Talk:Foreskin

Relevance/Validity of Expired AAP Statement

The line on the foreskin’s contribution to non-HIV STD transmission is hotly debated and controversial, to say the least. Many studies show men without foreskins have higher incidence of non-HIV STDs, many show the opposite, and some show no significant effect. A meta-analysis of 91 studies of non-HIV STDs and circumcision (https://doi.org/10.1155/2013/109846) concludes “This is the first systematic review of the medical literature looking at the incidence and the prevalence of any STI as opposed to not acquiring an STI based on circumcision status. This analysis indicates that prevalence of acquiring any STI is lower in intact men. Three of the four studies of incidence are consistent with the prevalence date, while one study from New Zealand indicated a significant protective effect. Overall, the incidence data indicate a trend that intact men have a lower incidence of any STI.”

There is quite a bit of research showing a link between male-to-female HIV transmission and the foreskin, that claim is more supportable and mentioned later in the article, but the claim that the foreskin is linked to other STD transmission is untenable and doesn’t reach acceptable standards of evidence. Yoleaux (talk) 23:26, 2 March 2023 (UTC)

@Yoleaux:. Hindawi is generally considered to be a predatory publisher.

The European Association of Urologists and several other medical organizations make similar statements to the AAP in this area. It's not limited to just them. KlayCax (talk) 09:07, 3 March 2023 (UTC)

Interestingly, the Wikipedia page for Hindawi says otherwise, that most of its journals are classified as academic and was removed from a list of predatory publishers. Since the study is a review, would it be better to cite all the sources it reviews separately? I assume that would fall under excessive citations. Yoleaux (talk) 09:59, 3 March 2023 (UTC)

I'm aware that Hindawi has improved a bit in standards (affilated with Wiley now) - but it's still not great. They were traditionally considered a predatory publisher/papermill. Now, it's more of a "gray" area. @Yoleaux: I wouldn't be against metastudies in high-quality journals and/or other major medical associations.KlayCax (talk) 11:12, 3 March 2023 (UTC)

By the way - I realize this relates to the circumcision article - but I removed "Australia" and "New Zealand" because they still have high prevalence. Their incidence is low. Circumcision's prevalence is still widespread. That's why I reverted your removal for those two polities. KlayCax (talk) 11:14, 3 March 2023 (UTC)

Clinal Significance section has NPOV issues

The "Clinal Significance" section suffer from several NPOV issues and worldview issues. First, it only mentions the views of the AAP and U.S. centric medical sources. Since the U.S. is still very pro-circumcision, views of medical groups from non-circumcision countries should be added to counterbalance the views on the risk of keeping the foreskin. Second, some of the risks shown do indeed have studies that support them but these studies do not however necessarily make the case for routine circumcision. To fix this, we should avoid broad statements about risks of having a foreskin nd be more specific who specifically might benefit from circumcision in such cases but also include alternative practices one can engage in that also lesson one's risk (other then removing the foreskin). For example, the section mentions the increased risks of HIV transmission in the uncircumcised male, but fails to mention that this would most benefit males in countries with high HIV rates and were it's more difficult to apply safer sex practices. For most developed countries, higher HIV transmissions rates among the uncircumcised are not currently seen a major risk justifying the practices. While it's fine to point out certain risks from having a intact foreskin, we should balance this with info on how likely such problems are in reality. For example, phimosis is not a commonly seen issue in non-circumcising countries. Also, the notion that the "foreskin can harbor micro-organisms that may increase the risk of urinary tract infections in infants and contribute to the transmission of some sexually transmitted infections in adults" as stated in the expired 2012 AAP report on circumcision is either not supported by medical groups/experts from countries where circumcision is not routine (such as the non-HIV STD increased transmission claim) or not considered significant enough in developed countries to justify routine circumcision (such as increased UTI claims or HIV transmission claims). Just putting out these medical statements on the clinical significance of having a foreskin without better context and/or opposing viewpoints is a NPOV violation. --Notcharliechaplin (talk) 19:02, 9 July 2023 (UTC)

I am also concerned with the section, because it just seems like a laundry list of issues the foreskin can have; nothing about potential clinical benefits. Also, if we have newer sources than the expired 2012 AAP viewpoint, the AAP source should be replaced with those per WP:MEDDATE. Most medical organizations have either come out with new viewpoints on circumcision or reaffirmed their old viewpoints, so actually, maybe we should just remove the AAP altogether, since they seem to be one of the only outliers without an update? Prcc27 (talk) 19:16, 9 July 2023 (UTC)

@Prcc27 To be fair, the clinical significance section of most body parts that have one is just "a laundry list of issues" that particular part can have. Most don't include any clinical benefits Man-Man122 (talk) 14:26, 10 September 2023 (UTC)

Why is the skin sample study unreliable?

Explain Man-Man122 (talk) 14:21, 10 September 2023 (UTC)

Infographics "Anatomy and function of the foreskin"

The infographics "Anatomy and function of the foreskin" was removed from this article on 18th October 2022. As the reason to do so the Wikipedian writes: "dubious / unnecessary content removal". This claim is not justified. The illustration visualizes valuable information on the foreskin that is of high relevance to readers of WIKIPEDIA. It has been designed by a professional scientific illustrator and clearly improves the article. Being a medical doctor myself I can see no "dubious or unnecessary content" here. I have put this valuable contribution back in place and ask to discuss this issue first before removing it again. Guido4 (talk) 18:37, 28 October 2022 (UTC)

Thanks. I wonder if in addition we can provide Wikilinks to the articles Ridged band and Preputial mucosa either from the diagram or the text, as the are necessary related articles.Thelisteninghand (talk) 14:22, 29 October 2022 (UTC)

The majority of the graphic isn't objectionable, @Guido4:. The issues relate to the the statements "function of the foreskin" and "ridged band". The claims of Taylor et al., 1996 are rejected by a significant percentage of major medical associations and several notable metastudies. (As mentioned above.)KlayCax (talk) 04:54, 31 October 2022 (UTC) The other graphic (By you? If so, thanks.) — showing the time of preputial seperation — is an objective improvement for the article and replaced it. (Although Øster, 1968 in now considered an overestimate - e.g. it underestimates the median, normative time of separation, estimating it several years before it actually occurs - by most researchers. I feel like context might be beneficial there.) KlayCax (talk) 04:54, 31 October 2022 (UTC)

@KlayCax: There are arguments on both sides about Taylor and we need to show that. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450466/ To rely exclusively on arguments presented by Cox, Krieger and Morris is to rely on authors with a vested interest - there must by a WP|VestedInterest policy somewhere. The paper https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498824/ is about circumcision - it's in the title. Biased, fringe source imo - not anatomy but a meta-study of less importance than the anatomical paper I cite. Secondly we are being extremely selective in our summary - genital end bulbs and free nerve ending may in fact be more significant than Meissner's corpuscles - "Malkoc et al. showed that free, nonbranched, nerve endings were least common in the proximal region (outer layer) of the prepuce and most common in the distal region (inner layer) [13]. " - just one example that shows that the discussion of 'function' is incomplete without a more accurate summation and further sources. I'm willing to work on this. Thelisteninghand (talk) 17:03, 31 October 2022 (UTC)

Hi @Guido4, I wanted to clarify that the infographics was not removed by me and my "dubious/ unnecessary" comment was refering to other edits, for which we had several discussions here. KlayCax removed the illustration because of two or three reasons: it mentions "function", "ridged band" and maybe the circumcision images, because there was a general consensus not to make this article about circumcision.

However, as @KlayCax mentions, except for these small issues the infographic as a whole has nothing wrong. I also think that an illustration can always be helpful, especially in anatomy articles and I'd like to see yours in this article. My suggestion would be a compromisation: if Guido4 could make small adjustents to the illustration to align with KlayCax's objections, we could bring it back in the article. Piccco (talk) 19:15, 31 October 2022 (UTC)

The word 'function' shouldn't be a problem, the article says the prepuce protects the glans. We definitely need a diagram.Thelisteninghand (talk) 22:02, 1 November 2022 (UTC)

Multiple major medical organizations deny the statement the prepuce protects the glans. Again, that introduces WP: NPOV issues.KlayCax (talk) 00:57, 4 November 2022 (UTC)

I am quoting this article.Thelisteninghand (talk) 20:08, 8 November 2022 (UTC)

At least among the 46 countries in Europe and their numerous medical associations not a single one has issued a claim that the "prepuce does not protect the glans". Furthermore it is normally not the work area of medical associations to claim or deny functions of body parts. On the other hand every anatomy book that I know as a medical doctor states that protecting the glans is what the foreskin does. Guido4 (talk) 00:37, 10 November 2022 (UTC)

Hello Piccco, sorry for mixing your comment on another edit with KlayCax deletion of the infographics. Guido4 (talk) 23:20, 9 November 2022 (UTC)

Hello @KlayCax, please let me first point out that you have removed the infographic twice, although after the first time you deleted it I opened this discussion and asked you to discuss first before removing it again, which you obviously did not comply with.

Please find here my point-by-point response:

1. The title "function of the foreskin" in the infographics relates to the movement of the skin forth and back, and as this function undoubtedly exists, there can't be any discussion that the word "function" should not be used.

2. To my knowledge as a medical doctor there is no medical association that has denied the existence of the ridged band. Furthermore medical associations normally do not give official statements on the existence or non-existence of anatomical structures as this is not their field of work. The references named above neither claim nor proof the non-existence of the ridged band.

Still I can see your point that the existence of the ridged band has been debated by anatomists. So I suggest that this does not order the infographic to be deleted, but that this debate should be stated in the text. However the ridged band should be depicted so that the reader can follow which anatomical region the debate is about.

3. As the fact of circumcision is mentioned in the foreskin article, I can see no reason why it should have to be excluded from the graphics. The illustration simply gives a representation of the anatomical result of the procedure, so just depicting it in the context of the anatomy does not discuss any aspects of it in one direction or another.

4. The infographics contributes a lot information to the article. It has been designed by two medical doctors and a professional illustrator pro bono for WIKIPEDIA. I can see no valid argument why we should withhold this informative visualization from the readers. Guido4 (talk) 00:20, 10 November 2022 (UTC)

As no more new and valid arguments are coming on this issue, I'll put the illustration back to its former place. To meet the concerns stated above, I have added a sentence that the existence of the ridged band has been questioned. If anyone feels like removing the illustration again, please refrain from doing so and discuss it here first. Guido4 (talk) 16:53, 29 November 2022 (UTC)

I see @Guido4:'s graphic didn't last yet again. Reading the reasons in the summary I think that could have sorted out here. Thelisteninghand (talk) 21:06, 16 January 2023 (UTC)

The discussion on this infographic was archived automatically on 18 March 2023 (Archive 5). I reactivated this thread.

We have uploaded a new version of this illustration. This version should meet the criteria stated before:

1. "function" removed from title,

2. panel "circumcision result" removed,

3. label "ridged band" removed and replaced by "mucocutaneous junction".

Any further objections @Thelisteninghand, @KlayCax, and @Piccco? DocBrinkmann (talk) 14:49, 22 September 2023 (UTC)

Seems like I was the one who suggested that those issues be fixed in order to avoid concerns, so i guess it's okay if you did. Piccco (talk) 15:41, 22 September 2023 (UTC)

DocBrinkmann (talk) 14:42, 22 September 2023 (UTC)

Hey, @DocBrinkmann:. I'd be open to it. Where's the link to the new version? KlayCax (talk) 00:38, 28 September 2023 (UTC)

Foreskin function

Hey, @Piccco: and @Prcc27:. I restored information that was recently deleted from the article. Why were these sections removed?

Prcc27 recently reverted the changes. Yet I'm not sure how there's any consensus on the matter in the literature. KlayCax (talk) 01:10, 28 September 2023 (UTC)

Also tagging @Thelisteninghand: and @Man-Man122:. (Who have been involved in previous discussions.) KlayCax (talk) 01:13, 28 September 2023 (UTC)

Tagging @Neveselbert: and @Bon courage: as well. KlayCax (talk) 01:35, 28 September 2023 (UTC)

These sources appear to be perfectly fine to me, and it is clearly not fringe material. Not sure why this was deleted at all, let alone why there would be edit warring to keep it out. MrOllie (talk) 01:46, 28 September 2023 (UTC)