Foreskin restoration

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Dual tension restorer applied to a circumcised penis for non-surgical foreskin restoration Dual Tension Restorer (DTR) applied.jpg
Dual tension restorer applied to a circumcised penis for non-surgical foreskin restoration

Foreskin restoration is the process of expanding the skin on the penis to reconstruct an organ similar to the foreskin, which has been removed by circumcision or injury. Foreskin restoration is primarily accomplished by stretching the residual skin of the penis, but surgical methods also exist. Restoration creates a facsimile of the foreskin, but specialized tissues removed during circumcision cannot be reclaimed. Actual regeneration of the foreskin is experimental at this time. Some forms of restoration involve only partial regeneration in instances of a high-cut wherein the circumcisee feels that the circumciser removed too much skin and that there is not enough skin for erections to be comfortable. [1]

Contents

History

In the Greco-Roman world intact genitals, including the foreskin, were considered a sign of beauty, civility, and masculinity. [2] In Classical Greek and Roman societies (8th century BC to 6th century AD), exposure of the glans was considered disgusting and improper, and did not conform to the Hellenistic ideal of gymnastic nudity. [2] Men with short foreskins would wear the kynodesme to prevent exposure. [3] As a consequence of this social stigma, an early form of foreskin restoration known as epispasm was practiced among some Jews in Ancient Rome (8th century BC to 5th century AD). [4]

Foreskin restoration is of ancient origin and dates back to the reign of the Roman Emperor Tiberius (AD 14–37), when surgical means were taken to lengthen the foreskin of individuals born with either a short foreskin that did not cover the glans completely [2] or a completely exposed glans as a result of circumcision. [5] Again, during World War II some European Jews sought foreskin restoration to avoid Nazi persecution. [6]

Non-surgical techniques

Tissue expansion

Non-surgical foreskin restoration, accomplished through tissue expansion, is the more commonly used method. [7]

Tissue expansion has long been known to stimulate mitosis, and research shows that regenerated human tissues have the attributes of the original tissue. [8]

Methods and devices

Application of a typical restoration device, the TugAhoy, called a 'Chinese puzzle' by its inventor Tugahoy1.jpg
Application of a typical restoration device, the TugAhoy, called a 'Chinese puzzle' by its inventor

During restoration via tissue expansion, the remaining penile skin is pulled forward over the glans, and tension is maintained either manually or through the aid of a foreskin restoration device. [9]

T-tape with a leg strap T-tape with a leg strap.jpg
T-tape with a leg strap

Surgical techniques

Foreskin reconstruction

Surgical methods of foreskin restoration, known as foreskin reconstruction, usually involve a method of grafting skin onto the distal portion of the penile shaft. The grafted skin is typically taken from the scrotum, which contains the same smooth muscle (known as dartos fascia) as does the skin of the penis. One method involves a four-stage procedure in which the penile shaft is buried in the scrotum for a period of time. [10]

Results

Stages of non-surgical restoration Foreskin Restoration in general.jpg
Stages of non-surgical restoration

Physical aspects

A partially restored foreskin after four years of non-surgical restoration After4yearsRestoring.jpg
A partially restored foreskin after four years of non-surgical restoration

Restoration creates a facsimile of the prepuce, but specialized tissues removed during circumcision cannot be reclaimed.[ medical citation needed ] Surgical procedures exist to reduce the size of the opening once restoration is complete (as depicted in the image above), [11] or it can be alleviated through a longer commitment to the skin expansion regime to allow more skin to collect at the tip. [12]

The natural foreskin is composed of smooth dartos muscle tissue (called the peripenic muscle [13] ), large blood vessels, extensive innervation, outer skin, and inner mucosa. [14]

The process of foreskin restoration seeks to regenerate some of the tissue removed by circumcision, as well as provide coverage of the glans. According to research, the foreskin comprises over half of the skin and mucosa of the human penis. [15]

Physical aspects

In a survey restorers reported restoration; increased their sexual pleasure for 69% and improved their relationship for 25% [16]

Organizations

Various groups have been founded since the late 20th century, especially in North America where circumcision has been routinely performed on infants. In 1989, the National Organization of Restoring Men (NORM) was founded as a non-profit support group for men undertaking foreskin restoration. In 1991, the group UNCircumcising Information and Resource Centers (UNCIRC) was formed, [17] which was incorporated into NORM in 1994. [18] NORM chapters have been founded throughout the United States, as well as in Canada, the United Kingdom, Australia, New Zealand, and Germany. In France, there are two associations about this. The "Association contre la Mutilation des Enfants" AME (association against child mutilation), and more recently "Droit au Corps" (right to the body). [19]

See also

Related Research Articles

<span class="mw-page-title-main">Glans penis</span> End of the penis

In male human anatomy, the glans penis or penile glans, commonly referred to as the glans, is the bulbous structure at the distal end of the human penis that is the human male's most sensitive erogenous zone and primary anatomical source of sexual pleasure. The glans penis is present in the male reproductive organs of humans and most other mammals where it may appear smooth, spiny, elongated or divided. It is externally lined with mucosal tissue, which creates a smooth texture and glossy appearance. In humans, the glans is located over the distal ends of the corpora cavernosa and is a continuation of the corpus spongiosum of the penis. At the summit appears the urinary meatus and at the base forms the corona glandis. An elastic band of tissue, known as the frenulum, runs on its ventral surface. In men who are not circumcised, it is completely or partially covered by a fold of skin called the foreskin. In adults, the foreskin can generally be retracted over and past the glans manually or sometimes automatically during an erection.

<span class="mw-page-title-main">Genital modification and mutilation</span> Permanent or temporary changes to human sex organs

Genital modifications are forms of body modifications applied to the human sexual organs, such as piercings, circumcision, or labiaplasty.

<span class="mw-page-title-main">Clitoral hood</span> Part of the vulva that covers and protects the glans of the clitoris

In female humans and primates in general, the clitoral hood is a fold of skin that surrounds and protects the glans of the clitoris; it also covers the external clitoral shaft, develops as part of the labia minora and is homologous with the foreskin in the male reproductive system. The clitoral hood is composed of mucocutaneous tissues; these tissues are between the mucous membrane and the skin, and they may have immunological importance because they may be a point of entry of mucosal vaccines.

<span class="mw-page-title-main">Penis enlargement</span> Technique aimed to increase the size of a human penis

Penis enlargement, or male enhancement, is any technique aimed to increase the size of a human penis. Some methods aim to increase total length, others the shaft's girth, and yet others the glans size. Techniques include surgery, supplements, ointments, patches, and physical methods like pumping, jelqing, and traction.

<span class="mw-page-title-main">Paraphimosis</span> Medical condition

Paraphimosis is an uncommon medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be reduced. If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.

<span class="mw-page-title-main">Phimosis</span> Medical condition

Phimosis is a condition in which the foreskin of the penis cannot stretch to allow it to be pulled back past the glans. A balloon-like swelling under the foreskin may occur with urination. In teenagers and adults, it may result in pain during an erection, but is otherwise not painful. Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.

The preputial mucosa of the penis is the epithelium of the inside of the prepuce, or foreskin. To differentiate it from the cutaneous skin of the outside of the prepuce, it is sometimes referred to as the inner mucosa. It starts at the ridged band of the prepuce and continues to the coronal sulcus, where it meets the epithelium of the glans and penile shaft. The preputial mucosa is devoid of hair, as is the cutaneous surface.

<span class="mw-page-title-main">Hypospadias</span> Medical condition

Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location on the head of the penis. It is the second-most common birth defect of the male reproductive system, affecting about one of every 250 males at birth. Roughly 90% of cases are the less serious distal hypospadias, in which the urethral opening is on or near the head of the penis (glans). The remainder have proximal hypospadias, in which the meatus is all the way back on the shaft of the penis, near or within the scrotum. Shiny tissue that typically forms the urethra instead extends from the meatus to the tip of the glans; this tissue is called the urethral plate.

<span class="mw-page-title-main">Balanitis</span> Inflammation of the glans penis

Balanitis is inflammation of the glans penis. When the foreskin is also affected, the proper term is balanoposthitis. Balanitis on boys still in diapers must be distinguished from redness caused by ammoniacal dermatitis. The word balanitis is from the Greek βάλανοςbalanos, literally meaning 'acorn', used because of the similarity in shape to the glans penis.

<span class="mw-page-title-main">Frenulum breve</span> Medical condition

Frenulum breve, or short frenulum, is a condition in which the frenulum of the penis, which is an elastic band of tissue under the glans penis that connects to the foreskin and helps contract it over the glans, is too short and thus restricts the movement of the foreskin. The frenulum should normally be sufficiently long and supple to allow for the full retraction of the foreskin so that it lies smoothly back on the shaft of the erect penis.

<span class="mw-page-title-main">Restoration device</span>

A restoration device is a device used for applying tension to skin during the process of non-surgical foreskin restoration. Those who use such a device employ the use of tissue expansion, which causes new skin to grow.

<span class="mw-page-title-main">Penile frenulum</span> Band of tissue under the glans penis connecting the foreskin to the ventral mucosa

The frenulum of the penis, often known simply as the frenulum or frenum, is a thin elastic strip of tissue on the underside of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa. In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin during erection. In flaccid state, it tightens to narrow the foreskin opening.

<span class="mw-page-title-main">Human penis</span> Human male external reproductive organ

In human anatomy, the penis is an external male sex organ that additionally serves as the urinary duct. The main parts are the root, body, the epithelium of the penis including the shaft skin, and the foreskin covering the glans. The body of the penis is made up of three columns of tissue: two corpora cavernosa on the dorsal side and corpus spongiosum between them on the ventral side. The human male urethra passes through the prostate gland, where it is joined by the ejaculatory duct, and then through the penis. The urethra traverses the corpus spongiosum, and its opening, the meatus, lies on the tip of the glans. It is a passage both for urination and ejaculation of semen.

<span class="mw-page-title-main">Corona of glans penis</span> Flare above the sulcus of the human penis

The corona of glans penis or penis crown refers to the rounded projecting border or flare that forms at the base of the glans in human males. The corona overhangs a mucosal surface, known as the neck of the penis, which separates the shaft and the glans. The deep retro-glandular coronal sulcus forms between the corona and the neck of the penis. The two sides of the corona merge on the ventral midline forming the septum glandis. The circumference of the corona is richly innervated and is described as a highly erogenous area of the glans.

<span class="mw-page-title-main">Dorsal slit</span> Incision on penis foreskin expoing the glans

A dorsal slit is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue. An ancient practice, it has been a traditional custom among a number of peoples, particularly Filipinos and Pacific Islanders, probably for thousands of years.

<span class="mw-page-title-main">Foreskin</span> Retractable fold of skin which covers and protects the glans of the penis

In male human anatomy, the foreskin, also known as the prepuce, is the double-layered fold of skin, mucosal and muscular tissue at the distal end of the human penis that covers the glans and the urinary meatus. The foreskin is attached to the glans by an elastic band of tissue, known as the frenulum. The outer skin of the foreskin meets with the inner preputial mucosa at the area of the mucocutaneous junction. The foreskin is mobile, fairly stretchable and sustains the glans in a moist environment. Except for humans, a similar structure known as a penile sheath appears in the male sexual organs of all primates and the vast majority of mammals.

<span class="mw-page-title-main">Circumcision surgical procedure</span>

Circumcision surgical procedure in males involves either a conventional "cut and stitch" surgical procedure or use of a circumcision instrument or device. In the newborn period, almost all circumcisions are done by generalist practitioners using one of three surgical instruments. In the US, the Gomco clamp is the most utilized instrument, followed by the Mogen clamp and the Plastibell. They are also used worldwide.

<span class="mw-page-title-main">Fibula (penile)</span> Ring fastened to the human penis

A penile fibula is foremost a ring, attached with a pin through the foreskin to fasten it above the glans penis. It was mainly used by ancient Roman culture, though it may have originated earlier. This ring type of fibula has been described akin to a "large modern safety pin". Its usage may have had several reasons, for example to avoid intercourse, to promote modesty or the belief that it helped preserve a man's voice. Some Jews also utilized fibulas to hide that they were circumcised. The word fibula could also be used in general in Rome to denote any type of covering of the penis for the sake of voice preservation or sexual abstinence, it was often used by masters on their slaves for this purpose. Fibulas were frequent subject of ridicule among satirists in Rome.

A penis extender is an external medical device with tentative evidence as of 2019 for Peyronie's disease. It acts as a mechanical, traction device that stretches the human penis in the flaccid state to make it longer.

<span class="mw-page-title-main">Penile raphe</span> Line of tissue on the human penis

The penile raphe is a visible line or ridge of tissue that runs on the ventral (urethral) side of the human penis beginning from the base of the shaft and ending in the prepuce. The line is typically darker than the rest of the shaft skin, even though its shape and pigmentation may vary greatly among males. The penile raphe is part of a broader line in the male reproductive organs, that runs from the anus through the perineum and continues to the scrotum and penis, collectively referred to as median raphe. The penile raphe is homologous to the female labia minora.

References

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  2. 1 2 3
    Circumcised barbarians, along with any others who revealed the glans penis , were the butt of ribald humor. For Greek art portrays the foreskin, often drawn in meticulous detail, as an emblem of male beauty; and children with congenitally short foreskins were sometimes subjected to a treatment, known as epispasm , that was aimed at elongation.
    Jacob Neusner, Approaches to Ancient Judaism, New Series: Religious and Theological Studies (1993), p. 149, Scholars Press.
  3. Hodges FM (2001). "The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme". Bulletin of the History of Medicine. 75 (3). Johns Hopkins University Press: 375–405. doi:10.1353/bhm.2001.0119. PMID   11568485. S2CID   29580193.
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Further reading