Isaac is cradled in his grandfather’s arms. In the space of a few minutes, the Orthodox ritual circumciser, or mohel, separates the foreskin from the head of Isaac’s penis, pulls the skin forward and inserts a metal shield that protects his penis while his foreskin is cut off. No anesthetic is used.
Meanwhile, Joseph is strapped down to a special mattress by a Reform mohel who injects an anesthetic into the base of his penis. During the following 10 minutes, the tip of his penis is covered by a bell-shaped clamp; the foreskin is sliced, pulled back over the clamp and cut off.
At such a young age, do Isaac or Joseph feel pain? And if so, how do their circumcisers feel about the pain they inflict? Are there moral issues in play here? Are some methods of circumcision more humane than others?
As Europeans and some Americans debate the acceptability of circumcision, the question of pain has surfaced as one of the key reasons opponents cite to ban this ancient religious practice. Those who perform Jewish ritual circumcision — brit milah — say they are concerned about pain, too, but have very different methods of minimizing it, depending on religious denomination.
Proponents of circumcision were given a major boost in August, when the American Academy of Pediatrics released its revised guidelines on male circumcision, stressing the medical benefits of the procedure in reducing the incidence of urinary tract infections and sexually transmitted diseases, including HIV.
But the AAP guidelines also stressed the importance of “effective pain management,” particularly local anesthetic or anesthetic creams, neither of which is used regularly by most Orthodox mohels. Nonmedical techniques alone, the AAP guidelines said, “are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia.”
Physicians, a number of whom practice as Reform mohels, say there is no question that infants feel pain. Reform mohel Steve Lerman, a pediatric urologist at University of California, Los Angeles, says that studies during the 1980s and ’90s showed that every pain indicator — heart rate, breathing rate, crying — is heightened in infants circumcised without anesthetic.
“There absolutely is anguish and pain that can occur from this,” Lerman said, “and any schmuck who tries to tell you they’re too young, they won’t feel it — that’s a bunch of bulls–t.”
Lerman, who performs secular circumcisions at UCLA Medical Center and ritual circumcisions in people’s homes, uses anesthetic every time. First he secures the baby into a circumstraint, a foam board with straps to hold down arms and legs (Lerman says he uses only the leg restraints). He injects Lidocaine into the base of the baby’s penis at the front and back. After about 10 minutes, when the area is numb, he fits a device called a Gomco clamp over the penis. Over the next 10 minutes, he performs the procedure.