Introduction

Balanitis is a condition that affects men globally, but it is often stigmatized and not talked about openly. Despite its seemingly harmless name, it can cause a range of physical, emotional, and social challenges that impact men's well-being. 

This condition involves inflammation of the glans penis and is often kept in the shadows, making it difficult to address openly. Therefore, it is crucial to look at its causes, symptoms, and its impact on relationships, self-esteem, and overall health.

What is Balanitis?

Pain and inflammation (swelling and irritation) of the glans (head) of the penis are symptoms of balanitis, which occurs most frequently in men who have not had circumcision or in people who were assigned male at birth (AMAB). 

The foreskin is the part of the skin that is removed during the circumcision surgery, which takes place near the head of the penis (glans).

In most cases, yeast infections are the cause of balanitis. However, certain skin conditions (dermatological issues), viral infections, and bacterial infections can also cause balanitis.

The condition impacts a range of 3 to 11 % of males throughout their lifespans.

Posthitis, a comparable condition, may occur concurrently. Reliable data indicate that approximately 6% of males who have not had circumcision experience balanoposthitis. Both circumcised and uncircumcised penises might be affected.

Doctors commonly use balanitis and balanoposthitis interchangeably, demonstrating their knowledge of these illnesses.

Types of Balanitis

Numerous infections, including those that are fungal, bacterial, viral, or parasitic, frequently cause balanitis. There are also some non-infectious types, which include:

Zoon's Balanitis: This long-lasting chronic form is characterized by an inflamed, discoloured head on the penis in individuals whose penises have not been circumcised. It may account for as much as 10% of all reported cases of balanitis.

Circinate Balanitis: Balanitis of this type is caused by reactive arthritis. You can have reactive arthritis if your immune system overreacts to an infection. In addition to inflammation and redness, circinate balanitis develops tiny lesions (sores) on the head of your penis.

Pseudoepitheliomatous Keratotic and Micaceous Balanitis (PKMB): Scaly warts or pimples may appear on the penile head if you have a rare form of balanitis. People over the age of 60 are disproportionately impacted.

Concealed Drug Overdose: When a drug or chemical causes a lesion on your skin, this is called a drug or chemical eruption.

Planula Lichen: This skin ailment manifests as a rash anywhere on the body.

Who is Susceptible to Balanitis?

Because yeast and bacteria thrive in the wet, warm area under the foreskin, uncircumcised men and individuals with AMAB (assigned male at birth) are disproportionately affected by this condition known as balanitis. 

It's more common in males with phimosis, a condition in which the foreskin is too tight to slide freely over the top of the penis. Those who are more likely to experience balanitis include

• People who rarely wash the area under their foreskin or the penis.
• The individual has reached at least middle age
• The individual with high diabetes levels has a risk of bacterial and fungal growth
• A person who has sexually transmitted infections.
• The individual who has a sensitivity to chemical irritants.

Causes of Balanitis

Infections are potential causes of balanitis, typically from a yeast or fungus infection. The foreskin's ability to trap moisture provides fertile ground for fungi and germs, but poor hygiene is usually the main reason.  

This can be caused by using items containing irritants, like fragrances and colors, or by not thoroughly washing the region after a shower.

Both insufficient cleaning and excessive washing can lead to irritation and swelling.

There are more triggers for balanitis, such as

• Reactions to latex in spermicides and condoms
• Certain medical conditions, such as diabetes and reactive arthritis. 
• Injuries to the tip of the penis or foreskin 
• Allergic reactions to certain medications, including some antibiotics and pain relievers
• Sexually transmitted infections (STIs) like gonorrhea and trichomoniasis

Symptoms of Balanitis

The most typical signs are reddening and swelling of the foreskin and the penile head. Depending on the underlying etiology, balanitis can also result in

• Tight, shiny skin on the glans
• Redness around the glans
• Inflammation, soreness, itchiness, or irritation of the glans
• A thick, cheesy white discharge under the foreskin (smegma)
• An unpleasant smell
• A tight foreskin cannot retract
• Painful urination
• Swollen glands near the penis
• Sores on the glans

Risk Factors Associated with Balanitis

Uncircumcised men are more likely to get balanitis due to poor hygiene. Cleaning and drying the penis regularly to remove moisture under the foreskin reduces the risk, although frequent genital washing with soap may increase it.

Additional Risks Include:

Diabetes patient’s risk of infection without proper blood sugar management. Some urine glucose may remain on the foreskin. Bacteria reproduce faster with glucose.

Tight foreskin causes phimosis. The foreskin cannot retract over the glans. Subcutaneous perspiration, urine, and other deposits irritate and foster bacteria. Phimosis rarely affects teens and adults.

Unprotected sexual activity and yeast infections in one or both partners enhance balanitis risk.

Additionally, balanitis can induce penile cancer. One study detected posthitis and balanitis in 45.1% of penile cancer patients.

Another meta-analysis found balanitis increased penile cancer risk by 3.8%. Early circumcision may prevent penile cancer. According to the study men who are circumcised have 68% fewer balanitis. Balanitis can also result from urinary catheterization, obesity, and irritants.

Diagnosis of Balanitis

A clinician can diagnose balanitis by seeing the red, inflamed penis glans. The appearance of inflammation can help in identifying the underlying cause, such as Candida inflammation, which is often noticeable.

If the reason is unknown or balanitis does not respond to treatment, the doctor may recommend one or more of the following tests:

• Collecting a sample with confidence and precision using a little cotton wool ball on a thin stick (swab) The sample is used to seek out infection-causing microorganisms
• An encouraging test for early detection of diabetes

If you suspect an STI, you can take charge and seek a referral to a genitourinary medicine clinic.

If a skin problem or allergy may be the cause, empower yourself by seeing a qualified and experienced skin specialist. If an allergy is suspected, allergy testing is advised.

Psychological Impact of Balanitis

Here are some of the psychological impacts  of Balanitis:

Embarrassment and Self-Esteem: People with balanitis may have feelings of embarrassment or have concerns over their physical appearance, hygiene, or sexual function. 

Anxiety and Stress: Dealing with a health condition, especially one affecting a sensitive area, can lead to increased stress and anxiety. Fear of judgment or concerns about the impact on sexual relationships may contribute to these feelings.

Effect on Sexual Relationships: Balanitis can result in discomfort during sexual activity, which may potentially damage intimate relationships. Effective communication with partners is essential for sustaining a robust sexual relationship during this period.

Medical Care Avoidance: Certain individuals may postpone getting medical help due to feelings of embarrassment or anxiety around the discussion of private health matters. This delay can worsen physical symptoms and prolong the psychological effects.

Treatments for Balanitis

The treatment for balanitis depends on what’s causing the condition. Treatments can include:

Antifungal Creams: Balanitis caused by yeast infection will be treated with antifungal cream. The cream must be applied to the penis head and foreskin.

Antibiotics: If you have an STD, your doctor will prescribe antibiotics. Antibiotics depend on the type of infection.

Manage Diabetes: Your doctor will teach you diabetes management.

Circumcision: If you get balanitis often, your doctor may recommend circumcision. Circumcision involves removing the penis's foreskin. Surgeons advise this treatment for tight foreskin. Your surgeon may perform a dorsal slit instead of a circumcision. A dorsal incision unveils the tight ring and penis head without foreskin removal.

Clean the Penis More Thoroughly. To prevent balanitis, your doctor will advise you to wash and dry under your foreskin. Do not overwash your penis with strong soaps. The water is usually warm enough.

Complications Related to Balanitis

Balanitis, if left untreated, can lead to persistent inflammation and problems like:

Lichen Sclerosus: The skin condition known as lichen sclerosus, or balanitis xerotica obliterans (BXO),  in the form of white, hard patches on the penis. This may cause problems with passing urine and sperm via the urethra.

Ulcerative Lesions: Balanitis can result in ulcerative lesions, such as painful blisters that bleed and scar over time. The danger of infection from outside bacteria and viruses is elevated in the presence of open sores.

Increased Cancer Risk: Persistent inflammation increases the risk of several different types of cancer. Studies have shown that men with balanitis, posthitis, balanitis Xerotica Obliterans (BXO), or phimosis have an increased chance of developing penile cancer.

Scar Tissue: The foreskin may become too tight to roll back over the glans if balanitis persists for an extended period and scar tissue forms in that area.

Can You Avoid Getting Balanitis?

Some prevention strategies against balanitis include:

The glans should be washed daily. While you're in the tub or shower, softly pull your foreskin back. Use either plain water or a mild soap to gently wash the glans. Before putting on underwear, make sure your penis, glans and all, is clean and dry.

If symptoms are connected to condom use, try using a condom that is developed for sensitive skin.

If you work with chemicals that can cause skin irritation, be sure to wash your hands before using the restroom.

Always use a condom when engaging in sexual activity with a new partner.

When is it Important to Consult a Doctor?

If you see signs of an infection, see a doctor immediately to prioritize your health. Remember, you can control your life and make healthy choices.

Fever, significant pain and swelling, or pus pouring from the area indicate illness, so seek medical attention immediately. Your strength to advocate for your health is crucial.

FAQs

Is balanitis an STI?

Balanitis isn't communicable or an STI. Some STIs can produce balanitis.

What is the fastest way to cure balanitis?

Consult a doctor for fast balanitis treatment. They diagnose, determine the cause, and treat. You can also use ice or a cold compress wrapped in a light towel for 10 minutes, many times a day, to reduce swelling.

Can balanitis heal by itself?

Most balanitis instances need treatment. Without therapy, your symptoms may worsen or increase.

What if I have inflammation on the head of my penis and my foreskin?

Balanoposthitis is foreskin and glans inflammation. This only affects uncircumcised men or AMAB. Itching, discomfort, and swelling of the foreskin and glans are balanoposthitis symptoms. Patients with diabetes or tight foreskin are more likely to develop balanoposthitis.

What is the difference between balanitis and herpes?

Herpes simplex 2 (HSV-2), commonly referred to as genital herpes, is a sexually transmitted infection (STI) caused by the herpes simplex virus type 2. It commonly affects the reproductive and anal regions, resulting in the development of painful blisters or sores. Nevertheless, HSV-2 can infect other regions of the body, such as the oral cavity and the eyes.

Balanitis is not an STI, and it's important to remember that. It can affect anyone, but with treatment, it can be overcome. You have the power to prevent its return by consistently washing and drying the area or considering a circumcision.

Conclusion

Balanitis is a condition where the head of the penis experiences inflammation, often caused by factors such as hygiene practices and being uncircumcised. You have the power to prevent the condition by prioritizing daily cleaning and choosing gentle alternatives to harsh chemicals.

When diagnosing the condition, a doctor will check for underlying conditions and proactively treat them to empower the balanitis to clear.

References

1. Balanitis: Causes, Symptoms, Treatment & Prevention. Available at https://my.clevelandclinic.org/health/diseases/21186-balanitis (Accessed 13 November 2023)
   
2. Balanitis: Causes, Symptoms, Treatment. Available athttps://www.medicalnewstoday.com/articles/184715 (Accessed 13 November 2023)
3. Balanitis: Causes, Symptoms, Diagnose. Available athttps://www.healthline.com/health/balanitis (Accessed 13 November 2023)
4. Balanitis: Causes, Symptoms and Treatments. Available athttps://patient.info/mens-health/penis-problems/balanitis (Accessed 13 November 2023)
5. Edwards S. Balanitis and balanoposthitis: a review. Genitourin Med. 1996 Jun;72(3):155-9. [PMC free article] [PubMed] [Reference list]https://patient.info/mens-health/penis-problems/balanitis (Accessed 13, November 2023)