Talk:Circumcision/Archive 77

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sale of excised foreskins to cosmetics or med research industry

Anybody got a better source on this than yahoo or Oprah ? http://voices.yahoo.com/human-foreskins-big-business-cosmetics-201840.html If it is as widespread as this then the med or med research literature must mention it a good bit. Views ? Should it go in the "Economic Considerations " section or in the med sections ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:57, 6 June 2013 (UTC)

See WP:BLOGS for Wikipedia's policy regarding the fitness of blogs such as the one you linked to as reliable sources. Re If it is as widespread as this then the med or med research literature must mention it a good bit -- I agree, so I searched PubMed for secondary sources covering "foreskin keratinocyte circumcision" and "foreskin fibroblast circumcision" and found nothing suitable, so a search of the medical literature did not find that it mentions it a good bit as you were hoping. Regardless, if appropriate sources can be found, the logical place for this would be Foreskin. We have covered this before. In fact, Tumadoireacht, by my count this is the tenth time you've brought this up without offering a satisfactory reliable source to support it (I can supply diffs if needed), and it is becoming tendentious. Zad68 04:42, 7 June 2013 (UTC)

New source article Zad and thus new information and thus new debate that is the wonderful part of a live encyclopedia.- perhaps it might be best to conduct a search on it elsewhere than in medicine( as it is notable as much for its commercial or supertstitious significance than medical) on WP to get some discussion going. It does not belong as a subject in a foreskin article alone because it is part of circumcision. The body part gets cut off and then gets sold. They go together like a horse and carriage. Also if you read my short entry above with care you will notice that I am looking for a BETTER source for article reference use so please do not characterize it as suggesting that that source be used - such characterizations are unhelpful and contrary to civility policy and best practice. Medical companies are selling the foreskins (for about 200 dollars in USA) and derived products. This is easily confirmed. Of course my mentioning it is tendentious - namely I hold the view that it should be mentioned in the circumcision article that circumcised foreskins are sold for cosmetic and for science and medical use and research. Did you mean to say tedious  ? Perhaps we do need a new section given over solely to describing how the different cutting religions and cultures and tribes dispose of the circumcised foreskins after they are cut off. I know the Xhosa bury them to avoid evil spells Some Jews bury them after circumcision, others incinerate them as do most USA americans I have no idea what Muslims or Aborigines do with the cut off foreskins - does anyone here have a good source  ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:29, 7 June 2013 (UTC)

Re Of course my mentioning it is tendentious - You agree that you are engaging in tendentious editing... that's interesting. Anyway, now that you have been pointed to WP:BLOGS I trust you will not be bringing blog posts as potential sources in the future? I did the search for you in PubMed because you said If it is as widespread as this then the med or med research literature must mention it a good bit and PubMed is one of the best central repositories of medical literature, the exact type of literature you specified. Regarding the potential location of the content, we already had the process vs. product discussion previously, nothing has changed about that since the previous conversation. The disposition of the foreskins after religious circumcisions would be interesting to cover in Religious male circumcision, I have that article watchlisted so I'll be interested to see what sources and content you bring to that article. Have a great weekend... Zad68 19:09, 7 June 2013 (UTC)

Tendentious -definition:" Marked by a strong implicit point of view" - YES ! the view that it is important that the article gives a full picture of the entire circumcision phenomenon including everything from forced foreskin and frenulum chop offs to who does what with the bits chopped off and at what price if any . You seem to be inferring some other meaning - Why is that ? Is there a reason why you resist including these facets of the circumcision practice ? Would you like to share that reason ? Try try try to answer the rationale raised at length above rather than attack the person please. And for the THIRD and final time I did not propose a blog as a source but as a resource( to find sources). Big difference.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:07, 7 June 2013 (UTC)

Sorry I don't think I've been making ad hominems, but I have made mention of a pattern of editing behavior of yours called tendentious editing - which you did not disagree with - and on Wikipedia it is considered disruptive editing and can lead to administrative sanctions. If it continues in a disruptive way, one can raise a discussion about it at an appropriate administrative noticeboard for possible administrative action.

For what should be in articles, review Wikipedia content policies. Wikipedia articles develop encyclopedic themes with the content located appropriately in the most relevant article. Wikipedia articles aren't Ripleys Believe It Or Not and not everything with a certain word in the phrase that describes it is best located in article that has that word for its title. This was a finding available for you to absorb (and still is) after the RFC you started that resulted in one of the most lopsided outcomes I've ever seen on Wikipedia, against your position.

Nobody is saying what you're proposing should not exist on Wikipedia at all, but rather that it's best located at the articles covering the specific cultures. The view of the Xhosa on circumcision is a great encyclopedic theme, there are great sources covering it, and it can be developed very nicely at Xhosa people. If you're interested in developing content here, what is the encyclopedic theme you want to develop, using what secondary source? "Bizarre Thing X exists" is not an encyclopedic theme. Zad68 03:56, 10 June 2013 (UTC)

I disagree Zad with your repeated labelling and ascribing of responses which did not occur ( "You agree that you are engaging in tendentious editing... that's interesting" et cetera) Your doing so is forming a pattern of providing your opinions on behaviour and policy to apparently avoid addressing points on content. So- once again-

1/ if forced circumcision in a tribal context is occurring on three continents and not only amongst the Xhosa as you seem to infer then it ought not to be "developed very nicely" at Xhosa people but included in the text of the new section you are proposing on Tribal Circumcisions in Circumcision

2/All Circumcisers worldwide dispose of the cut off foreskins in one way or another - what they do with them and why and how each cutting culture differs in the disposals both from each other and over their own history, should be mentioned in Circumcision.

3/ Some Circumcisers sell the cut off foreskins from circumcision for use in face creams, or as skin grafts for burns victims, or to harvest fibroblasts for medical and medical research applications. This should be mentioned in Circumcision

Why do you so strenuously attempt to dismiss these facts as trivia ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:46, 10 June 2013 (UTC)

I think we're talking past each other. Maybe you're right. Go ahead and identify the encyclopedic themes you are proposing to develop, locate the sources and develop the content you're proposing, let's discuss it. Zad68 13:14, 10 June 2013 (UTC)

The above is yet more avoidance of discussing these cogent points -forced cuts, disposal of cut foreskins, and sale of cut off foreskins are part of the circumcision culture and should be included here. No editor has come up with any good reason why they should not be included yet there are about a dozen who can be counted on to revert any mention of them. Why is that ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:05, 11 June 2013 (UTC)

We do not discuss how the tissues cut out from other surgeries are used as this is generally undue weight. Would be appropriate on "circumcision controversies" but not here. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:28, 11 June 2013 (UTC)

Circumcisions are generally cultural and anthropological acts and so comparisons with the disposal of clinical waste from other necessary surgeries is spurious. The method of disposal(many bury it but for many different reasons) of the cut off foreskin is the final part of the tribal circumcision ritual process has significance for some Jews, and Xhosa, and Aborigine and other cutters. Also generally, except in the case of organ donors, the excised body part is not sold or reused. So you comparison fails on two counts Doc. Not appropriate for controversy article as, for those doing the cutting, and disposing, there is no controversy. It has a spiritual or a commercial or scientific significance for them. For many USA americans it appears to have no particular significance and is incinerated as clinical waste when unsold. Some are sold on without parental knowledge or consent. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:04, 13 June 2013 (UTC)

Unsupported Facts

Sub-articles which originally said that the effects of circumcisions are inconclusive have been changed to say that there are positive affects of circumcision without supporting evidence to back up these claims. I have tried to undo changes but it has always been put back. — Preceding unsigned comment added by AlwynJPie (talk • contribs) 05:16, 16 June 2013 (UTC)

This image...

I want to raise an observation that the "before" photo on this composite image shows the penis with pubic hair shaved, which is not ideal, and appears to be an uncircumcised penis afflicted by phimosis (hence the need for the circumcision). Having a composite image is useful, but it does not need to be of exactly the same penis before and after a circumcision, especially this one which due to the hair shaving in one and tanned skin in the other barely looks like the same man anyway. I wonder whether there are more appropriate/better images available to show the reader the visual difference between an adult penis that has not been circumcised and one that has, which is the aim of the composite. We should show a natural and typical uncircumcised penis alongside a typical circumcised penis. --TBM10 (talk) 20:26, 13 June 2013 (UTC)

I'm puzzled by this view. It's very clearly the same individual in both the before and after images. It may not required to have a composite with the same individual posing for the before and after, but as the purpose of a before/after composite is to illustrate and highlight the changes effected by the procedure, having the same individual for the before and after images is ideal. For that reason (among others) I find the replacement of the image done in this edit a disimprovement and have undone the change. If the issue is really something to do with the level of tanning I can adjust the images with Photoshop-like software to make the color saturation levels equal across the before and after images, would that work? Zad68 20:59, 13 June 2013 (UTC)

If TBM is correct and the uncircumcised penis in the picture is suffering from phimosis it does seem an odd choice for a representative picture (of the healthy natural state uncut penis of the vast majority of the world population of penises) as phimosis is such a rare condition and for other reasons . The tanning question and proposed solution are hilarious In dog food ads when they wanted the dog to eat the food being pushed they poured engine oil over the other one. Are the majority of altered penises worldwide being done on children or adults ? --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:10, 13 June 2013 (UTC)

I do not have an issue with the tanning! I merely raised it to emphasise that the two images appear very different anyway. Having a more appropriate image of an uncircumcised penis would still achieve the objective of showing the changes effected by the procedure, that is my point. The current uncircumcised penis shown in the image is not representative of a typical one. --TBM10 (talk) 06:29, 14 June 2013 (UTC)

We need images that are in an anatomical position. The proposed new images are not. I do not consider the fact the the person has phimosis to be against using it. If Tuma is proposing we have a picture of a child before and after I would be very hesitant as there are cultural norms against picture of children's genitals. And adult images are good enough. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:07, 14 June 2013 (UTC)

Agree, I think Doc's change handles the issue. Zad68 13:44, 14 June 2013 (UTC)

I've also gone ahead and adjusted the color saturation level on the 'after' image to match the 'before', decreasing that visual difference between the two images, to keep the focus on only the anatomical change between the two. Zad68 16:04, 14 June 2013 (UTC)

The image which shows an uncircumcised penis and a circumcised penis was purely to illustrate the difference between the two. It's unfortunate that the two penises do not look alike but I feel that the original caption that explained the differences should be reverted back to and no mention of medical conditions should be included as this just causes confusion. AlwynJPie (talk) 04:29, 16 June 2013 (UTC)

Doc _ i find it hard to see how you extrapolate a suggestion to show a photo of a healthy uncircumcised penis as a suggestion to show a child's one. Can you explain your thinking a little more clearly please so we can attempt to understand.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:25, 19 June 2013 (UTC)

sexual pleasure , the loss of the 20,000 foreskin nerve receptors and this World Health Organization quote ?

"The World Health Organization states that functions of the foreskin include "keeping the glans moist, protecting the developing penis in utero, or enhancing sexual pleasure due to the presence of nerve receptors." Should this quote which is presently in the Foreskin article also be in this article, because this article is after all, about cutting the foreskin off ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:48, 9 June 2013 (UTC)

No. That sentence has no bearing on circumcision without an improper application of WP:SYNTH. As it is, we have Circumcision#Adverse_effects where we bring the general accepted medical opinion and a counterargument by the Dutch. -- Avi (talk) 22:30, 9 June 2013 (UTC)

The title of this section makes a statement about "20,000 foreskin nerve receptors" - what is the source for that? It does not appear in the WHO document, where are you getting it from? Zad68 03:56, 10 June 2013 (UTC)

If a new sect arose that cut off their children's left arm shortly after their birth - would there be editors here blithely saying that there should be no mention of loss of any of the functions of that arm in the article describing the amputations because that would be WP:SYNTH ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 07:17, 10 June 2013 (UTC)

Your argument suffers from various logical flaws:

1. The fallacy of Ignoratio elenchi; it is irrelevant to question at hand. Issues about arm-removing cults will be handled in the appropriate articles should the need arise, if ever.
2. False analogy. It has never been proven (nor will it, I believe) that removal of the foreskin is destructive as the removal of an arm. It is a dispute whether foreskin removal is disruptive, neutral, or constructive. Removal of an arm is always destructive (perhaps outside of cases of imminent death otherwise).
3. Following the above, the question is also a Loaded question, presupposing that foreskin removal is destructive, let alone as destructive as arm removal.

As such, it has no bearing on this discussion. -- Avi (talk) 17:04, 10 June 2013 (UTC)

There does not appear to be any good secondary WP:MEDRS-compliant sources which will support your contention that "Removal of an arm is always destructive" - even when excluding cases of imminent death otherwise.Zebulin (talk) 21:48, 10 June 2013 (UTC)

I believe you are incorrect, Zebulin. Please see the following, among others: [1], [2]. [3], [4] -- Avi (talk) 23:27, 10 June 2013 (UTC)

Please review WP:MEDRS "All Wikipedia articles should be based on reliable, published secondary sources". You have listed several primary sources.Zebulin (talk) 14:37, 11 June 2013 (UTC)

Here are more survey-type sources that support the contention [5], [6], [7]. Tuma's argumnent remains fallacious through irrelevancy regardless, but the preponderance of sources support its invalidity ipso facto as well as per above. -- Avi (talk) 15:04, 11 June 2013 (UTC)

Based on the content that's actually in the WHO document you've brought as a source to support your proposed content changes, this seems to be an off-target analogy. Where does the WHO make a statement about "20,000 foreskin nerve receptors"? Zad68 13:14, 10 June 2013 (UTC)

Lads - the World Health Organization, which you fall over yourselves quoting and eulogizing when you agree with its conclusions, states that the nerve receptors on the foreskin enhance sexual pleasure. But what would they know ? Someone should really tell them that it has never been proved. Because - Um - Avi said so. Ignoratio elenchi, False analogy, and Loaded question do not apply to the excised arm example but bringing them up as a riposte is weak and also a classic example of Ignoratio elenchi. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:23, 10 June 2013 (UTC)

I have shown how they do above. Merely stating they do not doth not make it so. In other words, the burden of proof to justify your above assertion lies on you, and has not been demonstrated. -- Avi (talk) 19:30, 12 June 2013 (UTC)

You sure that that's what the WHO says? Are you actually looking at the WHO's GTDPSA source, the same source we've been using here recently, or are you looking at some other WHO source you haven't identified here yet? Or are you looking at the Foreskin article and assuming it represents the WHO source accurate, because it might not. Zad68 19:36, 10 June 2013 (UTC)

Since the foreskin article cites J Fam Pract. 1986 Apr;22(4):353-5 as the source for the WHO statement we can at least be sure we aren't talking about WHO's 2007 GTDPSA source. I don't have access to the source to see how it may or may not represent any WHO finding but we can at least rest assured that any such finding by the WHO would have to date to 1986 or earlier.Zebulin (talk) 22:09, 10 June 2013 (UTC)

@Avi - A True Analogy assists in seeing the veracity of the original. An arm has naturally many more functions than a foreskin and is a more complex body part - nevertheless the analogy is comparing your and other's current resistance to acknowledging loss of function by slicing off the foreskin (despite the World Health Organization naming one of interest to sexually active adult males and their partners - sexual pleasure ) to a hypothetical editor holding the same preposterous position in relation to the arm cutting sect.

Thus your point that it has never been proved that the loss of a foreskin is( I am presuming that you meant to write "as" here) destructive as the loss of an arm, is off the point.

Any loss of function is noteworthy. The functions of an arm are well known. Maimonides and many others since, including the WHO have noted the sexual pleasure function of the foreskin. When you cut it off completely and consequently keratinize ( scar and toughen) the glans of the penis, the loss of functions is analogous to the loss of arm functions.

It has never been proven either that the loss of an arm is as destrucitve as the loss of a leg or a head but that red herring is laughably off the point too.

Thus you are demonstrating Ignorati elenchi as you are, to quote, "presenting an argument that may or may not be logically valid, but fails nonetheless to address the issue in question"

What is more interesting though, is to attempt to begin to understand what motivates such concerted resistance by circumcision enthusiasts, to inclusion of these facts about cutting off foreskins, and other facts like the disposals or commercial sale of the cut off foreskins --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:31, 13 June 2013 (UTC)

It is a result of secondary sources being found which claim that circumcision has no adverse effects whatsoever. This is an artifact of cultural bias. All of the secondary sources which make this claim are within cultures in which circumcision is prevalent to the point of being the norm and as such, forming "task forces" to craft and publish a policy for the implementation of non medically indicated circumcisions has relevance there. On the other hand, it would be strange in a normal culture to seek to publish a refutation as it would be something like publishing a finding that losing an arm is detrimental. Avi had amusing difficulty locating a secondary source that would support his (profoundly reasonable) contention that loss of an arm is detrimental and yet the absence of secondary sources asserting that loss of a foreskin in detrimental serves in this article as evidence that there is consensus that circumcision has no adverse effect. In fact, extraordinarily, a harsh criticism of the AAP circumcision task force report was published, but unsurprisingly as a letter to the AAP by a large group of MDs representing senior membership of several national medical associations.

http://pediatrics.aappublications.org/content/131/4/796.full?sid=b664414e-c520-48e7-be2a-eb1b77d80f37 (check out author affiliations, this is not a fringe group.)

They can be forgiven for not seeing any point in publishing their statement separately for much the same reason they see no need to publish secondary sources indicating that removal of arms has adverse effects. The current editors of the circumcision article are happily complying with the flawed WP:MEDRS but as a result are glaringly failing to comply with WP:Countering systemic bias. Furthermore, even within cultural regions where circumcision is the norm, there is clear dissent by medical professionals from the view that it has no adverse effects and direct criticism by at least one association of MDs of the secondary sources used but this is not represented in the article either. Any reader is left with the impression that most doctors feel circumcision has no adverse effect when it is obvious that there is not only no such consensus, but even that in most of the world circumcision on healthy patients will not be considered except for as an alternative to a more dangerous religious/cultural circumcision outside a medical facility.Zebulin (talk) 16:34, 20 June 2013 (UTC)

Not seeing how this comment is relevant as we do not use the AAP's policy statement in the article, and the AAP's systematic review the policy statement is based on is only one of four secondary sources used. We don't use unreviewed self-published sources from small fringe groups like DOC, see WP:SPS and WP:FRINGE; if they ever do get their work published in a reputable journal as a Review article or the like we can consider it. However you are correct in stating that the sourcing for the article does comply with WP:MEDRS, glad we can agree on that. Zad68 18:28, 20 June 2013 (UTC)

WE are a little off the point of this section's purpose here which was to consider whether we should include the World Health Organisation quote about the pleasure function of the foreskin when we value their other offerings so. And also whether the use, sale, or disposal of cut off foreskins by circumcision should be included in this circumcision article. it seems to me that these are all no brainers. Some other editors do not agree. Avi attempted to say that it had never been proven that having your foreskin lopped off was as destructive as having your arm lopped off but this was never asserted in the first place and was simply a distraction. The article still makes no mention of the diminishing popularity of circumcision --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 12:10, 21 June 2013 (UTC)he3

The sudden silence on this page is fascinating. Did it take a tremendous amount of organizing ? At what price in abandonment of WP principles ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:35, 3 July 2013 (UTC)

Inconsistency.

I think this needs fixing: "This article is about male circumcision. For female circumcision, see female genital mutilation." <--- inconsistency, anyone? I am seriously considering abandoning Wikipedia because of inconsistencies and incorrect info, that can't be corrected by the community. Krepta3000 (talk) 03:27, 20 June 2013 (UTC)

I took a look at your User page, which I think provides some valuable context for your question. The terms Wikipedia uses aren't consistent because the reliable sources don't use the terms consistently. Another way to look at this is to say that Wikipedia is consistent in reflecting the reliable sources accurately, even when the sources themselves aren't consistent. This is in accordance with Wikipedia content policy. Zad68 03:50, 20 June 2013 (UTC)

Comment by AlwynJPie

The whole article has become biased in support of circumcision. It appears Wikipedia has become infiltrated by those that support the procedure. Evidence which once showed that opinion has swung against any medical benefits of circumcision, that were once thought to exist, have been removed or altered to misrepresent them. This is very dangerous as a lot of people trust Wikipedia and are not aware that it can be edited by anyone.AlwynJPie (talk) 18:57, 24 June 2013 (UTC)

The article accurately reflects current worldwide medical consensus that routine infant circumcision is not generally recommended and that no major medical organization recommends routine circumcision, not even the AAP, and not even for the prevention of UTIs (as the article states, "prevention of UTIs does not justify routine use of the procedure"). The article states 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 only medical benefits discussed are the reliable sources that cover the current medical consensus that circumcision may be medically indicated in children for pathological phimosis, refractory balanoposthitis and chronic, recurrent urinary tract infections. Also the World Health Organization promotes circumcision as a preventive measure for sexually active men in populations at high risk for HIV. We have strong and explicitly medical sources to support these statements. If you have authoritative WP:MEDRS-compliant reliable secondary sources that state otherwise and aren't currently in use in the article with can consider them for inclusion. Zad68 20:13, 24 June 2013 (UTC)

While all that Zad says is true, the medium is the message, and the current layout, emphasis, section headings and omissions of many key facts such as the declining popularity of clinical circumcisions or the incidences of forced circumcisions all work together to normalize this strange ancient body part excision. The rationale about "medical" sources (so repeatedly proffered) serves to ensure that this imbalance is less likely to be corrected in the medium term. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:20, 27 June 2013 (UTC)

Tuma, as someone who presumably knows the community of anti circumcision activists well, are you able to say what percentage of them pretend to be heterosexuals concerned about loss of pleasure in vaginal intercourse but in reality they are homosexuals, angry becauee they think (rightly or wrongly I don't know) they would not have to use lubricant in homosexual penetration if they still had a foreskin?82.113.121.70 (talk) 16:46, 10 July 2013 (UTC)

82.113.121.70 sorry but I'm not understanding how this question would relate to a suggestion regarding this article's content. It looks like you're asking Tumadoireacht to engage in original research, to provide an answer that wouldn't even be useful for this article. This question seems unnecessarily inflammatory, unless I misunderstand what you're asking? Zad68 18:55, 10 July 2013 (UTC)

82- I do not know any anti circumcision activists and your ideas seem bizarre to me. I simply like any WP article to be balanced and to describe realities in a balanced and inclusive way omitting nothing on the subject in question.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:48, 10 July 2013 (UTC)

Additional links

Additional information with verifiable links added to section 4 Adverse effects surfingus (talk) 13:48, 18 July 2013 (UTC)

I have been unable to add the new links to the reference section. I have put them into the main text for now, hoping a moderator can fix them later. surfingus (talk) 14:02, 18 July 2013 (UTC)

Please use secondary sources per WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:32, 18 July 2013 (UTC)

Edit request on 21 July 2013

Please change the second sentence in the last paragraph under Human Immunodeficiency virus to say "Data is lacking..." instead of "Data are lacking..."

RunningDroid (talk) 02:10, 21 July 2013 (UTC)

Done per English_plurals#Irregular_plurals_from_Latin_and_Greek RudolfRed (talk) 02:44, 21 July 2013 (UTC)

Unnecessarily aggressive archiving of debate on this page

It seems to me that the robotic archiving from this page - set at just 7 days - is unnecessarily aggressive and is resulting in the cropping and curtailing of debate on the impartiality of this article. I am going to Assume good faith about the setting of the archiving policy, but I will say that it is counter-productive and should be substantially relaxed. Fig (talk) 14:47, 29 July 2013 (UTC)

It does seem indecently short but apparently is the standard length for high volume talk pages.The volume seems to have been turned down in recent weeks. I do not know whether discussions are put away seven days after last entry or seven days from creation. The downside in either case is that debates happen over and over.I am sure the cull period could be extended to 3 months but resistance may prevent this. This article is patrolled very vigorously at present to maintain a particular view on circumcision and debate here is largely a cosmetic futile exercise which will be of interest primarily to historians. The article will be a curiosity akin to the views of Kellogg. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:55, 31 July 2013 (UTC)

New study

It's scientific fact that the foreskin is erogenous tissue. It's obvious that removing it would reduce sexual pleasure. We don't question this in women (e.g. FGM). Please see: http://www.ncbi.nlm.nih.gov/pubmed/23374102?dopt=Abstract

The above source should be cited in the article.

Circumcision causes great harm. Additional evidence here:

http://www.ncbi.nlm.nih.gov/pubmed?term=21672947

The burden of proof actually resides within the community who supports male and female genital mutilation to prove that such actions on the body are NOT harmful. This proof does not exist. Crimsoncorvid (talk) 13:27, 15 July 2013 (UTC)

These are individual primary studies, we have four high-quality secondary sources supporting the current article content, we don't use individual primary studies to contradict the conclusions of secondary sources, see WP:MEDREV... surely you've been involved at this article long enough now to be familiar with WP:MEDRS and understand the sourcing rules? Zad68 13:36, 15 July 2013 (UTC)

I've been involved for long enough to know how you and others promote circumcision in the article. The secondary studies that you mentioned are cherry-picked to the pro-circumcision point of view. Furthermore, these studies don't directly mention penile sensitivity and/or have authors who are not credible. I have linked to over 40 studies that contradict your sources. You ignored my links.

Again, female prepuce removal is called type 1 female genital mutilation. Male prepuce removal is said to have no ill consequences. You continue to ignore ethical and legal concerns. It's no longer about "sources" and "evidence". It's about editors promoting a point of view despite copious evidence to the contrary. Crimsoncorvid (talk) 14:11, 15 July 2013 (UTC)

Article Talk pages are not for general discussion of one's own personal theories regarding the article topic, WP:MEDRS is the sourcing guideline for biomedical information, there's really nothing else to discuss here. Zad68 14:21, 15 July 2013 (UTC)

Unless, of course, Crimsoncorvid will offer some secondary studies to offset the "cherry-picked" studies.Zebulin (talk) 18:05, 15 July 2013 (UTC)

Sorry, Zad68, these are not my personal theories. They are facts as opposed to the viewpoint you and others trying to instill in the article. Please see references here: http://www.intactipedia.org/index.php?title=Foreskin_Sensitivity . Also: http://www.jamaicaobserver.com/magazines/allwoman/Male-circumcision-decreases-penile-sensitivity--study-shows_13833454

Please see the following: http://wiki.riteme.site/wiki/John_Harvey_Kellogg#Views_on_sexuality

Also http://wiki.riteme.site/wiki/The_Guide_for_the_Perplexed , in particular: “As regards circumcision, I think that one of its objects is to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate. Some people believe that circumcision is to remove a defect in man’s formation; but every one can easily reply: How can products of nature be deficient so as to require external completion, especially as the use of the foreskin to that organ is evident. The bodily injury caused to that organ is exactly that which is desired; This is, as I believe, the best reason for the commandment concerning circumcision.”

So Kellogg and the Jews knew that the foreskin was erogenous, but you folks don't? Sorry, time to stop the propaganda. Just ask an intact man. He'll tell you it's erogenous. Crimsoncorvid (talk) 19:32, 15 July 2013 (UTC)

I should mention that the Wikipedia definition of "reliable" is flawed. It doesn't include "credible" which, I believe, should be a requirement for any source. Wikipedians holds un-credible sources in just as high regard as credible ones as long as it meets the arbitrary criteria of "reliable" which is entirely up to the interpretation of editors. Proof? Jakew wouldn't allow the Boyle/Hill study criticizing the African studies. But you did. I'm glad you did, but this is proof of my point that it's all about editor control and has nothing to do with facts/science/accuracy. It's time to stop pushing the American cultural viewpoint and reflect the viewpoint of the world-wide medical community which holds that male circumcision is harmful and a human rights violation. Crimsoncorvid (talk) 19:35, 15 July 2013 (UTC)

Crimsoncorvid is it your intent to continue making personal attacks, and to continue to demonstrate the behaviors found at Wikipedia:Disruptive editing? Zad68 19:43, 15 July 2013 (UTC)

I have made no such personal attacks. Accusing people of personal attacks is one of the way you editors maintain control over this article. Nobody can dare call into question anything. Don't upset the status quo. Don't make corrections. It's all part of maintaining a viewpoint instead of reflecting the facts. Is it your intention to continue ignoring sources that contradict the viewpoint of this article? Crimsoncorvid (talk) 20:15, 15 July 2013 (UTC)

Indeed. I wonder if Zad has read his personal attacks link himself? I'm at a loss to see the personal attacks as defined there in anything we see from Crimsoncorvid here.Zebulin (talk) 20:22, 15 July 2013 (UTC)

Crimsoncordvid - I understand your frustration at the omissions from this article. I do mot believe that it is your intention either to attack other editors, nor to subvert Wikipedia's purpose. We all are equal in our attempts and desire to best interpret and further the aim of WP which is to "compile the sum of all human knowledge". I agree with you that much useful material is presently excluded from the article. While primary sources are not generally used to contradict secondary ones, they ARE used in many instances to compare,contrast and to amplify and to give a flavour of good science that reflects the latest work which may not have made it to secondary consideeration just yet. I find it remarkable that some editors of intelligence and diligence have an apparent blind spot when it comes to the contentious subject of male genital cutting and foreskin cutting off. Preventing the inclusion of entirely reasonable information about social and commercial aspects of this body modification is perhaps the best example of this. Try to tone down your language a bit when your block is ended and we can work together to ensure this article describes this arcane and increasingly unpopular practice most accurately.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:00, 17 July 2013 (UTC)

• This article reads like an advert for the circumcision society. It appears that all viewpoints critical of circumcision have been pushed out to the articles Circumcision controversies and Ethics of circumcision (if not off of Wikipedia entirely), which leaves an article that is substantially POV. Fig (talk) 13:29, 29 July 2013 (UTC)

- Agreed. Please see my new section on this talk page for more. --Hawkeye499 (talk) 16:24, 5 August 2013 (UTC)

Request for edit: Use of single study is polarizing the article

It seems that the citation currently numbered 18 ("American Academy of Pediatrics Task Force on Circumcision") is being used to present a polarized viewpoint on the effects of circumcision on the sensitivity of the penis.

From the article:

> "Circumcision does not appear to have a negative impact on sexual function.[18]"

> "Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction.[18]"

There are numerous primary sources which point to the opposite of this, or at least that this fact is debated. Here is one for a start: http://www.ncbi.nlm.nih.gov/pubmed/23374102

I'd suggest changing both of the above lines to something like:

> "Circumcision's effect on sexual function and sensitivity of the penis is debated."

Also, let's not jump straight into a debate about how the above source is invalid. Other users have [already been through those hoops](http://wiki.riteme.site/wiki/Talk:Circumcision/Archive_75#MO_of_circumcision_advocates_here). There are dozens of sources which report a loss of sensitivity as a result of circumcision: they deserve their place in the article. One source citing the opposite viewpoint is not enough to have all other viewpoints omitted.

--Hawkeye499 (talk) 16:22, 5 August 2013 (UTC)

Hi Hawkeye, take a closer look, that one reference [18] actually points to four separate secondary sources based on lots of individual primary sources. The study you're pointing to, PMID 23374102, is an individual primary source. We don't use individual primary sources to contradict the findings of secondary sources, please see WP:MEDREV. If you're interested in editing biomedical information on Wikipedia please take a look at WP:MEDRS, the biomedical sourcing guidelines. Zad68 16:56, 5 August 2013 (UTC)

But in the archived talk pages for this article, I see people pointing to something like 40 separate sources for the opposite viewpoint. Why are they being summarily dismissed? I don't want the article to say "circumcision reduces sensitivity", but nor do I want it to say "circumcision does not" (which is what it says at the moment!). I want the article to say "there is a debate." The academically-sourced debate is absolutely there - why isn't it included in this article? This article is *not* "fair and balanced." Hawkeye499 (talk) 17:13, 5 August 2013 (UTC)

Fundamentally, individual primary sources cannot be used to establish their own noteworthiness. Secondary sources are needed to do that. Please take a look at WP:MEDREV. Zad68 17:22, 5 August 2013 (UTC)

Surely that's a problem, at least in the case of this article, then? Any reasonable person can see that there are conflicting sources which have equal academic merit. Knowing this, surely the article needs to be adjusted? Editors should have a responsibility to ensure articles remain neutral and part of that needs to include researching sources which don't support their own personal views. Do you think that has happened in this case? It seems this page is very pro-circumcision and until we see some balance in this article my opinion of that won't change. I suppose my question should be: "are you happy that the article is neutral in its current state?" Because I don't think anyone should be. Hawkeye499 (talk) 18:04, 5 August 2013 (UTC)

No, it's not a problem, it's by design. I do not know of any sort of exception like you're describing made for any article on Wikipedia. I can't see anything particularly special about the subject of this article that would require it.

Hawkeye, what's really interesting is your statement: Any reasonable person can see that there are conflicting sources which have equal academic merit. - I see that there are some primary sources that find there is an effect, and there are others that find there is not. But on Wikipedia, we do not use "any reasonable person" to do the evaluation of the quality and relevance of evidence produced by the primary sources. Instead, we depend on the well-qualified experts producing reliable secondary sources to do that evaluation; all we do is summarize their findings. Zad68 18:25, 5 August 2013 (UTC)

Sure. You "summarize their findings" by cherry-picking the ones you want to summarize and blatantly ignoring the rest. I have never said I want this article to be anti-circumcision but I do want a balanced viewpoint. Your excuses about how the anti-circumcision studies are invalid are extremely convenient. This guy's comment has it exactly right. I also really like the comment from the above Talk point: "This article is patrolled very vigorously at present to maintain a particular view on circumcision and debate here is largely a cosmetic futile exercise which will be of interest primarily to historians." Puts it very nicely. I'll be opening disputes over this page. Hawkeye499 (talk) 18:31, 5 August 2013 (UTC)

It'd sure be nice if you would assume good faith, just as I am doing with you. If you have high-quality WP:MEDRS-compliant secondary sources you'd like to consider for use in this article, please identify them. Zad68 18:41, 5 August 2013 (UTC)

Assuming good faith is useful for maintaining civility, but it doesn't help to resolve issues. You must see that when several people comment on how they believe this page is being intentionally skewed to one side's opinion, that there is a problem. And there is a problem here. Hawkeye499 (talk) 18:46, 5 August 2013 (UTC)

Maintaining civility by assuming good faith (among other good behaviors) makes it possible to have the conditions under which editors who disagree are able to resolve issues. I understand the point of view of yourself and others, and how you've come to it. Zad68 18:55, 5 August 2013 (UTC)

Circumcision controversies

Why doesn't this article link in any way to Circumcision controversies? It's a huge and well-referenced article. Surely it should be linked to from the main circumcision article? --Hawkeye499 (talk) 18:10, 5 August 2013 (UTC)

Hawkeye, it is linked, please see the See alsos at Circumcision#Ethical and legal issues. Zad68 18:20, 5 August 2013 (UTC)

Not under the Adverse Effects section, though, which is a place where it definitely should be. If you read Circumcision controversies you'll see there are several large portions which deal with adverse effects. These need to be added to this main article's Adverse Effects section. That whole section is currently exclusively pro-circumcision. It reads like a pamphlet called "Why you shouldn't be afraid of circumcision". I intend to open an NPOV dispute about this as soon as I'm able. Hawkeye499 (talk) 18:29, 5 August 2013 (UTC)

The Circumcision controversies article may have its own problems and the existence of suboptimal content in one article isn't a strong argument for bringing that content to another article. But I took a quick look at that article, and the arguments regarding effects are attributed to those advocates pro and con holding those views. Regardless, on Wikipedia "NPOV" means representing views in proportion to the emphasis found in reliable sources. If the reliable secondary sources are in agreement in stating "X" then the article should reflect that. Zad68 18:38, 5 August 2013 (UTC)

I think there may be a form of systematic bias at play here. Certainly in the US, many of those arguing against circumcision do not qualify as reliable sources, so it is difficult to source their arguments, but In Europe circumcision is very rare (except for religious groups such as Jews), and it should be somewhat straightforward to find reliable sources in their medical and sociological literature. Gaijin42 (talk) 18:55, 5 August 2013 (UTC)

Editor Hawkeye argues cogently for referencing the Circumcision Controversies article in the Adverse Effects section of this article for the reasons stated , not for material transfer. Yet Zad's reply refers to doing so. Does any other editor understand why ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:53, 6 August 2013 (UTC)

Sorry if I wasn't clear. The reason it doesn't make sense to put that link in the Adverse effects section is because that section doesn't contain any content that discusses a controversy. It makes sense to put it in the Ethical and legal issues section because that section does have well-sourced content that discusses controversies ("There is a long-running and vigorous debate over ethical concerns regarding circumcision..."). Zad68 14:31, 6 August 2013 (UTC)

If the circumcision controversies article has large strong content on adverse effects of circumcision, then these should be referred to, or at least linked in the adverse effects section of this article

this following section is fascinating on adverse effects:

Another area of continuing dispute is the effect of circumcision on penile sensitivity. In April 2007, the British Journal of Urology published a study (Sorrells et al., 2007) that stated it "conclusively shows that circumcised males have a significant penile sensory deficit as compared with non-circumcised intact men" and that "the most sensitive regions in the uncircumcised penis are those removed by circumcision."[70]

But in June 2007, the BJU published a letter in response by Waskett and Morris, which concluded that "despite a poorly representative sample and a methodology prone to exaggerating the sensitivity of the prepuce, NOCIRC's claims remain unproven. When the authors' data are analysed properly, no significant differences exist. Thus the claim that circumcision adversely affects penile sensitivity is poorly supported, and this study provides no evidence for the belief that circumcision adversely affects sexual pleasure."[71]

Hugh Young responded to this, stating that Waskett and Morris "critique the finding of Sorrells et al. that 'circumcision ablates [removes] the most sensitive part of the penis' by excluding that part from consideration... That the foreskin itself has a sexual function was well-known for centuries before secular circumcision became widespread.

What would need to be proved rigorously is that cutting a significant part of the distal penis off does not diminish sexual pleasure." [72] Payne et al. reported that direct measurement of penile sensation in the shaft and glans during sexual arousal failed to support the hypothesised sensory differences associated with circumcision status.[73] --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 02:18, 8 August 2013 (UTC)

This was already addressed by my earlier responses. Zad68 12:55, 8 August 2013 (UTC)

Wrongly addressed -return to sender ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 07:17, 9 August 2013 (UTC)

Revision 568070766

My changes were undone despite being incredibly balanced. I deleted absolutely nothing from the original and did not attempt to replace any points with new or opposing ones. I added fully sourced balanced points to the article, with the same sources as used on Circumcision controversies. Undoing the entire edit is not acceptable. If the changes are undone again, the next step is NPOV. The time of this article's bias is over. Hawkeye499 (talk) 23:48, 11 August 2013 (UTC)

Hawkeye, if you'd like to be editing biomedical content on Wikipedia, you must read, understand and follow the appropriate guideline covering biomedical sourcing, which is found at WP:MEDRS. In particular, you are not applying WP:MEDREV, part of that sourcing guideline, specifically that part where it says Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources. Regarding NPOV: please be aware that on Wikipedia, NPOV is grounded in reliable sources, and here reliable sources are WP:MEDRS-compliant secondary sources, not individual primary studies like the one you are providing. This was all explained in the above section, please re-read it. If you have any more questions about WP:MEDRS and WP:MEDREV in particular I'd be happy to try to explain further. Zad68 01:26, 12 August 2013 (UTC)

Agree with Zad, per policy we do not use primary sources to refute the conclusions of secondary ones. Thus this edit was appropriately reverted. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:46, 12 August 2013 (UTC)

The danger with the eagerness to frequently mention the non refute guideline when material which does not support circumcision is proposed is that the fact that we can forget that primary sources are frequently used, with the contradiction caveat observed. The effect is that neophyte editor retreats in disarray and the article continues to paint a lop sided and partial picture of the cultural phenomenon of foreskin removals, still with no mentions whatever , for example, of disposal variations or sales of the excised skin and flesh or of vanity circumcisions or of forced circumcisions.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:51, 12 August 2013 (UTC)

Two questions:

1) The content on Circumcision controversies clearly details adverse effects from circumcision. Why is it allowed to remain there if it's apparently invalid? Just because it's a primary source, does it make the points false? Do the secondary sources on this article somehow "overrule" what's mentioned in the controversies article? And if so, why is that information still published on the controversies article? My point is: the information is either true or false; it's either there, or is not. If it's true, and is there, it should be on this article.

2) Why does so much effort go into finding (and policing) secondary sources which are pro-circumcision, and so little into finding those which are anti-? As frequently mentioned in the archive of this talk page, there are scores of sources which present the opposite view - are you telling me none of those are either secondary sources or have connected secondary sources to back them up? Hawkeye499 (talk) 15:05, 12 August 2013 (UTC)

Hawkeye, regarding your first question: As I explained already (above), the Circumcision controversies article may have its own problems, but honestly I was being far too gentle. Let me put a well-justified sharper point on it: Parts of the Circumcision controversies article are in terrible shape and need a complete reworking from the ground up, starting with the purging of the misuse of primary sources to get rid of the serious WP:OR (and specifically WP:SYNTH) problems they have. Your question "Why is it allowed to remain there if it's apparently invalid?" is a great one, and the answer is based in the fact that Wikipedia is a open encyclopedia anyone can edit. The reason why it's allowed to remain there is that simply nobody has gotten over there yet to fix it. The existence of bad content that nobody has fixed yet doesn't mean it's good or even acceptable. There is absolutely no Wikipedia "content police" to guarantee every edit is in line with Wikipedia content policy and guidelines. Lots and LOTS of Wikipedia articles have serious problems like that article has, and problems don't get fixed until someone decides to fix them.

Regarding your second question: No special effort has been made to find sources that meet or do not meet any particular view. I agree with your underlying idea that doing so is wrong. The best way to develop content is to survey the best-quality sources and let the sources lead you to the content. Use WP:MEDRS to identify the best-quality sources. Zad68 19:49, 12 August 2013 (UTC)

Conversely, Hawkeye, while medical sources are interesting and informative they only paint a tiny part of the picture of the cultural phenomenon called circumcision (and genital cutting and cutting off and disposal of bits of the human male sex organ) Thus anthropological,psychoanalytic,sociological,commercial,psychological,historical and news media sources may be more useful than confining one's researches to med secondary sources in attempting to round out this article and achieve one that is more balanced and informative.

These aspects are at present largely and oddly missing from this article.

What psychologically( or otherwise) motivates parents to cut bits off, or have others cut bits off their infant children's genitals is addressed a little better in the french and german versions of this article and they also address the legal ramifications and successful suing of parents who have cut their kids in USA by grown up circumcised sons. It is particularly odd that the diminishing popularity of circumcision continues to go unmentioned in this article but indicative of its many other odd omissions. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:15, 14 August 2013 (UTC)

Words that aren't even in this article

The word scar is only mentioned in the context of aboriginal Australian ritual scarification; which is a different practice. Scar appears 7 times in the article for female genital mutilation. Estrogen receptors are not even mentioned in this article or in the article on foreskin. — Preceding unsigned comment added by CensoredScribe (talk • contribs) 23:02, 11 August 2013

This is most strange - a comment (the new section scar one) attributed to me which I did not post. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:58, 11 August 2013 (UTC)

The article doesn't mention subsequent difficulties to masturbate and it only uses the term "mutilation" twice, and in no way does it address male circumcision as a form of mutilation which it unequivocally is... As a matter of fact, I suggest renaming the article to Male Genital Mutilation.Doriphor (talk) 08:05, 24 August 2013 (UTC)

If the same impossible medical standards were applied to other articles as is seen here; than no one would know that completely flaying someones skin decreases touch sensitivity because not enough people have been tortured in clinical settings in the last five years for a review article. I mean how do we really know that flaying someones skin has any effect on sensitivity unless it's been done in an MRI, or that other peoples feelings exist?

The following reference is unacceptable:

18. The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejad et al. "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyle et al. "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Perera et al. "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.

It has no links, no journals names, and based on the titles of the articles and institutions cited the pick is probably strongly skewed. 80.174.254.219 (talk) 23:24, 19 August 2013 (UTC)

Missing Anatomical Information and Poor Quality of Article

I find it extremely disturbing that this article and the article on foreskin completely ignore anatomical features found in the foreskin such as the tactile corpuscles. Now you can debate what effect the corpuscles have; but what isn't up for debate is that they have been removed. I think this article sets a terrible example for wikipedia; I have seen on other pages people discuss that the creation of a separate article titled controversies almost always worsens the credibility of the article and acts effectively as a free speech zone. The page for circumcision controversies does not require Wikipedia MEDRS standards, nor does it contain any reference to the Meisner Corpuscles or any other anatomical features like Estrogen Receptors. I would like to know where to petition for this articles rating to be lowered until a neutral point of view can actually be established. Also on a religious note no reference to Melchizedek/Shem's being born without a foreskin is made; which is important as he predates Abrahams covenant by several generations and was the priest of Salem who bestowed him with the robes of Adam. If circumcision is found earlier than Abraham it is of significant historical and biblical importance to have it mentioned if not here, than on the page for religious circumcision where Shem's status of not having foreskin is ignored. CensoredScribe (talk) 15:23, 2 September 2013 (UTC)

Hi CensoredScribe, it would make more sense for you to just propose the additions you would like to see in this article, supported by reliable sources. I see that on your User Talk page you have six messages from other editors requesting that you please pay attention to Wikipedia's sourcing policies, and I think you should consider those messages carefully, as you'll find the requirement to use high-quality, authoritative reliable sources applies to content in this article, just like any other. For biomedical information, Wikipedia's sourcing standard is WP:MEDRS. I have not run across a WP:MEDRS-compliant source detailing Meissner's corpuscles in relation to circumcision. The only thing even slightly relevant I've found for estrogen receptors is perhaps PMID 22341273, but that is a primary source and is studying hypospadias, not really circumcision. For other topics like the religious items you mention, WP:RS is the general guide. I've not run across the item about Melchizedek/Shem you mention and if you can find sourcing for it, there may be a place for it at Shem (it's not in that article at this time), or (if the sourcing for it establishes its relevance) in Religious male circumcision perhaps. But again, authoritative reliable sourcing is required. Zad68 18:01, 2 September 2013 (UTC)

This article is not about foreskin but about circumcision. In depth anatomical details about the foreskin can go at that article if you can find references. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:31, 3 September 2013 (UTC)

It is more than a little disingenuous to continue to decry attempts to include information about foreskin function pre- chop off in the very article concerned with people who cut off the foreskins f(or various reasons) . As astounding as the blanket opposition to even mentioning what the choppers do with the chopped off foreskins . I agree with CensoredScribe that the awarding of good article status for this partial and skewed article was premature and should be rescinded until lacunae addressed.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:40, 4 September 2013 (UTC)

Positive effects and negative effects both need to be mentioned, not just one or the other. That is the only way to achieve neutral point of view, exactly like the legal system. CensoredScribe (talk) 05:49, 5 September 2013 (UTC)

Just requires equally high quality references. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:29, 5 September 2013 (UTC)

After some consideration, I retract my statements on the quality of this article. Other than the large amount of estrogen receptors not being mentioned; all anatomic features and side effects are already mentioned on the page for foreskin. Mentioning everything about an organ on the page for the surgery that effects that organ would defeat the point of having a separate page for the organ, so this article is fine. Tumadoireacht, if you have a good source for the medical uses of foreskin you should add that to the page for skin grafts. The existence of controversy pages for any page diminishes the value of that page, considering every article has some level of controversy to it, :::Wikipedia could very easily gain an extra million articles consisting just of controversy pages.CensoredScribe (talk) 21.40 6 September 2013

If foreskin skin is sold as skin grafts then of course that information should go in the skin graft article Censoredscribe . The many medical and cell and cosmetic uses of foreskins cut off in circumcisions should,however, go in this circumcision article. As should the currently still missing information on what different foreskin chopping tribes,cultures, and religions do with the cut off foreskins as the final part of the circumcision cultural process. The well documented spates of forced circumcisions in several parts of Africa and in one conflict in Europe should also be included. The continued and effective resistance to these inclusions amongst a small but concerted and assertive cabal of editors and administrators is most odd.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:46, 6 September 2013 (UTC)

My apologies Tumadoireacht, you're correct that this article would be the best place to index that information, I'm assuming you have good references. For documented cultural practices, or a product sold by a corporation you would not need to meet the standards of wikipedia MEDRS. I doubt any official poll exists, but I'd guess the vast majority of people just bury the foreskins like is done with placentas. If there isn't already an article on all the commercial uses of human body parts and medical waste, than maybe there should be to index them all in one less controversial and more accessible location. I believe fight club is fairly accurate about the uses of human fat taken from lipo-suction to make soap, there's likely other business practices that use human by products like how the ancient greeks used urine for cleaning cloths and "night soil" for fertilizer. Than there's the more dubious uses of human body parts like the books bound in the skin of executed criminals, however if you really wanted to include every cultural use of human body parts in an article than you would have to include the uses of corpses in preparing zombie toxin in voodoo. I've managed to take this discussion off topic to an even darker place than circumcision, but does Wikipedia really need to become more like H.P. Lovecrafts Grimorum Necronomicon? I'm wondering whether having a sum of all human knowledge is actually a good idea considering how hateful we still are, or whether there are some things best for mankind not to know; like all the uses of body parts. CensoredScribe (talk) 06:18, 7 September 2013 (UTC)

Ww do not get to pick and choose the bits we like and just include those. That would make Wikipedia a fanzine not an encyclopedia. Also try not to illogically extend arguments of other editors. It is ineffective and weakens any point you wish to make.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:34, 7 September 2013 (UTC)

Changes: Positions of medical organizations

No sure why "No major medical organization recommends either universal circumcision for all infant males (aside from the recommendations of the World Health Organization for parts of Africa), or banning the procedure." to "Most major medical organizations do not recommend either universal circumcision for all infant males (aside from the recommendations of the World Health Organization for parts of Africa), or banning the procedure." This was done without providing a ref that a major medical organization either bans the procedure or recommends universal circ.

The other issue I have with these changes are their us of news sources. The news often gets it wrong. Do people have the actual statements from these organizations? Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:58, 10 September 2013 (UTC)

Quite right Doc - that pesky New York Times and its ilk have been noted for editorial sloppiness - for centuries now. What would they know about accuracy in secondary source eminent newspaper of note reportage after all ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 05:50, 16 September 2013 (UTC)

That was me. The last part of the statement No major medical organization recommends either universal circumcision for all infant males (aside from the recommendations of the World Health Organization for parts of Africa), or banning the procedure appears misleading, as various national medical associations do advocate outlawing non-medically indicated circumcision of minor males in their countries on human rights grounds. Examples are for Sweden (http://www.thelocal.se/39200/20120219/ , http://www.upi.com/Top_News/World-News/2012/02/19/Swedish-doctors-urge-ban-on-circumcision/UPI-61961329678560/ , http://www.gp.se/nyheter/sverige/1.864475-barnlakare-vill-stoppa-omskarelser [press reports, the last in Swedish]) and Germany (http://www.kinderaerzte-im-netz.de/bvkj/aktuelles1/show.php3?id=4322&nodeid=26 , http://www.dgkic.de/index.php/presse/189-pressemitteilung-juli-2012 , http://dakj.de/pages/posts/stellungnahme-zur-beschneidung-von-minderjaehrigen-jungen-123.php [medical organization press releases, in German] -- citations taken from https://wiki.riteme.site/wiki/Circumcision_and_law#Germany ). Shorespirit (talk) 19:18, 10 September 2013 (UTC)

News sources often get organizations position wrong. Have you seen any high quality secondary sources? Or sources published by the organizations in question that support this? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:34, 10 September 2013 (UTC)

The German links I gave are directly from the medical organization web sites. For Sweden, I haven't found the original position statement, but all the news stories I saw agree that the Swedish Pediatric Society called to ban child circumcision. Shorespirit (talk) 19:45, 10 September 2013 (UTC)

Shorespirit, what we're using in the article is a reliable secondary source, Bolnick 2012, which has an entire chapter devoted to reviewing and evaluating the positions of the world's major medical organizations. This secondary source determines which ones are important and influential enough to include in a review--we can't possibly include mention of EVERY medical organization out there, there have to be hundreds. Sweden was not in the list of major medical organizations Bolnick include. One of the issues with your edit was that it modified the article's summary of the source to make it appear to say something Bolnick didn't say--that is really not allowed. Beyond that, it's very problematic to take native-language press releases from individuals associated with organizations and try to interpret them as a policy statement backed by the organization. Several of the links you provided are to press releases and don't appear necessarily to be speaking as a policy statement for the organization as a whole. As Doc said, this is a case where we really need an expert secondary source (like Bolnick) to evaluate the statements. Zad68 19:48, 10 September 2013 (UTC)

Well, "no major medical organization" is a very strong statement. Is there some accepted criterion for what makes a medical organization "major"? Not having access to the book by Bolnick, I can't evaluate how thoroughly they checked medical organizations' policies (or how reliable a secondary source it is, in general -- Google Scholar shows zero other works citing it). Since the article does currently cite statements by Dutch and British medical associations, I don't see any objective measure by which German ones, for example, would be less worthy of consideration. Shorespirit (talk) 20:10, 10 September 2013 (UTC)

Agree we should mention the position of some of these German organizations in the article. We should see if we can find an English version. Google translate is not the best. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:24, 10 September 2013 (UTC)

The evaluation of "major medical organization" is done by the source, Bolnick 2012. But I'm on board with adding the most influential pediatric organization from Germany, I guess that would be the DGKJ? We just have to make sure that any source we use is actually describing a position of the organization as a whole, and not the opinions of individuals associated with the organization. Adding: Wherever possible, the article provides links to the full text of the sources, see the Google Books link to at least a preview of Bolnick at the bottom of the article, under the references list. Zad68 20:52, 10 September 2013 (UTC)

Thanks, Zad68. I was able to read most of the chapter on Google Books. Bolnick2012 surveys the positions of several medical organizations from different countries, but not any German ones, and concludes "many organizations have established new review committees. Thus, this review may well be dated." So I think it's relevant to mention that DGKJ and the other German pediatrics associations supported the 2012 court decision against nonmedically motivated child circumcision and opposed the subsequent bill to permit it. We should modify or qualify somehow the sentence about "no major medical organization". I add to the sources given above the Bundestag testimony of the head of one of the German pediatric organizations, given at http://www.kinderaerzte-im-netz.de/bvkj/kinpopup/psfile/pdf/70/121126_Ste50aa5e211e6a6.pdf with an English translation at http://arclaw.org/sites/default/files/BVKJ_Statement_Official_Translation.pdf — Preceding unsigned comment added by Shorespirit (talk • contribs) 21:36, 10 September 2013 (UTC)

This would go well under Society and Culture -> Ethical and legal. I'm a bit uncomfortable using a translation hosted at "ARC Law" which is an activism website, do you have a link to the translation directly hosted by the organization? Zad68 21:57, 10 September 2013 (UTC)

Agreed that the host of the translation is a concern, but as long as we also link to the original I think it would be OK for now. Shorespirit (talk) 22:03, 10 September 2013 (UTC)

Taking a closer look at it now, I think we're looking to do is expand the existing paragraph in Society and Culture -> Ethical and legal that starts "Generally, circumcision on a minor is not ethically controversial or legally questionable..." to include a summarization of the legal status in the major countries around the world. The legal events of 2012 in Germany would be mentioned, along with legal status in other countries. Circumcision and law provides a start but that article is really in bad shape and also out of date. I'd be happy to do it but it will take a few days to develop. Zad68 02:23, 11 September 2013 (UTC)

Legal status expanded now. Zad68 15:11, 11 September 2013 (UTC)

Law and media journal reports of successful cases of USA adult males suing the parents who cut them as children still missing from law section. Why is this ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:46, 11 September 2013 (UTC)

It would be useful if you provide a link to the articles in question that you hope to use as a ref. People sue over everything in the states, hot coffee being one. We are not going to have Wikipedia become a collection of US case histories. There must be significant coverage in secondary sources for mention in this article. If there is not than many it can go in the sub article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:49, 11 September 2013 (UTC)

Sources are not lacking.The "sub" articles are peppered with them. Sources,of course, as we both well know, are not the block to inclusion of full information about circumcision in this article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 05:44, 16 September 2013 (UTC)

Regarding Germany, while it appeared that most physicians participating in the circumcision controversy spoke out against non-therapeutic circumisions, others spoke out in favor of keeping it legal. This article in the daily newspaper for physicians Deutsche Ärztezeitung from July 2012, titled "Circumcision Splits German Medical Profession", reports that the head of the Hartmannbund (Germany's largest physicians' association) section in the German state of Lower Saxony demanded a resolution of his organization's decision-making body explicitly sanctioning members to perform religious circumcisions and action from Germany's parliament to make it explicit that religious circumcision should remain legal. Another physician's association in a different federal state took an opposing position.

As quickly and suddenly as the issue shot up the charts last summer, it died down soon after, both in the broader society and among medical professionals. This Google Trend chart -- http://www.google.com/trends/explore?q=Beschneidung#q=Beschneidung&cmpt=q -- shows changes in frequency for "Beschneidung" (circumcision) as a search term. (Note that "Beschneidung" has two other meanings: (1) female genital mutilation and (2) curtailment (e.g., of bankers' bonuses; these other meanings account for the majority of Google searches for the word before 2012, as evidenced by the news stories linked by GT with the chart.)89.204.137.70 (talk) 12:13, 12 September 2013 (UTC)

These are great points. This is exactly why it's important to pay attention to WP:NOTNEWS as content policy. It's also a great example demonstrating why independent, reliable secondary sources are so critical. Zad68 12:54, 12 September 2013 (UTC)

Unless of course they are eminent independent reliable secondary sources like national newspapers who have anything to report that fails to paint circumcision in a glowing positive light.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:49, 17 September 2013 (UTC)

Necessary Amendment to Adverse effects section

In the "Adverse effects" section of the "Circumcision" article the following is noted:

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

This is widely debated and controversial. A recent published study flatly contradicts this claim. A more accurate version of this article would highlight the controversy.

One article which contradicts the quote from the Wikipedia article: http://www.ncbi.nlm.nih.gov/pubmed/23374102

One article which affirms the controversial nature of the topic: http://www.ncbi.nlm.nih.gov/pubmed/23937309 Kylepeer (talk) 17:25, 29 August 2013 (UTC)

Hi Kyle, I see someone has already left you a welcome message on your User Talk page, please take a moment to review the information in those links, it'll help you get acclimated to Wikipedia editing. In addition to that, if you'd like to be editing biomedical information on Wikipedia, you should look at WP:MEDRS, and in particular WP:MEDREV (regarding the Bronselaer study PMID 23374102).

Regarding your suggestion here: PMID 23937309 by Brian Morris and John Krieger isn't an overview of controversies, it's a meta-analysis of primary study data. We do use the review article Circumcision controversies by Pinto, PMID 22857844, that is exactly such an overview, and it doesn't mention this as being controversial. When we have two secondary sources, one covering something directly, and one mentioning something in passing while covering something else, it's preferable to use the secondary source that is covering the topic directly. We might use Morris as a fifth secondary source supporting the existing article content, although as we already have four I'm not sure it's necessary. Zad68 18:44, 29 August 2013 (UTC)

I sincerely hope that we do not choose one overview or meta-analysis over another on the basis of it supporting the promotion of circumcision--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:16, 1 September 2013 (UTC)

See also Frisch et al., https://www.ncbi.nlm.nih.gov/pubmed/23509170 (authored by representatives of numerous European national pediatrics societies): "...Recent studies... suggest that circumcision desensitizes the penis and may lead to sexual problems in circumcised men and their partners. In light of these uncertainties, physicians should heed the precautionary principle and not recommend circumcision for preventive reasons." To claim that the contrary is any kind of medical consensus seems unjustified. Shorespirit (talk) 13:40, 12 September 2013 (UTC)

Based on the above, I suggested revising the last paragraph of Adverse effects to: "In the medical literature, there is controversy as to how to assess the evidence on the effect of circumcision on sexual pleasure and function. Advocates of routine circumcision argue that circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction [AAP2012, Morris2013, and other references]. Opponents of circumcision argue that circumcision may impair sexual pleasure and 'lead to sexual problems in circumcised men and their partners' [KNMG 2010 and Frisch2013]."

This suggested change doesn't use the sources mentioned appropriately. This edit would characterize the AAP as an "advocate[] of routine circumcision" which isn't true. It also characterizes the Frisch 2013 commentary as "medical literature", but it isn't, at least not according to Wikipedia's medical sourcing guidelines--it's a comment (basically a letter to the editor) in response to the AAP. Further, there is also no reason to remove the existing secondary sources (which are part of the "medical literature") Sadeghi-Nejad 2010, Doyle 2010 and Perera 2010. It also mischaracterizes KNMG 2010's position. We could add Morris 2013 I guess but again I don't see a reason to. The reality is that for this particular statement, the medical literature is remarkably consistent. Zad68 18:43, 16 September 2013 (UTC)

"This edit would characterize the AAP as an "advocate[] of routine circumcision" which isn't true."

I'll leave this link here: [8] — Preceding unsigned comment added by 81.15.239.11 (talk) 20:18, 23 September 2013 (UTC)

Even after re-reading WP:MEDRS and WP:MEDREV, I fail to see how this article can so boldly state that "Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction." "Circumcision" is a broad term, and varies widely in terms of tightness, cut, amount skin removed, etc. However, most circumcisions destroy or else completely obliterate the frenulum (especially when done on young children, where it is difficult to be precise), of which Wikipedia itself states:

The frenulum and the associated tissue delta on the underside of the penis below the corona has been described in sexuality textbooks as "very reactive" and "particularly responsive to touch that is light and soft." The “underside of the shaft of the penis, meaning the body below the corona” is a “source of distinct pleasure.”[5] Crooks and Baur observe that two extremely sensitive specific locations that many men find particularly responsive to stimulation are the corona, and the frenulum.

Given this, and the fact that "circumcision" almost always alters the frenulum, how can we say that it "does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction"? --MosheA (talk) 18:01, 3 October 2013 (UTC)

Penis piercings affect the glads and some claim it increases sexual satisfaction.Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:19, 4 October 2013 (UTC)

Yes, but it does not destroy it. Piercing a septum, for example, could increase sensitivity to the region (and conceivably increase sexual satisfaction, if such faculties were located in the nose), but removing a septum is another matter altogether. --MosheA (talk) 05:34, 4 October 2013 (UTC)

"Some Claim" that piercings are fun- ergo chopping off the most sensitive bits of the penis must not diminish pleasure or sensitiviity - Doc - please ! You and others are peddling dodgy notions here. Let us let the article tell the truth instead.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 05:41, 4 October 2013 (UTC)

Moshe, although I understand the theory behind what you're saying, we can't base article content on it because it would be original research to do so. On Wikipedia pretty much all we do is summarize what the best-quality reliable secondary sources say. Wikipedia can't be used as a reliable source for itself, see WP:CIRCULAR. Zad68 15:12, 4 October 2013 (UTC)

Okay, but this doesn't violate WP:CIRCULAR. The reason I put "very reactive" and "particularly responsive to touch" is that they come from a sexuality textbook (Hass, K.; Hass, A. (1993). Understanding Sexuality. St Louis: Mosby. pp. 99–100. ISBN 0801667488.)

How about something to this effect: "Circumcision often damages or destroys the frenulum, an area of the penis that has been show to be very responsive to sexual stimulation"<ref>Insert aforementioned reference</ref> ? --MosheA (talk) 05:32, 5 October 2013 (UTC)

Moshe, thanks for suggesting a clear content change and source, it makes discussion much easier! However, there are a few issues with the suggested edit. The most important one is that the source cited, Haas & Haas 1993 (3rd edition), doesn't appear to support the part of the edit stating "Circumcision often damages or destroys the frenulum". What I do see in Bolnick 2012's Surgical Guide to Circumcision are many instructions stating that the frenulum must be avoided (see p. 132 for just one clear example), although it says that because the frenulum is a common source of excess bleeding, rather than because of any sexual effect. I have not run across any up-to-date reliable secondary sources that give prevalence of damage to the frenulum, and I have never seen damage to the frenulum in particular cited as a common or even uncommon complication. Haas & Haas 1993 is also rather old at 20+ years, and would be a problem per WP:MEDDATE to use to support biomedical information. For these reasons, I don't think the edit suggested would be an improvement. Zad68 01:03, 6 October 2013 (UTC)

Thanks for your input. Would this source meet criteria for WP:MEDRS and WP:MEDREV? The International Journal of Contemporary Surgery: it is a double blind peer reviewed international journal which just commenced publication in January 2013 (very recently). If so, I will edit the article to include:

"The foreskin not only protects the glans penis but has specialized nerve endings (Meissner corpuscles) for fine touch, which enhances sexual pleasure...ritual circumcision removes the erogenous tissue, which serves important protective, sensory, and sexual purposes." Ahmad, Sartaj, et al. "Male Circumcision: A Modern Surgical Procedure and a Solution to the Problem." International Journal of Contemporary Surgery 1.1 (2013): 15.

If not, then I will keep looking. --MosheA (talk) 05:52, 6 October 2013 (UTC)

Does this article have a PubMed ID? I was unable to locate a National Library of Medicine catalog entry for the journal International Journal of Contemporary Surgery on PubMed. If the journal isn't even cataloged by the NLM (much less MEDLINE-indexed) that's a pretty serious red flag that the journal is probably not going to meet the bare minimum requirements for being WP:MEDRS compliant. Also, the title of the journal article itself doesn't sound very even-handed.

Moshe, I'm puzzled by the line of suggestions you're bringing up here, previously you were suggesting discussion of the frenulum and now this is discussing something else? Doesn't the article already cover the sexual effects of circumcision using the multiple up-to-date WP:MEDRS-compliant secondary sources?

If you're interested in having the article mention the function of the foreskin, that idea had been brought up earlier but the feeling was that those readers interested in that could go to the foreskin article through the Wikilink. However, I'd support adding a brief mention using the WHO's GTDPSA, something along the lines of "There are several theories regarding the purpose of the foreskin. It has been proposed that it serves to protect the penis as the fetus develops in the mother's womb, that it helps to preserve moisture in the glans, or that it improves sexual pleasure." Would that work for you? Zad68 02:40, 7 October 2013 (UTC)

Yes, that would work. Thanks for your help. --(Moshe) מֹשֶׁה‎ 05:06, 7 October 2013 (UTC)

 Done Added a very brief overview of the physical description of the foreskin, its theorized roles (good and bad), and the intended effect of the procedure here. I think it's a useful improvement. Zad68 19:48, 7 October 2013 (UTC)

What about the poor old( unmentionable?) frenulum which is often lopped of along with the fore skin- its function, its cutting, the effects of its loss ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:04, 7 October 2013 (UTC)

That is an eminently sensible edit to suggest Moshe. Perhaps "damages or cuts off" might be better than "damages or destroys". There seems to be a group of editors here though, who, from my previous experience abhor mention of the frenulum and circumcision in the same breath at all at all.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:27, 5 October 2013 (UTC)

Change name of article from 'Circumcision' to 'Male Genital Mutilation' to mirror the sister article 'Female Genital Mutilation'

Suggestion for a more scientifically accurate description. Current use of language such as 'uncircumcised' rather than 'intact' demonstrates a positive bias towards the procedure which is not present on the sister page 'Female Genital Mutilation'. In order to clarify any possible confusion, a redirection from 'Circumcision' should be targeted at 'Male Genital Mutilation'. — Preceding unsigned comment added by 101.161.140.37 (talk) 09:35, 24 September 2013 (UTC)

There is a persistent group of editors who maintain that the terminology in title and in article reflect the terms used in academic secondary sources and thus are deemed appropriate--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:44, 24 September 2013 (UTC)

Whilst I agree that most foreskin amputations are unnecessary and impair the function of the penis, most physicians would agree that there are sometimes medical reasons when removal of some or all of the foreskin may be necessary. As the term circumcision is more specific than male genital mutilation I would say keep it as circumcision. Felann96 (talk) 01:52, 6 October 2013 (UTC)

Too Biased in Favor of the Procedure

The article says little about the damage that circumcision does or about the function of the foreskin during sexual intercourse. Felann96 (talk) 02:42, 6 October 2013 (UTC)

Some editors feel that circumcision is primarily a medical procedure and less a cultural one, and consequently prevent such material from many non medical eminent secondary sources from being included in this article. I do not agree with this position and feel the article depth and balance are severely off kilter as a result of this enforcement.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:08, 7 October 2013 (UTC)

I agree that the article is too biased in favor of circumcision. Just reading over Wikipedia for my information, I would probably think that male circumcision is a good idea.

There are tons of sources out there that describe the negative effects of circumcision on sexual ability, sensitivity, and overall psychology (I mean, come on, it's the removal of a 3x5 inch size of skin on a sex organ). The problem is that most of these don't meet the guidelines for WP:MEDRS (viz. PubMed IDs and the National Library of Medicine - see my discussion above). However, interestingly enough, a lot of sources that do meet the criteria - a Hebrew study concluding that neonatal circumcision has no ill effects (http://www.ncbi.nlm.nih.gov/pubmed/23713368) and a Turkish study concluding the same thing for adult circumcision (http://www.ncbi.nlm.nih.gov/pubmed/23235976) - are inherently biased based on geography and culture. I'd love to see an Egyptian or Indonesian study on female circumcision.

(Speaking of, does anyone else think that there is a W:NPOV discrepancy between the circumcision page and the female genital mutilation page other than the names? The main image for the latter is a sign advocating against it from a public health perspective, while the main image for the former is a bunch of peaceful turbaned men looking like they're about to make salat or something. Additionally, I understand that we can't change the name of the "circumcision article" to "male genital mutilation", but maybe we can change the article "female genital mutilation" to "female circumcision?" The phrase, after all, is used within the first sentence of the article)

I understand that this article is a "Good" status, and I appreciate that, but I honestly feel it that is still a little too biased. --(Moshe) מֹשֶׁה‎ 17:36, 9 October 2013 (UTC)

You provide the answer to your own question in your comment! :) On Wikipedia, an article is "neutral" (meaning, it complies with the policy described at WP:NPOV) if it reflects the viewpoints in the best-quality reliable sources with the emphasis found therein. If you come to an article with a particular view and your view isn't the one supported by the reliable sources, you won't be happy with the article (if it complies with NPOV). If you believe water fluoridation is evil you won't like our article on water fluoridation, if you believe the MMR vaccine causes autism you won't like our article on the MMR vaccine controversy, if you believe colloidal silver is safe and effective you won't like our article on medical uses of silver. It isn't because those articles are biased, but rather they reflect what's found in reliable secondary sources. (Maybe another way to say this is the articles will reflect the same biases found in the reliable sources.) Same thing with the article names circumcision and female genital mutilation--the articles are named that way because that's how the reliable sources treat them.

(Side point - the two studies you mention from Israel and Turkey are primary sources and so wouldn't be useful here as we already have multiple secondary sources covering the topic. And, actually the most important and strongest evidence regarding sexual effects was not from either Israel or Turkey but rather the three large multi-center RCTs that were performed in Africa.) Zad68 18:37, 9 October 2013 (UTC)

The difference here is that if someone wants to play around with colloidal silver, or avoid fluoridated water, that is their choice. Circumcision is (most often) forced upon a non-consenting patient with zero say in the matter, and many times, such as in brit milah, even without anesthetic.

If someone wants to get circumcised, that's their business, and I don't care. If someone wants to get tattooed, that's their business as well. If someone wants to circumcise or tattoo a baby?...I'm sure you could do the tattooing in sterile conditions, but the bottom line is that it's messed up and just represents the will of the parents, without taking into consideration of the infant.

I think anyone who edits a highly controversial article (circumcision, Israel, George W. Bush, etc) obviously has an interest in that article, and obviously will have an opinion on it. So let me be clear: I most definitely do believe that possible benefits of circumcision should be included, but I think the article makes light of its downsides. As of now, there are only about two sentences in this entire, lengthy page with any "negatives": one statement (added by me) by the Royal Dutch Medical association discussing sexual complications, and the other (added recently) about benefits of the foreskin, with a sentence immediately after discussing its potential for infection and disease. (Tonsils and appendices get infected a lot- should we remove them at birth?)

Anyway, I'll keep trying to find sources that satisfy the conditions. --(Moshe) מֹשֶׁה‎ 05:16, 10 October 2013 (UTC)

Moshe, OK, you've made your personal dislike of the procedure pretty clear... You've made a number of statements along this line here on the article Talk page, so I need to point out to you that Wikipedia article Talk pages really are not for general discussion of the article topic, or for advocating for one's own views on it (see WP:TPG). Wikipedia article sourcing and content guidelines remain the same, regardless of the views of individual editors. You say you will keep looking for sources... you appear to be saying that you will be looking for sources that are in agreement with the viewpoint you are bringing to the subject, and will be ignoring the ones that don't. If so, that is not an approach to article development that will produce content in line with WP:NPOV. Zad68 14:28, 10 October 2013 (UTC)

I must respectfully disagree. This has nothing to do with my personal beliefs, and everything to do with what I view as a violation of WP:NPOV, which is one of Wikipedia's three core values. I have already stated that I have absolutely no problem with arguments advocating the procedure being included in the article (or even being the bulk of the article), but it seems that the pro-circumcision crowd wants literally nothing pointing out adverse effects; until the edit I put in place and the edit I suggested to you, there was, in fact, nothing on this matter.

The guideline for NPOV states:

• Indicate the relative prominence of opposing views. Is this being done in the article? Not really. There is an "Ethical and legal issues" section, which I appreciate. However, given that there is virtually zero prominence of opposing medical views, I don't think it is enough to comply with this NPOV rule, which recommends to: not give a false impression of parity, or give undue weight to a particular view. For example, to state that "According to Simon Wiesenthal, the Holocaust was a program of extermination of the Jewish people in Germany, but David Irving disputes this analysis" would be to give apparent parity between the supermajority view and a tiny minority view by assigning each to a single activist in the field. (emphasis mine)

I don't think including the medical reasons against it would be considered a "tiny minority" in this case. The Council of Europe recently declared it a "clear human rights violation", and in fact, most of the world is uncircumcised (these majority countries all have doctors and they're all avoiding it). It's really only Muslims, the Jewish diaspora, Israel, the US, the Philippines (US influence), and South Korea (US influence) that champion male circumcision. This is about 30% of the world, with 70% of that 30% figure being Muslim, meaning only 9% of the world practices circumcision outside of Islam. It just seems weird to me to be pushing this view, which outside of America and the Islamic world, holds no weight.

Anyway, maybe I'm entirely wrong about NPOV and the medical guidelines, in which case I'll limit the postings. Sorry for any misunderstandings, and no hard feelings. --(Moshe) מֹשֶׁה‎ 17:22, 10 October 2013 (UTC)

As a matter of fact, it was not the Council of Europe that recently pronounced on circumcision but the Parliamentary Assembly of the Council of Europe, a talking shop of people deputized from member-state parliaments, with no powers whatsoever. Their votes are not binding on anyone and they make even the rubber-stamp European Parliament look influential.89.204.135.114 (talk) 16:17, 13 October 2013 (UTC)

Aren't you conflating biomedical findings with views held by advocates? Viewpoints are expressed with the emphasis found in reliable sources, not any other calculation. Although you're citing the correct policy, your commentary doesn't seem to actually reflect an understanding of it, so I'm not sure how to move forward. No hard feelings, certainly, we're just talking about article content. Zad68 18:54, 10 October 2013 (UTC)

Here is the plain and simple guide for medical editors on pillar five

"Wikipedia does not have firm rules (the spirit of the rule trumps the letter of the rule). Following the rules to the letter does not guarantee that your contribution will be kept. The Wikipedia community holds common sense as its fundamental principle, and contributors who technically follow the rules but miss the spirit of the policy or are confrontational will not be successful."

The sad thing about this article is that the opposite is true - a group of editors is "following to the letter" the medical content policy and thus having the effect that vital information about many aspects of the CULTURAL phenomenon of male foreskins getting cut off go unrecorded- I, and other editors have listed these exclusions before - adverse effects, forced adult circumcisions, legal cases for damages against foreskin cutters of infants by adult victims, oral-genital contact between adult male cutters and infant males in one religion sub group resulting in lifelong infection or death, the sale of foreskins for cosmetic and medical use et cetera. Common sense would dictate mention of these factors. Their continued exclusion damages both the article's and WP's credibility.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 07:16, 14 October 2013 (UTC)

Required?

There's a proposed edit to Society and culture: Judaism to change "Circumcision is not required by Judaism for one to be considered Jewish" to "Circumcision is required by most denominations of Judaism for one to be considered Jewish". The current wording is sourced as follows: Glass 1999 says, "That circumcision is so central to Judaism is demonstrated by the fact that even the most unobservant Jews insist on circumcising their male children. Any child born to a Jewish mother is Jewish according to Jewish law. However, circumcision is seen as another vital component that confirms a male child as Jewish. It seems to be regarded by almost all Jews, observant and unobservant, as a defining feature of the religion; it is seen as essential to make the child a Jew, an idea that is found in the Midrash, the Jewish folklore." I see the important sentence here as "Any child born to a Jewish mother is Jewish according to Jewish law", so the source is saying a child born to a Jewish mother is still Jewish even if not circumcised. So if it isn't done, one of the things Jewish laws says is to be done hasn't been, but the child is still Jewish. Bolnick 2012 talks about medical situations where a boy born to a Jewish mother needs to have circumcised postponed or avoided. The source indicate converts have to have it done, and the article already states this, but a boy born to a Jewish mother would still be considered Jewish even if it weren't done. Does the article not summarize the sources accurately? Or is there a better source to use? (Please be aware that we can't use religious primary texts to source things in articles, we need to use secondary sources to interpret them.) Zad68 19:52, 11 October 2013 (UTC)

I think that the sources are fine, but the wording is misleading. As of now, it states that "Circumcision is not required by Judaism for one to be considered Jewish." Circumcision is essentially mandatory in nearly all denominations of Judaism, and only neglected in said denominations for very extreme cases, such as פיקוח נפש (endangerment of life). In fact, not being able to circumcise is considered a punishment - this is not for the article, just for your general knowledge: see here - so it stands to reason that the tradition is a core component of Judaism.

By saying: "Circumcision is not required by Judaism for one to be considered Jewish, but adherents foresee serious negative spiritual consequences if it is neglected", we might as well also say:

"Keeping kosher is not required by Judaism for one to be considered Jewish, but adherents foresee serious negative spiritual consequences if it is neglected" (true)

"Keeping the Sabbath is not required by Judaism for one to be considered Jewish, but adherents foresee serious negative spiritual consequences if it is neglected" (true)

It trivializes this aspect of the religion by implicitly comparing it to all others; whereas most Jews don't keep kosher or the Sabbath, most do circumcise. I would suggest the rewording as:

"Circumcision is central to Judaism, and a vital component of a male child's confirmation as a Jew. In most denominations, it is usually only avoided if it presents a danger to the child's life."

Also, since when can we not use religious primary texts as sources for religious articles? On the brit milah page alone, we have:

Source 7: Mishnah Shabbat 19:6 ;

Source 11: Talmud Bavli Tractate Yebamoth 71b ;

Source 18: Tractate Shabbos 133b ;

Source 17: Rambam ;

Source 18: Rashi on Tractate Shabbos 173a and 173b;

Source 31: Sdei Chemed vol.8 page 238 ;

Source 58: Rambam

Please not that not all of these are "opinions" or "so-and-so says"- some of these sources are being used to discuss very technical procedures (e.g., Source 7, Mishnah Shabbat, is referenced to talk about the removal of the epithelium).

If there is a problem with religious primary texts being used as sources of infomation on religious articles, might I also suggest looking into the articles: terefah, orlah, chadash, pidyon haben, and more.

Respectfully --(Moshe) מֹשֶׁה‎ 21:20, 11 October 2013 (UTC)

That is correct, it is a problem if religious texts are used to source article content. Religious texts are primary sources and editors cannot "analyze, synthesize, interpret, or evaluate" them (per policy). Almost all religious texts are in ancient versions of foreign languages, have self-contradictions within or between them, or between authoritative interpretations of them, and/or have very specific cultural or contextual applications and interpretations that are not at all obvious in their plain, literal interpretation. It also depends on whose translation you're reading, when it was written, and why. (See the King James Version of the Bible as a notorious example.) Misuse of religious texts as primary sources has been such a problem on Wikipedia that there is a special template just for them, see {{Religious text primary}}, which is used in several hundred locations. I see you are absolutely correct, articles like Brit milah, Orlah and others suffer from this serious problem, and I hope one day someone will fix them, but personally I have no interest in working on those articles; I generally spend my editing time in WP:MEDICINE-scope content.

Back to this issue, I really like your new proposed wording, but take a look at the existing paragraph--it starts off saying "Circumcision is very important to Judaism". Your new wording provides a needed correction in emphasis and seems to reflect the sources more accurately, let's move forward with adding it, but we may have to modify the existing wording so that the paragraph doesn't repeat itself. I still think we also have to make it clear that the sources say the child is still considered Jewish even if uncircumcised, so I think we'd be modifying the other sentences of the paragraph. Zad68 00:05, 13 October 2013 (UTC)

Adverse Effects (Again)

Okay, so to be honest, I've been bothered by the lack of information concerning adverse effects on the circumcision article, and my med sources/NPOV arguments were apparently not good enough to change it.
Again, I'm not saying take down what we have advocating circumcision; I'd just like to see more of the opposing side.
And then it hit me: why not check the Wikipedia page on circumcision from more enlightened (read: European) countries? Aha!
Well, I speak French and Spanish, and also some German. I don't know if anyone else here - specifically those I've been debating with - knows these languages, but I'll highlight some of the adverse effects described in the Spanish and French Wikis (translated). Many of the sources are in English, actually:
• A study in Denmark in 2011 concluded that circumcision is associated with difficulty in achieving orgasm. {source}
• Many studies indicate that circumcision dulls the sensitivity of the penis.{source}{source}
• Among these studies, the Ghent University hospital determined that uncircumcised men have a much greater sensitivity than circumcised men.{source}
The Spanish and French Wikis read virtually identical, and I think treat the material very fairly (most sentences about loss of sensitivity are followed by an opposing study).
The German Wiki, meanwhile, is different in that it goes to town against circumcision, with walls of texts describing ill effects, and even special subsections for those ill effects (compare to our two sentences). It even goes so far as to criticize American methodology:
Fälschlich wird gelegentlich eine Studie der amerikanischen Sexualforscher Masters und Johnson aus dem Jahre 1966 als Beleg dafür genannt, dass ein beschnittener Penis sensitiver als ein unbeschnittener sei.
(Falsely, a 1966 study by American sexologists Masters and Johnson is occasionally referenced to prove that a circumcised penis is more sensitive than an uncircumcised one)
I've also noticed that these Wikis all provide a terrible, graphic picture of the procedure, which is conspicuously absent in our version. The German Wiki contains no less than six of these pictures, detailing errors in the procedures, complications, etc. It additionally contains a picture of a messed up uncircumcised penis, which we also do not have.
tl;dr: Im going to translate some things over from the other Wikis. I'll post them in here for approval first. If they are not good enough, then maybe someone should contact the French/Spanish/German Wikis. --(Moshe) מֹשֶׁה‎ 04:43, 12 October 2013 (UTC)

Update: even the Hebrew Wiki (which, admittedly, I do not speak well, but I can read) has a short section on adverse sexual effects. We have none. --(Moshe) מֹשֶׁה‎ 05:15, 12 October 2013 (UTC)

It is heartening to see someone quizzing the odd pro circumcision slant of this english language article and digging up the massive discrpancies between it and those from other language WPs. You might be interested too, as i am in seeing that the article lists what the different foreskin chopping off cultures do with the piece they have cut off. Practice varies widely from burning to burying to selling. Until now a small but persistent group of editors have prevented all mention of this.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:14, 12 October 2013 (UTC)

Moshe, translating selected parts of articles on other-language Wikipedias would be a waste of your time, frankly. The existence of something in one location can't be used to justify it in another (see WP:OTHERSTUFFEXISTS, which is in the context of article notability but the concept is applied widely). All discussion related to article content on English Wikipedia needs to be based in sources that meets English Wikipedia's definition of reliable sourcing and needs to be presented in a way that meets with English Wikipia's own rules. The biomedical content on other language Wikipedias has no bearing at all on en.WP's. In fact, in general, the biomedical content on other-language Wikipedias has been found to be so lacking that there is a program to take the English Wikipedia articles and translate them to other languages for export, see the WikiProject Medicine Translation Task Force. There is no such program in reverse. Zad68 00:05, 13 October 2013 (UTC)

Moshe, your characterization of the German WP article on circumcision is fairly accurate. It is an example of the worst of the worst in any language Wikipedia, an extremist hitpiece ("goes to town", as you put it) that drops all pretense of orderly, hierarchical sourcing and instead wallows in an orgy of cherry-picking. It was even worse some time ago. I personally had them remove the false claim about 150 deaths annually from circumcision in the U.S. alone, though perhaps they've put it back; don't have the stomach to check. And you seriously propose that en:WP should take that garbage as exemplary?89.204.135.114 (talk) 16:26, 13 October 2013 (UTC)

Here's my issue:

I love Wikipedia, and use it all the time. I was an ardent supporter of it from its very initial stages, and championed it to all who criticized it ("What do you mean anybody can edit it?"), including an English teacher of mine.

Thus, it saddens me to see what I view as both an extremely one-sided article and blatant censorship. People like Tumadoireacht and I are not trying to turn this article into a giant anti-circumcision propaganda machine; there are other websites for that.

However, it seems that any effort to make legitimate criticism of this procedure is immediately silenced. The point here isn't the fact that foreign biomedical content exists and should therefore exist here. The point is that our article is really the only one out there that makes no mention of adverse effects, and that is what disturbs me. Before my suggestions (which were carried out to the minimum), we had nothing on those effects. We still do not even have a photograph of the procedure- not very encyclopedic, if you ask me.

Circumcision is not just a medical issue: it is a status issue, a sexuality issue, a gender issue, a psychological issue (of which we make zero mention), and ultimately, a human rights issue.

Additionally, a lot of the sources from the German, French, and Spanish Wikis were originally in English. I do not think it would be a waste of time to translate from these Wikis, even if only one out of every hundred of my translations would be good enough to make it through to the English project. It is in the interest of fairness, and eventually seeing an article which does not undermine the legitimacy of Wikipedia by promoting only one view- and a minority view, at that. --(Moshe) מֹשֶׁה‎ 17:35, 13 October 2013 (UTC)

Hi Moshe. I have to confirm what Zad68 has said about other language Wikipedias. They don't necessarily have the same content rules as Wikipedia, and, even if they do, there is no reason to believe that the articles on them follow the content rules more closely than English Wikipedia. Indeed, since none of the French, Spanish, and German Wikipedia Circumcision articles have GA status, much less FA status, there is no reason to believe that they would. Edits to English Wikipedia articles must be made based solely on English Wikipedia's content rules and on non-Wikipedia sources. If those other language Wikipedia articles use sources that conform to English Wikipedia's content rules, then you'll have something to discuss here. But the first step is finding those sources, and explaining why and how you think they should be used. Jayjg ^(talk) 17:46, 13 October 2013 (UTC)

Applying the very mature and extremely well-supported guidelines for sourcing biomedical information to ensure we use the best quality sources, and don't use the ones that aren't, should not be seen as "censorship"--this is a pretty serious misunderstanding of WP:NOTCENSORED. The Adverse effects section covers what it covers because that's what the available WP:MEDRS-compliant reliable sourcing says. If there are more WP:MEDRS-compliant sources we could be using but aren't, please bring them. You might even look at other-language Wikipedias to find sources but English Wikipedia's WP:MEDRS will be used as the guideline to determine their fitness for use here. Zad68 18:05, 13 October 2013 (UTC)

No picture of the procedure: I agree with you there, Moshe. I have argued in the past that a sequence of color photographs showing the most widely used circumcision method should be included.89.204.135.114 (talk) 18:24, 13 October 2013 (UTC)

So, just to start out, I have included a sample of these sources here. I will bring more sources in for discussion if I find them appropriate. I've taken the liberty of only including sources which are originally in English, except one, which I have noted. In light of the recent discussion, I have also only used sources with a PubMed ID, except sources {4}{9}{11}{12}, which are, respectively: a sexuality textbook, a psychological study (we have nothing on psychology), a statement by the Canadian Pediatric Society, and a news article discussing an aforementioned study, which does indeed have a PubMed ID.

I am not suggesting that all these sources be used, but I am bringing them to the table as possible inclusions. I have tried to be as fair as possible by including opposing view when relevant. --(Moshe) מֹשֶׁה‎ 19:41, 13 October 2013 (UTC)

Adverse Effects

The foreskin contains many Meissner's corpuscles, stimulated by elongation, and plays a role in male sexuality.{1}{2}

Circumcision, due to the removal of the highly innervated foreskin, leads to a keratinization of the glans and a decreased sensitivity of the penis.{1} However, to what extent these changes positively or negatively influence sexuality is a subject of scientific debate.

With the removal of the foreskin, the glans is not permanently covered; due to constant contact with the air and friction against clothing, sensitivity may be lost. Removal of the foreskin and frenulum itself can also reduce sensitivity, because both have many nerve endings.{3}

Damage to or removal of the frenulum during circumcision can also be considered critical. This part of the penis is more sensitive than the glans itself for many men.{4} This damage certainly applies to the highly sensitive area of the foreskin, in which the outer skin passes to the inner mucosa, and borders a highly erogenous zone.{1}

Some recent studies suggest that the sensitivity of the glans decreases after circumcision. {5}{6} Conversely, Krieger et al. (2008) found that adult Kenyans surveyed in an HIV prevention reported increased penis sensitivity after circumcision, and an enhanced ability to achieve orgasm. Circumcision was not associated with sexual dysfunction in this study.{7}

A 2006 study carried out by Michigan State University found that all the researchers' observed incidences of meatal stenosis occurred exclusively in previously circumcised boys. The study showed an 80% power in demonstrating a 21.4% difference in the incidence of meatal stenosis between circumcised and uncircumcised Tanner I boys of three years and older.{8}

According to Goldman (1999), the circumcision of a child carries the risk of mental trauma. Circumcision is associated with pain, stress, a loss of control, and could negatively impact a child’s mental development. The procedure can also affect the relationship between mother and child, especially when circumcision takes place in infancy during the highly sensitive period of the formation of the maternal bond (see Attachment Theory).{9}

In a study published in 2013, more than 1300 Belgian men were surveyed anonymously. The participants reported reduced sexual pleasure, lower orgasm intensity, and exhaustion in achieving orgasm at all with a circumcised penis. The problems concerned both the glans and the shaft of the penis. The study stressed “the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning”.{10}{11}

The Canadian Pediatric Society recommends that “circumcision of newborns should not be routinely performed”, when not taking into account religious and personal values.{12}

A 2008 study showed that reductions of vaginal lubrication after the circumcision of the partner "were significant ".{13} However, conclusions regarding the female's partner sexual satisfaction were indeterminate. Moreover, during intercourse, there is a lack of the friction-reducing sliding of the penis in its shaft skin, which cannot be adequately compensated by the existing lubrication of the vagina. One study found a higher incidence of problems related to orgasm, and dyspareunia, when the man was circumcised.{14}

Sources

{1} J. R. Taylor, A. Lockwood, A. Taylor: The prepuce: specialized mucosa of the penis and its loss to circumcision. In: British journal of urology February 1996, 77(2), S. 291–295, doi:10.1046/j.1464-410X.1996.85023.x, PMID 8800902 [9]

{2} C.J. Cold, J.R. Taylor: The prepuce In: British Journal of Urology January 1999, Volume 83, Suppl. 1; S. 34–44. PMID 10349413 [10]

{3} Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS: Fine-touch pressure thresholds in the adult penis. In: BJU Int. Band 99, Heft 4, April 2007, PMID 17378847, S. 864–869 [11]

{4} Crooks R., Baur K.: Our Sexuality, Fifth Edition, Redwood City, The Benjamin/Cummings Publishing Co., 1993, S. 129.

{5} Laumann EO, Masi CM, Zuckerman EW. (1997): Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice. In: JAMA; 277(13), PMID 9091693, S. 1052–1057 [12]

{6} Fink KS, Carson CC, DeVellis RF: Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction. In: J Urol. 2002 May;167(5), PMID 11956453, S. 2113–2116 [13]

{7} Krieger JN, Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S.: Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. In: J Sex Med. 2008 Nov;5(11):2610-22. doi:10.1111/j.1743-6109.2008.00979.x PMID 18761593 [14]

{8} Van Howe, R. S. (2006): Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clinical Pediatrics, 45(1), 49-54 PMID 16429216. [15]

{9} Goldman (1999): The psychological impact of circumcision. BJU Int, 83 (1), S. 93–102, doi:10.1046/j.1464-410x.1999.0830s1093.x.

{10} Guy A. Bronselaer, Justine M. Schober, Heino F.L. Meyer-Bahlburg, Guy T'Sjoen, Robert Vlietinck, Piet B. Hoebeke: Male circumcision decreases penile sensitivity as measured in a large cohort'. In: BJU Int. Online 4. Februar 2013, doi:10.1111/j.1464-410X.2012.11761.x , PMID 23374102. [16]

{11} Robert Bublak: Beschneidung kostet Sex-Spaß, Ärzte Zeitung online. 19, February 2013 [17] {NOTE: THIS IS A NEWS ARTICLE, AND IN GERMAN, BUT IT DISCUSSES THE ABOVE STUDY}

{12} Canadian Paediatric Society: Neonatal circumcision revisited, CMAJ 1996;154(6):769-80. [18]

{13} Cortés-González, J., Arratia-Maqueo, J., & Gómez-Guerra, L. (2008): Does circumcision has an effect on female’s perception of sexual satisfaction? Rev Invest Clin, 60(3), 227 PMID 18807735.

{14} Morten Frisch, Morten Lindholm, Morten Grønbæk: Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. In: International Journal of EpidemiologyOktober 2011, 40(5), S. 1367–1381, doi:10.1093/ije/dyr104, PMID 21672947. [19]

Which sources meet WP:MEDRS? Be sure to pay attention to WP:MEDREV and WP:MEDDATE. Per WP:BURDEN it's up to you to show the proposed new content meets the content standards. Zad68 19:45, 13 October 2013 (UTC)'

A very cursory look at the sources would indicate that seven (half!) are at least ten years old, and therefore immediately (and very obviously) fail WP:MEDDATE. Moshe, it would be helpful if you would review WP:MEDREV, WP:MEDDATE and WP:MEDRS before proposing to use sources. Here's what I hope will be a helpful hint: lead with your strongest sources, ones you are sure meet all the sourcing guidelines. That way (assuming the sources actually meet the sourcing guidelines) the discussion can focus on content, and (hopefully) reach agreement much more quickly. Jayjg ^(talk) 20:36, 13 October 2013 (UTC)

Moshe, I've got to say, reviewing this was a really interesting exercise! It's an excellent example of the vital importance of Wikipedia's policies and guidelines, especially regarding quality and authority of sources, the importance of secondary sources, and the importance of checking to make sure the source cited actually supports the what the article says. On the plus side, reviewing this list of sources led me to find one new source that might be useful. Curious what you think. Zad68 20:19, 13 October 2013 (UTC)

---

Following WP:MEDRS, I see that as per WP:MEDDATE, reviews should be “published in the last five years or so, preferably in the last two or three years.” There is currently a medical statistic on the English-language circumcision page that is from 2002. There are quite a few sources being used for medical information that are from 2006: I don't know if that's too outdated, but it will be 8 years old in two months. I've included them here in case they are.

Current Source from 2002

• Source [59]: referenced 3 times (statistical information from a medical paper)

Current Sources from 2006

• Source [44]: referenced 1 time (medical information)

• Source [47]: referenced 3 times (medical information)

• Source [48]: referenced 3 times (medical information)

• Source [57]: referenced 2 times (statistical information from a medical paper)

In light of the above, I’ll set 2006 as my benchmark year for sources and won't go below it. Taking out suggested sources older than this, we have the following. Tell me what you think. --(Moshe) מֹשֶׁה‎ 21:51, 13 October 2013 (UTC)

Adverse Effects

With the removal of the foreskin, the glans is not permanently covered; due to constant contact with the air and friction against clothing, sensitivity may be lost. Removal of the foreskin and frenulum itself can also reduce sensitivity, because both have many nerve endings. A 2007 study concluded that circumcision “ablates the most sensitive parts of the penis”.{3}

Damage to or removal of the frenulum during circumcision can also be considered critical. This part of the penis is more sensitive than the glans itself for many men.{4}
(1993, but sexology, not medicine, so not covered by WP:MEDRS- correct me if I’m wrong. We have a source from 1999 talking about Jewish psycho-spiritual reasons)

I removed the pro-circumcision Krieger study, which I had included for contrast in others studies that I have taken out as per WP:MEDDATE. We also already have something pro-circumcision Krieger that is more recent (2011).

A 2006 study carried out by Michigan State University found that all incidences of meatal stenosis occurred exclusively in previously circumcised boys. The study showed an 80% power in demonstrating a 21.4% difference in the incidence of meatal stenosis between circumcised and uncircumcised Tanner I boys of three years and older.{8}

According to Goldman (1999), the circumcision of a child carries the risk of mental trauma. Circumcision is associated with pain, stress, a loss of control, and could negatively impact a child’s mental development. The procedure can also affect the relationship between mother and child, especially when circumcision takes place in infancy during the highly sensitive period of the formation of the maternal bond (see Attachment Theory).{9}
(1999, but psychology, not medicinal, so not covered by WP:MEDRS- correct me if I’m wrong. We have a source from 1999 talking about Jewish psycho-spiritual reasons. Either way, whether we use this source or not, we definitely need a secular psychology perspective, because we don’t have one)

In a study published in 2013, more than 1300 Belgian men were surveyed anonymously. The participants reported reduced sexual pleasure, lower orgasm intensity, and exhaustion in achieving orgasm at all with a circumcised penis. The problems concerned both the glans and the shaft of the penis. The study concluded “the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning”. {10}{11} (Very recent; keep)

A 2008 study showed significantly reduced vaginal lubrication after the circumcision of the partner.{13} Moreover, during intercourse, there is a lack of the friction-reducing sliding of the penis in its shaft skin, which cannot be adequately compensated by the existing lubrication of the vagina. One study found a higher incidence of problems related to orgasm, and dyspareunia, when the man was circumcised.{14}

Sources

(As per above)

{3} Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS: Fine-touch pressure thresholds in the adult penis. In: BJU Int. Band 99, Heft 4, April 2007, PMID 17378847, S. 864–869 [20]

{4} Crooks R., Baur K.: Our Sexuality, Fifth Edition, Redwood City, The Benjamin/Cummings Publishing Co., 1993, S. 129.

{8} Van Howe, R. S. (2006): Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clinical Pediatrics, 45(1), 49-54 PMID 16429216. [21]

{9} Goldman (1999): The psychological impact of circumcision. BJU Int, 83 (1), S. 93–102, doi:10.1046/j.1464-410x.1999.0830s1093.x.

{10} Guy A. Bronselaer, Justine M. Schober, Heino F.L. Meyer-Bahlburg, Guy T'Sjoen, Robert Vlietinck, Piet B. Hoebeke: Male circumcision decreases penile sensitivity as measured in a large cohort'. In: BJU Int. Online 4. Februar 2013, doi:10.1111/j.1464-410X.2012.11761.x , PMID 23374102. [22]

{11} Robert Bublak: Beschneidung kostet Sex-Spaß, Ärzte Zeitung online. 19, February 2013 [23] {NOTE: THIS IS A NEWS ARTICLE, AND IN GERMAN, BUT IT DISCUSSES THE ABOVE STUDY}

{13} Cortés-González, J., Arratia-Maqueo, J., & Gómez-Guerra, L. (2008): Does circumcision has an effect on female’s perception of sexual satisfaction? Rev Invest Clin, 60(3), 227 PMID 18807735.

{14} Morten Frisch, Morten Lindholm, Morten Grønbæk: Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. In: International Journal of EpidemiologyOktober 2011, 40(5), S. 1367–1381, doi:10.1093/ije/dyr104, PMID 21672947. [24]

---

• Moshe, what is your proposal here? Are you suggesting that we replace the existing Adverse effects section with the above? Zad68 21:56, 13 October 2013 (UTC)

I am proposing that we include them. As it stands, the "Adverse effects" section doesn't really describe any adverse effects. --(Moshe) מֹשֶׁה‎ 22:10, 13 October 2013 (UTC)

Moshe, again, you're going about this backwards. The question is: does the Adverse effects section accurately represent what is found in the up-to-date, authoritative reliable sources? You answer this question by identifying the up-to-date, authoritative reliable sources, reviewing what they say, and summarizing them in the article. You don't go about article development by finding content somewhere else that fits your expectations of what should be included, and then trying to retrofit them into this article. Zad68 22:16, 13 October 2013 (UTC)

I did exactly this. There are barely any "adverse effects" in the adverse effects section. I brought a list of adverse effects from reputable sources with their PubMed IDs, weeded out the ones that did not conform, and have settled on sources that are all recent enough to fit criteria (or else as recent as sources we are already using). All I want to see here are different medical opinions represented on the circumcision page. This article is only slanted towards one. --(Moshe) מֹשֶׁה‎ 22:30, 13 October 2013 (UTC)

No that's not what happened... It sounds like you're looking at only the WP:MEDDATE section of WP:MEDRS but are ignoring the rest it. Can you identify which of the sources you've brought are primary sources, and which are secondary sources? It's possible you are just unfamiliar with how biomedical sourcing works. Could I ask you to please read Wikipedia:Plain and simple guide for medical editors?--the whole thing. Zad68 22:42, 13 October 2013 (UTC)

Moshe, as Zad68 points out, WP:MEDDATE is only one of the hurdles a source must clear to be considered appropriate. Before suggesting any other sources, please note that, for example, WP:MEDREV indicates that article content should be built on secondary sources. Which of the sources you've proposed using are secondary? After that, there are other hurdles to clear before a source can be considered appropriate. The current article is built on WP:MEDRS-compliant sources. That's where you start. The "adverse affects" Wikipedia cares about are solely the ones that are given significant weight in WP:MEDRS-compliant sources, and nothing else. Jayjg ^(talk) 00:57, 14 October 2013 (UTC)

*Okay, sorry for not knowing the guidelines.
"A secondary source in medicine summarizes one or more primary or secondary sources, usually to provide an overview of the current understanding of a medical topic, to make recommendations, or to combine the results of several studies."
For example:
“In addition to being more cost-effective, aggressive surveillance and treatment of STIs have the advantage of treating and preventing the spread of STIs and avoiding the damage caused by removing the most sensitive portion of penis [caused by circumcision]”
http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9
cites my
{3} Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS: Fine-touch pressure thresholds in the adult penis. In: BJU Int. Band 99, Heft 4, April 2007, PMID 17378847, S. 864–869 [25]
(New journal, not sure if this is good enough)

“Meatal stenosis requiring intervention occurs in 5%–10% of males circumcised in the newborn period.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2422979/
cites my
{8} Van Howe, R. S. (2006): Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clinical Pediatrics, 45(1), 49-54 PMID 16429216. [26]

...things to this effect. I don’t want to go on if this is not appropriate for WP:MEDRS. I'm also new to medical sourcing on Wikipedia, so please bear with me.
I also really think we should include a picture (File:Beschneidung 2.jpg is good), and someone should look into source [59] (from 2002), and the 2006 sources, if they are too old. --(Moshe) מֹשֶׁה‎ 02:55, 14 October 2013 (UTC)

The approach you're pursuing is still backwards. The Journal of Public Health in Africa item appears to be commentary (like a letter to the editor). So is the one in the Canadian Urological Association Journal, and its title demonstrates that it's an advocacy piece published as part of a debate. I wouldn't think advocacy commentary pieces would be the best sources to look for biomedical information, why would you think it'd be a good idea? After providing the definition of secondary sources, did you realize you provided two primary sources? We are being patient but you do need to please start picking up on and applying the sourcing standards we've been pointing you to. Regarding the image, we had an RFC a little while ago about it and there was no consensus to include that image as it didn't serve any educational purpose, and instead was found to be only distracting because it is indeed a "terrible, graphic picture" (as you put it--I agree). Detailed images can go into Circumcision surgical procedure.

I agree the 2002 source covering prevalence data could be aged out, or at least have dates applied inline. I think the WHO document should just be used for all the prevalence data. Will look to replace the 2006. Zad68 03:48, 14 October 2013 (UTC)

"Circumcision does not appear to have a negative impact on sexual function.[18]"

what a lie. It can reduce sensation to almost nothing, depending on how much inner foreskin is left.

the biggest disadvantage of circumcision is the ever increasing keratin skin layer which thickens and driens the mucosa skin. the skin of a circumcised penis can become up to 12 times as thick as an intact penis skin.

see this study :

http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06685.x/abstract;jsessionid=5645E67D7AFA9CA98E6D661DE0FF577F.f01t02 46.244.249.104 (talk) 15:14, 21 October 2013 (UTC)

Why are we born with foreskin?

If there are so many medicinal benefits to cutting off the foreskin, why are we born with foreskin? There should have been a higher survival rate for individuals born with less foreskin, and then foreskin would have disappeared due to natural selection. Why isn't this point addressed in the article? I am also curious wheter all human etisities have the same amount of foreskin. If less foreskin is beneficial against a disease which has a long history with a certain etnisity of mankind, then perhaps people belonging to this etnisity are born with less foreskin. 84.210.15.173 (talk) 17:52, 17 October 2013 (UTC)

Some mammals are born without a prepuce ("Aposthia"). In this condition, however, all of the organ's original natal nerves and tissue are intact. Vestigial organ theory has undergone significant changes over the years, and many of the originally proposed vestigial organs like the appendix and spleen are now recognized as useful. Things do occasionally go wrong with these organs and others, but I don't think anyone is credibly arguing that a foreskin is a vestigial organ any more than a clitoral hood is a vestigial organ. Tobias8844 (talk) 06:38, 22 October 2013 (UTC)

"Economic Considerations" Section

I propose including estimates of the total revenue generated by the male circumcision industry in the USA, including the procedure itself and paraphernalia sales (circumstraints etc.) to this section. Additional revenue is generated by male circumcision revisions, which are becoming increasingly popular: https://aap.confex.com/aap/2011/webprogram/Paper13760.html http://www.medpagetoday.com/MeetingCoverage/AAP/29075

The procedure is costly to the public when covered by government insurance, and costs more still when it needs to be revised.

Tobias8844 (talk) 07:03, 22 October 2013 (UTC)

I would like to see such an economic analysis included in the article - you might also include information on sale of the cut off penile skin for medical use,research and for cosmetics.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:05, 22 October 2013 (UTC)

Just FYI, Wikipedia generally does not find conference abstracts reliable sources, as they have not been peer-reviewed. However I did some searching and I found that that conference presentation did end up getting published as a journal article, see PMID 23820002. That particular article was published so recently that it does not even have its MEDLINE indexing established by the journal it is published in is indeed MEDLINE indexed so I'd expect the article to have its MEDLINE indexing soon. On the downside, it's a primary source. It covers data collected at 44 of the 220 or so children's hospitals in the US, and doesn't appear to cover any data from general (non-pediatric) hospitals, and there's like 5,000 hospitals in the US. Do we really want to add a primary-sourced statement about the trends found in a subset of only children's hospitals in one country to this general survey article? That seems WP:UNDUE to me, and the statistic pulled from this one study probably either under- or over-represents any larger, worldwide trend. It'd be my preference to wait until this kind of review information got combined with data from other hospitals and other countries before including. Zad68 14:49, 22 October 2013 (UTC)

My concern is that the data will continue to remain of that quality, as the medical industry in the USA has a conflict of interest here. If it is widely known with superb data the degree to which infant male circumcision is profitable, this will reflect poorly on the people promoting it.

Tobias8844 (talk) 16:38, 22 October 2013 (UTC)

Article content is limited by the availability of quality sourcing. That's just a fact of life for writing encyclopedia articles. Zad68 17:39, 22 October 2013 (UTC)

Well, at least it was published. The article seems to support the parallel notion that many people performing male circumcisions in developed areas receive little or no formal training (many are not even from surgery backgrounds, and are certainly not cosmetic surgeons): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758943/ I will be interested to see if Canada likewise is experiencing increased demand for revisions.

Tobias8844 (talk) 22:57, 22 October 2013 (UTC)

Zad68 is correct. There are guidelines that we are supposed to follow with regard health information, and Zad68 has sufficiently pointed this out above. Other places some of your arguments are addressed, Tobias8844, are in the FAQ and archives linked above on this talk page. Flyer22 (talk) 23:06, 22 October 2013 (UTC)

The only questions answered in this article's FAQ are about the article's title and one question about whether an FAQ is necessary... Tobias8844 (talk) 00:17, 23 October 2013 (UTC)

Nerve endings?

There are fewer nerve endings in a penis when the foreskin has been removed. Nerve endings relay information to the brain. This article contains the word 'nerve' three times by my browser's count, and never in this context.

...are nerve endings unimportant in this context? Why no discussion here? Are nerve endings unimportant to a discussion of human genitalia, or just unimportant in a discussion about foreskin removal?

Tobias8844 (talk) 06:34, 22 October 2013 (UTC)

Do you have a reliable source in mind that covers this as it relates to circumcision? I haven't seen one that says circumcision makes a clinically significant difference. Just a reminder that Wikipedia's sourcing guidelines for biomedical information is WP:MEDRS. Zad68 14:49, 22 October 2013 (UTC)

I think that puts the cart before the horse on this issue. The argument on the pro-circ side is infinitely regressive, and there seems to be no discussion of whether a severe or conservative male circumcision reduces sensation more. There are a finite number of nerve endings on a human penis, which convey information to the brain. Are any nerve endings necessary? Would it be all right if every nerve ending were removed during a male circumcision, or are they important? Do they have anatomical and sexual value?

If I am to gather from the sources this article does use that male circumcision has no effect whatsoever on sexual sensation, then the infinitely regressive quandary begins. Let's say for a moment that nerve endings are equally distributed on the surface area of the penis (unlikely, but let's suppose). Suppose a male circumcision is quite conservative--it removes twenty percent of the surface area. Eighty percent is not 100%, but the remaining nerves would convey more information than a severe male circumcision removing 50% of tissue.

Suppose a practitioner favoring severe circumcisions slipped a bit during the procedure, and removed 70% of the surface area instead of his or her typical 60%. Would the outcome be neurologically worse, or the same? If we say that the sensory outcome would be the same, then why would the destruction of 90% or 100% of the nerve endings be worse than the destruction of 20%?

Until and unless that issue comes to a more satisfactory discussion, the secondary sources will continue to be problematic here. Most of the quantified sensation tests the AAP reviewed--and accepted for the purposes of their review--did not in fact measure sensation in the areas commonly removed by male circumcision!

Which, unfortunately, seems to be the strategy.

Tobias8844 (talk) 16:55, 22 October 2013 (UTC)

No original research please, Tobias. As you state, there does not seem to be reliable sourcing that supports this content idea. We can't add content without sourcing. Zad68 17:39, 22 October 2013 (UTC)

I have sources that say the foreskin contains nerves. How about this: "The foreskin contains nerves. When the foreskin is removed from the penis, these nerves and nerve endings are removed. Whether and to what degree this reduction in nerve endings effects sexuality is controversial."

That seems about as neutral a statement one could make on the subject. Tobias8844 (talk) 19:17, 22 October 2013 (UTC)

So you would like the article to cover the sexual effects? The article already has four up-to-date secondary sources covering that. The function of the foreskin is already in the article too, see the introduction of the Technique section. Detail about the foreskin can be found at the Foreskin article, Wikilinked. Zad68 20:05, 22 October 2013 (UTC)

Once upon a time there was a sexual effects article which was deleted last time I checked. I would like more admission in the article that some parties believe that genital nerve endings are important, and that the amputation thereof is controversial. The foreskin article contradicts the circumcision article, as has been pointed out before: the foreskin article notes that the foreskin is densely ennervated and serves sexual functions. This article does not reflect that data...it discusses removing the foreskin with insufficient information of what it is and what it does. Without that information, the page looks slanted.

Tobias8844 (talk) 22:35, 22 October 2013 (UTC)

Tobias8844 (talk) 22:35, 22 October 2013 (UTC) I propose the following change for the sake of neutrality: "Male circumcision (from Latin circumcidere, meaning "to cut around")[1] is the surgical removal of the foreskin (prepuce) from the human penis.[2][3][4] 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’."[36 from "Foreskin"]"

Tobias8844 (talk) 22:38, 22 October 2013 (UTC)

This article is Circumcision and not Foreskin, and readers interested in general information about the foreskin can follow the Wikilink, this is standard for our articles on surgical procedures. This article actually includes more general information about the part involved than most other articles on surgical procedures, as was already explained. Zad68 14:38, 23 October 2013 (UTC)

Brit milah versus Brit Periah

I'm still hoping to see changes in the article to reflect that modern forms of male circumcision remove more tissue than the original Brit milah, which removed only the acroposthion. Brit periah (tearing away most of the mucosal tissue, instead of a smaall amount thereof) was a procedure adopted during the Hellenic period of Judaism in an attempt to thwart the earliest recorded attempts of Jewish foreskin restoration. This desire to hinder restoration is why male circumcision now looks as it does. I think this material deserves to be represented here. Thoughts welcome! Tobias8844 (talk) 06:50, 22 October 2013 (UTC)

From "History of Male Circumcision" "Techniques for restoring the appearance of an uncircumcised penis were known by the 2nd century BC. In one such technique, a copper weight (called the Judeum pondum) was hung from the remnants of the circumcised foreskin until, in time, they became sufficiently stretched to cover the glans. The 1st-century writer Celsus described two surgical techniques for foreskin restoration in his medical treatise De Medicina.[19] In one of these, the skin of the penile shaft was loosened by cutting in around the base of the glans. The skin was then stretched over the glans and allowed to heal, giving the appearance of an uncircumcised penis. This was possible because the Abrahamic covenant of circumcision defined in the Bible was a relatively minor circumcision; named milah, this involved cutting off the foreskin that extended beyond the glans. Jewish religious writers denounced such practices as abrogating the covenant of Abraham in 1 Maccabees and the Talmud.[20] Because of these attempts, and for other reasons, a second more radical step was added to the circumcision procedure. This was added around 140 AD, and was named Brit Peri'ah. In this step, the foreskin was cut further back, to the ridge behind the glans penis, called the coronal sulcus. The inner mucosal tissue was removed by use of a sharp finger nail or implement, including the excising and removal of the frenulum from the underside of the glans.[21]"

I find it all fascinating--turns out male circumcision and foreskin restoration have had quite an influence on one another! Tobias8844 (talk) 06:55, 22 October 2013 (UTC)

The article already covers this, using exactly the source you cite, did you read the History subsection Middle East, Africa and Europe? Zad68 14:49, 22 October 2013 (UTC)

The section mentioning brit milah versus brit peri'ah doesn't remark significantly on the change: male circumcision looks the way it does today not for any specific medical reason, but because early practitioners wanted to make restoration impossible. It's been copied since to look like this, with drastically more tissue removed, for no specific medical reason of which I'm aware.

Is there a secondary source that states the removal of so much mucosal tissue is necessary, compared to the removal of the acroposthion itself? I see little discussion of surgical styles in general. Depending on the style, little tissue or over 60% of the surface area may be removed. This article seems to presuppose that all male circumcisions result in equal tissue loss, which is untrue.

Tobias8844 (talk) 16:36, 22 October 2013 (UTC)

This is a WP:SUMMARY-style overview article. We can't put all the details about each group's particular history with the procedure here; there are specialized subarticles History of circumcision and Brit milah that are better places for lots of detail. I think the current wording already does address the basic points of the Judaism history here, but how do you think it could be expanded without overdoing it? Why should the article focus on Judaism here and not Islam or other groups?

For the "styles" proposal, that's been floated before but good-quality sourcing wasn't identified, do you have sourcing? Zad68 17:39, 22 October 2013 (UTC)

I do have sources that suggest that early male circumcisions were dorsal slits, ritual nicks, or amputations of only the acroposthion. Later developments to remove more tissue were mostly punitive in nature, as in the Hellenic period and in Dr. Kellogg's suggestion that male circumcision revisions be performed if the subject was able to loosen/stretch tissues during additional attempts for masturbation.

Happy to link to these.

Tobias8844 (talk) 19:20, 22 October 2013 (UTC)

This is largely already in the article. Have you actually read through the article carefully? Zad68 20:05, 22 October 2013 (UTC)

I don't see Kellogg mentioned in the article at all, unless I'm misspelling the name.

Tobias8844 (talk) 22:42, 22 October 2013 (UTC)

Instead of just searching for keywords, read the History section... our sources indicate Lewis Sayre and Peter Charles Remondino were around before Kellogg and had a greater role in "discovering" and popularizing the procedure. For example, source Alanis 2004 talks about Sayre and Remondino quite a bit and Kellogg not at all. Gollaher's book mentions Sayre by name 25 times, Remondino 7 times, and Kellogg 3 times. If you'd like to add something about Kellogg, what source would you like to use and how can it be shown that the material will be presented with due weight? Zad68 14:38, 23 October 2013 (UTC)

Medical indications

In the medical indications section, "Pathological phimosis" is listed. This is a medical myth which claims that the foreskin should be retractable in infants. It is categorically false, as the glans and inner mucosa are fused at birth, and don't separate in most males until adolescence if left to develop naturally. This structure and configuration is analogous to the female hymen.

http://www.cirp.org/library/normal/ — Preceding unsigned comment added by Tobias8844 (talk • contribs) 17:01, 22 October 2013 (UTC)

From the Phimosis article: "Phimosis (/fɪˈmoʊsəs/ or /faɪˈmoʊsəs/[1][2]), from the Greek phimos (φῑμός ["muzzle"]), is a condition in males where the foreskin cannot be fully retracted over the glans penis. The term may also refer to clitoral phimosis in women, whereby the clitoral hood cannot be retracted, limiting exposure of the glans clitoridis.[3] In the neonatal period, it is rare for the foreskin to be naturally retractable; Huntley et al. state that "non-retractability can be considered normal for males up to and including adolescence."[4] " Despite this, the foreskin is often forcibly retracted, leading to infection and other issues which can necessitate a male circumcision.

Tobias8844 (talk) 17:05, 22 October 2013 (UTC)

No original research please, Tobias. Suggesting we look for sourcing at amateur advocacy websites, whether pro- or anti-, is a terrible idea. Zad68 17:39, 22 October 2013 (UTC)

This one says the source is the British Association of Paediatric Urologists...

http://www.patient.co.uk/doctor/Phimosis-and-Paraphimosis.htm#ref-2

Tobias8844 (talk) 19:12, 22 October 2013 (UTC)

This article already covers "normal" (physiological) phimosis, see the section on Phimosis, balanitis and balanoposthitis. Zad68 20:05, 22 October 2013 (UTC)

Wikipedia is contradicting itself here; the phimosis article says that inability to retract can be considered normal up to and including adolescence. The male circumcision article says that the majority can be retracted by age four. This is untrue.

Tobias8844 (talk) 22:22, 22 October 2013 (UTC)

Yes, absolutely, you are right, the Phimosis article needs to be fixed. From a quick scan of the sources used, most of them fail WP:MEDDATE at the very least. That article is sorely in need of updating. Zad68 14:38, 23 October 2013 (UTC)

Even if you're using a source that is of supposed higher quallity, the foreskin is not retractable in the majority of cases except via forcible retraction. If a high quality source says this, it does so in error... It shouldn't be surprising that doctors know better in areas where the foreskin is not commonly cut off. Tobias8844 (talk) 18:48, 23 October 2013 (UTC)

Tobias, again, see Wikipedia's policy regarding no original research. The personal beliefs of individual editors will never trump what is in reliable sourcing. Zad68 13:29, 24 October 2013 (UTC)

Discussion of anesthesia?

Does anybody know of a more up to date source than this one? http://pediatrics.aappublications.org/content/101/6/e5.full

There is some advocacy for anesthesia use in the sources in the article but the most recent study I could find concluded that most neonatal male circumcisions were performed without anesthesia in the USA(1998). I am under the impression that most circumcisions among Jews and Muslims use no anesthesia either. As far as I know 100% of adult circumcisions are done with anesthesia in a clinical setting, but I haven't seen a study on that subject either.

Tobias8844 (talk) 07:26, 22 October 2013 (UTC)

many non infant circumcisions are inflicted in tribal settings worldwide without pain relief and by low skill personnel and in unsterile conditions - often with horrific injury or fatal results--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:10, 22 October 2013 (UTC)

Tobias you are correct to have second thoughts about using survey-based primary study from 1998 here. It'd be great to have reliable secondary sourcing about anesthesia use today across the various kinds of practitioners, if a satisfactory source could be found. Zad68 14:49, 22 October 2013 (UTC)

I agree that the source is pretty old, but I think it is probably the best information available (somebody correct me if I'm mistaken). The secondary sources mention that anesthesia is available, and sometimes used, but fail to mention any estimates on the frequency of that use.

All of this contributes to misconceptions on the subject of male and female cutting: the majority of cases seems to occur with no anesthesia. People assume that anesthesia would be used in a modern American clinical setting, but this seems not to be the case most of the time.

I don't have sources for how prevalent anesthesia is in the Muslim world. My guess is that nearly nobody uses it, especially in rural/undeveloped areas. It might be more prevalent in places like Turkey.

The article could safely state, then, "According to most recent data, the majority of male circumcisions in the USA are performed with no anesthesia".

Tobias8844 (talk) 16:44, 22 October 2013 (UTC) Tobias8844 (talk) 16:44, 22 October 2013 (UTC)

No original research please, Tobias. In addition to the source being a very out-of-date primary source as discussed, the suggested content is clearly not supported by it. Zad68 17:39, 22 October 2013 (UTC)

Your secondary source makes no mention of how frequently anesthesia is used. Until a more current source is found, that survey represents our best guess for how frequently anesthesia is used for infant male circumcisions in the USA. Do the secondary sources give us any reason to believe that anesthesia use is now more common?

Tobias8844 (talk) 19:09, 22 October 2013 (UTC)

This response doesn't address the concerns regarding the relevance, quality or noteworthiness of the primary source. A secondary sources is needed to show those things. Zad68 20:05, 22 October 2013 (UTC)

My understanding of sourcing is that a primary source should not be used to contradict a secondary source; so it is inadmissible for me to cite Sorrells et al. on the subject of sexual sensitivity. This primary source, however, does not contradict any of the secondary sources in this article to my knowledge. The AAP review, for example, does not give a more current estimate of the rates at which anesthesia is used. My suggested content, moreover, is absolutely supported by my primary source, and I still don't see the secondary data to counter it. That source says the majority of infant male circumcisions are performed without anesthesia. Tobias8844 (talk) 22:26, 22 October 2013 (UTC)

For reasons stated at WP:MEDRS, secondary sources are almost always preferred to primary sources for medical information. Flyer22 (talk) 22:50, 22 October 2013 (UTC)

That is my understanding as well, but only when the two contradict. If the AAP reviewed the data and concluded that the foreskin has no inherent value or sexual functions, then primary sources wouldn't be used to argue the point. As they are silent on that issue, however, primary sources may be used. If the AAP reviewed the data and concluded that a majority of circumcisions are performed with anesthesia, then I wouldn't be able to use this source either. As it is, though, I think all the secondary sources are silent on the subject of anesthesia prevalence, enabling the use of primary sources. Correct me if that is a mistake.

Tobias8844 (talk) 23:00, 22 October 2013 (UTC)

"Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources." I am not debunking any secondary sources on the issue of anesthesia prevalence. I am sourcing subject matter that those secondary sources do not mention. — Preceding unsigned comment added by Tobias8844 (talk • contribs) 23:03, 22 October 2013 (UTC)

These responses appear to neglect some other things WP:MEDRS says about primary sources. Zad68 14:38, 23 October 2013 (UTC)

What are you referring to specifically, other than a preference for sources <5 years old when available? When unavailable, my understanding is that an older primary source is acceptable. Tobias8844 (talk) 18:49, 23 October 2013 (UTC)

How about this wording: "In 1998, the majority of infant male circumcision performed in the USA did not use anesthesia. More recent data is unavailable regarding anesthesia prevalence." In what way is this objectionable under sourcing guidelines? Does it contradict any secondary sources? Tobias8844 (talk) 18:58, 23 October 2013 (UTC)

Tobias, if reliable secondary sources do not comment about a topic, then it means they do not consider the topic worthy of comment, or do not consider there to be any research on the topic worthy of comment. Either way, that means that commenting about the topic in a Wikipedia article is a violation of WP:UNDUE.

I'm going to repeat to you what I said to MosheA below, because it applies to you as well: I'm quite concerned about your approach to this article; to write a good article, one must start by reading high-quality secondary sources on the subject (in this case WP:MEDRS-compliant), then summarize what they say, whatever that happens to be. It appears that your approach is essentially the opposite; you have decided that certain things are THE TRUTH™, and are now searching for sources which support THE TRUTH™. This is the exact wrong way to write an article. I've been trying to take your statements here as good faith attempts to learn and conform to Wikipedia's content policies and guidelines, but this latest attempt to get around them appears, at best, disingenuous. Jayjg ^(talk) 23:47, 23 October 2013 (UTC)

Frankly, that does not sound like an attempt to uphold some objective 'Truth', but rather it sounds like a transparent attempt to censor information that does not reflect well on the practice of male circumcision in the United States. The secondary sources can be referenced (indeed, even preferred!) for what they discuss, not what they fail to discuss. If you present a secondary source about health risks of getting tattoos, and I present a primary source saying that most tattoo artists do not use anesthesia, then it is not within the power of the secondary source to dismiss discussion of that topic unless it is specifically addressed in the secondary source.

I am concerned about your approach to editing this article. It seems as if you are trying to use secondary sources to convey information on subjects not addressed by your secondary sources. Tobias8844 (talk) 03:57, 24 October 2013 (UTC)

Tobias, again, you need to read and understand what WP:MEDRS is saying here, and also apply a little common sense. It's inappropriate to try to game our sourcing guidelines to find a loophole through which you can get a limited, poor-quality, out-of-date or no longer relevant primary source into an article. Zad68 13:29, 24 October 2013 (UTC)

Tobias, I'm not "editing this article", so I'm definitely not "trying to use secondary sources" to do anything whatsoever, much less "censor information". Nor, for that matter, am I "trying to uphold some objective 'Truth'"; it's not clear to me that you've understood my post. What I am doing is watching the postings on this Talk: page with increasing dismay, though still hoping that I won't have to take more serious action. I strongly recommend that you read (or re-read) my previous post. Jayjg ^(talk) 01:06, 25 October 2013 (UTC)

This Article Is Contradictory

I'm not bringing in any new sources - fellas, you can rest easy - but I have a major issue with a couple of our existing sources.
"American Academy of Pediatrics Task Force on Circumcision" (2012), from the journal Pediatrics, is currently our Source [5].
"Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision" (2013), also from the journal Pediatrics, is currently our Source [71]. This document says, among other things:

"Physicians should heed the precautionary principle and not recommend circumcision for preventive reasons."

"There is growing consensus…that physicians should discourage parents from circumcising their healthy infant boys because non-therapeutic circumcision of underage boys in Western societies has no compelling health benefits..."

"Only [one] of the aforementioned arguments has some theoretical relevance in relation to infant male circumcision; namely, the questionable argument of UTI prevention in infant boys. The other claimed health benefits are also questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery…"

"It seems that the authors of the AAP report consider the foreskin to be a part of the male body that has no meaningful function in sexuality. However, the foreskin is a richly innervated structure that protects the glans and plays an important role in the mechanical function of the penis during sexual acts."

"Recent studies, several of which were not included in the AAP report (although they were published within the inclusion period of 1995–2010), suggest that circumcision desensitizes the penis and may lead to sexual problems in circumcised men and their partners."

---

Despite this, Source [71] is only mentioned once, in reference to African randomized controlled trials. We mention nothing else from it. Does this source fit WP:MEDRS or not? From my understanding, it is already good enough to be on the page, and is a recent, tertiary source from a reputable journal. Why are we censoring it? --(Moshe) מֹשֶׁה‎ 21:49, 24 October 2013 (UTC)

The "Cultural Bias" article is not a systematic review, it is a "Commentary" (note the bright red line at the top of it with the word "COMMENTARY" in it) that essentially disagrees with the AAP's 2012 Policy Statement, which is not cited in this article. It is not reliable as a WP:MEDRS for medical information, but rather only as a fair representation of the opinions of its authors, and that is how it is used. This source has been discussed previously, please review the archives. And finally, I'm trying to both assume good faith and help you here, but accusing the editors of this article of "censoring it" not only makes it unlikely that they will want to collaborate with you, but actually violates Talk: page guidelines. Jayjg ^(talk) 00:31, 25 October 2013 (UTC)

Jayjg, I am keeping a cool head here and presenting information here for discussion before blindly posting it in the article. I did not single out any individual editors for "censoring" the article, I meant it as an inclusive we.

That being said, I see nothing in WP:MEDRS about commentaries immediately being invalidated. In fact, the only time I see the word "commentary" is "Journal articles come in many types, including original research ranging from vast studies to individual case reports, reviews, editorials and op-ed pieces, advocacy pieces, speculation, book reviews, letters to the editor and other forms of commentary or correspondence, biographies, and eulogies. It is usually best to use reviews and meta-analyses where possible. Reviews in particular give a balanced and general perspective of a topic, and are usually easier to understand."

This says "best to use reviews and meta-analyses" not "exclusively use reviews and meta-analyses". In addition, this commentary is not a simple disagreement with the policy statement, but also finds fault with the methodology, specifically with cherrypicking in the report, as noted by its sources 21-29.

And again, not every single source on our page has to do with medicine or is WP:MEDRS-compliant. As I've stated many, many times, circumcision is not just medical: it is ethical, cultural, sexual, and psychological. You say that this source is "a fair representation of the opinions of its authors, and that is how it is used". This commentary is co-authored by no less than three dozen medical professionals from over ten different countries and a variety of institutions that is reduced to a mere afterthought criticizing a single study, which is just one element of what the commentary contains. The fact as it stands is that if we removed this source as it currently is in the article, it would literally have zero effect...that does not sound like fair representation to me. It represents a not insignificant view on the topic which is not being adequately addressed. --(Moshe) מֹשֶׁה‎ 03:23, 25 October 2013 (UTC)

Did you also read the AAP's commentary in reply to Frisch et al.'s commentary? If we're considering using commentary from one, why not the other? Commentary articles are letters to the editor, they are persuasive speech and can only be used to document the positions of the authors. With multiple independent secondary sources available, not written with any axe to grind, and independently supporting each others' findings, there's no reason to look for letters to the editor in trying to source scientific statements for encyclopedia articles. Zad68 14:12, 25 October 2013 (UTC)

Thank you for your response, Zad. I read over the response commentary, and found it interesting. However, the issue is that if we keep using opposing commentaries' opposing commentaries, we will run into an infinitely regressive loop. I am not asking us to use the Cultural Bias document to address an opinion…we are already using it. I'm merely asking that these opinions be given a greater prominence based on the factors I addressed.

This is not a simple "letter to the editor". As I said, the CB document represents the synthesized opinions and interests of about 40 doctors from several different countries belonging to various national health organizations and prestigious universities (e.g., Charles University, Ludwig Maximilian University, University of Helsinki). The AAP is one organizational body. Those scores of doctors, national health institutes, and research universities are finding faults with the AAP's methodology and motivation.

I read the AAP's response. I noticed that it did not address the CB paper's assertion that:

"There is no evidence that circumcision, whether in infancy, childhood, or adulthood, is effective in preventing heterosexual transmission…[of HIV in places] such as Europe and the United States. Sexually transmitted HIV infections in the West occur predominantly among men who have sex with men, and there is no evidence that circumcision offers any protection against HIV acquisition in this group [either]"

The AAP response fails to address issues of homosexuality or heterosexuality in HIV transmission, nor does it differentiate between HIV transmission in Western countries and HIV transmissions in developing ones.

It does, however, repudiate the CB claim that "sexually transmitted HIV infection is not a relevant threat to children [in the West]" by citing the statistic that there were 2266 HIV infections among US adolescents 13 to 19 years of age in 2008.

...Despite the fact that the AAP does not distinguish which of those infections were sexually transmitted, this figure still represents only 0.2% of the 1,178,350 Americans living with HIV in 2008, hardly a "threat". It further fails to distinguish what percentage of that figure is, in fact, 18 or 19 years of age, and thus no longer legally children.

I am not dismissing the AAP or the validity of its response- on the contrary. Every paper will of course have a cultural bias of some sort, and someone can find fault with the methodology or recommendations of any paper out there.

For example, the AAP response paper says that:

"Condoms represent one of several tools for reducing the risk of infections transmitted during sexual contact. Circumcision is another."

The CB paper says:

"There are alternative, less intrusive, and more effective ways of preventing HIV than circumcision"

This simply boils down to a matter of opinion. You can add up a bunch of numbers by hand or use a calculator. One is not "better" than the other, but one is more effective.

The Cultural Bias paper, which our article is already using, needs to be given more weight. --(Moshe) מֹשֶׁה‎ 19:37, 25 October 2013 (UTC)

I agree with your initial point about needing to avoid using this article as venue to entertain the back-and-forth of commentaries from various groups. We handle that by following our sourcing guidelines, which for this case indicate that we do not use any Commentary articles as sources for biomedical information, and we instead continue to use review articles, systematic review and meta-analyses, as we have plenty of those to support the content. The rest of your response largely avoids addressing the Wikipedia policy- and guideline-based points raised. Zad68 00:15, 27 October 2013 (UTC)

Zad, the AAP paper we're using has many faults in it, as addressed above.

Please tell me which sourcing guidelines indicate that "we do not use any Commentary articles as sources for biomedical information" specifically "for this case"? So far as I remember, it does not say "exclusively use reviews and meta-analyses", as per above

Would you at least accept including an opinion statement under Adverse Effects? We have one by the Royal Dutch Medical association that has thus far not generated any controversy. I would suggest adding something like:

::::::Several European health organizations, including the Paediatric Association of the Netherlands, the Austrian Society of Pediatric and Adolescent Surgery, the Norwegian Paediatric Association, the Finnish Association of Pediatric Surgeons, the British Association of Paediatric Surgeons, and others, have maintained that circumcision has "little public health relevance in a Western context", "desensitizes the penis" and "may lead to sexual problems in circumcised men and their partners" if performed when medically unnecessary{{source}}

Something to that effect. Would that work for you? --(Moshe) מֹשֶׁה‎ 02:53, 27 October 2013 (UTC)

I think you're misinterpreting the Frisch et al commentary as a position statement put forth by the various bodies that the individual authors are associated with. That's not the case, the views put forth in the commentary are those of the individuals, as stated in the abstract. However, I like the direction of your suggestion. I think it would make sense to use something along the lines of your suggested text (corrected to reflect the source accurately) to expand the discussion of the debate in the Society and culture section, although I'd prefer we find secondary source providing an overview of that. Zad68 04:23, 27 October 2013 (UTC)

Zad,

I think this should go in the adverse effects section along with the Royal Dutch Statement presently there.

Many of those individuals are, in fact, the heads of or else official spokespeople for their paediatric associations- I apologize if my suggestion to include "the Paediatric Association of the Netherlands has stated X" was viewed as misinterpretation. I would be just as happy saying "the President of the German Association of Pediatricians says X" (Wolfram Hartmann), or "the President of the British Association of Paediatric Urologists says Y" (Rowena Hitchcock). --(Moshe) מֹשֶׁה‎ 06:49, 27 October 2013 (UTC)

Moshe I appreciate your willingness to respect and apply Wikipedia's sourcing guidelines, it's a big help. It looks like you now recognize that the Frisch et al commentary is a statement of expert opinion. The next thing you need to review is WP:MEDASSESS. Per Wikipedia's sourcing guidelines, systematic reviews and other structured evidence reviews based on RCTs are the most preferred kinds of evidence sources; expert opinion is the least. As we have multiple instances of the most preferred kinds of evidence, it would go against our sourcing guidelines to present the least-preferred kinds of evidence sources as if they were equally valued. Additionally, if we're going to use the Frisch commentary, why wouldn't we then also use any of the other dozens of expert opinion commentaries published on this subject? We would then be back to the issue of using this article as venue to entertain the back-and-forth of commentaries from various groups--a direction you indicated would be problematic, and I definitely agree with you on that. The solution is straightforward: apply our sourcing guidelines to identify the best-quality evidence and summarize it accurately, as the article already does currently. Zad68 15:22, 27 October 2013 (UTC)

Bravo Moshe- I agree with your comments and applaud your clarity and courage in challenging the status quo on this article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 06:00, 25 October 2013 (UTC)

Back to Adverse Effects

These new discussions on our talk page have re-encouraged me to be bold. All of my suggestions for inclusion in "Adverse Effects" were dismissed because of age, and/or because they were primary sources. Fine, I can accept that.
However, I noticed that two of my adverse effects are actually non-medical, and were nonetheless dismissed under WP:MEDRS, though they are not subject to this (correct me if I am wrong). Like I stated earlier, circumcision is not purely a medical issue: it is a status issue, a sexuality issue, a gender issue, a psychological issue (of which we make zero mention), and ultimately, a human rights issue. As such, I am re-proposing the following inclusions for the "Adverse Effects" section:

According to Goldman (1999), the circumcision of a child carries the risk of mental trauma. Circumcision is associated with pain, stress, a loss of control, and could negatively impact a child’s mental development. The procedure can also affect the relationship between mother and child, especially when circumcision takes place in infancy during the highly sensitive period of the formation of the maternal bond (see Attachment Theory).{1}
(1999, but psychology, not medicinal, so not covered by WP:MEDRS- correct me if I’m wrong. We have a source from 1999 talking about Jewish psycho-spiritual reasons. Either way, whether we use this source or not, we definitely need a secular psychology perspective, because we don’t have one)

Damage to or removal of the frenulum during circumcision can also be considered critical. This part of the penis is more sensitive than the glans itself for many men.{2}
(1993, but sexology, not medicine, so not covered by WP:MEDRS- correct me if I’m wrong. Again, we have a source from 1999 talking about Jewish psycho-spiritual reasons)

{1} Goldman (1999): The psychological impact of circumcision. BJU Int, 83 (1), S. 93–102, doi:10.1046/j.1464-410x.1999.0830s1093.x.

{2} Crooks R., Baur K.: Our Sexuality, Fifth Edition, Redwood City, The Benjamin/Cummings Publishing Co., 1993, S. 129.

Let's discuss. --(Moshe) מֹשֶׁה‎ 16:56, 23 October 2013 (UTC)

I don't think you'll have much luck here, unless there really are separate guidelines for psychological and medical articles? Are there? The article does mention ethical objections to the procedure being done on minors, but I'm not sure it mentions that it is performed on minors in almost all cases. It says "about one-third of the world's men are circumcised". Tobias8844 (talk) 18:52, 23 October 2013 (UTC)

I'm not talking about the ethical objections here. Nor medical. Again, as I said above, circumcision is more than just a medical procedure (see for instance, how this talk page is under the Categories of "WikiProject Human rights articles" and "WikiProject Sexology and sexuality articles"). I am discussing psychological impacts, and impacts on sexuality. There are huge psychological and sexual components to circumcision. And there are adverse effects associated with those components. --(Moshe) מֹשֶׁה‎ 19:47, 23 October 2013 (UTC)

PubMed indexes everything related to human health. Physical and mental; they're all part of human health. Therefore psychology, which relates to mental health, is covered by WP:MEDRS. This should be trivially obvious if for no other reason than the fact that the first article was published by BJUI; as our article on the journal points out, it is "a peer-reviewed medical journal... the official journal of the British Association of Urological Surgeons, the Urological Society of Australia and New Zealand, the Urological Society of India, the Caribbean Urological Association, and the Hong Kong Urological Society."

MosheA, I'm quite concerned about your approach to this article; to write a good article, one must start by reading high-quality secondary sources on the subject (in this case WP:MEDRS-compliant), then summarize what they say, whatever that happens to be. It appears that your approach is essentially the opposite; you have decided that certain things are THE TRUTH™, and are now searching for sources which support THE TRUTH™. This is the exact wrong way to write an article. I've been trying to take your statements here as good faith attempts to learn and conform to Wikipedia's content policies and guidelines, but this latest attempt to get around them appears, at best, disingenuous. Jayjg ^(talk) 23:43, 23 October 2013 (UTC)

No. I'm not trying to get around the guidelines. That's why I'm putting suggestions here before just inserting them into the article, to make sure I'm getting things right. Of course I noticed that it was in the BJUI. I didn't think that just because something is in a medical journal, it is immediately subject to WP:MEDRS - the BJUI publishes things such as Circumcision: A Muslim view, but that doesn't mean I can't quote something like: "In the traditions that enumerate the features of natural religion (al-Din al-fitra), circumcision is mentioned under the heading Tahara (cleanliness)" on a page about khitan, even though the source is a medical one and from 1999, because I'm not discussing something medical, but rather something cultural.

The study of Islam is a humanities discipline, but that quote would be fine on the khitan page, would it not? Psychology is often considered a social science discipline, including at Harvard. Psychologists don't go to med school. Was there good reason for me to believe, therefore, that not all aspects of psychology on Wikipedia are covered by medical guidelines? Yes. Was I wrong? Yes. Can I admit that I was wrong? Yes.

Of course I have a particular view on the topic...as I think anyone interested in editing the page does. I'm more concerned with the fact that the majority of the world does not circumcise, and 91% of the world does not circumcise outside of Islam. Why is this? If this is such a great medical idea, why isn't everyone doing it? To me, this article just seems very promotive, and I think many others would agree. But I'll shut up for now. --(Moshe) מֹשֶׁה‎ 00:56, 24 October 2013 (UTC)

Regarding your questions about "that the majority of the world does not circumcise" etc., I will point you to WP:NOTAFORUM. Please start by reading WP:MEDRS-compliant secondary sources on this topic, and, when posting on this Talk: page, please restrict your posts to discussions of the content or use of those sources, not speculations about people's motivations, or statements about how the article "seems" to you and various unnamed "others". Jayjg ^(talk) 01:10, 24 October 2013 (UTC)

"when posting on this Talk: page, please restrict your posts to discussions of the content or use of those sources"------is there any admin person who would like to comment on this request from jayjig--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 05:53, 25 October 2013 (UTC)

Jayjig, thanks for your reply. However, you only discussed the last part of my post, which was not intended as a forum discussion- it was simply to show that this article's predominant outlook is a minority American one, and I was (still am) concerned that this Wiki page is championing a view that is held by less than 10% of people outside the Islamic world.

However, you did not address my two previous source concerns. Is the Goldman psychology study valid in a social sciences context, and is the Crooks sexological study valid in a sexology context? --(Moshe) מֹשֶׁה‎ 02:55, 27 October 2013 (UTC)

It is incorrect to say that this article adheres to an 'American outlook'. No American viewpoint document, such as the AAP Policy Statement, is used by this article to source any biomedical statements of fact. The sources supporting biomedical statements of fact are from secondary source reviews, meta-analyses and systematic reviews from around the world. The only "outlook" (so to speak) this article adheres to is the scientific consensus expressed by reliable secondary sources, without regard for country of origin. Zad68 04:23, 27 October 2013 (UTC)

Thank you for your prompt responses, Zad. Could you please answer my question: is the Goldman psychology study valid in a social sciences context, and is the Crooks sexological study valid in a sexology context? --(Moshe) מֹשֶׁה‎ 21:17, 27 October 2013 (UTC)

Regarding both Goldman 1999 and Crooks 1993, geez... neither one of those is a "study". Let me turn the question around: Did you do a review of the existing secondary sources available on the topic, reading widely what the current thinking on the topic is? Circumcision is a very active research area and a lot is published on it. Did you consider that there may be a reason why older theories are no longer raised in current sources? That is normal in well-researched subjects. Did you search for more updated versions of the textbook? (Why did you apparently not find my response to you here regarding Gray's Anatomy applicable to Crooks?) I actually think Crooks is a good source and think we should use it, but not the edition that's over 20 years old... come on! This is still coming across as a case of finding something somewhere and seeing how much of it you can stick into this article, without really thinking about it. If this were only the first or second time you've been pushing to use out-of-date sources, or versions of sources older than the most up-to-date versions, that could be forgiven, but it's not. You've been pointed to the guidelines and resources, and the methodology for acticle development has been explained to you. Will you show that you intend to participate in article development for this article in line with that? Zad68 02:46, 28 October 2013 (UTC)

Sorry, Zad, "study" was the wrong choice of words. Again, because I thought we are discussing social sciences and sexology, these were not subject to the same stricter guidelines (including the suggested cut-off date of five years) of WP:MEDRS.

Still, completely mea culpa on the outdated Crooks source. I found something in the latest 11th edition of the textbook (2010) that might be worth noting:

"Masters and Johnson (1966) report finding no difference in the sensitivity of the glans of circumcised and uncircumcised men. However, a more recent study reported that the glans of the circumcised penis is less sensitive to touch than the glans of the uncircumcised penis (Sorrells et al., 2007). Neither of these studies included the all-important dimension of subjective assessment by men who have experienced both conditions after achieving sexual maturity. Anecdotal reports in the medical literature testify that some men experience less sexual satisfaction after undergoing adult circumcision (Gange, 1999; Melby 2002b; Task Force on Circumcision, 1999)…It would seem that questions about the relationship between circumcision and male sexual arousal remain to be answered, and 'little consensus exists regarding the role of the foreskin in sexual performance and satisfaction' (Laumann et al., 1997, p. 1052)"

In light of this, may we revisit our statement that "Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction" and change it to "There is no consensus regarding circumcision's effect on penis sensitivity, sexual function or sexual satisfaction"?

--(Moshe) מֹשֶׁה‎ 03:20, 28 October 2013 (UTC)

First I'd prefer we use the 12th edition, published in 2013. Second I don't think the suggested wording represents the source accurately, and we don't just throw away all the other current secondary sources. I'd like to read this source more thoroughly before integrating what it says into the article. Zad68 03:38, 28 October 2013 (UTC)

The wording was a direct quote from the textbook. I only removed the section about improved sexual satisfaction due to circumcising a phimosis penis solely because that is circumcision for a medical reason, and is therefore not non-therapeutic. How does this not represent the source accurately? I'm not even pushing my point of view here. How much more NPOV can you get than "[no] consensus exists regarding the role of the foreskin in sexual performance and satisfaction"? Additionally, one of those secondary sources was the AAP 2012 report, with which I pointed out the methodology errors observed by other medical professionals. But I'll withhold further comments until we get the 2013 edition. :) --(Moshe) מֹשֶׁה‎ 04:35, 28 October 2013 (UTC)

Crooks 2013

For sexual effects, Crooks' selection of the primary source data they use to support their views of circumcision does seem uneven. Sections of the book are clearly aware of the trials that showed efficacy against HIV transmission, and use sources at least as recent as 2011 (see for example the Circumcision as a Strategy for Preventing HIV Infection box on p. 467). Those are the same trials that produced RCT data regarding sexual effects that at least a half-dozen other good-quality secondary sources have used, but Crooks chooses not to use it in their coverage of the topic. That's strange to me, but that is their prerogative.

Our job as Wikipedia editors is to summarize scientific consensus, so let's review what's out there. Add Crooks to the list, and I also see Tian et al have produced a meta-analysis published in the Asian Journal of Andrology, a MEDLINE-indexed journal, and it's not based in the US. So from what I've found, we have:

AAP Tech Report 2012 - PMID 22926175 - "Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction."

Sadeghi-Nejad 2010 - PMID 20092446 - "most recent articles do not show evidence of adverse effects on sexual function"

Doyle 2010 - PMID 19913816 - "Adult male circumcision does not seem to have an adverse impact on sexual function."

Perera 2010 - PMID 20065281 - "The evidence suggests that adult circumcision does not affect sexual satisfaction and function."

Crooks 2013 - "questions about the relationship between circumcision and male sexual arousal remain to be answered"

Tian 2013 - PMID 23749001 - "These findings suggest that circumcision is unlikely to adversely affect male sexual functions."

Based on this, I'm not sure Crooks 2013 changes what the article needs to say.

There's other things Crooks might be useful for:

• I think Crooks 2013 would be great to use for a paragraph on "intactivism" and the "what proponents say vs. what intactivists say" debate.
• Crooks mentions that less than half of those in the US undergoing circumcision receive anesthesia, wasn't that something suggested to be added?

Zad68 13:49, 28 October 2013 (UTC)

"Good" Article

I have lately been trying to learn and determine what makes a "Good" article on Wikipedia…it has been a very interesting exercise. I have specifically been focusing on "Good" articles in medicine, and more specifically, "Good" articles in medical procedures (of where there are 10, including circumcision). Some of my observations:

• Virtually every single "Good" article includes medical sources that would be dismissed as "too old" or "too primary" for our circumcision article. Some examples are brachytherapy including several from 2000; coffin birth including several from the 90s; and tracheal intubation (which is also of the interventions infobox format) including sources from 1989, 1997, 1995, 1998, 2000, etc. Please note that these are being used to cite purely medical information, views, and procedures- I'm not counting sources such as a 1985 source [74] in tracheal intubation being used to discuss a 1985 classification system. Primary sources include Smith [48] (a 2003 source) in tracheal intubation, Jongbloets [28] (a 1994 source) in lower limbs venous ultrasonography, and others (I am admittedly still not an expert distinguisher between primary and secondary sources, so feel free check those up. However, there are many others that also appear to be primary)

I fully recognize and respect the fact that other stuff exists and has no bearing on an article's validity. However, in light of other "Good" medical articles, I am getting less of an impression that other inferior-quality stuff exists in other "Good" medical procedure articles, and more of an impression that our own article is being both unnecessarily and unduly stringent in Wiki procedure for reasons unbeknownst to me.

Once again, the guidelines do not say we must "exclusively use reviews and meta-analyses". They also say in regards to primary sources for medicine:

Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse…etc (then going on to describe usage).

So we may indeed include primary sources, so long as they are "adjunct to secondary literature" and we indicate them with special rules. We are not commanded to excise them entirely. (†) Wikipedia itself says (original emphases):

"Primary" is not another way to spell "bad"

"Primary" is not, and should not be, a bit of jargon used by Wikipedians to mean "bad" or "unreliable" or "unusable". While some primary sources are not fully independent, they can be authoritative, high-quality, accurate, fact-checked, expert-approved, subject to editorial control and published by a reputable publisher. Primary sources can be reliable, and they can be used. Sometimes, a primary source is even the best possible source, such as when you are supporting a direct quotation...

However, there are limitations in what primary sources can be used for. {next section} You are allowed to use primary sources...carefully

This being said, why are we so strictly applying the rules as black-and-white and clear-cut here? I think maintaining the vast bulk of the article in secondary sources and meta-analyses, while including a few primary sources (and/or statements from medical organizations) and noting them as such, would absolutely not harm the page in any way. Please address (†), and thanks for everyone's patience and input here. --(Moshe) מֹשֶׁה‎ 17:24, 27 October 2013 (UTC)

Although WP:MEDREV doesn't rule out primary sources entirely, it is pretty restrictive on when they should be used, with all sorts of caveats about WP:SYNTH, WP:UNDUE, contradicting WP:SECONDARY sources, etc. Which specific primary material from which specific primary source do you think could be added without violating MEDREV? To use your example, is there a direct quotation already in the article that you feel needs to be supported by a primary source?

P.S. The goal for every Wikipedia article is to eventually get it to WP:FA status, fully compliant with all policies and guidelines. Suggestions that the sourcing requirements should be relaxed for a specific article do not fit with Wikipedia's ultimate goals. Jayjg ^(talk) 20:13, 27 October 2013 (UTC)

Two of the four adjectives WP uses to describe WP:FA status are neutrality and completeness. This article in its present state fails badly on both counts. There does seem to be a pattern of some "ultimate goals" here at present. They just are not those of Wikipedia.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:32, 27 October 2013 (UTC)

Wikipedia judges a WP:FA article's "neutrality and completeness" based on how reliable secondary sources describe the topic. Which WP:MEDRS-compliant secondary sources do you feel are not properly presented here? Jayjg ^(talk) 21:56, 27 October 2013 (UTC)

I would also like to see included the statement by those organizational bodies I suggested above, which can go along with the statement by the Royal Dutch in the Adverse Effects section (many editors have gone through and removed content from this section numerous times, and glossed over this statement each time without feeling a need to remove it. I doubt that including this statement, or one similar to it, would be violating any Wiki policy).

As per WP:UNDUE (emphasis mine):

Biased statements of opinion can be presented [with attribution]. For instance, "John Doe is the best baseball player" expresses an opinion and cannot be asserted in Wikipedia as if it were a fact. It can be included as a factual statement about the opinion: "John Doe's baseball skills have been praised by baseball insiders such as Al Kaline and Joe Torre." Opinions must still be verifiable and appropriately cited.

Merci mille fois,

--(Moshe) מֹשֶׁה‎ 22:19, 27 October 2013 (UTC)

"John Doe is the best baseball player" is a statement of subjective opinion and can't be stated as fact in Wikipedia's narrative voice because there's no objective standard for "best" in this case. But you can get several teams of statisticians to review the player's record for a season and have them each independently produce a statement like "John Doe's batting average for the 2012 season was 0.357." Wikipedia would then state that as a fact in its narrative voice. Bud Selig might one day say, "I think John Doe's batting average last season was like .248 or something." We wouldn't be doing the article a favor by making it say "John Doe's average for the 2012 season was .357 but Bud Selig said it's .248." Zad68 03:27, 28 October 2013 (UTC)

I completely agree. "Biased statements of opinion can be presented [with attribution]" as per WP:UNDUE. We can very well include a quote from the CB statement, which I think is significant for reasons discussed above, so long as we attribute it. --(Moshe) מֹשֶׁה‎ 17:28, 28 October 2013 (UTC)

If you're saying that Frisch et al could be used to develop content about notable opinions, pro and con, I agree. The article would be improved with a new paragraph in Society and culture about these sorts of differences of opinion. We could use Frisch et al as a primary source for the views of the individuals; I think this would be a case where it'd be OK to use a primary source like this. We could also use the AAP's response, and Crooks 2013's discussion of "intactivism". It'd be a very good addition to article. Zad68 18:32, 28 October 2013 (UTC)

Two Proposed Edits

Friends,

I am proposing two edits for discussion.

(1) Indications and contraindications. Change:
"The Royal Dutch Medical Association, which expresses the strongest opposition to routine neonatal circumcision, does not call for the practice to be made illegal..."
to
"The Royal Dutch Medical Association, which generally opposes routine neonatal circumcision, does not call for the practice to be made illegal..."
There are many organizations, such as Doctors Opposing Circumcision, which can easily be said to be far more vocal in their opposition. Royal Dutch is not "the strongest opposition" in the world - this is pure POV.

(2) Adverse effects. Expand:
"The Royal Dutch Medical Association's 2010 Viewpoint mentions that 'complications in the area of sexuality' have been reported"
to
"The Royal Dutch Medical Association's 2010 Viewpoint mentions that 'psychological problems' and 'complications in the area of sexuality have been reported"
...or else something longer (there is something on "extreme pain experiences in newborns causing behavioural changes which are still apparent years later")

Consensus? --(Moshe) מֹשֶׁה‎ 17:42, 28 October 2013 (UTC)

1) Did you not check to see what the source cited in support of the current article content says before changing it? You can't change article content to make it say something the cited source doesn't say. The source cited is providing a review of the positions of the world's major medical organizations; DOC is a tiny advocacy group and doesn't come close to being in this category.

2) The point about pain is already covered in Pain management with a systematic review, which is better than using a particular medical organization's Viewpoint document. A mention of "psychological problems" used to be in the article but it was challenged because there's no point in mentioning "psychological problems" if there are no details about what they are, how severe they are and what their prevalence might be, and I ended up having to remove it. The KNMG Viewpoint document doesn't help us out here.

Zad68 18:32, 28 October 2013 (UTC)

1) You cannot say that it is "the strongest opposition". That is clearly POV, and there is no source to support a statement that Royal Dutch is the world's "strongest" opponent of circumcision. Some words from the actual viewpoint of Royal Dutch (KNMG viewpoint, page 5, of current Source [55]) read as follows:

"There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene...Contrary to what is often thought, circumcision entails the risk of medical and psychological complications...Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity...the KNMG calls on (referring) doctors to explicitly inform parents/carers who are considering non-therapeutic circumcision for male minors of the risk of complications and the lack of convincing medical benefits. The fact that this is a medically non-essential intervention with a real risk of complications makes the quality of this advice particularly important...The KNMG respects the deep religious, symbolic and cultural feelings that surround the practice of non-therapeutic circumcision. The KNMG calls for a dialogue between doctors’ organisations, experts and the religious groups concerned in order to put the issue of non-therapeutic circumcision of male minors on the agenda and ultimately restrict it as much as possible."

That sounds to me more like "generally opposes routine [read: non-therapeutic] neonatal circumcision" far more than "expresses the strongest opposition to routine neonatal circumcision". What source are you referring to? The nearest "cited source" to this statement doesn't even mention Royal Dutch. I further think it is generally ambiguous to say "the strongest opponent" anyway; that's like saying the "best baseball player", as per our discussion above. There is absolutely no source to justify this phrasing, and I really don't see what the issue here.

2) Is there no point in mentioning "sexual complications" then if we don't go into them? Royal Dutch uses "Boyle, G., Male Circumcision: Pain, Trauma and Psychosexual Sequelae, Journal of Health Psychology, Vol. 7, No. 3, 329-343 (2002)" as a reference for psychological complications. Can I include them, or would this be too outdated and primary sourcing? (Even though I'm referring to a document referred to in another document) --(Moshe) מֹשֶׁה‎ 18:58, 28 October 2013 (UTC)

For 1), please stop doing original research, and the conversation can't move forward until you provide a response that shows you've actually read the sources cited in support of the article content. For 2) I think we have sourcing to include a mention like "There is a risk of psychological consequences." without further detail because in each of the few sources I've seen mention it, they simply do not provide further detail. If the sources for whatever reason don't see fit to provide the detail we shouldn't either. Give me a few minutes and I'll write up a proposal for discussion. Zad68 13:40, 29 October 2013 (UTC)

Zad, I fail to see how I am doing original research here. If anything, including the statement "strongest opponent" is the original research. I still don't know what source you are referring to. The nearest sourcing in our article to the "strongest opponent" statement (both preceding and succeeding) is Hay W, Levin M (25 June 2012), which doesn't even mention Royal Dutch/KNMG. Where is evidence saying that Royal Dutch is the world's strongest opponent to circumcision? --(Moshe) מֹשֶׁה‎ 17:40, 29 October 2013 (UTC)

??? Do you not see Reference 7 at the end of that paragraph?? Zad68 18:53, 29 October 2013 (UTC)

Whoops, I don't know what happened there. I guess I accidentally read a line up and saw the Hay/Levin source. I'm unable to see the journal because I don't have a subscription, but I'll trust you. Totally my fault here. --(Moshe) מֹשֶׁה‎ 20:03, 29 October 2013 (UTC)

Whew, you had me worried for a bit there! No worries, glad you found the ref. Zad68 15:52, 30 October 2013 (UTC)

Psychosocial effects

I reviewed the sourcing I could find on psychological consequences:

• KNMG 2010 - link - KNMG's Viewpoint statement; policy statement are written to argue a position - "psychological problems" have been reported but no details. The content in this Viewpoint is very poorly supported.
• Morris 2012 - PMID 22373281 - States that the evidence is insufficient and argues for neonatal circumcision. Although the article ticks all the WP:MEDRS checkboxes, it's written as part of debate, apparently, and so would be built trying to advance a position instead of dispassionately reviewing the evidence, so I'm a bit disinclined to use it.
• Perera 2010 - PMID 20065281 - "Adverse psychosocial effects may include dissatisfaction with circumcision, castration anxiety, and a heightened pain response." - Recent systematic review. Doesn't mention "psychological" consequences but rather "psychosocial". Does not mention psychosocial effects in the Conclusions of the Abstract, only in body.
• Pinto 2012 - PMID 22857844 - "Conflicting evidence exists as to the effects neonatal circumcision has on a man’s psychological well-being as well as his personal and sexual relationships in adulthood."
• RACP 2010 - link - RACP's policy statement; policy statement are written to argue a position - Mixed bag. "The potential harms include ... psychological complications." however the body of the document does not detail any psychological complications anywhere, and makes reference to case reports but not any studies. The Ethics section actually discusses psychosocial benefits.

Overall consensus of the sources is that there's weak support for a risk of psychosocial consequences. The strongest and most detailed evidence-based source is Perera 2010; it does not discuss "psychological" effects but rather "psychosocial" effects. Suggested content is to add:

Additionally, the procedure may carry the risks of heightened pain response for newborns, castration anxiety for boys in the phallic stage, and dissatisfaction with the result.(Perera 2010)

at the end of Adverse effects. Based on the weakness of its coverage in the sourcing, this would not go into the lead. Comments? Zad68 17:30, 29 October 2013 (UTC)

Must all psychological sources adhere to the WP:MEDRS guidelines? As I've mentioned many times before, circumcision is not just a medical procedure and nothing else. As I've also mentioned before, psychology is often considered a social science, including at Harvard. As I've also mentioned, just because something is in a medical journal does not mean it is discussing something that is medicine - note Glass JM (January 1999). "Religious circumcision: a Jewish view", in the BJUI and used in the article to discuss non-medical aspects of circumcision. Please direct me to something that says all psychology sources must adhere to WP:MEDRS. --(Moshe) מֹשֶׁה‎ 17:46, 29 October 2013 (UTC)

Are you saying you oppose the edit, or no? Is this response even regarding this particular edit, or have you moved on to something more general?

If you're looking to add a statement about how an intervention affects human health, and that includes mental health, WP:MEDRS is the guideline. PubMed is 100% appropriate for searching for sources, here is a list of several dozen MEDLINE-indexed psychology journals. Depression, bipolar disorder, cognitive behavioral therapy, dementia, child abuse, psychoanalysis, sleep disorder, ... are all psychology topics having an impact on human health, and so they are covered by both the Psychology WikiProject and the Medicine WikiProject.

Even if you consider psychology to be exclusively a "social" science and somehow are not making a statement regarding human health, then WP:SCIRS is the controlling guideline, and it says the same thing as WP:MEDRS: "Appropriate sources for discussing the natural sciences include comprehensive reviews in independent, reliable published sources, such as recent peer reviewed articles in reputable scientific journals, statements and reports from reputable expert bodies, widely recognized standard textbooks written by experts in a field, or standard handbooks and reference guides." If something is a science, including a social science, that means it makes testable claims that can be proven or disproven, and the science guidelines control.

This article does make use of non-medical, non-science sources, in, for example, the History and Society and culture sections. I'm having a hard time coming up with a case where you wouldn't need to use WP:MEDRS sourcing for things in the sections like Indications, Effects and Adverse effects which specifically cover the intervention's effect on human health. Zad68 18:40, 29 October 2013 (UTC)

I'm fine with that edit. Thanks. My main issue here isn't where sources come from, but when they come from. I, of course, recognize the importance of using high-quality sourcing, e.g., "independent, reliable published sources, such as recent peer reviewed articles in reputable scientific journals, statements and reports from reputable expert bodies, widely recognized standard textbooks written by experts in a field, or standard handbooks and reference guides". But it seems that the way the five-year-guideline is being applied here is a little too draconian. Tracheal intubation, for example (another "Good" article), includes a lot of sources that we would deem "too old". In fact, this seems to be the guideline for all "Good" medical procedure articles- this is not a case of other stuff exists, it seems to be that circumcision is the exception rather than the rule. The five year mark appears to be more of a suggestion than a law. Articles do not become invalid simply because they are five years or older. Articles only become invalid when they are outmoded by newer and better scientific information. --(Moshe) מֹשֶׁה‎ 20:03, 29 October 2013 (UTC)

Moshe, I've been reading this discussion, and I don't understand why you keep trying to use outdated sources like Glass. To the outside observer, it looks as if you want to get around the sourcing rules because you like what certain sources say. I hope that's not the case. Plot Spoiler (talk) 20:21, 29 October 2013 (UTC)

I do have my concerns about the interest in using outdated sources when it comes to scientific information, but in the specific case of Glass, that's OK, because it's only used for cultural information unlikely to change quickly. Zad68 20:30, 29 October 2013 (UTC) Adding: Probably just a mix-up in the names, Goldman is what was probably meant, and I think we have resolved this issue now with the more up-to-date source. Zad68 20:35, 29 October 2013 (UTC)

Great, as we have agreement on the edit, plus there hasn't been opposition to it, I've gone ahead and applied to the article. Zad68 15:54, 30 October 2013 (UTC)

My view on this matter is pretty much the same as Zad68's. Unless there is an extraordinary reason to use sources that are older than five years, such as research in the area not having made much progress at all or lately (which is covered at Wikipedia:MEDRS#Use up-to-date evidence), I don't see any reason to use the older sources for health information (other than for the aforementioned cultural instances). And though WP:SCIRS is not an official guideline, it is something that should obviously be kept in mind. Flyer22 (talk) 16:14, 30 October 2013 (UTC)

You're right Zad68, I meant Goldman. Plot Spoiler (talk) 16:24, 30 October 2013 (UTC)

Proposed Edit

I think I'm finally getting the hang of the guidelines for WP:MEDRS. What would we think of including some or all of the following in Adverse Effects? My source is a MEDLINE-indexed systematic review published within the past five years and states:

"Circumcision removes a complex, pentilaminar, specialized, junctional structure that contains nearly all the penis' fine-touch neuroreceptors. Not surprisingly, the foreskin is the most sensitive portion of the penis. Circumcision can reduce the sensitivity of the glans to fine-touch and vibration"

Let me know. While I very much appreciate the recent edit, I still think the Adverse Effects section is lacking. --(Moshe) מֹשֶׁה‎ 18:48, 31 October 2013 (UTC)

It's not a good idea to use advocacy pieces published as part of a "pro vs. con" debate as this Van Howe article is. Looking at the article here you can clearly see it's labeled a "VIEWPOINT" right at the top and so would be a statement of opinion. I see at Phimosis you characterized this article as a "systematic review"; it's definitely not that. After reading this "con" Viewpoint did you make sure to also read the "pro" Viewpoint that was also published? This is still coming across as hunting around to find particular articles that meet a particular point of view, and not surveying the sources generally to understand the consensus. Zad68 01:33, 1 November 2013 (UTC)

Adding: Is this the same Van Howe that the advocacy organization Intact America named as their "Intactivist of the month"?? Zad68 01:37, 1 November 2013 (UTC)

I actually found this piece by clicking the link provided above on this talk page (For a list of review articles from the last 5 years at PubMed, click here (limit to free review articles or to systematic reviews)). Inputted values were " AND Review[ptyp] AND "last 5 years"[PDat] " Maybe I'm missing something here?

Not sure if that's the same Van Howe, but he does appear to be the same person as our current Reference 71. --(Moshe) מֹשֶׁה‎ 02:21, 1 November 2013 (UTC)

Yes, it's clearly the same Van Howe. Jayjg ^(talk) 22:35, 3 November 2013 (UTC)

Is it invalid? I found it by using the suggestion at the top of this page: "For a list of review articles from the last 5 years at PubMed, click here (limit to free review articles or to systematic reviews)" --(Moshe) מֹשֶׁה‎ 22:40, 3 November 2013 (UTC)

Zad68's posts of Nov 1 already answer that question. Jayjg ^(talk) 23:16, 3 November 2013 (UTC)

MosheA, I should add that the notice box you are referring to clearly states search results are "possibly useful" - not that every source found in those links should be included. Yobol (talk) 23:18, 3 November 2013 (UTC)

ICD-10-PCS code in infobox

I just noticed that the ICD-10-PCS code given in the infobox is incorrect. The code that is given, Z41.2, is a reference to the ICD-10-CM code, although that's not what the infobox calls for. As such, I've gone ahead and inserted the ICD-10-PCS code. --Schaea (talk) 08:08, 3 November 2013 (UTC)

I am not sure why the ICD10 PCS is not being used? We automatically link to it and this is typically what we use. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:11, 13 November 2013 (UTC)

percentage of circumcisions performed by tribal or religious folk ?

Editor Yobol states without any reference

'the vast, vast majority of circumcisions are performed by physicians as a medical procedure"

Anybody got stats on this ? -presuming that the rest of the world mimics USA can lead to all sorts of mistaken shenanigans--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:27, 13 November 2013 (UTC)

Would circumcision be legal if it wasn't a religious tradition?

Cutting off body parts from children is in most country completely illegal, unless there are very strong medical reasons to do so. Are there strong enough medical evidences to justify the procedure, or does the justification mostly come from primitive old-fashioned religious superstition? I am pretty sure that the procedure would be illegal in most countries, if it wasn't for all the religious-traditional nonsense. Having a huge medical section is kinda ridiculous as most doctors don't think there are enough medical benefits to recommend the procedure. The outline of the article should reflect this view. The current outline of the article seems like jewish/islamic propaganda. Probably because the main contributers of this article are jews or muslims. This article should be written by atheists that don't have their thinking clouded by religious nonsense.84.210.15.173 (talk) 20:11, 11 November 2013 (UTC)

No, this article should not be written from one specific point of view or by one specific group of people. Like all articles, it should follow WP:NPOV as much as possible. If you think that all or part of the medical section has undue weight, please be specific about which parts and why. -- Fyrael (talk) 20:21, 11 November 2013 (UTC)

In this case a neutral point of view is an atheistic point of view. People that belong to the jewish or islamic faith naturally have a bias in their thinking about circumcision.84.210.15.173 (talk) 20:26, 11 November 2013 (UTC)

No, an atheistic point of view is not a neutral point of view. A neutral point of view is a neutral point of view. Please actually read the policy page that I linked. -- Fyrael (talk) 20:29, 11 November 2013 (UTC)

Please read some of the books by Richard Dawkins, and if you don't think an atheistic point of view reflects neutrality regarding circumcision, then please explain why. 84.210.15.173 (talk) 20:30, 11 November 2013 (UTC)

Now that you've voiced your own opinion, see WP:NPOV for how Wikipedia defines it. If this conversation goes any further into WP:NOTAFORUM territory, or sees any more personal attacks based on religion, it will be closed if not deleted. Zad68 20:37, 11 November 2013 (UTC)

Let me word this another way. This article can be viewed from a Catholic perspective. It can be viewed from a Muslim perspective. Or Buddhist, atheistic, pagan, etc. These are all singular points of view. They all have their biases. Wikipedia aims to balance all of these points of view and we call it "neutral point of view". At any rate, if you would like to discuss a specific change to the article, please do so. Debating points of view doesn't really accomplish anything. -- Fyrael (talk) 20:40, 11 November 2013 (UTC)

Well, if my "holy book" doesn't tell me if circumcision is good or bad, then how does my faith make me biased in this aspect?84.210.15.173 (talk) 20:43, 11 November 2013 (UTC)

Do you have a specific change to the article that you would like to discuss or do you not? -- Fyrael (talk) 20:49, 11 November 2013 (UTC)

Well, I think the section about "Ethical and legal issues" should be before all the medical propaganda.84.210.15.173 (talk) 20:55, 11 November 2013 (UTC)

So you think the "Society and Culture" section should come before the "Effects" section? Why do you think so? I have to say just reordering those sections doesn't seem like a very significant change. -- Fyrael (talk) 21:05, 11 November 2013 (UTC)

As has been pointed out in previous conversations, the sourcing for the topic of this article is overwhelmingly medical and so the article is organized per WP:MEDMOS. Zad68 21:08, 11 November 2013 (UTC)

But why are you treating circumcision mainly as a medical issue, when the practice comes from religious traditions? A million pubmed articles doesn't have the weight of either the bible or the quran. Circumcision is a practice mostly done for religious/traditional reasons, not a practice done for medical reasons. Do you disagree?84.210.15.173 (talk) 21:23, 11 November 2013 (UTC)

I don't see anywhere in the article that it says the procedure is mostly done for medical reasons. The very first sentence after the opening paragraph reads "Neonatal circumcision is often elected for non-medical reasons, such as for religious beliefs or for personal preferences possibly driven by societal norms." -- Fyrael (talk) 21:26, 11 November 2013 (UTC)

Ok, but if that is the case, then of course the Society and Culture sections should come before the medical section.84.210.15.173 (talk) 21:28, 11 November 2013 (UTC)

See previous responses. The article is organized per WP:MEDMOS because the sources covering it are overwhelmingly medical. The medical effects are the same regardless of the reason why it's done. Zad68 21:34, 11 November 2013 (UTC)

Well, I think it is very wrong to have it like it is now, because the current medical sections seem like circumcision propaganda. Putting this section so early and giving this section so much weight makes the whole article biased towards circumcision. I don't think this article has a neutral point of view at all.84.210.15.173 (talk) 21:44, 11 November 2013 (UTC)

Your opinion is noted, once again. Repeating for hopefully the last time: Per Wikipedia policy, articles are organized per the emphasis found in reliable sourcing, which for this topic is overwhelmingly medical. Zad68 21:55, 11 November 2013 (UTC)

Conversely, and probably NOT for the last time -there are many eminent secondary sources which cover the subject of circumcision from perspectives that are NOT medical but social. Consequently there are editors such as myself who firmly contest the opinion which Zad trots out so frequently on these talk pages that medical secondary sources rule here .In parts of the world circumcisions occur with no medical input or for reasons that have nothing to do with health. Most of the world chooses not to cut their children's genitals.In the article as presently constructed sufficient weight is lacking in drawing attention to this central latter fact alone (i.e most do not cut), never mind the omitting of all mention of the more bizarre aspects of the cultural phenomenon of circumcision some of which which I alluded to earlier. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 23:01, 11 November 2013 (UTC)

Regardless of intent, at least in the US (and likely the rest of the world - which is why it is so extensively discussed in the medical literature), the vast, vast majority of circumcisions are performed by physicians as a medical procedure, so using MEDMOS would seem to be appropriate here. Do we have reliable sources that say otherwise? Yobol (talk) 23:25, 11 November 2013 (UTC)

It certainly looks to me like the article covers the non-medical reasons for circumcision (and even more detail is given in the "for more information" links). And it very clearly states that "Approximately one-third of males worldwide are circumcised, most often for reasons other than medical indication". That right there seems to agree exactly with what Tumadoireacht is saying. I don't see how anything is lacking here. -- Fyrael (talk) 23:52, 11 November 2013 (UTC)

There's also a graphic giving very detailed prevalence information. Can you really draw more attention to something than by giving it a graphic? -- Fyrael (talk) 23:55, 11 November 2013 (UTC)

(edit conflict) To answer Yobol's question we need look no further than the lede of the article as it stands, which is well supported by sources that have been deemed acceptable here. It says, "The procedure is most often elected for religious reasons or personal preferences" and "About one-third of males worldwide are circumcised." So the main reasons it is done to children are not medical, and it is a minority position to take. So, although it has been 'medicalised' in the sense that it has been largely taken out of the hands of enthusiastic amateurs in often unsanitary conditions, it is not a medical procedure except in the 1% (or whatever it is) of cases where there are congenital abnormalities. I agree that it should not be treated here as primarily a medical treatment. On the worldwide scale (a) it is not done to the majority of male children or adults (b) when it is done it is usually not a medical treatment for any illness or disease in the patient. This perspective, or 'Point Of View', is not prevalent in the article, and it absolutely should be. --Nigelj (talk) 23:57, 11 November 2013 (UTC)

So, if I understand this correctly, Nigelj is saying that despite the article stating flat out several times that the motivation for most circumcisions is non-medical, you feel that the mere length of the "Effects" section is giving undue weight to the medical reasons? Is that right? -- Fyrael (talk) 00:23, 12 November 2013 (UTC)

I was primarily referring to the overall tone, and the insistence on MEDRS sources, but to be more specific:

1. Section heading 'Indications and contraindications' - this is medical terminology used in relation a procedure that is very rarely done for medical therapeutic purposes. The section talks about "non-medical" and "non-therapeutic", but the heading does not reflect that.
2. 'Medical indications' subsection does not give any indication of how rare these indications are, or what proportion of circumcisions they lead to.
3. 'Effects' section, as you say, is far too long. There should be perhaps 20 to 100 times more text about the social and religious traditions that lead to many times as many circumcisions, when compared to the medical reasoning that leads to the much smaller proportion.
4. 'Nowhere' is there a section about the two thirds of males who are never circumcised, all the reasons for that, what they and others have to say about it, etc.

The procedure requiring medical skill does not make this a medical procedure as the vast majority of operations are carried out on healthy, well-formed individuals with no illness or disease. Most of this article should be about that viewpoint, and that viewpoint does not require MEDRS sourcing. At the moment it is like requiring all our articles on air transport to be sourced from air crash investigation reports. --Nigelj (talk) 00:50, 12 November 2013 (UTC)

Nigel, there is insistence on WP:MEDRS sources for biomedical content, that's required. The general direction of your suggestions can't be pursued because the sourcing and Wikipedia content policy don't support it. To pick just one of your suggestions: "There should be perhaps 20 to 100 times more text about the social and religious traditions"... 20 to 100 times? those numbers are based on what? This suggestion isn't backed up by what's actually found in a survey of the sourcing, which both Google Scholar (not limited to medical) and Publish or Perish (not limited to medical) both show is overwhelmingly medical, and absolutely supports WP:MEDMOS layout. Wikipedia does have specialist articles to cover social and religious aspects specifically, see Circumcision controversies, Religious male circumcision, Khitan, Brit milah and others.

The issue is this: Let's say you're a good researcher, and someone tasks you to write an article on something you've never heard of before and have no opinion about, called "circumcision". After confirming you have the correct spelling, you go to you favorite academic search engines and indexes and you take a broad, general survey of the sourcing. Within a few minutes you'd come to the conclusion, "This is a medical topic, with some historical and social aspects." As Wikipedia editors, isn't that exactly how we're supposed to approach article development? Zad68 03:21, 12 November 2013 (UTC)

Suggestion that a procedure isn't "medical" because of the motivation of the person deciding on why the procedure is done is at best misguided. That the intention of the procedure is religious (or cosmetic, or social, etc) in nature doesn't make the procedure itself any less inherently medical. As an analogy, many plastic surgery procedures (face lift, breast augmentation, breast reduction, etc) can have purely cosmetic motivation (i.e. no "disease" is being treated); that, however, does not mean they are any less fully "medical" procedures. Suggestions that procedures done by medical personnel in a medical setting isn't medical are in the end not very convincing. Yobol (talk) 03:37, 12 November 2013 (UTC)

This is also a good point. Zad68 03:48, 12 November 2013 (UTC)

It might be a good or bad point but it does not address the arguments raised - instead it addresses one not raised -old politico's jaded turn.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 01:06, 13 November 2013 (UTC)

Off topic digression. This is not a forum for a general discussion of the topic
The following discussion has been closed. Please do not modify it.
Well, this procedure is enforced on children that don't have the ability to say yes or no, and it is more or less irreversible. Breast removal might decrease the chance of developing cancer, so we might start removing the tissue that will grow into breasts on female children. Then we might create a wikipedia article where we start by a long medical section describing the medical benefits of infant breast removal. Wouldn't you call that propaganda? This is pretty much what you are doing in this article. My wife finds me less sexually appealing as I don't have foreskin. 84.210.15.173 (talk) 19:53, 12 November 2013 (UTC)

Yobol does raise a good point: the intention behind circumcision is often 'cosmetic' on the part of secular parents. I don't think this article is part of Category:Cosmetic surgery. Should we put that right? --Nigelj (talk) 11:27, 13 November 2013 (UTC)

Nigel this article is already in that category. Although I actually think the sourcing does not support it, the article should be in Category:Elective surgery. Zad68 12:13, 13 November 2013 (UTC)

Merge sections 2,3,4 ( 2. Indications and contraindications, 3. Effects, 4. Adverse effects) into one called 'routine infant circumcision debate' or something similar.

I was thinking that there should be a section entitled something like 'the decision to circumcise' or 'routine infant circumcision' or 'non-therapeutic infant circumcision'. Something like that. Instead of the 3 sections mentioned above.

The reason I say this is because I am concerned about the Effects section. I am concerned that expecting parents may come here, look at the subsection headings : 3.1 Sexually transmitted diseases 3.2 Phimosis, balanitis and balanoposthitis 3.3 Urinary tract infections 3.4 Cancers , get scared unnecessarily and just think - oh we will get him circumcised to put our mind at ease. This is scaremongering and very irresponsible.

Original research is a clear breach of wikipedia principles. And original research can be presented in different ways. I would argue that the amount you weight a section (how big a section is in proportion to the article) is akin to original research. Because you the editor are deciding that this subsection is very important because you have assigned quite a lot of words to it.

I feel this is very irresponsible.

Another reason my proposal is a good idea is because you can highlight the fact - and it does need highlighting - that this 'debate' about whether to circumcise your newborn is almost absent in ALL western countries apart from the USA.

Another thing. The Effects section is littered with primary sources and it makes this article poor - untrustworthy and unreliable. So for instance, in the HIV section, we should not be citing Grey et al or Tobian.

This new section would draw upon the medical association reports. I propose we only use the reports of the medical associations. This is far better because it makes it far less likely that the article will be biased. If we agree that we should only use what was said in the medical association reports then it is likely we can reduce weighting bias.

Also another point to note. Having used a word counter tool, the effects and adverse effects section takes up 10,600 characters of 46,700 characters. Or 22% of the article - nearly a quarter. It goes into far too much detail - when a lot of it is irrelevant because on the whole it isn't medically beneficial according to most medical organisations. Because it isn't medically beneficial OVERALL - to give so much weight to promoting the health benefits is highly biased. What matters is if it is medically beneficial OVERALL when you are deciding. To use an analogy. Imagine an article on penectomy (removal of penis). That would prevent a lot of penile diseases and by listing them all in an article you could make it sound like a good idea. But the overall context would be lost.

This whole health effects thing is entirely confined to the routine infant circumcision debate in the USA. The amount of people who are adults and elect to have surgery for the health benefits is infinitesimal.

You might then ask if we were to get rid of these sections - what about HIV? That is important and deserves its own section.

I propose another section of the article. 'Circumcision as a HIV prevention tool in Africa'. In this section you can site the primary sources - the 3 randomised control trials. (There would also be a minor mention of HIV prevention in the other section - the routine infant circumcision debate - but it will be quite small in that section because it will be part of a wider discussion on whether the procedure as a whole is worth it.)

I feel 'Circumcision as a HIV prevention tool in Africa' is a very big and important topic, yet is hardly mentioned in this article. It deserves its own section so we can alert the reader to how it is going. All we say now is that the WHO recommends it. Not update on how it is going. We can also mention opposition to using circumcision as a HIV prevention tool.

Tell me what you think.

Tremello (talk) 18:51, 4 November 2013 (UTC)

Hi Tremello... The trouble with the suggested reorganization is that it doesn't take into account how the available reliable sourcing handles the subject, and consequently would introduce a problem per WP:MEDMOS. The available reliable sourcing overwhelmingly treats circumcision as a medical topic. In the Talk archives there are two independent analsyses of the available sourcing, using both Google Scholar and Publish or Perish, and both came to the conclusion that the sourcing is overwhelmingly medical, and therefore per Wikipedia standards WP:MEDMOS is the proper organization. As for the amount of medical vs. non-medical content, last I checked there was more non-medical content than medical. This is actually out of balance because, per the sources, the article now has too much non-medical content. This evolved out of compromise, but the sourcing does not support making it even further out of balance as you suggest. You are right that Tobian shouldn't be used--the content it's supporting is already supported by two proper sources so I'll take Tobian out. There's no need to use primary sources to support HIV content as there are plenty of secondary sources. Don't forget that this the main article in a WP:SUMMARY-style group of articles. Details about the pro- vs. anti- groups should be covered in detail in Circumcision controversies. Detail about circumcision and HIV should be covered in Circumcision and HIV. For both of those, this article should summarize the most important points. Zad68 20:01, 4 November 2013 (UTC)

Excellent suggestions Tremello, and cogently argued. I support your proposed changes for the reasons you outline and for reasons which i have outlined previously. There is a predictable circular fatal flaw in Zad's rebuttal of your suggestion. It is this ; Zad sets up medical sources as "the available reliable sourcing" and concludes then that as these medical sources deal with circumcision as a medical topic (predictably) that therefore medical sources should dominate. But medicine is only a very small part of the cultural phenomenon of circumcision. The editors who presently patrol the article will permit no mention of forced adult circumcisions, or the sale post-excision of the cut off foreskins for cosmetics manufacture for instance. Your arguments about the impression readers will get from the present subject divisions are the most compelling. As presently presented the article is organized like a gerrymandered constituency. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:08, 4 November 2013 (UTC)

Surely just an oversight, Tumadoireacht: the source databases I mentioned—Google Scholar and Publish or Perish—index scholarly research but are not at all limited to only medical sourcing. You must have been thinking of the PubMed database, which I do refer to quite a but, but I did not in my response above. Looking now, I actually see that you personally were involved in that previous thread that reviewed those source indexing databases. Zad68 02:59, 5 November 2013 (UTC)

Shouldn't indications and contra-indications come before technique, as per MEDMOS#Surgeries_and_procedures? --(Moshe) מֹשֶׁה‎ 03:17, 5 November 2013 (UTC)

Holy Moley you're right, I can't believe it has been ordered not in accordance with WP:MEDMOS for this long, and nobody caught it until now! Fixed, thanks!! Zad68 03:23, 5 November 2013 (UTC)

Adding: there needs to be more sections moved around, fixing... Zad68 03:26, 5 November 2013 (UTC) ... actually, no, it was just that one. There is not enough regarding recovery/rehab to break out into a new section separate from Technique. Zad68 03:30, 5 November 2013 (UTC)

Though WP:MEDMOS does not have to be strictly followed, and there are going to be times that it is best to not strictly follow it, it is generally preferable to follow it and therefore have uniformity across Wikipedia with regard to medical articles and anatomy articles. I agree that it is best to follow it in the case of the Circumcision article. Flyer22 (talk) 03:48, 5 November 2013 (UTC)

Just did a google scholar search : http://scholar.google.co.uk/scholar?hl=en&as_sdt=0,5&q=circumcision and it does seem it is primarily medical sources Zad. I also don't see how that bolsters your position - the fact that a lot of the info written about circumcision is medical and therefore the general public should be cajoled into thinking circumcision is overall medically beneficial. Which is what is occurring now by having a separate effects section detailing how circumcision prevents all these things.

The fact is that overall, most agree - apart from the AAP taskforce - that circumcision isn't worth it. For instance, with STI's including HIV, it has not been shown to reduce it in a Western setting. Also there have been many criticisms of the RCTs by medical professionals. Yes some of them are anti-circ activists but that doesn't mean their opinions should be dismissed. UTI's are not serious and easily treated. Cancer is very rare and the case for circumcising to prevent it is weak. Phimosis, balanitis and balanoposthitis - they are very rare, not that serious, and easily treated.

The circumcision controversies article and the circumcision and HIV article gets around 100 hits per day. So I am more concerned about the main circumcision article since it gets around 5000 hits a day. Since a lot of people may be getting the wrong impression. The general reader isn't that intelligent or knowledgeable about circumcision compared to us and may only skim the article - so headings and structure are important. It is important that we think about the impression the general reader will get. We don't want to scare exaggerate or mislead them. particularly if expecting parents are coming to this article to decide whether to circumcise their child.

So you can see that the way the article is presented now is akin to original research. In the sense that you are giving the impression to the general reader, via the arrangement and structure of the article, that it is better to be circumcised. If we followed my recommendation it would be more accurate to the reality. The reality is that most people don't think circumcision is worth it overall. Yes I think most people are willing to concede that it may reduce things slightly but overall the negatives outweigh the positives. In the same way removing a woman's breasts a birth would not be a good idea.

Also regarding a new section on circumcision to prevent HIV. Please note that the African researchers who conducted the RCT's were not originally pro-circ fanatics - they were AIDS and STI researchers that had done studies on other methods to combat HIV - they ended up trying circumcision as just another way to prevent AIDS. So their main motive and job ( I would hope) is to reduce HIV and other STI's in Africa - not promote circumcision. So I do think 'circumcision to combat HIV in Africa' deserves its own section. It is in this section that we can mention more about the 3 RCTS. We can also mention other STI studies done in Africa as a sidenote. As I say, circumcision to prevent disease is all about Africa. There is no HIV epidemic in the Western world. It is a very hard disease to catch. There is a 1 in 2000 chance of a man catching HIV if he has unprotected sex with an HIV infected woman (see: cdc HIV risk ).

Tremello (talk) 10:29, 5 November 2013 (UTC)

Tremello, on the organization proposal, I'm having trouble following your logic. You don't disagree that the sourcing for this topic is overwhelmingly medical, and you don't disagree that the article represents the sourcing accurately. If this is what the best-quality reliable sources say, then the article as it stands reflects the sources accurately... so, no Wikipedia policy-based argument is being raised here. The "original research" claim isn't supported by what's actually found in the sourcing, as it has been applied to Wikipedia content guidelines. If anything, your statement "overall the negatives outweigh the positives" appears to be original research that isn't based in the secondary sources, and it would be wrong to reorganize the article based on it.

I'm also not seeing the article content supporting your concerns, actually. The article accurately reflects current worldwide medical consensus that routine infant circumcision is not generally recommended and that no major medical organization recommends routine circumcision, not even the AAP, and not even for the prevention of UTIs (as the article states, "prevention of UTIs does not justify routine use of the procedure"). The article states 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 only medical benefits discussed are the reliable sources that cover the current medical consensus that circumcision may be medically indicated in children for pathological phimosis, refractory balanoposthitis and chronic, recurrent urinary tract infections. Also the World Health Organization promotes circumcision as a preventive measure for sexually active men in populations at high risk for HIV. We have strong and explicitly medical sources to support these statements.

There are some things I agree with you on: Regarding the opinions of activists-- I agree with you that we could expand coverage of the pro vs. anti a bit. In a previous discussion here on this Talk page I recommended that we have a paragraph covering "intactivism", so I am on board with that. We do have to keep in mind that, relative to the overall topic, "intactivism" is a very small piece, and our article's emphasis on it needs to be commensurate with that per WP:WEIGHT. If someone spends a lot of time seeking out and reading debate-related material on activism forums, it's easy to come away with the mistaken impression there's more emphasis on debate than there actually is, let's be careful not to make that mistake. The fact that the controversies article doesn't get that many hits actually supports that observation: it appears most readers coming to the article (by a 50:1 margin according to the numbers you provided) are finding what they're looking for and aren't so interested in the controversies topic. This is good evidence to support keeping the article organization the way it is now. And, I think your proposal of highlighting the coverage of circumcision and HIV into a higher-level section is good, and reflects the emphasis found in the sources accurately. Zad68 14:54, 5 November 2013 (UTC)

Perhaps the fact that the vast majority of humans are "intactivists" (to use that inadequate term) in relation to cutting off foreskins should have greater prominence in the article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 23:27, 5 November 2013 (UTC)

Tremello, Tumadoireachet, Every suggestion for change here must be based on how the preponderance secondary sources treat the topic, including the prominence given various elements of the topic. I have yet to see a suggestion here based on even one reliable secondary source; therefore, none of the suggestions made here are actionable in any way. Jayjg ^(talk) 23:58, 5 November 2013 (UTC)

Jayjig you are again quite incorrect in that assertion and off topic too. You are ducking the points raised -whether deliberately or inadvertently I cannot say.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 01:00, 6 November 2013 (UTC)

Sorry, I didn't mean to be "incorrect"; which reliable secondary sources did you cite in your comments in this section? Jayjg ^(talk) 01:09, 6 November 2013 (UTC)

But you did intend to be sarcastic ? The exhaustive inaccurate reiteration of part of the content policy about secondary sources by yourself and a small coterie of other editors is becoming both an increasingly obvious avoidance of relevant criticism of this currently artificially stalled article, and irksome too. The suggestions by Tremello are,of course "actionable", if by "actionable" you mean capable of being acted upon to improve the article (rather than giving sufficient reason to take legal action). Did you not notice that editors have been discussing the merits of implementing them, and have already made changes based on them, while you focussed so steadfastly on repeating a section of a policy on secondary sources ? When discussing article structure, the "secondary source" consideration is a secondary consideration.

If circumcisions are being forced on adults in several parts of the world, if foreskins are being sold, if children are being killed or maimed by circumcisers having oral-genital contact with them during circumcisions and we blithely blurt "oh the important medical sources do not mention these things" and repeatedly block all mention of them in the most consulted article on Circumcision, then we are failing in our undertaking as editors of Wikipedia. You may find re-reading these pages helpful:

• WP:NEWSORG
• WP:IDENTIFYUNCIVIL
• WP:IUC
• WP:5
• WP:5P
• WP:FIVE
• WP:FIVEPILLARS

--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 23:35, 6 November 2013 (UTC)

• Oppose This article follows WP:MEDMOS. We do this for consistency across topic areas. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:06, 13 November 2013 (UTC)
• Oppose per Doc James' reasons, as well as my own. While I am against routine infant circumcision, one's feelings on a given subject should not influence its article. If – and it's a big "if" – expectant parents come here, see the subsections under the "Effects" section and "get scared unnecessarily and just think - oh we will get him circumcised to put our mind at ease" as Tremello suggests, then these parents are being irresponsible for having such a knee-jerk reaction after only glancing at a few subheadings. It is the job of Wikipedia editors to accurately inform, a job which I think the editors here have done an exceptional job of doing considering the highly controversial nature of this topic. Editors can't be worried about what irresponsible people will do with parts of their information. Indeed, if that were the case, many articles on Wikipedia wouldn't exist! It isn't "scaremongering"; nobody is saying "your son will definitely get all of these bad things if you don't circumcise him." If that's what irresponsible readers choose to take away from the article, then there's nothing the editors can do to stop that. --Schaea (talk) 09:48, 15 November 2013 (UTC)
• Comment I also personally oppose routine neonatal circumcision and do not recommend the procedure. I have referred less than half a dozen kids for the procedure over 10 year of practice and all of them were for significant medical issues. Our personal positions are however not important for Wikipedia. Wikipedia currently does reflect my opposition "No major medical organization recommends non-therapeutic neonatal circumcision" as the sources support this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:02, 15 November 2013 (UTC)

Psychological trauma

Second paragraph states:

The positions of the world's major medical organizations range from considering neonatal circumcision as having a modest health benefit that outweighs small risks to viewing it as having no benefit and significant risks.

Is psychological trauma more than a significant risk?

— Preceding unsigned comment added by DavidHGrateful (talk • contribs) 10:24, 14 November 2013 (UTC)

Article already carries psychosocial risks with appropriate weight, sourced to a recent systematic review. Zad68 14:42, 15 November 2013 (UTC)

Adverse effects section update

This section clearly lacks a neutral point of view. The following must be addressed:

1)Immediate adverse effects

2)Post-operative adverse effects

3)Long-term emotional adverse effects

References

— Preceding unsigned comment added by DavidHGrateful (talk • contribs) 10:09, 14 November 2013 (UTC)

Hi David, as I explained on your User Talk, self-published statements by small advocacy groups are not considered reliable sources on Wikipedia for general statements about effects on human health. Information about effects on human health needs to be supported by reliable sourcing that complies with the WP:MEDRS guideline. The article currently does summarize adverse effects as found in up-to-date reliable sourcing that complies with the appropriate guidelines. You should read WP:NPOV for information on what Wikipedia considers "a neutral point of view"--it is based purely in what reliable sourcing says. Zad68 14:42, 15 November 2013 (UTC)

Why can't you find more sources about the negative consequences of circumcision? Why do you only look for positive sources? If you want this article to become more neutral (like you should be doing), then you should look for sources yourself.84.210.15.173 (talk) 15:48, 15 November 2013 (UTC)

The WP:BURDEN is on DavidHGrateful, not on Zad68. Flyer22 (talk) 03:25, 17 November 2013 (UTC)

And he doesn't "only look for positive sources"; he follows WP:Due weight with regard to the WP:MEDRS guideline, as he's stated many times now. Flyer22 (talk) 03:29, 17 November 2013 (UTC)

DavidHGrateful is proposing considering adverse effects in three separate time periods following cutting off the foreskin. Perhaps such an organisational shift in structure makes sense. Perhaps that is what this section should confine itself to debating.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:35, 19 November 2013 (UTC)

Addressing a percieved bias

As has been stated before, the opening paragraphs seem unduly weighted toward the discussion of a small number of rare conditions in which circumcision is beneficial. There is only a cursory mention of equivalent complications and no discussion of growing the prevelance of amateur surgery. Given that a senior urologist in at least one country has publicly stated that the increasing prevalence of procedures carried out by unqualified persons and/or in unsanitary conditions (presumeably for religious reasons) is killing infants, could this link be of any benefit to rebalancing the article somewhat? [27]. It should also be noted that the review that has been used for stating the frequency of complications and the low rate of infection is from pediatric sources only. On top of this, they state at the beginning of the review that there is a lack of data worldwide. This caveat has not been included in this article. 109.149.171.230 (talk) 19:42, 17 November 2013 (UTC)

If you've reviewed the archives to see that this has been raised before, surely you've also read the responses provided before: on Wikipedia we weight what's found in the articles in line with the weight found in the reliable sourcing. What the article covers is very well supported by how the sources cover it. I can't see how a popular-press article about one case report would be useful here, see WP:MEDASSESS. For the review, are you talking about Weiss? Zad68 05:16, 18 November 2013 (UTC)

Because, as now, the answers do not appear to fully address the points raised. I am not talking about "one popular news report" (although this seems perfectly adequate for other articles), but I am talking about the Secretary of the British Association of Paediatric Urologists stating that unqualified or unsatisfactory circumcision procedures are responsible for the deaths of infants in recent years. I fail to see how a (often criticized) study on HIV warrants detailed inclusion in the opening paragraphs, but the risk of complications such as increased infant mortality from amateur surgery barely gets a mention. By concentrating on certain positive paediatric reports, and completely ignoring either negative reports or rebuttals, this gives the impression that the circumcision is primarily a routine medical procedure carried out by professionals for the benefit of a patient's health. This may be the case in the US, but worldwide it is not. I have no great dipsute with most of the content in this article. My discomfort is due in part to it's layout, but mostly for it's omissions 109.149.171.230 (talk) 12:39, 18 November 2013 (UTC)

Here's that passage from the BBC website:

Consultant surgeon Feilim Murphy, secretary of the British Association of Paediatric Urologists, said: "The biggest issue is there are a number of children who are circumcised by people who are not experienced and don't understand what is required, and there can be significant complications with that."

He said this could include bleeding, which is particularly dangerous for babies, pain, damage to the penis and loss of the top of the penis.

He added: "Unfortunately children have died in the last number of years in Britain and Ireland from circumcision-related complications.

"It does make sense that everybody should register, that everybody should be on the same playing field.

"It makes sense for the child it makes sense for the family it makes sense for everyone."

How would you summarize this news report for this article? Perhaps like this:

In the UK, the secretary of the British Association of Paediatric Urologists called on circumcision providers to register, stating that a number of children had died in Britain and Ireland from circumcision-related complications in recent years. [REFERENCE: the BBC webpage.]

Problem with that is that we don't know where he got that information, about the fatal outcomes, from. It might be just hearsay.82.113.106.30 (talk) 03:07, 19 November 2013 (UTC)

The article already cites a mortality rate (at least for the US) and also states "Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age" and that's sourced to a strong worldwide systematic review. So what Murphy is stating as an individual in a popular press article is already covered, and with stronger sourcing. The amount of "mention" is proportionate for a very rare catastrophic complication. I have new content to add about procedures performed in non-medical settings, and the related complications, and that should go in soon. Zad68 05:10, 19 November 2013 (UTC)

I am delighted to read that you are going to attempt to address these areas Zad. They are certainly undercovered at present. I feel that there is an army of us contributing opinions here and a much smaller division of folk such as yourself with the means,time and dedication to actually source and add content. Perhaps you might put the proposed content up here on the talk page first as editor 82.113 has just done with his proposed content addition directly above, so that all interested editors may consider it. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:49, 19 November 2013 (UTC)

Tuma, I have not proposed a content addition. The sentence I gave was merely in the way of asking 109 for clarification: is this what he or she has in mind? If so, however, I consider it problematical and I stated why.89.204.153.68 (talk) 07:46, 20 November 2013 (UTC)

I must have misunderstood this sentence of yours Zad about adding content :

" I have new content to add about procedures performed in non-medical settings, and the related complications, and that should go in soon."--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:02, 20 November 2013 (UTC)

I agree. I have had a small amount of time this evening to do a little research. This 2010 review [28] could perhaps help in bridging the void. It states that there is a "lack of consensus" and "robust evidence" within the medical literature for things such as penile cancer, STI and UTI, while maintaining there is evidence for HIV prevention (at least in the African trials). If I had the time I would be tempted to run a statistical analysis on the medical reviews themselves! I suspect there would be a clear correlation betweeen the conclusions reached and the country from which they originated. Which brings us (in my opinion) to the crux of the matter. Rightly or wrongly, this is primarily a ritualistic or cosmetic procedure, regardless of what evidence or opinion the medical community has, or will provide. Therefore, to treat this as almost an entirely statistically based article, while only giving a cursory nod to the ethical debate, just feels wrong to me. I am certainly not advocating any bias either for or against. I would be happy to see quotes from Rabbis, Imams, surgeons and scholars. I also believe that any medical consensus (if proven) should remain the basis of the article. Perhaps a sub-heading of "controversy" may be worthwhile? 109.149.171.220 (talk) 02:12, 20 November 2013 (UTC)

Thanks to both of you for the kind words. The source you linked to, Perera et al. 2010, is a systematic review and in fact it's already used in this article, it's currently reference #26. The article already states that the evidence and the cost-benefit analysis for the procedure's effects on things like UTIs and penile cancer doesn't justify routine use. Perera isn't the only one that states this. The sourcing is overwhelmingly medical, IP, and it appears you acknowledge this fact and don't dispute it. Per Wikipedia policy we go by the emphasis found in the sources; although it seems it's not your personal preference (it "just feels wrong" to you), what the article presents is the result of Wikipedia content policy applied to what is found in the reliable sourcing. For the religious subtopics, there are indeed entire articles devoted to them, see for example Khitan (circumcision) and Brit milah. See WP:SUMMARY for this article development approach, it's pretty common on Wikipedia. Zad68 03:51, 20 November 2013 (UTC)

the relegation of one editor by another just above of a comment to hidden off topic status

Apart from a mildly misguided personalization at the end of one point about a penis with bits cut off the end of it (frenulum,foreskin et cetera) being unappealing to a sexual partner for pleasure mechanical reasons or aesthetic ones the hidden piece did address content issues. did it really merit hiding without any discussion?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 01:24, 13 November 2013 (UTC)

Personal problems don't belong on a WP Talk page, surely you agree. Then what's left of that comment is "soapboxing", also clearly prohibited by WP guidelines. Far too much of this was allowed in the past, I'm glad that WP rules are starting to be enforced on this page.--89.204.135.201 (talk) 06:55, 13 November 2013 (UTC)

that entry now hidden, is outlining an analogy between the idea of infant girl breast node removal as a disease preventative, and the idea of infant foreskin removal for the same reason, as an illustration of the current poor state of this article and in an attempt to address a perceived content fault.This is not soapboxing.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:22, 13 November 2013 (UTC)

It is sad how this wikipedia article seems to have been hijacked by circumcision supporters. I am generally against deforming babies, unless it is absolutely necessary for medical reasons. If people want their foreskin removed they can do it to themselves when they are adults. This is why I think the ethical debate should come before the medical propaganda. Do we have the right to deform our children? Why can't we let them decide for themselves when they are old enough to make such decisions.84.210.15.173 (talk) 18:50, 13 November 2013 (UTC)

If you feel so strongly that circumcision should be outlawed, then get off your duff and work to get your elected representatives to do your bidding. However, you are in the wrong place here. Study the WP talkpage guidelines to see what's allowed and what isn't.--89.204.130.54 (talk) 05:27, 14 November 2013 (UTC)

I think the wikipedia guidelines advocates for a neutral point of view. Right now this article looks more like circumcision propaganda.84.210.15.173 (talk) 06:12, 14 November 2013 (UTC)

It looks like propaganda to you because the article does not conform to your wishes, which presumably are to state outright that circumcision is barbaric, a human rights violation and a terrible crime, and harmful to people. I know that German wikipedia's article on the topic does in effect promote that point of view. Perhaps your home country's Wikipedia does, too. However, here the majority of editors have decided not to inject their personal opinions. Instead of quoting heavily from "intactivist" websites, showing gruesome color photographs of circumcisions gone wrong, and cherry-picking primary studies that show negative effects of circumcision, they are applying rigorously neutral sourcing standards. This time, the result is not in alignment with your personal preferences. However, think about it this way. On a different article, a group of editors could get together and enforce their point of view while not fairly representing the preponderance of relevant and reliable sources. Perhaps that article is on a topic you know well in a professional capacity. Wouldn't you be annoyed that the majority of editors are going against the grain of the literature then? That's why Wikipedia has a whole bunch of guidelines, to prevent such an occurrence.82.113.121.28 (talk) 09:37, 14 November 2013 (UTC)

If this article did indeed have a neutral point of view, we would expect just as many complaints from people believing that circumcision is a good thing as complains from people believing that circumcision is a bad thing. The people believing that circumcision is a good thing would complain that it is too negative, while the people believing that circumcision is a bad thing would complain that it is too positive. Here however we see almost only people complaining that the article is too positive to circumcision, while we see almost no one complaining that this article is too negative to circumcision. I also think it is a bit stupid to always have a neutral point of view. Then we should let nazis and fascists be heard as much as human rights activists. Personally I think the voice of human rights activists should be louder on wikipedia, and do we really have any right to deform our babies unless it is absolutely necessary for medical reasons?84.210.15.173 (talk) 16:08, 14 November 2013 (UTC)

You are right that pro-circumcision advocates are not complaining here in equal numbers. Why are they not here to complain that their view that circumcision is such a good thing that it should be mandatory right after birth is not given the weight it deserves? This is speculation on my part, but it could be that these people skew towards the highly educated and they know better than to engage in a futile battle. Another reason might be the legal status quo worldwide that circumcision is legal. People opposed to the status quo will naturally take their fight to every venue, including Wikipedia (even though it's against the rules to fight your policy battles here). Those who are content with the status quo, on the other hand, tend to be more complacent. But don't let the apparent frequency of complaints fool you. Whenever there is a so-called Request for Comment (a notice to the Wikipedia community at large to weigh in and help decide a controversy over a particular article), the majority invariably come down in favor of keeping this article's structure and orientation etc. largely unchanged -- because they are satisfied with its neutrality -- and the WP editor who starts the RfC hoping for backup loses.

One more comment on "let nazis and fascists be heard as much as human rights activists". I think this betrays a misunderstanding of the purpose of an encyclopedia. It's not a common room where anyone can post their views or step on a soapbox to spread their views. There are articles about nazism, about fascism, about various human-rights initiatives. In every case, the noteworthy activities of nazis, fascists, and human-rights activists are reported, or at least that's how it should be. Academic literature is preferred for reliable sources and currently few academics happen to be nazis or fascists, hence the fascist or nazi worldview is not reflected much in Wikipedia articles. If ever there comes a day when fascists take control of academic institutions and write the textbooks, Wikipedia will have to reflect that reality... or shut down. "Intactivists" are well aware that the reliable sources are not on their side, hence they work hard to demonize physicians and medical associations who do not share their view as financially motivated or ethnically/religiously biased. This may be effective in Europe where there is a cultural bias against circumcision and any argument against it, no matter how poorly founded, is welcome. It works less well in the U.S., and as most editors of English-language Wikipedia are Americans, those efforts at "winning" by using ad hominems will always be doomed to failure.82.113.121.28 (talk) 20:32, 14 November 2013 (UTC)

So I am biased against circumcision because I don't think we have a right to physically deform our babies? I think you are biased against human rights, as you don't see it as a human right to be allowed to grow up without being physically deformed. I am not biased against circumcision, because I think everybody should have the right to circumcise themselves as long as they make the decision themselves. What I am against is people forcing other people to become physically deformed. It should be an individual choice whether you want to become physically deformed or not. Please tell me why you feel like you (and other people) have the right to physically deform your babies. You certainly don't know if they are going to like the decision you made for them when they grow older. And if you think us Europeans are behind the Americans in this aspect, then I think you are badly mistaken. I am pretty sure that more babies are circumcised in the united states because people are more religious in the united states, and as a consequence ill-founded ideas like creationism and circumcision of babies flourish in the united states. Look upon the other countries in the world where religious superstition and circumcision flourish. Not exactly the most advanced countries, right?84.210.15.173 (talk) 21:05, 14 November 2013 (UTC)

Please tell me why you feel like you (and other people) have the right to physically deform your babies. This is called "putting words into people's mouths", and as a debating tactic is generally looked on very poorly. In addition to being extremely rude, it marks you out as a strident advocate for a cause. In any case, and I have mentioned this before, debating the topic of the article is not allowed on the talk page.89.204.135.125 (talk) 02:15, 15 November 2013 (UTC)

I've been observing the heated debates going on this talk page. Here is what I think is a major underlying issue (correct me if I am wrong): there is a massive information gap. Let me explain:

• Looking over the article, one gets the impression that circumcision, whatever the intent and method, is a medical procedure. Fine.

• "Neonatal circumcision is often elected for non-medical reasons". Fine.

• "About one-third of males worldwide are circumcised." Fine.

When reading this article as a purely neutral observer with no interest in the matter, one would be struck by how many benefits and few complications there are to this procedure. Circumcision prevents such-and-such disease, this disease, that disease, it's basically not risky at all, there are no minimal side effects, it makes no difference for sex. Why then, is it most "often elected for non-medical reasons"? Why is the US the only Western country doing it? Why would most of the world remain uncircumcised? Why don't developed countries with good healthcare like Japan and European nations do it? Discussing this in detail would obviously go off-topic in the article and would possibly detract from it, but this definitely leaves the reader wondering. This article basically comes across as: "Circumcision is a great idea medically" and "Most of the world doesn't do it for medical reasons". Does this not appear odd to anyone? (I don't know how to correct this problem, but I'm just observing it and verbalizing it.)

Another issue. I know other stuff exists, but look at, for example, rhinoplasty. This medical article is very detailed, yet glosses over "effects" - I'm sure it could go into great detail about the enhanced feelings of self-worth, boosted confidence, etc, etc, that having a new nose provides. Yet it doesn't. Clitoridectomy (which, noted, is a small article) states that "it is rarely needed as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris." Our circumcision article is not so blatant about the rare medical need of circumcision, although this is a rare need as well. Also, rhinoplasty's lead photo is a color one of the actual procedure, which is indeed graphic. Again, Wikipedia is not censored. If medical content is not "up to snuff" because it is 5 years+ old, why should a picture that is over 100 years old be the lead photo? An actual photo of circumcision ought to be included. A photo I suggested was previously dismissed because it was "graphic" (my use of the term in a previous post), but this is a graphic procedure, is it not? Thanks. --(Moshe) מֹשֶׁה‎ 05:08, 15 November 2013 (UTC)

Moshe, I think your comments about the prevalence and distribution information are sensible. The article does discuss those topics in history and in how positions of medical organizations interact with (both influence and follow) the cultural norms of the communities they serve. If you'd like the article to carry more, the answer is the same as always: Bring high-quality reliable sources that cover these topics and summarize them in the article. For effects, once again, what we do is summarize the best-quality reliable sources, taking care per WP:DUEWEIGHT to reflect the emphasis found in those sources. I haven't surveyed the sources for Rhinoplasty like I have for this article, but that article does seem to be lacking in coverage of the social aspects. I hope some day someone expands that article... it may not come up to the same proportion of coverage of society and culture as this article, which devotes over half its content to non-medical topics, but Rhinoplasty should have more than it does now. The current lead image reflects the cultural and historical aspects, as opposed to medical, that so many editors want to see this article emphasize, and it's a WP:FI as well... this has been discussed to death, frankly... don't you find it self-contradictory when those who say the the article should focus a lot more on cultural stuff also then want an explicit, graphic medical lead image? I sure do, anyway. Zad68 14:22, 15 November 2013 (UTC)

I also wonder why we have forskin if circumcision is such a great medical idea, like it is portrayed as in this article. You are familiar with basic evolutionary theory, right? If less forskin is a great medical idea, then we expect a higher survival rate for individuals born with less foreskin. Some mutations will cause less foreskin, and some individuals will be borned with those mutations. During thousands of years humans would have lost all forskin due to "survival of the fittest". Obviously we haven't lost our foreskin, so it is highly improbable that circumcision is a great medical idea. And for all the religious people that don't believe in evolution, do they think they can improve on God's creation by cutting off the foreskin? Why don't these religious people believe that God put the foreskin there for a reason? There are lots of things I wonder about when I read this article.84.210.15.173 (talk) 16:23, 15 November 2013 (UTC)

Traits that are passed on are not always necessarily beneficial; additionally, many of the deemed medical benefits of circumcision (prevention of penile cancers, HIV, minor UTIs) were not viable threats for much of human evolution. Lamarckian evolution was disproved long ago, so repeated circumcision won't affect foreskin at birth either. As for the religious question, there are many apologetic answers to that (I know most of the arguments...take them as you will). I've tried to briefly answer your questions so as not to discourage you, but either way, please remember that Wikipedia is not a forum, so speculative conclusions will not go very far on the talk page.

Well, sexually transmissible diseases have existed for a very very long time. Of course the amount of such diseases increased drastically with the fist civilizations about 10 000 years ago. But just since then humans have developed the ability to digest lactose. So even if sexually transmissible diseases became a problem only after the first civilizations, we might still have developed less foreskin from then until today. It is also quite unlikely that sexually transmissible diseases didn't have a negative impact on human surivial rates also before the first civilizations. If less foreskin is indeed a wonder medicine against all forms of sexually transmissible diseases, well then it should have generated a significantly higher survival rate for individuals born with less foreskin, and then we should have seen a tendency for less and less foreskin throughout the evolutionary history of mankind. The reality is probably the opposite. The genes involved in foreskin generation are probably well conserved throught the evolutionary history of mankind, which points to functionallity. Genes that are conserved have functionality. Looking upon conserved DNA is actually a modern way of finding out which parts of the genome have functionallity.84.210.15.173 (talk) 23:14, 15 November 2013 (UTC)

IP, I do understand where you're coming from here- but please realize that many terms we use in everyday life ("neutral", "reliable source") mean vastly different things on Wikipedia...just as uneducated people misuse the word "theory" to dismiss the validity of evolution by descent, ignorant of the fact that "theory" means something very different in the scientific world. I personally think Zad put it very well to me:

It isn't because those articles are biased, but rather they reflect what's found in reliable secondary sources. (Maybe another way to say this is the articles will reflect the same biases found in the reliable sources.) Same thing with the article names circumcision and female genital mutilation--the articles are named that way because that's how the reliable sources treat them.

Essentially, the problems with neutrality we see with this page are not a reflection of possible bias in Wikipedia, but rather possible bias in the medical community. If there exists a culture of circumcision, conclusions of medical reports may be reluctant to dismiss the practice; a place like Europe, which doesn't circumcise, doesn't even bother to publish so many studies, refutation articles, etc, simply because they already have an opinion on it and, as such, don't do it. This, if true, will obviously make an issue, but there is not much Wikipedia can do. Verifiability > Truth on Wikipedia; if you know something is true, but can't verify it, it does not belong on Wikipedia. Similarly, if something is verifiable but you know it is not true, it will likely still be on Wikipedia. This is an extremely important foundation of the website, and actually one of the things used to make sure articles on religion stay neutral and accurate. (Could you imagine what pages on various religions would look like if we didn't have this standard?)

Wikipedia is a summary of the world, not an interpreter of it. The "world" in this case is the medical world, and the medical world in this case is dismissing circumcision's adverse effects as minor, or at least appears to be. You or I may not agree with it, but it is the case for now. If the world changes (or we find some existing reliable sources of good quality that say otherwise), I am confident that Wikipedia will reflect that. --(Moshe) מֹשֶׁה‎ 20:36, 15 November 2013 (UTC)

Like Well stated! Zad68 21:01, 15 November 2013 (UTC)

I think wikipedia generates the mindset of future generations. These days kids go on wikipedia to find their facts, and they often find facts on wikipedia that completely contradicts the modern consensus in society. You might say that wikipedia is a reflection of the academic world, rather than of the society as a whole. In any case I think it is very wrong to have wikipedia articles that seem to encourage violations of human rights, and I think it is a human right to grow up in an unmutilated body. The ethical dilemma of wheter we have any right to mutlilate babies isn't given enough weight in this article. I wish it was given more weight early in the article.84.210.15.173 (talk) 23:34, 15 November 2013 (UTC)

Zad, I agree that there is a definitely some self-contradiction and misinformation with some of the proposed edits (including things which I personally believe, but recognize have no place here). However, as it stands, and in spite of opinions and suggestions of others, the article is primarily medical, and should have a lead medical image as such. If anything though, the bris photo File:Covenant of Abraham.JPG might technically be more encyclopedic, since it is (a) color, (b) far more recent, and (c) displays some modern tools that are used in circumcision. It's a little low-res, but the present photo doesn't reflect these. I was unaware that the present image is FI, so maybe that gives it "priority" status, but again, something fulfilling those three would probably be more ideal. While it doesn't have to necessarily be a lead photo, I definitely think a photo of the actual procedure should be included somewhere in the article. --(Moshe) מֹשֶׁה‎ 17:23, 15 November 2013 (UTC)

If you'd actually look through the article you'll see more space is given to non-medical aspects than medical... Regarding File:Covenant of Abraham.JPG, that image is actually already used in the article, in the Judaism subsection. I don't think it's an improvement to make it the lead image or feature it more in the article because according the WHO's numbers, circumcisions performed for Jewish religious reasons make up far less than 1%, I think even less than 0.3%. If there's any religion's rite this article needs to feature it's Islam's, as the current lead image does. Zad68 21:01, 15 November 2013 (UTC)

Agree on the Islamic circumcision (khitan) being more relevant than Jewish circumcision (bris). However, it just bothers me that the lead photo is 140+ years old...imagine if appendectomy's lead photo was the 1919 one, instead of the more modern, color one. It doesn't seem as if there are any good, modern, color, fair-use images available in this case, other than of the actual procedure, which is why I suggested it.

Regardless of whether it's lead or not, do you think an actual photo of the procedure should be included in the article? --(Moshe) מֹשֶׁה‎ 16:54, 16 November 2013 (UTC)

Appendectomy hardly seems like a good comparison--surely you understand that an appendectomy doesn't have the same level of cultural and historical connections. Images that support an encyclopedia article should explain and clarify, without distracting. We have to remember that our target reader isn't a medical student or specialist, rather a layperson. Often for medical topics, and things relating to human genitalia (especially those of infants), we will be much more successful in our job of relaying encyclopedic information to that audience by using illustrations. It's possible there's a photo that is encyclopedic and instructive beyond what the current images provide already, and which educates without distracting, but I haven't run across it yet. We've been asking the WHO for permission to use some of their images, as some of them could fit the bill, but we haven't gotten it yet. Zad68 05:16, 18 November 2013 (UTC)

Moshe wrote: if you know something is true, but can't verify it, it does not belong on Wikipedia. Similarly, if something is verifiable but you know it is not true, it will likely still be on Wikipedia. This is no longer on the article topic but a meta discussion on Wikipedia. None of the famed encyclopedias of the past, from Diderot's enlightenment-era encyclopedia to the sadly near-defunct Encyclopaedia Britannica, worked that way. If you have experts in a field writing articles, an editor's role is merely to support them with a light touch. If an expert -- a world-leading authority -- knows that something is not true, she or he will also know why it is not true. Then the choice is to leave the false information out; put in the correct information instead (for example, by correcting a math error or an obvious falsehood evident to anyone armed with little more than their faculties of hearing or seeing); or juxtapose a reporting of the false information found in the textbook or other "reliable source" with the contradicting evidence. Wikipedia disallows the first two because "anyone can edit", hence the insistence on robotically following prescribed procedure. That leaves only the third option for dealing with untrue information from reliable sources, and it is difficult to do; even experienced journalists struggle with this at times.

In the context of this article, however, the foregoing does not matter. The medical editing guidelines sensibly state that primary studies must not be used to refute the evidence of secondary studies. That's because the primary studies have already been factored into the secondary studies and you can't use them twice. And furthermore, most of the critics of this article make a moral, normative argument, not an argument based on truth. They say, I fervently believe that circumcision is morally wrong and the article should reflect my belief: it must condemn circumcision. But that argument is about moral values, not truth, and it doesn't belong here.82.113.121.224 (talk) 06:51, 16 November 2013 (UTC)

So you don't think wikipedia should care about morality at all? You think the wikipedia articles about murder, rape, pedophilia, mutilation of babies and so on only should talk about the process and leave out everything about morality? And to get a neutral point of view, you should give equally much space to the pleasure derived by the rapists as to the suffering derived by the victims?84.210.15.173 (talk) 16:21, 16 November 2013 (UTC)

84, you are on a crusade. I understamd that. But you must also understand that your increasingly repetitive comments are becoming tiresome and make one reluctant to carry on the conversation. 1) Morals and morality are material fit for inclusion in both an encyclopedia and in an "encyclopedia" like Wikipedia. 2) All relevant material about these topics (murder, etc.) that comes from reliable sources should be included. This includes statutory penalties, prosecution and punishment, which should give the reader a clue how society views these crimes. 3) No.82.113.121.114 (talk) 05:52, 18 November 2013 (UTC)

Having a 140 year old photo of some nice old blokes in Turbans sitting around as the lead photo for an article described by editor-admin Zad himself as being primarily about the present day clinical procedure of cutting of a foreskin is beyond a joke. It leads quickly to one questioning what other purpose having such an oblique photo might serve. That the photo itself has gotten some sort of barnstar is an utter red herring in this discussion. Stick that photo in the history of circumcision article and stick a decent photo of the procedure in ththis one.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:53, 21 November 2013 (UTC)