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Overview

Balanitis refers to the inflammation (irritation and swelling) of the head (glans) of the penis, most often seen in uncircumcised infants, young boys, and men or people who are assigned male at birth (AMAB). It can occur due to an infection, an allergic reaction, or an injury. The symptoms of balanitis vary according to the cause and age but typically include swelling, severe pain, itching, or redness on the head of the penis. 

Though balanitis is not a serious medical condition or contagious (spread from one person to another by direct contact), it requires prompt treatment. Treatment often includes antifungal topical creams, antibiotics, maintaining proper hygiene around the area of the penis, and, in some cases, circumcision. Circumcision is a procedure to remove the foreskin (a thin layer of skin that covers the head of the penis) from the head of the penis (glans). 

This article will explore balanitis, its causes, symptoms, treatment, and measures taken to prevent the condition. So read on!

What Is Meant By Balanitis?

An inflammation of the head of the penis (glans) is known as balanitis. It is most often caused by an infection (fungal, viral, or bacterial), an injury, or an allergic reaction that leads to swelling, redness, soreness, and increased itching. Balanitis is also commonly seen occurring in male infants and adults who do not have their penis circumscribed. 

There are three types of balanitis, namely:

  • Zoon's balanitis- It is a primary type of balanitis commonly seen in middle-aged males with an uncircumcised penis.
  • Circinate balanitis- This type of balanitis is caused due to reactive arthritis ( a type of inflammation that is often triggered due to an infection). There are tiny, painful, red sores on the head of the penis.
  • Pseudoepitheliomatous keratotic and micaceous balanitis- This is a rare form of balanitis seen in males aged over 60, characterized by scaly, wart-like bumps on the glans.

What Causes Balanitis?

Infectious and non-infectious factors most often cause balanitis:

Infectious causes in infants, young boys, and adults

  • Yeast infections that affect the genitals are known as candidiasis.
  • Bacterial infections are caused by streptococci and staphylococci organisms.
  • Viral infections as seen in herpes simplex virus (HSV), etc. HSV leads to a contagious condition causing painful blisters in the mouth and genitals.

Infectious causes only in adults

  • Sexually transmitted infections (STIs) like Gonorrhea and Syphilis.

Non-infectious causes in infants, young boys, and adults

  • Poor genital hygiene is a major contributing factor since not cleaning the foreskin well enough can trap moisture creating a favorable environment for bacterial and fungal infestation. 
  • Overwashing the penis can also cause swelling and irritation since the products used may contain irritants like perfumes and dyes.
  • Allergic reaction to medications like antibiotics and painkillers.
  • Certain skin conditions that cause itchy and dry scaly skin (eczema and psoriasis)
  • Malignant (cancerous) conditions like squamous cell carcinoma (common skin cancer that forms in the squamous cells of the middle and outer skin layers).
  • Trauma or injury to the tip of the penis or foreskin.
  • Scabies(a contagious, itchy skin condition caused by skin mites).

Non-infectious causes only in adults

  • Allergic reactions to condoms (made up of latex) and spermicides (substances that destroy the sperm).
  • Certain medical conditions like diabetes (increased blood sugar levels) and reactive arthritis.
     

What Are The Symptoms of Balanitis?

The symptoms of balanitis vary depending on the cause, with swelling and redness of the glans being the most common symptoms. 

Symptoms in infants and adults

Bacterial balanitis

  • Severe pain, soreness, and skin irritation around the glans (head of the penis).
  • Shiny, swollen, firm foreskin.
  • Unusual, foul-smelling discharge from the penis.

Fungal balanitis (candidiasis)

  • Small red “satellite” bumps or areas of dry skin.
  • Itching on the skin of the glans due to extreme irritation and dryness.
  • Painful sores on the head of the penis.

Viral balanitis

  • Painful lesions or ulcers on the foreskin and glans.
  • Lesions can form groups (geographic areas) surrounded by a white or reddish (erythematous) margin on the glans.

Drug-induced balanitis

  • Swelling of the glans with painful blisters.

Additional symptoms in adults

Balanitis due to STIs

  • Smegma, which is a thick, white-colored discharge seen under the foreskin.
  • Painful and difficult urination with a burning sensation.
  • Erectile dysfunction (failure to achieve or maintain an erection of the penis for sexual intercourse.

How is Balanitis Diagnosed?

Balanitis can easily be diagnosed through a physical examination since the symptoms are most often visible. However, your healthcare provider may recommend certain tests to determine the cause, which help plan the treatment accordingly. The diagnostic tests include:

  • A swab test- Your doctor will take a swab (a piece of sterile material, cotton or gauze to take a sample) of your urethral opening (the hole at the tip of your penis) and send to the laboratory to check for infections.
  • Urinalysis- Routine urine test is conducted to check for signs of diabetes (high sugar levels in urine) or infection (presence of microorganisms).
  • Blood tests- Serum glucose test to screen for diabetes.
  • A skin scraping test- A sample is taken from the skin scraping of the glans to examine for mites under a microscope.

How is Balanitis Treated?

Balanitis treatment remains the same for infants, young boys, and adults. These include general measures to maintain proper genital hygiene and specific measures that treat the underlying cause.A urologist (a doctor specializing in diseases of the urinary tract and male reproductive system) will treat Balanitis.

General measures

  • Always retract your foreskin, and gently clean it with plain warm water or with a gentle emollient (substances that soften the skin, such as coconut oil being a natural emollient).
  • Once washed, thoroughly dry the foreskin and the glans.
  • If the balanitis in adults is caused due to latex condoms or spermicides, your doctor can recommend alternative barrier methods.
  • Discontinue the drug (antibiotics or painkillers) that is causing the inflammation.

Specific measures

This help to treat the underlying cause that contributes to the development of balanitis.

Anti-fungal creams

  • Topical creams will be prescribed if a yeast or fungal infection is the cause of inflammation.

Steroid creams

  • This help to manage swelling, irritation, and severe itching of the skin

Anti-itch creams

  • These creams reduce the redness and itching of the skin.

Antibiotics

  • Antibiotics help treat sexually transmitted diseases that may contribute to developing balanitis.
  • These include oral antibiotics for adults and syrups for infants and young boys.

Management of diabetes in adults

  • Your doctor will prescribe medications to help reduce your blood sugar (glucose) levels and recommend lifestyle changes.
  • Lifestyle changes include
    • Eating a balanced diet (including fruits, vegetables, and whole grains).
    • Limiting foods high in sugar, like pastries, chocolates, etc.
    • Exercise regularly to lower your blood sugar levels, risk of heart disease, and stress levels.
    • Quit smoking and limit your alcohol consumption.

Circumcision

  • Your doctor may recommend circumcision if you experience recurrent balanitis symptoms. 
  • It is a procedure performed under local anesthesia, where the foreskin from the head of the penis is removed.
  • In infants and young kids, anesthetic syrups are administered to sedate them since they would not cooperate during the circumcision.
  • The child’s hands and legs would be held firmly by a nurse to prevent unwanted movements during the procedure.
  • Post-op oral painkillers or syrups would be prescribed to manage pain and discomfort.
  • A urinary catheter (a tube to drain the urine) may be placed for the initial days post-procedure in infants and young boys.
  • There are different methods of circumcision:

Dorsal slit

  • A dorsal slit is a procedure to open the tight ring of the foreskin so that the head of the penis is seen. This will not remove the foreskin.

Traditional method (Gomco clamp)

  • Here your doctor will make a small cut on your foreskin, which is retracted. 
  • Then a circumcision device, known as the Gomco clamp, is placed until the blood flow has stopped.

Mogen clamp

  • This method does not involve any cuts.
  • A hemostat is placed to separate the foreskin from the penis head.
  • The foreskin is retracted, and a Mogen clamp is placed over it to cut off the blood flow.

Also Read: urology

Plastibell

  • Here the foreskin is not removed; instead, a Plastibell is left in place, and the foreskin is pulled over it.
  • A string is held tightly around the foreskin to cut the blood supply.
  • The skin beneath will die (necrotize) and the bell and the foreskin will fall off after 10 to 12 days.

The Shang ring (Silicone ring)

  • This device consists of an inner and outer ring.
  • The inner ring is placed on the foreskin and retracted over it.
  • The outer ring is placed over the retracted foreskin, and the clasp is tightened.
  • The skin left behind is no longer useful and hence surgically removed.
  • The ring is left in place and removed after a week.

Laser circumcision

  • The foreskin is retracted with the help of forceps (a surgical instrument with two tongs). 
  • A laser beam is targeted on the foreskin, which is removed by the heat energy generated.

What Are The Complications of Balanitis?

Balanitis, if left untreated, can lead to chronic (long-lasting) inflammation and complications like:

  • Pain and ulceration (the formation of open sores due to poor blood circulation).
  • Extension of the inflammation to the foreskin (balanoposthitis).
  • Constriction in the opening of the foreskin prevents normal retraction (phimosis).
  • Difficulty in urination and sexual dysfunction.
  • Trapping of the foreskin near the glans of the penis limits blood flow (paraphimosis). This causes a sudden increase in the size of the penis accompanied by severe pain.
  • Recurrent genital infections such as candidiasis (a fungal infection).
  • Long-term balanitis can cause scarring around the glans.
  • A condition called lichen sclerosis forms white and hard patches on the skin. This blocks the semen and urine flow through the urethra (a tube through which urine is drained out of the body).
  • Increased risk of penile cancer.
  • Backflow of urine towards the kidneys (vesicoureteral reflux).

How to Prevent Balanitis?

You can take preventive measures to avoid the occurrence and recurrence of balanitis. These include:

Maintaining good genital hygiene

  • This helps to prevent moisture build-up and bacteria under your foreskin.
  • Bathe regularly using unscented soap. 
  • Avoid using soaps that contain harsh chemicals, perfumes, and dyes that cause Irritation.
  • Always make sure to retract the foreskin and wash it with lukewarm water.
  • Path dry your penis, and do not rub it forcefully.

Safety measures during sexual activity

  • Always use a latex-free condom.
  • Use alternative barrier methods instead of spermicides.
  • Get yourself tested regularly for STIs.

For a child with increased risk

  • Always change the diapers regularly.
  • Gently wash, and pat dry your child's penis regularly.
  • Avoid using baby wipes since they may increase moisture and create an environment for bacterial or fungal infestation.
  • The boys must learn how to keep their penis clean as they grow old.

Circumcision as a preventive measure

  • If you are at an increased risk of developing balanitis, circumcision can help lower your risk. 

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