Balanitis is an inflammation of the glans, or the head, of the penis, due to infection or another cause. Balanitis can be uncomfortable and sometimes painful, but it is not usually serious. It can be relieved with topical medication.
It is a common condition, affecting approximately 1 in every 25 boys and 1 in 30 uncircumcised males at some time in their life. Boys under the age of 4 years and uncircumcised men are at the highest risk, but it can happen at any age.
It is more likely if there is phimosis, a 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 falls.
Women can also have balanitis, as the term is used to describe an inflammation of the clitoris. However, this article will focus on the glans of the penis.
Balanitis affects the glans, or the head of the penis.
Balanitis can stem from a number of conditions.
Infection with Candida albicans is the most common cause. Candida is the fungus that causes thrush.
Other infections that can cause balanitis include:
- Bacteria: These can multiply rapidly in the moist and warm conditions under the foreskin
- Sexually transmitted infections (STIs): Examples include Herpes simplex virus, Chlamydia and syphilis.
- Lichen planus, a skin disease with small, itchy, pink, or purple spots on the arms or legs
- Eczema, a chronic, or long-term, skin condition that can lead to itchy, reddened, cracked, and dry skin
- Psoriasis, a dry, scaly skin disorder
- Dermatitis, an inflammation of the skin, due to direct contact with an irritant or an allergic reaction
In very rare cases, balanitis has been linked to skin cancer.
Irritation of the skin of the glans can lead to inflammation.
- Chemicals used in condoms, lubricants, and spermicides
- Detergents or washing powders and fabric conditioners that are not completely rinsed
- Perfumed soaps and shower gels
Washing daily and drying the penis carefully so no moisture remains under the foreskin helps reduce the risk, although excessive genital washing with soap may aggravate the condition.
Diabetes increases the risk of infections, especially if blood sugar levels are poorly controlled. If glucose is present in urine, some of it may remain on the foreskin. Glucose helps bacteria multiply more quickly.
Phimosis is when the foreskin is too tight and it is difficult or impossible to retract it, or pull it back, fully over the glans. Sweat, urine, and other substances can accumulate under the foreskin, causing irritation and allowing germs to multiply. Phimosis is rare in teenage and adult males.
Unprotected sex, poor hygiene, and having a urinary catheter also increase the risk. A woman who has vaginal thrush can infect a man, increasing the risk of developing balanitis.
Symptoms and diagnosis
Signs and symptoms of balanitis include:
- Tight, shiny skin on the glans
- Redness around the glans
- Inflammation, soreness, itchiness, or irritation of the glans
- A thick, lumpy discharge under the foreskin
- An unpleasant smell
- Tight foreskin that cannot be pulled back
- Painful urination
- Swollen glands near the penis
- Sores on the glans
Soreness, irritation, and discharge may occur under the foreskin 2 to 3 days after sexual intercourse.
Some of the signs and symptoms of balanitis are similar to those of an STI or thrush.
A doctor can diagnose balanitis by observing the redness and inflammation of the glans.
They may advise the patient on potential irritants and how to avoid them, and how to practice good hygiene. The doctor will ask teenage and adult patients about any latex condom use and sexual activity.
The doctor should examine the skin for any dermatosis, or skin disease, that can involve the genital area.
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.
Possible tests include:
- A swab from the glans to test for infection in the lab
- A urine test, if diabetes is suspected
- A blood test to determine glucose levels
Rarely, a biopsy may be done, in which a sample of the inflamed skin is taken and sent to the lab for testing.
Treatments and complications
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.
If the inflammation appears to be due to an allergic reaction or irritant, the doctor may prescribe a mild steroid cream, such as one percent hydrocortisone, for the swelling.
Antifungal creams can treat balanitis caused by Candida.
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 is a 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.
If there is a bacterial infection, the doctor will prescribe an antibiotic, such as erythromycin or penicillin.
If there is no infection and no irritant has been identified, the patient may be referred to a dermatologist, who specializes in skin conditions, or a genitourinary clinic.
If the patient has a tight foreskin and the balanitis keeps coming back, the doctor might suggest circumcision.
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 symptoms, as the warm water can reduce discomfort.
Balanitis is easy to treat, but complications can occur in some cases.
These may include:
- Scarring of the opening of the penis
- Inadequate blood supply to the penis
- Retracting the foreskin is painful
A foreskin that does not retract can be the result of long-term, untreated balanitis.
The earlier treatment is sought, the better the outlook will be.
To prevent infections, the head of the penis and the foreskin should be kept clean and dry. Daily washing, with particular attention to cleaning the penis, is essential.
Here are some hygiene tips:
- The foreskin should be pulled back so that the glans is exposed.
- The area should be washed thoroughly 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.
- Before replacing the foreskin, the glans should be completely dry.
- Men who tend to develop balanitis after sex should wash their penis after engaging in sexual activity.
If symptoms appear to be linked to substances present in condoms or lubricants, there are condoms available for sensitive skin.
It is best to use non-biological washing powder for underwear and to make sure all the detergent is rinsed out. People who work with chemicals or have traces of potential irritants on their hands should wash them before using the bathroom.