Talk:Circumcision

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POV added

1. The main article is too long, but potential medical benefits are listed and detailed as though they are particularly relevant to the decision to circ. They are not, but they are detailed again in the medical aspects main article. They are listed again in the CPS statement.

The following sections should be summarized in the main (circ) topic, and then detailed in the "main article" (Medical analysis of circumcision) should be combined with the main (medical aspects) article ... 4.2 HIV 4.2.1 Studies 4.2.2 Methodology 4.3 HPV 4.4 hygiene 4.5 Infectious and chronic conditions 4.6 Penile cancer 4.7 Phimosis and paraphimosis 4.8 Urinary tract infections.

2. The medical association opinions have been edited to reflect their full (unbiased) statements, hopefuly not ... but watch it be reverted. I hope the current verson makes quote accurate, and removes biased edits of the actual text.TipPt 15:48, 24 August 2006 (UTC)

3. The sexual effects section is a joke. For example, the frenulum is a primary erogenous zone, but it is generally reduced and may be removed during neonatal circs. It is a primary orgasm/ejaculation trigger [1][2]. The foreskin is very rich in estrogen receptors...

...and look at the lousy english..."There are few studies on sexual partner preference for penises with or without foreskins, and the results are inconclusive. They are discussed more fully in the full article."

What's the point saying any of that?TipPt 15:48, 24 August 2006 (UTC)

4. Someone keeps forcing an incorrect quote in the third paragraph. The BMA statement reads "do not recommend routine circumcision of male newborns," not the forced "do not recommend routine non-therapeutic circumcision."TipPt 15:21, 22 August 2006 (UTC)

Regarding the article length, there was a consensus a few talk archives back to develop this page fully, and THEN spin-off sections like medical to the proper articles, as it was too daunting to try and fix them all. So now, this article looks humongous, but it will overwrite much of its daughter articles, and be reduced, once it has been properly vetted. -- Avi 15:19, 22 August 2006 (UTC)

Hopefully, thank you. In the meantime though the same information is added again (again) in the CPS statement.TipPt 15:48, 24 August 2006 (UTC)

Recently concluded HIV/AIDS conference in Toronto

Possibly some of the literature coming out of this conference needs to be addressed. I should think that it's all quotable for Wikipedia purposes. Stephen Lewis of the UN has suggested that getting as many African men circumcised as possible and as soon as possible is a vital first step in the fight against HIV/AIDS. I wonder if there is any literature coming out of that conference to the contrary.Masalai 07:18, 24 August 2006 (UTC)

We shouldn't edit quotes to become biased.

Please compare these two sections. One is forced by Nand and Jakew, but contains edited (to be biased) quoted text. My version is unedited, and is therefore not biased.

[3]

Jakew calls it NPOV ... but mine is ALL from the text, unedited!TipPt 16:58, 24 August 2006 (UTC)

Looking again, I did add my own text to the CPS introduction (only). The statement accurately reflects their current position.TipPt 17:03, 24 August 2006 (UTC)

Editor blanket revert again.

There are several individual edits that Jakew reverts without cause. [4]

He should address each issue individually.

I decided it would be wasteful to try to include the deleted medical aspects (potential benefits listed in the main topic). Better for later when someone rewrites that sub-section. I don't find any of it very relevant (to the decision to circ, or cost/benefit).TipPt 21:06, 25 August 2006 (UTC)

And possibly take a look at this revert by Jakew... [5]TipPt 21:14, 25 August 2006 (UTC)

I'd say, take smaller steps. When a large edit has multiple changes, only some of which are agreeable, and gets reverted, it's foolish to continue to push the version which has a mixed reception. The wisest thing to do is to break it into small edits, each making only one small change; the ones which are disagreeable can then be debated, and the others can, meanwhile, be implemented during the discussion over the others. This allows the real bones of contention to be pinpointed, it allows for more breathing room in the edit summaries, and it allows the uncontroversial aspects of the massive edit to be accepted and go into effect during the debate over the controversial aspects.

Specifically, in this case, I'd say the removal of "than in other Western nation" and the rearrangement of the various religion sections seems to be completely separate from the other issues involving medical and ethical issues. Why not separate these?

My 2 cents would be: "than in other Western nations" is definitely required, or else "more prevalent" must be altered to "most prevalent"; the use of "more" implies that there will follow an explanation of what the subject is more than. "Most", by comparison, is an absolute; something which is "most" is more than everything in the related field. Which is it? Also, I feel the religions should be ordered, at the very least, with Judaism foremost, as it has (by giving birth to Christianity and then Islam) played probably the largest role of any religion in spreading the practise across the world. Kasreyn 08:58, 27 August 2006 (UTC)

Mammalian Foreskins

Is there something we can add to this article on the foreskins of non-human mammals? Is there a literature on the subject? Would be interestiing to know if all these medical "advantages" of circumcision in humans are observed in other mammals or not. How is it that mammals can be perfectly healthy and uncircumcised? Is there something different about the human penis from a medical viewpoint? Are there any recorded instances of zoo animals needing a circumcision for medical reasons? bunix 11:16, 27 August 2006 (UTC)

Good question, Bunzil. Anybody? --Nigelj 18:28, 27 August 2006 (UTC)

I recall reading a report about the circumcision of bulls. I do not however, remember where I read it or what it concluded. As for the difference between a human penis and that of a non human, the prepuce of a human may or may not retract during an erection or intercourse, hence the name foreskin; the prepuce of an animal must retract during erections and during intercourse. Basically the only time a penis might require circumcision is because there is scarring to the preputial sphincter, causing permanent phimosis. More conservative treatments exist for all other indications. I would say that the important difference here is that humans *like* cutting off parts(or all) of each others genitals. Christopher 04:32, 29 August 2006 (UTC)

So, we're trying two minor at a time....

[6]

and

[7] ... just making the language better.TipPt 18:39, 27 August 2006 (UTC)

The first link is to a different article, so I will not discuss it here. The proper place is Talk:Medical analysis of circumcision.

As for the second - this is completely unacceptable. You have deleted all references to the debate on the subject, including the BMA's observation that there is "significant disagreement" among its own memberships, and instead you have quoted only the opinion of the authors of the BMA report (and this report is almost unique among medical organisations in this respect - almost all the others acknowledge the benefits).

So in effect, you have hidden the fact that debate exists, replacing it with a single, non-representative opinion. This is a huge step away from NPOV, Tip. Jakew 19:00, 27 August 2006 (UTC)

How about adding ... The medical aspects of neonatal circumcision are debated, and research has been subject to bias ... We can cite the BMA for that quote.

The reader shouldn't care that individual doctors disagree ... that's why they have the association level statements. The American and CPS find minor potential benefits ... that do not justify the risks (they do not recommend).

These paragraphs are the introduction to the medical topic, with cost/benefit (hopefully meta analysis) summaries.

Remember it's (re relevance of potential benefits) partly about proper (normal) hygiene.TipPt 19:38, 27 August 2006 (UTC)

You focus on potential "benefits", I focus on net benefit.TipPt 19:43, 27 August 2006 (UTC)

The association's policies also disagree, Tip. This doubtless reflects the fact that the committees authoring them are groups of doctors. The quote from the BMA is illustrative of the fact that there is widespread debate.

As for bias, the BMA statement observes that there are claims of bias, so it is insufficient evidence that there actually is bias. Restoring the original quote will express this.

The quote of the BMA authors' opinion ("The medical benefits previously claimed...") should either be balanced with quotes from other organisations, or it should be removed. The latter is preferable, as it avoids repetition. Jakew 19:45, 27 August 2006 (UTC)

Sexual effects

Right now the reader is not (premitted) to learn that ~1/2 the normal shaft skin is removed. They learn nothing about the frenulum. They learn nothing about lost mucosa. The amount and location of skin and mucosa varies, as does the range of lost sensitivity...

Here's what I propose for the sexual effects intro:

Effects on Sexualily

Main article: Sexual effects of circumcision

The sexual effects of neonatal circumcision have not been studied. Loss of erogenous tissues and attendant sensitivity varies with the amount and location of excised or damaged mucosa. Specifically, according to Hass and Baur in college sexuality textbooks, the frenulum is "particularly responsive to stimulation," and "very reactive," thus contributing to erogenous pleasure during sexual activity. The frenulum is a primary orgasm and ejaculatory trigger zone.[8][9][10]

There are few studies on sexual partner preference for penises with or without foreskins, and the results are varied. The intromission function of the prepuce may facilitate penetration.[11][12]

The American Academy of Pediatrics states "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males." The American Academy of Family Physicians (AAFP) states "no valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."[13] A 2002 peer reviewed journal of the AAFP reported on research finding “participants reported significantly reduced erectile function, decreased penile sensitivity, no significant change in sexual activity, and significantly improved satisfaction after circumcision. This improved satisfaction represented a more satisfactory appearance of the penis and less pain during sexual activity.”[14]

— Preceding unsigned comment added by TipPt (talk • contribs)

Tip, the changes are almost entirely original research.

• "Loss of erogenous tissues and attendant sensitivity varies with the amount and location of excised or damaged mucosa." - Source?
• "Specifically, according to Hass and Baur in college sexuality textbooks, the frenulum is "particularly responsive to stimulation," and "very reactive," thus contributing to erogenous pleasure during sexual activity" - everything from 'thus contributing' onwards appears to be your own interpretation.
• "The frenulum is a primary orgasm and ejaculatory trigger zone" - The sources cited say no such thing.
• "The intromission function of the prepuce may facilitate penetration." - The first source speculates that this may be the case, the second does not.

I know you feel strongly about this, but you must not perform original research or misrepresent sources. Jakew 09:36, 28 August 2006 (UTC)

It's my primary concern ... that frenulums are being damaged, reduced, or excised. Note the quote below lists the "body below the corona" (frenular delta?...it's more that just the frenulum) as being sensitive. Many US hospital neonatal circumcisions reduce the frenulum (or delta). It is often excised to stem bleeding from damage, or to "cure" a perceived potential frenulum breve condition. I am disturbed hearing anecdotal reports from men finding erogenous sensation nearly two inches down from the corona! Most US hospital circs leave the scar line less than one inch down from the corona. I see recent reports of increased incidence of skin bridges, and the suggestion (from a doctor) that it may be because surgeons are increasingly placing the scar line closer to the corona. Parents don't have a clue.

I have neither performed original research, nor misrepresented sources.

The full (paragraph) quote from Baur is:

While the entire penis is sensitive to tactile stimulation (touch), the greatest concentration of nerve endings is found in the glans. Although the entire glans area is extremely sensitive, there are two specific locations that many men find particularly responsive to stimulation. One is the rim, or crown, that marks the area where the glans rises abruptly from the shaft. This distinct ridge is called the corona (ko-RO-na). The other is the frenum, or frenulum (FREN-yoo-lum), a thin strip of skin conecting the glans to the shaft on the underside of the penis. The location of these two areas is shown in figure 5.8.

The full quote from Hass (two paragraphs) is:

Glans The head of the penis is called the glans, Latin for acorn, which is what it resembles. The rim of the glans is called the corona. The glans, and even more the corona, are richly supplied with nerve endings and contribute substantially to pleasurable feelings experienced buring sexual activity. The small triangular area on the underside of the glans, where the frenulum, a delicate strip of skin, is attached to the head, is also very reactive. It seems particularly responsive to touch that is light and soft.

The entire penis responds to stimulation, but at least two other areas are sources of distinct pleasure. The underside of the saft of the penis, meaning the body below the corona, seeme sensitive to gentle friction. Another site is the base of the penis. Some men report that they can be brought to orgasm by them or their partner circling the base with their fingers and stroking.

The three (vibratory stimulation) sources fully support the statement "The frenulum is a primary orgasm and ejaculatory trigger zone." That's what the sources recommend you stimulate or actually stimulate to elicit ejaculation. If you insist, the sentence could read "the frenulum is a primary site for eliciting ejaculatory response."

I read that an orgasm is required to produce emissions, which then triggers ejaculation. That's why I included orgasm, not just citing ejaculation (as the goal). I couldn't find that source.TipPt 18:51, 28 August 2006 (UTC)

The relevant quote in the second cite (intromission, I thought) reads:

"During intercourse, the skin of an intact penis slides up and down the shaft, stimulating the glans and the nerves of the inner and outer foreskin. On the outstroke, the glans is partially or completely engulfed by the foreskin with more skin remaining inside the vagina than is the case with the circumcised penis. This ‘valve’ mechanism is thought to retain the natural lubrication provided by the female because the bunched up skin acts to block the lubrication escaping from the vagina, which results in dryness."5

That article is mostly about vaginal secretions, but it deals with the foreskin and sexuality, and it was published in the New Zealand Medical Journal.TipPt 18:57, 28 August 2006 (UTC)

All men are biased

Its simple.. If a man is circumcised he will sit here and say its for the better.. If a man is uncircumcised he will sit here and say its for the better..

Pktboy 16:46, 28 August 2006 (UTC)

Remove 1/3 to 3/4 of the skin off a penis, and he'll feel less sensation. Assuming it's not all about the orgasm (and getting there is most the fun, I think) he will feel less erogenous sensation during foreplay. Remove the frenulum, and he'll have a relatively hard time reaching orgasm (especially past 50).

I think the prepuce serves three additional purposes:

One, it's primarily an androgen receptor (in other mammals), and the human penis is loaded with hormone receptors. Might that effect the timing of the act? (men have cycles too) It hasn't been studied (other than in animals).

Two, it makes penetration more comfortable and reduces thrust friction for the woman. Vaginal secretions are more likely.

Three, the foreskin makes foreplay more pleasurable for the man, increasing it's likelyhood and duration.TipPt 19:12, 28 August 2006 (UTC)

PS ... the foreskin may be as much for the benefit of women (and sexuality) as men!TipPt 19:15, 28 August 2006 (UTC)

Saying that all circumcised men are in favour of it is a gross generalisation... I am loathe to bring ancedotal evidence into Wikipedia but I personally know some men that are very much against circumcision having been circumcised themselves, and there's one particularly hopeless case that is near suicidal over it because he feels that it was a form of abuse his parents brought on him. I can see your point regarding the natural bias in men here, but frankly it's an unavoidable fact and should have no bearing on the article or debate as there are many, many more cases where, like this one where the views of a person would be discounted because they are directly affected by the matter at hand, but where their viewpoints are important to the matter. In this case, men are the best and worst people to discuss circumcision. 82.47.2.79 16:59, 29 August 2006 (UTC)

It would be irresponsible to leave out the fact that many uncircumcised men have trouble using condoms. Condoms tend to not fit correctly, are uncomfortable, get stuck under the foreskin, and cause myriad problems. I don't believe that affect has been studied, either. I've also met men whose foreskins were so thick and so sensitive that they couldn't be touched at all, and I assure you their sexuality was affected for the negative. On the contrary I have never met a man who was unable to climax due to his foreskins having been removed as a baby.

adults with their foreskins, who have problems with them, can voluntarily go have them removed - informed consent and all (which is denied to those of us victimized by neonatal circumcision) Lordkazan 14:56, 31 August 2006 (UTC)

And onto hygiene (adding a paragraph, and "be left to")

Hygiene

According to the American Academy of Pediatrics 1975 statement "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk." [15] Studies in Denmark indirectly suggest that "good hygiene with regular washing may be just as effective at preventing the diseases treated by circumcision.”[16]. One researcher concludes that access to clean water and regular washing “should all but eliminate the risk for foreskin-related medical problems that will require circumcision.” [17]

Circumcision reduces the amount of smegma produced by the male. Smegma is a combination of exfoliated epithelial cells, transudated skin oils, and moisture that can be left to accumulate under the foreskin of males and within the female vulva area. It has a characteristic strong odor and taste, and is common to all mammals—male and female. While smegma is generally not believed to be harmful to health, the strong odour may be considered to be a nuisance or give the impression of a lack of hygiene. In rare cases, accumulating smegma may help cause balanitis.TipPt 19:55, 28 August 2006 (UTC)

Two editors with bias

Guess who this time...

[18]

Note the last paragraph, very important because it qualifies the prior (older) statement...

"A 2002 peer reviewed journal of the AAFP reported on research finding “participants reported significantly reduced erectile function, decreased penile sensitivity, no significant change in sexual activity, and significantly improved satisfaction after circumcision. This improved satisfaction represented a more satisfactory appearance of the penis and less pain during sexual activity. These results cannot be generalized to neonatal circumcision.”[19]TipPt 23:58, 28 August 2006 (UTC)

• Seriously TipPt, do you believe your own edits are unbiased? Fan-1967 00:12, 29 August 2006 (UTC)

Specifically Fan, do you feel exclusion of the above quote (AAFP) is not bias?TipPt 00:32, 29 August 2006 (UTC)

TipPt, I followed up on three of the sources you cited in your edit, specifically in the sentence concerning the frenulum. None of them said what you claimed they said. We've talked before about falsifying sources, and I thought we were clear that it is not cricket in any way. Until and unless you stop misrepresenting sources to push your POV, you should not be surprised when you are reverted. Nandesuka 00:34, 29 August 2006 (UTC)

All of the cites are professional, and recommend that you stimulate the frenulum to elicit ejaculatory response. Orgasm (emission) is required for ejaculation; thus the sentense inclusion of orgasm. I'm sorry you don't understand the purpose of the cites. They provide valuable information and evidence to the reader, so why do you object?TipPt 16:51, 29 August 2006 (UTC)

I object because lying about sources, as you are doing in that paragraph, is unethical and against Wikipedia policies. Nandesuka 17:31, 29 August 2006 (UTC)

I did not lie about those sources. They each provide proof for the statement. I'm sorry you don't understand. Your blockage of this information from the reader is unethical.TipPt 15:03, 30 August 2006 (UTC)

You claim that those sources indicate that the frenulum is a "primary site" for eliciting ejaculatory response. None of the sources you cite say anything of the sort. You need to re-read the policy on no original research and internalize why what you are doing gives the appearance of engaging in bald-faced deception. Nandesuka 15:12, 30 August 2006 (UTC)

Do you have any sources on the frequency of frenectomay as part of circumcision? I was under the impression it's uncommon, and thus not relevant to the general discusssion, but I have no sources for that, either. Fan-1967 15:09, 30 August 2006 (UTC)

For anyone trying to follow Nand's comments, here's the sentence and citations:

The frenulum is a primary site for eliciting ejaculatory response.[20][21][22]

The citations fully support the statement, and Nand doesn't want readers to know a valuable purpose of the frenulum.TipPt 15:47, 30 August 2006 (UTC)

Fan-1967:

You might view that video clip of a circ. That neonate lost most of his frenulum and all his delta.

I have no sources for frequency of frenectomies. The risk is also about reduction of the frenulum. The reader should know the risk, and potentially ask the operator to leave all the frenulur delta.

We could quote Hass "The entire penis responds to stimulation, but at least two other areas are sources of distinct pleasure. The underside of the saft of the penis, meaning the body below the corona, seeme sensitive to gentle friction," to support the statement that if the scar line is close to the corona, erogenous tissue (other than just the frenulum) is removed.TipPt 15:47, 30 August 2006 (UTC)

Not that anyone cares...

But I was at a coctail party Sunday night ... met this lively educated Brit lady. I was careful ... "are Brits and Americans the same in bed?" ... little bias. Her answer was essentially:

American men are faster (sooner and quicker when they do) to penetrate, frantic when they do, and seem to struggle for pleasure, relative to British men. She volunteered that it might be the lost prepuce (that's what they call it). Only then did I talk about this circ topic.TipPt 00:30, 29 August 2006 (UTC)

Reasons for the POS

First, Jakew, don't misrepresent your reverting ("rv to last by SmackBot").

Here are a few issues of bias, each representing blockage by Jakew and/or and Nandesuka of relevant information to the reader:

1. Any or all of the following paragraph, to be placed in Hygiene [23]: According to the American Academy of Pediatrics 1975 statement "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk." [24] Studies in Denmark indirectly suggest that "good hygiene with regular washing may be just as effective at preventing the diseases treated by circumcision.”[25]. One researcher concludes that access to clean water and regular washing “should all but eliminate the risk for foreskin-related medical problems that will require circumcision.” [26]

2. Any or all of the following paragraph, to be placed in Sexual (or s/b effects on sexuality) because it is later than the prior statement, and qualifies that prior statment.[27]: A 2002 peer reviewed journal of the AAFP reported on research finding “participants reported significantly reduced erectile function, decreased penile sensitivity, no significant change in sexual activity, and significantly improved satisfaction after circumcision. This improved satisfaction represented a more satisfactory appearance of the penis and less pain during sexual activity. These results cannot be generalized to neonatal circumcision.”[28]

3. Any or all of the following paragraphs, to be placed in Sexual (or s/b effects on sexuality):There are few studies on sexual partner preference for penises with or without foreskins, and the results are varied. The intromission function of the foreskin may facilitate penetration and vaginal wetness.[29][30]

4. Any or all of the following paragraphs, to be placed in Sexual (or s/b effects on sexuality):

The sexual effects of neonatal circumcision have not been studied. Circumcisions that reduce the frenulum or that include a frenectomy remove tissue that is "particularly responsive to stimulation," "very reactive," and "seems particularly responsive to touch that is light and soft," according to Hass and Crooks in college sexuality textbooks.ref Hass K., Hass A. Understanding Sexuality, St Louis: Mosby, 1993: 99-100. Crooks R., Baur K. Our Sexuality, Fifth Edition, Redwood City: The Benjamin/Cummings Publishing Co., 1993: 129 The frenulum is a primary site for eliciting ejaculatory response.[31][32][33] TipPt 15:30, 30 August 2006 (UTC)

Regarding the last paragraph specifically, readers who visit the three citations you provide will discover that exactly zero of them say that the frenulum is a "primary site" for eliciting ejaculatory response. Find a reliable source who says that. Otherwise, it's original research. Nandesuka 15:32, 30 August 2006 (UTC)

For anyone trying to follow Nand's comments, here's the sentence and citations:

The frenulum is a primary site for eliciting ejaculatory response.[34][35][36]TipPt 16:03, 30 August 2006 (UTC)

The citations fully support the statement, and Nand doesn't want readers to know a valuable (and potentially damaged) purpose of the frenulum.TipPt 16:03, 30 August 2006 (UTC)

To avoid being original research, the source would also need to say so in the context of circumcision... Jakew 15:38, 30 August 2006 (UTC)

Mark this one down everyone, Jakew says we can't cite related facts ... we should delete 90% of Wiki!TipPt 16:03, 30 August 2006 (UTC)

Oh, and regarding the specific points, I'd like to refer Tip to our previous conversations about them. There seems little point in going over it all over again. Jakew 15:39, 30 August 2006 (UTC)

Mark this one down too, Jakew has spoken.TipPt 16:03, 30 August 2006 (UTC)

How about blockage by TipPt of relevant information to the reader? It seems you really want the reader to know that US and Canadian medical societies don't recommend routine neonatal circumcision. It seems you don't want people to know they don't recommend against it, either. Half the truth is not truth. Fan-1967 15:40, 30 August 2006 (UTC)

The funniest part is that TipPt's edit summary claims that I'm editing bias into it by including both facts. Fan-1967 15:46, 30 August 2006 (UTC)

It's simply the actual text Fan, don't edit bias into actual text. Jakew ... hopefully, readers will glance at the talk page and understand a little more.TipPt 15:56, 30 August 2006 (UTC)

It's part of the text. Fan-1967 16:06, 30 August 2006 (UTC)

The Canadian Paediatric Society does recommend against routine neonatal circumcision. "Recommendation: Circumcision of newborns should not be routinely performed." DanBlackham 20:51, 31 August 2006 (UTC)

Editor misquotes the AMA and CPS

Jakew has just reverted to a false statement that is not reflected in the citation, or in fact. The exact quote from the citation is "do not recommend routine circumcision of male newborns."

Jakew makes it "neither discourage nor recommend" [37]

You can read the actual quotation from the AMA [38]

Here's the bottom line from CPS: “There is therefore no indication that the position taken by the CPS in 1982 should be changed”, which in turn reaffirms the 1975 statement that “there is no medical indication for circumcision during the neonatal period."

Caught you at a lie Jakew.TipPt 16:18, 30 August 2006 (UTC)

Firstly, let us try to be civil. Secondly, let us look at the entire quote:

Recent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns. The most recent statement by the American Academy of Pediatrics reads as follows: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."

— AMA, Neonatal Circumcision

It is true that the AMA does not recommend routine neonatal circumcision. It is also true that they do not recommend against routine neonatal circumcision.

More importantly is absence of the following paragraph, the first paragraph in the report (emphasis added is my own):

This report is confined to circumcisions that are not performed for ritualistic or religious purposes. In this case, the term "non-therapeutic" is synonymous with elective circumcisions that are still commonly performed on newborn males in the United States.

— AMA, Neonatal Circumcision

My personal opinion is that it neither construction was accurate, and TipPt, you are as guilty as you perceive Jake to be, in that you tried lumping in religious and ritualistic circumcision in the umbrella of not recommended . I don't think anyone "lied" per se, but we need a very clinical and corect construction, which in my opinion would be:

“ The AMA does not recommend non-medical, non-religious, and non-ritualistic circumcision to be performed as a routine procedure without parental determination as to what is in the best interest of the child ”

Anything else would not accurately reflect the entire sequence of paragraphs and would be an issue. -- Avi 16:26, 30 August 2006 (UTC)

Ritual and religious circumcision are BOTH non-theraputic, and are equally (if not more) of a crime. Sure some of us are biased (myself included) against circumcision as we have been victimized by it. However we are merely seeking accuracy, we don't have to make the article biased "in our favor" to "win" - the truth stands quite well enough for itself in showing that there is no medical excuse for male genital mutilation - never has been, and never will be Lordkazan 15:04, 31 August 2006 (UTC)

I believe you are completely missing the point. Your, my, and anyone's opinion is irrelevant in this article. My point is that the AMA citation used for supporting that part of the article SPECIFICALLY EXCLUDES ITSELF FROM COMMENT ON RELIGIOUS AND RITUAL CIRCUMCISION. Any application of ANYTHING in the AMA to religious or ritual circumcision is not only WP:OR, but an absolute error and misrepresentation of the AMA, and needs to be reverted on sight as a verifed falsehood. Further the AMA agrees to the possibility of medically necessary circumcision, I fail to see where your statement of “there is no medical excuse for male genital mutilation” has any basis in the AMA source. Our responsibility is to accurately portray reliable sources, no more, no less, and the way the AMA article was used was a violation thereof. -- Avi 15:18, 31 August 2006 (UTC)

sorry for the simplified statement creating confusing - "male genital mutilation" doesn't include the very small, and infrequent, cases of medically justifiable circumcision such as a true case of pathological phimosis (development phimosis, which you "grow out of", is often misdiagnosed as such), however there are also less invasive proceedures for correcting such, and recently the BMA told it's doctor's that using circumcision in such cases, when less invasive proceedures would work, is unethical. So the confusion is mine, however "non-theraputic" includes "ritual and religious" whether the AMA would like to admit it or not - if it's not for a medically justifiable reason, then it's non-theraputic by definition of the word theraputic! Lordkazan 15:59, 31 August 2006 (UTC)

however "non-theraputic" includes "ritual and religious" whether the AMA would like to admit it or not

— Lordkazan, 15:59, 31 August 2006 (UTC)

Unfortunately, the above is absolute and total WP:OR, and an example of someone's personal feeling intruding upon, AND CHANGING, what is documented in the citation. Lordkazan, I understand you feel strongly about this, but that does not, and can not, allow you or anyone to CHANGE what is written in the text of the American Medical Association's policies. They are completely clear, and felt strongly enough to place it as the very first paragraph. Whether you or I agree or disagree with that, changing it is false and vandalism and completely erodes any credibility wikipeia would have. Bring a similar source, from an organization as respected and notable as the AMA, and this article will be better off for it. -- Avi 16:29, 31 August 2006 (UTC)

Send in the british!

Medical Ethics Commitee, British Medical Association, 4 April 2003.

"The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision"

"The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks"

"parental preference alone is not sufficient justification for performing a surgical procedure on a child."

"The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."

The entire statmeent is here - the BMA is fairly hostile to circumcision and has been since 1949 - http://www.cirp.org/library/statements/bma2003/ Lordkazan 17:02, 31 August 2006 (UTC)

Lordkazan, we discussed that at LENGTH a few months ago. The BMA came out with a more recent 2006 position which is what is quoted in the article. So what you bring is outdated, irrelevant, and repudiated by the BMA itself. Check the archives of this page if you wish.

You now seem to be fishing to find something to repudiate both the AMA and the BMA. That smells very dtrongly of pushing a POV and not trying to add reputable, reliable quotes to both sides. -- Avi 17:08, 31 August 2006 (UTC)

The four quotes are not "outdated, irrelevant, and repudiated by the BMA itself". All four quotes are in the most recent version of the BMA guidance for doctors (June 2006) word or word. DanBlackham 20:35, 31 August 2006 (UTC)

Thank you, but i've given up trying to make this article biased - with Jakew's long history of ramrodding out anything that disagrees with his position, Avi's refusal to enforce wikipedia rules on him and is partisan support of Jakew (including accusing other users of breaking wikipedia rules and threatening to ban them when they have not) - I never expect this article to be unbiased, not with administrators backing POV-pushing pro-mutilation cognitive dissonance driven zealots. Lordkazan 11:58, 1 September 2006 (UTC)

Avi ... The paragraph ~topic is controversy, the source of which is Associations not recommending but parents expecting.

The quote needs to reflect the statements from authoritative associations (CPS, BMA, AMA, and Australian, German, New Zealand, France). The sentence should add at least the UK (BMA). All do not recommend neonatal circ. The strength of the statements from all but the US assoc's lead me to say "neither discourage" violates (lies about) their stance.

Saying "neither discourage" serves no purpose (other than to confuse the reader). In fact, doctors are expected to talk about risks.

Saying "AMA does not recommend ... without parental determination as to what is in the best interest of the child" is hogwash (another lie?). They don't recommend it at that time either! They will just perform the operation if so ordered. Inclusion of the phrase also conflicts with the paragraph lead sentence.

Worst case, I'll just keep publishing a short but detailed list of info the reader really needs to know in the talk page. That POV will probably never come off.TipPt 15:26, 1 September 2006 (UTC)

• "Saying "neither discourage" serves no purpose (other than to confuse the reader)." Actually it would also inform the reader of facts you don't want them to know. These societies do not recommend routine circumcision. They do not recommend against routine circumcision. They recommend that parents should make an informed decision. To selectively include some of that information and not the rest is misleading. Fan-1967 15:31, 1 September 2006 (UTC)

Auvert Study and Langerhans cells claims, POV, inaccurate

The Auvert study is a steaming pile of crap - it is fatally flawed in it's methodology as it does not account for the differences in sexual behavior bewteen it's "intact control group" and it's "circumcised expirimental group". The problem arsises from the fact of where they performed the study - people who are circumcised there are almost certainly muslim and engage in MONGOGAMOUS relationships with single partners as opposed to the uncircumcised people there being of a different subculture that is not nearly as monogamous, often has multiple-partners, doesn't use condoms, and is often exposed to sex workers.

Study with contrary results: http://www.docguide.com/news/content.nsf/news/852571020057CCF6852571CD005207D9 More refutations of various HIV studies: http://www.circumstitions.com/HIV.html

AS for the Langerhands cells claims - those were annhilated a long time ago by the CDC http://www.cirp.org/library/disease/HIV/dezzutti/

The lack of contradictory evidence presented, despite it's abundance and higher quality, constitutes a villation of the NPOV rules IMHO. Lordkazan 14:51, 31 August 2006 (UTC)

If you care to look at the Auvert study, you will find that differences in behaviour were indeed controlled for, and did not significantly affect the results. To quote: "When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%–77%)."

Furthermore, if you actually read the study, you'll see that men were randomly assigned to one of the two groups and then circumcised as part of the study. So unless being Muslim could have affected the randomisation process (a mathematical impossibility), your objection is invalid.

The article at docguide.com you cite is an observational study. While relevant, these are considered far weaker than randomised controlled trials (such as the Auvert study). As for the rantings of an activist on his website, these don't conform to reliable source guidelines and it is pointless to even discuss them.

The CDC 'annihilation' that you refer to did not even investigate preputial tissue, but instead focused on prostate tissue. Consequently, the CDC do not even mention it on their own factsheet on circumcision and HIV.

If you have serious evidence to the contrary, from reliable sources (eg peer-reviewed journals), then by all means add it to the article. Jakew 15:30, 31 August 2006 (UTC)

I see that they were then circumcized - my error before. I still fund the results of this study EXTREMELY dubious - especially with the difference between the two groups being 20 people vs 49 people - the claim of "60%" is misleading as it only supposedly reduced the rate by 1.25 cases per 100. Better results come from condoms, and that should be noted. Furthermore, based upon anecdotal evidence, intact men are more willing to use condoms (AFAIK no studies have been performed to confirm this unfortunately) - theoretically that would be because they are not missing 2/3rds of the erogenous nerves from their penis.

As for observational studies being "far weaker than RCTs" - that's assume the RCT is valid - the "60% protection" claim is based off a difference of 1.25 per 100 which could easily have merely been an abberation in the study. We will have to wait for a more specific refutation. It should remain noted that CONDOMS HAVE BETTER PROTECTIVE QUALITIES

As for "the rantins of some.. blah blah" - which includes citing studies, specific data. Just because he's ranting doesn't mean he's wrong, he gives all his reasoning and citations for you to doublecheck his statements.

as for dezzutti study - they're more epithelia with similiar properties. There are other refutations, I'll have to find them.

I'm trying to keep this article accurate and neutral as I believe that the best scientific research out there has failed to show any benefits of circumcision. Even if all the claims of benefits were true - those benefits can be gained through other means without the removal of healthy erogneious tissue (Which was done to me, against my will, long before I was able to consent/refuse)

If i'm uncivil with you then I will have to apologize, as you rae treading on the toes of someone who feels victimized by male genital mutilation Lordkazan 15:46, 31 August 2006 (UTC)

Strong personal feelings are all the more reason to step back and be very careful to watch out for letting personal feelings affect your opinion of studies. This is essential in articles on emotional issues. Fan-1967 15:50, 31 August 2006 (UTC)

You assume I don't? My feelings come from FACTS not the otherway around. I am not some weekminded fool who cannot seperate fact from feeling. I feel strongly on this subject for the very reason that no study has ever shown benefits of circumcision without methodological errors, or the same effect being achievable via non-mutilative means. I highly suspect Auvert because of the existing history of such studies on the subject being flawed, and it's usage of shock-value "60%" as it's primary claim instead of talking about the actually numbers, which were quite small, and could easily be a statistical abberation. Furthermore those who laud it keep conviently neglecting to mention the fact that condoms work much better, and fail to account for what is lost to circumcision. The idea of "it's just a flap of skin" when all the evidence to the contrary is staring them in the face, keeps running on. Here is a page (WITH SCIENTIFIC REFERENCES) of what is "lost to circ" http://www.noharmm.org/advantage.htm Lordkazan 15:53, 31 August 2006 (UTC)

A very astute point. Jakew 16:00, 31 August 2006 (UTC)

Your apology is accepted.

I'm sorry that you find the results dubious. Perhaps you should direct your energies towards finding peer-reviewed articles (or other reliable sources) expressing similar doubts. Certainly condoms should not be forgotten, and, for example, the recent WHO statement makes this very clear.

You appear to misunderstand my point about circumstitions.com: because the site itself does not conform to policy, we can't cite it. Therefore, it is pointless to even discuss the merits or lack thereof in the arguments, since a) WP:RS prevents us from citing it, and WP:NOR prevents us from analysing the points.

Since you express an interest, these are the findings of studies I'm aware of concerning circumcision status and condom usage: "Circumcised men were older and more likely to be Muslim. They were more likely to report a history of condom use" [39] "Condom use in men was associated with being young, living in town, being born in Kagera Region, high education and high income, being circumcised, and having causal or steady (non- martial) partners." [40] "Fewer uncircumcised men reported a history of condom use." [41] "There were no statistically significant differences between circumcised men and uncircumcised men in marital status, lifetime number of sex partners, number of non-spousal partners in the past 12 months, one-off sexual contacts and contacts with sex workers in the past 12 months, alcohol consumption and condom use." [42]

Jakew 16:00, 31 August 2006 (UTC)

I find the last one the most probably accurate (that there was no difference) - as I said it was merely anecdotal. However dismissing circumstitions is the wrong action - sure we cannot cite them directly, but we can clean interesting information from them, including often the leading criticism of studies, and then find independant sites that we can cite that say the same thing. He has a specific thing on the Auvert study that points out some egregrious flaws in the methodology. http://www.circumstitions.com/HIV-SA.html

"inclusion criteria: ... Consenting to avoid sexual contact (except with condom protection) during the 6 weeks following the medicalized circumcision"

"When you are circumcised you will be asked to have no sexual contact in the 6 weeks after surgery. To have sexual contact before your skin of your penis is completely healed, could lead to infection if your partner is infected with a sexually transmitted disease. It could also be painful and lead to bleeding. If you desire to have sexual contact in the 6 weeks after surgery, despite our recommendation, it is absolutely essential that your (sic) use a condom."

"Meanwhile the intact control group was not required to use condoms for the first six weeks of the study, just sent out to take their chances."

So there is your potentially show-stopping methodological error, and we don't have to cite circumstitions because we can cite the methodology of the study itself saying "However this study is potentially inaccurate as the circumcised experiment group was required to use condoms for 6 weeks while the intact control group was not, this potentially biased the data" Lordkazan 16:20, 31 August 2006 (UTC)

No, even if this was a problem, we couldn't criticise it in this way because it would be original research (ie, criticism which has not already been published in a reliable source). However, we know that it was not a problem because differences in condom usage were controlled for in the analysis, as noted in the quotation above, so hypothetically ignoring WP:NOR, all we could truthfully say is "it could potentially have been inaccurate for this reason, but the researchers were smart enough to check and control for this potential problem, so in fact it wasn't a problem." Jakew 16:36, 31 August 2006 (UTC)

claimed they compensated, and actually compensated, are two different things, furthermore human sexual behavior is not truly randomized - there are many problems with the study, pointing them out DOES NOT constitute original research if you have a source to cite - such as the study itelf - I find the data about the unreliability of the seroconversion count (posted below) even more damning however. Lordkazan 16:46, 31 August 2006 (UTC)

Lordkazan, could you please read information given to you? Specifically, please read Auvert's "authors' reply". You will see that they responded to Michael Glass, who raised the issue of the slightly different numbers reported. To quote: "Michael Glass has read a number of reports of our study. During the trial, we collected about 12,000 blood samples, performed about 12,000 clinical examinations, and collected about 48,000 questionnaires. We were careful to enter all these data with a double-entry procedure and even a triple-entry procedure for the laboratory data. This, of course, took considerable time. Nevertheless, we wanted to make available to the international community some preliminary information as soon as possible. We decided to release the results of the trial in a preliminary form at the International AIDS Society Conference in Rio de Janeiro. It is often the case that the results presented in a conference do not correspond exactly with those presented in the abstract, and that the final published results can be slightly different from those given in the oral presentation. We knew that this might be a problem, and we were careful to indicate to the PLoS Medicine editors that the results would be finalized only after the conference." Jakew 17:38, 31 August 2006 (UTC)

Given the history of this research all being as reliable as cold fusion claims, I still don't believe them - there are pretty clear methodological flaws in it, but unfortunately to date all the people who have pointed them out cannot be cited because of the overzealous pov-pushing original research rules Lordkazan 17:59, 31 August 2006 (UTC)

Unfortunately, you are not correct, Lordkazan. You can only cite published criticism of the study. Your own criticism of a published study is original research. -- Avi 16:52, 31 August 2006 (UTC)

It's not _MY_ criticism, i was quoting someone else. However that doesn't change your statement. I find this policy to be utter bullocks in this reguard as it is allowing flawed studies a free-pass simply because their opponants, no matter how correct, skilled and intelligent, cannot get published - that in and of itself constitutes a POV bias. However see above in the previous section where I started quoting the BMA Lordkazan 17:05, 31 August 2006 (UTC)

And please se where I point out that BMA 2003 has been superseded by BMA 2006, which is what is now referenced in the article, so the BMA you quote is outdated and basically rescinded by the BMA itself. -- Avi 17:46, 31 August 2006 (UTC)

I was actually looking for that, not realizing it was in the article - in some ways the BMA took more steps forward, and in some ways took steps backwards. Excepting the occasional medical condition such as pathalogical phimosis, the prepuce is healthy tissue and it's morally and ethically reprehensible to allow it's removal - we protect our daughters, why not our sons? (ok.. that was soapboxing, sorry.) Either way, the fact that I was looking for that refutes your insulting crap above about me trying to push POV IN THE ARTICLE. Yes I'm trying to "push pov", but not in the article, I don't have to pollute the information stream like the pro-circ people have by publishing false study after false study. Lordkazan 17:59, 31 August 2006 (UTC)

While I appreciate the zeal you bring, all editors must follow wikipedia guidelines and policies. "Righting the world from improper research" as noble as that may be, is forbidden on wikipedia. That is original research. All we are allowed to do is to bring published and verifiable data from reliable sources. No more, no less. Anything else is a simple violation of wiki policy, and will be dealt with according to wiki guidelines. The fact that you, I, Tipt, jake, or whomever may disagree as to the nature of the steps taken by the BMA is irrelevant. -- Avi 18:04, 31 August 2006 (UTC)

I was the one who needed to take a chill pill earlier, now it's your turn - look at my contributions list and you'll see that I haven't edited the page - I have only discussed this on the talk page, AS APPROPRIATE, since it is a controversial topic - I did remove a reference to it from another page that didn't have a source citation. I have a change I think we can all agree on the "60% reduction claim" is a bit misleading and POVish imho - it gives an exaggerated sense of protection - perhaps we should instead note the 0.85 per 100 for the circumcised group to the 2.1 per 100 for the intact control group, and note the difference in condom usage - that would both be in accordance with all wikipedia guidelines, and be more accurate. Lordkazan 18:09, 31 August 2006 (UTC)

Fair enough regarding my chilling out, consider me cool and copacetic . Regarding the change from relative to absolute statistcs, Disraeli said it best when he said there are lies, d@mn lies, and statistics. I suggest use both, a 60%change from 2.1 to 0.85. -- Avi 18:15, 31 August 2006 (UTC)

Sounds fair enough - perhaps note that it was "60% change from 2.1 per 100 to 0.85 per 100, or a total of 49 in the control group and 20 in the expirimental group." - which means that it takes 80 circ's to prevent one case of HIV when using circ as the only preventing (or no circs when using condoms! :P) Lordkazan 18:27, 31 August 2006 (UTC)

Also http://www.docguide.com/news/content.nsf/news/852571020057CCF6852571CD005207D9 despite being "an obersational study and being considered less accurate" shouldn't be censored from the main page either - it shows a mix of data that suggests that perhaps the statistics that Auvert came up with were right for it's data set but that perhaps it is only just a stastitical anomaly and that consistent results may not be found Lordkazan 18:35, 31 August 2006 (UTC)

I can't see any good reason for citing that particular paper - of all the 40 or 50 observational studies, why that one? It makes no sense: it's just arbitrary. It's more logical to cite one of the systematic reviews of observational studies, as we do at present, which gives a much better perspective on these. Jakew 18:42, 31 August 2006 (UTC)

good reason not to cite it: none. Good reason to cite it: article balance, because it's recent, infact released about the same time as Auvert Lordkazan 19:33, 31 August 2006 (UTC)

I have yet to see a good reason to not cite it from either of you. All i've asked with the Auvert study is dissent and criticism be shown, I'm not trying to censor the information the way you censor dissenting studies and claim it's "proportional representation" or some other garbage that just attempts to justify sticking to a biased page Lordkazan 21:32, 31 August 2006 (UTC)

Perhaps you misunderstood my earlier remark. This study (strictly speaking, news article about a study) doesn't specifically criticise the Auvert study. It is simply an observational study (and one with weaknesses explicitly noted in the article). It is no different to the studies reviewed by the Cochrane report (a small proportion of which had similar findings). So my question is this: is there anything special about this study that warrants special mention? Does it tell us anything that the Cochrane report does not already say? If so, what? If not, then should we not include every study ever done on the subject, in order to treat them fairly? If this is ridiculous and impractical, then perhaps it's best to simply include a recent systematic review of observational studies, along with the more recent - and important - findings of the RCT. Jakew 21:44, 31 August 2006 (UTC)

More data

Jennifer Vines, MD, of the Oregon Health & Science University in Portland, comments "...the authors did not control for other sources of HIV transimission such as blood transfusions or exposure through infected needles. ... Controlling for this route of infection could result in a smaller difference between HIV infection rates in the circumcised versus uncircumcised groups, indicating that circumcision may not be as effective at decreasing HIV transmission as the article suggests." http://medicine.plosjournals.org/perlserv?request=read-response&doi=10.1371/journal.pmed.0020298#r992

"Auvert and colleagues claim a “degree of protection equivalent to a vaccine of high efficacy” [1]. This is obviously overstated. A vaccine of high efficacy is expected to offer long-term protection of 95% or above. Smallpox was eradicated with such a highly efficient vaccine. If control of tetanus, measles, and poliomyelitis has been largely achieved in the world, it has been a result of high-efficacy vaccines. Furthermore, the analogy with vaccines appears misleading. A 96%-efficient measles vaccine means that 96% of vaccinated persons exposed to measles are indeed protected against infection. Protection lasts for many years, and revaccination permits dealing with loss of immunity over time. What Auvert and colleagues show is different: they show a 60% reduction in disease incidence over an 18-month period among circumcised men compared with uncircumcised men with similar exposure. To our knowledge, this does not mean that those men are really “protected” against HIV, especially in the case of repeated exposure. It simply means “reduced risk,” or reduced probability of contamination." Michel Garenne of the Institut Pasteur http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030078

IT also appears that 20 in the expirment and 49 in the control group may have been numerous false positives "The Abstract of the AIDS Conference in Rio reported 15 seroconversions from the circumcised group and 45 seroconversions in the uncircumcised group. (The New Scientist, 6 August, reported 15 seroconversions in the circumcised group but 51 in the uncircumcised group. On 29 July the Science and Development Network reported 18 seroconversions in the circumcised group and 51 in the uncircumcised group.) On 23 October, PLoS reported that there were 20 seroconversions in the circumcised group and 49 in the uncircumcised group. From the official figures: 15-45 at the AIDS Conference in Brazil and 20-49 in the PLoS Journal, between 1 August and 23 October there appear to have been 4 seroconversions among the uncircumcised and 5 seroconversions among the circumcised: in less than 3 months, a 3:1 difference has shrunk to 2.45:1 difference. "

"Rebecca Goldin points out that the low HIV/AIDS rate in the US means it would require 10,000 circumcisions to prevent 5.5 HIV infections, so the risks of circumcision are at least comparable." http://www.stats.org/record.jsp?type=news&ID=529 (404 :( damn - mirror http://www.circumstitions.com/News19.html#stats ) Lordkazan 16:32, 31 August 2006 (UTC)

Please see the authors' reply in which some of those issues are addressed. Jakew 16:36, 31 August 2006 (UTC)

Jake, this link appears to be dead. Have you got another one? gargoyle888 17:18, 31 August 2006 (UTC)

Try this. It may have been edited slightly, as this is the text as printed in the following issue, rather than the e-letter. Jakew 17:34, 31 August 2006 (UTC)

Their "Refutation" to the criticism about the sexual behavior differences is to assert that they believe something, they have no hard evidence, and I would like to know how they supposedly account for the difference.

they also propagate a medical myth The first paper on the association between male circumcision and HIV infection was published in 1986. In addition, it is possible - as far as I've read from reliable sources - it was practiced then, but there was never any mention of medical reasons in egyptian writings

nor do they refute the evidence that they were shown that male circumcision increases male->female transmission

They also reiterate their sampling problem of the fact that many of the participants WANTED to be circumcised, so they had a sample bias and at the size they claimed themselves of "The majority participated for the safe and free circumcision and to improve their health, 37.7% and 40%, respectively" that it is uncorrectably large

The Auvert study is fatally flawed, and I wait with baited breath for the medical community to descend upon it like a pack of wolves as they have eventually done to all the previous studies - of course the counter-studies never seem to get press for some reason even when they totallly destroy the pro-circ'ers claims. stupid media Lordkazan 18:25, 31 August 2006 (UTC)

Well, I hope you enjoy the wait. :) Incidentally, I personally addressed the claim that male circumcision increases male->female transmission in my own letter. Please see here. Basically, it was a case of an author cherry-picking studies supporting an anti-circumcision viewpoint, rather than taking the time to identify and assess all relevant studies. Systematic approaches are essential to avoid confirmation bias. Jakew 18:36, 31 August 2006 (UTC)

you also show that you irrationally believe it's impossible to confound an RCT study in that post (as you have demonstrated on here), which is blatantly false NO STUDY IS IMMUNE TO BEING CONFOUNDED - especially studies involving humans as their subjects - even more so studies that involve variables introduced by human behavior - no study is immune to confounding, and given the small REAL difference between the two groups un Auvert it is not as strong as you claim it is. It's pretty clear that Auvert has methodological and sample errors and you just hide behind the fact that the original research policy prohibits me from publishing many of the criticisms - then you act like author replies instantly invalidate criticisms. No they don't - several of the above criticisms from medical experts that I have posted should be noted in the article as well. Lordkazan 19:02, 31 August 2006 (UTC)

No shortcuts in circumcision

http://www.cbc.ca/news/viewpoint/vp_strauss/20051121.html

However, there was a fundamental ethical problem with its methodology. The men were given HIV tests before the project began and 146 were found to be HIV positive, but – underline the following in lipstick red – they weren't told about their status as researchers "considered it unethical to inform participants of their HIV status without their permission."

Not everyone believes the HIV infection numbers in men who hadn't been circumcised were so conclusive they justified the trial being shut down early. Part of the concern was caused by two recent papers that suggest that clinical trials claiming huge, big, early effects from drugs or other treatments as often as not turn out to be statistical blips and not true results.

"My sense is that the circumcision study may have been stopped too early and that there is a real danger we may be subjecting hundreds of thousands or millions of men to having circumcisions that may not have the benefit we assume," Jeremy Grimshaw, director of the Clinical Epidemiology Program at the University of Ottawa, warns me about the South African study.

So why stop a study when the number of people who had become infected wasn't even half as large as the number who had the disease to start with and weren't told they had it?

Frequency of frenectomy

"In 28 percent of our pediatric population undergoing elective circumcision we have demonstrated a previously undescribed ventral chordee of the glans, the result of a tethering effect of an unusually prominent frenulum ... Twenty of the 70 boys (28%) demonstrated a ventral glandular tilt (glandular chordee) due to an unusually prominent frenulum ... Persistent frenular chordee after circumcision may result in deformity of the penis on erection making sexual intercourse difficult or uncomfortable."

AS. Griffin and RL. Kroovand, Frenular chordee: implications and treatment, Urology 1990 Feb;35(2):133-4

So, frenectomy is quite common (the frenulum is torn from the corona by the application of the bell, the remnant is removed by the operator at the end of the circ)

Frenectomy can be avoided if the surgeon observes the frenulum before applying the bell, and performs a frenoplasty if the above is evidenced. The circ will then be performed without complication (accidental tears of the frenulum is the primary cause of beeding)TipPt 14:49, 1 September 2006 (UTC)

Reasons for the POV tag

Please see 12 above. Only one issue has been resolved, and it's not even in the list!TipPt 16:48, 1 September 2006 (UTC)

• Actually the POV tag is the one edit you've made that I absolutely agree with. (To be honest, I don't know if an NPOV article is actually possible here.) Fan-1967 16:51, 1 September 2006 (UTC)

One editor cannot force a POV tag onto an article forever, they are not permanent. You'll never be satisfied with the article unless it reflects your own strong anti-circumcision views, but at some point you have to respect the greater consensus and Wikipedia's WP:NPOV, WP:NOR, and WP:V policies. Jayjg ^(talk) 16:55, 1 September 2006 (UTC)

There's no consensus here. There are about three or four editors who hang out around the article keeping it as pro-circumcision as possible, and a steady stream of editors trying to make it more anti-circumcision (most get fed up and leave quickly). ^L_Wizard @ 18:31, 1 September 2006 (UTC)

"Pro-circumcision"? It doesn't promote, recommend, or suggest circumcision in any way, as far as I can tell. It does stricly adhere to the reliable source guideline, which makes it very difficult to get propagandistic material into the article. And your comment has exactly and precisely highlighted the major issue "a steady stream of editors" have here; they keep "trying to make it more anti-circumcision", in your own words, when they should be trying to make it adhere to our policies instead, particularly WP:NPOV, WP:NOR, and WP:V. Of course, the policy-violating edits are resisted by editors who actually care about having a neutrally presented, high-quality article, and this may indeed have the effect you mentioned, where anti-circumcision activists get frustrated and leave. Jayjg ^(talk) 19:24, 1 September 2006 (UTC)

Alright, I was trying to phrase things neutrally, but if you're going to be a dick about it, we can do it that way. The article is currently biased. You can cite reliable sources and not do original research and still have a bias. The article currently exaggerates the benefits of circumcision and downplays its risks and ethical issues. Frequently editors will stop by, read the article, and say to themselves "Jesus H. Christ, this is a horribly biased article. I'll fix it up a little to conform to WP:NPOV." Then someone, typically JakeW, will revert them, usually with little explanation. If pressed for explanation, he will explain that "2+2=4" is original research, and that major medical organizations are only reliable sources when they're directly quoting studies whose methods JakeW agrees with.

Here's a good guideline for NPOV: We can tell that the article is NPOV when an equal number of editors think it's biased in each direction. You've seen a steady stream of editors who think it has a pro-circ bias - how many can you name that think the current article (as reverted to by JakeW) has an anti-circ bias? ^L_Wizard @ 22:31, 1 September 2006 (UTC)

I would tentatively agree, in that I would personally consider the article to still have a mild to moderate bias in that it fails to give due weight to opponents of the practise and their claims of its harmfulness; though I think this can largely be understood more as a failure of conforming to a global viewpoint than a deliberate attempt at bias. (Ie., all too many of the medical organizations which have generally reliable scientific methodology happen to be in English-speaking western/westernized nations, and thus, it could be argued, share a viewpoint on the procedure which is in the world minority.)

However, please be more civil in your remarks (vis-a-vis saying others are "being a dick" etc.). It really doesn't help anything to be rude and insulting. Cheers, Kasreyn 01:11, 2 September 2006 (UTC)

Unfortunately, LW's suggestion can never be a fair test, because of the fact that there is a relatively large, active, and organised anti-circumcision activist lobby. Since many of them believe that circumcision is mutilation, a human rights abuse, and perhaps even child abuse, they are often highly motivated. In contrast, pro-circumcision(*) individuals are relatively few in number, have no real organisation, and have comparatively little motivation. Thus, we should expect to have more anti-circumcision activists trying to make the article more representative of anti-circumcision propaganda.

• - Some use this term in a very imprecise manner, meaning anything from rabidly promoting circumcision, to questioning anti-circ claims, or at another extreme, the entire set of people who are not anti-circ activists. I mean those who actually promote circumcision. Jakew 09:24, 2 September 2006 (UTC)

• Or, to put it more simply, the people LW labels as "pro-circumcision" believe the article should present both sides of the issue, and are satisified with an article that does so. The anti-circumcision group do not, and are not. Fan-1967 14:32, 2 September 2006 (UTC)

You people are impossible. Everyone has some bias. Until you are willing to admit that, we can't get anywhere. ^L_Wizard @ 19:56, 2 September 2006 (UTC)

I am extremely biased in favor of articles that conform to Wikipedia's content policies. Nandesuka 19:59, 2 September 2006 (UTC)

Of course everyone has some bias. That's why all facts need to be presented, without preference. We've seen repeated attempts by some anti-circumcision advocates to minimize, or even eliminate, opposing arguments. Fan-1967 21:33, 2 September 2006 (UTC)

If we're interested in presenting all facts and conforming to content policies, why are edits this this one reverted? ^L_Wizard @ 21:52, 2 September 2006 (UTC)

The reason that particular one was reverted is that it was the first of about six major edits in a row, and a later editor, rather than trying to sort every particular change, just reverted the whole lot. Maybe not the ideal way to handle it, but it was a rather agressive editing spree. I might point out though, that the first paragraph change at the top of that first page jumps out, and should have been reverted, because it's atrocious, mixing reports from three different years to take one line (with no context) from the 1975 report. The quote from the latest report in 1996 appears, as part of a much more complete statement, in the next paragraph. The full paragraph below makes numerous references to "benefits and harms" (i.e. two sides). TipPt's summary paragraph above would certainly seem to imply (by selective use of quotes) that the organization opposes neonatal circumcision, which a reading of the detail clearly does not support. On the contrary, they quite specifically state that the evidence of benefits and harms is "equally balanced". This has been a repeated issue with this editor's summaries on the positions of Canadian and US medical societies, where s/he states that an organization does not support circumcision, but leaves out the fact that they don't oppose it, either. Fan-1967 22:26, 2 September 2006 (UTC)

The Canadian Paediatric Society does oppose routine neonatal circumcision. "Recommendation: Circumcision of newborns should not be routinely performed." DanBlackham 21:36, 6 September 2006 (UTC)

Since that line is not in the rather long position statement we have from them, would you care to tell us where it's from? Fan-1967 21:48, 6 September 2006 (UTC)

The quote is in the CPS position statement. It is in the abstract section of the document. The bottom line is the CPS recommends that infant circumcision should not be routinely performed. That fact needs to be included in the article. DanBlackham 22:22, 6 September 2006 (UTC)

Dan, I'm sure we've been over this before. Routine circumcision is that which is done automatically, as standard practice, or as the AAP put it "The Task Force found the evidence of low incidence, high-morbidity problems not sufficiently compelling to recommend circumcision as a routine procedure for all newborn males. However, the Task Force did recommend making all parents aware of the potential benefits and risks of circumcision and leaving it to the family to decide whether circumcision is in the best interests of their child."[43] (emph added) So the CPS appear to have a similar recommendation: against routine circumcision, but no position on an elective basis. Jakew 08:53, 7 September 2006 (UTC)

(reset margin) Jake, I understand that is your POV, however the American Medical Association disagrees. The AMA says, "the term 'non-therapeutic' is synonymous with elective circumcisions that are still commonly performed on newborn males in the United States." [44] The AMA report uses the phrase "routine circumcision" to describe elective non-therapeutic circumcision. The two terms are interchangeable. DanBlackham 06:38, 8 September 2006 (UTC)

Dan, the AMA report you cite does not declare that the two terms are equivalent. I'm not prepared to take their statement regarding their meaning of a different term, and your assurances that it has the same meaning, as evidence. Sorry. Jakew 09:50, 8 September 2006 (UTC)

Again Jakew, although it is probably unintended you write as though you regard this article as your personal property... "I'm not prepared" etc. Using language as though you think you are the expert peer reviewer to accept or reject anyone's contribution is not going to help this very poor quality, POV and wordy article to progress. Have you noticed how many people over a couple of months have become heated talking to you? Think about it mate. --BozMo talk 12:04, 8 September 2006 (UTC)

Well, once again let's look at the actual language of the AMA study cited by DanBlackham: This report is confined to circumcisions that are not performed for ritualistic or religious purposes. In this case, the term "non-therapeutic" is synonymous with elective circumcisions that are still commonly performed on newborn males in the United States. So, very much unlike what DanBlackham, wants to imply the AMA uses the term "non-therapeutic" in a very limited sense that explicitly excludes religiously-based circumcisions. Any attempt to use this AMA report to imply otherwise would be at best careless, possibly dishonest, and perhaps even bigoted.Dasondas 12:13, 8 September 2006 (UTC)

Religious circumcision is elective circumcision. (Actually it is FORCED circumcision when performed on a person without their consent/before they're old enough to consent) Lordkazan 16:39, 8 September 2006 (UTC)

---

The Bias is primarily from JakeW ramrodding censorship of any and all dissenting information from this article. Furthermore bias is introduced by the lack of comparision information that plays up the benefits of circ - such as EVEN IF EVERY MEDICAL CLAIM WAS TRUE (which several of them ARE NOT) the same benefits can be gained from non-invasive means such as wearing condoms and bathing properly! JakeW is the primary ramrod of bias into this article to the point that he says that studies that support his position are FLAWLESS and UNIMPEACHABLE even when given a list of specific criticisms including show-stopping ones. He has consistently blocked my mentioning of a study that came out at the same time as Auvert that found different results than it simply because he asserts that it is of lesser quality Lordkazan 13:33, 5 September 2006 (UTC)

lead section

The lead section of an article should not contain lengthy quotations, and certainly not from one specific medical association; rather, the lead should succinctly summarize an article's contents in a neutral way. Articles should also try to have a global perspective, rather than focussing exclusively on the American POV. Please don't insert this absurdly long quotation (134 words!) in the lead again. Thanks. Jayjg ^(talk) 02:22, 3 September 2006 (UTC)

Jayjg I take your point and (basically) agree, however when I put that quote in it was in an attempt to correct the clear bias inherent in stating that the AMA, et. al. do not recommend routine circumcision without mentioning that neither do they discourage it. The "non-theraputic" qualifier does not fix this problem, and previous attempts to negotiate an editorial solution have failed. This appears to be a problem that long pre-dates my involvement with this article and represents "cherry picking" of quotations by advocates on one side of the debate. As I said, I wasn`t particularly enamored of the idea of placing that quote where I did, and I would prefer a more elegant editorial solution to the problem. I will certainly defer to your request to not reinsert the disputed quote, however I think that there is still an egregious problem with this article misrepresenting the policy of the AMA and other medical organizations and will look forward to any ideas you may have to resolve this.Dasondas 19:31, 3 September 2006 (UTC)

Well, do you think your latest edit handles the issue? I'm fine with it, if you do. Jayjg ^(talk) 17:43, 4 September 2006 (UTC)

I'm OK with it for now; there may still need to be some minor tweaking on this general point, and other sections of the article do still need attention (not necessarily to correct any bias), but I think that my last edit helps and is certainly magnitudes better than my previous clumsy attempt. In any event, at this point I'm not perceiving a great deal of bias one way or the other in the article; I'd like to see comments from other interested editors (on all sides of the issue, obviously). Dasondas 02:38, 5 September 2006 (UTC)

Suggestion

Should we move the arguments for and against circumcision into a separate article and keep this article clean on what it is? Otherwise the article quality is rather low --BozMo talk 09:25, 5 September 2006 (UTC)

That would be a good idea - move "medical benefits" off into circumcision advocacy and move the rebuttal to those supposed benefits to pages associated with the Genital Integrity movement Lordkazan 13:39, 5 September 2006 (UTC)

I don't think that medical benefits is a function of advocacy for circumcision. Medical benefits (and risks) are supposed to be objectively established phenomena that any informed parent (or subject) should be aware of. It's that way with any other medical procedure, from the least controversial (removing a burst, infected appendix) to the most controversial (some kind of cosmetic surgery). --Leifern 14:46, 5 September 2006 (UTC)

Quite agree. Facts exist independently of those arguing for or against. Advocates on both sides may use (or abuse) them, and this may in some cases be worthy of inclusion in the relevant articles. However, to decide to discuss such facts only in those other articles is truly bizarre, like insisting that the only mention of rain forests in Wikipedia is in a page on environmental lobbyists. Jakew 10:59, 6 September 2006 (UTC)

Hmm. Truly bizarre? Sounds a bit of a last refuge that... What you have now is an article listing in boring detail the positions which various people and professional bodies have pro and anti circumcision. Then there is the main article content lost in the mess most articles in Wikipedia are about their subject not one level of abstraction higher. --BozMo talk 11:20, 6 September 2006 (UTC)

Leifern the bias is that the disadvantages are not adequately covered and that studies contradicting the "benefits" are kept out - I pointed out a study that came out almost simultaneously with Auvert and JakeW objects to it as "what does it say that's not already been said by cochrane review" - the same is true of Auvert - auverrt is far from conclusive, but he has no objection to auvert because it conforms to his unencylopaedic agenda. It belongs in there because it's also "more recent" like Auvert. Also the "benefits" are not put into perspective - all those "benefits" are insignificant and can be obtained through non-invasive means when they exist at all. Generally cosmetic surgery is voluntary - my circumcision was not voluntary it was performed when I was days old. Now at the age of 22 I find I would like to have used my foreskin. I was deprived of the majority of the erogenious nerves of the penis by misinformed doctors. I want this article to be truthful and in perspective. As it is a biased piece that justifies non-voluntary circumcision. Lordkazan 16:21, 6 September 2006 (UTC)

No one can speak to your specific situation. I have compassion for you. In the U.S. there are no non-voluntary circumcisions. The permission of the parents is necessary, and that makes it voluntary. You can be angry at your parents for choosing to circumsize you, choosing your religion, screening and limiting your friends, all sorts of things. But trying to suggest that the medical community is mis-informed, or ethically wrong just isn't accurate. There are many people, myself included, that feel that circumcision is beneficial, and prefer to be circumsized.

You have a passion for your position, and you are a perfect candidate for being an activist for that position. Unfortunately, that isn't beneficial for being an editor with the goal of a neutral position. This article is not the proper place for activism. It can fairly balance the views, and point interested people to more information on those views. Atom 16:53, 6 September 2006 (UTC)

Bullocks - I suggest you look up the definition of voluntary and then refrain from attempting to belittle people who disagree with you. Circumcision is the only situation still legal in the USA where healthy tissue can be removed from a minor on parental preference. You're right - this article isn't the proper place for activism. Good thing I'm notr trying to make it be such - I'm trying to enforce NPOV. Lordkazan 18:38, 6 September 2006 (UTC)

Oh btw, I just remembered something. Don't know if it's still practice but in army hospitals they do it without parental consultation (as if parental consent was valid for this proceedure to begin with) Lordkazan 20:42, 6 September 2006 (UTC)

Actually, the same is not true of Auvert. The Cochrane Review specifically draws attention to the fact that, at time of publication, no randomised controlled trials had completed. It specifically singled out the importance of these trials, stating "In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV."

And Auvert's study is the first of these trials to report results. That is why organisations like the CDC, the WHO, UNAIDS are paying so much attention to it: because it isn't just another observational study, it's hard experimental evidence. Jakew 17:02, 6 September 2006 (UTC)

And Auvert's study has severe methodological flaws and has been contradicted by a report almost simultaneously release. Citing Auvert without the other is a POV violation Lordkazan 18:38, 6 September 2006 (UTC)

I understand that you consider the Auvert study to be flawed. However, observational studies and their findings are already covered by the Cochrane Review. Their value is "doubtful" in the light of the RCT data. Jakew 18:50, 6 September 2006 (UTC)

The study in question that came out at the same time as Auvert is NEWER - you cannot dismiss a study just because of it's classification of type of study and you dislike it's result. (BTW thanks for the link fix on my userpage) Lordkazan 18:57, 6 September 2006 (UTC)

Yes, I agree, it is newer. So too are the first 26 abstracts in this search of the AIDS 2006 conference presentations. So too are roughly the first 50 results returned when searching PubMed for "circumcision hiv". Do you propose that we include those 76 studies too? I suspect not. I suspect that you'd agree that they offer little value to the reader over what's already there. So pray tell: what is so important about this little study that it warrants inclusion? Please explain why a) it is more important than the studies reviewed by the Cochrane Collaboration (widely considered to be the authority on evidence-based medicine), b) why it is more important than the conclusion of the Cochrane Collaboration, who described the value of such studies as "doubtful", and highlighted the importance of randomised controlled trials instead, and c) why it is more important than any of the 76 or so published or presented in the last year. Jakew 19:22, 6 September 2006 (UTC)

You're changing the subject. I don't particularily care WHICH study is cited that calls Auvert into question - last I checked the article made Auvert sound like it was 100% set in stone as a true result. I just want everything in this article to be put in perspective so that people don't go out and take the choice away from their little kids Lordkazan 20:42, 6 September 2006 (UTC)

I think that you ought to review WP:NPOV and WP:NOT. Our role is to provide accurate, verifiable, and neutral information. We cannot be concerned with what people will do with that information - attempting to change society is activism, and is generally incompatible with the goals of the encyclopaedia.

Returning to the subject at hand, would it satisfy your concerns if we include something like the following from the joint WHO/UNAIDS/UNICEF/UNFPA/WB statement?

(existing discussion of RCT findings.) However, "UN agencies emphasize that the final results of the ongoing trials will be essential to determining the efficacy of circumcision in preventing HIV infection in men in differing social and cultural settings. Once the findings of these trials have been announced and reviewed in 2007, WHO, the UNAIDS Secretariat and their partners will define specific policy and programming recommendations." [45] Jakew 21:14, 6 September 2006 (UTC)

I recomment you review those. wikipedias role is to provide accurate, verifiable and neutral information. And it's failing to do all three. It's showing all the supposed benefits in detail while not covering the criticisms of those studies, not showing the disadvantages in detail, and is generally currently showing a pro-circumcision bias in the article. ALL I WANT IS A NEUTRAL FUCKING ARTICLE HOW DIFFICULT IS THAT FOR YOU TO UNDERSTAND. Lordkazan 15:12, 7 September 2006 (UTC)

I would argue that the article is meeting all of these goals. I've suggested a possible quote that might address the concerns you express, but you seem to have ignored it. And I'm sorry to say, but based upon your contributions (including edit summaries), you seem to be more interested in enforcing your point of view rather than helping the article to be neutral. Jakew 15:27, 7 September 2006 (UTC)

Bullocks, look at my edit history on the article - i've made PERHAPS two edits on the article - TWO EDITS. You guys act like I'm actually editing the article without discussion. Sorry Jakew, i cannot anymore give you the benefit of the doubt that you are acting in good faith after you have implied more than 20 times that I have edited the article to add POV commentary - I came TO THIS PAGE to discuss this as a means to try and raise the quality of the article and increase it's NPOV compliance - you have no interest in being NPOV compliant, you want the article to show your POV as clearly demonstrated by your behavior and edit history that users other than myself have noticed. Lordkazan 20:07, 7 September 2006 (UTC)

Now, please don't revise history. It's not that you can no longer AGF - you never did. You first accused me of "agenda pushing" in, I believe, our 2nd talk page interaction.[46] It's a pity, and it makes working with you more difficult, but I don't hold it against you.

As for your previous contributions, you have shown a tendency to impose your POV on articles. I refer you to edit summaries such as "Removed because the studies have fatal methodology flaws that render them junkscience," "I posted the counterevidence on the freaking talk page, this is not vandalism. There is no citation here, there is no good citation POSSIBLE here -all studies supporting are flawed," and "remove introduction of pov-pushing censorship. No medical benefit ever even suggested can justify non-voluntary genital alteration." I believe that it is therefore appropriate to remind you of actions that should be avoided; the intention is not to cause offense, and I apologise for any inadvertently caused.

Now, perhaps we could discuss the article? How do you feel about including the above quote from the WHO? Does their emphasis on waiting for the results of the other two trials address your concern about parents rushing out to circumcise their children? Jakew 20:25, 7 September 2006 (UTC)

Lordkazan you need to chill, and recall/review WP:CIV. We understand you feel strongly about it. People who feel strongly about issues shouldn't edit those articles, that's my opinion. In this article, NPOV means expressing both sides, or all sides proportionally and appropriately. It does not mean not expressing any view that someone disagrees with. There are people who advocate, prefer, and are for circumcision. That's okay. They get to express the factual data related to their perspective here, and their opinions on the talk page. My read of the article is that in numerous places it is clearly POV against circumcision. There doesn't seem to be a great deal of effort to present both sides in a balanced fashion. Your assertion that the article "is generally currently showing a pro-circumcision bias", IMO, is just unfounded. Your strong language, and your continued efforts to bias the article in one direction, rather than let the myriad of other editors find consensus on a balanced NPOV article is innapropriate (in my opinion). Please be civil. Please try to work on the article from a non-emotional perspective that assumes the other people are working with Good Faith. Atom 17:40, 7 September 2006 (UTC)

Hmm. I don't condone the language but Atom perhaps you should look at the history of edits a bit more... I am pretty ambivalent on the issue (its a bit of a non issue in my view as long as no one with scissors comes near my kids) but the introduction of the systematic bias pro circumcision looks like it comes from a small number of very opinionated individuals who are virtually squatting long term on the article. More importantly there is far too much material about the argument on the article which should be a neutral study of the practice. Sure a series of people come in, correct the NPOV get reverted, get cross and leave: but that's a bit understandable. On basis of your "People who feel strongly about issues shouldn't edit those articles, that's my opinion" a few of the regulars on this article shoul take a holiday.--BozMo talk 19:26, 7 September 2006 (UTC)

Circumcision and Culture

In the culture section I'd like to see someone add discussion on circumcision technique. For example is there any difference in the quantity of foreskin removed when comparing Jewish, Islamic and secular US circumcision? Are there any technique differences? 149.167.200.118 11:51, 5 September 2006 (UTC)

there is no such thing as secular circumcision, medicalized yes, but not secular. Circumcision was started in america in the late 1800s as a means to "cure" masturbation and was introduced by religious zealots. Many people still say they are doing it "for religious reasons" (even when they belong to religions that do not circumcise), and there is an example in the news recently of a man in canada who had the government pay for plastic surgery to graft skin onto his penile shaft to replace skin lost to a very henius circumcision. He was held down by two priests at approx age 8 and crudely circumcised "for his masturbatory ways" - they held him so forcefully they broke his arm and jaw and circ'ed him so severely that he couldn't get an erection without it being painful for the rest of his life (until the surgery). Lordkazan 13:36, 5 September 2006 (UTC)

Circumcision and Sensitivity

It seems to me that the debate on whether circumscision affects penile sensitivity or not is missing an important distinction. In this debate one needs to distinguish between newborn circumcision and adult circumcision. The studies seem to have focussed on adult circumcision and the results are contradictory...this suggests to me that on average there is no sensitivity difference in adults.

I can believe this because in adults the glans of the penis keratises and loses sensitivity with age anyhow. Also in adults the glans has had more exposure to friction throughout its lifetime.

However in newborns and infants I suspect the situation is quite different. Uncircumcised infants have glans that are so sensitive that the penis hurts should the foreskin retract a little, allowing the glans to rub against clothing. Circumcised infants therefore must fairly rapidly lose sensitvity in order to cope with this discomfort.

Thus I suspect if one was to study circumcised versus uncircumcised sensitivity in males in their teens and early twenties I would expect to see a difference. However as these same males approach their 40s and beyond, I suspect their penile sensitivities converge to roughly the same level due to keratisation and "wear and tear."

Thus I argue that if there are any sensistivity differences to be found, one should do research into the hypothesis that it is an *early* effect that wears off with age. My question is: has any such study been carried out? If so please report it in the article. 149.167.200.118 11:51, 5 September 2006 (UTC)

most of the adults I know that were circed as adults say there is a fairly rapid and massive loss of sensativity. Furthermore the only "study" i've heard on this subject was Masters & Johnson and that had a fatally flawed methodology, the way it tested sensativity would not have stimulated the nerves of the foreskin and frenulum Lordkazan 13:38, 5 September 2006 (UTC)

It's an interesting hypothesis, but it seems a rather desperate attempt to cling on to the keratinisation theory - for which there has never been any evidence - in spite of evidence showing it to be more myth than a real-world phenomena. It's a little like watching a devotee of Newtonian gravity arguing that perhaps Relativistic effects might apply in special cases that have just happened to coincide with experimental data, but these are exceptions to the usual rule in which Newtonian physics apply. You can't help thinking, "well, there's always a possibility, but Occam's Razor applies here."

Anyway, this is rather off-topic, so the short answer is that there have only been four studies to investigate the issue (Masters & Johnson 1966, Bleustein et al. 2003, Bleustein et al. 2005, and one other which temporarily escapes me). Bleustein controlled for age and did not find significant differences, I'm afraid. Jakew 10:50, 6 September 2006 (UTC)

(replies are the same level are supposed to be listed in CHRONOLOGICAL order - do not insert your replies above mine). Bleustein was a joke - it has a sample not large enough to use validly for statistical purposes - making extrapolation a stretch. Then it fatally (to any claims of validity) had a non-random sample. Bleustein was yet another piece of pro-circ junk science. Lordkazan 16:54, 6 September 2006 (UTC)

Thanks for that. Do let us know when your critique has been published in a peer-reviewed journal, and we can include it. Jakew 16:58, 6 September 2006 (UTC)

One thing should be easy...look at the statistics in all those "studies", and only include statistically relevant findings. Right now, we have small study groups with poor response rates, subjective responses with low variability, and lots of statistically irrelevant but confusing junk. Most of the studies involve circs as therapy on diseased foreskins (sex was poor before the circ, and improvement is relative)...TipPt 17:25, 6 September 2006 (UTC)

And how do you propose to determine 'statistical relevance' without performing OR, Tip? Jakew 18:08, 6 September 2006 (UTC)

The rules for disqualifying samples from being statistically relevant are well known and well established - i'm sure there is a wikipedia article on them somewhere. If applying established rules constitutes OR then the OR rules need to be looked at. As it is I already think the OR rules give a pro-establishment bias to wikipedia's medical section. There definantly needs to be OR rules, but they shouldn't be blocking valid criticisms (especially since most scientists down bother publishing pieces solely to criticise another since publishing isn't free) Lordkazan 23:21, 6 September 2006 (UTC)

Please review WP:NOR; you cannot include your own conclusions about studies. Please quote reliable sources instead. Jayjg ^(talk) 01:35, 7 September 2006 (UTC)

would you mind refraining from being an insulting by telling me things I already know and notice that I haven't edited the fucking article! see my above comment about the article is curretly NOT NEUTRAL. Lordkazan 15:14, 7 September 2006 (UTC)

Edits against earlier consensus

[[47]] establishes that uncircumcised is the agreed term so why is it all being changed back to non-circumcise by the only dissenter in that discussion? --BozMo talk 15:31, 6 September 2006 (UTC)

without looking at the earlier discussion i could guess the user finds "uncircumcised" to be a biased term... i could see that being argued either way - I would prefer the term "intact" Lordkazan 16:11, 6 September 2006 (UTC)

I vote intact or natural.TipPt 17:13, 6 September 2006 (UTC)

On further thought I definantly think "uncircumcised" is some what a weasel word. "un-" has a subconcious implication with many that it is the opposite of the normal state, in this case that couldn't be further from the truth. Lordkazan 23:17, 6 September 2006 (UTC)

The longstanding consensus is for the neutral and common English term uncircumcised. Jayjg ^(talk) 01:32, 7 September 2006 (UTC)

Longstanding consensus among a bunch of people who currently are holding the article in a pro-circ bias. Fuck longstanding consensus - that's argumentum ad populum ("consensus") and Argumentum ad antiquitatem ("longstanding"). Just becuase you agree on the term doesn't make it NOT a biased term! Lordkazan 15:15, 7 September 2006 (UTC)

1. Please be civil.
2. Consensus is how Wikipedia operates. As with WP:NOR, if you don't like it, you can propose changes at the appropriate place, but you're unlikely to be successful.
3. The term is not biased just because you deem it so.
4. Your argument holds no water. Consider "unaltered" or "unpasteurised", for example: neither implies that the opposite is normal. Jakew 15:22, 7 September 2006 (UTC)

I agree with you JakeW that uncircumcised is not POV. However your style is confrontational. We all recognise that there is a weakness in WP consensus when special interest groups stake out articles. It would be a shame if this article becames another sad example, and you should be awake to the risks. As a general remark JakeW I think you should probably try as a matter of courtesy to revert much less often and reworded other people's contributions inclusively more often... that is if you wish to encourage civlity. --BozMo talk 19:37, 7 September 2006 (UTC)

Thank you! Lordkazan 20:03, 7 September 2006 (UTC)

Dictionary.com definition 3 - http://dictionary.reference.com/search?r=2&q=uncircumcised - "3. heathen; unregenerate." - more support for the assertion that the term, is infact, somewhat POV. I don't feel to terribly strongly about this - but the term does strike me as somewhat weaselish Lordkazan 19:48, 8 September 2006 (UTC)

I'm having trouble here. I'm trying to imagine a situation in which a reader could conceivably read an article on circumcision and somehow make the mistake of thinking that the intended sense of the word 'uncircumcised' was in fact an obscure (and I strongly suspect mainly historical) religious term, rather than the more obvious meaning. Were this an article about 12th century religious texts, it would be just about believable. But it isn't.

So this hypothetical reader would have to be a) fairly literate, in order to know such an obscure meaning, and b) incredibly - unbelievably - lacking in the ability to apply contextual clues to such situations. Such a person would find daily life incredibly difficult, if not hazardous. We're talking about a mind that when told that you had a nasty habit would start to worry about your clothes. Jakew 20:06, 8 September 2006 (UTC)

Like I said - "I don't feel to terribly strongly about this - but the term does strike me as somewhat weaselish". I would prefer the term intact to be used, so I'm just pointing out various ways in which "uncircumcised" could be seen as somewhat pov-ish and weaselish. It's ability to used as a disparative is almost certainly where I get my sense of it being weasilish from. Lordkazan 20:10, 8 September 2006 (UTC)

I think that usage is uncommon (it is listed last) and specifically refers to its usage in Old Testament quotes, where it was used as a disparaging term for non-Jews, just as the clean-shaven Romans used "barbarian" (bearded) as an insulting term for outsiders. Fan-1967 20:25, 8 September 2006 (UTC)

Dasondas pov-pushing vandalism

I'm sick of edit warring with you - your vandalism and personal attacks have been reported at the appropriate pages. RESTORE THE CONTENT YOU VANDALIZED IMMEDIATELY http://en.wikipedia.org/w/index.php?title=Circumcision&curid=6783&diff=74594757&oldid=74594205 Lordkazan 21:31, 8 September 2006 (UTC)

Medical Aspects POV

Negative effects are not shown in sufficient detail, and much information is outright missing. See the following pages (which cite medical studies) http://www.noharmm.org/advantage.htm and http://www.noharmm.org/snip.htm Lordkazan 02:05, 9 September 2006 (UTC)

Neither of the pages you cite satisfy WP:RS. Furthermore, if you bother to follow up references, you'll find that a) many are misrepresented, b) many others are merely opinion pieces, rather than scientific studies, c) several contradict each other, and d) a simple literature search often reveals that the (carefully) selected references are in fact anomalous results and/or opinions contradicted by research. Jakew 09:11, 9 September 2006 (UTC)

Jakew I give your opinion about this much weight: 0. Pulling "That violates wikipedia rule XYZ" out of thin air every five seconds is REALLY tiring. They're a reliable source because they cite their sources. Even if you say NOHARMM is unreliable they cite their sources. I'm sick and tired of you keeping this article in a pro-circ NPOV and abusing wikipedia rules to do it. Lordkazan 14:26, 9 September 2006 (UTC)

There is more to reliable sources than merely citing other work, Lordkazan. Try reading the policy. Jakew 16:14, 9 September 2006 (UTC)

Which NPOV on neonatal circumcision

It seems to me that part of the problem is the matter of which question we take an NPOV on. Where is the fulcrum of the debate? What does "pro-circumcision" mean.

I guess we should be NPOV on the question on whether neonatal circumcision (without dire medical cause) should be considered/made illegal or be left to parental choice (which it seems to me is a wide public debate, with all sorts of guidelines being issued by professional bodies). In this regard the issue is a bit like abortion or smacking. Again, in these cases few if anyone is proposing compulsion, and so one POV is pro-choice and the other is "ban it".

Do we agree the contraversial issue for neonatal circumcision pro-choice versus banning? I don't see much serious discussion anymore from people proposing more aggressively pro-circumcision positions than pro-choice so I guess this defines the left hand POV? --BozMo talk 10:14, 9 September 2006 (UTC)

No, I don't think that's a good way to frame the argument. A lot of "intactivist" types would like to spread (what they believe is) the truth about circumcision, and then (they assume that) no one will choose it for any reasons but religious. No need to ban it. I think the issue is more comparable to smoking than abortion: it's a bad choice that people are free to make, but it's unethical the way it's pushed on children. ^L_Wizard @ 10:43, 9 September 2006 (UTC)

LizardWizard is partially wrong - "intactivists" want to to be illegal for it to be performed on someone without their consent/prior to their age of consent without clear medical need (BMA has some decent guidelines on using less invasive treatments first). So they're free to make it for themselves (like Jakew), but it is a crime to make it for others (like my parents did to me when I was merely days old) Lordkazan 14:31, 9 September 2006 (UTC)

Come now, LK. "Intactivists" are not a gestalt entity, they're individuals. While they're opposed to circumcision by definition, there's a fairly wide range of views. Some desire a law against circumcision, while others would prefer to reduce the numbers of circumcisions through "educating" others. The range of views I've seen expressed includes:

1. Circumcision should be illegal (eg Lordkazan on WP, MgmBill.org).
2. Circumcision should be strongly discouraged (eg LizardWizard on WP).
3. Circumcision is up to the parents and accurate information should be provided (eg yours truly on WP, AAP)
4. Circumcision should be strongly encouraged (eg Gerald Weiss)
5. Circumcision should be mandatory (eg a journalist whose name escapes me)

Jakew 16:48, 9 September 2006 (UTC)

What is "pro-circumcision" bias? 2 to 3 paragraphs about "risks" under one heading then multiple headings for specific benefits, completely ignoring many of the observed physiological changes, not putting the supposed benefits there are into perspective (IE X can also be obtained more reliably via condom use), preventing legitimate objections to the validity of pro-circ studies from being commented on. That is pro-circumcision bias, and the wikipedia rules are being abused to keep the article that way. Lordkazan 14:31, 9 September 2006 (UTC)

my reviews of medical sections

For example - the penile cancer claim is bunk - see http://www.circumstitions.com/Cancer.html (it cites it's sources, ANY article I think as evidence is going to cite it's sources) Lordkazan 14:38, 9 September 2006 (UTC)

The activist web page you cite is not a reliable source. Jakew 16:26, 9 September 2006 (UTC)

There is a reason I only cite sources that cite evidence. Just because it's an activist website doesn't mean it's wrong - especially when it's citing research. You're a biased editor who cannot keep your bias out of the article, why should I listen to you? Lordkazan 18:17, 9 September 2006 (UTC)

The HPV claim is also utter garbage Lordkazan 14:43, 9 September 2006 (UTC)

Your opinion of studies is OR by definition. Jakew 16:26, 9 September 2006 (UTC)

Yes it is, which it's a good thing there are other studies that contradict the bullshit claims that uncircumcised wangs propagate HPV, infact an article this last week in the International Herald Tribune points out one those claims to be BS based. not to mention the entire article is about the HPV vaccine! http://www.iht.com/articles/2006/08/30/healthscience/snvaccine.php ( Lordkazan 18:17, 9 September 2006 (UTC)

"Infectious and chronic conditions" is weasel wordy, how about you cite the difference in the rates - it's minisculue to the point of insigificance. Just like Auvert if, Auvert was correct, 1.25 per 100 means 400 people have to be circumcised to prevent 5 cases of AIDS - hardly fair to the 395. Just wear a farking condom! (Auvert is fatally flawed crap) Lordkazan 14:46, 9 September 2006 (UTC)

Would you care to suggest an alternative heading? Jakew 16:26, 9 September 2006 (UTC)

It wasn't the heading I was objecting to, it was the content. I want the NUMBERS of the difference in rates added Lordkazan 18:17, 9 September 2006 (UTC)

"Balanitis" section is good. Lordkazan 14:47, 9 September 2006 (UTC)

"Phimosis and paraphimosis" is generally ok, there are less invasive proceedures than circumcision to solve these as should be noted. The wikipedia article on Phimosis has a fairly decent list of them with source citations. Lordkazan 14:52, 9 September 2006 (UTC)

It is logical for an article on condition X to list all treatments for X. This article is about circumcision. Jakew 16:26, 9 September 2006 (UTC)

The balanitis section makes reference to some of the alternative treatments. I never said this should be an exhaustive list, it should just make notable reference to the fact that circumcision is not the only treatment Lordkazan 18:17, 9 September 2006 (UTC)

The UTI section is good Lordkazan 14:53, 9 September 2006 (UTC)

Now the completely missing list of negative effects -

Size of the adult foreskin "the mean surface area of the prepuce when folded out, was 46.7 cm2." http://www.cirp.org/library/anatomy/werker/

"ridged band" sensory mucosal tissue http://www.cirp.org/library/anatomy/taylor/

Loss of mechanical "sliding" function, body image issues (admittedly small sample) http://www.cirp.org/library/complications/money/

A poll on the effects found " Respondents reported wide-ranging physical consequences from their circumcisions. Among the most significant were prominent scarring (33%), insufficient penile skin for comfortable erection (27%), erectile curvature from uneven skin loss (16%), pain and bleeding upon erection/manipulation (17%), painful skin bridges (12%), other, e.g. beveling deformities of the glans, meatal stenosis, recurrent non-specific urethritis (20%).", and "The reported sexual consequences included progressive sensory deficit in the preputial remnant and glans (61%), causing sexual dysfunction (erectile problems, ejaculatory difficulties, and/or anorgasmia); extraordinary stimulation required for orgasm (40%), with many respondents reporting that vaginal sex offered inadequate stimulation for pleasure and/or orgasm; and sexual dysfunction resulting from emotional distress (see Psychological consequences).", "Other reports suggest that some circumcised individuals compensate for a diminished sexual response with either compulsive sexual behaviors [19] or those offering greater stimulation (masturbation, oral/anal sex) [20]. A desensitized glans and the absence of the fine-touch receptors [21,22] and erogenous mobility of the prepuce may necessitate inordinate stimulation of residual penile nerve endings to achieve pleasure and orgasm. Numerous respondents described needing to resort to extraordinary, often violent, thrusting during intercourse, with some respondents (or their wives) reporting genital dryness, abrasion, pain and bleeding.", "Emotional distress, manifesting as intrusive thoughts about one’s circumcision, included feelings of mutilation (60%), low self-esteem/inferiority to intact men (50%), genital dysmorphia (55%), rage (52%), resentment/depression (59%), violation (46%), or parental betrayal (30%). Many respondents (41%) reported that their physical/emotional suffering impeded emotional intimacy with partner(s), resulting in sexual dysfunction. For some, lack of compassion from parents, siblings or friends fostered bitter interpersonal conflict or alienation. Almost a third of respondents (29%) reported dependence on substances or behaviors to relieve their suffering (tobacco, alcohol, drugs, food and/or sexual compulsivity)." - these are all, admittedly, from a self-selected group with greater knowledge - the following are from generaly population , "One report suggested that 20% of circumcised men were dissatisfied with their condition, while 18%of them would rather not have been circumcised [31]. Another survey [32] canvassed 197 intact and circumcised American men, who reported their perception of their genital condition. Of intact men, 80%, 3% and 17% were satisfied, dissatisfied or ambivalent. Of the circumcised men, the respective values were 38%, 20% and 41%. Another report [33] revealed that half the respondents circumcised as infants were unhappy about it, compared with 3% of non-circumcised respondents who were unhappy being intact." http://www.noharmm.org/bju.htm

You can simply read the list and follow the citatios, and contrary to a certain persons assertion that this source isn't reliable - you can just cite the studies directly! Lordkazan 15:16, 9 September 2006 (UTC)

Amusingly, this poll was conducted by NOHARMM, and participants were recruited from their membership and those of foreskin restoration groups. In other words, it's a poll of male anti-circumcision activists. As for the others, Werker's of mild interest, and may be worth adding to the foreskin article. Money, as you (and he) acknowledge, is too small a sample to be meaningful (and is also contradicted by other research). As for Taylor, he merely speculated that the ridged band is sensory tissue. Jakew 16:26, 9 September 2006 (UTC)

Amusingly enough, you'll note THAT I SAID THAT and so did the source, and then they said moved onto studies of the general population, WHICH STILL showed negatively for circumcision. Your opinions carry zero weight with me Jakew, you're one of the worst offenders in here in keeping the article in a pro-circumcision bias. The article is appaulingly silent on the negative physical and phsycological effects of Male Genital Mutilation. Lordkazan 17:34, 9 September 2006 (UTC)

So the author gave us the figures on the anti-circ population, and then looked for and cited figures that (he says) are from the general population and which happened to agree (though in some cases he has to twist the facts to make them appear to fit)? :-) Jakew 18:04, 9 September 2006 (UTC)

Right, whatever, resort to "zomg!!! he twisted the facts" because you don't like the fact that the general population also showed a negative result for circ. Lordkazan 18:13, 9 September 2006 (UTC)

There I went back and highlighted something important you missed Lordkazan 17:35, 9 September 2006 (UTC)

Furthermore the fact that the ridged band contains sensory tissue is not speculation. Lordkazan 17:36, 9 September 2006 (UTC)

"We postulate that the `ridged band' with its unique structure, tactile corpuscles and other nerves, is primarily sensory tissue" (emph added). Jakew 18:04, 9 September 2006 (UTC)

"with its unique structure, tactile corpuscles and other nerves". It's not merely speculation, it's educated postulation based upon data. Lordkazan 18:13, 9 September 2006 (UTC)