Talk:Circumcision

Problematic addition to 'history'

Problematic material has been added to the 'Circumcision in the English-speaking world' subsection of 'history of circumcision'.

For reference, the addition consists of the following:

• Circumcision advocates such as John Harvey Kellogg advocated circumcision as a method for preventing masturbation and in his Plain Facts for Old and Young (1888), he wrote:

“ A remedy for masturbation which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. ”

There are several problems:

• Redundancy. The previous paragraph contains "In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation.[170]" If we make the (not unreasonable) assumption that the reader is capable of reading that paragraph, much of this addition seems pointless.
• Use of a primary source. The primary source (from 1888) is cited directly, rather than a secondary source. (For contrast, note that the previous paragraph cites ref 170 — Gollaher — which is a secondary source.
• Sensationalism. Let me be blunt. Advocating surgery without anaesthesia is shocking to the modern mind, and this quote is used on several dubious anti-circumcision websites, perhaps in the hope that less clear thinkers will associate that negative reaction with circumcision itself rather than Kellogg. The potential to shock isn't by itself a reason to include or exclude, but as an encyclopaedia with higher standards, we must be careful to avoid 'shock tactics' that make it difficult to achieve NPOV.
• Borderline original research. Little in the source itself indicates that Kellogg was writing about history. On what basis, then, do we include it under this heading? Presumably the rationale is of the form "well, it was published in the past and ... um ... it's about circumcision." The problem, of course, is that every source meets these criteria, and the number of sources mentioning circumcision that have ever been published is huge. Which ones made a difference? Was Kellogg very influential in this respect, or does the quote have value solely because it is shocking? This is a fundamental problem of use of a primary source: we need secondary sources to interpret primary sources and identify which ones were influential, illustrative, or otherwise important.
• Typographical splendour. A paragraph plus an indented quotation with those pretty bluish quotation marks? It's very attractive, but are Kellogg's words really so important that this quote should be unique in the article for receiving such treatment?
• Undue weight. Let's review the situation. Even though we've already discussed advocacy of circumcision to prevent masturbation, we discuss it a second time, giving the impression that this issue is vastly more important than others discussed in the previous paragraph. We use a specific primary source, giving the impression that this particular source is of vital importance to the history of circumcision. This particular primary source appears to have little benefit other than as a shock tactic. Finally, we dedicate a paragraph and a block quotation to the source, versus a single paragraph for every other issue. This seems an extraordinary amount of weight (for comparison, Gollaher dedicates only a handful of pages to the subject of masturbation in his 253-page Circumcision: a history of the world's most controversial surgery).

For these reasons, I'm removing this material. Jakew (talk) 10:46, 9 December 2008 (UTC)

Fully disagree with all points except Typographical splendour:

• Redundancy There is no redundancy, this information is not duplicated elsewhere, your assertion that it is "pointless" notwithstanding.
• Use of a primary source is not a problem, we use primary sources frequently elsewhere in the article.
• Sensationalism This objection is invalid, your assertions about "dubious anti-circumcision websites" and "less clear thinkers" standing as speculation and original research. Please note also the neutral point of view. For example, in my view, if we excluded "shock tactics" from this article, most of the World Health Organization and other circumcision advocacy material inciting fear of disease would also be excluded.
• Borderline original research. This objection is invalid, since it could easily apply to any material in the entire section, and any material in history of male circumcision. Clearly the material is historical and not current, and it is a grave misinterpretation of WP:OR policy to remove material summarized from a 120-year old source from a "history" section on the basis that the 120-year old source makes no reference to "history."
• Undue weight. The objection is invalid. We haven't "discussed" masturbation at all, we've merely listed it. This paragraph is important as it shows a historical public figure's published and openly expressed attitudes toward male circumcision. It is quoted in many websites indeed, as it seems many others feel it is quite notable (I agree).

As for the blue quotes, they are used in many other articles when quoting long passages, and I am neutral to them. However if you prefer to avoid them we can easily simply include the quote normally in the paragraph. Blackworm (talk) 17:54, 9 December 2008 (UTC)

Thank you for your comments, Blackworm.

I'm a little surprised, I have to say, that you argue that there is no redundancy. Would you not agree that there is a certain amount of repetition in the statements "Circumcision advocates such as John Harvey Kellogg advocated circumcision as a method for preventing masturbation [...]" and "In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation."? I would suggest that these are essentially similar, both telling the reader that circumcision was proposed by some authors as a method of preventing/treating masturbation. The only major difference is that one includes, quotes, and generalises from a specific example, while the other cites a secondary source. (Another interesting difference is the curiously redundant choice of words in "circumcision advocates ... advocated circumcision", but I digress.)

I'd certainly agree that primary sources can be used, with caution. However, as a general rule, we should prefer secondary sources to primary sources. In this case, given that a secondary source is already cited in the article, what is gained by citing a primary source as well? Does it allow the reader to verify that some authors proposed circumcision to prevent masturbation? No, the ref already cited (Gollaher, ref 170) satisfies WP:V. So what does it add, then, that isn't already present? The impression one receives is that the notability and influence of the source is so well-established that it is unnecessary to cite a secondary source, much like quoting from the US Declaration of Independence. Yet this has not been established.

I'm not sure whether I expressed my concerns about sensationalism sufficiently clearly. My point is essentially that we must be careful to avoid "shock tactics" and other forms of propaganda, since they are incompatible with a neutral encyclopaedia. We can, in principle, include "shocking" material, but only if it has significant encyclopaedic value. One question worth considering is whether there is an argument for inclusion if it had no "shock value". Consider the following, for example:

• "In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation.[170] For example, [reliable secondary source] cites an influential 1888 work by Kellogg, arguing that circumcision was a remedy for masturbation that was "almost always successful" in young boys.[ref]"

This edit, albeit hypothetical, would actually eliminate many (though not all) of the problems I mention. It would a) use a secondary source to establish historic influence, b) be more encyclopaedic in tone, c) reduces sensationalism and keeps the material focused on circumcision rather than on masturbation and the method of circumcision, and d) reduce the excessive weight. But it would seem difficult to make a strong argument for the second sentence in this article, as it adds little other than an example which seems unnecessary given the article's size.

I am, incidentally, curious about how you would expect WP:NPOV and WP:SOAP to be applied without editors thinking about how material is likely to affect the reader. It seems obvious to me that certain decisions about presentation of material, including recognising soapbox-ish material, require editorial judgement; I'm not sure that it's helpful to dismiss reasoning about such problems as original research.

I'm afraid that I don't quite follow your objection to "borderline original research". Much of the material in this section is problematic, as discussed (for different, but related reasons) in #Arbitrary subsection 5. However, the first paragraph largely draws from a Journal of Social History article by Gollaher — a secondary source. It isn't clear to me at what point a source becomes clearly "historical and not current", but even if it was clear I don't see what a primary source can tell us about the history of circumcision unless it was actually about that subject. For such interpretation of sources we need historians. Moreover, if we assume that material older than, say, 10 years is "historical" then the available sources must number in the thousands if not tens of thousands. Clearly we cannot possibly include every source, so we would need to choose the most important, influential, illustrative sources. How on earth can we identify these when the sources themselves aren't even about history? Again, we need secondary sources.

Regarding "undue weight", you seem to make a distinction between "discussion" and "listing" that isn't clear to me. The sentence I mention ("In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation") seems to be discussion to my mind; if you disagree I wonder if you could explain why. You say that the paragraph is important because it shows a "historical public figure's published and openly expressed attitudes toward male circumcision", but the problem is that this is true of any "historical" document. The question is, what's so valuable about this particular one? The fact that it is quoted on anti-circumcision websites is not by itself an indicator that the information is encyclopaedic, and as a general rule Wikipedia's coverage of material is not guided by lay websites. Glancing at two histories of circumcision (Gollaher and Dunsmuir and Gordon), I find it interesting that neither actually mention Kellogg, which makes it seem especially extraordinary to dedicate such a large fraction of space to that source here (if it were such a highly influential source, wouldn't one expect historians to at least mention it?).

Regarding the use of {{cquote}}, I think this is one of the more minor problems. However, I think it is perhaps illustrative of the soapboxy, undue-weight feel of the addition that this was the only quotation in the entire article that was given such rich typography. Jakew (talk) 23:32, 9 December 2008 (UTC)

Excellent points all round. I've removed it. Jayjg ^(talk) 03:18, 17 December 2008 (UTC)

Have a look at this: [1] It is clear that Kellogg is mentioned in many scholarly articles on circumcision and its history. If you prefer, I will use one of these secondary sources to illustrate essentially the same point, that at least one prominent and influential person, at the time of routine male circumcision's rise in popularity in the West, openly stated that the pain induced by male circumcision was beneficial in a punitive and preventative capacity (that is, preventative of masturbation) -- exactly as frequently commented on by the scholarly sources. Blackworm (talk) 04:10, 10 December 2008 (UTC)

Hmm. 412 results for "circumcision kellogg" (or 358 for "history circumcision kellogg", versus 36,100 for "circumcision history". So, as a rough estimate, about 1% of papers discussing circumcision history also discuss Kellogg. I guess it depends on what can be found among those results. I couldn't see any articles that were obviously histories of circumcision in the first two pages, but maybe some can be found.

Yes, I would certainly prefer a secondary source, and would be interested to see what you can find. However, I think that editing would need to be careful in order to ensure appropriate weight. In this article, I think at most a short parenthetical addition to the existing masturbation sentence might be appropriate, but perhaps such material might be more suited to a detailed article. In any case, it seems premature to discuss this until candidate sources have been found. Jakew (talk) 10:28, 10 December 2008 (UTC)

I don't agree that your Google hit statistics indicate or even suggest that "about 1% of papers discussing circumcision history also discuss Kellogg." Since our views of appropriate weight differ, it's unclear how best to proceed. I'll suggest an addition soon regardless. Blackworm (talk) 15:53, 10 December 2008 (UTC)

I'd also like to point out that if "Advocating surgery without anaesthesia is shocking to the modern mind," then the practices of circumcising religions and other circumcision advocates worldwide would similarly be shocking to the modern mind -- as most circumcisions still take place, in 2008, with no anaesthetic, as I believe you may be aware. In that context I cannot explain your statement, "Advocating surgery without anaesthesia is shocking to the modern mind," since that applies to all circumcision advocacy I've encountered, which at its best merely "recommends" anaesthesia rather than firmly stating that it should not be performed without it. Blackworm (talk) 18:01, 9 December 2008 (UTC)

I was thinking the same thing about surgery without anesthesia. Per some of Jakew's arguments, I suggest deleting the J.M. Glass quote from the pain section.

For this section, most of the arguments on both sides seem to me to be balanced or not strongly convincing either way, except for Jakew's argument about history books. A good way to determine due weight in the history section, it seems to me, is to base it on books of the history of circumcision, and similar sources (e.g. chapters on history of circumcision in other books). ☺Coppertwig(talk) 01:54, 10 December 2008 (UTC)

Please discuss changes to the summarizing of Glass in a separate section (and give a clearer rationale). Blackworm (talk) 04:10, 10 December 2008 (UTC)

This seems notable to me which is why placed it back in the article after Jake's first revert, however I'm indifferent to the quotes used. I have said before that one sentence about circumcision being used to cure or curtail masturbation seems under weight. I grew up being taught that circumcision was done for religious reasons and to prevent masturbation. In the bible belt we were taught that enjoying sex is bad and masturbation and sexual pleasure was decadence. I feel this should be expounded on, properly sourced of course. Garycompugeek (talk) 17:02, 10 December 2008 (UTC)

Re Glass: never mind. Clearly Jakew meant that circumcision of non-infants without anesthesia is shocking to the modern mind. I might start a thread about the Glass quote at a later date.

Oh, so it's the same Kellogg as the breakfast cereal. ☺Coppertwig(talk) 01:41, 12 December 2008 (UTC)

(Outdent.) I made this edit summarizing Kellogg's view via a secondary source. I hope it is seen as satisfactory. Blackworm (talk) 07:05, 17 December 2008 (UTC)

Ok, thank you for finding a secondary source.

Let's review some secondary sources:

• Gollaher does not mention Kellogg.
• Dinsmuir & Gordon do not mention Kellogg.
• Aggleton dedicates two short paragraphs to Kellogg (on p19) among 21 pages of text.

Given that this article is in summary style, and must briefly summarise historical reasons for circumcision, it seems disproportionate to include such lengthy treatment. I've edited it to reduce the excessive weight, but this still seems problematic. A better solution, I think, is to move this material (in its original form) to the detailed article, where there is room to include such material without it seeming to dominate the coverage. Jakew (talk) 10:23, 17 December 2008 (UTC)

Completely disagree; this material is weighted appropriately. If length is a concern, the paragraph following this one, which goes into enormous detail about prevalence in the U.S. during the 1900s, could be trimmed or removed instead. I'll make the change. Blackworm (talk) 16:47, 17 December 2008 (UTC)

Excellent point Blackworm. Garycompugeek (talk) 16:51, 17 December 2008 (UTC)

I'm willing to accept Jakew's edit as it stands as a compromise between our varying views of appropriate weight. A more detailed treatment can go into the appropriate subarticle(s). I hope you will agree, Jakew, and regardless of whether you do I'd like to thank you for not having reverted completely in that instance despite your reservations. Blackworm (talk) 04:39, 18 December 2008 (UTC)

As you acknowledge, Blackworm, I do have some reservations, but I think it is an tolerable compromise. Jakew (talk) 13:53, 18 December 2008 (UTC)

To Usergreatpower: you've reverted twice to your initial version, and once to Blackworm's version. On all three occasions, you've claimed that there is a consensus for this material to stay, which is perplexing since of the five editors (including myself) who have participated in this discussion, Jayjg and Coppertwig have expressed being persuaded by one or more of my arguments, and Blackworm and I seem to have reached a compromise which you just reverted. If anything, then, the most likely candidate for a consensus version seems to be that which you just reverted. Since your edit summary gave only this erroneous interpretation of consensus as a rationale for your edit, I wonder whether you have any content-based reasons for it? Jakew (talk) 13:53, 18 December 2008 (UTC)

Jake it seems you have a great aversion to the quote about circumcising without anesthesia to cause pain on purpose. I think its a nasty thing to do also but it's still a relevant sourced fact. Garycompugeek (talk) 23:05, 18 December 2008 (UTC)

No Gary, Jake is rightfully concerned about the word count, and has agreed to a compromise that includes this information succinctly, including the lack of anaesthesia favoured by Kellogg. Blackworm (talk) 23:44, 18 December 2008 (UTC)

Just because you two worked out a compromise doesn't mean I agree with it, however I will not revert again if no one else agrees with me. Garycompugeek (talk) 00:00, 19 December 2008 (UTC)

Re Kellogg:

• Do we have evidence that Kellogg's views are representative of a significant segment of society at the time, i.e. significantly more than just the one persson?
• Do we have evidence that Kellogg's views on this were significantly influential?
• Do we have evidence that Kellogg's views have been cited a notable amount in the more reliable sources?

If the answers are no, no and no, then I think the reference to Kellogg should be removed from this summary article. ☺Coppertwig(talk) 22:30, 20 December 2008 (UTC)

TotallyDisputed tag

{{totallydisputed}} I have placed the disputed content tag on the Topic while we work out several factual omissions. Please see the below list of problems, which were generally created when relevant referenced facts were deleted from the Topic:

• Removed from the introduction:

The frenulum may be cut at the same time, in a procedure called a frenectomy[2]

[3]

• Removed from Procedures:

The frenulum is cut frenectomy if frenular chordee is evident.[4]

[5]

• Fact removed from Complications:

Chordee of the glans may be the result of circumcision.[6]

• Facts removed from (or barely mentioned in) Complications:

“Meatal stenosis is a relatively common acquired condition occurring in 9-10% of males who are circumcised. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy is curative.” [7]

“Meatal stenosis is generally a direct consequence of circumcision that is seldom encountered in uncircumcised men; meatal calibre is know to be greater in uncircumcised individuals. The incidence of meatal ulceration following circumcision is from 8 to 20 per cent14,46,64. The aetiology is thought to be irritation of the external urethral meatus by ammoniacal substances present in wet sodden nappies. Such irritation is unlikely in the presence of a normal prepuce, which serves to protect the glans from these irritant substances46. In a prospective study of 140 consecutive neonatal circumcisions, Mackenzie64 found a 20 per cent incidence of meatal ulceration within the first 2-3 weeks after circumcision. It is thought that meatal ulceration after circumcision is the initiating event in a vicious cycle of stenosis and ulceration, followed by more stenosis64. Meatal stenosis following circumcision has been advanced as a cause of recurrent pyelonephitis and obstructive uropathy, for which meatotomy is curative64,65.”[8]

“Meatal stenosis is an under recognised complication of circumcision done in neonatal and nappy aged boys. Symptomatic presentation from meatal stenosis can be very late (two years).” [9]

“Traumatic meatitis of the unprotected post-circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis. CONCLUSION: Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.”[10]

• Gross propaganda:

The Circumcision topic in Wiki leads the reader to believe that the covenant made with Abraham (note the “commandment from God” sentence in the second paragraph) was the current radical practice (in that it removed the covering of the glans). In fact, we find "the circumcision which Abraham performed on himself and other male members of his household was the removal of the tip of the prepuce.” This tip of the prepuce removal circumcision was practiced by Jews and Muslims for thousands of years.[11][12][13] This simple (Milah) procedure resulted in much less pain and erogenous nerve loss than the current Bris and Sunnet practices.

• Removed from complications, and UTI:

"An epidemiological study of UTI during the first year of life involving 169 children born in Israel found that 48% (27/56) of the male infants presented with UTI within 12 days after ritual circumcision.51 The incidence of UTI among male infants was significantly higher just after circumcision (from 9 to 20 days of life) than during the rest of the first month of life and significantly higher in the first month of life than during the rest of the year. After the immediate postcircumcision period, the incidence rate of UTI dropped to a level comparable to that reported among circumcised male infants in the United States."[14]

• Removed from Pain:

Without exception, newborns in this study who did not receive an anesthetic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk. Two of 11 newborns in the study who received no local anesthetic had potentially dangerous episodes within minutes of the procedure. One newborn lost muscle tone, stopped breathing several times and vomited. The other choked and stopped breathing briefly, the researchers said.[15]

• Wiki leds us to believe circumcision is best done during infancy (see Advocates above, and the Topic), but:

“Circumcision at 5 months results in significantly fewer serious complications than circumcision in the neonatal period, irrespective of the method used. Therefore, neonatal circumcision should not be recommended.” [16]

• In the third paragraph we read … “Arguments for circumcision are that it provides important health advantages which outweigh the risks, that it has no substantial effects on sexual function, has a complication rate of less than 0.5% when carried out by an experienced physician, and is best performed during the neonatal period.[12]. Problem is, the medical community disagrees (finds factual fault) with the statements made by Schoen. Schoen states personal opinion, then cites a study on adult circumcision (thus not relevant to infant or toddler circ results) to claim no sexual effects, then references himself to claim a complication rate! Wiki should not call such subjective information “arguments for circumcision,” and should not use disreputable stats.

• Obscured from the reader:

Wiki should link to the actual Sorrell’s study.[17] Circumcision currently links to a very short summary. We should also convey the essence of their findings:

“The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis.”

…”Circumcision removes the most sensitive parts of the penis and decreases the fine-touch pressure sensitivity of glans penis. The most sensitive regions in the uncircumcised penis are those parts ablated by circumcision. When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis (the rim of the preputial orifice, dorsal and ventral, the frenulum near the ridged band, and the frenulum at the muco-cutaneous junction) that are missing from the circumcised penis were significantly more sensitive.”[18]

• Removed from sexual effects:

“While vaginal dryness is considered an indicator for female sexual arousal disorder,1,2 male circumcision may exacerbate female vaginal dryness during intercourse.3 O’Hara and O’Hara reported that women who had experienced coitus with both intact and circumcised men preferred intact partners by a ratio of 8.6 to one.4 Most women (85.5%) in that survey reported that they were more likely to experience orgasm with a genitally intact partner: ‘They [surveyed women] were also more likely to report that vaginal secretions lessened as coitus progressed with their circumcised partners (16.75, 6.88–40.77).’4”[19]

• Removed from sexual effects:

“Presence of the movable foreskin makes a difference in foreplay, being more arousing to the female.4 Women reported they were about twice as likely to experience orgasm if the male partner had a foreskin.4 The impact of male circumcision on vaginal dryness during coitus required further investigation.”[20]

• Removed from sexual effects:

“These preliminary figures support the claim by Morgan [1 and 2] that vaginal intromission is easier with a (retractable) foreskin in place. The mechanism is simple. The interposed foreskin decreases the friction between the introitus and the glans. The unretracted foreskin consists of a thin dermis that is folded on itself with very little friction between the layers. As the penis advances, the foreskin unrolls so that the portion that makes initial contact with the introitus is 6 cm. Up the shaft before any friction occurs between the device and the skin.”[21]

• Removed from sexual effects:

“Participants reported significantly reduced erectile function, decreased penile sensitivity, no significant change in sexual activity, and significantly improved satisfaction after circumcision. This improved satisfaction represented a more satisfactory appearance of the penis and less pain during sexual activity.” [22]

• Removed from sexual effects:

“Techniques are available to induce ejaculation in men with SCI (spinal cord injury), who are otherwise anejaculatory. The semen can then be used for in vitro fertilization. External vibratory stimulation involves the use of a vibrator over the glans and frenulum to induce an ejaculatory reflex. [23]

• Removed from sexual effects:

Boyle et al. (2002) argued that "structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation." “The loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response" may reduce a "circumcised man’s ability to achieve arousal." …"Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback" erectile dysfunction and premature ejaculation may be a complication of male circumcision, potentially making "intercourse is less satisfying for both partners when the man is circumcised.”[24]

Tip, we've been through this all before over the past few years. See the 40+ pages of talk. Lying low for two months and starting to edit war again will not help. -- Avi (talk) 00:57, 17 December 2008 (UTC)

Catagorically reverting Tip because of past transactions is very unadmin like behavior Avi. All he did was add a dispute tag and come here to talk about it. You also reverted Usergreatpower without a peep of explanation. Garycompugeek (talk) 01:35, 17 December 2008 (UTC)

Avi, you refer to "we've" ... you mean the cabal having dismissed the above facts? You mean text you agreed to and then removed? You mean the sham discussion? The above facts are significant to the reader but blocked without cause.TipPt (talk) 01:45, 17 December 2008 (UTC)

TipPt, as I think I've explained to you before, around July 2007, when you weren't around, there was consensus to shorten this article, moving much material to the subarticles linked to at the top of each section. See 32. Article too long?. If you wish to re-add much material, re-lengthening the article; or if you wish to keep the article the same length while substituting some material for some other material; you're welcome to discuss such proposals on this talk page, but I see no need for a "totally-disputed" tag during such discussions. While you've listed much material that has been deleted, you haven't stated any reasons why it should be re-instated except "The above facts are significant to the reader but blocked without cause": yes, the information is significant to the reader, but the cause of deleting it is that such details have been moved to subarticles. I suggest that you check the subarticles and try adding to them any pertinent information you feel is missing.

Re ancient Jewish circumcision: I'm not convinced by your sources. I went over a screenful of text at the first source and didn't notice anything relevant: could you specify which paragraph it's in? The second source looks OK but I'm not convinced it's a sufficiently reliable source for that type of historical fact; one is left wondering where they got their information from. With the third source, again I didn't notice anything relevant; which paragraph is it in? What exactly do you think needs to be changed in the article to remove what you call the gross propaganda? I see no problem, since the first sentence of the article defines circumcision in terms of "all or part" of the prepuce, so the article seems to me to be consistent with your claim.

I support removing the totally-disputed tag. I oppose lengthening the article by re-adding the above-mentioned material; I think it's beneficial to have an article that's short enough that many readers might read the whole thing from beginning to end, and other material can go in the sub-articles. Making the article too long leads to undue weight in effect, since many readers may read only the first part or some other part of the article, not receiving a balanced overview of the subject. Any readers interested in more detail can easily navigate to the subarticles. ☺Coppertwig(talk) 03:01, 17 December 2008 (UTC)

As Coppertwig put it, "We've" means the people who have been editing this article for the past few years, and yes albeit many of us share different views, we managed to shorten the article and work some things out. Coming back with the same old laundry list, Tip, is only going to serve to destabilize what delicate balance we all (and that means Me, Copper, Jake, Blackworm, Gary, etc.) are trying to maintain here. -- Avi (talk) 03:06, 17 December 2008 (UTC)

And Gary, you're right, I miskeyed the reversion and took out too much. Guess I have to return that "infallible" bumber sticker I just bought :) -- Avi (talk) 03:06, 17 December 2008 (UTC)

Agree with Coppertwig and Avi. Further, almost all of TipPt's complaints are essentially that certain fragments of text are not present. Irrespective of whether the article would be better or worse without these fragments, this is not an appropriate use of the "totallydisputed" tag. Generally speaking, this tag is intended to raise concerns about neutrality and accuracy of material that is in the article, not as a form of protest. Jakew (talk) 11:13, 17 December 2008 (UTC)

Yes, "totallydisputed" seems definitely overkill here. I don't think any tag is needed: we don't usually have tags during most discussions. But "totallydisputed" should be reserved for the very worst cases, e.g. blatantly false important statements in the article. ☺Coppertwig(talk) 13:51, 17 December 2008 (UTC)

Totally disputed is simply the name of the section Tip created. The tag adds Tip's concern of factual accuracy while the previous tag covers neutrality of title/subject matter. Let's all assume good faith and calmly talk about Tip's concerns. Sadly it always seems to be the same battle lines with the same editors on each side of pros and cons of circumcision. Garycompugeek (talk) 16:18, 17 December 2008 (UTC)

This has veered into a discussion about editors, rather than content, but since I was addressed by name I will say for the record that I am not maintaining any balance here as Avi says, as I believe the article to currently be unbalanced. Also, neutral point of view is not just about what is in the article, but may also be about what isn't, or about how the material in the article is organized and presented. I don't think "totallydisputed" is appropriate, but a "POV" tag may indeed be appropriate. I believe this article is "maintained" according to Coppertwig's view that "published sources mostly take such a stance ['in favour of male circumcision and in opposition to female circumcision'], so (arguably) NPOV requires that the Wikipedia article do the same."[25] I believe that view to be the antithesis of NPOV, and I'm not surprised that some are upset that it is being imposed here. Blackworm (talk) 17:40, 17 December 2008 (UTC)

Reply's to above:

• The most of those facts were taken out before the article was shortened. Adding them will not add much to length. To reduce length, I suggest reducing disputed "medical" issues. There's another "main article" with the same info! On the other hand, why isn't the reader told medical associations consider infant circ's to be "elective" surgery, and "non-theraputic." Both of those words are very specific terms. All we read is "do not recommend," with no why (it's not theraputic). That fact has been removed.

• It's gross propaganda to say "God commanded" something radically different from current practice. Here's the relevant paragraphs from the Jewish encyc:

“—In Apocryphal and Rabbinical Literature:

During the Babylonian exile the Sabbath and circumcision became the characteristic symbols of Judaism. This seems to be the underlying idea of Isa. lvi. 4: "The eunuchs that keep my Sabbath" still "hold fast by my covenant," though not having "the sign of the covenant" (Gen. xvii. 11, Hebr.) upon their flesh. Contact with Grecian life, especially at the games of the arena, made this distinction obnoxious to the Hellenists, or antinationalists; and the consequence was their attempt to appear like the Greeks by epispasm ("making themselves foreskins"; I Macc. i. 15; Josephus, "Ant." xii. 5, § 1; Assumptio Mosis, viii.; I Cor. vii. 18; , Tosef., Shab. xv. 9; Yeb. 72a, b; Yer. Peah i. 16b; Yeb. viii. 9a). All the more did the law-observing Jews defy the edict of Antiochus Epiphanes prohibiting circumcision (I Macc. i. 48, 60; ii. 46); and the Jewish women showed their loyalty to the Law, even at the risk of their lives, by themselves circumcising their sons.”

“In order to prevent the obliteration of the "seal of the covenant" on the flesh, as circumcision was henceforth called, the Rabbis, probably after the war of Bar Kokba (see Yeb. l.c.; Gen. R. xlvi.), instituted the "peri'ah" (the laying bare of the glans), without which circumcision was declared to be of no value (Shab. xxx. 6).”[26]

...and relevant text from the second source:

"Long before this, many of the Persians were circumcised and "became Jews, for the fear of the Jews had fallen upon them" (Esther 8:17, Heb. text; Josephus, Ant., XI, 6:13). The Book of Jubilees insists upon he strict observance of the law, and protests against those that "make the members of their body appear like those of the gentiles" (xv, 26, 27). During the period of Greek rule in Palestine, when those that kept the laws of Moses were put to death by the gentile tyrants (1 Maccabees 1:63; 2 Maccabees 6:10), some Jews, under Greek influence, "made themselves prepuces" and turned away from the ways and traditions of their fathers (1 Maccabees 1:15, 16; Joshua Ant., XII, 5:1). To this epispastic operation performed on the athletes to conceal the marks of circumcision St. Paul alludes, me epispastho (1 Corinthians 7:18). Therefore Jewish circumcision, in later times, tears the membrane that remains after circumcision given in the ordinary way, among the Arabs for instance, and thus defeats even the surgeon's skill."[27]

To fix? Either remove the "commandment from God" line, or properly qualify that strong statement with historical facts.

Finally, I tried to fix meatal stenosis in complications, but was reverted by Avi. Please bring suggestions to discussion. I will also from now on.TipPt (talk) 17:36, 17 December 2008 (UTC)

We've been through this near a dozen times already. The authoritative works of Rabbinic Judaism are the reliable sources for Rabbinic Judaism. Not some midwife's website or the Catholic encyclopedia. We are not supporting the Christian view of circumcision by using the works of Imam Ali, are we? I've already pointed out what the proper source is in the archives a number of times, and it does not support the erroneous, mistake-filled information you have above vis-a-vis Judaic circumcisions. Please stop trying to add incorrect information based on ignorant and/or miseducated people to the article. -- Avi (talk) 18:48, 17 December 2008 (UTC)

TipPt, I'm not convinced that medical associations consider all infant circumcisions to be "elective" or "non-therapeutic"; I assume there may sometimes be specific medical reasons for circumcising some particular infants to treat specific conditions the infants may have. ☺Coppertwig(talk) 22:18, 20 December 2008 (UTC)

TipPt, again, you've listed material you wish to have included, but you haven't stated reasons why it must be included or even reasons why it would be good or appropriate to include it. I suggested in my reply to you on my talk page that you may wish to construct arguments referring to WP:UNDUE and major reliable sources.

I don't see the phrase "God commanded" anywhere in the article and I don't think the article asserts that God commanded anything; if it did, that bit would need to be changed. It says "Male circumcision is considered a commandment from God in Judaism", which is fine; it's not asserting that God exists or that God commanded anything in particular; only a true statement about Judaism. "Assert facts, including facts about opinions" (WP:Neutral point of view#A simple formulation).

Finally, there is consensus of all editors except yourself not to have the "totallydisputed" tag, and that tag is only for extreme cases, not normal content discussion such as this; and there are already tags complaining about neutrality and factual accuracy is already a tag about neutrality^{(19:36, 21 December 2008 (UTC))} anyway, so I'm removing the tag.

Re reverted by Avi: I suggest phrasing your arguments concisely and in "What, where, why" format, to make it as easy as possible for people like me to follow the discussion. (Make sure you include the "why" arguments, preferably referring to policy, guidelines and reliable sources.) Note that reverting of new material is a normal occurrence and doesn't require a "totallydisputed" tag; see WP:BRD. If you get consensus before editing, as requested in the "controversial" template at the top of this talk page, then reverts probably won't happen.

I hope this message doesn't sound too confrontational. I look forward to discussing the material with you. ☺Coppertwig(talk) 19:32, 21 December 2008 (UTC)

Meatal Stenosis

• Proposed text:

Meatal stenosis is relatively common but under recognised complication of circumcision in infants [28]occurring in 9-10% of males who are circumcised. It is thought that because the foreskin no longer protects the meatus, ammonia formed from urine and friction in diapers irritates and inflames the exposed urethral opening. Meatal stenosis can lead to discomfort with urination, incontinence, bleeding after urination and urinary tract infections. Surgical meatotomy is curative.”[29][30]

• Existing text:

Meatal stenosis (a narrowing of the urethral opening) may be a longer-term complication of circumcision. It is thought that because the foreskin no longer protects the meatus, ammonia formed from urine in wet diapers irritates and inflames the exposed urethral opening. Meatal stenosis can lead to discomfort with urination, incontinence, bleeding after urination and urinary tract infections.TipPt (talk) 17:51, 17 December 2008 (UTC)

I can two obvious problems with the first sentence of your proposal, TipPt. "Meatal stenosis is [a] relatively common but under recognised complication of circumcision in infants..." No, a few authors (including Upadhyay et al., who are cited in your proposal) have expressed the POV that it is common and under recognised, but that doesn't make it a factual statement. "...occurring in 9-10% of males who are circumcised." This is misleadingly high; see meatal stenosis#Causes, incidence, and risk factors for a handful of estimates ranging from 0.9-11%. There's no reason to discuss the matter here anyway - this article is about circumcision, not meatal stenosis statistics. Jakew (talk) 19:36, 17 December 2008 (UTC)

It's sourced as a complication of male circumcision, thus surely it's relevant. The WP article you link to specifically says that circumcision "contributes to the development of urethral stricture." The only valid problem you mention is one of attribution of the statistics, which is easily addressed. Also it doesn't seem misleadingly high -- the one study finding a prevalance of 0.9% in its subjects only studied Iranian boys aged 6-12, where presumably many of them could have been treated for it in earlier infancy; thus it is misleading to present that statistic as a statement of "prevalence" in the meatal stenosis article (and I will address this soon). Excluding that study, the average of the other four sources is about 7%. We should probably create a better paragraph on meatal stenosis that cites all these sources and results properly. Blackworm (talk) 21:05, 17 December 2008 (UTC)

Actually, the meatal stenosis article states that "studies have indicated that circumcision contributes...", which is slightly more neutral than asserting that it does contribute. (Perhaps the wording could be improved, though. Thank you for bringing it to my attention, anyway.)

Anyway, it's true that we have sources asserting that it is a complication. Similarly, we have sources asserting that, say, HIV can be a complication of non-circumcision, is this an appropriate place to discuss HIV statistics? For that matter, is it appropriate to discuss possible complications of HIV? I think not. This is an appropriate place to discuss how a condition is related to circumcision, but for more information, the reader can refer to an article about that other condition.

The problem which you (elegantly) describe as "attribution of the statistics" is indeed a problem, and I think the only fair, neutral approach that avoids OR is to list the figures in the sources. We do this in the meatal stenosis article - the text reads: "Among circumcised males, reported incidence figures include 0.9%,[Yegane] 2.8%,[Griffiths] 7.29%,[Van Howe] 9-10%,[Angel] and 11%.[Stenram]" (ref numbers changed to author names). (Incidentally, this is not a complete list - from my old notes I also have 0% [Sorensen], 1.5% [Leitch], 0.01% [Cathcart], and 8% [Patel].) 9-10% matches a single source - Angel - but none of the other sources fall within that range, seven are lower, and one is higher. Thus we can view the assertion that meatal stenosis occurs in 9-10% of circumcised males as one of two things. Either a) it asserts (without even attributing) Angel's POV as fact in spite of the other viewpoints, violating NPOV, or it is a wildly inaccurate synthesis of figures into a range that is, in fact, higher than figures in most available sources.

I'd certainly be glad to discuss any thoughts you might have at Talk:Meatal stenosis, but regarding this article, a problem remains. To discuss and attribute these figures, neutrally and avoiding OR, takes space, and increases the effective weight given to the subject (and frankly, we already devote a disproportionate amount of space to meatal stenosis when compared with the literature). Again, the subject of this article is circumcision, not detailed information about other conditions, so we don't actually need to include this information here. Jakew (talk) 23:16, 17 December 2008 (UTC)

HIV a complication of non-circumcision. Thats rich. I hear death is a complication of life. Garycompugeek (talk) 23:32, 17 December 2008 (UTC)

Yes, Jake, that's what the article says, thanks for correcting that. But you seem to miss the point that if results of studies published in reliable sources are relevant, they are relevant. This seems to apply to both HIV and meatal stenosis. I wasn't debating the wording nor the statement in the meatal stenosis article.

Your point about HIV, in which you argue that sources say HIV is a complication of non-circumcision, is moot since we do discuss HIV statistics here; namely, the stated percentile risk reduction in several groups obtained via a randomized controlled trial that was ended early. Do you agree so far? Thus I fail to understand the direction you're going with your comments.

Your claims about asserting one viewpoint (matched by another apparently independent source) echo my concerns about the emphasis given the WHO's viewpoint with respect to estimates of male circumcision prevalence. I agree that one source isn't enough, as I said previously we should expand on it and include the context behind any results that editors feel is necessary to preserve WP:NPOV. So let's do that both in this case, meatal stenosis, and with male circumcision prevalence estimates -- let's list the range of estimates and say something about the restrictions on the groups studied, when it's not clear we're discussing prevalence among circumcised and non-circumcised males in general (6-12 year old boys in the case of the 0.9% meatal stenosis study, 15 year old males and older in the case of the WHO's male circumcision prevalence estimates). Does that sound reasonable?

You statement that we don't need to include this information here is interesting. It seems to me that meatal stenosis' link to male circumcision is evident in the literature. For example, there are about 6410 hits in Google Scholar for "balanitis",[31] 1580 hits (about 1/4) for "balanitis circumcision".[32] Balanitis is discussed in two rather large paragraphs in the article. "Meatal stenosis" has 2420 hits in Google Scholar,[33] or about 38% of "balanitis." It seems to deserve at least a medium paragraph, which the article as it currently stands lacks -- and yet you argue that it already devotes too much weight to it. Does the presentation of this evidence cause you to change your assertions regarding weight? There are 827 hits for "'meatal stenosis' circumcision",[34] or about 1/3 of the hits for "meatal stenosis". Seemingly, a greater fraction of articles about meatal stenosis mention circumcision than articles about balanitis. In that light, I do not believe your point about not needing to include this information has been made. Do you have other suggestions? Blackworm (talk) 04:03, 18 December 2008 (UTC)

Also, in the interest of a balanced presentation, I should perhaps mention that as balanitis is inflammation of the glans penis, and meatal stenosis apparently is a condition females also experience, the statistics on hit counts of scholarly articles may be more suggestive that a shorter treatment of meatal stenosis is to be made here. This is of course to the extent one is willing to accept that "circumcision" also applies to females -- disputed here in the circumcision article, which in my view inappropriately takes a firm stance through its content and organization that it doesn't apply to females. Blackworm (talk) 04:09, 18 December 2008 (UTC)

Blackworm, I don't think I'm missing your point ("that if results of studies published in reliable sources are relevant, they are relevant"), but I think that some pieces of information are more directly relevant than others. I'd hope you'd agree that we cannot possibly include everything about either meatal stenosis or HIV here, so surely the question is which pieces of information are sufficiently and directly relevant to an overview article about circumcision?

You say that we do discuss HIV statistics, citing the RCT risk reduction figures, but these figures are a measure of an association between circumcision and HIV. They summarise, in essence, a consequence of circumcision: what effect it has on HIV, and the magnitude of that effect. As a hypothetical, if we were to list data on the prevalence of HIV in uncircumcised populations, I think it would be a better comparison with the meatal stenosis figures. But how relevant would that be to the subject of the article? If I found a source saying that, say, 40% of uncircumcised men suffered from the common cold in their lifetimes, it doesn't suggest that those 40% are attributable to lack of circumcision. To indicate that some of those cases are attributable to lack of circumcision, we'd need studies that compared rates in these two groups and found significant differences (ideally RCTs, in order to establish causation). The hypothetical source I mention isn't really a fact about circumcision, it's about the lifetime prevalence of the common cold in a particular subpopulation that happen to be uncircumcised.

You suggest listing the "range" of estimates and discussing the populations studied. In the meatal stenosis article, that makes some sense. Unfortunately, here I perceive several problems. Firstly, it isn't quite clear what you mean by "range". If you mean to synthesise a range (eg 0-11%) from the figures, then that might make it more difficult to discuss the individual populations (and could have OR implications). Alternatively, if you mean to list all estimates, then that would involve citing 9 sources. Furthermore, if we were to discuss populations studied we'd need to do so for all studies. Even allowing a mere 7 words per source to describe the population (which may be unrealistic - more may be needed), that means another 60 words or so, doubling the size of the paragraph.

I'm not quite sure what your searches are intended to show. By comparing '"meatal stenosis" circumcision' to 'meatal stenosis', you are effectively determining what proportion of articles discussing meatal stenosis also discuss circumcision, which is a broad measure of the relevance of circumcision in the context of meatal stenosis. But while that's a worthwhile question when deciding how best to edit meatal stenosis, that's not the question here. The question is how significant meatal stenosis is in the context of circumcision. Searching for 'circumcision' returns 58,500 results, so as a percentage of that "balanitis circumcision" is 2.7% and '"meatal stenosis" circumcision' 1.4% ("circumcision hiv", for comparison, returns 10,100 or 17.3%). PubMed returns broadly similar figures: 38/4,210 or 0.9% for meatal stenosis and 156/4,210 or 3.7% for balanitis. I couldn't agree more that the amount of text dedicated to balanitis is excessive (it ought to be a couple of sentences), as I've commented on previously. That's a problem and it should be dealt with; it shouldn't be used to excuse a disproportionate amount of detail elsewhere. Jakew (talk) 12:20, 18 December 2008 (UTC)

By that logic, circumcision should not be mentioned in the HIV article ("circumcision HIV" is 0.25% of "HIV"). But it is, and at length. By that logic, "female circumcision" is 15.2% of "circumcision," and thus should be treated at length here, at least given as much attention as HIV. It isn't, it's given zero weight. Clearly these criteria are modulated by other editorial opinion. Blackworm (talk) 20:40, 22 December 2008 (UTC)

TipPt: where are your arguments to support this proposed change? ☺Coppertwig(talk) 19:38, 21 December 2008 (UTC)

Meatal Stenosis (continued)

Jakew fails to remove surveys of incidence in circs of boys, and surveys (of incidence) taken at too early an age (before 2). Meatal stenosis develops when the circumcision took place during "nappy" age. That's why the Iran study must be qualified (versus his reverts).

Jakew fails to understand that meatal stenosis "is an under recognised complication" (in common surveys of complications) because presentation is so late (2 years old).

The problem of mucosa exposed by circs subject to friction and moisture in diapers especially at the tip of the penis/urethra. The problem is easily prevented if parents are given (wiki) the information. I find it untenable that editors question the emedicine review of literature figure of 9 - 10%.TipPt (talk) 18:53, 21 December 2008 (UTC)

Again, here are the sources:

“Meatal stenosis is a relatively common acquired condition occurring in 9-10% of males who are circumcised. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy is curative.” [35]

“Meatal stenosis is generally a direct consequence of circumcision that is seldom encountered in uncircumcised men; meatal calibre is know to be greater in uncircumcised individuals. The incidence of meatal ulceration following circumcision is from 8 to 20 per cent14,46,64. The aetiology is thought to be irritation of the external urethral meatus by ammoniacal substances present in wet sodden nappies. Such irritation is unlikely in the presence of a normal prepuce, which serves to protect the glans from these irritant substances46. In a prospective study of 140 consecutive neonatal circumcisions, Mackenzie64 found a 20 per cent incidence of meatal ulceration within the first 2-3 weeks after circumcision. It is thought that meatal ulceration after circumcision is the initiating event in a vicious cycle of stenosis and ulceration, followed by more stenosis64. Meatal stenosis following circumcision has been advanced as a cause of recurrent pyelonephitis and obstructive uropathy, for which meatotomy is curative64,65.”[36]

“Meatal stenosis is an under recognised complication of circumcision done in neonatal and nappy aged boys. Symptomatic presentation from meatal stenosis can be very late (two years).” [37]

“Traumatic meatitis of the unprotected post-circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis. CONCLUSION: Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.”[38]TipPt (talk) 18:53, 21 December 2008 (UTC)

While the emedicine article (Angel) states that there is a rate of 9-10%, I don't see where in the article it does a review of the literature on rates: if I missed it, please tell me specifically where in the article it is, as I didn't see anything about rates other than a plain statement of that one figure.

If you wish to add words about it being an "under recognized complication" you would have to provide sources to verify this, and arguments that it's an important enough fact to include in this summary article.

I wouldn't say during "nappy" age; the source says neonatal or nappy age. We don't know whether the circumcision could be much earlier than the wearing of nappies which causes the problem. ☺Coppertwig(talk) 20:12, 21 December 2008 (UTC)

See the list of emedicine article references; thus the 9 - 10% range. How can any editor consider emedicine biased, or consider themselves a better professional in the field?

We could provide other review article ranges, like the 8 - 20% in[39] for meatal ulceration (a precurser complication).

Jakew ... can you provide any other review of literature surveys?

The condition occurs because infants are circ'd who wear (probably loose) diapers; thus the need for "nappy" or similar. When circumcision occurs post diaper age, you rarely see meatal ulceration or stenosis; thus the need to carefully review studies.TipPt (talk) 18:09, 22 December 2008 (UTC)

I don't believe that anyone has suggested that Angel is biased, TipPt. However, as Coppertwig pointed out, there is no basis for stating that Angel's figures constitute a literature review. Your suggestion that it is derived from the references is not only speculative but contradicted by the facts: Angel's refs 9 and 10 are Stenram and Van Howe, reporting rates of 7.29% and 11% respectively. Neither of these figures, I hardly need state, lie in the range 9-10%. Perhaps 9-10% is Angel's own estimate. We have no idea.

It would also be interesting if you could provide sources to support your assertion that "When circumcision occurs post diaper age, you rarely see meatal ulceration or stenosis". Interestingly, in Stenram's study, which reported the highest rate of meatal stenosis, 84.8% of boys were 3 years or older at the time of circumcision. Jakew (talk) 19:54, 22 December 2008 (UTC)

Jakew ... the Stenram study found 11% (or 8% - 11%) meatal stenosis as a complication of "circumcision for phimosis". These kids had a medical problem treated by circ and might better be left out of a general population rate scale.

I guess we need to qualify the paragraph by saying "nappy" age circ, and also list damage to the frenular artery as a possible cause.

I was drawing personal conclusions from the articles ... Sorry. Rubbing/irritation and wet/caustic against mucosa in diapers is a common listed eventual cause of stenosis. You also see damage to frenular artery as a probable cause (Stenram?). I guess dry rubbing could also cause stenosis (Stenram?).

I thought you called the emedicine article 9 - 10% POV. The nature of the article is a neutral review. It's basically the nature of emedicine. Take a look at emedicines "circumcision" ... quite neutral. Wiki doesn't need Jakew to understand the basis of the statement (9 - 10%) before using this high quality source. Why do you think you are more qualified to judge complication rates? Right now, we have nothing for a significant complication. That is biased.

What range would you accept for the main topic page? How about a short list? In the sub article, how would it be qualified (by age? by technique? by source??TipPt (talk) 17:27, 23 December 2008 (UTC)

TipPt, like all authors, Angel has a point of view, but that doesn't necessarily mean that he's biased. His point of view is that the rate is 9-10%. Griffiths offers another point of view: that the rate is 2.8%. Still more authors offer different points of view. It doesn't matter whether you call them "estimates", "opinions", "points of view", or anything else, and it's generally unproductive to discuss whether sources are biased or correct or whatever. The most important thing is whether we have a fact or an opinion. Wikipedia defines a fact as: "a piece of information about which there is no serious dispute." But this doesn't seem to be the case here: any reasonable person will agree that these estimates differ, so clearly this is "a matter which is subject to dispute". In such a situation, asserting one point of view as fact violates Wikipedia's NPOV policy. So too does giving one point of view an inappropriate or disproportionate amount of emphasis (known as undue weight).

So citing only a single source is problematic from an NPOV perspective. We need to evaluate some alternatives. One option is to cite a representative (or even complete) set of sources. This is the approach followed in the meatal stenosis article, and to do so there makes sense, since the article is, after all, about meatal stenosis. Here it is less appropriate, for several reasons. Firstly, the subject of the article is circumcision, not meatal stenosis, and in-depth detail about the incidence of meatal stenosis does not belong here. Secondly, space is limited - the article is already too long and contains too many refs (even copying the sentence from meatal stenosis would increase the length of the article by 1.4K and 5 refs). Thirdly, we already give meatal stenosis far too much emphasis in comparison with reliable sources (see WP:UNDUE), and adding more material can only make the problem worse.

Fortunately, there is a simple, straightforward alternative: don't cite a rate. We don't need to do so here, as I've already mentioned, and in any case this information is not directly related to circumcision. Jakew (talk) 20:34, 23 December 2008 (UTC)

By not showing a rate you trivialize the complication. We have a very high quality source saying 9 - 10%. That source is better for the reader than nothing! The current text misrepresents the issue.

It's not given honest coverage as is. It is a fairly common, underreported (in many surveys of complications), and farily serious. All well sourced. 2.8% you find in one survey (mostly older kids again with medical problems), 9 - 10% (neonates) in another 8 - 11% (neonates) in another for related complication ... Again, what would you accept?

Length is not a valid reason to remove relatively relevant facts.TipPt (talk) 18:08, 24 December 2008 (UTC)

TipPt, we do have a source saying 9-10%, but that source is of no higher quality than the others (actually, it is of somewhat lower reliability, since unlike the others it does not appear in a peer-reviewed scientific journal). Certainly there's no reason to favour one source over others, especially when doing so would potentially give the reader a non-representative view of the literature. Quoting a single source might be excused if we were ignorant of the existence of differing figures in other sources, but we're not ignorant. We know that seven of the eight other viewpoints are lower than this range and one is higher. To suggest that citing a single source is "better for the reader than nothing" is not only completely incompatible with WP:NPOV, but effectively proposes to knowingly mislead the reader as to the shape of the literature. Jakew (talk) 19:04, 24 December 2008 (UTC)

Oh, so the e-medicine ref (Angel) is not from a peer-reviewed journal. What I noticed is that it isn't at all what I would all a literature review: it just states the rate 9-10% and has a list of refernces, that's all: I didn't see any discussion at all about the references. Typically a scientific article will list references of relevant studies in the introduction section; that doesn't make it a literature review. ☺Coppertwig(talk) 00:50, 30 December 2008 (UTC)

Removal of the disputed tag

It is improper for Coppertwig to remove the disputed tag. SEVERAL relevant facts, clearly listed, are actively denied the reader. Please see the above list of missing information. We have made some progress with meatal stenosis.

Coppertwig said he wasn't sure neonatal circs were considered "elective" and "non-therapeutic" by medical associations. Please glance at [40]. There is no medical condition in infants that is treated by circumcision. Ask Jakew.TipPt (talk) 18:37, 22 December 2008 (UTC)

I don't think it's improper. The facts are not actively denied the reader: they can be in the subarticles, which are conveniently linked to. Putting more material in the article effectively makes other material harder to find: the reader only has so much time.

You misquote me: I didn't say that. Please provide verification of your claim that "There is no medical condition in infants that is treated by circumcision". It would need a reliable source, not just Jakew's say-so; I consider it an extraordinary claim. ☺Coppertwig(talk) 18:50, 22 December 2008 (UTC)

Indeed. If we consider every conceivable fact relevant to circumcision, everything that has ever been written about the subject, that material would probably fill several bookshelves. So even if we wanted to, we couldn't include everything in one article: any article shorter than, say, the entire set of Encyclopaedia Britannica is bound to exclude some material. Stating that material is excluded isn't a valid reason for a tag. It isn't even a logical argument for inclusion. Jakew (talk) 19:24, 22 December 2008 (UTC)

We're talking about several significant missing facts Jakew, especially significant relative to the misleading or poorly referenced info frequently provided.

Copper ... you denied knowing routine neonatal circs were labled "elective" and "non-therapeutic" by med associations ... I provided you that proof. Why aren't those critical (to the assoc and reader) facts in the introduction? The fact that neonatal circs is so labled explicitly MEANS there is no medical condition being treated.

The jewish encyclopedia was one (of two high quality) source for the authentic jewish procedure [41] not some midwife? stated above.TipPt (talk) 17:25, 23 December 2008 (UTC)

TipPt: you said, "Copper ... you denied knowing routine neonatal circs were labled "elective" and "non-therapeutic" by med associations ". I did not. You have misquoted me again. Please stop misquoting me. You can greatly reduce the chance of either misquoting me or of taking my words out of context by using only direct quotes of entire sentences of mine. ☺Coppertwig(talk) 00:46, 30 December 2008 (UTC)

The Jewish encyclopedia article, from 1906, is based primarily on non-religious sources from the late nineteenth century. In the past, I've brought the source in from the actual Jewish Legal Code as to what the procedure should be. When making statements about the Jewish legal tradition, the actual code is preferable. If you follow the Talmudic sources brought in the JE, they states "probably after the war of Bar Kokba " and bring as the source Yevamos 72a, (http://www.e-daf.com/index.asp?ID=1722&size=1). Actually reading that text (see the link) shows that no mention of any new institution regarding milah. Rather that the Greeks took Jews and forcibly re-extended the skin on the penis over the glans, causing the circumcision to be hidden (called a Mashuch משוך), and in the times of Bar Kokba (or bar Koziba as called on Yevamos 72a) the Jews threw off the yoke of the Greeks, and were able to re-expose the circumcision. What is discussed there is the Rabbinic requirement to re-expose the glans if it was re-covered, but the original method always had the glans exposed. Now I know you do not know how to read Talmudic Aramaic or Rabbinic Hebrew, but I do, and anyone who can can corroborate what that text actually says (the piece beginning at the two dots, tannu rabannan). Also, here is a link in English for an outline of how the halakha has been developed from this piece, and notice, it discusses the Mashuch, someone whose skin has been re-drawn over the glans. -- Avi (talk) 17:54, 23 December 2008 (UTC)

Avi ... you seem to think 1906 is a long time ago, but you reference the dark ages? Actually, the texts we need to read would be really ANCIENT. Talmudic and Rabbinic texts are WAY after the fact, and based on oral traditions (ever played pass the message?). Historians rely on actual historical accounts from the period in question.

Avi ... I have provided two high quality sources ... the Catholic Encyc[42] and the Jewish encyc. You are not a better source. Why do YOU want to deny the reader facts?

Please see the peer reviewed published authors you are disparaging below:

• Emil G. Hirsch, Ph.D., LL.D., Rabbi, Sinai Congregation; Professor of Rabbinical Literature and Philosophy, University of Chicago; Chicago, Ill.
• Kaufmann Kohler, Ph.D., Rabbi Emeritus of Temple Beth-El, New York; President of the Hebrew Union College, Cincinnati, Ohio.
• Joseph Jacobs, B.A., Formerly President of the Jewish Historical Society of England; Corresponding Member of the Royal Academy of History, Madrid; New York City.
• Aaron Friedenwald, M.D.TipPt (talk) 18:08, 24 December 2008 (UTC)

I already provided you with a detailed historical account of peputial restoration[43] which also details the change in procedure (radicalization).TipPt (talk) 18:21, 24 December 2008 (UTC)

The Catholic Encyclopedia is NOT a reliable source when it comes to Jewish legal tradition any more than the Quran is a reliable source on Catholic traditions of praying to saints. Secondly, when you read the article in the Jewish encyclopedia, it is an assumption, "possibly..." and they bring a text from the Talmud as the source. However, the text of the Talmud does not support that, as any trained Talmudic scholar can tell you. So, you do not have any reliable sources for the orginal tecnique. You have one source that makes a guess based on what appears to be a misreading of the text. I brought the source from the Jewish Legal code itself (Yoreh Deah 264:3) where it clearly states that the glans must be revealed. That is the only authoritative source for traditional Bris Mila. -- Avi (talk) 19:05, 24 December 2008 (UTC)

Just being from a long time ago doesn't make something unreliable. Some kinds of information become outdated or obsolete; others do not, or at a much slower rate. When you want to establish what happened a long time ago, sources from around that time can be very useful. ☺Coppertwig(talk) 00:46, 30 December 2008 (UTC)

CopperTwig, The Shulchan Aruch Yoreh Deah is unchanged since the sixteenth century. The Arba'ah Turim (Tur) Yoreh Deah predates that by around 250-300 years, and the Talmud predates that by around 500 years. Age is not the issue, accuracy is :). Jewish tradition basically followed the Talmud-->Shulchan Aruch until Reform Judaism broke off in the eighteenth century, and Orthodox Jewish tradition still follows it today (although there have been more recent glosses). -- Avi (talk) 05:07, 30 December 2008 (UTC)

Studies

It's hard for me to tell, but have the studies referred to in this article been taken into consideration? 69.243.66.74 (talk) 21:11, 20 December 2008 (UTC)

Not really. HPV's link to circumcision seems covered in the article, perhaps a mention that HPV increases the risk of cervical cancer in women seems unrelated to male circumcision. Then again, this is a secondary source, and they saw fit to mention the link, and its concerns seem related to ethics and this one level of indirection may be a valid addition to the article. What do others think?

It also interestingly mentions that "[Dr. Ronald Gray of Johns Hopkins University in Baltimore and colleagues] noted that the American Academy of Pediatrics does not recommend routine circumcision for newborns." Also, we quote the AAFP as stating, "Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive" in the footnote reference. Maybe you feel should be mentioned in the prose instead? Perhaps the news source is indeed reliable, and should be used in the article. Blackworm (talk) 23:14, 20 December 2008 (UTC)

In general, it's best to avoid citing the popular press on medicine and science-related subjects; they are not sufficiently reliable (see WP:MEDRS#Popular press. Thus, although it is a secondary source, the peer-reviewed papers themselves would be preferred. The abstracts of these studies may be found at PubMed: Nielson, Warner, and Auvert.

The study by Nielson et al. is interesting and doubtless valuable as a part of the literature, but by itself it is no more important than any of the other dozen or so (at a rough guess) observational studies of HPV and circumcision that have been conducted to date. While Warner et al. is a study of HIV rather than HPV, the situation is otherwise similar. It would probably be reasonable, I think, to include both in the detailed article, medical analysis of circumcision. I can't think of any particular reason to select these particular studies for inclusion here: the question "why these studies rather than one of the tens (or perhaps hundreds, in the case of HIV) of other studies?" would be difficult to answer.

The Auvert study is somewhat different. It is the first randomised controlled trial to report results on HPV and circumcision, and as such it is a high standard of evidence (see WP:MEDRS#Assess evidence quality). I think it would be wise to include it as well as meta-analyses of observational HPV data. Jakew (talk) 11:18, 21 December 2008 (UTC)

Is it my correct understanding of the Auvert study that HPV was not measured in the two groups at the start of the study, but was only measured once 21 months later? If so, wouldn't that effectively make this an observational study with respect to HPV, rather than a randomised controlled trial? Conceivably the HPV rates could have been 14% and 22% in the two groups at the start of the study as well, unless I'm not understanding something. Blackworm (talk) 19:39, 7 January 2009 (UTC)

As far as I can tell (from what is, I admit, a brief reading of the full text), your understanding is correct in that HPV testing was performed only at 21 months after randomisation. However, this does not mean that it isn't an RCT. The most important difference between an RCT and, say, an observational cohort study is that circumcision status (or more generally, the intervention) is assigned at random as part of the experiment. By contrast, in our hypothetical cohort study, men are either already circumcised or they aren't, and there might be associations with behaviour, etc., that we are unaware of (for example, circumcision might be associated with religion, and in turn with higher or lower levels of alcohol consumption, promiscuity, etc). The rates could have differed significantly at the start of the study, but it is rather improbable. Consider what it would mean. Because you're assigning men to one of the two groups on the basis of a random number - say a flip of a coin - any pre-existing characteristics of those men will tend to be distributed roughly equally in the two groups (given reasonably large groups). The randomisation process could 'preferentially' assign HPV positive men to one group, just as a non-weighted coin could give a sequence of fifty consecutive 'tails', but in both cases that outcome would be unlikely, and one could calculate exactly how unlikely. Jakew (talk) 22:26, 7 January 2009 (UTC)