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Do You Know: About circumcision pain relief?

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Blog, Do You Know?
February 9, 2017

Do you know there is no safe and effective anesthetic for circumcising a newborn baby?

In its February 2016 issue, Pediatrics published a study that found babies suffer pain from common medical procedures, such as heel pricks, and that the effects of the pain can last many years. The article, “Prevention and Management of Procedural Pain in the Neonate: An Update,” confirmed that commonly used pain relievers are neither effective nor safe for infants.

So, what is the status of pain control for circumcision? Actually, there are no reliable statistics on the various types of analgesia used. We review the common methods here.

NOTHING
Anecdotal evidence suggests that as many as half of the one million infant foreskin amputation surgeries performed in the United States each year are carried out with no pain relief at all. Rooted in the absurd and disproven belief that babies don’t feel pain, this practice is clearly unacceptable from any perspective.

SUGAR
Sugar is ok for sprinkling on Valentine’s Day cookies — but it’s not going to help your baby cope with the pain of circumcision. While a 2016 Cochrane Library study found that sugar’s commonly used relative sucrose “reduces different measures of newborn pain during heel lance, venipuncture and intramuscular injection,” however, the authors warn: “Sucrose does not provide effective pain relief during circumcision.”

Despite this, many doctors and hospitals persist in using pacifiers or syringes that deliver a mixture of sucrose and water to babies undergoing circumcision. Sucking on a sugar-soaked pacifier might make a baby cry less while his foreskin is being severed, but it does nothing to reduce the effects of pain and stress on his nervous system.

TOPICAL CREAMS
EMLA is a topical anesthetic cream sometimes used in circumcisions in the United States. There are two major problems with EMLA. The first is that while it may be helpful in numbing the skin for superficial procedures, EMLA doesn’t work for an invasive surgery such as foreskin amputation. The second is that, in the United Kingdom and several other countries, use of EMLA on mucus membrane or children’s genitalia is contraindicated. It’s not clear why EMLA is still permitted in the United States for infant circumcision.

INJECTIONS INTO THE BASE OF THE PENIS
Increasingly, doctors are injecting lidocaine or other numbing agents into the baby’s penis as a way of blocking the pain from circumcision. This method is also problematic. First, it requires at least two painful injections into the nerves at the base of the penis. Second, relief from pain is often only partial, and wears off quickly. Finally, various complications can occur, including penetration of the superficial dorsal vein (causing bruising and bleeding) and toxicity from the anesthetic itself.

Removing a baby’s foreskin is not medically necessary. The surgery is painful and the pain persists for days or weeks of the baby’s first days of life, and no available analgesics are both safe and effective. Therefore, parents who want to protect their precious newborn sons from pain and risk will want to say NO to circumcision.

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Marilyn

Marilyn Fayre Milos, multiple award winner for her humanitarian work to end routine infant circumcision in the United States and advocating for the rights of infants and children to genital autonomy, has written a warm and compelling memoir of her path to becoming “the founding mother of the intactivist movement.” Needing to support her family as a single mother in the early sixties, Milos taught banjo—having learned to play from Jerry Garcia (later of The Grateful Dead)—and worked as an assistant to comedian and social critic Lenny Bruce, typing out the content of his shows and transcribing court proceedings of his trials for obscenity. After Lenny’s death, she found her voice as an activist as part of the counterculture revolution, living in Haight Ashbury in San Francisco during the 1967 Summer of Love, and honed her organizational skills by creating an alternative education open classroom (still operating) in Marin County. 

After witnessing the pain and trauma of the circumcision of a newborn baby boy when she was a nursing student at Marin College, Milos learned everything she could about why infants were subjected to such brutal surgery. The more she read and discovered, the more convinced she became that circumcision had no medical benefits. As a nurse on the obstetrical unit at Marin General Hospital, she committed to making sure parents understood what circumcision entailed before signing a consent form. Considered an agitator and forced to resign in 1985, she co-founded NOCIRC (National Organization of Circumcision Information Resource Centers) and began organizing international symposia on circumcision, genital autonomy, and human rights. Milos edited and published the proceedings from the above-mentioned symposia and has written numerous articles in her quest to end circumcision and protect children’s bodily integrity. She currently serves on the board of directors of Intact America.

Georganne

Georganne Chapin is a healthcare expert, attorney, social justice advocate, and founding executive director of Intact America, the nation’s most influential organization opposing the U.S. medical industry’s penchant for surgically altering the genitals of male children (“circumcision”). Under her leadership, Intact America has definitively documented tactics used by U.S. doctors and healthcare facilities to pathologize the male foreskin, pressure parents into circumcising their sons, and forcibly retract the foreskins of intact boys, creating potentially lifelong, iatrogenic harm. 

Chapin holds a BA in Anthropology from Barnard College, and a Master’s degree in Sociomedical Sciences from Columbia University. For 25 years, she served as president and chief executive officer of Hudson Health Plan, a nonprofit Medicaid insurer in New York’s Hudson Valley. Mid-career, she enrolled in an evening law program, where she explored the legal and ethical issues underlying routine male circumcision, a subject that had interested her since witnessing the aftermath of the surgery conducted on her younger brother. She received her Juris Doctor degree from Pace University School of Law in 2003, and was subsequently admitted to the New York Bar. As an adjunct professor, she taught Bioethics and Medicaid and Disability Law at Pace, and Bioethics in Dominican College’s doctoral program for advanced practice nurses.

In 2004, Chapin founded the nonprofit Hudson Center for Health Equity and Quality, a company that designs software and provides consulting services designed to reduce administrative complexities, streamline and integrate data collection and reporting, and enhance access to care for those in need. In 2008, she co-founded Intact America.

Chapin has published many articles and op-ed essays, and has been interviewed on local, national and international television, radio and podcasts about ways the U.S. healthcare system prioritizes profits over people’s basic needs. She cites routine (nontherapeutic) infant circumcision as a prime example of a practice that wastes money and harms boys and the men they will become. This Penis Business: A Memoir is her first book.