Talk:Circumcision/Archive 73

Questions that need to be asked about HIV in lede, an alernative proposal and thoughts on 'context'
Just for reference I will reproduce what we say about HIV in the lede as it stands:


 * One analysis of studies done in Africa indicates that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%,[15][16] and studies have concluded it is cost effective in sub-Saharan Africa.[17] The WHO currently recommends circumcision be part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.[18] Some organizations have discussed under what circumstances circumcision is ethical.[19][20]

It seems to me nobody has picked up on the real bias shown by Jake. That is the decision as to what to include in the lede.

These are the questions we must ask:

Should we say anything at all about HIV in the lede?

What should we say about HIV?

Should we put the percentage reduction (the results of the cochrane study). Why? This is where Jake has shown bias.

There is also the question of context. Anyone who mentions the word context is wikilawyered and pointed to a certain rule where you cannot conflate sources as this is original research. But like I said before, the choosing of what goes in the lede is a form of original research because you, the wiki editor, are deciding from all the subtopics of circumcision which is deemed most important to put into the lede. Then there is how you phrase the information and the order it is put in - again the wiki user's personal thoughts - akin to original research. To make these decisions you have to have some original thought, no? So stop wikilawyering when anyone mentions the word context. You are being hypocritical if you do.

Regarding circumcision and Africa, currently we have a sentance:
 * "The WHO currently recommends circumcision be part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV".

This is a waste of space. Instead of this we should talk about what has happened since that recommendation was made. Take for instance this article: UNAIDS and the US President's Emergency Plan for AIDS Relief (PEPFAR) have launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015 as part of HIV prevention efforts. To me, we should definitely have something about the efforts by governments and big organisations like the UN to carry out circumcision programmes in Africa. Currently the general reader knows nothing about the massive effort to increase circumcision in Africa. About what is currently going on. So this is what I am saying about bias. It is subtle. Why put the results of the Cochrane study before a sentence about the scale up of circumcision in Africa?

So, an alternative proposal:


 * There are efforts to scale up circumcision Africa in the belief that it will reduce HIV.(link to http://www.malecircumcision.org/index.html for example) Studies have been done, largely in Africa,  which indicate circumcision reduces the risk of HIV.(link to cochrane)  Circumcision opponents question the validity of the studies (link to one of the anti-circ reviews), question the ethics of mass circumcision in Africa(link) and think there are better methods of HIV prevention.(link)

To me this is a lot better - more interesting and informative for the general reader and less biased.

Another point. Why pay so much heed to the words of big organisations? The choice of which organisations in particular to pay so much heed to is again akin to original research because you, the wiki user, are using your own personal thoughts to decide how important each organisation is. I think we need to stop showing so much reverence to big organisations like the UN and WHO. We shouldn't necessarily think that because the UN says it, then that is that, it is the majority view and any other view should not be given equal weight. In this instance the UN/WHO is basically the researchers who carried out the studies. So what I am saying is that in a lot of areas where Jake thinks the debate is done and dusted, the pro-circ view is the majority view, that is wrong. We should have equal weight. If we except this then I think there would be a lot less disputes here. Tremello (talk) 06:56, 30 May 2012 (UTC)
 * Thank you, Tremello, and with Coppertwig's research, it would seem the issue is settled against any further credibility for the Aftrican RCts. Robert B19 (talk) 17:51, 31 May 2012 (UTC)
 * Same reply posted in the several places Robert has brought up Van Howe & Storm so that we can consolidate into one discussion thread below So you're saying Van Howe & Storm's criticism of the Cochrane review brings up enough doubt that, according to Wikipedia policy and guidelines, we shouldn't use it? Let's discuss that, I will up a new thread for that discussion.  18:05, 31 May 2012 (UTC)


 * First of all, Tremello, comment on content, not the contributor. You've claimed that "I've" shown bias twice in the above text; presumably you think I wrote this material.  In fact, I didn't, but that's a moot point.  Don't make this personal.
 * Next, regarding whether HIV should be discussed in the lead, I refer you to Zad68's excellent comment.
 * Next, you claim that bias has been shown in including the percentage reduction, but you haven't explained why that's biased.
 * Next, you argue that "the choosing of what goes in the lede is a form of original research because you, the wiki editor, are deciding from all the subtopics of circumcision which is deemed most important to put into the lede". This doesn't seem a very constructive argument because, if applied to its logical extent, it would mean that the article would be an empty page.
 * Next, you claim that referencing the WHO's recommendations "is a waste of space", but you haven't said why.
 * Next, you ask "Why put the results of the Cochrane study before a sentence about the scale up of circumcision in Africa?" The answer is that we need to explain that circumcision has an effect against HIV before we explain why people are doing anything about it.
 * Next, you propose: "There are efforts to scale up circumcision Africa in the belief that it will reduce HIV.(link to http://www.malecircumcision.org/index.html for example) Studies have been done, largely in Africa, which indicate circumcision reduces the risk of HIV.(link to cochrane) Circumcision opponents question the validity of the studies (link to one of the anti-circ reviews), question the ethics of mass circumcision in Africa(link) and think there are better methods of HIV prevention.(link)". There are several problems with this; the most glaring problem is that is gives far too much weight to circumcision opponents.
 * Next, you say "I think we need to stop showing so much reverence to big organisations like the UN and WHO". I disagree.  The UN and WHO are extremely influential, having led directly to policy decisions by multiple countries.  They're cited in large numbers of sources.
 * Next, you say "So what I am saying is that in a lot of areas where Jake thinks the debate is done and dusted, the pro-circ view is the majority view, that is wrong. We should have equal weight." Equal weight would be undue. Only a tiny minority of secondary sources are negative towards circumcision as partial protection against female-to-male HIV transmission.  See User:Jakew/reviewsumm. Jakew (talk) 10:11, 30 May 2012 (UTC)
 * The WHO/UNAIDS is a highly respected organization and is exactly the type of high quality source we should be using. As to "equal weight", you should read WP:WEIGHT. We weight what the reliable sources weight. In this case, Cochrane and the UN are the highest quality sources we have, so we give them the most weight. Yobol (talk) 15:39, 30 May 2012 (UTC)
 * The guidance at wp:MEDRS is clear. We should work from the best quality sources available. Systematic reviews published by the Cochrane Collaboration are explicitly identified as such. LeadSongDog come howl!  06:56, 31 May 2012 (UTC)
 * A Cochrane review is not just "One analysis of studies" This is the foremost evidence based research organization in the world and there analysis hold more weight than most. Content regarding circumcision programs / efforts belongs in the "society and culture" section. Doc James  (talk · contribs · email) 08:54, 31 May 2012 (UTC)
 * Couldn't agree more. The "one analysis" wording failed to get consensus at .  There's a discussion at  about a possible compromise. Jakew (talk) 12:46, 31 May 2012 (UTC)

Sorry not got back to this, was busy.

Doc James says: "Content regarding circumcision programs / efforts belongs in the "society and culture" section". You could say to that, content about HIV belongs in the HIV section. Point I was making it should be in both. I was making a point about what exactly to put about HIV in the lead. Why this sentence: "circumcision reduces the risk of HIV infection in heterosexual men by 38-66%"? You would say that on the issue of "does circumcision reduce the risk of HIV infection in heterosexual men?" we turn to Cochrane because it the most reliable. But that doesn't decide the issue of whether to cite Cochrane in the lede does it? That doesn't decide the issue of how to approach the subject of HIV in the lede. It is only if we have first of all decided, and everyone has agreed that, regarding HIV and circumcision in the lede, we are only going to talk about female-to-male HIV transmission percentage reduction, does guidance at wp:MEDRS come into play. But we haven't decided that, and that is the pro-circ bias. I'd rather talk about HIV and circumcision in more general terms - see my alternate proposal.

Jakew says: regarding my alternative proposal: "There are several problems with this; the most glaring problem is that is gives far too much weight to circumcision opponents." Does it? I don't think it does. Not everything should be thought of in terms of "more words for anti-circ = more bias in favour of anti-circ". It merely explains the situation. It is more important to explain the situation. My alternative proposal does that better than the current paragraph.

Next, you claim that referencing the WHO's recommendations "is a waste of space", but you haven't said why. I think I did. Because it would be better if we talked about the scale up of circumcision in Africa as a result of the recommendations. That would bring the reader up to date. The only reason I can think someone would want to to retain this recommendation sentence is because you are more concerned about the lede coming across as an endorsement of circumcision rather than educating the reader on the situation regarding HIV in Africa - which is the reason the WHO got involved after all. To reduce HIV. No to endorse circumcision. Basically what happened is, the researchers went to the WHO or the UN. The UN/WHO agreed with the researchers. UN/WHO poured money into scaling up circumcision in Africa. If HIV is reduced, it will be hard to tell if circumcision was responsible, due to confounding factors. So really what you are saying is that the people at the WHO and the UN, lay people, who took the researchers at their word are the most reliable authoritative source. Obviously this is not true. The decision to pour the money in was probably made by a handful of people such as Chief Scientific Adviser to UNAIDS Catherine Hankins. . Who knows whether that is a good way to spend WHO/UN money? So I think there is a great case for equal weight. It is roughly a 50/50 split I'd say among informed people on whether circumcision is a good HIV prevention strategy in Africa. On the issue of circumcision as a HIV prevention strategy in the USA and other countries I would say, among informed people, it is more anti-circ than anything.

"The UN and WHO are extremely influential, having led directly to policy decisions by multiple countries. They're cited in large numbers of sources." Yes but that doesn't mean we should not give equal weight to the opposing view that HIV is not a good prevention strategy and more importantly the opposing view that circumcision is not a good prevention strategy in developed countries such as the USA (which is where most of the readers of this article will be from).

Only a tiny minority of secondary sources are negative towards circumcision as partial protection against female-to-male HIV transmission This is begging the question. The question being begged is: why should we only put the results of Cochrane on protection against female-to-male HIV transmission, including the percentage, which gives it an air of certainty? Rather than, as I say, a more general discussion of HIV such as my alternate proposal above. Again, this is where you are showing pro-circ bias. You point to User:Jakew/reviewsumm, but I don't think that is good enough to justify the type of sentence we currently have.

Yobol says: ''The WHO/UNAIDS is a highly respected organization and is exactly the type of high quality source we should be using. As to "equal weight", you should read WP:WEIGHT. We weight what the reliable sources weight. In this case, Cochrane and the UN are the highest quality sources we have, so we give them the most weight.'' This doesn't make sense. You say we weight what the reliable sources weight. So in this instance you are saying the UN and WHO are the reliable sources. So that would we mean we weight what the UN and WHO weight. But that isn't addressing whether we should not give equal weight to the opposite view to the UN and WHO. The decision to cite the WHO and UN is your decision, as a wikipedia editor. You are saying that because the UN and WHO have a view then the opposing view does not deserve equal weight. This is your own personal judgement, which is akin to original research. My view is that we should give equal weight because the issue that circumcision to reduce HIV in all scenarios, in all types of country is not an issue which is settled. At the moment that is the impression the lede is giving the general reader. Tremello (talk) 11:04, 1 June 2012 (UTC)


 * Tremello, regarding my observation that your proposal would give undue weight to the views of opponents, you say "Does it? I don't think it does."  Yes, it does, as I explained, and saying "It is more important to explain the situation" is a very poor excuse for violating NPOV.
 * Next, you justify your statement regarding the WHO's recommendations by saying "Because it would be better if we talked about the scale up of circumcision in Africa as a result of the recommendations". That is just using one of your opinions to justify another.  You say "Basically what happened is...", but you don't offer any sources in support of your account.
 * You say "It is roughly a 50/50 split I'd say among informed people on whether circumcision is a good HIV prevention strategy in Africa", but you don't offer any evidence for this. And your statement conflicts with the evidence which I have supplied which would suggest quite the contrary.
 * You say "You point to User:Jakew/reviewsumm, but I don't think that is good enough to justify the type of sentence we currently have", but you don't offer any objections of any substance. Jakew (talk) 11:42, 1 June 2012 (UTC)

Facts to consider with "due weight"
I believe the following are some interesting facts to consider when analyzing due weight in a lede. I believe the above questions are not covered sufficiently in wikipedia guidelines for us to make a conclusive decision. Pass a Method  talk  10:42, 4 June 2012 (UTC)
 * 1) Which of the many references should get foremost inclusion?
 * 2) How detailed should it be?
 * 3) How lengthy should it be?
 * 4) Should space should be afforded to opposing views? If so how much?
 * 5) Shold we consider the merits and validity of the argument when considering reliable sources?
 * 6) If a reliable source makes a commendable claim that criticizes a source with higher quality, should the former be acknowledged? Alternatively, should the higher quality source be modified as a compromise?


 * Most of these issues are general editorial questions rather than being "due weight" issues, specifically. Wikipedia policies and guidelines do actually offer a fair bit of guidance on these points:
 * WP:MEDASSESS states: "In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, such as anecdotes or conventional wisdom." It goes on to identify the better types of study.
 * Presumably you mean "how detailed should the lead be". WP:LEAD doesn't offer specific guidance on that, but it does give some general goals.
 * Again, presumably you mean "how lengthy should the lead be". WP:LEAD is fairly specific on this: "The lead should normally contain no more than four paragraphs".  We currently have five, but the same material could be presented in four without difficulty.
 * WP:UNDUE offers fairly specific guidance on this: "Wikipedia aims to present competing views in proportion to their representation in reliable sources on the subject". In other words, we aim to make the proportion of space describing a viewpoint roughly proportional to the representation of that viewpoint in reliable sources.
 * Both WP:MEDASSESS and WP:NOR indicate that we can't assess the merits or validity of an argument.
 * Where consistent with WP:UNDUE, we can include well-sourced criticism. To answer the second question, we must always reflect sources accurately; we can't say what we think they should have said. Jakew (talk) 12:17, 4 June 2012 (UTC)

Criticism of Cochrane
There has been expressed a desire to include some content on the criticism of the Cochrane study and its findings. There are enough sources out there that this topic in and of itself is notable. I would like to open a discussion about what to include, and where. I observe that this article Circumcision is already too long. It is the 1,638th largest of several million articles (putting it easily in the top 0.1% largest articles), and as it currently stands is over 140,000 raw bytes, and so is probably WELL into the Wikipedia recommendation to be divided up--"Readable prose size > 100 KB: Almost certainly should be divided," see WP:SIZERULE. According to Wikipedia guidelines, including WP:UNDUE, the article would be actively made worse by adding a large section about the criticism of this one source of data supporting maybe a dozen sentences in the article. I suggest that a new article be created, something along the lines of Criticism of medical analysis of circumcision, that a one-sentence summary along the lines of "Various sources and studies have criticized the methodology and findings of Cochrane and other studies," along with a "See also" linking to that new article. Thoughts? 15:10, 27 May 2012 (UTC)
 * I think it's a good idea to consider where might be a good place to put this material. However, WP:CRITICISM discourages "criticism of" articles, and for good reason, I think, as it's very hard to maintain NPOV with such a scope.  I see no reason why this material shouldn't be included in medical analysis of circumcision or circumcision and HIV, where there is plenty of space.  A section of circumcision and HIV would probably be the best option.  In this article, I'd like to point out that we do already cite criticism in the body ("Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.[95][96]"); does that wording need to be changed? Jakew (talk) 15:51, 27 May 2012 (UTC)
 * Unarchived for further discussion.   19:50, 7 June 2012 (UTC)
 * I think there is a lot of of merit to creating a page such as "Criticism of medical analysis of circumcision". I would be more than happy to begin generating content for this article. I feel that "Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy" is far too ambiguous for the scope of the criticisms that have been made, such as those that I pointed out in my edit dated 04:05, 1 June 2012 (UTC) here. FactoidDroid (talk) 03:17, 8 June 2012 (UTC)
 * We don't need more WP:POVFORKs like "Criticisms of..." pages. Expansion into circumcision and HIV would be most logical. Yobol (talk) 03:31, 8 June 2012 (UTC)
 * I agree with Yobol's and Jakew's reading of the Wikipedia recommendations here, they make a good point that there should not be a separate "Criticism of..." article, due to the likely WP:POVFORK and WP:NPOV issues that would arise. FactoidDroid, are you on board with putting this content in circumcision and HIV?  If so, we'd be starting to have consensus for that and could move forward.    13:23, 8 June 2012 (UTC)

Citing Cochrane
A concern has been expressed that the "strong evidence" sentence shouldn't be presented in Wikipedia's voice unattributed. However the attempts to address this concern have ended up mis-citing or mis-characterizing Cochrane. The Cochrane review isn't just "a study," it's a meta-analysis of several studies, with heavy statistical analysis and corrections for confounding factors. Per WP:MEDRS and other Wikipedia policy, this sort of meta-analysis of large bodies of data is "Wikipedia gold"--from WP:MEDRS: "Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies." We have exactly this. In my editorial judgment, the cites we have are strong enough to make a statement about the evidence in Wikipedia's voice. I feel like if this article were ibuprofen instead of circumcision, and we had the same kinds of sources, the article would say "Ibuprofen reduces pain by 40%" or whatever, without qualification or controversy, or even the need to say "Meta-analyses of studies show that there is strong indicates that indicates ibuprofen reduces pain by 40%." So for at least the time being, I am offering a compromise that attributes the results to Cochrane, and accurately characterizes both that kind of study Cochrane is, and the results. There is a second issue of discussing criticism of the Cochrane study in the article, and I'll open a separate Talk page topic about that. 14:39, 27 May 2012 (UTC)
 * experimental research results for Ibuprofen have been replicated and confirmed everywhere in the world, acorss all boundaries cultures peoples; the HIV benefit of circumcision has been subjected to no rigorous skepticism and experiemtnal testing. And, yes, we're still waiting for your explanation about the initial editorial motivation to include these tribal studies as final ande absolute fact for the introduction. Robert B19 (talk) 18:33, 27 May 2012 (UTC)


 * Robert, please review WP:MEDRS, specifically where it says "Ideal sources for biomedical material include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally recognised expert bodies." The Cochrane review and WHO statements meet Wikipedia's highest standards as references.  Requiring further studies that re-confirm what the Cochrane review and WHO already say is outside Wikipedia guidelines, and would fall under a "Moving the goalposts" style of argumentative fallacy. For what it's worth, I looked at aspirin.  (The article aspirin is a WP:GOOD article and ibuprofen is not, so I thought it would be a better demonstration of Wikipedia's standards at work.)  Aspirin says "In general, aspirin works well for dull, throbbing pain;..." and that is attributed to one source--a single journal article by one author.  The article doesn't say "In one study, Zbigniew Gaciong (2003) found aspirin generally to work well for dull, throbbing pain..." it simply says "In general, aspirin works well for dull, throbbing pain" and the sourcing for that statement is nowhere near as high-quality as what we have for circumcision.  Based on this, wouldn't you agree that the Cochrane and WHO findings meet Wikipedia requirements for unqualified inclusion, written in Wikipedia's voice?    16:14, 31 May 2012 (UTC)


 * Agree with Zad68. This seems like a reasonable compromise, as Cochrane reviews are widely held as high quality reviews. Yobol (talk) 21:00, 27 May 2012 (UTC)


 * Its far from a reasonable compromise. Try again. Pass a Method   talk  22:29, 27 May 2012 (UTC)
 * Perhaps you could explain what your objections are, and without the snark. Yobol (talk) 22:37, 27 May 2012 (UTC)


 * The reason i hesitate to make a new compromises is that you guys sometimes make it even less neutral than the previous ones. In order for us to reach an agreement, Yobol, Zad68 and Jakew need to ask themselves why so many editors have long complained about the biased state of the lede. I have edited hundreds of articles and the circumcision lede yesterday was by far the most non-neutral article i've seen. It is still non-neural now. Anyody so myopic to be unable to have seen the extreme bias in yesterday's lede I am unable to have a conversation with since we are obviously living on different planets. Pass a Method   talk  23:00, 27 May 2012 (UTC)


 * So instead of addressing directly the attempt at compromise, you declare everyone who has ever disagreed with your position as the problem, and refuse to engage in the conversation? Why exactly are you here on the talk page if you aren't willing to discuss the article? Yobol (talk) 23:05, 27 May 2012 (UTC)


 * Im willing to discuss the article, but seeing how previous discussions have gone, im not optimistic. I sort of feel like trying to compromise with people who defended yesterdays version is like trying to convince Joseph McCarthy to support free trade. It is a lot more difficult than you think. Pass a Method   talk  23:10, 27 May 2012 (UTC)
 * So discuss. What is wrong with the wording as proposed? Yobol (talk) 23:12, 27 May 2012 (UTC)


 * I have some reservations about it, but I think Zad68's edit is an acceptable compromise. Jakew (talk) 07:12, 28 May 2012 (UTC)
 * Typically when a source is a good as Cochrane we simply state the facts "In Africa circumcision reduces the risk of HIV infection in heterosexual men by 38-66%". However the compromise is reasonable. Doc James (talk · contribs · email) 15:36, 31 May 2012 (UTC)
 * My issue with this revision is that we are still taking a study conducted in Africa and extrapolating the results to apply to heterosexual men everywhere. The lead still states that the analysis "... indicates circumcision reduces the risk of HIV infection in heterosexual men by 38-66%" (emph. mine). We know the RCTs surveyed many high-risk individuals. The authors of the RCTs seemed to acknowledge this as well. To my knowledge, most of the rest of the world is not at high risk of HIV transmission. Prior to this discussion, the lead stated for over half a year that "circumcision has been shown to reduce the risk of acquiring HIV in heterosexual populations that are at high risk". I'd like to recap the conclusions made by two of the three authors of the African RCTs:
 * In, the authors of the Kenyan RCTs state in its abstract that "Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa".
 * The authors of the African RCT stated the following: "This study has some limitations. It was conducted in one area in sub-Saharan Africa and, therefore, may not be generalizable to other places. Nevertheless, because of the similar route of transmission of HIV in sub-Saharan Africa and because observational studies from various areas of sub-Saharan Africa have shown an association between HIV status and MC, the result of this trial is applicable to all of sub-Saharan Africa with some degree of confidence."
 * With Verifiability in mind, our lead seems to be inconsistent with the conclusions drawn from 2 of the 3 authors of the RCTs. FactoidDroid (talk) 03:07, 1 June 2012 (UTC)
 * We discussed this at length in Talk:Circumcision/Archive 72, didn't we? Also, even if it were a valid objection, I don't see how it differentiates between the three versions (ie., the long-standing "Strong evidence from Africa" version, the "One analysis of studies done in Africa" version, and the proposed compromise "A Cochrane meta-analysis" version), as all of these refer to heterosexual men. Jakew (talk) 09:40, 1 June 2012 (UTC)
 * An important distinction that could be made in the lead is that is has been shown to decrease female-to-male HIV transmission in African men. This is supported by the original authors of the studies, as I've shown, but the lead is currently far more generalized. FactoidDroid (talk) 02:50, 4 June 2012 (UTC)
 * As I said, wasn't that the subject we discussed in Talk:Circumcision/Archive 72? Jakew (talk) 07:22, 4 June 2012 (UTC)

(Unindenting) It looks as though we have rough consensus above in favour of this compromise. There are only two objections, one of which is a comment on contributors rather than content, and the other (which revisits the "African men" suggestion) applies equally to the other versions, and therefore is not a reason to reject this compromise. Jakew (talk) 09:51, 6 June 2012 (UTC)
 * Agree.   12:19, 6 June 2012 (UTC)

Passamethod, Robert, NeilN, and I reverted Zad's compromise in favor of the current compromise. I still believe if we are going to have this detail of HIV in the lead it must be balanced with its own prevalent well sourced criticsm. Garycompugeek (talk) 13:35, 6 June 2012 (UTC)
 * Incorrect, Gary. Only Robert B19 reverted Zad68's compromise.  See . Jakew (talk) 13:38, 6 June 2012 (UTC)
 * The page was protected after Robert reverted Zad's compromise which really isn't a compromise at all. I'll illustrate the changes..

original
 * "Strong evidence from Africa indicates that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%,"

2nd version
 * "One analysis of studies done in Africa indicates that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%,"

3rd version
 * "A Cochrane meta-analysis of three large randomized controlled trials from Africa has shown that there is strong evidence that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%,"

The only thing Zad's compromise accomplishes is to site Cochrane... The edit war was about removing "strong". Garycompugeek (talk) 18:08, 6 June 2012 (UTC)
 * I might agree with the Zad compromise if it did not have so much detail. Why not "a meta-analysis" without mentioning "Cochrane" or "three large randomized controlled trials" part? Also, why not a brief mention of reviews criticising the RCT's? Pass a Method   talk  18:27, 6 June 2012 (UTC)
 * Recall that in the discussion taking place at the time, the main objection was that "Wikipedia should not be taking the study's conclusions as its own" (this was clearly why the "one analysis" wording was introduced: so as to be able to attribute the conclusion to a particular source). But those objecting to the "one analysis" wording noted that it failed to do justice to the source, which is highly regarded and carries a great deal of weight in evidence-based medicine.  Zad68's compromise avoided stating the conclusion in Wikipedia's voice, but gave enough detail about the nature of the source to allow the reader to assign that weight him/herself.  "A meta-analysis" doesn't provide enough information to allow the reader to do that.  For example, "a meta-analysis" might describe a poorly-regarded meta-analysis of a handful of small, low-quality observational studies. Jakew (talk) 18:41, 6 June 2012 (UTC)
 * Consdering the study has been criticised by notable medical organizations and reviews, i would apprciate if you stopped using words such as "highly regarded" for Cochrane. Pass a Method   talk  19:16, 6 June 2012 (UTC)
 * A handful of papers have criticised the RCTs, but very few have actually criticised the Cochrane review itself. In any case, like it or not, Cochrane reviews are highly regarded. Jakew (talk) 19:24, 6 June 2012 (UTC)
 * Thats my point. RCT's and other methods in thie African study have been criticized. by notable medical organizations. Please take that into consideration when you make a proposal. Pass a Method   talk  19:41, 6 June 2012 (UTC)
 * We've already discussed the inclusion of criticism on many occasions. In any case, none of the three wordings refer to criticisms, so that isn't an argument for or against the compromise. Jakew (talk) 19:50, 6 June 2012 (UTC)
 * btw Doc James above has also indicated he is okay with merely mentioning reduced HIV incidinces. Pass a Method   talk  19:54, 6 June 2012 (UTC)
 * My position has been that a sound editorial judgment precludes the hiv studies from the lead. The prhrse one analysis barely passes muster. I don't see the relevant of the  hiv studies for english reader. Robert B19 (talk) 19:57, 6 June 2012 (UTC)
 * (e/c) Pass a Method, that's exactly the value of a Cochrane review. A Cochrane review is a systematic review that starts with a question to answer, reviews all the available information published about that question, selects the best information sources, and performs heavy meta-analysis on them. So even if some sources question a particular RCT, a systematic review like Cochrane will evaluate those questions, and cross-compare the methods and results of all the included RCTs to produce a very reliable result. It is for exactly this reason that Wikipedia policy WP:MEDRS gives the most weight to a systematic review, and even values Cochrane so highly that it says under "Use up-to-date evidence": "Cochrane Library reviews are generally of high-quality and are routinely maintained even if their initial publication dates fall outside the above window," allowing the use of Cochrane reviews for longer than other study results. Honestly, this unwillingness to accept the results of this Cochrane review is beginning to sound like nothing more than WP:IDONTLIKEIT, which is not an acceptable argument against using it.  19:59, 6 June 2012 (UTC)
 * Zad, i have never disregarded CXochrane. I am well aware of its merits. However, i am only asking that we balance it in a larger context. WP:MEDSCI also says that we should "make readers aware of controversies that are stated in reliable sources".  Pass a Method   talk  20:43, 6 June 2012 (UTC)
 * Do you have any proposals on how we should word the controversies of the African study? Pass a Method   talk  21:24, 6 June 2012 (UTC)
 * Pass a Method, re your statement "i have never disregarded CXochrane. I am well aware of its merits." -- I'm getting mixed messages here, because earlier you also said "i would apprciate if you stopped using words such as "highly regarded" for Cochrane." We need to clarify this--Can we both agree to the statement "According to Wikipedia standards, the Cochrane review is an ideal type of medical reliable source, and its findings should be used in the article."  I agree with this statement, do you? Regarding "Do you have any proposals on how we should word the controversies of the African study" -- What do you mean by "African study"?  Do you mean one of the individual RCTs included in the Cochrane review?  Or do you mean the Cochrane review itself?  (Is there an objection now to using the phrase "Cochrane review" at all??  I sure hope not.)  If you mean "Cochrane review", then this subject of including criticism of Cochrane in the article is actually off-topic for this discussion section, which was meant to be about Citing Cochrane--meaning, how exactly should the Cochrane review results (not the criticism of them) be presented in the lead.  Rest assured that myself and Jakew and others (I'm sure) agree that criticism of Cochrane is notable and should be covered by Wikipedia, and I actually already raised the topic of including criticism of Cochrane in the article--see Talk:Circumcision/Archive_72.  Jakew pointed out that the article already includes a mention of criticism of Cochrane and suggested expanding medical analysis of circumcision.  You didn't contribute to that discussion, maybe you missed it?  If you'd like to discuss that, would you please un-archive that thread and bring it to the top Talk page.  For clarity, I'm trying very hard to keep the separate discussions in their appropriate sections.    02:05, 7 June 2012 (UTC)
 * Zad, what i meant by that perceived contradiction is that Jake merely intends to mention the African study without mentioning those opposing the study. I believe Jake is giving undue emphasis on one journal and ignoring the dozens of others. The way Jake interprets wikipedia guidelines you almost get the impression that wikipedia policies state "we only use Cochrane. Anything contradicting Cochrane has to be disregarded, deleted and/or ignored."  Pass a Method   talk  02:28, 7 June 2012 (UTC)
 * In the interests of clarity, my position is that discussing critics in the lead would give them undue weight, since even a few words would represent a significant fraction of the total HIV material in the lead. However, I see nothing wrong with brief discussion in the body of the article (as is already the case), or lengthier discussion in one of the more detailed articles.  As Zad68 has commented, however, this discussion is off-topic for this thread.  Jakew (talk) 07:35, 7 June 2012 (UTC)
 * Jakew, I agree with you here.   19:45, 7 June 2012 (UTC)
 * Pass a Method, again, there is consensus from editors here, including myself and Jake, to mention the criticism of Cochrane in the article. Jake and I agree that, per WP:LEAD and WP:UNDUE, the correct placement of the criticism of Cochrane would be a sentence in the body mentioning it, and possibly expanding on it in medical analysis of circumcision.  And, again, the article already mentions the criticism of Cochrane, in the body.  It appears, based on your contributions here and your edits to the article, that you are generally in agreement with the ideas that:  1) Cochrane should be used and cited, and 2) Cochrane could be cited in the lead with a sentence like, "A Cochrane meta-analysis of three large randomized controlled trials from Africa has shown that there is strong evidence that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%."  This is good, because we actually need get to a consensus on these topics so that the article can remain stable, and we can dispense with the slow (or fast...) edit-warring and other stuff that lead to things like the full-protection and 1RR proposals.  With that, I'll un-archive the "Criticism of Cochrane" thread from the archive, and let's continue the discussion of the topic there.    19:45, 7 June 2012 (UTC)
 * You can't get aroundthemisleading wording that makes the african tribeal studies applicable to men elwhere. Robert B19 (talk) 22:37, 7 June 2012 (UTC)
 * There is nothing "misleading" in the source. We should stick to the wording of the source, which discusses risk in heterosexual men with no qualification. Yobol (talk) 23:16, 7 June 2012 (UTC)
 * qualifies it quite a bit Yobol"The review supported previous review fingings thatt the results from existing obessevational studies showed a strong  epidemiological associaltion between male cirucmsiiion and prevention of HIv, espeically among high-riskgroups."  — Preceding unsigned comment added by Robert B19 (talk • contribs) 22:00, 9 June 2012 (UTC)
 * The wording of the source without a qualifier runs contrary to the conclusions stated by two of the three authors of the RCTs (as I've pointed out in and this link). Perhaps I'm having trouble reconciling this with Verifiability. FactoidDroid (talk) 06:57, 14 June 2012 (UTC)
 * In terms of WP:V, there's a very important question: which source do we cite, and does that source support the qualifier? Jakew (talk) 07:33, 14 June 2012 (UTC)

Do Van Howe & Storm's criticism of Cochrane discredit or cast enough doubt to rule out its use?
A few editors have brought up Van Howe & Storm's criticism of Cochrane, and feel that their criticism discredits or casts enough doubt on Cochrane such that, per Wikipedia policy, it shouldn't be used. I'd like to hear the arguments why. On the outset, the credentials behind the Cochrane review appear to far outweigh Van Howe and Storm; Van Howe and Storm's analysis has itself been criticized by peers who have found enough error in Van Howe and Storm's criticism to cast at least equal doubt on their criticism; and Wikipedia policy weights well-respected meta-reviews much more highly than individual journal articles. Would those who are making the argument that Van Howe & Storm's criticism rules out the use of Cochrane please address this here. 18:11, 31 May 2012 (UTC)
 * The source for that article the "Journal of Public Health in Africa" is an open sourced journal that is not MEDLINE indexed, with a dubious looking editorial team (all of one person that is back in the main publishing house, PagePRESS). I doubt this qualifies as a WP:MEDRS, and would give zero weight to it. Even if it were to be used, it should be given considerably less weight than a Cochrane review (one of the highest quality MEDRS sources available), and certainly cannot be used to disqualify the Cochrane source. Yobol (talk) 18:16, 31 May 2012 (UTC)
 * Yobol, although I'm inclined to agree with you, Cochrane has (I believe) been in the article supporting content for quite some time now. It's a new proposal from some editors to remove the source from the article; per WP:BURDEN it's up to them to make a case for removing it to a sufficient degree that it should be removed per consensus, so I'd like to hear the arguments.    18:21, 31 May 2012 (UTC)
 * The text by Van Howe and Storm is not the only one criticizing the analysis., published in the Australian Journal of Law and Medicine, seems to take issue with many aspects of the analysis, stating "the trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission." , published in the Australian and New Zealand Journal of Public Health, criticizes the Cochrane analysis with respect to its application in Australia. The conclusion of the text reads: "Our conclusion is that such proposals ignore doubts about the robustness of the evidence from the African random-controlled trials as to the protective effect of circumcision and the practical value of circumcision as a means of HIV control". The Royal Dutch Medical Association has also scrutinized the studies, stating: "That the relationship between circumcision and transmission of HIV is at the very least unclear is illustrated by the fact that the US combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The Dutch situation is precisely the reverse: a low prevalence of HIV/AIDS combined with a relatively low number of circumcisions. As such, behavioural factors appear to play a far more important role than whether or not one has a foreskin." The very title of , published in The American Journal of Preventative Medicine, is "Male circumcision and HIV prevention insufficient evidence and neglected external validity".
 * At the very least, there seems to be merit to at least integrating into the lead that the analysis have been in scrutinized by valid sources such as those indexed by pubmed that I've linked to above. FactoidDroid (talk) 04:05, 1 June 2012 (UTC)
 * Per WP:UNDUE, the number of critical sources is less important than the proportion ("Wikipedia aims to present competing views in proportion to their representation in reliable sources on the subject"). Five critical sources in ten, say, is a significant number, and (all things being equal) would suggest similar weight.  Five critical sources in fifty is much less significant.  In User:Jakew/reviewsumm I sampled sixty of the most recent secondary sources in PubMed.  Only two were negative towards circumcision's partial protection against female-to-male transmission. Jakew (talk) 07:06, 1 June 2012 (UTC)


 * Jake, i think you may have a tilted understanding of WP:UNDUE. I believe the most important notion is the following question. How do we find the right balance between the conflicting references? Although our conclusion to what that balance is may differ. Pass a Method   talk  16:41, 3 June 2012 (UTC)
 * Do you agree that WP:UNDUE states "Wikipedia aims to present competing views in proportion to their representation in reliable sources on the subject", PassaMethod? Jakew (talk) 16:59, 3 June 2012 (UTC)


 * Yes i do, which bringe me to FactoidDroid's point above in the last sentence about valid scrutiny. Pass a Method   talk  17:26, 3 June 2012 (UTC)
 * Since you agree that the goal is to present views in proportion to their representation in reliable sources, would you explain why determining the proportion to which they're represented in reliable sources is inconsistent with WP:UNDUE? Jakew (talk) 17:35, 3 June 2012 (UTC)


 * I did not say that it is. Pass a Method   talk  18:04, 3 June 2012 (UTC)
 * Jakew, I imagine it would help if you mentioned how many of the sixty secondary sources had a discernible viewpoint one way or the other. That would help us put the proportion in better perspective. FactoidDroid (talk) 02:46, 4 June 2012 (UTC)
 * Thirteen are marked 'unclear', leaving thirty forty seven. Jakew (talk) 11:56, 4 June 2012 (UTC)
 * Jakew, I believe if you were to sample articles talking about circumcision anywhere but in Africa, you would find that very few actually address the validity of the African trials with respect to other continents; those few that do, are negative. The weight, then, is not 5 articles out of 50, but 5 articles out of maybe 7.
 * To further comment on the criticisms of the Cochrane review, these criticisms should focus on the applicability of the meta-analysis to other cultures, not on the methodology of the meta-analysis itself with regards to reducing HIV in Africa, since many articles reference Cochrane in reducing HIV in Africa. Rip-Saw (talk) 23:54, 7 June 2012 (UTC)
 * Rip-Saw, in this comment you mention that you had "actually read the article in question" and, therefore, it was "clear" to you that the Cochrane authors did not intend to generalize their conclusion to outside Africa. I have also read the article, and do not see what you were talking about. Could you please point out what part of the Cochrane study shows the Cochrane authors did not intend to generalize their conclusion? I would certainly hope not to be a part of "grossly irresponsible scientific reporting". Thanks. Yobol (talk) 00:27, 8 June 2012 (UTC)
 * Rip-Saw, I'm afraid your comments don't make a lot of sense. First of all, the scope of the sentences we're discussing is not restricted to non-African environments.  Consequently, there is no logical basis for assessing due weight as you propose.  Secondly, in a hypothetical situation in which such a method were appropriate, your method still wouldn't make sense because you haven't provided any evidence in support of your figures. Jakew (talk) 09:42, 8 June 2012 (UTC)
 * Yobol, I actually said it was clear that the authors intended the results apply to Africa. What is not clear is if they intended the results apply to other cultures outside the ones they studied. In science, it is assumed you do not come to conclusions about something without having first studied it. Since the authors never make any mention of cultures outside of Africa, I do not believe they intended to make such a scientific blunder. Their words are being misunderstood and taken out of context.
 * Jakew, the vast majority of articles that make reference to the Cochrane review are articles about Africa. In that respect, when it comes to Africa, the vast majority of literature supports the Cochrane reviews, and thus would be undue to call into question the validity of the review. Outside of the scope of Africa, the literature is split, with a substantial percent questioning the Cochrane review's external validity. This means it is perfectly OK to discuss the problems with the review in this context. To not do so would be POV. Rip-Saw (talk) 15:40, 8 June 2012 (UTC)
 * If we find ourselves discussing protective effects by continent, let's work out due weight accordingly. For the time being, however, it doesn't make sense to assess due weight in a different context than that of the sentences involved. Jakew (talk) 15:54, 8 June 2012 (UTC)
 * There is a conflict inmeaning then. Footnote 16, "Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review", refers to the first part of the sentence, "A Cochrane meta-analysis of studies done in Africa indicates that circumcision reduces the acquisition of HIV by heterosexual men between 38% and 66% over 24 months".  It's quite clear that the findings apply only to african or footnote 16 can't be included. else it impliesthat circumcision has been found costeffective for men everywhere, not just afraica which the  footnote doesnt support. Robert B19 (talk) 18:28, 8 June 2012 (UTC)

{Outdent}Robert what is the complete first sentence in the abstract at the very beginning of the article referenced by footnote 16? 19:41, 8 June 2012 (UTC)
 * @Rip-Saw: I think it takes a very unusual understanding of the words "out of context" to suggest using the words that the authors used, when there is no evidence to the contrary in the document, is somehow incorrect. The authors, at no point, suggest or say otherwise, but you have made it up in your mind you know what they are truly thinking and saying, against the plain reading of their words. Remarkable. Yobol (talk) 01:22, 9 June 2012 (UTC)
 * The Cochrane Review group on hiv/aid disagrees with you. Safety of task shifting for male medical circumcisionin Africa: a systematic review and meta-analysis "We restricted our reviewto studies done in Africa, as the region where malemedical circumcision is predominately being rolled outfor HIV prevention." http://hiv.cochrane.org/sites/hiv.cochrane.org/files/uploads/Ford_2011.pdf  Robert B19 (talk) 22:24, 9 June 2012 (UTC)
 * There are a number of reviews on the topic of HIV and circumcision, and the one you are linking is a completely different one than the one being used in the lead and is being discussed. Please stay focused on the topic. Yobol (talk) 22:47, 9 June 2012 (UTC)

{Outdent} Proposed revision to lead: "A Cochrane meta-analysis of circumcision experiments done on sexually active men in Africa indicates that circumcision reduces the acquisition of HIV by heterosexual men between 38% and 66% over 24 months" The lead probably misleads the layperson about the experiemnts. The layperson will assume we're desribing a beneit of infant circumcison. Can't we clarify it so there's no possiblity of confustion? Robert B19 (talk) 17:06, 10 June 2012 (UTC)
 * The first problem there is that the word "circumcision" in "circumcision experiments" is unnecessary. The second is that "experiments" is imprecise: "randomised controlled trials" is more informative, particularly if linked.  "Done on" is slightly awkward wording.  Finally, "circumcision reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months" is copied verbatim from the source, except that the word "by" is omitted, introducing a grammatical error.  See WP:PLAGIARISM for an explanation as to why this is a problem.
 * To correct these issues, I've rewritten it as follows: "A Cochrane meta-analysis of African randomized controlled trials indicates that circumcision reduces HIV infections among heterosexual men by 38%-66% over a period of 24 months." Jakew (talk) 17:27, 10 June 2012 (UTC)
 * I changed it to reduces the infection rate, as the way it was written was ambiguous. Rip-Saw  (talk) 03:36, 17 June 2012 (UTC)

Lead change removing Africa HIV information
The reason why the content was removed is as follows:


 * 1) Most circumcisions are done for non-therapeutic reasons on infants
 * 2) The Africa HIV claims are relevant to adult men in areas with high HIV prevalence among heterosexuals

Therefore:

The Africa HIV claim should not be in the lead since those claims are not relevant to the majority of the reasons for circumcisions. As WP:LEAD states: "material in the lead should reflect its relative importance to the subject". At best, this viewpoint represents a very low level of importance to the subject.

Because this information is of low importance to circumcision and the majority of reasons for circumcision, placing it in the lead violates WP:NPOV.

Furthermore, reliable secondary sources such as http://xa.yimg.com/kq/groups/23477339/1441224426/name/JLM_boyle_hill.pdf have cast serious doubt on the Africa HIV studies. This is all the more reason why this information should be kept out of the lead. It is not clear this is reliable information. The information that I removed from the lead is present in the article already, so I'm not removing facts or attempting to bias the article. The change I made makes the article more neutral as it removes a dubious, not-so-relevant claim from a high-visibility area of the article.

Additionally, my reasons for removal of this information are echoed by other Wikipedia editors. Please see Wikipedia_talk:Manual_of_Style/Lead_section. Crimsoncorvid (talk) 02:51, 14 June 2012 (UTC)
 * Proposals to remove that particular paragraph has undergone discussion for months (see for example this thread in the archives. It would be more fruitful for everyone involved if you were to read through the archive before propopsing similar changes which have never received consensus for removal. Note that those "other editors" in that thread were not told by you the specifics of this discussion and were only working on a hypothetical scenario which you proposed, and therefore holds no weight in this discussion. Yobol (talk) 03:05, 14 June 2012 (UTC)
 * Thanks for the pointer to the archives. It seems like most of the editors favor removing this statement from the lead so I am a bit confused. Also, I don't see the points I just brought up addressed directly. Crimsoncorvid (talk) 03:12, 14 June 2012 (UTC)
 * Perhaps you should read the thread I linked to again, where several editors, including myself, have given their reasons for including a discussion of HIV in the lead. We should not endlessly debate the same topic ad nauseum when they have alredy been discussed. Yobol (talk) 03:17, 14 June 2012 (UTC)
 * You mentioned that similar changes never reached consensus. We must continue to discuss this issue, obviously. It might be helpful if you could point to where my view on this issue is mistaken. I don't see the flaw in my reasoning and, as I mentioned before, the archived discussion does not directly address the points that I am making here.


 * I have read WP:DEMOCRACY so I know we're not supposed to "vote" per say, but I see more editors in favor of removing the Africa HIV statements. What exactly do you mean by "consensus" on this topic? Crimsoncorvid (talk) 03:51, 14 June 2012 (UTC)
 * I will provide a personal view that is expressed too strongly: Consensus is agreement between experienced editors regarding the best resolution of a proposal, where "best" is measured in terms of agreement with existing policies and practices. An "experienced editor" is one who has done significant work in a number of unrelated articles (for example, someone whose sole experience was adding a certain slant to all articles regarding a political event would be regarded as an WP:SPA, and their opinion on Wikipedia's practices would not rate highly). Johnuniq (talk) 07:48, 14 June 2012 (UTC)


 * Crimsoncorvid, re: "I don't see the flaw in my reasoning and, as I mentioned before, the archived discussion does not directly address the points that I am making here." -- Addressing your points directly:  The policy cited ("material in the lead should reflect its relative importance to the subject") is the relevant one, but the flaw in the reasoning is a misunderstanding or misapplication of it.  To understand what that bit from WP:LEAD means, you need to read WP:WEIGHT, which is part of Wikipedia core content policy.  The relevant sentence is:  "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint." (emphasis mine).  So the relevant amount of weight and detail in the article to a viewpoint is not in proportion to the prevalence of reasons why the procedure is performed (as you're suggesting), but rather in proportion to its discussion in reliable sources.  As a rough test of whether reliable sources give high prominence to discussing HIV in covering circumcision, do this quick exercise:  Go to scholar.google.com and search on "circumcision", how many of the search results mention HIV?  Answer:  About half.  So, it has been well-established that reliable sources give high prominence to discussing circumcision's effect on HIV transmission, and that is the reason why it is discussed in the proportion it is in the body of the article, and, therefore, that's the reason why 2 sentences of the lead discuss HIV.    12:33, 14 June 2012 (UTC)
 * Can someone point to the original talk page consensus to include the Cochrane reference in the article lead? I can't find it in the archives. AvocadosTheorem (talk) 17:58, 14 June 2012 (UTC)
 * Per WP:Consensus, "In discussions of textual additions or editorial alterations, a lack of consensus results in no change in the article." This particular change (removal) has been discussed for months now, and has never achieved consensus for removal. Yobol (talk) 18:06, 14 June 2012 (UTC)
 * I'm searching for the Archived Talk page that initially established the consensus to include the Cochrane reference in the article lead. I'd like to read it before weighing in on the current dispute to keep the reference. AvocadosTheorem (talk) 18:47, 14 June 2012 (UTC)
 * Thanks Yobol but AvocadosTheorem asked where in the archives is consensus for Cochrane referenced inclusion not removal. To be honest there has been mention of HIV in the lead since 2007 from the WHO and the CDC in 2008, which was replaced by the cochrane meta analysis in 2009.  Myself and others have lobbied to remove it from the lead (not the article) with little success.  I don't believe it has ever enjoyed consensus in the usual sense but it has Jake's blessing which amounts to the same thing in circumcision related articles. Garycompugeek (talk) 18:56, 14 June 2012 (UTC)
 * I was not involved in this article back then so I wouldn't know where to start looking for a discussion 3 years ago. As things stand, when there is no consensus to change, the default is to keep it how it is. If something has been in the article since 2009, it has consensus, and it is up to those who want it changed (in this case removed) to establish that new consensus to remove it. Yobol (talk) 19:01, 14 June 2012 (UTC)
 * I fail to see how this is consensus among editors just because the content has been there "for a long time". It is time to re-evaluate. Crimsoncorvid (talk) 06:10, 15 June 2012 (UTC)
 * It is what it is. Material that has been in the article for 3 years has the benefit of presumption of having consensus. If you want to change that material, the burden is on you to show the consensus has changed. Yobol (talk) 14:09, 15 June 2012 (UTC)
 * With the exception of the US CDC and NIH, not a single national medical organization has endorsed the Africa HIV studies. Brazil, Australia, and a number of European countries have issued statements rejecting these claims. The WHO and Cochrane studies have been called into question. I do not see consensus. Counting up medical studies is not consensus as that is proportional to the research funding. When an organization is trying to promote a point-of-view, it will fund studies in this area to generate support. Crimsoncorvid (talk) 06:10, 15 June 2012 (UTC)
 * I think you've misunderstood Zad68's point, Crimsoncorvid. The question Zad68 was addressing is "how much weight do reliable sources give HIV in the context of circumcision".  This is the question that needs to be answered in order to determine whether HIV should be discussed in the lead, and if so, how much coverage should be given to it.  As Zad68 points out, HIV is given considerable weight in reliable sources.
 * The question which you're addressing, I think, is "what is the relative prominence of the view that circumcision reduces the risk of female-to-male HIV transmission". Unfortunately, you've made several mistakes in addressing it.  First, you consider which agencies have "endorsed" the HIV studies; this rests on the flawed premise that medical organisations are likely to "endorse" a study, but that is not usually the case.  Second, you incorrectly state that a number of countries have rejected the studies.  A few organisations have considered whether circumcision should be promoted for HIV prevention in those countries, but that is not the same issue as whether circumcision reduces the risk of f-to-m transmission.  Third, you note that some have criticised the studies.  While true, this isn't an argument either way, as it would be unusual to find a view with no dissenting views (even the well-established association between HIV and AIDS has its critics).  Finally, you mistakenly suggest that the actual number of sources voicing a view does not count because of the influence of research funding.  This is erroneous, because WP:MEDASSESS clearly indicates that the reliability of a source does not depend on its funding: "Do not reject a high-quality type of study due to [...] funding sources". Jakew (talk) 08:30, 15 June 2012 (UTC)
 * I see two camps of editors ... the ones supporting the status quo, the others making a thoughtful case for change. The status quo camp's argument for keeping the improbable Who studies boils down to the same argument historically made for circumcision, "It's always been that way." Debunk Da Junk (talk) 19:57, 15 June 2012 (UTC)
 * "Debunk Da Junk", review the Wikipedia policies regarding no personal attacks and assume good faith. Please start making comments that address the content and not the editors.    20:19, 15 June 2012 (UTC)
 * I sense that we're going around and around in circles. Maybe this cannot be resolved. There are studies such as this one http://www.obgynnews.com/news/top-news/single-article/mandatory-circumcision-not-cost-effective-for-hiv-prevention/72782cada61b7f416a4f282dbaf4854b.html that shows that circumcision for HIV prevention is not cost effective in the US. Similar studies show that it is not cost effective for Africa either. If not cost effective, why is it important for it to be in the lead? Your WP:MEDASSESS statement is not relevant here because that refers to deciding whether or not a source is relevant for inclusion in the article. I'm referring to what determines medical consensus. On this issue, Wikipedia policies provide little guidance. The pro-circumcision viewpoint is a minority viewpoint.
 * I will reiterate that as circumcision is primarily done on babies that it is not relevant to mention a study on adults in the lead. Wikipedia guidelines require us to summarize the most relevant and salient points of the article. Africa HIV claims are not the most relevant. I completely disagree with the statements made above about weight and my interpretation.
 * Wikipedia policy of WP:LEAD states "emphasis given to material in the lead should reflect its relative importance to the subject, according to reliable sources". This is more in line with my interpretation. The Africa HIV claims are not all that important to circumcision compared to other items that are summarized in the lead -- especially since virtually all circumcisions are performed on infants and the Africa HIV research does not cover that. Of course, everything should be based on reliable sources. Crimsoncorvid (talk) 23:42, 15 June 2012 (UTC)
 * As you rightly note, we're going around in circles. To avoid unnecessary repetition, therefore, I'll just address your argument re cost-effectiveness.  There are basically two problems with your argument.  The first problem with your argument is that lack of cost effectiveness is an argument against circumcision programmes, but it's not necessarily an argument against inclusion in an encyclopaedia.  We include information about a topic, in accordance with the weight given by reliable sources, regardless of whether that information is positive or negative towards the subject.  For the sake of argument, suppose that nine tenths of the literature about circumcision was about HIV, and all of those papers agreed that it wasn't cost-effective.  That wouldn't be an argument against mentioning HIV; rather, it would be an argument for prominently discussing the lack of cost-effectiveness regarding HIV.
 * The second problem is that your assertion that circumcision is not cost effective in the US or Africa can only be reached by ignoring a large proportion of the literature. African studies have generally found that it is cost-effective (see a review of five such studies in ).  There are too few US studies to be able to say; Sansom et al (see ) found that it is cost-saving.  The article you cite appears to be about a study considering mandatory vs elective infant circumcision, which is not quite the same question.  Jakew (talk) 07:55, 16 June 2012 (UTC)
 * This has been argued through and through (more than once). This article is worldwide in scope; while most circumcisions may be done in infancy (or youth) for religious or cultural reasons, there are numerous places where the operation's value in preventing HIV spread is either increasing the elections of circumcision or is generating much debate over its efficacy and health benefits. To ignore this in the lead would be dumbing down the article because some folks have a POV that they feel threatened by its inclusion. With the logic above, why don't we just have the lead say, circumcision is a Moslem practice and chuck the rest, since the majority of circumcisions are done by Moslems for their religious reasons. Oh, but we have an article for that Khitan, and this is for the wider perspective. doh... Carlossuarez46 (talk) 16:18, 16 June 2012 (UTC)
 * I am not arguing against including this information in the article. I am arguing against including it in the lead. Crimsoncorvid (talk) 19:44, 16 June 2012 (UTC)
 * Possibly the best argument for circumcision in this world is the prevention of HIV in Africa. It is well-grounded in science, and elective male circumcision being cost-effective in Africa does not carry with it the moral issues that infantile circumcision carries. Nothing on the topic of circumcision is more lead worthy than reducing HIV in Africa. My only objections to the lead were in the way it was phrased, which seemed to apply the results to the entire world. Right now, the phrasing is written as well as it can be with the current literature that has been brought before us. Rip-Saw  (talk) 15:50, 17 June 2012 (UTC)
 * Fantastic, it looks like we have consensus on this now.   14:42, 18 June 2012 (UTC)

Weasel words
I think this passage is disingenious:


 * "The median risk of serious complications was 0% in both cases."

For the following reason: It is probably true, but it is misleading. For someone that is not familiar with the difference between mean and median averages it gives the impression that there is no risk. In reality, the statement simply says that less than half had serious complications. The sentence should be re-written to reflect the real risk of serious complications. — Preceding unsigned comment added by 213.100.0.16 (talk) 05:31, 18 June 2012 (UTC)
 * Personally I would think it better if the source had provided a few more decimal places. Nevertheless, Wikipedia's policy against original research means that we have to adhere fairly closely to the cited source.  We can't impose our own interpretations of its meaning.  Jakew (talk) 09:30, 18 June 2012 (UTC)
 * I agree with the point raised by 213.100.0.16 above. Some ways we can fix it while adhering to the source include:
 * Delete the sentence about median risk, helping to shorten the article.
 * Add information from the source: "The median risk of serious complications was 0% in both cases (ranges 0-2% and 0-3%)." No, wait.  What?  The article has three cases, not two.  The third case is with non-medically-trained practitioners and has higher rates and more serious complications.  We may need to change our wording to specify "with medically-trained practitioners" or something. link to the source.
 * Use different information from the source: e.g. something based on "Studies report few severe complications following circumcision." This could supplement or replace the statement about the median.  Or something based on "Most studies reported no severe adverse events". Actually, that may be best: just use that, and delete the stuff about "both cases".
 * We need to fix the "both cases" thing ... this requires more thought. (because the study has 3 cases, I think.) Here's another quote from the study: "Traditional circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical circumcision or traditional circumcision among neonates." ☺ Coppertwig (talk) 17:46, 18 June 2012 (UTC)
 * In this particular case, it would be preferable to give the range. Who uses medians anyways? Rip-Saw  (talk) 00:11, 19 June 2012 (UTC)

Questions that need to be asked about HIV in lede, an alernative proposal and thoughts on 'context'
Just for reference I will reproduce what we say about HIV in the lede as it stands:


 * One analysis of studies done in Africa indicates that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%,[15][16] and studies have concluded it is cost effective in sub-Saharan Africa.[17] The WHO currently recommends circumcision be part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.[18] Some organizations have discussed under what circumstances circumcision is ethical.[19][20]

It seems to me nobody has picked up on the real bias shown by Jake. That is the decision as to what to include in the lede.

These are the questions we must ask:

Should we say anything at all about HIV in the lede?

What should we say about HIV?

Should we put the percentage reduction (the results of the cochrane study). Why? This is where Jake has shown bias.

There is also the question of context. Anyone who mentions the word context is wikilawyered and pointed to a certain rule where you cannot conflate sources as this is original research. But like I said before, the choosing of what goes in the lede is a form of original research because you, the wiki editor, are deciding from all the subtopics of circumcision which is deemed most important to put into the lede. Then there is how you phrase the information and the order it is put in - again the wiki user's personal thoughts - akin to original research. To make these decisions you have to have some original thought, no? So stop wikilawyering when anyone mentions the word context. You are being hypocritical if you do.

Regarding circumcision and Africa, currently we have a sentance:
 * "The WHO currently recommends circumcision be part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV".

This is a waste of space. Instead of this we should talk about what has happened since that recommendation was made. Take for instance this article: UNAIDS and the US President's Emergency Plan for AIDS Relief (PEPFAR) have launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015 as part of HIV prevention efforts. To me, we should definitely have something about the efforts by governments and big organisations like the UN to carry out circumcision programmes in Africa. Currently the general reader knows nothing about the massive effort to increase circumcision in Africa. About what is currently going on. So this is what I am saying about bias. It is subtle. Why put the results of the Cochrane study before a sentence about the scale up of circumcision in Africa?

So, an alternative proposal:


 * There are efforts to scale up circumcision Africa in the belief that it will reduce HIV.(link to http://www.malecircumcision.org/index.html for example) Studies have been done, largely in Africa,  which indicate circumcision reduces the risk of HIV.(link to cochrane)  Circumcision opponents question the validity of the studies (link to one of the anti-circ reviews), question the ethics of mass circumcision in Africa(link) and think there are better methods of HIV prevention.(link)

To me this is a lot better - more interesting and informative for the general reader and less biased.

Another point. Why pay so much heed to the words of big organisations? The choice of which organisations in particular to pay so much heed to is again akin to original research because you, the wiki user, are using your own personal thoughts to decide how important each organisation is. I think we need to stop showing so much reverence to big organisations like the UN and WHO. We shouldn't necessarily think that because the UN says it, then that is that, it is the majority view and any other view should not be given equal weight. In this instance the UN/WHO is basically the researchers who carried out the studies. So what I am saying is that in a lot of areas where Jake thinks the debate is done and dusted, the pro-circ view is the majority view, that is wrong. We should have equal weight. If we except this then I think there would be a lot less disputes here. Tremello (talk) 06:56, 30 May 2012 (UTC)
 * Thank you, Tremello, and with Coppertwig's research, it would seem the issue is settled against any further credibility for the Aftrican RCts. Robert B19 (talk) 17:51, 31 May 2012 (UTC)
 * Same reply posted in the several places Robert has brought up Van Howe & Storm so that we can consolidate into one discussion thread below So you're saying Van Howe & Storm's criticism of the Cochrane review brings up enough doubt that, according to Wikipedia policy and guidelines, we shouldn't use it? Let's discuss that, I will up a new thread for that discussion.  18:05, 31 May 2012 (UTC)


 * First of all, Tremello, comment on content, not the contributor. You've claimed that "I've" shown bias twice in the above text; presumably you think I wrote this material.  In fact, I didn't, but that's a moot point.  Don't make this personal.
 * Next, regarding whether HIV should be discussed in the lead, I refer you to Zad68's excellent comment.
 * Next, you claim that bias has been shown in including the percentage reduction, but you haven't explained why that's biased.
 * Next, you argue that "the choosing of what goes in the lede is a form of original research because you, the wiki editor, are deciding from all the subtopics of circumcision which is deemed most important to put into the lede". This doesn't seem a very constructive argument because, if applied to its logical extent, it would mean that the article would be an empty page.
 * Next, you claim that referencing the WHO's recommendations "is a waste of space", but you haven't said why.
 * Next, you ask "Why put the results of the Cochrane study before a sentence about the scale up of circumcision in Africa?" The answer is that we need to explain that circumcision has an effect against HIV before we explain why people are doing anything about it.
 * Next, you propose: "There are efforts to scale up circumcision Africa in the belief that it will reduce HIV.(link to http://www.malecircumcision.org/index.html for example) Studies have been done, largely in Africa, which indicate circumcision reduces the risk of HIV.(link to cochrane) Circumcision opponents question the validity of the studies (link to one of the anti-circ reviews), question the ethics of mass circumcision in Africa(link) and think there are better methods of HIV prevention.(link)". There are several problems with this; the most glaring problem is that is gives far too much weight to circumcision opponents.
 * Next, you say "I think we need to stop showing so much reverence to big organisations like the UN and WHO". I disagree.  The UN and WHO are extremely influential, having led directly to policy decisions by multiple countries.  They're cited in large numbers of sources.
 * Next, you say "So what I am saying is that in a lot of areas where Jake thinks the debate is done and dusted, the pro-circ view is the majority view, that is wrong. We should have equal weight." Equal weight would be undue. Only a tiny minority of secondary sources are negative towards circumcision as partial protection against female-to-male HIV transmission.  See User:Jakew/reviewsumm. Jakew (talk) 10:11, 30 May 2012 (UTC)
 * The WHO/UNAIDS is a highly respected organization and is exactly the type of high quality source we should be using. As to "equal weight", you should read WP:WEIGHT. We weight what the reliable sources weight. In this case, Cochrane and the UN are the highest quality sources we have, so we give them the most weight. Yobol (talk) 15:39, 30 May 2012 (UTC)
 * The guidance at wp:MEDRS is clear. We should work from the best quality sources available. Systematic reviews published by the Cochrane Collaboration are explicitly identified as such. LeadSongDog come howl!  06:56, 31 May 2012 (UTC)
 * A Cochrane review is not just "One analysis of studies" This is the foremost evidence based research organization in the world and there analysis hold more weight than most. Content regarding circumcision programs / efforts belongs in the "society and culture" section. Doc James  (talk · contribs · email) 08:54, 31 May 2012 (UTC)
 * Couldn't agree more. The "one analysis" wording failed to get consensus at .  There's a discussion at  about a possible compromise. Jakew (talk) 12:46, 31 May 2012 (UTC)

Sorry not got back to this, was busy.

Doc James says: "Content regarding circumcision programs / efforts belongs in the "society and culture" section". You could say to that, content about HIV belongs in the HIV section. Point I was making it should be in both. I was making a point about what exactly to put about HIV in the lead. Why this sentence: "circumcision reduces the risk of HIV infection in heterosexual men by 38-66%"? You would say that on the issue of "does circumcision reduce the risk of HIV infection in heterosexual men?" we turn to Cochrane because it the most reliable. But that doesn't decide the issue of whether to cite Cochrane in the lede does it? That doesn't decide the issue of how to approach the subject of HIV in the lede. It is only if we have first of all decided, and everyone has agreed that, regarding HIV and circumcision in the lede, we are only going to talk about female-to-male HIV transmission percentage reduction, does guidance at wp:MEDRS come into play. But we haven't decided that, and that is the pro-circ bias. I'd rather talk about HIV and circumcision in more general terms - see my alternate proposal.

Jakew says: regarding my alternative proposal: "There are several problems with this; the most glaring problem is that is gives far too much weight to circumcision opponents." Does it? I don't think it does. Not everything should be thought of in terms of "more words for anti-circ = more bias in favour of anti-circ". It merely explains the situation. It is more important to explain the situation. My alternative proposal does that better than the current paragraph.

Next, you claim that referencing the WHO's recommendations "is a waste of space", but you haven't said why. I think I did. Because it would be better if we talked about the scale up of circumcision in Africa as a result of the recommendations. That would bring the reader up to date. The only reason I can think someone would want to to retain this recommendation sentence is because you are more concerned about the lede coming across as an endorsement of circumcision rather than educating the reader on the situation regarding HIV in Africa - which is the reason the WHO got involved after all. To reduce HIV. No to endorse circumcision. Basically what happened is, the researchers went to the WHO or the UN. The UN/WHO agreed with the researchers. UN/WHO poured money into scaling up circumcision in Africa. If HIV is reduced, it will be hard to tell if circumcision was responsible, due to confounding factors. So really what you are saying is that the people at the WHO and the UN, lay people, who took the researchers at their word are the most reliable authoritative source. Obviously this is not true. The decision to pour the money in was probably made by a handful of people such as Chief Scientific Adviser to UNAIDS Catherine Hankins. . Who knows whether that is a good way to spend WHO/UN money? So I think there is a great case for equal weight. It is roughly a 50/50 split I'd say among informed people on whether circumcision is a good HIV prevention strategy in Africa. On the issue of circumcision as a HIV prevention strategy in the USA and other countries I would say, among informed people, it is more anti-circ than anything.

"The UN and WHO are extremely influential, having led directly to policy decisions by multiple countries. They're cited in large numbers of sources." Yes but that doesn't mean we should not give equal weight to the opposing view that HIV is not a good prevention strategy and more importantly the opposing view that circumcision is not a good prevention strategy in developed countries such as the USA (which is where most of the readers of this article will be from).

Only a tiny minority of secondary sources are negative towards circumcision as partial protection against female-to-male HIV transmission This is begging the question. The question being begged is: why should we only put the results of Cochrane on protection against female-to-male HIV transmission, including the percentage, which gives it an air of certainty? Rather than, as I say, a more general discussion of HIV such as my alternate proposal above. Again, this is where you are showing pro-circ bias. You point to User:Jakew/reviewsumm, but I don't think that is good enough to justify the type of sentence we currently have.

Yobol says: ''The WHO/UNAIDS is a highly respected organization and is exactly the type of high quality source we should be using. As to "equal weight", you should read WP:WEIGHT. We weight what the reliable sources weight. In this case, Cochrane and the UN are the highest quality sources we have, so we give them the most weight.'' This doesn't make sense. You say we weight what the reliable sources weight. So in this instance you are saying the UN and WHO are the reliable sources. So that would we mean we weight what the UN and WHO weight. But that isn't addressing whether we should not give equal weight to the opposite view to the UN and WHO. The decision to cite the WHO and UN is your decision, as a wikipedia editor. You are saying that because the UN and WHO have a view then the opposing view does not deserve equal weight. This is your own personal judgement, which is akin to original research. My view is that we should give equal weight because the issue that circumcision to reduce HIV in all scenarios, in all types of country is not an issue which is settled. At the moment that is the impression the lede is giving the general reader. Tremello (talk) 11:04, 1 June 2012 (UTC)


 * Tremello, regarding my observation that your proposal would give undue weight to the views of opponents, you say "Does it? I don't think it does."  Yes, it does, as I explained, and saying "It is more important to explain the situation" is a very poor excuse for violating NPOV.
 * Next, you justify your statement regarding the WHO's recommendations by saying "Because it would be better if we talked about the scale up of circumcision in Africa as a result of the recommendations". That is just using one of your opinions to justify another.  You say "Basically what happened is...", but you don't offer any sources in support of your account.
 * You say "It is roughly a 50/50 split I'd say among informed people on whether circumcision is a good HIV prevention strategy in Africa", but you don't offer any evidence for this. And your statement conflicts with the evidence which I have supplied which would suggest quite the contrary.
 * You say "You point to User:Jakew/reviewsumm, but I don't think that is good enough to justify the type of sentence we currently have", but you don't offer any objections of any substance. Jakew (talk) 11:42, 1 June 2012 (UTC)

I have just taken this discussion from the archive to answer one of Jake's criticisms of my post.

Basically I was criticising the way we treat the WHO and UN as more important sources than any other sources. That we assume because the WHO or UN say something then the opposing view should not be given equal weight. When I described what basically happenned for the WHO and the UN to scale up circumcision in Africa above, Jake asked for a source. It is in the article Jake, reference 17: http://www.who.int/hiv/mediacentre/news68/en/index.html

The authors of the studies met with the UN and WHO officials and they basically agreed with the authors and then decided to pour money into scaling up circumcision in Africa.

Just for reference here is the newest incarnation of the HIV paragraph:

A Cochrane meta-analysis of studies done on sexually active men in Africa indicates that circumcision reduces the infection rate of HIV among heterosexual men by 38%-66% over a period of 24 months,[15] and studies have concluded it is cost effective in sub-Saharan Africa.[16] The WHO currently recommends circumcision be part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.[17]

Is it really that settled that circumcision as a prevention strategy for HIV is a good thing in Africa? The opposing view is not given anything at all in the lead. Surely we could include a study like this one from Boyle and Hill: http://www.ncbi.nlm.nih.gov/pubmed/22320006 PDF.

Also I still don't think the sentance about the WHO recommending circ for HIV prevention is as good as it could be. I still think it is outdated because the scale up has been going on for a long time now. And the reader knows nothing about it. Is this not odd to anyone else?

One more thing, regarding this sentence: A Cochrane meta-analysis of studies done on sexually active men in Africa indicates that circumcision reduces the infection rate of HIV among heterosexual men by 38%-66% over a period of 24 months

Should it be reduces or reduced? We are reporting a study. This gives the impression it is fact. Just because a study says something does not mean it is fact no matter how good you think the authors of Cochrane studies are. But as I said further up in this section, I don't think we should be citing percentages in the lead anyway. Tremello (talk) 17:02, 18 June 2012 (UTC)
 * With regards to the last comment only, it should be reduces. In the studies, they found a specific rate that HIV was reduced by, then applied some statistics to that rate to come up with a universal, medical range for that population. This range should apply is all situations given a certain population.
 * With regards to the original topic, if you can incorporate current circumcision policy in Africa into the body of circumcision first, then you can warrant talking about it in the lead. As it stands, i don't see that heavily discussed anywhere. You will have a much stronger argument if you introduce this into the body first. Rip-Saw  (talk) 00:21, 19 June 2012 (UTC)

Woman's point of view is unrepresented
I can't believe a woman's point of view is so unrepresented in your article. — Preceding unsigned comment added by Marylibrary (talk • contribs) 18:33, 16 June 2012 (UTC)
 * This is an article about male circumcision, so the female effect is unlikely to have much representation in this article . This article also belongs to no one, so if you have sourced information about how male circumcision affects women in some way, feel free to add it. Rip-Saw  (talk) 15:31, 17 June 2012 (UTC)

Your article really does European women a disservice. You should include all the information about bone-dry sex with a circumcised man that causes discomfort, even pain, for a woman. Your section about Sexual Effects is incomplete. — Preceding unsigned comment added by Marylibrary (talk • contribs) 17:57, 19 June 2012 (UTC)
 * Unless you can bring reliable sources that show that circumcision itself is the cause of "bone-dry" sex (and even if so, why circumcision itself also prevents that condition from being ameliorated in a variety of ways that I can think of), this seems very far off the topic here of what what this page is supposed to be used for: discussion of improvements to the Circumcision article.  And even if so, why would "European women" be the only ones so disadvantaged?  Either bring this discussion on-topic or close it.    18:10, 20 June 2012 (UTC)

There is some info on this in Sexual effects of circumcision.Circumcision a large subject and have several subarticles to make the size manageble. Gråbergs Gråa Sång (talk) 15:37, 27 June 2012 (UTC)

Request for a merge and rename of this article.
I request that circumcision be referred to as male genital mutilation on the page. Ideally, I would like the title to be changed. I believe that it is logically inconsistent to have female circumcision redirected to female genital mutilation, but male genital mutilation redirected to genital mutilation controversy. I also request that this article be merged with other practices like penile super incision and other male genital mutilation customs.

Having two separate articles for mgm practices is the least informative format possible. The fgm page includes all practices pertaining to female genital mutilation. I do not see why male genital mutilation should be split into different groups so it is harder for users to access all of the information in one place. According to the Wikipedia article on genital mutilation, genital mutilation is "The terms genital modification and genital mutilation can refer to permanent or temporary changes to human sex organs." Circumcision meets this definition and should therefore be categorized under male genital mutilation along with other practices. Currently, the page on circumcision only lists the phrase "male genital mutilation" once in the citation section. Ironically, the phrase "female genital mutilation" appears twice in the male circumcision article.


 * The reason circumcision is an independent article is that the topic is large enough to warrant such an article. The FAQ at the top of the page addresses your question directly. (I believe circumcision is also the least POV title for the article since "male genital mutilation" has sinister overtones.) (My first time interacting with an IPv6 editor!) OSborn arfcontribs. 17:39, 20 June 2012 (UTC)


 * Are you saying that make genital mutilation is sinister? — Preceding unsigned comment added by 86.167.19.166 (talk) 08:36, 24 June 2012 (UTC)

Okay. So it is a matter of Data production. If I can get enough reliable data to be produced named mgm instead of circumcision the title will be changed? I will be sure to spread the word if this interpretation is correct.


 * You won't be able to, so don't bother. Maybe in another 10 years you can try again. Rip-Saw  (talk) 06:18, 22 June 2012 (UTC)

Perhaps I will. I have a username now.


 * Here's the problem from an objective point of view--the word "circumcision" carries huge Biblical baggage; in fact, the earliest recorded written reference to "circumcision" apparently is from the Bible. Using a Biblical term to refer to Male Genital Mutilation precludes an objective point of view because the very word "circumcision" is heavily freighted with religious and cultural connotations.  An article on "circumcision" would be best focused on the religious rite, not the worldwide cultural practices that cut the penis in various ways.  Similar to Female Genital Mutilation, all involve the bodily alteration of the human genitalia.  "Circumcision" is a euphemism for an ancient Genital Mutilation that remains unacceptable for women but acceptable for men. Does anyone know the specific reference--Bettelheim or Freud I recall--that refers to the psychological wound of Genital Mutilation, the chief wound being a compulsion to repeat it on others. 208.54.15.50 (talk) 01:49, 27 June 2012 (UTC)
 * That does not change the fact that circumcision is the most widely used scientific term. We get plenty of perfectly valid words from biblical usage. A word's origin does not matter; words are merely labels. Rip-Saw  (talk) 02:00, 27 June 2012 (UTC)

HIV-Africa again (but not beating the dead horse this time)
I still do not believe that the HIV-Africa claims belong in the lead for reasons I've stated previously. However, the current wording is a tremendous improvement and I do not find it misleading or incorrect. Thanks to all who were involved in making this change. Crimsoncorvid (talk) 02:22, 29 June 2012 (UTC)


 * Fantastic, maybe we should get that dead horse taxidermied and hang it up on the wall as a trophy for our collaboration finally resulting in consensus! All of us as editors should be happy to see one of long-standing contentious points of this article get stabilized.    14:46, 29 June 2012 (UTC)
 * No consensus whatsoever for HIV-Africa to be in the lead, please don't overreach a conclusion from a temporary compromise. 65.6.127.171 (talk) 15:24, 29 June 2012 (UTC)
 * Correct. Crimsoncorvid (talk) 01:42, 30 June 2012 (UTC)
 * Crimsoncorvid, I disagree, there has been consensus to keep Cochrane in the lead for what looks to be at least a year by now, and consensus was most recently achieved explicitly to keep citing Cochrane in the lead in the thread you started about exactly that topic here: Talk:Circumcision/Archive_73.  I see in that thread you expressed that you were unsure what "consensus" means on Wikipedia (you asked "What exactly do you mean by 'consensus' on this topic?") and Johnuniq explained in part, "Consensus is agreement between experienced editors regarding the best resolution of a proposal, where 'best' is measured in terms of agreement with existing policies and practices."  Here is the relevant quote from the Wikipedia policy WP:CONSENSUS:  "editors try to persuade others, using reasons based in policy, sources, and common sense."  Again, consensus is based on the strongest arguments based in Wikipedia policy.  So in that thread, all the objections to keeping Cochrane in the lead were met with Wikipedia policy-based counterarguments, and those counterarguments were left unchallenged.  The thread even ended with "Fantastic, it looks like we have consensus on this now." and that observation was left unchallenged, and the thread archived.  It appears in this case that consensus came out not to your liking, but please be aware that (also from Wikipedia policy WP:CONSENSUS):  "Consensus on Wikipedia does not mean unanimity."  You should also be aware that continuing to edit against consensus can be viewed as disruptive editing.   03:10, 2 July 2012 (UTC)

re: zad comment "The thread even ended with "Fantastic, it looks like we have consensus on this now." and that observation was left unchallenged, and the thread archived." One might conclude that zad declared a consensus and then quoted his own declaration of a consensus. Sorry, that's not fair or aboveboard editing on the issue. 65.82.224.2 (talk) 18:45, 4 July 2012 (UTC)


 * Crimsoncorvid: adding: If you are unconvinced by my evaluation that consensus was achieved, I would be happy to put it out to a request for comment, so that you do not have to take my word on it.  It would be ideal if we could get some uninvolved administrators, who have been entrusted by the Wikipedia community to make evaluations about consensus, to comment on it.  I will be happy to do this if you will agree that if we have an evaluation from experienced, uninvolved administrators that consensus was achieved, we can indeed put this to rest.   03:16, 2 July 2012 (UTC)

Thanks for removing the word "strong" from the lead. Now I suggest removing it from the body. The Circumcision and HIV article mentions a number of studies criticizing conclusions from the randomized controlled trials (RCTs), for example pointing out that stopping trials early can introduce a statistical bias. I believe that since there are reliable sources expressing that point of view, per NPOV we can't state that there's "strong evidence" as a statement by Wikipedia. I suggest changing "There is strong evidence that circumcision reduces the risk of HIV infection in heterosexual men in populations that are at high risk." in the Sexually transmitted diseases section to "Evidence that circumcision reduces the risk of HIV infection in heterosexual men in populations that are at high risk has been called "conclusive" and "substantial"." (taking words from the two studies  in the footnotes to this sentence; I consider that it isn't weasel words when there are footnotes to show exactly who said it.) Perhaps also adding "though there has also been criticism." and adding a footnote to Boyle or another critical study. ☺ Coppertwig (talk) 21:53, 30 June 2012 (UTC)
 * Coppertwig, i agree with your suggestion. I have worded it as you wrote above. Pass a Method   talk  15:16, 1 July 2012 (UTC)
 * Thanks! Perfect! Thanks for formatting the Boyle reference; maybe I'll go format a reference in some other article in return.
 * Sorry, I reverted the change because there hasn't been consensus to water down the citation of Cochrane in this manner in all the many times it has come up for discussion in the archives. This was most recently discussed here:  Talk:Circumcision/Archive_73 (also mentioned in Talk:Circumcision/Archive_73) without consensus to change this article, and that was only 18 days ago.  Has something new happened in the past 18 days, or are there new policy-based arguments being raised?  I would like to avoid rehashing the same old arguments again, but please review WP:MEDRS, specifically "Ideal sources for such content includes general or systematic reviews published in reputable medical journals" and Cochrane is a systematic review published by one of the most reputable and highly respected medical review organizations around.  It would be against Wikipedia policy regarding undue weight to give Boyle-Hill what looks like equal footing.   03:34, 2 July 2012 (UTC)
 * Now I notice another sentence in that section: "Whether it protects against male-to-female transmission is disputed".  It gives two references, one saying there is weak evidence and the other saying there is no evidence.  I've only read the abstracts (not sure if I have access to the whole articles). However, that doesn't look to me like a "dispute".  I suggest changing this to "There is little or no evidence that it protects against male-to-female transmission". ☺ Coppertwig (talk) 22:19, 1 July 2012 (UTC)
 * Coppertwig, good catch! I made this change.  I had to specify that the (lack of) evidence is talking about HIV in particular, because it is that particular STD that the abstracts were talking about in regards to the paucity of evidence, and the section head the sentence is under is "Sexually transmitted diseases" in general and not HIV in particular.  I also cleaned up the end of that sentence for logical flow.  I guess if someone finds equally reliable sources that say that there is evidence that circumcision reduces M to F HIV infection, we will put back the "dispute" wording.    03:54, 2 July 2012 (UTC)

Thanks, Zad. Sorry, maybe I'm beating a dead horse, but the lead currently says "A Cochrane meta-analysis of studies done on sexually active men in Africa found that circumcision reduces the infection rate of HIV among heterosexual men by 38%-66% over a period of 24 months" and this sounds to me as if it could be interpreted to mean something different from what it should mean. What's that 24 months doing in there? Is the rate of HIV 38% to 66% lower at the end of the 24 months than at the beginning -- that is, that circumcision cures HIV? That's what it sounds like and I don't think that's what the studies said. How about deleting the "24 months" and changing "infection rate" to "infection risk" or "transmission rate"?

Re in the body of the article: I have nothing against citing Cochrane. I've argued that saying that there's strong evidence, in Wikipedia's voice, goes against NPOV. Please don't revert to this statement again without clearly stating on the talk page that you believe that it's consistent with NPOV to state that there is strong evidence in Wikipedia's voice in spite of the existence of more than one reliable source expressing a contrary point of view, and also providing an argument supporting your position. Zad, as I understand it, your main argument is against the "although" clause citing Boyle. I don't agree with your argument: I don't see an "although" clause without even a word of detail as being equal footing. However, I haven't had time to look into relative weighting of sources, so I'm not sure at this point whether the "although" clause should be included or not. However, for the rest of the sentence, I believe a change is appropriate as I've argued. I don't see this as watering down: only as providing appropriate attribution. (Why would readers believe Wikipedia more than they would believe the sources?) I'm changing it to "Evidence has been found to be strong that circumcision reduces the risk of HIV infection in heterosexual men in populations that are at high risk", without the "although" clause. ☺ Coppertwig (talk) 22:16, 2 July 2012 (UTC)
 * Good grief. After all that we've gone from "There is strong evidence" to "Evidence has been found to be strong". There really is no point in trying to improve this article, is there? --Nigelj (talk) 22:43, 2 July 2012 (UTC)
 * Now it's not only superflorous but also poor grammer. I still say "Strong" is a qualifier conclusion we should not be adding. Garycompugeek (talk) 14:41, 3 July 2012 (UTC)
 * As an outsider, I can tell you that the plug for HIV Africa in the lead is quite bizarre. — Preceding unsigned comment added by 184.38.59.124 (talk) 16:14, 3 July 2012 (UTC)


 * Coppertwig, re:


 * I encourage you to read the abstract of the Cochrane report (link to it here), which says exactly this. For your convenience, here is the Authors' conclusions" section, directly quoted in full:


 * And here is the "Plain language summary -- Male circumcision for prevention of heterosexual acquisition of HIV in men" section, directly quoted in full:


 * So, to answer What's that 24 months doing in there?, it's in there to report the findings accurately. Previously we had "Strong evidence from Africa indicates that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%", which I thought was more clear to read than what we have now, but that was changed to the current wording most recently after discussions and reaching consensus here, and I actually like your suggestion to remove "over 24 months" (and I'd rather use the word "acquisition rate" over "infection rate" but then we'd run into WP:PARAPHRASE problems) but I do not want to edit against the current consensus.  I can't tell if your question circumcision cures HIV? is rhetorical in nature and intended to point out your concern about how a reader might misinterpret the wording, or if that is actually what you are taking away from how it is worded.  I do not think the current wording would cause a typical reader in our target audience to misinterpret our paraphrase of the finding so substantially as to think "circumcision cures HIV".
 * re:
 * I'll say outright that stating in Wikipedia's voice that there is "strong evidence" not only is in accordance with WP:NPOV, it is perfectly in line with Wikipedia policies and guidelines, and many examples of using Wikipedia's voice to make a statement like this can be found in WP:GA- and WP:FA-quality articles. To understand why this is the case, please read the medical manual of style, specifically the section Medmos, where it says,
 * (emphasis mine) The Cochrane review is the most preferred kind of source for medical information (WP:MEDRS, "Ideal sources for such content includes general or systematic reviews...)  I gave a specific example of how these standards have been applied to the article Aspirin in this thread:  Talk:Circumcision/Archive_73, and also in that thread,  (Doc James, a practicing E.R. physician and a driving force behind WikiProject Medicine), confirmed, "Typically when a source is a good as Cochrane we simply state the facts 'In Africa circumcision reduces the risk of HIV infection in heterosexual men by 38-66%.'"  Here are a few more examples of the application of this guideline in WP:MEDICINE WP:FA-quality articles:
 * Antioxidant says, "By itself, UA-related risk of gout at high levels (415–530 μmol/L) is only 0.5% per year with an increase to 4.5% per year at UA supersaturation levels (535+ μmol/L)." and not "A 1987 study by Campion, Glynn, and Delabry found that, by itself, UA-related risk of gout...".
 * Bupropion says, "The addition of bupropion to an SSRI (primarily fluoxetine or sertraline) resulted in a significant improvement in 70–80% of patients who had an incomplete response to the first-line antidepressant." and not "A 1997 study by Bodkin et al. and a 1998 study by Spier found that the addition of bupropion to an SSRI..." etc.
 * and the studies used to support these statements made in Wikipedia's voice aren't as highly-valued by WP:MEDRS as our Cochrane study. The argument against "although..." has already been discussed, for a most recent discussion please see Talk:Circumcision/Archive_72, which goes into exhaustive detail of the relative strengths of Cochrane and the many other studies supporting its findings vs. Boyle/Hill and others, how WP:FRINGE applies, and how WP:UNDUE guides us in deciding on their use.
 * Also I am finding that change in wording to "Evidence has been found to be strong..." isn't an improvement and is actually more tortured wording to say effectively the same thing. If you don't mind, let's find a better way to say it, or perhaps return to the previous wording.
 * 16:54, 3 July 2012 (UTC)


 * The new wording IS a tremendous improvement, especially from since when I first entered the debate on the wording. Back then, I'm pretty sure the lead as it is written currently would have been reverted immediately, so it is nice to see that healthy debate enlightened everyone. I know I sure learned a lot about wikipedia policy, and I'm sure everyone learned something about how medical journals and studies work. if only the US government worked so smoothly (or any government...). Then again, it did take several months to re-word just the lead! :P Rip-Saw  (talk) 22:13, 3 July 2012 (UTC)
 * I made an NPOV copy-edit of the sentence "A Cochrane meta-analysis of studies done on sexually active men in Africa indicates that circumcision reduces the infection rate of HIV among heterosexual men..." (emph. mine), by editing "indicates" to "suggests". The word was edited by Yobol to "found", which is the strongest possible word one could use here. This is now in Wikipedia's voice to mean circumcision has been found to decrease HIV transmission in all heterosexual men; let's remember that this conclusion was inferred by one organization (albeit a strong one), but is still an argument with a good deal of evidence pointing to the contrary, especially with respect to the sources that have argued circumcision reduces HIV transmission particularly in high-risk areas (like the conclusions stated by two of the authors of the three RCTs). Even "indicates", the word I changed in the first place, is more NPOV than "found"... FactoidDroid (talk) 03:11, 5 July 2012 (UTC)
 * Please review my 16:54, 3 July 2012 reply to Coppertwig earlier in this thread (and the previous Talk threads it references) which addresses exactly this. As I already mentioned, according to Wikipedia WP:MEDMOS guidelines, the article should say, "Circumcision reduces the female-to-male HIV transmission rate by 38%-66%..." without referencing the underlying study or putting any qualifiers on the strength of the evidence.  The current wording that references the study is an exception to the guideline, made as a compromise with those who objected to such wording.   14:35, 5 July 2012 (UTC)
 * Zad86: I have no intention of challenging your claim of consensus. To do so would be to beat the dead horse further. I've made my opinion on this subject quite clear, but I also have no intention of "editing against consensus" or "disruptive editing" on this topic. I agree that there was consensus on the wording improvements and I do appreciate that. Crimsoncorvid (talk) 02:00, 6 July 2012 (UTC)

Reference to a serious, reliable source about the estimated number of deaths caused by circumcision
On July 7 I included a reference to an article in "Thymos: Journal of Boyhood Studies" that concluded that around 117 male infants die from circumcision each year, including complications from anastehesia reaction, stroke, hemorrhage and infection.

The user Zad68 reverted to the previous version, claiming that my contribution was "vandalism".

How can it be vandalism to include an accurate representation of a credible and important research finding in a high-quality peer-reviewed scientific journal?

Why shouldn't people be informed that serious researchers find that on average 117 children are dying per year from circumcision in USA alone?

Zad68 claims that my contribution is an "inaccurate paraphrase of unreliable source's interpration of an unreliable source that fails WP:MEDRS". This is a very strange point of view.

My reference to the source was very accurate, taking a sentence from the source and only adapting grammar slightly to make it fit into the Wikipedia article. My source is very reliable, and it fits very well with the abstract made by the authors of the original source. The original source is research material presented in a peer-reviewed scientific journal. How Zad68 can claim this to be "unreliable" is unknown, especially when comparing this scientific article with some of the other sources that look more like opinions than facts.

http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us/ — Preceding unsigned comment added by Joreberg (talk • contribs) 14:48, 8 July 2012 (UTC)


 * Hi Joreberg, thank you for taking your concerns to the Talk page, I'm happy to address them:
 * First, my revert of the edit as "vandalism" was indeed a mistake on my part as I simply hit the wrong link, and I apologize. As soon as I realized my mistake, I made a null edit with the edit summary   to indicate just that.  You did see this edit summary as you quoted it in your post above, so hopefully this no longer an issue.
 * I am glad that you take Wikipedia's sourcing standards for medical claims seriously. You correctly identify that sources cited need to be credible, reliable sources, and that peer-reviewed content published in scientific journals can be good sources for such information.  So, let's look at the sources:
 * The article currently uses a statement from the American Academy of Family Physicians, one of the largest medical organizations in the United States, putting the death rate from circumcision complications at 1 in 500,000 procedures. Using the AAFP estimate of 1,000,000 neonatal circumcisions performed each year, AAFP's numbers would project out to 2 deaths per year.
 * The author of the Thymos article, Dan Bollinger, is the owner and editor-in-chief of the International Coalition for Genital Integrity (ICGI). (Articles at icgi.org posted by "ICGI" are shown to be by Bollinger, if you click on the ICGI link, and this lists Bollinger as the main contact.)  Web citations of Bollinger show he is an anti-circumcision activist, so this is concerning regarding his impartiality.  Further, I cannot find any relevant academic credentials for Dan Bollinger.  From the results of my Web searches, he appears to have pursued a degree in Industrial Design and has a business selling refrigerator magnets, but I cannot find any evidence that he is affiliated with any university or hospital, holds a Ph.D. or M.D., or in fact has any formal medical or scientific training whatsoever, all of which would be basic requirements for Wikipedia to value his work in supporting a medical claim.  Joreberg, if you could find any credentials for Bollinger beyond what I found, please bring them forward, it would really help the case to use Bollinger's work.
 * As Carl Sagan said, "Extraordinary claims require extraordinary evidence." Bollinger's article puts the rate at 117 deaths per year, fully 58.5 times than the AAFP number.  This is orders of magnitude out of line with the AAFP statement, making this an extraordinary claim.
 * Thymos, the journal is which the article appears, is a social science journal and not a medical journal--it describes itself as publishing "current research and reflections on boys’ lives." It is described as "peer-reviewed," but the only editor listed is Diederik F. Janssen. Janssen's C.V. says he has an M.D. but is not affiliated with any university, hospital or medical organization, and lists his research interests as "anthropology of life phases, anthropology of the body, young masculinities, ethnosexology, poststructural theory in anthropology and education"--again, these are sociology areas of research, not medical.  I could not find any other editors listed doing the peer review; it appears to be just Janssen himself, and this would be rather weak for a peer review board.
 * The ICGI editorial you quote to support the 117 number is not a direct quote lifted from the Bollinger article, but rather a blog post from Dan Bollinger, quoting himself. (I also find it disingenuous that Bollinger doesn't identify himself as the author of both the blog post and the Thymos article, but that's not really relevant for this discussion.)  Even if we were to accept Thymos as a reliable source for medical claims, ICGI.org is a self-declared anti-circumcision organization, and so the editorializing it hosts is most certainly unsuitable to support any kind of medical claim, much less such an extraordinary one.
 * So to summarize, your instincts are good regarding what we should be looking for to support a medical claim, but the sources for this medical claim fail at every turn, and, in my judgment, can in no way be used to overturn the number from the highly-respected AAFP by a factor of nearly 60. However, if you are still unconvinced, I would be happy to post the claim and the source (along with the analysis of it I have provided here) to the Wikipedia Reliable Sources Noticeboard to get further opinions on it.  18:03, 8 July 2012 (UTC)

--

Zad68,

Thank you very much for your extensive comments! They were very useful!

I have looked more deeply into the matter now. I hadn't read the actual Thymos article myself (Many scientific journals still take paid for their content, which creates a terrible barrier between science and the tax payers who pay for the science). I found a blog entry from a person who has had access to the Thymos article and provided many quotes from it. He also provided comments to the quotes, and from going through these I now realize that there are several logical flaws in the Thymos article. The blog entry is available here: http://circumcisionnews.blogspot.no/2010/05/fatally-flawed-bollingers-circumcision.html

It does indeed seem that the Dan Bollinger who has written the Thymos article is indeed the same as the Dan Bollinger who is selling fridge magnets, e.g. from a LinkedIn profile: http://www.linkedin.com/in/danbollinger  If a person is selling refrigerator magnets, this doesn't prove that what the person is wrong, but it doesn't do anything to build up credibility in the field of medical science. Likewise, having a PhD is not a requirement for saying something interesting, but those who have one would get some credibility from that. Like you, I haven't found any academic credentials for Dan Bollinger.

And your observation that the Thymos journal is more directed towards social sciences than medicine also seems to be correct, relevant and important.

So I now realize that you did a very correct decision in taking away the reference I made to the Thymos article. Thank you!

(We agree that my contribution was definitely not "vandalism". I don't agree that my paraphrase was incorrect either, but when the source is so flawed as in this case, it doesn't help if the paraphrasing is done correctly...)

Your skeptic comments to the works of Dan Bollinger should be published in some more prominent place than this discussion field. The general public should be warned against pseudo-science.

Thanks for taking the time to provide such an extensive and convincing answer! — Preceding unsigned comment added by Joreberg (talk • contribs) 21:18, 8 July 2012 (UTC)
 * Glad to help, you're welcome!   01:48, 9 July 2012 (UTC)

Partial circumcision
Partial circumcision redirects here, but there is no mention of the slitting of the foreskin without complete removal, technically called dorsal slit, or the plastic surgical operation of preputioplasty. --Pawyilee (talk) 14:04, 14 July 2012 (UTC)

Appalling sexist bias in article
There is something slightly disgusting and sexually biased about Wikipedia applying the primary description of 'genital mutilation' to females whilst avoiding its accuracy as the primary description for males. In both cases adult humans mutilate the genitals of, usually, human babies or youngsters who are not in a position to effectively resist or defend themselves. Whether or not there are religious or social beliefs or pressures underlying the practice does not justify varying the description which, by most modern thinking, amounts to a form of physical child abuse, primitive, superstitious and barbaric in origin.

If cutting the genitals of babies or youngsters is accurately termed 'mutilation' when performed on females, it is also mutilation when performed on males. — Preceding unsigned comment added by 86.167.19.166 (talk) 22:50, 23 June 2012 (UTC)


 * Wikipedia is not the platform for you to express your views on this subject; Wikipedia does not publish original research and does not exist to make value judgements. The thread above sums up pretty well why it is unlikely for this article to be renamed any time soon. OSborn arfcontribs. 23:51, 23 June 2012 (UTC)


 * Do you have anything to contribute about the sexist bias? — Preceding unsigned comment added by 86.167.19.166 (talk) 08:34, 24 June 2012 (UTC)
 * I support this discussion of this very topic. Sources support a human-rights treatment of both male MGM/circumcision and FGM. The FGM article is approached from this point-of-view. Wikipedia policies don't dictate the way editors approach a subject (but of course, any approach must be backed up by sources). In the Circumcision case, they've chosen to follow only medical literature and have largely ignored the human-rights perspective. Crimsoncorvid (talk) 02:20, 29 June 2012 (UTC)
 * This article already has an "ethical issues" subsection and a "legal issues" subsection. Crimsoncorvid, it would be helpful if you would provide specific suggested changes to the article. Maybe you can find more reliable sources discussing the human-rights perspective, that can be added as references here or at Circumcision controversies.  Maybe you can suggest ways to re-arrange the order of the sections or shorten some sections.   Note that this article, even if already too long again, is very short in comparison to the huge literature on the topic out there, so anything to be added has to be justified with an argument about due weight. ☺ Coppertwig (talk) 14:53, 1 July 2012 (UTC)
 * "Males Preference For Circumcised Women In Northern Ghana" http://www.ajol.info/index.php/ajrh/article/viewFile/7884/1512 Improvement might be possible if the similarity between male and female genital cutting were discussed here.  No rational distinction can be drawn between cutting the genitalia of either sex.  Anyone with a background in human physiology understands the genital structures are basically the same. That bias merits acknowledgment in Wikipedia's voice. 201.236.221.9 (talk) 19:12, 6 July 2012 (UTC)


 * Wikipedia is not a place to express opinions on a topic or other editors. What counts are reliable sources, and the reason one article uses "circumcision" and another uses "mutilation" is that Wikipedia reflects what reliable sources have written. Johnuniq (talk) 03:13, 7 July 2012 (UTC)
 * Unfortunately, most "reliable sources" will not consider male and female genital mutilation as equal if only because of pre-established standards. Male mutilation has been accepted for thousands of years as "normal", but female mutilation has only been cast into the spotlight as a result of recent civil rights realizations. I know that Wikipedia thrives on reliable sources as its lifeblood, but consider that the fact that if more reliable sources are found supporting male mutilation than female, it is mostly because of vast patriarchical historical evidence. It's just perpetuating the male bias that most of history has. I am male, but I don't condone this sort of mutilation at all. — Preceding unsigned comment added by Fourshade (talk • contribs) 09:26, 11 July 2012 (UTC)

Personally I have severe reservations about male circumcision and very few reservations about female genital mutilation being counter-constructive and often sadistic mutilation. (I happen to be male, fwiw). However, the tone of the objections in this exchange seems to me to be inappropriate both in place and in WP in general. If you have not yet checked out the article Genital modification and mutilation, then why not, and why not take this aspect of the discussion there, with or without the sexist overtones? This article is primarily about the clinical aspects, and for my part all but the most superficial value-laden aspects could or should be exported to the Genital modification and mutilation article. JonRichfield (talk) 18:27, 15 July 2012 (UTC)

article is missing
the smell difference between circumcised and uncircumcised penis. Any woman knows this but this article is probably written by guys. No matter how much a guy cleans it- a woman can always tell the difference but the article doesn't mention that


 * Well, I didn't know that, but it is not terribly surprising, though it certainly is more interesting than the picture question. However, if what you say is correct, then the first thing to do is to find documentation describing published research, presumably necessarily by females, otherwise whatever you put in will count as OR, which is the most unconstructively inhibitory pillar of WP. Good luck, and tell us when to expect some publishable material. JonRichfield (talk) 17:49, 14 July 2012 (UTC)


 * And at the same time, we'd need to balance that against female smells, too, and naturally for intact and circumcised females. Fair is fair. Yes, I'm being sardonic. If you amputate a person's foot they don't smell either. What's the point again? Frank Koehler (talk) 20:25, 17 July 2012 (UTC)
 * The point is some women prefer cut guys, just like men in some countries prefer cut women. Let's leave preferences out of this. Rip-Saw  (talk) 00:57, 18 July 2012 (UTC)

Far too much detail regarding unfolding legal events in Germany, move this to Circumcision and law
I have removed the following content from the "Legal issues" section as it is far, far too large and detailed for this section of this article, as has been previously discussed and agreed to here on this Talk page. This level of detail regarding this one country's regional-level ruling and its possible consequences belongs at Circumcision and law, please move/merge the appropriate content there. The German ambassador to Israel, Andreas Michaelis, told Israeli lawmakers that Germany was working to resolve the issue and that it doesn't apply at a national level, but instead only to the local jurisdiction of the court in Cologne. The Council of the Coordination of Muslims in Germany condemned the ruling, stating that it is "a serious attack on religious freedom." Ali Kizilkaya, a spokesman of the council, stated that, "The ruling does not take everything into account, religious practice concerning circumcision of young Muslims and Jews has been carried out over the millenia on a global level." The Roman Catholic archbishop of Aachen, Heinrich Mussinghoff, said that the ruling was "very surprising", and the contradiction between "basic rights on freedom of religion and the well-being of the child brought up by the judges is not convincing in this very case." Hans Ulrich Anke, the head of the Protestant Church in Germany, said the ruling should be appealed since it didn't "sufficiently" consider the religious significance of the rite. A spokesman, Steffen Seibert, for German Chancellor Angela Merkel stated that Jewish and Muslim communities will be free to practice circumcision responsibly, and the government would find a way around the local ban in Cologne. The spokesman stated "For everyone in the government it is absolutely clear that we want to have Jewish and Muslim religious life in Germany. Circumcision carried out in a responsible manner must be possible in this country without punishment."

In July, a group of rabbis, imams, and others said that they view the ruling against circumcision "an affront on our basic religious and human rights." The joint statement was signed by leaders of groups including Germany’s Turkish-Islamic Union for Religious Affairs, the Islamic Center Brussels, the Rabbinical Centre of Europe, the European Jewish Parliament and the European Jewish Association, who met with members of European Parliament from Germany, Finland, Belgium, Italy, and Poland. European rabbis, who urged Jews to continue circumcision, planned further talks with Muslim and Christian leaders to determine how they can oppose the ban together.

The Jewish Hospital of Berlin has suspended the practice of male circumcision, and the German Medical Association has warned medical doctors nationwide to avoid doing non-therapeutic circumcision of children until the legal issue is clarified. 14:22, 17 July 2012 (UTC)
 * I don't recommend a complete removal. I recommend, for example, keeping the sentence "A spokesman, Steffen Seibert, for German Chancellor Angela Merkel stated that Jewish and Muslim communities will be free to practice circumcision responsibly, and the government would find a way around the local ban in Cologne," as it's a pretty major legal and governmental effect on the ruling, and helps readers perceive how it's viewed not just amongst Jews and Muslims, but also the current government. Thoughts? (I'm not calling to put back the whole thing, just that sentence) -- Activism  1234  21:17, 17 July 2012 (UTC)
 * Agree with both of you. It certainly warrants a mention but only a mention. Rip-Saw  (talk) 00:59, 18 July 2012 (UTC)
 * Just as an update, I did move all the info into the page specifically about legal issues. I would've put it there first, I just wasn't aware of the page. I hope that helps (I still recommend the sentence I mentioned above though). Thanks for pointing it out to me. -- Activism  1234  01:48, 18 July 2012 (UTC)
 * I think moving the bulk of the text to the law page, and mentioning it here are both good ideas. My one caution is that an encyclopedia isn't about current events. It takes the long view. That story is still playing out, so we should be prepared to monitor the situation and edit as it unfolds. Frank Koehler (talk) 12:15, 18 July 2012 (UTC)

A German court has ruled that parents can’t have their sons circumcised on religious grounds.
This might deserve a mention in this article (or Circumcision controversies). http://www.rt.com/news/germany-religious-circumcision-ban-772/ Gråbergs Gråa Sång (talk) 12:33, 27 June 2012 (UTC)


 * It seems WP:UNDUE to include in this already too-large, general article about the procedure. Also, this just happened, and it looks like an appeal is planned, but the various parties involved are still studying the decision, so adding it now would fall on the wrong side of WP:RECENTISM.  I was going to suggest a better spot for this would be at Circumcision_and_law, but I see someone has already added it there.    12:46, 27 June 2012 (UTC)
 * Fair enough. Gråbergs Gråa Sång (talk) 13:32, 27 June 2012 (UTC)


 * Do not think it is WP:UNDUE to include it - it is a short and simple statement. The article covers Sweden and Australia in much more detail, why not Germany? As of appeals, looking at [this http://m.aerzteblatt.de/news/50650.htm] and other headlines there won't be any. More likely those opposed to the current regulation will try to pass new laws changing the regulation. As of recentism, this has been hyped as todays headline but in reality this was the mainstream view for some time now. Richiez (talk) 22:49, 27 June 2012 (UTC)


 * I agree with Richie. We have 4 people in favor of including; myself, richie, graberg and bigzteve . Pass a Method   talk  23:12, 27 June 2012 (UTC)


 * Actually, when I look at the "Legal issues" section, it don´t seem like a good summary of it´s main article (Circumcision and law). How about replacing the text in that section with something like the lede from Circumcision and law? — Preceding unsigned comment added by Gråbergs Gråa Sång (talk • contribs) 15:35, 28 June 2012 (UTC)


 * The reliable sources reporting on this have been inconsistent in their reporting, specifically about how the court characterized the effects of circumcision, and also the effect on the legality of the procedure in Germany. The first stories seemed to downplay the decision, calling it "non-binding" and as not affecting the legal status. Later stories started giving the decision much more importance and having a big impact. If the first stories were right, and it was a non-binding opinion of one court without much lasting effect, it would be WP:UNDUE to put it here in this article. If it's as the later stories report, and would have the effect of making circumcision formally illegal in Germany, it would be appropriaFte to include a mention of it here. I am waiting for an other day or two for more clarification on this.  15:44, 28 June 2012 (UTC)
 * I don't know whether this has already been cleared up... If not, the truth is that the court's order is non-binding, and applies only a local scale, and other courts do not have to abide by it (no other courts have made similar ruling). The reason is becasue the court classified it as "minor bodily harm" rather than "major bodily harm." If it's not cleared up and you want me to provide references for this, I have a number of recent references that would be useful if you'd like.-- Activism  1234  02:07, 12 July 2012 (UTC)


 * Activism1234 yes please bring the sources, they could be useful for this article.   03:03, 12 July 2012 (UTC)
 * Sure no problem. I think on the contrary though, it won't be included in this article, if I'm reading what you wrote correctly above... But I'll bring it to back that up.
 * Here is one from The Times of Israel, reporting on statements made by the German envoy and Israeli ministers of Knesset. -
 * "Michaelis pointed out that the Cologne court had ruled that circumcisions are merely considered a minor bodily injury. Had the court defined the procedure as a severe bodily injury, all local prosecution offices in Germany would have been obligated to look for offenders. In the current situation, a mohel would only be subject to penalty if someone actually took him to court in the jurisdiction of the Cologne district court.


 * “I know that this is not satisfying, and that a feeling of legal uncertainty persists in the Jewish communities,” Michaelis told the Israeli lawmakers. “Your colleagues in Germany are already on summer break but I am sure that this question will be picked up again if we assess that this judgment genuinely creates legal problems in Germany.”


 * This is from the website Inside Islam: Challenging Misconceptions, Illuminating Diversity (University of Wisconsin, Wisconsin Public Radio). "There are about 4 million Muslims and 120,000 Jews in Germany, but as of now, only those in Cologne will be affected."


 * And another source, CBS News - "The German ambassador, Andreas Michaelis, told the Israeli lawmakers his country was working to resolve the issue and that the ruling doesn't apply at the national level."


 * Is this sufficient? I hope it helps. -- Activism  1234  04:27, 12 July 2012 (UTC)


 * Pass a Method, re "We have 4 people in favor of...", may I remind you that Wikipedia policy states that this is not a democracy and that we do not vote on content decisions. Consensus is formed on the strongest policy-backed arguments.    15:48, 28 June 2012 (UTC)


 * The change in the reporting may be partly due to the fact that the first reports came out before it became known that both parties apparently ceded their rights to appeal. As of binding or non-binding this is relative. Any 1st or 2nd instance court is very unlikely to make a different decision although in principle they could. Higher instance courts can issue different decision in theory. In the meantime the procedure (and possible complications) must not be covered by any insurance and it is unlikely any doctor would take the legal risk to make the procedure under the conditions specified by the court. Richiez (talk) 22:48, 28 June 2012 (UTC)


 * Gråbergs, i dont mind that. Zad, yes, i will watch the news too. Pass a Method   talk  02:01, 29 June 2012 (UTC)

Germany as most of the continental european states has not a case law. A singular verdict of a lower court brings no obligation for other courts to follow. One of the leading comments on criminal law, written by a judge from the Bundesgerichtshof, says, that religious circumcision ist not against the law according to the leading opinion in jurisprudence. (Thomas Fischer, Strafgesetzbuch und Nebengesetze, 55. Auflage, München 2008, Verlag C. H. Beck § 223 Rdnr. 6b, ISBN 978-3406565991) There exists a newer version of this comment, but usually the legal situation in Germany develops slowly... please keep this in mind. --Feliks (talk) 11:29, 29 June 2012 (UTC)

I think that we should wait until this has played out. The ruling could be struck down as it was made in a low court. I am sure it will make an interesting and relevant addition to the article no mater what the ultimate judicial outcome is. — Preceding unsigned comment added by LeetroyJnkns (talk • contribs) 10:11, 1 July 2012 (UTC)


 * Some things I want to add about this court decision - it should give a decent understanding of the (lack of?) importance of that decision:
 * Background: Circumcision has (intentionally) been a legal grey area in Germany for decades. In this case, a muslim boy was circumcised, it had some (minor) complications and the prosecution decided to press charges against the doctor. The first court aquitted the doctor, saying circumcision is legal, but the prosecution appealed. That was finally unsuccesful, but the reasoning of the court is the important part.
 * The reasoning and its meaning: The court said that circumcision without (acute) medical indication is illegal - even when done on religious grounds. The doctor was aquitted though, because he couldn't have known he would do something illegal. But that's an excuse that only works once - and this one time has been used up. That's the important impact, because it tells everyone in Germany (that's how it has meaning outside of the courts jurisdiction) that it's illegal. As a result, doctors are now under the threat to be convicted, while this threat didn't exist before - even if the courts decision could be ultimatively overturned in another trial.
 * I don't know if it is something that should be included in the article (maybe not) but I wanted to give some explanations of the situation and its meaning. --ToMaP (talk) 14:46, 2 July 2012 (UTC)


 * ToMaP, thanks for that analysis, it is in line with what I have been reading. However, the level of detail you are giving belongs at Circumcision_and_law and not at this already too-large general article about the procedure.  This article already mentions the possible effects of this ruling under section "Legal issues", and there is a "Main article" link in that section to Circumcision and law for the reader interested in that level of detail.    15:45, 2 July 2012 (UTC)


 * I have to agree. --ToMaP (talk) 15:55, 2 July 2012 (UTC)


 * Circumcisions trend in modern countries throughout the world is to be outlawed. If this outlawing pans out, it absolutely warrants inclusion in circumcision. Rip-Saw  (talk) 22:01, 3 July 2012 (UTC)

Agree with the analysis of ToMaP, in addition it should be stressed that the verdict is now final as both parties ceded their rights to appeal and accodring to German media the court sought to set a precedendce case. Richiez (talk) 12:03, 4 July 2012 (UTC)


 * The analysis here was correct, but in the text of the article the role of the decision as a binding precedent was presupposed. I changed this and explained a little, if too long, please cut it down to adequate size. Best--Olag (talk) 20:43, 6 July 2012 (UTC)


 * While I agree that there is a theoretical difference between the Anglosaxon and continental legal systems where the former did traditionally derive legality from legal precedents this difference plays an increasingly smaller role in practice today. There is plenty of laws in the US and plenty of gray areas ruled by legal precedents in Germany. As far as I know legal precedents can be overturned anytimes, in the US as well as in Germany. What is relevant here is that it was not the highest court which did the ruling. As of practical consequences, looking at the headlines of the last days it seems most major health care providers stopped the practice. Richiez (talk) 10:57, 7 July 2012 (UTC)


 * One point is still missing in the text. The court ruling of course applies to "children" which are bellow the age that they could decide for themselves. Religious or other circumcision of adults is not touched by this. (Accordingly, one of the suggestions how Jews could cope with the new legal situations was a symbolic ritual cut of the 8 day old boys that could be followed by a full circumcision by the age they are capable of informed consent.) As far as I know the definition of age of informed consent for this is not quite clear cut but the number "14" was often mentioned by the media.. does anyone know the exact details of that? I am somewhat suspicious of the number.. why would the age be lower than that when children can get tattoos or girls can ask for plastic surgery which is 16 in most cases? Richiez (talk) 20:06, 7 July 2012 (UTC)
 * You are right that precedents will have an influence on the practice of other courts. Still I would hesitate to argue that circumcision for other than medical reasons “is effectively illegal” in Germany.
 * While Germans are considered adult at the age of 18, the coming-of-age for full religious self-determination(so called "Religionsmündigkeit", see § 5 Gesetz über die religiöse Kindererziehung [RelKErzG) is considered 14 ys.
 * As far as I know, as yet no one ever tried to claim protection for tattoos and plastic surgery based on freedom of religion.--Olag (talk) 13:04, 9 July 2012 (UTC)
 * Perhaps we can find better formulation than "effectively illegal". My interpretation is that any doctor doing it in this situation has a considerable risk to face criminal prosecution and 1st and 2nd level courts are pretty likely to issue guilty verdict. Also the liablilty risk if something goes wrong is tremendous, insurance would not cover that. Not to mention, if something goes really badly wrong the criminal charges may escalate up to manslaughter. As far as I know most if not all doctors and clinics stopped the practice now? As of the age - I could certainly imagine young people wanting a variety of piercings, tatoos and other body modifications for religious reasons (Maori, Amazona Indians, some African tribes etc). Also, does Germany allow female genital mutilation for religious reasons at age 14? Richiez (talk) 11:20, 12 July 2012 (UTC)
 * I provided many many sources above in this talk discussion that answer many of your questions. Firstly, the doctor would not face criminal prosecution in 1st and 2nd level courts.  The ruling applies ONLY to the local court in Cologne and the area under its jurisdiction and ONLY if someone decides to bring that doctor to court, since the court ruled it's "minor bodily harm" and not "major bodily harm."  It is not a ban, and does not apply anywhere else in Germany, and the Geramn parliament and Chancellor Angela Merkel are actually working to fix the issue and protect religious freedom.  Currently, the hospital in the area of the local court has stopped circumcision for now, which has outraged many people, until a more precise understanding of the legal issue is clarified. For both Jews and Muslims, the ruling in Cologne is very problematic for those who live in Cologne (mainly applies to Muslims, but there is also a Jewish community there), as Jewish males are required to be circumcised at 8 days old and many Muslims circumcise at 13.  They view this as a violation of fundamental aspects of their religion. For Muslims it's a common tradition based on a sunnah, and for Jews it's a required commandment and oath and one that was passed through generation to generation even among those who didn't keep most aspects of the religion.  If you're interested in learning more about the requirement, you can read the British Chief Rabbi's response to the ban here. "Did the court know that circumcision is the most ancient ritual in the history of Judaism, dating back almost 4,000 years to the days of Abraham? Did it know that Spinoza, not religious but together with John Locke the father of European liberalism, wrote that brit milah [circumcision] in and of itself had the power to sustain Jewish identity through the centuries? Did it know that banning milah was the route chosen by two of the worst enemies the Jewish people ever had, the Seleucid ruler Antiochus IV and the Roman emperor Hadrian, both of whom set out to extinguish not only Jews but also Judaism?"  Germany has a ban on female mutilation, as many Western countries do, and I don't think there is an age requirement, but there is a vast difference between female mutilation and circumcision. Regarding the ruling in this court, the United Nations’ special rapporteur on religious freedom, Heiner Bielefeldt, weighed in on the issue, calling the ruling “nonsense.”  The World Health organization even recommends circumicision in certain countries. -- Activism  1234  21:19, 13 July 2012 (UTC)
 * Currently someone included the item about Germany in the article, but what they wrote is completely false, as the article doesn't even mention the word "courts." It's completely misleading, implying that it's a ban in all of Germany. I'm going to remove it, since it's false and misleading, and as the discussion continues people can decide whether they want to talk about this local court in the article or not. -- Activism  1234  21:19, 13 July 2012 (UTC)
 * Personally I'd be happy to write all the information I know about (which I think is a lot, if you look at some of my comments here) this ruling in Germany in the article, but I removed the current wording since it's not true. -- Activism  1234  21:24, 13 July 2012 (UTC)
 * Activism1234, it is not for Wikipedia to decide whether or not circumcision ought to be legal, so I don't see the relevance of most of what you posted above. Our role is to report the facts, and the facts are that a court in Germany has made a ruling which has had the result of effectively making circumcision illegal in that country.  Things may change in the future, especially given what Angela Merkel has since said; but just because you don't happen to like that ruling, that does not mean you can censor the mention of it.2.29.153.188 (talk) 23:26, 13 July 2012 (UTC)
 * First of all, show me where I said Wikipedia should decide this before you say that. Secondly, if you would read any of what I wrote above, or any of the references I source, you'd notice that what you wrote "which has had the RESULT of effectively making circumcision illegal in that country" completely false.  Thirdly, show me where I tried to censor the mention of it.  There is a lengthy talk page that wasn't even initated by me, I'm just participating, about whether or not to include the decision of a local court.  Fourthly, my response directly above was responding to another user who asked questions, which I answered, whether it should go in the article or not is irrelevant. But if you will include it, you better get your facts right, and include all parts of it. -- Activism  1234  00:06, 14 July 2012 (UTC)
 * Since I figured it'd probably just be reverted again, I put in correct language based on the references. I recommend that it stays (and obviously people can edit and change it around to improve it if they feel the need), but if people want to remove it and discuss it further on the talk page, go ahead. I only did it because it was possible a revert would happen again and the false and deceptive language would be reinstated, but it still provides good and accurate information. -- Activism  1234  00:25, 14 July 2012 (UTC)

I have simply removed the information on whether the court ruling is binding or not. Every court ruling of a higher court is a precedent that is likely to be observed and there is no court ruling that can not be overturned. Richiez (talk) 22:00, 15 July 2012 (UTC)
 * It's not a higher court, it's a local court. What you wrote in the edit summary though is 100% true, so I just added in a few words next to the appropriate ref about it falling under the jurisdiction of the local court in Cologne. It basically just clarifies the sentence, it doesn't apply at a national level. I hope this is better. -- Activism  1234  22:04, 15 July 2012 (UTC)
 * Everything that is not a first instance court is a higher court so obviously this one is a higher court. There are courts that could be loosely described as "local court"s in Germany but not this one. Richiez (talk) 11:50, 19 July 2012 (UTC)

Too much HIV in the lede
More than one third of the lede talks about HIV. I worked this out by counting 17 lines, 6 of whom are about HIV. This probably violates wp:undue. therefore i propose adding either the first or second sentence about HIV to the article body. Any thoughts? Pass a Method  talk  18:09, 17 July 2012 (UTC)
 * Pass a Method, this is, of course, after you yourself made a lot of edits to the other parts of the lead, chopping out quite a bit, right? It is only after your own edits to the other parts of the lead that you are bringing this up?  I'm all for reducing extraneous text and increasing the information density of of articles, so this effort is not necessarily a bad thing.  Anyway, a significant portion of the article body talks about HIV, because reliable sources give a lot of attention to circumcision and HIV.  According to WP:LEAD, the lead needs to summarize this important information about HIV that the body of the article covers, so of course information about HIV will stay in the lead.  So what you're proposing is, I assume:  How can we summarize information about HIV in the lead more succinctly?  Efforts in the past to do this haven't gone well because editors wanted to keep the many qualifiers and detail about the underlying studies in the lead sentence, but maybe we can come up with a more terse way to do it now.    18:19, 17 July 2012 (UTC)
 * I think you misunderstood me. I meant we could move one of the two sentences about HIV to the article body, either the Cochrane one or the WHO one. Pass a Method   talk  18:53, 17 July 2012 (UTC)
 * Pass a Method, maybe I did, sorry about that. I took a close look at the lead before and after your condensing edits, and largely, great job.  It says largely the same thing in many fewer words.  However, the following content was removed from the lead without being restated:
 * "The prevalence of circumcision varies mostly with religious affiliation, and sometimes culture. The timing of circumcision similarly varies, though it is commonly practiced between infancy and the early twenties."
 * "In addition, circumcision is used therapeutically, as one of the treatment options for a number of penile conditions."
 * leaving the lead with zero mention of the medical and therapeutic uses of circumcision except for the word "therapeutic". (Regarding the 2 cultural sentences that got removed, maybe a little bit of that info can be put back, but that's a different subject.)  This puts the lead out of line with what WP:LEAD requires and really needs to be corrected.  So we should take the existing lead paragraph that goes into too much detail about HIV and the Cochrane study (I agree with you that the paragraph addressing this needs improvement) and fold that information into one paragraph that summarizes the information in the article body about HIV, other STDs, hygiene, skin conditions, etc.   18:46, 17 July 2012 (UTC)


 * I did not mean to remove the timing of circumcision, but the religion and culture part is already covered. Actually (on second look) i moved that to the article body. Pass a Method   talk  18:58, 17 July 2012 (UTC)


 * Understood, but by moving to the body there's some portion of the body of the article that is now unrepresented in the lead. We can look at that later... Back to summarizing the medical aspects, here's a proposal:
 * Circumcision is a treatment option for some penile skin conditions and may reduce some STDs, and it reduces female-to-male HIV transmission significantly. Circumcision has found to be cost effective in sub-Saharan Africa, and the WHO recommends that it be considered as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.
 * Not saying it's perfect, just a start. Thoughts?    19:14, 17 July 2012 (UTC)
 * A little tighter:
 * Circumcision is a treatment option for some penile skin conditions and may reduce some STDs, and it reduces female-to-male HIV transmission significantly. Circumcision is cost-effective in sub-Saharan Africa, and the WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.
 * 19:21, 17 July 2012 (UTC)
 * I'm looking at the WP:MEDICINE WP:FA articles. I think we are counter-productively over-restricting ourselves with trying to condense the lead of this large and informative article down to the size range we are looking at.  This circumcision article is 140 KB.  Take a look at Virus a 120 KB article, and Fungus, a 140 KB article.  These are two comparably-sized WP:MEDICINE WP:FA-quality articles, and their leads are double the size that ours currently is.  We really should not be trying to over-tighten this article to the point where we are eliminating summarizing important points from the body of the article.  We should be discussing how to prudently expand the lead to make sure we meet the WP:LEAD requirements of ensuring all the most important points of the body of the article are covered, not tightening it up at the expense of summarizing content.    19:42, 17 July 2012 (UTC)
 * Adding: More WP:MEDICINE WP:FA-quality articles to compare, look at the size of the lead of:  Bacteria 115 KB article, Influenza 140 KB article--we are thinking in the wrong direction.    19:55, 17 July 2012 (UTC)


 * I dont mind a longer lede. But lets wait until someone proposes adding something lede-worthy instead of expanding for the heck of it. Pass a Method   talk  20:04, 17 July 2012 (UTC)


 * I implemented your second proposal. Does it look okay? Pass a Method   talk  20:17, 17 July 2012 (UTC)


 * Looks great! I'd really like to see this article promoted to GA at some point in the not-too-distant future.  It's comprehensive, well-referenced, and generally well-written.  That'll require  revisiting the lead, but until then, making the HIV paragraph match the terseness of the rest of the lead makes sense now.    01:38, 18 July 2012 (UTC)

Currently this paragragh is bad grammer with a run on sentence.
 * Circumcision is a treatment option for some penile skin conditions and may reduce some STDs, and it reduces female-to-male HIV transmission significantly.[22]. Circumcision is cost-effective in sub-Saharan Africa, and the WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV

I have changed it to this to correct but Zad has reverted without explanation.
 * Circumcision is a treatment option for some penile skin conditions and may reduce some STDs. A meta-analysis found it reduces female-to-male HIV transmission significantly [22] and is cost-effective in sub-Saharan Africa. The WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.

I did not add anything or take anything away except to remove the run on sentence and make the paragrapgh flow better. I inserted meta-analysis so we would not be starting the sentence with the word "circumcision" like the previous sentence and find the term meta-analysis informative. Thoughts? Garycompugeek (talk) 14:40, 18 July 2012 (UTC)
 * Come on, Gary, it wasn't "without explanation", I said "Gary please see open Talk page discussion about this paragraph, let's discuss there first". Anyway, here we are.  Pass a Method and I have been (for the time being) tightening up the lead.  As has been brought up before here on this Talk page, according to WP:MEDMOS, we shouldn't be mentioning the study itself in a statement like this in a WP:MEDICINE article, especially not when the source is as strong as Cochrane.  This was last discussed here:  Talk:Circumcision/Archive_73.  In fact, Gary, you were involved in that discussion, which was active as of just two weeks ago.  Maybe it has since slipped your mind.  Anyway, at that time I mentioned that at this article, for the Cochrane-based HIV statement, we have made an exception to the WP:MEDMOS guidelines as a compromise.  Yesterday, working with Pass a Method here, I suggested we reword that part of the lead in a way that now meets WP:MEDMOS, and it was implemented.  Perhaps that was too hasty.  We can return the paragraph back to the consensus of what it was before if there's a strenuous objection.    14:56, 18 July 2012 (UTC)
 * You said bring it to the talk page but didn't say why. Zad I'm not being obtuse but I still don't know what you find wrong with my grammer correction???  Are you saying that you object to the term "meta-analysis"? We can change it to "Circumcision" or "It" but both are poor substitutes in my opinion. Garycompugeek (talk) 16:47, 18 July 2012 (UTC)
 * Gary, regarding the grammar only, we currently have:
 * Circumcision is a treatment option for some penile skin conditions and may reduce some STDs, and it reduces female-to-male HIV transmission significantly. Circumcision is cost-effective in sub-Saharan Africa, and the WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.
 * Suggested improvement is:
 * Circumcision is a treatment option for some penile skin conditions and may reduce some STDs. It reduces female-to-male HIV transmission significantly, and is cost-effective in sub-Saharan Africa. The WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.
 * Your approach to addressing the run-on sentence is good, and actually makes the paragraph shorter. I'm OK with it, how about you?  Pass a Method?    17:08, 18 July 2012 (UTC)
 * I do object to mentioning the underlying study, because it is against WP:MEDMOS guidelines to do so, it unnecessarily draws attention away from the information that the article should be communicating, and it is against established Wikipedia practice as seen in WP:MEDICINE WP:FA-quality articles. Again, I explained all this in our discussion here:  Talk:Circumcision/Archive_73  If we could have agreement at this time while we are tightening up the lead to remove the mention of the underlying study, I feel that would improve the article.    17:08, 18 July 2012 (UTC)
 * I see. We are not mentioning "Cochrane" or anything specific, was just trying to find a way to start the next sentence without using the word "Circumcision" like the previous sentence or a pronoun and avoid repetitive poor writing style. Garycompugeek (talk) 17:20, 18 July 2012 (UTC)
 * OK so if this isn't an issue, how about the suggested rewording above?  17:34, 18 July 2012 (UTC)
 * Obviously not my first choice but still flows good. Changes implemented. Garycompugeek (talk) 17:48, 18 July 2012 (UTC)
 * Cheers!   17:55, 18 July 2012 (UTC)

Perhaps, we can use Dr. Fauci's quote in USA Today here, where he states that circumcision "reduces a man's risk of getting HIV by up to 70%". Powerful and concise. Carlossuarez46 (talk) 22:22, 18 July 2012 (UTC)
 * WP:MEDRS warns us not to use popular press as sources for medical claims.   22:37, 18 July 2012 (UTC)

Zad, what do you think about replacing "is a treatment option for some penile skin conditions" to "is used therapuetically"? Pass a Method  talk  22:22, 19 July 2012 (UTC)
 * "therapeutically for some penile skin conditions"? Makes sense to mention what it's used for, doesn't it?    03:07, 22 July 2012 (UTC)


 * The definition of therepeutic is "relating to the healing of disease". I think that would be stating the obvious dont you think? Since circumcision is obviously related to penile conditions Pass a Method   talk  06:18, 22 July 2012 (UTC)


 * My point wasn't about what "therapeutically" means, but rather giving details about what it's used therapeutically for. It's used therapeutically for two different kinds of things:  reactively for amelioration of skin conditions, and proactively against transmission of systemic diseases like HIV-AIDS.  I had put "skin conditions" back in so that the lead mentioned both kinds of things it's used therapeutically for separately.  I see you updated it, fine for now in my opinion, although the lead needs to be expanded to drill down to a greater level of detail to bring it in line with FA-quality articles.    14:25, 22 July 2012 (UTC)
 * Oh I see what you mean, that the definition of "therapeutically" you're using applies to existing conditions. Well, look at Therapy and Therapeutic effect, there's definitely room in the use of forms of the word "therapy" to apply to both existing conditions and also for pro-active or prophylactic effects, so I think mentioning "skin conditions" is warranted.    14:35, 22 July 2012 (UTC)


 * I dont feel strongly either way, but my thought is that mentioning "skin conditions" would be superfluous since it would be stating the obvious. The word "therepeutic" aleady hints at "conditoions" and circumcision is obviously for the "penile skin".  Pass a Method   talk  19:52, 22 July 2012 (UTC)
 * I'm much more interested in your input on the complete rewrite of the lead proposed below.  20:12, 22 July 2012 (UTC)

Foreskin donations
I am wondering why the widespread practice of neonatal foreskin donations is not mentioned here? , http://www.apligraf.com/professional/what_is_apligraf/how_is_it_made/ Richiez (talk) 18:26, 20 July 2012 (UTC)


 * It's probably not mentioned in this article because it doesn't seem relevant and notable enough for a mention here. The first document with  doesn't mention "circumcision" at all, at least not in the abstract... in fact I don't see that it mentions "foreskin" or "prepuce" either.  A Google scholar search for "Apligraf" with "circumcision" returns almost no quality results at all--the cites are to things like "foreskin-restoration.net" and "mothering.com" instead of academic institutions or publications.  You might consider trying to create a Wikipedia article for Apligraf and putting the information there, although I'm not sure if Apligraf meets Wikipedia criteria for notability.


 * Actually I just noticed that the article already includes a mention in this direction: "After hospital circumcision, the foreskin may be used in biomedical research, consumer skin-care products, skin grafts, or β-interferon-based drugs." although the specific company/product name "Apligraf" is not mentioned, and again due to notability issues I don't see that mentioning this specific brand name is needed.    15:08, 22 July 2012 (UTC)

Sub-article
I have just started the sub-article at circumcision surgical procedure. I need some help to expand it. Pass a Method  talk  21:17, 22 July 2012 (UTC)
 * I have just expanded it, we now need a picture, but the question is .... which one? Should there be one or two pictures?  Pass a Method   talk  22:48, 22 July 2012 (UTC)
 * I don't understand this split. The moved section is not too large for the article, and as circumcision is a surgical procedure, the titles seem to indicate identical scope.--Taylornate (talk) 23:11, 22 July 2012 (UTC)
 * There seems to be much support for a seperate article in the "rfc which image" section. above.  Pass a Method   talk  23:16, 22 July 2012 (UTC)
 * e/c adding: Basically, there's a lot of relevant, reliably-sourced content related to circumcision that isn't just about the surgical procedure. Consequently this article has grown very large and has been moving into a WP:Summary style article, with a basic description for each section and each section has a heading linking to a full article.  We already have Medical analysis of circumcision, Sexual effects of circumcision, Circumcision and HIV, Prevalence of circumcision, History of male circumcision, Circumcision controversies, Ethics of circumcision, Circumcision and law, Brit milah, Religious male circumcision and Khitan (circumcision) as section "see alsos" and so this is just another one.    23:22, 22 July 2012 (UTC)
 * Ok, it makes more sense now.--Taylornate (talk) 23:30, 22 July 2012 (UTC)
 * As far as pictures go, honestly I don't think we really have any good ones of the procedure at all. File:My_gomco_circ_may96.jpg, File:Plastibell1.jpg and File:Plastibell Circumcision Device.jpg are barely marginally useful. File:Rituelle Beschneidung.jpg might be useful but only if we can get an accurate and informative medical description of what exactly is going on in that photo from a reliable source.  As we've covered previously "Circumcision with a clamp, there was no phimosis" is so uninformative as to be nearly meaningless.  One decent image we have is File:Penile nerve block dorsal.jpg, it's clear, easily understood and illustrates a relevant step in the procedure, but not the procedure itself.  In the past I have tried to ask university hospitals for permission to use pictures they have posted on their web sites but never got any permission.  The very best thing we have are those Stanford Medical School videos.  I wonder if we can justify "fair-use" permission of stills from those videos.  My guess is "no" but maybe we should try.  Also, I have had luck finding images on Wikimedia Commons used in Wikipedias other than en.wikipedia.  Try looking at foreign-language Wikipedias and see what they have.  I found a good illustration that I was going to use after replacing the foreign-language wording with English.  Let me know what you find.    23:56, 22 July 2012 (UTC)

RFC: Which image?
Which image of the circumcision procedure (if any) should be added so that the article is improved in accordance with WP:MEDICINE WP:MEDMOS guidelines? (NSFW)   16:07, 13 July 2012 (UTC)

Available to the article are:

RFC !votes and comments

 * File:My_gomco_circ_may96.jpg
 * (!Voting as RFC initiator) -- Before 11 July, the article did not have any medical image of the procedure itself. On 11 July, an image was proposed to be added.  There is agreement that the article could be improved by selecting an appropriate image of the procedure, there is agreement the appropriate guideline to follow for the image selection is WP:MEDICINE WP:MEDMOS, and there is agreement that the current WP:MEDICAL WP:GOOD articles do not include any graphic human photos.  But, we do not have agreement as to which image to select.  I do not feel either of the "Rituelle Beschneidung" images (color or black and white) improve the article as they are confusing (you can't tell what's going on in the photo).  Also, the color version is too graphic to be in line with WP:MEDMOS, and is out of line with the existing pictures selected for the WP:MEDICINE WP:GOOD articles.  (See my comments in this section above regarding the pictures in  WP:MEDICINE WP:GOOD articles.)  The relevant section of WP:MEDMOS is:
 * "Shock value: Some images of medical conditions or procedures disturb some readers, e.g., because of visible deformities or the presence of blood. Potentially disturbing images should be not be used for their shock value, for decoration, or merely to add an image."
 * Also this section of Offensive material applies:
 * "'Not censored' does give not special favor to offensive content -- Especially with respect to images, editors frequently need to choose between alternatives with varying degrees of potential offensiveness. When multiple options are equally effective at portraying a concept, Wikipedia does not prefer the most offensive options merely to 'show off' its ability to include possibly offensive materials. Images containing offensive material that is extraneous, unnecessary, irrelevant, or gratuitous are not preferred over non-offensive ones in the name of opposing censorship. Rather, they should be judged based solely on other policies for content inclusion."
 * Improving this article to the point where it can be submitted for WP:GOOD status should be our goal. Of the choices, I see File:My_gomco_circ_may96.jpg as the image available to us that is the most clear and illustrative of the procedure, meets content guidelines, and stays within nature of the images selected for our WP:GOOD medical articles.   16:07, 13 July 2012 (UTC)

I find this picture "Rituelle Beschneidung.jpg" unacceptable. I admit I am so timid I cannot look at the picture and therfore place the shock way up there. If we drive people away from the article because of the images we have selected, we are not improving the main article. Perhaps as Doc James has supplied, a circumcision surgery sub article could be created with many grisly illustrations. I am not a doctor and lets be honest, most of us are not used to this degree of carnage. Garycompugeek (talk) 17:05, 13 July 2012 (UTC)

RFC general discussion

 * Comment  Does it really matter? The pics in the present list strike me as uninformative and therefore largely uninteresting. If they do not explain or illustrate an existing explanation, then what is the point??? Leave them all out. If you can find a set of pics showing entire procedures linked to the text, telling the how and the why and the why not and the alternatives, then sure, put them all in; and then the dumb questions and arguments about how nice or how nasty or how shocking will go away because the pics will either fit the topic or someone can delete the whole lot and good riddance. The proposed pics don't fit anything at present worth fitting; chuck the lot out. JonRichfield (talk) 14:00, 14 July 2012 (UTC)
 * Comment I agree with Doc James' proposition of a sub article describing the procedure, and all the current pictures should be moved there.--89.226.117.72 (talk) 13:16, 15 July 2012 (UTC)
 * Comment None of the pictures are really that good. My_gomco_circ_may96.jpg and Plastibell1.jpg are both much lower quality images compared to Rituelle Beschneidung.jpg.  My_gomco_circ_may96.jpg merely shows the clamp being placed on the penis and not the actual circumcision.  Plastibell1.jpg has a hand obstructing a large portion of the image and it's not very clear what is going on.  Is the Plastibell being placed on the penis or is it being removed?  Rituelle Beschneidung.jpg is the best quality image but again, what is going on?  The description says it's "Circumcision with a clamp" but there is no clamp in the image. Feathergun (talk) 15:10, 16 July 2012 (UTC)
 * Comment Agree with suggestion by DocJames to move to subarticle. I do not find any surgical pictures of all that much encyclopedic value, as most readers do not know enough anatomy to understand what is going on. These pictures seem more used for shock value than anything else. Yobol (talk) 16:45, 18 July 2012 (UTC)

RFC conclusion
We haven't gotten any RFC comments in the past few days and it looks like the RFC has run its course. There's clearly no consensus to include "Rituelle Beschneidung.jpg" in this article, and there's also consensus support to move the surgical procedure images out of this article and into a new article like Circumcision surgical procedure that will cover the detail of the surgical procedure. I will remove the images. I'll try to find sources for a new Circumcision surgical procedure article. 14:19, 22 July 2012 (UTC)
 * After five days or so? Next time, I think it'd be better to wait a bit longer. I was in the rather remote town of Seldovia, AK for a week with hardly any electricity, but here I am back and ready to voice my opinion. This opinion is: the images proposed above do very little to illustrate the procedure, and I also find them gross. I'm in support of the new article though. Jesse V. (talk) 06:36, 23 July 2012 (UTC)
 * Your feedback is indeed appreciated! Actually the RFC ran for between 8 and 9 days, it looks like the RFC bot didn't notify you until four days after the RFC started.  On Wikipedia things like WP:RFA and WP:AFD discussions run for a week as a rule of thumb, and when I look for RFCs to comment on, generally the discussion has moved on after a week.  I hate going to an interesting-looking RFC and finding out the last comment was made 25 days ago, it happens all the time.  We hadn't gotten any more RFC responses in those last 3-4 days so I figured it was done.  Please check out the new illustration in the article, I think it addresses all the concerns brought up by the RFC commenters.    12:21, 23 July 2012 (UTC)

Proposed new photo File:Rituelle Beschneidung.jpg does not improve this article along Wikipedia guidelines
Wikipedia articles are meant for the general reader, and are not targeted toward surgeons or other specialists. Wikipedia guidelines and practice reflect that. The new photo File:Rituelle Beschneidung.jpg proposed to be added to the article is not in line with WP:MEDMOS, specifically:
 * "Shock value: Some images of medical conditions or procedures disturb some readers, e.g., because of visible deformities or the presence of blood. Potentially disturbing images should be not be used for their shock value, for decoration, or merely to add an image."

It is also not in line with Offensive material:
 * "'Not censored' does give not special favor to offensive content -- Especially with respect to images, editors frequently need to choose between alternatives with varying degrees of potential offensiveness. When multiple options are equally effective at portraying a concept, Wikipedia does not prefer the most offensive options merely to 'show off' its ability to include possibly offensive materials. Images containing offensive material that is extraneous, unnecessary, irrelevant, or gratuitous are not preferred over non-offensive ones in the name of opposing censorship. Rather, they should be judged based solely on other policies for content inclusion."

The photo's shock value and gratuitous nature are not in line with these guidelines. To see these guidelines in practice, I took a look at other WP:MEDICINE articles and compared the nature and number of human medical/anatomical photos chosen with those in this article. Compare the the photos in this article to WP:MEDICINE Good articles: Please take special note of the photos in this article as compared to Brachytherapy (another surgical procedure) and Condom (involving the same body part). If our goal truly is to improve this article according to Wikipedia standards, we need to bring the image selection in line with with the WP:GOOD medical articles, and File:Rituelle Beschneidung.jpg does not move this article in that direction. 19:26, 12 July 2012 (UTC)
 * Abortion–breast cancer hypothesis -- No graphic human medical/anatomical photos; one illustration
 * Bates method -- No graphic human medical/anatomical photos; 6 black-and-white photos
 * Brachytherapy -- No graphic human medical/anatomical photos; two hospital-setting photos but no surgery
 * Coffin birth (defined as "the expulsion of a nonviable fetus through the vaginal opening of the decomposing body of a pregnant woman") -- No graphic human medical/anatomical photos; in fact, no images at all
 * Condom -- One low-contrast photo of a condom on a glans penis, the text of the use of the condom is supported by a black-and-white pencil illustration and no photos
 * Mental status examination -- No graphic human medical/anatomical photos
 * Tracheal intubation -- Three human medical/anatomical photos of much less shock value than the proposed photo


 * I also agree with you that we should get a wider range of opinions on this, so I will invite a few members of WP:MEDICINE to comment, including a regular Wikipedia contributor who is also an emergency room M.D. and a steward of the WP:MEDICINE WP:MEDMOS guideline itself.  13:48, 13 July 2012 (UTC)
 * IMO it looks like we should have a sub article describing the procedure of circumcision if we are using images that are this specific. This image can than go on that subpage. With the amount of text here one image is sufficient in that section. For example see Ingrown toenail and Surgical treatment of ingrown toe nails Doc James  (talk · contribs · email) (please reply on my talk page) 14:01, 13 July 2012 (UTC)
 * Thanks for the input Doc James. It sounds like you are saying that this image File:Rituelle Beschneidung.jpg is not a good choice for this general encyclopedia article about circumcision because it is too specific, do I have that right?  Also, can you give us some detail about what is going on in that image.  Is it a normal-looking circumcision procedure "with a clamp"?  The only clamps I see in that image look like hemostats, which I'd imagine are used in nearly every circumcision procedure.  The hemostat in the foreground looks like it's pointing at something, can you tell what it's pointing at?  What is this picture being used to illustrate?    14:32, 13 July 2012 (UTC)
 * Yes so feel it is a little too specific for this article. The hemostates look like they are simply retracting the foreskin. I do not think it is pointing to anything. I have never done this procedure myself. Doc James (talk · contribs · email) (please reply on my talk page) 18:43, 13 July 2012 (UTC)

The correct translation is "Ritual circumcision of a child by a Muslim doctor in a German university hospital. There was no **phimosis**." No confusion here. I disagree that this image is any way shocking. Are the images in hysterectomy or uterine fibroids in any way shocking for you? Richiez (talk) 18:01, 20 July 2012 (UTC)


 * Thanks for the translation. Please look carefully above, I specifically chose "good" WP:MEDICINE articles, those that are WP:GOOD-rated, as the standard to which we're aspiring to raise this article to. Hysterectomy and uterine fibroids aren't WP:GOOD articles.    04:03, 22 July 2012 (UTC)


 * Good point, I choose that articles as comparison because I am familiar with them and not terribly happy with the images and their placement in those articles. Richiez (talk) 12:28, 22 July 2012 (UTC)


 * Sure... seems smarter to use articles evaluated as "good" by the community rather than ones you're unhappy with as the standard for comparison.  14:21, 22 July 2012 (UTC)


 * The images displayed on this article do not seem to approximate the quality of images of articles dedicated to other common surgeries. I feel an image of a circumcision while carried out with a clamp is appropriate, given that many circumcisions seem to be performed with one (plastibell seem to be a minority by comparison). For some context on the images in Wikipedia articles for other common surgeries, please see Cholecystectomy, Tonsillectomy, Cataract surgery, Arthroscopy, Uterine myomectomy, Hysterectomy. This is to say, readers should be given at least a basic expectation of a surgery is when looking at its encyclopedia entry. FactoidDroid (talk) 02:51, 23 July 2012 (UTC)


 * The comparison we were making was to WP:MEDICINE WP:GOOD articles specifically.  The comments we got from the RFC were that the medical images were more shock-value than encyclopedic educational value, or too specific for this general summary article.  A significant difference between circumcision and other medical articles is that there's much more non-surgical content here than at those articles, take a look at the balance in this article between how much text covers the surgery vs. cultural, legal and other subjects, and compare that to other articles.  Beyond that, there's a new image in the article now, an illustration of the basic steps of the surgery that I think meets the needs of the article--it is clear, easy for the layman to understand, and directly supports the text in the article covering the surgical steps.    12:10, 23 July 2012 (UTC)


 * The new illustration has a cartoonish appearance, even with the "cut along perforated line" diagram. Your article deserves something more than a cartoon to depict the surgery. Marylibrary (talk) 18:07, 27 July 2012 (UTC)

Two problems with lead
I haven't edited here for a while, so I'm reading this article afresh, a good thing. What pops out as needing help are two claims in the lead, both of which are inconclusive or wrong.Frank Koehler (talk) 12:30, 18 July 2012 (UTC)

1. "Summaries of the views of professional associations of physicians state that none recommend routine circumcision, and that none recommend prohibiting the practice." The opening clause (of, of, of) is just bad writing, but easily fixed. More importantly, the phrase "recommend PROHIBITING" is odd, since is just proves what we already know: doctors are not legislators. More on point, and I think this is what the intent of this sentence is, there ARE some physician organizations that recommend against PRACTICING the procedure. I will look for those references."Frank Koehler (talk) 12:30, 18 July 2012 (UTC)

2. "Circumcision is cost-effective in sub-Saharan Africa." I know of one study that found the opposite; it says that condoms are 95 times more cost effective than circumcision. We should find a way to compare circumcision to the other methods, like condoms, ABC, and retrovirals.Frank Koehler (talk) 12:30, 18 July 2012 (UTC)


 * 1. I don't find the prose of that sentence particularly objectionable. And re: "doctors are not legislators"--be careful not to argue against a strawman position.  Maybe individual doctors are not legislators, but professional associations of physicians absolutely involve themselves in the forming of legislation.  I'll review the sources too.
 * The way the sentence is now, is suggests that phys. orgs are OK with practicing circumcision since, after all, they don't recommend prohibiting it. I'm sure they don't recommend prohibiting a lot of things. But what this does is skip over the orgs that are opposed to circumcision. As such, this sentence is misleading. I have found 6 physician's organizations that recommend against routing circumcsion including references.Frank Koehler (talk) 12:02, 19 July 2012 (UTC)


 * Hi Frank, be careful to look at the wording of the sentence, it doesn't say " No medical organization recommends routine circumcision...", it says " Summaries of the views of professional associations of physicians state that none recommend routine circumcision...." For medical articles like this we avoid using primary sources like individual statements from what might be small or fringe organizations to draw our own conclusions; instead, we depend on large, reputable, well-established organizations to do such reviews and provide the conclusions, and we simply paraphrase what they say.  That is what this sentence says.
 * That being said, I'm looking at the sources provided for the sentence now and I can't see off the top how the sources provided support the "Summaries of the views of..." sentence. The sentence has stood like that in the article for a while now, and nearly every sentence in this article (especially the lead!) has been hammered out over years of lengthy debate by experienced editors--check out the Talk archives, so I'm very cautious about changes.  Give me some time to look at the sources provided for the sentence, and review the article Talk archives.  There's no deadline, I'd rather take the time and do the reading and get it right here on the talk page instead of having a series of hasty and possibly incorrect edits to the article itself.  Appreciate it!    13:13, 19 July 2012 (UTC)


 * Good idea to look at that. The part "and that none recommend prohibiting the practice" is quite clearly attributed to Viens 2004 in the text. That one is not a review, not even a primary source but a "comment" from a symposium on circumcission. Go figure - how could that slip into the lead.. WP:MEDRS anyone? No matter what the source actually says but that does not belong into the lead. Richiez (talk) 18:12, 20 July 2012 (UTC)


 * Thanks for giving me a chance to look at that. I read through the sources cited and the Talk archives.  That sentence came from a history spanning over six months of discussion spanning several Talk archives pages, some 50k+ of debate, at least two RFCs, and a close of no consensus from an uninvolved admin.  From all that, I 100% agree now the entire sentence "Summaries of the views of professional associations of physicians state that none recommend routine circumcision, and that none recommend prohibiting the practice" needs to come out of the lead.
 * First it's a clear violation of WP:LEAD. Leads should only summarize what's already in the body, there shouldn't be anything in the lead not in the body.  The fact that Viens 2004 is a source found only in the lead is a red flag.  There's nothing in the body to support that sentence in the lead.
 * Second the claims the sentence makes are broad and strong, but the sources don't support them sufficiently. Neither source can be called clearly a "summary," which I would expect would come from a neutral review of medical associations around the world with selection criteria clearly stated and discussion of the primary sources.  The "none recommend routine circumcision" comes from a KNMG statement that is clearly persuasive and not neutral in nature; the "none recommend prohibiting" comes from an equally non-neutral source, a pro-circumcision persuasive essay.
 * Third the sentence is questionable as we have easily-found counterexamples for both claims the sentence makes.
 * Fourth the sentence really doesn't say anything useful.
 * I'm removing the sentence, if there's an objection please feel free to revert and discuss more here.   03:23, 22 July 2012 (UTC)


 * 2. The cost-effectiveness of condoms doesn't make circumcision not cost-effective. It's incorrect to say "one study ... found the opposite" when they have both been found to be cost-effective.  The subject of this article is circumcision, not condoms, and it's appropriate for the lead to focus on the subject of the article.  The body of the article already mentions the relative cost-effectiveness of circumcision and condoms.   13:19, 18 July 2012 (UTC)
 * Good point. I didn't notice the article made a distinction later on. Frank Koehler (talk) 12:02, 19 July 2012 (UTC)

I have replaced the KMNG medical summary statement. It is the best medical summary we have that accurately reflects the world's medial opinion. Routine infant circumcision is not recommended by any professional association of physicians. You were correct to remove Vein's statement and reference. It was a comment by one psychologist and had no business in the lead plus is stating the obvious for doctors are not lawmakers. Garycompugeek (talk) 15:14, 24 July 2012 (UTC)


 * Hi Gary, this is a very unconvincing argument for restoring only part of what we had before, and I'm sad to see that you see this as an opportunity to do so. Even if the KMNG statement is "the best medical summary we have", that doesn't justify trying to use it in this way if it is still unsatisfactory--meaning, if the tallest of your several children is 30 inches tall, that's not a good enough reason to allow one of your children on the ride at the amusement park if the minimum height requirement for the ride is 36 inches.  If the sourcing for a statement in the article is insufficient, the answer isn't to say "well it's the best we have," the answer is to remove it as poorly sourced.  The KNMG statement cannot fairly be called a "summary statement."  It was not written as an impartial overview of statements from the world's medical associations.  It is a WP:PRIMARY source.  It was not published in a peer-reviewed journal as at least Viens 2004 was.  It was written as a persuasive statement and can only be used to support statements in the article about the KNMG's opinions.    15:48, 24 July 2012 (UTC)
 * Odd analogy. Sorry to make you sad Zad, not my intention.  Why do you object to a medical summary statement?  It makes sense to have one in the lead.  I mean how else are we supposed to use it?  How can you clasify it as non-neutral?  It's simply a fact.  I would be happy to change or remove it if you can supply a reference that shows a professional association of physicians that does reccomend routine neonatal circumcision.  Frank and Richiez also feel the Viens statement is out of line but did not agree to remove KMNG medical summary. Garycompugeek (talk) 17:58, 24 July 2012 (UTC)


 * Heh... the analogy came from the fact that the family went to the amusement park last weekend! We had a great time even though not everyone got to ride all the desired rides.
 * Please don't mischaracterize my objection--I don't object to a well-sourced statement summarizing the surveyed positions of worldwide medical associations. The problem is we don't have one.  The KNMG statement isn't one.  And I think any impartial reader of the KNMG statement would clearly see that it's non-neutral and can't be used to support a claim like "Summaries of the views of professional associations of physicians...".  The statement in their paper "[T]he KNMG does believe that a powerful policy of deterrence should be established" regarding non-therapeutic circumcision of male minors is obviously non-neutral.  Also, take a look at just the endnotes in the KNMG statement, they cite:  a paper "Circumcision - a Victorian relic lacking ethical, medical, or legal justification", the anti-circumcision site nocirg.org, "Jews against circumcision", the anti-circumcision site circumstitions.com, the anti-circumcision site circinfo.org, on and on.  The best that could be done is to restate it as "The KNMG position paper on non-therapeutic circumcision of male minors states that..." and as the KNMG is a relatively small organization, it would be undue to keep it in the lead, and should be moved down to "Positions of medical associations -- The Netherlands".    19:14, 24 July 2012 (UTC)
 * I agree it's not the best source Zad, and much prefer the one it replaced but there was concern over its age. There was quite an edit war last year when Doc James removed it and it did not stop until another summery statement was found by Lizardwizard. The problem is summary statements are quite hard to come by but I do not object to replacing this with a better one assuming we can find one. Garycompugeek (talk) 22:12, 24 July 2012 (UTC)
 * Gary, let's be clear: The issue is not that the KNMG statement is "not the best source."  The issue is that it is an insufficient source.  Do you agree it is an insufficient source?    14:58, 25 July 2012 (UTC)
 * Let's not play semantics Zad. The KNMG source is acceptable or it would not have lasted 5 mins in the article. Garycompugeek (talk) 18:01, 25 July 2012 (UTC)
 * As you are unwilling to actually address any of my actual Wikipedia policy-based concerns regarding the fitness of the source, I will open a WP:RSN discussion about it so we have input from outside editors.   18:11, 25 July 2012 (UTC)
 * WP:RSN discussion opened here.   20:04, 26 July 2012 (UTC)

Reverting my changes
Hi,

Although I understand why my changes were undone (I'm a Wikin00b after all), I'm still not comfortable with at least 2 out of 3 studies being omitted from this article. These articles were:

http://xa.yimg.com/kq/groups/23477339/1441224426/name/JLM_boyle_hill.pdf http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9?mid=54866 http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2011.00761.x/full

Although, of course, this is not to be taken as absolute truth, I feel they are important to cite to be completely neutral on the following bases:

1) the studies are recent and at least shed some nuance on earlier studies 2) all studies follow scientific guidelines and are properly cited.

The first study (Boyle et al.) lists 13 3rd party studies which concluded there is NO relationship between HIV and circumcision state, and 4 studies which report a HIGHER HIV risk in circumcised men. Does a total of 17 backing studies still make a "low impact" article? Where is the limit to decide when scientific material comes out of the shadows and starts to be relevant?

The second study is backed by 43 references. I deem it important because it is a meta-study conducted around the scientific conduct of the recommendations of the WHO and UNAIDS. Not a small claim.

I can agree on omitting the 3rd one though, as it is very specific to Australia/New Zealand.
 * The first is published in a multidisciplinary law/medicine journal, of which it would be reliable for discussion of legal aspects of this controversial topic, but I do not feel comfortable using it to "debunk" much higher quality medical sources such as the WHO and Cochrane. Likewise the 2nd study is published in a journal not indexed in MEDLINE, which is a huge red flag about the reliability. The third was actually kept in the article, but move the reference to after the sentence about researchers having reservations. Yobol (talk) 16:54, 23 August 2012 (UTC)


 * What is wrong with multidisciplinary journals??


 * I can sort of agree with your statement about MEDLINE, for now. I come from another field of science; we don't really have similar databases other than Web of Science and SciFinder to check on relevance.
 * Multidisciplinary journals are great for areas in the intersection of those disciplines; however, in the case of straight medical information, we should be using sources that are medical journals. Yobol (talk) 17:33, 23 August 2012 (UTC)

Proposed rewrite of lead to move in the direction of Featured Article
I've tagged the lead as 'needs expansion'. Compare this article to the WP:MEDICINE WP:FA articles--the articles that have achieved the FA status we should be trying to raise this article to. The leads for the comparably sized and sourced MED-FA articles provide much better detail than this article does. Specifically, circumcision article is 140 KB, and compare its lead with: Virus, a 120 KB article, Fungus, a 140 KB article, Bacteria, a 115 KB article, Influenza, a 140 KB article. So, in the effort to move this article in the direction of FA, here's a proposed rewrite of the lead. I rewrote it based entirely on content already in the body of the article, as WP:LEAD says we should, and summarized all the most important parts of the body, so that the lead can stand on its own.


 * Male circumcision (from Latin circumcisio, meaning "to cut around") is the surgical removal of some or all of the foreskin (prepuce) from the penis. It is estimated that one-sixth to one-third of males worldwide are circumcised. It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa and the United States; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania.
 * The origin of circumcision is not known with certainty; the oldest documentary evidence for circumcision comes from ancient Egypt. Various theories have been proposed as to how it began, including as a religious sacrifice and as a rite of passage marking a boy's entrance into adulthood.  It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread.  It is considered religious law in Judaism and established tradition in Islam to circumcise sons.  Some other cultural and religious groups also practice it; it has been condemned by the Roman Catholic Church since 1442.
 * In modern times, for infants, the procedure is often performed using devices such as the Plastibell, or the Gomco or Mogen-style clamps. First, the foreskin is opened to reveal and allow inspection of the glans underneath.  Then, the inner lining of the foreskin is separated from its attachment to the glans. The circumcision device (if used) is placed and remains there until blood flow has stopped. Finally, the foreskin is removed.  Topical or locally-injected anesthesia may be used to reduce pain, and its use is advocated; if it is not used, the male experiences pain and physiologic stress.  For adults, general anesthesia is an option, and the procedure is often performed without a specialized circumcision device.
 * Circumcision is indicated for both prophylactic and therapeutic reasons. It is a treatment option for phimosis, posthitis and chronic balanitis and balanoposthitis, as well as other penile skin conditions.  It reduces the risk of acquiring HIV infection in heterosexual men between 38 percent and 66 percent over two years, reduces the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28%, and is associated with a reduced risk of both urinary tract infections (UTIs) and penile cancer.  Studies of its protective effects against other STDs have been inconclusive.
 * Worldwide, newborn medical circumcision was found to have a median complication frequency of 1.5% with almost no severe adverse events; for older children, the median frequency was found to be 6%. Blood loss and infection are the most common complications.  Incorrectly-performed circumcisions may result in an improper amount of skin being removed, concealed penis, urinary fistulas, and other complications.  Questions of whether circumcision carries lasting psychological effects, and what its effects are on sexual function, are both poorly determined, with various studies reporting mixed results.
 * Circumcision is controversial. Ethical questions have been raised over removing healthy, functioning genital tissue from a minor, and opponents of circumcision state that infant circumcision infringes upon individual autonomy and represents a human rights violation.  Some medical associations take the position that the parents should determine what is in the best interest of the infant or child; others state parents are not entitled to demand medical procedures contrary to their child's best interests, or infringe on the right of the child to make an informed choice for himself when older.  The legal status of circumcision sees a wide range of treatment from legislative bodies around the world.  As well, the many medical associations around the world give a wide variety of opinions regarding neonatal circumcision.
 * One hypothesis of how routine infant circumcision was taken up in the United States around 1900 is based in the germ theory of disease. The penis became "dirty" by association with its function, and, from this premise, circumcision was seen as preventative medicine to be practiced universally.  Also, circumcision was seen a method of treating and preventing masturbation.  Its prevalence in the United States increased from about 32% in 1933 to 70% and over post-World War II, declining into the 60s in the 1990s.

Feedback and improvements, please. 18:18, 22 July 2012 (UTC)
 * My first reaction is that your lede seems way too large. Pass a Method   talk  22:13, 22 July 2012 (UTC)
 * Well, I gave four examples of similarly-sized medical articles that are FA-quality, and this is how big the leads are: Virus, a 120 KB article, Fungus, a 140 KB article, Bacteria, a 115 KB article, Influenza, a 140 KB article.  This rewrite is right in line with how big they are and their level of detail.  This is how big a FA-quality medical article lead should be for the size of the body.  You don't agree with how big those FA-quality leads are either?  We could get input from people who have experience with FAs.    22:39, 22 July 2012 (UTC)


 * Is this article really 140kb? My guess is that much of that kb comes from some very lengthy references. If we were to shorten some reference paragraphs, the kb would prabably be much less. Pass a Method   talk  23:14, 22 July 2012 (UTC)
 * There isn't much chance of this article reaching WP:FA status without reaching WP:GA status first. Read over what it takes to create a good article and try to achieve that with this article first. Besides, FA reviewers, especially WP:MED FA reviewers, will ask that some of what you have removed from this article be returned to it. FA articles are usually bigger/more comprehensive than GA articles, which is why their leads are always three to four paragraphs long. References do add to an article's size, but you are supposed to disregard the references in that case; WP:SIZE goes over this. And since I see that some section material has been split from this article into its own article, per the section immediately below this one, also see what WP:SIZE says about splitting information from articles. And, finally, the very short sections and paragraphs in this article are not helping. Per Layout: "Very short or very long sections and subsections in an article look cluttered and inhibit the flow of the prose." And per Layout: "The number of single-sentence paragraphs should be minimized, since they can inhibit the flow of the text; by the same token, paragraphs that exceed a certain length become hard to read. Short paragraphs and single sentences generally do not warrant their own subheading." In this case, what is "very long" is more subjective than what is "very short," but I caution against having any section exceed six paragraphs unless the extension is needed and isn't extended by much or has been divided into a needed subsection. The lead generally should not exceed four, that's for certain. 218.87.20.10 (talk) 00:25, 23 July 2012 (UTC)
 * It would be annoying to find out that we'd have to chop the article down to "fit" into GA expectations when it's already FA size, and then have to turn around and expand it again to meet FA expectations.  I think this would be the first attempt to get an article through GA for most of the editors here, including myself, and the advice to read up on the criteria is on target.  Got to start somewhere, why not here.    00:45, 23 July 2012 (UTC)


 * Zad68, you wouldn't have to chop anything out of this article unless it's irrelevant or the article can simply do fine or better without it. Except for very short articles, reaching GA status doesn't require that the article's size be of a certain length and certainly not that it be shorter than a typical FA article's length. My point about FA articles usually being bigger/more comprehensive than GA articles is that some of what has been cut from this article would likely be returned upon the request of FA reviewers, at least if they are well-read on this topic and/or look into the article's edit history. My point was that there has been needless cutting. Knowing how much more extensive/tiring the FA nomination process is (for example, the GA nomination process only includes one reviewer, while the FA nomination process includes multiple or several reviewers), and that articles aren't likely to be promoted to FA status before being promoted to GA status first, I was trying to spare you some trouble. 109.123.115.21 (talk) 01:41, 23 July 2012 (UTC)


 * re "Is this article really 140kb?" Yes by the count of all the Wiki markup including the references.  This is the same way I measured the MED-FA articles I mentioned so it's an apples to apples comparison.  There are some duplicate refs I'm seeing now in this article, they could be folded down too to reduce Wiki markup size without changing any content.  I compared the ratio of reference to article content in each of the four MED-FA articles I mentioned, and in each of the four cases it's just about exactly twice as much article content as references--the refs make up about 1/3 of the article presentation.  For circumcision it is slightly more than that, maybe 40% and not 33%, but not that much more.  It can be cut down as described, but still the comparison about the relative lead size stands.    00:58, 23 July 2012 (UTC)


 * Thanks for bringing all of us on board Zad. Happy to provide my two cents so far.
 * The scope of the sentence “it reduces the risk of acquiring HIV infection in heterosexual men between 38 percent and 66 percent over two years" is blown a little out of proportion. The Cochrane meta-analysis, which we aren't citing anymore in this revision, is the prominent source that supports this. The rhetoric seems to run against what is expected out of Verifiability guidelines, as two of the three authors of the trials that it bases its conclusions on argued that it decreased female to male HIV among African men particularly.
 * If we are to mention a comprehensive list treatment options for circumcision (for "phimosis, posthitis and chronic balanitis and balanoposthitis, as well as other penile skin conditions"), then it may warrant indicating that several sources argue that there are more effective treatment options for the conditions described. At least in the next paragraph that discusses controversy. It seems we came to an agreement on this recently as well. FactoidDroid (talk) 03:24, 23 July 2012 (UTC)


 * Regarding the Cochrane HIV sentence (that darn horse just won't die!!!) we can return the wording back to the last consensus we had on that sentence, no problem.
 * Regarding the treatment options, by saying "It is a treatment option for phimosis..." instead of "It is the treatment for phimosis..." doesn't that cover the concern you raise?
 * Regarding the rest of it... any comments on other parts, or the general idea here of expanding the lead to provide a deeper level of detail covering the article content?
 * 12:32, 23 July 2012 (UTC)


 * Some points:
 * circumcision disambiguation - in anthropology "circumcision" is used to describe drastically different procedures ranging from a small cut over removal of all skin from the complete shaft of the penis, other variation is to slit open the urethra along the shaft.
 * "Circumcision is indicated for both prophylactic and therapeutic reasons". That should probably read "may be", and the "prophylactic" is highly controversial at best. For example the majority of doctors in Germany say that while there has been demonstrated prophylactic effect in Africa it is irrelevant as indication in Germany.
 * "Circumcision is controversial": first and foremost, neonatal circumcision is controversial.
 * Richiez (talk) 11:33, 23 July 2012 (UTC)
 * re disambig -- Doesn't the opening sentence of this article "Male circumcision is the surgical removal of some or all of the foreskin (prepuce) from the penis" set the context for the rest of the article? Or are you saying that there should be a Wikipedia WP:DAB page?  Overwhelmingly, when reliable sources talk about "circumcision" they're taking about "removal of some or all of the foreskin (prepuce) from the penis."  In reviewing the reliable sources on this topic, I've never seen "circumcision" as referring to "removal of all skin from the complete shaft of the penis" or the other variants you're describing.  If enough reliable sources can be brought about those subjects we can see how to fit them in to Wikipedia.
 * re "is" vs. "may be" indicated, yes the text can be adjusted. The HIV transmission prophylactic effect is well-documented by reliable sources, this is one of the "dead horses" we've beaten many many times over here, as I replied to Factoid we have a consensus sentence regarding this that can be used instead.
 * re "controversial" It has attracted controversy for both neonates and adults, and saying it "is controversial" without specifying an age range covers both, doesn't it?
 * Regarding the rest of it... any comments on other parts, or the general idea here of expanding the lead to provide a deeper level of detail covering the article content?
 * 12:50, 23 July 2012 (UTC)

Thanks for the feedback. I incorporated it into the following draft #2 Here it is:
 * It's shorter, I cut the whole paragraph about its history in the US, chopped parts out of the paragraphs and tightened up some wording
 * It's now four paragraphs, as is apparently the standard
 * I returned the previous consensus wording about Cochrane as requested by 2 editors
 * I reworded "Circumcision is indicated" to "Circumcision may be indicated"
 * Male circumcision (from Latin circumcisio, meaning "to cut around") is the surgical removal of some or all of the foreskin (prepuce) from the penis. It is estimated that one-sixth to one-third of males worldwide are circumcised. It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa and the United States; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania. The origin of circumcision is not known with certainty; the oldest documentary evidence for it comes from ancient Egypt. Various theories have been proposed as to how it began, including as a religious sacrifice and as a rite of passage marking a boy's entrance into adulthood. It is considered religious law in Judaism and established tradition in Islam to circumcise sons.
 * In modern times, for infants, the procedure is often performed using devices such as the Plastibell, or the Gomco or Mogen-style clamps. The foreskin is opened and then separated from the glans after inspection. The circumcision device (if used) is placed, and then the foreskin is removed.  Topical or locally-injected anesthesia may be used to reduce pain, and its use is advocated; if it is not used, the male experiences pain and physiologic stress. For adults, general anesthesia is an option, and the procedure is often performed without a specialized circumcision device.  Worldwide, newborn medical circumcision was found to have a median complication frequency of 1.5% with almost no severe adverse events; for older children, the median frequency was found to be 6%. Blood loss and infection are the most common complications. Incorrectly-performed circumcisions may result in an improper amount of skin being removed, concealed penis, urinary fistulas, and other complications. Questions of whether circumcision carries lasting psychological effects, and what its effects are on sexual function, are both poorly determined, with various studies reporting mixed results.
 * Circumcision may be indicated for both therapeutic and prophylactic reasons. It is a treatment option for phimosis, posthitis and other such conditions. A Cochrane meta-analysis of studies done on sexually active men in Africa found that circumcision reduces the infection rate of HIV among heterosexual men by 38%-66% over a period of 24 months, and studies have concluded it is cost effective in sub-Saharan Africa. The WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.  Circumcision reduces the incidence of HSV-2 infections by 28%, and is associated with a reduced risk of both urinary tract infections (UTIs) and penile cancer. Studies of its protective effects against other sexually transmitted infections have been inconclusive.
 * Circumcision is controversial. Ethical questions have been raised over removing healthy, functioning genital tissue from a minor, and opponents of circumcision state that infant circumcision infringes upon individual autonomy and represents a human rights violation. Some medical associations take the position that the parents should determine what is in the best interest of the infant or child; others state parents are not entitled to demand medical procedures contrary to their child's best interests, or infringe on the right of the child to make an informed choice for himself when older. The legal status of circumcision sees a wide range of treatment from legislative bodies around the world. As well, the many medical associations around the world give a wide variety of opinions regarding neonatal circumcision.

Feedback please. 03:00, 26 July 2012 (UTC)


 * Thanks again Zad for keeping us current on the progress of the lead. I only have a few suggestions.
 * I'm seeing a qualifier in this revision that states circumcision carries "almost no severe events" in neonates. In the body of the article for circumcision, I see that the same qualifier is actually used for both neonates as well as children. This should be a quick fix.
 * Following the proposed sentence "Questions of whether circumcision carries lasting psychological effects... mixed results", this seems to an appropriate spot to briefly mention that circumcision has been shown to sever a part of the human anatomy embedded with sensitive nerve endings. The College of Physicians and Surgeons of British Columbia have written that the foreskin "is rich in specialized sensory nerve endings and erogenous tissue". The Royal Dutch Medical Association argues that it is "a complex, erotogenic structure".  state that "the complex innervation of the foreskin and frenulum has been well documented, and the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings. PMID 3122584 argues that circumcision removes human "specialized nerve endings".  states circumcision "is associated with decreased erectile function and decreased penile sensitivity".  and  also both carry a similar dialogue regarding the foreskin containing nerve endings (I'll spare you more redundant quotes). There is, quite irrefutably, a presence of nerve receptors in the human foreskin which are severed by circumcision.
 * In Circumcision, there are over a dozen explanations for how the procedure might have began. For the sake of space, is it worth focusing on two possible explanations for its origin in the lead when there is only a remote chance of either explanation being correct? FactoidDroid (talk) 05:36, 26 July 2012 (UTC)
 * I prefer changing the "muslims world ... near universal)" bit to "muslim majority countries". Pass a Method   talk  12:49, 26 July 2012 (UTC)
 * Thanks Factoid and Pass a Method, I'll work on your suggestions.   03:35, 27 July 2012 (UTC)


 * I am not sure I would give the lead so much attention at this time, it is supposed to summarize the body and there may be still lots of work to be done to cleanup that. Coming back to the disambiguation issue, circumcision is commonly connected with initiation rites in most cultures. Hence the lead probably should mention male initiation rites and disambiguate that from medical circumcision. As of initiation rites involving male genital modification, WP has penile subincision, it is strangely missing stripping/flaying and and overview of male genital mutilation initiation rites. There is however genital modification and mutilation covering both sexes. Richiez (talk) 21:39, 26 July 2012 (UTC)


 * Hi Richiez, if you're not interested in working on the lead now, that's fine. The lead should summarize the body and otherwise follow the guidelines at WP:LEAD at any given point in time regardless.  But as you're providing feedback about the lead anyway...
 * I agree that the lead should mention circumcision's history featuring in initiation rites because the section in the article body on history touches on that, and you'll see that my proposed lead rewrite above does indeed cover this. There is a separate article on History of male circumcision.  This article's focus is on circumcision as a modern surgical procedure.  There are other articles on circumcision as religious rites, like Brit milah and Khitan (circumcision).  Look at the "See also" list at the top of the Cultures and religion section.
 * Regarding penile subincision missing "stripping/flaying" and the other articles you mentioned you're welcome to go edit those articles and add well-sourced content regarding those topics to them, but those subjects seem off-topic regarding this article and its lead.  Let me know if you have any other input regarding the lead.   03:33, 27 July 2012 (UTC)


 * Prevalence clean-up: Proposed draft: "It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa and the United States; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania." More accurate: "It is most prevalent in the Muslim world (where it is near-universal), Israel, the Philippines, South Korea, the United States, and much of Africa; it is less common in Europe, Latin America, parts of Southern Africa, and most of East Asia."  Comments on the changes: (1) added Israel, not the Muslim world, does seem to belong to the most prevalent (and perhaps the near universal comment is applicable there). "Parts of Southeast Asia" is vague and other than the Muslim countries there (Malaysia, Indonesia) and Muslims in the area seems only to apply to the Philippines (some may not even consider this SE Asia any way) and South Korea (rarely considered SE Asia) - also eliminates the ambiguity of whether "parts of" applies to SE Asia only, or carries through to Africa and the United States as well. (2) much of Africa, rather than all of as possibly implied. (3) changed "rare" to less common. I doubt one would consider it "rare" to find a circumcised man in all of the geographies listed ("rare" is an undefined and weasel word anyway). (4) East Asia replacing Asia, because much of Asia is in the Muslim World (say Turkey->Kazakhstan->Pakistan->a sizable minority in India (again, not likely to be rare if 15% of the people there are Muslim->Bangladesh->Malaysia through to Indonesia. Less common in East Asia specifically (China, Vietnam, Laos, Cambodia, North Korea, Burma, Thailand, Siberia). (5) Left out Oceania, as circumcision is near universal among many indigenous peoples of the region, and circumcised penises are hardly considered "rare" among the ANZACs. Carlossuarez46 (talk) 18:20, 27 July 2012 (UTC)

Would be good to add the links and references to this lead. Also may be useful using the "|quote" tags in the cite templates. While I do realize that the lead technically does not need references in controversial topics such as this one it is generally requested by our readership. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 18:55, 29 July 2012 (UTC)

Feedback has quieted down for Draft #2 so here's Draft #3. Thank you all, I think we're pretty close to applying the new lead. Discussion of suggestions and list of changes: Please review:
 * Language for "severe adverse events" updated per FactoidDroid
 * Re (from FactoidDroid): "this seems to an appropriate spot to briefly mention that circumcision has been shown to sever a part of the human anatomy...": That circumcision removes ennervated tissue isn't disputed, and the proposed lead in that very paragraph you're talking about already does mention "removing healthy, functioning genital tissue" so I think the lead already covers this and a duplicate mention isn't needed.  The part of the article body the "Questions of [circumcision]'s effects ... on sexual function" sentence is trying to summarize is "sexual effects."  The sources we have come to mixed conclusions regarding the sexual satisfaction of circumcision vs. uncircumcised adults, because our sources mention sexual satisfaction is very subjective, and the removal of ennervated tissue isn't the only factor in its determination.
 * Re (from FactoidDroid): "In Circumcision#History, there are over a dozen explanations for how the procedure might have began. For the sake of space, is it worth focusing on two possible explanations for its origin in the lead when there is only a remote chance of either explanation being correct?"  I glanced through the sources in this article and also History of male circumcision, and religious sacrifice and rite of passage are the two theories that have the most reliable source support.  The question isn't whether or not they're likely to be correct, but rather whether it's what the sources say, and the proposed lead is careful to qualify the theories by starting the sentence with "Various theories have been proposed as to how it began, including..."
 * Re (from Pass a Method): "Muslim world"... thats the term the article body uses.  I'd have to see if "Muslim-majority countries" is a synonym for "Muslim world" and how it matches up to the source cited.  I've left it alone for now but we can certainly revisit.
 * Re: Doc James' suggestion to add links and references to lead-- Yes, will do, I've just left them out while we finish drafting the rewrite for ease of editing.
 * Re (from Carlos) "prevalence" suggestions: You're probably right with your improvements to the accuracy regarding prevalence, but the lead should reflect the body.  I pulled the "prevalence" sentence just about verbatim from the body.  What we will do is review the sources used in the body, update the body sentence regarding prevalence, and then update the lead to reflect the change.
 * Changed "Blood loss" => "Bleeding" more specific description as found in sources
 * Replaced the "As well, the many medical associations around the world..." sentence with the previous "Summaries of the views ..." sentence per results of RSN discussion, no consensus to remove
 * Male circumcision (from Latin circumcisio, meaning "to cut around") is the surgical removal of some or all of the foreskin (prepuce) from the penis. It is estimated that one-sixth to one-third of males worldwide are circumcised. It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa and the United States; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania. The origin of circumcision is not known with certainty; the oldest documentary evidence for it comes from ancient Egypt. Various theories have been proposed as to how it began, including as a religious sacrifice and as a rite of passage marking a boy's entrance into adulthood. It is considered religious law in Judaism and established tradition in Islam to circumcise sons.
 * In modern times, for infants, the procedure is often performed using devices such as the Plastibell, or the Gomco or Mogen-style clamps. The foreskin is opened and then separated from the glans after inspection. The circumcision device (if used) is placed, and then the foreskin is removed.  Topical or locally-injected anesthesia may be used to reduce pain, and its use is advocated; if it is not used, the male experiences pain and physiologic stress. For adults, general anesthesia is an option, and the procedure is often performed without a specialized circumcision device.  Worldwide, medical circumcision was found to have a median complication frequency of 1.5% for newborns and 6% for older children; almost no severe adverse events were found for either group.  Bleeding and infection are the most common complications. Incorrectly-performed circumcisions may result in an improper amount of skin being removed, concealed penis, urinary fistulas, and other complications. Questions of whether circumcision carries lasting psychological effects, and what its effects are on sexual function, are both poorly determined, with various studies reporting mixed results.
 * Circumcision may be indicated for both therapeutic and prophylactic reasons. It is a treatment option for phimosis, posthitis and other such conditions. A Cochrane meta-analysis of studies done on sexually active men in Africa found that circumcision reduces the infection rate of HIV among heterosexual men by 38%-66% over a period of 24 months, and studies have concluded it is cost effective in sub-Saharan Africa. The WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.  Circumcision reduces the incidence of HSV-2 infections by 28%, and is associated with a reduced risk of both urinary tract infections (UTIs) and penile cancer. Studies of its protective effects against other sexually transmitted infections have been inconclusive.
 * Circumcision is controversial. Ethical questions have been raised over removing healthy, functioning genital tissue from a minor, and opponents of circumcision state that infant circumcision infringes upon individual autonomy and represents a human rights violation. Some medical associations take the position that the parents should determine what is in the best interest of the infant or child; others state parents are not entitled to demand medical procedures contrary to their child's best interests, or infringe on the right of the child to make an informed choice for himself when older. Summaries of the views of professional associations of physicians state that none recommend routine circumcision, and that none recommend prohibiting the practice. The legal status of circumcision sees a wide range of treatment from legislative bodies around the world.

I think we're very close, and if there are no major objections of the next day or two, I'm going to go ahead and make the update. Even if it's not 100% perfect the moment it goes in, the changes we're getting at this point aren't wholesale objections but tweaks and wording changes that can be handled with normal day-to-day editing. Thank you all for your participation! 20:28, 30 July 2012 (UTC)
 * I like it Zad. It's much more informative and encyclopedic. Good work. Garycompugeek (talk) 14:13, 31 July 2012 (UTC)
 * Thank you Gary! Sincerely appreciate it and good working with you on this.  Cheers...    15:26, 31 July 2012 (UTC)
 * This is still not perfect from my European point of view. More than 95% of circumcisions are done for traditionalist reasons - Muslim world and America, some for medical reasons -- and as far as I am aware only Jewish people are doing it for religious reasons. I think more focus should go on initiation rites, history and variations than on technical details. I do not know if it is a good idea to mention particular, possibly trademarked devices which are used for probably less than 10% circumcisions worldwide in the overview. Who does advocate local anesthesia? The body seems to attribute it to the AAP but can not find the exact reference. Instead of writing that it is advocated it would be better to know if it is used which is admittedly a difficult task when presenting a worldwide view. Current text proposal suggests that if local anesthesia is used the male will not experience any pain or physiologic stress - given my very limited experience with local anesthetics I do consider perfect effectivity as far from granted. There seems to be little experience with this in Europe. The complication frequency of 1.5% for newborns can be hardly worldwide. There are very little data for most European countries where it is a rarely performed surgery and I do not even want to think about other countries. More likely data is only available for 2 or 3 countries at all, the same problem like with the prevalence of hysterectomy. Likewise the older children. Mortality is not zero even in the US. "medical circumcision" - should it mean performed by medical professionals? Then it would be nice to have data on ritual circumcision which seems far more frequent. The HIV and other STD protection is overstated. I would think this overview should not say anything that is not in the summary section "medical aspects". In particular the early terminated trials over 24 months had a very small incidence of newly acquired infections and dropout rates that were several times as much. Given the difficulties, maybe the overview could be even shorter. Richiez (talk) 15:08, 31 July 2012 (UTC)
 * Hi Richie...
 * Re: "I think more focus should go on initiation rites, history and variations than on technical details."  Wikipedia does indeed cover all this, just not directly in this article.  The consensus-determined scope of this article is circumcision as a modern surgical procedure, whether done for medical, religious (you forgot Muslims!) and/or cultural reasons, and the focus here is on its medical aspects (this article is covered under WP:MEDICINE).  Its other aspects like its history, religious use, controversy, etc. are indeed touched on here, and as has been pointed out previously, this is a Wikipedia summary-style article--nearly every section has a "Main article" or "See also" heading where the interested reader can go to see more detail about:  Circumcision surgical procedure, Medical analysis of circumcision, Sexual effects of circumcision, Circumcision and HIV, Prevalence of circumcision, History of male circumcision, Circumcision controversies, Ethics of circumcision, Circumcision and law, Brit milah, Religious male circumcision, Khitan (circumcision), Circumcision scar, Frenectomy, Genital modification and mutilation, Holy Prepuce, and Preputioplasty (I count 17 such cross-links).  This is the typical and desirable result of Wikipedia's handling of a complex, well-sourced topic as it matures.
 * Re: the three devices mentioned are "used for probably less than 10% circumcisions worldwide".  There are sources that say those three clamps are the most prevalent used to do it, at least in the USA, but if that's felt to be too US-centric I wouldn't object to removing it.
 * Re: "Who does advocate local anesthesia?"  Among others, the AAP does--their 1999 "Circumcision Policy Statement" states: "if a decision for circumcision is made, procedural analgesia should be provided."  The lead summarizes the body, so you can find this here:  Circumcision
 * Re: "Instead of writing that [analgesia] is advocated it would be better to know if it is used"--covered in the same section, using what sources we have.  We only have primary sources for this so (in my evaluation) that shows there isn't enough attention paid to this topic by reliable sources for it to be notable enough to be mentioned in the lead (as compared to the AAP statement, which is a secondary source--the AAP reviews the literature and makes a recommendation).
 * Re: "Current text proposal suggests that if local anesthesia is used the male will not experience any pain or physiologic stress"  When writing this, I took care to avoid this confusion, so the proposed text seems clear to me:  "Topical or locally-injected anesthesia may be used to reduce pain" -- "reduce" and not "eliminate".
 * (added) *I see what you mean now, you're talking about the "... ; if not, ..." structure of the sentence. I will fix this, shorten it and also address the "advocated" issue you also brought up with the rewrite:  "Topical or locally-injected anesthesia may be used to reduce pain and physiologic stress."
 * Re: "The complication frequency of 1.5% for newborns can be hardly worldwide" -- This statistic comes from a systematic review, published in a well-respected peer-reviewed journal, of papers published worldwide on the topic.  From the abstract, "A total of 1349 published papers were identified, of which 52 studies from 21 countries met the inclusion criteria. The Arabic literature searches identified 46 potentially relevant papers, of which six were included."  This is found the body of the article, under Circumcision.  This is one of the strongest-supported statements we have with worldwide scope.
 * Re: "There are very little data for most European countries where it is a rarely performed surgery and I do not even want to think about other countries. More likely data is only available for 2 or 3 countries at all"  It looks like you're making assumptions that aren't in agreement with what the sources say.  We have to go with what the sources say.
 * Re: "Mortality is not zero even in the US."  The proposed lead doesn't say it is, not sure why you are bringing this up?
 * Re: "'medical circumcision' - should it mean performed by medical professionals?"  The source says "Child circumcision by medical providers" and I can see the possible confusion from my wording, good catch, I will make the update
 * Re: "it would be nice to have data on ritual circumcision which seems far more frequent."  Do you have any sources here?  We would have to evaluate where to put this info based on the source.
 * Re: "The HIV and other STD protection is overstated."  Really it's not overstated, as we have discussed many times here on this Talk page.  Based on a review of academic reliable sources, the most notable thing about circumcision these days is its protective effect against HIV:  we have a systematic review (Wikpedia's most-preferred type of study) and literally dozens of secondary and primary studies in this area.  To prove this to yourself, to scholar.google.com and search on "circumcision".  About half the results in the first few pages mention HIV.  We also have secondary sources regarding other STDs showing significant coverage in reliable sources
 * Re: "I would think this overview should not say anything that is not in the summary section "medical aspects"  The HIV effects are indeed in the "Medical aspects" section.  Or are you suggesting that the lead should not cover the whole article?  Take a look at WP:LEAD, which is our guideline here.
 * Re: "In particular the early terminated trials over 24 months had a very small incidence of newly acquired infections and dropout rates that were several times as much."  Cochrane is highly-respected and a systematic review is the most-preferred type of source according to WP:MEDRS.  We depend on Cochrane to do this kind of evaluation and analysis of the primary sources for us, we do not do it ourselves.  This is the reason why WP:MEDRS values a systematic review so highly.
 * 17:14, 31 July 2012 (UTC)

Updated lead applied
Updated lead applied, kudos to everyone who contributed! We all know this is a tough article to work on and I think we have a good result. 12:55, 1 August 2012 (UTC)
 * I like it. It was creative and well-written. I was pessimistic about the length but it seems to have turned out fine in practise. Thanks. Pass a Method   talk  20:20, 1 August 2012 (UTC)
 * Excellent! Appreciated.  Cheers...   20:48, 1 August 2012 (UTC)


 * Zad, i was just thinking about your use of the link self-ownership under "individual autonomy". I was wondering if the link bodily integrity would be more applicable. Pass a Method   talk  13:57, 2 August 2012 (UTC)


 * Hmmm... I looked at this. I picked "self-ownership" because it is the redirect target of "individual autonomy", so that's simply a pretty straightfoward application of not Wikilinking to a redirect but rather its target.  There could be the underlying question of whether the article itself should be changed from "individual autonomy" to "bodily integrity" in the first place.  First I note "individual autonomy" is a higher-level concept than "bodily integrity" so the idea of "bodily integrity" is included by the Wikilink to "self-ownership."  In the article body, the sources supporting "individual autonomy" are Somerville, Van Howe et al and Tanne, and I did some counts on them.  (For these counts I'm counting relevant exact matches or forms of the phrase, counted somewhat liberally, for example I count "autonomy and self-determination" as "individual autonomy.")  Somerville uses "individual autonomy" 15 times and "bodily integrity" 1 time, Van Howe uses "individual autonomy" 3 times and "bodily integrity" 7 times, Tanne uses "autonomy" 0 times and "integrity" 1 time.  These are of course not an exhaustive list of all sources on the subject, just what we've picked for sources.  I'm inclined to leave it as "individual autonomy" as it's a higher-level concept that includes "bodily integrity", our sources use it significantly, and the link target "self-ownership" has a hat-note "Further information: Bodily integrity" right at the top.  Make sense?    14:47, 2 August 2012 (UTC)


 * Uh, makes sense. its okay. Pass a Method   talk  14:52, 2 August 2012 (UTC)


 * I think the prevalence statements are not accurate. If 1/6 to 1/3 of males are circumcised, certainly the prevalence in Oceania is not relatively rarer than those ratios. The rates of current newborn circumcision in Australia and New Zealand may be below those numbers, but we're not solely discussing what happens at birth today but the "install base", so to speak. Carlossuarez46 (talk) 00:50, 28 August 2012 (UTC)

Subsaharan WHO studies called into question
The 2011 review by Gregory Boyle and George Hill demonstrated massive flaws in all three Subsaharan WHO studies from 2007.

Brian D. Earp relied on this paper for his Oxford blog entry "When bad science kills, or how to spread AIDS". Summarising quote:


 * While the “gold standard” for medical trials is the randomised, double-blind, placebo-controlled trial, the African trials suffered [a number of serious problems] including problematic randomisation and selection bias, inadequate blinding, lack of placebo-control (male circumcision could not be concealed), inadequate equipoise, experimenter bias, attrition (673 drop-outs in female-to-male trials), not investigating male circumcision as a vector for HIV transmission, not investigating non-sexual HIV transmission, as well as lead-time bias, supportive bias (circumcised men received additional counselling sessions), participant expectation bias, and time-out discrepancy (restraint from sexual activity only by circumcised men).

He also included objections by other reviewers, esp. the lack of regard for risk compensation (example: Zimbabwe).

This should be mentioned. -- 217.235.115.183 (talk) 21:21, 2 August 2012 (UTC)
 * I've read the literature extensively, and ALL MEN received the same counseling about safe sex. The trials were ended early, but only those men who completed the entire trial were included, and the follow-ups are still ongoing. IDK what to say about the cut men not having sex while their penises healed, but that's a relatively small amount of time to be responsible for the massive 60% reduction, a number that is not at all misleading. While the lack of a placebo is certainly a weakness, the nature of the test for HIV leads the experimenter bias a non-issue. I would certainly keep an eye out for the long-term consequences, but as for now, the experiments are adequate enough to not warrant additional mention of their supposed inadequacies. Rip-Saw  (talk) 23:42, 8 August 2012 (UTC)
 * I have to wonder if you read the Boyle & Hill review, because not only does it show that the points you named have other implications that damage validity, they are also just a part in its long list of objections.


 * As for that 60% figure, on its own it is indeed misleading and a common PR technique:


 * What does the frequently cited “60% relative reduction” in HIV infections actually mean? Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive, so the absolute decrease in HIV infection was only 1.31%, which is not statistically significant.


 * More about that relative vs. absolute reduction in this article; Wikipedia's own page contains a recommendation for a more honest presentation of such findings.


 * Any such effect has also absolutely no influence on the continued necessity to use condoms. Which, disastrously, is the opposite of the message many African men receive; see eg. the article linked above on the situation in Zimbabwe. -- 217.235.116.13 (talk) 18:53, 11 August 2012 (UTC)


 * Male Genital Modification (MGM) gets special treatment on Wikipedia for some reason. Wikipedia gives inordinate weight to purported medical benefits, in effect promoting MGM by handling it with kid gloves.
 * Here is the continuum for Human Genital Modifications:
 * Human Genitals at Birth <-> Human Genitals Altered by Others
 * By ascribing normalcy to some types of Genital Modification, Wikipedia finds a place on the line of Human Genital Modification that is acceptable. Giving equal weight to the arguments that encourage some type of genital modification for males, while denying, even renouncing, any similar arguments for female modifications, Wikipedia errs morally, psychologically, and intellectually. 208.79.246.79 (talk) 20:48, 18 August 2012 (UTC)


 * If we use the methods suggested in the Absolute risk reduction page above, then the number needed to treat (NNT) would be calculated in terms of the control group event rate (CER) and experimental group event rate (EER). The numbers above would then be CER = 0.0249 and EER = 0.0118, so NNT = 1 / (CER - EER) = 1/(0.0249-0.0118) = 76, i.e. for every 76 males circumcised, one HIV infection would be prevented.  Pretty impressive (compares very favorably with many treatments considered effective).  I don't think WP rules regarding original research would allow doing such calculations for the article; rather, I think we need to depend on the data as presented in reliable sources.  -- Scray (talk) 22:00, 18 August 2012 (UTC)


 * "Pretty impressive" — hell yeah. Unless you actually run the numbers:


 * African men, on average, have coitus once a week, and use condoms in 48% of their sexual encounters with women. Assume that 20% of sexually active women are HIV-positive, partners were contacted randomly, condoms are 98% effective when used, the baseline circumcision rate is 5%, and circumcision reduced the transmission rate of HIV infection by 50%. Since the transmission rate of HIV from females to males is one per 1000 unprotected coital acts, the HIV infection rate in men in this scenario would be 0.537 per 100 person-years (which is far below the rate reported in the three RCTs). If the circumcision rate increases from 5% up to 75%, the infection rate would decrease to 0.344 per 100 person-years. If in the baseline scenario with a 5% circumcision rate condom use increased from 48% up to 67.9% of sexual encounters, the infection rate would be 0.344 per 100 person-years. Consequently, the impact of a fifteen-fold increase in the rate of circumcision could be accomplished by a relative 41% increase in the use of condoms.


 * -- 217.235.120.47 (talk) 08:34, 21 August 2012 (UTC)


 * The afore-mentioned blog post is incorrect and deceptive. For starters, the author does not correctly assess statistical significance. An absolute reduction of "only" around 1% is huge. Similar absolute differences, for example, led to Vioxx's withdrawal from the marketplace and subsequent multi-million dollar settlements. The blog post should not, for any reason, be cited, nor seriously discussed here. 108.39.200.50 (talk) 13:18, 27 August 2012 (UTC)

More eyes on Foreskin, Medical analysis of circumcision‎ and Sexual effects of circumcision articles
Can we get more eyes on these articles and any other articles closely related to circumcision, please? Right now, Sugarcube73 is the most active editor of these articles. But as Zad68 has expressed, the editor seems to generally edit these articles with a pro-foreskin POV. To help with neutrality, I feel that more editors involved in the circumcision topic of Wikipedia should be looking after/editing these articles as well. Please do. 109.123.115.21 (talk) 18:37, 24 August 2012 (UTC)
 * Per WP:NPA, Wikipedia policy is to comment on content, not on contributors. It says, "Derogatory comments about other contributors may be removed by any editor." I wonder if this new section (including this comment) should be removed. --Nigelj (talk) 21:10, 24 August 2012 (UTC)
 * Hi. Comments on contributions are often made while also including mention of the contributor(s) who made them. This is often seen on this talk page and others, with assertions of POV. Expressing concern that an editor is or may be editing non-neutrally is perfectly allowed within guidelines, meaning that it is not considered a personal attack. If it were, then that would mean that Zad68 committed personal attacks all across/along that editor's talk page. Review the link you provided showing what does constitute a personal attack on Wikipedia. I stated that an editor seems to be editing non-neutrally and that more eyes on these articles can help ensure neutrality, considering that I know that not everyone at this article leans the same way on this subject. 109.123.115.222 (talk) 00:06, 25 August 2012 (UTC)
 * And I welcome Sugarcube73 here to address my concerns. 109.123.115.222 (talk) 01:21, 25 August 2012 (UTC)

WHat does it mean? reduces prevalent HPV but not new HPV infections?
I consider myself fairly literate, medically. I have not a clue what this means: "...studies...found reduced risk of prevalent HPV and ... some evidence of reduced risk of new HPV infections." This NEEDS clarification. 71.31.152.220 (talk) 17:50, 27 August 2012 (UTC)

Quoting the abstract of the article this passage is based on, "There was weak evidence that circumcision was associated with decreased HPV incidence (summary RR, 0.75, 95% CI, 0.57-0.99; 3 studies) and increased HPV clearance (summary RR, 1.33; 95% CI, 0.89-1.98; 3 studies) but no evidence of an association with prevalent genital warts (OR, 0.93, 95% CI, 0.65-1.33; 15 studies)." Distinguishing between prevalence of genital warts and the incidence of HPV infections seems to me to mean that, while circumcision was associated with a lower risk of acquiring HPV, it either did not lessen the risk of genital warts in men, or in men with circumcision. The article seems to misstate what the authors found by confusing HPV prevalence with the prevalence of genital warts. I'll dig a little deeper into the cited article and try to fix this passage up. 108.39.200.50 (talk) 01:06, 28 August 2012 (UTC)

The authors report that circumcision provided "a strong protective effect overall" with respect to HPV prevalence, that circumcision in randomized trials was protective against incident HPV infections--that is, new infections during the study period--that there is strong evidence circumcised men with HPV were more likely to clear the virus than non-circumcised men who were infected or became infected in a given period of time (essentially, they clear it faster), and finally that "there was no evidence of an association of circumcision and prevalent genital warts". So while circumcised men were less likely to contract HPV and spent less time infected with the virus, they were not less likely to develop genital warts. 108.39.200.50 (talk) 01:16, 28 August 2012 (UTC)

I have a draft sentence to replace the questionable line with: "In 2011, a meta-analysis of 23 studies, including both randomised controlled trials and observational studies, found that the prevalence of HPV was lower in circumcised men than uncircumcised men, indicating a strong protective effect of circumcision that was stronger at the glans and urethra than sites further from the foreskin. Furthermore, the authors found weaker evidence that circumcision was protective against new HPV infections, and that circumcision increases HPV clearance in infected men, and found that circumcision was not associated with prevalent genital warts." Comments, anyone? 108.39.200.50 (talk) 01:37, 28 August 2012 (UTC)

Quick Question
Can we add the newest AAP statement to the lead? I mean in the most neutral way possible if you will. Any response is appreciated.--216.31.211.11 (talk) 00:56, 30 August 2012 (UTC)
 * Probably not. The article maintains a worldwide scope, and the AAP's position is just one of many.  There's no clear reason to include the AAP's position in the lead and keep, for example, the Royal Dutch Medical Association's very anti-circumcision position out of it.    01:01, 30 August 2012 (UTC)
 * The study doesn't seem reliable. The African people that do get circumcised are most likely to be part of a local culture that encourages safer behavior, as opposed to the "anarchist" rest of the polled persons. They are more likely to remain in contact with medical bodies than the rest of their carefree counterparts. Increased safety can thus be a result of safer behavior/interactions, not necessarily a result of the circumcision itself. — Preceding unsigned comment added by 79.114.137.162 (talk) 10:30, 31 August 2012 (UTC)

Update
This specifically states it is an update of the 1999 statements http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1989.full.pdf+html Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:45, 28 August 2012 (UTC)
 * The update is about adding "that the procedure’s benefits justify access to this procedure for families who choose it" and about referring to more recent data. Note: It's "update", not "replace" or "change". And they specifically stress, in the same way as the old statement, that "health benefits are not great enough to recommend routine circumcision for all male newborns" --rtc (talk) 00:02, 29 August 2012 (UTC)
 * I have once again removed mention of the 1999 statement, and expanded the summary of the 2012 statement to hit all the major points. If any of the points are unchanged from 1999, there is no need to mention that point because it is already mentioned in the 2012 statement. If there is a change, then the 1999 statement should not be mentioned as it would be outdated. Either way, there is no need to mention the 1999 statement at all. Yobol (talk) 02:28, 29 August 2012 (UTC)
 * Agree with Yobol. For no other position statement do we do a historical review of previous statements in presenting the latest statement. I reverted Rtc's rather POV edits that looked like an attempt to downplay the 2012 statement by presenting it in comparison to the 1999 statement.  The article should present the most important points of the most recent position statement.  I see no benefit to the reader in trying to present the 2012 statement in comparison to the 1999 statement.    03:08, 29 August 2012 (UTC)
 * Of course the historical review is highly relevant here, because the presentation can only be misunderstood if you omit it; making it seem like the 2012 statement says anything significantly new or different, which it doesn't. The article should put the recent position statement in its historical context properly. We have a source for that, and why do you think press makes this comparison if the comparison were as unimportant as you claim? The reader will obviously be mislead if the 2012 statement is not presented in comparison to the 1999 statement. --rtc (talk) 06:23, 29 August 2012 (UTC)
 * It appears consensus is against the mention of the 1999 statement, please stop edit warring. We are not a newspaper, and there does not seem to be any encyclopedic relevance to mentioning the previous statement. Yobol (talk) 12:37, 29 August 2012 (UTC)
 * Mentioning the previous statement is a NPOV neccessity and certainly not irrelevant. The section further down even refers to it: "the American Medical Association supports the AAP's 1999 circumcision policy statement". Please be more rational, take back your revert and let's build consensus for mentioning the older statement. --rtc (talk) 12:47, 29 August 2012 (UTC)
 * FYI, I have left Rtc an official 3RR warning at his User Talk page here: User_talk:Rtc.    13:02, 29 August 2012 (UTC)
 * I have actually filed a report of Rtc's edit warring at WP:AN3. I have also self reverted my last revert to avoid the appearance of 3rr on my part, though I continue to believe there is a consensus against mention of the 1999 statement. Yobol (talk) 13:04, 29 August 2012 (UTC)
 * Please look at my arguments. Consensus is the result of arguments, not the other way around: merely because some people agree on something, that isn't an argument for the assumption they agree on. The section later refers to the AAP's 1999 circumcision policy statement. Not putting things into context would make that reference very confusing. And I still think there is a POV problem if the updated statement is not put into historical context. Since then you might misunderstand it as the AAP having only now, for the first time, issued such a statement on circumcision. You are certainly right: "We are not a newspaper" But isn't that an argument *for* historical context? --rtc (talk) 13:13, 29 August 2012 (UTC)

Section break
I'm really trying very hard to understand Rtc's arguments in favor of describing the 2012 statement in relation to the 1999 statement. They seem to be: 13:18, 29 August 2012 (UTC)
 * 1) It's necessary to avoid having the reader think the 2012 statement is significantly different from the 1999 statement.
 * 2) *Response: Why is it necessary for the reader to think anything about the previous positions at all?  The 2012 statement stands on its own, it is not written in a style like "This statement amends the 1999 statement in the following way:  Page one, paragraph 3, change 'this' to 'that'..." etc.  It is its own, complete, stand-alone position statement.
 * 3) A popular-press article discusses the changes between the 1999 and 2012 statements.
 * 4) *Why is this important for this article? It's a summary article with brief description statements from a number of organizations.  The article is not History of the AAP's positions on circumcision.  It would be confusingly undue to go through the history of one organization's historical positions.
 * 5) "Mentioning the previous statement is a NPOV neccessity"
 * 6) *It is unclear what the NPOV issue is of having the article present the most important points of the most recent statement. Can you please explain?
 * You are missing number 4: The section now makes a dangling reference to the 1999 statement. --rtc (talk) 13:20, 29 August 2012 (UTC)
 * Is this the only issue? You put a "neutrality disputed" tag on the section, but you have not yet clearly explained what the neutrality issue is.  Please explain this concern clearly or remove the tag.    13:22, 29 August 2012 (UTC)
 * The answer to #4 is simple: remove mention of the 1999 AAP statement from the AMA section as well and just state the position of the AMA. Yobol (talk) 13:35, 29 August 2012 (UTC)


 * No, I was just adding that to your list for you to object, too, if you wish. Reply to the other three is below. --rtc (talk) 13:36, 29 August 2012 (UTC)
 * ✅ I have updated the section with policy statements from the AMA from 2011, obviating the need to keep the 1999 AAP statements in for the reason of resolving the AMA's use of the 1999 statement.   16:06, 29 August 2012 (UTC)


 * About your objections: "Why is it necessary for the reader to think anything about the previous positions at all?" Because not mentioning that a previous statement existed suggests that there was no AAP policy on this issue before. And then, the policy statement sounds completely different. It sounds as if the AAP has, in 2012, out of the blue taken the position that circumcision has some potential health benefits, while, in fact, the AAP has held such a (or a very similar) position already since 1999, and only updated it now slighty, mainly about new data (being very very slightly more affirmative) and about insurance coverage of the method. "Why is this important for this article?" Because the fact that the AAP had an opinion on this before is significant, even crucial with respect to the topic of the section, circumcision in the United States. " It's a summary article with brief description statements" True, but it does not take that much space. If the section is too long, there are some opportunities other than this to make it shorter. "It is unclear what the NPOV issue is of having the article present the most important points of the most recent statement" The statement, as presented, is making a strong case in favour of circumcision. Read in the historical context, however, the statement sounds quite a bit different and more cautious. This may be a subtle point, but most NPOV issues are pretty subtle. --rtc (talk) 13:36, 29 August 2012 (UTC)

At first I was OK with removing the AAP 1999 policy statement but on further reflection I think Rtc is right. The AAP have not released a new policy but merely an addendum to the 1999 policy and we do have other policy statement agreeing with the 1999 policy of which we have no confirmation about their view on the addendum. Garycompugeek (talk) 13:57, 29 August 2012 (UTC)
 * After furthur review from the AAP website this appears to be new policy that stands on its own. I withdraw my objection but we must word some ot the other statments different that used to agree on the AAP policy statement from 1999. Garycompugeek (talk) 14:06, 29 August 2012 (UTC)
 * The abstract of the policy says that it is the policy's purpose to "update the Academy’s 1999 recommendations in this area". If you look at the policy itself, it is quite short, taking hardly one page, if you omit the space. Quite some of it repeats the 1999 recommendations, perhaps not word by word, but the meaning is the same. The policy document, as it is, certainly stands on its own, that's right. But I think that this does not contradict the fact that it is "merely an addendum to the 1999 policy". It adds new data (which is very slightly more affirmative), and it adds a recommendation for insurance to cover it. The rest is essentially the same. --rtc (talk) 14:14, 29 August 2012 (UTC)
 * It is definitely more pro circumcision now after browsing through it. There is no mention of a childs rights, mental effects, or sexual problems. I have been informed that the entire taskforce were men who were circumcised but have no way to validate that claim.  Regardless we are not here to pass judgment but to reflect what is out there accurately.  Considering they open their policy by comparing to the 1999 policy I have no objections to leaving it in either.  I do object to adding perceived health benefits for we already cover these things in detail in the article and repeating them would require us to add negative effects also mentioned in the policy. Garycompugeek (talk) 14:26, 29 August 2012 (UTC)
 * I do not dispute that the tone is a different one (and in fact the source I quoted in the section states that) -- if you read the 2012 version in isolation. But that is exactly my point. The 2012 version presents itself as an update of the 1999 version. The 1999 version is a lot more detailed about many points that are merely summarized in the update; the 1999 version is 10 pages long. So while the 2012 version stands on its own, it does so only with one leg. --rtc (talk) 14:32, 29 August 2012 (UTC)
 * Are we even talking about the same documents?? The 1999 statment's Abstract is one paragraph, 4 sentences long; its Summary and Recommendations section is one paragraph, 7 sentences long, and the whole document is 10 pages.  The 2012 statement's Abstract spans 2 pages and contains 16 separate bullet points worth of recommendations, its Conclusions section mirrors the Abstract in length and scope, and the whole document is 31 pages long.  Clearly the 2012 is in no way an "addendum" or just a small list of changes on top of the 1999 statement.  It is a completely new, independent and complete policy statement that stands on its own, and we would do the reader a tremendous disservice by misrepresenting it as a mere "tweak" of the 1999 statement.   14:58, 29 August 2012 (UTC)
 * I say we just go with the 2012 statement. As it replaces the 1999 one. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:38, 29 August 2012 (UTC)
 * Agreed, I have returned the article wording not to mention the 1999 statement as a convincing case to present the 2012 statement as relative to 1999 hasn't been made here. I've left the NPOV tag while we're still discussing that.    15:50, 29 August 2012 (UTC)
 * I have to admit that the recent edits made by User:Garycompugeek have clearly improved the section's neutrality. However, I still think that we are breaking NPOV and doing the reader a tremedous disservice if we censor the existence of the 1999 statement. I already replied to your questions and objections above. The 31 pages you are now referring to contain the AAP's technical report on the matter, not the policy statement cited in the article. What is so problematic about mentioning that the AAP had an opinion before?! The section on Canada does the same thing! --rtc (talk) 01:34, 30 August 2012 (UTC)
 * We do this with all topics. When an update comes out we use the update exclusively. And we would not call this censorship :-) Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:19, 30 August 2012 (UTC)
 * We don't do it with all topics; see the Canada topic. And we shouldn't be doing it with the US topic either... The information that policy statements were in effect before is significant and highly relevant. Wikipedia is an encyclopedia, which means it is not merely a description of the most recent information. It should include history, too. I have not seen any convincing argument against mentioning the 1999 statement. --rtc (talk) 11:39, 30 August 2012 (UTC)
 * We could use it afterwards to put the history in perspective. But should not be using it first or primarily. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 06:49, 31 August 2012 (UTC)
 * I am fine with that as long as it is mentioned at all. --rtc (talk) 07:18, 31 August 2012 (UTC)
 * I'll work up some proposed wording that uses 2012 primarily but mentions 1999 historically so we can wrap this up.  12:39, 31 August 2012 (UTC)

AAP 2012 proposal
Proposed draft:


 * In a 2012 position statement, the American Academy of Pediatrics (AAP) stated that a systematic evaluation of the medical literature shows that the "preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure" and that the health benefits "are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns," but "are not great enough to recommend routine circumcision for all male newborns". The AAP takes the position that parents should make the final decision about circumcision, after appropriate information is gathered about the risks and benefits of the procedure.  The 2012 statement is a shift in their position from their 1999 statement (which was re-affirmed in 2005), and provides new language stating that the health benefits of the procedure outweigh the risks, in addition to the AAP's support for having the procedure covered by insurance.


 * The AAP's 2012 position statement was also endorsed by the American College of Obstetricians and Gynecologists.



Rtc, I use the word "shift" deliberately, as both the NY Times and the LA Times describe the policy update as a "shift." The WaPo article depicts the updated statement as a non-trivial change and highlights the differences between the "their old stance" and "the new one." I know you appear to be of the opinion that the 2012 is not a significant change from the old one, but the reliable sources we have (including the LA Times that you yourself brought to this discussion) describe the new policy as a "shift" or a change and so if we're going to include a mention of the 1999 policy here, we have to describe it as such because the reliable sources do. Feedback please. 14:05, 31 August 2012 (UTC)
 * How about replacing "and provides new" by "insofar as it provides new"? This restrictes the word "shift" to what has actually been changed. --rtc (talk) 15:16, 31 August 2012 (UTC)
 * Not my preference to use words like "heretofore", "insofar", "insomuch", "hereinafter", etc. But I like that we're in general agreement about the content and are tweaking the wording.  How about "in that" and simplify the wording to focus on the AAP position instead of the words in the policy statements:
 * The 2012 statement shows a shift in the AAP's position from their 1999 statement in that AAP says the health benefits of the procedure outweigh the risks, and that the AAP supports having the procedure covered by insurance.
 * Good?   15:36, 31 August 2012 (UTC)
 * Yes. --rtc (talk) 15:44, 31 August 2012 (UTC)
 * ✅ Applied (with tiny copyedit, I removed second, redundant occurrence of "that the AAP"). Good working with you on this, cheers...    15:51, 31 August 2012 (UTC)


 * Gentlemen: Your article remains out of neutral balance with the long paragraphs about the American position, scarcely a mention of Germany and others, not in detail as the American mini-essay. Marylibrary (talk) 22:11, 1 September 2012 (UTC)
 * Do you have sources you wish to use to balance the page? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 08:05, 2 September 2012 (UTC)