Talk:Circumcision/Archive 29

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.

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Balance re harm/health benefit in early part of article

At present, in the introduction there is a paragraph about studies suggesting that circumcision reduces female-to-male HIV transmission (a possible health benefit of circumcision). Then there are many sections which do not discuss harm or benefit, and then later there are sections mentioning infection, death and other harm as well as other benefits. Therefore, the early part of the article is unbalanced: it mentions a possible benefit but does not mention any possible harm. I suggest either moving the paragraph mentioning HIV from the introduction into the later sections of the article, or else putting some information about possible harm of circumcision in the introduction to balance it. Note also this statement about the alleged HIV benefit: [1] Apparently it may be possible to explain the reduced HIV infection in the circumcised men in those studies by the period of abstinence they had to have to allow their circumcision wound to heal; and also, circumcision may increase the rate of male-to-female HIV transmission in heterosexual intercourse. It may be premature to recommend circumcision as an anti-HIV public health measure. On another issue: Here's a recent article re touch sensitivity: [2] --Coppertwig 15:06, 16 June 2007 (UTC)

A page at an activist website is not a reliable source, Coppertwig. Jakew 15:24, 16 June 2007 (UTC)

It's OK with me if the first reference I gave is not used as a reference on the article page: I wasn't suggesting that it be used as such. Everything I said still stands, and the second reference appears to me to be a published article appropriate for use as a reference on the article page. --Coppertwig 18:57, 16 June 2007 (UTC)

Are you serious? The second link is to a press release. The press release may be about a published article, but it is not itself a published article. (We discussed the article in #Sorrells Study.) Jakew 19:06, 16 June 2007 (UTC)

Of course I'm serious. The press release gives a link to an online copy of the published article which (the published article) I believe is appropriate to use as a reference to balance the existing discussion about sensitivity. --Coppertwig 19:56, 16 June 2007 (UTC)

The article is an appropriate source for Wikipedia. A press release is not. The article, along with other studies to investigate sensitivity, is cited in sexual effects of circumcision. Jakew 20:11, 16 June 2007 (UTC)

Right. Re harm/health benefit: I'm leaning towards moving the HIV paragraph from the introduction down into the section on HIV, and merging it into that section. --Coppertwig 12:20, 17 June 2007 (UTC)

Jakew, your sexual effects of circumcision is grossly misleading. Note that Sorrells et al blows apart many of those lousy studies ... for example, why is Masters even mentioned? You put there because it's pro circ; even though it's baseless and misleading work from a popular novel from the 60's!TipPt 17:59, 4 July 2007 (UTC)

Feel free to discuss that article at the appropriate place. Jakew 20:16, 4 July 2007 (UTC)

You introduced the subsection in the above talk...TipPt 22:29, 4 July 2007 (UTC)

HIV protection now shown as bunk - "It's the prostitutes, stupid!"

New analysis shows that what was previously thought to be a definite increase in protection against the spread of HIV caused by circumcision is in fact "statistically irrelevant once the study controls for the number of prostitutes in a country". The AAAS provides the layman summary, and links to the freely available journal article hosted by PLoS. Circumcision, HIV, and other Wikipedia articles definitely needs to be corrected/updated with this information. Their ultimate conclusion:

"This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries. An explanation is offered for why Africa has been hit the hardest by the AIDS pandemic and why there appears to be very little correlation between HIV/AIDS infection rates and country wealth."

— BRIAN0918 • 2007-06-20 13:39Z

Great find. Perhaps it is the economy (", stupid"). Prostitution is relied upon more heavily in places where gender/economic inequality severely limits (or entirely prohibits) other ways in which women could support themselves. A quote from the layperson summary:

It is not surprising that computer models rarely show the virus reaching epidemic proportions; it is very hard to transmit this illness heterosexually. Only when model building researchers introduce a highly sexually active infected subset of “prostitutes” to their mathematical models does the infection spread exponentially to the general population.

—Joie de Vivre ^T 14:23, 20 June 2007 (UTC)

It's interesting that this article was submitted back in November 2006, before the study in December was stopped early because they thought the circumcision finding was so compelling (don't forget that they also recommended the uncircumcised study participants for circumcision). They had already received research to the contrary, so why did they go with the "compelling" research that hadn't even been completed? — BRIAN0918 • 2007-06-20 14:34Z

You appear to have misunderstood this paper, Brian0918. It does not 'debunk' the protection afforded by circumcision. It argues that, using the author's preferred mathematical model at the population level, prostitution has more impact than circumcision: "At a macro level, this suggests that circumcision rates should also be less significant across countries in predicting HIV/AIDS levels once varying levels of commercial sex work are included in the analysis as there is a very high correlation between circumcision and the Muslim faith percentage." Jakew 14:31, 20 June 2007 (UTC)

I didn't misunderstand it. The whole point of this research is to stop the spread of AIDS in Africa. By touting circumcision as a potential cure to the spread, when in fact it is "statistically irrelevant", was irresponsible, and likely led to numerous more infections during circumcision with unsterilized equipment. But, anyways, this article should at least be updated to show that with respect to HIV/AIDS in Africa, circumcision is not going to help in the long run, and may even be detrimental if people are circumcised with unsterilized equipment (which of course is more common in the worse areas), and/or believe that they can have more sexual activity if they are circumcised (thus voiding any possible single-exposure benefit from circumcision). — BRIAN0918 • 2007-06-20 14:34Z

No, this article should not be updated as you describe, because doing so would a) violate WP:NPOV, and b) wildly extrapolate beyond the sources. Jakew 15:06, 20 June 2007 (UTC)

Obviously it should be updated, and obviously I did provide my own commentary, but I figured you would be able to know the difference between the two. It's also obvious that we can no longer just say "a man's risk of acquiring HIV through heterosexual intercourse is halved if he is circumcised". At most we can say that there is a correlation between previously-circumcised men and a reduced risk of getting HIV during individual sexual encounters, but that this may be due to cultural differences, such as the size of the prostitute population. This at least is more neutral and takes into account the actual evidence. — BRIAN0918 • 2007-06-20 15:56Z

This is an article on Circumcision, not on HIV prevention. If Circumcision reduces the chance of infection by HIV (all other things being equal), it is potentially worth mentioning. Other ways to prevent HIV infection are not suitable subjects for THIS article. It MIGHT be acceptable to include claims that the protection afforded by circumcision may lead more people to get infected if they stop using condoms, but this requires some sort of impirical evidence. You and I might think that this will happen, but until we have proof, we could be wrong.SimonHolzman 16:10, 20 June 2007 (UTC)

I don't think you understand. This article was misrepresenting the role of circumcision in preventing infection. While it may be correlated with a reduced chance of infection during individual sexual encounters, we cannot say (as we were in this article) that it definitely is somehow reducing the individual risk, let alone the overall risk. — BRIAN0918 • 2007-06-20 16:14Z

(Edit conflict.) No, we can't say that either. Again, it is unsupported by sources. Talbott's argument is that "cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic", not that "no data supports the theory that..."

Talbott's paper is arguing with the methodology used in one class of observational study: ecological studies. He specifically identifies Drain et al (his ref 9) and Halperin and Bailey (his ref 11). He argues that, if data are analysed differently, the effect of circumcision in the analysis is "less significant".

Cultural differences, such as the size of the prostitute population, can act as a confounding factor in observational studies (such as comparison of different countries). That is why the three randomised controlled trials were conducted, in which men from the same culture were randomly divided into two groups, and one group which was then circumcised. To quote from the 2003 Cochrane review: "However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from [randomised controlled trials], the value of IPD analysis of the included studies is doubtful." Jakew 16:19, 20 June 2007 (UTC)

Again, as I said, circumcision may reduce risk during individual sexual encounters, but as Talbott has shown, it won't work to slow the AIDS epidemic. — BRIAN0918 • 2007-06-20 16:23Z

Correction: as Talbott has argued. There are papers by Drain et al, Halperin and Bailey, Gray et al, and others that argue that it will work. Jakew 16:25, 20 June 2007 (UTC)

Two studies in the US found higher rates of STD's among the circumcised, who (probably) striving for sensation are less likely to use condoms and engage in elaborate sexual practice. Safe sex is the only answer to HIV transmission.TipPt 17:53, 4 July 2007 (UTC)

Studies conducted in the US have generally found lower risk of HIV among circumcised males, Tip. See the section of the CDC factsheet entitled 'HIV Infection and Male Circumcision in the United States'. Jakew 20:15, 4 July 2007 (UTC)

Both studies were limited to homosexual men, and neither controlled for income/education.TipPt 22:39, 4 July 2007 (UTC)

Do you have any sources for your claims, or is it just more original research? Jayjg ^(talk) 03:39, 5 July 2007 (UTC)

Please see the honest version

Corrects misrepresentation in procedures, sexual effects, history, Assoc statements, and jewish origin.

Please revert back to this honest version.

Also found here:[3]TipPt 00:55, 3 July 2007 (UTC)

Tip, these are huge changes for which you know you don't have consensus (your comment above makes it perfectly clear that you expect to be reverted). Jakew 11:39, 3 July 2007 (UTC)

Jakew, the honest version was once consensus ... even (with three paragraph exceptions) by you. Then I left for a several weeks and the religious cabal, with your consent, made radical changes. Your version is now very silly (that's why I left for so long ... to let it go crazy).

You deleted the most common complication (meatal stenosis), primary known cited sexual effects, misrepresent Assoc statements, mislead on pain, mislead on procedures, misrepresent the jewish tradition, and promote circumcision medically ... when it's never recommended medically (for neonates).

Your comment on reversion is silly, because you have evidently "reverted" away everything that's not pro-circ. The honest version is properly cited and bring the topic to scholarly reality.TipPt 14:52, 3 July 2007 (UTC)

At a minimun, put the POV tag back!TipPt 14:52, 3 July 2007 (UTC)

By reverting, Jakew owns this ridiculous topic. He bears responsibility for gross misrepresentation of facts, and the great harm he does readers and their infants.

Visiting editors ... please revert to the honest version, found here: [4]

If you have any question that circumcision reduces sexual pleasure, read this study [5]

By reverting ... even religous/ritual driven circumcisions can be done causing less harm to erogenous sensations ... you could save neonates from loosing their frenulum! Parents at least should know to request the mogen clamp properly angled.TipPt 17:49, 4 July 2007 (UTC)

User:TipPt, please accept that Wikipedia is not a soapbox. Please take your crusade to "save readers and their infants from harm" to the appropriate blog. Also, please avoid further uncivil references to "the religious cabal". Jayjg ^(talk) 03:38, 5 July 2007 (UTC)

Per the request for comment: The intro definitely is unbalanced - it spends way too much time talking about judgements - and the article spends way too much time on health and legal issues. Things like "history" and "procedure" are given far too little weight ... and the page is probably too long. Consider splitting out Ethics of circumcision and medical and health effects of circumcision to make the article more readable. Cheers, Wily D 22:41, 4 July 2007 (UTC)

Please see the honest version outline, which places emphasis as you suggest.

Note that Avi agreed and promised to consolidate the huge medical benefits sections into it's existing sub ... but then refused and blocked my attempts. Dishonest actionsTipPt 14:46, 5 July 2007 (UTC)

Jayg ... it helps editors to know the background of the cabal and it's motivations. Facts are not uncivil. The cabal does significant harm to readers and their infants by denying them facts:

Most of the Sexual Effects US assoc text about the glans, but the topic is the foreskin! Blocked is discussion of foreskin fine touch, frenular damage, erogenous sensation from movement and stretch.

The most common risk of circumcisions is blocked (meatal stenosis), though the treatment involves further damange to the frenulum.

Properly cited, but blocked by the cabal are facts regarding technique and pain ... pain relief not permitted by some religious factions.[6]

You might remember blockage of the proper use and pain reduction using the mogen clamp.

You might remember blockage of cited discussion of (unnecessary) damage to the frenulum and it's implications.

You might remember blockage of required presentation of the jewish covenant "The original Brit milah consisted of excising the foreskin tissue which extended beyond the tip of the glans penis, while current practice (Brit periah) removes the foreskin to completely expose the glans."[7] Don't you think some religious factions would choose the less invasive procedure to still satisfy the covenant?

Motivations are key to understanding what goes on in Circumcision.TipPt 15:20, 5 July 2007 (UTC)

Your intent to violate WP:SOAP is increasingly clear. Jakew 15:46, 5 July 2007 (UTC)

Properly cited relevant fact, not soap. I did read that section again and find violation of the propaganda guidelines means you and avi are guilty of WP:SOAP.TipPt 18:02, 5 July 2007 (UTC)

As a disinterested reader, it seems to me that there is FAR too much misinformation from the anti-circumcision fringe. It comes off as anti-Semitism and as immature ranting. --Charlene 08:52, 6 July 2007 (UTC)

Anti-circumcision is not a fringe, nor is it anti-Semitic. It is simply a disagreement with the idea that one should cut a healthy baby boy's penis up into a bloody mess, causing him immediate and future pain, and diminished sexual pleasure later in life. Show the average person a video of circumcision and they will be appalled and disgusted enough to oppose it (which is why a video of circumcision will never be allowed in this article). In our current female-dominated society, pointing this out is seen as whining; however enlightenment has always been slow to come to humanity. Speaking out against slavery was "immature ranting" only a hundred or two years ago, after all. Blackworm 09:10, 6 July 2007 (UTC)

You make Charlene's point perfectly. Jayjg ^(talk) 11:47, 6 July 2007 (UTC)

Hardly. And if you wish to call me an anti-Semite, Jayjg, have the courage and honesty to come out and do it openly; and we'll see where that discussion leads -- but don't do it tacitly, using someone else's words and agreeing with them. Blackworm 01:15, 7 July 2007 (UTC)

Charlene, please cite examples in the article of "misinformation from the anti-circumcision fringe". -- DanBlackham 03:44, 7 July 2007 (UTC)

I was going to ask Charlene on to either retract the comment about "misinformation" or provide examples, but according to the user page the user seems to have left Wikipedia. --Coppertwig 17:58, 21 July 2007 (UTC)

The Feast of the Circumcision

As this feast is now obsolete I believe that it is irrelevant in a general article such as this. It would, of course, be appropriate to an article on religion and circumcision. I propose to delete the references to this feast. If there are any comments or objections, please state them here. Michael Glass 12:32, 5 July 2007 (UTC)

Suggest that instead of deleing altogether, you move it to the (poorly named) Circumcision in the Bible. Jakew 15:43, 5 July 2007 (UTC)

Please do neither; the rename is largely a creation and practice of western brands of Christianity; Eastern Orthodoxy still celebrates this feast under substantially this name on January 1 (or January 14 by those using the older calendar). See January 1 (Eastern Orthodox liturgics), for WP's take on it or [8] for the Greek Orthodox Archdiocese of America (English language page) reference. Eastern Orthodoxy includes nearly 200 million Christians (largely in Eastern Europe) so is hardly a small sect to be fully ignored by saying its practices are "obsolete" which is POV and ill-informed. Carlossuarez46 00:58, 6 July 2007 (UTC)

Thanks for drawing attention to this fact. Please see the change that I have made. Michael Glass 12:45, 6 July 2007 (UTC)

The beginning of the article

I believe the beginning of the article is too long. It goes over material that would be far better dealt with in the article itself. All we need is the following:

Circumcision is the procedure that cuts some or all of the foreskin (prepuce) from the penis. The frenulum may also be cut away at the same time, in a procedure called a frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").

The rest mostly duplicates material already dealt with in the body of the article. Anything not dealt with could be transferred to the body of the article. Instead of a mini-article on circumcision it would be better to go straight from the introductory paragraph to the list of contents.Michael Glass 05:34, 7 July 2007 (UTC)

The lead section is actually intended to summarise the key facts in the article. To that extent, a small amount of duplication is expected. You're correct in stating that it is currently too long, but your proposed replacement is too short. Please see WP:LEAD. Jakew 10:33, 7 July 2007 (UTC)

Source for information about the Holy Prepuce

Unfortunately, the source of information about the Holy Prepuce is not reliable. The information [9] is part of a personal website, whose homepage [10] reveals that the author has a particular axe to grind about religion. Therefore this particular source of information cannot be used. Secondly, even if the information came from a reliable source it is doubtful that it is relevant to this topic. That is why I have deleted the paragraph that was recently added. Michael Glass 00:39, 8 July 2007 (UTC)

Then please call it the "Ideal Prepuce." The Topic requires information stating that many cultures placed high value on the prepuce.[11]TipPt 15:03, 9 July 2007 (UTC)

My edit

I think the previous discussion of the HIV aspect in the title was skewed. It was of the form "Smith and Jones state that .... Whilst some (disagree with this), the ABC reccomends that."

This is clearly giving more prominence to Smith and Jones. Their names are included in an academic style where as the other peer reviewed article mentioned was just "some".

I also added a quote from the AMA about the importance of sexual behaviour, I think it is responsible to highlight the fact that circumcised men are still at risk. Thehalfone 11:48, 8 July 2007 (UTC)

The HIV text should be one short sentence in the intro only, not propaganda.TipPt 19:08, 8 July 2007 (UTC)

I agree. There is, however, always going to be more problems getting a concensus over a one sentence introduction than a more detailed account. I see from this talk page that the discussion over this subject is already rather heated. How about something along the lines of "there is some evidence that circumcision may reduce the risk of HIV-infection." and then a sentence highlighting that the need for care amongst circumsised men is still present. Thehalfone 11:55, 9 July 2007 (UTC)

The sentence is far too weak. If our sources are describing the evidence as "firm" and "proven beyond reasonable doubt", then it misrepresents them if we say there is "some evidence that it may...". Jakew 16:44, 9 July 2007 (UTC)

Studies find circumcision reduced the incidence of HIV among permiscuous sub-Saharan Africa hetersexuals by 50-60%, but should never replace other known effective prevention methods.TipPt 02:58, 10 July 2007 (UTC)

Once again, the qualifiers are yours, not those of the sources. Jakew 11:11, 10 July 2007 (UTC)

If the introduction contains a single sentence suggesting that HIV prevention is (or may be) a benefit of circumcision, then as I pointed out above, the introduction should also contain some information about harm or possible harm from circumcision. The research about HIV prevention is recent and may soon be put into perspective by other research. Note that even if, as some studies suggest, circumcision reduces female-to-male HIV transmission, it may also increase male-to-female transmission (due to increased rubbing and minor damage to the inside of the vagina) and therefore may not decrease, and may increase, the overall infection rate in a population in the long run. I'm not suggesting that this idea be mentioned in the introduction; I'm mentioning it here to show why it may not be a good idea to mention HIV prevention in the introduction, but only later in the article where there's more room to explain exactly what the studies establish. --Coppertwig 18:07, 21 July 2007 (UTC)

The order of the article

At the moment, the article begins with "The procedures of circumcision". In fact, these are only some of the procedures used by doctors to do infant circumcisions. I believe it would make more sense to have the medical section appear in this order (the numbers mark the old order, ):

6 Medical aspects

1 The procedures of circumcision

4 Pain and pain relief during circumcision

6.1 Risks of circumcision

6.2 HIV

6.2.1 Langerhans cells and HIV transmission

6.3 HPV

6.4 Hygiene

6.5 Infectious and chronic conditions

6.5.1 Balanitis

6.6 Penile cancer

6.7 Phimosis and paraphimosis

6.8 Urinary tract infections

6.9 Policies of various national medical associations

6.9.1 United States

6.9.2 Canada

6.9.3 United Kingdom

6.9.4 Australasia

Please give me your feedback. Michael Glass 13:10, 8 July 2007 (UTC)

The Topic is currently focused on religious requirements and medical benefits (based on the relative amount of text and its order). But most english speaking readers (our audience) don't do it for religious or medical reasons. The article is boring and not relevant to most readers.

We know medical risks and benefits are minor ... and should be treated accordingly. Shifting that content to a sub will solve the length problem. On the other hand, it's surgery on a sexual organ, but we give relatively little coverage to surgical technique, risks, or sexual effects.TipPt 19:06, 8 July 2007 (UTC)

1 The procedures of circumcision

(its primarily a surgical procedure...expand)

1.1 Pain and pain relief during circumcision (expand)

2 History of circumcision

(done primarily for cultural ritual/religious/historical reasons)

2.1 Circumcision in the ancient world

2.2 Medical circumcision in the 19th century and early 20th century

2.3 Circumcision since 1950

3 Medical aspects

(evaluated medically)

3.1 Cost/benefit

3.2 Summary of risks (see sub ... to be created)

3.3 Summary of medical arguments (see sub ... to be expanded)

4 Sexual Effects: (its surgery on a sexual organ)

(the whole discussion should be in its sub above)

4.4 HIV

4.4.1 Langerhans cells and HIV transmission

4.5 HPV

4.6 Hygiene

4.7 Infectious and chronic conditions

4.7.1 Balanitis

4.8 Penile cancer

4.9 Phimosis and paraphimosis

4.10 Urinary tract infections

5 Cultures and religions

5.2 Christianity

5.3 Islam

5.4 Other faiths and traditions

6 Ethical issues

6.1 Consent

6.2 Emotional consequences

6.3 Legality

7 Policies of various national medical associations

7.1 United States

7.2 Canada

7.3 United Kingdom

7.4 Australasia (Australia, New Zealand and nearby islands)

8 Prevalence of circumcision

8.1 Australia

8.2 Denmark

8.3 South Korea

8.4 United Kingdom

8.5 United States

9 See also

10 References

11 External links

11.1 Circumcision opposition

11.2 Circumcision promotion

11.3 Circumcision techniques

12 Further reading

Note the administrator response to my request for comment:

Per the request for comment: The intro definitely is unbalanced - it spends way too much time talking about judgements - and the article spends way too much time on health and legal issues. Things like "history" and "procedure" are given far too little weight ... and the page is probably too long. Consider splitting out Ethics of circumcision and medical and health effects of circumcision to make the article more readable. Cheers, WilyD 22:41, 4 July 2007 (UTC)

In my opinion the positions of the various medical associations should precede the discussion of medical aspects. In this way, a reader searching for guidance will first encounter the positions of the regulatory institutions which govern medical practice. If they want more information they can read on to find more in-depth information.Zandrous 12:02, 9 July 2007 (UTC)

I wouldn't be entirely opposed to moving that section, Zandrous, but having said that, I think that it may be more natural to find that section after discussion of the details. Although we can't ourselves include conclusions, the positions of medical organisations essentially act as a 'conclusions' section, which one generally expects to find after in-depth information.

My thinking is that the policy and position statements are more significant and carry more weight than do the work of individual authors so they should lead. And given the encyclopedic nature of wikipedia, it might be appropriate to place the "bottom line" at the top where it's easier for people to find. Zandrous 22:56, 9 July 2007 (UTC)

As an aside, we really ought to add the WHO to that section... Jakew 12:26, 9 July 2007 (UTC)

WHO conlusions are not directed to english speaking neonates ... the vast majority of circ'd readers (via their parents).

Did you know that use of airbags has increased traffic fatalities? Drivers feel a little more secure and drive slightly faster ... and hit the wall a little harder! Safe sex is the only way.

Again, most of the medical aspects text belong in its sub. The Topic should only summarize potential benefits and risks (about equally, since they are judged thus by all Assoc).TipPt 14:30, 9 July 2007 (UTC)

Even if your statement ("WHO conlusions are not directed to english speaking neonates") were correct, the article should not be limited to English-speaking nations. Please see Wikipedia:Neutral point of view/FAQ#Anglo-American focus. Jakew 14:31, 9 July 2007 (UTC)

My point is no not mislead our primary readers. We currently do. A 50% reduction is lousy, if ultimately death results in the other 50%! A false sense of security (and associated behaviors) is worse than no security at all.

Other than english speaking folk, the other main applicable groups are muslims and central africans. The men who should consider circ to reduce HIV risk are permiscuous and those who practice unsafe sex (or can't afford condoms).TipPt 14:53, 9 July 2007 (UTC)

You're obviously entitled to your opinions about whether the reduction is worthwhile or not, but they are not relevant here.

Tip, as with any other article in this encyclopaedia, "primary readers" are simply those who wish to learn about the subject matter. Please stop viewing Wikipedia as a propaganda vehicle for dissuading parents from circumcising their sons, and recognise that it is supposed to be an NPOV encyclopaedia. Nothing more, and nothing less. Jakew 15:02, 9 July 2007 (UTC)

We find risks and benefits are balanced (though not accounting for sexual effects). The Topic misleads in it's extreme emphasis on potential benefits; HIV included. Until Assoc statements change, you must accept neutral presentation of the facts.

We should take the above recommended text ... "there is some evidence that circumcision may reduce the risk of HIV-infection" for the intro, with complete discussion in the sub.TipPt 15:51, 9 July 2007 (UTC)

No, Tip, we don't find anything re the risk-benefit balance. To do so would violate both NPOV and NOR. What we do instead is to discuss what others have concluded.

As for 'emphasis', try counting the number of paragraphs dedicated to risks and benefits in medical organisation statements. I did this myself previously; the results are in the archives. As it turns out, the ratio of paragraphs covering benefits:risks is actually more weighted towards risks than in most policy statements. Jakew 16:38, 9 July 2007 (UTC)

The cites ... the CPS, the BMA, RACP, the AMA, Stanford U, all of the cost/benefit studies ... find risks and benefits minor and fairly balanced. The Topic is not correspondingly balanced; thus it's propaganda.

Count the number of paragraphs in the Topic, not just the Assoc statements. For example, the current medical aspects section ... HIV, HPV, cancer, uti's, hygiene ect relative to the risks paragraphs.

The medical assoc statements summarize their conclusions ... bottom line, "not medically necessary" and "non-therapeutic". Sorry if you don't agree.TipPt 03:38, 10 July 2007 (UTC)

I agree with Zandrous that the assoc statements should lead the medical aspects ... risks and benefits summary. Again, most of those sections should be the sub.TipPt 03:44, 10 July 2007 (UTC)

Tip, as I explained above, the ratio of paragraphs discussing benefits and risks is weighted more towards risks in this article when compared with those in the medical organisaion's policy statements. Jakew 11:14, 10 July 2007 (UTC)

You force the assumption that the medical Assoc statement is neutral. In the US, medicine is foremost a business. Most bypass (save quad) and stents (other than WHEN your having a heart attack) without longevity benefit, focus on medications versus diet, excessive use of radiation (imaging). Specific to circs, Assoc statements reflect risks in a hospital setting with an experienced surgeon, versus the more common crude operator techniques. Other published work finds bias in those Assoc reviews.TipPt 16:44, 13 July 2007 (UTC)

Now you're contradicting yourself. To remind you, your argument was that these organisations "find risks and benefits minor and fairly balanced. The Topic is not correspondingly balanced; thus it's propaganda." Jakew 18:59, 13 July 2007 (UTC)

I don't follow your "contradicting" argument.

Not primarily organizations, but studies. Cost/benefit find minor effectively balance risks and benefits. Studies cited by most Assoc. You know there are many good studies. If risks and benefits are fairly balanced, so should the Topic focus.

To devote many lines to prospective benefits and relatively few to coresponding risks is biased ... leading the reader to conclude that benefits are greater than risks ... which is not the recommendations of the Assoc.TipPt 23:15, 13 July 2007 (UTC)

Getting back to the order of the article...it does seem to need some re-ordering. Is anyone still proposing to do so? Zandrous 15:43, 18 July 2007 (UTC)

Although what Wikipedians "find" about relative balance of risks/benefits is not itself to be presented in the article (e.g. article should not say "60% of the effects are..." or "60% of the sources say that..." if these are just findings of Wikipedians), nevertheless it is perfectly valid and expected for Wikipedians to study the sources, "find" things about relative balance and use those findings to decide what proportion of the article should be about one thing or another. (See WP:UNDUE.)

I agree that it's a good idea to state the conclusions first. This is good practice; it's like an abstract at the top of a scientific paper, or a topic sentence at the beginning of a paragraph. It aids the reader in finding the most important information.

I agree that the article need not necessarily follow the proportions of space given to various subtopics in medical assocation sources, as TipTp argues. There are other reliable sources, e.g. the studies themselves, which can also be taken into account. --Coppertwig 18:23, 21 July 2007 (UTC)

POV tag

We have several editors/administrators who recently find bias or needed change in the Topic. Some say it's too anti, others pro, others cite specific problems ... the “consensus” is only found among the cabal.

The Topic needs the POV tag so readers know to read the discussion.TipPt 19:23, 8 July 2007 (UTC)

Ongoing misrepresentation

I have reverted yet another attempt to add qualifiers to Newell and Bärnighausen.

This source states that the RCTs provide "firm evidence that the risk of acquiring HIV is halved by male circumcision". Regardless of the personal evaluation of this evidence by certain Wikipedia editors, they do not qualify this by adding the context of heterosexual intercourse. Nor do they qualify it by stating that it is Africa-specific. Nor, for that matter, do they state that it is true of heterosexual intercourse on Tuesdays. Please stop misrepresenting the sources by adding qualifiers that the sources themselves do not include.

Additionally, the same editor has misrepresented other sources, changing a sourced statement that refers to countries where circumcision is customary to an unsourced statement claiming that circumcision is only customary in certain regions. Jakew 11:58, 9 July 2007 (UTC)

The problem with the HIV studies is they do not belong in the intro, but rather in the medical aspects summary and then detail in the sub. The current placement gives undue emphasis on pro-circ info, not relevant to most readers (neonates in the US or other english ... advanced ... nations). A 50% reduction still leaves grave danger, and a false sense of security.TipPt 14:29, 9 July 2007 (UTC)

First, as I've noted above, we must not focus on English-speaking nations alone. Second, per WP:LEAD the lead is supposed to summarise important facts and "In general, the relative emphasis given to material in the lead should reflect its relative importance to the subject according to reliable sources." As you can readily verify through PubMed searches, HIV has received considerable attention in the literature. Jakew 14:38, 9 July 2007 (UTC)

My point is no not mislead our primary readers. We currently do. A 50% reduction is lousy, if ultimately death results in the other 50%! A false sense of security (and associated behaviors) is worse than no security at all.

Other than english speaking folk, the other main applicable groups are muslims and central africans. The men who should consider circ to reduce HIV risk are permiscuous and those who practice unsafe sex (or can't afford condoms ect).TipPt 14:56, 9 July 2007 (UTC)

This seems to be entirely your own opinion. Jakew 11:15, 10 July 2007 (UTC)

At least include the information that the recommendation is for regions where the incidence of HIV is >15%.TipPt 15:04, 13 July 2007 (UTC)

Sexual Effects

Jakew objected to my emphasis on the frenulum, but invited me to fully represent Boyle et al. Please consider the following:

Boyle et al. (2002) .^[1]argued that "heterosexual intercourse is less satisfying for both partners when the man is circumcised. Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback, it is highly likely that circumcision may promote sexual dysfunction such as premature ejaculation, and consequently, also the reduction of female sexual pleasure. The possible deleterious effects on social and marital relationships may be considerable, especially in countries where most men have been circumcised.”

Complications of circumcision, including “skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation” may result in diminished sensation. For example, “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.” …”A 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. Consequently, erectile dysfunction may be a complication of male circumcision.”

…”Circumcised men were significantly less likely to use condoms than were genitally intact men. Presumably, use of a condom reduces sexual sensation.”TipPt 15:59, 9 July 2007 (UTC)

PS ... I guess each paragraph should have the cite.TipPt 16:03, 9 July 2007 (UTC)

First that is far too long - it should be no more than 1 paragraph - and second it violates NPOV by confusing fact and opinion. For example, instead of saying that "Complications of circumcision ... may result in diminished sensation", you need to who is making that argument. Jakew 16:41, 9 July 2007 (UTC)

I put the last quote to emphasize the danger to placing (as now) too much emphasis on reduction of HIV ... it actually belongs in the HIV sub.

Your insistance on one paragraph represents propaganda. It's impossible to write a good paragraph that incorporates all the et al findings. Is it your intention to have lousy paragraphs in the Topic?TipPt 03:13, 10 July 2007 (UTC)

How about:

Boyle et al. (2002) argued that "…intercourse is less satisfying for both partners when the man is circumcised. Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback, it is highly likely that circumcision may promote sexual dysfunction such as premature ejaculation." …"Among the structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation." For example, “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 loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response … restricting a circumcised man’s ability to achieve arousal. Consequently, erectile dysfunction may be a complication of male circumcision.”^[2]

(unindenting) Tip, the reason why I suggest one paragraph is to avoid giving undue weight to Boyle et al. We should not give more emphasis to minority views than to mainstream views (as represented by medical organisations' statements).

The paragraph you suggest could use a little editing, but first could you please explain why you think it is superior to the existing discussion of Boyle et al.? Jakew 12:43, 10 July 2007 (UTC)

The current version is vague, but the cited text is specific, for example noting possible sexual effects of complications. Note that the Assoc statement is fairly specific, so I hope you think it's fair.

How about:

Boyle et al. (2002) argued that "structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation." For example, "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 loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response" may reduce a "circumcised man’s ability to achieve arousal." …"Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback" erectile dysfunction and premature ejaculation may be a complication of male circumcision, potentially making "intercourse is less satisfying for both partners when the man is circumcised."^[3] Taves (2002) argued that the foreskin may have an intromission function, facilitating penetration,[12], and Bensley et al. (2003) argued that circumcision may decrease vaginal wetness and orgasm in female partners.[13]

Still suffers from the same problems. Too long, insufficiently neutral, and you're failing to attribute. Jakew 15:37, 13 July 2007 (UTC)

It is the same length as the Assoc statement (13 lines). It is directly from the quoted articles (thus a neutral presentation of their views), and fully attributed to Bolye, Taves, and Bensley et al.TipPt 15:47, 13 July 2007 (UTC)

Talbott study

I've removed discussion of Talbott's study, because it has received so much criticism that it barely seems worth discussing. For example, see Nature, vol 447, 28 June 2007, pp1040-1. To quote one (of several) comments: '"The paper is total drivel, it should have been picked up in the review process," claims Tim Farley, an official in the World Health Organization’s HIV-prevention team in Geneva.' Jakew 11:08, 10 July 2007 (UTC)

The paper is certainly controversial, and this should be mentioned. However, the very fact that it stirred up so much controversy doesn't make it unworthy of mention. By all means mention the controversy, but don't suppress the study. Michael Glass 08:52, 11 July 2007 (UTC)

Michael I agree with you 100%, but I expect you will be told that you need to find a source that describes the Talbott paper as controversial, and that to simply describe it as such on your own is Original Research. Try this one: http://www.livescience.com/health/070626_prostitute_hiv.html I'm fascinated by the acceptance of Talbott's paper by the journal because he has no formal training in the field in which he is conducting his analysis, which is apparently not uncommon when it comes to experts on male circumcision. Zandrous 09:57, 11 July 2007 (UTC)

We have several sources that describe it as controversial, including the Nature article referenced above. Jakew 10:49, 11 July 2007 (UTC)

I didn't see any of the sources cited in the article to support the claim that it is controversial. Zandrous 13:09, 11 July 2007 (UTC)

From the Nature article cited: "A controversial recent publication argues that the evidence from cross-country statistics does not support male circumcision as a key intervention against HIV...." (emph added) Jakew 13:41, 11 July 2007 (UTC)

(unindenting) What I meant was that the sentence you are quoting above didn't have a citation attached to it. I'm not complaining, just trying to keep the article up to your high standards because I anticipated that someone might take issue. Zandrous 15:05, 11 July 2007 (UTC)

Farley Quote

Is quoting Farley alone giving him undue weight? Since Farley implies a failure of the review process, shouldn't we also mention that the review process was defended by the editor of PLoS? While the "total drivel" comment is certainly amusing, I don't understand why it warrants inclusion. Could we say that the review process was challenged by a WHO official and defended by the editor of the journal without quoting either of them? Wouldn't that be more encyclopedic and give a better overall impression of the controversy? I'll wait for feedback before taking the liberty of removing Farley's colorful comment. Zandrous 13:20, 11 July 2007 (UTC)

Zandrous, the subject of this article is circumcision, not the merits of the peer-review process of PLoS ONE. As such, I think that Farley's comments about the former are rather more relevant. Farley's comment doesn't seem atypical of researchers interviewed in that piece, and has the merit of being a very concise (if blunt) summary. Incidentally, I'm not even sure that we could truthfully say that the review process was defended by the editor. To quote: '"There are lessons to be learned from all papers that we publish; we are a young journal," says Chris Surridge, PLoS One’s managing editor, adding that its peer-review model is constantly under refinement. "We are feeling our way."' Jakew 13:40, 11 July 2007 (UTC)

I understand that the topic of the article is not the peer-review process of PLoS ONE, which is why I don't understand the inclusion of a phrase quoted out of the context of Farley opining that Talbott should not have passed that peer review process. And begging your pardon, but Farley's comment as quoted in our article is atypical in that it does not include any substantive critique as the other quotes from his critics do: "sweeping generalizations...our data were never intended to be used in this way...we are past this sort of ecological research". All of those are substantive crtitiques that give some information about why people find Talbott's analysis problematic. Furthermore, the rest of Farley's quote makes clear that he is criticizing the review process of PLoS ONE which allowed Talbott's article to be published. We don't need Farley's quote precisely because our topic is circumcision, and not the review policies of PLoS or the controversy surrounding them in regards to the publication of one of our sources. Stating that it is controversial is sufficient for our article on circumcision. Zandrous 15:05, 11 July 2007 (UTC)

I'd tend to disagree on one point. Farley's quote criticises both Talbott's paper ('it is total drivel') and the review process which allowed it to be published.

Sorry, I'm not sure what point you're referring to. All I am saying is that because our article is about circumcision, reference to the controversial nature of Talbott's work is sufficient without quoting any specifics of that controversy. If you can make a case for the inclusion of Farley's quoted phrase, please do so. Zandrous 16:31, 11 July 2007 (UTC)

I do agree that other criticisms, both in Nature and elsewhere, are more explicit in their criticisms. Certainly we could discuss any or all of these. I have to say, though, that I think that the real question is whether it is worth discussing Talbott at all. A PubMed search for 'circumcision HIV' returns 412 articles. Clearly we cannot include them all. So why is Talbott's paper worthy of inclusion? Jakew 15:19, 11 July 2007 (UTC)

Because it is significant enough for other journals to publish pieces about it. That suggests that it is significant enough to warrant inclusion here. But let's not lose sight of the fact that if the Talbott reference is included, the content of the controversy surrounding it is beyond the scope of our article on circumcision. Zandrous 16:36, 11 July 2007 (UTC)

So are you saying that we should include all papers that other journals mention? It occurs to me that many, perhaps most, papers are cited at least once by other journals, so that seems a poor choice of criteria for inclusion. Jakew 17:59, 11 July 2007 (UTC)

(unindenting) I am not saying that we should include all papers cited by other journals, I'm sorry if I wasn't clear; above I wrote "publish pieces about it" not "cite it as a reference" in an effort to avoid giving the impression that you received. I am saying that if an article is sufficiently notable that a journal like Nature publishes a whole piece just about that article and reactions to it (rather than simply citing the article as a reference), that it is probably significant enough to warrant inclusion. In other words, the Talbott article is itself the subject of an entire article in Nature. I hope that's clear. And because you have a lot more experience with wikipedia than I do, I am very curious as to what criteria you suggest for inclusion, given that we can't include all 400+ articles on circumcision and HIV. Zandrous 10:04, 12 July 2007 (UTC)

The criteria is obvious. Which paper best illustrates my point of view? Blackworm 11:58, 12 July 2007 (UTC)

Seriously Jakew, what criteria do you suggest? Blackworm's comment withstanding, you clearly know the literature very well and are something of an expert on circumcision as well as a very deft wikipedian; it would be very helpful for you to share your perspective on how you arrive at your opinion of what warrants inclusion. Zandrous 14:12, 12 July 2007 (UTC)

Just to let you know, Zandrous, I'm not ignoring your question, and I hope to answer it in considerable detail in due course. Jakew 15:35, 13 July 2007 (UTC)

Activists Polluting the article!

I have come to this article to check on it every few months this year. It is obviously clear that activists are polluting the article. I am not trying to be biased but whenever a person that has something to say that in some ways makes circumcision look good AND they provide a reasonable source it instantly gets attacked by anti-circumcision activists. Everyone has the right to believe what they want but no one and i mean no one (i don't even care if your the president of an anti-circumcision or pro-circumcision organization) should bias an article just to suit their own beliefs. I find it kind of funny that things about pros of circumcision are limited here. I don't care if you believe them, but their are sources out their that speak of the pros of circumcision. One example is circlist.com . I understand anti-circumcision activists have good intentions and want to protect children from percieved pain but this is ridiculous. Go post on another encyclopedia if you want to bias an article. Furthermore i think i am going to add something to the article about evolution that is FAIR and presents BOTH SIDES and does not try to make one side dominate. Some of you anti-circumcision activists think i'm being ridicouls but this actually offends people religious (muslim, jewish, aboriginines, protestants) or non religious (atheists) that get told how "ignorant or mininformed they are". I am not picking on your beliefs. I am picking on your beliefs trying to take over this article! You don't see a pro-circumcision activist trying to take over this article. Even if you do don't get back on them, make this article neutral. I also think it is important to get ahold of the circumcision style they used to "prevent masturbation". I personally have a theory it was a tight circumcision. 67.35.83.97 18:30, 11 July 2007 (UTC) {{editprotective}} add evolution area

You do no good unless you cite specific anti text.

I can cite specific pro text, for example see The American Urological Association statement in the current version: The American Urological Association (2007) recommends "that circumcision should be presented as an option for health benefits." The actual sentence is "believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks.TipPt 15:00, 13 July 2007 (UTC)

"Actual sentence"? Are you claiming that the text quoted in the article does not exist? Jakew 15:32, 13 July 2007 (UTC)

No, just that the end of that sentence is removed in the current version, suggesting pro-circ bias.TipPt 15:42, 13 July 2007 (UTC)

There are two different sentences, Tip. The one quoted in the article explicitly states what they recommend (and thus is quoted along with recommendations of other organisations). The one you quote, however, refers to what they believe. Perhaps both sentences should be included, but they are different sentences. Jakew 15:51, 13 July 2007 (UTC)

I couldn't find the one "quoted." Looked again ... it's not there.TipPt 15:55, 13 July 2007 (UTC)

Right here. Final paragraph. Jakew 15:56, 13 July 2007 (UTC)

Sorry, but I missed that because it pertains to HIV. Focus on one attribute of circs is pro ... the intro paragraph "believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks" is neutral.TipPt 16:30, 13 July 2007 (UTC)

Neutral or not, that is what they recommend. I suggest that you contact them if you're unhappy about it. NPOV requires us to be neutral in reporting, but we must not misrepresent sources in order to portray them as neutral. Jakew 16:45, 13 July 2007 (UTC)

I get your focus ... consistent recommendations. But the current "recommendation" is clearly in the context of HIV. I'll add the thrust of the intro sentence.TipPt 16:53, 13 July 2007 (UTC)

No, don't bother; your original research is never required in any article, but particularly in this one. Jayjg ^(talk) 18:09, 13 July 2007 (UTC)

Until you can make sense, I'm ignoring you. Other than to tell other editors your evidenced motivation.TipPt 23:39, 13 July 2007 (UTC)

You've been told on numerous occasions that doing so violates WP:NPA and WP:CIVIL. To quote WP:NPA: "Do not make personal attacks anywhere in Wikipedia. Comment on content, not on the contributor. Personal attacks will not help you make a point; they hurt the Wikipedia community and deter users from helping to create a good encyclopedia." I suggest you follow that advice. Jakew 10:45, 14 July 2007 (UTC)

Look at this whole talk page! We can't even talk about the article without emphasising if we are for or against it. No you cant claim that there is only pro-circ pollution in there. There is anti-circ pollution in there also! Unfortunately the people writing up this article are focusing too much on "negative aspects" on this. They obviously never went to freewebs.com/pro-circ or circinfo.com or cirlcist.com These all show a pro side. I think that the majority want to put negatives in. We have have to put "pros" and "negatives" You guys need to stop arguing. The only reason why this is under so much heat is because it pertains to the male penis which is very important to men."" NeutralActivist 16:56, 17 July 2007 (UTC)

The beginning of the article, part 2

Previously Michael and Jakew suggested:

I believe the beginning of the article is too long. It goes over material that would be far better dealt with in the article itself. All we need is the following:

Circumcision is the procedure that cuts some or all of the foreskin (prepuce) from the penis. The frenulum may also be cut away at the same time, in a procedure called a frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").

The rest mostly duplicates material already dealt with in the body of the article. Anything not dealt with could be transferred to the body of the article. Instead of a mini-article on circumcision it would be better to go straight from the introductory paragraph to the list of contents.Michael Glass 05:34, 7 July 2007 (UTC)

The lead section is actually intended to summarise the key facts in the article. To that extent, a small amount of duplication is expected. You're correct in stating that it is currently too long, but your proposed replacement is too short. Please see WP:LEAD. Jakew 10:33, 7 July 2007 (UTC)

But the intro does a lousy job of summarizing, and we can't agree on changes. I agree with Michael that a single paragraph should replace the current version. Frenectomy should be included because in 20 - 30% of circs a frenectomy is also preformed.

Circumcision is the procedure that removes some or all of the foreskin (prepuce) from the penis. The frenulum may also be cut away at the same time, in a procedure called a frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut"). (The first sentence for at least two years)TipPt 15:16, 13 July 2007 (UTC)

Avi reverts away frenectomy

See the above intro paragraph, which parallels other encyclopedia text, and was the Topic intro paragraph for years. Avi removed it citing "irrelevant" with it's own page. But it's almost always done at the same time as a circ, and is very commonly done (20 - 30% of circs). Because it is so common and done as part of the procedure ... required for the gomco or plastibell to fit over the glans ... it should be included in the paragraph. Any comments?TipPt 17:10, 13 July 2007 (UTC)

This article is about circumcisions, not frenectomies. Any reliable sources backing up your statistics? Jayjg ^(talk) 18:07, 13 July 2007 (UTC)

Equipment sterilization, and for that matter breathing, also often occur during circumcisions. There is no reason to link the two, especially in the lead. -- Avi 18:22, 13 July 2007 (UTC)

If a reliable source can be cited that frenectomy is required for common types of circumcision then I think it is appropriately included in the definition of the procedure. Why? Because if the frenulum is a separate part of the penis distinct from the foreskin (which it apparently is if foreskins can be removed without removing the frenulum) but the frenulum is commonly also removed along with the foreskin during circumcision, then I think it warrants mention in the definition because circumcision then is properly a procedure that removes both the foreskin and the frenulum. Clearly the widespread convention in virtually all sources is to refer to gomco and plastibell procedures as 'circumcision' not 'circumcision plus frenectomy', however if such procedures entail removal of both the foreskin and frenulum, then the definition of circumcision should include both. Hope that's clear. Zandrous 20:05, 13 July 2007 (UTC)

We probably ought to say something about the frenulum, but I think placing it in the first paragraph is not appropriate as it seems to be motivated by anti-circumcision bias. The way, the truth, and the light 20:26, 13 July 2007 (UTC)

What makes it appear motivated by anti-circumcision bias? Zandrous 22:26, 13 July 2007 (UTC)

Umm, the admitted agenda of the person who added it? Jayjg ^(talk) 22:41, 13 July 2007 (UTC)

First of all to address Jayg's (one of the religious cabal members) concern, yes there are very good cites linking circumcision directly to frenectomy.[14][15][16] The last cite claims chordee (and thus frenectomy) can be caused by circumcision.

Second, to address Avi's ... ~"should we then mention breathing as part of circumcision" ... we're talking about a procedure (circumcision) that may itself lead to frenectomy (another procedure). In neonates, frenectomies of the penis are never be performed in the absence of circumcision. The reader isn't fully informed about circumcision without including frenectomy. (Avi's ... a second religious cabal member ... probable purpose)TipPt 22:52, 13 July 2007 (UTC)

TipPt, your repeated references to a "religious cabal", and accusations that various Wikipedia admins are members of it, are a serious violation of Wikipedia's civility policy. I'm going to give you one last chance to desist from your behavior, but I will take action if you do not stop. Jayjg ^(talk) 23:03, 13 July 2007 (UTC)

When a group of editors/admins act together as a cabal (easily evidenced) it actually helps civility to point out what's going on. I mostly don't want editors to waste to much time in discussion. You already know I don't care about religious affiliation ... what should I call you all?TipPt 23:47, 13 July 2007 (UTC)

In response to The way, the truth, and the light's comments, I don't believe that what motivates an editor is particularly relevant as along as the edit is verifiable, from a reliable source, and not original research. Am I wrong about this? Even if an editor has an agenda, it is possible that in the course of pursuing that agenda s/he might make edits that are verifiable, reliable, and neutral. In these cases I believe that the edit should remain. If I am incorrect, could someone please explain why? Zandrous 09:23, 14 July 2007 (UTC)

Partly correct. Verifiable, reliable, and neutral are the minimum standard. But there are other questions, too. Perhaps the most important is: does it improve the article or make it worse?

Part of writing a credible article is not being too atypical in the emphasis on various subjects. If many/most sources don't mention the frenulum, or mention it only briefly and in passing, and if Wikipedia discusses it in the second sentence, then that means that our relative emphasis lacks balance. It appears as though we 'have a bee in our bonnet', and it comes across as pushing an agenda.

By analogy, consider the first paragraph in an article about automobiles. If it spoke about individual freedom, enabling commerce, etc., you might distrust the article because it read like motor industry propaganda. On the other hand, if it spoke about pollution, acid rain, global warming, etc., you might think it was environmental lobby propaganda. In both cases, every word might be verifiable, etc, but because of the relative emphasis it gives the impression of lack of neutrality. Now suppose that the focus was even more atypical - I don't know, perhaps it started the article by talking about fluffy dice hanging from the rear view mirror. Wouldn't it strike you as odd? Jakew 10:41, 14 July 2007 (UTC)

Frenectomy in the intro improves the article because it is often a component of circumcision ... the circ can't be completed or heal properly in many neonates without frenectomy. The reader should be able to see frenectomy and then read its' own article.

Jakew ... 20-30% incidence is not "atypical."

Relative to autos, you're assuming frenectomy is bad. It's a common procedure, clearly not propaganda (it just is). It is just science, which is not odd or misplaced focus. It is almost always associated with circumcisions.TipPt 19:09, 14 July 2007 (UTC)

I'm inclined to agree with TipPt's reasoning here. I don't see how explaining frenectomy in the opening creates the impression of pushing an agenda, unless that agenda is explaining the characteristics of the procedure commonly known as 'circumcision'. The fact that circumcision commonly involves the frenulum as well as the prepuce is value-neutral, is it not? Jakew could you be more clear about what agenda's appearance is created by describing this aspect of the procedure? Zandrous 11:52, 18 July 2007 (UTC)

Neutral or otherwise, we need to be careful to avoid placing excessive (as compared to our sources) emphasis on frenectomy. Taking sources that give an overview of circumcision as a sample, what proportion discuss frenectomy in such a prominent fashion? Very few, I suspect, if any. Jakew 12:46, 18 July 2007 (UTC)

By the same token, relatively few of the sources cited in our article include reference to the etymology of the word circumcision (but that is our second sentence) or that circumcision predates recorded history or that it might have been a stand-in for ritual sacrifice; yet these statements are in the lead paragraph because they are fundamental to the definition of the practice itself. I don't believe that we are absolutely bound to present information in the article in direct proportion to that information's appearance in all sources, especially when it comes to describing what constitutes the practice. If circumcision by it's nature affects not only the prepuce but also the frenulum, then how does mention of it constitute undue weight? Zandrous 14:38, 18 July 2007 (UTC)

I agree, but with respect, not all sources include within their scope an encyclopaedic overview of circumcision. Indeed, many (perhaps most) assume that the reader already understands what circumcision is. So please just consider those with an appropriate scope. I suspect that:

All will discuss excision of the prepuce itself.
None will discuss the fact that the operator is breathing at the time, or that the operator is a member of homo sapiens.
Some (mostly medical scope) will discuss clamps, etc.
Some (mostly medical scope) will discuss use of anaesthesia.
Very few, if any, will discuss the frenulum.
Those with broad (or non-medical) scope will discuss the etymology of the term.
Those with broad (or historical) scope will discuss the origins of the practice.

Jakew 16:33, 18 July 2007 (UTC)

Jakew, thank you for keeping this part of the discussion on topic. Given that what we are striving for with our article is exactly the encylopedic scope you mention and that with this goal in mind we cannot assume that our readers already understand what circumcision is, I think it important to mention those parts of the penis involved, which include the frenulum. From the sources cited in the procedures section of the article, the four (of six) references I checked include mention of the frenulum in the context of the circumcision procedure, just as they include mention of the glans, which appears accordingly in our article. Why not also the frenulum? Zandrous 16:56, 18 July 2007 (UTC)

Out of interest, which refs did you check? Jakew 18:17, 18 July 2007 (UTC)

17,18,21,and 22. I didn't check 19 or 20 because I couldn't easily access a copy of them. Zandrous 20:12, 18 July 2007 (UTC)

17 (Holman et al) refers to preservation/avoidance of the frenulum, but not to frenectomy. 18 (Peleg & Steiner) similarly refers to "avoiding the ventral frenulum", but not to frenectomy. (Griffin & Kroovand), as the title ("Frenular chordee: implications and treatment") suggests, is about frenular chordee, not circumcision. 22 (Shechet & Tanenbaum) doesn't purport to give an overview of circumcision. Jakew 11:22, 24 July 2007 (UTC)

(unindenting) You're correct Jakew, and after surveying the sources I have argued for inclusion of the frenelum, not frenectomy. I assumed this was clear form my statements above and below, I apologize if I was responsible for any misunderstanding to the contrary. Schechet and Tanenbaum mention the frenelum in the context of discussing the procedure and they are cited in the article; I don't know that it's relevant to this discussion whether or not they purport to give an overview. As you point out though, these several sources do in fact make mention of the frenelum, which indicates that it is a part of the penis involved in the procedure of circumcision (even if that involvement consists of taking care to avoid it) and thus warrants mention in the definition of the procedure. Zandrous 12:43, 25 July 2007 (UTC)

Could I ask you to clarify a couple of things, Zandrous? Firstly, when you say that you argue for inclusion of the frenulum, could you give me an idea of what, exactly, you propose to include? Secondly, are you arguing for inclusion of this text in the lead or in the 'procedures' section? Jakew 12:57, 25 July 2007 (UTC)

I think the frenelum belongs in the definition of circumcision in the lead as well as with a fuller explanation of its role in the procedures section. I am not proposing any specific wording, just trying to help establish whether reliable sources state that the frenelum is a part of the penis involved in circumcision (which I think we have established). I'm confident that more experienced editors can fine tune the wording. Zandrous 17:06, 25 July 2007 (UTC)

A prerequisite for fine-tuning the wording is proposed text. It would be helpful if those in favour of including mention of the frenulum would at least give some idea of what form this mention might take. Then we can discuss it. Jakew 11:20, 26 July 2007 (UTC)

Misleading edit summary

Here. I accidentally hit "vandal" instead of plain "rollback" (having issues with my trackpad, the pointer jumps right), but it's still misleading to remove quoted text lower in the article and have it in the same header. Joie de Vivre ° 18:16, 13 July 2007 (UTC)

Ah, ok. Regarding "misleading", not sure what you mean. Jayjg ^(talk) 18:18, 13 July 2007 (UTC)

You are not giving me a chance to reinstate the newever, shortened version of the phrase. I only get as far as reverting so I have something to work with, then you revert again. Please stop. Joie de Vivre ° 18:22, 13 July 2007 (UTC)

See above. -- Avi 18:23, 13 July 2007 (UTC)

Alternatively, you could stop reverting, and propose changes here. Jayjg ^(talk) 18:25, 13 July 2007 (UTC)

You will find the discussion above Jayg.TipPt 23:51, 13 July 2007 (UTC)

Pain and pain relief during circumcision

The current version, and the cabal blocks discussion of pain relief. The following paragraph has been deleted ...again:

Lander et al., found that babies circumcised without pain relief "exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns ... became ill following circumcision (choking and apnea)."[17] A 2004 Cochrane review, which compared the dorsal penile nerve block and EMLA (topical anaesthesia) found both anaesthetics appear safe, but neither of them completely eliminated pain.^[4] Razmus et al reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores.^[5] Ng et al found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.^[6]TipPt 22:32, 14 July 2007 (UTC)

Pain and pain relief during circumcision 2

PS read this indented CNN article (the underlying study could be cited directly). The bold is mine:

A new study found circumcision so traumatic that doctors ended the study early rather than subject any more babies to the operation without anesthesia.

Rabbi Ariel Asa has performed hundreds of circumcisions. When families request it, he says he puts an anesthetic on the skin, in an effort to reduce some of the pain. But he admits it's not very effective.

"Due to the fact that moyels (the people who do the procedure) do it very quickly and the pain that the baby experiences is minimal, I don't think that the overall benefits are gained," he says.

"But the researchers found that while topical anesthetics may help initially, they are woefully inadequate during foreskin separation and incision.

They concluded that if circumcision must be performed, it should be preceded by an injected anesthetic.

In fact, they found the results so compelling that they took the unusual step of stopping the study before it was scheduled to end rather than subjecting any more babies to circumcision without anesthesia.

But the cabal blocks readers from seeing the facts and solutions.TipPt 22:29, 14 July 2007 (UTC)

Could you give us the URL for this quotation, TipPt? Michael Glass 11:17, 15 July 2007 (UTC)

Woops. Don't bother. It's [18] Michael Glass 11:25, 15 July 2007 (UTC)

Sorry, here's the URL [19]TipPt 15:48, 15 July 2007 (UTC)

Respect for Jewish tradtions

The Cabal insists on gross misrepresentation (that's the opinion of my many Jewish friends) of the Jewish tradition of circumcision. Please read the following well cited, verifiable (and not disputed anywhere I could find) history:

The Jews adopted circumcision as a religious ritual8,10,15,18 and preserved this prehistoric practice into modern times.10,16,18 The circumcision of Abraham removed only the very tip that extended beyond the glans penis.8,17,22,28 Moses and his sons were not circumcised. (Exodus 4:25) Although Moses apparently prohibited circumcision during the 40 years in the wilderness,15,18 (Joshua 5:5) Joshua reinstituted circumcision at Gilgal after the death of Moses.15,18 (Joshua 5:2-10) It is interesting to note that after the Israelites were circumcised, they immediately became soldiers in Joshua's army for the conquest of Palestine. (Joshua 6:1-3)

In contrast to the Jews, the Greeks and the Romans placed a high value on the prepuce.31 The Romans passed several laws to protect the prepuce by prohibiting circumcision.31

Much later in the Hellenic period, about 140 C.E., the circumcision procedure was modified to make it impossible for a Jew to appear to be an uncircumcised Greek.8,18,25 A radical new procedure called peri'ah was introduced by the priests and rabbis. In this procedure the foreskin was stripped away from the glans, with which it is fused in the infant (See Normal.) In a painful procedure known today as a synechotomy, more foreskin was removed than before and the injury was correspondingly greater. With the introduction of peri'ah, the glans could not easily be recovered, and so no Jewish male would easily be able to appear as an uncircumcised Greek.8,18,25

It may have been at this time that the Pondus Judaeus (also known as Judaeum Pondum), a bronze weight worn by Jews on the residual foreskin to stretch it back into a foreskin,8,18,23 gained popularity amongst Jewish males. This lessened the ugly appearance of the bare exposed circumcised penis.18 This restorative procedure was known by the Greek word epispasm,8 or "rolling inward."

The third stage of ritual circumcision, the Messisa or Metzitzah, was not introduced until the Talmudic period (500-625 C.E).8,17,23 In Metzitzah, the mohel (ritual circumciser) sucks blood from the penis of the circumcised infant with his mouth.31 This procedure has been responsible for the death of many Jewish babies due to infection.13 In modern times, a glass tube is sometimes used instead.

Now, read the version forced by the cabal:

Circumcision is a fundamental rite of Judaism. It is a positive commandment obligatory under Jewish law for Jewish males, and is only postponed or abrogated in the case of threat to the life or health of the child.^[7] It is usually performed in a ceremony called a Brit milah (or Bris milah, colloquially simply bris) (Hebrew for "Covenant of circumcision"). A mohel performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the Torah (Genesis, chapter 17 verses 9-14), God commanded Abraham to circumcise himself, his offspring and his slaves as a sign of an everlasting covenant. According to Jewish law, failure to follow the commandment carries the penalty of karet, or being cut off from the community by God. Brit milah is considered to be so important that should the eighth day fall on the Sabbath, actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. The expressly ritual element of circumcision in Judaism, as distinguished from its non-ritual requirement in Islam, is shown by the requirement that a child who either is born aposthetic (without a foreskin) or who has been circumcised without the ritual must nevertheless undergo a Brit milah in which a drop of blood (hatafat-dam, הטפת דם) is drawn from the penis at the point where the foreskin would have been or was attached.^[8]

Note that the above utilizes http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1017.x which very few readers can access (or will pay for) to use to verify. Much of the text is a gross misrepresentation of that article.TipPt 15:44, 15 July 2007 (UTC)

Your characterization of those who disagree with you as a "religious cabal" is shameful. Please apologize. Nandesuka 15:47, 15 July 2007 (UTC)

And if you want to refer to what unreliable, partisan sources have to say, could you please avoid copyright infringement? Verbatim copying of the source violates their copyright. Although it is rarely necessary to refer to such a source, quoting the URL is sufficient on those occasions. Jakew 16:16, 15 July 2007 (UTC)

Just trying to save time. Let them worry about potential violation of their potential copyright. Note (as I have) that they do not have copyright protection text in their website. Note also that most content websites do.

Nand ... I removed "religious" from the Cabal description. I do not mean to disparage any religion. We can all figure out individual motivations ourselves. I'm sure most abhor what's going on here.TipPt 16:52, 15 July 2007 (UTC)

Tip, copyright protection is automatic. They don't have to declare it. As for 'let them worry', it is our responsibility not to violate copyright, and if we fail to do so it places the encyclopaedia in danger.

I strongly suggest that you delete the text above, and avoid infringing copyright in future. Jakew 18:13, 15 July 2007 (UTC)

Plain English

Circumcision may be a surgical operation if it is performed by a doctor. However, if it is done by a drunken thug with a broken beer bottle [20] or it's done by religious fanatics with a dirty knife [21] it's hardly a surgical procedure. Those who define circumcision as a the surgical procedure' are committing a logical fallacy. It's the same logical fallacy as those who used to define swans as white birds; then Europeans discovered the black swans of Western Australia. So, just as most swans are white, so most circumcisions can be classed as surgical procedures. But not all. Therefore, the most accurate definition of circumcision is the one expressed in plain English. Michael Glass 00:49, 17 July 2007 (UTC)

No, circumcision is still a surgical procedure if performed under those conditions. Regardless it wouldn't be a logical fallacy, just a factual one. I fail to see how your version is any simpler than the other, and 'circumcision means cutting ...' sounds unencyclopedic, as well. The way, the truth, and the light 07:43, 17 July 2007 (UTC)

Well, now it seems we've entered an Alice in Wonderland world, where an attack by a drunken lout with a beet bottle is classed as surgery, and where "a surgical procedure" is deemed to be as simple as the verb "to cut". Michael Glass 08:09, 17 July 2007 (UTC)

Hypothetically, Michael, a drunken lout could perform triple heart bypass surgery with a beer bottle... Jakew 10:21, 17 July 2007 (UTC)

I think the "circumcision is a procedure that removes" line is a nice compromise, especially since circumcision is also "a fundamental rite of Judaism" (which is actually a bit misleading, since the brit milah is the fundamental rite and circumcision is simply one aspect of it; a circumcision alone is not sufficient to enter a child into the covenant). It is not always only a surgery (it can also be part of a ritual) but it is always a procedure and it does always remove preputial tissue. Zandrous 11:57, 17 July 2007 (UTC)

That's certainly an improvement, though "Circumcision is the procedure that cuts..." is better and "Circumcision cuts..." says it in two words. Michael Glass 12:39, 17 July 2007 (UTC)

I wish people wouldn't keep re-hashing old arguments. Circumcision is a surgical procedure because that's what reliable sources say it is. See Talk:Circumcision/Archive 27#Circumcision is not Surgery. Jayjg ^(talk) 14:46, 17 July 2007 (UTC)

Just because "reliable" sources say something doesn't mean it's true. We could say something like "circumcision is defined by many sources to be a surgical procedure..." We don't have to say "circumcision is a surgical procedure", and I oppose saying it on the grounds that clearly as pointed out by Michael Glass it isn't necessarily always. I'm sure a lout with a beer bottle is far more likely to succeed in removing a part of the body than in performing a triple heart bipass. I support saying "circumcision is a procedure which removes..."; this does not contradict that many sources call it a surgical procedure, which can be pointed out later in the article but may be too wordy for the first sentence. --Coppertwig 16:13, 17 July 2007 (UTC)

Perhaps you haven't read WP:V recently; The threshold for inclusion in Wikipedia is verifiability, not truth. There's a reason it's the first sentence in the policy. In this case, it's not only verifiable, but also true, your incredibly Western-centric view of what constitutes surgery notwithstanding. Jayjg ^(talk) 17:17, 17 July 2007 (UTC)

Using this standard female circumcision is also a surgical procedure. DanBlackham 19:40, 17 July 2007 (UTC)

Do you have acceptable sources backing that? -- Avi 19:45, 17 July 2007 (UTC)

How about Harvard epidemiologist Carla Makhlouf Obermeyer's (1999) article in Medical Anthropology Quarterly 13(1):79-106 titled "Female Genital Surgeries: The Known, The Unknown, and the Unknowable." She includes a reasonable discussion of different terminology for the procedures variously termed "female circumcision" "female genital mutilation" and so on before settling on the usage "traditional female genital surgeries". We might take a lesson from her measured and scientific approach. Sorry I don't have a fancy wikilink to the article. For the record, I'm comfortable with the word "surgery" in our article but thought "procedure" might be more conciliatory since there's apparently not concensus. Zandrous 21:14, 17 July 2007 (UTC)

Having been told that a drunken attack with a beer bottle is surgery and that "a surgical procedure that removes" is as simple as "cuts", we are now informed that a drunken attack with a beer bottle has to be classed as surgery because a peer reviewed article defines medical circumcision as surgery, and furthermore we have to accept this nonsense because Wikipedia is not about truth but about verifiability. All the time, the article continues to say, 'The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut")'. Michael Glass 03:23, 18 July 2007 (UTC)

It sounds like the disagreement is about the definition of surgery, rather than about the nature of circumcision. Perhaps female genital mutilation is surgery - certainly it involves the use of a blade to incise and remove tissue. --Badger151 05:20, 18 July 2007 (UTC)

Yes, perhaps it is. Correct me if I'm wrong, but I understand that rather than being the Wikipedia Committee for Identification of Surgery we are trying to agree on the text in this article. The important issue is whether there is any serious disagreement in reliable sources over whether circumcision is surgery. Let's not get side-tracked. Jakew 09:51, 18 July 2007 (UTC)

Irrespective of whether there is disagreement in reliable sources or not, we are not obligated to include the word 'surgery' are we? I'm not fond of the latest edit ("circumcision involves cutting some or all of the foreskin") because it describes ("involves") circumcision rather than defines ("is") it and (to me) reads inelegantly. If we no longer have consensus on using the word 'surgery', I'll suggest again "circumcision is a procedure that removes some or all of the foreskin". I don't see the necessity of including either the word "cutting" or the word "surgery" in the definition, (although I'm not opposed to the latter). Zandrous 11:29, 18 July 2007 (UTC)

The questions about the wording as I see it are as follows:

Should the beginning of the article be expressed in plain English? If so, we should prefer "cuts" to "a surgical procedure that removes."
Is it accurate to say that all circumcision is surgery? I say that though most circumcisions can be classed as surgery, there are some examples where this is either misleading or quite inaccurate, such as the case where a man was assaulted with a broken beer bottle. Either you have to concede that this is not surgery, or you accept an attack by a drunken lout with a broken beer bottle as surgery!
Even if you accept a drunken assault with a broken beer bottle as surgery, you still have to demonstrate that a long-winded phrase is to be preferred to one word in plain and simple English.

I say, go with one plain English word instead of the verbose and less accurate alternative. Michael Glass 12:40, 18 July 2007 (UTC)

Circumcision is surgery, as all reliable sources attest. Oddly enough, it is usually the anti-circumcisionists that insist that circumcision is surgery, and pro-circumcision groups that insist it is not. According to the anti-circumcision activist Paul M. Fleiss, "Some, like rigidly Orthodox Jews, may deny that circumcision is surgery at all." Paul M. Fleiss, Frederick Mansfield Hodges, What Your Doctor May Not Tell You About(TM) Circumcision, p. 117. It seems that the anti-circumcision activists here have misunderstood the position of their movement. Anti-circumcisionists insist circumcision is a surgical procedure, and a dangerous one at that, so that they can then outlaw it. If it is not even a surgical procedure then there is less chance of getting it legislated out of existence. I think you need to consult your movement heads for proper strategy before pursuing this further. Jayjg ^(talk) 23:05, 18 July 2007 (UTC)

This appeal to authority is a logical fallacy. Not all swans are white, and not all circumcisions are surgery, as can be shown from these sources: [22] [23]. If you insist that all circumcisions are surgery then you have to class a drunken attack with a broken beer bottle as surgery. If that is what you want to do, go right ahead. I would have thought that someone who is pro-circumcision would want to distance himself from obvious abuses, but if you don't, that is your business. Michael Glass 23:40, 18 July 2007 (UTC)

Actually, you are committing a logical fallacy regarding the meaning of the word surgery; you keep mistakenly thinking that the specific tools used are critical to whether or not the word applies. When one performs a tracheotomy with a penkife and a ballpoint pen (as has been done), it's still "surgery". When prehistoric peoples performed trepanation with stone flakes and awls, that was also surgery. Finally, I have no idea what "someone who is pro-circumcision would want", but I prefer plain, meaningful English backed up by reliable sources. Jayjg ^(talk) 00:01, 19 July 2007 (UTC)

Also, regarding female genital cutting, Britannica's article on the subject describes it as a "ritual surgical procedure that has traditionally been performed etc." Jayjg ^(talk) 00:05, 19 July 2007 (UTC)

So, is torture also surgery in your view? Where do you draw the line? Michael Glass 00:11, 19 July 2007 (UTC)

Please stop personalizing this; your issue is with the Encyclopaedia Britannica and other reliable sources, not me. Jayjg ^(talk) 00:27, 19 July 2007 (UTC)

I'm trying to understand why Michael thinks that "appeal to authority" is a bad argument to be using in a tertiary sourced encyclopedia, and failing. Nandesuka 02:02, 19 July 2007 (UTC)

The reason is that while most circumcisions can be classed as surgery, there are some instances where this is at least questionable. I have supplied two examples [24] [25]. For other examples, read this: [26] Now, about the Encyclopaedia Britannica definition of circumcision as a "ritual surgical procedure". Most medical circumcisions are not ritual procedures. I question whether it is appropriate to label forced circumcisions as surgery, If a torturer pulled out your teeth, your fingernails or your testicles, would you class it as surgery? Would it make any difference if he or she happened to be a doctor? That's why I asked you where you drew the line. I would be interested in your reply to that question. Michael Glass 02:45, 19 July 2007 (UTC)

My point is that whether or not you think it's surgery is utterly unimportant. What's important is what reliable sources call it. Jayjg has cited a number of respected and persuasive sources. The opinion of Michael Glass that those sources must be mistaken is not terribly relevant. Nandesuka 03:37, 19 July 2007 (UTC)

I have no personal opinions on the matter, Michael. Jayjg ^(talk) 03:45, 19 July 2007 (UTC)

Look at the definition of "surgery." "operation or procedure, especially one involving the removal or replacement" "Middle English surgerie, from Old French, short for cirurgerie, from cirurgie, from Latin chīrūrgia, from Greek kheirourgiā, from kheirourgos, working by hand : kheir, hand; see ghes- in Indo-European roots + ergon, work; see werg- in Indo-European roots"...circumcision meets these definitions ... even if it's performed with a bottle cap.TipPt 23:31, 19 July 2007 (UTC)

From The New Oxford English Dictionary: Circumcision: "The act or rite of circumcising a person...". Circumcise: "Cut off the foreskin ..." --Coppertwig 22:33, 21 July 2007 (UTC)

Sexual Effects (continued)

I'm adding this paragraph to balance the Topic:

Boyle et al. (2002) argued that "structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation." For example, "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 loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response" may reduce a "circumcised man’s ability to achieve arousal." …"Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback" erectile dysfunction and premature ejaculation may be a complication of male circumcision, potentially making "intercourse is less satisfying for both partners when the man is circumcised."^[9] Taves (2002) argued that the foreskin may have an intromission function, facilitating penetration,[27], and Bensley et al. (2003) argued that circumcision may decrease vaginal wetness and orgasm in female partners.[28]TipPt 17:15, 20 July 2007 (UTC)

Too long, giving undue weight. A short summary is preferable. Jakew 10:22, 20 July 2007 (UTC)

It's shorter than the Assoc statement that's pro-circ ... the focus on the glans (not what's removed!) and using OLD Masters. The Bensley study isn't that strong ... how about if I remove that?TipPt 17:17, 20 July 2007 (UTC)

That would be a good start. Incidentally, it should be shorter - significantly so - than the coverage of the medical associations' policies. To quote from WP:UNDUE: "NPOV says that the article should fairly represent all significant viewpoints that have been published by a reliable source, and should do so in proportion to the prominence of each. Now an important qualification: Articles that compare views should not give minority views as much or as detailed a description as more popular views, and may not include tiny-minority views at all." (emph added). Jakew 21:16, 20 July 2007 (UTC)

Could you perhaps demonstrate that the specific quotes from the AAP and AAFP represent a majority view, and that the material from Boyle represents a minority view? Blackworm 12:20, 21 July 2007 (UTC)

The assumption that medical organisations' statements represent a majority view is implicitly made in many places in the article, and we would have an even more difficult task if we did not make it. It is not an unreasonable assumption, given that the statements of these organisations represent a consensus (of sorts) among representatives of those organisations. Jakew 13:40, 21 July 2007 (UTC)

Your explanation as to why it is not an unreasonable assumption is invalid. To say that an organization's statement represents a majority of the organization is a truism. What is at issue is whether these organizations speak for all people, i.e. represent "the majority view." One can label circumcision a "surgical procedure" in one's head, which would allow that person to morally make the leap to giving undue weight to the medical consensus (or rather, compromise) -- but to say that the two American medical associations represent a worldwide "majority view" is sheer nonsense. Blackworm 10:01, 22 July 2007 (UTC)

Since we are limited to reporting on views expressed (directly or indirectly) in reliable sources (academic journals, etc), the context must obviously be persons whose views are expressed directly or on their behalf in those reliable sources. Jakew 10:23, 22 July 2007 (UTC)

Unindent..

Your choice of the AAP and AAFP, as opposed to the RACP, CPS, or BMA is pro-circ bias. Your assumption that junior (fewer members, limited scope, generally circumcisers, smaller research budgets ... under the AMA or BMA) assiociations represents "concensus" is pro-circ bias. Your choice of doctors over scientists is pro-circ bias. You know the AAP and AAFP "concensus" was simply a compromise among strongly opossing views. Hardly a "majority."TipPt 22:18, 21 July 2007 (UTC)

When we started making the Sexual Effects section neutral you simply asked that it be no longer (# paragraphs and paragraph length) the same.

I'll also take out the second sentence...

Boyle et al. (2002) argued that "structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged" or removed "frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation." ..."The loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response" may reduce a "circumcised man’s ability to achieve arousal." …"Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback" erectile dysfunction and premature ejaculation may be a complication of male circumcision, potentially making "intercourse is less satisfying for both partners when the man is circumcised."^[10] Taves (2002) argued that the foreskin may have an intromission function, facilitating penetration,[29].TipPt 15:33, 21 July 2007 (UTC)

Tip, your repeated and barely comprehensible accusations are becoming extremely tedious. Furthermore, if you bother to check, you'll find that the RACP, CPS, and BMA do not discuss sexual effects, making quoting them a challenge to say the least. In contrast, the AAP and AAFP do comment.

As I have already pointed out, the sentence quoted from the AUA is their recommendation and it does not refer to risks. Clearly you haven't bothered to read that either. If and when you are prepared to actually read sources prior to discussing them, do let me know. Jakew 16:30, 21 July 2007 (UTC)

Please ignore my comments on Policy. The discussion is about the sexual effects sub.

Will you permit the above paragraph into Sexual Effects?TipPt 21:50, 21 July 2007 (UTC)

Honest non-Cabal Version

Please see http://en.wikipedia.org/wiki/User:TipPt/Circumcision

Note especially Sexual Effects, Procedures, and Policies.TipPt 15:50, 21 July 2007 (UTC)

IMHO, it's better than current version, but I doubt that it will be used. Nice work though. :-) --antiXt 20:49, 26 July 2007 (UTC)

What the CPS says about sexual effects...

... "a recent report has described numerous oval, rounded or elongated nerve corpuscles in the inner mucosal surface of the prepuce.31 These are similar to nerve endings seen, although less frequently, in the glans and the frenulum. Their function is unknown. The author of the report speculated that this specialized sensory tissue may perform different functions at different times of life and may be involved in sexual responses in adults. The presence of these nerve endings also emphasizes the need for pain control when circumcision is performed."[30] —The preceding unsigned comment was added by TipPt (talk • contribs).

Ok, the CPS states that the function of certain receptors in the prepuce is unknown, and remarks that another author has speculated that they may be involved in a sexual response. Jakew 11:07, 22 July 2007 (UTC)

The CPS and HIH texts are honest, and should be included in the Sexual Effects section, along with research.

You haven't reviewed and responded to the reduced Boyle et al and Taves text above.

The Bensley et al should be back in ... it's peer reviewed research dealing with the foreskin.

The AAP statement is dubious, dealing mostly with the glans (though it's the foreskin removed) and citing old (peer reviewed refuted) Masters.TipPt 17:13, 22 July 2007 (UTC)

I've no reason to doubt that the CPS statement, etc, is honest, but commenting on the speculation of a third party is of limited value. If there is consensus to include it then so be it, but I can't see how it would improve the article. As for the NIH article commenting on the beliefs of some, we could quote it, but it would add nothing since such the Boyle et al quote is evidence of the existence of such beliefs.

As for the AAP statement, I can only suggest that you write a letter to the AAP that expresses your objections. Jakew 18:10, 22 July 2007 (UTC)

Unindent... The AAP statement draws on unrelated (glans not prepuce) old refuted research.

The CPS draws on related research finding specialilzed nerve endings of known sensitivity.

Don't knock the CPS and NIH for honest cites.TipPt 15:38, 23 July 2007 (UTC)

Sexual Effects from Nat'l Library of Medicine (NIH)

The merits of circumcision are currently under debate, and opinions about the need for circumcision in healthy boys vary among physicians. Some place great value on the benefits of an intact foreskin, including a more natural sexual response during adulthood. Rather than routinely recommending circumcision for healthy boys, many physicians allow the parents to make the decision after presenting them with the pros and cons.[31]

Look again at the statement ... merits of circ under debated ... ie is there cost/benefit reason?

The statement goes on to say "some place great value on the benefits of an intact foreskin" (not opinion, just relative valuation). You have above unrefuted medical opinion.

The AAP statement represents a heated compromise among conflicting views. The reader should have access to all.TipPt 16:06, 23 July 2007 (UTC)

Perhaps you could look for statements regarding facts or evidence, rather than what other parties might believe? Jakew 11:10, 22 July 2007 (UTC)

"Other parties" with greater credibility than the CPS and NIH? The fact that they include those statements makes it credible and valuable to the reader.TipPt 15:48, 23 July 2007 (UTC)

Factual accuracy tag

I've added the

tag to Circumcision because it misrepresents and/or omits (by reversion by the Cabal) facts (frenectomy, Jewish history, Procedures, Sexual Effects, Policies, Pain and pain relief. I hope to avoid arbitration.TipPt 17:27, 22 July 2007 (UTC)

Frankly, I think this tag is totally over the top. I do have some issues with some of the wording, but it is not as bad as these labels suggest.Michael Glass 01:59, 26 July 2007 (UTC)

^ Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ Brady-Fryer, B (2004). "Pain relief for neonatal circumcision". The Cochrane Database of Systematic Reviews (3): Art. No.: CD004217. doi:10.1002/14651858.CD004217.pub2. PMID 15495086. Retrieved 2006-06-29. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
^ Razmus I, Dalton M, Wilson D. "Pain management for newborn circumcision". Pediatr Nurs. 30 (5): 414–7, 427. PMID 15587537.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Ng, WT (2001). "The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia". Ambul Surg. 9 (1): 9–12. PMID 11179706. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ Glass, J.M. (1999). "Religious circumcision: a Jewish view" (PDF). BJU International. 83 (Supplement 1): 17–21. doi:doi:10.1046/j.1464-410x.1999.0830s1017.x. PMID 10766529. Retrieved 2006-10-18. {{cite journal}}: Check |doi= value (help); Unknown parameter |month= ignored (help)
^ Shulchan Aruch, Yoreh De'ah, 263:4
^ Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[1] Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[2] Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[3] Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[4] Brady-Fryer, B (2004). "Pain relief for neonatal circumcision". The Cochrane Database of Systematic Reviews (3): Art. No.: CD004217. doi:10.1002/14651858.CD004217.pub2. PMID 15495086. Retrieved 2006-06-29. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)

[5] Razmus I, Dalton M, Wilson D. "Pain management for newborn circumcision". Pediatr Nurs. 30 (5): 414–7, 427. PMID 15587537.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[6] Ng, WT (2001). "The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia". Ambul Surg. 9 (1): 9–12. PMID 11179706. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[7] Glass, J.M. (1999). "Religious circumcision: a Jewish view" (PDF). BJU International. 83 (Supplement 1): 17–21. doi:doi:10.1046/j.1464-410x.1999.0830s1017.x. PMID 10766529. Retrieved 2006-10-18. {{cite journal}}: Check |doi= value (help); Unknown parameter |month= ignored (help)

[8] Shulchan Aruch, Yoreh De'ah, 263:4

[9] Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[10] Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

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