The mother of this 5-year-old boy was concerned about a whitish mass underneath her son's foreskin. The mass, first noted 6 months earlier, did not seem to bother the child. Urination was normal. The child was not circumcised. The mass was whitish, smooth, round, uniform, doughy, well-circumscribed, and underneath the foreskin in the midshaft of the penis.
The whitish mass is smegma- a cheesy-like material composed of desquamated epithelial cells. Smegma was once thought to be produced by sebaceous glands located within the mucosal surface of the foreskin near the frenulum. Subsequent histological examination of hundreds of foreskins has failed to find these glands.
The accumulation of smegma is simply part of the physiological retraction of the foreskin. Smegma helps to dissect the space between the glans and foreskin and also prevents readherence. In addition, smegma helps to protect and lubricate the glans and inner lamella of the prepuce.
There is some evidence that smegma may lead to genital cancer, but the subject is still very controversial. Rarely, smegma may harden to form smegma stones. Regular gentle retraction of the foreskin and meticulous genital hygiene may facilitate removal of the material.
FOR MORE INFORMATION:
? Leung AK, Wong AL. Pediatric genital disorders. Consultant for Pediatricians. 2003;2:122-130.
? Van Howe RS, Hodges FM. The carcinogenicity of smegma: debunking a myth. J Eur Acad Dermatol Venereol. 2006;20:1046-1054.