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Q. I have chronic balanitis with painful swelling. Kindly help.

Answered by
Dr. Sneha Mariam Varghese
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 09, 2020 and last reviewed on: Dec 24, 2020

Hello doctor,

I am a diabetic. I have chronic balanitis for the past two years. Now there is swelling under the foreskin that can open the foreskin to clean the white dirt. I dip the penis in cold water after excruciating pain and open the foreskin to clean. But the swelling is so much that closing the foreskin becomes difficult with unbearable pain. Please help.

#

Hello,

Welcome to icliniq.com.

I have seen the attached photos (attachment removed to protect patient identity). It looks like an ulcerated lesion on the glans penis along with balanitis, which could be due to fungal infection, herpes, chronic abrasion, or other sexual diseases (if there is a history of risky sexual exposure).

Have you taken any prior treatment for balanitis? How often do you get flare episodes of balanitis? Is the ulcer painful and bleed on touch? Any risky sexual exposure in the recent past? How long since this ulcerated lesion has appeared? Have you taken a culture study from the lesion before?

I would suggest you take a culture and sensitivity from the lesion to rule out a fungal infection or rule out other causes. After taking the culture study, a course of antibiotics shall be started, as if you take it before the test, the culture report can be altered. You can consult a surgeon to see if circumcision is advised as you have diabetes and there is a recurrence of balanitis (after a physical examination by the surgeon).

Until the test, you can take some symptomatic treatment like Paracetamol 500 mg twice daily (if painful), Cetirizine 10 mg once in the night (if itching present), and Fusidic cream for application twice daily after wash. But a culture test is required to treat the underlying cause.

You can also follow some measures as

1. Washing the area with warm saline water twice daily.

2. Keep the area always dry.

3. Wear loose cotton underclothes.

4. Do not scratch the area as it can lead to bacterial infection.

Thank you doctor,

I have never taken any treatment. What I feel is sperm was not cleaned due to tiredness and sleep and stayed in the penis. After a few times of such mistake, this problem began. Balanitis has been increasing for the last 18 months gradually ever since I had a wound under the foreskin. It kept on increasing even though I cleaned them with hot/cold saline water. I tried Cetirizine and Fusidic cream to heal the wounds and reduce the swelling. Pain is constant and does not stop. I tried Ketoconazole cream for the last six weeks. It has some 5% relief. Fluconazole tablet once a week and Gandaka Rasayana tablets. I never meet a doctor, and I am not sure if I can go for a culture test anytime soon.

#

Hello,

Welcome back to icliniq.com.

Yes, suppose you are not able to go for a culture check anytime soon. In that case, you can try with Fusidic acid cream in the morning and afternoon for two weeks, Miconazole cream for application at night for two weeks, tablet Paracetamol 500 mg twice daily for three days, tablet Cefadroxil 500 mg twice daily for seven days, and Cetirizine 10 mg once in the night (if itching present). Provided you do not have any prior allergy to these medications.

As I mentioned earlier, we have to consider many possibilities if there is a history of risky sexual exposure. If no improvement within two weeks, kindly take the culture and meet the surgeon for advice on circumcision.

Since you have diabetes, kindly maintain your sugar levels for proper healing. Kindly visit any local surgeon or a dermatologist for a proper physical examination of the lesion and look for any swollen lymph nodes. Kindly follow the general measures too.

Hereby I am attaching progress in 7 days

Today is first time after 7 days I could open my foreskin till the bottom to take pictures

So far pain was so much that couldn't open the foreskin more then the tip.

So all creams I have applied to the tip and not till the bottom of foreskin

Only today I could apply till the bottom.

There is another issue that when urine is passing there is pain but after finishing urine there is some pain as if there are acid like urine drops hidden in the lower areas

I try to remove everything but still they are there for long time

They feel like acid

Do you think my recovery is delayed due to diabetes or any other kidney issue if any ?

Let me know if you see any difference in fotos before and after

I don't see any difference but pain level has decreased alot and I tried one day with out paracetemol and pain was not that much that day.

Let me know if I need to change my medicines or continue with the same

Hoping I will be able to open till the fore skin bottom to apply medicine though it is most pain ful process and I strongly feel whole process opening foreskin till the bottom is also scrubing the wounds and allow them to heal.

Let me know your suggestions
# Hello
Welcome back to icliniq.com

1) I have seen the attached pictures, the improvement I expected after the full course of oral antibiotics is not seen. This makes a culture and sensitivity test from the area mandatory. So you have to do the test for further treatment.

2) Yes, being a diabetic can delay healing, but there should have been improvement if the ulcers by now if it was sensitive to the antibiotics. The antibiotics has just reduced the inflammation and failed to act upon the ulcerated lesions.

3) The burning sensation in urinating can be due to two reasons.
- the ulcers present
- a urinary tract infection

4) Kindly be advised to do the following without delay
- Complete urine routine
- Culture and sensitivity from the ulcer
- Urine culture and sensitivity
- Consultation with a surgeon for advice on circumcision and physical examination of the ulcer.
- check sugar levels

5) Kindly do the above following as it is mandatory.

Thank you.

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