Redness, itching and burning on the head of the penis are among the most common reasons why men of all ages see a urologist. Most often it is balanitis – inflammation of the glans, which is usually treated quickly once the cause is found.
However, the problem is rarely “just thrush”. Repeated balanitis often has undiagnosed diabetes, a skin condition, a tight foreskin or over-zealous hygiene behind it, so Dr Penev looks not only at how to calm the inflammation but also at why it keeps coming back.
What is balanitis
Balanitis is inflammation of the head (glans) of the penis; when the inner layer of the foreskin – the skin that covers the glans – is also affected, it is called balanoposthitis, the most common form in uncircumcised men. Under the foreskin it is warm and moist, and smegma builds up there – secretions and shed skin cells, which make a favourable environment for fungi and bacteria.
Symptoms
The symptoms develop over hours to days:
- redness, swelling and a shiny surface of the glans;
- itching, burning or pain, worse when passing urine and during sex;
- red spots or a whitish, cheesy coating (fungal infection);
- discharge under the foreskin, an unpleasant smell, cracks and difficulty pulling the foreskin back.
When it is urgent. If the retracted foreskin cannot be returned over the glans and the glans swells and turns blue, this is paraphimosis – go to an emergency department straight away. The same applies if you cannot pass urine, or if redness and swelling are spreading quickly and you have a high temperature.
Causes and risk factors
- Fungi (Candida) – the most common infectious cause, made more likely by diabetes, antibiotic treatment, a weakened immune system or a female partner with a fungal infection.
- Bacteria – streptococci, staphylococci and anaerobes.
- Sexually transmitted infections – less often; if there is discharge from the urethra, urethritis is also considered.
- Irritation – both from not washing enough and from washing too much with scented soaps and gels, latex or lubricants.
- Skin conditions – lichen sclerosus, lichen planus, psoriasis, eczema.
- Diabetes – the sugar in the urine feeds the fungi; repeated balanitis is sometimes the first sign of raised blood sugar.
- Phimosis – a tight foreskin traps secretions, and each bout of inflammation leaves scarring that makes the narrowing worse.
Diagnosis
Dr Penev asks about your hygiene habits and products, sexual contacts, medicines and symptoms of diabetes, and then examines the glans, the foreskin and the opening of the urethra. If the changes are unusual, dermatoscopy – examination under magnification – distinguishes inflammation from genital warts, pearly papules and skin diseases. If needed, a swab of the discharge, a urine test and blood sugar are checked, and if suspected, sexually transmitted infections too. A change that does not settle after several weeks of correct treatment is biopsied to rule out pre-cancerous changes.
Treatment
Treatment targets the cause, and the basis is always gentle hygiene: washing every day with lukewarm water with the foreskin pulled back, and stopping soaps and other irritants. For a fungal infection an antifungal cream is used for one to three weeks, and in persistent cases tablets too; for a bacterial infection, an antibiotic cream or an oral antibiotic chosen according to the culture. Irritant balanitis responds to emollients and a short course of a mild corticosteroid cream, while lichen sclerosus needs a stronger corticosteroid cream and follow-up. If diabetes is found, blood sugar control is crucial; with a fungal or sexually transmitted infection, the partner is treated as well.
With frequent recurrences, a persistently tight foreskin or lichen sclerosus, the most lasting solution is often circumcision – afterwards the glans stays dry and is easy to keep clean, and inflammation becomes much less frequent. Dr Penev decides whether it is suitable for you individually at the consultation in Plovdiv or Karlovo.
When to see a urologist
Book a consultation if the redness and itching do not settle after a few days of gentle hygiene without irritants; if the episodes keep coming back; if there is discharge, cracking, whitish thickened patches or difficulty pulling back the foreskin; if it hurts to pass urine, or after a new sexual partner.
Prevention
- Wash the glans every day with lukewarm water with the foreskin pulled back, dry it and return the foreskin to its place.
- Avoid scented soaps and intimate washes.
- Use a condom with a new partner and treat fungal infections in both partners at the same time.
- If you have diabetes, keep your blood sugar well controlled, and in boys with physiological phimosis never pull the foreskin back by force.
Balanitis is unpleasant, but it responds well to treatment as long as the cause is found. If the symptoms keep coming back or do not settle, book an appointment with Dr Penev.
Frequently asked questions
Is balanitis contagious?
The inflammation itself is not passed on, but some of the organisms that cause it can be exchanged between partners – for example fungi or sexually transmitted infections. So with such a cause both partners are treated, and it is sensible to use a condom until it has cleared up.
Can I buy a cream from the pharmacy and treat it myself?
A single mild episode often settles with gentle hygiene alone. However, creams used at random can mask the picture, and repeated inflammation means the cause needs to be found – most often diabetes, a skin condition or a tight foreskin, which do not go away on their own.
Why does my balanitis keep coming back?
The most common reasons for recurrence are incomplete treatment, undiagnosed or poorly controlled diabetes, ongoing irritation from soaps and gels, an untreated partner, a skin condition such as lichen sclerosus, or phimosis that gets in the way of hygiene.
Can balanitis be a sign of diabetes?
Yes. Repeated fungal balanitis is sometimes the first visible sign of raised blood sugar, because the sugar in the urine feeds the fungi. That is why Dr Penev recommends a blood sugar test if balanitis keeps coming back.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.