Talk:Sexual effects of circumcision

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Congradulations Jake on a very sensible article. Didn't know you had it in you.  ;} Sirkumsize 15:36, 29 October 2005 (UTC)

Contents

[edit] Regarding sensitivity of the foreskin

I noticed that many of these studies say there is "no difference" in sensitivity between intact and circumcised males, but they are measuring sensitivity in the glans or the shaft and not the frenulum or foreskin itsel. There are studies that say that these organs have distinct sensitivity. Here is the wikipedia article on the frenulum:

"The frenulum and the associated tissue delta on the underside of the penis below the corona has been described in sexuality textbooks as "very reactive," and "particularly responsive to touch that is light and soft." The “underside of the shaft of the penis, meaning the body below the corona” is a “source of distinct pleasure.”[1] Crooks and Baur observe that "Although the entire glans area is extremely sensitive, there are two specific locations that many men find particularly responsive to stimulation."[2] One is the corona, and the other is the frenulum.[2] The frenulum, sometimes together with the glans, can be stimulated to produce orgasm and peri-ejaculatory response.[3][4]"

http://en.wikipedia.org/wiki/Frenulum_of_prepuce_of_penis

[1] Hass K., Hass A. Understanding Sexuality, St Louis: Mosby, 1993: 99-100 [2] Crooks R., Baur K. Our Sexuality, Fifth Edition, Redwood City: The Benjamin/Cummings Publishing Co., 1993: 129 [3] Saulino, Michael F. (2006). Rehabilitation of Persons With Spinal Cord Injuries [4] Pryor, JL; LeRoy SC, Nagel TC, Hensleigh HC (1995). "Vibratory stimulation for treatment of anejaculation in quadriplegic men". Arch Phys Med Rehabil 76 (1): 59-64

Should this be included in the article when mentioning these studies, especially since circumcision may remove the frenulum?

http://en.wikipedia.org/wiki/Image:Glans_Penis_by_David_Shankbone.jpg

-J

While I'm at it I think that this is kind of a weird sentence and I'm going to go ahead and remove it. "There is a belief that the foreskin is sexually sensitive [13][14] [15] and this has been documented, in the main, by studies opposed to circumcision.[citation needed]"

Does it matter if a belief of this kind exists and who believes it? Surely it is trivially true that someone who believes that foreskins are sexually sensitive would be opposed to removing them.


-J —Preceding unsigned comment added by 24.218.18.121 (talk • contribs)

I think you're right to remove it. Beliefs are important in some contexts, but in a scientific article they potentially devalue the more meaningful studies. Jakew (talk) 10:47, 5 May 2008 (UTC)

Are there any studies about female visual arousal in regions where the majority of men are uncircumcised? It is important to remember that prototypicality and enculturation have a profound effect on what we find appealing. -J —Preceding unsigned comment added by 24.218.18.121 (talk) 06:33, 7 May 2008 (UTC)

Your question brings up interesting dichotomy from other cultures. Feel free to research this matter and add source applicable data from peer reviewed publications. If you can find this it will add a balanced perspective. Garycompugeek (talk) 17:11, 7 May 2008 (UTC)

[edit] Reading the article in conjunction with the original research

First of all, Jake, congratulations for the work that you have done. You will notice that I have added a caution to suggest that people follow the links to the reports of the original research. I hope you'll agree that this is an appropriate and sensible thing to add to the article. Michael Glass 12:35, 21 September 2005 (UTC)

I'll adjust the wording, Michael, since it's not up to us to dictate what use people make of material. Jakew 13:17, 21 September 2005 (UTC)

I have noticed your changes to the wording, Jake. However, I would class my wording as advice rather than an order. Michael Glass 13:41, 22 September 2005 (UTC)


Concerned Cynic, 22.10.05: I submit that if the title of this entry is taken as a question, it has no answer. There is no scientific instrument that records sexual sensations in numerical form. The random assignment of several hundred men to the categories "circumcised" and "intact", who would then be followed up for the rest of their lives, would be at once unethical and very expensive. Most or the respondents to the questionnaire circulated by the O'Haras were women recruited through ads in anti-circ newsletters and the like. This is not the way to do careful objective social science.

I do not know what to make of claims by some women that the foreskin makes a big difference either way in their enjoyment of intercourse. I think that the length and quality of foreplay, the woman's admiration of her partner, and many subtleties of mood and hormones (even her menstrual cycle) all play major roles in how a woman responds to a particular sexual episode. If I am correct, the foreskin slides into insignificance, especially given that most American women cannot distinguish circ from intact when both are fully erect.

When comparing the sensitivity of both kinds of men, one can only carry out measurements on tissues and erogenous zones retained by both. This evades the crux of the matter: intact men have extra nerve endings located on the underside and tip of the foreskin (about which the neuroanatomical work of Taylor and coauthors is convincing). Hence a comparison of the penile sensitivity of the two sorts of men cannot be carried out.

I predict that American parents are slowly coming to the opinion that circ makes intercourse less enjoyable. Any year now, that will become the conventional wisdom pushed by Cosmopolitan and the sex columnists in other women's magazines. I do not wish to assert that it is necessarioly true. But if I am correct, the rate of routine infant circumcision in the USA is about to go into free fall.

As they should. Sirkumsize 15:36, 29 October 2005 (UTC)

[edit] Stubbing

This is regarding the current quality offensive on circumcision, of which this is a sub-article.

I'm making this article a stub to further encourage addition of material. I have already voiced concerns that studies alone on the topic of circumcision unfortunately have little meaning, as for example it is not possible to make truly double-blind tests for obvious reasons. Also, several psychological factors are also notable, like cognitive dissonance. The impression that I am having from reviewing a few studies is that circumcised men tend to "brag" more about their sexual exploits than those that did not undergo the procedure, and as most studies inherently rely on males reporting things, are only of dubious reliability.

I would like more real material added to this article, rather than just a table. What are the sexual effects of circumcision? Dabljuh 09:02, 11 January 2006 (UTC)

As should be apparent, the effects (if any) are controversial and the evidence conflicting. The table summarises the results clearly. Jakew 11:48, 11 January 2006 (UTC)
As few experiments are totally objective, it would be interesting if the table, (and a jolly good one it is too!) included a column stating where these studies were performed. I have a hunch that the results may be skewed according to what the normal practise is in the study country. (i.e. studies done in countries where circumcision is the norm will tend to be pro-circumcision and vice versa.) This may not be the case but it would be good to see that info. These studies, (as stated above) can never be objective. Almost everyone knows whether they are circumcised or not, so the study can't even be "blind" yet alone "double blind". --Dumbo1 17:23, 13 January 2006 (UTC)

[edit] Practical experiment to demonstrate a possible effect of circumcision

Unfortunately this can only be done by uncircumcised men, but give it a go, and report back here if you like. Firstly retract the foreskin. Secondly keep it like that for a couple of days. Do you report any changes? I have tried this and in my case the glans became dry, (it is normally kept moist and lubricated as it is covered by the foreskin.) Secondly, after an hour or so, the glans became less sensitive. Unlike circumcision this is easily reversable, by rolling the foreskin back over the glans. Normal sensation returns soon, depending on the amount of time the glans is exposed. If any men who have recently been circumcised are reading this, did they experience the same loss in sensitivity? And with time did this sensitivity return? I'm not sure if this is the right place for this, but I couldn't find anywhere else. If there is somewhere more suitable, please let me know. Thanks! --Dumbo1 17:09, 13 January 2006 (UTC)

USENET, perhaps? Jakew 18:08, 13 January 2006 (UTC)
Of course these are all "do it yourself" experiments. Here's another. Pull your foreskin back and then try to jerk off by just rubbing your glans. Comfortable, eyh? Dabljuh 17:49, 13 January 2006 (UTC)
They don't have to be "do it yourself". You could try it on someone elses penis and ask what it feels like. Joking aside, I remember as a teenager (some time back) discussing such things with circumcised and uncircumcised friends, and the difference in masturbatory techniques, and for one circumcised friend, lubrication (I think handcream) was used, as he did find the sensation uncomfortable. Anyway I did have a question that I will repeat otherwise it will get lost: "do men who have been circumcised as adults experience a decrease in sensitivity, either in the short or long term, similar to the decrease in sensitivity they experienced when rolling back the foreskin for a number of hours?!--Dumbo1 18:06, 13 January 2006 (UTC)
Feel free to ask me on my talk page, Dumbo1. This page is really for discussion about the article. Jakew 18:09, 13 January 2006 (UTC)
Indeed, but the decrease in feeling in the glans due to the removal of the foreskin is a Sexual Effect of Circumcision and masturbation is a sexual act. JakeW, would you still rather me ask you this on your User page? If this is a common sexual effect of circumcision, then we should reflect it somewhere in this article eventually, if there are references.--Dumbo1 20:42, 13 January 2006 (UTC)


Where you want to know about my personal experience, rather than source-based research, I would think it would be appropriate to ask on my user talk page, yes. Sorry to be picky, but I would like to see one on-topic article discussion page. :) Jakew 22:29, 13 January 2006 (UTC)
Of course, JakeW, you are correct. I shall take this to User pages. But joking aside, and on a slightly different point, which I have requested above, it would be good if the info in the article showed which countries each study took place, and if possible whether circumcision is the norm in these countries. It would be good for the article if it was included, as the source of information helps us to understand the information itself. I would feel bad if this request got lost because we went off the point a bit because it was Friday night! I think I'll go back in time and repeat myself in the next posting: --Dumbo1 23:44, 13 January 2006 (UTC)
Actually, rather than answer anything to do with my practical experiment, I'd rather have some more info according to my posting in the section above: i.e. it would be good to see the locations and information about the populations which produced the results on the page"Sexual effects of circumcision". --Dumbo1 21:13, 13 January 2006 (UTC)
You probably want do some own "research" on the subject ;), because the topic is somewhat underrepresented in english medical literature. You might want to check [1] and [2].

[edit] Provenance of the Studies

It would fundamentally improve the article if it was stated, for each study, the "circumcision behaviour" of the study population, i.e. for each study was the population usually circumcised or uncircumcised? At the moment we don't know whether these are all the studies or just a sample of samples and if so, how was it determined that the results were or weren't included in the article. If they are just a sample of studies, then potentially this article could fall foul of many Wikipedia guidelines, depending on how those studies were chosen for inclusion. It may also be neccessary to enquire into what the purpose of each study was and the funding behind each. This may sound extreme but for many years I have been following the study of studies into the efficacy of Homeopathy, which is full of potentially similar pitfalls. In any case as the article stands it is just a list of studies and results, rather than an encyclopedia article on the sexual effects on circumcision and therefore contributes little, although it was a good idea. I understand that this is a very "hot" topic and as ever I aim to contribute through discussion on the talk pages to get consensus before changing the article. --Dumbo1 00:27, 14 January 2006 (UTC)

I have at various occasions tried to point out the flaws of using systematically not double-blind studies and sometimes even freaking internet surveys in determining the sexual effects of circumcision. There are too many psychological aspects involved with circumcision, infant and adult, and the genitalia in general to trust them, even when not taking the cultural norm into account. I have marked this article as a stub, as it is my own conviction it requires expansion. A much more trustworthy and informative approach, in my own assessment, to determine the sexual effects of circumcision is a priori research, meaning, determining the biology of the foreskin and, in addition, researching the history of circumcision. Dabljuh 06:45, 14 January 2006 (UTC)
At most, such an approach could only postulate sexual effects. Jakew 12:17, 14 January 2006 (UTC)
Just like studies can also only postulate anything. Dabljuh 13:00, 14 January 2006 (UTC)
Not necessarily. It depends on the design, but often, studies actually measure effects rather than predicting them. Jakew 13:03, 14 January 2006 (UTC)
Rationale and Empirics must always be consistent. Rationale must suggest models, empirism is there to eliminate models. But empirism without rationale is nothing, and rationale without the failed attempt to verify it, is nothing either. Models (theories, hypothesises, whatever you call them) can only be judged by one factor, that is how well they work - how well they explain or predict things.
A hypothesis like "Circumcision has effect X on sexual pleasure" is, unfortunately, inherently hard to verify/falsify, for psychological reasons. Circumcision is a procedure that is mostly irreversible, and effects like buyer's remorse can play into or dominate when assessing an empirical study purely questioning satisfaction.
Example: Several studies have shown that there is a slight increase in average time to ejaculation. This could be viewed as a strong argument that circumcision reduces penile sensation. But alternatively, penile sensation may be increased but the specific ejaculatory trigger may be reduced.
Lets make it a different way, instead of measuring time or reported pleasure, measure something relevant: Chemical energy per climax.
I would suggest the following study: Have a large group of circumcised people and intact people do some sort of wanking contest. Now what you check is the average chemical energy expended by either - Circ'd wanking in my own experience is a lot more violent, louder, and energy consuming. If now a carefully designed study would figure out that circ'd people do indeed expend more energy per climax than intact, I would say this is a definite hint that sexual sensation is greatly reduced, because the amount of energy expended to get 1 orgasm is much higher. Dabljuh 00:11, 15 January 2006 (UTC)

[edit] Personal testimony moved from article

  • This Wikipedia contributor was circumcised as an adult, at the age of 22. As I approach the decade anniversary of my circumcision, I remain grateful for my circumcision, due to its (admittedly subjectively) greater pleasure during fellatio, and the complete alleviation of frequent phimosis and balanitis problems which I had experienced prior to my circumcision. Purely in the sexual arena, I no longer have a foreskin to roll over the head and mute all sensation during the "out" stroke. Furthermore, I'm not aware of any glans desensitization, though my foreskin was naturally short and generally left my glans at least partially exposed. More detailed personal testimony is available at Circlist.
Thank you for giving us the benefit of your experience, but this really is just a case of WP:OR, and so not suitable for an article. Benami 11:08, 17 January 2006 (UTC)
I wouldn't call it OR. It just isn't exactly encyclopedic material. As long as there's a link to circlist in the external sources, I guess its ok Dabljuh 11:36, 17 January 2006 (UTC)
If it's not verifiable in reliable sources, it's original research. Jakew 11:47, 17 January 2006 (UTC)
I don't think that circlist is a legitimate source (as opposed to a notable external site). And I don't see how unverifiable personal testimony about one's own penis could be anything but OR.But Dabluh's right that it's not encyclopedic (whoa - you aren't changing your mind about WP being an encyclopedia, are you?). I can't remember ever seeing a contributer's personal testimony in an encyclopedia before. Benami 11:55, 17 January 2006 (UTC)
You misunderstand me. The articles on Wikipedia should be encyclopedia-like, not encyclopedic - because due to the freely editable nature of Wikipedia, the latter is simply impossible. I do not find personal testimonials not to satisfy even "encyclopedia-like" quality standards. On a side note, a personal testimonial cannot be Original Research, it simply is just a personal testimonial. And for a personal testimonial - if they were anyhow encyclopedia-like - A personal webpage would suffice as an RS. It simply isn't material that's worthy to be included. What I could agree to was to dumb it down to some weasel phrase like "Some circumcised men however refuse the notion that circumcision would reduce the sensual sensitivity of the penis during intercourse". But: If we can find arguments why the sensuality of the penis would not be reduced as a whole, proposed if possible by scientists in WP:RS! That would be even better! Although, as long as we would have absence of such material, I would argue that the weasel phrase should be left in the article. I prefer more information and valid opinions over less. Here's a reliable source on why the sensuality of the circumcised penis would not necessarily be decreased in intercourse. And interestingly, that article is from D.O.C. members. Dabljuh 12:23, 17 January 2006 (UTC)
That's a good source/article, thank you. More is usually better, and readers (maybe especially with ED) should be informed that circ can be a potential treatment for ED.TipPt 16:36, 26 April 2006 (UTC)

[edit] The table should be removed

The Senkul study is likewise misrepresented.TipPt 03:56, 13 April 2006 (UTC)

Fine by me. Alienus 04:27, 13 April 2006 (UTC)
On what grounds? Jakew 09:46, 13 April 2006 (UTC)
The findings were "differences in the mean BMSFI scores were not statistically significant in any of the five sections." Saying "no difference" in the table is inaccurate and misleading. The text cite is OK.TipPt 16:06, 13 April 2006 (UTC)
Ok then, we can say "no significant difference". Happy? Jakew 16:17, 13 April 2006 (UTC)
The proper thing to say is "no finding." It generally is ignored, for obvious reasons.TipPt 15:52, 14 April 2006 (UTC)
No, there was a finding, and it was that there were no significant differences. Jakew 16:50, 14 April 2006 (UTC)
The table should not be removed as it gives us a brief overview of research findings. --Siva1979Talk to me 10:02, 13 April 2006 (UTC)
Agree, though I'm happy to improve it. Jakew 16:17, 13 April 2006 (UTC)
The table makes false study conclusion statements. It is contains grossly inaccurate or irrelevant information, and must be removed.TipPt 15:56, 13 April 2006 (UTC)
It's tabulating findings, as the heading states, not conclusions. Anyway, could you be more specific? If you identify specific problems, they can be fixed, but if you're vague, we can't move forward. Jakew 16:17, 13 April 2006 (UTC)
In general, words like "no difference" "favors..." are opinion, and inaccurate for tabulating scientific findings.TipPt 16:28, 13 April 2006 (UTC)
Well, we can negotiate over the choice of words. I've suggested above changing 'no difference' to 'no significant difference'. Jakew 16:49, 13 April 2006 (UTC)
So far I have detailed Mastood, Senkul, and here's Denniston (2004) (in the Wiki citation for its use in the table and text) "...carried out a survey of 38 adult males who were circumcised at least 2 years after they commenced sexual intercourse. Thirteen men felt that sexual intercourse was better after circumcision, but 22 felt that intercourse was worse and would not have the circumcision again, because of loss of sexual pleasure."
The table misleads when Denniston is missing from the Overall satisfaction section.TipPt 16:23, 13 April 2006 (UTC)
You haven't mentioned Masood here. If you want to discuss it, you'd better comment here. Otherwise you'll just confuse editors with this page but not other pages on their watchlist.
As for Denniston, I'm hesitant to include it without having the text of the original paper to hand. I guess we could, but since it's not peer-reviewed anyway, it might be more sensible to remove Denniston altogether. Jakew 16:49, 13 April 2006 (UTC)

The problem is in the universal mischaracterization of the study results ... ALL OF THEM.TipPt 15:50, 14 April 2006 (UTC)

The Mastood (2005) study is correctly cited in the text, but wrongly in the table.

In the Summary of Research Findings table, this study is listed three times stating that the "Finding" was "no difference," or "favors circumcision." In fact the "finding" in all three should be the study conclusion "CONCLUSIONS: Penile sensitivity had variable outcomes after circumcision. The poor outcome of circumcision considered by overall satisfaction rates suggests that when we circumcise men, these outcome data should be discussed during the informed consent process."

Basically, the 61% "overall satisfaction" was considered low, given the disease state prior to circumcision.

Nowhere in the study do the authors state "no difference," or "favors circumcision." At best, someone is trying to interpret results.TipPt 16:19, 14 April 2006 (UTC)

You can quibble about the wording, but Masood's study is represented fairly, I think. The table clearly discusses findings, not conclusions. Let's examine these.

Under 'erectile function', the table states "No difference No; p=0.40"

To quote Masood: "The mean total IIEF-5 score of the 84 patients at baseline was 22.41 ± 0.94 compared to 21.13 ± 3.17 after circumcision. The difference between pre- and post-circumcision patients was not statistically significant (p = 0.4)."

If you like, we can change it to 'no significant difference'.

Under 'penile sensation': "Favours circumcision in 38%, non-circumcision in 18% Yes; p=0.01"

Masood: "Only 18% of the patients complained about loss of/or altered penile sensation, whereas 38% found better sensation (p = 0.01)."

Under 'overall satisfaction': "Favours circumcision (61% satisfaction) Not stated"

Masood: "Sixty-one percent were satisfied with the circumcision (p = 0.04). ... Fourteen patients (17%) were not satisfied with the circumcision, but only 1 patient in this group had any obvious post-operative complications (bleeding)"

Jakew 16:48, 14 April 2006 (UTC)

You play a good game Jakew. But totally lost is the truth. Your table representation more than distracts from the intended study focus.
The Masood study is titled "Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?"

The authors choose that title.

They conclude "The poor outcome of circumcision considered by overall satisfaction rates suggests that when we circumcise men, these outcome data should be discussed during the informed consent process."
The MAIN POINT in the study results is totally lost in the table.TipPt 02:51, 15 April 2006 (UTC)
That's a conclusion, not a finding. Jakew 09:49, 15 April 2006 (UTC)
I don't think you appreciate the limitations of statistical methods, and the value of the authors concluding statements (which take into account all the statistics and study variables.TipPt 02:41, 15 April 2006 (UTC)
By all means discuss it in the text. The table tabulates findings, not interpretations. Jakew 09:49, 15 April 2006 (UTC)

[edit] The table should be removed until it's fixed

The Table should be removed because:

  • It generally interperts and misrepresents study results.
  • It is labeled a "summary" but excludes partner studies, studies showing neurological changes, and studies on infants and boys.
  • It is not a summary of the above text.
  • It gives the false impression that there is fairly extensive research in the area of sexual effects, and that the research is generally relevant to circumcision as it is primarily practiced.
  • It "finds" "no difference" or "favors...," when all you can say is "no finding" because the results were not statistically significant. If there is no finding, it should not be listed.
  • The word "peer reviewed" is misused. Peer review can (did) occur after publication for at least one of the studies listed as "no."
  • Your complaints so far seem to be trivial at best, only requiring minor changes to language.
  • It is fair to call it a summary, since it summarises studies that have directly investigated sexual effects. It is speculative at best to link neurological changes to sexual effects, and obviously studies on infants and boys have not investigated sexual effects. As for partner studies, which would you propose including?
  • No, it is a summary of the studies.
  • I disagree. It identifies the relevant studies, leaving the reader to decide for themselves whether this is extensive. If you wish to speculate that it is irrelevant to circumcision as practiced, you'd better be prepared to find sources.
  • "No finding" means that no result was reported. A result of no statistically significant is not the same, and often gives a lot of information.
  • Which study was peer reviewed after publication?
The Masters.TipPt 02:15, 15 April 2006 (UTC)

None of these constitute worthwhile reasons for removing the table. Jakew 16:56, 14 April 2006 (UTC)

If any other editors are looking in ... I can demonstrate a double standard here.
Sounds like you will at least fix the Masood problems. Or, should I do it?

When they say they didn't find a stastically significant result, that is all you can repeat. "No finding," or "Failed to identify," or ... simply leave it out if it's not in the study conclusions.

I recommend a list of known studies and a short quote summarizing their conclusion(s) statements. It's all there, it's the most relevant condensed information from the authors, and it's not subject to bias. The reader gets the full benefit of their judgement.TipPt 02:43, 15 April 2006 (UTC)
No, a finding of no significant difference is a finding, and it should be reported. Feel free to add a list of studies and their conclusions, too, if you like, but the table gives a valuable summary to the reader and should remain.
The "finding" of "no difference" was not statistically significant. That's how you say it. Seems silly to list it.TipPt 17:43, 15 April 2006 (UTC)
As for Masters and Johnson, what was the nature of this post-publication peer-review? Jakew 09:53, 15 April 2006 (UTC)
I'm sure you're aware of the study problems, other than all they studied was the glans. I'll try to find it again.
You should know, I don't care much about the table. I just wanted to demonstrate to observers what you do in here.TipPt 17:43, 15 April 2006 (UTC)
Ok. I made the mistake of assuming good faith, and took you at face value. If, at some point in the future, you actually mean what you say, please let me know. Otherwise, I'll assume that you're just indulging in theatrics to waste my time. Jakew 20:02, 15 April 2006 (UTC)

It is impossible to work in good faith with you Jakew. The Masood study is clearly misrepresented.TipPt 00:10, 16 April 2006 (UTC)

I've been watching, and you've certainly succeeded. Alienus 17:50, 15 April 2006 (UTC)

I especially like the part where he removed a whole section of this Talk page, to hide his dishonesty. Too bad there's a whole history. Alienus 03:25, 16 April 2006 (UTC)
One problem with failing to assume good faith is that you look really foolish when you accuse someone of hiding things whereas in fact he just moved text to a more appropriate location, and then adjusted a link so that it correctly points to it. Jakew 10:32, 16 April 2006 (UTC)]
Thank you for adjusting the link. That was nice.
I hadn't said it before, but the fundamental problem with the table is that the stats are presented out of context. The end result is a reader that is mislead.
The pervasive bias in the topic seems purposeful and unconscionable; so I say you act with bad faith. You control this topic.TipPt 16:28, 16 April 2006 (UTC)

[edit] How about a section on sexuality for context?

This article is an excellent effort, but I feel that it is predicated on an extremely limited conception of human sexuality, ie one in which the physiological aspects are dominant to the exclusion of other factors. Circumcision and sexual experience involve more than just physical factors; they both include social, cultural, and psychological factors as well, and social scientists widely agree that these factors can override apparent physical constraints in a variety of contexts. As such, I intend to work up a section on sexuality to set the stage for the discussion of circumcision's effects.Zandrous 08:22, 19 April 2006 (UTC)

I'm a little concerned that this might be original research. Please make sure that you summarise published work by others on the subject of the sexual effects of circumcision, rather than forming novel ideas. Jakew 16:48, 19 April 2006 (UTC)
My thought was to add something about the relationship between physiology and sexuality because I think that's appropriate introductory/background information for an article treating the sexual effects of a procedure that modifies a physiological feature. My goal is to add some context to help clarify why the sexual effects of circumcision are so poorly understood. Do you think that's not appropriate for this entry? Because I thought it would help to make the lack of concensus on the sexual effects of circumcision easier to understand. And I'm not sure I understand your concern about original research; if you think general information about the relationship between physical factors and sexuality doesn't fit in this entry that's one thing; but is there something else about it that I'm missing? If you think such ideas are too novel, maybe have a look at human sexuality, which presents some of the various non-physical factors that affect sexual experience. Anyway, thanks for the tip, I'm still quite new to Wikipedia, so I appreciate your help. Zandrous 15:58, 21 April 2006 (UTC)
Zan, if the material is relevant, well-cited and relatively brief, then it should be fine. Alienus 16:22, 21 April 2006 (UTC)
Note also that the studies are primarily relevant to outcomes from elective or therapeutic ADULT circ's, and therefore mislead the reader with respect to neonatal circ's.TipPt 00:01, 25 April 2006 (UTC)

Apologies, I won't get around to adding this, although I urge anyone to take into consideration the relevance of non-physiological factors on sexual experience, check human sexuality the basic points made there I think would add a helpful dimension to this entry. I'm simply too busy with work to justify time spent editing here in wiki right now, Ciao Zandrous 11:44, 25 April 2006 (UTC)

[edit] Opinion, and a false citation; thus removed

Not all agree, however. Genital integrity activist and author Kristen O'Hara argues that the glans is the "male clitoris", with the foreskin maintaining at best a supporting role during sexual intercourse [3].TipPt 23:55, 24 April 2006 (UTC)

I've also removed the 'Not all agree, however.' because it was uncited. It could be that Kristen O'Hara made the statement attributed to her in some other place. If so, an appropriate comment could be inserted. Michael Glass 00:24, 25 April 2006 (UTC)

[edit] Stats

Maybe I can explain my Table reservations more clearly. The results are frequently "not statistically significant," but you insist on saying "no difference."

At a min., you need to say "not statistically significant" when you say "no difference." Right now, the table is a violation of neutrality.

But, the point I wanted to make is ... when you have small samples (especially with poor participation rates) and LOW VARIABILITY within those samples you frequently get insignificant results. For example, a study where guys generally say "I'm went from a 1 to a 2", or "5 to 3" or "7 to 6," will provide weak correlations relative to studies where guys range "1 to 4," and "2 to 9," and "3 to 7," and "7 to 1."

There simply isn't enough information in several of those Tabled small study samples to say anything including "no difference." The proper thing to say is simply "insignificant results," or "not statistically significant." Most readers don't understand the limitations of regression analysis, and saying "no difference" without lengthly qualification is introduces bias.TipPt 16:48, 26 April 2006 (UTC)

[edit] Removed inserted POV

I've removed the inserted claim that "Furthermore, research results from studies involving adults and adult circumcisions are less applicable to understanding potential sexual effects of circumcision on neonates and boys." This is obvious uncited POV; original research at best. Please ensure that claims are all neutral and cited from reliable sources. Jayjg (talk) 21:15, 26 April 2006 (UTC)

[edit] Paragraph added ...

Circumcisions that reduce the frenulum, or that involve a frenectomy remove tissue that is "particularly responsive to stimulation," "very reactive," and "seems particularly responsive to touch that is light and soft." The frenulum is a primary site for eliciting ejaculatory response.[4][5][6]TipPt 23:52, 28 August 2006 (UTC)

[edit] Inherent flaws in several of the studies

Several of the studies have inherent flaws in the selection of their polling group - that is they selected men who were circumcised as adults because it was (thought to be) medically neccesary. This will certainly skew those results Lordkazan 02:04, 9 September 2006 (UTC)

Either a) you're making this remark because you intend to add it to the article (which would violate WP:NOR, or b) you're abusing this talk page, the purpose of which is to discuss improving the article. May I ask which? Jakew 16:35, 9 September 2006 (UTC)
Jake: I assume you have read the literature and so are well placed to answer this question, if I had the time I would read the papers myself. Do all the papers that study adult circumcision patients use people who needed the procedure for medical reasons? One might have thought that there would be a large enough number of people electing to undergo the surgery for perceived cosmetic or religious reasons to allow a study that perhaps might be more less skewed. If there is such a difference in the sample groups I would suggest it might be beneficial to include such details in your table.
I'd also like to congratulate you on a good article, it seems pretty balanced as a whole, especially given much of the literature arguing both ways is so suspect. |→ Spaully°τ 13:07, 12 December 2006 (GMT)
Spaully, thanks for your comments. The problem is that this information is sometimes available, but often it is not (or at least, not in English). It would be very difficult to add it to the table without making it a complete mess, which I'd prefer to avoid.
It would certainly be interesting to statistically analyse studies to see whether there is any evidence that such differences might skew the results. Jakew 13:45, 12 December 2006 (UTC)
Seems I got my words a bit muddled there, but it doesn't effect your reply I would think. It's a shame that isn't available for these papers as I think it would help lend credibility (or not) to them for the readers; as it stands I feel many of them are likely to be inherently flawed from their sample groups and survey techniques. Such is science in these areas. Thanks for the reply. |→ Spaully°τ 00:13, 14 December 2006 (GMT)

[edit] Sexual effects of foreskin amputation

I believe this article may need to be renamed. Since a foreskin can be amputated in more ways than only that of the medical procedure called circumcision (in an accident, for example), this article should be renamed to "Sexual effects of foreskin amputation", with eventual subsections on eventual differences on sexual pleasure in the ways a man can lose his foreskin (circumcision or accident). 87.78.177.164 15:23, 20 September 2006 (UTC)

Every source cited refers to circumcision, not "foreskin amputation". Furthermore, as far as I know, there are absolutely no sources upon which we could draw to produce your proposed section on differences between situations. Jakew 15:33, 20 September 2006 (UTC)
"Every source" sounds like you know "every source", is that so? Nevermind. I just made the proposal of those sections in case someone came up with suitable sources. I think you'll agree that getting circumcised is basically not the same thing as losing the foreskin in an accident. Otherwise this article would be in need of either a suitable title reflecting all possible ways of losing the foreskin ("foreskin amputation" is one option I see) or else someone has to come up with at least one proper source about the difference between circumcision and accidental foreskin amputation in regard of sexual effects. That is to say: This article either needs subsections as I proposed OR it needs proper naming, because there are sources that explicitly tell of accidents resulting in the loss of foreskin - and those men suffer or benefit from maybe very similar effects as circumcised men although (and please relate to this fact) they never have been circumcised in the proper medical meaning of the word. So, if nobody comes up with a valid counterpoint, I propose renaming the article, because the sources refering to "circumcision" do not need to be reflected in the article name and only inappropriately narrow the scope of the article. 87.78.177.164 20:13, 20 September 2006 (UTC)
Well, yes, I have read every source, as it happens.
As far as broadening the scope goes, which sources did you have in mind that refer to loss of the foreskin without circumcision? Unless any scientific evidence actually covers that, and documents sexual effects of such, I can see no reason to rename. Jakew 20:21, 20 September 2006 (UTC)
You're mixing things up. Scientific evidence is not needed for the renaming, just one modest example from literature that such an accident has actually occured (and which I can provide) is enough for that. You are the one in need of scientific evidence if you wanted to maintain the article in its current state instead of widening the scope. See what I mean? It's two entirely different things. I opt for renaming instead of waiting until someone comes up with said scientific evidence that would make a seperate article on "Sexual effects of accidental foreskin amputation" necessary. Those two articles would probably be merged anyway and they could not be merged under the title of "circumcision" as I pointed out earlier. So far, you haven't been reasoning against the reasons for renaming I already gave. So, I will come up with that source speaking of something like "an accident involving the loss of a foreskin" (tomorrow, though, it's been long working hours today) and then the scientific evidence thing is on you if you want to keep the name. Agreed? 87.78.177.164 20:51, 20 September 2006 (UTC)


[edit] This should be merged with Circumcision

This should be merged with Circumcision to reduce the current pro-circ pov of that article that has been created the the huge ammount of text dedicated to supposed benefits of circumcision, why the detriments have been largely neglected and down played in that article. Lordkazan 04:25, 14 October 2006 (UTC)

It would really be a lot better to break the pro-circ POV sections into their own articles. Circumcision is already far too large, It needs to get smaller not the reverse.Christopher 05:31, 14 October 2006 (UTC)
That would work too - especially if we can get non-biased information into the medical section Lordkazan 15:35, 14 October 2006 (UTC)

[edit] An evolutionary angle?

I'm no biologist (at all) and I have no familiarity with any literature on this topic, but could there be an evolutionary perspective here? If circumsized males are more sexually responsive and/or more attractive to female partners wouldn't humans have been naturally selected with shorter foreskins? It would seem that way to a layman like me. Is there any literature on this topic that's worth including? Dkostic 19:53, 1 January 2007 (UTC)

There's very little in the literature. Only one paper springs to mind: Cox G. De virginibus puerisque: the function of the human foreskin considered from an evolutionary perspective. Med Hypotheses. 1995 Dec;45(6):617-21.
It occurs to me that the process of evolution is ongoing rather than complete, and it is possible that such selection is occurring, albeit very slowly. On the other hand, it may be that, through circumcision, we are interfering with such a selection process. Except for the above paper, however, I'm not aware of any significant discussion of these issues. Jakew 20:39, 1 January 2007 (UTC)
Yes, I agree with Dkostic. In all forms of humanity, the foreskin exists. The body does not randomly give itself things not important to function. In areas of sexuality, the human body maximizes procreation. Pleasure is a key ingredient in procreation. The nerves in the foreskin give increased pleasure to the male while the glan remaining non-abrasive is important to pleasure and comfort to the female. Jtpaladin 17:41, 25 May 2007 (UTC)

[edit] Questionable edits

One edit and two reverts have now changed this:

  • An analysis of a national U.S. survey by Laumann found that uncircumcised males had a higher overall rate of all seven types of sexual dysfunctions considered, especially after the age of 45 years, at a cumulative 93% statistical confidence level. He also found that circumcised men tend to engage in "more elaborated set of sexual practices" and that circumcision is associated with an increased incidence of sexually transmitted diseases, though this only reached statistical significance in the case of chlamydia. Concerning the differences in sexual practices, Laumann speculated "..differences in the association between circumcision status and sexual practice across ethnic groups suggest that cultural, rather than physiological forces may be responsible." [7]

To this:

  • An analysis of a national U.S. survey by Laumann concludes that "circumcision provides no discernible prophylactic benefit and may in fact increase the likelihood of STD contraction; that circumcised men have a slightly lessened risk of experiencing sexual dysfunction, especially among older men; and that circumcised men displayed a greater rates of experience of various sexual practices," including oral sex, anal sex, and masturbation. For example, among whites the "estimated ratio of the odds of masturbating at least once a month for circumcised men was 1.76 that for uncircumcised men." Dr. Laumann provides two explanations for the difference in sexual practices. "One is that uncircumcised men, a minority in this country, may feel a stigma that inhibits them. Another is that circumcision reduces sensitivity in the penis, leading circumcised men to try a range of sexual activities."[8]

Could these editors please explain why the primary focus of a paragraph in an article about sexual effects of circumcision has been changed from sexual function to STDs? Why is masturbation so important that it should be singled out, and why is masturbation only important when performed by white men? Also, what possible reason is there for replacing a quote from a peer-reviewed article with one from the lay press? Jakew 17:40, 17 January 2007 (UTC)

You make a good point about the unnecessary focus on STDs, so I've changed that. For the masturbation by white men, it's just a number to make the conclusion more concrete. It's in there for the same reasons that every sentence beginning "For example" is included anywhere. The popular press quote is preferred because it's a better quote. LWizard @ 08:24, 18 January 2007 (UTC)

[edit] Source for Sorrells funding?

The linked abstract makes no mention of the Sorrells study being funded by NOCIRC (or anyone else, for that matter). Do we have a source for that info? I'm not sure what the relevance of the funding source is, especially given that the funding sources aren't mentioned for any other studies cited. If sources of funding are relevant then they should be mentioned for other studies as well shouldn't they?Zandrous 15:33, 1 April 2007 (UTC)

It's from the full text. Specifically, the section entitled 'conflict of interest' on page 869. Jakew 17:08, 1 April 2007 (UTC)
The problem with this note is that it singles out the Sorrells study for special treatment. In no other case in articles about circumcision has the funding of studies been mentioned. Therefore this is giving undue weight to this information. This is especially so when the very first thing that one reads about the Sorrells study is its source of funding! I have therefore changed the text to tone down this obvious POV pushing. Michael Glass 12:09, 27 April 2007 (UTC)
Michael, can you think of other studies in which the funding source is a) interesting and/or b) noted in the 'conflict of interest' section? If so, perhaps this is special treatment. If not, as I believe to be the case, then this is merely a special 'feature' of the study. Jakew 12:17, 27 April 2007 (UTC)
I haven't gone through other studies in this detail. Have you? Whatever the situation is with other studies, the Sorrells study has been treated differently from every other study that is referred to. I think we should be particularly careful with such statements, especially if they appear to be one-sided.Michael Glass 13:46, 27 April 2007 (UTC)
I've looked at a fair number of other studies, yes, and couldn't find anything of interest. The funding source is an interesting fact about Sorrells' study that is noteworthy. Jakew 14:23, 27 April 2007 (UTC)

[edit] Additions to Female arousal section

While the paper you have cited certainly appears to be flawed this section does not currently adhere to WP:NOR or WP:NPOV. Assertions such as this need to be justified:

Thus bias arising from the seriously flawed study design causes this particular study to lack credibility and it should be ignored.

Furthermore, while it appears http://www.circinfo.net/ has many citations, in itself it does not adhere to WP:RS. If you wish to use its information to back up your point I would recommend going to the literature they cite. Finally, the paragraph is now written such that Kristen O'Hara wrote the disputed paper, which is not true. Thanks. |→ Spaully₪† 10:26, 8 May 2007 (GMT)

The paragraph added by 71.106.159.130 appears to be quoted verbatim from circinfo.net, although it is not identified as a quote. I would have to double check, but as I recall Prof Morris (the author of circinfo.net) included very similar criticism in his book. Jakew 12:22, 8 May 2007 (UTC)
Ah yes. It seems the whole paragraph was lifted in fact, including the rogue '[29]'. I will revert the additions and remove the tag, as clearly directly copying this source is not on. If it is rewritten then it might make a good addition though. |→ Spaully₪† 13:29, 8 May 2007 (GMT)
I agree. We must be careful to attribute such criticism. The paragraph was presumably added because it criticises Kristen O'Hara's hypothesis. She presented data in both her book and a BJU article; since the latter is a more reliable source than the former, we should perhaps alter the text to refer to it instead. We should certainly delete the link to sexasnatureintendedit.com, which is not a reliable source. Jakew 13:42, 8 May 2007 (UTC)

Just kind of curious, but how do you infer this comment "Bailey et al. report that there is a preference by women for the circumcised man, mentioning that circumcised men enter the woman more easily and cause fewer traumas." from a study (32) that isn't even really concerned with the issue? I.e. # ^ AIDS Care. 2002 Feb;14(1):27-40. The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya. Bailey RC, Muga R, Poulussen R, Abicht H. [14] In fact, the research provided in the quote just before (31) which specifically looked at female pleasure seems to point overwhelmingly to the opposite? http://www.cirp.org/library/anatomy/ohara/ —Preceding unsigned comment added by 38.112.16.62 (talk) 20:38, 28 February 2008 (UTC)

[edit] Criticism of Sorrells et al

A few days ago, BJU Intl published in their June 2007 issue a letter (co-authored by myself) containing criticism of the Sorrells study.

The letter included, among other things, a statistical reanalysis of data presented in Sorrells et al. The conclusion was as follows:

In conclusion, despite a poorly-representative sample and a methodology prone to exaggerating the sensitivity of the prepuce, NOCIRC's claims remain unproven. When the authors' data are analysed properly, no significant differences exist. Thus the claim that circumcision adversely affects penile sensitivity is poorly supported, and this study provides no evidence for the belief that circumcision adversely affects sexual pleasure.

Jakew 13:47, 30 May 2007 (UTC)

Jake, your quotation raises many questions. I wish to ask just one. When you say that there is 'no significant difference' in sensitivity between circumcised penises, was this a comparison between areas in common between circumcised and uncircumcised penises or was it a comparison between the sensitivity of the foreskin with the sensitivity of the rest of the penis? Michael Glass 00:28, 31 May 2007 (UTC)

Here you can read it without having to have a subscription: http://www.doctorsopposingcircumcision.org/pdf/sorrells_2007.pdf and as you can read it is funded by NoCirc: "Source of funding: The director of National Organization of Circumcision Information Resources Centers (MFM) was involved in the design and conduct of the study; collection and interpretation of the data; and review, or approval of the manuscript." So this is biased because who pays, rules. --Validside 09:28, 31 May 2007 (UTC)

Michael, the short answer is "both". Regarding comparisons between different points, the letter stated:
They claim that several locations on the uncircumcised penis are significantly more sensitive than the most sensitive location on the circumcised penis (the ventral scar), yet their Table 2 shows this applies only to their position 3, the orifice rim of the prepuce. However, after we used the Bonferroni method to correct for multiple comparisons, this significance disappeared.
(You may find Bonferroni correction helpful in understanding this.)
Regarding comparisons between the same points, the letter presented their data with the results of t tests in a table, commenting:
...in their Table 2 they fail to compare the same points on the circumcised and uncircumcised penis. Using their data we find no significant differences (Table 1), consistent with previous findings [2,3]...
If you email me, I'd be happy to send you a pdf of the full text of the letter. Jakew 10:08, 31 May 2007 (UTC)
Thank you to Jake for the offer of the PDF and to Validside for the link to the article. I note that the Sorrells found that the uncircumcised penis was most sensitive at position 3, the orifice rim of the foreskin. As this is cut off with circumcision then circumcision removes the most sensitive part of the penis. Michael Glass 01:12, 1 June 2007 (UTC)
Yes, Michael, that is a good summary of Sorrells' claim. The purpose of statistical significance testing is to determine whether a numerical difference in a sample reflects a real difference (significant) or a random variation due to chance (non-significant). The letter argues that difference between position 3 and a point on the circumcised penis is not statistically significant. Jakew 07:51, 1 June 2007 (UTC)
I believe that it is more accurate to refer to Sorrells' findings rather than Sorrells' claim. Even if there is no statistically significant difference between sensitivity between the points in common between circumcised and uncircumcised penises, there is a great difference between the sensitivity of the orifice rim of the foreskin and the rest of the penis. Sorrells found that the point of greatest sensitivity of the circumcised penis was on part of the circumcision scar. In one part of the scar, the point of sensitivity was 0.192. However, the orifice rim of the foreskin was 0.093. In simple terms, the rim of the foreskin was twice as sensitive as most sensitive part of the circumcision scar. Your letter to the BJU (thank you for sending it to me) excluded such a comparison. Michael Glass 00:52, 2 June 2007 (UTC)
Michael, the letter did not exclude this comparison. On the contrary, it explicitly referred to it: "They claim that several locations on the uncircumcised penis are significantly more sensitive than the most sensitive location on the circumcised penis (the ventral scar), yet their Table 2 shows this applies only to their position 3, the orifice rim of the prepuce. However, after we used the Bonferroni method to correct for multiple comparisons, this significance disappeared."
The mean threshold at point 3 was 0.093, and the standard error of the mean (SEM) 0.027. There were 68 samples in this (uncirc'd) group. At point 19, the respective values were 0.192 and 0.034, and there were 91 samples. Using these figures for an unpaired t test gives a p value of about 0.03, as shown in Sorrells' table 2. Because the p value is less than 0.05, it might be said to be a significant difference. However, there are eight significance tests and corresponding p values, so using Bonferroni's correction we would instead use 0.05/8=0.00625 as the upper limit for significant p values. As stated in the letter, the difference is not significant when this correction is applied.
Incidentally, I tend to use 'findings' to refer to data, and 'claim' to refer to interpretations of that data. "Smith found that the force of gravity on top of k2 was 9.79m/s/s, which he claimed was 0.02m/s/s higher than that predicted by theory." Jakew 10:36, 2 June 2007 (UTC)
Jake, as you point out, there are 8 points on the foreskin that did not correspond to points on circumcised penis. There are also two points on the circumcision scar that do not correspond to these 8 points on the foreskin. So when it comes to sensitivity, I understand that you are claiming that either two equals eight, or that two is not significantly different from 8 - at least after you apply Mr Bonferroni's correction. Is that what you're saying? Michael Glass 13:58, 2 June 2007 (UTC)
No, Michael, I'm afraid you have misunderstood. Bonferroni's correction is a method for interpretation of a series of statistical tests. Jakew 14:29, 2 June 2007 (UTC)
Jake, I'm afraid you missed the point that I was making, that there are more sensitive points on the foreskin than there are on the circumcised penis. There is also the question of whether Bonferroni's correction is either appropriate or suitable for applying to this test. I have my doubts. Please read the following comment [9]. I think you should also consider a third point: the number of men in the study was relatively small, 159 in all. This reduces the chance of obtaining a statistically significant result. By using the Bonferroni method to reduce the possibility of a false positive finding you increased the possibility of getting a false negative finding. Michael Glass 13:33, 4 June 2007 (UTC)
Michael, I haven't missed your point at all, but you seem to overlook the fact that significance tests are the means by which the study and critique (and, indeed, several other studies) chose to answer the "more sensitive" question.
Bonferroni's correction is not the only correction for such situations, some dislike it, and alternatives have been proposed. There is of course a tradeoff between type I and type II errors, and perhaps future studies might use a different sample size or methodology. However, now that we both understand the meaning of the terms we must be careful to avoid original research. It occurs to me that a more pressing question is: how should the criticism be covered in the text of the article? Jakew 13:57, 4 June 2007 (UTC)
I propose the following changes (alterations shown in italics):
Sorrells et al. (2007) measured the fine-touch pressure thresholds of 91 circumcised and 68 uncircumcised, adult male volunteers, They reported "[the] glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity." (The study was funded by NOCIRC.) [8] Waskett and Morris, however, report that "[using] their data we find no significant differences [...], consistent with previous findings."
Sorrells et al. (2007), in the study discussed above, measured fine-touch pressure thresholds of the penis, and concluded "The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates" (removes) "the most sensitive parts of the penis." According to Sorrells et al., the five penile areas most sensitive to fine-touch are located on the foreskin.[23] This is disputed by Waskett and Morris, who argue that Sorrells' "[table] 2 shows this applies only to their position 3, the orifice rim of the prepuce. However, after we used the Bonferroni method to correct for multiple comparisons, this significance disappeared."
Do you think this is a fair representation, Michael? Jakew 14:36, 4 June 2007 (UTC)
Jake, it appears that you have put two proposed alterations up for consideration. Was that your intention? Michael Glass 09:47, 5 June 2007 (UTC)
Yes, Michael. Do you think this is a fair representation of the sources? Jakew 10:07, 5 June 2007 (UTC)
Jake, I have problems with both of your suggested amendments.
  1. Both give the letter equal prominence with a peer reviewed article. This strikes me as giving undue weight to one letter.
  2. Both set a precedent for giving equal prominence to every letter that may be published in response to this study. Considering the nature of the topic, there could be quite a few of them. Another potential problem of undue weight.
  3. A reference to "the Bonferroni method to correct for multiple comparisons" gives the reader no clue that this method is controversial. Without this information about the Bonferroni method, the reference is misleading. With this information it raises the question of undue weight being given to the Bonferroni method. If the Bonferroni method is not mentioned, as in your first proposal, then the reader is left in the dark about the controversial nature of the test used to determine statistical significance.
I believe the best solution would be to wait until there are more comments about this study, and then, if necessary, report on the discussion that followed. Would this be acceptable to you? Michael Glass 02:57, 6 June 2007 (UTC)
Michael, thanks for your comments. If it was not clear, the two proposed additions are to different paragraphs.
Undue weight states that "NPOV says that the article should fairly represent all significant viewpoints that have been published by a verifiable source, and should do so in proportion to the prominence of each." Since journals typically publish criticism of articles as Letters to the Editor, excluding letters as a general rule would have the effect of excluding criticism or dispute. This would be incompatible with "fairly represent all significant viewpoints that have been published by a verifiable source". (As I recall you were pleased to include de Witte's Langerin article [which was published as a Letter] in discussion of Langerhans cells...)
In some cases, it is relatively easy to determine which is a 'prominent' (or, indeed, majority) view. However, this does not appear to be such a case: there are only two published sources on the issue of Sorrells' claims.
In any case, I disagree that the proposed changes give equal prominence to each, since the proposed wording gives approximately three times as much text to Sorrells than to the critique. Do you have an alternative wording in mind?
It is impossible to predict what may or may not be published in the future. This has not been a concern so far: as new sources have become available (such as Sorrells article itself), we have amended the article accordingly. I see no reason why this cannot continue.
At the present time, there are no published sources to indicate that the use of the Bonferroni correction is controversial in this instance. If that should change in future, we could of course amend the article accordingly. (As noted above, the two proposed additions are to different paragraphs; one criticism referred to the Bonferroni correction but the other did not.)
Given that Wikipedia can be altered at any time, I do not see any particular reason to wait until some unspecified future time for some possible discussion to take place. We did not adopt such an approach when Sorrells' study was first included, and there seems no reason to do so now. Jakew 12:20, 6 June 2007 (UTC)

NPOV would pretty much demand that the criticism of the study be included, if the study itself is to be included. Alternatively, neither should be included, since the study itself is already tainted by its source of funding, and appears to have garnered little attention. Jayjg (talk) 23:10, 6 June 2007 (UTC)

Jake, thank you for your detailed comments. You make some very good points about the NPOV policy. My problem with your proposed additions is that they are based on the Bonferroni correction, which, as i have pointed out, is not universally accepted. In all fairness, I think this should be touched on. I am, of course, opposed to the idea of excluding the Sorrells study from consideration. If that study was good enough for the British Journal of Urology to publish, it is good enough to be mentioned on Wikipedia. Michael Glass 14:17, 7 June 2007 (UTC)
Michael, the proposed additions are direct quotes from a published source. As I understand it, your objection is that you question the argument made in that source. If/when such an objection is made in another reliable source, I see no reason why it could not be included. However, as you know, OR is not allowed. I suppose we could Wikilink bonferroni correction in the text, which would allow readers to read more about the correction in that article. Does this seem reasonable? Jakew 16:02, 7 June 2007 (UTC)
The problem with a wikilink that you propose is that the article just gives the bare bones about the test in language that only a mathematician could love. The reference in the British Medical Journal [10] includes the following:
When more than one statistical test is performed in analysing the data from a clinical study, some statisticians and journal editors demand that a more stringent criterion be used for "statistical significance" than the conventional P<0.05.1 Many well meaning researchers, eager for methodological rigour, comply without fully grasping what is at stake. Recently, adjustments for multiple tests (or Bonferroni adjustments) have found their way into introductory texts on medical statistics, which has increased their apparent legitimacy. This paper advances the view, widely held by epidemiologists, that Bonferroni adjustments are, at best, unnecessary and, at worst, deleterious to sound statistical inference.
The summary sheet emphasis added says:
Adjusting statistical significance for the number of tests that have been performed on study data the Bonferroni methodcreates more problems than it solves.
The Bonferroni method is concerned with the general null hypothesis (that all null hypotheses are true simultaneously), which is rarely of interest or use to researchers.
The main weakness is that the interpretation of a finding depends on the number of other tests performed.
The likelihood of type II errors is also increased, so that truly important differences are deemed non-significant.
Simply describing what tests of significance have been performed, and why, is generally the best way of dealing with multiple comparisons.
As you have used the Bonferroni method to criticise the Sorrells findings, a direct link to this article would be appropriate. Michael Glass 03:17, 8 June 2007 (UTC)
Michael, Perneger's article makes no reference to the critique of Sorrells' paper (having been published 9 years beforehand), nor does it mention circumcision. Linking to it from this article would therefore be original synthesis.
However, there is no reason why the Bonferroni correction could not be expanded to include NPOV treatment of Perneger's views (and those of others) in an accessible form.
As an aside, I'm puzzled that you highlighted the sentence referring to the general null hypothesis. You may wish to think for a moment about how the hypothesis would be stated in this case. Jakew 09:43, 8 June 2007 (UTC)
Jake, Perneger warned about the limitations of the Bonferroni correction almost 10 years ago. His paper is mentioned in the article in Wolfram mathworld <http://mathworld.wolfram.com/BonferroniCorrection.html> and in a web page from the University of Manitoba <http://www.umanitoba.ca/centres/mchp/concept/dict/Statistics/bonferroni.html>. The general problem is also mentioned in a paper from the University of New England, in Northern NSW <http://www.une.edu.au/WebStat/unit_materials/c5_inferential_statistics/bonferroni.html>. The problem appears to be inherent in the use of this particular method. Michael Glass 14:20, 8 June 2007 (UTC)
Michael, it is not appropriate to use Wikipedia to debate the merits of this application of Bonferroni's correction. However, if you would like to discuss further by email, you're welcome to do so.
If you can find any articles discussing the critique in particular, please cite them. If not, please stop performing original synthesis. Jakew 16:25, 8 June 2007 (UTC)

Just a brief reminder, it is forbidden for an editor in wikipedia to take item a) and say that this implies result b) without have a source that exactly makes that point. Even if both item a) and b) are sourced, and there is no pure research being perfomed by the editor, saying that one data point implies a relationship, decision, or result about another, ex nihilo, is an example of original synthesis, which is also not allowed, no matter how obvious it may seem to some. Sorry. -- Avi 17:21, 8 June 2007 (UTC)

I believe that when Bonferroni's correction is mentioned it should be linked to an authoritative article that gives information about this method. One source is <http://home.clara.net/sisa/bonhlp.htm>. This gives an overview of this method. Does anyone have any comments? Michael Glass 01:10, 9 June 2007 (UTC)
At first glance, it looks like a suitable external link which could be added to the Bonferroni correction article. However, it should not be added to this article. Per WP:EL, we should avoid linking to "Sites that are only indirectly related to the article's subject: the link should be directly related to the subject of the article." (emph added).
In general, an unusual term used in an article should be linked to the relevant Wikipedia article, if a link is required. As a general rule, it's best to avoid Wikilinking text that is part of a direct quote. However, I would agree to making an exception in this case, making the relevant text appear as: This is disputed by Waskett and Morris, who argue that Sorrells' "[table] 2 shows this applies only to their position 3, the orifice rim of the prepuce. However, after we used the Bonferroni method to correct for multiple comparisons, this significance disappeared." Jakew 10:30, 9 June 2007 (UTC)
I have added extra references to the Bonferroni correction article. My point all along was not to argue that the Bonferroni method was wrong, but that there was some dispute about its use. To characterise this as an original synthesis is bizarre. I, too, have reservations about a Wikilink in a direct quote, but in the absence of another link I am prepared to consider it. I also have reservations about the wording you propose because it is not clear enough that Sorrells was working on figures that were controlled for age and other factors, whereas Waskett & Morris were not. Michael Glass 14:21, 9 June 2007 (UTC)
Michael, I'm glad that you added the extra refs to that article.
The problem is that there is no published dispute about the use of Bonferroni's correction in this case. Hence this synthesis of two arguments is original to Wikipedia.
I suggest that you propose alternative wordings for both paragraphs, which we can (hopefully) then agree upon. Jakew 17:00, 9 June 2007 (UTC)
Jake, have a look at this wording:
Sorrells et al. (2007) measured the fine-touch pressure thresholds of 91 circumcised and 68 uncircumcised, adult male volunteers in a study funded by NOCIRC, They reported "[the] glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity." [8] Waskett and Morris, however, on the basis of the raw data, said "we find no significant differences [...], consistent with previous findings."
Sorrells et al. (2007), in the study discussed above, measured fine-touch pressure thresholds of the penis, and concluded "The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates" (removes) "the most sensitive parts of the penis." They said that the five penile areas most sensitive to fine-touch are located on the foreskin [23]. However, Waskett and Morris, on the basis of Sorrells' raw data said it "shows this applies only to …the orifice rim of the prepuce.” However, they stated that after they used the Bonferroni method to correct for multiple comparisons, “this significance disappeared."
Would this draft wording suit you? —The preceding unsigned comment was added by Michael Glass (talk • contribs).
Mostly ok, but some minor changes are needed. Firstly - and I'm sorry to be pedantic - we should avoid "said" for written arguments. "Stated" is better. Secondly, it is inaccurate to refer to use of "raw data". Instead, we should use the phrases "on the basis of data presented by Sorrells et al." or "using Sorrells' data". Jakew 10:23, 10 June 2007 (UTC)

I'm happy with stated rather than said. However, using Sorrells' data is misleading because it could be taken as applying to the data that had been controlled for age and the other factors. I believe that raw data makes a clear distinction between the initial data and the data that had been controlled for other factors. It's a small but important point to make. If you don't like raw data how would you express the difference between the initial data and the data that had been controlled for age and other factors? Michael Glass 13:49, 10 June 2007 (UTC)

Michael, I believe that the term you are looking for is "unadjusted" or "crude" figures. The term "raw data" tends to refer to the entire, unprocessed data set from which any statistics may be calculated. Such data are rarely published in full: usually only summary data such as means and standard deviations (or related statistics) are provided.
In relation to the claim "They said that the five penile areas most sensitive to fine-touch are located on the foreskin", it would be misleading to state that unadjusted figures were used. The letter refers to "their Table 2", which includes both unadjusted and age-adjusted figures.
Regarding to the claim re the same points, I suggest using the language in the letter "Using their data". Jakew 14:33, 10 June 2007 (UTC)

Jake, your phrase "using their data" is not a problem in the context of your letter. However, when writing for Wikipedia, where most readers won't have access to your letter or the Sorrells study, we must make it clear that it was Sorrells' unadjusted data that you used. I like unadjusted. Here is what I suggest:

Sorrells et al. (2007) measured the fine-touch pressure thresholds of 91 circumcised and 68 uncircumcised, adult male volunteers in a study funded by NOCIRC, They reported "[the] glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity." [8] Waskett and Morris, however, on the basis of the unadjusted data, stated "we find no significant differences [...], consistent with previous findings."
Sorrells et al. (2007), in the study discussed above, measured fine-touch pressure thresholds of the penis, and concluded "The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates" (removes) "the most sensitive parts of the penis." They stated that the five penile areas most sensitive to fine-touch are located on the foreskin [23]. However, Waskett and Morris, on the basis of Sorrells' unadjusted data stated that it "shows this applies only to …the orifice rim of the prepuce.” However, after they used the Bonferroni method to correct for multiple comparisons, “this significance disappeared."

How do you feel about this wording? Michael Glass 01:54, 11 June 2007 (UTC)

Michael, I've already remarked that it would be misleading to use the term 'unadjusted' in the second paragraph, yet you have done so anyway. Is this an error? Jakew 10:17, 11 June 2007 (UTC)

I used the term unadjusted because this was the term that you used in place of raw data. I note your comment, but it was Sorrells' unadjusted data that you referred to in your letter and not the data that had been controlled for age etc. As I read it, Sorrells et al. used the data that was controlled for age etc while you used the unadjusted data and came to different conclusions. If this is not the case, please explain what is the case, and why you consider the word undajusted misleading. Michael Glass 03:31, 12 June 2007 (UTC)

Michael, there are two relevant sets of comparisons. The first paragraph relates to comparisons between the same points, which were presented in the table in the letter. The second paragraph, however, refers to comparisons between different points, which were presented in Sorrells' Table 2. As you can see, this table included both unadjusted and adjusted statistics for these points. It is misleading to state otherwise.
Both sources explicitly state that Table 2 is the source for their claims.
To quote from Sorrells et al: "When compared with the most sensitive area of the circumcised penis, several locations on the uncircumcised penis, which are missing from the circumcised penis, were significantly more sensitive (Table 2)."
To quote from W&M: "They claim that several locations on the uncircumcised penis are significantly more sensitive than the most sensitive location on the circumcised penis (the ventral scar), yet their Table 2 shows this applies only to their position 3, the orifice rim of the prepuce. However, after we used the Bonferroni method to correct for multiple comparisons, this significance disappeared." Jakew 10:41, 12 June 2007 (UTC)

Jake, you're right about Table 2. I withdraw my objection. Michael Glass 14:27, 12 June 2007 (UTC)

Ok. I've added the text to the article. Jakew 15:25, 12 June 2007 (UTC)
Focusing on location 3 is misleading ... circumcision removes relatively sensitive parts of the penis (locations 2, 3, 4, 5, 14, 15, and 16).TipPt 23:11, 4 July 2007 (UTC)
There is no 'focus' on position 3. The source simply notes that position 3 is the only statistically significant difference before Bonferroni's correction is applied. Jakew 10:20, 5 July 2007 (UTC)

[edit] Moving content here? Summary style proposal for Circumcision article

The Circumcision page is getting too long, and there is a proposal to shorten it. This proposal involves moving some content from that page to this one (or verifying that certain content there is already represented here). Please discuss at Talk:Circumcision#Article too long?. --Coppertwig 13:17, 11 August 2007 (UTC)

[edit] Details of moving content here

(Making sure all info from Circumcision#Sexual effects section is also here.) I'm not copying this sentence here because it contains essentially the same information as the reference to Laumann et al. (authors of the survey report) that's already here: "The American Academy of Pediatrics (1999) stated "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men." Actually, I think I can improve the Laumann citation. --Coppertwig 23:09, 17 August 2007 (UTC) Laumann citation as given in AAP statement: "Laumann EO, Masi CM, Zuckerman EW Circumcision in the United States. JAMA. 1997; 277:1052-1057". with url of [11] --Coppertwig 23:16, 17 August 2007 (UTC) I was confused; the Laumann citation is already completely cited here. --Coppertwig 23:20, 17 August 2007 (UTC)

I didn't move this sentence here because this article already contains a longer version of the same information: "Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men."" --Coppertwig 22:32, 18 August 2007 (UTC)

The Circumcision page cites the American Academy of Pediatrics position statement in the Sexual Effects section, but it seems unimportant to copy that particular reference here since here, the Masters and Johnson reference is given for essentially the same information; and the AAP is cited several other times on the Circumcision page so the reference is unlikely to get lost. --Coppertwig 22:54, 18 August 2007 (UTC)

It probably wouldn't hurt to summarise their summary, as well as those of other medical organisations, perhaps in a special section. Jakew 16:21, 19 August 2007 (UTC)

[edit] References

Some of the references were just url's. I copied the titles, authors etc. from the web pages and put them here. They need to be formatted, i.e. perhaps use "cite journal" or similar templates, change uppercase letters to lowercase, put author's name first etc. Some of the url's may not be reliable sources; a link to a collection of quotes on a website may not be an appropriate reference. --Coppertwig 15:54, 19 August 2007 (UTC)

Yes, some cleanup is needed. I'll do this within the next few days, assuming nobody gets there first. Jakew 15:56, 19 August 2007 (UTC)

There are two different Bleustein et al. references. Possibly these are two similar reports, perhaps one peer-reviewed and one not; possibly only one of the two is needed. --Coppertwig 16:03, 19 August 2007 (UTC)

(edit conflict) The 2003 abstract was presented at a conference of the American Urological Association, and the proceedings were printed somewhere in Urology, I believe. I think the findings were similar but represented different datasets; I'll dig out my copy of Bleustein 2005 and double-check. Jakew 16:18, 19 August 2007 (UTC)

References 25 and 39 seem to refer to the same article: "Boyle, Gregory J; Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem (2002). Male circumcision: pain, trauma, and psychosexual sequelae. Bond University Faculty of Humanities and Social Sciences.".

I've labelled reference 22 "broken link". --Coppertwig 16:16, 19 August 2007 (UTC)

References 26 and 29 seem to be duplicates: "DaiSik Kim, Myung-Geol Pang (2006) The effect of male circumcision on sexuality BJU International (OnlineEarly Articles). doi:10.1111/j.1464-410X.2006.06646" --Coppertwig 16:17, 19 August 2007 (UTC)

I checked the whole reference list and those were the only duplicates I found. (They still need to be fixed, though.) --Coppertwig 16:22, 19 August 2007 (UTC)

I think Jakew fixed the duplicates and removed the broken link. --Coppertwig 01:11, 20 August 2007 (UTC)

[edit] What about gay sex?

The opinion of women is mentioned, but what about men who sleep wtih men? Siúnrá (talk) 10:26, 18 December 2007 (UTC)

[edit] New study

Add data of the new study in the appropriate places? [12][13][14] --Shamir1 (talk) 02:48, 10 January 2008 (UTC)

I dislike citing news sources in material about scientific work, but cited the study directly in these edits. Jakew (talk) 13:41, 10 January 2008 (UTC)

[edit] Opposition

Please source that opponents oppose medically necessary circumcision. Thanks, SqueakBox 23:01, 8 April 2008 (UTC)

If the article makes such a claim, it should certainly be sourced. However, I can't find this claim anywhere. Please could you quote the relevant paragraph(s)? Jakew (talk) 23:06, 8 April 2008 (UTC)
Another problem is that the term 'non-medical' is unclear. With an extreme pro-circumcision viewpoint, all circumcisions could be considered medical because of the medical benefits of the procedure. On the other side, an anti-circumcision view would say that it is not medically necessary unless everything other than full circumcision has been tried to solve the problem.
Since anti-circumcision advocates are known to distort and deny the truth, I am confident that they would do everything possible to minimize the number of 'medical' circumcisions done.
Also, if it's so obvious that no one would oppose 'medical' circumcision, then why state it explicitly? It can only be to make an anti-circumcision point by subtly implying that circumcision proponents are extreme for trying to promote a 'non-medical' procedure. The standard rhetoric is pro- and anti-'circumcision', not pro- and anti-'non-medical circumcision', so it is the use of the latter term that must be justified. The way, the truth, and the light (talk) 23:41, 8 April 2008 (UTC)
"Since anti-circumcision advocates are known to distort and deny the truth" Please assume good faith. Broad disparaging comments do not help these controversial issues. I do agree with you that any pre descriptor of circumcision seems inadequate and unnecessarily one sided. If anything has to be used why not non-therapeudic like we have agreed upon in Circumcision. Garycompugeek (talk) 17:34, 5 May 2008 (UTC)