ABQ's most experienced plastic surgeon discusses male genital hygiene, smegma and circumcision.

Male genital hygiene and smegma 

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The glans or end of the penis is protected by a fold of skin called the foreskin or prepuce.  This is analogous to the  clitoral hood in women and is essential for normal function of the penis. It is rich in nerve endings and has many important functions in sexual activity.


When the penis becomes erect the prepuce slides away exposing the head of the penis for sexual stimulation.  It is lined with grease glands that secrete an oily material which lubricates the area and keeps this tissue pliable and soft. Smegma is composed of a mixture of desquamated surface cells and this grease. Children, both boys and girls, do not appear to create significant amounts of smegma. The body's production increases in adolescence, suggesting a functional or protective role in sexual activity.


Thrush,  or Candidiasis, is a common cause of vaginal irritation and is sometimes seen on the penis. Because of the whitish appearance it is commonly confused with smegma. Smegma accumulation is unusual in developed societies and most men who think they have it are probably infected with candida (monilia). Smegma is more likely to accumulate among the folds of the labia than on the penis, but even in woman a more likely cause of a whitish accumulation around the labial area is candida (monilia).


When this greasy material or smegma is not removed it can even harden in the fossa  or groove at the base of the head of the penis and in severe cases the irritation produced may produce adhesions. This means the foreskin can no longer move back and forth over the glans and may make sexual activity painful.


When smegma collects in the groove at the base of the head of the penis it may smell and collect bacteria and other germs. Cleaning the area is usually easy and involves pulling back the prepuce to expose the groove and is easier in men than women. As with the interior of the vagina, soaps and detergents may cause more harm than good and should be used sparingly, if at all  Simply rinsing well with fresh water using a  GENTLE hand-held shower heads work well.   It is impossible to clean this area by simply standing in a shower that does not detach. Incomplete circumcision may make this area harder to clean.


retracted prepuce

On the top the foreskin covers the glans, on the bottom it is pulled back showing the groove  where smegma can collect and cause adhesions

picture courtesy of wiki-commons


There is a common misconception that circumcision is more hygienic, or cleaner, than the natural condition of the penis.  There is minimal  evidence for this view. It is more  likely that the natural state is protective, and both cleaner and healthier.  In the non-erect state, the prepuce is held against the head of the penis by surface tension, rather like a protective Saran wrap. This prevents germs from entering behind it.  In contrast, in the circumcised penis the urinary meatus (where urine comes out) and head of the penis are constantly exposed to germs and urine. This may be especially so in standard medical circumcision that leaves significant amounts of skin in around 50% of patients. Ritual circumcision often removes more skin so there is less likelihood of incomplete circumcision, but the risk of scar problems is the same or greater.


The idea that smegma causes cancer is a myth. There is no evidence in either women or men, that smegma causes cancer in yourself or your partner. Indeed it may have a protective role in sexual activity.


Some men develop adhesions of the foreskin and inflammation that makes cleaning this sensitive area more difficult. In these cases it is even more important to avoid the collection of smegma.  Sometimes your doctor can gently release these adhesions but in rare cases they need surgical release or even circumcision.

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Author: Patrick Hudson MD,  Albuquerque, NM, USA Tel:505-242-0070
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