Preparing for circumcision
Preparing for circumcisionFlash 90

Haaretz recently published an article titled, “We Gave a Brit Milah To Our First Born, Is It OK Not To Do It For Our Second?” The piece interviews two different anti-Brit Milah activists, Ronit Tamir and Rani Kasher, who attempt to make the case that even if one has performed the rite for a first child, it doesn’t mean you have to do it for subsequent children. I couldn’t disagree more, but let’s take it step by step.

Brit Milah is not an ear piercing. It’s not a mere adornment that one should flippantly decide to give or not give to our sons. One of the most fundamental reasons to continue the practice is history. The Jewish people have been giving their sons britot since the days of Avraham Avinu: 4,000 years of tradition is nothing to scoff at. But as we all know, ours has not been an easy road. We have faced challenges to our religious freedom throughout the centuries. Many Jews have died to keep the tradition of Brit Milah alive. To stop now would be like desecrating their graves.

One of the largest concerns parents have with Brit Milah is safety. When it comes to risks associated with the procedure, statistics show that complications occur at an astonishingly low rate.

Jenny H. Yiee and Laurence S. Baskin write in the medical journal, Up To Date:

“The rate of procedure-related complications during and after circumcision in the neonate is approximately 2 to 6 per 1000. This rate increases 20-fold for boys who are circumcised between one and nine years of age, and 10-fold for those circumcised after 10 years of age.”

Perhaps more important than the low frequency of complications is the rate at which the likelihood of such complications increases with age. Medical professionals agree that the safest time to perform a circumcision is as young as possible — that is, around eight days of age.

Like many other anti-circumcisionists, Rani Kasher would like people to wait for the child to make his own decision when he comes of age. The problem is, as statistics show, by delaying the procedure, parents have all but guaranteed that the child will have a significantly more complicated and painful experience — plus the fact that the child will surely remember the event.

Kasher claims that the United States began routine circumcision in order to stop children from masturbating by removing the most sensitive part of the organ. Both of these claims are false. According to the book, “Your Baby’s Secret World: Four Phases of Effective Parenting” page 31, the truth is that during World War I, many American soldiers spent weeks in the trenches, unable to shower for long periods of time. Many contracted infections that required circumcisions as the remedy. This led most Americans, correctly, to associate circumcision with hygiene, and then the practice proliferated.

The sensitivity of the foreskin is a matter of great debate. The anti-Brit Milah movement claims that there are 20,000 nerve endings in this tiny piece of skin. This piece of data is a major leap from a limited amount of information gathered in a study done by Henry C. Bazett in 1932. According to the study in Archives of Neurology and Psychiatry, Bazett counted 212 nerve endings of all types in a single square centimeter. Only 2 of the 212 nerve endings were fine-touch receptors and none were genital corpuscles, the ones that most experts attribute to erogenous sensation.

The anti-circumcisionists just took the number Bazett found, measured the area of the skin which is generally removed in the procedure and multiplied. But there have been no studies done to measure the actual number or type of nerve endings that exist in the region.

What has been proven is that removal of the foreskin does have medical benefits; the list is not a short one. However, most of the benefits are not realized until later in life. Circumcision reduces the chances of contracting STDs, such as syphilis and AIDS. It even reduces the chances of both penile cancer and for cervical cancer for female partners.

However, some of the benefits of the procedure are immediate and have great utility. Anti-circumcisionists make light of the fact that circumcision reduces Urinary Tract Infections in the first year of life. But the leading cause of Sepsis, a disease which claims the life of almost 7,000 babies a year in the United States alone, are UTIs.

There is no doubt that an eight-day-old baby experiences pain. It’s an uncomfortable reality of Brit Milah. But the question is, how much pain is experienced? The claim in the Haartez article that one of the steps in the procedure is like having one’s nails ripped out is a gross exaggeration. When separating the foreskin from the glans, the probe used is not separating attached skin. In fact, the process the child undergoes would happen naturally with his first erection. But it is clear that this discomfort is momentary and mild in nature because as soon as the step is completed, 99% of the children stop crying immediately. If it was true that the level of pain was akin to tearing out a fingernail, the crying would last much longer.

As a mohel, I take pain management very seriously. A few years ago I met with the late Rav Moshe Tendler, zt”l, who instructed me that it’s our halakhic responsibility to reduce the pain to the best of our ability. The question is, what is the best way to do this?

There are those who claim that a full nerve block is the best technique because the baby doesn’t cry at all during the procedure. But, as a colleague of mine put it best, when it comes to Novocaine shots, “How much pain do you want to get to no pain?” The shots themselves are far from painless and administering them lasts longer than the Bris itself.

The best management to date is applying Lidocaine cream and giving Novimol before the event and sugar water (just as they receive when getting vaccinated) during the procedure. It is evident that this protocol is fully effective because just after the post procedural feeding, the baby is usually quietly sleeping. Parents tend to report that there isn’t usually a need for more than one additional dose of Novimol during the 24 hours following the Bris.

The bigger question is, why do we have to hurt our newborns at all? No one wants to have to do this. But it’s clear that something larger is going on here. If we focus just on the baby at the moment of the cut, no one would ever give his son a Bris. Who wants to hurt a baby? But When we zoom out and look at how important Brit Milah has been to the Jewish people, that it’s kept us a nation for thousands of years, the momentary pain experienced seems a small price to pay.

A constant theme throughout the Haaretz piece is that mohalim arrived at a home, cut the child, and were never heard of again. I’d like to take this opportunity to apologize for my colleagues' behavior. It’s not supposed to be this way.

We rabbis and mohalim are meant to be the nurturers of our tradition. We’re obligated to explain the meaning behind our rituals and support our community members through challenging times. There are many religious leaders, myself included, who dedicate their lives to providing the best our religion can offer. I implore readers not to take such anecdotes as the norm. The future of the Jewish people depends on it.

Rabbi Hayim Leiter, Certified 'Mohel', Founder of 'Magen HaBrit'