Foreskin restoration is the process of restoring, via surgical or other methods, the foreskin (prepuce), usually in a circumcised male. Foreskin restoration techniques may also be used by men who have sustained an injury to the foreskin, or who have a naturally short foreskin (see foreskin stretching ).
Men attempt foreskin restoration for many reasons. Some attempts to restore the foreskin, usually through tissue expansion techniques, are predicated by the expectation of greater sexual sensitivity. Other men have cited a desire to appear "natural," to regain a sense of control over their own bodies, or because of their personal views against circumcision.
Foreskin restoration is attempted mostly by circumcised adult men, sometimes with the assistance of support groups who share information and ideas. Many believe foreskin restoration should be delayed until sexual development is completed at around 18 years of age.
A form of foreskin restoration, historically known as epispasm, was practiced among some Jews in Hellenistic and Roman societies.
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.
The practice was revived in the late twentieth century using modern materials and techniques. The development of the T-Tape in the 1990's has enabled the process to take place more rapidly.
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 tecnniques have generally not produced satisfactory results, with some patients experiencing serious complications.
Nonsurgical methods of foreskin restoration are performed by means of stretching the skin, dartos muscle, and mucous membrane covering the shaft of the penis. The stretching stimulates new growth, but requires patience and dedication; the process may take several years to complete.
Varying degrees of success have been reported by males employing stretching techniques.
The most common method of restoring the foreskin is to use tape to provide adhesion to the skin. The tape can be attached to elastic straps or weights to apply tension to the skin, directing the skin, along with any remnant of inner mucosa, over the glans. Specialized devices that grip the skin without tape are also commercially available. The tension produced by any device used should be adjusted so as to never cause pain or discomfort. This is often the limiting factor in any tissue expansion, since there is a risk of damaging tissues by use of excessive tension.
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 called the dartos, which normally holds the foreskin closed, is 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" .
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.
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 .
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 .
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%) (see poll at NOHARMM).
Some men who have undertaken foreskin restoration report a visually 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 within the group studied.
Although research studies has found no measurable difference with respect to glans sensitivity  , 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. 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.
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 (see Penn, Greer, Goodwin, and circumcision.Boyle et al.. 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 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)).
- "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