Balanitis: Causes, symptoms, and treatments

What does balanitis look like?

Balanitis forms part of penile inflammatory skin disorders. It is very common. The main clinical features of balanitis are:

1. Redness (erythema) and swelling of the glans penis
2. Foreskin pain or pain at the glans or discomfort when passing urine or sexual activity
3. Itching or burning sensation on the glans
4. Discharge, typically foul smelling
5. Blisters, sores, or ulcers on the glans penis can form
6. Tightening or thickening of the foreskin, making it difficult to pull back or to replace in its natural position
7. In extreme cases, one can find difficulty with urination due to the narrowing of the urethral (water pipe) opening

Is balanitis a sexually transmitted infection (STI)?

Not all cases of balanitis are caused by a sexually transmitted infection.

Balanitis can be caused by various issues, including infections, irritants, and underlying medical conditions.

Certain STIs, such as herpes simplex (HSV) and human papillomavirus (HPV), can cause balanitis.

Other causes include poor hygiene, allergic reaction, irritation from tight clothing or condoms, and various skin issues like eczema or psoriasis.

What are the types of balanitis?

Balanitis can be classified into several types based on the underlying cause of the inflammation. Some of the most common types of balanitis include:

1. Infectious balanitis: this can be caused by bacterial, fungal (yeast infection), or viral infections. The most common organisms that cause balanitis include candida albicans (yeast), streptococci, staphylococci, and herpes simplex virus.
2. Allergic balanitis: due to exposure to various substances, such as latex, spermicides, or certain soaps, can cause balanitis.
3. Irritant balanitis: Irritants, such as harsh soaps or bubble baths, is one type of noninfectious balanitis.
4. Psoriasis: this is a chronic skin condition that can affect anywhere in the body
5. Zoon's balanitis: referred to as well as plasma cell balanitis or circinate balanitis. This is a rare condition, typically exhibiting plaques on the head of the penis.
6. Diabetes-associated balanitis: is one of the risk factors of balanitis that occurs especially in men with uncontrolled diabetes.

What do balanitis spots look like?

Typically these are red spots or patches on the head of the penis and/or foreskin. They may be raised and inflamed and can range in size from small to large. These spots can be painful.

Itching, burning, and rarely discharge from the are concerned are common findings with the red spots.

What is balanitis xerotica obliterans (BXO)?

BXO is a chronic inflammatory skin condition that affects the glans and/or the foreskin.

It is also called lichen sclerosis et atrophicus.

BXO causes the skin to become thin, dry, and white, leading to itching, burning, and discomfort. In some cases, BXO can cause the foreskin to narrow, leading to various degrees of phimosis.

The exact cause of BXO is unknown, but an autoimmune disorder is thought to be the underlying mechanism.

Topical corticosteroids are prescribed to reduce the inflammation leading to symptom resolution. These ointments are the first line of treatment. Low-potency topical steroids are recommended.

In severe recurring cases, circumcision addresses the issue effectively.

What is Zoon's balanitis?

Circinate balanitis is a rare skin condition that affects the glans or the foreskin. Small, red, elevated plaques are commonly found, which can be painful sores or itchy. Narrowing of the foreskin can happen.

The exact cause of Zoon's balanitis is not known. Postulations include either a bacterial infection or an autoimmune disorder.

Topical antibiotics or corticosteroids are initially prescribed. If it keeps returning or there is a narrowing of the foreskin, circumcision is indicated.

What is micaceous balanitis?

Micaceous balanitis is a rare form of chronic balanitis with shiny micaceous scales on the glans and foreskin. It is also referred to as shiny balanitis or lichen planus hypertrophic.

The micaceous risk factors are unknown, but an autoimmune or allergic reaction to an unknown substance is thought to be responsible. Uncircumcised males are more susceptible.

The condition can be chronic and may cause discomfort, itching and pain in the glans.

Treatment typically involves the use of topical or oral corticosteroids.

If balanitis symptoms recur and do not respond to conservative balanitis treatment, circumcision may be necessary.

Balanitis how to treat it.

Suppose you have inflammation on both the glans and your foreskin. In that case, you likely have a condition known as balanoposthitis, a combination of balanitis (inflammation of the head of the penis) and posthitis (inflammation of the foreskin).

Balanoposthitis can have a variety of causes, including infections, skin conditions, allergies, and irritation from irritants such as soaps or condoms.

The symptoms of balanoposthitis can include redness and swelling of the head of the penis and foreskin, itching or burning sensations, pain or discomfort during urination or sexual activity, and discharge from the penis. In some cases, the foreskin may become tight and difficult to retract, making it difficult to properly clean the head of the penis.

Your family doctor, NHS urology consultant or private urologist will be able to diagnose the condition based on your medical and sexual history and physical examination.

Most cases are diagnosed straightforwardly.

Treatment may include antifungal cream if a genital yeast infection is suspected or antibiotics depending on the cause. Topical creams or ointments to soothe the irritated foreskin or glans penis are commonly prescribed. Antifungal creams can be combined with topical steroids.

If you have a recent history of unprotected sex, you will be encouraged to undergo sexually transmitted infection screening at your closest sexual health clinic.

If you have coloured discharge, a swab for cultures may be taken to understand what is causing the infected balanitis (like bacterial balanitis) and address it appropriately.

If you suffer from diabetes, you will be asked to undergo tests (blood test, urine test) to make sure it is well controlled, and lifestyle changes will be encouraged.

Can my partner pass me trush (candidal balanitis)?

Yes, a partner can pass you a yeast infection known as thrush. This is a fungal infection caused by Candida yeast, commonly found in the mouth, throat, gut and genital area.

Trush can be passed through sexual contact. This is not considered part of sexually transmitted infections.

Females commonly develop trush from;

1. Antibiotic use: disrupts the balance of bacteria in the body, allowing the yeast to multiply.
2. Hormonal changes: that occur during pregnancy and contraceptives.
3. Diabetes: high sugar levels create a favourable environment for yeast to grow.
4. Weakened immune system: from medications, medical conditions and more
5. Poor hygiene: such as wearing tight, non-breathable clothing and not changing out of wet swimwear, can create a moist and warm environment ideal for yeast to grow.

If a man develops yeast balanitis, it is best to treat both partners.

Can balanitis heal by itself?

Balanitis can sometimes resolve without any treatment, especially if the cause of the balanitis is, for example, poor hygiene or skin irritation. Changing your hygiene routine or avoiding irritants may let the inflammation settle.

Home remedies for balanitis?

In some situations, natural remedies can be effective. However, these remedies may not work for all cases.

The following are common natural remedies that may be helpful for mild cases of balanitis:

1. Proper hygiene: wash the glans and foreskin daily with soap and water, and avoid using potential irritants like harsh soaps or certain shower gels.
2. Avoid chemical irritants: perfumed products or harsh soaps can irritate the skin on the head of the penis and foreskin and worsen balanitis. Avoid excessive genital washing.
3. Use a warm compress: Soak the glans-penis in warm water for 10 minutes daily to reduce swelling and relieve discomfort.
4. Tea tree oil: has antifungal and antimicrobial properties that may resolve mild balanitis caused by fungus or bacteria. A small quantity of tea tree oil is applied up to three times daily to the glans area. If you take baths, add a few drops to your bath water.
5. Manuka honey: has special antibacterial properties that may cure mild balanitis caused by bacterial infections. Apply a fine layer of Manuka honey to the glans, peni-s and foreskin up to three times daily.

If you try a natural remedy and do not see any improvement, it is best to seek medical advice.

What is the outlook for people who have balanitis?

In most cases, balanitis can be effectively treated with simple measures such as a combination of lifestyle (good hygiene, better diabetic control) and medical interventions, such as topical creams or ointments.

The inflammation typically calms down quickly, and the symptoms resolve.

However, if the balanitis repeatedly happens, underlying medical conditions must be addressed. If medical conditions are not the issue, your NHS urologist or private urologist will recommend a circumcision.

What can happen in untreated balanitis?

If left not addressed, balanitis can lead to several complications, including:

1. Scarring: difficulty retracting the foreskin, painful erections, and sexual difficulties.
2. Narrowing of the foreskin (phimosis): If left untreated, phimosis can lead to recurrent infections and difficulty with urination and sexual intercourse.
3. Infections: Balanitis can increase the risk of other infections, such as urinary tract infections (UTIs), and may also increase the risk of STIs.
4. Fertility issues: In severe rare cases, balanitis can cause scarring and damage to the waterpipe (urethra)
5. Emotional and psychological impact: discomfort and pain leading to sexual dysfunction and intimacy issues.

Can balanitis lead to penile cancer?

While balanitis does not typically cause penile cancer, chronic inflammation and irritation of the foreskin and glans due to untreated balanitis could potentially increase the risk of developing penile cancer.

However, penile cancer is relatively rare, and most cases are unrelated to balanitis.

Does circumcision prevent balanitis?

Circumcision is the removal of the foreskin and can be an effective treatment for certain types of balanitis, particularly if the cause of the balanitis is recurrent infections or tight foreskin (phimosis) that makes it difficult to keep the head of the penis clean.

Circumcision can reduce the risk of recurrent infections by removing the foreskin, which can harbour bacteria and other pathogenic agents.

However, it is important to know that circumcision is not a cure-all for balanitis and that the underlying cause must always be addressed to prevent future recurrences. For example, if the cause of the balanitis is poor hygiene, circumcision alone may not be enough to resolve the symptoms. If the cause of the balanitis is an underlying medical condition, such as diabetes, the condition must be well-managed to prevent recurrent outbreaks of balanitis.

Your urologist will discuss in detail the circumcision procedure highlighting the benefits and risks, and complications.

What are the steps of circumcision?

The procedure is usually performed under local or general anaesthesia, based on the patient's age and preference. The urologist will remove the foreskin and close the incision with absorbable sutures. This is typically a day case procedure.

Most patients experience discomfort, increased sensitivity, swelling, bruising and mild pain for the first few days after the surgery. Over-the-counter pain medications like paracetamol and cold compresses can help relieve these symptoms. Most men find that wearing loose cotton garments in the first few days is helpful.

Many return to their normal activities within two weeks.

Sexual abstinence is recommended for three to four weeks.