Changes

The '''pain''' of [[circumcision ]] is extreme and traumatizing.<ref name="bollinger2019">{{REFdocument

|Text=Our attention has been focused on the distress cry of infants. We have recorded numerous distress cries resulting from routine medical procedures such as taking blood samples and minor surgery such as [[circumcision]]. The distress cry is louder, longer, and noisier than the hunger cry. In also tends to be irregular, with more interruptions and gagging.

}}</ref> Winkelmann (1956) stated the human newborn prepuce "is a region of great sensitivity and possessed of an abundant nerve supply."<ref name="winkelmann1956">{{REFjournal |last=Winkelmann |init=RK |author-link=R. K. Winkelmann |title=The cutaneous innervation of human newborn prepuce |journal=Journal of investigative dermatology |volume=26 |issue=1 |pages=53–67 |url=http://www.cirp.org/library/anatomy/winkelmann2/ |pubmedID=http://www.ncbi.nlm.nih.gov/pubmed/13295637?dopt=Abstract |date=1956 |accessdate=2024-05-14}}</ref>

There are four painful steps in every infant [[circumcision]]:<ref name="bellini2022>{{REFjournal |last=Bellini |first= |init=CV |author-link= |etal=no |title=Neonatal infant pain scale in assessing pain and pain relief for newborn male circumcision |trans-title= |language= |journal=Int J Impot Res |location= |date=2022-03-29 |volume= |issue= |article= |page= |pages= |url=https://www.nature.com/articles/s41443-022-00551-x |archived= |quote= |pubmedID=35352017 |pubmedCID= |DOI=10.1038/s41443-022-00551-x |accessdate=2023-04-29}}</ref>

# Before [[circumcision ]] surgery can commence, the surgeon must first forcibly separate these two highly innervated body parts in an exquisitely painful procedure by forcing a blunt probe between the two parts to destroy, rip and tear the [[synechia]] apart.<ref name="bellini2022 /><ref>{{REFjournal

# Next, in another painful step, a [[dorsal slit]] must be cut in the foreskin, so that a special clamp can be installed.<ref name="bellini2022 />

}}</ref> Nervous tissue requires a large blood supply, so the [[foreskin ]] is richly vascularized with many blood vessels,<ref name="fleiss-hodges-vanhowe1998">{{REFjournal |last=Fleiss |init=P |author-link=Paul M. Fleiss |last2=Hodges |init2=F |author2-link=Frederick M. Hodges |last3=Van Howe |init3=RS |author3-link=Robert S. Van Howe |title=Immunological functions of the human prepuce |journal=Sex Trans Infect |date=FleissP HodgesF VanHoweRS 1998-10 |volume=74 |issue=5 |pages=364-67 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758142/pdf/v074p00364.pdf |quote= |pubmedID=10195034 |pubmedCID= |DOI= |accessdate=2019-10-15}}</ref> therefore the foreskin must be crushed with one of several special clamps in yet another painful step before the [[circumcision ]] can be carried out.<ref name="bellini2022 /><ref>{{REFjournal |last=

# Finally, in another, painful step, the foreskin must be cut away.<ref name="bellini2022 />

Lander et al. (1997) conducted a comparison neonatal non-therapeutic [[circumcision ]] without anesthesia (current practice in 1997), [[ring block]], [[dorsal penile nerve block]], and a topical eutectic mixture of local anesthetics ([[EMLA]]).<ref name="lander1997">{{REFjournalLanderJ etal 1997}}</ref> |last=Lander |init=J |first=Janice |author-link= |last2=Brady-Frerer |init2=B |first2=Barbara |author2-link= |last3=Metcalfe |init3=JB |first3=James BWith no anesthesia, the infants screamed continuously. |author3-link= |last4=Nazerali |init4=S |first4=Shermin |author4-link= |last5=Muttit |init5=S |first5=Sarah |author5-link= |etal=no |title= Comparison Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of ring block, dorsal penile nerve block, heart rate and topical anesthesia for neonatal high pitched cry throughout the [[circumcision |journal=JAMA |location= |date=1997-12-24 |volume=278 |issue=24 |pages=2157-64 |url=https://canadiancrc]] and following.com/Two newborns in the placebo group became ill following circumcision/AMA_journal_circumcision_1997(choking and apnea). One experienced projectile vomiting.aspx |archived<ref name= |quote= |pubmedID=9417009 |pubmedCID= |DOI= |accessdate=2020-11-10}}<"lander1997" /ref>

With no anesthesia, [[EMLA]] was the infants screamed continuouslyleast effective pain control. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate [[Dorsal penile nerve block]] (DPNB) was more effective, and high pitched cry throughout [[ring block]] was the circumcision and followingmost effective. Two The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the placebo group became ill following circumcision , and they were exposed to unnecessary risk (from choking and or apnea). One experienced projectile vomiting" The authors were so alarmed that they terminated the no anesthesia arm of the study early.<ref name="lander1997" />

}}</ref> Any infant boy who undergoes neonatal [[circumcision ]] will experience some pain and [[trauma]]. Boys who escape circumcision would have no pain or [[trauma]]. The authors concluded that circumcision should be performed with ''anesthetic'', however the text makes clear that they meant ''analgesia'', since full anesthesia is unsafe for neonates.<ref name="lander1997" />

[[Circumcision ]] is an invasive cutting and [[amputation]]. Like other invasive operations, post-surgical pain persists after the surgery for days or weeks. <ref name="agoglu2022">{{REFjournal |last=Aydoğlu |first= |init=B |author-link= |last2=Aydoğlu |first2= |init2=M |author2-link= |last3=Okur |first3= |init3=MH |author3-link= |etal=no |title=Social and psychological effects of circumcision: A narrative review |trans-title= |language= |journal=Journal of Applied Nursing and Health |location= |date=2022-12 |volume=4 |issue=2 |pages=264-71 |url=https://janh.candle.or.id/index.php/janh/article/view/110/138 |archived= |quote= ||DOI=10.55018/janh.v4i2.110 |format=PDF |accessdate=2023-12-15}}</ref> Infant boys will not receive effective analgesia because their young age makes such drugs dangerous. Howard et al. (1994) studied male infants after their neonatal [[circumcision]]. They recorded the comfort scores of the infants at numerous periods after circumcision. They also observed and recorded feeding behavior.  It was found that feeding behavior deteriorated significantly after [[circumcision]]. Some breastfeed breastfed infants were unable to [[Breastfeeding| breastfeed ]] and required formula feeding after [[circumcision]]. Acetaminophen was found to be almost totally ineffective against the post-circumcision pain. It did have some effect six hours after the circumcision. The authors concluded "that circumcision of the newborn causes severe and persistent pain."<ref name="howard1994">{{REFjournal |last=Howard |init=CR |first=Cynthia R.

Parents who choose to have a son [[circumcised ]] may expect the infant boy to be uncomfortable and fussy for some time.The surgical pain may be expected to last for three weeks.<ref name="garrett2024">{{REFweb |url=https://intactamerica.org/timeline-of-circumcision-suffering/ |title=A Timeline of Circumcision Suffering: A Detailed Look |last=Garrett |first= |init=C |publisher=Intact America |date=2024-02-02 |accessdate=2024-05-09}}</ref>

When an infant boy is to be [[circumcised]], it is the usual practice to immobilize the infant for the painful surgery by securely tying his limbs to a molded plastic board, called the [[Circumstraint]], specially made for that purpose. The infant thus is preventing from fighting or fleeing, which is the [[trauma]]-producing situation of ''inescapable [[shock]]'', described as a "physical condition in which the organism cannot do anything to affect the inevitable."<ref name="vanderkolk2014">{{REFbook |last=van der Kolk |first=Bessel A. |init=BA |author-link=Bessel van der Kolk |year=2014 |title=The Body Keeps the Score |url= |pages=76 |isbn=978-0-14-312774-1 |accessdate=2021-08-10 }}</ref> There is now substantial evidence that the extreme pain of infant circumcision causes [[Posttraumatic stress disorder| post -traumatic stress disorder]] ̪(PTSD). Preverbal memory starts to function before birth and continues to function in the newborn period,<ref>{{REFjournal

}}</ref> and infants are now known to feel pain intensely,<ref name="bellini2022 /><ref name="anand1987">{{REFjournal

|author-link=Kanwaljeet J. Singh Anand

|etal=yesno

|first=Gregory J. |author-link=Gregory J. Boyle

|author2-link=Ronald Goldman

|author3-link=J. Steven Svoboda

Bellini observed that [[circumcised]] boys evidently remember pain.<ref name="bellini2022 /> Taddio & colleagues (1995)(1997) studied the effect of neonatal [[circumcision ]] on the behavior of boys after surgery and at the time of vaccination. It was found that [[circumcised ]] boys had a higher pain response at time of vaccination six months later as compared with [[intact ]] boys,<ref name="taddio"1995">{{TaddioA etal 1995}}</ref><ref name="taddio1997">{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref> showing that the nervous system had been permanently sensitized to heightened pain sensation. Taddio et al. (1997) concluded: {{Citation |Text=Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination. |Author=Taddio et al. (1997) |ref=<ref name="taddio1997"/>}} John Rhinehart, {{MD}} (1999), a clinical psychiatrist, reported finding numerous cases of [[PTSD]] in his adult male patients pursuant to infant [[circumcision]].<ref>{{REFjournal |last=TaddioRhinehart |init=AJ |first=AnnaJohn

|last2=Goldbach |init2=M |first2=Morton |author2-link= |last3=Ipp |init3=M |first3=Moshe |author3-link= |last4=Stevens |init4=S |first4=Bonnie |author4-link= |last5=Koren |init5=G |first5=Gideon |author5-link= |etal=no |title=Effect of neonatal Neonatal circumcision on pain responses during vaccination in boysreconsidered |journal=Lancet |location=Tranactional Analysis Journal |date=19951999-07 |volume=34429 |issue=3 |pages=291215-221 |url=http://www.cirp.org/library/pain/taddio/ |archived= |quote= |pubmedID=7837863 |pubmedCID= |DOI=10.1016/s0140-6736(95)90278-3 |accessdate=2020-11-10}}</ref> <ref name="taddio1997">{{REFjournal |last=Taddio |init=A |first=Anna |author-link= |last2=Katz |init2=J |first2=Joel |author2-link= |last3=Ilersich |init3=AL |first3=A. Lane |author3-link= |last4=Gideon |init4=K |first4=Koren |author4-link= |etal=no |title=Effect of neonatal circumcision on pain response during subsequent routine vaccination |journal=Lancet |location= |date=1997-03-01 |volume=342 |issue=9052 |pages=599-603 |url=https://yorkspace.library.yorku.ca/xmluipsych/bitstreamrhinehart1/handle/10315/7941/KAT036.pdf?sequence=1&origin=publication_detail |archived= |quote= |pubmedID=9057731 |pubmedCID= |DOI=10.1016/S0140-6736(96)10316-0

}}</ref> showing that the nervous system had been permanently sensitized to heightened pain sensation.

Taddio et al. (1997) concluded:===History===<blockquote>Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as ====Investigating pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.<ref namecircumcision===="taddio1997" /></blockquote>

John Rhinehart, M. D., [[Paul Emil Flechsig]] (19991847-1929) a clinical was an eminent nineteenth-century German neuroanatomist, psychiatrist, reported finding numerous cases of PTSD and neuropathologist. He suggested in his adult male patients pursuant to infant circumcision1872 that infants could not feel pain because their nerves are not completely myelinated.<refname="cope1998">{{REFjournal |last=RhinehartCope |init=J |first=JohnDK

|title=Neonatal circumcision reconsideredpain: the evolution of an idea. |journal=The American Association of Anesthesiologists Newsletter |date=1998-09 |volume= |issue= |pages= |url= |accessdate=2020-11-12}}</ref> Incredible as it may seem today, his idea was accepted without question and without being tested.<ref name="vanhowe2008">{{REFjournal |last=Van Howe |first=Robert S. |init=RS |author-link=Robert S. Van Howe |last2=Svoboda |first2=J. Steven |init2=JS |author2-link=J. Steven Svoboda |etal=no |title=Neonatal pain relief and the Helsinki Declaration |journal=Tranactional Analysis Journalof Law, Medicine, and Ethics |location= |date=19992008-0712 |volume=2936 |issue=34 |article= |page= |pages=215803-2123 |url=httphttps://www.cirpacademia.orgedu/librarydownload/psych33981944/rhinehart127_Van_Howe.pdf |archived= |quote= |pubmedID=19094008 |pubmedCID= |DOI=10.1111/j.1748-720X.2008.00339.x |accessdate=20202021-1110-1131}}</ref> ===Effect As a result, medical doctors performed all manners of invasive, painful procedures on neonates without anesthesia or analgesia, including millions upon millions of painful circumcisions and even open heart surgery. Open heart surgery was performed with curare to paralyze the infant but without any anesthesia.  Flechsig's bizarre opinion was not questioned until the 1970s. Several lines of extreme empirical research carried out in the 1970s suggested that infants can in fact feel intense pain on developing nervous system==.<ref name="vanhowe2008" /> Fitzgerald & Walker * Anders et al. (20031970) argued showed that extreme measurement of serum cortisol is a useful indicator of pain (such as that caused by circumcision) may alter developing nervous tissue for psychological investigation in the very younginfancy.<refname="anders1970">{{REFbookREFjournal |last=FitzgeraldAnders |init=TF |first=MariaThomas F.

|last2=WalkerSachar |init2=EJ |first2=SuellenEdward J.

|yearlast3=2003Kream |titleinit3=J |first3=Jacob |author3-link= |last4=Roffwarg |init4=The role of activity in developing pain pathwaysHP |urlfirst4=http://wwwHoward P.cirp.org/library/pain/fitzgerald2/ |workauthor4-link= |last5=Hellman |init5=L |first5=Leon |author5-link= |etal=no |title=Proceedings of Behavioral state and plasma cortisol response in the 10th World Congress on Painhuman neonate |editorjournal=Dostovsky JO, Carr DB, Koltzenburg M (eds)Pediatrics |editionlocation= |date=1970-10 |volume=2446 |chapterissue=4 |pages=185532-967 |locationurl=http://www.cirp.org/library/pain/anders1/ |archived= |quote=Seattle |publisherpubmedID=ASP Press4323242 |isbnpubmedCID= |quoteDOI=In common with other areas of the central nervous system, synaptic development of spinal sensory connections is experience or activity dependent. Evidence from both animal and human studies shows that alterations in the patterns of sensory activity that can arise from tissue injury and pain in early life may disrupt normal synaptic organization within the somatosensory system. While these studies are incomplete and more investigation is needed in this area, the potential clinical importance of neonatal plasticity in pain development is clear. |accessdate=2020-11-18 |note=13}}</ref>

===History=======Investigating pain * Emde et al. (1971) showed that the "stress" of circumcision==== Paul Emil Flechsig (1847-1929) was caused an eminent nineteenthincrease in the amount of non-century German neuroanatomist, psychiatrist and neuropathologist. He suggested in 1872 that infants could not feel pain because their nerves are not completely myelinatedREM sleep.<ref name="cope1998emde1971">{{REFjournal |last=CopeEmde |init=DKRN |first=Robert N

|title=Neonatal pain: the evolution of an idea. |journal=The American Association of Anesthesiologists Newsletter |date=1998-09 |volume= |issue= |pages= |url= |accessdate=2020-11-12}}</ref> Incredible as it may seem today, his idea was accepted without question and without being tested. As a result, medical doctors performed all manners of invasive, painful procedures on neonates without anesthesia or analgesia, including millions upon millions of painful circumcisions and even open heart surgery. Open heart surgery was performed with curare to paralyze the infant but without any anesthesia.  Flechsig's bizarre opinion was not questioned until the 1970s. Several lines empirical of research carried out in the 1970s suggested that infants can in fact feel intense pain. * Anders et al. (1970) showed that measurement of serum cortisol is a useful indicator of pain for psychological investigation in infancy.<ref name="anders1970">{{REFjournal |last=Anders |init=TF |first=Thomas F. |author-link= |last2=SacharHarmon |init2=EJRJ |first2=Edward Robert J.

|last3=KreamMetcalf |init3=JD |first3=JacobDavid

|last4=Roffwarg Koenig |init4=HPKL |first4=Howard PKenneth L.

|last5=HellmanWagonfeld |init5=LS |first5=LeonSamuel

|title=Behavioral state Stress and plasma cortisol response in the human neonateneonatal sleep |journal=PediatricsPsychosom Med

|date=1970-101971 |volume=4633 |issue=46 |pages=532491-7 |url=http://www.cirp.org/library/painbirth/anders1emde/

|pubmedID=4323242

|accessdate=2020-11-13}}</ref>

* Emde et al. Richards, Bernal & Brackbill (1976) reported behavioral differences between American boys (circumcised) and British boys (1971genitally intact) showed that the "stress" of circumcision caused an increase in the amount of non-REM sleep.<ref name="emde1971richards1976">{{REFjournal |last=EmdeRichards |init=RN |first=Robert NMPM

|last2=HarmonBernal |init2=RJ |first2=Robert J.JF

|last3=MetcalfBrackbill |init3=DY |first3=DavidYvonne

|last4=Koenig |init4=KL |first4=Kenneth L. |author4-link= |last5=Wagonfeld |init5=S |first5=Samuel |author5-link= |etal=no |title=Stress and neonatal sleepEarly behavioral differences: gender or circumcision? |journal=Psychosom Med Dev Psychobiol

|date=19711976-01 |volume=339 |issue=61 |pages=49189-795 |url=http://www.cirp.org/library/birthpsych/emdebrackbill/

|pubmedID=767183

|accessdate=2020-11-13

* RichardsLuther, Bernal Kraybill & Brackbill Potter (1976) reported behavioral differences between American boys (circumcised) compared the level of cortisol in infants before and British boys (genitally intact)after circumcision. They found a substantial rise in the cortisol levels in the infants, which they said was due to the "stress" of circumcision.<ref name="richards1976">{{REFjournal |last=RichardsTalbert |init=MPMLM |first=Luther M.

|last2=BernalKraybill |init2=JFEN |first2=Ernest N.

|last3=BrackbillPotter |init3=Y |first3=YvonneHD

|title=Early behavioral differences: gender or Adrenal cortical response to circumcision?in the neonate. |trans-title= |language=English |journal=Dev PsychobiolObstet Gynecol

|date=1976-0108 |volume=946 |issue=12 |pages=89208-9510 |url=http://www.cirp.org/library/psychpain/brackbilltalbert/

|pubmedID=767183940653

* LutherRawlings, Kraybill Miller & Potter Engel (19761980) compared showed that as the level pain of cortisol in infants before and after circumcision. They found a substantial rise in the cortisol levels in the infantsincreased, which they said was due to oxygenation of the "stress" of circumcision[[skin]] decreased.<refname="rawlings1980">{{REFjournal |last=TalbertRawlings |init=LMDJ |first=Luther MDavid J.

|last2=KraybillMiller |init2=ENPA |first2=Ernest N.Patricia Anne

|last3=PotterEngel |init3=HDRR |first3=Rolf R.

|title=Adrenal cortical response to The effect of circumcision on transcutaneous PO2 in the neonate.term infants

|journal=Obstet Gynecol Am J Dis Child

|date=19761980-0807 |volume=46134 |issue=27 |pages=208676-108 |url=http://www.cirp.org/library/pain/talbertrawlings1/

|pubmedID=9406537395829

|DOI=10.1001/archpedi.1980.02130190044011

* Rawlings, Miller & Engel Gunnar et al. (19801981) showed that as recorded serum cortisol and behavior state throughout the pain of unanesthetized, non-therapeutic circumcision process. Serum cortisol levels and behavioral distress were found to be closely related. The authors stated:{{Citation |Text=Neonatal circumcision increased, oxygenation of is performed without anesthesia and it is clearly stressful for the skin decreasedinfant. |Author=Gunnar et al. (1981) |ref=<ref name="rawlings1980Gunnar et al 1981">{{REFjournal |last=RawlingsGunnar |init=DJMR |first=David JMegan R.

|last2=MillerFisch |init2=PARO |first2=Patricia AnneRobert O.

|last3=EngelKorsvick |init3=RRS |first3=Rolf R.Sherry

|title=The effect effects of circumcision on transcutaneous PO2 in term infantsserum cortisol and behavior.

|journal=Am J Dis ChildPsychoneuroendocrinology

|date=1980-071981 |volume=1346 |issue=73 |pages=676260-875 |url=http://www.cirp.org/library/pain/rawlings1gunnar/

|pubmedID=73958297291435

|DOI=10.10011016/archpedi.1980.021301900440110306-4530(81)90037-8

* Gunnar Marshall et al. (19811982) recorded serum cortisol and behavior state throughout the unanesthetized, nonstudied mother-therapeutic circumcision process. Serum cortisol levels and behavioral distress were found child interaction with regard to be closely related. The authors stated:<blockquote>Neonatal feeding behavior after circumcision is performed without anesthesia and it is clearly stressful for the infant.</blockquote>So great was Flechsig's influence, They found that [[circumcised]] boys had more interruptions of feeding in the authors were still unwilling to use the word ''pain'' and substituted the word ''stress''24-hour period of observation.<refname="marshall1982">{{REFjournal |last=GunnarMarshall |init=MRRE |first=Megan RRichard E.

|last2=FischPorter |init2=ROFL |first2=Robert OFran L.

|last3=KorsvickRogers |init3=SAG |first3=SherryAnn G.

|last4=DonhoweMoore |init4=JMJ |first4=John M.JoAnn

|title=The effects of circumcision on serum cortisol and behavior.Circumcision: II: Effects upon mother-infant interaction

|journal=PsychoneuroendocrinologyEarly Hum Dev

|date=19811982 |volume=67 |issue=34 |pages=260367-7574 |url=http://www.cirp.org/library/painbirth/gunnarmarshall2/

|pubmedID=72914357169032

|DOI=10.1016/03060378-45303782(8182)9003790038-8x |accessdate=2020-11-1314

* Porter, Miller & Marshall et al. (19821986) studied motherthe nature of pain cries during unanesthetized, non-child interaction with regard to feeding behavior after therapeutic circumcision without anesthesia. They the cries during circumcision were found that circumcised boys had to shorter, with more more interruptions frequent vocalizations; higher peak fundamental frequencies; fewer harmonics; and greater variability of feeding in the 24-hour period fundamental. Adult listeners judged these cries to have an unusual degree of observationurgency.<ref name="marshall1982porter1986">{{REFjournal |last=MarshallPorter |initfirst=REFran Lang |firstinit=Richard E.FL

|last2=PorterMiller |init2first2=FLRichard H. |first2init2=Fran L.RH

|last3=RogersMarshal |init3first3=AGRichard E |first3init3=Ann G.RE

|title=CircumcisionNeonatal pain cries: II: Effects upon mother-infant interactioneffect of circumcision on acoustic features and perceived urgency

|journal=Early Hum Child Dev

|date=19821986-06 |volume=757 |issue=43 |pages=367790-74802 |url=httphttps://www.cirpjstor.org/library/birth/marshall2stable/1130355?seq=1

|pubmedID=71690323720404

|DOI=10.10162307/0378-3782(82)90038-x 1130355 |accessdate=2020-11-1415

PorterSurgical operation on infants without anesthesia continued for well over a century, Miller & Marshall (1986) studied at least until 1987, when the nature [[American Academy of pain cries during unanesthetized, non-therapeutic circumcision. the cries during circumcision were found Pediatrics]] was forced to shorter, with more more frequent vocalizations; higher peak fundamental frequencies; fewer harmonics; and greater variability of issue a CYA statement that called for the fundamental. Adult listeners judged these cries to have an unusual degree use of urgencyanesthesia.<ref name="porter1986poland1987">{{REFjournal |last=PorterPoland |first=Fran LangRonald L. |init=FLRL

|last2=MillerRoberts |first2=Richard H.Ronald J |init2=RHRJ

|last3=MarshalGutierrez-Mazorra |first3=Richard EJuan F. |init3=REJF

|title=Neonatal pain cries: effect of circumcision on acoustic features and perceived urgencyanesthesia

|journal=Child DevPediatrics

|date=19861987-0609 |volume=5780

|pages=790-802446 |url=https://wwwpediatrics.jstoraappublications.org/stablecontent/1130355?seq=180/3/446

|pubmedID= 3720404

|DOI=10.2307/1130355 |accessdate=2020-11-1512}}</ref><ref name="vanhowe2008"/> Anand & Hickey (1987) published a paper in the ''New England Journal of Medicine'' that totally demolished Flechsig's ridiculous claims and conclusively proved that newborn infants are capable of feeling intense pain. After publication of this paper, no doubt about pain sensation in infants remained. The article stated: {{Citation |Text=Numerous lines of evidence suggest that even in the human [[fetus]], pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functional. Physiologic responses to painful stimuli have been well documented in neonates of various gestational ages and are reflected in hormonal, metabolic, and cardiorespiratory changes similar to but greater than those observed in adult subjects. Other responses in newborn infants are suggestive of integrated emotional and behavioral responses to pain and are retained in memory long enough to modify subsequent behavior patterns. |Author=Anand & Hickey (1987) |ref=<ref name="anand1987"/><ref name="vanhowe2008"/>}}

Surgical operation on infants without anesthesia continued for well over a century, at least until 1987, when Gunnar et al. (1988) examined the association between behavioral distress and adrenocortical activity. It was found that differences in behavioral distress did not reliably the [[American Academy level of Pediatrics]] adrenocortical activity. Moreover, it was forced found that while non-nutritive sucking reduces crying it did not reduce the adrenocortical response to issue a CYA statement that called for the use stressful stimulus of anesthesiacircumcision pain.<ref name="poland1987gunnar1988">{{REFjournal |last=Poland Gunnar |first=Ronald L.Megan |init=RLM

|last2=Roberts Connors |first2=Ronald JJoan |init2=RJJ

|last3=Gutierrez-MazorraIsensee |first3=Juan F.Jill |init3=JFJ

|last4=FonkalsrudWall |first4=Eric W.Lee |init4=EWL

|etal=noyes |title=Neonatal anesthesiaAdrenocortical activity and behavioral distress in human newborns

|journal=PediatricsDev Psychobiol

|date=19871988-0905 |volume=8021 |issue=34 |pages=446297-310 |url=httpshttp://pediatricswww.aappublicationscirp.org/contentlibrary/80pain/3gunnar1988/446

|pubmedID=3378676

|DOI=10.1002/dev.420210402 |accessdate=2020-11-1215

Anand & Hickey (1987) published a paper in the ''New England Journal of Medicine'' that Although by 1989 it was totally demolished Flechsig's ridiculous claims and conclusively proved clear that newborn infants are capable of feeling can feel intense pain, the [[American_Academy_of_Pediatrics#Third_policy_.281989. After publication 29 1989| American Academy of this paperPediatrics Circumcision Task Force]], no doubt about pain sensation in infants remained. The article stated:<blockquote><i>Numerous lines under the leadership of evidence suggest that even in the human fetus, pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functionalinfamous [[Edgar J. Physiologic responses to painful stimuli have been well documented in neonates of various gestational ages and are reflected in hormonalSchoen]], metabolic{{MD}}, and cardiorespiratory changes similar to but greater than those observed in adult subjects. Other responses in newborn infants are suggestive of integrated emotional and behavioral responses to pain and are retained in memory long enough declined to modify subsequent behavior patterns.</i><ref name="anand1987" /></blockquote></i> Gunnar et al. (1988) examined recommend the association between behavioral distress and adrenocortical activity. It was found that differences in behavioral distress did not reliably the level use of adrenocortical activity. Moreover, it was found that while analgesics for non-nutritive sucking reduces crying it did not reduce the adrenocortical response therapeutic neonatal [[circumcision]], thereby condemning millions of newborn baby boys to the a painful, stressful stimulus of , traumatizing circumcision pain.<ref name="gunnar1988">{{REFjournal |last=GunnarSchoen |first=MeganEdgar J. |init=MEJ |author-link=Edgar J. Schoen |last2=Connors Anderson |first2=JoanGlen |init2=JG

|last3=IsenseeBohon |first3=JillConstance |init3=JC

|last4=WallHinman Jr |first4=LeeFrank |init4=LF

|last5=Poland |first5=Ronald L. |init5=RL |author5-link= |last6=Wakeman |first6=Maurice |init6=ME |author6-link= |etal=yesno |title=Adrenocortical activity and behavioral distress in human newbornsReport of the Task Force of Circumcision

|journal=Dev PsychobiolPediatrics

|date=19881989-0510 |volume=2189

|pages=297388-31091 |url=http://www.cirp.org/library/painstatements/gunnar1988aap/#a1989

|pubmedID=33786762664697

|DOI=10.1002/dev.420210402 |accessdate=2020-11-1518

Although by 1989 it ====Finding an ethical way to do painful non-therapeutic circumcision==== The financially and psychologically vested circumcision industry suddenly found itself in a predicament. It was totally clear now suddenly proven beyond any shadow of a doubt that infants newborn baby boys can feel intense pain, . Medical ethics and the 1989 American Academy standard of Pediatrics Circumcision Task Forcecare now necessitated pain relief, under the leadership of the infamous however it is dangerous to give general anesthesia to neonates. [[Edward Wallerstein]] (1985) had proposed that [[Edgar J. SchoenRoutine Infant Circumcision| routine]], M. D., declined to recommend the use of analgesics for (non-therapeutic neonatal ) circumcision, thereby condemning million of newborn baby boys to a painfulbe eliminated just as routine tonsillectomy and adenoidectomy previously had been eliminated, stressful circumcision.<refname="wallerstein1985">{{REFjournal |last=SchoenWallerstein |first=Edgar J.Edward |init=EJE |author-link=Edgar J. Schoen |last2=Anderson |first2=Glen |init2=G |author2-link= |last3=Bohon |first3=Constance |init3=C |author3-link= |last4=Hinman Jr |first4=Frank |init4=F |author4-link= |last5=Poland |first5=Ronald L. |init5=RL |author5-link= |last6=Wakeman |first6=Maurice |init6=ME |author6-link=Edward Wallerstein |etal=no |title=Report of Circumcision: the Task Force of Circumcisionuniquely American medical enigma

|journal=PediatricsUrol Clin North Am

|date=1989-10 |volume=89 |issue=4 |pages=388-91 |url=http://www.cirp.org/library/statements/aap/#a1989 |archived= |quote= |pubmedID=2664697 |pubmedCID= |DOI= |accessdate=2020-11-18}}</ref> ====Finding an ethical way to do painful non-therapeutic circumcision==== The finacially and psychologically vested circumcision industry suddenly found itself in a predicament. It was now suddenly proven beyond any shadow of a doubt that newborn baby boys can feel intense pain. Medical ethics and the standard of care now necessitated pain relief, however it is dangerous to give general anesthesia to neonates. Wallerstein (1985) had proposed that routine (non-therapeutic) circumcision of baby boys be eliminated just as routine tonsillectomy and adenoidectomy previously had been eliminated,<ref name="wallerstein1985">{{REFjournal |last=Wallerstein |first=Edward |init=E |author-link=Edward Wallerstein |etal=no |title=Circumcision: the uniquely American medical enigma |trans-title= |language=English |journal=Urol Clin North Am |location= |date=1985 |volume=12 |issue=1

}}</ref> however this clearly would not do for the avid pro-circumcision lobby. No circumcision equals no fee for surgery. The financial gain from discontinuing non-therapeutic circumcision is just too high to discard. [[Dan Bollinger ]] (2012) estimated that the total annual cost of non-therapeutic circumcision to Americans is $3,647,000,000.<ref>{{REFweb

|author-link=Dan Bollinger

}}</ref> The avaricious American [[circumcision industry ]] is simply not willing to give that lucrative income up, so a way to make non-therapeutic circumcisions in infancy acceptable had to be found.

* Application of [[EMLA ]] Cream topical anesthetic. [[EMLA ]] is a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%. [[EMLA ]] Cream (lidocaine 2.5% and prilocaine 2.5%), applied to intact [[skin ]] under occlusive dressing, provides dermal analgesia by the release of lidocaine and prilocaine from the cream into the epidermal and dermal layers of the [[skin ]] and by the accumulation of lidocaine and prilocaine in the vicinity of dermal pain receptors and nerve endings.<ref>{{REFweb

* [[Dorsal penile nerve block| Dorsal Penile Nerve Block ]] (DPNB) as proposed by Kirya & Werthman (1978).<ref name="kirya1978">{{REFjournal

* [[Ring block| Ring Block]]. Broadman et al. (1987) proposed ring block for neonatal non-therapeutic circumcision.<ref name="broadman1987">{{REFjournal

}}</ref> Ring block is considered the most effective analgesic procedure for neonatal non-therapeutic circumcision. Infant boys feel less pain and suffer less trauma than with the other two pain reduction procedures.<ref name="lander1997" /> <ref name="stang1997">{{REFjournal

|last2=SnnellmanSnellman

{{Box|Boxtext=<big><b>However, none of the above three procedures totally eliminate pain. A baby boy will still experience some pain and [[trauma]] despite any of those analgesic procedures. <ref name="bellini2022 /> Prevention of pain requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary circumcision surgery experience no pain or [[trauma]].</b></big>}}

}}</ref> and [[Robert S. Van Howe |Van Howe]] & Cold (1998)<ref>{{REFjournal

|init=RS

Wellington & Rieder (1993) conducted a survey of physicians in London, Ontario. They found that only 4 percent used [[dorsal penile nerve block| DPNB]]. They concluded:<blockquote>{{Citation |Text=Despite evidence that neonates perceive pain and that there is a physiologic stress response to circumcision which can be reduced if analgesia is employed, the vast majority of physicians performing newborn circumcisions either do not employ analgesics or employ analgesics of questionable efficacy. Lack of familiarity with the use of analgesics among neonates and with dorsal penile block in particular are the most common reasons cited for lack of analgesic use. Educational efforts and research into less invasive techniques of analgesia for newborn circumcision are urgently required. |Author=Wellington & Rieder (1993) |ref=<ref>{{REFjournal

<blockquote>{{Citation |Text=DESPITE THE DEBATE that continues over the benefits and risks of nonritual neonatal circumcision, it remains a commonly performed surgical procedure in the United States. To the best of our knowledge, it is the only surgical procedure that is routinely performed without first administering analgesia or anesthesia. This unconscionable state of affairs exists, despite the overwhelming evidence that newborns, even those born prematurely, are capable of experiencing pain. Indeed, anyone present during a circumcision realizes that the newborn feels and responds to pain and will attempt to withdraw if unrestrained. In addition, this pain has physiologic correlates: elevated heart rate and blood pressure, lowered arterial oxygen saturation, and elevated levels of adrenocortical hormones. During the past 15 years, results of a multitude of studies have demonstrated that effective analgesia can prevent this pain and ameliorate the associated stress response. Furthermore, the failure to provide anesthesia or analgesia has been shown to cause not only short-term physiologic perturbations but also longer-term behavioral changes. |Author=Maxwell & Yaster (1999) |ref=<ref>{{REFjournal

The [[American Academy of Pediatrics]] convened a new task force on circumcision under the chair of Carole M. Lannon, M. D{{MD}}. That task force reversed the position previously taken under [[Edgar J. Schoen]]. It clearly stated that non-therapeutic infant circumcision is "not essential to the child’s current well-being." It provided an extensive discussion of procedural analgesia and said, quite strongly, that, if a circumcision is done, procedural analgesia should be provided.<ref name="aap1999">{{REFjournal

|last2= |first2= |init2= |author2-link= |last3= |first3= |init3= |author3-link= |last4= |first4= |init4= |author4-link= |last5= |first5= |init5= |author5-link= |last6= |first6= |init6= |author6-link= |last7= |first7= |init7= |author7-link= |last8= |first8= |init8= |author8-link= |last9= |first9= |init9= |author9-link= |etal=yes |title=Circumcision policy statement |trans-title= |language= |journal=Pediatrics |location= |date=1999-03

 It is now clear that boys are born with a healthy foreskins [[foreskin]] without evidence of disease. Therefore there are no indications for infant [[circumcision]], which is a non-therapeutic and medically-unnecessary surgical operation.<ref name="cps1996">{{REFjournal

}}</ref> <ref name="racp2010">{{REFdocument

}}</ref> <ref>{{REFdocument

}}</ref> Circumcision excises the highly functional foreskin, which provides numerous protective, immunological, sensory, and sexual functions,<ref name="cold1999">{{ColdCJ TaylorJR 1999}}</ref> so it is an irreversible, lasting injury. Bellini (2022) considered that the pain of neonatal circumcision "can have long term consequences for the developing child."<ref name="bellini2022 /> Non-therapeutic circumcision of male minors is ''not'' the standard of care.

Nevertheless, some non-therapeutic circumcisions of boys will continue to be performed for religious reasons, ethnic reasons, and the[[Adamant father syndrome| emotional needs of parents]]. When a [[circumcision ]] is to be performed, the standard of care requires that analgesia be provided to reduce the extreme level of pain and trauma.<ref name="poland1987" /> <ref name="cps1996" /> <ref name="lander1997" /> <ref name="aap1999" /> (Total anesthesia cannot be used with infants.)The Australian Association of Paediatric Surgeons (AAPS) (1996) opposed the practice of infant circumcision, but recognized that it would be performed for religious, cultural, or family reasons, in which case, the non-therapeutic [[circumcision]] should be deferred for six months, so that general anesthesia may be used. The AAPS stated:

<blockquote>In this event the procedure should be performed electively after six months of age. When performed, it should be carried out by a surgeon performing circumcisions on children on a regular basis with an anaesthetist using appropriate techniques. This would imply that the anaesthetist is fully trained in the art of paediatric anaesthesia, including the ability to perform caudal and penile regional or local anaesthesia. The operation should be carried out in a paediatrically orientated environment, designed to reduce the risk to the child and providing support to the parents or caregivers.<ref>{{REFdocument |title=Guidelines for Circumcision |url=Videoshttps://www.cirp.org/library/statements/aaps/ |contribution= |last=Leditshke |first=JF |publisher=Australasian Association of Paediatric Surgeons |location=Herston, QLD, Australia |format= |date=1996-04 |accessdate=2024-01-22}}</ref></blockquote>

=== Infant The practice of non-therapeutic circumcision procedure ===of boys has nearly died out in [[Australia]].

Please note how == Pain's injury to the infant's lips quiver with pain.nervous system ==

Anand & Hickey (1985) conclusively demonstrated that infants feel pain and feel it more intensely than adults.<youtube>SLhEoOQhsVw<ref name="anand1987"/youtube>

Here is an infant circumcision video Pain researcher Maria Fitzgerald (1998) reported the sensitivity of an Islamic circumcision from the Russian Federation. The surgical technique is different but the infant nervous system to extreme pain is no less:

<vimeoblockquote>259674034</vimeo> ==Adolescent We and adult circumcision== [[Adolescent others have established that the developing nervous system is even more vulnerable to injury than in adults and adult circumcision]] that changes to the pathways induced shortly after birth can become permanent. This is usually carried out under total anesthesiabecause newborn nerve damage not only results in the death of sensory nerve cells, either by local or regional but causes other sensory nerve terminals to sprout extensively and occupy areas normally exclusively devoted to the damaged nerve block or by general anesthesia,.<ref>{{REFjournal |last=HolmanFitzgerald |initfirst= |firstinit=John R.M

|title=Adult circumcisionThe Birth of Pain

|language=English |journal=American Family PhysicianMRC News

|date=1999-03-151998 |season=Summer |volume=59 |issue=6 |article= |page= |pages=151420-823 |url=https://www.aafpcirp.org/afplibrary/1999pain/0315fitzgerald/p1514.html

|pubmedID=10193593 |pubmedCID= |DOI= |accessdate=20202024-1101-1931}}</ref> so the pain of the surgery is not usually a concern. That does not mean that the operation is pain free. It is not.</blockquote>

* There is, of course, post-surgical Several later researchers suggested that extreme pain, which may be relieved by a potent oral analgesicin the newborn could cause neurological injury. One should have a two-week supply of analgesic medicine[[Kanwaljeet J.Singh Anand| Anand]] & Scalzo (2000) concluded:

* {{Citation |Text=The recovery public health importance of abnormal stimulation during the neonatal period cannot be overemphasized. While programs for adolescent formulating appropriate health policies and adult circumcision public education campaigns must disseminate this message, it is usually placed at six weeks. During that period of timealso important for these effects to be investigated, many patients experience pain when they they have involuntary nocturnal erections and particularly with a view to developing effective therapeutic strategies for the erection tightens the residual skin growing children and pulls at adolescents who were exposed to abnormal conditions during the incision and sutureneonatal period. |Author=Anand & Scalzo (2000) |ref=<refname="anand2000">{{REFjournal |last=DaiAnand |initfirst= |firstinit=A-JuanKJS |author-link=Kanwaljeet J. Singh Anand |last2=LiScalzo |init2first2= |first2init2=MiaoFM

|last3etal=Wangno |init3title=Can adverse neonatal experiences alter brain development and subsequent behavior? |first3=Litrans-Li |author3-link= |last4=Wang |init4= |first4=Xiao-Hua |author4-link= |last5=Huang |init5= |first5title=Yu-Hua |author5-link= |etal=no |titlelanguage=Improvement of erection related incision pain in circumcision patients using interrupted rapid eye movement sleep: A randomized controlled study |journal=Urol JBiol Neonate

|date=20182000-02 |volume=1577 |issue=32 |article= |page= |pages=12669-3182 |url=httpshttp://journals.sbmuwww.accirp.irorg/uroljlibrary/index.php/uj/articlepain/viewanand4/3981

|pubmedID=2930857910657682

|DOI=10.220371159/uj.v0i0.3981 000014197 |accessdate=20202021-1108-2809}}</ref> In a few cases, the erections may cause [[wound dehiscence]] which requires additional surgery to re-close the surgical wound.}}

* That is not the only source of Fitzgerald & Walker (2003) argued that extreme pain. (such as that caused by [[Circumcisioncircumcision]] amputates ) may alter developing nervous tissue in the protective [[foreskin]]very young.<ref>{{REFbook |last=Fitzgerald |first=Maria |init=M |author-link= |last2=Walker |first2=Suellen |init2=S |author2-link= |year=2003 |title=The role of activity in developing pain pathways |url=http://www.cirp. org/library/pain/fitzgerald2/ |work=Proceedings of the 10th World Congress on Pain |editor=Dostovsky JO, Carr DB, Koltzenburg M (eds) |edition= |volume=24 |chapter= |pages=185-96 |location=Seattle |publisher=ASP Press |isbn= |quote=In cases common with other areas of [[phimosis]], the [[glans penis]] may never have been exposed beforecentral nervous system, so there frequently synaptic development of spinal sensory connections is severe experience or activity dependent. Evidence from both animal and human studies shows that alterations in the patterns of sensory activity that can arise from tissue injury and pain when in early life may disrupt normal synaptic organization within the glans penis touches anythingsomatosensory system. Many men complain that they While these studies are unable to wear trousers for an extended period of time. Only time incomplete and [[keratinization]] can ease more investigation is needed in this area, the potential clinical importance of neonatal plasticity in paindevelopment is clear. |accessdate=2020-11-18 |note=* Circumcision }}</ref> Tye & Sardi advised: <blockquote>Thus, while there is inexact surgery. Surgeons have to guess at how much skin to amputateliterature that addresses the ways in which pain experienced by neonates not only has negative short- and long term psychological consequences, so they frequently get it wrong. If sufficient skin policy making documents on neonatal circumcision do not address the fact that such pain is not available to permit penis expansion adequately nor regularly controlled for during times of erection, then taut, painful erections are the result. This complication may be treated by [[tissue expansion]]. The tension may also cause [[wound dehiscence]]procedure, which would cause additional pain. * Neuromas may form at the [[circumcision scar]]. Cold & Taylor (1999) reported and that they are "notorious failure to control for generating pain."can have lasting effects on the child, possibly into adulthood.<ref name="cold-taylor1999tye2022">{{ColdCJ TaylorJR 1999}}</ref>REFjournal |last=Tye{{SEEALSO}} |first=* [[Posttraumatic stress disorder]] |init=NC* [[Psychological issues of male circumcision]] |author-link=* [[Shock]] |last2=Sardi |first2={{LINKS}} |init2=LM* {{REFjournal |author2-link= |etal=no |lasttitle=American Academy Psychological, psychosocial, and psychosexual aspects of Pediatricspenile circumcision |authortrans-linktitle=American Academy of Pediatrics |titlelanguage=The assessment and management of acute pain in infants, children, and adolescents |journal=PediatricsInt J Impot Res

|date=20012022-0903-28 |volume=108 |issue=3 |article= |page= |pages=793-7 |url=httphttps://www.cirpnature.orgcom/library/pain/re9933articles/s41443-022-00553-9

|pubmedID=1153335435347302

|DOI=10.15421038/peds.108.3.793.s41443-022-00553-9 |accessdate=20202022-1104-1729}}</ref></blockquote> ==Videos== === Infant circumcision procedure === This is a video of an actual infant [[circumcision]]. It has a sound tract so one can hear the comments of the doctor and the sounds made by the infant. The doctor gives an injection of local anesthetic that apparently does not stop any pain at all. The infant goes silent at about 6:15 on the video, so he may have gone into [[shock]] at that time. Not for the squeamish:

|url=httphttps://www.cirpreddit.orgcom/libraryr/painIntactivism/comments/qbpzqr/trained_medical_professionals_restrain_infant_to/

|title=Pain Trained medical professionals restrain infant to amputate part of circumcision its body while baby kicks and screams in pain control

|language=English |last=Hill |first=George

|publisher=Circumcision Reference Library

|date=2006-09-11 |accessdate=20202022-03-11-08

|quote=Circumcision is the most stressful surgical procedure commonly performed on newborns.

* {{REFweb |url=http[https://www.circinforeddit.com/r/Intactivism/comments/qbpzqr/trained_medical_professionals_restrain_infant_to/ Circumcision video] <youtube>SLhEoOQhsVw</youtube> Here is an infant circumcision video of an Islamic circumcision from the Russian Federation.orgThe surgical technique is different but the pain is no less: <vimeo>259674034</news_2018vimeo> Here is a video of Dr. Paul Fleiss speaking about the harm of circumcision, including pain and trauma.html#babies |archived<youtube>ouHSz-OmOH8</youtube> ===Ronald Goldman=== |title=Babies more sensitive to [[Ronald Goldman]] discussed pain than adultsand trauma in a video by [[Brendon Marotta]]: <youtube>lNItNHs9PR8</youtube>  |trans-title==Adolescent and adult circumcision== [[Adolescent and adult circumcision]] is usually carried out under total anesthesia, either by local or regional nerve block or by general anesthesia,<ref>{{REFjournal |languagelast=Holman |lastinit= |first=John R.

|publisherlast2=University of Oxford NewsStuessi |websiteinit2=http://www |first2=Keith A.circinfo.org/ |author2-link= |etal=no |title=Adult circumcision |trans-title= |language=English |journal=American Family Physician |location= |date=20151999-0403-2115 |accessdatevolume=202159 |issue=6 |pages=1514-03-188 |url=https://www.aafp.org/afp/1999/0315/p1514.html |formatarchived=

|pubmedID=10193593 |pubmedCID= |DOI= |accessdate=2020-11-19}}</ref> so the pain of the surgery is not usually a concern. That does not mean that the operation is pain free. It is not pain free.<ref name="bellini2022/> * There is, of course, post-surgical pain, which may be relieved by a potent oral analgesic. One should have a two-week supply of analgesic medicine. * The recovery period for adolescent and adult circumcision is usually placed at six weeks. During that period of time, many patients experience pain when they they have involuntary nocturnal [[erection]]s and the [[erection]] tightens the residual [[skin]] and pulls at the incision and suture.<ref>{{REFjournal |last=Dai |init= |first=A-Juan |author-link= |last2=Li |init2= |first2=Miao |author2-link= |last3=Wang |init3= |first3=Li-Li |author3-link= |last4=Wang |init4= |first4=Xiao-Hua |author4-link= |last5=Huang |init5= |first5=Yu-Hua |author5-link= |etal=no |title=Improvement of erection related incision pain in circumcision patients using interrupted rapid eye movement sleep: A randomized controlled study |journal=Urol J |location= |date=2018 |volume=15 |issue=3 |pages=126-31 |url=https://journals.sbmu.ac.ir/urolj/index.php/uj/article/view/3981 |archived= |quote= |pubmedID=29308579 |pubmedCID= |DOI=10.22037/uj.v0i0.3981 |accessdate=2020-11-28}}</ref> In a few cases, the [[erection]]s may cause [[wound dehiscence]] which requires additional surgery to re-close the surgical wound. * That is not the only source of pain. [[Circumcision]] amputates the protective [[foreskin]]. In cases of [[phimosis]], the [[glans penis]] may never have been exposed before, so there frequently is severe pain when the [[glans penis]] touches anything. Many men complain that they are unable to wear trousers for an extended period of time. Only time and [[keratinization]] can ease this pain. * Circumcision is inexact surgery. Surgeons have to guess at how much [[skin]] to amputate, so they frequently get it wrong. If sufficient [[skin]] is not available to permit [[penis]] expansion during times of [[erection]], then taut, painful [[erection]]s are the result. This complication may be treated by [[tissue expansion]]. The tension may also cause [[wound dehiscence]], which would cause additional pain. * Neuromas may form at the [[circumcision scar]]. Cold & Taylor (1999) reported that they are "notorious for generating pain.".<ref name="cold-taylor1999">{{ColdCJ TaylorJR 1999}}</ref> {{SEEALSO}}* [[Circumstraint]]* [[Does Cosmetic Surgery Harm Babies?]]* [[Post-traumatic stress disorder]]* [[Psychological issues of male circumcision]]* [[Shock]]* [[Sudden Infant Death Syndrome]]* [[Trauma]] {{LINKS}}* {{REFweb |url=http://www.cirp.org/library/pain/ |archived= |title=Pain of circumcision and pain control |trans-title= |language=English |last=Hill |first=George |author-link= |publisher=Circumcision Reference Library |website= |date=2006-09-11 |accessdate=2020-11-08 |format= |quote=Circumcision is the most stressful surgical procedure commonly performed on newborns.}}* {{REFjournal |etal=no |last=American Academy of Pediatrics |author-link=American Academy of Pediatrics |title=The assessment and management of acute pain in infants, children, and adolescents |journal=Pediatrics |location= |date=2001-09 |volume=108 |issue=3 |pages=793-7 |url=http://www.cirp.org/library/pain/re9933/ |archived= |quote= |pubmedID=11533354 |pubmedCID= |DOI=10.1542/peds.108.3.793. |accessdate=2020-11-17}}* {{REFjournal |last=Bellieni |first= |init=CV |etal=no |title=Neonatal Infant Pain Scale in assessing pain and pain relief for newborn male circumcision |trans-title= |language= |journal=Int J Impot Res |location= |date=2023-05 |volume=35 |issue=3 |article= |page= |pages=282-5 |url=https://www.researchgate.net/publication/359693934_Neonatal_Infant_Pain_Scale_in_assessing_pain_and_pain_relief_for_newborn_male_circumcision |archived= |quote= |pubmedID=35352017 |pubmedCID= |DOI=10.1038/s41443-022-00551-x |doi= |format=PDF |accessdate=2023-10-09}}* {{REFweb |url=http://www.drmomma.org/2009/10/mri-studies-brain-permanently-altered.html |archived= |title=MRI Studies: The Brain Permanently Altered From Infant Circumcision |trans-title= |language= |last=Tinari |first=Paul D. |author-link=Paul Tinari |publisher=Peaceful Parenting |website= |date=2008 |accessdate=2021-10-22 |format= |quote=A neurologist who saw the results to postulated that the data indicated that circumcision affected most intensely the portions of the victim's brain associated with reasoning, perception and emotions. Follow up tests on the infant one day, one week and one month after the surgery indicated that the child's brain never returned to its baseline configuration. In other words, the evidence generated by this research indicated that the brain of the circumcised infant was permanently changed by the surgery.}}* {{REFweb |url=http://www.circinfo.org/news_2018.html#babies |archived= |title=Babies more sensitive to pain than adults |trans-title= |language= |last= |first= |author-link= |publisher={{UNI|Oxford University|Oxon}} News |website=http://www.circinfo.org/ |date=2015-04-21 |accessdate=2021-03-18 |format= |quote=}}* {{REFweb |url=http://www.circumstitions.com/Pain.html |title=Circumcision and Pain |last=Young |first=High |date=2014 |accessdate=2021-10-17}}* {{REFweb |url=https://www.intactamerica.org/american-academy-of-pediatrics-end-the-pain/ |archived= |title=American Academy of Pediatrics: End the Pain |trans-title= |language= |last=Chapin |first=Georganne |author-link=Georganne Chapin |publisher=Intact America |website= |date=2016-02-13 |accessdate=2021-04-02 |format= |quote=}}* {{REFjournal |last=Carpenter |first=Llaura M. |init=LM |author-link= |url=https://onlinelibrary.wiley.com/doi/full/10.1111/1468-0424.12472 |title=If You Prick Us: Masculinity and Circumcision Pain in the United States and Canada, 1960–2000 |journal=Gender & History |date=2020-03-25 |volume=31 |issue=1 |pages=54-69- |DOI=10.1111/1468-0424.12472 |accessdate=2022-08-24}}* {{REFweb |url=https://docs.google.com/document/d/1YVlNQlwDKnRfUgMbqKa9uth7-JNsEpIl/edit |title=The pain that never goes away. |last=Anonymous |first= |init= |publisher=Google |date= |accessdate=2023-08-18}}* {{REFweb |url=https://intactamerica.org/timeline-of-circumcision-suffering/ |title=A Timeline of Circumcision Suffering: A Detailed Look |last=Garrett |first=Connor |init= |publisher=Intact America |date=2024-02-02 |accessdate=2024-02-09}} {{ABBR}}{{REF}} [[Category:Circumcision risk]][[Category:Pain]][[Category:Parental information]][[Category:Psychology]][[Category:Penile surgery]][[Category:Male circumcision]][[Category:Breastfeeding]][[Category:Trauma]]

{{REF}} [[Categoryde:Circumcision risk]][[Category:Pain]][[Category:Parental information]][[Category:Psychology]][[Category:Penile surgery]][[Category:Male circumcisionSchmerz]]