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'''Lipodermos''' (λιποδερμος, lit. "lacking [[skin]]") is an ancient Greek medical disease concept which describes a [[penis ]] with little or no [[foreskin]].<ref name="hodges2001">{{REFjournal
|last=Hodges
|init=FM
|issue=3
|page=375
}}</ref><ref>Pseudo-Galen, but presented as Galen in ''Definitiones medicae'' 164, in Kühn, MG (n. 9), 19: 445. See Jutta Kollesch, ''Untersuchungen zu den pseudogalenischen Definitiones Medicae'' (Berlin: Akademie-Verlag, 1973).</ref> The Greeks valued a longer prepuce, and pathologized the state of having a deficient prepuce, especially one that has been surgically ablated (i.e. circumcised).<ref name="hodges2001" /> It must be remembered that this medical conceptualization happened in the historical context of the legal efforts to abolish [[Brit Milah| ritual circumcision ]] throughout the Seleucid and Roman empires.<ref name="hodges2001" />
== Treatment of Lipodermos ==
=== Medicinal treatment ===
In his Materia medica, Dioscorides of Anazarbus (41–68 C.E.) suggested that the prepuce could be made supple to allow it to stretch by soaking it in honey and warm water repeatedly, provided the lipodermic condition not be due to circumcision.<ref>Dioscorides, ''De materia medica'' 2.82.2, in ''Pedanii Dioscuridis Anazarbei De materia medica'', ed. Max Wellmann, 3 vols. (Berlin: Weidmann, 1907), 1: 166.</ref> Dioscorides also recommended herbal treatment with the rubefacient plant thapsia (T. garganica). This plant was said to have the property of augmenting the volume of the parts onto it was applied, again, provided the condition was congenital and not the result of [[circumcision]].<ref>Ibid. 4.153.4–5 (Wellmann, 2: 300).</ref> Galen also advocated the use of thapsia and hinted that there were several topical preparations that were helpful for the treatment of lipodermic men.<ref>Galen, ''De compositione medicamentorum per genera'' 7.7 (Kühn, MG [n. 9], 13: 985).</ref>
=== Stretching ===
In ancient Greece, athletes or komasts used preputial ligature to keep the prepuce covering the [[glans ]] of the penis, as its exposure was seen as rude and vulgar (see [[kynodesme]]). The Ephesian physician Soranus, who lived under the reigns of Trajan and Hadrian (98–138 C.E.) indicates that there was a wider use of a ligature and a more general cultural diffusion of the concept of lipodermos. In his work ''Gynecology'', Soranus justifies the medically prescribed stretching of the [[foreskin ]] by an appeal to aesthetics. He advises wet nurses to massage the newborn child periodically, and to pay particular attention to performing manipulations designed to improve the appearance of the congenitally lipodermic penis:
''"If the male neonate appears to be lipodermic, [the wet nurse] should gently draw the [[Acroposthion| akroposthion ]] forward or even hold it together with a strand of wool to fasten it. If gradually stretched and continuously drawn forward, it easily stretches and assumes its normal length, covers the glans penis and becomes accustomed to keep [a] natural good shape.''<ref>Soranus, ''Gynaeciorum'' 2.36.103.20–25, in ''Sorani Gynaeciorum libri IV'', ed. Johannes Ilberg (''CMG'', IV)(Leipzig: Teubner, 1927), p. 79; translation adapted from Owsei Temkin, trans., ''Soranus' Gynecology'' (Baltimore: Johns Hopkins Press, 1956), p. 107.</ref>
Preserved in their original setting in De methodo medendi,<ref>Galen, ''De methodo medendi'' 14.16 (Kühn, MG [n. 9], 10: 1000–1001).</ref> Galen's nonsurgical methods of elongating the prepuce involve different applications of traction and tension. The abridged account of Galen's exposition that appears in Oribasius's compilation states:
:''"And, if the glans is bare and the man wishes for the look of the thing to have it covered, that can be done; but more easily in a boy than in a man; in one in whom the defect is natural, than in one who after the custom of certain races has been circumcised; and in one who has the glans small and the adjacent [[skin]] rather ample, while the penis itself is shorter, rather than in one in whom the conditions are contrary.''
:''Now the treatment for those in whom the defect is natural is as follows. The prepuce around the glans is seized, stretched out until it actually covers the glans, and there tied. Next the [[skin]] covering the [[penis ]] just in front of the pubes is cut through in a circle until the penis is bared, but great care is taken not to cut into the [[urethra]], nor into the blood vessels there. This done the prepuce slides forwards towards the tie, and a sort of small ring is laid bare in front of the pubes, to which lint is applied in order that flesh may grow and fill it up. <It is seen that a large enough part of the penis has been bared, if the [[skin]] is distended little or not at all, and if> the breadth of the wound above supplies sufficient covering. But until the scar has formed it must remain tied, only a small passage being left in the middle for the [[urine]]. But in one who has been circumcised the prepuce is to be raised from the underlying penis around the circumference of the glans by means of a scalpel. This is not so very painful, for once the margin has been freed, it can be stripped up by hand as far back as the pubes, nor in so doing is there any bleeding. The prepuce thus freed is again stretched forwards beyond the glans; next cold water affusions are freely used, and a plaster is applied round to repress severe inflammation. And for the following days the patient is to fast until nearly overcome by hunger lest satiety excite that part. When the inflammation has [Page 399] ceased, the penis should be bandaged from the pubes to the corona; over the glans the plaster is applied with the other end of the probe. This is done in order that the lower part may agglutinate, whilst the upper part heals without adhering."''<ref>Ibid. (Spencer, 3: 421–23)(angle brackets in original).</ref>
In addition to the surgical technique outlined by Celsus, the compilations of Paul of Aegina and Oribasius contain abridged accounts of a similar surgical treatment, originally from the Cheirourgoumena (preserved only in fragments), a lost work by Antyllus, a second-century C.E. Greek physician.<ref>Paul of Aegina, 6.53 (Heiberg [n. 36 ], 2: 94)-—a greatly abridged account; ''Antyllus apud Oribasium'' 50.1–2 (Raeder, ''OCMR'' [n. 36 ], 4: 55–56).</ref> Unlike Celsus, Antyllus freely uses the term lipodermos, but like Celsus, he stresses that this operation is of little value in circumcision-caused lipodermos. In a brief commentary, however, Paul of Aegina voices his disapproval of Antyllus's operation, expressing his doubt that anyone would choose to submit to its dangers.
{{SEEALSO}}
* [[Acroposthion]]
* [[Aposthia]]
* [[Foreskin]]