Balanitis in children Q&As
Published by Bupa's health information team, February 2009.
Answers to questions about balanitis in children
Thtis section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- My son has balanitis. Should I get him circumcised?
- How should I, or my son, wash his penis to prevent balanitis?
- Can nappy rash cause balanitis?
My son has balanitis. Should I get him circumcised?
A diagnosis of balanitis doesn't automatically mean your son should be circumcised. Only on very rare occasions should circumcision be considered - there are many other treatments available to try first.
Explanation
Circumcision is rarely used to treat balanitis. There are many medicines that can be used to successfully treat symptoms.
Your GP will usually advise you to keep your son's glans and foreskin as clean as possible by bathing them in salt water, and may prescribe him a mild steroid cream or antibiotics.
However, if your son develops balanitis xerotica obliterans (BXO), circumcision may be considered.
BXO is an inflammatory skin disorder that affects the foreskin and occasionally the glans. Your son's foreskin becomes tough and stiff, and you may notice white scarring on the tip. If your son has previously been able to pull back his foreskin, he may no longer be able to do so. Also, he may feel pain when urinating. BXO is rare in children under the age of five.
If the condition is left untreated it can eventually cause the urethra (the tube for passing urine and semen) to narrow making it very difficult for your son to pass urine. Circumcision is used to prevent this from happening.
Circumcision involves surgically removing your son's foreskin (the sleeve of skin that surrounds the head of the penis). The operation is usually carried out as a day case under general anaesthetic - this means your son will be asleep during the procedure. Your son may be uncomfortable for a few days after the operation, especially when going to the toilet.
If your son's urethra has already has narrowed, additional surgery may be required to open it up.
The decision to circumcise your son shouldn't be taken lightly. It's important to look at all the treatment options available and talk the matter through with your son's GP first.
Sources
- Management of foreskin conditions. British Association of Paediatric Urologists. www.bapu.org.uk, accessed 22 February 2008
- Clark C, Huntley J, Munro F, et al., Managing the paediatric foreskin. Practitioner, 2004. 248(1665): 888-894
How should I, or my son, wash his penis to prevent balanitis?
Good genital hygiene is vital in preventing your son from getting balanitis. Make sure you, or your son if he's old enough, is keeping his foreskin and glans clean and dry.
Explanation
Keeping your son's genital area clean and dry may help to prevent balanitis, especially if he's already had an infection.
A common cause of balanitis in children is bacterial infection. If your son's foreskin or glans (if the foreskin can be pulled back to expose it) isn't cleaned regularly, bacteria can spread causing inflammation. Children in nappies can be particularly at risk because the warm moist conditions inside the nappy can cause bacteria to spread quickly. If your son is still in nappies, make sure you change him regularly and apply a barrier cream.
For young children, use a flannel or sponge to wash around the scrotum (the loose bag of skin that hangs below the penis) and between the buttocks. Make sure you rinse the area well. If your son's foreskin is still attached to the head of his penis (glans), don't pull it back to wash underneath it. The foreskin remains attached to the glans until it gradually begins to separate at around the age of two. This is shouldn't be manually forced. Most boys can pull back their foreskin by the age of 10, and 95 percent can do this by the age of 17.
Older children, who are able to pull back their foreskin, should wash their glans. To do this, slide the foreskin back to expose the glans and wash it with warm water. Don't use soap as this can irritate the area, and can cause recurrent balanitis (when symptoms keep coming back). An aqueous cream such as E45 can be used to wash the area instead of soap, but make sure it's completely rinsed off.
After washing, the end of the penis and foreskin should be thoroughly dried with a soft towel. If your son can pull back his foreskin, the glans should be completely dry before the foreskin is replaced. Take care not to dry too vigorously as this may cause irritation.
Sources
- Balanitis. New Zealand Dermatological Society Incorporated. www.dermnetnz.org Accessed 14 February 2008
- Balanitis. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 14 February 2008
- Davenport M, ABC of General Surgery in Children: Problems with the penis and prepuce. BMJ, 1996. 312: 299-301
- Management of foreskin conditions. British Association of Paediatric Urologists. www.bapu.org.uk, accessed 22 February 2008
Can nappy rash cause balanitis?
Yes, nappy rash can cause the end of the penis (glans) and foreskin to become inflamed (balanitis), and if it's severe, can make urinating difficult and painful.
Explanation
Nappy rash is often caused by urine and faeces in a baby's nappy. If left for too long, the urine and faeces begin to break down into ammonia. A baby's skin is much thinner than an adult's skin and is more susceptible to skin irritants and infections. The ammonia irritates and burns the skin causing an inflamed area.
Infections can also cause nappy rash, specifically Candida albicans. This is also a common cause of balanitis. Skin that is left warm and damp in a nappy for too long can encourage bacteria to grow, irritating your baby's skin. Sometimes nappy rash starts because of ammonia and is then complicated by a bacterial infection.
Nappy rash usually appears as red dots or, in more severe cases, the skin may become broken with pus-filled spots.
Balanitis in babies is often an extension of nappy rash. The inflammation spreads, affecting the glans and foreskin. Nappy rash can usually be treated by changing your baby's nappy more regularly, using extra absorbency in the nappy and airing your baby's skin for 15 to 20 minutes between nappy changes. However, if the inflammation is causing the foreskin to become tight or your son is having difficulty urinating, you should seek treatment from your GP as soon as possible. If left untreated, balanitis can cause your son's foreskin to be non-retractable (it can't be pulled back) and may cause his urethra to narrow making urinating difficult and painful.
Treatment for balanitis in very young children usually involves keeping the penis clean with a saline solution (salt water) and making sure his nappy is changed regularly. If the inflammation is severe, your son's doctor may prescribe a mild steroid cream or antibiotics.
To prevent balanitis, as a result of nappy rash, make sure you clean and change your son regularly. Also, use a barrier cream to protect his genital area. However, don't use a barrier cream if your son already has nappy rash.
Sources
- Valman B, ABC of one to seven. 4th ed. London: BMJ Publishing Group, 2000
- Nappy rash. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 29 February 2008
- Stoppard M, Complete baby and childcare. 2nd ed. London: Dorling Kindersley, 2001
Related topics
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Mark Woodward MD FRCS (Paed) Consultant Paediatric Urologist, Bristol, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: February 2009
Balanitis in children factsheet
Visit the balinitis in children factsheet for more information.
Rate this page
