Balanitis - Types, Causes, Symptoms, Diagnosis, Treatment, and Complications

What Is Balanitis?

Swelling or inflammation of the glans penis is called balanitis. It presents as a sore, itchy, and smelly head of the penis. The lesion looks like red eroded patches with a cheese-like material present on it which can be wiped off easily. Inflammation of the prepuce (foreskin) alone is called posthitis. As the swelling of both the glans penis and foreskin occurs together, it is called balanoposthitis. Recurrent episodes can be suggestive of occult diabetes.

It is a very common condition that affects 1 in every 25 boys, especially those under four years of age. It is painful and is commonly seen in uncircumcised men. It can be seen even in circumcised men with minimal symptoms. It is treatable and is caused due to poor hygiene and tight foreskin. It is not a sexually transmitted disease and is not contagious, but the bacteria causing it can get transmitted.

What Are the Types of Balanitis?

The three types of balanitis are:

• Zoon’s Balanitis - It is commonly seen in middle-aged uncircumcised individuals and causes localized lesions on the glans and foreskin.

• Circinate Balanitis - It is the most common skin condition seen in reactive arthritis. The skin of the penis becomes inflamed and scaly.

• Pseudo Epitheliomatous Keratotic and Micaceous Balanitis - It mostly affects elderly uncircumcised men and presents as a hyperkeratotic plaque with a thick micaceous scale on the glans penis.

What Causes Balanitis?

The factors that contribute to or cause balanitis are:

• Common causes:

  • Improper hygiene.

  • Leaving unwashed soap on the penis.

  • Using a soap that is scented or dries the skin on the penis.

  • Scratching and rubbing.

  • Allergic reaction.

• Infectious causes:

  • Yeast infection.

  • Chlamydia - A sexually transmitted bacterial infection caused by Chlamydia trachomatis bacterium.

  • Fungal infections.

  • Herpes - A common sexually transmitted viral infection caused by the herpes simplex virus (HSV).

  • Human papillomavirus (HPV) - It is a type of viral infection that can be passed sexually or through skin contact.

  • Gonorrhea - A sexually transmitted infection by the bacterium Neisseria gonorrhoeae.

  • Chancroid - is a bacterial infection caused by the bacterium Haemophilus ducreyi.

  • Syphilis - The infection caused by the bacterium Treponema pallidum.

• Other conditions:

  • Eczema - A condition that results in dry, red, itchy, and inflamed patches of skin.

  • Diabetes.

  • Balanitis Xerotica Obliterans - A chronic inflammatory condition that affects male or female genitalia.

  • Injuries.

  • Psoriasis - An autoimmune condition where dead cells accumulate on the skin surface due to an increased cell turnover rate.

  • Reactive Arthritis - A type of arthritis that develops in response to infection in some other part of the body.

  • Phimosis - The inability to retract the foreskin.

  • Exposure to Chemicals - Latex condoms and lubricants.

Risk Factors:

• Middle-aged or older men.

• Obesity.

• Pre-existing sexually or non-sexually transmitted infection.

• Individuals with uncontrolled blood sugar levels.

What Are the Signs and Symptoms of Balanitis?

The common signs and symptoms include:

• Pain, tenderness, and irritation on the penis head and foreskin.

• The skin becomes discolored.

• Glans penis looks tight and shiny.

• Sometimes, the foreskin looks very dry.

• Foul-smelling discharge.

• Pain while urinating.

• The glands near the penis get swollen.

• Open sores.

• Skin lesions.

• Phimosis (tight foreskin).

• Itchy genitals.

How Is Balanitis Diagnosed?

Balanitis is usually diagnosed by clinical examination. If the doctor notices redness and inflammation of the penis, they will think of all the possible irritants. After advising to prevent potential irritants, the doctor might also educate people about practicing good hygiene, safe sex, and latex condoms.

The doctor might also rule out other health conditions that might cause balanitis.

If the condition is not resolved even after following the above methods, the doctor might suggest getting the following tests done:

• Blood Test - To check blood sugar levels and rule out diabetes.

• Tests to identify any sexually transmitted disease.

• Swab Test - Any penile discharge is collected using a swab from the glans to check for infection.

• Urine test.

• Biopsy - Rarely, a sample from the lesion or inflamed skin is taken and tested.

How Can Balanitis Be Treated?

Balanitis treatment depends on the underlying cause. The treatment options include:

Medications:

• Antifungal Creams - If the cause is yeast or fungal infection, then the doctor will prescribe an antifungal cream (Clotrimazole), which needs to be applied to the glans and foreskin.

• Antibiotics - If the doctor diagnoses the cause as a bacterial infection, then will be prescribed antibiotics.

• Antidiabetic Medication - If the blood glucose levels are high, the doctor will prescribe oral antidiabetic medicines or Insulin injections.

Proper Hygiene: The doctor will ask to wash and dry under the foreskin properly to reduce recurrence.

Circumcision: The doctor might suggest getting a circumcision done if have recurrent episodes of balanitis. Here, the entire foreskin is removed surgically.

What Are the Complications of Balanitis?

It is essential to get proper treatment for balanitis as early as possible. If left untreated, it can cause:

• Pain while retracting the foreskin.

• The blood supply to the penis might get reduced.

• Scars in the penis opening.

• Difficulty urinating.

• Long-standing balanitis might also cause phimosis (inability to retract the foreskin).

Phimosis and Balanitis:

Phimosis is when a man’s foreskin does not retract even after treatment for balanitis. It does not result from acute balanitis but is a complication of chronic or long-standing balanitis. Sometimes, untreated phimosis might require surgery where the surgeon cuts a slit along the top of the foreskin to separate it from the penis. In rare cases, circumcision, that is, the complete removal of the foreskin might also be needed. The earlier balanitis is treated, the better the prognosis will be.

How to Maintain Proper Penile Hygiene?

Some hygiene tips are as follows:

• Avoid using scented soaps and lotions.

• Always clean the glans penis after retracting the foreskin.

• The area should be washed with warm water.

• If needed, a neutral soap-free cleanser can be used.

• The soap should be thoroughly washed and rinsed off.

• The area should be completely dry after cleaning.

• Always wash the private areas after sexual intercourse.

As soon as any abnormality or changes in the penis is noticed, consult the doctor immediately. If treated early, balanitis does not cause permanent damage or complications. the doctor will suggest the best treatment option for the condition. Self-medication is never good, as it might worsen the situation.

Conclusion:

Male uncircumcised individuals are more likely to suffer from the curable disease known as balanitis. Inflammation and soreness in the penile head are the primary signs of balanitis. Antifungal lotions, antibiotics, frequent cleanings, and, in certain situations, circumcision are common forms of treatment.