Talk:Circumcision/Archive 75

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Archive 70

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Archive 73

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Viewpoints

I've been reading some of the recent discussions above and it seems that we have established, (a) that this is the top-level article on this subject, and so needs to summarise all WP:DUE viewpoints, (b) when writing from a medical viewpoint, we must observe WP:MEDRS etc. (c) In a worldwide context, there are many other respectable, scholarly viewpoints - historical, anthropological, sociological, ethical... I wonder if we have 'medicalised' the subject matter too much here in the past, with too much dependence on MEDRS. There are a great many peer reviewed and scholarly papers available that look at circumcision from the viewpoint of other academic disciplines, and these are no less worthy in their respective contexts. We can look at medical ethics, the social pressures on doctors, the way that social memes propagate through society, the history of the ways that ideas have become part of medical and social 'reality' and many other viewpoints, and not just in the United States. Here is just one example that I have been looking at: S K Hellsten (2004), Rationalising circumcision: from tradition to fashion, from public health to individual freedom—critical notes on cultural persistence of the practice of genital mutilation J Med Ethics 2004;30:248-253 doi:10.1136/jme.2004.008888 --Nigelj (talk) 23:34, 28 December 2012 (UTC)

That is a very reasonable Talk page comment and I cannot find anything to disagree with, although I have no opinion on the suitability of the proposed paper from J Med Ethics under WP sourcing guidelines. However, the questions asked by another editor 2 days ago deserve a response, too.--82.113.99.8 (talk) 22:26, 29 December 2012 (UTC)

Hi Nigel, this has already been brought up here on this Talk page. Overwhelmingly, reliable sources discuss the medical aspects more than anything else, and so the balance of the content in this article reflects what is found in reliable sources. This article also covers non-medical aspects such as History, Society and Cultures and Ethics. In fact, this article has more content covering non-medical aspects than medical. There are Wikilinks in the content to specialized subarticles, see WP:SUMMARY for an explanation of this style.

Regarding ethics and the Hellsten article you mentioned in particular, this Wikipedia article already has a large, balanced and comprehensive overview of the ethics arguments, pulled from a recent university-level textbook and supplemented with journal articles. Hellsten's arguments are all already covered by that overview. There is already an Ethics of circumcision article which might include the arguments of individual proponents and opponents, although I'd like to see a more recent article than 2004, and we have no evidence that Hellsten is a particularly notable voice. We need a secondary source covering the "pros" and the "antis" so that we can identify whose argumentation is notable. Hellsten also goes into medical justification but uses 2004 knowledge to make medical arguments; the 2008 Uganda studies make a large section of Hellsten's arguments out-of-date.

Further, there is not really any need to abandon WP:MEDRS for even ethics discussions here. PUBMED indexes an enormous number and wide variety of journals. For something even just tangentially related to medicine, to be PUBMED indexed is a very low and wide fence to jump over, and if a journal is not PUBMED indexed, it really is a red flag raising serious concerns about the journal's reliability or notability.

It is interesting to note that a PUBMED search of material published in the last 5 years pulls 1,446 results for "circumcision" and only 82 for "circumcision AND ethics", and about a third of those results appear to cover "female circumcision"--so, something less than 5% of the PUBMED-indexed journal articles covering (male) circumcision go into the ethics of it. The Wikipedia circumcision article currently devotes about 10% of its content to ethics.

Looking at the Journal of Medical Ethics in particular: I actually like that journal, this journal ranking site puts it near the top of its various medical ethics journal importance rankings. However, Journal of Medical Ethics has only published ONE article covering circumcision ethics in the last 5 years. Compare that to the numbers of articles it has published in the same timeframe concerning: euthanasia (52), abortion (35), stem cell research (19), and obesity (3). It would appears that even this good journal dedicated to medical ethics doesn't find the ethics of circumcision particularly notable.

Based on all this, adding a lot more detailed ethics content to this article would appear to be undue. Zad68 22:46, 29 December 2012 (UTC)

...Adding: The same sort of analysis needs to be done to determine what amount of content is due in this article for the other non-medical topics you mentioned. Considering that I have seen some ethics related content in the circumcision sources, and really not any mention at all of the other topics, I'm really curious what reliable sources you can find for them, and what the results are of your research to determine how much weight is due for each of them. Zad68 22:52, 29 December 2012 (UTC)

If you define 'reliable sources' by medical standards, then of course they will 'discuss the medical aspects more than anything else'. That is a circular argument. I also listed 'historical, anthropological, sociological' viewpoints and mentioned social pressures, social memes, and social reality. I could have added aesthetic, psychological and sexual viewpoints too. What I'm concerned about is the way that you regularly revert edits with comments like, "you must start adhering to WP:MEDRS for your edits",[1] "failing WP:MEDMOS",[2] "WP:MEDMOS changes",[3] and "per WP:MEDMOS please do not...".[4] These are all in the last 6 days, and here on the talk page you regularly tell the WP:NEWBIES that for this article all sources must meet these requirements. My point simply is that they need not. Sources should be academically respectable, and should be reliable for the statement being made, but they do not have to be medical in nature for this topic. I fear that editors are being set the wrong hurdle to jump, for no apparent reason, and to the detriment of balance in this article. --Nigelj (talk) 18:57, 30 December 2012 (UTC)

I think we can all agree medical content needs to be sourced to MEDRS, and non medical content need not (though I suspect topics like sexual content are medical in nature). This article is a highly controversial article that has been the subject of numerous POV warriors in the past; we need to keep the focus on good sourcing to keep the disruption to a minimum, otherwise this talk page (as you can see in the archive) will turn into a disaster area. Yobol (talk) 19:03, 30 December 2012 (UTC)

Nigel, you've made a number factually incorrect statements. I'll address them to you directly on your Talk page so as not to clutter up this article Talk page. Zad68 21:29, 30 December 2012 (UTC)

Is this "circumcision" article or "circumcision prevents HIV" article?

http://circumcisiondoctorsaustralia.wordpress.com/2012/01/28/dr-normal-blumenthal/ http://www.hsrc.ac.za/Research_Publication-20839.phtml http://www.circumcision.org/studies.htm http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9 http://jamespatemd.com/blog/?p=2153

There you go.

Most medical organizations claim that circumcision doesn't prevent ANY diseases.

I could list 450,321,085,163,872,186 articles and studies disproving the "WHO"'s findings that circumcision prevents diseases. But it wouldn't matter. This article is clearly controlled by circumcised men. Pathetic.

At least the German WP article is accurate. No wonder they're kicking our butts. This article must be controlled from Tel Aviv. Pathetic 75.1.54.56 (talk) 08:30, 30 December 2012 (UTC)

Any pubmed indexed secondary sources? Blogs are not suitable references. If you wish to be involved in discussion please keep your comments related to the literature and no to other editors. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:14, 30 December 2012 (UTC)

What is the "GA" status of this article and why would one editor be canvassing another about it ?

What is the "GA" status of this article and why would one editor be canvassing another about it ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:30, 31 December 2012 (UTC)

Note to editors

I've updated the articles Circumcision and law and Circumcision controversies with the latest information from Germany. You may want to add these articles to your "watchlists".--82.113.121.215 (talk) 00:11, 29 December 2012 (UTC)

You appear to be a regular contributor, but with highly dynamic IPs it's hard to know. Have you considered getting a userid? Jayjg ^(talk) 01:44, 1 January 2013 (UTC)

High bias in circumcision article.

This article is highly biased and one-sided. Male circumcision is very controversial and all viewpoints need to be presented. The present editors are mis-using Wikipedia policy to exclude information they don't like. This needs to change.

Sugarcube73 (talk) 12:30, 29 December 2012 (UTC)

All I'm seeing here is bald assertions with no specifics to back them up. If you are referring to "viewpoints" like the "article" by a Mr. Dan Bollinger being kept out, well all I can say is, More power to the editors who do so. There have to be minimum standards for what gets included in an encyclopedia, otherwise this place becomes even more of a loony bin than it is already.--82.113.121.215 (talk) 16:08, 29 December 2012 (UTC)

The subject of this article is controversial and content may be in dispute. When updating the article, be bold, but not reckless. Feel free to try to improve the article, but don't take it personally if your changes are reversed; instead, come here to the talk page to discuss them. Content must be written from a neutral point of view. Include citations when adding content and consider tagging or removing unsourced information.

Child circumcision for alleged medical reasons is very largely a custom only in English-speaking countries so English-speaking persons tend to be biased in favor of circumcision. One must guard against this bias when editing circumcision related articles.

Sugarcube73 (talk) 13:32, 29 December 2012 (UTC)

Please use recent review articles and organize article per WP:MEDMOS. Also you may want to get consensus for your proposed changes as they seem a little controversial. Thanks. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:36, 29 December 2012 (UTC)

One of the journals you quote is not pubmed index http://www.ncbi.nlm.nih.gov/nlmcatalog/101220158 Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:40, 29 December 2012 (UTC)

Doc James:

Wikipedia does not have any requirement that a reference journal be listed in PubMed. The article from Journal of Men's Health and Gender is a survey article as required by Wikipedia. The Journal of 'Men's Health and Gender is now called the Journal of Men's Health. It is published in Holland by Elsevier, a prominent medical pubilsher.

Since you are Canadian, you must be aware that male non-therapeutic neonatal circumcision is not covered by any of the 14 Health Insurance Plans in Canada because of its lack of medical value, and that its popularity has declined substantially in the past few decades.

Sugarcube73 (talk) 16:56, 30 December 2012 (UTC)

Of course I am aware. And most Canadians are not circumcised as there is insufficient evidence to support the practice in the world out side of Africa.Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:37, 2 January 2013 (UTC)

Medical journals not MEDLINE indexed are giant redflags, and usually the places where material are published when they can't be published in higher quality journals. I would not include questionable sources in an overview article like this, when there are so many good sources to choose from. Yobol (talk) 17:27, 30 December 2012 (UTC)

I agree with Yobol here. Medline/pubmed indexing is a necessary, but not sufficient, condition for inclusion of a secondary medical source per MEDRS. -- UseTheCommandLine (talk) 03:17, 2 January 2013 (UTC)

No, that's not what the policy says. That's not even close to what the policy says. ► Belchfire-TALK 08:29, 2 January 2013 (UTC)

On this article

(Note that this is somewhat of an extension of my comment in the "Realistic death risk" section above.)

This article is called Circumcision. It's not "Circumcision as a medical procedure" or "Circumcision in a hospital." While MEDMOS and MEDRS are great for purely medical articles, this is not a purely medical article. At this title, it should never become a purely medical article. Circumcision is (usually) a medical procedure, at least in the developed world. Medical procedures are done by trained medical people, generally (if possible) in clinics and hospitals and the like. Circumcision is sometimes done by medical professionals. It's also done by religious professionals. The procedure has both medical and religious concerns along with a storied past (such as being an attempt to inhibit masturbation).

Iff the article is solely to be about the procedure as done by medical professionals without covering any other part, including the religious background and cultural history, then MEDMOS and MEDRS absolutely apply. That would also mean the article should be renamed to define the limited scope, and another article would cover the rest.

Not everything needs to be included, but using MEDMOS and MEDRS as a hatchet is also not beneficial. --No unique names 15:40, 29 December 2012 (UTC)

Hi Nouniquenames, the question of how the balance of the the content in this article reflects the balance found in reliable sources has already been addressed here on this Talk page. The article actually contains more non-medical content than it does medical content, so I am unsure why you state a concern that "it should never become a purely medical article" when there's no evidence that this is a problem.

Re: While MEDMOS and MEDRS are great for purely medical articles...--you appear to have a misunderstanding here, WP:MEDRS is the Wikipedia-wide sourcing guideline for all biomedical content, in any article. Even an article that concerned itself purely with the ethics of circumcision would need to have WP:MEDRS-compliant sourcing for any biomedical claims. Non-biomedical content, such as in this article's History and Cultures and Religions sections, are indeed supported by non-WP:MEDRS sources, because those sections are generally not carrying biomedical content, exactly as you are stating you think it should be. Also, all the non-medical topics you are bringing up are already addressed in the article with due weight, and there are Wikilinks in the content to specialized subarticles, see WP:SUMMARY for an explanation of this style. Zad68 22:46, 29 December 2012 (UTC)

I'm sorry, given my mistakes here in the past, I should have been more specific in what I meant. Essentially, I'm putting forward a view that we don't necessarily need MEDMOS and MEDRS to apply, even within the discussion of the procedure. (My reasoning being that it isn't always done as a medical procedure.) I wasn't pushing for a specific change in content, it's just tiring seeing those put forth as reasoning on talk so often, especially when it seems the article is at least somewhat biased as for the procedure. Having been burned by it, I'm probably not the most neutral. Realizing that, I'm trying to avoid doing any major editing. (Not that I haven't made mistakes in that so far, just trying to do better going forward.) Again, apologies for the confusion. --No unique names 04:48, 30 December 2012 (UTC)

This is health care as much as the article on abortion is health care which means a great deal. Yes their are aspects that pertain to religion. But the same apply to abortion and HIV and all articles that pertain to sex. Health care content needs to be supported by WP:MEDRS compliant sources no matter what article it is in. If we are discussing religion or history sourcing requirements are a bit different but WP:RS also requires secondary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:21, 30 December 2012 (UTC)

I wonder if we should consider the turkish gentlemen in the article photo as conducting a "medical procedure".

Here are some useful excerpts from WP:RS cited just above.

audio, video, and multimedia materials that have been recorded then broadcast, distributed, or archived by a reputable party may also meet the necessary criteria to be considered reliable sources.

-The statement that all or most scientists or scholars hold a certain view requires reliable sourcing that directly says that all or most scientists or scholars hold that view.

Note that otherwise reliable news sources—for example, the website of a major news organization—that publish in a "blog" style format for some or all of their content may be as reliable as if published in a more "traditional" 20th-century format

.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:37, 30 December 2012 (UTC)

Blogs and self-produced videos fail WP:MEDRS because they are self-published and are not peer reviewed by independent evaluators. Anonymous self-published material is not a WP:NEWSBLOG, which is what you are quoting refers to. On Wikipedia biomedical claims need sourcing that passes WP:MEDRS. Zad68

Blogs and self produced videos may PASS WP inclusion standards if they are "broadcast, distributed, or archived by a reputable party"

Insisting that circumcision article material meet med journal criteria is misguided for what is clearly more of a cultural than a medical matter--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:03, 30 December 2012 (UTC)

Try taking off the WP:MED templatte at the top of the page and see how far that gets you. Interesting, isn't it, that I haven't seen anyone insist upon revmoing the Encyclopaedia Judaica source because it's not from a medical journal. I wonder where people get these ridiculous ideas? Biosthmors (talk) 21:19, 30 December 2012 (UTC)

And WP:SPS is the guide I use. Biosthmors (talk) 21:21, 30 December 2012 (UTC)

I think it counter-productive and worse to posit that there is some kind of "jewish" conspiracy to keep this article pro circumcision. In fact such sources are useful in unearthing such facts as the early jewish philosopher/doctors quoted in the WP article on jewish circumcision giving useful clues about the pleasure reduction intent of cutting an infant boys penis. It is odd that modern medical science seems unable 2000 years later to produce a referenceable article confirming that cutting off the fun tip affects pleasure when it was known so long ago.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:45, 30 December 2012 (UTC)

Also the german language article seems vastly better resourced with good photos of both circumcisions and complications - can we filch them for this article ?. I speak no german but they seem to have large sections on things like the anti circumcision movement and on others like HPV which are missing here. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:45, 30 December 2012 (UTC)

Yes we can get ideas from any other language article. Are you planning on making improvements to the article? Biosthmors (talk) 21:55, 30 December 2012 (UTC)

This seems to be such a well patrolled and contentious article that I think almost any amendment will be reverted and then discussed at exhaustive length. For instance I tried to include the fact that men in Judaism who are not circumcised are shunned by their community in a short mention but it was quickly excised. I would love to see a translation of the german article or see if the other world language articles are also more comprehensive.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:02, 30 December 2012 (UTC)

I just took a look at the sourcing for the German article and frankly their sourcing standards are very, very poor in comparison to English WP. I see a tremendous number of primary sources, individual hand-picked studies of small study sizes, ancient studies, papers by non-notable authors published in low-impact journals, very little use of secondary sources. It is possible that there is some sourcing that could be useful here but I'm not seeing anything worthwhile yet. Zad68 22:11, 30 December 2012 (UTC)

I am stumbling through the French article with rusty french. different emphasis but on first scan seems less gung ho pro circumcision than english one --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 02:11, 31 December 2012 (UTC)

Huh, how about that. I wonder what the Arabic Wikipedia article says? Actually this point-free musing is not in line with the purpose of this Talk page, which is for discussion of improvements to this article only. Could you please finish your research independently and come back when you have concrete suggestions and specific sources to discuss? Zad68 03:02, 31 December 2012 (UTC)

I agree. Biosthmors (talk) 03:21, 31 December 2012 (UTC)

What a good point -the arabic article may well have a markedly different cultural emphasis which ties in neatly to the point made by several editors now that MC is more a cultural than a medical matter. My raising the German article prompted Zad to go read it. Don't look now but we are discussing drawing from other language articles to improve this english language one (referred to by several editors as a mess) which is, after all, the purpose of this page. In WP we even work collaboratively sometimes too. Enough points to be getting on with ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:19, 31 December 2012 (UTC)

Tumadoireacht, by my count Wikipedia currently has articles on circumcision in 62 languages (besides English). Each of these Wikipedias is governed by different content rules, some quite radically different from English Wikipedia's. In addition, none of these articles would be considered a reliable source on English Wikipedia (nor are English Wikipedia's articles considered are a reliable source on English Wikipedia). Finally, there is no guarantee that these articles even satisfy the content policies of their own Wikipedia languages, much less those of English Wikipedia. Therefore, we cannot look to these articles for guidance as to what content belongs in this article, English Wikipedia's circumcision article. Instead we must rely on English Wikipedia's content policies, primary of which are WP:NOR, WP:NPOV, and WP:V. Suggesting that we examine various other language articles for unspecified content does not help us; the only way these other articles might help us is if they reference sources that meet English Wikipedia's content sourcing rules, and which this article does not yet use. Which of these articles has such sources? Please assist us all by naming those sources. Jayjg ^(talk) 23:26, 31 December 2012 (UTC)

How would anyone know without looking? To require a list of such articles instead of wholesale investigation is, at its most polite, counterintuitive. --No unique names 17:08, 2 January 2013 (UTC)

proposal for several new sections from the french wikipedia

I propose to insert translations of the following sections from french wikipedia

circumcision amongst orthodox new york jews

legal risks for parents, ritual circumcisers and doctors.

sale and commercial use of foreskins for medical and cosmetic products

a consequences section--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 07:00, 31 December 2012 (UTC)

Tumadoireacht,

We already cover the topic of Jewish circumcision generally in this article, and we discuss metzitzah b'peh in the Wikilinked specialized subarticle devoted to the subject here.
We already cover the topic of ethics and law generally in this article, and we discuss low-level details in the Wikilinked specialized subarticle devoted to the subject here.
We already cover the sale of foreskins in the Wikilinked specialized subarticle devoted to the subject of foreskins.
We already cover effects and adverse effects here in this article.

Zad68 13:17, 31 December 2012 (UTC)

The legal risks in the french article include useful information on children successfully suing their parents in USA for MC. the french WP regards the damage done by penile blood oral contact as "worthy of inclusion in the central article. the french WP has a long section on foreskin sale and reuse. They and I believe we should have one too.

our consequences section is paltry and theirs is not. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:42, 31 December 2012 (UTC)

Tumadoireacht, the French language Wikipedia is governed by content policies that differ in content and application from English Wikipedia's. In addition, no Wikipedia articles (in any language, including French) are considered a reliable source on English Wikipedia. Also, there is no guarantee that the French circumcision article even satisfies the content policies of French Wikipedia, much less those of English Wikipedia. Finally, regarding some of the specific content you have mentioned, as a simple example, the English Wikipedia has a Circumcision and law article, and summarizes it in the main article. French Wikipedia has no such main article, and therefore cannot do the same.

As a result, we cannot look to the French article for guidance as to what content belongs in this article, English Wikipedia's circumcision article. Instead we must rely on English Wikipedia's content policies, primary of which are WP:NOR, WP:NPOV, and WP:V. What we can do, however, is mine the French article for sources that a) have not yet been used here, and b) meet English Wikipedia's requirements. Does the French article have any such sources? If so, what are they? Jayjg ^(talk) 23:26, 31 December 2012 (UTC)

Do you believe that the regular WP rules you listWP:NOR, WP:NPOV, and WP:V. do not apply when WP is in a foreign tongue ? I believe you may be in error if so. Many, but not all of the same sources are used for both the english and french articles. However as I have already pointed out the french article arranges the material very differently and gives greater prominence to material outlining the downside in the introduction.

For instance the second paragraph mentions the Royal Australasian College of Physicians underlining the problem of the consent of the infant and the functional role of the foreskin.

The third paragraph mentions the Royal Dutch Medical Association,Swedish Paediatric Society, British Association of Paediatric Urologists, Swiss Association of Paediatric Surgery, and German Society for Paediatric Surgery "notably protested against non therapeutic circumcision of children, underlining the absence of medical benefits, the risks of complications, problems with ethics, and problems with Rights of Physical Integrity of the Body. These different opinions reflect the numerous controversies (whether medical, legal, or societal) connected to non therapeutic circumcision of minors. When it is performed for therapeutic reasons, principally as one of the treatments for phimosis or paraphimosis, circumcision is then called posthectomie and arises for 10 men in every 1000." The references for this section are listed and many are in english.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:57, 1 January 2013 (UTC)

See WP:OTHERCRAPEXISTS. Also, see WP:IDHT, which describes a kind of disruptive editing behavior. Zad68 16:13, 1 January 2013 (UTC)

Are you experiencing some editing as disruptive Zad ? Please elucidate. WP:OTHERCRAPEXISTS really does not apply when considering, as above for instance, the inclusion of the views of half a dozen national paediatric medical bodies. Perhaps you missed one of our colleagues asking for usable references from the french MC article. I understand all of the other language WPs attempt to adhere to the same encyclopedic standards as the english one. If several of them are choosing to present MC in a markedly similar way that differs from this one then our examining how and why is IMO a legitimate way of seeking to improve this one.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:05, 1 January 2013 (UTC)

While looking at other Wikis to find good sources is not a bad idea, the decision to model the English Wiki on other languages' Wikis is probably not great. We have enough trouble keeping our own articles in compliance with multiple guidelines and policies, we do not need to spread the discussion as to what is great or bad about other Wikis. If you have a good source, let's use/discuss it, but further digressions about other languages do not appear to be a fruitful use of limited editor time and energy. Yobol (talk) 18:32, 1 January 2013 (UTC)

Agree with Yobol and Jayjg. Other language WPs might be useful locations to look for sources, and in fact I have done exactly that and found things to use to improve en.wp's articles. However, proposed sourcing and content for English WP articles will always be evaluated on English WP's guidelines and standards, and not any other language's WP. Zad68 21:29, 1 January 2013 (UTC)

Is it worthy of mention in this MC article that foreign language wikipedia pages on the subject could, working with exactly the same set of rules produce articles so radically different ?. Is there an arrogance in presuming that our one is the best ? Finding substantial referenced mention of the harvest, sale and use of foreskins on the french MC site, for example has changed the flavour of the responses here to the idea that we should include mention also.

Another example is that The english language MC version section on adverse effects is a mere 10 lines with about eight references. The french one is 30 lines long, is subdivided into sections on a plethora of both immediate and later complications largely unreferenced in USA WP MC article, and a section on death . The adverse effects section contains 18 references including at least one secondary source(a study of other studies) which reveals that all cases of stenosis of the urethal entrance encountered were attributable to MC

ref

↑ a et b (en) R.S. Van Howe, « Incidence of meatal stenosis following neonatal circumcision in a primary care setting », in Clin Pediatr (Phila), vol. 45, no 1, 2006, p. 49–54 [lien PMID [archive], lien DOI [archive]]

It is odd that our MC article does not include statistics on deaths from circumcision complications in USA . If such information is unavailable from reliable sources then this lacuna is notable and should be in the article. Editors here have decried VanHowe and Bollinger who both say about a hundred a year in USA . Is there no acceptable record kept ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 23:00, 1 January 2013 (UTC)}

Not a single one of the 19 sources used in the French Wikipedia's Complications section passes WP:MEDRS. You appear not to be able to distinguish primary from secondary sources. See WP:MEDRS for Wikipedia's standards for sourcing for biomedical information. Your statement our MC article does not include statistics on deaths from circumcision complications in USA is factually incorrect. We do not include such things as a comparative analysis of our articles vs. those of other Wikis, or the unavailability of information unless an independent reliable secondary source states these things explicitly; doing so without a source is disallowed original research. Zad68 04:45, 2 January 2013 (UTC)

I see an estimate for circumcision deaths in the MC article but no statistics -are the statisitcs in hidden text ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:06, 2 January 2013 (UTC)

The content is in the article, the font style is not hidden and it appears in both browsers I tried. If you're having technical issues, try Wikipedia:Technical_support. Zad68 15:05, 2 January 2013 (UTC)

Adverse effects section flaw

The adverse effects section states Circumcision does not appear to have a negative impact on the sensitivity of the penis, sexual function or sexual satisfaction.[b] The Royal Dutch Medical Association's 2010 Viewpoint mentions that "complications in the area of sexuality" have been reported.[58]

Here is what the abstract of the referenced article (ref 58)actually says

The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.

Now how did one of the patrol editors here describe the WP article entry " as covering catastrophic complications with due weight, sourced to high-quality secondary sources." if the referencing is incorrect ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:52, 2 January 2013 (UTC).

What is your exact suggested content change, and please provide sources. Zad68 15:02, 2 January 2013 (UTC)

The source is the dutch entry 5 lines above this one. This is one of the secondary sources you praised in the Rfc discussion on gender reassignment caused by botched circumcisions. This is also the same secondary source which you did not recognize as a secondary source when you encountered it in the large french WP section on damage caused by circumcision. As I pointed out above the attributed idea does not match the source. You yourself have validated the source. I therefore propose a summary of the actual abstract ideas to replace the incorrect one.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:20, 2 January 2013 (UTC)

I didn't praise it and it is not used on the French WP's section on complications, which is what my statement about the WP:MEDRS fitness of the French sources covered--see what I actually wrote in the section above this one. Go ahead and write your proposed article content changes so we can discuss it. Zad68 15:36, 2 January 2013 (UTC)

Edit request on 7 January 2013

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The first sentence of the paragraph titled "Positions of medical associations" says "Outside of AIDS-ravaged Africa..." I would like to request that this phrase be changed to "Outside of places with high burdens of HIV..." or something similar. I think that "AIDS-ravaged Africa" is unnecessarily dramatic and stigmatizing; it is also not entirely accurate, as places outside of Africa have high burdens of HIV/AIDS, and many parts of Africa have very low burdens of HIV/AIDS. Thank you very much for your consideration! 140.247.0.2 (talk) 23:07, 7 January 2013 (UTC)

Good point. I changed it to "Outside the parts of Africa with high prevalence of HIV/AIDS..." This sentence can't talk about the parts of the world other than Africa because the source it's cited to explains that the medical organizations serving the high AIDS areas of Africa specifically have policies regarding circumcision that are different from everywhere else. Thanks for the suggestion... Zad68 00:19, 8 January 2013 (UTC)

Sexual effects of circumcision

The claim that circumcision does not affect male sexuality or sexual function is completely false. There are numerous studies showing that it has a dramatic affect on sexual performance. The foreskin is full of nerves and tissue that adds to sexual pleasure in men and women. There are numerous studies on this; I can provide if the editors are not aware of them. I don't understand why we say in this article that it has no effect. Not only that, but the source cited for this claim doesn't seem to prove this point. Crimsoncorvid (talk) 00:12, 14 January 2013 (UTC)

Wikipedia's standards for sourcing of biomedical information is WP:MEDRS, that hasn't changed. Please bring forward WP:MEDRS-compliant sources and proposed article content change so we can discuss it. Zad68 00:35, 14 January 2013 (UTC)

I have a few sources here. I think that they will help to prove my point:

Note that the last is a link to a blog. The blog isn't what is of interest, but the sources referenced. All of the sources (many of these from medical journals of the time) note that circumcision is a "cure for masturbation", desensitizes the penis, and makes masturbation more difficult since the skin of the penis is immobilized.

Americans have forgotten the sexual function of the foreskin, but this was well understood 100 years ago.

It is clear that circumcision harms sexual and masturbatory function. You only have to ask an intact man! I understand that this "original research" is not valid for Wikipedia, but consider that you won't find a study that shows that removal of a hand makes picking up things more difficult since it's obvious! Crimsoncorvid (talk) 06:02, 14 January 2013 (UTC)

It was acknowledged 2,000 years ago that MC reduced pleasure and was cited by jewish theologians(see http://en.wikipedia.org/wiki/Brit_milah) as a reason for the chop. A frequently referred to stat in comparing FGM to MC is that the clitoris has 8,000 nerve endings but the foreskin has 20,000. Do the math ! The insistence by a coterie of editors who patrol this page is that even the consideration of pleasure and most other aspects of MC are "medical" matters and subject to needing to be confirmed in a sort of capo di tutti capo article in a medical journal before they will countenance inclusion. Back on planet earth there does remain the problem of finding good material comparing subjective experience of pleasure amongst the cut and the uncut and their partners and deciding what discipline (psychology perhaps) is best equipped to provide a definitive research answer. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:57, 14 January 2013 (UTC)

Crimsoncorvid, you have already been directed to WP:MEDRS, Wikipedia's standards for sourcing biomedical information. You need to read it and start applying it. I am unwilling to repeat myself any more on this point. Zad68 03:26, 15 January 2013 (UTC)

I am not an expert in medical research by any means. Can you please explain why the sources I mentioned don't qualify for WP:MEDRS? Thanks! Crimsoncorvid (talk) 14:47, 15 January 2013 (UTC)

I'm not either, Crimsoncorvid, believe me, I understand--understanding and applying WP:MEDRS definitely has a learning curve, so your request is reasonable. I'll go through a few of them for you:

Sorrells 2007 is a small non-randomized primary study, and per WP:MEDASSESS (part of WP:MEDRS) produces low-quality evidence. If it is proposed that this study be used in a discussion on the sexual effects of circumcision, note that study itself doesn't draw a conclusion of the relevance of its own findings to sexual effects, and in fact Sorrells 2007 says more evidence is needed. One of the most-preferred types of secondary sources, the AAP 2012 report, comments "it is unclear that sensitivity to static monofilament (as opposed to dynamic stimulus) has any relevance to sexual satisfaction." Per WP:MEDREV (part of WP:MEDRS), we do not use the primary source to contradict the conclusion of a secondary source.
Kim 2007 is a survey-based primary study. The study does not mention how the subjects were selected, whether the subject selection was even randomized or not, or how many and what kinds of subjects did not respond to the survey, which are all important to know for confounding factors of a survey this small. Where does a survey fall in the WP:MEDASSESS scale of evidence quality? And again we do not use primary study results to contradict secondary sources.
Regarding the sources listed here: what is the age range WP:MEDRS specifies for sources? How old is the newest source mentioned here? To answer that second question: Campbell's Urology 1970 is over 40 years old. The latest edition is here, 10th edition, just released 2012. Per WP:MEDRS we do not cite 40+-year-old sources, especially when a newer edition is available.

Crimsoncorvid, I spent probably the better part of an hour doing this research for the sources you brought. I find that doing article development in accordance with Wikipedia policy and guideline is hard and very time-consuming. For each one of the dozens of sources that are in the article, hours were spent doing just the sort of research done here. Doing it requires learning WP:MEDRS and being willing get your hands on these sources yourself--the latest-edition Campbell's Urology is 4,320 pages and costs $567.00, and I had it in my hands yesterday. Now that you have a running start on WP:MEDRS, if you'd like to bring more sources to consider, can you please do this sort of leg-work yourself before bringing them to the article? Zad68 15:59, 15 January 2013 (UTC)

Thank you for your explanation. I did not realize that my request required so much work; I will do more legwork next time I bring sources. I want to say that I completely disagree that the AAP is a reliable source. They are a professional organization that seeks to enhance the value for its members and clearly falls under the category of Wikipedia:Conflicts_of_interest_(medicine). It has a vested interest in supporting circumcision as this aids both member doctors and medical device makers make money. Furthermore, the AAP has been strongly criticized by just about every one of its peers (e.g. medical organizations from around the world) for its recent policy statements. Not only does it have COI, but its opinions on circumcision have been largely discredited by the worldwide medical community.

It is odd to me that the Africa HIV studies that call themselves "RCTs" are in fact not but that's OK here on Wikipedia. That reminds me, why isn't Boyle/Hill accepted here? Crimsoncorvid (talk) 01:04, 16 January 2013 (UTC)

You can raise the question of the reliability of the AAP's technical report on COI grounds at WP:RSN, be sure to notify me and the other members of WP:MEDICINE if you do. And so we're jumping to HIV now? WP:MEDRS sources universally refer to the African trials as RCTs and so Wikipedia does too. By Boyle Hill do you mean this? Zad68 01:51, 16 January 2013 (UTC)

Yes Crimsoncorvid (talk) 13:26, 16 January 2013 (UTC)

What exact article content changes are you proposing using this? Is this request any different at all from the Talk page threads you yourself started 6-7 months ago?? Zad68 13:43, 16 January 2013 (UTC)

I never understood why this source couldn't be used to back a statement casting doubt upon the Africa HIV RCT research. Wikipedia policy allows this. Boyle/Hill is a reliable secondary source published in a medical journal as far as I can tell. They show that the African RCTs have serious flows (e.g. not being random, controlled, having ethical issues, etc.). I understand that Wiki considers WHO and the African RCT meta-studies reliable sources, but I never understood why Boyle/Hill couldn't be used. The previous discussions 6-7 months ago pertained to Boyle/Hill in the lead. Many supported my viewpoint, but others didn't. But what if the counter-statement was somewhere else? Crimsoncorvid (talk) 16:14, 16 January 2013 (UTC)

Before we go any further, would you please read this exhaustive and exhausting discussion started just 8 months ago by the account Erikvcl (talk · contribs). It covers thoroughly exactly the kinds of article changes you appear to be suggesting.

You mention "Many supported my viewpoint..." -- While you're reading through the Talk archives, you might notice that there are a lot of edits by accounts now inactive due to sockpuppetry problems, so it's hard to tell any more how much genuine support there may have been. Zad68 16:51, 16 January 2013 (UTC)

Yes, I am aware of that discussion. Jakew dismissed Boyle/Hill as fringe with a bunch of handwaving. Yet he has introduced Morris studies. I never received an adequate explanation of what was wrong with Boyle/Hill. I am still waiting for that explanation. Crimsoncorvid (talk) 22:10, 16 January 2013 (UTC)

Receiving an adequate explanation is not the same thing as not accepting the adequate explanation you received.

What exact article content change are you proposing using this source? Please be specific. Zad68 03:29, 17 January 2013 (UTC)

I propose [5] based on that source. It calls into question the trials used as a basis for the entire subsection's references. That said, a brief mention there seems enough to get the point across. --No unique names 05:29, 17 January 2013 (UTC)

Jakew's explanation was not adequate, sorry. If that qualifies as adequate, you are basically saying that certain sources (e.g. WHO) are infallible. This is certainly not the case. Wikipedia policy allows sources to call the conclusion of other sources into question. What Nouniquenames proposed is EXACTLY the change I had in mind. Crimsoncorvid (talk) 05:41, 17 January 2013 (UTC)

"[H]owever, trials providing this evidence have been called into question" is meaningless. It sounds like a political statement to me, not a medical statement. It's too vague to be worth anything. If you find a high-quality WP:MEDRS you should be able to generate statements like this, for example: "existing randomized controlled trials give moderate quality evidence that these stockings reduce the risk of post-thrombotic syndrome". Try again please. Biosthmors (talk) 06:09, 17 January 2013 (UTC)

It sounded like you were suggesting a complete rewrite of the HIV information, throwing out sources from Cochrane, the CDC, the WHO and others. If content like what Nouniquenames proposed is all you are proposing as well, you'll be happy to find out that content exactly like that is already in the article, in the History section. I reverted Nouniquenames' because it duplicated what's already in there. As the content change you were proposing is already covered in the article, we should be done here, yes? Zad68 13:46, 17 January 2013 (UTC)

Zad68, I guess we are done here. It's still not clear to me why Boyle/Hill isn't useful, but yes, the History section basically covers it. Crimsoncorvid (talk) 14:36, 17 January 2013 (UTC)

Actually one of the sources cited for that content, Siegfried 2006, did not support the content. So, I removed Siegfried 2006 and added Boyle Hill 2011 instead. So, Boyle-Hill 2011 is now in the article and being used for the purpose you were looking for. Zad68 15:23, 17 January 2013 (UTC)

How does the sourced note "Circumcision does not appear to have a negative impact on sexual function" warrant the article's claim that it "does not appear to have a negative impact on the sensitivity of the penis, sexual function or sexual satisfaction"? In particular, the sources do not talk about sensitivity, and since the absence of evidence is not evidence for absence, shouldn't this sentence be phrased "has not been shown to have a negative impact on sexual function or sexual satisfaction"? -- 217.235.96.186 (talk) 16:54, 20 January 2013 (UTC)

Let's take a look at the direct quotes of the summaries of the sources cited:

AAP 2012: "Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction."
Sadeghi-Nejad 2010: "Despite conflicting results in some of the historical observational studies, most recent articles do not show evidence of adverse effects on sexual function."
Perera 2010: "The evidence suggests that adult circumcision does not affect sexual satisfaction and function."
Doyle 2010: "Adult male circumcision does not seem to have an adverse impact on sexual function." and summarizes the Kenyan RCT (the only one described as reporting on sensitivity) with, "Circumcised men in the Kenyan trial demonstrated no difference in sexual dysfunction compared to controls. A majority of circumcised men did report more penile sensitivity and ease of achieving orgasm after their circumcision."

So two of the four sources cited do mention sensitivity. My assessment is that the existing article content is supported by the sources cited. Is the bundling of the refs in the note causing the confusion?? If so, let me know and I'll try to figure out a more clear way to do the WP:CITEBUNDLE. Zad68 04:18, 21 January 2013 (UTC)

Edit request on 18 January 2013

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The article is biased and not objective: - first circumcision is technically (it is not an opinion) a genital mutilation performed on non constening person and this should be stressed for sake of non biased (pro circumcision) perspective. That should also clarify why the rate of adult males performing circumcision, if not for medical reasons, is 0%. - second asserting that the circumcision does not affect sensitivity is false, as any male not circumcised can prove; the only ones that cannot know the difference are the circumcised males whose penises have decreased their sensitivity along the life span to compensate for the exposure of the most sensible part of the male human body - third, it is not clearly stated that UN has enforced a policy to perform circumcision , between 2012 and 2013, on 20 million non consenting african little boys to reduce statistically the chance of HIV trasmission; - forth it is not stated clearly that the most effective way of reducing HIV trasmission is the usage of condom, and a circumcised penis without a condom has the same chance of infection of a not circumcised penis without a condom Uranioradioattivo (talk) 10:56, 18 January 2013 (UTC)

Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. This template is only for uncontroversial changes, it's not a substitute for discussion and consensus building. --Six words (talk) 11:04, 18 January 2013 (UTC)

RFC

There is a strong consensus against the proposed paragraph's inclusion, based on the argument that it would give undue weight to something that very rarely intersects with the issue of "circumcision". The only rebuttal to that concern is that the paragraph shouldn't be totally excluded, but rather simply given less emphasis. Both policy and the broad consensus of editors in this discussion disagree; the few instances of these two issues intersecting is not enough to justify its inclusion in the main article. -- Lord Roem ~ (talk) 04:49, 31 January 2013 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Should the section on Involuntary sex assignment (botched male circumcisions in USA and the resultant genital reassignments and compensation cases) presently in WP article "Genital Modification and Mutilation" more properly be included in the "main" Circumcision article of which this is the talk page ? Please note a discussion on this has been taking place for four days already and lies just below this Rfc.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:45, 2 January 2013 (UTC)

Specific proposed content

Here is the specific proposed content this RFC is looking for comments on:

In some cases, a child's gender may be reassigned due to genital injury. There have been at least seven cases of healthy male infants being reassigned as female due to circumcision damaging their penises beyond repair,^[1]^[2]^[3]^[4] including the late David Reimer (born Bruce Reimer, later Brenda Reimer), who was the subject of John Money's John/Joan case, an unnamed American child, who was awarded $750,000 by Judge Walter McGovern of the Federal District Court after a military doctor was found guilty of medical malpractice in 1975, and an unnamed child who was circumcised at Northside Hospital, who received an undisclosed amount of money from the hospital.

^ Gearhart JP, Rock JA. Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup. J Urol 1989;142(3):799-801.

^ "David Reimer, 38, Subject of the John/Joan Case" The New York Times, New York, USA, Published May 12, 2004

^ "Family Is Awarded $850,000 For Circumcision Accident" The New York Times, New York, USA, Published November 2, 1975

^ Charles Seabrook. $22.8 million in botched circumcision. Atlanta Constitution, Tuesday, March 12, 1991.

RFC comments

Oppose per WP:UNDUE. Per Wikipedia policy, the amount of emphasis given to each aspect is proportionate to the coverage found in reliable sources. Over the last few decades there are thousands and thousands of reliable sources covering the general topic of 'circumcision' and a tiny handful cover the intersection of circumcision, catastrophic complications (botched circumcision procedure) and a result of a involuntary sex reassignment. A review of highest-quality secondary sources like the statements of the major medical associations or well-respected international encyclopedias shows that they do not mention these individuals by name as is proposed. The only secondary source I have found that approaches this topic is the 30-page American Academy of Pediatrics Task Force on Circumcision report, which only touches on this topic with the one paragraph,
The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this literature review). These rare complications include glans or penile amputation, transmission of herpes simplex after mouth-to-penis contact by a mohel (Jewish ritual circumcisers) after circumcision, methicillin-resistant Staphylococcus aureus infection, urethral cutaneous fistula, glans ischemia, and death.
and this paragraph is already cited and used appropriately in the article. It would be clearly undue to go down to this level of detail in this general survey article when the AAP technical report does not go down to this level of detail. Also there is no secondary source. All the sources are hand-selected primary sources. A secondary source is required to provide context and establish relevance.Zad68 02:54, 2 January 2013 (UTC)

Comment Is that the same secondary source American Academy of Pediatrics Task Force on Circumcision report that you judged to not fit our standards when you encountered it referencing the french WP MC section on MC negative consequences . The named victim here, now deceased by suicide has his own posthumous page here on WP so no worries on the "mention by name" score --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:51, 2 January 2013 (UTC)

Nope. Zad68 15:15, 2 January 2013 (UTC)

Oppose Zad said it as well, and probably better, than I would have. -- Avi (talk) 02:57, 2 January 2013 (UTC)

Support. The Rfc applies to the second paragraph only as previously indicated and listed in the discussion below. The Rfc is about inclusion not emphasis. Botched circumcision cases and their litigation history are at home in a circumcision article and not one on mutilation and modification. Editors coming fresh to this Rfc might profit from reading the discussion below .--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 03:19, 2 January 2013 (UTC)

~~Inclusion and emphasis cannot be separated.~~ The article already covers catastrophic complications with due weight, sourced to high-quality secondary sources. This RFC requests the inclusion of popular-press primary sources with no secondary sources to support them, and no Wikipedia policy-based justification to support them. But, I agree with you that new editors should read the discussion below carefully.Zad68 03:26, 2 January 2013 (UTC)

Comment "Inclusion and emphasis cannot be separated". I would like to hear more about this novel statement and maybe something in the way of WP policy to support it. The editor who posted it may have overlooked the PubMed journal article supporting the proposed text when describing the proposed text as having popular-press primary sources . — Preceding unsigned comment added by Tumadoireacht (talk • contribs)

Reply Sure, feel free to ask me about this on my User Talk page. Zad68 15:18, 2 January 2013 (UTC)

Your giving your WP policy rationale here instead of on your talk page would be more helpful in trying to understand what your point might be; As you have so succinctly put it yourself "where is support for this found in Wikipedia policy? Please specify the exact policy page and quote the relevant part of policy"--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:33, 2 January 2013 (UTC)

I have struck that distracting comment from my reply. Zad68 15:40, 2 January 2013 (UTC)

Oppose as currently formulated. If this were placed in the section on medical aspects i think it would violate WP:UNDUE as noted by others, but I would have no problem with its inclusion in a sub-article on cultural aspects of circumcision, or perhaps in an article about circumcision activism. It should be clear from section headings that this is a cultural issue, rather than a medical one though; perhaps rewritten too. — Preceding unsigned comment added by UseTheCommandLine (talk • contribs)
Oppose lacking evidence that appropriate sources give such events proportional coverage (i.e. due weight) as discussed above. -- Scray (talk) 03:45, 2 January 2013 (UTC)
Oppose 7 cases are not sufficiently notable to be mentioned. Maybe in the subarticle "circumcision controversies" or "circumcision and the law" if not already there. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:42, 2 January 2013 (UTC)
Comment :WP:UNDUE has been cited twice in opposition to inclusion, but this policy applies to opinions and viewpoints. These national newspaper reports, court cases, and academic records of damage are not opinions or viewpoints, but facts. WP:UNDUE applies to making decisions about emphasis and not decisions about inclusion. Therefore it does not apply. The suggestion that this damage to children be recorded under "cultural" is risible.

It can certainly be described in greater detail also and linked in the two sub-articles mentioned by another editor above.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:08, 2 January 2013 (UTC)

Oppose inclusion as undue weight. Including a tiny handful of freak occurrences out of hundreds of millions of successful and trouble-free procedures is a naked absurdity. ► Belchfire-TALK 09:13, 2 January 2013 (UTC)

Oppose. Millions of circumcisions are performed worldwide annually. Unless this is a common complication (which it isn't), the most space that should be devoted to this is a single sentence. The source for such a sentence should be a high-quality secondary source from the medical literature that discusses the management of complications from circumcision (and I'd leave the word "botched" out of it as well). JFW | T@lk 14:17, 2 January 2013 (UTC)

It may be of interest and relevance to know of the book written about one of these victims referenced here on his WP page http://en.wikipedia.org/wiki/David_Reime

@ Belchfire how many children would you reckon need to be gender reassigned due to botched circumcisions before you might consider their number significant ? What time period does "your successful and trouble-free" " hundreds of millions" refer to ? Is the "hundreds of millions" referring to one country or is it a worldwide figure ? Does it take account of other complications of MC? Do you have any references ? Also how does a naked absurdity differ from a clothed one ? --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 10:27, 2 January 2013 (UTC)

Oppose - I'm with the majority who say that this would represent a case of WP:UNDUE ReformedArsenal (talk) 12:21, 2 January 2013 (UTC)

Support valid risk should have valid coverage in article. --No unique names 17:03, 2 January 2013 (UTC)

The risk rate of catastrophic complications is already given valid coverage in article, in proportion to what is found in reliable sources. What Wikipedia policy are you basing your support !vote on? Zad68 17:44, 2 January 2013 (UTC)

Oppose. A few freak cases of involuntary sex reassignment do not satisy WP:DUE. Medical journals should discuss the risks, not newspaper stories. Ankh.Morpork 17:10, 2 January 2013 (UTC)

Oppose, undue, and note that an application of WP:MEDRS applies. If these exceedingly rare cases are mentioned in secondary high-quality medical journal reviews (rather than lay media which tends to sensationalize) that would be another matter, and even then, only a very brief mention would be warranted. SandyGeorgia (Talk) 17:26, 2 January 2013 (UTC)

Oppose. Medical statisticians would be performing a public service by listing complications for at least the twenty most common surgical procedures, a list naturally including circumcision. Such a list should be compiled in a strictly consistent manner and be broken down into categories from very moderate to extremely severe (including death, even if only a minuscule percentage). A separate Wiki article could then present this information in compact tabular form and serve as a target for internal wikilinks. To give context, this data should be compared to good-quality estimates of the total years of life saved by each of these surgical procedures as well as the number of cases of harmful medical conditions thereby prevented and/or remedied. At present, I do not see a way for the addition proposed by this RfC to be accepted.--89.204.138.189 (talk) 18:05, 2 January 2013 (UTC)
Oppose Gender reassignment as a result of botched surgery is not a risk of circumcision. These are odd case studies and not fundamental to understanding the topic. Blue Rasberry (talk) 14:40, 3 January 2013 (UTC)
Comment Risk is not the only reason for which these 7 cases are notable. On which research is the opinion that it is no longer a risk based ? In other med/legal articles such as this one http://en.wikipedia.org/wiki/Unethical_human_experimentation_in_the_United_States Bluerasberry you went along with case study inclusion. Understanding the topic is not the sole function of a WP article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:06, 3 January 2013 (UTC)
Oppose. Violates WP:UNDUE, as noted by most editors here. Plot Spoiler (talk) 23:37, 3 January 2013 (UTC)
Oppose The relatively small number of adverse events makes them inappropriate for inclusion in this general article; perhaps Tumadoireacht would be interested in creating a separate article. Miniapolis (talk) 03:53, 5 January 2013 (UTC)
Oppose per Zad68, WP:UNDUE. —Ynhockey ^(Talk) 19:14, 5 January 2013 (UTC)
Comment<siiigh!> Sorry folks, storms in coffee cups get me that way, especially when it is the same cup over and over. Has anyone stopped to think just how much difference the inclusion or exclusion of that little passage would make, particularly if some of the opposers could modulate the presentation with remarks on the total perspective on the matter (four or whatever cases among four million or something?) I have not checked, but suspect that where the claims and counter-claims go would be more important than whether they are included at all. And BTW, DO please put RFCs at the ENDs of talk pages will you all? Just searching for the RFC was more trouble than this particular RFC was worth. For heaven's sake will some of the more passionate partisans stand back and strive for a bit of perspective? Try to weigh up the consequences of the procedures against an article about state-supported kidney transplants or vaccination or perms or something, then think again about what you are writing about and what your opponents are responding to.JonRichfield (talk) 15:20, 6 January 2013 (UTC)
Comment. Tumadoireacht, I think I might understand why your view of this material is so different from almost every other editor's here. I think the section of WP:UNDUE the other editors are focusing on is the following (emphasis mine):

An article should not give undue weight to any aspects of the subject but should strive to treat each aspect with a weight appropriate to its significance to the subject. For example, discussion of isolated events, criticisms, or news reports about a subject may be verifiable and impartial, but still disproportionate to their overall significance to the article topic.

Once one reads it, it seems apparent that it was written to exclude exactly the kind of material you are proposing including. I suspect that you may simply not have seen that paragraph, or thought about it in this way. Now that you have, and you've seen the quite strong resonance it has with experienced editors, would it make sense for you to withdraw your RFC? Jayjg ^(talk) 21:44, 6 January 2013 (UTC)

I had seen that paragraph. I have partly addressed this point already. Perhaps you have not come across the text here where I have done so : There is a difference between emphasis and exclusion. The paragraph you quote refers to the former. These seven boys were damaged in the USA. The eight boys whom we know of who contracted herpes through circumcision and of whom two died as a a result were also in the USA. If deaths and injuries such as these are occurring in the most medically resourced country in the world as a result of an unnecessary surgical procedure, then it is noteworthy.No editor is doubting that the injuries and deaths occurred. An overlapping set of editors are proposing excluding the herpes material too. We include material on penile cancer prevention connected with MC despite more tenuous connection. Undue weight does not arise. A mention and link to one of the sub articles would suffice.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 03:34, 14 January 2013 (UTC)

The phrase you bring is not found in WP:UNDUE, and WP:UNDUE is itself quite clear that due weight includes both minimizing and/or entirely removing material. Indeed, if one were forced to include mention of every single verifiable statement from every WP:RS (regardless of its relative reliability, or whether or not it was WP:PRIMARY or WP:SECONDARY), then Wikipedia articles would become huge masses of generally unreadable prose. Again, WP:UNDUE specifically enjoins editors to remove material such as that which you are proposing to add. I urge you to re-read WP:RS and WP:MEDRS without thinking about this specific material you wish to add, but instead trying to understand the general intent and meaning of the guidelines. Jayjg ^(talk) 18:07, 20 January 2013 (UTC)

I urge you equally to consider the material and ask yourself whether death or damage to children is not relevant. I have not seen any section of UNDUE which recommends excising pertinent material. Perhaps you could quote it. You are also making the error of the "floodgates" argument in suggesting that mentioning damage to children and a 22 million dollar settlement for one of them constitutes the institution of unreadable prose.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:19, 22 January 2013 (UTC)

There's not much more to be said here other than we're all looking at the same policy page, and so far in this RFC, seventeen respondents (including five admins) representing over 500,000 edits have all come to the conclusion that the material proposed for inclusion is not suitable per WP:UNDUE. (And by the way I am not including Jayjg in this count because Jayjg has not !voted.) Tumadoireacht, it is now time for you to reflect on why your reading of WP:UNDUE here is so far out of line with Wikipedia community consensus. Zad68 19:19, 22 January 2013 (UTC)

Thank you for your kindly reminder of it being time to reflect Zad. Perhaps in this time of rumination you might reflect on why you felt it necessary to list the pedigrees of your fellow opponents of including mentioning this material at all- are you not confident in the arguments alone ? One of your fellow travellers, enlightened, has shifted from asserting "we never reference case studies" to "we do not normally reference case studies" in his submissions here on the subject. Perhaps there is hope for ye yet --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:45, 23 January 2013 (UTC)

Oppose As undue weight. Yobol (talk) 20:33, 10 January 2013 (UTC)
Oppose Undue weight, relatively poor sourcing, etc. etc. Mark Arsten (talk) 19:49, 11 January 2013 (UTC)
Oppose 7 cases of millions, really? It seems they are result of sloppiness, not of the procedure per se. This can be mentioned in passing (that "shit happens"), but each and every ~~medical procedure~~ human activity may be dangerous if carried out ineptly. If there were some high profile cases which changed something in law, custom, or procedure, then per wikipedia rules they may even deserve a separate article. But is this the case here? Staszek Lem (talk) 01:12, 19 January 2013 (UTC)

Comment@Staszek Lem NOT 7 cases of millions but 7 that we know of in a twenty year period of MC in USA. Rates of botched MC are likely to be both higher and unreported in poorer countries than the USA and, like suicide, botched MC in the USA may be both underreported and misreported. I have not found any procedural alteration record as you suggest though in two of the seven cases a piece of cauterizing equipment was used that had not hitherto been used for MC and is most unlikely to have been used since --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:19, 22 January 2013 (UTC)

Comment I have been looking at other medical articles on Wikipedia and found a few that mention rare adverse outcomes (death / permanent disfigurement). The questions is, should this be an argument for also including such outcomes in THIS article, or should these one-in-a-million events be struck from the other articles also? 82.113.98.243 (talk) 06:58, 24 January 2013 (UTC)
- Comment Neither. Please see Wikipedia:Arguments to avoid in deletion discussions#What about article x?; we handle each article individually. -- Avi (talk) 08:51, 24 January 2013 (UTC)
- Avi, thank you for replying but I'm not sure I understand. Much of the discussion here is about how to apply Wikipedia policies and guidelines, especially MEDRS. These policies and guidelines should apply across the board to all medical articles, no? I don't think you're saying that every article must be treated according to custom-made rules? 82.113.98.243 (talk) 15:46, 24 January 2013 (UTC)
  - In theory you are completely correct. In practice, however, as each article is written my different people (often from different countries, cultures, languages, etc.) we have to focus on each article on its own at a time, otherwise, we would be completely paralyzed by the need to change 1500 articles to change 1. As such, we usually try to forestall the argument of "it is in article x, so why not here." If you feel that there is a flaw in a different article, based on your discussion here, the best (albeit slow) way to effect change is to use the arguments you think are most valid in this case, and then apply them to the other article on its own merits. For example, if the discussion in article A brings you to a certain understanding of MEDRS that you feel is not being applied in article B, you go to article B and say "I don't think article B is conforming to MEDRS b/c of x, y, z" Not, it's different than article A, although you could say, based on discussions in article A, I think article B does bot conform to MEDRS due to X, y, z. Agreed that it is slow, but it works better than anything else we've tried so far :). Thank you. -- Avi (talk) 18:43, 24 January 2013 (UTC)

gender reassignment due to botched circumcision -paragraph from "genital mutilitation" article - should this get mention in "Circumcision"?

In some cases, a child's gender may be reassigned due to genital injury. There have been at least seven cases of healthy male infants being reassigned as female due to circumcision damaging their penises beyond repair,[6][7][8][9] including the late David Reimer (born Bruce Reimer, later Brenda Reimer), who was the subject of John Money's John/Joan case, an unnamed American child, who was awarded $750,000 by Judge Walter McGovern of the Federal District Court after a military doctor was found guilty of medical malpractice in 1975, and an unnamed child who was circumcised at Northside Hospital, who received an undisclosed amount of money from the hospital.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 23:03, 28 December 2012 (UTC)

Why should we? It's only a minimum of 7 people out of a world of about 7 billion. And [6][7][8][9] give absolutely no weight to the argument. The real issue is how much this gets mentioned within the context of MC in current reliable secondary medical sources. Simply raising the question without presenting more information and context doesn't help us make changes to the article, in my opinion. Please try to raise more substantive issues? If not, others may begin to not consider your posts with the seriousness they might deserve. Biosthmors (talk) 23:09, 28 December 2012 (UTC)

If this information is a big deal to advocates, it could be pointed out in a Society and culture section though... That might work. Biosthmors (talk) 23:11, 28 December 2012 (UTC)

The 7 out of 7 billion rationale amused me. What original research ! Are we counting women too (perhaps the talk of gender reassignment confuses but i can confirm- from original research admittedly that they do not have foreskins)

So it could be 7 out of 3.5 billion but it is not because they are all american.

So is it 7 out of the 79% of circumcised american males (122 million) or is it drawn from a smaller group again -that of the botched or complications list for which various low numbers circulate 1% (botch) of 56% (MC)of 2 million male births(per annum USA 2005) multiplied by the time period under study. 30 year period ?

Comes out to 7 in 336,000 ? A far cry from 7 billion

Try to be a bit more mindful with stats Biosthsmoors.

If not, others may begin to not consider your posts with the seriousness they might deserve. I suspect these results are "a big deal" to the parents and the victims and the insurance company that paid out 22.8 million for one of the seven.

Here are the references for the gender reassignment from the WP Genital Modification and Mutilation WP article

^ Gearhart JP, Rock JA. Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup. J Urol 1989;142(3):799-801.

^ "David Reimer, 38, Subject of the John/Joan Case" The New York Times, New York, USA, Published May 12, 2004

^ "Family Is Awarded $850,000 For Circumcision Accident" The New York Times, New York, USA, Published November 2, 1975

^ Charles Seabrook. $22.8 million in botched circumcision. Atlanta Constitution, Tuesday, March 12, 1991.

By pushing the "-secondary-medical sources-only - move along folks -nothing to see here now line" we are denying that these and other such events happened or are saying they have no relevance. Now THAT is reckless editing ! --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:05, 31 December 2012 (UTC)

Secondary sources are required to determine what amount of emphasis is due to each aspect, otherwise our articles would become huge collections of trivia or Ripley's Believe It or Not lists of exactly the kinds of things you list. This article already covers catastrophic adverse events in due weight as found in reliable secondary sources. Zad68 13:23, 31 December 2012 (UTC)

Children dying as a result of an unnecessary surgical act or losing their external genitals altogether are not trivial matters no matter how many WP policies are cited in opposing their mention. Pursuing an interpretation of selected site guidelines that results in a less than fully truthful main article is counterproductive and damaging to the credibility of WP.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:02, 1 January 2013 (UTC)

What Wikipedia policy supports these proposed edits? Zad68 12:36, 1 January 2013 (UTC)

WP:NOT, WP:NPOV, WP:NOR, WP:V, WP:RS, WP:CITE, and WP:MOS These facts and sections would be included because they are verifiable,not written from a particular point of view, are notable, and are not original research. Wikipedia's goal is to compile the sum of all human knowledge. Readers who speak only english should not be denied this information for that reason alone.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:34, 1 January 2013 (UTC)

This is a rather vague and self-contradictory, and therefore unconvincing reply. Zad68 14:09, 1 January 2013 (UTC)

These policies are rather important, straightforward and written in plain english- as is the point about access to information and language barriers -which bit are you having trouble understanding?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:34, 1 January 2013 (UTC)

This response does not address the points I raised. Zad68 16:13, 1 January 2013 (UTC)

I think our differences revolve partly around your saying "emphasis" when you mean "exclusion" . A guiding principle here could be that facts about death or damage to children by a generally unnecessary body modification should always be included as a baseline . Thus emphasis would be a secondary consideration. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:21, 1 January 2013 (UTC)

Regarding your statement, A guiding principle here could be that facts about death or damage to children by a generally unnecessary body modification should always be included as a baseline .--where is support for this found in Wikipedia policy? Please specify the exact policy page and quote the relevant part of policy. Zad68 21:34, 1 January 2013 (UTC)

We are building an encyclopedia. Every editor knows that. We do so by engaging in the principles listed 12 lines up. In this instance reliable sources recorded these injuries and the resultant lawsuits and gender modifications as a result of the MC activity which is the subject of this article. This is not a matter of opinion or pseudoscience but of fact. If one were to have to single out just one policy to justify inclusion of a fact it might be WP:ASF. Did you have a reliable source proving that these events did not occur ? Did you that feel they are insignificant or not notable ? :::::::::::::The entire section above which I lifted from the Genital Modification and Mutilation article actually belongs in the main MC article. It is not about mutilation but damage from MC and legal redress.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:23, 2 January 2013 (UTC)

WP:ASF isn't a policy, it's not even a guideline. Are you saying that facts (any and all facts) should be stated as long as they can be sourced? Is that what you are saying should be the guiding principle behind article development? Zad68 03:40, 2 January 2013 (UTC)

Illogical extension of an argument and going from the particular to the general are transparent, puerile, and futile debate stratagems unworthy of an experienced editor.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:21, 2 January 2013 (UTC)

While there is moderate risk of falling into reductio ad absurdum, I concur with Zad's assessment of your reasoning. It appears that you're trying to sidestep NPOV, undue weight and questionable relevance by saying the content must be included simply because it's sourced and falls into the subject area, while seeking policy cover shrouded in sophistry. It won't matter, the RfC is clearly going down in flames. ► Belchfire-TALK 09:37, 2 January 2013 (UTC)

Another issue I have is with sourcing. We do not use popular press, primary research or case reports for medical content. Please support content with high quality secondary sources such as review articles. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:05, 2 January 2013 (UTC)

THis is a legal matter as reported in the Atlanta and NY newspapers. Medical content criteria not applicable. Also WP:USEPRIMARY is worth a look. There are valid uses of primary sources even in medical articles, e.g., but one may not use non-independent primary sources to de-bunk or challenge the conclusions of independent and secondary sources, or even to pretend that all these sources are equally valid (per WP:GEVAL) Conversely misusing the UNDUE and MEDS guidelines to blanket exclude information makes for a peculiarly skewed article --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:36, 2 January 2013 (UTC)

We do not typically allow case studies as refs for major medical topics. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:10, 2 January 2013 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

A wealth of material excluded from this article by the interpretation of Wiki guidelines of those currently controlling the article

Here are two other snippets in addition to the MC death and gender reassignments of infants information in the USA alone which have been excluded from this article so far. http://www.canada.com/cityguides/ottawa/story.html?id=cb3b8281-4134-46ba-85d3-b076072bda75&k=25810 Here the "plastibell' device which apparently reduces the amount of surgical trimming and cutting off of skin in neonatal MC was the cause of death. Canada has a vastly lower % of MC than USA I wonder if such deaths should be mentioned in the article ? Here is an expert outlining some of the downside of MC. http://www.youtube.com/watch?v=DD2yW7AaZFw I agree with the editor who several entries ago asserted that the article is looking more like a promo leaflet for MC than a description of it. Two editors will not even permit the use of the verb "cut" in the opening paragraph but keep reverting to "separated" and "removed" as euphemisms for "cut" and " cut off". Such minimizing borders on the ludicrous --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:25, 1 February 2013 (UTC)

Agreed, this article is rife with pro-MGC euphemistic language where before it at least attempted to acknowledge both sides of the argument. Tobias8844 (talk) 17:32, 1 February 2013 (UTC)

Tumad., how your edit violated WP:V was already explained to you carefully elsewhere. Everyone needs to refer to WP:MEDRS for Wikipedia's sourcing guidelines for biomedical information. If you have WP:MEDRS-compliant sourcing you'd like to discuss, feel free to provide the PMID for it. Zad68 17:42, 1 February 2013 (UTC)

Neutrality of this article seems to have vanished

I have not looked in on this page for almost 4 months and it now reads like a pro circumcision pamphlet. All of the cons of circumcision have been buried, downplayed or simply deleted. Garycompugeek (talk) 22:02, 29 January 2013 (UTC)

The article was restructured as required to comply with WP:MEDMOS. The sourcing was entirely updated as required to comply with WP:MEDRS. Many of the sources that were being used before were very out-of-date. On Wikipedia, neutrality means accurately and proportionally representing what's found in the reliable sources. Is there a specific area of the article where you think the article content isn't accurately and proportionally representing what's found in the reliable sources? Zad68 22:16, 29 January 2013 (UTC)

Hello Zad. I have been out of touch lately. Last I saw, you had written a well balanced intro that I endorsed. I will not post it here to waste space but if any are curious feel free to check the page back in August and compare. You will find a very differt flavor article and a much more balanced approach. I shall not name names but in the past certain editors did their best to only allow pro circ sources and have con sources regulated to sub articles. As this article stands, can you honestly say you are fairly representing the prevalent international world opinion based on availible current sources? Garycompugeek (talk) 17:03, 30 January 2013 (UTC)

I went back the August 1 2012 version of the article lead and went through it line-by-line comparing it to the current lead. I'm surprised you feel so strongly that it is significantly different. There have been two types of changes since August 1. First, there has been general copyediting for WP:WTW compliance, terseness, clarity, and also the individual sentences of the lead have been reordered per WP:LEAD to match the WP:MEDMOS layout of the article sections (Technique, Indications, Effects, etc.). These changes largely did not change what information was carried in the lead. Second, lead was made to match the updated sourcing, and in particular, the coverage of sexual effects now reflects the best-quality sources (see other conversations regarding that in recent Talk page archives), and the poorly-sourced and not very informative mention of "poorly determined" psychological effects was removed after a Peer Review discussion with Casliber (a Featured Article reviewer who happens to be a psychiatrist). Content-wise, what is in the current lead probably still matches what was found August 1 by 95%, so, I'm puzzled why you're having this reaction. Zad68 17:51, 30 January 2013 (UTC)

Re, your direct question, "As this article stands, can you honestly say you are fairly representing the prevalent international world opinion based on availible current sources?" -- Just because a source is 'available' and 'current' doesn't mean it is a WP:MEDRS-compliant reliable source. I think the article does fairly represent the current consensus of the best-quality reliable sources. Zad68 17:57, 30 January 2013 (UTC)

Missing are all of the recent sources tying male genital cutting to erectile dysfunction, eg Frisch et al 2011. In fact, I don't see ED mentioned at all--the words "erectile" and "dysfunction" do not appear to occur in this article. What gives? Where's all the data about sexual dysfunction? 2011 is very current source material. Tobias8844 (talk) 17:28, 1 February 2013 (UTC) 06:03, 1 February 2013 (UTC)

Hi Tobias8844, as I mention above, just because a source is 'current' doesn't mean it's a reliable source by Wikipedia standards. Wikipedia's sourcing standards for biomedical information can be found here: WP:MEDRS. You mentioned Frisch 2011 but didn't specify which exact source you're talking about, but I'm going to guess you mean this?

There are two major problems with using: First, it's a primary study, and we already have several excellent-quality secondary sources covering this subject, and per WP:MEDREV we do not use primary studies to contradict secondary sources. In addition, the AAP technical report issued last fall had access to this survey's results and so can be expected to have taken them into account when producing its findings. Second, that source is a cross-sectional survey and so per WP:MEDASSESS falls near the very bottom of Wikipedia's evidence quality scale. For an interesting overview of the kinds of biases found in questionnaires, see Choi's A Catalog of Biases in Questionnaires. Also, surveys are notorious for being subject to self-selection bias - people who have problems are much more likely to respond than people who don't. I'm not saying that this particular problem is present in Frisch 2011 (although it is a concern with a response rate under 50%), but I'm explaining why Wikipedia's medical sourcing guidelines put survey data near the bottom in evidence quality.

So please review WP:MEDRS and keep it in mind when reviewing other sources for possible use in sourcing biomedical information on Wikipedia. Cheers... Zad68 14:28, 1 February 2013 (UTC)

The AAP statement is flawed in the same way this article is: it specifically fails to mention the research linking MGC to ED and it makes no mention of the deficiency of nerve endings after MGC...not even as simple and obvious an acknowledgment as "fewer nerve endings remain in the penis after MGC than before it" occurs in the AAP statement. Unlike Wikipedia, the AAP has a vested financial interest in promoting MGC and can't be taken as a neutral authority (re it is a bad source)...Wikipedia, meanwhile, can take advantage of the (usually) Asian and European research which has little or no vested interest in promoting MGC and therefore seldom does. This Talk section is very well taken; before neutrality completely vanished, there were sections discussing sexual function and discussing the fine touch nerve endings which are nearly entirely ablated during the procedure. These two issues, loss of sexual function and the married concept of loss of nervous function, are the most robust medical arguments against MGC, and they are now entirely censored from the article on MGC. It seems to have occurred by design.

But all right, the AAP has issued a new statement (to resounding criticism), and that statement is reflected in this article, fine. So where is the criticism of the AAP statement in this article? If we are going to use the AAP statement for its "currency" and its status as a secondary source, then were are the statements of virtually every other pediatric association worldwide which have reviewed the same evidence and then contradict it? More specifically, where is the statement of the German Pediatric Association, which specifically condemns the AAP's statement for ignoring sexual and nervous issues? http://www.intactamerica.org/german_pediatrics_statement

There was even a subarticle entitled "sexual effects of circumcision" which seems to have disappeared as well...however, some of the pro-MGC research on that article remains in this one, whereas the anti-research does not. At a bare minimum, the German statement should appear in this article along with any other pediatric association statement which fulfills the criteria for recency. Tobias8844 (talk)

You are correct in noting that the AAP's report is considered a reliable source on Wikipedia. The statement you link to appears to be one of many arguments in an ongoing debate in Germany over making religious circumcision explicitly legal. It does take a number of shots at the AAP but I'm not really seeing what use that statement could be for this article, this article isn't the place to host a debate between the AAP and other organizations. Zad68 17:49, 1 February 2013 (UTC)

The AAP is in the EXTREME minority endorsing MGC. Virtually every other pediatric association in the developed world does NOT endorse MGC, and you don't see how that is relevant to this article? Why doesn't the article reflect the fact that the AAP is the only one that came to this conclusion, despite the same evidence being available to all? How is the AAP statement relevant and the GPA statement irrelevant? The answer seems to be because one endorses MGC and the other does not.

In truth, they're both relevant because the subject is controversial. This article does not even acknowledge the breadth of the current controversy! Indeed, the GPA is lobbying the German government to ban MGC of minors, and they have medical arguments in favor of that ban! Is the AAP the only organization that should be paid attention to? Are German pediatricians just no good?

It has become quite obvious overnight how neutrality was spirited away from this article. In any reasonable, objective forum, medical statements from the AAP and GPA would both be paid attention. Tobias8844 (talk) 17:59, 1 February 2013 (UTC)

In fact the AAP does not 'endorse' routine infant circumcision. A review of the positions of world's major medical organizations is in the article, and the article already states that no major medical organization recommends either universal circ or banning it. The article does already have coverage of the ethics involved in the debate, and I've never run across a specific argument from any partisan, pro or anti, that isn't covered by it. If you have a PMID of a source we can review it. Zad68 18:07, 1 February 2013 (UTC)

The GPA statement I linked is more current than the AAP statement. I have yet to hear an argument against including it--why isn't the GPA statement here, immediately after the AAP statement? The review on the statements of other medical organizations is obscured at the very end of the article and completely neglects to mention that the AAP is the only organization leaning in favor of MGC. It also fails to mention that almost all pediatric groups are opposed--instead, it notes that most don't advocate routine MGC or a ban. There's a big difference between acknowledging that the other organizations are opposed and saying "They don't want to require it or ban it". Meanwhile, the AAP's statement is mentioned much earlier in the article and none of the criticism of that statement is mentioned.

Some more thoughts: there are various issues omitted from the "Adverse effects" section. 1. Amputation neuromas. They occur after not ten percent, not fifty percent, but one hundred percent of foreskin amputations. Neuromas conduct abnormal sensations to the brain, were before nerve endings were conducting normal nervous signals to the brain. 2. Reduction in nerve endings, in particular Meissner's corpuscles. One hundred percent of cases subtract from the finite number of nerve endings on the male genitalia. 3. Destruction or extensive damage to the frenar band, which occurs in one hundred percent of cases. The frenar band is an important anatomical structure, in no small part because it is the most sensitive region on the penis to fine touch. 4. Damage to the interior musculature of the penis, which occurs in one hundred percent of cases. 5. Disruption of the normal circulatory network of the penis.

Again, the AAP statement is not to be preferred: it does not mention any of these effects (which, as I have tirelessly emphasized, occur in ALL cases). The AAP also conveniently neglects to mention its own conflict of interest, which is that its members profit from ongoing MGC. Compare to the Frisch et al. study, in which Frisch discloses that he is opposed to MGC. Tobias8844 (talk) 22:52, 1 February 2013 (UTC)

I haven't read your complete posts, because I want sources to do the talking. While you might have a point, a doctor speaking publicly does not carry as much weight as an official organizational policy/statement. From a quick glance at the link above, the statement is hosted at http://www.kinderaerzte-im-netz.de/bvkj/show.php3?id=1 What is that website? And how do we know that organization would qualify for WP:MEDRS? From a quick google search, http://www.dgkj.de/metas/english_summary/ that seems to be a website of a respected German organization. Do you know their stance? Biosthmors (talk) 22:30, 2 February 2013 (UTC)

So you're saying the source you're referring to does not have a PUBMED ID? The argument against using it is that it doesn't appear to meet Wikipedia's requirements for sourcing biomedical information. An "expert statement" (that's what the title of document says it is) made as a lobbying effort made by an individual to a legislature isn't normally where we look for biomedical sourcing. WP:MEDRS puts expert opinion at the very bottom of the WP:MEDASSESS hierarchy. (It may not be totally relevant but it's interesting to note that the position this document was lobbying for was eventually rejected by the German legislature, which ended up voting overwhelmingly to "to keep male circumcision legal" according to the Deutsche Welle story.) I understand that this statement is somehow tied to the German BVKJ and other organizations; we actually already have an excellent secondary source in use in the article that provides a summary of the world's major medical organizations, and the organizations mentioned are not listed among them. As a further note, the translation appears to have been provided by the activist organization Intant America, which wouldn't be considered a WP:RS for this, and at the very least we'd need an official translation if we're to use any of it. I understand that something is supposed to be published in Pediatrics soon, we've been notified about it before, why don't we just wait for that and see what it is and how it might be useful?

Regarding "some more thoughts", if you have WP:MEDRS-compliant sources to support your statements, please bring them forward, include PMIDs if available. We need excellent-quality WP:MEDRS-compliant sourcing for all biomedical claims. Zad68 03:35, 3 February 2013 (UTC)

I agree with some of the other people who have posted that this reads like a pro-circ pamphlet. I also understand the calm voice saying "yes but... sources... yes but...". However, at the very least, there should be a "controversy" section... and not one buried under the "Society and Culture" section. A specific section devoted to the very obvious controversy about this issue. The US (and increasingly Africa) seems to be the only place that this mutilation is seen as normal by secular people. It is decreasing at a steady rate, but I don't want to have to wait until the old guard just dies out before we can have a reasonable wiki page about the issue. 71.58.11.158 (talk) 01:29, 4 February 2013 (UTC)

GA Review

This review is transcluded from Talk:Circumcision/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Jmh649 (talk · contribs) 22:12, 29 January 2013 (UTC)

Here are the description of what a good article should be (GA) and a guideline on engaging in the good article review process http://en.wikipedia.org/wiki/GA_criteria and http://en.wikipedia.org/wiki/Wikipedia:Reviewing_good_articles I hope that this article can achieve the balance required to meet this standard in the future.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:59, 31 January 2013 (UTC)

Will review

Over the next while. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:12, 29 January 2013 (UTC)

POV problem

The article is currently not suitable for GA status at all. It is not neutral. It presents what may look superficially like a balanced presentation, but from a point of view that is obviously American or similarly pro-circumcision. The US is unique in that it still practises male infant circumcision on a large scale for non-religious reasons. Some specific problems:

"No major medical organization recommends universal circumcision for all infant males or banning the procedure." This is misleading. The Royal Dutch Medical Association (KNMG) states in its position paper, which is referred to elsewhere in the article: "There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as exists for female genital mutilation. However, the KNMG fears that a legal prohibition would result in the intervention being performed by non-medi-cally qualified individuals in circumstances in which the quality of the intervention could not be sufficiently guaranteed. This could lead to more serious complications than is currently the case."
"Significant acute complications happen rarely, occurring in about 1 in 500 newborn procedures in the United States. [...] There is an estimated death rate of 1 infant in 500,000." This is badly in need of globalisation, onas the numbers will likely be significantly worse in some countries.
"Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction." This statement is seriously POV and supported through selective quotation. Decreasing sensitivity has always been the main purpose of circumcision (although the article does not seem to mention this fact anywhere), and some studies have shown it is effective.
The words shock and trauma do not appear even once in the article. These are very significant adverse effects of infant circumcision. When the prepuce is torn off the penis, many infants fall into a shock that makes them go through the following extremely painful operation without crying or indeed any reaction. Some studies have measured this pain. Others have documented circumcision-induced trauma after a year or even in teenagers. The KNMG paper says about this and the previous point: "Alongside these direct medical complications, psychological problems and complications in the area of sexuality have also been reported, as have extreme pain experiences in newborns causing behavioural changes which are still apparent years later. Similarly, the high social costs of circumcision as a result of complications have been cited."
There are countless citations to a severely biased advocacy document: American Academy of Pediatrics Task Force on Circumcision (2012). It was written by a committee of circumcision advocates. The literature review in this document has a cut-off date right after a number of major studies that would have significantly changed the outcome if they had been included. There is a lot of convincing criticism of the paper here: [6] (It's an activist source, but that does not invalidate the concrete, verifiable points of criticism such as: "In its recommendations for future research, the AAP report calls for research into potential benefits [and complications]. There is no mention of future research into the harm [as opposed to complications].")
"There is strong evidence that circumcision reduces the risk of HIV infection in heterosexual men in high-risk populations. [...] Whether it is of benefit in developed countries is undetermined." This is very one-sided. To quote the KNMG position paper again: "Due to the large number of medical benefits which were wrongly ascribed to circumcision, it is frequently asserted that circumcision is ‘a procedure in need of a justification’. In recent decades, evidence has been published which apparently shows that circumcision reduces the risk of HIV/AIDS, but this evidence is contradicted by other studies. // Moreover, the studies into HIV prevention were carried out in sub-Saharan Africa, where transmission mainly takes place through heterosexual contact. In the western world, HIV transmission is much more frequently the result of homosexual contact and the use of contaminated needles. That the relationship between circumcision and transmission of HIV is at the very least unclear is illustrated by the fact that the US combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The Dutch situation is precisely the reverse: a low prevalence of HIV/AIDS combined with a relatively low number of circumcisions."
Just like the AAP advocacy paper, the article makes no attempt to weigh the purported benefits of circumcision against the adverse effects. The KNMG has done this, and the result was not favourable for circumcision.
No discussion of male circumcision is complete without a comparison with female genital mutilation, especially with female genital mutilation of types Ia and Ib.
The more politically correct term male genital mutilation is never used or mentioned even once in the article, although that title redirects to it.
Judaism: This section misses the chance to mention the motivations for circumcision in Judaism. According already to Maimonides: "One of the reasons for it is, in my opinion, the wish to bring about a decrease in sexual intercourse and a weakening of the organ in question, so that this activity be diminished and the organ be in as quiet a state as possible. [...] In fact this commandment has not been prescribed with a view to perfecting what is defective congenitally, but to perfecting what is defective morally. The bodily pain caused to that member is the real purpose of circumcision. None of the activities necessary for the preservation of the individual is harmed thereby, nor is procreation rendered impossible, but violent concupiscence and lust that goes beyond what is needed are diminished. The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable. For if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened. The Sages, may their memory be blessed, have explicitly stated: It is hard for a woman with whom an uncircumcised man has had sexual intercourse to separate from him. In my opinion this is the strongest of the reasons for circumcision." The latter reason of course points to possible adverse effects later in life, or even earlier for those who are less sensitive to begin with. Maimonides has been very influential on this topic.
The article says "Circumcision may be medically indicated for phimosis [...]". This is a way to avoid saying that there is less invasive treatment for phimosis and that the prevalency of phimosis diagnoses is primarily a function of the prevalency of non-therapeutic circumcisions, and that almost every diagnosis of phimosis in a very young boy is deceptive or the result of violent or otherwise inappropriate 'hygienic' interventions, usually due to misinformation.

I don't think this list is complete, but I will stop here for now. Hans Adler 21:47, 8 February 2013 (UTC)

The common thread that I see running through the statements made by intactivists is a human-anatomy version of "The Bumblebee Can't Fly!" (see, e.g., http://www.straightdope.com/columns/read/1076/is-it-aerodynamically-impossible-for-bumblebees-to-fly). They think that circumcised men must be crippled, their sex life diminished, because they cannot imagine it to be otherwise. They ignore the evidence of a billion circumcised men enjoying rich, pleasureful sex lives. Just like the aerodynamicist in the apocryphal tale could not figure out a way for the bumblebee to stay aloft, the intactivists cannot figure out a way for circumcised men to experience rich, fulfilled sex lives with their partners, hence they think this must be impossible. So they spend much of their waking hours selectively compiling data to validate their hypothesis while ignoring everything that would invalidate it.188.107.215.90 (talk) 00:35, 9 February 2013 (UTC)

This is a medical topic. You don't seem to be taking it seriously if you resort to such cheap rhetoric tricks. If you have something serious to say, I suggest that you do it and remove this comment and my response as an unnecessary distraction. Hans Adler 01:04, 9 February 2013 (UTC)

Sorry if my previous comment displeases you. On the other hand, you will surely agree that purple prose such as "There are countless citations to a severely biased advocacy document: American Academy of Pediatrics Task Force on Circumcision (2012)." is unlikely to win over many people to your camp. --188.107.215.90 (talk) 03:20, 9 February 2013 (UTC)

Well, that's what it is, whether you like it or not. And here it seems to be treated like a Cochrane review or something. Totally inappropriate. Hans Adler 08:20, 9 February 2013 (UTC)

Zad has done an excellent job addressing issues of concern in his recent edits. As I do not see further significant concerns I am passing this as a GA. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:39, 12 February 2013 (UTC)

That was a very slight improvement that made next to no difference. The article is still severely POV. Passing it in this state was very inappropriate. Hans Adler 18:32, 12 February 2013 (UTC)

Final Review

GA review (see Wikipedia:Good article criteria and WP:GACN)

Well written.
a (clear and concise prose which doesn't violate copyright laws, grammar and spelling are correct): b (MoS for lead,layout, word choice, and fiction:
Factually accurate and verifiable.
a (well-referenced): b (citations to reliable sources): c(Wikipedia:No original research):
Broad in its coverage.
a (covers major aspects): b (well-focused):
Neutral .
Fair representation, no bias:
Stable.
No edit wars nor disputed contents:
Illustrated appropriately by images.
a b (appropriate use with suitable captions):
Result: Good work, keep it up! Doc James (talk ·contribs · email) (if I write on your page reply on mine) 15:36, 12 February 2013 (UTC)
Pass/Fail:

NOT GOOD ENOUGH YET

I contest the assertion that this article is accurate, broad in coverage,neutral,stable and that the illustrations are adequate. I feel the GA pass was given prematurely. There is and has been for some time a fierce debate going on in the talk pages about content and emphasis and many disputed and reverted recent edits. For these last two reasons(content debate and edit wars) the Good Article status is generally expressly not granted. Why were they ignored here ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:40, 13 February 2013 (UTC)

Agreed. The article looks like a war zone between pro-circumcision and anti-circumcision parties, just like the subject itself. The pro-circumcision side seems to have an upper hand right now, so listing this as a good article only makes sense to me as a victory from their point of view... A truly terrible representative of the ideals of Wikipedia. NosferatuBatman (talk) 23:19, 1 March 2013 (UTC)

blanket reversion of 5 edits with no discussion and bizarre assertion of including unsourced material

Zad, you left a message on my talk page asserting that I had included unsourced material and your opinion that I may be consequently blocked just after you reverted 5 edits with no discussion from the article on Male Circumcision. Please explain your actions and your statements.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:59, 1 February 2013 (UTC)

Tumadoireacht, your edit: removed "after inspection" but inspection is required; changed "separated" to "cut" which is simply not true, the separation is done with a blunt instrument; changed "foreskin is removed" to "foreskin is cut off" which isn't true in the case of a Plastibell circumcision (one of the most common types), in which the Plastibell clamps around and causes the foreskin to necrose and separate, which is why the more general "removed" is more accurate than "cut off"; added a duplicate mention in paragraph 2 of the lead that it may be "undertaken for aesthetic, religious, or cultural" reasons, and this information is already in paragraph 3. Please stop changing article content away from what sources say. If you'd like to discuss further you should start a new discussion topic at the article Talk page. Zad68 17:02, 1 February 2013 (UTC)

Zad -

!/inspection is a given for any surgical procedure- by your rationale perhaps we should also mention that a surgeon wears gloves or scrubs up ?

2/Plastibell (which killed at least one child in Canada recently) may be used in USA but involves slicing flesh and trimming skin as well as its necrotizing effect. You can read about it here http://en.wikipedia.org/wiki/Plastibell Also the sentence begins "In a typical procedure" typical where exactly ? In a USA hospital ? A synagogue? A north african campsite ?

3/If, as the WHO rightly states in the first article in the reference section that the majority of MC is for religious or cultural reasons then this should take precedence in the first paragraph over prominent mention of the likes of phimosis which does not even apply to neonatals -the largest group of involuntary recipients of this procedure.

4/ Your assertion of "unsourced material " as justification for your 5 reverts remains a mystery--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:46, 1 February 2013 (UTC)

"Inspection" is explicitly stated in the reliable sources as one of the steps involved in the procedure. Take a read through a layman's description of the Plastibell procedure here, "The Plastibell works on similar principles to the Gomco clamp, except rather than the foreskin being cut, the blood supply to the foreskin is stopped, so that the foreskin tissue dies (or 'necroses') and eventually falls off (within 7 to 12 days) after the procedure." This article is organized by WP:MEDMOS so the follows the article structure: technique and indications, effects, history, society and culture - there is not need to add duplicate material to the lead as you were suggesting. Changing article content to introduce material not found in sources, as you did, is addition of "unsourced material", see WP:V. I made one revert, not five. Zad68 17:58, 1 February 2013 (UTC)

Direct quotes from the Plastibell site cited by Zad "The top of the foreskin is then cut vertically down about 1 cm from the tip of the skin to where it meets the head of the penis" and "Sometimes excess foreskin is trimmed from around the bell using scissors or a laser and then the bell is removed" No cutting ? Please ! Inspection is rightly not mentioned in this source and is in any case not pertinent as it always occurs. Points 3 and 4 remain unaddressed. You reverted 5 edits. "explicitly stated " !- we do not include 'padding' material in articles --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:26, 1 February 2013 (UTC)

The article content you are suggesting changes to is a paraphrase of the following paragraph found on pp. e757-8 of the source cited:

The 3 most common operative methods of circumcision for the newborn male include: the Gomco clamp, the Plastibell device, and the Mogen clamp (or variations derived from the same principle on which each of these devices is based). The elements that are common to the use of each of these devices to accomplish circumcision include the following: estimation of the amount of external skin to be removed; dilation of the preputial orifice so that the glans can be visualized to ensure that the glans itself is normal; bluntly freeing the inner preputial epithelium from the epithelium of the glans; placing the device (at times a dorsal slit is necessary to do so); leaving the device in situ long enough to produce hemostasis; and removal of the foreskin.

The source's "so that the glans can be visualized to ensure that the glans itself is normal" is paraphrased in the article as "inspection". If as you say inspection "always occurs" (and the source cited and quoted above agrees with you) then that's a strong argument for including it in this article, not removing it. The step regarding the opening of the foreskin is already in the article, "this sometimes requires a dorsal slit"; this is not the step that removes the foreskin, as you appear to misunderstand. Regarding 3, I already did address the placement of the phrase regarding non-medical reasons for circumcision. Regarding 4, as has already been carefully explained before, your introduction of content into the article unsupported by the sources is indeed by definition adding unsourced content. You also need to read the WP:3RR instructions to clear up your misunderstandings about how Wikipedia counts a 'revert'. Zad68 03:05, 3 February 2013 (UTC)

It does aid clarity to read policy before glib citing of it. WP:3RR red herring in this instance-member of a growing shoal.

Gomco ? "The Gomco clamp is left in place for about five minutes to allow clotting to occur, then the foreskin is severed using a scalpel." and "Probably over 75% of circumcised American men born between 1950 and 1980 were circumcised with a Gomco clamp or a variant" 67 % at other times. Still stoutly adhering to the "lets just use euphemisms for cutting" in MC mindset ? The article also lacks stats on how many MCs are performed by which method worldwide amongst its numetous other lacunae but some of the religious groups who inflict MC require bleeding to occur.

The "blunt" "separation" initially that drags the foreskin away from the glans generally produces some bleeding in neonatals as phimosis is the natural state at that stage. Heaven forbid that we mention that prominently though !

Instead the first paragraph as presently defended blithely refers to solving phimosis !

Mogen clamp is apparently less painful for the victim than the Plastibell but "The glans is not visualized before removal of the foreskin[" - two more infant boys had their glans chopped off using this tool in USA in 2007 and 2011. Lets not mention them in the main article though.

The most common clamp necrotizing this article is none of the three sometimes used but a metaphorical one.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 05:46, 4 February 2013 (UTC)

Mogen clamp should have that content, in my opinion. Also, if you have good sources on usage, please help edit the article. Biosthmors (talk) 18:21, 6 February 2013 (UTC)

Americas

There were two edits that were made to the section Americas, and they introduced a few problems. First, the edits added a source from the conference proceedings of the activist organization NOCIRC (but no new article content was added). Generally we would not expect a partisan source like this to have the kind of reputation for fact-checking required to meet WP:RS, and actually we have evidence for this: a few months ago, there was a proposal to add article content from another conference proceedings document from the same group, and on investigation we found it was misrepresenting the study it was using. This problematic source is unnecessary anyway because there is already a good source for the existing content, so I've removed it. Second, the use of Doyle was expanded in the Americas section to mention Polynesians and Aborigines, which are off-topic in Americas, so I've trimmed the quote, and also paraphrased, which is preferred. Zad68 14:21, 6 February 2013 (UTC)

Edit request on 6 February 2013

This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

Suggested Psychological effects on New Born circumcision and later in life.

Studies conducted on the possibility of Psychological Trauma have been suggested and have been supported by studies. After a review of the surprising abilities of infants and their responses to circumcision pain, the long-term psychological effects of circumcision are examined from the perspectives of both traditional and more recent, innovative psychological theories. We learn that circumcision has potential effects not only on men and sexuality, but also on mother-child relationships, male-female relationships, and societal traits and problems. The text is supported with clinical reports, interviews, surveys, and thorough documentation.

Source: http://www.circumcision.org/cht.htm

The Jewish Circumcision Resource Center issued a statement to Jewish Americans last week to encourage critical thinking about circumcision and dispel various cultural misunderstandings about the practice.

“We want Jews to know that in this country and abroad, some Jews do not circumcise their sons. Circumcision is a choice, and now that we know the serious harm caused by circumcision, there are strong reasons to forgo it,” said Ronald Goldman, Ph.D., Executive Director. Dr. Goldman is the author of Questioning Circumcision: A Jewish Perspective, endorsed by five rabbis.

Dr. Goldman also suggests that Jews think about the ethics of causing significant pain and cutting off a natural, healthy body part that has important functions. “There are psychological effects of circumcision, too. Some Jewish men are very dissatisfied, angry, or distressed about being circumcised,” said Dr. Goldman.

Source: http://www.icgi.org/2011/06/jewish-group-questions-circumcision-cites-harm/

It is noted in psychoanalytic literature that operations actually performed on the penis, such as circumcision, arouse castration fears whatever the level of libidinal development, and facilitate the development of homosexual trends in boys (Fenichel, 1945).

Source: http://onlinelibrary.wiley.com/doi/10.1111/j.2044-8341.1965.tb01314.x/abstract

More listed complications of circummcision: http://www.circumstitions.com/Complic.html

XantorAmnobius (talk) 18:07, 6 February 2013 (UTC)

Please see WP:MEDDATE and understand that we are an encyclopedia. We don't just randomly add things because we like them or happen to agree with them. Maybe reading over Wikipedia:What Wikipedia is not would help. Biosthmors (talk) 18:15, 6 February 2013 (UTC)

large unaddressed omissions in this article

There seems to be little research material included in this article on what % of circumcisions take place outside of "First World" hospital settings and the outcomes of these.

Here is one unreferenced but indicative source

Bungoma district, Kenya: Assessment of traditional and medicalised male circumcision The study, which was conducted to establish a pre-training baseline assessing safety of male circumcision in resource-poor settings found high rates of adverse events for both medical (17%) and traditional circumcision (35%). The most common were profuse bleeding, infections, pain, insufficient foreskin removal and torsion. The study findings highlight what could go wrong if providers are not well trained and adequately equipped to perform male circumcision in hygienic settings with good post-surgical follow-up.

UNAIDS/CAPRISA Consultation on Social Science Perspectives on Male Circumcision for HIV Prevention 18-19 January, 2007

If there are up to 35% complications in such high risk HIV regions involving open penile wounds how does this affect the susceptibility of the sufferer to HIV and other infection ? No available or acceptable research on this ????

Also the information on the % breakdown of MC methods used everywhere is missing from the article, as is the information on how painful the three clamp/necrotizing methods of lopping off the penis top and glans cover are compared to each other.

What percentage of male babies worldwide are sliced with a knife and no antiseptic or pain relief at all ? No one could know from this article. (How do these numbers compare with similar field female circumcision numbers ?)

There are no photographs of circumcision in the article. The arm and leg clamps used in neonatal circumcision are not mentioned or shown.

Glaring omissions such as these need to be addressed. The peer review that recently closed and the current "Good Article" candidacy have so far failed to consider such central omissions--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:20, 7 February 2013 (UTC)

We could speculate about the effects on HIV transmission... or look to the MEDRS that are already cited, showing a significant reduction of HIV transmission in those randomized to circumcision in resource-limited countries. Phrases like "sliced with a knife" don't convey a sense of neutrality. -- Scray (talk) 23:18, 7 February 2013 (UTC)

What term or phrase would you prefer to use to distinguish medical industry circumcisions from tribal, religion, or cultural group ones where a scalpel or a scalpel/clamp combo is not used and where the cutting takes place outside a "medical "setting ? The limited sub saharan studies that were cut off short for ethical reasons really do not cut it (puns almost inevitable here)--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:58, 8 February 2013 (UTC)

My preference isn't really important - reliable sources are. I don't think they reflect the point you're trying to make. -- Scray (talk) 01:08, 8 February 2013 (UTC)

The downside of the "reliable sources": mantra chorus (limiting references to a narrow medical interpretation of MC activity) is that a précis of the current article would read : Circumcision is wonderful and also essential to protect primitive tropicals from their promiscuous ways --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 01:35, 8 February 2013 (UTC)

Circumcision as a major cause of meatal stenosis

Here is the Meatal Stenosis article on WP

Studies have indicated that male circumcision contributes to the development of urethral stricture. Among circumcised males, reported incidence figures include 0%,[1] 0.01%,[2] 0.55%,[3] 0.9%,[4] 2.8%,[5] 7.29%,[6] 9-10%,[7] and 11%.[8] In Van Howe's study, all cases of meatal stenosis were among circumcised boys.[6] When the meatus is not covered by the foreskin, it can rub against urine soaked diapers resulting in inflammation and mechanical trauma.[7] Meatal stenosis may also be caused by ischemia resulting from damage to the frenular artery during circumcision.[6][7][9] In non-circumcised males, meatal stenosis can occur where phimosis or lichen sclerosus is present.[10][11]

Here are the references

^ Sörensen SM, Sörensen MR (1988). "Circumcision with the Plastibell device. A long-term follow-up". Int Urol Nephrol 20 (2): 159–66. doi:10.1007/BF02550667. PMID 3384610.

^ Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE (July 2006). "Trends in paediatric circumcision and its complications in England between 1997 and 2003". Br J Surg 93 (7): 885–90. doi:10.1002/bjs.5369. PMID 16673355.

^ Simforoosh N, Tabibi A, Khalili SA, et al. (November 2010). "Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell". J Pediatr Urol 8 (3): 320–3. doi:10.1016/j.jpurol.2010.10.008. PMID 21115400.

^ Yegane, R.A.; A.R. Kheirollahi, N.A. Salehi, M. Bashashati, J.A. Khoshdel and M. Ahmadi (May 2006). "Late complications of circumcision in Iran". Pediatr Surg Int 22 (5): 442–445. doi:10.1007/s00383-006-1672-1. PMID 16649052.

^ Griffiths, D.M; Atwell JD, Freeman NV (1985). "A prospective survey of the indications and morbidity of circumcision in children". Eur Urol 11 (3): 184–7. PMID 4029234.

^ a b c Van Howe, R.S. (2006). "Incidence of meatal stenosis following neonatal circumcision in a primary care setting". Clin Pediatr (Phila) 45 (1): 49–54. doi:10.1177/000992280604500108. PMID 16429216.

^ a b c d e Angel, C.A. (June 12, 2006). "Meatal stenosis". eMedicine. Retrieved 2008-09-07.

^ Stenram A, Malmfors G, Okmian L (1986). "Circumcision for phimosis: a follow-up study". Scand. J. Urol. Nephrol. 20 (2): 89–92. doi:10.3109/00365598609040554. PMID 3749823.

^ Persad, R.; S. Sharma, J. McTavish, C. Imber and P.D. Mouriquand (January 1995). "Clinical presentation and pathophysiology of meatal stenosis following circumcision". British Journal of Urology 75 (1): 91–93. doi:10.1111/j.1464-410X.1995.tb07242.x. PMID 7850308.

^ Parkash, S.; S. Jeyakumar, K. Subramanyan and S. Chaudhuri (August 1973). "Human subpreputial collection: its nature and formation". The Journal of Urology 110 (2): 211–212. PMID 4722614.

^ Buechner, S.A. (September 2002). "Common skin disorders of the penis". BJU Int 90 (5): 498–506. doi:10.1046/j.1464-410X.2002.02962.x. PMID 12175386.

I do wonder why this fails to be mentioned in the absurdly short Adverse Effects section . Perhaps some shepherd editor of the article in its current form, keen on GA status could attempt to explain this omission.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:13, 2 February 2013 (UTC)

Maybe it should be mentioned, but that article is not ideal. I've tagged it. Please provide content that follows WP:MEDDATE. Biosthmors (talk) 22:19, 2 February 2013 (UTC)

Maybe instead the article editorial coterie might get around to acknowledging that the history of ideas and practice around MC has rarely been obliging enough to match the logic of WP:MEDDATE. Too many interested editors of this article seem incapable of recognizing the illogic. As one old beekeeper said of an arcane book on bees - it is all very well but it is such a shame that the bees cannot read --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:48, 3 February 2013 (UTC)

I don't follow. Are you suggesting medical articles should not follow WP:MEDRS? Biosthmors (talk) 18:19, 6 February 2013 (UTC)

Are you suggesting cultural articles should be limited by your interpretation of what guidelines say is proper for medical articles ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:08, 7 February 2013 (UTC)

Tumadoireacht, the subject you have raised is meatal stenosis, which is a medical condition, not a cultural issue, and the references you have listed above are all medical in nature. Are you suggesting that discussions of medical issues not follow WP:MEDRS? Jayjg ^(talk) 17:19, 8 February 2013 (UTC)

Meatal Stenosis is an ailment caused in this case by an archaic practice (MC) involving damaging one sensitive body part and slicing off another very sensitive body part often performed by persons with no medical training for cultural reasons and mostly inflicted on restrained subjects who cannot speak or defend themselves ? Is that medicine or did I miss something ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:45, 10 February 2013 (UTC)

Talk pages are not for ranting. How would you like to improve the article, using policy and guidelines? Biosthmors (talk) 18:49, 10 February 2013 (UTC)

Interesting that you report experiencing a realistic description of MC in response to your question on" medical" as a "rant" Tell me more of why this is. Could it be that by referring to "rant" that you are ducking answering the point ? I have made many suggestions on improving the article. Here we are discussing the artificial and misapplied standard which you and others champion leading to an unbalanced article --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:24, 10 February 2013 (UTC)

tl;dr. additional unproductive rant noted. Biosthmors (talk) 20:35, 10 February 2013 (UTC)

Is "rant" a code for views expressed on article content or improvement that do not tally with one's own ? Has any editor found this a useful approach in the past ? Could it be that repeatedly labelling the good faith contributions of another editor as 'rant' (instead of attempting finding consensus) is an "unproductive" exercise in itself and contrary to WP:AVOIDYOU, civil or wiki etiquette.

According to the above references stenosis and artery damage occur in up to 11% of circumcisions in rich countries The article also lacks material on the stats of these conditions occurring under the more primitive circumstances where circumcision is performed in poorer or more primitive cultures or those outside of medical settings everywhere, but they are unlikely to be better - physical damage or death resulting from cultural bodily mutilitation such as this supersedes the merely medical. I suppose that in this instance my suggestion is that for this reason we abandon the rigid interpretation of circumcision as a medical phenomenon which seems to have, until now, prevented the article from considering such sequalae, to its detriment. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 23:15, 10 February 2013 (UTC)

Which of "the above references" are WP:MEDRS-compliant? That would probably be the best place to start. Jayjg ^(talk) 23:34, 10 February 2013 (UTC)

Per WP:MEDRS "Peer reviewed medical journals are a natural choice as a source for up-to-date medical information in Wikipedia articles." but my point here is a different one - the one in bold lettering in my previous entry -THIS IS NOT A MEDICAL PHENOMENA -even if some medical personnel conduct some of these procedures AND if some of the resulting damage is recorded sometimes in medical material- it is primarily a CULTURAL phenomenon and thus WP:MEDRS is not an overriding consideration here. If the "secondary sources" so beloved of several editors who are on this article a lot have not yet caught up with the death and damage to victims of MC reported in popular press,legal journals, and primary medical journals then it behoves us to include such information until such time as they do.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:17, 11 February 2013 (UTC)

I'm afraid I'm confused now, and I apologize for that. I believe you've opened a discussion in this section about meatal stenosis, and given a list of ten or so medical studies regarding it. While I agree that circumcision is not purely a medical phenomenon (as the article itself points out at length), do you not think that meatal stenosis, the specific topic of this Talk: page section, is a medical condition? If not, then why bring all those medical studies here as examples of relevant sources? Jayjg ^(talk) 01:13, 12 February 2013 (UTC)

References number 34 and 56 seem to link to the same page

References number 34 and 56 seem to link to the same page--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:57, 11 February 2013 (UTC)

Tumadoireacht, you created this duplicate ref problem when you added it in this edit. The text you added with this edit was also a copyright violation. Please take more care in the future. I have fixed the errors, see next section. Zad68 15:20, 11 February 2013 (UTC)

Yikes. Really, Tumado? I hope that's not true. Biosthmors (talk) 17:58, 11 February 2013 (UTC)

Where are we on length?

Could this article stand to have some prose added (per WP:LENGTH)? Biosthmors (talk) 18:30, 11 February 2013 (UTC)

We are already over 50k of readable prose and per WP:SIZERULE we really should not be expanding this article significantly. This is already a very mature WP:Summary style article with lots of subarticles, which is where a lot of the content being discussed should go, if it isn't there already... most if not all of the content being proposed is already covered on English Wikipedia in this article or its subarticles. Zad68 18:38, 11 February 2013 (UTC)

Thank you for this revealing reaction. Hans Adler 18:46, 11 February 2013 (UTC)

That wasn't necessary. Biosthmors (talk) 18:53, 11 February 2013 (UTC)

According to the tool that I am using, we are at 40kB of text only readable prose size, so adding a bit more before restructuring is not a big problem. No doubt some of the stuff on contested very minor effects on various extremely rare diseases will have to go to subarticles. This is not why people circumcise. It is transparently a post facto rationalisation that can be summarised with little loss to this article, so long as it is discussed elsewhere. Hans Adler 18:48, 11 February 2013 (UTC)

~~What tool are you using? I didn't know there was such a tool available, I have just been doing character counts in my editor.~~ Nevermind I found one. Zad68 18:52, 11 February 2013 (UTC)

WHO global Trends and Determinants 2007 pdf

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

This is a huge useful source and outlines some of the horrific stats and procedures in non clinical circumcisions missing from the WP article. It is easy to read. It also considers social class and circumcision unlike WP. It is the first reference currently cited.

Here is the summary from the Medical indications, Clinical Procedures and Safety of Male Circumcision section

Male circumcision is medically indicated for only a few conditions. There is substantial evidence that cir- cumcised men have a lower risk of some reproductive tract infections, as well as penile cancer, but some of these conditions are rare while others are uncommon or treatable, and routine neonatal circumcision is not currently recommended on medical grounds. The safety of male circumcision depends crucially on the setting, equipment and expertise of the pro- vider. Neonatal circumcision is a simpler procedure than adult circumcision, and has very low rates of adverse events. Adolescent or adult circumcision in clinical settings can cause bleeding, haematoma or sepsis, but with no long-term sequelae when undertaken in a clinical setting by experienced, well- trained providers. In contrast, circumcisions under- taken in unhygienic conditions, by inexperienced providers with inadequate instruments, or with poor after-care, can result in serious complications and even death.

Does any editor feel that these conclusions are well reflected in the WP article ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 02:59, 11 February 2013 (UTC)

Every one of these points is already currently covered in the article, please take a careful read of what is actually in the article. Also the WHO doc is from 2007 and we have updated secondary sources we're citing too, but that WHO doc is one of the best sources of prevalence data. Zad68 05:17, 11 February 2013 (UTC)

Where is death mentioned in the brief adverse effects section?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:07, 11 February 2013 (UTC)

Seems like it could be mentioned, but we don't want to use it as a scare tactic. Do we have any idea how often death occurs in substandard conditions? Do we have any idea how often poor-care is used out of all circumcisions? Getting one's ear pierced can cause an infection and I assume one can possibly die if you just let it take over. Isn't that how it is for all procedures that break the skin? This isn't exactly news. Biosthmors (talk) 17:57, 11 February 2013 (UTC)

Basically yes, but this operation doesn't just break the skin. In infant circumcision, this is what happens: First you have to tear the foreskin off the glans. (That must hurt like hell, and according to some studies this is where many babies fall into a trance-like state that is easily mistaken for tranquility but really a shock state.) And then there is quite a bit of cutting. The resulting wound consists of the glans as well as the edge of the remaining foreskin. One can easily fail to keep such a big wound in the diaper clean.

I have often seen an estimate of 2 circumcision-related deaths per year in the US. In less advanced countries the numbers will be a lot worse due to poor sanitary conditions, lack of awareness of hemophilia etc. According to the Talmud, after two boys have died due to circumcision, a family should not circumcise any further boys. That sounds as if historically the statistics weren't very good. (For perspective: The same also applies to mediaeval baptism when it still involved complete submersion in cold water. At some point that was replaced by a more symbolic practice.) Hans Adler 20:05, 11 February 2013 (UTC)

Tumadoireacht asks "Where is death mentioned in the brief adverse effects section?". I've just read the Adverse effects section, and noticed this sentence:

There is an estimated death rate of 1 infant in 500,000 procedures.

It appears to have been there for some time. I hope that's helpful. Jayjg ^(talk) 01:40, 12 February 2013 (UTC)

Tumadoireacht has changed the above-quoted sentence to:

A position paper from one USA medical organisation gives an estimate of a death rate of 1 infant in every 500,000 circumcision procedures conducted within the USA.

I consider this an improvement as it adds precision. 79.243.94.219 (talk) 22:06, 13 February 2013 (UTC)

Potential source

PMID 22971182 but I don't have access to it. Has anyone read it? Biosthmors (talk) 21:12, 12 February 2013 (UTC)

Download it from here. It's an editorial, is the author's opinion notable? Zad68 21:14, 12 February 2013 (UTC)

The article very clearly describes the European mainstream view on circumcision, although of course as an editorial it does not claim so explicitly. Hans Adler 21:21, 12 February 2013 (UTC)

I've read many such opinion statements like this from advocates on both sides, and the arguments made all fall into the categories covered by the ethics section. I'm not sure exactly what use this could be to the article? Zad68 21:24, 12 February 2013 (UTC)

I think we have done a good job separating discussing into "routine neonatal circ" which is not recommended by any major organization except in parts of Africa. And therapeutic circ which is useful for the treatment of some difficulties. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:27, 12 February 2013 (UTC)

Hans, if this article were indeed biased, I would expect this document to express a viewpoint that has not yet been expressed in the article. Is that the case? Biosthmors (talk) 21:30, 12 February 2013 (UTC)

Have you read it? Let me know if you still don't have access. The document doesn't prove anything, of course, and is not directly usable. But at least 70% of what it says would come as a big surprise to any reader of this article who previously knew nothing about circumcision or foreskins. It discusses the legal, human rights, social and political dimensions. Here is the last sentence: "It is surprising that using children as mere means to satisfy parental religious or cultural needs should be considered acceptable in the 21st century version of Immanuel Kant’s homeland." The author declared a potential conflict of interest: He was circumcised for medical reasons and is not troubled by it.Hans Adler 22:09, 12 February 2013 (UTC)

Of course it's directly usable. (Yes that link worked, thanks Zad.) We could attribute it to the author if nothing else if it will help this article improve. See the NPOV and history section problem. We don't have to contribute to that problem. Biosthmors (talk) 00:51, 13 February 2013 (UTC)

I do not think that would be a good idea. As I asked earlier, is the opinion of this person notable? The last thing this article needs is a huge WP:QUOTEFARM of quotes from or even paraphrases of articles by this person, and this person, and this person, and this person, etc... Each one of these would be an WP:UNDUE and inappropriate use of primary sources, each article being a primary source of the opinions of each person. Who says each person's opinion is notable, or representative? What we need are neutral, independent reliable secondary sources covering the debate and the opinions. I will try to find this. Zad68 01:01, 13 February 2013 (UTC)

I don't understand the question: "is the opinion of this person notable?", and I'm not calling for a quotefarm. (Notability is a concept used only in article deletion discussion, AFAIK.) Bioethics published it, so it's expert opinion, worthy of inclusion to satisfy NPOV. If we had one paragraph that paraphrased or quoted 3 to 5 experts or organizations with viewpoints not otherwise represented (in an encyclopedic way) I don't see the harm. Biosthmors (talk) 01:09, 13 February 2013 (UTC)

Wikipedia has lots of rules that direct us not to just include everything that mentions the article topic. WP:MEDRS and WP:UNDUE are two for starters. How will we decide which three people to include? What criteria will we apply to choose them? "This guy because I know he's important" or "I like what he says" aren't good criteria. Zad68 01:19, 13 February 2013 (UTC)

MEDRS applies to biomedical information, which this information is not. I assume we'd get it out of respected journals or textbooks. Biosthmors (talk) 01:25, 13 February 2013 (UTC)

(ec) I really, really agree with Zad68 on this point, except that MEDRS doesn't matter as the editorial would presumably not be cited for medical claims but for facts/opinions related to ethics. But UNDUE does apply.

By the way, many editors refer to the quality required for inclusion in an article, which is analogous to notability but more local, as noteworthiness. I have found that it helps in discussions to always keep the two apart clearly in your own discourse, but quietly assume that other people mean noteworthiness when only that makes sense, even when they say notability. Hans Adler 01:31, 13 February 2013 (UTC)

The commercial use of babies' foreskins and the promotion of neonatal circumcisions for this purpose

Another subject this article fails to present, the use of babies' foreskins in the cosmetic industry, who extract the fibroblast and use it in cosmetic creams and injections. You can read the articles in the San Francisco Chronicle, Americanhealthandbeauty, about the brands SkinMedica and Allergan.
This commercial use (and the selling of foreskins by hospitals who perfomed the neonatal circumcision, as stated in this book), initiated a debate over the promotion of neonatal circumcisions, notably in South Africa (see this article).--83.199.29.194 (talk) 22:27, 12 February 2013 (UTC)

The topic should probably be mentioned very briefly, but the reporting is probably a little sensationalist. This could be a better source, for example. Hans Adler 22:35, 12 February 2013 (UTC)

This suggestion has come up before, the appropriate place for this content is at foreskin, where I believe it is already covered. Zad68 01:10, 13 February 2013 (UTC)

That's not completely clear, as this topic seems to play a role in the circumcision controversy, which needs to be summarised in the present article. In the same way that the Aspartame article mentions some bizarre attacks against the sweetener in summary style because they are noteworthy for the topic, it's conceivable that we might ultimately decide that this conspiracy theory worthy material is noteworthy in the appropriate context. I don't have a strong opinion yet, but overall I doubt it. In the as yet unwritten article circumcision controversy it would certainly belong, though. Hans Adler 01:48, 13 February 2013 (UTC)
The french language wikipedia article on circumcision contains a strong well resourced section on the market for human foreskins the product of the cultural practice which our article here purports to cover.

It is titled Sale and commercial use of children's foreskins in medical products and in cosmetics It references cosmetic product names SkinMedica and Allergan, the sale from USA hospitals of the cut off foreskins, the growth of cloned skin from harvested foreskins and the anticipated multi million dollar industry in sales which will result from the circumcision promotion in South Africa.

But this of course does not belong in the english language circumcision article because -oh just because {[MED SCHMED]} dontcha know. Even if you do not speak french it is worth going over the chapter headings in the french article to see the vast area and divisions of material on the subject which are being excluded in this article- diminished sexual pleasure, psychoanalytic perspectives,a country by country breakdown, recent human rights fights against circumcision - you know all the stuff that is unopposed in the female genital mutilation article.... The sections considering medical evidence are also far better balanced and less inclined to just selectively pluck out the pro circumcision stuff from secondary sources.

Here is a translation of the first paragraph of the french article Circumcision(from the latin to cut around) is in its most practiced form the total ablation of the prepuce thus leaving the glans of the penis uncovered.Per the WHO in 2009 661 milion men of over 15 years old will be in a circumcised state, that is about 30% of the world male population. Ritual circumcision has been practiced for cultural and religious motifs since ancient times. In judaism ir is called brit milah. Although not mentioned in the koran, circumcision is practiced all over the muslim world, being most often considered as a sunna. It is also practiced by members of certain oriental religious orthodox churches.

Compare that with the first paragraph of the english article which was yesterday, wrongly in my opinion been given "good article" status in contravention of the good article guidelines as the content in still hotly disputed. But it gives a flavour of how out of kilter our article is.

The french article contains well written and researched sections on the effects on sexuality and on many of the other obvious topics which are not permitted to be mentioned here.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:02, 13 February 2013 (UTC)

Edits from 11 Feb 2013

I have reverted some edits from 11 Feb 2013 due to the following issues:

A copyright violation was introduced as copyrighted text from the AUA's website was copied and pasted into the article. The information can be used but not by creating a copyright violation like this.
Duplicate material was added to the lead regarding WHO's statement that they do not recommend universal neonatal circumcision, but this is already covered in the same paragraph in the lead two sentences later, where it says "No major medical organization recommends universal circumcision for all infant males" and this includes the WHO.
The Effects section was renamed Positive and Adverse Effects but the extra words are unnecessary
A duplicate AUA Policy reference was added
Qualifying complications as 'medical' is a pleonasm

Zad68 15:20, 11 February 2013 (UTC)

Qualifying complications as 'medical' is not a pleonasm. This is not a purely medical article because circumcision as a primarily cultural practice is not, perhaps not even primarily, a medical topic. The fact that in large part this article pretends otherwise is part of the problem with it.

On 4th November 2010, a physician in Cologne committed criminal assault on a four-year-old Muslim boy by carrying out a non-therapeutic circumcision on him under local anaesthesia. He committed the offence on request of the victim's parents. The request was religiously motivated. Afterwards he sutured the trauma and, in the evening, further treated the victim medically at the victim's home.

On 6th November 2010, the victim was brought to the emergency room of Cologne's university clinic for the treatment of secondary haemorrhage, a medical complication. According to press reports, it was a serious one: the boy nearly died.

The clinic staff informed the prosecutor's office, which then charged the perpetrator with one count of aggravated assault. This was not a medical complication, it was a legal complication of the circumcision.

On 21 September 2011, the perpetrator was acquitted of aggravated assault, based on the local court's opinion that the operation was socially adequate and the parents' consent was sufficient. On the same day, the attorney's office appealed against the local court's decision. This was a second legal complication.

On 7 May 2012, the district court decided that the offence constituted criminal assault, but not aggravated assault because a scalpel, when used normally by a surgeon in the course of an operation, is not a dangerous weapon in the sense of the German criminal code. Due to his age, the victim was not able to consent. The parents have a right to religious education, but the child's right to physical integrity and self-determination takes precedence. The social adequacy of the offence cannot mend the fact that the parents cannot consent to this permanent, irreparable body modification.

Despite this finding of criminal assault, the district court acquitted the defendant. It found that due to subjectively correct behaviour and a mistake of law he did not know that he was committing a crime. It found further that the mistake of law was inevitable because the legal literature is divided over the matter and there were no precedents.

Even though the defendant was acquitted, this was a significant social complication. Hans Adler 17:46, 11 February 2013 (UTC)

It's significant, but is including it encyclopedic? Do you see a section this kind of content might be summarized under? Or is a section missing, in your opinion? Might there another article it would fit better in? Not all circumcisions are the same, is there a specific page for the specific procedure in this scenario? Biosthmors (talk) 17:54, 11 February 2013 (UTC)

As far as I know it was a standard circumcision as they are performed by physicians on that age group. I have no further information on this and doubt that it is available in public. The press never mentioned that anything other than the medical, legal and social complications was remarkable about it. My point here was simply that "medical complication" is definitely not a pleonasm.

The Cologne decision was the first time that a recent shift in the international legal literature has made it into a court decision. In my opinion it is notable enough for its own article. It is certainly noteworthy in this article, though of course not in great detail. One or two sentences will be enough so long as the general legal problem is discussed in greater detail. [added 18:31, 11 February 2013 (UTC)]

There isn't just a section missing here, it's several points of view on the topic that are missing in the article:

the general medical point of view from medically advanced countries with low circumcision rates (important because the single strongest predictor for whether a child will be circumcised, apart from the parents' religion, is where applicable the circumcision state of the physician or the physician's sons)
the point of view of cosmetic surgery
the point of view of sex (after all we are talking about a body modification performed on the genitals, so issues such as penile sensitivity, lubrication, masturbation and circumcision fetishism are absolutely on topic)
foreskin restoration as an approximate reversal of circumcision (bizarrely, currently not once mentioned or linked from this article)
the legal point of view (human rights - positive/negative religious, children's and physical; legal comparison to gender assignment, FGM and child sex abuse)

There may be a need to move some material to subarticles, but that must happen in a balanced way and per WP:Summary style#Avoidance of POV forks. This is not supposed to be the article how and why to perform circumcisions. Hans Adler 18:22, 11 February 2013 (UTC)

I will try to address some of these concerns this week, thanks. Biosthmors (talk) 18:25, 11 February 2013 (UTC)

"On 4th November 2010, a physician in Cologne committed criminal assault" False. The trial court acquitted, the prosecutor then appealed and the next-higher court found the defendant guilty of assault but excused due to ignorance of the law. Almost certainly this finding would have been overturned on appeal but the defendant had no standing to appeal as he had not been punished. The resulting legal uncertainty moved the German parliament to explicitly legalize what had always been permitted, albeit with a few modern safeguards tacked on.

Assuming they exist, any reports in the German press that the "boy nearly died" should be taken with more than a grain of salt. Due to a communication problem -- the boy's mother (who is legally blind) was from out of town, she spoke no German or English and was hysterical due to some hemorrhaging from the boy's wound -- the hospital doctors mistook her to say that the boy had been circumcised under unsanitary conditions by a non-qualified person and rushed to take what they felt to be corrective action: they re-cut the entire operation under general anesthesia. Whether that was the wisest course of action is unclear.

As a non-native speaker of English, Adler may not be aware that "complications" in the context of a medical article implies "medical". For legal consequences, the noun to use is not "complications" but, well, "consequences". 79.243.67.196 (talk) 18:56, 11 February 2013 (UTC)

The district court found the physician to have committed criminal assault, but without guilt. The decision cannot be appealed, so it holds and my first sentence was correct. If it had been appealed, the matter might have ultimately landed before the European Court of Human Rights. As the physician had not even tried to pretend medical reasons, the result would have been rather obvious. Food for thought: My religion requires me to cut off my children's little fingers and little toes so that they don't resemble the Highest Being too strongly. Should I be allowed to have that done? Surely the ECHR would not think so.

The law decided by the Bundestag was a travesty, pushed through ignoring the advice of the German Ethics Council (that anaesthesia is required) and the Federation of German Paediatricians (no circumcisions under the age of 14) as well as 70% of the population. It has been constructed so poorly that after an appeal to the German supreme court either male circumcision will be illegal again or FGM type 1a will be legal.

Thanks for the detailed information about what happened. Clearly you know more than I do about the specific circumstances, so I won't hunt for the newspaper article from which I got the information. I am aware of how unreliable newspapers are on details.

I don't know what kind of speaker of English you are, IP address from Frankfurt, but in English the word "complication" has more than one meaning, just like in German. [7] Definitions 1d and to a lesser extent 1b or even 1a are perfectly applicable to my use of "legal/social complication" above. Hans Adler 19:36, 11 February 2013 (UTC)

Please keep in mind the policies of Wikipedia regarding etiquette on Article Talk pages. 79.243.67.196 (talk) 19:58, 11 February 2013 (UTC)

In any case the place for what Adler is suggesting be included is here. That sub-article could also use some clean-up; some of what it's in there belongs in another sub-article, "Circumcision controversies". 79.243.67.196 (talk) 20:18, 11 February 2013 (UTC)

There is a policy, guideline or essay for everything. Hans Adler 20:09, 11 February 2013 (UTC)

Maybe so, but as I understand it, policies -- unlike guidelines, let alone essays -- are mandatory and you ignore them at your peril. 79.243.67.196 (talk) 20:18, 11 February 2013 (UTC)

If they are mandatory, why do a handful of editors here disregard them and continue to impart a pro-circumcision bias here? Why did a handful of editors support an editor who violated COI for many years? Let's think about that for a moment. Crimsoncorvid (talk) 17:29, 12 February 2013 (UTC)

I mentioned WP policies with regard to Adler's WP:SOAPBOXING on this Talk page. In particular his characterizing as "travesty" the Bundestag's 434-to-100 vote in favor of keeping circumcision legal. Do you have any comment to add on Adler's behavior? 79.243.94.219 (talk) 21:52, 13 February 2013 (UTC)

How about you get an account. Your IP carries no weight with me. I see you're here to promote a pro-circumcision agenda, so I'm really not interested in what you have to say. My point is valid and yours is not. Crimsoncorvid (talk) 03:57, 14 February 2013 (UTC)

Use of the "circumstraint" for neonatal circumcisions

As this article talks about the Gomco clamp, Plastibell and Mogen clamp, it should aslo talk about the device used to immobilize children during neonatal circumcisions. This device, the circumstraint (i don't know if it's the brand or the broad term) is very specifically used for neonatal circumcision in order to attach the child. --83.199.29.194 (talk) 20:58, 12 February 2013 (UTC)

This should absolutely be part of the article. A pic should be included as well. Crimsoncorvid (talk) 04:19, 13 February 2013 (UTC)

Please cite WP:RELIABLE sources that can be used for the purpose you desire. How widely is this device used? --79.243.94.219 (talk) 21:55, 13 February 2013 (UTC)

Are you putting me on? For every single hospital circumcision. Crimsoncorvid (talk) 03:55, 14 February 2013 (UTC)

Still waiting for an explanation...

I am still waiting for an explanation of why the FGM article is approached from a human rights perspective and the male circumcision article isn't. Is there some medical benefit to any form of FGM that would justify a medical treatment of the FGM article? Think about it. Crimsoncorvid (talk) 04:03, 14 February 2013 (UTC)

We are here just to reflect the stance of the best available literature. So you would need to provide evidence that the literature approaches them the same.Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:00, 15 February 2013 (UTC)

A lot of literature does, but obviously it doesn't satisfy MEDRS standards because it's not medical literature in the first place. E.g. there are publications in peer-reviewed legal journals which discuss the legality of non-therapeutic circumcision. And there are entire books discussing the ethics of it. This topic doesn't get anywhere near the prominence that it deserves. The entire article is written under the assumption that cutting off parts of children's genitals is a perfectly normal and natural thing to do as long as you do it only with boys.

I can't make a concrete proposal yet as I am still collecting literature and have nowhere near a complete overview. Meanwhile the article needs a POV tag for this and many other reasons. An editor removed it under the pretext that it was just me complaining. It wasn't, as anyone reading this talk page can verify. I will restore it now.

The purpose of a POV tag is not as a badge of shame for the 'owners' of an article, it is to warn readers that they may not be getting neutral information. Therefore the only reason for removing it is if the article is actually neutral. The fact that the pro-circumcision party is stronger and more easily mobilised does not mean that the article is neutral in this state. Equilibrium of power among editors is not neutrality. For most articles it is a reasonable approximation, but not for highly controversial topics such as this one. Hans Adler 08:36, 15 February 2013 (UTC)

The POV template instructions explicitly say "Do not use this template to 'warn' readers about the article". Plot Spoiler (talk) 16:07, 15 February 2013 (UTC)

Interesting. I stand corrected. I do not agree with those instructions and do not think that they are normally followed, but I have to concede this point. I do not believe that this template does a good job of its official purpose, attracting additional editors of various viewpoints. On this article it is in fact more likely to exacerbate the systemic bias. I am sorry that I did not check the instructions.

Crimsoncorvid: Sorry for this distraction. I hope we can now return to the real problem. Hans Adler 18:01, 15 February 2013 (UTC)

Circumcision decreases penile sensitivity, new study (4 february 2013)

A new study has been released about this subject: Male circumcision decreases penile sensitivity as measured in a large cohort by Pr Hoebeke and five others, from the Ghent University Hospital (Belgium).

The new study surveyed 1,369 men over the age of 18, who responded to leaflets handed out in train stations across Belgium.(...)Overall, 310 men who took the survey were circumcised, and 1,059 were not. Each rated how sensitive their penis was on a scale from 0 to 5, with higher numbers being the most sensitive. Overall, uncircumcised men reported between 0.2 points and 0.4 points higher sensitivity and sexual pleasure when their penis's head - known as the glans - was stroked during arousal, compared to circumcised men.

Reuters report. It deserves to be added to the article.--90.59.135.85 (talk) 17:41, 15 February 2013 (UTC)

Already was discussed, see up this page. Zad68 17:52, 15 February 2013 (UTC)

MO of circumcision advocates here

I'm tired of this MO:

I propose a change and provide a source to a medical journal article or study
I am told this source is invalid as per Wikipedia policy
I restate that the source is valid providing proof citing a more appropriate Wikipedia policy
I am ignored until the original section is archived
I claim editors have an agenda; I get reprimanded for "personal attacks"; I am asked to restate sources if I really have a point
I restate sources, but I'm ignored again

This is all part of an agenda to keep the pro-circumcision bias in this article. Look back over this talk page. My valid points on many topics have all been ignored. These are direct questions to Jayg, Zad68 and Yobol. Let's grow up and resolve these issues. We have issues of penile sensitivity, masturbation, circumstraint, and ethics all pending. Where are the answers to my questions? Do I need to restate AGAIN? Or can you all search the archives as I've been told to do many times. Let me remind you all that I have tried being very very nice here. Now... not so nice. ;) Crimsoncorvid (talk) 04:24, 13 February 2013 (UTC)

Have you tried a RfC? Pick one issue. State that you want to change X to Y with X as sources. Than allow the community to weight in. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:06, 14 February 2013 (UTC)

I've done that many times. Are you kidding me? The pro-circ fanatics here deny scientific facts every time I present them. Crimsoncorvid (talk) 03:53, 14 February 2013 (UTC)

I'll repost this from earlier on the page since nobody responded: I have listed my problems with this section many many times in the past. Please search the archives. Furthermore, as you say: "Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources". Well in this case THERE ARE NO SECONDARY STUDIES that directly study the sensitivity of the foreskin. Once again, your pro-circumcision agenda is clouding your judgement. Please step up and give us an actual reason why the following studies can't be used: http://www.nocirc.org/touch-test/bju_6685.pdf http://www.ncbi.nlm.nih.gov/pubmed/17155977 http://www.ncbi.nlm.nih.gov/pubmed/23374102?dopt=Abstract . The scientific evidence is quite clear on this subject. Or wait, do we not care about science? I forgot. Crimsoncorvid (talk) 03:59, 14 February 2013 (UTC)

Wikipedia is based on discussion and consensus. If your proposals do not get community support there is not really much more you can do. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:58, 15 February 2013 (UTC)

In this case, Wikipedia is based on editor agenda. Please see this: http://intactipedia.org/index.php?title=Foreskin_Sensitivity . There are 43 sources stating that the foreskin is erogenous tissue and affects sex and masturbation. There are 5 opposing secondary studies listed in this article. There are 3 editors (not counting yourself) who consistently push a pro-circ agenda. The rest of the editors are like me and are trying (without success) to fix this article. Crimsoncorvid (talk) 12:33, 15 February 2013 (UTC)

Which study do you think had the strongest methodology? Please provide a PMID. Later in the week I can see what secondary sources cited it. I cited a source (the European perspective one) that cited one of the studies I think you mentioned, but there was no consensus to incorporate it into the article. Biosthmors (talk) 20:08, 16 February 2013 (UTC)

Missing sections from this Circumcision article

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

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

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

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

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

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

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

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

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

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

10/ Harvesting, sale price, and the many research, cosmetic, and cloned skin manufacture uses to which the cut off foreskins are put.

--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:15, 17 February 2013 (UTC)

More evidence for no HIV protective qualities in MSM

http://www.fridae.asia/newsfeatures/2013/02/18/12240.circumcision-makes-no-difference-to-hiv-infection-in-uk-gay-men

This is a more recent study than the ones that were referenced before. This would make every single study so far show that circumcision has no effect on HIV transmission among MSM. That sentence ought to be updated accordingly.

172.218.105.181 (talk) 05:26, 19 February 2013 (UTC)

New study

http://www.ncbi.nlm.nih.gov/pubmed/23374102?dopt=Abstract GothHick49 (talk) 03:49, 8 February 2013 (UTC)

Thanks... It's an interesting result. Per WP:MEDRS, as it's a recently-published primary study with a conclusion that contradicts the general consensus of high-quality, up-to-date secondary sources such as reviews, meta-analyses and statements of major medical organizations, we should hold off on including the result in the article until its findings have been picked up and reflected in those kinds of high-quality secondary sources. The fact it was an Internet-based self-assessment survey makes me think the evidence quality will be evaluated as low. Zad68 03:56, 8 February 2013 (UTC)

I respectfully disagree. Precisely because it contradicts the general consensus, and it itself conforms to WP:MEDRS as a qualified secondary or tertiary resource, it needs to be included. To do otherwise, is to censor, unduly. Tftobin (talk) 13:58, 8 February 2013 (UTC)

There is no such general consensus except in countries with a strong tradition of religiously motivated circumcision and, as a curious exception, also in the US. Wikipedia articles are not expected to be written with a US or religious point of view, and this is particularly important for medical (dis-)information. Hans Adler 00:31, 9 February 2013 (UTC)

Tom, sure, when there's disagreement it's always best to have respectful content-focused discussion, agree. In this case, this is a primary source, see WP:MEDRS#Definitions. This is a field where we already have multiple high-quality up-to-date secondary sources, they are in the article. Per WP:MEDREV, "Individual primary sources should not be cited or juxtaposed so as to 'debunk' or contradict the conclusions of reliable secondary sources." This is a very straightforward application of WP:MEDREV. Zad68 14:20, 8 February 2013 (UTC)

Zad68, are you kidding me? It is common knowledge that the foreskin is erogenous tissue. Medical consensus outside of the biased pro-circumcision American medical community does not agree with your statement. I've sent numerous sources to point that out. As I've stated before, we've forgotten the knowledge we've had 100 years ago. Worldwide medical sources know that the foreskin is erogenous. You folks at Wikipedia like to mis-use Wikipedia policy to misrepresent the truth and to promote an agenda. I'm sure of that now. This has nothing to do with accuracy and everything to do with promoting an agenda. As I've said before, look at the German article on this subject. Crimsoncorvid (talk) 17:46, 8 February 2013 (UTC)

This study does not meet the requirements per WP:MEDRS, WP:WEIGHT, WP:PSTS. We need to see relevant high quality secondary reviews to include this information in the article. Yobol (talk) 17:52, 8 February 2013 (UTC)

Well actually it does meet all of the necessary requirements. ScienceApe (talk) 00:15, 18 February 2013 (UTC)

Did you not notice that one of the strongest sources cited in support of the relevant article content is from a team based in Australia and funded by the Australian Government Department of Health and Aging? As far as I can tell, every one of the secondary sources cited reviewed and/or used data collected from around the world. Zad68 19:13, 8 February 2013 (UTC)

Wikipedia allows use of primary sources with care; you denying them in this case is nothing more than editorial discretion: bias. At least two studies now proving the foreskin is erogenous have been rejected by Zad68. Furthermore, secondary sources are merely interpretations of primary studies and peer review is rarely effective at vetting articles for conflict of interest: http://www.cochrane.org/news/blog/how-well-do-meta-analyses-disclose-conflicts-interests-underlying-research-studies . So the effect of Wikipedia's policy is to ensure that conflict of interest and bias makes its way to articles since editors are not allowed to vet articles! Australian, British, German, etc. medical organizations have all described the foreskin as erogenous tissue. Are you saying it isn't? Crimsoncorvid (talk) 19:29, 8 February 2013 (UTC)

What Australian study are you talking about? When I look at the citations in the article, they all have to do with STDs and HIV. Obviously those studies have an agenda. The only one that didn't have to do with STDs and HIV was the absolutely silly AAP study; the AAP is not a reliable source for circumcision information since they are promoters and have a conflict of interest. (Maybe you all should review that part of Wikipedia policy). Studies on HIV and STDs are not the most relevant studies for penile sensitivity. In fact, studies directly addressing penile sensitivity have been ignored by you folks. Again, this is a bunch of hand-waving and posturing in an attempt to act like you're "following Wikipedia policy". Crimsoncorvid (talk) 19:34, 8 February 2013 (UTC)

On large overview articles like this, there is almost never a need to point to primary articles like this. If the point you are trying to make is an important enough point to make, you can find that same point in a high quality secondary review source. If you can't find the same point in a high quality secondary review article, then that point is not important enough to include here. Rather than trying to argue to include this one primary reference, everyone's time would be better spent finding a high quality secondary source that says this, if you wish to include it. Yobol (talk) 19:45, 8 February 2013 (UTC)

Crimsoncorvid, this article follows WP:MEDRS for all medical information, as it must. These are not rules invented by any of the editors here, these are Wikipedia's rules. WP:MEDRS is quite clear: "Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources". If you want to remove this requirement from WP:MEDRS, please initiate a discussion at Wikipedia talk:Identifying reliable sources (medicine), but in any event please do not make arguments or proposals here based on "common knowledge", personal beliefs, articles on other Wikipedias, or any other sources that fail WP:MEDRS. Jayjg ^(talk) 19:52, 8 February 2013 (UTC)

As I've mentioned many times before, this article should NOT be bound to WP:MEDRS. Not one editor has ever explained to me why this article is subject to MEDRS when the FGM article isn't. I'm still waiting for that explanation. The difference in treatment is cultural bias and sexism. There are many in FGM-practicing cultures who claim that the FGM article should get medical treatment just as this one does (see FGM talk page archives if you don't believe me). Furthermore, all three of you (Yobol, Zad68, Jayg) do not exactly represent the paragon of following Wikipedia rules. You may remember an editor who ran a pro-circumcision website, published pro-circumcision studies, and participated in pro-circumcision advocacy across the internet. This is in clear violation of WP:COI. Per WP:COI: "Editors who may have a general conflict of interest are allowed to make certain kinds of non-controversial edits". However, this individual was allowed autocratic control of this article for 7 years and interjected tons of uncited (false) information including citations of his own studies. Zad68, though I don't agree with him in many ways did a good job of ridding the article of the horrible bias induced by this editor. Yet all three of you told me that this editor was doing a good job and was maintaining neutrality! Please don't piss on my back and tell me it's raining. I'm tired of playing this game where you guys keep saying "bring me the studies and we'll use them" when we DO bring the studies and you reject them for a myriad of reasons. What is at play here is an agenda, plain and simple. I am still waiting for Zad68 to provide me a link to this Australian study which I can't find in the citations for the claim in question that circumcision doesn't affect sexual function. Also, please note that my claim is that the foreskin is erogenous. Although it naturally follows that the foreskin would benefit sexual function, I'm not making that statement. SO, please tell me again why the 2 studies (fine-touch and the recent one) can't be used? There ARE NO SECONDARY STUDIES THAT DISPUTE THESE CLAIMS. The secondary studies you are talking about refer to sexual enjoyment. Foreskin sensitivity and affecting sexual pleasure are different. Another point is that masturbation is obviously affected by loose vs tight skin. There are references to this too, but this clear fact is not represented in the article. For your own edification, please ask an intact man if his foreskin is sensitive. Sure, that isn't a citation for Wikipedia, but it'll help you to understand the absolute silliness of this discussion. Crimsoncorvid (talk) 03:52, 9 February 2013 (UTC)

On the use of MEDRS here, there are two issues:

(1) Whether to use it. According to its second sentence, it applies to "the biomedical information in all types of articles". The guideline once said that it applies to medical articles. This was corrected on my initiative in late 2009. (See WT:Identifying reliable sources (medicine)/Archive 3#Scope of this guideline.) Circumcision is to a large extent a medical topic, but of course it has cultural, social, political dimensions etc. According to uncontroversial general practice, MEDRS is applicable to the medical aspects, but not to the non-medical aspects. IMO, the grey area in between must be handled flexibly.

(2) How to use it. Circumcision is a highly politicised topic in which diametrically opposite positions can be supported to MEDRS standard. There is a culture among medical editors of banging MEDRS on non-medical editors' heads and not taking their opposition seriously. To a large extent this is appropriate because laypeople often try to push positions that go against the mainstream. It does become a problem in the case of topics where the polarisation goes right through the medical community. This is one of them. This kind of thing should not happen with a scientific issue, but it's not the first time that it does.

Medical articles on the English Wikipedia tend to be dominated by American and to a lesser extent by British editors. This creates a systemic bias which is often not a big problem, but in this case it is. The two sides in the medical conflict around evaluation of the practice of non-therapeutic circumcision have roughly equal size globally, but with very unequal distribution locally. The US is firmly at one end, and I believe the UK is also skewed a bit in that direction within Europe. (Not completely sure about the UK.) But the US medical community, while at the spearhead of research in many areas, cannot be the ultimate arbiter of a medical controversy that is cultural in origin. Some day it will be enough to just follow MEDRS while considering primarily American sources, or while considering primarily European sources, because the most high quality sources in all regions will agree with each other. But we are not there yet.

The German Wikipedia does not have lower standards for medical topics than the English Wikipedia, although as always practices there are slightly different in the details. As everyone can imagine, the topic is getting a lot of attention there after the decision of the court in Cologne. This kind of attention is known to result in more balanced articles. The German article on the topic contradicts the present article to a large extent and discusses many significant issues that are not even mentioned here. Hans Adler 08:55, 9 February 2013 (UTC)

Hear, hear, Hans Adler. I have had this page on my watchlist for many years, and have occasionally tried to contribute, but it seems utterly unique among Wikipedia articles. There is a very strong self-supporting ethos in control here. I think it will need the combined efforts of people who are expert on WP policies with those who are expert in the topic in all its facets to break the cycle, which seems also to be supported from high in Wikipedia's administration. I look forward to the day when that process seems to have started. --Nigelj (talk) 12:45, 9 February 2013 (UTC)

"According to uncontroversial general practice, MEDRS is applicable to the medical aspects, but not to the non-medical aspects." The current editors do not seem to allow any non-MEDRS sources. A good example of this is the realm of penis sensitivity which is not entirely a "medical" issue persay. The ethical, psychological, and other aspects of circumcision are largely neglected here and the editors do not allow content on these topics if the content will put circumcision in a negative light. So I guess this is another area where the stewardship of the article is failing. Crimsoncorvid (talk) 13:26, 9 February 2013 (UTC)

Crimsoncorvid, are you sure you've read the entire article as it currently stands? Here is a link to it. If you read it through, you might note that one of the longest sections of the article is devoted to the ethical aspects of circumcision. Jayjg ^(talk) 17:19, 10 February 2013 (UTC)

Sometimes, I'm not sure if you're serious or joking, Jayg. That ethics section is lacking in uncountable ways and contains a strong pro-circumcision bias. Sorry, wrong, try again. Crimsoncorvid (talk) 15:20, 11 February 2013 (UTC)

I'm completely serious, Crimsoncorvid. I'm glad we both agree that there is, in fact, a lengthy discussion of ethics in this article, though you obviously disagree with its content. Now, I don't want to burden you with having to list every single one of the "uncountable ways" the section is "lacking" and "contains a strong pro-circumcision bias", but if you were to even list one specific issue (citing reliable sources, of course), I think that would help clarify the problems you see with the section, and will hopefully lead to its improvement. Jayjg ^(talk) 01:09, 12 February 2013 (UTC)

I have listed my problems with this section many many times in the past. Please search the archives. Furthermore, as you asy: "Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources". Well in this case THERE ARE NO SECONDARY STUDIES that directly study the sensitivity of the foreskin. Once again, your pro-circumcision agenda is clouding your judgement. Please step up and give us an actual reason why the following studies can't be used: http://www.nocirc.org/touch-test/bju_6685.pdf http://www.ncbi.nlm.nih.gov/pubmed/17155977 http://www.ncbi.nlm.nih.gov/pubmed/23374102?dopt=Abstract . The scientific evidence is quite clear on this subject. Or wait, do we not care about science? I forgot. Crimsoncorvid (talk) 14:56, 12 February 2013 (UTC)

Crimcsoncorvid, we were discussing the ethics section of the article, which you stated was "lacking in uncountable ways and contains a strong pro-circumcision bias". None of those sources you've provided appear to discuss ethics. Do you have any WP:MEDRS-compliant sources that discuss the ethics of circumcision, which might be used to improve that section? Jayjg ^(talk) 19:34, 18 February 2013 (UTC)

Masturbation more difficult in circumcised men

Besides being entirely obvious, a study backs up the fact that masturbation is more difficult in circumcised men: http://www.ncbi.nlm.nih.gov/pubmed/17155977 . Why we need a study to show that is beyond me. But there you go. Why don't we revert Yobol's last change and add that study as the citation. Crimsoncorvid (talk) 05:58, 9 February 2013 (UTC)

We use secondary sources such as review articles. And this is neither one of those. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:25, 9 February 2013 (UTC)

I am aware that Wikipedia prefers improperly-vetted (see http://www.cochrane.org/news/blog/how-well-do-meta-analyses-disclose-conflicts-interests-underlying-research-studies) secondary studies funded by special interest instead of citing the actual studies themselves. Furthermore, you are incorrect about Wikipedia policy. Wikipedia allows primary sources if they are used with care. This is a time when the policy says its acceptable as there are no secondary sources on the subject and the claims are quite obvious. According to the Wikipedia "Masturbation" page I quote: "Masturbating by gripping and sliding the foreskin back and forth" (there's an image). The absence of a foreskin would make this method impossible. Ergo, masturbation is more difficult since there are fewer methods with which to do it. You don't need research, just a brain and some common sense. Crimsoncorvid (talk) 16:01, 9 February 2013 (UTC)

We don't need meta studies to state that the sky is blue. The normal method of male masturbation makes significant use of the foreskin and is obviously impossible once that has been removed completely. That does not apply to all forms of circumcision, but it is perfectly obvious for complete foreskin removal. Even this very basic information is missing from the article, and there is no excuse for that. There is some serious POV pushing going on here. Hans Adler 16:07, 9 February 2013 (UTC)

We can include "The normal method of male masturbation makes significant use of the foreskin" with a normal source. I agree. It's more of a sexual thing than a medical or science thing. The study, meanwhile, concluded, "There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision", in part. There's a difference between what you said and what that study concluded. Is anyone aware of any highly respected human sexuality textbooks out there, by the way? We wouldn't want to leave out basic sexuality facts, in my opinion. Biosthmors (talk) 23:30, 9 February 2013 (UTC)

Has anyone done a database search to see if the primary study has been cited by any review articles? Biosthmors (talk) 23:31, 9 February 2013 (UTC)

Biosthmors, I believe that you may be missing the point. There are two issues here. One is that the lack of a foreskin makes masturbation more difficult. This is as obvious as the sky is blue. The other is that lack of a foreskin decreases masturbatory pleasure. Research is clear on this fact as well. It's also kind of obvious since it's an irrefutable scientific fact that the foreskin has 15k-20k nerves. It's also shown by a great deal of research that the foreskin is erogenous. Research into circumcision status and sexual intercourse enjoyment has shown mixed results, but generally tending towards circumcision being harmful to sexual enjoyment. Crimsoncorvid (talk) 00:57, 10 February 2013 (UTC)

From WP:CITE, "Wikipedia's Verifiability policy requires inline citations for any material challenged or likely to be challenged". Per the discussion above, we can all agree that probably there will not be a single statement in this article that will not be challenged, so that kind of content you are proposing will need a citation to a reliable source, just like every other statement in this article has. Zad68 05:09, 10 February 2013 (UTC)

Obviously. But I think the main point is that this is an example for how extremely biased this article is. I am really not interested in circumcision as I have never had the mythical hygienic problems and my foreskin is just fine, thank you very much, and I am about to reach an age where sensitivity will decline without such additional measures. I would much rather edit on mathematics, card games, metrology and linguistics. But the heavily cited disinformation through selective choice of sources that is evident in this article is a disgrace to the project.

I am pretty sure that this article presents some statements as facts because they have been stated by some highest-quality sources, ignoring that other sources of equally high quality have stated the opposite. And that it concentrates on purported benefits and reluctantly covers complications, while ignoring almost all regular adverse effects, even though they can be sourced just as well.

Going by this article, the KNMG must be a bunch of madmen on an anti-religious crusade, because in the article there is no grounds for saying that the only reason not to make non-therapeutic circumcision illegal is that it would still happen secretly. Not to mention the extreme sexism that is inherent in the difference of treatment between this form of MGM and the less intrusive FGM type 1a that is almost uniformly being rejected even as a substitute for the much more severe typical forms of FGM.

Making this article neutral would be a lot of work even for a team consisting exclusively of neutral medical experts, but it will no doubt be a Herculean task for laypeople. Unfortunately, due to the cultural pro-circumcision bias in the Anglosphere, it appears that most medical experts with no or anti-circumcision bias prefer editing in other languages and the task here will fall to laypeople. You seem to know this article very well. It would be really nice of you if you could help with this task. Hans Adler 13:01, 10 February 2013 (UTC)

Hi Hans. I've been reading your posts here, including your ones at the GAR above, and while I understand that you feel there are issues with the article, I must admit that I'm a bit mystified as to what is prompting your concerns or how they can be addressed. Are there specific sentences that you feel have not fairly summarized the sources they are cited to? Are there WP:MEDRS-compliant sources you feel should be cited but are not? Jayjg ^(talk) 17:17, 10 February 2013 (UTC)

I think I have explained that sufficiently elsewhere. I am not planning to be just complaining here, but I obviously haven't got a library full of books on medical ethics, human rights, paediatrics etc. So far all my research on this topic was relatively deep but aimed on forming a sound opinion on the German circumcision debate rather than on contributing to Wikipedia. I am going to privately prepare concrete proposals for this article, but this will take time. Hans Adler 22:32, 11 February 2013 (UTC)

It could be that Hans and other editors find the line

"Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction" in the tiny ten line adverse effects section which is tucked away under the HUGE positive effects section, every so slightly risible, when the diminishing effect has been acknowledged for several thousand years.

Add to this the prominent mention of curing phimosis in the first paragraph of the article when for the vast majority of victims of circumcision, phimosis is the natural state.

The utter absence of any section comparing and contrasting male and female circumcision is one of the HUGE faults of the article.

Many articles cite the 20,000 specialist nerve endings lopped off in male circumcision and contrast them with the 8,000 lost in female circumcision. Where are these facts considered in the article ? Oops -they are not here. Come on lads !--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:42, 11 February 2013 (UTC)

Thanks ⦿⨦⨀Tumadoireacht for echoing my sentiments here. I'm sure you can see their MO by now. They keep saying "tell us what the problem is and we'll fix it". Then you tell them what's broken and they won't accept changes. You give sources and they reject them. Then when you call them out on their scheme, it's a "personal attack". It's a perfect system to ensure the pro-circumcision bias. Crimsoncorvid (talk) 15:51, 11 February 2013 (UTC)

Tumadoireacht, it's difficult for readers of this discussion to evaluate the quality of the arguments being made here in the absence of reliable sources backing up those arguments. Can you assist us in that regard? Jayjg ^(talk) 01:04, 12 February 2013 (UTC)

Always delighted to help Jayjig - check out the french and german articles references aplenty here is one to get you started http://ije.oxfordjournals.org/content/early/2011/06/13/ije.dyr104.abstract--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:49, 13 February 2013 (UTC)

It's difficult when the archiving for this page is so frequent. I posted a very long list of resources a couple of weeks ago. Please search the archives. Both myself and other have made the sources both available and quite clear. To ask me to restate them is to waste my time. Crimsoncorvid (talk) 14:36, 12 February 2013 (UTC)

Tumadoireacht, it appears that that source is a self-selected, survey-based, primary source. WP:MEDASSESS therefore places it at lowest end of reliability, and, given that the article already has four high quality secondary sources that disagree with its conclusions, WP:MEDRS would indicate that it shouldn't be used. Do you have any secondary sources that support your arguments and comply with WP:MEDRS and WP:MEDASSESS? Jayjg ^(talk) 19:25, 18 February 2013 (UTC)

Neutrality and GA status disputed

I am disputing the neutrality of this article for the reasons I gave at Talk:Circumcision/GA1. The reviewer, Jmh649 (Doc James) pretended that these concerns had been taken into account, but that is transparently not true as only minimal changes were made to the article that did not noticeably improve the overall balance.

The article fails GA criterion 4 (neutral). It also fails criterion 3 (broad: addresses the main aspects, does not go into unnecessary detail) and it is clear that it is soon going to fail criterion 5 (stability; the content dispute is already there). In addition, there are problems with criterion 2 (verifiability: overuse of a biased source) and arguably with criterion 6 (not a single illustration of the operation). Hans Adler 18:52, 12 February 2013 (UTC)

Sure I read what you wrote and found issue with much of it:

Typically one does not refer to the statement produced by the American Academy of Pediatrics as "a severely biased advocacy document: American Academy of Pediatrics Task Force on Circumcision (2012). It was written by a committee of circumcision advocates." and an " advocacy paper"

The difficulty is no reliable sources use the "politically correct term male genital mutilation" thus we do not either

A number of things such as "Decreasing sensitivity has always been the main purpose of circumcision" are mentioned but without any reliable sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:09, 12 February 2013 (UTC)

Hans, what are your current concerns? I see the first one at the good article review doesn't appear to be valid anymore. I was trying to make sure the article is neutral, because you were disputing, but it appears that that first point you made about KNMG has been fixed. What are your current issues? Thanks. Biosthmors (talk) 21:27, 12 February 2013 (UTC)

And you could always strike (per WP:CHEAT) the ones that have been addressed over at the GA, although I bet you already know how to strike. That could be an easy way to do it. Biosthmors (talk) 21:40, 12 February 2013 (UTC)

Striking them would be a waste of time as the article is nowhere near neutral. It's about half written at this point, or three quarters tops. Hans Adler 21:57, 12 February 2013 (UTC)

(ec) It may not be typical to refer to the AAP committee and statement in this manner, but that's what it is. I gave the reason and it wasn't even discussed. The KNMG statement largely comes to diametrically opposed conclusions and contrary to the AAP statement does not factor into the overall presentation. That is not appropriate.

I am fully aware that due to general WP principles we cannot use the term MGM to refer to circumcision as a matter of fact. My concern was: "The more politically correct term male genital mutilation is never used or mentioned even once in the article, although that title redirects to it." You attacked a strawman. The reason why circumcision is a hot topic at the moment is that two human rights clash with each other: individual children's rights and collective religious rights. Also gender/sex equality issues, since the closest analogous operation in girls (FGM type 1a) is arguably less harmful, but is illegal almost everywhere when done for religious motives. This is widely discussed in high-quality reliable sources, but not in the article.

Regarding the main purpose of circumcision: We will probably not be able to say that it is that. But beyond any doubt it is verifiable that it has at many times, including rather recently, been considered an important purpose. And the existence of numerous studies which support that circumcision actually meets this purpose need to be mentioned. KNMG on this topic: "Another part of this argument says that NTC does not affect male sexuality. The foreskin is regarded as a part of the body that has no function at all in male sexuality. Many sexologists contradict this idea: in their view, the foreskin is a complex, erotogenic structure that plays an important role ‘in the mechanical function of the penis during sexual acts, such as penetrative intercourse and masturbation’. The many attempts by men to restore their foreskins by mechanical or surgical means also contradict the idea that the foreskin is a useless part of the body."

Wikipedia is not a bureaucracy. An article is not automatically neutral for the formal reason that editors on one side of a debate have spent a lot of effort on sourcing and editors on the other side have trouble getting access to the appropriate literature. To challenge the neutrality of a severely biased article it is not necessary to make concrete, immediately actionable proposals for improvement complete with sources. This article is not neutral and will likely not be neutral in the near future.

I have given you a long list of problems, both on the GA page and on this talk page, from which you just picked a few to contradict. For example, you ignored the topic of sex. For most men considering this genital body modification, this will be the most important aspect, more important than any possible health effects. Here is the full extent of what the article says: "Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction. The Royal Dutch Medical Association's 2010 Viewpoint mentions that "complications in the area of sexuality" have been reported." What the AAP says "appears" to be true in Wikipedia's voice, what the KNMG says is attributed. Also the extent of the coverage of sexuality is woefully inadequate.

The list was not, and was not intended to be, complete. E.g., there is practically no discussion of non-medical circumcision practices, even though that's an extremely common way of performing this operation. Going by this article, one would believe that 1/3 of all men in the world have a higher life expectancy due to being circumcised. Surely there must be statistics available on circumcision-related deaths in countries with poor health standards.

There is also no mention of other interventions that are closely related to circumcision, notably steroid cream and plastic surgery as alternative interventions in case of phimosis, and foreskin restoration as a way of improving the life standard of individuals who describe themselves as circumcision victims.

This is all very transparently part of a general cleansing of this article of any and all information that might cause someone to have second thoughts on circumcising their child.

You simply declared that all POV concerns had been taken into account when that was obviously not the case, and then passed this article as GA when you should have quick-failed it due to the massive problems. That was seriously inappropriate behaviour, and I must ask you to self-revert before this escalates further. Hans Adler 21:57, 12 February 2013 (UTC)

No this article fulfills the good article criteria. There is no "massive problems". There are a few things that could be adjusted. We clearly state "No major medical organization recommends either universal circumcision for all infant males" This does not seem like a positive statement on the practice. Maybe try a RfC if you want to get further input. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:02, 12 February 2013 (UTC)

Another forum for appeal would be WP:GAR; instructions for how to appeal can be found at that page. Having read over Hans's comments so far, my impression is that they're long on hostility and short on sources; I'd suggest this balance be reversed in any appeal, if one is necessary. -- Khazar2 (talk) 00:14, 13 February 2013 (UTC)

Sorry, doc. The only people who think this article meets the "good article" criteria are circumcision advocates who reject scientific consensus. Sorry, thanks, try again. Hans is absolutely correct. Crimsoncorvid (talk) 04:18, 13 February 2013 (UTC)

@ Doc James - are ongoing content and edit disputes not two of the six quickfail problems that should preclude granting GA status?

Shortcut

WP:GAQF

--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:15, 19 February 2013 (UTC)

Feel free to start a RfC if you wish. IMO the controversy does not extent beyond a small group. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:50, 19 February 2013 (UTC)

Does the GA policy specify ignoring "small group "edits?. Perhaps I missed that section --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:57, 19 February 2013 (UTC)

Questions which those who have better access to research than I might care to attempt to find answers to and thus improve the article

1/ how many males get cut each year worldwide ?

2/ How many of these are done in hospitals and how many are done elsewhere ?

3/ How do the complication rates of the hospital versus non hospital cuttings compare exactly ?

4/ Do up a table showing rates with both figures and percentages for cutting for the last 10 years worldwide and broken down by country ?

5/ Find research comparing the sensation loss in female and male genital cuting, mutilation and where bits get cut off completely ?

6/ A comparison of the “shunning” practices of the different cuttting cultures - Muslim versus USA versus Jewish versus Aborigine towards those with intact foreskins and a comparing and contrasting with the shunning of genitally intact female adults in some similar cutting cultures.

7/ An examination of circumcision as presented in literature and in popular media. One recent example was an episode of “Nip Tuck” where a doctor’s son attempted a self circumcision using instructions found on the internet as he thought his girlfriend would find his foreskin repulsive.

8/ An examination of humour around circumcision – In the UK the cut and uncut are sometimes referred to as “roundheads and cavaliers” respectively in reference to a resemblance to the headgear of Cromwell’s troops and those opposing them.

9 Given that this article is currently so restricted in length that much of the most interesting or controversial information has been farmed out to related wikiarticles –should an exception be made to the general guideline of not having( in some articles with medical content) a “see also “ section listing the twenty or so directly related articles and sub articles ?

10 Should there be some better explanation of how the glans becomes “keratinized” including some decent photos. There are some very good ones here on the website of a company offering a foreskin restoration operation ( mention of restoration also missing from the article) http://www.foregen.org/learn-more/picture-gallery/

11 Should there be a mention in the article of the average dollar fee charged per circumcision in the USA as this is the country where most of the article material is drawn from. Various estimates are from 100 to 2,000 dollars depending on local economics and whether hospital fees and anaesthesia et cetera are included.

12 Here is a decent recent overview of Circumcision, albeit once again from a USA perspective. http://www.nytimes.com/2011/08/23/health/23consumer.html?_r=0--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 03:39, 19 February 2013 (UTC)

I agree with a few of these suggestions. I'd like to find a good source providing historical and up-to-date rate information. We'd need to make sure any new topics being considered for addition to the article are being done so in compliance with Wikipedia's policy regarding WP:WEIGHT.

And that NY Times article was really very, very good, and it was great to see that just about all the information in that news article we already have covered in this article. I did not see any significant differences, excepting, of course, that the Wikipedia article has the latest AAP 2012 information. That NY Times article could actually probably prove very useful as a secondary source to identify specific individuals such as Chapin and Bollinger as circumcision opponents, if we're looking for opposition opinions to quote (here or elsewhere). Zad68 02:58, 19 February 2013 (UTC)

Euphemism and Sexism

The title of this article is a sexist euphemism and nothing less. Either it should be changed to "Male genital mutilation" or the female article be changed to "Female circumcision" and this article changed to "Male Circumcision". Acoyoa Chaemetay (talk) 06:16, 21 February 2013 (UTC)

Your question is a very frequently asked question, and has been discussed extensively - please see the result of this search of this Talk page's archive. -- Scray (talk) 06:31, 21 February 2013 (UTC)

More like soapbox archive. Acoyoa Chaemetay (talk) 05:11, 22 February 2013 (UTC)

Okay, I've changed my mind about this page being changed to "Male genital mutilation". Although, the article should at least mention the term "Male genital mutilation" like other articles mention other words/terms for a subject. Acoyoa Chaemetay (talk) 05:25, 22 February 2013 (UTC)

Are there any reliable sources that use or define the term? I have looked and have had trouble finding a single review article that mentions it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:50, 22 February 2013 (UTC)

And the pro-circumcision POV pushing continues. Genital mutilation is not a purely medical topic, it's just as much a social, political, theological and historical topic. Medical review articles aren't even particularly good sources for the point under discussion, let alone the only acceptable sources. Use or non-use of euphemisms, dysphemisms etc. are not biomedical information.

See for example this section from a book on genital mutilation. It puts circumcision into a spectrum of male genital mutilations ranging from incision to full genital skin stripping. It is clearly similar to the corresponding spectrum for female genital mutilation. Some more sources:

"From time immemorial, people have mutilated themselves and each other in a ritual fashion. While the modern observer may view such practices with distaste, alarm or horrified fascination, they are not necessarily to be seen as some pathological aberration from normal human behaviour, but are to be recognized rather as essential symbolic acts within the experience and periodic celebration in some cultures of a person’s passage through life. Circumcision, one of the more extreme forms, is a classic rite de passage wherever it is observed, signifying just such a transition, though its precise meaning, symbolism or purpose often eludes definition. It is certainly an ancient rite, and is perhaps a surprising survival in the supposedly higher forms of religion, such as Judaism and Islam, to this day.
And because its origins and original significance are lost in the mists of prehistory, it remains a puzzle to intrigue the enquirer. The present discussion is restricted to the West Semitic world and to male circumcision, which provides enough puzzles to be getting on within the space available." Circumcision and Circumstance: Male Genital Mutilation in Ancient Israel and Ugarit

"Although the term genital cutting has been introduced in the hope of calming the debate, and although some culture-focused feminist critics have sought to “challenge western polemics” (James and Robertson 2002), it is still generally true that not to call genital alteration of women or girls “female genital mutilation” results in accusations of trivializing the offence, but to call genital alteration of boys “male genital mutilation” is likely to elicit accusations of emotionalism, even by those who agree that routine circumcision of males is unnecessary and should generally not be performed (Nye 2005). [...] It is only recently that MGA has been raised as a human rights issue at the United Nations, and to date no serious discussion of the topic has occurred, let alone any action (Svoboda 2002, 2004).
It might be thought that the reason for this double standard lies in the greater physical severity of FGA, but this is to confuse cause with effect. On the contrary, it is the tolerant or positive attitude toward MGA and the rarity of FGA in Western societies that promote the illusion that the operation is necessarily more sexually disabling, and without benefit to health, when performed on girls or women. A second reason for the double standard is that, although MGA is thought to designate a single surgical procedure, the term female circumcision is expansive, referring to any one or more of several different procedures. [...]
But the effects of MGA are also highly unpredictable, depending on how much penile tissue is removed, on the skill of the surgeon, on the precise configuration of penile blood vessels and nerve networks, on the genetically determined length of the foreskin, and on the eventual size attained by the penis at puberty and maturity. The more tissue excised, the greater the damage to the penis and the greater the effect on sexual functioning and capability. Although equivalent quantities of tissue may be lost, outcomes will be worse in cases where the penis grows larger in maturity, where the infant or boy has only a short foreskin, or where the unpredictable locations of blood vessels and nerves mean that important connections are severed. Because the slack (“redundant”) surface tissue is needed to accommodate the enlarged penis when tumescent, a severe alteration will render erections painful or even impossible (Boyle et al. 2002; Hammond 1999; Peterson 2001; Warren et al. 1996; Williams and Kapila 1993). A further common outcome among boys circumcised in infancy, especially when the operation excises a large quantity of penile shaft skin (as is the U.S. norm, particularly when the Gomco clamp is used), is that scrotal skin gets pulled up onto the penis shaft as the wound heals, and even more when the penis enlarges at puberty (Cold and Taylor 1999; Money and Davison 1983; Taylor et al. 1996; Zwang 1997)." [8]

In the Google preview of a German source from Terre des Femmes I also found an explicit statement that the reason anti-FGM groups have so far not discussed MGM (i.e. circumcision) was purely pragmatical. That would also be relevant information for this article after the sourcing problem has been solved. Hans Adler 09:40, 22 February 2013 (UTC)

Any pubmed indexed reviews or major textbooks from the last 5 years? Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:29, 22 February 2013 (UTC)

Stop pretending that they are necessary for non-medical claims. Your refusal to get the point is getting seriously disruptive. Hans Adler 11:22, 22 February 2013 (UTC)

Hi Hans, thanks for providing sources that we can review, it is always best when article content discussions are grounded in specific sources. I reviewed the sources you brought:

This book is the proceedings of an anti-circumcision conference, run by the activist group NOCIRC, as you can see here.
This journal article, if it's written by this Nick Wyatt, seems reputable, although the I don't know how reputable the Journal for the Study of the Old Testament is. It is a primary source, the results of original research by Wyatt. Wikipedia would really prefer strong secondary sources. The abstract and the snip you provided refer to the practice as circumcision. I'd actually like to have a copy of the article for my reading, but I'm not sure what sort of article content change this source can support.

The rest of the sources unfortunately appear to be a WP:COPYVIO problem, copied and pasted largely unchanged from here, an anti-circumcision activist website. The copied text itself is the result of the original research and personal interpretation of the anonymous editor of that website, and would not be WP:RS for Wikipedia use. But I'll comment on the underlying sources used:

"Although the term genital cutting..." sourced to Nye 2005 gives reasons for why the term MGM is not used, and so wouldn't appear to be a good argument for using it.
Svoboda is another anti-circumcision activist and the founder of ARC Law. This is not to say his work isn't useful, but it needs to be seen as partisan, and isn't an impartial academic source.
The other sources are based on medical content and can be expected to be found in PubMed MEDLINE-indexed journal articles. What's interesting is that they take pains to avoid using the the phrase MGM.
Re "In the Google preview of a German source from Terre des Femmes I also found an explicit statement that the reason anti-FGM groups have so far not discussed MGM (i.e. circumcision) was purely pragmatical." - This is a description of the non-use of the term.

Overall, they only thing these support is that there are some primary sources from partisans themselves showing some anti-circumcision activists refer to circumcision as MGM, and this is not in doubt. Even for a comment on this use, we'd need to have an independent reliable secondary source covering it, and we haven't found one. What wasn't provided is support that impartial academic sources use the term regularly to refer specifically to circumcision. Zad68 15:25, 22 February 2013 (UTC)

I am not sure what you think I am arguing for. The problem is that male genital mutilation redirects here, and the term does not even appear in the article. We don't have to use it, but it's sufficiently noteworthy to require mention. The fact that it's used primarily, or maybe even exclusively, by activists is not relevant for whether to mention it but only for formulating the sentence in which we do so.

The sources were just quick examples to demonstrate that our failure to mention the term is a problem. In detail:

The book is indeed from a conference on genital mutilation that appears to have been organised by NOCIRC. That makes it partisan but not necessarily unusable any more than the AAP task force publication is automatically unusable due to its transparently partisan nature. This needs further examination, in both cases.
The theological paper was just an example for what is out there and is essentially ignored by this article. It's likely not directly usable. The body of the paper does not use the phrase "genital mutilation", but the text I quoted makes it clear that the paper itself supports the claim made by its title.
The largish chunk of text that I quoted was from the article which I gave as the source. It appeared in Medical Anthropology Quarterly, the peer-reviewed journal of the Society for Medical Anthropology. That's just about the best kind of scholarly source we can hope for when it comes to the examination of non-therapeutic surgical operations. I would have thought that the portion of the huge article which I quoted still falls under fair use, though I am not an expert on such quantitative fine points of American copyright law. In any case this should not be relevant to whether or how we can use the source. "The copied text itself is the result of the original research and personal interpretation of the anonymous editor of that website, and would not be WP:RS for Wikipedia use." This is simply wrong, unless the authors of the scholarly article simply copied the material from the internet and the peer review was merely pro forma. Hans Adler 23:12, 22 February 2013 (UTC)

Zad68 has since retargeted Male genital mutilation to Genital modification and mutilation. I agree with that move. However, it does not solve the problem that this article presents circumcision as a largely rational practice and downplays opposition, controversy and human rights implications of the practice. The failure to even mention the term "mutilation" (except in a South African aboriginal context) let alone to compare this form of male genital mutilation to the other forms and to female genital mutilation, is still a problem. Hans Adler 10:28, 25 February 2013 (UTC)

Men rights

Why is this article not named Male genital mutilation but the one about female circumcision is?

I propose this article be renamed Male Genital Mutilation for the sake of equality between sexes — Preceding unsigned comment added by 190.31.229.48 (talk) 18:39, 23 February 2013 (UTC)

Because Wikipedia reflects the literature, which frames these issues differently. Biosthmors (talk) 01:54, 25 February 2013 (UTC)

Claims

German Pediatric Association and the Royal Dutch Medical Association just claimed that circumcision does not reduce HIV.

Also this is an interesting article from NBC News.

http://www.nbcnews.com/id/50813329/ns/health/

arguing that circumcision DOES have negative side effects.

Why does this article say circumcision has no sexual side effects?

Who wrote this ridiculous WP article?

99.55.142.31 (talk) 08:12, 24 February 2013 (UTC)

Do you have sources for your first claims? That would be helpful. Thanks. Biosthmors (talk) 01:55, 25 February 2013 (UTC)

The study is the same Bronselaer online self assessment survey that was brought up earlier. Zad68 02:09, 25 February 2013 (UTC)

See e.g. the statement of the German BVKJ's president Hartmann to the parliamentary legal committee from last November. An English translation can be read here.

Rather than just denying an effect of circumcision, their argument is that given e.g. the very low HIV infection rates of heterosexuals in the West (~ 630 in Germany 2012, i.e. ~ 275 men) and the independent obligation to safer sex practices renders such effect irrelevant — especially once the abysmally poor performance of the circumcised US in regard to HIV and other STDs is considered.

For instance, Hartmann's statement contains the abstract of reply to the AAP, written by him and 37 other renown European specialists (incl. the heads of other national associations, such as the KNMG's Willem Fetter). Its last sentence:

The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts and penile cancer, are questionable, weak and likely to have little public health relevance in a Western context, and do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

-- 188.192.253.145 (talk) 13:58, 26 February 2013 (UTC)

We've discussed the Hartmann lobbying statement to the German parliament before. You haven't made clear what exact article content changes you're suggesting be sourced to this, but if you're suggesting it be used to source biomedical content, we generally don't look to legal lobbying argumentation to support biomedical claims. This statement might be useful to expand the detail of the Germany section of Circumcision and law, where it is noted that Germany ended up legalizing/confirming the legality of religious neonatal circumcision given certain conditions.

Regarding the exact claims in the statement, a lot of what Hartmann said actually already appears in this article: circumcision has no effect on the incidence of genital warts and only "possibly" has an effect on herpes; circumcision's protective effects against penile cancer do not justify the procedure because the incidence of penile cancer is so low; no major medical organization recommends routine infant circumcision for the prevention of HIV, excepting of course for the WHO's recommendations for those parts of Africa. The article already states all this, and we have strong and explicitly medical sources (as opposed to political) to support it. Zad68 14:34, 26 February 2013 (UTC)

My comment was a direct reply to Biosthmors's request for sources, not a call for changes. Also, the reply to the AAP by some 37 of Europe's most renown medical specialists (plus an Australian) is neither "lobbying" nor "political"; it is a direct rejection of the AAP's medical arguments and thus a negation of its advocacy for non-therapeutic infant circumcision. That, on the other hand, should indeed be included, at least (or especially) once this weird delay is over and Pediatrics finally publishes it in full. -- 188.192.253.145 (talk) 17:41, 26 February 2013 (UTC)

The AAP does not advocate for routine neonatal circumcision, please take care to characterize the positions expressed by our sources accurately. As was said when this was discussed before, if and when something does get published, we'll review it and see what use it can be to this or other articles. Zad68 21:22, 26 February 2013 (UTC)

I didn't write that it does, and I'm aware that its case is weak to the point that some of its authors themselves refrained from endorsing circumcision (Diekema in the NYT, Freedman in the TJW). Nonetheless, it employs it to favor infant circumcision (which, incidentally, is also almost the only part that the media hyped), and that's what those 38 specialists repudiate. As for the article however, I understand that one has to wait for the actual publication. Meanwhile it is still notable though that the AAP's "somewhat advocacy" is opposed by far more national medical associations which openly object to non-therapeutic infant circumcision. -- 188.192.253.145 (talk) 23:34, 26 February 2013 (UTC)

Regarding above concerns on neutrality

I'm seeing a lot of statements saying that "this isn't neutral" or "this is one-sided", but at the same time i'm seeing absolutely no secondary sources presented to back up these complaints. For me, this immediately sets off the alarm bells of WP:OR and WP:TRUTH. If sources aren't being presented, I think the complaints should just be ignored. Silver seren^C 09:54, 25 February 2013 (UTC)

What do you expect? A Cochrane review of medical studies on whether this Wikipedia article is neutral? That seems to be approximately the standard required by some of the editors here. There is a clear statement by the Royal Dutch Medical Association that non-therapeutic circumcision should remain legal only because it can't be prevented and if it is done at all it's better if it's done by medical staff. Is that not secondary enough for you?

The article clearly concentrates on aspects that make circumcision appear to be a rational practice, while downplaying everything that could suggest otherwise. For example, search for the string "hygien" on the page. The argument that circumcising babies somehow supports hygiene is still heard very often, and in places it reverberates in this article. This is of course totally ridiculous, as is obvious to every man with intact foreskin. A little boy's glans doesn't need to be scrubbed any more than the inside of a little girl's vagina. Yet the debunking of this myth finds no place in the article at all.

I am not a medical expert, and even for the legal aspects I am still collecting sources. Circumcised men are more likely to be interested in the topic, and more likely to have a positive view on it, for reasons that should be obvious. The same holds for physicians who have talked patients or parents of patients into circumcision. They can hardly be expected to come around to the view that this is unethical. Unsurprisingly, these two groups make up the majority of the really active editors of this article. With the cards stacked against neutrality in this way, it is going to take some time to find appropriate sources for making this article neutral, and once they have been identified, it may take some additional time and wider community involvement to break irrational opposition against their use.

To challenge an article's neutrality it is not necessary to make concrete proposals for improvement. That's merely the ideal method, where possible. For a totally broken article such as this one this is not possible. Hans Adler 10:20, 25 February 2013 (UTC)

The Royal Dutch Medical Association source might be enough to include a sentence giving their opinion on the matter, but it's certainly not enough to overturn decades of scientific opinion. And that rest of your long comment just boils down to "I have an opinion and I am right". Until you have appropriate secondary sources to present that back up your claims, you shouldn't try to be arguing for changes in the article. I'm sure you've had to deal with WP:FRINGE topics before, right? The argument you just made is pretty much exactly the kind of argument that the fringe people make to try and validate their claims. There's a reason why we have specific sourcing requirements. Silver seren^C 10:43, 25 February 2013 (UTC)

Well, your argument is not much better, either, is it? Hans Adler 12:17, 25 February 2013 (UTC)

Have you edited the German wikipedia article on circumcision and if so, using what screen name?89.204.153.109 (talk) 13:30, 25 February 2013 (UTC)

(1) That question is at least borderline inappropriate, especially from someone who is hiding behind a non-geolocatable IP in a spammy neighbourhood. (2) I do not remember ever touching the German article or its talk page. I am 100% sure that I never made any substantial edit there, or commented. I am not particularly interested in circumcision, and that article is sufficiently neutral so I see no reason to mess with it. (3) I have a global account under my real name and no sockpuppets. If I had touched the article, it would have been with the present account. Hans Adler 14:33, 25 February 2013 (UTC)

Neutral? The German WP article on circumcision is a horrible disaster, a textbook example of what happens when you flout medical sourcing guidelines that the editors here can learn from. Hans, you are very quick to judge people and ascribe motivations to them. What makes you think that I am hiding? Either back up your claim or retract it now. Likewise, how can you be so sure that "circumcised men ... and physicians who have talked patients or parents of patients into circumcision ... make up the majority of the really active editors of this article"? Have you considered that a mirror-image ad hominem attack could be leveled against the editors of the German wiki?89.204.153.109 (talk) 15:01, 25 February 2013 (UTC)

What makes me think that you are hiding? Well, you are using an IP address rather than a pseudonym. This prevents the kind of accountability of which I have the maximum possible. And from this position of anonymity you are asking me intrusive questions. It is also a fact that your IP address is on numerous block lists for the provider's (claimed) spam friendliness. I am always happy to retract any wrong accusations I may have made, but I honestly can't see any here.

How can I be so sure about the demographics of the active editors here? It's an educated guess based on observable behaviour and the state of the article. In German-speaking countries I have only ever seen similar behaviour from members of the two circumcising religions and from ruthless politicians. (In the latter category I am including fundamentalist Christians who have come out of the woodwork recently to promote the idea that collective religious rights trump individual human rights such as physical integrity.)

As to the mirror-image attack – you are in the wrong place for that. If you want to change the German article, go to the German Wikipedia. If you are right and it's the one that is biased, you should ultimately be able to fix the problem. Just don't be surprised if the German Wikipedia doesn't accept a small, essentially self-selected task force of pediatrists from the Western world's center of male genital mutilation as an unbiased arbiter on the practice . Hans Adler 20:14, 25 February 2013 (UTC)

As a word of general advice and caution may I direct everyone's attention to WP:TPG. Article Talk pages are to be used only for discussion of improvements to the article. They are not to be used for discussion of other editors or speculations about their motivations. Going any further down this road is not advisable and will likely lead to administrator action. Just advice, feel free to take it or leave it. Zad68 20:18, 25 February 2013 (UTC)

Zad is quite right on this point. Ascribing characteristics to other editors or groups of editors based on their individual or group editing or reverting habits is rude and unhelpful. What is more important is helping the article reflect better the cultural rather than the medical nature of cutting off bits of males genitals. One corollary of this is that the many non USA and non medical legitimate sources which could enrich the article would then be required to be included. to paraphrase Johst "when i hear the word culture i reach for my scalpel " --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:49, 25 February 2013 (UTC)

Which "decades of scientific opinion" (implying that there is an established one) would you be referring to? Other than by religious and American doctors — the latter as a indirect legacy of the Victorian prudes who introducted circumcision to the Anglosphere — there hasn't been any significant circumcision advocacy (with regard to healthy men outside of high-risk HIV areas, that is) after WW2 and in particular in recent decades; in fact, European doctors are moving ever more vehemently against it — thus also their full rejection of the recent AAP policy, "Cultural Bias in AAP’s 2012 Technical Report and Policy Statement on Male Circumcision" (submitted to the AAP's Pediatrics in Oct/Nov but still not published there). -- 188.192.253.145 (talk) 11:47, 26 February 2013 (UTC)

Foreskin restoration

I haven't seen it mentioned within this article already, would including a section on restoration be a reasonable addition? There is already a reasonably detailed article on it. Foreskin restoration Thermoelectric (talk) 08:13, 25 February 2013 (UTC)

Absolutely, as it's a closely related operation. It shouldn't get too much weight, of course, as it's relatively rare. Some statistics would be nice. For sourcing, keep in mind that biomedical information about the operation must satisfy the high standard of WP:MEDRS. Hans Adler 09:59, 25 February 2013 (UTC)

As male circumcision is a cultural phenomenon only rarely conducted for a medical reason WP:MEDRS does not apply. WP:MEDRS has been exhaustively cited to attempt to excuse the rabidly pro circumcision tone and content in this article as presently constructed and patrolled --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:24, 27 February 2013 (UTC)

Yes. A lot can be said about foreskin restoration that is not biomedical information. I took that for granted. Hans Adler 00:01, 28 February 2013 (UTC)

Sexual problems

The following results should be included in this article: http://dx.doi.org/10.1111/j.1464-410X.2012.11761.x 92.229.116.173 (talk) 19:15, 1 March 2013 (UTC)

Bronselaer again... this has been brought up several times before, please see elsewhere on this Talk page and also in the archives. Zad68 19:18, 1 March 2013 (UTC)

I've found that medical "studies" regarding circumcision tend to lean strongly toward the culture the study originated in. American studies find no sexual disadvantages with being circumcised and emphasize the lack of smegma and dirt build-up, while European studies find numerous disadvantages with the practice and also find that circumcised men have smaller penises, are less able to please women, etc. Frankly, the only study I'd pay any attention to would be one conducted by lesbians. It's the only way I can think of for eliminating bias. 68.100.138.56 (talk) 02:45, 6 March 2013 (UTC)

I was circumcised from birth and I've never had problems with penile sensitivity and I can easily reach an orgasm with no trouble during sexual intercourse. What kind of bullshit study is that? - Preceding unsigned comment added by 108.21.95.140) — Preceding unsigned comment added by Pentrazemine (talk • contribs)

Hello Pentrazemine... generally we're not supposed to use article Talk pages for discussion of our own opinions or experiences, a Talk page is to be used to discuss the related Wikipedia article only. Please check out WP:TPG for guidance on the use of Talk pages. Also please check out WP:MEDRS for Wikipedia's guidelines on sources for biomedical content, if you're interested in contributing such information to articles. Cheers... Zad68 20:19, 8 March 2013 (UTC)

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

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

Missing sections from this Circumcision article :

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Male circumcision(aka genital mutilation):global trends and determinants of prevalence, safety and acceptability

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A NEW STUDY

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

New studies show that circumcision reduces penile sensitivity.

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

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

Penis sensitivity after circumcision

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

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

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

Recent related edits:

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

I am copying my earlier explanation of the problem:

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

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

So far there was no response to this post.

Meanwhile I have flagged an unusual and serious citation problem with the sentence. [9] Sometimes it makes sense to combine several sources in a single citation footnote. Here, the sentence is supported by a an alphabetic footnote saying:

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

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

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

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

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

(edit conflict)

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

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

Morris, B. J.; Bailey, R. C.; Klausner, J. D.; Leibowitz, A.; Wamai, R. G.; Waskett, J. H.; Banerjee, J.; Halperin, D. T.; Zoloth, L.; Weiss, H. A.; Hankins, C. A. (2012). "Review: A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries". AIDS Care. 24 (12): 1565–1575. doi:10.1080/09540121.2012.661836. PMC 3663581. PMID 22452415.

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

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

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

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

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

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

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

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

Trad. (eastern) Jewish circumcision

As part of wider revert [10], the following text was removed from the article:

In New York, circumcised infants have contracted herpes, consequent brain damage or death through an unusual procedure involving oral genital contact with the circumcising agent. 3,600 boys are circumcised by this method annually ^[1]

.

I've no opinion on the revert, but I was struck by the similarity with an older discourse on Jewish circumcision and its association with tuberculosis and the cultural image of the diseased body of the "Jew". Sander Gilman has written a very nice study covering some of these issues. It might perhaps warrant inclusion in the history section considering more recent revivals of these fears as indicated by NYT source above. See [11]. FiachraByrne (talk) 13:08, 19 March 2013 (UTC)

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

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

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

It may be because I posted a google.ie link rather than an google.com one, try this: [12]. Really though, it belongs to another article detailing the immigration of Eastern Jews into Western Europe. FiachraByrne (talk) 18:24, 19 March 2013 (UTC)

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

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

European comment on AAP's 2012 policy statement

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

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

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

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

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

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

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

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

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

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

^ http://www.nytimes.com/2012/09/13/nyregion/regulation-of-circumcision-method-divides-some-jews-in-new-york.html?pagewanted=all&_r=0

[1] Gearhart JP, Rock JA. Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup. J Urol 1989;142(3):799-801.

[2] "David Reimer, 38, Subject of the John/Joan Case" The New York Times, New York, USA, Published May 12, 2004

[3] "Family Is Awarded $850,000 For Circumcision Accident" The New York Times, New York, USA, Published November 2, 1975

[4] Charles Seabrook. $22.8 million in botched circumcision. Atlanta Constitution, Tuesday, March 12, 1991.

[5] ttp://www.nytimes.com/2012/09/13/nyregion/regulation-of-circumcision-method-divides-some-jews-in-new-york.html?pagewanted=all&_r=0

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