THE LANCET, Volume 345: Page 927,
8 April 1995.


Sir-Taddio and colleagues (Feb 4, p. 291) are to be commended for their study showing the permanent psychological damage inflicted on infants subjected to unanesthetised penile reduction surgery—i.e., circumcision. It is both instructive and frightening that the severe and unalleviable pain of circumcision permanently alters the neural pathways in an adverse fashion. Where else might the clinician look for signs of circumcision flashback?

The suggestion that analgesia be used for circumcision is, however, incongruous with the results of Taddio and colleagues' study. Investigations of the effectiveness of analgesia in circumcision show that at best, topical, caudal, or dorsal analgesia may cause infants to suffer only slightly less.

For instance, Stang et al1 found that an injection of lignocaine hydrochloride reduced the plasma cortisol concentration slightly, but left the babies with a concentration of 331 nmol/L, whereas a contented child at rest has a plasma cortisol concentration of 28-138 nmol/L. Benini et al2 found that EMLA (lignocaine/prilocaine local anaesthetic cream) could only reduce the circumcised child's heart rate from 180 to 160 beats a minute. No infant's heart should beat at 160 beats a minute, nor should his plasma cortisol concentration be 331 nmol/L. These rates are consistent with torture. With or without anaesthesia, circumcision will cause the psychoneural damage found by Taddio et al.

Despite the obviously irrational cruelty of circumcision, the profit incentive in American medical practice is unlikely to allow science or human rights principles to interrupt the highly lucrative American circumcision industry. It is now time for European medical associations to condemn the North American medical community for participating in and profiting from what is by any standard a senseless and barbaric sexual mutilation of innocent children.

Paul M. Fleiss, MD, 1824 North Hillhurst Avenue, Los Angeles, CA 90027 USA
  1. Stang HJ, Gunnar MR, Snellman L, Condon LM, Kestenbaum R. Local anesthesia for neonatal circumcision; effects on distress and cortisol response. JAMA 1988;259:1507-11.
  2. Benini F, Johnston C, Faucher D, Aranda JV. Topical anesthesia during circumcision in newborn infants. JAMA 1993;270:850-53.

(File revised 15 December 2006)