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Male Neo Natal Circumcision: Pain, Trauma and Psychosexual Consequence

I am appalled at the amount of references and articles sited in this paper. The American people have no idea about this abuse of power nor the psychological consequence circumcision has on baby boys.

(Lengthy Paper - Read more at provided links) Journal of Health Psychology

Link: http:// www. cirp. org/ library/ psych/boyle6/

In the English speaking world, circumcision was introduced as a medical procedure in the late-nineteenth century (Hodges, 1997).

Victorian notions about the "ills of masturbation" influenced some physicians to endorse amputation of the erotogenic foreskin as "preventative therapy" since circumcised boys could not use their foreskins for masturbation (Moscucci, 1996).

Circumcision subsequently was accepted as a panacea for many conditions, including epilepsy, paralysis, malnutrition, "derangement of the digestive organs," chorea, convulsions, hysteria, and other nervous disorders (Gollaher, 2000).

In the ensuing decades, as each claimed benefit of circumcision was disputed, another would come to take its place (Hodges, 1997).

Various national medical associations have evaluated studies on therapeutic rationales for infant circumcision under standard surgical conditions and management (see Denniston, Hodges, & Milos, 1999, for example).

However, no national medical association anywhere in the world that has studied the issue recommends routine circumcision (American Academy of Pediatrics, 1999; Australasian Association of Paediatric Surgeons, 1996; Australian College of Paediatrics, 1996; British Medical Association, 1996; Canadian Paediatric Society, 1996). Recently, the American Medical Association (2000) has gone even further, confirming that infant circumcision is non-therapeutic.

It is now generally acknowledged that any potential medical benefits of routine circumcision are outweighed by its risks and drawbacks (AAP, 1999).

Circumcision Pain:

One of the fundamental issues that divides opinion on the practice of circumcision regards the presence or degree of pain. To address this issue, we turn to the concept of pain and the evidence for pain sensitivity in infants. As defined by scientists, pain is an unpleasant sensory experience associated with tissue damage (IASP, 1986).

There is no doubt that circumcision entails observable pain and identifiable tissue damage (see joint statement of American Academy of Pediatrics and American Pain Society (American Academy of Pediatrics, 2001).

The only matter of some interpretation is the infant's behaviour during circumcision. As with adults, pain in infants is expressed in stereotypic ways involving vocalisation, facial expression, body movements, and autonomic activity. Analysing the vocalisations of 30 newborn males during circumcisions of varying levels of invasiveness, Porter, Miller, and Marshall (1986) found that the invasiveness of the procedure was positively correlated with duration of crying, more pronounced peak fundamental frequencies, reduced harmonics, and greater variability of the fundamental.

Crying extended to a day after circumcision and was interrupted by greater periods of quiet when anaesthesia was provided (Dixon, Snyder, Holve, & Bromberger, 1984). It is also notable that adult listeners agreed on the urgency of these cries as a function of the intensity of the pain-producing stimulus.

Levine and Gordon (1982) reviewed literature on the spectrographic analysis of pain-induced vocalisations (PIV) in infants and found remarkable similarity with the basic features of PIV in animals.

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.


http:// www. cirp. org/ library/ psych/boyle6/

Circumcision Trauma:

Van Howe (1996, p. 431) reported that, "Newborn males respond to circumcision with a marked reduction in oxygenation during the procedure, a cortisol surge, decreased wakefulness, increased vagal tone, and less interactions with their environment following the procedure..." Rhinehart (1999) in a report of clinical cases noted that the only response available to the infant is shock, wherein the central nervous system is overwhelmed by pain, followed by numbing, paralysis, and dissociation.

Possibly, dissociation of the traumatic experience and emotional pain may be employed by the infant as a psychological defence (Chu & Dill, 1990; Noyes, 1977; Rhinehart, 1999). While some babies have been described as being "quiet" after circumcision, Rhinehart concluded that the observed stillness most likely represents a state of dissociation or shock in response to the overwhelming pain.


http:// www. cirp. org/ library/ psych/boyle6/

Impacts of Circumcision:

The outcome of painful childhood trauma includes long-lasting neurophysiological and neurochemical brain changes (Anand & Carr, 1989; Anand & Scalzo, 2000; Ciaranello, 1983; Taddio et al., 1997; van der Kolk & Saporta, 1991).

Richards, Bernal, and Brackbill (1976) found that circumcision may impact adversely on the developing brain, and that reported "gender differences" may actually arise from behavioural changes induced by infant or childhood circumcision.

Rhinehart (1999) in a report of adult clinical cases concluded that a man circumcised as a child is more likely to react with terror, rage and/or dissociation when confronted with situations interpreted as threatening. As in any situation of post-traumatic stress, an event resembling any aspect of the original traumatic experience is more likely to provoke negative emotions such as panic, rage, violence, or dissociation.

Psychological considerations:

In Gemmell and Boyle's (2001) survey, involuntary circumcision impacted negatively on various psychological measures. They found that as compared with genitally intact men, circumcised men were often unhappy about being circumcised, experienced significant anger, sadness, feeling incomplete, cheated, hurt, concerned, frustrated, abnormal, and violated (cf. Hammond, 1999). They also found that circumcised men reported lower self-esteem than did genitally intact respondents.

Hammond's (1997) sample of circumcised men reported

emotional harm (83%)

physical harm (82%)

general psychological harm (75%)

low self-esteem (74%)

The circumcised men frequently reported

feeling mutilated (62%)

unwhole (61%)

resentful (60%)

abnormal/unnatural (60%)

that one's human rights had been infringed (60%)

angry (54%)

frustrated (53%)

violated (50%)

inferior to genitally intact males (47%)

impeded sexually (43%)

betrayed by one's parents (34%).

Similar findings emerged from a larger sample of 546 circumcised men studied by Hammond (1999).


The body of empirical evidence reviewed here suggests that there is severe pain at the time of circumcision and shortly thereafter in unanaesthetised boys, as well as heightened pain sensitivity for some considerable period of time afterwards.

Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well.

A variety of forces are converging from fields as diverse as psychology, medicine, law, medical ethics, and human rights, all questioning the advisability of circumcision which originated millenia ago and was promoted in the Victorian era.

As Chamberlain (1998) pointed out, "parents are not warned that their infants will endure severe pain and will be deprived of a functional part of their sexual anatomy for life."

Non-therapeutic circumcision of male minors is now being questioned by legal and ethics scholars in an unprecedented way.

The mental health community can play an important role in the growing debate about circumcision.

We encourage closer examination of this issue and even more empirical research into the psychosexual sequelae associated with circumcision.


http:// www. cirp. org/ library/ psych/boyle6/


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