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:::::::Prevalence clean-up: Proposed draft: "It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa and the United States; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania." More accurate: "It is most prevalent in the Muslim world (where it is near-universal), Israel, the Philippines, South Korea, the United States, and much of Africa; it is less common in Europe, Latin America, parts of Southern Africa, and most of East Asia." Comments on the changes: (1) added Israel, not the Muslim world, does seem to belong to the most prevalent (and perhaps the near universal comment is applicable there). "Parts of Southeast Asia" is vague and other than the Muslim countries there (Malaysia, Indonesia) and Muslims in the area seems only to apply to the Philippines (some may not even consider this SE Asia any way) and South Korea (rarely considered SE Asia) - also eliminates the ambiguity of whether "parts of" applies to SE Asia only, or carries through to Africa and the United States as well. (2) much of Africa, rather than all of as possibly implied. (3) changed "rare" to less common. I doubt one would consider it "rare" to find a circumcised man in all of the geographies listed ("rare" is an undefined and weasel word anyway). (4) East Asia replacing Asia, because much of Asia is in the Muslim World (say Turkey->Kazakhstan->Pakistan->a sizable minority in India (again, not likely to be rare if 15% of the people there are Muslim->Bangladesh->Malaysia through to Indonesia. Less common in East Asia specifically (China, Vietnam, Laos, Cambodia, North Korea, Burma, Thailand, Siberia). (5) Left out Oceania, as circumcision is near universal among many indigenous peoples of the region, and circumcised penises are hardly considered "rare" among the ANZACs. [[User:Carlossuarez46|Carlossuarez46]] ([[User talk:Carlossuarez46|talk]]) 18:20, 27 July 2012 (UTC)
:::::::Prevalence clean-up: Proposed draft: "It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa and the United States; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania." More accurate: "It is most prevalent in the Muslim world (where it is near-universal), Israel, the Philippines, South Korea, the United States, and much of Africa; it is less common in Europe, Latin America, parts of Southern Africa, and most of East Asia." Comments on the changes: (1) added Israel, not the Muslim world, does seem to belong to the most prevalent (and perhaps the near universal comment is applicable there). "Parts of Southeast Asia" is vague and other than the Muslim countries there (Malaysia, Indonesia) and Muslims in the area seems only to apply to the Philippines (some may not even consider this SE Asia any way) and South Korea (rarely considered SE Asia) - also eliminates the ambiguity of whether "parts of" applies to SE Asia only, or carries through to Africa and the United States as well. (2) much of Africa, rather than all of as possibly implied. (3) changed "rare" to less common. I doubt one would consider it "rare" to find a circumcised man in all of the geographies listed ("rare" is an undefined and weasel word anyway). (4) East Asia replacing Asia, because much of Asia is in the Muslim World (say Turkey->Kazakhstan->Pakistan->a sizable minority in India (again, not likely to be rare if 15% of the people there are Muslim->Bangladesh->Malaysia through to Indonesia. Less common in East Asia specifically (China, Vietnam, Laos, Cambodia, North Korea, Burma, Thailand, Siberia). (5) Left out Oceania, as circumcision is near universal among many indigenous peoples of the region, and circumcised penises are hardly considered "rare" among the ANZACs. [[User:Carlossuarez46|Carlossuarez46]] ([[User talk:Carlossuarez46|talk]]) 18:20, 27 July 2012 (UTC)
{{od}} Would be good to add the links and references to this lead. Also may be useful using the "|quote" tags in the cite templates. While I do realize that the lead technically does not need references in controversial topics such as this one it is generally requested by our readership. [[User:Jmh649|<span style="color:#0000f1">'''Doc James'''</span>]] ([[User talk:Jmh649|talk]] · [[Special:Contributions/Jmh649|contribs]] · [[Special:EmailUser/Jmh649|email]]) (if I write on your talk page please reply on mine) 18:55, 29 July 2012 (UTC)


== Sub-article ==
== Sub-article ==

Revision as of 18:55, 29 July 2012

Proposed new photo File:Rituelle Beschneidung.jpg does not improve this article along Wikipedia guidelines

Wikipedia articles are meant for the general reader, and are not targeted toward surgeons or other specialists. Wikipedia guidelines and practice reflect that. The new photo File:Rituelle Beschneidung.jpg proposed to be added to the article is not in line with WP:MEDMOS, specifically:

"Shock value: Some images of medical conditions or procedures disturb some readers, e.g., because of visible deformities or the presence of blood. Potentially disturbing images should be not be used for their shock value, for decoration, or merely to add an image."

It is also not in line with Wikipedia:Offensive material:

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

The photo's shock value and gratuitous nature are not in line with these guidelines. To see these guidelines in practice, I took a look at other WP:MEDICINE articles and compared the nature and number of human medical/anatomical photos chosen with those in this article. Compare the the photos in this article to WP:MEDICINE Good articles:

  • Abortion–breast cancer hypothesis -- No graphic human medical/anatomical photos; one illustration
  • Bates method -- No graphic human medical/anatomical photos; 6 black-and-white photos
  • Brachytherapy -- No graphic human medical/anatomical photos; two hospital-setting photos but no surgery
  • Coffin birth (defined as "the expulsion of a nonviable fetus through the vaginal opening of the decomposing body of a pregnant woman") -- No graphic human medical/anatomical photos; in fact, no images at all
  • Condom -- One low-contrast photo of a condom on a glans penis, the text of the use of the condom is supported by a black-and-white pencil illustration and no photos
  • Mental status examination -- No graphic human medical/anatomical photos
  • Tracheal intubation -- Three human medical/anatomical photos of much less shock value than the proposed photo

Please take special note of the photos in this article as compared to Brachytherapy (another surgical procedure) and Condom (involving the same body part). If our goal truly is to improve this article according to Wikipedia standards, we need to bring the image selection in line with with the WP:GOOD medical articles, and File:Rituelle Beschneidung.jpg does not move this article in that direction. Zad68 19:26, 12 July 2012 (UTC)[reply]

  • Plastibell circumcision day 6 post operation
    Plastibell circumcision day 6 post operation
  • Circumcision with a clamp
    Circumcision with a clamp
  • Injection of lignocaine at 10 o'clock and 2 o'clock
    Injection of lignocaine at 10 o'clock and 2 o'clock
How, according to you, is the photo of the circumcision using a plastibell not offensive but the circumcision using a clamp offensive? Both methods of circumcision are widely used and must be equally illustrated, otherwise it is an obvious bias. And there is also a photo of an injection in the article, which is much less useful but as offensive/inoffensive as the other two photos, and no one asked for its removal.--89.226.117.72 (talk) 19:44, 12 July 2012 (UTC)[reply]
Hi 89.226.117.72, sorry your response does not at all address any of the Wikipedia guideline-based reasons (backed up with examples of implementation) I gave why the file is not an improvement for the article. I did not say anything about the Plastibell picture or the injection picture, and I did not discuss bias. Could you please read what I wrote and address my points based in Wikipedia policy and guidelines? Thank you. Zad68 20:40, 12 July 2012 (UTC)[reply]
File:Rituelle Beschneidung.jpg is not more or less offensive of the two other photos of the plastibell and of the injection. It does not show more blood or more genitalia than the photo of the plastibell. This photo illustrates this type of circumcision and therefore is necessary, relevant, not gratuitous and not extraneous (see Wikipedia:Offensive material). The medical articles you listed above do not include any graphic human photos but it has never been a rule and has never been applied on this article; As everyone can check, the photo of the plastibell and of the injection have been in this article for months. Your interpretation of the Wikipedia guideline is wrong. Do not misinterpret them, thank you.--89.226.117.72 (talk) 06:57, 13 July 2012 (UTC)[reply]
Thank you for finally engaging my arguments (although, again, in this discussion I am not talking about the relevance or nature of the OTHER images in this article). You are saying that this image improves the article in the following way: It is relevant and informative as an image of the procedure. I agree with you. It is good to see also that you agree with me that the WP:MEDICINE WP:GOOD articles do not include any graphic human photos. Based on these two things, if a different image could be found that also improves the article in the same way--by providing a relevant illustration of the procedure--and that image were to be more in line with the nature of the images in the WP:MEDICINE WP:GOOD articles, that would be an improvement over File:Rituelle Beschneidung.jpg, correct? Zad68 10:58, 13 July 2012 (UTC)[reply]
If you think this article shouldn't contain graphic images (this is not my opinion), then all of them should be removed or replaced, not just this one. You can't decide to apply strictly the rules just for one image and not for the others, it would be a double standard. Maybe we should ask for the opinion of other contributors on that matter.--89.226.117.72 (talk) 11:49, 13 July 2012 (UTC)[reply]
To be clear, I actually agree with you, as I think the article would be improved along Wikipedia guidelines by removing the Plastibell recovery and anesthesia injection images because they are really less relevant to the subject of the article than an appropriate image of the procedure itself. So we agree on a number of points here:
  • We agree that the article could be improved by selecting an appropriate image of the procedure itself
  • We agree that the relevant guideline is WP:MEDMOS
  • We agree that the existing WP:MEDICAL WP:GOOD articles do not include any graphic human photos
However, I feel that there are several rather serious problems with File:Rituelle Beschneidung.jpg as an image proposed to increase the encyclopedic educational value of this article:
  • It is very hard for the lay-person to tell what is going on in the image. There are other images that are more understandable to the layperson.
  • It is described as "circumcision with a clamp" but that is vague at best. Nearly all circumcisions are done with clamp. There are lots of different clamps. Take a look at this list: Circumcision clamp Which one is being used? It is very clearly not the Gomco clamp and it is very clearly not the Mogen clamp. By the description, it doesn't seem like it's a Plastibell procedure, as that's not usually described as a "clamp." So this image actually reduces the encyclopedic educational value of the article by adding confusion.
  • The description in German attached to the image is: "Rituelle Beschneidung eines Kindes durch einen muslimischen Arzt in einem deutschen Universitätsklinikum. Es bestand keine Vorhautverengung." which appears to translate as: "Ritual circumcision of a child by a Muslim doctor in a German university hospital. There was no foreskin." What does "There was no foreskin" mean? Does it mean that this was an unusual circumcision case? Again, confusion.
  • Also as I have previously mentioned, the nature of the image does not appear to be in line with the images selected for the existing WP:MEDICAL WP:GOOD articles.
So, let's open the discussion, which of the images of the procedure available to us would best improve the encyclopedic value of the article along WP:MEDICINE WP:MEDMOS guidelines? Here is a selection to choose from:
  • A 22-year-old Canadian man being circumcised with a Gomco clamp.
    A 22-year-old Canadian man being circumcised with a Gomco clamp.
  • A baby midway through a Plastibell circumcision.
    A baby midway through a Plastibell circumcision.
  • "Circumcision with a clamp"
    "Circumcision with a clamp"
  • "Circumcision with a clamp" in black and white
    "Circumcision with a clamp" in black and white
I also agree with you that we should get a wider range of opinions on this, so I will invite a few members of WP:MEDICINE to comment, including a regular Wikipedia contributor who is also an emergency room M.D. and a steward of the WP:MEDICINE WP:MEDMOS guideline itself. Zad68 13:48, 13 July 2012 (UTC)[reply]
IMO it looks like we should have a sub article describing the procedure of circumcision if we are using images that are this specific. This image can than go on that subpage. With the amount of text here one image is sufficient in that section. For example see Ingrown toenail and Surgical treatment of ingrown toe nails Doc James (talk · contribs · email) (please reply on my talk page) 14:01, 13 July 2012 (UTC)[reply]
Thanks for the input Doc James. It sounds like you are saying that this image File:Rituelle Beschneidung.jpg is not a good choice for this general encyclopedia article about circumcision because it is too specific, do I have that right? Also, can you give us some detail about what is going on in that image. Is it a normal-looking circumcision procedure "with a clamp"? The only clamps I see in that image look like hemostats, which I'd imagine are used in nearly every circumcision procedure. The hemostat in the foreground looks like it's pointing at something, can you tell what it's pointing at? What is this picture being used to illustrate? Zad68 14:32, 13 July 2012 (UTC)[reply]
Yes so feel it is a little too specific for this article. The hemostates look like they are simply retracting the foreskin. I do not think it is pointing to anything. I have never done this procedure myself.Doc James (talk · contribs · email) (please reply on my talk page) 18:43, 13 July 2012 (UTC)[reply]

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

Thanks for the translation. Please look carefully above, I specifically chose "good" WP:MEDICINE articles, those that are WP:GOOD-rated, as the standard to which we're aspiring to raise this article to. Hysterectomy and uterine fibroids aren't WP:GOOD articles. Zad68 04:03, 22 July 2012 (UTC)[reply]
Good point, I choose that articles as comparison because I am familiar with them and not terribly happy with the images and their placement in those articles. Richiez (talk) 12:28, 22 July 2012 (UTC)[reply]
Sure... seems smarter to use articles evaluated as "good" by the community rather than ones you're unhappy with as the standard for comparison. Zad68 14:21, 22 July 2012 (UTC)[reply]
The images displayed on this article do not seem to approximate the quality of images of articles dedicated to other common surgeries. I feel an image of a circumcision while carried out with a clamp is appropriate, given that many circumcisions seem to be performed with one (plastibell seem to be a minority by comparison). For some context on the images in Wikipedia articles for other common surgeries, please see Cholecystectomy, Tonsillectomy, Cataract surgery, Arthroscopy, Uterine myomectomy, Hysterectomy. This is to say, readers should be given at least a basic expectation of a surgery is when looking at its encyclopedia entry. FactoidDroid (talk) 02:51, 23 July 2012 (UTC)[reply]
The comparison we were making was to WP:MEDICINE WP:GOOD articles specifically. The comments we got from the RFC were that the medical images were more shock-value than encyclopedic educational value, or too specific for this general summary article. A significant difference between circumcision and other medical articles is that there's much more non-surgical content here than at those articles, take a look at the balance in this article between how much text covers the surgery vs. cultural, legal and other subjects, and compare that to other articles. Beyond that, there's a new image in the article now, an illustration of the basic steps of the surgery that I think meets the needs of the article--it is clear, easy for the layman to understand, and directly supports the text in the article covering the surgical steps. Zad68 12:10, 23 July 2012 (UTC)[reply]
The new illustration has a cartoonish appearance, even with the "cut along perforated line" diagram. Your article deserves something more than a cartoon to depict the surgery. Marylibrary (talk) 18:07, 27 July 2012 (UTC)[reply]

RFC: Which image?

Which image of the circumcision procedure (if any) should be added so that the article is improved in accordance with WP:MEDICINE WP:MEDMOS guidelines? (NSFW) Zad68 16:07, 13 July 2012 (UTC)[reply]

Available to the article are:

  • File:My_gomco_circ_may96.jpg -- A 22-year-old Canadian man being circumcised with a Gomco clamp.
    File:My_gomco_circ_may96.jpg -- A 22-year-old Canadian man being circumcised with a Gomco clamp.
  • File:Plastibell1.jpg -- A baby midway through a Plastibell circumcision.
    File:Plastibell1.jpg -- A baby midway through a Plastibell circumcision.
  • File:Rituelle Beschneidung.jpg -- "Circumcision with a clamp"
    File:Rituelle Beschneidung.jpg -- "Circumcision with a clamp"
  • File:Rituelle Beschneidung black and white.jpg -- "Circumcision with a clamp" in black and white
    File:Rituelle Beschneidung black and white.jpg -- "Circumcision with a clamp" in black and white

RFC !votes and comments

(!Voting as RFC initiator) -- Before 11 July, the article did not have any medical image of the procedure itself. On 11 July, an image was proposed to be added. There is agreement that the article could be improved by selecting an appropriate image of the procedure, there is agreement the appropriate guideline to follow for the image selection is WP:MEDICINE WP:MEDMOS, and there is agreement that the current WP:MEDICAL WP:GOOD articles do not include any graphic human photos. But, we do not have agreement as to which image to select. I do not feel either of the "Rituelle Beschneidung" images (color or black and white) improve the article as they are confusing (you can't tell what's going on in the photo). Also, the color version is too graphic to be in line with WP:MEDMOS, and is out of line with the existing pictures selected for the WP:MEDICINE WP:GOOD articles. (See my comments in this section above regarding the pictures in WP:MEDICINE WP:GOOD articles.) The relevant section of WP:MEDMOS is:
"Shock value: Some images of medical conditions or procedures disturb some readers, e.g., because of visible deformities or the presence of blood. Potentially disturbing images should be not be used for their shock value, for decoration, or merely to add an image."
Also this section of Wikipedia:Offensive material applies:
"'Not censored' does give not special favor to offensive content -- Especially with respect to images, editors frequently need to choose between alternatives with varying degrees of potential offensiveness. When multiple options are equally effective at portraying a concept, Wikipedia does not prefer the most offensive options merely to 'show off' its ability to include possibly offensive materials. Images containing offensive material that is extraneous, unnecessary, irrelevant, or gratuitous are not preferred over non-offensive ones in the name of opposing censorship. Rather, they should be judged based solely on other policies for content inclusion."
Improving this article to the point where it can be submitted for WP:GOOD status should be our goal. Of the choices, I see File:My_gomco_circ_may96.jpg as the image available to us that is the most clear and illustrative of the procedure, meets content guidelines, and stays within nature of the images selected for our WP:GOOD medical articles. Zad68 16:07, 13 July 2012 (UTC)[reply]

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

RFC general discussion

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

RFC conclusion

We haven't gotten any RFC comments in the past few days and it looks like the RFC has run its course. There's clearly no consensus to include "Rituelle Beschneidung.jpg" in this article, and there's also consensus support to move the surgical procedure images out of this article and into a new article like Circumcision surgical procedure that will cover the detail of the surgical procedure. I will remove the images. I'll try to find sources for a new Circumcision surgical procedure article. Zad68 14:19, 22 July 2012 (UTC)[reply]

After five days or so? Next time, I think it'd be better to wait a bit longer. I was in the rather remote town of Seldovia, AK for a week with hardly any electricity, but here I am back and ready to voice my opinion. This opinion is: the images proposed above do very little to illustrate the procedure, and I also find them gross. I'm in support of the new article though. Jesse V. (talk) 06:36, 23 July 2012 (UTC)[reply]
Your feedback is indeed appreciated! Actually the RFC ran for between 8 and 9 days, it looks like the RFC bot didn't notify you until four days after the RFC started. On Wikipedia things like WP:RFA and WP:AFD discussions run for a week as a rule of thumb, and when I look for RFCs to comment on, generally the discussion has moved on after a week. I hate going to an interesting-looking RFC and finding out the last comment was made 25 days ago, it happens all the time. We hadn't gotten any more RFC responses in those last 3-4 days so I figured it was done. Please check out the new illustration in the article, I think it addresses all the concerns brought up by the RFC commenters. Zad68 12:21, 23 July 2012 (UTC)[reply]

Too much HIV in the lede

More than one third of the lede talks about HIV. I worked this out by counting 17 lines, 6 of whom are about HIV. This probably violates wp:undue. therefore i propose adding either the first or second sentence about HIV to the article body. Any thoughts? Pass a Method talk 18:09, 17 July 2012 (UTC)[reply]

Pass a Method, this is, of course, after you yourself made a lot of edits to the other parts of the lead, chopping out quite a bit, right? It is only after your own edits to the other parts of the lead that you are bringing this up? I'm all for reducing extraneous text and increasing the information density of of articles, so this effort is not necessarily a bad thing. Anyway, a significant portion of the article body talks about HIV, because reliable sources give a lot of attention to circumcision and HIV. According to WP:LEAD, the lead needs to summarize this important information about HIV that the body of the article covers, so of course information about HIV will stay in the lead. So what you're proposing is, I assume: How can we summarize information about HIV in the lead more succinctly? Efforts in the past to do this haven't gone well because editors wanted to keep the many qualifiers and detail about the underlying studies in the lead sentence, but maybe we can come up with a more terse way to do it now. Zad68 18:19, 17 July 2012 (UTC)[reply]
I think you misunderstood me. I meant we could move one of the two sentences about HIV to the article body, either the Cochrane one or the WHO one. Pass a Method talk 18:53, 17 July 2012 (UTC)[reply]
Pass a Method, maybe I did, sorry about that. I took a close look at the lead before and after your condensing edits, and largely, great job. It says largely the same thing in many fewer words. However, the following content was removed from the lead without being restated:
  • "The prevalence of circumcision varies mostly with religious affiliation, and sometimes culture. The timing of circumcision similarly varies, though it is commonly practiced between infancy and the early twenties."
  • "In addition, circumcision is used therapeutically, as one of the treatment options for a number of penile conditions."
leaving the lead with zero mention of the medical and therapeutic uses of circumcision except for the word "therapeutic". (Regarding the 2 cultural sentences that got removed, maybe a little bit of that info can be put back, but that's a different subject.) This puts the lead out of line with what WP:LEAD requires and really needs to be corrected. So we should take the existing lead paragraph that goes into too much detail about HIV and the Cochrane study (I agree with you that the paragraph addressing this needs improvement) and fold that information into one paragraph that summarizes the information in the article body about HIV, other STDs, hygiene, skin conditions, etc. Zad68 18:46, 17 July 2012 (UTC)[reply]
I did not mean to remove the timing of circumcision, but the religion and culture part is already covered. Actually (on second look) i moved that to the article body.[1] Pass a Method talk 18:58, 17 July 2012 (UTC)[reply]
Understood, but by moving to the body there's some portion of the body of the article that is now unrepresented in the lead. We can look at that later...

Back to summarizing the medical aspects, here's a proposal:

Circumcision is a treatment option for some penile skin conditions and may reduce some STDs, and it reduces female-to-male HIV transmission significantly. Circumcision has found to be cost effective in sub-Saharan Africa, and the WHO recommends that it be considered as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.
Not saying it's perfect, just a start. Thoughts? Zad68 19:14, 17 July 2012 (UTC)[reply]
A little tighter:
Circumcision is a treatment option for some penile skin conditions and may reduce some STDs, and it reduces female-to-male HIV transmission significantly. Circumcision is cost-effective in sub-Saharan Africa, and the WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.
Zad68 19:21, 17 July 2012 (UTC)[reply]
I'm looking at the WP:MEDICINE WP:FA articles. I think we are counter-productively over-restricting ourselves with trying to condense the lead of this large and informative article down to the size range we are looking at. This circumcision article is 140 KB. Take a look at Virus a 120 KB article, and Fungus, a 140 KB article. These are two comparably-sized WP:MEDICINE WP:FA-quality articles, and their leads are double the size that ours currently is. We really should not be trying to over-tighten this article to the point where we are eliminating summarizing important points from the body of the article. We should be discussing how to prudently expand the lead to make sure we meet the WP:LEAD requirements of ensuring all the most important points of the body of the article are covered, not tightening it up at the expense of summarizing content. Zad68 19:42, 17 July 2012 (UTC)[reply]
Adding: More WP:MEDICINE WP:FA-quality articles to compare, look at the size of the lead of: Bacteria 115 KB article, Influenza 140 KB article--we are thinking in the wrong direction. Zad68 19:55, 17 July 2012 (UTC)[reply]
I dont mind a longer lede. But lets wait until someone proposes adding something lede-worthy instead of expanding for the heck of it. Pass a Method talk 20:04, 17 July 2012 (UTC)[reply]
I implemented your second proposal. Does it look okay? Pass a Method talk 20:17, 17 July 2012 (UTC)[reply]
Looks great! I'd really like to see this article promoted to GA at some point in the not-too-distant future. It's comprehensive, well-referenced, and generally well-written. That'll require revisiting the lead, but until then, making the HIV paragraph match the terseness of the rest of the lead makes sense now. Zad68 01:38, 18 July 2012 (UTC)[reply]

Currently this paragragh is bad grammer with a run on sentence.

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

I have changed it to this to correct but Zad has reverted without explanation.

Circumcision is a treatment option for some penile skin conditions and may reduce some STDs. A meta-analysis found it reduces female-to-male HIV transmission significantly [22] and is cost-effective in sub-Saharan Africa. The WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.

I did not add anything or take anything away except to remove the run on sentence and make the paragrapgh flow better. I inserted meta-analysis so we would not be starting the sentence with the word "circumcision" like the previous sentence and find the term meta-analysis informative. Thoughts? Garycompugeek (talk) 14:40, 18 July 2012 (UTC)[reply]

Come on, Gary, it wasn't "without explanation", I said "Gary please see open Talk page discussion about this paragraph, let's discuss there first". Anyway, here we are. Pass a Method and I have been (for the time being) tightening up the lead. As has been brought up before here on this Talk page, according to WP:MEDMOS, we shouldn't be mentioning the study itself in a statement like this in a WP:MEDICINE article, especially not when the source is as strong as Cochrane. This was last discussed here: Talk:Circumcision/Archive_73#HIV-Africa_again_.28but_not_beating_the_dead_horse_this_time.29. In fact, Gary, you were involved in that discussion, which was active as of just two weeks ago. Maybe it has since slipped your mind. Anyway, at that time I mentioned that at this article, for the Cochrane-based HIV statement, we have made an exception to the WP:MEDMOS guidelines as a compromise. Yesterday, working with Pass a Method here, I suggested we reword that part of the lead in a way that now meets WP:MEDMOS, and it was implemented. Perhaps that was too hasty. We can return the paragraph back to the consensus of what it was before if there's a strenuous objection. Zad68 14:56, 18 July 2012 (UTC)[reply]
You said bring it to the talk page but didn't say why. Zad I'm not being obtuse but I still don't know what you find wrong with my grammer correction??? Are you saying that you object to the term "meta-analysis"? We can change it to "Circumcision" or "It" but both are poor substitutes in my opinion. Garycompugeek (talk) 16:47, 18 July 2012 (UTC)[reply]
  • Gary, regarding the grammar only, we currently have:
Circumcision is a treatment option for some penile skin conditions and may reduce some STDs, and it reduces female-to-male HIV transmission significantly. Circumcision is cost-effective in sub-Saharan Africa, and the WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.
Suggested improvement is:
Circumcision is a treatment option for some penile skin conditions and may reduce some STDs. It reduces female-to-male HIV transmission significantly, and is cost-effective in sub-Saharan Africa. The WHO recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV.
Your approach to addressing the run-on sentence is good, and actually makes the paragraph shorter. I'm OK with it, how about you? Pass a Method? Zad68 17:08, 18 July 2012 (UTC)[reply]
I see. We are not mentioning "Cochrane" or anything specific, was just trying to find a way to start the next sentence without using the word "Circumcision" like the previous sentence or a pronoun and avoid repetitive poor writing style. Garycompugeek (talk) 17:20, 18 July 2012 (UTC)[reply]
OK so if this isn't an issue, how about the suggested rewording above? Zad68 17:34, 18 July 2012 (UTC)[reply]
Obviously not my first choice but still flows good. Changes implemented. Garycompugeek (talk) 17:48, 18 July 2012 (UTC)[reply]
Cheers! Zad68 17:55, 18 July 2012 (UTC)[reply]

Perhaps, we can use Dr. Fauci's quote in USA Today here, where he states that circumcision "reduces a man's risk of getting HIV by up to 70%". Powerful and concise. Carlossuarez46 (talk) 22:22, 18 July 2012 (UTC)[reply]

WP:MEDRS warns us not to use popular press as sources for medical claims. Zad68 22:37, 18 July 2012 (UTC)[reply]

Zad, what do you think about replacing "is a treatment option for some penile skin conditions" to "is used therapuetically"? Pass a Method talk 22:22, 19 July 2012 (UTC)[reply]

"therapeutically for some penile skin conditions"? Makes sense to mention what it's used for, doesn't it? Zad68 03:07, 22 July 2012 (UTC)[reply]
The definition of therepeutic is "relating to the healing of disease". I think that would be stating the obvious dont you think? Since circumcision is obviously related to penile conditions Pass a Method talk 06:18, 22 July 2012 (UTC)[reply]
My point wasn't about what "therapeutically" means, but rather giving details about what it's used therapeutically for. It's used therapeutically for two different kinds of things: reactively for amelioration of skin conditions, and proactively against transmission of systemic diseases like HIV-AIDS. I had put "skin conditions" back in so that the lead mentioned both kinds of things it's used therapeutically for separately. I see you updated it, fine for now in my opinion, although the lead needs to be expanded to drill down to a greater level of detail to bring it in line with FA-quality articles. Zad68 14:25, 22 July 2012 (UTC)[reply]
Oh I see what you mean, that the definition of "therapeutically" you're using applies to existing conditions. Well, look at Therapy and Therapeutic effect, there's definitely room in the use of forms of the word "therapy" to apply to both existing conditions and also for pro-active or prophylactic effects, so I think mentioning "skin conditions" is warranted. Zad68 14:35, 22 July 2012 (UTC)[reply]
I dont feel strongly either way, but my thought is that mentioning "skin conditions" would be superfluous since it would be stating the obvious. The word "therepeutic" aleady hints at "conditoions" and circumcision is obviously for the "penile skin". Pass a Method talk 19:52, 22 July 2012 (UTC)[reply]
I'm much more interested in your input on the complete rewrite of the lead proposed below. Zad68 20:12, 22 July 2012 (UTC)[reply]

Two problems with lead

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

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

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

1. I don't find the prose of that sentence particularly objectionable. And re: "doctors are not legislators"--be careful not to argue against a strawman position. Maybe individual doctors are not legislators, but professional associations of physicians absolutely involve themselves in the forming of legislation. I'll review the sources too.
The way the sentence is now, is suggests that phys. orgs are OK with practicing circumcision since, after all, they don't recommend prohibiting it. I'm sure they don't recommend prohibiting a lot of things. But what this does is skip over the orgs that are opposed to circumcision. As such, this sentence is misleading. I have found 6 physician's organizations that recommend against routing circumcsion including references.Frank Koehler (talk) 12:02, 19 July 2012 (UTC)[reply]
Hi Frank, be careful to look at the wording of the sentence, it doesn't say "No medical organization recommends routine circumcision...", it says "Summaries of the views of professional associations of physicians state that none recommend routine circumcision...." For medical articles like this we avoid using primary sources like individual statements from what might be small or fringe organizations to draw our own conclusions; instead, we depend on large, reputable, well-established organizations to do such reviews and provide the conclusions, and we simply paraphrase what they say. That is what this sentence says.
That being said, I'm looking at the sources provided for the sentence now and I can't see off the top how the sources provided support the "Summaries of the views of..." sentence. The sentence has stood like that in the article for a while now, and nearly every sentence in this article (especially the lead!) has been hammered out over years of lengthy debate by experienced editors--check out the Talk archives, so I'm very cautious about changes. Give me some time to look at the sources provided for the sentence, and review the article Talk archives. There's no deadline, I'd rather take the time and do the reading and get it right here on the talk page instead of having a series of hasty and possibly incorrect edits to the article itself. Appreciate it! Zad68 13:13, 19 July 2012 (UTC)[reply]
Good idea to look at that. The part "and that none recommend prohibiting the practice" is quite clearly attributed to Viens 2004 in the text. That one is not a review, not even a primary source but a "comment" from a symposium on circumcission. Go figure - how could that slip into the lead.. WP:MEDRS anyone? No matter what the source actually says but that does not belong into the lead. Richiez (talk) 18:12, 20 July 2012 (UTC)[reply]
Thanks for giving me a chance to look at that. I read through the sources cited and the Talk archives. That sentence came from a history spanning over six months of discussion spanning several Talk archives pages, some 50k+ of debate, at least two RFCs, and a close of no consensus from an uninvolved admin. From all that, I 100% agree now the entire sentence "Summaries of the views of professional associations of physicians state that none recommend routine circumcision, and that none recommend prohibiting the practice" needs to come out of the lead.
First it's a clear violation of WP:LEAD. Leads should only summarize what's already in the body, there shouldn't be anything in the lead not in the body. The fact that Viens 2004 is a source found only in the lead is a red flag. There's nothing in the body to support that sentence in the lead.
Second the claims the sentence makes are broad and strong, but the sources don't support them sufficiently. Neither source can be called clearly a "summary," which I would expect would come from a neutral review of medical associations around the world with selection criteria clearly stated and discussion of the primary sources. The "none recommend routine circumcision" comes from a KNMG statement that is clearly persuasive and not neutral in nature; the "none recommend prohibiting" comes from an equally non-neutral source, a pro-circumcision persuasive essay.
Third the sentence is questionable as we have easily-found counterexamples for both claims the sentence makes.
Fourth the sentence really doesn't say anything useful.
I'm removing the sentence, if there's an objection please feel free to revert and discuss more here. Zad68 03:23, 22 July 2012 (UTC)[reply]
2. The cost-effectiveness of condoms doesn't make circumcision not cost-effective. It's incorrect to say "one study ... found the opposite" when they have both been found to be cost-effective. The subject of this article is circumcision, not condoms, and it's appropriate for the lead to focus on the subject of the article. The body of the article already mentions the relative cost-effectiveness of circumcision and condoms. Zad68 13:19, 18 July 2012 (UTC)[reply]
Good point. I didn't notice the article made a distinction later on. Frank Koehler (talk) 12:02, 19 July 2012 (UTC)[reply]

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

Hi Gary, this is a very unconvincing argument for restoring only part of what we had before, and I'm sad to see that you see this as an opportunity to do so. Even if the KMNG statement is "the best medical summary we have", that doesn't justify trying to use it in this way if it is still unsatisfactory--meaning, if the tallest of your several children is 30 inches tall, that's not a good enough reason to allow one of your children on the ride at the amusement park if the minimum height requirement for the ride is 36 inches. If the sourcing for a statement in the article is insufficient, the answer isn't to say "well it's the best we have," the answer is to remove it as poorly sourced. The KNMG statement cannot fairly be called a "summary statement." It was not written as an impartial overview of statements from the world's medical associations. It is a WP:PRIMARY source. It was not published in a peer-reviewed journal as at least Viens 2004 was. It was written as a persuasive statement and can only be used to support statements in the article about the KNMG's opinions. Zad68 15:48, 24 July 2012 (UTC)[reply]
Odd analogy. Sorry to make you sad Zad, not my intention. Why do you object to a medical summary statement? It makes sense to have one in the lead. I mean how else are we supposed to use it? How can you clasify it as non-neutral? It's simply a fact. I would be happy to change or remove it if you can supply a reference that shows a professional association of physicians that does reccomend routine neonatal circumcision. Frank and Richiez also feel the Viens statement is out of line but did not agree to remove KMNG medical summary. Garycompugeek (talk) 17:58, 24 July 2012 (UTC)[reply]
Heh... the analogy came from the fact that the family went to the amusement park last weekend! We had a great time even though not everyone got to ride all the desired rides.
Please don't mischaracterize my objection--I don't object to a well-sourced statement summarizing the surveyed positions of worldwide medical associations. The problem is we don't have one. The KNMG statement isn't one. And I think any impartial reader of the KNMG statement would clearly see that it's non-neutral and can't be used to support a claim like "Summaries of the views of professional associations of physicians...". The statement in their paper "[T]he KNMG does believe that a powerful policy of deterrence should be established" regarding non-therapeutic circumcision of male minors is obviously non-neutral. Also, take a look at just the endnotes in the KNMG statement, they cite: a paper "Circumcision - a Victorian relic lacking ethical, medical, or legal justification", the anti-circumcision site nocirg.org, "Jews against circumcision", the anti-circumcision site circumstitions.com, the anti-circumcision site circinfo.org, on and on. The best that could be done is to restate it as "The KNMG position paper on non-therapeutic circumcision of male minors states that..." and as the KNMG is a relatively small organization, it would be undue to keep it in the lead, and should be moved down to "Positions of medical associations -- The Netherlands". Zad68 19:14, 24 July 2012 (UTC)[reply]
I agree it's not the best source Zad, and much prefer the one it replaced but there was concern over its age. There was quite an edit war last year when Doc James removed it and it did not stop until another summery statement was found by Lizardwizard. The problem is summary statements are quite hard to come by but I do not object to replacing this with a better one assuming we can find one. Garycompugeek (talk) 22:12, 24 July 2012 (UTC)[reply]
Gary, let's be clear: The issue is not that the KNMG statement is "not the best source." The issue is that it is an insufficient source. Do you agree it is an insufficient source? Zad68 14:58, 25 July 2012 (UTC)[reply]
Let's not play semantics Zad. The KNMG source is acceptable or it would not have lasted 5 mins in the article. Garycompugeek (talk) 18:01, 25 July 2012 (UTC)[reply]
As you are unwilling to actually address any of my actual Wikipedia policy-based concerns regarding the fitness of the source, I will open a WP:RSN discussion about it so we have input from outside editors. Zad68 18:11, 25 July 2012 (UTC)[reply]
WP:RSN discussion opened here. Zad68 20:04, 26 July 2012 (UTC)[reply]

Foreskin donations

I am wondering why the widespread practice of neonatal foreskin donations is not mentioned here? PMID 19591680, http://www.apligraf.com/professional/what_is_apligraf/how_is_it_made/ Richiez (talk) 18:26, 20 July 2012 (UTC)[reply]

It's probably not mentioned in this article because it doesn't seem relevant and notable enough for a mention here. The first document with PMID 19591680 doesn't mention "circumcision" at all, at least not in the abstract... in fact I don't see that it mentions "foreskin" or "prepuce" either. A Google scholar search for "Apligraf" with "circumcision" returns almost no quality results at all--the cites are to things like "foreskin-restoration.net" and "mothering.com" instead of academic institutions or publications. You might consider trying to create a Wikipedia article for Apligraf and putting the information there, although I'm not sure if Apligraf meets Wikipedia criteria for notability. Zad68
Actually I just noticed that the article already includes a mention in this direction: "After hospital circumcision, the foreskin may be used in biomedical research, consumer skin-care products, skin grafts, or β-interferon-based drugs." although the specific company/product name "Apligraf" is not mentioned, and again due to notability issues I don't see that mentioning this specific brand name is needed. Zad68 15:08, 22 July 2012 (UTC)[reply]

Proposed rewrite of lead to move in the direction of Featured Article

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

HATing draft #1 to propose draft #2
The following discussion has been closed. Please do not modify it.
Male circumcision (from Latin circumcisio, meaning "to cut around") is the surgical removal of some or all of the foreskin (prepuce) from the penis. It is estimated that one-sixth to one-third of males worldwide are circumcised. It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa and the United States; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania.
The origin of circumcision is not known with certainty; the oldest documentary evidence for circumcision comes from ancient Egypt. Various theories have been proposed as to how it began, including as a religious sacrifice and as a rite of passage marking a boy's entrance into adulthood. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread. It is considered religious law in Judaism and established tradition in Islam to circumcise sons. Some other cultural and religious groups also practice it; it has been condemned by the Roman Catholic Church since 1442.
In modern times, for infants, the procedure is often performed using devices such as the Plastibell, or the Gomco or Mogen-style clamps. First, the foreskin is opened to reveal and allow inspection of the glans underneath. Then, the inner lining of the foreskin is separated from its attachment to the glans. The circumcision device (if used) is placed and remains there until blood flow has stopped. Finally, the foreskin is removed. Topical or locally-injected anesthesia may be used to reduce pain, and its use is advocated; if it is not used, the male experiences pain and physiologic stress. For adults, general anesthesia is an option, and the procedure is often performed without a specialized circumcision device.
Circumcision is indicated for both prophylactic and therapeutic reasons. It is a treatment option for phimosis, posthitis and chronic balanitis and balanoposthitis, as well as other penile skin conditions. It reduces the risk of acquiring HIV infection in heterosexual men between 38 percent and 66 percent over two years, reduces the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28%, and is associated with a reduced risk of both urinary tract infections (UTIs) and penile cancer. Studies of its protective effects against other STDs have been inconclusive.
Worldwide, newborn medical circumcision was found to have a median complication frequency of 1.5% with almost no severe adverse events; for older children, the median frequency was found to be 6%. Blood loss and infection are the most common complications. Incorrectly-performed circumcisions may result in an improper amount of skin being removed, concealed penis, urinary fistulas, and other complications. Questions of whether circumcision carries lasting psychological effects, and what its effects are on sexual function, are both poorly determined, with various studies reporting mixed results.
Circumcision is controversial. Ethical questions have been raised over removing healthy, functioning genital tissue from a minor, and opponents of circumcision state that infant circumcision infringes upon individual autonomy and represents a human rights violation. Some medical associations take the position that the parents should determine what is in the best interest of the infant or child; others state parents are not entitled to demand medical procedures contrary to their child's best interests, or infringe on the right of the child to make an informed choice for himself when older. The legal status of circumcision sees a wide range of treatment from legislative bodies around the world. As well, the many medical associations around the world give a wide variety of opinions regarding neonatal circumcision.
One hypothesis of how routine infant circumcision was taken up in the United States around 1900 is based in the germ theory of disease. The penis became "dirty" by association with its function, and, from this premise, circumcision was seen as preventative medicine to be practiced universally. Also, circumcision was seen a method of treating and preventing masturbation. Its prevalence in the United States increased from about 32% in 1933 to 70% and over post-World War II, declining into the 60s in the 1990s.

Feedback and improvements, please. Zad68 18:18, 22 July 2012 (UTC)[reply]

My first reaction is that your lede seems way too large. [[WP:LEAD}} states that the lede should mention the most important bits. Why dont you tell me which of the above parts you think are msot important to mention so we can work from there? I personally think one more paragraph would be sufficient. I would also prefer if we start from the current lede, and propose adding new content bit by bit, instead of an entire rwrite. Pass a Method talk 22:13, 22 July 2012 (UTC)[reply]
Well, I gave four examples of similarly-sized medical articles that are FA-quality, and this is how big the leads are: Virus, a 120 KB article, Fungus, a 140 KB article, Bacteria, a 115 KB article, Influenza, a 140 KB article. This rewrite is right in line with how big they are and their level of detail. This is how big a FA-quality medical article lead should be for the size of the body. You don't agree with how big those FA-quality leads are either? We could get input from people who have experience with FAs. Zad68 22:39, 22 July 2012 (UTC)[reply]
Is this article really 140kb? My guess is that much of that kb comes from some very lengthy references. If we were to shorten some reference paragraphs, the kb would prabably be much less. Pass a Method talk 23:14, 22 July 2012 (UTC)[reply]
There isn't much chance of this article reaching WP:FA status without reaching WP:GA status first. Read over what it takes to create a good article and try to achieve that with this article first. Besides, FA reviewers, especially WP:MED FA reviewers, will ask that some of what you have removed from this article be returned to it. FA articles are usually bigger/more comprehensive than GA articles, which is why their leads are always three to four paragraphs long. References do add to an article's size, but you are supposed to disregard the references in that case; WP:SIZE goes over this. And since I see that some section material has been split from this article into its own article, per the section immediately below this one, also see what WP:SIZE says about splitting information from articles. And, finally, the very short sections and paragraphs in this article are not helping. Per Wikipedia:Layout#Headings and sections: "Very short or very long sections and subsections in an article look cluttered and inhibit the flow of the prose." And per Wikipedia:Layout#Paragraphs: "The number of single-sentence paragraphs should be minimized, since they can inhibit the flow of the text; by the same token, paragraphs that exceed a certain length become hard to read. Short paragraphs and single sentences generally do not warrant their own subheading." In this case, what is "very long" is more subjective than what is "very short," but I caution against having any section exceed six paragraphs unless the extension is needed and isn't extended by much or has been divided into a needed subsection. The lead generally should not exceed four, that's for certain. 218.87.20.10 (talk) 00:25, 23 July 2012 (UTC)[reply]
It would be annoying to find out that we'd have to chop the article down to "fit" into GA expectations when it's already FA size, and then have to turn around and expand it again to meet FA expectations. I think this would be the first attempt to get an article through GA for most of the editors here, including myself, and the advice to read up on the criteria is on target. Got to start somewhere, why not here. Zad68 00:45, 23 July 2012 (UTC)[reply]
Zad68, you wouldn't have to chop anything out of this article unless it's irrelevant or the article can simply do fine or better without it. Except for very short articles, reaching GA status doesn't require that the article's size be of a certain length and certainly not that it be shorter than a typical FA article's length. My point about FA articles usually being bigger/more comprehensive than GA articles is that some of what has been cut from this article would likely be returned upon the request of FA reviewers, at least if they are well-read on this topic and/or look into the article's edit history. My point was that there has been needless cutting. Knowing how much more extensive/tiring the FA nomination process is (for example, the GA nomination process only includes one reviewer, while the FA nomination process includes multiple or several reviewers), and that articles aren't likely to be promoted to FA status before being promoted to GA status first, I was trying to spare you some trouble. 109.123.115.21 (talk) 01:41, 23 July 2012 (UTC)[reply]
re "Is this article really 140kb?" Yes by the count of all the Wiki markup including the references. This is the same way I measured the MED-FA articles I mentioned so it's an apples to apples comparison. There are some duplicate refs I'm seeing now in this article, they could be folded down too to reduce Wiki markup size without changing any content. I compared the ratio of reference to article content in each of the four MED-FA articles I mentioned, and in each of the four cases it's just about exactly twice as much article content as references--the refs make up about 1/3 of the article presentation. For circumcision it is slightly more than that, maybe 40% and not 33%, but not that much more. It can be cut down as described, but still the comparison about the relative lead size stands. Zad68 00:58, 23 July 2012 (UTC)[reply]
Thanks for bringing all of us on board Zad. Happy to provide my two cents so far.
  • The scope of the sentence “it reduces the risk of acquiring HIV infection in heterosexual men between 38 percent and 66 percent over two years" is blown a little out of proportion. The Cochrane meta-analysis, which we aren't citing anymore in this revision, is the prominent source that supports this. The rhetoric seems to run against what is expected out of Wikipedia:Verifiability guidelines, as two of the three authors of the trials that it bases its conclusions on argued that it decreased female to male HIV among African men particularly.
  • If we are to mention a comprehensive list treatment options for circumcision (for "phimosis, posthitis and chronic balanitis and balanoposthitis, as well as other penile skin conditions"), then it may warrant indicating that several sources argue that there are more effective treatment options for the conditions described. At least in the next paragraph that discusses controversy. It seems we came to an agreement on this recently as well. FactoidDroid (talk) 03:24, 23 July 2012 (UTC)[reply]
Regarding the Cochrane HIV sentence (that darn horse just won't die!!!) we can return the wording back to the last consensus we had on that sentence, no problem.
Regarding the treatment options, by saying "It is a treatment option for phimosis..." instead of "It is the treatment for phimosis..." doesn't that cover the concern you raise?
Regarding the rest of it... any comments on other parts, or the general idea here of expanding the lead to provide a deeper level of detail covering the article content?
Zad68 12:32, 23 July 2012 (UTC)[reply]
Some points:
  • circumcision disambiguation - in anthropology "circumcision" is used to describe drastically different procedures ranging from a small cut over removal of all skin from the complete shaft of the penis, other variation is to slit open the urethra along the shaft.
  • "Circumcision is indicated for both prophylactic and therapeutic reasons". That should probably read "may be", and the "prophylactic" is highly controversial at best. For example the majority of doctors in Germany say that while there has been demonstrated prophylactic effect in Africa it is irrelevant as indication in Germany.
  • "Circumcision is controversial": first and foremost, neonatal circumcision is controversial.
Richiez (talk) 11:33, 23 July 2012 (UTC)[reply]
re disambig -- Doesn't the opening sentence of this article "Male circumcision is the surgical removal of some or all of the foreskin (prepuce) from the penis" set the context for the rest of the article? Or are you saying that there should be a Wikipedia WP:DAB page? Overwhelmingly, when reliable sources talk about "circumcision" they're taking about "removal of some or all of the foreskin (prepuce) from the penis." In reviewing the reliable sources on this topic, I've never seen "circumcision" as referring to "removal of all skin from the complete shaft of the penis" or the other variants you're describing. If enough reliable sources can be brought about those subjects we can see how to fit them in to Wikipedia.
re "is" vs. "may be" indicated, yes the text can be adjusted. The HIV transmission prophylactic effect is well-documented by reliable sources, this is one of the "dead horses" we've beaten many many times over here, as I replied to Factoid we have a consensus sentence regarding this that can be used instead.
re "controversial" It has attracted controversy for both neonates and adults, and saying it "is controversial" without specifying an age range covers both, doesn't it?
Regarding the rest of it... any comments on other parts, or the general idea here of expanding the lead to provide a deeper level of detail covering the article content?
Zad68 12:50, 23 July 2012 (UTC)[reply]

Thanks for the feedback. I incorporated it into the following draft #2

  • It's shorter, I cut the whole paragraph about its history in the US, chopped parts out of the paragraphs and tightened up some wording
  • It's now four paragraphs, as is apparently the standard
  • I returned the previous consensus wording about Cochrane as requested by 2 editors
  • I reworded "Circumcision is indicated" to "Circumcision may be indicated"

Here it is:

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

Feedback please. Zad68 03:00, 26 July 2012 (UTC)[reply]

Thanks again Zad for keeping us current on the progress of the lead. I only have a few suggestions.
  • I'm seeing a qualifier in this revision that states circumcision carries "almost no severe events" in neonates. In the body of the article for circumcision, I see that the same qualifier is actually used for both neonates as well as children. This should be a quick fix.
  • Following the proposed sentence "Questions of whether circumcision carries lasting psychological effects... mixed results", this seems to an appropriate spot to briefly mention that circumcision has been shown to sever a part of the human anatomy embedded with sensitive nerve endings. The College of Physicians and Surgeons of British Columbia have written that the foreskin "is rich in specialized sensory nerve endings and erogenous tissue". The Royal Dutch Medical Association argues that it is "a complex, erotogenic structure". PMID 22114254 state that "the complex innervation of the foreskin and frenulum has been well documented, and the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings. PMID 3122584 argues that circumcision removes human "specialized nerve endings". PMID 17437774 states circumcision "is associated with decreased erectile function and decreased penile sensitivity". PMID 8800902 and PMID 17378847 also both carry a similar dialogue regarding the foreskin containing nerve endings (I'll spare you more redundant quotes). There is, quite irrefutably, a presence of nerve receptors in the human foreskin which are severed by circumcision.
  • In Circumcision#History, there are over a dozen explanations for how the procedure might have began. For the sake of space, is it worth focusing on two possible explanations for its origin in the lead when there is only a remote chance of either explanation being correct? FactoidDroid (talk) 05:36, 26 July 2012 (UTC)[reply]
I prefer changing the "muslims world ... near universal)" bit to "muslim majority countries". Pass a Method talk 12:49, 26 July 2012 (UTC)[reply]
Thanks Factoid and Pass a Method, I'll work on your suggestions. Zad68 03:35, 27 July 2012 (UTC)[reply]
I am not sure I would give the lead so much attention at this time, it is supposed to summarize the body and there may be still lots of work to be done to cleanup that. Coming back to the disambiguation issue, circumcision is commonly connected with initiation rites in most cultures. Hence the lead probably should mention male initiation rites and disambiguate that from medical circumcision. As of initiation rites involving male genital modification, WP has penile subincision, it is strangely missing stripping/flaying and and overview of male genital mutilation initiation rites. There is however genital modification and mutilation covering both sexes. Richiez (talk) 21:39, 26 July 2012 (UTC)[reply]
Hi Richiez, if you're not interested in working on the lead now, that's fine. The lead should summarize the body and otherwise follow the guidelines at WP:LEAD at any given point in time regardless. But as you're providing feedback about the lead anyway...
I agree that the lead should mention circumcision's history featuring in initiation rites because the section in the article body on history touches on that, and you'll see that my proposed lead rewrite above does indeed cover this. There is a separate article on History of male circumcision. This article's focus is on circumcision as a modern surgical procedure. There are other articles on circumcision as religious rites, like Brit milah and Khitan (circumcision). Look at the "See also" list at the top of the Cultures and religion section.
Regarding penile subincision missing "stripping/flaying" and the other articles you mentioned you're welcome to go edit those articles and add well-sourced content regarding those topics to them, but those subjects seem off-topic regarding this article and its lead. Let me know if you have any other input regarding the lead. Zad68 03:33, 27 July 2012 (UTC)[reply]
Prevalence clean-up: Proposed draft: "It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa and the United States; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania." More accurate: "It is most prevalent in the Muslim world (where it is near-universal), Israel, the Philippines, South Korea, the United States, and much of Africa; it is less common in Europe, Latin America, parts of Southern Africa, and most of East Asia." Comments on the changes: (1) added Israel, not the Muslim world, does seem to belong to the most prevalent (and perhaps the near universal comment is applicable there). "Parts of Southeast Asia" is vague and other than the Muslim countries there (Malaysia, Indonesia) and Muslims in the area seems only to apply to the Philippines (some may not even consider this SE Asia any way) and South Korea (rarely considered SE Asia) - also eliminates the ambiguity of whether "parts of" applies to SE Asia only, or carries through to Africa and the United States as well. (2) much of Africa, rather than all of as possibly implied. (3) changed "rare" to less common. I doubt one would consider it "rare" to find a circumcised man in all of the geographies listed ("rare" is an undefined and weasel word anyway). (4) East Asia replacing Asia, because much of Asia is in the Muslim World (say Turkey->Kazakhstan->Pakistan->a sizable minority in India (again, not likely to be rare if 15% of the people there are Muslim->Bangladesh->Malaysia through to Indonesia. Less common in East Asia specifically (China, Vietnam, Laos, Cambodia, North Korea, Burma, Thailand, Siberia). (5) Left out Oceania, as circumcision is near universal among many indigenous peoples of the region, and circumcised penises are hardly considered "rare" among the ANZACs. Carlossuarez46 (talk) 18:20, 27 July 2012 (UTC)[reply]

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

Sub-article

I have just started the sub-article at circumcision surgical procedure. I need some help to expand it. Pass a Method talk 21:17, 22 July 2012 (UTC)[reply]

I have just expanded it, we now need a picture, but the question is .... which one? Should there be one or two pictures? Pass a Method talk 22:48, 22 July 2012 (UTC)[reply]
I don't understand this split. The moved section is not too large for the article, and as circumcision is a surgical procedure, the titles seem to indicate identical scope.--Taylornate (talk) 23:11, 22 July 2012 (UTC)[reply]
There seems to be much support for a seperate article in the "rfc which image" section. above. Pass a Method talk 23:16, 22 July 2012 (UTC)[reply]
e/c adding: Basically, there's a lot of relevant, reliably-sourced content related to circumcision that isn't just about the surgical procedure. Consequently this article has grown very large and has been moving into a WP:Summary style article, with a basic description for each section and each section has a heading linking to a full article. We already have Medical analysis of circumcision, Sexual effects of circumcision, Circumcision and HIV, Prevalence of circumcision, History of male circumcision, Circumcision controversies, Ethics of circumcision, Circumcision and law, Brit milah, Religious male circumcision and Khitan (circumcision) as section "see alsos" and so this is just another one. Zad68 23:22, 22 July 2012 (UTC)[reply]
Ok, it makes more sense now.--Taylornate (talk) 23:30, 22 July 2012 (UTC)[reply]
As far as pictures go, honestly I don't think we really have any good ones of the procedure at all. File:My_gomco_circ_may96.jpg, File:Plastibell1.jpg and File:Plastibell Circumcision Device.jpg are barely marginally useful. File:Rituelle Beschneidung.jpg might be useful but only if we can get an accurate and informative medical description of what exactly is going on in that photo from a reliable source. As we've covered previously "Circumcision with a clamp, there was no phimosis" is so uninformative as to be nearly meaningless. One decent image we have is File:Penile nerve block dorsal.jpg, it's clear, easily understood and illustrates a relevant step in the procedure, but not the procedure itself. In the past I have tried to ask university hospitals for permission to use pictures they have posted on their web sites but never got any permission. The very best thing we have are those Stanford Medical School videos. I wonder if we can justify "fair-use" permission of stills from those videos. My guess is "no" but maybe we should try. Also, I have had luck finding images on Wikimedia Commons used in Wikipedias other than en.wikipedia. Try looking at foreign-language Wikipedias and see what they have. I found a good illustration that I was going to use after replacing the foreign-language wording with English. Let me know what you find. Zad68 23:56, 22 July 2012 (UTC)[reply]
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