Foreskin restoration
[Image:Foreskin Restoration in general.jpg|thumb|Stages of non-surgical restoration]
Foreskin restoration or foreskin reconstruction refers to the process of recreating the foreskin of the penis, which has been removed by circumcision or injury. Foreskin restoration is primarily accomplished by gently tugging the skin of the penis by hand or with a restoration device to stimulate the production of more skin through tissue expansion, but surgical methods also exist. Restoration creates a functional facsimile of the foreskin, but specialized tissues removed during circumcision such as the preputial orifice cannot be reclaimed.
History
In the Greco-Roman world, intact genitals, including the foreskin, were considered a sign of beauty, civility, and masculinity. In Classical Greek and Roman societies, exposure of the glans was considered disgusting and improper, and did not conform to the Hellenistic ideal of gymnastic nudity. Men with short foreskins would wear the kynodesme to prevent exposure and potentially permanently lengthen the foreskin. As a consequence of this social stigma, an early form of foreskin restoration known as epispasm was practiced among some Jews in Ancient Rome. The history of foreskin restoration changed the practice of circumcision itself. Jewish religious leaders were upset that circumcision was being undone and changed the practice to remove significantly more skin in an attempt to make restoration more difficult.Foreskin restoration is of ancient origin and dates back to the Alexandrian Empire. Hellenized Jews stopped circumcising their sons to avoid persecution and so they could participate in the gymnasium. Some Jews at this time attempted to restore their foreskins, which caused conflict within Second Temple Judaism, some Jews viewed circumcision as an essential part of the Jewish identity. Following the death of Alexander, Judea and the Levant was part of the Seleucid Empire under Antiochus Epiphanes. Antiochus outlawed the Jewish practice of circumcision, both 1st and 2nd Maccabees records Jewish mothers being put to death for circumcising their sons. Some Jews during Antiochus' persecution sought to undo their circumcision. Within the 1st century A.D., there were still some forms of foreskin restoration being sought after. During the third Jewish-Roman Wars, the Romans had renamed Jerusalem as Aelia Capitolina and may have banned circumcision; however, Roman sources from the period only mention castration and say nothing about banning circumcision. According to rabbinic sources, during the Bar Kokhba revolt, Jews who had engaged in foreskin restoration were recircumcised. Again, during World War II, some European Jews sought foreskin restoration to avoid Nazi persecution.
Foreskin restoration is featured prominently in the 2017 documentary American Circumcision. In the film, Ron Low, a device inventor, estimates a quarter million people worldwide were restoring in 2010.
Non-surgical techniques
Tissue expansion
Non-surgical foreskin restoration, accomplished through tissue expansion, is the most commonly used method.Tissue expansion has long been known to stimulate mitosis, and research shows that regenerated human tissues have the attributes of the original tissue.
Care must be taken not to injure or tear the skin. Applying tension to different parts of the skin can change the overall physical shape. This allows the restorer to change the ratio of outer skin to inner skin. Partial restoration can allow cosmetic and functional improvements in the case of circumcision complications such as uneven or excessive skin removal.
Methods and devices
There are multiple restoration methods, in the most common one the remaining penile skin is pulled forward over the glans, and tension is maintained either by hand or through the aid of a foreskin restoration device. These may be complex handmade devices or simple multi-purpose tools such as cohesive bandage. The process slowly creates more skin, allowing more coverage and protection of the glans even when tension is removed.Surgical techniques
Foreskin reconstruction
Surgical methods of foreskin restoration, known as foreskin reconstruction, usually involve 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 as 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.Results
Physical aspects
[Image:After4yearsRestoring.jpg|thumb|right|A partially restored foreskin after four years of non-surgical restoration. The bottom left image shows a manual tugging technique.]Restoration creates a functional facsimile of the prepuce, but specialized tissues removed during circumcision such as the preputial orifice, the ridged band, and the frenulum cannot be reclaimed. Surgical procedures exist to reduce the size of the opening once restoration is complete, or it can be alleviated through a longer commitment to the skin expansion regimen to allow more skin to collect at the tip.
The natural foreskin is composed of smooth dartos muscle tissue, large blood vessels, extensive innervation, outer skin, and inner mucosa.
The process of foreskin restoration seeks to regenerate some of the tissue removed by circumcision, as well as provide coverage of the glans. According to research, the foreskin comprises over half of the skin and mucosa of the human penis.
Partial restoration can confer benefits such as ease of masturbation and protection of the rim around the glans known as the corona.
In a survey of foreskin restorers, 69 percent of respondents reported increased sexual pleasure and 25 percent reported improved relationships.