Changes

'''Foreskin restoration''' refers to the process of expanding the residual [[skin ]] on the [[circumcised ]] [[penis]] by non-surgical means in order to recreate the [[foreskin]] which was removed in [[circumcision]].<ref name="wisdom">{{REFjournal

|author-link=Travis Wisdom

}}</ref> It can also refer to the process of [[Tissue expansion| expanding existing skin]] in a on an [[intact]] [[penis ]] whose foreskin is abnormally short or non-existent (see [[aposthia]]).<ref name="collier2011">{{REFjournal

|accessdate=2023-10-10

Foreskin restoration can be achieved via surgical and/or non-surgical means. Men take up foreskin restoration to restore [[Dekeratinization| sensation]] to the [[glans penis]] and to restore the [[gliding action]] of the natural [[penis]]. Another reason for restoring is a desire to create the natural appearance of an [[intact ]] penis with the [[foreskin]] covering the [[glans penis]]. [[Jim Bigelow]] (1995) listed aesthetics, sensitivity of the glans, sexual stimulation and sexual function of a restored foreskin, and sense of wholeness as reasons that men give for desiring foreskin restoration.<ref>{{REFbook |last=Bigelow |first=Jim |author-link=Jim Bigelow |year=1994 |title=The Joy of Uncircumcising!: Exploring Circumcision: History, Myths, Psychology, Restoration, Sexual Pleasure, and Human Rights |url=https://www.amazon.com/Joy-Uncircumcising-Circumcision-Psychology-Restoration/dp/093406122X |editor= |edition=2 |volume= |chapter=Why Men Today Want to Uncircumcise |pages=113-4 |location= |publisher=Hourglass Book Pub |isbn=978-0934061223}}</ref> Foreskin restoration techniques are most commonly undertaken by men who resent having been [[circumcision|circumcised]] as children, or who have sustained an injury. <ref name="ozer2020">{{REFjournal |last=Özer |first= |init=M |author-link= |last2=Timmermans |first2=Floyd W. |init2=FW |author2-link= |etal=no |title=An insight into circumcised men seeking foreskin reconstruction: a prospective cohort study |trans-title= |language= |journal=Int J Impot Res |location= |date=2020-11 |season= |volume=32 |issue=6 |article= |page= |pages=611-6 |url=https://www.nature.com/articles/s41443-019-0223-y |archived= |quote= |pubmedID=31896833 |pubmedCID= |DOI=10.1038/s41443-019-0223-y |accessdate=2022-10-14}}</ref> They are also used by [[intact ]] men who simply desire a longer [[foreskin]] and by [[regret men]].

=== Ancient history ===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

|location=New York, New YorkNY |publisher={{UNI|Oxford University |Oxon}} Press

|quote=Foreskin [[stretching ]] (called "uncircumcision," or epispasm) appears to have been a common practice among Hellenized Jewish men...

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 a short foreskins[[foreskin]], a condition known as ''lypodermos'', would wear a leather cord called a ''kynodesme'' to prevent its accidental exposure.<ref>{{REFjournal

The sight of [[circumcised ]] genitals at public baths or gymnasia would inspire laughter and ridicule. Jewish men who wished to gain acceptance in the larger social world gave themselves a presentable appearance by pulling the remaining [[foreskin ]] forward as far as possible, and keeping it under enough tension to encourage permanent [[stretching ]] toward its original length. Using a fibular pin or a cord, they pierced the front of the remaining foreskin, drew it forward, and fixed it in place; sometimes they would attach a weight to maintain tension. Over time the foreskin stretched and restored at least some of the appearance of an [[intact ]] organ.<ref>{{REFbook

|location=New York, New YorkNY |publisher={{UNI|Oxford University |Oxon}} Press

}}</ref> Up until the 2th century, [[Jewish circumcision]] involved only partial foreskin removal. Rabbis of the 2th century mandated ''[[Periah| peri’ah]]'', or the complete ablation of the [[foreskin ]] in order to prevent Jewish men from engaging in foreskin restoration.<ref>{{REFbook

|location=New York, New YorkNY |publisher={{UNI|Oxford University |Oxon}} Press

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.<ref name="NORM history">{{REFweb | quote= | url=http://www.norm.org/history.html | title=NORM - History | last=Griffiths | first=R. Wayne | publisherauthor-link=R. Wayne Griffiths | workpublisher= | date=2006 | accessdate=2019-09-30}}</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.

Nonsurgical foreskin restoration is the most commonly used method of foreskin restoration. It is accomplished through [[tissue expansion]] and involves pulling on the remnants of the [[foreskin]]. Both the skin of the penile shaft and the mucosal [[mucosa]]l 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 straps. In the latter two cases a device must be attached to the skin; surgical tape is often used.

[[Image:Tlctugger applied.jpg|thumbnail|left|150px| TLCTugger device applied to a [[circumcised ]] penis for non-surgical foreskin restoration.]]

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 [http://intactwiki.org/wiki/Category:Foreskin_restoration_devices restoration devices] (like the [[TLC-X|TLC Tugger]] shown in the picture) that grip the [[skin ]] with or without 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.

| quote= | url=http://www.norm.org/regimen.html | title=NORM - Recommended Restoration Regimen | last=Griffiths | first=R. Wayne | publisherauthor-link=R. Wayne Griffiths | workpublisher= | date= | accessdate=2006-08-27

| quote= | url=http://foreskinrestorationchat.info/manualtugging.html | title=Foreskin Restoration Chat Manual Restoration Method and Guide | last= | first= | publisher= | work= | date= | accessdate=2006-08-27

| quote= | url=http://pages.suddenlink.net/manual_methods/ | title=Manual Methods of Foreskin Restoration | last= | first= | publisher= | work= | date= | accessdate=2007-07-19

|journal={{UNI|University of Texas Medical Branch |UTMB}} Department of Otolaryngology Grand Rounds

}}</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.

[[Intact ]] men who would like to have a longer [[foreskin ]] may use these same techniques of [[tissue expansion]] to lengthen a short [[foreskin]]. Benefits include improved protection of the [[glans penis]], improved [[gliding action]], and improved physical appearance.

See also: [[Basics of foreskin restoration]]. 

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 by [[tissue expansion]] successfully restores sensitivity to [[glans penis]] and restores the [[gliding action]]. Certain parts of the natural foreskin cannot be reformed. In particular, the [[ridged band]], a nerve-bearing tissue structure extending around the [[penis ]] just inside the tip of the foreskin,<ref name="Taylor interview">{{REFweb | quote= | url=http://www.intact.ca/taylor.html | title=Interview with John Taylor | last=Taylor | first=John R. | publisherinit=JR |author-link=John R. Taylor | workpublisher= | date=1997-02-04 | accessdate=2007-08-26

}}</ref> 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.<ref name=Joy-touchup>{{REFbook

As the [[shaft skin ]] expands and gets longer the [[circumcision scar]] will travel down toward the tip and eventually turn under and be concealed inside the restored foreskin.

When the [[glans penis]] is habitually covered by the regrown foreskin, the increase in protection, plus moisture and oil from [[transudation]] provided by the new [[foreskin ]] will result in [[Keratinization#De-keratinization_treatment| de-keratinization]] of the [[glans penis ]] and increase in sensation.

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 [https://www.thecanadianencyclopedia.ca/en/article/metis-experiences-at-residential-school 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

See also: [[Surgical foreskin restoration]]

The natural foreskin has three principal components, in addition to blood vessels, nerves and connective tissue: [[skin]], which is exposed exteriorely; [[mucous membranemucosa]], which is the inside surface in contact with the [[glans penis]] when the [[penis]] is flaccid; and a layer of [[Dartos| muscle]] fibers under the foreskin. The [[ridged band]] is just inside 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."<ref name="Goodwin">{{REFjournal

Nonsurgical foreskin restoration does not restore portions of the [[Frenulum| frenulum]] or the [[ridged band]] removed excised during [[circumcision]]. Although not commonly performed, there are surgical [http://intactwiki.org/wiki/Category:Foreskin_restoration_touch-up_surgeries "touch-up" techniques] that can re-create some of the functionality of the frenulum and dartos muscle.<ref>{{REFbook

The process of foreskin restoration seeks to regenerate some of the tissue removed by circumcision by [[Tissue expansion| expansion of residual tissue]], as well as providing coverage of the glans. According to research, the [[foreskin]] comprises over one-half of the skin and [[mucosa ]] of the human penis.<ref>{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref>

By growing more [[penile skin]], foreskin restorers recover the skin mobility that was eliminated by their circumcision. The ability to [[gliding action|glide the skin of the penis over the glans]] constitutes a mechanical component of the stimulation mechanism of the penis.

In some men, foreskin restoration may alleviate certain problems they attribute to their circumcisions[[circumcision]]. 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

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.

}}</ref><ref name = "bleustein2003">{{REFconference

|title=[[American Urological Association ]] 98th Annual Meeting

Sorrells (2007) et al. and Yang et al. (2008) have reported empirical data that proves there is more sensation in [[intact ]] males.<ref name="sorrels">{{Sorrells etal 2007}}</ref><ref name="yang">{{REFjournal

# ''An end to tight and painful erections[[erection]]s''. Increasing the quantity of skin results in longer skin and less tension when the [[penis ]] is erect.

</ref> The motion of the [[penile skin ]] by the [[gliding action]] stimulates the [[Meissner's corpuscles| nerves in the skin]] which are sensitive to motion and [[stretching]].# ''Moist glans penis'': A restored foreskin keeps the [[glans penis ]] moist and oily by [[transudation]] in the same manner as a natural [[foreskin]].# ''Appearing and Feeling whole'': The [[circumcision scar]] has turned under the restored foreskin and is invisible. The presence of the restored foreskin causes one to look and feel [[intact]], whole, complete, and normal.# ''Coverage of the glans'': this is beneficial because (a) it protects the [[glans ]] from uncomfortably rubbing up against things, and (b) by keeping the glans moist and protected, it leads to [[dekeratinization]], which subsequently increases sensation.# ''More sensation'': It is true that non-surgical foreskin restoration cannot restore the [[ridged band]] or the [[frenulum]], but a restored foreskin does have some nerves in it. Those nerves are stimulated by the [[Gliding action| gliding]] of the foreskin, so it is quite pleasurable to have a restored foreskin. Some men who were [[circumcised ]] as adults and subsequently restored have estimated that they got back about 80 percent of what they had lost in sensation.

Foreskin restoration has been reported as having beneficial emotional results in some [[circumcised]] men,.<ref name="Greer"/><ref name="Goodwin"/><ref name="Penn">{{REFjournal

}}</ref><ref name="Boyle">{{REFjournal |last=Boyle |init=GJ |last2=Goldman |init2=R |author2-link=Ronald Goldman |last3=Svoboda |init3=JS |last4=Fernandez |init4=E |title=Male Circumcision: Pain, Trauma and Psychosexual Sequelae |journal=Journal of Health Psychology |volume=7 |issue=3 |pages=329-343 |url=http://www.cirp.org/library/psych/boyle6/ |quote= |pubmedID= |pubmedCID= |DOI=10.1177/1359105302007003225 |date=BoyleGJ GoldmanR SvobodaJS FernandezE 2002 |accessdate=2019-09-29}}</ref> and has been proposed Watson & Golden (2017) recommend non-surgical foreskin restoration as a treatment for negative feelings in some many adult men about their involuntary infant circumcisions[[circumcision]].<ref name="watson2017">{{REFjournal

In an effort to provide men partaking in foreskin restoration a reference to the extent of their circumcision skin loss, various foreskin coverage indexes have been created. Coverage indexes may be used by both [[circumcised ]] and [[intact ]] men to describe the extent of their coverage. All three systems are in use.

The first coverage index (2008) comes to us from [[Australia]]. It is still online at [https://archive.is/20121231212745/http://www.newforeskin.biz/CI/CIchart.htm Coverage Index].

It The original coverage index was not completely satisfactory and was replaced supplemented by the [http://www.restoringforeskin.org/public/foreskin-restoration-real-coverage-index-rci Real Coverage Index], which lacked illustrations. ===Newest coverage index===

===Advanced Devices coverage index=== The latest and most complete example is the [https://foreskinrestoration.men/foreskin-restoration-coverage-index/ ADI Coverage Index] (2020). The index depicts a range of penises in both the flaccid and erect state from 0 to 10, with 0 being the tightest [[circumcision ]] and 10 the longest [[foreskin]]. Men undergoing foreskin restoration can chart their progress using the coverage index (CI).

Recently [[Foreskin regeneration| there has been growing interest in regenerative medicine ]] as a means to regenerate the human male [[foreskin]]. This is a completely different process from foreskin restoration by [[tissue expansion]] as described above. This option, if successful, unlike non-surgical foreskin restoration, would result in a true human male [[foreskin ]] being regrownregenerated.

The proposed method would involve placing the patient under general anesthesia. 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>{{REFweb

In 2018, [[Foregen ]] announced the creation of a "decellularized extracellular matrix–based biomaterial scaffold" for the purpose of regenerating human foreskin.<ref>{{REFjournal

[[Foreskin regeneration ]] is only theoretical as of 20212024. No foreskin has ever been regenerated. There is no assurance that foreskin regeneration would actually be successful, if attempted. [[Foregen]] had announced its desire to conduct trials on human volunteers in April 2023, but it has not yet happened.<ref>{{REFweb |url=https://www.foregen.org/research |title=Research |last= |first= |publisher=[[Foregen]] |date=2021 |accessdate=2022-03-24}}</ref> == Conclusion == Timmermans et al. (2021) reported that "non-surgical foreskin restoration methods yield good results."<ref name="timmermans2021">{{REFjournal |last=Timmermans |first= |init=FW |author-link= |last2=Mokken |first2= |init2=SE |author2-link= |last3=Poor Toulabi |first3= |init3=SCZ |author3-link= |etal=yes |title=A review on the history of and treatment options for foreskin reconstruction after circumcision |trans-title= |language= |journal= Int J Impot Res |location= |date=2021-04-14 |season= |volume= |issue= |article= |page= |pages= |url=https://www.researchgate.net/profile/Floyd-Timmermans/publication/350881409_A_review_on_the_history_of_and_treatment_options_for_foreskin_reconstruction_after_circumcision/links/607d5ae9881fa114b41189e1/A-review-on-the-history-of-and-treatment-options-for-foreskin-reconstruction-after-circumcision.pdf |archived= |quote=Nonsurgical methods of reconstruction are rarely mentioned in literature. Nonetheless, nonsurgical methods, such as manual [[stretching]] and device-assisted tissue expansion, are commonplace among those who pursue foreskin reconstruction. Although the nonsurgical methods have yielded good results with minimal adverse effects, no proper medical research has been performed to quantify these outcomes. |pubmedID=33854205 |pubmedCID= |DOI=10.1038/s41443-021-00438-3 |format=PDF |accessdate=2022-06-09}}</ref> == Videos ===== Wayne Griffiths - Foreskin Restoration & Human Rights === [[R. Wayne Griffiths]], {{MS}}, co-founder of [[NORM]], discusses foreskin restoration and human rights in 2009. <youtube>v=qWIyipxe2uE</youtube> === Foreskin Restoration === [[Ron Low]], a manufacturer of a foreskin restoration device, discussed foreskin restoration. <youtube>v=7B98RAGbJkc</youtube>

* [[Psychological issues of male circumcisionSurgical foreskin restoration]]

|website=[[Doctors Opposing Circumcision(D.O.C.)]]

|quote=Foreskin restoration is a slow process of [[stretching ]] the [[penile skin ]] over the naked glans, and can take several years. Many men, however, report an improvement in comfort and sensitivity after only a couple of weeks.

* [{{REFweb |url=http://www.iomfats.org/resources/restoring/media/restoring_faq.pdf |title=My responses to a few Frequently Asked Questions about Non-Surgical Foreskin Restoration], |last=Payne |first=Roy M. Payne; |last2=Fryer, |first2=Leo ( |format=PDF |date=2001-03)}}

|publisher={{UNI|Queen's University |Queen's}} Journal