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'''{{FULLPAGENAME}}''' is the term applied to the space on the [[intact]] [[penis]] between the [[prepuce]] and the [[glans penis]].<ref>{{REFweb

}}</ref> The preputial sac may also be called the '''sub-preputial space''' or '''preputial cavity'''. [[Circumcised]] men do not have a preputial sac.

==Description==When boys are born, the preputial sac is sealed shut by a [[synechia]] called the ''balanopreputial lamina'',<ref name="deibart1933">{{REFjournal |last=Deibart |init=GA |title=The separation of the prepuce in the human penis |journal=Anat Rec |date=1933 |volume=57 |issue= |pages=387-99 |url=http://www.cirp.org/library/anatomy/deibert/ |quote= |DOI=https://doi.org/10.1002/ar.1090570409 |accessdate=2023-05-23}}</ref> so it cannot be [[Infection| infected]]. The preputial sac will remain closed for a variable number of years.  The preputial sac is lined with [[mucosa]] as is appropriate for an internal organwhere moisture is present.<ref name="cold-taylor1999">{{ColdCJ TaylorJR 1999}}</ref> [[Urine]] and other sources of moisture are not harmful to it. The [[glans penis]] (head of the [[penis]]) is covered and protected from friction and abrasion by the [[foreskin]] while it is in the preputial sac, so it does not accumulate [[keratin]], and maintains its [[Foreskin sensitivity| natural sensitivity]].

Parkash et al. (1973) reported that epithelial debris [exfoliated skin or mucosa] accumulates in the preputial sac and forms [[smegma]].<ref name="parkash1873">{{REFjournal

}}</ref>, a natural, normal, benign, healthy, and beneficial product of the body, which will collect harmlessly in the preputial sac.

Wetness in the preputial sac is normal and associated with having a longer [[foreskin| prepuce]].<ref name="ofarrell2008">{{REFjournal

}}</ref> The preputial sac may also receive [[pre-ejaculate]]. The authors further reported that the wetness is rich in lytic material.<ref name="parkash1982" /> Lytic material causes lysis or a breakdown of pathogen cell walls.<ref>{{REFweb

}}</ref> Moistness also may be maintained by [[transudation]].<ref name="cold-taylor1999" />The sac may vary from very slightly moist to wet.

A longer [[prepuce]] helps to keep out contaminants and pathogens.<ref name="fleiss1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> Lakshmanan & Parkash (1980) described the muscle fibers in the [[prepuce ]] (known as the [[dartos]]), which contract to keep the prepuce snugly close to the [[glans penis. The muscle fibers form a whorl at the tip to keep the tip of the foreskin and the preputial sac closed against the outside world and contamination]].<ref>{{REFjournal

}}</ref> The muscle fibers form a whorl at the tip to keep the tip of the [[foreskin]] and keep the preputial sac closed against the outside world and contamination.<ref name="fleiss1998" />

Cold & Taylor (1999) described a healthy [[microbiome ]] that lives within the preputial sac.<ref name="cold-taylor1999" /> They also reported that Langerhans cells are found in the mucosa of the preputial sac. [[Langerhans cells]] are part of the immunological defenses of the [[penis]]. De Witte et al. (2007) reported that Langerhans cells produce a substance named ''langerin''. The langerin offers protection against HIV infection:

Birley et alThe fragrance may contain stimulating pheromones and is variously characterized. (1993) studied 43 men with recurrent or persistent [[balanitis]] at an outpatient genitourinary disease clinic in LondonA few find it offensive, but others find it attractive, pleasing, exciting, stimulating, [[United Kingdom| UK]] where most men are [[intact]]. Of the study group only 33 percent were [[circumcised]]. Birley and colleagues discovered that the men in that group washed frequently with soap or shower gelarousing. <ref name="vocabulary2024" />

Some believe that the use of soap in the preputial sac harms the natural [[microbiome]] and increases the strength of the fragrance. The musky foreskin fragrance may be contained by avoiding retraction of the [[foreskin]]. ==Washing==Birley et al. (1993) studied 43 men with recurrent or persistent [[balanitis]] at an outpatient genitourinary disease clinic in London, [[United Kingdom| UK]] where most men are [[intact]]. Of the study group only 33 percent were [[circumcised]]. Birley and colleagues discovered that the men in that group washed frequently with soap. The men were instructed to wash less frequently, to stop using soap, and to treat with emollients. The soap and shower gel apparently removed the natural skin oil, which appears to be essential for health of the [[mucosa]] of the preputial sac.<ref name="birley1993">{{REFjournal

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"/> 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 sac at least daily to prevent [[infection]]. This advice is outmoded.<ref name="birley1993" /> <ref name="fleiss1998" /> Washing may introduce pathogens into the preputial cavity.<ref name="fleiss1998" /> It also removes the skin oil and protective lytic substances described above. It is better to rinse only as necessary, using only clear warm water.<ref>{{FleissP HodgesF VanHoweRS 1998REFbook |last=Bigelow |first=Jim |author-link=Jim Bigelow |year=1994 |title=The Joy of Uncircumcising!: Exploring Circumcision: History, Myths, Psychology, Restoration, Sexual Pleasure, and Human Rights |url=https://www.amazon.com/Joy-Uncircumcising-Circumcision-Psychology-Restoration/dp/093406122X |editor= |edition=2 |volume= |chapter=The Reputation of the Foreskin in America |pages=74 |location= |publisher=Hourglass Book Pub |isbn=978-0934061223}}</ref>It is customary to wash before and after sex. If the [[foreskin]] is non-retractable, then a rubber-bulb ear syringe may be used to squirt warm water into the [[foreskin]] to flush it out for an occasional washing. Washing is recommended before and after sex and as desired to remove accumulated [[smegma]]. <b>Soap, body wash, and shampoo should not be used inside the preputial sac, because they remove the beneficial skin oil.</b> == Urination==[[Intact]] men sometimes ask, "do I have to retract my [[foreskin]] when I pee?"<ref>Some men with abundant overhanging foreskin find it awkward and difficult to retract and keep retracted their [[foreskin]] because the foreskin is constantly pushing to glide forward to return to its normal position of covering and protecting the [[glans penis]].</ref> They may have been heard myths that it is unhealthy to have [[urine]] inside the [[foreskin]], however there is no factual basis for that claim. Urine has a healthy microbiome<ref name="cold-taylor1999" /> when it leaves the urethra and is helpful for flushing out the [[foreskin]] and keeping it clean. Boys by necessity pee through their [[foreskin]] because it does not retract and men with [[phimosis]] also pee through their foreskin because the foreskin does not retract. It does no harm so it is not necessary to pull back when you pee. Everything in the preputial sac is covered with [[Mucosa| mucosal membrane]] (similar to the inside of your mouth), which likes to be wet, so no damage or threat to health or well-being is caused by having [[urine]] inside the [[foreskin]]. The sphincter action of the preputial orifice functions as a one way valve, blocking the entry of contaminants and pathogens while allowing the passage of urine.<ref name="fleiss1998" /> The [[urine ]]will help to flush contaminants and pathogens out of the [[foreskin]]. Some individuals may experience [[ballooning of the foreskin]], which is harmless. The [[foreskin]] overhang or [[acroposthion]] may be used as a hose nozzle to control and direct the stream. It may help to stretch one's [[foreskin]] out from one's body. One man said, "When I need to pee, I open my fly, pull my foreskin out and give it a tug to get any wrinkles out, then I hold my foreskin with the thumb and forefinger of both hands and use the overhang of my foreskin to direct my stream. When I finish, I milk it a bit to get any residual pee out of my [[urethra]]."

The presence of the healthy microbiome, the [[Langerhans cellsForeskinned]], and the lytics in men may report feeling a slight tickling sensation as the sub-preputial moisture give the preputial sac strong immunological functions. [[Circumcisionurine]] destroys the preputial sac and its protective immunological functions and makes the patient more vulnerable to flows out through their [[infectionacroposthion]] throughout life.<ref name="fleiss1998" />

One frequently hears the advice to wash the preputial cavity at least daily to prevent infectionmay pull back or not pull back for [[urination]]. This advice Either way is outmodedokay.<ref name ="birley1993" ==Video===A NSFW video of a [[foreskinned]] man urinating through his [[acroposthion]].  https:/> <ref name="fleiss1998" /> Washing may introduce pathogens into the preputial cavitywww.reddit. It also removes the skin oil com/r/4skinoverhang/comments/15xxkyc/overhang_soft_pee/ {{SEEALSO}}* [[Balanitis]]* [[Care of intact elderly men]]* [[Hygiene]]* [[Immunological and protective lytic substances described abovefunction of the foreskin]]* [[Meatus]]* [[Microbiome]]* [[Penis]]* [[Pheromone]]* [[Posthitis]]* [[Pre-ejaculate]]* [[Semen]]* [[Smegma]]* [[Transudation]]* [[Urinary tract infection]]{{LINKS}}* {{REFweb |url=https://www. It is better to wash only as necessarycirp.org/library/hygiene/ |title=Penile hygiene in the intact non-circumcised male |last=Anonymous |first= |init= |publisher=Circumcision Reference Library |date=2013 |accessdate=2023-10-31}}* {{REFweb |url=https://intactamerica.org/intact-penis-care/ |title=Intact Penis Care: Embracing Natural Well-being |last=Garrett |first=Connnor |init= |publisher=Intact Aamerica |date=2024-03-09 |accessdate=2024-05-10}}

[[Category:TermMedical term]]