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Van Howe Meta-Analysis

I would like to see Van Howes meta-analysis cited. Van Howes meta-analysis is at the same time a higly profound critique of several kinds of bias, mainly sampling bias and lead-bias. He critisizes John Hopkins study for selective misrepresentation of collected material: "Why would Tobian and the research group from John Hopkins collect samples from the penile shaft and glans but only report the result of the glans?"

In "urinary tract infections" - For nonspecific urethritis Van Howe concludes a lower risk for intact men.

As abstract in "Sexually trandmitted Disease" insert: "Van Howe's meta-analysis of 91 selected articles comes to the conclusion, that there is no overall significance for "Clamydia, gonorrhea, genital herpes, and human papillomavirus", "Syphillis showed mixed results", while "intact men appear to be of greater risk for genital ulcerative disease while at lower risk for genital discharge syndrome, nonspecific urethritis, genital warts, and the overall risk of any sexually transmitted infection." He points at the obvious fact, that studies of general populations make positive impacts of circumcision highly unlikely."

In the section on HIV implement insert: "Van Howe decided against including the three African trials into his meta-analysis concerning STD and Circumcision. He mainly points at the neglected lead bias, the time, where circumcised men are unable and/or not advised to have sexual intercourse (4-6 weeks). This most significant methodological flaw was not avoided or critisized by the major funding organisations nor by the high-quality articles citing the studies. He also argues, that 20% of infections in the Sub-Saharan setting "are not spread through sexual contact". The biological argument is classified by Van Howe as hypothetic at best and disproved in the case of the Lagerhans-cell-theory. He argues, that the Lagerhans-cells rather prevent infections and explain the lower transmission of STD in intact men. "

If you again decide to delete this detailed quotation of a high quality meta-analysis I would insist on a qualified discussion why it was deleted´and why Van Howes Meta-analysis should not be implemented in the article.

References

Preconscious (talk) 14:18, 26 July 2014 (UTC)

Preconscious, the journal that published the Van Howe article you are mentioning is not even MEDLINE-indexed. See WP:MEDRS for English Wikipedia's standards for reliable sourcing for biomedical information. The questioning of the utility of the results of the African HIV RCTs is indeed already mentioned in the article, see the Modern times subection of the History section. In fact an article by Van Howe (one that is MEDLINE-indexed) is already mentioned there, so an article by Van Howe is already in use to support content along the lines you are describing. Zad68 02:30, 27 July 2014 (UTC)

I just won 10 Dollars as I bet, that Zad would pull a sophistic argument. I will enter the sophistic argument by citing the same source MEDRS you are quoting, but the section on independet sources: "Many medical claims lack reliable research about the efficacy and safety of proposed treatments or about the legitimacy of statements made by proponents. In such cases, reliable sources may be difficult to find while unreliable sources are readily available. Whenever writing about medical claims not supported by mainstream research, it is vital that third-party, independent sources be used."

So the simple discussion is about quality of the article. As you say, there already is an article cited by the same author, so his quality is out of question. It is MORE up to date. (See guidelines for MEDRS up to date). And, most of all, Van Howes critique is essential for the public opinion on the STD-Debate. Why would you really want to withhold this information? Preconscious (talk) 17:53, 27 July 2014 (UTC)

Your comments are off-target, I am afraid. I am not sure why you are quoting from WP:MEDRS about "reliable sources may be difficult to find"... the sourcing in use is reliable per WP:MEDRS and easily available so I don't see how that passage you are quoting is relevant. Zad68 02:44, 28 July 2014 (UTC)

Yes, yes, just follow WP:MEDRS...appropriately...and other editors generally will not have any problems with your edits at this article. Flyer22 (talk) 02:49, 28 July 2014 (UTC)

Stay scientific in your argument and stick to the topic and other users will not have any problems with your edits at this article. What in Van Howes study prevents you from listing it? Van Howes meta-analysis is not a primary source (which could be even used in some cases according to WP:MEDRS) and the rest is up to the discussion, as there are only guidelines in Wp:MEDRS. Van Howes article provides an up to date critique of methods applied in high-standard-sources you cite here. This has to be respected. Van Howe questions the very scientific method of the sources as he points to the obvious fact that they don't include lead time bias. Why would you really want to disclose this fact to the public? Preconscious (talk) 08:58, 28 July 2014 (UTC)

There are high-quality sources that say X, if a lower-quality source (as discussed earlier) disagrees we don't concern ourselves with it. Why would it improve an article to base content on lower-quality sources when high-quality sources are available? Zad68 13:36, 28 July 2014 (UTC)

Where in Wikipedia WP:MEDRS does it say, that ISRN urology should not be used as a source? It is in the NLM Catalogue, which pretty much makes it a medliine-indexed source, doesn't it? http://www.ncbi.nlm.nih.gov/nlmcatalog/?term=ISRN+Urology Also Van Howes article is in PubMed. http://www.ncbi.nlm.nih.gov/pubmed/?term=ISRN+Urology+van+howe Preconscious (talk) 15:59, 28 July 2014 (UTC)

You should probably read the links you provide, where it says the journal is "Not currently indexed for MEDLINE." In cases where red flags such as lack of MEDLINE indexing, you can see if there are any positive citations in journals of undisputed reliability. The only citation I see where that article is discussed in any detail is this review article, which states in part, Van Howe "(1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for “sampling bias,” (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others...Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds." So no, this is not an article that has gained any positive traction in the medical literature, so should not be used, per WP:MEDRS. Yobol (talk) 16:48, 28 July 2014 (UTC)

A review by the very same authors which obvious flaws were uncovered by Van Howe. One can tell the racket, that he suggests. Of course, most medics in the US have performed circumcision and most will seek to suppress feelings of guilt. Add political pressure, as the Pepfar is funding mass-circumcision. Many issues at stake that should turn any scientist deeply suspicious against such "reviews" and the prior studies involved.

Anyhow, you mainly argue, that it is "not yet" discussed or cited. An article from only one year ago... well, even four authors of the "critical" review needed one year to publish their defense only in mid 2014. Again my argument is, that you retreat to sophistry and that you don't judge the article on its own.Preconscious (talk) 18:08, 28 July 2014 (UTC)

I'm sorry you feel a discussion of the correct application of WP:MEDRS of a proposed source through its acceptance/citation in the relevant peer-reviewed literature is "sophistry". As you have not actually addressed the crux of the issue (that this source is not MEDRS compliant because it is not MEDLINE indexed nor positively cited in the medical literature), I will assume you have no actual response to these points and no further discussion is necessary. Yobol (talk) 20:02, 28 July 2014 (UTC)

I totally got your argument. Ever heard about quotation cartels? Or publication bias? Your argument is simply bureaucratic and not benefitting the reader who would like to follow a discussion objectively. Preconscious (talk) 22:24, 29 July 2014 (UTC)

"Human immunodeficiency virus"

Insert: "In cross-country comparisons, higher national circumcision-rates do not correllate with a lower HIV-rate." Sources: https://en.wiki.x.io/wiki/Circumcision#mediaviewer/File:Global_Map_of_Male_Circumcision_Prevalence_at_Country_Level.png together with the map about HIV-infections: https://en.wiki.x.io/wiki/HIV/AIDS#mediaviewer/File:AIDS_and_HIV_prevalence.svg Preconscious (talk) 09:47, 28 July 2014 (UTC)

This suggestion is based on original research, you are interpreting a primary source of data and drawing your own conclusions from it. Zad68 13:36, 28 July 2014 (UTC)

Your suggestion, that a map on HIV or Circumcision would be a primary source of Data is not well justified. A map on HIV is a meta-analysis in itself, containing loads of primary sources from all countries. If the maps are implemented in both wikipedia-articles, what is wrong with showing them, when the article draws conclusions about interrelations between circumcision and HIV? What would the article be afraid of? Evidence? If it is only my conclusion, would you then agree to implement the map on HIV in the named section without comment, as it matters to grasp the subject? Preconscious (talk) 15:33, 28 July 2014 (UTC)

"A map on HIV is a meta-analysis in itself" --- Um, what? No, that is patent nonsense. Please review Meta-analysis, as you clearly do not understand the meaning of that word. Yobol (talk) 16:49, 28 July 2014 (UTC)

→Please review semantics if you should mistake this comparison as plain equation. It is not a primary source either. Nonetheless maps are used by wikipedia articles for illustration. Anyhow, what exactly is it with this specific map that you can't show it? Preconscious (talk) 20:50, 28 July 2014 (UTC)

Everything can be used as a primary source for itself, even if that thing is a secondary source for something else. Your use of the data to draw a conclusion from it that isn't stated by the source is original research using the data as a primary source. Zad68 21:41, 28 July 2014 (UTC)

Looks like an attempt at WP:OR. So oppose. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:02, 28 July 2014 (UTC)

The method applied by now is not editing constructively at the moment, but blocking nervously. I offered to revise and suggested only applying the HIV-Map to the article. So any user can decide for his own, what to make with the picture. You can then find a cochrane study proving or disproving anything. I don't care. I think it is for the benefit of the user, if you have not only a circumcision map but also an HIV-map in the section, where the interrelation of HIV and CC is relevant. Why would one censor the wikipedia-map, if not for being scared and having no argument? Preconscious (talk) 08:15, 29 July 2014 (UTC)

Re "nervously" and "scared": Preconscious, stop personalizing content discussions. Is that clear? This is perhaps the 7th or so warning you have received to stop doing this, from multiple editors.

Your suggestion is textbook WP:SYNTH, please review that policy page. Zad68 13:45, 29 July 2014 (UTC)

Thanks for the confirmation. And also stay civil, please, ref: "Is that clear?" You also received several warnings to stop blocking useful edits from several editors. Preconscious (talk) 22:33, 29 July 2014 (UTC)

Importance of Article

collapse off-topic discussion with no specific changes requested, against WP:TPG

It is related to this article, to ensure, that the editors and admins are aware of its importance. I don't know, if they have been to Africa. In Africa, despite the colonial and post-colonial progresses to eradicate smallpox and reduce other diseases, there is an incredibly frustration and a load of (sometimes occult) conspiracy about racist medical intervention. Vaccination campaigns are under permanent suspicion of sterilizing women. It is not, that African societies are not used to medical fraud. In some regions "homeopaths without borders" are present, in most regions you have herbalists and quacks. But that is the situation: HIV is considered as a western bio-weapon or myth by many and western medicine is countered with suspicion and especially vaccinations. If now, for some reason, circumcision is at first advertized as the new 60% reliable-vaccine against HIV, and then later on, after millions of Africans were bribed into circumcision, a proofreading of incomplete studies shows that the orginal database was flawed or that other factors are far more important in the spread of HIV/AIDS, it will have an effect on other therapies including Retroviral therapy. In short, if by now after millions of circumcisions the HIV-rates are not dropping significantly, it has not only an effect on opinion about circumcision in Africa, but vast parts of Africans will also put this into a general conspiracy theory and turn against vaccinations and biomedicine in general. So the result of flaws in circumcision-studies will in the end cause distrust against vaccinations against polio and other diseases. In any way, Africans loose: foreskins or lives due to confusion about biomedicine and efficiacy. Therefore I call for a policy of citing pro-circumcision studies only after having read and understood them, and quoting them in the best scientific way: sceptical. The current practice here is a simple publication-hierarchy, where studies are true, if they are cochrane. This is bureaucracy and not knowledge. And it seems to me that it is against the method of cochrane itself to "believe" in it for publication reasons, as its oulines always call for a critical questioning of studies - also of its own findings. I'm not against citing cochrane, I'm voting for respecting critique of methods also if not cochrane and logical critique, which in history has often provided better results than data-mining (compare homeopathy, which could be disproved by the logic of any 13-yrs. student while empiric research multiplies into thousands of studies by now). Preconscious (talk) 08:10, 29 July 2014 (UTC) Please do not use this article Talk page to detail your personal theories about things. And I'm sorry but, perhaps because you are not a native speaker of English, I am having a hard time understanding what your point is here. When writing content well-supported by high-quality sources, we write plain assertive statements, see our style guideline WP:MEDMOS. Zad68 13:33, 29 July 2014 (UTC) Agree with above, this appears to be more of a WP:SOAPBOX rather than a specific suggestion to improve the article. I suggest that any further off-topic or other WP:TPG violations be hatted. Controversial subjects like this need to have concrete proposals for specific wording changes with specific sources cited. Broad soapboxing and discussions of the topic need to be limited. Yobol (talk) 17:51, 29 July 2014 (UTC) Also it appears to me to be some kind of a WP:SOAPBOX: "Articles must be balanced to put entries, especially for current events, in a reasonable perspective, and represent a neutral point of view. Furthermore, Wikipedia authors should strive to write articles that will not quickly become obsolete. Self-promotion: It can be tempting to write about yourself or projects in which you have a strong personal involvement. However, remember that the standards for encyclopedic articles apply to such pages just like any other. This includes the requirement to maintain a neutral point of view, which can be difficult when writing about yourself or about projects close to you."Preconscious (talk) 22:14, 29 July 2014 (UTC) Also pay respect to "Wikipedia is not a social networking service like Facebook or Twitter. You may not host your own website, blog, wiki, or cloud at Wikipedia." Seriously, pls. It is understandable, that people new to the concept of science are attracted by fixed rules (overstrict super-ego employed to govern or vent subconscious fears and drives) to overcome feelings of insecurity, but authoritarian personality and positivism should not gain traction in wikipedia. Preconscious (talk) 22:18, 29 July 2014 (UTC) Do you, or do you not, have a specific suggestion to change the article cited to a specific source? Yobol (talk) 22:29, 29 July 2014 (UTC) If I would, it would be blocked, wouldn't it. As I can't afford a cochrane study to clarify simple semantic flaws, apories and contradictions in this article (or in another poor conducted cochrane study, maybe the worst ever). Preconscious (talk) 22:39, 29 July 2014 (UTC)

Biological explanations

"There are plausible explanations based on human biology for how circumcision can decrease the likelihood of female-to-male HIV transmission. The superficial skin layers of the penis contain Langerhans cells, which are targeted by HIV; removing the foreskin reduces the number of these cells."

Modify into:

"Explanations based on human biology for how circumcision can decrease the likelyhood of female-to-male HIV transmission remain disputed. The superficial skin layers of the penis contain Langerhans cells. If these cells are involved in the transmission or prevention of HIV-infections remains disputed. Langerhans cell#HIV"

Delete the following passage or provide plausible explanation and sourcing: "When an uncircumcised penis is erect during intercourse, any small tears on the inner surface of the foreskin come into direct contact with the vaginal walls, providing a pathway for transmission."

Argument: If the explanations are plausible or not is not subject to the article, it is subject of studies cited. If you cite, please see: WP:MEDRS The Langerhans-cell-theory is not accepted by vast parts of science, in contradiction it is suggested, that Langerhans cells are killing HIV-Viruses, which explains the LOW infection rate (1 per 1000 intercourses). If there are more tears in an intact penis than in a circumcised remains highly suggestive. Prove it or delete it. Preconscious (talk) 09:24, 28 July 2014 (UTC)

The current article content for both of those statements is well-supported by high-quality sourcing. Wikipedia cannot be used as a reliable source for itself, and again please see WP:NOR. Zad68 13:36, 28 July 2014 (UTC)

I don't cite Wikipedia as a source, I insist on linking the section in another article, where it matters. Since when does wikipedia prohibit proper interlinks? And the statement is doubted by high-quality sourcing, which a user could see at the redirected link. I then insist on citing here in addition to the above sentence: "[...] Langerin prevents HIV-1 transmission by LCs. HIV-1 captured by Langerin was internalized into Birbeck granules and degraded. Langerin inhibited LC infection and this mechanism kept LCs refractory to HIV-1 transmission; inhibition of Langerin allowed LC infection and subsequent HIV-1 transmission. Notably, LCs also inhibited T-cell infection by viral clearance through Langerin. Thus Langerin is a natural barrier to HIV-1 infection, and strategies to combat infection must enhance, preserve or, at the very least, not interfere with Langerin expression and function."

Please also justify, how information here is blocked by persistent sophistry. How do you keep your arguments free of sophistry and therefore scientific in its true sense, which means self-sceptical and not fact-oriented, where facts might be manipulated by perception, bias or lobby-groups? If you cannot explain, why this wikipedia-article is blocking diversification of information, I will open a case, as I don't see you willing to discuss or cite counterevidence. The current "methodology" is prohibiting sources (cochrane, ISRN, Nature, and others) at will with vague and suggestive hints at WP:MEDRS. Preconscious (talk) 15:41, 28 July 2014 (UTC)

References

Preconscious - Please end your comments after your signature with {{reflist-talk}} if you are going to use references on the talk page. I have added it to this comment. Cheers. EvergreenFir (talk) Please {{re}} 19:40, 28 July 2014 (UTC)

A review of the source easily shows that the item from de Witte is a letter to the editor, and so is near the bottom of the source quality ranking per WP:MEDRS, see WP:MEDASSESS. It also does not mention "circumcision" anywhere in it. The sources the article currently uses are the most-preferred and address the effect of circumcision on HIV transmission directly. Zad68 21:48, 28 July 2014 (UTC)

The source in the article is actually quoted false. Correct is: "HIV may gain easier access to these [LC] through the thin foreskin." (Weiss, Dickson et alii). The article right now says without further sourcing:

"Langerhans cells, which are targeted by HIV; removing the foreskin reduces the number of these cells." According to the source which is cautious ("may gain easier access") you are exaggerating the source to factual evidence ("are targeted"). Also find a source that confirms the following: "removing the foreskin reduces the number of these cells". Please adhere to WP:MEDRS, as logical conclusions like these are personal opinion and outruled for some reason. Preconscious (talk) 08:40, 30 July 2014 (UTC)

What is sourced by sceptical science, if one really is interested in the subject and not in publication statistics and this is my last attempt at mediating biases and poor standards in this article: Either you redirect after Langerhans-cells or you insert directly the most plausible biological explanation so far cited.

"A research group of Youichi Ogawa et alii confirmed the findings of de Witte et alii, that langerin protects Langerhans cells from being infected by HIV and other STD. "This study also showed that langerin was involved in capture of HIV and subsequent internalization within Birbeck granules, where it was degraded." However, Oguwa et alii found, "when LCs were exposed to high viral concentrations of HIV, there was significant infection of LCs by R5 virus, followed by viral transmission to T cells." Oguwa et alii also observed, that anaerobic bacteria do not "enhance HIV susceptibility in LCs". However they conclude, that Gram-positive bacteria components "directly augmented HIV infections in LCs by activating TLR2."

References

Preconscious (talk) 08:40, 30 July 2014 (UTC)

This appears to be the same content suggestion made at Circumcision and HIV, I have commented here as to why I don't think this suggested content change is an improvement, starting with problems with the sourcing. Zad68 03:19, 31 July 2014 (UTC)

Category:Violence against men

Looking over the category description and pages categorized with it, this does not seem to be the kind of article that belongs there. This seems more about the medical procedure. Perhaps the cat belongs on one of the other pages linked in the various culture-related sections? EvergreenFir (talk) Please {{re}} 04:57, 8 July 2014 (UTC)

Agree, category not supported. Zad68 05:11, 8 July 2014 (UTC)

Conversely we have another article devoted to the surgical procedure and this one IS SUPPOSED to be, and one day may become the "flagship" overview article mentioning all pertinent aspects of the varieties of circumcision in all its horror and its joy.When children and adults have a body part involuntarily and sometimes forcibly cut off for cultural reasons this ought to be mentioned here. That it is not tells us a great deal about the ongoing weakness of the wikipedia model in the face of a concerted cabal --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:57, 8 July 2014 (UTC)

WP:NOTAFORUM
The following discussion has been closed. Please do not modify it.
Evergreen, cognitive dissonance dictates that you do not want to believe what was done to you (I presume you are circed because your profile says you are American). Nevertheless a lot of people believe circumcision to be a violent act. You could argue that up to 2/3 of the world's men who aren't circumcise would argue it was a violent act.Tremello (talk) 17:21, 11 July 2014 (UTC) Any excision of a body part which is cut off against the consent of the chopped person is a human rights violation, an act of violence, and an act of rape, by definition, as here it involves a sexual organ. However there is a concerted cabal working this article, who, for some reason, cannot accept this reality or countenance it being mentioned in the article, and work to ensure that the benign false useful picture of circumcision here described is not interfered with. It may be a cultural thing where editors to whom circumcision represents a covenant with their deity, cannot have its uglier aspects or diminishing popularity given any space here. --— ⦿⨦⨀Tumadoireacht Talk/Stalk 17:55, 11 July 2014 (UTC)

Notice: Please do not use Wikipedia article Talk pages to air your personal opinions about the article topic. There are plenty of Internet chat forums for that purpose, this is not one of them. Especially do not use Wikipedia article Talk pages to make personal attacks against or theorize about personal aspects of other editors. Continuing to do so may result in sanctions per WP:NPA and WP:TPG. Zad68 19:22, 11 July 2014 (UTC)

Zad it night be best if you handed over the blanking and blocking decisions on discussion of this topic to another editor, ideally one who is not so heavily invested in this article in its current state. as you are. The omission of key information about circumcision over a long period now from this article is a phenomenon that cannot go unremarked or quickly hidden forever. Please attempt instead to discuss the cogent points raised concerning human rights, mutilation, violence and rape.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:39, 11 July 2014 (UTC)

Zad was correct in hatting that discussion as it was FORUM. We must discuss the the article itself. The word violence is not used once in the article. There's no support for it based on the current article. The category is already on Forced circumcision which is a much better fit for it. EvergreenFir (talk) Please {{re}} 22:37, 11 July 2014 (UTC)

Is that a typo or did you wish to say that Zad$Zachariah hated the discussion ? or halted the discussion?. The discussion was, im either mode of Zachariah, mostly concerned with the article and its current oddly unbalanced editorial state.I suggested that Zad&Zachariah recuse himself from admin functions such as blanking out discussions on this article for the reason stated. we have still to hear from Zad^Zach. on the subject of this suggestion We must work to ensure that the rape and human rights violation aspects of circumcision, alongside the disease, disfigurement,and death caused by circumcision get the mention and weight appropriate to them in this, the flagship article on the subject. This article is not supposed to be confined to, or chiefly concerned with, the medical aspects alone of the primarily cultural act of this variation of cutting off bits of the penis. I appeal to editors and administrators of whatever belief system who have still managed to retain objectivity in this contentious subject to come forward to assist in this process of correction and rebalance.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 22:22, 16 July 2014 (UTC)

Not a typo. Referring to the template Zad used: {{hat}}. Note, you are going pretty far in asking someone to recuse themselves because you disagree with them. EvergreenFir (talk) Please {{re}} 22:37, 16 July 2014 (UTC)

Tumadoireacht per WP:TPG I will not use this article Talk page to respond to non-article related points, but will on your User Talk. Zad68 02:24, 17 July 2014 (UTC)

Add "see also: Forced circumcision" or soemthing to the effect. — Preceding unsigned comment added by 92.1.65.57 (talk) 07:40, 29 July 2014 (UTC) @EvergreenFir - of course disagreeing with another editor's opinions is a foolish reason to ask him/her to recuse themselves. But asking another editor to review their actions in pushing some aspects of circumcision while ensuring that other aspects are ignored is an entirely reasonable and a WP policy consistent request. Choosing to characterize the latter as the former is an understandable misapprehension.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:24, 6 August 2014 (UTC)

Mogen Clamp Company defaults due to awards for botched circumcisions using its implement -noteworthy ?

One of the three implements commonly used to sever foreskins from neonatal boys in the USA is the Mogen clamp. Due to two recent compensation awards against it totalling 18 million dollars for severing two penises using the device the company went into default but the device is still used .Noteworthy ? http://www.jacksonwhitelaw.com/az-personal-injury/2012/03/21/the-controversy-behind-the-mogen-clamp/--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:49, 20 August 2014 (UTC)

Here are some photos of the device in use

http://www.circumcisionquotes.com/rdr5.html

- would photos such as these make more sense for the lead photo in this article ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:51, 20 August 2014 (UTC)

Not for this article. Lawsuits already discussed in Mogen clamp where this material belongs. Yobol (talk) 18:59, 20 August 2014 (UTC)

First of all we must be exceedingly careful in showing pediatric genitals for obvious reasons.

Second agree with Yobol it belongs on the other article where it is already. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:20, 20 August 2014 (UTC)

Tumadoireacht in the above section you make an unsourced assertion about the funding of the medical society whose practice guidelines were published in JAMA, and do not explain why you are making this assertion. In this section you suggest adding new content based on an advertisement (it even says "Call (480) 648-xxxx to make an appointment") produced by a for-profit law firm. Have I summarized that correctly? Zad68 19:26, 20 August 2014 (UTC)

No Zad you have not. Once again you cite an article without reading it fully - the source for the big pharma funding of the medical society which you misnamed is within the article you cited. Please peruse it more carefully. The Mogen Clamp fiascos are well documented in many references including on the Mogen Clamp article which your friends Yoboll and Doc James have already referred to and with which you are most familiar yourself. Is it possible that you are being a tad disingenuous or attempting irony ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:40, 21 August 2014 (UTC)

Science Magazine Article The Circumcision Conundrum

Is this useful ? http://www.sciencemag.org/content/345/6193/161.full --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:23, 21 August 2014 (UTC)

For what? Zad68 19:27, 21 August 2014 (UTC)

May be useful in the Circumcision and HIV article, citing it for a statement that the mechanism of action for protection is not clear. Yobol (talk) 19:29, 21 August 2014 (UTC)

That the exact mechanism isn't well-known is already covered, what's offered are plausible explanations. Although it's in Science, it is a really short news article (is it really only 5 paragraphs?), and I think we've got better sources on the possible mechanisms of action. It does describe ongoing research though that might one day yield results we can use. Zad68 03:46, 22 August 2014 (UTC)

HIV prevention update

Last month, the International Viral Society published its HIV Prevention in Clinical Care Settings recommendations in JAMA. The 2014 circumcision recommendations are particularly strong for sexually active heterosexual males; the recommendations are given an AIa evidence rating (strong support, top-level evidence). Based on this, it is time to update the article's coverage regarding HIV. Specifically, the HIV prevention rates currently quoted at 38–66% can be narrowed to 53-60%, and cost-effectiveness can be additionally sourced to this article. There is a statement currently in the article that there is no evidence for direct benefit for heterosexual women but the IVS recommendations add the likelihood of indirect, population-wide benefit. Also the characterization of the procedure as "safe", which is currently sourced to an aging 2008 AUA guideline, can be sourced to this IVS document.

Just dropping this here for comment while composing specific updates. Zad68 04:18, 20 August 2014 (UTC)

Is there a more up to date consideration within the article Zad is keen to include (or elsewhere) of the counter-arguments to promotion of Circumcision as a HIV preventative measure ? These include but are not limited to : iatrogenic transmission, colonial factors, the anti viral protective functions of the foreskin and ethical and human rights et cetera as this NCBI Sexual Transmitted Infection Journal letter from Doctors Opposing Circumcision does in 2003

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744772/ and again in 2008 http://www.doctorsopposingcircumcision.org/info/HIVStatement.html  ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:54, 20 August 2014 (UTC)

I think when Zad mentions "THe International Viral Society" he means to say "The International Antiviral Society-USA Panel"(formerly the AIDS Society) as no such former organization exists. Here is the link for the abstract and the full article https://jama.jamanetwork.com/article.aspx?articleid=1889145 The emphasis in the article conclusions differs somewhat from Zad's conclusions.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:11, 20 August 2014 (UTC)

The International Antiviral Society USA is funded by 14 major multinational drug and surgical equipment companies.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:31, 20 August 2014 (UTC)

And? We are using a position statement published in JAMA not the doctorsopposingcircumcision website. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:34, 20 August 2014 (UTC)

Agreed. No indication that the self published commentary by an advocacy group deserves any WP:WEIGHT per MEDRS. Yobol (talk) 18:56, 20 August 2014 (UTC)

No Doc James - we are not. We are considering a proposal by Zad to include an as yet unspecified text in a new article section? based on his selection from a set of recommendations he mentions. This surprises me as Zad has generally been opposed to doing this in the past and relies heavily on a strict adherence to only using article conclusion summaries. Also- for YOBol and Doc James/Jmh69- should we not consider the ideas of doctors who have reservations about circumcision as well as those of doctors who promote it Does a letter published in Sex Transm Infect constitute self publishing  ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:06, 20 August 2014 (UTC)

I suggested making minor updates and additions to existing content. I thought that was pretty clear. Where did I suggest a new article section?

What source are you providing for your suggested content, what is that suggested content, and how will you show it complies with WP:WEIGHT? Zad68 19:32, 20 August 2014 (UTC)

We use recent review articles and position statements published in high quality sources. So yes a more than 10 year old letter in Sex Transm Infect is not appropriate. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:17, 20 August 2014 (UTC)

And so we come back to my original question - a more up to date reference for counter and wider consideration than pro circumcision material alone ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:24, 20 August 2014 (UTC)

Why are you having such trouble finding sourcing to support your content ideas? Zad68 19:33, 20 August 2014 (UTC)

I am not having trouble -I have listed two leading world newspapers(NYT and ST) which reference the circumcision foreskin harvesting industry . With regard to the assertions on HIV reduction by circumcision I asked whether any other editor had access to more up to date material providing a usable counterargument. This is collaborative editing at work. I think you yourself may have access to medical databases which I do not . However lke the Doctors against Circuncision group have stated I think that circumcision proponents should consider recusing themselves. Do YOU have difficulty accepting material that runs contrary to your content ideas ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:51, 21 August 2014 (UTC)

Tumadoireacht, I'm looking to make the updates to the topic of HIV coverage based on a high-quality, authoritative source. This is without regard to whether I agree with the conclusions the source is drawing. If this source said there was no effect, I'd look to reflect that appropriately and with due weight, given the sourcing available.

In contrast, you are starting out with a particular conclusion, and then suggesting that we search out sourcing to support it, while citing a self published commentary by an advocacy group as a base, as Yobol put it. I disagree with that approach you are bringing to this article.

You are also looking to the same self-published advocacy website to back up your beliefs regarding editors of this article. Who are you characterizing as "circumcision proponents"? Why haven't you suggested equally that circumcision opponents should consider recusing themselves? Zad68 18:08, 21 August 2014 (UTC)

I am not sure what you mean about editors here Zad and "back up" from the DAC letter published in the BMJ Sexually Transmitted Infections journal ( the world's longest running international journal on sexual health) perhaps you could be a little clearer on what you are trying to infer. With regard to your proposal to select some material from within the paper you cited -as Yobol/Doc/ yourself and the crew are so fond of so frequently sweetly asking "what exactly is the wording of your suggested content " Are you not the same editor who prefers WP article wording drawn exclusively from abstracts and conclusions? I have not seen any edits permitted to remain on this article that are not pro-circumcision and have not seen any circumcision opponents contributions in the article  ? Have you ? Who are they?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:00, 21 August 2014 (UTC)

Letters to the editor are generally not WP:MEDRS compliant, no matter what journal they're published in. The JAMA article Zad68 proposes, however, does appear to be MEDRS compliant and should be incorporated into this article. Material that enters this article needs to be MEDRS compliant; if most of the information that is in MEDRS is "pro-circumcision" (whatever that means), then that is how our article will turn out as well. We do not artificially lower our standards for sources to satisfy the wishes of WP:SPA editors with an axe to grind. Yobol (talk) 19:09, 21 August 2014 (UTC)

Tumadoireacht, re: I am not sure what you mean about editors here Zad and "back up" from the DAC letter published in the BMJ - Apparently referring to editors, you wrote "However lke the Doctors against Circuncision group have stated I think that circumcision proponents should consider recusing themselves." I didn't see that in the 2003 STI letter, so you're backing up your belief about who should recuse themselves with something you found on that advocacy group's website. Regardless, neither that self-published advocacy website you've brought nor that letter to the editor appear useful for this topic. Zad68 03:29, 22 August 2014 (UTC)

What text are you proposing to add to the article ?

Also if you believe that disposal of circumcised foreskins is "off topic" in the circumcision article then a corollary of such a severe editing policy evenly applied would make for a very very short article. Both the effect of circumcision on HIV rates( never mind whether it increases HIV or decreases it) and the uses of foreskins post the chop are consequences of circumcision. I cannot understand how you persist in your belief that you should facilitate inclusion of the former and block attempts to mention the latter. Apligraf and Dermagraf are brand names of artifical skins created from harvested foreskins from infant circumcision. I find it hard to believe that in your industrious endeavours to rustle up material on circumcision that you have not come across them ......--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:52, 23 August 2014 (UTC)

Interesting 2009 overview article on history of circumcision in general and the HIV debate

http://www.nytimes.com/2009/08/30/weekinreview/30rabin.html?module=Search&mabReward=relbias%3As The phrase "a cure in search of a disease " is hilarious Final paragraph from director of the african HIV research revealing--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:21, 26 August 2014 (UTC)

article is too biased

This 'article' is too biased and too in favor of circumcision, instead of being neutral or presenting the alternative that it's completely unnecessary, and that the majority of men in the world are intact and they and their sexual partners have no sexual and/or health consequences. — Preceding unsigned comment added by 68.238.240.252 (talk) 05:24, 11 September 2014 (UTC)

From the opening sentences of the body: "Neonatal circumcision is often elected for non-medical reasons, such as for religious beliefs or for personal preferences possibly driven by societal norms. ... No major medical organization recommends non-therapeutic neonatal circumcision ... ". Seems pretty clear to me. Alexbrn ^{talk|contribs|COI} 05:40, 11 September 2014 (UTC)

It IS remarkable that the declining popularity of circumcision gets nil mention. And that adverse effects leaves out substantial information on deaths and injury from circumcision. And that the information on the loss of pleasure nerve endings and the loss of the mechanical and hydraulic assistance provided by the foreskin in penetrative sex is omitted and readers must seek it, bizarrely, at the foreskin article instead. et cetera. But other wise the article is fantastic. fantastic.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 07:00, 11 September 2014 (UTC)

This article also fails to mention the risk of herpes infection (and brain damage including death) if one receives oral suction as is popular in brit milah. — Preceding unsigned comment added by 71.174.236.5 (talk) 23:42, 16 September 2014 (UTC)

71.174.236.5, according to Brit milah, that topic is an aspect of "metzitzah b'peh" which is specific to brit milah only, and is covered at Brit_milah#Metzitzah_B'peh. Zad68 02:33, 17 September 2014 (UTC)

The potential HIV preventative aspect of circumcision is specific only to non tribal circumcision conducted in clinics for a single type of sex act, for one partner of that sex act, for some small trial groups under some halted research in three sections of sub saharan Africa. Yet it features in our opening paragraph. Hmmm - perhaps specificity is subjective.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:28, 17 September 2014 (UTC)

You would have a point if the specificity you are suggesting is found in the source. If the source does not say it is specific, we don't either. Yobol (talk) 01:49, 18 September 2014 (UTC)

There are many sources on this piece of research and many analyses of it not just one. To suggest that we rely on one source is odd. The African trials found heterosexual men were less likely to acquire the H.I.V. virus after circumcision, but largely ignored the question of whether women were safer — or possibly put at even greater risk of infection, as one small study suggested — if the man was circumcised; they also focused exclusively on heterosexual transmission, though in the United States, men who have sex with men are at higher risk. The director of this research (before it was halted for ethical reasons) Dr. Gray cast doubt on applying the research in the USA and said “If you were to ask me, should the U.S. be promoting circumcision, my answer would be, ‘no,’ ” Which source are you referring to Yobol- please list in your reply specifically to the section where the non specific aspect is referred to.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:22, 19 September 2014 (UTC)

Source 10 and 32 supporting the first sentence of the STD section. Yobol (talk) 13:01, 19 September 2014 (UTC)

Is an adult infecting, maiming for life , or killing an infant through sucking their penis in a religious but non sexual context appropriate to the STD section ? I suspect not.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:35, 14 October 2014 (UTC)

Disposal of cut off foreskins from circumcisions and the big silence here in this article on it

Here is the section in the foreskin article on use of foreskins from circumcision

"Foreskin-based medical and consumer products: Foreskins obtained from circumcision procedures are frequently used by biochemical and micro-anatomical researchers to study the structure and proteins of human skin. In particular, foreskins obtained from newborns have been found to be useful in the manufacturing of more human skin.[61]

Human growth factors derived from newborns' foreskins are used to make a commercial anti-wrinkle skin cream, TNS Recovery Complex.[62]

Foreskins of babies are also used for skin graft tissue,[63][64][65] and for β-interferon-based drugs.[66]

Foreskin fibroblasts have been used in biomedical research.[67"

Now circumcision produces all these foreskins. They do not fall off, run down a trouser leg and get collected by lab or cosmetic employees off the street. Labs buy them online from hospitals. Yet there is a concerted group of editors on this article who quickly revert any mention in the circumcision article of what is done with the foreskins cut off during circumcisions. A reader may wonder but will never know. Not from this article. Why do you think this is ? Is it like an article on trawler fishing making no mention of the catch disposal ? Should this omission be corrected ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:41, 27 July 2014 (UTC)

I agree, it is essential information and should be implemented in the article. Preconscious (talk) 17:56, 27 July 2014 (UTC)

Agree a mention of it belongs here, but there's already info at Foreskin#Foreskin-based_medical_and_consumer_products as well. Foreskin makes more sense if we're gonna keep the info in a parent article. If you feel there's a enough info, create an article for it and add {{main}} to the section here and on foreskin. EvergreenFir (talk) Please {{re}} 22:20, 27 July 2014 (UTC)

The selling of the cut off foreskins from circumcision is part of the process of circumcision, as it arises solely from it and so needs a mention in this article. It would be good to describe what other non- and pre-clinical disposal methods are favoured in various cutting cultures - I understand that some bury the cut off skin? refs anyone ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 01:00, 28 July 2014 (UTC)

Sure, if up-to-date, high-quality sourcing can be found that supports the content and demonstrates compliance with WP:WEIGHT. But, this suggestion sounds familiar. Didn't you propose this exact same thing about a year and a half ago, here? The issue at that time was that the content was bits of trivia strung together, and the sourcing was poor, so there was no consensus to add it. I looked for good-quality sourcing and didn't find it at that time. But Tumadoireacht you've had a year and a half to work on that since then, so surely by now you have found up-to-date, high-quality sourcing? Links please (for medical journal articles a PMID would be sufficient, of course). Thanks... Zad68 02:11, 28 July 2014 (UTC)

Tumadoireacht, you know the deal by now. Flyer22 (talk) 02:49, 28 July 2014 (UTC)

A constructive mediation: Insert section as "Circumcision as source for cosmetic and medical use of foreskins"

Add redirect to Foreskin#Foreskin#Foreskin-based_medical_and_consumer_products. Preconscious (talk) 08:01, 30 July 2014 (UTC)

Not good enough boys- and you know it--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:25, 30 July 2014 (UTC)

Here is a detailed and well researched newspaper article on sale and use of circumcision foreskins. There are others.

http://www.sdcitybeat.com/sandiego/article-7356-the-$140-million-foreskin.html

It is interesting that of three companies mentioned using circumcision harvested cells that two of them are, apparently, cloning or growing all the cells they need from one particular foreskin, The other company says it "produces research-use only products using neonatal foreskins discarded from circumcisions with full, informed consent.” It might be useful if the circumcision article mentioned these industries( wound healing and cosmetics principally) running into the hundreds of millions of dollars annually on products from circumcision foreskins. It might also be useful to have a section on the "full informed consent" part - who is informed ? who consents to the industrial and medical re-use of the foreskins ? How much are hospitals paid ? Do the parents get this amount knocked off the circumcision bill ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:09, 8 August 2014 (UTC)

This would be best suited for an article on Life Sciences Corporation. Maybe a mention at Foreskin but probably not. Don't see a place for its use here. Zad68 19:53, 8 August 2014 (UTC)

Did you read the article Zad  ? A half dozen corporations who use circumcision harvested foreskins are mentioned in the newspaper article and the many applications that the harvested foreskins are involved in.There is some history on skin transplants using foreskin skin going back to 1891 book of Peter Charles Remondino " The History of Circumcision" and reference to the outcry when it was revealed on the Oprah show that circumcision harvested foreskins are used (amongst many other applications) in the preparation of cosmetic facial creams. I find your suggestion that it might deserve only a mention in a non existent article about one of those corporations a little odd - perhaps you could expand a bit on your reasoning in drawing such a conclusion that seems to be at odds with a well written secondary source. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:30, 9 August 2014 (UTC)

The article is more focused on San Diego businesses than this Wikipedia topic, which isn't surprising because it's from a small local paper called "San Diego City Beat". You say "a half dozen corporation" but a half-dozen is six, and the article only mentions four. Of those the article says Advanced Tissue Sciences is defunct, and of Advanced BioHealing and SkinMedica, the article says "neither company has acquired a prepuce in nearly 20 years" so the mentions of those businesses don't seem currently related to this topic. This left Life Technologies Corporpation (sorry I wrote "Life Sciences Corporation" but it's also a red-link through a disambig). Were you proposing specific content related to Life Technologies Corporation, and are you asserting that the use of this article would meet with the Wikipedia content policy regarding WP:DUEWEIGHT? Zad68 02:21, 10 August 2014 (UTC)

Adding: Yes, Life Technologies Corporation is a red-link through a disambig. You seem particularly interested in the business of foreskin sales (you've brought it up at least once before, I think) so why not go create an article about a company that does that? You already have an appropriate source, and it's a very normal thing while looking at one article to find that there's the potential for a new article to spin out of it. Zad68 02:26, 10 August 2014 (UTC)

THe companies that use circumcision harvested foreskins listed in the newspaper article that we are discussing are 1/ Advanced Biohealing 2/Invitrogen Corporation,3/Life Technologies Corporation4/Advanced Tissue Sciences5/Skin Medica . I guess neither of us can count, but the issue is not the exact number of companies or where they are located but the issue of including this part of the circumcision industry in the circumcision article and the other issues around informing parents and around consent.(If you read the article more carefully you will see that the two companies that have not acquired a foreskin in twenty years are working off growing cells from one particular foreskin). I AM more particularly interested in your implacable stout resistance to any mention of this circumcision related business in the circumcision article. Have you no thought for our readers who may like to know what all the cutters worldwide do with all the millions of foreskins ? This article provides a part of the answer.

Try to address some of the issues raised Zad rather than spurious objections based on number of companies or geography. Aristotle Onassis had the stools in his ship board bar covered in leather made from whale foreskin, but while novel, this fact has no place in this article as the foreskins were not removed by vivisection but post mortem. However the human foreskins used by the foreskin re-use industry come from the process that this talk page is about and so deserve mention. I propose to write a new section for this article on disposal of circumcised human foreskins. any help would be appreciated from any editor.— Preceding unsigned comment added by Tumadoireacht (talk • contribs)

Re I AM more particularly interested in your implacable... -- Tumadoireacht please do not further personalize this content discussion, focus on the article and not me. I am not your enemy here, do not use an article Talk page for WP:BATTLEGROUND behavior.

RE I guess neither of us can count - No, my count is correct, as the newspaper article says Invitrogen is a subsidiary of Life Technologies Corp. Again, this is a small newspaper article focused on San Diego-area businesses, it isn't a general overview of this market, and makes only a peripheral connection to the topic of this Wikipedia article.

Re Aristotle Onassis... were not removed by vivisection but post mortem. - Are you actually saying that if he did acquire them via vivisection, per your understanding of Wikipedia content policy there would be justification for including that content here? If so, that's disappointing that your understanding of Wikipedia content policy hasn't evolved after all this time, at the very least please review the results of the RFC you started some time ago.

Re address some of the issues raised - The thing is, I am, but your responses do not indicate that you're listening.

Re any help would be appreciated from any editor - Sure, I'm happy to help. You're not considering using this small newspaper's article as a primary source for the basis of a significant new section of content are you? What sourcing will you be bringing to solve the exact same issues present here that also existed in your previous proposals for example here and here? Looking forward to how this proposal will be different. Zad68 15:44, 10 August 2014 (UTC)

I think I meant any other editor.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 10:27, 12 August 2014 (UTC)

I agree with Zad68's assessment above, and find your replies and overall attitude not conducive for a collaborative environment. We should not place undue weight for a subject sourced only to a local business paper. Yobol (talk) 14:09, 12 August 2014 (UTC)

I am not at all surprised Zobol.Let me ask you then if a national british or usa newspaper carried an article or several about the same "harvested from circumcision" foreskin multimillion euro annual turnover industry- would you still oppose and revert any mention of it here? --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:14, 15 August 2014 (UTC)

The point of the talk page, as you should well know by now, is not to talk about hypothetical scenarios but to suggest specific improvements to the articles based on reliable sources. Yobol (talk) 16:19, 15 August 2014 (UTC)

Zad now appears to consider that a newspaper is a primary source. Wikipedia, on the other hand considers a newspaper to be a secondary source. My asking you Yobol whether you will stoutly resist by reversion, or otherwise,any usage of secondary source material about the industry of circumcision harvested cut off foreskins is not a hypothetical scenario. It is a question. Try to answer it . We might get to improve the article if we can determine what it s about this part of the circumcision industry that you find difficult to have mentioned here.

Here are some other secondary source newspaper articles about the foreskins for sale and re-euse industry.

http://www.sundaystandard.info/article.php?NewsID=14420&GroupID=4

http://www.thesundaytimes.co.uk/sto/style/article217240.ece

http://www.nytimes.com/1990/09/12/business/business-technology-3-companies-speed-artificial-skin.html?module=Search&mabReward=relbias%3Ar%2C%7B%222%22%3A%22RI%3A17%22%7D

What is it exactly that makes mentioning this circumcision process industry so repugnant to a few insistent editors ? How can we help them into the light?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:09, 16 August 2014 (UTC)

Re Wikipedia, on the other hand considers a newspaper to be a secondary source -- Incorrect, fundamentally. Please see the relevant links you have already been provided on this. Also, please stop personalizing this content discussion and start paying attention to the content concerns raised and requests made of you, if you would do so that would make this a productive discussion. And re Zobol -- Some time ago I wasn't writing out your name in full and I caught on that you didn't appreciate that; since then I have been careful to spell our your full name correctly. Couldn't you do the same? It's a simple matter of respect for your fellow editors. Thanks. Zad68 03:01, 17 August 2014 (UTC)

Try a little harder Zad to follow your own advice and address the references and the proposal. With regard to your behaviour and expressed opinions about what you will permit included in this article I fear you may be "policy shopping" . Please review these

https://en.wiki.x.io/wiki/Wikipedia:No_original_research#Primary.2C_secondary.2C_and_tertiary_sources

https://en.wiki.x.io/wiki/Secondary_source

Meanwhile the British Sunday Times and the New York Times articles above which discuss the industrial re-uses of circumcision-harvested neonatal foreskins remain unaddressed. Would it be your position that this WP article should ignore these sources also  ? — Preceding unsigned comment added by Tumadoireacht (talk • contribs)

Re address the references and the proposal - Sure, what is the specific content change proposed, citing which sources? Zad68 12:41, 19 August 2014 (UTC)

A new section on circumcision generated dismembered foreskins which will initially reference the newspaper articles cited on industrial and cosmetic and medical re-use of foreskins ( as previoulsly stated)--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:10, 19 August 2014 (UTC)

Great, looking forward to seeing the specific proposed new content and what sources you've found to solve the sourcing and weight issues identified previously. Zad68 04:15, 20 August 2014 (UTC)

Sources are above (per Yobol request for furhter coverage than local article on circumcision harvested foreskins and their industrial uses. Proposed content below:--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:28, 19 September 2014 (UTC)

Proposed text

Proposed Text - section heading DISPOSAL OF FORESKINS POST-CIRCUMCISION

Little information is available about what different circumcision cultures and practitioners do with the excised foreskins from circumcisions. However there are a number of companies which put some neonatal foreskins to use in cosmetics, fibroblast harvesting and regrowth, and other medical applications." References Sunday Times and New York Times as previously referenced.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:20, 21 August 2014 (UTC) This would do for a start - perhaps an overview of tribal ritual around foreskin disposal would make a good counterpoint to the clinical and commercial and lab re-use paragraph.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:20, 21 August 2014 (UTC)

Appears too off-topic here. May be useful in the foreskin article, but having to dig into 25 year old sources is a red flag. Yobol (talk) 19:31, 21 August 2014 (UTC)

In addition to what Yobol said, the first sentence does not appear to be supported by either source specified. Zad68 20:57, 21 August 2014 (UTC)

Boys : if what circumcisers do with circumcised foreskins after circumcising them "appears too off topic" in the circumcision article to both of you, then i strongly believe that you urgently need to review your editing and critical faculties.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:39, 23 August 2014 (UTC)

Seconded.Brakoholic (talk) 16:31, 13 October 2014 (UTC)

It does not seem to be appropriate in this article. This is about the procedure, not the piece of skin itself. For example, I do not see mention of what happens to body parts after procedures in any of the following articles: Appendectomy, Hemispherectomy, Hypophysectomy, Amygdalohippocampectomy, Ganglionectomy, Neurectomy, Thyroidectomy, Parathyroidectomy, Pinealectomy, Photorefractive keratectomy, Pericardiectomy, Glossectomy, Colectomy, Cervicectomy, Lumpectomy, Frenectomy, or Ganglionectomy to name but a few. Where discussion of the use of removed foreskins belongs is not in the article about the removal procedure, but the article about the foreskin itself—and it is already there at Foreskin#Foreskin-based medical and consumer products. So, I suggest that the "editing and critical faculties" review you suggest has already happened and the proper decision has been made, and is consistent with how the English Wikipedia project addresses all surgical procedures. -- Avi (talk) 16:34, 29 August 2014 (UTC)

Avi -we already have an article about the procedure. Not surprisingly it is called "Circumcision surgical procedure." Here it is :https://en.wiki.x.io/wiki/Circumcision_surgical_procedure

This article, however is the lead article referencing ALL aspects of the cultural phenomenon of male circumcision. It is not limited to the (surgical) procedure. For instance we discuss the history of circumcision and the many mistaken ideas in the past about its curative properties.. We discuss the possibility that it may help in combatting AIDS. And many other aspects. We have, so far, failed to reference particular aspects which I have drawn attention to like the clamp device fiascos, the transmission of herpes to children from oral contact with the child's genitals from the cutter in Vienna, Israel and New York, forced circumcisions on 3 continents, and the psychoanalytic, human rights and legal aspects of the act and and its perpetrators and those on whom it is performed. The disposal of and re-use of circumcised foreskins IS an integral part of the procedure in the wider non surgical sense.There does seem to be a small group of editors who fiercely defend the article in its present partial state and revert any attempt to include other pertinent information. Why do you think that is ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:43, 29 August 2014 (UTC) Here is a film and article considering all aspects of the current state of play about circumcision from the perspective of one of the major genital cutting religions. Should we reference the film ? http://forward.com/articles/137577/outlawing-circumcision/

http://www.cutthefilm.com/

--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:34, 19 September 2014 (UTC)

I think continued violation of the WP:TPGs is getting awfully close to warranting a topic ban. Alexbrn ^{talk|contribs|COI} 09:38, 19 September 2014 (UTC)

All I see above is a discussion on proposed changes to the associated article. Your comment, however, comes off as bullying and/or a threat, with the appearance of intending to silence a valid proposal for consideration which, thus far, has been argued for rather convincingly. First and foremost, if Wikipedia is to remain neutral, then alternate viewpoints should be represented equally in the article, assuming valid sources exist for each. Second, if one user's stance on this topic of discussion is a COI, then it stands to reason that so is the stance of the other user.Brakoholic (talk) 17:00, 13 October 2014 (UTC)

Brakoholic, you might want to review the lengthy Talk: page archives of this article. If I recall correctly, the editors here have discussed several times at length including material on foreskins. Also, regarding alternate viewpoints, it is critical to recall that WP:NPOV "means representing fairly, proportionately, and, as far as possible, without bias, all of the significant views that have been published by reliable sources on a topic" (emphasis mine). This most definitely is not the same as stating "alternate viewpoints should be represented equally in the article" - in fact, it's often the opposite. Jayjg ^(talk) 18:44, 13 October 2014 (UTC)

What is most alarming Jayjig, in the pattern of your and a small group of fellow traveller editors' individual and coordinated rebukes and shut downs of attempts to help this article shed its current blinkers is that WP policy is misreferenced to support laughingly glaring omissions. The most common howler presented over and over is that of the undue weight policy being hijacked to mean that no mention at all should be made of aspects of a subject that do not fit a particular world view. The next most popular is the misapplication of medical guidelines to the cultural aspects of willy chopping. The dearth of mention of tribal and forced circumcisions also gives a false picture.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:53, 14 October 2014 (UTC)

@ Alexbrn - I am curious about your cryptic comment on a topic ban - whom do you wish to have banned and why ? You mention violation of talk page guidelines - please be more specific.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:42, 14 October 2014 (UTC)

The film "Cut-Slicing Through the Myths of Circumcision" by Jewish film maker Eliyahu Ungar-Sargon 2011

Since there is no specific proposal for improving the article, further discussion about the film is a violation of WP:TPG

"Cut" is a documentary film by Eliyahu Ungar-Sargon on male circumcision from a religious, scientific and ethical perspective. Using cutting-edge research, in addition to interview footage of rabbis, philosophers, and scientists, Cut asks viewers to confront their biases by asking difficult questions about this long-standing practice. Does this film merit a mention in this encyclopedia article ?--— ⦿⨦⨀Tumadoireacht Talk/Stalk 09:46, 19 September 2014 (UTC) What high quality secondary sources have documented this film's impact on the cultural, social, political, religious or medical aspects of circumcision, and what is the specific wording you are proposing to add to this article with those sources? Yobol (talk) 13:03, 19 September 2014 (UTC) No secondary sources that I am aware of have documented any changes in the 5 aspects of willy chopping that you mention Yobol. To answer your second question I am not proposing a specific wording at this time. Perhaps you could suggest which section of this presently peculiarly selective article we should mention the film in and a wording that might not offend you or lead you or others to another instant undiscussed revert ? Hmmmm ? Perhaps the film rabbis and philosophers and scientists who feature in it are the wrong kind of scientists and philosophers and the wrong kind of rabbis ?--— ⦿⨦⨀Tumadoireacht Talk/Stalk 13:45, 10 October 2014 (UTC) Here is a link to an excerpt from the film http://topdocumentaryfilms.com/cut-slicing-through-the-myths-of-circumcision/--— ⦿⨦⨀Tumadoireacht Talk/Stalk 15:26, 14 October 2014 (UTC)

A discussion on the merits of including mention of this film in the Circumcision article was cut prematurely short previously. As the film includes interviews with a wide range of practitioners, experts, circumcised, and stakeholders in the Circumcision industry/culture I ask the question whether it constitutes a secondary source and thus merits mention. The editors who have stated that discussion of a potential article reference source without immediate content proposal constitutes a breach of guidelines are misleading and in error. Whichever administrator cut short the discussion on this potential source may have been acting from a similar mistaken mindset. I ask again for those editors who have taken the trouble or had the facility to see the film or read review of it - what, if any, mention of it should be made in the Circumcision article ? Here is the Youtube excerpt from the film ( 6.5 minutes). https://www.youtube.com/watch?v=VkBsrBHpbDs This section of the film is concerned with the loss of functions and sensation of the penis when the foreskin is cut off, in particular Meissner's corpuscles loss, the gliding mechanism function of the foreskin in sex, the Ridged Band function in sexual arousal and interviews with late life circumcision choosers comparing their penile sensitivity pre and post circumcision, and the process of attempting to "restore" foreskins post-circumcisions. The high sales of sexual lubricants in the largely circumcised USA society compared to other similar societies is attributed to loss of natural lubrication from circumcision. So far we have not managed to reference any of this material, or this film at all, in the Circumcision article. Would the article be improved by including a reference to this film ? Here is the Amazon link for the film http://www.amazon.com/Cut-Slicing-Through-Myths-Circumcision/dp/B002J0TP0K --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:22, 15 October 2014 (UTC)

The film is clearly not MEDRS compliant and therefore is not appropriate for any health related claims including material about sexual function. I have yet to see a specific proposal for wording with which to use this source. This is not a WP:FORUM to promote this film, but for improvement of this article. Please provide specific wording to improve this article. Yobol (talk) 18:18, 15 October 2014 (UTC)

If you have watched the excerpt you will have seen the cogent point made that the subjective question of loss of sensation post-circumcision is not, at the very least, solely a medical matter. Have you yet to see the film or even the excerpt ? If you have seen it , do you feel that the article would be improved by including a reference to it ? If I can establish a consensus on the relevance of the film content then I will propose a wording for the reference. Or you can.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:27, 15 October 2014 (UTC)

Tumadoireacht, per WP:TPG, and also WP:BURDEN, which is policy, it is up to you to use this article Talk page to both make a specific actionable article change suggestion, and then support it with a source you have identified, per your best understanding of Wikipedia's content policies, as being an appropriate reliable source.

Therefore Tumadoireacht, 1) Because in this edit you are making specific reference to biomedical information mentioned in the movie and which you apparently find noteworthy enough to talk about here, please confirm that you believe the movie "Cut-Slicing Through the Myths of Circumcision" to be an acceptable source per WP:MEDRS for biomedical content on Wikipedia; 2) Provide the article change suggestion using that source, in a manner you believe is appropriate per your understanding of Wikipedia's content policies. Thanks... Zad68 18:30, 15 October 2014 (UTC)

I am delighted to see you join this discussion Zad. I do not have sufficient technical skill to determine which admin it was who cut off the previous discussion of whether to reference this film so precipitously. My "actionable article suggestion' is : for interested editors to view the film and to arrive at a consensus on the merits of its mention per the best WP traditions of consensus building pre edit. I do not think this is a case where a be-bold edit would do. Have you seen the film ? Which section of the article do you think mentioning it would be most appropriate in if at all? Perhaps you could help with my earlier question on whether it constitutes a secondary source ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:57, 15 October 2014 (UTC)

Glad you're delighted. You brought this item to this article Talk page; others are not responsible for doing your work for you. You did not approach either request I made. I ask for you to please address both of them. Zad68 19:03, 15 October 2014 (UTC)

Is that why you are ignoring my requests and questions ? You asked three questions I have answered question one re action- perhaps you did not notice. As to question two it follows a pattern of some of your questions which are not really questions at all but attempts to attribute negative actions or indefensible positions, which have no existence in reality. Question three re early content suggestions i have answered several times. Which section of the policies which you cite do you feel prohibits consideration of a source without an immediate content change wording proposal ?. Now please answer my questions.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:59, 15 October 2014 (UTC)

Tumadoireacht, OK, I understand-- you're not proposing any content or even any thoughts of your own regarding the fitness of this item as a Wikipedia reliable source because you do not understand Wikipedia content rules such as WP:MEDRS well enough to do so, also you indicate you needed help in determining "whether it constitutes a secondary source". Fortunately you have already received an evaluation from an experienced medical editor, see here, and some good guidance here. Zad68 04:10, 16 October 2014 (UTC)

No Zad- you still seem to be having difficulty in seeing that there is a difference between an entirely medical scholarly secondary source and a secondary source dealing with the much wider picture concerning Circumcision. Please try to resist the temptation to attribute motives to other editors. It is an ongoing weakness of yours. Seeking the opinions of other editors is not a fault, but part of the consensus process we strive for. Try to examine the source as you would any other source proposed by any other editor. A film is not an academic article journal but the process of editors examining the source and making a decision on its provenance, relevance and how best to reference it should be much the same . Have you seen the film ? Or have you decided you do not like it without seeing it ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:47, 17 October 2014 (UTC)

Is it the same editor who closed the first discussion of this film as a potential source for the circumcision article who has now amalgamated the closed discussion and the ongoing one ? And amalgamated them way back up the page at the location of the closed one - Hmmm --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:46, 18 October 2014 (UTC)

Has any other editor had a chance to view all or some of this film about Circumcision ? I will shortly add a section the article concerning this film unless I hear some objection from another editor who has examined the source and raised some criticism of it --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:32, 21 October 2014 (UTC)

IAS–USA recommendation

Regarding the sentence:

"Circumcision is also recommended by the International Antiviral Society for all sexually active heterosexual males and it is recommended that it be discussed with men who have sex with men."

1. The society is always explicitly referred to as "International Antiviral Society-USA", also by itself. (Acronym: IAS–USA)
2. The linked reference is about HIV prevention and the available abstract does not mention circumcision — could somebody check?
3. Also regarding 2., the article sentence should be changed in a way to make it obvious that this IAS–USA recommendation is given in the context of HIV prevention.

— 188.195.0.204 (talk) 16:53, 23 October 2014 (UTC)

You are quite right. I had mentioned the odd misnaming of the International Antiviral Society USA amongst other criticisms. I hope that there was no intention in the misnaming to lend the report's source a more eminent origin than it has.Their funding is a bit dodge. On your second point re abstracts- has been my experience in this article in particular that there exist a small cohort of editors who will object to any mention of content from a secondary source which does not shed a positive light on circumcision, when it is not mentioned in the source's abstract, while where the reverse is the case, as in this case, they contradict their own strictures. This is a very unhealthy article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:05, 23 October 2014 (UTC)

@IP 188: I have confirmed the source and adjusted per your recommendation. Yobol (talk) 22:13, 23 October 2014 (UTC)

"Male Circumcision" vs. "Female Genital Mutilation": An Inherent Bias in the Title of Two Similar Articles

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section. A summary of the conclusions reached follows.

This is mostly WP:FORUM. Genital modification and mutilation exists and articles are titled by WP:COMMONNAME.

---

The Wikipedia page for the female equivalent of circumcision is titled "Female Genital Mutilation", and lists "female circumcision" as an alternative name for the practice. This name is widely considered accurate, and rightly so. This article, however, makes absolutely no mention of male genital mutilation whatsoever, and instead treats circumcision as a normalized and medically necessary practice. While there may be some medical benefits to being circumcised, there is no dispute to the fact that some routine aspects of the practice, such as the removal of the frenulum, have absolutely no benefit whatsoever, and serve only to decrease sensitivity. Furthermore, circumcision is rarely a medical necessity, and is usually done for cosmetic, cultural, and religious reasons, rather than for the health benefits. I'd like to open a discussion about the title of this article being changed to more accurately reflect what circumcision is. At the very least, people searching for "male genital mutilation" should be redirected to this page, as it is, in fact, the equivalent of female genital mutilation. 208.54.4.187 (talk) 07:19, 24 October 2014 (UTC)

No basis - our Genital modification and mutilation article exists and male genital mutilation redirects to a section there. Alexbrn ^{talk|contribs|COI} 07:32, 24 October 2014 (UTC)

THis discrepancy has been pointed out many times before 208.54. A small but co-ordinated number of editors continue to resist any mention of that parallel in the article or indeed any negative aspect of circumcision -such as forced circumcisions, disease and death from infections incurred during circumcisions, botched circumcisions, malfunctioning circumcision devices which burnt off several infants penises completely(https://en.wiki.x.io/wiki/David_Reimer), loss of sensitivity in the penis after the foreskin is cut off, and the declining popularity of circumcision. I am at a loss on how to address this most peculiar situation. I think that if it were almost any other subject then the link would have been made a long time ago.Perhaps we should take our lead from the WP mutilation https://en.wiki.x.io/wiki/Mutilation which gives two references for the following sentence in its introductory section

Whether or not male circumcision amounts to mutilation is a subject of active academic debate.[3][4]

Denniston, G. C., F. M. Hodges, M. F. Milos (1999). "Preface". Male and female circumcision: Medical legal and ethical considerations in pediatric practice. Kluwer. pp. i–vii. ISBN 0-306-46131-5.

and

Benatar M, Benatar D (2003). "Between prophylaxis and child abuse: the ethics of neonatal male circumcision". Am J Bioeth 3 (2): 35–48. doi:10.1162/152651603766436216. PMID 12859815.

Perhaps consideration of these two sources could enrich debate here on this page and content and referencing and links within the article.

--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:05, 26 October 2014 (UTC)

I do not consider sources dating from over a decade ago a good representation of an "active" debate. What specific wording are you proposing to add, to what location in the article, using which source? Yobol (talk) 20:38, 6 November 2014 (UTC)

The wording is in bold print above. I propose to add it to the article introduction.Using both sources.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:53, 6 November 2014 (UTC)

You have not specified where this would be going, but oppose any addition of the text as quoted above, as these are old sources, and certainly not strong enough to support the controversial nature of your proposal. Yobol (talk) 21:04, 6 November 2014 (UTC)

To be clear- you are opposing a 15 year old secondary source academic medical book on this exact subject as being "too old" and an 11 year old secondary source article in a distinguished journal too - Are you aware of better and more recent overviews than these on this precise area - perhaps you could share  ? And you also are opposed to even mentioning that there is any debate about whether circumcision amounts to mutilation ? Any editors out there (apart from the good 'ole boys) who agree that this is all a bit dog in the manger ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:24, 6 November 2014 (UTC)

I am opposing the use of sources that are greater than 10 years old to support that there is an "active" debate about the subject. Yobol (talk) 21:29, 6 November 2014 (UTC)

Can we drop the word "active" and make you happy with the edit using those two secondary sources -or do you know of better ones I ask -um - well-again ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:35, 6 November 2014 (UTC)

No, we can't just drop the word "mutilation" like this. What is the context? How prevalent is it considered this? If we are going to bring it up, we have to discuss the context. I'm not convinced that 2 sources over 10 years ago count. Do we have any better sources than this? Yobol (talk) 21:43, 6 November 2014 (UTC)

In the absence of any huge advances in the field of medical ethics in this small field in the interim your opposition is most odd. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:49, 6 November 2014 (UTC)

It amuses me Yobol that one of the two books in the article bibliography is over a decade old and there are references in the article reference section from 1992 and 1999 which cause you no distress,alarm, or sleepless nights, or any of your lads either But it is has become abundantly clear what is going on with this article. I had hoped that WP had moved beyond this sort of primitive and transparent hijacking of an article, particularly a medical one. Enjoy. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:29, 7 November 2014 (UTC)

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

Another study which pours doubt over this article's stance on the sexual effect of circumcision

The view of this article is that (according to the lead) "Circumcision does not appear to have a negative impact on sexual function." I believe this does not reflect the current consensus.

I have spoken about this problem before : Talk:Circumcision/Archive_79#Summarizing_the_effects_of_circumcision_on_sexual_function

Here is a new primary study: PMID 23600924. Tremello (talk) 12:17, 4 October 2014 (UTC)

WP:MEDRS 101 - not usable. Alexbrn ^{talk|contribs|COI} 12:28, 4 October 2014 (UTC)

Most interesting Tremello. Alexbrn is quite mistaken in suggesting that the article is unusable. As he may have forgotten, the policy he cites states quite clearly that primary sources may be used to supplement secondary ones. The 10% figures in the article abstract on erectile dysfunction and on delayed orgasm are alarming and bear out what at least one of the Cutting Religions has acknowledged openly for thousands of years as both a purpose and a result of Circumcision- that cutting away the foreskin reduces sexual sensitivity and pleasure. At present under the control of a small but apparently determined group of editors, any mention of historical, or current evidence of, the deleterious effects of circumcision are quickly reverted. Despite this, Circumcision is becoming less popular in the world. We do not presently mention this fact in the article either.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:54, 10 October 2014 (UTC)

WP:MEDRS 101 again - we don't use primaries to undercut high-quality reliable secondaries, which have a settled take on this topic so far as I can see. Alexbrn ^{talk|contribs|COI} 14:25, 10 October 2014 (UTC)

well if you read what I wrote in the archive link above I dont think "Circumcision does not appear to have a negative impact on sexual function." reflects the secondary sources either. It is all adding up. I don't think this article can have this stance for much longer. Tremello (talk) 06:02, 13 October 2014 (UTC)

You may have a WP:CRYSTALBALL but Wikipedia can't make use of it. If/when high quality secondary sources do drift from where they are now, we will of course faithfully follow. Alexbrn ^{talk|contribs|COI} 06:17, 13 October 2014 (UTC)

Is your crystal balling about the future development of this article so very different from that of the editor whom you direct your sarcasm at Alex?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:37, 14 October 2014 (UTC)

Yes—it's safe to predict this page will continue to follow WP:PAGs since that at least is under our control. On which topic, we should confine our discussions here to proposing changes that might improve the article in line with those WP:PAGs. We're not, though, going to be using weak primary sources for sourcing dubious health content. Alexbrn ^{talk|contribs|COI} 10:04, 14 October 2014 (UTC)

The royal "We"is not appropriate. Are you aware Alex of the distinction that WP policy makes between using a primary source to contradict a secondary one and using a primary source to supplement a secondary one ? --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:22, 14 October 2014 (UTC)

Bizarre comment, since the proposed source is precisely being used as a primary source to contradict secondary sources used in this article, and therefore is a clear violation of WP:MEDRS. We're headed towards (if not already at) tendentious level of wikilwayering and WP:IDHT. Yobol (talk) 15:38, 14 October 2014 (UTC)

Agree, without a specific article content change suggestion, backed in WP:MEDRS-compliant reliable sources, this is an idle philosophical musing that really isn't an appropriate use of this article's Talk page. Zad68 15:40, 14 October 2014 (UTC)

The proposed source has not been used Yobol. It's possible use has been discussed but not yet at length. The assertion from one editor containing the phrase "a settled take" on the subject is alarming. Perhaps the editor Tremello who kindly brought the article to our attention would like to attempt to outline a proposed wording for an article addition which would mention this new article without breaching the guideline of attaching too much weight to it and a second wording to support his/her assertion on the other deleterious effects of circumcision. What is important too is to not permit any group of editors, no matter how ancient, or eminent, or bemedalled to intimidate or stifle discussion and debate when it has any possibility of improving this very patchy article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:54, 14 October 2014 (UTC)

It is incumbent on those proposing to use the source to make a specific proposal, per WP:TPG. If one has not been presented, it is therefore a violation of those guidelines. Your continued insinuation that there is a cabal is not helpful, and it would be more helpful if you provide a specific proposal rather continue your pontification on the talk page. Yobol (talk) 16:01, 14 October 2014 (UTC)

Agreed. For general information: It is a normal part of Wikipedia to restrict editors who, within a certain topic area, consistently misunderstand and misapply content policies and guidelines, and who present persistent behavior problems, from editing within that topic area. Zad68 16:08, 14 October 2014 (UTC)

Tremello, and especially Tumadoireacht, how many times must you bring this topic up before you get the point? Actually, I think you do get the point; you're just not accepting of it. You don't have to accept it, unless trying to edit the article or other Wikipedia topics about it, but you don't have to beat a dead horse either. I don't see why others keep replying to you on this matter, since it's pretty much the same discussion over and over. And that qualifies for WP:Disruptive editing (on your parts, not theirs), in my opinion. Flyer22 (talk) 22:40, 14 October 2014 (UTC)

Oh, but thank you, Tremello, for pointing to that archive above. I thank you because it led me to Talk:Circumcision/Archive 79#"Prevalence of circumcision" map, where Jookieapc (talk · contribs) commented with an inappropriate signature; it's not so much that his name is a play on Zad68's name that's the problem; it's that he linked to Zad68's name in part of his signature...as though we couldn't guess by the color and the "68" portion of his signature that he is mocking Zad68. If he posts with that signature again (I mean with the Zad68 link intact), I will do something about it (in other words, he will not be allowed to post with that link in his username again). Hopefully, he gets a ping about this via WP:Echo, and that can serve as his warning. Flyer22 (talk) 22:55, 14 October 2014‎ (UTC)

Flyer - please attempt to confine your remarks on this page to efforts to improve the article. Your continued Aunty remarks are impolite and not appropriate. I have no idea what your last entry is referring to but apart from its bizarre tone it has no place on this page. I ask you again also to attempt to understand the difference between contradicting and supplementing a secondary source. One of your fellow circumcision article editors used the verb "undercut" -I presume no pun was intended. A contrasting research finding need not necessarily contradict.

In terms of policy violation( Is "violation" an excessively strong verb for a guideline - perhaps the strength of the condemnation in its sentiment is inversely proportional to the weakness of the argument ..) I will refer you to this paragraph in the policy you so frequently cite

Campaign to drive away productive contributors: act counter to policies and guidelines such as Wikipedia:Civility, Wikipedia:No personal attacks, Wikipedia:Ownership of articles, engage in sockpuppetry/meatpuppetry, etc. on a low level that might not exhaust the general community's patience, but that operates toward an end of exhausting the patience of productive rule-abiding editors on certain articles.

and ask that you re-examine your own condemnations, dismissals, contempts and threats in the light of it.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:36, 15 October 2014 (UTC)

Nah, my comments above are quite appropriate. Your WP:Disruptive editing, "I can't drop the stick" editing, and WP:Single purpose account editing (all of that combined) at the Circumcision article and its talk page are not. The productive editors of this talk page indeed need to start ignoring you until you make a problematic edit to the Circumcision article. And I have no idea what "policy [I] so frequently cite" you are referring to. Something tells me that you are confusing a guideline with a policy or with an essay, or an essay with a policy or with a guideline, especially given that the vast majority of your Wikipedia editing is confined to exhausting editors at this talk page. Flyer22 (talk) 11:45, 15 October 2014 (UTC)

Flyer -Your ignorance of the policy you so frequently cite is suggested by your not recognizing it when its content is quoted to you as above . Something tells me you that you cite policy more often than read it, or indeed observe it, but opinions are as common as Clint Eastwood's metaphor. You are, I presume familiar with the injunction to use this page to improve the article ? If you need to refresh your memory it is available at the page top. I hope that familiarizing yourself with it will not prove too 'exhausting". It is a positive sign that you at least read the policy excerpt which I quoted for your benefit, even if only to employ the word exhausted. Please desist from attempting to intimidate good faith editors, especially junior ones, who come to this article in attempts to improve its shoddy imbalance. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:56, 15 October 2014 (UTC)

As many editors at this site know, I am very familiar with Wikipedia policies and guidelines, and I adhere to them (usually anyway;WP:Ignore all rules should be used sparingly). You, on the other hand, are not/do not. Your "policy you so frequently cite" commentary is silly because, as I've noted to you before, I barely comment on this talk page. Here is a link to prove it. I every now and then comment at this talk page, and I certainly have not frequently cited any policy at it. Compare that link to a link regarding your participation at this talk page. Clearly, you are far ahead of me when it comes to commenting at this talk page. You are told repeatedly what the deal is -- to follow the WP:MEDRS guideline (yes, that's a guideline, not a policy, just in case you aren't sure). And you have repeatedly rebelled against it. Yes, you are a WP:Disruptive editor as far as the Circumcision article and its talk page goes, a WP:Disruptive editor who exhausts the good editors of this article and talk page. As for the rest of what you stated... Nah. Flyer22 (talk) 05:08, 16 October 2014 (UTC

Your nine edits this month alone belie your "barely there" asssertion above Flyer. Circumcision is largely not a medical phenomenon but a cultural one. If you feel that any editor is disruptive there is a process for having that opinion examined and acted upon. But this page is not the place. Here we try to improve the article content. Have you had a chance to examine the film "Cut - Slicing through the Myths of Circumcision" referenced above ? Do you think mentioning it would improve the article ? --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:58, 17 October 2014 (UTC)

LOL, my nine (now ten) edits this month that are all located in this section replying to you. As always, you are wrong when it comes to me. And to state that "[c]ircumcision is largely not a medical phenomenon" is also wrong. I'll let you get back to pestering people now. Flyer22 (talk) 09:14, 17 October 2014 (UTC)

"Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction" is what it says on the adverse effects sections. That might not be true.. [1], [2]. Prcc27 (talk) 00:38, 21 October 2014 (UTC)

Medical information on Wikipedia is based on WP:MEDRS; we use high quality secondary studies, not primary studies such as those you have linked to. Yobol (talk) 01:01, 21 October 2014 (UTC)

• @Yobol: Will this work then..? Prcc27 (talk) 08:58, 21 October 2014 (UTC)

@Prcc27: I assume you're asking seriously; the Daily Mail is the canonical example of an unreliable source for health topics. Alexbrn ^{talk|contribs|COI} 09:10, 21 October 2014 (UTC)

• @Alexbrn: Oh.. I'll try harder to find a more reliable source then. Prcc27 (talk) 09:25, 21 October 2014 (UTC)

That primary study mentioned in the Daily Mail article Prcc27 simply bears out what at least one cutting religion has acknowledged for thousands of years - that both a purpose and a result of cutting off a substantial portion of the sensitive penis tip reduces sensation and leads to an evenly scarred or " keratinized" dried penis head. With all its faults as a sensational tabloid, nevertheless the Daily Mail has managed to provide in that short article an overview of the current situation regarding Circumcision that is superior to this WP article ! I wonder whether the "Good Article" status which this article currently erroneously enjoys should be rescinded until such time as the huge and obvious omissions in both content and referencing in the WP Circumcision article are corrected ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:40, 21 October 2014 (UTC)

Is it reliable enough..? If so, then we should definitely use this article! Prcc27 (talk) 01:56, 22 October 2014 (UTC)

No, it does not meet WP:MEDRS. Yobol (talk) 02:25, 22 October 2014 (UTC)

Not all of the references for this article are "medical' nor should they be as Circumcision is a cultural practice primarily. Therefore not all future references need to be taking account of the medical information guidelines on WP. Over-referencing mis-referencing or Blanket referencing WP:MEDRS (for most every proposed new edit) by a small group of editors has severely hampered the development of this article which continues to have no reference to the declining popularity of Circumcision or to forced circumcisions around the world, to mention two of the dozens of weird gaps in the article. At least the Daily Mail article has the merit of mentioning the former.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:53, 23 October 2014 (UTC)

Discussion of sexual function is clearly medical related. If an editor wants to propose non-medical content based on that source, they need to be explicit about what they propose. Yobol (talk) 22:00, 23 October 2014 (UTC)

The article refers to a survey of circumcision victims and non victims and seems to confirm the long held belief that foreskin deprived penises are less sensitive.. 1800 men were handed leaflets at a Belgian railway station to which they responded. It is not recorded whether any of them were medical workers. Perhaps we should include a paragraph, as so many WP articles do, which begins " A non-scientific survey was conducted....... to include this information.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:58, 25 October 2014 (UTC)

It is a survey about medical effects, and any discussion about medical effects is covered by MEDRS. Again, if you have a specific edit to suggest, please do so. Yobol (talk) 23:55, 25 October 2014 (UTC)

Is there a danger that you are attempting to medicalize a part of human experience that predates medicine and will outlive it ? Does a man need a doctor to advise him on how his penis feels with and without a foreskin ? --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:55, 26 October 2014 (UTC)

As has been pointed out to you multiple times before, this is not a forum for general discussion of the topic. Do you have a specific proposal for the use of this source, or not? Yobol (talk) 14:53, 26 October 2014 (UTC)

Look north nine lines to see proposal. My question about attempting to medicalize a survey of subjective human experience remains unsurprisingly unaddressed. Do you support this proposal ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 12:30, 28 October 2014 (UTC)

I see no specific proposal, just inappropriate commentary, per usual. Please be specific as to what your proposed change to this article is and which source you want to source that change to. Yobol (talk) 13:07, 28 October 2014 (UTC)

I see that you amended your reply to cut this:

Note that I have already responded to your survey question, noting that a survey of medical information (sexual function) does not need to be "medicalized" because it already is medical in nature."

on the grounds that that part of your reply is "off topic material" .Hardly. A surveyor handing out leaflets asking about subjective experience of penis sensitivity of the cut men and the uncut men has nothing to do with the medical industry despite the results being collated by a doctor. Is it possible that you resist the mention of the survey by wrongly citing WP:MEDRS because you dislike the results? Try to imagine a similar survey being conducted on circumcised women to gain some perspective. You see the proposal and you know the source, so please give the old filibustering "tell me your proposal " guff a rest. It gets very old very quickly--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:07, 29 October 2014 (UTC)

I ask one final time: do you have a specific proposal or not? Yobol (talk) 16:24, 29 October 2014 (UTC)

Yes. i propose the survey be mentioned as outlined above, and as is common with other less beleagured WP articles with any of the following introductions - "Conversely a primary study has found ...." or as I suggested above " A non scientific survey was conducted" Is there a difficulty understanding this proposal ? --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 03:22, 30 October 2014 (UTC)

Yes, you are proposing fragments of a sentence, and it is not clear what the exact wording is. If you have a proposal, be explicit about the specific, entire wording, where you propose adding it, and which exact source you propose using. Yobol (talk) 13:50, 30 October 2014 (UTC)

Very well - in the adverse effects section the following sentence

Bearing out what has been acknowledged within Judaism for thousands of years and in contrast to some secondary studies two recent surveys in Portugal and in Belgium yielded results that appeared to confirm a marked diminution in pleasure and sensitivity at the penis post-circumcision.

references as cited above.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 23:41, 6 November 2014 (UTC)

Not yet seeing that the suggestion is in line with Wikipedia content guidelines. There's a lot of text above, could you please specify which sources you're citing exactly, taking care to make sure the sources meet with Wikipedia's sourcing guidelines? Are you stating that your suggested edit is entirely supported by those sources? Also could you please explain how your suggestion isn't a problem per WP:MEDREV? Thanks. Zad68 04:03, 7 November 2014 (UTC)

Sorry if I am cutting in. But just to clarify my point once more. If you look at the evidence I outlined in this post: Talk:Circumcision/Archive_79#Summarizing_the_effects_of_circumcision_on_sexual_function you will get my point. Please read it if you are someone who is opposing before a knee-jerk reaction of no. According to wikipedia guidelines the best available evidence is the RCT - my point is that in this case it isn't. Therefore the summary of sexual effects in the lead "Circumcision does not appear to have a negative impact on sexual function.[18]" is something I wish to change. Those who oppose - would you at least be open to a more neutral stance suggestion? Tremello (talk) 06:36, 8 November 2014 (UTC)

"According to wikipedia guidelines the best available evidence is the RCT" ← no, a RCT is primary research and so no use for this. We use the best evidence now, and can't say other than what we say now unless that best evidence changes. Alexbrn ^{talk|contribs|COI} 06:47, 8 November 2014 (UTC)

I don't see anybody providing a "knee-jerk reaction of no", I see comments based in Wikipedia content policy after due evaluation of the sources and their suggested use. Zad68 04:12, 9 November 2014 (UTC)

Should the link to the Forced Circumcision article at the end of this article just contain the adjective "Forced" or the full phrase "Forced Circumcision ? should the circumcision article mention forced circumcision?

Should the link to the Forced Circumcision article at the end of this article just contain the adjective "Forced" or the full phrase "Forced Circumcision ? Zad and one other editor felt strongly enough about it that they twice reverted my adding the noun "Circumcision" to the link. Zad and I have discussed this on our respective talk pages - here https://en.wiki.x.io/w/index.php?title=User_talk:Zad68&diff=632702533&oldid=632668551 and here https://en.wiki.x.io/w/index.php?title=User_talk:Tumadoireacht&action=edit&section=32 but Zad/Zach does not want that conversation carried here.The portion on his page has been struck from it but can be found in his archive -his reply to that portion remains on my home talk page

As a further question is it nonsensical to link the Circumcision article and the Forced Circumcision article when forced circumcision cannot get a mention at all at all under the current regime within the Circumcision article body ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:21, 6 November 2014 (UTC)

Forced is sufficient. Circumcision is implied. Doc James (talk · contribs · email) 02:26, 7 November 2014 (UTC)

As I indicated several times previously, the discussion about the template should be at that template's Talk page. It'd be appropriate to put a notification here about the discussion there, but the discussion should be held at the Talk page for the content page. Zad68 03:46, 7 November 2014 (UTC)

I ask again - why are we linking to Forced Circumcision article and failing to mention it at all at all in the Circumcision article ???--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:19, 7 November 2014 (UTC)

We last had a substantive conversation about this topic just earlier this year here, I gave you specific suggestions, have you completed that work yet? Zad68 16:32, 7 November 2014 (UTC)

No Zad you are mistaken once again. We have not ever discussed the illogic of having a Forced Circumciision link at the end of this article when it contains nil reference to the subject. So I ask once more. Sheesh. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:34, 8 November 2014 (UTC)

I was assuming you were using the article Talk page for its intended purpose--discussion of the content of the related article--sorry if I got that wrong. Are you instead proposing that the link be removed from the Template because you find it "illogical"? If so, please use the Template Talk page for that. If you're not actually proposing either content change suggestion, please be reminded not to use an article Talk page for discussions other than those relevant to the related article content. Zad68 04:12, 9 November 2014 (UTC)

Di I sniff a whiff of wikilawyering here Zad/Zach ? My question (still unanswered naturally) is about article content. This page is about article content. So sorry if you did not understand that once again.I have suggested that the article should contain a reference to Forced Circumcision as it includes a link to "Forced" (Circumcision) hidden at its base. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:53, 10 November 2014 (UTC)

Then please explain how my response to you dated 16:32, 7 November 2014 (UTC) wasn't directly addressing your concern. Zad68 14:56, 10 November 2014 (UTC)

My dear fellow -I refer you in turn once more to my answer of 18:34, 8 November 2014.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 15:25, 10 November 2014 (UTC)

I will wait until you make it more clear exactly what it is you want. Zad68 15:29, 10 November 2014 (UTC)

I ask any other editor or admin whether it is inconsistent with WP practice that every other link subject at page end to other Circumcision related pages has mention WITHIN the body of the main circumcision article except Forced Circumcision, and whether therefore we should mention Forced Circumcision within the text of the main Circumcision article both in the History section and in a new separate section - perhaps called Violence and Circumcision ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:36, 10 November 2014 (UTC)

Most links in navigation templates would not also be duplicated in the articles those templates appear on. The standard practice is to include a navigation template precisely because it is preferable to maintaining an independent set of links in every article pertaining to the navigation template's subject. - MrOllie (talk) 18:44, 10 November 2014 (UTC)

Yet most links are mentioned here bar "Forced Circumcision". Also most articles seem to have the links template at page end set to "Show" default position rather than "Hide" as it is here.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:55, 10 November 2014 (UTC)

I think a link to forced circumcision, as well as a brief discussion of it in the body is appropriate. It is quite obviously part of the broader topic of circumcision. Gaijin42 (talk) 18:49, 10 November 2014 (UTC)

Agree, see my comments above linking to a conversation previously about how exactly to accomplish this. Zad68 19:05, 10 November 2014 (UTC)

Zad/Zach apparently continues to fail to see that there are three issues here. As the title of this section indicates.These are, of course, the question of the truncated and hidden Forced Circumcision link, the relationship between that link and indeed any link within an article's content (that is that the article generally refers somewhere to the subject of the link naturally ), and the question of why the article fails to mention Forced Circumcision (amongst a host of other glaring omissions) at all at all.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:06, 10 November 2014 (UTC)

UK National Health Service acknowledges sensitivity loss from Circumcision- should we continue to make no mention of sensitivity loss ?

http://www.nhs.uk/conditions/circumcision/Pages/Advantages-and-disadvantages.aspx If such an eminent authority as the NHS are saying

"Reduced sensitivity –

an uncircumcised penis is more sensitive than a circumcised penis, meaning that circumcised men may experience less pleasure during sex." perhaps it is time to amend the stout denial of this in the article.

It is interesting also that the NHS says " there are much more effective and less invasive ways" of preventing UTIs, STIs, HIV, and genital herpes, bacterial vaginosis,trichomoniasis, and penile cancer than Circumcision. We seem to have omitted this information from the article for some reason, So far.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:47, 6 November 2014 (UTC)

The page actually says that this reduced sensitivity case is merely what "critics of circumcision argue". They're right about that, eh! Alexbrn ^{talk|contribs|COI} 08:51, 6 November 2014 (UTC)

If they are "right about it" as you say Alex and choose to see it as significant enough to mention it prominently on their advice page on circumcision then we should too .... um eh ? EH etc.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:14, 6 November 2014 (UTC)

What specific edit are you suggesting using this source? Zad68 19:17, 6 November 2014 (UTC)

Two edits really - one mentioning "the more effective and less dangerous than Circumcision" NHS direct quote re Circumcision as a treatment for the 7 ailment categories mentioned by the NHS. And a second one mentioning the listing by the NHS on their website of the mindset concerning the loss of sensitivity after the chop - something we have failed to mention here - um - until now. Which section(s) of the article do you yourself feel they would be best mentioned in ?Naturally the wording will depend on where in the article we choose to share this important information. Also- Any views on where in the article we should mention Forced Circumcision so that the link at the article end to the Forced Circumcision article makes sense ? Are you opposed to the NHS as a source or do you dislike the content Zad/Zach ? --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:11, 6 November 2014 (UTC)

What specific wording are you proposing? I repeat, what specific complete wording, using complete sentences, and specific location in the article, are you proposing to add using this source? Yobol (talk) 20:37, 6 November 2014 (UTC)

Until we determine where to put it the wording is secondary. What exactly are you repeating exactly Yobol - this is your first contribution - No ? I am waiting for interested editors to discuss the subject more fully rather than accede to the blanket stern demands for immediate content that the tag team seems to consider a non transparent ploy. I ask you or any sincere interested editor - AGAIN ( for real) where do you consider this information from a major health authority should be placed. I ask you also ( a question I am not holding my breath about getting answered but I live in hope ) Are you opposed to the NHS as a source or do you dislike the content? There is not really a point in proposing a wording if the gatekeepers of this article are opposed in principle or opposed on autopilot.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:02, 6 November 2014 (UTC)

I am not the one proposing to use the source, you are. Please make a specific proposal as to the specific wording, location, and source. Yobol (talk) 21:33, 6 November 2014 (UTC)

Very well:

in the adverse effect sections I will insert this sentence

The British National Health Service sees fit to mention in its internet advice page that "critics of Circumcision argue ...that an uncircumcised penis is more sensitive than a circumcised penis, meaning that circumcised men may experience less pleasure during sex

In the introduction for the article first paragraph I will add this sentence

The British National Health Service maintains that "there are much more effective and less invasive ways of preventing UTIs, STIs, HIV, and genital herpes, bacterial vaginosis,trichomoniasis, and penile cancer than Circumcision

at the end of that first paragraph.

reference will in both cases be the NHS official website --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 23:29, 6 November 2014 (UTC)

Not a particularly good source thus adding it to the lead is undue weight. I think we could use it in the society and culture section to mention that "critics argue that it decreases sensitivity"

With respect to the second sentence we already state "but routine circumcision is not justified for the prevention of those conditions". So oppose. Doc James (talk · contribs · email) 02:23, 7 November 2014 (UTC)

Agree, generally patient pages aren't as good quality, and this one doesn't even cite its sources, we already have much better in the article and suggested medical content would be repetitive. Zad68 03:53, 7 November 2014 (UTC)

Agree with Doc James and Zad68, would not include suggested edit as unnecessary given already cited material saying the same in article. Yobol (talk) 22:13, 12 November 2014 (UTC)

Quite right lads - what would the NHS know about health after all ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:31, 7 November 2014 (UTC)

It is amusing Zad?Zach that your distaste for "patient page"s arises here so suddenly yet reference number 15 (http://www.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-prevention) has nestled snugly within the article for ages now - a "patient page" briefly mentioning circumcision for penile cancer, also without references has caused you no alarm at all at all. Why might this be ? Your attempted point about repitition is also moot- no other such eminent national body as the NHS has provided the ideas contained in those two quotes above as clearly . That the NHS has chosen to do so is part of the reason for including them. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:18, 10 November 2014 (UTC)

Circumcision as Mutilation ? Should this secondary academically documented idea be mentioned within the Circumcision article ?

The discussion above about whether the two secondary sources which are referenced within the Mutilation WP article should also be referenced within this article was cut short above. This academic textbook and academic journal article are younger and more focussed than several article and book references which we already use. Despite this one editor objects to them being described as "active" and objects to their age . Please see discussion above. Please comment. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:04, 10 November 2014 (UTC)

I hope you will be making this discussion different from the one EvergreenFir closed by identifying high-quality reliable sources and making a specific proposal. Please specify which sources you're talking about, and what content you're proposing exactly? I'm curious to know what source you're describing as an "academic textbook". Zad68 19:10, 10 November 2014 (UTC)

I cannot be responsible for your hopes and yearnings Zad/Zach. References as in previous discussion. Do you too feel that this subject should have references younger than the current article references as Yobol apparently does ? A simple yes or no would be clear - though perhaps you could explain your support or opposition too. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:31, 10 November 2014 (UTC)

Specify those reference you discussed with Yobol here please, I have learned not to assume. And you need to propose specific content if you'd like comment about it. Zad68 19:39, 10 November 2014 (UTC)

Benatar M, Benatar D (2003). "Between prophylaxis and child abuse: the ethics of neonatal male circumcision". Am J Bioeth 3 (2): 35–48. doi:10.1162/152651603766436216. PMID 12859815.

Perhaps consideration of these two sources could enrich debate here on this page and content and referencing and links within the article.

Here is the Benatar and Benatar article http://mwbdvjh.muse.jhu.edu/journals/american_journal_of_bioethics/v003/3.2benatar.html from the MIT website.

I originally proposed the following content Whether or not male circumcision amounts to mutilation is a subject of active academic debate.

Despite these references being younger than several references currently in use within the article, Yobol, as you know, felt that they were too "old". So I offered to excise the word "active" Yobol then, I think, did not like the word "Mutilation", but consideration of "Mutilation" is the central point of the proposed edit . I hope this is now as clear to you now here as it was there then .--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:03, 10 November 2014 (UTC)

I will reiterate my opposition to the proposed edit; the source is old, and gives undue weight to concern of "academic debate", as the source mentions only one other source (Denniston 1999). The source also appears to largely discount the conclusion that this is "mutilation", and therefore the proposed edit would not be a good summary of the source. Yobol (talk) 22:22, 12 November 2014 (UTC)

Thank you for your reiteration Yobol. Your reply fails to address the point that there are older references already used within the article. The point of the edit is not to describe Circumcision as Mutilation but to record that these two amongst other sources consider it important to acknowledge that some consider it so, as the wording of the proposed edit bears out. But reason seems to have little bearing on the concerted opposition to balancing this article The Benatar and Benatar article has several dozen references which must have escaped your notice.???--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:12, 13 November 2014 (UTC)

Yobol did indeed meet your point, please reread what he wrote. Many of your statements in this reply aren't relevant to the points being made. Zad68 00:39, 14 November 2014 (UTC)

Beg to differ once again Zad - your merely stating that it is so does not make it so, particularly without any supporting argument but your support for Yobol/Doc James/Alexbrn/Flyer22 and the rest of the Desert Patrol remains predictable.Try to answer the argument raised and those in immediately previous discussions instead of merely circling the wagons.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:48, 14 November 2014 (UTC)

Academics rarely debate whether something is "mutilation"—academics might study whether significant numbers of people in a certain group regard something to be mutilation, but generally academics researching this topic would study things like whether circumcision on a baby is painful, what complication might occur, what health outcomes might be, and what people believe. What is obvious is that academics publish thousands of articles each month, and a very large number of unlikely topics are covered. Before Wikipedia can assert that something is a "subject of active academic debate", we would need a reliable secondary source to verify the statement—a couple of papers mentioning a topic do not amount to an academic debate—see WP:UNDUE. Johnuniq (talk) 00:09, 15 November 2014 (UTC)

What "couple of papers" are you referring to- Johnuniq ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:54, 17 November 2014 (UTC)

Description of technique is Western-centric

Globally about 30% of men (1.2 billion) are circumcised. The article's description of how circumcision is performed only reflects the methods used in the US. The majority of boys are cut in ritual 3rd-world conditions, with unsanitary instruments, by medically-untrained traditional practitioners. In Africa there have been hundreds of thousands of hospitalizations and over 400 deaths in the past decade. Source: http://www.theguardian.com/commentisfree/2014/aug/25/male-circumcision-ceremonies-death-deformity-africa

Footage of a traditional African circumcision ceremony: www.vice.com/en_au/video/imbalu-circumcision-party-2-of-2

Circumcision of boys in the Philippines at puberty without anesthesia: http://phys.org/news/2011-05-philippine-city-mass-circumcision-youths.html

Complications of traditional African circumcision (NSFW): http://ulwaluko.co.za/ — Preceding unsigned comment added by 96.40.125.144 (talk • contribs) 14:54, 15 November 2014‎ (UTC)

It isn't that the article's description is Western-centric but rather per Wikipedia content policy it reflects the emphasis found in the reliable soucing, and the article's sourcing comes from sources around the world. I noticed that the article about the Philipines doesn't appear to support the assertion that anesthesia generally wasn't used for the one event the article describes. Also I didn't see a source for the assertion "the majority of boys are cut in ritual 3rd-world conditions"; actually the sourcing provided in the Wikipedia article doesn't support that. Sourcing does indeed support that risks of complications are higher when the procedure is performed by an inexperienced operator or in unsterile conditions, and the article already states that. This does remind me that I was going to add a bit more about that, and I will do so, thanks for the reminder. Also Wikipedia does have an article that focuses specifically on religious aspects, see here. Zad68 03:05, 16 November 2014 (UTC)

@96.40.125.144|14:54. You are quite correct - the article has a strong pro-circcumcision stance and a strong USA leaning in many aspects. Statistics given are based on USA statistics but presented as if universal. Many of the deleterious aspects of Circumcision are simply not permitted to be referenced at all within the article under the current editorial regime here. The massive decline in the popularity of circumcision is presented in an hilariously obscure way, et cetera. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:00, 17 November 2014 (UTC)

Should Have Section on Pain

I think that this article should have a section describing the pain experienced by infants or persons undergoing this procedure. According to a recent review of the pain relief of circumcision from the cochraine organization, as well as any observer of the procedure, this procedure is painful as noted by loud crying, distorted facial expressions, and intense shaking or vibrating. I think that since we are describing a surgery we should have a section detailing the pain persons may go through as a side effect of this surgery. JohnPRsrcher (talk) 20:53, 24 November 2014 (UTC)

There is already a section on Pain management in the article. I reviewed the Cochrane database publications on this topic published in the last 5 years, which are you talking about exactly? Do you mean Cyna and Middleton, or Kassab et al.? Zad68 21:04, 24 November 2014 (UTC)

It is Brady-Fryer B, Wiebe N, Lander JA. Try going to BJU. This clearly states that it is painful regardless of intervention as indicated by facial expressions, salivation, loud crying, and many other factors. — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

From 2004? I thought you said "recent review"? The article already states that the procedure causes pain, using more up-to-date sourcing, I don't see what the advantage is in using a 10-year-old review. Zad68 02:53, 25 November 2014 (UTC)

I agree with this proposal that there should be a separate and better section on pain. It should have sub sections on pain in infant, adolescent, adult and in forced and bush ciccumcisions. These should include information on pain during the act, in the recovery period, and the long term pain effects from loss of tissue, scarring, impaired penis function, and pain for penetrative sexual partners of the circumcised.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 07:56, 27 November 2014 (UTC)

I don't see support for this in the sourcing. What sourcing are you referring to? For ease of reference provide PMIDs for medical sources. Zad68 02:26, 28 November 2014 (UTC)

http://link.springer.com/chapter/10.1007/978-1-4757-3351-8_12#page-1 This is one of many studies which points up some of the negative outcomes of Circumcision. But what will now happen is that despite the Circumcision article already using decade old old medical sources and websites, Doc, Flop, Gop or one of the gang will come on and say; "no we do not like dis one 'cos its too old /too singular /too negative. We will not permit it to be added to this article which should really be renamed "Circumcision -the best bits " This of course despite it being from a well regarded book on the subject. Is there really no overview by WP of the ongoing scandal of one admin and a posse who have been heading this article off at the pass for a decade now !--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:54, 1 December 2014 (UTC)

Summary Does not Properly Represent Circumcision, Please do not automatically delete edits

Saying that the foreskin is taken off after being inspected is not true. According to research it must be broken from the glans first and then cut off. This is not too descriptive as people reading the page should be able to know what a circumcision is.

In addition, saying that circumcision is non-painful in opening paragraph is not correct. It is painful as indicated by many different factors (loud crying for one.) This should not be looked over. — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

The article does state "separated from the glans", maybe you missed that. The article already summarizes the technique as detailed in a specialized surgical guide and a major technical report from the AAP both from 2012. According to the sourcing, many procedures are performed with a device that clamps the skin and causes separation, so specifying "a cut is made" doesn't cover the range of techniques adequately. Also please review WP:MEDDATE, we use up-to-date sources where available. Zad68 02:53, 25 November 2014 (UTC)

Those who presently maintain this article in its present bizarrely unbalanced state are generally at pains to select the most convoluted euphemisms for "cut off' of the foreskin, breaking the adhesions to the penis head, and cutting off of the frenula.Words such as "open" and 'remove" are chosen instead They also selectively quote from article abstracts, and give undue emphasis to any article content, even when unmentioned in the abstract, if it has anything positive to say about circumcision. Consequently many aspects of Circumcision such as forced circumcision, the sale of circumcised foreskins, bush fatalities from circumcision, gender re-asssignment due to botched circumcisions, and fatal diseases transmitted in New York, Israel and and Austria from religious circumcisions of infants continue to go unmentioned here as well as the omissions you attempted to correct.We must investigate the mechanisms that WP has in place to try to curb this sort of hijacking of an important article on this form of cultural body modification. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:18, 25 November 2014 (UTC)

Agree with Zad68. We should be using non technical terms, especially for the lead, and using up to date sources. Yobol (talk) 19:27, 25 November 2014 (UTC)

Yes this is true. I think that we agree that these words open and remove are biased and unrealistic when it comes to talking about this procedure. Rather, we should use words that properly represent the procedure, which involves the tearing of two structures as well as a cut of an organ.

JohnPRsrcher (talk) 19:21, 25 November 2014 (UTC)

See Yobol's comment on this above, also please review WP:MEDMOS, we write for the general reader. Zad68 20:55, 25 November 2014 (UTC)

If you are sincere in saying that then cut out the half dozen euphemisms in the lead.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:58, 1 December 2014 (UTC)

Should Have Section Detailing Possible Effects on Function and Sexual Function

Hi. I think that we should have a sections of this page detailing possible effects that this surgery could have on function and sexual function. This is because the penis is both an organ and is also used during sex. I think that this should be agreeable since with any surgery there are possible affects on the function of the organ operated on. With new research coming out from Sorrels, Morris in the British Journal of Urology and Frisch Morten and Linholm Morton in the International Journal of Epimiology indicating that this procedure may remove the most sensitive parts of the penis, well as make sex more painful and less pleasureful for women, I believe that evidence exists indicating that this could negatively affect pleasure and function. JohnPRsrcher (talk) 20:44, 24 November 2014 (UTC)

There's already a summary of the secondary sourcing regarding this topic in the article. The existing content is well-supported with many (I believe we're up to 6 now) WP:MEDRS-compliant secondary sources. All I am aware of from Sorrels and Morten are individual primary studies, and they've already been discussed. Per WP:MEDREV we do not use individual primary studies to counter multiple sources. What are the PMIDs of the sources you're mentioning, and which Morris are you talking about? Zad68 20:58, 24 November 2014 (UTC)

These aren't from PubMed they're from the British Journal of Urology, which has done much research over the past years regarding circumcision and its effects on function. Its Sorrells L. Morris . The article is fine touch pressure thresholds in the adult penis.

Also there is another article in the BJU on its affect on sexual function indicating that it is negative. See The Effect of Male circumcision on sexuality. Also see Male circumcision decreases penile sensitivity as measured in a large cohort. And see the article the Prepuce in the BJU that details its roles. — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

You mean Morris Sorrells? That is not "new research", that is a 1997 primary study that is already taken into account by the secondary sources. Please look at WP:MEDRS for Wikipedia's sourcing standards for medical content, and WP:MEDREV which covers particular situation. Zad68 02:53, 25 November 2014 (UTC)

That is not my only source. That was only an example. I believe that adverse effects is not the proper term for a sub-section, as this procedure is a bodily modification that lasts a lifetime. Since this surgery is also a type of body modification, we should have an effects on function section. In addition, there should be an effect on sexuality section, as the penis is both an organ that is used for sex and is used for other bodily tasks.

JohnPRsrcher (talk) 20:27, 25 November 2014 (UTC)

Those are all good points JohnPR. Both the content and "gerrymandered" layout of this article have been odiously and glaringly defective for a long time now. Some editors work hard to maintain this sorry state of affairs. Some do so by simply reverting any addition to the article that is not positive to Circumcision. Others feign interest in improving the article and then raise objections to proposed content on spurious grounds- by misrepresenting WP policy, or objecting to content which is younger than currently used pro-circumcision references as "too old". They baulk at other references as being "not medical enough" despite Circumcision being largely a cultural act.Abstracts and articles are selectively quoted omitting negatives and cautions. Conversly many references have been provided for the long acknowledged deadening effect of circumcision on penile sensitivity beginning with Maimonides who stated

"the main purpose of the act is to repress sexual pleasure, with the strongest reason being that it is difficult for a woman to separate from an uncircumcised man with whom she has had sex"

Other research has looked at diminished pleasure for women from the loss of the sliding action that a foreskin provides and for other reasons. There appears to be little chance of this group of editors permitting any mention of these in the english language WP at any rate at present. The German and French language WP articles on Circumcision are better at the wider picture. You might like to check them out -I think that there is a translator facility attached to them. The Effects section and Adverse Effects sections here in USA WP Circumcision article are particularly hilarious results of this agenda over time. While the embargo on change in this article has lasted for many years I think it is still important to draw attention to it on this page for many reasons, even if only for future editors and anthropologists !.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 07:36, 27 November 2014 (UTC)

Would you please respect Wikipedia's Talk page guidelines? Your comment in large part is talking about editors and not content. The Talk page guidelines say:

Comment on content, not on the contributor: Keep the discussions focused upon the topic of the talk page, rather than on the personalities of the editors contributing to the talk page.

(emphasis in original) Would you please be so kind as to stop using this article Talk page to make comments about editors.

Regarding the content, are you suggesting that we use a 12th-Century philosopher's findings on this subject over up-to-date WP:MEDRS-compliant sources based on modern large, multi-center RCTs? Please clarify your position regarding the sourcing here. Zad68 02:26, 28 November 2014 (UTC)

Zad - your capacity to apparently selectively misinterpret borders on the infinite. The point that the pleasure reducing purpose of cutting bits off the penis tip has been acknowledged for many centuries is one you really cannot pretend not to see. As for not commenting on the contributor- Zad-!- I am afraid I must point out your propensity in that regard is second to none. would it be so terrible for you if this article became a balanced one ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:46, 1 December 2014 (UTC)

No. Not at all Zad. I just believe that since this procedure is both a body modification and a surgery that we are obligated to explain its long term effects on form and function on the page. I believe that by maintaining this page we are obligated to recognize and attempt to explain the long term effects of circumcision. We can do this by adding sub-sections for the affect of circumcision on form and the affect of circumcision on function.

JohnPRsrcher (talk) 23:11, 29 November 2014 (UTC)

Request to have debate/discussion over this topic following December 15th:

Hi, I will be at school taking final exams for the next two weeks. I would like it very much if we could possibly have a discussion on this topic on or around December 15th when I get back. Are you willing to do a discussion or debate after December 15th?

JohnPRsrcher (talk) 23:17, 29 November 2014 (UTC)

I believe effects on "form" and "function," including long-term effects, are already covered, in the sections on technique and effects. For example, the effects on penile cancer incidence and HIV transmission are long-term consequences, well-covered in the literature. The content is supported by WP:MEDRS-compliant secondary sources, which review the available primary sourcing, evaluate their quality and provide context. I'm having trouble guessing what else you might be talking about regarding "function," are you saying you found sourcing covering effects on urination, or something? It'd help if you'd please specify exactly what you mean, and provide appropriate sourcing.

I've been contributing to Wikipedia for years and plan on continuing to contribute to Wikipedia after December 15 too, no worries, but I have to say I am not interested in general "debate," no interest really, and per Wikipedia's guidelines we're not to use article Talk pages for general discussion of the article topic. (See the notes at the top of this Talk page.) But, happy to discuss specific suggestions to improve the article, based in Wikipedia content policy and high-quality sourcing. And good luck to you on your exams! :) Zad68 02:40, 30 November 2014 (UTC)

Thanks. I'm talking about the affect that it has on the overall form. Circumcision clearly takes part of the inner foreskin and forces it to heal to the shaft skin at the base of the penis. It also removes glands, veins, and many other things. My opinion is that we should be covering the alteration to the genital anatomy in the article, as this is a body modification and it is controversial as to whether this procedure is harmful or beneficial. (This is for form). In addition, we should try to explain the effect that the removal of the foreskin could have on sex. Does it change the general action at which it occurs? I have a good literature review indicating that there are large holes in the medical literature when it comes to explaining circumcision's affect on sex. Also, it probably affects the growth of the penis as well. It might even affect a mans brain as they may be emasculated (lacking an important testosterone giving organ) after having this procedure. I would much like to do research on these topics and add them to the page. I also think that we should definitely have sub sections for affects on form and function as these are some of the most important things that can be known about the procedure.

JohnPRsrcher (talk) 00:43, 1 December 2014 (UTC)

Well, per Wikipedia content policy we follow the sources, not our own opinions. This is especially important to do with an article like this one, where we regularly get people coming here bringing their own very strong opinions regarding the article topic--I'm sure you understand.

I haven't seen the sourcing organize content like you're suggesting and some of the claims you're making are a bit surprising. Are you actually saying that you believe that the foreskin produces testosterone in any significant amount? Source please.

If you're looking at sources and have a content suggestion, would you please specify them. Specify sources preferably by PMID, and provide a draft of the proposed content based on it, so that we can see what you're talking about exactly. Zad68 02:37, 1 December 2014 (UTC)

http://link.springer.com/chapter/10.1007/978-1-4757-3351-8_12#page-1 This is one of many studies which points up some of the negative outcomes of Circumcision. But what will now happen is that despite the Circumcision article already using decade old old medical sources and websites, Doc, Flop, Gop or one of the gang will come on and say; "no we do not like dis one 'cos its too old /too singular /too negative. We will not permit it to be added to this article which should really be renamed "Circumcision -the best bits " This of course despite it being from a well regarded book on the subject. Is there really no overview by WP of the ongoing scandal of one admin and a posse who have been heading this article off at the pass for a decade now !--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:54, 1 December 2014 (UTC)

Tumadoireacht, what you are describing as "a well regarded book on the subject" is the self-published conference proceedings of the advocacy group that calls itself "NO CIRC", see here. You were notified here when you brought up another self-published conference proceedings from the same group. Are you stating that you believe that the self-published conference proceedings of an advocacy group meet Wikipedia's sourcing guidelines for biomedical content? Please state your position clearly. Zad68 21:29, 1 December 2014 (UTC)

I am referring to the book published by Springer. Perhaps you are unfamiliar with that academic publishing house. You attempted to confuse two references on that last occasion. Is that what you are attempting here once more ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 21:38, 1 December 2014 (UTC)

The book that is the conference proceedings of the advocacy group is indeed published by Springer. Look at the copyright information page. Again, are you stating that it is your belief that this is a source that meets WP:MEDRS? Zad68 22:00, 1 December 2014 (UTC)

Are you saying that you will only consider pro circumcision material and never permit contrasting material ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:06, 3 December 2014 (UTC)

Proposed Expansion of Summary Paragraph 2

In paragraph 2 of the summary it is listed that ethical concerns have been raised over circumcision. I believe that we should expand this point. Recently, two large political decisions have been made that have caused widespread controversy over circumcision. One of these is the 2012 ruling by the German district court of Cologne that circumcision is an offense that can be prosecuted. The other is the 2013 resolution by the Parliamentary Assembly Council of Europe that determined that male circumcision is a violation of the physical integrity of a child, and asked states to adopt legal provisions to ensure that these practices are not carried out until the children are old enough to be consulted.

I think the best way to represent this is to either expand it in the summary or add another subsection titled circumcision and the law. Or circumcision and controversy.

JohnPRsrcher (talk) 20:58, 25 November 2014 (UTC)

Both of these have been discussed here before. Neither of them panned out as particularly impactful: the Cologne ruling ended up with Germany voting overwhelmingly to make non-medical neonatal circumcision explicitly legal, under certain conditions; PACE is an advisory body only and its recommendations were never acted on, and checking the news archives I don't see any significant follow up since then. Regardless, these topics are already covered at Circumcision and law.

John could I ask you please: Before making more suggestions please do review the archives, just about every one of the suggestions you've brought up has already been discussed thoroughly, probably several times. Zad68 21:16, 25 November 2014 (UTC)

Agree, with Zad68's comments above, and note that we should not give WP:UNDUE weight to recent political decisions just because they are recent. Yobol (talk) 05:15, 26 November 2014 (UTC)

JohnPR - Do not be intimidated by suggestions that any aspect of Circumcision has been "discussed thoroughly" What this can mean is simply that someone previously was fobbed off from making a useful change to this very poor article. Ditto for misreferencing WP policy - for example the UNDUE reference above addresses not whether one mentions an aspect of a subject but what weight one gives to it in proportion to others. Caveat Scriptor !--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 08:02, 27 November 2014 (UTC)

Would you please respect Wikipedia's Talk page guidelines? A new editor shouldn't dismiss the archives. In fact, the Talk page guidelines say:

Read the archives: If you are a new editor to an article, be sure to read the archives. Not only are content disputes valuable examples of talk page behavior, but they contain a lot of expert knowledge surrounding the topic. You may quickly find your questions and/or objections have already been answered if you try searching all the archives for that article at once using the prefix parameter.

(emphasis in original) Zad68 02:26, 28 November 2014 (UTC)

I hope Zad that you are not suggesting that new editors dismiss the archives.Amongst their many useful functions they record patterns of some group, individual and cabal behaviour.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:40, 29 November 2014 (UTC)

@Tumadoireacht, your recent editing on this talk page constitutes disruption under the appropriate behavioral policies. Please lay off—there is absolutely no need for comments such as the one you made on November 29. Zach and others, please feel free to drop me a note if you feel this behavior is continuing. NW (Talk) 22:10, 1 December 2014 (UTC)

@NuclearWarfare What do you feel is being disrupted ? I feel that it is important to draw attention to the process of intimidation and unbalanced selective article construction that is happening here. Are you oblivious to this ? By drawing attention to it, I am attempting to improve the article which is the purpose of this page after all. If anyone feels intimidated by the pro circumcision content and atmosphere maintained here and within the article, feel free to drop me a line. --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:04, 3 December 2014 (UTC)

Um, calling a set of editors a "cabal" and referring to their edits as creating a "process of intimidation" is what would do it... NW (Talk) 16:30, 3 December 2014 (UTC)

Not so much the article edits as the reversions and strong discouragement of new editors in particular- or any editors who question the imposed and unbalanced positivity here towards the subject. Intimidation is making or attempting to make others timid. A group of people who act in apparent but unacknowledged concert constitutes a cabal. Um yourself.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 09:25, 4 December 2014 (UTC)

FAQ appears twice at the top of this page

Hello: The FAQ for this article appears twice in the numerous headers at the top. I wanted to edit one of them out, but it seems to be part of one of the other templates. I surely can not figure it out, but it seems that the FAQ should only appear once, and there should be a talk page for that FAQ. Eddymason (talk) 22:59, 4 December 2014 (UTC)

Is this page necessary?

Note: This was moved from Talk:Circumcision/FAQ, I think. Eddymason (talk) 23:00, 4 December 2014 (UTC) Theres only one posting to it, and it could easily be put in the chunk of warning messages on top of the Circumcision article's page. 74.128.43.180 (talk) 06:09, 1 August 2013 (UTC) -->

It does seem odd that such an apparently contentious page has such a ridiculously short FAQ. If this article is to be owned, then at least this FAQ should be substantially longer. Eddymason (talk) 22:56, 4 December 2014 (UTC)

Rape and Circumcision -oh and this may be my last edit on this page as this page's Cabal are planning to ban me from it !

Administrators Zad and Nuclear Warfare ( really ?) had the public part of their discussion about banning me from this page - here -

https://en.wiki.x.io/w/index.php?title=User_talk:NuclearWarfare&action=edit&section=5

on Nuclear Warfare's homepage. They were most careful to not mention me by name ( which would have given me and others some better notice of their intentions -hmmmm) The Zenith of Zad's high dudgeon was that I had the temerity to dare to even mention the parallels between circumcision and rape.

As this may be my last contribution for some time on this page, or for ever, per the lads, if I do not promise to be a good boy and not mention forced circumcisions, lethal infant penis sucking mohels, or any other negative aspect of circumcision ever ever again on this page - I urge those interested, and who are not of the pro-circumcision camp (which so dominates this article at present ) to continue to attempt to make this a good and a balanced article which includes all views on this popular type of the cultural phenomenon of genital cutting.

It is interesting to note as an aside that apart from obvious parallels between circumcision and rape ( both uninvited assaults on the genitals) that in 1889 it was proposed that all African Americans be forcibly circumcised to deal with the "Negro rape problem" This from a medical doctor, one of so many with bizarre racist notions about how to employ Circumcision - this "cure in search of a disease". In the words of Marilyn Milos "Circumcision is where sex and violence meet for the first time " But this aspect of circumcision is unlikely to get mentioned here even on the talk page, if the lads get their way. Damn the torpedoes !--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 12:52, 4 December 2014 (UTC)

...and you wonder why people are talking about topic banning you? This over the top behavior really needs to stop. Yobol (talk) 14:15, 4 December 2014 (UTC)

Yes, it's making this Talk page hard to use & is a time sink. Alexbrn ^{talk|contribs|COI} 14:57, 4 December 2014 (UTC)

Pretty obvious WP:TENDENTIOUS behavior. Can't get consensus? Be tendentious instead. --jpgordon^{::==( o )} 15:35, 4 December 2014 (UTC)

Yes disruption. Something needs to be done. Tumadoireacht has had his say and it had not been accepted. Him continueing does not improve Wikipedia. Doc James (talk · contribs · email) 16:49, 4 December 2014 (UTC)

Remarkable ! QED, all the usual suspects (plus one ) and not a single one addressing even a single one of the issues raised re content ! I am still wondering what you are creating here. It certainly is not a wikipedia article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 17:21, 4 December 2014 (UTC)

That guy Tumadoireacht talks a lot of sense. Why is this article so much slanted in favor of it and leaving out all the downside? — Preceding unsigned comment added by 86.46.22.115 (talk) 21:56, 5 December 2014 (UTC)

I have blocked Tumadoireacht for one week for disruptive editing and also fairly obvious sockpuppetry (IP 86.46 above). If necessary, I'll bring this to ANI another time. NW (Talk) 17:38, 6 December 2014 (UTC)

Sentence is not clear enough for Casual Reader : "associated with reduced rates of cancer causing forms of HPV[14] and risk of both UTIs and penile cancer."

The risk of UTI and penile cancer is very small, 7 to 14 in 1000 for uncircumcised males and 0.58 cases/ 100000 respectively. UTI's, according to much medical literature, are also not difficult to treat and prevalent in females as well as males. According to wikipedia guidelines medical articles should be writing for the casual reader. I believe that this can be interpreted as " writing for the casual reader especially in the article summary" as many readers seem to read the summary in more detail then the other sections, if they get to those sections at all. Just stating that it reduces the rate of UTI and penile cancer is a poor representation of the issue, as our actual audience will most likely be regular americans who have no idea about the actual extent of these two diseases. They may leave wikipedia thinking that their child would have a 90 percent chance of penile cancer if they don't circumcise him. Think about prospective parents visiting this site, who, stressed and undergoing pregnancy, are looking for good information fast for the circumcision decision. I think it is important to include some additional info here about the scope of UTI's and penile cancer. I see that the next sentence saying that circumcision will not prevent these disorders, but we should also note somewhere that they are very unlikely.

JohnPRsrcher (talk) 00:02, 16 December 2014 (UTC)

The article is summarizing the source cited. I have no idea where any reasonable reader might get the idea They may leave wikipedia thinking that their child would have a 90 percent chance of penile cancer from this article lead, we can't gear article content to emotionally distressed people. We actually had a discussion not too long ago about adding ARR and it was decided against. Zad68 13:27, 16 December 2014 (UTC)

I think that using the statement "reduces the rate of UTI and penile cancer" is unclear and could be misinterpreted by the casual reader. Since the reader most likely will not know about these disorders (if they are not involved in medicine) it may be difficult for them to grasp the bounds of this statement. It should be our requirement to add some additional information identifying the constraints of this rate change, or at least directing the reader to additional information.

JohnPRsrcher (talk) 02:13, 18 December 2014 (UTC)

Again I don't see that your worries follow from the actual article content. Zad68 05:13, 18 December 2014 (UTC)

Poor citation : #16

1. 16 is 3 citations in one. It is hard to read and is confusing.

JohnPRsrcher (talk) 00:52, 19 December 2014 (UTC)

Question about this Sentence: "For adults, general anesthesia is an option, and the procedure is often performed without a specialized circumcision device"

Can anyone show me the citation for this statement. Is there a statistic justifying that adults often times do not use a specialized circumcision device. I would judge ( based on my knowledge) that adults would often opt to use a circumcision device as it is a rather scary procedure, and they typically would be doing so for a conversion into the Islam faith.

JohnPRsrcher (talk) 03:15, 15 December 2014 (UTC)

This is a continuation off of my prior statement. I have now searched three major medical journals and have not found any evidence indicating that adult males often times choose not to use a specialized circumcision device. It seems that not much research has been done on this topic, as it may not be done very much at all

JohnPRsrcher (talk) 18:06, 15 December 2014 (UTC)

This can be reworded from "is often" to "may be". Re your statement I would judge ( based on my knowledge) that adults would often opt to use a circumcision device as it is a rather scary procedure, and they typically would be doing so for a conversion into the Islam faith. -- please use reliable sources to support assertions, we don't go by the presumptions of individual editors. Zad68 13:27, 16 December 2014 (UTC)

I think that changing it to may be is ok, but that now we are poorly representing the procedure. Many adults may not be aware of the fact that it can be done by hand, and just saying it may be done with a circumcision device will not increase their awareness of that. I opt that we change it to " For adults, the procedure may be performed with a specialized circumcision device or by hand, and anesthesia is an option."

JohnPRsrcher (talk) 20:31, 16 December 2014 (UTC)

Some of the specialized devices are used as part of a manual surgical method, so what you're suggesting isn't really accurate. Zad68 05:13, 18 December 2014 (UTC)

But if this page is to describe all types of circumcision around the world; then we would have to include the fact that in some countries circumcision is done only with a knife. It is difficult to convey to the reader that there are types of circumcision using both a specialized device and scalpel. I think that saying a specialized circumcision device or scalpel can be used best shows that techniques range from using only a scalpel to only a specialized circumcision device.

JohnPRsrcher (talk) 23:32, 18 December 2014 (UTC)

I think the existing wording already covers this range. Zad68 13:26, 19 December 2014 (UTC)

Poor Phrasing : "and is associated with reduced rates of cancer causing forms of HPV[14] and risk of both UTIs and penile cancer"

Hi. This sentence has poor phrasing. Circumcision is not associated with reduced risk of UTIs and penile cancer by doctors. According to the Padiatrics Task Force on Circumcision, this was mainly confirmed by looking over statistical studies. Since the change in UTI is only 7 to 14/1000 to 1 to 2/1000, I don't think that most doctors necessarily associate being circumcised with getting less UTIs. A similar analogy is: doctors tend to associate getting a flu shot with not getting the flu. Thats why they tell kids that they should get flu shots. If they don't get their flu shot the doctor might predict that they will come back in with the flu. I don't see pediatricians telling parents, "you better have him circumcised, or he'll be back in here with a UTI." The prevalence of UTI's is much too small for them to recognize that.

JohnPRsrcher (talk) 23:47, 15 December 2014 (UTC)

The wording specifically states it's associated with a reduced rate, not that it causes it, per the source cited. This is further explained in the article body. Zad68 13:27, 16 December 2014 (UTC)

I think the results of a study I was reading ( a meta-analysis) show that it reduces the risk of UTI. It isn't associated with a reduction in risk of UTI, it just reduces the risk of UTI.

JohnPRsrcher (talk) 02:32, 18 December 2014 (UTC)

I'm going to expand on my prior statement. As of now I cannot observe the references for the part on HPV (as they are poorly cited in the article, I don't know what journal they're coming from) but I have read over the information from the pediatrics task force on HPV. According to task force HPV has not been found to reduce the rate of cancer-causing HPV, the studies it has all indicate that it reduces the detection of HPV on certain areas of the penis. 2 studies from Africa(cited as the most important ones by the task force) both show that there is a reduced rate of infection, not the overall rate. Since we cannot say for sure that it reduces the rate of infection, we can say that it is associated with a reduction in the rate of infection (but not overall rate) based on this data.

In regards to UTI, it is not associated with a reduction in the rate of UTI. According to population statistics it reduces the rate of UTI by a certain fraction.

For penile cancer, it is associated with a reduction in penile cancer, and this is correct. There is not substantial evidence to show that rate goes down just because of circumcision but connection of HPV and penile cancer causes this trend.

JohnPRsrcher (talk) 01:07, 19 December 2014 (UTC)

The content in the article is supported by the sources cited. The relationship between the oncogenic type of HPV and penile cancer is already covered in the article. Zad68 13:26, 19 December 2014 (UTC)

Medical Jargon in Summary, should Replace.

Words in the summary may be too complex for the common reader to understand. See sentences:

1.The procedure is most often elected for religious reasons or personal preferences,[1] but may be indicated for both therapeutic and prophylactic reasons. Words (to fix): Therapeutic and prophylactic. 2.Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision. Words : Therapeutic 3. Circumcision reduces the rates of HSV-2 infections by 28%,[14] and is associated with reduced rates of cancer causing forms of HPV[15] and risk of both UTIs and penile cancer. Words: UTI, HPV, HSV-2. 4. A 2010 review of literature worldwide found circumcisions performed by medical providers to have a median complication rate of 1.5% for newborns and 6% for older children, with few cases of severe complications Words: median complication rate.

JohnPRsrcher (talk) 04:00, 18 December 2014 (UTC)

I think finding more common words to replace "therapeutic" and "prophylactic" would be fine. For abbreviations for specific conditions and viruses, there are Wikilinks. Zad68 05:13, 18 December 2014 (UTC)

Question. It is difficult to find common words to take the place of these. Instead should use a short phrase

JohnPRsrcher (talk) 02:34, 19 December 2014 (UTC)

I'll work on this. Zad68 13:26, 19 December 2014 (UTC)

Unneeded Sentence: Routine circumcision, however, is not justified for the prevention of those conditions.[2][17]

This sentence is unneeded. The focus of this article is not the prevention of urinary tract infections and penile cancer. Should be on circumcision. Basically it is similar to stating: "circumcising all children would not prevent all penile cancer or urinary tract infections."

JohnPRsrcher (talk) 01:16, 19 December 2014 (UTC)

No it is saying the degree of benefit is not sufficient to recommend routine circ. Doc James (talk · contribs · email) 02:34, 19 December 2014 (UTC)

Doc is correct, please read the sources cited more carefully. Zad68 13:26, 19 December 2014 (UTC)

Summary Paragraph Sentence "The procedure is most often elected for religious reasons or personal preferences"

Question about this sentence. This was cited with the report from the World Health Organization. While reading the summary page for this report I never saw this statement. What they said was that it is typically undertaken for religous, cultural, and secular reasons. In both the introductory statement of the articles and the summary, the emphasis seemed to be on the procedure being undertaken either culturally or for religous reasons. They did note that some people in South Africa would like to be circumcised, but did not say that personal preferences was the primary determinant for the procedure. Rather then personal preferences, I believe that cultural reasons is a better standpoint. JohnPRsrcher (talk) 02:18, 15 December 2014 (UTC)

The general categories of religious, cultural, and medical reasons are repeated throughout the WHO's document. Zad68 13:27, 16 December 2014 (UTC)

I think that we should change this to elected for religous reasons, cultural reasons, or because of a family history. This should encompass all circumcision practicing areas quite well. For African areas, the main focus of the WHO report, it seems that it is religous or cultural. For southeast asia and areas like the phillipines, I would argue that it is cultural or religious. For instance, in the Phillipines they practice Tuli. This is a sort of cultural coming of age practice. It seems to be part of their culture to want to toughen up their boys by having their genitals undergo a surgery when they hit adolescence. In South Korea, I would argue a mix of family practice and cultural.

For the US and Canada, I would argue that it is mainly for the reason of family history and medical reasons. In the past circumcision was encouraged by our medical field. Today it is still encouraged but not pushed like it was beforehand. Today, I think most adults do it to their sons because it was done to them.

JohnPRsrcher (talk) 23:20, 18 December 2014 (UTC)

Well, Wikipedia isn't interested in the speculations of individual editors, please don't use the article Talk page for that, let's just stick to using the sources. Zad68 13:26, 19 December 2014 (UTC)

Ok. I did a search of some medical journals (pediatrics, BJU, BMC) and could not find any data about the determinant of male circumcision. Best source as of yet is the WHO report from 2008. After a 2nd review of report, seems they are emphasizing religious, cultural, social, and medical. Social means many things according to report.

They do state that it involves the desire to conform, due to a study in Denver, Colorado (in United States) that found fathers circumcised their sons to make them look like them. This was the primary determinant in this region.

According to article, it differs in the phillipines, where boys do it to avoid being uncircumcised, or because it is tradition.

Also, could be part of social desirability. (more hygienic.)

Since social is confusing and hard to determine (involves numerous factors), should change to religious and cultural at this point.

JohnPRsrcher (talk) 18:04, 19 December 2014 (UTC)

Question about sentence "Circumcision reduces the rates of HSV-2 infections by 28%"; Poor phrasing

Circumcision does not reduce the rate of HSV-2 infection, it has a preventative effect against this sort of infection. The phrase "reduce the rate" is not appropriate for this type of STI. To get HSV-2 you must have intercourse with an individual with this virus.

JohnPRsrcher (talk) 23:37, 15 December 2014 (UTC)

Rate reduction is rate reduction even if it's an STI, I don't understand the objection. What is your suggested new wording? Zad68 13:27, 16 December 2014 (UTC)

Before I get to that issue, I have one more regarding this sentence. This does not have proper citation from the literature. Source number 28 is an overall review of ways to prevent STI's. The only study it has supporting this statement [ reduces the risk of HSV-2 by 28%] is one study from Uganda, which is cited in its references. Upon observing the Pediatrics Task Force on circumcision, I did find one meta analysis on circumcision's effect on HSV-2 infection but its findings were not statistically significant. The Pediatrics Task force also cites 2 studies from Africa (Uganda and Orange Farm) where it seems to reduce HSV-2 infection, but also references two studies from New Zealand and North America that find no affect on HSV-2 infection.

JohnPRsrcher (talk) 14:56, 17 December 2014 (UTC)

One more problem I would like to present. While observing the study from Uganda from which we are presenting this number, I have found numerous differences in the population from Uganda with populations in other areas that could sway its result. Also, problems with the studies methods could have had a large impact. Firstly, the population differences. In the study, 2141 of the males were already HSV-2 positive at its start. This is 38.7 % of the population. Compare this to the US, where according to the Pediatrics Task Force on Circumcision, 16.2 % of individuals in this age range have this infection. In addition, from what I read in the study, one of the populations (trial 2) may have not been checked for AIDS. That means HIV positive individuals were undergoing this study. In the 2nd trial they didn't check HIV status. In trial 1 the actual data was 7.7 % infected (circumcised ) vs. 9.9% infected (uncircumcised). In trial 2 it was 8.6 % infected (circumcised) vs. 14.0 % infected (uncircumcised.) The number 28 percent was only come across after a statistical analysis ( mathematical manipulation ) of this data.

For the 2nd problem involving the methods: The way this study was carried out was by circumcising individuals and then checking in on them after a maximum period of 24 months, that is 2 years after the surgery, and then comparing them to uncircumcised individuals during this 2 year period. Isn't it true that these individuals would be healing, that is, not sexually active, during part of this period. Also, might it be possible that stress over the procedure may prevent them from partaking in intercourse for a longer time. I tried to find some data on the healing time of circumcision, but after searching 2 databases did not find any data. Since we don't have any data about the length of time that the circumcised males in this study would have been recovering, and therefore not acquiring HSV-2, I believe that this study may be in question.

JohnPRsrcher (talk) 15:07, 17 December 2014 (UTC)

Generally when we have a high-quality secondary source from an authoritative body like the AAP, we don't try outdo them with our own analysis of the primary sources, this is covered at WP:MEDRS, please read WP:MEDRS. If you get your own secondary source published in a WP:MEDRS-compliant source we can consider using it, but until then... Does the current article content summarize the secondary source accurately? Zad68 05:13, 18 December 2014 (UTC)

Ok. Sorry for writing all of that. I think that I was summarizing the article as I read it in this paragraph. To answer your question, the current article does not summarize the secondary source accurately. There is no data for "reduces the rates of HSV-2 infections by 28%". The meta analysis that is cited for the article has one study with data on HSV-2. Only one study does not constitute a meta analysis. This statement has to be taken down.

JohnPRsrcher (talk) 23:38, 18 December 2014 (UTC)

Your claim "There is no data" is simply untrue. The source cited says "HSV-2 incidence was reduced by 28% (62) in the trials that assessed these endpoints." Some of your objections here are really unreasonable. Zad68 13:26, 19 December 2014 (UTC)

The source states "HSV-2 incidence was reduced by 28% (62) in the trials that assessed these endpoints." If you go to #62, you will see that this is one study performed in Uganda. This is not a literature review. Your claim that "there is data" is correct. However, we don't have enough data on the page right now. This statement cannot be on the page according to wikipedia guidelines.

JohnPRsrcher (talk) 16:27, 19 December 2014 (UTC)

OK, so you agree there is indeed data, great. There several other sources that cover HPV but I'm fine with the specific "28%" removed. Zad68 05:21, 21 December 2014 (UTC)

Missing Information in summary: Adult Circumcision more Risky then Child Circumcision according to WHO

According to WHO report on circumcision, adult circumcision carries higher risk of bleeding, haematoma, and sepsis then child circumcision. Missing information of these risks on page summary (only covers child and infant risks.)

JohnPRsrcher (talk) 04:06, 18 December 2014 (UTC)

The lower risk level and complication rates of the procedure in infants vs. adults is repeated enough across the sourcing that this is probably warranted to summarize briefly in lead. Zad68 05:13, 18 December 2014 (UTC)

Request for aid: I cannot access the source : McClung, Chris; Voelzke, Bryan (2012). "Adult Circumcision". In Bolnick, David A.; Koyle, Martin; Yosha, Assaf. Surgical Guide to Circumcision. London: Springer. pp. 165–175. doi:10.1007/978-1-4471-2858-8_14.ISBN 978-1-4471-2857-1. Retrieved April 6, 2014. (subscription required (help)).

Do you know how I can get access to add to summary as well as section about risks of adult circumcision.

JohnPRsrcher (talk) 00:29, 22 December 2014 (UTC)

Question about Statement: A 2010 review of clinical trial data found that circumcision reduced the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28% under "Other Infections"

I already reviewed the sourcing for this statement and found that the source was not a literature review and was only supported by one study. I had to review the same statement from the summary. Support to remove this statement?

JohnP 02:50, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

User Doc James has just started an edit warring

I've brought several references of the major articles about the loss of sensivity caused by circumcision. Doc James deleted them without explanation. That unfriendly behaviour is against the rules and I'm askinf for protection. Michel Hervé Bertaux-Navoiseau (talk) 15:19, 28 December 2014 (UTC)

You can't have references up that don't support anything. It's against the wikipedia rules.

JohnP 16:23, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

You need to use secondary sources per WP:MEDRS as mentioned on your talk page. Doc James (talk · contribs · email) 01:56, 29 December 2014 (UTC)

Question on 3rd Paragraph of Article Summary , Beginning Statement

I have a question about the beginning statement of paragraph 3. I see that the cochraine analysis found that there is a decrease in HIV acquisition for heterosexual men and women, however, the article does not note that there is no effect of circumcision on HIV and STI's for homosexual men. This can be justified by two recent meta analysis from JAMA and Cochraine.

JohnPRsrcher (talk) 17:23, 15 December 2014 (UTC)

"Cochrane"... it's spelled Cochrane without an "i". The information about male-to-male transmission rates is covered in the article body. The lead summarizes the most important topics, and per the sourcing the effect on female-to-male transmission rates is by far a more important topic. However I think it'd be fine to summarize the findings on male-to-male, briefly. Zad68 13:27, 16 December 2014 (UTC)

Ok. I agree. I think it should come after the sentence about male-female. We also should make it very clear that we are talking about female to male in the first sentence, and male to male in the second so that casual readers of the page don't become confused.

JohnPRsrcher (talk) 20:32, 16 December 2014 (UTC)

It is more complicated than "For homosexual men, circumcision does not seem to have an effect on the risk of HIV infection or the risk of other sexually transmitted diseases". Ref says "Male circumcision had a protective association with HIV in studies of MSM conducted before the introduction of highly active antiretroviral therapy" and "The odds of being HIV-positive were not significantly lower among MSM who were circumcised than uncircumcised (odds ratio, 0.95; 95% confidence interval, 0.81-1.11; number of independent effect sizes [k]=15) [corrected].). Higher study quality was associated with a reduced odds of HIV infection among circumcised MSM (beta, -0.415; P = .01)." At best it is unclear. Doc James (talk · contribs · email) 04:53, 18 December 2014 (UTC)

Doc James brings up a good point, the existing article content "For men who have sex with men the evidence is less clear" is a better option for summarizing the sources. Zad68 05:13, 18 December 2014 (UTC)

Please see another meta-analysis on topic.

In addition, for your statement [Male circumcision had a protective association with HIV in studies of MSM conducted before the introduction of highly active antiretroviral therapy], this is a sub-section of overall study and is not justifiable. For second statement [he odds of being HIV-positive were not significantly lower among MSM who were circumcised than uncircumcised ] please see 2nd meta analysis. This had same results with more studies then this one.

I highly disagree with your edit to my change. Wish you would have come to talk page before changing it to discuss proposed changes. Problems include:

Stating [For men who have sex with men the evidence is less clear.[11]] after [A 2009 Cochrane meta-analysis of studies done on sexually active heterosexual men in Africa found that circumcision reduced their number of new cases of HIV by 38–66% over a period of 24 months.[10] ] is phrased such that it sounds like homosexuals have protection from AIDS when there's no data.

Men who have sex with men is medical jargon. Better to used a term everyone in country uses (homosexual) for general reader.

JohnPRsrcher (talk) 00:22, 19 December 2014 (UTC)

I still think that we should write "For homosexuals, it seems that there is no affect on the prevalence of STI's and HIV from circumcision." This is supported by overall data, there is no indication yet of the contrary.

JohnPRsrcher (talk) 00:45, 19 December 2014 (UTC)

How about "the evidence is not clear" Doc James (talk · contribs · email) 02:31, 19 December 2014 (UTC)

The Cochrane review states "Current evidence suggests that male circumcision may be protective among MSM who practice primarily insertive anal sex, but the role of male circumcision overall in the prevention of HIV and other sexually transmitted infections among MSM remains to be determined" [http://www.ncbi.nlm.nih.gov/pubmed/21678366[

This is definitely not saying "no affect". This is saying maybe benefit but not clear.Doc James (talk · contribs · email) 02:33, 19 December 2014 (UTC)

But both studies show no affect on circumcision and STIs. We should focus on the overall data first as this is the most important and is not subject to bias. However, it seems that, from conclusion of both studies, doctors want to do further research on this issue. So how about:

For homosexuals, the current data does not indicate that circumcision has an affect on HIV or other sexually transmitted diseases.

By saying "the current data", you are indicating to the reader that more medical research may be done on this topic.

Also, for the part about primarily insertive anal sex, we should add that to the further sections to explain this point.

JohnPRsrcher (talk) 02:59, 19 December 2014 (UTC)

The objection that a sentence that clearly qualifies on heterosexual men might be read to apply to homosexual men is unreasonable.

"Men who have sex with men" is vey plain wording about a sex act and not medical jargon, and "homosexual" carries a lot of cultural meaning that isn't relevant, the point is to cover the transmission rates for those who engage in the sex act. The source covers the sex act and not the sexual orientation.

And as Doc James points out your suggestion isn't supported by the sources. The evidence is not good enough to say "no effect", the sources cited say the evidence isn't good enough to make a determination, they are not the same thing. Zad68 13:26, 19 December 2014 (UTC)

If you read both citations, one states that there is insufficient evidence (JAMA) that it protects from HIV and the other states that there is no clear association (Cochrane.) The Cochrane study had 71693 participants and the JAMA study had 53567 participants. For the benefit of the doubt, the american task force on pediatrics also issued a statement. They state: "Circumcision seems to be less likely to protect MSM, however, and has not been associated with decreased acquisition of HIV among MSM." The evidence is less clear in insufficient. Rather should use the association is unclear.

JohnPRsrcher (talk) 16:32, 21 December 2014 (UTC)

Just to let you know, I had to remove the current statement from the article. This is because there is no clear consensus yet on this talk page.

JohnPRsrcher (talk) 16:37, 21 December 2014 (UTC)

What is with adding links to this http://www.circinfo.org/? We have a couple of good sources that provide tentative evidence of benefit for MSM so why remove? Doc James (talk · contribs · email) 21:39, 21 December 2014 (UTC)

Those links don't involve this. I'm going to use these links for another argument. These are policy statements from all around the world. I found them from a cite (cirp) that has them all posted for free as secondary sources. They have a lot of good info based on other countries approach to circumcision, this will be good for the page in future.

JohnPRsrcher (talk) 22:00, 21 December 2014 (UTC)

But we hadn't come to agreement yet. I looked it over (task force, JAMA, and Cochrane) and still think evidence points to no association. I removed until we come to agreement.

JohnPRsrcher (talk) 22:02, 21 December 2014 (UTC)

Some links do not accurately reflect the sources in question. Circinfo is potentially one of those. You add refs when there is text that they support not before. Doc James (talk · contribs · email) 22:03, 21 December 2014 (UTC)

I was only using circinfo because a policy statement from the College of Physicians and Surgeons of British Columbia (CPSBC) was posted on their website. This is a secondary source. I was citing it for the document that they have bought for their website.

JohnPRsrcher (talk) 22:13, 21 December 2014 (UTC)

The ref says the "role of male circumcision overall in the prevention of HIV and other sexually transmitted infections among MSM remains to be determined" [3]

This means the same as "For men who have sex with men the evidence is less clear"

Stop removing it. Doc James (talk · contribs · email) 23:06, 22 December 2014 (UTC)

Here is my argument that you can also find on my talk page.

The best literature review on this topic that I have seen on the page comes from the American Academy of Pediatrics Task Force on circumcision. If you check, they do not use info from the Cochraine study and only use info from the JAMA study. Their statement is: Circumcision seems to be less likely to protect MSM, however, and has not been associated with decreased acquisition of HIV among MSM. To me, it sounds like they are saying that male circumcision has not been associated with a decrease in HIV among MSM. This would be our most credible source on the topic as this has been done by Pediatricians, who understand how to analyze this type of medical research. These two studies on the page right now are good, but we also have this literature review which has analyzed one of these studies and others. In response to your statement on insertive anal sex: This would be good to put in the summary as it reflects a possible trend in the outcome of the trials. I think that our best option is to go with the AAP since our abilities in performing a literature review of these studies is questionable.

JohnPRsrcher (talk) 18:38, 23 December 2014 (UTC)

What url, what source? Doc James (talk · contribs · email) 00:04, 24 December 2014 (UTC)

This is what it says "The association of circumcision and the decreased likelihood of HIV acquisition applies to heterosexual males. Circumcision seems to be less likely to protect MSM, however, and has not been associated with decreased acquisition of HIV among MSM.61 There is fair evidence from 1 study that there is a protective effect of circumcision from HIV infection in MSM; however, this study used self-report to establish circumcision status.62 One study with fair evidence is neutral regarding the relationship between circumcision and HIV infection in MSM.61 It is probable that the differences found in the level of protection (or lack of protection) by studies of MSM are confounded by the fact that MSM commonly perform both receptive and insertive sex. It is not known to what extent circumcision may be protective against HIV transmission for MSM who practice insertive sex versus for those who engage in receptive sex."[4]

So all three sources now agree "the evidence is less clear". I do not know what the issues is? Doc James (talk · contribs · email) 02:35, 24 December 2014 (UTC)

John, Cochrane is not a "study", it's a meta-analysis. Doc has provided an accurate assessment of the summaries of the sources, which are all in agreement. Three good secondary sources in agreement is more than enough to support the statement. Zad68 06:04, 24 December 2014 (UTC)

All three sources don't agree that "the evidence is less clear." I would like to refute this statement. The AAP clearly states "has not been associated with decreased acquisition of HIV among MSM." If you look at the source, in this statement the AAP is summarizing the evidence that they have reviewed thus far. This includes all statements after this said statement regarding the studies. One of meta-analyses that the AAP is citing is the one from JAMA. The findings from this study, which they reviewed, clearly were summarized in their initial statement. In addition, the AAP also found significant problems in some of the studies they were reviewing, which could be justifying this statement. For instance, see "however, this study used self report to establish circumcision status" for the first listed study that they reviewed." This came after the first study that they found, in "There is fair evidence from 1 study that there is a protective effect of circumcision from HIV infection in MSM."

Zad, your interpretation that all three studies agree that "the evidence is less clear" is incorrect. The AAP summarizes their literature review with the statement "has not been associated with decreased acquisition of HIV among MSM." The AAP performed a review of one of the other 2 studies. Instead, based on this analysis, that would mean that all 3 studies disagree with this statement since the AAP reviewed one of them and found no correlation, and since the Cochrane meta-analysis found no correlation.

Like I told DocJames, the AAP is clearly the most valid source to use since they performed a literature review of all the evidence to date. They are also doctors, so they have the experience that will allow them to make a statement on this topic. Since we are only wikipedia editors, we cannot say whether circumcision prevents HIV for homosexuals or not. This is up to the doctors with pediatrics. They have stated that "has not been associated with decreased acquisition of HIV among MSM," so we should be obliged to hold true to this statement. Since my rebuttal has found that all three studies show that "for homosexuals, there is no clear association", and that we are unable to state this since we do not hold the professional standing of the AAP, our stating of "the evidence is less clear" is clearly going against the consensus in the medical community.

JohnP 17:31, 27 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

No, you still seem to be unaware or are confusing the fact that the AAP has produced two separate documents, a technical report and a policy statement. We're using one and not the other. They are not the same thing. A policy statement isn't categorized the same way as a literature review by the standard abstract indexing services like PubMed. And as Doc pointed out it's just one of several sources, and Doc made a point regarding the specialties you haven't addressed. As you're continuing to make these very basic errors regarding the sourcing it's very hard to have a productive conversation with you, sorry. Zad68 04:42, 28 December 2014 (UTC)

Ok. I meant to say their technical report, not the policy statement. And it seems, based on what you just said, that you have not yet read my argument. Please review my argument and then get back to me.

Also, in response to your question about adressing the point that DocJames made. Yes, it seems that some studies in the medical community have shown that insertive and receptive anal sex have different degrees of protection. But this does not mean that the overall medical community has come to consensus yet over the issue, it still needs more research and studies to confirm.

The AAP makes note of this in their task force when they state: "It is probable that the differences found in the level of protection (or lack of protection) by studies of MSM are confounded by the fact that MSM commonly perform both receptive and insertive sex. It is not known to what extent circumcision may be protective against HIV transmission for MSM who practice insertive sex versus for those who engage in receptive sex." Just because it is probable does not mean it is confirmed. The AAP has performed a review of all of the literature to date on this topic and have made this conclusion. Since it is still unconfirmed and under review, this makes it unvalid for the page summary. We should be summarizing the overall protection for MSM, not an issue that is currently under review.

JohnP 16:20, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

One more point to make. This statement in the summary is inconsistent with the statements on HIV and MSM already in the article. In the section "Sexually Transmitted Diseases" it states "It is undetermined whether circumcision benefits men who have sex with men.[42][12]" It seems that reference numbers 42 and 12 both say that the effect is undetermined. This is not the same as the evidence is less clear.

JohnP 17:58, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

Ok I just looked over all of the references we have for this statement, so now I feel refreshed and more able to discuss this topic. The references are the AAP task force, the meta-analyses from JAMA and Cochrane, and "Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men" from the journal Current Opinion in Infectious Diseases in 2010. All of these studies are saying that either there is no clear association between HIV and circumcision, or it is yet to be determined. However, 2 of the 4 studies (not including the technical report) do indicate that homosexual men who are taking the insertive role may be at a lower risk and this may be confounding the data. But note that they are saying "may be", not that it is conclusive yet. In addition, all of the overall data for each study is showing that there is either no association or it is undetermined. This is different from the current statement that "the evidence is less clear", since overall there is no association or the association is undetermined. It is known that an insertive role may be protective, but all of the studies are saying that this is probable, not that it is confirmed.

I have changed my mind slightly after this review. Since the prior statement involves heterosexuals in Africa, and these studies observe homosexuals all over the globe, the two are not really consistent with each other. Also, note that JAMA and Cochrane both noted that more research should be done in the area.

I opt that we change it to "for MSM there is no clear association" or get rid of it altogether.

JohnP 02:00, 29 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

• • • - Just see this comment. Read this one first if you don't want to read the others.

How about this. I just did one more review of the three studies from JAMA, Cochrane, and the third on the page from the Journal of infectious diseases. JAMA concludes that there is insufficient evidence that it protects from HIV but that there should be further investigation. Cochrane concludes that the role of circumcision on HIV remains to be determined. Infectious Diseases concludes that the evidence that it prevents HIV is weak and inconsistent. These conclusions all seem to be saying that the role of circumcision on HIV for MSM remains to be determined. Maybe we should change this statement to "for MSM the effect on HIV remains to be determined" or remove it. We could remove it in the case that it is not consistent with what we are discussing their in the summary, since in that section we are mainly talking about the benefits that circumcision has for African populations. I still don't know if these studies focused mainly on African populations or not.

JohnP 02:33, 29 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

"Weak and inconsistent" mean the same thing as "unclear". "Unclear" is just a synonym here. How you then are objecting to the summary of what the sources are saying--that the evidence is indeed unclear--is just perplexing, bordering on unreasonable. There is no basis for removing the current text. Zad68 04:36, 30 December 2014 (UTC)

Ok. I think we should use the third source from infectious diseases to cite this as well.

JohnP (talk) 16:21, 30 December 2014 (UTC)

I have found many policy statements and technical reports from other countries with info for page

After going to cirp.com I found many links to other countries policy statements. Most of them are available on those organizations websites, but some (as of now) are only available on cirp. After christmas it is possible to contact these organizations in order to obtain these documents. These include the Royal Australian College of Physicians, which is "is a not-for-profit professional organisation responsible for training, education, and representing over 13,500 physicians and paediatricians and 5,000 trainees in 25 medical specialties in Australia and New Zealand.[1]" The Royal Dutch Medical Society. The Canadian Paediatric Society. The College of Physicians and Surgeons of British Columbia (CPSBC). The Central Union for Child Welfare in Finland. The Medical Ethics Comitee of the British Medical Association. The British General Medical Council (a body that regulates medical care in the United Kingdom.) The British Association of Pediatric Surgeons. And also more. These can be added to page to help support or add to statements "The positions of the world's major medical organizations range from considering neonatal circumcision as having no benefit and significant risks to having a modest health benefit that outweighs small risks. " and "No major medical organization recommends either universal circumcision for all infant males (aside from the recommendations of the World Health Organization for parts of Africa), or banning the procedure.[7] Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision.[8][9]" They can also be used extensively for further sections as many include cost analyses of circumcision benefits for individual nations, and consensus of the literature for different medical societies.

JohnPRsrcher (talk) 22:11, 21 December 2014 (UTC)

Linking to cirp is not allowed because they violate several Wikipedia sourcing principles, including violating copyright. Why would you be looking at a self-published advocacy website like cirp anyway for editing Wikipedia?

There are hundreds of medical organizations around the world that could have policy statements, they're of widely varying quality in support of their position statements, and all over the place in terms of authority and influence. This article cannot possibly carry statements from all of them, and put them in the proper context and weight in doing so. Luckily we do not have to argue over whether this or that policy statement qualifies as "major" or not, the Bolnick source has a chapter that surveys the available policy statements and covers the major ones.

It's possible that Wikipedia could carry an article simliar to Circumcision and law, maybe called Circumcision by country, which could feature "highlights" from all the many medical organizations. Zad68 22:28, 21 December 2014 (UTC)

I disagree. Many of them seem major. The RACP is a major representative of physicians in Australia and also New Zealand. Also, the Pediatrics Society of Canada represents all of Canada. Not to mention, we're already using the American Task Force (i.e a policy statement) for most of our material. Zad, I highly disagree. These policy statements all include reviews performed by medical practitioners in respective countries. Neglecting their information will make this page North American and not universal.

JohnPRsrcher (talk) 22:44, 21 December 2014 (UTC)

Also. I'm not using cirp because its bias, I'm using it because its very useful. Fortunately it contains a lot of information on the topic, including many policy statements done by major organizations on circumcision.

JohnPRsrcher (talk) 22:48, 21 December 2014 (UTC)

Although it might "seem major" to you it's better to use an academic secondary source that covers the topic, right? We are not using any policy statement from any American medical organization to support any biomedical statement, perhaps you are confusing the Technical Report, which is a literature review and analysis we do use, with any policy statement. Zad68 01:21, 22 December 2014 (UTC)

I do not request for these to support biomedical statements. Rather, for the statements we have in the article on circumcision policy and current developments related to circumcision. Similar to the America Task Force, many of these are literature reviews as well. In Neonatal Circumcision Revisited, by the Canadian Paediatric Society, they note in the beginning: "The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed." This information would be valuable for us as it represents a review of literature with respect to Canadian demographics. The KNMG, the royal dutch medical association, notes that : "This viewpoint was formulated following consultation with relevant scientific organisations, who also support this stance. This ensures that this viewpoint has a broad basis of support from the relevant professional associations." They also state that: "This viewpoint by the KNMG is jointly endorsed by the following scientific associations: π The Netherlands Society of General Practitioners π The Netherlands Society of Youth Healthcare Physicians π The Netherlands Association of Paediatric Surgeons π The Netherlands Association of Plastic Surgeons π The Netherlands Association for Paediatric Medicine π The Netherlands Urology Association π The Netherlands Surgeons’ Association" It seems that the Dutch have also performed a scientific review, by representing a scientific consensus collected from all of these associations representing the persons within their country. Similarly, the RACP (Australia and New Zealand) notes that: After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.

It seems that most of these policy statements made available to us by cirp are in fact literature reviews, done based on unique demographic factors for individual countries.

JohnPRsrcher (talk) 18:46, 22 December 2014 (UTC)

A policy statement is not a literature review. We are not using the policy statement from the AAP. Zad68 06:04, 24 December 2014 (UTC)

A literature review is a review of the literature by a specific organization. In this case, the Canadian article, the Australian article, and the Dutch article all indicate that their Major Pediatric Organizations have all performed literature reviews in order to determine the extent of the effect that circumcision has on their populations with respect to certain diseases (such as UTI, penile cancer, etc.) These articles are of the same type as the American Task Force (which is a technical report) since they include a summary of the populations policy statement in the summary, and then a long review of the effect circumcision has on a multitude of diseases as well as other factors (such as ethics.)

I'm sorry Zad but these are not policy statements, they are technical reports from major organizations in Pediatric literature. Their literature reviews on different effects for circumcision (such as UTI, penile cancer, etc) should be made valid for this page.

JohnP 01:10, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

Note that they also include a lot of literature reviews and meta-analyses that I was not made aware of, which could aid in the construction of this page. These are unique to different populations living in these countries. These are all cited throughout the papers and in their references.

JohnP 01:12, 28 December 2014 (UTC)

It's very hard to see how a medical ethics textbook covering exactly this question can be found not to support the subject it's covering. Zad68 04:42, 28 December 2014 (UTC)

Lets cut to the chase here though with regard to the technical reports. Can we use these technical reports? They give a lot of good info of other countries interpretations over the findings on circumcision. For instance, the Australian one has their one consensus on HPV, along with references that are of value, similar to the one from the American Task Force. These references are studies that may have been performed in Australia or nearby, and could widen the amount of sourcing we have for the page so that it better represents world literature.

JohnP 19:04, 28 December 2014 (UTC)

JohnP 19:04, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

Which sources are you talking about? PMIDs please. Zad68 04:36, 30 December 2014 (UTC)

Ok. Document "Non-therapeutic circumcision of male minors" by the KNMG. See the link http://knmg.artsennet.nl/Publicaties/KNMGpublicatie/77942/Nontherapeutic-circumcision-of-male-minors-2010.htm for a copy.

Document Neonatal Circumcision Revisited from Canadian Paediatric Society: Pubmed ID 8634956

Document "The law & ethics of male circumcision - guidance for doctors" from British Medical Association (medical ethics commitee). See the link http://bma.org.uk/search?query=circumcision%20AND%20policy

Document "Guidance for doctors who are asked to circumcise male children, 1997" from British General Medical Council (medical care regulator): See link http://www.gmc-uk.org/guidance_circumcise_1997.pdf_25416429.pdf

I have more as well. Just cannot find online yet. Will post later.

JohnP (talk) 01:56, 31 December 2014 (UTC)

Poor Source: "Professional Standards and Guidelines – Circumcision (Infant Male)" (PDF). College of Physicians and Surgeons of British Columbia. September 2009. Retrieved 2012-09-11.

The link to this source dosen't go to anything. We need to find the actual link to this site and use it for this source.

JohnP (talk) 01:23, 31 December 2014 (UTC)

All that happened is that the convenience link doesn't work any more since they reorganized their website, that doesn't make the source itself poor. I'll remove the convenience link until the new location can be restored. Zad68 20:18, 1 January 2015 (UTC)

Poor Statement: Christopher Columbus reported circumcision being practiced by native Americans.[citation needed]

This needs a citation. It really shouldn't be up if we can't cite it.

JohnP (talk) 17:58, 1 January 2015 (UTC)

 Done cite restored, thanks for pointing it out. Zad68 20:18, 1 January 2015 (UTC)

Poor Position of Sentence: The WHO recommends considering circumcision as part of a comprehensive HIV program in areas with high rates of HIV, such as sub-Saharan Africa,[13][14] where studies have concluded it is cost-effective against HIV.

This sentence is poorly positioned. The medical community seems to agree that the benefits of circumcision are most relevant in southern Africa. According to WHO in report on circumcision: "There is increasing demand for male circumcision in southern Africa and future expansion of circumcision services must be embedded within comprehensive HIV prevention programming, including informed consent and risk-reduction counselling." Individual countries differ on their encouragement of circumcision depending on prevalence of circumcision and attitude towards it. According to AAP Task Force on circumcision: "The Task Force concluded that the health benefits of newborn male circumcision outweigh the risks and justify access to this procedure for families who choose it." However, according to the Royal Australian College of Physicians in 2010 statement on circumcision: "After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand." Both organizations seem to agree that the benefits or consequences are small enough that the parents should make the final decision. To justify this, according to AAP Task Force: "Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families." According to Royal Australian College: "However it is reasonable for parents to weigh the benefits and risks of circumcision and to make the decision whether or not to circumcise their sons." The majority of current literature seems to indicate that there can be a slight benefit or risk for individual countries based on the demographics (overall prevalence of STIs) and costs of procedure. The primary benefit in regard to HIV and STIs is emphasized on Southern Africa. This sentence should be in the lead to indicate that the primary health benefits of circumcision apply to Southern Africa.

JohnPRsrcher (talk) 15:46, 19 December 2014 (UTC)

Allow me to summarize my prior statement. The consensus of the literature available to us on the page right now seems to be indicating that the benefit for HIV is greatest in areas of southern Africa. In addition, all of the research we have on HIV is only applicable to African populations. It is still undetermined whether it benefits populations in developed countries. This is supported by the statements in the article under "Human Immunodeficiency Virus." We should have this sentence placed first, before the data on HIV, so that the summary is consistent with the rest of the article and the sourcing.

JohnP 18:05, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

Thank you very much indeed for providing a concise summary, conciseness is appreciated and preferred. None of the sources indicate that there is any human biology related to HIV transmission in this area that is peculiar to Africans and would make the protective effects not applicable to male humans in general, right? Just making sure we're clear on that--the opening sentence of the paragraph applies to male humans, generally. The next sentence describes the WHO's recommendations to Africa, a particular use of this effect of this intervention, but not the only one. This is a logical progression from the general to the specific, I don't see the need to rearrange the paragraph in the way you're suggesting--as if the sources indicate the procedure's effect applies only to Africans, which the sources do not indicate. Zad68 04:36, 30 December 2014 (UTC)

Well the second source concludes that "The evidence from these biological studies, observational studies, randomized controlled clinical trials, meta-analyses, and cost effectiveness studies is conclusive. The challenges to implementation of male circumcision as a public health measure in high-risk populations must now be faced." However, this is still applied to high-risk populations. The sentence in the article "Whether it is of benefit in developed countries is undetermined." indicates that we still don't know if it applies to male humans in general.

It looks like the sources don't only apply to Africans. It seems that they apply only to areas of high-risk. That is a difficult term, I'm still unsure of who overall it is applying to.

JohnP (talk) 16:55, 30 December 2014 (UTC)

Yeah I just read the source from the World Journal of Urology. Most of the data they have seems to be applied to developing countries or Africa.

JohnP (talk) 17:07, 30 December 2014 (UTC)

Ok. It was unclear from source 2 what areas the HIV benefit was applying to. I just read over their sourcing. They have observational data from the study "Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries" from "BMC Infectious Diseases" showing less prevalence of AIDS in developing countries where HIV is primarily spread through heterosexual contact. The best data comes from trials in Africa (The 3 RCTs.) As of now our sourcing seems to be saying that circumcision is effective against HIV in developing areas of the world where HIV is primarily spread through heterosexual contact.

JohnP (talk) 17:31, 30 December 2014 (UTC)

• • • • • • • (

I looked over all the studies one more time. This is final analysis. This is my answer to your first question. Circumcisions' protective effects do not apply to all humans. The source from the World Journal of Urology shows that it does have a preventative effect against HIV. However, the source from Current Opinion in Urology shows it is undetermined whether it prevents HIV in developed countries due to many different factors involved, such as different behaviors, established health care systems, different ways it is transmitted (homosexuals mainly in US), etc.

JohnP (talk) 02:25, 31 December 2014 (UTC)

• • • • • • (

Just looked over the evidence again. Circumcision's protective effects do not apply to all humans. The World Journal of Urology shows that it does prevent HIV. So circumcision has a protective effect against HIV, but we still don't have evidence of how this is affected by behavioral factors and other factors outside of Africa. The source from the Current Opinion in Urology shows that it's undetermined whether it prevents HIV in developed countries (and undeveloped ones as well) due to many different factors involved. This shows that the benefit of HIV still mainly applies to Africa.

For this reason, we should rearrange the summary paragraph. The benefits of HIV still apply mainly to Africa or high risk areas. We don't know how different characteristics of populations in developed and developing countries may effect the HIV benefit. We should rearrange the first paragraph to indicate that the HIV benefit, as of now, applies to areas in Africa and areas at high risk for HIV. This is what the sourcing is indicating.

JohnP (talk) 16:42, 1 January 2015 (UTC)

Circumcision's protective effects do not apply to all humans -- Simply wrong, or you're confusing the human-wide biological effect with its calculated cost-benefit utility in particular situations. Africa is not the only locale where public health authorities are making this calculation, although it is per the sourcing the most important one. Zad68 20:18, 1 January 2015 (UTC)

Circumcision does have the human-wide biological effect of preventing HIV. However, it is still unknown whether this biological effect would be effective at preventing HIV in developed countries. This is supported by the conclusion of the source from Current Opinion in Urology that states "The broader application of this procedure to other areas of the world with different population, infrastructure and disease characteristics warrants further investigation." I do not think that this is a cost effect. This article is stating that the populations, infrastructure, and disease characteristics in developed countries could change the benefit from HIV.

This is why I state that circumcision's protective effects do not apply to all humans. Yes, it does have a biological preventative effect. But there are other factors involved within developed countries that could drastically alter this effect.

JohnP (talk) 01:21, 2 January 2015 (UTC)

Circumcision is associated with reduced rates of cancer causing forms of HPV[15][16] : Poor representation of the literature and a poorly cited statement.

This statement is a poor representation of the literature. If you read the AAP Task force on circumcision they seem to be arguing that "There is good evidence that male circumcision is protective against all types of HPV infection." They use two groups of studies to justify this claim. For the first group of studies, the task force does note that they show a protective effect and a reduced prevalence, but also states that "these studies fail to provide information on the risk of acquiring HPV and may reflect persistence of HPV rather than acquisition of infection." And also that "The selection of anatomic sites sampled may influence the results." This suggests that the medical community is still questioning the results of these studies. The studies that the task force seems to be putting the most emphasis on, that is, using the most to justify their claims, is the two large randomized control trials in Africa in Uganda and Orange Farm, South Africa. The methods of these studies made them ideal for showing a correlation between infection and circumcision, and this is why the task force seems to be relying the most on them for their statement.

The two studies that are currently cited are insufficient to use to represent this information. Larkes meta-analysis observed the prevalence of infection of certain areas of the penis while comparing circumcised to uncircumcised males in order to make its argument over prevalence. The same study by Larkes states near the beginning that " systematic review of studies published to March 2006 found no evidence of an association between circumcision and genital HPV (OR, 1.20; 95% CI, 0.80–1.79) [9]. However, this review was criticized methodologically, and a reanalysis of the same studies found a strongly protective effect (OR, 0.56; 95% CI, 0.39–0.82) [10]. An updated meta-analysis using the same search strategy and including studies published to September 2007 found a similar effect (OR, 0.52; 95% CI, 0.33–0.82) [11]." It seems that the medical community is still not at consensus over recent circumcision studies. The conclusion of Larke's study was: "Circumcised men are at substantially lower risk for prevalent genital HPV infection than non-circumcised men. Few studies assessed the effect of circumcision on HPV incidence or clearance, but data suggest strong evidence of an effect of circumcision on reducing HPV incidence and weak evidence of an effect on increasing HPV clearance. There was no evidence of an association of circumcision with genital warts. " It seems that the main conclusion that he had was that the infection rate went down, this is consistent with the statement by pediatrics. In Rehmeyer's study, he remarks that "Most of the research about HPV and male circumcision has been observational in nature and was conducted in the past 10 years. These investigations are extremely varied in sampling technique, HPV detection method, and the stage of infection under study, making them extremely challenging to review." With regard to what the studies are actually observing, he states that "Most studies have been limited to reporting HPV prevalence data. Because disease prevalence is a product of both the incidence and duration of infection, it does not demonstrate whether circumcision is influencing the acquisition of HPV, the ability of the host to clear the infection, or both. " Rehmeyer's study was not a meta-analysis but a literature review of studies involving circumcision and HPV. From what I read, it seems his main conclusion was that it reduces the incidence of infection. However, it seems he was the only author of this study (is subject to selection bias.) Both of these studies that are currently on wikipedia state that there have been different conclusions found by meta-analyses in the past 10 years, and Rehmeyer notes that most of the data is difficult to analyze due to inconsistent methodology. The Pediatrics Task Forces statement seems to best represent the literature at this point.

JohnPRsrcher (talk) 19:12, 20 December 2014 (UTC)

As you note, the AAP technical report says "There is also good evidence from randomized controlled trials that male circumcision is associated with a lower prevalence". The sources cited discuss this, that the reduced prevalence is likely from increased clearance of the virus by the body as opposed to decreased incidence. The Wikipedia article is careful to explain this in the Human papillomavirus. Are you suggesting an edit? Zad68 05:21, 21 December 2014 (UTC)

Yes. The AAP also notes flaws in the studies observing prevalence, stating that "These studies fail to provide information on the risk of acquiring HPV and may reflect persistence of HPV rather than acquisition of infection." Larke and Rehmeyer also both note that there has been difficulty in determining an outcome of the data. Rehmeyer states that most of it has been obtained in the past 10 years. Both the AAP and the RACP (Australia) both note that circumcision is protective against HPV infection. I recommend that we change it to "circumcision is protective against HPV infection, and is associated with a reduced risk of UTI and penile cancer."

JohnPRsrcher (talk) 01:10, 22 December 2014 (UTC)

(******

Let me summarize my statement from before. So far we have 3 studies on HPV from Larke, Albero, and Rehmeyer. Larke and Albero are both meta-analyses. Larke and Albero found that circumcision reduces HPV prevalence. Rehmeyer found that circumcision does not effect LR-HPV prevalence but does effect HR-HPV prevalence. As of now, the summary and section on HPV both state Rehmeyer's findings that it only reduces HR-HPV prevalence. I don't think this is correct. Rehmeyer is not a meta-analysis. I think that Larke and Albero's findings that circumcision reduces the prevalence of all types of HPV infection should be used.

JohnP (talk) 17:49, 1 January 2015 (UTC)

Actually this sentence is fine. I see that you found that these were conflicting so you took account of that in the sentence on prevalence. That's why you're only saying that it reduces HR HPV, there is no literature review to state the contrary.

JohnP (talk) 01:01, 4 January 2015 (UTC)

 Done Great. Zad68 05:03, 4 January 2015 (UTC)

Missing an Infobox: Cosmetic above Picture of Circumcision being Performed

Hi,

the content of this article makes it unclear as to whether circumcision is appropriate as a medical intervention or not. See the statements "The positions of the world's major medical organizations range from considering neonatal circumcision as having no benefit and significant risks to having a modest health benefit that outweighs small risks." and "Neonatal circumcision is often elected for non-medical reasons, such as for religious beliefs or for personal preferences possibly driven by societal norms." This should be classified as a cosmetic procedure and an intervention.

JohnPRsrcher (talk) 18:44, 23 December 2014 (UTC)

This article summarizes what the medical sources say, which is that it is indicated for presenting medical need in a few cases. Only a patient working with a physician can decide whether it's an appropriate intervention in each individual case, it is not Wikipedia's role to make that kind of recommendation, see WP:MEDICAL. Zad68 06:04, 24 December 2014 (UTC)

Yes, this is true. But do you know why the word "intervention" is over the picture of the infant being circumcised? If it isn't the title of the picture then there's really no reason for it to be there.

JohnP 02:45, 28 December 2014 (UTC)

Because it's in the Wikipedia category of intervention, like procedures and drugs, as opposed to another topic like disease or condition, this is standard categorization for articles with infoboxes in Category:Medicine_infobox_templates. Zad68 04:42, 28 December 2014 (UTC)

Adding - I see you modified your original comment after others replied to it. Please do not do that. Regarding "cosmetic surgery", intervention is the Wikipedia infobox label, even Rhinoplasty (nose job) and Liposuction, which similarly have therapeutic as well as cosmetic uses, are similarly Intervention in the infoboxes. I don't see a reason to make an exception for this article. Zad68 04:48, 30 December 2014 (UTC)

Allow me to summarize my thoughts on the topic. I think that it is important to change the pages Rhinoplasty (nose job) , plastic surgery, and circumcision so that they have infoboxes called cosmetic as well as intervention. This is because circumcision in most cases is non-therapeutic, done for religious or social reasons. Plastic surgery is also not a medical intervention because there is no medical reason for it (at least that I know of.) I think that we should add a cosmetic infobox so that this page is also classified as cosmetic. That is because this medical procedure is both cosmetic and an intervention.

JohnP (talk) 02:31, 31 December 2014 (UTC)

I see you've taken this idea to WT:MED, which was a sensible thing to do, and it was firmly rejected. Suggest you drop the stick, see Wikipedia:Drop the stick and back slowly away from the horse carcass. Zad68 03:47, 31 December 2014 (UTC)

The "intervention" labelled lead picture contains nothing along the lines of Zad's " Only a patient working with a physician can decide whether it's an appropriate intervention in each individual case" - no physician/ no mutual decision. It is an ancient photo which does nothing to illustrate or elucidate the penis cutting process.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 02:12, 1 January 2015 (UTC)

If we can get consensus on this page that circumcision is a cosmetic procedure as well as a medical intervention I’m sure we could convince the people at WikiProject Medicine to add the infobox. This seems to be supported by our sourcing.

JohnP (talk) 01:37, 4 January 2015 (UTC)

After a week of discussion I don't see any support forming on the WT:MED page for this idea at all. Zad68 05:03, 4 January 2015 (UTC)

yea but a main concern seemed to be that it would cause edit warring. If we can gain consensus then we could affirm that there would be no edit warring.

JohnP (talk) 01:49, 5 January 2015 (UTC)

Lacking Info on Adolescent and Adult Circumcision

Hi, according to our sourcing many of the circumcisions in the world occur to adolescents as well as infants. We currently have only one sentence on the safety of adolescent and teenage circumcision : "Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age.[18] " This study is limited to children under the age of 12.

JohnP (talk) 22:54, 6 January 2015 (UTC)

New Sources for Page on Adult Circumcision

See pmids 17335574, 21124715 , 10193593

JohnP (talk) 01:00, 7 January 2015 (UTC)

Some useful pointers for 2015 improvement of this article.

Circumcision questions

Imagine a new wikipedian reading this article .

She might ask

1/ how many males or females get circumcised every year?(8 year old figure in article !) What percentage of these have no choice in the matter ?

2/ What is the breakdown per country ?

3/ How many circumcisions are conducted in aseptic conditions by medically competent personnel ? How many are botched despite such precautions ?

4/ How many are conducted in other more dangerous circumstances ? If it is the most common “procedure” in the world – why are these and other statistics missing in the article ?

5/ What percentage of those getting cut are forced adult circumcisions ?

6/ What do cutters do with the cut off foreskins ?

7/ For those circumcised foreskins sold for cosmetics and for medical use and research what is involved ?

8 How much does it cost to buy a cut off foreskin ? Is this profit deducted from the bill given to parents of circumcised infants?

9 What is the fee charged in different countries by circumcisers per circumcision ?

10 How many cases of circumcised adults suing those who cut off their foreskin as children have occurred and how many have been won ?

11 Has the popularity of circumcision declined ?

12 Is there a concerted and sustained effort underway to keep this article unbalanced ?

13 There are groups of doctors and other groups who campaign in opposition to the practice of circumcision on many grounds – why do they go unmentioned ?

This article in its present deplorably defective selective state answers none of these questions fully or at all in most cases.

Perhaps in 2015 we can set about making this article better by tackling these omissions and the other poor, selective and unbalanced content, structure and tone.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 13:45, 28 December 2014 (UTC)

Tumadoireacht how is this anything other than the continuation of the tendentious editing that NuclearWarfare blocked you for? This is exactly more of the same as before. Zad68 03:05, 30 December 2014 (UTC)

Thank you for your opinion once again Zad. Is it another example of your tendentious editing for which you so far lead a largely charmed life ?

Tendentious editing includes "repetitive attempts to insert or delete content or behavior that tends to frustrate proper editorial processes and discussions" Are you attempting once again to inhibit discussion here ? An editor of your vast experience should know better by now than to attempt to do that. You have duplicated this comment today on another page already. Do you intend to continue ? Try to resist the temptation to comment on the editor and devote your energy to addressing the 13 issues raised here which are sorely in need of work. Happy New Year. "When did you stop beating your wife ?"--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 11:55, 31 December 2014 (UTC)

Silence unsurprising. Where is the regular stenorian chorus of article guardians to answer these lacunae ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 20:08, 8 January 2015 (UTC)

Section "Adverse Effects." Statement: "Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction.[20][59]"

I looked over the sourcing for this statement. Most of the sources are just restating the findings from the 3 RCTs in Africa. Since the data is quite limited I think that this calls for elaboration on this point.

JohnP (talk) 01:57, 7 January 2015 (UTC)

I looked over all the data. There is better justification then just the 3 RCTs given by the AAP and the review titled a snip in time. This one is resolved.

JohnP (talk) 23:41, 8 January 2015 (UTC)

 Done

JohnP (talk) 23:43, 8 January 2015 (UTC)

New Studies on Phimosis

I have a meta-analysis from Cochrane and a few reviews about treating phimosis and balanitis with circumcision. See pmids 25180668, 24295833, 21298220, 16800325

JohnP (talk) 01:41, 9 January 2015 (UTC)

Those might be useful at Phimosis, BXO, etc. which focus on those topics. Zad68 23:00, 10 January 2015 (UTC)

New Literature Review on Circumcision: Review of the Current State of the Male Circumcision Literature

This literature review is titled "Review of the Current State of the Male Circumcision Literature" and it is from the Journal of Sexual Health. It does a review of much circumcision literature to date. Its conclusion is: Further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America. You can gain access through the British Journal of Urology or the Journal of Sexual Health.

JohnP 16:27, 28 December 2014 (UTC)

Okay and what do you wish to support with this review? Most articles conclude with the statement that more research is needed. The Lancet from what I remember does not allow this statement.Doc James (talk · contribs · email) 01:58, 29 December 2014 (UTC)

Note that another part of the conclusion is: Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men’s sexual partners, and reasons for circumcision.

In the summary, the statement "Circumcision does not appear to have a negative impact on sexual function."

- This could support this or change it depending on level of results with respect to other studies.

Add to section “Routine and Elective” to note that the Journal of Sexual Health has drawn attention to significant gaps in the literature that need to be addressed for North America.

The section "Adverse Effects" statement: "Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction.[20][58] A 2013 systematic review and meta-analysis found that circumcision did not appear to affect sexual desire, pain with intercourse, premature ejaculation, time to ejaculation, erectile dysfunction or difficulties with orgasm."

- This has shown that research in some of these fields is lacking. Can support these statements or change.

Add to section "Adverse Effects".

- Maybe could add to this statement. Depends on review of sourcing we already have.

Maybe for section Economic considerations”, statement: “The American Academy of Pediatrics (2012) recommends that neonatal circumcision in the United States be covered by third-party payers such as Medicaid and insurance.”

- This criticizes economic considerations by the United States. This could make note of that.

JohnP 03:15, 29 December 2014 (UTC)

Not seeing how the conclusions of this particular review support these suggestions, especially for the areas where we cite many high-quality secondary sources. We already qualify most of the results by evidence quality (like "good" instead of "excellent"), I don't see what this is adding other than the author's opinion. Zad68 04:41, 30 December 2014 (UTC)

The very structure of this Wikipedia Circumcision article is skewed to paint Circumcision in a positive light. The having an "Effects" section and then an "Adverse Effects" section is a good example. Should they not be "adverse" and "beneficial" or "Negative " and "Positive" ? The turbanned gentlemen sitting around as the lead photo is also too funny.Minimization again. Sadly this photo has now popped up on the until now superior French language Circoncision. Mediocrity creeping in all over. Also why is there no mention within the English article of the remaining penis shaft and head skin being sewn up again after the foreskin is cut out ? I understand that this usually happens in adult circumcisions at least ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 12:23, 31 December 2014 (UTC)

Also why is there no mention within the English article of the remaining penis shaft and head skin being sewn up again after the foreskin is cut out ? I understand that this usually happens in adult circumcisions at least ? That is actually a useful question Tuma. Now if you could keep the 10 percent of your contributions that are productive and cut out the 90 percent that are not (such as the vicious personal attack on another editor in a recent edit summary of yours), this could be a better place for everyone.--89.204.130.241 (talk) 15:54, 31 December 2014 (UTC)

It might be a useful suggestion if a reliable source were (ever) offered to support the claim, this is just another one in a long series of assertions where no reliable source is offered. Zad68 20:26, 1 January 2015 (UTC)

A paragraph sub-headlined "Post-operative care" in either the Circumcision or "Circumcision surgical technique" article could be useful.89.204.130.241 (talk) 16:01, 31 December 2014 (UTC)

Ok Zad took your comment into account. I think that we should add to the section adverse effects to note that this review has found that more research is needed regarding sexual functioning. I think we should add to the section routine or elective to note that more research should be done to address the reasons for circumcision. I think we should add to the section routine or elective to note that further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America.

JohnP (talk) 17:04, 31 December 2014 (UTC)

Thanks but as Doc pointed out, that can be said regarding just about anything, and so doesn't add any useful information. Again, we already summarize how the sources qualify regarding the quality of the available evidence. Zad68 20:18, 1 January 2015 (UTC)

No. But note that in the conclusion of this review, it is stated that "This review highlights considerable gaps within the current literature on circumcision. " This is not something that can be said just about anything, because this means that this review has recognized serious problems with the studies that we have to date. I cannot say that "just about anything" has serious problems, because there are no literature reviews that are saying that about anything else on this page. The problems that this review recognizes are in the areas of sexual functioning and the reasoning for circumcision. Since there are serious problems with our data on sexual functioning and the circumcision choice, we should recognize this.

JohnP (talk) 01:51, 2 January 2015 (UTC)

What DocJames stated was: "Most articles conclude with the statement that more research is needed. The Lancet from what I remember does not allow this statement." However, that is not the outcome of this review. This review stated: "This review highlights considerable gaps within the current literature on circumcision. " That means that there are significant problems with the literature that we have to date.

JohnP (talk) 02:42, 2 January 2015 (UTC)

---

The results of this review are: This review highlights considerable gaps within the current literature on circumcision. The emphasis is on factors that should be addressed in order to influence research in becoming more applicable to North American populations. Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men’s sexual partners, and reasons for circumcision. Additional factors that should be addressed in future research include the effects of age at circumcision (with an emphasis on neonatal circumcision) and the need for objective research outcomes.

This is not the same as what Doc James because the conclusion of this review is not that more research is needed. The conclusion of this review is that there are significant gaps in the literature in the areas of circumcision and sexual function, penile sensitivity, the effect of circumcision on men’s sexual partners, and reasons for circumcision. By saying gaps the review is actually saying problems. This is because, on reading the review, it highlights many problems that exist in our current studies.

Zad what I think that we should do is add a statement to indicate that the literature we have on sexual health has significant gaps. An example is: "A 2014 literature review found that there are significant gaps in the literature in the areas of circumcision and sexual function, penile sensitivity, the effect of circumcision on men’s sexual partners, and reasons for circumcision." We can add this to the section adverse effects.

JohnP (talk) 03:36, 12 January 2015 (UTC)

Sentence "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision.[8][9]" Does not properly represent world lliterature.

Hi, this sentence has been cited based on a textbook and study published in North America. Many medical organizations have issued policy statements on circumcision that present their understanding of the questions that have been raised over circumcision. These include the Royal Australian College of Physicians (which represents pediatric physicians in Australia and New Zealand,) the Royal Dutch Medical Society, the Canadian Paediatric Society and organizations for individual provinces in Canada, the Central Union for Child Welfare in Finland, etc. Issues that they present do not only include ethical and legal questions over informed consent but also a human rights violation. Proposal to add these support references and do a further review to best represent literature?

JohnPRsrcher (talk) 22:41, 21 December 2014 (UTC)

The textbook cited is published by Cambridge University Press, which is based in the UK and not North America. The individual policy statements of various societies are primary sources for the views of those societies. I actually did not see, for example, the CPS statement had a mention of "human right" anyway. The university textbook cited instead provides an overview of the ethical discussion. What is better is a non-agenda driven, academic overview of various arguments involved. Zad68 01:19, 22 December 2014 (UTC)

Canada does recognize that groups are questioning human rights, in their statement: “Groups opposed to neonatal circumcision have been formed and have become visible lobbyists (for example, the National Organization to Halt the Abuse and Routine Mutilation of Males, San Francisco, and the National Organization of Circumcision Information Resource Centers based in San Ansel mo, Calif., with branches across the United States and in Canada and other countries) [29].”

In response to your statement I have done a review of all literature on both sides. First off, I would like to question the textbook and the study already on wikipedia. This textbook only has one chapter on circumcision and this procedure is not its primary focus. It states that two debates have been raised over circumcision: 1. whether circumcision of newborns should not be routine. And 2. whether non-thereapeutic circumcision should be performed at all. This is different then the statement which is already on Wikipedia, as it does not only concern informed consent and autonomy. Based on this statement, if the procedure really shouldn’t be performed at all, then it could be interpreted as violating human rights if it is painful and causes any lasting damage. Also note that, from what I could see on google books all of the sourcing for this textbook was from North America and the UK. For the second source by Kirk Pinto called Circumcision Controversies , the main focus of his article does not seem to be to identify overall questions regarding the procedure, as his conclusion is rather obscure and calls for more information. The first statement of his article summary is: “The ultimate fate of neonatal circumcision is as obscure as its origin. Despite the exhaustive research on this fascinating subject, the lack of consensus calls for even more unbiased study”. He also states that “If medical research does not answer the outstanding questions about circumcision, clinicians should be aware of the sobering reality that there are legal and socioeconomic forces marshaling eager to answer these questions for us.” Neither of these studies have done considerable reviews of world populations to determine overall questions regarding the procedure; they both had short statements regarding their observations on the questions that are being asked. Their justifiability for this statement comes most from an overall impression made on medical professionals and not an impression made from demographic data.

For my second argument, I would like to observe the nature of the statement: "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision.[8][9]" This statement is merely recognizing questions that have been raised (by a considerable population) about the procedure. From what I have read from the textbook and study, these both seem to give a good impression of the questions that have been raised, but both of them did not do a considerable review of this topic. They were also both limited to North American populations.

With regard to the new policy statements made available to us by cirp, I would like to remind you that most of these are literature reviews that have been conducted with respect to their own countries. In addition, according to cirp these constitute all policy statements made by English speaking nations (although this isn’t credible and must be further reviewed.) Most of these countries have done a review of literature and cost based analyses before publishing their results. The fact that almost all of them (Australia, New Zealand, Canada, and the British Medical Association) are stating that they are aware of the fact that groups are questioning whether this is a human rights violation, should make this question one of prominence for the page. In addition, one group, The Central Union for Child Welfare in Finland, which represents many NGOs and municipalities, is raising the question of whether this violates the boys physical integrity. This is similar to stating it is a human rights violation.

In regard to your statement on we should be using a non-agenda driven academic overview. I think that this should be our goal, but I don’t think that our current sources have fulfilled this purpose.

JohnPRsrcher (talk) 18:10, 23 December 2014 (UTC)

Please don't use this article Talk page to air your own interpretations and views on this topic.

Regarding "Ethical and legal questions ... have been raised" -- Yes, Wikipedia reports on the arguments, it does not engage in them. You have found instances of individual advocacy groups or societies engaging in these sorts of arguments, so the statement is supported, just like the source says. And again, a policy statement isn't generally looked upon as a literature review. Zad68 06:04, 24 December 2014 (UTC)

Yes thats true. But I don't think that I aired my own interpretations and views on the topic. I was reviewing the sources that are already on the page and then I suggested that we use the technical reports from the US and other countries (sorry I should have said technical reports originally; these are technical reports, not policy statements) to indicate questions that have been raised.

First, lets cover the sources already on the page. The first source is a case based textbook that has the purpose of educating doctors of how to react in the case that they are asked to perform a circumcision. Its primary purpose is not to inform the reader of questions that are being raised by all people about this procedure. It does have a short paragraph on this topic, where it states "2 debates surround circumcision. Whether it should be routine or whether it should not be performed at all." This cannot support the statement "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision.[8][9]" because it isn't saying that at all. Its stating that the debate is asking whether it is needed.

The second source covers circumcision controversies, but it only has one author. This isn't a literature review. The source's primary goal is to recognize circumcision controversies that exist in the medical field. Because of that, it is not sufficient to represent questions that arise over the procedure from common people. This makes it a poor source for the statement. It does note that controversy in the medical field exists over informed consent and the parental role; which is stated in the article. However, questions raised in the medical field are not the same as questions that are raised overall. It does have a few statements about questions that are raised by different groups in society. It states "Ethicists, lawyers, philosophers, and members of anti-circumcision groups also have concerns about the legal and moral issues surrounding the operation" and "Opponents of newborn circumcision argue that the loss of foreskin during circumcision, in itself, is an irreversible and unnecessary harm and that parents cannot consent to procedures that do not benefit their child."

The current sourcing is insufficient to represent the statement "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision.[8][9]". We need a better source that does a review of questions asked in the overall community over the procedure.

JohnP 02:41, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

The primary goal of the case based textbook is to inform doctors of what to do when they are asked to perform different medical operations. The case based textbook only has one chapter on circumcision. Its primary goal is to inform doctors of how to react in the case they are asked to perform a circumcision. It does not give an overview of questions that have been raised about the procedure, and doesn't cover sources of controversy in the medical field (only debates). This makes it unfit to speak for this topic. Maybe it would be better to use it to highlight another statement involving controversies in the medical field.

The second source titled Controversies with one author is ok, as it does go over some medical controversies that exist, notably in consent and the parental role.

I think a better sourcing for this statement "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision.[8][9]" would be one that highlights significant questions from community groups in a specific demographic. If we could get a source that is clearly indicating that these questions are being raised that would be better.

JohnP 02:58, 29 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

I just disagree that the ethics textbook isn't useful for the statements it's supporting, I can't see anything in your argument against it other than "I don't like it". The book has a more than acceptable pedigree, what are the reasons against? I don't see a reason to remove the general overview "Ethicial and legal questions..." but if you're identifying up-to-date policy statements from major medical organizations (see Bolnick) that sounds like a useful addition. Zad68 04:36, 30 December 2014 (UTC)

• • • • Just read this comment*******

Let me summarize my conclusion on the case based textbook. This is a poor source. We should get rid of it. It has one chapter on circumcision and instructs doctors of how to react in the case they are asked to do a circumcision. It doesn't go over the controversies that exist in the medical field.

The other source controversies is ok. It does bring up questions that are brought up in the medical field. We are still lacking info on questions that are brought up by opponents of circumcision.

JohnP 17:24, 29 December 2014 (UTC)

A better statement to represent the source "controversies" would be "legal and moral questions regarding informed consent and the parental role have been raised over non-therapeutic neonatal circumcision. " Also, this source does note that "opponents of newborn circumcision argue that the loss of foreskin during circumcision, in itself, is an irreversible and unnecessary harm and that parents cannot consent to procedures that do not benefit their child." We should change the statement so that it says:

"legal and moral questions regarding informed consent and the parental role have been raised over non-therapeutic neonatal circumcision. " and add some info about what groups that are opposing circumcision are asking.

JohnP 17:33, 29 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)

• • • • • • • (

I looked over this one again. My argument still stands. The textbook shouldn't be used because it is unfit to speak about circumcision controversies. The article titled "Circumcision Controversies" can be better represented by this statement. It recognizes that controversy over consent and the parental role has been raised. It also uses the wording "moral and legal questions" to describe this. A better statement is "legal and moral questions regarding informed consent and the parental role have been raised over non-therapeutic neonatal circumcision."

JohnP (talk) 16:12, 1 January 2015 (UTC)

In addition, I've found one more unbiased source on this topic (questions in the medical community.) This is from the UK, so it offers a different perspective then our current one. See PMID 12503896. This is supposed to be a consideration of the circumcision controversy from the perspective of a child's nurse.

JohnP (talk) 16:15, 1 January 2015 (UTC)

The article titled Circumcision Controversies by Pinto? The Cambridge U. ethics textbook echos and expands on Pinto, which covers medical aspects more. And the article content isn't limited to "controversies" but rather it's an overview of ethics, so I don't see the merit in your objection. The Crawford article is over 10 years old so would be out of date regarding the cost-benefit equation, please use up-to-date sources. Zad68 20:18, 1 January 2015 (UTC)

The textbook isn't a good source. This is because ethics is not the same as questions posed about circumcision. The definition of ethics is the moral principles of an individual. The Cambridge U. ethics textbook has the goal to educate doctors about how to behave ethically, or morally, with respect to our national laws while circumcising a child. Nowhere, other then in one sentence, does it mention the questions that are raised by the medical community over circumcision.

With respect to circumcision controversies, Pinto's source is a good source because Pinto objectively goes over many sources of controversy in the circumcision literature. However, it is limited as it is only valid with respect to North America. As we are writing a page under the English Wikipedia Page, we should be attempting to represent all English countries with our writing.

The only other source I could find on controversy was the Crawford article. Although this is over 10 years old, it does give us a unique perspective on the circumcision controversies in the UK. Note, also, that this was the only other unbiased article on controversies that I could find on pubmed. In this case, I believe that this is an up to date source as it is the most recent source that we have for the specific region of the UK.

JohnP (talk) 01:44, 2 January 2015 (UTC)

I appreciate that you're doing your best to seek out unbiased sourcing. The issues with a 10-year-old source in this field should be obvious, given the highly influential research that has been conducted since then. Zad68 05:03, 4 January 2015 (UTC)

When you say research in the field, do you mean research on controversies? Controversies may have changed over the ten year period, but I'm not sure how much. I don't think that these are really research articles (both Pinto and Crawford,) they seem to be both giving a summary of the general opinion on circumcision with respect to these areas. Since the Crawford article is from the UK it really is unique, as Pinto is only from North America. Its insights on controversy are valuable for this page, given that we are currently only listing controversies from North America.

JohnP (talk) 01:46, 5 January 2015 (UTC)

The point being that like for just about every other intervention, any medical "controversy" is a cost-benefit analysis, and a discussion of that has to reflect the current state of research, especially as it's changed so much in the past 10 years. Zad68 03:35, 6 January 2015 (UTC)

This is true but this sentence really isn't about medical controversies, we're just using data on medical controversies to support it. This isn't ideal but it's what the literature mandates that we do because of how we can't really use a document that is anti-circumcision or pro-circumcision to support it. What this statement is doing is recognizing overall questions in the medical community that exist over circumcision.

I've already pointed out that the textbook isn't good because it only has one sentence on this topic. Pinto is good but I think that the statement has misinterpreted it. What Pinto is saying is: Legal and moral questions regarding informed consent and the parental role have been raised over non-therapeutic neonatal circumcision. Can we start out by making these changes?

JohnP (talk) 23:09, 6 January 2015 (UTC)

The article already states plainly that there's a debate over ethical concerns, consent, and legal status, using Pinto and others. How is what you're suggesting a detectable improvemenet? Zad68 23:00, 10 January 2015 (UTC)

This will be a detectable improvement because this textbook explains case scenarios in which doctors are asked to perform a circumcision. It does not illustrate questions about the procedure but illuminates legal and ethical difficulties that doctor’s experience when they’re asked to perform it.

This will cause a perceptible difference because this sentence, which is supposed to represent questions in the field, will do just that. It will not be limited by ethical and legal problems that doctor’s experience when they're asked to do the procedure but will illustrate a summary of the questions that people overall are asking.

JohnP (talk) 04:07, 13 January 2015 (UTC)