Host Ginger_9msn: Dr Terry Russel and Mr John Aldous, good evening and thank you both for joining us to answer questions on this very important topic.

Host Terry: I'd be very pleased to answer any questions of a technical nature about circumcision.

Host John: Anything that people wish to know about restoration, I'll answer questions now, and if you wanted to contact me by email you can do so on aldous@rebel.net.au.

Mandy: Dr Russell, what percentage of babies are circumcised these days?

Host Terry: In the US it's 85 percent, in Muslim countries it's virtually 100 percent, in Brisbane around 50 percent and in the rest of Australia it's somewhat lower than that, probably around 25 percent in the rest of Australia. I think that the reason there's such a high proportion done in Brisbane is because of the technical advantages of the Plastibell after prior application of the anaesthetic cream. It's just so painless and low risk.

Able: John, would you say male circumcision is just as barbaric and unnecessary as female circumcision?

Host John: Definitely. It's removing natural erogenous tissue. It's healthy, there's no reason for it to be amputated. It is as barbaric to do it to a boy as it is to do it to a girl.

doc: Terry, at what age should you not circumcise boys? My first son was, but my second was ill and then in Canberra you could not get it done any more from reputable practitioners.

Host Terry: I will only do a circumcision if I can do it with a Plastibell. Plastibells are done in a size range that will suit a boy from birth to puberty. The older boys are still done with EMLA anaesthetic cream. The one on the show was nine months old and he laughed and giggled his way through the procedure. Within that time frame, however, the younger the better.

raimondo: John, please tell me why would anyone go through what would seem quite a painful experience to restore a foreskin that cannot possibly have the sensitivity the original bit of skin had?

Host John: First things, restoration is not painful. It's time consuming. What one does is not to restore sensitivity that one had before, but to retain the sensitivity that one has. Constant abrasiveness of clothing thickens the sensitive surfaces, therefore the nerve endings are deeper from the surface and therefore not as sensitive. Following restoration, the surplus surface skin cells no longer required are then shed and sensitivity is improved. On a scale of 10 for a natural male, a circumcised male is lucky if they have two, a restored male about five or six on that same scale of sensitivity.

Host Terry: It beats me why they bother going through the process, because a very big study published in the US two years ago found a higher rate of sexual dysfunction amongst uncircumcised males.

Kaili: Dr Terry, my son is seven years old and it has only been recently (as recommended) that I have started to educate him about pulling the foreskin back to clean it, but it seems unable to retract. Is this a problem?

Host Terry: Yes it is. Either the opening of the foreskin is too tight, or alternatively the foreskin is stuck to the head of the penis by adhesions. He is almost certainly accumulating smegma under that foreskin. Smegma acts as a focus for infection, it's smelly, and it is the presence of smegma in the young that predisposes them to cancer of the penis later in life.

Host John: I would recommend that you seek advice from a paediatrician, with the possibility of the use of Kenacomb cream. This helps to slacken the skin slightly and in many cases allows a tight opening to stretch sufficiently to clear the head of the penis. I've had many people with a similar problem - where urologists have recommended circumcision as the only course -  where Kenacomb has actually amended it, ie they still have their foreskin.

Sandman: I have three sons, all uncircumcised, yet I am. I feel I should have had it done at birth for all of them. What are my options now?

Host John: Leave well alone. They were made with a foreskin, we've been cutting them off for thousands of years, but they still keep growing in a newborn. Leave well alone.

Host Terry: I would suggest that the best option is to have them circumcised with a Plastibell, with prior application of EMLA anaesthetic cream. It is a painless procedure. Furthermore, the anaesthetic effect lasts for about four hours afterwards, by which time the tissue beyond the tie is dead anyway, so that there should not be any interval during which they experience pain. Failing that, it is almost impossible for the boys to keep the penis clean, and even if you can teach your boys to clean under their foreskin, most parents tell me that you can't even teach your boy to keep his room clean. How will he ever clean under his foreskin?

Host John: The operation is painless, but what happens years later is we have thousands of men coming to us saying they feel incomplete. It's not a physical pain, it's a mental pain which lasts for a lifetime.

Jules: What are the statistics that circumcised boys get less urinary tract infections than uncircumcised boys and girls?

Host Terry: Okay, uncircumcised boys are approximately 20 times more likely to get a urinary tract infection than circumcised boys. Girls are about five times more likely to get a urinary tract infection than a circumcised boy. Urinary tract infection in the young is very serious, often does result in kidney damage and can be fatal.

Host John: Many urinary tract infections are caused by parents, nurses and doctors attempting to clean inside the foreskin. In a baby, do not attempt to clean inside a foreskin - it is attached to the glands. By trying to clean, invariably bacteria is pushed inside and causes the said infections. Don't clean the inside, it is self-cleaning.

Host Terry: I would dispute John's suggestion that urinary tract infections are caused by doctors and nurses.

syd: Guests: in your opinion, do you think that more mums or dads make the decision? I think that this is an important issue for the debate.

Host Terry: Okay, I do over 1500 circumcisions a year and it's largely the mums who make that decision. They do not do it lightly. They research it first and make an informed decision for the benefit of their child. I actually did a research paper on that particular thing and the vast majority did it for health reasons.

Host John: Health reasons given so far have been repudiated by worldwide authorities on the human body. Circumcision has no, repeat no, medical benefits. Everything that has been put forward as a medical benefit has been proven wrong or false, including the latest so-called findings that circumcision prevents HIV/AIDS. It does not.

Circumcised_Dad: Dr Terry, what about the risk of infection to the partner of uncircumcised males. Is the risk of cervical cancer greater or less?

Host Terry: That bit about HIV/AIDS was from Professor Short at Monash University, who is very highly regarded.

Host John: The same article has been ridiculed throughout America.

Host Terry: Every uncircumcised male accumulates smegma under the foreskin. Smegma is a mixture of old mucus and dead skin cells. There is a bacteria called bacillus smegmae which inhabits the smegma. Bacillus smegmae is the natural host for wart virus types 16 and 18, that is HPV (human papilloma virus) types 16 and 18. It is that virus which is responsible for cancer of the penis in the uncircumcised male and it is exactly the same virus that is implicated in the causation of cancer of the cervix in female partners.

Host John: In 1999 the American Cancer Research Council published a paper stating to medical people: "Do not recommend circumcision as a preventative measure for penile or cervical cancer. It does not prevent it." Only one in perhaps 100,000 males may contract penile cancer. If circumcision was a preventative measure for cancers then every baby girl should have a mastectomy, as one in nine women in Australia will contract breast cancer. Each is equally as life threatening. The risks associated with a circumcision far outweigh the slight chance of penile or cervical cancer being contracted from an uncircumcised penis.

Host Terry: Cancer in the penis affects one in 600 uncircumcised males.

fh: Dr Terry, my sons aged seven and nine are uncircumcised but seem to have a lot of itching under their foreskins. We have shown them how to clean them but are worried that maybe circumcision is the best answer. Thank you for your unemotional balanced explanation tonight - for the first time I feel like I can make a decision based on fact, not fanfare.

Host Terry: The itching suggests accumulations of smegma and an infection, possibly with candida (that is thrush).

Host John: I think the same thing applicable to the earlier chatter -  again, visit a reputable paediatrician for their opinion before anything else.

Shane: Doctor, I was circumcised as a baby. I find it uncomfortable having intercourse with my fiancee without a lubricant. Do other circumcised men experience similar problems? My fiancee also complains of pain if we don't use a lube.

Host Terry: I must say that that's getting a little bit out of my field, as you are older. I would suggest you go and see your doctor.

Host John: Perhaps more foreplay prior to intercourse would help.

Nicole: Dr Terry, I have a 10-month-old - I've been told you can't get them circumcised past six months without needing a general anaesthetic. Is this true?

Host Terry: The easy answer to that one is that the little boy who giggled his way through the operation was nine months old and he was done with EMLA anaesthetic cream. The EMLA must be applied liberally two hours prior to the circumcision and the whole penis is then wrapped in glad/cling wrap. It should be topped up from time to time during the two hours. It is slowly absorbed over that time and if he has had a generous amount of EMLA cream covering his penis for over two hours there should be no pain.

Host John: I reiterate on that that the surgical procedure may be pain-free, but he's left with a lifelong trauma of not having a foreskin.

Host Terry: There is an easy answer to what John is saying: ask any circumcised male if he has a life of trauma. I always ask my circumcised and uncircumcised dads if they are emotionally damaged and if they fail to enjoy sex, but that's getting far away from the original question.

Ken: Can you tell us where we can get information so we, as parents, can make informed decisions?

Host Terry: (07) 3349 6444 or (07) 3349 7444 is for anyone to get factual information taken from the standard medical literature on circumcision.

Host John: You should also look at other alternatives wherever you may be. (08) 8297 1925 is my number, and I was going to suggest that if you're in NSW, a paediatrician, Dr George Williams, who is the founder of NoCirc. Or in Brisbane, Dr Mervin Lander (also of NoCirc).

bim: What website is the best to recommend parents to research?

Host Terry: Professor Brian Morris from Sydney Uni, www.usyd.edu.au.

Host John: I would suggest any search engine and type in "circumcision" and see what comes up. There are hundreds of sites.

Jod: I am concerned that my baby, who is one, and done by a different doctor, looks totally different to his siblings. It looks like he has left a little bit more than normal. Our doctor said that he will grow into his penis. Is this true?

Host John: One of the things with circumcision is that no doctor, not even Terry, can tell how the baby will grow, how he will develop post-puberty. Many natural men have a short foreskin, others have an overhang of foreskin. But during the circumcision, they are left with the same amount of skin. This often results in a tight skin when erect post-pubertal.

Host Terry: The answer to that one is that babies put on puppy fat in front of the pubic bone which runs from perhaps six months of age through to when they are two or three. The shaft of the penis extends all the way back to the pubic bone and the puppy fat pushes the shaft skin forward over the head of the penis. He will lose that puppy fat as he gets older and you will see the shaft skin getting stretched further and further up onto the shaft where it belongs.

Mel: I have heard men who have been circumcised later in life say that there is no difference in the sensitivity during sex. How can men who have been circumcised at birth complain of lesser sensitivity when they cannot compare?

Host John: I was not circumcised at birth, I enjoyed 38 years of natural sex prior to my circumcision. Two years after the circumcision, sensitivity had reduced so far that I had to fantasise about what it used to be like prior to the circumcision in order to fully enjoy sex. Men who are circumcised at birth haven't got that comparison. They don't know what they're missing.

Host Terry: The study that I quoted before, the big study, showed a higher proportion of sexual dysfunction amongst the uncircumcised males.

Host John: I haven't seen that study. The studies I have seen show the exact opposite.

Madonna: Dr Russell, is circumcision available to any baby, irrespective of health cover?

Host Terry: I would say yes, there is a rebate from Medicare.

John: Dr Russell, are there any situations when you think it's not appropriate to circumcise?

Host Terry: Yes. If the boy has a hypospadia which needs repair I would postpone the circumcision. If the baby had some serious health problem I would also postpone the circumcision pending resolution of that health problem.

Karen: A lot of girls like circumcised guys. Why would guys still want to be uncut?

Host John: What experience has a girl got of a foreskin? She may have seen her brothers or maybe her father as circumcised. Women can enjoy much more foreplay with a natural penis than with a cut one. The sexual stimulation during intercourse with a natural penis is far more stimulating for a woman than the dry thrusting action of a cut one.

pongo: Terry and John, what is the difference between a normal surgical circumcision and that of a Jewish bris?

Host Terry: I have never observed the Jewish bris and therefore can't comment.

Host John: I have only observed the Jewish bris on a television program on SBS, It's a Boy, so I can't really comment either.

syd: Just to pursue my point - if dads do it for tradition I don't agree, but I guess theirs is an informed choice. But if mums do it because they think it is cleaner/less hassle for them, then I find that objectionable. Please doctor, what is the title of your research paper on this issue? Love to read it.

Host Terry: Please contact (07) 3349 6444 and leave your address and I will forward it to you.

Host Ginger_9msn: Gentlemen, thank you both for joining us tonight. Would you be kind enough to repeat your contact details and websites for our chatters please?

Host John: My contact phone number is (08) 8297 1925, email address is aldous@rebel.net.au

Host Terry: The phone is (07) 3349 6444 or fax (07) 3349 7444.

Host Ginger_9msn: Dr Terry Russell and Mr John Aldous, thank you again on behalf of all our chatters for joining us here and for your educated comments on this topic. We greatly appreciate your time tonight.

Host Terry and John: Thank you/Thank you.

Host Ginger_9msn: This concludes our 60 Minutes live chat with Dr Terry Russell and John Aldous, October 8, 2000. Produced by ninemsn.com.au in Sydney, Australia. ninemsn.com.au ©2000.