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Chronic balanitis in adults

Published by Bupa's health information team, September 2008.

This factsheet is for men who have chronic balanitis, or who would like information about it.

Balanitis is an inflammation of the head of the penis (glans). Often the foreskin is affected, and inflammation can spread down the shaft of the penis. When both the glans and the foreskin are inflamed the condition is balanoposthitis; however, this is often also referred to as balanitis.

About balanitis
Symptoms of balanitis
Complications of balanitis
Causes of balanitis
Diagnosis of balanitis
Treatments for balanitis
Prevention of balanitis
Further information
Questions and answers
Related topics
Sources

About balanitis

Balanitis is an inflammation of the glans penis. The foreskin is often affected, as well as the shaft of the penis.

The glans is the head of the penis underneath the foreskin (the sleeve of skin that surrounds the top of your penis). The urethra, the tube for passing urine and semen, goes through the centre of the glans.

Chronic balanitis is when your symptoms last for several weeks, months or longer - the term chronic refers to time, not how serious the condition is. It can affect men of any age. Balanitis can also be acute (lasting only a few weeks) or recurrent (it keeps coming back).

Symptoms of balanitis

The symptoms of chronic balanitis can vary depending on the cause. They mainly affect your penis, although they can sometimes affect other parts of the body. The following is a general list of symptoms that you may have, for more specific symptoms see Causes.

The symptoms of balanitis affecting the penis are:

a red rash at the tip, this may be scaly or ulcerated
pain, tenderness and swelling
itching and discomfort
discharge or pus from underneath your foreskin, which may smell fishy
you may be unable to pull back your foreskin

Other symptoms, affecting the rest of the body, include:

a sore mouth
pain in your joints
swollen or painful glands
a rash on another part of your body (not just your penis)
feeling generally unwell

If you have any of these symptoms, particularly those affecting your penis, you should see your GP.

Complications of balanitis

A possible complication of balanitis is being unable to pull back your foreskin (phimosis). This is more likely if your symptoms last a long time (chronic balanitis) or if they keep coming back (recurrent balanitis).

Also, inflammation at the tip of the penis can cause your urethra to narrow. This causes pain when you urinate and can make aiming difficult.

Causes of balanitis

There are many causes of chronic balanitis. The most common is an inflammatory skin condition; however, occasionally the cause can be malignant (cancerous).

Balanitis xerotica obliterans (BXO)

BXO is an inflammatory skin disorder affecting the foreskin, and sometimes the glans. It causes the tip of the foreskin to develop a tight white ring which can make pulling it back difficult. It can also narrow the urethra making urinating difficult.

It usually affects men aged 45 to 60. If left untreated there is a five percent chance that it will turn malignant (cancerous).

Zoon's balanitis

This is a rare skin condition of the glans and foreskin, also known as balanitis circumscripta plasmacellularis. It's a non-cancerous (benign) condition that affects men who haven't been circumcised. Its exact cause is unknown at present.

Usually there are few symptoms and very little or no pain. You may see orange-red lesions and smaller redder spots on your glans and adjacent foreskin.

Circinate balanitis

Circinate balanitis usually develops in men who have Reiter's syndrome. Also known as reactive arthritis, Reiter's syndrome is a group of inflammatory conditions that affect the joints, urethra and eyes. On your glans, you may have greyish white areas that join up with a white border.

Erythroplasia of Queyrat

This is an early form of skin cancer found on the glans or inner lining of the foreskin. It's also referred to as Bowen's disease. You may have a velvety, red, raw area on your glans. It mostly affects men who haven't been circumcised.

Penile squamous cell carcinoma

This is a skin cancer affecting your penis. There may be a lesion on your glans, which can be either flat or shaped like a pimple, and develops into ulcers. It's relatively rare.

Chronic skin conditions

These include:

psoriasis, an inflammatory skin condition which appears as raised red patches on the skin covered with silvery scales
seborrhoeic dermatitis, a skin condition which causes an itchy or sore red rash
lichen planus, an itchy non-infectious rash
pemphigus, an auto-immune disease (caused by antibodies from your immune system attacking your body), causing blistering of the skin

Each of these conditions can have different symptoms. If you have any of the symptoms mentioned, it's important to see your GP.

Irritant-contact balanitis

Balanitis caused by a skin irritant (such as latex condoms, lubricants, soaps or antiseptics) can become chronic if you keep using the product that is irritating you.

Diagnosis of balanitis

Your GP will examine your penis and talk to you about your symptoms. Your symptoms can often indicate the cause of your balanitis, so it's helpful to keep a note of them for your GP.

He or she may take a swab from underneath your foreskin and a biopsy, a small sample of tissue. This will then be sent to a laboratory for testing to determine what has caused your balanitis, and if it's benign (not cancerous) or cancerous.

Occasionally, it may be necessary for your GP to refer you to a urologist. A urologist is a doctor who specialises in identifying and treating conditions of the urinary tract. He or she may take a biopsy of your penis under a local or general anaesthetic. If you have a general anaesthetic you will be asleep during the procedure, whereas if you have a local anaesthetic your penis will be blocked of feeling and you will stay awake.

Balanitis can sometimes indicate diabetes. If you have recurrent balanitis, your GP will take a urine sample to test for this.

Treatments for balanitis

Firstly, your GP will advise you to keep the head of your penis and foreskin as clean as possible, and not to use anything that might irritate the area, such as soap or latex condoms.

Self-help

Cleaning your penis twice a day with a weak saline solution (salt water) can be soothing and can relieve discomfort. To make a weak saline solution, mix a teaspoonful of salt into half a litre (500ml) of warm water. Alternatively, you could also try using an aqueous cream (eg E45 cream) to soothe and clean the area.

If a skin irritant (eg soap or washing powder) is causing your balanitis, symptoms often go a couple of days after you stop using the product. But be careful - if you start using the product again symptoms can come back.

Medicines

Your GP will usually prescribe a mild steroid cream. This helps to reduce the inflammation around your glans. You will also receive treatment for any other underlying medical conditions causing your balanitis. Your GP may ask you to come back after a week or so to see how you are getting on with your treatment.

If your symptoms aren't responding to treatment or they keep coming back despite treatment, you should tell your GP. He or she may give you a different medication or refer you to a genitourinary medicine (GUM) clinic or a urologist so your symptoms can be investigated further. GUM clinics specialise in identifying and treating sexual health conditions and conditions related to the urinary system (the system that produces urine). A urologist is a doctor who specialises in identifying and treating conditions of the urinary tract.

Surgery

Circumcision is sometimes used to treat balanitis, especially Zoon's balanitis and BXO. Circumcision is an operation to remove the foreskin from the penis. It's usually done as a day case under general anaesthesia - this means you will be asleep during the procedure.

If your balanitis is caused by a cancerous condition, you will need to have the growth or lesion surgically removed, or you may need to be circumcised. You may also need follow-up treatments and therapies, such as radiotherapy or chemotherapy.

Prevention of balanitis

Good genital hygiene is essential in preventing balanitis. Try to keep the head of your penis and foreskin clean and dry. And, if you are prone to balanitis after sex, use a non-latex condom or make sure you wash and dry your penis shortly after having sex.

Also, make sure you wash your hands after using the toilet.

Further information

Malehealth
www.malehealth.co.uk