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Revision as of 18:42, 31 August 2006

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POV added

1. The main article is too long, but potential medical benefits are listed and detailed as though they are particularly relevant to the decision to circ. They are not, but they are detailed again in the medical aspects main article. They are listed again in the CPS statement.

The following sections should be summarized in the main (circ) topic, and then detailed in the "main article" (Medical analysis of circumcision) should be combined with the main (medical aspects) article ... 4.2 HIV 4.2.1 Studies 4.2.2 Methodology 4.3 HPV 4.4 hygiene 4.5 Infectious and chronic conditions 4.6 Penile cancer 4.7 Phimosis and paraphimosis 4.8 Urinary tract infections.

2. The medical association opinions have been edited to reflect their full (unbiased) statements, hopefuly not ... but watch it be reverted. I hope the current verson makes quote accurate, and removes biased edits of the actual text.TipPt 15:48, 24 August 2006 (UTC)

3. The sexual effects section is a joke. For example, the frenulum is a primary erogenous zone, but it is generally reduced and may be removed during neonatal circs. It is a primary orgasm/ejaculation trigger . The foreskin is very rich in estrogen receptors...

...and look at the lousy english..."There are few studies on sexual partner preference for penises with or without foreskins, and the results are inconclusive. They are discussed more fully in the full article."

What's the point saying any of that?TipPt 15:48, 24 August 2006 (UTC)

4. Someone keeps forcing an incorrect quote in the third paragraph. The BMA statement reads "do not recommend routine circumcision of male newborns," not the forced "do not recommend routine non-therapeutic circumcision."TipPt 15:21, 22 August 2006 (UTC)

Regarding the article length, there was a consensus a few talk archives back to develop this page fully, and THEN spin-off sections like medical to the proper articles, as it was too daunting to try and fix them all. So now, this article looks humongous, but it will overwrite much of its daughter articles, and be reduced, once it has been properly vetted. -- Avi 15:19, 22 August 2006 (UTC)

Hopefully, thank you. In the meantime though the same information is added again (again) in the CPS statement.TipPt 15:48, 24 August 2006 (UTC)

Recently concluded HIV/AIDS conference in Toronto

Possibly some of the literature coming out of this conference needs to be addressed. I should think that it's all quotable for Misplaced Pages purposes. Stephen Lewis of the UN has suggested that getting as many African men circumcised as possible and as soon as possible is a vital first step in the fight against HIV/AIDS. I wonder if there is any literature coming out of that conference to the contrary.Masalai 07:18, 24 August 2006 (UTC)

We shouldn't edit quotes to become biased.

Please compare these two sections. One is forced by Nand and Jakew, but contains edited (to be biased) quoted text. My version is unedited, and is therefore not biased.

Jakew calls it NPOV ... but mine is ALL from the text, unedited!TipPt 16:58, 24 August 2006 (UTC)

Looking again, I did add my own text to the CPS introduction (only). The statement accurately reflects their current position.TipPt 17:03, 24 August 2006 (UTC)

Editor blanket revert again.

There are several individual edits that Jakew reverts without cause.

He should address each issue individually.

I decided it would be wasteful to try to include the deleted medical aspects (potential benefits listed in the main topic). Better for later when someone rewrites that sub-section. I don't find any of it very relevant (to the decision to circ, or cost/benefit).TipPt 21:06, 25 August 2006 (UTC)

And possibly take a look at this revert by Jakew... TipPt 21:14, 25 August 2006 (UTC)

I'd say, take smaller steps. When a large edit has multiple changes, only some of which are agreeable, and gets reverted, it's foolish to continue to push the version which has a mixed reception. The wisest thing to do is to break it into small edits, each making only one small change; the ones which are disagreeable can then be debated, and the others can, meanwhile, be implemented during the discussion over the others. This allows the real bones of contention to be pinpointed, it allows for more breathing room in the edit summaries, and it allows the uncontroversial aspects of the massive edit to be accepted and go into effect during the debate over the controversial aspects.

Specifically, in this case, I'd say the removal of "than in other Western nation" and the rearrangement of the various religion sections seems to be completely separate from the other issues involving medical and ethical issues. Why not separate these?

My 2 cents would be: "than in other Western nations" is definitely required, or else "more prevalent" must be altered to "most prevalent"; the use of "more" implies that there will follow an explanation of what the subject is more than. "Most", by comparison, is an absolute; something which is "most" is more than everything in the related field. Which is it? Also, I feel the religions should be ordered, at the very least, with Judaism foremost, as it has (by giving birth to Christianity and then Islam) played probably the largest role of any religion in spreading the practise across the world. Kasreyn 08:58, 27 August 2006 (UTC)

Mammalian Foreskins

Is there something we can add to this article on the foreskins of non-human mammals? Is there a literature on the subject? Would be interestiing to know if all these medical "advantages" of circumcision in humans are observed in other mammals or not. How is it that mammals can be perfectly healthy and uncircumcised? Is there something different about the human penis from a medical viewpoint? Are there any recorded instances of zoo animals needing a circumcision for medical reasons? bunix 11:16, 27 August 2006 (UTC)

Good question, Bunzil. Anybody? --Nigelj 18:28, 27 August 2006 (UTC)

I recall reading a report about the circumcision of bulls. I do not however, remember where I read it or what it concluded. As for the difference between a human penis and that of a non human, the prepuce of a human may or may not retract during an erection or intercourse, hence the name foreskin; the prepuce of an animal must retract during erections and during intercourse. Basically the only time a penis might require circumcision is because there is scarring to the preputial sphincter, causing permanent phimosis. More conservative treatments exist for all other indications. I would say that the important difference here is that humans *like* cutting off parts(or all) of each others genitals. Christopher 04:32, 29 August 2006 (UTC)

So, we're trying two minor at a time....

and

... just making the language better.TipPt 18:39, 27 August 2006 (UTC)

The first link is to a different article, so I will not discuss it here. The proper place is Talk:Medical analysis of circumcision.

As for the second - this is completely unacceptable. You have deleted all references to the debate on the subject, including the BMA's observation that there is "significant disagreement" among its own memberships, and instead you have quoted only the opinion of the authors of the BMA report (and this report is almost unique among medical organisations in this respect - almost all the others acknowledge the benefits).

So in effect, you have hidden the fact that debate exists, replacing it with a single, non-representative opinion. This is a huge step away from NPOV, Tip. Jakew 19:00, 27 August 2006 (UTC)

How about adding ... The medical aspects of neonatal circumcision are debated, and research has been subject to bias ... We can cite the BMA for that quote.

The reader shouldn't care that individual doctors disagree ... that's why they have the association level statements. The American and CPS find minor potential benefits ... that do not justify the risks (they do not recommend).

These paragraphs are the introduction to the medical topic, with cost/benefit (hopefully meta analysis) summaries.

Remember it's (re relevance of potential benefits) partly about proper (normal) hygiene.TipPt 19:38, 27 August 2006 (UTC)

You focus on potential "benefits", I focus on net benefit.TipPt 19:43, 27 August 2006 (UTC)

The association's policies also disagree, Tip. This doubtless reflects the fact that the committees authoring them are groups of doctors. The quote from the BMA is illustrative of the fact that there is widespread debate.

As for bias, the BMA statement observes that there are claims of bias, so it is insufficient evidence that there actually is bias. Restoring the original quote will express this.

The quote of the BMA authors' opinion ("The medical benefits previously claimed...") should either be balanced with quotes from other organisations, or it should be removed. The latter is preferable, as it avoids repetition. Jakew 19:45, 27 August 2006 (UTC)

Sexual effects

Right now the reader is not (premitted) to learn that ~1/2 the normal shaft skin is removed. They learn nothing about the frenulum. They learn nothing about lost mucosa. The amount and location of skin and mucosa varies, as does the range of lost sensitivity...

Here's what I propose for the sexual effects intro:

Effects on Sexualily

The sexual effects of neonatal circumcision have not been studied. Loss of erogenous tissues and attendant sensitivity varies with the amount and location of excised or damaged mucosa. Specifically, according to Hass and Baur in college sexuality textbooks, the frenulum is "particularly responsive to stimulation," and "very reactive," thus contributing to erogenous pleasure during sexual activity. The frenulum is a primary orgasm and ejaculatory trigger zone.

There are few studies on sexual partner preference for penises with or without foreskins, and the results are varied. The intromission function of the prepuce may facilitate penetration.

The American Academy of Pediatrics states "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males." The American Academy of Family Physicians (AAFP) states "no valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction." A 2002 peer reviewed journal of the AAFP reported on research finding “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.”

— Preceding unsigned comment added by TipPt (talk • contribs)

Tip, the changes are almost entirely original research.

• "Loss of erogenous tissues and attendant sensitivity varies with the amount and location of excised or damaged mucosa." - Source?
• "Specifically, according to Hass and Baur in college sexuality textbooks, the frenulum is "particularly responsive to stimulation," and "very reactive," thus contributing to erogenous pleasure during sexual activity" - everything from 'thus contributing' onwards appears to be your own interpretation.
• "The frenulum is a primary orgasm and ejaculatory trigger zone" - The sources cited say no such thing.
• "The intromission function of the prepuce may facilitate penetration." - The first source speculates that this may be the case, the second does not.

I know you feel strongly about this, but you must not perform original research or misrepresent sources. Jakew 09:36, 28 August 2006 (UTC)

It's my primary concern ... that frenulums are being damaged, reduced, or excised. Note the quote below lists the "body below the corona" (frenular delta?...it's more that just the frenulum) as being sensitive. Many US hospital neonatal circumcisions reduce the frenulum (or delta). It is often excised to stem bleeding from damage, or to "cure" a perceived potential frenulum breve condition. I am disturbed hearing anecdotal reports from men finding erogenous sensation nearly two inches down from the corona! Most US hospital circs leave the scar line less than one inch down from the corona. I see recent reports of increased incidence of skin bridges, and the suggestion (from a doctor) that it may be because surgeons are increasingly placing the scar line closer to the corona. Parents don't have a clue.

I have neither performed original research, nor misrepresented sources.

The full (paragraph) quote from Baur is:

While the entire penis is sensitive to tactile stimulation (touch), the greatest concentration of nerve endings is found in the glans. Although the entire glans area is extremely sensitive, there are two specific locations that many men find particularly responsive to stimulation. One is the rim, or crown, that marks the area where the glans rises abruptly from the shaft. This distinct ridge is called the corona (ko-RO-na). The other is the frenum, or frenulum (FREN-yoo-lum), a thin strip of skin conecting the glans to the shaft on the underside of the penis. The location of these two areas is shown in figure 5.8.

The full quote from Hass (two paragraphs) is:

Glans The head of the penis is called the glans, Latin for acorn, which is what it resembles. The rim of the glans is called the corona. The glans, and even more the corona, are richly supplied with nerve endings and contribute substantially to pleasurable feelings experienced buring sexual activity. The small triangular area on the underside of the glans, where the frenulum, a delicate strip of skin, is attached to the head, is also very reactive. It seems particularly responsive to touch that is light and soft.

The entire penis responds to stimulation, but at least two other areas are sources of distinct pleasure. The underside of the saft of the penis, meaning the body below the corona, seeme sensitive to gentle friction. Another site is the base of the penis. Some men report that they can be brought to orgasm by them or their partner circling the base with their fingers and stroking.

The three (vibratory stimulation) sources fully support the statement "The frenulum is a primary orgasm and ejaculatory trigger zone." That's what the sources recommend you stimulate or actually stimulate to elicit ejaculation. If you insist, the sentence could read "the frenulum is a primary site for eliciting ejaculatory response."

I read that an orgasm is required to produce emissions, which then triggers ejaculation. That's why I included orgasm, not just citing ejaculation (as the goal). I couldn't find that source.TipPt 18:51, 28 August 2006 (UTC)

The relevant quote in the second cite (intromission, I thought) reads:

"During intercourse, the skin of an intact penis slides up and down the shaft, stimulating the glans and the nerves of the inner and outer foreskin. On the outstroke, the glans is partially or completely engulfed by the foreskin with more skin remaining inside the vagina than is the case with the circumcised penis. This ‘valve’ mechanism is thought to retain the natural lubrication provided by the female because the bunched up skin acts to block the lubrication escaping from the vagina, which results in dryness."5

That article is mostly about vaginal secretions, but it deals with the foreskin and sexuality, and it was published in the New Zealand Medical Journal.TipPt 18:57, 28 August 2006 (UTC)

All men are biased

Its simple.. If a man is circumcised he will sit here and say its for the better.. If a man is uncircumcised he will sit here and say its for the better..

Pktboy 16:46, 28 August 2006 (UTC)

Remove 1/3 to 3/4 of the skin off a penis, and he'll feel less sensation. Assuming it's not all about the orgasm (and getting there is most the fun, I think) he will feel less erogenous sensation during foreplay. Remove the frenulum, and he'll have a relatively hard time reaching orgasm (especially past 50).

I think the prepuce serves three additional purposes:

One, it's primarily an androgen receptor (in other mammals), and the human penis is loaded with hormone receptors. Might that effect the timing of the act? (men have cycles too) It hasn't been studied (other than in animals).

Two, it makes penetration more comfortable and reduces thrust friction for the woman. Vaginal secretions are more likely.

Three, the foreskin makes foreplay more pleasurable for the man, increasing it's likelyhood and duration.TipPt 19:12, 28 August 2006 (UTC)

PS ... the foreskin may be as much for the benefit of women (and sexuality) as men!TipPt 19:15, 28 August 2006 (UTC)

Saying that all circumcised men are in favour of it is a gross generalisation... I am loathe to bring ancedotal evidence into Misplaced Pages but I personally know some men that are very much against circumcision having been circumcised themselves, and there's one particularly hopeless case that is near suicidal over it because he feels that it was a form of abuse his parents brought on him. I can see your point regarding the natural bias in men here, but frankly it's an unavoidable fact and should have no bearing on the article or debate as there are many, many more cases where, like this one where the views of a person would be discounted because they are directly affected by the matter at hand, but where their viewpoints are important to the matter. In this case, men are the best and worst people to discuss circumcision. 82.47.2.79 16:59, 29 August 2006 (UTC)

It would be irresponsible to leave out the fact that many uncircumcised men have trouble using condoms. Condoms tend to not fit correctly, are uncomfortable, get stuck under the foreskin, and cause myriad problems. I don't believe that affect has been studied, either. I've also met men whose foreskins were so thick and so sensitive that they couldn't be touched at all, and I assure you their sexuality was affected for the negative. On the contrary I have never met a man who was unable to climax due to his foreskins having been removed as a baby.

adults with their foreskins, who have problems with them, can voluntarily go have them removed - informed consent and all (which is denied to those of us victimized by neonatal circumcision) Lordkazan 14:56, 31 August 2006 (UTC)

And onto hygiene (adding a paragraph, and "be left to")

Hygiene

According to the American Academy of Pediatrics 1975 statement "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk." Studies in Denmark indirectly suggest that "good hygiene with regular washing may be just as effective at preventing the diseases treated by circumcision.”. One researcher concludes that access to clean water and regular washing “should all but eliminate the risk for foreskin-related medical problems that will require circumcision.”

Circumcision reduces the amount of smegma produced by the male. Smegma is a combination of exfoliated epithelial cells, transudated skin oils, and moisture that can be left to accumulate under the foreskin of males and within the female vulva area. It has a characteristic strong odor and taste, and is common to all mammals—male and female. While smegma is generally not believed to be harmful to health, the strong odour may be considered to be a nuisance or give the impression of a lack of hygiene. In rare cases, accumulating smegma may help cause balanitis.TipPt 19:55, 28 August 2006 (UTC)

Two editors with bias

Guess who this time...

Note the last paragraph, very important because it qualifies the prior (older) statement...

"A 2002 peer reviewed journal of the AAFP reported on research finding “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. These results cannot be generalized to neonatal circumcision.”TipPt 23:58, 28 August 2006 (UTC)

• Seriously TipPt, do you believe your own edits are unbiased? Fan-1967 00:12, 29 August 2006 (UTC)

Specifically Fan, do you feel exclusion of the above quote (AAFP) is not bias?TipPt 00:32, 29 August 2006 (UTC)

TipPt, I followed up on three of the sources you cited in your edit, specifically in the sentence concerning the frenulum. None of them said what you claimed they said. We've talked before about falsifying sources, and I thought we were clear that it is not cricket in any way. Until and unless you stop misrepresenting sources to push your POV, you should not be surprised when you are reverted. Nandesuka 00:34, 29 August 2006 (UTC)

All of the cites are professional, and recommend that you stimulate the frenulum to elicit ejaculatory response. Orgasm (emission) is required for ejaculation; thus the sentense inclusion of orgasm. I'm sorry you don't understand the purpose of the cites. They provide valuable information and evidence to the reader, so why do you object?TipPt 16:51, 29 August 2006 (UTC)

I object because lying about sources, as you are doing in that paragraph, is unethical and against Misplaced Pages policies. Nandesuka 17:31, 29 August 2006 (UTC)

I did not lie about those sources. They each provide proof for the statement. I'm sorry you don't understand. Your blockage of this information from the reader is unethical.TipPt 15:03, 30 August 2006 (UTC)

You claim that those sources indicate that the frenulum is a "primary site" for eliciting ejaculatory response. None of the sources you cite say anything of the sort. You need to re-read the policy on no original research and internalize why what you are doing gives the appearance of engaging in bald-faced deception. Nandesuka 15:12, 30 August 2006 (UTC)

Do you have any sources on the frequency of frenectomay as part of circumcision? I was under the impression it's uncommon, and thus not relevant to the general discusssion, but I have no sources for that, either. Fan-1967 15:09, 30 August 2006 (UTC)

For anyone trying to follow Nand's comments, here's the sentence and citations:

The frenulum is a primary site for eliciting ejaculatory response.

The citations fully support the statement, and Nand doesn't want readers to know a valuable purpose of the frenulum.TipPt 15:47, 30 August 2006 (UTC)

Fan-1967:

You might view that video clip of a circ. That neonate lost most of his frenulum and all his delta.

I have no sources for frequency of frenectomies. The risk is also about reduction of the frenulum. The reader should know the risk, and potentially ask the operator to leave all the frenulur delta.

We could quote Hass "The entire penis responds to stimulation, but at least two other areas are sources of distinct pleasure. The underside of the saft of the penis, meaning the body below the corona, seeme sensitive to gentle friction," to support the statement that if the scar line is close to the corona, erogenous tissue (other than just the frenulum) is removed.TipPt 15:47, 30 August 2006 (UTC)

Not that anyone cares...

But I was at a coctail party Sunday night ... met this lively educated Brit lady. I was careful ... "are Brits and Americans the same in bed?" ... little bias. Her answer was essentially:

American men are faster (sooner and quicker when they do) to penetrate, frantic when they do, and seem to struggle for pleasure, relative to British men. She volunteered that it might be the lost prepuce (that's what they call it). Only then did I talk about this circ topic.TipPt 00:30, 29 August 2006 (UTC)

Reasons for the POS

First, Jakew, don't misrepresent your reverting ("rv to last by SmackBot").

Here are a few issues of bias, each representing blockage by Jakew and/or and Nandesuka of relevant information to the reader:

1. Any or all of the following paragraph, to be placed in Hygiene : According to the American Academy of Pediatrics 1975 statement "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk." Studies in Denmark indirectly suggest that "good hygiene with regular washing may be just as effective at preventing the diseases treated by circumcision.”. One researcher concludes that access to clean water and regular washing “should all but eliminate the risk for foreskin-related medical problems that will require circumcision.”

2. Any or all of the following paragraph, to be placed in Sexual (or s/b effects on sexuality) because it is later than the prior statement, and qualifies that prior statment.: A 2002 peer reviewed journal of the AAFP reported on research finding “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. These results cannot be generalized to neonatal circumcision.”

3. Any or all of the following paragraphs, to be placed in Sexual (or s/b effects on sexuality):There are few studies on sexual partner preference for penises with or without foreskins, and the results are varied. The intromission function of the foreskin may facilitate penetration and vaginal wetness.

4. Any or all of the following paragraphs, to be placed in Sexual (or s/b effects on sexuality):

The sexual effects of neonatal circumcision have not been studied. Circumcisions that reduce the frenulum or that include a frenectomy remove tissue that is "particularly responsive to stimulation," "very reactive," and "seems particularly responsive to touch that is light and soft," according to Hass and Crooks in college sexuality textbooks.ref Hass K., Hass A. Understanding Sexuality, St Louis: Mosby, 1993: 99-100. Crooks R., Baur K. Our Sexuality, Fifth Edition, Redwood City: The Benjamin/Cummings Publishing Co., 1993: 129 The frenulum is a primary site for eliciting ejaculatory response. TipPt 15:30, 30 August 2006 (UTC)

Regarding the last paragraph specifically, readers who visit the three citations you provide will discover that exactly zero of them say that the frenulum is a "primary site" for eliciting ejaculatory response. Find a reliable source who says that. Otherwise, it's original research. Nandesuka 15:32, 30 August 2006 (UTC)

For anyone trying to follow Nand's comments, here's the sentence and citations:

The frenulum is a primary site for eliciting ejaculatory response.TipPt 16:03, 30 August 2006 (UTC)

The citations fully support the statement, and Nand doesn't want readers to know a valuable (and potentially damaged) purpose of the frenulum.TipPt 16:03, 30 August 2006 (UTC)

To avoid being original research, the source would also need to say so in the context of circumcision... Jakew 15:38, 30 August 2006 (UTC)

Mark this one down everyone, Jakew says we can't cite related facts ... we should delete 90% of Wiki!TipPt 16:03, 30 August 2006 (UTC)

Oh, and regarding the specific points, I'd like to refer Tip to our previous conversations about them. There seems little point in going over it all over again. Jakew 15:39, 30 August 2006 (UTC)

Mark this one down too, Jakew has spoken.TipPt 16:03, 30 August 2006 (UTC)

How about blockage by TipPt of relevant information to the reader? It seems you really want the reader to know that US and Canadian medical societies don't recommend routine neonatal circumcision. It seems you don't want people to know they don't recommend against it, either. Half the truth is not truth. Fan-1967 15:40, 30 August 2006 (UTC)

The funniest part is that TipPt's edit summary claims that I'm editing bias into it by including both facts. Fan-1967 15:46, 30 August 2006 (UTC)

It's simply the actual text Fan, don't edit bias into actual text. Jakew ... hopefully, readers will glance at the talk page and understand a little more.TipPt 15:56, 30 August 2006 (UTC)

It's part of the text. Fan-1967 16:06, 30 August 2006 (UTC)

Editor misquotes the AMA and CPS

Jakew has just reverted to a false statement that is not reflected in the citation, or in fact. The exact quote from the citation is "do not recommend routine circumcision of male newborns."

Jakew makes it "neither discourage nor recommend"

You can read the actual quotation from the AMA

Here's the bottom line from CPS: “There is therefore no indication that the position taken by the CPS in 1982 should be changed”, which in turn reaffirms the 1975 statement that “there is no medical indication for circumcision during the neonatal period."

Caught you at a lie Jakew.TipPt 16:18, 30 August 2006 (UTC)

Firstly, let us try to be civil. Secondly, let us look at the entire quote:

Recent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns. The most recent statement by the American Academy of Pediatrics reads as follows: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."

— AMA, Neonatal Circumcision

It is true that the AMA does not recommend routine neonatal circumcision. It is also true that they do not recommend against routine neonatal circumcision.

More importantly is absence of the following paragraph, the first paragraph in the report (emphasis added is my own):

This report is confined to circumcisions that are not performed for ritualistic or religious purposes. In this case, the term "non-therapeutic" is synonymous with elective circumcisions that are still commonly performed on newborn males in the United States.

— AMA, Neonatal Circumcision

My personal opinion is that it neither construction was accurate, and TipPt, you are as guilty as you perceive Jake to be, in that you tried lumping in religious and ritualistic circumcision in the umbrella of not recommended . I don't think anyone "lied" per se, but we need a very clinical and corect construction, which in my opinion would be:

Anything else would not accurately reflect the entire sequence of paragraphs and would be an issue. -- Avi 16:26, 30 August 2006 (UTC)

Ritual and religious circumcision are BOTH non-theraputic, and are equally (if not more) of a crime. Sure some of us are biased (myself included) against circumcision as we have been victimized by it. However we are merely seeking accuracy, we don't have to make the article biased "in our favor" to "win" - the truth stands quite well enough for itself in showing that there is no medical excuse for male genital mutilation - never has been, and never will be Lordkazan 15:04, 31 August 2006 (UTC)

I believe you are completely missing the point. Your, my, and anyone's opinion is irrelevant in this article. My point is that the AMA citation used for supporting that part of the article SPECIFICALLY EXCLUDES ITSELF FROM COMMENT ON RELIGIOUS AND RITUAL CIRCUMCISION. Any application of ANYTHING in the AMA to religious or ritual circumcision is not only WP:OR, but an absolute error and misrepresentation of the AMA, and needs to be reverted on sight as a verifed falsehood. Further the AMA agrees to the possibility of medically necessary circumcision, I fail to see where your statement of “there is no medical excuse for male genital mutilation” has any basis in the AMA source. Our responsibility is to accurately portray reliable sources, no more, no less, and the way the AMA article was used was a violation thereof. -- Avi 15:18, 31 August 2006 (UTC)

sorry for the simplified statement creating confusing - "male genital mutilation" doesn't include the very small, and infrequent, cases of medically justifiable circumcision such as a true case of pathological phimosis (development phimosis, which you "grow out of", is often misdiagnosed as such), however there are also less invasive proceedures for correcting such, and recently the BMA told it's doctor's that using circumcision in such cases, when less invasive proceedures would work, is unethical. So the confusion is mine, however "non-theraputic" includes "ritual and religious" whether the AMA would like to admit it or not - if it's not for a medically justifiable reason, then it's non-theraputic by definition of the word theraputic! Lordkazan 15:59, 31 August 2006 (UTC)

however "non-theraputic" includes "ritual and religious" whether the AMA would like to admit it or not

— Lordkazan, 15:59, 31 August 2006 (UTC)

Unfortunately, the above is absolute and total WP:OR, and an example of someone's personal feeling intruding upon, AND CHANGING, what is documented in the citation. Lordkazan, I understand you feel strongly about this, but that does not, and can not, allow you or anyone to CHANGE what is written in the text of the American Medical Association's policies. They are completely clear, and felt strongly enough to place it as the very first paragraph. Whether you or I agree or disagree with that, changing it is false and vandalism and completely erodes any credibility wikipeia would have. Bring a similar source, from an organization as respected and notable as the AMA, and this article will be better off for it. -- Avi 16:29, 31 August 2006 (UTC)

Send in the british!

Medical Ethics Commitee, British Medical Association, 4 April 2003.

"The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision"

"The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks"

"parental preference alone is not sufficient justification for performing a surgical procedure on a child."

"The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."

The entire statmeent is here - the BMA is fairly hostile to circumcision and has been since 1949 - http://www.cirp.org/library/statements/bma2003/ Lordkazan 17:02, 31 August 2006 (UTC)

Lordkazan, we discussed that at LENGTH a few months ago. The BMA came out with a more recent 2006 position which is what is quoted in the article. So what you bring is outdated, irrelevant, and repudiated by the BMA itself. Check the archives of this page if you wish.

You now seem to be fishing to find something to repudiate both the AMA and the BMA. That smells very dtrongly of pushing a POV and not trying to add reputable, reliable quotes to both sides. -- Avi 17:08, 31 August 2006 (UTC)

Auvert Study and Langerhans cells claims, POV, inaccurate

The Auvert study is a steaming pile of crap - it is fatally flawed in it's methodology as it does not account for the differences in sexual behavior bewteen it's "intact control group" and it's "circumcised expirimental group". The problem arsises from the fact of where they performed the study - people who are circumcised there are almost certainly muslim and engage in MONGOGAMOUS relationships with single partners as opposed to the uncircumcised people there being of a different subculture that is not nearly as monogamous, often has multiple-partners, doesn't use condoms, and is often exposed to sex workers.

Study with contrary results: http://www.docguide.com/news/content.nsf/news/852571020057CCF6852571CD005207D9 More refutations of various HIV studies: http://www.circumstitions.com/HIV.html

AS for the Langerhands cells claims - those were annhilated a long time ago by the CDC http://www.cirp.org/library/disease/HIV/dezzutti/

The lack of contradictory evidence presented, despite it's abundance and higher quality, constitutes a villation of the NPOV rules IMHO. Lordkazan 14:51, 31 August 2006 (UTC)

If you care to look at the Auvert study, you will find that differences in behaviour were indeed controlled for, and did not significantly affect the results. To quote: "When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%–77%)."

Furthermore, if you actually read the study, you'll see that men were randomly assigned to one of the two groups and then circumcised as part of the study. So unless being Muslim could have affected the randomisation process (a mathematical impossibility), your objection is invalid.

The article at docguide.com you cite is an observational study. While relevant, these are considered far weaker than randomised controlled trials (such as the Auvert study). As for the rantings of an activist on his website, these don't conform to reliable source guidelines and it is pointless to even discuss them.

The CDC 'annihilation' that you refer to did not even investigate preputial tissue, but instead focused on prostate tissue. Consequently, the CDC do not even mention it on their own factsheet on circumcision and HIV.

If you have serious evidence to the contrary, from reliable sources (eg peer-reviewed journals), then by all means add it to the article. Jakew 15:30, 31 August 2006 (UTC)

I see that they were then circumcized - my error before. I still fund the results of this study EXTREMELY dubious - especially with the difference between the two groups being 20 people vs 49 people - the claim of "60%" is misleading as it only supposedly reduced the rate by 1.25 cases per 100. Better results come from condoms, and that should be noted. Furthermore, based upon anecdotal evidence, intact men are more willing to use condoms (AFAIK no studies have been performed to confirm this unfortunately) - theoretically that would be because they are not missing 2/3rds of the erogenous nerves from their penis.

As for observational studies being "far weaker than RCTs" - that's assume the RCT is valid - the "60% protection" claim is based off a difference of 1.25 per 100 which could easily have merely been an abberation in the study. We will have to wait for a more specific refutation. It should remain noted that CONDOMS HAVE BETTER PROTECTIVE QUALITIES

As for "the rantins of some.. blah blah" - which includes citing studies, specific data. Just because he's ranting doesn't mean he's wrong, he gives all his reasoning and citations for you to doublecheck his statements.

as for dezzutti study - they're more epithelia with similiar properties. There are other refutations, I'll have to find them.

I'm trying to keep this article accurate and neutral as I believe that the best scientific research out there has failed to show any benefits of circumcision. Even if all the claims of benefits were true - those benefits can be gained through other means without the removal of healthy erogneious tissue (Which was done to me, against my will, long before I was able to consent/refuse)

If i'm uncivil with you then I will have to apologize, as you rae treading on the toes of someone who feels victimized by male genital mutilation Lordkazan 15:46, 31 August 2006 (UTC)

Strong personal feelings are all the more reason to step back and be very careful to watch out for letting personal feelings affect your opinion of studies. This is essential in articles on emotional issues. Fan-1967 15:50, 31 August 2006 (UTC)

You assume I don't? My feelings come from FACTS not the otherway around. I am not some weekminded fool who cannot seperate fact from feeling. I feel strongly on this subject for the very reason that no study has ever shown benefits of circumcision without methodological errors, or the same effect being achievable via non-mutilative means. I highly suspect Auvert because of the existing history of such studies on the subject being flawed, and it's usage of shock-value "60%" as it's primary claim instead of talking about the actually numbers, which were quite small, and could easily be a statistical abberation. Furthermore those who laud it keep conviently neglecting to mention the fact that condoms work much better, and fail to account for what is lost to circumcision. The idea of "it's just a flap of skin" when all the evidence to the contrary is staring them in the face, keeps running on. Here is a page (WITH SCIENTIFIC REFERENCES) of what is "lost to circ" http://www.noharmm.org/advantage.htm Lordkazan 15:53, 31 August 2006 (UTC)

A very astute point. Jakew 16:00, 31 August 2006 (UTC)

Your apology is accepted.

I'm sorry that you find the results dubious. Perhaps you should direct your energies towards finding peer-reviewed articles (or other reliable sources) expressing similar doubts. Certainly condoms should not be forgotten, and, for example, the recent WHO statement makes this very clear.

You appear to misunderstand my point about circumstitions.com: because the site itself does not conform to policy, we can't cite it. Therefore, it is pointless to even discuss the merits or lack thereof in the arguments, since a) WP:RS prevents us from citing it, and WP:NOR prevents us from analysing the points.

Since you express an interest, these are the findings of studies I'm aware of concerning circumcision status and condom usage: "Circumcised men were older and more likely to be Muslim. They were more likely to report a history of condom use" "Condom use in men was associated with being young, living in town, being born in Kagera Region, high education and high income, being circumcised, and having causal or steady (non- martial) partners." "Fewer uncircumcised men reported a history of condom use." "There were no statistically significant differences between circumcised men and uncircumcised men in marital status, lifetime number of sex partners, number of non-spousal partners in the past 12 months, one-off sexual contacts and contacts with sex workers in the past 12 months, alcohol consumption and condom use."

Jakew 16:00, 31 August 2006 (UTC)

I find the last one the most probably accurate (that there was no difference) - as I said it was merely anecdotal. However dismissing circumstitions is the wrong action - sure we cannot cite them directly, but we can clean interesting information from them, including often the leading criticism of studies, and then find independant sites that we can cite that say the same thing. He has a specific thing on the Auvert study that points out some egregrious flaws in the methodology. http://www.circumstitions.com/HIV-SA.html

"inclusion criteria: ... Consenting to avoid sexual contact (except with condom protection) during the 6 weeks following the medicalized circumcision"

"When you are circumcised you will be asked to have no sexual contact in the 6 weeks after surgery. To have sexual contact before your skin of your penis is completely healed, could lead to infection if your partner is infected with a sexually transmitted disease. It could also be painful and lead to bleeding. If you desire to have sexual contact in the 6 weeks after surgery, despite our recommendation, it is absolutely essential that your (sic) use a condom."

"Meanwhile the intact control group was not required to use condoms for the first six weeks of the study, just sent out to take their chances."

So there is your potentially show-stopping methodological error, and we don't have to cite circumstitions because we can cite the methodology of the study itself saying "However this study is potentially inaccurate as the circumcised experiment group was required to use condoms for 6 weeks while the intact control group was not, this potentially biased the data" Lordkazan 16:20, 31 August 2006 (UTC)

No, even if this was a problem, we couldn't criticise it in this way because it would be original research (ie, criticism which has not already been published in a reliable source). However, we know that it was not a problem because differences in condom usage were controlled for in the analysis, as noted in the quotation above, so hypothetically ignoring WP:NOR, all we could truthfully say is "it could potentially have been inaccurate for this reason, but the researchers were smart enough to check and control for this potential problem, so in fact it wasn't a problem." Jakew 16:36, 31 August 2006 (UTC)

claimed they compensated, and actually compensated, are two different things, furthermore human sexual behavior is not truly randomized - there are many problems with the study, pointing them out DOES NOT constitute original research if you have a source to cite - such as the study itelf - I find the data about the unreliability of the seroconversion count (posted below) even more damning however. Lordkazan 16:46, 31 August 2006 (UTC)

Lordkazan, could you please read information given to you? Specifically, please read Auvert's "authors' reply". You will see that they responded to Michael Glass, who raised the issue of the slightly different numbers reported. To quote: "Michael Glass has read a number of reports of our study. During the trial, we collected about 12,000 blood samples, performed about 12,000 clinical examinations, and collected about 48,000 questionnaires. We were careful to enter all these data with a double-entry procedure and even a triple-entry procedure for the laboratory data. This, of course, took considerable time. Nevertheless, we wanted to make available to the international community some preliminary information as soon as possible. We decided to release the results of the trial in a preliminary form at the International AIDS Society Conference in Rio de Janeiro. It is often the case that the results presented in a conference do not correspond exactly with those presented in the abstract, and that the final published results can be slightly different from those given in the oral presentation. We knew that this might be a problem, and we were careful to indicate to the PLoS Medicine editors that the results would be finalized only after the conference." Jakew 17:38, 31 August 2006 (UTC)

Given the history of this research all being as reliable as cold fusion claims, I still don't believe them - there are pretty clear methodological flaws in it, but unfortunately to date all the people who have pointed them out cannot be cited because of the overzealous pov-pushing original research rules Lordkazan 17:59, 31 August 2006 (UTC)

Unfortunately, you are not correct, Lordkazan. You can only cite published criticism of the study. Your own criticism of a published study is original research. -- Avi 16:52, 31 August 2006 (UTC)

It's not _MY_ criticism, i was quoting someone else. However that doesn't change your statement. I find this policy to be utter bullocks in this reguard as it is allowing flawed studies a free-pass simply because their opponants, no matter how correct, skilled and intelligent, cannot get published - that in and of itself constitutes a POV bias. However see above in the previous section where I started quoting the BMA Lordkazan 17:05, 31 August 2006 (UTC)

And please se where I point out that BMA 2003 has been superseded by BMA 2006, which is what is now referenced in the article, so the BMA you quote is outdated and basically rescinded by the BMA itself. -- Avi 17:46, 31 August 2006 (UTC)

I was actually looking for that, not realizing it was in the article - in some ways the BMA took more steps forward, and in some ways took steps backwards. Excepting the occasional medical condition such as pathalogical phimosis, the prepuce is healthy tissue and it's morally and ethically reprehensible to allow it's removal - we protect our daughters, why not our sons? (ok.. that was soapboxing, sorry.) Either way, the fact that I was looking for that refutes your insulting crap above about me trying to push POV IN THE ARTICLE. Yes I'm trying to "push pov", but not in the article, I don't have to pollute the information stream like the pro-circ people have by publishing false study after false study. Lordkazan 17:59, 31 August 2006 (UTC)

While I appreciate the zeal you bring, all editors must follow wikipedia guidelines and policies. "Righting the world from improper research" as noble as that may be, is forbidden on wikipedia. That is original research. All we are allowed to do is to bring published and verifiable data from reliable sources. No more, no less. Anything else is a simple violation of wiki policy, and will be dealt with according to wiki guidelines. The fact that you, I, Tipt, jake, or whomever may disagree as to the nature of the steps taken by the BMA is irrelevant. -- Avi 18:04, 31 August 2006 (UTC)

I was the one who needed to take a chill pill earlier, now it's your turn - look at my contributions list and you'll see that I haven't edited the page - I have only discussed this on the talk page, AS APPROPRIATE, since it is a controversial topic - I did remove a reference to it from another page that didn't have a source citation. I have a change I think we can all agree on the "60% reduction claim" is a bit misleading and POVish imho - it gives an exaggerated sense of protection - perhaps we should instead note the 0.85 per 100 for the circumcised group to the 2.1 per 100 for the intact control group, and note the difference in condom usage - that would both be in accordance with all wikipedia guidelines, and be more accurate. Lordkazan 18:09, 31 August 2006 (UTC)

Fair enough regarding my chilling out, consider me cool and copacetic . Regarding the change from relative to absolute statistcs, Disraeli said it best when he said there are lies, d@mn lies, and statistics. I suggest use both, a 60%change from 2.1 to 0.85. -- Avi 18:15, 31 August 2006 (UTC)

Sounds fair enough - perhaps note that it was "60% change from 2.1 per 100 to 0.85 per 100, or a total of 49 in the control group and 20 in the expirimental group." - which means that it takes 80 circ's to prevent one case of HIV when using circ as the only preventing (or no circs when using condoms! :P) Lordkazan 18:27, 31 August 2006 (UTC)

Also http://www.docguide.com/news/content.nsf/news/852571020057CCF6852571CD005207D9 despite being "an obersational study and being considered less accurate" shouldn't be censored from the main page either - it shows a mix of data that suggests that perhaps the statistics that Auvert came up with were right for it's data set but that perhaps it is only just a stastitical anomaly and that consistent results may not be found Lordkazan 18:35, 31 August 2006 (UTC)

I can't see any good reason for citing that particular paper - of all the 40 or 50 observational studies, why that one? It makes no sense: it's just arbitrary. It's more logical to cite one of the systematic reviews of observational studies, as we do at present, which gives a much better perspective on these. Jakew 18:42, 31 August 2006 (UTC)

More data

Jennifer Vines, MD, of the Oregon Health & Science University in Portland, comments "...the authors did not control for other sources of HIV transimission such as blood transfusions or exposure through infected needles. ... Controlling for this route of infection could result in a smaller difference between HIV infection rates in the circumcised versus uncircumcised groups, indicating that circumcision may not be as effective at decreasing HIV transmission as the article suggests." http://medicine.plosjournals.org/perlserv?request=read-response&doi=10.1371/journal.pmed.0020298#r992

"Auvert and colleagues claim a “degree of protection equivalent to a vaccine of high efficacy” . This is obviously overstated. A vaccine of high efficacy is expected to offer long-term protection of 95% or above. Smallpox was eradicated with such a highly efficient vaccine. If control of tetanus, measles, and poliomyelitis has been largely achieved in the world, it has been a result of high-efficacy vaccines. Furthermore, the analogy with vaccines appears misleading. A 96%-efficient measles vaccine means that 96% of vaccinated persons exposed to measles are indeed protected against infection. Protection lasts for many years, and revaccination permits dealing with loss of immunity over time. What Auvert and colleagues show is different: they show a 60% reduction in disease incidence over an 18-month period among circumcised men compared with uncircumcised men with similar exposure. To our knowledge, this does not mean that those men are really “protected” against HIV, especially in the case of repeated exposure. It simply means “reduced risk,” or reduced probability of contamination." Michel Garenne of the Institut Pasteur http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030078

IT also appears that 20 in the expirment and 49 in the control group may have been numerous false positives "The Abstract of the AIDS Conference in Rio reported 15 seroconversions from the circumcised group and 45 seroconversions in the uncircumcised group. (The New Scientist, 6 August, reported 15 seroconversions in the circumcised group but 51 in the uncircumcised group. On 29 July the Science and Development Network reported 18 seroconversions in the circumcised group and 51 in the uncircumcised group.) On 23 October, PLoS reported that there were 20 seroconversions in the circumcised group and 49 in the uncircumcised group. From the official figures: 15-45 at the AIDS Conference in Brazil and 20-49 in the PLoS Journal, between 1 August and 23 October there appear to have been 4 seroconversions among the uncircumcised and 5 seroconversions among the circumcised: in less than 3 months, a 3:1 difference has shrunk to 2.45:1 difference. "

"Rebecca Goldin points out that the low HIV/AIDS rate in the US means it would require 10,000 circumcisions to prevent 5.5 HIV infections, so the risks of circumcision are at least comparable." http://www.stats.org/record.jsp?type=news&ID=529 (404 :( damn - mirror http://www.circumstitions.com/News19.html#stats ) Lordkazan 16:32, 31 August 2006 (UTC)

Please see the authors' reply in which some of those issues are addressed. Jakew 16:36, 31 August 2006 (UTC)

Jake, this link appears to be dead. Have you got another one? gargoyle888 17:18, 31 August 2006 (UTC)

Try this. It may have been edited slightly, as this is the text as printed in the following issue, rather than the e-letter. Jakew 17:34, 31 August 2006 (UTC)

Their "Refutation" to the criticism about the sexual behavior differences is to assert that they believe something, they have no hard evidence, and I would like to know how they supposedly account for the difference.

they also propagate a medical myth The first paper on the association between male circumcision and HIV infection was published in 1986. In addition, it is possible - as far as I've read from reliable sources - it was practiced then, but there was never any mention of medical reasons in egyptian writings

nor do they refute the evidence that they were shown that male circumcision increases male->female transmission

They also reiterate their sampling problem of the fact that many of the participants WANTED to be circumcised, so they had a sample bias and at the size they claimed themselves of "The majority participated for the safe and free circumcision and to improve their health, 37.7% and 40%, respectively" that it is uncorrectably large

The Auvert study is fatally flawed, and I wait with baited breath for the medical community to descend upon it like a pack of wolves as they have eventually done to all the previous studies - of course the counter-studies never seem to get press for some reason even when they totallly destroy the pro-circ'ers claims. stupid media Lordkazan 18:25, 31 August 2006 (UTC)

Well, I hope you enjoy the wait. :) Incidentally, I personally addressed the claim that male circumcision increases male->female transmission in my own letter. Please see here. Basically, it was a case of an author cherry-picking studies supporting an anti-circumcision viewpoint, rather than taking the time to identify and assess all relevant studies. Systematic approaches are essential to avoid confirmation bias. Jakew 18:36, 31 August 2006 (UTC)

1. Hass K., Hass A. Understanding Sexuality, St Louis: Mosby, 1993: 99-100
2. Crooks R., Baur K. Our Sexuality, Fifth Edition, Redwood City: The Benjamin/Cummings Publishing Co., 1993: 129
3. Cite error: The named reference AAP1999 was invoked but never defined (see the help page).

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