How often is anesthesia used during circumcision, and how effective is its use in warding off the otherwise unbearable pain of having one's genitals probed, sliced, and cut away?
Frequency of Anesthesia
Because physicians in the United States are not required to keep records of when and how circumcision is performed, we do not have concrete numbers on the exact percentage of times anesthesia is used during infant circumcision. University of Alberta research (Edmonton, AB) estimates that the majority - 96% - of physicians in the U.S. and Canada do not using anesthesia prior to circumcision, even when parents are told otherwise.
Nursing staff in recent years have come forward (sometimes by name when they have left a job, at other times, anonymously) to admit that they typically are instructed to tell all parents their newborn babies will receive anesthesia, or "pain relief" prior to circumcision, but more often than not this is no more than a sucrose (sugar) dipped pacifier and/or topical EMLA Cream.
Sugar has been demonstrated to be ineffective in pain reduction. While this seems commonsense to adults (would you cut your genitals with a scalpel, or have amputative surgery performed on your body, while you are given nothing more than a sugary sucker?) it piggy-backs a long held myth that "babies don't feel pain." Certainly, nothing could be further from the truth. Research now confirms that while sugar in the mouth may change facial expressions during inflicted pain, it does not reduce the neurological brain response (significant cortisol spikes) that takes place, or the body responses (rapid heart rate, respiration, and occasional intense trauma responses - shock, heart failure, seizure, coma, stroke) that may occur.
Like sugar, EMLA Cream used as "pain relief," or as an anesthetic, is equally ineffective. This is yet another experiment any consenting adult can try on him/herself: rub some EMLA Cream over your genitals, or any part of your body, and make a pin prick with a needle or a slice with your razor. Feel it? So do babies - with even more intensity. In fact, not only is EMLA ineffective at blocking pain in the many dermal layers of the skin, it does nothing to block the deep and highly sensitive nerves in the penis - the majority of which are concentrated in the foreskin. And even when used in an ernest attempt to reduce pain, physicians are not waiting the recommended 1-2 hours after application of EMLA to begin cutting of the exterior layers of the penis (the only tissues that would be numbed by EMLA Cream).
In addition to its ineffectiveness, EMLA cream is not to be used on infants or the genitals of children. The EMLA Cream manufacturer's insert cautions:
EMLA is used to temporarily numb the surface of the skin. It is used for pain relief on the skin prior to procedures such as needle insertion and minor skin surgery in adults and children over 12 months of age. Its effectiveness is lessoned in children under 7 years of age.
When using EMLA Cream, it should not be applied to the following areas:
• cuts, grazes or woundsIn addition, the following warnings have been issued for professionals using EMLA cream in their practice:
• skin rashes or eczema
• in or near the eyes
• inside the nose, ear, mouth, anus
• on the genitals of children
- EMLA cream should not be applied to open wounds.
- Controlled studies of EMLA Cream in children under the age of seven years have shown less overall benefit than in older children or adults. These results illustrate the importance of emotional and psychological support of younger children undergoing medical or surgical procedures.
- During or immediately after treatment with EMLA Cream on intact skin, the skin at the site of treatment may develop erythema or edema or may be the locus of abnormal sensation.
- Blistering on the foreskin in neonates about to undergo circumcision has occurred.
- In patients treated with EMLA Cream on intact skin, local effects observed in the trials included: paleness (pallor or blanching) 37%, redness (erythema) 30%, alterations in temperature sensations 7%, edema 6%, itching 2% and rash, less than 1%.
- EMLA Cream must be applied to intact skin at least 1 hour before the start of a routine procedure and for 2 hours before the start of a painful procedure.
Despite its continued use in U.S. hospitals on neonates, EMLA Cream is ineffective and counter-indicated to be used in this fashion.
Dorsal Penile Nerve Block
Logic would suggest that if we cannot reduce the pain of genital cutting by sugar water or EMLA Cream, a block to the dorsal nerve in the penis may be the solution. However, studies demonstrate that even a nerve block is ineffective when it comes to the intense pain of genital cutting. In a study conducted in part by the University of Iowa College of Medicine, approximately half of newborn males were circumcised with a local dorsal penile nerve block (experiment group), and the other half (control group) were circumcised without anesthetic. Adrenal cortisol levels in the brain (neurological indicators of extreme stress exhibited when humans are in pain) were compared. The findings indicate that neurological and physiological response to pain of the surgery was not significantly reduced by the administration of the penile nerve block. All infants showed trauma-induced stress responses.
Research conducted by Dr. Paul D. Tinari and colleagues suggests this neurological shift in functioning to withstand the pain of circumcision has a lasting impact on the brain. Studies that look at infant pain and its relation to adult perceptions of pain, and neurological response in adulthood, would support these conclusions -- extreme pain in infancy impacts the brain and body for a lifetime.
In the following case examples (videos below) from clinicians, anesthesia is used prior to circumcision. Hundreds more examples can be found today online in educational videos made for medical students, and on YouTube videos (occasionally uploaded by well meaning parents in the U.S. who were never told that circumcision is unnecessary, risky, painful and removes the important, purposeful prepuce organ that all mammals on earth are born having, and the majority keep happily for a lifetime).
Watching these examples contributes to the ubiquitous realization that circumcision surgery is extraordinarily painful, and is not remedied with anesthetic in the majority of cases. Only under full anesthesia would an infant not experience pain during genital cutting. And because general anesthesia is counter-indicated for newborns unless there is a life-threatening reason to us these operative means, rarely would they be implemented. Even in cases that general anesthesia is used, a baby does not have the means to have adequate post-operative pain relief during the healing stage -- something a consenting adult can choose to self-medicate for if s/he opts for any form of genital cutting later in life. Should we find a way to make circumcision 100% pain free during and after surgical amputation, we are still permanently removing important parts of the human body, forever impacting a child who will grow to be an adult, unable to get back pivotal parts of the penis that were removed.
To learn more about the most common forms of circumcision today, see:
New to this topic? Find more: Should I circumcise my son?
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