Preputial sac

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Preputial sac is the term applied to the space between the prepuce and the glans penis.[1] The preputial sac may also be called the sub-preputial space or preputial cavity.

Description

The preputial sac is lined with mucosa as is appropriate for an internal organ where moisture is present.[2] Urine and other sources of moisture are not harmful to it.

Parkash et al. (1973) reported that epithelial debris accumulates in the preputial sac and forms smegma.[3], a natural, normal, benign, healthy, and beneficial product of the body, which will collect in the preputial sac.

Wetness in the preputial sac is associated with having a longer prepuce.[4] Parkash et al. (1982) studied the wetness to learn its source. The authors concluded "that the space is kept moist and also clean in those with preputial stenosis, by the secretions of the prostate, supplemented by the seminal secretion of the mucin content of the secretion of the urethral glands."[5] The authors further reported that the wetness is rich in lytic material.[5] Lytic material causes lysis or a breakdown of cell walls.[6] Moistness also may be maintained by transudation.[2] The preputial sac may also receive pre-ejaculate.

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 keep the preputial sac closed against the outside world and contamination.[7]

Cold & Taylor (1999) described a healthy microbiome that lives within the preputial sac.[2] 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:

Langerin is a natural barrier to HIV-1 transmission by Langerhans cells
Langerin prevents HIV-1 transmission by LCs. HIV-1 captured by Langerin was internalized into Birbeck granules and degraded. Langerin inhibited LC infection and this mechanism kept LCs refractory to HIV-1 transmission; inhibition of Langerin allowed LC infection and subsequent HIV-1 transmission. Notably, LCs also inhibited T-cell infection by viral clearance through Langerin. Thus Langerin is a natural barrier to HIV-1 infection, and strategies to combat infection must enhance, preserve or, at the very least, not interfere with Langerin expression and function.[8]

Washing

Birley et al. (1993) studied 43 men with recurrent or persistent balanitis at an outpatient genitourinary disease clinic in London, 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 gel.

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.[9]

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.[10]

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.[10]

One frequently hears the advice to wash the preputial cavity at least daily to prevent infection. This advice is outmoded.[9] [10] 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.

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.

See also

References

  1. REFweb (2012). preputial sac, The Free Dictionary by Farlex. Retrieved 7 October 2022.
  2. a b c REFjournal Cold CJ, Taylor JR. The prepuce. BJU Int. January 1999; 83, Suppl. 1: 34-44. PMID. DOI. Retrieved 8 July 2021.
  3. REFjournal Parkash S, Jayakumar S, Subramanyan K, Chaudhuri S. Human subpreputial collection: its nature and formation.. J. Urol.. August 1973; 110(2): 111-2. PMID. DOI. Retrieved 7 October 2022.
  4. REFjournal O'Farrell N, Chung CK, Weiss, Helen. Foreskin length in uncircumcised men is associated with subpreputial wetness. Int J STD AIDS.. December 2008; 19(23): 821-3. PMID. DOI. Retrieved 7 October 2022.
  5. a b REFjournal Parkash S, Raghuram R, Venkatesan K, Ramakrishnan S. Sub-preputial wetness - Its nature. Ann Nat Med Sci (India). July 1982; 16(3): 109-12. Retrieved 7 October 2022.
  6. REFweb (2012). Lytic, The Free Dictionary by Farlex. Retrieved 7 October 2022.
  7. REFjournal Lakshmanan S, Parkash S. Human prepuce: some aspects of structure and function. Indian J Surg. 1980; 44: 134-7.
  8. REFjournal de Witte L, Nabatov A, Pion M, Fluitsma D, de Jong MAWP, de Gruijl T, Piguet V, van Kooyk Y, Geijtenbeek TBH. Langerin is a natural barrier to HIV-1 transmission by Langerhans cells PDF. Nature Medicine. 4 March 2007; 13(3): 367-71. PMID. PMC. DOI. Retrieved 6 October 2022.
  9. a b REFjournal Birley HDL, Walker MM, Luzzi GA, Bell R, et al. Clinical Features and management of recurrent balanitis; association with atopy and genital washing] PDF. Genitourin Med. October 1993; 69(5): 400-3. PMID. PMC. DOI. Retrieved 9 October 2022.
  10. a b c REFjournal Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Infect. October 1998; 74(5): 364-67. PMID. PMC. DOI. Retrieved 14 January 2022.