Foreskin restoration
Encyclopedia
Foreskin restoration is the process of expanding the residual skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

 on the penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...

, via surgical
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...

 or non-surgical methods. It can be performed for several reasons, among them being a desire to create the appearance of a natural foreskin
Foreskin
In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...

 (prepuce) covering the glans penis
Glans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...

, 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
Circumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....

 or who have sustained an injury, but are also used by men who desire a longer foreskin and by men who have phimosis
Phimosis
Phimosis , from the Greek phimos ), is a condition where, in men, the foreskin cannot be fully retracted over the glans penis...

.

History

In classical Greek times the exposure of the glans of the penis was considered offensive and men with short foreskin would wear the kynodesme
Kynodesme
A kynodesme was a thin leather strip worn by some athletes in Ancient Greece to restrain the penis such as to prevent the exposure of the glans. It was tied tightly around the akroposthion, the part of the foreskin that extended beyond the glans...

 to prevent its accidental exposure.

A form of foreskin restoration, historically known as epispasm, was practiced among some Jews
Hellenistic Judaism
Hellenistic Judaism was a movement which existed in the Jewish diaspora that sought to establish a Hebraic-Jewish religious tradition within the culture and language of Hellenism...

 in Hellenistic and Roman
Ancient Rome
Ancient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....

 societies.

Some European Jews sought out underground foreskin restoration operations during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

 as a method to escape Nazi persecution
The Holocaust
The Holocaust , also known as the Shoah , was the genocide of approximately six million European Jews and millions of others during World War II, a programme of systematic state-sponsored murder by Nazi...

.

The practice was revived in the late twentieth 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 techniques

Surgical methods of foreskin restoration, sometimes known as foreskin reconstruction, usually involve a method of grafting
Skin grafting
Skin grafting is a type of graft surgery involving the transplantation of skin. The transplanted tissue is called a skin graft.Skin grafting is often used to treat:*Extensive wounding or trauma*Burns...

 skin onto the distal portion of the penile
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...

 shaft. The grafted skin is typically taken from the scrotum
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...

, which contains the same smooth muscle
Smooth muscle
Smooth muscle is an involuntary non-striated muscle. It is divided into two sub-groups; the single-unit and multiunit smooth muscle. Within single-unit smooth muscle tissues, the autonomic nervous system innervates a single cell within a sheet or bundle and the action potential is propagated by...

 (known as dartos fascia
Dartos
The dartos fascia is a fat-free layer of smooth muscular fiber outside the external spermatic fascia but below the skin. It is a continuation of Scarpa's fascia, which is a membranous layer of the subcutaneous tissue in the abdominal wall...

) 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 eight years old, in what he stated was "a routine form of punishment" for masturbation at residential schools. Following a lawsuit
Lawsuit
A lawsuit or "suit in law" is a civil action brought in a court of law in which a plaintiff, a party who claims to have incurred loss as a result of a defendant's actions, demands a legal or equitable remedy. The defendant is required to respond to the plaintiff's complaint...

 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.

Nonsurgical techniques

Nonsurgical foreskin restoration, accomplished through tissue expansion
Tissue expansion
Tissue expansion is a technique used by plastic and restorative surgeons to cause the body to grow additional skin, bone or other tissues.-Skin expansion:...

, is the more commonly used method of foreskin restoration. 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
Rubber band
A rubber band is a short length of rubber and latex formed in the shape of a loop and is commonly used to hold multiple objects together...

 straps. In the second two cases a device must be attached to the skin; surgical tape
Surgical tape
Surgical tape is a form of pressure-sensitive adhesive tape used in medicine and first aid as a bandage to hold a dressing onto a wound. It will generally have a gentle hypoallergenic adhesive, and be breathable to allow air to reach the skin. Breathable tapes like Kinesiology Tape, and other...

 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
Restoration device
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 technique of tissue expansion, which causes new skin to grow.-History:...

 (like Dual Tension Restorer shown in the picture) that grip the skin with or without tape
Adhesive tape
Adhesive tape is one of many varieties of backing materials coated with an adhesive. Several types of adhesives can be used.-Types:Pressure sensitive 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.

The amount of tension produced by any method must be adjusted to avoid causing injury
Injury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...

, pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 or discomfort, and provides a limit on the rate at which new skin can be grown. There is a risk of 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.

Tissue stretching has long been known to stimulate mitosis
Mitosis
Mitosis is the process by which a eukaryotic cell separates the chromosomes in its cell nucleus into two identical sets, in two separate nuclei. It is generally followed immediately by cytokinesis, which divides the nuclei, cytoplasm, organelles and cell membrane into two cells containing roughly...

, 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.

Artificial foreskins

Instead of growing new skin, some men may opt to use an artificial covering for the glans. Men who have less extreme circumcisions may also be able to use a device to hold the foreskin over the glans (similar to the ancient Greek kynodesme
Kynodesme
A kynodesme was a thin leather strip worn by some athletes in Ancient Greece to restrain the penis such as to prevent the exposure of the glans. It was tied tightly around the akroposthion, the part of the foreskin that extended beyond the glans...

). Viafin-Atlas sells a "prosthetic foreskin" made of latex
Latex
Latex is the stable dispersion of polymer microparticles in an aqueous medium. Latexes may be natural or synthetic.Latex as found in nature is a milky fluid found in 10% of all flowering plants . It is a complex emulsion consisting of proteins, alkaloids, starches, sugars, oils, tannins, resins,...

 that protects the glans in a moist environment. Another product is Manhood. It is an undergarment that holds the skin in place for people who have loose circumcisions. Manhood is also used as a "hood" to protect the circumcised man's exposed glans from chafing and is made of a double layer of soft material. The outer layer chafes against undergarments and minimises friction on the inner layer and consequentally the glans.

Results

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
Ridged band
The term ridged band is a description of an area/band of wrinkly skin toward the end of the foreskin. The term ridged is used to describe the area instead of the more commonly used term "wrinkled". More particularly it refers to the "transitional area from the external to the internal surface ofthe...

, 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.

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, had been founded. A clinical trial had been scheduled for late 2010, but there were insufficient donations to follow through.

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.

Physical aspects

The natural foreskin has three principal components, in addition to blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

s, nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...

s and connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...

: skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

, which is exposed exteriorly; mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...

, which is the surface in contact with the glans penis
Glans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...

 when the penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...

 is flaccid; and a band of muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...

 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. According to some observers it is difficult to distinguish a restored foreskin from a natural foreskin because restoration produces a "nearly normal-appearing prepuce."

Nonsurgical foreskin restoration does not restore portions of the frenulum
Frenulum of prepuce of penis
The word frenulum on its own is often used for the frenulum of prepuce of penis, which is an elastic band of tissue under the glans penis that connects to the prepuce, or foreskin to the vernal mucosa, and helps contract the prepuce over the glans. This is sometimes colloquially known as the "banjo...

 or the ridged band
Ridged band
The term ridged band is a description of an area/band of wrinkly skin toward the end of the foreskin. The term ridged is used to describe the area instead of the more commonly used term "wrinkled". More particularly it refers to the "transitional area from the external to the internal surface ofthe...

 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, as reported to an anti-circumcision group by men circumcised in infancy or childhood, include prominent scarring
Circumcision scar
In males who have been circumcised, the circumcision scar refers to the scar after a circumcision has healed. In some cases, the scar can be darker-colored, and, in all cases, it will encircle the shaft of the penis.-Appearance:...

 (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."

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. A study that investigated the effect of glans coverage on levels of keratinisation found no difference in keratin levels within the group studied.

Several studies have suggested that the glans is equally sensitive in circumcised and uncircumcised males, while others have reported that it is more sensitive in uncircumcised males (the interpretation of one of these studies is disputed). It has been suggested that the perceived sensitivity gains of the glans reported by some men are psychological, with glans sensitivity itself being unaffected.

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.

In "Prepuce Restoration Seekers: Psychiatric Aspects," a 1981 report published in the Archives of Sexual Behavior, four men seeking surgical foreskin restoration were examined. The report provides descriptions of the motivational forces behind the desire for foreskin restoration among these four homosexual men. Schultheiss et al. (1998) are critical of Mohl's report, stating that "loss of prepuce function in sexual activity" is not mentioned, and that in more recent times the majority of the males performing skin-stretching are heterosexual.

Criticism

Kirby notes that some aspects of the debate regarding restoration suffer from a lack of evidence, or are based on anecdotal evidence. He states that restoration procedures are "certainly feasible, but they are not without considerable risks, not least of which is loss of sensation of the penile shaft", and comments that "the placebo effect
Placebo effect
Placebo effect may refer to:* Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work...

 ... cannot be discounted."

See also

  • TLC Tugger
    TLC Tugger
    The TLC Tugger is a tapeless foreskin restoration device invented by Ron Low. The device consists of a silicone 'tugger', retaining cone, and an elastic strap. The silicone tugger is placed against the glans. Skin from the penile shaft or inner skin is then rolled over the tugger. The retaining...

  • NORM-UK
    NORM-UK
    NORM-UK is a British-based charity concerned with foreskin health and matters related to circumcision. It provides information about conservative treatments for foreskin problems including phimosis, non-surgical foreskin restoration, and hosts and participates in conferences about genital...

  • Circumcision
    Circumcision
    Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....

  • Foreskin
    Foreskin
    In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...

  • Foreskin restoration devices
    Restoration device
    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 technique of tissue expansion, which causes new skin to grow.-History:...

  • Penis
    Penis
    The penis is a biological feature of male animals including both vertebrates and invertebrates...

  • Ridged band
    Ridged band
    The term ridged band is a description of an area/band of wrinkly skin toward the end of the foreskin. The term ridged is used to describe the area instead of the more commonly used term "wrinkled". More particularly it refers to the "transitional area from the external to the internal surface ofthe...

  • Phalloplasty
    Phalloplasty
    Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....


External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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