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Pain
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The '''pain''' of [[circumcision ]] is extreme and traumatizing.<ref name="bollinger2019">{{REFdocument
|title=Child Genital Cutting as an Adverse Childhood Experience
|trans-title=
{{Citation
|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.
|Author=Ostwall & Peltzman (1974)
|ref=<ref name="ostwald1974">{{REFjournal
}}</ref>
There are four painful steps in every infant [[circumcision]]:<ref name="bellini2022>{{REFjournal
|last=Bellini
|first=
}}</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
|last=Oliver
|init=JE
|DOI=
|accessdate=2020-11-08
}}</ref> Nervous tissue requires a large blood supply, so the [[foreskin ]] is richly vascularized with many blood vessels,<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</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=
|first=
# 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">{{REFjournal
|last=Lander
|init=J
|DOI=10.1186/1824-7288-39-38
|accessdate=2021-05-29
}}</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" />
===Post-surgical pain===
}}</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
}}</ref>
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:
}}
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=Rhinehart
|init=J
So great was Flechsig's influence, the authors were still unwilling to use the word ''pain'' and substituted the word ''stress''.<ref name="Gunnar et al 1981"/>
* Marshall et al. (1982) studied mother-child interaction with regard to feeding behavior after circumcision without anesthesia. They found that [[circumcised ]] boys had more interruptions of feeding in the 24-hour period of observation.<ref name="marshall1982">{{REFjournal
|last=Marshall
|init=RE
}}</ref>
Although by 1989 it was totally clear that infants can feel intense pain, the 1989 American Academy of Pediatrics Circumcision Task Force, under the leadership of the infamous [[Edgar J. Schoen]], {{MD}}, declined to recommend the use of analgesics for non-therapeutic neonatal [[circumcision]], thereby condemning millions of newborn baby boys to a painful, stressful' traumatizing circumcision.<ref>{{REFjournal
|last=Schoen
|first=Edgar J.
===Historic attitudes and practices===
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:
{{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.
}}</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.)
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