The Facts About Balanitis

Frequently linked to poor hygiene, balanitis is a prevalent irritation of the glans of the penis, aka the penis head. It can happen to anyone who has a penis, but balanitis is an especially common skin disorder for males who are uncircumcised. It affects 1 in 25 boys. Children younger than 4 years old are especially prone to balanitis, at least in part because they've often not yet learned proper hygiene.

One in 30 uncircumcised adult men will develop balanitis at some point. Overall, about 10 percent of men will experience balanitis, according to Cleveland Clinic.

Uncircumcised males tend to get balanitis more frequently than their circumcised counterparts, but that's not an indication it's unhygienic to be uncircumcised. The problem, especially for men and boys who have a tight foreskin, is that bacteria can easily become trapped under the foreskin and cause irritation and inflammation. It's important for all men to practice good hygiene procedures.

The easy first step is to clean and dry the foreskin and glans daily, making sure to rinse away all the soap. Change your underwear daily. And don't wear damp underwear for too long after a workout or on a sweaty, hot day.

Contrarily, cleaning the area too much or using harsh antibacterial soaps to clean down there may also contribute to the development of balanitis. Avoid harsh body sprays and perfumes, because they can also cause irritation.

Being uncircumcised is one of the biggest risk factors for developing balanitis. One reason uncircumcised males are more susceptible is that the area beneath the foreskin is difficult to keep clean. The penis head underneath the foreskin is subject to an overgrowth of yeast and bacteria due to its moist environment and the fact it is rarely exposed to the air.

This makes men and boys who have a tight foreskin that doesn't move easily—a condition called phimosis—susceptible.

Having diabetes puts you at higher risk, too, due to elevated blood sugar levels that can stimulate bacterial and fungal growth. Being obese is another risk factor, as is having sexually transmitted infections (STIs), or an especially strong sensitivity to chemical irritants.

The symptoms of balanitis include many of the typical skin irritations and the inflammation you see with many other conditions—only this is happening on the penis head underneath the foreskin. They may include the following:

• Redness
• Itching
• Swelling
• Pain
• Discharge
• A bad odor
• Bleeding or sores around the foreskin
• White shiny skin on the penis
• Difficulty, or more difficulty, retracting the foreskin

Balanitis isn't a single bacteria or fungus. It's better understood as being a constellation of symptoms that have the location of the penis head and foreskin in common, but which may have various causes.

That means the diagnosis is largely down to a physical exam.

Your healthcare provider will look closely at your penis head and foreskin if it's intact. With that visual information, they will likely be able to determine if you have an infection. They may want to swab the opening of your urethra—the hole that you pee out of—and send a sample to the lab to rule out an STI.

Balanitis itself is not a serious condition, but ignoring a skin condition in such a sensitive area is a bad idea. Left untreated, this easy-to-treat condition can lead to more problematic, serious complications, including:

• Scarring of the urethral opening
• Narrowing of the urethral opening
• Urine retention
• Backflow of urine to the kidneys
• Painful retraction of the foreskin
• Problems with urinating and chronic discomfort and irritation of the penis head
• Reduced blood flow to the penis
• Erectile difficulties

According to Cleveland Clinic, long-term inflammation of the penis head due to balanitis can sometimes even cause the following:

• Balanitis xerotica obliterans (BXO). This condition causes the skin of the glans to harden and turn white, making it difficult to impossible to urinate.
• Phimosis. Chronic inflammation can lead to scarring, which can, in turn, cause the foreskin to grow tighter and more difficult or even impossible to retract.
• Penile cancer. Chronic inflammation is thought to potentially lead to a higher risk of penile cancer.

Treating balanitis is usually pretty straightforward, with creams, antibiotics and cleanliness at the forefront. More serious recurrent cases, however, may require circumcision.

Antifungal creams

If your provider determines that a yeast infection is the cause of your balanitis—that is most frequently the case—they will prescribe a topical antifungal cream that contains an ingredient called clotrimazole.

Antibiotics

Sometimes, an STI can be the cause. In this case, your provider will likely prescribe an antibiotic.

Cleaning more thoroughly

You'll probably be asked to clean and dry your penis head and foreskin more thoroughly. Be sure not to over-scrub or use harsh antibiotic soaps.

Blood sugar management

If you have diabetes, your provider will likely explain how higher levels of blood sugar are like presenting a loaded buffet for yeast to dine on. Better managing your blood sugar can help reduce the likelihood of future balanitis outbreaks.

Circumcision

If worse comes to worst and you get constant, recurring bouts of balanitis that are causing your foreskin to grow tighter, your provider may suggest considering circumcision. This is often the recommendation for people who already have some degree of phimosis or a tight foreskin that's difficult to retract, making it more difficult to keep the area clean.

Ignoring balanitis or living with the condition in the hopes that it will go away on its own is not a great idea. For starters, it's unlikely the most common causes of balanitis—a fungal infection or a bacterial infection such as you get from an STI—will simply vanish.

However, living with balanitis until it clears up becomes much easier once you've seen your healthcare provider. They can prescribe the proper topical cream to quickly get rid of the fungus causing the inflammation and recommend over-the-counter pain relief medication if it's bothering you a great deal.

Another way to get some relief from the irritation is to take sitz baths with warm water and Epsom salts a couple of times a day. Just make sure to wash, rinse and thoroughly dry the area afterward.

To keep balanitis from returning, your front-line defense is to step up your hygiene practices while making sure not to overdo it. You want to be sure to clean daily under the foreskin using gentle soap and water and dry the area thoroughly afterward. Avoid harsh, antibacterial soaps. Never scrub. Don't overwash the area, because this can cause irritation.

If you don't use a condom during sex, be sure to clean and dry your penis afterward. Wear clean underwear daily, and don't wait too long to take a shower and change into clean underwear after a workout or on a hot, sweaty day.

Is balanitis an STI?

Balanitis is not a sexually transmitted infection or disease, though it may be caused by one. Most often, balanitis is caused by an overgrowth of fungus in the damp, moist atmosphere between the foreskin and the penis head. Sometimes, though, it can be a bacterial infection caused by an STI or STD. Your healthcare provider can help determine the best course for treatment in either case.

What does balanitis look like?

Balanitis presents as red, irritated, itchy skin on the head of the penis. There may be discolored patches of skin on your penis, swelling of the penis head, or areas of shiny, white skin on the penis. You might also notice an overgrowth of smegma—a white discharge that appears beneath the foreskin—or a foul smell.

Will balanitis go away on its own?

Usually, balanitis requires treatment before it clears, whether it's due to fungal overgrowth or bacterial infection.