Talk:Circumcision/Archive 46

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Time Out

Let us talk about the issues and not each other. Casting dispersions is not going to get us anywhere. Garycompugeek (talk) 22:57, 5 September 2008 (UTC)

Good point, Gary. To paraphrase HAL 9000, I honestly think we ought to sit down calmly, take a stress pill, read this essay, and think things over. AlphaEta 23:06, 5 September 2008 (UTC)

I like that idea. --MPerel 23:17, 5 September 2008 (UTC)

Undue reliance on single source in "Sexual effects"

Beejaypii mercifully removed a horribly sourced bit of info from the "Sexual effects" section (how did we miss this for so long?), but I object to the recent expansion of the info from the 2002 Boyle et al. paper. The amount of speculative material from the paper presented in this Wikipedia article is now disproportionate with its prominence. Why should the opinions presented in this single paper be given so much space in comparison with the Sorrells et al., Payne et al. and Krieger et al. results? AlphaEta 23:36, 6 September 2008 (UTC)

I don't know how that was missed - people just add stuff without thinking how it fits in. I can see where beejay is coming from though. It does seem like the sexual effects section is pro-circ. For instance I don't think you can call what masters and johnson did a proper "study" - it is basically 2 pages in a book. It is also 40 years old, wasn't peer-reviewed and I seem to recall an article that said it contacted masters or johnson and they didn't even remember doing the "study"! Articles like the sorrells are much more scientific, not to mention recent and of course peer-reviewed. So I think we should judge which are the most reliable studies and then work from there in choosing which to present on the main circ page and which to leave to the "sexual effects" page. Tremello22 (talk) 23:56, 6 September 2008 (UTC)

I agree. Of course, whether or not the 2002 Boyle et al. paper is a "study" is also debatable. It doesn't appear to present any new data, so I would be more inclined to call it a "review" or an "analysis". AlphaEta 00:03, 7 September 2008 (UTC)

Ok, then we must make that clear. Tremello22 (talk) 00:13, 7 September 2008 (UTC)

I mildly disagree with both of you on the Schoen paragraph. Edgar Schoen is ubiquitous in scientific literature on circumcision, and apparently has strong views in favour of the procedure[1], and his study there is notable (and fascinating). I suppose I could probably find a different source discussing the subject of women's preferences relating to male circumcision. I believe that in some cultures men can't marry unless they undergo circumcision, and I wonder how much women's sexual preference has a role in that. Blackworm (talk) 01:38, 7 September 2008 (UTC)

Also, you may wish to note that actress Jenny McCarthy wrote a book in which she said: “If you don’t know what an uncircumcised penis looks like, you will once you baby boy is born. When I saw my son’s for the first time, I thought it looked kind of like a wrinkled french fry. I had the hardest time knowing that I would have to be the one to tell the doc, “Go ahead.” How could I do anything to cause him pain? But I did, and my main reason was that I wanted him to have a pretty penis.”

It's amazing, because it sounds exactly like the reasoning used by parents who circumcise daughters in Africa. I wish we could refer to sources that comment on this parallel, but I won't bother looking for them, since there's no article in Wikipedia where it would be allowed (since this circumcision article apparently can't discuss female circumcision). Blackworm (talk) 07:29, 7 September 2008 (UTC)

Schoen reads like a pro-circ because he is pro-circ, has been a pro-circ activist for decades and advocate for non-anaesthetised infant male circumcision. He shouldn't even be cited. His article isn't a peer-reviewed paper and most of the time he is citing himself from other papers that mostly aren't peer-reviewed either . Also keep in mind that was for a Canadian audience, but it is heavily reliant on studies into male circumcision for HIV prevention in Sub-Saharan Africa. He conveniently ignores all the studies that without fail show that widespread circumcision variously would have a neutral to mildly worsening effect on HIV transmission rates in more temperate climates. The only solid fact is the penile cancer thing .. and he would circumcise every male at birth for the less than one in ten million chance that they will get penile cancer? Says it all really. The fact that something is published in a medical journal doesn't make it true, reliable and peer reviewed, or even believable (for how many years was Jake's bizarre letter to the Lancet used as a citation on here?). Medical journals will often publish stuff like this to spark debate: Volume 22, Number 18 of The New England Medical Journal did it with Poland v Schoen on the question of neonatal circumcision – one for and one against – each with their own unreviewed article. If you use Schoen, then you may as well cite directly from circumcicion.org too. That's my view. Finn (talk) 11:59, 7 September 2008 (UTC)

Many of these same arguments could be used to exclude the 2002 Boyle et al. review (from the opposite perspective), but as long as the viewpoints are represented in proportion to their prominence, and supported with verifiable citations, I see no reason why either author should be left out completely. AlphaEta 18:08, 7 September 2008 (UTC)

That is a very fair point, Alpha. Personally I don't think Boyle has a place here either though. I'd get rid of both; because neither are what I call genuine research: they both set out knowing what they want to find, they both have a vested interest that gives them selective vision and they both cheerfully ignore evidence that contradicts them. Keeping both is just as valid as getting rid of both though. Finn (talk) 18:33, 7 September 2008 (UTC)

‘Shocking’ rates of adverse events seen with traditional and medical circumcision in Kenya

This one has the potential to be a bit controversial; so, before adding it to the article, I am putting it out here for discussion.

It is a WHO report about what it describes as “shocking” rates of adverse events seen with both traditional and medical circumcision in Kenya (35% in traditional and 18% in medically performed circumcisions).

The authors, who include Robert Bailey, the principal investigator on the one of the three randomised controlled studies of circumcision as an HIV prevention method, say:

“Our results…should serve as an alarm to ministries of health and the international health community that focus cannot only be on areas where circumcision is low…it must address the safety of circumcision in areas where it is already widely practised."

“If the practices in these communities continue to be largely ignored ... the gains to be achieved by promotion and provision of circumcision for HIV prevention may well be undermined by further accounts of unnecessary suffering.”

Finn (talk) 19:19, 6 September 2008 (UTC)

Here's the full citation if we choose to use this info: Bailey RC, Egesah O and Rosenberg S. (2008). Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Bulletin of the World Health Organisation 86(9):669-677. AlphaEta 18:57, 6 September 2008 (UTC)

(This is related to the conversation Blackworm and I had last week, so I'll copying it from archive 45):

Complications from traditional circumcision

I pulled the following sentence from the "complications" section:

A 1999 study of 48 boys seen between January 1981 and December 1995 found that haemorrhage occured in 52% of boys, infection in 21% and one child had his penis amputated.reference

Rationale: The study examines boys who had undergone "traditional" circumcision (presumably in Africa). However, "traditional" circumcision is not defined in the abstract or the Wikipedia article. It is also unclear if the 48 boys examined in the study were selected because they were experiencing complications, or if they were randomly selected from a pool of boys who had undergone traditional circumcision. This important distinction should be made if we include this study in the article.

I'm going to try to access the full article to clear up these details, but it may take a while since the IngentaConnect link on PubMed says "Page Not Found." If someone has library access to Annals of Tropical Paediatrics: International Child Health, please see if you can elucidate these issues. Thanks, AlphaEta 18:36, 31 August 2008 (UTC)

Thank you for checking facts, AlphaEta. By the way, that sentence was added in this edit on Aug. 18 by Tremello22. ☺ Coppertwig (talk) 01:07, 1 September 2008 (UTC)

I think for now, that AlphaEta's concerns would be addressed by writing, "A 1999 study of 48 boys who had complications from traditional male circumcision in Nigeria found that..." From the abstract, it seems clear to me that these boys were brought to the hospital because of their complications. I agree that it's misleading without noting this, and given this fact I'm not sure what the value of the information to this article is. Blackworm (talk) 20:25, 1 September 2008 (UTC)

Excellent suggestion. I've re-added it, for now. Do you feel the study is too specific for inclusion in the main article? We can always move it over to one of the sub-articles (I believe there are at least 20 to choose from). AlphaEta 21:13, 1 September 2008 (UTC)

I don't know, perhaps the best place to put it would be in the "circumcision procedures" section, in the same paragraph as In poor African countries, male circumcision is often performed by non-medical personnel under unsterile conditions. Then again, some may argue that this is synthesis, since we may be unduly implying without a source that there is a relation between the poorness and Africa-ness of the circumcisions and the kinds of complications encountered. What do you think? Blackworm (talk) 00:29, 2 September 2008 (UTC)

Yeah, I actually had the exact same idea. It's also associated with this little gem that I added earlier today. I suppose we could use all three refs to make a new paragraph about the potential problems of inexpertly performed/non-sterile/"traditional" circumcision. I know the status quo around here is to just throw quotes into the article (thinking is tough!), but I figure between the two of us (and anyone else who wants to join in), we may actually be able to make some new words. Thoughts on the new words idea? (If we don't overstate the relationship between these three stories, we can probably avoid most WP:SYN concerns.) AlphaEta 01:19, 2 September 2008 (UTC)

Thanks, AlphaEta, I hadn't noticed that one before. Ditto the citation - but the link I provided actually links to the full text of the report and I'm a step ahead on that:

<ref name = "WHO08Sept">{{cite journal | last = Bailey | first = Robert C | coauthors = Omar Egesah, Stephanie Rosenberg | year = 2008 | month = Sept | title = Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya | journal = Bulletin of the World Health Organization | volume = 86 | issue = 9 | pages = 657-736] | url = http://www.who.int/bulletin/volumes/86/9/08-051482/en/index.html | format = Full | accessdate = 2008-09-06 }}</ref> ;)

The main issue as I see it is how to work it in without sensationalising it; but still keeping it in the context of

• a study that is a direct reaction to the WHO circumcision initiative
• Kenyan government to roll out circumcision
• written by the author of the studies that triggered the WHO initiative
• has serious concerns about medically performed procedures too

At least with having the full text and diagrams on this one, there is no ambiguity and the limitations are clearly stated. Finn (talk) 19:19, 6 September 2008 (UTC)

And maybe balance it with this one:

Mattson CL et al. Risk compensation is not associated with male circumcision in Kisumu, Kenya: a multi-faceted assessment of men enrolled in a randomized controlled trial. PloS One, 3(6): e2443 doi:10.1371/journal.pone.0002443

It is a substudy of the original halted Kisumu randomised controlled circumcision trial, and basically concludes that (with the obvious exception of HIV) there were virtually no differences in risk behaviour, or in STI infections, between circumcised and uncircumcised men.

In light of the fact that rather a lot of public health advocates and political leaders have been reluctant to endorse circumcision for fears that its benefits will be negated by increased risk behaviour by men who perceive that their risk of HIV has been reduced (myself included, because I feared it would put women at greater risk from pressure to engage in unprotected sex), I do think that this is important citation to add for the sake for balance. Finn (talk) 19:36, 6 September 2008 (UTC)

It looks like Mattson et al. have second paper coming out on the issue of risk compensation and circumcision:

Mattson C.L. et al. "Scaling Sexual Behavior or "Sexual Risk Propensity" Among Men at Risk for HIV in Kisumu, Kenya". AIDS Behav. 2008 Jul 24. [Epub ahead of print]. doi:10.1007/s10461-008-9423-z. PMID:18651213

I agree that these should be included. AlphaEta 20:48, 6 September 2008 (UTC)

Is this a fair summary?: A 2008 WHO study of 1007 young men and boys amongst a traditionally-circumcised ethnic group in Kenya, published shortly after the Kenyan government announced plans to fast track an ambitious national rollout of male circumcision, observed what its authors described as “shocking” rates of adverse events (35% in traditional circumcision and 18% in medical circumcisions). 6% of operations resulted in permanent and irreversible damage (torsion of the penis, injuries to the glans, loss of penile sensitivity caused by scarring and erectile dysfunction) and, but for the intervention of the researchers, one traditional procedure would almost certainly have resulted in death. In stark contrast to recent HIV-preventative circumcision trials, which found that 96% of wounds had fully healed within 30 days, not a single wound had properly healed by this time in the WHO study. One in three traditional procedures, and one in six medical procedures, required re-circumcision. Infections, ranging from mild swelling and redness to life-threatening necrosis occurred in 42% of the medical procedures and 50% of traditional procedures. Antibiotic powders, where used, were of questionable benefit and tended to delay healing and result in thick scarring. Finn (talk) 21:01, 6 September 2008 (UTC)

This looks like a fair representation of the results. Two questions: 1) Should we define "traditional" circumcision? and 2) Does this belong in the "Procedures" section or the "Complications" section? On the one hand, the procedures section is severly deficient in info on traditional circumcision techniques, but do you think we will run into problems by presenting the Kenyan study as the norm? It's a tough call. AlphaEta 22:13, 6 September 2008 (UTC)

One way of getting around this problem would be to start a paragraph like this:

Traditional circumcisions are known to incur more complications. This is because... bla bla bla... the techniques used are ... bla bla bla... A 2008 WHO study of 1007 young men and boys amongst a traditionally-circumcised ethnic group in Kenya...A 1999 study of 48 boys seen between January 1981 and December 1995.... So just keep it all in one paragraph. Tremello22 (talk) 23:33, 6 September 2008 (UTC)

I think that's an excellent idea. AlphaEta 23:42, 6 September 2008 (UTC)

Yes, I think we should define traditional. In fact, I think we should go further than that and draw the clear distinction between cost pressured medical and well-resourced medical (the observational study in Kenya has both and the results are markedly different) so in final presentation I need to build the above summary into a framework that says: there is compelling evidence supporting male circumcision, but there is also compelling evidence to say that it has to be done right if it is to be effective.

The honest truth is that this would sit far more comfortably in an article about HIV-preventive circumcision. Rip half the crap out of this article to make it a nice and objective, relatively stable, article about circumcision; with a couple of factual but contentious sections about the ethics ... and have all the fast changing obfuscating crap together, in a separate article, where it could be dealt with properly and in its proper context, rather than used for devise purposes to forward one argument over the other (as it is here at the moment). Life would be so much easier then .. and yes, that is one of the other reasons I would like to see circumcision go to more of a disambiguation page :)Finn (talk) 09:12, 7 September 2008 (UTC)

I think this is a good idea. We spend 90+% of our time debating a few points while most of the article goes neglected. A good example of this is the lede. We've produced thousands of words debating whether or not the AMA quote and WHO info should be there. I say pull both of them out of the lede, and move all but the most pertinent info out to sub-articles. AlphaEta 18:08, 7 September 2008 (UTC)

I disagree. We spend pages discussing medical benefits and harms, and opinions from the medical arena. We go on at length about circumcision and HIV, reflecting the huge amount of published research searching for or stating the existence of a link. The reader is better served by knowing what this article is about from the WP:LEAD. If it's to be trimmed, suggest trimming the "crap" first, not the lead which currently properly introduces the "crap." Blackworm (talk) 22:08, 7 September 2008 (UTC)

And I don't even understand how any of this is "fast changing" (other than perhaps the WHO's official definitions of female genital mutilation, which it says is incorrectly known as female circumcision). Why can't we deal with it now, if there's issues? Blackworm (talk) 22:12, 7 September 2008 (UTC)

That is the whole point though: we aren't reflecting the HIV circumcision research and we certainly aren't reflecting the totally different ethics debates that are going on about it. Selective bits are being cherry picked and artificially applied to arguments on which they actually have no bearing what-so-ever. There isn't a single piece of HIV research in this article that has any relevance outside of Africa and Asia - if we were reflecting HIV research, that would be glaringly obvious. By doing that, we are actually relegating the credibility of this article to that of just another one of the many pro and anti circ sites (from which half the citations are copied in the first place). A WHO report on the damaging effects of poorly resourced circumcision in Kenya is massive (it highlights the differences between the real world and tightly controlled well resourced trial environments); but it is wholly irrelevant to how most cultural / religious circumcision is performed outside of Africa. Finn (talk) 07:32, 8 September 2008 (UTC)

Paring back the WHO info

Proposed re-write of the HIV section (refs in italics):

While more than 40 epidemiological studies have suggested that circumcision provides a protective effect for men against HIV infection,(Szabo & Short, 2000) early meta-analyses of observational and epidemiological data differed as to whether there was sufficient evidence for an intervention effect of circumcision against HIV.(Weiss, et al., 2000)(Siegfried, et al. Cochrane review) However, randomized controlled trials conducted in South Africa,(Auvert, et al., 2005) Kenya(Bailey, et al., 2007) and Uganda(Gray, et al., 2007) found that male circumcision reduced vaginal-to-penile transmission of HIV by 60 percent, 53 percent, and 51 percent, respectively. All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the intact group.(Bailey, et al., 2007) A meta-analysis of the African randomised controlled trials and other observational studies confirmed that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit. According to this particular meta-analysis, 72 circumcisions would need to be performed to prevent 1 HIV infection.(Mills et al., 2008)

As a result these findings, WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an efficacious intervention for HIV prevention when done by well trained medical professionals and under conditions of informed consent.("New Data on Male Circumcision and HIV Prevention... WHO)("WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention... WHO)("Male circumcision: Global trends and determinants of prevalence... WHO/UNAIDS) Both the WHO and CDC indicate that it may not reduce HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner.("New Data on Male Circumcision ... WHO)("Male Circumcision and Risk for HIV Transmission and Other Health Conditions... CDC) The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should never replace known methods of HIV prevention.("WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention... WHO)

Other reports have indicated that circumcision has little to no effect on HIV transmission.(Carael, et al., 1988)(Grosskurth, et al., 1995)(Barongo, et al., 1992) Furthermore, some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.(Mills & Siegfried, 2006)(Dowsett, et al., 2007)

Thoughts? Criticisms? Grievances? Accusations of pro- or anti-circumcision bias (/sarcasm)? Overt or subtle insults? AlphaEta 00:44, 7 September 2008 (UTC)

If you keep the introduction that I added then yes I think that is a big improvement. Nice work. Tremello22 (talk) 02:14, 7 September 2008 (UTC)

I like it; but going forward and working and looking towards overall improvements to the article, the problems I see on it are that the WHO/UNIADS statement was very specifically about:

1. young adults and adolescents
2. countries with high prevalence and generalized heterosexual HIV epidemics that currently have low rates of male circumcision - in other words, it was targeted very much at sub-Saharan Africa where a combination of resources and climate make wetness (genital hygiene) a general problem

If we can work that in, then we also:

1. explain why WHO / UNAIDS justifiably ignored the evidence that circumcision would have no impact in countries / regions where other factors prevail
2. explain why it isn't a worldwide recommendation
3. make it clear that it is a very different set of ethical arguments to those in the infant circumcision debate Finn (talk) 08:31, 7 September 2008 (UTC)

It sounds well-written and well-organized: it flows much more smoothly than the current version. Thank you, AlphaEta! ☺ The only piece of information I notice that you've added or removed is that you've removed the mention of keratin as a hypothesis as to the reason for circumcision's preventive effect. I oppose the removal of this information, as I think it adds significant meaning to what is otherwise just statistics as numbers without explanation. I've changed the keratin sentence as I had suggested at the bottom of the thread Talk:Circumcision/Archive 42#HIV. I suggest that this modified sentence be retained; I suggest adding it as the last sentence of the first paragraph of your draft. Coppertwig (talk) 12:36, 7 September 2008 (UTC)

Except that Szabo's keratinised glans theory is hotly disputed; so if we keep that section, then it needs to be rewritten to make it reflect that and cite the opposing views (as acknowledged in Szabo's very own paper). The test for me is whether reference to it actually helps understading. I would suggest it doesn't, so my vote says we just get rid of it. Finn (talk) 15:46, 7 September 2008 (UTC)

In fact, do I read that right and is Szabo & Short being used as a direct replacement for the McCoombe paper? If so, that would be a mistake; because one speculates about keratinised glans and the other speculates about poorly keratinised glans - which just goes to show that whatever process is going on just isn't understood at all - something happens on the penis, but we don't actually know exactly what it is - and that we would be better off without it, before we sink in a sea of conflicting citations. Finn (talk) 16:20, 7 September 2008 (UTC)

I agree with Finn. All of the mechanistic explanations are speculative at this point. This info would be more suitable in the "Medical aspects" sub-article, or in a new HIV/circ sub-article. AlphaEta 18:08, 7 September 2008 (UTC)

I thought both papers were saying something similar: that the inner surface of the foreskin lacks keratin. I don't have time to re-check at the moment. We could keep the statement, and add a brief statement like "though others dispute this" or whatever, for NPOV. Good to describe the controversy. We don't delete stuff just because there's controversy. Are there any other theories as to why circumcision might prevent HIV? ☺ Coppertwig (talk) 22:11, 7 September 2008 (UTC)

I don't have time to re-read the sources right now, but assuming I previously cited them correctly, one is saying the inner surface of the foreskin has only a thin keratin layer, the other is saying it has no keratin layer: that's essentially the same thing, it lacks the thick keratin layer of most normal skin including the glans, and thus is hypothesized as a viral entry point. ☺ Coppertwig (talk) 22:17, 7 September 2008 (UTC)

I recently read that removal of preputal Langerhans cells may play a more important role than keratinization. Give me a little while to dig up the source. Of course, these two concepts aren't mutually exclusive, but it seems like most of the explanations are guesswork at this point. AlphaEta 22:23, 7 September 2008 (UTC)

I agree with Coppertwig. We shouldn't relegate controversies to subarticles. What a refreshing change! Blackworm (talk) 23:39, 7 September 2008 (UTC)

Dealing with it in its proper context isn't relegation - it is giving it the attention it deserves and in a context in which it makes sense.Finn (talk) 07:38, 8 September 2008 (UTC)

Look, here is an example of the real importance of the Langerhans' cells debate: Observational studies in a clinic in South Africa shows a 50% tendency to moisture beneath the foreskin in uncircumcised men. Do the same study in a similar clinic in an ethically varied part of London and there is an overall 7% tendency to moisture beneath the foreskin (but look at the detail of the study and you see that it differs dramatically along ethnic and cultural lines and that the tendency is down to 3% amongst men of African descent). Moisture is important because, above a certain level, it creates an environment in which HIV can survive outside of the body (HIV dies instantly when exposed to the air, but not when it is trapped in a moist airtight ridge below the glans with loads of immune system cells to lock onto and do battle with). Model the theory at 7% and , from an HIV prevention point of view, it is a very slight advantage to being uncircumcised. Model the theory at 50% and, from an HIV prevention point of view, it is a distinct advantage to circumcised. The research is mentioned in the article; but not in the context of the Langerhans' cells debate and only (until I reworded it) to try to make a banal point about uncircumcised men being dirty because they don't wash as frequently as circumcised men. What the series of research papers said, as an aside from the main objective of understanding HIV transmission and the function of Langerhans' cells, was that the sample of circumcised men were slightly more likely to wash their penis more than once a day and that in temperate climates – and temperate climates only – washing your genitals more than once a day left you more vulnerable to diseases (because it leaves you short of the Langerhans' cells that will normally afford a degree of protection from diseases other than HIV, but which HIV can piggyback). In other words, the citation was used to make a point that the research wasn't even making and to draw original conclusions that was potentially totally contrary to that of the research. That is very far from being the only example tortured use of HIV citations in this article that both Schoen and Boyle would be proud of.Finn (talk) 08:41, 8 September 2008 (UTC)

Dialogue or vitriol?

The following comments are rather disappointing. If editors involved in this discussion can say the following, I believe it sheds light on their ability to discuss and compromise on this, if not any, issue. Contrast my original comment to Finn earlier this morning, after a note dropped on my page by IZAK with some of Finn's responses:

Collection of quotations

Hello, Finn. Work has been getting really busy this week, and I have not had the time for much more than "drive-by" vandalism reversions and the occasional correction this week, as you can see from my contribution history. I am trying to follow the discussion on the talk page, but I really don't have the time to comment at length. However, I feel that comments such as this one are really not helpful in continuing dialogue. You did let IZAK know that Englisc and precursor languages to English was a particular are of expertise of yours, and his response was not directed at you personally, but a counter-argument to yours. So when you respond to his argument as you did, it does seem to be inconsiderate and discourteous. Remember, that yours may not be the only point of view. Furthermore, making the claim that …circumcision served no other purpose than to impede masturbation and reduce the pleasure to be had from carnal acts. basically completely denies the deep, historic, and undeniable religious significance that circumcision has had for around 3,720 years (assuming the correctness of the Masoretic dating of the birth of Abraham), and certainly for well over 2,500 years (assuming archeological datings of the destruction of the first temple are accurate at ~500 BCE). So while to you, the aforementioned edit summary may have been completely innocent, it would be rather hurtful to a devout Jew or Muslim. This article has been, is, and likely will remain to be a continually contentious article due to the ancientness of the practice, and the deeply held emotional response it generates among those who both support and oppose the practice. As such, taking the extra step to craft all statements as well, and as least attacking, as possible is a necessity for discussion to continue. I know I have not been the perfect contributor either, and at times I post and then later regret the wording, but I have been around that article long enough to know that your last edits are not going to enhance dialogue. OK, enough preaching, feel free to delete this on sight, and I hope in the next few weeks I'll be able to get into the article some more, at least until Rosh HaShana, Yom Kippur, and Succos roll around . Thank you. — Avi, 10:06, 9 September 2008 (UTC) [to IZAK] Oh, do grow up you pathetic little man. As if I am going to be intimidated by some dimwitted trolling Yid playing the victim and trying to impose his perverted religious beliefs on us. And don't bother giving me that tired old crap about 'Yid' being offensive and anti-Semitic, when it is Yiddish slang and used on a daily basis by most of the Jews in London. As for perverted – yes, that is exactly what I mean. Anyone who uses a debate to promote his belief that it is fine to subject an infant, who isn't even able to give his consent, to one of the most painful surgical procedures imaginable; but not OK (and indeed worse) for a consenting adult to allow themselves to be tattooed and pierced, really does qualify as a pervert and no better than a paedophile. — Finn, 10:53, September 9, 2008 [to Eyeserene] Do I care about this block? Not at all .. it just proves to me what I have always thought: namely that the administration of Wikipedia is utterly inept and tribal. Some of us are actually trying to contribute something- others, like IZAK are nothing more than cheap dimwitted trolls trying to push thier perverted religious beliefs on others. Good luck to Wikipedia and all the fuckwits who sail in her. — Finn, 11:21, September 9, 2008 [to FisherQueen] As for the thicker than frozen pig-shit on a stick admins who actually seem to think that this is a genuine unblock request, rather than simply being a response where I have been denied any other opportunity to respond to fucktards like IZAK and his fellow member of the Yid pro-circ cabal, Avi, get a life you shrivled old prunes. As if I would really care that I have been blocked (and as if a block would actually stop me editing on Wikipedia). LOL — Finn, 12:07, September 9, 2008 [to Avi] Get a life, Avi. As if I would really worry what you of all people had to say. You and your chummy bunch of sicko chums have been abusing Wikipedia for years. You use passive-aggressive tactics to inflame and abuse. You habitually use veiled suggestions of anti-Semitism against anyone who dares to disgaree with you. You habitially abuse and misrepresent article policies in order to further religious beliefs and bias, whilst accusing others bias. Sorry, but if there is one person on Wikipedia I will NEVER respect and listen to, then YOU are it. — Finn, 13:07, September 9, 2008

When virulence and antipathy of such depth is exposed, in my opinion, it demonstrates a lack of either understanding, or acceptance, of wikipedia policy and guideline, it also makes it more difficult for those of us who are at least attempting issue- and content- related dialogue. I am hoping that Finn is an exception (as I hoped Nokilli, Dabljuh, and others are examples of the exception and not the rule) and that the rest of us can, over time, continue to discuss the issues. Thank you. -- Avi (talk) 16:54, 9 September 2008 (UTC)

Hmm, I feel uneasy that this was transposed to Talk:Circumcision, Avi. Judging by his contributions to this article, I'm not sure how Finn's off-page POV declarations are particularly pertinent here. Granted, the exchange with IZAK above became quite heated, but Finn's overall conversation on this talk page has been useful, and he hasn't done anything to disrupt or inject his POV into the circumcision article. AlphaEta 17:29, 9 September 2008 (UTC)

I think that statements such as "…one of the most painful surgical procedures imaginable;" "…cheap dimwitted trolls trying to push thier [sic] perverted religious beliefs on others," "…Yid pro-circ cabal," "habitially [sic] abuse and misrepresent article policies in order to further religious beliefs and bias, whilst accusing others bias," serve as a warning about the editor's comments. We all have a POV, AlphaEta, it is how we let that POV affect our editing that needs guarding. I agree that until today Finn's contributions had demonstrated value, but when those are placed in the context of the vitriol shown on his talk page, it really worries me as to whether Finn was truly interested in enhancing the encyclopedia or more interested in using wiki as a vehicle for disseminating his POV. Regardless, I understand your concern and I've put the actual quotes into a collapsed box for now. Is that a suitable compromise, AlphaEta? -- Avi (talk) 17:56, 9 September 2008 (UTC)

I think Avraham ("Avi")'s unwillingness to condemn IZAK for the mound of useless, POV original research and personal attacks on editors is more notable than anything else that has occured here. This is the second time Avi has looked the other way while accusations of antisemitism were used to silence opposition to the male circumcision advocacy that rears its head here. It's not acceptable, especially from an administrator. [This is just false. :) Sorry Avi. -BW] Blackworm (talk) 18:46, 9 September 2008 (UTC)

Perhaps I misunderstood the discussion of English vs. Englisc and the effects of the Anglo-Saxon and Norman influences on the language, but Finn did say "Being that this is my specialist (degree) subject and I am one of the few people who are actually able to read and speak Englisc (along with the old Frisian and Norse dialects which contributed to it), you are more than welcome to take me on about the reliability of those sources; but I don't fancy your chances" and IZAK responded with a long discussion of how various languages affected the English term of "circumcision". Where did IZAK accuse Finn of Anti-semitism? -- Avi (talk) 18:50, 9 September 2008 (UTC)

Sorry Avi, I've struck most of my the remark. The antisemitism talk was from Tomer, and directed at Pwnage8, but after reading Pwnage8's comments I don't think Tomer asid anything wrong. Sorry again, I should not be so careless. I'm still disappointed that you haven't commented on IZAK's posts, which I think are clearly long, OR diatribes. Blackworm (talk) 22:10, 9 September 2008 (UTC)

Can we take this to our user talk pages? I think we're doing more harm than good by hashing out these issues in this particular forum. Oh yeah, and everybody remember to sit down calmly, take your stress pills and think things over. AlphaEta 19:05, 9 September 2008 (UTC)

If anything, Finn's comments such as "…perverted religious beliefs…" may be construed as anti-semitic, or anti-religious at the very least. And as for the Jayjg issue from last year, Blackworm, I reiterate that I believe you misunderstood what he wrote, and our discussions on your talk page stand to that. -- Avi (talk) 19:07, 9 September 2008 (UTC)

Both sections under Time Out seem rather trollish to me. I would have removed them immediantely to stop what followed but didn't want to be seen as taking sides. It was my hope that Avi or another admin would do this. I agree that Finn's comments were a bit brutal but can see him getting caught up in the moment. Overall he has been contributing in NPOV way to this article. Garycompugeek (talk) 19:23, 9 September 2008 (UTC)

Cherchez la femme

Let me try and see if I can distill the arguments about the name above, being as direct as possible. Please feel free to add/subtract/correct/remove any mistakes or biases on my part. My own POV is known, and affects my disproportionate knowledge and experience with one side of the issue as opposed to the other.

Main arguments

Arguments in favor of moving the article to Male Circumcision are:

• The term circumcision is used to refer to cliterodectomies and other procedures performed on women, and wikipedia is supposed to remove ambiguity.

Arguments in favor of leaving the article named Circumcision are:

• The term is overwhelmingly used to refer to the procedure performed on men, and wikipedia is supposed to use the most common and recognizable name.

Confounding issues include

Religious beliefs about circumcision

• Will tend to view procedures on female as fundamentally different.
• Will tend to view the application of the term "circumcision" being applied to females as a recent conflation, possibly politically motivated.

Ethical beliefs about genital integrity

• Will tend to view procedures on female as fundamentally similar.
• Will tend to view the application of the term "circumcision" being applied to females as natural, and resistance as possibly politically motivated.

Relevant facts may include

Historicity of circumcision

• Most recorded history of circumcisions relate to males (Bible, Qur'an, etc.)
  • This may reflect the lack of African historical texts (yes female circumcision is not common in english speaking territories therefore english documentation is sparse)

Prevalence of female circumcision

• Female circumcision seems to be prevalent mostly in African and Middle east
• Wikipedia should not be used to further any religious, political, sociological, linguistic, or other agenda.
  • The name of the article should "prefer what the greatest number of English speakers would most easily recognize, with a reasonable minimum of ambiguity, while at the same time making linking to those articles easy and second nature."
    • Should we cover both genders in "Circumcision" and stub out to genders in greated detail?

(modified by Garycompugeek (talk) 21:18, 9 September 2008 (UTC))

I'm sure there are other facts and issues; perhaps if we throw everything on the table, we can get a better picture of what the proper wikipedia name should be, and at the very least, if the article goes into mediation, we'll have a dispassionate record of pros and cons. -- Avi (talk) 19:50, 9 September 2008 (UTC)

My framing of the debate would look quite different indeed. I'd prefer if editors read the debate instead of this summary, and frankly I'm disappointed that you could possibly summarize the position of those supporting this change in that way. It seems like you haven't listened to the comments of those supporting the change at all. You slip in language such as "overwhelmingly used" and "fundamentally" which are close, but not quite accurate and only tell the preferred side of the story. I've also noticed that one tactic of debate for those demanding the status quo has been to start new top-level sections with a preferred section title, for a debate that already has a top-level section. I oppose that. I do thank Avi for laying out his view of the state of this debate, which if one were to read today without reading any views from those opposing Avi, would likely readily support Avi's position. I'm willing to post my own framing of the debate, too. It's all these in my comments in the discussions. Blackworm (talk) 09:42, 10 September 2008 (UTC)

Well, Blackworm, I did preface my comments with a statement that I do have a POV. Secondly, perhaps you misunderstood the purpose of my post. It was not to paint a neutral picture of the argument, but to give the arguments of each side, as proposed by each side. The use of "overwhelming" was no slip, Blackworm, the contention of those who support the current article name is that the name is "overwhelmingly" used to refer to the procedure on men, notwithstanding the technical definition in some lexicons. That is part of the argument and to leave out the word "overwhelmingly" would be to misstate that position. Forgive me if I am wrong, but I have always understood your and Gary's argument to be that the name is ALSO used to refer to a procedure on women, not that the term was used predominantly for women, or even equivalently for women. Do you, Gary, Michael, etc. disagree with that? If so, then please say so; that is the purpose of this section, for us to lay out our arguments as best we can without any of the side-show soap operas that editors on both sides (myself unfortunately included) seem to get trapped in. By all means, frame the debate as you see it, Blackworm, and then we can continue the discussion. Thank you. -- Avi (talk) 15:48, 10 September 2008 (UTC)

As for the thread title, since we are discussing the term circumcision vis-a-vis women, I thought to add a soupçon of humor, since we all seem to be rather tense about the issue. -- Avi (talk) 15:50, 10 September 2008 (UTC)