Balanitis: Causes, Symptoms, and Diagnosis (original) (raw)

Balanitis can occur due to an infection, allergic reaction, or injury. Symptoms can vary depending on the cause but typically include swelling or redness of the head of your penis.

Balanitis is inflammation of the glans penis, also known as the head of the penis. While fairly common and not typically serious, the inflammation is often accompanied by other uncomfortable symptoms.

It can occur in anyone who has a penis, but it mostly affects those who are uncircumcised, often also causing inflammation of the foreskin (posthitis).

This most often happens as a result of improper hygiene, especially because the foreskin can trap moisture, creating the perfect environment for fungus and bacteria to thrive.

Improper hygiene can mean not washing well enough, but it can also mean over-washing, which can both cause irritation and swelling. Not rinsing all of the soap from the area after showering or using products that contain irritants like perfumes and dyes can also cause this.

Other causes of balanitis include:

• allergic reaction to latex condoms and spermicides
• allergic reaction to certain medications, including some antibiotics and pain relievers
• sexually transmitted infections (STIs), like gonorrhea and trichomoniasis
• scabies, which is an infestation of tiny skin mites
• certain medical conditions, including diabetes and reactive arthritis
• injuries on the tip of the penis or foreskin

There are three types of balanitis:

• Zoon’s balanitis: Also just called balanitis, this is the primary type of balanitis. It mainly affects middle-aged people with uncircumcised penises.
• Circinate balanitis: This type of balanitis is caused by reactive arthritis, which is a type of arthritis that’s triggered by infection. With this type of balanitis, the inflammation is also accompanied by tiny sores on the head of the penis.
• Pseudoepitheliomatous keratotic and micaceous balanitis: This rare type of balanitis affects people over 60 with penises. It causes scaly, wart-like bumps on the glans.

People of any age with penises can develop balanitis, but those at highest risk are children under the age of 4 and uncircumcised, middle-aged adults.

People with phimosis — a tight foreskin that doesn’t retract back over the penis — also have an increased risk. Foreskin loosens and becomes easier to retract with age. This usually happens by around the age of 5.

Balanitis is a symptom rather than a condition and therefore can’t be transmitted. It can, however, be caused by infections — sexually transmitted and otherwise — and mites that can be transmitted to others.

Yeast infections and STIs can be transmitted during vaginal, anal, and oral sex. Scabies and some STIs can also be transmitted through skin-to-skin contact.

Scabies, which is highly contagious, can also be transmitted through infested clothing and bedding.

Swelling and redness of the head of the penis are the most common symptoms and often affect the foreskin.

Depending on the cause, balanitis might also cause:

• soreness, pain, and irritation around the glans
• tight, shiny foreskin
• itching on the skin of the glans
• unusual penile discharge
• sores on the head of the penis
• a thick, white discharge under the foreskin (smegma)
• a foul smell from the penis
• painful urination
• swollen groin lymph nodes

Balanitis can usually be diagnosed during a physical examination because most of its symptoms are visible.

Other tests are needed to determine the cause. Which tests your clinician orders will depend on your symptoms. Tests can include:

• a swab of your urethral opening to check for STIs and other infections
• urinalysis to check for signs of infection or diabetes
• blood tests to check for signs of infections, diabetes, and other conditions
• a skin scraping sample to examine for mites under a microscope

Balanitis treatment usually begins with improving your genital hygiene by washing and drying under the foreskin and avoiding the use of hygiene products that contain potential irritants, like perfumes.

If caused by an allergic reaction to certain products or medications, your clinician can help you find suitable alternatives. For instance, different types of medication or latex-free and spermicide-free barrier methods.

Other treatments can be used to help relieve the inflammation and treat the underlying cause. This might include:

• Antifungal creams: Creams, such as clotrimazole or miconazole, might be prescribed if the inflammation is caused by a yeast infection.
• Anti-itch creams: Over-the-counter and prescription anti-itch creams can help with itching and redness.
• Steroid creams: Creams containing corticosteroids can help relieve inflammation and itching.
• Antibiotics: If caused by an STI, antibiotics may be prescribed. The type of antibiotic and duration will depend on which STI you have.
• Diabetes treatment: If you have diabetes, your clinician will recommend a treatment plan to manage it. This usually involves a combination of medication and lifestyle modifications to control your blood sugar.
• Circumcision: If you develop recurrent balanitis symptoms or phimosis, a clinician might recommend circumcision to remove the foreskin and prevent future symptoms and complications.

Left untreated, balanitis can cause chronic inflammation and lead to complications, such as:

• Lichen sclerosus: Also called balanitis xerotica obliterans (BXO), lichen sclerosus occurs when white, hard patches form on the skin. This can interfere with the flow of urine and semen through the urethra.
• Scar tissue: Long-term balanitis can lead to scarring around the glans and make the foreskin too tight to retract back over the glans.
• Ulcerative lesions: Balanitis can cause painful sores and blisters that ulcerate and bleed, and eventually cause scarring. Open sores increase the risk of introducing other bacteria and viruses into the body.
• Increased risk of cancer: Chronic inflammation increases the risk of several types of cancer. According to research, balanitis, posthitis, BXO, and phimosis are associated with a higher risk of penile cancer.

Prompt treatment of balanitis and any underlying causes can significantly reduce the risk of complications and improve your outlook.

Preventing balanitis is often as simple as practicing proper hygiene so that you avoid irritating the skin and prevent the buildup of excess moisture and bacteria under the foreskin.

To do this, bathe regularly using unscented soap, making sure to clean under your foreskin and dry thoroughly by gently patting the skin dry — not rubbing.

Avoid using chemicals on and around your genitals, such as soaps and detergents, shower gels, or lotions containing dyes and perfumes. Spermicides should also be avoided if you’ve had a reaction to them.

Use condoms or other barrier methods when you engage in sexual activity and get tested for STIs regularly.

Consult a healthcare professional if you have symptoms of balanitis or if treatment for balanitis hasn’t worked.

Seek immediate medical attention if you develop signs of infection, such as fever, severe pain and inflammation, and pus draining from the area.

Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.