Talk:Circumcision/Archive 26

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NPOV?

The American Academy of Pediatrics (1999) stated "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men."[62]

It's worth noting that an extraordinarily large proportion of American males are circumcised and thus there is the cultural and psychological imposition of this as a requirement of 'manhood' per se. I'd say that this is indicative of a biased audience of participants due to the cultural pressures applied on them and thus negates the purposive application of that citation completely. 211.30.75.123 02:26, 12 April 2007 (UTC)

If the AAP had made similar comments, we would doubtless include them. However, Wikipedia is not the place to include original criticism of published work. Jakew 12:46, 12 April 2007 (UTC)

Sexual Effects

Jakew prefers a vague summary of Boyle et al. I prefer quotes of specific loss.

If Jakew prefers, I can summarize all their primary points ... there are many ... just like we've done with the Assoc quotes.TipPt 17:07, 12 April 2007 (UTC)

The best way to summarize their points without giving undue weight to their views is to quote from their conclusions.

The following examples are called 'cherry-picking', and do not represent the primary conclusions.

Boyle et al. (2002) report that "although the frenulum was reported as an area of heightened erogenous sensitivity, in the typical circumcised male, either no frenulum remains or only a small severely damaged remnant exists."

(This is a quote from the middle of a paragraph. It is not from the conclusions at all. It is not even a general comment -- the authors are in the middle of discussing a study by Gemmell and Boyle.)

"...Loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response, thereby restrict a circumcised man’s ability to achieve arousal."

(This is a quote from the middle of a paragraph, discussing Money and Davidson. Again, it is not from the conclusions, and is a comment about a specific study.)

The authors conclude: "We encourage closer examination of this issue and even more empirical research into the psychosexual sequelae associated with circumcision."

(Although not cherry-picking, this fails the 'so what' test: it's nice that Boyle and colleagues encourage such research, but it doesn't actually inform the reader about any information already known. The text formerly present read "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well." -- which actually summarises the claimed effects.)

All in all, not a good edit. Jakew 17:25, 12 April 2007 (UTC)

Thank you for taking the time to reply. You're right about that "so what test" sentence ... the current version is better.

I find no conclusion in the "Circumcision and sexuality" section of the cited article. The current version does not draw from a conclusion.

There are two intro paragraphs, which talk about ~"neurological castration," and "a strategy to reduce sexual gratification." I find no evidence that these considerations are motivations today.

Next, we have the heading "Structural Changes." Basically, they talk about "surgical complications" (mostly dealt with elsewhere) and "less penile sensation". But the last two sentences say lots, and both versions take from those sentences:

Although the frenulum was reported as an area of heightened erogenous sensitivity, in the typical circumcised male, either no frenulum remains or only a small severely damaged remnant exists. The complex innervation of the foreskin and frenulum has been well-documented (Cold & McGrath, 1999; Cold & Taylor, 1999; Fleiss, 1997; Taylor et al., 1996), and the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings--many of which are lost to circumcision, with an inevitable reduction in sexual sensation experienced by circumcised males (Immerman & Mackey, 1998; O'Hara & O'Hara, 1999).

We know (cited) the frenulum is a primary erogenous zone. Sexual Effects need focus on primary issues, like damage or removal of the frenulum. I pick from the middle of the paragraph:

"Although the frenulum was reported as an area of heightened erogenous sensitivity, in the typical circumcised male, either no frenulum remains or only a small severely damaged remnant exists."

The current version picks out from the end of the paragraph relatively vague language. "Thousands of receptors," versus damage or removal of specific tissue identified as erogenous. The current version also leaves out the critical link between loss of receptors and "an inevitable reduction in sexual sensation experienced by circumcised males." Here's the current version:

Boyle et al. (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings--many of which are lost to circumcision."

Next in the "Circumcision and sexuality" part of the article we find "Functional Changes." The statement "...loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response, thereby restricting a circumcised man's ability to achieve arousal" captures a primary issue (circ' may restrict stretch/movement).

Would this be OK?:

Boyle et al. (2002) Boyle et al. (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings--many of which are lost to circumcision. "Although the frenulum was reported as an area of heightened erogenous sensitivity, in the typical circumcised male, either no frenulum remains or only a small severely damaged remnant exists." The authors conclude: "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."TipPt 00:58, 13 April 2007 (UTC)

I think that's alright, provided that you lose the reference to frenectomy and the quote beginning "Although the frenulum..." I understand that you believe the frenulum to be of supreme importance, but such a focus is not found in the source, and comes across as soapboxy. As for "relatively vague language", the nature of a summary is to make general, rather than specific, statements.

By the way, we don't know that "the frenulum is a primary erogenous zone." We only know that an author may have stated that to be the case. There is a difference. Jakew 10:14, 13 April 2007 (UTC)

Several editions of two college textbooks (four professors), Wiki (cites elsewhere), the focus of treatment of anejaculation ... Jakew won't let me include, but search google for fellatio technique! What more could you ask to support that statement? I know there's double standard here, but I'm still trying.TipPt 19:25, 14 April 2007 (UTC)

By that logic, we don't know anything. To deny that the frenulum is a primary erogenous zone is simple nonsense. Ask ten men with frenulums if rubbing it feels good. You'll get ten "yes" answers. That doctors and medical professionals confirm it, and yet some people still deny it based on a pro-circumcision agenda, is a sad statement on humanity. Blackworm 21:59, 13 April 2007 (UTC)

I simply quoted the two sentences in order, and then the conclusion sentence. I also put back the intromission paragraph that someone keeps taking out. Even with those two paragraphs ... the Assoc statement stuff is longer.TipPt 19:15, 14 April 2007 (UTC)

Yes, of course the quotations from mainstream medical associations are longer -- to quote WP:NPOV#Undue weight, "NPOV says that the article should fairly represent all significant viewpoints that have been published by a verifiable source, and should do so in proportion to the prominence of each." (emph added) Jakew 20:41, 14 April 2007 (UTC)

Frenular stimulation and ejaculation

Patients missing their frenulums are not able to achieve ejaculation ... [1] ... according to the sales rep. If I can get a Co. letter to that effect, can I include?TipPt 00:59, 13 April 2007 (UTC)

Tangential. Place in Frenulum of prepuce of penis article. -- Avi 04:24, 13 April 2007 (UTC)

If circumcision often removes the frenulum, as is stated in this article, how are the effects of that "tangential?" That's like saying that the fact that decapitation results in death is tangential to decapitation and shouldn't be included in the "decapitation" article. Blackworm 06:23, 13 April 2007 (UTC)

Because circumcisions in general do not remove the frenulum. It is more like saying that since it is possible to get decapitated while riding in an elevator (sticking your head into the closing doors) we need to discuss death in the elevator article. -- Avi 06:41, 13 April 2007 (UTC)

There is also the fact that the source Tip cites does not support the claim we're discussing. Which, if you think about it, is unsurprising. Jakew 10:06, 13 April 2007 (UTC)

That's not fair ... I asked a question. I also provided the Co. site instructions for use. I doubt the rep was lying to me, but I also didn't ask for the letter.TipPt 19:03, 14 April 2007 (UTC)

Well, now, Avi, you are implying that frenectomy in circumcision is as rare as being decapitated by an elevator. I doubt that is that case. If you compare the female circumcision (renamed Female Genital Mutilation because of cultural bias) article, which clearly states that the clitoris is not harmed in all cases, they still go into the negative effects which are directly related to the more severe forms. (Jakew: I do agree that it is unsurprising that the claim is unsupported. Ejaculation and orgasm has more to do with the brain than the genitals. Indeed, women who have undergone severe forms of circumcision and have no clitoris at all, still report sexual pleasure and orgasm. These women have the same aversion to the claim that circumcision is harmful that men in our society have.) Blackworm 21:52, 13 April 2007 (UTC)

I was bringing a counter-example. My point remains that it is tangential enough that it belongs in the frenulum article; not here. Also, this is the circumcision article, not the female genital mutilation article. If you have issues with that article, please use its talk page. Thanks. -- Avi 22:54, 13 April 2007 (UTC)

I already assumed Jakew wouldn't leave such a reference in the Topic. Also, I basically asked...How do you post such a letter in Wiki without it being part of the article (like a cite)? Lots of effort on my part, reverted away, another waste of time. But you all know a little more about the frenulum. Interesting that the salesman would basically refuse a sale by telling me his experience with these patients.

Avraham ... all circs using the gomco and plastibell remove significant frenular zone tissue. A tight circ using the gomco or plastibell will remove most of the frenulum. I call that mutilation, because the parents certainly didn't sign up for that loss.

Note that mohel's now frequently angle shield (as with the mogen) along the angle of the glans, thus preserving much more of the frenulum and it's delta. It's less likely that they have to touch the frenulum to solve breve. These are the primary reasons (faster, safer, less painful, less manipulation of the foreskin, and less erogenous tissue removed) the reader should know to request a mohel (with confimrmation re the shield angle) or a mogen circ! I figure Jakew can have his cake and eat it too.TipPt 19:03, 14 April 2007 (UTC)

You can, in principle, cite a letter just as with any other published work: just quote the journal name, volume, issue, page number(s), etc. If, on the other hand, you mean a letter to you personally, then that is not a published work and does not conform to WP:RS. Hence you cannot cite it.

As for cakes, well, Wikipedia isn't here for advocacy. The reader can make his or her own decisions, and we aren't here to manipulate him or her in any way. Maybe a Mogen circumcision is better, maybe not; we're not the Mogen advertising department. Jakew 20:50, 14 April 2007 (UTC)

Jakew ... please humor my new attitude. I'm just trying to be contructive. Those are high quality, relevant quotes. Your removing the sentence "The World Health Organization reports that the Mogen clamp "compares favourably, because it is easy to use and has no parts to assemble. In the literature, the fewest complications with this method have been reported in the context of circumcision in 8 day old babies."[2] is frankly hard to understand.

You revert to deny the reader knowledge that the WHO finds the Mogen has (for good reasons...easy to use and no parts to asssemble) the fewest complications! and call it mogen advertising?

To the gomco paragraph we could add citations finding risk to over-manipulation of the foreskin, using the wrong sized bell, or attempting a circ with mismatched bell and brace.TipPt 16:18, 15 April 2007 (UTC)

A little history of POV

16:56, 15 April 2007 Avraham (Talk | contribs) (Revert deletion of cited material and unsolicited advertisement) (cur) (last) 16:54, 15 April 2007 TipPt (Talk | contribs) (Hard to believe anyone in good conscience could deny this fact to the reader)

Here we have Avraham denying the reader the cited answer ... according to the World Health Organization ... to the question, "which procedure has the found "the fewest complications."

He calls it advertisment and deletes it.TipPt 17:14, 15 April 2007 (UTC)

• As mentioned above (or perhaps the archive now) this belongs in an article about the Mogen clamp; not here. In the Mogen clamp article it would be relevant, here it is pushing one item over another, and uncalled for. Your mischracterizations only serve to demonstrate your inability to seperate encyclopedia-building from POV-pushing, I am afraid. We have an article on the Gomco clamp; why don't you write one (adhereing to wiki policy, of course) on the Mogen clamp? -- Avi 17:18, 15 April 2007 (UTC)
  • Like you say, we're building an archive. Relative risks of procedures is a primary issue for the Topic and that section. Your argument is without merit and shows extreme bias.TipPt 17:35, 15 April 2007 (UTC)

Avraham's "authentic" sentence...

...is from this paragraph:

The “Circumcision Policy Statement” mentioned the Gomco clamp, the Plastibell device, and the Mogen clamp and recommended using analgesia to minimize pain. We should mention the authentic traditional Jewish neonatal bris (ritual circumcision), the fastest and most humane. Unlike the others, clamps or hemostats are not permitted, so the infant does not suffer from the pain associated with crushing tissue. Excision time is about 1 second and the entire procedure takes about 10 seconds. The wound heals naturally by second intention. Hemorrhaging and other complications are rare. With the authentic traditional bris, it is more humane not to subject the infant to a local anesthetic. Jewish patients interested in this technique should be referred to a mohel (ritual circumciser) who is adept at performing the authentic traditional bris.

— Tannenbaum & Shechet, Circumcision---The Debates Goes On, Pediatrics 105 (3), 682–683

The paragraph is all about pain and analgesia. Avraham's sentence misrepresents. It's not "in proportion to the prominence of each."

Please note that I agree with their position. Maybe we should have one paragraph summarizing the pro and con of techniques.TipPt 17:26, 15 April 2007 (UTC)\

You are correct, I left out the humanness of no anasthesia. I have placed that in the article, and clarified that this is Tannenbaum and Shechet. -- Avi 17:36, 15 April 2007 (UTC)

"in proportion to the prominence of each" ... so I look to summarize the whole sexual section.TipPt 16:46, 15 April 2007 (UTC)