Neonatal Breathing Reveals Circumcision Pain Is Not Severe

A new study suggests that infants circumcised without anesthesia do not experience more pain or a greater likelihood of sleep disturbances than boys who were not circumcised.

Researchers at West Virginia University (Morgantown, USA) conducted a retrospective study from 1994 to 1999 that analyzed respiration rates among 17 babies before and after circumcision, and compared those results to 4 uncircumcised boys and 23 girls. The researchers used the Quiet Sleep Respiratory Rate (QSRR) scale as a marker of pain, since the expectation is that pain by circumcision would affect sleep in newborns.

The results showed that an increase in breaths-per-minute on the QSRR scale was observed across all of the babies in the sample, including a significant increase in the uncircumcised boys, but the differences between the two groups was not significant. The researchers also looked at differences in QSRR based on whether children were bottle-fed or breast-fed, but again no discernible difference was observed. The study was presented as a poster session at the annual meeting of the Associated Professional Sleep Societies (APSS), held during June 2013 in Baltimore (MD, USA).

“Of course, we can't ask children if they feel any pain. There is no real measure of pain for these infants,” said lead author and study presenter PhD student Margeaux Schade, BSc. “The idea is if they have elevated cortisol because of chronic pain exposure then theoretically they will exhibit increases in stable respiratory rate. There was an increase between groups, but there was no significant difference between groups.”

Male circumcision remains the subject of controversy on a number of grounds, including religious, ethical, sexual, and health. The Ancient Greeks and Romans valued the foreskin and were opposed to circumcision—an opposition inherited by the canon and secular legal systems of the Christian West that lasted at least through to the Middle Ages. Traditional Judaism and Islam have advocated male circumcision as a religious obligation.

Although previous claims of benefits like curing masturbation, gout, epilepsy, and even insanity were no doubt absurd, important research has shed light on real medical benefits of circumcision. In particular, the procedure has consistently shown to result in the decreased risk of debilitating and costly diseases such as HIV, cervical cancer, and infantile urinary tract infection. Because of advances in the understanding of the anatomy of the foreskin and pain conditioning in infants, prevailing attitudes about anesthesia and analgesia during the procedure remain in controversy.

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