[If you do not see a blue menu bar on the right, click here. You are at "Pain". See also the Circumcision Video.]

Dr. Adrian Lloyd Thomas, Head of the Accute Pain Service at Great Horman Street Hospital in Toronto, Canada, comments, while watching a video of a neonatal circumcision (1995): "You can see, there, a very definate response from the baby as soon as the forcepts are applied to the foreskin. The baby is holding his breath, shivering. Infants having an operation may actually experience more pain than adults do having the same procedure, and the reason for this is that the control mechanisms, particularly in the spinal cord, which are highly developed to damp down and suppress pain in a mature adult nervous system, are not so well developed in the small baby. So, the pain signals travel through uncontrolled, unsuppressed.... I think it would be unwise to draw that conclusion [that the baby stopped crying because the pain was over]. I'd more prefer to think that the experience had been so overwhelming that the baby can't... put up a fight anymore.... My personal feeling as a pediatric anesthesiologist is that it is not ethical to perform circumcisions without some form of topical anesthesia."

In 1997, a study on circumcision and pain response "found circumcision so traumatic that doctors ended the study early rather than subject any more babies to the operation without anesthesia.", adding that "for those circumcised without anesthesia there was not only severe pain, but also an increased risk of choking and difficulty breathing.". Read the full CNN article here: Circumcision study halted due to trauma.

Lidocaine-Prilocaine (EMLA) Cream Was Safe, But Not Effective, For Relieving Pain From Heel Lance in Preterm Infants



Another explaination of newborn pain response to circumcision is described in the Journal of Health Psychology, Volume 07 Issue 03 - Publication Date: 1 May 2002, "Despite the obvious unavailability of self-report, further evidence of pain has been demonstrated through observation of the facial expressions of infants undergoing circumcision. Regarded as the most definitive behavioural evidence of pain in the infant, it consists of a lowered brow, eyes squeezed shut, deepened nasolabial furrow, opened mouth, and a taut cupped tongue (Grunau, Johnston, & Craig, 1990). This expression closely resembles the adult facial expression of pain, but it occurs with even greater consistency in infants undergoing painful procedures such as circumcision." (This "face" can be seen in the photos on this page.)

Moreover, studies have been done on the psychological impact of circumcision, stating, "Infants circumcised with no anaesthesia (reflecting common practice) experience not only great pain, but also an increased risk of choking and difficulty in breathing. Increases in heart rate of 55 bpm have been recorded, i.e. 1.5 times the baseline rate. After circumcision, the level of blood cortisol increased by a factor of 3-4 times the level before circumcision. As a surgical procedure, circumcision has been described as 'among the most painful performed in neonatal medicine'. Investigators reported, 'This level of pain would not be tolerated by older patients'. Using a pacifier during circumcision reduced crying but did not affect the hormonal pain response. An infant may also go into a state of shock to escape the overwhelming pain. Therefore, while crying may be absent, other body signals show that severe pain is always present during circumcision....

"The question of an infant's capacity to experience trauma needs to be emphasized. Wilson, an author with a national reputation for trauma research, supports the idea that trauma can occur 'at any point in the life cycle, from infancy to the waning years of life'. In addition, the DSM-IV states that traumatic effects 'can occur at any age'. Clinicians have documented that children are particularly vulnerable to trauma. Psychic trauma seems to have a permanent effect on children, no matter how young they are when they are traumatized. Furthermore, psychopathology increases as the age of the child at the time of the trauma decreases.

"Trauma results in dissociation, a separation of the traumatic experience and associated emotional pain from awareness. [This can be seen in the video on this site where the baby is frowning and "staring off into space".] Dissociation is a psychological survival response. To preserve a semblance of attachment to the mother, a child who has suffered trauma alters reality and 'forgets' that the trauma ever happened. In altering reality, the child is also altered. Based on neurological research, painful experience and trauma in childhood can result in long-term physiological changes in the central nervous system and neurochemical changes. Two brain-imaging studies of adults with histories of child sexual abuse reported a reduced size of the hippocampus, a part of the brain associated with memory, and in a test of verbal short-term memory, adults who had been abused had lower scores."

"...In response to circumcision, the baby cries a helpless, panicky, breathless, high-pitched cry!...[or] lapses into a semi-coma. Both of these states...are abnormal in the newborn."-- Justin Call, MD., pediatrician and child psychiatrist.

"A newborn baby is... able to perceive pain as any other person... Some babies scream frantically while being circumcised. However, some babies... lapse into a semi-coma... the pain and trauma are so great the baby cannot cry! This absense of crying has led many parents, doctors and others to believe that the operation did not hurt him."-- Rosemary Romberg, Circumcision: The Rest of the Story-- A Selection of Articles, Letters, and Resources, 1979-1993, edited by Peggy O'Mara, Mothering.

"Exposure to prolonged or severe pain may increase neonatal morbidity; infants who experienced pain during the neonatal period (up to 1 month of age) respond differently to subsequent painful events; a lack of behavioral responses (including crying and movement) does not necessarily mean lack of pain." --American Academy of Pediatrics and Canadian Paediatric Society Policy Statement. Prevention and Management of Pain and Stress in the Neonate. Pediatrics 2000 Feb; (105)2:454-461.

From Does Circumcision of the Newborn Require an Anesthetic?, Charles Weiss, Clinical Pediatrics, March 1968.

"Should the current practice of performing circumcisions on newborn infants without an anesthetic be continued? In the past, medical and lay writers have assured us that neonates have little or no sensation for pain and that this operation is so trifling that 'the ordinary infant of eight days passes through it easily, sleeping most of the time.'

"Mothers and nurses who actually take care of babies know that this is not true. The suffering of circumcised infants is referred to in the classical literature. Recent investigations indicate that they go through a period of stress, since they are irritable and show oozing and edema of their wounds for several days.

"Throughout the ages attempts were made to decrease the pain of this operation. Some offered up special prayers in their behalf; others drowned out their cries by loud songs. During the nineteenth century the French physician du Havre pleaded for the use of an anesthetic -- a plea subsequently repeated by medical men in the United States, New Zealand and Germany.

"Newer discoveries should lead us to revise our concepts about the neonate and his foreskin. The prepuce is not identical with skin taken from other parts of the body; some of its metabolic activities are different. It contains a complex network of nerves, an abundance of muco-cutaneous endorgans of Vater-Pacini and terminal free-ending fibers most of which are non-myelinated -- probably sensory or autonomic in function.

"Some infants seem to recover rapidly from the stress of the circumcision operation when done without anesthesia, but it remains to be determined whether they retain in their subconscious minds the painful insult to the seat of their libido."

"I know that the circumcisions I have done, without exception, have been painful for the baby. In medical school I was taught that the baby's nervous system is not developed sufficiently to be aware of the pain... But my experience in doing it and observing the baby's reactions tell me otherwise."-- Howard Marchbands, MD, Circumcision: The Painful Dilemma, p.133).

"I've videotaped circumcisions for teaching purposes, and no one, especially the doctor, is aware of the pain until he sees the baby's reaction on tape. It's horrifying-- there's no doubt that he's feeling intense pain."-- Marianne Neifert, MD, Pediatrician, Child, Jan./Feb. 1989)

"It has been argued that the infant suffers little or no pain in the circumcision process. The evidence offered is that in the ritual Jewish circumcision, the infant, who is given an alcohol teat during surgery, cries little and almost immediately goes to sleep. That argument shows an ignorance of the effects of alcohol on infants and fails to acknowledge that 'sleep' may be a response to pain."-- William E. Brigman, "Circumcision as Child Abuse: The Legal and Constitutional Issues," Journal of Family Law, University of Louisville School of Law, Louisville, Kentucky.

From Routine Non-Ritual Circumcision in Infancy, A New Look at an Old Operation, Charles Weiss, Clinical Pediatrics, Sept 1964.

"'I have not the slightest doubt' writes Professor Peiper, a Leipzig pediatrician, 'that a newborn infant is definitely sensitive to pain... The adult takes upon himself the right to demand that he be protected form painful stimuli. Because of their sensitivity to pain, newborn and nursing infants possess the same right; but, in contrast to adults, they are helpless when their rights are violated.'

"In a similar vein, a psychiatrist remarked, 'I find it difficult to believe that circumcision, as practiced in our hospitals would not represent stress and shock of some kind. Nobody who has witnessed the way these infants are operated on without anesthesia, the infant screaming in manifest pain, can reasonably deny that such treatment is likely to leave traces of some kind on the personality. This is one of the cruelties the medical profession thoughtlessly inflicts on infants, just because these cannot tell what they suffer. Characteristically, no research seems ever to have been done on developmental and personality differences between a group of circumcised and one of uncircumcised infants.'

"Dr. A. W. Wilkinson, wrote from London: 'I do not think there is any doubt that infants in the first week of life are sensitive to pain because, when inadequately anaesthetised, they respond very sharply to an incision with a knife. Moreover, since they have brains they must be presumed to have psyches and subconscious minds even though we are unable to demonstrate them or satisfactorily penetrate to them. My main interest is in neonatal surgery and I have no hesitation on the grounds of risk to anaesthetise and operate on babies and have done so down to a weight of 900 grams.'

"Finally, from Scotland, this comment: 'It is our custom here to give them a general anesthetic however young, although very few (circumcisions) are done as early as the first week.'"

"The younger the child is, the closer he is to conception, the more open and vulnerable that child is to hurt. Newborn babies have that much more feelings, more sensitivity, and are more vulnerable to pain than older children."-- E. Micheal Holden, MD, from Circumcision: The Painful Dilemma, by Rosemary Romberg, Bergin & Garvey, 1985, p. 306.

"Newborns do feel pain... the contrary belief that the smallest of babies... are oblivious to pain has persisted for decades among many physicians who have routinely operated on these children with little or no anesthesia."-- "Infants' Sense of Pain is Recognized, Finally," New York Times, Nov. 24, 1987.

"The American Academy of Pediatrics, saying that even premature babies are capable of feeling pain during surgery, has recommended the use of anesthesia on newborn infants... the academy, in a policy statement published in the September issue of Pediatrics, said that recent research shows that even premature babies are capable of feeling deep pain in surgery."-- "Baby Doctors Say Newborns Can Feel Pain," San Francisco Chronicle, Sept. 7, 1987.

"She [the anesthesiologist] also noted that she had not considered other methods of pain control because babies, according to all available evidence, did not feel pain. All she used was the paralyzing agent Pancuronium bromide (Pavulon). The department chairman was in total agreement and suggested that Jeffery's pain was comparable to the discomfort experienced by patients having a tube placed down their throats. In both cases, he added, the endorphines produced in the brain under stress would be sufficient to mask even deep pain. Not until later did I learn that the endorphin levels required to inhibit pain are 10,000 times higher than those recorded in any newborn, and that the levels produced by infants under the stress of unanesthatized surgery are insufficient to mask the pain."-- Jill R. Lawson, The Politics of Newborn Pain, on her son Jeffrey's death after unanesthetized heart surgery at 25 weeks gestation in 1985.

"The operation is decidedly painful and in newborns anesthesia (local or general) is rarely used because of the possible risks."-- "Physicians have found no health justification for routine circumcision of newborns," New York Times, August 14, 1985.

"Research reveals that the pain pathways are much more advanced in newborns than previously thought, and the physical response to pain is the same for both newborns and adults... Using the pain cry as an indicator, some investigators have shown that newborns are actually more sensitive to pain than older infants... Babies not only feel the pain of circumcision but they also seem to remember the pain."-- "New research shows infants do feel pain at damaging levels," San Fransisco Examiner, Dec. 17, 1987.

"Infants undergoing circumcision without anesthesia demonstrate physiological responses suggesting that they are experiencing pain. The observed responses include behavioral, cardiovascular, and hormonal changes. Pain pathways was well as the cortical and subcortical centers necessary for pain perception are well developed by the third trimester. Responses to painful stimuli have been documented in neonates of all viable gestational ages. Behavioral changes include a cry pattern indicating distress during the circumcision procedure and changes in activity (irritability, varying sleep patterns) and in infant-maternal interaction for the first few hours after."-- American Academy of Pediatrics, Report of the Task Force on Circumcision, 1989.)

"Circumcision is a stressful and painful event... with... changes in heart rate, respiratory rate, transcutaneous pO2, adrenal cortical hormone secretions, sleep patterns, and behavioral patterns during and/or following circumcision. Indeed, circumcision has been recommended as a model for studying pain in the neonate, and its effects are suggested to be long-lasting."-- Developmental and Behavioral Pediatrics, Vol.5, No.5, October 1984.

"Sir-Taddio and colleagues (Feb 4, p.291) are to be commended for their study showing the permanent psychological damage inflicted on infants subjected to unanesthetised penile reduction surgery--i.e., circumcision. It is both instructive and frightening that the severe and unalleviable pain of circumcision permanantly alters the neural pathways in an adverse fashion....Stang et al found that an injection of lignocaine hydrochloride reduced the plasma cortisol [a hormone which rises in response to stress] concentration slightly, but left the babies with a concentration of 331 nmol/L, whereas a contented child at rest has a plasma cortisol concentration of 28-138 nmol/L. Benni et al found that EMLA (lignocaine/prilocaine local anesthetic cream) could only reduce the circumcised child's heart rate from 180 to 160 beats a minute. No infant's heart should beat at 160 beats a minute, nor should his plasma cortisol concentration be 331 nmol/L. These rates are consistant with torture. With or without anaesthesia, circumcision will cause the psychoneural damage found by Taddio et al."-- Circ Info Network 950412 Letter, The Lancet, Vol 345, P.927, 8 Apr., 1995.

"I repeatedly asked the doctor if it [the circumcision operation] would hurt Shawn and he repeatedly said no."-- Shawn's mother, Vicki Campbell, Circumcision: The Painful Dilemma, p. 317.

"I can tell you all about my sons adhesions and my nephews surgery to correct his botched circ though. And I can assure you that no one told us circ would help protect against AIDS. We were told it was needed and just done. I also was told it was painless and was laughed at when I cried about my son crying in pain. I was told it was my imagination and it was not his penis causing any pain. Funny how Kam screamed for the first 2 days after circ and then was the perfect baby. The look on his face after his circ was heartbreaking. And if circ did help lower his risk of AIDS, you can bet today, I'd say no way. It would not be worth all the pain and complications my sons have suffered from this routine thing we call circ." --Jennifer (4/2001)