Traditional circumcision gentler? (Associated Press)
Jewish Circumcision Gentler Because Of Tools Used
Connecticut Post 08/21/97
HARTFORD (AP) Mohels, the deft practitioners of the ancient Jewish rite of circumcision, appear to inflict less pain on their newborn subjects than most doctors do. And the secret could lie in the different tools they use, says a doctor at a Catholic hospital where the competing techniques were put to the test.
In a study involving 48 newborn boys, the clamp used by mohels was found to be much quicker to deploy and less painful than the one favored by most doctors. The boys circumcised with a Mogen, the clamp used by mohels, had less than half the heart rate increase and total crying time of infants circumcised with a Gomco, the device used by most doctors.
Oxygen levels were also higher in the Mogen infants, a sign they suffered less stress, said Dr. Hema N. DeSilva, director of neonatology at St. Francis Hospital and Medical Center, the study leader and a regular user of the mohel's tool of trade.
"With the Mogen clamp, half of them didn't cry at all. They were comfortable," DeSilva said.
"With the Gomco clamp they cried longer. They cried over 60 percent of the time."
Results of the study were published in last month's edition of the OB/GYN News and presented in May at the annual meeting of the Pediatric Academic Societies in Washington.
Dr. Thomas E. Wiswell, a professor of pediatrics at Thomas Jefferson University in Philadelphia and an expert on circumcision, said he found the report intriguing but warned that it was a relatively small study.
"It's one of those things where if there had been a lot more babies, there may have been a significant difference," said Wiswell, who has performed about 3,500 circumcisions, mostly with the Gomco. "Really, we need a lot more studies."
The findings were no surprise to Rabbi Yehuda Lebovics, a Los Angeles mohel who has performed more an 10,000 circumcisions
``Doctors are not as comfortable with the whole procedure. With a Mogen I can do it in 20 to 30 seconds.
The doctors take 3 to 5 minutes," he said.
Mohels, who typically do their work in the home, also are under added pressure to perform well, Lebovics said.
"A mohel is used to working with a grandmother breathing down his neck," he said, laughing.
"You are concerned, of course, for the baby, but you're also in front of a crowd. A surgeon couldn't handle that."
For Jews, the ritual circumcision symbolizes the entrance of a male child into the traditional covenant with God. It is performed on the eighth day after birth health permitting; the child's godfather usually holds the infant on his lap while the mohel works.
The circumcisions in the study were all conducted by doctors at the hospital between 18 hours and 48 hours after birth. The children revere held on a plastic table with a restraint by a nurse.
Anesthesia was given only in some cases, and the doctors concluded that infants should be anesthetized to reduce pain no matter which clamp is used.
[See The Wisdom of Using Sweet Wine.]
With the Gomco clamp, the doctor raises the foreskin over a steel belllike part of the apparatus, then applies pressure and the clamp before removing the device.
The procedure took an average of 3 1/2 minutes in the study.
The Mogen, which is a flat clamp, has no bell, so the mohel just has to situate and close the clamp to complete the procedure. That method took about 90 seconds.
The doctors did not know whether to attribute the babies' shorter crying time and lower stress level to the use of the Mogen itself, the fact that the Mogen requires less manipulation of the foreskin, or simply the brevity of the procedure.
Wiswell said he prefers the Gomco because he feels it gives him more control and because he believes it produces a more aesthetic appearance.
DeSilva, who has performed more than 5, 000 circumcisions, says the Mogen is just as safe and easier to apply and produces a good appearance.
The practice of circumcising newborn boys is controversial in itself.
While some doctors recommend circumcision to prevent urinary tract infections and penile cancer and to promote better overall hygiene, others believe the medical benefits are negligible.