News Whole again: the practice of foreskin restoration ayne Griffiths was stand - his father and older brother were before foreskins to go see psychiatrists.” ing in the doorway of an him, and he holds no ill will toward his Historically, men have sought to W associate’s office one day parents. Even his own sons are circum - restore their foreskins not for health or in the spring of 1991 when he felt the cised. It wasn’t until he was 56 years sexual reasons, but rather, for fear of tape on his penis come undone. The old that he began stretching his fore - religious persecution. In his paper 7-ounce weight that had been attached skin, hoping it would remedy the “Uncircumcision: A historical review of to the tape slid down a pant leg and decline in physical enjoyment he was preputial restoration,” German urologist hit the floor. Griffiths quickly stooped experiencing during sex. Dr. Dirk Schultheiss details the history and picked up the weight, shoving it of the practice, which has been around in his pocket. His associate asked if almost as long as circumcision ( Plast something was wrong. No, he had Reconstr Surg 1998;101: 1990 −8). merely dropped something, Griffiths Throughout history, there have been assured him. many eras in which Jewish people It is understandable why Griffiths were persecuted and during those didn’t go into greater detail about times, circumcised men sometimes what that something was. After all, it attempted to restore their foreskins to would only have raised more ques - avoid harm. In Biblical times, for tions if he had told his associate that a instance, the practice was popular with device of his own making, a small circumcised men who participated in dumbbell he calls Foreballs, consist - athletic events or frequented public ing of two ball bearings joined by a s baths, both of which required public h t fi stainless steel rod, was attached to his f nudity. There were even times when i r G penis to stretch his foreskin. Well, at e ruling powers outlawed circumcision, n y least it had been attached before the a prompting some who had already been tape gave way. W cut to seek restoration in hopes of Foreskin restoration advocate Wayne Griffiths is the founder and execu - Griffiths makes 200- to 350-g devices avoiding stigma or improving their tive director of the National Organiza - called Foreballs to be attached to the social and economic positions. tion of Restoring Men, or NORM for penis to stretch the skin. There are also reports of circum - short, a group that helps circumcised cised men undergoing surgery to regain men restore their foreskins. The organ- Before he created Foreballs, Grif - their prepuce in Germany during Nazi ization was launched in San Francisco, fiths used tape to attach two stainless rule, even if they weren’t Jewish, California, in 1993 and now has mem - steel ball bearings to the skin on his according to Schultheiss’ paper: “So bers across the United States and in penis, allowing gravity to do its work. every circumcised man at that time was other countries, including Canada, He wore the weight under his blue in danger of being denounced and, Australia and the United Kingdom. jeans at his job as a construction therefore, had to hide his genital state Some men, including Griffiths, restore inspector. Eventually, he had enough or have it uncircumcised.” their prepuce to improve their sex loose skin to not only cover the glans In the modern era, uncircumcision lives, hoping the glans of their penises of his penis when flaccid, but to over - has gained popularity only in the last will become more sensitive once it is hang it by three-quarters of an inch. few decades, mostly in the US. Today, some men do it for sexual reasons, Many circumcised men “are extremely angry though the nerves lost during circumci - sion cannot be regenerated. Others do it at doctors and hospitals and their parents” − to achieve emotional wholeness, believ - ing they are victims of genital mutila - Wayne Griffiths, founder of NORM. tion. “Many patients really become fix - ated on this problem,” Schultheiss covered. Others do it for emotional And it did indeed increase both the writes in an email. reasons, wanting to get back what they sensitivity of the glans and his enjoy - Health professionals are getting bet - believe was wrongly taken from them ment of sex, he says. ter at validating and treating the emo - as infants. Other men have reported similar ben - tional problems sometimes experi - “A good portion of them are efits, physically and emotionally, from enced by circumcised men, Schultheiss extremely angry at doctors and hospi - restoring their foreskins. Still, the med - noted in his paper. “Nowadays the tals and their parents,” Griffiths says. ical community has mostly dismissed understanding of the psychological He does not include himself in the such men when they seek the help of motivations for uncircumcision is latter group. Born in San Francisco in physicians, says Griffiths. “Most doctors increasing, and the problem is dealt 1933, Griffiths was circumcised just as tell people who want to restore their with more seriously.” 2092 CMAJ, December 13, 2011, 183(18) © 2011 Canadian Medical Association or its licensors News There have always been two means Ontario, writes in an email. Stubbs, (derma and muscle) to perform mitosis by which men could restore their fore - who became Canada’s leading penis- and grow additional cells.” The organi - skins: skin expansion or surgery. An lengthening surgeon after learning the zation also discourages restoration seek - early mention of a surgery for “decir - technique pioneered in China by a ers from seeking to speed up the cumcision” was made by a Roman physician whose name was Dr. Long, process, which can take several years, medical writer named Aulus Cornelius added that the two-stage restoration by using excessively heavy weights. Celsus in the year 50 AD. Many cen - procedure he created required a “dedi - “Damage to the tissue and a much turies later, Dr. Johann Friedrich Dief - cated patient who prepared to undergo longer healing time are the results of fenbach, a German surgeon and pio - two surgeries and all the follow-up. excessive tension,” the program states. neer in reconstructive surgery, Healthy and realistic were the two “As well, it is simply not necessary and described operations to restore the pre - most important pre-requisites.” will not speed up the process.” — puce in two of his textbooks, published Nonsurgical procedures, though time Roger Collier, CMAJ in 1820 and 1845. consuming, are more common. They Surgical methods, however, are not generally involve tape, elastic, weights CMAJ 2011. DOI:10.1503/cmaj.109-4009 very popular today. They require the or some other means of creating tension transplanting of skin, and the new fore - to stretch the skin on the penis. The skin often differs from the original National Organization of Restoring Editor’s note: Third of a six-part series: penile skin in colour and texture. “Most Men advises such a slow but safe results are cosmetically unsatisfactory,” approach called “A successful restora - Part I: Circumcision indecision: Schultheiss writes in an email. tion regimen” (www.norm.org /regimen The ongoing saga of the world’s Because the results are often disap - .html). It involves wearing a stretching most popular surgery (www.cmaj.ca pointing and the procedure itself rather device during the day for four to eight /lookup /doi/10.1503/cmaj.109-4021). complicated, few doctors perform it, hours and recommends removal if the Part II: Vital or vestigial? The foreskin says Dr. Stephen Giunta, a leading US wearer feels constriction or pain. The has its fans and foes (www.cmaj.ca surgeon in the field of phalloplasty (cos - device should not be worn at night, so /lookup /doi/10.1503/cmaj.109-4014). metic surgery on the penis). During the as to allow time for “the shaft tissue past two decades, Giunta has performed thousand of procedures to enlarge penises but does not offer foreskin restoration, instead recommending hanging-weight techniques to patients who request it. “There is quite a bit of interest in it, more than you would expect, especially on the west coast of this country, though I rarely get a request for it and don’t do the surgery,” says Giunta, who practises in Alexandria, Virginia. Patients seeking foreskin restoration surgery may be in for a long search. The procedure remains outside the periphery of mainstream medicine, which is no surprise, says Giunta, because the entire field of genital cosmetic surgery is only now getting recognized. “We remain a small number, those of us doing it, and mainstream medical societies are now just beginning to accept it,” he says. Even physicians who do offer fore - skin restoration tend to be selective in who they perform it on, mainly because it involves at least two procedures and a lengthy healing period. “Before I retired, I performed 3 of these complex procedures on specially selected patients,” Dr. Robert Stubbs, a former phalloplasty surgeon in © 2011 Canadian Medical Association or its licensors CMAJ, December 13, 2011, 183(18) 2093.