Up until the 1980's, most circumcisions were done within a week of the baby's birth without any pain relief. The traditional Jewish 'bris' is always performed without pain relief. Prior to the use of analgesia, it was thought that babies could not 'feel pain'. We now know that babies experience pain (as adults do) from as early as 20 weeks of the pregnancy when inside their mother's womb. Some recent research also suggests that newborns can experience pain memory.
The pain of a circumcision is felt (if no anaesthetic is used) and babies have been observed to experience behavioural changes due to pain and discomfort in the hours and days after the procedure, as the circumcision heals.
These days, various anaesthetic techniques can be used to perform a routine (non-religious) circumcision. The method used will depend on the age of the baby, the preferences of the surgeon (and anaesthetist if they are participating) and sometimes the type of surgical method used to remove the foreskin.
The types of analgesia that can be used include:
Local anaesthetic gel or cream
Local anaesthetic injections
General anaesthetic
Local anaesthetic gel or cream. This method is more commonly used in newborn babies under 6 months of age and babies born premature. (It would not be appropriate for an older child or an adult). The most commonly used local anaesthetic cream is called EMLA cream. The cream or gel needs to be applied to the baby's foreskin for 60 to 90 minutes before the circumcision, for it to provide adequate pain relief. The gel is said to reduce the pain to a degree, but does not totally eliminate it.
EMLA cream can cause local irritation of the skin for some babies (making their skin look white or reddened) and sometimes blister will form on the skin. There is also a concern that large and repeated does of EMLA (and the use of EMLA on very small premature babies) can possibly lead to a very rare complication called 'methemoglobinaemia'.