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== Säuglingsbeschneidung ==
 
== Säuglingsbeschneidung ==

Version vom 28. April 2022, 15:30 Uhr

Der „Schmerz“ der Beschneidung ist extrem und traumatisierend.[1] Säuglingsjungen schreien einen besonderen Notschrei. Ostwall & Peltzman (1974) bemerkten:

”Unsere Aufmerksamkeit wurde auf den Notschrei von Säuglingen gerichtet. Wir haben zahlreiche Notschreie aufgezeichnet, die bei routinemäßigen medizinischen Eingriffen wie der Entnahme von Blutproben und kleineren chirurgischen Eingriffen wie der Beschneidung entstanden sind. Der Notschrei ist lauter, länger und lauter als der Hungerschrei. In neigt auch dazu, unregelmäßig zu sein, mit mehr Unterbrechungen und Würgen.
– Ostwall & Peltzman (1974)[2]


Säuglingsbeschneidung

Schmerz während der Operation

Beschneidung wird am häufigsten an Neugeborenen als nicht-therapeutische kulturelle Neukonfiguration des Körpers durchgeführt. In diesem zarten Alter ist die Vorhaut normalerweise mit der darunter liegenden Eichel durch eine Synechialmembran verschmolzen, die beiden Teilen gemeinsam ist.[3]

Bei jeder Säuglingsbeschneidung gibt es vier schmerzhafte Schritte:

  1. Bevor die Beschneidungsoperation beginnen kann, muss der Chirurg zuerst diese beiden stark innervierten Körperteile in einem äußerst schmerzhaften Verfahren gewaltsam trennen, indem er eine stumpfe Sonde zwischen die beiden Teile zwingt, um die Synechie zu zerstören, zu zerreißen und auseinanderzureißen.[4]
  2. Als nächstes muss in einem weiteren schmerzhaften Schritt ein dorsaler Schlitz in die Vorhaut geschnitten werden, damit eine spezielle Klemme angebracht werden kann.
  3. Die Vorhaut ist erogenes Gewebe[5] und daher stark innerviert.[6] Nervengewebe benötigt eine große Blutversorgung, daher ist die Vorhaut reich mit vielen Blutgefäßen vaskularisiert[7], weshalb die Vorhaut in einem weiteren schmerzhaften Schritt mit einer von mehreren speziellen Klemmen gequetscht werden muss, bevor die Beschneidung durchgeführt werden kann.[8]
  4. Schließlich muss in einem weiteren, schmerzhaften Schritt die Vorhaut weggeschnitten werden.
(Dieser Artikel wurde noch nicht aus dem Englischen übersetzt oder enthält noch englische Textpassagen. Bitte beziehe dich vorerst auf die Informationen im englischen Artikel. Klicke dazu in der IntactiWiki-Navigation im Abschnitt "In anderen Sprachen" auf "English".)

Lander et al. (1997) conducted a comparison neonatal non-therapeutic circumcision without anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics (EMLA).[9]

With no anesthesia, the infants screamed continuously. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea). One experienced projectile vomiting.[9]

EMLA was the least effective pain control. Dorsal penile nerve block (DPNB) was more effective, and ring block was the most effective. The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea)." The authors were so alarmed that they terminated the no anesthesia arm of the study early.[9] None of the analgesic measures tested provided total pain relief.[10] Any infant boy who undergoes neonatal circumcision will experience some pain and trauma. Boys who escape circumcision would have no pain or trauma. The authors concluded that circumcision should be performed with anesthetic, however the text makes clear that they meant analgesia, since full anesthesia is unsafe for neonates.[9]

Schmerz nach der Operation

Circumcision is an invasive cutting and amputation. Like other invasive operations, post-surgical pain persists after the surgery for days or weeks. Infant boys will not receive effective analgesia because their young age makes such drugs dangerous.

Howard et al. (1994) studied male infants after their neonatal circumcision. They recorded the comfort scores of the infants at numerous periods after circumcision. They also observed and recorded feeding behavior.

It was found that feeding behavior deteriorated significantly after circumcision. Some breastfeed infants were unable to breastfeed and required formula feeding after circumcision. Acetaminophen was found to be almost totally ineffective against the post-circumcision pain. It did have some effect six hours after the circumcision. The authors concluded "that circumcision of the newborn causes severe and persistent pain."[11]

Parents who choose to have a son circumcised may expect the infant boy to be uncomfortable and fussy for some time.

Traumatische Auswirkung der Säuglingsbeschneidung

When an infant boy is to be circumcised, it is the usual practice to immobilize the infant for the painful surgery by securely tying his limbs to a molded plastic board specially made for that purpose. The infant thus is preventing from fighting or fleeing, which is the trauma-producing situation of inescapable shock, described as a "physical condition in which the organism cannot do anything to affect the inevitable."[12]

There is now substantial evidence that the extreme pain of infant circumcision causes post traumatic stress disorder ̪(PTSD). Preverbal memory starts to function before birth and continues to function in the newborn period,[13] and infants are now known to feel pain intensely,[14] so all of the necessary requirements are present.[15]

Taddio & colleagues (1995)(1997) studied the effect of neonatal circumcision on the behavior of boys after surgery and at the time of vaccination. It was found that circumcised boys had a higher pain response at time of vaccination six months later as compared with intact boys,[16] [17] showing that the nervous system had been permanently sensitized to heightened pain sensation.

Taddio et al. (1997) concluded:

Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.[17]

John Rhinehart, M. D., (1999) a clinical psychiatrist, reported finding numerous cases of PTSD in his adult male patients pursuant to infant circumcision.[18]

Auswirkung extremer Schmerzen auf die Entwicklung des Nervensystems

Several researchers have suggested that extreme pain in the newborn could cause neurological injury. Anand & Scalzo (2000) concluded:

The public health importance of abnormal stimulation during the neonatal period cannot be overemphasized. While programs for formulating appropriate health policies and public education campaigns must disseminate this message, it is also important for these effects to be investigated, particularly with a view to developing effective therapeutic strategies for the growing childen and adolescents who were exposed to abnormal conditions during the neonatal period.[19]

Fitzgerald & Walker (2003) argued that extreme pain (such as that caused by circumcision) may alter developing nervous tissue in the very young.[20]

Geschichte

Untersuchung des Beschneidungsschmerzes

Paul Emil Flechsig (1847-1929) was an eminent nineteenth-century German neuroanatomist, psychiatrist and neuropathologist. He suggested in 1872 that infants could not feel pain because their nerves are not completely myelinated.[21] Incredible as it may seem today, his idea was accepted without question and without being tested.[22]

As a result, medical doctors performed all manners of invasive, painful procedures on neonates without anesthesia or analgesia, including millions upon millions of painful circumcisions and even open heart surgery. Open heart surgery was performed with curare to paralyze the infant but without any anesthesia.

Flechsig's bizarre opinion was not questioned until the 1970s. Several lines of empirical research carried out in the 1970s suggested that infants can in fact feel intense pain.[22]

  • Anders et al. (1970) showed that measurement of serum cortisol is a useful indicator of pain for psychological investigation in infancy.[23]
  • Emde et al. (1971) showed that the "stress" of circumcision caused an increase in the amount of non-REM sleep.[24]
  • Richards, Bernal & Brackbill (1976) reported behavioral differences between American boys (circumcised) and British boys (genitally intact).[25]
  • Luther, Kraybill & Potter (1976) compared the level of cortisol in infants before and after circumcision. They found a substantial rise in the cortisol levels in the infants, which they said was due to the "stress" of circumcision.[26]
  • Rawlings, Miller & Engel (1980) showed that as the pain of circumcision increased, oxygenation of the skin decreased.[27]
  • Gunnar et al. (1981) recorded serum cortisol and behavior state throughout the unanesthetized, non-therapeutic circumcision process. Serum cortisol levels and behavioral distress were found to be closely related. The authors stated:

Neonatal circumcision is performed without anesthesia and it is clearly stressful for the infant.

So great was Flechsig's influence, the authors were still unwilling to use the word pain and substituted the word stress.[28]

  • Marshall et al. (1982) studied mother-child interaction with regard to feeding behavior after circumcision without anesthesia. They found that circumcised boys had more interruptions of feeding in the 24-hour period of observation.[29]

Porter, Miller & Marshall (1986) studied the nature of pain cries during unanesthetized, non-therapeutic circumcision. the cries during circumcision were found to shorter, with more more frequent vocalizations; higher peak fundamental frequencies; fewer harmonics; and greater variability of the fundamental. Adult listeners judged these cries to have an unusual degree of urgency.[30]

Surgical operation on infants without anesthesia continued for well over a century, at least until 1987, when the American Academy of Pediatrics was forced to issue a CYA statement that called for the use of anesthesia.[31] [22]

Anand & Hickey (1987) published a paper in the New England Journal of Medicine that totally demolished Flechsig's ridiculous claims and conclusively proved that newborn infants are capable of feeling intense pain. After publication of this paper, no doubt about pain sensation in infants remained. The article stated:

Numerous lines of evidence suggest that even in the human fetus, pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functional. Physiologic responses to painful stimuli have been well documented in neonates of various gestational ages and are reflected in hormonal, metabolic, and cardiorespiratory changes similar to but greater than those observed in adult subjects. Other responses in newborn infants are suggestive of integrated emotional and behavioral responses to pain and are retained in memory long enough to modify subsequent behavior patterns.[14] [22]

Gunnar et al. (1988) examined the association between behavioral distress and adrenocortical activity. It was found that differences in behavioral distress did not reliably the level of adrenocortical activity. Moreover, it was found that while non-nutritive sucking reduces crying it did not reduce the adrenocortical response to the stressful stimulus of circumcision pain.[32]

Although by 1989 it was totally clear that infants can feel intense pain, the 1989 American Academy of Pediatrics Circumcision Task Force, under the leadership of the infamous Edgar J. Schoen, M. D., declined to recommend the use of analgesics for non-therapeutic neonatal circumcision, thereby condemning million of newborn baby boys to a painful, stressful circumcision.[33]

Die Suche nach einem ethischen Weg, schmerzhafte, nicht-therapeutische Beschneidung durchzuführen

The financially and psychologically vested circumcision industry suddenly found itself in a predicament. It was now suddenly proven beyond any shadow of a doubt that newborn baby boys can feel intense pain. Medical ethics and the standard of care now necessitated pain relief, however it is dangerous to give general anesthesia to neonates. Edward Wallerstein (1985) had proposed that routine (non-therapeutic) circumcision of baby boys be eliminated just as routine tonsillectomy and adenoidectomy previously had been eliminated,[34] however this clearly would not do for the avid pro-circumcision lobby. No circumcision equals no fee for surgery. The financial gain from discontinuing non-therapeutic circumcision is just too high to discard. Dan Bollinger (2012) estimated that the total annual cost of non-therapeutic circumcision to Americans is $3,647,000,000.[35] The avaricious American circumcision industry is simply not willing to give that lucrative income up, so a way to make non-therapeutic circumcisions in infancy acceptable had to be found.

Three methods were proposed:

  • Application of EMLA Cream topical anesthetic. EMLA is a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%. EMLA Cream (lidocaine 2.5% and prilocaine 2.5%), applied to intact skin under occlusive dressing, provides dermal analgesia by the release of lidocaine and prilocaine from the cream into the epidermal and dermal layers of the skin and by the accumulation of lidocaine and prilocaine in the vicinity of dermal pain receptors and nerve endings.[36]
  • Dorsal Penile Nerve Block (DPNB) as proposed by Kirya & Werthman (1978).[37]
  • Ring Block. Broadman et al. (1987) proposed ring block for neonatal non-therapeutic circumcision.[38] Ring block is considered the most effective analgesic procedure for neonatal non-therapeutic circumcision. Infant boys feel less pain and suffer less trauma than with the other two pain reduction procedures.[9] [39]


However, none of the above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of those analgesic procedures. Prevention of pain requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary circumcision surgery experience no pain or trauma.


Wallerstein (1985)[40] and Van Howe & Cold (1998)[41] have suggested that it would be better to abandon the practice of non-therapeutic infant circumcision because of the pain associated with it.

The Daily Mail (2021) reported the pain stress of non-therapeutic neonatal circumcision increases the risk of SIDS, and that the incidence of Sudden Infant Death Syndrome (SIDS) is lower where baby boys are not circumcised.[42]

Einstellungen und Praktiken zur Analgesie bei der Neugeborenenbeschneidung

Historische Einstellungen und Praktiken

Wellington & Rieder (1993) conducted a survey of physicians in London, Ontario. They found that only 4 percent used DPNB. They concluded:

Despite evidence that neonates perceive pain and that there is a physiologic stress response to circumcision which can be reduced if analgesia is employed, the vast majority of physicians performing newborn circumcisions either do not employ analgesics or employ analgesics of questionable efficacy. Lack of familiarity with the use of analgesics among neonates and with dorsal penile block in particular are the most common reasons cited for lack of analgesic use. Educational efforts and research into less invasive techniques of analgesia for newborn circumcision are urgently required.[43]

Ryan & Finer (1994) carried out a training program for physicians in the newborn nurseries of the Womens' Pavilion, Royal Alexandra Hospital, Edmonton, Alberta, Canada. After a training program, they found that 66 percent of physicians who perform non-therapeutic neonatal circumcisions had started to use analgesia during the procedure. This applies to one hospital in Canada.[44] (Non-therapeutic neonatal circumcisions are no longer performed in most Canadian hospitals.)[45]

Maxwell & Yaster (1999) called on physicians to use analgesia during neonatal non-therapeutic circumcision surgery, saying:

DESPITE THE DEBATE that continues over the benefits and risks of nonritual neonatal circumcision, it remains a commonly performed surgical procedure in the United States. To the best of our knowledge, it is the only surgical procedure that is routinely performed without first administering analgesia or anesthesia. This unconscionable state of affairs exists, despite the overwhelming evidence that newborns, even those born prematurely, are capable of experiencing pain. Indeed, anyone present during a circumcision realizes that the newborn feels and responds to pain and will attempt to withdraw if unrestrained. In addition, this pain has physiologic correlates: elevated heart rate and blood pressure, lowered arterial oxygen saturation, and elevated levels of adrenocortical hormones. During the past 15 years, results of a multitude of studies have demonstrated that effective analgesia can prevent this pain and ameliorate the associated stress response. Furthermore, the failure to provide anesthesia or analgesia has been shown to cause not only short-term physiologic perturbations but also longer-term behavioral changes.[46]

The American Academy of Pediatrics convened a new task force on circumcision under the chair of Carole M. Lannon, M. D. That task force reversed the position previously taken under Edgar J. Schoen. It clearly stated that non-therapeutic infant circumcision is "not essential to the child’s current well-being." It provided an extensive discussion of procedural analgesia and said, quite strongly, that, if a circumcision is done, procedural analgesia should be provided.[47]

Kraft (2003) reported that "many health care practitioners routinely perform this procedure without the use of any or with inadequate or ineffective analgesia and anesthesia."[48]

Zeitgenössische Einstellungen und Praktiken

Little is known about current attitudes and practices regarding the use of analgesia in circumcision of the newborn. Application of analgesia prior to neonatal nontherapeutic circumcision takes additional physician time, so there may be a tendency to skip it.

Pflegestandard

It is now clear that boys are born with healthy foreskins without evidence of disease. Therefore there are no indications for infant circumcision, which is a non-therapeutic and medically-unnecessary surgical operation.[49] [50] [51] Circumcision excises the highly functional foreskin, which provides numerous protective, immunological, sensory, and sexual functions,[52] so it is an irreversible, lasting injury. Non-therapeutic circumcision of male minors is not the standard of care.

Nevertheless, some non-therapeutic circumcisions of boys will continue to be performed for religious reasons, ethnic reasons, and the emotional needs of parents. When a circumcision is to be performed, the standard of care requires that analgesia be provided to reduce the extreme level of pain and trauma.[31] [49] [9] [47] (Total anesthesia cannot be used with infants.)

Videos

Verfahren der Säuglingsbeschneidung

This is a video of an actual infant circumcision. It has a sound tract so one can hear the comments of the doctor and the sounds made by the infant. The doctor gives an injection of local anesthetic that apparently does not stop any pain at all. The infant goes silent at about 6:15 on the video, so he may have gone into shock at that time. Not for the squeamish:

Here is an infant circumcision video of an Islamic circumcision from the Russian Federation. The surgical technique is different but the pain is no less:

Ronald Goldman

Ronald Goldman discussed pain and trauma in a video by Brendon Marotta:

Jugendlichen- und Erwachsenenbeschneidung

Adolescent and adult circumcision is usually carried out under total anesthesia, either by local or regional nerve block or by general anesthesia,[53] so the pain of the surgery is not usually a concern. That does not mean that the operation is pain free. It is not.

  • There is, of course, post-surgical pain, which may be relieved by a potent oral analgesic. One should have a two-week supply of analgesic medicine.
  • The recovery period for adolescent and adult circumcision is usually placed at six weeks. During that period of time, many patients experience pain when they they have involuntary nocturnal erections and the erection tightens the residual skin and pulls at the incision and suture.[54] In a few cases, the erections may cause wound dehiscence which requires additional surgery to re-close the surgical wound.
  • That is not the only source of pain. Circumcision amputates the protective foreskin. In cases of phimosis, the glans penis may never have been exposed before, so there frequently is severe pain when the glans penis touches anything. Many men complain that they are unable to wear trousers for an extended period of time. Only time and keratinization can ease this pain.
  • Circumcision is inexact surgery. Surgeons have to guess at how much skin to amputate, so they frequently get it wrong. If sufficient skin is not available to permit penis expansion during times of erection, then taut, painful erections are the result. This complication may be treated by tissue expansion. The tension may also cause wound dehiscence, which would cause additional pain.
  • Neuromas may form at the circumcision scar. Cold & Taylor (1999) reported that they are "notorious for generating pain.".[55]

Siehe auch

Weblinks

  • REFweb Hill, George (11. September 2006). Pain of circumcision and pain control, Circumcision Reference Library. Abgerufen 8. November 2020.
    Zitat: Circumcision is the most stressful surgical procedure commonly performed on newborns.
  • REFweb Tinari, Paul D. (2008). MRI Studies: The Brain Permanently Altered From Infant Circumcision, Peaceful Parenting. Abgerufen 22. Oktober 2021.
    Zitat: A neurologist who saw the results to postulated that the data indicated that circumcision affected most intensely the portions of the victim's brain associated with reasoning, perception and emotions. Follow up tests on the infant one day, one week and one month after the surgery indicated that the child's brain never returned to its baseline configuration. In other words, the evidence generated by this research indicated that the brain of the circumcised infant was permanently changed by the surgery.

Einzelnachweise

  1. ↑ REFdocument Bollinger, Dan / Georganne Chapin: Child Genital Cutting as an Adverse Childhood Experience [Genitalbeschneidung bei Kindern als negative Kindheitserfahrung] (Englisch) PDF, Intact America (Tarrytown, New York, USA). (1. August 2019). Abgerufen 30. Juni 2021.
  2. ↑ REFjournal Ostwald, Peter F., Peltzman, Philip. The cry of the human infant [Der Schrei des menschlichen Säuglings] (Englisch). Scientific American. März 1974; 230(3): 84-90. PMID. DOI. Abgerufen am 21. Juni 2021.
  3. ↑ REFjournal Deibart GA. The separation of the prepuce in the human penis [Die Trennung der Vorhaut im menschlichen Penis] (Englisch). Anat Rec. 1933; 57: 387-99. DOI. Abgerufen am 8. November 2020.
  4. ↑ REFjournal Oliver JE. Circumcision and cruelty to children [Beschneidung und Grausamkeit gegenüber Kindern] (Englisch). Br Med J. 1979; 2(6195): 933. PMID. PMC. DOI. Abgerufen am 8. November 2020.
    Zitat: Ohne Betäubung verursacht die Operation bei Babys Schmerzen, intensives und anhaltendes Schreien, Luftschlucken, Erbrechen, manchmal gefolgt von Apnoe, und manchmal dauerhafte lokale Komplikationen.
  5. ↑ REFjournal Falliers. Circumcision. JAMA. 21. Dezember 1970; 214(12): 2194. Abgerufen am 8. November 2020.
  6. ↑ REFjournal Winkelmann RK. The cutaneous innervation of the human newborn prepuce [Die kutane Innervation der menschlichen neugeborenen Vorhaut] (Englisch). J Invest Dermatol. Januar 1956; 26(1): 53-67. Abgerufen am 8. November 2020.
  7. ↑ REFjournal Fleiss PM, Hodges FM, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Infect. Oktober 1998; 74(5): 364-67. PMID. PMC. DOI. Abgerufen am 14. Januar 2022.
  8. ↑ REFjournal Circumcision procedure (Gomco Clamp method) [Beschneidungsverfahren (Gomco-Klemme-Methode)] (Englisch). Patient Care. 15. März 1978; 12: 82-85. Abgerufen am 8. November 2020.
  9. ↑ a b c d e f REFjournal Lander J, Brady-Frerer B, Metcalfe JB, Nazerali S, Muttit S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA. 24. Dezember 1997; 278(24): 2157-64. PMID. Abgerufen am 10. November 2020.
  10. ↑ REFjournal Bellieni, Carlo V., Alagna, Maria G., Buonocore, Giuseppe. Analgesia for infants’ circumcision. Ital J Pediatr. 13. Juni 2013; 39: 39. PMID. PMC. DOI. Abgerufen am 29. Mai 2021.
  11. ↑ REFjournal Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics. April 1994; 93(4): 641-6. PMID. Abgerufen am 9. November 2020.
  12. ↑ REFbook van der Kolk B (2014): The Body Keeps the Score. S. 76. ISBN 978-0-14-312774-1. Abgerufen 10. August 2021.
  13. ↑ REFjournal Hepper PG. Fetal memory: Does it exist? What does it do?. Acta Pædiatrica Supplement (Stockholm). Oktober 1996; 416: 16-20. PMID. DOI. Abgerufen am 11. November 2020.
  14. ↑ a b REFjournal Anand KJS, Hickey PR, et al. Pain and its effects in the human neonate and fetus. N Engl J Med. 19. November 1987; 317(21): 1321-9. PMID. DOI. Abgerufen am 11. November 2020.
  15. ↑ REFjournal Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol. 2002; 7(3): 329-43. PMID. DOI. Abgerufen am 11. November 2020.
  16. ↑ REFjournal Taddio A, Goldbach M, Ipp M, Stevens S, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995; 344: 291-2. PMID. DOI. Abgerufen am 10. November 2020.
  17. ↑ a b REFjournal Taddio A, Katz J, Ilersich AL, Gideon K. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1. März 1997; 342(9052): 599-603. PMID. DOI. Abgerufen am 11. November 2020.
  18. ↑ REFjournal Rhinehart J. Neonatal circumcision reconsidered. Tranactional Analysis Journal. Juli 1999; 29(3): 215-21. Abgerufen am 11. November 2020.
  19. ↑ REFjournal Anand KJS, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior?. Biol Neonate. Februar 2000; 77(2): 69-82. PMID. DOI. Abgerufen am 9. August 2021.
  20. ↑ REFbook Fitzgerald M, Walker S (2003): The role of activity in developing pain pathways. Arbeit: Proceedings of the 10th World Congress on Pain. Dostovsky JO, Carr DB, Koltzenburg M (eds) (Hrsg.). Bd. 24. S. 185-96. Seattle: ASP Press. Zitat: In common with other areas of the central nervous system, synaptic development of spinal sensory connections is experience or activity dependent. Evidence from both animal and human studies shows that alterations in the patterns of sensory activity that can arise from tissue injury and pain in early life may disrupt normal synaptic organization within the somatosensory system. While these studies are incomplete and more investigation is needed in this area, the potential clinical importance of neonatal plasticity in pain development is clear.. Abgerufen 18. November 2020.
  21. ↑ REFjournal Cope DK. Neonatal pain: the evolution of an idea.. The American Association of Anesthesiologists Newsletter. September 1998; Abgerufen am 12. November 2020.
  22. ↑ a b c d REFjournal Van Howe RS, Svoboda JS. Neonatal pain relief and the Helsinki Declaration. Journal of Law, Medicine, and Ethics. Dezember 2008; 36(4): 803-23. PMID. DOI. Abgerufen am 31. Oktober 2021.
  23. ↑ REFjournal Anders TF, Sachar EJ, Kream J, Roffwarg HP, Hellman L. Behavioral state and plasma cortisol response in the human neonate. Pediatrics. Oktober 1970; 46(4): 532-7. PMID. Abgerufen am 13. November 2020.
  24. ↑ REFjournal Emde RN, Harmon RJ, Metcalf D, Koenig KL, Wagonfeld S. Stress and neonatal sleep. Psychosom Med. 1971; 33(6): 491-7.
  25. ↑ REFjournal Richards MPM, Bernal JF, Brackbill Y. Early behavioral differences: gender or circumcision?. Dev Psychobiol. Januar 1976; 9(1): 89-95. PMID. Abgerufen am 13. November 2020.
  26. ↑ REFjournal Talbert LM, Kraybill EN, Potter HD. Adrenal cortical response to circumcision in the neonate.. Obstet Gynecol. August 1976; 46(2): 208-10. PMID. Abgerufen am 13. November 2020.
  27. ↑ REFjournal Rawlings DJ, Miller PA, Engel RR. The effect of circumcision on transcutaneous PO2 in term infants. Am J Dis Child. Juli 1980; 134(7): 676-8. PMID. DOI. Abgerufen am 13. November 2020.
  28. ↑ REFjournal Gunnar MR, Fisch RO, Korsvick S, Donhowe JM. The effects of circumcision on serum cortisol and behavior.. Psychoneuroendocrinology. 1981; 6(3): 260-75. PMID. DOI. Abgerufen am 13. November 2020.
  29. ↑ REFjournal Marshall RE, Porter FL, Rogers AG, Moore J, Anderson B, Boxerman SB. Circumcision: II: Effects upon mother-infant interaction. Early Hum Dev. 1982; 7(4): 367-74. PMID. DOI. Abgerufen am 14. November 2020.
  30. ↑ REFjournal Porter FL, Miller RH, Marshal RE. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. Child Dev. Juni 1986; 57(3): 790-802. PMID. DOI. Abgerufen am 15. November 2020.
  31. ↑ a b REFjournal Poland RL, Roberts RJ, Gutierrez-Mazorra JF, Fonkalsrud EW. Neonatal anesthesia. Pediatrics. September 1987; 80(3): 446. Abgerufen am 12. November 2020.
  32. ↑ REFjournal Gunnar M, Connors J, Isensee J, Wall L, et al. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol. Mai 1988; 21(4): 297-310. PMID. DOI. Abgerufen am 15. November 2020.
  33. ↑ REFjournal Schoen EJ, Anderson G, Bohon C, Hinman Jr F, Poland RL, Wakeman ME. Report of the Task Force of Circumcision. Pediatrics. Oktober 1989; 89(4): 388-91. PMID. Abgerufen am 18. November 2020.
  34. ↑ REFjournal Wallerstein E. Circumcision: the uniquely American medical enigma. Urol Clin North Am. 1985; 12(1): 123-32. PMID. Abgerufen am 15. November 2020.
  35. ↑ REFweb Bollinger, Dan (2012). High cost of circumcision Icons-mini-file acrobat.gif (PDF), Academia. Abgerufen 15. November 2020.
  36. ↑ REFweb (21. April 2020). EMLA, Drugs.com. Abgerufen 21. November 2020.
  37. ↑ REFjournal Kirya C, Werthman Jr MW. Neonatal circumcision and penile dorsal nerve block—a painless procedure.. J Pediatr. Juni 1978; 92(6): 998-1000. PMID. DOI. Abgerufen am 16. November 2020.
  38. ↑ REFjournal Broadman LM, Hannallah RS, Belman AB, Elder PT, Ruttiman U, Epstein BS. Post-circumcision analgesia—a prospective evaluation of subcutaneous ring block of the penis. Anesthesiology. 31. August 1987; 67(3): 399-402. PMID. DOI. Abgerufen am 18. November 2020.
  39. ↑ REFjournal Stang HJ, Snnellman LW, Condon LM, Conroy MM, Liebo R, Brodersen L, Gunnar MR. Beyond dorsal penile nerve block: A more humane circumcision. Pediatrics. August 1997; 100(2): e3. PMID. DOI. Abgerufen am 18. November 2020.
  40. ↑ REFjournal Wallerstein, Edward. Is non-religious circumcision necessary?. J Am Acad Child Psychiatr. Mai 1985; 24(3): 364-5. Abgerufen am 30. Juni 2021.
  41. ↑ REFjournal Van Howe RS, Cold CJ. Local Anesthesia For Infants Undergoing Circumcision. JAMA. 15. April 1998; 299(15): 1169-71. Abgerufen am 8. Juli 2021.
  42. ↑ REFnews Thompson, Alexandra (27. Juli 2021)."Circumcising newborn boys increases their risk of cot death due to the stress of the procedure - and could explain why it is more common in boys than girls, study finds", Daily Mail. Abgerufen 2. August 2021.
  43. ↑ REFjournal Wellington N, Rieder MJ. Attitudes and practices regarding analgesia for newborn circumcision. Pediatrics. Oktober 1993; 92(4): 541-3. PMID. Abgerufen am 18. November 2020.
  44. ↑ REFjournal Ryan CA, Finer NN. Changing attitudes and practices regarding local analgesia for newborn circumcision.. Pedatrics. August 1994; 94(2): 230-3. PMID. Abgerufen am 19. November 2020.
  45. ↑ James Loewen (2019). Personal communication.
  46. ↑ REFjournal Maxwell, Yaster. Analgesia for neonatal circumcisionː No more studies, just do tt. Arch Pediatr Adolesc Med. Mai 1999; 153(5): 444-5. PMID. DOI. Abgerufen am 21. November 2020.
  47. ↑ a b REFjournal Lannon, Carole M., et al. Circumcision policy statement. Pediatrics. März 1999; 103(3): 686-93. PMID. DOI. Abgerufen am 12. Juli 2021.
  48. ↑ REFjournal Kraft NL. A pictorial and video guide to circumcision without pain. Adv Neonatal Care. April 2003; 3(2): 50-62. PMID. DOI. Abgerufen am 18. November 2020.
  49. ↑ a b REFjournal Eugene, Outerbridge. Neonatal circumcision revisited. CMAJ. 15. März 1996; 154(6): 769-80. PMID. PMC. Abgerufen am 11. Juli 2021.
  50. ↑ REFdocument Circumcision of Infant Males PDF, Royal Australasian College of Physicians. (1. September 2010). Abgerufen 11. Juli 2021.
  51. ↑ REFdocument Non-therapeutic circumcision of male minors PDF, Royal Dutch Medical Association (KNMG). (27. Mai 2010). Abgerufen 11. Juli 2021.
  52. ↑ REFjournal Cold CJ, Taylor JR. The prepuce. BJU Int. Januar 1999; 83, Suppl. 1: 34-44. PMID. DOI. Abgerufen am 8. Juli 2021.
  53. ↑ REFjournal Holman, John R., Stuessi, Keith A.. Adult circumcision. American Family Physician. 15. März 1999; 59(6): 1514-8. PMID. Abgerufen am 19. November 2020.
  54. ↑ REFjournal Dai, A-Juan, Li, Miao, Wang, Li-Li, Wang, Xiao-Hua, Huang, Yu-Hua. Improvement of erection related incision pain in circumcision patients using interrupted rapid eye movement sleep: A randomized controlled study. Urol J. 2018; 15(3): 126-31. PMID. DOI. Abgerufen am 28. November 2020.
  55. ↑ REFjournal Cold CJ, Taylor JR. The prepuce. BJU Int. Januar 1999; 83, Suppl. 1: 34-44. PMID. DOI. Abgerufen am 8. Juli 2021.
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