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No adverse psychological aftermath has been demonstrated . A longitudinal study in the UK , beginning in 1946, involving over 5,000 individuals followed from birth to age 27 found no difference in developmental and behavioural indices between circumcised and uncircumcised males . Long-term psychological, emotional, and sexual impediments from circumcision are anecdotal [234, 386] and can be discounted. It must be recognized that there are many painful experiences encountered by the child before, during and after birth . Circumcision, if performed without anaesthetic is one of these. Cortisol levels, heart rate and respiration have registered an increase during and shortly after the procedure [347, 349], indicating that the baby is not unaware of having had something painful done in instances when circumcision has been carried out without anesthesia. It is therefore generally advised that local anesthetic be used for all circumcisions on infants (more on anesthesia later). The response is variable and, even without anesthetic, some babies show no signs of distress at all. Most do, however, and this may be contributed by the restraining procedure, as well as the surgery itself. In the past doctors and parents had to weigh up the need to inflict this short-term pain in the context of a lifetime of gain from prevention or reduction of subsequent problems. Use of anesthetic for circumcision makes it virtually pain-free.