George Aroney's first sexual experience was painful and his second wasn't any better.
So, at the age of 16, he underwent adult circumcision. It was only after he healed that he could understand his mates' enthusiasm for sex.
George Aroney, who was circumcised as an adult, believes sex education at school should cover care of the foreskin.Credit:James Brickwood
"I thought that was just how it was – painful. But, speaking to my friends, they said that's not how it should be. I talked to my parents, then I saw a doctor," Mr Aroney, now a 19-year-old software salesman from Marrickville, said.
Young boys and men are increasingly being circumcised. The number of circumcisions with a local anaesthetic grew by nearly 60 per cent from 6518 in the year ending June 2017 to 10,352 in the year ending June 2019, Medicare item reports show.
The number of circumcisions with a regional nerve block more than doubled from 5425 in 2017 to 11,526 in 2019. These numbers do not include services provided by hospital doctors to public patients in public hospitals. Last financial year there were 4174 admissions to public hospitals for circumcision for medical reasons, the Australian Institute of Health and Welfare reported.
Circumcision for medical reasons is free in a public hospital but the median waiting time for the procedure is 60 days. A circumcision in a private hospital can cost between $700 and $3000.
The rate of newborn circumcision, once routine for social reasons, has plummeted to between 10 and 20 per cent of babies, the Paediatrics & Child Health Division of the Royal Australasian College of Physicians said.
The rise in older age circumcision is due to a condition called phimosis, a narrowing of the foreskin, which may make retraction over the shaft of the penis impossible. Phimosis can cause multiple infections and even rupturing of the foreskin, but its onset happens well after birth. The only permanent fix is circumcision.
Between 2001 and 2016 the number of times GPs managed phimosis soared nearly 90 per cent, from 18,100 to 34,100, according to figures compiled by University of Sydney research fellow Chris Harrison. The average age for treatment of phimosis is 17.
Royal Australian College of General Practitioners president Harry Nespolon said the decrease in social circumcisions had led to an increase in phimosis and an attendant increase in medical circumcisions. Phimosis can only occur in those who have foreskins. Dr Nespolon said he sees a number of patients who do not know what is normal in an uncircumcised penis.
"The father is circumcised and the mother doesn't know either," he said. "That's when they pop along to the GP and the vast majority of cases are going to be normal. Nowadays our advice is to leave them alone and let nature take its course."
But that doesn't work for everyone. Christine Matthews' son was nine when he told her his penis was sore. As parents do, she told him not to worry and to go to sleep. The next day it was worse and they went to a doctor. He was diagnosed with an infection under his foreskin and given some cream to administer. The condition did not improve so they visited a second GP who tried to retract the foreskin.
"That made it a lot worse and it was a terrible experience for him," said Ms Matthews, of Croydon in Melbourne. Two GPs had given two contrasting pieces of advice and there was no improvement. When they eventually went to emergency, medical staff told Ms Matthews: "If you'd left this much longer, he would have lost the top of his penis."
The vast majority of Australian men and boys do not experience these complications, but, for those who do, it can be a very painful experience. The GPS looking after Ms Matthews' son had suggested that a process of twice daily application of an ointment and then attempting to stretch the foreskin could be an option.
"He's not that kind of kid," she said. She said her son was adamant that he wanted to be circumcised. He didn't want to go through the pain again. Ms Matthews' son was off school for a week after the circumcision and the whole process cost about $3000.
Surgeon Gideon Sandler has a number of patients referred to him for what is colloquially called groinery: circumcisions, undescended testes and hernias. Boys and young men come because they have foreskin infections or their foreskin is painful, can't be retracted, or balloons on urination, then discharges urine.
Dr Sandler said some parents say it is difficult to talk to their sons about penile health. There may be no male parent in the home to instruct the boy on foreskin care and, when there is, he may be circumcised and have no experience with it.
Dr Sandler also sees young men requesting circumcision who have had multiple foreskin infections (balanitis), have been unable to return their foreskin to the normal position following retraction (paraphimosis), or have injured their foreskin during sexual intercourse.
The Royal Australasian College says routine infant circumcision is not warranted in Australia or New Zealand; but it also recognises the procedure continues as a religious or cultural ritual.
Jeffrey Klausner, professor of medicine at the UCLA Fielding School of Public Health, has advocated for routine circumcision for years. He said there are multiple benefits, including a reduction in urinary tract infections, which outweigh the risks of circumcision. He rejects the argument that no child should be circumcised until he is able to choose for himself.
"Parents make decisions every day including vaccination, diet and education," Professor Klausner said.
Mr Aroney believes sex education at school should cover care of the foreskin.
"There's a lot of emphasis being placed on educating the young on different gender pronouns but telling boys how their penises work is a higher priority and making sure they don't damage themselves," he said.
Mr Aroney said that if he has sons, he will have them circumcised as newborns.
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