Balanitis

Symptoms: Irritation around penile glans, soreness and pain in the penis, tight and stretchy foreskin, itching on glans' skin, odd discharge, sores on penis head, thick white discharge or smegma, foul penile odour, difficulty in urination, fever, inflammation

Causes: Bacterial or fungal infections, improper hygiene including overwashing penis, sexually transmitted infections, skin conditions like dermatitis, chemical irritants

Risk Factors: Diabetes, phimosis, unprotected intercourse, age, obesity, sensitivity to chemicals, allergy to condoms and spermicides, injuries at the penis' tip, scabies

Prevalence: Balanitis is an inflammation of the glans penis (head of the penis); it is relatively common, affecting 3-11% of males over their lifetime.

Severity: Mild to moderate

Which doctor to consult: Urologist and General Surgeon

Overview 

Balanitis is a condition causing painful inflammation and redness of the penile head, usually occurring in an uncircumcised penis.

Balanitis is caused by infection from bacteria or fungus. It usually occurs in boys younger than four, but it can also happen in adults. Due to the presence of excess foreskin around the penis, moisture, sweat and debris get trapped inside the skin, providing a breeding ground for bacteria and fungus to fester.

A general surgeon recommends diagnosing balanitis through physical testing, urinalysis, swab examination, and blood assessment. Depending on the test results, the experts suggest treatments, which include antifungal creams and pain—and itch-relieving medications.

The most efficient way to prevent the occurrence of the disease is by ensuring proper hygiene. Washing and drying the penis carefully with skin-friendly products can reduce the risk of balanitis. However, excessive washing can lead to trapped moisture in the uncircumcised skin's penis, which can lead to infection and aggravation of the condition.

Types of balanitis:

Balanitis is an inflammation of the glans, or the head, of the penis, and it can manifest in several forms. The main types of balanitis include:

Zoon’s balanitis: This chronic form primarily affects uncircumcised middle-aged individuals, causing inflammation and discolouration of the penis head1.
Circinate balanitis: Associated with reactive arthritis, this type results in inflammation and small lesions on the head of the penis.
Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB): A very rare form that leads to scaly warts or bumps on the head of the penis.
Treatment for balanitis depends on the underlying cause but may include antifungal creams, antibiotics, and proper hygiene practices. In some cases, circumcision may be recommended1. Maintaining good hygiene and managing risk factors like diabetes can help prevent balanitis.

Symptoms:

The symptoms include:

Symptoms of a sore, itchy, and odorous penis include redness, swelling, and pus.
Symptoms may include small, eroded, itchy spots/plaques with white cheese-like matter that can be easily rubbed off and pain while peeing.
Some adults may also have a tight foreskin that will not retract. The condition is known as phimosis.

Causes:

Infections, either bacterial (possibly sexually transmitted) or fungal (Candida)
Skin conditions like eczema, psoriasis, dermatitis, or lichen planus
Irritation from shower gels, soaps, or chemicals in condoms and lubricants
Poor hygiene, which can lead to infections

Risk factors:

Certainly, here are the risk factors associated with balanitis:

Poor Hygiene: Not cleaning the penis regularly can lead to infections.
Tight Foreskin (Phimosis): Difficulty in retracting the foreskin can cause irritation and infection.
Uncontrolled Diabetes: High blood sugar levels can promote the growth of yeast.
Allergies or Irritations: Reaction to certain chemicals in soaps, lotions, or condoms/lubricants.
Sexual Activity: Engaging in unprotected sex can increase the risk of sexually transmitted infections (STIs), which can cause balanitis.
Skin Conditions: Diseases like eczema, psoriasis, or lichen planus can contribute to the development of balanitis.
Injuries: Minor injuries to the genital area can cause infection, leading to balanitis.
It’s important to address these risk factors to prevent balanitis. Maintaining good hygiene, managing health conditions like diabetes, and using hypoallergenic products can help reduce the risk. If symptoms occur, seeking medical advice is crucial for appropriate treatment.

Possible Complications:

• Balanoposthitis: If neglected for a long, the infection causing inflammation of the glans penis spreads to the prepuce, causing balanoposthitis. After the spread, the infected area appears more swollen and discoloured. It is also a likely result of diabetes in the body. That's why experts recommend taking urgent assistance to understand the real cause behind the inflammation and discomfort in the penis.

• Phimosis: Persistent inflammation and itching can cause scarring of the penile tissue. The marred area leads to constriction of the foreskin. It can reach a point where moving the skin becomes impossible and extremely painful.

• Lichen sclerosus: Due to scarring and chronic inflammation, the skin of the penis hardens and acquires a patchy white appearance. With the hardening of the foreskin, it becomes difficult for any fluid to pass through the urethra, leading to pain during urination or ejaculation.

• Erectile dysfunction: Erectile dysfunction occurs with ongoing inflammation, which makes erection either painful or not achievable. Not only can it impact the sexual health of the patient, but it also causes a range of emotional problems like low self-esteem.

• Urinary tract infections (UTIs): Bacteria festering without adequate elimination through excretory processes leads to urinary tract infections in balanitis. If left undiagnosed, they can spread to the prostate, causing prostatitis.

• Ulcerative lesions: Balanitis can result in the formation of painful sores and blisters on the foreskin. These sores can be excruciating and also lead to bleeding. Additionally, such lesions act as an open ground for bacteria to cause serious infection.

• Penile cancer: Untreated penile balanitis also paves the way for a high likelihood of cancer. With unretractable foreskin, the chances of infection increase multifold. The higher occurrence of infection weakens the immune system, making the patient prone to developing cancer.

Prevention:

Preventing balanitis involves maintaining good hygiene and making some lifestyle adjustments. Here are some key prevention strategies:

• Good Hygiene: Clean the penis regularly with warm water and gently dry it, especially under the foreskin.

• Safe Sex: Use condoms to reduce the risk of sexually transmitted infections (STIs) that can cause balanitis.

• Avoid Irritants: Use hypoallergenic soaps or soap substitutes if regular soaps cause irritation.

• Manage Health Conditions: Control diabetes to prevent high blood sugar levels, which can promote yeast growth.

• Proper Urination: Retract the foreskin when urinating and dry any urine before replacing the foreskin.

• After Intercourse: Wash the penis after sexual activity, especially if balanitis tends to flare up afterwards.
  These measures can help reduce the risk of developing balanitis. If you have recurrent episodes despite following these steps, it’s important to consult a healthcare provider for further evaluation and advice.

When to Consult a Doctor?

The right time to consult a doctor is when symptoms start appearing. Any appearance of redness or swelling, itching, irritation during urination, unusual discharge with a foul odour and penile sores must be treated with immediate assistance.

Delay in seeking treatment might lead to debris building up around the skin of the penis, causing smegma. Additionally, chronic balanitis can result in obstruction in the urethra, causing pain with semen passage or urination. It can also inhibit penis erection or result in a painful erection.

Failure of treatment: After the initial diagnosis, doctors may recommend over-the-counter medicine to treat itchiness and inflammation. Generally, the patients respond to treatment within 3-5 days.

However, if the infection has spread beyond the surface, you must consult your doctor again. In the progressed stages, the patients face fever, inflammation and draining pus from the penile region, which requires urgent medical help.

Patients with phimosis: If you're suffering from phimosis, i.e. tighter foreskin, you must keep a check on the health of your penis with regular checkups. Individuals dealing with phimosis are more likely to develop balanitis.

Diagnosis:

Physical examination: An urologist conducts a physical examination of the penis to analyse the root cause. In this assessment, the doctor checks for the organ's inflammation and redness to see if any infection is festering. As the symptoms are already visible, physical examination confirms the presence of balanitis in the patient.

Swab testing: A urologist can recommend swab testing of penile discharge to determine the type of infection and offer the appropriate treatment. This method checks a sample from the urethral opening for microorganisms propagating inside the body.

It is also helpful in understanding if the inflammation occurs due to conditions other than balanitis, such as STIs. Moreover, the culture discharge acquired through swabs enables urologists to detect the kind of candida yeast causing the disease.

Urinalysis: Urinalysis is the method doctors use if the adult patient exhibits signs of high sugar. On the basis of the presence of glucose levels in the urine, a doctor starts the treatment for the underlying issue while helping with symptom alleviation. 

Blood tests: Urologists might also recommend a blood test to understand the overall status of balanitis in the body. The expert aims to check for infection through a serum glucose test in this analysis.

Biopsy: In rare cases, urologists will ask for a biopsy on the inflamed part. In this method, a skin sample is taken from the affected region and sent to a lab for testing mites and cancerous growths. This method is useful for checking scabies when all other diagnosis techniques do not provide a conclusive result.

Treatment:

Medications: The treatment for balanitis depends on the underlying cause, but here are some examples of medications that may be prescribed:

Antibiotics: Medications like Penicillin or Cefadroxil may be used for bacterial infections.
Antifungal Creams: Creams such as Clotrimazole or Miconazole are commonly prescribed to treat yeast infections.
Steroid Creams: A mild steroid cream like Hydrocortisone might be recommended for inflammation and irritation.
It’s important to use these medications only under the guidance of a healthcare provider, as they will choose the treatment based on the specific cause of the balanitis. Always consult with a doctor for the correct diagnosis and treatment plan.

Surgery: Urologists recommend circumcision (removal of the foreskin) for patients suffering from recurrent balanitis infections to reduce the risks of future infections. Generally, patients are advised to undergo surgery in the cases of BXO. Balanitis Xerotica Obliterans progresses into severe and more complicated forms, affecting the urinary and sexual capacity of individuals. It can lead to urethral stenosis and phimosis, which obstruct the urethra and cause painful symptoms.

Lifestyle changes: Since the most common cause of balanitis is improper hygiene habits, doctors recommend ensuring proper cleanliness in the penile region. It can include regular washing with mild soap. However, patients are also cautioned not to overindulge in cleanliness which can cause further irritation to the sensitive penis. 
It's important to consider the washing agent for hygiene reasons for patients suffering from chemical-induced balanitis.

Additional Information

Which type of STIs can cause balanitis?

Balanitis is also a symptom of penile infection. Some sexually communicable infections can lead to balanitis. These include:

1. Herpes: The occurrence of painful blisters, itchiness, redness of the penis, and scabs can pave the way for balanitis. The spread of herpes can even lead to vesicles in the prepuce, shaft and scrotum, causing extreme discomfort and inflammation.

2. Gonorrhoea: This condition involves discharge from the penis with the tenderness of the penile head. It also involves the creation of yellow or white pus inside the foreskin. The combined symptoms lead to balanitis, causing reduced penile functions.

3. Syphilis: Characterised by a foul smell, red rashes and lumpy discharge, syphilis is an infection affecting the penis. The progression of this infection leads to symptoms of balanitis.

What can you do to alleviate balanitis symptoms at home?

Generally, balanitis infection responds to the prescribed course of treatment within 3-5 days. In the meantime, the patients can take the assistance of home remedies to relieve symptoms, such as:

1. Gentle washing: Pull back the foreskin and clean it and the tip of the penis gently using water and mild soap. Remember to retract the skin to ensure the removal of accumulated debris or germs. Avoiding chemically-formulated soaps: Some patients are allergic to the cleaning agents used in soaps. Additionally, the lubricants used in condoms can also lead to inflammation of the penis. Ensure using skin-friendly contraceptives and cleaning products.

2. Keeping the area dry: Moisture underneath the skin of the uncircumcised penis leads to higher chances of infection. Excessively humid areas provide ideal conditions for bacteria like candida to grow. By keeping the intimate region dry and clean, a patient can avoid infections and several complications like BXO.

3. Proper hygiene practices: Washing the area routinely, cleaning the foreskin carefully and avoiding growing pubic hair are general practices for keeping your genitals healthy.