At the neck of the penis, skin known as the foreskin or prepuce grows. In circumcised men, the foreskin has been removed. In uncircumcised men, the foreskin is very loose skin that resembles the scrotum and it covers the glans of the penis when the penis is flaccid (limp). The sac-like space between the foreskin and the glans when the foreskin is draped over the tip of the penis is called the preputial sac.
Pulling the foreskin off the glans is called “retraction.” During childhood the foreskin often attaches to the glans and it cannot be retracted. As young men age, their penis grows and they repeatedly have erections (especially during puberty). These will cause the foreskin to separate from the glans. Boys and young men should not forcibly retract the foreskin if it has not yet separated completely from the glans.
This can rip the sensitive skin covering the glans.
The amount of foreskin can vary from one man to the next, but there are trends in different ethnic groups. Men from Southeast Asia (southern India, Sri Lanka, Malaysia, and New Guinea) tend to have foreskins that not only completely cover the glans, but continue onwards and create a longer tapered end hanging off the tip of the penis. White Europeans from the Northern Mediterranean and East Asians (Chinese and Japanese) tend to have smaller foreskins that rarely completely cover the glans. A study performed in Australia that polled uncircumcised men found that when flaccid, 67% had a foreskin that completely covered the glans with extra draping off the tip, 15% had a foreskin that just covered the glans, and 15% had a foreskin that covered about half of the glans, with the remaining 3-4% having a small foreskin that left the glans fairly exposed. When these same men were asked how completely the glans was covered by foreskin during an erection, 15% reported that the glans was still covered by the foreskin with extra draping off the tip, 22% had the glans just covered, 32% had the glans half covered, and 41% had the glans completely bare.[i]
The high rate of foreskin covering the glans when flaccid often requires uncircumcised men to retract the foreskin before urinating. Likewise, with approximately half of men still having the glans covered (either completely or partially) by the foreskin when they have an erection, these men often retract their foreskin prior to sexual activity. Issues involving excessive foreskin can be found by clicking HERE.
The foreskin also contains preputial glands (also called Tyson’s glands). These glands are sebaceous glands. Like other sebaceous glands in the skin, they secrete oils and waxy substances. Tyson’s glands in particular produce a waxy substance that, when mixed with dead skin cells, is called smegma. Smegma functions as a lubricant between the foreskin and the glans and collects in the preputial sac. Smegma can look like anything from small flakes to being pus-like in some instances. It can have a relatively foul smell when not washed off regularly. When smegma accumulates in the preputial sac, it can be a breeding ground for bacteria.[ii] Because of this, it’s important to go over some basic hygiene tips for uncircumcised men or parents of uncircumcised boys.
Hygiene for the Foreskin
Newborn boys typically don’t need any special care other than ensuring that diaper changes occur regularly to prevent urine and stool from becoming trapped under the foreskin. The foreskin is tightly attached to the glans of the penis at birth and retraction can cause tearing of these sensitive skin surfaces.
During childhood the foreskin will begin to retract bit by bit. The stretching of the penis that occurs during erections will gently roll part of the foreskin off the glans. As part of the foreskin becomes separated from the glans, it’s important for boys to clean between the glans and the foreskin with each bath/shower, being sure to rinse thoroughly and replace the foreskin up over the tip of the penis when finished. By age 10, nearly half of boys will have the foreskin completely detach from the glans so that it can be fully retracted (pulled back) from the glans. By age 17, nearly all young men (99% or so) will be able to fully retract their foreskin.
After young men are able to retract their foreskin fully, it is important to cleanse the foreskin and glans daily by retracting the foreskin and cleaning the area with a mild soap and rinsing the area thoroughly. After cleaning the area, the foreskin should be replaced over the head of the penis.
In addition, retracting the foreskin during urination to prevent urine from spraying into the preputial sac (the “sac-like” area between the glans and the foreskin that is made by the foreskin itself) can also help keep the area clean. However, whenever the foreskin is retracted (for cleaning, urinating, or sexual activity) it should be replaced over the glans of the penis to prevent paraphimosis which is discussed below.
[i] http://www.circinfo.net/what_is_circumcision.html (9/29/18)
[ii] Slide 8 on presentation at http://www.slideshare.net/AshaDamodhar/my-ppt-60868693 (3/25/17)
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