The Pain of Circumcision

Pain according to the dictionary is defined as “an unpleasant feeling that is conveyed to the brain by sensory neuron, the discomfort that signals actual or potential injury to the body.”

Presumably pain is part of evolution in order to prevent the injury or potential harm that can impose on our body.

The interesting question is: do we develop such physiological protection only after we mature into adulthood?

The question of the usage of anesthesia on infants while performing circumcision has been long debated. It is known that neonates have low pain scores compared to the older infants.

Well, that must be true, as a baby must endure the resilience of “pain” passing through the narrow birth canal during childbirth.

In view of the pliability and tolerance of the newborns, it has been argued the pain reactivity appears to be inhibited during fetal life, and this lead to the suggestion that performing any invasive procedure within ninety days after birth, with have minimal impact on the child.

The critics often argue it is cruel to an infant through an operation with no anesthesia. The neonates are believed to experience pain, but are just unable to convey the displeasure.

Winston Churchill once said: “Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things”.

Today we discuss the subject of pain during circumcision for infants, and address the necessity of anesthesia in such intervention for neonates.

Dear Dr. G,

I am a proud father of two boys. My eldest is now five years old and my wife has just given birth to another boy.

As a family tradition, my father and I were both circumcised for hygiene purposes, and really think I have benefited from the operation all my life.

My Dad took me to the doctors when I was 15 years old and I had the operation as a teenager. I must confess, I had a really tough time after the operation.

I remembered having bleeding and pain during and after the operation. This was particularly bad two weeks after the surgery when I get morning erection and the wound was simply unbearable.

When my elder son was born, I advocate early intervention at the age of four, as I understand children have fewer problems with pain and the wound would heal faster. Sadly, my son also experienced pain after the circumcision.

I am certain; this will have lasting scarring effects on him. Now, we are blessed with a second son.
I understand in the United States, most circumcisions are done within a few days of birth without anesthesia. Is that true?

Is it true that young children experience no pain at all during the operation?

I am worried my son might feel something, what kind of anesthesia can we give him, and what are the side effects?

I really need your help.

Warmest regards

Joe

Circumcision is the surgical removal of the skin covering the glans penis, which has been practiced since the ancient times, with the origin in religious rites.

Clearly, no anesthesia was applied in the those days. Today, many parents make decisions to have their sons circumcised for religious and medical reasons, and the issue of anesthesia for the children is often a concern.

Anesthesia was not advocated for infant circumcision, as it was believed the procedure caused little or no pain to the child.

On the hand, the side effects of medications and injections outweigh the benefits. It is now known that infants do experience pain, and such experience may interfere with mother-infant interaction and even results in behavioral changes in adulthood.

Therefore, the usage of analgesia and anesthesia are generally encouraged.

The utilization of anesthesia can be pharmacological and non-pharmacological.

The injection of local anesthesia as ring or dorsal block is simple and safe, even for premature low birth-weight newborn infants.

The use of anesthetic cream on the foreskin, before the operation, has also been shown to be effective.

The non-pharmacological intervention such as sucrose pacifier has also been shown to be effective in controlling the pain.

In others studies, even music has also been used as a method of pain relief.

Despite the benefit and proven safety of anesthesia for infants undergoing circumcision, a recent study in the United States revealed the non usage of anesthesia is ranging from 54-96%.

Another study demonstrated only 71% of pediatricians, 56% of family practitioners and 25% of obstetricians offered anesthesia to infants when discussing the operation.

The famous American author, poet, actress and singer, Maya Angelou once said: “History, despite its wrenching pain, cannot be unlived, but if faced with courage, need not be lived again”.

Although the age-old practice of circumcision without anesthesia dates back centuries, the marvel of modern medicine ensures the safety and benefits of such protection of the vulnerable infants.

So, Dr. G’s advice is: “Have a heart, don’t let the pain you cause your son come back to haunt you!”