Circumcision Resources

Supporting families to make healthy, safe choices based on scientific evidence.

Circumcision Pain

The pain and stress of the circumcision experience is intensely traumatic. Taddio et al. have documented behavior suggestive of post-circumcision traumatic stress disorder in infants at the age of six months. Rhinehart has documented PTSD from neonatal circumcision in middle-aged men. Anand and Scalzo suggest that early adverse experiences may result in stress disorders, hyperactivity, and self-destructive behavior.

– The CIRP Library

Some doctors performing infant circumcision may use a product called EMLA. (Eutectic Mixture of Local Anesthetics) This topical anesthetic cream is only slightly effective for that purpose. Not only has it been found that EMLA only relieves pain during approximately 1/3 of the procedure, but EMLA simply does not penetrate deeply enough to be effective: During circumcision, the membranes are torn from the glans, the inner and outer layers are clamped, and the foreskin is cut away with a scalpel. EMLA simply cannot control the extreme deep pain of such physical trauma to human tissue.

WARNING to parents: EMLA cream is not approved for use in the first thirty days of life due to the threat of methemoglobinemia, a blood disease. The package insert from the manufacturer states that EMLA should not be used on mucosal tissue (which would rule out its use for circumcision), and in any case should not be used on children under 12 months of age, because of the risks of its use. Furthermore, it is not a sterile preparation and should not be used on open wounds.

Some doctors will use dorsal penile nerve block (DPNB) which does not block the ventral nerve pain pathways so it is only partially effective. The infant still feels pain when DPNB is used. In fact, the Cochrane Review states “it can be concluded that DPNB and EMLA do not eliminate circumcision pain”. 

Post-operatively, circumcision pain is severe and persistent and continues beyond 24 hours.

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