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Overview

Balanoposthitis is an inflammation (swelling and irritation) of the head of the penis (glans) and the foreskin (a thin layer of skin covering the tip and head of the penis), commonly seen in uncircumcised infants, young boys, and men. It presents with severe pain, swelling, redness, and an itching sensation around the affected penis. Infections, allergic reactions, STDs (sexually transmitted diseases), and STIs (sexually transmitted infections) are the common etiologies (causes) of balanoposthitis. 

Balanoposthitis can be easily diagnosed through a physical examination and a series of diagnostic tests (urinalysis, skin test, etc.) Treatment includes general measures to maintain proper genital hygiene and specific measures to treat the underlying cause through medications.

Let us discuss balanoposthitis in detail, highlighting its causes, symptoms, diagnosis, and treatment.

What is Balanoposthitis?

"Balanitis" refers to inflammation of the glans of the penis, "posthitis" refers to inflammation of the foreskin, and "balanoposthitis" refers to inflammation of the glans of the penis and the foreskin. Usually, balanoposthitis is not a serious medical condition or contagious (spreads from one person to another through direct physical contact) and can be easily treated. 

It occurs in almost 12 to 20% of uncircumcised males and boys below the age of 5 years. Circumcision is a surgical procedure involving removing the foreskin from the head of the penis. It is the part that is most susceptible to infections (bacterial, fungal, or viral) since it can easily trap moisture and provide a favorable environment for the microorganisms to grow. 

What Causes Balanoposthitis?

The causes of balanoposthitis can be classified as infectious and non-infectious factors. 

Infectious causes in both infants and adults

  • Bacterial infections are caused by streptococci and staphylococci.
  • Viral infections are caused by HPV( human papillomavirus), and HSV (herpes simplex virus).
  • Fungal or yeast infections such as candidiasis.

Infectious causes in adults

  • STIs like syphilis (a bacterial infection spread by sexual contact which begins as a painless sore) and gonorrhea (a sexually transmitted bacterial infection that may cause infertility).
  • STDs like HIV (human immunodeficiency virus) cause AIDS (acquired immunodeficiency syndrome).

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

Poor genital hygiene

  • Improper washing or cleaning of the penis.
  • Overwashing the penis with products that contain harmful irritants and dyes causes skin irritation.

Allergic reactions

  • Allergic reactions to medications like antibiotics and painkillers can cause irritation, redness and swelling (edema) around the foreskin and glans.

Medical conditions

  • Certain skin conditions form dry, scaly and itchy skin as seen in eczema (a skin condition with dry, scaly patches) and psoriasis (a condition in which there are abnormal skin cells build up to form dry, scaly patches). 
  • Phimosis is a condition characterized by a tight foreskin.

Injury or trauma to the penis

  • Injury can occur during high-impact sports and activities, like soccer, hockey, and football.
  • The foreskin and penis glans have sensitive skin which gets easily inflamed or swollen after an injury.

Certain activities could predispose the development of balanoposthitis

  • Swimming in which the water contains chlorine can irritate the skin of the penis.
  • Irritation due to forceful rubbing or scratching of the penis.

Non-infectious causes in adults

  • Allergic reactions to certain substances like latex condoms, and substances that destroy sperm (spermicides). 
  • Diabetes (increased blood sugar levels) is the most common medical condition that contributes to the inflammation of the penis glans and foreskin.
  • Reactive arthritis is a condition that triggers an inflammatory response due to infection. 

What Are The Symptoms Of Balanoposthitis?

The symptoms of balanoposthitis appear near the glans of the penis and the foreskin and depend on the cause, which can occur in combination with other symptoms. These include:

Infectious balanoposthitis

  • Severe pain and tenderness
  • Discolouration of the skin
  • Frequent and unusual foul-smelling discharge from the tip of the penis (smegma)

Balanoposthitis due to allergies

  • Dry skin with severe irritation and itching
  • Burning sensation
  • Unusual swelling (edema)

Balanoposthitis due to medical conditions

  • Thick and leathery skin
  • Tight foreskin
  • Skin erosions, lesions, or ulceration 

Balanoposthitis due to trauma

  • Difficulty urinating
  • Uncomfortable sexual intercourse
     

How Is Balanoposthitis Diagnosed?

Physical signs and symptoms around the penis glans and its foreskin are the classic diagnostic interpretation if you suffer from balanoposthitis. However, consult a urologist (a doctor who specializes in diseases of the urinary tract) or a dermatologist (a doctor who specializes in the diseases of the skin and related tissues) for further evaluation by:

Medical history

  • Your doctor will assess your hygiene habits, sexual practices, history of allergies and any exposure to infections.

Physical examination

  • Your symptoms like discharge, rash, and erythema (red discoloration around the margins) will be evaluated by your doctor through a physical examination.

Blood tests

  • Blood samples will be collected to check for any infections or medical conditions like diabetes.

Urinalysis

  • The chemical and microscopic elements of your urine are analyzed by sending a sample to the laboratory.
  • It can also diagnose the presence of glucose (sugar) in your urine, an early indicator of diabetes.

Skin test

  • A sterile cotton swab is gently rubbed over the foreskin and the sample is sent to the laboratory.

A urethral discharge swab test

  • A sterile gauze or applicator is inserted gently into 3/4th of your urethral opening (a hole at the penis tip), and a swab sample is collected and sent to the laboratory for analysis.

Biopsy

  • It is a surgical procedure that involves the removal of a tissue sample from the penis and examining it under a microscope to determine the cause.

How Is Balanoposthitis Treated?

Balanoposthitis treatment is the same for infants and adults and can be classified as general treatment or specific treatment (that treats the underlying cause).

General Treatment

  • Keep your foreskin area clean by washing it with plain lukewarm water. 
    If necessary you can use an emollient (a soft lubricating moisturizer), that prevents skin dryness. You may use coconut oil, a natural emollient, or the one your doctor prescribes.

Specific Treatment

  • Antibiotics
    • These treat bacterial infections that cause inflammation of the penis.
    • These include oral antibiotics for adults and syrups for infants and young boys.
  • Antifungal drugs
    • Oral or topical medications help treat fungal or yeast infections.
    • Your doctor may also prescribe antifungal soaps that prevent inflammation.
  • Steroid creams
    • These topical creams reduce symptoms like swelling, skin irritation, redness, and itching. 
  • Managing diabetes in adults 
    • Medications to reduce blood sugar levels will be prescribed by your doctor.
    • Several lifestyle changes can lower your blood sugar levels and decrease your risk for balanoposthitis. These include:
      • A healthy diet consisting of fruits, vegetables, meat, eggs, and whole grains.
      • Regular exercise will keep you healthy and keep your blood sugar levels under control.
        Limit smoking and alcohol consumption.
  • Circumcision
    • This can provide relief to some extent; however, balanoposthitis may recur if proper precautions are not taken. 
    • For infants and young boys, anesthetic syrups are given to sedate and put them to sleep since most kids would not cooperate.
    • It is important to keep the child by holding the hands and legs firmly to prevent sudden, unwanted movements during the procedure.
    • Young children may be given a urinary catheter (a tube to drain urine) since they may experience urinary retention.

Circumcision can be done using different techniques, such as the following.

1. Gomco clamp technique

  • Here the foreskin is separated from the glans and a cut is made to expose it.
  • The cap of the clamp is placed over the glans and the foreskin is stretched over the cap, and the screw is fit tightly to squeeze the foreskin.
  • This blocks the blood supply, and the foreskin dies (necrosis) and eventually falls out.

2. Mogen clamp technique

  • This technique does not involve any cuts or incisions
  • A hemostat (a surgical instrument used to hold a tissue firmly) is used to grasp the foreskin, and another fine hemostat is used to open the plane between the glans and the foreskin.
  • The morgan clamp is placed over the retracted foreskin to cut the blood supply.
  • The foreskin eventually falls out due to necrosis.

3. Plastibell technique

  • A Plastibell is placed to expose the glans, and the foreskin is pulled over it.
  • A string is held tightly around the retracted foreskin to cut the blood supply.
  • This causes necrosis of the foreskin, which will fall out after 10 to 12 days, along with the Plastibell.

What Are The Complications Of Balanoposthitis?

Balanoposthitis is the least contagious medical condition and can generally resolve on its own. However, treatment is important when symptoms persist for a long time. 

If left untreated, balanoposthitis may lead to complications like

  • Chronic (long-lasting) inflammation and associated symptoms like severe pain, swelling, and itching around the penis glans and the foreskin.
  • Associated phimosis (a condition that involves constriction in the opening of the foreskin, making retraction difficult).
  • Urinary retention due to obstruction.
  • Ulceration on the penis (open sores due to poor blood supply).
  • Increased risk of penile cancer.
  • Scarring around the glans.
  • Lichen sclerosis is a condition that forms hard, white patches on the skin, blocking the normal semen and urine flow.

How To Prevent Balanoposthitis?

Adhering to certain preventive measures can effectively help prevent the occurrence or recurrence of balanoposthitis. 

  • Maintaining good genital hygiene
    • Bathe regularly and wash your foreskin carefully.
    • Retract your foreskin gently and wash the area underneath with plain warm water.
    • Avoid using soaps with harsh chemicals and dyes that may irritate your skin.
    • Proper genital hygiene will prevent the infestation of microorganisms.
    • Avoid tight underwear since the heat and moisture create a favorable environment for the growth of fungi and bacteria.
  • Practice proper sexual habits
    • Avoid forceful retraction of the foreskin.
    • Use a latex-free condom to avoid skin allergies.
  • Circumcision
    • It is a procedure that involves removing the foreskin from the head of the penis.
    • It can be used as a preventive measure. 
  • For infants and young children
    • Frequent diaper changes (especially soiled diapers) will help prevent the growth of microorganisms.
    • Educate your young kids to wash their genitals properly after every visit to the washroom.
    • Avoid using baby wipes since they may increase moisture and create an environment for bacterial or fungal infestation.

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Frequently Asked Questions

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Balanoposthitis treatment involves following proper hygiene habits and using antibiotics or antifungal medications to treat the underlying infection. It may take around 5 to 7 days for the condition to heal, depending on the duration of the medications prescribed.

Though balanoposthitis is a curable condition, the treatment provided is not permanent. A multidisciplinary approach to treating balanoposthitis includes proper genital hygiene, treating underlying infections with antibiotics or antifungal medications, and having safe and protected sex. Failure to follow any treatment options may lead to the recurrence of balanoposthitis.
 

Initially, you may not notice the symptoms of balanoposthitis or ignore them, unaware of the condition. The infection may take weeks to months to progress and may tend to be chronic (long-lasting). Sometimes it may be poorly responsive to treatment as well.
 

Balanoposthitis is not contagious and usually does not spread to others by direct contact. It can be caused by bacterial, fungal, or viral infections, allergic reactions, or trauma. When balanoposthitis is caused by an infection, the organism causing it can spread to others (e.g., spread to fungal and yeast infections), but the disease itself does not spread.
 

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