Balanitis

Balanitis is when the head of your penis becomes swollen and painful (inflamed). Some people may notice redness, itch or irritation. If you also have an inflamed foreskin it's called balanoposthitis. It can affect children and adults. 

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Other symptoms may include:

• a white discharge under your foreskin
• an unpleasant smell
• a tight foreskin which is difficult to retract
• pain when peeing
• a rash.

If your infection is more severe you may feel unwell and have a fever. 

A common cause of balanitis is thrush, which is caused by an overgrowth of a yeast. If you're uncircumcised, the warm, moist environment under the foreskin provides ideal conditions for yeast to grow. Read more about thrush in men.

Balanitis may also be caused by a sexually transmitted infection (STI) such as gonorrhoea, chlamydia or herpes simplex, or by a bacterium called streptococcus (streptococcal balanitis). 

Other causes include allergies or sensitivity to soaps, shower gels or condoms or skin conditions such as psoriasis, eczema and scabies.

Who is at risk of balanitis?

Balanitis is more common in uncircumcised men or people assigned male at birth because the moist, warm area under the foreskin is the ideal place for yeast and bacteria to grow. It can occur at any age and is more common in people who have a tight foreskin that doesn’t easily move over the head of their penis (phimosis).

Groups with a higher risk of balanitis include people who:

• have poor genital hygiene
• have poorly controlled diabetes
• are obese
• have inflammatory skin conditions such as psoriasis
• are taking some medicines, including chemotherapy.

Your healthcare provider will talk to you about your medical and sexual history and will do a physical examination. They may take a swab to look for bacteria, yeasts, fungi and viruses. This will be sent off to a lab for testing. 

The treatment for balanitis depends on what's causing it. If it's a symptom of an STI it should clear up once the STI has been treated. Read more about gonorrhoea, chlamydia and herpes simplex and their treatment. 

If your balanitis is caused by a streptococcal infection, you may feel unwell and have a fever. You'll be prescribed oral antibiotics and followed up in a few days to check your progress and review the results of any tests. 

It's important to have good genital hygiene. Wash your genitals at least once a day, gently pull back your foreskin and wash the area with warm water. Dry gently after washing. You should avoid soap, hot water and vigorous rubbing, which can make the inflammation worse.

If your symptoms don’t get better with good hygiene alone, ask your healthcare provider or pharmacist about using an antifungal cream or a mild steroid cream.

• Antifungal cream: If a yeast infection is causing balanitis, using an antifungal cream (eg, clotrimazole) can treat the infection. You’ll need to apply the cream to the head of your penis and foreskin.
• Steroid cream: This is useful for balanitis caused by allergies or eczema.

Good genital hygiene is the best way to prevent balanitis.

• Wash your hands before touching your penis.
• Gently pull your foreskin back so you can clean the area underneath.
• Wash your penis soon after sex, especially if balanitis tends to get worse soon after sex.
• If you're uncircumcised, pull back your foreskin when urinating and dry any urine before replacing the foreskin.

Avoid frequent washing of your penis with soaps – use a light emollient (skin cream) and dry the area properly before putting on clothing.

Image credit: Healthify He Puna Waiora