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The proponents of not circumcising nevertheless stress that lifelong penile hygiene is required. This acknowledges that something harmful or unpleasant is happening under the prepuce. Studies of middle class British  and Scandanavian  schoolboys concluded that penile hygiene, as such, is at best poor and at worst non-existent.
Smegma is produced by the foreskin's inner surface and contains neutral lipids, fatty acids, sterol and exfoliated cells. Excretion of smegma increases in adolescence and peaks at age 20-40 years. Whereas initially it is a lubricant having a white or pale yellow color, with time, chemical transformations take place and it becomes mixed with epithelial cells, dirt and micro-organisms; these form aggregates and produce foul odors. The bacteria alone give off an offensive smell and most people consider smegma to be unclean . Improved penile hygiene is perhaps the major reason for circumcision (82% in one study ) and, for most, smegma is regarded as unclean and infected with micro-organisms (88% in the same study ). Penile hygiene is often difficult to achieve and attempting a very high degree of hygiene in uncircumcised men can result in new dermatological problems. For mothers and fathers, it is far easier to maintain cleanliness of their son's penis if it is circumcised.
A survey in London of 150 uncircumcised and 75 circumcised men found 4% of circumcised compared with 26% of uncircumcised men had inferior genital hygiene behavior, i.e., did not always wash the entire penis (the uncircumcised men did not always wash under the foreskin) . Balanitis, phimosis or other foreskin conditions that made foreskin retraction painful might have contributed to their inferior hygiene. The circumcised men also washed the genitals more than once per day (37% vs 19%; P = 0.01).