Balanitis is swelling 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 that can affect both boys and men, although it happens more often in men who have not been circumcised.

Balanitis is not normally serious and can usually be prevented with good hygiene. 

What are the symptoms?

Symptoms of balanitis include:

• swelling
• redness
• soreness
• thick discharge under the foreskin

Read more about the symptoms of balanitis.

When to see your GP

Visit your GP or local sexual health or genito-urinary (GUM) clinic if you have any of the symptoms of balanitis. While balanitis is not usually a serious condition, it can be a sign that you have another, underlying health condition, such as a sexually transmitted infection (STI) or thrush (a type of fungal infection).

Also visit your GP if your son develops balanitis. They may need prescription-only medication, such as antibiotics.

Who is affected

Balanitis can happen at any age. An estimated 1 in 20 boys under five years old are affected by balanitis. One in 10 men who attend a sexual health or genito-urinary (GUM) clinic have balanitis.

Skin irritation is the most common cause of balanitis in boys. It is usually related to poor hygiene, such as not getting rid of excess urine from the end of the penis after urinating.

In men, balanitis can have a number of causes, including:

• skin irritation due to exposure to substances, such as perfumed soaps or shower gels
• an allergic reaction after coming into contact with chemicals that are used in products such as soaps or detergents
• skin conditions, such as psoriasis
• sexually transmitted infections (STIs), such as gonorrhoea, genital herpes and syphilis
• persistent dribbling of urine following urination

Read more about the causes of balanitis.

Treatment

Most cases of balanitis are easily treated with a combination of creams or ointments and good hygiene, such as avoiding substances that irritate the penis.

In rare cases of balanitis that keeps coming back, circumcision (surgical removal of the foreskin) may be recommended. For example, if a man has a pre-existing condition that makes them unable to pull back their foreskin to clean it (phimosis), or persistent dribbling of urine following urination.

Read more about treatment for balanitis.

Inflammation

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

The symptoms of balanitis vary in severity. You may not experience all of them. They include:

• red skin around the head of your penis (glans)
• swelling of the head of your penis
• irritation and soreness on the head of your penis
• thick discharge under the foreskin
• a rash or ulcers (sores) around the head of your penis
• itchiness around the head of your penis
• 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 a serious condition, it can be a sign that you have another, underlying health 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 genito-urinary (GUM) clinic to have your symptoms diagnosed and to receive any necessary treatment.

You should also visit your GP if your son develops balanitis. They may require prescription-only medication, such as antibiotics, to treat their symptoms. Your GP can advise them on how to improve their hygiene by regularly cleaning the head of their penis, particularly under the foreskin.

Discharge

Discharge is when a liquid such as pus oozes from a part of your body.

Pain

Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Swelling

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Poor hygiene

Poor hygiene is the most common cause of balanitis, with young boys being at particular risk. This is because the head of their penis can become irritated due to having a tight foreskin.

This can make it difficult to pull the foreskin back to clean, leading to poor hygiene and a build-up of a substance called smegma. Smegma is a ‘cheesy’, white secretion that is produced by glands inside the penis. Smegma can cause the skin around the penis to become irritated and inflamed, triggering the symptoms of balanitis.

Poor hygiene is also a surprisingly common cause of balanitis in men as well as in boys.

Other causes

Other causes of balanitis include:

• fungal infection (thrush) – people with diabetes are particularly at risk of developing this type of infection because their immune system (the body’s natural defence against infection and illness) is usually weakened
• bacterial infection – streptococcal bacteria is the most common type of bacteria to cause balanitis
• 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, repeated manipulation of the foreskin, e.g. playing or fiddling with their foreskin

Additional causes of balanitis in men include:

• having unprotected sex with a woman who has a vaginal fungal infection (vaginal thrush)
• sexually transmitted infections (STIs), such as genital herpes, chlamydia, gonorrhoea and syphilis
• irritation caused by the latex that is used in condoms

A number of other skin conditions are known to cause symptoms of balanitis in men.

They are:

• lichen planus – a non-infectious, itchy rash that can affect a number of areas of the body
• lichen sclerosus – a skin condition of unknown cause that affects the skin around the genitals and anus, causing it to become inflamed and itchy
• Zoon's balanitis – a rare condition of unknown cause that usually affects middle-aged men and causes the head of the penis to become red, shiny and itchy
• circinate balanitis – a type of psoriasis that can sometimes affect men with reactive arthritis (a type of arthritis that causes inflammation throughout the body, including the head of the penis)

Sometimes, if all of the skin conditions that can cause 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.

Antibiotics

Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.

Bacteria

Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.

Circumcised

Circumcision is a simple operation in which the foreskin is snipped from the penis. This is done for religious reasons or because the foreskin is too tight to pull back.

Glucose

Glucose (or dextrose) is a type of sugar that is used by the body to produce energy.

Inflammation

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Although you may initially feel embarrassed about visiting your GP with the symptoms of balanitis, it is important that you do.

This is because you (or your child) may require prescription-only medication, such as antibiotics or antifungals (see balanitis – treatment for more information), which you will only be able to access through your GP.

It is also possible that your symptoms could be a sign of a more serious underlying health condition, such as diabetes, for which you may need additional testing.

Children

In trying to determine what is causing balanitis, your GP will examine your child’s penis and ask them (or you) whether they have any additional symptoms, such as itchiness or pain when passing urine.

Your GP may also ask a number of questions to help determine the cause of your child’s balanitis. For example, they may ask:

• how often your son cleans his penis or, in younger children, how often they have their nappy changed
• whether they may have been exposed to irritants, such as soap or bubble bath
• whether you have noticed them playing or fiddling with their foreskin
• whether they have a history of skin conditions, such as eczema

Further testing is usually only required if a child’s symptoms are particularly severe or fail to respond to treatment. This usually involves taking a small sample of cells from the head of the penis (a biopsy) and testing them for the presence of an infectious agent, such as bacteria or fungus.

Adults

To determine the cause of balanitis in adults, a similar process is followed. Your GP will examine your penis and ask you about your symptoms.

They will also ask questions to help establish what is causing your symptoms, such as exposure to irritants, or whether you may have damaged the head of your penis during sex.

As with children, further testing is usually only needed if your symptoms are severe, if they have not responded to treatment, or if you have had repeated episodes of balanitis.

In addition to taking a sample of cells from your penis, your GP may refer you for 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.

Your GP may also recommend that you are tested for sexually transmitted infections (STIs). They may refer you to a sexual health clinic.

Bacteria

Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.

Biopsy

A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Urine sample

Urinalysis / UA is when a urine sample is tested, commonly to check for any signs of infection, or protein or sugar levels.

If you or your child has balanitis, the recommended treatment will depend on what is causing your condition. See balanitis – causes for more information.

Treatments for some of the most common causes of balanitis are outlined below.

Skin irritation

If your balanitis is the result of skin irritation that is caused by poor hygiene or exposure to a substance that has irritated your penis, you will usually be prescribed a topical corticosteroid (steroid cream or ointment).

Apply the cream to the head of your penis once or twice 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 itchy skin and a skin rash.

It is important to avoid using soaps and other potential irritants while symptoms are present (see below). Also make sure that the head of your penis and your foreskin do not come into contact with urine after you urinate.

Potential irritants to avoid

If you have balanitis, urine is the most important irritant to keep away from the skin of your penis. Other irritants to avoid include:

• soap and shower gel
• bubble baths
• baby wipes
• latex condoms
• lubricants
• antiseptics
• hygiene sprays

Fungal infection

If your balanitis is the result of a fungal infection, you will be prescribed either an antifungal cream, such as imidazole, or an oral antifungal medication (tablet or capsule), such as fluconazole. 

Fluconazole is not recommended for children who are under 16 years old. It can also cause side effects. The most common ones are:

• headache
• skin rash
• nausea (feeling sick)
• vomiting (being sick)
• abdominal pain
• diarrhoea

If your symptoms are particularly troublesome, you may also be prescribed a seven-day course of a topical corticosteroid, usually in the form of a cream or ointment.

Bacterial infection

If your balantis is the result of a bacterial infection, you will be prescribed a seven-day course of oral antibiotics (antibiotic tablets or capsules).

An antibiotic called amoxicillin is usually recommended. However, if you are allergic to penicillin, erythromycin or clarithromycin may be prescribed.

Common side effects of these types of antibiotics include:

• skin rash
• nausea (feeling sick)
• vomiting (being sick)
• diarrhoea
• abdominal pain

Again, if your symptoms are particularly troublesome, you may also be prescribed a seven-day course of a topical corticosteroid.

Follow-up

All of the treatments listed above should start working in seven days. Contact your GP if your symptoms do not improve after this time because you may require an alternative treatment.

Referral to a specialist

If your balanitis is not caused by an infection and your GP cannot identify anything that is irritating your penis, you may be referred to a dermatologist (skin specialist) or genito-urinary (GUM) clinic for further investigation.

If you have phimosis (a tight foreskin) and you have repeat episodes of balanitis, circumcision may be viewed as an option.

Antibiotic

Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.

Circumcision

Circumcision is a simple operation in which the foreskin is snipped from the penis. This is done for religious reasons or because the foreskin is too tight to pull back.

Inflammation

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Pain

Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Good hygiene

The best way to prevent developing balanitis is to always maintain good levels of hygiene. For example:

• if you get up during the night to urinate, make sure that the tip of your penis (glans) is completely dry and free of urine before going to back to bed
• carefully wash the head of your penis every day and gently clean under your foreskin
• avoid using perfumed shower gels; using water on its own or with a mild soap is enough to clean your penis; alternatively, using aqueous cream as a soap substitute will help to avoid irritation
• after bathing or showering, make sure that you dry your penis thoroughly before getting dressed

For tips on keeping your penis and testicles clean, read how to wash a penis.

Avoiding irritants

The advice outlined below, regarding potential irritants, will also help you to avoid getting balanitis.

• Urine – after urinating, make sure that the tip of your penis is completely dry and free of urine before replacing your foreskin.
• Condoms and lubricants – sometimes, the chemicals that are used in condoms or lubricants can irritate the penis. If you think your symptoms may be related to this, try using a condom that is specifically made for sensitive skin. Ask your pharmacist, GP or nurse at your local sexual health or genito-urinary (GUM) clinic for advice.
• Detergents – wash your underwear with non-biological washing powder and make sure that all of the detergent has been rinsed out of your underwear before wearing it.
• Chemicals – wash your hands before using the toilet if you work with chemicals or if you have traces of other products on your hands, which could irritate the delicate skin of your penis.