What is balanitis?
Balanitis is an inflammation of the glans penis (head of the penis).
What are the symptoms of balanitis?
The symptoms and signs of balanitis are variable. They may include:
- A pink or red rash, which may be smooth or scaly, spotty or patchy
- Redness, swelling and tenderness of the glans
- Discharge or oozing
- Itching and discomfort
- In severe cases, it may be difficult to retract the foreskin (phimosis)
Balanitis may be accompanied by urethritis (inflammation of the urethra) and/or other skin problems.
What causes balanitis?
Balanitis is a general term that includes specific skin conditions and infections that may affect the penis, including:
- Dermatitis of various kinds including contact allergy, e.g. to rubber condoms, fragrances or medicament
- Flexural psoriasis
- Reiter syndrome
- Lichen sclerosus
- Lichen planus
- Plasma cell balanitis
- Fixed drug eruption
- Penile intraepithelial neoplasia
In these conditions, there are usually signs of the skin condition elsewhere. Specific tests may help make the diagnosis. When these are negative, the origin of the balanitis is considered 'nonspecific'. It is a type of intertrigo.
Nonspecific balanitis appears to be an irritant reaction related to proliferation of bacteria (pseudomonas, anaerobes) and yeasts (candida). These may normally be found in small numbers on healthy skin.
Predisposing factors include:
- Moisture (sweat), which permits the microorganisms to thrive. Nonspecific balanitis nearly always affects uncircumcised men, as the tissue under the foreskin may fail to dry out properly.
- Infrequent washing and/or failure to dry the glans after washing
- Conversely, over-frequent washing, especially with standard alkaline soap, or drying vigorously with a harsh towel
- Diabetes mellitus, which especially increases the likelihood of Candida albicans infection
- Sexual partner suffering from vaginal thrush (in which case it's the partner's yeasts that cause the irritation rather than a sexually transmitted infection)
- Chemical irritants, e.g., lubricating jelly, medicated creams
- Minor trauma – this may include friction during sexual intercourse
The main aim of treatment is to keep the head of the penis and foreskin clean and dry. This should prevent infection and thus complications. Daily showering with particular attention to cleaning this area is necessary.
Slide the foreskin back towards your body so the head of the penis is exposed. Wash with warm water; do not use soap as this may irritate the area. A nonsoap cleanser such as aqueous cream may be used if desired, then it should be rinsed off.
After washing, dry the area thoroughly. Make sure the head of the penis is completely dry before replacing the foreskin.
If you are prone to develop balanitis a few hours after sex, wash the penis shortly after having sex.
Medical management of balanitis
To determine which factors are contributing to balanitis, a swab may be taken for bacterial and yeast culture. Urethral cultures may also be necessary, and occasionally, blood tests for syphilis and diabetes. In persistent cases, a skin biopsy is appropriate to determine whether there is an underlying skin disease or cancer.
Frequently the most useful treatment is a combination of the following:
- Astringent compressess using dilute vinegar (acetic acid 1%), Burow's solution (aqueous solution of aluminium acetate) or potassium permanganate
- Topical antifungal medication
- Topical antiseptic or antibiotic
- Mild topical steroid
The problem may recur, in which case the treatment may be repeated. Potent topical steroids should only be used for a few days, or under careful medical supervision, as they may thin the tissues. Also, withdrawal of topical steroids can result in a flare of symptoms (periorifical dermatitis or steroid dependency).
In refractory cases, circumcision may be necessary to prevent recurrence.
What are the complications of balanitis?
The main complication of balanitis is phimosis. This is where the foreskin adheres to the inflamed and swollen glans penis and cannot be retracted. Correction of phimosis requires a surgical procedure, such as a dorsal slit or circumcision (removal of the foreskin).