Balanitis

What is balanitis?

Balanitis is an inflammation of the end of the penis (the glans). Often the foreskin is also inflamed at the same time as the glans. (The foreskin is the loose skin that covers the glans if you have not been circumcised.)

Balanitis is common, and it can occur at any age. It more commonly affects boys under four years and also men who have not been circumcised. About one in 25 boys and about one in 30 uncircumcised men are affected with balanitis at some time in their life. It is very uncommon in men who have been circumcised.

What are the symptoms of balanitis?

The most common symptoms include redness, irritation and soreness of the end of the penis. It can range from a small patch of redness confined to part of the skin surface of the glans, to the whole glans becoming red, swollen and painful. Sometimes there is a thick clumpy discharge which comes from under the foreskin.

It may be impossible to pull the foreskin back. You may also have pain or discomfort when passing urine.

What can cause balanitis?

There are many different causes of balanitis.

Poor hygiene

Poor hygiene around this area, combined with a tight foreskin, can lead to irritation by smegma. Smegma is a cheesy-like substance which forms under the foreskin if the glans under the foreskin is not cleaned. This is the most common cause of balanitis.

Infection - not sexually transmitted

Various germs that live on the skin in small numbers may multiply and cause infection. A common cause of infection is with a yeast called candida. Candida is the same germ that causes vaginal thrush in women. Small numbers of candida commonly live on the skin and can sometimes cause infection.

Some types of bacteria are also a common cause of balanitis. Any man or boy can develop an infection. However, an infection of the glans is more likely to develop if you:

• Already have some inflammation of the penis due to an allergy or irritant (see below).
• Have diabetes. In particular, if your diabetes is not well-controlled and the urine contains sugar. After going to the toilet, drops of urine which contain sugar may remain behind the foreskin and allow germs to multiply easily.
• Have a phimosis. This is a condition where the foreskin does not retract (pull back) over the glans. This is common in young boys. After the age of five years the foreskin will usually retract easily so the glans can be gently cleaned. You are more likely to get a balanitis if you have a phimosis, as sweat, debris and urine may collect under the foreskin. This can irritate directly, or can encourage germs to thrive and cause infection.

Infection - sexually transmitted

Some sexually transmitted infections (STIs) can occasionally cause balanitis. In particular, an STI is more likely if you also have urethritis (inflammation of the tube that passes out urine.) Various STIs can cause a urethritis and a balanitis. For example, genital herpes, chlamydia, and gonorrhoea. Symptoms of urethritis include pain when you pass urine, and a discharge that comes from the urethra.

Allergy and irritants

The skin of the glans is sensitive. It may 'react' and become inflamed if it comes in contact with various chemicals or other substances. For example:

• If you do not wash under your foreskin, old skin, urine, sweat, and other 'debris' can collect there. This may irritate the glans and may lead to inflammation.
• Certain soaps and disinfectants that you may use to clean the penis.
• Over-washing or scrubbing may also irritate the delicate skin of the glans.
• Condoms, spermicides, the lubricant in condoms, and lubricants used when having sex can all irritate the glans.
• Chemicals spilt on your hands may be transferred to the penis when you go to the toilet.
• Some washing powders or fabric conditioners that are not rinsed well from underpants.

Skin conditions

Certain skin conditions may cause a balanitis, or be mistaken for a balanitis. For example, psoriasis and some uncommon skin conditions can affect the penis.

How is the cause of the balanitis diagnosed?

A doctor can easily diagnose balanitis by the red and inflamed look of the end of the penis. In some cases the likely cause can be determined by the look of the inflammation. For example, the inflammation caused by candida often looks quite typical. So, in certain cases your doctor is able to diagnose the cause and advise on treatment straight away.

If your doctor is not sure about the cause, or the balanitis does not clear with treatment, your doctor may suggest one or more or the following.

• A swab to look for certain bacteria that can cause infection.
• A test to check for diabetes if this is suspected.
• Referral to a genito-urinary medicine (GUM) clinic if a sexually transmitted infection is a suspected cause.
• Referral to a skin specialist if a skin condition or allergy is thought to be the cause. Allergy testing may be advised if an allergy is suspected.
• Rarely, if the inflammation persists, a biopsy (small sample) of inflamed skin may be taken to look at under the microscope. This can help to find the cause.

What is the treatment for balanitis?

The following is recommended if you have balanitis, regardless of the cause:

• Avoid soaps when inflammation is present. You can use an emollient (moisturiser cream or ointment) to clean instead of soap.
• Use luke warm water to clean your penis and then dry gently.
• Some people find that salt baths are soothing whilst treatment takes effect.

The treatment depends on the cause of the balanitis. The following are often given:

• An anti-yeast cream or a course of anti-yeast tablets are a common treatment if the balanitis is caused by candida.
• Antibiotics will clear infection caused by bacteria (including certain sexually transmitted infections).
• A mild steroid cream to reduce inflammation is useful for balanitis caused by allergies or irritants. Sometimes a steroid cream is used in addition to anti-yeast or antibiotic medication to reduce inflammation caused by infection. (Note: if there is infection of the glans then a steroid cream should not be used alone, as steroids can make infection worse.)

If you have recurring balanitis and have a phimosis, then an option is to be circumcised to remove the foreskin. If this is the case, then your doctor will refer you to a specialist to discuss this in more detail.

Can balanitis be prevented?

Tips which may help to prevent some cases of balanitis include:

• Wash the glans each day. Pull the foreskin back gently whilst in the bath or shower. Then gently clean the glans using just water, or water and a bland soap. Make sure the penis and glans are dry before you put on underpants.
• If symptoms are related to condom use, try using a condom which is designed for sensitive skin.
• Wash your hands before going to the toilet if you work with chemicals which can irritate delicate skin.
• Use a condom each and every time you have sex with a new sexual partner.