foreskin it's a touchy topic i'm dr rena
malek urologist and pelvic surgeon and
today we're going to dive right in today
i'm going to talk about what we know in
the scientific literature in regards to
foreskin restoration well foreskin is
the skin on top of the shaft of the
penis typically in uncircumcised men
that foreskin extends over the glands or
the head of the penis however some
individuals are born with a congenitally
shortened prep use meaning they don't
have long foreskin just based on the way
they were born and others had
circumcisions when they were born and
desire having their foreskin back to the
way it was normally it's important to
understand that some men who undergo
circumcision at birth develop a feeling
of anger and shame and resentment in
having that circumcision done they often
feel like they've lost their bodily
autonomy and they are misunderstood very
frequently by both society and medical
professionals and so that's where this
was developed but there's actually
historical roots so let me go back all
the way back to the era of the roman
empire so back during these times bath
houses were very common and people
gathered there and were naked in front
of each other and in society it was
actually considered unacceptable or even
ugly to have an uncircumcised or
congenitally absent foreskin on the
penis in fact it wasn't even allowed to
retract the foreskin in public and this
led to the first non-surgical approach
to lengthening foreskin called judium
pundum it's a funnel shaped copper tube
that's placed around the penile shaft
the copper tube is then pulled on to
allow for stretch of the foreskin over
the glands and it was thought that with
prolonged stretching this would increase
the length of the foreskin another
famous physician dyes creatus actually
recommended applying honey and warm
water prior to stretching to try and
enhance the stretching abilities another
item that was used is called kaino
desney which was literally translated to
dog leash and this was actually like a
leather thong that men wore that
provided traction on the foreskin
upwards then it was tied in a bow and
fastened around the waist this is
primarily used for sporting events to
prevent the glands from popping out
during sporting events and being seen
and lastly the most invasive option at
this time was called infibulation they
would take some sort of device either a
metal clamp or a string and actually go
through the foreskin to keep it shut
over the glands the first actual
surgical technique that was ever
described was described by a physician
named celsius in a book called de
medicina it's a very famous physician in
a very famous book
and it's described as making an incision
around the penis around the foreskin
either at right underneath the head of
the penis or at the base of the penis
depending on if they had a circumcision
previously or if they were just having a
shortened prep use and then they took
the skin that was remaining there and
extended it over the glands itself they
used some sort of traction to keep it in
place there just like infindablation
they then tied that foreskin again
leaving just enough space that you can
urinate and the remaining part of the
shaft that was remained open was
actually allowed to heal by what's
called secondary intention and what that
means is that it just heals from the
inside out interestingly at this point
in time they also put some sort of
specialized dressing underneath the the
skin in between the skin and the glands
to prevent it from sticking down into
the glands this was actually made with
lead oxide and they also wanted to
really prevent erections and so they
kept men who underwent the surgery
hungry for long periods of time so they
would be weakened and then not get
erections this is obviously not ideal in
so many ways but that skin that was left
to heal by itself tend to have lots of
contractors meaning that it shrunk down
and
caused disfiguring appearances and so
there wasn't a great outcome from this
so after that for quite some time
there's very limited reportings of
foreskin restoration in the biomedical
literature until world war ii so since
this time a number of different types of
grafts have been used to cover that area
that's created when you're trying to
extend the foreskin and essentially
things have been used like the scrotal
skin which works quite well but it is a
hair bearing area as well as penile skin
and different configurations with that
penile skin and in multiple stages in
one stage and ultimately even using
split thickness skin grafts but nothing
has been consistently reported with
great outcomes to date that has been at
least reported literature there is some
research being done they've
built a decellularized extracellular
matrix that is made from human foreskin
cells that can be used essentially as a
graft however it still hasn't been
extensively studied in humans however in
2021 the indian journal of plastic
surgery published their reports on their
foreskin restoration surgery on 46
patients they specifically had patients
who wanted to have foreskin restoration
most commonly for religious reasons they
also didn't want it to be visible even
when it was erect and they also didn't
want to have any visualization of any
sort of penile scar that it would make
it obvious that they had surgery and
what they did essentially is they took
off all the skin not just on the shaft
of the penis but also on the glands of
the penis they then after taking all of
this off they extended the foreskin
above the glands and then
rolled it over so that they could suture
it down to the pee hole and make it look
like the glands was completely covered
by foreskin and they follow these
patients for quite a long period of time
again this is a very small subset of
patients but they followed these
patients at least 37 of them for up to
almost two years that's pretty
impressive and out of those 37 that were
followed up again nine of them were lost
to follow up so we don't really know
exactly what happened after the first
three months maybe they had bad outcomes
but out of those 37 only one had a
failure there was really no evidence of
other issues like infections or
either of the urine or of the foreskin
and they had normal erections that were
painless and not affected by the
procedure itself so that's the most
up-to-date surgical literature on
foreskin restoration what about
non-surgical approaches if you google
foreskin restoration you're going to see
tons of stuff and devices that are being
marketed to people and unfortunately
there's not a lot of data that has been
studied meaning men that have used these
techniques and devices to allow for
foreskin restoration and see how they do
over time so all of this data that i'm
providing to you was actually summarized
an article that took it all from online
sources because we don't have anyone who
studied this scientifically and
essentially all of these things that are
out there work by what we call tissue
expansion principles these are often
used in plastic surgery for example when
you're allowing for breast
reconstruction often tissue expanders
are used to allow for breasts to get
enlarged and then the implants to be
placed in and this is also sometimes
used in young children when they're
trying to get surgery on the penis for
what's called hypospadias what this
principle is is that skin maintained on
traction forms additional skin cells
over time and allows them to stretch so
these non-surgical approaches are
typically defined in two categories
taping or non-taping the first
description was in the 1980s where tape
was used to pull the foreskin and tape
it over the glands of the penis this
process
in theory is very very slow and would
take many many years another type of
taping was described in the early 90s
called mtc taping using this mtc taping
what they do is they take about seven to
ten centimeters of cloth tape they tape
it together and then they make a little
tea that tea goes around the foreskin
and then it's pulled on onto an attached
to an elastic band this is typically
done over 24 hours except for urination
and hygiene purposes when it's taken off
and the entire process of foreskin
restoration has been described to take
about two to four years
also described is using these things
called four balls which are two little
balls they're attached to each other
they're about 200 grams in weight and
one is stuck to the foreskin and the
other is attached to a weight to also
provide some additional weight to allow
for traction to be a little bit sped up
however ultimately the clinical results
of this are vague because they haven't
been studied generally speaking there
are multiple options out there all of
them use some form of traction on the
foreskin with some potential weighted
addition and essentially when you look
at all the information that we have
generally speaking they say that using
some traction on the foreskin at least
for one to two hours a day may provide a
six millimeter growth over a short
period of time but usually it takes a
long period of time to see meaningful
results one thing to look out for is
when you're stretching the foreskin a
couple things may happen one is that
when you're stretching you don't really
have specific control of how it's
stretching so we'll not only pull it
longer but it will also pull it wider
and that may not give you an
aesthetically pleasing outcome at the
end of it also it may cause what's
called pino scrotal webbing pinot
scrotal webbing is where it looks like
there's a fusion between the penile skin
and the scrotal skin it looks like a web
and that again may not be aesthetically
pleasing ultimately i think if you're
struggling from this i'm so so sorry
that you are struggling and feeling
unhappy with either what you were born
with or what happened to you shortly
after birth that was not um done by your
consent
and fortunately there are some options
available there however they have not
been extensively studied in large
cohorts of men and you just need to
realize that you need to be thoughtful
careful and it's going to take a long
period of time if you start noticing
anything abnormal make sure you come see
a urologist so we can do an exam and
make sure that nothing else untoward is
going on as always remember to take care
of yourself because you're worth it
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you