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Balanitis

Balanitis, or balanoposthitis, is inflammation of the head of the penis. The foreskin (the loose flap of skin that covers the head of the penis) is also often affected.

Balanitis, or balanoposthitis, is inflammation of the head of the penis. The foreskin (the loose flap of skin that covers the head of the penis) is also often affected.

Balanitis is a common condition affecting both boys and men. It occurs more often in men who have not been circumcised.

Symptoms can include:

  • redness, swelling and soreness around the head of the penis or foreskin
  • a thick discharge under the foreskin
  • a rash on the penis
  • itchiness
  • an unpleasant odour
  • pain when urinating

Some people may also have a tight foreskin that will not retract (pull back). This is called phimosis.

When to seek medical advice

Balanitis is not usually serious, but it can be a sign of another condition, such as a sexually transmitted infection (STI) or thrush (a type of fungal infection).

It's therefore important to visit your GP or a local sexual health or genitourinary medicine (GUM) clinic if you think you have balanitis.

You should also see your GP if your son has symptoms of balanitis.

Read more about diagnosing balanitis.

What causes balanitis?

Skin irritation is the most common cause of balanitis in boys. This can occur because it's not always possible to pull back the foreskin fully at this age, leading to a build-up of a cheesy-looking substance called smegma that can irritate the skin.

Irritation by smegma is also a common cause of balanitis in uncircumcised men if the penis is not kept clean.

Other causes of balanitis include:

In some cases, no cause can be found.

How balanitis is treated

Most cases of balanitis are easily managed with a combination of creams or ointments, good hygiene and avoiding substances that irritate the penis (see below).

This may include corticosteroid, antibiotic and antifungal creams and ointments, depending on what the underlying cause of the condition is.

These treatments will usually start to have an effect within a week and can be stopped after around two weeks, although in some people it does eventually come back after treatment.

A partial circumcision may sometimes be recommended for a small number of cases of recurring phimosis.

Read more about treating balanitis.

Preventing balanitis

You can reduce your chances of developing balanitis by:

  • avoiding potential irritants, such as soaps, bubble baths and latex condoms
  • keeping your penis clean – you should wash it with water every day
  • avoiding STIs – use condoms whenever you have sex and don't share sex toys

Babies and young children who still wear nappies should have their nappies changed regularly because the warm and moist conditions can increase their risk of balanitis.

Read more about preventing balanitis.



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Balanitis

Your GP should be able to diagnose balanitis by examining your penis.

Your GP should be able to diagnose balanitis by examining your penis.

You may initially feel embarrassed about visiting your GP with the symptoms of balanitis, but it's important that you do because the symptoms could be a sign of a more serious underlying condition and you or your child may need prescription-only medication.

Seeing your GP

To determine what is causing balanitis, your GP will examine your (or your child’s) penis and ask a number of questions to help determine the cause. They may ask:

  • how often you clean your penis
  • whether you may have been exposed to irritants, such as soap or bubble bath
  • whether you have a history of skin conditions, such as atopic eczema
  • whether you may have damaged the head of your penis during sex

For children, your GP may ask whether you have noticed your child playing with their foreskin and, if your child is very young, they may want to know how often they have their nappy changed.

Further testing is usually only needed if the symptoms are particularly severe or do not clear with treatment. This usually involves taking a small sample of cells from the head of the penis (a swab) and testing them for infection.

Occasionally, your GP may arrange blood and urine tests to measure your blood sugar levels. This is to check whether you have developed diabetes, which may be making you more vulnerable to infection.

Referral to a specialist

In some cases, your GP may refer you to a specialist such as a dermatologist (skin specialist) or urologist (specialist in conditions affecting the urinary tract and genitals).

For example, you may be referred if your GP is not sure what is causing your condition, treatment isn't helping, or your GP thinks you could have an underlying condition.

If your GP thinks your symptoms could be caused by a sexually transmitted infection (STI), they may recommend getting tested at a sexual health clinic. Testing of your recent sexual partner(s) may also be arranged if appropriate.


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Balanitis

Treatments for balanitis include corticosteroid creams for skin irritation, fungal creams for fungal infections, and antibiotics for bacterial infections.

If you or your child has balanitis, the recommended treatment will depend on what is causing the condition.

Self-care

In all cases, you should keep your penis clean by washing it with warm water once a day.

You should also try to avoid potential irritants, such as soap, bubble bath and baby wipes. You may find it helpful to use an emollient as a soap substitute.

Read about preventing balanitis for more information on hygiene and avoiding irritants.

Topical corticosteroids

If your balanitis is the result of skin irritation and not an infection, you will usually be prescribed a topical corticosteroid (steroid cream or ointment).

Apply the cream to the head of your penis once a day until your symptoms have gone. Do not use the medication for more than 14 days in a row because this could lead to side effects, such as thinning of the skin.

Antifungal medication

If your balanitis is the result of a fungal infection, you will be prescribed either an antifungal cream to use several times a day for at least two weeks, or a single dose of the oral antifungal medication (tablet or capsule) fluconazole.

Side effects of antifungal creams can include a rash, itching and swelling. These creams can also damage latex condoms, so you should use an alternative form of contraception for at least five days after treatment stops.

Fluconazole is not recommended for children who are under 16 years old. It can also cause side effects, including nausea, vomiting, bloating, diarrhoea, and abdominal (tummy) pain.

If your symptoms are particularly troublesome, you may be prescribed a topical corticosteroid to use as well.

Antibiotics

If a bacterial infection is the cause of your balanitis, you will be prescribed a seven-day course of an oral antibiotic (antibiotic tablets or capsules), such as flucloxacillin or metronidazole.

Common side effects of these types of antibiotics include a rash, nausea, vomiting and diarrhoea.

Again, if your symptoms are particularly troublesome, you may also be prescribed a topical corticosteroid.

Further treatment

The treatments listed above should start working within seven days. Contact your GP if your symptoms do not start improving by this time because you may require alternative treatment and you may need to see a specialist.

In rare cases, if you have phimosis (a tight foreskin) and you have repeat episodes of balanitis, you may be advised to have a partial circumcision (where some of the foreskin is removed).



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Balanitis

You can usually reduce your chances of developing balanitis if you avoid potential irritants and infections, and keep your penis clean.

You can usually reduce your chances of developing balanitis if you avoid potential irritants and infections, and keep your penis clean.

Avoiding irritants

Possible irritants to avoid include:

  • soaps and bubble bath
  • baby wipes
  • creams
  • latex condoms
  • lubricants

You can buy emollients to use instead of soap and latex-free condoms made for sensitive skin.

Penis hygiene

To keep your penis clean, you should:

  • make sure the tip of your penis is completely dry and free of urine after urinating
  • carefully wash the head of your penis with water every day and gently clean under your foreskin
  • make sure you dry your penis thoroughly after bathing or showering

This advice also applies to children, although young boys may not yet be able to clean under their foreskin because it may not fully pull back. This should not be forced and should eventually become possible as they get older.

Babies and young children who still wear nappies may also be at a higher risk of balanitis due to the warm and moist conditions, so make sure you change your child's nappy regularly.

Read about how to wash a penis.

Preventing STIs

Sexually transmitted infections (STIs) can sometimes cause balanitis, so reducing your chances of picking up one of these infections may lower your risk of developing the condition.

STIs can often be prevented by using appropriate contraception and taking other precautions, such as:

  • using condoms every time you have vaginal or anal sex
  • using a condom to cover the penis, or a latex or plastic square (dam) to cover the female genitals, if you have oral sex
  • not sharing sex toys, or washing them and covering them with a new condom before anyone else uses them

Read more advice about STIs.



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Balanitis

Symptoms of balanitis include red skin and swelling around the head of the penis, irritation, soreness and a tight foreskin (phimosis).

The symptoms of balanitis can vary in severity and you may not experience all of them.

Symptoms include:

  • red skin, swelling or irritation and soreness around the head of your penis (glans) or the foreskin
  • thick discharge under the foreskin
  • a rash or ulcers (sores)
  • itchiness
  • an unpleasant odour
  • a tight foreskin that will not retract (pull back); the medical name for this is phimosis
  • pain when passing urine

When to seek medical advice

While balanitis is not usually serious, it can be a sign of another condition, such as a sexually transmitted infection (STI) or thrush (a type of fungal infection).

It is therefore important to visit your GP or your local sexual health or genitourinary medicine (GUM) clinic.

You should also visit your GP if your son develops balanitis. They may require prescription-only medication, such as antibiotics. Your GP can give advice on cleaning the head of the penis, particularly under the foreskin.



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Balanitis

The causes of balanitis include the build up of a substance called smegma, fungal infections, and sexually transmitted infections (STIs).

The causes of balanitis include the build up of a substance called smegma, fungal infections, and sexually transmitted infections (STIs).

Smegma

In most cases, balanitis occurs when the skin is irritated by the build up of a smelly, cheesy-looking substance called smegma.

Smegma is a natural lubricant that keeps the penis moist. It's found on the head of the penis and under the foreskin.

In young boys, smegma may build up because it can be difficult to fully retract the foreskin at this age. This makes it hard to keep the penis clean.

A build up of smegma can also lead to balanitis in uncircumcised men if the penis is not kept clean.

Other causes

Other causes of balanitis include:

  • fungal infection (thrush
  • bacterial infection – streptococcal bacteria is the most common type of bacteria to cause balanitis
  • an allergic reaction or skin irritation – caused by an adverse skin reaction to certain substances, such as a bubble bath, or soap (the medical term for this type of skin reaction is contact dermatitis)
  • an underlying skin condition, such as atopic eczema, or psoriasis (see below)
  • in boys, repeatedly playing with their foreskin

Additional causes of balanitis in men include:

A number of other skin conditions are known to cause symptoms of balanitis in men, including:

  • lichen planus – a non-infectious, itchy rash affecting a number of areas of the body
  • lichen sclerosus – a skin condition affecting the skin around the genitals and anus
  • Zoon's balanitis – a rare condition affecting middle-aged men and causes the head of the penis to become red, shiny and itchy
  • circinate balanitis – a type of psoriasis that sometimes affects men with reactive arthritis 

If all causes of balanitis have been ruled out, you may have non-specific balanoposthitis. This is when the foreskin and the surface of the glans are inflamed, red and swollen, making it painful and difficult to pass urine. Balanoposthitis is usually treated with antibiotics, but in very severe cases circumcision may be required.



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