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Balanitis (Swollen Foreskin): Symptoms, Causes and Prevention

Balanitis means an inflammation of the glans (or a head of the) penis. There are also similar conditions such as posthitis (inflammatory processes manifested in the prepuce) and balanoposthitis which combines the symptoms of both. The sole reason for a distinction between these three conditions is the impossibility of prepuce irritation in circumcised males. Thus balanitis is more common as it affects both male categories.

However, for the most part in clinical practice, everything is clumped together into the term balanitis which means that an inflammation of the glans and foreskin is present.  It is also important to keep in mind child’s normal physiology when dealing with infantile balanitis.

If the child is uncircumcised the inability to pull a foreskin back over the glans is considered a normal event. That happens because of the adhesions of the foreskin to the glans during early childhood. They separate usually by the age of 11 and nothing needs to be done so long as the child is able to urinate properly.

Balanitis Causes

Infectious causes are the following:

  • Anaerobic bacteria
  • Balanitis candida case – more common in males with diabetes or those who have their partners suffering from regular yeast infections. Children are also considered a risk category due to frequently observed failures to keep up a proper hygiene. Balanitis might also be caused by a diaper dermatitis or recent antibiotic use.
  • Gonorrhea
  • Herpes simplex virus
  • Human papillomavirus
  • Streptococcal infection

Non-infectious causes include:

  • Allergy  – people allergic to latex might be prone to getting a reaction after condom use.
  • Contact dermatitis – not only balanitis can be caused by poor hygiene which means that the person doesn’t have a proper cleaning technique, it might also be due to excessive cleaning. Excessive washing with water and soap can irritate and overdry the glans which eventually will lead to balanitis.
  • Atopic dermatitis
  • Psoriasis
  • Drug eruption – this condition generally manifests itself in 40 minutes (up to 7 hours) after medication intake. Possible drugs implicated in provoking a reaction are tetracyclines, sedative hypnotics, and salicylates. Balanitis can be the only drug-induced skin reaction observable.
  • Poor hygiene

It is also worth mentioning that candida infection that results in balanitis can really be an initial presentation of diabetes, especially in the otherwise healthy male. So if we have balanitis which never occurred before or if we have recurring balanitis it is strongly recommended to do a quick glucose check to rule out diabetes.

Balanitis Symptoms

Most of those suffering from balanitis might have a rash that will have small erythematous lesions which can ulcerate or scale causing pain, pruritis, and tenderness as well. If left untreated it might lead to scar tissue formation and swelling that might result in phimosis or even paraphimosis. The latter would be an urologic emergency because it results in the foreskin retracted behind the glans causing a tourniquet effect. There are cases when paraphimosis is confused with balanitis (presented by erythema and rash) and paraphimosis can be presented with red glans caused by a constricting effect as venous blood outflow will be reduced with arterial inflow unchanged.

There are also signs which might indicate balanitis. If a strep infection is present anywhere else on the body skin or throat then this is a possible clue for having strep as the main reason for balanitis. Discharges having a foul odor might indicate that an anaerobe microorganisms are present while satellite lesions are considered candidal balanitis symptoms. Discharge or ulcers are usually indicative of sexually transmitted diseases such as gonorrhea. Finally, when conducting physical self-examination, if you palpate supra-pubic area and you feel soreness when touching there (this is where the bladder resides), it might indicate a complicated case of balanitis paired with urinary retention. This case is an emergency and a urologist should be seen immediately.

Balanitis Management and Prevention

To reduce the symptoms that are associated with balanitis one should start doing Sitz baths and perform good hygiene. A person with this condition should get a q-tip, pull the foreskin back and ensure that everything is thoroughly cleaned.  Water irrigation, especially at the beginning, is also very important.

There is no universal balanitis cure as it depends on the cause in every separate case and should be chosen appropriately.

  • If improper hygiene is identified as the main cause of the disease then you should proceed with aforementioned procedures. One of the core things in balanitis treatment when poor hygiene is involved is its future prevention and a proper hygiene. If these recommendations are ignored then the swelling, exfoliated skin, and bacterial organisms that are naturally produced by the flora are going to overproduce and it will lead to a recurrent balanitis case. Overcleaning with water and soap should also be avoided as it may contribute to atopic dermatitis.
  • Candidal infection is treated with topical aerosols such as Clotrimazole or Miconazole. The course lasts from one to three weeks with a medication applied twice per day. Alternatively, a single Fluconazole dose might be used or Nystamin cream.
  • Dermatitis/allergy – you’ll obviously want to remove the allergic agent and apply 1% hydrocortisone cream to the head of the penis. People are usually afraid to treat sensitive areas with a steroid medicine, however, the cream is much less potent than ointments and 1% is a very low dose of a hydrocortisone which is a very weak topical steroid by itself. The application of the cream has to be repeated twice daily but the course should last no longer than one week – this is considered safe and it’ll help alleviate the symptom.
  • Drug eruption – this case is also going to resolve on its own as soon as you stop the medication but if the symptoms are severe then 1% hydrocortisone cream will help to relieve the inflamed areas.
  • If an anaerobic infection is considered the cause of the disease it should be treated with appropriate antibiotics such as metronidazole 500 mg twice a day for a week, augmentin twice a day for about week or a clindamycin topical cream applied twice a day for a week.
  • Streptococcal infectious agents are usually treated with a course of penicillin for ten days.  If an allergy is present than the medication might be substituted by beta-lactamase inhibitors antibiotics such as macrolide.

In case no amelioration is observed after 3-5 weeks of treatment, it is strongly recommended to consider referring to the urologist for a consultation and defining further treatment