No Excuse For Circumcision Pain!

Dr. Greene, 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?
Julie – Redwood City, California

No Excuse for Circumcision Pain

Dr. Greene’s Answer:

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 pain 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.

Circumcision is quite controversial. Well-meaning people feel strongly about it on both sides. Whatever other arguments people make, there is insufficient evidence to support the medical benefit of routine circumcision for healthy boys born in the US. Whether or not people agree about the damage or benefit of circumcision — in general or in specific circumstances –I hope we can all agree that if the choice is made to circumcise, children deserve truly effective pain relief.

EMLA cream may seem attractive because it is so easy to use and doesn’t involve needles. When spread onto half the length of the penis 60 to 90 minutes prior to the procedure, this topical anesthetic does provide pain relief, but moderate relief at best (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.

More recently, topical anesthetics have become 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.

But at this very moment, newborn boys are scattered around the globe, screaming with a bewildered pain they need never have experienced. In the past we didn’t know. Now we do.

There is no longer any excuse.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Najey Rifai

    Circumcision is aimless torture practiced by Americans and third-worlders. The vast majority of the developed worlds most prestigious scientific and medical organisations disagree with circumcision:

    The BMA
    The Finnish Medical Association
    The Indian Journal of Sexuality & Transmitted Diseases (this one is worth picking up whether you agree or not!)
    The Royal Australian College of Physicians
    The CPS
    The AAP (2012)
    The Royal Dutch Medical Association
    The College of Physicians and Surgeons of British Columbia

    Referring to it as everything ranging from pointless to an infringement of bodily integrity!

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  2. waheeda

    Being a Muslim we do this silly thing to our babies too, but unfortunately I did never know that this thing is not an Islamic thing, neater was in Islam.

    God says in our holy book that he made us in a perfect shape, so why would we change some thing that God made? if it’s to prevent HIV use condom and you wouldn’t have a problem or stop having sex with 1000 women’s around .. simple as that.

    I feel so sorry for my baby and I wish that the time goes just a day back. I wish I did not do this thing. My baby is in pain. Yes I give him pain killer, but after that his smile towards me makes me so upset. It’s like taking a beloved one to the grave and he laugh still. Ouch.

    I won’t do it for my next baby. My cute baby can’t sleep because of pain. Also panadol or any other brand is a chemical that effects the system of us and babies for sure effects babies more cause their stomach can’t take chemicals.

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    • Yale

      Circumcision is based on Judaism (Abraham) and Christianity (Jesus)

      Luke 2:21
      “After eight days had passed, the infant was circumcised and named Jesus, the name given him by the angel before he was conceived in the womb”.

      Genesis 17:11 God Said to Abraham
      And you shall be circumcised in the flesh of your foreskin, and it shall be the sign of the covenant between Me and you. 12″And every male among you who is eight days old shall be circumcised throughout your generations,

      Genesis 17:25, 26
      And Ishmael his son was thirteen years old when he was circumcised in the flesh of his foreskin. In the very same day Abraham was circumcised, and Ishmael his son.

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  3. Reader1

    What about Plastibell? Does that cause pain? I want my little boy circumcised but don’t want him to suffer it on his very first day of life, and I don’t want him in constant pain for weeks afterwards. It seems to me that having a thing tied around your penis until the end drops off would be painful. Any advice Dr?

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    • Najey Rifai

      It will be in constant pain until the head callouses, about a year into the child’s life. Most of the worlds scientific community KNOW that circumcision isn’t worth it.

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  4. Julia

    I wish the american culture would adjust to the rest of our world. A circumcised man doesn’t know what kind of pleasure he is going to miss. Honestly kids and men in europe don’t get sick because of a foreskin. Me as an european women; I had both and had to leave my last boyfriend, because intimacy wasn’t as good as with an uncircumcised man. And his penis wasn’t as sensitive and beautiful looking, it wasn’t a surprise, I had always to stare at his naked thing. It was just gross, so gross. I can’t agree to do it to a baby. It’s ok if you have a choice as an adult, but not as a baby. I honestly feel very sorry for all men which are circumcised without their choice. You don’t know what you miss in life and how it’ll affect your intimacy later. I never ever want to be in anything again with a cutted man. Sorry guys,…this is so brutal. Babies are humans with feelings …

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  5. Diana Lipka

    Doing research on newborn circumcision currently and would love to ask you if you think if a parent does decide, should the newborn be at least 24 hours old?

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    • Najey Rifai

      The child should be 18 years old and capable of making their own informed decisions.

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  6. wendy

    CIRCUMSICION IS SO WRONG! ESPECIALLY STICKIN A NEEDLE IN A TINY SENSITIVE PENIS! SO OBVIOUSLY MY PRECIOUS SON PENIS WAS LEFT ALONE! OMG! MAYBE THE DR. PERFORMIN THE SURGERY ON A POOR BABY BOY SHOULD HAVE A NEEDLE STUCK IN HIS GROWNUP SENSITIVE PENIS! SOOOO UNNECESSARY FOR A LIL BABY BOY COME ON THINK ABOUT IT!!

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  7. Notmyson

    Circumcision is male genital mutilation, anesthetic or no.

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    • mike

      Leaving that skin on is nasty and can cause all kinds of problems and infections if not cleaned properly. My son will have his done just like my other son. It’s safe, smart and the healthy choice. No man I know wants a huge wad of skin around their penis. You should probably read why they do it before you make such radical idiotic statements

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      • TXmom

        In Europe, Russia and China a circumcised penis would look deformed and in a permanent erection (because it is rare). ED is linked to circumcision. No one should feel like they have to hide what is a natural body part, nor should it be removed at birth (just like an appendix, tonsils, wisdom teeth) because of an unlikely potential problem. I feel sorry for men who didn’t have a choice. It should at least be a choice because if men waited until later they would see firsthand which would be better. We wouldn’t remove fingernails because you had to clean under them. But in this country we could make anything “fashionable”.

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      • Najey Rifai

        Rediculous and idiotic? Here are the most prestigious medical organisations in the developed world to disagree with you:

        The BMA
        The Finnish Medical Association
        The Indian Journal of Sexuality & Transmitted Diseases (this one is worth picking up whether you agree or not!)
        The Royal Australian College of Physicians
        The CPS
        The AAP (2012)
        The Royal Dutch Medical Association
        The College of Physicians and Surgeons of British Columbia

        Enjoy :D !

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  8. ShaunCrystalina Ketterman

    It’s better to take your whole baby home and let him keep his whole penis. This country slices up little newborns and calls Africa barbarians for doing much the same thing to girls who are much older… The mind reels.

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    • mike

      How can you compare circumcision to Africa? It’s a choice and it’s the cleaner healthier one. I feel bad for your son who will have a huge nasty skin fold to clean and hide from women

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      • Sara

        The penis cleans itself. Like everything else in nature, it’s designed that way. Some cause issues by forcing back the foreskin to ‘clean’, which can result in damage and infections. So, cleanliness is not a reason to routinely circumcise baby boys. Others have cited less chance of contracting STDs – surely prevention via condoms, etc is better than slicing off part of your body!!! There is more chance of medical complications from a circumcision (even death), than there are potential benefits. So, if having done some research yourself (which I suggest you have not, besides having looked at your own penis), you still want to cut your little baby boy and put him through that pain (and yes, perhaps some reduction in his sexual sensation as an adult) for aesthetic reasons, then you should consider whether you are being a little selfish about this.

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      • Najey Rifai

        Cleaner and healthier? Here are the most prestigious medical organisations in the developed world to disagree with you:

        The BMA
        The Finnish Medical Association
        The Indian Journal of Sexuality & Transmitted Diseases (this one is worth picking up whether you agree or not!)
        The Royal Australian College of Physicians
        The CPS
        The AAP (2012)
        The Royal Dutch Medical Association
        The College of Physicians and Surgeons of British Columbia

        Enjoy :D !

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  9. I never imagined that circumcision didn’t cause pain. I refused to have my son circumcised. I just couldn’t put my baby through that kind of pain.

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