Difference between revisions of "Pain"
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There are four painful steps in every infant circumcision: | There are four painful steps in every infant circumcision: | ||
| − | + | # Before circumcision surgery can commence, the surgeon must first forcibly separate these two highly innervated body parts in an exquisitely painful procedure by the passage of a blunt probe between the two parts to rip and tear the [[synechia]] apart.<ref>{{REFjournal | |
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| − | + | # Next, in another painful step, a [[dorsal slit]] must be cut in the foreskin, so that a special clamp can be installed. | |
| − | + | # The foreskin is erogenous tissue,<ref>{{REFjournal | |
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| − | + | # Finally, in another, painful step, the foreskin must be cut away. | |
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Lander ''et al''. (1997) conducted a comparison of no anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics (EMLA). | Lander ''et al''. (1997) conducted a comparison of no anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics (EMLA). | ||
Revision as of 08:52, 12 November 2020
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The pain of circumcision is severe and traumatizing.
Contents
Infant circumcision
Intraoperative pain
Circumcision is most-commonly performed on newborn infants as a non-therapeutic cultural body re-configuration. At that tender age, the foreskin normally is fused with the underlying glans penis by a synechial membrane that is common to both parts.[1]
There are four painful steps in every infant circumcision:
- Before circumcision surgery can commence, the surgeon must first forcibly separate these two highly innervated body parts in an exquisitely painful procedure by the passage of a blunt probe between the two parts to rip and tear the synechia apart.[2]
- Next, in another painful step, a dorsal slit must be cut in the foreskin, so that a special clamp can be installed.
- The foreskin is erogenous tissue,[3] so it is highly innervated.[4] Nervous tissue requires a large blood supply, so the foreskin is richly vascular with many blood vessels,[5] therefore the foreskin must be crushed with one of several special clamps in yet another painful step before the circumcision can be carried out.[6]
- Finally, in another, painful step, the foreskin must be cut away.
Lander et al. (1997) conducted a comparison of no anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics (EMLA).
With no anesthesia, the infants cried continuously. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea).
EMLA was the least effective pain control. Dorsal penile nerve block (DPNB) was more effective, and ring block was the most effective. The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea)." The authors were so alarmed that they terminated the no anesthesia arm of the study early.
None of the analgesic measures tested provided total pain relief. Any infant boy who undergoes neonatal circumcision will experience some pain and trauma. Boys who escape circumcision would have no pain or trauma. The author concluded that circumcision should be performed with anesthetic.[7]
Post-surgical pain
Circumcision is an invasive cutting operation. Like other invasive operations, post-surgical pain persists after the surgery for days or weeks. Infant boys will not receive effective analgesia because of their young makes such drugs dangerous.
Howard, Howard, & Weitzman (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 infants were unable to 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."[8]
Traumatic effect of infant circumcision
There is now substantial evidence that infant circumcision causes post traumatic stress disorder. Memory starts to function before birth and continues to function in the newborn period,[9] and infants are now known to feel pain intensely,[10] so all of the necessary requirements are present.[11]
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 as compared with intact boys.[12] [13]
Taddio et al. (1997) concluded:
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 infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.[13]
John Rhinehart, M. D., a clinical psychiatrist, reported finding numerous cases of PTSD in his adult male patients secondary to infant circumcision.[14]
History
Paul Emil Flechsig (1847-1929) was an eminent nineteenth-century German neuroanatomist, psychiatrist and neuropathologist. He suggested in 1872 that infants could not feel pain because their nerves are not completely myelinated. Incredible as it may seem today, his idea was accepted without question and without being tested.
Video
Infant circumcision procedure
Please note how the infant's lips quiver with pain.
External links
Hill, George (11 September 2006). Pain of circumcision and pain control
, Circumcision Reference Library. Retrieved 8 November 2020.
Quote:Circumcision is the most stressful surgical procedure commonly performed on newborns.
References
- ↑
Deibart, G.A.. The separation of the prepuce in the human penis. Anat Rec. 1933; 57: 387-99. DOI. Retrieved 8 November 2020.
- ↑ Oliver, JE. Circumcision and cruelty to children. Br Med J. 1979; 2(6195): 933. PMID. PMC. DOI. Retrieved 8 November 2020.
Quote:Without anaesthetic the operation in babies causes pain, intense and prolonged crying, air swallowing, vomiting sometimes followed by apnoea, and sometimes permanent local complications.
- ↑ Falliers. Circumcision. JAMA. 21 December 1970; 214(12): 2194. Retrieved 8 November 2020.
- ↑ Winkelmann, RK. The cutaneous innervation of the human newborn prepuce. J Invest Dermatol. January 1956; 26(1): 53-67. Retrieved 8 November 2020.
- ↑ Fleiss, P., Hodges, F., Van Howe, R.S.. Immunological functions of the human prepuce. Sex Trans Infect. October 1998; 74(5): 364-67. PMID. Retrieved 15 October 2019.
- ↑ Circumcision procedure (Gomco Clamp method). Patient Care. 15 March 1978; 12: 82-85. Retrieved 8 November 2020.
- ↑ Lander, Janice, Brady-Frerer, Barbara, Metcalfe, James B., Nazerali, Shermin, Muttit, Sarah. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA. 24 December 1997; 278(24): 2157-64. PMID. Retrieved 10 November 2020.
- ↑ Howard, Cynthia R., Howard, Fred M., Weitzman, Michael L.. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics. April 1994; 93(4): 641-6. PMID. Retrieved 9 November 2020.
- ↑ Hepper, PG. Fetal memory: Does it exist? What does it do?. Acta Pædiatrica Supplement (Stockholm). October 1996; 416: 16-20. PMID. DOI. Retrieved 11 November 2020.
- ↑ Anand, KJS, Hickey, PR, et al. Pain and its effects in the human neonate and fetus. N Engl J Med. 19 November 1987; 317(21): 1321-9. PMID. DOI. Retrieved 11 November 2020.
- ↑ Boyle, Gregory J, Goldman, Ronald, Svoboda, J. Steven, Fernandez, Ephrem. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol. 2002; 7(3): 329-43. PMID. DOI. Retrieved 11 November 2020.
- ↑ Taddio, Anna, Goldbach, Morton, Ipp, Moshe, Stevens, Bonnie, Koren, Gideon. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995; 344: 291-2. PMID. DOI. Retrieved 10 November 2020.
- ↑ a b Taddio, Anna, Katz, Joel, Ilersich, A Lane, Gideon, Koren. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1 March 1997; 342(9052): 599-603. PMID. DOI. Retrieved 11 November 2020.
- ↑ Rhinehart, John. Neonatal circumcision reconsidered. Tranactional Analysis Journal. July 1999; 29(3): 215-21. Retrieved 11 November 2020.
