Balanitis is a condition of the penis marked by inflammatory (swelling, redness, pain) changes of the foreskin and head of the penis. The risk of balanitis is greater in uncircumcised males compared to circumcised males. There are number of causes that can lead to balanitis, including infection, trauma, irritation by environmental substances and poor hygiene. Treatment options are directed towards the cause. Usually drug treatment for underlying infection is sufficient. In a few cases of balanitis where poor hygiene is due to an inability to retract the foreskin, circumcision is recommended.
The symptoms of balanitis includes :
- Red and swollen head of the penis and foreskin
- Pain of the penile head and foreskin
- Foul smelling penile discharge
- Rashes on the head and adjacent area of the penis
- Difficulty in urination
Sometimes neglected cases of balanitis may present with :
- Scarring and narrowing of the penile orifice (opening) due to repeated attacks of balanitis (meatal stricture).
- Difficulty in pulling back (retraction) of the foreskin over the tip of the penis due to small opening (phimosis) leading to difficulty in urination and recurrent infection.
- Due to recurrent episodes of balanitis, the foreskin may become trapped behind the head of the penis (paraphimosis) leading to decreased blood supply to the tip of the penis (gangrene).
Causes of balanitis includes :
- Poor penile hygiene: failure to wash the penis after retracting (pulling back) the foreskin is one of the common causes of balanitis. Uncircumcised men are more prone to balanitis although circumcised people may also suffer from balanitis.
- Overuse of soap during washing, use of abrasive agents and failure to rinse soap and foam (residual soap) properly can also cause irritation and lead to balanitis.
- Irritation of the skin of the penis by chemicals present in condoms, spermicidal gel, soaps, detergents (due to inadequate washing of clothes) and certain fabrics.
- Infection: bacterial (warm and moist environment under the foreskin serve as the ideal area for bacterial growth), viral even fungal (Candida usually from the female partner suffering from vaginal candidiasis) infection can cause balanitis. Sexually transmitted diseases (STDs) predispose a person to balanitis.
- Poorly controlled diabetes mellitus (sugar diabetes).
- Physical injury to the penis.
- Circinate balanitis: Co-existent with other disease like reactive arthritis (also known as reiter’s disease manifested as inflammatory changes of joints, urethra and eyes), some skin diseases like eczema, psoriasis (dry scaly skin disorder), lichen planus (itchy , purple plaques over arms, legs oral mucosa).
- Unknown causes: Zoon’s balanitis , is a rare skin disease of the foreskin due to unknown cause, that is usually treated with circumcision.
- Poor penile hygiene
- Overuse of soap
- Uncircumcised penis
- Diabetes mellitus
- Sexually transmitted diseases
Causes of balanitis determine the mode of treatment. Although it can be an embarrassing condition, balanitis should not be ignored. It can lead to severe complications and permanent damage to the penis.
- Infections due to bacterial, fungal, viral infection require treatment with the appropriate antibiotic, antifungal and antiviral drugs.
- In severe cases where maintenance of good hygiene is impossible due to inability to retract (pull back) the foreskin beyond the tip of the penis (phimosis), circumcision is necessary.
- Anti-inflammatory drugs are useful for reducing the swelling and pain but only offer symptomatic relief.