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Illustrated here is an uncircumcised adult male with foreskin retracted. This individual presents with a significant but not untypical accumulation of smegma (sometimes called 'cock cheese'). Smegma is thought to be the cause of numerous penile infections as well as female urinary/genital infections in the man's partner. The penis begins producing ever greater quantities of smegma during puberty and, if the male is not circumcised, care must be taken to wash the penis regularly to prevent the accumulation of this foul-smelling substance.

Younger uncircumcised males should be regularly checked to ensure that no smegma has been allowed to collect under the foreskin or behind the glans. A good indication of a smegma problem in a pre-pubescent or pubescent boy is if he repeatedly feels his genitals through his clothing, perhaps as often as every couple of minutes. Sometimes mistaken for masturbation, such behaviour actually indicates a need for some urgent parental intervention at bathtime.

But is it only uncircumcised men that have problems with smegma? No. The extent to which circumcision cures the smegma problem depends on the style of circumcision. A loose style that allows residual inner foreskin to bunch up behind the glans when the penis is flaccid may reduce the amount of smegma produced, but it will not eliminate it completely. Only a tight style (leaving the sulcus permanently exposed) will achieve that.

Paediatric case study from Thailand

The following image shows a major accumulation of smegma beneath a foreskin that had not been regularly retracted. Parents who fail to supervise their sons in the bathroom please note! Forget any embarrassment; preferably wash his genitals yourself or failing that watch closely to make sure he does so properly. That means fully retracting the foreskin of an uncircumcised boy as soon as retraction becomes possible. Stretch it right back so as to access the groove of the sulcus, which is where smegma develops. Merely exposing the tip of the glans is not sufficient. Seek help in respect of any foreskin that will not retract fully by the time the boy reaches five years of age.

In the case depicted here, the boy was immediately circumcised in order to prevent a recurrence.

Major accumulation of smegma in a pre-pubescent boy

PHOTO CREDIT:  Nakornping Hospital, Thailand.

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