Balanitis is a relatively common condition that affects the foreskin and the head of the penis, causing discomfort, redness, swelling, pain, itching and other symptoms. While it’s not often discussed openly, balanitis can significantly impact the quality of life and overall health. In this first instalment of our series on balanitis, we’ll examine the condition, its potential causes, and why understanding it is essential for effective treatment and prevention.
What is Balanitis?
Balanitis refers to inflammation of the glans (head) of the penis. In many cases, it also involves the foreskin of uncircumcised men, which is referred to as balanophosthitis. This condition can affect men and boys of all ages, though it is more common in uncircumcised individuals due to hygiene and foreskin-related factors.
Common Symptoms
Symptoms can range from mild to severe and typically include:
- Redness and Swelling: The glans (head of the penis) and sometimes the foreskin become red and swollen. This is often the most noticeable symptom.
- Itching and Irritation: A persistent itch or irritation around the glans and foreskin can occur, causing significant discomfort.
- Pain or Discomfort: Pain, especially during urination or sexual activity, is common. This can range from mild to severe.
- Discharge: A foul-smelling discharge from under the foreskin is often a sign of infection.
- Shiny or White Patches: The skin on the glans may appear shiny or develop white patches. These patches can indicate a fungal infection or other skin conditions.
- Tight foreskin (Phimosis): In severe cases, the foreskin may become tight and difficult to retract. This condition is known as phimosis and can complicate hygiene and exacerbate symptoms.
- Soreness and Tenderness: The affected area can become sore and tender to the touch, making daily activities uncomfortable.
- Ulcers or Sores: Small ulcers or sores may sometimes develop on the glans or foreskin. These can be painful and may bleed.
- Burning Sensation: A burning sensation during urination or when the area is touched.
- Crusting: The formation of crusts or scabs on the glans or foreskin
- Swollen Lymph Nodes: Swelling of the lymph nodes in the groin area can occur if the infection spreads.
What causes Balanitis?
Balanitis can result from various factors, and understanding the underlying cause is crucial for appropriate treatment.
poor hygiene
Poor hygiene is one of the most common causes of balanitis, especially in uncircumcised men. The foreskin may trap sweat, urine, and other debris, creating an environment where bacteria, fungi, or yeast can thrive.
How it causes balanitis: If the area under the foreskin is not cleaned regularly, a build-up of smegma (a combination of oils, dead skin cells, and other secretions) can occur. This build-up can irritate the skin of the glans, creating inflammation and increasing the risk of infection.
Prevention: Regular cleaning of the genital area with mild soap and water, especially under the foreskin, can help reduce the risk of developing balanitis.
Infections (Bacterial, fungal, viral)
Bacterial Infections
Bacteria, including Staphylococcus or Streptococcus, typically cause infections such as bacterial balanitis. These bacteria can infect the glans due to poor hygiene or injury. The infection can lead to swelling, pain and pus formation. In some cases, sexually transmitted infections (STIs), such as gonorrhea or chlamydia, may also be contributing factors.
Fungal Infections
The most common cause of balanitis is Candida albicans, the same organism responsible for yeast infections. Warm, moist environments, such as under the foreskin, provide an ideal breeding ground for this fungus. It often occurs when there’s an overgrowth of yeast, which factors like moisture, antibiotic use, or diabetes can trigger. Candida balanitis may cause itching, redness, and thick, white discharge.
Viral Infections
Herpes Simplex Virus (HSV) is a viral cause of balanitis. The infection can cause painful sores on the glans, accompanied by redness and swelling. The sores may take time to heal and can be recurrent.
diabetes
People with poorly controlled diabetes are more susceptible to infections, including balanitis. High blood sugar levels can provide an ideal environment for bacterial and fungal growth, which increases the risk of balanitis. Moreover, individuals with diabetes may have difficulty with immune response and healing, which can make balanitis harder to treat.
How it causes balanitis: The high glucose levels in the urine of diabetic individuals create a breeding ground for bacteria and fungi, which can infect the glans and foreskin.
Prevention: Proper diabetes management, blood sugar control, and proper hygiene practices can reduce the risk of developing balanitis.
allergic reactions and irritants
Certain substances such as soap, lotions, condoms (latex) or detergents can cause an allergic reaction or irritation to the sensitive skin of the penis. Similarly, exposure to irritants like scented body washes or lubricants can trigger inflammation.
How it causes balanitis: Allergens or irritants may cause redness, itching, and swelling in the glans. This condition is usually temporary and resolves once the irritant is removed. However, chronic exposure to such irritants may lead to recurrent cases of balanitis.
Prevention: Avoiding harsh chemicals and using hypoallergenic products can help prevent allergic reactions.
Skin conditions (dermatological issues)
Eczema: Eczema or atopic dermatitis is a skin condition that causes itching, redness, and inflammation. If eczema affects the penis, it can cause balanitis.
Psoriasis: Psoriasis can cause scaly, dry patches of skin, and when it affects the glans, it may lead to balanitis.
Lichen Schlerosus: This chronic skin condition leads to thinning and scarring of the skin, particularly around the genital area. It can cause balanitis and is associated with long-term inflammation and potential scarring of the penis.
sexually transmitted infections (stis)
Balanitis can be associated with STIs or from partners who have conditions like vaginal yeast infections (thrush). Shared fungal infections are a common pathway.
How it causes balanitis: These infections can cause inflammation and irritation of the glans, often accompanied by discharge and pain during urination or sexual activity.
Prevention: Safe sexual practices, including common usage and regular STI screenings, can reduce the risk of acquiring STIs that could cause balanitis.
Phimosis (tight foreskin)
Phimosis, the condition where the foreskin is too tight to be pulled back over the glans, can contribute to the development of balanitis. The tightness can trap moisture and bacteria and inhibit proper hygiene practices, leading to irritation and infection.
How it causes balanitis: A tight foreskin can prevent proper hygiene and increase the risk of infection under the foreskin, which in turn causes inflammation of the glans.
Prevention: Treating phimosis with stretching exercises or medical intervention can help alleviate the risk of balanitis caused by tight foreskin. For more information about Phimosis, check out our Phimosis series – https://thebentbanana.com/phimosis/
Trauma or injury
Injury to the penis, whether accidental or through vigorous sexual activity, can cause balanitis. Even minor cuts or abrasions on the glans can become infected and lead to inflammation.
How it causes balanitis: When the skin is broken, it provides an entry point for bacteria, which cause infection and swelling.
Prevention: Being mindful during sexual activity to reduce as much as possible the risk of trauma to the genital area.
Why Understanding the Cause is Important
The treatment of balanitis depends heavily on its cause. Inadequate or incorrect treatment can lead to chronic inflammation, recurrent infections, or complications such as scarring of the foreskin. Therefore, it is critical to see a healthcare professional to determine the root cause.
When to seek Medical Advice
If you experience any of the symptoms listed above, you must consult a healthcare professional, especially if:
- Symptoms persist for more than a few days
- There is severe pain or difficulty urinating
- You notice a foul-smelling discharge
- The condition recurs frequently
What will a Doctor do?
Medical history and physical examination
The healthcare professional will start by taking a detailed medical history, including any symptoms, recent infections, hygiene practices and underlying health conditions like diabetes.
A thorough physical examination of the penis and foreskin is conducted to look for signs of infection, inflammation and other abnormalities.
laboratory tests
The healthcare professional may request the following laboratory tests to be done:
- Swab Test: A swab of the affected area or the urethral opening may be taken to identify bacterial, fungal, or viral infections. This helps determine the specific pathogen causing the symptom.
- Urine Test: Urine samples can be tested for infection or other underlying conditions contributing to balanitis.
- Blood Tests: Blood tests may be performed to screen for diabetes, STIs or other systemic conditions contributing to the symptoms.
additional diagnostic procedures
- Culture Tests: If an infection is suspected, culture tests can help identify the specific type of bacteria or fungus, guiding appropriate treatment.
- Biopsy: In chronic or severe cases, a small tissue sample (biopsy) from the affected area may be taken to rule out other conditions, such as skin cancers or chronic inflammatory disease.
- Allergy Tests: If an allergic reaction is suspected, allergy tests may be conducted to identify specific irritants or allergens.
Imaging
- Ultrasound: In rare cases, an ultrasound may assess any underlying structural abnormalities or complications.
differential diagnosis
- Exclusion of Other Conditions: The healthcare professional will also consider and rule out other conditions that can cause similar symptoms, such as STIs, lichen planus, or psoriasis.
Complications from Balanitis
Though rare, complications from balanitis can occur if the condition is left untreated or becomes severe.
- Persistent Pain and Swelling: Ongoing pain and swelling that do not improve with treatment.
- Difficulty Urinating: Pain or discomfort during urination or difficulty starting the urine stream.
- Discharge: Persistent or worsening discharge with a foul smell.
- Bleeding: Bleeding from the glans or foreskin.
- Ulcers or Sores: Development of painful ulcers or sores on the glans or foreskin.
- Phimosis: Inability to retract the foreskin over the glans, which can lead to hygiene issues and futher infections.
- Paraphimosis: The foreskin becomes trapped behind the glans and cannot be pulled back over which can restrict blood flow.
- Scarring: Formation of scar tissue on the glans or foreskin, which can lead to narrowing of the urethral opening and difficulty urinating.
- Balanitis Xerotica Obliterans (BXO): A chronic condition that causes hardening and whitening of the glans and foreskin, potentially leading to severe phimosis.
- Systemic Symptoms: Fever, chills, or other signs of a systemic infection, indicating that the infection may have spread.
Potential Long-Term Complications
- Chronic Balanitis: Recurrent episodes of balanitis can lead to chronic inflammation and scarring.
- Penile Cancer: Chronic inflammation and infection have been associated with an increased risk of penile cancer.
- Sexual Dysfunction: Pain and discomfort can interfere with sexual activity and lead to long-term sexual dysfunction.
Key Takeaway
Balanitis is more than just a temporary irritation. It is a condition that reflects your body’s response to various external or internal factors. By understanding its causes and pursuing the correct diagnosis, you empower yourself to seek effective treatment and adopt strategies to prevent it from returning. If you are not happy with the progress of your current treatment, I hope you have enough information to discuss alternative options with your healthcare provider.
Stay tuned for further articles on recurrent balanitis and balanitis and sexual health: what you and your partner need to know.