Talk:Circumcision/Archive 22

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Feast of the Circumcision

I have revised some wording for greater clarity. I noticed a reference to some traditionalist Catholics still celebrating the feast of the Circumcision of Christ. A quick Google search failed to find evidence of this. However, I did notice a discussion of this change in the liturgy on a website of an Anglo-Catholic. I therefore revised the sentence and included a link to that website. Perhaps other editors would have more information about this matter. Michael Glass 08:37, 19 November 2006 (UTC).

I am puzzled. One editor has removed the link on discussion about the change in the liturgy surrounding the Feast of the Circumcision and replaced it with a 'citation needed' notice. This is quite bizarre. I will restore the link and i invite anyone who has a problem with it to discuss it here. Michael Glass 12:41, 20 November 2006 (UTC)

Avi gave the reason in the edit summary for this edit, Michael: "Blogs, in general, fail WP:RS". See WP:RS, which states:

A self-published source is a published source that has not been subject to any form of independent fact-checking, or where no one stands between the writer and the act of publication. It includes personal websites, and books published by vanity presses. Anyone can create a website or pay to have a book published, and then claim to be an expert in a certain field. For that reason, self-published books, personal websites, and blogs are largely not acceptable as sources. (emph added)

Jakew 13:50, 20 November 2006 (UTC)

The reference was to establish that the change in liturgy had led to some discussion. A blog is a discussion. However, if this is not satisfactory evidence, it is best to remove the whole sentence, because it is so trivial it's not worth mentioning. Michael Glass 21:46, 20 November 2006 (UTC)

Introductory paragraphs

The introductory section is very ponderous, with the repetitious 'non ritualistic elective' phrase occurring repeatedly. I have cut out the worst example. The American Medical Association is reporting on medical rather than ritual circumcisions; the point doesn't have to be laboured.

In another place, I quoted the actual percentage of parents (23.5%) who listed 'health reasons' as their reason for choosing circumcision for their sons. The source did say 'most important', but this was their interpretation of their findings, not the finding itself. I feel it is better to quote their actual findings. Michael Glass 22:07, 21 November 2006 (UTC)

I have now removed much of the excess wordiness of the paragraph, simplifying the language and hopefully making it much more readable. Michael Glass 22:26, 21 November 2006 (UTC)

RACP statement

The existing edit of the RACP statement is incomplete, missing critical phrases like:

"In recent years there has been evidence of possible health benefits from routine male circumcision"

"may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit" and,

"Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate"

The replaced version adds these phases in context.TipPt 17:13, 22 November 2006 (UTC)

Metzizah b'peh (oral suction of the circumcision wound)

The section on Metzizah b'peh needed revising. The procedure needs to be explained so that the general reader knows what is being talked about. The general reader also needs to know that oral suction is only performed by a minority of ultra-Orthodox mohels. The medical risks of oral contact with the circumcision wound need to be stated clearly and unequivocally, and the assertion by defenders of the practice that there is 'no conclusive proof' that HSV infected mohels actually infected the babies needs to be balanced with the view of health authorities. The fact that the New York government reached a political agreement with the Hassidic mohels also needs to be noted. Michael Glass 00:00, 23 November 2006 (UTC)

The above is solely your opinion, and is not at all apparent from the NYT article and the resulting agreement with the NYS Dept. of Health. On your own blog you may do as you wish. On wikipedia, however, personal opinions cannot be added to the article text, even in the guise of "helpful" information. -- Avi 00:02, 23 November 2006 (UTC)

Of course it's my opinion. It's also my opinion that you censored information in the guise of removing POV material. If it's wrong to add personal opinions to articles it is also wrong to suppress information. This is also POV and biased. I contend that the view of Dr Thomas Frieden, New York City's Health Commissioner that "There exists no reasonable doubt that 'metzitzah b'peh' can and has caused neonatal herpes infection," is worth noting in the article, provided that it is clear that this is his opinion. I have removed the word 'political' but restored the information about the agreement between the Hassidic rabbis and the state authorities. I am willing to work with you to improve this section of the article, but this does not extend to suppressing information. Michael Glass 00:46, 23 November 2006 (UTC)

I made some changes to your prose to remove titillatory statements, and added more information about the case and the protocols. I also updated your citations to the format of the article, and combined, well, see below.

• Changes made:
  1. Removed "ultra", more than just ultra-Orthodox still perform the rite
  2. WebMD is just quoting Gesundheit study. We already reference the source, no need to reference someone who brings that very source.
  3. Other than titillation, what need for bringing brain damage?
  4. Newman already quoted above in "Judaism" secton, combined citations.
  5. M'B issue with Freidman fleshed out considerably
  6. State department links added
  7. City and Frieden link converted to wiki format.
• -- Avi 02:21, 23 November 2006 (UTC)

Comments:

• 1. Media sources describe the practitioners of Metzizah b'peh as being 'ultra-Orthodox' [1]'ultra-Orthodox' or 'haredi' [2] or 'fervently Orthodox' [3]. Using the description 'Orthodox' suggests that the practice is more widespread than it really is.I feel that this is misleading. The way to get round this is to quote the wording from one of the websites
  2. Since when did a report of brain damage cause 'titillation'? The fact of brain damage to infants must be reported because it is a serious side effect of HSV infections in newborns.
  3. The comment 'no conclusive medical evidence' is actually a quotation from the defence attorney of the Mohel, Mark J. Kurzmann [4]. As such, it should be attributed to the defence attorney.

I'll take a closer look later. Michael Glass 12:10, 23 November 2006 (UTC)

I noticed Avi's mention of the use of a pippette or a glass tube for the rite. This should be mentioned, but not at the expense of describing metzizah b'peh itself. It is also important to note the political context of the controversy over metzizah b'peh. Information from the New York Times helps to explain this in a non-partisan way. Michael Glass 21:44, 23 November 2006 (UTC)

It's usually done with a sterile glass pipette, and in any event is not circumcision per se, but about a post-circumcision cultural practice surrounding it; please don't distort this practice, nor distort this article by placing undue weight on peripheral items. Jayjg ^(talk) 22:28, 23 November 2006 (UTC)

Jayig, it is you that should explain your actions. Why did you remove fully referenced material from the article? You say that metzizah b'peh is mostly done with a glass tube, but that's not at issue. The issue is that some people are using their mouths to perform this as part of the circumcision ritual. They argue that it is an essential part of the ritual. The evidence in the New York Times:

The use of suction to stop bleeding dates back centuries and is mentioned in the Talmud. The safety of direct oral contact has been questioned since the 19th century, and many Orthodox and nearly all non-Orthodox Jews have abandoned it. Dr. Frieden said he hoped the rabbis would voluntarily switch to suctioning the blood through a tube, an alternative endorsed by the Rabbinical Council of America, the largest group of Orthodox rabbis.

But the most traditionalist groups, including many Hasidic sects in New York, consider oral suction integral to God's covenant with the Jews requiring circumcision, and they have no intention of stopping.

"The Orthodox Jewish community will continue the practice that has been practiced for over 5,000 years," said Rabbi David Niederman of the United Jewish Organization in Williamsburg, Brooklyn, after the meeting with the mayor. "We do not change. And we will not change." [5]

Therefore, I regard your deletion of fully referenced material as a form of vandalism because.

• It removed a fully referenced definition of metzizah b'peh.
• It replaces this fully referenced definition with a tendentious statement that confuses the distinction between metzizah b'peh and the use of a glass tube.
• It deletes information from the New York Times that explains the politics surrounding the dispute in New York City.
• It deletes a statement from the Rabbinical Council of America justifying the use of a glass tube.

Removing information under the excuse of removing distortions is not good practice. Michael Glass 00:04, 24 November 2006 (UTC)

It is also becoming way out of the scope of this article, which is on circumcision. I beleieve you want the article Brit milah#Metzitzah. -- Avi 00:07, 24 November 2006 (UTC)

I agree. The practice may form a part of (some) bris ceremonies, but it is beyond the scope of an article on circumcision. Discussion here - if any - should be brief (to avoid undue weight), avoid sensationalism, and should be confined to the section specific to Judaism. Lengthier treatment may be appropriate in the article about the specific ceremony, but it is not suitable here. Jakew 12:44, 24 November 2006 (UTC)

As you can see from above, some regard metzizah b'peh as "an essential part of the ritual". None of my points have been answered. The only thing you can say is 'undue weight', which is POV. . You also censor out the opinion of the Rabinnical Council of America. So your judgment of 'undue weight' doesn't exactly come from the mainstream, does it? Michael Glass 00:57, 24 November 2006 (UTC)

The RCA endorses the use of the tube, which is already listed above in the "Judaism" section where metziza is referenced, as the primary method of performance. So please explain where the censorship is? -- Avi 00:59, 24 November 2006 (UTC)

The RCA is not mentioned in that section. Don't come the raw prawn. Michael Glass 01:21, 24 November 2006 (UTC)

“Raw prawn”? Sorry, I have no clue what you mean. Secondly, this is not the metzitzah article. Metztiza is brought in this section specifically to discuss the inherent danger when performed sans pipette. The RCA has nothing to do with this. The RCA is brought in the Brit Milah article under tube where it belongs. -- Avi 03:29, 24 November 2006 (UTC)

Don't come the raw prawn" is Australian slang for "Don't try to fool me!" There is no mention of the ruling of the Rabinnical Council of America. For some reason you are determined to censor out any discussion of the politics of metzizah b'peh, Avi. I believe that this is misplaced. Here is how the Jewish Week deals with the issue:

Jewish and secular newspapers in New York City have been filled recently with reports and commentary on the controversial circumcision practice of metztizah b’peh, the oral suctioning of blood by the mohel from the lesion to the penis during the circumcision ceremony. As The Jewish Week put it recently, “some fervently Orthodox” mohelim have insisted upon retaining this ritual, and the New York City Department of Health and Mental Hygiene and the Bloomberg administration “have agreed not to ban this practice after vigorous lobbying by New York’s fervently Orthodox community.” This despite warnings by health officials that this practice can and apparently has led “to the potentially fatal danger of transmitting herpes to vulnerable newborns.” [6]

In the Jewish Week article there is no mincing about the facts or the politics of the procedure. If a Jewish magazine can be forthright about the politics, if the New York Times can be clear about the politics, why are you being so skittish? I know it's a sensitive issue for you and I want to work with you to ensure that this issue is dealt with fairly and succintly. But this does not extend to censorship of information. Michael Glass 09:45, 25 November 2006 (UTC)

The information is hardly being "censored", but it's all about metzizah, not about circumcision, and doesn't belong here. Please recall the "undue weight" provisions of the NPOV policy. Jayjg ^(talk) 05:30, 26 November 2006 (UTC)

Jayig, you claim that information about the politics gives 'undue weight' to metzizah b'peh. That comment is POV. It is based on the assumption that metzizah is not an integral part of a Jewish circumcision. Now both you and I know that some believe that metzizah b'peh is an essential part of the ritual. i would therefore argue that some information about metzizah b'peh is essential in this article, and if mention is made of the controversy in New York, then some comment about the politics is appropriate. Michael Glass 13:31, 26 November 2006 (UTC)

Some information about metzizah is already given in this article. You seem to be confusing a circumcision with a Brit milah. A circumcision is a medical procedure in which the foreskin is removed. A Brit milah is a Jewish religio-cultural ritual which includes circumcision as one of its major components. While some do argue that metzizah b'peh is an integral part of a Brit milah, no-one argues that it is an integral part of a circumcision. If you feel the Brit milah article needs a more complete or nuanced discussion of metzizah feel free to work on that; however, this article is about circumcision, not Brit milah. Jayjg ^(talk) 22:01, 26 November 2006 (UTC)

Jayig, what you wrote above makes a good point about the distinction between circumcision as a medical or cultural procedure and about the specifics of Jewish circumcision. However, in practice, the distinction becomes blurred. Doctors have been expressing concern about metzizah b'peh for over a century, so the medical implications of meitzizah are relevant to this article. Also, as this article discusses Jewish circumcision, then a discussion about metzizah b'peh is relevant. Therefore the issue is not the discussion of Jewish circumcision or even some discussion about metzizay b'peh. The only point of difference is whether the politics of metzizah b'peh should be touched on. Your point is about undue weight. My point is that the politics of metzizah b'peh must be touched on to give a clear picture of the situation. If your point about undue weight is genuine we should be able to agree on the wording. If, however, you are pushing another agenda, this may not be so. Is your only objection to discussing the politics of metzizah 'undue weight' or do you have other concerns? Michael Glass 22:34, 26 November 2006 (UTC)

1. As stated above, metzizah is a brit-related practice (not a circumcision-related practice)

2. As the links already in the article point out, metzizah is usually done with a glass tube these days, so focussing on a minority practice is undue weight.

The Brit Milah article is the right place to deal with this, and I'd appreciate it if you would avoid further violations of WP:AGF (e.g. "pushing another agenda"). Jayjg ^(talk) 03:18, 27 November 2006 (UTC)

I think the way to go is to eventually spin off the controversy into its own article. This article is actually about circumcision, a Bris comes in tangentially under Jewish religious circumcision, and metztitzah is a subset of that. I'm unsure whether there should be any mention here. There definitaly should be some mention in Brit milah, and a description of the procedure, the usage or non-usage of tubes, the policies of various rabbinical and hasidic organizations, the medical issues that arise when the tube is not used, and the politics of the Fisher case should be in its own article. But that's just my opinion. -- Avi 00:34, 27 November 2006 (UTC)

There already is a lengthy discussion of this in Brit_milah#Metzitzah, which seems entirely reasonable. Jayjg ^(talk) 03:18, 27 November 2006 (UTC)

Title

The title of this article is misleading; it should be Male Circumcision. As it is now, I would expect to find information on circumcision as it pertains to male, female and intersexed peoples. The title implies that male circumcision is the default, which is not only incorrect but sexist. Brighteyes097 19:27, 8 December 2006 (UTC)

Agreed. Suggest 'move'? --Nigelj 23:51, 8 December 2006 (UTC)

Yep, let's move it. Headwes 01:50, 9 December 2006 (UTC)

Well, under the title it does say male circumcision. Nigel and Headwes, what are you suggesting to move? :) callarse1

'Move' is the technical term round here: I'm suggesting the whole article be renamed to Male circumcision. Then the Circumcision article could be reinstated as a disambiguation page. --Nigelj 11:08, 21 December 2006 (UTC)

Foreskins grow back???

Are people happy with this edit? The comment was that "The foreskin can be restored through a form of tugging at the penis which encourages cell growth". If that were true, then I imagine many burns victims and other people scheduled for skin grafts would be very interested to hear it. At least I'd like to see a citation if that's the consensus. --Nigelj 11:16, 21 December 2006 (UTC)

This is called Tissue expansion and it indeed helps many burns victims. 87.160.222.84 01:46, 1 February 2007 (UTC)

The skin is elastic and so can be manipulated to once again overlap the head. Creating the natural anaerobic internal organ envirornment that is naturally suppose to be to protect the glands on the penis. However the numerous nerve-endings is lost in circucision and so extensively reducing sexual stimuli forever. Lord Metroid 21:17, 25 December 2006 (UTC)

OK, now I'm confused by you guys. I find this extraordinary claim in the article, two people tell it's fine by them, and one (ASD below) finds a citation. So I think, "OK, I'm no expert, but I'll put the reference in." Then Jakew deletes the reference (not the claim, note), saying, "CIRP is not a reliable source. suitable citation is needed instead". So you allow unreferenced nonsense in your article, it's just the unreliable references you delete? I'm still trying to learn what makes the psychology of this strange article tick so I'll leave the claim in for now, but I really think it should go. --Nigelj 13:56, 28 December 2006 (UTC)

Let me explain, Nigel. The original claim is fundamentally true (see foreskin restoration), and it's not particularly difficult to find a source for it that meets Wikipedia's requirements (one possible example is: ISBN 0-934061-22-X). The present claim (that it is "hard to reverse") shouldn't be too difficult to source either. So while I'm quite happy for it to be removed, I don't see any urgency in doing so. I therefore felt that the interests of the article are best served by leaving the claim but requesting a citation. Jakew 14:33, 28 December 2006 (UTC)

Missing information this article should include -- poor Wikipedia performance generally

I understand that there are several types of circumcision. I have even been told that there are terms for the various kinds in Hebrew (or more recently?, Yiddish derived) for them. The only one I can pronounce (or remember) is 'radical' circumcision. My understnding is that the terms refer to various degrees of removal, and that at various times in history, one or another style was prevalent. Since, in the Western world, the Jewish tradition is the oldest, most influential, and best(?) documented, I would like to have learned something about what the difference is between the styles and how one came to be dropped and another followed. This article is completely silent on any of this. And I think that's not good enough for the Wikipedia. The history section is particulary barren.

I've looked thorough the astonishing archives (not enought time to read it all!!) and found little to enlighten. Mostly agruments from one ideological position or another, or accusations of bias... This is not very good performance for an article of considerable interest. And the article is hardly as good as it might be either. Wikpedia editors should be able to do better than this. Even on a controversial topic. I note that other controversial topics (eg, Attack on Pearl Harbor) have done better. Why not this one? 67.86.174.12 17:47, 23 December 2006 (UTC)

Also, I read through the article and I find it lacks many sections regarding more scientific perspective. So much religion and so little science! Penn & Teller's Bullshit show on circumcision adressed many of the issues that is not in this article. I also find it to be very skewed with an American POV. In Sweden circumcition is even illegal to perform if I remember correctly. Lord Metroid 21:22, 25 December 2006 (UTC)

The article medical analysis of circumcision has more of a scientific focus. As for Sweden, you are incorrect - circumcision is legal, but has certain restrictions about how and by whom it may be performed. Please see here. Jakew 21:28, 25 December 2006 (UTC)

Foreskins Restoration

I think it can be done. See here here. ASD 02:04, 28 December 2006 (UTC)

Human Rights Issue

Regardless of the back-and-forth arguments of medical benefits or sexual issues, the most fundamental issue is whether anyone has the right to cut away healthy living tissue from someone else without their consent.

Unless there is a fundamental medical matter that requires neonatal circumcision, it should be left to someone who is an adult to make the decision whether they want to have circumcision performed on themselves. Anything else violates the very basics of medicine and not conducting elective surgery on someone who has not given their consent is important as a basic human right. Jtpaladin 17:42, 6 January 2007 (UTC)

The GIM is referenced in the article. Individual editors such as you and I need to refrain from inserting personal opinions into articles to conform with WP:NOR and WP:NPOV regardless of the strength of our relative convictions and personal interpretations of various jurisprudential precendents. -- Avi 07:51, 8 January 2007 (UTC)

Avi, I agree with you but in the article titled, "Sexual effects of circumcision", that article is very biased towards those that support Circumcision. I think that the subject should be expanded by including studies that demonstrate that circumcision makes sex less enjoyable and that neonatal circumcision is a disruption of the human rights of the child. Jtpaladin 15:35, 8 January 2007 (UTC)

I think it may be more accurate to say that the verifiable, peer-reviewed, and published data and studies give rise to that perception, not the POV of the editors. -- Avi 20:49, 8 January 2007 (UTC)

That is essentially the root cause of the 'problem', yes. Jakew 21:00, 8 January 2007 (UTC)

someone add this

Ethical debates arise over the potential complications from circumcision which include; skin-tags, skin-bridges, unevenness, scarring, traumatic shock, seizures, blood flow and nerve development complications, and less often, death.[7] Another concern is the buildup of nerveless cells that grow on the glans of a circumcised penis, called [keratin], toughening the texture of the glans over time. [8]

Whether or not circumcision is justifiable is a matter of opinions, which greatly vary. Wikipedia defines surgery as the "medical specialty that treats diseases or injuries by operative manual and instrumental treatment". Since routine circumcision removes healthy foreskin, not injured or diseased foreskin, it is often incorrectly labeled as a surgical procedure. Logically and technically speaking, it can not be surgery. It is mutilation. That is why, internationally, such practices are referred to as male and female genital mutilation. Some doctors object to it, claiming that it is a violation of the Hippocratic Oath. [www.circumcision.org/ethics.htm] These doctors claim that removing a healthy normal body part, causing bleeding and unnecessary pain, contradicts the oath, "First do no harm." There are plenty of studies claiming that this pain has long-lasting effects and consequences. [www.circumcision.org/ethics.htm] The human foreskin has twelve known functions, such as to contact the G Spot. [9] It is the opinion of some researchers that foreskin can be a tool for intercourse. In the book Sex as Nature Inteded It author Kristen O'Hara argues that foreskin is a natural gliding stimulator of the vaginal walls during intercourse, increasing a woman's overall clitoral stimulation and allowing for the achievement of female orgasm more often and in shorter periods of time. [10] It is therefore believed by some that the absence of the foreskin and gliding action makes it more difficult, not impossible, for a woman to achieve orgasm during intercourse.

Physicians and surgeons earn thousands of dollars per year, performing circumcisions. Some believe that there is a conspiracy behind medical circumcision and that the justifications keep changing rapidly as each theory is disproved over time. [11] Many believe that circumcision advocates are clinging to the new theories that circumcision can help prevent AIDS. However, Professor Valiere Alcena, MD of the Albert Einstein College of Medicine claims that most of the studies on AIDS and circumcision are controlled trials. He claims that from the start, they are intended to claim circumcision can prevent AIDS when other studies have claimed the exact opposite. Some studies even say that the consequences of circumcision can cause AIDS. [12] If this is true, then most of what you read about HIV in this article would be completely misleading disinformation, typed by someone who may know very little about the subject and the potential misinformation. In western Europe, where men are not normally circumcised, AIDS is considered uncommon. However, in Africa, where hundreds of millions are circumcised, AIDS is rampant.[13] —The preceding unsigned comment was added by ShitakiMan (talk • contribs) 01:17, 9 January 2007 (UTC).

No, it would be better not to add it. Some of it is simply false, most of it non-neutral, and there are no reliable sources. Jakew 11:50, 9 January 2007 (UTC)

"Sexual" is a D grade section

It's prejudiced to simply (only) quote two American pediatric associations (aap and aafp) in the main topic section. I'd say the fox guarding the chickens. Their citing Masters (1966) and glans sensitivity ... from a popular book of that time ... is odd, and Wiki repeating those quotes is a joke. That closing sentence defies fact. For example, here's one study THEY posted on their website [14].

All circumcisions remove sensitive penile shaft mucosal tissue*, reduce (because the circumcised shaft is relatively tight) movement* of mucosal and frenular zone tissues*, reduce the surface area of the frenular delta*, remove hormone receptors*, and remove pheromone producing (Tyson’s) glands*. Easily cited, but always blocked by the pro-circ editor(s).

(*Erogenous or important to natural sexual function.)

Reduced potential to experience voluptuous sensation is severe when the frenulum fully excised. All you guys out there with an intact normal frenulum … imagine sex without one.

Prossibly 30% [15] [16] of US hospital circumcisions involve full excision of the frenulum, because the tighter (due to circumcision) shaft skin pulls on relatively short frenulums that may otherwise produce chordee of the glans.

It's a needless loss for that ~30%; because you can do the routine circumcisions without damaging the frenulum. Parents have no information about treatment of the frenulum ... the sexual value of which is almost ignored in US medical literature ... so there are many sexual organ mutilations going on behind those surgery doors.

I wonder if this cleanup project means more neutral editors will be looking at facts, and the cabel editor who owns this topic.TipPt 22:29, 13 January 2007 (UTC)

Cocktail party talk, but I think male circumcision may be worst for women [17].

Jakew and Jayjg ... can I put any of that information in your topic?TipPt 22:50, 13 January 2007 (UTC)

It depends in large part upon whether it's original research. If you can find a reliable source stating these things in the context of circumcision, then cite it and we can find some suitable text. If this is merely your own original synthesis, then policy forbids it. Jakew 17:02, 14 January 2007 (UTC)

I provided one NIH, one NZMA, one AAP, and one AAFP article to include in Sexual, each with information worthy (certainly more than much of what's there now) of the intro "sexual" section. The question again is, how will you permit their inclusion?

I suggest first framing the "sexual" issue anatomically (known receptors and where), because potential changes to sensation are very subjective; individually based on what exactly is done and how (and when?). Second, discuss known changes to sexual function, response, and behaviors ... for both men and women. Third, summarize circumcision studies in adults. Finally, include some of the Asssociations quotes (without that last sentence).TipPt 15:38, 15 January 2007 (UTC)

The in-depth article, Sexual effects of circumcision, contains the detailed discussion you describe. This article should summarise the important points instead, which is why it quotes the analysis of these two medical organisations. Jakew 15:50, 15 January 2007 (UTC)

The two (junior) US medical associations do not summarise any of those important points (anatomical and sexual function, for example). Almost all the "in-depth" article is devoted to the adult circ studies, which are not relevant to neonatal circs.

I wasn't expecting to get anywhere ... I just wanted everyone looking to see how this topic is run.TipPt 16:51, 15 January 2007 (UTC)

Why the Circumcision topic is very pro-circ

First, it may be a religous requirement for many, but the extent of the amputation varies significantly, and is subject to local and historical convention.

Second, cost/beneift studies show little net gain or loss to circumcision. In other words, the medical benefits roughly equal the risks. In Wiki, medical benefits are dealt with, in detail, in the first page text ... each with it's own section, and then again in Association statements, and than again covered, in detail, the "main article" text.

On the other hand, most specific risks and complications are covered in a single paragraph, and Wiki would have you believe that "Virtually all of these complications are preventable with only a modicum of care."

Third, "Sexual" is a joke. You remove ~half of the relatively erogenous tissue from a penis, but this Wiki section is very short and presents only US medical association statements. The "Sexual Effects of Circ" is rambling, and the studies are summarized improperly (leaving the impression of "no difference" when "no finding" is proper).TipPt 16:33, 15 January 2007 (UTC)

Sexual getting the short shift by pro-circ editor....

I placed Sexual effects of circumcision on the first Circumcision page, and the Table of study results on a secondary page. Jakew reverts citing circumcision topic length.[18][19]

The circumcision topic is too long. Please see the next discussion topic on shortening...

Jakew reverts my changes to Sexual. But he forces a current version that does not summarize the main article (Sexual effects of circumcision). His version places all emphasis on two junior medical association statements, which contain dubious statements, and are biased. The effect is to put very (relatively) little first page emphasis on studies into sexual effects.

We're dealing with surgery on a sexual organ. Sexual should not get marginal treatment; it belongs on the first page.

It's funny, when I first came to this topic it was mostly plagiarized from some Irish medical association website/statement on circumcision. That's still true with respect to Medical Aspects.TipPt 20:09, 18 January 2007 (UTC)

Tip, that restructuring is dramatic and needs proper discussion. The proper thing to do is to add {{mergefrom}} and {{mergeto}} tags at the top of both articles, and add a suitable section to one of the talk pages. Then, if there is consensus for the merge, it can be done at a later time. Jakew 20:14, 18 January 2007 (UTC)

My change is not a merge, but a swap. In most of Wiki, seeking concensus would be the appropriate approach. In this topic, there has very rarely been discussion among editors ... it's almost exclusively you ... constantly. You represent the only relevant "concensus,"' and I have not found you to be honest. Because of you, most other editors give up (unless, looking at recent participation, they might be a very pro-circ orthodox religous editor).

Sexual effects of a circ is primary to the topic of circumcision, but only the secondary page (Sexual effects of circumcision)currently covers the issues fairly well, and should be given first page coverage.

Anyone else want the swap? (and here comes jayg!). I'm also interested in Avi's comments, since he promised at least twice (while blocking me) to summarize the medical aspects (the "benefits") ... but hasn't.TipPt 22:43, 18 January 2007 (UTC)

Tip, a swap would consist of (effectively) renaming this article as sexual effects of circumcision, and renaming that article as circumcision. This - incorporating the contents of one article into another - is a merge.

Now, if you want to propose doing so, then I suggest that you create a new heading here with an appropriate title ("proposal to..."), and ask for comments. It might also help if you avoid personal attacks against other editors... Jakew 10:58, 19 January 2007 (UTC)

The circumcision article needs shortening

The article is way too long because pro-circ editors (cabels) insist on placing medical "beneifts" (reasons commonly cited as reasons to circ) in great depth on the circumcision page, and again in even greater depth it's own "main article," and again in (Canadian) Assoc statements. I think they seek to confuse the reader.

Jakew refuses to permit summary of "medical benefits" on the first page, and consolication of "benefits" research on its own main page. That would reduce duplication and greatly shorten the article(net of the sexual effects additions). He has reverted my attempts to make those changes.TipPt 20:09, 18 January 2007 (UTC)

Can editors place their personal website links all over the circumcision topic?

I find it improper that Jakew has placed his own pro-circ website pages all over in the topic of circumcision. Propaganda (heavy emphasis placed on the pro-circ studies) is inappropriate in an encyclopedia. Please see http://www.circs.org/index.html

Anyone else agree?TipPt 22:39, 18 January 2007 (UTC)

The site is used as a source for articles that otherwise are unavailable on the web, similar to "circs.org", an organization I presume is more attractive to you, AND which engages in actually using HTML code to selective highlight passages they like, and ignore passages that counter their position, something CIRP does NOT do. -- Avi 00:14, 19 January 2007 (UTC)

Did you mean the other way around? :-) Jakew 10:13, 19 January 2007 (UTC)\

Yes, I did. Sorry. -- Avi 14:34, 19 January 2007 (UTC)

Your presumption is telling. I did not express preference for source. Most of those references (where he now uses his website) can be found in unaltered form. Basically, we should use NIH pages. Other editors need to know the nature of what's going on in this topic.TipPt 04:34, 19 January 2007 (UTC)

Where the full text is available from the original publisher (eg BMJ) or from PubMedCentral, we should definitely prefer that source. In many cases, however, we have a choice between PubMed's abstract and the full text at either CIRP or CIRCS, and it's obvious that the full text gives more value to the reader. Jakew 10:13, 19 January 2007 (UTC)

I wholeheartedly agree with you, Tip, that we should use primary sources, and if you check my few hundred edits on this page, you'll see that that is exactly what I try to do. Whether it is cirp or circs, if I can hunt down the full text elsewhere, I do so. Ofttimes, the full text is unavailable, which is why we have so many links to cirp and circs. -- Avi 14:36, 19 January 2007 (UTC)

I withdraw my complaint, which was partly based on frustration using Jakew's website ... seemed like all the articles I needed to read required me to move the page curser to read all the line of text! All the pro-circ (I looked at) fit the page. I might have seen a bad sample (not indicative).TipPt 23:54, 20 January 2007 (UTC)

Circumcision question

Hello, Tip. A few points. Firstly, is this mohel that you spoke with Orthodox? I have no idea how the other branches of Judaism have changed what the tradition should be. Secondly, for the same reason, that website you brought is completely unauthoritative when it comes to understanding Orthodox Judaism's Circumcision rite. Thirdly, I would be interested to know if there are statistics for UTI's post Orthodox ritual as opposed to post any procedure, just for interest sakes; regardless, I believe that the documentation that is replete in the article sheds light on the matter. If you have contradictory information that is as respected, reliable, and verifiable as the studies in the article, it should be brought to light on the article's talk page. Fourthly, the article MUST be kept free of original research. No matter how strongly you or I believe circumcision affects or does not affect sexual response, Circumcision#Sexual brings both sides, and brings the opinions of two of the most respected organizations (AAP/AAFP) as to the matter, which in my mind supports WP:NPOV -- both opinions brought with reliable, verifiable supporting documentation. -- Avi 14:23, 19 January 2007 (UTC)

1. Yes, Orthodox.

2. I used that website because it hit all the points quickly; I think I said sorry. Note that until confirmation from a practitioner, I did not believe that frenectomies are part of a Bris. Bad as is was, the historical stuff seemed to match what you find on official religious websites.

3. I've found two studies in Israel finding a very high UTI rate post ritual circumcision. You might remember the one from the Canadian Medical Association statement on circ's.

4. Back to the Bris ... Wiki should contain discussion of the original mandated religious procedure and result. Wiki should also present the argument that the amount and location of tissue removed during a typical Jewish circumcision could be varied while still meeting religious requirements. I'm guessing you won't stand for that, so ... At least by implication?

5. I don't care about circumcision; I think it probably feels best for the man to have a ~loose skin circ that leaves all the frenular delta. I think it's always bad for women; see this article in the New Zealand Medical Assoc website: [20].TipPt 20:36, 20 January 2007 (UTC)

6. I care about frenectomies being done without parents knowledge.

7. Any discussion of sexual sensation and satisfaction that does not include coverage of the frenulum and frenular delta is biased. The current version purposely (Jakew) ignores frenular tissues.

8. Your "respected" Medical Association quotes (Circumcision#Sexual) ... do not include any mention of the frenulum ... but does put emphasis on a very old study that tested the dorsal side of the glans. Medicine is primarily a business, and most editors will agree that it's propaganda to only present Assoc statements. The closing sentence defies fact, evidenced by a blocked (Jakew) review posted in an Assoc website!

9. As for original research. That's something I do for myself to feel confident that I'm helping readers know facts. Here's one for you: Search google for "fellatio technique" and see for yourself how it's best done ... the most intense erogenous sensations are from the frenulum and frenular delta not the glans.

10. Jakew forced me to remove an exact quote from the article... The “underside of the shaft of the penis, meaning the body below the corona” is a “source of distinct pleasure. That quote comes from a UCLA human sexuality textbook in it's ?5th edition ... hasn't changed over time ... slightly positive tone overall in the the stuff on circumcision. Jakew's removing that sentence is unconscionable.

I've spent so long replying ... I need to post this on the discussion page.TipPt 16:08, 19 January 2007 (UTC)

Let me respond to a few points.

3. Some studies do indicate that UTI may be a rare complication of certain forms of circumcision, yes, but I'm not aware of any that give data on the absolute incidence of this complication.

7. What you need to do is to find studies that specifically discuss the frenulum in the context of circumcision. Your argument, as I understand it, is that circumcision sometimes involves removal of the frenulum and that this causes reduced sensation. Right or wrong, you need to find published articles making that argument before Wikipedia can include it. You cannot perform original synthesis of other arguments, even if it seems obvious to you that the two are linked.

8. I'm sorry that you feel that the medical associations' statements are propaganda, and you're entitled to hold that belief, but it's a very poor argument for deleting what they have to say.

10. I don't know the context of your complaint. When and where did I 'force' you to remove this? I do know that you kindly posted lengthier quotes from that source at User talk:Jakew#Frenulum quotes, and in our following discussion I explained that I felt you were misinterpreting the authors. Jakew 21:25, 19 January 2007 (UTC)

Reply to Jakew (I reply indented)

Let me respond to a few points. 3. Some studies do indicate that UTI may be a rare complication of certain forms of circumcision, yes, but I'm not aware of any that give data on the absolute incidence of this complication."

Here’s one: ”Effect of timing of circumcision An epidemiological study of UTI during the first year of life involving 169 children born in Israel found that 48% (27/56) of the male infants presented with UTI within 12 days after ritual circumcision." Cohen HA, Drucker MM, Vainer S et al: Postcircumcision urinary tract infection. Clin Pediatr (Phila) 1992; 31: 322-324”[21]

The second study showed high infection rates (not UTI specific) found after ritual circs in Israel, and in Turkey. It was cited in a journal article at the library...I'll get the details and a copy...the argument revolved around the trend to hospitalize circs.TipPt 23:09, 20 January 2007 (UTC)

7. What you need to do is to find studies that specifically discuss the frenulum in the context of circumcision. Your argument, as I understand it, is that circumcision sometimes involves removal of the frenulum and that this causes reduced sensation. Right or wrong, you need to find published articles making that argument before Wikipedia can include it. You cannot perform original synthesis of other arguments, even if it seems obvious to you that the two are linked.

I found three studies that specifically discuss the frenulum in the context of circumcision from two quality (NIH and AAP) sources giving rates of frenular chordee related to circumcision and treated with frenectomy. The rates of frenectomy with circumcision were 26.7%, 20%, and 33.33% of patients. The studies involved finding frenular chordee in children "undergoing" routine circumcision, ritual circumcision in range of ages, or to treat male dyspareunia. You might have read these before blocking my presentation:[22]

To save time, here's the text from the above link ... “Twenty of 75 male children undergoing elective circumcision demonstrated a ventral glandular chordee produced by an unusually prominent frenulum. Surgical incision of this prominent band of tissue relaxed the glandular traction (chordee), more adequately exposing the ventral inner prepuce, facilitating skin incisions, and permitting an improved cosmetic and functional outcome.”

Here’s second important text and link:

"The cohort involves 480 recent Russian immigrants who requested a bris (ritual circumcision). They ranged in age from 11⁄2 month to 66 years. Their mean age was 23.8 years. The circumcisions were performed on an outpatient basis under a local anesthetic. The following are their pre-bris findings: Table 1 identified the following according to the mohel: 85 had phimosis; their prepuce could not be retracted unless forced or dilated. Two adult patients came in for a bris after having developed phimosis secondary to inflammation and infection. (Phimosis in adult uncircumcised males has previously been noted by Whelan.1 He reported that 25/48 [52%] had phimosis and in 10/48 [20%] of the cases it caused secondary pain during coitus. In our cohort 85/480 [17.7%] had phimosis.) 160/480 had a tight frenulum that bent the glans, 160/480 had a tight frenulum that bent the glans upon erection, forming a frenular chordee also known as glandular or skin chordee. (Frenular chordee can cause dyspareunia secondary to pain during coitus. Such findings have previously been noted. Griffin and Kroovand2 found (20/70) a 28.5% incidence of frenular chordee. Whelan1 found (10/48) a 20% incidence of short frenulum (frenular chordee). In our cohort we found (160/480) a 33.3% incidence of frenular chordee. By lysing the frenulum during the bris, the condition was relieved.[23]

8. I'm sorry that you feel that the medical associations' statements are propaganda, and you're entitled to hold that belief, but it's a very poor argument for deleting what they have to say.

My primary concern is that the current “Sexual” does not summarize the main article, and does not reflect a meaningful body of knowledge for those readers who don’t want to delve further.

The thrust of the paragraph is propaganda, because it presents very dated research of questionable relevance. The paragraph closes with that dubious statement…"no valid evidence,” which defies facts as presented in the main article.

I propose moving the Sexual Effects article up onto the front page, and put the table on it’s own page. Surgery on a sexual organ, but Wiki/Circumcision currently devotes about 2% of it's space to sexual issues. Wiki devotes 32% on "benefits," and 9% on risks. Jakew, do you not think that is biased?

I propose putting the Assoc. statements into those boxes … like the other assoc. statements (I tried to, but messed up the commands? … what to type … to achieve the format).

10. I don't know the context of your complaint. When and where did I 'force' you to remove this? I do know that you kindly posted lengthier quotes from that source at User talk:Jakew#Frenulum quotes, and in our following discussion I explained that I felt you were misinterpreting the authors. Jakew 21:25, 19 January 2007 (UTC)

From our discussion you mentioned above: “The full quote from Hass (two paragraphs) in Hass K., Hass A. Understanding Sexuality, St Louis: Mosby, 1993: 99-100). For other readers, note that this is a UCLA sexuality textbook:

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

“The entire penis responds to stimulation, but at least two other areas are sources of distinct pleasure. The underside of the shaft of the penis, meaning the body below the corona, seems sensitive to gentle friction. Another site is the base of the penis. Some men report that they can be brought to orgasm by them or their partner circling the base with their fingers and stroking.” Hass K., Hass A. Understanding Sexuality, St Louis: Mosby, 1993: 99-100

Jakew forced the removal of the paragraph (citing frenular sensation) from the Circumcision Topic, and forced me to remove this sentence: The “underside of the shaft of the penis, meaning the body below the corona” is a “source of distinct pleasure.” And forced the resulting very diluted paragraph to be placed only on the frenulum page.

Note that in presenting frenular/sexuality evidence, I would also like to provide a link to a vib stim manufacturer, where they show a picture of exactly where you apply the vibration’’’ to best elicit ejaculation. The center of the applicator can be seen to be right over the middle of the frenular delta, and ranges up to below the edge of the corona and down an equal distance.

That sentence is highly relevant, and Jakew’s removal of that sentence quite unconscionable. At least some of that “body below the corona”...a “source of distinct pleasure”...is removed during US gomco clamp circumcisions. See the picture showing optimal vibratory location and a picture of a typical (you can pick it jakew) showing the typical location of the US hospital circ scar ... he's missing part of the frenular delta.

We can let the reader decide if missing your frenulum and/or delta means anything sexually (once properly noted as erogenous based on already agreed on citations), instead of drawing obvious conclusions (a compromise ... otherwise the real nutcases will go really nuts).

Jakew ... I also found your behavior regarding the deletion of highly relevant text from the Australiasia statement to be improper[24]. Here's the link to the Association website and text[25].TipPt 00:02, 21 January 2007 (UTC)

The significance of the frenulum and ventral surface of the penis

Snellman L.W., Stang H.J. Pediatrics. 1995; 95: 705­8.

Prospective evaluation of complications of dorsal penile nerve block for neonatal circumcision.

OBJECTIVE. To evaluate the complications of the dorsal penile nerve block (DPNB) when used for routine neonatal circumcisions.

METHODS. All male newborns born in a community hospital between November 1, 1989 and August 31, 1990, and circumcised after DPNB were evaluated. Questionnaires were completed at the time of hospital discharge and at a health supervision visit 2 weeks later.

COMMENT:

... "While dorsal penile nerve block lessens the pain and cortisone response, it is not eliminated completely. Some have anecdotally claimed a high failure rate of the anesthetic. Theoretically, the block should be effective. One possible explanation for the apparent failures is that the ventral surface of the penis may not receive a complete block. The highest concentration of nerves in the penis is located in the frenulum on the ventral surface of the penis. The severing the frenulum may be responsible for this pain breakthrough as well as most bleeding complications, meatal stenosis, and urethral fistulae.

The above study sheds light on the relative intensity of frenular sensation.

We need to add information on proper anesthesia (looks like you need to use all three methods ... cream, dorsal block, and ring).TipPt 23:22, 20 January 2007 (UTC)

We discuss anaesthesia briefly, in the section entitled "The procedures of circumcision." Do you think it should be expanded and/or moved into its own section? Jakew 16:10, 21 January 2007 (UTC)

Expanded in Procedures. Also presented in Sexual.

I've a recent study basically says EMLA and Ring Block are needed.

We should show in Procedures this study[26] ... why doctors choose to not use any local. It adds info needed in the Risks section as well.TipPt 16:53, 21 January 2007 (UTC)

Please see reference 17. We already cite that study.

I've no objection to a little expansion of the anaesthesia text. I suggest proposing changes on this page first, so that we can all work on the text. Jakew 17:17, 21 January 2007 (UTC)

We only cite less important information from that study. "Procedures" should present research into optimal locals.TipPt 17:59, 21 January 2007 (UTC)

"Risks" should include mention that many doctors choose to not use a local due to feared complications. "Risks" should also include discussion of the fact that most circs are down without a local; thus pain is a complication.

Most important ... Will you help include this sentence in the "Sexual" section? "The highest concentration of nerves in the penis is located in the frenulum on the ventral surface of the penis. The severing the frenulum may be responsible for this pain breakthrough"TipPt 17:46, 21 January 2007 (UTC)

Circumcision is bad for women

An article in the New Zealand Medical Association website[27]

"Women reported they were about twice as likely to experience orgasm if the male partner had a foreskin.4"

..."women who had experienced coitus with both intact and circumcised men preferred intact partners by a ratio of 8.6 to one.4"

..."more likely to have experienced vaginal dryness during intercourse with circumcised than with genitally intact men χ2 (df = 1, n = 20) = 5.0, p <0.05.5".TipPt 23:33, 20 January 2007 (UTC)

I can think of studies with different findings (plus a few others), so I don't think that the firm conclusion in your subject line is justified. I suggest that we locate and identify as many relevant studies as we can, and discuss them at Talk:Sexual effects of circumcision with a view to adding them to that in-depth article. Jakew 16:15, 21 January 2007 (UTC)

I know how to write it honestly, and that NZMA studies summary needs to be on the front page.TipPt 16:38, 21 January 2007 (UTC)

Just find what you can, I'll do the same, and we'll work together on writing it up for inclusion. But I really think that it belongs in the in-depth article. Jakew 16:43, 21 January 2007 (UTC)

That NZMA article needs to be introduced on the first page ... "There are few studies on sexual partner preference for penises with or without foreskins, and the results are varied. The intromission function of the foreskin may facilitate penetration and vaginal wetness.[28][29]" In the main article you can delve into your reservations.TipPt 17:55, 21 January 2007 (UTC)

Yeah I agree, an article such as this can not be left out. It should be added to the page as soon as its issues, if any, are worked out. - James xeno 10:48, 30 January 2007 (UTC)

The current "Sexual" is primarly about the Glans

Note that Jakew is up for Admin Status [30]

The current Circumcision topic devotes about 2% of it's text to sexual issues. That discussion does not include any mention of the frenulum, though between 20% and 33% of circs include a frenectomy.TipPt 23:44, 21 January 2007 (UTC)

The bolded text in the current version refer to the glans! That's about all there is in the whole paragraph on Sexual Effects. There's anecdotal, but Masters. It is propaganda.TipPt 00:26, 21 January 2007 (UTC)

Sexual

The American Academy of Pediatrics states "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men." The American Academy of Family Physicians (AAFP) states "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction." —The preceding unsigned comment was added by TipPt (talk • contribs).

TipPt, what did the AAFP mean by "valid" evidence? Is it not possible that they mean "nothing conclusive?" We don't actually know. Even if we were sure if was propaganda, that's not grounds for deleting the text, because of the authoritative nature of the source. Jakew 16:21, 21 January 2007 (UTC)

The paragraph ends up being fairly misleading. Sexual should summarize the main article, and it does not. At least, the Statements should be in their own lil boxes.TipPt 16:35, 21 January 2007 (UTC)

First, I'll put the quotes in the boxes (give me a few minutes)

Second, why don't you find the published article that best approximates your view, and we'll include a brief quote as an alternative view ("However, X argues that...")? Jakew 16:41, 21 January 2007 (UTC)

Thanks for putting Assoc in boxes.

In Sexual, we should present nerve types in the glans versus the frenulum and corona, and their known sensation profiles. For example [31]. Basically, the glans is innervated with free nerve endings and Pacinian Corpuscles ... good at sensing pain, heat, cold, and pressure, respectively. Miessmer Corpuscles (touch) predominate in the corona and frenular delta. Let the reader assume (or not) the relevance to sexual sensation.TipPt 18:26, 21 January 2007 (UTC)

In Sexual, we should also present the vib stim citations, circ anesthesia pain breakthrough, and the UCLA textbook frenulum and vernal body ("the body below the corona") sensation quotes. It's not "my view". Let the reader decide the sensation value of the frenular zone based on known nerve types, respected textbook quotes, and studies.TipPt 18:14, 21 January 2007 (UTC)

Sexual Effects ... Deleted by Jakew

See belowTipPt 03:14, 22 January 2007 (UTC)

Usually it's better to throw it against the wall and see what sticks...

But lets try discussion. Here's what I'd like ... so far ... in Sexual Effects:

Proponents of genital integrity (see pages eleven through thirteen in[32]) condemn circumcision, emphasizing the resulting loss of sexual sensation. Circumcisions may reduce the size of the frenular delta, or include a frenectomy. Frenectomy was documented in 26.7%, 20%, and 33.33% of circumcised patients[33][[34]. One researcher states that "the highest concentration of nerves in the penis is located in the frenulum on the ventral surface of the penis"[35]. The frenulum and the associated tissue delta on the underside of the penis below the corona has been described in sexuality textbooks as "very reactive," and "particularly responsive to touch that is light and soft." The “underside of the shaft of the penis, meaning the body below the corona” is a “source of distinct pleasure.” Crooks and Baur observe that "Although the entire glans area is extremely sensitive, there are two specific locations that many men find particularly responsive to stimulation." One is the corona, and the other is the frenulum. The frenulum, sometimes together with the glans, can be stimulated to produce orgasm and ejaculatory response.

There are few studies on sexual partner preference for penises with or without foreskins, and the results are varied. Some have argued that the foreskin may have an intromission function, facilitating penetration,[36] or that circumcision may decrease vaginal wetness and orgasm in female partners.[37] Sadovsky, noting a preliminary study that found decreased erectile function and penile sensitivity but increased satisfaction after adult circumcision, argued that research on adult circumcision, sexual function, and satisfaction should not be generalized to neonatal circumcision. [38]

The American Academy of Pediatrics states:

A survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men.

— Circumcision Policy Statement, American Academy of Pediatrics

The American Academy of Family Physicians (AAFP) states:

The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction.

— Circumcision: Position Paper on Neonatal Circumcision, American Academy of Family Physicians

—The preceding unsigned comment was added by TipPt (talk • contribs).

Mogen clamp and mohels

Is it really true that all mohels use Mogen clamps, as stated in the article? Ciotog 07:02, 22 January 2007 (UTC)

Changed "all" to "some", as http://www.circumcision.net/clamp.htm indicates that it's not common (although the website does indicate strong bias) Ciotog 19:27, 22 January 2007 (UTC)

BMA link

I've asked Avi to fix all the BMA citation links that end up blanks... s/b http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision

Anyone else know how ... otherwise tomorrow I'll add a bunch of old fashioned links.TipPt 17:46, 22 January 2007 (UTC)

Done. They are all tied to the first mention when using named ref's, and if that one is deleted, we get a bunch of blanks. -- Avi 18:25, 22 January 2007 (UTC)

Work in progress ... Proposed Sexual Effects intro paragraph

Potential sexual effects of circumcision are debated, and study results vary. Proponents of genital integrity argue that circumcision and frenectomy cause sexual harm, citing research into glans keratinisation, damage to, or loss of the frenulum, and loss of stretch potential and nerve receptors in the foreskin and frenulum.[39] Snellman and Stang, conclude that "the highest concentration of nerves in the penis is located in the frenulum on the ventral surface of the penis"[40] in researching anesthesia and pain breakthrough, and semen gathering in men with anejaculation relies on vibratory stimulation of the frenulum, sometimes together with the glans, to produce orgasm and ejaculation.[41]TipPt 17:33, 24 January 2007 (UTC)

That's a start, but you've got way too much emphasis on your own arguments re the frenulum. Concentrate on summarising the first source, then we'll work on neutrality. Also, this is not an intro paragraph, it's not the mainstream view (as expressed by the medical organisations) and belongs as a "however" at the end of the section. This means it needs to be concise to avoid placing undue weight on the arguments. Jakew 18:33, 23 January 2007 (UTC)

I suggest the following:

Boyle et al, however, state that circumcision is harmful. They argue that keratinisation of the glans and loss of stretch receptors in the foreskin and frenulum cause a reduction in sexual sensation.[42]

Please note that I've changed the URL to point to the version that was published in the Journal of Health Psychology.

In order to avoid undue weight, this paragraph should replace the paragraph that is currently at the end of this section. Comments? Jakew 19:26, 23 January 2007 (UTC)

Boyle alone makes no sense. What I presented was written by four well known genital integrity (GI) proponents. It's their argument. I then list two related frenular sensivity research conclusions.

We have potentially several aspects of Sexual Effects to cover. So far, partner studies, and male innervation loss/response studies. Each will require it's own paragraph or section. The Assoc. quotes should follow. You know I hope to bring some of the "main" article information up to the front, and add anatomical research.

Your talk about "undue weight" is unfounded. Sexual effects of excision tissue from an erogenous organ ... we could logically devote 1/4 of the topic to this section; with the topic covering religious/cultural, medical, sexual, and statistics about equally. In the light of the extremely heavy emphasis you currently place on what lay folk might consider "benefits" your undue weight comment is spurious.

I'll present the mainstream GI argument and related studies and statements, and you present mainstream medical assoc statements and related studies and statments. We need an opening paragraph, which I have rewritten above.TipPt 17:33, 24 January 2007 (UTC)

Tip, please look at the Boyle et al paper. The authors are the same as "four well known genital integrity (GI) proponents," the title is the same... Need I go on? :-)

Next, the main article for sexual effects is the sexual effects of circumcision article, and that is where detailed discussion belongs. It does not belong here. In this article, we give a brief summary. We (obviously) include the findings of the AAP and AAFP. We can summarise the arguments of genital integrity proponents, as stated by Boyle et al, as an alternative view, but to avoid undue weight this should be kept short. Detailed discussion, as I say, belongs in the main article.

As for your other comments about undue weight, please take a look at, for example, the AAP's policy statement. Count the paragraphs devoted to sexual aspects, risks, and benefits. Now compare this to the article. You'll find the percentages are fairly similar. Jakew 19:25, 24 January 2007 (UTC)

Let me try to explain better.

1. We have two (relevant) articles. One is about circumcision in general, the other is specifically about the sexual effects of circumcision.
2. Now, it is pointless to exhaustively discuss the same facts twice. It makes sense to discuss briefly in one place, and then in depth in another. Given the article names, it is obvious which is which.
3. Since this subject is hard to summarise without violating NOR, it makes sense to make use of reviews. We include the findings of two evidence-based reviews (AAP and AAFP).
4. I don't see a problem with summarising another review (Boyle et al) from circumcision opponents.
5. If we go into detail about specific claims, however, then we would be giving undue weight to those arguments.
6. To satisfy WP:NPOV we would have to include studies finding the opposite. What we would end up with is effectively a duplicate of sexual effects of circumcision. This brings us back to 2.
7. Logically, therefore, the choice is between citing Boyle and not citing Boyle.

I hope that helps. Jakew 19:58, 24 January 2007 (UTC)

I wish you would write more text.

Take a look at the length of sexual issues in female circumcision.

I like the pdf link because we should reference the page numbers, and it's an accredited university website not cirp[43]

We can categorize them as proponents of GI because they all are active in organizations promoting anti-circumcision information, law, and legislation. Their statements on pages 10 - 13 are fairly represented, and there's one sentence which serves to evidence validity to their views. The AAP and AAFP cited studies. I don't make any argument.

You come up with whatever other side you want. If you want to take the assoc statements out of those lil boxes, that's ok. See below.TipPt 01:55, 25 January 2007 (UTC)

(unindenting) Tip, female genital cutting is a different subject, involving different procedures and different anatomy. Many sources place different emphasis on the two. Consequently the shape of the two articles is different. In the case of (male) circumcision, it got to the point where it was so large that it needed to be divided into smaller articles. Maybe that will happen to female genital cutting one day. I don't know.

I think you make a fair point about the Bond University pdf link.

As for the sentence describing their views, I don't mind if you want to expand on it a little. But please describe arguments that they actually make. Jakew 10:28, 25 January 2007 (UTC)

Actually, women tell me that their most erogenous point is right where their hood attaches to the clitoris. Sexual effects (sensation) of removal of that union point may be similar. You also know the degree of a circ ranges dramatically...some routinely perform a meatodomy. Note there is a credible account of a man having his glans cut off, and stating it still felt just as good. Anyway, what's below isn't too long or in-depth.

History suggests that the Circumcision topic outline and emphasis mirror an Irish med assoc statement on circ. The AAP and AAFP are similar. I don't see why their format should fix Wiki's.

The GI's introduce the argument that the frenulum is sensitive (and stretch and...). All I do is include two studies that support their contention. I don't even make the link explicit.

It's only a short paragraph. It really should be proponents of GI....TipPt 16:09, 25 January 2007 (UTC)

Tip, what you're doing is introducing two studies that do not discuss the sexual effects of circumcision, and using them together in a different context to support the contention of Boyle et al.

-- WP:NOR

See the problem?

Now, this is why I'm asking you to simply summarise what Boyle et al say. Leave analysis and synthesis of published arguments to these authors - just describe what they said. Jakew 16:26, 25 January 2007 (UTC)

Boyle et al argue that the frenulum is sensitive. That enables me to present the two studies ... that support their contention. I make the link more explicit in the first sentence.TipPt 15:47, 26 January 2007 (UTC)

We don't do so with the AAP or the AAFP's review, and we have no need to do so with Boyle's. Describe Boyle's argument instead. Jakew 16:25, 26 January 2007 (UTC)

Undent... You could if you wanted to with the AAP AAFP. You do not determine reader "need." I am simply enhancing Boyle's argument with directly related research.TipPt 16:35, 26 January 2007 (UTC)

Here's the new paragraph:

Boyle et al, however, argue that circumcision and frenectomy remove tissues with “heightened erogenous sensitivity,” stating “the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings.” Snellman and Stang, in researching circumcision anesthesia and pain breakthrough, conclude that "the highest concentration of nerves in the penis is located in the frenulum on the ventral surface of the penis,"[44] and semen gathering in men with anejaculation relies on vibratory stimulation of the frenulum, sometimes together with the glans, to produce orgasm and ejaculation. Boyle et al claim that damage to, or loss of the frenulum, and loss of stretch potential and nerve receptors in the foreskin and frenulum result in “an inevitable reduction in sexual sensation,” which may “restrict a circumcised man’s ability to achieve arousal.”(pages 10 - 13)TipPt 16:44, 26 January 2007 (UTC)

Policy does determine what we can and cannot do. Boyle et al cited and analysed several studies in the context of their assertion. For example, they stated "The complex innervation of the foreskin and frenulum has been well documented (Cold & McGrath, 1999; Cold & Taylor, 1999; Fleiss, 1997; Taylor et al., 1996)".

They did not cite Stang and Snellman's (1995) study. Nor did Stang and Snellman make this statement in the context of sexual effects. The idea that S&S supports Boyle's claim is an unpublished argument.

This is why I'm saying describe Boyle's arguments. Expand the paragraph a little, but stick to arguments that those authors actually made. Jakew 17:04, 26 January 2007 (UTC)

I've added the relevant part of Boyle's conclusion to that paragraph. Jakew 17:13, 26 January 2007 (UTC)

I'm not disputing NOR. I'm disputing that you determine the readers' need to know.

Boyle argues the frenulum is sensitive, and show supporting research. Their argument enables me to provide the reader other related frenulum sensitivity research. This approach is very common in Wiki. How else could Wiki incorporate new research into any topic argument? I am not creating or changing their argument.TipPt 16:17, 30 January 2007 (UTC)

I am not taking Stang and Snellman out of context. The context is frenular sensitivity, which they address.TipPt 17:56, 26 January 2007 (UTC)

First, it is not more recent. Stang and Snellman's study was published in 1995. Boyle's paper is dated 2002. Second, as I keep explaining, Stang and Snellman did not discuss sexual effects. If they had, it might belong in the sexual effects of circumcision article, but they didn't. We cannot reinterpret their words in a different context. Third, even if it were otherwise, the summary in this article needs to be short and must avoid giving undue weight. As I explained above, two medical organisations' reviews and a review by GI proponents achieves that, but a detailed discussion does not. Jakew 18:20, 26 January 2007 (UTC)

(Outdenting) A quick reading here implies to me, Tip, that you are engaging in original synthesis. Even if it is extremely obvious to you that A implies B, unless someone says explicitly that A implies B, for you to bring A and B and say that there exists a syllogistic relationship between them is unfortunately against wiki policy. Saying "their argument enable me to provide…" seems to just underscore this point. This approach is actually NOT common in Wiki, and needs to be removed in the places that it exists, as it is in direct violation of one of our main, major policies. For better or for worse, that's life here in wiki. One upon a time I too made that error, and thankfully it was pointed out to me as well. -- Avi 18:27, 26 January 2007 (UTC)

Look, I hate seeing what appears to be editing and reverting, editing and reverting. I do agree that synthesis is not allowed. However, it is possible, with work, that the additions that TipPt is adding could be worked through. I created a place that he can make a copy of the article, make all the edits he desires over a period of time until he works things out, hopefully with contrusctive comments from others, and then we can discuss consensus for that new version after it is polished?? Atom 19:39, 26 January 2007 (UTC)

Both forms of anaesthetic

TipPt, I think you really need a source for this: "Adult circumcisions often utilize both a general and local anesthetics." Did you mean "either a general or a local" by any chance? Jakew 18:54, 23 January 2007 (UTC)

I've got to go to the library again ... it's common practice in the US to use both general and a ring block. Pain breakthrough ... "he came off the table when I cut the frenulum" is to be avoided.TipPt 15:23, 24 January 2007 (UTC)

Sexual

Main article: Sexual effects of circumcision

The American Academy of Pediatrics states "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men." The American Academy of Family Physicians (AAFP) states "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."

Boyle et al, however, argue that circumcision and frenectomy remove tissues with “heightened erogenous sensitivity,” stating “the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings--many of which are lost to circumcision.” Snellman and Stang, in researching circumcision anesthesia and pain breakthrough, conclude that "the highest concentration of nerves in the penis is located in the frenulum on the ventral surface of the penis,"[45] and semen gathering in men with anejaculation relies on vibratory stimulation of the frenulum, sometimes together with the glans, to produce orgasm and ejaculation. Boyle et al claim that damage to, or loss of the frenulum, and loss of stretch potential and nerve receptors in the foreskin and frenulum result in “an inevitable reduction in sexual sensation,” which may “restrict a circumcised man’s ability to achieve arousal.”(pages 10 - 13)

Some have argued that the foreskin may have an intromission function, facilitating penetration,[46] or that circumcision may decrease vaginal wetness and orgasm in female partners.[47] Sadovsky, noting a preliminary study that found decreased erectile function and penile sensitivity but increased satisfaction after adult circumcision, argued that research on adult circumcision, sexual function, and satisfaction should not be generalized to neonatal circumcision. [48]TipPt 16:46, 26 January 2007 (UTC)

Genital Integrity organisations

I have added links to several genital integrity organisations to give interested readers access to a range of approaches in the genital integrity movement. While all genital integrity organisations oppose involuntary circumcision, only some explicitly call for legal prohibitions against infant circumcision. Michael Glass 00:40, 30 January 2007 (UTC)

New Intro paragraph to Medical Aspects

Anyone think of a better section title? Medical costs and benefits? It's not why most circ's are done, so I guess aspects is ok.

I put a proposed new intro paragraph into medical aspects hereplace. Note that Ganiats found net costs to circumcision ... both longevity and financial.TipPt 17:19, 30 January 2007 (UTC)

do women like uncut or cut men more?

I am a man who was wondering what womens opinions were any women out there? —The preceding unsigned comment was added by 24.105.199.23 (talk) 04:22, 31 January 2007 (UTC).

I prefer uncut, if I wanted something that functions just like a cut one I'd just buy a dildo. —The preceding unsigned comment was added by 201.23.32.2 (talk) 20:17, 9 February 2007 (UTC).

Jakew's back reverting....

Here's two sections where content has been lost:

Boyle et al, however, argue that circumcision and frenectomy remove tissues with “heightened erogenous sensitivity,” stating “the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings.” Snellman and Stang, in researching circumcision anesthesia and pain breakthrough, conclude that "the highest concentration of nerves in the penis is located in the frenulum on the ventral surface of the penis,"[49] and semen gathering in men with anejaculation relies on vibratory stimulation of the frenulum, sometimes together with the glans, to produce orgasm and ejaculation. Boyle et al claim that damage to, or loss of the frenulum, and loss of stretch potential and nerve receptors in the foreskin and frenulum result in “an inevitable reduction in sexual sensation,” which may “restrict a circumcised man’s ability to achieve arousal.”(pages 10 - 13)

Becomes (thanks to Jakew):

Boyle et al, however, argue that circumcision and frenectomy remove tissues with “heightened erogenous sensitivity,” stating “the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings.” Boyle et al claim that damage to, or loss of the frenulum, and loss of stretch potential and nerve receptors in the foreskin and frenulum result in “an inevitable reduction in sexual sensation,” which may “restrict a circumcised man’s ability to achieve arousal.”(pages 10 - 13)

The reader looses valuable information that has been properly introduced.TipPt 19:00, 3 February 2007 (UTC)

See above section entitled #Work in progress ... Proposed Sexual Effects intro paragraph Jakew 19:28, 3 February 2007 (UTC)

Don't bother; he hasn't added anything new there for a long time.TipPt 14:54, 4 February 2007 (UTC)

Jakew messing with pain as a risk of circumcision...

Pain is a potential risk of circumcision:

“Overwhelming” evidence exists that neonatal circumcision is painful [50], but according to a 1998 study, 45% of physicians used anesthesia for infant circumcisions. Among physicians using anesthesia, 85% use dorsal penile nerve block, but dorsal penile nerve block alone may not provide complete analgesia. Newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores, and EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture. Stang et al states that "performing a circumcision on a newborn without using anesthesia is justified, only if one would be willing to perform a circumcision on an older child or adult without anesthesia."

Jakew makes the paragraph:

Razmus et al reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores, and Ng et all found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture. Stang et al argues that "performing a circumcision on a newborn without using anesthesia is justified, only if one would be willing to perform a circumcision on an older child or adult without anesthesia."

Does the reader learn that only 45% are provided anesthesia for an extremely painful procedure?TipPt 19:13, 3 February 2007 (UTC)

Assuming the reader is awake, (s)he will already be aware of the study reporting the 45% figure, since it is included in the section entitled 'the procedures of circumcision'. To repeat it is repetition. Moreover, performing an original synthesis of studies to advance a point is not allowed. This case is a particularly blatant example of original research: combining one author's opinion that evidence is overwhelming with a finding in a different study that a certain proportion of physicians use anaesthesia. Jakew 19:27, 3 February 2007 (UTC)

You assume the reader didn't jump to read risks, where pain needs representation. Procedures is a joke, but I ~like it that way ... thinking readers will look into techniques at other websites.

Your revision version is a joke. Pain is a risk of circumcision. You must cite anesthesia not being provided, or you are a fraud.TipPt 14:50, 4 February 2007 (UTC)

How's this...

Lander’s, in researching neonatal circumcision without anesthesia, found that without exception, newborns in this study who did not receive an anesthetic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk. Two of 11 newborns in the study who received no local anesthetic had potentially dangerous episodes within minutes of the procedure. One newborn lost muscle tone, stopped breathing several times and vomited. The other choked and stopped breathing briefly.[51] According to a 1998 study, 45% of physicians used anesthesia for infant circumcisions. Among physicians using anesthesia, 85% use dorsal penile nerve block, though newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores, and EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture. Stang et al states that "performing a circumcision on a newborn without using anesthesia is justified, only if one would be willing to perform a circumcision on an older child or adult without anesthesia."TipPt 15:15, 4 February 2007 (UTC)