SYDNEY MORNING HERALD, Sydney, NSW, Australia, July 1, 2004.

Circumcision rates rise for some

By Judy Skatssoon
July 1, 2004

For a little tube of skin at the end of a penis, the foreskin raises some mighty passionate emotions.

There now are signs that circumcision, unfashionable among an entire generation of Australian males, is coming back into vogue.

Marie Jacobs is expecting a baby in September and knows from an ultrasound that it's a boy. Jacobs, a public affairs officer from Balmain, says her son will not be circumcised. "It's probably painful for the baby for a start and I've never thought it necessary," she says.

She would need to be convinced that circumcision offered significant health benefits before reconsidering her position.

Jacobs and her husband represent the majority of Australian parents who say no to the snip. But Medicare figures show evidence of a pro-circumcision backlash for the first time in a decade.

The latest statistics show a 10 per cent increase in circumcisions performed in Australia between 1994 and 2003. In 1994 just under 20,000 procedures were recorded, increasing to 20,200 in 2000 and 22,000 in 2003.

Other research, now under consideration for publication in the Medical Journal of Australia, cites an increase in the incidence of circumcision from 10.6 per cent in 1993 to 12.9 per cent for the year to date. The research, by the director of< Circumcision Information Australia, Shane Peterson, reveals a significant disparity between states.

The most circumcisions occurred in Queensland (19.3 per cent), NSW (16.3 per cent) and South Australia (14.3 per cent) and the lowest rate was in Tasmania (1.6 per cent).

The figures do not provide a breakdown of how many Jewish or Muslim boys are included in the statistics, although it has been suggested the rise may reflect an increase in Australia's Muslim community.

Circumcision critics say it is painful, sexually and psychologically harmful and unnecessary. They say removing the foreskin diminishes sexual sensitivity and can even lead to post-traumatic stress syndrome. But the pro-circumcision camp says it protects against a range of medical problems including HIV and cervical cancer, and should be performed on all baby boys.

Canberra historian Roger Darby has spent four years researching the history of circumcision in Britain and Australia. His book on the topic is due to be published next year.

He says circumcisions were first performed in Australia in the 1890s. About this time it became a routine medical procedure for the first time in English-speaking countries, used to prevent a range of ills, including masturbation, rheumatism and alcoholism. During the world wars it was advocated for personal hygiene and the prevention of sexually transmitted diseases.

By the 1930s, most Australian boys underwent the procedure, and during the 1950s and 1960s about 90 per cent of boys were being cut, Darby estimates.

Separate figures suggest circumcision fell from 50 per cent in 1974 to 24 per cent in 1983 and 10 to 15 per cent by the mid 1990s.

Darby says the increase since then has occurred mainly in NSW and Queensland. He puts the trend down to "propaganda" and community fear driven by a small number of advocates in those states.

"I started doing research on this when it was my impression that circumcision is one of those dead dogs like frontal lobotomy," he says. "I'm absolutely astonished that in the last few years there's been all this stuff being whipped up, all these weird 19th-century ideas are being revived."

One of those ideas is that circumcision prevents sexually transmitted disease.

Melbourne HIV/AIDS specialist Professor Roger Short presented research at a Fertility Society Conference last November showing male circumcision reduced the incidence of HIV/AIDS in men and cut the risk of cervical cancer in women.

According to Short, the inner part of the foreskin is rich in cells containing specific receptors for the virus but lacks the protective keratin "coating" found elsewhere on the penis. He said the research provided a compelling reason for Australia to rethink its opposition to the practice.

His theory was backed with the publication in March this year of a United States paper in The Lancet reporting that circumcision protected against AIDS because the foreskin was enriched with HIV target-cells.

The study of almost 3000 Indian men by researchers from Johns Hopkins University found that circumcised men were less susceptible to HIV than their non-circumcised counterparts. Critics say the research is flawed because of the study's demographic and say there is no scientific evidence showing circumcision prevents HIV or other STDs in modern western societies.

Professor Brian Morris, of Sydney University, says the recent increase in circumcisions is a response to the "avalanche of medical information" showing its benefits.

He advocates universal circumcision and has no doubt Australia is set to return to the high circumcision rates of 40 years ago.

He says urinary tract infections are 12-fold higher in uncircumcised infants and non-circumcision is also associated with a higher risk of penile cancer and cervical cancer, which are caused by the sexually transmitted disease human papilloma virus or HPV.

Other benefits include prevention of phimosis (a condition where the foreskin does not retract) and even a complication of diabetes.

However, the weight of Australia's medical establishment remains opposed to circumcision.

The Royal Australasian College of Physicians and the Australasian Association of Paediatric Surgeons officially say there is no reason to routinely circumcise boys.

The spectre of parents, hospitals and doctors being sued by men who were circumcised as babies was raised in the American [Errata: should be Australian] Journal of Law and Medicine in 2000. The authors, including Queensland psychologist Gregory Boyle, say circumcision should be considered an assault. Thepaper declared legal action was "long overdue" in Australia.

Meanwhile, there has been a marked rise in medically indicated circumcision to treat phimosis in boys under five. A recent West Australian study reviewed circumcision in the state's hospitals between 1981 and 1999, and also found a 70 per cent increase in circumcision for phimosis in boys aged 10-14.

Author Katrina Spilsbury says that based on her figures, seven times more boys would be circumcised for phimosis by the time they were 15 than had it.

Melbourne pediatric surgeon Dr Paddy Dewan says the research implies a "high rate of unnecessary surgery" and could reflect a situation where parents and GPs feel they have to come up with a medical excuse in the current climate.

Dewan adds that hygiene could become a problem in uncircumcised boys if circumcised men were raising intact sons. "There is a barrier, with the father saying, 'I don't know what to do with it'."