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::You need to use secondary sources per ] as mentioned on your talk page. ] (] · ] · ]) 01:56, 29 December 2014 (UTC) | |||
== New Literature Review on Circumcision: Review of the Current State of the Male Circumcision Literature == | == New Literature Review on Circumcision: Review of the Current State of the Male Circumcision Literature == |
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Summary Paragraph Sentence "The procedure is most often elected for religious reasons or personal preferences"
Question about this sentence. This was cited with the report from the World Health Organization. While reading the summary page for this report I never saw this statement. What they said was that it is typically undertaken for religous, cultural, and secular reasons. In both the introductory statement of the articles and the summary, the emphasis seemed to be on the procedure being undertaken either culturally or for religous reasons. They did note that some people in South Africa would like to be circumcised, but did not say that personal preferences was the primary determinant for the procedure. Rather then personal preferences, I believe that cultural reasons is a better standpoint. JohnPRsrcher (talk) 02:18, 15 December 2014 (UTC)
- The general categories of religious, cultural, and medical reasons are repeated throughout the WHO's document.
Zad68
13:27, 16 December 2014 (UTC)
I think that we should change this to elected for religous reasons, cultural reasons, or because of a family history. This should encompass all circumcision practicing areas quite well. For African areas, the main focus of the WHO report, it seems that it is religous or cultural. For southeast asia and areas like the phillipines, I would argue that it is cultural or religious. For instance, in the Phillipines they practice Tuli. This is a sort of cultural coming of age practice. It seems to be part of their culture to want to toughen up their boys by having their genitals undergo a surgery when they hit adolescence. In South Korea, I would argue a mix of family practice and cultural.
For the US and Canada, I would argue that it is mainly for the reason of family history and medical reasons. In the past circumcision was encouraged by our medical field. Today it is still encouraged but not pushed like it was beforehand. Today, I think most adults do it to their sons because it was done to them.
JohnPRsrcher (talk) 23:20, 18 December 2014 (UTC)
- Well, Misplaced Pages isn't interested in the speculations of individual editors, please don't use the article Talk page for that, let's just stick to using the sources.
Zad68
13:26, 19 December 2014 (UTC)
Ok. I did a search of some medical journals (pediatrics, BJU, BMC) and could not find any data about the determinant of male circumcision. Best source as of yet is the WHO report from 2008. After a 2nd review of report, seems they are emphasizing religious, cultural, social, and medical. Social means many things according to report.
They do state that it involves the desire to conform, due to a study in Denver, Colorado (in United States) that found fathers circumcised their sons to make them look like them. This was the primary determinant in this region.
According to article, it differs in the phillipines, where boys do it to avoid being uncircumcised, or because it is tradition.
Also, could be part of social desirability. (more hygienic.)
Since social is confusing and hard to determine (involves numerous factors), should change to religious and cultural at this point.
JohnPRsrcher (talk) 18:04, 19 December 2014 (UTC)
Question about this Sentence: "For adults, general anesthesia is an option, and the procedure is often performed without a specialized circumcision device"
Can anyone show me the citation for this statement. Is there a statistic justifying that adults often times do not use a specialized circumcision device. I would judge ( based on my knowledge) that adults would often opt to use a circumcision device as it is a rather scary procedure, and they typically would be doing so for a conversion into the Islam faith.
JohnPRsrcher (talk) 03:15, 15 December 2014 (UTC)
This is a continuation off of my prior statement. I have now searched three major medical journals and have not found any evidence indicating that adult males often times choose not to use a specialized circumcision device. It seems that not much research has been done on this topic, as it may not be done very much at all
JohnPRsrcher (talk) 18:06, 15 December 2014 (UTC)
- This can be reworded from "is often" to "may be". Re your statement
I would judge ( based on my knowledge) that adults would often opt to use a circumcision device as it is a rather scary procedure, and they typically would be doing so for a conversion into the Islam faith.
-- please use reliable sources to support assertions, we don't go by the presumptions of individual editors.Zad68
13:27, 16 December 2014 (UTC)
I think that changing it to may be is ok, but that now we are poorly representing the procedure. Many adults may not be aware of the fact that it can be done by hand, and just saying it may be done with a circumcision device will not increase their awareness of that. I opt that we change it to " For adults, the procedure may be performed with a specialized circumcision device or by hand, and anesthesia is an option."
JohnPRsrcher (talk) 20:31, 16 December 2014 (UTC)
- Some of the specialized devices are used as part of a manual surgical method, so what you're suggesting isn't really accurate.
Zad68
05:13, 18 December 2014 (UTC)
But if this page is to describe all types of circumcision around the world; then we would have to include the fact that in some countries circumcision is done only with a knife. It is difficult to convey to the reader that there are types of circumcision using both a specialized device and scalpel. I think that saying a specialized circumcision device or scalpel can be used best shows that techniques range from using only a scalpel to only a specialized circumcision device.
JohnPRsrcher (talk) 23:32, 18 December 2014 (UTC)
- I think the existing wording already covers this range.
Zad68
13:26, 19 December 2014 (UTC)
Question on 3rd Paragraph of Article Summary , Beginning Statement
I have a question about the beginning statement of paragraph 3. I see that the cochraine analysis found that there is a decrease in HIV acquisition for heterosexual men and women, however, the article does not note that there is no effect of circumcision on HIV and STI's for homosexual men. This can be justified by two recent meta analysis from JAMA and Cochraine.
JohnPRsrcher (talk) 17:23, 15 December 2014 (UTC)
- "Cochrane"... it's spelled Cochrane without an "i". The information about male-to-male transmission rates is covered in the article body. The lead summarizes the most important topics, and per the sourcing the effect on female-to-male transmission rates is by far a more important topic. However I think it'd be fine to summarize the findings on male-to-male, briefly.
Zad68
13:27, 16 December 2014 (UTC)
Ok. I agree. I think it should come after the sentence about male-female. We also should make it very clear that we are talking about female to male in the first sentence, and male to male in the second so that casual readers of the page don't become confused.
JohnPRsrcher (talk) 20:32, 16 December 2014 (UTC)
- It is more complicated than "For homosexual men, circumcision does not seem to have an effect on the risk of HIV infection or the risk of other sexually transmitted diseases". Ref says "Male circumcision had a protective association with HIV in studies of MSM conducted before the introduction of highly active antiretroviral therapy" and "The odds of being HIV-positive were not significantly lower among MSM who were circumcised than uncircumcised (odds ratio, 0.95; 95% confidence interval, 0.81-1.11; number of independent effect sizes =15) .). Higher study quality was associated with a reduced odds of HIV infection among circumcised MSM (beta, -0.415; P = .01)." At best it is unclear. Doc James (talk · contribs · email) 04:53, 18 December 2014 (UTC)
- Doc James brings up a good point, the existing article content "For men who have sex with men the evidence is less clear" is a better option for summarizing the sources.
Zad68
05:13, 18 December 2014 (UTC)
Please see another meta-analysis on topic.
In addition, for your statement , this is a sub-section of overall study and is not justifiable. For second statement please see 2nd meta analysis. This had same results with more studies then this one.
I highly disagree with your edit to my change. Wish you would have come to talk page before changing it to discuss proposed changes. Problems include:
Stating ] after ] is phrased such that it sounds like homosexuals have protection from AIDS when there's no data.
Men who have sex with men is medical jargon. Better to used a term everyone in country uses (homosexual) for general reader.
JohnPRsrcher (talk) 00:22, 19 December 2014 (UTC)
I still think that we should write "For homosexuals, it seems that there is no affect on the prevalence of STI's and HIV from circumcision." This is supported by overall data, there is no indication yet of the contrary.
JohnPRsrcher (talk) 00:45, 19 December 2014 (UTC)
- How about "the evidence is not clear" Doc James (talk · contribs · email) 02:31, 19 December 2014 (UTC)
- The Cochrane review states "Current evidence suggests that male circumcision may be protective among MSM who practice primarily insertive anal sex, but the role of male circumcision overall in the prevention of HIV and other sexually transmitted infections among MSM remains to be determined" [http://www.ncbi.nlm.nih.gov/pubmed/21678366[
- This is definitely not saying "no affect". This is saying maybe benefit but not clear.Doc James (talk · contribs · email) 02:33, 19 December 2014 (UTC)
- How about "the evidence is not clear" Doc James (talk · contribs · email) 02:31, 19 December 2014 (UTC)
But both studies show no affect on circumcision and STIs. We should focus on the overall data first as this is the most important and is not subject to bias. However, it seems that, from conclusion of both studies, doctors want to do further research on this issue. So how about:
For homosexuals, the current data does not indicate that circumcision has an affect on HIV or other sexually transmitted diseases.
By saying "the current data", you are indicating to the reader that more medical research may be done on this topic.
Also, for the part about primarily insertive anal sex, we should add that to the further sections to explain this point.
JohnPRsrcher (talk) 02:59, 19 December 2014 (UTC)
- The objection that a sentence that clearly qualifies on heterosexual men might be read to apply to homosexual men is unreasonable.
"Men who have sex with men" is vey plain wording about a sex act and not medical jargon, and "homosexual" carries a lot of cultural meaning that isn't relevant, the point is to cover the transmission rates for those who engage in the sex act. The source covers the sex act and not the sexual orientation.
And as Doc James points out your suggestion isn't supported by the sources. The evidence is not good enough to say "no effect", the sources cited say the evidence isn't good enough to make a determination, they are not the same thing.
Zad68
13:26, 19 December 2014 (UTC)
If you read both citations, one states that there is insufficient evidence (JAMA) that it protects from HIV and the other states that there is no clear association (Cochrane.) The Cochrane study had 71693 participants and the JAMA study had 53567 participants. For the benefit of the doubt, the american task force on pediatrics also issued a statement. They state: "Circumcision seems to be less likely to protect MSM, however, and has not been associated with decreased acquisition of HIV among MSM." The evidence is less clear in insufficient. Rather should use the association is unclear.
JohnPRsrcher (talk) 16:32, 21 December 2014 (UTC)
Just to let you know, I had to remove the current statement from the article. This is because there is no clear consensus yet on this talk page.
JohnPRsrcher (talk) 16:37, 21 December 2014 (UTC)
- What is with adding links to this http://www.circinfo.org/? We have a couple of good sources that provide tentative evidence of benefit for MSM so why remove? Doc James (talk · contribs · email) 21:39, 21 December 2014 (UTC)
Those links don't involve this. I'm going to use these links for another argument. These are policy statements from all around the world. I found them from a cite (cirp) that has them all posted for free as secondary sources. They have a lot of good info based on other countries approach to circumcision, this will be good for the page in future.
JohnPRsrcher (talk) 22:00, 21 December 2014 (UTC)
But we hadn't come to agreement yet. I looked it over (task force, JAMA, and Cochrane) and still think evidence points to no association. I removed until we come to agreement.
JohnPRsrcher (talk) 22:02, 21 December 2014 (UTC)
- Some links do not accurately reflect the sources in question. Circinfo is potentially one of those. You add refs when there is text that they support not before. Doc James (talk · contribs · email) 22:03, 21 December 2014 (UTC)
I was only using circinfo because a policy statement from the College of Physicians and Surgeons of British Columbia (CPSBC) was posted on their website. This is a secondary source. I was citing it for the document that they have bought for their website.
JohnPRsrcher (talk) 22:13, 21 December 2014 (UTC)
- The ref says the "role of male circumcision overall in the prevention of HIV and other sexually transmitted infections among MSM remains to be determined"
- This means the same as "For men who have sex with men the evidence is less clear"
- Stop removing it. Doc James (talk · contribs · email) 23:06, 22 December 2014 (UTC)
Here is my argument that you can also find on my talk page.
The best literature review on this topic that I have seen on the page comes from the American Academy of Pediatrics Task Force on circumcision. If you check, they do not use info from the Cochraine study and only use info from the JAMA study. Their statement is: Circumcision seems to be less likely to protect MSM, however, and has not been associated with decreased acquisition of HIV among MSM. To me, it sounds like they are saying that male circumcision has not been associated with a decrease in HIV among MSM. This would be our most credible source on the topic as this has been done by Pediatricians, who understand how to analyze this type of medical research. These two studies on the page right now are good, but we also have this literature review which has analyzed one of these studies and others. In response to your statement on insertive anal sex: This would be good to put in the summary as it reflects a possible trend in the outcome of the trials. I think that our best option is to go with the AAP since our abilities in performing a literature review of these studies is questionable.
JohnPRsrcher (talk) 18:38, 23 December 2014 (UTC)
- What url, what source? Doc James (talk · contribs · email) 00:04, 24 December 2014 (UTC)
- This is what it says "The association of circumcision and the decreased likelihood of HIV acquisition applies to heterosexual males. Circumcision seems to be less likely to protect MSM, however, and has not been associated with decreased acquisition of HIV among MSM.61 There is fair evidence from 1 study that there is a protective effect of circumcision from HIV infection in MSM; however, this study used self-report to establish circumcision status.62 One study with fair evidence is neutral regarding the relationship between circumcision and HIV infection in MSM.61 It is probable that the differences found in the level of protection (or lack of protection) by studies of MSM are confounded by the fact that MSM commonly perform both receptive and insertive sex. It is not known to what extent circumcision may be protective against HIV transmission for MSM who practice insertive sex versus for those who engage in receptive sex."
- So all three sources now agree "the evidence is less clear". I do not know what the issues is? Doc James (talk · contribs · email) 02:35, 24 December 2014 (UTC)
John, Cochrane is not a "study", it's a meta-analysis. Doc has provided an accurate assessment of the summaries of the sources, which are all in agreement. Three good secondary sources in agreement is more than enough to support the statement.
Zad68
06:04, 24 December 2014 (UTC)
- What url, what source? Doc James (talk · contribs · email) 00:04, 24 December 2014 (UTC)
All three sources don't agree that "the evidence is less clear." I would like to refute this statement. The AAP clearly states "has not been associated with decreased acquisition of HIV among MSM." If you look at the source, in this statement the AAP is summarizing the evidence that they have reviewed thus far. This includes all statements after this said statement regarding the studies. One of meta-analyses that the AAP is citing is the one from JAMA. The findings from this study, which they reviewed, clearly were summarized in their initial statement. In addition, the AAP also found significant problems in some of the studies they were reviewing, which could be justifying this statement. For instance, see "however, this study used self report to establish circumcision status" for the first listed study that they reviewed." This came after the first study that they found, in "There is fair evidence from 1 study that there is a protective effect of circumcision from HIV infection in MSM."
Zad, your interpretation that all three studies agree that "the evidence is less clear" is incorrect. The AAP summarizes their literature review with the statement "has not been associated with decreased acquisition of HIV among MSM." The AAP performed a review of one of the other 2 studies. Instead, based on this analysis, that would mean that all 3 studies disagree with this statement since the AAP reviewed one of them and found no correlation, and since the Cochrane meta-analysis found no correlation.
Like I told DocJames, the AAP is clearly the most valid source to use since they performed a literature review of all the evidence to date. They are also doctors, so they have the experience that will allow them to make a statement on this topic. Since we are only wikipedia editors, we cannot say whether circumcision prevents HIV for homosexuals or not. This is up to the doctors with pediatrics. They have stated that "has not been associated with decreased acquisition of HIV among MSM," so we should be obliged to hold true to this statement. Since my rebuttal has found that all three studies show that "for homosexuals, there is no clear association", and that we are unable to state this since we do not hold the professional standing of the AAP, our stating of "the evidence is less clear" is clearly going against the consensus in the medical community.
JohnP 17:31, 27 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
- No, you still seem to be unaware or are confusing the fact that the AAP has produced two separate documents, a technical report and a policy statement. We're using one and not the other. They are not the same thing. A policy statement isn't categorized the same way as a literature review by the standard abstract indexing services like PubMed. And as Doc pointed out it's just one of several sources, and Doc made a point regarding the specialties you haven't addressed. As you're continuing to make these very basic errors regarding the sourcing it's very hard to have a productive conversation with you, sorry.
Zad68
04:42, 28 December 2014 (UTC)
Ok. I meant to say their technical report, not the policy statement. And it seems, based on what you just said, that you have not yet read my argument. Please review my argument and then get back to me.
Also, in response to your question about adressing the point that DocJames made. Yes, it seems that some studies in the medical community have shown that insertive and receptive anal sex have different degrees of protection. But this does not mean that the overall medical community has come to consensus yet over the issue, it still needs more research and studies to confirm.
The AAP makes note of this in their task force when they state: "It is probable that the differences found in the level of protection (or lack of protection) by studies of MSM are confounded by the fact that MSM commonly perform both receptive and insertive sex. It is not known to what extent circumcision may be protective against HIV transmission for MSM who practice insertive sex versus for those who engage in receptive sex." Just because it is probable does not mean it is confirmed. The AAP has performed a review of all of the literature to date on this topic and have made this conclusion. Since it is still unconfirmed and under review, this makes it unvalid for the page summary. We should be summarizing the overall protection for MSM, not an issue that is currently under review.
JohnP 16:20, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
One more point to make. This statement in the summary is inconsistent with the statements on HIV and MSM already in the article. In the section "Sexually Transmitted Diseases" it states "It is undetermined whether circumcision benefits men who have sex with men." It seems that reference numbers 42 and 12 both say that the effect is undetermined. This is not the same as the evidence is less clear.
JohnP 17:58, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
Question about sentence "Circumcision reduces the rates of HSV-2 infections by 28%"; Poor phrasing
Circumcision does not reduce the rate of HSV-2 infection, it has a preventative effect against this sort of infection. The phrase "reduce the rate" is not appropriate for this type of STI. To get HSV-2 you must have intercourse with an individual with this virus.
JohnPRsrcher (talk) 23:37, 15 December 2014 (UTC)
- Rate reduction is rate reduction even if it's an STI, I don't understand the objection. What is your suggested new wording?
Zad68
13:27, 16 December 2014 (UTC)
Before I get to that issue, I have one more regarding this sentence. This does not have proper citation from the literature. Source number 28 is an overall review of ways to prevent STI's. The only study it has supporting this statement is one study from Uganda, which is cited in its references. Upon observing the Pediatrics Task Force on circumcision, I did find one meta analysis on circumcision's effect on HSV-2 infection but its findings were not statistically significant. The Pediatrics Task force also cites 2 studies from Africa (Uganda and Orange Farm) where it seems to reduce HSV-2 infection, but also references two studies from New Zealand and North America that find no affect on HSV-2 infection.
JohnPRsrcher (talk) 14:56, 17 December 2014 (UTC)
One more problem I would like to present. While observing the study from Uganda from which we are presenting this number, I have found numerous differences in the population from Uganda with populations in other areas that could sway its result. Also, problems with the studies methods could have had a large impact. Firstly, the population differences. In the study, 2141 of the males were already HSV-2 positive at its start. This is 38.7 % of the population. Compare this to the US, where according to the Pediatrics Task Force on Circumcision, 16.2 % of individuals in this age range have this infection. In addition, from what I read in the study, one of the populations (trial 2) may have not been checked for AIDS. That means HIV positive individuals were undergoing this study. In the 2nd trial they didn't check HIV status. In trial 1 the actual data was 7.7 % infected (circumcised ) vs. 9.9% infected (uncircumcised). In trial 2 it was 8.6 % infected (circumcised) vs. 14.0 % infected (uncircumcised.) The number 28 percent was only come across after a statistical analysis ( mathematical manipulation ) of this data.
For the 2nd problem involving the methods: The way this study was carried out was by circumcising individuals and then checking in on them after a maximum period of 24 months, that is 2 years after the surgery, and then comparing them to uncircumcised individuals during this 2 year period. Isn't it true that these individuals would be healing, that is, not sexually active, during part of this period. Also, might it be possible that stress over the procedure may prevent them from partaking in intercourse for a longer time. I tried to find some data on the healing time of circumcision, but after searching 2 databases did not find any data. Since we don't have any data about the length of time that the circumcised males in this study would have been recovering, and therefore not acquiring HSV-2, I believe that this study may be in question.
JohnPRsrcher (talk) 15:07, 17 December 2014 (UTC)
- Generally when we have a high-quality secondary source from an authoritative body like the AAP, we don't try outdo them with our own analysis of the primary sources, this is covered at WP:MEDRS, please read WP:MEDRS. If you get your own secondary source published in a WP:MEDRS-compliant source we can consider using it, but until then... Does the current article content summarize the secondary source accurately?
Zad68
05:13, 18 December 2014 (UTC)
Ok. Sorry for writing all of that. I think that I was summarizing the article as I read it in this paragraph. To answer your question, the current article does not summarize the secondary source accurately. There is no data for "reduces the rates of HSV-2 infections by 28%". The meta analysis that is cited for the article has one study with data on HSV-2. Only one study does not constitute a meta analysis. This statement has to be taken down.
JohnPRsrcher (talk) 23:38, 18 December 2014 (UTC)
- Your claim "There is no data" is simply untrue. The source cited says "HSV-2 incidence was reduced by 28% (62) in the trials that assessed these endpoints." Some of your objections here are really unreasonable.
Zad68
13:26, 19 December 2014 (UTC)
The source states "HSV-2 incidence was reduced by 28% (62) in the trials that assessed these endpoints." If you go to #62, you will see that this is one study performed in Uganda. This is not a literature review. Your claim that "there is data" is correct. However, we don't have enough data on the page right now. This statement cannot be on the page according to wikipedia guidelines.
JohnPRsrcher (talk) 16:27, 19 December 2014 (UTC)
- OK, so you agree there is indeed data, great. There several other sources that cover HPV but I'm fine with the specific "28%" removed.
Zad68
05:21, 21 December 2014 (UTC)
Poor Phrasing : "and is associated with reduced rates of cancer causing forms of HPV and risk of both UTIs and penile cancer"
Hi. This sentence has poor phrasing. Circumcision is not associated with reduced risk of UTIs and penile cancer by doctors. According to the Padiatrics Task Force on Circumcision, this was mainly confirmed by looking over statistical studies. Since the change in UTI is only 7 to 14/1000 to 1 to 2/1000, I don't think that most doctors necessarily associate being circumcised with getting less UTIs. A similar analogy is: doctors tend to associate getting a flu shot with not getting the flu. Thats why they tell kids that they should get flu shots. If they don't get their flu shot the doctor might predict that they will come back in with the flu. I don't see pediatricians telling parents, "you better have him circumcised, or he'll be back in here with a UTI." The prevalence of UTI's is much too small for them to recognize that.
JohnPRsrcher (talk) 23:47, 15 December 2014 (UTC)
- The wording specifically states it's associated with a reduced rate, not that it causes it, per the source cited. This is further explained in the article body.
Zad68
13:27, 16 December 2014 (UTC)
I think the results of a study I was reading ( a meta-analysis) show that it reduces the risk of UTI. It isn't associated with a reduction in risk of UTI, it just reduces the risk of UTI.
JohnPRsrcher (talk) 02:32, 18 December 2014 (UTC)
I'm going to expand on my prior statement. As of now I cannot observe the references for the part on HPV (as they are poorly cited in the article, I don't know what journal they're coming from) but I have read over the information from the pediatrics task force on HPV. According to task force HPV has not been found to reduce the rate of cancer-causing HPV, the studies it has all indicate that it reduces the detection of HPV on certain areas of the penis. 2 studies from Africa(cited as the most important ones by the task force) both show that there is a reduced rate of infection, not the overall rate. Since we cannot say for sure that it reduces the rate of infection, we can say that it is associated with a reduction in the rate of infection (but not overall rate) based on this data.
In regards to UTI, it is not associated with a reduction in the rate of UTI. According to population statistics it reduces the rate of UTI by a certain fraction.
For penile cancer, it is associated with a reduction in penile cancer, and this is correct. There is not substantial evidence to show that rate goes down just because of circumcision but connection of HPV and penile cancer causes this trend.
JohnPRsrcher (talk) 01:07, 19 December 2014 (UTC)
- The content in the article is supported by the sources cited. The relationship between the oncogenic type of HPV and penile cancer is already covered in the article.
Zad68
13:26, 19 December 2014 (UTC)
Medical Jargon in Summary, should Replace.
Words in the summary may be too complex for the common reader to understand. See sentences:
1.The procedure is most often elected for religious reasons or personal preferences, but may be indicated for both therapeutic and prophylactic reasons. Words (to fix): Therapeutic and prophylactic. 2.Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision. Words : Therapeutic 3. Circumcision reduces the rates of HSV-2 infections by 28%, and is associated with reduced rates of cancer causing forms of HPV and risk of both UTIs and penile cancer. Words: UTI, HPV, HSV-2. 4. A 2010 review of literature worldwide found circumcisions performed by medical providers to have a median complication rate of 1.5% for newborns and 6% for older children, with few cases of severe complications Words: median complication rate.
JohnPRsrcher (talk) 04:00, 18 December 2014 (UTC)
- I think finding more common words to replace "therapeutic" and "prophylactic" would be fine. For abbreviations for specific conditions and viruses, there are Wikilinks.
Zad68
05:13, 18 December 2014 (UTC)
Question. It is difficult to find common words to take the place of these. Instead should use a short phrase
JohnPRsrcher (talk) 02:34, 19 December 2014 (UTC)
- I'll work on this.
Zad68
13:26, 19 December 2014 (UTC)
Missing Information in summary: Adult Circumcision more Risky then Child Circumcision according to WHO
According to WHO report on circumcision, adult circumcision carries higher risk of bleeding, haematoma, and sepsis then child circumcision. Missing information of these risks on page summary (only covers child and infant risks.)
JohnPRsrcher (talk) 04:06, 18 December 2014 (UTC)
- The lower risk level and complication rates of the procedure in infants vs. adults is repeated enough across the sourcing that this is probably warranted to summarize briefly in lead.
Zad68
05:13, 18 December 2014 (UTC)
Request for aid: I cannot access the source : McClung, Chris; Voelzke, Bryan (2012). "Adult Circumcision". In Bolnick, David A.; Koyle, Martin; Yosha, Assaf. Surgical Guide to Circumcision. London: Springer. pp. 165–175. doi:10.1007/978-1-4471-2858-8_14.ISBN 978-1-4471-2857-1. Retrieved April 6, 2014. (subscription required (help)).
Do you know how I can get access to add to summary as well as section about risks of adult circumcision.
JohnPRsrcher (talk) 00:29, 22 December 2014 (UTC)
Poor citation : #16
- 16 is 3 citations in one. It is hard to read and is confusing.
JohnPRsrcher (talk) 00:52, 19 December 2014 (UTC)
Unneeded Sentence: Routine circumcision, however, is not justified for the prevention of those conditions.
This sentence is unneeded. The focus of this article is not the prevention of urinary tract infections and penile cancer. Should be on circumcision. Basically it is similar to stating: "circumcising all children would not prevent all penile cancer or urinary tract infections."
JohnPRsrcher (talk) 01:16, 19 December 2014 (UTC)
- No it is saying the degree of benefit is not sufficient to recommend routine circ. Doc James (talk · contribs · email) 02:34, 19 December 2014 (UTC)
Doc is correct, please read the sources cited more carefully.
Zad68
13:26, 19 December 2014 (UTC)
Poor Position of Sentence: The WHO recommends considering circumcision as part of a comprehensive HIV program in areas with high rates of HIV, such as sub-Saharan Africa, where studies have concluded it is cost-effective against HIV.
This sentence is poorly positioned. The medical community seems to agree that the benefits of circumcision are most relevant in southern Africa. According to WHO in report on circumcision: "There is increasing demand for male circumcision in southern Africa and future expansion of circumcision services must be embedded within comprehensive HIV prevention programming, including informed consent and risk-reduction counselling." Individual countries differ on their encouragement of circumcision depending on prevalence of circumcision and attitude towards it. According to AAP Task Force on circumcision: "The Task Force concluded that the health benefits of newborn male circumcision outweigh the risks and justify access to this procedure for families who choose it." However, according to the Royal Australian College of Physicians in 2010 statement on circumcision: "After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand." Both organizations seem to agree that the benefits or consequences are small enough that the parents should make the final decision. To justify this, according to AAP Task Force: "Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families." According to Royal Australian College: "However it is reasonable for parents to weigh the benefits and risks of circumcision and to make the decision whether or not to circumcise their sons." The majority of current literature seems to indicate that there can be a slight benefit or risk for individual countries based on the demographics (overall prevalence of STIs) and costs of procedure. The primary benefit in regard to HIV and STIs is emphasized on Southern Africa. This sentence should be in the lead to indicate that the primary health benefits of circumcision apply to Southern Africa.
JohnPRsrcher (talk) 15:46, 19 December 2014 (UTC)
Allow me to summarize my prior statement. The consensus of the literature available to us on the page right now seems to be indicating that the benefit for HIV is greatest in areas of southern Africa. In addition, all of the research we have on HIV is only applicable to African populations. It is still undetermined whether it benefits populations in developed countries. This is supported by the statements in the article under "Human Immunodeficiency Virus." We should have this sentence placed first, before the data on HIV, so that the summary is consistent with the rest of the article and the sourcing.
JohnP 18:05, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
Circumcision is associated with reduced rates of cancer causing forms of HPV : Poor representation of the literature and a poorly cited statement.
This statement is a poor representation of the literature. If you read the AAP Task force on circumcision they seem to be arguing that "There is good evidence that male circumcision is protective against all types of HPV infection." They use two groups of studies to justify this claim. For the first group of studies, the task force does note that they show a protective effect and a reduced prevalence, but also states that "these studies fail to provide information on the risk of acquiring HPV and may reflect persistence of HPV rather than acquisition of infection." And also that "The selection of anatomic sites sampled may influence the results." This suggests that the medical community is still questioning the results of these studies. The studies that the task force seems to be putting the most emphasis on, that is, using the most to justify their claims, is the two large randomized control trials in Africa in Uganda and Orange Farm, South Africa. The methods of these studies made them ideal for showing a correlation between infection and circumcision, and this is why the task force seems to be relying the most on them for their statement.
The two studies that are currently cited are insufficient to use to represent this information. Larkes meta-analysis observed the prevalence of infection of certain areas of the penis while comparing circumcised to uncircumcised males in order to make its argument over prevalence. The same study by Larkes states near the beginning that " systematic review of studies published to March 2006 found no evidence of an association between circumcision and genital HPV (OR, 1.20; 95% CI, 0.80–1.79) . However, this review was criticized methodologically, and a reanalysis of the same studies found a strongly protective effect (OR, 0.56; 95% CI, 0.39–0.82) . An updated meta-analysis using the same search strategy and including studies published to September 2007 found a similar effect (OR, 0.52; 95% CI, 0.33–0.82) ." It seems that the medical community is still not at consensus over recent circumcision studies. The conclusion of Larke's study was: "Circumcised men are at substantially lower risk for prevalent genital HPV infection than non-circumcised men. Few studies assessed the effect of circumcision on HPV incidence or clearance, but data suggest strong evidence of an effect of circumcision on reducing HPV incidence and weak evidence of an effect on increasing HPV clearance. There was no evidence of an association of circumcision with genital warts. " It seems that the main conclusion that he had was that the infection rate went down, this is consistent with the statement by pediatrics. In Rehmeyer's study, he remarks that "Most of the research about HPV and male circumcision has been observational in nature and was conducted in the past 10 years. These investigations are extremely varied in sampling technique, HPV detection method, and the stage of infection under study, making them extremely challenging to review." With regard to what the studies are actually observing, he states that "Most studies have been limited to reporting HPV prevalence data. Because disease prevalence is a product of both the incidence and duration of infection, it does not demonstrate whether circumcision is influencing the acquisition of HPV, the ability of the host to clear the infection, or both. " Rehmeyer's study was not a meta-analysis but a literature review of studies involving circumcision and HPV. From what I read, it seems his main conclusion was that it reduces the incidence of infection. However, it seems he was the only author of this study (is subject to selection bias.)
Both of these studies that are currently on wikipedia state that there have been different conclusions found by meta-analyses in the past 10 years, and Rehmeyer notes that most of the data is difficult to analyze due to inconsistent methodology. The Pediatrics Task Forces statement seems to best represent the literature at this point.
JohnPRsrcher (talk) 19:12, 20 December 2014 (UTC)
- As you note, the AAP technical report says "There is also good evidence from randomized controlled trials that male circumcision is associated with a lower prevalence". The sources cited discuss this, that the reduced prevalence is likely from increased clearance of the virus by the body as opposed to decreased incidence. The Misplaced Pages article is careful to explain this in the Human papillomavirus. Are you suggesting an edit?
Zad68
05:21, 21 December 2014 (UTC)
Yes. The AAP also notes flaws in the studies observing prevalence, stating that "These studies fail to provide information on the risk of acquiring HPV and may reflect persistence of HPV rather than acquisition of infection." Larke and Rehmeyer also both note that there has been difficulty in determining an outcome of the data. Rehmeyer states that most of it has been obtained in the past 10 years. Both the AAP and the RACP (Australia) both note that circumcision is protective against HPV infection. I recommend that we change it to "circumcision is protective against HPV infection, and is associated with a reduced risk of UTI and penile cancer."
JohnPRsrcher (talk) 01:10, 22 December 2014 (UTC)
I have found many policy statements and technical reports from other countries with info for page
After going to cirp.com I found many links to other countries policy statements. Most of them are available on those organizations websites, but some (as of now) are only available on cirp. After christmas it is possible to contact these organizations in order to obtain these documents. These include the Royal Australian College of Physicians, which is "is a not-for-profit professional organisation responsible for training, education, and representing over 13,500 physicians and paediatricians and 5,000 trainees in 25 medical specialties in Australia and New Zealand." The Royal Dutch Medical Society. The Canadian Paediatric Society. The College of Physicians and Surgeons of British Columbia (CPSBC). The Central Union for Child Welfare in Finland. The Medical Ethics Comitee of the British Medical Association. The British General Medical Council (a body that regulates medical care in the United Kingdom.) The British Association of Pediatric Surgeons. And also more. These can be added to page to help support or add to statements "The positions of the world's major medical organizations range from considering neonatal circumcision as having no benefit and significant risks to having a modest health benefit that outweighs small risks. " and "No major medical organization recommends either universal circumcision for all infant males (aside from the recommendations of the World Health Organization for parts of Africa), or banning the procedure. Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision." They can also be used extensively for further sections as many include cost analyses of circumcision benefits for individual nations, and consensus of the literature for different medical societies.
JohnPRsrcher (talk) 22:11, 21 December 2014 (UTC)
- Linking to cirp is not allowed because they violate several Misplaced Pages sourcing principles, including violating copyright. Why would you be looking at a self-published advocacy website like cirp anyway for editing Misplaced Pages?
There are hundreds of medical organizations around the world that could have policy statements, they're of widely varying quality in support of their position statements, and all over the place in terms of authority and influence. This article cannot possibly carry statements from all of them, and put them in the proper context and weight in doing so. Luckily we do not have to argue over whether this or that policy statement qualifies as "major" or not, the Bolnick source has a chapter that surveys the available policy statements and covers the major ones.
It's possible that Misplaced Pages could carry an article simliar to Circumcision and law, maybe called Circumcision by country, which could feature "highlights" from all the many medical organizations.
Zad68
22:28, 21 December 2014 (UTC)
I disagree. Many of them seem major. The RACP is a major representative of physicians in Australia and also New Zealand. Also, the Pediatrics Society of Canada represents all of Canada. Not to mention, we're already using the American Task Force (i.e a policy statement) for most of our material. Zad, I highly disagree. These policy statements all include reviews performed by medical practitioners in respective countries. Neglecting their information will make this page North American and not universal.
JohnPRsrcher (talk) 22:44, 21 December 2014 (UTC)
Also. I'm not using cirp because its bias, I'm using it because its very useful. Fortunately it contains a lot of information on the topic, including many policy statements done by major organizations on circumcision.
JohnPRsrcher (talk) 22:48, 21 December 2014 (UTC)
- Although it might "seem major" to you it's better to use an academic secondary source that covers the topic, right? We are not using any policy statement from any American medical organization to support any biomedical statement, perhaps you are confusing the Technical Report, which is a literature review and analysis we do use, with any policy statement.
Zad68
01:21, 22 December 2014 (UTC)
I do not request for these to support biomedical statements. Rather, for the statements we have in the article on circumcision policy and current developments related to circumcision. Similar to the America Task Force, many of these are literature reviews as well. In Neonatal Circumcision Revisited, by the Canadian Paediatric Society, they note in the beginning: "The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed." This information would be valuable for us as it represents a review of literature with respect to Canadian demographics. The KNMG, the royal dutch medical association, notes that : "This viewpoint was formulated following consultation with relevant scientific organisations, who also support this stance. This ensures that this viewpoint has a broad basis of support from the relevant professional associations." They also state that: "This viewpoint by the KNMG is jointly endorsed by the following scientific associations: π The Netherlands Society of General Practitioners π The Netherlands Society of Youth Healthcare Physicians π The Netherlands Association of Paediatric Surgeons π The Netherlands Association of Plastic Surgeons π The Netherlands Association for Paediatric Medicine π The Netherlands Urology Association π The Netherlands Surgeons’ Association" It seems that the Dutch have also performed a scientific review, by representing a scientific consensus collected from all of these associations representing the persons within their country. Similarly, the RACP (Australia and New Zealand) notes that: After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.
It seems that most of these policy statements made available to us by cirp are in fact literature reviews, done based on unique demographic factors for individual countries.
JohnPRsrcher (talk) 18:46, 22 December 2014 (UTC)
- A policy statement is not a literature review. We are not using the policy statement from the AAP.
Zad68
06:04, 24 December 2014 (UTC)
A literature review is a review of the literature by a specific organization. In this case, the Canadian article, the Australian article, and the Dutch article all indicate that their Major Pediatric Organizations have all performed literature reviews in order to determine the extent of the effect that circumcision has on their populations with respect to certain diseases (such as UTI, penile cancer, etc.) These articles are of the same type as the American Task Force (which is a technical report) since they include a summary of the populations policy statement in the summary, and then a long review of the effect circumcision has on a multitude of diseases as well as other factors (such as ethics.)
I'm sorry Zad but these are not policy statements, they are technical reports from major organizations in Pediatric literature. Their literature reviews on different effects for circumcision (such as UTI, penile cancer, etc) should be made valid for this page.
JohnP 01:10, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
Note that they also include a lot of literature reviews and meta-analyses that I was not made aware of, which could aid in the construction of this page. These are unique to different populations living in these countries. These are all cited throughout the papers and in their references.
JohnP 01:12, 28 December 2014 (UTC)
- It's very hard to see how a medical ethics textbook covering exactly this question can be found not to support the subject it's covering.
Zad68
04:42, 28 December 2014 (UTC)
Lets cut to the chase here though with regard to the technical reports. Can we use these technical reports? They give a lot of good info of other countries interpretations over the findings on circumcision. For instance, the Australian one has their one consensus on HPV, along with references that are of value, similar to the one from the American Task Force. These references are studies that may have been performed in Australia or nearby, and could widen the amount of sourcing we have for the page so that it better represents world literature.
JohnP 19:04, 28 December 2014 (UTC)
JohnP 19:04, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
Sentence "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision." Does not properly represent world lliterature.
Hi, this sentence has been cited based on a textbook and study published in North America. Many medical organizations have issued policy statements on circumcision that present their understanding of the questions that have been raised over circumcision. These include the Royal Australian College of Physicians (which represents pediatric physicians in Australia and New Zealand,) the Royal Dutch Medical Society, the Canadian Paediatric Society and organizations for individual provinces in Canada, the Central Union for Child Welfare in Finland, etc. Issues that they present do not only include ethical and legal questions over informed consent but also a human rights violation. Proposal to add these support references and do a further review to best represent literature?
JohnPRsrcher (talk) 22:41, 21 December 2014 (UTC)
- The textbook cited is published by Cambridge University Press, which is based in the UK and not North America. The individual policy statements of various societies are primary sources for the views of those societies. I actually did not see, for example, the CPS statement had a mention of "human right" anyway. The university textbook cited instead provides an overview of the ethical discussion. What is better is a non-agenda driven, academic overview of various arguments involved.
Zad68
01:19, 22 December 2014 (UTC)
Canada does recognize that groups are questioning human rights, in their statement: “Groups opposed to neonatal circumcision have been formed and have become visible lobbyists (for example, the National Organization to Halt the Abuse and Routine Mutilation of Males, San Francisco, and the National Organization of Circumcision Information Resource Centers based in San Ansel mo, Calif., with branches across the United States and in Canada and other countries) .”
In response to your statement I have done a review of all literature on both sides. First off, I would like to question the textbook and the study already on wikipedia. This textbook only has one chapter on circumcision and this procedure is not its primary focus. It states that two debates have been raised over circumcision: 1. whether circumcision of newborns should not be routine. And 2. whether non-thereapeutic circumcision should be performed at all. This is different then the statement which is already on Misplaced Pages, as it does not only concern informed consent and autonomy. Based on this statement, if the procedure really shouldn’t be performed at all, then it could be interpreted as violating human rights if it is painful and causes any lasting damage. Also note that, from what I could see on google books all of the sourcing for this textbook was from North America and the UK. For the second source by Kirk Pinto called Circumcision Controversies , the main focus of his article does not seem to be to identify overall questions regarding the procedure, as his conclusion is rather obscure and calls for more information. The first statement of his article summary is: “The ultimate fate of neonatal circumcision is as obscure as its origin. Despite the exhaustive research on this fascinating subject, the lack of consensus calls for even more unbiased study”. He also states that “If medical research does not answer the outstanding questions about circumcision, clinicians should be aware of the sobering reality that there are legal and socioeconomic forces marshaling eager to answer these questions for us.” Neither of these studies have done considerable reviews of world populations to determine overall questions regarding the procedure; they both had short statements regarding their observations on the questions that are being asked. Their justifiability for this statement comes most from an overall impression made on medical professionals and not an impression made from demographic data.
For my second argument, I would like to observe the nature of the statement: "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision." This statement is merely recognizing questions that have been raised (by a considerable population) about the procedure. From what I have read from the textbook and study, these both seem to give a good impression of the questions that have been raised, but both of them did not do a considerable review of this topic. They were also both limited to North American populations.
With regard to the new policy statements made available to us by cirp, I would like to remind you that most of these are literature reviews that have been conducted with respect to their own countries. In addition, according to cirp these constitute all policy statements made by English speaking nations (although this isn’t credible and must be further reviewed.) Most of these countries have done a review of literature and cost based analyses before publishing their results. The fact that almost all of them (Australia, New Zealand, Canada, and the British Medical Association) are stating that they are aware of the fact that groups are questioning whether this is a human rights violation, should make this question one of prominence for the page. In addition, one group, The Central Union for Child Welfare in Finland, which represents many NGOs and municipalities, is raising the question of whether this violates the boys physical integrity. This is similar to stating it is a human rights violation.
In regard to your statement on we should be using a non-agenda driven academic overview. I think that this should be our goal, but I don’t think that our current sources have fulfilled this purpose.
JohnPRsrcher (talk) 18:10, 23 December 2014 (UTC)
- Please don't use this article Talk page to air your own interpretations and views on this topic.
Regarding "Ethical and legal questions ... have been raised" -- Yes, Misplaced Pages reports on the arguments, it does not engage in them. You have found instances of individual advocacy groups or societies engaging in these sorts of arguments, so the statement is supported, just like the source says. And again, a policy statement isn't generally looked upon as a literature review.
Zad68
06:04, 24 December 2014 (UTC)
Yes thats true. But I don't think that I aired my own interpretations and views on the topic. I was reviewing the sources that are already on the page and then I suggested that we use the technical reports from the US and other countries (sorry I should have said technical reports originally; these are technical reports, not policy statements) to indicate questions that have been raised.
First, lets cover the sources already on the page. The first source is a case based textbook that has the purpose of educating doctors of how to react in the case that they are asked to perform a circumcision. Its primary purpose is not to inform the reader of questions that are being raised by all people about this procedure. It does have a short paragraph on this topic, where it states "2 debates surround circumcision. Whether it should be routine or whether it should not be performed at all." This cannot support the statement "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision." because it isn't saying that at all. Its stating that the debate is asking whether it is needed.
The second source covers circumcision controversies, but it only has one author. This isn't a literature review. The source's primary goal is to recognize circumcision controversies that exist in the medical field. Because of that, it is not sufficient to represent questions that arise over the procedure from common people. This makes it a poor source for the statement. It does note that controversy in the medical field exists over informed consent and the parental role; which is stated in the article. However, questions raised in the medical field are not the same as questions that are raised overall. It does have a few statements about questions that are raised by different groups in society. It states "Ethicists, lawyers, philosophers, and members of anti-circumcision groups also have concerns about the legal and moral issues surrounding the operation" and "Opponents of newborn circumcision argue that the loss of foreskin during circumcision, in itself, is an irreversible and unnecessary harm and that parents cannot consent to procedures that do not benefit their child."
The current sourcing is insufficient to represent the statement "Ethical and legal questions regarding informed consent and autonomy have been raised over non-therapeutic neonatal circumcision.". We need a better source that does a review of questions asked in the overall community over the procedure.
JohnP 02:41, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
Bias Wording: Intervention above Picture of Circumcision being Performed
Hi,
the content of this article makes it unclear as to whether circumcision is appropriate as a medical intervention or not. See the statements "The positions of the world's major medical organizations range from considering neonatal circumcision as having no benefit and significant risks to having a modest health benefit that outweighs small risks." and "Neonatal circumcision is often elected for non-medical reasons, such as for religious beliefs or for personal preferences possibly driven by societal norms." Adding the title "Intervention" above the painting may distract readers from the overall theme of the article and cause misinterpretation.
JohnPRsrcher (talk) 18:44, 23 December 2014 (UTC)
- This article summarizes what the medical sources say, which is that it is indicated for presenting medical need in a few cases. Only a patient working with a physician can decide whether it's an appropriate intervention in each individual case, it is not Misplaced Pages's role to make that kind of recommendation, see WP:MEDICAL.
Zad68
06:04, 24 December 2014 (UTC)
Yes, this is true. But do you know why the word "intervention" is over the picture of the infant being circumcised? If it isn't the title of the picture then there's really no reason for it to be there.
JohnP 02:45, 28 December 2014 (UTC)
- Because it's in the Misplaced Pages category of intervention, like procedures and drugs, as opposed to another topic like disease or condition, this is standard categorization for articles with infoboxes in Category:Medicine_infobox_templates.
Zad68
04:42, 28 December 2014 (UTC)
Question about Statement: A 2010 review of clinical trial data found that circumcision reduced the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28% under "Other Infections"
I already reviewed the sourcing for this statement and found that the source was not a literature review and was only supported by one study. I had to review the same statement from the summary. Support to remove this statement?
JohnP 02:50, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
Some useful pointers for 2015 improvement of this article.
Circumcision questions
Imagine a new wikipedian reading this article .
She might ask
1/ how many males or females get circumcised every year?(8 year old figure in article !) What percentage of these have no choice in the matter ?
2/ What is the breakdown per country ?
3/ How many circumcisions are conducted in aseptic conditions by medically competent personnel ? How many are botched despite such precautions ?
4/ How many are conducted in other more dangerous circumstances ? If it is the most common “procedure” in the world – why are these and other statistics missing in the article ?
5/ What percentage of those getting cut are forced adult circumcisions ?
6/ What do cutters do with the cut off foreskins ?
7/ For those circumcised foreskins sold for cosmetics and for medical use and research what is involved ?
8 How much does it cost to buy a cut off foreskin ? Is this profit deducted from the bill given to parents of circumcised infants?
9 What is the fee charged in different countries by circumcisers per circumcision ? 10 How many cases of circumcised adults suing those who cut off their foreskin as children have occurred and how many have been won ?
11 Has the popularity of circumcision declined ?
12 Is there a concerted and sustained effort underway to keep this article unbalanced ? 13 There are groups of doctors and other groups who campaign in opposition to the practice of circumcision on many grounds – why do they go unmentioned ?
This article in its present deplorably defective selective state answers none of these questions fully or at all in most cases. Perhaps in 2015 we can set about making this article better by tackling these omissions and the other poor, selective and unbalanced content, structure and tone.--— ⦿⨦⨀Tumadoireacht /Stalk 13:45, 28 December 2014 (UTC)
User Doc James has just started an edit warring
I've brought several references of the major articles about the loss of sensivity caused by circumcision. Doc James deleted them without explanation. That unfriendly behaviour is against the rules and I'm askinf for protection. Michel Hervé Bertaux-Navoiseau (talk) 15:19, 28 December 2014 (UTC)
You can't have references up that don't support anything. It's against the wikipedia rules.
JohnP 16:23, 28 December 2014 (UTC) — Preceding unsigned comment added by JohnPRsrcher (talk • contribs)
New Literature Review on Circumcision: Review of the Current State of the Male Circumcision Literature
This literature review is titled "Review of the Current State of the Male Circumcision Literature" and it is from the Journal of Sexual Health. It does a review of much circumcision literature to date. Its conclusion is: Further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America. You can gain access through the British Journal of Urology or the Journal of Sexual Health.
JohnP 16:27, 28 December 2014 (UTC)
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