The Journal of Sex Research Vol. 28, No.1, pp.

145-156 February, 1991

Clinical Notes
SEXOLOGY, BODY IMAGE, FORESKIN RESTORATION, AND BISEXUAL STATUS

JOHN MONEY, Ph.D.

Johns Hopkins University and Hospital

Foreskin restoration, far from being a modem fad, has ancient origins. The history of this practice traces back to Roman times. During the reign of the Emperor Tiberius (A.D. 14-37), in Book III of De Medicina (Trans., 1938), Aulus Cornelius Celsus described two surgical methods of foreskin restoration. Both are illustrated diagrammatically in Schneider (1976) and Rubin (1980). The more radical operation was for those who had been circumcised and had a completely exposed glans penis. The less radical was for those whose own foreskin was too short to cover the glans completely. The latter required a circular cut at the base of the penis so as to free the skin of the penis to be stretched forward, until there was enough foreskin to cover the entire glans and to be held there, tied with a string. The former required a circular cut around the head of the penis at the corona. The skin of the shaft of the penis was then degloved from its underlying tissue. Thus freed, it could then be pulled forward to cover the glans penis in the manner of a foreskin. The raw tissue over which it was pulled forward was packed with plaster to prevent adhesions while healing, and the reconstruction was held in place with a bandage. The fact that Celsus described an operation to lengthen a natural foreskin that was too short is itself proof that the function of the operation was cosmetic. It enabled a young athlete to conform to the Hellenistic ideal of gymnastic nudity, namely that competitors should have a foreskin that completely covered the glans penis. The same applied also to the operation devised for young athletes who had formerly been circumcised. They were sons of the circumcising peoples of North Africa and the eastern Mediterranean. So that they could compete in the games, they also needed to conform to the Hellenistic ideal. As the ideal of the Hellenistic athlete faded with the fall of Rome, so also did the practice of foreskin restoration become neglected, if one judges by the silence of the historical record. That silence was broken only in the recent past when the cosmetics of the foreskin and its restoration underwent a revival. In the United States, this revival coincided with the genesis of a healthreform movement that repudiates routine neonatal circumcision as an unnecessary surgical mutilation (Wallerstein, 1980). Neonatal circumcision had

Supported by USPHS Grant HD 00325. Requests for reprints should be sent to Dr. John Money, Suite LL20, Old Town Office Center, 1235 E. Monument Street, Baltimore, MD 21202. 145

146

CLINICAL NOTES

become a routine practice in the 19th century on the basis of the faulty belief that it would prevent masturbation in later years (Kellogg, 1888; 1906). This belief was derived from Tissot's 18th-century revival of the ancient Ayurvedic theory that loss of the sukra (semen) caused degeneracy, disease, and death (Money, 1985; Prakasam et aI., 1991). The revival of foreskin restoration more or less coincided also with the rise of the sexual liberation movement, including the gay liberation movement, which gave men the freedom to be explicit about the foreskin as an erotic organ. In response to an invitation in the Newsletter of the Uncircumcised Society of America (USA), volunteers and their partners, both male and female, provided written comments on the foreskin as a visual and tactile erotic organ (Berkeley & Tiffenbach, 1983). Some seekers of foreskin restoration attempted on their own initiative to regain a foreskin by means of taping, tying, and progressive stretching. Others underwent plastic surgery (Greer et aI., 1982; Mohl et aI., 1981) or selfsurgery (Walter & Streimer, 1990). Establishing a kinship of purpose, some of them formed BUFF, a small network of Brothers United for Future Foreskins. Independently of this network, in the six years after 1977, four men applied to Johns Hopkins Psychohormonal Research Unit (PRU) to request advice and to give information regarding their fixation on foreskin restoration. A fifth man volunteered an account of his personal experience of foreskin restoration by stretching. These are the people whose cases are here reported. The purpose of the report is documentary. It is also comparative, insofar as each case differs from the other four in the degree and pervasiveness of the fixation on foreskin restoration. Sample and Procedure The five cases constitute a self-selected, availability or opportunity sample, assembled over a six-year period. The size of the foreskin restoration population from which they are self-selected is not known, nor is the range of its phenomenological variability. Table 1 summarizes various pertinent characteristics of the five cases. The data in this report were collected according to the Systematic Schedule of Inquiry regularly used in the PRU. Interviews were recorded and transcribed. They were then indexed so that data could be categorized for use in the tables and in biographies of the Findings section. Findings The findings listed in Table 2 provide chronological and other data pertinent to the circumstances regarding circumcision and the quest for foreskin restoration and its outcome. Table 3 provides data on various sexuoerotic practices and fantasies relative to the development of sexuoerotic experience as homosexual (Kinsey rating 6) or heterosexual (Kinsey rating 0) rated severally for prepuberty, adolescence, and adulthood. The sample lacks homogeneity to a degree sufficient to require documentation of individual differences. Hence the brief biographies of circumcision and foreskin restoration that follow. Their sequence is chronological, according to the order in which they were obtained.

CLINICAL NOTES

147

Table 1
Sample Characteristics: Foreskin Restoration Cases (N

= 5)
Biography 4 43 years Invitation Biography
5

Biography 1 Age referred Referral by Education Religion Offspring Erect penis length Psychotherapy history Selfdiagnosed Suicidal ideation 20 years Self (mail) College courses Evangelical Protestant None 7 inches Yes Yes Yes

Biography 2 48 years Psychotherapist Trade training Protestant Seven 6 inches Yes Yes Yes

Biography 3 49 years Self (mail)

33 years Invitation College graduate Jewish None 6Y2 inches No Yes No

College College graduate graduate FundaRoman mentalistl Catholicl Protestant Atheist None None
51t~

inches

6 inches No Yes No

Yes Yes No

Table 2
Circumcision and Foreskin Restoration Data (N

= 5)
Biography 4 Birth Routine No 22 years Insensitive, too dry 27 years Surgery Defective Try again Biography
5

Biography 1 Age circumcised Reason circumcised Father circumcised Onset felt mutilated Glans defect Onset restoration fixation Restoration method Restoration outcome Outcome response 10 years Paternal decision Yes 10 years No

Biography 2 2 years Maternal decision No? 7 years No

Biography 3 Birth Routine No 8 years No

Birth Bris Yes 30 years Sensitive, painful 30 years Stretching Excellent Satisfied

10 years Surgery Failure Resignation

42 years None None Unascertained

24 years None None Acceptance

148
Table 3

CLINICAL NOTES

Se:JCuoerotic Practices and Fantasies: Foreskin Restoration Cases (N

= 5)

Biography Biography Biography Biography Biography 1 2 4 5 3 Kinsey rating: Prepuberty Adolescent Adult Primary sex partner(s) Male/Female Transexual implications Paraphilic-type imagery Bondage Urinary Masturbation Give oral sex Accept oral sex Give anal sex Accept anal sex Penovaginalsex

K2 Kl Kl
Female No Yes No Yes Yes Yes Yes Yes Yes

K2 K6 K5
Female No No Yes Yes Yes Yes No No Yes

K6 K6 K5-6
Male No No No Yes Yes Yes No No Yes

KO-l KO-l KO
Female No No No Yes Yes Yes No No Yes

K6 K6 K6
Male No No Yes Yes Yes Yes No? No? No

Biography 1

The son who is the subject of this biography had a father who had been routinely circumcised as a baby. When the son was young, the father would often remark unfavorably on the boy's foreskinned penis in comparison with his own, particularly with respect to urinary hygiene. He harassed the boy if he saw him urinate without retracting his foreskin, which was difficult to do. When the boy was ten, the father announced, as casually as if it were time for a haircut, that it was time for him to be circumcised. Without comprehending what actually would happen, the boy acquiesced. Postsurgically, the first time he saw his raw and denuded penis, he became desperate to have the operation reversed. He blamed himself for having acquiesced. Years later, the father's justification for the circumcision was fear of infection. He had had a friend in childhood who had developed an infection requiring circumcision. But the son had a suspicion that his father "had believed in circumcision as a way of altering a person's personality. If he had done that to me to alter my personality from what it was, it upset me bad enough to make me want to die. So maybe I should have given him a taste of it [death), himself." Evidently, the son's preoccupation with foreskin restoration served as a distraction from patricide. To be circumcised was to be like his father who had not only brought about the mutilation of his penis but also had quit fathering him at the age of six, when he broke away from his marriage. Thereafter, the children saw their father only infrequently. Another problematic paternal characteristic was the potentially stigmatizing one of skin color: the father was partially of dark Hispanic heritage, and the mother was not. By age twenty, foreskin restoration was the all-consuming preoccupation of the young man's life. He searched academic libraries for books and articles on

CLINICAL NOTES

149

genital reconstruction and sent out to clinics and doctors manifold copies of a letter requesting surgical help. He was incontestably convinced that perfect foreskin restoration, which would completely cover his glans penis again, was technically feasible. He became so desperate at not finding a surgeon who would promise such a perfect restoration that he unwisely attempted self-surgery. The circumstances were that he had been intoxicated. Leaving his touring theater group, he wandered off to a wooded lakeside alone. With a razor blade, he cut deeply around the corona of his penis, only to find that no skin would pull forward to cover the glans. Confronted with failure, he slashed his wrists, but could not prevent the blood from coagulating, even by submerging his arms in the lake, and scraping the wounds with a stick. He went to sleep on the marshy lake shore, expecting to die from exposure to the wet and cold. He lived to go back to the village, phone his mother, and be rescued. Six months later, he came to Johns Hopkins, self-referred. Here he was overwhelmed by the tragedy of finding yet another plastic surgeon who could not guarantee a full-length foreskin. He could not accept the option of a partial foreskin, possibly to be extended later in a second operation. Following a hiatus of several years, he wrote to say that after his Johns Hopkins visit, he had designed a surgical procedure and found a surgeon who would perform it. A tubular sleeve of skin was lifted, one end of which would eventually be detached and grafted into place to heal as a foreskin. When the graft failed to attach to the shaft of the penis, the donor skin was regrafted in its original location. The young man was not ready to admit defeat. He designed and constructed "a prosthetic foreskin of nylon and compounded silicones," which was, he wrote, "for my purposes undetected as being artificial. After using the device for about a year, I found that my mental state had calmed, and I felt much more at peace with myself. Eventually, I found myself no longer compelled to use the device." During his first interview, he had said: "If I can find the surgery I want, and if the results are pleasing to me, I'll probably marry my girlfriend. But if that isn't the case, and we split up for any reason, then almost as easily as considering a relationship with a woman, I would consider one with a man, just for the sake of experience, if nothing else. But I don't think I'd be quite as easily led into a loving relationship with a man as with a woman." In actual fact, he and his girlfriend did split up, but he did not have a male relationship. He became a recluse, immersed in his career which, upon remission of the foreskin obsession, changed from theater to computers. The theme of sexual injustice in his own life became generalized to a concern for individuals and minorities subjected to sexual injustice and false accusation. The theme of being inexplicably subjected to surgery became generalized to being alert to mysterious predictions and coincidences. Apparently, the trauma of circumcision had had a far-reaching impact on his life.
Biography 2

In mid-life, this man had already had several years of counseling for sexual and marital problems. He procrastinated before implementing his therapist's

150

CLINICAL NOTES

recommendation to seek a sexological consultation regarding the feasibility of foreskin restoration. The precipitating factor for the consultation was the excellence of surgical restoration after an accidental injury to a little finger. "The constant reminder of seeing it has further intensified my feeling about replacing the missing foreskin," he said. He had been circumcised when he was two years old-"apparently for no greater reason," he said, "than my mother reading some government health journals that recommended circumcision for infant males, whereupon she took me to the local public health clinic, and they obliged.... I remember standing on a table and feeling embarrassed, having my clothes taken off in this big room in front of everybody. I felt the physician or somebody doing something to the end of my penis, and I felt a burning sensation." Postsurgically, the wound became infected: "My mother told me that it was a traumatic experience and that-in her words-the doctor bungled the job." With his father away for weeks at a time, working, and his mother, an invalid, he lived in a coed boarding school during the middle years of his childhood. At bedtime, there were unsupervised opportunities to see other children naked. He could recall playing sex games with girls and asking boys who were uncircumcised "to pull their foreskin back. I had great fascination to watch that... I knew that I was deprived, that something was missing that I should have had, but I didn't know why." In early adolescence, he had perhaps a dozen experiences with four different homosexual men who had picked him up when he was hitch-hiking from the outer suburbs into the city. "I don't think it was the sex so much as their companionship and friendliness I enjoyed.... I never gave it a thought [that I might become the same as they were].... Now that I think about it, I was always kind of curious to see if the men were circumcised or not. And in every case they were." Retrospectively, he did not recall anything specific to circumcision or foreskins between puberty and age 40. Both of his sons had been routinely circumcised. The end of his first marriage left him lonely and depressed. His second marriage lacked the affectionate intimacy for which he yearned; there was less intimacy when they were closely body to body than when they talked about circumcision. "We're both involved in Bible study, and the Old Testament talks about circumcision endlessly. It's a constant theme .... My wife thinks: You are circumcised, so why can't you accept that and forget it?" His Old Testament, fundamentalist spirituality was completely at odds with what he identified as a 40- to 60-day cycle "of going into a kind of sexual fantasy, repetitive thing ... a sexual aberration... After a period of what I would consider being my normal, everyday self, then comes a feeling or pressure of something building up. And then I go into this fantasy pursuit ... a sexual fantasy trip. I spend an afternoon in the porno district of the city, just watching films, and later fantasizing and masturbating." As masturbation stimuli, films in which the male actors had foreskins were more effective than the others. The search for foreskins in what he called "porno flicks" allowed him to become aroused to a degree not fulfilled in his marriage. Having a restored foreskin of his own promised to be a talisman, so to speak, that would bring erotic passion to his otherwise perfunctory marital relationship-perfunctory

CLINICAL NOTES

151

in part, he conjectured, by reason of his wife's older age and postmenopausal status. Regarding the extent to which male actors and models with foreskins may have been homosexually stimulating, he said: "Homosexual contact, it is only a fantasy in my mind, a relationship with an uncircumcised male, just, um, I suppose, on the level of curiosity.... I'm very cautious about the emotional implications that would be involved [in having sex with a male]. This is where my spiritual or religious background and training put a damper on taking it any further than fantasy." The chief item on the patient's agenda in seeking a sexological consultation had been to ascertain the state of the art of plastic surgery for foreskin restoration. He was advised that, if his foreskin obsession failed to go into remission, there could be no prophetic guarantee ahead of time that foreskin restoration surgery would resolve it. The question would be answered only by taking the real-life test of actually undergoing surgery. That test should not be embarked upon precipitously and would require additional consultations. None was requested, and the patient became lost to follow-up.
Biography 3

"The matters which I hope to communicate to you, Dr. Money, had their beginning the day I was born: Like many, if not most, Americans, I was circumcised." The writer of the unsolicited letter in which this statement appeared was responding to a male-to-female transexual's on-camera conversation with Dr. Money and the host of an after-midnight television show. The sexual explicitness of the discourse permitted the letter-writer to disclose what he had formerly withheld from several psychiatrists, he said, namely, that at the age of 8 or 9 he had "developed an immediate feeling that something was wrong with me .... I have two cousins; and my brother and I were pis sing against the side of the cow shed when one cousin looked over and said: 'Hey, they ain't got no skin on the end of their dicks.'" He had been brought up too prudishly to inspect his cousin's penis, or to ask for more explanation. He was too near-sighted to see clearly the difference between the cut and the uncut penises of other boys. Forty years later, he wrote, "I have still-existing feelings of inferiority .... I have a fixation, if not a fetishism, about foreskins." Twice around the age of 30, he reported, "something had caused me to go off my rocker." He had been hospitalized both times in a state of acute psychiatric crisis. Subsequently, he was maintained on an outpatient basis with medication. "My hospitalizations," he wrote, "resulted in my giving up hope of a normal life and marriage. I came out of the closet and cruised the gay bars for a few years." This practice was in conflict with his fundamentalist religious beliefs. "It seemed to me at that time that the guys to whom I expressed an interest, and liked because of their foreskins, rejected me for apparently reducing them to a little flap of skin.... Nevertheless, I still have the hangup about foreskins, and a curiosity about what is normal, mentally as well as experientially, for other guys. . . . Any information or references you can give me would be greatly appreciated."

152

CLINICAL NOTES

After a period of three years, he said: "Well, it would be nice to have a foreskin, but it's not essential. I used to have the feeling that there was something wrong with me. But now I no longer have that feeling. I accept myself as I am. Strangely enough, watching some pornographic films seemed to help. I have a videocassette recorder .... I saw some films that feature guys who were circumcised. That somehow just sort of soothed my psyche, just to realize that it doesn't really make that much difference any more .... I would not desire the operation [to restore the foreskin], even if I had the opportunity."
Biography 4

The subject of this biography volunteered to be included in the present study. He first came to attention by way of an article he had written on surgical foreskin restoration, copies of which he mailed to various people whose names he found in anticircumcision newsletters. He promoted the sharing of information on foreskin restoration as an extension of his interest in obtaining surgical restoration for his own foreskin. Formerly, he had been interested in sharing an avocational interest in handcrafting model guns. His main vocation was in industrial design graphics. His parents came from a gentile tradition with no family history of circumcision. However, his mother consented to the Americanization of her newborn son by allowing him to be circumcised. The shaft of the penis was excessively denuded. At puberty, there was insufficient skin for erectile comfort and easy masturbation. He knew from an early age that some boys had a foreskin whereas he did not. When pubertal, he compared himself with other boys who masturbated at summer camp and began to have an image of his circumcised penis as having been mutilated. There was no change in this image of mutilation in the course of three marriages. He was in his thirties when he came across "personals" in various special-interest newspapers and magazines that specified an interest in uncircumcised men. Progressively, he became dedicated to the ideal of regaining the perfect penis with which he had been born. Using library services, he found out everything he possibly could about foreskin restoration. The outcome was that he decided to undergo a surgical procedure for foreskin restoration. To picture stage 1 of the procedure, suppose that the glans penis is completely bare and needs at least 4 cm of foreskin to cover it. Then, measuring 4 cm from the corona of the glans penis along the penile shaft, the surgeon makes a ring-shaped cut around the skin covering of the shaft. Then the surgeon releases and peels a tube of skin forward from the cut (rather like peeling back the skin of a sausage), until it covers the glans at the head of the penis. The exposed surface of the tube as well as the denuded section of the shaft of the penis are, of course, both raw. They need to be covered with skin from some other part of the body, namely from the scrotum by means of a tunnel graft. A tunnel is pierced downward through the skin of the scrotum. The tip of the penis is then threaded through this tunnel until the tip of the glans and its urinary opening are exposed. Within the tunnel, the raw surfaces of the peeled penile shaft and the future foreskin fuse with the raw surface of the scrotal skin which, when released, becomes the exterior surface of the foreskin and of the peeled section of the penile shaft.

CLINICAL NOTES

153

Stage 2 of the procedure is undertaken several weeks later, after fusionhealing within the tunnel is completed. The entrapped section of the penis, newly enveloped in scrotal skin, is surgically released from its tunnel. This is done by cutting the scrotal skin bilaterally along each side of the tunnel. The two outer edges are then sutured together on the underside of the penis. In the present instance, the success of stage 2 was severely compromised by postoperative bleeding beneath the skin on one side of the penis and the scrotum. Healing eventually took place, leaving an excess of scar tissue, a curvature of the glans penis, and an uncosmetic appearance. Not one to be defeated by surgical failure, the man discovered a new report of nonsurgical foreskin restoration by stretching. He obtained some initial gain from stretching, but it did not improve the appearance, color, and thickness of a foreskin constructed of scrotal skin. He planned, therefore, to continue to stretch the unspoiled skin on the distal shaft of his penis until it was sufficiently redundant to permit additional surgery for cosmetic repair. Foreskin restoration by stretching became the new ideal he promoted.
Biography 5

This man gave his foreskin restoration history for present purposes at the request of a friend. He reported that he had a vivid memory of being perhaps as young as three and sitting in front of a neighbor's new Hamilton washer and dryer, "watching the clothes fall through the dryer with the little glass window, the incandescent lamp, and the purple germicidal lamp." By the time he was sixteen, he was enamored of second-hand household labor-saving devices, various models of which he remembered from childhood. He made a hobby of collecting and restoring them. As an adult, he owned several antique working models which he put into operation from time to time. He then became fascinated with the challenge of restoring his foreskin. It was as though, with a foreskin, he would become a one-of-a-kind model, namely, a Jew who had a functionally restored foreskin. Although Judaism was the faith in which he had been circumcised, his upbringing had been secular. At age sixteen, he became active in the faith and adhered to the kosher dietary rules. Meanwhile, his parents had become practicing Protestants. He did not join them, in part to distance himself from his mother whom he characterized as an emotional abuser. He characterized himself as having become emotionally self-sufficient. By having a foreskin, he considered that he might also have an improved erotic life, for the ridge of tissue at the corona of his circumcised penis was painfully hypersensitive, especially to the rubbing of masturbation. He masturbated alone to avoid exposure to AIDS. He had first become aware of sexual attraction as early as age five. It was toward a man and remained exclusively toward men. By way of advertisements in gay magazines, he knew that there were other gay men interested in foreskin restoration. He read about attempts at restoration through stretching and by surgery. Only stretching appealed to him. He developed his own method by trial and error. Initially, it was necessary to stretch the small amount of redundant skin on the shaft of the penis by pulling it forward over the glans as far as it could be stretched and then taping it down for as long a time as possible. Next, the incipient foreskin was stretched even

154

CLINICAL NOTES

more by packing sponge or gauze around the corona of the glans, and then pulling the skin over the glans as far as it would go before taping it down so that it would not retract. Eventually, there was enough length of foreskin so that it could be pulled through a tight-fitting metal ring worn firmly in place on the glans, like a ring on a finger. This speeded up the stretching of the skin so that, after the ring had been in use for a year, only a small area around the urinary meatus could be seen when the ring was in place, as was evident in a medical photograph. After another couple of years, the new foreskin hid the entire glans penis, and the ring was no longer needed. The restored foreskin was so satisfactory in appearance that its possessor was accepted for membership in a brotherhood of The Uncut. His agenda completed, he had no additional body-image concerns. Discussion The five cases share in common a preoccupation with body image specific to the circumcised end of the penis. It is a cosmetic body-image preoccupation, of which there are three categories: restoration, ablation, and refiguration. Foreskin restoration belongs self-evidently in the first category. Among the five cases, preoccupation with foreskin restoration varied according to age of onset, intensity, psychopathology, morbidity, context of life in which it appeared, orientation as homosexual or heterosexual, method of treatment, and outcome. In the two cases of attempted surgical restoration, the outcome was cosmetically and functionally unsuccessful. In the case of restoration by self-administered, progressive stretching, the outcome was cosmetically and functionally successful. According to self-reports in foreskin restorers' newsletters, there have been cases in which the stretching method fails, possibly through lack of persistence; and satisfactory cosmetic success by the surgical method has apparently not been fully achieved in any cases. The unexpected outcome of Biography 1 was that, although persistently severe, the obsession went into remission after the patient's personal surgical design had been tried and had failed. There was also a remission of the obsession in Biography 5 following success by stretching. The ultimate postsurgical outcome in Biography 4 is not known. In Biography 3, the obsession went into remission with the circumcision unaltered, and in Biography 2 there may also have been a remission. There was no evidence in any of the five cases of conspiratorial selfmutilation in the manner of Munchausen's syndrome, nor of the erotization of pain, as in paraphilic masochism. Preoccupation with restoration of one's foreskin might be regarded as the antipode or converse of paraphilic fetishism directed to the foreskin of others. An analogy would be preoccupation with becoming an amputee oneself (apotemnophilia) and its antipode, paraphilic attraction to the amputated stump of an amputee (acrotomophilia). Not one of the five men was dependent on foreskin to such a degree that erotic arousal and achievement of orgasm was contingent on either the presence or the mental image of a foreskinned penis. Thus, preoccupation with foreskin restoration does not qualify as a paraphilia. However, in Biographies 2,3, and 5, the men did have imagery of males with foreskins on some occasions when they masturbated, which suggests a mild degree of sexological

CLINICAL NOTES

155

proximity to paraphilia. It suggests also sexological proximity to homosexuality of erotic orientation. A lifetime of exclusively homosexual orientation was present only in Biography 5, as also in the biography of his brother who was, however, in different to foreskin restoration. Apart from four heterosexual contacts, the man of Biography 3 was also homosexually oriented, but his opportunities were restricted by his obsession to find foreskins. Thus, he was able to adhere more closely to the fundamentalist teachings of his religion. Antihomosexual religious scruples were also important to the twice-married man of Biography 2. His homosexual outlet was visual only, in bimonthly binges at sex movies and porno stores. In Biography I, homosexuality of orientation postpubertally existed only in imagery. Most of the imagery, however, was heterosexual. This was in conformity with exclusively heterosexual practice. In Biography 4, foreskin restoration was a bridge between heterosexual and homosexual, but only by reason of inquiries from homosexual foreskin seekers who were members of the same information network. In sum, except for Biography 5, foreskin restoration served as a bisexual bridge with individually diverse degrees and phenomena of homosexual and heterosexual on either side of the bridge, respectively. These five cases illustrate the marvelous complexity of the sexology of body image in its relationships to erotic imagery and practices and to sexual orientation, whether bisexual, heterosexual, or homosexual.

References BERKELEY, B., & TIFFENBACH, J. (1983). Foreskin: Its past, its present and . .. its future? Copyright, Bud Berkeley, P.O. Box 26011, San Francisco, CA 94126. CELSUS, A. C. (1938). De Medicina, with an English translation by W. G. Spencer. Vol. III, Book VII, pp. 421-425. Cambridge: Harvard University Press. GREER, D. M., JR., MOHL, P. C., & SHELEY, K. A. (1982). A technique for foreskin reconstruction and some preliminary results. The Journal of Sex Research, 18, 324-330. KELLOGG, J. H. (1888). Plain facts for old and young. Burlington, Iowa: I. F. Segner. New York: Arno Press, Reprint Edition, 1974. KELLOGG, J. H. (1906). Man the masterpiece, or plain truths plainly told about boyhood, youth, and manhood. Warburton, Victoria, Australia: Signs of the Times Publishing Association. MOHL, P. C., ADAMS, R., GREER, D. M., & SHELEY, K. A. (1981). Prepuce restoration seekers: Psychiatric aspects. Archives of Sexual Behavior, 10, 383-393. MONEY, J. (1985). The destroying angel' Sex, fitness and food in the legacy of degeneracy theory, graham crackers, Kellogg's com flakes and American health history. Buffalo, NY: Prometheus Books. PENN, J. (1963). Penile reform. British Journal of Plastic Surgery, 16, 287288.

156

CLINICAL NOTES

PRAKASAM, K. S., MO:-.iEY, J., & JOSHl, V. N. Web., 1991). Theory of semen conservation in ancient Ayurvedic and modern sexology. Proceedings of the First International Conference on Orgasm, New Delhi, in press. RUBIN, J. P. (1980). Celsus' decircumcision operation: Medical and historical implica' tion. Urology, 16, 121-124. SCHNEIDER, T. (1976). Circumcision and "uncircumcision." South African MedicalJournal, 50, 556-558. WALLERSTElK, E. (1980). Circumcision: An American health fallacy. New York: Springer. WALTER, G., & STREIMER, J. (1990). Genital self-mutilation: Attempted foreskin restoration. British Journal of Psychiatry, 156, 125-127.