(Editor's note: Dra. Bles Salvador resumes her health and science education through media via a regular blog on news.abs-cbn.com. After the House of Representatives rejected a new franchise for ABS-CBN Corp. last July. Her radio program on DZMM/TeleRadyo ended on August 23, 2020 after more than 2 decades.)

What is smegma? And can it cause cervical cancer?

A lot of times, cruel funny jokes among teenaged boys involve name-calling such as hick, scumbag, twat, f** face, and the like.

But for Filipino teenagers, being called such names in Filipino tends to be more hurtful. When one is called “supot”, for instance, it connotes not only the literal meaning of being uncircumcised but also the state of being less of a male.

In the Philippines, if one is a school grader or nearing the age of puberty, having a circumcision is a must for almost all the boys. And it is considered almost a crime, if not the butt of jokes, if one is in his 20s or more to still be uncircumcised; unlike of course in other countries where circumcision is a matter of choice or considered cultural.

One even hears of many a man who opted to skip circumcision in his younger years, only to have the procedure done in a hurry when about to be married, for fear of the bride laughing at or unaccepting of his “unclean” condition. We also hear of Filipino women who get married to uncircumcised foreign men, and somehow make a big fuss out of it, albeit in a hushed tete-a-tete with a woman friend or two.

For most Filipinos, having a circumcision is a necessary event, and a rite of passage from boyhood to manhood. After the procedure is done by a physician surgeon, one’s penis is considered "guapo" or handsome if the boy opts for the the clean-cut German style, while the Dorsal slit style which has two small flaps likened to a cobra’s neck is considered sexually mean or macho.

The penis is the male organ of sexual intercourse. It has a root that is attached to the wall of the abdomen, a body or shaft, and a head or glans at its end. The glans is covered by loose skin or foreskin.

In the olden days and olden places, this foreskin was stretched out over the glans and swiftly cut off with a sharp knife or a sharp thin knife-like bamboo piece by the neighborhood "manunuli", the man who does the “tuli” or circumcision. The patient is asked to chew some guava leaves which are then plastered to the wound to stop the bleeding and prevent infection; some are asked to jump into the cold river for natural water compression and a symbolic cleansing of the new man.

With the foreskin out of the way and an exposed glans, a guy is then considered clean. Without circumcision, the area between the glans and the foreskin will accumulate a malodorous opaque whitish yellowish creamy substance composed of shed epithelial cells or dead skin, and sebum or oily secretions produced by the sebaceous glands of the genitalia.

A female also has such secretions from her sebaceous glands and the same substance is deposited in the skin surrounding the clitoris. This substance is what we call the smegma in both male and female. It is known as “kupal” in Filipino--and certainly nobody wants to be called a kupal, even as a joke.

Having smegma in one’s body is considered unclean. This being so, it has always been considered a factor in many women’s ailments, cervical cancer included. In fact, smegma has repeatedly been implicated as a carcinogen.

A carcinogen is an agent with the capacity to cause cancer. Many believe that cervical, penile, and prostate cancer come about with background smegma. So, are the pieces of evidence sufficient to say that smegma can cause cervical cancer?

The cervix is a fibromuscular tissue shaped like a cylinder at the lowermost portion of the uterus. It is likened to the neck of the uterus, connecting it to the vagina. Hence, many would call the cervix as “kuwelyo ng matres” in Filipino.

Cervical cancer is cancer of the cells of the cervix. It is estimated that 70% of cervical cancer is due to HPV or Human Papilloma Virus infection. That is why an anti-HPV vaccine is touted as an anti-cervical cancer vaccine. Getting rid of possible HPV infection is like getting rid of 70% chance of having cervical cancer. The remaining 30% is due to factors like hereditary, smoking, multiple sexual partners, having a sexual partner who has multiple sexual partners, frequent untreated infections, and being dirty down there as in using unwashed sexual toys, dirty fingers, and the like.

This is where smegma comes in, since it is considered dirty. Many doctors suggest circumcision of the partner if a patient has repeated cervico-vaginal infections, even if they themselves do not really consider smegma as promotive of infection or cancer. Many studies on animals ang humans do not find a valid supportive evidence of smegma being carcinogenic. But a percentage of write- ups continue to incriminate this opaque, whitish-yellowish, malodorous and creamy substance around the clitoris and the glans penis.

If a woman has sex with an uncircumcised male with his collection of smegma between his glans and foreskin area, the smegma could be deposited to her vagina and cervix and cause cervical cancer, so they say. But we know better.