Foreskin restoration is the process of expanding the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

on the

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males d ...

to reconstruct an organ similar to the

foreskin 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 ...

, which has been removed by

circumcision 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. Top ...

or injury. Foreskin restoration is primarily accomplished by stretching the residual skin of the penis, but

surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

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.

History

In the

Greco-Roman world The Greco-Roman civilization (; also Greco-Roman culture; spelled Graeco-Roman in the Commonwealth), as understood by modern scholars and writers, includes the geographical regions and countries that culturally—and so historically—were dir ...

intact

genital A sex organ (or reproductive organ) is any part of an animal or plant that is involved in sexual reproduction. The reproductive organs together constitute the reproductive system. In animals, the testis in the male, and the ovary in the female, a ...

s, including the

, were considered a sign of beauty,

civility Civility comes from the word ''civis'', which in Latin means "citizen". Merriam Webster defines civility as civilized conduct (especially: courtesy or politeness) or a polite act or expression. Historically, civility also meant training in the hum ...

, and masculinity. 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 In Classical antiquity, the Hellenistic period covers the time in Mediterranean history after Classical Greece, between the death of Alexander the Great in 323 BC and the emergence of the Roman Empire, as signified by the Battle of Actium in ...

ideal of gymnastic nudity. Men with short foreskins would wear the

kynodesme A kynodesmē (, English translation: "dog tie") was a cord or string or sometimes a leather strip that was worn primarily by athletes in Ancient Greece and Etruria to prevent the exposure of the glans penis in public (considered to be ill-manner ...

to prevent exposure. As a consequence of this social stigma, an early form of foreskin restoration known as ''epispasm'' was practiced among some

Jews Jews ( he, יְהוּדִים, , ) or Jewish people are an ethnoreligious group and nation originating from the Israelites Israelite origins and kingdom: "The first act in the long drama of Jewish history is the age of the Israelites""The ...

Ancient Rome In modern historiography, ancient Rome refers to Roman people, Roman civilisation from the founding of the city of Rome in the 8th century BC to the collapse of the Western Roman Empire in the 5th century AD. It encompasses the Roman Kingdom ...

(8th century BC to 5th century AD). Foreskin restoration is of ancient origin and dates back to the reign of the Roman Emperor

Tiberius Tiberius Julius Caesar Augustus (; 16 November 42 BC – 16 March AD 37) was the second Roman emperor. He reigned from AD 14 until 37, succeeding his stepfather, the first Roman emperor Augustus. Tiberius was born in Rome in 42 BC. His father ...

(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 or a completely exposed glans as a result of

. Again, during

World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...

some

European Jew The history of the Jews in Europe spans a period of over two thousand years. Some Jews, a Judaean tribe from the Levant, Natural History 102:11 (November 1993): 12–19. migrated to Europe just before the rise of the Roman Empire. A notable ...

s sought foreskin restoration to avoid Nazi persecution.

Non-surgical techniques

Tissue expansion

Non-surgical foreskin restoration, accomplished through

tissue expansion Tissue may refer to: Biology * Tissue (biology), an ensemble of similar (or dissimilar in structure but same in origin) cells that together carry out a specific function * ''Triphosa haesitata'', a species of geometer moth ("tissue moth") found i ...

, is the more commonly used method. Tissue expansion has long been known to stimulate

mitosis In cell biology, mitosis () is a part of the cell cycle in which replicated chromosomes are separated into two new nuclei. Cell division by mitosis gives rise to genetically identical cells in which the total number of chromosomes is maintai ...

, and research shows that regenerated human tissues have the attributes of the original tissue.

Methods and devices

During restoration via tissue expansion, the remaining penile skin is pulled forward over the glans, and

tension Tension may refer to: Science * Psychological stress * Tension (physics), a force related to the stretching of an object (the opposite of compression) * Tension (geology), a stress which stretches rocks in two opposite directions * Voltage or el ...

is maintained either manually or through the aid of a foreskin restoration device. Many specialized foreskin restoration devices that grip the skin with or without tape are also commercially available. Tension from these devices may be applied by weights, elastic straps, or inflation as a means to either push the skin forward on the penis, or by a combination of these methods. 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 Grafting or graftage is a horticultural technique whereby tissues of plants are joined so as to continue their growth together. The upper part of the combined plant is called the scion () while the lower part is called the rootstock. The succ ...

skin onto the

distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

portion of the penile shaft. The grafted skin is typically taken from the

scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum co ...

, which contains the same

smooth muscle Smooth muscle is an involuntary non- striated muscle, so-called because it has no sarcomeres and therefore no striations (''bands'' or ''stripes''). It is divided into two subgroups, single-unit and multiunit smooth muscle. Within single-unit ...

(known as

dartos fascia The dartos fascia or simply dartos is a layer of connective tissue found in the penile shaft, foreskin, scrotum and labia. The penile portion is referred to as the superficial fascia of penis or the subcutaneous tissue of penis, while the scrotal ...

) 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. The

frenulum A frenulum (or frenum, plural: frenula or frena, from the Latin ''frēnulum'', "little bridle", the diminutive of ''frēnum'') is a small fold of tissue that secures the motion of a mobile organ in the body. In human anatomy Frenula on the h ...

can also be reconstructed.

British Columbia British Columbia (commonly abbreviated as BC) is the westernmost province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include rocky coastlines, sandy beaches, for ...

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.

Results

Time required

The amount of time required to restore a foreskin using non-surgical methods depends on the amount of skin present at the start of the process, the subject's degree of commitment, the techniques used, the body's natural degree of plasticity, and the length of foreskin the individual desires. The results of surgical restoration are immediate, but often described as unsatisfactory and most restoration groups advise against surgery.

Physical aspects

Restoration creates a facsimile of the prepuce, but specialized tissues removed during circumcision cannot be reclaimed. Surgical procedures exist to reduce the size of the opening once restoration is complete (as depicted in the image above), or it can be alleviated through a longer commitment to the skin expansion regime to allow more skin to collect at the tip. The natural foreskin is composed of smooth dartos muscle tissue (called the ''peripenic muscle''), large blood vessels, extensive innervation, outer skin, and inner mucosa. The natural foreskin has three principal components, in addition to

blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide awa ...

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the ...

s, and

connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...

: skin, which is exposed exteriorly;

mucous membrane A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It i ...

, which is the surface in contact with the

glans penis In male human anatomy, the glans penis, 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 their primary anatomical source of sexual pl ...

when the

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". 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. In some men, foreskin restoration may alleviate certain problems they attribute to their circumcision. Such problems include prominent

scarring A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...

(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 had a great loss of sensation in the glans because his foreskin was not present.

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 that someone else decided to have performed on them.

Organizations

Various groups have been founded since the late 20th century, especially in

North America North America is a continent in the Northern Hemisphere and almost entirely within the Western Hemisphere. It is bordered to the north by the Arctic Ocean, to the east by the Atlantic Ocean, to the southeast by South America and th ...

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, which was incorporated into NORM in 1994. 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).