Balanitis

Overview

What is balanitis?

Balanitis is pain and inflammation (swelling and irritation) of the glans (head) of the penis that happens most often in uncircumcised males. Circumcision is a procedure performed to remove skin (the foreskin) from the head of the penis (the glans). Balanitis is typically caused by a yeast infection, however it can be due to a bacterial or viral infection. It’s not contagious.

How common is balanitis?

It’s estimated that up to 10% of males will have balanitis during their lifetime. Balanitis is more likely to occur in uncircumcised men and boys under the age of 4.

What are the types of balanitis?

Balanitis is classified into three types:

  • Balanitis (also called Zoon’s balanitis): This is the main type of balanitis, it usually affects uncircumcised, middle-aged men and causes an inflamed, red penis head.
  • Circinate balanitis: This type of balanitis is a result of reactive arthritis, a type of arthritis that develops in response to an infection in the body. In addition to inflammation and redness, circinate balanitis causes small lesions (sores) on the head of the penis.
  • Pseudoepitheliomatous keratotic and micaceous balanitis: This very rare form of balanitis causes scaly warts on the glans. It affects men over 60.

Who is affected by balanitis?

Balanitis primarily affects uncircumcised males because the moist, warm area under the foreskin is the ideal place for yeast and bacteria to grow. It can occur at any age and is more common in males who have phimosis (tight foreskin that does not easily move over the head of the penis). Groups with a higher risk of balanitis include men who:

  • Practice poor hygiene.
  • Are middle-aged or older.
  • Have diabetes, because the increased glucose (sugar) on their skin can stimulate bacterial and fungal growth.
  • Are obese.
  • Have sexually transmitted diseases.
  • Have a sensitivity to chemical irritants.

Symptoms and Causes

How do people get balanitis?

The most common cause of balanitis is poor hygiene in uncircumcised males. Other causes include:

  • Genital yeast infection (candidiasis).
  • Sexually transmitted diseases.
  • Scabies (tiny burrowing parasite) infection.
  • Sensitivity or allergy to harsh soaps or chemicals.
  • Skin conditions that cause itchy, dry, scaly skin (such as psoriasis and eczema).
  • Diabetes.
  • Reactive arthritis, a type of arthritis that develops in response to an infection somewhere in the body.

What are the symptoms of balanitis?

Symptoms of balanitis may appear suddenly or develop gradually. They can include:

  • Pain and irritation on the glans (head of the penis).
  • Redness or red patches on the penis.
  • Itching under the foreskin.
  • Swelling.
  • Areas of shiny or white skin on the penis.
  • White discharge (smegma) under the foreskin
  • Foul smell.
  • Painful urination.
  • Sores or lesions on the glans (this symptom is rare and appears with a type of balanitis that affects men over age 60).

Diagnosis and Tests

How is balanitis diagnosed?

Healthcare providers diagnose balanitis with a physical examination to determine if an infection is causing your symptoms. Your provider may swab your urethral opening (the hole at the tip of the penis) and send the sample to a lab for testing. Your provider may also order a urine or blood test to check for diabetes and other infections.

How do I know if I have balanitis?

If you have pain, irritation, and redness on your penis, you may have balanitis. The risk increases if you are uncircumcised. See your provider for treatment and to determine what is causing your symptoms. Other conditions (such as HIV and other sexually transmitted diseases) can cause a rash and redness on the penis. It’s important to see your provider to get tested.

Management and Treatment

What are the treatments for balanitis?

The treatment for balanitis depends on what is causing the condition. Treatments can include:

  • Antifungal creams: If a yeast infection is causing balanitis, your provider will prescribe an antifungal cream such as clotrimazole to treat the infection. You will need to apply the cream to the glans (head of the penis) and foreskin as prescribed.
  • Antibiotics: If a sexually transmitted disease is the cause of your symptoms, your provider will treat the infection with antibiotics. The antibiotic will depend on the type of infection.
  • Improved hygiene: Your provider will recommend that you wash and dry under your foreskin often to reduce the risk of balanitis returning.
  • Diabetes management: If you have diabetes, your provider will show you how to manage the condition.
  • Circumcision: If you have recurring symptoms of balanitis, your provider may recommend circumcision. Circumcision is a surgical procedure in which a provider removes the foreskin covering the penis. Providers recommend this treatment most often for men who have an especially tight foreskin (phimosis).

What are the complications associated with balanitis?

Untreated balanitis can cause chronic (long-term) inflammation (redness and irritation). Lasting inflammation can cause health issues, including:

  • Balanoposthitis: Balanitis can lead to balanoposthitis (inflammation of the foreskin and glans). This only occurs in uncircumcised males. Signs of balanoposthitis include itching, irritation, and swollen foreskin and glans. Balanoposthitis occurs more often in males who have diabetes or a tight foreskin.
  • Balanitis xerotica obliterans (BXO): Also called lichen sclerosus, BXO occurs when skin on the glans hardens and turns white. The hard tissue can make it difficult or impossible for urine and semen to flow through the urethra (the tube that allows fluids to exit the penis).
  • Phimosis: Long-term inflammation can lead to scarring on the penis, which can cause the foreskin to become constricted. The foreskin can become so tight that it cannot retract (pull back) over the glans.

What can I do to help relieve symptoms of balanitis?

To ease the irritation and inflammation of balanitis, you should:

  • Bathe often: Wash every day. Be sure to pull your foreskin back so you can clean underneath.
  • Avoid harsh soaps: Try not to use strong soap or lotions that can irritate your skin.
  • Stay dry: After urinating, dry the area under the foreskin so urine doesn’t become trapped under the foreskin.
  • Teach proper hygiene: Teach boys appropriate hygiene, especially if they are uncircumcised.

Prevention

How can you prevent balanitis?

Preventing balanitis begins with practicing proper hygiene. To prevent balanitis, you should bathe often. Take the time to pull back your foreskin and clean underneath. Always use a condom when having sex to avoid contracting a sexually transmitted disease that can cause balanitis.

Outlook / Prognosis

What is the outlook for patients who have balanitis?

Most men with balanitis recover with treatment. For men who are not circumcised, it is common for balanitis to return after treatment. The risk increases when men do not practice good hygiene, such as cleaning under the foreskin.

Living With

When should I call my healthcare provider about balanitis?

If you have symptoms of balanitis, you should visit your provider. Your provider will test you for infection and recommend good hygiene practices.

Last reviewed by a Cleveland Clinic medical professional on 11/04/2019.

References

  • Merck Manual. Inflammation of the Penis. (https://www.merckmanuals.com/home/men-s-health-issues/penile-and-testicular-disorders/inflammation-of-the-penis) Accessed 11/8/2019.
  • Morris BJ, Krieger JN. Penile Inflammatory Skin Disorders and the Preventive Role of Circumcision. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439293/) Int J Prev Med. 2017 May 4;8:32. Accessed 11/8/2019.
  • Wray AA, Khetarpal S. Balanitis. (https://www.ncbi.nlm.nih.gov/books/NBK537143/) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 April 21. Accessed 11/8/2019.

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