Balanitis is characterized by inflammation of the glans penis (the tip of the penis) that leads to symptoms such as redness, itching and swelling in the area. In most cases, it is caused by a yeast infection (from Candida albicans fungus), but it can also be caused by a bacterial infection or allergy.

Although it balanitis can in any young or old male patient, it is more common in men who have not undergone circumcision. Having intact foreskin can increase the risk for secretions, moisture and microorganisms is accumulate near the tip of the penis, leading to inflammation.

If you suspect you may have balanitis, you are advised to consult a urologist or your family doctor. Treatment will vary depending on the underlying cause, and your doctor may order oral or topical antifungals, corticosteroids, or antibiotics.

Main symptoms

The main symptoms of balanitis are:

Redness on the glans penis
Firm, shiny skin on the glans
Intense itching, pain or irritation of the glans
Foul odor
Swelling of the glands penis
Pain when urinating
Cheesy-like substance under the foreskin, known as smegma

In some cases, it may be difficult to pull back the skin covering the penis, as the area becomes more swollen and the skin becomes tighter.

If you notice these symptoms, it is important to consult a urologist or family doctor to identify the underlying cause and begin treatment.

Is balanitis a sexually transmitted infection?

Balanitis is not considered to be a sexually transmitted infection (STI), however, it can be caused by STIs like syphilis, gonorrhea, chlamydia, HPV or trichomoniasis.

Confirming a diagnosis

A balanitis diagnosis is starts with assessment of your symptoms, health history and a physical exam. The doctor will inspect the characteristics of any lesions on your glans and foreskin and note the presence of any swelling or discharge

Usually, no additional tests are necessary. However, depending on your symptoms, your doctor may opt to collect a sample of secretions from the penis to be analyzed in the lab. This can help to identify the microorganism responsible for the infection and guide treatment.

In addition, other tests may be requested by your doctor to confirm or rule out other infections, like herpes, syphilis, Trichomonas, scabies or Mycoplasma.

Difference between balanitis, posthitis and balanoposthitis

Balanitis refers to inflammation of the glans penis (the tip or head of the penis), while posthitis refers to inflammation of the foreskin, the skin that covers the glans. Balanoposthitis, as the name suggests, refers to an inflammation that affects both the glans and the foreskin.

Possible causes

Balanitis is typically caused by an infections, and is most commonly a symptom of a yeast infection. A yeast infection in men is more likely to occur in men with uncontrolled diabetes or inadequate personal hygiene, however it can also emerge non-infectious reasons.

The main causes of balanitis are:

Inadequate hygiene;
Allergy to spermicides, condoms, soaps, shower gels, underwear fabric or medications
Direct traumas
Diseases such as heart failure, nephrosis or cirrhosis
Morbid obesity
Bacterial infections, such as group B and group A beta-hemolytic streptococci or Gardnerella vaginalis
Sexually-transmitted infections, such as syphilis, trichomoniasis, gonorrhea, HPV or chlamydia

Additionally, some skin diseases, such as eczema or psoriasis, can also develop in the genital area and lead to balanitis.

Types of balanitis

There are four types of balanitis, which include:

1. Zoon Balanitis

Zoon's balanitis is the most common type of balanitis. It mainly affects older, uncircumcised men and causes chronic inflammation of the glans penis and foreskin.

The exact cause of this type of balanitis is not completely known, but it is believed to be related to irritation caused by excess moisture, heat, and smegma under the foreskin.

2. Circinate balanitis

Circinate balanitis is a type of balanitis that can occur in men who have reactive arthritis. It causes sores on the glans penis in addition to the other classic symptoms of balanitis.

3. Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB)

PKMB is a rarer type of balanitis that most often affects men over the age of 60. It is associated with scaly warts on the tip of the penis.

4. Balanitis xerotica obliterans

Balanitis xerotica obliterans, also known as penile lichen sclerosus, can affect not only the glans but also the foreskin and urethra. It is associate with white spots on the penis and may lead to obstruction of the urethra.

The exact cause of balanitis xerotica obliterans is not fully known, but it is believed to be related to direct trauma, infection, or chronic inflammation.

Treatment options

Most cases of balanitis can be treated with adequate hygiene and by using cotton underwear. However, if symptoms do not improve, you should see your doctor to identify the cause and start a targeted treatment.

Generally, the doctor can prescribe:

Corticoid ointments: Like hydrocortisone, which can be used in all cases to improve symptoms and decrease inflammation.
Antifungal ointments: Like nystatin, clotrimazole and terbinafine, which are used to treat yeast infections. Check out other ways to treat yeast infections.
Antibiotic ointments: like clindamycin or mupirocin, which are used to treat bacterial infections

If balanitis was caused by sexually transmitted infections, the doctor should also indicate the most appropriate treatment according to the type of STI. In this case, it is also important to treat your partner and use a condom during all sexual relations.

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If a latex condom allergy is causing symptoms, you can opt for condoms made from polyurethane or polyisoprene.

Possible complications

The main complications associated with balanitis, especially if left untreated, are pain, formation of painful wounds or ulcers on the penis, narrowing of the urethra which can interfere with urine flow, or the development of malignant (cancerous) or pre-malignant lesions. Cancer is more common in cases where balanitis becomes a chronic or recurring problem.

Another complication is the development of paraphimosis or phimosis, which are considered to be a medical emergency.