Balanitis and Balanoposthitis in Men

Balanitis (foreskin infection)

Balanitis is an infection and swelling of the foreskin and the tip of the penis (called the glans penis). Balanoposthitis is called a more severe infection of the head of the penis along with the foreskin.

Hygiene and Avoiding Irritants

Balanitis usually occurs in uncircumcised men due to an infection or inadequate hygiene. Patients are advised to wash daily with lukewarm water and keep the foreskin retracted until the glans penis is dry, when possible. It is crucial to avoid irritants such as soap or bubble baths.

Treatment Options Based on Underlying Cause

Specific treatment options depend on the likely underlying cause of balanitis.

• Non-Specific foreskin infection: If a non-specific skin infection is suspected, we suggest prescribing topical hydrocortisone 1% cream or imidazole cream until symptoms settle or up to 14 days.

• Irritant or Allergic Contact Dermatitis: For suspected irritant or allergic contact dermatitis, patients are advised to avoid triggers and use topical hydrocortisone cream or ointment until symptoms settle or up to 14 days.

• Fungal Balanitis: In cases of suspected or confirmed candidal balanitis, severe symptoms should be treated with an imidazole cream or oral fluconazole. If marked inflammation is present, topical hydrocortisone cream or ointment may be considered.

• Bacterial Balanitis: For suspected or confirmed bacterial balanitis, management varies from topical antibiotic preparations for mild infection to oral antibiotics for severe cases.

• Other Specific Conditions: We recommend managing suspected seborrhoeic dermatitis and genital psoriasis. If there is a suspected or confirmed sexually transmitted disease, referral to a local sexual health clinic is advised.

Foreskin infection is more common in diabetic men. Balanitis is often caused by a fungal infection, such as candida infection.  Scarring after the balanitis can lead to phimosis and tightening of the foreskin, which can cause pain during sex and make it difficult to pull the foreskin back.

Summary

Antibiotic or steroid treatment and good hygiene often help to treat balanitis.  It is essential to wash the foreskin with salty water to prevent infection. However, recurrent balanitis can lead to scarring and phimosis in adults.  In the case of repeated balanitis and balanoposthitis, adult circumcision is an effective treatment option.

Urgent professional advice is also recommended for cases associated with phimosis, suspected Zoon's balanitis, lichen sclerosus, or penile intraepithelial neoplasia or malignancy.

Further resources

1. https://www.nhs.uk/conditions/balanitis/

2. https://cks.nice.org.uk/topics/balanitis/

3. https://patient.info/mens-health/penis-problems/balanitis