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Foreskin restoration

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Foreskin stretching (called "uncircumcision," or epispasm) appears to have been a common practice among Hellenized Jewish men in Hellenistic and Roman societies,<ref name="Rubin">{{REFjournal
| last=Rubin | first=Jody P. | coauthors= | title=Celsus's Decircumcision Operation | journal=Urology | volume=16 | issue=1 | pages=121-4 | url=http://www.cirp.org/library/restoration/rubin/ | quote= | pubmedID=6994325 | pubmedCID= | DOI=10.1016/0090-4295(80)90354-4 | date=1980-07 | accessdate=
}}</ref> from at least as early as the 2nd century BCE.<ref>{{REFbook
|last=Glick
Key features of Hellenistic culture were athletic exercises in gymnasia and athletic performances in public arenas, where men appeared in the nude. While the penis sheathed in an intact foreskin was normal and acceptable, ancient Greeks and their Hellenistic successors considered the circumcised penis to be offensive, as it was perceived as a vulgar imitation of erection, unfit for public display. The ancient Greeks and their Hellenistic successors considered the "ideal prepuce" to be long, tapered, and "well-proportioned." Removing it was considered mutilation. Men with short foreskins, a condition known as lypodermos, would wear a leather cord called a kynodesme to prevent its accidental exposure.<ref>{{REFjournal
| last=Hodges | first=Frederick M. | coauthorsauthor-link=Frederick M. Hodges | title=The Ideal Prepuce in Ancient Greece and Rome: Male Genital Aesthetics and Their Relation to Lipodermos, Circumcision, Foreskin Restoration, and the Kynodesme | journal=Bulletin of the History of Medicine | date=Fall 2001 | volume=75 | issue=3 | pages=375-405 | url=http://www.cirp.org/library/history/hodges2/ | quote= | pubmedID=11568485 | pubmedCID= | DOI= | accessdate=2019-09-30
}}</ref>
During World War II, some European Jews sought out underground foreskin restoration operations as a way to escape Nazi persecution.<ref name="Tushmet">{{REFjournal
| last=Tushmet | first=Leonard | coauthors= | title=Uncircumcision | journal=Medical Times | volume=93 | issue=6 | pages=588-93 | url=http://www.cirp.org/library/restoration/tushmet1/ | quote= | pubmedID= | pubmedCID= | DOI= | date=1965 | accessdate=
}}</ref>
|first=Jim
|author-link=Jim Bigelow
|coauthors=
|title=Uncircumcising: undoing the effects of an ancient practice in a modern world
|journal=Mothering
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|dartos fascia]]) as does the skin of the penis. One method involves a four stage procedure in which the shaft is buried in the scrotum for a period of time.<ref name="Greer">{{REFjournal
| last=Greer | first=Donald M. | coauthorslast2=Mohl, |first2=Paul C.; |last3=Sheley, |first3=Kathy A. | title=A technique for foreskin reconstruction and some preliminary results | journal=The Journal of Sex Research | volume=18 | issue=4 | pages=324-30 | url=http://www.cirp.org/library/restoration/greer1/ | quote= | pubmedID= | pubmedCID= | DOI=10.1080/00224498209551158 | date=1982 | accessdate=
}}</ref> 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, 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.<ref name="Tyee article">{{REFjournal
| last=Euringer | first=Amanda | coauthors= | title=BC Health Pays to Restore Man's Foreskin | journal=The Tyee | volume= | issue= | pages= | url=http://thetyee.ca/News/2006/07/25/Circumcision/ | quote= | pubmedID= | pubmedCID= | DOI= | date=2006-07-25 | accessdate=
}}</ref><ref name="NRM article">{{REFjournal
| last=Laliberté | first=Jennifer | coauthors= | title=BC man's foreskin op a success | journal=National Review of Medicine | volume=3 | issue=12 | pages= | url=http://www.nationalreviewofmedicine.com/issue/2006/06_30/3_patients_practice01_12.html | quote= | pubmedID= | pubmedCID= | DOI= | date=2006-06-30 | accessdate=
}}</ref>
Applying tension to tissue has long been known to stimulate [[mitosis]], and research shows that expanded human tissues have the attributes of the original tissue.<ref name="Cordes">{{REFjournal
| last=Cordes | first=Stephanie | coauthorslast2=Calhoun, |first2=Karen H.; |last3=Quinn, |first3=Francis B. | title=Tissue Expanders | journal=University of Texas Medical Branch Department of Otolaryngology Grand Rounds | volume= | issue= | pages= | url=http://www.utmb.edu/otoref/Grnds/tissue-expand.html | quote= | pubmedID= | pubmedCID= | DOI= | date=1997-10-15 | accessdate=
}}</ref> 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.
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.<ref>{{REFjournal
| last= | first= | coauthors= | title=Foregen | journal= | volume= | issue= | pages= | url=http://www.foregen.org/blog/?p=84 | quote= | pubmedID= | pubmedCID= | DOI= | date=2010-09-21 | accessdate=2010-11-28
}}</ref>
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.<ref>{{REFjournal
| last= | first= | coauthors= | title=Clinical Regen Trial | journal= | volume= | issue= | pages= | url=http://www.foregen.org/projects/ | quote= | pubmedID= | pubmedCID= | DOI= | date=June 23, 2010 | accessdate=2010-06-23
}}</ref>
In 2018, Foregen announced the creation of a "decellularized extracellular matrix–based biomaterial scaffold" for the purpose of regenerating human foreskin.<ref>{{REFjournal
| last=Purpura | first=V. | coauthorslast2=Bondioli |first2=E, . |last3=Cunningham EJ, ''et al'' |first3=E.J. |etal=yes | title=The development of a decellularized extracellular matrix–based biomaterial scaffold derived from human foreskin for the purpose of foreskin reconstruction in circumcised males | journal=Journal of Tissue Engineering | date=2018 | volume=9 | issue= | pages=1-11 | url=https://journals.sagepub.com/doi/full/10.1177/2041731418812613 | quote= | pubmedID=30622692 | pubmedCID=PMC6304708 | DOI=10.1177/2041731418812613 | accessdate=2019-09-25
}}</ref>
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."<ref name="Goodwin">{{REFjournal
| last=Goodwin | first=Willard E. | coauthors= | title=Uncircumcision: A Technique For Plastic Reconstruction of a Prepuce After Circumcision | journal=J Urol | volume=144 | issue=5 | pages=1203-51205 | url=http://www.cirp.org/library/restoration/goodwin1/ | quote= | pubmedID=2231896 | pubmedCID= | DOI= | date=1990 | accessdate=
}}</ref>
The process of foreskin restoration seeks to regenerate some of the tissue removed by circumcision by expansion of residual tissue, 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.<ref>{{REFjournal
| last=Taylor | first=JRJ.R. |author-link=John R. Taylor | coauthorsfirst2=A.P. |last2=AP Lockwood, AJ |first3=A.J. |last3=Taylor | title=The prepuce: Specialized mucosa of the penis and its loss to circumcision | journal=Brit J Urol | date=1996-02-01 | volume=77 | issue= | pages=291-5 | url=http://www.cirp.org/library/anatomy/taylor/ | quote= | pubmedID= 8800902 | pubmedCID= | DOI=10.1046/j.1464-410x.1996.85023.x | accessdate=
}}</ref>
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 [[Circumcision scar|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">{{REFjournal
| last=Hammond | first=T. | coauthorsauthor-link=Tim Hammond | title=A Preliminary Poll of Men Circumcised in Infancy or Childhood | journal=BJU Int | volume=83 | issue=Suppl. 1 | pages=85-92 | url=http://www3.interscience.wiley.com/cgi-bin/fulltext/119091408/PDFSTART | quote= | pubmedID=10349419 | pubmedCID= | DOI=10.1046/j.1464-410x.1999.0830s1085.x | date=1999 | accessdate=
}}</ref>
|note=
}} (excerpt accessible [http://www.circs.org/library/masters/ here])</ref><ref name="bleustein">{{REFjournal
| last=Bleustein | first=Clifford B. | coauthorsfirst2=James D. |last2=Fogarty, |first3=Haftan |last3=Eckholdt, |first4=Joseph C. |last4=Arezzo and |first5=Arnold |last5=Melman | title=Effect of neonatal circumcision on penile neurologic sensation | journal=Urology | volume=65 | issue=4 | pages=773-7 | url= | quote= | pubmedID=15833526 | pubmedCID= | DOI=10.1016/j.urology.2004.11.007 | date=April 2005 | accessdate=
}}</ref><ref name = "bleustein2003">{{REFconference
| place=Chicago, Illinois
| accessdate=2019-09-29
}}</ref><ref name="payne2007">{{REFjournal
| last=Payne | first=Kimberley | coauthorslast2=Thaler, |first2=Lea; |last3=Kukkonen, |first3=Tuuli; |last4=Carrier, |first4=Serge; and [[ |last5=Binik |first5=Yitzchak |author5-link=Irving M. Binik|Binik, Yitzchak]] | title=Sensation and Sexual Arousal in Circumcised and Uncircumcised Men | journal=J Sex Med | volume=4 | issue=3 | pages=667-674 | url=http://www.blackwell-synergy.com/doi/abs/10.1111/j.1743-6109.2007.00471.x | quote= | pubmedID= | pubmedCID= | DOI=10.1111/j.1743-6109.2007.00471.x | date=2007-05 | accessdate=2019-09-30
}}</ref>
Others have reported that it is more sensation in intact males.<ref name="sorrels">{{REFjournal
| last=Sorrells | first= | coauthors= | title=Fine-touch pressure thresholds in the adult penis | journal=BJU Int | volume=99 | issue=4 | pages=864-869 | url=http://www3.interscience.wiley.com/cgi-bin/fulltext/118508429/PDFSTART | quote= | pubmedID=1737884 | pubmedCID= | DOI= | date=April 2007 | accessdate=
}}</ref><ref name="yang">{{REFjournal
| last=Yang | first=DMD.M. | coauthorslast2=Lin |first2=H, . |last3=Zhang |first3=B, . |last4=Guo |first4=W. | title=Circumcision affects glans penis vibration perception threshold | journal=Zhonghua Nan Ke Xue | volume=14 | issue=4 | pages=328-330 | url=https://www.researchgate.net/publication/5370953_Circumcision_affects_glans_penis_vibration_perception_threshold | quote= | pubmedID=18481425 | pubmedCID= | DOI= | date=2008-09-14 | accessdate=2019-09-30
}}</ref> It has been suggested that the perceived sensitivity gains of the glans reported by some men are psychological, with glans sensitivity itself being unaffected.<ref>{{REFjournal
| last=Kirby | first=RS | coauthors=R.S. | title=The Joy of Uncircumcising! Restore your birthright and maximize sexual pleasure | journal=BMJ | date=1994-09-10 | volume=309 | issue= | pages=679 | url=http://bmj.bmjjournals.com/cgi/content/full/309/6955/679/a | quote= | pubmedID= | pubmedCID= | DOI=10.1136/bmj.309.6955.679a | accessdate=2019-9-29
}}</ref>
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="Goodwin"/><ref name="Penn">{{REFjournal
| last=Penn | first=Jack | coauthors= | title=Penile Reform | journal=British Journal of Plastic Surgery | volume=16 | issue=287-8 | pages= | url=http://www.cirp.org/library/restoration/penn1/ | quote= | pubmedID=14042759 | pubmedCID= | DOI=10.1016/S0007-1226(63)80123-X | date=1963 | accessdate=2019-09-29
}}</ref><ref name="Boyle">{{REFjournal
| last=Boyle | first=GJG.J. | coauthorslast2=Goldman |first2=R.; |author2-link=Ronald Goldman |last3=Svoboda, |first3=J.S.; |last4=Fernandez, |first4=E. | title=Male Circumcision: Pain, Trauma and Psychosexual Sequelae | journal=Journal of Health Psychology | volume=7 | issue=3 | pages=329-43 | url=http://www.cirp.org/library/psych/boyle6/ | quote= | pubmedID= | pubmedCID= | DOI=10.1177/1359105302007003225 | date=2002 | accessdate=2019-09-29
}}</ref>
* [http://www.iomfats.org/resources/restoring/media/restoring_faq.pdf My responses to a few Frequently Asked Questions about Non-Surgical Foreskin Restoration], Roy M. Payne; Fryer, Leo (2001-03)
* {{REFjournal
| last=Brandes | first=S.B. | coauthorslast2=McAninch, |first2=J.W. | title=Surgical methods of restoring the prepuce: a critical review | journal=BJU Int | volume=83 | issue=Suppl. 1 | pages=109-13 | url=https://onlinelibrary.wiley.com/doi/epdf/10.1046/j.1464-410x.1999.0830s1109.x | quote= | pubmedID=10349422 | pubmedCID= | DOI=10.1046/j.1464-410x.1999.0830s1109.x | date=1999 | accessdate=2019-09-30
}}
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