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	Circumcision has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it.
Article milestones Date Process Result February 3, 2013 Peer review Reviewed February 12, 2013 Good article nominee Listed
Current status: Good article

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Use of foreskins cut off by circumcisions

Foreskin-based medical and consumer products

Foreskins obtained from circumcision procedures are frequently used by biochemical and micro-anatomical researchers to study the structure and proteins of human skin. In particular, foreskins obtained from newborns have been found to be useful in the manufacturing of more human skin. Human growth factors derived from newborns' foreskins are used to make a commercial anti-wrinkle skin cream, TNS Recovery Complex.(subscription required) Foreskins of babies are also used for skin graft tissue, and for β-interferon-based drugs. Foreskin fibroblasts have been used in biomedical research.

This section above,currently in the foreskin article really belongs here in the circumcision article, as these uses of foreskins arise from circumcision and not from the simple existence of foreskins. (Also the long section in the foreskin article that at least references the arguments about sexual pleasure for men and women with and without a foreskin attached belongs here too. !)--— ⦿⨦⨀Tumadoireacht /_Stalk 07:48, 24 October 2013 (UTC)

Tumadoireacht, by my count this is at least the eighth time in less than a year you have advocated for this, previous attempts by you were 12/2012, 12/2012, 02/2013, 02/2013, 02/2013, 06/2013, and most recently 09/2013, just last month. In particular, the importance of quality sourcing and encyclopedic themes was pointed out to you here, and the lack of quality sourcing was explained to you here. Why would things be any different now? Have you identified new, high-quality sourcing that was not available previously, or no? Or are you actually simply re-proposing the exact same edit based on the exact same sources? If you're simply re-proposing the same edit based on the same sources for the eighth time in less than a year, can you please explain how this can be anything other than tendentious editing, a form of disruptive editing? Zad68 13:20, 24 October 2013 (UTC)

Your use of the passive form of the inferred first person plural is fascinating Zad, as is the zealouusness with which you document oppositions to the particular flavour of article you garden here. But if you are capable of putting down the wikilawyering baton (bludgeon overkill) the simple facts remain that all of this research and medicine and commercial sale and use of circumcised foreskins still occurs, whether we wikilawyer our way to continuing to exclude it from the article or not.

In your comment counts have you kept a similar tally of how many dozen times you have advanced the "oh but it is not a secondary medical source tsk tsk" for so many editors who have proposed making the article more real ? As you well know, or ought to, common sense trumps the rules in Misplaced Pages. Pointing this out is not disruptive editing. Labelling it as such shows a profound misapprehension of our purpose here. Try to address the issue not the messenger. Are you denying that these activities occur?--— ⦿⨦⨀Tumadoireacht /_Stalk 20:12, 24 October 2013 (UTC)

Tumadoireacht, all sorts of activities "occur" in the real world that are of absolutely no interest to Misplaced Pages; the only thing that Misplaced Pages considers to be relevant to "making article more real" are what reliable secondary sources say on a topic. As I've said to other editors here, rather than starting with one's own personal views of what is important to discuss on a topic, to write a good article one must instead start by reading high-quality secondary sources on the subject (in this case WP:MEDRS-compliant), then summarize what they say, whatever that happens to be. That is the relevant issue here which must be addressed. Continually suggesting identical edits that ignore WP:MEDRS and WP:UNDUE (supported by appeals to "common sense" and claims of "wikilawyering"), is, in fact, disruptive editing. Jayjg 23:38, 24 October 2013 (UTC)

I'll take this response to mean that once again there will be no satisfactory sources forthcoming. Zad68 02:52, 25 October 2013 (UTC)

@ Zad :you can't get no satisfaction and the article suffers--— ⦿⨦⨀Tumadoireacht /_Stalk 05:43, 25 October 2013 (UTC)

@ Jayjig - Of course all sorts of things happen in the real world that have no relevance to particular wikipedia articles. But that fact is a red herring here. You are also quite mistaken in saying that the only thing WP considers relevant are secondary sources. Please re-read carefully the reference text that you have cited above. And read the fundamental references elsewhere to common sense trumping narrow rule interpretation. You are also quite wrong in ascribing a personal view motive in this case ( another oily red fish) I hope that you are not doing these things to avoid attempting to gainsay the reasonable logic of including in an article about cutting something off the body, the information details about what the cutters do with the cut off stuff. It is really a no-brainer. The concerted resistance to including it with due weight (and calling that resistance consensus !) is a most interesting development.--— ⦿⨦⨀Tumadoireacht /_Stalk 19:24, 26 October 2013 (UTC)

A persistent and oft-repeated argument has been made on this talk page that material should be included in the article because it it is a "fact" or "real". It is no "red herring" to point out that being "factual" or "real" is not nearly enough to qualify material for article inclusion. For example, it is a fact that this individual was killed in a car accident last week - and it's also supported by reliable sources. It's also quite important, certainly for the individual and his loved ones, friends and acquaintances. And, without doubt, it is "relevant" to Misplaced Pages's traffic collision article. That does not mean, however, that the material should be added to the traffic collision article. Reliable secondary sources are the arbiters of what belongs in Misplaced Pages articles, and in what proportion. Appeals to any other authority, particularly the highly subjective ones being used here (e.g. "common sense", "more real", "reasonable logic", "narrow rule interpretation") will never succeed, because they are not consonant with Misplaced Pages's purpose and goals. Jayjg 20:33, 27 October 2013 (UTC)

It is truly remarkable Jayjig, that instead of addressing the points raised you embark on establishing what all accept. Unrelated material is, de facto/by definition/ of course, unrelated - yet you give another lengthy example of unrelated material for what purpose I cannot see. I find it hard to believe that you cannot understand the point that what happens to foreskins after the cutters cut them off their baby boy children is relevant to an article about cutting off foreskins. Is it possible that you could confine your mind and response to addressing just that point ? Have you read the policy stuff in WP on common sense. I do not think I have to give an editor of your vast seniority the refs.--— ⦿⨦⨀Tumadoireacht /_Stalk 21:24, 27 October 2013 (UTC)

Tumadoireacht, you may not have read my previous response; I gave an example of related material that didn't belong in an article, not unrelated. Please review my previous comment. Thanks! Jayjg 21:58, 27 October 2013 (UTC)

a particular RTA is of course not pertinent to an article on RTAs unless it had some unique pertinent feature. That is,however, no parallel to including information on the disposal and sale of cut off foreskins in the cutting off foreskins article.All foreskins get disposed of in some way BY THE CUTTERS and this article is about what the cutters do. Some cut off foreskins and frenulums are buried after being cut off,some are sold for research or skin grafts or cosmetics. The information is pertinent and related.

The triple objections given by those who have continued to block and revert ANY description or even mention of the disposals or sales of foreskins are-1/it is not real,2/ it is not relevant, or3/ it is not real or relevant because some journals have not done overview studies on it. Those are patently absurd positions.--— ⦿⨦⨀Tumadoireacht /_Stalk 00:45, 28 October 2013 (UTC)

Jayjg, I don't know how true it is that what happens to healthy foreskins post-op is not relevant to Misplaced Pages. The article human penis, under the "Circumcision" section, includes the following:

After hospital circumcision, the foreskin may be used in biomedical research, consumer skin-care products, skin grafts, or β-interferon-based drugs. In parts of Africa, the foreskin may be dipped in brandy and eaten by the patient, eaten by the circumciser, or fed to animals. According to Jewish law, after a Brit milah, the foreskin should be buried.

I think the first sentence would be interesting to explore in detail, perhaps under the "Economic considerations" section of our article (or maybe it's just fine where it is, I don't know). The fact is that circumcision in the US is mostly non-therapeutic, and therefore presents an interesting and notable exception to all other hospital amputations, which are done in response to disease, trauma, or pain. The majority of body parts amputated in the instance of American circumcision are healthy, so one might very well wonder what happens to them as opposed to various other amputated non-healthy body parts which end up in biohazardous waste. I don't know where exactly this discussion belongs, but it is definitely not irrelevant to Misplaced Pages. --(Moshe) מֹשֶׁה‎ 19:12, 28 October 2013 (UTC)

It's not irrelevant to Misplaced Pages, it's already covered on Misplaced Pages at Foreskin, because that's what the sourcing provided supports. If you think there's sourcing to support it here, maybe you can locate the needed sourcing? I have looked for such sourcing several times and didn't find it. I had no idea that same text was not only already in Foreskin but also Human penis. It clearly doesn't belong there. Maybe some day somebody will fix that. Regarding the rest of your response, once again, no original research please, and per Misplaced Pages policy, good-quality authoritative reliable secondary sourcing is the only thing we use to determine weight. Zad68 13:40, 29 October 2013 (UTC)

Zad, again, I am not doing original research here. I didn't bother sourcing my statements because they're obvious. Circumcision is most often elected for cultural or religious reasons , not medical ones. Amputations are most often performed for infection, disease, or injury reasons , not religious or cultural ones. I was merely remarking that this is not irrelevant to Misplaced Pages. I know you've said that the foreskin article needs to be gutted re-written from scratch, but if/when it does, I do think this section should be kept, since the body part in question is a unique case of amputation. I further thought that because I saw this on the human penis article under the circumcision, it might possibly have some relevance. But again, other stuff exists, and I actually have no strong feelings about where this section belongs (I merely think it belongs somewhere), so I'd prefer to focus more on the other topics addressed below :) --(Moshe) מֹשֶׁה‎ 18:04, 29 October 2013 (UTC)

Moshe, we are on the same page here. I agree with you Misplaced Pages should carry the content. What we have supports it at Foreskin and if/when I were ever to do significant work on that article I would keep the coverage of it there (although I would look for better sourcing). Good we agree on this! Zad68 15:52, 30 October 2013 (UTC)

Zad68, respectfully, are you serious when you state that the selling of foreskins belongs in the foreskin article, and not in the circumcision article? When have you heard of the sale of a foreskin, when circumcision has not taken place? It belongs in circumcision, because it only takes place after circumcision. It is a function of circumcision, not a property of a foreskin.Tftobin (talk) 11:50, 12 November 2013 (UTC)

Two Proposed Edits

Friends,

I am proposing two edits for discussion.

(1) Indications and contraindications. Change:
"The Royal Dutch Medical Association, which expresses the strongest opposition to routine neonatal circumcision, does not call for the practice to be made illegal..."
to
"The Royal Dutch Medical Association, which generally opposes routine neonatal circumcision, does not call for the practice to be made illegal..."
There are many organizations, such as Doctors Opposing Circumcision, which can easily be said to be far more vocal in their opposition. Royal Dutch is not "the strongest opposition" in the world - this is pure POV.

(2) Adverse effects. Expand:
"The Royal Dutch Medical Association's 2010 Viewpoint mentions that 'complications in the area of sexuality' have been reported"
to
"The Royal Dutch Medical Association's 2010 Viewpoint mentions that 'psychological problems' and 'complications in the area of sexuality have been reported"
...or else something longer (there is something on "extreme pain experiences in newborns causing behavioural changes which are still apparent years later")

Consensus? --(Moshe) מֹשֶׁה‎ 17:42, 28 October 2013 (UTC)

1) Did you not check to see what the source cited in support of the current article content says before changing it? You can't change article content to make it say something the cited source doesn't say. The source cited is providing a review of the positions of the world's major medical organizations; DOC is a tiny advocacy group and doesn't come close to being in this category.

2) The point about pain is already covered in Pain management with a systematic review, which is better than using a particular medical organization's Viewpoint document. A mention of "psychological problems" used to be in the article but it was challenged because there's no point in mentioning "psychological problems" if there are no details about what they are, how severe they are and what their prevalence might be, and I ended up having to remove it. The KNMG Viewpoint document doesn't help us out here.

Zad68 18:32, 28 October 2013 (UTC)

1) You cannot say that it is "the strongest opposition". That is clearly POV, and there is no source to support a statement that Royal Dutch is the world's "strongest" opponent of circumcision. Some words from the actual viewpoint of Royal Dutch (KNMG viewpoint, page 5, of current Source ) read as follows:

"There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene...Contrary to what is often thought, circumcision entails the risk of medical and psychological complications...Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity...the KNMG calls on (referring) doctors to explicitly inform parents/carers who are considering non-therapeutic circumcision for male minors of the risk of complications and the lack of convincing medical benefits. The fact that this is a medically non-essential intervention with a real risk of complications makes the quality of this advice particularly important...The KNMG respects the deep religious, symbolic and cultural feelings that surround the practice of non-therapeutic circumcision. The KNMG calls for a dialogue between doctors’ organisations, experts and the religious groups concerned in order to put the issue of non-therapeutic circumcision of male minors on the agenda and ultimately restrict it as much as possible."

That sounds to me more like "generally opposes routine neonatal circumcision" far more than "expresses the strongest opposition to routine neonatal circumcision". What source are you referring to? The nearest "cited source" to this statement doesn't even mention Royal Dutch. I further think it is generally ambiguous to say "the strongest opponent" anyway; that's like saying the "best baseball player", as per our discussion above. There is absolutely no source to justify this phrasing, and I really don't see what the issue here.

2) Is there no point in mentioning "sexual complications" then if we don't go into them? Royal Dutch uses "Boyle, G., Male Circumcision: Pain, Trauma and Psychosexual Sequelae, Journal of Health Psychology, Vol. 7, No. 3, 329-343 (2002)" as a reference for psychological complications. Can I include them, or would this be too outdated and primary sourcing? (Even though I'm referring to a document referred to in another document) --(Moshe) מֹשֶׁה‎ 18:58, 28 October 2013 (UTC)

For 1), please stop doing original research, and the conversation can't move forward until you provide a response that shows you've actually read the sources cited in support of the article content. For 2) I think we have sourcing to include a mention like "There is a risk of psychological consequences." without further detail because in each of the few sources I've seen mention it, they simply do not provide further detail. If the sources for whatever reason don't see fit to provide the detail we shouldn't either. Give me a few minutes and I'll write up a proposal for discussion. Zad68 13:40, 29 October 2013 (UTC)

Zad, I fail to see how I am doing original research here. If anything, including the statement "strongest opponent" is the original research. I still don't know what source you are referring to. The nearest sourcing in our article to the "strongest opponent" statement (both preceding and succeeding) is Hay W, Levin M (25 June 2012), which doesn't even mention Royal Dutch/KNMG. Where is evidence saying that Royal Dutch is the world's strongest opponent to circumcision? --(Moshe) מֹשֶׁה‎ 17:40, 29 October 2013 (UTC)

??? Do you not see Reference 7 at the end of that paragraph?? Zad68 18:53, 29 October 2013 (UTC)

Whoops, I don't know what happened there. I guess I accidentally read a line up and saw the Hay/Levin source. I'm unable to see the journal because I don't have a subscription, but I'll trust you. Totally my fault here. --(Moshe) מֹשֶׁה‎ 20:03, 29 October 2013 (UTC)

Whew, you had me worried for a bit there! No worries, glad you found the ref. Zad68 15:52, 30 October 2013 (UTC)

Psychosocial effects

I reviewed the sourcing I could find on psychological consequences:

• KNMG 2010 - link - KNMG's Viewpoint statement; policy statement are written to argue a position - "psychological problems" have been reported but no details. The content in this Viewpoint is very poorly supported.
• Morris 2012 - PMID 22373281 - States that the evidence is insufficient and argues for neonatal circumcision. Although the article ticks all the WP:MEDRS checkboxes, it's written as part of debate, apparently, and so would be built trying to advance a position instead of dispassionately reviewing the evidence, so I'm a bit disinclined to use it.
• Perera 2010 - PMID 20065281 - "Adverse psychosocial effects may include dissatisfaction with circumcision, castration anxiety, and a heightened pain response." - Recent systematic review. Doesn't mention "psychological" consequences but rather "psychosocial". Does not mention psychosocial effects in the Conclusions of the Abstract, only in body.
• Pinto 2012 - PMID 22857844 - "Conflicting evidence exists as to the effects neonatal circumcision has on a man’s psychological well-being as well as his personal and sexual relationships in adulthood."
• RACP 2010 - link - RACP's policy statement; policy statement are written to argue a position - Mixed bag. "The potential harms include ... psychological complications." however the body of the document does not detail any psychological complications anywhere, and makes reference to case reports but not any studies. The Ethics section actually discusses psychosocial benefits.

Overall consensus of the sources is that there's weak support for a risk of psychosocial consequences. The strongest and most detailed evidence-based source is Perera 2010; it does not discuss "psychological" effects but rather "psychosocial" effects. Suggested content is to add:

Additionally, the procedure may carry the risks of heightened pain response for newborns, castration anxiety for boys in the phallic stage, and dissatisfaction with the result.(Perera 2010)

at the end of Adverse effects. Based on the weakness of its coverage in the sourcing, this would not go into the lead. Comments? Zad68 17:30, 29 October 2013 (UTC)

Must all psychological sources adhere to the WP:MEDRS guidelines? As I've mentioned many times before, circumcision is not just a medical procedure and nothing else. As I've also mentioned before, psychology is often considered a social science, including at Harvard. As I've also mentioned, just because something is in a medical journal does not mean it is discussing something that is medicine - note Glass JM (January 1999). "Religious circumcision: a Jewish view", in the BJUI and used in the article to discuss non-medical aspects of circumcision. Please direct me to something that says all psychology sources must adhere to WP:MEDRS. --(Moshe) מֹשֶׁה‎ 17:46, 29 October 2013 (UTC)

Are you saying you oppose the edit, or no? Is this response even regarding this particular edit, or have you moved on to something more general?

If you're looking to add a statement about how an intervention affects human health, and that includes mental health, WP:MEDRS is the guideline. PubMed is 100% appropriate for searching for sources, here is a list of several dozen MEDLINE-indexed psychology journals. Depression, bipolar disorder, cognitive behavioral therapy, dementia, child abuse, psychoanalysis, sleep disorder, ... are all psychology topics having an impact on human health, and so they are covered by both the Psychology WikiProject and the Medicine WikiProject.

Even if you consider psychology to be exclusively a "social" science and somehow are not making a statement regarding human health, then WP:SCIRS is the controlling guideline, and it says the same thing as WP:MEDRS: "Appropriate sources for discussing the natural sciences include comprehensive reviews in independent, reliable published sources, such as recent peer reviewed articles in reputable scientific journals, statements and reports from reputable expert bodies, widely recognized standard textbooks written by experts in a field, or standard handbooks and reference guides." If something is a science, including a social science, that means it makes testable claims that can be proven or disproven, and the science guidelines control.

This article does make use of non-medical, non-science sources, in, for example, the History and Society and culture sections. I'm having a hard time coming up with a case where you wouldn't need to use WP:MEDRS sourcing for things in the sections like Indications, Effects and Adverse effects which specifically cover the intervention's effect on human health. Zad68 18:40, 29 October 2013 (UTC)

I'm fine with that edit. Thanks. My main issue here isn't where sources come from, but when they come from. I, of course, recognize the importance of using high-quality sourcing, e.g., "independent, reliable published sources, such as recent peer reviewed articles in reputable scientific journals, statements and reports from reputable expert bodies, widely recognized standard textbooks written by experts in a field, or standard handbooks and reference guides". But it seems that the way the five-year-guideline is being applied here is a little too draconian. Tracheal intubation, for example (another "Good" article), includes a lot of sources that we would deem "too old". In fact, this seems to be the guideline for all "Good" medical procedure articles- this is not a case of other stuff exists, it seems to be that circumcision is the exception rather than the rule. The five year mark appears to be more of a suggestion than a law. Articles do not become invalid simply because they are five years or older. Articles only become invalid when they are outmoded by newer and better scientific information. --(Moshe) מֹשֶׁה‎ 20:03, 29 October 2013 (UTC)

Moshe, I've been reading this discussion, and I don't understand why you keep trying to use outdated sources like Glass. To the outside observer, it looks as if you want to get around the sourcing rules because you like what certain sources say. I hope that's not the case. Plot Spoiler (talk) 20:21, 29 October 2013 (UTC)

I do have my concerns about the interest in using outdated sources when it comes to scientific information, but in the specific case of Glass, that's OK, because it's only used for cultural information unlikely to change quickly. Zad68 20:30, 29 October 2013 (UTC) Adding: Probably just a mix-up in the names, Goldman is what was probably meant, and I think we have resolved this issue now with the more up-to-date source. Zad68 20:35, 29 October 2013 (UTC)

Great, as we have agreement on the edit, plus there hasn't been opposition to it, I've gone ahead and applied to the article. Zad68 15:54, 30 October 2013 (UTC)

My view on this matter is pretty much the same as Zad68's. Unless there is an extraordinary reason to use sources that are older than five years, such as research in the area not having made much progress at all or lately (which is covered at Misplaced Pages:MEDRS#Use up-to-date evidence), I don't see any reason to use the older sources for health information (other than for the aforementioned cultural instances). And though WP:SCIRS is not an official guideline, it is something that should obviously be kept in mind. Flyer22 (talk) 16:14, 30 October 2013 (UTC)

You're right Zad68, I meant Goldman. Plot Spoiler (talk) 16:24, 30 October 2013 (UTC)

Proposed Edit

I think I'm finally getting the hang of the guidelines for WP:MEDRS. What would we think of including some or all of the following in Adverse Effects? My source is a MEDLINE-indexed systematic review published within the past five years and states:

"Circumcision removes a complex, pentilaminar, specialized, junctional structure that contains nearly all the penis' fine-touch neuroreceptors. Not surprisingly, the foreskin is the most sensitive portion of the penis. Circumcision can reduce the sensitivity of the glans to fine-touch and vibration"

Let me know. While I very much appreciate the recent edit, I still think the Adverse Effects section is lacking. --(Moshe) מֹשֶׁה‎ 18:48, 31 October 2013 (UTC)

It's not a good idea to use advocacy pieces published as part of a "pro vs. con" debate as this Van Howe article is. Looking at the article here you can clearly see it's labeled a "VIEWPOINT" right at the top and so would be a statement of opinion. I see at Phimosis you characterized this article as a "systematic review"; it's definitely not that. After reading this "con" Viewpoint did you make sure to also read the "pro" Viewpoint that was also published? This is still coming across as hunting around to find particular articles that meet a particular point of view, and not surveying the sources generally to understand the consensus. Zad68 01:33, 1 November 2013 (UTC)

Adding: Is this the same Van Howe that the advocacy organization Intact America named as their "Intactivist of the month"?? Zad68 01:37, 1 November 2013 (UTC)

I actually found this piece by clicking the link provided above on this talk page (For a list of review articles from the last 5 years at PubMed, click here (limit to free review articles or to systematic reviews)). Inputted values were " AND Review AND "last 5 years" " Maybe I'm missing something here?

Not sure if that's the same Van Howe, but he does appear to be the same person as our current Reference 71. --(Moshe) מֹשֶׁה‎ 02:21, 1 November 2013 (UTC)

Yes, it's clearly the same Van Howe. Jayjg 22:35, 3 November 2013 (UTC)

Is it invalid? I found it by using the suggestion at the top of this page: "For a list of review articles from the last 5 years at PubMed, click here (limit to free review articles or to systematic reviews)" --(Moshe) מֹשֶׁה‎ 22:40, 3 November 2013 (UTC)

Zad68's posts of Nov 1 already answer that question. Jayjg 23:16, 3 November 2013 (UTC)

MosheA, I should add that the notice box you are referring to clearly states search results are "possibly useful" - not that every source found in those links should be included. Yobol (talk) 23:18, 3 November 2013 (UTC)

ICD-10-PCS code in infobox

I just noticed that the ICD-10-PCS code given in the infobox is incorrect. The code that is given, Z41.2, is a reference to the ICD-10-CM code, although that's not what the infobox calls for. As such, I've gone ahead and inserted the ICD-10-PCS code. --Schaea (talk) 08:08, 3 November 2013 (UTC)

Merge sections 2,3,4 ( 2. Indications and contraindications, 3. Effects, 4. Adverse effects) into one called 'routine infant circumcision debate' or something similar.

I was thinking that there should be a section entitled something like 'the decision to circumcise' or 'routine infant circumcision' or 'non-therapeutic infant circumcision'. Something like that. Instead of the 3 sections mentioned above.

The reason I say this is because I am concerned about the Effects section. I am concerned that expecting parents may come here, look at the subsection headings : 3.1 Sexually transmitted diseases 3.2 Phimosis, balanitis and balanoposthitis 3.3 Urinary tract infections 3.4 Cancers , get scared unnecessarily and just think - oh we will get him circumcised to put our mind at ease. This is scaremongering and very irresponsible.

Original research is a clear breach of wikipedia principles. And original research can be presented in different ways. I would argue that the amount you weight a section (how big a section is in proportion to the article) is akin to original research. Because you the editor are deciding that this subsection is very important because you have assigned quite a lot of words to it.

I feel this is very irresponsible.

Another reason my proposal is a good idea is because you can highlight the fact - and it does need highlighting - that this 'debate' about whether to circumcise your newborn is almost absent in ALL western countries apart from the USA.

Another thing. The Effects section is littered with primary sources and it makes this article poor - untrustworthy and unreliable. So for instance, in the HIV section, we should not be citing Grey et al or Tobian.

This new section would draw upon the medical association reports. I propose we only use the reports of the medical associations. This is far better because it makes it far less likely that the article will be biased. If we agree that we should only use what was said in the medical association reports then it is likely we can reduce weighting bias.

Also another point to note. Having used a word counter tool, the effects and adverse effects section takes up 10,600 characters of 46,700 characters. Or 22% of the article - nearly a quarter. It goes into far too much detail - when a lot of it is irrelevant because on the whole it isn't medically beneficial according to most medical organisations. Because it isn't medically beneficial OVERALL - to give so much weight to promoting the health benefits is highly biased. What matters is if it is medically beneficial OVERALL when you are deciding. To use an analogy. Imagine an article on penectomy (removal of penis). That would prevent a lot of penile diseases and by listing them all in an article you could make it sound like a good idea. But the overall context would be lost.

This whole health effects thing is entirely confined to the routine infant circumcision debate in the USA. The amount of people who are adults and elect to have surgery for the health benefits is infinitesimal.

You might then ask if we were to get rid of these sections - what about HIV? That is important and deserves its own section.

I propose another section of the article. 'Circumcision as a HIV prevention tool in Africa'. In this section you can site the primary sources - the 3 randomised control trials. (There would also be a minor mention of HIV prevention in the other section - the routine infant circumcision debate - but it will be quite small in that section because it will be part of a wider discussion on whether the procedure as a whole is worth it.)

I feel 'Circumcision as a HIV prevention tool in Africa' is a very big and important topic, yet is hardly mentioned in this article. It deserves its own section so we can alert the reader to how it is going. All we say now is that the WHO recommends it. Not update on how it is going. We can also mention opposition to using circumcision as a HIV prevention tool.

Tell me what you think.

Tremello (talk) 18:51, 4 November 2013 (UTC)

Hi Tremello... The trouble with the suggested reorganization is that it doesn't take into account how the available reliable sourcing handles the subject, and consequently would introduce a problem per WP:MEDMOS. The available reliable sourcing overwhelmingly treats circumcision as a medical topic. In the Talk archives there are two independent analsyses of the available sourcing, using both Google Scholar and Publish or Perish, and both came to the conclusion that the sourcing is overwhelmingly medical, and therefore per Misplaced Pages standards WP:MEDMOS is the proper organization. As for the amount of medical vs. non-medical content, last I checked there was more non-medical content than medical. This is actually out of balance because, per the sources, the article now has too much non-medical content. This evolved out of compromise, but the sourcing does not support making it even further out of balance as you suggest. You are right that Tobian shouldn't be used--the content it's supporting is already supported by two proper sources so I'll take Tobian out. There's no need to use primary sources to support HIV content as there are plenty of secondary sources. Don't forget that this the main article in a WP:SUMMARY-style group of articles. Details about the pro- vs. anti- groups should be covered in detail in Circumcision controversies. Detail about circumcision and HIV should be covered in Circumcision and HIV. For both of those, this article should summarize the most important points. Zad68 20:01, 4 November 2013 (UTC)

Excellent suggestions Tremello, and cogently argued. I support your proposed changes for the reasons you outline and for reasons which i have outlined previously. There is a predictable circular fatal flaw in Zad's rebuttal of your suggestion. It is this ; Zad sets up medical sources as "the available reliable sourcing" and concludes then that as these medical sources deal with circumcision as a medical topic (predictably) that therefore medical sources should dominate. But medicine is only a very small part of the cultural phenomenon of circumcision. The editors who presently patrol the article will permit no mention of forced adult circumcisions, or the sale post-excision of the cut off foreskins for cosmetics manufacture for instance. Your arguments about the impression readers will get from the present subject divisions are the most compelling. As presently presented the article is organized like a gerrymandered constituency. --— ⦿⨦⨀Tumadoireacht /_Stalk 22:08, 4 November 2013 (UTC)

Surely just an oversight, Tumadoireacht: the source databases I mentioned—Google Scholar and Publish or Perish—index scholarly research but are not at all limited to only medical sourcing. You must have been thinking of the PubMed database, which I do refer to quite a but, but I did not in my response above. Looking now, I actually see that you personally were involved in that previous thread that reviewed those source indexing databases. Zad68 02:59, 5 November 2013 (UTC)

Shouldn't indications and contra-indications come before technique, as per MEDMOS#Surgeries_and_procedures? --(Moshe) מֹשֶׁה‎ 03:17, 5 November 2013 (UTC)

Holy Moley you're right, I can't believe it has been ordered not in accordance with WP:MEDMOS for this long, and nobody caught it until now! Fixed, thanks!! Zad68 03:23, 5 November 2013 (UTC)

Adding: there needs to be more sections moved around, fixing... Zad68 03:26, 5 November 2013 (UTC) ... actually, no, it was just that one. There is not enough regarding recovery/rehab to break out into a new section separate from Technique. Zad68 03:30, 5 November 2013 (UTC)

Though WP:MEDMOS does not have to be strictly followed, and there are going to be times that it is best to not strictly follow it, it is generally preferable to follow it and therefore have uniformity across Misplaced Pages with regard to medical articles and anatomy articles. I agree that it is best to follow it in the case of the Circumcision article. Flyer22 (talk) 03:48, 5 November 2013 (UTC)

Just did a google scholar search : http://scholar.google.co.uk/scholar?hl=en&as_sdt=0,5&q=circumcision and it does seem it is primarily medical sources Zad. I also don't see how that bolsters your position - the fact that a lot of the info written about circumcision is medical and therefore the general public should be cajoled into thinking circumcision is overall medically beneficial. Which is what is occurring now by having a separate effects section detailing how circumcision prevents all these things.

The fact is that overall, most agree - apart from the AAP taskforce - that circumcision isn't worth it. For instance, with STI's including HIV, it has not been shown to reduce it in a Western setting. Also there have been many criticisms of the RCTs by medical professionals. Yes some of them are anti-circ activists but that doesn't mean their opinions should be dismissed. UTI's are not serious and easily treated. Cancer is very rare and the case for circumcising to prevent it is weak. Phimosis, balanitis and balanoposthitis - they are very rare, not that serious, and easily treated.

The circumcision controversies article and the circumcision and HIV article gets around 100 hits per day. So I am more concerned about the main circumcision article since it gets around 5000 hits a day. Since a lot of people may be getting the wrong impression. The general reader isn't that intelligent or knowledgeable about circumcision compared to us and may only skim the article - so headings and structure are important. It is important that we think about the impression the general reader will get. We don't want to scare exaggerate or mislead them. particularly if expecting parents are coming to this article to decide whether to circumcise their child.

So you can see that the way the article is presented now is akin to original research. In the sense that you are giving the impression to the general reader, via the arrangement and structure of the article, that it is better to be circumcised. If we followed my recommendation it would be more accurate to the reality. The reality is that most people don't think circumcision is worth it overall. Yes I think most people are willing to concede that it may reduce things slightly but overall the negatives outweigh the positives. In the same way removing a woman's breasts a birth would not be a good idea.

Also regarding a new section on circumcision to prevent HIV. Please note that the African researchers who conducted the RCT's were not originally pro-circ fanatics - they were AIDS and STI researchers that had done studies on other methods to combat HIV - they ended up trying circumcision as just another way to prevent AIDS. So their main motive and job ( I would hope) is to reduce HIV and other STI's in Africa - not promote circumcision. So I do think 'circumcision to combat HIV in Africa' deserves its own section. It is in this section that we can mention more about the 3 RCTS. We can also mention other STI studies done in Africa as a sidenote. As I say, circumcision to prevent disease is all about Africa. There is no HIV epidemic in the Western world. It is a very hard disease to catch. There is a 1 in 2000 chance of a man catching HIV if he has unprotected sex with an HIV infected woman (see: cdc HIV risk ).

Tremello (talk) 10:29, 5 November 2013 (UTC)

Tremello, on the organization proposal, I'm having trouble following your logic. You don't disagree that the sourcing for this topic is overwhelmingly medical, and you don't disagree that the article represents the sourcing accurately. If this is what the best-quality reliable sources say, then the article as it stands reflects the sources accurately... so, no Misplaced Pages policy-based argument is being raised here. The "original research" claim isn't supported by what's actually found in the sourcing, as it has been applied to Misplaced Pages content guidelines. If anything, your statement "overall the negatives outweigh the positives" appears to be original research that isn't based in the secondary sources, and it would be wrong to reorganize the article based on it.

I'm also not seeing the article content supporting your concerns, actually. The article accurately reflects current worldwide medical consensus that routine infant circumcision is not generally recommended and that no major medical organization recommends routine circumcision, not even the AAP, and not even for the prevention of UTIs (as the article states, "prevention of UTIs does not justify routine use of the procedure"). The article states circumcision has no effect on the incidence of genital warts and only "possibly" has an effect on herpes; circumcision's protective effects against penile cancer do not justify the procedure because the incidence of penile cancer is so low; no major medical organization recommends routine infant circumcision for the prevention of HIV, excepting of course for the WHO's recommendations for those parts of Africa. The only medical benefits discussed are the reliable sources that cover the current medical consensus that circumcision may be medically indicated in children for pathological phimosis, refractory balanoposthitis and chronic, recurrent urinary tract infections. Also the World Health Organization promotes circumcision as a preventive measure for sexually active men in populations at high risk for HIV. We have strong and explicitly medical sources to support these statements.

There are some things I agree with you on: Regarding the opinions of activists-- I agree with you that we could expand coverage of the pro vs. anti a bit. In a previous discussion here on this Talk page I recommended that we have a paragraph covering "intactivism", so I am on board with that. We do have to keep in mind that, relative to the overall topic, "intactivism" is a very small piece, and our article's emphasis on it needs to be commensurate with that per WP:WEIGHT. If someone spends a lot of time seeking out and reading debate-related material on activism forums, it's easy to come away with the mistaken impression there's more emphasis on debate than there actually is, let's be careful not to make that mistake. The fact that the controversies article doesn't get that many hits actually supports that observation: it appears most readers coming to the article (by a 50:1 margin according to the numbers you provided) are finding what they're looking for and aren't so interested in the controversies topic. This is good evidence to support keeping the article organization the way it is now. And, I think your proposal of highlighting the coverage of circumcision and HIV into a higher-level section is good, and reflects the emphasis found in the sources accurately. Zad68 14:54, 5 November 2013 (UTC)

Perhaps the fact that the vast majority of humans are "intactivists" (to use that inadequate term) in relation to cutting off foreskins should have greater prominence in the article.--— ⦿⨦⨀Tumadoireacht /_Stalk 23:27, 5 November 2013 (UTC)

Tremello, Tumadoireachet, Every suggestion for change here must be based on how the preponderance secondary sources treat the topic, including the prominence given various elements of the topic. I have yet to see a suggestion here based on even one reliable secondary source; therefore, none of the suggestions made here are actionable in any way. Jayjg 23:58, 5 November 2013 (UTC)

Jayjig you are again quite incorrect in that assertion and off topic too. You are ducking the points raised -whether deliberately or inadvertently I cannot say.--— ⦿⨦⨀Tumadoireacht /_Stalk 01:00, 6 November 2013 (UTC)

Sorry, I didn't mean to be "incorrect"; which reliable secondary sources did you cite in your comments in this section? Jayjg 01:09, 6 November 2013 (UTC)

But you did intend to be sarcastic ? The exhaustive inaccurate reiteration of part of the content policy about secondary sources by yourself and a small coterie of other editors is becoming both an increasingly obvious avoidance of relevant criticism of this currently artificially stalled article, and irksome too. The suggestions by Tremello are,of course "actionable", if by "actionable" you mean capable of being acted upon to improve the article (rather than giving sufficient reason to take legal action). Did you not notice that editors have been discussing the merits of implementing them, and have already made changes based on them, while you focussed so steadfastly on repeating a section of a policy on secondary sources ? When discussing article structure, the "secondary source" consideration is a secondary consideration.

If circumcisions are being forced on adults in several parts of the world, if foreskins are being sold, if children are being killed or maimed by circumcisers having oral-genital contact with them during circumcisions and we blithely blurt "oh the important medical sources do not mention these things" and repeatedly block all mention of them in the most consulted article on Circumcision, then we are failing in our undertaking as editors of Misplaced Pages. You may find re-reading these pages helpful:

• WP:NEWSORG
• WP:IDENTIFYUNCIVIL
• WP:IUC
• WP:5
• WP:5P
• WP:FIVE
• WP:FIVEPILLARS

--— ⦿⨦⨀Tumadoireacht /_Stalk 23:35, 6 November 2013 (UTC)

Would circumcision be legal if it wasn't a religious tradition?

Cutting off body parts from children is in most country completely illegal, unless there are very strong medical reasons to do so. Are there strong enough medical evidences to justify the procedure, or does the justification mostly come from primitive old-fashioned religious superstition? I am pretty sure that the procedure would be illegal in most countries, if it wasn't for all the religious-traditional nonsense. Having a huge medical section is kinda ridiculous as most doctors don't think there are enough medical benefits to recommend the procedure. The outline of the article should reflect this view. The current outline of the article seems like jewish/islamic propaganda. Probably because the main contributers of this article are jews or muslims. This article should be written by atheists that don't have their thinking clouded by religious nonsense.84.210.15.173 (talk) 20:11, 11 November 2013 (UTC)

No, this article should not be written from one specific point of view or by one specific group of people. Like all articles, it should follow WP:NPOV as much as possible. If you think that all or part of the medical section has undue weight, please be specific about which parts and why. -- Fyrael (talk) 20:21, 11 November 2013 (UTC)

In this case a neutral point of view is an atheistic point of view. People that belong to the jewish or islamic faith naturally have a bias in their thinking about circumcision.84.210.15.173 (talk) 20:26, 11 November 2013 (UTC)

No, an atheistic point of view is not a neutral point of view. A neutral point of view is a neutral point of view. Please actually read the policy page that I linked. -- Fyrael (talk) 20:29, 11 November 2013 (UTC)

Please read some of the books by Richard Dawkins, and if you don't think an atheistic point of view reflects neutrality regarding circumcision, then please explain why. 84.210.15.173 (talk) 20:30, 11 November 2013 (UTC)

Now that you've voiced your own opinion, see WP:NPOV for how Misplaced Pages defines it. If this conversation goes any further into WP:NOTAFORUM territory, or sees any more personal attacks based on religion, it will be closed if not deleted. Zad68 20:37, 11 November 2013 (UTC)

Let me word this another way. This article can be viewed from a Catholic perspective. It can be viewed from a Muslim perspective. Or Buddhist, atheistic, pagan, etc. These are all singular points of view. They all have their biases. Misplaced Pages aims to balance all of these points of view and we call it "neutral point of view". At any rate, if you would like to discuss a specific change to the article, please do so. Debating points of view doesn't really accomplish anything. -- Fyrael (talk) 20:40, 11 November 2013 (UTC)

Well, if my "holy book" doesn't tell me if circumcision is good or bad, then how does my faith make me biased in this aspect?84.210.15.173 (talk) 20:43, 11 November 2013 (UTC)

Do you have a specific change to the article that you would like to discuss or do you not? -- Fyrael (talk) 20:49, 11 November 2013 (UTC)

Well, I think the section about "Ethical and legal issues" should be before all the medical propaganda.84.210.15.173 (talk) 20:55, 11 November 2013 (UTC)

So you think the "Society and Culture" section should come before the "Effects" section? Why do you think so? I have to say just reordering those sections doesn't seem like a very significant change. -- Fyrael (talk) 21:05, 11 November 2013 (UTC)

As has been pointed out in previous conversations, the sourcing for the topic of this article is overwhelmingly medical and so the article is organized per WP:MEDMOS. Zad68 21:08, 11 November 2013 (UTC)

But why are you treating circumcision mainly as a medical issue, when the practice comes from religious traditions? A million pubmed articles doesn't have the weight of either the bible or the quran. Circumcision is a practice mostly done for religious/traditional reasons, not a practice done for medical reasons. Do you disagree?84.210.15.173 (talk) 21:23, 11 November 2013 (UTC)

I don't see anywhere in the article that it says the procedure is mostly done for medical reasons. The very first sentence after the opening paragraph reads "Neonatal circumcision is often elected for non-medical reasons, such as for religious beliefs or for personal preferences possibly driven by societal norms." -- Fyrael (talk) 21:26, 11 November 2013 (UTC)

Ok, but if that is the case, then of course the Society and Culture sections should come before the medical section.84.210.15.173 (talk) 21:28, 11 November 2013 (UTC)

See previous responses. The article is organized per WP:MEDMOS because the sources covering it are overwhelmingly medical. The medical effects are the same regardless of the reason why it's done. Zad68 21:34, 11 November 2013 (UTC)

Well, I think it is very wrong to have it like it is now, because the current medical sections seem like circumcision propaganda. Putting this section so early and giving this section so much weight makes the whole article biased towards circumcision. I don't think this article has a neutral point of view at all.84.210.15.173 (talk) 21:44, 11 November 2013 (UTC)

Your opinion is noted, once again. Repeating for hopefully the last time: Per Misplaced Pages policy, articles are organized per the emphasis found in reliable sourcing, which for this topic is overwhelmingly medical. Zad68 21:55, 11 November 2013 (UTC)

Conversely, and probably NOT for the last time -there are many eminent secondary sources which cover the subject of circumcision from perspectives that are NOT medical but social. Consequently there are editors such as myself who firmly contest the opinion which Zad trots out so frequently on these talk pages that medical secondary sources rule here .In parts of the world circumcisions occur with no medical input or for reasons that have nothing to do with health. Most of the world chooses not to cut their children's genitals.In the article as presently constructed sufficient weight is lacking in drawing attention to this central latter fact alone (i.e most do not cut), never mind the omitting of all mention of the more bizarre aspects of the cultural phenomenon of circumcision some of which which I alluded to earlier. --— ⦿⨦⨀Tumadoireacht /_Stalk 23:01, 11 November 2013 (UTC)

Regardless of intent, at least in the US (and likely the rest of the world - which is why it is so extensively discussed in the medical literature), the vast, vast majority of circumcisions are performed by physicians as a medical procedure, so using MEDMOS would seem to be appropriate here. Do we have reliable sources that say otherwise? Yobol (talk) 23:25, 11 November 2013 (UTC)

It certainly looks to me like the article covers the non-medical reasons for circumcision (and even more detail is given in the "for more information" links). And it very clearly states that "Approximately one-third of males worldwide are circumcised, most often for reasons other than medical indication". That right there seems to agree exactly with what Tumadoireacht is saying. I don't see how anything is lacking here. -- Fyrael (talk) 23:52, 11 November 2013 (UTC)

There's also a graphic giving very detailed prevalence information. Can you really draw more attention to something than by giving it a graphic? -- Fyrael (talk) 23:55, 11 November 2013 (UTC)

(edit conflict) To answer Yobol's question we need look no further than the lede of the article as it stands, which is well supported by sources that have been deemed acceptable here. It says, "The procedure is most often elected for religious reasons or personal preferences" and "About one-third of males worldwide are circumcised." So the main reasons it is done to children are not medical, and it is a minority position to take. So, although it has been 'medicalised' in the sense that it has been largely taken out of the hands of enthusiastic amateurs in often unsanitary conditions, it is not a medical procedure except in the 1% (or whatever it is) of cases where there are congenital abnormalities. I agree that it should not be treated here as primarily a medical treatment. On the worldwide scale (a) it is not done to the majority of male children or adults (b) when it is done it is usually not a medical treatment for any illness or disease in the patient. This perspective, or 'Point Of View', is not prevalent in the article, and it absolutely should be. --Nigelj (talk) 23:57, 11 November 2013 (UTC)

So, if I understand this correctly, Nigelj is saying that despite the article stating flat out several times that the motivation for most circumcisions is non-medical, you feel that the mere length of the "Effects" section is giving undue weight to the medical reasons? Is that right? -- Fyrael (talk) 00:23, 12 November 2013 (UTC)

I was primarily referring to the overall tone, and the insistence on MEDRS sources, but to be more specific:

1. Section heading 'Indications and contraindications' - this is medical terminology used in relation a procedure that is very rarely done for medical therapeutic purposes. The section talks about "non-medical" and "non-therapeutic", but the heading does not reflect that.
2. 'Medical indications' subsection does not give any indication of how rare these indications are, or what proportion of circumcisions they lead to.
3. 'Effects' section, as you say, is far too long. There should be perhaps 20 to 100 times more text about the social and religious traditions that lead to many times as many circumcisions, when compared to the medical reasoning that leads to the much smaller proportion.
4. 'Nowhere' is there a section about the two thirds of males who are never circumcised, all the reasons for that, what they and others have to say about it, etc.

The procedure requiring medical skill does not make this a medical procedure as the vast majority of operations are carried out on healthy, well-formed individuals with no illness or disease. Most of this article should be about that viewpoint, and that viewpoint does not require MEDRS sourcing. At the moment it is like requiring all our articles on air transport to be sourced from air crash investigation reports. --Nigelj (talk) 00:50, 12 November 2013 (UTC)

Nigel, there is insistence on WP:MEDRS sources for biomedical content, that's required. The general direction of your suggestions can't be pursued because the sourcing and Misplaced Pages content policy don't support it. To pick just one of your suggestions: "There should be perhaps 20 to 100 times more text about the social and religious traditions"... 20 to 100 times? those numbers are based on what? This suggestion isn't backed up by what's actually found in a survey of the sourcing, which both Google Scholar (not limited to medical) and Publish or Perish (not limited to medical) both show is overwhelmingly medical, and absolutely supports WP:MEDMOS layout. Misplaced Pages does have specialist articles to cover social and religious aspects specifically, see Circumcision controversies, Religious male circumcision, Khitan, Brit milah and others.

The issue is this: Let's say you're a good researcher, and someone tasks you to write an article on something you've never heard of before and have no opinion about, called "circumcision". After confirming you have the correct spelling, you go to you favorite academic search engines and indexes and you take a broad, general survey of the sourcing. Within a few minutes you'd come to the conclusion, "This is a medical topic, with some historical and social aspects." As Misplaced Pages editors, isn't that exactly how we're supposed to approach article development? Zad68 03:21, 12 November 2013 (UTC)

Suggestion that a procedure isn't "medical" because of the motivation of the person deciding on why the procedure is done is at best misguided. That the intention of the procedure is religious (or cosmetic, or social, etc) in nature doesn't make the procedure itself any less inherently medical. As an analogy, many plastic surgery procedures (face lift, breast augmentation, breast reduction, etc) can have purely cosmetic motivation (i.e. no "disease" is being treated); that, however, does not mean they are any less fully "medical" procedures. Suggestions that procedures done by medical personnel in a medical setting isn't medical are in the end not very convincing. Yobol (talk) 03:37, 12 November 2013 (UTC)

This is also a good point. Zad68 03:48, 12 November 2013 (UTC)

Well, this procedure is enforced on children that don't have the ability to say yes or no, and it is more or less irreversible. Breast removal might decrease the chance of developing cancer, so we might start removing the tissue that will grow into breasts on female children. Then we might create a wikipedia article where we start by a long medical section describing the medical benefits of infant breast removal. Wouldn't you call that propaganda? This is pretty much what you are doing in this article. My wife finds me less sexually appealing as I don't have foreskin. 84.210.15.173 (talk) 19:53, 12 November 2013 (UTC)

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