Balanitis

Balanitis is the term doctors use to describe inflammation of the glans, i.e. the head of the penis.

Balanitis can be caused by a bacterial, viral or yeast infection. However, an irritation (for example, due to the use of perfumed soap) or an allergic reaction (e.g. to latex in condoms) may also cause this condition to develop.

Inflammation of the glans can mostly be prevented by regular, gentle personal hygiene.

Pain and redness in the area of the glans may indicate an inflammation.

Other typical symptoms of balanitis are:

• itching
• swelling of the penis
• pain when urinating
• purulent discharge (i.e. pus-containing fluid) from the urethral opening (hole at the tip of the penis)
• skin rashes, e.g. in the form of blisters
• difficulty pulling back the foreskin

Balanitis may have a range of causes. It is frequently caused by poor personal hygiene in the area, which results in a build-up of smegma between the foreskin and the head of the penis. Smegma is a substance comprising a mixture of skin oil secreted by glands in the genital area, shed skin cells and bacteria, which makes an infection more likely to develop. 

Most cases of balanitis are caused by yeast from the candida family. This condition is known as candida balanitis. However, inflammation of the glans can also be caused by infections with sexually transmitted bacteria and viruses, such as gonorrhea, chlamydia or genital herpes.

Cosmetic products, such as perfumed soaps, which attack the skin’s protective acid mantle, as well as excessive cleaning of the area are other possible causes of balanitis. In addition, allergic reactions to medication (medication allergy) or latex in condoms (contact allergy) may trigger an inflammation.

Finally, other skin conditions, such as psoriasis or lichen sclerosus (a rare and chronic skin disease in the genital area), may cause the head of the penis to become inflamed.

Inflammation of the glans is relatively common. Around 3% to 11% of all men will develop balanitis at some point in their lives.

Balanitis is also more likely to occur if phimosis (a condition where the foreskin is too tight to be pulled back) is already present. As boys can only pull back the foreskin from the age of about 5, the glans is more likely to become inflamed in boys of a younger age.

The best prevention is to wash the penis and glans regularly. When doing so, uncircumcised men should carefully pull back the foreskin and give the head of the penis a gentle but thorough wash with water and mild soap. This prevents a buildup of smegma – a whitish secretion that forms between the glans and the foreskin – which can serve as a breeding ground for infection. 

Using a condom during sex also prevents balanitis by offering protection against sexually transmitted infections (STIs) and thus also against inflammation in the genital area. Men with a latex allergy can use latex-free condoms.

Redness and skin changes on the glans usually indicate an inflammation. To determine whether the man is suffering from a yeast infection or infection with sexually transmitted bacteria, tests are used to identify pathogens. A possible infection with the herpes simplex virus (HSV) – the pathogen that causes genital herpes – can also be detected this way.

If the man is uncircumcised, the doctor will also determine how easily the foreskin moves and how easily it can be pulled back in order to exclude complications such as phimosis.

In very rare cases, a tissue sample (biopsy) will also be taken if a more serious underlying cause is suspected.

Regular cleaning of the glans (head of the penis) is important to allow balanitis to heal. The foreskin should always be pulled back during washing of the penis to keep smegma at bay. It is also advisable to avoid irritating soaps when washing the area.

If the inflammation is caused by a yeast infection, anti-fungal ointments (anti-fungals) can be applied to the skin. Anti-inflammatory cortisone creams can be used if the cause is an allergic reaction. Antibiotic creams are used to treat inflammations caused by a bacterial infection. If treatment with ointments/creams proves ineffective, these medications can also be taken in tablet form.