Balanitis

What balanitis looks like

• red or blotchy patches on the glans
• soreness, itching or burning
• swelling of the glans and foreskin
• thick, lumpy discharge under the foreskin or an unpleasant smell
• shiny or tight skin
• pain when peeing
• difficulty pulling back the foreskin

In young boys, balanitis typically causes a red, swollen foreskin and discomfort peeing. It is usually mild and settles quickly.

Causes

Infections

Irritation (non-infectious)

• Poor hygiene: buildup of smegma (oily secretions and skin cells) under the foreskin
• Over-washing or scrubbing with soap
• Irritant products: perfumed soaps, shower gels, bubble bath, detergent residue, lubricants, spermicides, latex condoms
• Urine trapped under the foreskin, especially with incontinence
• Medicines causing fixed drug eruptions (such as some antibiotics and NSAIDs)

Skin conditions

• Zoon's (plasma cell) balanitis: shiny, orange-red patches in older uncircumcised men
• Circinate balanitis: painless gray-white patches, part of reactive arthritis
• Lichen sclerosus: white, scarred skin that can tighten the foreskin
• Psoriasis and eczema

Risk factors

• being uncircumcised, especially with a tight foreskin (phimosis)
• diabetes, because sugar in urine feeds yeast and bacteria
• obesity
• a weakened immune system
• recent antibiotics

Diagnosis

A doctor will ask about symptoms, hygiene, products, sexual history and previous episodes, then examine the penis. Tests may include:

• a swab from under the foreskin for yeast and bacteria
• tests for sexually transmitted infections
• urine or blood glucose tests for diabetes, especially if balanitis recurs
• a skin biopsy for persistent patches, to rule out lichen sclerosus or precancerous changes

Treatment

General measures for everyone

• Wash the penis daily with warm water only. Gently pull back the foreskin (in adults and older boys whose foreskin retracts), rinse, dry and return it.
• Avoid soaps and shower gels on the area; use a plain emollient soap substitute instead.
• Dry gently after peeing and washing.
• Avoid sex until symptoms clear; use condoms if a partner may have thrush.

Do not forcibly retract a young boy's foreskin. It is normally non-retractable until around age 5 or later, and forcing it can cause injury and scarring.

Medicines

• Candida: antifungal cream such as clotrimazole twice daily for 1 to 2 weeks, or an oral antifungal if severe. Partners may also need treatment.
• Bacterial: antibiotic cream or tablets, depending on severity.
• Irritant dermatitis: stop the irritant and use a mild steroid cream for a short time.
• Sexually transmitted infections: specific treatment, with partner notification.
• Skin conditions: stronger steroid ointments for lichen sclerosus, specialist care for others.

Circumcision

Circumcision may be recommended for recurrent balanitis, phimosis or lichen sclerosus that does not respond to treatment.

Complications

• phimosis: scarring and tightening of the foreskin
• paraphimosis: a retracted foreskin trapped behind the glans
• narrowing of the urethral opening
• long-standing inflammation, which slightly increases the risk of penile cancer

Prevention

• daily water-only washing under the foreskin
• avoiding perfumed products and harsh detergents
• good blood sugar control in diabetes
• using condoms
• drying the penis after washing and peeing

Frequently asked questions

What causes balanitis?

The most common causes are candida yeast infection, poor hygiene with smegma buildup, irritation from soaps and other products, and bacterial infection. Diabetes, a tight foreskin and recent antibiotics increase the risk. Sexually transmitted infections and skin conditions can also cause it.

How do you treat balanitis?

Wash daily with warm water only and avoid soaps. Depending on the cause, treatment includes antifungal cream for yeast, antibiotics for bacteria, or a mild steroid cream for irritation. Most cases improve within a week. See a doctor if it does not improve or keeps returning.

Is balanitis a sexually transmitted infection?

Balanitis itself is not an STI, and most cases are not sexually transmitted. However, some STIs can cause it, and yeast can pass between partners. If you have a new partner or symptoms such as sores or discharge, get tested for STIs.

Can balanitis be a sign of diabetes?

Yes. Recurrent balanitis, especially yeast balanitis, can be a sign of undiagnosed or poorly controlled diabetes, because sugar in the urine encourages yeast growth. A simple blood or urine glucose test can check.

How long does balanitis last?

With proper hygiene and the right treatment, most cases of balanitis improve within 3 to 7 days and clear within 2 weeks. If symptoms persist beyond that, a swab, diabetes testing or a skin biopsy may be needed.