochester School of Medicine documented the disturbing fact that babies still experience severe pain at least twenty-four hours after the circumcision surgery.[31] This study was able to measure pain for only twenty-four hours because most of the babies in the study were discharged from the hospital during this time. The excruciating pain undoubtedly lasts much longer.

Anyone who has had surgery knows that severe pain can last for weeks. Patients must usually take massive doses of powerful painkillers for a week or more. Tragically, babies are still being denied postoperative pain relief. Hospital routines are slow to adjust to scientific advances. Just as many hospital administrators still push circumcision, they also choose to ignore the overwhelming evidence that now exists on the pain of circumision and refuse to require all circumcisers to use aneshesia.

The throbbing pain of the circumcision amputation wound is aggravated every time the baby urinates. Babies have no choice but to urinate into the raw circumcision wound. The hot acidic urine burns the raw flesh, inflicting even more genital pain. Nurses who work in maternity wards have told me that they can always tell which babies in the nursery have been circumcised. These poor babies act strangely and seem withdrawn. They also scream hysterically when they urinate in their diapers.

I strongly advise parents to avoid being misled into believing that wine on a pacifier or dripped into the baby's mouth through a bottle provides anesthesia or analgesia. The baby may become intoxicated, but this is dangerous and unhelpful itself. Some circumcisers wrongly claim that this method is useful. This is a falsehood. Also, you would be wise to resist the temptation to believe that sugar water (glucose) provides anesthesia or analgesia. Sugar may stimulate the opioid receptors in the brain, but this is hardly going to block the excruciating pain of circumcision. If a circumciser ever tries to talk you into letting him give your child a sugar solution while he cuts your child's penis, ask him if he would willingly substitute a bottle of cola for anesthesia before allowing a surgeon to cut his penis.

Even though the American Academy of Pediatrics now urges circumcisers to use local anesthesia,[32] circumcisers almost universally ignore these recommendations.[33] They also ignore the fact that the American Academy of Pediatrics actually recommends protecting babies from circumcision in the first place. Many circumcisers are unwilling to change their habits or learn new techniques. Many have chosen to ignore the evidence that they are inflicting major harm on babies. Many just don't care. Consequently, most babies who are circumcised in U.S. hospitals today are denied any form of pain relief during and after the surgery. General anesthesia is extremely dangerous for babies and local anesthesia is largely ineffective, but does this mean that pain relief should be dismissed as unimportant? Hospital spokesmen complain that the death and complication rate from local anesthesia itself is a disincentive for using it. It is true that anesthesia has resulted in tragic injuries and deaths. What then are caring parents supposed to do? It is clear to me that the only moral way of protecting babies from pain, injury, and stress disorders is to protect them from circumcision.

[d] By: Guest
Date: Fri-May-15-2009
Response
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