Balanoposthitis

Balanoposthitis is inflammation of the glans and of the foreskin together. The two surfaces sit against each other, so an irritation of one almost always involves the other, and treating only half of it is why episodes repeat.

The space under the foreskin is warm and moist, and that suits both yeast and bacteria. Candida is the commonest organism in adults. Soaps, shower gels, disinfectants and over-washing strip the natural oils and inflame the skin on their own, and under-washing leaves smegma and urine in contact with it. Condoms, lubricants and spermicides irritate some men.

In an adult, a first episode after years without one is worth taking seriously as a sign of something else. High blood sugar puts glucose into the urine and feeds yeast, and balanoposthitis is a recognised way for undiagnosed diabetes to announce itself. Skin conditions such as lichen sclerosus and eczema, and sexually transmitted infection, account for most of the rest.

Your doctor makes the diagnosis by looking. They examine the glans and the foreskin, retract the foreskin if it will retract, and look at the skin underneath for redness, moist white patches, cracking, ulceration or a pale thickened area, since each points somewhere different.

A swab is taken where there is discharge, and a urine or blood sugar is checked in almost every adult who has not been tested recently. Where there has been a new partner, a full sexual health screen is offered, and that is a routine part of the assessment.

The examination takes a few minutes. Tell your doctor how many episodes you have had and what you have already applied, including anything bought over the counter, because a steroid or an antifungal cream used for weeks changes what the skin looks like. A patch that does not settle on treatment is examined again, and a sample of the skin is taken where the appearance does not fit.

Most episodes settle within a week to ten days once the right cream is being used, and the soreness eases within two or three days. Your doctor will usually ask you to stop soap on the area entirely and wash with water alone while it heals.

Where sugar control is the driver, the skin follows the sugar. Episodes keep returning until the glucose comes down, and that takes weeks to months of work with the doctor managing it. Where an irritant is the cause, stopping the product is the treatment and the skin is clear in a fortnight.

If surgery is chosen for repeated episodes, expect a few days of swelling, desk work within two to three days, and about four weeks before sexual activity. Your doctor will want to see you once more to confirm the skin has settled fully, since a partly treated episode is the one that comes back.