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]

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 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]

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]

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

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]

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]

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]

• Circumcision controversies
• Regeneration in humans
• Restoration device
• Tissue expansion