Introduction
Background
Balanitis is inflammation of the glans penis.1 Balanitis involving the foreskin and prepuce is termed balanoposthitis. The most common complication of balanitis is phimosis, or inability to retract the foreskin from the glans penis.
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Pathophysiology
Uncircumcised men with poor personal hygiene are most affected by balanitis. Lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema. Adherence of the foreskin to the inflamed and edematous glans penis causes phimosis, which is the major presenting complication of balanitis seen in the ED. Meatal stenosis with urinary retention may accompany balanitis. In rare cases, balanitis may contribute to the "buried penis syndrome."
Frequency
United States
Balanitis is a common condition affecting 11% of adult men seen in urology clinics and 3% of children. Phimosis, an occasional complication of balanitis, can be seen in a majority of children younger than 3 years.
International
Balanitis may occur in as many as 3% of uncircumcised males worldwide.
Mortality/Morbidity
No mortality is associated with balanitis. Morbidity is associated with the complications of phimosis.
Race
Among adult patients seen at Veterans Administration Hospital clinics, balanitis is seen twice as often in blacks and Hispanics. This may be related to different circumcision rates.
Age
Balanitis can occur in males at any age. Etiologies vary depending on age.
Clinical
History
Patients with balanitis usually present with the following complaints:
- Penile discharge
- Inability to retract foreskin
- Impotence
- Difficulty urinating or controlling urine stream (in very severe cases)
- Inability to insert a Foley catheter
- Tenderness of the glans penis
- Itching
- Recurrent urinary tract infections (UTIs) in male children
Physical
Physical examination findings may include the following:
- Erythema and edema of glans penis or foreskin
- Inability to visualize glans penis or urethral meatus
- Discharge
- Ulceration and/or plaques
- Phimosis
- Meatal stenosis
- Bladder distension
- Ballooning of the foreskin when voiding
- Lymph node involvement
Causes
- Diabetes is the most common underlying condition associated with adult balanitis.
- Other causes include the following:
- Poor personal hygiene
- Chemical irritants (eg, soap, petroleum jelly)
- Edematous conditions, such as congestive heart failure (right-sided), cirrhosis, and nephrosis
- Drug allergies (eg, tetracycline, sulfonamide)
- Morbid obesity
- Several organisms and viruses cause balanitis, including the following:
- Candidal species (most commonly associated with diabetes)
- Anaerobic infection
- Human papilloma virus
- Gardnerella vaginalis
- Treponema pallidum (syphilis)
- Trichomonal species
- Group B and group A streptococci
- Borrelia vincentii and Borrelia burgdorferi
- Penile cancer
- Balanitis xerotica obliterans (lichen sclerosus): This is a chronic dermatosis identified by whitish plaques involving the glans and foreskin (shown in the image below).
Balanitis xerotica obliterans (lichen sclerosus). Courtesy of Wilford Hall Medical Center Slide collection.
- Zoon balanitis - Reddish velvety lesion on the glans
- Reiter disease - Circinate and eroding lesions on the glans
More on Balanitis |
 Overview: Balanitis |
| Differential Diagnoses & Workup: Balanitis |
| Treatment & Medication: Balanitis |
| Follow-up: Balanitis |
| Multimedia: Balanitis |
| References |
| Next Page » |
References
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Georgala S, Gregoriou S, Georgala C, et al. Pimecrolimus 1% cream in non-specific inflammatory recurrent balanitis. Dermatology. 2007;215(3):209-12. [Medline].
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Kizer WS, Prarie T, Morey AF. Balanitis xerotica obliterans: epidemiologic distribution in an equal access health care system. South Med J. Jan 2003;96(1):9-11. [Medline].
McGregor TB, Pike JG, Leonard MP. Pathologic and physiologic phimosis: approach to the phimotic foreskin. Can Fam Physician. Mar 2007;53(3):445-8. [Medline].
Muratov ID. [Bacteriological pattern of acute purulent balanoposthitis in children]. Zh Mikrobiol Epidemiol Immunobiol. Mar-Apr 2004;83-5. [Medline].
O'Farrell N, Quigley M, Fox P. Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study. Int J STD AIDS. Aug 2005;16(8):556-9. [Medline].
Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol. Dec 2007;178(6):2268-76. [Medline].
Tanagho EA. Smith's General Urology. 14th ed. New York: McGraw-Hill; 1995:966.
Further Reading
Keywords
balanitis, glans penis inflammation, balanoposthitis, phimosis, penile discharge, inability to retract foreskin, impotence, tenderness of glans penis, candidal infection, human papilloma virus infection, treatment, symptoms
