Foreskin restoration

Last updated December 20, 2024

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]

History

In the Greco-Roman world, uncircumcised 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 Alexandrian Empire (333 BC). Males participated in the gymnasium nude and because the Greeks did not practice circumcision anyone who was circumcised was socially shunned. Hellenized Jews stopped circumcising their sons to avoid persecution and so they could participate in the gymnasium. Some Jews at this time attempted to restore their foreskins. This caused conflict within Second Temple Judaism, some Jews viewed circumcision as an essential part of the Jewish identity (1 Maccabees 1:15).^[5] Following the death of Alexander, Judea and the Levant was part of the Seleucid Empire under Antiochus Epiphanes (175-164 BC). Antiochus outlawed the Jewish practice of circumcision, both 1st and 2nd Maccabees records Jewish mothers being put to death for circumcising their sons (1:60-61 and 6:10 respectively).^[6] Some Jews during Antiochus' persecution sought to undo their circumcision.^[7] Within the 1st century A.D., there was still some forms of foreskin restoration being sought after (1 Corinthians 7:18). During the third Jewish-Roman Wars (AD 132–135), the Romans had renamed Jerusalem as Aelia Capitolian and may have banned circumcision; however, Roman sources from the period only mention castration and say nothing about banning circumcision. During the Bar Kokhba revolt, there is Rabbinic evidence that records, Jews who had removed their circumcision (meaning that foreskin restoration was still being practiced) they were recircumcised, voluntarily or by force.^[8] Again, during World War II, some European Jews sought foreskin restoration to avoid Nazi persecution.^[9]

Non-surgical techniques

Tissue expansion

Non-surgical foreskin restoration, accomplished through tissue expansion, is the more commonly used method.^[10]

Tissue expansion has long been known to stimulate mitosis, and research shows that regenerated human tissues have the attributes of the original tissue.^[11]

Methods and devices

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.^[12]

Dual tension restorer applied to a circumcised penis for non-surgical foreskin restoration
T-tape with a leg strap
Silicone device with a one-way valve that allows air to be pumped to inflate and expand the foreskin.
Application of a typical restoration device, the TugAhoy, called a 'Chinese puzzle' by its inventor

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.^[13]

Results

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),^[14] or it can be alleviated through a longer commitment to the skin expansion regime to allow more skin to collect at the tip.^[15]

The natural foreskin is composed of smooth dartos muscle tissue (called the peripenic muscle^[16]), large blood vessels, extensive innervation, outer skin, and inner mucosa.^[17]

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.^[18]

In a survey restorers reported restoration; increased their sexual pleasure for 69% and improved their relationship for 25% ^[19]

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,^[20] which was incorporated into NORM in 1994.^[21] 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).^[22]

Related Research Articles

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.

Genital modifications are forms of body modifications applied to the human sexual organs. When there's cutting involved, genital cutting or surgery can be used. The term genital enhancement seem to be generally used for genital modifications that modify the external aspect, the way the patient wants it. The term genital mutilation is used for genital modifications that drastically diminish the recipient's quality of life and result in adverse health outcomes, whether physical or mental.

In female humans and other mammals, 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 and foreskin 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.

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.

Balanitis is inflammation of the glans penis. Balanoposthitis is the proper term when the foreskin is also affected. Balanitis on persons in diapers must be distinguished from redness caused by ammoniacal dermatitis.

<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.

Male circumcision has been a subject of controversy for a number of reasons including religious, ethical, sexual, and medical.

Circumcision likely has ancient roots among several ethnic groups in sub-equatorial Africa, Egypt, and Arabia, though the specific form and extent of circumcision has varied. Ritual male circumcision is known to have been practiced by South Sea Islanders, Aboriginal peoples of Australia, Sumatrans, and some Ancient Egyptians.

<span class="mw-page-title-main">Restoration device</span> Device to apply tension to the skin

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.

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.

Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topical or locally injected anesthesia is generally used to reduce pain and physiologic stress. Circumcision is generally electively performed, most commonly done as a form of preventive healthcare, as a religious obligation, or as a cultural practice. It is also an option for cases of phimosis, other pathologies that do not resolve with other treatments, and chronic urinary tract infections (UTIs). The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health.

In human anatomy, the penis is an external sex organ through which males urinate and ejaculate. Together with the testes and surrounding structures, the penis functions as part of the male reproductive system.

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.

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.

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.

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 between the penile frenulum. 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 along with the skin between it are homologous to the female labia minora.

References

↑ Lerman SE, Liao JC (December 2001). "Neonatal circumcision". Pediatric Clinics of North America. 48 (6): 1539–57. doi:10.1016/s0031-3955(05)70390-4. PMID 11732129.
1 2
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.
↑ 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.
↑ Rubin JP (July 1980). "Celsus' decircumcision operation: medical and historical implications". Urology. 16 (1): 121–4. doi:10.1016/0090-4295(80)90354-4. PMID 6994325.
↑ Barry, John D., David Bomar, Derek R. Brown, Rachel Klippenstein, Douglas Mangum, Carrie Sinclair Wolcott, Lazarus Wentz, Elliot Ritzema, and Wendy Widder, eds. The Lexham Bible Dictionary. Bellingham, WA: Lexham Press, 2016.
↑ Aymer, Margaret. “Acts of the Apostles.” In Women’s Bible Commentary, edited by Carol A. Newsom, Jacqueline E. Lapsley, and Sharon H. Ringe, Revised and Updated. Louisville, KY: Westminster John Knox Press, 2012.
↑ Kaiser, Walter C., Jr., Peter H. Davids, F. F. Bruce, and Manfred T. Brauch. Hard Sayings of the Bible. Downers Grove, IL: InterVarsity, 1996.
↑ Ramos, Alex. “Bar Kokhba.” In The Lexham Bible Dictionary, edited by John D. Barry, David Bomar, Derek R. Brown, Rachel Klippenstein, Douglas Mangum, Carrie Sinclair Wolcott, Lazarus Wentz, Elliot Ritzema, and Wendy Widder. Bellingham, WA: Lexham Press, 2016.
↑ Tushmet L (1965). "Uncircumcision". Medical Times. 93 (6): 588–93. Archived from the original on 2013-10-23.^{[ unreliable medical source? ]}
↑ Collier R (December 2011). "Whole again: the practice of foreskin restoration". CMAJ. 183 (18): 2092–3. doi:10.1503/cmaj.109-4009. PMC 3255154 . PMID 22083672.
↑ Cordes S, Calhoun KH, Quinn FB (1997-10-15). "Tissue Expanders". University of Texas Medical Branch Department of Otolaryngology Grand Rounds. Archived from the original on 2004-10-11.
↑ Goodwin, Willard E. (1990-11-01). "Uncircumcision: A Technique for Plastic Reconstruction of a Prepuce after Circumcision". Journal of Urology. 144 (5): 1203–1205. doi:10.1016/S0022-5347(17)39693-3. PMID 2231896.
↑ Greer Jr DM, Mohl PC, Sheley KA (2010). "A technique for foreskin reconstruction and some preliminary results". The Journal of Sex Research. 18 (4): 324–30. doi:10.1080/00224498209551158. JSTOR 3812166.
↑ Griffith RW (1992). "Finishing Touches to the Foreskin". In Bigelow J (ed.). The Joy of Uncircumcising! (1998 ed.). Hourglass Book Pub. pp. 188–192. ISBN 0-9630482-1-X.
↑ Brandes, S.B.; McAninch, J.W. (2002-05-27). "Surgical methods of restoring the prepuce: a critical review". BJU International. 83 (S1): 109–113. doi:10.1046/j.1464-410x.1999.0830s1109.x. ISSN 1464-4096. PMID 10349422. S2CID 37867161.
↑ Jefferson G (1916). "The peripenic muscle: some observations on the anatomy of phimosis". Surgery, Gynecology & Obstetrics. 23: 177–81.
↑ Cold CJ, Taylor JR (January 1999). "The prepuce". BJU International. 83 (Suppl 1): 34–44. doi: 10.1046/j.1464-410x.1999.0830s1034.x . PMID 10349413. S2CID 30559310.
↑ Taylor JR, Lockwood AP, Taylor AJ (February 1996). "The prepuce: specialized mucosa of the penis and its loss to circumcision". British Journal of Urology. 77 (2): 291–5. doi:10.1046/j.1464-410X.1996.85023.x. PMID 8800902.
↑ Hammond T, Sardi LM, Jellison WA, McAllister R, Snyder B, Fahmy MAB (May 2023). "Foreskin restorers: insights into motivations, successes, challenges, and experiences with medical and mental health professionals – An abridged summary of key findings". International Journal of Impotence Research. 35 (3): 309–322. doi:10.1038/s41443-023-00686-5. PMID 36997741.
↑ Bigelow J (Summer 1994). "Uncircumcising: undoing the effects of an ancient practice in a modern world". Mothering: 36–60.
↑ Griffiths RW. "NORM - History" . Retrieved 2006-08-21.
↑ "Qui sommes-nous?". Droit au Corps. 14 May 2013. Retrieved 29 August 2017.