Balanoposthitis: Symptoms, Causes, Diagnosis & Treatment

Balanoposthitis is an inflammation of the glans (head) of the penis and the foreskin (prepuce) that surrounds it. This condition occurs primarily in uncircumcised males, as the moisture beneath the foreskin provides an ideal breeding ground for bacteria and fungi.

Although it can affect males of any age, individuals with poor hygiene, diabetes, or a weakened immune system are more vulnerable to the disease. If not treated in time, it can lead to severe complications like phimosis (inability to retract the foreskin) or even penile cancer in rare cases.

There are several types of balanoposthitis, which can be categorised based on the underlying cause and the nature of the inflammation. In terms of the nature of the inflammation:

1. Acute Balanoposthitis: This is characterised by a sudden onset of symptoms, including redness, swelling, and discharge. Bacterial or fungal infections often cause it.

2. Chronic Balanoposthitis: It persists for an extended period and may be associated with underlying skin conditions or persistent infections.

Based on Underlying Causes

Grades of Balanoposthitis

There is no specific grading system for balanoposthitis. However, it can be classified based on the severity of the symptoms. The assigned grades help doctors select the right treatment option based on each patient's requirements.

The symptoms of balanoposthitis can vary depending on the underlying cause of the disease. The indications may include:

• Redness, swelling, and sensitivity of the glans and foreskin.

• Itching or burning sensation around the affected portion.

• White or yellow discharge under the foreskin

• Difficulty retracting the foreskin (phimosis) 

• Pain during urination or sexual intercourse.

• Foul odour coming from the penis.

• Skin changes, such as thickening or cracking of the foreskin.

The primary cause that leads to balanoposthitis is poor personal hygiene in uncircumcised males. Moisture beneath the foreskin allows bacteria and fungi to grow and multiply when hygiene is not maintained.

Risk Factors for Balanoposthitis

Some factors increase the chances of developing balanoposthitis. Common aspects include the following: 

1. Diabetes: High blood sugar levels can alleviate fungal growth.

2. Poor Immune System: Conditions that suppress immunity like HIV/AIDS, can enhance the risk of infections.

3. Irritants: Exposure to harsh soaps, lotions, or spermicides can irritate the delicate skin of the glans and foreskin.

4. Allergies: Hypersensitivity reactions to substances like latex condoms or certain medications can trigger inflammation.

5. Skin Conditions: Underlying skin disorders like psoriasis or lichen planus can contribute to balanoposthitis.

How to prevent balanoposthitis? 

Balanoposthitis can be prevented by practising basic hygiene consistently. Some strategies include:

1. Hygiene practises: Using mild, unscented cleaning agents and dodging overwashing can help prevent irritation. Excessive genital washing may increase the risk.

2. Keeping the area dry: After urinating, pull back the foreskin and dry any urine before replacing the foreskin. There should be no moisture trapped under the foreskin.

3. Practising safe sex: Using condoms during sexual activity can help prevent sexually transmitted infections. Washing the penis soon after sex can also help if balanoposthitis tends to flare up after intercourse.

4. Managing underlying conditions: Properly controlling diabetes and maintaining a healthy weight is extremely important. Treating any skin conditions like psoriasis or eczema also goes a long way.

5. Avoiding irritants: Limiting contact with potential irritants like spermicides, latex condoms (in case of allergies), and harsh chemicals can help prevent contact dermatitis.

6. Retracting the foreskin regularly: Gently pulling back and replacing the foreskin frequently can prevent phimosis and allow for better hygiene. For babies and young children, forceful retraction must be avoided.

Diagnosing balanoposthitis typically involves a combination of a few steps. These include:

1. Physical Examination: A doctor will evaluate the penis and foreskin for signs of inflammation or skin changes. It is easy to get confused in the balanoposthitis vs balanitis debate; therefore, an accurate diagnosis is required.

2. Medical History: The provider will ask about symptoms, hygiene practices, sexual activity, and underlying health conditions.

3. Swab Tests: Any discharge or skin cells sample may be collected and sent to a laboratory for analysis. This is done to identify the presence of bacteria or fungi.

4. Urine Tests: A urine sample may be analysed to check for signs of infection or diabetes.

5. Blood Tests: If an underlying condition like diabetes or HIV is suspected, blood tests may be ordered.

How to prepare for a doctor consultation? 

It is essential to prepare beforehand for a consultation with a healthcare provider. Here are the steps that should not be missed:

1. Gather all relevant medical data and test results to bring to your appointment.

2. Make a list of all current medications, including dosages and frequency.

3. Document the symptoms, including when they started, how often they occur, and how they affect daily life.

4. Jot down all the questions and doubts related to the treatment process.

Questions to Ask the Doctor 

Before a clinic or hospital visit, patients must keep their questions ready. Here are the essential doubts that must be cleared with the urologist doctor:

1. What type of balanoposthitis do I have?

2. What are the treatment options and recommended course of action?

3. What are the potential risks of the treatment?

4. How will this condition affect my day-to-day life?

5. Are there any lifestyle changes I should make?

Preventing balanoposthitis involves various treatment options based on the unique indications of the patient. Here is a brief description of the available methods:

Homoeopathic Treatment

1. Mercurius solubilis: For cases with gleety, white urethral discharge and painful urination

2. Sulphur: When there is intense itching, redness, and burning pain. Warmth aggravates the symptoms.

3. Cantharis: Severe burning pain and redness. Urine passes in drops with severe burning.

4. Thuja: Wart-like growths may be seen on the glans. Symptoms are worse from heat.

Non-surgical Treatment Options

1. Topical antifungal creams: Imidazoles such as clotrimazole, miconazole, or nystatin are the treatment of choice for most patients. They are usually used for 1-3 weeks, especially in the case of candidal balanoposthitis, which is caused by fungi.

2. Topical antibiotics: For bacterial infections, ointments like metronidazole cream are prescribed. If the symptoms are mild, these have to be applied 3 times a day for 7-14 days.

3. Low-potency topical steroid creams: These may be used briefly to treat irritant or allergic contact dermatitis.

4. Oral antibiotics: In more severe bacterial cases or when phimosis is present, oral antibiotics may be needed to eradicate the bacteria.

5. Improved sanitation measures: Proper hygiene, including frequent washing and drying, is an essential preventive and treatment measure. The patient must avoid excessive washing and irritants.

6. Treatment of underlying conditions: If the disease is secondary to conditions like diabetes or skin disorders, it is important to manage these primary issues first.

Surgical Treatment 

1. Circumcision or preputioplasty: This surgery may be recommended in recurrent balanoposthitis, which is unresponsive to conservative treatment. Circumcision removes the foreskin, while preputioplasty widens the foreskin opening.
2. Frenuloplasty: An incision is made on the frenulum, excising the ridge underneath the surface. The technique separates it from the glans, preventing bridging and maintaining hygiene.

While practising in Mumbai, I encountered a case of balanoposthitis in a young construction worker who had been neglecting personal hygiene due to his demanding job. Upon examination, I noted severe erythema and discharge, and a thorough history revealed he had been using over-the-counter creams without consulting a doctor.

After prescribing a combination of topical antibiotics and antifungals and advising on proper hygiene practices, his condition improved significantly within a week.

- Dr. Deepak Sharma
Urologist

The Laser Circumcision procedure is the treatment option for Balanoposthitis. The cost can vary significantly based on the hospital, the severity of the condition, and the treatment required. The average cost of Laser Circumcision is around ₹ 37,000 and can be extended upto 47,000.

Risks of Delaying Balanoposthitis Treatment

Delaying treatment for balanoposthitis can lead to severe risks. These include:

1. Phimosis: Chronic inflammation can cause scarring and fibrosis of the foreskin. It makes it tight and difficult to retract over the glans penis. 

2. Paraphimosis: In some cases, the inflamed foreskin may get stuck behind the glans and cannot be pulled back over to its normal position. This situation is considered an emergency as it can restrict blood flow to the glans.

3. Urethral meatal stenosis: Prolonged inflammation around the urethral opening can lead to scarring and narrowing of the urethra, causing difficulty in urination.

4. Increased risk of infections: Delayed treatment allows time for infections to worsen or spread. In patients with diabetes, there is a risk of serious infections like Fournier's gangrene.

5. Progression to penile cancer: While rare, chronic inflammation slightly increases the risk of developing penile squamous cell carcinoma if left untreated for a long time.

When to call a doctor?

It is necessary to seek medical attention if the patient experiences certain indications. Here is a list:

1. Persistent redness, swelling, or tenderness of the glans or foreskin.

2. Discharge from beneath the foreskin that does not resolve with hygiene measures.

3. Pain during urination or sexual intercourse.

4. Inability to retract the foreskin or return it to its original position.

5. Recurrent balanoposthitis despite treatment.

While there is no specific diet for balanoposthitis, certain dietary changes can help manage underlying conditions. The list includes:

• Ensure consumption of a balanced diet rich in all essential nutrients.

• For individuals with diabetes, limit sugar intake to control blood sugar levels.

• Drinking minimum 3 litres of water everyday to flush out bacteria and promote genital health.

• Consuming probiotic-rich foods, such as yoghurt or kefir to maintain the balance of good bacteria in the body.

• Excluding high in spice foods that can potentially irritate the urinary tract and exacerbate symptoms.

Balanoposthitis is a common condition that affects uncircumcised males, causing inflammation of the glans and foreskin. By understanding the causes, symptoms, and treatment options, individuals can take steps to prevent and effectively manage this condition.

If you suspect you have balanoposthitis symptoms, don't feel shy about explaining your condition to a doctor. At HexaHealth, we are dedicated to providing comprehensive, patient-centric care for all your healthcare needs. Our team of experienced professionals is here to guide you through every step of your journey, from diagnosis to recovery.