Should baby boys be circumcised?
Airdate: 
Tuesday, October 2, 2012 - 20:30

Male circumcision is far less popular in Australia than it used to be.

But there’s a small but vocal movement of doctors and medical researchers calling for it to be routinely offered for health reasons, including hygiene and to prevent sexually transmitted infections .

They’ve been bolstered by a new policy statement from the American Academy of Pediatrics which recently reviewed more than a thousand studies and concluded that the 'preventative health benefits of elective circumcision of male newborns outweigh the risks".

It’s not just health that’s a factor in the decision making. Male circumcision still plays a religious role in Australia’s Jewish and Muslim communities and is a traditional cultural practice for some people from Indigenous, African, Middle Eastern and Islander backgrounds. And for some, it's just the way it's always been done.

And if you decide you want a circumcision for your child, there are hurdles: in some parts of Australia it’s virtually impossible to find doctors who will perform the procedure. And no one seems to be able to agree on what’s the best age.

This week on Insight: does the medical evidence stack up? Is it ok to undergo surgery for non-health reasons? And who should have the right to make the decision to snip?

Producer: Jane Worthington
Associate Producer: Hannah Meagher

 

Web Extra: For and against circumcision

The major health benefits that may result from circumcision are:

- Recurrent Urinary Tract Infections (UTIs)
- Penile and prostate cancer
- Cancer of the cervix / HPV (Human papillomavirus)
- HIV and other sexually transmitted diseases

However, the jury is still out as to whether circumcision is significantly beneficial.

For circumcision  Against circumcision
Studies have shown that circumcision reduces the risk of Urinary Tract Infections by ten-fold.
Urinary tract infections are rare in young boys (occurring in approximately 2 per cent of boys under 7 years of age) and can generally be treated with antibiotics.

Stan Wisniewski, former head of the Urological Society of Australia and New Zealand argues that the studies that show a greater susceptibility of uncircumcised boys to UTIs are flawed as they fail to take into account other vital factors that also contribute to the development of UTIs in young boys.

Studies have shown there is over twenty-fold decrease in the risk of invasive penile cancer.

Cancer of the penis is extremely rare with an incidence of 1 in 250,000 Australian men. The rarity of penile cancer, combined with the lack of randomised controlled trial evidence suggests circumcision is not justified for the sole purpose of protecting against penile cancer.

 

There are studies that provide fair evidence that male circumcision protects against HPV which causes genital warts and cervical cancer in women.
Australia has a population-based HPV immunisation program.

In November 2011, the Pharmaceutical Benefits Advisory Committee recommended that boys be added to the National HPV Vaccination Program.


In 2007, WHO/UNAIDS recommended male circumcision as an HIV-preventative measure based on three large, widely acclaimed sub-Saharan African randomised clinical trials into female-to-male sexual transmission that showed an average 60 per cent reduction in HIV infections amongst circumcised heterosexual males.
Critics have pointed out that:

-    The “60 per cent” figure refers only to a 'relative reduction'. Absolute reduction in HIV transmission was only 1.3 per cent.

-    The trials were carried out in Africa, amongst heterosexuals. A 2011 Cochrane review states further research is needed to determine whether the benefits are applicable and cost effective in other countries.

-    Factors such as whether there is repeat exposure to the virus or whether there is proper condom use when exposed will have greater significance than a man’s circumcision status in whether HIV will be transmitted.

 
A systematic review of meta-analysis of 26 research studies found circumcised men to have a reduced risk of syphilis and a lower association rate with genital herpes and chancroid.


These studies were performed principally in African countries (20/26 studies) and among men at a higher risk of STI (16/26).

There has been conflicting evidence regarding the association between circumcision and STIs.

There are studies that have been done in Australia, the US and Britain that found circumcisions did not confer significant protective benefit against STI/HIV infection.

Also, why not wear a condom?



-    Eliminates the risk of phimosis, which affects one in ten older men and boys.

Phimosis is a tight foreskin that cannot be pulled back fully, making cleaning and passing urine difficult, and erections painful.

 
The Tasmanian Law Reform Institute’s August 2012 review of male circumcision noted that it is "important to put circumcision’s prophylactic effect into a meaningful context.

"The world’s leading health policy organisations have cautioned against attributing too much significance to circumcision’s prophylactic effect for those who reside in the developed world.

"They stress that circumcision’s prophylactic effect is generally most established for ailments that are relatively minor and treatable (like most UTIs) or rare in Australia (like penile cancer, or female to male heterosexually transmitted HIV)".

Transcript

JENNY BROCKIE:  Hi, I'm Jenny Brockie. Let's start tonight with talking about why people are getting male children circumcised. Sabina, you just had your new baby Jake circumcised - why?

SABINA MCDONALD:  Yes.  For me it was about keeping up with the family tradition. We've had everyone circumcised from generations and generations. And it's something that I don't even think about. It's something that had to happen. And it's something that we've discussed before we got married and it's something out of respect to my family.

 

JENNY BROCKIE:  You're Jewish?

 

SABINA MCDONALD:  Yes I am Jewish.

 

JENNY BROCKIE:  How old was Jake?

 

 

SABINA MCDONALD:  Jack was eight days old. It happened on the eighth day.

 

 

JENNY BROCKIE:  Ben, now you are not Jewish.

 

 

BEN MCDONALD:  No, that’s right.

 

 

JENNY BROCKIE:  How did you fell about Jake being circumcised?

 

 

BEN MCDONALD:  I was done too but I was done later on because I had complications, eight or nine years old. I got infections and things like that. I probably maybe would have felt a bit different about it if maybe I wasn't done.

 

 

JENNY BROCKIE:  Hershel, you’re actually the moil who performed Jake's Briss. It’s called a Briss.

 

 

DR. HERSHEL GOLDMAN:  Yes, that’s right.

 

 

JENNY BROCKIE:   Briss Milah, is that right?

 

 

DR. HERSHEL GOLDMAN:  Briss Milah.

 

 

JENNY BROCKIE:   Briss Milah which is the circumcision ceremony, isn’t it?  The whole thing.

 

 

DR. HERSHEL GOLDMAN:  A Briss for a Jewish person is more than just a circumcision, there's a ceremony. The word Briss or Brit if you are speaking Ivrit, which is the Hebrew way - means a covenant and it's the expression of the Jewish people's connection to God. So obviously we're talking something which is spiritual and something which is a belief system. In other cultures, it might be done later on when people come to manhood when they're 13 or 20 or something as part of initiation or it is part of their manhood ritual. In Judaism it was always done at eight days as part of the covenant. It was specifically meant to be done as part of a covenant when a baby is not a party to it.

 

 

JENNY BROCKIE:   Tell us what you actually did? How do you actually perform?

 

 

DR. HERSHEL GOLDMAN:  The actual operation of circumcision? The technical side, it's very, the instrument I use is talked about I think in about the 600s already.

 

 

JENNY BROCKIE:  What do you do though?

 

 

DR. HERSHEL GOLDMAN:   Well, shall I show you the instrument?

 

 

JENNY BROCKIE:  Yeah.

 

 

DR. HERSHEL GOLDMAN:  The instrument of a circumcision is that. That's just basically a little, basically a little thing with a line in it and the foreskin is pulled up through the skin. I hope I'm not getting too technical. And the bits that don't want are on top. The bits you want are on the bottom and - it comes away. It is just a quick cut….

 

 

JENNY BROCKIE:  So you cut it away?

 

 

DR. HERSHEL GOLDMAN:  Yes.

 

 

JENNY BROCKIE:  How long does that take?

 

 

DR. HERSHEL GOLDMAN:  From starting to annoy the baby til you have the bandage on - about 15 seconds, if that.

 

 

JENNY BROCKIE:  Is it painful for the baby?

 

 

DR. HERSHEL GOLDMAN:  Um, it can be done with anaesthetics. So the answer is it's probably uncomfortable for the baby but doesn't have to be painful.

 

 

JENNY BROCKIE:  Did you watch this?

 

 

BEN MCDONALD:  In our case, we had, I took the anaesthetic option for baby Jake. And everybody - all the men who were there as part of the sort of ceremony, originally they were holding, clenching.

 

 

JENNY BROCKIE:  Crossing their legs.

 

 

BEN MCDONALD:  And the next thing it was over. And they go, "That was the most peaceful circumcision they've ever been to." Because we are always waiting for the screams, but there is no scream.

 

JENNY BROCKIE:  Terry Russell, you are a GP and you've performed more than 35,000 circumcisions. Is this right?

 

DR TERRY RUSSELL:  Yes, Jenny.

JENNY BROCKIE:  Let's look at one you did this week.

 

MAGNUS’S STORY:

 

NANETTE:   My name is Nanette and my baby is called Magnus. Magnus has just turned four weeks. I pretty much just applied an topical anaesthetic cream and wrapped it in Glad Wrap, and what that does is it just  numbs the area for the baby prior to procedure. 

 

DR TERRY RUSSELL:  I do the circumcision with a PlastiBell device. The way it works is that ring fits inside the foreskin and then it's clamped around the outside with string. The first step in this procedure is to put two clips on the end of the foreskin and separate off the foreskin from the head of the penis. Once we've separated that off and stretched the foreskin up a little, it's normal then to do a snip down the mid line of the foreskin.. The foreskin gets snipped to open it up to fit in the plastic valve.

 

That's better.

 

It is normal practice once the circulation's cut off to trim off most of the surplus foreskin because otherwise it's more likely to get infected.

 

NANETTE:   I'm glad it's over and done with. You still get a bit nervous with this procedure.

 

 

JENNY BROCKIE:  Terry, we spared everyone the close-ups there while the baby was crying of what you were actually doing. How does the PlastiBell work? You have one here to show us. Explain to us how it works?

 

 

DR TERRY RUSSELL:  Okay, the way it works is that, that ring fits inside the foreskin and then it's clamped around the outside with string. The head of the penis sits there and the baby wees out through that hole. You can ignore the handle. That's simply for ease of insertion. That just cracks off once it's in place. Now, the PlastiBell cuts off the circulation so that it can't bleed.

 

 

JENNY BROCKIE:  What about being in pain, though? How much pain would that child be in?

 

 

DR TERRY RUSSELL:  I would say zero, Jenny, because he wasn't reacting to what I was doing.

 

 

JENNY BROCKIE:  How did you know that?

 

 

DR TERRY RUSSELL:  If you put a clamp on and he doesn't flinch, stands to reason.

 

 

JENNY BROCKIE:  Stan, you're shaking your head, not looking happy with these descriptions?

 

 

DR STAN WISNIEWSKI, UROLOGICAL SURGEON:  Obviously that child was enjoying the procedure, wasn't he? I mean heavens above. In all young boys born, the glans of the penis and the foreskin – the prepuce - is cemented together with adhesions. To perform a circumcision in a neonate, you've got to cut in there, break down all the adhesions and rip them apart from the glands, then you've got to start installing whatever device you're going to use to do the procedure.

 

DR TERRY RUSSELL:  There is no cutting or tearing involved.

 

DR STAN WISNIEWSKI:  We are all born with foreskins. What have we done in our civilisation to demean the foreskin that it needs attention of people who make their livelihood from removing it? There's an insensibility about the fact people are using false science to declare they have got something to offer the patient, the child, and there has been not one study in the world that has ever shown circumcision to have a public health benefit.

 

JENNY BROCKIE:  Ben Fleming, you have a 9-month-old son and you're still deciding whether or not to circumcise him. Which way do you think you'll go?

 

 

BEN FLEMING:  Still don't know.

 

 

JENNY BROCKIE:  I can see you watching this with keen interest. What sort of things are you weighing up?

 

 

BEN FLEMING:  Look, there's a family history. I was circumcised. That has a bit of influence on things.

 

 

JENNY BROCKIE:  Why does it have influence?

 

 

BEN FLEMING:  The sameness argument, I guess you would call it.

 

 

JENNY BROCKIE:  Of looking the same?

 

 

BEN FLEMING:  Yeah.  But then the opposite side of that is, and watching a procedure there, I don't know whether that baby was in pain or not, but it really kicks those emotions of a father trying to protect your child from any sort of pain. That argument in my mind is what I went through, was it justification, or what I'm seeing there – I’m not sure.

 

 

JENNY BROCKIE:  How does your wife feel?

 

 

PIP FLEMING:   Exactly the same.

 

 

JENNY BROCKIE:  You’re weighing it up as well.

 

 

PIP FLEMING:   Trying to weigh it up. As a mother, you look at that and want to protect your child from that pain. There's that factor. The other side, it's what my family has always done. So there's that part of your culture – is it a culture?

 

 

JENNY BROCKIE:  Yeah. In one era, it was very fashionable to do and now it's much less so.

 

 

PIP FLEMING:   Is that justification to do something that may hurt a child. We're undecided.

 

 

JENNY BROCKIE:  Nadneem, you have an Indian Muslim background. What's the significance of circumcision in your culture?

 

 

NADEEM MERCHANT:  From my point of view it's not really compulsory, it's actually highly recommended.

 

 

JENNY BROCKIE:  Why is it highly recommended?

 

 

NADEEM MERCHANT:  Why?  It has got scientific reasons. I know there are people in here who won't agree, but there are scientific reasons. Other reasons are also a person who is actually circumcised enjoys a sexual life more than a person who is not circumcised.

 

 

JENNY BROCKIE:  Does anyone else want to comment on that, while we are on that subject? Preferably men, actually.

 

 

NATHAN:  How can you tell the difference? Have you gone from one, gone to the other and compared it?

 

 

BEN FLEMING:  From what I know, it reduces sensitivity. If anything, the girl is going to like it more because you might be able to last a bit longer.

 

 

JENNY BROCKIE:  OK. Ozgur, I wanted to talk to you because your son Veli was circumcised when he was four years old - why?

 

 

OZGUR BICER:  We had medical reasons. He had an infection around the penis.

 

 

JENNY BROCKIE:  Now you have a Turkish background?

 

 

OZGUR BICER:  I have a Turkish background and it's in our culture as well, like many of the Middle Eastern. It is in our culture. We've actually spoken with our son and told him and said that your father, your grandfather and all them - they were all circumcised. He understood what he was getting himself in to.

 

 

JENNY BROCKIE:   Did you have to coax him in to it?

 

 

OZGUR BICER:  Absolutely not, look the thing with us, after the circumcision we have this great big party. We dress him like the sultan or the Prince, we call our friends around. There's a photo up there already.

 

 

JENNY BROCKIE:  Which one is he?

 

 

OZGUR BICER:  The one on the right. We got our nephew done at the same time as well. They were sort of war buddies and supporting each other.

 

 

JENNY BROCKIE:  What did he think about it when it happened?

 

 

OZGUR BICER:  He got it done at the hospital. The nurses, the doctors were absolutely fantastic. They knocked them out and before theatre my wife went in with him and made sure he was OK.

 

 

JENNY BROCKIE:  If he hadn't had those infections, you think you still would have done it anyway?

 

 

OZGUR BICER:  Absolutely, if your kids are not circumcised within the Turkish community and I can only speak for the Turkish community, they may be outcast as well.

 

 

JENNY BROCKIE:  How big was the party?

 

 

OZGUR BICER:  The party…. Look, we had about 70 people.

 

 

JENNY BROCKIE:  It's a big community thing.

 

 

OZGUR BICER:  We had a big jumping castle, kebabs and everything. It is more an ethnic thing, he felt comfortable and a lot of the, most of the ethnic people know that we pin money on the person. We celebrate he's actually gone to manhood.

 

 

JENNY BROCKIE:  Did he complain about how much it hurt?

 

 

OZGUR BICER:  I don't think he was aware of it. I think he was knocked out before.

 

 

JENNY BROCKIE:  So he was completely knocked out?

 

 

OZGUR BICER:  We did tell them that, even before we came here, I asked him whether he liked it before or after? He actually said it looked better now and he felt better.

 

 

JENNY BROCKIE:  How old is he now?

 

 

OZGUR BICER:  He is six - he has just had his sixth birthday about three days ago.

 

 

JENNY BROCKIE:  Kevin, you're from a remote community in the Northern Territory. Do all the boys in your community get circumcised?

 

 

KEVIN ROGERS:  Yes they do.

 

 

JENNY BROCKIE:  They do. At what age?

 

 

KEVIN ROGERS:  At seven or eight. It's a tradition that we've had all along throughout our history. We use a professional person who is good at doing like this moil over here.

 

 

JENNY BROCKIE:  How do they do it, Kevin?

 

 

KEVIN ROGERS:  They do it the same way, like the old fella said there. Pull that thing out and bang.

 

 

JENNY BROCKIE:  Cut.

 

 

KEVIN ROGERS:  Cut. Bang. No worries.

 

 

JENNY BROCKIE:  Do the boys get anything to stop the pain?

 

 

KEVIN ROGERS:  We'll give them something - we give them a bit of rag to chew on. Some cry. Weaklings we call them. Weaklings. It's a tradition of becoming a man. You've got to stand the pain of becoming, it's part of our culture, that you become a man.

 

 

JENNY BROCKIE:  What would happen if you didn't get circumcised in your community?

 

 

KEVIN ROGERS:  We don't have that.

 

 

JENNY BROCKIE:  It doesn't happen?

 

 

KEVIN ROGERS:  No.

 

 

JENNY BROCKIE:  It's a long procedure leading up to it – you said about a month?

 

 

KEVIN ROGERS:  Yes and then everybody participates. We send them out to get other people from other tribes coming in. And everybody is getting together and performing our cultural happening. The parents have to cater for that and our families have to look after the dancers.

 

 

JENNY BROCKIE:  Do all Aboriginal communities practice circumcision?

 

 

KEVIN ROGERS:  Every tribal group have their own thing done. Everybody has their own song lines that they teach later, that becomes part of through their manhood going up to ceremonies and that enables them to understand and start showing respect.

 

 

JENNY BROCKIE:  OK, are there other reasons why people are getting young baby boys circumcised?

 

 

SHARON ORAPELENG:  For me, my son Xavier, we made that decision to circumcise him because we come from Botswana. Botswana is a country like many other African countries that are ravaged by HIV AIDS. There are studies and there is evidence that shows dramatic decrease in HIV infections for people who have been circumcised. To make that decision was very easy for us to do because it would reduce the risk of infection. We are obviously going to be teaching him other methods, other strategies to prevent infection from HIV.

 

 

JENNY BROCKIE:  I'm going to one of our international guests now – Andrew Freedman in Los Angeles, welcome. Good to have you with us. You've looked at a lot of international research on male circumcision. I wonder what have you found is the main reason that people do it?

 

DR ANDREW FREEDMAN, PAEDIATRIC UROLOGIST:  Well, I think what your audience has expressed there is a wide range of reasons we see in our daily practice. For many patients it's really a sense of a cultural connection, either religious connection or a broader sense of the word culture. They feel this has been what their family always does or this is what is commonly done in their nation of origin. There is certainly a large percentage of patients who feel that there is a health benefit.

To be fair, my involvement was with American Academy of Paediatrics and the task force that's developed new guidelines. We're not partisans in this circumcision debate. We really feel we're neutral evaluators of the medical literature to look specifically at medical risks and benefits without passing judgment on other non-medical decision-making that goes in to the circumcision decision.

 

 

JENNY BROCKIE:  Your organisation has just changed its view on circumcision, why – on male circumcision?

 

 

DR ANDREW FREEDMAN:  This has been a study process of revision since the '70s. It has been because of the new data related to HIV and protection from HIV acquisition in the specific setting of HIV negative male engaging in high-risk heterosexual behaviour. That information was compelling enough to make us go back and look at the data and see what's been new since the last statement. Our change really has been very incremental. I think that people saw our previous stance as neutral and people are seeing our stance as slightly positive.

I think to be fair, what our stance boils down to is that there are some public health benefits from circumcision as a newborn, although they're very modest. There are some risks, likewise, the risks are very modest. Overall, we feel the benefits outweigh the risk but not by enough that we are recommending circumcision for everyone.

 

 

JENNY BROCKIE:  George Williams, you're a paediatrician and you also run an anti-circumcision website. What do you think about this decision in America and what's been recommended and what's the situation here?

 

 

DR GEORGE WILLIAMS, PAEDIATRICIAN:   I'm disappointed. I thought the American position and the Australian College is a fence-sitting position. The Royal Dutch Medical Association say there's no medical indication for circumcision. We should curtail the practice and stop circumcising children. Why is it that the European countries don't promote circumcision like the Americans, the Australians and the Canadians?

 

 

JENNY BROCKIE:  You can ask that question both ways.

 

 

DR GEORGE WILLIAMS:   You are altering the body of another person. That person has a right to own that body.

 

 

KARL WILLIAMS:  The benefits outweigh the risks, George.

 

 

DR GEORGE WILLIAMS:  That's bullshit.

 

 

KARL WILLIAMS:  No, no that is not bullshit.

 

 

JENNY BROCKIE:  Andrew, can I get a response to you to that?

 

 

DR ANDREW FREEDMAN:  Yeah.  I think one of the things this discussion highlights is very easy to make your point depending on how you framed the data. There is a recognition that there is some benefit but it's a very modest benefit in the United States. The CBSE has estimated that the protective effect of circumcision in the US based on its current modes of HIV acquisition would only be about 15% life time risk over a very small life time risk.

 

And the same thing with penile cancer, we looked at this in very great detail in the technical report that accompanied the policy statement and it's true, if you have a foreskin, you have a higher risk of penile cancer. But it's a very rare cancer. I think the thing is you're never going to have a medical study that's going to be a knockout punch. There's never going to be one study that's so great that will say everybody should have it or nobody should have it.

Then it really comes down to how do you frame the ethical debate? That's a discussion we should be having. The paradigm that we adopted was that our overriding ethical concern is the best interests of the child. We recognise the circumcision crosses more paradigms than just medical paradigm. And so we feel the person who in the best decision to decide what's in the best interests of their child over that child's lifetime is not me, not the courts, it is the parent.

 

 

 

JENNY BROCKIE:  Tonight we're talking about male circumcision. I want to talk about risks now. A little bit more about the risks of doing it and of not doing it. Amanda, you told your Jewish husband Adrian that you wouldn't marry him if he wanted to circumcise your future children. Why were you so passionately against it when it was a part of his culture?

 

 

AMANDA LEEPER-KUBIK:   When I was in my late teens, I’d nannied for a short period of time and I    took care of a newborn baby that had been done. It was swollen and bruised and he screamed every time I touched his penis to change his nappy and that stayed with me. About a year or so after that I joined a couple of Human Rights groups and started to get involved with female genital mutilation and it started to click in my head, ‘hang on - what's going on here’. And I started to think it was actually very similar. And that it was a body of a future man and something has been taken away from him without his choice.

 

 

JENNY BROCKIE:  So, you see it as a real human rights issue?

 

 

AMANDA LEEPER-KUBIK:   Yes - a fundamental Human Rights issue.

 

 

JENNY BROCKIE:  You don't think a parent has the right to do that?

 

 

AMANDA LEEPER-KUBIK:   Not when it comes to genital autonomy, I think every child has the right to have their body intact until they reach the age of 18. Or whatever country they are of legal age to make that decision over their own body to share with whoever they fall in love with and what's their choice.

 

 

JENNY BROCKIE:  How did your husband feel about that clash between your ethical position on this and his cultural?

 

 

AMANDA LEEPER-KUBIK:   He was shocked at first. His first instinct was to think I felt something was wrong with him and he was a bit defensive.

 

JENNY BROCKIE:  Because he is circumcised?

 

AMANDA LEEPER-KUBIK:   Yes, yes and once he obviously knew my interests before then. And once I started over the next few weeks to show him information, that there's a high number of Jewish communities in the US which are involved in anti-circumcision and I showed him some information that's coming out of there. And he said he would go along with it.

 

JENNY BROCKIE:  OK, Tracey I want to bring you in at this point because you have your son Nathan here who was circumcised. Now what happened?

 

TRACEY:  Nathan was five weeks when he was circumcised so I was a young single mum who was struggling with the decision. The doctor that delivered him offered to circumcise him in the hospital. I knew I was having a boy and I went to great lengths to interview every man and some random strangers as to whether it was a good idea to have my son circumcised. I looked at things like my grandfather, brother and father were circumcised, my boyfriend was circumcised - most of the men I know are circumcised.

 

But the great trend at that time, 20 years ago, was to not circumcise boys. It was a new thing – you don’t do it anymore and I felt like I should do it because everyone else before me had done it. In the end it took me five weeks to decide to have him circumcised. I was referred to someone who proceeded to botch the circumcision. We went in to phase two of regret, trauma. Nathan ended up with stitches in his penis. The dressing that was supposed to stay on for a week fell off and the nappy, it's not a hygienic situation under a nappy. So then we had an infection. Antibiotics and some scarring for a short time. Nathan assures me everything is fine now.

 

JENNY BROCKIE:  Is everything OK now Nathan?

 

NATHAN:  As far as I know.

 

JENNY BROCKIE:  How do you feel hearing all this now Nathan?

 

NATHAN:  I have no problem. I don't remember the pain – I don’t remember anything. I don't know any different.

 

TRACEY:   Do you resent me taking away that human right to remove your foreskin?

 

NATHAN:   Why would I want somebody to go and cut something off me at this age? It would hurt 10 times more – like seriously.

 

TRACEY:  But are you missing it, do you want it back?

 

NATHAN:  How can you miss something you don't remember?

 

JENNY BROCKIE:  Terry, how often do complications happen with circumcisions?

 

DR TERRY RUSSELL:  Very, very rarely.

 

JENNY BROCKIE:  Have you ever had problems?

 

DR TERRY RUSSELL:  Not a proper botch job, no. Never, Jenny. I've never had a transfusion, never had a systemic infection, never lost a penis.

 

JENNY BROCKIE:  It's good you've never lost a penis I think.

 

DR TERRY RUSSELL:  It is.

 

JENNY BROCKIE:  People will be reassured to hear that.

 

 

DR TERRY RUSSELL:  If you listen to the anti-circumcision minority groups, you'd think that it would happen all the time but it's extremely rare.

 

 

JENNY BROCKIE:  Stan, you've performed circumcisions. How commonly do these sorts of things happen?

 

DR STAN WISNIEWSKI:  I'm an adult urologist so I see the tail end of young boys coming in to puberty who are now faced with problems. A boy in Western Australia has lost the glans penis – the tip of his penis and at the age of 24, he's trying to establish an identity and it's just a critical thing for him - an unnecessary operation that went bad.

 

 

JENNY BROCKIE:  Do you dispute that there can be any benefit in terms of hygiene or some of the things we've heard talked about tonight?

 

DR STAN WISNIEWSKI:  Jenny, the reality is it is education before removal. There are so many things that years ago… the first circumcision was done in the early 19th century were to stop boys masturbating and all the doctors got on board and it was going to cure everything. There is a vogue and we are going through a similar vogue now. And the circumcision industry is looking for parameters again to give it a profile.

 

 

JENNY BROCKIE:  Brian Morris in Melbourne, you're a passionate advocate for circumcision, are you part of this vogue, this desire to make it something that everybody does now?

 

PROFESSOR BRIAN MORRIS, MOLECULAR BIOLOGIST:   I'm a medical scientist.

 

JENNY BROCKIE:  You're a molecular biologist, is that right?

 

PROFESSOR BRIAN MORRIS:  I am and I got in to this area because I invented a new test for HPV, for screening women for cervical cancer because uncircumcised men increase the risk of cervical cancer in their female partners. From that early beginning in the 1980s, I was drawn in to this field and I can tell you that the benefits of circumcision start in infancy by protecting against urinary tract infections which are 10 times higher in uncircumcised boys. For that reason alone, circumcision is like a surgical vaccine. As they get older, they're protected against inflammatory conditions that affect 10% against Phimosis which causes painful and difficult erection as they get older and past puberty.

 

 

JENNY BROCKIE:  But Brian, we've already heard Andrew saying that the studies can be used this way and that way. You're being very absolute here and a lot of people listening at home are going to think, "What evidence do you have that is absolutely iron clad to suggest that these things are true?"

 

PROFESSOR BRIAN MORRIS:  The American Academy of Paediatric Statement considered evidence up until April 2010. They called for a risk benefit analysis. In fact, the Circumcision Foundation of Australia, consisting of prominent members of the Royal Australasian College of Physicians wrote its own policy statement and published it earlier this year. In that there is a risk benefit analysis where we listed all of the conditions that circumcision protects against and when we tallied them up, we showed that, in fact, over the lifetime, one in two males will suffer an adverse condition and of course many of them will die from some of those, such as HIV, penile cancer and possibly prostate cancer as well.

 

 

JENNY BROCKIE:  George, you're shaking your head listening to this - why?

 

 

DR GEORGE WILLIAMS:  This is scaremongering. If circumcision is that beneficial, the whole of China, the whole of India should be circumcised. These are large populations, we don’t see them circumcised. We don't see these diseases that Professor Morris talks about. They don't report these diseases. Do you understand?

 

 

DR TERRY RUSSELL:  George, China is rife with it.

 

 

JENNY BROCKIE:  Rife with what?

 

 

DR TERRY RUSSELL:  HIV.

 

 

MAN:   HIV. He's saying penile cancer.

 

JENNY BROCKIE:  Presumably not all the HIV in China can be attributed to uncircumcised penises? Can I ask Andrew this? Andrew has looked at the research as parts of his exercise. Andrew, do you agree with what Brian is saying?

 

 

DR ANDREW FREEDMAN:  Again, one of the problems is everything he said, you could find a paper or a scientific study that supports what he says. Unfortunately, what you'll find, you'll find conflicting reports and what we find is people who are very strong proponents will pull the papers that support them. People who are strong opponents will find the papers that support them. We try to give a more balanced view.

 

JENNY BROCKIE:  Andrew, what about the argument? You mentioned before about ethics. What about the argument of why would you interfere with a healthy male body when you don't need to at birth? Why do this procedure at all?

 

 

DR ANDREW FREEDMAN:  This is the discussion that I think will be most beneficial for our society. Parents make decisions that greatly affect their child in many ways throughout their lifetime. The question is why does there have to be a single answer?

 

JENNY BROCKIE:  I want to talk a bit more about the risks of not being circumcised. Alison, you've wanted your son Ethan circumcised now since he was born, really, six years ago, why?

 

 

ALISON SCOTT:  We can't. We're told at the time, we were told we were bad parents for wanting to.

 

JENNY BROCKIE:  Where was this, in Tasmania?

 

 

ALISON SCOTT:  In Davenport - Tasmania.  I made a submission because they're claiming that Tasmanian parents are choosing not to circumcise. We can't get a doctor in Tasmania to circumcise.

 

 

JENNY BROCKIE:  You can't get anyone in Tasmania to circumcise your son?

 

 

ALISON SCOTT:  No. I have two sons - a six and 4 year old. The 4-year-old is fine. His foreskin retracts and he can clean. Ethan’s foreskin does not retract at all and he gets constant infections, he has got an infection at the moment. At first we would just take him to the hospital every time he had the infection. We thought that way they'd see he had problems and would do a medical circumcision if we pushed it enough. They just say I have to wait until he's eight and possibly then take him through to Melbourne.

 

 

MAN:  How many infections has he had?

 

 

ALISON SCOTT:  About every five weeks – he has one at the moment.

 

 

JENNY BROCKIE:  He gets an infection about every five weeks?

 

 

ALISON SCOTT:  He does – he calls it spitting rocks.

 

 

JENNY BROCKIE:  Stan, your reaction to that, a situation where you can't get a child circumcised when you want to?

 

DR STAN WISNIEWSKI:  Medical indications should not be thwarted. If there is a need to improve the quality of that child, previous treatments have failed and all other alternatives have been dealt with.

 

 

JENNY BROCKIE:  Do you accept there are situations where circumcision is the right thing to do?

 

 

DR STAN WISNIEWSKI:  Of course, I do. For medical reasons - and there are many - and I've done them myself but I'm not removing normal skin in infants that done give consent for the procedure.

 

 

JENNY BROCKIE:  Let's get back to Alison's situation. Your response to that?

 

 

ALISON SCOTT:  My son is worried that his doodle was going to fall off. That's what he asked the doctor. He walked in with his daks down and said, "Is my doodle going to fall off, because it is always sore?"

 

DR STAN WISNIEWSKI:  Look I have great sympathy and if I had seen you and you had had all the other therapies, why would I deny you that.

 

 

AMANDA LEEPER-KUBIK:   It retracts when it's old enough to do so. Interfering with it will cause an infection.

 

 

JENNY BROCKIE:    Yeah, but with respect Amanda, you don't know the circumstances of this. Reaction Brian, to listening to this?

 

 

PROFESSOR BRIAN MORRIS:  I mean, really, the issues are much like vaccination.

 

 

JENNY BROCKIE:  So you call this a surgical vaccination, is that right?

 

 

PROFESSOR BRIAN MORRIS:  It is, it is. The issues are very similar, in fact it is much safer.

 

 

DR STAN WISNIEWSKI:  Absolutely incorrect.

 

 

JENNY BROCKIE:  George, your reaction to that?

 

 

DR GEORGE WILLIAMS:  You take a virus, you take a bacteria, you give it in the mouth, you inject into the child and you cause an immune response – that’s what vaccination is.

 

 

JENNY BROCKIE:  Let Brian finish.

 

 

DR GEORGE WILLIAMS:  Cutting off a child's foreskin has nothing to do with vaccination.

 

 

JENNY BROCKIE:  Wait a minute, wait a minute. Brian, you finish.

 

 

PROFESSOR BRIAN MORRIS:  I'm an academic.

 

 

DR GEORGE WILLIAMS:  I am too.

 

 

PROFESSOR BRIAN MORRIS:  I'm a scientist. I have 35 publications.  And I have many chapters in large books and these are all about circumcision, amongst my over 300 publications.

 

 

JENNY BROCKIE:  I just want to ask you why you use this term surgical vaccine? Why do you see it in that way?

 

PROFESSOR BRIAN MORRIS:  Because infant circumcision provides protection from a wide range of adverse medical conditions, some of which are fatal to the man and to their future sexual partners, such as cervical cancer over the lifetime from cradle to grave, it provides enormous protections. The benefits exceed the risks by over 100 to 1.

 

 

JENNY BROCKIE:  George, your response?

 

 

DR GEORGE WILLIAMS:  It's rubbish.

 

 

DR STAN WISNIEWSKI:  A vaccine responds in your body to exposure to an antigen and every time that you are exposed to that antigen you get an increased resistance to it. A circumcision exposes you it an antigen or an infection and you have no resistance to it.

 

JENNY BROCKIE:  Okay, let’s take the vaccine away from it, he's making the point he believes that it provides protection in the way a vaccine does and you dispute that?

 

 

DR STAN WISNIEWSKI:  It is not right. It is not good science. It is leading people in to doing procedures which are unnecessary and which have complications, side effects, injury to patients and to believe that you are somehow sanctimoniously protecting the world and you will die with not one force intact in the universe is absolutely not the right way to practice.

 

 

JENNY BROCKIE:  Seipati, you're studying here and you had your 11-year-old son circumcised in South Africa last year. Why was that?

 

 

 

SEIPATI DITSOANE:  It was for medical reasons because he was getting infections and the penis would, the foreskin would be sticking to the penis and it would be a bit bloody and even the discharge, so it was for that purpose. But when he was born, I was undecided, together with the father, whether to take him to circumcision or not. But we thought of waiting for him to make his own decision, so for medical reason.

 

 

JENNY BROCKIE:  Did this talk about HIV come in to your decision at all?

 

 

SEIPATI DITSOANE:  Actually there was a campaign to encourage males to circumcise as a way of minimising the infection of HIV. So coincidentally, my son also went for circumcision and the friends went for circumcision, getting inspired by my son.

 

 

JENNY BROCKIE:  And Sharon, you're from Botswana, yes?

 

 

SHARON ORAPELENG:  Yes.

 

 

JENNY BROCKIE:  And you said the HIV situation in Botswana which has the second highest rate in the world?

 

 

SHARON ORAPELENG:  It is quite a very scary situation. The government has done - and this came about from a recommendation from the World Health Organisation and the UN Aids - for countries that have low male circumcision and high prevalence of HIV to scale-up the male circumcision. 13 countries in Africa have taken that up that preventative strategy for HIV. And that's in addition to a whole other strategy that is already in place.

 

 

JENNY BROCKIE:  Is it traditional practice in Botswana?

 

 

SHARON ORAPELENG:  Yes, it used to be. There are still certain tribes that practice that. Nowadays obviously they have to go to the hospital or have a medical doctor to be able to perform it.

 

 

JENNY BROCKIE:  Was HIV the only reason that you did it, I mean if that hadn’t been in the picture, would there have been other reasons you would have done it?

 

 

SHARON ORAPELENG:  I mean, for me it was the main reason for my husband and I to make that decision. My husband is circumcised as well and women that I know prefer males that are circumcised.

 

 

JENNY BROCKIE:  Is it right?

 

 

WOMAN:  Yeah. Definitely.

 

 

TRACEY:  There was overwhelming feedback from female friends that at the time some of them actually said that would be their only preference and they would not date a man that was not circumcised.

 

 

DR TERRY RUSSELL:  There was a study done in Sydney in the mid' 90s where women were asked what they preferred and 94% of them said they wanted a circumcised partner.

 

 

DR GEORGE WILLIAMS:  It is called cultural conditioning.

 

 

JENNY BROCKIE:  Cultural conditioning George?

 

 

GIRL:  I grew up in New Zealand and you know who was circumcised and who wasn't because they were excluded. It was quite a friendly school but they were called circy if they had circumcisions.

 

 

JENNY BROCKIE:  Tracey?

 

 

TRACEY:  Just on that topic of being the same as the peer group, one of my biggest concerns as I said, was to do what my past family members had done or what the currents generation was doing and would my son be different to everybody else and maybe be ostracised or picked on because of that. Nathan actually went to an All Boys boarding school for his six years of high school and I did quiz him only in the last couple of years on did he feel different to everyone else, was there an overwhelming majority one way or another, is it something that boys cared about or talked about and his response?

 

 

NATHAN:  It’s just like, just a question. You circumcised? You? No. Whatever. There's nothing different about it.

 

 

JENNY BROCKIE:  No-one cared? The other questions I wanted to ask for younger men in the audience, is a lot of the fathers say, "I want to do it because they'll be worried about not looking like me."

 

 

YOUNG MAN:  My dad is circumcised. I'm not. No difference. I don’t look at my dad's penis and be worried.

 

 

 

JENNY BROCKIE:  We're talking about male circumcision tonight. Karl, you chose to be circumcised at 18. Why?

 

 

KARL WILLIAMS:  Um, I had a tight fraenulum from a young age and it wasn’t something that was rectified when use was a child.

 

 

JENNY BROCKIE:  So a tight foreskin.

 

 

KARL WILLIAMS:  Well, the fraenulum is the connective tissue which joins the foreskin to the glands of the penis to the underside where that ridge is. That was always a bit tight for me and was something I always wanted to get rectified because I wasn't able to, for some period, clean properly. It wasn't that comfortable and I really wanted to do something about it.

 

 

JENNY BROCKIE:  What did you do to prepare for this beforehand?

 

 

KARL WILLIAMS:  OK. I did an awful lot of research. For some period, I got quite sucked in to a lot of anti-circumcision websites with a lot of their emotive and manipulative rhetoric they like to push about circumcision. There came a point where I started really questioning it because I found that the emotive language and imagery and discussions that they were having were really trying to mask the fact they had no evidence to back up their claims. So once I kind of got over that, I decided to look really deep in to it and look much broader.

 

 

JENNY BROCKIE:  Were you doing it just for the physical reason or other reasons as well?

 

 

KARL WILLIAMS:  Well, I don't know - I think it's better, it looks better aesthetically and you mention what I did to prepare. For a period I wore my foreskin back which some men can do and I did it and I did it I think for two years and that was a part of me figuring out if I would lose sensitivity from it which didn't happen. So then I decided when I was 18 to go ahead with it and I’m very happy with it.

 

 

JENNY BROCKIE:  That's a pretty extreme thing to do. You wore it back the whole time?

 

 

KARL WILLIAMS:  For a good two years and I'm really glad I did that because for me it helped me ensure that what I was doing was the right thing and I wouldn't lose any sensitivity. That was something which I was a bit nervous about.

 

 

JENNY BROCKIE:  Stan, I understand that you did this operation?

 

 

DR STAN WISNIEWSKI:  Yes I did.

 

 

JENNY BROCKIE:  How did you feel about doing that given that you don’t like circumcision by the sound of it?

 

 

DR STAN WISNIEWSKI:  For medical reasons, I'm a very strong proponent of treating the patient. Listening to the problems and dealing with them and again, conservatively if possible and using surgery as the last step and I think we had a lot of discussions. We went away from each other - I sent him away, please think about it, come back if you're so dogmatic and he then was given a full consent knowing all the things that could possibly go wrong.

 

 

KARL WILLIAMS:  You were very good about that, Stan.

 

 

DR STAN WISNIEWSKI:  And really, I'm very comfortable in that circumstance. How does a newborn baby give informed consent for a procedure?

 

 

JENNY BROCKIE:   Asung, I wanted to ask you also because you chose to be circumcised in your early 20s?

 

 

ASUNG SWANDY:   Yeah. That's right.

 

 

JENNY BROCKIE:  Why?

 

 

ASUNG SWANDY:   It's just for hygienic reason. Yeah.

 

 

JENNY BROCKIE:  Why did you decide at that age, though? Was it something you had thought about for a long time?

 

 

ASUNG SWANDY:   It's not the tradition in my family or culture that we were circumcised when we were babies. As I grew up, I heard all good things about being circumcised. So I chose to do that and I'm happy with that.

 

 

JENNY BROCKIE:  Do you wish it have been done as a baby? When you hear about the argument of ethics whether the parents should make the decision or whether it should be left to the child to make it when they're older, what do you think about that?

 

 

ASUNG SWANDY:   I wish it was done when I was a baby so I don't have to go through the process.

 

 

JENNY BROCKIE:  So you both wish you had it done.

 

 

AMANDA LEEPER-KUBIK:   And that takes away the respect of a baby as far as I’m concerned.

 

 

JENNY BROCKIE:  I'm asking for their point of view, I’m not asking for your point of view I’m asking for their point of view because they've gone through it and I'm interested in what they think.

 

 

KARL WILLIAMS:  That's a good point because we actually have an understanding of this procedure that a lot of other people here do not have. We know what it's like before and after. There are so many people who will swear black and blue that it reduces pleasure and it ruins your sex life and all kinds of things and it's a load of bollocks.

 

 

JENNY BROCKIE:  Elwyn, I wanted to ask you about your experience because you wished you hadn't been circumcised as a baby, why?

 

 

ELWYN MOIR:   I can relate to what Karl said, however, I had a choice made for me that there's not much I can do to undue. I realised that I was circumcised and saw an intact penis and I was quite shocked.

 

 

JENNY BROCKIE:  So, when did you reach a point where you become concerned about it?

 

 

ELWYN MOIR:  Probably in my teen years.

 

 

JENNY BROCKIE:  Was this because of any health problems or was it purely aesthetic? What was the main reason?

 

 

ELWYN MOIR:   I just became sexually active or sexually interested and I was, I became incensed that there were parts of my sexual anatomy that I didn't have. We've heard people talk about the responsibility that parents have to make decisions on behalf of their children and have to decide what school to send them to and what values to instil but there are all sorts of decisions that parents don't need to make. This is a decision that parents can make but there's no need for them to make it. I would very much like to have been able to reach maturity and decide what to do with my own sexual anatomy.

 

 

JENNY BROCKIE:  See, I find this very interesting, Desleigh, you're the mum here in this story. How do you feel when you hear that?

 

 

DESLEIGH MOIR:  Sometimes I feel guilty. We had Elwyn circumcised when he was two weeks of age and the doctor said he had a tightening of the foreskin that needed to be circumcised.

 

 

JENNY BROCKIE:  So you were given a medical reason to do it?

 

 

DESLEIGH MOIR:   Yeah. We were. But it was part of a family tradition also that males were circumcised so we didn't feel guilt then. The thing I think is that we're talking about a lot of medical issues and cultural issues but education I think is the most important factor here. I had very little education. It wasn’t something that was discussed all the time back then. I grew up in a family that you didn't talk about all that sort of thing openly whereas with my boys we have been much more open with our conversations.

 

 

JENNY BROCKIE:  So Elwyn, where are you up to with this now, what are you doing?

 

 

ELWYN MOIR:   Well, I have looked at the option of restoring. When I first considered that, I thought it was radical and ridiculous. When I say restoring, I mean restoring the foreskin. I dismissed it. I returned a few years ago to examining that option because I did find myself very consumed with annoyance and dissatisfaction.

 

 

JENNY BROCKIE:  Are you still considering trying to restore?

 

 

ELWYN MOIR:   I have started that process.

 

 

JENNY BROCKIE:  And what does that involve?

 

 

ELWYN MOIR:  There are ways of doing it. There are surgical options. And they aren't great in my view and I've spoken to urologists about it and they agree. They use scrotum tissue to replace the foreskin which isn't the same.

 

 

JENNY BROCKIE:  No.

 

 

ELWYN MOIR:  Other options – you know how people put things in their ears and stretch the ears like that.

 

 

JENNY BROCKIE:  Like these?

 

 

ELWYN MOIR:  Yeah. But they also have discs on them and in some places they put things in their lips and the lips have discs in them. You're stretching the tissue to make more tissue. You can take any remaining tissue and use them long term, gentle tension on that to create more. That's an arduous process.

 

 

JENNY BROCKIE:  Just to summarise where you're up to at the moment, you're going through this process of trying to restore your foreskin?

 

 

ELWYN MOIR:  I have started it. I'm not sure if I have the discipline to complete it. It I'm using the stretching method. Using some simple clean materials to grasp what foreskin is left and just using a weights or an elastic strap tied to the leg or something, just to apply…

 

 

JENNY BROCKIE:  To stretch it and is it working?

 

 

ELWYN MOIR:  It is, actually.

 

 

KARL WILLIAMS:  How long will it take?

 

 

ELWYN MOIR:  Two or three years if you're disciplined. Three to five years George?

 

 

DR GEORGE WILLIAMS:  Longer? You need to do it in a group, you need to be motivated and supported.

 

 

JENNY BROCKIE:  In a group? You all get together and do it. That's a whole other dimension I hadn't considered.

 

 

DR GEORGE WILLIAMS:  Restore your Birth Right.

 

 

DR STAN WISNIEWSKI:  To get into a group mean that there are many men, Internet sites. This isn't just one aspect. There are a lot of men.

 

 

JENNY BROCKIE:  Andrew, I noticed you shaking your head listening to some of this. I wonder what you make of what you are hearing at the moment about the lengths that people will go to to do something about it?

 

 

DR ANDREW FREEDMAN:   I understand. We're very sensitive to people, at the end of the day, we want people to be happy. If children are not circumcised, 3% will go on to have a medical issue. That's different to someone who as an adult can make their own decision for aesthetic reasons. It's important to keep those two groups separate. I've been very convinced people are very adamant about wanting to restore their foreskin and there really are no good surgical options that are well accepted at this time.

 

 

JENNY BROCKIE:  Where are we left with all of this, Andrew? Given where your organisation is at at the moment, if you look around the world and look at different cultures, we have different attitudes to this, what is the future for circumcision in various parts of the world? In Europe it's out of favour. There seems to be a move back towards it in America. How do you think it's going to turn out?

 

 

DR ANDREW FREEDMAN:   Most of the world doesn't have the circumcision dilemma, most of the world, you live in a society where everyone does it or no-one does it. It's really just the US, Canada and Australia where there's this circumcision decision and this whole dilemma and debate. Most of the world with circumcision is a closely held religious, cultural ethnic value. It's really not this sort of a discussion about the health risks of circumcision or the medical indications of circumcision.

Where I think the debate should be held is in the culture. Rather than forcing people to all fit in to one mould, have the debate in the culture and let people do what's best for them. With that education, we'll see what happens over time.

 

 

JENNY BROCKIE:  Ben and Pip, you've listened to all of this. What do you think?

 

 

BEN FLEMING:  Look, I'm personally still undecided. I think we've got to go home and have a pretty robust conversation about this. I've heard both pros and cons here tonight. I think Andrew's points really resonated strongly. We have to go home and make a choice. That's what we do every day with Oscar.

 

 

JENNY BROCKIE:  Will you let us know what you choose?

 

 

BEN FLEMING:  Sure. I'll write in.

 

 

JENNY BROCKIE:  We'll put it on the website. Thank you for joining us. Thank you, everybody, for joining us for this conversation. It's been really interesting and very good of you to share your experiences with us. I do appreciate it. Thank you to all our experts. Thank you, Andrew and thank you, Brian, for joining us for this discussion tonight. You can keep talking about this online. Go to insight's Facebook page. You can find out more information about the new policy that Andrew worked on and more information on circumcision in Australia and around the world.