You can leave your hat on, boys, but it's not cut and dried

Male Circumcision Under Fire in Australia

Thanks to Frederick Ehrlich, some 3,000 foreskins are no more.

That is the number of circumcisions the prolific Professor Ehrlich estimates he has performed - mostly as a surgeon, but several hundred in his capacity as mohel, a Jewish ritual circumciser.

With his eyesight failing, Professor Ehrlich is no longer routinely removing the loose skin covering from the tip of the penis of infant boys. But he has performed the operation on his own family, including grandsons Eitan, who had the operation last year, and Noah.

Professor Ehrlich, with colleagues around the world, is preparing to defend the procedure that has become a children's rights battleground - hotly contested between cultural leaders, doctors and the men's movement.

Australia's peak pediatricians' body is reviewing its circumcision policy, while internationally the trend against circumcision continues to gain ground. Sweden recently became the first country to outlaw it, to the fury of Jewish and Muslim groups.

The reason why pediatric surgeons tend to be anti-circumcision and [doctors who treat adults] are for it is that the benefit to the infant is not apparent, Professor Ehrlich said.

But circumcision in infancy could protect adults from health problems, said a United States-based urologist, Dr Samuel Kunin, who joined Professor Ehrlich last night in East Sydney for a debate convened by the Australian Jewish Medical Foundation.

Uncircumcised men with diabetes have problems with chronic infection and sexual dysfunction, Dr Kunin said.

In addition, several studies had concluded circumcised men were at lower risk of urinary tract infections, HIV/AIDS and cancer of the penis.

About one in 10 Australian male infants is now circumcised, down from more than half in the 1960s. Medicare paid for 15,415 infant circumcisions last year, and 2,798 on boys up to 10 - usually due to medical problems.

But George Williams, a pediatrician at the  Children's Hospital at Westmead, said circumcision carried too great a risk of complications for it to be justified for healthy infants.

In Australia we have a death every five years from circumcision. Bleeding affects one in 300, infections one in 300, said Dr Williams, who spoke on the other side of the debate.

Botched operations could lead to further complications. Scarring could occur, and the penis could not grow properly if too much skin was removed, causing painful bending. A child has a right to his own body. This is an elective mutilating procedure.

The president of the pediatrics and child health division of the  Royal Australasian College of Physicians, Dr Jill Sewell, said it was unlikely the group's revised policy would come out clearly for or against circumcision when it is finalised early next year.

On the whole it's not a necessary procedure even though there's some evidence it may protect against things later in life, she said. It's an area where unless the evidence is very clear we haven't got the right to say anything definitive.

Although anti-circumcision groups argued it was the child's right to remain intact, Dr Sewell said it could be argued there was a right of the child to be the same as other children in that culture. If you drive these things underground you often increase the medical risks associated with them.

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