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== Physical Aspects ==
== Physical Aspects ==


According to Taylor, a pathologist and advocate against circumcision, and colleagues, the foreskin comprises over half of the skin and mucosa of the human penis [http://www.cirp.org/library/anatomy/taylor/]. Taylor himself, when asked to comment on foreskin restoration, during an interview with fellow anti-circumcision advocate Lawrence Barichello, of Intact Canada, stated:
According to Taylor, a pathologist and anti-circumcision activist, and colleagues, the foreskin comprises over half of the skin and mucosa of the human penis [http://www.cirp.org/library/anatomy/taylor/]. Taylor himself, when asked to comment on foreskin restoration, during an interview with fellow anti-circumcision advocate Lawrence Barichello, of Intact Canada, stated:


:"... I think it's a loser, if you've lost that specialized mucosa, you know, just stretching the rest of the skin doesn't compensate."[http://health.groups.yahoo.com/group/independentreference/message/8]
:"... I think it's a loser, if you've lost that specialized mucosa, you know, just stretching the rest of the skin doesn't compensate."[http://health.groups.yahoo.com/group/independentreference/message/8]
Line 46: Line 46:
In some men, foreskin restoration may alleviate perceived or sometimes real problems, including 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 figures are taken from a poll of men contacting anti-circumcision organisations, and may not be representative of the wider population. The full text of the poll is available at[http://www.noharmm.org/bju.htm]). Special consideration of these factors are important when deciding whether or not to restore, and what devices are appropriate.
In some men, foreskin restoration may alleviate perceived or sometimes real problems, including 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 figures are taken from a poll of men contacting anti-circumcision organisations, and may not be representative of the wider population. The full text of the poll is available at[http://www.noharmm.org/bju.htm]). Special consideration of these factors are important when deciding whether or not to restore, and what devices are appropriate.


Some men report a visually smoother [[glans]], which they attribute to decreased levels of [[keratin|keratinization]] following restoration. However, a study that investigated the effect of glans coverage on levels of keratinisation found no difference in keratin levels between the the glans of both circumcised and uncircumcised penises [http://www.circs.org/library/szabo/index.html] within the group studied.
A study that investigated the effect of glans coverage on levels of keratinisation found no difference in keratin levels between the the glans of both circumcised and uncircumcised penises [http://www.circs.org/library/szabo/index.html] within the group studied. There is some anecdotal evidence from those who have restorered that over time their glans penis appears visually smoother but there is no scientific finding to confirm this reported phenomenon.


A research study conducted by Bleustein, Eckholdt, Arezzo, and Melman found no significant differences in glans sensation between circumcised and uncircumcised men with respect to vibration, spatial perception, pressure, warm and cold thermal thresholds [http://www.circs.org/library/bleustein/index.html]. An earlier study by Masters and Johnson also found no difference in sensitivity.[http://www.circs.org/library/masters/index.html] However, some men have reported a qualitative improvement in sensitivity of the glans, but it has been suggested that the perceived increase in glans sensitivity is psychological, the result of the placebo effect, with actual glans sensitivity being unaffected[http://www.circs.org/library/kirby/index.html][http://www.circs.org/library/waskett/index.html].
A research study conducted by Bleustein, Eckholdt, Arezzo, and Melman found no significant differences in glans sensation between circumcised and uncircumcised men with respect to vibration, spatial perception, pressure, warm and cold thermal thresholds [http://www.circs.org/library/bleustein/index.html]. An earlier study by Masters and Johnson also found no difference in sensitivity.[http://www.circs.org/library/masters/index.html] However, some men have reported a qualitative improvement in sensitivity of the glans, but it has been suggested that the perceived increase in glans sensitivity is psychological, the result of the placebo effect, with actual glans sensitivity being unaffected[http://www.circs.org/library/kirby/index.html][http://www.circs.org/library/waskett/index.html].

Revision as of 07:59, 16 January 2005

Foreskin restoration is the process of restoring the foreskin (prepuce), or creating the appearance of a foreskin, usually in a man who has previously undergone circumcision.

While the aim of foreskin restoration is to create "the look" of being uncircumcised a number of reasons are put forward by those who have embarked on restoring some of which are due to the promise of improved sensitivity by foreskin restoration groups, a desire to appear "natural," to regain a sense of control over their own bodies, or because of views against circumcision. Some believe that this decision may be symptomatic of an underlying mental and/or emotional disorder,[1][2]or inherent sexual dysfunction and others cite influence by anti-circumcision organisations as a possible factor [3]. However, Boyle et al., suggests circumcision as the source of many emotional disorders.[4][5], and suggests that uncircumcision is the logical treatment. Boyle and others' position supports the findings of Hammond's poll that a proportion of those circumcised men who choose to undergo foreskin restoration have emotional, psychological, and psychiatric problems, that anti-circumcision advocates such as Hammond, Boyle, Bensley, Goldman, & colleagues associate with circumcision.[6][7][8]

Some men undertake restoration with the assistance of support groups who share information and ideas. Promotion and support groups are now active in several nations.

Some believe foreskin restoration should be delayed until physical development is completed at around 18 years of age.

History

A form of foreskin restoration, historically known as epispasm, was practiced among some Jews in Hellenistic and Roman societies.[9]

European Jews, along with men circumcised for medical reasons, sought out underground foreskin restoration operations during World War II as a method to escape Nazi persecution.[10]

The practice was revived in the late twentieth century using modern materials and techniques.[11] The development of the T-Tape in the 1990's has enabled the process to take place more rapidly.

Surgical procedures have been developed to create a foreskin but these have been largely abandoned in favour of non-surgical restoration, which is generally believed to produce more satisfactory results without complications, and at low expense.

Surgical techniques

Surgical methods of foreskin restoration, sometimes known as foreskin reconstruction, usually involve some method of grafting skin and/or mucous membrane taken from elsewhere on the body, typically the scrotum, onto the distal portion of the penis. Another method involves a four stage procedure in which the penile shaft is buried in the scrotum for a period of time(1). Such techniques have produced some satisfactory results, but many men have experienced serious complications.

Nonsurgical techniques

Nonsurgical methods of foreskin restoration are performed by means of stretching the skin, dartos muscle, and mucous membrane covering the shaft of the penis to stimulate new growth. The process may take several years to complete, and varying degrees of success have been reported.

The most common method of restoring the foreskin is by stretching and using tape to hold the skin in place. The tape can be attached to an elastic strap to apply tension to the skin, directing the skin and remnant of inner mucosa over the glans. Specialized devices that grip the skin without tape are also commercially available. The tension level of any device should never cause pain or discomfort. This is often the limiting factor in tissue expansion, since there is a risk of damaging tissues by use of excessive tension.

The 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 muscle is called the dartos, which normally holds the foreskin closed. This portion is removed in the majority of circumcisions and cannot be regrown with known non-surgical techniques, so the covering acheived usually looser than that of a natural foreskin. According to some observers, however, it is difficult to distinguish a restored foreskin from a natural foreskin because restoration produces a "nearly normal-appearing prepuce" [12].

Nonsurgical foreskin restoration does not restore the frenulum or the ridged band. Although not commonly performed, there are surgical "touch-up" techniques that can re-create some of the functionality of the frenulum and dartos muscle. Some of the techniques require tissue removal. Restoring men sometimes choose only the non-surgical options with the understanding that there is simply less risk involved, and that natural regenerative processes could be more effective.

Several manufacturers have created ingenious devices to aid in applying tension to the residual skin. Their products are offered on the Internet.

Physical Aspects

According to Taylor, a pathologist and anti-circumcision activist, and colleagues, the foreskin comprises over half of the skin and mucosa of the human penis [13]. Taylor himself, when asked to comment on foreskin restoration, during an interview with fellow anti-circumcision advocate Lawrence Barichello, of Intact Canada, stated:

"... I think it's a loser, if you've lost that specialized mucosa, you know, just stretching the rest of the skin doesn't compensate."[14]

The goal of restoration is usually to provide coverage of the glans by the restored "foreskin." Tissue stretching has long been known to stimulate mitosis, and some research shows that regenerated human tissues have many of the attributes of the original tissue [15] although whether this is true in the case of foreskin restoration has yet to be ascertained.

In some men, foreskin restoration may alleviate perceived or sometimes real problems, including 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 figures are taken from a poll of men contacting anti-circumcision organisations, and may not be representative of the wider population. The full text of the poll is available at[16]). Special consideration of these factors are important when deciding whether or not to restore, and what devices are appropriate.

A study that investigated the effect of glans coverage on levels of keratinisation found no difference in keratin levels between the the glans of both circumcised and uncircumcised penises [17] within the group studied. There is some anecdotal evidence from those who have restorered that over time their glans penis appears visually smoother but there is no scientific finding to confirm this reported phenomenon.

A research study conducted by Bleustein, Eckholdt, Arezzo, and Melman found no significant differences in glans sensation between circumcised and uncircumcised men with respect to vibration, spatial perception, pressure, warm and cold thermal thresholds [18]. An earlier study by Masters and Johnson also found no difference in sensitivity.[19] However, some men have reported a qualitative improvement in sensitivity of the glans, but it has been suggested that the perceived increase in glans sensitivity is psychological, the result of the placebo effect, with actual glans sensitivity being unaffected[20][21].

Emotional, psychological, and psychiatric aspects

Foreskin restoration has been reported as having beneficial results in some men who have exiisting emotional problems, and has been proposed as a treatment for negative feelings in some adult men which they see as resulting from their circumcision (see Penn, Greer, Goodwin, and Boyle et al.. Such claims are not supported by all medical authorities, however.

Negative feelings were discussed in the poll mentioned above. Respondents reported to suffer from: emotional distress, manifesting as intrusive thoughts about one’s circumcision, including feelings of mutilation (60%), low self-esteem/inferiority to intact men (50%), genital dysmorphia (55%), rage (52%), resentment/depression (59%), violation (46%), or parental betrayal (30%). Many respondents (41%) reported that their physical/emotional suffering impeded emotional intimacy with partner(s), resulting in sexual dysfunction. Almost a third of respondents (29%) reported dependence on substances or behaviors to relieve their suffering (tobacco, alcohol, drugs, food and/or sexual compulsivity).

In "Prepuce Restoration Seekers: Psychiatric Aspects," a 1981 study published in the Archives of Sexual Behavior, four case study subjects seeking surgical foreskin restoration were examined. The studies provide examples of the psychiatric motivational forces behind the desire for foreskin restoration among some men (see full text at (Mohl et al)). Mohl reported that foreskin restoration may have value in treating people with such psychosexual psychiatric problems:

"Our curiosity led to empathy for the discomfort felt by these patients, discomfort largely relieved by the foreskin restoration in the four we accepted for surgery."[22]

Boyle et al. suggest that: "Some men who have undergone foreskin restoration have reported ... a lessening of associated negative emotions."[23] Penn reported, "The result was satisfactory physically and the patient was completely rehabilitated psychologically."[24]

See also

Books

  • "Decircumcision: Foreskin Restoration, Methods and Circumcision Practices" by Gary M. Griffin, ISBN 1879967057.
  • "The Joy of Uncircumcising!: Exploring Circumcision: History, Myths, Psychology, Restoration, Sexual Pleasure, and Human Rights" by Jim Bigelow and James L. Snyder, ASIN 093406122X
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