# How do you tell the difference b/w pus and smegma?



## mamaverdi (Apr 5, 2005)

I'm sure there is info on here somewhere. Can someone link me directly or just tell me? Thanks.


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## l_olive (Jan 18, 2005)

I think probably the only definitive way would be to have it cultured (without retraction, of course).

But as a general rule, an infection with pus will worsen, but if it's simply smegma washing out, you might see some (or in my son's case a LOT of) redness or swelling, but it was completely gone within 24 hours.


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## MCatLvrMom2A&X (Nov 18, 2004)

Pus can have a really foul odor while smegma while smelling dosnt have that nasty smell.

It is important to rememeber that smegma can be thick, thin or runny. It can be white, offwhite, greenish or yellowish.


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## mamaverdi (Apr 5, 2005)

It seems from reading this: http://www.cirp.org/library/normal/wright1/ that smegma in a diapered child could grow bacteria if not rinsed away. Am I reading that correctly? Is this true?


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## MCatLvrMom2A&X (Nov 18, 2004)

Well I have never had that problem but smegma is dead skin cells mixed with body oil and as well know the whole body is covered in bacteria so I could see how it could grow if it wasnt washed properly or left to sit for a long time in the diaper that is not on the child.

But as long as it is on the body of the child and the child is reasonably healthy I dont see that as being a issue.


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## mamaverdi (Apr 5, 2005)

The child is not healthy.


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## MCatLvrMom2A&X (Nov 18, 2004)

Well if someone is not healthy male/female they are more prone to getting all kinds of things. Like yeast for example.

The only thing that could be done is to make sure that the child is bathed regularly and swish the penis well. If there is room for the smegma to come out it will but if there isnt it wont cause problems.

You would have to be very careful about letting the child sit in soapy water as well. Since soap can be very irritating opening the way for bacteria to move in.

I dont agree with everything I read in that link you provided since I have found different information else were. Example being that a man with phimosis not being able to clean the smegma out would lead to disease. I just dont see that happening since there are men who never retract at all and have no problems. Since smegma in and of itself does not cause disease any more than dandruff does.


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## l_olive (Jan 18, 2005)

Smegma is exactly the same stuff that women get in the folds of their labia if they're not careful or frequent with bathing. It's not a harmful substance, but yes, I would imagine that if it were left to sit there for a really long time, it would probably get pretty yucky.

Are you willing to share more details of whatever this situation is so that we can address more than hypothetical questions?


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## mamaverdi (Apr 5, 2005)

Oh, sorry, it's not hypothetical. It's just extremely complicated. Let me think on this a bit and see if I need to explain more.


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## mamaverdi (Apr 5, 2005)

Would the primary differentiating factor w/o a culture be the smell? (The culture is easy to get, but just not at the this time of night.)


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## l_olive (Jan 18, 2005)

When my son was just a little over 4, we had a problem with the classic separation "trauma" -- lots of swelling and discomfort. I freaked out, got online, and figured out what was probably going on. I had him soak in a warm tub (no soap) for awhile, and after he was out and dressed, he was sitting in my lap. I noticed an odd smell coming, and when I checked it out, there were two dime-sized smears of a rather smelly, light, but almost pinkish-colored substance in his underwear. I know, without question, that this was smegma which had built-up under his newly-retracting foreskin. And then it was diluted enough by urine or bathwater to wash out when the sphincter of his foreskin relaxed enough for it to do so.

Almost immediately after washing out, the swelling started to subside, and was completely gone within a day -- never (to this point at least) to return.

It was smelly, but I'm sure it was smegma, not an infection. An infection that would create that amount of pus would not go away within a few hours without treatment.


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## MCatLvrMom2A&X (Nov 18, 2004)

I would say that the smell would be the biggest give away without a culture.

When my ds had his bacterial infection and his penis was swollen to 5x's the normal size the only discharge I saw was a light greenish color but I didnt need to get any closer to check smell because it was obvious he had a infection due to the other signs.

Another big indicater would be if the redness, swelling and discharge increased over time instead of getting better.

Pus will smell nasty and corrupted smegma will smell like very strong BO and possibly soured.


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## mamaverdi (Apr 5, 2005)

I managed to lose my more information post somehow. Urg.

But this leads me to think it needs to be cultured.

The problem is, we're not completely sure where the pus is coming from. And he can't be bathed frequently.

If it were "old" smegma, would it likely reproduce quickly enough to have the same rotten smell and small amount 8 hours after a bath? For over a month?


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## MCatLvrMom2A&X (Nov 18, 2004)

It sounds like more is definatly going on than just regular smegma. After only 8 hours I dont think it should smell as funky again if it were just smegma involved.

Some people do have pretty strong body odors especially in the genital area but not so that you would be disturbed by it.


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## MCatLvrMom2A&X (Nov 18, 2004)

Does he have redness and swelling along with this discharge?


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## l_olive (Jan 18, 2005)

Well, now I'm a little confused. He's had this discharge from an unknown place for over a month?

This sounds bigger than what I would be comfortable with, but if it's ongoing, then it shouldn't be an issue that it can't be cultured tonight, right?

I'm just missing something. I'm sorry not to be more helpful, mamaverdi.

Oh, and you probably know this, but just to be sure.... smegma can't reproduce - it accumulates if not washed away. It's skin cells and oils, not something growing like bacteria.


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## mamaverdi (Apr 5, 2005)

Nope. Except when he retracted himself (which was new)...which is how we saw any smegma ... what definitely seemed to be smegma, not pus at all.

The problem is so complex. Let me try to briefly explain:

He has multiple urogenital issues/anomalies in addition to a probable immune disorder and metabolic disorder.

He has an opening to his bladder right now b/c his uretha is non-functional. He has had a fistula that runs from the prostate through the scrotum which closed almost 3 y 10 mo ago.

It looks like the pus was coming from his scrotum. But the point at which the tip of his foreskin rests on his scrotum, and on the diaper is the same place where the fistula exit hole and the pus that we see on the diaper is.







: Confused yet?

He complains of pain at the base of his penis on the abdomen where there has been occasional swelling for the last 18 mo.

He has been examined by the ped uro, the ped uro fellow, a gen'l surgeon, two pediatricians. He's had an u/s and a lot of blood work. This is all in the last month and a half since the pus began.

No one can find it, but the gen'l consensus with him is, unless we can find it, we have to wait for all sorts of reasons.

We are supposed to come right back in if we actually see the exit point on his body of the pus.

If what we saw was smegma when he retracted himself, then this is not the pus. If it is pus, then it's more concerned, b/c then it is coming potentially from his urethra...which I'm not even sure is possible.


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## mamaverdi (Apr 5, 2005)

Quote:


Originally Posted by *l_olive* 
Oh, and you probably know this, but just to be sure.... smegma can't reproduce - it accumulates if not washed away. It's skin cells and oils, not something growing like bacteria.

Oh, I'm just tired. Of course. I meant, reaccumulate.


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## MCatLvrMom2A&X (Nov 18, 2004)

You can take some cotton guaze and loosely wrap that around his penis so it would pick up anything coming from there. Wouldnt have to leave it very long hopefully and depending on which side the spot was on you could at least see were it is coming from.

Not sure if it would work with him though just the thought that popped into my head.


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## mamaverdi (Apr 5, 2005)

That's a great idea.


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## l_olive (Jan 18, 2005)

Wow. You're leagues above any advice I might have.

I'm sorry he's having pain, and I'm sorry the medical professionals that you've seen haven't been more helpful.

But I'm really surprised that they won't just culture the opening of the urethra, just to make sure that nothing is amiss there? Here's a really simplistic suggestion... when he has a diaper on, can his penis point upwards so that the foreskin isn't in the same place as his fistula?

And I'm really tired, too, and heading to bed. I hope you can get some real answers, and I hope you'll continue to update here, OK?


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## mamaverdi (Apr 5, 2005)

They aren't being unhelpful. They just can't really do anything at this point. It's a pretty frustrating situation for all of us.

I've tried pointing his penis up, but it doesn't seem to stay there.


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## l_olive (Jan 18, 2005)

Well that's OK, I like MCatLvrMom's suggestion much better anyway!


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## eepster (Sep 20, 2006)

Much smaller quantities of pus would be visible on a kleenex, than a piece of guaze, so you could see what was going on faster. When DS was very little (as in 5 1/2 lbs) and we needed to know if he peed even a tiny amount we put kleenex in his diapers.


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## mamaverdi (Apr 5, 2005)

Boy this is a lovely conversation huh?

Kleenex is a good idea too.


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## Frankly Speaking (May 24, 2002)

Quote:


Originally Posted by *mamaverdi* 
It seems from reading this: http://www.cirp.org/library/normal/wright1/ that smegma in a diapered child could grow bacteria if not rinsed away. Am I reading that correctly? Is this true?


You have to realize that this article is from 38 years ago when the base of knowledge was far less than it is now. I find reason to argue the artcle. For instance:

Quote:


Originally Posted by *From the Article*
Is Smegma useful? Yes, certainly. It lubricates the cavity between the foreskin of the penis and the glans, thus allowing smooth movement between them during intercourse.

In reality, smegma has little lubricating property and is quickly dispersed during sexual activity. It certainly does not have the lubricating properties of vaginal fluids. I can see that it would have some lubricating properties in allowing a smooth transition between the foreskin and glans in non-sexual movements but that is all. During sexual activity the smegma would be dispersed within the first few strokes eliminating any potential for it to be an effective sexual lubricant.

Quote:

They find that in childhood sebaceous glands are in fact present in the inner surface of the foreskin. As age advances, these glands decrease in number and in adult life occur only at the base of the foreskin, inconstantly and sparsely.

Other researchers have found them in rather large numbers in some individuals. But in general, it is now clear that while sebum forms an essential part of smegma in childhood it makes no significant contribution to it in later life.

It appears that smegma is essential to children as an occlusive barrier. For adults, it's function is less known but I suspect it has the function of a repository of essential enzymes and beneficial bacterial colonies. That is, it provides a home for these essential parts of the immune system.

Quote:

They find that in childhood sebaceous glands are in fact present in the inner surface of the foreskin. As age advances, these glands decrease in number and in adult life occur only at the base of the foreskin, inconstantly and sparsely

This would indicate that older men do not have smegma secretions or not significant smegma secretions. As an "older man" myself and from communications with men as old as in their mid 60's, I can tell you that is certainly not true. What is true is that with daily baths, the volume of smegma is not visible but if allowed to accumulate for two days, there will be a thin but visible layer and after the third day, it will be a very noticeable accumulation.

Quote:

Smegma is a substance of considerable chemical complexity, but little is known of its exact composition beyond the fact that it contains neutral fats, fatty acids, sterols; other lipids and cell debris.

I think this is the most accurate statement in the article. However, I have issue with the "fats" statement. These fats would be observed as oils contributing to an oiliness inside the preputial space and it is anything but. A glans that has been exposed for long enough to completely dry out will take on an appearance of chapped lips. That is, completely dried out and taking on a leathery, puckered and cracked appearance. It is obvious there is no oil accumulation there. Simply rinsing the smegma away would leave a significant coating of these fatty oils and none of these exist. Likewise, circumcision advocates will assert that the preputial space is "sweaty" but in fact, mucosal skin has no sweat glands so there is no sweat in the preputial space.

Quote:

But, if allowed to accumulate in the foreskin cavity, it becomes changed into an unpleasant, unhealthy, and bad-smelling substance.

Smegma is only unpleasant from a cultural and esoteric point of view. Yes, I can see that a heavy coating of smegma could be a visual deterent to a sexual partner but it is not unhealthy. If anything, in it's normal state, it is healthy and an essential component to the immune system. However, it does not need to be a significant or even visible collection to have this benefit except in children who are in the process of becoming retractile.

Quote:

In addition, foreign material may gain access to the smegma deposit in the form of dirt, dust or sand, and urine and semen.

This may be a factor in cultures that do not wear clothing and do not bathe regularly. For modern man, the penis is not exposed to dirt, dust or sand. Urine is sterile but I do understand that it can become contaminated. I also understand that it will become contaminated by the normal and beneficial bacteria contained in the preputial space. If urine were a problem in the preputial space, it would also be a problem in the urethra and that is just not the case. I also have a problem in believing that our normal bodily secretions (semen) will have a delatory effect on our health.

Quote:

Cancer of the penis is not common in the United States but is frequent in certain tropical countries. It is almost always associated with uncleanliness and longstanding ill health of the penis. Usually a preceeding phimosis is present. Since the tumor commonly develops with such a closed foreskin cavity, it has been considered that retained smegma could be the cancer-inducing agent.

This is clear evidence that this article should be taken with a grain of sand. It is simply a product of the times and as such is outdated and irrelevant. It is now known that penile cancer is caused by the HPV virus. The relationship with tropical cultures probably has to do with the prevalent sexual practices and level of health care in those cultures.

Quote:

Smegma is a substance of considerable chemical complexity, but little is known of its exact composition beyond the fact that it contains neutral fats, fatty acids, sterols; other lipids and cell debris.

Much is made of the cell debris or "dead skin cells" but I do not believe they constitute a significant portion of smegma. It seems these terms are used to imply a significant portion of smegma consists of these cells. If that were true, the skin of the inner foreskin and glans would quickly erode away. I will agree that little is known about the composition of smegma. It is a topic that could benefit from investigation but I don't believe much useful information could be derived from such investigation and suspect that is the reason such investigation has not been done.

Quote:

Meanwhile, personal hygiene and care of the penis rank high as a protection against chronic disease. Remember that it is stale and accumulated smegma that is a source of ill health for the penis. Freshly formed smegma, washed away regularly and constantly replenishing itself, is a wholesome lubricant

I disagree with the former part of this statement. This kind of information is the reason uninformed physicians insist that young children be forcibly retracted and cleaned. It is now known that children should not be subjected to this cleaning and maintain perfect genital health for decades or more. I have personally communicated with men in their 20's and 30's whose foreskins have never been retracted and they have enjoyed perfect genital health with no infections ever. I do agree that smegma is wholesome but have some issue with it being a lubricant. It might have some slight lubricating properties facilitating the foreskin automatically recovering the glans after an erection but I don't see any benefit as a sexual lubricant.

Frank


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## Frankly Speaking (May 24, 2002)

Quote:


Originally Posted by *mamaverdi* 
Would the primary differentiating factor w/o a culture be the smell? (The culture is easy to get, but just not at the this time of night.)


That would be an indicator but it would take a trained nose to go further than that. The problem is that the physical characteristics of smegma and pus are so similar that when mixed, they are virtually impossible to differentiate.

Quote:

The problem is, we're not completely sure where the pus is coming from. And he can't be bathed frequently.

If it were "old" smegma, would it likely reproduce quickly enough to have the same rotten smell and small amount 8 hours after a bath? For over a month?

I've read ahead a little bit and I'm wondering if your son has been on antibiotics recently? If so, that could account for the "rotten smell." Antibiotics will destroy the normal bacterial cultures that keep these odors in check.

Quote:

The problem is so complex. Let me try to briefly explain:

He has multiple urogenital issues/anomalies in addition to a probable immune disorder and metabolic disorder.

He has an opening to his bladder right now b/c his uretha is non-functional. He has had a fistula that runs from the prostate through the scrotum which closed almost 3 y 10 mo ago.

It looks like the pus was coming from his scrotum. But the point at which the tip of his foreskin rests on his scrotum, and on the diaper is the same place where the fistula exit hole and the pus that we see on the diaper is. Confused yet?

He complains of pain at the base of his penis on the abdomen where there has been occasional swelling for the last 18 mo.

He has been examined by the ped uro, the ped uro fellow, a gen'l surgeon, two pediatricians. He's had an u/s and a lot of blood work. This is all in the last month and a half since the pus began.

No one can find it, but the gen'l consensus with him is, unless we can find it, we have to wait for all sorts of reasons.

We are supposed to come right back in if we actually see the exit point on his body of the pus.

If what we saw was smegma when he retracted himself, then this is not the pus. If it is pus, then it's more concerned, b/c then it is coming potentially from his urethra...which I'm not even sure is possible.

Unfortunately, your son's problems are far beyond the capabilities of this forum. However, for there to be significant accumulation of pus, there would have to be an originating point. When you saw the substance (smegma or pus) did you see an originating point? That is, did you see an open sore or ulcerated area? If not, most likely it was only smegma. For any significant amount of pus to accumulate, there would have to be other physical characteristics such as an open wound or ulceration.

I don't think the physicians are being unhelpful, they are just stumped for an answer. It would appear that at this point, the only way to isolate the infection would be exploratory surgery. I can understand that neither they or you are ready to take that step. I suspect they are waiting until sufficient symptoms develop to make a diagnosis without surgery. That is a cautious approach that I would agree with. You take small steps first and if they don't work, you take bigger steps with the most invasive being withheld for last.

I wish you and your son well and quick healing with this problem.

Frank


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## Quirky (Jun 18, 2002)

I don't have anything helpful to contribute but I am sorry for what you and your son are going through. I hope you can find some answers and some healing.


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## mamaverdi (Apr 5, 2005)

Thanks Frank.

I appreciate the thoughts. The article was simply the only one I could find beyond wikipedia about smegma.







:

I was certainly not relying on the forum to diagnose a child who baffles teams of doctors.







I do agree with their approach, but I don't want to wait until the point of life-threatening sepsis, if something can be done sooner.

I also don't want everyone going around thinking that it is pus when it is just smegma. I was hoping for a simpler answer for this complex child.

They said we will save exploratory surgery for if it becomes basically life-threatening as surgery is a huge risk for him as well.

Unfortunately I can't rely on the idea that there isn't an infection based on not being able to see it on his body b/c he has too many nooks and crannies that most people do not have where infection could breed.

Thanks again.


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## Frankly Speaking (May 24, 2002)

Quote:


Originally Posted by *mamaverdi* 
They said we will save exploratory surgery for if it becomes basically life-threatening as surgery is a huge risk for him as well.


This is not what it once was. With the invention of the endoscope and other techniques, it is often very minor. My Dad had back surgery in the early 1970's and had a 6" incision and was bed ridden for about 2 months afterward. My best friend had the same surgery in the mid 1990's and had a half inch incision and was up and walking around the next day. 2 weeks later, he was out on his boat rafting up with the rest of us. Depending on where the suspected problem is, this could end up being endoscopic surgery and minimally invasive. But, I agree that it should be an option of last resort.

Frank


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## mamaverdi (Apr 5, 2005)

The issue for him is metabolic: fasting before, anesthesia, trauma of the surgery (even minimally invasive), and waiting afterwards to feel better. Last time he had just a very minor surgery he ended up in a coma.


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