Inflammation of the Penis Head and Foreskin, or Balanitis

Balanitis is an inflammation that affects the head of the penis (glans penis). When the foreskin (prepuce) is affected, it is referred to as balanoposthitis. Balanitis and balanoposthitis occur primarily in uncircumcised men.

Most common in men over 40 years old, though it can affect males of any age, balanitis is a condition affecting about 11% of adult men and 4% of children. Balanitis is typically characterized by a shiny red or reddish-orange area, but can also show up as a yellow patch with pinpoint spotting.

Occurring only in uncircumcised men, balanitis can cause the following symptoms:

• Redness of the glans penis
• Swelling and tenderness of the penile head
• Discharge from the penis (called smegma; may be foul-smelling)
• Impotence
• Painful urination
• Foul odor
• Difficulty passing urine
• Inability to retract the foreskin (phimosis)
• Inability to return the foreskin over the glans penis (paraphimosis)

The exact causes of balanitis are not known for certain. Poor hygiene may lead to an accumulation of smegma (a buildup of dead cells and body oils on the genitals) that reduces aeration and irritates the skin of the penile head, ultimately causing inflammation and swelling.

Possible contributors to balanitis include: 

• Poor hygiene in an uncircumcised male (the most common cause)
• Diabetes (a common underlying cause of balanitis)
• Overwashing
• Friction
• Response to infection
• Lubricants and spermicides in condoms
• Scented soaps or shower gels
• Detergents and fabric softeners
• Not properly rinsing soap when bathing
• Antibiotic use
• Allergic reactions to some medicines or an allergen such as latex
• Penile cancer (a rare cause of balanitis)

Infections, whether viral, bacterial or fungal, can cause balanitis to develop. A common fungal infection that can cause balanitis is candida, which also causes thrush.

Other viruses and organisms that may cause balanitis include HPV (human papillomavirus), strep, gonorrhea, chlamydia, and syphilis.

Though rare, the most common serious complication of balanitis is phimosis (the inability to retract the foreskin from the glans penis) or paraphimosis (the inability to return the foreskin to cover the glans penis). Other rare complications that may develop with balanitis and balanoposthitis include:

• Cellulitis, a bacterial infection of the deeper layers of the skin
• Buried penis syndrome, a condition where the penis is buried beneath folds of skin (usually associated with obesity)
• Meatal stenosis, an abnormal narrowing of the opening at the tip of the penis
• Balanitis xerotica obliterans, chronic dermatitis of the glans penis and foreskin
• Scarring
• Reduced blood flow to the glans penis
• Increased risk of penile cancer

If you experience the signs and symptoms of balanitis, you should seek medical attention. Proper hygiene and avoiding irritants is important. Depending on potential causes of the balanitis, such as bacterial or fungal infection, your doctor may prescribe antibiotic pills or creams, or anti-fungal cream. In cases of other skin diseases, your doctor may prescribe a steroid cream.

For most cases, balanitis and balanoposthitis can be controlled with medication .In rare and severe cases, such as with phimosis or paraphimosis, circumcision may be recommended.

Rarely, when balanitis does not respond effectively to treatment, a biopsy may be considered.