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Balanitis

  • Author: Mark J Leber, MD, MPH; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Sep 12, 2015
 

Background

Balanitis is inflammation of the glans penis.[1] Balanitis involving the foreskin and prepuce is termed balanoposthitis. In 2015,  European guidelines were published outlining the current management of balanoposthitis. The aims of management are to minimize sexual dysfunction and  urinary dysfunction, as well as to exclude penile cancer, treat premalignant disease, and diagnose and treat STIs. Predisposing factors include poor hygiene and overwashing, use of over-the-counter medications, and nonretraction of the foreskin.[2] Though uncommon, a complication of balanitis (usually only in recurrent cases) is constricting phimosis, or inability to retract the foreskin from the glans penis.

For additional information, see Medscape's Urology Resource Center.

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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. Though uncommon, complications of balanitis include phimosis and cellulitis. Meatal stenosis with urinary retention may rarely accompany balanitis. In very few cases, balanitis may contribute to the "buried penis syndrome."

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Epidemiology

Balanitis is a common condition affecting an estimated 3-11% of males.

No mortality is associated with balanitis. Morbidity is associated with the complications of phimosis.

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.

Balanitis can occur in males at any age. Etiologies vary depending on age.[3, 4]

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Contributor Information and Disclosures
Author

Mark J Leber, MD, MPH Assistant Professor of Emergency Medicine in Clinical Medicine, Weill Cornell Medical College; Attending Physician, Lincoln Medical and Mental Health Center

Mark J Leber, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Anuritha Tirumani, MD Research Coordinator, Department of Emergency Medicine, Brooklyn Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Edward Bessman, MD, MBA Chairman and Clinical Director, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
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  2. Edwards S, Bunker C, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS. 2014 May 14. 25 (9):615-626. [Medline].

  3. Kuehhas FE, Miernik A, Weibl P, Schoenthaler M, Sevcenco S, Schauer I, et al. Incidence of Balanitis Xerotica Obliterans in Boys Younger than 10 Years Presenting with Phimosis. Urol Int. 2012 Dec 29. [Medline].

  4. Mohammed A, Shegil IS, Christou D, Khan A, Barua JM. Paediatric balanitis xerotica obliterans: an 8-year experience. Arch Ital Urol Androl. 2012 Mar. 84(1):12-6. [Medline].

  5. Johnsson KM, Ptaszynska A, Schmitz B, Sugg J, Parikh SJ, List JF. Vulvovaginitis and balanitis in patients with diabetes treated with dapagliflozin. J Diabetes Complications. 2013 Sep-Oct. 27(5):479-84. [Medline].

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  10. Bakkour W, Chularojanamontri L, Motta L, Chalmers RJ. Successful use of dapsone for the management of circinate balanitis. Clin Exp Dermatol. 2014 Apr. 39 (3):333-5. [Medline].

  11. 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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  13. Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC. Treatment of phimosis with topical steroids in 194 children. J Urol. 2003 Mar. 169(3):1106-8. [Medline].

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  15. Steadman B, Ellsworth P. To circ or not to circ: indications, risks, and alternatives to circumcision in the pediatric population with phimosis. Urol Nurs. 2006 Jun. 26(3):181-94. [Medline].

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  17. Homer L, Buchanan KJ, Nasr B, Losty PD, Corbett HJ. Meatal Stenosis in Boys following Circumcision for Lichen Sclerosus (Balanitis Xerotica Obliterans). J Urol. 2014 Jun 30. [Medline].

  18. Philippou P, Shabbir M, Ralph DJ, Malone P, Nigam R, Freeman A, et al. Genital lichen sclerosus/balanitis xerotica obliterans in men with penile carcinoma: a critical analysis. BJU Int. 2013 May. 111(6):970-6. [Medline].

  19. Buechner SA. Common skin disorders of the penis. BJU Int. 2002 Sep. 90(5):498-506. [Medline].

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  24. Kiss A, Király L, Kutasy B, Merksz M. High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study. Pediatr Dermatol. 2005 Jul-Aug. 22(4):305-8. [Medline].

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  26. McGregor TB, Pike JG, Leonard MP. Pathologic and physiologic phimosis: approach to the phimotic foreskin. Can Fam Physician. 2007 Mar. 53(3):445-8. [Medline].

  27. Muratov ID. [Bacteriological pattern of acute purulent balanoposthitis in children]. Zh Mikrobiol Epidemiol Immunobiol. 2004 Mar-Apr. 83-5. [Medline].

  28. 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. 2005 Aug. 16(8):556-9. [Medline].

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  30. Tanagho EA. Smith's General Urology. 14th ed. New York: McGraw-Hill; 1995. 966.

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Balanitis xerotica obliterans (lichen sclerosus). Courtesy of Wilford Hall Medical Center Slide collection.
 
 
 
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