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, uprotected intercourse, age, obesity, sensitivity to chemicals, allergy to condoms and spermicides, injuries at the penis' tip, scabies

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 of age less 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.

Depending on the cause of the occurrence, balanitis is divided into three types, ie. Zoon's Balanitis, Circinate Balanitis and Balanitis Pseudoepitheliomatous Keratotic and Micaceous. The condition exhibits symptoms like sores on the head of the penis, inflammation, itching and irritation during urination, unusual discharge and so on.

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

In some cases, doctors also recommend surgical circumcision of the foreskin if balanitis recurs frequently. 
If left untreated for a long, balantis can result in chronic inflammation and itching, and increase the risk of developing penile cancer. Persistent inflammation can cause balanoposthitis. Additionally, complications such as balanitis xerotica obliterans or lichen sclerosis are also seen in a few patients. In this disease, white and hard patches form on the skin and interfere with the passing of semen and urine through the urethra.

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.

When to Consult a Doctor?

On symptoms: The right time to consult a doctor is as soon as the 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 inflammation and redness of the organ to see if there's any infection festering. As the symptoms are already visible, physical examination confirms the presence of balanitis in the patient.

Swab testing: To conclude the type of infection and offer the appropriate treatment, a urologist can recommend a swab testing of penile discharge. In this method, a sample from the urethral opening is checked for microorganism culture propagating inside the body.

It is also helpful in understanding if the inflammation is happening 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: For understanding the overall status of balanitis in the body, urologists might also recommend a blood test. In this analysis, the expert aims to check for infection occurrence through a serum glucose test.

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: Typically, urologists recommend topical therapy with a range of ointments and creams to alleviate symptoms. Additionally, the prescription will also include antifungal or antibacterial lotion to relieve the impact of infection. The patient will have to use the cream on the infected area to see the results.

Additionally, the doctors also recommend medications, including antibiotics. Generally, these medicines help with the relief from STIs. But, in severe balanitis infection, antibiotics like amoxicillin also form a part of the treatment.

Surgery: For patients suffering from recurrent balanitis infections, urologists recommend circumcision (removal of foreskin) 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. 
That being said, for patients suffering from chemical-induced balanitis, it's important to consider the washing agent for hygiene.

Risk and Complications if Left Untreated

• Balanoposthitis: If neglected for 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 also cause a range of emotional problems like low self-esteem.
• Urinary tract infections (UTIs): The festering of bacteria without adequate elimination through excretory processes leads to urinary tract infections in balanitis. If left undiagnosed, it 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 leading to making the patient prone to developing cancer.

Additional Information

Which type of STIs can cause balanitis?

Balanitis is also a form of 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 beneath it and tip of the penis gently using water and mild soap. Keep in mind 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 of foreskin carefully and avoiding growing of pubic hair are general practices for keeping your genitals healthy.