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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Male circumcision, the removal of some or part of the foreskin, is performed for many reasons. Parents have their male children circumcised for religious purposes, others as a preventative measure against future medical problems. Some uncircumcised male children eventually have the procedure for medical reasons. One of the most common is phimosis, an abnormally tight foreskin that won’t retract.
Research has consistently shown some medical benefits to circumcision. The risk of urinary tract infections is higher in uncircumcised males of all age groups (Morris, 2013). A study in South Africa found circumcision, if performed by medical professionals, reduces the risk of female-to-male HIV transmission by 60% (Auvert, 2005). Among gay and bisexual men, studies have suggested circumcised “tops” (those who engage sexually only in the insertive role) have a significantly reduced HIV risk as well (Wiysonge, 2011).
Circumcision has been with us for millennia, and the idea of restoring one’s foreskin has been around nearly as long. From ancient times to as recently as the 1940s, foreskin restoration was primarily attempted by Jewish men to pass for another ethnicity.
Some might think the foreskin, which biologists call the prepuce, is simply a flap of excess skin. While a person can obviously live without one, the foreskin is different from the skin surrounding it. Research suggests that the foreskin is more sensitive than the glans (head of the penis) (Taylor, 1996).
There are a number of reasons why some men wish to restore their foreskin. Because that tissue is more sensitive than the glans, some circumcised men believe they are missing out on sexual pleasure by not having a foreskin. Some men seek restoration because they feel they are reclaiming something lost, while some might suffer from body image issues regarding the appearance of their penis. Yet others see it as a form of personal expression, a body modification like a piercing or a tattoo.
There are many arguments for and against circumcision, which we won’t wade into any further here. This article’s scope will be the history of foreskin restoration, the current methods employed, and any potential risks.
We should note upfront that the phrase “foreskin restoration,” while commonly used, is a slight misnomer. Once removed, one cannot grow a “new” foreskin any more than one could a new toe. What we call restoration is creating a covering that has the look, and some believe the feel, of a foreskin.
History of foreskin restoration
A common misconception in the West is that circumcision began as an ancient Jewish ritual, spread through the Abrahamic religions. But there is evidence that circumcisions were common practice on the Arabian Peninsula at least as far back as 3,000 BC, predating modern Judaism’s existence by over two thousand years. Paintings in Egypt dating to 2,300 BC depict the practice, at least five hundred years before Abraham was born (Doyle, 2005).
It was not limited to the Middle East and Northern Africa, either. The practice is common in Australian Aboriginal and Polynesian tribes. There is some evidence of it occurring among the Inca, Mayan, and Aztec peoples. Some researchers speculate that ancient peoples developed it as a hygienic practice, as a preventative against infection (Doyle, 2005).
Whatever the reasons for taking the foreskin off, the idea of foreskin recreation or extension has been around for centuries. The First Book of Maccabees, written around the second century B.C., talks of secular Jews who “hid the fact of circumcision” to better fit in with the region’s gentiles (Tushnet, 1965). They achieved this by attaching weights to their remaining foreskin and slowly extending it.
In ancient Rome, a longer foreskin was considered more attractive by many. Aulus Cornelius Celsus’ De Medicina, written sometime in the first century, describes a rather gruesome process for extending a small foreskin (Schultheiss, 1998). Dioscorides’ De Materia Medica, written sometime between 50 and 70 A.D., recommends a salve of deadly carrot (Thapsia) juice and sulfur as a less invasive solution.
There’s even reference to foreskin restoration in the New Testament. Though the followers of Jesus decided to ditch circumcision as a practice, St. Paul spoke ill of men attempting to “become uncircumcised” in 1 Corinthians. “Play the glans you’re dealt,” he said (or something to that effect).
Fast-forward almost two thousand years, and a circumcised penis could quickly become a death sentence for Jewish men in Nazi-occupied Europe. Plastic surgery to simulate foreskin became an underground market. One doctor from occupied Holland described a ‘method somewhat similar to Celsus.’ The surgeon would make an incision around the base of the penis. Then, they slipped the shaft skin over the glans. As this exposed the shaft base, they took skin from the rear of the scrotum for grafting the wound (Schultheiss, 1998).
Modern methods of foreskin restoration don’t differ too much from the old ways but have been refined and are much safer.
Penis transplant surgery: candidates, procedure, risks
Skin grows when stretched. This growth happens through a process called mitosis. It’s very complicated, but in the simplest of terms, new skin cells are created when a “parent” cell splits into two genetically identical “daughter” cells. Overstretching the skin induces this process (Zöllner, 2013).
Typically this is done with tissue expanders. These are balloons placed under the skin that are slowly inflated over weeks or months. In time, enough tissue expansion has occurred for the purpose needed. Cosmetic surgeons do this to grow new skin for some purpose, such as to replace damaged skin on a burn victim.
Non-surgical procedures stretching the skin from the outside have the same effect. Skin expansion is one of the oldest known body modifications humans have performed. It dates back much further than the millennial with ear gauges at your local coffee shop. Archaeologists have found lip stretchers (called “labrets”) dating as far back as 8700 B.C. (Garve, 2017).
From Jews in ancient Greece to foreskin restorers of the present day, stretching has been the most common practice of foreskin restoration (Collier, 2011).
There are different ways to stretch the skin. The simplest is the manual tugging of one’s penile skin. Once you have enough slack, taping a weight to the penile skin will eventually stretch it enough to cover the glans penis.
Wayne Griffiths, the founder of the National Organization of Restoring Men (NORM), developed a product for this purpose he named “Foreballs.” Foreballs looked like tiny barbells and would provide equal weight on both sides of the shaft. One could attach increasingly weightier Foreballs until they reached their desired length.
Today, many more complex foreskin restoration devices are available to simplify and speed up the process. There isn’t much literature on these devices, and reports on their efficacy and safety are anecdotal.
Skin stretching takes time. It could take anywhere from six months to several years to achieve the desired effect. The stretched skin will not narrow towards the tip of the glans the way an original foreskin would. Some men may elect surgery to create such a taper after reaching their optimum foreskin length (Schultheiss, 1998).
As noted above, however, this is not a restored foreskin but a new and different one. Penile shaft skin does not have the same makeup as a prepuce. There are different capillary and nerve structures.
Before you decide to undertake any procedure like this, even if it seems generally safe to you, it’s best to consult with your healthcare provider.
Is my penis normal? What does the average penis look like?￼
Modern surgical techniques differ little from those used in times past—and results aren’t always much better. In his book The Joy of Uncircumcising, author Jim Bigelow interviewed several men who had gone through surgical foreskin restoration. Not all patients were satisfied with the results, and one went for recircumcision. Scarring and differences in skin texture between the grafts and original skin were among the reasons stated, neither of which were issues found with the stretching method (Schultheiss, 1998).
Non-surgical foreskin restoration is sometimes recommended instead of surgery by some healthcare professionals. Some phalloplasty surgeons (plastic surgeons of the penis) will not perform the surgical process (Collier, 2011). That said, it’s always best to discuss decisions like this with your healthcare professional to learn what approach truly is right for you.
The future of foreskins
Some research into bioengineering new foreskins has taken place at an Italian company called Foregen (Purpura, 2018). Their theory is that by “decellularizing” foreskins from cadaver penises and “recellularizing” the empty framework with a patient’s cells, one can regrow a real foreskin. However, this science is in its infancy and has not gone into animal trials as of yet.
Non-surgical methods remain the most recommended approach, even if they are somewhat slow. Talk to a healthcare provider and follow their medical advice before starting any foreskin restoration regimen.
- Auvert, B., Taljaard, D., Sitta, R., Puren, A., Lagarde, E., Sobngwi-Tambekou, J. (2005). Randomized, controlled Intervention trial of male circumcision for reduction of HIV infection risk: The anrs 1265 trial. PLoS Medicine, 2(11), e28. doi: 10.1371/journal.pmed.0020298. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16231970/
- Collier, R. (2011). Whole again: The practice of foreskin restoration. CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 183(18), 2092–2093. doi: 10.1503/cmaj.109-4009. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22083672/
- Doyle, D. (2005). Ritual male circumcision: A brief history. The Journal of the Royal College of Physicians of Edinburgh, 35(3), 279–285. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16402509/
- Garve, R., Garve, M., Türp, J. C., Meyer, C. G. (2017). Labrets in Africa and Amazonia: Medical implications and cultural determinants. Tropical Medicine & International Health: TM & IH, 22(2), 232–240. doi: 10.1111/tmi.12812. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27862688/
- Morris, B. J., & Wiswell, T. E. (2013). Circumcision and lifetime risk of urinary tract infection: A systematic review and meta-analysis. The Journal of Urology, 189(6), 2118–2124. doi: 10.1016/j.juro.2012.11.114. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23201382/
- Purpura, V., Bondioli, E., Cunningham, E. J., De Luca, G., Capirossi, D., Nigrisoli, E., Drozd, T., Serody, M., Aiello, V., Melandri, D. (2018). The development of a decellularized extracellular matrix-based biomaterial scaffold derived from human foreskin for the purpose of foreskin reconstruction in circumcised males. Journal of Tissue Engineering, 9, 2041731418812613. doi: 10.1177/2041731418812613. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30622692/
- Schultheiss, D., Truss, M. C., Stief, C. G., & Jonas, U. (1998). Uncircumcision: A historical review of preputial restoration. Plastic and Reconstructive Surgery, 101(7), 1990–1998. doi: 10.1097/00006534-199806000-00037. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9623850/
- Taylor, J. R., Lockwood, A. P., & Taylor, A. J. (1996). The prepuce: Specialized mucosa of the penis and its loss to circumcision. British Journal of Urology, 77(2), 291–295. doi: 10.1046/j.1464-410x.1996.85023.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/8800902/
- Tushnet, L. (1965). Uncircumcision. Medical Times, 93, 588–593. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14287361/
- Wiysonge, C. S., Kongnyuy, E. J., Shey, M., Muula, A. S., Navti, O. B., Akl, E. A., & Lo, Y.-R. (2011). Male circumcision for prevention of homosexual acquisition of HIV in men. The Cochrane Database of Systematic Reviews, 6, CD007496. doi: 10.1002/14651858.CD007496.pub2. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21678366/
- Zöllner, A. M., Holland, M. A., Honda, K. S., Gosain, A. K., & Kuhl, E. (2013). Growth on demand: Reviewing the mechanobiology of stretched skin. Journal of the Mechanical Behavior of Biomedical Materials, 28, 495–509. doi: j.jmbbm.2013.03.018. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23623569/
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.