What is Balanitis?
Balanitis is an inflammation of the glans, or the head, of the penis. Balanitis may be caused by an infection and mostly affects uncircumcised males. The condition is usually not life-threatening but can be uncomfortable and sometimes painful.
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Balanitis can occur at any age, but it mostly affects boys under the age of 4 years and uncircumcised men.
It is more likely if there is phimosis (condition where the foreskin of the penis is too tight). When boys reach the age of 5 years, the foreskin becomes easy to retract, and the risk of balanitis reduces.
Apart from uncircumcised males, females can also have balanitis. This occurs when the clitoris becomes inflamed.
Symptoms of Balanitis
Some signs and symptoms of balanitis are similar to those of an STI or thrush. Signs and symptoms of balanitis may include:
- An unpleasant smell
- Painful urination
- Tight, shiny skin on the glans
- Sores on the glans
- Inflammation, soreness, itchiness, or irritation of the glans
- A thick, lumpy discharge under the foreskin
- Redness around the glans
- Swollen glands near the penis
- Tight foreskin that cannot be pulled back
Types of Balanitis
There are mainly three types of balanitis:
Zoon’s balanitis: This is inflammation of the head of the penis and the foreskin. It usually affects uncircumcised middle-aged to older men.
Circinate balanitis: This is mostly caused by reactive arthritis
Pseudoepitheliomatous keratotic and micaceous balanitis: This is characterized by scaly, wart-like skin lacerations on the head of the penis.
Causes of Balanitis
Balanitis can stem from a number of conditions. The most common cause of balanitis is the infection with Candida albicans. Candida is the fungus that causes thrush. Other infections that can cause balanitis include:
- Bacteria: These can multiply quickly in moist and warm conditions under the foreskin
- Sexually transmitted infections (STIs): These include chlamydia, syphilis, and herpes simplex virus.
Skin conditions can also trigger the condition. These include:
- Psoriasis: This is a dry, scaly skin disorder
- Eczema: This is a chronic, or long-term, skin condition that can lead to cracked, dry, itchy, and reddened skin
- Dermatitis: This is an inflammation of the skin, due to direct contact with an irritant or an allergic reaction
- Lichen planus: This is a skin disease with small, itchy, pink, or purple spots on the arms or legs
Irritation of the skin of the glans can lead to inflammation. Irritants include:
- Chemicals used for producing spermicides, condoms, and lubricants
- Detergents or washing powders and fabric conditioners that are not completely rinsed
- Perfumed soaps and shower gels
Diabetes: Diabetes increases the risk of infections, especially if blood sugar levels are poorly managed. If glucose is present in urine, some of it may remain on the foreskin. Glucose helps bacteria multiply more quickly.
Phimosis: This is a condition that develops when the foreskin is too tight, and it is difficult to retract it fully over the glans. Sweat, urine, and other substances can build up under the foreskin, causing irritation and allowing germs to multiply.
Balanitis is easy to treat, but complications can occur in some cases.
These may include:
- Insufficient blood supply to the penis
- Scarring of the opening of the penis
- Retracting the foreskin
- Poor hygiene
- Engaging in unprotected sex
- Having a urinary catheter
A woman who has vaginal thrush can infect a man, increasing the risk of developing balanitis.
Balanitis can be diagnosed by a doctor closely observing the redness and inflammation of the glans. The doctor will survey the skin for any dermatosis, or skin disease that can involve the genital area.
More tests may be ordered if balanitis does not resolve after:
- avoiding potential irritants
- practicing good hygiene
- treating yeast infection.
Possible tests include:
- A swab from the glans to test for infection in the lab
- If diabetes is suspected, a sample of the patient’s urine is taken for testing
- Blood test to determine glucose levels
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Treatments for Different Causes
Treatment for balanitis depends on the cause.
If balanitis is caused by a bacterial infection, penicillin or erythromycin will be prescribed by the doctor. However, if there is no infection, the patient may be referred to a dermatologist.
Candida is a yeast infection and a antifungal cream, such as clotrimazole or miconazole may be prescribed by your doctor. The patient’s sex partner should also be treated. Both partners should abstain from sex while treatment is ongoing.
If balanitis is caused by an allergic reaction or irritant, your doctor may prescribe a mild steroid cream, such as one percent hydrocortisone, to ease the swelling.
An antibiotic or antifungal medication may also be prescribed. These may be available over-the-counter. If there is an infection, the patient should not use a steroid cream on its own.
Soaps and other potential irritants should be avoided while treatment lasts until symptoms disappear.
Circumcision may be suggested if the patient has a tight foreskin and the balanitis keeps recurring. Alternatively, a slit may be cut along the top of the foreskin to separate it from the penis. A sitz bath may help to manage painful symptoms.
To prevent infections, the head of the penis and the foreskin should be kept clean and dry. Here are some hygiene tips:
- The foreskin should be pulled back so that the glans is exposed.
- The area should be washed carefully and gently with warm water. Soap may irritate, so it should be avoided.
- An aqueous cream or some other neutral nonsoap cleanser may be used, but it should be completely rinsed off.
- Ensure the glans is properly dry before replacing the foreskin
- Men should wash their penis properly after sexual intercourse.
Good personal hygiene helps treat balanitis. Hygiene tips include:
- Clean the penis properly every day.
- Avoid using soap or bubble bath or anything that could act as an irritant.
- Dry underneath the foreskin gently after urinating.
- Use an emollient instead of soap