22,208
edits
Changes
Jump to navigation
Jump to search
|trans-title=
|language=English
Pain researcher Maria Fitzgerald [[Paul Emil Flechsig]] (19981847-1929) reported the sensitivity of the infant nervous system to extreme pain:<blockquote>We was an eminent nineteenth-century German neuroanatomist, psychiatrist and others have established that the developing nervous system is even more vulnerable to injury than neuropathologist. He suggested in adults and 1872 that changes to the pathways induced shortly after birth can become permanent. This is infants could not feel pain because newborn nerve damage their nerves are not only results in the death of sensory nerve cells, but causes other sensory nerve terminals to sprout extensively and occupy areas normally exclusively devoted to the damaged nervecompletely myelinated.<refname="cope1998">{{REFjournal |last=Fitzgerald |first=Cope |init=MDK
|etal=no |title=The Birth Neonatal pain: the evolution of Pain |trans-title= |language=an idea. |journal=MRC News |location=The American Association of Anesthesiologists Newsletter |date=1998 |season=Summer-09
</blockquote>
Fitzgerald & Walker * Emde et al. (20031971) argued that extreme pain (such as showed that the "stress" of circumcision caused by circumcision) may alter developing nervous tissue an increase in the very youngamount of non-REM sleep.<refname="emde1971">{{REFbookREFjournal |last=FitzgeraldEmde |firstinit=MariaRN |initfirst=MRobert N
</blockquote>
===History=======Investigating pain of circumcision==== [[Paul Emil Flechsig]] * Luther, Kraybill & Potter (1847-19291976) was an eminent nineteenth-century German neuroanatomist, psychiatrist compared the level of cortisol in infants before and neuropathologistafter circumcision. He suggested They found a substantial rise in the cortisol levels in 1872 that the infants could not feel pain because their nerves are not completely myelinated, which they said was due to the "stress" of circumcision.<ref name="cope1998">{{REFjournal |last=CopeTalbert |init=DKLM |first=Luther M.
As a result* Rawlings, 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 empirical research carried out in the 1970s suggested that infants can in fact feel intense pain.<ref name="vanhowe2008" /> * Anders et al. Miller & Engel (19701980) showed that measurement as the pain of serum cortisol is a useful indicator circumcision increased, oxygenation of pain for psychological investigation in infancythe [[skin]] decreased.<ref name="anders1970rawlings1980">{{REFjournal |last=AndersRawlings |init=TFDJ |first=Thomas FDavid J.
|last5=Wagonfeld
|init5=S
|first5=Samuel
|author5-link=
* LutherPorter, Kraybill Miller & Potter Marshall (19761986) compared studied the level nature of cortisol in infants before and after pain cries during unanesthetized, non-therapeutic circumcision. They the cries during circumcision were found a substantial rise in to shorter, with more more frequent vocalizations; higher peak fundamental frequencies; fewer harmonics; and greater variability of the cortisol levels in the infants, which they said was due fundamental. Adult listeners judged these cries to the "stress" have an unusual degree of circumcisionurgency.<refname="porter1986">{{REFjournal |last=TalbertPorter |initfirst=LMFran Lang |firstinit=Luther M.FL
* RawlingsSurgical operation on infants without anesthesia continued for well over a century, Miller & Engel (1980) showed that as the pain of circumcision increasedat least until 1987, oxygenation of when the [[skinAmerican Academy of Pediatrics]] decreasedwas forced to issue a CYA statement that called for the use of anesthesia.<ref name="rawlings1980poland1987">{{REFjournal |last=RawlingsPoland |initfirst=DJRonald L. |firstinit=David J.RL
* Gunnar et al. (1981) recorded serum cortisol and behavior state throughout the unanesthetized, non-therapeutic circumcision process. Serum cortisol levels and behavioral distress were found to be closely related. The authors stated:
}}
So great Although by 1989 it was Flechsig's influencetotally clear that infants can feel intense pain, the authors were still unwilling to use [[American_Academy_of_Pediatrics#Third_policy_.281989.29 1989| American Academy of Pediatrics Circumcision Task Force]], under the word ''pain'' and substituted leadership of the word ''stress''infamous [[Edgar J.<ref name="Gunnar et al 1981"/> * Marshall et al. (1982) studied motherSchoen]], {{MD}}, declined to recommend the use of analgesics for non-child interaction with regard to feeding behavior after circumcision without anesthesia. They found that therapeutic neonatal [[circumcisedcircumcision]] , thereby condemning millions of newborn baby boys had more interruptions of feeding in the 24-hour period of observationto a painful, stressful, traumatizing circumcision.<ref name="marshall1982">{{REFjournal |last=MarshallSchoen |initfirst=REEdgar J. |firstinit=Richard E.EJ |author-link=Edgar J. Schoen |last2=PorterAnderson |init2first2=FLGlen |first2init2=Fran L.G
Porter, Miller & Marshall (1986) studied the nature of pain cries during unanesthetized, ====Finding an ethical way to do painful non-therapeutic circumcision. the cries during ==== The financially and psychologically vested circumcision were industry suddenly found to shorter, with more more frequent vocalizations; higher peak fundamental frequencies; fewer harmonics; 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 greater variability the standard of the fundamentalcare now necessitated pain relief, however it is dangerous to give general anesthesia to neonates. Adult listeners judged these cries to have an unusual degree [[Edward Wallerstein]] (1985) had proposed that [[Routine Infant Circumcision| routine]] (non-therapeutic) circumcision of urgency.baby boys be eliminated just as routine tonsillectomy and adenoidectomy previously had been eliminated,<ref name="porter1986wallerstein1985">{{REFjournal |last=PorterWallerstein |first=Fran LangEdward |init=FLE |author-link= |last2=Miller |first2=Richard H. |init2=RH |author2-link= |last3=Marshal |first3=Richard E |init3=RE |author3-link=Edward Wallerstein
|last3=Gutierrez-Mazorra
|first3=Juan F.
|init3=JF
|author3-link=
|last4=Fonkalsrud
|first4=Eric W.
|init4=EW
|author4-link=
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 * [[fetusRing block| Ring Block]], 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"/>}} Gunnar Broadman et al. (19881987) examined the association between behavioral distress and adrenocortical activity. It was found that differences in behavioral distress did not reliably the level of adrenocortical activity. Moreover, it was found that while proposed ring block for neonatal non-nutritive sucking reduces crying it did not reduce the adrenocortical response to the stressful stimulus of therapeutic circumcision pain.<ref name="gunnar1988broadman1987">{{REFjournal |last=Gunnar |first=MeganBroadman |init=MLM
The financially 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. [[Edward Wallerstein]] (1985) had proposed that [[Routine Infant Circumcision| routine]] (non-therapeutic) circumcision of baby boys be eliminated just as routine tonsillectomy and adenoidectomy previously had been eliminated,<ref name="wallerstein1985">{{REFjournal
|title=High cost of circumcision
|trans-title=
|language=English
|last=Bollinger
|first=Dan
|author-link=Dan Bollinger
|publisher=Academia
|website=
|date=2012
|accessdate=2020-11-15
|format=PDF
Three methods were proposed:The pain that infant boys experience would not be acceptable in older boys and adults. It is not clear why infant boys are still subjected to a lesser standard of care with regard to pain than older boys and adults.
* Application of [[EMLA]] Cream topical anesthetic. [[EMLA]] is a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%. [[EMLA]] Cream (lidocaine 2.5% ==Attitudes and prilocaine 2.5%), applied to intact [[skin]] under occlusive dressing, provides dermal practices regarding 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 |urlfor newborn circumcision=https://www.drugs.com/pro/emla.html#s-34069-5 |archived= |title=EMLA |trans-title= |language=English |last= |firstHistoric attitudes and practices= |author-link= |publisher=Drugs.com |website= Wellington & Rieder (1993) conducted a survey of physicians in London, Ontario. They found that only 4 percent used [[dorsal penile nerve block|date=2020-04-21 |accessdate=2020-11-21 |format= |quote=}}</ref>DPNB]]. They concluded:
* [[Dorsal {{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 nerve blockin 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. | Dorsal Penile Nerve Block]] (DPNB) as proposed by Kirya Author=Wellington & Werthman Rieder (19781993). |ref=<ref name="kirya1978">{{REFjournal |last=KiryaWellington |first=ChristopherNancy |init=CN
* Ryan & Finer (1994) carried out a training program for physicians in the newborn nurseries of the Womens' Pavilion, [[Ring block| Ring Blockhttps://www.albertahealthservices.ca/rah/rah.aspx Royal Alexandra Hospital]]. Broadman et al, Edmonton, Alberta, Canada. (1987) proposed ring block for neonatal After a training program, they found that 66 percent of physicians who perform non-therapeutic circumcisionneonatal circumcisions had started to use analgesia during the procedure. This applies to one hospital in [[Canada]].<ref name="broadman1987ryan1994">{{REFjournal |last=BroadmanRyan |first=C. Anthony |init=LMCA
|last3=Belman
|init3=AB
|author3-link=
|last4=Elder
|init4=PT
|author4-link=
|last5=Ruttiman
|init5=U
|author5-link=
|last6=Epstein
|init6=BS
|author6-link=
|last3=Condon
|first3=Lawrence M
|init3=LM
|author3-link=
|last4=Conroy
|first4=Mary Margaret
|init4=MM
|author4-link=
|last5=Liebo
|first5=Rhoda
|init5=R
|author5-link=
|last6=Brodersen
|first6=Laurie
|init6=L
|author6-link=
|last7=Gunnar
|first7=Megan R.
|init7=MR
|author7-link=
The pain that infant boys experience would not be acceptable in older boys ===Contemporary attitudes and adults. It is not clear why infant boys are still subjected to a lesser standard of care with regard to pain than older boys and adults.practices===
==Attitudes Little is known about current attitudes and practices regarding the use of analgesia for in circumcision of the newborn . Application of analgesia prior to neonatal nontherapeutic circumcision==takes additional physician time, so there may be a tendency to skip it.
Wellington & Rieder (1993) conducted It is now clear that boys are born with a survey of physicians in London, Ontario. They found that only 4 percent used healthy [[dorsal penile nerve block| DPNBforeskin]]without evidence of disease. They concluded:{{Citation |Text=Despite evidence that neonates perceive pain and that Therefore there is a physiologic stress response to are no indications for infant [[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 a non-therapeutic and with dorsal penile block in particular are the most common reasons cited for lack of analgesic usemedically-unnecessary surgical operation. Educational efforts and research into less invasive techniques of analgesia for newborn circumcision are urgently required. |Author=Wellington & Rieder (1993) |<refname=<ref"cps1996">{{REFjournal |last=WellingtonEugene |first=NancyOuterbridge |init=N
|last2=Rieder
|first2=Michael J.
|init2=MJ
|author2-link=
Maxwell & Yaster (1999) called on physicians to use analgesia during neonatal non-therapeutic circumcision surgery, saying:<blockquote>{{Citation |Text=DESPITE THE DEBATE that continues over In this event the benefits and risks procedure should be performed electively after six months of nonritual neonatal circumcisionage. When performed, it remains should be carried out by a surgeon performing circumcisions on children on a commonly performed surgical procedure in the United Statesregular basis with an anaesthetist using appropriate techniques. To This would imply that the best of our knowledge, it anaesthetist is fully trained in the only surgical procedure that is routinely performed without first administering analgesia or anesthesia. This unconscionable state art of affairs existspaediatric anaesthesia, despite including the overwhelming evidence that newborns, even those born prematurely, are capable of experiencing painability to perform caudal and penile regional or local anaesthesia. IndeedThe operation should be carried out in a paediatrically orientated environment, anyone present during a circumcision realizes that designed to reduce the newborn feels and responds risk to pain the child and will attempt providing support to withdraw if unrestrainedthe parents or caregivers. In addition, this pain has physiologic correlates<ref>{{REFdocument |title=Guidelines for Circumcision |url=https: elevated heart rate and blood pressure, lowered arterial oxygen saturation, and elevated levels of adrenocortical hormones//www. 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 changescirp.org/library/statements/aaps/ |contribution= |last=Leditshke |Authorfirst=Maxwell & Yaster (1999)JF |refpublisher=<ref>{{REFjournalAustralasian Association of Paediatric Surgeons |lastlocation=MaxwellHerston, QLD, Australia |initformat= |firstdate=1996-04 |authoraccessdate=2024-01-22}}</ref></blockquote> The practice of non-linktherapeutic circumcision of boys has nearly died out in [[Australia]]. == Pain's injury to the infant nervous system == Anand & Hickey (1985) conclusively demonstrated that infants feel pain and feel it more intensely than adults.<ref name="anand1987"/> Pain researcher Maria Fitzgerald (1998) reported the sensitivity of the infant nervous system to extreme pain: <blockquote>We and others have established that the developing nervous system is even more vulnerable to injury than in adults and that changes to the pathways induced shortly after birth can become permanent. This is because newborn nerve damage not only results in the death of sensory nerve cells, but causes other sensory nerve terminals to sprout extensively and occupy areas normally exclusively devoted to the damaged nerve.<ref>{{REFjournal |last2last=YasterFitzgerald |init2first= |first2init=M |author2author-link=
|pubmedID=10323622 |pubmedCID= |DOI=10.1001/archpedi.153.5.444 |accessdate=20202024-1101-2131
}}</blockquote> Several later researchers suggested that extreme pain in the newborn could cause neurological injury. [[Kanwaljeet J. Singh Anand| Anand]] & Scalzo (2000) concluded:
|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=yesno |title=Circumcision policy statementCan adverse neonatal experiences alter brain development and subsequent behavior?
Kraft Fitzgerald & Walker (2003) reported argued that "many health care practitioners routinely perform this procedure without extreme pain (such as that caused by [[circumcision]]) may alter developing nervous tissue in the use of any or with inadequate or ineffective analgesia and anesthesiavery young."<ref name="kraft2003">{{REFjournalREFbook |last=KraftFitzgerald |initfirst=NLMaria |firstinit=Nancy LM
===Contemporary attitudes and practices===Little is known about current attitudes and practices regarding the use of analgesia in circumcision of the newborn. Application of analgesia prior to neonatal nontherapeutic circumcision takes additional physician time, so there may be a tendency to skip it.Tye & Sardi advised:
==Standard of care==<blockquote>It Thus, while there is now clear literature that boys are born with a healthy [[foreskin]] without evidence of disease. Therefore there are no indications addresses the ways in which pain experienced by neonates not only has negative short- and long term psychological consequences, policy making documents on neonatal circumcision do not address the fact that such pain is not adequately nor regularly controlled for infant [[circumcision]]during the procedure, which is a non-therapeutic and medically-unnecessary surgical operationthat failure to control for pain can have lasting effects on the child, possibly into adulthood.<ref name="cps1996tye2022">{{REFjournal |last=EugeneTye |first=Outerbridge |init=NC
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"/youtube>SLhEoOQhsVw<ref name="cps1996"/youtube><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 Here is an 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 video 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 Islamic circumcision from the art of paediatric anaesthesia, including the ability to perform caudal and penile regional or local anaesthesiaRussian Federation. The operation should be carried out in a paediatrically orientated environment, designed to reduce surgical technique is different but the risk to the child and providing support to the parents or caregivers.<ref>{{REFdocument |title=Guidelines for Circumcision |url=httpspain is no less://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}}</refvimeo>259674034</blockquotevimeo>
The practice Here is a video of Dr. Paul Fleiss speaking about the harm of non-therapeutic circumcision of boys has nearly died out in [[Australia]], including pain and trauma.
==Videos==<youtube>ouHSz-OmOH8</youtube>
* {{REFweb |url=https://www.reddit.com/r/Intactivism/comments/qbpzqr/trained_medical_professionals_restrain_infant_to/ |archived= |title=Trained medical professionals restrain infant to amputate part of its body while baby kicks and screams in pain |trans-title= |language= |last= |first= |author-link= |publisher= |website= |date= |accessdate=2022-03-11 |format= |quote=}} *[https://www.reddit.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. The surgical technique is different but the pain is no less: <vimeo>259674034</vimeo><br>Here is a video of Dr. Paul Fleiss speaking about the harm of circumcision, including pain and trauma.<youtube>ouHSz-OmOH8</youtube><br> ===Ronald Goldman===[[Ronald Goldman]] discussed pain and trauma in a video by [[Brendon Marotta]]:
}}
* {{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.
Pain
,using template LanderJ etal 1997
The '''pain''' of [[circumcision]] is extreme and traumatizing.<ref name="bollinger2019">{{REFdocument
|title=Child Genital Cutting as an Adverse Childhood Experience
|url=http://adversechildhoodexperiences.net/CGC_as_an_ACE.pdf
|archived=
}}</ref>
}}
==Infant circumcision==
# 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 |first=Janice |author-link= |last2=Brady-Frerer |init2=B |first2=Barbara |author2-link= |last3=Metcalfe |init3=JB |first3=James B. |author3-link= |last4=Nazerali |init4=S |first4=Shermin |author4-link= |last5=Muttit |init5=S |first5=Sarah |author5-link= |LanderJ etal=no |title= Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision |journal=JAMA |location= |date=1997-12-24 |volume=278 |issue=24 |pages=2157-64 |url=http://www.cirp.org/library/pain/lander/ |archived= |quote= |pubmedID=9417009 |pubmedCID= |DOI= |accessdate=2020-11-10}}</ref>
With no anesthesia, the infants screamed 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). One experienced projectile vomiting.<ref name="lander1997" />
[[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.<ref name="lander1997" />
None of the analgesic measures tested provided total pain relief.<ref name="bellieni2013">{{REFjournal
|last=Bellieni
===Traumatic effect of infant circumcision===
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
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.
}}</ref>
===Pain's injury to the infant nervous systemHistory===Anand & Hickey (1985) conclusively demonstrated that infants feel ====Investigating pain and feel it more intensely than adults.of circumcision====
|author-link=
|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=Journal of Law, Medicine, and Ethics |location= |date=2008-12 |volume=36 |issue=4 |article= |page= |pages=20803-23 |url=https://www.cirpacademia.orgedu/librarydownload/pain/fitzgerald33981944/27_Van_Howe.pdf |archived=
|quote=
|pubmedID=19094008 |pubmedCID= |DOI=10.1111/j.1748-720X.2008.00339.x |accessdate=20242021-0110-31
}}</ref>
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 later researchers lines of empirical research carried out in the 1970s suggested that extreme infants can in fact feel intense pain in the newborn could cause neurological injury. [[Kanwaljeet J<ref name="vanhowe2008" /> * Anders et al. Singh Anand| Anand]] & Scalzo (20001970) concluded:{{Citation |Text=The public health importance showed that measurement of abnormal stimulation during the neonatal period cannot be overemphasized. While programs for formulating appropriate health policies and public education campaigns must disseminate this message, it serum cortisol is also important for these effects to be investigated, particularly with a view to developing effective therapeutic strategies useful indicator of pain for the growing children and adolescents who were exposed to abnormal conditions during the neonatal periodpsychological investigation in infancy. |Author=Anand & Scalzo (2000) |ref=<ref name="anand2000anders1970">{{REFjournal |last=AnandAnders |firstinit=TF |initfirst=KJSThomas F. |author-link=Kanwaljeet J. Singh Anand |last2=ScalzoSachar |first2init2=EJ |init2first2=FMEdward J.
|author2-link=
|etallast3=Kream |init3=J |first3=Jacob |author3-link= |last4=Roffwarg |init4=HP |first4=Howard P. |author4-link= |last5=Hellman |init5=noL |titlefirst5=Can adverse neonatal experiences alter brain development and subsequent behavior?Leon |transauthor5-titlelink= |etal=no |languagetitle=Behavioral state and plasma cortisol response in the human neonate |journal=Biol NeonatePediatrics
|location=
|date=20001970-0210 |volume=7746 |issue=2 |article= |page=4 |pages=69532-827 |url=http://www.cirp.org/library/pain/anand4anders1/
|archived=
|quote=
|pubmedID=106576824323242
|pubmedCID=
|DOI=10.1159/000014197 |accessdate=20212020-0811-0913}}</ref>}}
|author-link=
|last2=WalkerHarmon |first2init2=SuellenRJ |init2first2=SRobert J.
|author2-link=
|yearlast3=2003Metcalf |titleinit3=D |first3=David |author3-link= |last4=Koenig |init4=The role of activity in developing pain pathwaysKL |urlfirst4=http://wwwKenneth L.cirp.org/library/pain/fitzgerald2/ |workauthor4-link= |last5=Wagonfeld |init5=S |first5=Samuel |author5-link= |etal=no |title=Stress and neonatal sleep |journal=Proceedings of the 10th World Congress on PainPsychosom Med |editorlocation=Dostovsky JO, Carr DB, Koltzenburg M (eds) |editiondate=1971 |volume=2433 |chapterissue=6 |pages=185491-967 |url=http://www.cirp.org/library/birth/emde/ |locationarchived=Seattle |publisherquote=ASP Press |isbnpubmedID= |quotepubmedCID=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. |accessdateDOI=2020-11-18 |noteaccessdate=}}</ref> Tye * Richards, Bernal & Sardi advised:<blockquote>Thus, while there is literature that addresses the ways in which pain experienced by neonates not only has negative short- Brackbill (1976) reported behavioral differences between American boys (circumcised) and long term psychological consequences, policy making documents on neonatal circumcision do not address the fact that such pain is not adequately nor regularly controlled for during the procedure, and that failure to control for pain can have lasting effects on the child, possibly into adulthoodBritish boys (genitally intact).<ref name="tye2022richards1976">{{REFjournal |last=Tye |first=Richards |init=NCMPM
|author-link=
|last2=Sardi |first2=Bernal |init2=LMJF
|author2-link=
|last3=Brackbill
|init3=Y
|first3=Yvonne
|author3-link=
|etal=no
|title=Psychological, psychosocial, and psychosexual aspects ofpenile Early behavioral differences: gender or circumcision |trans-title= |language=? |journal=Int J Impot ResDev Psychobiol
|location=
|date=20221976-03-2801 |volume=9 |issue= |article= |page=1 |pages=89-95 |url=httpshttp://www.naturecirp.comorg/library/psych/articlesbrackbill/s41443-022-00553-9
|archived=
|quote=
|pubmedID=35347302767183
|pubmedCID=
|DOI=10.1038/s41443-022-00553-9 |accessdate=20222020-0411-2913
}}</ref>
|author-link=
|titlelast2=Neonatal pain: the evolution of an idea.Kraybill |journalinit2=The American Association of Anesthesiologists NewsletterEN |datefirst2=1998-09Ernest N. |volume= |issue= |pages= |url= |accessdate=2020author2-11-12}}</ref> Incredible as it may seem today, his idea was accepted without question and without being tested.<ref name="vanhowe2008">{{REFjournal |lastlink=Van Howe |firstlast3=Robert S.Potter |initinit3=RSHD |authorauthor3-link=Robert S. Van Howe |last2etal=Svobodano |first2title=JAdrenal cortical response to circumcision in the neonate. Steven |init2=JS |author2trans-link=J. Steven Svoboda |etaltitle=no |titlelanguage=Neonatal pain relief and the Helsinki DeclarationEnglish |journal=Journal of Law, Medicine, and EthicsObstet Gynecol |location= |date=20081976-1208 |volume=3646 |issue=4 |article= |page=2 |pages=803208-2310 |url=httpshttp://www.academiacirp.eduorg/downloadlibrary/33981944pain/talbert/27_Van_Howe.pdf
|archived=
|quote=
|pubmedID=19094008940653
|pubmedCID=
|DOI=10.1111/j.1748-720X.2008.00339.x |accessdate=20212020-1011-3113
}}</ref>
|author-link=
|last2=SacharMiller |init2=EJPA |first2=Edward J.Patricia Anne
|author2-link=
|last3=KreamEngel |init3=JRR |first3=JacobRolf R.
|author3-link=
|last4etal=Roffwarg no |init4title=HPThe effect of circumcision on transcutaneous PO2 in term infants |first4=Howard P. |author4trans-link= |last5=Hellman |init5title=L |first5language=Leon |author5-link= |etal=no |title=Behavioral state and plasma cortisol response in the human neonateEnglish |journal=PediatricsAm J Dis Child
|location=
|date=19701980-1007 |volume=46134 |issue=47 |pages=532676-78 |url=http://www.cirp.org/library/pain/anders1rawlings1/
|archived=
|quote=
|pubmedID=43232427395829
|pubmedCID=
|DOI=10.1001/archpedi.1980.02130190044011
|accessdate=2020-11-13
}}</ref>
* Emde Gunnar et al. (19711981) showed that recorded serum cortisol and behavior state throughout the "stress" 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 caused an increase in is performed without anesthesia and it is clearly stressful for the amount of non-REM sleepinfant. |Author=Gunnar et al.(1981) |ref=<ref name="emde1971Gunnar et al 1981">{{REFjournal |last=EmdeGunnar |init=RNMR |first=Robert NMegan R.
|author-link=
|last2=HarmonFisch |init2=RJRO |first2=Robert JO.
|author2-link=
|last3=MetcalfKorsvick |init3=DS |first3=DavidSherry
|author3-link=
|last4=KoenigDonhowe |init4=KLJM |first4=Kenneth LJohn M.
|author4-link=
|etal=no
|title=Stress The effects of circumcision on serum cortisol and neonatal sleepbehavior. |trans-title= |language=English |journal=Psychosom Med Psychoneuroendocrinology
|location=
|date=19711981 |volume=336 |issue=63 |pages=491260-775 |url=http://www.cirp.org/library/birthpain/emdegunnar/
|archived=
|quote=
|pubmedID=7291435
|pubmedCID=
|DOI=10.1016/0306-4530(81)90037-8 |accessdate=2020-11-13
}}</ref>
}}
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"/>
* Richards, Bernal & Brackbill Marshall et al. (19761982) reported behavioral differences between American boys (studied mother-child interaction with regard to feeding behavior after circumcision without anesthesia. They found that [[circumcised) and British ]] boys (genitally intact)had more interruptions of feeding in the 24-hour period of observation.<ref name="richards1976marshall1982">{{REFjournal |last=RichardsMarshall |init=MPMRE |first=Richard E.
|author-link=
|last2=BernalPorter |init2=JFFL |first2=Fran L.
|author2-link=
|last3=BrackbillRogers |init3=YAG |first3=YvonneAnn G.
|author3-link=
|last4=Moore |init4=J |first4=JoAnn |author4-link= |last5=Anderson |init5=B |first5=Barbara |author5-link= |last6=Boxerman |first6=Stuart B. |init6=SB |author6-link= |etal=no |title=Early behavioral differencesCircumcision: II: gender or circumcision?Effects upon mother-infant interaction |trans-title= |language=English |journal=Early Hum Dev Psychobiol
|location=
|date=1976-011982 |volume=97 |issue=14 |pages=89367-9574 |url=http://www.cirp.org/library/psychbirth/brackbillmarshall2/
|archived=
|quote=
|pubmedID=7671837169032
|pubmedCID=
|DOI=10.1016/0378-3782(82)90038-x |accessdate=2020-11-1314
}}</ref>
|author-link=
|last2=KraybillMiller |init2first2=ENRichard H. |first2init2=Ernest N.RH
|author2-link=
|last3=PotterMarshal |first3=Richard E |init3=HDRE
|author3-link=
|etal=no
|title=Adrenal cortical response to Neonatal pain cries: effect of circumcision in the neonate.on acoustic features and perceived urgency
|trans-title=
|language=English
|journal=Obstet Gynecol Child Dev
|location=
|date=19761986-0806 |volume=4657 |issue=23 |pages=208790-10802 |url=httphttps://www.cirpjstor.org/library/pain/talbertstable/1130355?seq=1
|archived=
|quote=
|pubmedID=9406533720404
|pubmedCID=
|DOI=10.2307/1130355 |accessdate=2020-11-1315
}}</ref>
|author-link=
|last2=MillerRoberts |init2first2=PARonald J |first2init2=Patricia AnneRJ
|author2-link=
|last3=EngelGutierrez-Mazorra |init3first3=RRJuan F. |first3init3=Rolf R.JF
|author3-link=
|last4=Fonkalsrud
|first4=Eric W.
|init4=EW
|author4-link=
|etal=no
|title=The effect of circumcision on transcutaneous PO2 in term infantsNeonatal anesthesia
|trans-title=
|language=English
|journal=Am J Dis ChildPediatrics
|location=
|date=19801987-0709 |volume=13480 |issue=73 |pages=676-8446 |url=httphttps://wwwpediatrics.cirpaappublications.org/librarycontent/pain80/rawlings13/446
|archived=
|quote=
|pubmedID=7395829
|pubmedCID=
|DOI=10.1001/archpedi.1980.02130190044011 |accessdate=2020-11-1312}}</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=Neonatal circumcision is performed without anesthesia Numerous lines of evidence suggest that even in the human [[fetus]], pain pathways as well as cortical and it is clearly stressful subcortical centers necessary for pain perception are well developed late in gestation, and the infantneurochemical 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=Gunnar et al. Anand & Hickey (19811987) |ref=<ref name="anand1987"/><ref name="vanhowe2008"/>}} Gunnar et al 1981. (1988) examined the association between behavioral distress and adrenocortical activity. It was found that differences in behavioral distress did not reliably the level of adrenocortical activity. Moreover, it was found that while non-nutritive sucking reduces crying it did not reduce the adrenocortical response to the stressful stimulus of circumcision pain.<ref name="gunnar1988">{{REFjournal
|last=Gunnar
|initfirst=MRMegan |firstinit=Megan R.M
|author-link=
|last2=FischConnors |init2first2=ROJoan |first2init2=Robert O.J
|author2-link=
|last3=KorsvickIsensee |init3first3=SJill |first3init3=SherryJ
|author3-link=
|last4=DonhoweWall |init4first4=JMLee |first4init4=John M.L
|author4-link=
|etal=noyes |title=The effects of circumcision on serum cortisol Adrenocortical activity and behavior.behavioral distress in human newborns
|trans-title=
|language=English
|journal=PsychoneuroendocrinologyDev Psychobiol
|location=
|date=19811988-05 |volume=621 |issue=34 |pages=260297-75310 |url=http://www.cirp.org/library/pain/gunnargunnar1988/
|archived=
|quote=
|pubmedID=72914353378676
|pubmedCID=
|DOI=10.10161002/0306-4530(81)90037-8dev.420210402 |accessdate=2020-11-1315
}}</ref>
|author2-link=
|last3=RogersBohon |init3first3=AGConstance |first3init3=Ann G.C
|author3-link=
|last4=MooreHinman Jr |init4first4=JFrank |first4init4=JoAnnF
|author4-link=
|last5=AndersonPoland |init5first5=BRonald L. |first5init5=BarbaraRL
|author5-link=
|last6=BoxermanWakeman |first6=Stuart B.Maurice |init6=SBME
|author6-link=
|etal=no
|title=Report of the Task Force of Circumcision: II: Effects upon mother-infant interaction
|trans-title=
|language=English
|journal=Early Hum DevPediatrics
|location=
|date=19821989-10 |volume=789
|issue=4
|pages=367388-7491 |url=http://www.cirp.org/library/birthstatements/marshall2aap/#a1989
|archived=
|quote=
|pubmedID=71690322664697
|pubmedCID=
|DOI=10.1016/0378-3782(82)90038-x |accessdate=2020-11-1418
}}</ref>
|etal=no
|title=Neonatal pain criesCircumcision: effect of circumcision on acoustic features and perceived urgencythe uniquely American medical enigma
|trans-title=
|language=English
|journal=Child DevUrol Clin North Am
|location=
|date=1986-061985 |volume=5712 |issue=31 |pages=790123-80232 |url=httpshttp://www.jstorcirp.org/stablelibrary/general/wallerstein/1130355?seq=1
|archived=
|quote=
|pubmedID= 37204043883617
|pubmedCID=
|DOI=10.2307/1130355
|accessdate=2020-11-15
}}</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 |url=https://www.academia.edu/6442587/High_Cost_of_Circumcision_3_6_Billion_Annually |archived= |title=High cost of circumcision |trans-title= |language=English |last=Bollinger |first=Dan |author-link=Dan Bollinger |publisher=Academia |website=Surgical operation on infants without anesthesia continued for well over |date=2012 |accessdate=2020-11-15 |format=PDF |quote=}}</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. Three methods were proposed: * Application of [[EMLA]] Cream topical anesthetic. [[EMLA]] is a centuryeutectic mixture of lidocaine 2.5% and prilocaine 2.5%. [[EMLA]] Cream (lidocaine 2.5% and prilocaine 2.5%), at least until 1987applied to intact [[skin]] under occlusive dressing, when provides dermal analgesia by the release of lidocaine and prilocaine from the cream into the epidermal and dermal layers of the [[American Academy of Pediatricsskin]] was forced to issue a CYA statement that called for and by the accumulation of lidocaine and prilocaine in the use vicinity of anesthesiadermal pain receptors and nerve endings.<ref name="poland1987">{{REFjournalREFweb |lasturl=https://www.drugs.com/pro/emla.html#s-34069-5 |archived= |title=EMLA |trans-title= |language=Poland English |firstlast=Ronald L. |initfirst=RL
|author-link=
|publisher=Drugs.com |website= |date=2020-04-21 |accessdate=2020-11-21 |format= |quote=}}</ref> * [[Dorsal penile nerve block| Dorsal Penile Nerve Block]] (DPNB) as proposed by Kirya & Werthman (1978).<ref name="kirya1978">{{REFjournal |last=Kirya |first=Christopher |init=C |author-link= |last2=Roberts Werthman Jr |first2=Ronald JMilton W. |init2=RJMW
|author2-link=
|etal=no
|title=Neonatal anesthesiacircumcision and penile dorsal nerve block—a painless procedure.
|trans-title=
|language=English
|journal=PediatricsJ Pediatr
|location=
|date=19871978-0906 |volume=8092 |issue=36 |pages=446998-1000 |url=httpshttp://pediatricswww.aappublicationscirp.org/contentlibrary/80pain/3kirya1/446
|archived=
|quote=
|pubmedID=660375
|pubmedCID=
|DOI=10.1016/s0022-3476(78)80386-2 |accessdate=2020-11-1216}}</ref><ref name="vanhowe2008" />
|author-link=
|last2=Connors |first2=JoanHannallah |init2=JRS
|author2-link=
|last3=Isensee |first3=JillBelman |init3=JAB
|author3-link=
|last4=Wall |first4=LeeElder |init4=LPT
|author4-link=
|etallast5=Ruttiman |init5=U |author5-link= |last6=yesEpstein |titleinit6=Adrenocortical activity and behavioral distress in human newbornsBS |transauthor6-titlelink= |etal=no |languagetitle=EnglishPost-circumcision analgesia—a prospective evaluation of subcutaneous ring block of the penis |journal=Dev PsychobiolAnesthesiology
|location=
|date=19881987-0508-31 |volume=2167 |issue=43 |pages=297399-310402 |url=http://www.cirp.org/library/pain/gunnar1988/
|archived=
|quote=
|pubmedID=33786763307533
|pubmedCID=
|DOI=10.10021097/dev.42021040200000542-198709000-00019 |accessdate=2020-11-1518}}</ref> Although by 1989 it was totally clear that infants can feel intense pain, the 1989 American Academy of Pediatrics Circumcision Task Force, under Ring block is considered the leadership of the infamous [[Edgar J. Schoen]], {{MD}}, declined to recommend the use of analgesics most effective analgesic procedure for neonatal non-therapeutic neonatal [[circumcision]], thereby condemning millions of newborn baby . Infant boys to a painful, stressful' traumatizing circumcisionfeel less pain and suffer less trauma than with the other two pain reduction procedures.<refname="lander1997"/><ref name="stang1997">{{REFjournal |last=SchoenStang |first=Edgar Howard J. |init=EJHJ |author-link=Edgar J. Schoen |last2=AndersonSnellman |first2=GlenLeonard W. |init2=GLW
|author2-link=
|last3=BohonCondon |first3=ConstanceLawrence M |init3=CLM
|author3-link=
|last4=Hinman JrConroy |first4=FrankMary Margaret |init4=FMM
|author4-link=
|last5=PolandLiebo |first5=Ronald L.Rhoda |init5=RLR
|author5-link=
|last6=WakemanBrodersen |first6=MauriceLaurie |init6=MEL
|author6-link=
|last7=Gunnar
|first7=Megan R.
|init7=MR
|author7-link=
|etal=no
|title=Report of the Task Force of CircumcisionBeyond dorsal penile nerve block: A more humane circumcision
|trans-title=
|language=English
|journal=Pediatrics
|location=
|date=19891997-1008 |volume=89100 |issue=42 |pages=388-91e3 |url=httphttps://wwwpediatrics.cirpaappublications.org/librarycontent/statements100/aap2/#a1989e3
|archived=
|quote=
|pubmedID=26646979233974
|pubmedCID=
|DOI=10.1542/peds.100.2.e3
|accessdate=2020-11-18
}}</ref>
{{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===Finding an ethical way to do painful "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>}}
|last=Wallerstein
|first=Edward
|init=E
|author-link=Edward Wallerstein
|etal=no
|title=Circumcision: the uniquely American medical enigmaIs non-religious circumcision necessary?
|trans-title=
|language=English |journal=Urol Clin North J AmAcad Child Psychiatr
|location=
|date=1985-05 |volume=1224 |issue=13 |article= |page= |pages=123364-325 |url=http://www.cirp.org/library/generalpain/gunnar1984/#wallerstein/
|archived=
|quote=
|pubmedID=3883617
|pubmedCID=
|DOI=
|accessdate=20202021-1107-150}}</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. and [[Dan BollingerRobert S. Van Howe|Van Howe]] & Cold (20121998) estimated that the total annual cost of non-therapeutic circumcision to Americans is $3,647,000,000.<ref>{{REFwebREFjournal |last=Van Howe |first=Robert S. |init=RS |author-link=Robert S. Van Howe |last2=Cold |first2=Christopher J. |init2=CJ |author2-link=Christopher J. Cold |etal=no |title=Local Anesthesia For Infants Undergoing Circumcision |journal=JAMA |location= |date=1998-04-15 |volume=299 |issue=15 |article= |page= |pages=1169-71 |url=httpshttp://www.academiacirp.eduorg/library/6442587pain/High_Cost_of_Circumcision_3_6_Billion_Annuallylander/letters.html
|archived=
|quote=
|pubmedID= |pubmedCID= |DOI= |accessdate=2021-07-08}}</ref> have suggested that it would be better to abandon the practice of non-therapeutic infant circumcision because of the pain associated with it. The avaricious American ''Daily Mail'' (2021) reported the pain stress of non-therapeutic neonatal circumcision increases the risk of [[circumcision industrySIDS]] , and that the incidence of Sudden Infant Death Syndrome (SIDS) is simply lower where baby boys are not willing [[circumcised]].<ref name="thompson2021">{{REFnews |title=Circumcising newborn boys increases their risk of cot death due to give that lucrative income upthe stress of the procedure - and could explain why it is more common in boys than girls, so a way to make nonstudy finds |url=https://www.dailymail.co.uk/health/article-5998771/Circumcising-newborn-boys-increases-risk-cot-death-stress-therapeutic circumcisions in infancy acceptable had to be foundprocedure.html |last=Thompson |first=Alexandra |coauthors= |publisher=Daily Mail |website= |date=2021-07-27 |accessdate=2021-08-02 |quote=}}</ref>
|author-link=
|last2=Werthman JrRieder |first2=Milton WMichael J. |init2=MWMJ
|author2-link=
|etal=no
|title= Neonatal Attitudes and practices regarding analgesia for newborn circumcision and penile dorsal nerve block—a painless procedure.
|trans-title=
|language=English
|journal=J PediatrPediatrics
|location=
|date=19781993-0610
|volume=92
|issue=64 |pages=998541-10003 |url=httphttps://wwwpediatrics.cirpaappublications.org/librarycontent/pain92/kirya14/541?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token
|archived=
|quote=
|pubmedID=6603758414824
|pubmedCID=
|DOI=10.1016/s0022-3476(78)80386-2 |accessdate=2020-11-1618
}}</ref>
}}
|author-link=
|last2=HannallahFiner |first2=Neil N. |init2=RSNN
|author2-link=
|etal=no
|title=PostChanging attitudes and practices regarding local analgesia for newborn circumcision. |trans-circumcision analgesia—a prospective evaluation of subcutaneous ring block of the penistitle= |language=English |journal=AnesthesiologyPedatrics
|location=
|date=19871994-08-31 |volume=6794 |issue=32 |pages=399230-4023 |url=https://pediatrics.aappublications.org/content/94/2/230
|archived=
|quote=
|pubmedID=33075338036079
|pubmedCID=
|DOI=10.1097/00000542-198709000-00019 |accessdate=2020-11-1819}}</ref> Ring block is considered the (Non-therapeutic neonatal circumcisions are no longer performed in most effective analgesic procedure for Canadian hospitals.)<ref name="jamesloewen2019">[[James Loewen]] (2019). Personal communication.</ref> Maxwell & Yaster (1999) called on physicians to use analgesia during neonatal non-therapeutic circumcisionsurgery, saying: {{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. Infant boys feel less In addition, this pain has physiologic correlates: elevated heart rate and blood pressure, lowered arterial oxygen saturation, and suffer less trauma than with elevated levels of adrenocortical hormones. During the other two past 15 years, results of a multitude of studies have demonstrated that effective analgesia can prevent this pain reduction proceduresand 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 name="lander1997"/><ref name="stang1997">{{REFjournal |last=StangMaxwell |firstinit=Howard J. |initfirst=HJ
|author-link=
|last2=SnellmanYaster |first2init2=Leonard W. |init2first2=LW
|author2-link=
|etal=no
|title=Beyond dorsal penile nerve block: A Analgesia for neonatal circumcisionː No more humane circumcisionstudies, just do tt
|trans-title=
|language=English |journal=PediatricsArch Pediatr Adolesc Med
|location=
|date=19971999-0805 |volume=100153 |issue=25 |pages=e3444-5 |url=https://pediatricsjamanetwork.aappublications.orgcom/contentjournals/100jamapediatrics/2article-abstract/e3346832
|archived=
|quote=
|pubmedID=923397410323622
|pubmedCID=
|DOI=10.15421001/pedsarchpedi.100153.25.e3444 |accessdate=2020-11-1821
}}</ref>
}}
The [[American Academy of Pediatrics]] convened a new task force on circumcision under the chair of Carole M. Lannon, {{Box|Boxtext=<big><b>However, none of MD}}. That task force reversed the above three procedures totally eliminate pain. A baby boy will still experience some pain and position previously taken under [[traumaEdgar J. Schoen]] despite any of those analgesic procedures.<ref name="bellini2022 /> Prevention of pain requires protecting a boy from elective neonatal It clearly stated that non-therapeutic infant circumcisionis "not essential to the child’s current well-being. Only boys who are protected from the medically unnecessary " It provided an extensive discussion of procedural analgesia and said, quite strongly, that, if a circumcision surgery experience no pain or [[trauma]]is done, procedural analgesia should be provided.</b></big>}} Wallerstein (1985)<refname="aap1999">{{REFjournal |last=WallersteinLannon |first=EdwardCarole M.
|init=
|author-link=Edward Wallerstein |etal=noyes |title=Is non-religious circumcision necessary? |trans-title= |language=Circumcision policy statement |journal=J Am Acad Child Psychiatr |location=Pediatrics |date=19851999-0503 |volume=24103
|issue=3
|article=
|page=
|pages=364686-593 |url=httphttps://wwwpediatrics.cirpaappublications.org/librarycontent/pain103/gunnar19843/#wallerstein686
|archived=
|quote=
|pubmedID=10049981
|pubmedCID=
|DOI=https://doi.org/10.1542/peds.103.3.686 |accessdate=2021-07-012}}</ref> Kraft (2003) reported that "many health care practitioners routinely perform this procedure without the use of any or with inadequate or ineffective analgesia and [[Robert Sanesthesia. Van Howe|Van Howe]] & Cold (1998)"<refname="kraft2003">{{REFjournal |last=Van HoweKraft |firstinit=Robert S.NL |initfirst=RSNancy L |author-link=Robert S. Van Howe |last2=Cold |first2=Christopher J. |init2=CJ |author2-link=Christopher J. Cold
|etal=no
|title=Local Anesthesia For Infants Undergoing CircumcisionA pictorial and video guide to circumcision without pain |journal=JAMAAdv Neonatal Care
|location=
|date=19982003-04-15 |volume=2993 |issue=15 |article= |page=2 |pages=116950-7162 |url=httphttps://wwwjournals.cirplww.orgcom/libraryadvancesinneonatalcare/painAbstract/lander2003/letters04000/A_PICTORIAL_AND_VIDEO_GUIDE_TO_CIRCUMCISION.2.htmlaspx |archived=
|quote=
|pubmedID=12881947
|pubmedCID=
|DOI= |accessdate=2021-07-08}}</ref> have suggested that it would be better to abandon the practice of non-therapeutic infant circumcision because of the pain associated with it. The ''Daily Mail'' (2021) reported the pain stress of non-therapeutic neonatal circumcision increases the risk of [[SIDS]], and that the incidence of Sudden Infant Death Syndrome (SIDS) is lower where baby boys are not [[circumcised]]10.<ref name="thompson2021">{{REFnews |title=Circumcising newborn boys increases their risk of cot death due to the stress of the procedure - and could explain why it is more common in boys than girls, study finds |url=https:/1053/wwwadnc.dailymail2003.co.uk/health/article-5998771/Circumcising-newborn-boys-increases-risk-cot-death-stress-procedure50015.html |last=Thompson |first=Alexandra |coauthors= |publisher=Daily Mail |website= |date=2021-07-27 |accessdate=20212020-0811-02 |quote=18
}}</ref>
===Historic attitudes and practices=Standard of care==
|author-link=
|etal=no
|title=Attitudes and practices regarding analgesia for newborn Neonatal circumcision |trans-title= |language=Englishrevisited |journal=PediatricsCMAJ
|location=
|date=19931996-1003-15 |volume=92154 |issue=46 |article= |page= |pages=541769-380 |url=https://pediatricswww.aappublicationsncbi.orgnlm.nih.gov/contentpmc/92articles/4PMC1487803/541?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000pdf/cmaj00090-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token0027.pdf
|archived=
|quote=
|pubmedID=84148248634956 |pubmedCID=1487803
|DOI=
|accessdate=20202021-07-11-18}}</ref>}} Ryan & Finer (1994) carried out a training program for physicians in the newborn nurseries of the Womens' Pavilion, [https://www.albertahealthservices.ca/rah/rah.aspx Royal Alexandra Hospital], Edmonton, Alberta, Canada. After a training program, they found that 66 percent of physicians who perform non-therapeutic neonatal circumcisions had started to use analgesia during the procedure. This applies to one hospital in [[Canada]].<ref name="ryan1994racp2010">{{REFjournalREFdocument |lasttitle=RyanCircumcision of Infant Males |firsturl=Chttps://www. Anthony |init=CA |authorracp.edu.au//docs/default-source/advocacy-library/circumcision-of-infant-link= |last2=Finer |first2=Neil Nmales. |init2pdf?sfvrsn=NNeaa32f1a_10 |author2-linkcontribution= |etallast=no |titlefirst=Changing attitudes and practices regarding local analgesia for newborn circumcision. |trans-titlepublisher=[[Royal Australasian College of Physicians]] |language=English |journal=Pedatrics |locationformat=PDF |date=19942010-0809-01 |volumeaccessdate=942021-07-11 |issue=2}}</ref><ref>{{REFdocument |pagestitle=230Non-3therapeutic circumcision of male minors |url=https://pediatricspool.aappublicationsintactiwiki.org/contentimages/94/2/230KNMG-viewpoint-Non-therapeutic-circumcision-of-male-minors-27-05-2010-v2.pdf |contribution= |archivedlast= |quotefirst= |pubmedIDpublisher=8036079Royal Dutch Medical Association (KNMG) |pubmedCIDformat=PDF |DOIdate=2010-05-27 |accessdate=20202021-07-11-19}}</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 neonatal circumcision of male minors is ''not'' the standard of care. Nevertheless, some non-therapeutic circumcisions are no longer of boys will continue to be performed in most Canadian hospitalsfor 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="jamesloewen2019poland1987"/><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 [[James Loewencircumcision]] (2019)should be deferred for six months, so that general anesthesia may be used. Personal communication.</ref>The AAPS stated:
|etal=no
|title=Analgesia for neonatal circumcisionː No more studies, just do ttThe Birth of Pain
|trans-title=
|language=English |journal=Arch Pediatr Adolesc MedMRC News
|location=
|date=1999-051998 |season=Summer |volume=153 |issue=5 |article= |page= |pages=44420-523 |url=https://jamanetworkwww.cirp.comorg/journalslibrary/jamapediatricspain/article-abstractfitzgerald/346832
|archived=
|quote=
}}</ref>
{{Citation |Text=The [[American Academy public health importance of Pediatrics]] convened a new task force on circumcision under abnormal stimulation during the chair of Carole Mneonatal period cannot be overemphasized. LannonWhile programs for formulating appropriate health policies and public education campaigns must disseminate this message, {{MD}}. That task force reversed the position previously taken under [[Edgar J. Schoen]]. It clearly stated that non-therapeutic infant circumcision it is "not essential also important for these effects to be investigated, particularly with a view to developing effective therapeutic strategies for the child’s current well-being." It provided an extensive discussion of procedural analgesia growing children and said, quite strongly, that, if a circumcision is done, procedural analgesia should be providedadolescents who were exposed to abnormal conditions during the neonatal period. |Author=Anand & Scalzo (2000) |ref=<ref name="aap1999anand2000">{{REFjournal |last=LannonAnand |first=Carole M. |init=KJS |author-link=Kanwaljeet J. Singh Anand |last2=Scalzo
|first2=
|init2=FM
|author2-link=
|trans-title=
|language=
|journal=PediatricsBiol Neonate
|location=
|date=19992000-0302 |volume=10377 |issue=32
|article=
|page=
|pages=68669-9382 |url=httpshttp://pediatricswww.aappublicationscirp.org/contentlibrary/103pain/3anand4/686
|archived=
|quote=
|pubmedID=1004998110657682
|pubmedCID=
|DOI=https://doi.org/10.15421159/peds.103.3.686000014197 |accessdate=2021-0708-1209
}}</ref>
}}
|author-link=
|etallast2=noWalker |titlefirst2=A pictorial and video guide to circumcision without pain Suellen |journalinit2=Adv Neonatal CareS |locationauthor2-link= |dateyear=2003-04 |volumetitle=3 |issue=2 |pages=50-62The role of activity in developing pain pathways |url=httpshttp://journalswww.lwwcirp.comorg/advancesinneonatalcarelibrary/Abstractpain/2003fitzgerald2/04000/A_PICTORIAL_AND_VIDEO_GUIDE_TO_CIRCUMCISION.2.aspx |archivedwork=Proceedings of the 10th World Congress on Pain |editor=Dostovsky JO, Carr DB, Koltzenburg M (eds) |edition= |volume=24 |chapter= |pages=185-96 |quotelocation=Seattle |pubmedIDpublisher=12881947ASP Press |pubmedCIDisbn= |DOIquote=10In common with other areas of the central nervous system, synaptic development of spinal sensory connections is experience or activity dependent.1053/adncEvidence 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.2003.50015While 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=
}}</ref>
|author-link=
|last2=Sardi
|first2=
|init2=LM
|author2-link=
|etal=no
|title=Neonatal Psychological, psychosocial, and psychosexual aspects ofpenile circumcision revisited
|trans-title=
|language=
|journal=CMAJInt J Impot Res
|location=
|date=19962022-03-1528 |volume=154 |issue=6
|article=
|page=
|pages=769-80 |url=https://www.ncbinature.nlm.nih.gov/pmccom/articles/PMC1487803/pdf/cmaj00090s41443-022-00553-0027.pdf9
|archived=
|quote=
|pubmedID=863495635347302 |pubmedCID=1487803 |DOI=10.1038/s41443-022-00553-9 |accessdate=20212022-0704-1129}}</ref><ref name/blockquote> ==Videos=="racp2010">{{REFdocument |title=== Infant circumcision procedure ===Circumcision 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 Infant Maleslocal 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: * {{REFweb |url=https://www.racpreddit.edu.aucom/r/Intactivism/docscomments/default-sourceqbpzqr/advocacy-librarytrained_medical_professionals_restrain_infant_to/circumcision- |archived= |title=Trained medical professionals restrain infant to amputate part ofits body while baby kicks and screams in pain |trans-infant-males.pdf?sfvrsntitle=eaa32f1a_10 |contributionlanguage=
|last=
|first=
|author-link= |publisher=[[Royal Australasian College of Physicians]] |formatwebsite=PDF |date=2010-09-01 |accessdate=20212022-0703-11}}</ref><ref>{{REFdocument |titleformat=Non-therapeutic circumcision of male minors |urlquote=}} *[https://poolwww.intactiwikireddit.orgcom/r/imagesIntactivism/KNMG-viewpoint-Non-therapeutic-circumcision-of-male-minors-27-05-2010-v2.pdf |contribution= |last= |first= |publisher=Royal Dutch Medical Association (KNMG) |format=PDF |date=2010-05-27 |accessdate=2021-07-11}}<comments/ref> Circumcision excises the highly functional foreskin, which provides numerous protective, immunological, sensory, and sexual functions,<ref name="cold1999">{{ColdCJ TaylorJR 1999}}<qbpzqr/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 trained_medical_professionals_restrain_infant_to/> Non-therapeutic circumcision of male minors is ''not'' the standard of care.Circumcision video]
=== Infant circumcision procedure Ronald Goldman===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:
<youtube>lNItNHs9PR8</youtube>
|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.
{{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
|format=PDF
|accessdate=2023-10-09
}}
* {{REFweb
|accessdate=2023-08-18
}}
* {{REFweb
|url=https://intactamerica.org/timeline-of-circumcision-suffering/
|title=A Timeline of Circumcision Suffering: A Detailed Look
|last=Anonymous
|first=
|init=
|publisher=Intact America
|date=2024-02-02
|accessdate=2024-02-09
}}
{{ABBR}}
{{REF}}