Balanitis is an inflammation of the end of the penis (the glans). Often the foreskin is also inflamed at the same time as the glans. (The foreskin is the loose skin that covers the glans if you have not been circumcised.)
Balanitis is common and it can occur at any age. It more commonly affects boys aged under 4 years and also men who have not been circumcised. About one in 25 boys and about one in 30 uncircumcised men are affected with balanitis at some time in their lives. It is very uncommon in men who have been circumcised.
There are a number of anti-fungal creams you can buy at your pharmacy (for example, clotrimazole, and terbinafine). Be aware though that if you use the wrong cream then it can make fungal skin infections worse.— Dr Oliver Starr, Antifungal Medicines
The most common symptoms include redness, irritation and soreness of the end of the penis (the glans). It can range from a small patch of redness confined to part of the skin surface of the glans, to the whole glans becoming red, swollen and painful. Sometimes there is a thick clumpy discharge which comes from under the foreskin.
It may be impossible to pull the foreskin back. You may also have pain or discomfort when passing urine.
What can cause balanitis?
There are many different causes of balanitis.
Poor hygiene around this area, combined with a tight foreskin, can lead to irritation by smegma. Smegma is a cheesy-like substance which forms under the foreskin if the end of the penis (the glans) under the foreskin is not cleaned. This is the most common cause of balanitis.
Infection - not sexually transmitted
Various germs (bacteria) that live on the skin in small numbers may multiply and cause infection. A common cause of infection is with a yeast called candida. Candida is the same germ that causes vaginal thrush in women. Small numbers of candida commonly live on the skin and can sometimes cause infection.
Some types of bacteria are also a common cause of balanitis. Any man or boy can develop an infection. However, an infection of the glans is more likely to develop if you:
- Already have some inflammation of the penis due to an allergy or irritant (see below).
- Have diabetes. In particular, if your diabetes is not well controlled and the urine contains sugar. After going to the toilet, drops of urine which contain sugar may remain behind the foreskin and allow germs to multiply easily.
- Have a phimosis. This is a condition where the foreskin does not pull back (retract) over the glans. This is common in young boys. After the age of 5 years the foreskin will usually retract easily so the glans can be gently cleaned. You are more likely to develop a balanitis if you have a phimosis, as sweat, debris and urine may collect under the foreskin. This can irritate directly, or can encourage bacteria to thrive and cause infection.
Infection - sexually transmitted
Some sexually transmitted infections (STIs) can occasionally cause balanitis. In particular, an STI is more likely if you also have inflammation of the tube (urethra) that passes out urine (a condition called urethritis). Various STIs can cause a urethritis and a balanitis - for example, genital herpes, chlamydia, and gonorrhoea. Symptoms of urethritis include:
- Pain when you pass urine.
- A discharge that comes from the urethra.
Allergy and irritants
The skin of the glans is sensitive. It may 'react' and become inflamed if it comes into contact with various chemicals or other substances. For example:
- If you do not wash under your foreskin, old skin, urine, sweat and other debris can collect there. This may irritate the glans and may lead to inflammation.
- Certain soaps and disinfectants that you may use to clean the penis.
- Over-washing or scrubbing may also irritate the delicate skin of the glans.
- Condoms, spermicides, lubricants used when having sex and the lubricant in condoms can all irritate the glans.
- Chemicals spilt on your hands may be transferred to the penis when you go to the toilet.
- Some washing powders or fabric conditioners that are not rinsed well from underpants.
Certain skin conditions may cause a balanitis or be mistaken for a balanitis - for example, psoriasis and some uncommon skin conditions can affect the penis. Very occasionally, an early type of skin cancer can present as inflammation of the end of the penis. It's worth getting these symptoms checked out.
How is balanitis diagnosed?
A doctor can easily diagnose balanitis by the red and inflamed look of the end of the penis (the glans). In some cases the likely cause can be determined by the look of the inflammation. For example, the inflammation caused by candida often looks quite typical. So, in certain cases your doctor is able to diagnose the cause and advise on treatment straightaway.
If your doctor is not sure about the cause, or the balanitis does not clear with treatment, one or more of the following tests may be suggested:
- Taking a sample with a small ball of cotton wool on the end of a thin stick (a swab). The sample is used to look for certain germs (bacteria) that can cause infection.
- A test to check for diabetes if this is suspected.
- Referral to a genitourinary medicine (GUM) clinic if an STI is a suspected cause.
- Referral to a skin specialist if a skin condition or allergy is thought to be the cause. Allergy testing may be advised if an allergy is suspected.
- Rarely, if the inflammation persists, removing a small sample of the inflamed skin tissue (a biopsy) may be suggested. The sample can be taken to be looked at under the microscope. This can help to find the cause.
The following is recommended if you have balanitis, regardless of the cause:
- Avoid soaps when inflammation is present. You can use a moisturising cream or ointment (an emollient) to clean instead of soap.
- Use lukewarm water to clean your penis and then dry gently.
- Some people find that salt baths are soothing whilst treatment takes effect.
The treatment depends on the cause of the balanitis. The following are often given:
- An anti-yeast cream or a course of anti-yeast tablets is a common treatment if the balanitis is caused by candida.
- Antibiotics will clear infection caused by germs (bacteria), including certain STIs.
- A mild steroid cream to reduce inflammation is useful for balanitis caused by allergies or irritants. Sometimes a steroid cream is used in addition to anti-yeast or antibiotic medication to reduce inflammation caused by infection. (Note: if there is infection of the end of the penis (the glans) then a steroid cream should not be used alone, as steroids can make infection worse.)
It is unusual for a child to have recurring balanitis. Your GP may ask a specialist to advise. If you are an adult with a recurring problem and have a condition where the foreskin does not pull back (retract) over the glans (a phimosis), an option is to be circumcised to remove the foreskin.
Can balanitis be prevented?
Tips which may help to prevent some cases of balanitis include:
- Wash the end of the penis (the glans) each day. Pull the foreskin back gently whilst in the bath or shower. Then gently clean the glans using just water, or water and a bland soap. Make sure the penis including the glans is dry before you put on underpants.
- If symptoms are related to condom use, try using a condom which is designed for sensitive skin.
- Wash your hands before going to the toilet if you work with chemicals which can irritate delicate skin.
- Use a condom each and every time you have sex with a new sexual partner.
Further reading and references
Management of balanoposthitis; British Association for Sexual Health and HIV (2008)
Lisboa C, Ferreira A, Resende C, et al; Infectious balanoposthitis: management, clinical and laboratory features. Int J Dermatol. 2009 Feb48(2):121-4.
Edwards S, Bunker C, Ziller F, et al; 2013 European guideline for the management of balanoposthitis. Int J STD AIDS. 2014 May 1425(9):615-626.
Balanitis; NICE CKS, July 2015 (UK access only)