Balanitis
Introduction
Balanitis is inflammation of the head of the penis (the glans). The foreskin (the loose flap of skin covering the head of the penis) is often affected too.
This common condition can occur at any age, but happens a little more often in men who have not been circumcised.
Balanitis is not normally serious and can usually be prevented with good hygiene.
What are the symptoms?
Symptoms include swelling, redness and soreness around the head of the penis and lumpy discharge under the foreskin (see the Symptoms section for more information
When to see your GP
Visit your GP or local sexual health or genito-urinary (GUM) clinic if you have any of the symptoms of balanitis. While balanitis is not usually a serious condition, it can be a sign that you have another, underlying health condition, such as a sexually transmitted infection (STI) or thrush (a type of fungal infection).
Also visit your GP if your son develops balanitis. They may need prescription-only medication, such as antibiotics.
Who is affected
Balanitis can happen at any age. An estimated 1 in 20 boys under five years old are affected by balanitis. One in 10 men who attend a sexual health or genito-urinary (GUM) clinic have balanitis.
Skin irritation is the most common cause of balanitis in boys. It is usually related to poor hygiene, such as not getting rid of excess urine from the end of the penis after urinating.
In men, balanitis can have a number of causes, including:
- skin irritation due to exposure to substances, such as perfumed soaps or shower gels
- an allergic reaction after coming into contact with chemicals that are used in products such as soaps or detergents
- skin conditions, such as psoriasis
- sexually transmitted infections (STIs), such as gonorrhoea, genital herpes and syphilis
- persistent dribbling of urine following urination
Read more about the causes of balanitis.
Treatment
Most cases of balanitis are easily treated with a combination of creams or ointments and good hygiene, such as avoiding substances that irritate the penis.
In rare cases of balanitis that keeps coming back, circumcision (surgical removal of the foreskin) may be recommended. For example, if a man has a pre-existing condition that makes them unable to pull back their foreskin to clean it (phimosis), or persistent dribbling of urine following urination.
Read more about treatment for balanitis.
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Symptoms
Symptoms of balanitis vary in severity and you may not have all of them. Symptoms can include:
- red skin around the head of the penis,
- swelling of the head of the penis;
- irritation, and soreness of the head of the penis;
- thick, lumpy discharge under the foreskin;
- a rash or ulcers around the head of the penis,
- itchiness around the head of the penis,
- an unpleasant odour,
- a tight foreskin that will not retract (phimosis),
- pain when passing urine.
When to seek medical advice
These symptoms can also be a sign of another condition, such as a sexually transmitted infection (STI) or thrush. It’s important to see your GP or visit your local sexual health (GUM) clinic for an exact diagnosis and treatment.
You should also visit your GP if your son develops balanitis. They may require prescription-only medication, such as antibiotics, to treat their symptoms. Your GP can advise them on how to improve their hygiene by regularly cleaning the head of their penis, particularly under the foreskin.
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Causes
Poor hygiene
Poor hygiene is the most common cause of balanitis, with young boys being at particular risk. This is because the head of their penis can become irritated due to having a tight foreskin.
This can make it difficult to pull the foreskin back to clean, leading to poor hygiene and a build-up of a substance called smegma. Smegma is a ‘cheesy’, white secretion that is produced by glands inside the penis. Smegma can cause the skin around the penis to become irritated and inflamed, triggering the symptoms of balanitis.
Poor hygiene is also a surprisingly common cause of balanitis in men as well as in boys.
Other causes
Other causes of balanitis include:
- fungal infection (thrush) – people with diabetes are particularly at risk of developing this type of infection because their immune system (the body’s natural defence against infection and illness) is usually weakened
- bacterial infection – streptococcal bacteria is the most common type of bacteria to cause balanitis irritation – caused by an adverse skin reaction to certain substances, such as a bubble bath, or soap (the medical term for this type of skin reaction is contact dermatitis)
- an underlying skin condition, such as atopic eczema, or psoriasis (see below)
- in boys, repeated manipulation of the foreskin, e.g. playing or fiddling with their foreskin
Additional causes of balanitis in men include:
A number of other skin conditions are known to cause symptoms of balanitis in men.
They are:
- lichen planus – a non-infectious, itchy rash that can affect a number of areas of the body
- lichen sclerosus – a skin condition of unknown cause that affects the skin around the genitals and anus, causing it to become inflamed and itchy
- Zoon's balanitis – a rare condition of unknown cause that usually affects middle-aged men and causes the head of the penis to become red, shiny and itchy
- circinate balanitis – a type of psoriasis that can sometimes affect men with reactive arthritis (a type of arthritis that causes inflammation throughout the body, including the head of the penis)
Sometimes, if all of the skin conditions that can cause balanitis have been ruled out, you may have non-specific balanoposthitis. This is when the foreskin and the surface of the glans are inflamed, red and swollen, making it painful and difficult to pass urine. Balanoposthitis is usually treated with antibiotics, but in very severe cases circumcision may be required.
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Diagnosis
Although you may initially feel embarrassed about visiting your GP with the symptoms of balanitis, it is important that you do.
This is because you (or your child) may require prescription-only medication, such as antibiotics or antifungals (see balanitis – treatment for more information), which you will only be able to access through your GP.
It is also possible that your symptoms could be a sign of a more serious underlying health condition, such as diabetes, for which you may need additional testing.
Children
In trying to determine what is causing balanitis, your GP will examine your child’s penis and ask them (or you) whether they have any additional symptoms, such as itchiness or pain when passing urine.
Your GP may also ask a number of questions to help determine the cause of your child’s balanitis. For example, they may ask:
- how often your son cleans his penis or, in younger children, how often they have their nappy changed
- whether they may have been exposed to irritants, such as soap or bubble bath
- whether you have noticed them playing or fiddling with their foreskin
- whether they have a history of skin conditions, such as eczema
Further testing is usually only required if a child’s symptoms are particularly severe or fail to respond to treatment. This usually involves taking a small sample of cells from the head of the penis (a biopsy) and testing them for the presence of an infectious agent, such as bacteria or fungus.
Adults
To determine the cause of balanitis in adults, a similar process is followed. Your GP will examine your penis and ask you about your symptoms.
They will also ask questions to help establish what is causing your symptoms, such as exposure to irritants, or whether you may have damaged the head of your penis during sex.
As with children, further testing is usually only needed if your symptoms are severe, if they have not responded to treatment, or if you have had repeated episodes of balanitis.
In addition to taking a sample of cells from your penis, your GP may refer you for blood and urine tests to measure your blood sugar levels. This is to check whether you have developed diabetes, which may be making you more vulnerable to infection.
Your GP may also recommend that you are tested for sexually transmitted infections (STIs). They may refer you to a sexual health clinic.
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Treatment
If you or your child has balanitis, the recommended treatment will depend on what is causing your condition. See balanitis – causes for more information.
Treatments for some of the most common causes of balanitis are outlined below.
Skin irritation
If your balanitis is the result of skin irritation that is caused by poor hygiene or exposure to a substance that has irritated your penis, you will usually be prescribed a topical corticosteroid (steroid cream or ointment).
Apply the cream to the head of your penis once or twice a day until your symptoms have gone. Do not use the medication for more than 14 days in a row because this could lead to side effects, such as itchy skin and a skin rash.
It is important to avoid using soaps and other potential irritants while symptoms are present (see below). Also make sure that the head of your penis and your foreskin do not come into contact with urine after you urinate.
Potential irritants to avoid
If you have balanitis, urine is the most important irritant to keep away from the skin of your penis. Other irritants to avoid include:
- soap and shower gel
- bubble baths
- baby wipes
- latex condoms
- lubricants
- antiseptics
- hygiene sprays
Fungal infection
If your balanitis is the result of a fungal infection, you will be prescribed either an antifungal cream, such as imidazole, or an oral antifungal medication (tablet or capsule), such as fluconazole.
Fluconazole is not recommended for children who are under 16 years old. It can also cause side effects. The most common ones are:
- headache
- skin rash
- nausea (feeling sick)
- vomiting (being sick)
- abdominal pain
- diarrhoea
If your symptoms are particularly troublesome, you may also be prescribed a seven-day course of a topical corticosteroid, usually in the form of a cream or ointment.
Bacterial infection
If your balantis is the result of a bacterial infection, you will be prescribed a seven-day course of oral antibiotics (antibiotic tablets or capsules).
An antibiotic called amoxicillin is usually recommended. However, if you are allergic to penicillin, erythromycin or clarithromycin may be prescribed.
Common side effects of these types of antibiotics include:
- skin rash
- nausea (feeling sick)
- vomiting (being sick)
- diarrhoea
- abdominal pain
Again, if your symptoms are particularly troublesome, you may also be prescribed a seven-day course of a topical corticosteroid.
Follow-up
All of the treatments listed above should start working in seven days. Contact your GP if your symptoms do not improve after this time because you may require an alternative treatment.
Referral to a specialist
If your balanitis is not caused by an infection and your GP cannot identify anything that is irritating your penis, you may be referred to a dermatologist (skin specialist) or genito-urinary (GUM) clinic for further investigation.
If you have phimosis (a tight foreskin) and you have repeat episodes of balanitis, circumcision may be viewed as an option
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Prevention
Good hygeine
The best way to prevent balanitis is through good hygiene. For example:
- if you get up during the night to urinate, make sure that the tip of your penis (glans) is completely dry and free of urine before going to back to bed
- Wash the glans carefully every day, making sure you gently clean under the foreskin.
- Don’t use perfumed shower gels. Using water alone or water and a mild soap, is sufficient to clean the penis. Alternatively, use aqueous cream as a soap substitute, to avoid irritation.
- Make sure you fully dry the penis before getting dressed.
Avoiding irritants
The advice outlined below, regarding potential irritants, will also help you to avoid getting balanitis.
- Urine – after urinating, make sure that the tip of your penis is completely dry and free of urine before replacing your foreskin.
- Condoms/lubricants: sometimes the chemicals used in condoms or lubricants can irritate the penis. If you think your symptoms may be related to this, try using a condom for sensitive skin. Ask your pharmacist, GP or nurse at your local sexual health (GUM) clinic for advice.
- Detergents: wash your underwear with non-biological washing powder and make sure all the detergent is rinsed out before wearing.
- Chemicals: wash your hands before using the toilet if you work with chemicals or have traces of other products on your hands that could irritate the delicate skin of the penis.
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