Talk:Phimosis/Archive 1

reference changes
Despite the good intentions and large amount of work, the new style conceals the actual references. A printed version of the page loses all the references. If a URL becomes broken, the reference is gone. Please don't use this format on articles with long reference lists. Thanks. alteripse 11:33, 22 March 2006 (UTC)


 * Then why was the page listed for reference cleanup? As it was, I hadn't even finished converting the links. It is entirely possible to adapt the previous format, including authors, what content is in the article, the publisher, using the   format. Jud e  (talk,contribs,email) 11:43, 22 March 2006 (UTC)

If you can convert it to a style that doesn't lose the actual references I am all for it. The tag was put there by someone else who hasn't been involved with the article and didn't follow through with the promised explanation on the talk page. Several different citation systems have been proposed around here over the last couple of years, and I don't have a strong preference as long as we use one that makes journal references fully legible to the reader, both on-screen and in print. Among the reasons: URL links decay with time, and we should not use a system that depends solely on those as we will slowly develop red links that cannot be restored easily. Also, most people who are especially interested in a topic like to check references quickly to see if it is a familiar or already checked source, so it should be possible to glance at the journal citation without clicking on the link and going to another website to see what it is. --


 * For example, with the first citation used in the article (http://www.emedicine.com/emerg/topic423.htm):




 * That reference assumes that the publisher of the work is eMedicine.com, and that the original publication date of the article was in 2004 (the only date reference that I could find on the page). As it stands, the reference in the current version (not mine) is followed by "Excellent Emedicine overview.", which does not appear to be WP:NPOV, and it doesn't give anything more to the reference, so it should probably be removed. Jud e (talk,contribs,email) 12:10, 22 March 2006 (UTC)


 * If you wantto remove the description, go ahead, but some carry more useful indicators to the reader of the content. This is not a print journal citation, so is not a good example of the handling of journal refs. alteripse 12:53, 22 March 2006 (UTC)


 * There is , which uses a similar format, that can be used on journal citations. The current reference style has a few problems: Reference [1] does not correspond to the reference numbered #1; references are provided as links, instead of endnotes, meaning that a reader either has to scroll to the bottom of the page to find out what the article is, or click on the link and read the article.


 * I'd also like to draw your attention to Bath School disaster, the current featured article, which has 34 references made in this format. Cape Horn, yesterday's featured article, has 45, again in this format. Finally, I wish that you had addressed your concerns and voiced your worries about this format on my talk page, or even by email, before reverting several hours of work. Jud e (talk,contribs,email) 13:28, 22 March 2006 (UTC)

I realized you were putting a lot of work into it, and assumed it would result in improvement until I looked at the new version this morning. I have not been paying attention to the various citation systems, but apparently there are advantages and disadvantages of each. It is just that for a medical or scientific article for which each sentence was disputed and negotiated, the references are important and it is important to quickly see what the reference is. If you look back at the history of this article, there was much argument and reversion of sources and references. It has been stable for the last year because I put far more than "several hours of work" into it, rewrote the whole thing and negotiated between both warring factions until we agreed on the sources and references. In other words, for this article even more than most, we must be able to see at a glance what the reference is to prevent sneaky POV insertions and vandalism. I checked your contributions and this seems to be the first article you have overhauled. You may want to explain to those interested before you do any other pages that your system obliterates the journal references from sight, eliminates them from the print version, and makes them wholly dependent on outside URL links. In my opinion these are fatal disadvantages and I would ask you not to implement it on articles that rely on heavy referencing of medical, scientific, or academic print sources. Sorry. alteripse 19:24, 22 March 2006 (UTC)


 * As I said before, there is Template:Cite journal explicitly for journal citations.


 * An example:




 * If desired, these references can even be followed with text. I've converted several other articles to this format, including Cannabis (drug), which was using and  . Jud e  (talk,contribs,email) 23:12, 22 March 2006 (UTC)

That looks fine, but that is not the format you used, is it? I just went back and looked at your last version and couldn't even match that reference you used as an example to one of the refs. Am I misunderstanding something or are you proposing another conversion to an entirely new format? alteripse 00:55, 23 March 2006 (UTC)


 * Sorry, I should explain: Basically, I initially built the references based on the instances of the link in the actual text, rather than on the external links at the end. As they were primarily hyperlinks, I used the Template:Cite web citation format. I hadn't realised that the majority of them were journal citations, otherwise I would've used Template:Cite journal instead, which is the example I gave above. Either way, both Cite web and Cite journal are merely the template used to format the link, Cite/Cite.php/ is the wrapper which converts it into 1 which links to the endnote. Jud e (talk,contribs,email) 06:12, 23 March 2006 (UTC)

Can we make the url link embedded in the PMID rather than the title of the paper? If you feel like reformatting a few like this, let's take a look at the results and then do the rest. alteripse 11:19, 23 March 2006 (UTC)


 * I don't know the acronym PMID. An example of that format User:Bookofjude/Phimosis for the first paragraph of the article. As the first link isn't a journal, merely a review, I've kept to the Cite web format, but I've used Cite journal on the two journal references. Jud e (talk,contribs,email) 12:36, 23 March 2006 (UTC)

"Postec"
Since 2003 there is "an innovative and exclusive topical association of  steroid betamethasone and hyaluronidase enzyme", made by Apsen Farma, which is said to be "safer and more efficacious than isolated topical steroid in the non surgical  treatment of phimosis in children and adults (90 % vs. 70%) due to the synergistic action of betamethasone and hyaluronidase enzyme".

I think it (Postec) should be somehow added to the "treatment" sections, but I don't know how to write it (my English is rather limited to write certain very technical texts).

Cuzandor 23:23, 10 May 2006 (UTC)

provide a link with more info and i'll see what i can do   alteripse 01:41, 11 May 2006 (UTC)


 * http://pharmalicensing.com/licensing/displicopp/2709 , but everything else is in portuguese. Cuzandor 17:26, 11 May 2006 (UTC)

Non-surgical circumcision?
There's a "High rates of success have been reported with several nonsurgical measures:" followed by some non-surgical thing then a preputioplasty and a circumcision. When did circumcision stopped being a surgery? Cuzandor 02:49, 17 June 2006 (UTC)

You are correct. I fixed the order. alteripse 11:08, 17 June 2006 (UTC)

Phimosis in history
Can that info be verified? And I think the supposed speculation on murderous behaviour being caused by phimosis to be a bit ridiculous. 199.126.137.209 07:51, 1 November 2006 (UTC)

Acquired Phimosis and Scar-Tissue from Over-stretching
I have to raise a concern at this article as I find the section on acquired phimosis pretty misleading. One of the principle causes of acquired phimosis relates to excessive stretching of the foreskin which causes scar tissue that makes the foreskin unretractable. This is a far far more common reason for acquired phimosis occuring than BXO or skin conditions, I don't have any figures but I do know that phimosis caused by skin conditions is incredibly rare. The article places "forceful foreskin retraction" at the end of the section and implies that skin conditions such as BXO are the principle causes.

The reason why I'm raising this issue is that I'm involved in sexual education and the misinformation on this issue is without doubt one of the largest contributing factors to incidences of phimosis. The amount of boys who reach puberty with some natural tightness of their foreskin and overstretch the skin at a young age causing irreversible damage to themselves is ridiculous. I would strongly advocate changing the wording of this section of the article. blankfrackis 21:29, 11 May 2007 (UTC)

"Intact" vs. "Uncircumcised"
Incorrect use of Language? Yes, there certainly is! I don't feel that the choice of words is an issue of political correctitude, but rather a question of accuracy. Using the term "uncircumcised" to describe an intact, natural, normal penis perpetuates the typically American, myopic misconception that a penis with its foreskin surgically amputated is natural or normal, when the exact opposite is true. "Uncircumcised" clearly implies to the reader that the surgically altered penis is medically normal. Would one call a man with both arms a non-amputee? In countries where genital mutilation is uncommon, or even illegal, a circumcised or "cut" penis is unquestionably viewed as abnormal and unnatural. I think it all depends on how one wishes to see himself.MrEguy 10:30, 15 November 2006 (UTC)

Sorry you are absolutely and completely wrong. Take the circ war elsewhere. alteripse 11:16, 15 November 2006 (UTC)


 * I've already responded at Talk:Penis. Can I respectfully request that this discussion continue there, rather than here and at umpteen other talk pages? Jakew 11:28, 15 November 2006 (UTC)
 * Fine. I just want it elsewhere. alteripse 11:33, 15 November 2006 (UTC)


 * I wasn't aware there was a "circumcision war" I guess people get overly touchy about this subject, however I think the first poster (MrEguy) is completely correct. The term should be intact rather than uncircumcised. An intact penis is the default state of a penis and referring to the default state with reference to a non-default state such as "uncircumcised", "undead", "unflying", etc., is bad English. —The preceding unsigned comment was added by 86.139.124.191 (talk) 20:52, 11 May 2007 (UTC).
 * The term uncircumcised is far more widely used than "intact" in cultures where circumcision is the norm, especially in medical contexts like this article. It is not bad English. To argue otherwise is to betray your profession of ignorance about circ wars, as well as your subordination of acurate linguistics to a social advocacy position. Take it elsewhere. alteripse 23:21, 11 May 2007 (UTC)


 * Sorry if I've walked into some adolescent point scoring contest here, but is it possible to have a civilised debate concerning something as rudimentary as the usage of a word without trying to satisfy your vanity through flimsy veiled insults and a freshly thumbed thesaurus? Much appreciated.


 * Now putting ridiculous (underline it) posturing aside, of course it's bad English, it may well be the more popular usage, but that doesn't change the fact that in the English language referring to the default state of an object with reference to a non-default state is undesirable. We do not call a car a "non-flying vehicle", or a male with two fully functioning legs a "non-disabled individual". These terms would only be permissable in a given context - in this case as you've just said, in a culture where circumcision is the norm - but given that circumcision is not the norm throughout the entire world and that the natural state of a penis is to have an intact foreskin, I see no reason to use the word uncircumcised. As for your comment about "betraying my profession of ignorance about circ wars" I have never heard of a "circumcision war". I am aware some rather defensive minded individuals feel rather strongly concerning circumcision, but to suggest that opinions on something as banal as the definition of a word could be driven by prejudices concerning something as bland as the issue of circumcision is laughable. blankfrackis 07:23, 11 May 2007 (UTC)


 * Every dictionary I've checked (including those from the US and UK) defines 'uncircumcised' as 'not circumcised'. None that I've checked define 'intact' as 'not circumcised'. Usage of the former term seems to be common in UK publications (eg NHS Direct Wales). Jakew 09:49, 12 May 2007 (UTC)

And no dictionary gives not circumcised as a common meaning of intact. I have no trouble discussing this with civility but that has rarely characterized any aspect of the circ war arguments in this article or any other. Your assertion about intact vs uncircumcised is simply wrong in terms of both semantic precision and clearness of meaning. Intact simply and literally means "untouched". Uncircumcised is more precise in the same way that circumcised is more precise than touched. My rejection of intact was also from experience that at wikipedia, advocacy of "intact" has nearly always been associated with extreme POV mongering, edit warring, and detrimental changes to articles. alteripse 14:07, 12 May 2007 (UTC)


 * I have no strong opinions about this issue (contrary to the irritated response I gave you several posts up). I made a contribution to the discussion and received a decidedly rude and needless response which irritated me greatly, hence my response. I would strongly urge you to be a little more respectful in your relations with other users rather than leaping at the opportunity to provide a diatribe whenever a point of view disagrees with your own as I can't imagine I'm the only one who's been irritated at such a response. As for the issue itself I have no complaints with leaving the definition used if, as JakeW says, the dictionary definitions are as they are. Blankfrackis 19:20, 14 May 2007 (UTC)

A minor quibble
This condition is not only suffered by intact men, some circumcised men suffer from it too.

The numbers are smaller, of course, but it is a matter of factual innaccuracy to claim that this condition has some form of exclusivity to the intact.


 * I do not mean to argue, but might I ask how that is possible? If the foreskin is removed in the process of circumcision (at least, I know it was when I was circumcised for this particular reason), how is it that a circumcised male could suffer from phimosis, when it involves the foreskin not completely folding back? —The preceding unsigned comment was added by 74.111.115.80 (talk) 02:38, 5 December 2006 (UTC).

http://www.channel4.com/health/microsites/E/embarrassing_illnesses/programme2_3.html 91.104.18.182 12:11, 16 June 2007 (UTC)

Blog in external links
I've once again removed the following from the external links, per WP:EL: "11. Links to blogs and personal web pages, except those written by a recognized authority."


 * e-Journal of a phimosis sufferer curing his condition via the Beauge Method.

Unless and until policy changes, please do not add this again. Jakew 12:51, 4 August 2007 (UTC)

positive?
Could phimosis be considered a positive thing, since its almost like a natural condom? Tehw1k1 09:37, 9 April 2007 (UTC)
 * So are congenital syphilis and cerebral palsy. Or perhaps I don't understand what you mean by "natural". As it says in the article non-retractability can be normal (i.e., not a bad thing) in infancy. alteripse 09:42, 9 April 2007 (UTC)
 * It might protect you from STDs if every erection hurts and you avoid having sex. alteripse 09:48, 9 April 2007 (UTC)

-yes, alteripse, it can indeed protect you from STDs and babies that way if its bad enough. It can get very painful and split etc It can also put women off. However, otherwise, no not really. It IceDragon64 23:56, 25 August 2007 (UTC)


 * No, for a start it doesn't act like a natural condom, ejaculate still exits the penis, the only difference is that the head of the penis is covered by skin. Secondly not being able to retract your foreskin would prohibit you from cleaning the area effectively (or at least it would make it more difficult). It's certainly not a positive condition, it's not unduly negative because people can live with it without any great problems, but it's certainly not positive.

diabetes as the cause of phimosis
It seems that diabetes can trigger phimosis, from googling, and from personal experience, can this be mentioned in the article?
 * Give us a link. alteripse 19:57, 5 June 2007 (UTC)

quote:"Adult phimosis (ie, pathologic or true phimosis) may occur secondary to poor hygiene or an underlying medical condition (eg, diabetes mellitus)."

from- http://www.emedicine.com/med/topic2873.htm

It's been a while now, so I went ahead and added

Phimosis may also sometimes be brought on my diabetes, due to high levels of sugar being present in the urine of some diabetics, which creates the right conditions for bacteria to breed, under the foreskin.

I'm not an expert so perhaps someone might like to edit it but it seems to me that there should be some reference on the main page to diabetes. —Preceding unsigned comment added by 88.105.134.241 (talk) 07:59, 29 October 2007 (UTC)

Picture "Relative phimosis in adult"
Someone keeps reverting this picture. It's not my picture but I think it should stay here.

Most relative phimosis looks like the first picture, not the second picture. I know, because I had a relative phimosis fixed by preputialplasty some years ago. And I wish I'd had it fixed sooner.

It's important to show what the typical case looks like, not an extreme case.

If people come to this page thinking they might have phimosis, only see the really extreme case, and think "that doesn't look like me", and so don't get it fixed -- then that's a really bad thing WP has done for them.

Much better people go on thinking they might have relative phimosis, and go straight to their doctor to find out for sure - and get it fixed.

I don't know about circumcision, but preputialplasty is a very simple operation, and post-op I didn't even use the painkillers they issued me with, after the anaesthetic wore off -- the effects were that minor. (I believe circumcision can be a bit more painful; but that's just from what I've read). -- Jheald 10:21, 16 July 2007 (UTC)
 * Thank you. 206.248.128.31 (talk) 16:05, 13 August 2008 (UTC)

Gentle Foreskin Stretcher for Tight Foreskin | Phimosis
I am very concerned that this section on Phimosis is out of date and does not reflect what is actually happening in the real world.

The references to a tool to help stretch the foreskin are inaccurate.

The GFS Gentle Foreskin Stretcher tool and webiste is missing. Third party verifiable sources show that at least 200,000 people have obtained assitance form the GFS.platigo.com webiste in recent times. The GFS Gentle Foreskin Stretcher device is a balloon based device that allows users to gently stretch their forskin based on well accepted skin stretching principles.

I would like to know why the so called source of truth "wikipedia" does not have the referrence to the GFS. Failure to refer to the GFS from Platigo Corporation fails to provide the facts and the truth to the user of this site.

Perhaps someone can answer this question as to why the leading website on this topic of gentle foreksin stretching for tight foreskin or phimosis is not referred to at all in "wikipedia"?

Regards Cindy Cindy69 (talk) 10:31, 17 August 2008 (UTC)


 * Simple answer - there's no reference to GFS because nobody has added a reference to it yet. If you know of a piece of information which you think would improve the article then you should add it. Blankfrackis (talk) 00:41, 10 December 2008 (UTC)

reversion of claim
To claim that excessive retraction is the "most common" cause of acquired phimosis requires a reference to evidence. The reference supported no such statement. No more dishonestly referenced additions. alteripse 23:28, 11 May 2007 (UTC)


 * As stated above, I do not have figures for the statement, I'm basing it on my own personal knowledge. The reference was for the other information contained in the paragraph, however if there is a problem with the "most common" phrase (which I know from my own experience to be true) removing the phrase or rewording it is surely the answer rather than deleting the entire paragraph. In this instance I made a judgement call that including information I know to be true but cannot reference was better than leaving it out.


 * Regardless, the issue I raised at the top of this discussion page still stands, BXO is not the primary cause of acquired phimosis yet the article presents it as though this is the case - presumably because a great deal of confusion exists in the medical community such that all issues of scarring are classed as BXO because of the similar appearance of white nodules on the skin. However BXO has to be identified using a biopsy, the vast majority of cases which are identified as BXO are simply common scarring. I would strongly suggest either replacing the section I put into the article (changing the "most common" phrase if you must) or adding a similar section using different wording. The status quo is completely unacceptable, the relevance of BXO to phimosis is vastly exaggerated. blankfrackis 06:53, 11 May 2007 (UTC)
 * Thanks for recognizing exactly what the issue is. You might be correct about the relative frequency of BXO as a cause of phimosis. If you can offer an article from the literature that BXO is an uncommon cause, then let's change it. If you can offer a paper that provides evidence that unnecessary childhood retraction is the most common cause of phimosis, I agree that it should be changed as well. alteripse 14:11, 12 May 2007 (UTC)
 * I think you are right about that. I sometimes browse the internet looking for people with phimosis problems and have yet to come across someone whose phimosis was caused by BXO.  That is not to say it doesn't exist .  It does and it does cause phimosis.  It is just not as prevalent as phimosis caused by scarring through either mechanical manipulation (due to certain masturbation techniques) or the after effects of some kind of bacteria-induced inflammation. Tremello22 (talk) 12:09, 11 March 2009 (UTC)

Another dubious revert
Tremello22 has reverted my edits to the "Natural development of the foreskin" section. Let's examine the effect of this revert:

This:
 * "The American Academy of Pediatrics and the Canadian Pediatric Society state that no attempt should be made to retract the foreskin."

Has been changed to this:
 * "Now it is understood that no attempt should be made to retract the foreskin."

"Now it is understood that" is vague and imprecise. Understood by whom? Neither of the sources say anything about 'understanding'. So why change a statement from a precise, accurate sentence to a vague, sweeping claim that is not supported by the sources?

This:
 * "Age is reportedly a factor in non-retractability: according to Huntley et al. the foreskin is reportedly retractable in approximately 50% of cases at 1 year of age, 90% by 3 years of age, and 1% by age 17. These authors argue that, unless scarring or other abnormality is present, non-retractibility may "be considered normal for males up to and including adolescence.""

Has been changed to this:
 * "The non-retractile foreskin is normal in boys and no cause for concern."

Firstly, no source is provided, and secondly, it is obviously a point of view, but it is unattributed. Presumably, Hill is intended to act as a source for it, because exactly the same sentence appears in there, copied verbatim.

And:
 * "Full retractability of the foreskin may not be achieved until late childhood or early adulthood."

I must admit that I previously made the error of assuming that the cited source substantiates the claim. Having now checked, I find that it does not. Why change detailed, precise information from a good-quality secondary source to a vague statement that isn't supported by the cited source?

Finally, this:
 * "Cantu states that acquired phimosis may be caused by forceful retraction, due to the formation of scar tissue."

Has been changed to this:


 * "There is some suspicion that forceful retraction may actually contribute to pathological phimosis at an older age."

If we examine the cited source, we see that Cantu states that: "Repetitive forceful retraction of a congenital phimosis by parents attempting to clean the underlying glans may lead to an acquired phimosis because of scar formation and a resultant fibrotic ring of tissue at the prepuce." So why revert to wording that is less faithful to the original source?

Jakew (talk) 20:23, 12 March 2009 (UTC)
 * The edits quote obviously violate WP:V and WP:NPOV. Does anyone imagine that wording like "Now it is understood" complies with policy? That changing accurate statistics about phimosis with the unsourced original research "The non-retractile foreskin is normal in boys and no cause for concern." is actually acceptable? Can anyone think that changing the accurate, WP:V compliant sentence "Cantu states that acquired phimosis may be caused by forceful retraction, due to the formation of scar tissue." to the weasel worded and less accurate "There is some suspicion that forceful retraction may actually contribute to pathological phimosis at an older age." benefits the article in any way? Jayjg (talk) 00:22, 13 March 2009 (UTC)

Thoughts
Maybe I should clarify my feelings. They are obviously not being heard. More likely they are being ignored deliberately. This is an article for the general reader. At the moment it is more like a medical journal article. Naming authors in the lead isn't helpful at all. Using the lead to debate the different terminology used when they all really mean the same thing is also a big mistake. As for taking things seriously - talk about hypocritical. how about you take my opinion seriously. Tremello22 (talk) 09:51, 13 March 2009 (UTC)


 * I believe we only name one author (Rickwood) in the lead. I agree that this isn't ideal. The alternatives are a) to remove reference to Rickwood's claim (it seems a good summary of much of the "Natural development of the foreskin" section), b) to rephrase as "it has been suggested that" (rather WP:WEASELish), or c) to assert that phimosis is over-diagnosed (or in effect to assert that large numbers of professionals are incompetent; this would violate WP:NPOV). Naming Rickwood seems to be the best of the available options.
 * I don't understand your complaint about discussing terminology in the lead, since the version which you prefer includes something similar: "Some have suggested that physiological infantile phimosis be referred to as developmental nonretractility of the foreskin to more clearly distinguish this normal stage of development from pathological forms of phimosis".
 * I also don't know how to respond to your objection that it is "like a medical journal article". I don't understand what qualities cause it to seem this way to you, and I don't understand why those should seem to be a bad thing. I've read some excellent articles in medical journals that are clear, precise, and highly accessible. I've read others that are incomprehensible. I'm certainly in favour of making articles accessible, but I see no need to 'dumb down' information on the assumption that the reader is an idiot, and I certainly see no need to violate WP:NPOV or WP:V. Perhaps it would be wise to suggest how material might be made more accessible while working within the framework of applicable policies. Jakew (talk) 12:52, 13 March 2009 (UTC)


 * In the neonatal period, it is rare for the foreskin to be retractable; "non-retractability can be considered normal for males up to and including adolescence."[1] Some authors use the terms "physiologic" and "pathologic" to distinguish between these types of phimosis.
 * Is it me or does this not even make any sense. You have mentioned only 1 type of phimosis (non-pathological phimosis - which generally isn't even called phimosis) and then you use the plural "these".  You have also not explained why there is often confusion around the term. Tremello22 (talk) 18:26, 14 March 2009 (UTC)


 * You're absolutely right. The problem can be solved by exchanging the two sentences beginning "Rickwood, as well..." and "Some authors use...".  I'll make the change. Jakew (talk) 19:04, 14 March 2009 (UTC)

Miscellaneous comments
I'm starting by reading the article, and posting comments here; then I'll read the talk page. Sorry if that's not ideal, but I have to start somewhere, and if I read the article I'm going to want to comment on what I see. That's as far as I've gotten for now. ☺ Coppertwig (talk) 17:27, 14 March 2009 (UTC)
 * "non-retractibility may be regarded as normal" sounds prescriptive and therefore needs to be changed per NPOV. How about "The authors of a study of referrals involving the foreskin state that non-retractibility can be considered normal for young males including adolescents."
 * "provides a protective cocoon for the delicate developing glans": this needs to be changed or put in quotation marks to avoid potential copyvio (and/or plagiarism) in my opinion. Copyvio is not just about number of words, but the amount of creativity expressed in those words.  Wikipedia articles should be new creative works.  Sources can be used as sources of ideas, not as sources of sentences or phrases (except technical phrases that cannot be accurately expressed in different words).  The early part of the same sentence is almost identical to that in the source and should be changed too; avoiding copyvio generally means writing new sentences, not taking a sentence from a source and making a few changes such as substituting synonyms, unless quotation marks are used.
 * "The foreskin is designed to be non-retractable in infancy and early childhood, when the developing glans needs complete protection from the mechanical trauma of the nappy and clothing, and the chemical trauma of ammoniacal urine": sounds as if whoever designed the penis knew we were going to be using nappies and clothing. I don't think this is a universally accepted POV.


 * In regards your first point. Can you clarify what you are getting at, about it being prescriptive and non neutral?  I am not aware of any sources that claim non-retractibility isn't normal.  If it is the established view and not a minority view, then there isn't a problem. Tremello22 (talk) 18:20, 14 March 2009 (UTC)
 * No, Coppertwig is correct. The fact that studies such as Rickwood's ""Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?" exist is itself evidence of multiple points of view.  Rickwood is essentially arguing that other physicians regard (incorrectly, in Rickwood's view) non-retractibility as problematic, and hence diagnose (again, incorrectly, in Rickwood's view) phimosis and propose circumcision as treatment. Jakew (talk) 18:57, 14 March 2009 (UTC)


 * Yes but Rickwood isn't the only one to hold that view. It is the established view Jake.  Can you cite studies which hold a different view? Tremello22 (talk) 19:12, 14 March 2009 (UTC)


 * Yes, I am aware that other studies exist that express a similar view to that of Rickwood. That's why I referred to "studies such as Rickwood's".  I'm not sure why you think it is "the established view".  It's fairly clear that there are at least two viewpoints, but I don't see any way to determine which is an "established" view.
 * In answer to your request, here are some sources which appear not to agree that a non-retractable foreskin is "normal for males up to and including adolescence":
 * "the foreskin should become retractable in a few years [after birth]" -- Stephan Sanders, Madeleine Debuse. Endocrine and Reproductive Systems: Endocrine and Reproductive Systems. Elsevier, 2003. p163.
 * "[t]he foreskin should be fully retractable by puberty." -- Philip L. Glick, Michael S. Irish, Michael Caty, Richard Pearl. Pediatric surgery secrets. Elsevier, 2000. p206.
 * "Some adhesions are normal in males <3 years. However, the foreskin should be fully retractable in uncircumcised males aged 3-5 years." -- Jason K. Wilbur, Mark Graber. Family Medicine Examination and Board Review: Family Practice & Board Review, Second Edition. McGraw Hill 2009. p34.
 * Jakew (talk) 20:02, 14 March 2009 (UTC)


 * Good points, Coppertwig. Instead of "The authors of a study of referrals involving the foreskin...", can I suggest "Huntley et al.."? Jakew (talk) 18:57, 14 March 2009 (UTC)


 * Wouldn't it be better to establish the majority viewpoint. Instead of naming authors. Can you prove this is a contentious issue Jake?  You are implying that Rickwood's view is a radical view.  Clearly there are others who agree with Rickwood.  I am asking you to state your sources which disagree with Rickwood and others. Find me an article which states that an infant should be circumcised if his foreskin doesn't retract. Tremello22 (talk) 19:58, 14 March 2009 (UTC)
 * Oh, wow, I wasn't expecting this much attention; I haven't even finished reading the article yet, let alone the talk page. By the way, I noticed this page because Jakew's talk page is on my watchlist and there was some activity there a couple of days ago and this page was mentioned.
 * Tremello, the sentence uses the verb "may"; this seems to me to be telling readers what they are allowed to do. Wikipedia articles are supposed to provide facts, not tell readers what they may or may not do. "I am not aware of any sources that claim non-retractibility isn't normal." I think Jakew has now listed some sources which express a viewpoint essentially similar to that. "If it is the established view and not a minority view, then there isn't a problem." See WP:NPOV. If there is a majority view and also a significant minority view, then the article must present both (giving more weight to the majority view).  For many things there is no one established view, or there may be views which are established to varying degrees. Wikipedia is not supposed to figure out which view seems to be true or the most well-established and present only that.
 * Tremello, you said "Wouldn't it be better to establish the majority viewpoint. Instead of naming authors." How do we know there is one majority viewpoint? Couldn't there be, for example, three viewpoints each with about an equal degree of acceptance?  We need to describe the viewpoints, per NPOV. You said "Can you prove this is a contentious issue Jake?" When there is more than one significant viewpoint, we need to describe them, regardless of whether the people with those viewpoints are contending or just calmly expressing opinions.
 * Tremello, you said to Jakew, "Find me an article which states that an infant should be circumcised if his foreskin doesn't retract." It's not clear to me why you're asking for that, because I don't think Jakew has proposed that the article make that statement.
 * Jakew, re "Huntley et al.": sure: why didn't I think of that? You've done stuff like this before, haven't you? ☺ Coppertwig (talk) 00:09, 15 March 2009 (UTC)

☺ Coppertwig (talk) 14:23, 15 March 2009 (UTC)
 * "and are encouraged to masturbate in the normal fashion": Oh. Um, this is a little embarassing. I wasn't aware that there was one specific "normal fashion" in which to masturbate.  :-)  Seriously, see WP:ASF.
 * "Instead, masturbate in the normal fashion. Do this by lightly gripping the penis around the shaft and moving the skin up and down, in order to mimic the action of sexual intercourse more closely." If that's "the" "normal" method, how come people need instructions? Seriously, Wikipedia is supposed to state facts, not tell readers what to do. ("I have to do it this way! Wikipedia told me to!" Hey...) It might be OK to have this as a direct or indirect quote.
 * "In diabetics, levels of glucose in the urine are higher than normal. This could increase the risk of a bacterial infection and consequently phimosis." No source is given for this. It looks like it may be a WP:SYN violation. How about just deleting it?
 * Paraphimosis image: I don't think it's usual (and I'm guessing is against MOS) to give a link to an image like that. How about presenting the image as an illustration to the article in the normal way?  "The proximal penis is flaccid." Is this supposed to be true of that image in particular?  It seems to be saying it about all cases of paraphimosis.
 * "It has the advantage of only extremely limited pain and a very short time of healing relative to the rather more traumatic circumcision, together with no cosmetic effects." Sounds somewhat exaggerated and difficult to believe as such, especially "extremely", "very" and "no". I changed it to "It has the advantage of only limited pain and a short time of healing relative to circumcision, and avoids cosmetic effects."
 * "They vary widely because of the difficulties of distinguishing physiological phimosis (developmental nonretractility) from pathological phimosis, definitional differences, ascertainment problems, and the multiple additional influences on post-neonatal circumcision rates in cultures where most newborn males are circumcised." This sentence needs help. I don't know where to start.

Lead
Tremello22 reverted my rewrite of the lead in this edit, citing unspecified "major POV issues". Please explain, and let's discuss. Jakew (talk) 10:37, 12 March 2009 (UTC)

Too many primary sources. Too much space taken up on various diseases. Not a big enough distinction is made between pathological phimosis and physiological phimosis. Too many: such and such said this, such and such said that. Just very confusing for the general reader. It does not improve on how it stands now. Tremello22 (talk) 18:49, 12 March 2009 (UTC)


 * Hmm. Well, let's examine these issues:
 * First, you say that there are too many primary sources. If we look at the relevant version, we see that a total of nine sources are cited.  Of these, refs 2, 5, 6, and 9 are review articles, and thus secondary sources almost by definition.  Of the remaining five, 1, 3, and 4 act as secondary sources as they are used in the article.  This leaves 7 and 8, which are primary sources, but it is unclear why two constitute "too many".
 * Second, you say that too much space is dedicated to 'various diseases'. It is unclear whether you mean diseases that may cause phimosis, or diseases that may be caused by phimosis.  The former consumes 40 words (25% of the total 160 words), and the latter 12 words (7.5%).  These roughly correspond to the sections "Pathological/Acquired phimosis" and "Potential complications of acquired phimosis", respectively. Of the 1558 words in the body of the article, 393 (25%) are dedicated to the former, and 109 (7%) are dedicated to the latter.  So in fact, rather than dedicating too much space, the proportions are almost exactly the same as in the body of the article.
 * Third, you say that an insufficient distinction is made between pathological and physiological phimosis. This is quite an extraordinary assertion.  Most of the second paragraph &mdash; 51 words, or 32% of the lead &mdash; is given over to discussing the distinction, which in proportional terms is somewhat more than the 358 words (23%) making up the "Natural development of the foreskin" section.
 * Your other objections are too imprecise to be addressed in their present form.


 * For comparison, let's examine the current version of the lead, which you favour:


 * Phimosis is a condition where the male foreskin cannot be fully retracted from the head of the penis. The word derives from the Greek phimos (φῑμός, "muzzle"). So far, so good.


 * As most boys are born with a non-retracting foreskin, the term is confusing because it denotes both a normal stage of development, and a pathological condition (i.e. a condition that causes problems for a person). This statement is unverifiable due to the absence of a source.


 * This confusion is particularly pronounced in regard to infants. Another statement that fails WP:V.


 * Conflicting incidence reports and widely varying post-neonatal circumcision rates reflect looseness in the diagnostic criteria.[1][2] As stated, this sentence is almost incomprehensible. It is at least sourced, though.


 * Phimosis has become a topic of contention in circumcision debates.[3] Here there is a source, but it fails to substantiate the claim attributed to it.


 * It is normal for a baby's foreskin not to retract. We've already said "As most boys are born with a non-retracting foreskin", so this sentence is unnecessary. It's also unsourced.


 * The time it becomes retractable varies. Unsourced.


 * Some foreskins do not become retractable until the age of 18. Still unsourced.


 * Some have suggested that physiological infantile phimosis be referred to as developmental nonretractility of the foreskin to more clearly distinguish this normal stage of development from pathological forms of phimosis.[4] It is unclear who these "some" are. Certainly they are not the authors of the cited source, for two reasons. First, they do not use the term "developmental nonretractility". Second, though they do use the similar term "developmental unretractability", they do not "suggest" the term, nor even do they call attention to their use of it. (Rickwood 1989, however, briefly discuss the term "non-retractile foreskin"; this was cited in my version.)


 * Different management is appropriate. In other words, there are different degrees of phimosis, and treatment may vary on the degree of phimosis. No sources are cited for either statement.


 * Causes of pathological phimosis include unusual masturbation habits, balanitis xerotica obliterans and other types of chronic inflammation, repeated catheterization, and forceful foreskin retraction. Treatments depend on the cause of the condition. Note the continuing absence of sources.


 * Women can suffer from clitoral phimosis.[5] There is, at least, a source here.


 * To sum up, the current version contains 11 sentences that fail verifiability, either due to the absence of a source, or because the cited source fails to substantiate the claim attributed to it. It contains a significant amount of redundancy, and gives undue weight to physiologic phimosis (101 of the 212 words, or 48%).  In contrast, my version is fully sourced, and gives an appropriate amount of weight to sub-topics in proportion to the rest of the article.  Your claim that "It does not improve on how it stands now" is, frankly, extraordinary.  Jakew (talk) 19:59, 12 March 2009 (UTC)


 * A bit pedantic here. If you look at a lot of featured articles, they do not have references in the lead.  I fail to see this as a problem.  If you asked the general reader which was most imformative, he would say my version.  If you asked which was the most confusing, he would say your version.  Everything said in the lead is verified within the article. Tremello22 (talk) 22:20, 12 March 2009 (UTC)
 * The lead is no exception to Wikipedia's sourcing requirements; please see WP:LEADCITE. If you think of any objections more objective than your own personal assessment of what is "confusing", please raise them.  In the meantime, I'm going to revert, for reasons discussed above. Jakew (talk) 22:28, 12 March 2009 (UTC)


 * I have reverted your edit. I agree with some of what you have suggested, not with others.  Not all sentences require sources.  You are being totally hypocritical. One rule for you , another for everyone else it seems. Tremello22 (talk) 23:19, 12 March 2009 (UTC)


 * Jakew, you said that the statement about phimosis being confusing was "unverifiable". I don't think there's any way to know that it's unverifiable.  Maybe you mean "unverified".  I did a search in Google scholar for "phimosis confusing" and while I didn't exactly verify that statement, I did find some somewhat related sources:
 * Google snippet "In neonates natural adhesion between the inner foreskin and the glans causes physiological phimosis that is often confused with pathological phimosis." Ashfield et al. 2009? Treatment of Phimosis With Topical Steroids in 194 Children
 * "The true definition of phimosis has been confused in the literature." Santos et al. (sounds like a POV)
 * "n neonates natural adhesion between the inner foreskin and the glans causes physiological phimosis that is often confused with pathological phimosis." Nzayisenga et al. 2005
 * Google snippet "difficult to retract the foreskin. This physiologic phimosis is often confused with a true phimosis. It is reported that as many" Hartke et al. 2006
 * The above sources say "confused", which is different from "confusing", I think.
 * "It is normal for a baby's foreskin not to retract. " is an opinion. See WP:ASF. It's also confusing: it could be seen as implying that it's abnormal for a baby's foreskin to retract, and have parents rushing to their doctor looking for surgical intervention because their baby seems to have an abnormal foreskin that retracts.
 * "The time it becomes retractable varies." Jakew, you said of this "Unsourced." Actually, I would consider this to be a reasonable summary of that source that says 50% at age something-or-other and only 1% (99%?) in adolescence or whatever. Therefore verifable. Though probably redundant.
 * "Different management is appropriate." This is also an opinion and is prescriptive.
 * "Women can suffer from clitoral phimosis." I wasn't able to find where the source asserts this. It quotes someone who asserts it.  This verifies that someone has that view; we can report that, but we can't assert it as fact unless the actual statement is verifiable.
 * Tremello said, "I have reverted your edit. I agree with some of what you have suggested, not with others." In such situations I urge you to revert only the parts you disagree with.
 * I agree with many of Jakew's points and support the newer version of the lead. I didn't notice any parts of the version Tremello was reverting to that I preferred, though it's possible that there are some.
 * Currently, the article doesn't mention female phimosis at all. Perhaps it should. Though perhaps not just in the lead and nowhere else.
 * Tremello, my understanding is that anything that is challenged or likely to be challenged requires a citation (see that WP:LEADCITE link Jakew gave). If Jakew is challenging these statements, then they require citations. I think that this is a controversial topic and therefore having citations for everything is good, even in the lead. ☺ Coppertwig (talk) 19:14, 15 March 2009 (UTC)

Image
I support this edit changing to a different image. Jakew may have inadvertently reverted this edit while reverting some other "silliness". This image seems to me to illustrate phimosis much more clearly. ☺ Coppertwig (talk) 10:43, 16 March 2009 (UTC)
 * I agree, it's a better image. However, I fear you're mistaken: my revert did not affect the image, but merely reversed an "addition" to the first paragraph of the lead. Jakew (talk) 11:57, 16 March 2009 (UTC)
 * You're right: I was confused. Sorry about that. ☺ Coppertwig (talk) 14:07, 16 March 2009 (UTC)

Recent changes
There are a number of problems with recent changes:


 * Addition of: "As most boys are born with a non-retracting foreskin, the term is confusing because it denotes both a normal stage of development, and a pathological condition (i.e. a condition that causes problems for a person)." -- this is problematic for several reasons. First, the construct "As most boys are born with..." implies that this has already been established.  It hasn't.  Second, the sentence is nonsensical: many infants scream when they're hungry, and many adults scream when in pain, but this does not mean that the word "scream" is confusing.  Third, it is absolutely ludicrous to state that the term is confusing, as though this were a universal truth.  It may be the case that some authors find the term confusing, but it is questionable whether this fact is notable enough to belong in the lead.
 * Deletion of: "In the neonatal period, it is rare for the foreskin to be retractable; "non-retractability can be considered normal for males up to and including adolescence."" -- the reasoning for this is not apparent.
 * " "Non-retractability can be considered normal for males up until adolescence."" -- this quote is now presented without any context.
 * Addition of "The AAP recommends not forcing the foreskin back uring infancy, but allowing it to develop naturally." -- this is original research because the source is not "directly related" to the subject of the article. In fact, the source presents this information in a page that doesn't even mention phimosis.
 * "Phimosis is a risk factor for" has been changed to "Pathological phimosis is a risk factor for..." -- I don't believe that this is supported by the sources, which refer simply to "phimosis".

Jakew (talk) 23:49, 16 March 2009 (UTC)


 * Jake, as Coppertwig pointed to above and in the sources I provided, there is confusion over the term. Tremello22 (talk) 23:54, 16 March 2009 (UTC)


 * Tremello, even if the sources made the precise argument that the term is "confusing", it would still not require us to assert it as fact (as opposed to attributing the opinion), and it would still not require that the material should be in the lead. However, neither of the sources you provided support the claim that the term is confusing.
 * Cantu states that "The true definition of phimosis has been confused in the literature." (emph added).
 * Dewan states that "Confusion about the definition of true phimosis is highlighted by the study of Griffiths and Frank, who found that of 128 boys with a medical reason for referral to a paediatric urologist for circumcision, only 30 had true phimosis (although they did not give an exacting definition). They suggested that ballooning and non-retractability is often over interpreted. In some cases, the referring practitioner may have used the term `phimosis' to facilitate referral, thus further confusing the debate on the appropriate management of phimosis."
 * Neither of these sources say that the term "phimosis" is confusing. They state, instead, that confusion has arisen over what is meant by it (though, interestingly, neither source actually seems to offer any evidence of actual confusion). Jakew (talk) 00:12, 17 March 2009 (UTC)


 * Just to go over your other points.
 * Given that there is confusion over the non-retractability of the foreskin. And that some mistake that for true phimosis.  Also the fact that foreceful retraction often leads to true phimosis.  I fail to see your objection.
 * The urinary retention ref does mention true pathological phimsosis (as opposed to developmental non-retractability). Penile Cancer is not common in infancy, it is usually restricted to old men - so it isn't going to be caused by developmental non-retractability, is it? Tremello22 (talk) 00:06, 17 March 2009 (UTC)
 * Tremello22, if you're trying to use my comment to justify the sentence, you may be confusing "confused" with "confusing".
 * If there is confusion, it's not necessarily because the terms are confusing; it could be because some people are confused. If you want the article to state that the term is confusing, try finding a source that states that the term is confusing.
 * If penile cancer is "not common" in infancy, perhaps it occasionally occurs in infancy – or in adolescence, when 1% of males still have developmental non-retractility. Do you know whether there are any old men with developmental retractility?  I don't know that.  Do you know whether phimosis at a younger age is a risk factor for cancer that appears at a later time?  I don't know that.  So I don't follow your OR. ☺ Coppertwig (talk) 00:14, 17 March 2009 (UTC)


 * I've reverted for now. I will find sources and amend certain things.  Tremello22 (talk) 00:26, 17 March 2009 (UTC)
 * Thank you. I'm sorry if I sounded abrupt. ☺ Coppertwig (talk) 00:32, 17 March 2009 (UTC)
 * Wait – I thought you meant you had reverted your edit. You reverted Jakew's revert of your edit.  If that's what you intended to do: I would prefer that you follow WP:BRD. Nevertheless, I'm still sorry if I sounded abrupt. ☺ Coppertwig (talk) 00:36, 17 March 2009 (UTC)
 * Tremello, could you please explain your revert of my edit?
 * You've done the following:
 * Restored: "As most boys are born with a non-retracting foreskin, the term can be confusing because it denotes both a normal stage of development, and a pathological condition (i.e. a condition that causes problems for a person)." -- both Coppertwig and I have explained that "confusing" is problematic. I have also pointed to other problems with this sentence above.
 * Restored: "The AAP state that "foreskin retraction should never be forced". " -- as I've pointed out above, this is OR.
 * Restored (without context): ""Non-retractability can be considered normal for males up until adolescence." "
 * Jakew (talk) 00:42, 17 March 2009 (UTC)
 * Tremello, as Jake has noted immediately above, there are significant issues with your modifications, particularly around WP:NOR and WP:V. Coppertwig has also noted these issues, particularly around terms such as "confusing". I'm going to restore the version of the article that complies with the content policies. Please ensure that any future proposed changes take into account WP:NOR, WP:V, and the comments of editors on this talk page. Thanks. Jayjg (talk) 00:48, 17 March 2009 (UTC)


 * I changed it to "can be" confusing. which is what the source says.
 * As I pointed out. It is not OR.
 * Why is it without context? Tremello22 (talk) 00:51, 17 March 2009 (UTC)


 * Confusion about the definition of true phimosis is highlighted by the study of Griffiths and Frank, who found that of 128 boys with a medical reason for referral to a paediatric urologist for circumcision, only 30 had true phimosis (although they did not give an exacting definition). They suggested that ballooning and non-retractability is often over interpreted. In some cases, the referring practitioner may have used the term `phimosis' to facilitate referral, thus further confusing the debate on the appropriate management of phimosis.
 * The true definition of phimosis has been confused in the literature. 
 * That is what the sources say. Tremello22 (talk) 00:58, 17 March 2009 (UTC)


 * Jake, you say : Neither of these sources say that the term "phimosis" is confusing. They state, instead, that confusion has arisen over what is meant by it
 * Surely that is the same thing. Tremello22 (talk) 01:25, 17 March 2009 (UTC)
 * Tremllo22, three editors have complained about the same issues with your edits. They are quite obvious (and by the way, cirp is an unreliable advocacy website, so please don't bother quoting it). Rather than trying to edit-war this non-compliant material into the lede, please gain consensus in talk for the change. Jayjg (talk) 01:32, 17 March 2009 (UTC)
 * Tremello, the sources mention confusion, but they do not state that it is the terms themselves that cause it. ☺ Coppertwig (talk) 01:55, 17 March 2009 (UTC)
 * OK then maybe we can word it differently (I used to be tremello) Outliner09 (talk) 08:40, 17 March 2009 (UTC)

Describing causes and complications of patholoical phimosis
Current version:

''Lichen sclerosus et atrophicus (thought to be the same condition as balanitis xerotica obliterans), is regarded as a common (or even the main ) cause of phimosis. Other causes may include balanitis and scarring due to forcible retraction of the foreskin. Complications of phimosis may include urinary retention and carcinoma of the penis. Common treatments include steroid creams and circumcision. ''

Should we be saying which is the most common on the basis of 1 primary source? Especially in the lead?

Also, 'complications of phimosis' is quite definite-sounding. The section title is actually 'potential complications'. Say a boy of 10 came to this article, I think it is a bit irresponsible to make it seem that phimosis causes cancer. He would be a little scared, don't you think? When all he has is developmental non-retractability - a non-pathological condition.

Is carcinoma of the penis caused by phimosis? I thought it was just a risk factor? No attempt is made to say how common these risk factors are either. —Preceding unsigned comment added by Tremello22 (talk • contribs) 19:53, 14 March 2009
 * I know! I know! (Waves hand in air to attract attention of teacher.) "Bolla et al. regard it as the most common..." ☺ Coppertwig (talk) 00:28, 15 March 2009 (UTC)
 * Wait: on re-reading, I see that it doesn't state that it's the main cause; it says "or even the main" with a footnote, implying that there's at least that one study in the footnote regarding it as the main cause. So I think that's OK, and is nicely concise.
 * I agree that cancer should not be identified by Wikipedia as a "complication" but only as a "risk factor"; unless it's practically always called a "complication" in the sources. ☺ Coppertwig (talk) 14:28, 15 March 2009 (UTC)
 * I've changed the article to read "Phimosis is a risk factor for..." Jakew (talk) 19:17, 15 March 2009 (UTC)
 * In regards to BXO being the most common cause. Is this the only source which states that?  Are there other sources which have a different view? That was my only concern - relying on one primary source for quite an important statement.  Tremello22 (talk) 23:12, 16 March 2009 (UTC)
 * It is not the only source. Here are some extracts, obtained via Google Scholar, from some other sources that make similar claims:
 * "Several publications have reported that LS [ie., lichen sclerosus] is a common lesion in boys with phimosis. As a matter of fact, it appears to be the main cause of phimosis (1,8-10)" Drut RM, Gómez MA, Drut R, Lojo MM. Human papillomavirus is present in some cases of childhood penile lichen sclerosus: an in situ hybridization and SP-PCR study. Pediatr Dermatol. 1998 Mar-Apr;15(2):85-90.
 * "It is the most common cause of acquired phimosis in boys (47)" Funaro D. Lichen sclerosus: a review and practical approach. Dermatol Ther. 2004;17(1):28-37.
 * "...it occurs also in males, where it is the most frequent cause of acquired phimosis." Lukowsky A, Muche JM, Sterry W, Audring H. Detection of expanded T cell clones in skin biopsy samples of patients with lichen sclerosus et atrophicus by T cell receptor-gamma polymerase chain reaction assays. J Invest Dermatol. 2000 Aug;115(2):254-9
 * Jakew (talk) 16:52, 17 March 2009 (UTC)

Beaugé
"stop the exacerbating masturbation techniques": is this in one of the Beaugé sources? I read most of one of them and didn't see it. In fact he recommends alternating between the older and newer techniques while becoming accustomed to the newer, and my impression was that it was the newer technique that helped stretch the foreskin, not the older technique that needed to be stopped for any reason. The Beaugé material is pretty much repeated twice in the article. I reworded one of them to be more true to the source but it would be probably be better to just describe it once. ☺ Coppertwig (talk) 00:42, 17 March 2009 (UTC)
 * OK, I read the other Beaugé source and it isn't there either. This page said, "Other causes may include: scarring caused by forcible retraction of the foreskin,[3] unusual masturbation practices,[6] and balanitis.". I changed "unusual masturbation practices" to "not masturbating in a way that slides the skin up and down". The previous version makes it sound as if (a) masturbating in an unusual way causes phimosis, which is not supported by the source, and (b) that unusual masturbation practices cause scarring which cause phimosis. Actually, the source describes how "conventional" masturbation stretches the skin and cures phimosis; it does not assert that masturbating in other ways directly causes phimosis: it's the lack of masturbating in the "conventional" way that leads to it.  The version misrepresenting Beaugé's results was added on January 22, 2009 by Tremello22:  I wonder how many people have unnecessarily modified their masturbation practices based on reading this in order to avoid an unfounded fear of causing phimosis by such practices? (which, according to an earlier version of the article, as Tremello22 pointed out, sounded as if it might cause cancer...) ☺ Coppertwig (talk) 22:31, 18 March 2009 (UTC)

Comparison of Beaugé translation
I'm comparing the English translation by J. P. Warren as given here and as linked in our reference list of Beaugé (1991) with the original French as given here and as provided as a link from the English copy. Translation normally involves a certain amount of paraphrasing, so just because I would translate something differently doesn't necessarily mean the translation is wrong. I've rated myself fr-3 in my Babel boxes. I've compared most of the two versions, and except for the section I skipped (noted below) and except for the discrepancies I list here, to the best of my knowledge the translation seems accurate, although there are a few words, not all noted here, that I'm not familiar with that I didn't find dictionary definitions for. Note that there are some passages of text of significant length present in the English version that are not present in the French version.

I'm getting tired, so I'm skipping the part from "the foreskin is the eyelid of the glans" to the beginning of the Conclusions.
 * Title: The French title is "Traitement médical du phimosis congénital de l'adolescent". I would translate this as "Medical treatment of congenital phimosis in adolescents".  I don't see any reason for it to be translated as Warren did, "Conservative treatment of primary phimosis in adolescents": that is, I don't see where the word "conservative" came from.
 * The section beginning "I thank" doesn't seem to appear in the French version. The heading "Introduction" doesn't appear; the French version just starts, like a Wikipedia article.
 * First sentence: I would translate "grands adolescents" as "older adolescents" rather than as "older children". The next paragraph makes it clear that the age range in question is 18-22.
 * "sillon ballanique" translated as "sulcus": I'm not familiar with these terms in either French or English so I can't verify this part of the translation but have no reason to think there's anything wrong with it.
 * "inferior preputial ring" should just be "preputial ring". The phrase "inférieur au" is being used in the sense of "less than" and has already been translated as such, so the word "inferior" shouldn't be there.
 * "many have failed": I would have translated this bit as "many have experienced a failure".
 * "plastie": I'm not familiar with this term so I can't verify the translation as "plastic surgery".
 * Generally, the same words or concepts are presented in the same order, but the formatting may be different, e.g. paragraphs joined, or some items moved from sentence format to point-form format.
 * "modification anatomique" I would translate as "anatomical modification"; here it's been translated as "mutilation".
 * "la certitude de normalité n'est pas acquise en général" I would translate as "the certainty of normality has not been acquired in general" or perhaps "confidence of normality has not been achieved in general"; they've translated it as "has scarcely acquired knowledge of normality."
 * "may fail due to scar formation": the French makes it clearer that what is meant here is that the tightening may reappear in the form of scar tissue.
 * "among those subjects who attach guilt": I would write "these" rather than "those"; it seems to me to be talking about the same group of subjects. I could be wrong here.
 * "displaced to one side or even": these words seem to have been added unnecessarily by the translator.
 * "cette génération" has been translated as "this population studied"; perhaps that's reasonable. I would have written "this generation".
 * The section "roles of masturbation" seems to be missing from the French original. The next section in the French says something like "roles of masturbation in adolescents as described in the 5 preceding points", but the material referred to doesn't seem to be present at least in this copy.
 * "Faced with a man suffering from phimosis" could say "young man" rather than just "man".
 * "This could explain why boys fail": I would have written "these" before "boys", and put "easily" (or possibly "naturally") before "fail"; the translator seems to have ignored the words "ces" and "volontiers".
 * "Therefore I advise "prescribe"" would be better translated as 'Also I often advise". (Original: "Aussi je conseille souvent".)
 * "gradual stretching" (after "soft tissues") This part could be translated instead as "of which the mobilisation permits a gradual lengthening and softening" rather than just "gradual stretching." Original: "sur lesquels la mobilisation permet un allongement et un assouplissement progressifs".
 * "particularly when it occurs for the first time" I would translate as "particularly when it occurs for one of the first times". Original: "surtout s'il s'agit d'un des premiers"
 * "30 to 40 boys annually" I would translate as "about 40 boys annually". Original contains: "une quarantaine".
 * "a number were given the same advice": instead of "a number" I would write "several tens" or more loosely "several dozen". Original: "plusieurs dizaines"; "dizaine" can mean "ten" or "about ten".
 * "I never had to refer a single one for surgery" I would translate as "I never referred a single one for surgery".
 * Last 2 paragraphs of section "results" in the English version I don't see in the French (or haven't found them yet).
 * "It occurs in all young children": I would translate as "It concerns all young children" or "It involves all young children". Original: "Elle concerne tous les petits enfants". However, the way Warren translated it may be a reasonable translation. At first I thought this contradicted information elsewhere in the article, but apparently the situation for young children may be different from that for adolescents.
 * "and is the usual form of sexual expression" I would translate as "and it usually trains the sex life" or "and it normally prepares the man for sex life". Original: "elle forme habituellement la vie sexuelle".
 * "Georges Mendel in "Anthropologie Differentielle" points out that "If we recall the universality of infantile masturbation during the first years and the near- universality in adolescent boys, we realise then what a role it must take."" This passage does not appear in the French version.
 * I was going to accidentally translate "maîtresse" as "mattress" instead of "mistress"!
 * "A young girl who wants to defer her first real relationship": this passage doesn't appear in the French version.
 * "is sufficient to justify it, we think." I would translate as "seems to us to still be justified." Original: "elle nous semble se justifier encore."
 * ""The Animal Sad After---",": here instead of a comma, the French has a paragraph break.
 * "This sexual activity distances the individual from the worries and constraints of daily life lulling him to sleep. whereas the pre-existing depressed state of mind would have prevented sleep. By ejaculating the adolescent sends himself to sleep just as infants and some older children do by sucking their thumb for comfort." This passage is not present in the French version.
 * "Autoeroticism and fantasising are described by Gerard Mendel as "productions of the same nature, that is memories, secondary and associative." and furthermore: "masturbation is in the last resort only the means to recall, of renewing intensely the memory of the pleasure arising from the penis, as well as the whole range of sensory memories which, when stimulated, constitute fantasy."" This passage is not present in the French version.
 * "a defect in the skin (the labial slit or eczema)" I'm not sure whether translating it so as to call the labial slit a "defect" gives quite the same impression as the original. I don't know what "tégumentaire" means, but "anomalie" could perhaps be translated as "anomaly" or "abnormality" rather than "defect".  Later in the article, Warren translates the same phrase as "cutaneous abnormality".
 * "well beyond what reason would lead one to expect" This phrase is not present in the French version.
 * "from a very widespread genital activity, but one which is often very poorly accepted due to the taboo which continues without reason to weigh upon it." This says more than what is present in the French version. I would just translate it as "lifts a taboo". Original: "lever un tabou".

Here's a source which apparently (according to Google Scholar snippet) cites Beaugé, but I may not have access to the full text:. "Conservative Management of Foreskin Conditions /Book	Circumcision and Human Rights/Publisher	Springer Netherlands/DOI	10.1007/978-1-4020-9167-4/Copyright	2009/ISBN 978-1-4020-9166-7 (Print) 978-1-4020-9167-4 (Online)/DOI	10.1007/978-1-4020-9167-4_10/Pages	121-131/Subject Collection	Biomedical and Life Sciences/SpringerLink Date	Tuesday, December 23, 2008 ☺ Coppertwig (talk) 23:31, 21 March 2009 (UTC)


 * Coppertwig, thank you for your attention to detail in this matter. If I may summarise, it seems that the French and English versions differ slightly, but not to a huge extent. Some thoughts:
 * I have some concerns about citing a thesis (which this document is), as such a document has not had the benefit of peer-review. I am particularly concerned about citing a translation held at an unreliable website (ie., CIRP).
 * This ref (no. 24) is cited twice at present. Does it support the claims in these two locations?  Can we achieve verifiability by citing Beauge 1997 instead?
 * Is the French version believed to be essentially the original text of Beauge's thesis? I think if we do cite this document we ought to cite the original first, and cite Warren's translation as a convenience for non-French speakers. Jakew (talk) 10:24, 22 March 2009 (UTC)

Josef Fritzl
I think this is an unnecessary addition that has too much negative association... awh well —Preceding unsigned comment added by 79.71.228.70 (talk) 20:51, 31 March 2009 (UTC)

Associated with
The source says:

Unusual masturbatory practices

"The history obtained from these patients invariably showed that their practice of masturbation differed from the usual manipulation that mimics the dynamics of coitus and tends to force the preputial orifice back toward the base of the penis, thus exposing the glans."

Associated seems a good concise way of putting across this. Tremello22 (talk) 10:29, 7 April 2009 (UTC)

Jayg your version is: "Beaugé has suggested a treatment involving masturbation."

How is that an accurate representation of above? It is vague and describes a treatment. It doesn't mention what Beauge found which was that patients had unusual masturbation habits. My version is :"Beauge found that phimosis was associated with "unusual" masturbatory practices that differed from the usual pulling down of the foreskin that mimics sexual intercourse." This is an accurate representation of the source.

I fail to see what is wrong with this? Maybe you would show some courtesy and provide an explanation. Tremello22 (talk) 13:03, 8 April 2009 (UTC)


 * I agree with Jayjg and Coppertwig (see 22:31, 18 March 2009 in, above). If we say that "Beauge found that phimosis was associated with "unusual" masturbatory practices that differed from the usual pulling down of the foreskin that mimics sexual intercourse" it implies that "unusual" masturbatory practices were the cause of phimosis, but that isn't what Beauge is saying. Note that Beauge specifically notes that "Some [patients with phimosis] never masturbate": what he is saying is that it is the absence of what he describes as the "usual manipulation that mimics the dynamics of coitus" that is associated with phimosis, not the presence of masturbating in other ways.
 * I am also concerned about the reintroduction of Beauge 1991 into the lead. This is a questionable source: not only is it a university thesis that has not had the benefit of peer review, but it is CIRP's (an unreliable website's) translation of a French-language original.  It's debatable whether it belongs in the article, but it certainly doesn't need to be included in the lead; Beauge's 1997 piece in Br J Sex Med is sufficient. Jakew (talk) 13:40, 8 April 2009 (UTC)
 * Agreed. Non-peer reviewed thesis, translated on a partisan and unreliable website. I've taken it out. Jayjg (talk) 21:55, 8 April 2009 (UTC)
 * It was in the Br J Sex Med. i already took out the 1991 ref from lead.  Pay attention Tremello22 (talk) 17:54, 9 April 2009 (UTC)

NPOV
The first sections, questionable to whole article seems to push Phimosis in a stance against circumcision by only citing articles in favor of phimosis being minor or self-correcting and most of all talks about circumcision extensively in a dis-affirmative stance.--134.84.69.69 (talk) 17:39, 23 March 2010 (UTC)
 * Can you suggest some sources that present a different point of view? Jakew (talk) 18:22, 23 March 2010 (UTC)


 * I have boldly edited the Natural Development of the Foreskin section to reflect only the natural development, not any of the "interference" implications from the anti-circumcision group (with no offence to them implied.) I've taken the liberty of removing the NPOV tag, as my experience is that the tags sometimes don't get removed even after the issue is resolved. Please feel free to re-add it if the changes in that section do not satisfy NPOV. I made sure that all info was cited.
 * I have also, however, added a section on the use of real, inaccurate, future/potential or possibly falsified phimosis diagnosis as a justification for circumcision, as this disease is DIRECTLY cited as a reason for preventive circumcision. I've tried to make it as NPOV as possible, using again only cited sources (I think mostly from MDs). Rather than going into possible reasons against circumcision, it simply points to the controversy wiki article. (I only came here because a book I was reading used the word phimosis, lol.) I hope this has helped but I leave it to you editors with a long-time investment in the article to judge. Tkech (talk) 20:15, 4 April 2010 (UTC)

Treatments in lead
Should it be mentioned that steroid treatment is the most cost effective? I thought that circumcision was only needed with BXO. Tremello22 (talk) 23:08, 16 March 2009 (UTC)

I think the image is very disturbing to many younger readers of Wikipedia. I think it should be removed incase anyone too young stumbles across it on Wikipedia as it could frighten them and is to explicit for certain ages. —Preceding unsigned comment added by 92.15.93.168 (talk) 13:56, 30 October 2010 (UTC)
 * Sorry, while it's obvious that you have the best of intentions, Wikipedia has a site-wide policy against that sort of thing. Please see WP:NOTCENSORED and, also, WP:NOSEE. Jakew (talk) 15:03, 30 October 2010 (UTC)

Photos
Does anybody have strong feelings about Image:Phimosis.jpg and Image:Erect_phimosis.jpg? If not, I intend to remove these on the basis that they are badly out of focus and it is impossible to make out any detail. Jakew 12:51, 4 August 2007 (UTC)


 * Keep. For the reasons I've given two sections above, on this talk page, I think the first image is useful.


 * I have no objection to images being replaced, if you can find better images. But until we have something better to put in their place, I don't see any value in deletion for the sake of deletion.  It's not the detail that's most important in these photos.  It's an overall sense of what the article is talking about. Jheald 19:13, 4 August 2007 (UTC)


 * Kill the photos: ugly, distracting, poor quality, and not very informative. alteripse 17:17, 7 August 2007 (UTC)


 * Delete, but search for replacements. Wikipedia has two competing issues here.  First of all, we are an encyclopedia.  As an encyclopedia, it is unquestionably in our interest to illustrate topics appropriately, where they enlighten the reader and shed light on a given subject.  However, as a free and open encyclopdia, we are under more or less constant siege by those people who feel that the most important thing in the world is that their picture of their genitalia be the one being exposed to our millions of readers.  The result of this is that we end up with articles that either have poor or low quality images or, even worse, end up with an entire gallery of low quality images as a "compromise" ("Hey, it's OK!  We can all have our penis on Wikipedia!").  This article is not (yet) flooded with too many pictures, but the specific images here are worse than average.  They are of sufficiently low quality that I imaging people reading the article having to stop and spend 5 minutes figuring out just what it is they are supposed to be seeing.  In other words, they make the article worse.  We should definitely seek replacement images for these (high quality, properly lit), but I won't cry crocodile tears about these being removed in the meantime.  This is a case where having no images, for a while, is better than having these images. Nandesuka 12:50, 17 August 2007 (UTC)


 * Delete, I would rather prefer illustrations to replace the photos. The images look too obscene to look "encyclopedic" Akira Tomosuke (talk) 14:40, 12 October 2008 (UTC)

At the risk of some childish comments- thank you to whoever made this article and especialy for the pic of Phimotic ring, which told me what I needed to know; gave me the courage to go to a doctor and the reassurance that I am not alone in the world. —Preceding unsigned comment added by IceDragon64 (talk • contribs) 00:06, August 26, 2007 (UTC)

There are clear and clinical photos on the Commons which could usefully be put in (or returned to) the article and I would urge that this be done. IceDragon64's observation is surely compelling as to the utility of such photos; he refers to a photo of a phimotic foreskin drawn back which some officious party unilaterally deleted from this article but which remains on the Preputioplasty article. The trouble is that a detumescent phimotic penis looks the same as a perfectly functional penis; it needs to be either tumescent or detumescent with the foreskin withdrawn and forming a "waist" for the phimosis to be evident. This appears to be Mrs Grundy's objection; assuredly someone with Photoshop expertise can use the apparently objectionable photos to create non-contentious drawings, though I fail to see why it should be necessary. Masalai (talk) 05:37, 4 December 2008 (UTC)

Actually, having just looked at the photo that Jakew refers to, viz., Image:Phimosis.jpg, I cannot see what he means when he says it is badly out of focus. It isn't. He must have some other objection. Perhaps he could elaborate. Masalai (talk) 05:40, 4 December 2008 (UTC)


 * Isn't it possible to put a cascading menu? That way, is someone wants to see the picture, he can just click on "unfold" or something. This will end the discussion, and meet all parties halfway. No censorship, and no exposure to things that you dont want to see. —Preceding unsigned comment added by 94.209.61.107 (talk) 15:22, 20 March 2011 (UTC)

The above two images
I've reverted the addition of the images named by CommonsNotificationBot in the above two sections. The images added little encyclopaedic value. More importantly, while Wikipedia is not censored, I'm concerned that gratuitous inclusion of photographs of the genitals of minors, particularly in an erect state, may place the project at risk. Jakew (talk) 10:27, 27 September 2011 (UTC)

I agree the images shouldn't be here because they aren't very encyclopedic due to their poor quality (they look like they were shot using a webcam!) but photographs of genitals of minors is not really a reason for deletion since Wikipedia is not censored, and a simple Google search will show up many such results (but of higher quality) across a variety of medical websites.

Inappropriate photo
Hi guys, I'm a med student doing some research but I was pretty shocked when I opened the article and there was an uncensored erect penis by the first paragraph. Normally with genital issues a tasteful medical diagram is used, especially with feminine issues but it shouldn't be any different for males. I think that you should either have a page warning that you need to be over 18 to view the material, or you should just have a normal medical diagram on the page and then have external links for the photos at the bottom. I don't want kids to be able to see this kind of content without restriction, but I do understand that the pictures are helpful if you're doing actual research.

Thanks, J
 * Please see WP:NOTCENSORED. Jakew (talk) 15:42, 29 February 2012 (UTC)


 * imo, the picture doesn't even show a case of phimosis at all. The guy's foreskin may not be currently retractable but as the article itself states, non-retractability does not equal phimosis.  Do a google images search on phimosis and you will see some much more accurate representations of the condition (albeit even less appetising ones!) Scowie (talk) 16:56, 20 April 2012 (UTC)

Dyspareunia
MowbrayL (talk) —Preceding undated comment added 05:15, 13 May 2012 (UTC).
 * 1) Noting that Richiez recently undid the addition of this one word as well as all the previously existing wording about painful sexual intercourse in the prognosis section of the article, some work needs to be done. The following under the management section of the article is suggested:
 * 2) Phimosis can be the cause of dyspareunia (painful sexual intercourse). Whelan’s statistics (ref: Whelan.P Male dyspareunia due to short frenulum: an indication for adult circumcision. BMJ 1977; 24-31: 1633-4) show that in 50% of the 48 adults circumcised at the Churchill Hospital, Oxford, in 1975 and 1976, phimosis had been the only indication, and that 40% of those patients had also complained of pain on intercourse.  Whelan’s statistics also show that ten of the 48 patients presented a short frenulum as the only indication, and that they had all previously suffered pain on intercourse.  The treatment completely alleviated all symptoms in 90% of patients with a short frenulum (i.e. the 90% who responded to the follow-up questionnaire, making the alleviation of symptoms complete in 100% of the patients who responded).  Dockray, Muir and Findlayson’s statistics (Dockray, J., Finlayson, A. and Muir, G. H. (2011), Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring.BJU International. doi: 10.1111/j.1464-410X.2011.10678.x) published in December 2011 show similar successful treatment with frenuloplasty.  Whelan commented that a short frenulum should be sought as a cause of dyspareunia in patients who may erroneously be labelled as having psychosexual problems.


 * I was looking for references but I think the subject belongs into the paraphimosis article and we already have this in the natural prognosis. Without looking at your references in too much detail (please link PMID whenever possible) they seem only loosely related to phimosis and instead describe problems caused by a short frenulum.


 * For me it seems phimosis is mostly cured long before sexual maturity (natural regression in 50-80% cases, medical treatment). The small rest may develop into paraphimosis which then may cause all kind of problems hopefully described in that article. Thus I see no point describing the complications of paraphimosis in this article, unless you can find sources saying specifically that phimosis is causing pain at sexual intercourse. Richiez (talk) 12:13, 13 May 2012 (UTC)


 * Thank you, Richiez. Yes, the Whelan paper (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633287/ ) does differentiate between cases and respective numbers with pain on intercourse: Hygiene (3/0),  Paraphimosis (2/0), Phimosis (25/10),  Phimosis+balanitis (6/3), Balanitis alone (2/0) and Short Frenulum (10/10).  Interestingly, neither of the two cases of paraphimosis reported pain on intercourse, perhaps because they had never had intercourse or because the paraphimosis occoured during manipulation rather than during intercourse.  We don’t know.  Either way, it’s a very small sample for paraphimosis.  It does show, however, that 10 out of the 25 with only phimosis had pain on intercourse.  I understand what you say about the references to a short frenulum.  The trouble is, however, that for anyone perceiving their problem as simply a tight foreskin (which is how a vulnerable short frenulum feels) and they search Wikipedia for that they are taken straight to the Phimosis article.  Perhaps they should be given a choice of Phimosis, Frenulum Breve and Paraphimosis when searching for information on ‘tight foreskin’.  Here is a link to finding the Dockray, Muir and Finlayson paper (http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10678.x/abstract).  MowbrayL (talk) 22:19, 15 May 2012 (UTC)

Phimosis/Paraphimosis
Phimosis is pretty painful, but paraphimosis is much worse than that! I cannot describe paraphimosis to anybody. --68.103.31.159 (talk) 03:01, 15 December 2012 (UTC)

please don't delete aap reference
It is relevant to the article and is factual. It is wishy-washy and doesn't come down strongly on either side of the circumcision debate. You are being rude to delete it without discussion. What's the objection? Alteripse

It's a partial quote of the concluding paragraph, essentially quoting sentences (or partial sentences) that are favourable to the anti-circumcision POV. If included at all, the entire paragraph should be present, but it's better off without it, since it is not directly relevant to the article. Please note that I did not delete the reference - just the quote. - Jakew 16:55, 8 Nov 2004 (UTC)


 * The original quote did not even include the part most favorable to the pro-genital integrity POV, "the procedure is not essential to the child's current well-being". Any quote that summarizes the position of a national medical organization, including the AAP, will be favorable to the pro-genital integrity POV because every national medical organization that has an official policy on circumcision says there is no medical indication for infant circumcision.  In my opinion first two sentences of the AAP summary should be included without selective editing.  -- DanBlackham 21:29, 8 Nov 2004 (UTC)

DanBlackham, I've no objection to this. It's a definite improvement. - Jakew 22:04, 8 Nov 2004 (UTC)

At the risk of nitpicking, it is more accurate to say that "every national medical organization... says there is no medical indication for routine neonatal circumcision." Your version, taken literally, denies that there might ever be a disease or condition which parents and doctors might choose to treat by circumcision. While this might be your opinion, or you might not have intended to say this, it is a misrepresentation of all the medical organizations' statements and intentions. Alteripse 22:26, 8 Nov 2004 (UTC)


 * You are correct to point out that occasionally there is a medical problem that requires circumcision for treatment. However in the overwhelming majority of cases there is no medical indication for a baby boy to have a normal healthy part of his penis cut off by a doctor.  Is there any other surgery that doctors will perform on children where the medical benefits of the surgery do not far outweigh the medical risks and harms or the surgery does not correct a birth defect? -- DanBlackham 23:00, 8 Nov 2004 (UTC)

I am assuming your question is rhetorical. However, there are certainly surgeries where after time and careful statistics, it has been shown that the benefits for many of the children are not as great as originally expected, and may often not much exceed the risks. An obvious example is tonsillectomy, which is done less often than a few decades ago. Alteripse 23:09, 8 Nov 2004 (UTC)


 * My question was not just rhetorical. If there is any other surgery that doctors will perform on infants or children that has a ratio of medical benefits to medical risks and harms that is similar to infant circumcision, I would like to know.  To the best of my knowledge there isn't one; non-therapeutic circumcision is the only exception to the normal standard of care for infants and children. If that is not the case, I want to know. -- DanBlackham 03:41, 10 Nov 2004 (UTC)

Perhaps the closest kind of procedure to circumcision in this regard is minor plastic surgery, which has a similarly low measurable risk but a benefit that is subjective, social, and impossible to measure. Examples are surgeries on minor hemangiomas, ear "pinning," repair of minor cleft lips, and scar revisions. All could be considered similar to circumcision in their primary intended benefits: to make the child look like the other members of the group. Parents are empowered in all cultures to make decisions about plastic surgery for their children. There are lots of "preventive" treatments for which both the NNT and NNH (number needed to treat to achieve benefit and number needed to harm) are so high that they are difficult to measure. Surgical removal of asymptomatic but "impacted" wisdom teeth comes to mind if you want a surgical example. A lot of medical treatments like postmenopausal estrogen replacement can be looked at this way.

Circumcision is like minor cosmetic surgery in our culture because the primary intended benefit (being like the other males in a group) is subjective and impossible to quantitate. The claimed health benefits are so uncommon that dozens if not hundreds of boys have to be routinely circumcised to achieve a significant benefit for one boy; the NNH for measurable harm is similarly very high. A high number means that benefits only occur to very small percentage of those treated. We allow a high NNT for a low risk intervention like mammography. On the other hand doing routine appendectomies at one year of age to prevent all cases of emergency appendicitis would not be justified becaue the risks of the treatment would probably exceed the risks of bad outcomes from future appendicitis. The measurable risks of circumcision are low (penis loss, death from infection or exsanguination) but there is no universal consensus on how to "weigh" a newborn's pain, and even less consensus on the relative social and personal and sexual risks and benefits of the procedure. Obviously no one is proposing that all children have those plastic procedures done, but the loudest circumcision opponents ignore the fact that most people who perform or condone circumcisions don't insist it be done routinely or universally. That's why most of the circumcision debates seem so ridiculous to most pediatricians and most American men: the loudest advocates on both sides make exaggerated claims, preposterous accusations about their opponents, and as soon as they start arguing by analogy or making medical judgements they are in over their heads. I'm not attacking you, just abstaining from the stupidity and ignorance of the circumcision debate here. Alteripse 13:13, 10 Nov 2004 (UTC)

Are bxo and lichen sclerosis the same
Anonymous, I modified your claim. Sorry but a 60 year old paper pointing out similarities and concluding "In our opinion lichen sclerosus et atrophicus and balanitis xerotica obliterans are identical." is not quite enough to support a bald assertion that they are the same disease. In fact, since the same paragraph says that the cause is still not known for certain, it is illogical on the face of it to claim they are identical without expressing any uncertainty. Here is where you get to make a choice. It's time to uncloak yourself and show an interest in the same goals most of the rest of us have. I am trying to provide an article with evidence supporting the assertions and an indication as to the strength of the assertion. I don't particularly care whether they are the same or not, but I am immediately suspicious that you are a POV warrior when you stay anonymous, and overstate the evidence from a relatively biased source in the circumcision debates. So tell us who you are and show us some stronger evidence for such a strong assertion. Thanks. alteripse 03:20, 18 Nov 2004 (UTC)

Anonymous, please do not insert erroneous POV info. Circumcision is an effective and traditional surgical treatment. Whether you think alternatives are better does not make that statement false. The alternatives are already given far more space. Furthermore, your aap reference was dishonest. Please observe community ethics here and let's make this an accurate article, not a polemic. Even the message you want will be stronger if the article is balanced. Thank you. alteripse 13:21, 18 Nov 2004 (UTC)


 * Tonsillectomy is an effective and traditional surgical treatment for tonsillitis, however now doctors only remove a child's tonsils when the child has repeat serious infections that do not respond to antibiotics. The article says, "Choice of treatment is often determined by whether the patient (or doctor) views circumcision as an option of last resort to be avoided or as the preferred course."  However the British Medical Association says:
 * "Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence.  Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate." -- The Law & Ethics of Male Circumcision - Guidance for Doctors
 * Doctors should use the same standard of care for a boy's foreskin that they use for his tonsils and the rest of his body. Surgery should be the last resort, not the preferred option. -- DanBlackham 17:04, 18 Nov 2004 (UTC)

I understand what you are saying and because of that I included several sentences referring to overdiagnosis, emphasized the opinion of many that too much surgery was done, that there were effective medical alternatives, and that some groups wanted these facts propagated even more strongly. The overall sum of research articles I provided support the same thing. How can you possibly with any intellectual honesty complain about a single sentence that says that surgery is the usually effective traditional treatment for pathologic phimosis? Many of your favored assertions don't even make sense unless we acknowledge that that is the tradition. Tradition and effective is a relatively weak endorsement, and if you guys can't even stand to let that simple truth be stated, you are proving my assertion about the basic lunacy and bad faith of the extremists on either side of the debate. alteripse 01:33, 19 Nov 2004 (UTC)
 * I sit here wondering for just how long you will be able to stand your ground until they wear you down through sheer numbers and persistency? - Robert the Bruce 02:26, 19 Nov 2004 (UTC)


 * Alteripse, why do you think the AAP reference of the anonymous contributor was dishonest? That is a rather strong accusation. -- DanBlackham 10:06, 20 Nov 2004 (UTC)
 * I made a mistake. I just checked the reference and it is a fairly good comparison of treatment alternatives by a urologist. I initially thought it was misuse of an aap policy statement neonatal circumcision. However, note that even the author of this paper acknowledges that non-surgical treatments are not effective 100% of the time and is not claiming that there is no place for surgical circumcsion. I should have simply pointed out that the added text, not the reference, was dishonest. I put the reference back in.alteripse 12:21, 20 Nov 2004 (UTC)

Robert the Bruce
You know better. How can you leave a comment like that a few days ago and then remove a section without discussion? You're just another f___g POV zealot who acts with contempt for what most of us are trying to do. Go find a Usenet group to annoy.alteripse 12:58, 21 Nov 2004 (UTC)
 * You seem to be such a nice person. I suggest the mistake you are making here is formulating this article on the basis of the circumcision debate. Phimosis is a subject in its own right and should be dealt with as such. Where issues seem to converge a referal to the appropriate circumcision article with suffice. - Robert the Bruce 02:46, 22 Nov 2004 (UTC)

Well it doesn't do me much good to be a nice person if you act like this. What harm does it do to acknowledge that the opposite team of loonies has an opposite opinion? How can you possibly care that much? alteripse 04:21, 22 Nov 2004 (UTC)
 * I would like you to produce evidence that I have introduced an opinion into this article. Until such time I suggested you remain guarded as to how wide of the brush of accusation you use. As I stated before phomosis is a subject in its own right and deserves better treatment than merely to be explained as a part of the ongoing circumcision debate. To continue to do so is to do a diservice to wikipedia. - Robert the Bruce 04:33, 22 Nov 2004 (UTC)

There are 3 problems with what you say and do.
 * 1) Phimosis is already part of the circumcision debate even in medical journals as reference 14 and several others demonstrate.
 * 2) I have tried to segregate the more extreme opinions and references to a paragraph clearly labelling them as viewpoints of anticircumcision advocates. It does not ruin the article even if the paragraph contains a bit more advocacy than I might have included on my own, and considerably less than some of them might like.
 * 3) Part of the process here is to devise constructive ways of expressing a range of viewpoints. You are as contemptuous of community standards here as they can be. Why be so symmetrically offensive? Why not set yourself apart? alteripse 04:43, 22 Nov 2004 (UTC)
 * Clam down Alterprise. Yes phimosis is indeed part of the circumcision debate and there is a section on it in the article Medical analysis of circumcision which is where the debate aspect of this should be discussed if at all. In the main article I contend phimosis should be covered and attention drawn to the fact that it is a factor in the circumcision debate and provide a link for those who wish to find out more on that aspect of the issue. In your role as self appointed arbiter you have clearly failed (so please revert to Plan B). Produce a neutral article on phimosis and avoid unnecessary duplication by linking it to the circumcision article. Once again a simple truth you may have missed is that it is not a question of balancing viewpoints it is a matter of accurately presenting information on a subject in an NPOV form. Quite simple really. - Robert the Bruce 04:10, 23 Nov 2004 (UTC)

If you have so little respect for this community project why do you inflict your ignorance and bad manners on us? Do you have some delusional idea that anyone here has any respect or admiration for what you are doing? I suppose we can simply be thankful that (1) your universe revolves around circumcision to the exclusion of lots of other topics that you don't mess with, and (2) we don't need any contact with you in the real world on any business that matters more than this. Add me to the list of people who consider you an unredeemable a_____e. alteripse 04:30, 23 Nov 2004 (UTC)
 * Sadly now that you have realised that you are not going to get your own way you are self-destructing as you spew out personal attacks left right and centre. Water off a ducks back, mate. - Robert the Bruce 04:54, 24 Nov 2004 (UTC)

Robert, three different contributors have reverted your deletion. There is a consensus the section should stay in the article. Please do not delete it again. -- DanBlackham 05:35, 24 Nov 2004 (UTC)
 * Three foreskin activists hardly constitute consensus. Sorry Dan. - Robert the Bruce 16:45, 24 Nov 2004 (UTC)

Robert, for you to call Alteripse a "foreskin activist" is a good indication of just how extreme your pro-circumcision POV is. -- DanBlackham 20:24, 24 Nov 2004 (UTC)
 * That you can claim that the support of three people equates to consensus is a hoot. What does that tell us about you Dan? - Robert the Bruce 05:45, 26 Nov 2004 (UTC)

Please fellows, all concerned should cease ad hominems immediately. They serve only to muddy the water and make the actual issue of who is right a far more tricky one to discern. Besides, Wikipedia is not a forum for personal contempt to be aired, the discussion pages exist solely for the debate and decision making process for the factual content of this fine institution. If you wish to hurl derogatives you should find a more appropriate venue designed to accomodate you.IndigoJones

Mislabeled photo
Photo #3 under the heading of "phimosis" is actually not a photo of phimosis but paraphimosis.

To Robt Blair
I actually agree with jakew on this one. You removed an objectively accurate description of the links with the dishonest description that you were "removing POV." Don't do that. alteripse 20:16, 25 Feb 2005 (UTC)

Cleaning up after a circumcision skirmish
I am reverting back to an earlier structure of the article. Blair's rearrangement to put some unsourced historical gossip in the middle of the medical section makes no sense. I have laboriously gone through every edit since the version I reverted to. I have saved and re-inserted the new refs and minor improvements contributed since mid-January. I am using the NLM refs rather than the links from Nocirc for several reasons. Please do not change them back again.

With regard to the historical notes, there have been 2 different claims inserted for Louis xv1-- phimosis and frenulum breve. I confess I don't even understand what it has to do with circumcision wars, but can someone reference some authoritative statement of his condition?

As this has been a contentious article afflicted by both vandalism and propaganda, please do not make changes without discussion here. For the next few days at least, I will simply revert any re-insertions of old, already discussed stuff that is not accompanied by discussion here. Thanks. alteripse 05:14, 6 Mar 2005 (UTC)

Good job...

-Revamp 23:15 March 6 2006

Beaugeblog
By the fact that it has been up for a few weeks I am guessing that no one finds the link too objectionable. Am I correct?