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normalize et al. (AMA)
}}</ref></blockquote>
Emde ''et al''. (1971) being curious about changes in infant behavior after painful heel sticking, decided to test baby boys before and after routine (non-therapeutic) circumcision performed without anesthesia. Not surprisingly, they found that circumcision changed behavior. They concluded:
<blockquote>
Routine hospital circumcision, done without anesthesia, was chosen as a potential stressor which might be expected to produce prolonged bombardment of pain pathways. Two studies, one without polygraphic manipulation and one with EEG and polygraphic manipulation and one with EEG and polygraphic recording, resulted in similar findings. Circumcision was usually followed by prolonged, non-REM sleep. Effects of circumcision were demonstrable in terms of an increase in the amount of non-REM sleep (p<0.01) and a decrease in latency to the onset of non-REM sleep (P<0.05). Infants were used as their own controls and were compared with non-circumcised males for statistical analysis. Postcircumcision increase in non-REM sleep was also reflected in an increased total number of non-REM sleep periods and an increased number of extremely long non-REM sleep periods.<ref name=emde1971">{{REFjournal
}}</ref>
Marshall ''et al''. (1980) tested newborn boys before and after plastibel circumcision. They reported that boys have a greater capacity for memory than previously believed, that infants behave differently after circumcision, that future researchers must consider and record the circumcision status of their subjects, and that boys might actually be feeling pain. They suggested that anesthesia by dorsal penile nerve block might be appropriate.<ref>{{REFjournal
|last=Marshall
|init=RE
}}</ref>
Gunnar ''et al''. (1981) studied the effect of circumcision of male infants on serum cortisol and behavior. The authors identified circumcision as "a potential traumatic event experienced by the majority of newborn males in this country (United States)." The authors reported that serum cortisol during unanesthetized circumcision rose to about four times the pre-circumcision level. Behavior paralleled the increase in cortisol. They reported that "neonatal circumcision is performed without anesthesia and it is clearly stressful for the infant.<ref name="gunnar1981">{{REFjournal
|last=Gunnar
|first=Megan R.
}}</ref>
Marshall ''et al''. (1982) studied the effect of circumcision on mother-child interaction (primarily breastmilk substitute feeding behavior) in a hospital setting. They reported: "The experimental group exhibited fewer intervals of uninterrupted feeding than did the control group."<ref name="marshall1982">{{REFjournal
|last=Marshall
|init=RE
}}</ref>
Gunnar ''et al''. (1984) tested the effects of a pacifier during circumcision. They reported:
<blockquote>
The results showed that stimulating the newborn with the pacifier reduced crying by about 40%. Reducing crying, however, had no significant effect on adrenocortical response. Elevations of serum cortisol predicted average behavioral state following circumcision, whereas crying during circumcision did not. Furthermore, there was evidence that the neonatal adrenocortical system was sensitive in variations in surgical procedures. The results indicate the importance of obtaining data on both behavioral and hormonal systems in studies of stress and coping in human newborns.<ref name="gunnar1984">{{REFjournal
}}</ref></blockquote>
Porter ''et al''. (1986) recorded the pain cries of boys undergoing circumcision. They reported that "Subjective judgments and objective quantitative data converge to demonstrate that infants' cries are perceived as varying and objectively, do systematically vary with respect to the the intensity of the painful stimuli."<ref name="porter1986">{{REFjournal
|last=Porter
|first=Fran Lang
}}</ref>
Porter ''et al''. (1988) recorded the cries of boys undergoing non-therapeutic child circumcision. They found that the pitch of the cries increased as stress (euphemism for pain) increases.<ref name="porter1988">{{REFjournal
|last=Porter
|first=Fran Lang
}}</ref>
Taddio ''et al''. (1995) (1997) studied the behavior of circumcised boys in comparison to the behavior of intact boys at the time of routine vaccination. Taddio ''et al''. (1995) reported:
<blockquote>
Male circumcision is the most common neonatal surgical procedure. It causes intense pain and measurable changes in behaviour that last up to 1 day. We found that circumcision status was associated with increased infant pain response to routine vaccination at 4-6 months. Circumcised boys had significantly longer crying bouts and higher pain scores. That both outcome measures, pain index, and cry duration, were influenced by circumcision lends credibility to our observations. During the second (HIB) vaccination, circumcision status was more clearly associated with the observed pain response than after DPT. The DPT injection might have had a priming effect in circumcised infants which led them to exhibit even more pain after the HIB injection. The effects of memory and reinforcement on later nocioceptive experience in neonates are not known. Because memory of pain is believed to be important in subsequent pain perception, and the main structures for memory are functional in the neonatal period, it is conceivable that pain from circumcision may have long-lasting effects on pain response and/or perception.<ref name="taddio1995">{{REFjournal
</blockquote>
Taddio ''et al''. (1997) followed with a larger second study in which circumcised boys were compared with intact boys at time of vaccination four to six months after birth. Three measures to determine pain were used. Once again circumcised boys showed greater response to the pain of vaccination than intact boys.
Taddio ''et al''. reasoned that:
<blockquote>
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>
Boyle ''et al''. (2002) report:
<blockquote>
A traumatic experience is defined in DSM-IV as the direct consequence of experiencing or witnessing of serious injury or threat to physical integrity that produces intense fear, helplessness or (in the case of children) agitation (American Psychiatric Association, 1994). The significant pain and distress described earlier is consistent with this definition. Moreover, the disturbance (e.g., physiological arousal, avoidant behaviour) qualifies for a diagnosis of acute stress disorder if it lasts at least two days or even a diagnosis of post-traumatic stress disorder (PTSD) if it lasts more than a month. Circumcision without anaesthesia constitutes a severely traumatic event in a child's life.<ref name="boyle2002">{{REFjournal
==Socio-effective processing==
Miani ''et al.'' (2020) theorized that adult men "who underwent neonatal circumcision, compared to those who did not, will display alterations in socio-affective processing conforming to the fast life-history strategies, namely, decreased reliance on social environment and increased perceived stress and sexual activity."<ref name="miani2020">{{REFjournal
|last=Miani
|init=A