In an infant, the prepuce is still attached to the glans, like a fingernail to a finger. Thus it is necessary to peel them apart before pulling the prepuce forward to cut it off. This peeling ("lysis" in the medical jargon) is the most painful part of a circumcision, according to medical studies that examined crying, oxygen levels, and stress hormone levels during the procedure.
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from the article: German court bars woman from circumcising 6-year-old son