What Is Balanitis? What Causes Balanitis?

Balanitis is an inflammation of the glans (the rounded head) of the penis. Posthitis is inflammation of the foreskin. The foreskin is the loose skin that covers the head of the penis if the male has not been circumcised. Balanoposthitis is when both the glans and the foreskin are inflamed. Balanitis can also mean inflammation end of the clitoris. This text focuses on balanitis when it affects the glans of the penis.

Balanitis can occur at any age, but is more likely to affect boys under four years of age, as well as adult males who have not been circumcised. It is a common condition, affecting approximately 1 in every 25 boys and 1 in 30 uncircumcised males (at some time in their life). Balanitis is rare among circumcised adult males.

Balanitis can have both infectious and noninfectious causes. It is more common in patients with phimosis (the foreskin of the penis is too tight). Patients with diabetes mellitus are more susceptible to developing balanitis.

Chronic (long-term, recurring) balanoposthitis increases the risk of developing balanitis xerotica obliterans (chronic dermatitis, most often involving the glans and foreskin), phimosis (foreskin too tight), paraphimosis (when the foreskin is retracted it cannot return to its original location), and cancer.

According to Medilexicon's medical dictionary:

Balanitis is "Inflammation of the glans penis or clitoris"

What are the signs and symptoms of balanitis?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign. Signs and symptoms of balanitis may include:

• The area around the glans (head of the penis) is red
• Inflammation of the glans
• Soreness of the glans
• Irritation of the glans
• Under the foreskin there may be a lumpy, thick discharge
• Itchiness around the glans area
• An unpleasant smell
• Phimosis - the foreskin is tight and does not retract (can't pull it back)
• Painful urination
• The soreness, irritation and discharge under the foreskin typically occurs two to three days after sexual intercourse

Some of the signs and symptoms of balanitis are similar to those of some STIs (sexually transmitted infections) or thrush.

What are the causes of balanitis?

Balanitis can be a symptom of the following skin conditions:

• Lichen planus - a skin disease with small, itchy, pink or purple spots on the arms or legs.
• Eczema - A chronic (long-term) skin condition, in which the skin becomes itchy, reddened, cracked and dry.
• Dermatitis - inflammation of the skin that is caused either by direct contact with an irritant, or an allergic reaction. Eczema is known as eczematous dermatitis. Other types are called non-eczematous dermatitis.
• Psoriasis - a dry, scaly skin disorder; believed to be genetic. It is caused by the immune system being mistakenly "triggered", resulting in skin cells being produced too quickly.

Irritation to the penis - irritation of the skin of the glans may be caused by:

• Some chemicals that exist in condoms, lubricants and spermicides
• Some detergents (washing powders) if not completely rinsed
• Some fabric conditioners if not completely rinsed
• Some perfumed soaps
• Some shower gels

Infection - germs exist on the skin all the time and do not generally cause any problems because their numbers are small. Sometimes, however, they may multiply rapidly. There are two types of infection that can cause balanitis:

• Candida - this is a type fungus. The one that causes thrush.
• Bacteria - which may multiply rapidly in the moist and warm conditions under the foreskin. Washing daily and drying the penis carefully so no moisture remains under the foreskin helps reduce the risk. However, excessive genital washing with soap may be a strong contributing factor to balanitis.

Diabetes - males with diabetes are more susceptible to infections, especially if the blood sugar is poorly controlled. If glucose is present in urine, some of it may remain on the foreskin. Glucose helps bacteria to multiply more quickly.

Phimosis - the foreskin is too tight and it is very difficult or impossible to retract it (pull it back) fully over the glans. Old sweat, urine and other substances may accumulate under the foreskin, causing irritation and allowing germs to multiply. Phimosis is very rare among teenage and adult males.

Unprotected sex - if the woman has vaginal thrush, the male may become infected, increasing the risk of developing balanitis. Genital herpes, Chlamydia and syphilis may also cause balanitis.

Diagnosing balanitis

Balanitis is fairly easy to diagnose. A GP (general practitioner, primary care physician) can make a diagnosis by detecting the redness and inflammation of the glans. The doctor may initially advise the patient on potential irritants (and to avoid them) and the practice of good hygiene. The doctor should ask teenage and adult patients about any latex condom use.

The doctor should also carefully examine the skin for any dermatosis (skin disease) capable of genital involvement.

If the balanitis does not resolve after avoiding potential irritants, the practice of good hygiene, or treatment for a yeast infection, the doctor may order some diagnostic tests, which may include:

• A sample - a swab is taken from the glans and sent to the lab to determine whether there is an infection.
• Urine test - if diabetes is suspected.
• Blood test - to determine glucose levels.
• Biopsy (rare) - a sample of the inflamed skin is taken and sent to the lab.

What are the treatment options for balanitis?

Treatment for balanitis depends on the cause. In most cases the doctor will advise on what substances to avoid, and give the patient information on hygiene.

Allergic reaction - if the inflammation is thought to be caused by an allergic reaction or some irritant the doctor may prescribe a mild steroid cream, such as 1% hydrocortisone, for the swelling. An antifungal or antibiotic medication may also be prescribed. If there is an infection the patient should not use a steroid cream on its own. All soaps and other potential irritants should be avoided during treatment, and until signs and symptoms have completely gone.

Candida (yeast infection) - the doctor will prescribe an antifungal cream, such as clotrimazole or miconazole. The patient's sex partner should also be treated. While treatment is underway he should either abstain from sex or use a condom.

Bacterial infection - the patient will be prescribed an antibiotic, such as erythromycin or penicillin.

If the GP determines that there is no infection and no irritant has been identified, the patient may be referred to a dermatologist (a doctor specialized in skin conditions), or a genitor-urinary clinic.

Phimosis and recurrence - if the patient has a tight foreskin and the balanitis keeps coming back, the doctor might suggest circumcision.

Prevention of balanitis

In order to prevent infections, the head of the penis (glans) and foreskin should be kept clean and dry. Daily washing, with particular attention to cleaning the penis is essential.

• The foreskin should be retracted (pulled back) so that the glans is exposed.
• The area should be washed thoroughly and gently with warm water. As soap may irritate it should not be used.
• An aqueous cream or some other neutral nonsoap cleanser may be used - but it should be completely rinsed off.
• Before replacing the foreskin the glans should be completely dry.
• Men who tend to develop balanitis after sex should wash their penis after sex.

Avoid irritants - if you think your symptoms are linked to substances present in condoms or lubricants, try using a condom for sensitive skin. Use non-biological washing powder for your underwear and make sure all the detergent is rinsed out. If you work with chemicals or have traces of potential irritants in your hands, wash them before using the toilet.