Excess Smegma Production post Balanitis?

[UDontKnow]

Had a 32 y/o patient presenting to family medicine clinic and he is s/p 2 episodes balanitis successfully tx w/OTC clotrimazole cream.

He complained of excess smegma accumulation starting a few days after the last episode of balanitis cleared up. My attending counseled him on proper shower hygiene and recommended him to apply petroleum jelly on the glans and the shaft of penis after retracting the foreskin 2x/daily for 7 d.

He came back to follow up in 2 wks time and stated he developed excess smegma accumulation within 48 hours of stopping petroleum jelly application. My attending and I were not sure how to further counsel this patient aside from continuing petroleum jelly application.

I would appreciate input on mgmt of a clinical scenario like this.

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[felipe5]

smegma is just epithelial debri that accumulates under the prepuce which likely has been exacerbated by his balanitis. at this point I'd recommend a circ--not sure petroleum jelly is of any benefit honestly

 

[UDontKnow]

smegma is just epithelial debri that accumulates under the prepuce which likely has been exacerbated by his balanitis. at this point I'd recommend a circ--not sure petroleum jelly is of any benefit honestly

Thanks. I'll forward the recommendation to my attending tomorrow.

But are you telling me that there is no other recourse aside from circumcision? The pt. did not have phimosis at any point, his foreskin retracts back rather easily, and the only problem seems to be just cosmetic at this point.

 

[felipe5]

yeah, circumcision is recommended in uncirc'ed pts with recurrent balanatis. It'll also allow him to keep things cleaner which is likely contributing to the problem. Topical treatments will just treat infections when possible but are not used for prophylaxis (we do occasionally use steroid cream in those with tight phimotic prepucial bands to loosen things up if they don't want circs). I think any urologist would rec a circ at this point

 

[birchswing]

OK, I came across this randomly while Googling something, but am I reading this correctly that a doctor is trusting another stranger on the Internet representing himself as a doctor for whether he should remove the foreskin of his patient?

Is that how medicine really works?

I don't have an MD. I have a high school diploma. I don't know if that counts for anything around MDs, but reading this, my first thought was: has anyone checked him for diabetes? That would explain the frequent infections.

It seems like typical American medicine to identify a symptom and treat it, often barbarically, without looking for a root cause.

That's what a caveman would do. He wouldn't think to himself: well if the foreskin is the problem, in which way is it the problem? What about the foreskin is diseased? Is my assumption that the foreskin is the problem even correct? If the foreskin is the problem, why isn't it the problem for every man who has one, and why isn't the clitoral hood a problem for ever woman who has one?

The issue at this point should not be treatment but diagnosis.

For all you know, you might have a patient who wants a circumcision for cosmetic purposes and is trying to get it justified by his insurance.

It's 5:20 AM and I am crashing so I hope I made sense.

Think before you circumcise.
Hope is not enough.

 

[cpants]

OK, I came across this randomly while Googling something, but am I reading this correctly that a doctor is trusting another stranger on the Internet representing himself as a doctor for whether he should remove the foreskin of his patient?

Is that how medicine really works?

I don't have an MD. I have a high school diploma. I don't know if that counts for anything around MDs, but reading this, my first thought was: has anyone checked him for diabetes? That would explain the frequent infections.

It seems like typical American medicine to identify a symptom and treat it, often barbarically, without looking for a root cause.

That's what a caveman would do. He wouldn't think to himself: well if the foreskin is the problem, in which way is it the problem? What about the foreskin is diseased? Is my assumption that the foreskin is the problem even correct? If the foreskin is the problem, why isn't it the problem for every man who has one, and why isn't the clitoral hood a problem for ever woman who has one?

The issue at this point should not be treatment but diagnosis.

For all you know, you might have a patient who wants a circumcision for cosmetic purposes and is trying to get it justified by his insurance.

It's 5:20 AM and I am crashing so I hope I made sense.

Think before you circumcise.
Hope is not enough.

I think you got lost. Diabetes is a risk factor for balanitis. Screening for diabetes should, of course, be done, and presumably has been as the patient is seen regularly by a PCP.

Why is the foreskin not a problem for every man? Why is the appendix not a problem for everyone? Some uncircumcised men get balanitis. That is just the way it is. There are numerous risk factors for developing the inflammation, and it can be prevented with good hygiene, but not always. In recurrent cases circumcision is a valid option. The patient should be informed of the risks and benefits, and he will have to decide for himself whether he wants to go through with it. Balanitis can be extremely painful, and I have seen patients begging for a circ. Who are you to judge?