Talk:Circumcision

missing sections from this Circumcision article rendering it substandard for "good article" status recently awarded

Putting aside the lightning quick recent reversions of any edit diverging from the pro circumcision selective plucking out of bits from even the permitted sources, here are some topics, some of which are covered well in the french and german language wikipedias and some of which are documented in the current sources of the english wikipedia article overleaf but never permitted to be mentioned in the article.

Missing sections from this Circumcision article :

1/ The recent successful spate of lawsuits in the USA taken by adult children against their parents who subjected them to male circumcision in infancy.

2/ The horrific statistics in the WHO article( reference number one in the WP MC UK article !) on death and injury to circumcision victims in non medical settings worldwide.

3/ Wallerstein's study showing circumcision has no effect on penile cancer.

4/The 3,600 jewish male infants who risk life long infection or infant brain damage or death due to herpes each year in New York as they are subjected to the male foreskin cutter sucking the penis wound orally just after.

5/The danger of legal liability for parents, doctors, and others who inflict genital mutilation on children.

6/ The several different "cuts" of circumcision( high and low et cetera) - see photos in the french language article here - some good photos there too of the actual cutting -perhaps an editor more skilled than I could import them to this aticle. http://fr.wikipedia.org/wiki/Circoncision#L.27acte_chirurgical_et_ses_cons.C3.A9quences .

7/ The estimate of 117 deaths per annum from infant male circumcision in the USA alone. The kinder estimate of 1 in 500,000 from a position paper is, however included. Does it stretch the bounds of credulity that in the USA no firmer record is available of these deaths other than estimates ?

8/The massive reduction in the popularity of circumcision in the USA in recent years.

9/ Adult male circumcision for vanity or aesthetic reasons. This is analogous to a similar operation to the external labia on the female genitals

10/ Harvesting, sale price, and the many research, cosmetic, and cloned skin manufacture uses to which the cut off foreskins are put.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:14, 27 February 2013 (UTC)

Please sign your talk page posts per the cheatsheet thanks. Can you provide a full reference or PMID or DOI for point 4? Biosthmors (talk) 21:09, 25 February 2013 (UTC)

I don't see anything wrong with including an estimate on point 7. What source does so? Biosthmors (talk) 21:13, 25 February 2013 (UTC)

References for both in french wikipedia article--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:14, 27 February 2013 (UTC)

The same fantastic "estimates" by a refrigerator magnet salesman that have been debunked only about half a million times already? Tuma, you deserve some sort of award for sheer dogged persistence :D 94.1.48.14 (talk) 05:04, 28 February 2013 (UTC)

Could it be that we include one position paper on circumcision deaths (1/500,000 infant deaths annually in the litigious USA )estimate and reject another( 9/100,000 infant deaths annually in USA also ) for the same reason that we are relying on estimates and not statistics in the first place - misreporting or underreporting of the deaths due to litigation fear amongst doctors - also the stats for non doctor developing world deaths due to male circumcision far outstrip both above internal USA estimates above per the WHO --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:42, 28 February 2013 (UTC)

@Biosthmors-per your request above -reference link for the 3,600 jewish male infants in NYC each year whose mohel sucks their penis with his own mouth immediately after cutting the tip off it :"The city believes about 3,600 male infants are circumcised with direct oral suction each year and estimates their risk of contracting herpes at roughly 1 in 4,000. The Centers for Disease Control and Prevention has called the procedure unsafe and recommended against it." fourth paragraph from article end http://www.nytimes.com/2012/09/14/nyregion/health-board-votes-to-regulate-jewish-circumcision-ritual.html?_r=1& --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 12:39, 11 March 2013 (UTC)Notable ?

Yes, notable and already covered by Wikipedia in the appropriate location here. Many things you suggest have already been covered before, please do take a moment to search this article's Talk page archives before posting questions, as you are advised to do in the large information box at the top of this Talk page:

Discussions on this page often lead to previous arguments being restated. Please read recent comments, look in the archives and review the FAQ before commenting.

Cheers... Zad68 13:06, 11 March 2013 (UTC)

Of course it's not covered in the present article, because that would detract from the present article's reinvention of circumcision as a medical, rather than cultural, operation. Hans Adler 13:08, 11 March 2013 (UTC)

3,600 kids at risk of death or permanent brain injury, or lifelong infection annually from an involuntary elective cultural practice involving genital cutting and excision, and adult child oral-genital contact, in one of the richest cities in one of the world's richest countries, and highlighted by the local health authority as an ongoing risk in the most eminent newspaper of record is not a fact that should be shunted off to the backwater of a sub-article. It should be in this article. It is remarkable that there exists a cohort of editors in WP who actively enforce a directly contrary policy unchallenged.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:25, 15 March 2013 (UTC)

Babies circumcision paraphernalia, and other objects related to the american culture of neonatal circumcisions

As mentionned earlier, this article should mention the circumstraint, a table generally used to strap babies during neonatal circumcisions in the United States.
It could also more widely describe the culture of neonatal circumcisions in the United States and the paraphernalia related to it, with objects like this Infant circumcision home trainer, which would be considered utterly disgusting in most other cultures.--92.135.169.62 (talk) 20:15, 26 February 2013 (UTC)

We don't source content like you are suggesting to advertisements. Zad68 20:19, 26 February 2013 (UTC)

We don't have to name the brands, the Circumstraint is just the most common "newborn immobilizer" (item only used for neonatal circumcisions).--92.135.169.62 (talk) 20:29, 26 February 2013 (UTC)

Is the Circumstraint notable, by the way? One could create the article, perhaps. If the kinds of sources we've used to write the article discuss it, then we could mention it in the article. Biosthmors (talk) 21:29, 26 February 2013 (UTC)

We know, we know -nothing negative about knob-chopping is notable --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 01:56, 28 February 2013 (UTC)

/sigh The above formulation does tend to indicate a conflict between the personal point of view and Wikipedia editing, sadly. -- Avi (talk) 16:31, 3 March 2013 (UTC)

Apparently it's hard not to have strong feelings on genital mutilation, one way or the other. Hans Adler 16:57, 3 March 2013 (UTC)

And it is also hard not to have strong feelings about circumcision as well, that is understood. One can edit Wikipedia whilst having strong opinions, as long as the edits are made in accordance with NPOV. It is when the edits are guided more by personal opinion than policy that we have issues. Using potentially inflammatory language, language whose purpose seems to be to inflame ones opponents, on the talk page of a contentious article indicates someone whose command of editing within policy has problems, at least to me. Thank you. -- Avi (talk) 18:16, 5 March 2013 (UTC)

Am I detecting some irritability related to an accurate description of the process of cutting off functional parts of genitals for cultural reasons? At least when it affects only boys? You seem to be merely confirming what I said. Strong feelings on both sides. Hans Adler 15:30, 6 March 2013 (UTC)

I don't think so; I was, am, and will continue to agreeing with what you said (I've said similar myself many times). Circumcision engenders strong feelings. Genital mutilation engenders strong feelings. Many concepts engender strong feelings (Look at the list of ArbCom editing restrictions for a few dozen examples). That is the nature of humanity. We have policies to help us build a project despite the fact that we are all human and share the capability for both emotion and logic. So, as long as we all agree to abide by the appropriate and applicable wikipedia policies and guidelines, we should be able to contribute here positively. That has always been my plan, at least. -- Avi (talk) 17:45, 6 March 2013 (UTC)

The saddened "Tut Tut" style of defending this unswervingly pro circumcision article and concomintant resistance to including a picture other than the spreading to the unconvinced rest of the world of the diminishing yet gung ho USA attitude to male child chopping echoes one of its chief and influential USA past proponents; Kellogg- who wanted male penis tip chop off done with no anaesthetic and also was keen on burning the clitoris with acid. Naturally under the current editor regime this article is prevented from exploring such parallels between chopping male and female child genitals. Anyone with a tither of wit reading this article can see this process in action and its continuation merely serves to diminish the credibilty of Wikipedia. The unintentionally hilariously saddened tut tutters failed to notice the alliteration and its economy in expressing a suggestion about balance and inclusiveness of information . To read the article one would have no clue about the huge variety of cutters, tools and methods other than doctors in the foreskin cutting cultures around the world. Reference number one (-the W.H.O.) one is excellent on this particular subject but strangely these sections of the WHO article are ignored in the WP article. Can anyone skilled lift the photos of circumcision in progress from the french WP "circoncision" article - I think they would improve this one a bit --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:21, 11 March 2013 (UTC)

Regarding the "circumcision in progress" image, we actually had a discussion and an RFC about images not too long ago and the current image selection meets with that consensus. We also actually have an active request out to the WHO to get their permission to use their images. As soon as we have approval we'll have access to more good-quality and informative images.

Feel free to stop making personal attacks and start using article Talk pages only for their intended purpose at any time. Zad68 03:28, 11 March 2013 (UTC)

Feel free to desist from characterizing input on content and editing practice as a "personal" "attack" - which person was attacked per prevous entry  ? Feel free to attempt to address the issues raised instead of sidestepping them with the spurious.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:54, 11 March 2013 (UTC)

Per WP:NPA and WP:TPNO, editors should not use article Talk: pages to "characterize... editing practice". That would also include making references to "unintentionally hilariously saddened tut tutters". Jayjg ^(talk) 18:49, 17 March 2013 (UTC)

@ Jaygig - I quite agree on your point about characterizing input on content and editing practice as personal attack when it is not (If indeed that was your point ?). Even those who "sigh" or self describe as "saddened" as a comment on the good faith suggestions of other editors with fresh or contrasting content ideas may desist from sharing their emotions in the future. Such patronizing responses may discourage or inhibit the editor they are directed at and also discourage other potential editors who see such unconstructive comments made and left unchallenged by administrators--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:41, 18 March 2013 (UTC)

implements and other materials used to circumcise human penis worldwide per World Health Organisation

The primary W.H.O. 2007 report on circumcision

Male circumcision:global trends and determinants of prevalence, safety and acceptability

lists many methods, tools, and healing procedures in worldwide circumcision variations which take place in non medical settings devoting 3 pages of a 30 page article to it.

We have not so far managed to be so proportionate here in this WP article.

The relevant section is on pages 19 to 21 .http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf

It is fascinating to read of Turkish barbers and drummers, Jewish church officials, Sudanese and South African Xhosa tribesmen and others using penknives.razor blades, sea shells, plant leaves and other implements and unguents in their ritual cuttings of the penis tip. The ethiopian jews who often require a second circumcision if they immigrate to Israel( as the local "cut" is in a different style) are worth a mention too.

Are we giving undue emphasis to USA practices in foreskin removals in direct contravention of WP policy at present ?

Is the article then giving the false impression that MC is safer than it really is at least elsewhere ?

Here are three illustrative instances in the W.H.O. report missing(so far !) from WP MC article adverse effects section ....  :

40–50 deaths annually following ritual circumcision in South Africa. 243 deaths plus 214 genital amputations for circumcisions between 1995 and 2004 in one region of South Africa alone.

the Xhosa in South Africa use unsterilized unwashed blades on many victims of circumcision in a single day's session of cutting.

The WHO cite a study amongst the Babukusu in Kenya where 21 of twenty four of the circumcisions observed ( 12 trad ones and 12 medical ones ) "suffered adverse events", none were healed after 30 days and 7 men -that is 29% had permanent adverse sequelae.

WP:CPVIO removed, source is the WHO's Male circumcision: Global trends and determinants of prevalence, safety and acceptability, p. 21. Zad68 13:35, 11 March 2013 (UTC)

http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf

It will be interesting to see these practices and results put up against the flawed and curtailed studies so heavily featured in WP article trumpeting the usefulness of MC in supposedly diminishing HIV in Africa.

Here is the WHO non med adverse effects part - it is certainly more comprehensive than ours and includes clinical screw ups too. It is remarkable that the stats from Africa seem better kept than the stats from USA where policy and this article are based on estimated deaths.

WP:CPVIO removed, source is the WHO's Male circumcision: Global trends and determinants of prevalence, safety and acceptability, p. 20-21. Zad68 13:35, 11 March 2013 (UTC)

http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:16, 11 March 2013 (UTC)

Tumadoireacht, it's against Wikipedia's policies regarding copyright to copy and paste enormous sections of copyrighted documents like that. You've provided the link, all you have to do is describe what sections you are talking about, interested readers can easily click on the link. As a favor to you, so that you don't run into trouble regarding Wikipedia's policies in this area, I've removed the copyrighted material and replaced it with a description of where in the document the material can be found. Zad68 13:38, 11 March 2013 (UTC)

Thank you Zad. I have sought WHO permission in the interim. For the moment I have modified my references based on your advice. I believe the warershed for quoting using quotation marks is a max of seven words. I remain confident your speedy excision will not inhibit discussion of the issues and we will allow ourselves the time to improve and balance the article before any premature attempt to seek featured article status--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:16, 11 March 2013 (UTC)

Great, thanks Tumad. My understanding of your main suggestion is that coverage of circumcision in non-clinical settings should be expanded. I have no objection to that and am happy to collaborate, but of course we need to make sure it's done in accordance with Wikipedia policy, especially regarding due weight, and the new content is located appropriately. On Wikipedia, "due weight" means that the emphasis given in the article is in proportion with the prominence found in reliable sources, and for this subject, reliable sources overwhelmingly consider circumcision as a clinical procedure and discuss its medical effects, especially regarding HIV. That is the reason for the present organization of the article.

The content you appear to be suggesting generally should be expanding the existing Society and culture sections. African tribesmen and Aboriginals are both already described there but more detail could be added. The Aboriginal use of sea shells is mentioned in History but more from the WHO document could be added in Society and culture, also content in Religious male circumcision could be expanded.

Regarding your other points, for the USA, our sources indicate that catastrophic complications such as death are so extremely rare that there is not an exact complication rate calculated from them per se but rather they are tracked only as individual case reports; this is already in the article.

You also mention the article is using "flawed and curtailed studies" and presumably you would like to seem them removed from the article? Which sources specifically are you suggesting are not reliable? Please provide the PMIDs and we will investigate the fitness of the specific sources you are questioning.

Cheers... Zad68 15:07, 11 March 2013 (UTC)

Perhaps the 50 deaths annually in one region of South Africa alone from circumcisions which the WHO choose to feature in their definitive circumcision document would be better mentioned in the adverse effects section rather than in the cultural or history section as you oddly suggest. Ditto the risk to 3,500 children annually of herpes or death in NYC which the local health authority drew attention to.

Perhaps you missed the point about at least 10% of the WHO article content on MC being given over to consideration of the adverse effects that I listed above. The WHO reported that 457 boys lost their lives or their entire genitals in a nine year period within one region of South Africa due to circumcision yet our WP article currently ignores this statistic. Can any editor enlighten me how an article maintained in such an ignorant state can so readily attain "good article' status ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:12, 15 March 2013 (UTC)

Sorry, it's unclear what specific edit you are suggesting, based on what WP:MEDRS compliant sources. Jayjg ^(talk) 18:53, 17 March 2013 (UTC)

Which bit of the WHO article ( very first reference in the reference section of this WP article) section on adverse effects are you having difficulty understanding ? My suggestion is to include these WHO statisitics on death or entire genitals loss or lifelong infection in the WP MC adverse effects section rather than the culture section which another editor prefers .Pages 19 to 21 of the WHO article referenced three times in the entry above. Any clearer ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:44, 17 March 2013 (UTC)

The procedure is most often elected for religious reasons , personal preferences and "hygiene"

1-The procedure is most often elected for religious reasons , personal preferences and "hygiene"

UNAIS > Male Circumcision: context, criteria and culture (Part 1) 26 February 2007 health and sexual benefits In more recent times, perceptions of improved hygiene and lower risk of infections through male circumcision have driven the spread of circumcision practices in the industrialised world. In a study of US newborns in 1983, mothers cited hygiene as the most important determinant of choosing to circumcise their sons, and in Ghana, male circumcision is seen as cleansing the boy after birth. Improved hygiene was also cited by 23% of 110 boys circumcised in the Philippines and in South Korea, the principal reasons given for circumcision were ‘to improve penile hygiene’ (71% and 78% respectively) and to prevent conditions such as penile cancer, sexually transmitted diseases and HIV. In Nyanza Province, Kenya, 96% of uncircumcised men and 97% of women irrespective of their preference for male circumcision stated their opinion that it was easier for circumcised men to maintain cleanliness. http://www.unaids.org/en/Resources/PressCentre/Featurestories/2007/February/20070226MCpt1/

2-Reasons Parents May Choose Circumcision There are a variety of reasons why parents choose circumcision. Medical benefits, including:Easier genital hygiene.AAP/ http://www.healthychildren.org/english/ages-stages/prenatal/decisions-to-make/pages/Circumcision.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token — Preceding unsigned comment added by Nguessanx (talk • contribs)

Sorry, not sure what point you're trying to make. Jayjg ^(talk) 18:52, 17 March 2013 (UTC)

Probably this: By having a section "Indications and contraindications" with very little cultural discussion, this article gives undue weight to the retroactive medical justification attempts for a non-medical practice rooted in religion and superstition and sometimes also performed as cosmetic surgery, even on babies. A reader of this article with no prior knowledge of the topic might well believe that circumcision is primarily performed to treat actual phimosis or out of a hope to get one or more of a variety of supposedly proved tiny positive effects.

This is patently not the case. The incidence of phimosis requiring any treatment at all is quite low in countries in which circumcision is not practised for ritual or fashion reasons, and it can usually be treated non-surgically. (The supposed positive effects were 'proved' only recently, after the earlier 'medical' anti-masturbation indication became thoroughly unacceptable, FGM became clearly outlawed, and children's rights became more of an issue, suggesting that the practice of male circumcision without medical indication might soon become illegal.)

The title of this article is "circumcision", not "circumcision with medical indication". That needs to be reflected by the article's content. Hans Adler 23:29, 17 March 2013 (UTC)

The flavour of response from many of the editors who maintain the current state of this article seems to have changed recently to minimal engagement with all suggestions for a wider consideration of the subject within the article on the talk page, coupled to lightning quick reversions of any material in the article without prior discussion, which does not conform to a pro circumcision agenda and painting a picture of it as a safe, necessary, and homogenous medical procedure only . The suggestion has been made that excision of female infant breast material at birth as a way of reducing rates of breast cancer in adulthood belongs to the same school of logic as many of the arguments here selected for inclusion on MC. @Hans Adler - you give, as so often before a succinct and perceptive précis. If you were not averse to barnstars I would nail one up.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:58, 18 March 2013 (UTC)

Hans, if I understand you correctly, you are concerned that this article gives too much weight to the medical aspects of the procedure vs. the cultural aspects, and support this by providing your personal views on the procedure's medical effects. It is fine for you to have that perspective, however for Wikipedia articles we must look to the emphasis as found in the sources, per WP:DUE. You're concerned that someone new to the subject reading the Wikipedia article would come away with the impression that circumcision is a medical procedure. If that same unknowledgeable person were to go to Google Scholar and do a search on "circumcision" for up-to-date sources, that's exactly the impression that person would have. Do this for yourself: Go to Google Scholar, and search for "circumcision" in sources published in, say, the last 10 years. My review of the first 40 results shows that all 40 results were discussion of circumcision's medical aspects, as a medical procedure. By far the #1 most important topic was circumcision's effects on HIV, with about 75% of the results relevant to that topic. Most of the other results were circumcision's effects on other STDs, medical practice guidelines, and other medical topics. A non-medical article "Circumcision by Barbers in Rural India: A Scientific Study of an Ancient Method" didn't appear until result #98, the next was at about #130. Now look at the Wikipedia article; it correctly reflects the emphasis found in the sources. (As a control, to make sure Google Scholar is searching non-medical source database, I also did searches on the body-modification topics "Padaung neck rings" and "foot binding", which returned non-medical sources from JSTOR and other databases almost entirely.)

Second, please note that well over half the article is devoted to non-medical aspects such as history, culture, religion, and ethical and legal issues. That fact that circumcision is elected for non-medical reasons is the very first thing mentioned in Indications and contraindications, and the discussion in Society and culture of its use by the various cultures and religions is actually larger than what is found in the Indications and contraindications section, so I am not really understanding why you feel there's a problem here, especially given the actual emphasis as found in the sources. In fact, as it currently stands, a proposal based on WP:UNDUE to reduce the amount of emphasis placed on the non-medical aspects would be hard argue against, although I am not proposing this. Zad68 04:15, 18 March 2013 (UTC)

Indications and Contraindications is a medical term and its prominent placement does not reflect the wide variation in ways in which circumcision is inflicted upon children worldwide. Is there any link from this article to the WP Forced Circumcision article for instance  ? http://en.wikipedia.org/wiki/Forced_circumcision

A great deal of the World Health Organization 2007 Circumcision document is given over to the awful adverse effects of medical and non medical circumcisions in half a dozen settings worldwide as i have mentioned several times recently on this talk page yet this due weight is presently unreflected in our article.

The severe ostracizing of male and female uncircumcised in many cultures from the Jewish one for males to current african and aboriginal ones for male and female is unincluded too.

The current article reference to such severe social shunning by Jews of their uncircumcised brethren as "severe negative spiritual consequences" is an odd euphemism. What earthly source confirms a severe negative spiritual consequence ? Better to describe the actual confirmable negative social consequences .This section also self contradicts stating " Circumcision is not required by Judaism for one to be considered Jewish" and also "over 90% of adherents having the procedure performed as a religious obligation."

Shunning of the uncut amongst other circumcision cultures, including the USA one also goes unmentioned.

This following contemporary material from the History of Circumcision article more properly belongs in this one :

http://news.bbc.co.uk/2/hi/africa/3069491.stm -death and damage from "botched" "bush" circumcisions

Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection. [50] A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns.[51] A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience."[52] A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons."[53] A 2005 study speculated that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.[54] In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".[53] In the United States, statistics (1999) collected by the National Center for Health Statistics show that the overall rate of neonatal circumcision had remained near 65% since data collection began in 1979.[55] However, strong regional differences in the circumcision rates have developed during this time. While more than 80% of newborn boys are circumcised in the Midwest and South, circumcision rates have declined to about 37% in the West in 1999.[56] This has been attributed in part to increasing births among Latin Americans, who usually do not circumcise.[57]

Circumcision in the 21st century

The AMA states that "virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice.".[50] Specifically, major medical societies in the USA,[58] Britain,[59] Canada,[60] Australia and New Zealand[3][dead link] do not recommend routine non-therapeutic infant circumcision. The AAP advises that "Physicians counseling families concerning this decision should assist the parents by explaining the potential benefits and risks and by ensuring that they understand that circumcision is an elective procedure."[58] Some have voiced ethical concerns about the procedure. See Bioethics of neonatal circumcision for more information. Neonatal circumcision nonetheless still remains the most common pediatric operation carried out in the U.S. today.

The South African Children's Act (No. 38 of 2005) has made the circumcision of male children unlawful except for medical or religious reasons.[61] For current circumcision rates, please see prevalence of circumcision. Studies indicate that male circumcision can reduce the chance of HIV infection in heterosexual men.[62] A criticism of encouraging the adoption of adult male circumcision in areas or populations heavily affected by HIV is that even in the best of studies the measure is merely reductive, not preventative, and may embolden the recipient of the operation to willfully undermine the demonstrably safe methods of serial monogamy and condom usage with new partners; for a more thorough look at the scientific research visit Circumcision and HIV. The AMA remarked that, in one study, physicians in "nearly half" of neonatal circumcisions "did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son. Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision."[50]

As of July 2011, eighteen American state Medicaid programs had discontinued payment for non-therapeutic circumcision.[63] On 7 May 2012 the Cologne, Germany Regional court (Köln Landgericht) ruled that parents could not grant consent for ritual (non-therapeutic) circumcision of children.[64]--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 10:27, 18 March 2013 (UTC)

Zad68, your argument from Google Scholar search results is not valid because it does not take into account the different publication practices in various fields. The fallacy is easily demonstrated by Google Scholar searches for other topics that are clearly not primarily medical topics, either (numbers in each case out of the first 10 hits):

• children: 4 medical/psychological articles.
• dogs: 9 medical/veterinary articles.
• sleep: All 10 articles of a medical nature.
• abortion: 5 medical articles, 1 on flowers, only 4 on ethics/policy/politics/sociology.
• drink: 8 medical/dietetic articles.
• report: 7 medical/psychology articles.
• study: 5 medical articles.
• are: 6 medical articles.

In the case of circumcision, the skewed numbers are absolutely predictable based on the following:

• Much lower scholarly standards and much higher pressure to publish in the medical and related sciences than in other scholarly fields. Also much more money for research.
• People in the third world who practise circumcision with rusted knives don't write about it, and it's not very easy to study them.

(I didn't try to make this list complete.)

I don't know if "elective" counts as a medical indication, but it's certainly misleading to treat it as one in an encyclopedia for general use. The section does its best to detract from the fact that circumcision is normally inflicted for non-medical reasons by describing it in convoluted language and putting under the misleading sub-heading "routine or elective". Under "Indications and contraindications", routine circumcision is off-topic because "routine" is not a medical indication. The obvious purpose of mixing this up here is to avoid an honest sub-heading such as "Non-medical motivations" and contextualise "elective" as "elective as opposed to routine", where it should be "elective as opposed to medically indicated". Hans Adler 12:13, 18 March 2013 (UTC)

"Elective" (or other forms of the word) and its synonyms are what is used in the sources, so that's what's used in the article.

Sorry, I'm not seeing how these search results are a counterargument to my statements; if anything, they support them. For example, my impression is that abortion is a medical procedure that has a very strong social component, and the Google Scholar abortion search results bear that out. Your observation that not much is published about "circumcision with rusted knives" is not an argument to emphasize it more, per WP:DUE. If you don't think reviewing Google Scholar search results is a good way to do it, can you suggest a different way of reviewing the sources to ensure the article complies with WP:DUE?

In addition to it being forbidden by WP:TPG, I have found that it is almost never productive to discuss speculations about editors' motivations ("The section does its best to detract...", "The obvious purpose of mixing this up here is to avoid an honest sub-heading...") on an article Talk page so I will not be engaging you in a discussion on that here, and request that you do not either, please. Zad68 13:00, 18 March 2013 (UTC)

I have carefully read the WP:TPG page referenced directly above. It does not include the word "forbidden" nor the idea. There exists a danger in too readily citing policy pages hoping they contain the exhortations one might wish for without checking that they actually do. That particular policy page DOES contain an exhortation to discuss edits however. An editor who comments on patterns of editing, reverting, mis-labelling or material selection which lead to an article being unbalanced, is not attacking any other editor nor commenting on personality. An editor who characterizes such discussion as contrary to policy might however be seen as attempting to intimidate, or to stifle exploration of ways to improve the article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:00, 18 March 2013 (UTC)

You are welcome to report me to an appropriate noticeboard if you think it's appropriate or helpful. I certainly disagree with your opinion that you can censor my vivid descriptions of how the article is formulated and the effects it has on readers, and force me to use boring, impersonal, rhetorically weak language – just because someone (I have no idea who or even how many) has written it.

To be clear: I am not claiming that anyone, let alone anyone in particular, has done this on purpose. The problem could also be caused innocently by self-selection in connection with cultural and professional bias. In which case my accusation of what the article wants to do can be read as a wider one against status-quo-stabilising effects in the circumcising culture(s) which has/have ultimately written this article. I am being so explicit now, once, because you have prompted it with your overreaction.

I am not going to change my approach unless forced. This article is seriously biased. Any attempts to censor accurate descriptions of details of the problem are totally inappropriate, and I will resist them. Hans Adler 14:29, 18 March 2013 (UTC)

PS: Perhaps I should explain why I am still not actually working on the article, just complaining. The reason is that it's incredibly frustrating to source anything here, especially to the impeccable standard required for improvements due to the hostile atmosphere. The main problem is that sources of the kind that have so far been used primarily are generally not available free on the internet (especially from Europe; Google Books is more generous in the US), are very expensive, and are not readily available to me from my university library. Hans Adler 14:44, 18 March 2013 (UTC)

Hans, I had an independent editor, SandyGeorgia (talk · contribs), review the article and she had some very positive things to say about the high standard of the article's sourcing here. I'm sure we can all agree that meeting a standard of high-quality sourcing can only help an article. Zad68 18:50, 18 March 2013 (UTC)

European comment on AAP's 2012 policy statement

The AAP has published in their journal Pediatrics a four-page commentary from a number of (mostly) European researchers and physicians, criticizing what they describe as the AAP's "cultural bias". The commentary seems mostly to criticize not technical findings but what the AAP stressed in making their 2012 policy statement. The one thing that seemed useful was their critique of the applicability of circumcision as an effective tool to reduce the spread of HIV/AIDS; I've updated the article to include this commentary in the list of those critiquing this aspect. The AAP also provided their response alongside it. Zad68 12:44, 18 March 2013 (UTC)

Instead of simply adding the reference might it be more pertinent/useful to add a paragraph not unlike your entry on this talk page to the article itself ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:35, 18 March 2013 (UTC)

That would make it all too obvious that most Western medical authorities reject non-therapeutic neonatal circumcision, and "we" don't want that. Just read the second paragraph of the article: "positions [...] range". Never mind that for Westerners, only one is remotely positive on NNC (though the Canadian one is apparently about to go "neutral"), and this very commentary was penned by "a number of (mostly) European" senior specialists, who include heads of several national pediatric societies. 188.194.186.113 (talk) 16:01, 18 March 2013 (UTC)

The commentary that you refer to (http://justasnip.files.wordpress.com/2013/03/pediatrics-2013-frisch-peds-2012-289611.pdf) is proof of the American cultural bias and poor quality of this Wikipedia article. We still have ridiculous statements such as "Circumcision does not appear to decrease the sensitivity of the residual tissues of the penis, harm sexual function or reduce sexual satisfaction" which have no basis in scientific or medical fact. The 5 sources provided are not evidence and I've linked to 40+ sources that contradict that one. However, my sources have been ignored. Remember that the worldwide medical community including all medical organizations worldwide have views and opinions IN LINE WITH the commentary I've linked to. It is only American medical organizations with a profit motive that say otherwise. Wikipedia has always had a very difficult time with understanding conflict of interest. It's mentioned the policy guidelines, but this guideline is never followed. Crimsoncorvid (talk) 22:05, 18 March 2013 (UTC)

Be sure to read the AAP's response to the European commentary as well: http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2013-0081.full.pdf+html?sid=9ce60386-ec70-4cfc-b3f5-1235d8ad2ff1 Zad68 22:44, 18 March 2013 (UTC)

That response is hogwash. Sorry, try again. That commentary is NOT reliable or credible but rather the blathering nonsense by a group of quacks trying to protect their precious cash cow. They do an absolutely terrible job of refuting the original commentary and dismiss the ethical, legal, and harm aspects of circumcision with hand-waving and vague statements. It mentions Diekema as a contact who supports FGM and some very dubious, unethical medical practices. He has absolutely no credibility within the medical community. Furthermore, he is a pro-circumcision advocate and carries with him the same conflict of interest concerns that the AAP does. What's next, a BP study on Deepwater Horizon showing that no harm came to sea life is sourced on Wikipedia? Or how about a study by a pedophile of how sex with children doesn't harm them? Who are we kidding? Again, COI is NOT taken seriously here on Wikipedia... it's about time it did. Sorry, but a response that mentions a Jewish circumcision advocate does not hold any water against a commentary by 17 worldwide medical professionals. Crimsoncorvid (talk) 23:40, 18 March 2013 (UTC)

So, nothing about e.g. the horrendous STD rates in the circumcised US. Nor about the objections regarding UTIs by Frisch et al. Instead they further invoke e.g. the WHO, whose European Action Plan for HIV/AIDS makes not even a single reference to circumcision. Lucky for them that Frisch et al did not mention Freedman, whose statements include just how proud he is to personally have religiously circumcised his son on his parents' kitchen table (which, if your editing history is any indication, you probably don't find questionable). I look forward to how Frisch et al will continue this conversation - the commentary included heads from 19 European pediatric societies, after all. -- 188.195.2.19 (talk) 16:43, 20 March 2013 (UTC)

Holm Putzke (he is responsible for the whole discussion in Germany), a law professor of the University of Passau (Germany), said about the AAP and their statement : "Erstens handelt es sich um eine von Lobbyisten beeinflusste Erklärung. Denn zu dem Verband gehören auch die US-amerikanischen Geburtshelfer. Vor allem für sie ist das Beschneiden von Neugeborenen ein profitträchtiges Geschäft. Ihre Umsätze brachen ein, nachdem sich die AAP in den Jahren 1999 und 2005 noch gegenteilig geäußert hatte. In der aktuellen Stellungnahme findet sich der verräterische Hinweis, dass die Kehrtwende der AAP ausdrücklich von den Geburtshelfern unterstützt wird. Zweitens bestand die Projektgruppe der AAP selber aus zahlreichen Beschneidungsbefürwortern, die teilweise sogar ihre eigenen Kinder hatten beschneiden lassen. Es liegt doch auf der Hand, dass solche Leute zur Rechtfertigung des eigenen Verhaltens die Vorhautamputation harmlos finden wollen und bestrebt sind, irgendetwas Nützliches daran zu entdecken. Drittens hat die Projektgruppe aktuelle Studien ignoriert oder jedenfalls bei der Gesamtbetrachtung unberücksichtigt gelassen, unter anderem zu den Auswirkungen der Vorhautamputation auf die Sensibilität und zu den Folgen der erlittenen Schmerzen. Viertens haben weltweit zahlreiche kinderärztliche Verbände dem AAP-Pamphlet energisch widersprochen – kurz: die AAP steht mit ihrer Fehleinschätzung inzwischen weltweit völlig isoliert da." (http://hpd.de/node/14709). 37.206.22.25 (talk) 10:16, 19 March 2013 (UTC)

A crude google translation of the preceding passage for me and other non german speakers : First, there is an influence of lobbyists explanation. For the Association to include the U.S. obstetricians. Especially for them to trim newborn is a profit-oriented business. Their sales plummeted after the AAP had in 1999 and 2005 still expressed otherwise. In the current opinion, is the telltale indication that the turnaround of the AAP is expressly supported by obstetricians. Second, the project team consisted of the AAP itself from many circumcision advocates, who had in some cases even their own children to be circumcised. It is quite obvious that such people in order to justify their own behavior will find the foreskin amputation harmless and seek to discover anything useful about it. Third, the project group has ignored recent studies, or at least disregarded in the overall analysis, including the impact of the foreskin amputation of the sensitivity and the effects of the pain suffered. Fourth world numerous pediatric associations have the AAP pamphlet objected vigorously - in short, the AAP is now worldwide with their misjudgment completely isolated. "--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:50, 19 March 2013 (UTC)

Putzke is not "responsible for the whole discussion in Germany", it had been going among experts on for years. If anyone is "responsible" for the publicity, that unfortunate boy of Muslim parents who almost bled to death is. -- 188.195.2.19 (talk) 16:43, 20 March 2013 (UTC)

sorrels et all

"Circumcision ablates the most sensitive parts of the penis.".

Very simple. No secondary source in the article (or elsewhere) appears to contradict this. It would be original research to construe the tangentially related generalization in the listed secondary sources to somehow contradict this primary source. Furthermore, not everything suitable for mention in wikipedia can necessarily be found in a secondary source.Zebulin (talk) 15:32, 18 March 2013 (UTC)

Secondary sources are required for medical content. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:38, 18 March 2013 (UTC)

The AAP 2012 Technical Report is a secondary source that explicitly lists and comments on Sorrells, along with many other primary studies, in coming to its conclusion "The literature review does not support the belief that male circumcision adversely affects penile sexual function or sensitivity, or sexual satisfaction, regardless of how these factors are defined." We have several other secondary sources that do the same. Sensitivity is something we have good-quality, up-to-date secondary sources covering, so there's no need to include individual primary studies like Sorrells or others. Zad68 15:48, 18 March 2013 (UTC)

For the purposes of improving the article, how are good quality secondary sources distinguished from poor quality secondary sources? (a link to a relevant wikipedia policy page would be welcome as a response as well). <edit> nevermind. The archives for this article direct me to http://en.wikipedia.org/wiki/Wikipedia:MEDRS enough to get the hint. Zebulin (talk) 15:58, 18 March 2013 (UTC)

Even that AAP Report still mentions "There is fair evidence from a cross-sectional study of Korean men of decreased masturbatory pleasure after adult circumcision." -- 188.194.186.113 (talk) 16:08, 18 March 2013 (UTC)

(ec) You can't contradict a primary source with a secondary source that discusses a slightly different question. It is consistent that cutting off the most sensitive tissue of the penis would not adversely affect "penile sexual function or sensitivity, or sexual satisfaction, regardless of how these factors are defined". However, there are methodical problems that have less to do with how these factors are determined and more with what is determined in whom. E.g., the type of sexual feelings in the subject, the partner(s) or both could be changed without necessarily affecting overall satisfaction. ("Wow, it's different now and still quite good! How nice to have a change!") Or the increased satisfaction of subjects whose premature ejaculation problem was solved or who switched to anal sex, which they found too painful previously, could statistically compensate serious and problematic loss of sensitivity in the same number of other subjects.

The two studies cited by the AAP as supporting no effects or positive effects were made in Africa (Uganda and Kenya – two countries with high rates of FGM, a fact that may or may not be relevant), and while I have no reason to doubt the AAP's characterisation of these as "the most rigorous in design" (after all, where else but in Africa can you find subjects who are prepared to undergo circumcision when there is no relevant cultural background, or to serve as the control group when there is?), I also see no reason to trust the details of execution of these studies, as it must be hard if not impossible to prevent bragging by analphabetic subjects interrogated by nurses. Hans Adler 17:09, 18 March 2013 (UTC)

There is fair evidence that men circumcised as adults demonstrate a higher threshold for light touch sensitivity with a static monofilament compared with uncircumcised men; these findings failed to attain statistical significance for most locations on the penis, however, and it is unclear that sensitivity to static monofilament (as opposed to dynamic stimulus) has any relevance to sexual satisfaction.132 There is fair evidence from a cross-sectional study of Korean men of decreased masturbatory pleasure after adult circumcision.

- we also see that the authors of the aap policy statement are not denying that circumcision ablates the most sensitive areas of the penis but in fact are limiting comparison to those areas examined by Sorrels et all that are not excised by circumcision and can be directly compared between the two groups. They are obviously not comparing the most sensitive areas of the the two groups or indeed examining any of the data collected from areas of the penis ablated by circumcision and this is clear from the wording in the statement.Zebulin (talk) 16:19, 18 March 2013 (UTC)

- Here are some useful quotes from WP policy and articles on secondary sources

"many sources can be considered either primary or secondary, depending on the context in which they are used. Moreover, the distinction between primary and secondary sources is subjective and contextual, so that precise definitions are difficult to make.

legal writers usually prefer to cite primary sources because only primary sources are authoritative and precedential, while secondary sources are only persuasive at best.

examples of secondary source materials include a summary of the literature in the Introduction of a scientific paper published in a journal, a description of what is known about a disease or treatment in a chapter in a reference book, or a synthesis written to review available literature.

primary sources avoid the problem inherent in secondary sources, where each new author may distort and put their own spin on the findings of prior cited authors."

As Circumcision is a bio-psycho-socio-legal cultural phenomenon sometimes executed in a medical setting or for a medical reason but often not, the standards often mentioned here for exclusively medical articles do not apply to it. On this particular point there are many historical. religious, and social secondary sources which record and discuss the acknowledged recognition of circumcision's diminishing effect on sexual pleasure for the male through the ages, and for some cultures, most notably Jewish culture it has been a primary purpose of male circumcision. Some posit a similar reduction in pleasure for the female from MC . or in masturbation, both for mostly hydraulic and mechanical reasons. The history of circumcision article is particularly good for these secondary sources.http://en.wikipedia.org/wiki/History_of_male_circumcision So far there has been great resistance to the idea of including these sources in the English language "main" MC WP page.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:49, 18 March 2013 (UTC)

Actually, for claiming that circumcision as practised today objectively does or does not have a certain measurable effect, we clearly do need WP:MEDRS quality sources. On the other hand, for claiming that 100 years ago physicians practised circumcision in order to prevent masturbation, this standard is obviously totally irrelevant and inappropriate. Many things that are or should be mentioned are somewhere in the continuum between these two poles. Hans Adler 17:18, 18 March 2013 (UTC)

furthermore from

Further information: Wikipedia:Secondary does not mean independent

:

"Secondary" is not, and should not be, a bit of jargon used by Wikipedians to mean "good" or "reliable" or "usable". Secondary does not mean that the source is independent, authoritative, high-quality, accurate, fact-checked, expert-approved, subject to editorial control, or published by a reputable publisher. Secondary sources can be unreliable, biased, self-serving and self-published.

According to our content guideline on identifying reliable sources, a reliable source has the following characteristics:

* It has a reputation for fact-checking and accuracy.

* It is published by a reputable publishing house, rather than by the author(s).

* It is "appropriate for the material in question", i.e., the source is directly about the subject, rather than mentioning something unrelated in passing.

* It is a third-party or independent source, with no significant financial or other conflict of interest.

* It has a professional structure in place for deciding whether to publish something, such as editorial oversight or peer review processes.

the aap and other professional organization secondary sources listed in the article are all self published and not subject to third party review. Therefore, they should, in fact, be regarded as less suitable for the article by wikipedia policies. There is nothing about a professional organization that discourages it from making extremely biased or even willfully inaccurate publications to serve it's own stated agendas.Zebulin (talk) 18:10, 18 March 2013 (UTC)

There is a danger in attempting to over medicalise many aspects of human experience. It is unlikely that medical science or any other hard science will provide an objective measure of comparative pleasure despite Sorrell and the like proving diminished penile sensitivity post-chop. We rely, in its absence, on the wisdom I have already cited. A western medical circumcision in a hospital removes at least 20,000 nerve endings (an FGM only removes 8,000); a tribal one can remove many more and leave more troublesome scarring, that is if the victim survives. No study in the areas of Africa where MC is being pushed as a help to quell HIV has taken the scarrings and subsequent increased openness to infection in such circumcisions into account. The cases counted as having avoided HIV through circumcision had a six week rest from sex activiity post chop and were given sex ed and condoms while the control group had no such break from sex --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:19, 18 March 2013 (UTC)

Luckily we don't have to worry about doing our own analysis here; in fact, we are instructed not to. Instead, we rely on reliable secondary sources to do that for us, and we simply cite the sources. Zad68 18:46, 18 March 2013 (UTC)

Unfortunately creating articles is not that simple - we select from amongst a wide variety of sources -primary, secondary and tertiary and from within those sources selected we choose to give prominence to some material and to minimize or ignore others (such as the deaths of circumcision victims in South Africa that the WHO thought notable but we do not) Cabals arise and articles suffer.--— 

⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:17, 18 March 2013 (UTC)

given that the AAP policy statement is self published with no 3rd party review how is that an acceptable secondary source?Zebulin (talk) 20:12, 18 March 2013 (UTC)

Earlier in this very thread you mentioned that you had found WP:MEDRS; didn't you see where that document says "Ideal sources for biomedical material include... medical guidelines and position statements from nationally or internationally recognised expert bodies"? Zad68 20:30, 18 March 2013 (UTC)

exactly what I am criticizing here. how are these bodies recognized?Zebulin (talk) 21:39, 18 March 2013 (UTC)

Let's not forget that the AAP is not a reliable source. It is not reliable due to conflict of interest. It is a professional organization that profits (as well as its member constituents) from promoting circumcision. But as I've mentioned before, Wikipedia doesn't seem all that interested in following COI guidelines. Crimsoncorvid (talk) 22:09, 18 March 2013 (UTC)

The AAP's technical reports are absolutely considered reliable on Wikipedia. There is a secondary source in the article we can use to identify major medical organizations, and then we can look at the methodology used to identify and evaluate the evidence. Zad68 22:39, 18 March 2013 (UTC)

The AAP contradicts other professional organisations of similar standing. They are of course all reliable sources, but due to the political conflict they all fall under WP:RS#Biased or opinionated sources and must be treated with particular care. The AAP's opinion doesn't trump the others just because it's the only American one and Wikipedia's servers are located in the US. Wikipedia is a world-wide project. Hans Adler 23:20, 18 March 2013 (UTC)

Exactly! Zad68, please explain why the AAP carries more weight than the opinions of at least half a dozen medical organizations of similar standing? Why are American organizations more "reliable"? Why isn't it equal to the Dutch medical organization? Crimsoncorvid (talk) 23:33, 18 March 2013 (UTC)

Hans, sorry, you appear to be responding to something I didn't say. Agree that the particular policy recommendations of each medical organization would only be useful to cite the opinions of each respective organization, but we're not using any medical organization's policy recommendations in this article, so I'm not sure why you're mentioning this. Zad68 03:29, 19 March 2013 (UTC)

I was talking about the AAP task force's biased evaluation of the literature. It also contradicts similar conclusions by similar organisations, not just the policy recommendations. Otherwise it wouldn't make much sense that the policy recommendations are so different. Hans Adler 09:20, 19 March 2013 (UTC)

Zad68, you are playing the usual game and ignoring the important point we're bringing up. British, Dutch, Swedish, Australian, and German medical organizations all disagree with the AAP. That makes the AAP's opinion qualify as "fringe" which, as Jakew told me (and you supported him), that it's not worthy of inclusion on Wikipedia. The policy statements provide comprehensive coverage ethical and legal issues in addition to the issues of foreskin function and harm. Policy statements should serve as a guideline for the content of this article since they've vetted the evidence that is out there in the medical community. You are continuing your crusade to present an American point of view here and it is not right. Please read my previous comments; I've brought up some good points which have been ignored. Crimsoncorvid (talk) 12:33, 19 March 2013 (UTC)

Crimson, I see you started a new section about the AAP specifically below. Thanks for doing it that way, it's better when we discuss one issue per section. Responses are below. Zad68 03:30, 20 March 2013 (UTC)

A NEW STUDY

http://www.jamaicaobserver.com/magazines/allwoman/Male-circumcision-decreases-penile-sensitivity--study-shows_13833454

New studies show that circumcision reduces penile sensitivity.

So the part in the article that states that circumcision does not affect one's sex life needs to be changed. 99.55.142.31 (talk) 23:36, 18 March 2013 (UTC)

So the anonymous troll mentions something that's not even in the article. Nice. Please read: "This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population," the researchers said." Nowhere in the article does it say circumcision doesn't affect one's sex life. Nice try. Crimsoncorvid (talk) 00:13, 19 March 2013 (UTC)

Cite every primary source mentioned by the secondary, or just the conclusion?

In an edit to the article, Driftwoodzebulin proposed adding the following to the article under Adverse effects:

However, there is "fair" evidence of decreased masturbatory pleasure after adult circumcision.

sourced to the AAP's Technical Report. I had removed it as we already cite the AAP's overall findings in this area, and we had not been in the habit of citing all the individual primary studies mentioned in the secondary sources - we're only citing the main conclusions of each area discussed. In response, Driftwood suggested "feel free to add the other 10 sourced bits of info not already presented in the article" so I went ahead and did that, I put together what it would look like if instead of citing the conclusions, we cited all the individual primary studies mentioned. So, the proposal is to add (something like) this entire paragraph to the article:

Two large, good-quality trials involving thousands of men found that men circumcised as adults reported both less pain during sexual intercourse and significantly increased sexual satisfaction over time. One of these studies also indicated that nearly two-thirds of the circumcised men reported significantly increased penile sensitivity, and that over half the men circumcised found achieving orgasm easier, although this last finding was not statistically significant. Other studies of significantly worse design failed to provide evidence of sufficient quality to conclude that a circumcised penis is less sensitive than an uncircumcised one. There is both fair and good evidence from different studies to indicate that circumcision makes no significant difference in sexual sensation or satisfaction. There is evidence of fair quality that a circumcised penis is less sensitive to a light touch from a wire on certain parts of the penis, although this finding appears to be irrelevant to sexual function, and there is fair evidence of decreased masturbatory pleasure after adult circumcision.

Is this an improvement? In my assessment, no: It's WP:UNDUE, it doesn't use the secondary sources in the way intended (which is to use them to synthesize the primary sources for us), and doing this for all the secondary sources used throughout the article would make the article some ten times larger than it currently is, and much less readable. Zad68 03:20, 19 March 2013 (UTC)

This was a seriously problematic edit, and I have reverted it. As the article already alludes to, though hidden under History → Modern times, circumcision was a popular treatment of masturbation until fairly recently. To judge from the medical section that would be totally puzzling as apparently the ability to masturbate is only interrupted for 4-6 weeks after the operation. But of course that's not true. As every man knows or should know, the normal method of male masturbation makes critical use of the foreskin. (The only information about the foreskin's functions, which include lubrication and pheromone production, that I can find is also in the paragraph about Victorian circumcisions: "the foreskin was seen as harboring infection-causing smegma".) This information is being kept out of the article through exaggerated demands on reliable sources discussing it. Even the openly biased AAP committee found that they couldn't just hide the issue totally. Decreased masturbatory pleasure when the standard method is impossible or severely impacted is by no means surprising and in fact is and has been considered [one of] the main purpose[s] by many, including Maimonides and physicians right into the 20th century. Hans Adler 06:15, 19 March 2013 (UTC)

This edit was not constructive. I can see how referring to the penis as it remains after circumcision as "the remaining tissues" is problematic, but the solution is obviously to find a better description for the problem that the sensitivity comparisons are and cannot be made in some of the most sensitive tissue because that no longer exists after the circumcision. If a study found that eye-sight is not impaired after removing the healthy left eye for cultural reasons, it's unlikely that we would even mention it. But if we did, we would certainly mention that that's eye-sight as measured in the right eye only. I used the formulation "remaining parts of the penis". Maybe there is a better formulation, but don't just remove this clarification.

Jmh649 immediately reverted my edit before I had even finished the present comment. I restored it. Hans Adler 06:32, 19 March 2013 (UTC)

Hans before you continue reverting it might be good to get consensus here first. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:45, 19 March 2013 (UTC)

Jmh659, before you revert another editor's obvious structural improvement of a section, it might be good if you think about a rational argument that you can offer. Otherwise it's indistinguishable from pure edit warring to prevent a POV status quo.

I am now specifically talking about your revert of these two edits of mine. By combining it with another revert (which you just repeated without engaging my argument), you have made the changes a bit less obvious. But maybe we can first discuss why you find it better to mix up HIV prevention with non-medical motivations in a section about "Indications and contraindications", even when that requires mentioning HIV prevention twice in subsequent subsections. Hans Adler 06:58, 19 March 2013 (UTC)

Circumcision is typically divided into elective / routine and as a treatment for a medical issue. Was primarily the heading changes I have an issue with. Restored the other change. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:06, 19 March 2013 (UTC)

Before we continue: Are you trying to argue that "elective" or "routine" are medical indications in some technical sense? Hans Adler 07:11, 19 March 2013 (UTC)

No what I am saying is that this is how the procedure is usually discussed. The ref in question uses it a couple of times. [1] I do not agree with you changing it to a different term because you some how do not like it. By the way referring to the APP as a "biased or opinionated source" by Hans in this edit summary [2] raises concerns. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:14, 19 March 2013 (UTC)

To the contrary. I would say that you denying that an AAP statement that contradicts statements by numerous other similar professional organisations all over the world falls under WP:RS#Biased or opinionated sources raises concerns. I explained the problem above. To put it a bit pointedly: Who is biased? The AAP, the KNMG, or both? As they are seriously contradicting each other for no apparent reason, they can't be both unbiased. In my opinion it's clearly the AAP that is biased, in yours it may be the KNMG. (Or don't you see the contradiction?) The way such situations are usually handled in Wikipedia is by treating both sides as "biased or opinionated".

Obviously this applies only to the extent that the organizations do contradict each other. The default way of dealing with medical professional organizations is to treat them as basically unbiased on medical issues even when they could affect income, and evidence to the contrary would have to be more extreme before we could treat such a source as so biased that it approaches unreliability. Hans Adler 07:31, 19 March 2013 (UTC)

So the KNMG states "in general, circumcision for medical/therapeutic reasons is not controversial". With respect to sexual function KNMG states "Many sexologists contradict this idea: in their view, the foreskin is a complex, erotogenic structure that plays an important role ‘in the mechanical function of the penis during sexual acts, such as penetrative intercourse and masturbation" Yes that would be expert opinion and expert opinion referenced to Med Hypotheses, which by the way we at WP:MED in English do not allow due to issues around much of what it publishes being fringe. Feel free to ask for further input if you want. A strong consensus would be needed before the AAP however is deemed biased. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:43, 19 March 2013 (UTC)

I haven't checked the details of your response yet, but this is what a constructive response looks like. The AAP and the KNMG contradict each other in their conclusions. Therefore a statement that supports the AAP opinion cannot safely be sourced to the AAP alone without attribution. By examining what the KNMG has to say (or other organisations that similarly contradict the AAP) and citing them as appropriate, we may be able to remove the attribution. Unfortunately you removed it prematurely, twice, without improving the sourcing and before engaging in this discussion. [3] [4] Hans Adler 07:57, 19 March 2013 (UTC)

(ec) Thanks for the partial self-revert. [5]

I have no problem with the terms routine surgery or elective surgery. I do have a problem with misleading subheadings. According to all sources which discuss this, including several MEDRS standard ones, the motivations for circumcision are overwhelmingly non-medical. This is true even for circumcisions done by physicians. The section Circumcision#Indications and contraindications currently groups all non-medical motivations together in a single subsection, which is already problematic. Then it further conflates the issue by mixing it up with the issue of routine circumcision. Routine circumcision is a complex topic related mostly to prevalence, hygiene, education of parents and disease prevention. It is also somewhat related to non-medical motivations for circumcision, but not so much that the section on non-medical motivations would be the logical place to discuss it.

Non-medical motivations are of course not discussed extensively in the medical literature because they are totally off-topic there. But this article is not medical literature, it is an encyclopedia article about circumcision in general, with all its aspects. It must treat all motivations for circumcision with due weight, regardless of whether they are medical or non-medical. Hans Adler 07:47, 19 March 2013 (UTC)

So that is the thing the KNMG and the AAP in there substance do not really contradict each other. Both recommend circ for treatment of certain conditions. Neither recommended universal circ. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:10, 19 March 2013 (UTC)

This seems to be a response to my 7:57 comment further up. It has nothing to do with my 7:47 comment immediately above. I would have moved it, but now I can't because I am not sure what Tumadoireacht below at 8:23 is referring to.

Please be careful where you put your responses, especially when defending an article that has come under attack as biased. Making discussions confusing benefits the status quo in such cases and would be seriously disruptive behaviour if done on purpose. Conversely, defenders of the status quo should be particularly careful not to create chaos. Hans Adler 08:33, 19 March 2013 (UTC)

The chief confusion here may be the conflating of health and medicine. The WHO, and others discuss in detail non medical circumcisions at length with "due" proportion including grievous and mortal sequelae. So far, contrary to WP policy, we do not.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:23, 19 March 2013 (UTC)

Sorry if we butted heads on an edit conflict Hans. My point does not relate directly to the reversion etiquette discussion. I have since taken the bull by the horns and added 3 references to the adverse effect section. Most of the article layout is still seriously skewed/ flawed particularly the section headings.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:14, 19 March 2013 (UTC)

Edits should follow wp:medrs. Picking specific primary studies to highlight something violates wp:medrs and wp:undue. Heptor _talk 12:31, 19 March 2013 (UTC)

If wp:medrs will be used to banish from all wikipedia articles that even tangentially relate to medicine any information contrary to any summarizing statement found in any secondary source unless it is backed by a summarizing statement from another secondary source then obviously wp:medrs will have not only ceased to have any value to wikipedia it will even stand in direct opposition to principles upon which wikipedia has been built over these years. The vast bulk of extant medical knowledge does not appear in summarizing statements in secondary sources. The 2012 AAP circumcision policy has been hugely controversial amongst medical professionals worldwide and the article as written now treats the AAP summary statements as infallible statements of scientific fact.Zebulin (talk) 00:25, 20 March 2013 (UTC)

The intent is to follow Wikipedia policy in using reliable secondary sources to do the evaluation, analysis and synthesis of the primary sources for us. If the secondary source makes specific mention of a primary source it reviewed but does not include the specific finding of that particular primary source in its synthesis, that's a good indication there wasn't enough good-quality evidence to make the conclusion. This sort of thing is exactly the value of good secondary sources. If you have questions about how WP:MEDRS is to be applied you can ask at WT:MEDRS or WT:MED. Zad68 03:57, 20 March 2013 (UTC)

I have questions about the appropriateness of WP:MEDRS in wikipedia. As written it seems far more likely to be harmful to wikipedia and its readers on almost any topic it touches than to have any redeeming qualities.Zebulin (talk) 14:27, 20 March 2013 (UTC)

This type of mega-revert is totally inappropriate without a much better justification, so I have reverted it. There is no way that your blanket statement can justify all aspects of that edit. If you want to have say in the direction of this article, you will have to do more than just revert to an old version every now and then. That's pro-status-quo edit warring.

For the record, as it was tricky to find out: Heptor's 2013-03-19 12:23 revert went back 19 versions [6] to Zad68's 2013-03-18 18:54 version, or equivalently to Jmh649's 2013-03-18 15:30 version, or equivalently to Zad68's 2013-03-18 12:43 version. Hans Adler 17:34, 20 March 2013 (UTC)

Hans, your revert was inappropriate and I was disappointed to see you do this. Clearly there is no consensus for the changes, just look at this Talk page; just the description you provided of the edit history indicates three separate editors who disagree with the changes proposed. Zad68 18:49, 20 March 2013 (UTC)

I think you should read WP:BRD. There was no consensus for the proposed changes because they placed too much emphasis on outdated or irrelevant mortality data and singled out a single primary source from many used in a secondary source. Please work with other editors for consensus. Plot Spoiler (talk) 18:59, 20 March 2013 (UTC)

Penis sensitivity after circumcision

The following problem is not being constructively addressed so far, due in part to other things being discussed at the same time. It's about the following passage:

"Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction."

The anatomical definition of the penis includes the foreskin. (I don't expect anyone to deny this, but if someone does, please do it explicitly.) As the tip of the foreskin (in flaccid state) is felt distinctly from the remainder of the penis and is highly sensitive, this statement is problematic. (In my personal experience: In flaccid state, the part of the foreskin that is removed in circumcisions feels like a separate organ, and it is definitely much more sensitive than the glans. Just saying, for the benefit of those who never got the chance to have this experience and so are likely not aware of the extent of the issue.)

Recent related edits:

• long-standing(?) version: "sensitivity of the penis"
• 2013-03-18 16:41: "sensitivity of the residual tissues of the penis" Driftwoodzebulin "clarification"
• 2013-03-18 18:54: "sensitivity of the penis" Zad68 "accurify to source"
• 2013-03-18 06:21: "sensitivity of the remaining parts of the penis" Hans Adler "Clarify that post-circumcision sensitivity is not measured in the cut-off foreskin."
• 2013-03-18 06:23: "sensitivity of the penis" Jmh649 (no explanation)

I am copying my earlier explanation of the problem:

This edit was not constructive. I can see how referring to the penis as it remains after circumcision as "the remaining tissues" is problematic, but the solution is obviously to find a better description for the problem that the sensitivity comparisons are and cannot be made in some of the most sensitive tissue because that no longer exists after the circumcision. If a study found that eye-sight is not impaired after removing the healthy left eye for cultural reasons, it's unlikely that we would even mention it. But if we did, we would certainly mention that that's eye-sight as measured in the right eye only. I used the formulation "remaining parts of the penis". Maybe there is a better formulation, but don't just remove this clarification.

Jmh646 immediately reverted my edit before I had even finished the present comment. I restored it. Hans Adler 06:32, 19 March 2013 (UTC)

So far there was no response to this post.

Meanwhile I have flagged an unusual and serious citation problem with the sentence. [7] Sometimes it makes sense to combine several sources in a single citation footnote. Here, the sentence is supported by a an alphabetic footnote saying:

For "Circumcision does not appear to have a negative impact on sexual function," please see references: [AAP_2012][sadeghi-nejad_2010][perera_2010][doyle_2010]

This is not appropriate for two reasons: (1) The sentence in question goes far beyond the statement in the footnote, so the statements about penile sensitivity and sexual satisfaction are technically unsourced. (2) It is impossible to find out which of the four references, if any, are supposed to support these other statements without reading them all. Hans Adler 09:13, 19 March 2013 (UTC)

I believe at least one of the studies that supposedly support the statement really measured sensitivity in the glans, which appears logical. I would consider "sensitivity of the glans" a good solution if that is supported by the sources overall, but I have trouble checking this due to the strange indirect citation method. Hans Adler 09:47, 19 March 2013 (UTC)

Thank you Hans for clarifying this important issue. It's been scattershot, I guess. What we have here is a bunch of circumcised men who don't want to admit they've been harmed or a functional part of their penis removed. Men always get upset when they're told their penis is inadequate. So, as a result, they ignore science/evidence that would make them feel inadequate. Crimsoncorvid (talk) 12:29, 19 March 2013 (UTC)

@ Crimsoncorvid - while i agree with many points you make about the weaknesses of the current article, please do not ascribe/ describe/denigrate other editors in this way. It is against the rules here, gets dealt with pretty severely, and only serves to have other editors take your arguments less seriously and those you oppose more seriously . The assume good faith dictum can be hard to stick to but it is a good starting point. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 12:40, 19 March 2013 (UTC)

(edit conflict)

I think you're overstating the problem. The explanatory footnote and associated references are currently used to support two sentences, one in the lead ("Circumcision does not appear to have a negative impact on sexual function") and one in the section on adverse effects ("Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction."). The principal source supporting the statement in the body of text is the AAP Technical Report (3rd item in footnote 5). The Technical Report states: "Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction." This source alone would support the article content. I'd probably recommend removing the explanatory footnote and just creating a single bundled citation including sources on sensitivity, sexual function and satisfaction. The source in Footnote 20, this paper, reviews the literature for male circumcision and sexual function concluding that " most recent articles do not show evidence of adverse effects on sexual function". It does discuss a single study on male circumcision and sensitivity, stating: "The effect of adult MC on men’s sexual function and pleasure was also evaluated by the investigators of the previously reviewed Kisumu, Kenya, randomized controlled trial of circumcision to reduce HIV ... Changes pertaining to increased penile sensitivity were reported by 64.0% of the circumcised men and approximately half of the circumcision group reported significantly increased ease of reaching orgasm at month 24. These changes notwithstanding, the authors concluded that MC was not associated with sexual dysfunction." The source in Footnote 21, this paper, states: "The evidence suggests that adult circumcision does not affect sexual satisfaction and function"; it doesn't say anything about sensitivity. I can't access the article in the Journal of Urology.

Incidentally, the following review paper, which is not currently included in the article, might be a decent source on the general topic of sexual function and male circumcision.

FiachraByrne (talk) 12:45, 19 March 2013 (UTC)

I think Fiachra's comment is accurate. The AAP 2012 Technical Report by itself would be enough to support the article content, but given the history of this article's Talk page, it's justified to augment that one source with the three others. To prevent the appearance of WP:OVERCITE it's correct to bundle the sources used into one ref. The article citation was done with a bundled lettered footnote ref, but could also be done with a straight bundled ref as suggested, I'm fine with either.

I knew about PMID 22452415, Review: a critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries by Morris et al. but chose not to include it. The pedigree of that article (and several others like it) would easily make it a WP:MEDRS and qualify for use here but because some people find Morris's personal advocacy views unacceptable, I didn't include Morris. Also, PMID 22452415 wasn't necessary to use. Equally, I have avoided including sources from others viewed to be engaged in advocacy against. However, if someone were to add that source to the article, I wouldn't be able to come up with a solid WP:MEDRS-based reason to argue against it. Zad68 13:12, 19 March 2013 (UTC)

Re Morris - it should be included, I think. It's peer-reviewed and reviews and critiques the relevant literature. If there's a similar MEDRS source that takes the opposing view it can also be included (with appropriate evaluation of "weight" and "due", etc).FiachraByrne (talk) 13:25, 19 March 2013 (UTC)

What might be even better than individual articles pulled from this and that journal are the chapters from this book: Surgical Guide to Circumcision. It's an authoritative reference work published just late last year on the subject, and parts VI and VII of that book cover "the case against" and "the case for". Morris (and Cox) wrote one of the chapters in the "the case for" part, the other chapter in that part is "Circumcision, Sexual Function, and Sexual Satisfaction." "The case against" covers "Circumcision: Case Against Surgery Without Medical Indication", "Care and Conditions of the Uncircumcised Phallus", and "A Comment on Informed Consent". Doc had a look at it and he felt it was top-tier WP:MEDRS, and we already cite it in the article. I can work on getting those chapters. The advantage to using a particular book's chapters is that an authoritative source, the editors of the book, have done the selection of balanced material for us. Zad68 13:36, 19 March 2013 (UTC)

Looks good. FiachraByrne (talk) 21:32, 19 March 2013 (UTC)

@Zad -your rationale as outlined above for excluding any material from those whose "advocacy views" are displeasing to "some here" - would the corollary be that organisations with "advocacy views" be excluded also or even editors with public advocacy views ? Where would it end ? Perhaps it might be better to simply examine what was said by those qualified to do so whatever their advocacy with regard to the suitability of where they said it --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:56, 19 March 2013 (UTC)

Regarding your above comment, Tumadoireacht, allow me to respond. If the folks around here would respond to my points, I would be happy to stick to the subject. Otherwise, I'll point out the truth. Crimsoncorvid (talk) 22:14, 19 March 2013 (UTC)

Trad. (eastern) Jewish circumcision

As part of wider revert [8], the following text was removed from the article:

In New York, circumcised infants have contracted herpes, consequent brain damage or death through an unusual procedure involving oral genital contact with the circumcising agent. 3,600 boys are circumcised by this method annually

.

I've no opinion on the revert, but I was struck by the similarity with an older discourse on Jewish circumcision and its association with tuberculosis and the cultural image of the diseased body of the "Jew". Sander Gilman has written a very nice study covering some of these issues. It might perhaps warrant inclusion in the history section considering more recent revivals of these fears as indicated by NYT source above. See [9]. FiachraByrne (talk) 13:08, 19 March 2013 (UTC)

This peculiar practice is already well-covered here: Brit_milah#Suction.2C_metzitzah. It is something done by a subset of Orthodox Jews after the removal of the foreskin is complete. Even the secondary sources providing the broadest coverage of circumcision, like the AAP 2012 Technical Report, do not really go into it, and it's not a complication or a risk of circumcision per se. This has come up before, and the best place to locate this material is in that Brit milah article. I've never heard of Kafka's views on the "diseased Jew" and couldn't read the book at the link. Not sure where article content from that source would go... Zad68 13:17, 19 March 2013 (UTC)

LOL. The technical report is not a suitable source to evaluate the inclusion of cultural or historical content. Sander Gilman is a major figure in Jewish and medical history. It would be for the history section and it relates more to late-nineteenth early-twentieth century European perspective of the (Eastern - non assimilated) Jewish body as diseased and polluting and (the idea of) ritual circumcision in that construction. There's some material that is relevant to the introduction of circumcision as a medical procedure in the US as well. Anyhow, you may be right that it's an imperfect fit for this article. FiachraByrne (talk) 15:00, 19 March 2013 (UTC)

I'd still like to read it, Fiachra... If you can point me to a way to get the source I'd appreciate it, for some reason the Google Books link did not work for me. Sounds interesting. Zad68 18:13, 19 March 2013 (UTC)

It may be because I posted a google.ie link rather than an google.com one, try this: [10]. Really though, it belongs to another article detailing the immigration of Eastern Jews into Western Europe. FiachraByrne (talk) 18:24, 19 March 2013 (UTC)

That fixed it! Appreciate it. Yes you're right about the placement of the material but it is interesting. Zad68 18:49, 19 March 2013 (UTC)

You're welcome and yes, it is interesting. Gilman is an excellent cultural historian. FiachraByrne (talk) 21:33, 19 March 2013 (UTC)

Reversion of edits to the "Adverse" section mentioning deaths and injury to children in NYC, Africa and low rate of complications in a large cohort in Israel

(continuation of brief discussion directly above oddly labelled "trad eastern jewish circumcision)

child deaths in two locations worldwide/ presentation of american stats as though they are universal/ low low complication rates in Israel- should mention of these have been reverted ?

@Fiachra It is remarkable that any editor would see an article describing a real danger to jewish children's health and lives and attempts to make it safe as a continuation of centuries old anti-semitism. Even this NYT article describes attempts within Judaism itself to make it safe.

That Parents are sometimes not informed beforehand that it will take place is also notable.

The numbers of children killed or brain damaged or with lifelong infections from it are not well covered in the Brit milah article( it is riddled with primary sources) nor are the 3,600 potential new victims each year in NYC alone mentioned at all. Reading around the subject a bit more might enlighten. Here is a good place to start on the history from a jewish/ medical/historical perspective http://www.matziv.com/pictures/drbermanarticlemetzitzah

@ Zad - most subjects in this article are covered more fully in the 25 or so sub articles about circumcision. i fail to see what argument you are advancing to suggest that that should not be so in this case too.

Several other edits were reverted alongside this one. The stats from circumcision practices within America are presented as if they applied worlwide. An edit correcting this error was reverted.

http://en.wikipedia.org/w/index.php?title=Circumcision&diff=prev&oldid=545398719

The following edits, (additions to the adverse effects section) were also reverted in the same sweep

In Israel The "overall estimated complication rate of circumcision was 0.34%" based on a cohort of 19,478 births in 2001. All of these were conducted in non medical settings.,

and

In Sub Saharan Africa circumcisions conducted in several settings- clinical and tribal non clinical, have had grievous injury and mortality rates.

Two of these are from secondary sources. Is there a mindset that says "yeah these are circumcisions I suppose,. and properly sourced, but they are doing it wrong so we will not mention it - um - it must not be notable" ? Don't look now but the New York Times quoting health authorities and Jewish religious leaders on a dangerous non clinical procedure involving wine, and adult oral to child genital contact is both notable and a secondary source however you cut it. The World Health Organization devoting 3 pages of an article shorter than 30 pages to 50 deaths a year from one SA region alone, from primitive circumcisions sure is notable. Any input on these reverted edits folks? Should I be confident of a consensus here  ? Or am I counting my foreskins before they are lopped ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:34, 19 March 2013 (UTC)

Looking at the changes suggested. From just the changes visible from the diff provided:

Suggested change #1, current article text is:

Significant acute complications happen rarely,(AAP 2012)(Weiss 2010) occurring in about 1 in 500 newborn procedures in the United States.(AAP 2012) Severe to catastrophic complications are sufficiently rare that they are reported only as individual case reports.(AAP 2012) The mortality risk is estimated at 1 in every 500,000 neonatal procedures conducted within the United States.(AAFP 2007)

Suggested change is:

A 2010 review of literature worldwide found circumcisions performed by medical providers to have a median complication rate of 1.5% for newborns and 6% for older children, with few severe complications.(Weiss 2010) In the United States, significant acute complications happen rarely,(AAP 2012)(Weiss 2010) occurring in about 1 in 500 newborn procedures, with severe to catastrophic complications occurring so rarely that they are reported only as individual case reports.(AAP 2012)

Suggested change #2, current article text is:

The mortality risk is estimated at 1 in every 500,000 neonatal procedures conducted within the United States.(AAFP 2007)

Suggested change is:

The mortality risk has been estimated at 1 in every 500,000 neonatal procedures conducted within the United States.(AAFP 2007)

These two sound good to me, ok with you?

Suggested change #3, add:

In Israel The "overall estimated complication rate of circumcision was 0.34%" based on a cohort of 19,478 births in 2001. All of these were conducted in non medical settings.(PMID 15984378)

This is cited to a 12-year-old primary source study of four centers. Per WP:MEDRS we prefer recent secondary sources.

Zad68 18:42, 19 March 2013 (UTC)

The NYT article is inappropriate for a section on adverse effects; such a section should be reserved for medical sources only. I think referring to "3,600 potential new victims each year" is unduly hyperbolic considering that, according to the article, 11 babies contracted herpes between 2000 and 2011, two of whom died.

As to the linkage with an older discourse on the Eastern unassimilated Jew and the practice of ritual circumcision, these are very different contexts and I certainly wouldn't describe the NYT article as antisemetic but there are very interesting parallels in terms of how the practice is being framed as a health issue and also in regard to the divergence of views within the Jewish community on the practice. I'm not informed enough of the present controversy in Germany or Denmark to offer an opinion on the discourse there, but I'd assume it's framed as a health/ethical issue in the main (maybe with an admixture of the strange, foreign, exotic, savage and barbaric?). My main reason for remarking on it is that Sander Gilman's treatment of the topic of the Jewish body and its medical construction is excellent. Unless I could show a more extensive literature, I think I'd be hard pushed to really argue that it belongs in this article. Thanks for the link to Berman, but he's a physician without any real background in medical history - his authority on such issues, such as it is, is likely to be narrow and limited.

I do wonder if they have similar discussions when compiling other encyclopedias. FiachraByrne (talk) 18:55, 19 March 2013 (UTC)

@ Fiachra :The idea that an adverse effects section should exclude stats on deaths of children in non medical circumcisions because they are not covered in medical literature is beyond ludicrous. But they ARE recorded in the WHO article (impeccable secondary medical source) which pushes all the buttons here when it waxes lyrical on MC saving africans from HIV but it is unacceptable when it mentions circumcision killing 50 a year in the same country  ? I still have no idea where you are going with the " admixture of the strange, foreign, exotic, savage and barbaric" Is there an article improvement idea buried in there somewhere ?I think the german concern may have been human rights prompted by a recent non medical circumcision death. Human rights and legal aspects of MC are unaddressed in this article but covered well in the female circumcision article. Funny that .

@Zad - I do not see where you got the suggested changes you list. They omit a great deal of the originals.

The WHO in a short definitive article give 3 pages to discussing all these aspects of adverse effects- we give seven heavily censored lines - something wrong here lads --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:31, 20 March 2013 (UTC)

Forced Adult Make Circumcision - also shunning

http://www.irinnews.org/Report/92564/KENYA-Plea-to-ICC-over-forced-male-circumcision

This is interesting. I have seen other references to contemporary forced circumcision elsewhere on the planet. The ideas about reclasssifyiing it are noteworthy.From the article as it presently stands a reader might presume that forced circumcision is all in the distant past. Though every infant circumcision is a forced circumcision too I suppose. Should forced circumcision be mentioned at all in the article ? Should shunning of the uncircumcized for marriage or social or religious groupings be mentioned at all at all ? Have I missed a mention and a link to the Forced Circumcision WP article http://en.wikipedia.org/wiki/Forced_circumcision .....?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:48, 19 March 2013 (UTC)

Seems like a good source to use at Forced circumcision. Zad68 18:11, 19 March 2013 (UTC)

AAP as a reliable source

Can someone please explain why the AAP is a reliable source on male circumcision? Why is COI not applicable? Crimsoncorvid (talk) 22:16, 19 March 2013 (UTC)

Yes there are cultural & professional biases and, for some of the authors, potential financial COIs (apparently resolved! through negotiation with the AAP board). Against that, it's a broad based review by a respected body of specialists which is endorsed by the US Assoc of Gyn and Obs. Also, for many of the issues covered by Technical Report - which should be clearly distinguished from the Policy Statement - there's a lack of comparable secondary sources that could be used. I wouldn't describe it as an ideal source then, but it's OK. One should also bear in mind that cultural biases, at least, are not unique to the US physicians and there's been a considerable hardening of attitudes towards circumcision and no little activism in Europe and elsewhere.

Throughout the article the APA Policy Statement and Technical Report are used to support a range of statements. I'll go through these section by section in the following.

Removal of the foreskin & Pain Management: the statements which the AAP sources are used to support in this section are qutie mundane and, I think, uncontroversial.

STD: HIV: uncontroversial content supported, I think.

Sexual function: it is used to support the statement that there is no loss of sexual function or sensitivity following circumcision and, I think, if more secondary sources can be found that look at this issue that would be beneficial. However, my initial search for such material has turned up only limited suitable sources. There are 29 review papers on PubMed that, to some extent, address circumcision and sexual function. Of these 29, those articles published in the last 5 years which mention circumcision and sexual function in their article abstract are: I haven't cherry picked the results but they all state that there's no loss of sexual function.

Sensitivity Available secondary sources are: - Hans Adler makes an excellent point in the discussion above that the surgical removal of the foreskin must logically reduce sensitivity (although one assumes that this is actually dependent on how sensitivity is defined and measured). We need a secondary source to make this point for us, however.

UTI: it's also used in the section on UTI - where it's supported by other good secondary sources (Cochrane Reviews, etc). The context for the UTI section is generally good I think as it indicates that the absolute rate of UTI in the population is low and the benefit is negligible after the first year of life anyway.

Cancers: all controversial claims are supported by good secondary sources and I don't think that there's much controversy that circumcision does reduce the rate of penile cancer in any case. The benefits that accrue are tempered in this section by the acknowledgement that the rate of penile cancer in the general population is low.

Adverse effects: used to support statement about the most frequent complications arising from circumcision; supported by AAFP position paper on circumcision; also that complications are rare, particularly serious ones. . Other secondary sources on complications: Also, used to support statement that there's no loss in sensitivity, sexual function or satisfaction, dealt with above (this should not be placed in so many sections).

That's it.

FiachraByrne (talk) 02:31, 20 March 2013 (UTC)

There's little there that actually contradicts the AAP Technical Report - probably the least supported contention is in regard to loss of sensitivity. FiachraByrne (talk) 03:07, 20 March 2013 (UTC)

Statement by AAP on methodology and in defence of Policy Statement and Technical Report [11]. FiachraByrne (talk) 03:07, 20 March 2013 (UTC)

There's a special issue on circumcision that's going to be published by the BMJ Group's Journal of Medical Ethics [12]. Some of the articles have already been published online and are now available [13]. They include a critique of the AAP's Policy Statement . FiachraByrne (talk) 03:15, 20 March 2013 (UTC)

That's a great review of the sources, Fiachra, thanks.

Also, Fiachra makes a very good point (one that I tried to make earlier, but too subtly, I guess) that there are two kinds of information the AAP produced, 1) the Technical Report, and 2) their Policy Statement. As for all medical organizations, the Policy Statement will express their "biases" if by that we mean their collective assessments of the potential harms vs. benefits, and (as pointed out in the article) the relative weights placed on them will reflect cultural attitudes; however, we are not using the AAP's policy recommendations in the article.

Regarding the Technical Report, one thing that needs to be emphasized is the openness, rigor and depth of analysis that went into the collecting, evaluation and synthesis the AAP did. They defined source search criteria, identified 1,388 possible sources, ended up including over 1,000, and they had each source reviewed by a Task Force member and also one outside specialist physician, so (probably) hundreds of specialists were involved. They determined the quality of the evidence provided by each source. Their methodology and the lists of sources used are publicly available. Does the research supporting any other medical organization's policy statement come close to meeting the standard the AAP set?

Regarding Hans' discussion that the removal of the foreskin should be expected to reduce sensitivity, that's a reasonable hypothesis. Luckily, it has already been tested, including in a well-designed RCT involving over 1,000 men, and has been reported on in our secondary sources, including by the AAP. We already cite the secondary sources on this issue in the article. Zad68 03:18, 20 March 2013 (UTC)

Thank you. Given the difference between the Policy Statement and the Technical Report - although a pain - it might be worthwhile unbundling them (currently footnote 5). Re: sensitivity, yes, that's the African study. Just to reaffirm after you introduced the text, adding Surgical Guide to Circumcision to the sources used for this article should be an absolute priority. For issues of sexual function and sensitivity, the relevant chapters would appear to be:

(From comment by Fiachra Byrne): "Hans Adler makes an excellent point in the discussion above that the surgical removal of the foreskin must logically reduce sensitivity (although one assumes that this is actually dependent on how sensitivity is defined and measured)."

Not a medical doctor, so apologize in advance for imprecise language. However, this point does not strike me as persuasive. Intactivists like to talk about special erotogenic sensors in the foreskin but they never mention that these sensors are not yet formed in an eight-days-old infant's body. So at that point in time, nothing is lost but a square inch or so of ordinary tissue containing ordinary cells, blood vessels, nerves. Medical science tells us that the brain is amazingly capable of adapting to cope with injury. Is it such an outlandish notion that neural pathways may get rewired in the child's development so that the sensitivity of the penis (not only the shaft, but especially the glans) in a sexual encounter gets increased to make up for the loss of the foreskin? That would explain why circumcised men are just as capable as non-circumcised to achieve and maintain an erection, reach orgasm, and pleasure their sexual partners. As one circumcised man said, "Difficult to imagine how an experience that sets off fireworks in your head and nearly makes you faint from bliss could possibly be even stronger."

It's a difficult and complex topic as it gets into, among other things, the question of qualia and how subjective experiences could be compared. However, my speculation might go part of the way towards explaining why anecdotal reports suggest that adult men sometimes experience dissatisfaction with the outcome of their circumcision performed after puberty, whereas men circumcised as infants are near-universally content with their status.89.204.138.82 (talk) 09:12, 20 March 2013 (UTC)

These are interesting questions which could be elaborated on if they are covered in appropriate sources. One other thing, the invective on this page is probably unhelpful. I'd ask you to refrain from using terms like "intactivists". Thanks. FiachraByrne (talk) 13:38, 20 March 2013 (UTC)

As far as invective goes, "intactivist" is actually the term that those activists use to describe themselves, and so it probably was not meant as an insult, and probably would not come across as one to them. This article Talk page is already hosting a lot worse than that, but I 100% agree that inflammatory language is counterproductive on article Talk pages and it needs to be avoided.

The larger issue is WP:NOR which applies to article Talk pages as well as the articles. The IP's comments are welcome, but we should limit our discussion to just what the reliable sources say. Cheers... Zad68 14:38, 20 March 2013 (UTC)

Right, and I am not demanding that my speculation (which I labeled as such) be incorporated into the article, merely pointing out that Adler's argument may not be such an "excellent point" after all once you look past its superficial plausibility. Opponents of non-medical circumcision keep running into this problem, namely that "the bumblebee does fly", and like the befuddled aerodynamicist they are at a loss to come up with an explanation for what should by rights be impossible according to their thinking, in this case the testimony of circumcised men and their partners.89.204.138.82 (talk) 15:02, 20 March 2013 (UTC)

To some extent one could also speculate that eye-sight in the right eye improves after amputation of the left eye. Or, as a radical birth control measure, we could just cut off the glans and leave the foreskin. Then maybe the sensitivity of the glans transfers to the foreskin?

That's not a particularly strong argument before there is any evidence that such a thing actually happens. Of course such a phenomenon could explain why the essentially normal post-circumcision skin of the glans appears to be as sensible (as measured by degree, not necesarily by type of sensation) as the pre-circumcision mucosa.

But the problem is still this: Roughly half of the most sensitive tissue is removed, and then sensitivity is measured in the remaining part, pre- and post-operation. By the same standard, why measure sensitivity in the glans? Why not measure it in the anus or on the finger tips? What the 'objective' tests measure is intensity per square centimetre. That's interesting for checking the effect of the radical change in the previously internal tissue that suddenly becomes external. But as a matter of principle, the outcome of such measurements can never be that sensitivity of the entire organ is not affected. That's because the relevant (highly sensitive) area is significantly reduced. On top of that, the type of stimulation changes after circumcision and probably becomes less manifold. Certain types of stimulation are only possible on the foreskin, not on the glans, because only the foreskin is sufficiently flexible. I guess these are similar to certain very effective ways of stimulating certain women, which also become impossible after removal of the clitoral hood (FGM type I). Hans Adler 17:17, 20 March 2013 (UTC)

Danish study

Could you please add the following paragraphs to the article (to the section: "Adverse effects"):

According to the study conducted by Denmark's National Institute of Public Health, the problems to reach orgasm were three times higher among circumcised men and their female partners when compared to non-circumcised men and their partners (variables such as religion, cultural background, education, income level and maritial status were controlled in the study). The result was similar regardless of whether circumcision was done on religious basis or not. The study also found that the female partners of circumcised men were also times more likely to have pains during sexual intercourse than women who had non-circumcised men as their partners.