NOTE: IMAGES OF INTACT INFANTS AND SMEGMA PEARLS SHOWN ON THE BOTTOM OF THIS PAGE.
Imagine that you’re changing your two-year-old son’s diaper one day and you notice a lump on his penis that you hadn’t seen before. If you had to describe it, you’d call it a cyst. It is a little squishy and might even shift around when you press on it. You are worried and immediately call to schedule an appointment with your son’s pediatrician. Now imagine these two scenarios happen at the doctor’s office:
Scenario 1: The doctor looks at your son’s penis, recognizes the lump, and without retracting his foreskin tells you it’s no big deal. It’s a smegma pearl and will clear out on its own.
Smegma, while the word itself sounds a bit gross, is actually a normal, natural substance found in mammalian genitalia. (Yes, non-human mammals have it, too!) This white amalgam of skin cells, oils, and moisture can build up underneath the foreskin of males and around the clitoris and labia minora of females. In an adult male, the main purpose of smegma is to provide lubrication during intercourse by allowing the foreskin to glide without friction. Both adult males and females can easily wipe away any visible smegma accumulation in the shower and rinse with warm water.
In infants, more smegma is created as the foreskin starts to naturally separate from the glans. Because that smegma has a relatively small amount of space to float around in, and only a small hole from which to exit, small lumps of smegma may form and will eventually wash out when the child urinates.
Scenario 2: The doctor looks at your son’s penis, sees the lump, feels it, and either: (1) retracts his foreskin a little bit (a no-no!), telling you not to worry too much, but that if it keeps happening, your son will need to be circumcised; or (2) retracts his foreskin all the way back and starts rubbing the smegma off his glans, telling you that the prepuce of infants should be retracted and cleaned daily.
The doctor in both versions of Scenario 2 is not only incorrect, but may have caused irritation, pain, inflammation, and/or or infection by retracting the child’s foreskin. These symptoms then might result in the doctor claiming that the child needs to be circumcised when the issues never would have arisen if he had just been left alone.
The first scenario is what would happen if you took your son to a pediatrician in a country where natural penises are the norm. The pediatrician would be knowledgeable about smegma pearls and would have seen them hundreds, if not thousands, of times.
The second scenario is what happens far too often in the United States, where the majority of pediatricians lack education on the normal, whole, male genitals because they were likely circumcised or have circumcised spouses. Furthermore, the education and materials used in medical schools and various training programs is often incorrect. The organization Doctors Opposing Circumcision (D.O.C.) explains the maddening reasoning for this: “Unfortunately, of the 40-odd medical, nursing and parent-advice books we at D.O.C. have surveyed, only FOUR give the proper advice. The rest regurgitate 19th century puritanical folklore, a sad commentary.”
It can be very frustrating as a parent of an intact boy in the United States to not be able to rely on your doctor for accurate care of your son’s body. And it’s even more frustrating that this kind of misinformation perpetuates the cycle of unnecessary genital cutting in the USA.
Below you will find some images of what smegma pearls can look like.
Of course, all human body parts have the potential for illness and disease, but the majority of the time, in cases of the intact penis, the body is doing what it is meant to do. Smegma is naturally occurring in many mammals and is nothing to be disgusted by or fear.