Balanitis: Causes, Symptoms and Treatments

Balanitis is an inflammation of the skin at 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 aged under 4 years and also men who have not been circumcised. In middle-aged or older men, it is called Zoon's balanitis. About one in 25 boys and about one in 30 uncircumcised men are affected with balanitis at some time in their lives. Not being circumcised increases the risk of balanitis.

Balanitis causes

In many cases no cause is found for balanitis. The most common causes include the following:

• Skin infections. The most common infection is with a germ called candida (a yeast infection, also known as thrush). Less commonly, other germs (bacteria) cause a balanitis. Sometimes a sexually transmitted infection (STI) such as gonorrhoea can cause balanitis. However, balanitis is not usually caused by an STI.
• Skin conditions. Various skin conditions can affect the penis and cause balanitis. These include: psoriasis, eczema (dermatitis), lichen sclerosus and lichen planus.
• Irritant balanitis. Some men develop an inflamed penis after contact with certain substances. For example, some soaps and shower gels are irritants if left in contact with the skin for any length of time. Condoms, lubricants and spermicides can also sometimes cause irritant balanitis in some men.
• Reactive arthritis. Some men develop balanitis along with other symptoms such as inflamed joints and inflamed eyes. This is called reactive arthritis (previously called Reiter's syndrome).

Balanitis symptoms

In most cases of balanitis, one or more of the following symptoms occur:

• Redness and inflammation of the glans. (The foreskin may also become inflamed.)
• A discharge (fluid) under the foreskin, which may smell. (The penis does not usually discharge unless there is an STI.)
• Soreness and irritation of the glans. This may be mild or quite severe.
• Tightness of the foreskin.
• Occasionally, pain when passing urine.

Balanitis diagnosis

A doctor is usually able to diagnose balanitis from examining the penis and asking questions about symptoms. Sometimes a swab is taken from the glans, to check for infection. A skin scraping or biopsy (small piece of skin sent to a lab) is sometimes needed to confirm an underlying skin condition.

If balanitis seems related to an STI, you may be referred to a genitourinary medicine (GUM) clinic, where the appropriate tests can be done.

Balanitis treatment

Good hygiene is important for all cases of balanitis. If you have a foreskin, pull it back and gently wash the glans with clean water every day. Avoid using soaps or shower gels on the glans and under the foreskin.

Apart from good hygiene, the treatment for balanitis depends on the underlying cause:

• Infection. If a candida (yeast) infection is the cause, an antifungal cream (such as clotrimazole) is prescribed. Antibiotic treatment may be needed if bacteria are the cause.
• Skin conditions. Treatment depends on the underlying skin condition, and may include steroid creams or ointments, antihistamines (for eczema that has an allergic element).
• Irritant balanitis. The key is to identify and then avoid using the irritant that is causing the problem. A short course of mild steroid cream (such as 1% hydrocortisone) may be prescribed to ease any inflammation.

Circumcision (removal of the foreskin) may be considered if balanitis keeps coming back, as this can prevent further episodes.

'Ask Gogodoc About' is an educational series providing information on various symptoms, pains, and disorders. It is intended for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment.