Changes

[[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 [[Synechia| synechial membrane]] that is common to both parts.<ref name="deibart1933">{{REFjournal

|last=Deibart

|first=G.A.

|title=The separation of the prepuce in the human penis

# 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

|last=Oliver

|title=Circumcision and cruelty to children

|journal=Br Med J

|date=1979

|volume=2

|pages=933

|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1596753/pdf/brmedj00095-0057c.pdf

|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.

|pubmedCID=1596753

|DOI=10.1136/bmj.2.6195.933-b

}}</ref> so it is highly innervated.<ref>{{REFjournal

|last=Winkelmann

|title= The cutaneous innervation of the human newborn prepuce

|journal=J Invest Dermatol

|date=1956-01

|volume=26

}}</ref> Nervous tissue requires a large blood supply, so the foreskin is richly vascular with many blood vessels,<ref name="fleiss-hodges-vanhowe1998">{{REFjournal

|last=Fleiss

|author-link=Paul M. Fleiss

|last2=Hodges

|author2-link=Frederick M. Hodges

|last3=Van Howe

|author3-link=Robert S. Van Howe

|title=Immunological functions of the human prepuce

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.<ref name="lander1997">{{REFjournal

|last=Lander

|first=Janice

|author-link=

|last2=Brady-Frerer

|first2=Barbara

|author2-link=

|last3=Metcalfe

|first3=James B.

|author3-link=

|last4=Nazerali

|first4=Shermin

|author4-link=

|last5=Muttit

|first5=Sarah

|author5-link=

|etal=no

|title= Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision

|journal=JAMA

|location=

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."<ref name="howard1994">{{REFjournal

|last=Howard

|first=Cynthia R.

|author-link=

|last2=Howard

|first2=Fred M.

|author2-link=

|last3=Weitzman

|first3=Michael L.

|author3-link=

There is now substantial evidence that infant circumcision causes [[Posttraumatic stress disorder| post traumatic stress disorder]]. Memory starts to function before birth and continues to function in the newborn period,<ref>{{REFjournal

|last=Hepper

|author-link=

|etal=no

|title=Fetal memory: Does it exist? What does it do?

|journal=Acta Pædiatrica Supplement (Stockholm)

|date=1996-10

|volume=416

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

|last=Anand

|author-link=

|last2=Hickey

|author2-link=

|etal=yes

|title=Pain and its effects in the human neonate and fetus

|journal=N Engl J Med

|location=

}}</ref> so all of the necessary requirements are present.<ref>{{REFjournal

|last=Boyle

|first=Gregory J

|author-link=

|last2=Goldman

|first2=Ronald

|author2-link=

|last3=Svoboda

|first3=J. Steven

|author3-link=

|last4=Fernandez

|first4=Ephrem

|author4-link=

|etal=no

|title=Male circumcision: pain, trauma and psychosexual sequelae

|journal=J Health Psychol

|location=

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.<ref name="taddio"1995">{{REFjournal

|last=Taddio

|first=Anna

|author-link=

|last2=Goldbach

|first2=Morton

|author2-link=

|last3=Ipp

|first3=Moshe

|author3-link=

|last4=Stevens

|first4=Bonnie

|author4-link=

|last5=Koren

|first5=Gideon

|author5-link=

|etal=no

|title=Effect of neonatal circumcision on pain responses during vaccination in boys

|journal=Lancet

|location=

}}</ref> <ref name="taddio1997">{{REFjournal

|last=Taddio

|first=Anna

|author-link=

|last2=Katz

|first2=Joel

|author2-link=

|last3=Ilersich

|author3-link=

|last4=Gideon

|first4=Koren

|author4-link=

|etal=no

|title=Effect of neonatal circumcision on pain response during subsequent routine vaccination

|journal=Lancet

|location=

John Rhinehart, M. D., a clinical psychiatrist, reported finding numerous cases of PTSD in his adult male patients secondary to infant circumcision.<ref>{{REFjournal

|last=Rhinehart

|first=John

|author-link=

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.<ref name="cope1998">{{REFjournal

|last=Cope

|author-link=

|title=Neonatal pain: the evolution of an idea.

* Anders ''et al''. (1970) showed that measurement of serum cortisol is useful for psychological investigation in infancy.<ref name="anders1970">{{REFjournal

|last=Anders

|first=Thomas F.

|author-link=

|last2=Sachar

|first2=Edward J.

|author2-link=

|last3=Kream

|first3=Jacob

|author3-link=

|first4=Howard P.

|author4-link=

|last5=Hellman

|first5=Leon

|author5-link=

|etal=no

|title=Behavioral state and plasma cortisol response in the human neonate

|journal=Pediatrics

|location=

* Emde ''et al''. (1971) showed that the "stress" of circumcision caused an increase in the amount of non-REM sleep.<ref name="emde1971">{{REFjournal

|last=Emde

|first=Robert N

|author-link=

|last2=Harmon

|first2=Robert J.

|author2-link=

|last3=Metcalf

|first3=David

|author3-link=

|last4=Koenig

|first4=Kenneth L.

|author4-link=

|first5=Samuel

|author5-link=

|etal=no

|title=Stress and neonatal sleep

|journal=Psychosom Med

|location=

* Richards, Bernal & Brackbill (1976) discovered behavioral differences between American boys (circumcised) and British boys (intact).<ref name="richards1976">{{REFjournal

|last=Richards

|author-link=

|last2=Bernal

|author2-link=

|last3=Brackbill

|first3=Yvonne

|author3-link=

|etal=no

|title=Early behavioral differences: gender or circumcision?

|journal=Dev Psychobiol

|location=