Changes

Fleiss, Hodges & Van Howe (1998) reported the presence of cathepsin B, lysosyme, chymotrypsin, neutrophil elastase, and cytokine in the sub-preputial moisture. These substances have a destructive lytic effect on pathogens and make the preputial sac a trap for disease-causing organisms.<ref name="fleiss1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> The presence of the healthy microbiome, the [[Langerhans cells]], and the lytics in the sub-preputial moisture give the preputial sac strong immunological functions. [[Circumcision]] destroys the preputial sac and its protective immunological functions and makes the patient more vulnerable to [[infection]] throughout life.<ref name="fleiss1998" /> One frequently hears the advice to wash the preputial cavity at least daily to prevent infection. This advice is outmoded.<ref name="fleiss1998" /> Washing may introduce pathogens into the preputial cavity. It also removes the skin oil and protective lytic substances described above. It is better to wash only as necessary.