||This article's lead section may not adequately summarize key points of its contents. (October 2014)|
Foreskin restoration is the process of expanding the residual skin on the penis, through surgical or non-surgical methods, in an attempt to expand or restore the foreskin, which may have been removed by circumcision, with new tissue.
Foreskin restoration can be attempted for several reasons, among them being a desire to create the appearance of a natural foreskin (prepuce) covering the glans, or to increase sexual sensitivity of the glans and the interior of the restored foreskin, or to reduce discomfort due to exposure of sensitive areas during everyday activities. Foreskin restoration techniques are most commonly undertaken by men who have been circumcised or who have sustained an injury, but are also used by men who desire a longer foreskin and by men who have phimosis. Bigelow lists:
- restoration of glanular sensation
- sexual stimulation and restored sexual function
- restoration of a sense of wholeness
- improvement of body image
as reasons that circumcised men choose to restore their missing foreskin.
A form of foreskin restoration, historically known as epispasm, was practiced among some Jews in Hellenistic and Roman societies. Some European Jews sought out underground foreskin restoration operations during World War II as a method to escape Nazi persecution.
The practice was revived in the late 20th century using modern materials and techniques. In 1982 a group called Brothers United for Future Foreskins (BUFF) was formed, which publicized the use of tape in non-surgical restoration methods. Later in 1991, another group called UNCircumcising Information and Resources Centers (UNCIRC) was formed.
The National Organization of Restoring Men (NORM) was founded in 1989 in San Francisco, as a non-profit support group for men restoring the appearance of a foreskin. It was originally known as RECAP, an acronym for the phrase Recover A Penis. In 1994 UNCIRC was incorporated into this group. Since its founding, several NORM chapters have been founded throughout the United States, as well as internationally in Canada, the United Kingdom, Australia, New Zealand, and Germany.
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. Such techniques are costly, and have the potential to produce unsatisfactory results or serious complications related to the skin graft.
British Columbia resident Paul Tinari was held down and circumcised at the age of eight in what he stated was "a routine form of punishment" for masturbation at residential schools. Following a lawsuit Tinari's surgical foreskin restoration was covered by the British Columbia Ministry of Health. The plastic surgeon who performed the restoration was the first in Canada to have done such an operation, and used a technique similar to that described above.
Non-surgical foreskin restoration, accomplished through tissue expansion, is the more commonly used method. Both the skin of the penile shaft and the mucosal inner lining of the foreskin, if any remains after circumcision, may be expanded.
The skin is pulled forward over the glans, and tension is applied manually, by using weights or elastic straps. In the second two cases a device must be attached to the skin; surgical tape is often used. An example of a device using elastic straps is the T-Tape method, which was developed in the 1990s with the idea of enabling restoration to take place more rapidly. Many specialized foreskin restoration devices (like Dual Tension Restorer shown in the picture) that grip the skin with or without tape are also commercially available. Tension from these devices may be applied by weights or elastic straps, by pushing the skin forward on the penis, or by a combination of these methods. Another method which has gained traction in recent years amongst men on the forum www.restoringforeskin.org is the technique of inflation. It involves sealing off the area between the glans and the skin pulled over it using a clamping device (commonly baby bottle nipples are used) and either inflating the skin or a balloon placed under the skin. This causes circumferential skin stretch which is thought to stimulate mitosis. Men using this technique report fast skin regenerative growth, and in particular it is thought to be beneficial to stimulate growth of inner skin (mucous membrane) tissues which are vital to restoring the lubrication function of the foreskin.
The amount of tension produced by any method must be adjusted to avoid causing injury, pain or discomfort, and provides a limit on the rate at which new skin can be grown. There is a risk of seriously damaging tissues from the use of excessive tension or applying tension for too long. Websites about foreskin restoration vary in their recommendations, from suggesting a regimen of moderate amounts of tension applied for several hours a day, to recommending periods of higher tension applied for only a few minutes per day, as with manual techniques.
Tissue stretching has long been known to stimulate mitosis, and research shows that regenerated human tissues have the attributes of the original tissue. Unlike conventional skin expansion techniques, however, the process of nonsurgical foreskin restoration may take several years to complete. The time required depends on the amount of skin available to expand, the amount of skin desired in the end, and the regimen of stretching methods used. Patience and dedication are needed; support groups exist to help with these (see External links section). The act of stretching the skin is often described informally as "tugging" in these groups, especially those on the internet.
Instead of growing new skin, some men may opt to use a device to hold over the glans the remaining skin of a less extreme circumcision similar to the ancient Greek kynodesme). Others could use an artificial covering for the glans such as Viafin-Atlas sells a "prosthetic foreskin" made of latex that covers the glans in a moist environment. The product Manhood is an undergarment that holds loose circumcisions in a double layered soft fabric "hood" to minimize friction on the glans.
Results of surgical foreskin restoration are much faster, but are often described as unsatisfactory, and most restoration groups advise against them.
Results of non-surgical methods vary widely, and depend on such factors as the amount of skin present at the start of the restoration, degree of commitment, technique, and the individual's body. Foreskin restoration only creates the appearance of a natural foreskin; certain parts of the natural foreskin cannot be reformed. In particular, the ridged band, a nerve-bearing tissue structure extending around the penis just inside the tip of the foreskin, which helps to contract the tip of the foreskin so that it remains positioned over the glans, cannot be recreated. Restored foreskins can appear much looser at the tip and some men report difficulty in keeping the glans covered. Surgical "touch-up" procedures exist to reduce the orifice of the restored foreskin, recreating the tightening function of the band of muscle fibers near the tip of the foreskin, though they have not proven successful in every case. A loose effect can also be alleviated by creating increased length, but requires a longer commitment to the restoration program. In addition, several websites claim that the use of O-rings during the restoration program can train the skin to maintain a puckered shape. The circumcision scar becomes covered and invisible as the lengthened shaft skin starts to fold due to increased length and this contributes to the improved more natural appearance.
Regeneration of the foreskin
Recently there has been growing interest in regenerative medicine as a means to regenerate the human male foreskin. This option, unlike foreskin restoration, would result in a true human male foreskin being regrown. Pioneers in the field of regenerative medicine include Dr. Anthony Atala of the Wake Forest Institute of Regenerative Medicine (WFIRM).
In early 2010, Foregen, a non-profit organization dedicated to funding a clinical trial for the purposes of regrowing the human male foreskin using the regenerative capabilities of the extracellular matrix, in the hopes of eventually being able to provide free regeneration to circumcised men, was founded. A clinical trial had been scheduled for late 2010, but there were insufficient donations to follow through. The goal was reached in June 2012, and they managed to obtain a laboratory and cooperation from biochemists and regenerative medicine experts. Results from their first clinical trial were released in February 2013, and they are preparing for a human application trial. Clinical trials on human subjects might be achieved by 2019.
The proposed method would involve placing the patient under general anaesthesia. The penile skin would be opened at the circumcision scar, while the scar tissue is surgically debrided. A biomedical solution would then be applied to both ends of the wound, causing the foreskin to regenerate with the DNA in the patient's own cells. A biodegradable scaffold would be used to offer support for the regenerating foreskin. While social forums have assisted in the discussion of current tools and hurdles towards this method  scientific and medical institutes, and bioengineering companies must be involved for a more professional and meaningful discourse, and plan of action.
Foreskin regeneration along with laboratory-grown penises (regeneration of the entire penis) could be possible very soon. In 2014, it was announced that it might be possible in 5 years.
The natural foreskin has three principal components, in addition to blood vessels, nerves and connective tissue: skin, which is exposed exteriorly; mucous membrane, which is the surface in contact with the glans penis when the penis is flaccid; and a band of muscle within the tip of the foreskin. Generally, the skin grows more readily in response to stretching than does the mucous membrane. The ring of muscle which normally holds the foreskin closed is completely removed in the majority of circumcisions and cannot be regrown, so the covering resulting from stretching techniques is usually looser than that of a natural foreskin. Nonetheless, according to some observers it is difficult to distinguish a restored foreskin from a natural foreskin because restoration produces a "nearly normal-appearing prepuce."
Non-surgical foreskin restoration does not restore portions of the frenulum or the ridged band removed during circumcision. Although not commonly performed, there are surgical "touch-up" techniques that can re-create some of the functionality of the frenulum and dartos muscle.
The process of foreskin restoration seeks to regenerate some of the tissue removed by circumcision, as well as providing coverage of the glans. According to research, the foreskin comprises over half of the skin and mucosa of the human penis.
In some men, foreskin restoration may alleviate certain problems they attribute to their circumcisions. Such problems include prominent scarring (33%), insufficient penile skin for comfortable erection (27%), erectile curvature from uneven skin loss (16%), and pain and bleeding upon erection/manipulation (17%). The poll also asked about awareness of or involvement in foreskin restoration, and included an open comment section. Many respondents and their wives "reported that restoration resolved the unnatural dryness of the circumcised penis, which caused abrasion, pain or bleeding during intercourse, and that restoration offered unique pleasures, which enhanced sexual intimacy."
One man reported he has great loss of sensation in the glans because his foreskin is not present. Some men who have undertaken foreskin restoration report a visibly smoother glans, which some of these men attribute to decreased levels of keratinization following restoration.
Emotional, psychological, and psychiatric aspects
Foreskin restoration has been reported as having beneficial emotional results in some men, and has been proposed as a treatment for negative feelings in some adult men about their infant circumcisions.
- Tissue expansion
- RestoringForeskin.org - Foreskin Restoration Community (forum)
- Foreskin Restoration Network (forum)
- TLC Tugger
- RTM/Reverse Taping Method
- Bigelow J. The Joy of Uncircumcising. Hourglass; 1992. ISBN 0-9630482-1-X. Why men today want to uncircumcise. p. 113–20.
- 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". Bull. Hist. Med. 75 (3): 375–405. doi:10.1353/bhm.2001.0119. PMID 11568485.
- Rubin JP. Celsus's Decircumcision Operation. Urology. 1980;16(1):121–4. doi:10.1016/0090-4295(80)90354-4. PMID 6994325.
- Tushmet L. Uncircumcision. Medical Times. 1965;93(6):588–93.
- Bigelow J. Uncircumcising: undoing the effects of an ancient practice in a modern world. Mothering. 1994;Summer:36–60.
- Griffiths, R. Wayne. "NORM - History". Retrieved 2006-08-21.
- Greer DM. A technique for foreskin reconstruction and some preliminary results. Journal of Sex Research. 1982;18(4):324–30. doi:10.1080/00224498209551158.
- Euringer, Amanda (2006-07-25). "BC Health Pays to Restore Man's Foreskin". The Tyee.
- Laliberté J. BC man's foreskin op a success. Nat Rev Med. 2006;3(12).
- Collier. Whole again: the practice of foreskin restoration. CMAJ. 2011;183(18):2092-3. doi:10.1503/cmaj.109-4009. PMID 22083672. PMC 3255154.
- Griffiths, R. Wayne. "NORM - Recommended Restoration Regimen". Retrieved 2006-08-27.
- "Foreskin Restoration Chat Manual Restoration Method and Guide". Retrieved 2006-08-27.
- "Manual Methods of Foreskin Restoration". Retrieved 2007-07-19.[dead link]
- Cordes, Stephanie; Calhoun, Karen H.; Quinn, Francis B. (1997-10-15). "Tissue Expanders". University of Texas Medical Branch Department of Otolaryngology Grand Rounds.
- Taylor, John R. (1997-02-04). "Interview with John Taylor".
- Bigelow. The Joy of Uncircumcising!. p. 13. ISBN 0-9630482-1-X.
- Bigelow. The Joy of Uncircumcising! (1998 ed.). pp. 188–192. ISBN 0-9630482-1-X.
- "Cell and Tissue Types". June 23, 2010. Retrieved 2010-06-23.
- "Foregen". 09-21-2010, 2010. Retrieved 2012-06-12. Check date values in:
- "Clinical Regen Trial". June 23, 2010. Retrieved 2010-06-23.
- "Epistemcouk can create foreskin". January 29, 2012. Retrieved 2012-01-19.
- Jefferson G (1916). "The peripenic muscle; some observations on the anatomy of phimosis". Surg Gynecol Obstet (Chicago) 23 (2): 177–81.
- Cold CJ, Taylor JR. The prepuce. BJU Int. 1999;83 (Suppl 1):34–44. doi:10.1046/j.1464-410x.1999.0830s1034.x. PMID 10349413.
- Goodwin, Willard E. (1990). "Uncircumcision: A Technique For Plastic Reconstruction of a Prepuce After Circumcision". Journal of Urology 144 (5): 1203–5. PMID 2231896.
- Bigelow, Jim. The Joy of Uncircumcising!, pp. 188-191.
- Taylor JR, Lockwood AP, Taylor AJ (1996). "The prepuce: specialized mucosa of the penis and its loss to circumcision". Br J Urol 77 (2): 291–95. doi:10.1046/j.1464-410X.1996.85023.x. PMID 8800902.
- Hammond, T. (1999). "A Preliminary Poll of Men Circumcised in Infancy or Childhood" (PDF). BJU Int 83 (Suppl. 1): 85–92. doi:10.1046/j.1464-410x.1999.0830s1085.x. PMID 10349419.
- Anonymous. The Joy of Uncircumcising! Restore Your Birthright and Maximize Sexual Pleasure. BMJ. 1994;309(6955):679. doi:10.1136/bmj.309.6955.679a. PMC 2541521.
- Penn, Jack (1963). "Penile Reform". British Journal of Plastic Surgery 16: 287–8. doi:10.1016/S0007-1226(63)80123-X. PMID 14042759.
- Boyle, GJ; Goldman R.; Svoboda, J.S.; Fernandez, E. (2002). "Male Circumcision: Pain, Trauma and Psychosexual Sequelae". Journal of Health Psychology 7 (3): 329–43. doi:10.1177/1359105302007003225. PMID 22114254.
- Griffin, Gary M. (1992). Decircumcision: Foreskin Restoration, Methods and Circumcision Practices. Los Angeles: Added Dimensions Publishing. ISBN 1-879967-05-7.
- Bigelow, Jim (1992). The Joy of Uncircumcising!: Exploring Circumcision: History, Myths, Psychology, Restoration, Sexual Pleasure, and Human Rights. Aptos, CA: Hourglass Book Publishing. ISBN 0-9630482-1-X. (foreword by James L. Snyder)
- Foreskin Restoration
- CIRP Foreskin restoration for circumcised males
- Foreskin Restoration
- Foreskin Restoration Community
- Payne, Roy M.; Fryer, Leo (March 2001). "My responses to a few Frequently Asked Questions about Non-Surgical Foreskin Restoration:" (PDF).
- Brandes, S.B.; McAninch, J.W. (1999). "Surgical methods of restoring the prepuce: a critical review" (PDF). BJU Int 83 (Suppl. 1): 109–13. doi:10.1046/j.1464-410x.1999.0830s1109.x.
- Schultheiss D, Truss MC, Stief CG, Jonas U (1998). "Uncircumcision: a historical review of preputial restoration". Plast Reconstr Surg 101 (7): 1990–8. doi:10.1097/00006534-199806000-00037. PMID 9623850.