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Miscellaneous comments

I've made a number of small edits to the article. Here are some other possible changes for discussion:

Arbitrary subsection 1

• Article size: When editing the page, a note at the top says, "This page is 140 kilobytes long. It may be appropriate to split this article into smaller, more specific articles. See Misplaced Pages:Article size."
• In the procedures section it says "The device is then placed (this sometimes requires a dorsal slit) and remains there until bleeding has stopped." I think "bleeding has stopped" is the wrong phrase. In the source it says "hemostasis". I think in this context it means that blood flow to the tissue has stopped. I suggest changing it to "until blood flow has stopped"; or if we're not sure what it means, then changing it to "hemostasis" as in the source.
• I suggest deleting this part from the "cultures and religion" section, since it's material more relevant in the "prevalence" section: "Circumcision is most prevalent in the Muslim world, parts of South East Asia, Africa, the United States, The Philippines, Israel, and South Korea. It is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania."
• This doesn't sound NPOV to me: "While endorsing circumcision for males, scholars note that it is not a requirement for converting to Islam": all scholars endorse circumcision? Should it say "Islamic scholars" or something? ☺Coppertwig(talk) 00:32, 2 November 2008 (UTC)

  I'm changing it to "blood flow has stopped", and I'm also removing the link to hemostasis. I think hemostasis here means "the stoppage of the circulation of blood in a part of the body", definition 2 here, whereas the hemostasis page deals only with definition 1.

  Prevalence: I'm moving this to the prevalence section (after the 2nd sentence); but it seems unsourced, may be redundant with information already in the prevalence section and should perhaps be deleted.

  I'm inserting "Islamic". ☺Coppertwig(talk) 15:33, 6 December 2008 (UTC)

Arbitrary subsection 2

• Re "Obstetricians used anaesthesia significantly less often (25%)": I skimmed the study and found the 25% figure mentioned twice, but I didn't find it saying anywhere that this result was statistically significant. Is anyone else more familiar with this study able to pinpoint where it says that? Otherwise perhaps we need to change the wording. I suspect it may be wrong, because it's wrong in another way: it was 25% of obstetricians who responded to the survey, not 25% of obstetricians (in the whole world) as the article seemed to say (I'm just changing it).
• Re "A 2006 follow-up study revealed that the percentage of programs that taught circumcision and also taught administration of topical or local anesthetic had increased to 97%." Is this really what the source says, or does it say that of those that taught circumcision, 97% also taught anesthetic?
• Pain section: Isn't there a source somewhere stating that in addition to pain relief during the operation, pain relief during healing over the following few days should also be used? If so, that should be added; if the opinions that it's relatively painless are included then the opinions of pain-relief advocates should also be included. The section heading might need to be changed to just "Pain and pain relief" rather than "Pain and pain relief during circumcision". If changing a section heading, it's a good idea to insert <span id="Pain and pain relief during circumcision" />
• "a causal relationship between lack of circumcision and HIV," I suggest changing to "a causal relationship between circumcision and reduced rate of HIV acquisition"; it sounds more logical and NPOV to me It's harder to visualize how a non-act can cause something, and "lack of circumcision" makes it sound as if circumcision is the norm.☺Coppertwig(talk) 00:32, 2 November 2008 (UTC)

  Re Obstetricians: I'm deleting "significantly."

  Pain relief and 2006 followup study still need to be addressed.☺Coppertwig(talk) 15:33, 6 December 2008 (UTC)

Arbitrary subsection 3

• Millet et al study says among other things: " Male circumcision had a protective association with HIV in studies of MSM conducted before the introduction of highly active antiretroviral therapy (odds ratio, 0.47; 95% confidence interval, 0.32-0.69; k = 3)." Our article citing it: "A meta-analysis of data from fifteen observational studies of men who have sex with men found insufficient evidence of a protective effect of circumcision; the authors recommended further investigation." doesn't seem an accurate summary to me. How about "A meta-analysis of data from fifteen observational studies of men who have sex with men found insufficient evidence of a protective effect of circumcision in the pooled data, but indications of a protective effect from data before the introduction of highly active anti-retroviral therapy; the authors recommended further investigation."
• I suggest shortening the HPV section. I'm not aware of any reason to give it that much weight in comparison to HIV and other infections.
• "In a cross-sectional study of 398 patients, Fakjian et al. reported that balanitis was diagnosed in 12.5% of uncircumcised men and 2.3% of circumcised men." I'm not sure if I have easy access to this study. Is the study claiming that 12.5% of the men who were not circumcised among the 398 patients they studied had a diagnosis of balanitis, or are they claiming that 12.5% of the general population of men who are not circumcised have diagnoses of balanitis? (worldwide?) The way it's stated in the article sounds like the latter to me, but the number of significant digits is unbelievable in that case, so I suspect the study means the former, in which case we need to reword it, perhaps by inserting "the" before "uncircumcised" and again before "circumcised".
• The first mention of urinary tract infections is in the Complications from circumcision section, and seems to imply that circumcision may lead to a higher rate of UTIs. Several sections later is the Urinary tract infections section, which seems to imply strongly that circumcision lowers the rate of UTIs. Perhaps these two sections could be moved closer together, or the sections could each mention the other ("see also"), or something else done to help resolve this apparent discrepancy. ☺Coppertwig(talk) 00:32, 2 November 2008 (UTC)

Good points, Coppertwig. I agree with your proposals regarding Millett and Fakjian.

Regarding HPV, I would certainly agree with shortening the material. I don't think it's necessary to directly discuss the HPV primary sources in this article, given that we already discuss two meta-analyses (Van Howe & Castellsague). We could probably just include these. As you mention in another subsection, the size of the article is becoming slightly problematic, and trimming the material would help in this respect. It might be a good idea to examine what other parts of the article can be simplified, too.

I think that the UTI material is potentially confusing, but the underlying problem is that the entire paragraph beginning "Meatal stenosis (a narrowing of the urethral opening)..." is too long and detailed. The final sentence (which mentions UTIs) is about conditions potentially caused by meatal stenosis, which seems an absurd amount of detail since that isn't the subject of this article. I don't think we go into this much detail about any other proposed risk or benefit. It would make sense to remove this paragraph and instead add the words "meatal stenosis" to the paragraph beginning, "Other complications include..." Jakew (talk) 16:10, 2 November 2008 (UTC)

Arbitrary subsection 4

• "Two studies have reported that the rate of penile cancer is 3 to 22 times higher in men who were not circumcised." This seems to imply "higher than the rates mentioned in the previous sentence", which is probably not what is meant.
• "Neonatal circumcision is not considered medically necessary and is therefore categorised as non-therapeutic." Really? In all cases? Hard to believe. Citation needed.
• US policy: As I think Jakew may have pointed out, the last sentence of the 1st paragraph and the 1st sentence of the 2nd paragraph are mutually redundant.
• AMA: I suggest replacing "The American Medical Association does not recommend non-therapeutic circumcision and supports the AAP's 1999 circumcision policy statement." with "The American Medical Association supports the AAP's 1999 circumcision policy statement, which states that while there is evidence for potential benefits, "data are not sufficient to recommend routine neonatal circumcision.""☺Coppertwig(talk) 00:32, 2 November 2008 (UTC)

Re the penile cancer statement, it does need rephrasing. Another problem is that, as written, it implies that exactly two studies have investigated the issue (in fact, several have done so; see medical analysis of circumcision for citations). I would suggest something like "Researchers have reported that the risk of penile cancer is greater in uncircumcised men than in circumcised men; estimates of the relative risk include 3 and 22."

Re the unsourced "Neonatal circumcision..." sentence, the entire paragraph is somewhat problematic. Consider the previous sentence, which is also unsourced: "Most guidelines make a distinction between therapeutic and non-therapeutic circumcision." Do they? I think we should consider deleting this paragraph, replacing it with some kind of sourced overview. One possibility - while not ideal - is to use the AMA's statement: "Recent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns."

Re the US policies section, specifically that of the AMA, I would note that this material has been changed slightly. However, since we've described the policy of the AAP in the previous paragraph, it seems rather unnecessary to restate it. Wouldn't it make more sense to simply state that the AMA supports the AAP's statement? It seems to me that we could expand discussion of the AAP in the first paragraph, and still use fewer words overall. Jakew (talk) 16:46, 2 November 2008 (UTC)

Yes and no Jake. On one hand we could remove the first part of the sentence "The American Medical Association does not recommend non-therapeutic circumcision and supports the AAP's 1999 circumcision policy statement." and leave the AMA's support of the AAP statement, but in this case redundancy strengthens the statement's position because another major is supporting it. The reader may only be interested in one particular organizations stance and not forced to read others for conclusion. Garycompugeek (talk) 17:20, 2 November 2008 (UTC)

Coppertwig, what is the rationale behind your suggestion? It seems that it needlessly makes the sentence longer, and only by repeating information already presented. It also makes it sound like the AAP only believes there are benefits, just not enough of them to recommend it; when the phrase they use elsewhere in their conclusion is "there are potential benefits and risks," seemingly indicating that a weighing of such benefits and risks had them arrive at their finding that the data on its benefits is insufficient to recommend it. Blackworm (talk) 22:36, 3 December 2008 (UTC)

I'm trying to make it more accurate. "The American Medical Association does not recommend non-therapeutic circumcision" sounds as if it could be interpreted to mean they recommend against it. I don't think they say anything along the lines of "We do not recommend non-therapeutic circumcision". Making a statement about what is missing from a source seems to me to be OR. Can you think of other suggested wordings? ☺Coppertwig(talk) 23:21, 3 December 2008 (UTC)

The source is crystal clear Coppertwig. They do not recommend non-therapeutic circumcision and supports the AAP's 1999 circumcision policy statement which does not recommend circumcision. Garycompugeek (talk) 23:33, 3 December 2008 (UTC)

It seems to me that it follows that if they state (or agree) that the data are insufficient to recommend circumcision, then they do not recommend male circumcision. The problem I think you're talking about is how "not recommending" is often (but not always) used to mean "recommend against" -- however we do not know which meaning the AAP/AMA intend here (hypothetically it's possible that they do in fact recommend against it, but are intentionally or unintentionally unclear on that, for example). Thus, due to this lack of clarity in meaning, it is best to summarize their statement with minimal editorializing. How about: "The American Medical Association agree with the AAP that data are insufficient to recommend non-therapeutic circumcision." That seems to be very close to the source, short, and leaves open whether they are neutral to the procedure or (perhaps secretly or vaguely) recommend against it. Blackworm (talk) 06:30, 4 December 2008 (UTC)

I agree with Coppertwig. Saying "does not recommend non-therapeutic circumcision" is apparently OR, and without the context provided in the original document it may potentially mislead. Their actual policy statement is somewhat more complex and subtle than that. The AMA themselves express it by reference to the AAP's policy ("The AMA supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics..."). Once again, it seems that the sensible approach is to simply state that the AMA supports the AAP's policy statement, which is after all discussed in the preceding paragraph. Certainly the current explanation of the AAP's policy is inadequate, and suffers from the same problems that Coppertwig highlighted, but to my mind it seems that the solution is to solve this problem once, in the appropriate place, not to try to express what is largely the same information twice, in two consecutive paragraphs. Jakew (talk) 10:36, 4 December 2008 (UTC)

Let's quote their actual policy statement then, as I suggest. How about replacing the AAP and AMA paragraphs with:

The American Academy of Pediatrics (1999) stated: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child." The AAP recommends that if parents choose to circumcise, analgesia should be used to reduce pain associated with circumcision. It states that circumcision should only be performed on newborns who are stable and healthy.

The American Medical Association supports the AAP's 1999 circumcision policy statement with regard to non-therapeutic circumcision, which they define as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. They state that "policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns."

Blackworm (talk) 18:44, 4 December 2008 (UTC)

Sure that is accurate (can't get more accurate than quoting the source) Blackworm, but for simplification, I think people typically only want to know if X medical association recommends circumcision or not. Garycompugeek (talk) 20:53, 4 December 2008 (UTC)

It may be too long and put undue weight on U.S. organizations. Other than that, at the moment I don't see any problem with it. No strong objection. ☺Coppertwig(talk) 02:05, 5 December 2008 (UTC)

Likewise, I think it's ok, and I've implemented the change. Jakew (talk) 12:08, 5 December 2008 (UTC)

(sigh) I'm still not convinced it was necessary (considering article size and above arguments) but I have no strong objection to quoting the source directly. Garycompugeek (talk) 14:12, 5 December 2008 (UTC)

Re penile cancer: I used Jakew's wording, adjusted slightly to reflect the categories of circumcision status described in the sources.☺Coppertwig(talk) 15:33, 6 December 2008 (UTC)

Arbitrary subsection 5

• "The medical harms or benefits of non-therapeutic circumcision have not been unequivocally proven": this statement seems non-NPOV to me, as well as not being supported by the given source, and, as Jakew pointed out, is not about U.S. policy. In addition, it's a news source; these tend not to be very reliable for medical information.
• I'm just noting this here for future reference: "The 1989 statement by the Academy reversed a long-standing opinion that medical indications for routine circumcision were lacking." from the AMA "Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision".
• The link to the American Urological Association website for document "Circumcision" doesn't work; I looked at their site map and got the impression they no longer have such a page.
• "Circumcision in the English-speaking world": why do we have such a section? Is this undue weight? Within the section, is too much weight given to U.S. information? I suggest shortening this section; the detailed information can be provided in a subpage (presumably History of male circumcision). Some of the material in this section might be more appropriate in the Prevalence of circumcision section.
• "Map published by the United Nations": Is this the same map as the one published by the United Nations, or has it been redrawn by Emilfaro? Who owns the copyright?

☺Coppertwig(talk) 00:32, 2 November 2008 (UTC)

I've fixed the link for the AUA's policy. It seems that they've reorganised their site recently: previously there was a page containing a number of policies (possibly all of their policies), whereas now they seem to have a page per policy.

Re the English-speaking world, the coverage certainly seems rather Anglo-centric. I'm not sure whether this is undue weight; it may simply reflect the coverage in available sources. I think there's a certain amount of overlap between the 'prevalence' and 'history' sections, especially with older prevalence data. It does seem as though too much weight is given to US info, and I would be in favour of shortening the material.

Re the map, the description is inaccurate. This isn't the same map, and describing it as such is misleading. It's also unnecessary to cite the sources used by the source we cite (and doing so misses the point of secondary sources, I think). I would suggest rephrasing to something like: "Map showing percentage of males who have been circumcised at country level. Based upon United Nations (WHO/UNAIDS) publication." Jakew (talk) 17:20, 2 November 2008 (UTC)

Thanks for all your comments, and for fixing that link, Jake.

Re "The medical harms and benefits": this sentence is no longer there, so that's fine.☺Coppertwig(talk) 15:33, 6 December 2008 (UTC)

Ethical Issues Image

Has anyone ever taken a close look at the image in the ethical issues section of the artical? Its not even a real protest. Its poster pasted in front of a man on the street.

It's not like it is a big deal, but I think it needs to be acctual protesters. NOT a fake picture. Azcolvin429 (talk) 12:46, 26 November 2008 (UTC) (This comment was deleted by Azcolvin429 on 07:45, 6 December 2008)

What leads you to believe the picture is fake? Blackworm (talk) 22:41, 26 November 2008 (UTC)

If you look close, the posters have been cut and pasted from something else. No one is even holding the poster, and you can see the holes where it would be tacked up on a wall. Its not like its that important, but the picture IS indeed "fake". Azcolvin429 (talk) 11:03, 27 November 2008 (UTC) (Deleted by Azcolvin429 07:45, 6 December 2008)

It seems one poster is leaning on something, and the other is being held by the man. The left poster is casting a shadow on the ground. Sorry but I remain unconvinced that the photo is fake. Blackworm (talk) 19:01, 27 November 2008 (UTC)

I see no evidence that the photo is fake. The man seems to be holding the poster on the right. The posters have bits of string or something protruding from the holes in the corners, and the bottom edges of the poster on the right are bent, apparently because the string is pulling on the poster to hold up its weight. The man is apparently holding whatever is attached to the corners of the poster. ☺Coppertwig(talk) 00:07, 28 November 2008 (UTC)

Ok, whatever. Im a digital photo editor, and I can tell the difference between real and fake. And it is fake. But who cares, it dosent matter. Azcolvin429 (talk) 07:54, 29 November 2008 (UTC) (Deleted by Azcolvin429 07:45, 6 December 2008)

Feel free to remove fake protest image and replace with a real protest image... Garycompugeek (talk) 20:05, 1 December 2008 (UTC)

What is it about the photo that tells you it's fake? ☺Coppertwig(talk) 01:06, 2 December 2008 (UTC)

I oppose (and reverted) this edit. At least two editors seem unconvinced that the image is a fake. Editors may also wish to view this image, this image, and this image, which seem to indicate that the photo is authentic. Blackworm (talk) 19:18, 3 December 2008 (UTC)

By the way, this discussion is about this image. The man looks like the same person as the one in the first of three links given by Blackworm. ☺Coppertwig(talk) 18:22, 6 December 2008 (UTC)

I can verify that photo is authentic and so are its attributes. What you can't see is that there is a fiberglass rod framework on the back. The four rods go through the grommet holes and the tension on the rods, whose other end is attached to a central handle, pull the poster taut. (98.212.221.72 (talk) 19:38, 10 December 2008 (UTC))

Ah, I thought it was something like that. ☺Coppertwig(talk) 01:41, 12 December 2008 (UTC)

Recent edits to intact penis caption

I oppose this edit. The caption is an inappropriate place for the information, which besides seeming a bit glowing and unencyclopedic (one might even say "brochure-like," potentially violating Misplaced Pages's neutral point of view policy), is uncited. Also, the reasons given by the IP editor for the multiple reversions seem somewhat contradictory: can it be true both that "it is a common misconception that a circumcised penis and an uncircumcised penis are exactly the same when erect" and that "What is stated is common knowledge to the vast majority of the world's men and women?" In any case, if both those statements are each true to an extent, then surely reliable sources may be found that put any misconceptions to rest. Blackworm (talk) 07:41, 27 November 2008 (UTC)

I agree with Blackworm. See Misplaced Pages's verifiability policy. I note the above comment as a sign of neutrality on Blackworm's part. ☺Coppertwig(talk) 14:17, 27 November 2008 (UTC)

Pointing out the neutrality on an editor's part in a thread unrelated to that editor's neutrality seems to actually cast doubt on the editor's reputation for neutrality. I'd rather you not do that. Thanks. Blackworm (talk) 19:07, 27 November 2008 (UTC)

You're right. I apologize. Would you like me to delete that part of my comment? Or you may delete it, and optionally this comment can be deleted at the same time. ☺Coppertwig(talk) 23:46, 27 November 2008 (UTC)

List of organisations which either advocate or oppose circumcision in the introduction

I see the list of organisations which advocate circumcision in the introduction has three different organisations listed whereas the list of organisations which oppose circumcision has just one listed. What happened to keeping the intro neutral??? Usergreatpower (talk) 14:27, 5 December 2008 (UTC)

The AMA blanket statement is considered a better source than listing multiple agencies in the lead. Please gain consensus here before edit warring a lead change on this heavily watched article. I agree with Jake and reverted your other edits as unsourced or unnecessary but left the masterbation addition with source from kellog. Garycompugeek (talk) 15:14, 5 December 2008 (UTC)

Re this edit with edit summary "Undoing an unjustifed mass revert like it was vandalism or something": I don't think Jakew had any intention of implying that your edits were vandalism, Usergreatpower. On an article such as this one, good faith edits are frequently reverted, even if they have some good parts. This article is on a controversial topic, is frequently edited and frequently viewed, and has a template at the top of this talk page saying "Please discuss substantial changes here before making them". This article is highly polished and huge amounts of discussion have gone into writing some parts of it. Small edits such as fixing grammatical errors can often just be boldly done, but for more substantial changes it's preferable to discuss the new material on the talk page, iron out any problems and get consensus before putting it into the article. Jakew included a reasoning for the revert in his edit summary; I usually take that as an indication that the person doesn't consider the edit to be vandalism.

I agree with Garycompugeek: the current version quotes the AMA as saying "Virtually all current policy statements from specialty societies and medical organizations..." This is as much of an endorsement of such a position as listing the individual organizations would be, and I think it's preferable to present the information concisely like this when possible, especially in the lead. ☺Coppertwig(talk) 12:31, 6 December 2008 (UTC)

Re this edit by Usergreatpower:

It says that certain organizations "do not recommend" routine infant circumcision. As I stated above, this could be interpreted as meaning that they recommend against it. I don't think we should say this unless those organizations say something like "We do not recommend..." and I'm not sure the AAP has said that. I've just realized that that quote by the AMA can be taken as the AMA saying that; can we assume they mean the AAP as one of the organizations they're mentioning?

Also, as Jakew points out, this edit is redundant. It gives U.S.-centric information which is essentially already contained in the quote in the following sentence.

Jakew said in an earlier edit summary, "...several problems, including replacement of a secondary source with synthesis of multiple sources." I assume this might apply to this edit.

As I said above, the standard on controversial articles such as this is to discuss and agree on the wording on the talk page before implementing it. Reverting to the earlier consensus version is OK, but I would like to discourage repeated insertion of the same or different versions of new material.

As I stated above, it's more concise to have a single statement summarizing the fact that many organizations have a similar position. When we have the opportunity to be concise, I think that's better. As Jakew points out, it's also usually considered preferable in Misplaced Pages to use secondary rather than primary sources. ☺Coppertwig(talk) 13:53, 7 December 2008 (UTC)

(unindenting) Now there have been two more attempts to make similar edits. These edits have added the text "Many medical associations including the American Medical Association and American Academy of Pediatrics do not recommend routine male circumcision." to this paragraph.

The edit summaries are puzzling. The edit summary for the first edit reads: "Clarrified (1) AMA is not the only medical association opposing routine male circumcision. (2) These medical associations continue this point of view since 1999 to this day."

The first point is utterly perplexing, since the following sentence includes the quote: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision". I cannot imagine how anyone could read that and require this "clarification".

The second point is also puzzling, since both of the cited sources date from 1999. I would think it fairly obvious that a published source cannot tell us whether the opinion is held at a time after the publication date. Consequently the edit has no relationship whatsoever with this stated rationale.

But there are other problems. Firstly, the sentence is completely unnecessary. It is redundant. It contains no more information than the "Virtually all current policy statements". Secondly, it is at worst unsourced and at best original synthesis. This is painfully obvious from the sentence structure itself: it supplies examples: "including the American Medical Association and American Academy of Pediatrics", which are of course primary sources and then cites those examples as "sources". But of course they aren't sources for the central claim ("Many medical associations do not recommend routine male circumcision"), which is in fact unsourced. It could be sourced, and in fact it is sourced in the following sentence. Which of course brings us back to the fact that the added sentence is pointless and redundant, being little more than redundant synthesis.

After I reverted the first edit due to the redundancy and synthesis, it was again made. The edit summary read: "Their views are clearly stated in the sources". Perhaps so, but this suggests that the problem has been misunderstood. Nobody (to my knowledge) disputes the accuracy of the statement that the AMA and AAP do not recommend routine infant circumcision. But that doesn't mean that we have to waste words in the lead by saying so twice, when once is perfectly sufficient. Nor does it mean that we can relax Misplaced Pages's requirements for verifiability and avoidance of original research. Jakew (talk) 14:12, 7 December 2008 (UTC)

Fully agree. Blackworm (talk) 18:40, 7 December 2008 (UTC)

Archive guide, and FAQ

I'd like to set up two pages, Talk:Circumcision/Archive guide and Talk:Circumcision/FAQ. I'm thinking of working on the archive guide first. Discussion of this proposal is welcome. Both pages have the goal of saving time by reducing the need for repetitive discussion.

The archive guide, as I envision it, will be complementary to the archive index. It will have sections corresponding to the sections and subsections of the article, and within each of those, sub- sections corresponding to controversial issues about the article, each containing a list of links to the talk page archive discussions about those topics.

I see a need for the archive guide because I sometimes search the archive index for discussions and put links in active threads to past related discussions, but when the active thread is later archived I feel that that information has been lost and that I would have to search the archives again to find that list of links. I may not remember the section heading of the discussion, and not all of the section headings are very informative (sorry about the "miscellaneous comments one"; best I could do). The archive guide would be a permanent place to easily find such links.

The archive guide as I envision it won't contain discussion, but may have NPOV mnemonic titles beside the links to help people find things. It need not be complete: at least at first it might contain links to discussions only about the things we discuss most often.

The FAQ, as I envision it, will contain descriptions in essay format of various talk page discussions. It may say things like "Some editors believe that this part of the article should be arranged this way, because blah blah blah, while some other editors believe it should be arranged that way, because blah blah blah." In other words, it will be like NPOV except that instead of summarizing controversies about circumcision based on reliable sources, it will summarize controversies about what this article should contain, using the talk page discussions as sources. Collaboratively wiki-editing the FAQ may help us to understand each others' positions better.

Another possibility is to have one page combining both functions. In any case, discussion about editing the page(s) would take place on this talk page.

What do people think of these ideas? ☺Coppertwig(talk) 20:00, 6 December 2008 (UTC)

Problematic addition to 'history'

Problematic material has been added to the 'Circumcision in the English-speaking world' subsection of 'history of circumcision'.

For reference, the addition consists of the following:

• Circumcision advocates such as John Harvey Kellogg advocated circumcision as a method for preventing masturbation and in his Plain Facts for Old and Young (1888), he wrote:

There are several problems:

• Redundancy. The previous paragraph contains "In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation." If we make the (not unreasonable) assumption that the reader is capable of reading that paragraph, much of this addition seems pointless.
• Use of a primary source. The primary source (from 1888) is cited directly, rather than a secondary source. (For contrast, note that the previous paragraph cites ref 170 — Gollaher — which is a secondary source.
• Sensationalism. Let me be blunt. Advocating surgery without anaesthesia is shocking to the modern mind, and this quote is used on several dubious anti-circumcision websites, perhaps in the hope that less clear thinkers will associate that negative reaction with circumcision itself rather than Kellogg. The potential to shock isn't by itself a reason to include or exclude, but as an encyclopaedia with higher standards, we must be careful to avoid 'shock tactics' that make it difficult to achieve NPOV.
• Borderline original research. Little in the source itself indicates that Kellogg was writing about history. On what basis, then, do we include it under this heading? Presumably the rationale is of the form "well, it was published in the past and ... um ... it's about circumcision." The problem, of course, is that every source meets these criteria, and the number of sources mentioning circumcision that have ever been published is huge. Which ones made a difference? Was Kellogg very influential in this respect, or does the quote have value solely because it is shocking? This is a fundamental problem of use of a primary source: we need secondary sources to interpret primary sources and identify which ones were influential, illustrative, or otherwise important.
• Typographical splendour. A paragraph plus an indented quotation with those pretty bluish quotation marks? It's very attractive, but are Kellogg's words really so important that this quote should be unique in the article for receiving such treatment?
• Undue weight. Let's review the situation. Even though we've already discussed advocacy of circumcision to prevent masturbation, we discuss it a second time, giving the impression that this issue is vastly more important than others discussed in the previous paragraph. We use a specific primary source, giving the impression that this particular source is of vital importance to the history of circumcision. This particular primary source appears to have little benefit other than as a shock tactic. Finally, we dedicate a paragraph and a block quotation to the source, versus a single paragraph for every other issue. This seems an extraordinary amount of weight (for comparison, Gollaher dedicates only a handful of pages to the subject of masturbation in his 253-page Circumcision: a history of the world's most controversial surgery).

For these reasons, I'm removing this material. Jakew (talk) 10:46, 9 December 2008 (UTC)

Fully disagree with all points except Typographical splendour:

• Redundancy There is no redundancy, this information is not duplicated elsewhere, your assertion that it is "pointless" notwithstanding.
• Use of a primary source is not a problem, we use primary sources frequently elsewhere in the article.
• Sensationalism This objection is invalid, your assertions about "dubious anti-circumcision websites" and "less clear thinkers" standing as speculation and original research. Please note also the neutral point of view. For example, in my view, if we excluded "shock tactics" from this article, most of the World Health Organization and other circumcision advocacy material inciting fear of disease would also be excluded.
• Borderline original research. This objection is invalid, since it could easily apply to any material in the entire section, and any material in history of male circumcision. Clearly the material is historical and not current, and it is a grave misinterpretation of WP:OR policy to remove material summarized from a 120-year old source from a "history" section on the basis that the 120-year old source makes no reference to "history."
• Undue weight. The objection is invalid. We haven't "discussed" masturbation at all, we've merely listed it. This paragraph is important as it shows a historical public figure's published and openly expressed attitudes toward male circumcision. It is quoted in many websites indeed, as it seems many others feel it is quite notable (I agree).

As for the blue quotes, they are used in many other articles when quoting long passages, and I am neutral to them. However if you prefer to avoid them we can easily simply include the quote normally in the paragraph. Blackworm (talk) 17:54, 9 December 2008 (UTC)

Thank you for your comments, Blackworm.

I'm a little surprised, I have to say, that you argue that there is no redundancy. Would you not agree that there is a certain amount of repetition in the statements "Circumcision advocates such as John Harvey Kellogg advocated circumcision as a method for preventing masturbation " and "In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation."? I would suggest that these are essentially similar, both telling the reader that circumcision was proposed by some authors as a method of preventing/treating masturbation. The only major difference is that one includes, quotes, and generalises from a specific example, while the other cites a secondary source. (Another interesting difference is the curiously redundant choice of words in "circumcision advocates ... advocated circumcision", but I digress.)

I'd certainly agree that primary sources can be used, with caution. However, as a general rule, we should prefer secondary sources to primary sources. In this case, given that a secondary source is already cited in the article, what is gained by citing a primary source as well? Does it allow the reader to verify that some authors proposed circumcision to prevent masturbation? No, the ref already cited (Gollaher, ref 170) satisfies WP:V. So what does it add, then, that isn't already present? The impression one receives is that the notability and influence of the source is so well-established that it is unnecessary to cite a secondary source, much like quoting from the US Declaration of Independence. Yet this has not been established.

I'm not sure whether I expressed my concerns about sensationalism sufficiently clearly. My point is essentially that we must be careful to avoid "shock tactics" and other forms of propaganda, since they are incompatible with a neutral encyclopaedia. We can, in principle, include "shocking" material, but only if it has significant encyclopaedic value. One question worth considering is whether there is an argument for inclusion if it had no "shock value". Consider the following, for example:

• "In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation. For example, cites an influential 1888 work by Kellogg, arguing that circumcision was a remedy for masturbation that was "almost always successful" in young boys."

This edit, albeit hypothetical, would actually eliminate many (though not all) of the problems I mention. It would a) use a secondary source to establish historic influence, b) be more encyclopaedic in tone, c) reduces sensationalism and keeps the material focused on circumcision rather than on masturbation and the method of circumcision, and d) reduce the excessive weight. But it would seem difficult to make a strong argument for the second sentence in this article, as it adds little other than an example which seems unnecessary given the article's size.

I am, incidentally, curious about how you would expect WP:NPOV and WP:SOAP to be applied without editors thinking about how material is likely to affect the reader. It seems obvious to me that certain decisions about presentation of material, including recognising soapbox-ish material, require editorial judgement; I'm not sure that it's helpful to dismiss reasoning about such problems as original research.

I'm afraid that I don't quite follow your objection to "borderline original research". Much of the material in this section is problematic, as discussed (for different, but related reasons) in #Arbitrary subsection 5. However, the first paragraph largely draws from a Journal of Social History article by Gollaher — a secondary source. It isn't clear to me at what point a source becomes clearly "historical and not current", but even if it was clear I don't see what a primary source can tell us about the history of circumcision unless it was actually about that subject. For such interpretation of sources we need historians. Moreover, if we assume that material older than, say, 10 years is "historical" then the available sources must number in the thousands if not tens of thousands. Clearly we cannot possibly include every source, so we would need to choose the most important, influential, illustrative sources. How on earth can we identify these when the sources themselves aren't even about history? Again, we need secondary sources.

Regarding "undue weight", you seem to make a distinction between "discussion" and "listing" that isn't clear to me. The sentence I mention ("In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation") seems to be discussion to my mind; if you disagree I wonder if you could explain why. You say that the paragraph is important because it shows a "historical public figure's published and openly expressed attitudes toward male circumcision", but the problem is that this is true of any "historical" document. The question is, what's so valuable about this particular one? The fact that it is quoted on anti-circumcision websites is not by itself an indicator that the information is encyclopaedic, and as a general rule Misplaced Pages's coverage of material is not guided by lay websites. Glancing at two histories of circumcision (Gollaher and Dunsmuir and Gordon), I find it interesting that neither actually mention Kellogg, which makes it seem especially extraordinary to dedicate such a large fraction of space to that source here (if it were such a highly influential source, wouldn't one expect historians to at least mention it?).

Regarding the use of {{cquote}}, I think this is one of the more minor problems. However, I think it is perhaps illustrative of the soapboxy, undue-weight feel of the addition that this was the only quotation in the entire article that was given such rich typography. Jakew (talk) 23:32, 9 December 2008 (UTC)

Excellent points all round. I've removed it. Jayjg 03:18, 17 December 2008 (UTC)

Have a look at this: It is clear that Kellogg is mentioned in many scholarly articles on circumcision and its history. If you prefer, I will use one of these secondary sources to illustrate essentially the same point, that at least one prominent and influential person, at the time of routine male circumcision's rise in popularity in the West, openly stated that the pain induced by male circumcision was beneficial in a punitive and preventative capacity (that is, preventative of masturbation) -- exactly as frequently commented on by the scholarly sources. Blackworm (talk) 04:10, 10 December 2008 (UTC)

Hmm. 412 results for "circumcision kellogg" (or 358 for "history circumcision kellogg", versus 36,100 for "circumcision history". So, as a rough estimate, about 1% of papers discussing circumcision history also discuss Kellogg. I guess it depends on what can be found among those results. I couldn't see any articles that were obviously histories of circumcision in the first two pages, but maybe some can be found.

Yes, I would certainly prefer a secondary source, and would be interested to see what you can find. However, I think that editing would need to be careful in order to ensure appropriate weight. In this article, I think at most a short parenthetical addition to the existing masturbation sentence might be appropriate, but perhaps such material might be more suited to a detailed article. In any case, it seems premature to discuss this until candidate sources have been found. Jakew (talk) 10:28, 10 December 2008 (UTC)

I don't agree that your Google hit statistics indicate or even suggest that "about 1% of papers discussing circumcision history also discuss Kellogg." Since our views of appropriate weight differ, it's unclear how best to proceed. I'll suggest an addition soon regardless. Blackworm (talk) 15:53, 10 December 2008 (UTC)

I'd also like to point out that if "Advocating surgery without anaesthesia is shocking to the modern mind," then the practices of circumcising religions and other circumcision advocates worldwide would similarly be shocking to the modern mind -- as most circumcisions still take place, in 2008, with no anaesthetic, as I believe you may be aware. In that context I cannot explain your statement, "Advocating surgery without anaesthesia is shocking to the modern mind," since that applies to all circumcision advocacy I've encountered, which at its best merely "recommends" anaesthesia rather than firmly stating that it should not be performed without it. Blackworm (talk) 18:01, 9 December 2008 (UTC)

I was thinking the same thing about surgery without anesthesia. Per some of Jakew's arguments, I suggest deleting the J.M. Glass quote from the pain section.

For this section, most of the arguments on both sides seem to me to be balanced or not strongly convincing either way, except for Jakew's argument about history books. A good way to determine due weight in the history section, it seems to me, is to base it on books of the history of circumcision, and similar sources (e.g. chapters on history of circumcision in other books). ☺Coppertwig(talk) 01:54, 10 December 2008 (UTC)

Please discuss changes to the summarizing of Glass in a separate section (and give a clearer rationale). Blackworm (talk) 04:10, 10 December 2008 (UTC)

This seems notable to me which is why placed it back in the article after Jake's first revert, however I'm indifferent to the quotes used. I have said before that one sentence about circumcision being used to cure or curtail masturbation seems under weight. I grew up being taught that circumcision was done for religious reasons and to prevent masturbation. In the bible belt we were taught that enjoying sex is bad and masturbation and sexual pleasure was decadence. I feel this should be expounded on, properly sourced of course. Garycompugeek (talk) 17:02, 10 December 2008 (UTC)

Re Glass: never mind. Clearly Jakew meant that circumcision of non-infants without anesthesia is shocking to the modern mind. I might start a thread about the Glass quote at a later date.

Oh, so it's the same Kellogg as the breakfast cereal. ☺Coppertwig(talk) 01:41, 12 December 2008 (UTC)

Not a gender-exclusive topic

Isn't there such a thing as female circumcision? Why isn't it mentioned in the article? --IdLoveOne (talk) 19:43, 13 December 2008 (UTC)

Excellent question. We have been debating that subject and have been unable to form a consensus on why the article isn't called male circumcision since thats all it covers. Garycompugeek (talk) 20:22, 13 December 2008 (UTC)

TotallyDisputed tag

Template:Totallydisputed I have placed the disputed content tag on the Topic while we work out several factual omissions. Please see the below list of problems, which were generally created when relevant referenced facts were deleted from the Topic:

• Removed from the introduction:

The frenulum may be cut at the same time, in a procedure called a frenectomy

• Removed from Procedures:

The frenulum is cut frenectomy if frenular chordee is evident.

• Fact removed from Complications:

Chordee of the glans may be the result of circumcision.

• Facts removed from (or barely mentioned in) Complications:

“Meatal stenosis is a relatively common acquired condition occurring in 9-10% of males who are circumcised. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy is curative.”

“Meatal stenosis is generally a direct consequence of circumcision that is seldom encountered in uncircumcised men; meatal calibre is know to be greater in uncircumcised individuals. The incidence of meatal ulceration following circumcision is from 8 to 20 per cent14,46,64. The aetiology is thought to be irritation of the external urethral meatus by ammoniacal substances present in wet sodden nappies. Such irritation is unlikely in the presence of a normal prepuce, which serves to protect the glans from these irritant substances46. In a prospective study of 140 consecutive neonatal circumcisions, Mackenzie64 found a 20 per cent incidence of meatal ulceration within the first 2-3 weeks after circumcision. It is thought that meatal ulceration after circumcision is the initiating event in a vicious cycle of stenosis and ulceration, followed by more stenosis64. Meatal stenosis following circumcision has been advanced as a cause of recurrent pyelonephitis and obstructive uropathy, for which meatotomy is curative64,65.”

“Meatal stenosis is an under recognised complication of circumcision done in neonatal and nappy aged boys. Symptomatic presentation from meatal stenosis can be very late (two years).”

“Traumatic meatitis of the unprotected post-circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis. CONCLUSION: Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.”

• Gross propaganda:

The Circumcision topic in Wiki leads the reader to believe that the covenant made with Abraham (note the “commandment from God” sentence in the second paragraph) was the current radical practice (in that it removed the covering of the glans). In fact, we find "the circumcision which Abraham performed on himself and other male members of his household was the removal of the tip of the prepuce.” This tip of the prepuce removal circumcision was practiced by Jews and Muslims for thousands of years. This simple (Milah) procedure resulted in much less pain and erogenous nerve loss than the current Bris and Sunnet practices.

• Removed from complications, and UTI:

"An epidemiological study of UTI during the first year of life involving 169 children born in Israel found that 48% (27/56) of the male infants presented with UTI within 12 days after ritual circumcision.51 The incidence of UTI among male infants was significantly higher just after circumcision (from 9 to 20 days of life) than during the rest of the first month of life and significantly higher in the first month of life than during the rest of the year. After the immediate postcircumcision period, the incidence rate of UTI dropped to a level comparable to that reported among circumcised male infants in the United States."

• Removed from Pain:

Without exception, newborns in this study who did not receive an anesthetic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk. Two of 11 newborns in the study who received no local anesthetic had potentially dangerous episodes within minutes of the procedure. One newborn lost muscle tone, stopped breathing several times and vomited. The other choked and stopped breathing briefly, the researchers said.

• Wiki leds us to believe circumcision is best done during infancy (see Advocates above, and the Topic), but:

“Circumcision at 5 months results in significantly fewer serious complications than circumcision in the neonatal period, irrespective of the method used. Therefore, neonatal circumcision should not be recommended.”

• In the third paragraph we read … “Arguments for circumcision are that it provides important health advantages which outweigh the risks, that it has no substantial effects on sexual function, has a complication rate of less than 0.5% when carried out by an experienced physician, and is best performed during the neonatal period.. Problem is, the medical community disagrees (finds factual fault) with the statements made by Schoen. Schoen states personal opinion, then cites a study on adult circumcision (thus not relevant to infant or toddler circ results) to claim no sexual effects, then references himself to claim a complication rate! Wiki should not call such subjective information “arguments for circumcision,” and should not use disreputable stats.

• Obscured from the reader:

Wiki should link to the actual Sorrell’s study. Circumcision currently links to a very short summary. We should also convey the essence of their findings:

“The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis.”

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

• Removed from sexual effects:

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

• Removed from sexual effects:

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

• Removed from sexual effects:

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

• Removed from sexual effects:

“Participants reported significantly reduced erectile function, decreased penile sensitivity, no significant change in sexual activity, and significantly improved satisfaction after circumcision. This improved satisfaction represented a more satisfactory appearance of the penis and less pain during sexual activity.”

• Removed from sexual effects:

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

• Removed from sexual effects:

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

Tip, we've been through this all before over the past few years. See the 40+ pages of talk. Lying low for two months and starting to edit war again will not help. -- Avi (talk) 00:57, 17 December 2008 (UTC)

Catagorically reverting Tip because of past transactions is very unadmin like behavior Avi. All he did was add a dispute tag and come here to talk about it. You also reverted Usergreatpower without a peep of explanation. Garycompugeek (talk) 01:35, 17 December 2008 (UTC)

Avi, you refer to "we've" ... you mean the cabal having dismissed the above facts? You mean text you agreed to and then removed? You mean the sham discussion? The above facts are significant to the reader but blocked without cause.TipPt (talk) 01:45, 17 December 2008 (UTC)

TipPt, as I think I've explained to you before, around July 2007, when you weren't around, there was consensus to shorten this article, moving much material to the subarticles linked to at the top of each section. See 32. Article too long?. If you wish to re-add much material, re-lengthening the article; or if you wish to keep the article the same length while substituting some material for some other material; you're welcome to discuss such proposals on this talk page, but I see no need for a "totally-disputed" tag during such discussions. While you've listed much material that has been deleted, you haven't stated any reasons why it should be re-instated except "The above facts are significant to the reader but blocked without cause": yes, the information is significant to the reader, but the cause of deleting it is that such details have been moved to subarticles. I suggest that you check the subarticles and try adding to them any pertinent information you feel is missing.

Re ancient Jewish circumcision: I'm not convinced by your sources. I went over a screenful of text at the first source and didn't notice anything relevant: could you specify which paragraph it's in? The second source looks OK but I'm not convinced it's a sufficiently reliable source for that type of historical fact; one is left wondering where they got their information from. With the third source, again I didn't notice anything relevant; which paragraph is it in? What exactly do you think needs to be changed in the article to remove what you call the gross propaganda? I see no problem, since the first sentence of the article defines circumcision in terms of "all or part" of the prepuce, so the article seems to me to be consistent with your claim.

I support removing the totally-disputed tag. I oppose lengthening the article by re-adding the above-mentioned material; I think it's beneficial to have an article that's short enough that many readers might read the whole thing from beginning to end, and other material can go in the sub-articles. Making the article too long leads to undue weight in effect, since many readers may read only the first part or some other part of the article, not receiving a balanced overview of the subject. Any readers interested in more detail can easily navigate to the subarticles. ☺Coppertwig(talk) 03:01, 17 December 2008 (UTC)

As Coppertwig put it, "We've" means the people who have been editing this article for the past few years, and yes albeit many of us share different views, we managed to shorten the article and work some things out. Coming back with the same old laundry list, Tip, is only going to serve to destabilize what delicate balance we all (and that means Me, Copper, Jake, Blackworm, Gary, etc.) are trying to maintain here. -- Avi (talk) 03:06, 17 December 2008 (UTC)

And Gary, you're right, I miskeyed the reversion and took out too much. Guess I have to return that "infallible" bumber sticker I just bought :) -- Avi (talk) 03:06, 17 December 2008 (UTC)

1. ^ Cite error: The named reference AAP1999 was invoked but never defined (see the help page).
2. "Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision". 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports. American Medical Association. 1999. p. 17. Retrieved 2006-06-13. {{cite web}}: Unknown parameter |month= ignored (help)
3. Cite error: The named reference WHO-Info-2 was invoked but never defined (see the help page).
4. Kellogg, J.H. (1888). "Treatment for Self-Abuse and Its Effects". Plain Facts for Old and Young. Burlington, Iowa: F. Segner & Co. {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)
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