Balanitis (Inflammation of the Glans Penis)

Balanitis is a descriptive term for inflammation of the glans penis (the head of the penis). It is much more common in uncircumcised men and affects up to 10% of men at least once in their lifetime.

When the inflammation affects both the glans and the foreskin, it is called balanoposthitis. Most people who present with balanitis also have inflammation of their foreskin and therefore have balanoposthitis.

Balanitis can be acute (lasting a few days or weeks), or it can be a recurrent or chronic issue that affects a person's quality of life for months or years. The symptoms can vary but typically include:

• Skin changes: Redness, patches, itchiness, irritation, soreness, swelling, or scarring.
• Discharge: A collection of mucus under the foreskin.
• Phimosis: A subtle or significant tightness of the foreskin, which can lead to pain during sex and cuts that are slow to heal.
• Urinary issues: Narrowing of the urinary opening, which can make it difficult to pass urine.

Balanitis can be caused by a single or multiple underlying conditions. The most common causes include:

• Infections: This can be from an STI (like Chlamydia or Syphilis), a fungal infection (like thrush), or a bacterial or viral infection.
• Irritants or Allergens: The skin of the penis is sensitive and can react to things like soaps, shower gels, condoms, lubricants, or even washing powders.
• Skin Conditions: Conditions such as Zoon's balanitis, genital psoriasis, and lichen planus can cause balanitis.
• Poor Hygiene: Difficulty cleaning under a tight foreskin can lead to inflammation.
• Underlying Health Issues: Diabetes and high stress levels can trigger or worsen symptoms.

Yes, balanitis can be a symptom of several STIs, including Chlamydia, Gonorrhea, and Genital herpes. It is essential to get an STI screen to rule out these infections when diagnosing the cause of balanitis.

Diagnosis is best done by a clinician with expertise in penile skin conditions. The process usually involves:

• A detailed consultation: The clinician will discuss your symptoms, medical history, and lifestyle factors.
• A physical examination: A thorough examination of the affected area, often with pictures taken to monitor progress.
• Appropriate testing: This may include an STI screen, bacterial or fungal cultures, urine analysis, blood tests (for diabetes), or, in some cases, a penile biopsy.

Treatment depends entirely on the cause of the inflammation. Your clinician may prescribe medication to treat an underlying STI or a bacterial or fungal infection. Steroid creams can also be used to reduce inflammation. In rare cases where a person has a very tight foreskin, a circumcision may be recommended as a last resort.

When no specific cause can be identified, the condition is called non-specific balanitis. These cases are managed on an individual basis. Many people find relief by using a salt water bath or saline wipes on the affected area to soothe the symptoms.

Good hygiene and avoiding irritants can help prevent balanitis. You should:

• Wash your penis daily, including under the foreskin, and dry it thoroughly.
• Avoid using harsh soaps or shower gels on the area.
• Consider using latex-free condoms or condoms for sensitive skin if you find that they cause irritation.
• Wash your hands before touching your penis or using the toilet.

While serious complications are rare, long-term or untreated balanitis can lead to:

• Stricture of urethral meatus: Scarring that narrows the opening of the urethra, leading to a weak urinary stream.
• Phimosis: The foreskin becomes constricted and too tight to retract over the glans, causing pain and difficulty during sex.
• Paraphimosis: A medical emergency where the foreskin gets trapped behind the glans and cannot be pulled back to its normal position. This can restrict blood flow and may require urgent medical intervention.