Balanitis is an inflammation of the glans (AKA balanus), but is not necessarily an infection. Balanitis may occur together with posthitis (inflammation of the foreskin, AKA posthe), when it is known as balanoposthitis. Balanitis xerotica obliterans (BXO) is a separate and distinct condition. For more information on BXO, see Balanitis xerotica obliterans. Balanitis can occur in both circumcised and intact (non-circumcised) males.
It has many causes, including fungal, yeast, virus, or bacterial infection, environmental irritants, excess sugar in urine, and others. The treatment of balanoposthitis requires accurate diagnosis of the cause of the balanoposthitis because different treatments are required for different causes. Abdennader et al. (1996) observe that such dermatological conditions as psoriasis, lichen planus, lichen sclerosus, fixed drug eruptions, and bullous diseases are not balanitis.
One can’t properly treat balanoposthitis until one knows what is causing it. Different causes require different treatments. When one knows the cause, then an appropriate treatment can be selected.
Diagnosis requires an accurate history, and such tests as biopsy and a swab with a culture. In the absence of a diagnosis, any prescription for treatment is a guess and is likely to fail.
The foreskin is protective of the glans penis in childhood. Van Howe (1997) reported data collected in his pediatric practice on 468 boys up to 18 years of age. Among boys less than three years of age, circumcised boys were significantly more likely to have a reddened meatus or balanitis. Boys who have been circumcised are likely to experience balanitis caused by exposure to ammoniacal diapers (nappies). Hsieh et al. (2006), working in Taiwan, where boys are not circumcised, examined 2,149 elementary pre-adolescent schoolboys. Hsieh et al. found only one case of balanitis in the intact 2,149 boys, which suggests a protective effect for the foreskin.
Excessive washing and non-specific dermatitis
Birley et al. (1993) report excessive washing, especially with the use of soap, will dry the oils out of tissues and cause a balanitis like inflammation. The use of soap (including body wash, shower gel, and shampoo) should be avoided. Although it is commonly believed that the human foreskin is the source of infection so must be constantly washed to prevent infection, that is not true. Fleiss, Hodges & Van Howe (1998) reported the foreskin has both protective and immunological functions that help to prevent disease. Washing removes the protective substances and leaves the penis prone to infection, so washing should be limited and soap should not be used.
Balanoposthitis is not usually an indication for circumcision.
Diabetic males who have high sugar in their urine may have recurrent yeast infections. Verma & Molina (2011) report that balanoposthitis caused by yeast infection is prevalent in India where circumcised men are rare and the rate of diabetes is high. Better control of sugar levels is indicated. Recurrent yeast infections that are not responsive to better management of diabetes may be relieved by circumcision.
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