This is an archive of past discussions about Circumcision. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.
"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)
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. Zad6815:48, 18 March 2013 (UTC)
I'm still not seeing where the AAP or other secondary sources actually contradict the Sorrells conclusion that Circumcision ablates the most sensitive parts of the penis.
In the AAP technical report the only discussion given is as follows:
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
So we find that "most" locations failed to attain statistical significance and this is obvious from the primary source. It is also obvious that all of those locations that did attain statistical significance are located on the foreskin. So far, the AAP report does not contradict the conclusion of Sorrells et al. The other observation offered by the AAP is that sensitivity to static monofilament (as opposed to dynamic stimulus) may not have any relevance to sexual satisfaction, which likewise does not contradict the Sorrells conclusion that circumcision ablates the most sensitive parts of the penis. The AAP has quite clearly informed us that they found sorrells compatible with their summary because it showed that most areas of the penis are not significantly less sensitive in circumcised men and because they speculate that sensitivity to static stimulus may not be relevant to sexual satisfaction.Zebulin (talk) 00:34, 21 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 Adler17:09, 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.--— ⦿⨦⨀TumadoireachtTalk/Stalk16:49, 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 Adler17:18, 18 March 2013 (UTC)
"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.
* 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 --— ⦿⨦⨀TumadoireachtTalk/Stalk18:19, 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. Zad6818:46, 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.--—
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"? Zad6820:30, 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. Zad6822:39, 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 Adler23:20, 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. Zad6803:29, 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 Adler09:20, 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. Zad6803:30, 20 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. Zad6803:20, 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 Adler06:15, 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.
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 thesetwo 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 Adler06:58, 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 Adler07:11, 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 Adler07:31, 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 Adler07:57, 19 March 2013 (UTC)
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 Adler07:47, 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 Adler08:33, 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.--— ⦿⨦⨀TumadoireachtTalk/Stalk08:23, 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.--— ⦿⨦⨀TumadoireachtTalk/Stalk11:14, 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. Zad6803:57, 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 Adler17:34, 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. Zad6818:49, 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)
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/
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 Adler23:29, 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.--— ⦿⨦⨀TumadoireachtTalk/Stalk00:58, 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. Zad6804:15, 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 :
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]--— ⦿⨦⨀TumadoireachtTalk/Stalk10:27, 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):
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 Adler12:13, 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. Zad6813:00, 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.--— ⦿⨦⨀TumadoireachtTalk/Stalk14:00, 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 Adler14:29, 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 Adler14:44, 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. Zad6818:50, 18 March 2013 (UTC)
Almost nobody is neutral on the topic of circumcision. SandyGeorgia is an American editor and often edits medical topics, so it is not surprising that she missed the extreme American and medicalisation bias of this article. "Meeting a high standard of high-quality sourcing" is neither a completely objective criterion, especially when it comes to deciding on the kind of high-quality sources that one wants to allow, and sourcing issues do not override POV concerns. Sometimes we delete BLP articles on technically notable people because it is impossible to write a biography from reliable sources that does not give undue weight to a specific event. For some pseudoscience topics there are well established mainstream newspaper articles supporting the pseudoscience and only scientist or activist blogposts debunking it. In such cases, "meeting a high standard of high-quality sourcing" is a popular technique of fringe promoters. That's why WP:PARITY is so complicated.
The same principle applies to the archaic practice of cutting off parts of genitals of other, nonconsenting, people for no or insufficient medical reasons.
There is some serious systemic bias here. People who are not immersed in a circumcising culture, understand that studies on unnecessary amputation of parts of genitals must not get ethical clearance. Only researchers who don't understand this can easily make such studies. Also, psychology predicts and observation confirms that they also tend to be the more motivated. Due to the extremely low quality of medical research standards, as uncovered by Nature in this article (Results in only 6 of 53 pre-clinical cancer studies were reproducible. In many cases, the authors themselves knew that what they were publishing was not reproducible.), this automatically biases the overall outcomes of what are by technical measures the most high-quality studies. In other words: The normal techniques for eliminating publication bias don't work here because they can't deal with the massive self-selection bias of technically high-quality circumcision researchers. Hans Adler20:25, 20 March 2013 (UTC)
Hans, assuming for the sake of discussion that this is true, the logical conclusion then would be to delete this article, because it would be impossible to source it without bias?? I'm not sure what your proposal is here. Zad6803:42, 22 March 2013 (UTC)
UTI
The current section on Urinary Tract Infections reads:
Urinary tract infections
[...] There is good but not ideal evidence that circumcision reduces the incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3–10 times,[5][51] but prevention of UTIs does not justify routine use of the procedure.[2] Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,[5][51] and may be used to treat recurrent UTIs.[2]
References
[2] Lissauer T, Clayden G (October 2011). Illustrated Textbook of Paediatrics, Fourth edition. Elsevier. pp. 352-353. ISBN978-0-7234-3565-5.
[5] American Academy of Pediatrics Task Force on Circumcision (2012). "Policy Statement". Pediatrics 130 (3): 585–586. doi:10.1542/peds.2012-1989. ISSN 0031-4005. PMID22926180 & American Academy of Pediatrics Task Force on Circumcision (2012). "Technical Report". Pediatrics 130 (3): e756–e785. doi:10.1542/peds.2012-1990. ISSN 0031-4005. PMID22926175.
The best source looking at the evidence for the relationship between routine neonatal circumcision and UTI is the Cochrane Review, Routine neonatal circumcision for the prevention of urinary tract infections in infancy, published in November 2012. It should be considered a superior source to the AAP's Policy Statement or Technical Report, or Lissauer and Clayden's Illustrated Textbook of Paediatrics (2012), a tertiary source. As the Cochrane review was published after the AAP's Policy Statement and Technical Report it is not cited there. The Cochrane review states:
The comprehensive search used in this review provided no references to relevant studies. The lack of relevant randomised controlled trials, as well as any robust evidence to support or refute the use of routine neonatal circumcision for prevention of UTI in infancy, highlighted the lack of sound evidence on the subject, hence the guidelines advocated by professional agencies may not have an adequate scientific basis. Over the last 10 years there have been several observational studies and reviews evaluating the effectiveness of routine neonatal circumcision for prevention of UTI in infancy (Amato 1992; Singh-Grewal 2005). Although these studies have provided some limited data, questions still remain unanswered as to whether treatment options based on this intervention can be considered both effective and safe for routine and universal recommendation.
Concluding:
The evidence from this review does not at present allow confident decision-making about the use of routine neonatal circumcision for prevention of UTI in infancy, since there were no included studies in the review. Until further evidence becomes available, clinicians should continue to base their decisions on regional position statement recommendations (American Academy of Pediatrics 1999; American Urological Association 2007) in conjunction with the parents' opinions in individual circumstances.
The Cochrane review is incorrectly cited in support of the statements above. These cites should be removed or the article text rewritten. It could, perhaps, be used to support the statement that "prevention of UTIs does not justify routine use of the procedure", but it's position is in fact much stronger than this. I don't think this section as it currently stands adequately reflects the finding of this review and it should instead unambiguously state, in my opinion, that there is no adequate evidence in support of or against the routine use of circumcision to prevent UTI and that guidelines from medical orgs on this question may lack sufficient scientific evidence. FiachraByrne (talk) 13:15, 21 March 2013 (UTC)
If I remember right, Doc James and I had some conversations about this - how to handle the fact that secondary sources (other than Cochrane) identified some evidence, but not the ideal (RCT) evidence that Cochrane was looking for, and the current article wording attempts to reflect that. Article wording could always be improved, of course, but I'm not sure changing the article content to read "no adequate evidence" is moving the article content in better alignment with the sources. There is some evidence; there is not ideal evidence. Cochrane does specifically say to refer to the standards of the regional organizations, and the AAP Technical Report is one of them. I'll scrutinize the sources again for differences between the article text and the sources. Zad6813:36, 21 March 2013 (UTC)
The first issue is that the Cochrane Review does not support the text it is being used to support in the current article version. That's all drawn from the Technical Report (henceforth the TR). The citations to the Cochrane Review should be removed from those statements. FiachraByrne (talk) 14:13, 21 March 2013 (UTC)
The second is that the Cochrane's conclusions, as the superior source, should, minimally, come before the report of findings with inferior evidence to support them. FiachraByrne (talk) 20:50, 21 March 2013 (UTC)
Fiachra I re-examined the sources and article content, and I agree with you that a change is needed.
First, I need to start by saying that my impression is that the AAP 2012 TR and the Jagannath 2012 Cochrane review are not contradicting each other. There are two things being discussed: 1) What evidence is there that circumcision has an effect on the incidence of UTIs, and 2) Is there enough evidence examining both the effectiveness and safety of circumcision for UTIs to recommend routine (i.e. all newborn males) circumcision for that purpose. A positive answer to question 2) demands a much higher evidence standard of both effectiveness and safety than 1). Regarding 2), both the TR and the Cochrane review (and Lissauer 2012) are in agreement that there is not enough of the right kind evidence to recommend routine circumcision - the Cochrane review says so explicitly, the AAP says so implicitly in their policy statement (they do not recommend routine circumcision). Regarding 1), the TR provides some data that circumcision reduces the incidence of UTIs, Lissauer agrees, and we have two other textbooks that support this (Rudolph 2011, Hay 2012); however, Cochrane does not address this question at all (the research question was "To assess the effectiveness and safety of routine neonatal circumcision for the prevention of UTIs in infancy" and not "Does circumcision reduce incidence of UTIs?"). So, there is agreement across our sources used here (TR, Cochrane, textbooks) that circumcision has some utility in reducing or treating some UTIs, they also agree there's not a strong enough evidence base to demonstrate a cost-benefit great enough to recommend routine circumcision for that purpose.
Based on this, here's the proposed change.
Current
Proposed
There is good but not ideal evidence that circumcision reduces the incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3-10 times,(AAP 2012)(Jagannath 2012) but prevention of UTIs does not justify routine use of the procedure.(Lissauer 2012) Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,(AAP 2012)(Jagannath 2012) and may be used to treat recurrent UTIs.(Lissauer 2012)
There is evidence that circumcision reduces the incidence of UTIs in boys under two years of age(AAP 2012)(Lissauer 2012) but the evidence for its effectiveness and safety is not strong enough to recommend routine circumcision for the purpose of preventing the condition.(Jagannath 2012)(Lissauer 2012) When elected, circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,(AAP 2012) and may be used therapeutically to treat recurrent UTIs.(Lissauer 2012)
Yes, I can sign off on that - it's a very carefully worded to properly reflect the sources. Thank you. I would still like the Policy Statement and Technical Report in footnote 5 unbundled and, probably, the removal of explanatory note b. FiachraByrne (talk) 21:50, 21 March 2013 (UTC)
Excellent!
To do after protection expires:
Apply this UTI change (assuming no substantial disagreement from other editors)
True, but I don't think the article does actually use the AAP Policy Statement anywhere. Such references would probably using it as a primary source, and all discussion in the article about positions of medical organizations is sourced to secondary sources. If you can find a spot in the article where we are citing the AAP Policy Statement, let me know and I'll fix it. Zad6813:43, 22 March 2013 (UTC)
The last sentence in Zad68's proposal makes a nonsensical claim: "When elected, circumcision [...] may be used therapeutically to treat recurrent UTIs." When it's as treatment for recurrent UTIs, it's of course not elective surgery. This isn't just nonsense, it also gives lay readers unfamiliar with the terminology the wrong idea of what "elective" means.
I wonder if we can't make the real issue a bit clearer while sticking to the reliable sources:
There is evidence for reduced UTIs.
UTIs are very rare to begin with.
There is evidence that serious circumcision complications are rare. (I actually disagree with this statement, as babies are more sensitive to pain than adults and this obscenely painful surgery is normally carried out without anaesthesia. But pain doesn't seem to count if the patient can't sue the surgeon.)
There is insufficient evidence to weight the two effects against each other for random baby boys...
... but for those who are getting UTIs all the time the evidence is sufficient. (I wonder, though, if they have considered that the complication rate of circumcision might also be higher in that group. I haven't got the time to check now. Does anyone know?) Hans Adler16:06, 22 March 2013 (UTC)
I see Hans's point, and agree the proposed wording could be made more specific/accurate. I think all the bullet points Hans lists are covered; in the UTI section, the article already states "There is about a 1% risk of UTIs in boys under two years of age, and the majority of incidents occur in the first year of life" (that part of the article wasn't pulled into this discussion) so that's there already. I haven't seen sourcing for complication rates of those getting circumcised for chronic UTIs in particular. Suggested tweak might simply be to split that one sentence up into two: "When elected, circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects.(AAP 2012) The procedure may also used therapeutically to treat recurrent UTIs.(Lissauer 2012)" although not 100% delighted with that either, don't have time to focus on this properly right now, suggestions welcome. Zad6816:25, 22 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.[1][2]
--Jarkka Saariluoma (talk) 19:03, 20 March 2013 (UTC)
I saw this but the study is primary and therefore should not be included. The findings should be incorporated into the literature at the next secondary review of this question. FiachraByrne (talk) 19:07, 20 March 2013 (UTC)
Is this the study led by Danish researcher Morten Frish? If it does get used, that study probably should be examined carefully for what it does and does not say. According to <a href="http://www.jpost.com/Opinion/Op-EdContributors/Article.aspx?id=287044">this Jerusalem Post article</a>, its scope may be limited:
What public debate has refused to deal with, however, is the fact that Frisch’s study almost exclusively dealt with males circumcised far into their adulthood (i.e., they were not religiously circumcised, but circumcised because of pre-existing medical problems in the lower regions). Just two Jewish males, and three Muslims participated.
It's this study: PMID21672947. I would not expect secondary sources to evaluate the evidence quality to be very high. As mentioned, if it's worthwhile data it'll get picked up in the next round of secondary sources that come out on this topic. Zad6819:48, 20 March 2013 (UTC)
There's no need to comment on the quality of this study. It's primary. Let the secondary sources, in time, evaluate it and we can report their evaluation. FiachraByrne (talk) 13:17, 21 March 2013 (UTC)
Men getting circumcised due to a religious blood ritual would introduce their own bias. All in all, given that next to no uncut men volunteer for circumcision (that fact alone should make one pause) without medical or religious need, it's next to impossible to exclude all biases in a large study (though given the South Korean particularity, maybe something would be possible there). Nonetheless, I would argue that a man circumcised due to foreskin problems is actually much more likely to be satisfied with the outcome than one who had none.
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
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.
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.,[3]
and
In Sub Saharan Africa circumcisions conducted in several settings- clinical and tribal non clinical, have had grievous injury and mortality rates. [4]
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 ?--— ⦿⨦⨀TumadoireachtTalk/Stalk15:34, 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.(PMID15984378)
This is cited to a 12-year-old primary source study of four centers. Per WP:MEDRS we prefer recent secondary sources.
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.
@ 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 --— ⦿⨦⨀TumadoireachtTalk/Stalk16:31, 20 March 2013 (UTC)
Tumadoireact. Please link to the WHO source you mention above.
There's no way we can source this information to a newspaper article because, as editors, we're not equipped to evaluate whether 2 deaths in 3,600 procedures is significant or notable.
There is a medical literature on "Traditional" circumcision, which is not covered in this article. See Wilcken, A.; Keil, T.; Dick, B. (2010). "Traditional male circumcision in eastern and southern Africa: A systematic review of prevalence and complications". Bulletin of the World Health Organization. 88 (12): 907–914. doi:10.2471/BLT.09.072975. PMC2995181. PMID21124715. To make an argument for inclusion it will be necessary to establish first that the prevalence of traditional circumcision is significant. Given, as indicated in the paper above, the proportion of circumcisions performed in Africa at least that are done in a traditional manner, I think such an argument would be credible. You should gather the other available literature before making such a proposal however. Adding newspaper articles weakens rather than strengthens your case. FiachraByrne (talk) 20:36, 21 March 2013 (UTC)
Fiachra, I'm pretty sure Tumad. is talking about the World Health Organization's 2007 Male circumcision: Global trends and determinants of prevalence, safety and acceptability, reference #1 in the article. This is an article the WHO prepared after the evidence from three African RCTs was in that indicated circumcision significantly reduced female-to-male transmission of HIV, and there was interest in rolling out a large program of circumcision services to curb the AIDS epidemic there. The purpose of the document was to survey the current state of the acceptability of circumcision to make the program rollout as effective as possible.
Based on the edit history to this article, like this and this, I think the suggested changes are to put detail about non-clinical tribal and ritual circumcision in with the medical information in the Technique and Adverse effects sections. In my view, there's room for this content on Wikipedia, and maybe even in this article, but not in the locations suggested, which are for covering the clinical procedure. I think the best fit for this would be a mention in the appropriate Society and culture sub-section, with full detail to be developed in, for example, Religious male circumcision.
This is part of a broader opinion that's been raised that this article gives too much weight to clinical circumcision. But looking at policy, per WP:DUE, we are to give emphasis to viewpoints in proportion to the emphasis found in the reliable sources. Based on my review of sources (for example, search for "circumcision" on Google Scholar and see what viewpoint the returned search results emphasize), it's correct to organize this article per WP:MEDMOS. For more on that discussion, search up this page for the post by Hans with "this article gives undue weight to the retroactive medical justification", my reply with "you are concerned that this article gives too much weight", and subsequent replies. Zad6803:28, 22 March 2013 (UTC)
Thanks for the WHO link. Those Xhosa are some hardy men.
I agree that it would be confusing to mix such material with the relevant sections covering the medical procedure. I think, however, the article should indicate to readers that not all circumcisions are medical procedures and that outcomes and complications from non-medical circumcisions may differ from those performed under normal surgical conditions. There is a logic to including such material in the Society and culture section of the article, perhaps as part of the introductory text.
But I would argue for the creation of a new section between the sections on adverse effects and prevalence. I'm not sure what title such a section should have (perhaps simply "Non-medical circumcision"?) but it would be intended to very briefly cover (one paragraph only) some of the medical aspects of non-medical circumcision. The rationale behind the placement of the proposed section is that most of the literature on ritual and traditional circumcision that meets WP:MEDRS, as with the WHO article, focuses on the increased rate of complications relative to the medical procedure and its placement after the adverse effects section, which is the last section of the article strictly limited to the medical procedure, would provide a natural context and point of comparison. Further the section on prevalence is not currently confined to medical circumcision and simply provides the global estimates of male circumcision which must include non-medical circumcision. It might be important, therefore, to indicate to the reader before this point that not all circumcisions from the global total are performed as medical procedures. I don't think that this proposal would compromise the layout per WP:MEDMOS.
On the subject of WP:MEDMOS, I agree that the scholarly literature on the topic is overwhelmingly medical (ratio at least 7:1 according to Web of Knowledge), notwithstanding the fact that the simple counting of number of publications in different disciplines to determine weight is highly problematic. Also, I don't quite agree with your Google Scholar analysis above as it follows the Google Ranking which, while the results can be OK, the basis of it is unknown. It would be better to rank the articles by number of cites which you can do with software like Harzing's Publish or Perish (which I find very nifty). That doesn't change the fact that the literature on the topic is overwhelmingly medical. However, circumcision should be regarded as a WP:PRIMARY TOPIC for a range of sub-articles. This is not to argue that WP:MEDMOS should not apply, nor to argue that overly messing with the structure of good article is advised, but as the top level article for a range of sub-articles it should also function to direct the reader to the appropriate sub-articles. So I guess all I'm saying is that it has this organizational function for the broad topic of circumcision - which it does a decent job of doing now, admittedly - and this should be borne in mind in the calculation of WP:DUE. FiachraByrne (talk) 21:28, 22 March 2013 (UTC)
The proposal to create a new section sounds good to me too, Fiachra, let's pursue it. Although such a new section wouldn't strictly be WP:MEDMOS, it's well-supported by your argument, and so I think this is one of those "occasional common sense exceptions" allowed by our guideline.
I hadn't heard of Harzing's Publish or Perish before, it does look useful. Google Scholar counts were the best I've known about up to this point, but Harzing's does appear better. It was interesting to see the software actually uses Google Scholar for its raw data, but it looks like it does its own proprietary bean-counting to come up with more meaningful results, helpful for WP:DUE. This article has evolved over the years to be a WP:SUMMARY-style main article with about a dozen sub-articles, but I think we're pointing in the same direction here. Zad6802:45, 24 March 2013 (UTC)
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 .....?--— ⦿⨦⨀TumadoireachtTalk/Stalk16:48, 19 March 2013 (UTC)
Our article here purports to be an overview of MC . Yet it contains narry a single link to the forced circumcision WP article - where should I insert such a reference and link ?--— ⦿⨦⨀TumadoireachtTalk/Stalk21:24, 24 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: Morris, B. J.; Bailey, R. C.; Klausner, J. D.; Leibowitz, A.; Wamai, R. G.; Waskett, J. H.; Banerjee, J.; Halperin, D. T.; Zoloth, L.; Weiss, H. A.; Hankins, C. A. (2012). "Review: A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries". AIDS Care. 24 (12): 1565–1575. doi:10.1080/09540121.2012.661836. PMC3663581. PMID22452415. Sadeghi-Nejad, H.; Wasserman, M.; Weidner, W.; Richardson, D.; Goldmeier, D. (2010). "Sexually Transmitted Diseases and Sexual Function". Journal of Sexual Medicine. 7 (1 Pt 2): 389–413. doi:10.1111/j.1743-6109.2009.01622.x. PMID20092446. Perera, C. L.; Bridgewater, F. H. G.; Thavaneswaran, P.; Maddern, G. J. (2010). "Safety and Efficacy of Nontherapeutic Male Circumcision: A Systematic Review". The Annals of Family Medicine. 8 (1): 64–72. doi:10.1370/afm.1073. PMC2807391. PMID20065281. Doyle, S. M.; Kahn, J. G.; Hosang, N.; Carroll, P. R. (2010). "The Impact of Male Circumcision on HIV Transmission". The Journal of Urology. 183 (1): 21–26. doi:10.1016/j.juro.2009.09.030. PMID19913816. I haven't cherry picked the results but they all state that there's no loss of sexual function.
Sensitivity Available secondary sources are: Morris, B. J.; Bailey, R. C.; Klausner, J. D.; Leibowitz, A.; Wamai, R. G.; Waskett, J. H.; Banerjee, J.; Halperin, D. T.; Zoloth, L.; Weiss, H. A.; Hankins, C. A. (2012). "Review: A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries". AIDS Care. 24 (12): 1565–1575. doi:10.1080/09540121.2012.661836. PMC3663581. PMID22452415. Morris, B. J. (2007). "Why circumcision is a biomedical imperative for the 21st century". BioEssays. 29 (11): 1147–1158. doi:10.1002/bies.20654. PMID17935209. - 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.
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)
There's a special issue on circumcision that's going to be published by the BMJ Group's Journal of Medical Ethics[8]. Some of the articles have already been published online and are now available [9]. They include a critique of the AAP's Policy Statement Svoboda, J. S.; Van Howe, R. S. (2013). "Out of step: Fatal flaws in the latest AAP policy report on neonatal circumcision". Journal of Medical Ethics. doi:10.1136/medethics-2013-101346.. 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. Zad6803:18, 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: Schröder, A. (2012). "Circumcision: Case Against Surgery Without Medical Indication". Surgical Guide to Circumcision. pp. 185–190. doi:10.1007/978-1-4471-2858-8_16. ISBN978-1-4471-2857-1. Morris, B. J.; Cox, G. (2012). "Current Medical Evidence Supports Male Circumcision". Surgical Guide to Circumcision. p. 201. doi:10.1007/978-1-4471-2858-8_19. ISBN978-1-4471-2857-1. Krieger, J. N. (2012). "Circumcision, Sexual Function, and Sexual Satisfaction". Surgical Guide to Circumcision. pp. 233–239. doi:10.1007/978-1-4471-2858-8_20. ISBN978-1-4471-2857-1. — Preceding unsigned comment added by FiachraByrne (talk • contribs) 13:34, 20 March 2013 (UTC)[10]
(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...Zad6814:38, 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 Adler17:17, 20 March 2013 (UTC)
Reductio ad absurdum is fine... if it works. If not, then this rhetoric will backfire on you, and so it is with your "amputate left eye" example. It is impossible to imagine a group of people who had their left eye amputated in infancy that would willingly forgo the chance to get that eye back. Can't be a pilot, surgeon, [insert dozens of other professions] without stereoscopic vision! What happens if you lose the right eye? Etc. Thus your reductio fails. I've noticed, Hans, that you are spending huge amounts of Wiki-capital on this article: by edit-warring, by leaving bullying notices on editors' personal talk pages, and by interminable discussion on this Talk page. I guess you expect to "win" in the long run?89.204.138.82 (talk) 19:16, 20 March 2013 (UTC)
Your argument doesn't work due to psychological factors that make it somewhat hard even to find infibulation victims who are willing to admit that there is a problem with that practice. And on the other hand it's not as if there are no male circumcision victims who complain. They are used to being belittled and so tend to shut up, just like male victims of other forms of sexual violence, but as the debate continues to gain momentum, more and more have been willing to describe their suffering in public. Hans Adler13:32, 21 March 2013 (UTC)
Indeed, and I wonder if he's thought about the Deaf Community's attitudes towards the profound loss of hearing before writing any of that about the profound loss of stereoscopic depth perception in your thought experiment of a culture that removes the left eye.Zebulin (talk) 16:41, 21 March 2013 (UTC)
Please may I recommend that everyone pay attention to WP:TPG and avoid original research or commenting directly on other editors? As has been noted before, this is a difficult enough article to work on as it is, and if we can minimize Talk page acrimony by limiting our discussion only to article improvements based on specific sources, it'll make it easier for everyone here. Cheers...Zad6819:23, 20 March 2013 (UTC)
Agreed - if there's really an issue take it to the user's talk page. I'd appreciate it if 89.204.138.82 (talk·contribs) would strike the comments above relating to the imputed behaviour or Hans.
FiachraByrne, you did not address my statement in any way. You erred when you said there is little to contradict the AAP. There was a commentary by 38 medical professionals representing medical associations worldwide contradicting it. I linked to it on this talk page if you haven't seen it already. The AAP recommendation has been thoroughly discredited. Furthermore, you failed to discuss COI. Can you please tell me why the AAP isn't subject to COI concerns? Thanks! Crimsoncorvid (talk) 20:14, 20 March 2013 (UTC)
"In any way" - that's a bit harsh. ;) I did acknowledge that there were likely cultural and professional biases at play as well as COIs. I do not consider the Technical Report, and much less the Policy Statement, to be an ideal source. The Technical Report is OK and only that, in my opinion. Part of the problem is that the evidence from the best sources is so marginal either way (marginal/no benefit vs marginal risk). Culture and personal decision will dictate the practice. The reason to go through the other review literature was to see whether the AAP's Technical Report was broadly supported in the best available medical literature. While I should have looked into the UTI question in more detail (see below), broadly the Technical Report, or at least those aspects of it used in this article, is supported. More specifically on the question of COI, I would agree with the essay WP:MEDCOI, which states that, "a conflict of interest does not mean a source or editor can be dismissed a priori." Where a medical source is not ideal I would tend to evaluate its specific use in an article (i.e. the individual statements it is used to support) and whether its claims find support in the best available literature (review articles/meta-analyses, etc). It's quite possible that this literature is also biased, or indeed whole fields may be biased, but there is little we an do to correct that. So how do we use, if at all, the Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision? I'm not sure really. It's not a systematic review of the literature (although neither the Technical Report nor Policy Statement by the AAP are categorised as such by PubMed). It critiques both the Policy Statement and Technical Report and some of the criticism is germane. I don't think it could be given the same status, however, as a proper systematic review or meta-analysis nor could it be used to contradict the findings from such sources. I would like to look in more detail at how representativeness of the authors of the commentary. Overall, my inclination would be to use the TR with care and conservatively. I think the article should give greater consideration to the current controversy and the level of medical (and indeed social, political and cultural) dissension over the practice. Within that context, the commentary would merit brief inclusion and the general issue could be elaborated on in greater depth in the appropriate sub-article. FiachraByrne (talk) 14:01, 21 March 2013 (UTC)
Did you read the European commentary? They did not 'thoroughly discredit' the AAP Technical Report in any way, they largely addressed the Policy Statement based on the Technical Report, and once again we don't use the AAP Policy Statement recommendation in the article. Also, I'm sure if you mean this, but be aware that COI in general isn't the same thing as WP:COI, which has a very specific meaning on Wikipedia and doesn't apply here. Zad6820:26, 20 March 2013 (UTC)
Yes I did read the commentary and it very much did thoroughly discredit the AAP report and the policy statement. It addressed the issues and concluded that the AAP was incorrect. It's not an issue of whether the AAP policy statement is used in this article. It's an issue of whether the AAP is a reliable source. Furthermore, the commentary is proof of what I've been saying all along: this article is biased towards the American, not worldwide point of view on the subject of male circumcision. The commentary was authored by 38 medical professionals representing more than 2 dozen medical orgs/universities/hospitals in 17 countries. I guess this isn't significant for you. I have very little interest or patience for endless battles over wording and minor points when most of this article is incorrect, misleading, and does not represent the current medical/scientific consensus. With regards to COI, I was thinking of WP:COI, actually. But it doesn't seem that Wikipedia has any policy on the views of sources, only editors. And this is wrong. It is wrong that certain sources are considered reliable even when they have a conflict of issue. Crimsoncorvid (talk) 20:53, 20 March 2013 (UTC)
Please be sure to use technical terms such as reliable source correctly, or things get terribly confusing. The standard for reliable sources is actually pretty low, and there is no doubt in my mind that the AAP publication meets it. The real issues are as follows:
Degree of overall reliability. This is particularly important in connection with attempts to strictly enforce an interpretation of WP:MEDRS. Some here claim that overall reliability is extremely high for the AAP technical report.
Reliability of individual bits of information. This can only be disproved by disproving the information. If a lot of individual bits can be disproved, the entire text may be considered unreliable.
Neutrality; using the source as a guide on how to weight information and what to include. There are serious problems with that. The source clearly falls under WP:RS#Biased or opinionated sources for reasons I have explained elsewhere on this page.
Reliability means that statements of fact in the source will be correct. If the AAP reports cites a study and describes its outcome, we can trust it that the study exists and found essentially that outcome, possibly among other things. Maybe we can even trust it not to misrepresent the overall outcome through cherry picking from the results; this is a borderline question. We can't trust it not to have used a biased selection though, by methods such as strategical choice of cut-off date for the review, and we can't trust the AAP's overall conclusions. All these things are not clear statements of fact but must be treated as opinions, for which we need either neutral sources or (when there are none, as is the case for this topic) a selection of sources representing all positions. Hans Adler13:47, 21 March 2013 (UTC)
@Crimson - WP:COI only applies to individual Wikipedia editors. Unless you are suggesting that there are individual Wikipedia editors here who are in the employ of the AAP it does not apply. Zad6813:51, 21 March 2013 (UTC)
Hans, the problem I have here is that the Wikipedia community believes that certain sources, such as the AAP and the WHO are infallible and that any publications by these organizations are reliable. Only the most naive person would believe that the AAP or WHO are reliable sources on the subject of circumcision. These two organizations benefit greatly from the needless mutilation of infants. As Wikipedia policy does not allow editors to verify the correctness of source material---even when that source has an obvious COI, I believe that both of these sources must be deemed unreliable out of hand. Especially since these two "medical organizations" are anomalies in the worldwide medical community. The rest of the world believes that male circumcision is unethical, a violation of human rights, and harmful. Crimsoncorvid (talk) 16:15, 21 March 2013 (UTC)
Wherefore the prepuce? Is this absent object worthy of its own concise section in an encyclopedia article on its removal? FiachraByrne (talk) 20:41, 21 March 2013 (UTC)
Just to point out a significant cultural blindspot, if 1/3 or the male population are circumcised it seems unlikely that "the rest of the world [exclusive of the US] believes that male circumcision is unethical". FiachraByrne (talk) 20:45, 21 March 2013 (UTC)
I think "rest of the world" was meant as a reference to other paediatric organisations worldwide that have published statements on the topic. Hans Adler21:08, 21 March 2013 (UTC)
Hans understood what I meant; sorry for the confusion. I have made the claim that the AAP is out of line with worldwide medical opinion many many times. Crimsoncorvid (talk) 14:57, 24 March 2013 (UTC)
(ec) Once more in different words: "Reliable source" is a technical term that is merely meant to exclude forum posts, random blogs, pamphlets distributed by lunatics and self-published books. Being a reliable source does not imply that everything is correct, let alone unbiased. Fox News, for example, is obviously totally biased, yet it's a reliable source. The same is true for the Socialist Worker. If you don't believe me, go to WP:RS/N and ask.
The AAP document is used inappropriately on this article, but you are not going to change this by making unrealistic claims about its (non-)reliability. It's technically reliable but at the same time overused and inappropriately used for questions of weight (i.e. what to include and what not). There is no contradiction between these two statements. Hans Adler21:08, 21 March 2013 (UTC)
Hans, are there specific statements in the article sourced to the Technical Report that you'd like to raise for discussion? FiachraByrne (talk) 10:40, 22 March 2013 (UTC)
European intactivists (or "opponents of non-therapeutic circumcision", if you prefer) are pushing very very hard to paint the AAP and WHO as "fringe" or "hopelessly biased" and claim for themselves not only the moral high ground but also dominance in the court of expert opinion. (By the way, this viewpoint totally rules the article on German WP and, as far as I can tell, also French WP.) Of course, their claims do not hold up to non-partisan inspection. There are more than 50 member states in the Organisation_of_Islamic_Cooperation, with a combined 1.6 billion population. Just because their medical societies haven't come out with detailed, lengthy position statements on male circumcision (MC) does not mean that they can be counted in the camp of "do not agree with AAP or WHO." Far more likely is that any controversies over MC are so far off their radar screens that they never considered it necessary to take a public stand. Add Israel and South Korea, plus countries with regionally high prevalence of MC, and you have a good chunk of the world's population where people are so untroubled about MC that they never bother with it.89.204.130.51 (talk) 05:05, 22 March 2013 (UTC)
@89.204.130.51. If you indent your posts it's easier to keep track of the conversation and who you're responding to. Use colons to indent. For example:
89.204.130.51, yes, what you write about efforts to "paint the AAP" is an agreement with what I've been reading. For this article, the notion has come up that the AAP TR is biased or opinionated and therefore its use in the article would have to be qualified, but I haven't yet seen support for an argument that any specific technical finding in the TR is wildly out of line with all the other secondary and tertiary sources we have. Zad6813:39, 22 March 2013 (UTC)
"bias" means making a specific technical finding that is "wildly out of line with" the secondary and tertiary sources "we" have?Zebulin (talk) 21:56, 28 March 2013 (UTC)
FiachraByrne, the fact that you cite studies from Morris/Waskett/Haplerin is disturbing. It shows your own editorial bias. Morris & Waskett are not even medical doctors and have no standing in the medical community. They also have agendas. And that begs a larger question. So I have been told that reliability has a very low standard and has nothing to do with facts, COI, etc. But I've asked Zad68 to strike a Morris source on this basis -- and he did. But at the same time, we don't use Bollinger which apparently doesn't meet MED:RS. So is reliability a low standard or isn't it? I guess maybe my concern is regarding the fact that we are giving AAP and the American point of view UNDUE weight on this subject. Crimsoncorvid (talk) 15:04, 24 March 2013 (UTC)
The basis for their inclusion is that they are review article (i.e. secondary sources), fairly recent, and published in recognised medical journals. If there are other publications that meet that criteria, please feel free to include them. FiachraByrne (talk) 17:40, 24 March 2013 (UTC)
I proposed above that a new, short section on "Non-medical circumcision" should be created between the current sections on adverse effects and prevalence[11]. User:Zad68 commented favorably on the proposal [12], but not other editor has yet offered an opinion. It was proposed that this section should look, mostly, at medical aspects of non-medical circumcision (complications, etc) and should be kept distinct from the sections detailing the medical procedure. The rationale behind this proposal and its placement are as follows:
The article should indicate to readers that not all circumcisions are medical procedures and that outcomes and complications from non-medical circumcisions may differ from those performed under normal surgical conditions
The rationale behind the placement of the proposed section is that most of the literature on ritual and traditional circumcision that meets WP:MEDRS, as with the WHO article, focuses on the increased rate of complications relative to the medical procedure and its placement after the adverse effects section, which is the last section of the article strictly limited to the medical procedure, would provide a natural context and point of comparison
The section on prevalence is not currently confined to medical circumcision and simply provides the global estimates of male circumcision which must include non-medical circumcision. It might be important, therefore, to indicate to the reader before this point that not all circumcisions from the global total are performed as medical procedures
A search of pubmed returns 12 review articles treating of aspects of traditional, ritual, or non-medical circumcision. It's unlikely that all of these articles are appropriate for inclusion, but I'll list them all below in any case.
The search query used in pubmed was:
((("traditional male circumcision"[Title/Abstract] OR "traditional circumcision"[Title/Abstract]) OR "ritual circumcision"[Title/Abstract]) AND "review"[Publication Type])
Table: Pubmed search results for review articles on traditional, ritual or non-medical circumcision & WHO article
Y Good, useful source; already used elsewhere in article
3
Schreiber, M.; Schott, G. E.; Rascher, W.; Bender, A. W. (2009). "Juristische Aspekte der rituellen Zirkumzision". Klinische Pädiatrie. 221 (7): 409–414. doi:10.1055/s-0029-1233494. PMID20013563.
N Not really on the topic area proposed, 2009, concerns legal aspects since outdated by December 2012 approval of bill by German parliament
N Not really any more info in than what's in PMID21124715, and not convinced Afr J Tradit Complement Altern Med is a better journal than Bulletin of the World Health Organization for the little bit of info provided.
5
Vincent, L. (2008). "'Boys will be boys': Traditional Xhosa male circumcision, HIV and sexual socialisation in contemporary South Africa". Culture, Health & Sexuality. 10 (5): 431–446. doi:10.1080/13691050701861447. PMID18568868.
Y Part review, part arguing a new thesis ("This paper argues...", "This study is based on..."). Focuses specifically on Xhosa. Discusses ceremony and also high mortality and injury rate. Useful.
6
Thomson, R.; Finau, S.; Finau, E.; Ahokovi, L.; Tameifuna, S. (2006). "Circumcision of pacific boys: Tradition at the cutting edge". Pacific health dialog. 13 (2): 115–122. PMID18181400.
N Not really on topic, traditional non-clinical circumcision not discussed. Paper attempts to argue in favor of clinical circumcision using outdated (through Sept. 2005) database. Poor quality evident from numerous obvious factual errors, typos and the fact that their research efforts were hampered by "Net Nanny"-style software in place at the university library they were using.
7
Essid, A.; Hamzaoui, M.; Sahli, S.; Houissa, T. (2005). "Glans reimplantation after circumcision accident". Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 15 (4): 745–747. PMID16459701.
N Off topic, individual case study.
8
Hirschberg, M.; Tovi, J.; Bowald, S. (2004). "Open discussion about male ritual circumcision turned emotions hot. A study of a debate in Lakartidningen during the years 1997-2003". Lakartidningen. 101 (45): 3520, 3522–3. PMID15575426.
N Off topic, an analysis of a debate in a Swedish medical journal 10-15 years ago.
9
Puig Solà, C.; García-Algar, O.; Vall Combelles, O. (2003). "Childhood circumcision: Review of the evidence". Anales de pediatria (Barcelona, Spain : 2003). 59 (5): 448–453. PMID14588217.
N 10-year-old review of medical benefits of circumcision, outdated and does not appear to cover traditional/non-clinical circumcision.
10
Mayatula, V.; Mavundla, T. R. (1997). "A review on male circumcision procedures among South African blacks". Curationis. 20 (3): 16–20. PMID9496032.
? 1997 is dated, Curationis is a defunct nursing journal. Xhosas (again) and Sothos, don't have access to full article text but no reason to think this article will have more info than the other articles we do have.
11
l'Archevesque, C. I.; Goldstein-Lohman, H. (1996). "Ritual circumcision: Educating parents". Pediatric nursing. 22 (3): 228, 230–4. PMID8717842.
N Outdated, 17-year-old article appears to cover complications.
12
Wallerstein, E. (1985). "Circumcision. The uniquely American medical enigma". The Urologic clinics of North America. 12 (1): 123–132. PMID3883617.
N Off-topic, ("Ritual circumcision is not germane to this discussion..."), outdated 28-year-old article but maybe useful elsewhere for history.
Y On topic, useful, already used elsewhere in article.
Is there a consensus that this article merits such a section?
If there is agreement on the inclusion of a section on non-medical circumcision, what sources should be used in such a (necessarily brief) section?
FiachraByrne (talk) 14:53, 24 March 2013 (UTC)
Long Overdue section - but such a section should not be limited to medical sources as it is, by definition, not a medical procedure in this instance. WHO article gives a good overview and some stats. Could also link forced circumcisions here ?--— ⦿⨦⨀TumadoireachtTalk/Stalk21:33, 24 March 2013 (UTC)
Tumad., if you have non-medical sources you'd like to consider for use please bring them along with the proposed article content using them. A reminder, throughout all articles on Wikipedia, statements of biomedical information are covered by WP:MEDRS for the sourcing. This is true no matter what the subject of the article is, and this should not be a problem as the breadth of WP:MEDRS sourcing is enormous. For example, smoking is a purely cultural and non-medical activity, yet PubMed lists over 100,000 documents related to it, with over 2,600 recent secondary sources available, including over 100 Cochrane reviews. Also, just because something has a PubMed ID doesn't mean that it is "purely medical", there are lots of articles with PubMed IDs that cover non-medical aspects such as society, ethics and culture. We use lots of articles with PubMed IDs in this article to source non-medical information.
A link to forced circumcision would only make sense in the new section we're discussing if forced circumcision were a significant subtopic of ritual/non-clinical circumcision, and so far in my reading of the sources that subtopic hasn't come up. Zad6802:21, 29 March 2013 (UTC)
I have reviewed the sources in the table (thank you Fiachra!) and made my notes alongside them (hope you don't mind me editing your table). It seems the Xhosa get more press than average regarding their particular brand of ritual circumcision, to be reflected with WP:DUE weight. I'm reading the sources now, I think there is a good, meaningful paragraph on an encyclopedic theme here. Zad6802:21, 29 March 2013 (UTC)
Nice review - I don't disagree with your assessment of any of those sources. Also, I think, aside from anything else, the article will be more coherent if this section details the medical aspects of non-medical circumcision. I'm a bit pressed for time at the moment so I probably won't be posting here for a bit. FiachraByrne (talk) 21:38, 29 March 2013 (UTC)
There is a danger in confusing health with medicine (which is one remedy for ill health). Sewage works, for instance have often done more to improve public health than an entire fuster of doctors. A small coterie of editors have prevented even mention of some of the most interesting aspects of circumcision( foreskin sales, parents sued by adult cut sons, forced circumcision, shunning of the uncut ,the "circumstraint" et cetera) in this article. I fear that this new section will be as castrated as most of the rest of the article, but I live in hope.
I have already given many references for these but here are some more on forced circumcision in both intra and inter tribal and cultural settings - so far unlinked to this "main" article on circumcision. Are all infant circumcisions also "forced ' ?
Tumad., re your comments once again regarding A small coterie of editors... Hans left you some excellent advice on his User Talk page, please consider it carefully, especially where he advises "Cutting through the 'us vs. them' thinking." By continually commenting about editors, you're not only violating WP:TPYES (bullet point #2) and WP:NPA (second sentence), you're actually interfering with the development of the discussion regarding the kinds of content changes you appear to be proposing, and beyond that, you're interfering with similar proposals from others. (This is the last time I hope to discuss behavior here.)
From the 11 sources provided, after weeding out the four non-WP:RS, misrepresented, off-topic and already-used ones, and then combining the redundant ones, I see one potential subtopic emerging, but it's poorly supported by the sources you provided and in need of additional sourcing. What secondary sources are you providing to establish context, relevance and compliance with Wikipedia's policy regarding due and undue weight? And what specific content are you proposing, using which sources? Zad6803:24, 3 April 2013 (UTC)
@ Za :Thank you once again for your many opinions Za. Your interpretation of site rules and practices is always interesting and often novel. Noticing a pattern of reversions and its effect on content is part of tending to content and article improvement. I am afraid that you lost me in the undergrowth about the "interfering with similar proposals from others", but rather than elucidate it might be simpler for all if you follow through on your undertaking to not discuss behaviour here.--— ⦿⨦⨀TumadoireachtTalk/Stalk14:29, 14 April 2013 (UTC)
Fiachra, here's the first go at the new content, it only pulls from the WHO's GTDPSA, I'll fill it out with the other sources later. It's two paragraphs on "how" and one on complications, we may split this up into two sections.
Religious and cultural circumcisions are frequently performed in non-clinical settings by those with little to no formal medical training, with techniques ranging from being considered safe to very risky. Typically, these procedures involve pulling the foreskin forward and cutting off the portion of prepuce that extends beyond the tip of the glans, with some variation in the technique used and the resulting amount of foreskin removed. Jewish mohels may use a technique similar to that employed by medical providers with the Mogen clamp: after the foreskin is pulled forward, it is placed through the narrow gap in the clamp before excision, and then any remaining foreskin is removed. Some Muslim traditional practitioners may use a very similar device and technique; others may use a grass straw to push the glans in while pulling the foreskin forward, and then bind the foreskin with a knotted cord before excising it. These non-clinical techniques employed by Jewish and Muslim ritual practitioners are considered relatively safe, and the neonatal timing of Jewish and some Muslim circumcisions is safer than when done at an older age.(GTDPSA, p. 19)
The Xhosa of South Africa perform their rite with a razor or penknife, and without anaesthesia. The wound is then covered with maize, or with eucalyptus, which has antiseptic properties. The Australian Aboriginals and Polynesians also use eucalyptus oil after removing the prepuce, which is thought to be done with seashells. Certain cultures in East Africa do not remove all of the foreskin, leaving some to hang down below the glans; others remove all the foreskin along with some skin from the shaft of the penis.(GTDPSA, pp. 19-20)
Some of these circumcision traditions have the potential for significantly more serious complications. It has been found that in parts of East Africa, traditional rituals made up the large majority (80% or more) of those admitted to hospital for circumcsion complications, with several suffering catastrophic complications including the loss of penis and death. Another group from this area reported traditional circumcsions to have nearly double the complication rate, and with the additional problems of slow healing, excessive pain and scarring. Particular ritual customs, such as the Xhosa custom of dehydrating the initiate before the rite, may also exacerbate complications.(GTDPSA, pp. 20-21)
Sounds O.K. to me. Couple of comments: "considered relatively safe" is too vague-sounding. I've seen abstracts of medical studies that found the rate of complications for traditional circumcisions performed by a mohel to be no higher than those performed by a surgeon in a hospital. "thought to be done with seashells" again, too vague-sounding. I think more needs to be written on the differences both in technique and in effect (pain+healing, lifetime health+sexuality) between the combination of mogen shield and scalpel customarily used by mohels on the one hand and the use of a mogen or gomco clamp by surgeons on the other. This could be done either here or at "brit milah". In fact, the brit milah article lacks a description of the actual cutting. Apparently there is a big trend all across the Muslim world away from using traditional (non-medical) circumcisers toward having the procedure done in a hospital, but I do not know of a good source that can be used to reference this.82.113.99.98 (talk) 19:33, 3 April 2013 (UTC)
I appreciate the feedback, thanks! Regarding the vague "considered relatively safe", if you can provide WP:MEDRS-compliant sourcing that is more definitive in characterizing the safety of these procedures, we can use it - I will look too. Regarding "thought to be done with seashells" is too vague, we're limited by what the source says, which is "reportedly removed using seashells" - if the source is vague, we have to be vague too. I haven't seen any secondary sources examining differences between circumcisions done by mohels (or traditional Muslim circumcisers) vs. the various hospital techniques, and in fact the studies I've seen on circumcised men don't treat those circumcised by mohels any different from those circumcised in clinical settings. If you can find sourcing for this, please bring it, although because those circumcised by mohels make up far less than 1% of all those circumcised worldwide, that would probably fit better at brit milah. I actually have found sourcing for the prevalence of Muslim circumcisions in hospital, Surgical Guide to Circumcision p. 276, "The prevalent practice in modern-day Egypt as well as the majority of the Muslim world is that children born in hospitals are circumcised before discharge." but I don't know what fraction of all Muslims are born in hospital, it's a bit vague. Zad6803:39, 4 April 2013 (UTC)
I am delighted to see finally some solid mention of non clinical MC along the lines which I have been proposing for months. Well done Za and Fiachra and 82.113.99 etc.--— ⦿⨦⨀TumadoireachtTalk/Stalk14:29, 14 April 2013 (UTC)
Herpes from traditional Jewish circumcision ritual
I have no medical background but I just came across this ABC News report which I presume should be added by someone who can put it in the proper perspective. Apparently it is common enough that it requires a disclaimer form. EllenCT (talk) 04:12, 6 April 2013 (UTC)
@ Ellen CT --I, and several other editors, disagree strongly with Zad's opinion and reversion of any mention on this alarming practice in this article. That it involves preventable death or lifelong injury or infection to infants in Israel and in NYC is, we feel, worthy of, at the very least, a mention in this article and a link to the section in the fuller Jewish circumcision article where it is only slightly better explored.--— ⦿⨦⨀TumadoireachtTalk/Stalk14:14, 14 April 2013 (UTC)
Tumad, at some point you really should read Wikipedia's policy regarding due and undue weight and how we look to secondary and tertiary sources (instead of relying on our own opinions) to determine this. Zad6814:21, 14 April 2013 (UTC)
I loved the "instead of relying on our own opinions bit in your last entry Za. Are opinions like noses ? Does everyone have one ? You and other editors will be familiar with the idea by now that circumcision is primarily cultural, and hence, that secondary sources such as eminent newspapers are perfectly legitimate material for inclusion on the shocking human rights abuses and injuries visited on children and others involuntarily by circumcision practice.--— ⦿⨦⨀TumadoireachtTalk/Stalk14:51, 14 April 2013 (UTC)
New circumcision/HIV study
I know it's a primary study and we need to wait for it to make its way into secondary literature but just FYI.
Circumcision is known to reduce a man's risk of HIV infection by at least half, but scientists don't know why. A new study offers support for the theory that removing the foreskin deprives troublesome bacteria of a place to live, leaving the immune system in much better shape to keep the human immunodeficiency virus at bay.
Anyone who has ever lifted a rock and watched as the earth beneath it was quickly vacated by legions of bugs and tiny worms would be familiar with the principle, said study leader Dr. Cindy Liu: After the foreskin is cut away, the masses of genital bacteria that once existed beneath it end up disappearing.
"It's the same as if you clear-cut a forest," said Liu, a pathologist at the Translational Genomics Research Institute in Flagstaff, Ariz. "The community of animals that once lived in that forest is going to change."
Of particular note is that circumcision undercuts anaerobic bacteria, the microbes that thrive in oxygen-deprived environments, she said. By reducing the number of anaerobic bacteria, the body's immune cells may be better able to destroy the virus — and less likely to fall prey to its Trojan horse-style of attack, the authors suggest.
Liu and her colleagues present their case in a paper published Tuesday in the journal mBio.
Thanks for keeping your eye out for sources. It surely seems like this article is talking about PMID20066050, which was published January 2010 and picked up by the secondary source PMID21042054, which we already cite in the article in the Human immunodeficiency virus section's paragraph, supporting the content: "There are plausible explanations based on human biology for how circumcision can decrease the likelihood of female-to-male HIV transmission. ... When an uncircumcised penis is flaccid, the pocket between the inside of the foreskin and the head of the penis provides an environment conducive to pathogen survival; circumcision eliminates this pocket." I have no idea why the LA times just decided to pick up this study as a story recently! Zad6817:18, 17 April 2013 (UTC)
Adding - Actually you're right, it does look like Liu and colleagues published a new study here. Too early to have a PMID yet. It looks like they're continuing the research they were doing when they published PMID20066050. And as you mentioned, we'll wait to see if it gets picked up by secondary sources before seeing if the Wikipedia article needs a content change. Thanks... Zad6817:30, 17 April 2013 (UTC)
edit request
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Recent edits by user:Ewawer should be reversed, in particular, this change:
Circumcision is not required by Judaism for one to be considered Jewish
This article should link to other forms of male genital cutting, like subincision, bifurcation, penectomy, castration, etc. Those practices are listed on the "genital modification and mutilation" page, but there is not a link in this article to them. Ideally all these practices should be grouped somehow. Tobias8844 (talk) 03:57, 23 April 2013 (UTC)
It already is, look at the bottom of the page, see the category "Genital modification", click on that, it takes you to this complete list of all related items. Zad6804:13, 23 April 2013 (UTC)
I've checked the subsection on Bris milah here versus the separate article, and neither mentions the difference between milah and periah. This subject does occur in "Religious male circumcision":
"David Gollaher has written that the rabbis added the procedure of periah to discourage men from trying to restore their foreskins: ‘Once established, periah was deemed essential to circumcision; if the mohel failed to cut away enough tissue, the operation was deemed insufficient to comply with God's covenant’ and ‘Depending on the strictness of individual rabbis, boys (or men thought to have been inadequately cut) were subjected to additional operations.’[17] In addition to milah (the actual circumcision) and priah, mentioned above, the Talmud mentions a third step, metzitzah, or squeezing some blood from the wound."
This would be good to add in the history subsection, as it demonstrates that the modern method of more extensive tissue removal was originally a backlash against early attempts at foreskin restoration. Tobias8844 (talk) 16:43, 23 April 2013 (UTC)
To no one's great surprise the AAP has encountered a great deal of criticism for their 2012 policy statement on MGC. This is a response published in Pediatrics from a group of European pediatricians criticising the AAP's principal claims. As I understand it, several of the authors are chairs of European national Pediatrics associations themselves, the equivalent of the AAP. This statement won't require an official translation; a concern was raised about this when I mentioned the German Pediatrics Association contradicting the AAP independently--but in German.
This group, naturally, had access to the same primary studies as the AAP and came to a radically different conclusion. To quote them:
"It seems that the authors of the AAP
report consider the foreskin to be
a part of the male body that has no
meaningful function in sexuality. However, the foreskin is a richly innervated
structure that protects the glans and
plays an important role in the mechanical function of the penis during
sexual acts.16–20 Recent studies, several of which were not included in the
AAP report (although they were published within the inclusion period of
1995–2010), suggest that circumcision
desensitizes the penis21,22 and may
lead to sexual problems in circumcised
men and their partners.23–29 In light of
these uncertainties, physicians should
heed the precautionary principle and
not recommend circumcision for preventive reasons."
Again, the same studies were reviewed and this group of others found the studies demonstrating adverse sexual effects convincing--and, meanwhile, say in the same statement that the only prophylactic benefit attributable to MGC might be fewer UTIs, which are easily treatable less invasively with antibiotics. Tobias8844 (talk)
Hi Tobias, regarding the suggested use of this Frisch et al. commentary: As it states right at the top, that isn't a peer-reviewed meta-analysis, systematic review or review article (the kinds sources we prefer), but rather a commentary, like a letter to the editor, and so is expert opinion. Per WP:MEDASSESS, that puts it at the bottom of the evidence quality hierarchy, and so it really can't be used alongside the existing multiple high-quality secondary sources in use in the article. And to be clear, this Wikipedia article accurately reflects current worldwide medical consensus that routine circumcision is not recommended and that no major medical organization recommends routine circumcision, not even the AAP, and not even for the prevention of UTIs (as the article states, "prevention of UTIs does not justify routine use of the procedure"). Zad6813:02, 19 April 2013 (UTC)
I find the above posting by Tobias8844 more than a little disingenuous. Somehow he neglects to tell us that those European doctors never performed anything that came even close to the AAP`s Technical Report: a multi-year, multi-physician thorough review, with selection based on objective criteria, analysis, and write-up of the "state of medical science" on male circumcision. I don't know that their statement even has a place in this article, though it might in Circumcision controversies.82.113.99.79 (talk) 21:36, 19 April 2013 (UTC)
Zad: What is the process for determining if a reference is biased by a conflict of interest? If a source was doing a meta analysis of the effects of Drug A and Drug B, and the majority of the authors were profiting from Drug A, would their review of all of the literature that concluded that Drug A was safe and Drug B was hazardous be considered legitimate? Or, would the cobflict of interest be pointed out
, and their claims dismissed as dubious? This is pretty much the same issue. No one is making money off of not cutting infants.
IP address: Disingenuous? Frisch et al have no vested financial interest in MGC; they come from care based medical communities instead of profit based medicine and - surprise! - reach an opposite conclusion. How's that for objective? Tobias8844 (talk) 02:36, 20 April 2013 (UTC)
In this case some pretty dodgy uncompleted research linking HIV transmission reduction and male genital cutting is being promoted and legitimate rebuttal largely ignored or unreferenced. Beware also editors who purport to have a definitive interpretation of WP policy. Circumcision is, in any case, a cultural not a medical phenomenon.--— ⦿⨦⨀TumadoireachtTalk/Stalk12:01, 20 April 2013 (UTC)
I do not think Zad is biased, he is following the medical article guidelines to the letter, which eliminate dubious sources like Morris and Waskett in addition to primary sources that have no vested financial research. The problem, though, as Tumaidoreact has pointed out time and again, is that circumcision is only a medical procedure when it actually treats a diagnosable illness that does not respond to less invasive forms of treatment--otherwise, it is just a body modification like tattoos, except performed on children without their informed consent. Amputation of the thumb is not a medical procedure unless necrosis or some other type of localized problem necessitated it. Otherwise, it would be purely cultural in a culture that commonly amputated thumbs.
Regarding the point brought up in the SSRI scandal, you are absolutely right. The exact same problem exists. Studies designed to demonstrate the safety of Drug A are funded by the company producing Drug A, instead of a third party, and invariably crown Drug A with laurels. Same question applies: do we embrace this dubious material, or point out the blatant financial cobflict of interest and prefer sources without demonstrable conflicts of interest?
I think I speak for Tumaidoreacht, Adler and myself when I say we would prefer the latter approach. They can correct me if I am mistaken. Tobias8844 (talk) 20:59, 20 April 2013 (UTC)
I am suggesting that this article, and indeed, all articles with these type of vested interests at work, be completely purged of sources with demonstrable vested financial interests. These financial interests distort the outcome of any purportedly neutral study or analysis. In this case, I suggest removing statements from American pediatric and obstetric organizations, as they have a financial interest in promoting MGC and can't be trusted in the least to be objective. Indeed, exactly what you would expect would happen is actively happening: nations where doctors are still profiting from MGC are issuing statements more in favor of MGC than nations with little financial interest. Tobias8844 (talk) 01:54, 21 April 2013 (UTC)
MGC is male genital cutting, comprising a wide variety of practices: bifurcation, subincision, partial or total amputations of various an sundry parts of the external male genitals. You see MGC and MGM appear side by side sometimes, but MGC seems closer to neutral language.
The sections topic is pointing out a published statement--what Zad calls expert opinion--that contradicts the 2012 AAP statement on nearly all counts. Zad suggests that the source I posted is of lesser quality, so I'm now arguing that the AAP review is of lesser quality due to its demonstrable conflict of financial interest. Consequently, the source I posted should be preferred.
Given that definition of "MGC", the AAP has released no statement that I know of "promoting MGC" as you describe it, and no source at all from the AAP regarding MGC as defined is used in this article, so your request to have such a source removed appears to be unrelated to what is actually used in this article.
Tobias, I have some idea of what you might be trying to say, but what I'm thinking you are getting at is so peculiar I really need you to spell it out, exactly what you mean to say, naming names, because I don't want to go through the process of responding to it if it isn't what you mean to say. Zad6821:01, 21 April 2013 (UTC)
Speaking of bias and conflict of interest, Dr. Frisch himself notes:
Conflicts of interest: M.F. has been an author of articles on the possible role of male circumcision in relation to penile cancer risk and has taken part in national debates about the ethics surrounding male and female circumcision. M.L. and M.G. declare that they have no conflicts of interest.
European opponents of circumcision in the medical community have no privileged position that would give their arguments more weight. On the contrary, their arguments are sometimes sloppy at best, this has been discussed here before.
In any case I suspect that Tobias8844 is arguing for a change in WP policy and this type of meta discussion should probably be conducted elsewhere.89.204.130.211 (talk) 22:11, 21 April 2013 (UTC)
Zad: Consider a hypothetical scenario. Glenn Beck commissions a team of psychologists to assess his intelligence. They test him and conclude that he is the most intelligent and empathetic human in the history of the world. Would this study be worthy of inclusion in the Wikipedia article on Beck, or would it be flawed intrinsically by a financial conflict and unworthy of standing? I say the latter. Statements that come from organizations like the AAP have the same problem; they review the subject of preputial amputation and claim that 'benefits outweigh the risks' while profiting from the procedure to the tune of hundreds of dollars per procedure. This financial incentice plecludes them from producing objective data. If secondary or tertiary sources from organizations without this financial incentive exist, they should absolutely be used. Otherwise, primary sources without this conflict of interest are of apparent higher quality.
IP address: Frisch is making no money by not cutting the genitals of babies. Members of the AAP, meanwhile, are making substantial amounts of money cutting the genitals of babies; indeed, they wanted to cut the genitals of female babies at one point too. This is a dubious, financially driven amalgamation of physicians whose predilections derive not from review of the data (eg Frisch). If they did, they would be in keeping with opinions from care based medical systems.
This is indeed a topic which requires attention in all wikipedia articles, not just this one. The aforementioned SSRI articles funded by SSRI companies are dubious sources as well. In due time, special financial interests will be divorced frlm their attempted monopoly on truth: the internet will find them out. Tobias8844 (talk) 06:57, 22 April 2013 (UTC)
Tobias, who is the "Glenn Beck" here and which are the psychologists? I'm sorry, you're still talking around whatever the actual meat is behind the point you're trying to make. Are you saying that all secondary sources from all American medical associations (AAP, AMA, American Academy of Orthopaedic Surgeons, American Cancer Society, ...) are monetarily conflicted and therefore unreliable sources and so should be ripped out of all Wikipedia articles because the organizations behind them are based in America, which you are saying does not have a "care based medical system" but instead is "profit based medicine"? Are you saying the AAP recommends vaccines not because they care about kids' health but because they profit off of selling vaccines? That the AAOP recommends intra-articular corticosteroids for short-term pain relief for patients with symptomatic OA of the knee because they make money off of selling steroids and not because they care about patients with symptomatic OA more comfortable? And that the American Cancer Society recommends colonoscopies not because they care about protecting adults' health but because doctors make money selling colonoscopies? I have no interest in a philosophical discussion here about the pros and cons of the American vs. European health care systems, I only care about making changes to articles that are in line with Wikipedia policy and guideline. Say what it is you mean to say, please, so it can be addressed directly, otherwise this conversation should be closed as not providing a specific convincing argument for the significant article change you are proposing. Zad6813:27, 22 April 2013 (UTC)
In this analogy, the Beck is genital cutting itself: it is a subject which financially enriches its investigators, who then report that it has more pros than cons. This is a predictable outcome in the given situation; that which makes the researcher money will be considered good even if evidence demonstrates the contrary.
As to the point about other procedures done in American medicine, this one is rather unique and touches upon the subject of proportionality that Frisch et al discuss. Care driven and profit driven systems alike recommend vaccines against certain illnesses, treatments for tumors, and pain relief for those in acute or chronic pain. The care centered systems are a good reference point to check against runaway greed in our own medical system: care based physicians respond to cancer with radiation therapy and chemotherapy just as doctors do in profit based medicine. That's good, and it confirms the utility of these treatments. Genital cutting, meanwhile, is a disproportionate procedure, as Frisch et al argue. It does not treat any disease, and does not offer sufficient prophylactic effect to offset its negative physical and sexual effects. Care based systems know this, and they disrecommend it accordingly. When we compare the profit based model on this issue, we come up with a conflict. The men in Europe and Asia are not dying in droves of dread genital plagues, and yet male genital cutting rates are comparatively low there.
That is what makes the issue of genital cutting unique; the conflict of interest on this subject is demonstrable because it is a procedure scorned by care based medicine. It is a cash cow. It is unnecessary for human health, and remains a global oddity.
All of this goes to say that the use of these particular secondary sources, which under normal circumstances might be valuable, is worthless because the secondary sources in use are flawed on this particular issue. They are not in keeping with the verdicts of care based medicine, and the most obvious explanation for this discrepancy is their financial conflict of interest. The best sources for information on this issue remain primary sources from regions with little demonstrable financial incentive: Asia and Europe in particular.
If we can find a secondary source from a region with no vested interest, like the EU, China, India, etc etc, by all means let's use it. Otherwise, the primary studies will serve better and provide objective outcomes. Tobias8844 (talk) 03:50, 23 April 2013 (UTC)
Tobias, is it the case that you have such intense negative personal feelings about the subject of this article that you refuse to even use the word "circumcision"? Zad6804:23, 23 April 2013 (UTC)
Tobias, that's one of the most cynical viewpoints I've come across in a while, and the equating of Glenn Beck with "genital cutting itself" gave me quite a laugh!
I'd first like to point out the the AAP Technical Report is only one of many secondary sources used. You didn't say exactly which parts of the article content you most object to having the AAP TR source, but it is only one of four sources covering UTIs, one of four sources covering sexual effects, and one of thirteen sources covering HIV. A review of secondary sources shows the AAP TR is very middle-of-the-road and is generally in line with worldwide scientific consensus. Honestly we could probably source the entire article without it and not have to change any content, but there's no reason to entertain that idea.
But in any case, you are welcome to open a discussion at WT:MEDRS asking for that Wikipedia-wide guideline to be changed to make an exception in the one particular case of the subject of this article, and to have WT:MEDRS state that in the case of circumcision, all American/"profit based" secondary sources are to be disregarded as hopelessly biased, and individual primary studies are to be used instead. Be sure to notify WP:MEDICINE. Until the Wikipedia guideline changes, the AAP Technical Report will be seen as a reliable secondary source. Zad6804:47, 23 April 2013 (UTC)
Tobias8844 may think that motivations of physicians in a "care-driven system" (as opposed to money-grubbing Americans) are pure as the driven snow, but that is not necessarily true. In particular, in the case of Germany's sudden outburst of hysteria over circumcision last year, we saw all sorts of motivations in play. Some of these motivations were exclusive to physicians. Others were commonly held by broad swathes of the population, with physicians not forming an exception.
-- Antisemitism. The head of Germany's Nazi party loudly proclaimed his tearful concern for the well-being of "innocent and helpless" Jewish and Muslim infants. If you believe him then I have a bridge to sell you. Countless people who suddenly made this their No.1 concern for a number of months were positively wallowing in their disgust expressed over Jewish (mostly Jewish, the Muslims were hardly ever mentioned) "child abuse". Their stormtrooper dad or granddad had hurled Jewish babies headfirst against walls, now they cried thick crocodile tears over the "unbearable pain" and "life-long trauma" suffered by the grand-children or great-grandchildren of Holocaust survivors. Finally -- finally! -- they had "the Jew" dead to rights... and by golly they would not let him get away easily! Finally a chance to turn the tables and put "them" on trial. An opportunity to sink your teeth into and not let go. As survey after survey has shown, antisemitism is far more widespread in society than the Nazi party's polling results (usually below five percent) would seem to indicate.
-- Anti-Americanism. In Germany, access to medical school is restricted in principle to those with the very best high school grade point average only. The young men and women who manage to achieve "straight A's" consider themselves a cognitive elite. When they spend a year in the U.S. as part of their medical schooling, it comes as a shock -- a narcissistic insult -- to encounter Americans who are even more driven, more competitive, harder-working and just plain smarter than themselves. It bugs them that so many of the important advances in medical science are made in the U.S., not in Europe. Denouncing the "backwardness" and "barbarism" of the prevalence of circumcision in the U.S. comes as a welcome relief from these feelings of inferiority.
-- Militant atheism. Like all of Europe, Germany is a post-religious society. Rabid atheism, of the Richard Dawkins variety, is widespread. The belief that the state knows better than parents what is good for children is unquestioned. "Their" children are not their children, they are ours and we have delegated to the state the power to determine their best interests. There is that small matter of Germany's constitution which provides for religious freedom and elevates parental rights to decide on their children's religious upbringing to the highest rank, but we will just pretend that the constitutional guarantee of bodily inviolability stands alone and that no balancing of guarantees need be done.
-- Currying favor. The medical profession in Germany has been rocked by a series of scandals, from widespread bribes paid by medical equipment manufacturers and pharmaceutical companies, to falsification of records in order to cut ahead in the organ transplant line. Most Germans are enrolled in compulsory health plans that hardly pay doctors enough to cover their cost. They see how high-income patients with private health insurance get preferential treatment and deeply resent physicians for making them wait weeks for an appointment and giving them only the mandatory minimum of care... and sometimes even less. Bashing a tightly circumscribed minority of citizens, playing into widely held prejudices among the populace, is a safe way to curry favor with voters who will elect the politicians who determine the size of medical budgets.
I could go on... but I think my point is made. In any case, as I said earlier, this kind of meta discussion does not belong here, but I felt that I could not let Tobias8844's claims go unopposed.82.113.121.157 (talk) 08:51, 23 April 2013 (UTC)
82.113.121.157, that is interesting stuff and surely some European biomedical sources have their own problems, but per WP:TPG we should avoid straying from the topic at hand: discussion of whether the AAP TR is a reliable source for biomedical information. You are correct in stating that discussion of Tobias' suggestion needs to be held elsewhere, and probably at WT:MEDRS as suggested. Zad6813:25, 23 April 2013 (UTC)
Zad: I could try and criticise your position personally as well, and claim that you have some psychological bias in favor of genital cutting (as you seem to think that I have some psychological/emotional aversion to it), but that would be irrelevant to the substance of your arguments just as your claim that I am personally affected is irrelevant to the substance of my arguments. The philosophical/ethical question at hand is the principle of self-ownership, with which genital cutting is not in keeping.
As to the term 'genital cutting', I have read convincing arguments that it is the most accurate, most neutral term on the subject. The article on genital modification and mutilation lists male circumcision, suggesting that it is a modification or mutilation depending on your perspective. Whether one thinks of it as modification or mutilation, it is a literal cutting of the genitalia, which means genital cutting accurately describes the practice whether one holds one or the other point of view. Circumcision is a problematic term because people want it to be applied to both men and women. At the opposite end, some people refer to MGM and FGM and want to think of both of these procedures as mutilations. MGC and FGC are a reasonable compromise.
It's fine that you find my points humorous. I've read that opposition often laughs at ethical arguments before they're accepted as self-evident. The AAP is a financially motivated organization, pure and simple. This is the same group that wanted to perform "ritual nicking" on the clitoris or clitoral hood of baby girls--presumably not for free! And one of the same authors of the current 2012 policy statement wrote the argument in favor of this idea, stating that ritual nicking would be far less invasive and extensive than preputial amputation for boys. He's right, but both practices are unethical.
IP address: As far as I'm aware, the majority of anti-Semitic attacks in the EU are committed by one genital cutting subculture on another. One can always speculate about conflict of interests that aren't demonstrable, but that goes both ways. You can impugne Frisch et al. as closeted anti-Semites and Nazis until you're blue in the face, just as I could speculate that the AAP contains circumfetishists and broken people who are merely robotically and compulsively reenacting childhood traumas. That doesn't avail us anything, but the financial incentive and money trail is there--following the money can show us all kinds of things.
In any case, the majority of Germans supported the ban on MGC before the national debate and after when polled. The actions of the legislature, supposedly representing public opinion went against it in this case. This public majority in opposition to violations of self-ownership is probably true in Scandinavia as well, where bans are likewise being debated. As far as I can tell, leftist parties are leading the push for bans--not the far right. You will continue to see more and more contributors like myself championing self-ownership in the Millenial generation. This is one of our political issues, and we will further the already considerable decline of MGC in the States and elsewhere.
On the subject of financially conflicted sources: the SSRI scandal was cited before in this talk page, in which companies producing the drugs funded studies demonstrating their efficacy and safety. Do you think that these studies are legitimate, or dubious? As Zad has said, this is bound to be a good debate in terms of what types of studies from what types of sources are acceptable in Wikipedia medical articles.Tobias8844 (talk) 16:37, 23 April 2013 (UTC)
Circumcision is indeed a form of MGC, as you define it, but it's not the only one as you yourself note, so MGC is not specific enough a term to use when discussing the subject of this article. One's personal reading on the subject isn't relevant, and certainly the AAP TR and other reliable secondary sources we use don't equate the two, so it's just plain inaccurate to say the AAP TR covers the subject of MGC when it only covers the specific form of MGC that is circumcision. Anyway, now that you've specified, I guess I don't really care if for whatever reason you prefer to use a less specific term, I agree this is largely off topic with respect to our discussion. I'll just mentally substitute "circumcision" every time you use the term MGC, you'll just have to specify if you mean some other form of MGC instead of circumcision.
Re your comments I've read that opposition often laughs... both practices are unethical - see WP:BATTLEGROUND and WP:NOTAFORUM. It's really unproductive to think of fellow editors as "opponents" and I have no interest in debating the ethics of circumcision, and you should probably avoid revealing your personal thoughts about the practice any more than you already have. Also can we all please agree to abide by WP:TPG and avoid general discussion about worldwide current events.
Regarding your proposed WP:MEDRS changes, please notify us if you open a discussion discussion at an appropriate venue. It doesn't appear that this conversation is going to be of productive value to the article here. Zad6817:10, 23 April 2013 (UTC)
Tobias, Re where you wrote: You will continue to see more and more contributors like myself championing self-ownership in the Millenial generation. This is one of our political issues, and we will further the already considerable decline of MGC in the States and elsewhere. - you appear to be saying that your involvement in editing this area of Wikipedia is to champion a cause and further progress on a political issue. Do I understand you correctly? Zad6817:40, 23 April 2013 (UTC)
Response from AAP Task Force to criticism
A PDF file of the AAP Task Force's response to the European doctors' critique of their Technical Report can be found here. Specifically, the response addresses the claims of cultural bias, HIV prevention, and sexual effects. In my opinion, both the Euro criticism and the Task Force response have a place in WP sub-article circumcision controversies, but neither should be in this article.89.204.138.250 (talk) 19:39, 28 April 2013 (UTC)
lead photo
Does anyone else feel that, as we are so pernickity about up to date "medical" references that having a lead photo of a few turbaned gentlemen from over a hundred years ago is a bit passé ?--— ⦿⨦⨀TumadoireachtTalk/Stalk13:51, 14 April 2013 (UTC)
That particular image is (as far as I know) the only circumcision-related image we have on Wikipedia that is Featured-quality content. As the info page for the image itself states, "members of the community have identified it as one of the finest images on the English Wikipedia, adding significantly to its accompanying article" and it was also selected a picture of the day on the English Wikipedia for May 22, 2010. The one image brings together three of the most important aspects of the article's topic: the procedure itself, the procedure's religious and cultural significance, and the procedure's history. I can't imagine a better or more-qualified image. Based on your past suggestions, I know you look to the French and German articles as models, and for what it's worth, this image is also the main image on both of those two languages' Wikipedia articles. Zad6814:16, 14 April 2013 (UTC)
Whatever past accolades the picture has received Za(are you sure you listed them all ?), you and several other editors have been at pains to point out (and ensure) that this article is chiefly, about the clinical procedure, which, per the article volume devoted to western hospital foreskin clipping is most prominent. Going from the particular aspects of the French and German MC articles which I have praised in the past (e.g. their coverage of the legal minefield of MC and the human rights, recycling of foreskins, and psychological aspects and the injury rates- so far oddly missing from this "featured" candidate English article) to a general illogical extension of my argument is, once again, part of the novel approach you so often tickle me with.--— ⦿⨦⨀TumadoireachtTalk/Stalk14:42, 14 April 2013 (UTC)
Nope; I do not think the image detracts at all. It is of high quality, it is inoffensive, and, as was mentioned, was considered a featured image. -- Avi (talk) 16:35, 16 April 2013 (UTC)
Perhaps you want this article to be like german.WP article on the topic: chock full with gruesome, horrific color photographs of the outcomes of botched circumcisions, never mind that such severe consequences are exceedingly rare.82.113.99.79 (talk) 21:41, 19 April 2013 (UTC)
We would do well to emulate the German article on this subject; negative outcomes of genital cutting are being suppressed with great dedication in the English article. I agree with Tumaidoreacht and would further say that images of various types of cutting procedures and styles, in various states of healing, would not be amiss. "Normal" and "botches" outcomes should be viewable as well, so people know what they may be getting into. The article can still say that botches are rare. Tobias8844 (talk) 03:54, 23 April 2013 (UTC)
Saying botches are rare on the one hand and then putting in a bunch of eye-catching photos emphasizing them would clearly be WP:UNDUE here. However, such photos would probably make sense at Circumcision surgical procedure. Also you appear to view this article as providing medical advice ("so people know what they may be getting into"), that's an incorrect view, see WP:MEDICAL. Zad6804:20, 23 April 2013 (UTC)
The arguments advanced for a continuing incomplete article are often remarkable. Surgical accidents and negative outcomes may be comparatively rare per the poor stats gathered about them in "Western" medicine but are much more common in tribal and non surgical settings per the literature. Also the diffidence amongst some editors about including photos of the penis during the actual procedure and the apparatus, or cutting tools used (baby restraint harness et cetera) is remarkable. What will be of interest to future examiners of the subject and of the wikipedia article versions of it which dominated at this time will be the contortions engaged in to have the article continue to have its current flavour for such an extended period. Is it necessary to say also again that as circumcision is generally not a medical procedure but a cultural one that the "we cannot dispense medical advice" stance is a red herring --— ⦿⨦⨀TumadoireachtTalk/Stalk21:49, 27 April 2013 (UTC)
WP:UNDUE is not an "argument[] advanced for a continuing incomplete article", but rather a fundamental component of Wikipedia content policy. What might be appropriate for a detailed article (e.g. Circumcision surgical procedure) might not be appropriate for an overview article (such as this one). Also, I have not seen anyone here asserting that this article "is chiefly, about the clinical procedure". On the contrary, only the "Techniques" section focuses primarily on that topic, while the vast majority of the article is about various other circumcision-related topics. Jayjg (talk)21:46, 5 May 2013 (UTC)
@Jayjig - How surprising that a Master Editor at level three (no less!) would confuse the citing of a policy to support a dubious argument with the policy itself. It may also have escaped your notice that a great deal of the discussion of this article takes place elsewhere. But then the concomitant barnstar swopping amongst the editors who currently dictate the content of this page seems to be contagious. Do all belong to a particular type of group ? Should such partisan memberships be declared in editing such a contentious article ? Should some recuse themselves even? The current leader of the pack and present self appointed gatekeeper of the article has defined the article as being chiefly about the clinical procedure and has also justified reversions on that basis. With your highly developed skills finding these occasions in this page history and in WikiProject Medicine should present no barrier. Or maybe you could just ask the editor concerned.--— ⦿⨦⨀TumadoireachtTalk/Stalk18:18, 7 May 2013 (UTC)
Wrong information oddly expressed re Jewish requirement for male circumcision - also new section on film,fiction and humour about circumcision
"Circumcision is not required by Judaism for one to be considered Jewish, but adherents foresee serious negative spiritual consequences if it is neglected"
The above sentence in the current article is untrue. The second section "adherents foresee serious negative spiritual consequences if it is neglected" is both a fuzzy wording and only a part of the truth. Most of the Jewish sub sects and all the big important ones require male infant or adult male convert circumcision and vigourously shun males who are not cut . This "cutting off" ( pun presumably unintended) is called Kareth or Kareit, and can involve a severe "sending to Coventry" type of social exclusion or even killing ! http://en.wikipedia.org/wiki/Kareth
I propose to amend the article to include this.
On an unrelated front, I am considering writing a new subsection under" culture" referencing portrayals of circumcision by film makers, fiction writers and comedians. Any ideas from other editors on content or references appreciated.--— ⦿⨦⨀TumadoireachtTalk/Stalk10:29, 2 May 2013 (UTC)
Regarding the Judaism sentence, I reviewed the sources cited and the current wording in the article does indeed reflect the sources accurately. I also double-checked the information against other authoritative sources and they corroborate what the sources used say. What other authoritative reliable secondary source are you proposing to have this article section use? You mention the article Kareth but please note that Wikipedia articles cannot cite other Wikipedia articles as references (see WP:CIRCULAR) and the Kareth article itself does not cite any sources that can be reused here to support the change you're proposing.
Regarding the "Popular culture" proposal, what reliable secondary sources will you be providing to ensure the new content complies with the Wikipedia policy regarding due and undue weight? The sources I have reviewed that survey the general topic of circumcision do not really emphasize this. Bolnick 2012 chapter 23 does make a brief mention of circumcision humor specific to Judaism, but not enough for a new section on just that in this article, although it could be added to brit milah. Zad6812:41, 2 May 2013 (UTC)
Not all circumcision humourous or fiction references are concerned with Judaism Za. I have already mentioned the cosmetic aspect addressed over several episodes of Nip Tuck. With regard to references for shunning and circumcision within Judaism: The Mishnah, Genesis 17:10-14, Josephus (Antiquities of the Jews 3.12:1,Teshuvah, 8:5,Year book of the Central Conference of American Rabbis: Volume 27 Central Conference of American Rabbis.
"There is no more sacred rite in Judaism," says Rabbi Stephen Wylen of Temple Beth Tikvah, a Reform synagogue in Wayne. "To be Jewish and not to be circumcised is to be outside the fold."
Genesis 17:10-14 mandates that a Jewish boy be circumcised on the eighth day after his birth.
"This is my covenant, which you shall keep, between me and you and your descendants after you: Every male among you shall be circumcised," God commands Abraham, the Jewish patriarch. "Any uncircumcised male who is not circumcised in the flesh of his foreskin shall be cut off from his people; he has broken my covenant."
Twenty-eight centuries later, the threat of shunning - as well as the fear of disappointing generations of ancestors, some of whom died defending their loyalty to Judaism -still weighs heavily on Jewish parents.--— ⦿⨦⨀TumadoireachtTalk/Stalk22:22, 2 May 2013 (UTC)
You have not yet provided an authoritative reliable secondary source to support any of your proposed content. Proposing to base content on an episode of a TV show you saw that had a circumcision in it doesn't demonstrate compliance with the Wikipedia content policy of WP:WEIGHT as I mentioned. Proposing to base content on your personal interpretations of ancient religious primary source texts is extremely problematic; in fact, it's such a problem that Wikipedia has a template {{Religious text primary}} for exactly that.
Is it your assertion Za, that the majority of jewish sects do NOT require male circumcision for membership ? Is this why you resist and revert any mention of shunning by Jews of the uncircumcised ? Why otherwise ? Your suggestion that I use anti circumcision/male genital mutilation sites to find references for shunning by jews of uncircumcised males is incorrect and mildly abusive as is the corollary you attempt to shoe in. Please desist from such attributions and attacks Try a little harder to address the arguments and evidence raised and less of your opinions about perceived failings or motivations of your fellow editors.(Such attacks do not contribute to improving the article and are against both the spirit and rules of WP) For example, as raised above - could there be a more muddled and obscure sentence than "adherents foresee serious negative spiritual consequences if it is neglected" Which adherents ? adherents of what ? how do they do the foreseeing? spiritual consequences? neglected? --— ⦿⨦⨀TumadoireachtTalk/Stalk13:05, 4 May 2013 (UTC)
So yes it appears that to become Jewish per the BBC one needs to be circumcised if male. However it does not state that if born Jewish to remain Jewish one needs to be circumcised. What text exactly do you want to support with it? The next ref states that this is only required for conversion by a "conservative rabbi" [13]. It seems to imply if done by a liberal rabbi it is not needed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:50, 5 May 2013 (UTC)
Given the rather large number of academic sources available on Jewish practices, I would strongly recommend using them, rather than about.com, Jewish Federation, or news organization websites. Jayjg (talk)21:50, 5 May 2013 (UTC)
"Circumcision is not required by Judaism for one to be considered Jewish"- this is what the article currently states. This statement is true for females and for some of the tiny minority of breakaway modern jewish sects It is not true for the majority of male jews.Is it the position of editors opposing mention of the jewish requirement to be cut and the shunning of the uncut males (and awarding each other barnstars for opposing such mention !) that circumcision and shunning are not mandated ? I propose changing the wording to" Judaism generally requires male circumcision and those uncircumcised are ostracized per the custom of kareth"--— ⦿⨦⨀TumadoireachtTalk/Stalk09:29, 7 May 2013 (UTC)
I think you might be misunderstanding the meaning of kareth. There is no duty on the community to ostracise anyone who has violated a commandment that bears the punishment of kareth. Even those who wilfully out of sentiment against God violate commandments (mumar le-hach'is) are not excommunicated (barring specific exceptions).
According to Jewish thought, the punishment of kareth is enacted by the Heavenly Court and not on earth. JFW | T@lk18:22, 7 May 2013 (UTC)
From WP article on Kareth "In most cases the Torah uses the term such as that in Leviticus 18:29; the persons who commit them shall be cut off from among their people, which he says is a reference to a punishment in this world. " Are you maintaining that uncircumcised jews are welcomed unconditionally by other jews ? ˜ Perhaps I should be referring to Cherem instead ? Interestingly circumcision amongst swedish jews runs currently at about 40% but at above 90% amongst jews in the USA and Israel. It is odd that a religion would ban other mutilations of the body and insist on this one. http://www.jewishvirtuallibrary.org/jsource/judaica/ejud_0002_0004_0_04318.html--—⦿⨦⨀TumadoireachtTalk/Stalk20:17, 7 May 2013 (UTC)
Yes, I can only speak confidently about Orthodox Judaism, but someone born a Jew remains a Jew regardless of what he or she does—it is impossible to "relinquish" ones Jewishness. One can only exercise one's own free will and choose to honor the traditions—adhere to the commandments—or not. -- Avi (talk) 22:19, 7 May 2013 (UTC)
I did not think we were discussing the relinquishing of Jewishness but the merits of mentioning in the article that the majority of jewish sects require males to be circumcised and shun uncut males . At present the article says the opposite. It appears that Reform, Conservative, Reconstructionist, Orthodox all cut, while Classical Reform, Humanistic,Neolog,and Jewish Renewal and Jewish Science branches are less likely to cut.--— ⦿⨦⨀TumadoireachtTalk/Stalk00:09, 8 May 2013 (UTC)
They are no more or less likely to be shunned than those who eat on Yom Kippur, which is also an isur kares - a prohibition whose punishment is kares. The covenant of circumcision is thousands of years old, and Jews believe it is one of the first commandments ever given (second, to be precise) and is indicative of the bond between G-d and Israel. So it actually stands to reason that even the less traditional main branches of Judaism (e.g. Conservative, Reform) would still maintain this tradition, I believe. -- Avi (talk) 01:23, 8 May 2013 (UTC)
Tumadoireacht, your most recent proposal was " Judaism generally requires male circumcision and those uncircumcised are ostracized per the custom of kareth" but as noted above you did not provide sufficient sourcing to support it. In particular, the assertion "those uncircumcised are ostracized per the custom of kareth" wasn't supported by any source you brought. You need to provide authoritative reliable sourcing and modify your proposed content so that it reflects the sourcing accurately. Zad6804:30, 8 May 2013 (UTC)
Have you just contradicted yourself Zad ? Also note Avi's remarks directly above yours, and the acknowledgment of Doc James There are exceptions to the rules within Judaism about circumcision -i.e for haemophiliacs or male siblings of those who have died under the mohels knife but the majority are still bound by what Avi refers to as the second commandment. Most of my questions about the current misguided wording remain unanswered--in particular the second part of the sentence ?--— ⦿⨦⨀TumadoireachtTalk/Stalk06:15, 8 May 2013 (UTC)
What is your updated article content change suggestion and what sources are you providing to support it? Zad6815:40, 8 May 2013 (UTC)
Tuma, I would argue with the "ostracized" phrase, as kares is not a socially-imposed interaction ban, that is a cherem (which really is unused today). Kares is a divinely implemented punishment; something very different. -- Avi (talk) 15:41, 8 May 2013 (UTC)
Agreed, and more fundamentally, Tumadoireacht has not yet provided any authoritative reliable sourcing to support the assertion that in society and culture, for the religion Judaism, lack of circumcision results in ostracism. Zad6815:52, 8 May 2013 (UTC)
And I doubt he will, for the reason that I believe it is incorrect, as I posted above. -- Avi (talk) 17:15, 8 May 2013 (UTC)
This extract from http://www.torah.org/advanced/mikra/5757/sh/dt.57.2.09.html# Perhaps the article needs a general section on shunning of the uncircumcised amongst cutting cultures, that does not focus only on the judaic. Many of the shunning and forced circumcisions amongst the african cutters are documented and there are records of shunning of the uncut in USA society - for aesthetic and for imagined hygiene reasons, paricularly amongst gays and youth. ⦿⨦⨀TumadoireachtTalk/Stalk
(e/c) The article already mentions "serious negative spiritual consequences if [circumcision] is neglected." Torah.org isn't as authoritative a source as we are already using anyway. As before you've provided no sources to support "shunning". If you had intended the linked text to support such, it doesn't. Zad6815:37, 10 May 2013 (UTC)
Thank you for your opinion once again Zad and Tippy's too. When the article uses the bizarre phrase "adherents foresee negative spiritual consequences" what, if anything other than scratching their heads do you think readers understand by this ? Apart from consequences in the future("foresee") spirit world what relevance does it have to describing how uncut males are viewed or treated by their peers ? Are you both proposing that uncut males are not treated any differently in real life by the cut or their female relatives? While you are at it you could consider the idea of a general article on shunning of the uncut in the world or do you deny that it happens amongst other tribes too ? --— ⦿⨦⨀TumadoireachtTalk/Stalk17:48, 10 May 2013 (UTC)
Please provide your proposed article content change supported by authoritative reliable sourcing. Zad6817:51, 10 May 2013 (UTC)
The fallback position of "provide your proposed article content change supported by authoritative reliable sourcing" when the discussion takes a turn one cannot handle is getting old --— ⦿⨦⨀TumadoireachtTalk/Stalk17:58, 10 May 2013 (UTC)
Are you still suggesting an edit? if so, can you please restate it and provide sources that we would consider reliable? TippyGoomba (talk) 01:28, 11 May 2013 (UTC)
@Tumadoireacht: I read the article, it was interesting. Recently you have provided two suggestions:
One was to include article content asserting that Jews who are not circumcised are not considered Jewish - you wrote "Circumcision is not required by Judaism for one to be considered Jewish"- this is what the article currently states. This statement is true for females and for some of the tiny minority of breakaway modern jewish sects It is not true for the majority of male jews; the article you provided states otherwise: "According to Ronit Tamir, the question of whether an uncircumcised boy is Jewish often comes up in Kahal meetings. 'It’s usually in the wake of claims by the extended family that the boy is not a Jew. That of course is not the case: If the mother is Jewish, so are her children.' The Rabbinate confirm this statement."
You have also suggested new article content asserting that Jews who are not circumcised are "shunned" or "ostracized" ("Judaism generally requires male circumcision and those uncircumcised are ostracized per the custom of kareth") and again the article you provided states otherwise in several places. For example, "'To avoid possible problems, most parents of uncircumcised children inform the preschool teachers of the situation in advance. 'None of the places to which I sent the children made any fuss over it,' one mother notes." and another example "Asked whether he was mocked or otherwise singled out in the army or in other social frameworks, he says, 'The short answer is: No, no one made fun of me. The long answer is that I never made a big deal out of it. I didn’t walk around naked, provocatively, but I also did not hide anything, act ashamed or ask to shower after everyone else so they wouldn’t see.'" with several other examples given. Not that article content could be based on a handful of individual examples like this, but that was a message of the article.
I assume that because you provided this article, which refutes your own suggestions, you have now abandoned those two suggestions for this article, correct? Zad6802:35, 12 May 2013 (UTC)
Is that a royal "We" Tippy ?, @Zad the ease with which you slip from the highest to the lowest standards of sourcing to support your 'finger in the dyke defense' of circumcision and a matching half blind article on all fronts frequently makes me laugh out loud. Thank you. Assume nothing though please. One can take presumption too far, like fake attributions.Perhaps in your haste to find a quote supporting your ideas you failed to notice the title of the article here it is "Even in Israel, more and more parents choose not to circumcise their sons
What will the kids in school say – not to mention army buddies? What is healthier? Should such men be called Jews?" reflecting the concerns within Judaism which I have raised and which we have been discussing.--— ⦿⨦⨀TumadoireachtTalk/Stalk16:29, 12 May 2013 (UTC)
I see. So I guess we'll just wait until you're ready to provide your proposed article content change supported by authoritative reliable sourcing. Zad6804:49, 13 May 2013 (UTC)
two more deaths from oral genital circumcision contact-moral duty of WP to inform readers of this dangerous practice
"moral duty"? Is that how you see your involvement at this article?
To answer your more general question, paraphrased as "Should this be mentioned to WP readers?", the answer is Yes and it is already covered at Brit_milah#Metzitzah_Techniques. You were involved in pretty much the exact same discussion six weeks ago, is there a reason you're bringing this up again? Zad6820:50, 7 May 2013 (UTC)
Reason ? - Yes -Fresh scrotum lesions, 2 more lifelong infections, and the ongoing mortal danger to these and 3,600 other kids annually from a dangerous cultural procedure that many parents are uninformed about -hence the question about the morality of suppressing this information in the main overview article. Do you see your involvement as above moral consideration ?--— ⦿⨦⨀TumadoireachtTalk/Stalk23:22, 7 May 2013 (UTC)
But it's more complicated than that. What if you come across information you feel would be your moral duty to include in an article, but Wikipedia content policy would not allow it - say, for example, you're sure the information is true but the sourcing for it does not technically meet Wikipedia's guidelines. As you are the editor driven by moral duty, what would you do? Zad6804:20, 8 May 2013 (UTC)
A better title which I keep changing it to is brit milah#oral suction because this is the practice in question which is receiving all the attention. "Techniques" is a vague way of avoiding that, and completely unsourced. Ranze (talk) 05:10, 9 May 2013 (UTC)
No, we don't have a moral duty. These things need to be argued rationally. Why don't you make a rational argument, instead of an emotional plea that will be rejected out of hand. TippyGoomba (talk) 04:31, 8 May 2013 (UTC)
Shoals of red herrings abound ! No emotion, and no rule defying information and no airy hypotheticals either -just notable facts folks -perfectly in line with the highest ideals of wikipedia and part too of the vision of health promotion envisaged by Doc James and others -what is not to love ? --— ⦿⨦⨀TumadoireachtTalk/Stalk05:57, 8 May 2013 (UTC)
Tippy - you brought up emotion, Zad raised an "airy hypothetical" while I offered several concrete rationales -so exactly what is it you wish to say ?--— ⦿⨦⨀TumadoireachtTalk/Stalk14:02, 10 May 2013 (UTC)
This isn't even a matter of sourcing but context. What the newspapers are talking about is a ritual called "metzitzah b'peh", it's done only after the foreskin removal (the topic of this article), it's only done by a very small group, and it's thought to be the cause of about one case of herpes per year. There is good sourcing for it, for example a Pediatrics article here covers 8 individual case reports over 9 years. This is already well-covered at Brit milah#Metzitzah B'Peh but the sourcing I've reviewed for the overall topic of circumcision doesn't give it enough prominence for inclusion here. I've tried to explain this many times now, why Tumadoireacht keeps bringing it back up here is anybody's guess, although Tumadoireacht has brought up the idea it's a "moral duty to include mention of this dangerous cultural practice" here, without concern for the how the sources handle it. Zad6815:03, 10 May 2013 (UTC)
@ Doc James : Prioritizing academic overview articles and textbook sources over others where possible, is part of the medical information guidelines for WP. This discussion is not about medical treatment. It is about the ongoing mortal or life long infection or brain damage to children from a preventable cultural practice involving adult oral to infant genital contact where one or both have consumed alcohol, inflicted on 3,600 children annually in New York. In this case established newspapers such as The Daily Mail and the New York Times and the dozens of other mainstream media secondary sources who have reported on this practice and attempts to make it safe are perfectly acceptable WP sources. Such fierce and concerted resistance to its mention here on the overview circumcision article at all at all looks odder and odder.--— ⦿⨦⨀TumadoireachtTalk/Stalk15:20, 10 May 2013 (UTC)
No subject is ever covered "completely" anywhere Zad . One man's "fact" is another man's fiction. 26 lines of the Brit Milah article do discuss this practice, the consequences of it, and mention its use in NYC and in Israel. The coverage is incomplete and uneven and references are skewed in favour of the idea that there may be no connection between the herpes infected mohels and the infected babies. However, like material which is gone into at greater length in the 30 or so sub articles of the "main" circumcision article of which this is the talk page -a preçis of this sometimes lethal practice should be included here with a link to the sub article and other useful sources. --— ⦿⨦⨀TumadoireachtTalk/Stalk16:06, 10 May 2013 (UTC)
A preçis in line with WP:DUEWEIGHT, as supported by the secondary sources, of the intersection of circumcision and Judaism is indeed already provided in this article, with links to the specific Brit milah article, including a clearly-labeled "Main article: Brit milah" right at the top. Zad6816:36, 10 May 2013 (UTC)
You misunderstand Zad. This discussion is not about jewish circumcision but about the sub group who practice the adult child oral genital routine with the herpes risk.--— ⦿⨦⨀TumadoireachtTalk/Stalk16:41, 10 May 2013 (UTC)
So not even Judaism but a small subgroup within Judaism? I agree. All the more reason to show the proposed addition would be WP:UNDUE. Zad6817:06, 10 May 2013 (UTC)
Okay, say I'm someone who read about the NYC controversy and comes to WP's circumcision article to find out more. "That's odd," I think, "there doesn't appear to be anything here." Would I give up at that point or would I Ctrl+F "Jew" and quickly find the link to the "brit milah" sub-article? I think the latter. There's all kinds of noteworthy info for which there is no room in this article but which gets put into sub-articles. Isn't that how it's supposed to work?89.204.137.143 (talk) 17:13, 10 May 2013 (UTC)
Exactly, per WP:SUMMARY. More likely you'd be searching on the unfamiliar term in the newspaper article: "metzitzah b'peh". Putting that into the Wikipedia search bar takes you right to Brit milah#metzitzah b'peh, where you'll find coverage. Zad6817:20, 10 May 2013 (UTC)
@89.20THis is how it is supposed to work :http://en.wikipedia.org/wiki/Wikipedia:SUMMARY Ongoing events well documented in worthy journals where thousands of male babies are in danger each year merit mention in this MC Summary article but there seems to be a deep rooted organized opposition to so doing here at the present time--— ⦿⨦⨀TumadoireachtTalk/Stalk17:24, 10 May 2013 (UTC)
The other way to say that is that there is strong support for keeping article development in line with Wikipedia's 5 pillars. Zad6817:30, 10 May 2013 (UTC)
For once I agree entirely and unreservedly with Zad. What a shame that the ongoing prevention of readers from learning of this lethal practice from this article defies at least four of those 5 core principles--— ⦿⨦⨀TumadoireachtTalk/Stalk17:39, 10 May 2013 (UTC)
diminishing numbers getting circumcised -where to include this information
Is there mention anywhere in the article that circumcision is getting less popular ? Should it go in Prevalence section or in the opening paragraph ?--— ⦿⨦⨀TumadoireachtTalk/Stalk18:01, 10 May 2013 (UTC)
Source? Yes, Prevalence and also lead, probably, in the paragraph starting "About one-third of males worldwide are circumcised." We'd have to see what the source says exactly to incorporate such content. Zad6818:04, 10 May 2013 (UTC)
I agree, documenting the decline of the practice in the article would be most welcome. Of course, we'd need appropriate sources. TippyGoomba (talk) 01:31, 11 May 2013 (UTC)
There is that royal "we" again Tippy. Use it again and some might assume they are being addressed by a princess. Here are some USA circumcision droop stats from the CDC
see especially "Incidence of newborn male circumcision decreased from 62.5% in 1999 to 56.9% in 2008 in the National Hospital Discharge Survey (average annual percentage change (AAPC) = -1.4%; p<0.001); from 63.5% in 1999 to 56.3% in 2008 in the Nationwide Inpatient Sample (AAPC = -1.2%; p<0.001); and from 58.4% in 2001 to 54.7% in 2010 in the Charge Data Master (AAPC = -0.75%; p<0.001)."
With your keen interest in the subject and stated eagerness to see the decline recorded here that matches my own perhaps you and Zad (is that the "we" duo or it some other collective I am unaware of ?) could help find matching worldwide decline stats ? — Preceding unsigned comment added by Tumadoireacht (talk • contribs)
There's no "royal we". This a collaborative effort, "we" includes you and all other from which a consensus is drawn. TippyGoomba (talk) 18:45, 12 May 2013 (UTC)
That CDC MMW Report from 2011 added just a data point or two beyond what we already had in the WHO's GTDPSA from 2007. I had been meaning to add a bit of coverage of the country-by-country changes in rates over time - it was one of the items mentioned when I requested a peer review for the article - but just hadn't got around to it. Anyway, this was useful nudge, I added a the new paragraph on America, Australia and the UK here in Prevalence with a bit of copyediting to make it flow. I plan to finish Asia and the Middle East tomorrow, although there's not much to add. Thanks for the source and the suggestion. Zad6804:47, 13 May 2013 (UTC)
How do you add the tag that says 'By whom?'?
There's a part of the paragraph that says, 'Circumcision features prominently in the Hebrew Bible. The narrative in Genesis chapter 17, considered to have taken place around 1800 BCE'. I think this needs a reference or specification of who considers this to be so.--Jcvamp (talk) 22:21, 28 May 2013 (UTC)
A point of view (POV) fork is a content fork deliberately created to avoid neutral point of view guidelines, often to avoid or highlight negative or positive viewpoints or facts. All POV forks are undesirable on Wikipedia, as they avoid consensus building and therefore violate one of our most important policies.
aged to choose
Tremello (talk) 18:16, 16 May 2013 (UTC)
Not so fast lads - while the article is moving towards a summary style article, there remains a strong concerted movement to suppress and exclude many aspects of the phenomenon of circumcision from any mention at all within it as with so many of the circumcision and genital cutting articles of which there are about 30 . This resistance falls exactly within the WP definition of Content Forking. At least that article has managed to select and mount as its primary image a decent photo of a circumcision in progress - something which so laughably has eluded this "main" article so far.--— ⦿⨦⨀TumadoireachtTalk/Stalk17:51, 20 May 2013 (UTC)
Tumadoireacht, in your edit here, you provided the edit summary "the choppers still chop - content AND foreskins". You appear to be saying that the Wikipedia editors working on this article are themselves individuals who "chop foreskins". Is that what you mean to say? If so, how would a comment about editors like this help the development of this article? Zad6818:28, 20 May 2013 (UTC)
Perhaps you can help us understand better, by explaining who "the choppers" who "chop - content" are, and what relevance they have here. Jayjg (talk)19:28, 26 May 2013 (UTC)
@Jayjig -perhaps you can explain your obsession with the use of the word chop. I used it as a shorthand in the phrase "the chopping religions" meaning those religions who generally insist on their male babies and adult male converts having the resting top of their genitals lopped off. Currently some even capture teens who have not been chopped and chop them involuntarily. But the content choppers here so far have managed to evict any mention of such practices. ( or any mention of the sale and use of circumcised foreskins, the successful suing of chopping parents by their chopped adult children et cetera et cetera )Maybe Jayjig you could explain these ongoing lacunae. --— ⦿⨦⨀TumadoireachtTalk/Stalk19:19, 29 May 2013 (UTC)
Tuma, you are the one who repeatedly uses terms like "chopping". not Jayjg. 'nuff said. -- Avi (talk) 06:40, 30 May 2013 (UTC)
Fortunately Avi you are not empowered to rule on when "enough has been said" -I use the terms for the reasons I just explained. Jayjig repeatedly professes to being confused by it for reasons yet to be revealed. But it does amuse me that the same predictable members of the tag team greek chorus pop up from the depths clutching red herrings and neatly ducking the more important question of the major omissions from this article--— ⦿⨦⨀TumadoireachtTalk/Stalk08:48, 30 May 2013 (UTC)
suggested new first paragraph for the article
The WP article on genital mutilation has a short section on male circumcision. It then refers readers to our current clusterflop. I suggest we use it as the first paragraph of the introduction. Here it is :
Male circumcision is the removal of the foreskin, usually for religious, cosmetic, or medical reasons. The removal of the frenulum may be performed at the same time. The age at which circumcision may be performed varies widely, with groups such as Americans and Jews typically circumcising in the neonatal period and African tribes such as the Maasai and Xhosa circumcising in teenage years as initiation into adulthood. In modern medicine, circumcision may be used as treatment for phimosis or recurrent balanitis. Advocacy is often centered around preventive medicine while opposition is often centered around human rights and the potentially harmful side effects of circumcision. The World Health Organization estimates that roughly 30% of the world's men are circumcised.
The current lede summarizes the contents of this article, in the order in which it is written, and complies with WP:LEDE. Your proposed first paragraph does not; for example, the article doesn't even mention the frenulum, and the paragraph itself appears to be some sort of summary of the entire article, leaving the next three paragraphs in limbo, and leaving out much critical information found in the first paragraph. A good article lede should be three to four coherent paragraphs summarizing the entire article, exactly what is found in the current lede. Please review WP:LEDE. Jayjg (talk)21:46, 20 May 2013 (UTC)
Suggestion does not look like an improvement: it introduces duplicate information, introduces information into the lead unsupported by sources or the article body, highlights tiny groups and ignores the world's largest circumcising group (Muslims), among other problems. Zad6803:56, 21 May 2013 (UTC)
Excuse my presumptiveness but judging from our previous interactions, I suspect your goal here is to introduce the idea of informed consent into the first paragraph. I'd like to point out that the second paragraph covers this issue nicely Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision.TippyGoomba (talk) 05:00, 21 May 2013 (UTC)
Compare it to the current first paragraph which achieves few of the aims of a "Lede"(Lead ?) first paragraph per WP policy : a clear accessible style and an overview et cetera
Male circumcision (from Latin circumcidere, meaning "to cut around")[1] is the surgical removal of the foreskin (prepuce) from the human penis.[2][3][4] In a typical procedure, the foreskin is opened and then separated from the glans after inspection. The circumcision device (if used) is placed, and then the foreskin is removed. Topical or locally injected anesthesia may be used to reduce pain and physiologic stress.[5] For adults, general anesthesia is an option, and the procedure is often performed without a specialized circumcision device. The procedure is most often elected for religious reasons or personal preferences,[1] but may be indicated for both therapeutic and prophylactic reasons. It is a treatment option for pathological phimosis, refractory balanoposthitis and chronic urinary tract infections (UTIs);[2][6] it is contraindicated in cases of certain genital structure abnormalities or poor general health.[3][6]
The current lead goes into way too much detail and thus fails as an overview. Incidentally why is the removal of the frenulum not covered in the article ?--— ⦿⨦⨀TumadoireachtTalk/Stalk18:43, 21 May 2013 (UTC)
Maybe you're unclear on this, but the "lead" is all the paragraphs that appear before the TOC. This article has a lead with four paragraphs, they're all part of the lead, not just the first paragraph. Incidentally, I had already provided you the answers to both the question you posed in your edit summary ("what should a lead contain ?") and your frenulum question here, yesterday. Zad6819:05, 21 May 2013 (UTC)
Perhaps you misunderstood Za - when i post a question, (as I have pointed out before) it is not addressed to you personally in general nor to respond to material you have posted but to any editor who might be interested.My suggestion pertains to the first paragraph of the lead section. As the title of this discussion indicates. On frenulum - is it normally removed as part of MC ? Would a reader get to know the answer from this patchy article ? (This question is also not just for you Za)--— ⦿⨦⨀TumadoireachtTalk/Stalk21:07, 21 May 2013 (UTC)
As a general comment, not specifically on this article, I sympathize with Tuma's preference for an article lead written in more "accessible" style. I have not run the current lead through one of the "readability" analyzers that come with programs such as MS WORD, but I suspect it would rank near the top of their scales. That is to say, comprehension requires more than twelve years of education. And the footnotes sprinkled throughout the lead compound the difficulty, as the reader must decide each time whether to click on a blue superscript number to read the footnote now or to make a mental note to perhaps read it later; such mental effort disrupts the flow of reading.
I'm not sure that this particular criticism was a concern Tuma was actually bringing up, but I hear ya on that one. There's a conflicting set of goals for the lead: terseness, accuracy to the sources, and providing a complete overview on the one hand, and ease of reading and accessibility of the language on the other. To try be terse and accurate, the technical terms are used, because usually the technical term conveys exactly what is meant in the fewest words. For example, we could replace "oncogenic" with "cancer-causing" or "may be indicated for both therapeutic and prophylactic reasons" with "may be recommended by doctors to both cure a medical problem a person has, or to possibly prevent medical problems from happening in the future" but you can see the trade-off in wordiness. The blue Wikilinks are intended to help that - depending on how you have your browser set up, if you hover over the blue Wikilink of a term you don't understand, you'll get an explainer. In the body of the article there's more room to put explainers in-line. Zad6813:14, 22 May 2013 (UTC)
My suggesting by quoting WP lead policy guideline recommending "a clear accessible style" was a dead giveaway that this was a principal concern.Frenulum question remains unaddressed too ! --— ⦿⨦⨀TumadoireachtTalk/Stalk13:49, 22 May 2013 (UTC)3
Whoops, you're right, I missed that bit of text, sorry! And I sure hope someone else also weighs in on your 'frenulum' concern; as you know, regarding that, I have already pointed to what I had written to you on your User Talk page, which does address it, but you've indicated you're keen to get input from others as well on it. Zad6814:00, 22 May 2013 (UTC)
Article content should follow the sources. Which reliable secondary sources discuss the frenulum, and what weight to they place on discussing it? Jayjg (talk)19:34, 26 May 2013 (UTC)
Doc: In that short first paragraph of the lead, you have ten, count 'em, ten blue superscript numerals that each indicate a footnote. I am proposing to get rid of every single one of them. Why not? The lead only summarizes info that will be found further down in the article, right? I guarantee you fewer readers will drop out already in the first paragraph.89.204.130.97 (talk) 20:03, 28 May 2013 (UTC)
I agree, technically they're not necessary and they don't make things prettier! However, per WP:CITELEAD they are actually recommended to have in articles covering contentious topics. Historically, if they get taken out, the lead is likely to attract {{citation needed}} tags or unsourced changes. As a compromise we might consider putting the refs in only as comments in the source text, and maybe leaving just the few refs for only the items that most often see unsourced content changes. I know Doc prefers the refs, if he'd be OK with trying commenting out a large handful I'd be happy to give it a go. Zad6820:27, 28 May 2013 (UTC)
The procedure is most often elected for religious reasons or personal preferences...... What do you think readers understand by "personal preferences" - cosmetic ? other ? Is this elucidated in the article -where ? answers on whale foreskin vellum please (aristotle onassis used tanned whale foreskins to cap the stools in the bar on his yacht. Another onanist ?)--— ⦿⨦⨀TumadoireachtTalk/Stalk10:00, 30 May 2013 (UTC)
here is a video of a circumcision that is alien to that described in our article
here is a video [15] of a circumcision that is alien to that described in our article - would we regard National Geographic (the eminent and one of the largest non-profit scientific and educational institutions in the world) as a "dodgy" source and so exclude this account of cutting so very different from our carefully tended article ? --— ⦿⨦⨀TumadoireachtTalk/Stalk21:04, 3 June 2013 (UTC)
I am not suggesting an edit yet Tippy -I am initiating a discussion. Which may lead to a consensus driven better edit. To improve the article. Which is the purpose of this talk page.--— ⦿⨦⨀TumadoireachtTalk/Stalk21:14, 3 June 2013 (UTC)
I think Tumadoireacht is just suggesting to add this link to a YouTube video of a Xhosa circumcision from National Geographic, now added. Zad6821:15, 3 June 2013 (UTC)
The link is a little out of place right now because the article does not mention Xhosa circumcision yet, so it is "orphaned" at the moment from the article content, but a few weeks ago we did discuss proposed new content covering it. There was broad support for that new content. I will finish the editing it still needed and add it, hopefully later tonight, and that will support the new Xhosa video. If anyone is uncomfortable with the new Xhosa video being orphaned from the article content until then feel free to revert my addition. Zad6821:21, 3 June 2013 (UTC)
Thank you for adding the video link Zad, I look forward to seeing here on the talk page what text you propose adding about Xhosa or tribal MC generally--— ⦿⨦⨀TumadoireachtTalk/Stalk23:29, 3 June 2013 (UTC)
My thanks to Zad and others for helping this article improve! It is listed as #6 out of the most controversial articles (if the table is in order) according to a recent study (and there is a link to the study in this news coverage). Good work. =) Biosthmors (talk) 23:51, 3 June 2013 (UTC)
Can I suggest a change to the picture? It paints a misleading picture of the surgical procedure as circumcision is not done on a desert floor with village elders all sat around. Almost all of it is done in a medical setting, like at a hospital. — Preceding unsigned comment added by Oxr033 (talk • contribs) 19:00, 27 May 2013 (UTC)
Hiya Oxr033, the main problem with the image you uploaded is that it is almost certainly a copyright issue - it looks like it was scanned from a medical textbook without attribution. The listed source "I had it on my hard drive" isn't going to pass Wikipedia copyright muster and how it's used won't be a valid fair-use exception. Most likely that image will be deleted shortly. Besides, the image is far too small and low-resolution to be useful. Also, although sources indicate the procedure is mostly done in medical settings, the existing picture gives a nod to its ties to culture and history in a way the new image doesn't. Zad6800:34, 28 May 2013 (UTC)
Hi thanks for replying, I see what you mean about the copyright i'm not really familiar with how strict Wikipedia is, I don't have permission but it is widely available on the web (like everything else that can be digitized). Circumcision is performed by both Muslims and Jews, and a lot of Americans and South Koreans. Many black Africans too. The picture I feel could mislead a viewer. In giving a nod to it's ties and history, it also colours the reader's impression as something ancient and 'other'. Most people reading this in the English speaking world will have circumcisions being performed in medical settings, so I think it's important a reader doesn't the wrong impression The other picture of of just the penis circumcised and uncircumcised, is a lot clearer on what actually happens, and it's free from bias/prejudice too (unless you count the skin colour - which i'm not sure is the central defining object of the image).Oxr033 (talk) 00:43, 28 May 2013 (UTC)
Sure... Yep indeed Wikipedia takes copyright very seriously, and the rule is: if you can't prove it's OK, it's out. If you can find the location on the Web where the image is published, proof that the publisher owns the image, and proof that the owner released the image under the CC-by-SA (or compatible) license, we can use it. If not, we can't. There are certain exceptions to these requirements but they wouldn't apply here. It's a good image, it'd be great if you could do that research - maybe we can use it, but until it's proven the image is released in a way Wikipedia can use it, we can't.
Regarding concerns that the existing image paints a picture that the procedure is something ancient and 'other' well... the History section shows circumcision predates recorded history, so it's ancient. Also, the Prevalence section shows that most men (about two-thirds of all men) are not circumcised, and so it is 'other.' So if the image reflects that... more reasons it's a good image! Zad6801:21, 28 May 2013 (UTC)
I'm not sure 1 33% of men represent an 'other'. 5-10% maybe, not not a whole third. It's common enough for it not to be considered 'something they do'. I don't think i'll be able to prove it, i'll look for a more widespread image that doesn't have copyright attached to it, not now but when i'm less busy. ThanksOxr033 (talk) 03:20, 28 May 2013 (UTC)
Sure... Don't get me wrong, an illustration very much like the one you provided, but released under CC-by-SA, would definitely be useful in the article. We would only be having a discussion over whether it should replace the infobox image, or be placed elsewhere in the article. That discussion might be done with a request for comments. But please do look, and thanks for doing so. Zad6803:31, 28 May 2013 (UTC)
Here is a great photo of a circumcision in progress(Circumcision with a clamp) which has been cleared for wikipedia use. Oddly I remember it being in colour last time - has the naughty circumcision fairy been at it ?--— ⦿⨦⨀TumadoireachtTalk/Stalk19:02, 29 May 2013 (UTC)
Here's the colour version. Would there be objections to making this the primary photo? I haven't checked the archives for previous discussions, perhaps someone can give a brief summery of the issues. TippyGoomba (talk) 06:12, 30 May 2013 (UTC)
I prefer the picture we have now. There are enough pictures of the procedure itself in the article; this one reflects the antiquity of the procedure. Also, in general, I prefer througout all wikipedia to have less graphic images in the lede Wikipedia is not censored, but it shouldn't be a pencil in the eyeball either. This photo is relevant and considered excellent ("featured") and is a better choice than any of the others posted here. Especially with the images found later in the article. -- Avi (talk) 06:39, 30 May 2013 (UTC)
Tippy, actually yes, that specific image has come up for discussion before and we had a full RFC about it here. The consensus that emerged as a result of that RFC was that that image should not be used in this article. Doc James made a good point that the image was too specific to be of use in this general overview article; based on that discussion we created a new subarticle Circumcision surgical procedure, where that image is now, and that article could use further expansion. We also had a separate discussion about the merits of the existing infobox image just six weeks ago here; there was no consensus to change the existing image. Zad6813:59, 30 May 2013 (UTC)
Heaven forbid that an article on circumcision have a lead photo of a circumcision instead of a lead photo of a group of men sitting around a hundred years ago wearing turbans. Perhaps the turbanned gentlemen would be happier if "featured" in the History of Circumcision WP article and we replaced the turban wearers club with this contemporary photo of the central procedure of the central subject of the article. A "pencil in the eye ball" What does that even mean ? A scissors in the willy ? --— ⦿⨦⨀TumadoireachtTalk/Stalk09:01, 30 May 2013 (UTC)
Tumadoireacht, I hope you'll forgive me for not understanding you here, but you have repeatedly said "circumcision is primarily cultural and not medical", or words to that effect: [16][17][18][19][20][21][22][23][24] The article currently has a WP:Featured pictures-quality image for the infobox photo that emphasizes the cultural and historical aspects of the procedure. Based on your past statements I would expect that the current image would meet with your views. But you seem to be repeatedly favoring a purely medical image that entirely discounts the cultural and historical aspects of the procedure. You last brought this up just six weeks ago here, we discssed the pros and cons of the current image, and you did not counter the content-based arguments in favor of it at that time. It really seems you're just having another whack at a WP:DEADHORSE here; I'm not sure what - if anything - might ever make you happy regarding this article that would still be respectful of Wikipedia content policies. Zad6813:34, 30 May 2013 (UTC)
Your concern for my happiness aside Zad, another editor( we are not the only two after all) has raised the issue and so dead horse red herrings do not apply. I am delighted with the chance to revisit the choice of lead photo you imposed when we last discussed it and heartened to see another editor thinking along the same lines. While circumcision is primarily a cultural phenomenon, someone still has to do the cutting. You have been at pains to point out in the past that you regard this article as being primarily concerned with the clinical procedure but yet you refuse to countenance a photo of that very act. What is wrong with this picture ( as they say)--— ⦿⨦⨀TumadoireachtTalk/Stalk13:55, 30 May 2013 (UTC)
"You have been at pains to point out in the past that you regard this article as being primarily concerned with the clinical procedure" Can you post links to where Zad68 said that?89.204.135.68 (talk) 16:27, 30 May 2013 (UTC)
I'm trying to avoid going down the road of the law of diminishing returns as Avi points out below, but... I've pointed out that doing a Google Scholar search shows that the sourcing predominately covers medical aspects, and Fiachra corroborated this in doing her own research on Web of Knowledge and Publish or Perish. Nobody, including me, is suggesting that this article cover only medical aspects, and this article appropriately covers non-medical aspects such as culture and history. In fact, non-medical aspects make up more than half the article. No good argument has been brought forward as to why the infobox image should be changed to ignore what more than half the article content covers. Zad6816:40, 30 May 2013 (UTC)
Law of diminishing returns
Zad, I appreciate your efforts, but as you point out, Tuma has been somewhat self-contradictory. At this point, it is pretty clear that current the lede is appropriate per policy (general and Medical) and the image is fine and both are approved by a consensus of editors. Tuma can contiue to make his (I presume Tuma is a he; perhaps she is a she) "witty" comments and rail against the massive conspiracy of chopaholics who are busy chopping away at all Chopopedia articles about chopping procedures and how we have a distinct turbanistic POV which is unfair to all homburg, derby, bowler, deerstalker, beanie, bicorne, and fedora wearers everywhere. However, unless s/he can demonstrate distinct policy violations, there is no reason to change wording that is among the most scrupulously measured in all of Wikimedia. As for the apparent obsession with all things cutting, if his wording is making you or anyone else on this page uncomfortable, there always is WP:RFC/U. -- Avi (talk) 16:28, 30 May 2013 (UTC)
I have been thinking about this also. Definitely, Tuma can be hugely annoying. No question that he goes out of his way to rile up people, but so far the regular editors of this article have been doing a good job of passing over his innuendo and antagonizing, while following up on the useful suggestions he makes every once in a while. Regarding the picture of the surgical procedure, yes it is rather shocking but I would include it in the article. Compare to a WP article such as rhinoplasty, where there are plenty of pics to discomfit the squeamish. My preference would be to move the "before/after" illustration to the top so that it is the first picture that readers see, move the 19th century photograph down to a history/culture section, and add the color photograph of the surgical procedure to a medical section. Note that I am opposed to including images of complications which are both rare and severe, which would give such complications undue weight.89.204.135.68 (talk) 18:56, 30 May 2013 (UTC)
The problem I have with the image is that it doesn't add and support the article content, it only subtracts. Aside from being hugely distracting for a lay reader of the article, it's very confusing. What is happening in the photo? What is the clamp supposed to be showing us? Which type of procedure is this, and what step in that procedure is being shown? Why does the penis appear to be stretched like that?...the article content doesn't say that is a step in the procedure. Why is that particular step being shown and not any of the other steps? Is it the most important step? If the whole idea behind a circumcision is the removal of the foreskin, why isn't that happening in the image? This is why the existing procedural illustration is much more useful: it clearly shows the steps described in the text it supports, in a logical order, and the information in that illustration is easy for the typical non-medical reader to view and access. Images need to support and add to, not distract from, the article content. Zad6819:13, 30 May 2013 (UTC)
Zad wouldn't nearly all of these objections apply to any static image of any portion of any circumcision procedure that doesn't detail the entire procedure? You endorse the "Circumcision surgery with hemostats and scissors" image even though it is not representative of most circumcisions and has a header that makes it sound as if it were the only procedure in use. Are you opposed to images from other circumcision procedures in general in this article? Are you opposed to static images of portions of any medical procedure appearing in any wikipedia article that do not show the entire procedure? Would not all or nearly all of your objections be better raised as captioning objections rather than apparently objectioning to the image appearing in the article in any form whatsoever?Zebulin (talk) 22:09, 5 June 2013 (UTC)
I want the supplemental media to add encyclopedic value. They should 1) Materially add encyclopedic information; 2) Be directly supported by the article text; 3) Not distract from the prose, keeping in mind that our audience is a non-specialist reader. Can we agree that these are the goals for the use of media? This article Circumcision is the only WP:MEDICINE-scope GA article about a procedure, so I looked to other kinds of articles for examples. I did the review for (and passed) the article Burn for WP:GA. It has a really nice table of the different burn degrees. There's a description of the requirements to diagnose each degree, and there's an image illustrating each. This is done very well: it is easy to see that each image clearly illustrates the specific article content it is linked to, and it's done in a way that the images do not distract from the educational value being provided, even though some of the images are a bit stomach-turning.
If we're looking for images to educate the reader about the forceps circumcision procedure (which does not use a circumcision device), and our choices are the existing illustration or the image proposed in this section, which also appears to be a circumcision without a device just like the existing illustration, clearly the existing illustration is better. It conveys the information, is supported by the article content it's next to, and is very easy for a non-specialist general reader to understand, without being a distraction. The proposed image has none of these good qualities.
If we're interested in illustrating the procedures using the devices, why don't we make better use of the Stanford videos, currently in the External links section. Each of the three videos is produced by Stanford University's top-notch medical school for the express purpose of educating about circumcision techniques. They are explicit videos that show each circumcision technique in its entirety, along with expert running commentary by the MD performing it, and are directly supported by the article content. We can move the links to these videos up to the main article body alongside the existing illustration, and then the four most commonly used techniques will be supplemented with educational multimedia. Sound good? Zad6803:09, 6 June 2013 (UTC)
@Avi - delighted to see you have a sense of humour Avi. I especially enjoyed the tongue in cheek illogical argument extension hat list. You too, however, fail to see, for whatever reason, that contemporary cultural practice inclusion does not require historical illustration from 100 years ago. Further, if one is discussing proportionality, then naturally medical sources will of course be overwhelmingly about medical aspects(Duh) The vast literature on anthropological, religious, news, political, psychoanalytic and other aspects of the chop will perhaps loom larger. Trying to use the guidelines for med info to censor other info on cutting is transparently silly but surprisingly effective. No contradiction then but several attempts since at obfustification-Why ? I will also ask the question that if Zad or any other editor is of so delicate a disposition that the mere mention of cutting gives them the vapours- what on earth they are doing editing an article about it ?
(reposted from 89's talk page ) Hi 89 - I would be delighted to find you a representative example of Zad stating that the circumcision article is or should be about the clinical procedure, but it would be vastly simpler and easier for you to ask the editor whether he/she has said so and where. Is there a reason why you stay an IP (is that the term?) number and do not fully join WP - would you be willing to share the reason ? I have not seen Zad deny that he has said so -only several greek chorus singers clamouring in a misguided defence. What would be the consequences for you, your attitude or the betterment of the article if he/she or I confirm to your satisfaction that he/she has said so ? I am glad to see you support the photo.
Zad -your barrage of new objections to the photo of the article's subject is fascinating - should I attempt a meta-analysis of a sub-text ? would it be "confusing and HUGELY distracting"? Is it partly prompted by one or two or three editors liking the idea of a photo more in line with your oft stated article purpose ? --— ⦿⨦⨀TumadoireachtTalk/Stalk20:51, 30 May 2013 (UTC)
The photo may well have a place in the article; I do not prefer ir for the infobox, however. -- Avi (talk) 17:14, 3 June 2013 (UTC)
Proposed new section on traditional and rite-of-passage
Proposal is to add a new level-2 subsection after Adverse effects, adding:
Traditional
Religious and cultural circumcisions are frequently performed in non-clinical settings by those with little to no formal medical training, with techniques ranging from being considered safe to very risky. Typically, these procedures involve pulling the foreskin forward and cutting off the portion of prepuce that extends beyond the tip of the glans, with some variation in the technique used and the resulting amount of foreskin removed. Jewish mohels may use a technique similar to that employed by medical providers with the Mogen clamp: after the foreskin is pulled forward, it is placed through the narrow gap in the clamp shield before excision, and then any remaining foreskin is removed. Some Muslim traditional practitioners may use a very similar device and technique; others may use a grass straw to push the glans in while pulling the foreskin forward, and then bind the foreskin with a knotted cord before excising it. These non-clinical techniques employed by Jewish and Muslim ritual practitioners are considered relatively safe, and the neonatal timing of Jewish and some Muslim circumcisions is safer than when done at an older age.[4]
In southern and eastern Africa, traditional circumcision is generally done as a rite of passage, when the boy is between 13 and 20 years of age.[5] Certain cultures in East Africa do not remove all of the foreskin, leaving some to hang down below the glans; others remove all the foreskin along with some skin from the shaft of the penis.[4] The Xhosa of South Africa perform their rite with a razor or penknife, and without anaesthesia. The wound is then covered with maize, or with eucalyptus, which has antiseptic properties.[4] The rituals of these cultures have the potential for significantly more serious complications. It has been found that in parts of East Africa, traditional rituals made up the large majority (80% or more) of those admitted to hospital for circumcision complications, with several individuals suffering catastrophic complications including the loss of penis and death. Particular ritual customs, such as the Xhosa custom of dehydrating the initiate before the rite, may also exacerbate complications.[4] The data published is too limited to draw strong conclusions about complication rates of rite-of-passage circumcsion traditions in eastern and southern Africa,[5] but such traditions have a significantly increased risk of complications, and of more severe complications, than circumcisions performed on neonates or in medical settings.[6]
That seems to fit the bill well Zad. Well Done. Perhaps "the neonatal timing of Jewish and some Muslim circumcisions" could become "the neonatal timing of most Jewish and some Muslim circumcisions" Did you come across any overall estimate of the total numbers circumcised annually amongst the Xhosa ? Forced circumcision of teen males is also a factor there - worth a mention ?--— ⦿⨦⨀TumadoireachtTalk/Stalk10:00, 9 June 2013 (UTC)
Thank you! I think we should wait another day or two for more comments before adding to the article, but we're off to a good start.
Regarding the suggested change to "the neonatal timing of most Jewish..." - the source we're using, WHO GTDPSA 2007, states that the Jewish traditional circumcision is "a neonatal procedure" and this is backed up by our other sources like Glass 1999. So, the sources we're using don't support changing it to "most", unless you can identify an equally authoritative source that would support the suggested wording change?
Regarding the Xhosa, I did not find any specific numbers of Xhosa circumcised annually, but my back-of-the-envelope calculations estimate it to be something less than 0.2% of those performed worldwide (although we can't include my original research). Forced circumcision by the Xhosa would be even more rare. For other cultures, the sources I've read on this indicate that it's very rare, reported as individual case reports like this one. There was also this incident from 2007, and that was not related to the Xhosa but rather the Luo, and it appears to be something related a particular political event local to the region that happened at that time. These sorts of low-level details specific to relatively small populations would make sense to locate at the articles for the individual cultures they affect, like Xhosa people, and at the specialized Forced circumcision article, if sufficient secondary sourcing can be brought to support a mention. Zad6812:56, 4 June 2013 (UTC)
What text and links are there at present from this main article to the forced circumcision article ? It gives examples of historical forced cutting and contemporary forced male cutting in Uganda, Australia and Yugoslavia - reference number four there refers to the generally accepted practice of open season for forced cutting on any uncut male over twenty five years of age amongst Xhosa. These alone are noteworthy for the main article. It is not just about numbers but on the numbers front there are 8,000,000 Xhosa - to paraphrase the movie Jaws - I think you need a bigger envelope !--— ⦿⨦⨀TumadoireachtTalk/Stalk22:37, 4 June 2013 (UTC)
Hoping to keep things straight here:
Are you OK with the current proposed new content as given above regarding the techniques of traditional and rite-of-passage circumcision, and their complications as compared to circumcisions performed by medical providers, even if the proposed new content does not mention "forced circumcision" at this time? Or are you saying you now oppose the new proposed content if it does not mention forced circumcision? I think this forced circumcision topic is unrelated to the proposed new content above, and I'm hoping it does not derail its addition to the article if it's not mentioned. I am now unsure whether we have agreement at least between the two of us regarding the proposed new content, please clarify.
What encyclopedic theme involving forced circumcisions are you proposing to develop in this article? My impression is that it's not something fundamental to the understanding of circumcision itself; rather, it's fundamental to the individual cultures where it happens, and should be developed at those articles, as I mentioned earlier. As an analogy, imagine that there is a relatively small cultural group, the Smokhas, where everyone smokes cigarettes, and if someone doesn't smoke, they are made to suffer cigarette burns. I can see a brief mention of the Smokhas in the article Cigarette but the discussion the peculiar cultural feature of Smokhas' use of cigarette burns would be in the article Smokhas because that topic isn't fundamental to the understanding of cigarettes. If you still think the sourcing supports it, feel free to develop the proposed content and bring it here for discussion (in a separate new section dedicated only to its discussion, please). Personally, I'm not seeing an encyclopedic theme fundamental to circumcision to develop here.
Thank you Zad for sharing once again and again at length your opinions, characterizations, suppositions, delightful if misguided analogies, and inferences. There is however a danger of overstepping and presenting these as if they were co-terminus with policy. Doing so is counterproductive and not in line with best practice. Instead of stating your assumptions repeatedly about the imagined opinions of other editors it might be more productive to address the arguments raised about content and to address content itself only. The forced circumcisions are an integral part of the subject of tribal bush circumcision culture or religious or political terrorism and have been a factor of circumcision throughout history.
In recent years forced circumcision is occuring on three continents; in Europe, in Africa and in Australia. Thus it needs to be mentioned in the text body of the main article not just as a template. You have proposed some text for the new section on one of the many omitted aspects of circumcision which I have been proposing for some time. This one is non clinical circumcisions. This is where the forced circumcisions are occuring so a separate section for discussing how to include them in the new section is not appropriate.
It is not just about the numbers of teen or adult males whose foreskins are involuntarily cut off and in this case often literally chopped off – though I understand you abhor that verb, it is a central part of what we are writing about.
In the Jay Leno clip I referenced, he jests that 100% of the neonatal males in San Francisco "voted in favour of the ban" on circumcison then contemplated there. He has a point. All of these are involuntary circumcisions too, though no literature that is presently permitted to be mentioned in this article acknowledges this so we will have to park it where we parked your envelope calculations for now.
From a human rights perspective the mostly failure of government and international bodies to fully address this horrific practice( forced circumcison) is also notable. It is foreskins not any other body part which gets lopped, thus it belongs here. --— ⦿⨦⨀TumadoireachtTalk/Stalk21:23, 5 June 2013 (UTC)
Yes or No please, are you now stating that you no longer support the proposed new content, as shown above? Zad6803:18, 6 June 2013 (UTC)
Things seem to have stalled regarding this new section covering traditional and rite-of-passage techniques and their outcomes as compared to those done in medical settings, so I've asked for more input from WP:MEDICINEhere. Zad6819:34, 6 June 2013 (UTC)
I think the proposed content is well written and would make a good addition to the article. The only thing I am not sure of is where to put it. Does level 2 mean ==Traditional==? Consider putting it in society and culture maybe? (Off topic) For that matter, it struck me as strange to have ==Effects== and then ==Adverse effects==? The former seems to be discussing only beneficial effects, whilst the latter discusses mostly immediate complications or possible long term negative effects. Consider renaming to Beneficial effects, or having beneficial effects and adverse effects as the 2 subheadings? Alternatively, consider a complications section for immediate adverse effects, and then discuss the possible negative long term effects in the above mentioned section. Lesion (talk) 20:55, 6 June 2013 (UTC)
Thanks! Yeah that was a quandary, where to put it. I considered Society and culture but this particular bit of new content is really covering the technique and complications so it belongs near the other medical content, it's not really society and culture. The other options were to break it up into separate paragraphs and put the pieces in the individual sections but it all goes together as a unit, so I didn't want to do that. That's why I ended up proposing it as a separate section. The existing section names follow WP:MEDMOS, that's why they're named and ordered the way they are. Zad6821:03, 6 June 2013 (UTC)
Comment Would be best under society and culture IMO as more discusses these procedures generally than just adverse effects. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:08, 6 June 2013 (UTC)
@Lesion - I have attempted to have the adverse effects reflect that cogent point you make about balance in the "Effects" in the past. So far without success. @ Zad - the content you propose fills a glaring gap and is fine as far as it goes but is incomplete without reference to forced circumcision which is a well documented integral part of tribal circumcisions in several settings worldwide. So your question Yes or No is not appropriate. It might be wiser to seek opinions from areas OTHER than medicine as it is more a sociological, anthropological and, in the case of the forced circumcision attacks, a human rights question rather than a medical one.--— ⦿⨦⨀TumadoireachtTalk/Stalk21:59, 6 June 2013 (UTC)
Is it impossible to address the medical consequences of tribal circumcision without also talking about forced? Why can't we develop.them separately? They are orthogonal. That is my only question here. Zad6822:18, 6 June 2013 (UTC)
I honestly still don't know what your position is here and wish that you would make yourself plainly clear. Others are supporting and at the very least you don't appear to be expressing yourself as plainly against it so I'll just move forward from there. Zad6804:42, 7 June 2013 (UTC)
Not so happy with this passage:
Jewish mohels may use a technique similar to that employed by medical providers with the Mogen clamp: after the foreskin is pulled forward, it is placed through the narrow gap in the clamp before excision, and then any remaining foreskin is removed.
Well, sure, they "may" use that technique. But do most of them do so, or do they continue to use the traditional combination of Mogen shield and scalpel? From what I read (unfortunately, not in WP:MEDRS compliant sources), the traditional technique is still the method of choice. Also (again, not from WP:MEDRS compliant sources), the Mogen clamp, while better at stopping bleeding, is supposedly much more painful if no anesthetic is applied. My apologies for not being able to show acceptable sources.89.204.130.197 (talk) 23:31, 6 June 2013 (UTC)
Yep, you're right, in my proposed text, it should say "narrow gap in the shield" and not "clamp", I just checked that against the WHO source, good catch, I'll fix it above... you know your stuff! I have WP:MEDRS-compliant sources that compare the Mogen clamp with the Plastibell and the Gomco but I don't know of any sources that compare the Mogen clamp vs. Mogen shield, most likely because the shield isn't used in medical settings, the clamp is. As I'm sure you're aware, with an article like this, the content doesn't change unless we've got excellent WP:RS to support. Zad6804:42, 7 June 2013 (UTC)
In common parlance in Commonwealth countries, these terms(roundheads and cavaliers) are used to refer to the cut and the uncut penises. Has anyone got a good reference ? It could form part of a new "Humour about circumcision" section Also Nelson Mandela writes about his teen Xhosa circumcision in his autobiography - should we also have a new section on such prominent cut figures from many cultures who have written about the experience ?--— ⦿⨦⨀TumadoireachtTalk/Stalk11:46, 3 June 2013 (UTC)
Could you maybe expand on that bald opinion Avi and let the rest of us know what you mean by inappropriate ? Is it inappropriate like mentioning the sale of foreskins after they are cut off ? or inappropriate like the 3,600 jewish kids at mortal risk in NYC each year from oral genital contact with herpes infected circumcisers or is it a different kind of inappropriate ? Should the wit of "Roundheads and Cavaliers" go unfeted -even if not in a humour section it is a very common method of referring to the cut and uncut. Here are some circumcision humour sites the first one is run by a mohel from Ontario who apparently is capable of appreciating the lighter side of it all ....http://www.drjesin.com/bris7aj.htmlhttp://www.jokebuddha.com/Circumcision and Jay Leno on the recent attempted ban on circumcision in San Francisco http://www.jokebuddha.com/Circumcision--—⦿⨦⨀TumadoireachtTalk/Stalk20:39, 3 June 2013 (UTC)
Are these two suggestions in any way related? What high-quality, authoritative secondary sources will you be providing, Tumadoireacht, to demonstrate that the new content added will be in compliance with Wikipedia content policy? Zad6821:05, 3 June 2013 (UTC)
What edit are you suggesting? Sorry Tippy -could not resist the p.d.- but seriously -have you listened to the Carlin routine -he is satirizing those who minimize rape, but it may be that you are right -that humour even of a useful kind like Carlin's might be offensive to a rape victim reading the rape article. The mistake you are making however is extrapolating that mindset onto this article - if a mohel can run a website featuring just circumcision jokes, or the English apply pythonian wit in distinguishing intact wrinkly ended knobs from bright shiny keratinized chopped ones it is noteworthy and the information rounds out the article. Two suggestions related ? No - that is why there are two imtermitted by a full stop followed by the word "Also" I find it a little difficult to understand from the brevity of your sentence about rape, what it is you are attempting to say - are you saying that rape and circumcision are similar serious assaults on the body ? --— ⦿⨦⨀TumadoireachtTalk/Stalk21:39, 3 June 2013 (UTC)
I was pointing out the absurdity of your suggestion. Anyway, this strikes me as equivalent to having a WP:TRIVIA section, such things should be integrated into the article, if we agree they're somehow relevant. Make a concrete suggestion so we can evaluate it. TippyGoomba (talk) 22:42, 3 June 2013 (UTC)
Sometimes great truths are contained within humour. Your rape analogy absurdity point is still a bit muddled to me To answer your last demand I will refer you to closer reading of the first 25 words in this section. Evaluate away. Would you have similar heartfelt objections to a section on circumcision in literature ?--— ⦿⨦⨀TumadoireachtTalk/Stalk23:26, 3 June 2013 (UTC)
It's generally problematic to start with some idea that crosses your mind ("roundheads and cavaliers") and then scout about trying to find a source to back-fill the idea. It's better to survey the best-quality sources and then let the sources lead you to the content. In this particular case, these slang terms appear to be uncommon and extremely localized, and I found that once again to read up on a suggestion of yours I had to go to anti-circumcision websites - [25][26][27]... none of these would be reliable sources, of course. Zad6804:04, 4 June 2013 (UTC)
Not problematic at all - that is how most good ideas begin. I will continue to look out for a usable literary or etymological reference. I hope the anti-circumcision websites were not too distressing - these jocular and wonderfully visual cue terms(roundhead and cavalier for cut and uncut penises) are on several urban slang dictionary websites but not yet on any of the mainstream online dictionaries that i could see. Hope your weekend was all you hoped- here In Ireland we are having what we call a heatwave - for a brief spell we no longer have to chainsaw the ice sheet to seaswim- what Joyce called the scrotum tightening sea--— ⦿⨦⨀TumadoireachtTalk/Stalk09:58, 9 June 2013 (UTC)
Yow! You're a tougher man than I, it's finally been warm enough here that the swimming pools are starting to open and they're still too chilly for my preference. We've also had quite a bit of rain recently and the ground's really softened up. Makes for muddy outings but the garden is really loving it.
Thanks for your concern regarding the advocacy websites, but no worries - they're not distressing to me, they're just irrelevant to Wikipedia work. You need to understand that they are inappropriate places to look for sources or topics for Wikipedia articles. You are of course free to visit whatever advocacy websites you fancy when off-Wiki, but with so many good-quality sources available there's no reason to consider basing content on them. Zad6803:56, 10 June 2013 (UTC)
More logical sequence of imagery
Following up on the discussion of what image(s) to include, I wish to propose a different and in my view more logical ordering of images. The table below shows, from top to bottom, the current sequence in the first (leftmost) column and my proposed changed sequence in the third column, with my notes to the right of each image column.
CURRENT
Notes
PROPOSED
Notes
A circumcision performed in central Asia, possibly Turkmenistan c. 1865–1872
A very specific place and time, not a generic image.
Adult circumcision, before (left) and after (right). The glans is exposed even when the penis is flaccid.
As generic an image as one is likely to get. The "before/after" format shows what the procedure is all about.
Circumcision surgery with hemostats and scissors
No. 2 position is right for this image. Artist's illustration more generic than a photo, deserves to come sooner.
Circumcision surgery with hemostats and scissors
However: is this method the most frequently performed worldwide? If not, can an illustration of the most widely performed method be found?
Adult circumcision, before (left) and after (right). The glans is exposed even when the penis is flaccid.
No.3 position too lat for this pic. Should be No.1.
Kawai Dreamatone (multi)
Obviously just a placeholder. This should be a montage of the most widely used c. devices: Mogen clamp, Gomco clamp, Plastibell, ...?
Prevalence of circumcision by country
Position is good for this pic (complements text). However, currently 21 paragraphs of text with no pic before this pic appears.
Operation of a canal lock 1-3. Boat enters 'empty' lock 4. Bottom gates are closed, bottom paddles closed, top paddles opened, lock starts to fill 5. Lock is filling with water, lifting boat to the higher level
Another placeholder. A sequence of color photographs, taken from same position, showing exemplary moments of the most common circumcision procedure used worldwide.
And those are my proposed changes. I see three difficulties:
(1) Which are the most widely used circumcision devices worldwide?
(2) Which is the most widely performed circumcision procedure worldwide?
(3) How to obtain "time-lapse" photographs of this procedure (and fit them all in a single picture frame). Could they be extracted from an educational video? I do not have the technical means to do that. And would it be o.k. to do so or would it present a copyright problem?89.204.130.197 (talk) 23:19, 6 June 2013 (UTC)
89.204.130.197, that's a thoughtful review. If we were to change infobox image to be something purely clinical, I'd agree with your suggestion. But, as was discussed before, the current image is a WP:FI and also references the history and culture of the procedure; a purely clinical image doesn't. It's not unreasonable to use an Islam-specific image as most circumcisions are performed for the requirements of that religion. Others might agree with you, though... let's see where the discussion goes. I agree that if we change the infobox image to the before/after photo we should move the Turkmenistan image down to history.
Regarding lots of text without images, that's fine, there's no requirement to have images, and per WP:MOS images should not be used just to "decorate" the article.
Regarding the ordering, Why not Islam first?, in history of the procedure the chronological was Judaism first and then Islam, and that makes the article prose easier because what Islam does is described as something relative to what Judaism had been doing: In Cultures and religions, Judaism's practice is based on Genesis 17, and so is Islam; in the proposed content above, Judaism often uses the Mogen, and so does Islam, but then they also may do something else. This is order the WHO does it in their Global Trends document, for the same reasons, see page 19.
Regarding your other suggestions, as always it comes down to finding excellent-quality sources and using what they say. I have good sources to say that the three devices are most often used in the USA but I don't think I have a global one. I have tried several different sources to get images of the devices but haven't gotten them yet. We have written the WHO several times to get permission to use their images but haven't gotten a successful response yet, and I have personally written Stanford Medical School several times to get permission to use their images but they have always declined. Getting permission to use stills from their excellent videos would be great but as you guessed it would absolutely be a copyright problem to do that without permission. I have also written the authors of some of the review articles to use their images and haven't gotten permission yet, but will keep working on it. Zad6804:42, 7 June 2013 (UTC)
Avi, Doc James: Why? The present infobox image is not well suited. If it were shown separate from the context of this article, hardly anyone seeing it for the first time will say, "Oh, that's a circumcision". The practice of showing "before/after" color photographs as the first image is well established in Wikipedia, e.g., at https://en.wikipedia.org/wiki/Breast_augmentation.82.113.98.162 (talk) 01:42, 11 June 2013 (UTC)
But it is not shown in a vacuum, it is shown in context. In context, it is very relevant; not every lede image has to be plainly medical, and I personally prefer more graphic images further down. Wikipedia is not censored, but it shouldn't be brainless or mindless either. Let me reverse the question, what is gained by the image replacement? The fact that the results of circumcision are seen right away? It makes more sense to show it at Circumcision#Technique, and that is precisely where that image is now. Moreover, more lede text relates to culture and reception than technique, making the current image even more apropos, in my opinion. -- Avi (talk) 05:59, 11 June 2013 (UTC)
What's gained by the proposed new ordering is that the before/after image offers maximal relevance and maximal density of information content. Some readers do not read more than the lead, thus the top image should be the most informative. I reject your characterization of my proposals as "brainless" or "mindless". The before/after photo is not especially "graphic", but the photograph captioned "circumcision with a clamp" is; Zad68 has already listed the arguments that make it a poor choice. A person entering "circumcision" into the search box cannot really claim to be shocked by a color photograph of a penis. It does not belong under Circumcision --> Technique as it does not show any of the circumcision techniques being performed. I do not have time to launch an RfC and stay with it from start to conclusion. Am still hoping that the regular editors will give due consideration to my argument.89.204.139.113 (talk) 20:24, 11 June 2013 (UTC)
Sorry, I seem to have implied that the suggestion itself was brainless/mindless. My apologies. I meant that thought should be given to the ramifications of every image placement, especially the lede. You have obviously done so, and I understand your argument (I believe). However, I think that less is lost by having that image in the Technique section and more is gained by having the cultural and less eye-poking image at the top. Not everyone gets here on purpose for that matter. Once again, sorry about any unintentional mischaracterization, and we will just have to agree to disagree on the cost/benefits of the placement for now. I agree that I'd like to hear more opinions; although the three responses seem to all be in agreement. As for regular editors, what do you mean by that? -- Avi (talk) 20:51, 11 June 2013 (UTC)
I'm laughing my ass off at yall
It's been YEARS, literally YEARS, that this page has been obviously biased.
There are American blogs pointing out the grievous half-truths and outright lies; most of which stem from the known fetishists that have been active for the past DECADE trying to brainwash people... who have taken control of the page.
The same guys that are in charge of CIRCLIST post here, and you let them walk all over you. That isn't right.
It is a new day and age, many people are becoming aware of how corrupt the "pro-circumcision " fetishists are; the federal investigations help a bit I imagine. And yet you keep the same dialogue as if no-one has access to legitimate scientific resources.
^Link proves that the only reason the HIV prevalence FALLS with circumcision is because of the demographics; less men being circumcised + less time to have sex due to surgery = lower rates. All view-able in the raw data, thought they don't write it in their paper, so go read it and don't give me your bullshit. Link also proves that circumcision increases keratin thickness, which by default = lower sensitivity.
^ Link deals with the fact that circumcision doesn't lower the rates of VD in males, which makes no sense if it lowers the transmission rate of a retrovirus; viewing the RAW DATA, it becomes apparent that this is so due to the fact that VD's are much more common in regards to HIV.
The numbers are obviously inflated and purposefully skewed to sell the idea of circumcision to the African/Asian uneducated.
oh yeah, and that whole "uncircumcised" bullshit is some nice psychology. It really should be "intact" or "grossly normal" *edit* @zad68 or whoever you are, the fetishists are DOCUMENTED AND PUBLIC about their views, I'm not putting words in anyone's mouth. They are PUBLICLY in agreement with sites like circlist, have membership to those sites, and PUBLICLY bring their bullshit over here. Either you acknowledge the truth or you present fiction as fact. It is common knowledge that circlist was used on this page; we all know WHAT that site is for and WHO their target audience is. Using an encyclopedia to change public POV and having such links, casual or otherwise, between circlist and wikipedia is fairly damning. Oh, and your comments are POV and don't cite their resources zad, could you please work on that? — Preceding unsigned comment added by 66.91.45.169 (talk) 05:31, 11 June 2013 (UTC)
Thanks for that. I was beginning to think I was the only one who noticed. I only realized how biased this page had become when I came to Wikipedia looking for information on Intactivism for a friend and discovered the page had been "merged" as a couple of lines into yet another page heavily skewed towards circumcision. As you rightly point out there is a great deal of empirical data available. More than enough to produce a "balanced" page at a bare minimum. All that is apparently lacking are people with the time and willingness to go through what will almost certainly be a long and tedious process with the pro-circumcision crowd. MichaelWGrayII (talk) 10:27, 11 June 2013 (UTC)
Michael, it's very much appreciated that you were willing to modify what you had written to remove at least some of the inflammatory language as mentioned below, thank you. As you appear to be a new contributor, you might not have known this yet, but generally if you make a comment and someone writes a reply to it, you really should not modify your original comment, because then the reply that was made to your original comment might look out of context, as happened here. Instead you should use strikeout and insert. Please see WP:TPG for Wikipedia's guidelines on how to use Talk pages. Thanks... Zad6822:56, 11 June 2013 (UTC)
Zad, I appreciate your understanding of my newness to Wikipedia talk pages. And I appreciate your efforts at making sure everyone who reads the page understands that newness and the resulting procedural error I made in trying to conform to your statement of the rules. MichaelWGrayII (talk) 09:38, 12 June 2013 (UTC)
66.91.45.169, I don't really understand the basis for your concern. This article has no links to circlist in it at all, as far as I know the article does not cite any sources authored by anybody responsible for the content of circlist, and as far as I know nobody with an association with circlist has edited here for a year (although for those last two points it wouldn't even matter if the opposite were true). Did you know these things before commenting here? Zad6801:54, 12 June 2013 (UTC)
Welcome to Wikipedia. First off, you are welcome to your own opinions but be aware that characterizing people here as "pro-mutilation" or "fetishists" trying to "brainwash" people is a violation of several of Wikipedia's policies, possibly including the ones regarding civility, biographies of living persons, and personal attacks. This will not be tolerated and can very quickly result in having your ability to edit restricted. As you might already be aware, due to very strongly-held opinions, this is a difficult subject area to edit in and the discussion is not helped by such inflammatory language.
Second, Wikipedia's guideline for sourcing biomedical information is WP:MEDRS. Both of the sources mentioned are individual primary sources; in a field as well-studied as this Wikipedia requires reliable secondary sources.
Third, no original research is allowed. The sources must be accurately summarized, and that is the extent to which they are allowed to be used; personal interpretation of or extrapolation from source data is not allowed. Zad6813:47, 11 June 2013 (UTC)
Note: The comment by MichaelWGrayII above, which my comment here quoted, was modified in this edit after my comment was made. Zad6822:56, 11 June 2013 (UTC)
@Michael - something that some editors on this article sometimes forget to mention in relation to cutting off foreskins is that it is primarily a cultural and not a medical act. Thus in sourcing material for reference or inclusion often the guidelines used here for medical information do not apply. The current ongoing tribal forced circumcisions in several African countries,in Australia and in former Yugoslavia, for instance, have so far gone unmentioned here as have the planned commercial sales of the anticipated harvest of foreskins from the current drive to increase circumcision rates in Africa, and the ongoing oral- genital circumcision contact hepatitis risk to NYC babies . Rather than see things in terms of cutting and non cutting camps amongst editors it is better to think in terms of including all pertinent material from reputable newspapers, anthropology journals, psychoanalysis journals et cetera as well as the medical ones.
Apply this UTI change (assuming no substantial disagreement from other editors)
Good, useful source; Bulletin of the World Health Organization
Not really on the topic area proposed, 2009, concerns legal aspects since outdated by December 2012 approval of bill by German parliament
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