Smegma is the white, thick, cheesy substance that collects under the foreskin of the penis. It is common in uncircumcised male as this substance tends to collect under the foreskin, if left unwashed after awhile.

Common misconceptions of Smegma

Smegma is not a disease and is a natural occurrence for males. It is released by sebaceous glands in the penis to keep it lubricated. Therefore, it is made from a combination of fatty oils, dead skin cells, and some moisture such as sweat. 

That being said, accumulated smegma can become a nidus of infection for bacteria and pathogens. This may cause some bad smell and lead to further inflammation of the penis head and foreskin. 

To prevent smegma accumulation, good hygiene is always advised. People with phimosis may also have more frequent smegma build-up as the foreskin is usually left unretracted. 

In cases of severe smegma build-up, circumcision may be an option.

Grade 1

Penis is larger but not hard

Grade 2

Penis is hard but not enough for penetration

Grade 3

Penis is hard enough for penetration but not completely hard

Grade 4

Penis is completely hard
Medication

Oral medications is a method to reverse erectile dysfunction by enhancing the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis.

Although they work in similar ways, each oral medication has a slightly different chemical makeup. These minor differences affect the way each medication works, such as how quickly it takes effect and wears off, and the potential side effects. Your doctor will consider these factors as well as other conditions you have and possible interactions with other medications you take.

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Sildenafil (Viagra)

This medication is most effective when taken on an empty stomach one hour before sex. It's effective for four to five hours or more if you have mild to moderate erectile dysfunction.

Duration of effectiveness/half-life: 4 hours Dosage: 25mg, 50mg, 100mg Common side effects: Hot flushing, headache, abnormal vision (changes in colour vision), muscle pain, uncomfortable stomach
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Tadalafil (Cialis)

Duration of effectiveness/half-life: 17.5 hours Dosage: 2.5mg, 5mg, 10mg, 20mg Common side effects: Hot flushing, headache, stomach upset, back pain, stuffy nose, dizziness

Duration of effectiveness/half-life:
17.5 hours

Dosage:
2.5mg, 5mg, 10mg, 20mg

Common side effects:
Hot flushing, headache, stomach upset, back pain, stuffy nose, dizziness

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Vardenafil (Levitra)

Duration of effectiveness/half-life: 4.5 hours Dosage: 2.5mg, 5mg, 10mg, 20mg Common side effects: Hot flushing, headache, stomach upset, back pain, stuffy nose, dizzines, flu-like symptoms

Duration of effectiveness/half-life:
4.5 hours

Dosage:
2.5mg, 5mg, 10mg, 20mg

Common side effects:
Hot flushing, headache, stomach upset, back pain, stuffy nose, dizzines, flu-like symptoms

Treatment

Surgery

Circumcision

Principle of therapy:
Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. After foreskin is removed, smegma is unlikely to accumulated within foreskin anymore. 

Duration of Surgery:
45 minutes to 1 hour

Pre-procedure preparation: Advisable to come with a family member/friend. Prior topical anaesthesia will be given to be applied over penile shaft and base to reduce pain during surgery and nerve block injection.

Post-procedure care:
Minimal bleeding is normal post circumcision. Compression bandage and bed rest may be advised during first day post procedure. Wound would be bandaged for at least 3 days. Wound inspection would be done on day 3 after surgery, after which bandage would be removed and further follow up usually not required unless further complications should happen. Wound should be kept dry at all times after surgery. Make sure to dry/ blow dry with hair dryer after shower. Sutures used are usually absorbable suture – no need for removal.

Treatment

The treatment method for frenulum breve is called a ‘frenuloplasty’, where the tension over the frenulum will be released surgically and a number of sutures would be applied to close the wound. 

Frenuloplasty may be done together with circumcision, sometimes, especially if the patient is having phimosis or other indications for circumcision.

Men's Health

Penile filler

Frequency: 
Depending on filler type. For absorbable fillers, in general, a top up is required every 2-3 years. 

Duration: 
Depending on target. A rough estimate of 30minutes- 45minutes. 

Pre-procedure preparation:
Numbing cream will be applied to site of procedure and left for at least 20minutes.

Penile block will then be given, so no pain will be felt throughout the procedure. 

Post-procedural care:
Minimal pain may be felt once anaesthesia wears off. Adequate pain killers will be supplied. 

Minimal to nil bleeding may be expected. 

No bandaging required.

No urinary issues is expected. 

May resume regular intercourse once pain subsided.

Men's Health

Priapus Shot (P-shot)

Principle of therapy:
Using Platelet Rich Plasma (PRP) from our blood that contains proteins involved in healing and growth

Duration of therapy:
30 minutes per session.

Frequency of therapy: Recommended frequency of once a week

Pre-procedure preparation:
None.

Side effects:
Blood will be taken from arm via syringe and needle. PRP will be extracted from blood and injected back into penis. Mild pain or discomfort may be observed over site of injection, however not lasting as small needle is used for injection.

Men's Health

EMkegel

Principle of therapy:
Using electromagnetic waves to simulate kegel exercise, strengthening perineal muscles- muscles involved during erection and intercourse.

Duration of therapy:
30 minutes per session.

Frequency of therapy: Recommended frequency of therapy would be 2-3 times per week, however flexible.

Pre-procedure preparation:
None.

Side effects:
Mild tingling sensation during procedure. Zero downtime post procedure.

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