What Is Balanitis?

Overview

Balanitis is a condition involving  inflammation of the head of the penis (glans). It can  arise from  various causes, such as infections, poor genital hygiene, skin conditions, skin irritations and allergies to toiletries or other products, diabetes, reactive arthritis, or sexually transmitted infections (STIs). It can cause  pain and soreness, itching, redness, swelling, and may cause a discharge or difficulty and/or pain urinating. Depending on the cause, balanitis can be treated with antifungal creams, antibiotics, steroid creams, or circumcision.. It can also be prevented by: maintaining proper genital hygiene, avoiding irritants, practicing safe sex, and managing diabetes appropriately.¹

Types of balanitis

There are different types of balanitis – classified according to the cause, and appearance of the inflammation. the three main ones are:

• Zoon's balanitis:

This is a chronic type that often affects uncircumcised, middle-aged men and causes an inflamed, discolored penis head. It is the most common type accounting  for up to 10% of balanitis cases⁹

• Circinate balanitis: 

This type is a result of reactive arthritis, a form of arthritis that develops in response to an infection in the body. It causes small lesions (sores) on the head of the penis along with inflammation and discoloration¹⁰

• Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB): 

This very rare type mainly affects men over sixty years old and results in  scaley warts or bumps on the head of the penis^{2 6}

Causes of balanitis

There are a variety of causes of balanitis including:

• Infection by bacteria, fungi, viruses, or parasites. This can be due to poor hygiene, sexual transmission, or diabetes (increased sugar secreted onto the skin can encourage the growth of bacteria, yeasts and fungi.)
• Skin conditions such as eczema, psoriasis, dermatitis, or lichen planus that affect the penis skin
• Irritation due to shower gels, soaps, perfumes, chemicals in condoms or lubricants, or not rinsing off the soap completely when washing
• Allergic reaction to latex condoms, spermicides, certain medications, or other substances that come in contact with the penis
• Injury of the tip of the penis or foreskin that causes inflammation and infection⁵
• An infection in the body that causes reactive arthritis and can also cause circinate balanitis¹

Signs and symptoms of balanitis

The symptoms of balanitis include:

• The head of the penis is itchy, irritated, sore, and painful 
• Discolouration – redness or red patches
• Swelling
• Cheesy-looking discharge collecting under the foreskin (smegma) that is white and lumpy
• White shiny skin patches on the glans (head of the penis)
• Itchy genitals
• Bleeding around the foreskin
• Difficulty pulling the foreskin back from the glans
• Sores or lesions on the head of the penis
• Pain when passing urine⁶

Risk factors for balanitis

Risk factors for balanitis include:

• Poor hygiene: 

This can lead to infection or irritation of the penis, especially if you are uncircumcised and do not wash or dry your penis properly¹ ² ³

• Overwashing:

This can also cause irritation or inflammation of the penis, especially if you use soap or products that contain perfumes or chemicals¹ ²

• Uncontrolled diabetes: 

This can increase the sugar level in your urine, which can promote the growth of yeast and cause fungal infection¹ ² ³

• Phimosis: 

This is a condition where the foreskin is too tight to pull back over the head of the penis, which can trap sweat and urine and increase the risk of infection¹ ² ³

• Sexually transmitted infections (STIs):

Some STIs, such as gonorrhoea and trichomoniasis, can cause balanitis by infecting the penis¹

Diagnosis of balanitis

Balanitis can be diagnosed by a healthcare provider who will perform a physical examination of your penis and look for signs of inflammation, infection, or skin conditions. Your provider may also take a swab of your urethral opening (the hole at the tip of your penis) and send it to a lab for testing.⁷  In some cases, you may need a blood glucose test to check for diabetes, or a biopsy of the affected skin to rule out chronic skin conditions.³

Management and treatment of balanitis

The treatment and management of balanitis depends on the cause of the inflammation. 

 Possible treatments include:

• Antifungal creams or ointments such as clotrimazole or miconazole to treat yeast infection
• Antibiotics such as penicillin or cefadroxil to treat bacterial infection
• Steroid creams or ointments such as hydrocortisone to reduce irritation and inflammation
• Salt baths to relieve itching and pain caused by balanitis. A handful of salt can be added to a tub of warm water and the  penis soaked  for 10 minutes twice a day
• Circumcision – which is  surgery to remove the foreskin. This may be considered if a child keeps getting balanitis and other treatments have not helped⁸

Complications of balanitis

Balanitis can have some complications if left untreated. Some of the possible complications are:

• Balanitis xerotica obliterans (BXO): 

This is a condition where the skin on the head of the penis hardens and turns white, which can interfere with the flow of urine and semen¹ ²

• Phimosis: 

This is a condition where the foreskin becomes too tight to pull back over the head of the penis, which can cause pain, further infection, and difficulty urinating¹ ²

• Urethral stenosis: 

This is a condition where the urethra (the tube that carries urine and semen out of the body) becomes narrow or blocked, which can cause urinary problems and, potentially, kidney damage 

• Malignancy: 

This is a rare but severe complication where balanitis can lead to cancer of the penis⁴

FAQs

How can I prevent balanitis?

Balanitis can be prevented by taking some simple steps to keep your penis clean and to avoid irritation. Some of the ways to prevent balanitis are:⁶

• Wash your penis every day with warm water, gently pulling back your foreskin, if you have one, to clean under it. Avoid using soap or shower gel as they can irritate the skin. You can use a mild emollient (moisturiser) instead
• Dry your penis thoroughly after washing because moisture can promote the growth of bacteria and fungi that cause infection
• Practice safe sex to avoid sexually transmitted infections (STIs) that can cause balanitis. If you have multiple partners, using condoms and getting regularly tested can help prevent contracting STIs and spreading them to partners
• Avoid irritants such as perfumes, chemicals, dyes, or latex that can cause allergic reactions or inflammation. Choose products that are suitable for sensitive skin and rinse off any residues after their use
• Get tested for diabetes if you have symptoms of high blood sugar such as frequent urination, thirst, or fatigue. Control and manage the diabetes as instructed by your physician because diabetes can increase your risk of balanitis by making your urine more sugary thereby encouraging yeast growth

How common is balanitis?

Balanitis is relatively common and affecting approximately 3-11% of males during their lifetime.²³ It is more prevalent in uncircumcised men, who have an approximately 68% increased lifetime incidence.⁴

When should I see a doctor?

If you notice any of the symptoms of balanitis and/or have inflammation of the penile area, contact your doctor.

Summary

Balanitis is an inflammation of the glans of the penis (head of the penis) that can be caused by infections, irritation, or inadequate hygiene. Balanitis can be prevented by maintaining proper hygiene of genitals,using soap substitutes and toiletries for  sensitive skin to avoid irritation, practicing safe sex to avoid STIs,, and getting tested for and managing diabetes as appropriate It is important to consult your GP for diagnosis of the cause of the inflammation so that the balanitis can be treated and managed appropriately.