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Foreskin restoration

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Foreskin restoration is the process of expanding the skin on the penis, via surgery or stretching methods, to replace the foreskin (prepuce) covering the glans penis. It may be useful for men who have been circumcised, who have a naturally short foreskin, or who have sustained an injury to the foreskin. Males with phimosis may also use techniques similar to non-surgical foreskin restoration to remedy their condition.

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[edit] Surgical techniques

Surgical methods of foreskin restoration, sometimes 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.<ref name="Greer">Greer, Donald M., Mohl, Paul C.; Sheley, Kathy A. (1982). "A technique for foreskin reconstruction and some preliminary results". The Journal of Sex Research 18 (4): 324-30.</ref> Such techniques are costly, and have the potential to produce unsatisfactory results or serious complications related to the skin graft.

Surgical foreskin restoration was recently publicized when British Columbia resident Dr. Paul Tinari spoke with news media about his experience. Following a lawsuit which recovered funding from the British Columbia Ministry of Health, he underwent surgical foreskin restoration, and was satisfied with the results. 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 in the above paragraph.<ref name="Tyee article"> Euringer, Amanda (2006-07-25). "BC Health Pays to Restore Man's Foreskin". The Tyee.</ref><ref name="NRM article">Laliberté, Jennifer (2006-06-30). "BC man's foreskin op a success". National Review of Medicine 3 (12).</ref>

[edit] Nonsurgical techniques

Nonsurgical foreskin restoration, accomplished through tissue 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 either manually, by using weights, or by using elastic straps. In the second two cases the problem of attaching a device to the skin arises, for which there are different solutions. Surgical tape may be used to attach weights to the skin, or to attach an elastic strap. 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 that grip the skin with or without tape are also commercially available. Tension from these devices may be applied by weights or elastic straps, or by pushing the skin forward on the penis.

The amount of tension produced by any method should be adjusted so as to never cause pain or discomfort, and may be seen as a limiting factor in foreskin restoration. There is a risk of damaging tissues from use of excessive amounts of 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<ref name="NORM regimen">Griffiths, R. Wayne. NORM - Recommended Restoration Regimen. Retrieved on 2006-08-27.</ref>, to recommending periods of higher tension applied for only a few minutes per day.<ref name="FRC manual">Foreskin Restoration Chat Manual Restoration Method and Guide. Retrieved on 2006-08-27.</ref><ref name="Doug's site">Manual Methods of Foreskin Restoration. Retrieved on 2006-08-27. </ref>

Tissue stretching has long been known to stimulate mitosis, and research shows that regenerated human tissues have the attributes of the original tissue.<ref name="Cordes">Cordes, Stephanie, Calhoun, Karen H.; Quinn, Francis B. (1997-10-15). "Tissue Expanders". University of Texas Medical Branch Department of Otolaryngology Grand Rounds.</ref> Unlike conventional skin expansion techniques, however, the process of nonsurgical foreskin restoration may take several years to complete, and 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 often 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.

[edit] Reasons for foreskin restoration

Men attempt foreskin restoration for many reasons. Some attempts to restore the foreskin, usually through tissue expansion techniques, are aimed at improving sexual sensation. Restoring the foreskin can help protect the glans from daily abrasion from clothes, and so some men choose to restore for increased comfort. Other men have cited a desire to appear natural, or to regain a sense of control over their sexual organs.

Foreskin restoration is attempted mostly by circumcised adult men, sometimes with the assistance of support groups who share information and ideas. Some websites recommend that foreskin restoration be delayed until sexual development is completed in the late teenage years.

[edit] 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 to prevent its accidental exposure.

A form of foreskin restoration, historically known as epispasm, was practiced among some Jews in Hellenistic and Roman societies.<ref name="Rubin">Rubin, Jody P. (1980-07). "Celsus's Decircumcision Operation". Urology 16 (1): 121-4.</ref>

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.<ref name="Tushmet">Tushmet, Leonard (1965). "Uncircumcision". Medical Times 93 (6): 588-93.</ref>

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. <ref name="Bigelow - uncirc">Bigelow, Jim (1994). "Uncircumcising: undoing the effects of an ancient practice in a modern world". Mothering Summer: 121-4.</ref>

The National Organization of Restoring Men (NORM) was founded in 1989 in San Francisco, as a non-profit support group for men restoring their foreskins. It was originally known as RECAP, an acronym for the phrase Recover A Penis. In 1994 UNCIRC was incorporated into this group.<ref name="NORM history">Griffiths, R. Wayne. NORM - History. Retrieved on 2006-08-21.</ref> 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.(See NORM Locations worldwide)

[edit] Physical aspects

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 often completely removed in the majority of circumcisions and cannot be regrown, so the covering achieved via stretching techniques is 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."<ref name="Goodwin">Goodwin, Willard E. (1990). "Uncircumcision: A Technique For Plastic Reconstruction of a Prepuce After Circumcision". Journal of Urology 144: 1203-5.</ref>

Nonsurgical 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 [1].

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 (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."<ref name="Hammond">Hammond, T. (1999). "A Preliminary Poll of Men Circumcised in Infancy or Childhood" (PDF). BJU International 83 (Suppl. 1): 85-92.</ref>

Foreskin restoration can be a means for man (and his sexual partner) to experience the rolling and gliding action of the penile shaft skin along the erect shaft. This mode of stimulation is not available to circumcised men without restoration.

Some men who have undertaken foreskin restoration report a visibly smoother glans, which they attribute to decreased levels of keratinization following restoration. However, a study that investigated the effect of glans coverage on levels of keratinisation found no difference in keratin levels[2] within the group studied.

Although research studies have found no measurable difference with respect to glans sensitivity [3] [4], some men have reported a qualitative improvement in sensitivity of the glans. Some have suggested that the perceived sensitivity gains of the glans are psychological, with glans sensitivity itself being unaffected[5][6]. According to some, however, protecting the glans from dryness and abrasion with clothing can allow the glans texture to change to a quality similar to that of intact genitalia among men who undergo this process.

[edit] 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.<ref name="Greer"/><ref name="Penn">Penn, Jack (1963). "Penile Reform". British Journal of Plastic Surgery 16: 287-8.</ref><ref name="Goodwin"/><ref name="Boyle">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.</ref> Such claims are not supported by all medical authorities, however.

Such negative feelings were discussed in the poll mentioned above. Respondents suffered 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 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 men.<ref name="Mohl">Mohl, PC, Adams R, Greer DM, Sheley KA (1982). "Prepuce restoration seekers: psychiatric aspects". Archives of Sexual Behavior 10: 383-93.</ref>

[edit] See also

[edit] Notes

<references/>

[edit] Books

  • 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)

[edit] External links

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