What is Balanitis (Penile Swelling)?

Balanitis is a condition where the head of the penis becomes inflamed and is quite common, affecting between 3-11% of men at some point. Another condition, called posthitis, involves inflammation of the foreskin. Balanoposthitis is a condition that combines these two, meaning both the head and the foreskin of the penis are inflamed. This condition is found in about 6% of males who are not circumcised. These conditions often occur together, and their names are usually used interchangeably.

It’s important to note that balanitis is not a sexually transmitted disease (STD). Rather, it’s caused by certain fungi like yeast or certain bacteria or viruses, including those that can cause STDs like gonorrhea. While the disease itself can’t be passed from person to person, the organisms that cause it can be.

Here’s an important point to consider: if a man experiences repeated flare-ups of balanoposthitis, it could be a sign of underlying diabetes. In such cases, it’s recommended that he gets a blood sugar level test to check for diabetes and meet with a urinary system specialist, called a urologist, for further evaluation.

What Causes Balanitis (Penile Swelling)?

There are numerous diseases that can harm male genitalia, including inflammatory conditions, infections, and cancer-related issues. The most frequent trigger of balanitis, a particular condition that causes inflammation of the head of the penis, is inadequate personal hygiene, particularly in uncircumcised men. This can lead to infections thriving in the warm, damp environment beneath the foreskin, often caused by fungi.

Fungal infections are the most common identifiable cause, with most of these being due to Candida albicans. This yeast is usually found on the skin of the penis and is generally harmless. However, if a man has certain pre-existing conditions, doesn’t practice good hygiene habits, or experiences changes in pH, an overgrowth of this yeast can occur, causing an infection. While yeast infections are very common, there are many other possible causes of balanitis and healthcare providers need to consider these when treating the patient.

There are both infectious and non-infectious causes. Some infectious causes include various types of bacteria and viruses, such as those commonly associated with diabetes or sexually transmitted infections like gonorrhea, Chlamydia, syphilis, and human papillomavirus.

Non-infectious causes can include poor personal hygiene, allergic reactions to things like spermicides, detergents, soaps, fabric softeners or condoms, drug allergies, being extremely overweight, certain physical conditions like congestive heart failure, cirrhosis or nephrosis, certain cellular conditions, exposure to activated pancreatic transplant exocrine enzymes, physical trauma, and neoplastic (tumor-related) conditions.

Risk Factors and Frequency for Balanitis (Penile Swelling)

Balanitis is a condition that can happen at any age but is particularly common in boys under 4 years old and uncircumcised men. The condition affects about 1 in 25 boys and 1 in 30 uncircumcised men at some point in their lives. Balanitis tends to occur most frequently in those who have a tight foreskin that can’t be easily pulled back over the penis, known as phimosis. Once a boy reaches about 5 years old, the foreskin usually begins to pull back more easily, reducing their risk of balanitis.

Studies have found that circumcised men are 68% less likely to develop balanitis compared to uncircumcised men. In addition, individuals with balanitis are nearly four times more likely to develop penile cancer, although it’s important to note that balanitis doesn’t directly cause cancer. The data also show a connection between balanitis and being uncircumcised but does not provide evidence of direct causation. Finally, it suggests that being circumcised can help protect against some of the common infections that affect the penis.

The following are risk factors for balanitis:

Having a foreskin
Being severely overweight
Poor personal hygiene
Diabetes, especially if it is uncontrolled and leads to excess sugar on the skin, which can promote bacterial and fungal growth
Living in a nursing home
Use of condom catheters
Sensitivity to chemicals found in products like soaps and lubricants
Conditions causing swelling, such as heart failure or nephrosis
Reactive arthritis
Sexually transmitted infections

Signs and Symptoms of Balanitis (Penile Swelling)

Medical professionals check for risks of sexually transmitted infections (STIs) and look for signs of skin conditions like eczema or psoriasis or diseases like reactive arthritis. When examining the genitals, they check for inflammation and discharge from the urethral opening, as well as other symptoms like a rash, mouth ulcers, swollen lymph nodes in the groin, and arthritis. Sustained inflammation and swelling can cause the foreskin to stick to the tip of the penis, which may eventually lead to “phimosis.” Phimosis is a condition where the foreskin becomes too tight and can’t be retracted, or pulled back, over the tip of the penis. Similar to this but slightly different, paraphimosis is when the foreskin gets stuck in the retracted position and cannot be returned to its normal position to cover the tip of the penis, which needs immediate medical attention.

Tight and shiny skin on the tip of the penis
Redness around the tip of the penis
Inflamed, sore, itchy, or irritated tip of the penis
Thick, cheese-like white discharge under the foreskin
Unpleasant smell
Foreskin that can’t be pulled back
Pain when peeing
Swelling in the glands near the penis
Sores on the penis tip

Testing for Balanitis (Penile Swelling)

Balanitis is a condition that affects the head of the penis, causing pain and redness. Doctors can usually diagnose it just by looking at it and considering the symptoms. However, if further investigation is needed, they might run additional tests. These tests can include cultures to check for bacteria, herpes simplex virus testing for blister-like or ulcer-like sores, syphilis testing if there’s an ulcer, and tests for scabies, trichomonas, and Mycoplasma genitalium if there are signs of urethritis, an inflammation of the urethra.

The doctor also physically examines the penis. If it looks inflamed and red, that confirms the diagnosis of balanitis. If the patient is not circumcised, the doctor will also check how well the foreskin can move. This is done to ensure that there are no complications like phimosis (tight foreskin) and paraphimosis (foreskin stuck in a retracted position) — the latter is a medical emergency and needs immediate specialist attention.

Sometimes, the doctor may notice features like a white, cheese-like discharge during the examination, which might indicate a yeast infection. If needed, they can use a microscope to spot yeast cells or fungal filaments with a special type of test using potassium hydroxide.

Treatment Options for Balanitis (Penile Swelling)

The main purposes of diagnosing and treating certain conditions are to rule out sexually transmitted infections (STIs), limit issues with urination and sexual activity, and reduce the risk of penile cancer.

Good hygiene, like regularly washing and drying the foreskin, can help prevent these conditions. However, washing the genitals with soap too often might actually make the situation worse.

A common treatment for most patients with balanoposthitis, an inflammation of the foreskin, is to apply antifungal creams for a period of one to three weeks. Medications like clotrimazole or miconazole, used twice a day, are usually the first options recommended. If someone is allergic to these drugs, nystatin cream can be used instead.

If the inflammation is severe, one dose of fluconazole, taken orally, or a combination of a topical antifungal and a mild steroid cream such as hydrocortisone, can often help. If there’s a risk of cellulitis, a skin infection, then a first-generation cephalosporin, a type of antibiotic, may be suitable for treatment.

Circumcision, the removal of the foreskin, is advised in cases where the condition keeps coming back, particularly for individuals with weakened immune systems or diabetes. According to research, men who are circumcised are 68% less likely to develop balanitis compared to those who aren’t. It’s also been shown that having balanitis can increase the chance of penile cancer nearly four times.

Female sexual partners of men with balanitis should consider getting tested for candida, a type of yeast, or could be treated to decrease the chance of spreading the infection.

Balanitis is a term that describes a variety of skin conditions causing inflammation or infection. These skin conditions may share similar symptoms, but require different treatments, and it’s important to distinguish them from possible cancerous conditions. Balanitis can be caused by:

Yeast infections, like Candida
Bacterial infections, including anaerobic bacteria
Viral infections
Parasites
Sexually transmitted infections

Certain skin disorders can also lead to balanitis:

Lichen planus: itchy, pink or purple spots on the arms or legs
Psoriasis: a condition causing dry, scaly skin
Eczema: a long-term condition that can make the skin itchy, red, cracked, and dry
Dermatitis: inflammation of the skin because of an irritant or allergen

In very rare circumstances, balanitis has been associated with skin cancer.

There are three specific types of balanitis:

Zoon’s balanitis: inflammation of the penis’ head and foreskin, usually found in middle-aged to older uncircumcised men
Circinate balanitis: often related to reactive arthritis. It’s characterized by small, painless ulcer-like sores on the penis’ head. The symptoms can be similar to psoriasis and can be mistaken for psoriasis. Tests for sexually transmitted infections and the presence of HLA-B27 antigen are recommended.
Pseudoepitheliomatous Keratotic and Micaceous Balanitis: Leads to scaly, warty skin lesions on the penis’ head

Possible Complications When Diagnosed with Balanitis (Penile Swelling)

Balanitis, an inflammation of the head of the penis, can result in several complications. These include pain, sores on the foreskin or glans (the head) of the penis, phimosis (tightening of the foreskin opening), paraphimosis (an emergency condition where the foreskin can’t be pulled back over the head of the penis), narrowing of the urethra (the tube where urine and semen exit the body), and the risk of cancerous lesions developing.

Phimosis is when the foreskin opening becomes too small to pull back over the head of the penis. This can be caused by chronic inflammation and swelling of the foreskin, and can lead to problems with sexual activity, urination, and hygiene. In some cases, if the foreskin is forced back, it can become trapped – this is paraphimosis.

In emergencies, phimosis can be treated by gently expanding the opening using a surgical instrument and pain relief. If this isn’t successful, a procedure called dolorous slit circumcision can be done to temporarily fix the problem. The final treatment, usually performed electively, is full circumcision.

Paraphimosis is a serious condition where the foreskin is trapped behind the head of the penis. It requires immediate medical attention. In these situations, the trapped foreskin restricts blood and lymph flow out of the penis, while still allowing arterial flow in. If not treated rapidly, the head of the penis can swell and become extremely painful.

In healthy people, genital yeast infection (also known as “candidiasis” or “thrush”) is rare. But for individuals with weakened immune systems such as those with HIV, or those with diabetes or cancer, candidiasis can lead to serious bloodstream infections.