Talk:Medical analysis of circumcision

Looks ok to me

Even though the article is disputed, having read it in full, I would say that it reflects current medical thinking. Where is the bias? --Dumbo1 14:34, 20 Sep 2004 (UTC)

12.24.47.10

Regarding the smegma/HPV claim inserted by an anonymous user: Cite a source, please.—Eloquence 11:16, Aug 19, 2003 (UTC)

As announced, I have incorporated what I consider useful edits by User:12.24.47.10, in spite of his strong bias in favor of circumcision and his repeated attempts to remove critical information. On the edits which I have not included in my revision:

All vs. many major medical groups -- if you claim that a major medical group still recommends routine infant circumcision, cite it. I have searched and have not found any.
Balanitis can occur in both circumcised and uncircumcised men, and according to Van Howe [1], is actually more common in circumcised men. Preputial adhesions are one of the causes of phimosis but generally harmless. You have your terminology very confused.
Studies showing a prevalence of phimosis among uncircumcised boys are hardly relevant since we know already that phimosis is a condition of the foreskin -- by definition, it cannot occur in fully circumcised males.
The number of circumcised/uncircumcised men in the dermatological study is irrelevant as long as we do not know the circumcision rate in the control group, which is not listed in the abstract.
The US army report is of little interest because the quoted paragraph is only opinion, no hard data. The actual hard data (number of hospital admissions) is not correlated with circumcision.
Dr. Dagher's statement is hardly relevant as it contains no hard data but only opinion. This would be interesting if Dagher represented a major medical association, which is not the case.
The Danish study on cervical cancer [2] found no statistically significant increased risk because of circumcision: "Other potentially important factors, although not statistically significant, were .."
The Ginsburg/McCracken study on UTIs is hardly relevant (nor is Schoen's personal opinion on the matter) [3], as CIRP notes: "Parkland Hospital is a public hospital that serves a large urban population. At the time that this study was carried out, Parkland Hospital had a policy of refusing to do circumcisions even if requested. The hospital's client population of young male infants, therefore, would have been almost completely non-circumcised. Ginsburg and McCracken's observation that only 5 percent of male infants were noncircumcised, therefore, should not be surprising and may not indicate that noncircumcised infants get more urinary tract infections."
Some of your text was lifted straight from the medicirc website, such as the following paragraph. This makes me suspicious of all of your additions -- we have a strong policy against copyright infringements, so please do not copy material from other sources.
- Uncircumcised men were first shown to be more likely to acquire heterosexual HIV infection over a decade ago, in articles in the leading medical journals "Lancet" and "New England Journal of Medicine". Since then over 40 separate studies have shown that uncircumcised men are more likely to become infected with HIV on heterosexual exposure. The ease with which the foreskin tears during intercourse, leaving mini-abrasions through which the virus enters, can lead to the infections. It has recently been shown that certain specialized cells in the foreskin, Langerhans cells, can trap the HIV virus and promote infection.
Your long list of studies that show a HIV correlation is of little help -- we could inflate the article with a discussion of dozens of studies. Obviously, you are prone to selection bias and only present those studies which match your preconceived belief that circumcision is useful -- you entirely ignore those studies which found no link or even a higher risk of HIV for circumcised males. We could inflate the article by discussing all the 40+ studies on HIV/circumcision, but it makes more sense to simply give an overview, as the present version does, and present some of the methodological criticisms.
Citing HIV/AIDS data for more countries is of no relevance -- circumcision opponents do not claim that the higher AIDS rates in industrialized countries which circumcise disprove the hypothesis, they say that they merely show that behavioral factors are much more important.
The "large outcry" argument hardly merits inclusion since there was no "large outcry" against many other questionable medical procedures such as lobotomies or genital surgery to prevent masturbation for many decades. Furthermore, you have not provided the source for the statistical comparison (1 in 4500). That circumcision is a riskier procedure when not done with proper medical equipment is hardly a matter that is open to discussion.

Your attempts to remove countless studies which do not match your belief system will of course not be tolerated. The present version incorporates those edits of yours which were reasonably neutral, so if you persist in back and forth reverting the article, I will request for the page to be protected.—Eloquence 01:38, Aug 28, 2003 (UTC)

Oh, Eloquence. You have have strayed so far from NPOV. Yet, I have included much of your additions and replaced much of your deletions. I include citations and you remove them. Why? You place long quotes from your sources yet you think no copyright issue obtains...why do you think a small quote from medicirc constitutes one? Your deletions are more in the nature of someone trying to prove a point. I have deleted some of your assertions that are unsupported by any cite. As for "All" versus "Most", do you have a cite that "ALL" is correct? Isn't is more likely that "Most" is correct because you don't know who all is out there, albeit you'll think they are biased: the Egyptian Urology Association or its Israeli counterpart perhaps?

You claim to be "Eloquence" but in reality you are hide-the-ball. Your cites to circumstitions and cirp sites are inappropriate, because the unadulterated articles are not to be found there...only the anti-circumcision editorialized ones. You should be ashamed....and speaking of copyright where's your righteous indignation, dude? 12.24.47.10

You have failed to respond to the points above. If you continue to revert the page to your less neutral revision, I will ask for it to be protected. As for the copyright issue, fair use of quotations is not a problem as long as they are properly labeled as such. If a quotations is presented as your material, it becomes a copyright violation and fair use is no longer applicable. It will be hard to even argue with you as long as you 1) continue to remove facts which you do not like, 2) continue to add silly nonsense like the list of people who are circumcised or a bunch of AIDS studies which you selected (see above).—Eloquence 01:01, Aug 29, 2003 (UTC)

You are just wrong. Why do you delete the AIDS rates studies that show that in Africa circumcision rates are closely associated with lower AIDS rates?

Why do you want to obscure (or ignore) the fact that there is a large body of scientific literature that demonstrates that circumcision protects against the heterosexual (esp. female to male) transmission of AIDS?

Why do you cite to biased sources written by people without any scientific background?

Why do you insist on using terms like "mutilated" "intact" and the like which are not NPOV?

Why do you totally misunderstand copyright law?

Why do you keep deleting material that you don't agree with?

Why do you want to hide the fact that many of the anti-circumcision forces are led by people advocating the homosexual rights movement? Discrimination on your part? Or shame? 12.24.47.10

1) I have explained why listing individual AIDS studies is pointless above. There are studies which found a positive link, a negative one, or no link at all. It makes no sense to list them all, and you obviously only list the ones which match your bias. We can play this game endlessly, but it makes more sense to list the general methodological criticisms of this research and its current state. As the page notes, the main criticism is that circumcision is not performed randomly -- it is found in cultures with specific rites and hygienic practices, and as such, a link between circumcision and HIV rates is also a link between HIV rates and specific hygienic and sexual practices.

2) Which biased sources written by people without a scientific background are cited?

3) I have never referred to circumcision as "mutilation". Someone else has done so in the main circumcision article, but that was reverted.

4) You are the person who inserted uncredited copyrighted text in violation of US copyright code, not me. Please see fair use and related pages for more information.

5) I do not delete material that "I don't agree with", I delete material that is irrelevant, such as a list of circumcised people. As I have demonstrated, the studies you have cited are actually largely written by people who oppose routine neonatal circumcision.

6) Any alleged links to the homosexual movement are hardly relevant to a medical discussion; they are hardly relevant at all, and require a high standard of evidence which you have not followed. Furthermore, if you want to play that game, I can add links to articles about people who clearly have a sexual fetish for circumcising, about circumcision fans who also advocate female circumcision "for aesthetic reasons" and so on. This is all anecdotal. In any case, do you claim that in European countries, which don't circumcise, there is somehow a higher prevalence of homosexuality? Do you claim that the natural, biologically evolved foreskin is somehow linked to homosexuality? It is much more likely that the cultural practice of circumcision is linked to specific sexual beliefs and patterns rather than that the normal (in 84% of the population) status of the foreskin is linked to any such patterns.

Since you refuse to cooperate on developing this page in a neutral fashion, I will now ask a sysop to protect it. —Eloquence 17:49, Aug 29, 2003 (UTC)

A sysop arrives

(to Martin) Could you act as a neutral mediator for the page Medical analysis of circumcision? An anonymous user is trying to turn this page, and circumcision, into a pro-circumcision propaganda page. To this end, he has removed studies and citations which he did not like, source dumped large amounts of material from pro-circumcision websites, added a list of circumcised people to prove that circumcision is associated with intelligence, claimed that circumcision is linked to homosexual beliefs etc. I have explained specifically why I have not integrated certain of his edits on Talk:Medical analysis of circumcision, but he just keeps reverting to his revision instead of discussing his changes. At this point, I think it would make most sense to protect either my last revision (which integrates those edits from him which I consider neutral) or the one before he started editing the page, in order to make him discuss his proposed changes. I would of course refrain from editing the page as long as it is protected, but back and forth reverting the page is pointless.—Eloquence 18:57, Aug 29, 2003 (UTC)

Hi folks.

Eloquence asked me to intervene in this page as a mediator. To declare my personal biases up front, I was circumcised a few years ago, for medical reasons, I was brought up as a Christian, and am currently a non-militant atheist. I hope, 12.24.47.10, that you will accept me as a suitably impartial third party in this dispute.

I have not read the article yet, and I will now do so and attempt to find a version that can serve as a temporary "protected page" on the subject while we try to resolve this issue.

Thanks for your time,
Martin

Proposal

Hi again. I have attempted to understand the nature of this dispute, based on the edits I see in the history, and this talk page, as well as User talk:12.24.47.10.

I see many disputes here, across a wide range of issues. Looking at the diff between the two conflicting versions, I see that the majority of the article is effected in some way or another. Some of these disputes are over facts, others are over relevance, such as the relevance of certain studies. The large number of disputes is itself a problem in such cases, spreading discussion out over many fronts.

I cannot in fairness simply take the version of either Eloquence or 12.24.47.10 and protect that, as that would express a bias towards either the one person or the other, which I cannot do.

Therefore, I propose the following procedure. Where 12.24.47.10 wishes to change some paragraph, I shall leave that paragraph alone. Where 12.24.47.10 wishes to add a paragraph, I shall add that paragraph, but add an explicit disclaimer that the added paragraph is disputed, either on grounds of fact, or on grounds of neutrality, or on grounds of relevance. Additionally, I intend to place a full copy of 12.24.47.10's version at user:12.24.47.10/Medical analysis of circumcision, so that he can work on it independantly if he so chooses. I trust that both parties will be able to accept that as a temporary cease-fire line while the various issues are resolved.

Then, Eloquence and 12.24.47.10, along with other interested parties, can proceed through the changes, one at a time. I suggest that they work from top to bottom and try to find an appropriate solution that they can both agree with. This will take time and patience on both sides, and I beg the patience of all concerned.
Martin 21:20, 29 Aug 2003 (UTC)

Well, this will result in lots of redundancy (because I have rephrased some of 12.24's sections elsewhere) and a very chaotic article. I would prefer it to discuss the disputed sections individually on the talk page.—Eloquence 21:42, Aug 29, 2003 (UTC)

I propose the following further procedure: I will edit those statements which I think can be integrated without significant changes of meaning. I will move the remaining statements to talk, one by one, and comment on why I think they are redundant/not relevant/wrong. This allows me to whip the article into shape even if 12.24 does not cooperate.—Eloquence 21:58, Aug 29, 2003 (UTC)

That is a good proposal.

However, I ask you to remember that 12.24.47.10 does not spend as much time on Wikipedia as yourself, and therefore you may need to proceed slower than you might otherwise. Martin 22:10, 29 Aug 2003 (UTC)

He'll have all the time in the world to respond, but since this article is probably a frequent Google-target, I would like to make sure that the public revision is reasonably neutral and redundancy-free ASAP.—Eloquence 22:19, Aug 29, 2003 (UTC)

Understood. Martin

A quick note to 12.24.47.10 - please do not reinstate the sections below without replying to Eloquence's detailed comments. Discussion is key to resolving NPOV disputes while avoiding edit wars. Martin 00:04, 30 Aug 2003 (UTC)

Disputed paragraphs and comments

Please indent your comment on the next indentation level respectively using a ":" before the paragraph. The disputed paragraph is always on the first level in italics.

Recent studies from Europe demonstrate the prevalence of balanitis and phimosis due to the low rate of circumcision.

This phrasing is not neutral. First, it generalizes studies with conflicting data. Second, as I have already explained, phimosis is a condition of the foreskin -- it is obvious that it will all but disappear with routine neonatal circumcision.—Eloquence

Doctors at Royal Liverpool Children’s Hospital diagnosed over 100 cases (a 4% rate) of balanitis in a 3 ½ year survey of English boys. (Source: Escala JM, Rickwood AMK. Balanitis. Brit J Urol 1989;63:196-197).

This is now summarized under the heading "Balanitis".—Eloquence

Doctors from the Children’s Hospital, Sheffield found a prevlance of phimosis among uncircumcised English boys. (Source: Rickwood AMK, Hemalatha V, Batcup G, Spitz L. Phimosis in Boys. Brit J Urol 1980;52:147-150).

Not only is this duplicated, it is also wrong. The study, which can be found here, examines 23 boys suffering from phimosis to determine the actual pathology of the condition. It makes no claims of frequency whatsoever. Instead it states that, "The findings of a previous survey (Rickwood, 1977) confirm that phimosis in the pathological sense is rarely seen in pre-school boys. Its aetiology remains obscure." Rickwood at al. have repeatedly criticized routine circumcision, including in their 1980 paper, as a method to prevent phimosis. But this study is of no relevance at all to the circumcision question -- it is only relevant to the aetiology of phimosis.—Eloquence

From the quoted study abstract:

All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosus was diagnosed in only 1 circumcised patient. Most patients with psoriasis, lichenplanus, and seborrheic eczema (72%, 69%, and 72%, respectively) were uncircumcised at presentation. The majority of men with penile infections (84%) were uncircumcised.

While this is interesting data, it is only relevant when related to the sociodemographic data of the community. What is the circumcision rate in the area of referral? We know that the majority of men in the UK are uncircumcised by now, so it should not be surprising that the majority of men with penile infections are uncircumcised. The study works with a control group to obtain its odds ratio, but the data above does not work with the control group. Only the actual odds ratio is statistically relevant, and the abstract does not show if they examined confounding variables like genital washing habits, sociodemographic status, sexual behavior etc. -- which is all different depending on circumcision status. I'll say this many times so you remember it: Circumcision is not performed randomly. If you examine circumcision status, you always have to examine for tons of confounding variables. I can't really judge the scientific value of the study without looking at it, but they want 12 dollars for the DRM protected full text. If you have a copy of the full text, let me know.—Eloquence

A study conducted in Denmark examined 9,545 Danish boys between 6 and 17 years of age, and found that 4% had phimosis, (incidence of 8% among 6 year olds), 33% had preputal adhesions (63% among 6 year olds), and 5% had smegma. (Source: Øster J. Further fate of the foreskin. Arch Dis Child 1968; 43:200-203.)

I have already accurately summarized this study. It does not claim that these are actual medical conditions. Both preputial adhesion and smegma are part of the natural development of the foreskin, and as Øster himself states, these problems disappear at a later age. You are distorting Øster's conclusions by not reporting this.—Eloquence

In "Medical Department, United States Army, Surgery in World War II, Urology", links observed by clinicians in the field were surveyed and compiled. In it, the author notes that “hospital admissions for paraphimosis, phimosis, balanitis, and condyloma acuminata during 1942-1945 totaled 146,793.&;#8221; (Source: JF Patton, Medical Department, United States Army, Surgery in World War II, Urology, p. 145).

The numbers themselves are uninteresting unless they are correlated with circumcision status and checked for confounding variables. Patton's assessment itself is not entirely irrelevant, but mostly outdated (chancroid is of little relevance today, and the beliefs about phimosis as well as treatment methods have been largely superceded by modern knowledge). I have summarized it in the article.—Eloquence 02:05, Aug 30, 2003 (UTC)

Statement by Dagher

Despite overwhelming evidence from urological surgeons that neoplasm of the penis is a lethal disease that can be prevented by removal of the foreskin, some physicians continue to argue against routine neonatal circumcision in a highly emotional and aggressive fashion.

This is pure opinion. Irrelevant.—Eloquence

'Schoen's claim on penile cancer

The evidence that circumcision protects against penile cancer is overwhelming. In the US, incidence of penile cancer in circumcised men is essentially zero (about one reported case every five years)

This is so misleading as to make Schoen completely unreliable. Hitchcock only mentions this briefly in her response but at least on the talk page it deserves greater emphasis. He claims that penile cancer in circumcised men is essentially zero based on the number of published case reports! This is of course nonsensical and fraudulent. Cases will only be reported by doctors who find them interesting and unusual -- most of the time it simply does not matter whether the person in question is circumcised or not, the cancer is treated and the patient either dies or is released. Regardless, I have always included Schoen's claim in my revisions, including the response from Hitchcock.—Eloquence

Circumcision as an indication of elite status

Circumcision is fast becoming a mark of the elite – a status it enjoyed prior to the 19th Century.

Followed by a list of "famous circumcised men". This is not only completely unrelated to the medical analysis of circumcision, it is also extremely silly. Of course you can list many famous and important Americans and Jews here because circumcision is so prevalent in the United States and a Jewish ritual. Anti-circ advocates can list countless famous Europeans, and Americans who were born before circumcision became popular in the US. Indeed, it should not come as a surprise that a nine-page "gallery of famous intact men" can be found on one of the genital integrity websites. Many of these are/were of course part of the elite of their time, refuting the allegation that circumcision is a defining feature of elite status (although it is true that in certain regions, at certain times, it is or was such a feature). As such, this list is completely pointless, here or elsewhere, as it proves nothing and will only lead to similar lists from the other side.—Eloquence 02:13, Aug 30, 2003 (UTC)

Schoen's claims about UTI

On his website, Dr. Schoen, a circumcision advocate, states:

Uncircumcised boys are about 10 times as likely to get serious kidney infections in the first year of life as are circumcised infants; uncircumcised older boys and men are more likely to get UTIs as well. These kidney infections are most dangerous in the first 3 months, during which time they often lead to hospitalization and can result in overwhelming blood infection and other serious infections. Kidney scarring has been shown to occur later. There is concern that future kidney failure and high blood pressure may follow infantile UTIs. Abnormal kidney function and hormonal secretion can occur with infant UTIs. Fecal contamination of the moist inner foreskin layer with bacterial attachment leads to these kidney infections.

These claims are Schoen's interpretation of the present research. Schoen is of course highly biased and unreliable, as we have seen above, and he picks the highest estimates for UTI incidence in intact males instead of the one with the best methodology. Because this is a summarizing statement that does not come from a medical group nor from a methodologically impeccable meta-analysis, it is of no relevance to the article. The cohort study by To et al. is the best designed one I have found so far.—Eloquence 07:33, Sep 8, 2003 (UTC)

Twentieth century doctors once believed that circumcision has no effect on sexual intercourse. That belief, however, is weakening as new evidence of sexual effects accumulates. Medical historians have shown that nineteenth century doctors introduced male circumcision as an intentional sexual injury with the intent of making masturbation impossible. The medical evidence on the effects of circumcision on sexuality are somewhat contradictory. Nevertheless, a pattern is beginning to emerge as more research becomes available.

Can we substantiate any of this? If not, this comes across as POV — the nineteenth-century doctors were maliciously chopping off foreskins, and that only recently has medicine seen the light. Also, this phrasing implies that ALL DOCTORS EVERYWHERE believed whichever; this is a rather absurd generalization that needs some clarification. Finally, the last two sentences are duplicated; we'll need to either remove them from this paragraph or remove the intro paragraph from the "Sexual Effects" section. - jredmond 00:23, 18 Sep 2004 (UTC)

I believe that much of the quoted passage above can be substantiated. However, it would need to be phrased in more neutral language and recast in chronological order. I would start off by referring to the Nineteenth Century doctors who introduced circumcision as a way of curbing masturbation. Then, when circumcision became established doctors began to claim that it had no effect on sexual performance, e.g., as in the Masters and Johnson study. Lately, however, new evidence has been accumulating that suggests that circumcision does have an impact on coitus for both the male and the female. At this point, to give it credibility, every example of impact should be substantiated with a link to further information or studies. Such information should be expressed in neutral language. Now where this could or should be done is a question that I would leave to others. Michael Glass 03:32, 19 Sep 2004 (UTC)

AIDS in Africa

It is quite curious how massively the "circumcision prevents HIV/AIDS" fallacy is promoted, particularly by Halperin and Bailey. Here is a map of HIV adult prevalence in Africa:

File:Aidsafricamap.gif

As you can see, AIDS is clearly most widespread in sub-Saharan Africa. Curiously enough, circumcision rates are higher in the northern countries -- but more importantly, if AIDS had a single epidemiological source in southern Africa, then it would be expected that the disease is most concentrated in the south. It has nothing to do with circumcision -- and it probably has little to do with sex at all. Recent research indicates that heterosexual transmission only accounts for 25-35% of HIV infections -- the majority is from unsafe medical care. Circumcision obviously has nothing to do with it. But that does not prevent charlatans from making outrageous claims about circumcision -- whenever there's a new disease, there's a new disease that circumcision can cure. I will update the article to reflect the flaws in the research.—Eloquence 03:15, Sep 4, 2003 (UTC)

Hmm, that might make a good map for an AIDS-related article. Shame it's only fair use.

Doesn't look like 12.24.47.10 is coming back. Martin 09:02, 4 Sep 2003 (UTC)

Paraphimosis

I would question some of the information in this passage:

Circumcision formerly was the recommended remedy for this condition, which typically arises in teenagers experimenting with sex, but medical treatment with topical steroid ointment has replaced circumcision as the preferred treatment modality.[4] In the NHS of the U.K. it is recommended to patients who wish to retain their foreskin for religious or sexual reasons. A newer, proven, procedure is minor surgery to make a small slit in the foreskin without removing any tissue.[5]

Where is the evidence for this?

which typically arises in teenagers experimenting with sex

my doctor, by mouth, from some NHS database.

or this?

In the NHS of the U.K. it is recommended to patients who wish to retain their foreskin for religious or sexual reasons.

ditto. Martin 13:00, 26 Sep 2003 (UTC)

I believe that this passage would be more accurate if it read:

Circumcision formerly was recommended for this condition but treatment with topical steroid ointment has replaced circumcision as the preferred treatment method in the NHS of the U.K.[6] A newer, proven, procedure is minor surgery to make a small slit in the foreskin without removing any tissue.[7]

Others might be able to suggest further changes to more accurately reflect the relative popularity of these methods of treatment in different countries.

Length of the article

As this article is so long, perhaps it would be the time to consider dealing with matters such as phimosis, paraphimosis, penile cancer. AIDS and circumcision in their own articles and reducing this article to a summary of findings with links to the other articles.

What do other contributors think? Michael Glass 16:34, 4 Sep 2004 (UTC)

Historical information

The topic of this article is a medical analysis of circumcision. The following historical information is interesting, but in my opinion it is not relevant to a medical analysis of circumcision. Also the information is already included in the main Circumcision article.

Circumcision, a religious requirement in Muslim and Jewish traditions, and a cultural practice in some other communities, was taken up by doctors in the late 19th century in several English-speaking countries, often as a cure for masturbation. It never gained popularity in continental Europe, but became more or less accepted in the United States, the United Kingdom and much of English-speaking Canada, Australia and New Zealand.

More recently (first in the United Kingdom and then in other Commonwealth countries), circumcision has become less popular. As this happened, voices of concern were raised in the United States about neonatal circumcision and it is now considered highly controversial by some American medical professionals.

In my opinion the discussion of the history of circumcision should be in the main Circumcision article, not this one. -- DanBlackham 09:59, 5 Oct 2004 (UTC)

Links from introduction

In my opinion the following links from the introduction would be more appropriately located in the sections of the article that discuss penile cancer and complications, instead of the introduction.

Penile cancer: [8][9][10][11][12][13]
Complications: [14]

DanBlackham 09:59, 5 Oct 2004 (UTC)

I've included the penile cancer information in the relevant section. I've also removed lengthy discussions of now irrelevant ancient medical studies, and NPOVd the text, which was obviously written from an anti-circumcision viewpoint (e.g. pro-circumcision advocates were described as such, anti-circumcision advocates were not, etc.). Jayjg 15:40, 5 Oct 2004 (UTC)

NPOV Concerns

I am deeply concerned about Robert the Bruce's comment:

We need to strive toward the truth and not be concerned it that does not appear to be "balanced"

NPOV requires that both sides be presented, not judging either (or an intermediate one!) as "right". NPOV does not mean that every disputed entry (ie. something that doesn't match Robert's opinion) must be deleted, all while the pro-mutilation propaganda should go unscathed. I'm fully accepting of sections of this article that have constant pro-mutilation slant. So why is this comment about "truth, not balance" even present. Let both sides present their view without "value judgement" and let the reader decide. And let's all wonder why we don't have 'Medical analysis' articles for any other procedure. DanP 17:50, 12 Oct 2004 (UTC)

I believe that striving towards the truth is important, too. However, striving towards the truth is not aided by a one-sided presentation. Michael Glass 23:14, 12 Oct 2004 (UTC)

In response to the question "With which penis types have you had sexual experience?", 16.5% revealed that they had had sexual contract with both circumcised and uncircumcised men. Only 5.5% had sexual experience exclusively with uncircumcised sexual partners, and the remainder of the sample was sexually experienced only with circumcised men.

As only 21% of the sample of women in the Williamson study had sexual contact with uncircumcised men it is more accurate to say that most of them had no contact rather than some of them. As Robert says, we should strive toward the truth.

Correcting Inaccuracies

In the section on phimosis I have made two main changes. One was to simplify the wording describing the Oster study and to indent his quoted words. The other was to replace an inaccurate summary of the cohort study in New Zealand with a direct quotation from the PubMed abstract. The study was about penile problems in general. It was not restricted to phimosis.

If anyone has any problem with these edits I would appreciate it if they would state their objections, and not just revert to a previous version.Michael Glass 13:00, 18 Oct 2004 (UTC)

Michael, the summary of Fergusson's study is accurate. While the study did examine penile problems in general, results were presented relating to phimosis specifically, which is what this section is about. It may be worth moving the quotation from the abstract to another (new?) section. The abstract does not discuss the phimosis findings, but the full text of the study does. - Jakew 19:49, 18 Oct 2004 (UTC)

Jakew, you have acknowledged that the summary of Fergusson's study is accurate. Despite this admission you have substituted a version that is quite inconsistent with the abstract. The Fergusson abstract says:

By 8 years, circumcised children had a rate of 11.1 problems per 100 children, and uncircumcised children had a rate of 18.8 per 100. The majority of these problems were for penile inflammation including balanitis, meatitis, and inflammation of the prepuce. [15]

If the full study says something different, then a full reference should have been given. Instead, in a highly contentious area, you have made things even worse by suppressing the link to the abstract of the article. You cannot expect people to take your assertion about the full article on trust. Give us the evidence or revert to the abstract. Michael Glass 23:27, 18 Oct 2004 (UTC)

Michael, the abstract is still there, under "Penile Problems". I haven't removed it. I have, however, added Fergusson's specific findings on phimosis to that section.

You raise an interesting point about taking things on trust. Should Wikipedia only include information that is verifiable on the internet? I strongly believe that everything should be available, but the fact remains that for much information, we have to visit a library, bookstore, or specialist (eg medical) library. Is that so unreasonable? - Jakew 11:12, 21 Oct 2004 (UTC)

Jake, I've included the information from the abstract in a new section on penile problems. If you wish to refer to the original paper, then by all means do so, even if it's not available on the net. Of course, a full citation would be necessary, so that people who are interested in checking it could do so.Michael Glass 22:42, 22 Oct 2004 (UTC)

Bensley/Boyle survey

User:Robert the Bruce has made edits suggesting that the participants in the vaginal dryness survey were not women. The survey itself [16] said, "We conducted a survey of 35 female sexual partners aged 18 to 69 years who had experienced sexual intercourse with both circumcised and genitally intact men. Participants completed a 35-item sexual awareness survey. Women reported they were significantly more likely to have experienced vaginal dryness during intercourse with circumcised than with genitally intact men." Robert has consistently challenged unsupported claims in articles, and I think that this has often improved the articles' accuracy. However, a line has to be drawn. Robert is attempting to discredit the survery merely because he doesn't like its results. He has offered no evidence that the survey's participants were not female. Instead, he seeks to use insinuation to try to discredit the survey by filling the paragraph around it with his own underhanded attacks. This should not be allowed in a Wikipedia article. Acegikmo1 04:18, 21 Oct 2004 (UTC)

I challenge you to produce the detail of this survey by these two Bensley/Boyle anti-circumcision zealots. I would suggest that unless this detail is made available all reference to this survey be deleted from Wikipedia. It should be unacceptable to those who claim to be in search of the truth that the use of such snippets of information be attempted to be introduced as incontrovertible fact. This is an absolute disgrace and brings shame on Wikipedia. In other words we have reached a point where either "you put up or shut up". BTW good to see you have come out of the closet (so to speak) and given up your previous pretence of neutrality. - Robert the Bruce 05:09, 21 Oct 2004 (UTC)
- The survey was published in full in Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. Details are provided at the link to the article, inlcuding numebr of participants, age of participants, age of partners, number of items in the survey, etc. No-one is trying to claim that the results are incontrovertible fact, as your qualifying statements in the article make clear. You're being unreasonable. I never had a "pretence of neutrality". I was and am interested in ensureing that Wikipedia articles are accurate and adhere to the NPOV policy. Acegikmo1 05:30, 21 Oct 2004 (UTC)
  - I am not being unreasonable. I am asking for the detail to be published. For instance what were the 32 points/questions in the survey? How were the participants recruited? I could go on forever. There is nothing more disgraceful than someone who pushes a POV while hiding underthe veil of supposed neutrality and then swears on a stack of Bibles that all he wants is to ensure that NPOV is achieved. You should be ashamed of yourself. - Robert the Bruce 16:52, 21 Oct 2004 (UTC)
    - As I stated above, it was published. The fact that it isn't online doesn't mean it wasn't published, not does it mean we can't use it as a resource. I have even offered on your talk page to e-mail the authors of the survey, requesting more information. You have specified two things you want to know above. What else is there? If you will prepare a list of the things you want to know about the survey, I will contact Boyle and ask for the information. I think that demonstrates that I'm the one interested in accuracy and neutrality while you're more interested in pushing your own point of view. Acegikmo1 00:13, 22 Oct 2004 (UTC)

I've reverted to Acegikmo1's version. The possible bias of those conducting the survey is mentioned and unless there is any credible evidence of the claim then there is simply no reason at all to assert that the participants might not have been female. --Starx 04:29, 21 Oct 2004 (UTC)

Now why does that not comes as a surprise? Acegikmo1 supports the assertion that "the world is flat" and you now agree that it is up to those who believe that the world is round to prove their point. You you will no doubt state (with a straight face) that you are contributing to NPOV? ;-) - Robert the Bruce 05:09, 21 Oct 2004 (UTC)
- Actually, my assertion was that the participants in a sexual awareness survey about vaginal dryness were female, as the survey stated. You're the one who thinks they were male. Acegikmo1 05:30, 21 Oct 2004 (UTC)
  - You read the survey? Where? There is not enough detail on the survey anywhere I know of. Post the detail by Sunday morning or the trash gets deleted. - Robert the Bruce 16:52, 21 Oct 2004 (UTC)
    - Everything I stated above appears in the New Zealand Medical Journal article. I don't find your argument that "there is not enough detail" very persuasive. If the information above was thorough enough to appear in a medical journal, why not Wikipedia? Acegikmo1 00:13, 22 Oct 2004 (UTC)

In another paper, Bensley and Boyle explain that they surveyed 35 female and 42 gay male participants. In light of this, I think we can believe that the women were indeed female. However, they also admit that "the present findings" were "based on self-selected participants", and fail to explain how they were recruited. Are we looking at another O'Hara-style survey of anti-circumcision activists? - Jakew 11:12, 21 Oct 2004 (UTC)

Thanks for posting that Jake. Well I suppose no one should be surprised that this turns out to be yet another pile of dog shit. Have these people got no shame? Based on what we know and still don't know about the O'Hara and Bensley/Boyle pieces of trash they should be deleted from Wikipedia. Before deleting this trash I suppose one should give Acegikmo1 and his fellow anti-circumcision activists a day or so to post a plea in mitigation. No explanation of why it should stay then by Sunday morning they will be gone. - Robert the Bruce 16:52, 21 Oct 2004 (UTC)

You're jumping to conclusions. The quote about "self-selected participants" read:

In view of the present findings based on self-selected participants, the possible negative effects on adults' sexual function and psychological well-being need to be discussed in obtaining informed consent for circumcision (sexual reduction surgery) imposed on unconsenting male minors. Much larger representative samples are desirable.

I'm not sure how you interpreted that to mean the survey is "trash". Nor am I sure why you label me an "anti-circumcision activist". I suppose that you you think everyone who challenges your edits must be one. As to why the data from the survey should stay:

It contains information about the effects of circumcision on sexual intercourse.
It is a contemporary investigation of the claims made by O'Hara, Bigelow, Moynihan, and Leiblum.
It was conducted by Gregory Boyle, who holds two Ph.Ds and has published over 150 research papers in national and international journals
It appeared in the New Zealand Medical Journal
It is revelent to the article at hand and the information it contains cannot be found elsewhere.

While this may not convince you, Robert, I think that it's enough to warrant keeping the survey (along with your disclaimers about it) unless and until it is conclusively demonstrated the the methodology was flawed. I am willing to undertake this investigation, Robert, and I hope you will follow up on what you have previously stated and tell me excatly what details you want to know about the survey.Acegikmo1 00:13, 22 Oct 2004 (UTC)

Acegikmo1, the movement will indeed be proud of you. A sterling defence of Bensley/Boyle. 
The problem is that there is very little to be found other than the occasional (carefully 
selected) snippet of information on this survey. Each of these snippets are served up as a 
"must include" gem of information. The obvious POV pushing is hilarious. And yet you continue 
with the "who me?" line.  ;-) 
Surely it is quite reasonable to expect the detail of a study to be public? Why would they not? 
It is a reasonable deduction therefore (given the low honesty quotient evident among anti-circ
activists) that they are hiding something. That is why I challenged you to produce the detail. 
I did this because you are the main champion in fighting to keep this junk-science in the 
article. Instead of producing the detail you produce some junk about why the references to the
survey should be kept. I say again that until such time as the detail has been produced and
scrutinised it should be removed in toto.
Now onto the O'Hara piece of trash. Given that the participants were recruited through an 
"anti-circumcision newsletter" with obvious dishonest intent why should this trash be allowed 
to be mentioned in Wikipedia other than as an example of anti-circumcision dishonesty?
- Robert the Bruce 04:01, 22 Oct 2004 (UTC)

Robert, I agree that being able to see the full survey would be nice. However, since it is not online and since I do not own a copy, I cannot magically "produce" it. Now, I am satisfied that the NZMJ article about the survey provides enough information to include it in the article, for the reasons I list above. You are not. That's fine.

On your talk page, you stated, "you are challenged to produce the detail of the survey. Why don't you email Bensley/Boyle?" Above you stated, "I am asking for the detail to be published. For instance what were the 32 points/questions in the survey? How were the participants recruited? I could go on forever."

As I've said, I am willing to e-mail Boyle. However, you have not been forthcoming about exactly what you want to know before you accept the survey. This prevents me from e-mailing Boyle with specific questions. Other than the two listed above points, what exactly do you want to know, Robert? Acegikmo1 03:25, 24 Oct 2004 (UTC)

Acegikmo1, please do not attempt the juvenile tactic of trying to pass the buck to me. You want the crap included so the onus remains firmly with you to produce the detail. Email these characters then and try to prise the detail out of them. But in the meantime at least have the intellectual integrity to remove reference until the detail is in the public domain where it can be scrutinised. It is refreshing to communicate with you now that you are out of the closet (anti-circumcision speaking) and you have give up the pretence of feigned neutrality. So today's the day the Bensley/Boyle crap gets deleted, I will watch your reaction with close interest. - Robert the Bruce 03:47, 24 Oct 2004 (UTC)

As I said above, "I am satisfied that the NZMJ article about the survey provides enough information to include it in the article, for the reasons I list above." You are the only one challenging the inclusion of the survey. You are the only one who thinks that the information that appeared in a medical journal is not detailed enough.

I have removed the paragraph from the article myself, to show that I am interested in recognizing that you dispute it and discussing your problems with it here. However, you'll have to be willing to work with me. I cannot simply make the full survey appear online. We have established that. I can, however, e-mail the author, which I am willing to do. So tell me Robert, what questions should I ask in the e-mail?

Acegikmo1 04:04, 24 Oct 2004 (UTC)

The disputed text:

A survey by O'Hara & O'Hara of women who have had experience with both circumcised and intact males reported that the women preferred an intact male sexual partner.[17] However, this study has been criticised on the grounds that it was performed by an anti-circumcision activist, and the subjects were largely recruited from an anti-circumcision mailing list. A summary of sexual awareness survey published in the New Zealand Medical Journal reported that the participants, 35 females, reported that they were significantly more likely to have experienced vaginal dryness during intercourse with circumcised men.[18] However, the small size of the survey, the methodology, the method of recruitment, and the known anti-circumcision bias of the authors has led to doubt as to the accuracy of the reported findings.

Evidence of the sexual effects of circumcision

Robert has every right to correct things that are not true or inaccurate or distorted. However, that does not extend to suppressing information that doesn't fit his mindset. Let's look at one particularly bad example. I quoted Fink's findings and Fink's words:

Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised.

Robert mutilates this by cutting out the parts he doesn't like:

However, of the men 50% reported benefits, 38% reported harm and overall, 62% of men were satisfied with having been circumcised.

Is this honest? Isn't this "hiding something" by using just a snippet? Robert challenges the honesty of others. I challenge him to apply the same standards to his own contributions to Wikipedia.Michael Glass 23:35, 22 Oct 2004 (UTC)

Michael, thank you for your input. I shall use this as a check on your own standard of intellectual integrity (or the lack thereof). It is clear that you set different and higher standards for other than you or your fellow anti-circumcision activists are able to maintain yourselves. Like with that "sympathetic" admin around here who can be relied upon to support your cause you fail to keep your "own" honest and turn a blind eye when the head-bangers post the most off-the-wall stuff. Unfortunately most the people who feign neutrality fail the test of intellectual honesty as well so you are not alone (although you find yourself in very dubious company). Taken for example the pathetic desperation to neutralise the Foreskin restoration article by turning what is obviously an activity of base psychosexual motivations (by people the majority of whom appear to have serious mental illness) to one where if on these poor "victims" could regain a long juicy anteater of a foreskin they would feel whole again (in the mens room). So please Michael don't lecture me on what should or should not be done, what should or should not be quoted and importantly on how not to be selective in how one quotes from studies. - Robert the Bruce 03:19, 23 Oct 2004 (UTC)

Robert, Thank you for your comment. I understand that you don't like to be lectured. However, you had no answer to my point that your partial quote was a distortion of Fink's findings. I will restore the complete quote and I expect it to be left alone.Michael Glass 00:01, 24 Oct 2004 (UTC)

A second instance of selective quotation was in relation to Moses et al.

Here is how the article read:

Winklemann identified the foreskin as a "specific erogenous zone" with nerve endings arranged in rete ridges.[19] Taylor et al. further developed this information with the discovery of a heavily innervated "ridged band" area near the tip of the foreskin.[20] Circumcision invariably removes this ridged band. Moses et al. commented: +

There is indirect evidence suggesting that the foreskin may have an important sensory function, although aside from anecdotal reports, it has not been demonstrated that this is associated with increased male sexual pleasure. Some loss of sensory function may not be an important consideration, or may not even be felt to be disadvantageous by men and women more troubled by premature ejaculation than concerned with increased penile sensitivity. However, few studies have investigated the relation between male circumcision and sexual pleasure or satisfaction; more research is needed to clarify the role of the foreskin in sexual health. [21]

Here is how Robert edited it to read:

Winklemann identified the foreskin as a "specific erogenous zone" with nerve endings arranged in rete ridges.[22] Taylor et al. further developed this information with the discovery of a heavily innervated "ridged band" area near the tip of the foreskin.[23] Circumcision invariably removes this ridged band. However, as Moses et al. noted, "it has not been demonstrated that this is associated with increased male sexual pleasure."; [24]

Is that an honest edit? Are we given a fair picture of what Moses et al wrote? I think not.Michael Glass 14:05, 24 Oct 2004 (UTC)

As they say around here those interested can follow the link and read the detail for themselves. What say now? - Robert the Bruce 14:29, 24 Oct 2004 (UTC)

Quote fairly. Michael Glass 03:10, 25 Oct 2004 (UTC)

ditti - Robert the Bruce 04:47, 25 Oct 2004 (UTC)

In my opinion Robert's selective quote of Moses, et al is misleading. The whole sentence should be included, "There is indirect evidence suggesting that the foreskin may have an important sensory function, although aside from anecdotal reports, it has not been demonstrated that this is associated with increased male sexual pleasure." -- DanBlackham 07:52, 25 Oct 2004 (UTC)

Unrelated to medical analysis

The following paragraph is not relevant to a medical analysis of circumcision.

A 1988 study of new mothers found that 71% preferred a circumcised partner for sexual intercourse, and 83% for giving fellatio. When asked why, 92% responded that it stays cleaner and 90% that it looks sexier. Although 78% of the women had not had direct contact with an uncircumcised penis, those who did expressed the same preference[25]However, this study has been criticised for alleged pro-circumcision bias of the authors and the fact that the study was done in an area of the United States where circumcision was the norm.

The paragraph should be in an article on an ethical or cultural analysis of circumcision, not a medical analysis of circumcision. -- DanBlackham 04:21, 24 Oct 2004 (UTC)

Dan I welcome your sudden change of heart in that you have a new concern for keeping content focussed narrowly on the article subject on hand. Would I be naive to expect your total support when I get amongst the off topic anti-circ propaganda that has been insidiously inserted into numerous articles over a period of time? Ok then ... somehow I thought not. - Robert the Bruce 10:54, 24 Oct 2004 (UTC)

Robert, please explain how the sexual preference of women in Iowa, most of whom had no sexual experience with intact men, is related to the medical analysis of circumcision. -- DanBlackham 07:57, 25 Oct 2004 (UTC)

Loony Tunes Link

There were links to pictures of invasive penile cancer in the article:

Images of Invasive Penile Cancer in Uncircumcised Men (http://www.dermis.net/bilder/CD52/img0084.jpg) (http://www.dermis.net/bilder/CD55/img0066.jpg) (http://www.dermis.net/bilder/CD16/img0038.jpg) (http://www.dermis.net/bilder/CD14/img0092.jpg) (http://www.dermis.net/bilder/CD16/img0037.jpg)

I wrote: "When I clicked on the links provided, all I got was a page that said that dermis net, where the pictures were housed, had expired. (They were there only a few days ago!")

Robert replied:"(They're back! Now fancy that Michael - nice try though ;"

I have tried three times in the last 24 hours and got the following notice:

"This domain name expired on 10/16/2004 and is pending renewal or

deletion."

Robert, as I write this, they're not back. Why did you say that they were back when they weren't? Michael Glass 13:51, 25 Oct 2004 (UTC)