By: Jack Penn
Date: July 1963
Source: Penn, Jack. "Penile Reform." British Journal of Plastic Surgery 16 (July 1963).
About the Author: Jack Penn was born in Cape Town, South Africa, in 1909. A plastic surgeon by training, he worked in South Africa, Scotland, Japan, Taiwan, Israel, and the United States. During World War II (1938–1945) he was a battlefield surgeon and later treated atomic bomb victims in Japan.
The ritual of male circumcision predates the Bible; while Jewish men were circumcised as part of religious ritual, ancient Greeks and Romans specifically forbade circumcision in their respective societies. Muslims consider the procedure a part of Islam, although the Koran does not specifically mention it. Unlike Jewish males, who are circumcised on the eighth day after birth, Muslim boys experience the ritual at an older age, after they recite the Koran in full, around the onset of puberty.
European and United States physicians began to call for routine infant male circumcision in the mid-nineteenth century. Physicians such as Jonathan Hutchinson, a British doctor, proposed a connection between overexcitement of the sexual organs and maladies such as epilepsy, hysteria, and mental illness. According to Hutchinson's theory, overexcitement and stimulation, caused by the friction of the foreskin (or prepuce) against the glans of the penis, led to more frequent masturbation. Excessive masturbation, especially at a young age, led to an increased sexual appetite, which allegedly drove men to use prostitutes, leading to the spread of venereal disease.
Hutchinson used data on Jewish men, who were circumcised as part of their religious beliefs, to examine venereal disease rates in 1850s London. His research, later proven to be faulty, showed an alleged connection between circumcision and lower rates of sexually transmitted disease. By circumcising males in infancy, he theorized, mental illness as well as sexual disease could be curtailed.
Other physicians, such as gynecologist Isaac Baker Brown, proposed similar theories concerning females and the clitoral hood, but female circumcision did not gain the popularity that secular male circumcision gained in the late 1800s and early 1900s. By the 1910s, female circumcision had been relegated to a tiny fraction of babies born with ambiguous genitalia, while increasing numbers of boys born in the United States and Britain were circumcised shortly after birth.
During World War II, the concept of foreskin restoration emerged as a protective measure for Jewish men attempting to conceal their religious identity. Fear of concentration camps in German-occupied areas fed an underground movement of foreskin restoration, though the method was crude and left the person vulnerable to infection.
By 1963, when South African plastic surgeon Jack Penn developed the surgical technique noted below, the circumcision rate in the United States was nearly 80 percent.
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Foreskin restoration via surgery was uncommon in 1963, when Penn performed this operation, and the idea of "uncircumcision" was greeted with great skepticism in medical circles. The resulting foreskin reconstruction is not a true foreskin, in that the nerve endings present in the foreskin found in the frenar band and Meissner's corpuscles, which account for approximately 40 percent of penile nerve sensation and arousal, cannot be replicated or created via surgical or other methods.
Plastic surgeons in the U.S. perform foreskin restoration surgeries at a cost of between $10,000-$50,000. Three operations are often required, with a 70 percent success rate. Unlike Penn's technique, in most modern surgical restorations the surgeon removes a portion of the scrotum to sculpt a foreskin that has a mucosal quality to it.
Foreskin restoration via foreskin stretching is another technique that is used to create a foreskin. In Greek society, Jewish men used weights on the ends of their existing foreskin to stretch it; the process, called epispasm, helped to cover the exposed glans. By the mid 1970s, a small group of men in the United States began to self-restore, using complex stretching techniques. By applying a series of weights to the existing foreskin, these men slowly stretched the skin over a period of 1-3 years, eventually creating a sheath around the glans of the penis.
The National Organization of Restoring Men (NORM), an organization devoted to men who wish to restore their foreskins surgically or via stretching techniques, does not keep statistics on men who stretch their foreskins (labelled "tuggers"), but in 2000, the organization estimated that 20,000 men worldwide were actively stretching foreskins for restoration. Restorers claim that while they can never replicate the original foreskin, a restored foreskin can provide heightened sexual sensation and protect the glans, helping to undo keratinization, or the build up of skin cells in the glans that occurs over time when it is exposed by circumcision.
Routine infant circumcision ended in England in 1949, and the Canadian Academy of Pediatrics has not recommended the procedure since 1981. In 1999, the American Academy of Pediatrics issued a policy that routine infant circumcision holds no medical benefits.
From a high point of eighty-five percent in 1975, the circumcision rate in the United States steadily decreased to fifty-five percent in 2003. The circumcision rate in the United Kingdom was approximately four percent in 2003.
Darby, Robert J. A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain. Chicago: University of Chicago Press, 2005.
Gollaher, David L. Circumcision: A History of the World's Most Controversial Surgery. Basic Books, 2000.
Dawson, Benjamin E. "Circumcision in the Female: Its Necessity and How to Perform It." American Journal of Clinical Medicine 22, no. 6 (June 1915).
Schultheiss, Dirk, M.D. "Uncircumcision: A Historical Review of Preputial Restoration." Plastic and Reconstructive Surgery 101, no. 7 (June 1998): 1990–1998.
American Academy of Pediatrics. "Circumcision Policy Statement" 〈http://pediatrics.aappublications.org/cgi/content/abstract/103/3/686〉 (accessed March 22, 2006).
National Organization of Restoring Men〈http://www.norm.org〉 (accessed March 22, 2006).