Letters

Sir—Taddio and colleagues [Feb 4, p. 291] report that neonatal circumcision affects pain responses in boys at vaccination up to six months later, and suggest that the pain from circumcision may have long lasting effects on pain response up to six months later, and suggest that the pain from circumcision may have long lasting effects on pain response and/or perception. They recommend that analgesia should be routine for circumcision to prevent this possible long-term effect. However, there is no certainty that short-term local analgesia would do so.

In neonatal circumcision there must be more than one component of pain. There will be acute pain when the foreskin is crushed by a clamp and then excised, and this pain would be reduced or obliterated by local analgesia. But since the prepuce is adherent to the glans, circumcision involves tearing these layers apart, leaving the glans raw and bleeding. This raw surface must cause pain as it is abraded by soiled napkins for days after surgery. Local analgesia is only effective for a few hours. The only sure way of avoiding the long-term harmful effects of neonatal circumcision is for doctors to abandon this unnecessary, intrusive, mutilating, and painful operation.

John Warren, MD, Princess Alexandra Hospital NHS Trust, Harlow, Essex CM20 1QX, UK.