Talk:Circumcision/Archive 52

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Recent edits to intact penis caption

I oppose this edit. The caption is an inappropriate place for the information, which besides seeming a bit glowing and unencyclopedic (one might even say "brochure-like," potentially violating Wikipedia's neutral point of view policy), is uncited. Also, the reasons given by the IP editor for the multiple reversions seem somewhat contradictory: can it be true both that "it is a common misconception that a circumcised penis and an uncircumcised penis are exactly the same when erect"[1] and that "What is stated is common knowledge to the vast majority of the world's men and women?"[2] In any case, if both those statements are each true to an extent, then surely reliable sources may be found that put any misconceptions to rest. Blackworm (talk) 07:41, 27 November 2008 (UTC)

I agree with Blackworm. See Wikipedia's verifiability policy. I note the above comment as a sign of neutrality on Blackworm's part.^{(23:46, 27 November 2008 (UTC))} ☺Coppertwig(talk) 14:17, 27 November 2008 (UTC)

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

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

Archive guide, and FAQ

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

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

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

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

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

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

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

Ethical Issues Image

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Re this edit by Usergreatpower:

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

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

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

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

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

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

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

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

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

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

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

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

Not a gender-exclusive topic

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

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

Problematic addition to 'history'

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

For reference, the addition consists of the following:

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

“ A remedy for masturbation which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. ”

There are several problems:

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

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

Fully disagree with all points except Typographical splendour:

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

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

Thank you for your comments, Blackworm.

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

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

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

• "In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation.[170] For example, [reliable secondary source] cites an influential 1888 work by Kellogg, arguing that circumcision was a remedy for masturbation that was "almost always successful" in young boys.[ref]"

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

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

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

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

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

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

Have a look at this: [3] It is clear that Kellogg is mentioned in many scholarly articles on circumcision and its history. If you prefer, I will use one of these secondary sources to illustrate essentially the same point, that at least one prominent and influential person, at the time of routine male circumcision's rise in popularity in the West, openly stated that the pain induced by male circumcision was beneficial in a punitive and preventative capacity (that is, preventative of masturbation) -- exactly as frequently commented on by the scholarly sources. Blackworm (talk) 04:10, 10 December 2008 (UTC)

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

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

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

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

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

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

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

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

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

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

(Outdent.) I made this edit summarizing Kellogg's view via a secondary source. I hope it is seen as satisfactory. Blackworm (talk) 07:05, 17 December 2008 (UTC)

Ok, thank you for finding a secondary source.

Let's review some secondary sources:

• Gollaher does not mention Kellogg.
• Dinsmuir & Gordon do not mention Kellogg.
• Aggleton dedicates two short paragraphs to Kellogg (on p19) among 21 pages of text.

Given that this article is in summary style, and must briefly summarise historical reasons for circumcision, it seems disproportionate to include such lengthy treatment. I've edited it to reduce the excessive weight, but this still seems problematic. A better solution, I think, is to move this material (in its original form) to the detailed article, where there is room to include such material without it seeming to dominate the coverage. Jakew (talk) 10:23, 17 December 2008 (UTC)

Completely disagree; this material is weighted appropriately. If length is a concern, the paragraph following this one, which goes into enormous detail about prevalence in the U.S. during the 1900s, could be trimmed or removed instead. I'll make the change. Blackworm (talk) 16:47, 17 December 2008 (UTC)

Excellent point Blackworm. Garycompugeek (talk) 16:51, 17 December 2008 (UTC)

I'm willing to accept Jakew's edit as it stands as a compromise between our varying views of appropriate weight. A more detailed treatment can go into the appropriate subarticle(s). I hope you will agree, Jakew, and regardless of whether you do I'd like to thank you for not having reverted completely in that instance despite your reservations. Blackworm (talk) 04:39, 18 December 2008 (UTC)

As you acknowledge, Blackworm, I do have some reservations, but I think it is an tolerable compromise. Jakew (talk) 13:53, 18 December 2008 (UTC)

To Usergreatpower: you've reverted twice to your initial version, and once to Blackworm's version. On all three occasions, you've claimed that there is a consensus for this material to stay, which is perplexing since of the five editors (including myself) who have participated in this discussion, Jayjg and Coppertwig have expressed being persuaded by one or more of my arguments, and Blackworm and I seem to have reached a compromise which you just reverted. If anything, then, the most likely candidate for a consensus version seems to be that which you just reverted. Since your edit summary gave only this erroneous interpretation of consensus as a rationale for your edit, I wonder whether you have any content-based reasons for it? Jakew (talk) 13:53, 18 December 2008 (UTC)

Jake it seems you have a great aversion to the quote about circumcising without anesthesia to cause pain on purpose. I think its a nasty thing to do also but it's still a relevant sourced fact. Garycompugeek (talk) 23:05, 18 December 2008 (UTC)

No Gary, Jake is rightfully concerned about the word count, and has agreed to a compromise that includes this information succinctly, including the lack of anaesthesia favoured by Kellogg. Blackworm (talk) 23:44, 18 December 2008 (UTC)

Just because you two worked out a compromise doesn't mean I agree with it, however I will not revert again if no one else agrees with me. Garycompugeek (talk) 00:00, 19 December 2008 (UTC)

Re Kellogg:

• Do we have evidence that Kellogg's views are representative of a significant segment of society at the time, i.e. significantly more than just the one persson?
• Do we have evidence that Kellogg's views on this were significantly influential?
• Do we have evidence that Kellogg's views have been cited a notable amount in the more reliable sources?

If the answers are no, no and no, then I think the reference to Kellogg should be removed from this summary article. ☺Coppertwig(talk) 22:30, 20 December 2008 (UTC)

TotallyDisputed tag

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

• Removed from the introduction:

The frenulum may be cut at the same time, in a procedure called a frenectomy[4]

[5]

• Removed from Procedures:

The frenulum is cut frenectomy if frenular chordee is evident.[6]

[7]

• Fact removed from Complications:

Chordee of the glans may be the result of circumcision.[8]

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

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

“Meatal stenosis is generally a direct consequence of circumcision that is seldom encountered in uncircumcised men; meatal calibre is know to be greater in uncircumcised individuals. The incidence of meatal ulceration following circumcision is from 8 to 20 per cent14,46,64. The aetiology is thought to be irritation of the external urethral meatus by ammoniacal substances present in wet sodden nappies. Such irritation is unlikely in the presence of a normal prepuce, which serves to protect the glans from these irritant substances46. In a prospective study of 140 consecutive neonatal circumcisions, Mackenzie64 found a 20 per cent incidence of meatal ulceration within the first 2-3 weeks after circumcision. It is thought that meatal ulceration after circumcision is the initiating event in a vicious cycle of stenosis and ulceration, followed by more stenosis64. Meatal stenosis following circumcision has been advanced as a cause of recurrent pyelonephitis and obstructive uropathy, for which meatotomy is curative64,65.”[10]

“Meatal stenosis is an under recognised complication of circumcision done in neonatal and nappy aged boys. Symptomatic presentation from meatal stenosis can be very late (two years).” [11]

“Traumatic meatitis of the unprotected post-circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis. CONCLUSION: Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.”[12]

• Gross propaganda:

The Circumcision topic in Wiki leads the reader to believe that the covenant made with Abraham (note the “commandment from God” sentence in the second paragraph) was the current radical practice (in that it removed the covering of the glans). In fact, we find "the circumcision which Abraham performed on himself and other male members of his household was the removal of the tip of the prepuce.” This tip of the prepuce removal circumcision was practiced by Jews and Muslims for thousands of years.[13][14][15] This simple (Milah) procedure resulted in much less pain and erogenous nerve loss than the current Bris and Sunnet practices.

• Removed from complications, and UTI:

"An epidemiological study of UTI during the first year of life involving 169 children born in Israel found that 48% (27/56) of the male infants presented with UTI within 12 days after ritual circumcision.51 The incidence of UTI among male infants was significantly higher just after circumcision (from 9 to 20 days of life) than during the rest of the first month of life and significantly higher in the first month of life than during the rest of the year. After the immediate postcircumcision period, the incidence rate of UTI dropped to a level comparable to that reported among circumcised male infants in the United States."[16]

• Removed from Pain:

Without exception, newborns in this study who did not receive an anesthetic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk. Two of 11 newborns in the study who received no local anesthetic had potentially dangerous episodes within minutes of the procedure. One newborn lost muscle tone, stopped breathing several times and vomited. The other choked and stopped breathing briefly, the researchers said.[17]

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

“Circumcision at 5 months results in significantly fewer serious complications than circumcision in the neonatal period, irrespective of the method used. Therefore, neonatal circumcision should not be recommended.” [18]

• In the third paragraph we read … “Arguments for circumcision are that it provides important health advantages which outweigh the risks, that it has no substantial effects on sexual function, has a complication rate of less than 0.5% when carried out by an experienced physician, and is best performed during the neonatal period.[12]. Problem is, the medical community disagrees (finds factual fault) with the statements made by Schoen. Schoen states personal opinion, then cites a study on adult circumcision (thus not relevant to infant or toddler circ results) to claim no sexual effects, then references himself to claim a complication rate! Wiki should not call such subjective information “arguments for circumcision,” and should not use disreputable stats.

• Obscured from the reader:

Wiki should link to the actual Sorrell’s study.[19] Circumcision currently links to a very short summary. We should also convey the essence of their findings:

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

…”Circumcision removes the most sensitive parts of the penis and decreases the fine-touch pressure sensitivity of glans penis. The most sensitive regions in the uncircumcised penis are those parts ablated by circumcision. When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis (the rim of the preputial orifice, dorsal and ventral, the frenulum near the ridged band, and the frenulum at the muco-cutaneous junction) that are missing from the circumcised penis were significantly more sensitive.”[20]

• Removed from sexual effects:

“While vaginal dryness is considered an indicator for female sexual arousal disorder,1,2 male circumcision may exacerbate female vaginal dryness during intercourse.3 O’Hara and O’Hara reported that women who had experienced coitus with both intact and circumcised men preferred intact partners by a ratio of 8.6 to one.4 Most women (85.5%) in that survey reported that they were more likely to experience orgasm with a genitally intact partner: ‘They [surveyed women] were also more likely to report that vaginal secretions lessened as coitus progressed with their circumcised partners (16.75, 6.88–40.77).’4”[21]

• Removed from sexual effects:

“Presence of the movable foreskin makes a difference in foreplay, being more arousing to the female.4 Women reported they were about twice as likely to experience orgasm if the male partner had a foreskin.4 The impact of male circumcision on vaginal dryness during coitus required further investigation.”[22]

• Removed from sexual effects:

“These preliminary figures support the claim by Morgan [1 and 2] that vaginal intromission is easier with a (retractable) foreskin in place. The mechanism is simple. The interposed foreskin decreases the friction between the introitus and the glans. The unretracted foreskin consists of a thin dermis that is folded on itself with very little friction between the layers. As the penis advances, the foreskin unrolls so that the portion that makes initial contact with the introitus is 6 cm. Up the shaft before any friction occurs between the device and the skin.”[23]

• Removed from sexual effects:

“Participants reported significantly reduced erectile function, decreased penile sensitivity, no significant change in sexual activity, and significantly improved satisfaction after circumcision. This improved satisfaction represented a more satisfactory appearance of the penis and less pain during sexual activity.” [24]

• Removed from sexual effects:

“Techniques are available to induce ejaculation in men with SCI (spinal cord injury), who are otherwise anejaculatory. The semen can then be used for in vitro fertilization. External vibratory stimulation involves the use of a vibrator over the glans and frenulum to induce an ejaculatory reflex. [25]

• Removed from sexual effects:

Boyle et al. (2002) argued that "structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation." “The loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response" may reduce a "circumcised man’s ability to achieve arousal." …"Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback" erectile dysfunction and premature ejaculation may be a complication of male circumcision, potentially making "intercourse is less satisfying for both partners when the man is circumcised.”[26]

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

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

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

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

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

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

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

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

Agree with Coppertwig and Avi. Further, almost all of TipPt's complaints are essentially that certain fragments of text are not present. Irrespective of whether the article would be better or worse without these fragments, this is not an appropriate use of the "totallydisputed" tag. Generally speaking, this tag is intended to raise concerns about neutrality and accuracy of material that is in the article, not as a form of protest. Jakew (talk) 11:13, 17 December 2008 (UTC)

Yes, "totallydisputed" seems definitely overkill here. I don't think any tag is needed: we don't usually have tags during most discussions. But "totallydisputed" should be reserved for the very worst cases, e.g. blatantly false important statements in the article. ☺Coppertwig(talk) 13:51, 17 December 2008 (UTC)

Totally disputed is simply the name of the section Tip created. The tag adds Tip's concern of factual accuracy while the previous tag covers neutrality of title/subject matter. Let's all assume good faith and calmly talk about Tip's concerns. Sadly it always seems to be the same battle lines with the same editors on each side of pros and cons of circumcision. Garycompugeek (talk) 16:18, 17 December 2008 (UTC)

This has veered into a discussion about editors, rather than content, but since I was addressed by name I will say for the record that I am not maintaining any balance here as Avi says, as I believe the article to currently be unbalanced. Also, neutral point of view is not just about what is in the article, but may also be about what isn't, or about how the material in the article is organized and presented. I don't think "totallydisputed" is appropriate, but a "POV" tag may indeed be appropriate. I believe this article is "maintained" according to Coppertwig's view that "published sources mostly take such a stance ['in favour of male circumcision and in opposition to female circumcision'], so (arguably) NPOV requires that the Wikipedia article do the same."[27] I believe that view to be the antithesis of NPOV, and I'm not surprised that some are upset that it is being imposed here. Blackworm (talk) 17:40, 17 December 2008 (UTC)

Reply's to above:

• The most of those facts were taken out before the article was shortened. Adding them will not add much to length. To reduce length, I suggest reducing disputed "medical" issues. There's another "main article" with the same info! On the other hand, why isn't the reader told medical associations consider infant circ's to be "elective" surgery, and "non-theraputic." Both of those words are very specific terms. All we read is "do not recommend," with no why (it's not theraputic). That fact has been removed.

• It's gross propaganda to say "God commanded" something radically different from current practice. Here's the relevant paragraphs from the Jewish encyc:

“—In Apocryphal and Rabbinical Literature:

During the Babylonian exile the Sabbath and circumcision became the characteristic symbols of Judaism. This seems to be the underlying idea of Isa. lvi. 4: "The eunuchs that keep my Sabbath" still "hold fast by my covenant," though not having "the sign of the covenant" (Gen. xvii. 11, Hebr.) upon their flesh. Contact with Grecian life, especially at the games of the arena, made this distinction obnoxious to the Hellenists, or antinationalists; and the consequence was their attempt to appear like the Greeks by epispasm ("making themselves foreskins"; I Macc. i. 15; Josephus, "Ant." xii. 5, § 1; Assumptio Mosis, viii.; I Cor. vii. 18; , Tosef., Shab. xv. 9; Yeb. 72a, b; Yer. Peah i. 16b; Yeb. viii. 9a). All the more did the law-observing Jews defy the edict of Antiochus Epiphanes prohibiting circumcision (I Macc. i. 48, 60; ii. 46); and the Jewish women showed their loyalty to the Law, even at the risk of their lives, by themselves circumcising their sons.”

“In order to prevent the obliteration of the "seal of the covenant" on the flesh, as circumcision was henceforth called, the Rabbis, probably after the war of Bar Kokba (see Yeb. l.c.; Gen. R. xlvi.), instituted the "peri'ah" (the laying bare of the glans), without which circumcision was declared to be of no value (Shab. xxx. 6).”[28]

...and relevant text from the second source:

"Long before this, many of the Persians were circumcised and "became Jews, for the fear of the Jews had fallen upon them" (Esther 8:17, Heb. text; Josephus, Ant., XI, 6:13). The Book of Jubilees insists upon he strict observance of the law, and protests against those that "make the members of their body appear like those of the gentiles" (xv, 26, 27). During the period of Greek rule in Palestine, when those that kept the laws of Moses were put to death by the gentile tyrants (1 Maccabees 1:63; 2 Maccabees 6:10), some Jews, under Greek influence, "made themselves prepuces" and turned away from the ways and traditions of their fathers (1 Maccabees 1:15, 16; Joshua Ant., XII, 5:1). To this epispastic operation performed on the athletes to conceal the marks of circumcision St. Paul alludes, me epispastho (1 Corinthians 7:18). Therefore Jewish circumcision, in later times, tears the membrane that remains after circumcision given in the ordinary way, among the Arabs for instance, and thus defeats even the surgeon's skill."[29]

To fix? Either remove the "commandment from God" line, or properly qualify that strong statement with historical facts.

Finally, I tried to fix meatal stenosis in complications, but was reverted by Avi. Please bring suggestions to discussion. I will also from now on.TipPt (talk) 17:36, 17 December 2008 (UTC)

We've been through this near a dozen times already. The authoritative works of Rabbinic Judaism are the reliable sources for Rabbinic Judaism. Not some midwife's website or the Catholic encyclopedia. We are not supporting the Christian view of circumcision by using the works of Imam Ali, are we? I've already pointed out what the proper source is in the archives a number of times, and it does not support the erroneous, mistake-filled information you have above vis-a-vis Judaic circumcisions. Please stop trying to add incorrect information based on ignorant and/or miseducated people to the article. -- Avi (talk) 18:48, 17 December 2008 (UTC)

TipPt, I'm not convinced that medical associations consider all infant circumcisions to be "elective" or "non-therapeutic"; I assume there may sometimes be specific medical reasons for circumcising some particular infants to treat specific conditions the infants may have. ☺Coppertwig(talk) 22:18, 20 December 2008 (UTC)

TipPt, again, you've listed material you wish to have included, but you haven't stated reasons why it must be included or even reasons why it would be good or appropriate to include it. I suggested in my reply to you on my talk page that you may wish to construct arguments referring to WP:UNDUE and major reliable sources.

I don't see the phrase "God commanded" anywhere in the article and I don't think the article asserts that God commanded anything; if it did, that bit would need to be changed. It says "Male circumcision is considered a commandment from God in Judaism", which is fine; it's not asserting that God exists or that God commanded anything in particular; only a true statement about Judaism. "Assert facts, including facts about opinions" (WP:Neutral point of view#A simple formulation).

Finally, there is consensus of all editors except yourself not to have the "totallydisputed" tag, and that tag is only for extreme cases, not normal content discussion such as this; and there are already tags complaining about neutrality and factual accuracy is already a tag about neutrality^{(19:36, 21 December 2008 (UTC))} anyway, so I'm removing the tag.

Re reverted by Avi: I suggest phrasing your arguments concisely and in "What, where, why" format, to make it as easy as possible for people like me to follow the discussion. (Make sure you include the "why" arguments, preferably referring to policy, guidelines and reliable sources.) Note that reverting of new material is a normal occurrence and doesn't require a "totallydisputed" tag; see WP:BRD. If you get consensus before editing, as requested in the "controversial" template at the top of this talk page, then reverts probably won't happen.

I hope this message doesn't sound too confrontational. I look forward to discussing the material with you. ☺Coppertwig(talk) 19:32, 21 December 2008 (UTC)

Meatal Stenosis

• Proposed text:

Meatal stenosis is relatively common but under recognised complication of circumcision in infants [30]occurring in 9-10% of males who are circumcised. It is thought that because the foreskin no longer protects the meatus, ammonia formed from urine and friction in diapers irritates and inflames the exposed urethral opening. Meatal stenosis can lead to discomfort with urination, incontinence, bleeding after urination and urinary tract infections. Surgical meatotomy is curative.”[31][32]

• Existing text:

Meatal stenosis (a narrowing of the urethral opening) may be a longer-term complication of circumcision. It is thought that because the foreskin no longer protects the meatus, ammonia formed from urine in wet diapers irritates and inflames the exposed urethral opening. Meatal stenosis can lead to discomfort with urination, incontinence, bleeding after urination and urinary tract infections.TipPt (talk) 17:51, 17 December 2008 (UTC)

I can two obvious problems with the first sentence of your proposal, TipPt. "Meatal stenosis is [a] relatively common but under recognised complication of circumcision in infants..." No, a few authors (including Upadhyay et al., who are cited in your proposal) have expressed the POV that it is common and under recognised, but that doesn't make it a factual statement. "...occurring in 9-10% of males who are circumcised." This is misleadingly high; see meatal stenosis#Causes, incidence, and risk factors for a handful of estimates ranging from 0.9-11%. There's no reason to discuss the matter here anyway - this article is about circumcision, not meatal stenosis statistics. Jakew (talk) 19:36, 17 December 2008 (UTC)

It's sourced as a complication of male circumcision, thus surely it's relevant. The WP article you link to specifically says that circumcision "contributes to the development of urethral stricture." The only valid problem you mention is one of attribution of the statistics, which is easily addressed. Also it doesn't seem misleadingly high -- the one study finding a prevalance of 0.9% in its subjects only studied Iranian boys aged 6-12, where presumably many of them could have been treated for it in earlier infancy; thus it is misleading to present that statistic as a statement of "prevalence" in the meatal stenosis article (and I will address this soon). Excluding that study, the average of the other four sources is about 7%. We should probably create a better paragraph on meatal stenosis that cites all these sources and results properly. Blackworm (talk) 21:05, 17 December 2008 (UTC)

Actually, the meatal stenosis article states that "studies have indicated that circumcision contributes...", which is slightly more neutral than asserting that it does contribute. (Perhaps the wording could be improved, though. Thank you for bringing it to my attention, anyway.)

Anyway, it's true that we have sources asserting that it is a complication. Similarly, we have sources asserting that, say, HIV can be a complication of non-circumcision, is this an appropriate place to discuss HIV statistics? For that matter, is it appropriate to discuss possible complications of HIV? I think not. This is an appropriate place to discuss how a condition is related to circumcision, but for more information, the reader can refer to an article about that other condition.

The problem which you (elegantly) describe as "attribution of the statistics" is indeed a problem, and I think the only fair, neutral approach that avoids OR is to list the figures in the sources. We do this in the meatal stenosis article - the text reads: "Among circumcised males, reported incidence figures include 0.9%,[Yegane] 2.8%,[Griffiths] 7.29%,[Van Howe] 9-10%,[Angel] and 11%.[Stenram]" (ref numbers changed to author names). (Incidentally, this is not a complete list - from my old notes I also have 0% [Sorensen], 1.5% [Leitch], 0.01% [Cathcart], and 8% [Patel].) 9-10% matches a single source - Angel - but none of the other sources fall within that range, seven are lower, and one is higher. Thus we can view the assertion that meatal stenosis occurs in 9-10% of circumcised males as one of two things. Either a) it asserts (without even attributing) Angel's POV as fact in spite of the other viewpoints, violating NPOV, or it is a wildly inaccurate synthesis of figures into a range that is, in fact, higher than figures in most available sources.

I'd certainly be glad to discuss any thoughts you might have at Talk:Meatal stenosis, but regarding this article, a problem remains. To discuss and attribute these figures, neutrally and avoiding OR, takes space, and increases the effective weight given to the subject (and frankly, we already devote a disproportionate amount of space to meatal stenosis when compared with the literature). Again, the subject of this article is circumcision, not detailed information about other conditions, so we don't actually need to include this information here. Jakew (talk) 23:16, 17 December 2008 (UTC)

HIV a complication of non-circumcision. Thats rich. I hear death is a complication of life. Garycompugeek (talk) 23:32, 17 December 2008 (UTC)

Yes, Jake, that's what the article says, thanks for correcting that. But you seem to miss the point that if results of studies published in reliable sources are relevant, they are relevant. This seems to apply to both HIV and meatal stenosis. I wasn't debating the wording nor the statement in the meatal stenosis article.

Your point about HIV, in which you argue that sources say HIV is a complication of non-circumcision, is moot since we do discuss HIV statistics here; namely, the stated percentile risk reduction in several groups obtained via a randomized controlled trial that was ended early. Do you agree so far? Thus I fail to understand the direction you're going with your comments.

Your claims about asserting one viewpoint (matched by another apparently independent source) echo my concerns about the emphasis given the WHO's viewpoint with respect to estimates of male circumcision prevalence. I agree that one source isn't enough, as I said previously we should expand on it and include the context behind any results that editors feel is necessary to preserve WP:NPOV. So let's do that both in this case, meatal stenosis, and with male circumcision prevalence estimates -- let's list the range of estimates and say something about the restrictions on the groups studied, when it's not clear we're discussing prevalence among circumcised and non-circumcised males in general (6-12 year old boys in the case of the 0.9% meatal stenosis study, 15 year old males and older in the case of the WHO's male circumcision prevalence estimates). Does that sound reasonable?

You statement that we don't need to include this information here is interesting. It seems to me that meatal stenosis' link to male circumcision is evident in the literature. For example, there are about 6410 hits in Google Scholar for "balanitis",[33] 1580 hits (about 1/4) for "balanitis circumcision".[34] Balanitis is discussed in two rather large paragraphs in the article. "Meatal stenosis" has 2420 hits in Google Scholar,[35] or about 38% of "balanitis." It seems to deserve at least a medium paragraph, which the article as it currently stands lacks -- and yet you argue that it already devotes too much weight to it. Does the presentation of this evidence cause you to change your assertions regarding weight? There are 827 hits for "'meatal stenosis' circumcision",[36] or about 1/3 of the hits for "meatal stenosis". Seemingly, a greater fraction of articles about meatal stenosis mention circumcision than articles about balanitis. In that light, I do not believe your point about not needing to include this information has been made. Do you have other suggestions? Blackworm (talk) 04:03, 18 December 2008 (UTC)

Also, in the interest of a balanced presentation, I should perhaps mention that as balanitis is inflammation of the glans penis, and meatal stenosis apparently is a condition females also experience, the statistics on hit counts of scholarly articles may be more suggestive that a shorter treatment of meatal stenosis is to be made here. This is of course to the extent one is willing to accept that "circumcision" also applies to females -- disputed here in the circumcision article, which in my view inappropriately takes a firm stance through its content and organization that it doesn't apply to females. Blackworm (talk) 04:09, 18 December 2008 (UTC)

Blackworm, I don't think I'm missing your point ("that if results of studies published in reliable sources are relevant, they are relevant"), but I think that some pieces of information are more directly relevant than others. I'd hope you'd agree that we cannot possibly include everything about either meatal stenosis or HIV here, so surely the question is which pieces of information are sufficiently and directly relevant to an overview article about circumcision?

You say that we do discuss HIV statistics, citing the RCT risk reduction figures, but these figures are a measure of an association between circumcision and HIV. They summarise, in essence, a consequence of circumcision: what effect it has on HIV, and the magnitude of that effect. As a hypothetical, if we were to list data on the prevalence of HIV in uncircumcised populations, I think it would be a better comparison with the meatal stenosis figures. But how relevant would that be to the subject of the article? If I found a source saying that, say, 40% of uncircumcised men suffered from the common cold in their lifetimes, it doesn't suggest that those 40% are attributable to lack of circumcision. To indicate that some of those cases are attributable to lack of circumcision, we'd need studies that compared rates in these two groups and found significant differences (ideally RCTs, in order to establish causation). The hypothetical source I mention isn't really a fact about circumcision, it's about the lifetime prevalence of the common cold in a particular subpopulation that happen to be uncircumcised.

You suggest listing the "range" of estimates and discussing the populations studied. In the meatal stenosis article, that makes some sense. Unfortunately, here I perceive several problems. Firstly, it isn't quite clear what you mean by "range". If you mean to synthesise a range (eg 0-11%) from the figures, then that might make it more difficult to discuss the individual populations (and could have OR implications). Alternatively, if you mean to list all estimates, then that would involve citing 9 sources. Furthermore, if we were to discuss populations studied we'd need to do so for all studies. Even allowing a mere 7 words per source to describe the population (which may be unrealistic - more may be needed), that means another 60 words or so, doubling the size of the paragraph.

I'm not quite sure what your searches are intended to show. By comparing '"meatal stenosis" circumcision' to 'meatal stenosis', you are effectively determining what proportion of articles discussing meatal stenosis also discuss circumcision, which is a broad measure of the relevance of circumcision in the context of meatal stenosis. But while that's a worthwhile question when deciding how best to edit meatal stenosis, that's not the question here. The question is how significant meatal stenosis is in the context of circumcision. Searching for 'circumcision' returns 58,500 results, so as a percentage of that "balanitis circumcision" is 2.7% and '"meatal stenosis" circumcision' 1.4% ("circumcision hiv", for comparison, returns 10,100 or 17.3%). PubMed returns broadly similar figures: 38/4,210 or 0.9% for meatal stenosis and 156/4,210 or 3.7% for balanitis. I couldn't agree more that the amount of text dedicated to balanitis is excessive (it ought to be a couple of sentences), as I've commented on previously. That's a problem and it should be dealt with; it shouldn't be used to excuse a disproportionate amount of detail elsewhere. Jakew (talk) 12:20, 18 December 2008 (UTC)

By that logic, circumcision should not be mentioned in the HIV article ("circumcision HIV" is 0.25% of "HIV"). But it is, and at length. By that logic, "female circumcision" is 15.2% of "circumcision," and thus should be treated at length here, at least given as much attention as HIV. It isn't, it's given zero weight. Clearly these criteria are modulated by other editorial opinion. Blackworm (talk) 20:40, 22 December 2008 (UTC)

TipPt: where are your arguments to support this proposed change? ☺Coppertwig(talk) 19:38, 21 December 2008 (UTC)

Meatal Stenosis (continued)

Jakew fails to remove surveys of incidence in circs of boys, and surveys (of incidence) taken at too early an age (before 2). Meatal stenosis develops when the circumcision took place during "nappy" age. That's why the Iran study must be qualified (versus his reverts).

Jakew fails to understand that meatal stenosis "is an under recognised complication" (in common surveys of complications) because presentation is so late (2 years old).

The problem of mucosa exposed by circs subject to friction and moisture in diapers especially at the tip of the penis/urethra. The problem is easily prevented if parents are given (wiki) the information. I find it untenable that editors question the emedicine review of literature figure of 9 - 10%.TipPt (talk) 18:53, 21 December 2008 (UTC)

Again, here are the sources:

“Meatal stenosis is a relatively common acquired condition occurring in 9-10% of males who are circumcised. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy is curative.” [37]

“Meatal stenosis is generally a direct consequence of circumcision that is seldom encountered in uncircumcised men; meatal calibre is know to be greater in uncircumcised individuals. The incidence of meatal ulceration following circumcision is from 8 to 20 per cent14,46,64. The aetiology is thought to be irritation of the external urethral meatus by ammoniacal substances present in wet sodden nappies. Such irritation is unlikely in the presence of a normal prepuce, which serves to protect the glans from these irritant substances46. In a prospective study of 140 consecutive neonatal circumcisions, Mackenzie64 found a 20 per cent incidence of meatal ulceration within the first 2-3 weeks after circumcision. It is thought that meatal ulceration after circumcision is the initiating event in a vicious cycle of stenosis and ulceration, followed by more stenosis64. Meatal stenosis following circumcision has been advanced as a cause of recurrent pyelonephitis and obstructive uropathy, for which meatotomy is curative64,65.”[38]

“Meatal stenosis is an under recognised complication of circumcision done in neonatal and nappy aged boys. Symptomatic presentation from meatal stenosis can be very late (two years).” [39]

“Traumatic meatitis of the unprotected post-circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis. CONCLUSION: Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.”[40]TipPt (talk) 18:53, 21 December 2008 (UTC)

While the emedicine article (Angel) states that there is a rate of 9-10%, I don't see where in the article it does a review of the literature on rates: if I missed it, please tell me specifically where in the article it is, as I didn't see anything about rates other than a plain statement of that one figure.

If you wish to add words about it being an "under recognized complication" you would have to provide sources to verify this, and arguments that it's an important enough fact to include in this summary article.

I wouldn't say during "nappy" age; the source says neonatal or nappy age. We don't know whether the circumcision could be much earlier than the wearing of nappies which causes the problem. ☺Coppertwig(talk) 20:12, 21 December 2008 (UTC)

See the list of emedicine article references; thus the 9 - 10% range. How can any editor consider emedicine biased, or consider themselves a better professional in the field?

We could provide other review article ranges, like the 8 - 20% in[41] for meatal ulceration (a precurser complication).

Jakew ... can you provide any other review of literature surveys?

The condition occurs because infants are circ'd who wear (probably loose) diapers; thus the need for "nappy" or similar. When circumcision occurs post diaper age, you rarely see meatal ulceration or stenosis; thus the need to carefully review studies.TipPt (talk) 18:09, 22 December 2008 (UTC)

I don't believe that anyone has suggested that Angel is biased, TipPt. However, as Coppertwig pointed out, there is no basis for stating that Angel's figures constitute a literature review. Your suggestion that it is derived from the references is not only speculative but contradicted by the facts: Angel's refs 9 and 10 are Stenram and Van Howe, reporting rates of 7.29% and 11% respectively. Neither of these figures, I hardly need state, lie in the range 9-10%. Perhaps 9-10% is Angel's own estimate. We have no idea.

It would also be interesting if you could provide sources to support your assertion that "When circumcision occurs post diaper age, you rarely see meatal ulceration or stenosis". Interestingly, in Stenram's study, which reported the highest rate of meatal stenosis, 84.8% of boys were 3 years or older at the time of circumcision. Jakew (talk) 19:54, 22 December 2008 (UTC)

Jakew ... the Stenram study found 11% (or 8% - 11%) meatal stenosis as a complication of "circumcision for phimosis". These kids had a medical problem treated by circ and might better be left out of a general population rate scale.

I guess we need to qualify the paragraph by saying "nappy" age circ, and also list damage to the frenular artery as a possible cause.

I was drawing personal conclusions from the articles ... Sorry. Rubbing/irritation and wet/caustic against mucosa in diapers is a common listed eventual cause of stenosis. You also see damage to frenular artery as a probable cause (Stenram?). I guess dry rubbing could also cause stenosis (Stenram?).

I thought you called the emedicine article 9 - 10% POV. The nature of the article is a neutral review. It's basically the nature of emedicine. Take a look at emedicines "circumcision" ... quite neutral. Wiki doesn't need Jakew to understand the basis of the statement (9 - 10%) before using this high quality source. Why do you think you are more qualified to judge complication rates? Right now, we have nothing for a significant complication. That is biased.

What range would you accept for the main topic page? How about a short list? In the sub article, how would it be qualified (by age? by technique? by source??TipPt (talk) 17:27, 23 December 2008 (UTC)

TipPt, like all authors, Angel has a point of view, but that doesn't necessarily mean that he's biased. His point of view is that the rate is 9-10%. Griffiths offers another point of view: that the rate is 2.8%. Still more authors offer different points of view. It doesn't matter whether you call them "estimates", "opinions", "points of view", or anything else, and it's generally unproductive to discuss whether sources are biased or correct or whatever. The most important thing is whether we have a fact or an opinion. Wikipedia defines a fact as: "a piece of information about which there is no serious dispute." But this doesn't seem to be the case here: any reasonable person will agree that these estimates differ, so clearly this is "a matter which is subject to dispute". In such a situation, asserting one point of view as fact violates Wikipedia's NPOV policy. So too does giving one point of view an inappropriate or disproportionate amount of emphasis (known as undue weight).

So citing only a single source is problematic from an NPOV perspective. We need to evaluate some alternatives. One option is to cite a representative (or even complete) set of sources. This is the approach followed in the meatal stenosis article, and to do so there makes sense, since the article is, after all, about meatal stenosis. Here it is less appropriate, for several reasons. Firstly, the subject of the article is circumcision, not meatal stenosis, and in-depth detail about the incidence of meatal stenosis does not belong here. Secondly, space is limited - the article is already too long and contains too many refs (even copying the sentence from meatal stenosis would increase the length of the article by 1.4K and 5 refs). Thirdly, we already give meatal stenosis far too much emphasis in comparison with reliable sources (see WP:UNDUE), and adding more material can only make the problem worse.

Fortunately, there is a simple, straightforward alternative: don't cite a rate. We don't need to do so here, as I've already mentioned, and in any case this information is not directly related to circumcision. Jakew (talk) 20:34, 23 December 2008 (UTC)

By not showing a rate you trivialize the complication. We have a very high quality source saying 9 - 10%. That source is better for the reader than nothing! The current text misrepresents the issue.

It's not given honest coverage as is. It is a fairly common, underreported (in many surveys of complications), and farily serious. All well sourced. 2.8% you find in one survey (mostly older kids again with medical problems), 9 - 10% (neonates) in another 8 - 11% (neonates) in another for related complication ... Again, what would you accept?

Length is not a valid reason to remove relatively relevant facts.TipPt (talk) 18:08, 24 December 2008 (UTC)

TipPt, we do have a source saying 9-10%, but that source is of no higher quality than the others (actually, it is of somewhat lower reliability, since unlike the others it does not appear in a peer-reviewed scientific journal). Certainly there's no reason to favour one source over others, especially when doing so would potentially give the reader a non-representative view of the literature. Quoting a single source might be excused if we were ignorant of the existence of differing figures in other sources, but we're not ignorant. We know that seven of the eight other viewpoints are lower than this range and one is higher. To suggest that citing a single source is "better for the reader than nothing" is not only completely incompatible with WP:NPOV, but effectively proposes to knowingly mislead the reader as to the shape of the literature. Jakew (talk) 19:04, 24 December 2008 (UTC)

Oh, so the e-medicine ref (Angel) is not from a peer-reviewed journal. What I noticed is that it isn't at all what I would all a literature review: it just states the rate 9-10% and has a list of refernces, that's all: I didn't see any discussion at all about the references. Typically a scientific article will list references of relevant studies in the introduction section; that doesn't make it a literature review. ☺Coppertwig(talk) 00:50, 30 December 2008 (UTC)

Removal of the disputed tag

It is improper for Coppertwig to remove the disputed tag. SEVERAL relevant facts, clearly listed, are actively denied the reader. Please see the above list of missing information. We have made some progress with meatal stenosis.

Coppertwig said he wasn't sure neonatal circs were considered "elective" and "non-therapeutic" by medical associations. Please glance at [42]. There is no medical condition in infants that is treated by circumcision. Ask Jakew.TipPt (talk) 18:37, 22 December 2008 (UTC)

I don't think it's improper. The facts are not actively denied the reader: they can be in the subarticles, which are conveniently linked to. Putting more material in the article effectively makes other material harder to find: the reader only has so much time.

You misquote me: I didn't say that. Please provide verification of your claim that "There is no medical condition in infants that is treated by circumcision". It would need a reliable source, not just Jakew's say-so; I consider it an extraordinary claim. ☺Coppertwig(talk) 18:50, 22 December 2008 (UTC)

Indeed. If we consider every conceivable fact relevant to circumcision, everything that has ever been written about the subject, that material would probably fill several bookshelves. So even if we wanted to, we couldn't include everything in one article: any article shorter than, say, the entire set of Encyclopaedia Britannica is bound to exclude some material. Stating that material is excluded isn't a valid reason for a tag. It isn't even a logical argument for inclusion. Jakew (talk) 19:24, 22 December 2008 (UTC)

We're talking about several significant missing facts Jakew, especially significant relative to the misleading or poorly referenced info frequently provided.

Copper ... you denied knowing routine neonatal circs were labled "elective" and "non-therapeutic" by med associations ... I provided you that proof. Why aren't those critical (to the assoc and reader) facts in the introduction? The fact that neonatal circs is so labled explicitly MEANS there is no medical condition being treated.

The jewish encyclopedia was one (of two high quality) source for the authentic jewish procedure [43] not some midwife? stated above.TipPt (talk) 17:25, 23 December 2008 (UTC)

TipPt: you said, "Copper ... you denied knowing routine neonatal circs were labled "elective" and "non-therapeutic" by med associations ". I did not. You have misquoted me again. Please stop misquoting me. You can greatly reduce the chance of either misquoting me or of taking my words out of context by using only direct quotes of entire sentences of mine. ☺Coppertwig(talk) 00:46, 30 December 2008 (UTC)

The Jewish encyclopedia article, from 1906, is based primarily on non-religious sources from the late nineteenth century. In the past, I've brought the source in from the actual Jewish Legal Code as to what the procedure should be. When making statements about the Jewish legal tradition, the actual code is preferable. If you follow the Talmudic sources brought in the JE, they states "probably after the war of Bar Kokba " and bring as the source Yevamos 72a, (http://www.e-daf.com/index.asp?ID=1722&size=1). Actually reading that text (see the link) shows that no mention of any new institution regarding milah. Rather that the Greeks took Jews and forcibly re-extended the skin on the penis over the glans, causing the circumcision to be hidden (called a Mashuch משוך), and in the times of Bar Kokba (or bar Koziba as called on Yevamos 72a) the Jews threw off the yoke of the Greeks, and were able to re-expose the circumcision. What is discussed there is the Rabbinic requirement to re-expose the glans if it was re-covered, but the original method always had the glans exposed. Now I know you do not know how to read Talmudic Aramaic or Rabbinic Hebrew, but I do, and anyone who can can corroborate what that text actually says (the piece beginning at the two dots, tannu rabannan). Also, here is a link in English for an outline of how the halakha has been developed from this piece, and notice, it discusses the Mashuch, someone whose skin has been re-drawn over the glans. -- Avi (talk) 17:54, 23 December 2008 (UTC)

Avi ... you seem to think 1906 is a long time ago, but you reference the dark ages? Actually, the texts we need to read would be really ANCIENT. Talmudic and Rabbinic texts are WAY after the fact, and based on oral traditions (ever played pass the message?). Historians rely on actual historical accounts from the period in question.

Avi ... I have provided two high quality sources ... the Catholic Encyc[44] and the Jewish encyc. You are not a better source. Why do YOU want to deny the reader facts?

Please see the peer reviewed published authors you are disparaging below:

• Emil G. Hirsch, Ph.D., LL.D., Rabbi, Sinai Congregation; Professor of Rabbinical Literature and Philosophy, University of Chicago; Chicago, Ill.
• Kaufmann Kohler, Ph.D., Rabbi Emeritus of Temple Beth-El, New York; President of the Hebrew Union College, Cincinnati, Ohio.
• Joseph Jacobs, B.A., Formerly President of the Jewish Historical Society of England; Corresponding Member of the Royal Academy of History, Madrid; New York City.
• Aaron Friedenwald, M.D.TipPt (talk) 18:08, 24 December 2008 (UTC)

I already provided you with a detailed historical account of peputial restoration[45] which also details the change in procedure (radicalization).TipPt (talk) 18:21, 24 December 2008 (UTC)

The Catholic Encyclopedia is NOT a reliable source when it comes to Jewish legal tradition any more than the Quran is a reliable source on Catholic traditions of praying to saints. Secondly, when you read the article in the Jewish encyclopedia, it is an assumption, "possibly..." and they bring a text from the Talmud as the source. However, the text of the Talmud does not support that, as any trained Talmudic scholar can tell you. So, you do not have any reliable sources for the orginal tecnique. You have one source that makes a guess based on what appears to be a misreading of the text. I brought the source from the Jewish Legal code itself (Yoreh Deah 264:3) where it clearly states that the glans must be revealed. That is the only authoritative source for traditional Bris Mila. -- Avi (talk) 19:05, 24 December 2008 (UTC)

Just being from a long time ago doesn't make something unreliable. Some kinds of information become outdated or obsolete; others do not, or at a much slower rate. When you want to establish what happened a long time ago, sources from around that time can be very useful. ☺Coppertwig(talk) 00:46, 30 December 2008 (UTC)

CopperTwig, The Shulchan Aruch Yoreh Deah is unchanged since the sixteenth century. The Arba'ah Turim (Tur) Yoreh Deah predates that by around 250-300 years, and the Talmud predates that by around 500 years. Age is not the issue, accuracy is :). Jewish tradition basically followed the Talmud-->Shulchan Aruch until Reform Judaism broke off in the eighteenth century, and Orthodox Jewish tradition still follows it today (although there have been more recent glosses). -- Avi (talk) 05:07, 30 December 2008 (UTC)

Complications section

The complications section of the article is somewhat disorganised, and needs some attention. I've made a couple of minor changes that are unlikely to be controversial (or so at least I hope), but I have some remaining concerns. These include (paragraph numbers refer to this revision):

• The discussion of absolute complication rates seems fractured, as it is presented in several different places: the first paragraph, the second sentence of the second, and the first sentence of the third. Consequently, it is somewhat difficult to follow.
• In the second paragraph, the words "A major survey of circumcision complications by Kaplan in 1983 revealed that" fall short of NPOV. "Kaplan reported in 1983 that" or "In Kaplan's 1983 review" would be somewhat better.
• The third sentence of the second paragraph is troubling for several reasons. Most importantly, it is potentially misleading. While it may be technically correct to say "haemorrhage occurred in 52% of the boys", this can easily be taken to mean "haemorrhage occurred in 52% of boys who were circumcised" rather than "haemorrhage occurred in 52% of the boys who were seen for any circumcision complication". The placement of the sentence adds to this problem: because it appears immediately after Kaplan's estimate of the absolute incidence of bleeding complications, it is natural to expect that it is another such estimate, rather than a relative measure of the frequency of specific complications. I don't understand what this sentence is intended to achieve, anyway. We've already cited a secondary source stating that haemorrhage and infection are the most common complications in the first sentence, so I don't see why we need to cite a primary source to make the same point again.
• The purpose of the third paragraph seems to have been lost somewhere. This series, which found a 0.2% complication rate, logically belongs in the first paragraph, together with estimates by the CPS and Williams and Kapila. But although this (Christakis) was a large study, it is still a primary source, and it is questionable whether it should be included at all. It would be more logical to cite a few more reliable secondary sources in the 1st paragraph - such as the AAP, etc.
• 4th paragraph: meatal stenosis. We're still spending too many words here. As a minimum we ought to delete the last sentence, which is highly indirect, being about possible complications of meatal stenosis, itself a possible complication of circumcision. Also, why cite 3 sources? Why not just cite one secondary source - say, W&K?
• 5th paragraph: 3rd sentence onwards ("Van Howe states that..."). Well, yes, Van Howe does state this, but not in connection with phimosis nor apparently any other complication. Instead, his words are in the context of his observation that there are differences in the appearance of circumcised penes. So why do we dedicate 3x as much text in this paragraph to a quote that isn't even about complications? Inexplicable.
• 6th paragraph. Should be joined to 5th after deleting Van Howe quote.

Jakew (talk) 17:49, 17 January 2009 (UTC)

Thanks for your comments, Jakew.

• Re Kaplan: one way might be just changing "revealed" to "reported". Re the study of 48 boys: how about changing it to "A 1999 study in Nigeria found that, among a set of 48 boys who were seen for complications from traditional male circumcision, haemorrhage occurred in 52% of these cases, infection in 21% and one child had his penis amputated."
• The third paragraph looks OK to me. How about joining the 1st and 3rd paragraphs together, followed by the 2nd paragraph?
• Deleting the sentence about effects of meatal stenosis is OK with me; I see your point, that we don't discuss the symptoms of HIV etc. That's handled by wikilinks.
• Re the van Howe quote: I think you're right. Apparently placing this quote in this context amounts to OR. I suggest just deleting it, or replacing it with this quote from Williams and Kapila (1993): "one of the commonest complaints is of an unsatisfactory cosmetic result."
• I agree with joining the very short Cathcart paragraph onto the previous paragraph.

☺Coppertwig(talk) 20:29, 18 January 2009 (UTC)

And thank you for your comments, Coppertwig. :-)

Re Kaplan, I think changing "revealed" to "reported" would be a good idea, but I'm still uncomfortable with "major survey". It raises some difficult questions. What, I wonder, is a major (as opposed to minor) survey, and how does one distinguish between the two? Also, given that we cite dozens (at a rough guess) of literature surveys, but do not introduce these in such a way, is this one more major than the others? I guess we could say "A survey of circumcision complications by Kaplan in 1983 reported that", but it seems unnecessarily long-winded and perhaps a little redundant given the context (after all, it's hardly likely to be a survey of cabbage farming techniques).

Re the study of 48 boys, I think your suggestion is good, particularly if this sentence is moved so that it immediately follows the second sentence. However — and I'm sorry to repeat myself — I don't understand the function of this sentence. We've already stated that bleeding and infection are the most common complications, so why do we need to repeat ourselves? More to the point, what is so important about these 48 boys that we dedicate as many words to them as to the secondary source (AMA)? If the purpose is to describe the situation in Africa, then there are probably better (and secondary) sources - for example a systematic review by Muula et al.

I wouldn't be strongly opposed to keeping a shortened version of the third paragraph, as you describe. However, I do think it should be shortened considerably, as the discussion is disproportionate: in the first paragraph, we dedicate 26 words to 2 secondary sources (CPS and Williams & Kapila), but then we dedicate roughly 4 times this amount — 107 words if I've counted correctly — to a primary source in what is currently the 3rd paragraph. If our coverage of secondary sources was reasonable, then I suppose this might seem reasonable, but it is actually fairly poor, and several important secondary sources (eg AAP, AMA, etc) are left out. It would seem a far better use of the available word count to discuss secondary sources than to go into such depth about a primary source. (I also have some concerns about the tone of this paragraph, which seems poorly balanced, and due to selective quoting is more negative towards circumcision than the source itself, which concluded "Overall, routine newborn circumcision appears to be a relatively safe procedure. It is not without some risks, however, and these risks do not seem to be mitigated by the hands of more experienced physicians." Unfortunately addressing these concerns would increase the word count further.)

We seem to agree re meatal stenosis, Van Howe, and Cathcart. :-) Jakew (talk) 22:56, 18 January 2009 (UTC)

Jakew, I have looked at most of the literature on circumcision and it seems that Kaplan, and Williams and Kapilla are the 2 main surveys of circumcision complications out there. If you know differently then please explain and tell me of the others. It would be helpful if you could list all the survey studies on circumcision complications (that you know of). That way we have the same information and we can decide which is major, which is minor etc and what that means. I hope that isn't too much trouble.

On the subject of complications arising from circumcision in Africa, it is probably best if that comes under a new section heading. This is just to avoid confusion between circumcision in a developed country and in a non-developed country. It must be noted though that circumcisions are performed in many ways in Africa (i) in the hospital - similar to developed countries, (ii) in a hut, (iii) out in the open. (ii) and (iii) usually being part of a tribal ritual. It will be tricky to condense all this info into one section entitled "circumcision complications" I think you will agree.

In regards to your discussion of secondary sources vs. primary sources. Couldn't the same thing be levelled at the sections on sexually transmitted diseases, hygiene and Penile Cancer. Seems like double standards to me. If we address that in this section then I hope to see you doing the same in those sections. Tremello22 (talk) 16:22, 20 January 2009 (UTC)

Hello Tremello22. I'm afraid that I don't intend to prepare a list of literature reviews re circumcision complications, because even if you and I were to agree on a scheme to classify these articles as "major", "minor", etc, that scheme would be original research and thus unusable in a WP article. Even if we agreed that Kaplan's review was "major" (and I'm not saying that it isn't), two fundamental problems would remain: to describe it as such would be unverifiable, and it would serve to advance that position (since by presenting one source as "major" we imply that the viewpoint attributed to it is particularly important), thus potentially creating WP:NPOV problems.

I would oppose creation of a sub-section entitled "complications of circumcision in Africa" (or similar), for several reasons. It would invite creation of similar sub-sections for the other continents in order to avoid giving Africa special treatment. It would tend to increase the word count, when the article is already too long. Also, it would introduce uncertainty about where material belongs (is source X about "complications of circumcision" or about "complications of circumcision in Africa"?). Finally, if - as you say - it would be difficult to keep such discussion short, then that may indicate that this material is better suited to an in-depth article such as medical analysis of circumcision.

Re secondary vs primary sources, I agree that there is too much emphasis on primary sources (and too little on secondary sources) in much of the article. This is more of a problem in some sections than others. I encourage you to read the archives (or simply ask) rather than making assumptions about my views; I don't think it is particularly constructive, nor particularly civil, to make accusations of double standards, but I trust you will have the grace to apologise. Jakew (talk) 19:49, 20 January 2009 (UTC)

In regards to accusations of original research. As editors we have to choose what goes in to an article We have to make a judgment on what to include, particularly in an article such as this, due to lack of space. So then we must decide what is major and what is minor, surely? Hence why a list of surveys would have been helpful.

On the second point. It was just a suggestion. But leaving it out, means that readers do not learn that there are high complication rates in Africa. That could be seen as hiding undesirable(?) information.

I think I have a good handle on your views on circumcision. I don't feel I have anything to apologise for. I said it seems like double standards. If you say it isn't then, OK. Tremello22 (talk) 21:44, 20 January 2009 (UTC)

Yes, I suppose we might decide what is a "major" source in the sense of that which is significant and/or important enough to include. But that doesn't seem to be an issue here: nobody is suggesting that Kaplan should be excluded. So the only purpose of deciding whether it is "major" or not would be to say so in the article, which would be OR. Jakew (talk) 10:19, 21 January 2009 (UTC)

OK, I concede this point. We needn't use the word 'major', if you have a problem with it. Tremello22 (talk) 21:57, 22 January 2009 (UTC)