Balanitis
Treatment of inflammation of the head of the penis, including addressing infection or irritation when present
What is balanitis?
Balanitis is inflammation of the glans, and balanoposthitis is inflammation of the glans and foreskin together. It is common, and it describes what is happening without naming a single cause.
The causes fall into three groups. Infection is the largest, most often candida and sometimes bacteria or a sexually transmitted organism. Irritation comes from soap, retained smegma, or moisture trapped under a foreskin that does not retract. And a group of skin conditions, lichen sclerosus and psoriasis among them, present in exactly the same place.
Recurrence is what changes the management. A single episode is treated and forgotten. A pattern of episodes means something is keeping it going, and identifying that is the whole job of the consultation.
What you might notice
- Soreness and redness of the head of the penis
- Foreskin that will not pull back
- Burning when passing urine
How it is diagnosed
The examination looks at the pattern and distribution of the inflammation, the state of the foreskin, and whether the skin has begun to scar or lose its pigment.
A swab is taken for candida and bacteria, and screening for sexually transmitted infection is offered where the history warrants it. Blood sugar is checked in every adult with repeated episodes, because poorly controlled diabetes is the commonest reason a cycle will not break.
Where the appearance is atypical, does not settle on treatment, or has been present for months, a small biopsy is taken. Persistent changes in this skin need a firm diagnosis before another course of cream is prescribed.
Recovery
An infective episode settles within one to two weeks of the right treatment, applied to both partners where that is relevant, alongside washing with water only and drying carefully afterwards.
Where a skin condition is behind it, treatment is measured in months and there is a maintenance routine after the initial course. Lichen sclerosus in particular needs continuing review well beyond the initial course.
Where the foreskin has been dealt with surgically, healing takes four to six weeks. Episodes generally stop after it, because the warm moist space they depended on is gone.
If it is left untreated
A single mild episode often settles with hygiene alone and needs nothing more than an explanation of what caused it.
Repeated episodes scar. The foreskin tightens, which traps more moisture and drives the next episode, and the cycle tends to accelerate instead of settling. Scarring can also narrow the opening of the urethra at the tip, which is a harder problem to fix than the inflammation was.
Lichen sclerosus deserves separate mention. It is a chronic scarring condition carrying a small long-term risk of cancer in the affected skin, so it is followed over years and not treated once and forgotten.
Questions about balanitis
Why does it keep coming back?
Recurrence means something is sustaining it. The three usual culprits are undiagnosed or poorly controlled diabetes, which feeds candida; a foreskin that does not retract fully, so moisture and smegma are trapped against the glans; and an underlying skin condition such as lichen sclerosus or psoriasis being treated as if it were an infection. Reinfection from an untreated partner is a fourth. Which of these applies is settled with a blood sugar, a swab and a careful look at the skin, and treating the cause is what breaks the cycle.
Is it sexually transmitted?
Usually not. Most episodes are candida or irritation, and candida is a normal skin organism that overgrows in warm moist conditions instead of being caught from a partner. It can be passed between partners, so treating both is sensible when episodes recur. A minority of cases do involve a sexually transmitted organism, so screening is offered where the history suggests it, particularly with a new partner, discharge, or an atypical appearance. Getting that answered matters, because the treatment differs.
Will circumcision stop it?
In most men with recurrent balanitis driven by a foreskin that traps moisture, yes, because the environment the inflammation depends on is removed. It is offered once creams and hygiene measures have been tried properly and the episodes keep returning, or where the skin has already started to scar. Where lichen sclerosus is the cause, circumcision both treats it and provides tissue for a diagnosis, and follow-up continues afterwards because the condition can affect the tip of the urethra as well.
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Day CareTalk to a care coordinator about balanitis
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one