Balanitis is an inflammation of the glans penis, the rounded head of the penis. It can cause symptoms such as redness, swelling, itching, and discomfort. Balanitis can result from a variety of causes, including infections (bacterial, fungal, or viral), poor hygiene, allergic reactions, and underlying health conditions like diabetes. Treatment typically involves addressing the underlying cause, maintaining good hygiene, and using medications such as antifungal or antibacterial creams. If left untreated, balanitis can lead to complications like scarring and difficulty retracting the foreskin.

What is balanitis?

Balanitis is an inflammation of the glans penis, which is the rounded head of the penis. This condition can affect males of any age, although it is more common in uncircumcised men. Balanitis can cause a range of uncomfortable symptoms and can be due to various factors, including infections, poor hygiene, and skin conditions.

Causes of balanitis

Balanitis can be caused by various factors, including infections, skin conditions, and other irritants. Here are the primary causes:

Infections:

• Bacterial infections: Poor hygiene can lead to bacterial growth under the foreskin, causing inflammation.
• Fungal infections: Candida (yeast) infections are common, particularly in those with diabetes or who are immunocompromised.
• Viral infections: Certain viruses, such as the herpes simplex virus, can cause balanitis.

Poor Hygiene:

• Accumulation of smegma, a combination of skin cells, oils, and moisture, can irritate the glans if not regularly cleaned.

Skin Conditions:

• Conditions like eczema, psoriasis, or dermatitis can cause inflammation and irritation of the glans.

Irritants:

• Chemical irritants: Soaps, lotions, or condoms containing allergens or harsh chemicals can cause an allergic reaction or irritation.
• Mechanical irritants: Prolonged friction from tight clothing or vigorous sexual activity can irritate the skin.

Underlying Health Conditions:

• Diabetes: High blood sugar levels can promote fungal growth and infection.
• Phimosis: A condition where the foreskin is too tight to be pulled back over the glans can trap bacteria and other pathogens, leading to inflammation.

Sexually Transmitted Infections (STIs):

• Certain STIs, such as gonorrhea or chlamydia, can lead to balanitis.

Medications:

• Certain antibiotics or chemotherapy drugs can predispose individuals to infections that may result in balanitis.

Symptoms

Balanitis is characterized by a variety of symptoms, which can vary in severity. Common symptoms include:

• Redness: The glans penis may appear red and inflamed.
• Swelling: Swelling of the glans and sometimes the foreskin.
• Itching: Itching or a burning sensation on the glans.
• Pain or Discomfort: Pain or tenderness, especially when the area is touched.
• Discharge: A thick, sometimes foul-smelling discharge may be present under the foreskin.
• Soreness: The area may feel sore or irritated.
• Rashes: The appearance of a rash or patches on the glans or foreskin.
• Difficulty Retracting the Foreskin: Inflammation can make it difficult to pull back the foreskin (a condition known as phimosis).
• Ulcers or Sores: In severe cases, there may be ulcers or sores on the glans.
• Cracked or Dry Skin: The skin on the glans or foreskin may appear dry or cracked.

Diagnosis

Diagnosing balanitis involves a combination of medical history, physical examination, and sometimes additional tests. Here’s an overview of the diagnostic process:

Medical History:

• The healthcare provider will ask about symptoms, their duration, and any potential irritants or behaviors that could contribute to the condition, such as hygiene practices, sexual activity, or recent use of new products like soaps or lotions.
• A history of diabetes or other underlying health conditions will also be considered.

Physical Examination:

• A thorough examination of the genital area, including the glans and foreskin, will be conducted to look for signs of inflammation, infection, or other abnormalities.

Laboratory Tests:

• Swab Test: A swab of the affected area may be taken to check for bacterial, fungal, or viral infections. This can help identify the specific pathogen causing the inflammation.
• Urine Test: A urine sample might be analyzed to rule out a urinary tract infection or sexually transmitted infection (STI).
• Blood Test: Blood tests can check for diabetes or other systemic conditions that may contribute to balanitis.
• Skin Biopsy: In rare cases, if the diagnosis is unclear or if there is a suspicion of a more serious condition like penile cancer, a small sample of skin from the affected area may be taken for biopsy.

Allergy Testing:

• If an allergic reaction is suspected, patch testing may be conducted to identify any specific allergens causing the irritation.

Examination for STIs:

• Testing for sexually transmitted infections (STIs) may be recommended if there is a history of unprotected sex or if the symptoms suggest an STI.

Complications

Complications can arise if the condition is not properly treated or if it recurs frequently. Some potential complications of balanitis include:

• Phimosis: Inflammation and swelling can cause tightening of the foreskin (phimosis), making it difficult or impossible to retract over the glans.
• Balanoposthitis: This refers to inflammation involving both the glans and the foreskin. It often occurs concurrently with balanitis and can complicate treatment and resolution.
• Fungal or bacterial infections: Balanitis can make the affected area more susceptible to secondary infections by bacteria (such as Staphylococcus aureus) or fungi (such as Candida albicans). These infections can exacerbate symptoms and prolong healing.
• Scarring: Chronic or severe inflammation may lead to scarring of the foreskin or the glans, which can potentially interfere with normal urinary and sexual function.
• Difficulty urinating: Swelling and inflammation can sometimes narrow the urethral opening, making it difficult or painful to urinate.
• Recurrent balanitis: Without addressing underlying causes such as poor hygiene, diabetes, or skin conditions, balanitis may recur, leading to ongoing discomfort and potential complications.
• Sexual dysfunction: In severe cases, persistent balanitis and related complications may contribute to sexual dysfunction, although this is rare.

Treatment of balanitis

The treatment of balanitis depends on the underlying cause of the condition. Here are the general approaches to managing balanitis:

Improving Hygiene:

• Regularly clean the penis with warm water and avoid using harsh soaps or chemicals.
• Gently retract the foreskin (if uncircumcised) to clean underneath it and then dry thoroughly.

Medications:

• Antifungal Creams or Ointments: Used if the balanitis is caused by a yeast infection (e.g., clotrimazole, miconazole).
• Antibiotic Creams or Oral Antibiotics: Prescribed if a bacterial infection is identified (e.g., mupirocin, metronidazole).
• Steroid Creams: Mild steroid creams (e.g., hydrocortisone) can help reduce inflammation and itching.
• Antiviral Medications: If the balanitis is due to a viral infection, such as herpes simplex virus, antiviral medications (e.g., acyclovir) may be used.

Addressing Underlying Conditions:

• Diabetes Management: Better control of blood sugar levels in diabetic patients can help prevent recurrent infections.
• Treatment of STIs: Appropriate antibiotic or antiviral treatment for any identified sexually transmitted infections.

Avoiding Irritants:

• Identify and avoid potential irritants such as certain soaps, lotions, or condoms that may be causing an allergic reaction.
• Use hypoallergenic and fragrance-free products.

Lifestyle Adjustments:

• Wearing loose-fitting, breathable underwear to reduce moisture and friction.
• Ensuring thorough drying of the genital area after bathing or swimming.

Circumcision:

• In recurrent or severe cases, circumcision may be considered to prevent the buildup of smegma and recurrent infections, particularly if phimosis (a tight foreskin) is contributing to the problem.

Consultation with a Specialist:

• In complicated or persistent cases, referral to a urologist or dermatologist may be necessary for further evaluation and management.

Prevention

Preventing balanitis involves maintaining good hygiene, managing underlying health conditions, and avoiding known irritants. Here are some key preventive measures:

Maintain Good Hygiene:

• Clean the penis regularly with warm water. Gently retract the foreskin (if uncircumcised) to clean underneath it, then dry thoroughly.
• Avoid using harsh soaps, scented products, or chemicals that can irritate the skin.

Practice Safe Sex:

• Use condoms to reduce the risk of sexually transmitted infections (STIs).
• Ensure both you and your partner are aware of and manage any infections promptly.

Manage Underlying Health Conditions:

• Keep blood sugar levels under control if you have diabetes.
• Follow medical advice to manage any chronic conditions that might predispose you to infections.

Avoid Irritants:

• Use hypoallergenic and fragrance-free soaps, lotions, and personal care products.
• Avoid using products that have previously caused irritation or allergic reactions.

Wear Appropriate Clothing:

• Wear loose-fitting, breathable underwear made of natural fibers to reduce moisture and friction.
• Change out of wet or sweaty clothes promptly.

Proper Care During Antibiotic Use:

• If you need to take antibiotics, be aware that they can disrupt the natural balance of bacteria and fungi. Discuss preventive measures with your healthcare provider.

Regular Medical Check-ups:

• Regular visits to a healthcare provider can help monitor and manage any potential risk factors, such as diabetes or recurrent infections.

Educate Yourself:

• Be aware of the symptoms of balanitis and seek medical advice promptly if symptoms develop to prevent complications.

Summary

Balanitis is the inflammation of the glans penis, often causing redness, swelling, itching, and discomfort. Common causes include poor hygiene, infections (bacterial, fungal, or viral), skin conditions, and irritants. Prompt medical attention and proper care can effectively manage and prevent balanitis.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE