Balanoposthitis in men

According to WHO, 11% of all men who visit a urologist’s office go to the doctor with balanoposthitis¹. This intimate problem can be dealt with at home, but only a doctor will prescribe competent treatment.

In this article, together with an expert, we will understand what balanoposthitis is, what symptoms it has, how to treat this delicate problem, and what preventive measures exist.

What is balanoposthitis

Balanoposthitis is a skin disease of the penis characterized by damage to the glans and inner layer of the foreskin.².

In medicine, two more similar diseases are distinguished: balanitis – inflammation of the glans penis, and fasting, in which the foreskin is affected.

“However, both of these problems rarely occur separately, since these structures are in close contact, and the inflammatory process easily spreads to surrounding tissues. As a rule, inflammation does not occur in an isolated form (only balanitis or only fasting), so both names are combined into one disease, explains urologist Victoria Shaderkina.

Balanoposthitis in men can develop as an independent disease (primary balanoposthitis), or act as a complication of another disease, such as diabetes mellitus or urethritis (secondary balanoposthitis)³. Balanoposthitis is always accompanied by an inflammatory process, which causes considerable discomfort.

What does balanoposthitis look like

With balanoposthitis, the skin of the glans penis and foreskin becomes bright red, swelling appears. Sometimes other external signs can be observed: sores and erosion, rash, discharge. It is painful for the patient to urinate, contact with linen causes extremely unpleasant sensations, sexual life is simply impossible.

Only a specialist, a urologist, can distinguish balanoposthitis from another disease of the external genital organs, based on the clinical picture and test results.

Causes of balanoposthitis in men

The skin of the glans penis and foreskin is very vulnerable to mechanical injury, as well as infection². A favorable environment for the reproduction of infection is created by a comfortable body temperature, high humidity in the inguinal zone, lack of hygiene, and the “greenhouse” effect of synthetic underwear.

The most common cause of balanoposthitis in men is a bacterial or viral infection, as well as a fungal infection.⁴. An unfavorable background for the development of the disease will be: reduced immunity, diabetes mellitus, any inflammatory diseases of other organs, a tendency to allergic reactions.

The most common causes of balanoposthitis in men:

1. Aerobic and anaerobic bacteria and viruses. These include staphylococci, streptococci, enterobacteria (bacteria of the intestinal group). Sexually transmitted infections (STIs) are of great importance. In developed countries, the herpes simplex virus is the most common cause of erosive and ulcerative lesions of the genitals.⁴.
2. Yeast fungi. The most common candidal infection (candidal balanoposthitis is considered one of the most common forms of the disease¹). The Candida microorganism lives in a small amount in the body of a woman, but during sexual contact, the fungus can pass to a man and provoke an inflammatory reaction. In the case of candidal balanoposthitis, in the presence of STIs, treatment should be carried out by both partners.
3. non-infectious. In addition to infections, trauma, burns, an allergic reaction, contact with chemicals can become the cause of balanoposthitis. These are rare forms of the disease, with which even urologists do not often meet.

Symptoms of balanoposthitis in men

The classic symptoms of the disease are flushing (redness), swelling and soreness.⁶. In addition, depending on the etiology of the disease, other signs may be observed.

So, with candidal balanoposthitis, erosions form on the head and inner leaf of the foreskin – damage to the mucous membrane. The patient complains of itching and burning, and erosions can be covered with white cheesy, and sometimes purulent plaque.

Bacterial balanoposthitis may be accompanied by painful sores, red spots on the head of the penis, and an unpleasant odor.¹. In a chronic disease, the signs may be insignificant and erased, so the clinical picture is not enough to make a diagnosis and prescribe treatment. Laboratory studies are required.

Treatment of balanoposthitis in men

Treatment of balanoposthitis begins with the collection of anamnesis and laboratory tests. To help the patient get rid of unpleasant symptoms faster, the doctor may recommend various ointments and creams that will relieve redness and swelling and relieve pain.

But to remove the symptoms does not mean to cure the disease completely. For effective treatment of balanoposthitis, you must first establish its cause.

Diagnostics

According to European standards, a mandatory examination for balanoposthitis includes: anamnesis, bacteriological examination of the contents of the preputial sac, a blood test for glucose, an analysis for HIV and STIs⁴.

With recurrent balanoposthitis, the following studies are prescribed:

1. measuring blood glucose (sugar) levels to rule out diabetes;
2. bacterial culture of discharge from the urethra, from the surface of the glans penis and foreskin;
3. smear-imprint from the surface of the glans penis and foreskin. If the symptoms of balanoposthitis do not disappear even after treatment, it is necessary to exclude oncological disease of the glans penis;
4. determination of the titer of HIV, human papillomavirus (HPV), STIs – in some cases;
5. serological tests for syphilis.

Modern treatments

With timely access to a doctor, even chronic balanoposthitis responds well to treatment. The choice of therapy depends on the age of the patient, the characteristics of his body and the course of the disease.

Ointment

As an independent remedy, the ointment can help with an uncomplicated form of balanoposthitis, and if the disease occurs for the first time. Also, ointments and creams are used in the complex therapy of complex cases of balanoposthitis.

Corticosteroids (synthetic hormonal substances), which include betamethasone, hydrocortisone, and clobetasol, are often used to treat inflammation. But hormonal external agents are best used under the supervision of a doctor, because. they have a number of side effects. Depending on the cause of the disease, antibacterial ointments and drugs to treat the fungus can be used. Creams can be used as an aid to help relieve irritation.

The ointment is applied directly to the damaged skin with a uniform, neat layer. The duration of the course and the number of applications in each individual case is determined by the doctor.

Pills

If the use of creams and ointments is not enough, in the treatment of balanoposthitis, the doctor may prescribe medications in the form of tablets.

For example, antifungal drugs from the azole group (fluconazole, flucostat, diflucan) are used to treat candidal infections. For some bacterial infections, antibiotics and antimicrobial agents (most often metronidazole) are indicated.

With allergic balanoposthitis, antihistamines are prescribed that affect the entire body.

Antiseptic solutions

Along with ointments and creams for the treatment of uncomplicated forms of balanoposthitis in men, washing the preputial sac with medicinal solutions is used. For this, chlorhexidine or miramistin are used. But the skin cannot be treated with alcohol-based solutions – there is a high risk of aggravating irritation and soreness.

Surgical methods

When long-term and often recurrent balanoposthitis leads to narrowing of the foreskin (phimosis), surgery may be required – surgical excision of the foreskin. The procedure is called circumcision, or circumcision.

The indications for the operation are:

• ineffectiveness of conservative therapy for balanoposthitis;
• frequent relapses of balanoposthitis with a gradual cicatricial change in the flesh, leading to its narrowing,
• predisposition to phimosis⁵.

The operation can be performed on an outpatient basis under short-term intravenous anesthesia. After the procedure, the patient spends several hours in the hospital, and then goes home. The postoperative recovery period lasts about 2 weeks, after which a man can return to a full life and to sexual intercourse. 

Contraindications to circumcision: acute balanoposthitis and purulent skin lesions in the area of ​​intervention.

Prevention of balanoposthitis in men at home

First of all, in order to avoid problems in the intimate area, it is necessary to follow the rules of hygiene. Rinse with plain water or pH-neutral products. At the same time, not only insufficient hygiene can bring harm, but also excessive efforts in this direction. Too often and diligently washing the genitals is not recommended.

Barrier contraceptives can protect against infections. After all, many bacteria and fungi enter the male body through sexual contact.

Another method of prevention is circumcision. This procedure has been known since ancient times. In regions with an arid climate with an insufficient level of hygiene, circumcision was carried out in the prevention of inflammatory diseases of the foreskin.

 Currently, circumcision does not lose its relevance: every third man in the world is circumcised⁷. The procedure, according to a number of doctors, can reduce the risk of developing urogenital infections. There is also a statement that penile cancer (a prerequisite for which may be balanoposthitis) practically does not occur in men who underwent circumcision in childhood⁸.

Popular questions and answers

What will happen if balanoposthitis is not treated, what complications it can lead to, as well as other popular questions, our expert Victoria Shaderkina, urologist, scientific editor of Uroweb.ru, answers.

Sources of:

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