Talk:Circumcision

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

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

Missing sections from this Circumcision article :

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Male circumcision:global trends and determinants of prevalence, safety and acceptability

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The procedure is most often elected for religious reasons , personal preferences and "hygiene"

1-The procedure is most often elected for religious reasons , personal preferences and "hygiene"

UNAIS > Male Circumcision: context, criteria and culture (Part 1) 26 February 2007 health and sexual benefits In more recent times, perceptions of improved hygiene and lower risk of infections through male circumcision have driven the spread of circumcision practices in the industrialised world. In a study of US newborns in 1983, mothers cited hygiene as the most important determinant of choosing to circumcise their sons, and in Ghana, male circumcision is seen as cleansing the boy after birth. Improved hygiene was also cited by 23% of 110 boys circumcised in the Philippines and in South Korea, the principal reasons given for circumcision were ‘to improve penile hygiene’ (71% and 78% respectively) and to prevent conditions such as penile cancer, sexually transmitted diseases and HIV. In Nyanza Province, Kenya, 96% of uncircumcised men and 97% of women irrespective of their preference for male circumcision stated their opinion that it was easier for circumcised men to maintain cleanliness. http://www.unaids.org/en/Resources/PressCentre/Featurestories/2007/February/20070226MCpt1/

2-Reasons Parents May Choose Circumcision There are a variety of reasons why parents choose circumcision. Medical benefits, including:Easier genital hygiene.AAP/ http://www.healthychildren.org/english/ages-stages/prenatal/decisions-to-make/pages/Circumcision.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token — Preceding unsigned comment added by Nguessanx (talk • contribs)

Sorry, not sure what point you're trying to make. Jayjg ^(talk) 18:52, 17 March 2013 (UTC)

Probably this: By having a section "Indications and contraindications" with very little cultural discussion, this article gives undue weight to the retroactive medical justification attempts for a non-medical practice rooted in religion and superstition and sometimes also performed as cosmetic surgery, even on babies. A reader of this article with no prior knowledge of the topic might well believe that circumcision is primarily performed to treat actual phimosis or out of a hope to get one or more of a variety of supposedly proved tiny positive effects.

This is patently not the case. The incidence of phimosis requiring any treatment at all is quite low in countries in which circumcision is not practised for ritual or fashion reasons, and it can usually be treated non-surgically. (The supposed positive effects were 'proved' only recently, after the earlier 'medical' anti-masturbation indication became thoroughly unacceptable, FGM became clearly outlawed, and children's rights became more of an issue, suggesting that the practice of male circumcision without medical indication might soon become illegal.)

The title of this article is "circumcision", not "circumcision with medical indication". That needs to be reflected by the article's content. Hans Adler 23:29, 17 March 2013 (UTC)

The flavour of response from many of the editors who maintain the current state of this article seems to have changed recently to minimal engagement with all suggestions for a wider consideration of the subject within the article on the talk page, coupled to lightning quick reversions of any material in the article without prior discussion, which does not conform to a pro circumcision agenda and painting a picture of it as a safe, necessary, and homogenous medical procedure only . The suggestion has been made that excision of female infant breast material at birth as a way of reducing rates of breast cancer in adulthood belongs to the same school of logic as many of the arguments here selected for inclusion on MC. @Hans Adler - you give, as so often before a succinct and perceptive précis. If you were not averse to barnstars I would nail one up.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 00:58, 18 March 2013 (UTC)

Hans, if I understand you correctly, you are concerned that this article gives too much weight to the medical aspects of the procedure vs. the cultural aspects, and support this by providing your personal views on the procedure's medical effects. It is fine for you to have that perspective, however for Wikipedia articles we must look to the emphasis as found in the sources, per WP:DUE. You're concerned that someone new to the subject reading the Wikipedia article would come away with the impression that circumcision is a medical procedure. If that same unknowledgeable person were to go to Google Scholar and do a search on "circumcision" for up-to-date sources, that's exactly the impression that person would have. Do this for yourself: Go to Google Scholar, and search for "circumcision" in sources published in, say, the last 10 years. My review of the first 40 results shows that all 40 results were discussion of circumcision's medical aspects, as a medical procedure. By far the #1 most important topic was circumcision's effects on HIV, with about 75% of the results relevant to that topic. Most of the other results were circumcision's effects on other STDs, medical practice guidelines, and other medical topics. A non-medical article "Circumcision by Barbers in Rural India: A Scientific Study of an Ancient Method" didn't appear until result #98, the next was at about #130. Now look at the Wikipedia article; it correctly reflects the emphasis found in the sources. (As a control, to make sure Google Scholar is searching non-medical source database, I also did searches on the body-modification topics "Padaung neck rings" and "foot binding", which returned non-medical sources from JSTOR and other databases almost entirely.)

Second, please note that well over half the article is devoted to non-medical aspects such as history, culture, religion, and ethical and legal issues. That fact that circumcision is elected for non-medical reasons is the very first thing mentioned in Indications and contraindications, and the discussion in Society and culture of its use by the various cultures and religions is actually larger than what is found in the Indications and contraindications section, so I am not really understanding why you feel there's a problem here, especially given the actual emphasis as found in the sources. In fact, as it currently stands, a proposal based on WP:UNDUE to reduce the amount of emphasis placed on the non-medical aspects would be hard argue against, although I am not proposing this. Zad68 04:15, 18 March 2013 (UTC)

Indications and Contraindications is a medical term and its prominent placement does not reflect the wide variation in ways in which circumcision is inflicted upon children worldwide. Is there any link from this article to the WP Forced Circumcision article for instance  ? http://en.wikipedia.org/wiki/Forced_circumcision

A great deal of the World Health Organization 2007 Circumcision document is given over to the awful adverse effects of medical and non medical circumcisions in half a dozen settings worldwide as i have mentioned several times recently on this talk page yet this due weight is presently unreflected in our article.

The severe ostracizing of male and female uncircumcised in many cultures from the Jewish one for males to current african and aboriginal ones for male and female is unincluded too.

The current article reference to such severe social shunning by Jews of their uncircumcised brethren as "severe negative spiritual consequences" is an odd euphemism. What earthly source confirms a severe negative spiritual consequence ? Better to describe the actual confirmable negative social consequences .This section also self contradicts stating " Circumcision is not required by Judaism for one to be considered Jewish" and also "over 90% of adherents having the procedure performed as a religious obligation."

Shunning of the uncut amongst other circumcision cultures, including the USA one also goes unmentioned.

This following contemporary material from the History of Circumcision article more properly belongs in this one :

http://news.bbc.co.uk/2/hi/africa/3069491.stm -death and damage from "botched" "bush" circumcisions

Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection. [50] A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns.[51] A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience."[52] A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons."[53] A 2005 study speculated that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.[54] In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".[53] In the United States, statistics (1999) collected by the National Center for Health Statistics show that the overall rate of neonatal circumcision had remained near 65% since data collection began in 1979.[55] However, strong regional differences in the circumcision rates have developed during this time. While more than 80% of newborn boys are circumcised in the Midwest and South, circumcision rates have declined to about 37% in the West in 1999.[56] This has been attributed in part to increasing births among Latin Americans, who usually do not circumcise.[57]

Circumcision in the 21st century

The AMA states that "virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice.".[50] Specifically, major medical societies in the USA,[58] Britain,[59] Canada,[60] Australia and New Zealand[3][dead link] do not recommend routine non-therapeutic infant circumcision. The AAP advises that "Physicians counseling families concerning this decision should assist the parents by explaining the potential benefits and risks and by ensuring that they understand that circumcision is an elective procedure."[58] Some have voiced ethical concerns about the procedure. See Bioethics of neonatal circumcision for more information. Neonatal circumcision nonetheless still remains the most common pediatric operation carried out in the U.S. today.

The South African Children's Act (No. 38 of 2005) has made the circumcision of male children unlawful except for medical or religious reasons.[61] For current circumcision rates, please see prevalence of circumcision. Studies indicate that male circumcision can reduce the chance of HIV infection in heterosexual men.[62] A criticism of encouraging the adoption of adult male circumcision in areas or populations heavily affected by HIV is that even in the best of studies the measure is merely reductive, not preventative, and may embolden the recipient of the operation to willfully undermine the demonstrably safe methods of serial monogamy and condom usage with new partners; for a more thorough look at the scientific research visit Circumcision and HIV. The AMA remarked that, in one study, physicians in "nearly half" of neonatal circumcisions "did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son. Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision."[50]

As of July 2011, eighteen American state Medicaid programs had discontinued payment for non-therapeutic circumcision.[63] On 7 May 2012 the Cologne, Germany Regional court (Köln Landgericht) ruled that parents could not grant consent for ritual (non-therapeutic) circumcision of children.[64]--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 10:27, 18 March 2013 (UTC)

Zad68, your argument from Google Scholar search results is not valid because it does not take into account the different publication practices in various fields. The fallacy is easily demonstrated by Google Scholar searches for other topics that are clearly not primarily medical topics, either (numbers in each case out of the first 10 hits):

• children: 4 medical/psychological articles.
• dogs: 9 medical/veterinary articles.
• sleep: All 10 articles of a medical nature.
• abortion: 5 medical articles, 1 on flowers, only 4 on ethics/policy/politics/sociology.
• drink: 8 medical/dietetic articles.
• report: 7 medical/psychology articles.
• study: 5 medical articles.
• are: 6 medical articles.

In the case of circumcision, the skewed numbers are absolutely predictable based on the following:

• Much lower scholarly standards and much higher pressure to publish in the medical and related sciences than in other scholarly fields. Also much more money for research.
• People in the third world who practise circumcision with rusted knives don't write about it, and it's not very easy to study them.

(I didn't try to make this list complete.)

I don't know if "elective" counts as a medical indication, but it's certainly misleading to treat it as one in an encyclopedia for general use. The section does its best to detract from the fact that circumcision is normally inflicted for non-medical reasons by describing it in convoluted language and putting under the misleading sub-heading "routine or elective". Under "Indications and contraindications", routine circumcision is off-topic because "routine" is not a medical indication. The obvious purpose of mixing this up here is to avoid an honest sub-heading such as "Non-medical motivations" and contextualise "elective" as "elective as opposed to routine", where it should be "elective as opposed to medically indicated". Hans Adler 12:13, 18 March 2013 (UTC)

"Elective" (or other forms of the word) and its synonyms are what is used in the sources, so that's what's used in the article.

Sorry, I'm not seeing how these search results are a counterargument to my statements; if anything, they support them. For example, my impression is that abortion is a medical procedure that has a very strong social component, and the Google Scholar abortion search results bear that out. Your observation that not much is published about "circumcision with rusted knives" is not an argument to emphasize it more, per WP:DUE. If you don't think reviewing Google Scholar search results is a good way to do it, can you suggest a different way of reviewing the sources to ensure the article complies with WP:DUE?

In addition to it being forbidden by WP:TPG, I have found that it is almost never productive to discuss speculations about editors' motivations ("The section does its best to detract...", "The obvious purpose of mixing this up here is to avoid an honest sub-heading...") on an article Talk page so I will not be engaging you in a discussion on that here, and request that you do not either, please. Zad68 13:00, 18 March 2013 (UTC)

I have carefully read the WP:TPG page referenced directly above. It does not include the word "forbidden" nor the idea. There exists a danger in too readily citing policy pages hoping they contain the exhortations one might wish for without checking that they actually do. That particular policy page DOES contain an exhortation to discuss edits however. An editor who comments on patterns of editing, reverting, mis-labelling or material selection which lead to an article being unbalanced, is not attacking any other editor nor commenting on personality. An editor who characterizes such discussion as contrary to policy might however be seen as attempting to intimidate, or to stifle exploration of ways to improve the article.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 14:00, 18 March 2013 (UTC)

You are welcome to report me to an appropriate noticeboard if you think it's appropriate or helpful. I certainly disagree with your opinion that you can censor my vivid descriptions of how the article is formulated and the effects it has on readers, and force me to use boring, impersonal, rhetorically weak language – just because someone (I have no idea who or even how many) has written it.

To be clear: I am not claiming that anyone, let alone anyone in particular, has done this on purpose. The problem could also be caused innocently by self-selection in connection with cultural and professional bias. In which case my accusation of what the article wants to do can be read as a wider one against status-quo-stabilising effects in the circumcising culture(s) which has/have ultimately written this article. I am being so explicit now, once, because you have prompted it with your overreaction.

I am not going to change my approach unless forced. This article is seriously biased. Any attempts to censor accurate descriptions of details of the problem are totally inappropriate, and I will resist them. Hans Adler 14:29, 18 March 2013 (UTC)

PS: Perhaps I should explain why I am still not actually working on the article, just complaining. The reason is that it's incredibly frustrating to source anything here, especially to the impeccable standard required for improvements due to the hostile atmosphere. The main problem is that sources of the kind that have so far been used primarily are generally not available free on the internet (especially from Europe; Google Books is more generous in the US), are very expensive, and are not readily available to me from my university library. Hans Adler 14:44, 18 March 2013 (UTC)

Hans, I had an independent editor, SandyGeorgia (talk · contribs), review the article and she had some very positive things to say about the high standard of the article's sourcing here. I'm sure we can all agree that meeting a standard of high-quality sourcing can only help an article. Zad68 18:50, 18 March 2013 (UTC)

European comment on AAP's 2012 policy statement

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

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

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

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

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

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

sorrels et all

"Circumcision ablates the most sensitive parts of the penis.".

Very simple. No secondary source in the article (or elsewhere) appears to contradict this. It would be original research to construe the tangentially related generalization in the listed secondary sources to somehow contradict this primary source. Furthermore, not everything suitable for mention in wikipedia can necessarily be found in a secondary source.Zebulin (talk) 15:32, 18 March 2013 (UTC)

Secondary sources are required for medical content. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:38, 18 March 2013 (UTC)

The AAP 2012 Technical Report is a secondary source that explicitly lists and comments on Sorrells, along with many other primary studies, in coming to its conclusion "The literature review does not support the belief that male circumcision adversely affects penile sexual function or sensitivity, or sexual satisfaction, regardless of how these factors are defined." We have several other secondary sources that do the same. Sensitivity is something we have good-quality, up-to-date secondary sources covering, so there's no need to include individual primary studies like Sorrells or others. Zad68 15:48, 18 March 2013 (UTC)

For the purposes of improving the article, how are good quality secondary sources distinguished from poor quality secondary sources? (a link to a relevant wikipedia policy page would be welcome as a response as well). <edit> nevermind. The archives for this article direct me to http://en.wikipedia.org/wiki/Wikipedia:MEDRS enough to get the hint. Zebulin (talk) 15:58, 18 March 2013 (UTC)

Even that AAP Report still mentions "There is fair evidence from a cross-sectional study of Korean men of decreased masturbatory pleasure after adult circumcision." -- 188.194.186.113 (talk) 16:08, 18 March 2013 (UTC)

(ec) You can't contradict a primary source with a secondary source that discusses a slightly different question. It is consistent that cutting off the most sensitive tissue of the penis would not adversely affect "penile sexual function or sensitivity, or sexual satisfaction, regardless of how these factors are defined". However, there are methodical problems that have less to do with how these factors are determined and more with what is determined in whom. E.g., the type of sexual feelings in the subject, the partner(s) or both could be changed without necessarily affecting overall satisfaction. ("Wow, it's different now and still quite good! How nice to have a change!") Or the increased satisfaction of subjects whose premature ejaculation problem was solved or who switched to anal sex, which they found too painful previously, could statistically compensate serious and problematic loss of sensitivity in the same number of other subjects.

The two studies cited by the AAP as supporting no effects or positive effects were made in Africa (Uganda and Kenya – two countries with high rates of FGM, a fact that may or may not be relevant), and while I have no reason to doubt the AAP's characterisation of these as "the most rigorous in design" (after all, where else but in Africa can you find subjects who are prepared to undergo circumcision when there is no relevant cultural background, or to serve as the control group when there is?), I also see no reason to trust the details of execution of these studies, as it must be hard if not impossible to prevent bragging by analphabetic subjects interrogated by nurses. Hans Adler 17:09, 18 March 2013 (UTC)

There is fair evidence that men circumcised as adults demonstrate a higher threshold for light touch sensitivity with a static monofilament compared with uncircumcised men; these findings failed to attain statistical significance for most locations on the penis, however, and it is unclear that sensitivity to static monofilament (as opposed to dynamic stimulus) has any relevance to sexual satisfaction.132 There is fair evidence from a cross-sectional study of Korean men of decreased masturbatory pleasure after adult circumcision.

- we also see that the authors of the aap policy statement are not denying that circumcision ablates the most sensitive areas of the penis but in fact are limiting comparison to those areas examined by Sorrels et all that are not excised by circumcision and can be directly compared between the two groups. They are obviously not comparing the most sensitive areas of the the two groups or indeed examining any of the data collected from areas of the penis ablated by circumcision and this is clear from the wording in the statement.Zebulin (talk) 16:19, 18 March 2013 (UTC)

- Here are some useful quotes from WP policy and articles on secondary sources

"many sources can be considered either primary or secondary, depending on the context in which they are used. Moreover, the distinction between primary and secondary sources is subjective and contextual, so that precise definitions are difficult to make.

legal writers usually prefer to cite primary sources because only primary sources are authoritative and precedential, while secondary sources are only persuasive at best.

examples of secondary source materials include a summary of the literature in the Introduction of a scientific paper published in a journal, a description of what is known about a disease or treatment in a chapter in a reference book, or a synthesis written to review available literature.

primary sources avoid the problem inherent in secondary sources, where each new author may distort and put their own spin on the findings of prior cited authors."

As Circumcision is a bio-psycho-socio-legal cultural phenomenon sometimes executed in a medical setting or for a medical reason but often not, the standards often mentioned here for exclusively medical articles do not apply to it. On this particular point there are many historical. religious, and social secondary sources which record and discuss the acknowledged recognition of circumcision's diminishing effect on sexual pleasure for the male through the ages, and for some cultures, most notably Jewish culture it has been a primary purpose of male circumcision. Some posit a similar reduction in pleasure for the female from MC . or in masturbation, both for mostly hydraulic and mechanical reasons. The history of circumcision article is particularly good for these secondary sources.http://en.wikipedia.org/wiki/History_of_male_circumcision So far there has been great resistance to the idea of including these sources in the English language "main" MC WP page.--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 16:49, 18 March 2013 (UTC)

Actually, for claiming that circumcision as practised today objectively does or does not have a certain measurable effect, we clearly do need WP:MEDRS quality sources. On the other hand, for claiming that 100 years ago physicians practised circumcision in order to prevent masturbation, this standard is obviously totally irrelevant and inappropriate. Many things that are or should be mentioned are somewhere in the continuum between these two poles. Hans Adler 17:18, 18 March 2013 (UTC)

furthermore from

Further information: Wikipedia:Secondary does not mean independent

:

"Secondary" is not, and should not be, a bit of jargon used by Wikipedians to mean "good" or "reliable" or "usable". Secondary does not mean that the source is independent, authoritative, high-quality, accurate, fact-checked, expert-approved, subject to editorial control, or published by a reputable publisher. Secondary sources can be unreliable, biased, self-serving and self-published.

According to our content guideline on identifying reliable sources, a reliable source has the following characteristics:

* It has a reputation for fact-checking and accuracy.

* It is published by a reputable publishing house, rather than by the author(s).

* It is "appropriate for the material in question", i.e., the source is directly about the subject, rather than mentioning something unrelated in passing.

* It is a third-party or independent source, with no significant financial or other conflict of interest.

* It has a professional structure in place for deciding whether to publish something, such as editorial oversight or peer review processes.

the aap and other professional organization secondary sources listed in the article are all self published and not subject to third party review. Therefore, they should, in fact, be regarded as less suitable for the article by wikipedia policies. There is nothing about a professional organization that discourages it from making extremely biased or even willfully inaccurate publications to serve it's own stated agendas.Zebulin (talk) 18:10, 18 March 2013 (UTC)

There is a danger in attempting to over medicalise many aspects of human experience. It is unlikely that medical science or any other hard science will provide an objective measure of comparative pleasure despite Sorrell and the like proving diminished penile sensitivity post-chop. We rely, in its absence, on the wisdom I have already cited. A western medical circumcision in a hospital removes at least 20,000 nerve endings (an FGM only removes 8,000); a tribal one can remove many more and leave more troublesome scarring, that is if the victim survives. No study in the areas of Africa where MC is being pushed as a help to quell HIV has taken the scarrings and subsequent increased openness to infection in such circumcisions into account. The cases counted as having avoided HIV through circumcision had a six week rest from sex activiity post chop and were given sex ed and condoms while the control group had no such break from sex --— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 18:19, 18 March 2013 (UTC)

Luckily we don't have to worry about doing our own analysis here; in fact, we are instructed not to. Instead, we rely on reliable secondary sources to do that for us, and we simply cite the sources. Zad68 18:46, 18 March 2013 (UTC)

Unfortunately creating articles is not that simple - we select from amongst a wide variety of sources -primary, secondary and tertiary and from within those sources selected we choose to give prominence to some material and to minimize or ignore others (such as the deaths of circumcision victims in South Africa that the WHO thought notable but we do not) Cabals arise and articles suffer.--— 

⦿⨦⨀Tumadoireacht ^Talk/_Stalk 19:17, 18 March 2013 (UTC)

given that the AAP policy statement is self published with no 3rd party review how is that an acceptable secondary source?Zebulin (talk) 20:12, 18 March 2013 (UTC)

Earlier in this very thread you mentioned that you had found WP:MEDRS; didn't you see where that document says "Ideal sources for biomedical material include... medical guidelines and position statements from nationally or internationally recognised expert bodies"? Zad68 20:30, 18 March 2013 (UTC)

exactly what I am criticizing here. how are these bodies recognized?Zebulin (talk) 21:39, 18 March 2013 (UTC)

Let's not forget that the AAP is not a reliable source. It is not reliable due to conflict of interest. It is a professional organization that profits (as well as its member constituents) from promoting circumcision. But as I've mentioned before, Wikipedia doesn't seem all that interested in following COI guidelines. Crimsoncorvid (talk) 22:09, 18 March 2013 (UTC)

The AAP's technical reports are absolutely considered reliable on Wikipedia. There is a secondary source in the article we can use to identify major medical organizations, and then we can look at the methodology used to identify and evaluate the evidence. Zad68 22:39, 18 March 2013 (UTC)

The AAP contradicts other professional organisations of similar standing. They are of course all reliable sources, but due to the political conflict they all fall under WP:RS#Biased or opinionated sources and must be treated with particular care. The AAP's opinion doesn't trump the others just because it's the only American one and Wikipedia's servers are located in the US. Wikipedia is a world-wide project. Hans Adler 23:20, 18 March 2013 (UTC)

Exactly! Zad68, please explain why the AAP carries more weight than the opinions of at least half a dozen medical organizations of similar standing? Why are American organizations more "reliable"? Why isn't it equal to the Dutch medical organization? Crimsoncorvid (talk) 23:33, 18 March 2013 (UTC)

A NEW STUDY

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

New studies show that circumcision reduces penile sensitivity.

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

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