Talk:Circumcision

Is this relevant?

This was recently tucked into the HIV section:

According to Valiere Alcena [4], it was he who first hypothesised that low rates of circumcision in Africa were partly responsible for the continent's high rate of HIV infection.[102] He did this via a letter to the New York State Journal of Medicine in August 1986.[103] He also alleges that the late Aaron J. Fink stole his idea when Fink published a letter to the New England Journal of Medicine entitled A possible explanation for heterosexual male infection with AIDS, in October 1986.[104]

Any objections to moving this to one of the subarticles? I guess it's interesting, but is it notable enough for the main circ article? More importantly, if these people are still alive, are the refs up to par? Thoughts? Complaints? Accusations of pro- or anti-circ bias? AlphaEta 19:22, 4 September 2008 (UTC)

Who added it? I don't think removing the arguments as to who was responsible for the hypothesis that circumcision reduces HIV risk is a problem, as long as the discussions (and supporting evidence to the discussion) remains. However, I agree with you that it would be an appropriate addition to the Medical Effects sub-article. -- Avi (talk) 19:37, 4 September 2008 (UTC)

I added it. I think it is a good intro to the HIV section because it marks the beginning of the link between the 2 things. What links are not up to par? How can it be pro-circ or anti-circ , it is what happened.Tremello22 (talk) 21:12, 6 September 2008 (UTC)

Sorry, the pro- anti-circ thing was an attempt at sarcasm. It never plays well on the internet. Also, it wasn't directed at any particular editor. AlphaEta 22:07, 6 September 2008 (UTC)

I also think that the views of the WHO which currently take up 3 quite big paragraphs is excessive. It maybe violates some kind of NPOV policy. 1 paragraph would be sufficient. Tremello22 (talk) 21:58, 6 September 2008 (UTC)

I'm all for making things more concise. What did you have in mind? AlphaEta 23:02, 6 September 2008 (UTC)

The problem I have with the WHO is that they aren't the original source. So they are just providing conclusions and acting on those conclusions, in doing so, implying a result to the trials that might differ from the conclusions other readers would draw. I was just thinking of the wiki policy "let the reader decide". That is all. Tremello22 (talk) 23:39, 6 September 2008 (UTC)

Looking it over, the WHO info may be a bit excessive! AlphaEta 23:49, 6 September 2008 (UTC)

Intro to HIV section

Why was the intro taken out coppertwig? What exactly do you object to? How does it go off on a tangent? Is it not important when and who originated this theory? I would say it is very important and should be included. Tremello22 (talk) 16:29, 7 September 2008 (UTC)

I apologize: perhaps I should not have deleted this without discussing it first. If this paragraph has been discussed previously on this talk page, please put a link to it. I've self-reverted and restored the paragraph because of your message, though I still oppose its inclusion as currently formulated.

"According to Valiere Alcena [1], it was he who first hypothesised that low rates of circumcision in Africa were partly responsible for the continent's high rate of HIV infection. He did this via a letter to the New York State Journal of Medicine in August 1986. He also alleges that the late Aaron J. Fink stole his idea when Fink published a letter to the New England Journal of Medicine entitled A possible explanation for heterosexual male infection with AIDS, in October 1986."

I don't oppose the inclusion of this information somewhere in this article or in a subarticle. It might be better to put most of it in a subarticle or footnote, to save space. The way the paragraph is now, I think it loses the reader's attention and doesn't give the reader a clear idea of what this section of this article is supposed to be about. This article is supposed to be about circumcision, not about who published what article in a scientific journal when.

I suggest replacing this paragraph with a single sentence as follows, and putting the rest of the information in a footnote: "A hypothesis that low rates of circumcision in Africa were partly responsible for the continent's high rate of HIV infection was proposed in 1986." As long as a footnote is given explaining who claims to have proposed it, I don't think this counts as weasel words.

There are problems with this paragraph. Please propose new material on the talk page first so that problems can be worked out before putting it into the article. The Alcena reference needs to be formatted correctly. The Alcena reference doesn't seem to support the statement: I see nothing about HIV on that web page. The Alcena reference may or may not count as a reliable source: it seems to be self-published: we would have to discuss this.

Thanks for contributing interesting material to the article, though, and I apologize for just deleting it rather than moving it to the talk page, moving it to a subarticle or modifying it; I'm glad you were watching. ☺ Coppertwig (talk) 12:33, 8 September 2008 (UTC)

The Alcena link above is his own personal webpage. This is just to show who he is. The other references are all published in medical journals so there shouldn't be a question over their reliability. here is where he first proposed the hypothesis that HIV infection had something to do with Africa's high HIV rates in the new york state journal of medicine in August '86. Here is Aaron J. Fink's letter in October '86. Here is a letter Alcena wrote in response to the South Africa randomised control trial in PLOS medicine journal in 2006, 20 years after his original idea. I think it is important for the reader to understand where this idea originated. Tremello22 (talk) 10:19, 10 September 2008 (UTC)

I agree that this is excessive detail for this article. It doesn't tell the reader anything about circumcision. Instead, it tells the reader about a dispute about who first published a hypothesis. In the detailed article, it seems reasonable to discuss this as part of discussion of the history of circumcision & HIV research, but I can't really see why this is important. Given that more than 500 articles have been published about circumcision and HIV, I think we need to be a little more selective. Jakew (talk) 18:49, 22 September 2008 (UTC)

I disagree. I am going to re-add it. If anything should stay it is how this theory started. —Preceding unsigned comment added by Tremello22 (talk • contribs)

Questionable assertion, for two reasons. First, we can't really say that "it is how this theory started" without carefully checking the references to every study and verifying that we can trace a path back to the supposed origin. There may in fact be multiple origins: it is perfectly possible that Fink and Alcena generated the hypothesis independently, and for that matter it is equally possible that the investigators who performed later studies were unaware of either. All we can say is that X was the first time that circumcision and HIV were linked in print (and the possibility remains that some as-yet undiscovered paper may have been published previously).

Second, assuming that there is a single origin, if the history of HIV/circumcision research should be discussed, then why only the origin of the hypothesis? Surely, if the history is to be considered, then the first ecological study is just as historic, as is the first case-control study, the first cohort study, the first meta-analysis? And why should an allegation that someone "stole" an idea get half (one of two sentences) of the discussion of the history? As currently presented, the article implies that Alcena had an idea in 1986, Fink allegedly stole it, and then - boom!! - three randomised controlled trials were published. To put it mildly, that's somewhat misleading. Jakew (talk) 11:33, 23 September 2008 (UTC)

Well because the journal Alcena printed his letter in wouldn't have accepted it otherwise. So I think we can assume that he was the first to do it - to have printed it anyway. Whether Fink knew of Alcena's study I don't know - Alcena seems to think so. That allegation by Alcena can be removed if you want. If you want to add a sentence or 2 of what led up to the randomized control trials then fine - i was about to do it but have not got round to it. AlphaEta revised this section anyway which can be seen here in a discussion that was recently archived. The studies in between were either found to be flawed/biased in methodology or contradicted each other anyway according to Van Howe's survey study - which is partly why the RCT's were conducted. Tremello22 (talk) 12:14, 23 September 2008 (UTC)

I'm afraid it's unclear what you mean by "Well because the journal Alcena printed his letter in wouldn't have accepted it otherwise". I think you mean that PLos Medicine wouldn't have published Alcena's 2006 letter unless he actually was the first, but I think you're placing a lot of faith in their review process. Even if we assume that PLoS use a rigorous peer-review process for letters, it would be asking a lot of the reviewers to confirm that none of the millions of journal articles published before Alcena's 1986 letter mentioned such a hypothesis!

It seems unwise to state Van Howe's review as fact, since it was itself the subject of criticism; see Moses et al and O'Farrell and Egger, for example. Later meta-analyses differed somewhat in their assessment of the value of observational data (see refs 111 and 112 in the article). If you read the 'Introduction' to Auvert et al., you'll see that both of these refs (12 [Weiss 2000] and 13 [Siegfried 2005]) are cited as background information. In particular ref 13 is cited in support of the need for experimental (ie., RCT) data.

Regardless, even if the observational studies were flawed/biased/etc., that seems a poor reason to overlook their existence in a discussion of the history of this research. This brings me back to my main point: if we're to discuss history of circumcision and HIV at all, then we need to do so properly. But to do that properly and neutrally would require several paragraphs, and given the limited space available here it seems far more appropriate to do so in the detailed article. Jakew (talk) 13:19, 23 September 2008 (UTC)

I've shortened the intro section and followed Alpha Eta's re-write on the archived talk page. Tremello22 (talk) 14:19, 23 September 2008 (UTC)

Thank you. I think the current version is reasonable: "The origin of the theory that circumcision can lower the risk of a man contracting HIV is disputed. " This acts as a brief introduction to the idea of the whole section. I still think it puts too much emphasis on that dispute here (where the reader may be more interested in the theory and results than in who originated them) but only two words, so not too bad. I think it may be better to mention the RCTs earlier, perhaps as early as the first sentence, with the current first sentence perhaps becoming the second sentence; the RCT results are the most important and interesting information so they should be presented where the reader is most likely to notice them. It would also make more sense that way: the current first sentence talks as if the reader has already heard of the theory (i.e. "the theory", as opposed to "a theory") which doesn't seem the right narrative flow to me. ☺ Coppertwig (talk) 12:51, 25 September 2008 (UTC)

That is the point - the theory came first - then the study. I have to disagree with you about the order. I think chronologically is best. Tremello22 (talk) 17:21, 25 September 2008 (UTC)

I agree with Coppertwig. The very first question that the reader is likely to ask after (s)he sees the "HIV" heading is, "what the *!*& does this have to do with circumcision", or to put it another way, "what is the relationship between circumcision and HIV". So let's start with that. The background to the RCTs, if this information belongs at all, should be discussed afterwards. Jakew (talk) 18:06, 25 September 2008 (UTC)

Jakew, re:your comment "The very first question that the reader is likely to ask after (s)he sees the "HIV" heading is, "what the *!*& does this have to do with circumcision" Can I ask which sentence it is you are referring to? If you are referring to the half of a line that mentions the origin of the theory then I think you are wrong to assume the reader thinks that, for one - he would have read it before he would have had time to think that. It seems to me that introducing the theory is the logical way to structure a topic about which the majority, or at least some of the readers are unaware of. Also ask yourself, what is the heading of the topic? - is it "circumcision lowers the risk of contracting HIV" or is it "how circumcision relates to HIV"(i.e medical analysis in relation to circumcision) It is the second obviously. Now for all the reader knows, circumcision could raise the risk. I personally think taking only a few lines to explain the back story doesn't make the reader wait too long before he gets to the (as you seem to think) important bits. It also means that they understand the whole picture - why the trials needed to be conducted etc. Tremello22 (talk) 20:29, 26 September 2008 (UTC)

Tags

I propose removing the tags. This is a highly visible article. The tags reduce its credibility. The problems being worked on are relatively minor in comparison to the article as a whole, and discussion can continue whether the tags are there or not. Above all: the tags are not connected with a specific list on the talk page of problems to be fixed. One of the tags has apparently been there since June. ☺ Coppertwig (talk) 21:41, 17 September 2008 (UTC)

Makes sense. There's always someone who insists the article is unbalanced (on both sides), and a number of editors who won't be satisfied until it's a partisan screed. The tags on this article are generally used as weapons of defacement, and serve no real encyclopedic purpose. Jayjg ^(talk) 00:23, 18 September 2008 (UTC)

This is a highly flawed article, and needs the tag. The Topic has several specific factual deficiencies, which I have detailed. I will list them again ASAP (see below). There are more than three (# required) specific complaints of factual inaccuracies or omission of relevant fact, so you can't just remove the tag.TipPt (talk) 16:38, 18 September 2008 (UTC)

Apparently neither one of you know what a tags purpose is. They were not created to be weapons and/or deface articles. Currently the title has a "No consensus" status and some concerned editors are trying to correct what they perceive as factual and/or NPOV violations. The tag draws attention to debates here on talk. Typically this ends up strengthening an article one way or another. Garycompugeek (talk) 12:32, 23 September 2008 (UTC)

Coppertwig ... there is no logic in your discussion about Meatal Stenosis. Currently we barely mention a common known complication of circumcision ... though properly referenced (with consistent stats) from several high end studies and articles. Accurate, unbiased information is blocked/reverted from the Topic. You can not block highly relevant fact. So many facts are blocked that the article becomes pro-circ propaganda.TipPt (talk) 16:38, 18 September 2008 (UTC)

Oppose removal of the tags, as they redirect attention to the disputed title and disputed material that remains with no confidence and no consensus for or against, present in the article now and authored and/or insisted upon by Avi, Jakew, Jayjg, and Nandesuka. Blackworm (talk) 02:14, 5 October 2008 (UTC)

And by the way, it is inappropriate to argue that tags should be removed because they "reduce its credibility." Any reduction in perceived credibility is due to the open, balanced acknowledgement of a good-faith dispute on content by editors. Unless you prefer that disputes happen via editwars, or that the fact of a dispute between editors on the material remain secret to the reader, I don't see why one would want to remove the tag indicating an ongoing dispute. The tags are a reminder that our work here isn't done. When there's no consensus on either side, then better a disputed, "defaced" article than a non-neutral, "clean" article. Blackworm (talk) 02:23, 5 October 2008 (UTC)

More reasons for the Factual problem tag

• Obscured from the reader:

First, we should link to the actual Sorrells study, published in the Brit Journal of Urology. Circumcision currently links to a very short summary.

We should also convey the essence of their findings: “The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis.”

…”Circumcision removes the most sensitive parts of the penis and decreases the fine-touch pressure sensitivity of glans penis. The most sensitive regions in the uncircumcised penis are those parts ablated by circumcision. When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis (the rim of the preputial orifice, dorsal and ventral, the frenulum near the ridged band, and the frenulum at the muco-cutaneous junction) that are missing from the circumcised penis were significantly more sensitive.”[2]

• Removed from sexual effects:

“While vaginal dryness is considered an indicator for female sexual arousal disorder,1,2 male circumcision may exacerbate female vaginal dryness during intercourse.3 O’Hara and O’Hara reported that women who had experienced coitus with both intact and circumcised men preferred intact partners by a ratio of 8.6 to one.4 Most women (85.5%) in that survey reported that they were more likely to experience orgasm with a genitally intact partner: ‘They [surveyed women] were also more likely to report that vaginal secretions lessened as coitus progressed with their circumcised partners (16.75, 6.88–40.77).’4”[3]

• Removed from sexual effects:

“Presence of the movable foreskin makes a difference in foreplay, being more arousing to the female.4 Women reported they were about twice as likely to experience orgasm if the male partner had a foreskin.4 The impact of male circumcision on vaginal dryness during coitus required further investigation.”[4]

• Removed from sexual effects:

“These preliminary figures support the claim by Morgan [1 and 2] that vaginal intromission is easier with a (retractable) foreskin in place. The mechanism is simple. The interposed foreskin decreases the friction between the introitus and the glans. The unretracted foreskin consists of a thin dermis that is folded on itself with very little friction between the layers. As the penis advances, the foreskin unrolls so that the portion that makes initial contact with the introitus is 6 cm. Up the shaft before any friction occurs between the device and the skin.”[5]

• Removed from sexual effects:

“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.” [6]

• Removed from sexual effects:

Snellman and Stang, in researching circumcision anesthesia and pain breakthrough, conclude that “the highest concentration of nerves in the penis is located in the frenulum on the ventral surface of the penis,"[7]

• Removed from sexual effects:

“Techniques are available to induce ejaculation in men with SCI (spinal cord injury), who are otherwise anejaculatory. The semen can then be used for in vitro fertilization. External vibratory stimulation involves the use of a vibrator over the glans and frenulum to induce an ejaculatory reflex. [8]

• Removed from sexual effects[9]:

Boyle et al. (2002) argued that "structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation." “The loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response" may reduce a "circumcised man’s ability to achieve arousal." …"Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback" erectile dysfunction and premature ejaculation may be a complication of male circumcision, potentially making "intercourse is less satisfying for both partners when the man is circumcised."TipPt (talk) 15:11, 20 September 2008 (UTC)

The principal question, in my mind, is what level of detail is appropriate for the general circumcision article, and what is more appropriate for the Sexual effects of circumcision article? Adding every single study that address the sexual effects of circumcision to this article will rapidly degrade its quality and cause major problems with prominence and reliability. What would be the threshold for inclusion? Does a study based on respondents to a survey in an anti-circumcision pamphlet give a good indication of women's attitude about sex with circed and noncirced partners? Does a study that measures a man's sexual pleasure following a circumcision for a condition that made sex painful warrant inclusion in this article? I don't think either of these studies should be placed in the general article. AlphaEta 15:36, 20 September 2008 (UTC)

Alpha is right to bring up the question of how much detail to include in the main article and what to leave for the more specific sub-article. I personally think taking a study by study approach with a general article is wrong. We should leave sentences like "such and such a study said this.... And "such and such a study said that" to the subarticle. I think just outline some of the main points from each side of the argument. This would have the added benefit of keeping the article short as well. Tremello22 (talk) 20:05, 20 September 2008 (UTC)

Agreed. The article was broken into sub-articles for a reason. -- Avi (talk) 01:13, 21 September 2008 (UTC)

Should we also put the part cited from the Letter to the Editor about it being "more humane" to refrain from providing a male infant anaesthetic before cutting into his penis into a subarticle, Avi? WP:SUMMARY can be invoked to sidestep WP:NPOV -- let's be wary of that. I oppose the removal of the parts AlphaEta mentions unless this piece of unreliably sourced POV is also removed. Blackworm (talk) 19:17, 21 September 2008 (UTC)

Which source are we talking about, specifically? AlphaEta 19:24, 21 September 2008 (UTC)

Also, I'm not sure what I've proposed for removal.... AlphaEta 19:37, 21 September 2008 (UTC)

I oppose lengthening the article. I think we need to keep it as balanced and NPOV as possible within length constraints. Too much information would simply overwhelm most readers, who wouldn't read the whole thing; it's good to select the most notable information for this article, leaving more detail to the subarticles. I agree with Blackworm about due weight: I think the paragraph beginning "J.M. Glass" and ending "local anesthetic" gives undue weight to a couple of publications which are little more than individual opinion, and which are not review articles (see WP:MEDRS); I suggest shortening this paragraph to a single sentence with a single reference, not the letter to the editor. I suggest trying to stick to the length of each section listed in one of the tables at Talk:Circumcision/Archive 32#Article too long?. ☺ Coppertwig (talk) 19:47, 21 September 2008 (UTC)

[edit conflict] Search for "Tannenbaum and Shechet, 2000" in the article. Their letter to the editor forms half a paragraph of this article, and attempts to move or remove it have been resisted by Avi etc. Note also this discussion -- which I believe shows a community consensus that the material must be removed, and Avi believes shows a community consensus that the material can be included without any mention of it being a letter to the editor.

You've proposed moving two sources to subarticles, in your post above, if I'm not mistaken. The only problem I see with them if it is not made clear to the reader that the male adult patients had medical problems which interfered with sexual pleasure and function, and underwent circumcision as treatment. Obviously many such studies are cited in an attempt to show that circumcision increases sexual pleasure, which of course is disingenuous to the alert reader (but it works for the masses, so it's in Wikipedia). Blackworm (talk) 19:50, 21 September 2008 (UTC)

I just picked a couple of examples that I've read in the past few months. I didn't realize they actually appear in this article! I'll have to conduct another careful reading of the citations. AlphaEta 13:48, 23 September 2008 (UTC)

I agree with you that the statements by Tannenbaum and Shechet are given undue prominence. The idea that Jewish ritual circumcision is shorter and less painful than methods that utilize clamps or ligature, which involve crushing hemostasis, appears to be speculative. Moreover, the citation used by Tannenbaum and Shechet in the 2000 AAP letter to support this claim is another letter they wrote to JAMA in 1998. The JAMA letter posits that an anesthesia injection would be more painful than the bris itself. However, I don't see any evidence to support this claim (it's possible I'm overlooking it, though). I would recommend that we condense the material to something like:

Some researchers claim that because traditional Jewish bris is rapid and does not rely on clamps or ligature for hemostasis, it is less painful than other circumcision techniques, and that the pain of an analgesic injection would actually cause more distress than the procedure itself.[Glass, 1999], [Tannenbaum and Shechet, 2000]

Or, delete it outright. Thoughts? AlphaEta 13:48, 23 September 2008 (UTC)

No, I have no objection to Glass, and I'm unsure about merging these two sources into one sentence where they weren't before. Jakew, is that good WP:SYN or bad WP:SYN? I never understood the distinction you seemed to draw. AlphaEta, I think that's a slight improvement overall. I'd prefer to get rid of the weaseling ("Some researchers...") and have Glass and T&S cited separately (at least). We should consider moving T&S to the subarticle, since that seems to be an occasionally acceptable solution to reduce the "heat level" of mildly disputed but irksome passages. Failing that I'd strongly suggest that T&S be cited as a letter to the editor ("Letter.) in the prose, and especially in the <ref>, but that seems disputed. Avi, thoughts? In the meantime, I'd agree that's probably closer to a consensus. Thanks, AlphaEta. Blackworm (talk) 00:29, 27 September 2008 (UTC)

On meta-analyses

In the 2nd paragraph of 'complications':

One meta-analysis found hemorrhage and infection to be the most common complications of circumcision, occurring at a rate of about 2%.[ref]

The reference cited is Singh-Grewal 2005. This sentence is misleading for several reasons. Firstly, as written, the sentence implies that the authors performed a meta-analysis of complication rates. In fact, their meta-analysis was of the association between UTI and circumcision. Their study did not "confirm" that haemorrhage and infection were the most common complications, they merely stated it (in the text, they cited Williams & Kapila's review in support of the statement). Nor did they confirm the rate. In fact, the authors explicitly stated that the rate used was an estimate: "we have used a conservative estimate of circumcision complications of 2%". And in an accompanying editorial, they received criticism for using this figure: "The 2% complication rate mentioned is high. In a 1999 report,[6] the American Academy of Pediatrics stated that complications of newborn circumcision are "rare and usually minor" and that complications occur at a rate of 0.2% to 0.6%—3 to 10 times lower than the rate cited by Singh-Grewal et al." (Schoen EJ. Circumcision for preventing urinary tract infections in boys: North American view. Arch Dis Child. 2005 Aug;90(8):772-3)

So, to be more accurate, we'd need to say something like: "In one study, the authors used an estimate of the complication rate of 2%". When put like this, though, it is questionable whether the material belongs in the article. I mean, if it had been a meta-analysis then it would have some value, but an estimate barely seems notable, especially since it is in turn based upon the reviews (W&K and Kaplan) that are already cited.

A similar problem exists in 'HIV':

A meta-analysis of the African randomised controlled trials and other observational studies confirmed that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit. According to this particular meta-analysis, 72 circumcisions would need to be performed to prevent 1 HIV infection.

The second sentence is ok, but the first is erroneous. A meta-analysis can estimate a summary NNT, but cannot confirm that consistently safe practices would be required. A mathematical model could be used to predict the assertion in the first sentence, but in this case it appears to be the authors' conclusion. Additionally, there appears to be an error: the article says "A meta-analysis of [...] and other observational studies", but the abstract indicates that only RCTs were included: "We conducted a systematic review of medical literature, and included any RCTs assessing male circumcision to prevent heterosexually acquired HIV infection among males. [...] We identified three RCTs that met our inclusion criteria, involving a total of 11 050 men." Finally, I cannot understand why we mention the meta-analysis but omit the result of the meta-analysis - a relative risk of 0.44 (95% CI 0.33-0.60). I included a summary of this, and two other meta-analyses including RCT data, here.

I realise that this may seem rather pedantic, but the term "meta-analysis" has a very precise meaning in epidemiology, and if we use it incorrectly it reflects poorly on the article. Jakew (talk) 14:12, 23 September 2008 (UTC)

Not everyone reading this will understand statistical terms like relative risk and confidence interval. How about "the meta-analysis found that circumcision reduces the overall risk of contracting HIV by 0.44%." Tremello22 (talk) 14:59, 23 September 2008 (UTC)

I think that must be a typo! A relative risk of 0.44 means that the risk among circumcised men is 44% of (or 0.44 times) the risk among uncircumcised men. Jakew (talk) 15:06, 23 September 2008 (UTC)

No not a typo , just me not being acquainted with relative risk. But I am now, you just divide the amount of men infected in the uncirc group by the ones in the circ group, right? However articles such as this which state "circumcision can reduce the transmission of HIV in heterosexual men by as much as 65 percent." is kind of misleading and deliberately sensationalising the results. If you take the results of the Ugandan trial:

• 22 of the 964 retained in the circumcised group got HIV. Which gives a risk of 22/964 X 100 = 2.28 (infected with HIV per 100 people)
• 45 of the 980 retained in the uncircumcised group got HIV. Which gives a risk of 45/980 X 100 = 4.59 (infected with HIV per 100 people)
• 4.59%-2.28%= X 100 = 2.31 <----

So the chances of African men contracting HIV has only increased by ~2%. But of course that wouldn't be as impressive a way of presenting the findings. Also there have been many criticisms of the trials; I'm sure if confounding factors were limited and some of the flawed methodologies were rectified then that 2% could easily be accounted for.

You mention you have a problem with the author's conclusion yet you don't seem to have a problem with the WHO giving their conclusion? Either way I am sure you will find the best way to put a positive spin on it.Tremello22 (talk) 19:42, 23 September 2008 (UTC)

I've warned you about this before, Tremello22. Comment on content, not on the contributor. Jayjg ^(talk) 00:12, 24 September 2008 (UTC)

Tremollo, that is the difference between absolute and relative risk, and is one of the fundamental problems of any statistical study. In this particular study, on an absolute percentage basis, the difference is 2.31%. However, uncircumcised men were still more than twice as likely to get HIV than circumcised ones. The incidence of HIV worldwide is still very low, thank G-d. There could be many other factors that contribute to why more than 95% of the population does not contract HIV. From a frequentist's perspective, as most people are, the only way to compare the two groups is to compare their relative rates, which is why the 44% (or 2.27 multiplier) is accurate. If you were subscribed to the Bayesian school of thought, we would need some more data, I reckon.

Just to compare, the Hemorrhage bullet in the "immediate complications" section of Medical analysis of circumcision brings as its source Hiss and Horowitz (2000) which describes one case of hemorrhage. Which, out of the estimated 1.2 million circumcisions in the US (as per that very paper) is a rate of .000083%. Yet that was significant enough to get its own section. The 2.31% savings in HIV is over 270,000 times as significant, if you would like to look at it that way. -- Avi (talk) 01:42, 24 September 2008 (UTC)

Small²

I have no problems making quotes even smaller, Tremollo. However, you do know that the refs are already in smaller fonts due to the{{reflist}} template, and also, Firefox and other browsers render the refs as a scrollable list, so space is not an issue in the refs. -- Avi (talk) 18:57, 25 September 2008 (UTC)

no I didn't know that. Tremello22 (talk) 21:47, 25 September 2008 (UTC)

According to that page the reflist|colwidth code "will allow the browser to automatically choose the number of columns based on the width of the web browser. Choose a column width that is appropriate for the average width of the references on the page." It doesn't say anything about scrollable and it is not a scrollable list for me and I am using firefox. Also the quotes are bigger for me if I don't use the "small" code. Tremello22 (talk) 19:54, 26 September 2008 (UTC)

Same here, Tremello. My firefox doesn't default to a scrollable ref list, and the text size is not automatically reduced when quotes are compiled using the reflist format. I prefer using small font for quotations, but I guess it could negatively affect the browsing experience of others. AlphaEta 21:10, 26 September 2008 (UTC)

Then maybe something is different by me, but both at work and at home, I get the scrollable refs. -- Avi (talk) 21:39, 26 September 2008 (UTC)

'Foreskin-based medical and consumer products' section

Is there any particular reason why this section is here? It seems only tangentially related to circumcision, and would fit much better in foreskin. Jakew (talk) 19:59, 25 September 2008 (UTC)

No, because it only deals with foreskins that have been cut off - by circumcision. Foreskins can't be used for these products if they're still attached to the penis, which is what the foreskin article deals with. --Pwnage8 (talk) 20:53, 25 September 2008 (UTC)

That shouldn't matter, Pwnage8. The products are not circumcision products, they are foreskin products. Are fur-related items under fur or skinning? You cannot get the fur without skinning the animal, but we are interested in the product not the procedure—here too. -- Avi (talk) 20:58, 25 September 2008 (UTC)

They are products made from human tissue obtained through circumcision of male infants, as discussed specifically in the sources. Not "tangential" at all. The reader interested in reading about male circumcision should be made aware of the marketable for-profit products of circumcision. Blackworm (talk) 21:21, 25 September 2008 (UTC)

So why isn't fur discussed in skinning according to you? They are marketable foreskin products. Blackworm, can you provide a logical basis for differentiating between fur/skinning and foreskin/circumcision, please? -- Avi (talk) 21:24, 25 September 2008 (UTC)

The lead paragraph of the skinning (stub) article says that skinning is done "mainly as preparation for consumption of the meat beneath and/or use for the fur." So if you want an analogy, let's put the following in the lead paragraph of circumcision: Male circumcision is also performed in order to obtain infant foreskins for use in commercial and medical products, such as anti-aging skin creams. Then you can delete the section. Do we have agreement? Blackworm (talk) 21:36, 25 September 2008 (UTC)

Blackworm, are you aware of any reliable sources stating that the purpose of circumcision is to produce foreskins for use in these products? None of the sources in the article seem to state this, as far as I can tell, so it seems to be a poor analogy. There's a difference in the degree of relevance between the reason why X is done and something that sometimes happens to be done with the byproducts after X is performed. Jakew (talk) 21:52, 25 September 2008 (UTC)

I'm aware of reliable sources stating that foreskins from circumcised babies are used in commercial products. That's enough for me to feel quite comfortable in opposing your and Avi's attempt to remove this information from circumcision. Blackworm (talk) 22:09, 25 September 2008 (UTC)

It isn't accurate to say (or imply) that circumcisions are done to "harvest" foreskin for commercial uses, but I get the point. I think the section is kind of interesting, and I contributed a couple of sentences to it, but I'm not particularly concerned whether it is retained or removed. AlphaEta 22:13, 25 September 2008 (UTC)

Perhaps not, but it is accurate to say that male circumcision results in medical and consumer products that would not exist without male circumcision. Once there is a product based on something (anything), then there is a market for that something. Why should we suppress discussion of the raw materials of the market created by male circumcision (i.e., severed infant foreskins) and the processed consumer products created from those materials (e.g., wrinkle creams for women)? We must have a neutral POV on this, correct? Blackworm (talk) 22:24, 25 September 2008 (UTC)

I think the current verbage is neutral, and the section is interesting, but with respect to removal or retention, I'm not particularly compelled to argue either way. I just wanted to chime in since Blackworm and I are the primary contributors to the section. In other words, I have nothing useful to contribute at this time.... AlphaEta 22:40, 25 September 2008 (UTC)

I find the section fascinating. I had know idea about it until it was added to this article. I think It should be mentioned here as a direct result/byproduct of circumcision. Garycompugeek (talk) 22:16, 25 September 2008 (UTC)

Indeed, but some people would apparently prefer if you remained ignorant of this information. Blackworm (talk) 22:24, 25 September 2008 (UTC)

No one is trying to supress information, Blackworm, but the proper place for foreskin-related products is in foreskin, not circumcision. Other than sensationalism, I cannot think of a reason why products should be listed under the process used to get the raw materials, as opposed to the material itself. Again, notwithstanding irrelevant arguments such as sensationalist wording in opening paragraphs, fur products belong under fur, not skinning. Wigs belong under Hair, not Haircuts. Woolen fabric belongs under Wool, not Shearing, etc. As I said, other than some form of emotional attachement, why is this any different? -- Avi (talk) 23:08, 25 September 2008 (UTC)

Indeed, why is it? Jayjg ^(talk) 23:55, 25 September 2008 (UTC)

Because the circumstance (I couldn't resist) make this special. This is human material being refashioned. It makes it interesting and notable as to "how?" and "from where?". Garycompugeek (talk) 00:02, 26 September 2008 (UTC)

So is head hair when being used to make a wig, but it still does not belong in haircut, but hair, Gary. -- Avi (talk) 00:04, 26 September 2008 (UTC)

As opposed to wigs? In any event, it will be as interesting in the foreskin article as here, and far more relevant. Jayjg ^(talk) 00:05, 26 September 2008 (UTC)

Oh, and Gary, we discuss fertilizer in urine see (Urine#Other uses), not Excretion: quod erat demonstrandum :-) -- Avi (talk) 00:07, 26 September 2008 (UTC)

I think it's notable in both articles. Garycompugeek (talk) 00:53, 26 September 2008 (UTC)

Yes, but that's just an assertion, not an argument, so it carries no weight. Jayjg ^(talk) 01:02, 26 September 2008 (UTC)

(ec) I agree with Gary. I think the foreskin products are interesting and notable and should be mentioned in this article; and can also be mentioned in the foreskin article. Arguments for mentioning them here include that around the time of circumcision, a mother may sign a form giving permission for her baby's foreskin to be used for such purposes, therefore the existence of such products is sometimes part of the whole procedure surrounding circumcision; and that "circumcision" or "circumcised" are mentioned in at least 3 of the references talking about this product, making it notable in this context. Perhaps the same arguments cannot necessarily be made about wigs, fur etc. I think intuitively that this information is interesting and relevant to the topic of circumcision, and I don't see convincing reasons to exclude it: merely analogies without accompanying explanations. Another argument is that many readers of this article may be people considering having their baby circumcised, and I think they would be interested to know that there may be a possibility that they could sign a form and have their baby's foreskin used in this way. I would delete the part about the price of the product, though: that seems relatively trivial and probably time-dependent. One way to do it might be a short mention in this article (at least a sentence, I would say) and perhaps a longer mention in the foreskin article, with of course a link from here. The reason for putting the longer mention in the foreskin article is that while some of the refs mention "circumcision", I think more of them use the word "foreskin"; some mention "foreskin" but do not mention "circumcision", I believe. ☺ Coppertwig (talk) 01:15, 26 September 2008 (UTC)

(<-)Coppertwig, so the fact that the uses of blood are discussed in the blood article and not in bleeding or exsanguination, uses of intestines are discussed in Gastrointestinal tract and not in disembowelment, urine are discussed in the urine article, and not in urination or excretion, and the uses of semen are discussed in the semen article, and not in ejaculation, and the uses of fur are discussed in the fur article, and not in skinning, and the uses of wool are discussed in the wool article, and not in shearing, etc. etc. is irrelevant? If people want to know how the foreskin is used, they would naturally go to the foreskin article, not circumcision, the same way no one would go to urination to learn how urine is used. -- Avi (talk) 01:49, 26 September 2008 (UTC)

Ah! You're thinking that the people who would be interested in this information would begin by asking "I wonder how the foreskin is used". That might apply to wool, urine, etc.; but in this case, I think many of the people who would be quite interested in this information would not even have thought of the idea that the foreskin would be used for anything at all. They might begin with the question, "I wonder what it's like to have a baby circumcised?" or "I wonder what happens when a baby is circumcised?" Simply listing a number of examples of how other articles are arranged, without saying anything about why they are arranged that way, doesn't convince me; and I notice that you haven't addressed the two things I pointed out as possible differences between the case of circumcision and those other examples. I think the important thing to include in this article is a statement of the fact that foreskins are used; the details of how they're used can perhaps be in another article, with a link from here. Regards, ☺ Coppertwig (talk) 02:10, 26 September 2008 (UTC)

Exactly Coppertwig. I had no idea such a relationship existed, however my interest in this topic revealed the connection. Garycompugeek (talk) 02:38, 26 September 2008 (UTC)

I agree with those saying this section needs to be restored. Avi, some things on that list of topics you mentioned aren't procedures and they don't have an end product. Of the procedures you mentioned: the skinning article is more like a stub. The wool and the uses of wool are obvious and it is also a vast subject - which means that the sheering article would be too long. Adding a short section in the circumcision article is fine. Avi you took it out with the explanation "per talk" as if there was consensus to remove it. Tremello22 (talk) 19:46, 29 September 2008 (UTC)

Tremollo, I did not delete it, but moved it up in the article to the procedures sections. Being that this article is a somewhat contentious one, I would consider it a personal favor if you were to look at what I have written in both the article and the talk page before assuming that I am trying to suppress anything. Thank you. -- Avi (talk) 00:53, 2 October 2008 (UTC)

The information hasn't been removed, Tremello, and calling for its restoration is therefore somewhat puzzling. The same sources are now cited, along with others, in a new paragraph at the end of the 'Modern circumcision procedures' section. See the following section for the rationale. Jakew (talk) 20:09, 29 September 2008 (UTC)

Re-writing the sections

After thinking about Coppertwig's point, I can see that there should be some mention of what is done with the foreskin after circumcision. For example, in Judaism, it is buried, and forbidden to be used. So I am going to edit the "Modern circumcision procedures" by adding a paragraph about post-circumcision foreskin treatment in which it is stated that some foreskins are used by the medicinal industry, foreskins from a bris milah are buried, and if there are other special dispositions they are listed there. Specific examples such as $130 skin cream belongs in the foreskin article. This way, immediately in the procedures section there is a link to disposition, and we do not have $130 sensationalism. -- Avi (talk) 03:47, 26 September 2008 (UTC)

• Change to this article
• Addition to Foreskin article

--Avi (talk) 03:49, 26 September 2008 (UTC)

This seems an acceptable compromise, and at least we don't have an entire section of dubious relevance. Let's keep an eye out for a reliable secondary source that summarises this info, though. If one can be found we can cite that instead. Jakew (talk) 11:15, 26 September 2008 (UTC)

Not dubious to me Jake. I thought we agreed to keep the section. We can drop the price since that is irrelavant and I like Avi's addition to Modern circumcision. Garycompugeek (talk) 17:21, 26 September 2008 (UTC)

Avi, it is not acceptable for you to label anything which you wish to suppress "sensationalism," as I've seen you do in the past. This information, i.e. the foreskin market and parts of the penis being viewed and used as "raw materials" greatly informs the debate on circumcision. (Jakew labels the foreskin severed by circumcision a "byproduct," but that is a POV -- what isn't a POV (i.e. is verifiable) is that the foreskin severed by circumcision is being made into products.) I do not believe any other human body parts (tissue, with nerves, blood, pain receptors, etc., not hair) are extracted from humans who do not give their consent, then bought and sold and used to make consumer products; thus any analogies with "fur" or "hair" are falling on deaf ears in my case. Circumcision and circumcision advocacy is the mechanism which creates these for-profit products, as specifically mentioned in the sources, and I strongly object to your attempts to suppress this material here. If the facts about what are being done with severed foreskins upset you, write a letter to your politician -- labeling neutral information from reliable sources "sensationalist" and using that as a rationale for keeping the information far away from information on circumcision (i.e. this article) is not WP:NPOV and therefore not acceptable. Blackworm (talk) 18:07, 26 September 2008 (UTC)

The article as written discusses the "circumcised foreskin" near the top of the article, so you should have nothing to fear, Blackworm. Also, your own opinion as to what is bought/sold after medical procedures is exactly that, your own opinion. I understand that you do not like the comparisons to urine, semen, blood, and fur, since it counteracts your emotional belief. However, this is wikipedia, not Blackwormapedia, and thus we need to discuss these issues as respectfully and as neutrally as possible, as Coppertwig and Gary have done in this discussion. -- Avi (talk) 18:17, 26 September 2008 (UTC)

Uh, no, it's not my own opinion -- severed foreskins from circumcisions are sold as consumer products, just like the reliable source says. Please strike out that part of your response. The rest of your response is similarly irrelevant. I believe your, Jayjg's, and Jakew's responses are disrespectful too, in the extreme -- but then coming from such diametrically opposed points of view it isn't surprising that we both feel that way (I believe the penile foreskin is a part of the human male body, while you apparently agree with Jakew that it is a "byproduct"). Blackworm (talk) 18:29, 26 September 2008 (UTC)

I've reviewed the changes Avi made and can abide by them, although I'm not sure the uses and disposal of foreskins severed by circumcision belong in the "procedure" section. I suppose it's all right for now, until we add more information, and create a new section to explore these details. I've added some more material related to this as well. Also, with regard to analogies to other articles, one example of an article on a procedure which deals extensively with the products of that procedure is seal hunting. As the procedure is controversial, it makes much more sense that the facts surrounding the controversy be explored in greater detail, as is the case here. The consumer products are not the seals, which were always there, but the dead seals, killed by seal hunting. The consumer products are not the foreskins, which were always there, but the severed foreskins, severed by male circumcision. Blackworm (talk) 21:41, 26 September 2008 (UTC)

Avi, I appreciate the flexibility and creativity you showed in listening, compromising, and also adding additional interesting material. It's delightful to finally be involved in a discussion at the same time as you (and to boldly split infinitives...); I was already thinking of saying that before you started agreeing with me – honest! (Not the part about the infinitives, though. Or the flexibility etc. Not the part after "Now, here's the plan.")

Would you please provide a more complete citation for the Yoreh Deah reference? I think we need a page number or section number (chapter and verse?),^{(16:10 28 September 2008)} I think we also need (or at least it would be useful to have) a quote in Hebrew and a translation of the quote into English; the translation can be by a Wikipedian. All that can go in the footnote. See Wikipedia:Verifiability#Non-English sources. I'm not sure if the part about burying the foreskin has an English translation in Wikisource. Here's another possibly useful reference: "After circumcision, Jews traditionally bury the foreskin." [10] (From Abraham to America By Eric Kline Silverman.) The bit about burying the foreskin needs to be reworded: the Wikipedia article must not itself assert that anyone "must" do something. The exact rewording may depend on what precisely the source says. How about inserting "Under Jewish law," at the beginning of the sentence? Do all major groups of Jews recognize this law? ☺ Coppertwig (talk) 13:38, 27 September 2008 (UTC)

Coppertwig, the way sections are referenced in the Shulchan Aruch is exactly how I have given it: Which Work (Yoreh Deah, Oruch Chaim, Even Ha'Ezer, or Choshen Mishpat) and then Chapter and Section ("Seif" in wikisource). So the requirement for burying the foreskin is in Chapter 265, Section 10, which has not been translated in wikisource just yet, I've just added it. Page numbers are not the proper way to reference this, as there have been multiple printings, each with the exact same words, but different layouts. This is the way all the responsa reference Shulchan Aruch, and anyone with a copy (and almost every Orthodox Jeish home will have one, and every shul, yeshiva, and kollel will have multiple copies) can find it immediately with that reference. It is eminently reliable and easily verifiable in print if necessary. -- Avi (talk) 02:49, 28 September 2008 (UTC)

I have amended the text to read "should" instead of "must" and added "According to halakha..." which should cover which branches do what. -- Avi (talk) 02:51, 28 September 2008 (UTC)

And lastly, I would be remiss for leaving out that it is a pleasure to work with you as well . Of course, you know that I greatly respect your ability and judgment -- Avi (talk) 03:04, 28 September 2008 (UTC)

Severed foreskins

This couching of circumcision in language like "removed" instead of "cutting" or "severing" or "amputating" seems a result of emotional attachment to male circumcision, but is not reflected in reliable sources. Please see pages 31 and 50 of [11], Circumcision in Man and Woman: Its History, Psychology and Ethnology, a 2001 book on circumcision (all circumcision, not only the male circumcision discussed in this article and incorrectly and non-neutrally labeled "circumcision"). Other Google Scholar searches on other terms such as "amputation" and especially "cutting" (still no idea why that is suppressed) will reveal that the terminology is well reflected in reliable sources. Blackworm (talk) 21:53, 26 September 2008 (UTC)

Removed is also used in literature (http://www.jimmunol.org/cgi/content/abstract/160/1/60 for example). So restoring "shocking" terms is also evidence of an emotional attachment to circumcision and foreskins, I reckon. 8-) -- Avi (talk) 21:56, 26 September 2008 (UTC)

• http://www.springerlink.com/content/r5639303326050kt/
• http://www.jhc.org/cgi/reprint/38/12/1847

Just some other examples of "removed" in the literature. -- Avi (talk) 22:01, 26 September 2008 (UTC)

That the word "severed" is shocking to you is irrelevant. The word "severed" means, [12] to put or keep apart : divide; especially : to remove (as a part) by or as if by cutting; : to become separated. It is used in reliable sources to describe the severed foreskin. It is both more accurate and more informational than "removed" as the latter word says nothing about how it was removed, and also carries an implication that the foreskin is not a part of what it was "removed" from, i.e. the penis, which in this case is disputed. (I realize every attempt is made here to frame the foreskin as a separate "byproduct" of the body to be "removed," and not a part of the penis that is often "severed," but clearly reliable sources contradict that.) Plenty of words and phrases used in this article are shocking to me ("circumcision," "uncircumcised," "benefits," (to some extent, compare its antonym, "harms") "removal of too little skin," "more humane [not to use anaesthetic]," etc.) and yet I have no rationale to oppose them merely based on the terms, because those terms are used in reliable sources. The thing is, for so long editors here have only acknowledged one side's emotional attachment to the subject, and have organized and written the entire article in that perspective, avoiding all recognition that the idea of circumcision itself is shocking to many. That double standard must change, Avi. Blackworm (talk) 22:12, 26 September 2008 (UTC)

Per Google hits, "removal" seems preferable for the first sentence of the article. Google hits: "circumcision severing" 14,400; "circumcision severance" 27,500; "circumcision removal" 928,000. (Not all hits involve relevant uses of the words.) See also discussion at Talk:Circumcision/Archive 41#Circumcision is, of course, surgery. Blackworm, I think you have a good point that the word "removal" could be taken as implying that the foreskin is not part of the penis; "severance" seems better to me in that regard. "Severance" would apply even if it is considered that crushing with a clamp isn't "cutting". It would resolve the possible ambiguity in "removal" (i.e. retraction). "Severance" would be accurate whether the procedure involves surgery or any other situation (done by barbers; forced circumcisions, or whatever). However, I'm impressed by the preponderance of Google hits and support the use of the word "removal", which after all doesn't seem to me to have any very serious problems. Besides, "severance" is a less common word and might be confusing to some people. ☺ Coppertwig (talk) 03:16, 27 September 2008 (UTC)

The above is an odd approach, Coppertwig. Must we use the same term consistently, universally, and throughout? There is no rationale for Avi's changing "severed foreskin" to "removed foreskin."[13] Here are some much more relevant Google search statistics: "severed foreskin"[14] has 2140 hits, while "removed foreskin"[15] has 1750 hits. Blackworm (talk) 04:08, 27 September 2008 (UTC)

NPOV requires that we document points of view, but not that we share them. POVs should generally be described with a detached tone. For example, if a judge described a convicted murderer as a "brutal sociopath", then instead of saying "Smith was a brutal sociopath", we say (for example) "the sentencing judge described Smith as a 'brutal sociopath'". (I'm assuming, for the sake of argument, that it is judged important to note this description. If not, we might say something else, like "the judge sentenced Smith to life imprisonment".) Other sources may use language to express viewpoints in more subtle ways. A proponent of circumcision might say "as a result of this beneficial procedure, tissue is available for burn victims". An opponent might describe the same fact by saying "after the child has been cruelly mutilated, the amputated foreskin can become available for burn victims". If the fact (let's presume that it is a fact) is important, then the language used by the sources is unimportant, and we should choose the most neutral term. If the language used by the source is also important, then it's probably wise to quote or otherwise attribute any inflammatory or otherwise non-neutral language. "Severance" does have certain non-neutral connotations, so I would recommend "removal". Jakew (talk) 13:02, 27 September 2008 (UTC)

I think "removal" lends itself to "take from not apart of" ie John had a wart removed. Garycompugeek (talk) 13:43, 27 September 2008 (UTC)

I think it could just as easily be "John had a leg removed", Gary. A quick search of Google Scholar reveals several examples: "...physicians must remove a limb from a patient to prevent the spread of disease...", "...remove a limb such as a leg or an arm...", "...sufferers from BIID who attempt unsuccessfully to remove a limb themselves...", "Remove a limb following irreparable trauma to the extremity...", "A child undergoing a single surgery to remove a limb..." Jakew (talk) 13:58, 27 September 2008 (UTC)

Who would say, "John had a leg removed?" They would say, "John had his leg amputated" or "John lost his leg." And according to Google there's over 800 occurances of "amputated a limb," but don't you think it would be a bit disingenuous to list a handful here? You have no evidence that the word "severance" has non-neutral connotations. Please Jakew, abide by policy. Blackworm (talk) 19:35, 27 September 2008 (UTC)

Jakew -- did you even CHECK this? "Amputate a limb" in Google Scholar, 182 hits. "Remove a limb" in Google Scholar, 48 hits. Please stop assuming the term you prefer is the most common or the most neutral term. Blackworm (talk) 19:39, 27 September 2008 (UTC)

I think you may have misunderstood my point, Blackworm. I didn't say that it was the most common term, and I'm not sure how one could determine neutrality of a term by frequency of use. My point was merely that "removed" can apply as easily to a leg as to a wart. Jakew (talk) 19:52, 27 September 2008 (UTC)

So how would you determine neutrality then? By WP:CONSENSUS? Is there a consensus on "severed" vs. "removed," Jake? If not, and considering my rationale for my edit, and Avi's rationale for his edit partially reverting mine, what is the proper way the article should read right now, Jakew? Let's settle that first, okay? Blackworm (talk) 21:31, 27 September 2008 (UTC)

(ec!) In my comment above I was only talking about the first sentence of the article; I hadn't looked at the changes to the procedures section yet. I favour using "removal" in the first sentence and "severed" in the procedures section. "Severed" seems to me to be a reasonably neutral term and is preferable for some reasons I gave above; and the phrase "the removed foreskin" sounds awkward to me: perhaps "removed" is not often used as an adjective, or is it because the cluster of consonants vdf is hard to pronounce? There are advantages for NPOV and style to using different terms in different places in the article. As a compromise, I suggest avoiding both terms by saying instead "the foreskin after circumcision". It's great to have you back, by the way, Jake. ☺ Coppertwig (talk) 14:07, 27 September 2008 (UTC)

Sure I'm not trying to say it cannot be used and understood in a proper sentence. I'm trying to point out what the word itself means in general terms. [[16]]:moving or being removed, relocation, dismissal. This leaves room for ambiguity. A more direct term would state that what we are "removing" was attached to something else. Garycompugeek (talk) 14:15, 27 September 2008 (UTC)

"removed" would be used when you are taking something (such as an organ) out of the body I reckon, severed implies it was cut out/off, therefore it is more accurate to say "severed". I don't think using severed is "shocking" - I think people know what circumcision entails. Also, I think removed is often used when the thing being removed is bad and needs to be removed - i.e "we removed the tumor" or "we removed the abscess" So in a way "removed" is less neutral. Tremello22 (talk) 20:26, 27 September 2008 (UTC)

(<-)I took out all adjectives so everyone can relax :) -- Avi (talk) 02:31, 28 September 2008 (UTC)

Why must we put no adjective, rather than describe it as "severed," Avi? What rationale do you have for that edit? Blackworm (talk) 04:25, 28 September 2008 (UTC)

Because the use of of any of the terms is engendering complications, be it "removed" or "severed" or "circumcised" or whatnot, so since the sentence is no re-written as to obviate the need for any adjective, there should be no more problems. Unless, of course, someone is not interested in building an encyclopedia, but instead is trying to push some sort of agenda in which one term or the other would be useful in adding an emotional charge to the article. But of course, we all know that is not allowed in wikipedia. -- Avi (talk) 04:38, 28 September 2008 (UTC)

Pure nonsense. You are denying a forms of expression you don't like based on your own narrow, unsourced, original research. You are the one appearing to push an agenda by attempting to ban language used in reliable sources based on nothing more than your fiat. When this is made clear to you, you take more steps acting like some neutral party ("everyone relax"), with an air of invoking some administrative privilege, but with a result that still bans the neutral language you don't like. Now, when that is exposed as nonsense, you break into this wild attack in which you accuse me of pushing an agenda because I described a foreskin cut off the rest of a penis "severed." Completely ridiculous and disrespectful, Avi. You have no sources, no rationale, nothing. I am trying to build an encyclopedia, what are you trying to do? Where is your proof that the word "severed" is considered too biased to describe the piece of the foreskin separated by cutting from the penis? You have none. Abide by policy, and self-revert your rationale-less edit. No one objects to "removed," it's in the the first sentence of this article; similarly no one should object to "severed foreskin." "The edit has 'complications'" -- seriously Avi, in the face of someone asking you for a rationale, that doesn't cut it and I think you know it. Blackworm (talk) 07:15, 28 September 2008 (UTC)

In a nutshell, unless you are imagining some company making skin cream out of attached foreskins, or feeding the foreskin to the calf with the rest of the person, your continued perseverance in trying to sensationalize the article is not in compliance with WP:NPOV. -- Avi (talk) 07:30, 28 September 2008 (UTC)

Pure original research. You have no rationale to oppose the phrase "severed foreskin." Blackworm (talk) 17:23, 28 September 2008 (UTC)

The exact same rationale you use to oppose "removed foreskin," Blackworm . And since I was able to have the article disseminate the same information without using any such adjective, I have followed the wiki way here. Further attempts to re-introduce unnecessary contentious verbiage would appear, at face value, to be disruptive editing. -- Avi (talk) 18:57, 28 September 2008 (UTC)

So if it's same rationale as me, why is mine wrong and yours correct? Why do you oppose "severed foreskin?" How is the foreskin not severed from circumcision, or under what circumstances is it inappropriate to refer to the segment or entirety of the foreskin that is cut off from the rest of the penis, as "severed?" You appear to have a great interest in removing "severed foreskin," judging by the effort you make to remove the language (multiple reverts), but you have not demonstrated any rationale. Is your interest in the matter similar to my interest in removing the word "uncircumcised"[17] (sometimes meaning "heathen") from the article,(read Jakew's[18] and your[19] responses to that), in your view? Since you raise WP:NPOV concerns on it, what connotations, in your mind (if not in any reliable sources, which so far you have failed to bring), does the word "severed" bring? I'm willing to be convinced by an argument, but all you have is assertion. Do you allow me to veto terms used in reliable sources because of a perceived potential emotional response provoked by the words, Avi? Or is that a privilege reserved to you, and those who agree with you? You haven't shown any rationale or applied any Wikipedia policy in changing my preferred adjective in this sentence to yours, or to the use of no adjective. Blackworm (talk) 20:45, 28 September 2008 (UTC)

More historical reading (full Talk sections): Prelude,[20] and extended discussion.[21] Blackworm (talk) 20:59, 28 September 2008 (UTC)

Speaking of historicity, Blackworm, it was I who first penned that sentence in the article. Your insertion of severed was the revision. Regardless, I found a neutral way to phrase the information, which somehow, disappoints you. I'm sorry that WP:NPOV doesn't please you in this case, but our goal here is not to please you or me, but to build an encyclopedia in accordance with wiki's core principles. It appears to me that in this particular instance you are the sole editor not wishing to have the article be more neutral. Why would that be? You have professed to desire to edit in accordance with wiki's guidelines. What has changed now? -- Avi (talk) 01:54, 29 September 2008 (UTC)

No, you seem to misrepresent the facts (there was no "insertion," it was a "replacement"), and make further personal attacks ("sole editor not wishing to have the article be more neutral"). At first, you penned "circumcised foreskin."[22] You apparently recognized the need for an adjective. Unfortunately, that adjective was somewhat confusing and imprecise, as it could be read to mean the remaining fragment of foreskin. My change was perfectly neutral, and had no such confusion: "severed foreskins." You objected to that wording, and changed "severed" to "removed,"[23] to which several editors have pointed possible out POV issues. I put "severed" back, you put "removed" back again.[24] For some unknown reason (do you see POV in both terms?), you then removed the adjective altogether,[25] leaving a sentence that conveys less information. Presumably, if "part or all" of the foreskin is (removed/severed) during male circumcision (see our definition), then the foreskin remaining on the penis may be referred to as the "circumcised foreskin," correct? Is that the one being used to make anti-wrinkle creams for women? Likely not. The current edit still has some of that potential confusion, for the "disposition of the foreskin" may mean the state of the remaining foreskin on the penis. Now, note that "removed" is used in the lead sentence of this article. Despite the POV issues with the word raised by several editors here (apparently banned from the definition: "(genital) mutilation," "(genital) cutting," "surgery,") I think we all recognize that we need to use some word, whether preferred by those supporting male circumcision or those opposing it, to convey the essence of circumcision, and thus there hasn't more than grumbling resistance to "removal." But, "removal" has high prominence already, and repeating it like a mantra (i.e. removing occurrences of any other terms) seems to reinforce, rather than dampen the POV issues editors here seem concerned about. What is the reason for that, Avi? I suggest we use a variety of terms to describe circumcision, as reflected in the sources. "Severed" is a neutral term, as the reliable sources show, and as several editors here agree. You have no rationale to insist on the deletion of the term, especially given your failure to provide sources backing up your claims of it being "shocking" terminology. Blackworm (talk) 03:43, 29 September 2008 (UTC)

You are repeating yourself, Blackworm, so I will as well. In a nutshell, there were issues with various terms, the sentence has been re-written to obviate the need for any terms, which is in accordance with wiki's policy of WP:NPOV. Simple enough, it appears. -- Avi (talk) 18:40, 29 September 2008 (UTC)

Prove that there is an issue with "severed." Your reasoning (i.e. your uncited assertion that "severed" has NPOV issues) was apparently not a valid rationale for me to oppose "uncircumcised,"(though I had a source[26], and an argument) according to you, thus I do not recognize it for "severed." What's simple enough is that you have no case to delete "severed." I will restore it, per the discussion here, should you continue to fail to provide a supporting rationale. Blackworm (talk) 19:42, 29 September 2008 (UTC)

Note also WP:CIVIL, which states: Editors are expected to be reasonably cooperative, to refrain from making personal attacks, to work within the scope of policies, and to be responsive to good-faith questions. Why are you making personal attacks, failing to work within the scope of policies, and failing to respond to my questions above, Avi? Your incivility has now reached a high level. Blackworm (talk) 19:54, 29 September 2008 (UTC)

Blackworm is making some valid points here. Avi and Jakew, you've stated that "severed" is non-NPOV and has connotations, but I don't remember seeing any more detail than that. What connotations do you see it as having, and why do you consider it non-NPOV? What arguments do you have to support those points?

The word is not redundant in the sentence. I was going to point out, as Blackworm did, that "the disposition of the foreskin" could be taken to mean the disposition of that part of the foreskin that's still attached to the penis: are stitches used to close the wound? Is anything done to prevent skin bridges? etc. Leaving out the word could mislead the reader, violating the principle of least astonishment, i.e. leading to a jarring sensation when one comes to the next sentence and suddenly realizes that something quite different is meant. To me, the word "severed" seems to have an appropriate level of precision (conveying more information than "removed", for example), and to have a neutral, medical-sounding tone while not excluding non-medical situations.

While I prefer "severed" for the reasons given above, (and besides, I like the sound of the word,) as a compromise, instead of "After circumcision, the disposition of the foreskin varies." I suggest "The disposition of the foreskin after separation from the penis varies." ☺ Coppertwig (talk) 01:36, 30 September 2008 (UTC)

Thank you, Coppertwig, for the much needed new voice. I could abide in this instance by: "The disposition of the foreskin (or part thereof) separated from the penis varies." This, in accordance with our definition, which states that circumcision removes "part or all" of the foreskin. I still protest the consistent enforcement of language potentially implying that the foreskin is not an integral part of the human male body, and the avoidance of all language potentially implying that it is an integral part of the human male body. I believe this enforcement violates WP:NPOV policy, but I suggest this edit in the interest of putting this petty but significant example of ownership of an article by fiat behind us. I reserve the right to describe foreskins severed by male circumcision as "severed foreskins," both here and in the article at any time. Blackworm (talk) 06:49, 30 September 2008 (UTC)

Separation is usually used to describe the gradual, natural separation of the foreskin from the glans. When a boy is born his foreskin is attached to his glans. Sometime between infancy and adulthood the foreskin naturally separates from the glans and becomes retractable. In my opinion using separation to describe a foreskin that has been cut off from a boy's penis is confusing. -- DanBlackham (talk) 08:06, 30 September 2008 (UTC)

Apparently we're not allowed to say "cut off." It's always "removed." Like a tumor, cyst, mole, or parasite. That is the policy according to Avi and Jakew. Blackworm (talk) 20:43, 30 September 2008 (UTC)

(<-)I'll try saying this again, Coppertwig. Being that there is consternation about the connotation of both terms "severed" and "removed", as I was able to re-write the sentence without the need for either, yet maintaining perfect clarity, why are we still discussing this? Isn't finding a neutral, non-partisan way to word things the essence of WP:NPOV? -- Avi (talk) 00:55, 2 October 2008 (UTC)

We're discussing it because your edit is disputed, and apparently lacks WP:CONSENSUS. Blackworm (talk) 06:31, 2 October 2008 (UTC)

Also, if you won't respond to my questions, could you please respond to Coppertwig's questions, since apparently you "greatly respect [his] ability and judgment" ? Or are you going to be incivil to him, as well? Blackworm (talk) 07:05, 2 October 2008 (UTC)

Avi, you are claiming "severed" is non-neutral when it isn't. It is the most accurate word to describe what happens. This isn't a place for euphemisms. I think if this was a one-off people wouldn't be that bothered, but it isn't. There has been a concerted effort from certain editors to tone down the unpleasant aspects of circumcision which isn't right because it is not reflecting the true reality, and Wikipedia isn't a place for censorship. Tremello22 (talk) 12:01, 2 October 2008 (UTC)

The main problem with "severed" is that the word carries connotations of gore and violence, Tremello. From an anti-circumcision perspective, perhaps those connotations are justified or even intended, but of course Wikipedia is not a soapbox. The proper way to "reflect the true reality" of the procedure is through neutral, appropriately-sourced description of the procedure, not by attempting to drive the point home by using certain language throughout the article. As a general rule, if a point is so weak that can only be made through use of loaded words (as opposed to neutral description), it probably isn't worth making. Jakew (talk) 13:47, 2 October 2008 (UTC)

Jake severed only carries those connotations because of your perception. Wiktionary define's[severed] as separated, cut off or broken apart. Doesn't sound too dramatic or violent to me. In the end it would depend on the context. Garycompugeek (talk) 14:57, 2 October 2008 (UTC)

Jakew, welcome back to this discussion. If you haven't noticed, I asked a question of you above, days ago. Please respond to questions addressed to you. Thank you. Blackworm (talk) 21:20, 2 October 2008 (UTC)

(<-)And also unnecessary, Gary, the way the paragraph is written. -- Avi (talk) 15:01, 2 October 2008 (UTC)

How can you say this again, without further expansion, in the face of two editors (myself and Coppertwig) asserting the contrary and giving a rationale? Also, what gives you and Jakew the right both to ban language you feel has "anti-circumcision" POV connotations ("severed," with more than two editors opposing you), and insist on the use of language others feel has "pro-circumcision" POV connotations ("removed," with more than two editors feeling that way)? Note, again, that both terms you non-neutrally label "problematic"[27] are already in the article, as they are used in many reliable sources. (I see no objection to the lead sentence from you, and assume you would revert attempts to remove the "problematic" word "removal" there. Am I wrong?) You have no case. Please resume having some civility at some point, and allow other editors to use terms used in reliable sources (including very pro-circumcision sources[28]). At the very least, acknowledge the parallel of your "argument" without sources to arguments to remove the word "uncircumcised" due to explicit, sourced high-quality references[29] showing the word has extremely negative connotations -- arguments you have also shrugged off without rationale. If you want to have this issue moderated or arbitrated, I am prepared to go that route. Are you? Blackworm (talk) 21:20, 2 October 2008 (UTC)

Jakew, the definition of gore is "Blood, especially coagulated blood from a wound." Now that seems pretty accurate to me. My point still stands. It is nothing to do with me getting on a soap box and trying to use loaded words. Like I said it is a medical term and is the most accurate word to use to describe what happens. Tremello22 (talk) 15:20, 2 October 2008 (UTC)

(<-)C-Twig, since circumcision is defined above as removal of some or all of the foreskin, I think it self-evident that we are discussing the removed foreskin, but I personally can accept the compromise of "separated foreskin" as you suggest. -- Avi (talk) 23:40, 2 October 2008 (UTC)

"Separation" is the term used to describe the natural separation of the foreskin from the glans some time between infancy and adolescence. The 1999 AAP Circumcision Policy Statement says, "Separation of epithelial layers that may be only partially complete at birth progress with the development of desquamated tissue in pockets until the complete separation of tissue layers forms the preputial space. As a result of this incomplete separation, the prepuce or foreskin may not be fully retractable until several years after birth." -- DanBlackham (talk) 05:33, 3 October 2008 (UTC)

And "removed" is used in the literature to describe the foreskin separated due to circumcision, but there are those here who do not like that term either, Dan. We are trying to come to some acceptable form of compromise; there are issues with every term. Which is why, I still maintain that the optimal construction has no term, and I am much less concerned that readers will have cognitive issues thinking that pharmaceutical companies are making skin cream out of foreskins still attached to infants; but others here seem to be worried about that image, so we are working on finding a solution acceptable to all. -- Avi (talk) 10:19, 3 October 2008 (UTC)

Why should we? "Removed" isn't banned from the article despite concerns nor will it be. Same for "uncircumcised" (i.e. "heathen"). "Severed" shouldn't be either, as that would be enforcing a POV-based double-standard. Why should anyone "compromise" when that compromise can only apparently mean "we exclude all terms Avi/Jakew want excluded, and exclude no terms Avi/Jakew don't want excluded." Also please respond to my suggestion that we enter formal mediation regarding this issue. Blackworm (talk) 15:31, 3 October 2008 (UTC)

As the lengthy discussion above makes quite clear, this emotive pleonasm is both unnecessary and unhelpful. Please avoid WP:POINT, thanks. Jayjg ^(talk) 22:47, 5 October 2008 (UTC)

It's not clear to me, Jayjg. Would you please explain, including an explanation as to what part of my argument of 01:36, 30 September 2008 you disagree with? That's where I explain why, in my opinion, the word "severed" (or equivalent) is not redundant, by which I mean that it's not unnecessary. Avi, you say it's self-evident that we're discussing the removed foreskin. It doesn't seem self-evident to me. Since it might be only part of the foreskin being removed, the reader might reasonably think it's the part still attached to the body being talked about. After all, the part still attached to the body is somewhat important: it may affect that person for the rest of their life, for example whether they have a skin bridge. The part being removed one might think is simply discarded and unimportant, and the reader might not give it a second thought, might not even be consciously aware of rejecting the possibility that that's what's being talked about, because it doesn't seem important. ☺ Coppertwig (talk) 01:04, 7 October 2008 (UTC)

Circumcision is the removal of the foreskin from the penis. Once it is removed, it is, well, removed. That means no longer part of the penis. They don't bury it or eat it or make it into medical products while it's still attached to the infant. Jayjg ^(talk) 01:11, 7 October 2008 (UTC)

C-twig, the paragraph discusses burial, skin grafts, cosmetics, candying, etc. I find it very hard to believe that someone is going to think that IN a paragraph discussing the PROCESS of circumcision (not foreskins in general) that a pharmaceutical company is turning infant foreskins into cream while the foreskin is attached to the baby's penis. C-Twig, if I said the following: “Human skin has been used for cosmetic implantation in Lip enhancement” (see Lip enhancement#Materials and techniques would you seriously believe that that on the surgeon's table there is a person having their skin partially flayed off, with one end attached to the donor and the other being stuffed into the lips of the recipient? I hope not. Same here. I note in the Autologen section of Lip enhancement) it says "an injectable dermal material made from the patient’s own skin," not removed skin, severed skin, flayed skin. I believe that is selbsverstandlich as is the case here, and I would request of you, C-Twig, to explain why there is the possibility of imagining infants having their foreskins buried or whatever while still attached to their penis? -- Avi (talk) 01:22, 7 October 2008 (UTC)

Jayjg and Avi, I meant no disrespect in my last edit to the article. In the absence of comments on the alternatives I'd suggested in the following section, it seemed a good idea to me to try the one of them that I preferred most, until getting a clear indication that there was opposition to it. I didn't see your comments until after I'd edited the article, and then didn't have time to reply immediately.

Jayjg, I agree with each of the statements in your last comment but don't see how they contradict what I said: could you explain further? Avi, LOL, that's not what I mean at all! That would be ridiculous. Certainly, when the reader gets to the part about cosmetics, burial etc. they know that it's a detached foreskin. My point is this. Let's assume a reader who has not previously read the article starts at the beginning of the paragraph, reads along until he or she comes to the end, and then stops. (Allusion to Alice in Wonderland.) In that case, when reading the sentence about the disposition of the foreskin, the reader will not yet have read about cosmetics, skin grafts etc. Therefore, when reading that sentence, the reader may well misunderstand it as I said. That's what I meant. When reading the following sentence, any such reader who had misunderstood will then do a double-take and get straightened out. I don't think in any case, even if the reader stops reading mid-paragraph, that there is any danger here of the reader leaving the article with some misconceptions. The only problem, in my opinion – and it is a relatively minor one, concerned only with style and flow, not with NPOV – is that the reader is subjected to that brief misunderstanding and double-take.

I've added some more alternatives in the section below. ☺ Coppertwig (talk) 12:28, 8 October 2008 (UTC)

You are correct about the need for a disambiguating adjective, but you are missing the broader point that we do not generally allow editors to mandate the exclusion from the article of terms used in reliable sources, based on the expressed views of the editor concerned about the term, in absence of support from reliable sources. Arguments based on the idea that "we can rewrite it using terms [certain editors] don't object to" have been rejected by Jakew and Avi in the past, with the sole rationale being an assertion by these editors that the terms are neutral, but it seems that that exact argument is embraced by the same editors when the terms are opposed by them, despite the presence of even more editors who claim the terms are neutral and appropriate. Instead of narrowing the discussion to each specific instance and seemingly changing our approach based on whether the terms are perceived to be supportive or critical of circumcision (a violation of WP:NPOV), we should be attempting to find a consensus on a method of handling these types of disputes -- obviously the current approach is inconsistent.

The only viable solution I can see is that the choice and frequency of use of terms should more or less reflect that of the terms used in reliable sources. As it happens, policy seems to mandate this approach: "Neutral articles are written with a tone that provides an unbiased, accurate, and proportionate representation of all positions included in the article."(WP:NPOV) Also, WP:TONE (guideline) states, "Standards for formal tone vary depending upon the subject matter, but should follow the style used by reliable sources, while remaining understandable to the educated layman." If the position of a large fraction of sources seems to be that "severed" or "uncircumcised" are neutral and impartial, then it seems those terms may be used in this article, does it not? Blackworm (talk) 17:40, 8 October 2008 (UTC)

Alternative terms for "severed"

Current text: "After circumcision, the disposition of the foreskin varies."

An earlier version: "The disposition of the severed foreskin varies."

Suggested by Blackworm: "The disposition of the foreskin (or part thereof) separated from the penis varies."

Possible alternatives, with words selected from Roget's Thesaurus:

• The disposition of the foreskin (or part thereof) detached from the penis varies.
• The disposition of the detached foreskin varies.
• The disposition of the detached foreskin (or part thereof) varies.
• The disposition of the foreskin (or part thereof) when no longer connected to the penis varies.
• The disposition of the foreskin (or part thereof) when no longer attached to the penis varies.
• The disposition of the foreskin (or part thereof) parted from the penis varies.
• The disposition of the foreskin (or part thereof) extracted from the penis varies.
• The disposition of the foreskin (or part thereof) sundered from the penis varies.
• The disposition of the foreskin (or part thereof) cleft from the penis varies.
• The disposition of the foreskin (or part thereof) after being disjoined from the penis varies.
• The disposition of the foreskin (or part thereof) after being uncoupled from the penis varies.
• The disposition of the foreskin (or part thereof) after being dissevered from the penis varies.
• After partition of the foreskin (or part thereof) from the penis, its disposition varies.
• After scission of the foreskin (or part thereof) from the penis, its disposition varies.
• After abscission of the foreskin (or part thereof) from the penis, its disposition varies.

Some more words selected from Roget's Thesaurus:

• disconnected, dissociated, disengaged, reliinquished
• unattached, hived off
• split, unhitch, set apart
• divided, riven, cleft, cloven
• isolated, freed, apart, asunder, sequestered
• divorced, estranged, alienated
• divergence, dichotomy, cleavage, section
• laceration
• incise, trim, clip, snip, snick, prune, dock, pluck
• no longer at one
• no connection
• expropriated, withdrawn
• severally, unconnectedly

I still prefer "severed" but I recognize that some editors see it as having connotations of violence, so perhaps one of the above terms can be used instead. Avi, perhaps you didn't see this comment of mine above or didn't follow my argument as to why in my opinion the word "severed" (or equivalent) is not redundant (nor unnecessary) in this sentence: perhaps you could explain what part of my argument you disagree with. Blackworm, you've asked Jakew to answer a question, but I don't think you've specified a particular question: this previous post of yours contains approximately five questions. All editors should strive to establish good communication, but I don't see Jakew's answering those particular questions as being particularly useful or necessary to this discussion: they look more like rhetorical questions to me, or else like questions to be answered by a consensus process among all editors, not by just one editor. ☺ Coppertwig (talk) 15:39, 4 October 2008 (UTC)

Here are some more alternatives. I know we don't normally use questions in encyclopedic writing, but possibly it's time for an exception.

• (Minimize neoplasm with a zero-length sentence, i.e. just delete that sentence: it adds no information. It does, if understood properly by the reader, help the reader navigate the paragraph, though.)
• The fate of the foreskin after circumcision varies.
• The disposition of foreskins from circumcision varies.
• Where do foreskins end up after circumcision?
• What is the fate of the foreskin?
• Foreskins from circumcision are used for skin grafts. Other...

☺ Coppertwig (talk) 12:25, 8 October 2008 (UTC)

I object to this entire subsection, as it is far from established that we must seek alternatives to "severed." The question I most want answered from Avi/Jakew/Jayjg is: Do you allow other editors with apparently opposite points of view to veto terms used in reliable sources because of a perceived potential emotional response provoked by the words, unsupported by any reliable sources, or is that a privilege reserved to you, and those who agree with your point of view? Blackworm (talk) 17:54, 8 October 2008 (UTC)

Lead

Recent edits have added some problematic material to the lead. This addition is problematic from an NPOV perspective. In the previous version, we include four claims by proponents and four claims by opponents. Depending on how one counts claims, the changes result in dedicating either six or seven claims to opponents.

In one of the edit summaries for these changes, the reason is given that the length of the text differs. To accomodate this concern, we need to change the length of the text, not the number of arguments. We could dedicate six claims to each, but why not seven or eight? At some point, we have to say enough, and four seems a good choice if we're to keep the lead reasonably short.

I've therefore edited each sentence, to try to make them approximately equal in length. (Clarification: I haven't actually edited the sentences in the article yet, but have edited the versions presented here for discussion.)

• Opponents of circumcision claim that it violates the bodily rights of the individual, is medically unnecessary, has an adverse effect upon sexual pleasure and performance, and is a practice defended by myths. [208 characters, 32 words]

• Advocates for circumcision claim that it provides important health benefits which outweigh the risks, has no substantial effects on sexual function, has a low complication rate, and is best performed on neonates. [212 characters, 32 words]

Can anyone improve on this? Jakew (talk) 12:23, 26 September 2008 (UTC) (clarification added 13:06, 26 September 2008 (UTC))

I have restored this to beginning of the para. "There is scientific evidence supporting both sides of the circumcision controversy." Garycompugeek (talk) 13:50, 26 September 2008 (UTC)

I feel like word count is irrelevant, so I'll stick with number of points made to support each side, and their relative gravity.

The risk of complications should be included in the opposition sentence. It should displace the "myths" clause, which is a minor argument that is infrequently used. The following sentence includes 4 arguments that support the opponent's viewpoint.

• Opponents of circumcision claim that it violates the bodily rights of the individual, is medically unnecessary, has an adverse effect upon sexual pleasure and performance, and may incur post-procedural complications.

Schoen's claim that circumcision is best perforned during the neonatal period is also a minority viewpoint, and should be removed. The claim that circumcision provides important health benefits which outweigh the risks is so inclusive that it I think it should allow the advocate's position to be supported by only 3 arguments and still balance the opponent's position.

• Advocates for circumcision claim that it provides important health benefits which outweigh the risks, has no substantial effects on sexual function and has a low complication rate.

Finally, the newly-readded introductory sentence is redundant and confusing in its current form. It reads: There is scientific evidence supporting both sides of the circumcision controversy. At this point in the article/lede, it isn't obvious that a controversy exists, but we refer to the circumcision controversy as though it has already been defined. Part of the problem is that it isn't clear what the "advocates" and "opponents" listed in the subsequent sentences are advocating or opposing. Circumcision in general, or neonatal circumcision, specifically. Perhaps a minor re-wording of the introductory sentence would be helpful. AlphaEta 15:18, 26 September 2008 (UTC)

I disagree Alpha, however it is a matter of perspective. We state there is a controversy then illustrate it. The other way seems backwards to me. I also believe circumcision is largely defended by myths. Garycompugeek (talk) 15:42, 26 September 2008 (UTC)

I partly agree and partly disagree, AlphaEta.

On one hand, I agree with your argument that the number and nature of the points is more important than the exact word count (though, having said this, we don't want to dedicate vastly more text to one side than the other).

On the other hand, I agree that the "myths" argument is infrequently used in its exact form, but I think that opponents frequently dispute the reasons that are often given for circumcision, and from their point of view, these reasons may seem little different from myths. Since the purpose of this paragraph is to illustrate the debate in general, the "myths" argument may thus be more representative than it would seem at first.

I would also question your classification of Schoen's claim re the neonatal period as a minority viewpoint. This argument appears quite regularly in pro-circumcision opinion pieces, and I'm not sure that it is a minority viewpoint in that context. As you note, there is some ambiguity over the nature of the controversy. If we consider voluntary adult circumcision (in HIV prevention, for example), then Schoen's argument is irrelevant, but so too is the "bodily rights" argument from the opponents. If we consider neonatal circumcision, then both arguments are relevant.

I agree with your comment about the sentence that has recently been added. In addition to your comments, I'd add that it has no apparent relationship to the text that follows. The sentence discusses evidence, whereas the following text discusses claims. Jakew (talk) 16:59, 26 September 2008 (UTC)

HIV section

The following sentences from the HIV section require further thought:

Since the idea was first mooted, over 40 epidemiological studies have been conducted to investigate the relationship between circumcision and HIV infection,[116] mostly in Africa.[117] The authors of meta-analyses performed on these studies reached differing conclusions. Two recommended against circumcision being used as a prevention method against HIV in Africa,[117][118] however another recommended it should be used.[119] Because of the questions over the reliability of previous studies, 3 randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors.

Let me explain some of the problems:

1. There is a synthesis of two facts in the first sentence. "More than 40" comes from one source and "mostly in Africa" from another. Setting aside issues of OR, extrapolating from one sample to another is potentially problematic.
2. The next two sentences raise some interesting questions. These are:
   • Why do we include Siegfried 2003, which wasn't a meta-analysis?
   • Why do we exclude Moses et al 1999 and O'Farrell & Egger 1999, both of which contained results of meta-[re]analysis of data gathered by Van Howe?
   • More generally, what are the inclusion criteria? This is an important because, since we enumerate the papers, we imply that exactly three papers of class X exist (compare "the solar system contains one gas giant, Jupiter" with "the solar system contains a gas giant, Jupiter" - the second does not imply that there is exactly one, and is hence more accurate).
   • Since we're ignoring the results of meta-analysis, might it make more sense to introduce these papers as systematic reviews or even just "reviews"?
   • Why do we say "recommended against circumcision being used as a prevention method against HIV in Africa", when the sources don't make that statement? For example, Siegfried et al don't mention Africa in their conclusions, and their conclusion is closer to an absence of a recommendation for rather than a recommendation against: "We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men". Would it not be better to remove the second of these two sentences, and add the refs to the end of the first?
   • Similarly "recommended [circumcision] should be used [as a prevention method against HIV in Africa]" seems an imprecise summary of "consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised", which seems closer to a recommendation that we should think about it, rather than urging that it should be done.
3. The final sentence is unsourced, and seems to imply that the observational studies were problematic. But as Auvert et al explain, the main problem with the observational studies was simply that they were observational (as opposed to experimental): "All of these studies were based on observational data, and, in the absence of experimental studies, a causal relationship between MC and protection against HIV infection could not be determined [13]. Direct experimental evidence is needed to establish this relationship and, should a protective effect of MC be proven, to convince public health policy makers of the role of MC in reducing the spread of HIV [7,13,14]."[30] I'd therefore suggest something like: "Because experimental evidence was needed to establish a causal link..."

Jakew (talk) 12:12, 30 September 2008 (UTC) (updated 13:24, 30 September 2008 (UTC))

Good points. The problem is while editing it is hard to fit everything you want to say without it being too long. So Ive just left it as saying reviews of the studies reached differing conclusions on whether to use circ as prevention strategy. I've added the o farrell one but couldn't find Moses. Tremello22 (talk) 21:32, 30 September 2008 (UTC)

Lead again

There are some serious problems with material recently added to the lead:

1. "In most of Europe, both the rate and prevalence of circumcision is low;" - this is extrapolation beyond the sources.
2. "The concept of circumcision as a preventive, and then routine, procedure emerged in the mid-nineteenth century, in Britain." - according to Darby. Why do we favour Darby's chronology, as opposed to that of Gollaher, say, who begins with a Manhattan physician? It is extraordinarily non-neutral to assert one viewpoint as fact. Given that there are multiple viewpoints, it's best to leave such detail out of the lead.
3. "Circumcision was cited to prevent or cure such things as impotence, phimosis, sterility, priapism, masturbation, venereal disease, epilepsy, bed-wetting, night terrors, " precocious sexual unrest" and homosexuality." - what is the purpose of listing these claims, and why are these particular claims chosen? And why do they belong in the lead?
4. "Despite originating in Britain," - again, favouring Darby's chronology.
5. "the practice of routine infant circumcision (RIC) only lasted there from the 1870s to the 1940s and probably affected no more than a third of boys at its peak points;" - two problems: first, how can something be routine if it affected no more than a third of boys? This is a description of infant circumcision, not "routine" infant circumcision. Second, "probably" according to whom? If J. Random Author says that this is "probably" the case, then why is that opinion notable enough to be in the lead?
6. "it did though become more widespread among it's English speaking colonies, principally the USA, Australia and New Zealand and Canada.[11] In Australia the rate of RIC has fallen in recent years[12];" - again, incorrect use of terminology. Should be "infant circumcision", not "RIC".
7. "in the 1970's the rate was over 50% but since that time medical organisations have discouraged the practice" - this is redundant. We already quote the AMA's comments on policies of other medical organisations in the lead.
8. "and health insurance has ceased to cover the procedure[13]; consequently the rate has declined to less than 15%.[12]" - how do we know that one caused the other? We don't.
9. "Similarly in Canada, while the rate was higher than 50% in the 1970's, the rate has fallen to less than 15%[14] due to medical organisations finding no medical indication for neonatal circumcision.[15]" - same problem: causation is asserted but not verifiable, and more redundancy.
10. "The United States has also seen a decline in routine infant circumcision, although to a lesser degree." - unsupported by sources.
11. "One study reported that approximately 32% of American boys were circumcised in 1933, rising to a peak of 85% in 1965 and dropping to 77% in 1971.[16]" - no, Laumann's study was of adult men, and determined whether they were circumcised at the time of the study. It did not determine when they were circumcised, and would include men circumcised after the neonatal period.

As a general comment, this is far too much detail for the lead. Jakew (talk) 15:33, 2 October 2008 (UTC)

According to WP:LEAD:

• The lead should be able to stand alone as a concise overview of the article. It should establish context, explain why the subject is interesting or notable, and summarize the most important points—including any notable controversies that may exist. The emphasis given to material in the lead should roughly reflect its importance to the topic according to reliable, published sources. While consideration should be given to creating interest in reading more of the article, the lead nonetheless should not "tease" the reader by hinting at—but not explaining—important facts that will appear later in the article. The lead should contain no more than four paragraphs, should be carefully sourced as appropriate, and should be written in a clear, accessible style to invite a reading of the full article.

At the moment it gives no explanation as to how routine infant circumcision came about. Nor does it explain the fact that circumcision is hardly ever practiced in Europe and that it is more common in the USA for non-religious reasons than anywhere else. I think what I wrote is a good starting point. There may be some minor issues but there is no need to just revert all of it. Just to go over some of your points:

1. It is true - it is low in most of Europe. Easily verifiable - here is one such ref: [31]
2. Ok, easily fixed
3. Why not? - seems OK to me.
4. easily fixed
5. my mistake, easily fixed
6. easily fixed
7. no it is not redundant see above quote from WP:LEAD, it should bea able to stand alone
8. I think we do know. I can easily find a ref that states the fact that it is what caused. what else would have cause it? A little common sense?
9. same as above.
10. no, the sources follow.
11. easily fixed.

Here is the new paragraph in question. how would you change it?

• According to the World Health Organization (WHO), global estimates suggest that 30% of males are circumcised, of whom 68% are Muslim.
• The prevalence of circumcision varies widely between cultures. Due to religious obligations, nearly all boys are circumcised in the Middle East. In most of Europe, both the rate and prevalence of circumcision is low; for example 2% of boys are circumcised in Scandinavia and currently less than 5% of boys are routinely circumcised in Britain.

• The concept of circumcision as a preventive, and then routine, procedure emerged in the mid-nineteenth century, in Britain. Circumcision was cited to prevent or cure such things as impotence, phimosis, sterility, priapism, masturbation, venereal disease, epilepsy, bed-wetting, night terrors, " precocious sexual unrest" and homosexuality. Despite originating in Britain, the practice of routine infant circumcision (RIC) only lasted there from the 1870s to the 1940s and probably affected no more than a third of boys at its peak points; it did though become more widespread among it's English speaking colonies, principally the USA, Australia and New Zealand and Canada. In Australia the rate of RIC has fallen in recent years; in the 1970's the rate was over 50% but since that time medical organisations have discouraged the practice and health insurance has ceased to cover the procedure; consequently the rate has declined to less than 15%. Similarly in Canada, while the rate was higher than 50% in the 1970's, the rate has fallen to less than 15% due to medical organisations finding no medical indication for neonatal circumcision. The United States has also seen a decline in routine infant circumcision, although to a lesser degree. One study reported that approximately 32% of American boys were circumcised in 1933, rising to a peak of 85% in 1965 and dropping to 77% in 1971. Between 1980 and 1999 the rate remained stable within the 60% range. The most current study estimated the circumcision rate to be 56%.

Tremello22 (talk) 16:37, 2 October 2008 (UTC)

(indentation omitted due to complex formatting) I'm glad that you've quoted from WP:LEAD, Tremello. To summarise, the lead should serve as an overview of the article, but should also be concise, preferably no more than four paragraphs. These are obviously conflicting goals, and finding the right balance is difficult. At present, we currently have five paragraphs, which is really a little too much. If anything, we should try to make the lead more compact. It is questionable whether adding two paragraphs will improve the situation.

To address your responses in order:

1. The source you cite asserts that it is true, certainly. However, if you'll read the full text, the author doesn't provide or cite any evidence in support of this assertion. Thus it appears to be an opinion.
2. The question is how to fix it. Given the tight space constraints of the lead, we can't really say "According to X, blah blah. However, according to Y, blah blah". It's probably safe to say that historians agree that rates of circumcision began to increase in English-speaking countries in the 1800s, however.
3. "Why not?" is a poor rationale for including material in the lead.
4. Ok.
5. Please could you address my questions?
6. Ok
7. Yes, it is redundant. Please see the last-but-one paragraph of the lead, which states "...Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision..."
8. As a practical matter, It's almost impossible to know why trends occur. We might be able to find a source that speculates that one is the reason for the other, but would such speculation belong in the lead?
9. Same problem.
10. In that case this is synthesis.
11. Laumann could be represented correctly, in theory.

How would I change it? Well, frankly I'm not sure that we need to add this information to the lead. If anything should be added, it ought to be as brief as possible. Firstly I'd reorganise the material to place current estimates together, followed by material briefly discussing historical and more recent trends:

• According to the World Health Organization (WHO), global estimates suggest that 30% of males are circumcised, of whom 68% are Muslim. The prevalence of circumcision varies widely between cultures. For example, estimates of the rate of circumcision among boys include nearly all in the Middle East, 2% in Scandinavia and less than 5% in Britain. Recent estimates of the rate of infant circumcision include 56% in the United States, less than 14% in Canada, and less than 15% in Australia. Neonatal circumcision is thought to have become common in English-speaking countries in the mid-nineteenth century; more recently incidence is reported to have declined in Australia and Canada. In the United States reports variously state that it is falling, stable, or increasing.

Again, I'm not saying that this material ought to be added. In fact, I think that it is better left out of the lead. Jakew (talk) 19:08, 2 October 2008 (UTC)

I disagree that the basic information not be added. As to your suggestion I think it says all I wanted to say but more concise , so I am happy to go with that. We can leave out why it became popular, but it is important we note when it became popular if we are to abide by WP:LEAD policy of the lead being able to act alone as an article. After all, this is an English speaking encyclopedia and half the page or more is taken up discussing aspects of infant circumcision (where it is popular - i.e in english speaking countries), so it would be helpful to put it in context.

In regard to length and keeping it at 4 paragraphs. Well, first of all, a lot of paragraphs are short, for instance the first paragraph is only one line long.

If we were to describe the structure of the lead: The first paragraph is 1 line long and tells us what circumcision is. The second (including your suggestion) is 8 lines long and tells us of its prevalence and history in the world. The third is 3 lines long and tells us of the debate that there is. Finally, the fourth and fifth are basically dealing with the same subject - i.e various organisations giving their views on the procedure. So in theory, the fourth and fifth could be melded into one to create one paragraph. Which would be 4 paragraphs. Tremello22 (talk) 21:24, 2 October 2008 (UTC)