Talk:Circumcision/Archive 81

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May have misinterpreted terms in sentence: "but the procedure is associated with increased clearance of the virus by the body,[15][16] which can account for the finding of reduced prevalence.[16]"

Hi,

Note that this is in the section Human Papillomavirus. Here it's said that the procedure is associated with an increased clearance of the virus from the body. Rehmeyer didn't conclude that circumcision increases the clearance of it from the body, he states that it reduces the persistance of HPV infection. Just wanted to point that out; these might mean two different things. I think that clearance in these studies refers to when the virus clears itself from the penis. HPV never really goes away after you get it, so its never cleared from your body.

JohnP (talk) 01:20, 4 January 2015 (UTC)

The sourcing (and there are several used in that section) discusses "clearance". If you'd like a direct quote I can get that for you. Zad68 05:03, 4 January 2015 (UTC)

I think that Larke uses clearance but Rehmeyer dosen't. You can get that for me if you'd like. You're saying it wrong though. HPV is never cleared by the body, you have it for life.

JohnP (talk) 01:52, 5 January 2015 (UTC)

Yes, Larke says "increased HPV clearance" right in the abstract, so what is the problem if the article also refers to "clearance" like the source does? Note that the article wikilinks to Clearance (medicine) when the term is used. Zad68 03:35, 6 January 2015 (UTC)

No but that's not the problem. The problem is that in the article you're stating that it causes an increased clearance of the virus from the body. HPV is never cleared from the body. I recently went to kidshealth.org to look up an article on HPV. Here is what it said: "Is there a cure? No. HPV is a chronic, lifelong infection." When I read Rehmeyer and Larke's studies I think what they were saying is it clears itself from the fluids, or outer skin on the penis faster if you're circumcised.

JohnP (talk) 23:15, 6 January 2015 (UTC)

So you're agreeing the sourcing mentions "clearance" specifically and so the Wikipedia article is supported by the source. You're just concerned that readers may misinterpret what "clearance" means in this context, even though there's a Wikilink? Zad68 23:00, 10 January 2015 (UTC)

No. Its because you say directly in the text that circumcision causes increased clearance of HPV from the body. HPV is never cleared from the body. It is cleared from the penis faster. It can't be cleared from the body because it is a life long illness.

JohnP (talk) 04:10, 13 January 2015 (UTC)

May not be a Proper Source: Section Technique, Sentence: Proposed theories for the purpose of the foreskin are that it serves to protect the penis as the fetus develops in the mother's womb, that it helps to preserve moisture in the glans, or that it impr

Citing this statement with the WHO report on circumcision may not be a good idea. The focus of their report is global trends and determinants of prevalence, safety, and acceptability. Their focus is not on the role of the prepuce.

JohnP (talk) 02:04, 4 January 2015 (UTC)

The idea that the WHO can't be used as a reliable source on this seems rather unreasonable. Zad68 05:03, 4 January 2015 (UTC)

I don’t think that the focus of this paper is on the foreskin at all. Shouldn’t we have a source that describes the foreskin for this information?

JohnP (talk) 00:46, 6 January 2015 (UTC)

The focus of the WHO's paper is circumcision and they mention it to provide a bit of context. Are you suggesting that we should remove the sentence from this Wikipedia article altogether, as this article is circumcision and not foreskin? Zad68 03:35, 6 January 2015 (UTC)

I mean I like how we have the little summary on the foreskin there before we go to technique. No, what I'm suggesting is that we find a source that actually represents the prepuce rather then one that's focused on the global trends and determinants of prevalence, safety, and acceptability for circumcision.

JohnP (talk) 23:18, 6 January 2015 (UTC)

The WHO is giving a brief overview of the theorized functions of the foresking in the context of discussing circumcision, the Wikipedia article is just doing likewise by summarizing the WHO here, you're saying the WHO can't be trusted on this? I don't see how the source is a problem. Zad68 23:00, 10 January 2015 (UTC)

Yes. I'm saying the source can't be trusted. Is naturally biased. Its purpose is to help fight the AIDS epidemic in Africa. It is focusing on circumcision’s prevalence, safety, and acceptability purposely, and not objectively, because they are trying to scale it up to prevent HIV in areas where there is a lot of HIV.

JohnP (talk) 04:19, 13 January 2015 (UTC)

In some of these countries, up to 25% of people have HIV. Have you read the RCTs?

JohnP (talk) 04:20, 13 January 2015 (UTC)

Section Medical Indications, Statement "and is recommended that it be discussed with men who have sex with men, especially in areas where HIV is common.[26]"

The reccomendations from this study are "Voluntary medical male circumcision should be discussed with men who have sex with men and who engage in primarily insertive anal sex, particularly in settings of high HIV prevalence. Rating: BIIb " This does not apply to all MSM only those that practice insertive sex.

JohnP (talk) 02:34, 5 January 2015 (UTC)

If the source says discussed with MSM why is it a problem if Wikipedia says "discussed with men who have sex with men". Zad68 03:35, 6 January 2015 (UTC)

No, that's not the problem. It's because the Wikipedia article does not say that it only needs to be discussed between MSM who practice insertive anal sex. This article is saying that it should be discussed between MSM who practice insertive anal sex not all MSM.

JohnP (talk) 23:19, 6 January 2015 (UTC)

OK I see, sure I'm fine with adding that qualifier, to have the Wikipedia article say "discussed with men who have mostly insertive anal sex with other men." I have made this change. Zad68 23:00, 10 January 2015 (UTC)

The change dosen't represent the summary. They say it should be discussed with MSM who engage in primarilly insertive anal sex. They don't say "have mostly insertive anal sex." This could be misinterpreted. By primarilly they're trying to emphasize that they want the ones who are mainly practicing this type to do it. I already made this change.

JohnP (talk) 04:25, 13 January 2015 (UTC)

If We have a Good Source, and it dosen't directly support anything on the page, Shouldn't we still be able to add it?

Hi. Based on some current behavior on the page I felt obliged to bring this up. Myself and some other editors have added new sources and DocJames has deleted them. When I asked DocJames about this, he said that all of the sources have to directly support parts of the text. However, I just checked Wikipedia and it seems like you can add sources to a page as long as they generally support the article content. So this means that the sources don't have to directly support parts of the text.

JohnP (talk) 00:43, 7 January 2015 (UTC)

No, the References section is for resolving ref-tag references used in the article, it isn't a dumping ground for other stuff. Zad68 23:00, 10 January 2015 (UTC)

Nowwhere on WikiProject Medicine did I see this "rule" that you cannot cite a source that is directly in the text. Actually, what WikiProject Medicine is saying that good sources are recent literature reviews, meta-analyses, and systematic reviews on the topic and that all of these should be put in the references, whether or not they support a direct statement on the page.

JohnP (talk) 04:37, 13 January 2015 (UTC)

Question about Statement: A 2010 review of clinical trial data found that circumcision reduced the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28% under "Other Infections"

I already reviewed the sourcing for this statement and found that the source was not a literature review and was only supported by one study. I had to remove the same statement from the summary. This already recieved consensus. We can't have this statement up because there is no literature review, meta-analysis, or systematic review supporting that circumcision reduced HSV-2 by this number

JohnP (talk) 02:28, 15 January 2015 (UTC)

I have found many policy statements and technical reports from other countries with info for page. Had to repost this one. This was not concluded but was sent to the archives.

I found new policy statements and technical reports that have information on circumcision. Zad I think that you stated that we could add these but I didn't get confirmation.

Here are the documents:

Document "Non-therapeutic circumcision of male minors" by the KNMG. See the link http://knmg.artsennet.nl/Publicaties/KNMGpublicatie/77942/Nontherapeutic-circumcision-of-male-minors-2010.htm for a copy.

Document Neonatal Circumcision Revisited from Canadian Paediatric Society: Pubmed ID 8634956

Document "The law & ethics of male circumcision - guidance for doctors" from British Medical Association (medical ethics commitee). See the link http://bma.org.uk/search?query=circumcision%20AND%20policy

Document "Guidance for doctors who are asked to circumcise male children, 1997" from British General Medical Council (medical care regulator): See link http://www.gmc-uk.org/guidance_circumcise_1997.pdf_25416429.pdf

-- I currently can't find a few from provinces in Canada. These are from manitoba, saskatchewan, and British Columbia. I will contact these organizations in order to provide links to these documents. Then I will post the links here.

Zad can I get confirmation on adding these? WikiProject Medicine says technical reports are valid sources.

JohnP (talk) 02:31, 15 January 2015 (UTC)

Have to repost this because it was sent to archives but not concluded: Poor Position of Sentence: The WHO recommends considering circumcision as part of a comprehensive HIV program in areas with high rates of HIV, such as sub-Saharan Africa,[13][14]

I thought that it would be good to start this paragraph with the sentence "The WHO recommends considering circumcision as part of a comprehensive HIV program in areas with high rates of HIV, such as sub-Saharan Africa,[13][14] where studies have concluded it is cost-effective against HIV.[13] " This is because our sourcing is indicating that circumcision biologically prevents HIV, but the HIV benefit in developed countries is undetermined due to different population and behavioral factors. Since the benefit in developed countries is undetermined still, we shouldn't introduce the HIV benefit like it applies to all humans. The literature does not indicate that

JohnP (talk) 02:37, 15 January 2015 (UTC)

Not the conclusion: "A 2013 systematic review and meta-analysis found that circumcision did not appear to affect sexual desire, pain with intercourse, premature ejaculation, time to ejaculation, erectile dysfunction or difficulties with orgasm.[59]"

The conclusion of this source is "In summary, male circumcision does not appear to adversely affect penile sexual function or sensitivity when compared with uncircumcised men. " This means that it has an affect,

JohnP (talk) 00:34, 13 January 2015 (UTC)

Huh? looks well-summarized to me. Alexbrn ^{talk|contribs|COI} 06:26, 13 January 2015 (UTC)

no the conclusion says does not appear to adversely affect these things. Not affecting and not adversely affecting are two different things. The fact that it didn't adversely affect these things means it still had an affect.

JohnP (talk) 02:46, 15 January 2015 (UTC)

Question on Section: "Medical indications", Sentence: "Circumcision may be medically indicated in children for pathological phimosis, refractory balanoposthitis and chronic, recurrent urinary tract infections (UTIs) in males who are chronically susceptib"

Is this statement directly quoted from the textbook? I'm asking because based on the Phimosis page it seems to be false. Children don't get pathological phimosis, they get Physiologic phimosis. This is normal and can be treated with steroid cream.

JohnP (talk) 01:36, 9 January 2015 (UTC)

Black's says "Phimosis (restricted opening of the foreskin) is sometimes an indication for circumcision", Wolter's says "The most common indication is phimosis", Lissauer lists phimosis specifically as a "medical indication", similar is echoed in many other sources. Wikipedia's pages on phimosis and related topics are particularly terrible, don't use them as a sources or a model for anything. Zad68 23:00, 10 January 2015 (UTC)

Yes but this is only pathological phimosis that is brought about by Traumatic tearing of the foreskin by parents, Chronic balanoposthitis, and Balanitisxeroticaobliterans as indicated by my new sources. This is not physiological phimosis that almost 90 percent of children get. There is no need for circumcision with this type of phimosis you can leave it alone or use steroid cream.

This sentence is ok. I have some new sources that talk about the medical indications for circumcision. These have pmids of 21298220 and 16800325. Maybe we should take these into account.

JohnP (talk) 03:16, 15 January 2015 (UTC)

We should be using the study Review of the Current State of the Male Circumcision Literature, see .mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}PMID 25284631 because of WikiProject Medicine Guideline

According to WikiProject Medicine literature reviews, systematic reviews, and meta-analyses are the highest quality medical sources we can use. This is a literature review that points out significant gaps and problems that exist in the literature involving circumcision's effect on sexual health. We only have one meta-analysis on the topic already; so this and the meta-analysis are the highest quality medical evidence on sexual effects that we have. I don't understand why you won't let me write about it.

JohnP (talk) 03:39, 15 January 2015 (UTC)

Are your efforts being frozen out John ?--— ⦿⨦⨀Tumadoireacht ^Talk/_Stalk 12:43, 15 January 2015 (UTC)

AIDS part in summary isn't really clear.

The part in summary dosen't match up with what we have written in article. There's level 1 evidence as of now so we might as well point it out. But also should point out that the inclusion in the health policies of other developed countries is undetermined.

JohnP (talk) 03:33, 17 January 2015 (UTC)

We are writing for a general audience. The term "level 1" evidence is not appropriate, at least not in the lead. Doc James (talk · contribs · email) 23:09, 17 January 2015 (UTC)

Should not use the word routine when talking about the developed world. Noone is even thinking about routine in the developed world. Should seperate out part on homosexuals from MSM. Make MSM part more clear

JohnP (talk) 02:20, 18 January 2015 (UTC)

Yes agree. We can summarize this further as "Its use to prevent HIV in the developed world is unclear"

Effects in MSM apply globally. Thus this should come after the global discussion. We can summarize as " For men who have sex with men the evidence of an HIV benefit is less clear" Which ref says "slight benefit"? And these details are best dealt with in the body of the article. Doc James (talk · contribs · email) 02:28, 18 January 2015 (UTC)

I don't think section 1.1 should be called routine or elective.

I don't think that the literature is indicating that most people are thinking about routine or elective circumcision. The Bolnick textbook seems to be saying that countries are arguing over its medical value. It also says that no country recommends it non-therapeutically and no one wants to ban it either.

Well, overall the source doesn't give any indication that people are thinking about it routinely. This should be taken out of this title.

JohnP (talk) 00:14, 23 January 2015 (UTC)

Do not see what is wrong with it. Doc James (talk · contribs · email) 02:50, 24 January 2015 (UTC)

I mean noone is even arguing over it being routine or elective. Keeping it as routine or elective shouldn't be done because we're describing a discussion in the medical field that isn't even existant. We're basically lying to Wikipedia readers.

JohnP (talk) 16:10, 24 January 2015 (UTC)

Sorry you have lost me. Lots of sources use those terms. Doc James (talk · contribs · email) 21:25, 24 January 2015 (UTC)

I'm talking about the Bolnick book. They clearly state that noone wants to do it routinely and noone wants to ban it. Also, they say that medical organizations are arguing over whether its pros outweigh its cons or its cons outweigh its pros basically.

JohnP (talk) 01:04, 25 January 2015 (UTC)

Okay so what is the issue? Doc James (talk · contribs · email) 02:11, 25 January 2015 (UTC)

I do not see an issue, routine and elective are the terms the sources use, are you suggesting the article be edited to not use the terms the authoritative sources use? Zad68 02:55, 25 January 2015 (UTC)

you can't discredit Bossio because she's a masters student

You can't discredit Bossio just because she's a masters student. WikiProject Medicine Guidelines say that literature reviews are the highest quality medical sources so this still must be included in page. Also, even though here conclusion relates to North America please see her results. She clearly states that there are gaps in the overall literature relating to sexual health. Here conclusion was written in that way to Emphasize the fact that the gaps in the literature regarding sexual health are so severe that people in North America need to look at their policies regarding circumcision.

JohnP (talk) 21:51, 21 January 2015 (UTC)

Bossio is a master's student in psychology, she has no medical qualifications whatsoever. She also has almost no publishing footprint. It's a very weak source. In addition her conclusions are very clearly localized to North America, the abstract alone mentions this a half-dozen times. Frankly it's really quite unreasonable of you, on the one hand for some things, to insist on tiny wording changes to nudge the content closer to the source (here I'm thinking of your request to add "insertive anal sex" to the recommendations for MSM) but in this case feel it unnecessary at all to mention how specific Bossio's comments are to North America alone. Zad68 03:14, 25 January 2015 (UTC)

Sentence on circumcision controversies

Why'd you delete my sentence. The ethics textbook is a really bad source, it dosen't even go over controversies. Crawford gives a good perspective of controversies in the UK and Pinto gives a good perspective of controversies in the US. Crawford gives a good summary of the controversy over sexual health in the UK and puts emphasis on it, we can't leave this out.

JohnP (talk) 02:14, 17 January 2015 (UTC)

Leaving the sentence as is clearly makes the page North American bias. And the textbook is a poor source.

JohnP (talk) 02:15, 17 January 2015 (UTC)

Crawford is a little old. Why remove this which provides a good summary? Doc James (talk · contribs · email) 02:27, 17 January 2015 (UTC)

The textbook does not talk about questions that are being asked about circumcision. Only covers legal and ethical problems that doctors can encounter when asked to circumcise.

JohnP (talk) 03:28, 17 January 2015 (UTC)

Yes and the sentence it supports is about "Ethical and legal questions" Doc James (talk · contribs · email) 23:08, 17 January 2015 (UTC)

No its about questions that have been raised overall. Not ethical and legal questions that doctors naturally have to work through when they're asked to circumcise. This is not a statement about the law, its about what the literature overall is saying.

JohnP (talk) 02:12, 18 January 2015 (UTC)

Once again please do not keep repeatedly bringing up the same topic in multiple Talk page sections. Zad68 03:17, 25 January 2015 (UTC)