Chapter 19

HUMANE ALTERNATIVES IN INFANT CIRCUMCISION?

This book was originally intended to be an investigation, rather than a denunciation of infant circumcision. I began my research with a neutral stance on the subject. My only concern was the pain experienced by the infant. I imagined that the operation conferred many benefits. This is what the American middle class has been led to believe. I had originally planned that this book would simply guide parents to either decision, rather than specifically influence them against circumcision. And in my original plans it was very important that I discuss humane alternatives for those who did choose circumcision, so as to help alleviate the infant’s pain.

Today I have found myself on a soapbox crusading against infant circumcision. But in the early stages of my research I was uncertain over whether I had made the right decision for my sons and undecided over whether or not I would ever have another son circumcised. I often became angry and bewildered to find so many people adamantly opposed to the operation! Even though this book has turned out to be a polemic, strongly opposing infant circumcision, I was actually several months into my research before the overwhelming facts and heartrending personal experiences convinced me that babies should not have their foreskins cut off.

It is ironic that today some people label me as “dogmatic” or “biased” about this issue, and are unaware of my neutral beginnings. When I hear other people’s uncertain or noncommittal viewpoints about circumcision, all I am hearing are my own views before I became deeply involved in this research.

Shortly after my son Ryan was born, when my concerns about circumcision were first dawning, I had a friend who gave birth to a baby boy who was born with a naturally short foreskin which made it appear as if he had been circumcised. At the time, this event seemed to me the “ideal solution” -‑ to have a baby boy whose penis looked like our culturally accepted norm without having to undergo the pain of circumcision. I believed that if there was some way that the pain of the operation could be eliminated or greatly minimized for the infant, then the “problem” would be solved. I had no comprehension that foreskins were of any value to the individual. I had absolutely no concern over which “style” of penis males happened to have. I had never imagined that any man had ever been dissatisfied over his lack of foreskin. Nor did I have any awareness that the presence or absence of the foreskin could make any difference sexually. Women rarely have had any knowledge of such things. However, these issues are of crucial, central importance to most of the men who are concerned about circumcision.

When I was originally collecting information and working on this book my three circumcised sons were my only children. Eric was 5, Jason – 3, and Ryan just a few months old when I first decided to write my book. They were still little guys, in a constant state of small child immodesty and continual need of mother’s attention in dressing, bathing, etc. Therefore, I was continually reminded of my own little sons’ circumcised states while researching a continued stream of literature and communications repeatedly informing me (sadly), too late, of the operation’s cruelty and non-necessity. (I conducted some of the interviews in this book while holding my youngest baby in my arms!) I believe that I have been a caring, sensitive mother in almost every other respect. If any mother in the world has ever wanted to believe that what was done to her own children was something beneficial and positive, it would have been me! I am certain that I battled internally with what I was learning far more intensely than most people who have researched this subject. But the overwhelming facts have won out over my initial determination to be “impartial.” Some of my childbirth education peers have tried to insist upon “neutrality” on this (and other emotional issues surrounding birth.) My answer: It is easy to be “neutral” about something if one does not know very much about it. I simply have heard and learned too much. “Neutrality” for me would mean shutting down my brain and closing my heart. I am incapable of reverting back to my previous state of ignorance.

Although the issue of pain experienced by infants has been of primary importance to me as a mother, it is of secondary importance to the overall anti‑circumcision concern. The central issue is that the infant’s penis should be left in its natural state regardless of the pain. One cannot improve on the body by cutting any part off. The other chapters in this book have uncovered some disastrous consequences of circumcision. But even if cutting off the foreskin conferred minor benefits, or made absolutely no difference to the well‑being of the individual, the operation, when performed on an infant is a violation of essential human rights because the infant does not have a choice over whether or not he should have his foreskin. Circumcision of an infant is taking away something that belongs to that individual ‑- painful or not!

Nonetheless, fair coverage should be given to the use of anesthetics and efforts to minimize the pain felt by infants undergoing circumcision.

Ever since people first began cutting off the foreskins of infants, many have insisted that the baby feels little or no pain. Usually this is simply a means of placating one’s own conscience about the matter. Others, while not thinking to question the loss of a useful piece of body tissue, have been conscious and aware enough to have heartfelt concern for the baby’s distress, and have sought measures to alleviate the infant’s pain.

Dr. Weiss, a Jewish physician who has written many articles expressing concern over the pain experienced by infants undergoing circumcision comments:

“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.” 1

Fathergazing at baby

© Suzanne Arms


“If general anesthesia were deemed necessary for infant circumcision, this would force most parents and medical practitioners to THINK about the necessity of the operation.”


Frequently during the Jewish ritual the infant is given a small amount of wine from a spoon or to suck from a small piece of cloth. It is doubtful that the infant ingests enough wine for the alcohol to have an anesthetic effect. If an infant were actually given enough alcohol to make him drunk this would be dangerous to his system. But the sucking action may have some value in helping the infant cope with the stress of the operation.

Older children and adults are usually given general anesthesia if they are to undergo circumcision. Could this method be employed for newborns? Newborn infants are usually given general anesthesia if they have to have serious, necessary surgery.

General anesthesia requires the use of an operating room and an anesthesiologist on duty. If all male neonates undergoing routine circumcision were being given general anesthesia, this would tie up the use of valuable hospital facilities and personnel, making them unavailable for more necessary, life‑saving procedures. General anesthesia would add greatly to the expense of the operation, as well as lengthen the baby’s hospital stay after birth. If general anesthesia were deemed necessary for infant circumcision, this would force most parents and medical practitioners to think about the necessity of the operation. People would have to realize that circumcision is surgery. More parents would decide against infant circumcision. Insurance companies would be reluctant to cover the operation. Doctors would usually advise parents against it.

General anesthesia can result in complications. Its use is riskier when administered to a tiny baby. There is no question that if the millions of newborn male infants who undergo circumcision each year were all given general anesthesia, a number of these would experience dangerous complications and a few would die. For this reason alone, few people would wish to adopt its use.

For many, the most common “solution” has been to disregard the infant’s distress from circumcision by insisting that the baby feels little or nothing. For many others, the preferred “solution” is to leave the baby as nature made him.

There is one other alternative that some doctors have tried. In June 1978 The Journal of Pediatrics published an article describing the use of a penile dorsal nerve block for infant circumcision.

The penis has two main nerves called dorsal nerves because they are situated along the upper surface of the penile shaft. In the procedure described, two injections of lidocaine are administered into the infant’s penis at the site of these two nerves, prior to circumcision.

“Stabilizing the organ with gentle traction of the skin of the penis at an angle of about 20 to 25 degrees, the skin is pierced at one of the dorsolateral positions and the needle advanced posteromedially into the subcutaneous tissue. The depth of the needle need not be more than 0.25 to 0.5 cm. There should be no further resistance felt after the skin is penetrated, the top of the needle remaining freely movable. At this point infiltration of 0.2 to 0.4 ml. of 1% lidocaine is made, taking great care to avoid ac­cidental vascular injection. Under no circumstance should the infiltration be made as the needle is being advanced or withdrawn. The same procedure is repeated at the other dorsolateral position.2

The authors conclude that this technique renders the operation painless and non­ traumatic for the infant.

Had I come across this article early in my research, before I was aware of the many other issues surrounding circumcision, I may have pronounced this the “ideal solution.” However, this technique demands many considerations. The authors do exhibit a certain amount of humanitarianism for their concern about the feelings of the infant. But it is questionable that this method renders circumcision totally painfree and non‑traumatic for the baby. And, as previously stated, pain is certainly not the only consideration surrounding circumcision. It appears that in response to the concern that has been expressed over the infant’s pain from circumcision, some medical professionals have simply sought less painful methods of operating, rather than taken the time to question the wisdom of cutting off part of someone’s body.

When the dorsal nerve block is used, the infant is still strapped down to a Circumstraint board. Being forcibly restrained, strapped to a plastic board, and worked over by a giant adult, may be a more significant element in circumcision trauma than the actual pain. In Leslie Pam’s primal therapy experience (see interview) the feelings of fear, total helplessness, and being “numb” with terror at the time of the actual cutting, were more crucial than the pain itself.

Additionally, two injections into the penis are certainly not without pain. Would an adult or child be nonchalant about needles being stuck into his penis? (I can bear personal witness to this. A recent fall on the ice caused me to need stitches on the inner part of my upper lip. An injection of local anesthesia was needed. I learned that the ultra sensitive tissue inside the mouth is NOT a comfortable place to receive an injection! I am an adult yet was screaming “bloody murder” as the needle went in! Of course genital tissue is the same kind of extremely sensitive tissue. One only needs to consider this.) This brings us back to the “babies don’t feel pain” hoax.

Certainly complications can result from this method, either from adverse reaction to the lidocaine or from mistakes in administering the injection. A newborn infant’s penis is quite tiny and the procedure does require great care and skill. Dr. Call mentions that a local injection presents a problem with swelling of tissues and resultant difficulty in making an even cut. (See interview.)

Finally, the effects of lidocaine wear off completely in a short time. However, it is well known that the soreness, swelling, pain upon urination, and general discomfort in healing of the infant’s penis last for several days. The surface of the freshly circumcised infant’s glans is raw, newly‑exposed tissue from which the foreskin has literally been torn away. This cannot be disregarded.

Perhaps the most significant function of the dorsal nerve block is that it alleviates the consciences of the adults involved.

A more recent article has suggested introduction of a sweetened substance as a means of alleviating pain of circumcision for a baby. Babies are naturally attuned to sweet tastes and mothers’ milk is highly sweet in flavor. The author derived his idea from having observed the wine soaked cloths given to a babies during Jewish bris ceremonies. For hospital circumcisions he tested the use of sugar based solutions. (Elsewhere candied “ring pops” have been used.) As expected the use of a sugared substance decreased the infant crying time, and as adult we presume crying to indicate a measure of pain experienced. Obviously a baby cannot suckle and cry out at the same time. It may be that the action of suckling itself distracts the baby from the pain.3

However, now that we have the documented study that has verified the obvious, that infants experience pain equal to if not more than adults, we must question the “sugar as pain relief” finding.4 How many adults would accept a lollipop or a bottle of sweetened soft drink as effective anesthesia for surgery on an exquisitely sensitive body part?

I find it difficult to believe that anyone after reading this book in its entirety would still wish to have their infant son circumcised. Even if a method could be devised that would render neonatal circumcision totally painless and non-traumatic, a consideration of the horrendous complications that have resulted, the sexual advantages of possessing one’s foreskin, the ethics of altering another person’s body without his permission, and the simple, common-sense value of leaving the body in its natural state should certainly convince most people that the operation should not be done.

However, there are some parents who still decide, after reading all the literature and arguments opposing the operation, that their sons must be circumcised. Parents who already have one or more circumcised sons sometimes find it extremely difficult to make the decision not to have it done to a subsequent son. I have also seen parents in strong disagreement over the decision. Usually it has been the mother who wants with all her heart to protect her baby from any harm while the father callously insists that his son must “match” him. (This is why I am especially angered when some people insist on blaming mothers for perpetuating the practice!) Parents who cannot make the decision to leave their sons as nature made them should consider alerting their doctor to the dorsal nerve block procedure, in the hopes that this will at least partly alleviate some of the baby’s pain.

Jewish parents who believe that circumcision of their newborn sons is an expression of their “covenant with God” may wish to consider incorporating the dorsal nerve block procedure into the Jewish ritual. Different mohelim will undoubtedly have varying feelings about using this technique. However, I know of no stipulation in Jewish law that would prohibit this. The procedure definitely involves administering medication. Therefore a mohel would probably not be qualified to perform this part of the operation. If the parents believe that a mohel must perform the circumcision, they may have to employ a doctor to administer the anesthetic beforehand. This method may involve some additional expense, but some parents will consider it worth it if it will alleviate some of the baby’s pain.

Jeffrey R. Wood has suggested yet another alternative to “conventional” routine circumcision. Some parents have chosen to have only the tip of their baby’s foreskin severed without separating the remaining foreskin from the glans. If this is done with an extremely sharp blade this should be no more painful than an injection and would not involve any accompanying risks of anesthesia. The operator would have to employ unusual skill and caution, however, not to damage the glans, since no protective “bell” device would be used.5

This option, or other variations of the “mini” circumcision, would afford the individual the opportunity to stretch his remaining foreskin over his glans should he later decide that he prefers the intact appearance.

It must be emphasized, however, that cutting off even a tiny amount of foreskin still involves strapping the baby down in the conventional manner. It still involves hurting his penis and exposing him to trauma and risk of complications.

There have been parents who have read our literature and have agonized over the circumcision decision, and have finally opted for a “partial” circumcision such as this as a “compromise.” Most anti‑circumcision activists have difficulty understanding such people. Why can’t they be motivated to simply leave the baby’s penis alone?!

Yet just as in other countries where female circumcision is common, many people today are opting for less radical variations of the operation because the custom is too culturally ingrained to be totally abandoned, there are some American parents who can not be persuaded to leave their sons totally intact, but can be persuaded to accept partial circumcision for their sons. It will probably take many years for American parents and doctors to totally do away with routine infant circumcision. However, perhaps many of the “partially” circumcised baby boys of today, born to parents who cannot let go of the circumcision concept, will some day, as fathers, be more willing to leave their own sons intact.

References:

  1. Weiss, Charles, Ph.D., M.D. “Does Circumcision of the Newborn Require an Anaesthetic?” Clinical Pediatrics, Vol. 7, No. 3, March 1968, p. 128‑129.
  2. Kirya, Christopher, M.B., & Werthmann, Milton W., Jr., M.D. “Neonatal Circumcision and Penile Dorsal Nerve Block -‑ A Painless Procedure” The Journal of Pediatrics, Vol. 92, No. 6, June 1978, p. 998‑1,000.
  3. Gaff, Terry, M.D., “Sweet Solutions Can Help Manage Pain”, Kpcnnews, January 7, 2017
  4. McIntosh, James, “World-first MRI Study Shows Babies Experience Pain ‘Like Adults'”, Medical News Today, April 2015.
  5. Wood, Jeffrey R., (personal correspondence).

 
Informational Resources

https://peacefulbeginningsrosemary.wordpress.com/circ-information/local-anesthesia/
http://coloradonocirc.org/files/handouts/Circumcision_Techniques_and_Complications.pdf (shows use of dorsal nerve block)
http://cpj.sagepub.com/content/25/8/412.abstract
http://pediatrics.aappublications.org/content/87/2/215.abstract
http://www.ajog.org/article/S0002-9378%2815%2900249-5/abstract
http://www.circumstitions.com/Pain.html
http://www.cirp.org/library/pain/
http://www.dailymotion.com/video/xjkd30_infant-circumcision-injection-and-procedure_news
http://www.drmomma.org/2008/11/the-effectiveness-of-anesthesia-for.html
http://www.drmomma.org/2010/09/sugar-does-not-relieve-newborn-pain.html?m=1
http://www.healthcare.philips.com/main/products/mother_and_child_care/post_natal_care/well_baby/calming_and_soothing/sweetease/
http://www.hma.eu/fileadmin/dateien/Human_Medicines/CMD_h_/Paediatric_Regulation/Assessment_Reports/Article_45_work-sharing/Lidocaine_2013_07_45_PdAR.pdf
http://www.ncbi.nlm.nih.gov/m/pubmed/22059457/
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012623/ (Pain relief info – lidocaine, etc.)
http://www.ox.ac.uk/news/2015-04-21-babies-feel-pain-adults
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltext
http://www.usa.philips.com/healthcare/product/HC989805603401/sweet-ease-natural-15-ml-cup
http://www.webmd.com/parenting/baby/news/19991202/sugar-coating-pacifier-ease-infants-pain
http://www.webmd.com/parenting/baby/news/20120820/anesthesia-may-harm-childrens-brains
https://en.wikipedia.org/wiki/Pain_in_babies