Uncircumcised: A Look At The History And Evolution Of Foreskin Restoration

Male circumcision, or the removal of the penile foreskin, is a procedure performed on most male infants in the United States today. Although the rate of circumcision has declined during the last few decades, it continues to be widely performed in the U.S. for many reasons. However, circumcision has grown increasingly controversial. In addition, it is not uncommon to hear circumcised men lament the removal of their foreskin and express a desire to be "uncircumcised." In light of this, some have wondered whether there is anything that can be done in cases like this. That is, is it possible to restore foreskin post-circumcision?

Believe it or not, the practice of "foreskin restoration" (also known as "decircumcision”) is something that has been around for millennia. It seems that ever since people starting removing foreskin (or in medical terms, the prepuce), some have been trying to put it back in place. In fact, the earliest known writings on foreskin restoration are believed to have appeared between 14 and 37 C.E.--a full 2000 years ago [1]! Why were people seeking foreskin restoration back them? For some, it was a way of concealing a stigmatized religious identity, whereas for others, it was to improve their penile appearance in cases where one’s foreskin had not fully developed. Indeed, in those days, “the circumcised penis was considered deformed and disfigured” [1].

However, the outcomes probably weren’t so great for people who sought foreskin restoration back then. For the squeamish, you might want to skip a few paragraphs ahead. The procedure began by going part way down the shaft of the penis and making a “degloving” incision. In other words, they would make a cut in the skin the entire way around the penis, and then pull that skin all the way back to cover the glans (i.e., head). Ouch! The patient was then starved for a few days afterward because this was thought to help the healing process (the goal was to prevent erections while the tissues healed, and they thought that hungry guys wouldn’t get erections—not the smartest idea…).

In the view of modern day urologists, “it is difficult to see how this technique had any success at producing a cosmetic or functional prepuce” [1].

One obvious problem with this procedure is that you’ve removed the skin from the shaft of the penis. No matter how much time you allow for healing, it’s just not going to be the same afterward. In light of this, later physicians modified the procedure by attaching skin grafts to the portion of the shaft that had been “degloved,” with the goal of improving cosmetic appearance. However, scrotal skin was often used for this purpose, which would have led to another problem: a hairy shaft (as some of you may know, scrotums can be pretty hairy).

Variations and modifications of this surgical technique have been used in modern times (see here for an example, including some diagrams). However, they are not commonly used. Also, as discussed in a scientific review article on this topic, “surgical methods for restoration of the prepuce are not standard, and reports in the literature are primarily anecdotal, with poorly documented follow-up” [1]. In other words, we don’t have very good data on these procedures.

Non-surgical approaches to restoring foreskin seem to be more common. These can take different forms, but generally involve stretching the penile skin over a long period of time (as in years) in such a way that some of it ends up covering the glans. For instance, weights might be attached to the penis for several hours per day to create stretching tension. As with the surgical procedures, though, we are currently lacking good data on outcomes, but it’s unlikely that either approach would be enough to satisfy a patient with very high expectations.

We are likely to see better results in the future, though, if circumcised men are eventually able to regrow their foreskin from stem cells. In fact, at least one company is currently researching this possibility now. However, it is unlikely to be an option any time soon.

As you can see, foreskin restoration is an age-old practice that continues to evolve even today. The currently available options are limited in many ways, but science may one day offer a possibility of true restoration.

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[1] Brandes, S. B., & McAninch, J. W. (1999). Surgical methods of restoring the prepuce: A critical review. BJU international83(S1), 109-113.

Image Source: 123RF.com

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