By Lois Zoppi, BA
Reviewed by Emily Henderson, B.Sc.
Balanitis is a condition in which the head of the penis becomes swollen and sore. It is a fairly common condition that is estimated to affect around 3 to 11% of men during their lives.
Causes of Balanitis
There are several causes for balanitis, and some conditions may cause and coexist with balanitis.
Non-specific dermatitis
Non-specific dermatitis is the most common cause of balanitis in young boys. It can also cause balanitis in uncircumcised men.
Contact dermatitis
Allergic contact dermatitis may cause balanitis if a man comes into contact with soap, bubble bath, fragrances, lubricants, condoms, or medications that he is allergic to. A man may experience pain, burning, or itchiness, along with a red and scaly rash on the head of the penis.
Other skin conditions that can cause balanitis may include psoriasis and seborrheic dermatitis.
Lichen sclerosis
Lichen sclerosis is a chronic, inflammatory, and progressive skin condition that causes scarring and itching.
Lichen planus
Lichen planus is another inflammatory skin condition. It causes purple plaques on the head of the penis as well as the shaft of the penis too.
Phimosis
Phimosis is a condition in which the foreskin is very tight and cannot be pulled back over the head of the penis, meaning it is not possible to clean underneath the foreskin. While it is normal in babies and toddlers up to the age of 6, phimosis can cause problems in older children, such as difficulty urinating, redness, inflammation, and soreness on the head of the penis.
A build-up of smegma, known as smegma pearls, is a collection of smegma (a substance made up of oil and dead skin cells underneath the foreskin) that can irritate the head of the penis. Phimosis can prevent cleaning smegma from the penis.
In adults, phimosis can sometimes be linked to certain sexually transmitted infections (STIs), and balanitis can be linked to gonorrhea and chlamydia.
Bacterial and fungal infections
Infections with Candida albicans, which causes redness on the surface underneath the head of the penis, and itchy spots on the head of the penis, the shaft, and the scrotum. There may also be a thick, white discharge.
Beta-hemolytic streptococci and Staphylococcus aureus may also cause bacterial infections, which are characterized by redness on the head of the penis, swelling, and discharge from open sores on the penis.
Other types of infections can include:
- Gardnerella
- Herpes simplex
- Trichomonas
- Syphilis
- Scabies.
Poor hygiene
Not maintaining good hygiene can cause balanitis, but using soap, shower gels, or condoms can irritate the skin too. Additionally, irritating the penis by cleaning too harshly can also cause balanitis.
Diabetes
Diabetes may also be behind a case of balanitis, as the high levels of sugar in the urine caused by diabetes can lead to thrush.
Zoon’s balanitis
This is the name for a benign, chronic type of balanitis that has no certain cause. It is more common in older men. It is characterized by shiny, symmetrical lesions on the head of the penis that are orange-red. It may develop due to irritation caused by extended contact with urine.
Circinate balanitis
This is a chronic type of balanitis that can occur in men with post-infective Reiter’s syndrome and psoriasis. It can also occur on its own. Circinate balanitis is characterized by red or grey plaques on the head of the penis with a white border.
Pre-cancerous conditions
Some conditions that may lead to squamous cell carcinoma may cause balanitis. This conditions may include:
- Bowenoid papulosis
- Bowen’s disease of the penis
- Erythroplasia of Queyrat.
Symptoms of Balanitis
The symptoms of balanitis affect the head of the penis. The symptoms include the head of the penis being red, swollen, sore, and itchy. Additional symptoms can include:
- Pain during urination
- Thick discharge from underneath the foreskin
- Bleeding around the foreskin
- An unpleasant odor
- Difficulty in pulling back the foreskin in adults.
Risk Factors for Balanitis
The risk factors for balanitis include:
- Being uncircumcised (having a foreskin)
- Obesity
- Poor hygiene
- Diabetes
- Living in nursing homes
- Sensitivity to soaps or condoms
- Reactive arthritis
- Sexually transmitted infections
- Chronic heart failure (CHF)
- Kidney disease (nephrosis).
Balanitis Diagnosis
The skin of the penis may be tested for infections by taking a sample with a cotton bud over the head of the penis.
If a man also has thrush, the balanitis is severe, and a cause for the balanitis cannot be found, blood tests may be necessary to check for diabetes.
Treatment for Balanitis
A doctor will be able to diagnose a case of balanitis, and men can also go to sexual health clinics to get treatment.
Mild steroid creams and ointments and antifungal creams and ointments can be used to treat balanitis. Antibiotics can also be used to treat the infection.
In cases where balanitis does not respond to treatment or balanitis keeps coming back, circumcision (a surgery that removes the foreskin of the penis) may be suggested.
If a test for diabetes shows that a man with balanitis has the condition, diabetes treatment will be followed.
If a man has balanitis, it is recommended that he washes his penis every day by gently pulling back the foreskin and washing the penis with warm water. Soap or shower gels should not be used, but a gentle moisturizer can be used during washing. It is important to dry the penis gently after washing to avoid further irritation to the skin and to always wash the hands before urinating or touching the penis.
Condoms for sensitive skin should be used if a man engages in sexual intercourse while he has balanitis.
If a child has balanitis, their carer should follow the same care, and also change diapers regularly if the child wears them. If the foreskin is tight, which is common in children, do not force it back. Soap, bubble bath, shower gels, or baby wipes should not be used to clean the penis in children.
Summary
Balanitis is a common inflammatory condition that affects the head of the penis. It has a wide range of causes, and medical advice should be sought if a case of balanitis is suspected. Common treatments for balanitis include topical steroid creams and ointments or antifungal creams and ointments. Some surgical options are available, but they are reserved for the more serious cases of balanitis or balanitis that recurs often.
Easy ways to prevent balanitis from developing is by practicing good hygiene, which includes regularly and gently washing the penis with warm water to prevent a build-up of bacteria, smegma, or other irritants.
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