A penis sheath is either a medical device used to manage urinary incontinence or a traditional garment worn by indigenous peoples in parts of Papua New Guinea and Africa. The term covers two very different things depending on context, and both are worth understanding.
The Medical Device: External Urinary Catheters
In healthcare, a penis sheath (also called a condom catheter or external catheter) is a soft, flexible sleeve that fits over the penis and connects to a drainage bag to collect urine. It’s the primary alternative to an indwelling catheter, which is a tube inserted directly into the bladder through the urethra. National infection prevention guidelines recommend condom catheters over indwelling catheters for men who don’t have urinary retention, because they significantly reduce the risk of catheter-associated urinary tract infections. A randomized trial comparing the two devices found that men using condom catheters had lower rates of bacterial infection, symptomatic UTI, and death compared to those with indwelling catheters.
The device looks and fits much like a condom. Some versions are self-adhesive, coated with a skin-safe sticky substance. Others require medical tape or a special skin-safe glue to stay in place. Certain brands also use supportive underwear to help keep everything secure. The tip of the sheath connects to flexible tubing that runs to a collection bag, typically strapped to the leg or hung beside a bed.
Sizing and Fit
Getting the right size is one of the most important parts of using a penis sheath safely. Sheaths are measured by the diameter of the penis at its widest point, in millimeters. Standard sizes typically range from 25 mm to 40 mm, with several increments in between (28, 30, 32, and 35 mm are common options). If your measurement falls between two sizes, choosing the smaller one is generally recommended for a more secure fit.
A sheath that’s too tight can restrict blood flow, potentially causing tissue damage or even necrosis (tissue death) in serious cases. One that’s too loose will leak and detach. Healthcare providers use a simple measuring tool, essentially a ring gauge, to find the right diameter quickly. The most common causes of strangulation and skin injury are using the wrong size or wrapping adhesive tape directly around the penis, both of which are considered poor practice.
Materials: Silicone vs. Latex
Most penis sheaths are made from either silicone or latex. Silicone is increasingly preferred because latex allergies are a real concern, particularly among people who use catheters regularly and among healthcare workers with frequent latex exposure. Silicone sheaths also resist kinking better and allow urine to flow more freely through the tubing.
Latex sheaths do have one practical advantage: they tend to create less friction during removal, requiring significantly less force to take off. Silicone devices can need up to twice the removal force of latex-based options, which matters for comfort during daily changes. For most people, though, the lower allergy risk and better flow properties of silicone make it the standard choice.
Daily Care and Skin Health
A penis sheath should be changed once every 24 hours. During each change, the skin of the penis needs to be washed, dried, and inspected for redness, irritation, or breakdown. Urine sitting against skin is a direct cause of irritation and bacterial growth, so making sure the tubing has no kinks or loops where urine can pool is essential. The tubing should always run downhill from the sheath to the collection bag so gravity keeps things flowing.
Adhesive buildup in pubic hair is another common problem that leads to skin damage over time. Keeping the area trimmed and cleaning off old adhesive residue before applying a fresh sheath helps prevent this. Any signs of swelling, color changes, or open sores on the penis warrant immediate removal of the device.
The Traditional Garment
Outside of medicine, a penis sheath is a garment worn by indigenous men in parts of Papua New Guinea and Africa. It is exactly what it sounds like: a close-fitting cover shaped to enclose the penis, typically leaving the scrotum exposed unless the design specifically covers it.
In the western highlands of Papua New Guinea, the sheath is most commonly called a koteka, though the name varies by tribe. For men of the Dani, Yali, and Tiom tribes, the koteka is not just clothing but the only acceptable form of dress. Many men wear it as their sole garment, though some pair it with additional items. Papua New Guinean kotekas are traditionally made from dried gourds, often elongated and sometimes decorated.
In Africa, documentation of penis sheaths dates back to 1670, with use recorded across large areas of West Africa, multiple South African tribes, and parts of the Congo. African sheaths tend to be made from leaves, other vegetation, or wood rather than gourds. The practice declined earlier in Africa than in Papua New Guinea. The Thonga tribe, for example, abandoned the sheath in 1820 in favor of Western-style clothing. Before that shift, they wore covers made from palm leaves and sheaths constructed from wood or gourds.
In both regions, the sheath functions as a form of modesty covering, cultural identity, and personal adornment. Researchers categorize it as an item designed to confine the penis rather than a purely decorative accessory, though ornamentation and style carry social meaning within the communities that wear them.