VICE: Motherboard
February 17, 2015
How One
Company Aims to Help Circumcised Men Grow Their Foreskin Back
by Arikia Millikan
If someone has grown up male in the United States, odds are that he
doesn’t have a foreskin. Most Americans likely haven’t given this much
thought, and if they have, it’s probably along the lines of “good, it’s
better this way.”
But a growing number of men known as "intactivists" are expressing
outrage about being circumcised—which they call an “unnecessary
amputation”—before they were old enough to understand the implications
of the procedure and consider providing consent.
As adults, short of undergoing a complex surgery that transplants
scrotal tissue onto the penile shaft, or practicing a body mod
technique called ‘tugging’ that can sometimes stretch the remaining
foreskin tissue back over the head of the penis, these men have been
left to wonder: “What would sex be like with a foreskin?”
Now, a company called Foregen purports to soon be able to help these
men answer that question by using regenerative medicine to regrow their
foreskins—much like a salamander can regrow a severed appendage.
“The premise behind Foregen is that if we are regenerating entire body
parts from more complex body parts, why not apply this to the only body
part that hundreds of millions of boys are missing,” says Foregen
spokesperson Eric Clopper.
Of the 660 million circumcised men worldwide, 115 million of them are
American, making the United States the country with the most
circumcised men, even outnumbering African and Middle Eastern
countries, according to stats from the World Health Organization. In
fact, the United States is the only developed country where male infant
circumcision is the norm, rather than something done out of religious
ceremony.
Today, national circumcision rates hover between 50–60 percent, but in
the 1980s as many as 83 percent of infants were circumcised in the
Midwest; in some places it was so common that physicians wouldn’t even
bother consulting new mothers on whether or not they want their infant
sons circumcised, they’d just go ahead and do it.
Though circumcision has been steadily decreasing in the US, dropping
about 10 percent over the past 35 years and hitting a regional low of
30 percent on the present day West Coast, rates are much higher than in
European countries. There, only about 10 percent of boys are
circumcised, and rates are as low as 1.6 percent in Denmark.
But what exactly are circumcised guys missing? Depending on who you
ask, the answer ranges from “penile cancer” to “the best sex you and
your partner have never had.” It’s hard to weigh the factors around
this issue, as the science is wrought with bias and even deliberate
interference, and sexual enjoyment is largely subjective. But after
conducting extensive research on the topic, I’ve found the intactivists
make a more compelling case.
Since the 1800s, proponents of circumcision in the US have pointed to
health as the main reason parents should have their infants
circumcised. Back then, circumcision was medically touted as a method
of reducing a boy’s urge to masturbate, which was believed by the
Puritans of New England to be the cause of illnesses. There’s a pretty
clear medical consensus these days that this isn’t the case, but the
tradition lingered and foreskin became associated with a new host of
ailments.
In December of 2014, the US Centers for Disease Control and Prevention
released a draft endorsing infant male circumcision. This mirrors a
2012 statement by the American Academy of Pediatrics which links
circumcision with the decreased transmission of HIV, STDs that can
cause cancer, and urinary tract infections. However, both statements
were called out by the international medical community by and large as
lacking on a scientific and ethical basis.
When it comes to medical recommendations about circumcision, there is
an undeniable cultural bias that is persistently reflected in the
scientific literature. Most medical societies in developed
nations—except for the American ones—agree that in environments where
hygienic conditions allow men to wash themselves regularly, any health
benefits circumcision might offer cease to outweigh the risks. “The
other claimed health benefits, including protection against HIV/AIDS,
genital herpes, genital warts, and penile cancer, are questionable,
weak, and likely to have little public health relevance in a Western
context,” states the critique of the AAP’s stance on circumcision led
by Danish epidemiologist Morten Frisch.
The European scientists did find that circumcision can result in
reduced UTIs, but only by about 1 percent. They cite the AAP’s own
estimates of the risk of complications from circumcision to conclude
that “1 case of UTI may be prevented at the cost of two cases of
hemorrhage, infection, or, in rare instances, more severe outcomes or
even death.” A UTI is no picnic, but I’m sure it beats a penile
hemorrhage.
Logic is often no match for religious
zealots, or those on the other end of the spectrum: "circumfetishists."
This isn’t a new stance either—scientists have been arguing against
circumcision on the basis of health benefits since the 1970s. But logic
is often no match for religious zealots who think masturbation is a
sin, as well as those the other end of the spectrum—circumfetishists.
Most egregiously, one Australian man named Brian Morris has been
plaguing circumcision-related research for the past decade, lying about
his scientific credentials and publications, submitting criticisms of
circumcision research in which he disproportionately cites himself,
and “issuing misstatements faster than they can be checked and
refuted.” I can’t speak to his motivation for doing this, but one
circumcision watchdog site observed him linking to circumcision
erotica.
Aside from the scientific debate, there is a parallel ethical debate
which revolves around the issue of consent. Even if medical science
could irrefutably prove health benefits from circumcision, many
intactivists contend that performing a preventative surgery on a child
is unethical; the decision to circumcise should only be made for
children in medical emergencies, or voluntarily by adults such as is
the case with cosmetic surgery and other body modifications. This view
rubs up against religious views that circumcision is necessary to
protect children from their sexual impulses, which could distract them
from God.
“I think that children should be protected from having their genitals
modified because they don’t understand what’s at stake,” says Brian
Earp, an ethics researcher at the University of Oxford. “In general we
should consider legal adults competent to modify their own bodies.” He
raised the point that removing the breast buds of infant girls could
prevent breast cancer, but nobody would seriously recommend doing that
in a medical setting.
Earp says he became interested in the ethics of circumcision after the
city of San Franciscio considered banning infant circumcision in 2011,
and more so in 2012 when a local court in Germany ruled that child
circumcision was illegal, even with parental consent, after a botched
circumcision involving a four-year old Muslim boy. “While the court
held that religious circumcisions in fact are to be deemed illegal
because they violate the child's right to physical integrity and
self-determination, it differentiated such acts from instances when a
circumcision is medically necessary,” the ruling reads. Similar legal
measures have been considered in Finland, Denmark, and Sweden.
Religious dictates aside, the main ethical consideration parents use to
have their baby boys circumcised in the US is the pop cultural belief
that in doing so they are somehow protecting their kids from future
locker room harassment. But studies show this isn’t actually a
problem—if guys are going to have their penises made fun of for any
reason, it will probably be the size, not whether or not they’re
circumcised.
But locker rooms are one thing—what about the room where it really
matters: the bedroom?
Think about what a foreskin does, biologically: In a non-erect penis,
the foreskin covers the shaft completely, hanging over the tip and
making it effectively an internal organ. When its gets hard, the
foreskin secretes lubrication that allows the skin to slide back and
forth against the shaft. When it gets really hard, the top part of the
foreskin flips inside out, exposing a really sensitive part called the
frenulum and the head of the penis, which is almost always otherwise
covered. Some liken the function of a foreskin to that of a lip or an
eyelid, as it protects the mucosal membrane beneath.
Circumcision removes about 15 square inches of skin containing about
20,000 nerves (as an adult), makes the penis an external organ with the
head constantly exposed, disables the frenulum, the lubricating
function, and its gliding mobility, and even dulls the color of the
penis—and that’s if the procedure goes well.
“Overwhelmingly, men who have foreskins like them and want to retain
them, whereas men who have never had a foreskin assume it’s useless,”
Earp says.
Largely absent from the scientific and medical literature is research
on the sexual benefits of foreskin for men; there’s almost a complete
void when it comes to how male circumcision impacts sex from a female
partner’s perspective. A 2015 paper by Jacobs and Arora claims that
foreskin has basically no effect on sexuality, but it cites likely
biased sources connected with Brian Morris, and, as Earp points out in
a critique published in the American Journal of Bioethics, the
research they cite relies mainly on a pair of clinical trials that were
carried out—not on infants—but on adult men who were voluntarily
circumcised.
But even absent a basis for comparison or any compelling research,
intactivists contend that the loss is dire.
“The effects of adult circumcision, whatever they are, cannot be simply
mapped on to neonates,” Earp says.
Likewise, the big question for the folks over at Foregen is if they can
map the function of adult foreskin back onto someone who was
circumcised as a neonate.
Clopper, whose friends call him “foreskin guy,” has been a vocal
intactivist ever since his college rugby team went to Scotland. “We’d
get really drunk and naked and do really stupid things. Not gay things,
just weird things,” Clopper says, which was when he noticed that his
Irish counterparts weren’t circumcised, prompting a debate over which
penile format was better.“I said, ‘I think being circumcised is better
so I’ll do my own research.’ Now that I know that having the entire
penis is better, it seems insane that I felt otherwise,” Clopper says.
Ever since his initial foray into circumcision research, he’s connected
with several other men who also feel they have been robbed of one of
nature’s coolest biological functions, and are pissed about it. “It’s
really a brainwashing,” he says. “Once they realize what they lose—and
the internet’s a huge help—that’s where the outrage comes from.”
The biomedical technologies that would enable a procedure like this to
be conducted safely are still theoretical at best, but Foregen founder
Vincenzo Aiello of Rome, Italy, says he plans to have a procedure
patented and cleared for clinical trials within five years.
“The peripheral nervous system can regenerate. The only obstacle to
getting this to work is getting the new nerve endings to connect to the
severed ones,” Clopper says. “We are able to graft entire limbs to
amputees right now. We’re doing the same thing using the same exact
technology but on a smaller scale with a bigger market.”
"Now that I know that having the entire
penis is better, it seems insane that I felt otherwise."
The process Clopper described would involve taking a donor foreskin and
decellularizing it, or 3-D printing a new cellular skeleton, then
“reseeding the decellularized matrix” with stem cells matched to the
recipient. “They’ll pick up on the cellular signals and grow into the
full tissue,” Clopper says. They completed their first animal
experiment in December of 2013 at the University of Bologna’s School of
Veterinary Medicine in Italy. “Foreskin has proved exceptionally
fruitful as a regenerative agent, making the likelihood of real
foreskin regeneration in vivo, on a living male, all the better,” the
website claims.
Though the science may be theoretically possible, it’s definitely not
there yet. Perhaps the greatest challenge, even beyond the theoretical
stem cell science, is the piece that involves grafting or regenerating
peripheral nerves; nobody can do that yet, and the first people to
figure it out probably won’t use it for foreskin.
When I asked Aiello about the exact details of the procedure, he said
he couldn’t tell me because he wanted to protect his future patent, but
I got the feeling that he still had some conceptual track to lay. After
all, Aiello is a mosaic artist, not a scientist. That said, plenty of
startup founders know nothing about the technology that powers their
products when they go into VC meetings. Currently, he is working on a
sculpture project that he described as an anatomical depiction of the
adult foreskin, which he expects to be highly controversial.
The Foregen team admits that “the main obstacle in achieving foreskin
regeneration is aligning the overwhelming demand for a cure for
circumcision with the correct scientific personnel.” Aiello told me the
biomedical researchers who have agreed to work with Foregen so far have
done so on the condition that he doesn’t name them. “I think they are a
little bit scared for many reasons. They don’t want to be remembered in
history for regenerating the foreskin. It’s basically a taboo.”
Aiello estimates that Foregen, a nonprofit registered in the US and
Italy, has raised about $100,000 to date from private donors, mainly
Americans, and intends to crowdfund the rest. But this is a negligible
amount compared to what will be needed to set up a clinic if and when
the procedure makes it through clinical trials. “We’d like to do
everything in four years, but we don’t know if this will be possible
because the bureaucracy makes the entire process very slow,” he says.
Regardless of whether or not Foregen meets their quotas, the main
variable that will impact the prevalence of infant circumcision in the
United States and beyond in coming years is the culture. If present
trends are any indication, that culture is shifting in favor of
foreskins. What’s needed now to confirm that this is indeed the most
beneficial path—health-wise, ethically, and sexually—is unbiased
research collected to this end that could formally influence the
recommendations of respected medical bodies and perhaps even local law.
When I asked Earp how to achieve this, he shrugged. “It would be great
if there was some dispassionate researcher somewhere who was just
curious about the effects of circumcision.”
Correction: This post was updated to clarify how often Brian Morris's
research criticism cites his own work, changing "mostly" to
"disproportionately." The post was also updated to clarify
that the city of San Francisco considered, not proposed, a 2011
proposal for a circumcision ban.
[Variations of this story were
published widely with headings like "Men Will Soon Be Able To Regrow
Their Foreskin". This is hopelessly optimistic and discounts the
importance of leaving babies' foreskins on them. Already some objectors
to infant cutting are being told "Who cares? If he doesn't like it, he
can just restore it when he grows up."]
