What Is Balanitis: Causes, Symptoms, Treatment, and Prevention

Introduction

Balanitis is the inflammation and swelling of the head of the penis or foreskin. This condition is not always serious but can be painful. Balanitis can happen at any age. It affects approximately one in 20 males and is more commonly seen in uncircumcised men. This condition tends to be quite uncommon in circumcised men.

Symptoms

The main symptom of balanitis is redness and swelling of the foreskin. However, there are also other symptoms that may indicate balanitis. They include:

• Tight foreskin
• Penile pain
• Penile discharge
• Genital itching
• Unpleasant smell
• Sores on penis

The skin folds can trap debris, enabling a combination of discharge, dead cells, and skin oils to build up and form smegma. Penile swelling can also cause painful urination due to the extra pressure put on the urethra. Balanitis can also interfere with your sex life. 

Types of Balanitis

The three types of balanitis are:

• Zoon’s Balanitis: This type of balanitis often affects uncircumcised middle-aged and elderly men. This condition is characterized by the inflammation of the foreskin and glans penis (head of the penis). 

• Circinate Balanitis: Also called balanitis circinata, is a skin inflammation that develops due to reactive arthritis. 

• Pseudoepitheliomatous, Keratotic, and Micaceous Balanitis: It is a rare type of balanitis, which is characterized by wart-like and scaly lesions on the glans penis of older and uncircumcised men. 

Causes

Balanitis can have different causes. They include:

1. Poor Personal Hygiene

Males with poor hygiene are more prone to developing skin irritation and infections in the genital area. If the end of the penis underneath the foreskin is not cleaned, smegma may form. Smegma is a thick and cheesy-like substance that forms under the foreskin if the penis is not properly and regularly washed. Poor personal hygiene is the most common cause of balanitis. 

2. Bacterial or Fungal Infections

When bacteria and fungi rapidly multiply on the skin, they can cause an infection. A yeast (Candida) infection is one of the most common causes of balanitis. Vaginal thrush in women is also caused by Candida. 

In most cases, a bacterial infection of the glans often develops in males if they have any of the following:

• Uncontrolled diabetes
• An existing inflammation of the penis caused by irritants or certain allergens
• Phimosis (tight foreskin that is commonly seen in young male children)

3. Sexually Transmitted Infections (STIs)

In a few cases, balanitis can also be due to certain sexually transmitted infections (STIs). An STI often leads to balanitis if urethritis is also present. The common symptoms of urethritis include:

• Urethral discharge
• Painful urination

STIs that can cause urethritis and balanitis are:

• Chlamydia
• Genital herpes
• Gonorrhea

4. Irritation and Allergic Reactions

If the skin of the glans comes into contact with irritating substances or chemicals, it may react and get inflamed. The following substances may cause irritation of the glans: 

• Shower gels, soaps, or disinfectants used to clean the genital area
• Scrubbing or too much cleansing 
• Spermicides, condoms, and lubricants
• Antiseptics and ointments
• Fabric softeners or detergents if there is improper underwear rinsing

5. Other Skin Conditions

Certain skin conditions, such as psoriasis, may be mistaken for balanitis or may cause balanitis. In rare cases, inflammation of the head of the penis may indicate an early type of skin cancer. Make sure to consult a doctor if you have symptoms of balanitis to rule out serious medical conditions. 

Diagnosis

Balanitis can be easily diagnosed by a doctor based on your symptoms and physical examination. However, to confirm the diagnosis, some tests may be performed. They include:

• Blood sugar test for diabetes
• A culture of the urethral discharge
• STD testing
• Allergy testing if an allergy is suspected
• Other tests for certain conditions that lead to balanitis

Treatment

The treatment for balanitis usually depends on its cause. In most cases, doctors prescribe any of the following treatments:

• Oral or Topical Antifungal Drugs - These medications are often prescribed if balanitis is caused by a yeast (Candida) infection. 

• Antibiotics - These medications may be prescribed in the form of pills or creams for the treatment of bacterial balanitis. 

• Topical Steroids - Creams that contain steroid can help treat balanitis if it is caused by certain skin diseases. However, if the head of the penis is infected, topical steroids should not be generally used alone since they can make the infection worse. 

Complications

If balanitis is left untreated, the following complications may develop:

• Urethral stricture (narrowing of the urethra)
• Urinary retention (inability to completely empty the urinary bladder)
• Vesicoureteral reflux (backward flow of urine toward the kidneys)
• Circulation problem in the penis (weak erections)
• Penile scar tissue
• Painful foreskin retraction

Circumcision might be required in severe cases of balanitis. 

Prevention

To help prevent balanitis and infections in the genital area, it is essential to properly and regularly clean the penis. The foreskin and head of the penis should also be dry and clean. 

Other preventive measures include:

• Exposing the glans by pulling back the foreskin. 
• Using mild soap and warm water to thoroughly clean the genital area. 
• Avoiding the use of irritating soap. 
• Using nonsoap cleansers or aqueous cream for cleaning, but should be thoroughly rinsed off. 
• Washing the penis after sex and other sexual activities.
• Using condoms for sensitive skin. 
• Using a hypoallergenic detergent to wash clothes and underwear. 
• Good handwashing habits before and after using the bathroom, especially if your work involves using chemicals and other potential irritants. 

Outlook

The symptoms of balanitis may last for a few days if the condition is early addressed. If balanitis is chronic and frequently occurs, it may be a cause for concern. In such cases, they can be treated with over-the-counter drugs or prescribed medications to shorten the condition. 

Although OTC medications can help relieve the symptoms, it is still important to see a doctor to have a proper diagnosis and treatment. Aside from the use of OTC or topical medications, most cases of balanitis can be improved by developing good personal hygiene.